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Alan Apter

Publications and source records attributed to Alan Apter.

At least 37 records · Page 2Linked to original sources
PubMed2005

Effect of the broadcast of a television documentary about a teenager's suicide in Israel on suicidal behavior and methods.

Portrayals of suicide in the media are controversial because they may impact on suicide rates and methods. The aim of this study was to analyze the effect of the broadcast of a television documentary wherein an adolescent girl is interviewed about her suicide plan and subsequently dies by suicide. National suicide rates during the 8 weeks prior to the program and the 4 weeks following it were compared to the same periods in the previous year. There was no significant difference in the rates of completed and attempted suicides before and after the program. There was a shift toward the method used in the film after the broadcast, but it was found to be nonspecific to that year. A significant decrease was noted in the mean age of suicide attempters in the last promotional week prior to the broadcast compared to the previous year (p = .032). These preliminary findings suggest that the repeated televised promotion of a documentary on suicide may raise the risk of suicide in vulnerable populations. Further investigations in bigger populations are needed.

Adolescent↗
PubMed2005

Pilot study: fluvoxamine treatment for depression and anxiety disorders in children and adolescents with cancer.

OBJECTIVE: To evaluate the safety, tolerability, and benefit of fluvoxamine for the treatment of major depressive disorder or anxiety disorders in children and adolescents with cancer. METHOD: The study was conducted from 2001 to 2004 at a pediatric hematology-oncology center. Fifteen children and adolescents with cancer were treated with fluvoxamine 100 mg/day in an open prospective 8-week trial. Safety and tolerability were evaluated at baseline and at weeks 4 and 8 by blood tests and the Side Effects Checklist. Clinical benefit was assessed with the Clinical Global Impressions-Improvement, the Children's Depression Rating Scale-Revised, and the Pediatric Anxiety Rating Scale. RESULTS: Fluvoxamine was well tolerated by all subjects. Psychiatric symptoms improved significantly. CONCLUSIONS: In this open trial, fluvoxamine appeared to be well tolerated and was associated with a promising reduction in the depression and anxiety symptoms of pediatric patients with cancer.

Adolescent↗
PubMed2004

Psychosocial situations, quality of depression and schizophrenia in adolescents.

The relationships between acute life events and type of depression were evaluated among inpatient adolescents with schizophrenia. Forty-two adolescent inpatients were assessed, 25 with schizophrenia and 17 with personality disorder. Acute life events and other psychosocial situations were identified with the ICD-10 Axis V semistructured interviews. The Depression Equivalent Questionnaire for Adolescents (DEQ-A) and the Positive and Negative Symptom Scale (PANSS) were used to measure quality and severity of depression. In the patients with schizophrenia, psychosocial situations were related to the anaclitic type of depression, whereas in the subjects with personality disorder, they were highly correlated with introjective depression. In the schizophrenic group, the psychosocial situations related to depression were of a more intrapersonal nature and, in the personality-disordered group, they were more interpersonal. Environmental factors play an important role in the course of schizophrenia in adolescents and should remain a focus of study. Object relations theory may be of heuristic value in the investigation of these factors.

Adolescent↗
PubMed2004

CAG repeat polymorphism within the KCNN3 gene is a significant contributor to susceptibility to anorexia nervosa: a case-control study of female patients and several ethnic groups in the Israeli Jewish population.

