Biomedical subjects

Dov Aizenberg

Publications and source records attributed to Dov Aizenberg.

At least 19 recordsLinked to original sources

PubMed2006

Suicide attempts amongst elderly bipolar patients.

BACKGROUND: Bipolar disorder is associated with high risk of suicide. In the elderly suicide rates are the highest of all age groups. There is a paucity of data regarding suicide amongst elderly bipolar patients. Mood stabilizers and particularly lithium are established as "antisuicide" compounds. OBJECTIVE: We aimed to evaluate the association between exposure to psychotropic drugs and suicide attempts in a cohort of elderly patients suffering from bipolar affective disorder (BAD). METHOD: This was a preliminary, retrospective, matched, case-controlled evaluation over a 10-year period. All records of admissions of patients with BAD (ICD-10) were assessed. The index group comprised all patients who had attempted suicide in the month prior to admission. The control group consisted of the next admission of a patient suffering from BAD, matched for sex and age who had not attempted suicide in the month prior to admission. RESULTS: The index group during the period 1995 to 2004 consisted of 16 patients, (8 men and 8 women.), mean age 74.8 +/- 1.3 years. The control group patients (N = 16) were matched for age (mean 74.3 +/- 1.5 years) and sex. The number of patients who had a history of a suicide attempt was significantly greater in the index group (7/16 vs., 2/16; p = 0.039). In the control group patients treated by both a mood stabilizer and an antidepressant were at a significantly lower risk for recent suicide attempt (p = 0.047). LIMITATIONS: Sample size is small, treatments were not standardized and data were collected retrospectively. CONCLUSION: Elderly BAD patients treated with mood stabilizers and antidepressants may be at reduced risk of attempting suicide. These findings need support from prospective randomized trials.

Aged↗

PubMed2006

Antidepressants reduce the risk of suicide among elderly depressed patients.

Treatment with selective serotonin reuptake inhibitors (SSRIs) may increase the risk of impulsive acts including suicide, while data from epidemiological studies suggest that the effect of SSRIs in the elderly may be beneficial. We aimed to evaluate the association between exposure to antidepressants and suicidality in a cohort of elderly patients suffering from major depressive disorder (MDD). This was a retrospective matched case-controlled evaluation over a 10-year period. All records of admissions of patients with MDD (ICD-10) were assessed. The index group comprised all patients who had attempted suicide in the month prior to admission. The case-controlled group was the next admission of a patient suffering from MDD, matched for sex and age who had not attempted suicide in the month prior to admission. The index group during the 10-year period (1995-2004) consisted of 101 patients suffering from MDD who were hospitalized following a suicide attempt. Mean age for the group was 76.5+/-6.6 years; there were 42 men and 59 women. The control group patients (N=101) were matched for age (mean 76.6+/-6.9 years) and sex. The proportion of patients exposed to an antidepressant was significantly greater in the control group, than in the group of patients who had attempted suicide (58 vs 42%, odds ratio 1.94 (95% CI: 1.1-3.4), p=0.019). SSRIs were prescribed in 29% of patients in the control group vs 21% of patients in the index group (p=0.03). It is of interest to note that concomitant prescription of benzodiazepines also conferred a protective effect. In conclusion, elderly depressed patients treated with antidepressants may be at reduced risk of attempting suicide. These findings need support from prospective randomized trials.

Aged↗

PubMed2006

Association between antidepressant prescribing and suicide in Israel.

