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Biomedical subjects

A Valevski

Publications and source records attributed to A Valevski.

At least 19 recordsLinked to original sources
PubMed2005

Circulatory neurosteroid levels in underweight female adolescent anorexia nervosa inpatients and following weight restoration.

Nineteen female adolescent inpatients diagnosed with anorexia nervosa, restricting type (AN-R) and 16 non-eating disordered (ED) controls were assessed for plasma dehydroepiandrosterone (DHEA), dehydroepiandrosterone-sulphate (DHEA-S), and cortisol levels, and for eating-related and non-eating-related psychopathology. AN-R patients were assessed at admission, 1 month and 4 months following hospitalization. The non-ED controls were assessed once. No baseline between-group differences were found in plasma cortisol, DHEA, and DHEA-S levels, whereas the patient group had a significantly lower Cortisol/DHEA-S ratio and elevated scores on most psychopathological parameters. A significant increase was found in the body mass index of the AN-R patients at 4 months post-hospitalization, accompanied by a decrease in plasma cortisol levels and a trend towards decreased Cortisol/DHEA and Cortisol/DHEA-S ratios, whereas no change occurred in psychopathology. The difference in Cortisol/DHEA-S ratio between AN-R patients and non-ED controls, and the different patterns of change in cortisol vs. DHEA(-S) levels following weight restoration, may in part account for the feeding difficulties in AN, particularly during refeeding.

Adolescent↗
PubMed2003

NQO2 gene is associated with clozapine-induced agranulocytosis.

Clozapine is a dibenzodiazepine neuroleptic with atypical pharmacological and clinical profiles. Treatment with this drug may be complicated with agranulocytosis (AGR). It is likely that defective oxidative mechanism may be the cause of AGR. A candidate gene, dihydronicotinamide riboside (NRH) quinone oxidoreductase 2 (NQO2), which is involved in detoxification of drugs, was selected. This gene has been mapped to the short arm of chromosome six. The gene was studied by single-strand conformation polymorphism analysis and direct sequencing in 98 schizophrenic patients that were treated with clozapine. Eighteen of these patients developed AGR. Ten polymorphisms in the coding regions, in intron 1, and in the promoter region were found, two of which were novel. Comparisons of the polymorphisms in the first intron in AGR patients and controls suggested that this site might be connected with AGR. Quantitative reverse transcriptase-polymerase chain reaction analysis showed that the level of NQO2 mRNA is low in AGR patients compared with the control group. Such a reduction in message suggests that the NQO2 gene may be involved in the development of clozapine-induced AGR.

Agranulocytosis↗
PubMed2002

Mianserin or placebo as adjuncts to typical antipsychotics in resistant schizophrenia.

The beneficial effect of atypical antipsychotic drugs (APDs) in treatment-resistant schizophrenia patients has been attributed, mostly, to their relatively high serotonergic (5-HT)2 to dopaminergic (D)2 receptor blockade ratio. We hypothesized that a combination of typical APDs (D2 antagonists) and mianserin, a potent 5-HT2 antagonist, might also exert superior efficacy in this population. Eighteen inpatients with treatment-resistant schizophrenia who had an acute psychotic exacerbation of the disorder received, in a double-blind design, 30 mg/day mianserin (n = 9) or placebo (n = 9) in conjunction with typical neuroleptics [haloperidol (n = 9) or perphenazine (n = 9)]. Clinical status was evaluated before, during, and at the end of 6 weeks of combined treatment with the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms and Hamilton Rating Scale for Depression. The typical APD/mianserin group exhibited significantly greater improvement in total BPRS scores (17.6% versus 5.5%; P= 0.03) and a trend towards greater improvement in SAPS scores (35.3% versus 13.0%; P = 0.07). Our study indicates that patients with chronic treatment-resistant schizophrenia who have an acute psychotic exacerbation ('acute-on-chronic') may benefit from the addition of a potent 5-HT2 blocker, such as mianserin, to typical antipsychotics. Our findings may further emphasize the contribution of enhanced 5-HT2 blockade to the 'atypicality' of the atypical APDs and to their greater efficacy in alleviating symptoms of chronic treatment-resistant schizophrenia.

Adult↗
PubMed2001

Stability of diagnosis: a 20-year retrospective cohort study of Israeli psychiatric adolescent inpatients.

