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Biomedical subjects

A Y Shalev

Publications and source records attributed to A Y Shalev.

At least 55 records · Page 3Linked to original sources
PubMed1996

Treatment of recent trauma survivors with benzodiazepines: a prospective study.

BACKGROUND: Most types of psychotropic drugs have been tried in the treatment of chronic posttraumatic stress disorder (PTSD), but have yielded limited results. Theory and retrospective research predict that early treatment may be more efficacious. Specifically, high-potency benzodiazepines have been recommended for the treatment of acute responses to trauma and for prevention of PTSD. This study prospectively evaluates the effect of early administration of benzodiazepines on the course of PTSD and PTSD symptoms. METHOD: Thirteen trauma survivors (the benzodiazepine group) were treated within 6.7 +/- 5.8 days after the trauma (range, 2-18) with either clonazepam (N = 10, 2.7 +/- 0.8 mg/day) or alprazolam (N = 3, 2.5 mg/day). Thirteen other trauma survivors, pair-matched with subjects in the active treatment group for gender and symptom severity in the first week after the trauma, constitute the control group. Both groups were reevaluated 1 and 6 months after the trauma for PTSD symptoms (Horowitz Impact of Event Scale; Mississippi Rating Scale for Combat-Related PTSD-civilian trauma version), PTSD status (Clinician Administered PTSD Scale), state anxiety, depression, and resting heart rate. RESULTS: Subjects in the benzodiazepine group did not differ from controls in 1-month and 6-month PTSD and anxiety scores. Repeated measures ANOVA showed no group or group-by-time effect on psychometric measures. A trend toward group-by-time interaction in resting heart rate was noted (progressive decrease in the benzodiazepine group). Nine benzodiazepine subjects and 3 controls met PTSD diagnostic criteria 6 months after the trauma. CONCLUSION: Contrary to expectations, the early administration of benzodiazepines to trauma survivors with high levels of initial distress did not have a salient beneficial effect on the course of their illness, while reducing physiologic expression of arousal.

Alprazolam↗
PubMed1995

Delirium associated with mianserin.

Delirium may develop in vulnerable subjects under normal doses of psychotropic drugs. The occurrence of delirium in patients treated with tricyclic antidepressants is attributed to the anticholinergic activity of these drugs. Mianserin, characterized by low anticholinergic activity, has been recommended for treatment of depression in elderly patients. We report five cases of delirium in elderly patients treated with mianserin. The incidence of organo-mental side effects associated with this drug may be higher than previously reported.

Aged↗
PubMed1995

Physiologic responses to loud tones in Vietnam veterans with posttraumatic stress disorder.

The authors evaluated eyeblink and autonomic components of the acoustic startle response in combat-related posttraumatic stress disorder (PTSD). Thirty-seven Vietnam combat veterans with current PTSD and 19 combat veterans without PTSD were exposed to 15 consecutive 95-dB, 500-ms, 1000-Hz tones with 0-ms rise and fall times, while orbicularis oculi electromyogram, skin conductance, and heart rate responses were measured. PTSD veterans produced larger averaged electromyographic and heart rate responses, and a slower decline in skin conductance responses, across the 15 tone presentations compared to non-PTSD veterans. Results of this study provide laboratory support for an exaggerated startle response in PTSD and replicate and extend previous findings of increased autonomic responses to loud tone stimuli in this disorder.

Acoustic Stimulation↗
PubMed1994

Israeli adolescents' norms of the Brief Symptom Inventory (BSI).

The internal consistency and concurrent validity of a Hebrew version of Derogatis' Brief Symptom Index (BSI) were assessed in a sample of 840 high school students from three different towns in Israel. The results show high levels of internal consistency and good concurrent validity of the Hebrew version. The type of high school and the country of origin of the subjects' parents had no significant effect on BSI scores. Differences between Israeli and US subjects are reported. BSI norms presented in this study might be used in further studies in Israel.

Adolescent↗
PubMed1993

Levels of trauma: a multidimensional approach to the treatment of PTSD.

