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Biomedical subjects

G Ratzoni

Publications and source records attributed to G Ratzoni.

At least 19 recordsLinked to original sources
PubMed2003

Olanzapine, risperidone and haloperidol in the treatment of adolescent patients with schizophrenia.

OBJECTIVES: To evaluate and compare the drug response and side effects of adolescents with schizophrenia treated with olanzapine, risperidone, and haloperidol. METHODS: Forty-three patients were treated with olanzapine (n = 19), risperidone (n = 17) and haloperidol (n = 7) for 8 weeks in an open clinical trial. Clinical improvement was evaluated with the Positive and Negative Syndrome Scale (PANSS), and side effects with the Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale. RESULTS: Significant clinical improvement was observed by week 4 for all medications. Olanzapine and haloperidol induced fatigability more frequently than risperidone. Haloperidol was associated with a higher frequency of depression and more severe extrapyramidal symptoms. CONCLUSIONS: To the best of our knowledge this is the first study in adolescents to compare the efficacy and side effects of three most commonly prescribed antipsychotic medications. Olanzapine, risperidone and haloperidol appear to be equally effective for the treatment of schizophrenia in adolescent inpatients but have different side effect profiles.

Adolescent↗
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

Electroconvulsive therapy in adolescents: similarities to and differences from adults.

OBJECTIVE: Information on the indications, technique, and effectiveness of electroconvulsive therapy (ECT) in adolescent patients is scarce. The recommendations for the use of ECT in this age group are similar to those in adults. This study compares the experience with ECT in the two age groups in the same community psychiatric institution, which adheres to the accepted protocols for diagnosis and treatment. METHOD: The files of 24 consecutive adolescent patients treated in an ECT unit located in the center of Israel in the years 1991-1995 were retrospectively examined, and the findings were compared with those in 33 adult patients who started their ECT course on the same day. The technique for applying ECT was essentially the same in the two age groups. RESULTS: ECT was equally effective for adolescents and adults (58% in each group achieved remission). The main difference was the diagnosis for which patients were referred: most of the adolescents were in the "psychotic spectrum, whereas most of the adults were in the "affective spectrum." CONCLUSIONS: The findings support the current medical recommendations for the use of ECT in adolescents. Possible explanations for the differences in diagnosis between the two age groups are discussed.

Adolescent↗
PubMed2001

Injections of depot antipsychotic medications in patients suffering from schizophrenia: do they hurt?

INTRODUCTION: Long-acting depot injections of antipsychotic medications are an important way to monitor treatment noncompliance in patients suffering from schizophrenia. Pain and discomfort at the injection site may result in patients' refusal of depot injections. The present study is a pilot study that attempts a systematic characterization of injection site pain. METHOD: Thirty-four consecutive outpatients suffering from DSM-IV-defined schizophrenia or schizoaffective disorder and treated with depot antipsychotic medications were evaluated. The pain they suffered from the injections was quantified using a visual analog scale. This evaluation was made 5 minutes before the injection, 5 minutes after. 2 days after, 10 days after, and before the next injection. Patients were also administered a modified version of the Rating of Medication Influences scale that included a specific question on the possible relationship between injection-associated pain and future compliance to depot treatment. RESULTS: The depot injections cause pain, which is maximal immediately after the injection, declines substantially 2 days after, and disappears by the tenth day after the injection. A correlation exists between reported injection site pain and the effect it has on patients' attitude toward the depot injection as reported by the patients. Zuclopenthixol depot injection is more painful than other depot medications. CONCLUSION: Depot injections are painful. The pain they inflict has a typical course, and medication type is among the factors that influence this pain. This pain might have an effect on patients' attitude toward depot injections and thus is of importance in the management of patients suffering from schizophrenia.

Adolescent↗
PubMed1998

Association between multiple suicide attempts and negative affects in adolescents.

