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Shilton T, Shilton H, Mosheva M, Amsalem D, Negri O, Cohen T, Hertz-Palmor N, Waniel-Zaga A, Pesach IM, Tuval-Mashiach R, Hasson-Ohayon I, Gothelf D. Parents' experience of a shared parent-child stay during the first week of hospitalization in a child psychiatry inpatient ward. Eur Child Adolesc Psychiatry 2024; 33:1039-1046. [PMID: 37202584 DOI: 10.1007/s00787-023-02225-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/04/2023] [Indexed: 05/20/2023]
Abstract
Hospitalization of children in an inpatient psychiatric ward is stressful for both the children and their parents, and separation from the parents during hospitalization is probably one major cause of this stress. We designated one room in a closed inpatient unit to enable a parent to stay with his/her child, including overnight, during the 1st week of hospitalization. We then examined the parents' experience of the shared parent-child stay. Thirty parents of 16 children aged 6-12 years admitted to our inpatient child psychiatry ward completed in-depth semi-structured interviews after that week's experience. The interviews covered the parents' experiences of the 1st week in the larger context of pre-hospitalization period, which also includes the decision to hospitalize the child. The contents of the interviews were analyzed by means of independent coders that identified the following major themes: (1) ambivalence and confusion of the parents as related to their decision to hospitalize their child in the time period just before admission; (2) gradual process of separation from the child during the joint stay at the ward; (3) building confidence and trust toward the staff. Themes 2 and 3 express benefits from the joint hospitalization that may have a strong positive impact on the child's and the parent's recovery. These themes warrant further evaluation of the proposed shared stay during hospitalization in future studies.
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Affiliation(s)
- Tal Shilton
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, 5262000, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hany Shilton
- Department of Education and Psychology, The Open University, Haifa, Israel
| | - Mariela Mosheva
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, 5262000, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doron Amsalem
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
| | - Ofir Negri
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Tal Cohen
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, 5262000, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nimrod Hertz-Palmor
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, 5262000, Ramat Gan, Israel
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Ariela Waniel-Zaga
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, 5262000, Ramat Gan, Israel
- Faculty of Education, Bar-Ilan University, Ramat Gan, Israel
| | - Itai M Pesach
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, 5262000, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Doron Gothelf
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, 5262000, Ramat Gan, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
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Hertz-Palmor N, Ruppin S, Matalon N, Mosheva M, Dorman-Ilan S, Serur Y, Avinir A, Mekori-Domachevsky E, Hasson-Ohayon I, Gross R, Gothelf D, Pessach IM. A 16-month longitudinal investigation of risk and protective factors for mental health outcomes throughout three national lockdowns and a mass vaccination campaign: Evidence from a weighted Israeli sample during COVID-19. Psychiatry Res 2023; 323:115119. [PMID: 36881950 PMCID: PMC9968478 DOI: 10.1016/j.psychres.2023.115119] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 02/13/2023] [Accepted: 02/18/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND COVID-19 is an ongoing global crisis, with a multitude of factors that affect mental health worldwide. We explored potential predictors for the emergence and maintenance of depression, anxiety, and posttraumatic stress symptoms (PTSS) in the general population in Israel. METHODS Across the span of 16 months, 2478 people completed a repeated self-report survey which inquired psychiatric symptoms and pandemic related stress factors (PRSF). We applied mixed-effects models to assess how each stressor contributes to depression, anxiety and PTSS at each time point, and longitudinally assessed participants who completed at least two consecutive surveys (n = 400). We weighted our sample to increase representativeness of the population. RESULTS Fatigue was the strongest predictor for depression, anxiety and PTSS at all time points, and predicted deterioration overtime. Financial concerns associated with depression and anxiety at all time points, and with their deterioration overtime. Health related concerns were uniquely associated with anxiety and PTSS at all time points and their deterioration, but not with depression. Improvement in sense of protection overtime associated with decrease in depression and anxiety. Hesitancy towards vaccination was associated to higher financial concerns and lower sense of protection by the authorities. CONCLUSIONS Our findings accentuate the multitude of risk factors for psychiatric morbidity during COVID-19, and the centrality of fatigue in determining mental health outcomes.
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Affiliation(s)
- Nimrod Hertz-Palmor
- The Child and Adolescent Psychiatry Division, Edmond and Lily Safra Children Hospital at Sheba Medical Center, Israel; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; School of Psychological Sciences, Faculty of Social Sciences, Tel Aviv University, Israel.