The effects of antidepressants on suicide are controversial; on the one hand they decrease the incidence of death by suicide, as reflected in epidemiological studies, and on the other hand, there are claims that they increase the risk of impulsivity and suicide. In 1998, primary care physicians in Israel were not allowed to prescribe selective serotonin reuptake inhibitors and in 1999 this prohibition was lifted. We thus evaluated the association between patterns of antidepressant prescribing and the rate of death by suicide in Israel in 1998 compared with that in 2002. Data regarding deaths by suicide were obtained from the Central Bureau of Statistics. Annual rates of antidepressant prescribing were computed from the Intercontinental Marketing Services database. The Intercontinental Marketing Services data covers three out of the four Health Maintenance Organizations in Israel, encompassing 46% of all citizens. Prescribing of all antidepressants increased 2.6-fold between 1998 and 2002. This increase was significantly more pronounced for the selective serotonin reuptake inhibitors. A shift in prescription practices was noted, with a 1.37-fold increase in prescribing by primary care physicians. While the concomitant decrease in overall national rates of completed suicide did not reach significance (17-14 per 100,000), the incidence decreased significantly in men aged 55-74 years (33-22 per 100,000; P=0.029). An overall reduction in suicides, which was significant only in elderly men, was noted in association with increased rates of antidepressant prescription. This study is limited in scope but adds a unique viewpoint related to the possible positive effect of increased antidepressant prescribing in primary care on suicide.

Aged↗

PubMed2005

Reduced cancer incidence among patients with schizophrenia.

BACKGROUND: The incidence of cancer in patients with schizophrenia has been conversely reported to be higher, lower, or similar to that in the general population. The effects of lifestyle factors such as excess smoking, exposure to neuroleptic medications, and genetic factors that may influence the incidence of cancer in this group are not clear. The current study was performed to evaluate the frequency of cancer in a large cohort of patients with schizophrenia and to determine the standardized incidence ratios (SIRs) of any malignancy in this group. METHODS: Data regarding the design, setting, and participants of the current study were analyzed from a cohort of 3226 patients with schizophrenia who were enrolled in the computerized health registry of the Abarbanel Mental Health Center between 1993-2003. The mean age of the patients at the time of the diagnosis of cancer was 49 +/- 14.7 years, with the majority of patients (61%) being male. All patients with schizophrenia records in the database were combined with the records of the Israeli National Cancer Registry to identify pathologically confirmed cancer comorbidity. The cancer incidence rates among patients with schizophrenia were compared with the expected incidence in an age-matched and gender-matched general population sample for the same time interval. RESULTS: Among 1247 female patients with schizophrenia, 22 (1.8%) developed breast cancer and 68 (5.5%) developed cancers of any type. Fifty-two of the 1979 male schizophrenic patients (2.6%) developed cancer. The SIRs were 0.58 (95% confidence interval [95% CI], 0.48-0.69) with a P value of < 0.05 for all cancers in the cohort, and 0.60 (95% CI, 0.37-0.90) for female breast cancer. CONCLUSIONS: The results of the current study demonstrate a reduced risk of cancer in patients with schizophrenia. The mechanisms responsible for the lower risk need be investigated further.

Adult↗

PubMed2005

Patients with very-late-onset schizophrenia-like psychosis: a follow-up study.

OBJECTIVE: The topic of course and outcome of very-late-onset schizophrenia-like psychosis (VLOSLP) has not received the research attention it deserves. The aim of this study was to evaluate the course of clinical symptoms and functional status of patients with VLOSLP in comparison with patients with life-long schizophrenia. METHODS: Telephone interviews were conducted on primary caregivers of 21 patients with VLOSLP who had recently been released from inpatient care. Their treating staff evaluated 21 schizophrenia inpatients according to the same criteria. RESULTS: The majority of patients with VLOSLP did not present cognitive and functional deterioration. On the other hand, 8 of the 19 patients in the elderly schizophrenia group had some functional decline; 3 of those 8 patients seemed to have some cognitive decline, as well. CONCLUSIONS: The results suggest that the VLOSLP patients present stable cognitive and everyday functioning, as compared with chronically institutionalized elderly patients with schizophrenia.

Activities of Daily Living↗

PubMed2005

Increased risk of attempted suicide among aging holocaust survivors.