OBJECTIVE: To compare the level of negative emotions-anxiety, depression, aggression, and impulsivity-in hospitalized adolescents with a history of either a single or multiple suicide attempts. METHOD: Thirty-two adolescents hospitalized for a first suicide attempt, 19 hospitalized for a repeated attempt (fifth or more), 109 nonsuicidal psychiatric inpatients, and 85 community controls were assessed for level of depression, anxiety, aggression, and impulsivity with the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Multidimensional Anger Inventory, and the Suicide Potential Scale. RESULTS: Both suicidal groups demonstrated higher levels of most of the negative emotions than both the normal controls and the nonsuicidal inpatients. When the first attempters were compared with the multiple attempters, similarly high levels were noted for most dimensions of anxiety and depression. A trend toward increased aggression was noted among the multiple suicide attempters on all parameters evaluated; some of these differences were significant. CONCLUSION: In already highly anxious and depressed suicidal inpatients, a high level of aggression might significantly increase the risk of recidivism.

Adolescent↗
PubMed1998

Aggression and sexual offense in Asperger's syndrome.

Asperger's Syndrome is one of the diagnostic subcategories of pervasive developmental disorders. It is characterized by a defect in reciprocal social interaction, lack of empathy for others and poor non-verbal communication. Antisocial acts, including aggression and sexual offense, are not considered to be common in this disorder. We describe an adolescent with Asperger's Syndrome whose main problems are his violence and sexual offenses. We assume that these symptoms are secondary to his diagnosis of Asperger's as a manifestation of his difficulties with the "theory of mind" of others. This atypical case report is in contrast with the low prevalence of aggression and sexual offense in Asperger's, as reported in the literature. We discuss the reasons for this low prevalence. Our conclusions are based on one case history and a literature review. We call for further research in this field.

Adolescent↗
PubMed1997

Suicidal adolescents and ego defense mechanisms.

OBJECTIVES: To identify defense mechanisms that characterize adolescents with a range of suicidal behaviors and to differentiate them from nonsuicidal adolescents. METHODS: Fifty-five suicidal adolescent inpatients admitted for a definite suicide attempt were compared with 87 adolescent inpatients who had no history of suicide attempt or ideation and 81 nonpatients. Defense mechanisms were assessed by the Ego Defense Scale (EDS) which is part of a larger semistructured interview, the Child Suicide Potential Scale (CSPS), and by a self-report questionnaire, the Life Style Index (LSI). The CSPS was also used to quantity violent and suicidal behaviors. RESULTS: On the LSI suicidal adolescent patients scored higher on denial, displacement, repression, and total defenses than the nonpatients. On the EDS they scored higher on regression, denial, projection, introjection, repression, and total defenses and lower on sublimation. LSI scores on displacement (higher) and on compensation (lower) distinguished suicidal from nonsuicidal inpatients. Denial and regression correlated positively and sublimation correlated negatively with both suicidal and violent behaviors. Introjection and repression correlated with suicidal behavior only. CONCLUSIONS: Overuse of displacement is connected with increased risk for suicidal and aggressive behaviors, while sublimation is probably a protective factor. In addition, several immature ego defenses possibly amplify aggression, which then is directed against the self by the maladaptive overuse of introjection, displacement, and repression.

Adolescent↗
PubMed1997

Obsessive-compulsive disorder with and without tics in an epidemiological sample of adolescents.

OBJECTIVE: This study was undertaken to discriminate subtypes of obsessive-compulsive disorder in adolescents. METHOD: Forty individuals with obsessive-compulsive spectrum disorders were ascertained from an epidemiological sample of 861 adolescents. Interviews were conducted by child psychiatrists using semistructured diagnostic interviews, including a clinician-rated Yale-Brown Obsessive Compulsive Scale. Discriminant analysis was performed to compare the scores on the Yale-Brown scale of groups with and without comorbid tics and to compare boys and girls. RESULTS: Adolescents with tics were more prone to aggressive and sexual images and obsessions than were adolescents without tics; these differences could not be wholly attributed to sex differences. CONCLUSIONS: The subtypes among unreferred adolescents are similar to those of adult patients with obsessive-compulsive disorder with and without Gilles de la Tourette syndrome. Subtypes evident in adulthood may be established relatively early in the natural course of obsessive-compulsive disorder.

Adolescent↗
PubMed1996

State and trait anxiety in adolescent suicide attempters.