The human small-conductance Ca(2+)-activated potassium channel gene KCNN3 has been involved in mechanisms underlying neuronal function and plasticity. A multiallelic CAG repeat polymorphism within the KCNN3 has been associated with schizophrenia and bipolar disorder. We have previously reported in a family-based study that longer CAG repeats are preferentially transmitted to patients with anorexia nervosa (AN). The present study extends the analysis of KCNN3 allele distribution to a larger series of AN female patients and control groups, incorporating information on ethnicity and co-morbidities associated with AN. The data analysis is presented while considering separately the two alleles of each individual, namely a minor (shorter) and a major (longer) allele. This study has found that the KCNN3 allele distribution in the general Israeli population does not differ significantly in at least four Jewish ethnic groups of Ashkenazi, North African, Iraqi, and Yemenite origin. These have been used as control groups in a matched case-control analysis that has demonstrated a significant over-representation of KCNN3 alleles with longer CAG repeats among AN patients (P < 0.001 for the major allele and P = 0.035 for allele sum). Under dichotomization, a significantly higher prevalence of the L allele (>19 repeats) has been observed among AN patients (P < 0.001). While considering AN and co-morbid phenotypes, a tendency towards longer (L) alleles has been observed in the subset of patients with obsessive-compulsive disorder (OCD) co-morbidity. These findings further implicate KCNN3 as a significant contributor to predisposition to AN.

Adolescent↗
PubMed2004

Obsessive-compulsive disorder in patients with velocardiofacial (22q11 deletion) syndrome.

The study of neurogenetic microdeletion syndromes provides an insight into the developmental psychopathology of psychiatric disorders. The aim of the study was to evaluate the prevalence of psychiatric disorders, especially obsessive-compulsive disorder (OCD), in patients with velocardiofacial syndrome (VCFS), a 22q11 microdeletion syndrome. Forty-three subjects with VCFS of mean age 18.3 +/- 10.6 years were comprehensively assessed using semi-structured psychiatric interview and the Yale-Brown obsessive compulsive scale (Y-BOCS). Best estimate diagnoses were made on the basis of information gathered from subjects, parents, teachers, and social workers. Fourteen VCFS subjects (32.6%) met the DSM-IV criteria for OCD. OCD had an early age of onset and generally responded to fluoxetine treatment. It was not related to mental retardation. The most common obsessive-compulsive symptoms were contamination, aggression, somatic worries, hoarding, repetitive questions, and cleaning. Sixteen of the 43 patients (37.2%) had attention-deficit/hyperactivity disorder (ADHD), and 7 (16.2%) had psychotic disorder. The results of our study suggest that there is a strong association between VCFS and early-onset OCD. This finding may be significant in the understanding of the underlying genetic basis of OCD.

Adolescent↗
PubMed2004

Genetic, developmental, and physical factors associated with attention deficit hyperactivity disorder in patients with velocardiofacial syndrome.

Velocardiofacial syndrome (VCFS) is a relatively common developmental neuropsychiatric syndrome caused by a 22q11 microdeletion. There is an extensive variability in the phenotypic expression of this disease. The most common psychiatric disorder in VCFS is attention-deficit/hyperactivity disorder (ADHD), affecting 35-55% of patients. This study investigated the association of familial, developmental, and physical factors with the occurrence of ADHD in 51 patients with nonfamilial VCFS. Twenty-one patients (41.2%) were diagnosed with ADHD. There was a significantly greater prevalence of ADHD in the first-degree relatives of the patients with ADHD than in those without (OR = 5.9, 95% CI = 1.6-22.1, P = 0.006). No differences were noted between the ADHD and non-ADHD groups in mean Obstetric Complication Scale Score, gestational age, birth weight, age at first words, walking, and achieving bowel control. The two groups also had similar IQ scores (total, verbal, and performance) and had a similar average degree of severity of facial dysmorphism and cardiac and cleft anomalies. These findings indicate that ADHD in VCFS has a genetic contribution and the patients' VCFS-related developmental factors and physical illnesses play a lesser role.

Adolescent↗
PubMed2004

Suicidal behavior and self-disclosure in adolescent psychiatric inpatients.

The inability to communicate feelings and thoughts to people close to oneself may be an important risk factor for suicidal behavior. This inability has been operationalized in the concept of self-disclosure. The purpose of this article was to evaluate the correlation of self-disclosure with suicidal behavior in adolescents. Eighty consecutive admissions to an adolescent psychiatric inpatient unit were evaluated. Thirty-four were suicide attempters, 18 were suicidal ideators, and 18 were nonsuicidal. Assessment measures included the Child Suicide Potential Scale, the Suicide Intent Scale, the Suicide Ideation Scale, and the Self-Disclosure Scale. The results show that low self-disclosure levels are associated with suicidal thinking, suicide attempts, and suicidal attitudes. Thus, low self-disclosure may well be a risk factor worthy of further evaluation in the attempt to understand adolescent suicidal behavior.