Outcome according to diagnosis and stability of diagnosis were investigated in a follow-back study of 351 adolescents with various psychiatric disorders hospitalized in a closed psychiatric ward. The duration of follow-back was 15-19 years. All diagnoses were based on the ICD-9. Data were collected from the Health Ministry registry and, in the patients who could be located, by structured telephone interview. Special attention was directed at the diagnosis of transient adolescent psychosis (TAP) vs. schizophrenia and prognostic indicators of suicide. The results showed that the most stable diagnosis was anxiety disorder. The stability of the different diagnoses over time was greater between the second and last admission than between the first and last (for patients with three or more admissions). Number of hospitalizations correlated negatively with prognosis. TAP at second admission was an unstable diagnosis; 66% of these patients had a final diagnosis of schizophrenia. However, patients with a diagnosis of TAP at first admission had a higher predictive index score and a higher outcome score than schizophrenic patients. TAP appeared to be a valid diagnostic entity, distinguishable from schizophrenia in course, frequency of suicidal behaviour and social-occupational outcome. Suicide victims had a higher cumulative length of stay than age- and sex-matched non-suicidal patients. Fifty per cent of the suicide victims had a final diagnosis of schizophrenia, compared to 30 per cent for the whole sample. In conclusion, these findings indicate that TAP is associated with a relatively good prognosis and should probably be differentiated from schizophrenia. Further retrospective and prospective studies of adolescent psychiatric inpatients may help delineate the nature and course of psychosis and other psychopathology in this age group.

Adolescent↗
PubMed2001

Abnormal thermoregulation in drug-free male schizophrenia patients.

Schizophrenia patients may develop various thermoregulatory disturbances. We hypothesized that a standardized exercise-heat tolerance test [two 50-min bouts of walking a motor-driven treadmill at 40 degrees C (relative humidity=40%)] would reveal abnormal thermoregulation in drug-free schizophrenia patients. Six drug-free schizophrenia outpatients and seven healthy comparison subjects participated in this study. The schizophrenia patients exhibited significantly higher baseline and exertion-related rectal temperature. The relevance of these findings to the pathophysiology of schizophrenia-related thermoregulatory disorders is as yet unclear.

Adult↗
PubMed2000

Beneficial effect of the addition of the 5-HT 2A/2C and alpha2 antagonist mianserin to ongoing haloperidol treatment in drug-resistant chronically hospitalized schizophrenic patients.

Atypical neuroleptics that block serotonin 2A (5-HT 2A) and dopamine 2 (D2) receptors have been shown to possess efficacious antipsychotic activity. We assessed the efficacy of the addition of the 5-HT 2A/2C and alpha2 antagonist mianserin to ongoing haloperidol treatment in chronically hospitalized (> 10 years) drug-resistant schizophrenic patients (N = 12). The patients were assessed at baseline and every three months for one year with the Brief Psychiatric Rating Scale and the Clinical Global Impression. Results showed a significant (but < 10%) improvement in the core symptoms of schizophrenia; however, only the reduction (by 43%) in anxiety was clinically relevant (P < 0.0001). The beneficial effect of mianserin may be related to the combined blockade of 5-HT 2A and histamine (H1) receptors.

Adrenergic alpha-Antagonists↗
PubMed2000

Neuroendocrinological response to standardized mixed meal in female anorectic patients during active and refeeding phases.

To evaluate the neuroendocrinological dysfunction in anorexia nervosa, plasma somatostatin, glucose, insulin, and growth hormone were monitored in ten patients with anorexia nervosa in the active and refeeding (remission) phases of the disorder and in nine age-matched healthy control subjects. Somatostatin levels were significantly higher in the anorectic patients in both the active and refeeding phases than in the controls at baseline (mean+/-SD 27.4 +/-5.5 and 31.1+/-2.6 vs 21.3+/-1.9 pg/ml; p<0.001), and significantly higher in the anorectic patients in the active phase compared to the refeeding phase and to the controls in response to a mixed meal (p<0.05). Insulin levels were significantly lower in the anorectic patients in both the active and refeeding phases compared to the controls at baseline (9.3+/-1.1, 7.6+/-1.0 vs 14.7+/-3.5 microU/ml; p<0.0001) and after a mixed meal (p<0.05). An attenuated glucose response discriminated the anorectic patients in the active state from the same patients in the refeeding state and the controls (p<0.0001). There was no significant difference in growth hormone response between the anorectic patients and the controls. These findings suggest that there is an augmented response of somatostatin and an attenuated response of insulin to mixed meal stimulation in active anorexia. The diminished insulin response persists during the refeeding phase. It seems that central and peripheral alterations in endocrine function occur in anorexia nervosa.