| | - Shachar Ruppin
- School of Psychological Sciences, Faculty of Social Sciences, Tel Aviv University, Israel
| | - Noam Matalon
- The Child and Adolescent Psychiatry Division, Edmond and Lily Safra Children Hospital at Sheba Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Mariela Mosheva
- The Child and Adolescent Psychiatry Division, Edmond and Lily Safra Children Hospital at Sheba Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Shirel Dorman-Ilan
- The Child and Adolescent Psychiatry Division, Edmond and Lily Safra Children Hospital at Sheba Medical Center, Israel
| | - Yaffa Serur
- The Child and Adolescent Psychiatry Division, Edmond and Lily Safra Children Hospital at Sheba Medical Center, Israel
| | - Asia Avinir
- The Child and Adolescent Psychiatry Division, Edmond and Lily Safra Children Hospital at Sheba Medical Center, Israel
| | - Ehud Mekori-Domachevsky
- The Child and Adolescent Psychiatry Division, Edmond and Lily Safra Children Hospital at Sheba Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | - Raz Gross
- The Child and Adolescent Psychiatry Division, Edmond and Lily Safra Children Hospital at Sheba Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Doron Gothelf
- The Child and Adolescent Psychiatry Division, Edmond and Lily Safra Children Hospital at Sheba Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel; Sagol School of Neuroscience, Tel Aviv University, Israel
| | - Itai M Pessach
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Pediatric Intensive Care Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
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Erez G, Yakubovich S, Sadeh H, Shoval G, Schoen G, Meiri G, Hertz-Palmor N, Bretler T, Barzilai Y, Mosheva M, Gothelf D, Bloch Y. Correction: Pediatric psychiatric emergency rooms during COVID-19: a multi-center study. BMC Psychiatry 2023; 23:71. [PMID: 36703106 PMCID: PMC9878984 DOI: 10.1186/s12888-023-04561-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Galit Erez
- grid.415607.10000 0004 0631 0384Shalvata Mental Health Center and Tel Aviv University, Hod Hasharon, Israel
| | - Sol Yakubovich
- grid.415607.10000 0004 0631 0384Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Hadar Sadeh
- grid.7489.20000 0004 1937 0511Soroka Medical Center and Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Gal Shoval
- grid.415340.70000 0004 0403 0450Geha Mental Health Center and Tel Aviv University, Petah Tikva, Israel
| | - Gila Schoen
- grid.415340.70000 0004 0403 0450Geha Mental Health Center and Tel Aviv University, Petah Tikva, Israel
| | - Gal Meiri
- grid.7489.20000 0004 1937 0511Soroka Medical Center and Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Nimrod Hertz-Palmor
- grid.413795.d0000 0001 2107 2845Sheba Medical Center and Tel Aviv University, Ramat Gan, Israel
| | - Tali Bretler
- grid.415739.d0000 0004 0631 7092Ziv Medical Center (Safed) and Bar-Ilan University, Safed, Israel
| | - Yael Barzilai
- grid.415607.10000 0004 0631 0384Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Mariela Mosheva
- grid.413795.d0000 0001 2107 2845Sheba Medical Center and Tel Aviv University, Ramat Gan, Israel
| | - Doron Gothelf
- grid.413795.d0000 0001 2107 2845Sheba Medical Center and Tel Aviv University, Ramat Gan, Israel
| | - Yuval Bloch
- Shalvata Mental Health Center and Tel Aviv University, Hod Hasharon, Israel.
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Erez G, Yakubovich S, Sadeh H, Shoval G, Schoen G, Meiri G, Hertz-Palmor N, Butler T, Barzilai Y, Mosheva M, Gothelf D, Bloch Y. Pediatric psychiatric emergency rooms during COVID-19: a multi-center study. BMC Psychiatry 2022; 22:828. [PMID: 36575441 PMCID: PMC9793352 DOI: 10.1186/s12888-022-04371-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/05/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The COVID-19 (SARS-CoV-2) pandemic has been a major stressor for the mental health and well-being of children and adolescents. Surveys and reports from hotlines indicate a significant rise in mental health problems. As the psychiatric emergency room (ER) is a first-line free-of-charge facility for psychiatric emergencies, we expected to see a significant increase in visits, specifically of new patients suffering from anxiety, depression, or stress-related disorders. METHODS Data from two psychiatric hospital ERs and one general hospital were included. All visits of children and adolescents from the computerized files between March and December of 2019 were analyzed anonymously and compared to the same months in 2020, using multilevel linear modeling. RESULTS There was a significant decline in the total number of visits (p = .017), specifically among those diagnosed as suffering from stress-related, anxiety, and mood disorder groups (p = .017), and an incline in the proportion of visits of severe mental disorders (p = .029). DISCUSSION The limited use of child and adolescent psychiatric emergency facilities during the pandemic highlights the importance of tele-psychiatry as part of emergency services. It also suggests the importance of the timeline of the emergence of clinically relevant new psychiatric diagnoses related to the pandemic. Future studies are needed to establish the long-term effects of the pandemic and the expeditious use of tele-psychiatry.
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Affiliation(s)
- Galit Erez
- grid.415607.10000 0004 0631 0384Shalvata Mental Health Center and Tel Aviv University, Hod Hasharon, Israel
| | - Sol Yakubovich
- grid.415607.10000 0004 0631 0384Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Hadar Sadeh
- grid.7489.20000 0004 1937 0511Soroka Medical Center and Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Gal Shoval
- grid.415340.70000 0004 0403 0450Geha Mental Health Center and Tel Aviv University, Petah Tikva, Israel
| | - Gila Schoen
- grid.415340.70000 0004 0403 0450Geha Mental Health Center and Tel Aviv University, Petah Tikva, Israel
| | - Gal Meiri
- grid.7489.20000 0004 1937 0511Soroka Medical Center and Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Nimrod Hertz-Palmor
- grid.413795.d0000 0001 2107 2845Sheba Medical Center and Tel Aviv University, Ramat Gan, Israel
| | - Tali Butler
- grid.415739.d0000 0004 0631 7092Ziv Medical Center (Safed) and Bar-Ilan University, Safed, Israel
| | - Yael Barzilai
- grid.415607.10000 0004 0631 0384Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Mariela Mosheva
- grid.413795.d0000 0001 2107 2845Sheba Medical Center and Tel Aviv University, Ramat Gan, Israel
| | - Doron Gothelf
- grid.413795.d0000 0001 2107 2845Sheba Medical Center and Tel Aviv University, Ramat Gan, Israel
| | - Yuval Bloch
- Shalvata Mental Health Center and Tel Aviv University, Hod Hasharon, Israel.
