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Biomedical subjects

Gil Zalsman

Publications and source records attributed to Gil Zalsman.

52 records · Page 3Linked to original sources
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Heart rate variability in patients with major depression.

This study compared cardiac autonomic modulation in physically healthy patients with major depressive disorder to that in mentally healthy heart transplant recipients and physically and mentally healthy comparison subjects by using a nonlinear measure and a conventional measure of heart rate variability. No significant differences in cardiac autonomic modulation were noted between the depressive group and the transplant recipients, but both of those groups had significantly lower mean values for heart rate variability measures relative to the healthy comparison subjects. The results support the hypothesis that cardiac autonomic imbalance (reduced vagal modulation) to the extent of cardiac neuropathy is present in depression.

Algorithms↗
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Psychopharmacology of violent behavior in adolescents.

The aim of this review is to discuss the biological basis for the pharmacotherapy of violence in adolescents. The current and updated views on the etiology, biochemistry and neuroanatomy of violence in youth are presented. Concepts in the treatment and the pharmacological agents that are used both in short and long term are discussed and we conclude with some of recent findings in the exciting field of genetics of violence. The review emphasizes that treatment should always combine a socio-psycho-biological and multi-disciplinary approach, because any single treatment for violence cannot stands on its own.

Adolescent↗
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Terrorism and the adolescent: a review.

In recent years suicide bombings have became a part of life in Israel. Adolescents seem to be more vulnerable to the issues of life and death since they have to choose psychologically whether to live or die ("the fourth organizer"). The reaction to terrorism in this age group is unique. After September 11th, a great interest on the subject has arisen in the United States and some new data has been gathered. One of the important messages is that terrorism does not simply equal trauma. The aim of this article is to review current literature on emotional reaction, impact, and therapeutic strategies to terrorism in the adolescent population.

Adolescent↗
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Alcohol and adolescent suicide.

Adolescent suicide is a major public health problem. In this review, the authors discuss different aspects of the relation between alcohol abuse and suicidal behavior in adolescents, including epidemiology, role of family history, comorbidity, gender differences, neurobiology, treatment, and prevention. In the general population, about 2,000 adolescents in the United States die by suicide each year. Suicide continually ranks as the second or third leading cause of death of persons between the ages of 15 and 34 years old. The suicide rate in young people has more than doubled during the period from 1956 to 1993. This increasing suicide rate has been blamed on the increase of adolescent alcohol abuse. Availability of alcohol and guns at home may contribute to suicide risk in adolescents. Comorbid psychopathology, which is common among adolescent alcohol abusers, substantially increases risk for suicide completions and attempts. Depressed adolescents may use alcohol to self-medicate depressive symptoms. Alcohol abuse and suicidal behavior in adolescents and in adults has been found to have biochemical, genetic, and psychological correlates. Ideally, treatment of adolescents who receive a diagnosis of an alcohol use disorder and co-occurring suicidality should follow an integrated protocol that addresses both conditions. Future studies of psychological and neurobiological mechanisms of suicidality in adolescents with alcohol and/or substance abuse are merited.

Adolescent↗
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Selective serotonin reuptake inhibitors and the risk for suicidality in adolescents: an update.

The controversy regarding Selective Serotonin Reuptake Inhibitors (SSRIs) and suicidality dates back to the early 1990s. The first agent reported to be associated with suicidality was fluoxotine. In 2003, the British Medicines and Healthcare Products Regulatory Agency (MHRA) warned about possible risk of suicidality in children and adolescents treated with paroxetine for Major Depressive Disorder (MDD). This warning was soon extended to all the SSRIs as well as venlafaxine and mirtazapine. Similarly, the United States Food and Drug Administration (FDA) issued a "black box warning" on these medications in 2004. We address the debate concerning this warning and its clinical implications and review the latest contributions to the literature.

Adolescent↗
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Suicide in early childhood: a brief review.

The rate of suicide in the United States among prepubertal children and young adolescents had increased by 120% from 1980 to 1992. From 1992 to the present the rate has decreased slightly by 33%. We address a brief review of the most relevant findings in literature that are related to the risk of suicide. Although the most reported findings were child mood disorder, any type of family distress and family history of suicide attempts, the severity of those does not seem to increase the risk of suicide. However, there were other environmental factors that may influence the risk of suicide, such as the access to firearms. It is critical to detect risk factors and triggers in prepubertal populations in order to reduce the incidence of suicide in this age group and older age groups.

Adolescent↗
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Family-based association study of 5-HT(2A) receptor T102C polymorphism and suicidal behavior in Ashkenazi inpatient adolescents.

UNLABELLED: Suicidal behavior runs in families and is partially genetically determined. Since greater serotonin 5-HT(2A) receptor binding has been reported in postmortem brain and platelets of suicide victims, the 5-HT(2A) receptor gene polymorphism T102C became one of the candidate sites in the study of suicide and impulsive-aggressive traits. However, studies that examined the association of this polymorphism with suicidality have contradictory results. This study used a family-based method and one homogenous ethnic group to overcome ethnic stratification in order to test this association. METHODS: Thirty families of inpatient adolescents from Jewish Ashkenazi origin, with a recent suicide attempt, were genotyped. All subjects were interviewed for clinical diagnosis, depressive and impulsive-aggressive traits and demographic data. Allele frequencies were assessed using the Haplotype Relative Risk method for trios. RESULTS: No difference was found in allelic distribution between transmitted and non-transmitted alleles. There was no significant association of genotype with any of the clinical traits CONCLUSIONS: These preliminary results suggest that the 5-HT(2A) T102C polymorphism is unlikely to be associated with suicidal behavior and related traits in adolescent suicide attempters.