OBJECTIVE: Suicide rates are higher in elderly persons than in those at other phase of the life-cycle. The majority of World War II (WWII) veterans and Holocaust survivors still define their war experiences as being the "most significant stressor" of their lives. Aging of survivors is frequently associated with depression, reactivation of traumatic syndromes, physical disorders, loss, and psychological distress, possibly increasing the risk of suicide. The aim of the present study was to investigate, among a large cohort of elderly Holocaust survivors, whether their WWII experiences confer an increased risk of suicidal behavior. METHODS: All medical records of elderly patients admitted to a psychiatric hospital in Israel during a 5-year period were retrospectively evaluated. Suicidal patients were compared with patients who had not attempted suicide. RESULTS: Of 921 eligible patients, 374 were Holocaust survivors; 135 (14.6%) had attempted suicide in the month before admission. Ninety Holocaust survivors (24%) had attempted suicide, versus 45 of the 502 patients (8.2%) with no WWII experience. The risk of attempted suicide among Holocaust survivors was significantly increased. CONCLUSION: Although these findings are from a highly selected sample, we suggest that aging Holocaust survivors are at increased risk of attempting suicide. The growth of the elderly population, of whom many had had traumatic life experiences, emphasizes the need to implement preventive strategies so that suicidal risk may be contained.

Age Factors↗

PubMed2004

Suicide attempts amongst elderly schizophrenia patients: a 10-year case-control study.

BACKGROUND: Suicide is frequent amongst the elderly. Schizophrenia is one of the disorders in which suicide attempts and death by suicide are pronounced. However, there is paucity of data regarding suicide attempts by elderly schizophrenia patients. The aim of the present study was to characterize elderly schizophrenia patients who had attempted suicide (AS). METHOD: Over a 10-year period, all computerized records of admissions of schizophrenia patients 60 years or older were examined. Patients who had attempted suicide were defined as the index group and the comparison group was comprised of the next two admissions suffering from schizophrenia who did not attempt suicide prior to hospitalization. RESULTS: 1066 admissions of patients 60 years or older suffering from schizophrenia were examined. There were 392 women and 300 men, mean age for the group 67.4 years. Forty-nine suicide attempts were documented comprising 4.6% of the admissions. Attempts were carried out by 30 patients of whom 10 had had attempted suicide more than once. There was an almost significant difference on gender composition with more males in the suicidal group. No other variables tested were positively associated with suicidality. CONCLUSIONS: The present study is unique in its scope and targeting elderly schizophrenia patients. Despite the lack of identified risk factors, further studies focusing on aging schizophrenia patients are needed as low base rate of suicide exists in this group.

Aged↗

PubMed2004

Switching elderly chronic psychotic patients to olanzapine.

The purpose of this study was to examine whether elderly chronic schizophrenia or schizoaffective disorder patients would clinically improve if switched to olanzapine from previous neuroleptic treatment. Twenty-one hospitalized patients, aged 6088 yr, with a diagnosis of chronic schizophrenia or schizoaffective disorder who were being treated with typical neuroleptic medication were switched to olanzapine. The Positive and Negative Symptom Scale (PANSS), Geriatric Depression Scale (GDS) and Clinical Global Impression Severity (CGI-S) Scale were completed while patients were on their previous medication regimen and again 6 months after the last patient had been started on olanzapine. The mean duration of treatment was 289 d (S.D.=139). Three patients discontinued the medication. Mean end dose of olanzapine was 12.9 mg (S.D.=5.7). Paired sample t tests were used to test change on PANSS Positive, Negative and Total scales, CGI, GDS and body weight. PANSS (Positive, p=0.002; Negative, p=0.003; General, p=0.003; and Total, p=0.000) and CGI (p=0.000) but not the GDS (p=0.67) demonstrated statistically significant improvement. There was no significant change in body weight (p=0.61). Elderly patients with aggravation of chronic schizophrenia showed improvement after being switched to olanzapine with no weight gain. Clinically meaningful change was observed in positive and negative psychotic symptomatology but not in depressive symptoms.

Aged↗

PubMed2004

Heart rate variability increases in elderly depressed patients who respond to electroconvulsive therapy.