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Basel D, Mosheva M, Maeder J, Schneider M, Shani S, Weinberger R, Eliez S, Gothelf D. Stimulant treatment effectiveness, safety and risk for psychosis in individuals with 22q11.2 deletion syndrome. Eur Child Adolesc Psychiatry 2022; 31:1367-1375. [PMID: 33871687 DOI: 10.1007/s00787-021-01780-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/07/2021] [Indexed: 12/22/2022]
Abstract
This study aimed to retrospectively evaluate an association between stimulant treatment for attention-deficit/hyperactivity disorder (ADHD) in individuals with 22q11.2DS and the development of psychotic disorders, to evaluate long-term effectiveness and safety of stimulant treatment in individuals with 22q11.2DS compared to individuals with idiopathic ADHD, and to explore effects of catechol-O-methyltransferase (COMT) genotype on 22q11.2DS response to stimulants and risk of side effects. Rates of stimulant use and methylphenidate equivalent exposure were compared among individuals with 22q11.2DS, between 51 with psychotic disorders and a control group of 57 22q11.2DS without psychotic disorders, from Tel Aviv and Geneva. In addition, 44 individuals with 22q11.2DS and ADHD from Tel Aviv who initiated stimulants before age 18 years were compared to a control group of 35 age- and sex-matched controls with idiopathic ADHD, for treatment effectiveness (Clinical Global Impression Scale-Improvement), and rates of side effects. Stimulant use history and methylphenidate equivalent exposure did not differ among individuals with 22q11.2DS, between those with and without psychotic disorders. The long-term retrospective follow-up (5.3 ± 4.1 years) of stimulant-treated individuals with 22q11.2DS showed a higher rate of significant clinical improvement of ADHD symptoms, compared to idiopathic ADHD individuals (p = 0.013), and similar side effect rates. There was no effect of the COMT genotype on response to stimulants or on any side effects. This preliminary long-term retrospective analysis suggests that stimulant treatment in 22q11.2DS is apparently safe in terms of psychosis conversion and rates of side effects, and that it is effective in alleviating ADHD symptoms.
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Affiliation(s)
- Dana Basel
- Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5262000, Tel Hashmoer, Israel.
| | - Mariela Mosheva
- Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5262000, Tel Hashmoer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Johanna Maeder
- Developmental Imaging and Psychopathology Lab, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Maude Schneider
- Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Shachar Shani
- Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5262000, Tel Hashmoer, Israel
| | - Ronnie Weinberger
- Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5262000, Tel Hashmoer, Israel
| | - Stephan Eliez
- Developmental Imaging and Psychopathology Lab, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Doron Gothelf
- Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5262000, Tel Hashmoer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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6
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Cleper R, Hertz-Palmor N, Mosheva M, Hasson-Ohayon I, Kaplan R, Kreiss Y, Afek A, Pessach IM, Gothelf D, Gross R. Sleep Difficulties Among COVID-19 Frontline Healthcare Workers. Front Psychiatry 2022; 13:838825. [PMID: 35573372 PMCID: PMC9098971 DOI: 10.3389/fpsyt.2022.838825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/28/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To identify COVID-19 work-related stressors and experiences associated with sleep difficulties in HCW, and to assess the role of depression and traumatic stress in this association. METHODS A cross-sectional study of HCW using self-report questionnaires, during the first peak of the pandemic in Israel (April 2020), conducted in a large tertiary medical center in Israel. Study population included 189 physicians and nurses working in designated COVID-19 wards and a comparison group of 643 HCW. Mean age of the total sample was 41.7 ± 11.1, 67% were female, 42.1% physicians, with overall mean number of years of professional experience 14.2 ± 20. The exposure was working in COVID-19 wards and related specific stressors and negative experiences. Primary outcome measurement was the Insomnia Severity Index (ISI). Secondary outcomes included the Primary Care-Post Traumatic Stress Disorder Screen (PC-PTSD-5); the Patient Health Questionnaire-9 (PHQ-9) for depression; the anxiety module of the Patient-Reported Outcomes Measurement Information System (PROMIS); Pandemic-Related Stress Factors (PRSF) and witnessing patient suffering and death. RESULTS Compared with non-COVID-19 HCW, COVID-19 HCW were more likely to be male (41.3% vs. 30.7%) and younger (36.91 ± 8.81 vs. 43.14 ± 11.35 years). COVID-19 HCW reported higher prevalence of sleep difficulties: 63% vs. 50.7% in the non-COVID group (OR 1.62, 95% CI 1.15-2.29, p = 0.006), mostly difficulty maintaining sleep: 26.5% vs. 18.5% (OR 1.65, 95% CI 1.11-2.44, p = 0.012). Negative COVID-19 work-related experiences, specifically witnessing patient physical suffering and death, partially explained the association. Although past psychological problems and current depression and PTSD were associated with difficulty maintaining sleep, the main association remained robust also after controlling for those conditions in the full model. CONCLUSION AND RELEVANCE COVID-19 frontline HCW were more likely to report sleep difficulties, mainly difficulty maintaining sleep, as compared with non-COVID-19 HCW working at the same hospital. Negative patient-care related experiences likely mediated the increased probability for those difficulties. Future research is needed to elucidate the long-term trajectories of sleep difficulties among HCW during large scale outbreaks, and to identify risk factors for their persistence.