Adolescent↗
PubMed1999

Homicide by schizophrenic patients in Israel.

Thirty-three schizophrenic inpatients aged 45.3 +/- 13.5 years who had been found not guilty of homicide by reason of insanity were compared with 28 schizophrenic patients matched for age, sex and duration of disease who had not committed any crime. Statistical analysis revealed a high rate in the study group of individual factors associated with aggression, such as alcohol abuse, previous contact with the police, aggressive behavior and threats (P < 0.05). Significantly more of them were also immigrants (P < 0.05). There was no between-group difference in familial factors. These findings support earlier studies indicating that schizophrenic patients with the profile of alcoholism, aggressiveness and foreign country of origin are at high risk of homicidal behavior.

Adolescent↗
PubMed1998

Recurrence pattern of serum creatine phosphokinase levels in repeated acute psychosis.

BACKGROUND: Elevated serum creatine phosphokinase (CPK)MM level is frequently found in acute psychosis. Theories relate this CPKemia to psychomotor agitation and medication. We hypothesized that psychosis-related CPKemia observed in individual patients is relatively consistent. METHODS: Ninety psychotic patients were studied; 83% were schizophrenics (Brief Psychiatric Rating Scale scores > or = 40) whose serum CPKMM levels were recorded during two or more different acute psychoses. The serum CPKMM levels used were the maximal levels monitored during the beginning of each hospitalization. The last CPK measurement in a circumscribed period was defined as the index serum CPK level (IndCPK). The mean of all other individual maximal CPK measurements during other psychotic episodes was defined as the average CPK (AvgCPK). RESULTS: Multiple linear regression analysis showed a significant correlation of natural logarithm (Ln) of (IndCPK with Ln(AvgCPK), as well as with gender (coefficient = .65 and .63, p < .0001 and p < .01, respectively). There were significantly higher IndCPK levels among male patients than among female patients (p < or = .001). A relatively consistent individual pattern of serum CPKMM levels during repeated acute psychotic episodes was observed. CONCLUSIONS: Serum CPKMM levels and gender were found to be good predictors of maximal serum CPKMM levels during every repeated acute psychotic episode. High IndCPK levels are probably risk factors for neuroleptic malignant syndrome.

Acute Disease↗
PubMed1998

HLA-B38 and clozapine-induced agranulocytosis in Israeli Jewish schizophrenic patients.

To further substantiate reports of an association between the major histocompatibility complex subtypes and clozapine-induced agranulocytosis, HLA typing was performed in 61 Jewish Israeli schizophrenic patients, in 11 of whom agranulocytosis developed following clozapine treatment and in 50 (controls) of whom it did not. Of the 11 agranulocytosis patients, seven (63%) were of Ashkenazi origin and four (37%) of Sephardi origin. There was no difference in ethnic origin between the arganulocytosis and non-agranulocytosis groups (chi 2 = 2.4, d.f. = 1, P = 0.11), although the agranulocytosis patients had a higher frequency of the HLA B38 antigen (8/11 or 72% vs. 6/50 or 12%; chi 2 = 18.7, d.f. = 1, P < 0.001). These results suggest that major histocompatibility complex gene products could be involved in clozapine-mediated haematological complications.

Adult↗
PubMed1997

Elevated levels of serum interleukin-1 beta in combat-related posttraumatic stress disorder.

Levels of serum interleukin-1 beta (IL-1 beta) and soluble interleukin-2 receptor (sIL-2R) were assessed in 19 male patients with combat-related posttraumatic stress disorder (PTSD) in comparison to 19 age- and sex-matched healthy volunteers. Serum IL-1 beta levels (but not sIL-2R) were significantly higher (p < .001) in the PTSD patients than in the controls. IL-1 beta levels did not correlate with cortisol levels, severity of PTSD, anxiety, depressive symptoms, or alexithymia score; however, they did correlate significantly (r = .54, p < .005) with the duration of PTSD symptoms. It is possible that desensitization of the hypothalamic-pituitary-adrenal axis in chronic PTSD patients counteracts the stimulatory effect of IL-1 beta on cortisol secretion.

Adult↗
PubMed1995

Effect of melatonin on active transport of serotonin into blood platelets.