OBJECTIVES: To evaluate the parasympathetic modulation in elderly inpatients with major depressive disorder (MDD) before and after electroconvulsive therapy (ECT) using both linear and nonlinear methods of heart rate variability (HRV) analysis. METHOD: A measure of local dimensional complexity (pointwise correlation dimension, PD2), as well as spectral analysis measures (LF, low-frequency range; HF, high-frequency range) were calculated for the heart rate time series of 10 elderly inpatients with MDD (70+/-7 years) before and after ECT. Hamilton Depression Rating Scale (HAM-D) was evaluated concomitantly. RESULTS: Only the responders to ECT (n=7; >or=50% reduction in HAM-D) exhibited a significant increase in PD2 (P=.0035), which showed a tendency towards a correlation with symptom improvement (r=.73, P=.06). Spectral analysis measures did not show a significant difference after ECT. CONCLUSION: Elderly patients with MDD, who respond to ECT, might show increased vagal modulation. Since nonlinear HRV measures have been shown to be reduced by aging, similar to cholinergic deficit, they might shed light on the increased risk for cardiac mortality in depression.

Aged↗

PubMed2004

Suicide among the homeless: a 9-year case-series analysis.

BACKGROUND: Among the homeless there are high rates of mortality and a significant number of attempted and completed suicides. In Tel-Aviv, Israel, there is an ongoing municipal outreach program for the homeless. OBJECTIVE: The aim of the present study was to describe the subgroup of homeless persons who had died by suicide. METHOD: Over a 9-year period the records of each homeless person who had died were assessed by two psychiatrists and a clinical criminologist. The project was undertaken in a large city and was feasible due to close cooperation between the municipal welfare department and mental health consultants. RESULTS: Of the 1,192 homeless persons located and contacted, 156 persons had died (13.1%). Nine of the deaths were by completed suicide (5.8%). All were male. Mean age for the suicide subgroup was 34 +/- 8.7 years, significantly younger than those who died of other causes (p < .01). The majority had completed high school education. While the majority of deaths were drug or alcohol related, in only 1 of 9 deaths by suicide was there a history of drug abuse. Psychiatric comorbidity was recorded in 4 of the 9 persons. The majority of persons (6/9) had died of suicide by hanging. CONCLUSION: Suicide is not a negligible cause of death among the homeless population.

Adolescent↗

PubMed2004

Psychiatric services in nursing homes in Israel: should the American legislation be adopted?

BACKGROUND: Nursing homes provide care for the elderly who require medical, nursing or rehabilitation services. Legislation for the public health model of mental health care for nursing home residents in the USA was enacted in 1987. OBJECTIVE: To determine whether the USA act regulating psychiatric care for nursing homes may be applied in Israel. METHODS: Publications analyzing the outcome of the USA regulations demonstrate improved care as reflected by decrease in restraints and better use of psychotropic compounds. The shortcomings as well as benefits of the USA legislation are tested as to their relevance to the specific economic, environmental and medical issues in Israel. CONCLUSIONS: The adoption of USA legal acts regulating nursing home residents' psychiatric care may not be feasible in Israel. However, quality of care in nursing homes can be significantly improved if such regulations were "tailored" to Israel's unique structure of nursing homes.

Aged↗

PubMed2003

Precautionary measures reduce risk of definite neuroleptic malignant syndrome in newly typical neuroleptic-treated schizophrenia inpatients.

Neuroleptic malignant syndrome (NMS) is a potentially lethal antipsychotic drug (APD)-induced thermoregulatory disturbance. We hypothesized that several precautionary measures taken after administeration of APDs might prevent progression to definite NMS. The study group included 657 consecutively admitted drug-free schizophrenia inpatients who received various typical APDs for 28 days. Specific predefined precautionary measures were employed for this group. The comparison group (n=192) consisted of typical APD-treated schizophrenia inpatients in whom such precautionary measures were not imposed. The study group exhibited a significantly lower incidence of definite NMS (1/657=0.2% versus 4/192=2.1%; P=0.01, odds ratio=13.96; 95% confidence interval 1.55-125.63). Antipsychotics were discontinued in 28 patients (28/657=4.3%) from the study group due to NMS (n=1) or early detection of potential NMS-related signs (probable abortive NMS) (n=27). Our findings suggest that specific precautionary measures can effectively reduce the incidence of definite NMS by approximately one order in newly medicated schizophrenia inpatients.

Adult↗

PubMed2003

Effects of olanzapine on lipid abnormalities in elderly psychotic patients.