Adolescent↗
PubMed2004

The Military Life Scale: a measure of perceived stress and support in the Israeli Defense Force.

GOALS: The purpose of this study was to construct a reliable and valid measure of perceived stress and support by adolescents in the Israeli military, and to explore its structure and psychometric properties. METHOD: A large stratified sample of soldiers, representing different types of units, different lengths of service in the Israel Defense Force, and different ranks, were administered the Military Life Scale. Principal component factor analysis with varimax rotation resulted in a 5-factor structure for the stress scale, and a 5-factor structure for the support scale. RESULTS: All factor-derived scales showed satisfactory scale reliability and discriminant validity. CONCLUSIONS: The Military Life Scale is useful for measuring the stress experienced by individuals and groups within the Israel Defense Force. In addition, the Military Life Scale may be of use in other military environments, and with minor revision, in non-military environments in which the normative passage from late adolescence into adulthood occurs, such as a college setting.

Adolescent↗
PubMed2004

Schizophrenia in adolescent twins: a case study.

Studies of schizophrenia in twins have historically influenced the psychiatric world in shifting the focus of the etiology of psychiatric disorders from a psychodynamic to a genetic one. Although twinning is as frequent a phenomenon as schizophrenia, clinical issues relating to the development of twins and treatment of psychiatrically sick twins are relatively infrequent in the literature. This article presents the treatment of adolescent schizophrenic twins, and focuses on specific developmental, educational and therapeutic issues that must be considered when treating twins. The recent treatment of identical schizophrenic twins has allowed us to review the literature and revisit some of these issues.

Adolescent↗
PubMed2003

Attention patterns in children with attention deficit disorder with or without hyperactivity.

The objective of this study was to differentiate the attention patterns associated with attention deficit disorder with or without hyperactivity using continuous performance test (CPT). The diagnoses were based on the DSM-III, III-R, and IV criteria and of the 39 children who participated in the study, 14 had attention deficit disorder with hyperactivity (ADDH) and 11 had attention deficit disorder without hyperactivity (ADDWO), while 14 normal children served as a control group. Attention patterns were examined according to the performance of subjects on the CPT and parental scores on the ADHD Rating Scale, the Child Attention Profile, and the Conners Rating Scale. CPT performances were assessed before and after administration of 10 mg methylphenidate. We found as hypothesized that the CPT differentiated between the ADDH and ADDWO groups. However, contrary to our expectations, the ADDH children made more omission errors than the ADDWO children; they also showed more hyperactivity and impulsivity. The performance of both groups improved to an equal degree after the administration of methylphenidate. It is concluded that different subtypes of the attention deficit disorders are characterized by different attention profiles and that methylphenidate improves scores on test of continuous performance.

Adolescent↗
PubMed2003

Depression and suicidal behavior in adolescent inpatients with obsessive compulsive disorder.