Previous research has demonstrated that the circadian rhythm of melatonin negatively correlates with that of the sensitivity of platelet serotonin uptake sites. Moreover, serotonin has been found to be a competitive inhibitor of melatonin binding to platelets. The goal of the present study was to investigate whether melatonin directly affects platelet serotonin transport. Blood samples from 12 healthy subjects were assayed for both serotonin transport into platelets. Active transport of serotonin (at a concentration of 10(-6) M) into blood platelets was measured in the presence of melatonin at physiological concentrations (10(-12) M to 2 x 10(-9) M) and high nonphysiological concentrations (2 x 10(-8) M to 2 x 10(-3) M). Melatonin inhibited serotonin uptake by blood platelets at the high concentrations only ( > 10(-5) M with IC50 value of 1.1 x 10(-3) M) and had no effect at physiological concentrations.

Adult↗
PubMed1995

Mood and hormonal changes during late pregnancy and puerperium.

The present study was designed to assess the relationship between puerperal hormonal changes and mood. Twenty-five postpartum physically and mentally healthy, drug-free women were included in the study; seven later dropped out. Blood samples 'were drawn between 8 and 9 a.m. just prior to delivery, and again three days after delivery, before discharge. Blood levels of LH TSH, FSH, estrogen and prolactin were determined. Three days after delivery, a psychiatric interview was conducted during which psychometric rating scales (Brief Psychiatric Rating Scale, Hamilton Depression and Hamilton Anxiety Rating Scales, and Beck Depression Inventory) were completed. The rate of change in hormonal blood levels was analyzed in relation to the scores on the rating scales. Results showed that the rise in prolactin plasma levels had a negative and significant correlation with the scores on the Hamilton anxiety scale. This may indicate that high prolactin plasma levels, associated with milk production, may lead to lower anxiety levels in lactating women.

Adult↗
PubMed1994

Environmental factors and admission rates in patients with major psychiatric disorders.

The aim of this study was to identify environmental factors that might correlate with the admission rate of patients with major psychiatric disorders. During the years 1988-90, 393 consecutive admissions (119 unipolar depressed patients, 211 schizophrenic patients, and 63 bipolar depressed patients) were monitored. Correlations were calculated between the mean daily admission rate for each month and monthly photoperiod, rate of change in photoperiod, mean temperature, mean relative humidity, and mean barometric pressure. It was found that the admission rate of bipolar depressed patients negatively correlated with monthly photoperiod, which means that during winter the admission rate of these patients increased.

Adult↗
PubMed1994

Serum cholesterol levels and suicidal tendencies in psychiatric inpatients.

BACKGROUND: Cholesterol has been generally associated with suicide and aggression. The aim of this study was to investigate the relationship between serum cholesterol levels and suicide in psychiatric inpatients. METHOD: Data on age, sex, serum cholesterol levels, absence or presence of suicidal ideations, absence or presence of past suicide attempts, ethnicity, weight, Hamilton Rating Scale for Depression scores, and physical illnesses were collected from 584 inpatient medical records. The patients were diagnosed by the authors according to the DSM-III-R criteria. Serum cholesterol levels were evaluated 24 to 48 hours after admission. The entire group and each diagnostic group were divided as follows: patients who had attempted suicide at least once, patients who expressed a suicidal wish or plan during hospitalization or the month before hospitalization, and patients who had neither made suicidal gestures nor expressed suicidal thoughts. Statistical evaluation was done using analysis of variance and chi-square test. RESULTS: Patients who had attempted suicide had significantly lower serum cholesterol than nonsuicidal patients (F = 4.68, df = 2, p < .01). Comparison on the basis of specific diagnoses revealed similar results in age- and sex-matched depressed patients (F = 4.02, df = 2, p < .01), but not in schizophrenic or bipolar patients. These results were not influenced by age, sex, ethnicity, weight, disease severity, or physical health. CONCLUSION: Our findings may imply that an association exists between cholesterol, suicide, and depression.

Cholesterol↗
PubMed1993

Computerized patient information system in a psychiatric unit: five-year experience.

A computerized psychiatric clinical application based on CLICKS program was developed, consisting of a network of 34 personal computers, run by Novell Netware version 3.11. It includes all clinical records and covers most of the administrative needs of the department; it may be used also in the outpatient clinics. Implementation of the system followed the stages of planning, record structuring, record programming, practice and operation. The system is favorably accepted by the patients, has several important advantages over pencil and paper record keeping, and although it is slightly more time-consuming, it improves record quality and departmental efficiency.

Attitude to Computers↗