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Affiliation(s)
- Rony Cleper
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nimrod Hertz-Palmor
- The Chaim Sheba Medical Center, Ramat Gan, Israel.,School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Mariela Mosheva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Chaim Sheba Medical Center, Ramat Gan, Israel
| | | | | | - Yitshak Kreiss
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Itai M Pessach
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Doron Gothelf
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Raz Gross
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Chaim Sheba Medical Center, Ramat Gan, Israel
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Soul O, Gross R, Basel D, Mosheva M, Kushnir J, Efron M, Dekel I, Weizman A, Gothelf D. Stimulant Treatment Effect on Anxiety Domains in Children with Attention-Deficit/Hyperactivity Disorder With and Without Anxiety Disorders: A 12-Week Open-Label Prospective Study. J Child Adolesc Psychopharmacol 2021; 31:639-644. [PMID: 34339282 DOI: 10.1089/cap.2021.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: The effect of stimulants on anxiety domains has not been systematically studied. We assessed prospectively the impact of stimulant treatment in children with attention-deficit/hyperactivity disorder (ADHD) on the severity of anxiety domains and on ADHD with comorbid anxiety disorders. Methods: Children with ADHD (n = 57, aged 6-15 years) started a stimulant or were switched from one stimulant to another. Assessments were conducted at four time points (baseline and weeks 2, 6, and 12) and consisted of parental questionnaires (ADHD rating scale, screen for child anxiety related disorders [SCARED]), and side effect questionnaire completed by a child psychiatrist. Results: A significant improvement in total SCARED scores was obtained after 12 weeks stimulant treatment in children both with and without anxiety disorders. Significant reductions were detected in generalized anxiety, separation anxiety, and school avoidance SCARED subscales, but not in panic and social anxiety subscales. ADHD symptoms significantly improved both in children with and without anxiety comorbidities. Conclusion: We found specific effects of stimulants on anxiety domains. Stimulant treatment, even for ADHD children diagnosed with comorbid anxiety disorders, is relatively safe regarding the risk of anxiety exacerbation. Moreover, the presence of anxiety symptoms or disorders does not interfere with the beneficial effect of the stimulants on the ADHD core symptoms. Clinical trial regestration number: IRB SMC-6893-20.
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Affiliation(s)
- Omer Soul
- The Child Psychiatry Division, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Raz Gross
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel
| | - Dana Basel
- The Child Psychiatry Division, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Mariela Mosheva
- The Child Psychiatry Division, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Kushnir
- The Child Psychiatry Division, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Martin Efron
- The Child Psychiatry Division, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Idit Dekel
- The Child Psychiatry Division, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Abraham Weizman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Research Unit, Geha Mental Health Center, Petah Tikva, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Doron Gothelf
- The Child Psychiatry Division, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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8
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Mosheva M, Gross R, Hertz‐Palmor N, Hasson‐Ohayon I, Kaplan R, Cleper R, Kreiss Y, Gothelf D, Pessach IM. The association between witnessing patient death and mental health outcomes in frontline COVID-19 healthcare workers. Depress Anxiety 2021; 38:468-479. [PMID: 33544405 PMCID: PMC8014064 DOI: 10.1002/da.23140] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/11/2021] [Accepted: 01/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Healthcare workers (HCW) treating coronavirus disease 2019 (COVID-19) patients face high levels of psychological stress. We aimed to compare mental health outcomes, risk and protective factors for posttraumatic stress symptoms (PTSS), probable depression, and anxiety between HCW working in COVID-19 and non-COVID-19 wards. METHODS A self-report survey, administered in a large tertiary hospital in Israel during the peak of the COVID-19 outbreak was completed by 828 HCW (42.2% physicians, 57.8% nurses. Patient-Reported Outcomes Measurement Information System; the Patient Health Questionnaire-9; the Primary Care-Post Traumatic Stress Disorder Screen for DSM-5 (PC-PTSD-5) were used for assessing anxiety, depression, and PTSS, respectively. Pandemic-related stress factors, negative experiences, and potential protective factors were also assessed. RESULTS Median PC-PTSD scores differed significantly between study teams (χ2 [5] = 17.24; p = .004). Prevalence of probable depression and anxiety were similar in both groups. Risk factors for mental health outcomes included mental exhaustion, anxiety about being infected and infecting family. Overall, higher proportion of the COVID-19 team witnessed patient deaths as compared to the non-COVID-19 team (50.2% vs. 24.7%). Witnessing patient death at the COVID-19 wards was associated with a four-fold increased likelihood of PTSS (odds ratio [OR] = 3.97; 95% confidence interval [CI], 1.58-9.99; p = .0007), compared with the non-COVID-19 wards (OR 0.91; 95% CI, 0.51-1.61; p = .43). CONCLUSIONS Witnessing patient death appears to be a risk factor for PTSS unique to HCW directly engaged in treating patients with COVID-19. Our findings suggest that helping HCW cope with COVID-19 related deaths might reduce their risk of posttraumatic stress.