BACKGROUND: To investigate the prevalence and correlations of suicidal behavior in obsessive compulsive disorder (OCD) among adolescent psychiatric inpatients. METHODS: A total of 348 adolescents, representing consecutive admissions to an adolescent inpatient unit, were assessed. Of these, 40 patients had OCD, 118 had schizophrenia, 59 had an affective disorder, 81 had a conduct disorder and 50 had an eating disorder. In addition, 87 normal community controls were assessed. All subjects were assessed for suicidal behavior by the Childhood Suicide Potential Scale (CSPS), for depression by the Beck Depression Inventory, for impulsiveness by the Impulse Control Scale, for anxiety by the State-Trait Anxiety Scale and for aggression by the Yudowsky Overt Aggression Scale. RESULTS: All the psychiatrically ill subjects, including those with OCD, had high levels of depression, anxiety and impulsiveness, which were far higher than those of the controls. The rate of attempted suicide was, however, much lower in the OCD subjects. In addition, there was a significant inverse correlation between suicidal behavior levels on the CSPS and depression in the OCD subjects, while all other subjects showed the expected significant positive correlation between level of suicidal behavior and depression. LIMITATIONS: This study looked at a referred population and generalization to outpatient and community samples cannot be made. Distinguishing between the primary and the comorbid diagnosis is difficult and some findings are based on small sample size and therefore may be vulnerable to type I error. CONCLUSIONS: Although suicidal ideation and depressive symptoms are common in OCD adolescent inpatients, they seem to be protected against suicide attempts. The inverse relationship between suicidal behavior and depression may mean that suicidal behavior is, in some ways, qualitatively different from that seen in other psychiatrically ill adolescents.

Adolescent↗
PubMed2003

Psychiatric aspects of pediatric cancer.

Recent progress in the understanding of psychological and social factors related to cancer is important because cancer is the most common fatal disease of childhood and adolescence. Research interest in children and adolescents who have survived cancer also has increased over the past several years. Attention has focused on the long-term social outcomes of these children and adolescents. With increased survival, quality-of-life issues have assumed a more prominent role in the treatment protocols being developed for childhood cancer. The presence of long-lasting uncertainty about recurrence of the disease or second malignancy together with recognition of cognitive and physical side effects of treatment make childhood cancer a potentially chronic condition. Survivors experience actual or potential threats to future health; more than half have medical cognitive or psychological problems.

Adolescent↗
PubMed2003

Comparison of the suicidal behavior of adolescent inpatients with borderline personality disorder and major depression.

The objective of the study was to examine the hypothesis that some forms of suicidal behavior among adolescents are related to helplessness and depression, whereas others are related to anger and impulsivity. Sixty-five adolescents were studied. Thirty-three had borderline personality disorder (BPD), of whom 17 had made a recent suicide attempt. Thirty-two had major depressive disorder (MDD), of whom 16 had made a recent suicide attempt. Assessments were made with the Child Suicide Potential Scale, the Beck Depression Inventory, the Beck Hopelessness Scale, the Multidimensional Anger Inventory, the Overt Aggression Scale, the Impulsiveness-Control Scale, and the Suicide Intent Scale. Adolescents with BPD had more anger, aggression, and impulsiveness than those with MDD, but similar levels of depression and hopelessness. Suicidal versus nonsuicidal adolescents were more depressed, hopeless, and aggressive, but not more angry or impulsive. There were no significant differences in impulsiveness for the MDD suicidal group versus the MDD nonsuicidal group, but the suicidal BPD adolescents were significantly more impulsive than the nonsuicidal BPD adolescents. In the subjects with BPD, impulsiveness and aggression correlated significantly and positively with suicidal behavior. In the subjects with MDD, no such correlations were seen. In both diagnostic groups, depression and hopelessness correlated positively and significantly with suicidal behavior. Anger did not correlate with suicidal behavior in either of the groups. The suicidal subjects with MDD had significantly higher suicidal intent scores than the suicidal adolescents with BPD. We conclude that the nature of suicidal behavior in adolescents with BPD differs from that seen in MDD with respect to the role of anger and aggression.

Adolescent↗
PubMed2003

Methylphenidate treatment for attention-deficit/hyperactivity disorder in children and adolescents with velocardiofacial syndrome: an open-label study.