INTRODUCTION: Recently concern regarding the cause or worsening of diabetes mellitus by some of the second-generation antipsychotics and their adverse affects on lipid metabolism has caused growing concern amongst physicians and patients. This study aims to assess these effects in elderly patients with schizophrenia. METHODS: In a prospective 6-month follow-up study of elderly inpatients experiencing an acute psychotic exacerbation and exposed to olanzapine for the first time, patients underwent physical and psychiatric assessments including: routine laboratory tests (including serum cholesterol and triglycerides levels), and bodyweight and clinical rating scale measurement. All tests and evaluations were performed at baseline and at the end of study. RESULTS: Twenty-one elderly patients with schizophrenia (15 women and six men) mean age 71.7 +/- 8.2 years were included. All were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (4th edition) as patients with schizophrenia or schizoaffective disorder. Mean duration of olanzapine treatment was 289 days (SD +/- 139) and the mean olanzapine dosage at the end of the study was 12.9 mg/day. At the end of the study, no significant change from baseline serum lipid levels were found for triglycerides (paired differences = -12.8 [SD +/- 38.5], 95% CI -30.3 to +4.7, t = -1.5, df = 20, p = 0.143) or cholesterol (paired differences = -9.0 [SD +/- 43.5], 95% CI = -28.8 to +10.8, t = -0.95, df = 20, p = 0.355). CONCLUSION: The association between olanzapine exposure and lipid abnormalities may not hold true for older patients. Larger studies with elderly patients are needed to support the present report.

Aged↗

PubMed2002

Anticholinergic burden and the risk of falls among elderly psychiatric inpatients: a 4-year case-control study.

OBJECTIVE: Falls are an everyday risk for the elderly and their etiology is multifactorial. Because there are little data focusing on falls among elderly psychiatric inpatients, we aimed to retrospectively assess the characteristics of inpatients that had sustained a fall during hospitalization. METHODS: Over 4 years, all adverse-event reports of falls were reviewed. Inclusion criteria were age >65 years and intact cognition. The control group consisted of the previous and next admission of an elderly patient to the same ward. Anticholinergic score was calculated for each patient. RESULTS: Of 414 admissions of elderly patients, 34 (8.2%) patients had had a fall. The control group (n = 68) did not differ in mean age, distribution of diagnoses, or use of benzodiazepines, antidepressants, or antipsychotics. Two variables were significantly associated with falls: female gender (68% vs. 39%, p < .05) and anticholinergic burden score (ABS) (mean: 3.7 vs. 2.1, p < .05). CONCLUSIONS: Our results support reported findings of higher rates of falls among elderly women and suggest that ABS may be a risk factor for falls.

Accidental Falls↗

PubMed2002

High serum creatinine kinase level: possible risk factor for neuroleptic malignant syndrome.

High creatinine kinase (CK) levels and leukocytosis are known to be associated with neuroleptic malignant syndrome (NMS). The authors sought to determine if their presence during non-NMS psychotic episodes is predictive of the later development of NMS. Sixteen psychotic inpatients who met the criteria for NMS were included. For statistical comparison, two control groups were formed by matching each study patient with two non-NMS patients for age, gender, ethnicity, and year and ward of hospitalization (n = 32). The maximal individual serum levels of CK, lactate dehydrogenase (LDH), serum glutamic oxaloacetic transaminase (SGOT), and white blood cell count (WBC) during all non-NMS psychotic episodes (Brief Psychiatric Rating Scale 40) were averaged. To normalize the distribution, the individual averages were transformed to natural logarithms (Ln). Mean Ln (average [CK]) in the patients with NMS was found to be 6.46 +/- 0.91 IU/L, and in the non-NMS patients, 5.24 +/- 0.90 IU/L (actual serum CK levels, 911 +/- 747 IU/L and 343 +/- 620 IU/L, respectively). This difference was statistically significant (F [2,15] = 10.5, p < 0.0001). In addition, CK levels above the upper limit of normal were noted in 76% of psychotic episodes in the patients with NMS and in only 30% of psychotic episodes in the non-NMS patients (p < 0.0001). There was no significant difference between the NMS and non-NMS groups in Ln(LDH), Ln(SGOT), or Ln(WBC) (F [2,15] = 1.4, 2.1, and 0.9, respectively). The authors concluded that high serum CK level during non-NMS psychotic episodes seems to be a risk factor for future NMS. Therefore, CK measurement may be justified on admission of acutely psychotic patients who have other risk factors and a history of psychosis-associated CKemia.