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Affiliation(s)
- Mariela Mosheva
- The Chaim Sheba Medical CenterRamat GanIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Raz Gross
- The Chaim Sheba Medical CenterRamat GanIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Nimrod Hertz‐Palmor
- The Chaim Sheba Medical CenterRamat GanIsrael,School of Psychological SciencesTel Aviv UniversityTel AvivIsrael
| | | | | | - Rony Cleper
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Yitshak Kreiss
- The Chaim Sheba Medical CenterRamat GanIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Doron Gothelf
- The Chaim Sheba Medical CenterRamat GanIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Itai M. Pessach
- The Chaim Sheba Medical CenterRamat GanIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
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Amsalem D, Martin A, Mosheva M, Soul O, Korotkin L, Ziv A, Gothelf D, Gross R. Delivering Difficult News: Simulation-Enhanced Training Improves Psychiatry Residents' Clinical Communication Skills. Front Psychiatry 2021; 12:649090. [PMID: 33746804 PMCID: PMC7973022 DOI: 10.3389/fpsyt.2021.649090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Delivering difficult news to individuals diagnosed with mental health disorders and their family members can be challenging. The use of simulated patients (SP) is an effective teaching method to enhance clinical skills, particularly those around communication. We developed, implemented, and evaluated the effectiveness of an SP-based training module to improve psychiatric residents' clinical communication skills in delivering difficult news. Methods: We conducted 5-h workshops consisting of 3 components: (1) a high-fidelity simulation session with a professional actor; (2) a 30-min lecture; and (3) role-playing of 3 short scenarios, during which residents rotated taking on different roles (as psychiatrist, patient, or family member). We observed through a 1-way mirror and videotaped each resident's simulation session and followed it with personalized debriefing. Following the workshop, each resident received the full-length video of their simulated interview, together with a list of questions as a take-home assignment. Two months after the workshop, the residents were invited to a second SP-based session, during which 2 independent evaluators, each a board-certified psychiatrist with expertise in medical simulation, evaluated the participants' communication skills using a previously validated instrument. To avoid observation bias, the 2 evaluators rated the videotapes blind to the timing of the simulation (pre- vs. post-training). Participants completed self-report questionnaires on satisfaction and self-confidence, before, after, and 2 months following the workshop. Findings: Of the 28 psychiatric residents who participated in the training day, 24 (86%) completed the post-workshop evaluation. Mean communication score increased from 24.9 to 27.8 (paired t-test: 5.6, p < 0.001). The mean score for the self-confidence questionnaire, calculated on a 1 to 5 Likert scale, increased from 3.4 to 4.0 after the training day, and remained unchanged (4.2) 2 months later (p < 0.001). Conclusions: An SP-based training module proved useful in improving the objectively measured communication skills of psychiatric residents delivering difficult news. The training further enhanced participants' subjective sense of confidence in those clinical skills.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mariela Mosheva
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Child & Adolescent Psychiatry, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Omer Soul
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Child & Adolescent Psychiatry, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Liran Korotkin
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amitai Ziv
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sheba Medical Center, Integrated Rehabilitation Hospital, Ramat Gan, Israel
| | - Doron Gothelf
- Division of Child & Adolescent Psychiatry, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
- Faculty of Medicine, Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Raz Gross
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel
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Mosheva M, Hertz‐Palmor N, Dorman Ilan S, Matalon N, Pessach IM, Afek A, Ziv A, Kreiss Y, Gross R, Gothelf D. Anxiety, pandemic-related stress and resilience among physicians during the COVID-19 pandemic. Depress Anxiety 2020; 37:965-971. [PMID: 32789945 PMCID: PMC7436709 DOI: 10.1002/da.23085] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Physicians play a crucial frontline role in the COVID-19 pandemic, which may involve high levels of anxiety. We aimed to investigate the association between pandemic-related stress factors (PRSF) and anxiety and to evaluate the potential effect of resilience on anxiety among physicians. METHODS A self-report digital survey was completed by 1106 Israeli physicians (564 males and 542 females) during the COVID-19 outbreak. Anxiety was measured by the 8-item version of the Patient-Reported Outcomes Measurement Information System. Resilience was evaluated by the 10-item Connor-Davidson Resilience Scale. Stress was assessed using a PRSF inventory. RESULTS Physicians reported high levels of anxiety with a mean score of 59.20 ± 7.95. We found an inverse association between resilience and anxiety. Four salient PRSF (mental exhaustion, anxiety about being infected, anxiety infecting family members, and sleep difficulties) positively associated with anxiety scores. CONCLUSIONS Our study identified specific PRSF including workload burden and fear of infection that are associated with increased anxiety and resilience that is associated with reduced anxiety among physicians.
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Affiliation(s)
- Mariela Mosheva
- Sheba Medical CenterTel HashomerIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | | | | | | | - Itai M. Pessach
- Sheba Medical CenterTel HashomerIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Arnon Afek
- Sheba Medical CenterTel HashomerIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Amitai Ziv
- Sheba Medical CenterTel HashomerIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Yitshak Kreiss
- Sheba Medical CenterTel HashomerIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Raz Gross
- Sheba Medical CenterTel HashomerIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Doron Gothelf
- Sheba Medical CenterTel HashomerIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
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Mosheva M, Korotkin L, Gur RE, Weizman A, Gothelf D. Effectiveness and side effects of psychopharmacotherapy in individuals with 22q11.2 deletion syndrome with comorbid psychiatric disorders: a systematic review. Eur Child Adolesc Psychiatry 2020; 29:1035-1048. [PMID: 30949827 DOI: 10.1007/s00787-019-01326-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 03/26/2019] [Indexed: 12/14/2022]
Abstract
22q11.2 deletion syndrome (22q11.2DS) is the most common microdeletion in humans and is associated with high rates of attention deficit/hyperactivity disorder (ADHD), psychotic spectrum disorders and mood and anxiety disorders. The objective of the study was to systematically review studies regarding pharmacological treatments for psychiatric disorders in individuals with 22q11.2DS and to provide practical guidelines for the psychiatric management and side effect monitoring in 22q11.2DS. A literature search was conducted using the databases PubMed, PsycINFO and Embase. Information regarding study population, drug treatment, side effect profile and efficacy for each trial was extracted. Data collection was completed on May 2018. The search identified 705 studies. A total of seven studies, describing 182 individuals, were included. Pharmacological interventions included three studies for antipsychotic treatment, two studies for stimulants, one study for selective serotonin reuptake inhibitors (SSRIs), one study for S-adenosyl-L-methionine (SAMe), and one case series for metyrosine. The presented data support the clinical impression that individuals with 22q11.2DS and comorbid psychiatric disorders are treated in a manner comparable to non-22q11.2DS individuals. However, distinct medical comorbidities common in individuals with 22q11.2DS may complicate the administration of pharmacotherapy. Further trials with RCT design, larger sample sizes and more syndrome-specific pharmacological agents are needed to improve evidence-based psychiatric care of 22q11.2DS individuals with comorbid mental disorders.