BACKGROUND: Velocardiofacial syndrome (VCFS) is a common microdeletion syndrome associated with psychiatric morbidity and developmental disabilities. Although attention-deficit/hyperactivity disorder (ADHD) is the most common psychiatric problem associated with VCFS, there are no reports on methylphenidate treatment in this patient population. Indeed, clinicians have commonly avoided the use of methylphenidate in children with VCFS because of concerns about ineffectiveness or psychotic exacerbation. METHOD: Forty subjects of mean +/- SD age 11.0 +/- 5.0 years with VCFS were assessed for DSM-IV diagnoses using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children, Present and Lifetime Version, and its extended ADHD module (K-SADS-P-ADHD). Those found to have comorbid ADHD were treated with methylphenidate, 0.3 mg/kg once daily. Treatment efficacy was evaluated after 4 weeks with the K-SADS-P-ADHD, the Conners' Abbreviated Teacher Questionnaire, and the Conners' Continuous Performance Test. Side effects were evaluated with a modified version of the Barkley Side Effects Rating Scale. RESULTS: Of the 18 subjects (45%) diagnosed with ADHD, 12 agreed to participate in the study. Their ADHD symptoms, both behavioral and cognitive, improved significantly with treatment. None of the patients showed clinical worsening or psychotic symptoms. Side effects were usually mild and did not warrant discontinuation of methylphenidate. The most common side effects were anorexia and depressive-like symptoms. CONCLUSION: This open-label study indicates that methylphenidate is effective and safe in patients with VCFS. Therefore, its current limited use in this population seems to be unjustified. Larger, controlled clinical and pharmacogenetic studies are needed to confirm these findings.

Adolescent↗
PubMed2003

[The influence of gender on risk factors for child and adolescent suicidal behavior].

Suicide is the second leading cause of death among youths in many countries, and is a serious concern for public health. There are significant epidemiological differences between females and males--the "gender paradox". On the one hand, females report suicidal ideation more frequently, and attempt suicide more often. On the other, boys exceed females in the rates of suicidal deaths. Although many studies have been conducted to identify the risk factors for suicidal behavior, these have not focused on gender differences. In this review we examine the differences between suicidal females and males, in childhood and adolescence, as well as in adults. We review the gender differences concerning risk factors that have been linked to suicidal behavior. We also relate to the gender dependent social attitude toward suicidal behavior. Identifying the risk factors for suicidal behavior for each gender separately will help us understand, why girls try to commit suicide more often, but are relatively protected from dying from such acts, and the opposite is relevant for boys. This discussion is vital for the development of suicide prevention programs.

Adolescent↗
PubMed2002

Weight gain associated with olanzapine and risperidone in adolescent patients: a comparative prospective study.

OBJECTIVE: To evaluate weight gain associated with olanzapine, risperidone, and haloperidol treatment and its clinical risk factors in adolescent patients. METHOD: The study was conducted at three adolescent psychiatric departments in two mental health centers in the Tel Aviv area. All patients were Jewish Israelis. Weight and body mass index (BMI) of hospitalized adolescents treated with olanzapine (n = 21), risperidone (n = 21), or haloperidol (n = 8) were prospectively monitored on a weekly basis for the first 12 weeks of treatment. Various clinical risk factors were tested for association with weight gain. RESULTS: The olanzapine and risperidone groups experienced significant weight gain between baseline and endpoint (p < .01), whereas the average weight of the haloperidol group did not change. Average weight gain was significantly higher for the olanzapine group (7.2 +/- 6.3 kg, 11.1% +/- 7.8%) than for the risperidone (3.9 +/- 4.8 kg, 6.6% +/- 8.6%) and haloperidol (1.1 +/- 3.3 kg, 1.5% +/- 6.0%) groups. Extreme weight gain (>7%) was recorded in 19 patients (90.5%), 9 patients (42.9%), and 1 (12.5%) patient, respectively Gender (males), low concern about gaining weight (females), low baseline BMI, and paternal BMI were positively correlated with weight gain, whereas previous neuroleptic history, neuroleptic dosage, response to treatment, and illness duration were not. CONCLUSIONS: Olanzapine and risperidone are associated with extreme weight gain in adolescents, much higher than that reported in adults. This side effect should be taken into consideration before prescribing these medications, especially in patients at high risk.

Adolescent↗