OBJECTIVE: To examine the relationship between anxiety and suicidal behavior in adolescents. METHOD: Forty-six adolescents who had been hospitalized in an inpatient psychiatric unit after a suicide attempt were compared on measures of anxiety and depression with 72 adolescent psychiatric inpatients who had no history of suicide attempts. RESULTS: The suicide attempters exhibited significantly higher levels of both state and trait anxiety. However, when controlling for depression, the attempters did not differ in their level of state anxiety from the nonattempters, but they still manifested significantly higher levels of trait anxiety than nonattempters. CONCLUSIONS: The results suggest that anxiety, both state and trait, is a risk factor for suicidal behavior in adolescents. Yet, only trait anxiety appears to be relatively independent of depression in its effect on suicidal behavior risk. These findings imply that clinicans should take into account anxiety, both state and trait, for assessment and treatment of adolescents at risk for suicidal behavior.

Adolescent↗
PubMed1996

Obsessive-compulsive characteristics: from symptoms to syndrome.

OBJECTIVE: To assess the distribution and severity of obsessions and compulsions in a nonclinical adolescent population. METHOD: During preinduction military screening, 861 sixteen-year-old Israelis completed a questionnaire regarding the lifetime presence of eight obsessive-compulsive (OC) symptoms and three severity measures. The presence or absence of obsessive-compulsive disorder (OCD) or subclinical OCD was ascertained by an independent interview. RESULTS: Although only 8.0% and 6.3% of respondents reported disturbing and intrusive thoughts, respectively, 27% to 72% of subjects endorsed the six remaining OCD symptoms. Twenty percent of subjects regarded the symptoms they endorsed as senseless and 3.5% found them disturbing; 8% reported spending more than an hour daily on symptoms. OCD and subclinical OCD cases differed significantly from non-OCD cases, but not from each other, in distress and mean number of symptoms. Although the distribution of nine of the items differed for noncases, compared with OCD and subclinical OCD cases, the distributions for all items overlapped markedly across the three groups. CONCLUSIONS: OC phenomena appear to be on a continuum with few symptoms and minimal severity at one end and many symptoms and severe impairment on the other. Defining optimal cutoff points for distinguishing between psychiatric disorder and OC phenomena that are common in the general population remains an open question.

Adolescent↗
PubMed1995

Reduction in serotonin 5HT2 receptor binding on platelets of delinquent adolescents.

The possible involvement of serotonin receptors of the 5HT2 type in aggressive behavior was studied in juvenile delinquents. A group of 28 delinquent adolescents (13-18 years old) who had committed violent crimes was compared with a group of age matched controls. Subjects were drug and medication free during the study. 5HT2 receptors were labeled on platelet membranes using tritiated ketanserin. Receptor binding in the delinquent adolescents was significantly lower than in age matched controls. Mean +/- SD of 76 controls was 32.3 +/- 14.2 fm/mg, compared to 16.6 +/- 8.2 fm/mg in 28 delinquents (P < 0.002, Student's t-test). These results support a role for serotonin in general and 5HT2 receptors in particular in human aggressive behavior.

Adolescent↗
PubMed1995

Correlation of suicidal and violent behavior in different diagnostic categories in hospitalized adolescent patients.

OBJECTIVE: To determine the relative importance of aggression and depression in adolescent suicide within different diagnostic categories. METHOD: One hundred sixty-three consecutive admissions to an adolescent psychiatric inpatient unit were assessed using a semistructure diagnostic instrument, the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Scores for depression, suicidal behaviors, and violent behaviors were calculated from this assessment. RESULTS: Anorexia nervosa and conduct disorder patients had the highest suicidal behavior scores. In addition, patients with conduct disorder were significantly more violent than patients with major depressive disorder, and scores on the Violent Behavior Scale correlated with suicidal symptoms but not with depressive symptoms. CONCLUSION: Aggression may be as important in some kinds of suicidal behaviors as is depression. Thus it seems that there are hypothetically at least two types of suicidal behaviors during adolescence: a wish to die (depression) and a wish not to be here for a time (impulse control). The first type of suicidal behavior characterizes that seen in disorders with prominent depression such as major depressive disorder and anorexia nervosa, and the second characterizes disorders of impulse control such as conduct disorder.

Adolescent↗
PubMed1995

An epidemiological study of trichotillomania in Israeli adolescents.