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Affiliation(s)
- Mariela Mosheva
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5262000, Tel Hashomer, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Liran Korotkin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raquel E Gur
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Philadelphia Pennsylvania, Philadelphia, PA, USA
- Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abraham Weizman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Geha Mental Health Center and Felsenstein Medical Research Center, Petah Tikva, Israel
| | - Doron Gothelf
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5262000, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Mosheva M, Serretti A, Stukalin Y, Fabbri C, Hagin M, Horev S, Mantovani V, Bin S, Mattiaccio A, Nivoli A, Vieta E, Popovic D. Association between CANCA1C gene rs1034936 polymorphism and alcohol dependence in bipolar disorder. J Affect Disord 2020; 261:181-186. [PMID: 31634677 DOI: 10.1016/j.jad.2019.10.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/10/2019] [Accepted: 10/09/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Bipolar disorder (BD) is a highly heritable and disabling mental illness, commonly associated with substance abuse, being alcohol abuse the most frequent. Comorbid BD and substance abuse disorders are often associated with high levels of health service utilization and destabilization of the course of illness resulting in poor treatment outcomes. Although recent genome-wide association studies have detected a number of risk genes for BD, the data is still sparse and inconclusive for those genes that may contribute to the increased risk of comorbid alcohol abuse (AA) in BD. The primary aim of the present study was to investigate the effects of 46 single-nucleotide polymorphisms (SNPs) within eight genes on different phenotypes of BD patients, such as comorbid alcohol abuse. We further assessed clinical variables associated with AA. METHODS One-hundred fifty-eight BD I and II patients were enrolled in a naturalistic cohort study. Genomic DNA of 92 patients was extracted from whole blood using standard procedures and 46 tag SNPs in eight genes of interest (ANK, CACNA1C, CACNB2, FKBP5, GRM7, ITIH3, SYNE1 and TCF4) were genotyped. RESULTS Seventy-one patients out of 158 (45%) satisfied diagnostic criteria for comorbid AA. Among 46 SNPs analyzed, the only SNP associated with comorbid AA was rs1034936 polymorphism in the CANCA1C gene. This polymorphism was also associated with lifetime cocaine abuse, manic switch and current atypical antipsychotics. CONCLUSIONS Our findings suggest a role of rs1034936 CACNA1C gene variant in BD-AA group. Despite their preliminary nature, the present results may provide new insight on mechanisms underlying AA in BD.
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Affiliation(s)
- Mariela Mosheva
- Bipolar Disorders Programme, Psychiatry B, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Yelena Stukalin
- School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Tel-Aviv, Israel
| | - Chiara Fabbri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Michal Hagin
- Bipolar Disorders Programme, Psychiatry B, Sheba Medical Center, Tel Hashomer, Israel
| | - Sagi Horev
- Bipolar Disorders Programme, Psychiatry B, Sheba Medical Center, Tel Hashomer, Israel; Semmelewis University, Budapest, Hungary
| | - Vilma Mantovani
- Centre for Applied Biomedical Research - CRBA, University of Bologna, St. Orsola Hospital, Bologna, Italy
| | - Sofia Bin
- Centre for Applied Biomedical Research - CRBA, University of Bologna, St. Orsola Hospital, Bologna, Italy
| | - Alessandro Mattiaccio
- Centre for Applied Biomedical Research - CRBA, University of Bologna, St. Orsola Hospital, Bologna, Italy
| | - Alessandra Nivoli
- Clinica Psichiatrica, Dipartimento di Medicina Clinica e Sperimentale, University of Sassari, Italy
| | - Eduard Vieta
- Barcelona Bipolar Disorders Program, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Spain
| | - Dina Popovic
- Bipolar Disorders Programme, Psychiatry B, Sheba Medical Center, Tel Hashomer, Israel.
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Sentissi O, Popovic D, Moeglin C, Stukalin YB, Mosheva M, Vieta E, Serretti A, Souery D. Predominant polarity in bipolar disorder patients: The COPE bipolar sample. J Affect Disord 2019; 250:43-50. [PMID: 30826493 DOI: 10.1016/j.jad.2019.02.053] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/17/2019] [Accepted: 02/19/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The concept of predominant polarity (PP) is defined as presenting more symptoms of one polarity. Previous studies have defined PP as one polarity (either a depression or mania episode) occurring during at least two-thirds of the lifetime. METHODS We conducted an observational study with the COPE-BD (Clinical Outcome and Psycho-Education for Bipolar Disorder, Clinical Outcome Measures Section) dataset to identify the diagnostic and treatment differences between bipolar disorder (BD) patients with and without PP. RESULTS The final sample included 210 BD-I (59.0%) and 146 BD-II (41.0%) patients. Of these, 28.9% patients presented predominant polarity (PP): 62 (17.4%) of those patients were depressed polarity predominant (DPP), 41 (11.5%) were manic polarity predominant (MPP), and 253 (71.1%) met criteria for bipolar disorders but did not present with PP. In comparison to this group of BD patients with undetermined polarity, the group of BD patients with PP presented more rapid cycling. Furthermore, in the undetermined polarity group, the onset of illness occurred earlier, and the duration of the illness was longer, with more hypomanic/manic and depressive episodes than patients who met the PP criteria. LIMITATIONS This study has a naturalistic and retrospective design and does not allow a specific follow-up of polarity over time. CONCLUSIONS These different clinical characteristics underline the importance of considering PP in patients with BD, and justify the need for differential treatment approach which could have an impact on patients' prognosis. Yet, more independent and prospective research is needed to confirm these findings, especially with the new classification of DSM-5 concerning mixed states.