The historical course of professional interest in psychological trauma in the 20th century parallels the cycle of intrusion and denial characteristic of traumatized individuals, in which periods of recognition and concern alternate with times of forgetfulness and neglect (Glass et al. 1966; Ingraham et al. 1986). The inclusion of the diagnostic category of posttraumatic stress disorder (PTSD) in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. (DSM-III-1980) inescapably confronted the mental health community with the problem of psychic trauma and catalyzed the quest for a deeper understanding of the disorder. This has led to a variety of explanatory models from such distant fields as neurobiology (Krystal et al. 1989; Pitman 1989; van der Kolk et al. 1985), psychophysiology (Kolb 1987), learning theory (Keane et al. 1985), psychoanalysis (Krystal 1978; Laufer 1988), cognitive psychology (Janoff Bulman 1985), and existential-humanistic philosophy (Lifton 1988).

Adaptation, Psychological↗
PubMed1993

Post-traumatic stress disorder following medical events.

Four patients developed characteristic symptoms of post-traumatic stress disorder following medical and surgical events. Post-traumatic symptomatology was associated with poor recovery, a tendency to avoid further medical treatment and life-threatening behaviour. The authors provide clinical guidelines for the diagnosis of PTSD among patients whose medical conditions or treatment are highly stressful and discuss the need for prompt diagnosis and treatment of specific mental disorders among the medically ill.

Adult↗
PubMed1993

Psychophysiologic assessment of traumatic imagery in Israeli civilian patients with posttraumatic stress disorder.

OBJECTIVE: This study used a script-driven imagery technique, previously used with combat veterans, to assess physiologic responses of Israeli survivors of noncombat traumas. METHOD: Each subject had experienced an event meeting DSM-III-R criterion A for posttraumatic stress disorder (PTSD). The subjects were classified on the basis of the full DSM-III-R criteria into a current PTSD group (N = 13) and a non-PTSD group (N = 13). Thirty-second scripts describing each subject's personal traumatic event, as well as other events, were prepared. The scripts incorporated subjective visceral and muscular responses reported to have accompanied each experience. In the laboratory, the scripts were read one at a time to the subject, who was instructed to imagine each event portrayed as vividly as possible, while heart rate, skin conductance, and left lateral frontalis electromyogram levels were measured. RESULTS: Multivariate analysis of variance revealed that the physiologic responses of the PTSD subjects during imagery of their personal traumatic experiences were significantly greater than those of the non-PTSD subjects. This difference was not explained by age, gender, or rated severity of the traumatic event. A physiologic discriminant function derived from previously studied Vietnam veterans correctly classified nine of the 13 PTSD subjects (sensitivity = 69%) and 10 of the 13 non-PTSD subjects (specificity = 77%). CONCLUSIONS: These results replicate previous findings of heightened physiologic responses during personal combat imagery in male American war veterans and extend them to a group of male and female Israeli civilian victims of trauma, supporting the robustness of physiologic responding during personal traumatic imagery as a measure of PTSD.

Adult↗
PubMed1993

Auditory startle response in blind subjects.

Blindness is often associated with hypervigilance and arousal. The auditory startle response has been suggested as a measure of arousal. This study evaluated the auditory startle response of 10 blind individuals and 10 sighted controls who were exposed to a series of 15 1000-Hz, 95-db, 0-rise-time pure-tone stimuli, administered to both ears. The subjects' heart-rate, skin-conductance, and orbicularis-oculi-electromyogram responses to the tones were measured. Blind subjects did not differ from controls in the magnitude and in the habituation-rate of their responses. Results were interpreted as showing that blind persons' capacity for discriminative learning and for regulation of arousal is unimpaired. Task-related anxiety of blind persons should be differentiated from stimulus-related anxiety.

Acoustic Stimulation↗
PubMed1993

Post-traumatic stress disorder: a biopsychological perspective.

This paper provides a critical review of the current explanatory models of the post-traumatic stress disorder (PTSD). Most of these models are incomplete and lack empirical confirmation. It is argued that unidimensional treatment modalities, derived from such models, fail to address the complex nature of the disorder and are likely to generate partial results. A broad hypothesis-testing approach, combining biological, psychological and psychosocial interventions, should be preferred in clinical practice. Rehabilitation should replace curative techniques and unrealistic goals in many cases.