OBJECTIVE: To determine the prevalence of trichotillomania and comorbid psychopathology in nonreferred adolescents. METHOD: Using a questionnaire and interview, 794 Israeli 17-year-olds were screened for current and past hair-pulling and comorbid psychopathology. RESULTS: Eight current or past hair-pullers (5 male, 3 female) were identified, yielding a lifetime prevalence of hair-pulling of 1%. Four subjects reported current hair-pulling (point prevalence of 0.5%). None of these reported alopecia, distress, or tension before pulling; only two reported relief after pulling. Thus, none met the full DSM-III-R criteria for trichotillomania. Four subjects reported past but not current hair-pulling, with bald spots in two cases. Three of the four current hair-pullers had significant obsessive-compulsive symptoms, a significantly elevated rate compared to the entire screened population. Two subjects with obsessive-compulsive disorder also had generalized anxiety disorder and, in one case, chronic simple vocal tics. Hair-pullers did not differ significantly from non-hair-pullers in IQ, physical fitness, and overall competency, or prevalence of other comorbid disorders. CONCLUSIONS: In a community adolescent sample, only 25% of hair-pullers reported resulting bare spots and none endorsed both rising tension and subsequent relief. The prevalence of obsessive-compulsive symptoms was significantly elevated in these nonreferred hair-pullers.

Adolescent↗
PubMed1995

Defense mechanisms in severe adolescent anorexia nervosa.

OBJECTIVE: To compare ego defense mechanisms in adolescents with anorexia nervosa and other major psychiatric disorders, to defenses in healthy adolescents. METHOD: Thirty-seven patients with anorexia nervosa, 30 with major depressive disorder, 20 with obsessive-compulsive disorder, 53 with borderline personality disorder, 60 with schizophrenia, and 81 healthy controls were assessed with Pfeffer's Ego Defense Scale. RESULTS: Regression, denial, projection, repression, introjection, and total defenses were common to all psychiatric patients and distinguished them from normal adolescents. In addition to these defenses, anorectic patients also used intellectualization more frequently than normal adolescents and psychiatric patients. They used sublimation more than other psychiatric patients. Patients with disorders, apart from obsessive-compulsive disorder, that are considered to be often comorbid with anorexia did not have different defense than schizophrenic patients. CONCLUSIONS: Anorectic adolescents overutilize relatively more mature defenses than do psychiatrically ill adolescents, and they overutilize immature defenses compared with normal adolescents. This combination of mature and immature defenses may be related to the uniquely heterogeneous ego functioning seen in anorectic patients, and it may provide insight into the nature of the psychopathology of anorexia nervosa. It also could have important psychotherapeutic and prognostic value.

Adolescent↗
PubMed1995

Life events and severe anorexia nervosa in adolescence.

The purpose of the study was to study the influence of life events on adolescent patients suffering from anorexia nervosa. Twenty one hospitalized adolescent inpatients with severe anorexia nervosa were compared with 79 adolescent nonanorectic psychiatric inpatients and 40 healthy adolescents for stressful life events throughout their lives. The nonanorectic patients suffered from schizophrenia, affective disorders, anxiety disorders, borderline personality disorder or conduct disorder. The assessment of the contribution of life events to the development of anorexia and the control mental disorders was based on semistructured interviewing of the patients, their parents and the patients' therapists. The instrument used was that developed by Pfeffer. The anorectic patients showed significantly higher negative life event scores than healthy controls in all the areas of life events examined. In addition, they showed significantly more negative life events concerning parents than patients in the other psychiatric diagnostic categories. These findings have relevance for the growing literature on the association between eating disorders and certain forms of child abuse.

Adolescent↗
PubMed1994

The sociocultural theory in the development of anorexia nervosa.

The relationship between anorexia nervosa (AN) and sociocultural factors is examined. Anorexia nervosa was first described in the West and was reported as particularly rare or absent in Eastern cultures. However, the frequency of its presentation has increased worldwide over the past two decades, probably as a consequence of changes in cultural norms and concepts of feminine beauty and an increasing inflow of Western values into other countries. Sociocultural factors are important in the development of AN in psychologically vulnerable young females, although other factors may also be implicated.

Adolescent↗