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Affiliation(s)
- Othman Sentissi
- Department of Mental Health and Psychiatry, Address: CAPPI Jonction, 35 Rue des Bains, 1205 Geneva, Switzerland.
| | | | - Clotilde Moeglin
- Department of Mental Health and Psychiatry, Address: CAPPI Jonction, 35 Rue des Bains, 1205 Geneva, Switzerland
| | | | | | - Eduard Vieta
- Bipolar Disorders Program, Hospital Clinic, Barcelona, Spain
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Daniel Souery
- Laboratoire de Psychologie Médicale, Université Libre de Bruxelles, and Centre Européen de Psychologie Médicale-PsyPluriel, Brussels, Belgium
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Mosheva M, Pouillard V, Fishman Y, Dubourg L, Sofrin-Frumer D, Serur Y, Weizman A, Eliez S, Gothelf D, Schneider M. Education and employment trajectories from childhood to adulthood in individuals with 22q11.2 deletion syndrome. Eur Child Adolesc Psychiatry 2019; 28:31-42. [PMID: 29934817 DOI: 10.1007/s00787-018-1184-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 06/13/2018] [Indexed: 12/30/2022]
Abstract
22q11.2 deletion syndrome (22q11.2DS) is the most common known microdeletion in humans occurring in 1 out of 2000-4000 live births, with increasing numbers of individuals with the microdeletion living into adulthood. The aim of the study was to explore the education and employment trajectories of individuals with 22q11.2DS from childhood to adulthood in a large cohort composed of two significant samples. 260 individuals with 22q11.2DS, 134 male and 126 female, aged 5-59 years (mean age 21.3 ± 10.8 years) were evaluated at two sites, Geneva (GVA) and Tel Aviv (TA). Psychiatric comorbidities, IQ score, and adaptive functioning were assessed using gold-standard diagnostic tools. Demographic factors, such as data about education, employment, marital status, and living status, were collected. Children entering elementary school (5-12 years) were significantly more likely to attend a mainstream school, while adolescents were significantly more likely to attend special education schools (p < 0.005). Cognitive abilities, and not adaptive functioning, predicted school placement. Among adults with 22q11.2DS (n = 138), 57 (41.3%) were unemployed, 46 (33.3%) were employed in open market employment, and 35 (25.4%) worked in assisted employment. In adulthood, adaptive functioning more than cognitive abilities predicted employment. Surprisingly, psychotic spectrum disorders were not found to be associated with employment. Individuals with 22q11.2DS are characterized by heterogeneity in educational and employment profiles. We found that cognitive abilities and adaptive functioning, and not the presence of psychiatric disorders, are key factors in school placement and employment. These factors should, therefore, be taken into account when planning optimal development of individuals with 22q11.2DS.
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Affiliation(s)
- Mariela Mosheva
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5262000, Tel Hashomer, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Virginie Pouillard
- Developmental Imaging and Psychopathology Lab, Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland
| | - Yael Fishman
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5262000, Tel Hashomer, Israel
| | - Lydia Dubourg
- Developmental Imaging and Psychopathology Lab, Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland
| | - Dafna Sofrin-Frumer
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5262000, Tel Hashomer, Israel
| | - Yaffa Serur
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5262000, Tel Hashomer, Israel
| | - Abraham Weizman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Geha Mental Health Center and Felsenstein Medical Research Center, Petah Tikva, Israel
| | - Stephan Eliez
- Developmental Imaging and Psychopathology Lab, Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland.,Department of Genetic Medicine and Development, School of Medicine, University of Geneva, Geneva, Switzerland
| | - Doron Gothelf
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5262000, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Maude Schneider
- Developmental Imaging and Psychopathology Lab, Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland
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Manevich-Mazor M, Weissmann-Brenner A, Bar Yosef O, Hoffmann C, Mazor RD, Mosheva M, Achiron RR, Katorza E. Added Value of Fetal MRI in the Evaluation of Fetal Anomalies of the Corpus Callosum: A Retrospective Analysis of 78 Cases. Ultraschall Med 2018; 39:513-525. [PMID: 29879745 DOI: 10.1055/s-0043-113820] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the added value of fetal MRI to ultrasound in detecting and specifying callosal anomalies, and its impact on clinical decision making. METHODS Fetuses with a sonographic diagnosis of an anomalous corpus callosum (CC) who underwent a subsequent fetal brain MRI between 2010 and 2015 were retrospectively evaluated and classified according to the severity of the findings. The findings detected on ultrasound were compared to those detected on MRI. An analysis was performed to assess whether fetal MRI altered the group classification, and thus the management of these pregnancies. RESULTS 78 women were recruited following sonographic diagnoses of either complete or partial callosal agenesis, short, thin or thick CC. Normal MRI studies were obtained inµ19 cases (24 %). Among these, all children available for follow-up received an adequate adaptive score in their Vineland II adaptive behavior scale assessment. Analysis of the concordance between US and MRI demonstrated a substantial level of agreement for complete callosal agenesis (kappa: 0.742), moderate agreement for thin CC (kappa: 0.418) and fair agreement for all other callosal anomalies. Comparison between US and MRI-based mild/severe findings classifications revealed that MRI contributed to a change in the management for 28 fetuses (35.9 %), mostly (25 fetuses, 32.1 %) in favor of pregnancy preservation. CONCLUSION Fetal MRI effectively detects callosal anomalies and enables satisfactory validation of the presence or absence of callosal anomalies identified by ultrasound and adds valuable data that improves clinical decision making.