Antidepressive Agents↗
PubMed1992

Physiologic responses to loud tones in Israeli patients with posttraumatic stress disorder.

Orbicularis oculi (eye blink) electromyogram, skin conductance, and heart rate responses to 15 consecutive 95-dB, 500-millisecond, 1000-Hz tones with 0-millisecond rise and fall times were measured in 14 patients with posttraumatic stress disorder, 14 patients with other anxiety disorders, 15 mentally healthy subjects with past traumatic experiences, and 19 mentally healthy subjects with no trauma history. The patients with posttraumatic stress disorder showed significantly larger skin conductance and heart rate responses and a trend toward larger electromyogram responses to the tones than every other group. These effects were not explained by subjective anxiety, resting physiologic arousal, physiologic arousal preceding the tone trials, or initial physiologic responsivity. The group with posttraumatic stress disorder was the only one that failed to show habituation of skin conductance responses.

Acoustic Stimulation↗
PubMed1992

Hypouricemic effect of zuclopenthixol: a potential marker of drug compliance?

Twelve newly-admitted psychotic patients were treated with clinical doses of zuclopenthixol (ZPT). Plasma uric acid (PUA) was measured before and during treatment. ZPT reduced PUA in all the patients by an average of 29.6% (P < 0.0001). PUA levels during treatment correlated with those obtained before treatment (R = 0.871, P < 0.0002). PUA returned to initial levels on discontinuation of treatment. Uric acid excretion increased during treatment. It is concluded that ZPT is a potent uricosuric agent, capable of producing persistent hypouricemia while administered. Such hypouricemia might be a useful indicator of drug compliance.

Adult↗
PubMed1992

Posttraumatic stress disorder among injured survivors of a terrorist attack. Predictive value of early intrusion and avoidance symptoms.

Fifteen injured survivors of a terrorist attack on a civilian bus were followed during their admission, and 12 of the 14 living survivors were examined 10 months later. A substantial amount of distress was found, in the entire group, across the study. Four patients (33%) suffered from diagnosable PTSD on follow-up. Symptoms of intrusion and denial, recorded during admission, failed to predict PTSD, and were not significantly correlated with psychiatric symptoms on follow-up. This paper discusses the finding of low predictive validity of early PTSD symptoms, and suggests that measures of arousal should be added to those of cognitive symptoms in future prospective studies of traumatic stress.

Adult↗
PubMed1992

Psychophysiologic response during script-driven imagery as an outcome measure in posttraumatic stress disorder.

BACKGROUND: A psychophysiologic method previously validated in Vietnam veterans was used to evaluate the responses of medication-free Israeli posttraumatic stress disorder (PTSD) patients to script-driven imagery, before and after treatment with systematic desensitization. METHOD: Skin conductance, heart rate, and frontalis EMG responses during imagery of traumatic events were assessed in three unmedicated Israeli PTSD patients. The t test of significance was used to compare the magnitude of the response to traumatic imagery with that of responses to imagery of nine other events. RESULTS: The elevated physiologic responses to traumatic imagery, observed before treatment, normalized after systematic desensitization. Imagery of traumata that were not treated by desensitization continued to produce elevated responses. CONCLUSION: Physiologic response during traumatic imagery may be useful in the evaluation of differential treatment outcome in PTSD.

Adult↗
PubMed1992

Auditory startle reflex in post-traumatic stress disorder patients treated with clonazepam.

Manifestations of acute hyperarousal in the Post-Traumatic Stress Disorder (PTSD) have been assimilated with panic attacks. This study examines the auditory startle reflex in PTSD patients treated with clonazepam, a benzodiazepine with anti-panic properties. PTSD patients treated with clonazepam did not differ from drug-free PTSD patients in the magnitude and the habituation rate of their responses to an auditory startle, with both groups showing abnormally slow habituation. It is suggested that the mechanisms underlying phasic hyperarousal in PTSD might differ from those which have been implied in the genesis of panic attacks.

Adult↗