Adult↗

PubMed2002

Very late-onset schizophrenia-like psychosis: clinical and imaging characteristics in comparison with elderly patients with schizophrenia.

Studies of late-onset schizophrenia began in the early 1940s with work by M. Bleuler. Despite this fact, the emphasis on age of onset in young adulthood distracted researchers of schizophrenia from accumulating data on the subgroup of patients whose disease onset is in late life. Recently, the diagnostic entity of very late-onset schizophrenia-like psychosis (VLOSLP) was proposed for patients with disease onset after age 60 years, and it may have validity and clinical utility. The present study aims to prospectively identify patients suffering from VLOSLP over a 2-year period and to compare them with elderly schizophrenia patients on measures of brain structure, demographics, and treatment response, so that distinct features, if any, can be identified. Twenty-one VLOSLP patients (15 women, 6 men; mean age, 78.1 years) were enrolled and compared with 21 age- and gender-matched elderly schizophrenia patients. All had undergone brain CT scan, and all were treated with risperidone. The VLOSLP group was characterized by more education, higher percentage being married, more pronounced cerebellar atrophy, and better response to treatment. The authors suggest that VLOSLP is a valid diagnostic entity and that its features imply that involvement of neurodegenerative process may be etiologically relevant to psychosis with onset in late life.

Aged↗

PubMed2002

Suicide amongst Alzheimer's disease patients: a 10-year survey.

Suicide is a major public health problem with advancing age being one of the factors associated with increased risk. It has been suggested that most DSM axis-I disorders contribute to increased suicidal risk while dementia is one of the few exceptions. We conducted a 10-year retrospective analysis of all elderly patients suffering from dementia admitted to a large urban mental health center. Between 1991 and 2000 there were 1,551 admissions to our center who were 65 years or older. Of these, 341 were diagnosed (DSM-IV criteria) as suffering from dementia and 215/341 as suffering from Alzheimer's disease (AD). Sixteen AD patients (7.4% of all AD patients) were admitted immediately following a suicide attempt. The control group consisted of the next admission of an elderly AD patient matched for age and gender. The index group (suicidal patients) differed from controls in Clinical Dementia Rating scores (p = 0.017) and higher frequency of previous suicide attempts (p = 0.022). Lifetime psychopathology was not associated with higher rates of suicide attempts (p = 0.068). Physicians should be aware that suicide attempts are not rare in elderly AD patients. Higher level of daily functioning and previous suicide attempts are associated with increased suicidal risk.

Aged↗

PubMed2002

Sexual function and behavior in social phobia.

BACKGROUND: Social phobia is a type of performance and interpersonal anxiety disorder and as such may be associated with sexual dysfunction and avoidance. The aim of the present study was to evaluate sexual function and behavior in patients with social phobia compared with mentally healthy subjects. METHOD: Eighty subjects participated in the study: 40 consecutive, drug-free outpatients with social phobia (DSM-IV) attending an anxiety disorders clinic between November 1997 and April 1999 and 40 mentally normal controls. The Structured Clinical Interview for DSM-IV Axis I Disorders and the Liebowitz Social Anxiety Scale were used to quantitatively and qualitatively assess sexual function and behavior. RESULTS: Men with social phobia reported mainly moderate impairment in arousal, orgasm, sexual enjoyment, and subjective satisfaction domains. Women with social phobia reported severe impairment in desire, arousal, sexual activity, and subjective satisfaction. In addition, compared with controls, men with social phobia reported significantly more frequent paid sex (p < .05), and women with social phobia reported a significant paucity of sexual partners (p < .05). CONCLUSION: Patients with social phobia exhibit a wide range of sexual dysfunctions. Men have mainly performance problems, and women have a more pervasive disorder. Patients of both genders show difficulties in sexual interaction. It is important that clinicians be aware of this aspect of social phobia and initiate open discussions of sexual problems with patients.

Adult↗