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Affiliation(s)
| | | | - Omer Bar Yosef
- Pediatric Neurology, Sheba Medical Center at Tel Hashomer, Israel
| | - Chen Hoffmann
- Department of Radiology, Sheba Medical Center at Tel Hashomer, Israel
| | - Roei David Mazor
- Obstetrics and Gynecology, Sheba Medical Center at Tel Hashomer, Israel
| | - Mariela Mosheva
- Pediatric Psychiatry, Sheba Medical Center at Tel Hashomer, Israel
| | | | - Eldad Katorza
- Obstetrics and Gynecology, Sheba Medical Center at Tel Hashomer, Israel
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16
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Mosheva M, Eyal S, Weisman O, Gilad R, Fishman Y, Weinberger R, Weizman A, Gothelf D. Higher adaptive functioning and lower rate of psychotic comorbidity in married versus unmarried individuals with 22q11.2 deletion syndrome. Am J Med Genet A 2017; 176:2365-2374. [DOI: 10.1002/ajmg.a.38555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 09/28/2017] [Accepted: 11/03/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Mariela Mosheva
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital; Sheba Medical Center; Tel Hashomer Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Stav Eyal
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital; Sheba Medical Center; Tel Hashomer Israel
| | - Omri Weisman
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital; Sheba Medical Center; Tel Hashomer Israel
- Sagol School of Neuroscience; Tel Aviv University; Tel Aviv Israel
| | - Reut Gilad
- Jerusalem Mental Health Center; Eitanim Psychiatric Hospital; Jerusalem Israel
| | - Yael Fishman
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital; Sheba Medical Center; Tel Hashomer Israel
| | - Ronnie Weinberger
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital; Sheba Medical Center; Tel Hashomer Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Abraham Weizman
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Geha Mental Health Center and Felsenstein Medical Research Center; Petah Tikva Israel
| | - Doron Gothelf
- The Child Psychiatry Division, Edmond and Lily Safra Children's Hospital; Sheba Medical Center; Tel Hashomer Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Sagol School of Neuroscience; Tel Aviv University; Tel Aviv Israel
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N. Fountoulakis K, Popovic D, Mosheva M, Siamouli M, Moutou K, Gonda X. MOOD SYMPTOMS IN STABILIZED PATIENTS WITH SCHIZOPHRENIA: A BIPOLAR TYPE WITH PREDOMINANT PSYCHOTIC FEATURES? Psychiat Danub 2017. [DOI: 10.24869/psyd.2017.148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mosheva M, Mekori E, Kantor S, Berg Y, Weizman A, Gothelf D. Do Antidepressants Induce Psychosis in Children and Adolescents? A Naturalistic Study in Ambulatory Pediatric Population. J Child Adolesc Psychopharmacol 2016; 26:478-84. [PMID: 27166781 DOI: 10.1089/cap.2015.0229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of the present study was to examine if selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) induce psychotic symptoms in children and adolescent outpatients. We secondarily aimed to assess the occurrence of adverse events (AE), with particular interest in psychiatric adverse events (PAE), timing of their onset, and the effectiveness of antidepressants in children and adolescents. METHODS We retrospectively evaluated the computerized medical records of children and adolescents treated with antidepressants (SSRIs or SNRIs) for depressive disorders, anxiety disorders, and obsessive-compulsive disorders. AE and Clinical Global Impressions scores were recorded. RESULTS Sixty-nine children and adolescents aged 13.3 ± 3.0 years were included. None of the patients treated presented with acute psychotic symptoms (delusions, hallucinations, and disorganized thinking or behavior). Duration of treatment extended over 13.4 ± 11.8 months. PAE occurred in 39% of cases. Of these, 16% included suicidality (ideations or attempts), and 3% included nonpsychotic hypomanic symptoms. Significant clinical improvement was achieved in 41% of patients. CONCLUSIONS In contrast to the clinical impression of some clinicians, antidepressant treatment in pediatric ambulatory population was not associated with emergence of psychotic symptoms.
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Affiliation(s)
- Mariela Mosheva
- 1 The Child Psychiatry Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center , Tel Hashomer, Israel .,2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Ehud Mekori
- 1 The Child Psychiatry Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center , Tel Hashomer, Israel .,2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Shir Kantor
- 3 University of Maryland, College Park , Maryland
| | - Yael Berg
- 1 The Child Psychiatry Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center , Tel Hashomer, Israel .,2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Abraham Weizman
- 2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel .,4 Research Unit, Geha Mental Health Center , Petah Tikva, Israel
| | - Doron Gothelf
- 1 The Child Psychiatry Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center , Tel Hashomer, Israel .,2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
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