Adolescent↗
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Children's Depression Inventory (CDI) and the Children's Depression Rating Scale-Revised (CDRS-R): reliability of the Hebrew version.

The Children's Depression Inventory (CDI) and Children's Depression Rating Scale-Revised (CDRS-R) are two widely used instruments, which measure depression in children and adolescents. This pilot study assessed the reliability of the Hebrew versions of these two instruments. Both CDRS-R and CDI were translated from English into Hebrew and then back translated. Seventeen healthy Israeli bilingual children volunteers were interviewed with both scales with a one day intermission between the interviews. Non-parametric correlations were used to compare scores in the two versions for each item. Results showed high agreement between the two versions for almost all items of the CDI and moderate to high for the CDRS-R. When CDRS-R summary scores for each item were compared, the agreement was high for this instrument as well. It is concluded that both CDI and CDRS-R Hebrew versions are reliable and can be used for studies of depression in the Israeli pediatric population.

Adolescent↗
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Suicide attempts among adolescents in northeastern Slovenia: a 25 year report.

UNLABELLED: Slovenia is one of the countries with the highest national suicide rates (30/100,000/year). The rate of suicide attempts is accordingly high, for both adolescents and adults. Suicidal children and adolescents from the four North-eastern regions of Slovenia are hospitalised at the Child and Adolescent Psychiatry Unit of the General Hospital Maribor. The aim of this study was to show the pattern of changes in these hospitalisations along 25 years. METHOD: The data was collected retrospectively, using chart review of this unit by a psychiatrist for the years 1978 through 2004. RESULTS: The data consists of two different samples. The first sample contains gender distribution (n = 774) from 1978 to mid 2004 with 664 girls and 110 boys, and the second sample (n = 1,477) consisted of suicide attempts as well as alcohol (n = 772) and drug abuse (n = 115) data for the last decade. The number of hospitalisations was increasing in a wavy curve with average 7,5 times more admitted girls than boys. In 98%, the suicide method was intoxication, and most were additionally diagnosed with "adolescent crisis" (ICD-10: F93.8). CONCLUSION: The rise in the number of admitted suicidal adolescents was partly consequent to the improvement of their detection maybe because 25 years ago most of these cases were recorded as "accidental poisonings" and did not include the diagnosis of a suicide attempt. The socio-economic changes characteristic of a country in transition also contributed to this increase, as did the development of the Unit with more trained staff and advanced treatment.

Adolescent↗
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Impulsive-aggressive traits and suicidal adolescents and young adults with alcoholism.

Suicidal behavior and alcohol use disorders among adolescents and young adults are serious public health problems. In the study of suicidal behavior among young people with alcoholism, it has been shown that aggression and impulsivity are higher among those who attempted suicide. Impulsivity has been related to suicidal and self-destructive behaviors within different psychiatric conditions, i.e. alcohol and substance use disorders, mood disorders, conduct disorder, impulse control disorders, antisocial personality disorder, and borderline personality disorder. The term impulsivity has been used to define different constructs such as (1) personality trait or cognitive style in which disinhibition is the core characteristic, (2) a tendency to act immediately in response to external or internal stimuli, and (3) a group of psychiatric disorders with behavioral dyscontrol. Among adolescents suicidal behavior is transmitted in families independently of psychiatric conditions, but not independently of impulsivity/aggression. Two causal links between impulsiveness and alcoholism have been proposed: (1) adolescents who develop alcoholism possess higher premorbid levels of impulsiveness than those who do not develop alcoholism, and (2) levels of impulsiveness differentiate both populations only after the development of alcoholism, with higher levels of impulsiveness among those adolescents who developed alcoholism. Cognitive behavioral techniques have shown promising results in the treatment of adolescents with alcohol and substance use disorder and suicidality. The relative frequency of suicidal behavior among adolescents and young adults suffering from alcoholism and its subsequent devastating effects on individuals, families and society merits further research and development of prevention strategies.

Adolescent↗
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Prevalence of alcohol misuse among adolescents and young adults evaluated in a primary care setting.

OBJECTIVE: To determine the prevalence of alcohol misuse among older adolescents and young adults evaluated in a primary care setting using the CAGE questionnaire. METHODS: In this crossover descriptive study, a general practitioner, using the CAGE questionnaire, interviewed consecutive primary care patients aged 18-30 years. RESULTS: 29.5% of adolescents and young adults answered "yes" to at least one question of the CAGE questionnaire. However, only 7.4% of study participants gave an affirmative answer to at least two CAGE questions. There were more males than females among subjects who answered "yes" to at least one question. Furthermore, males more commonly gave an affirmative answer to at least two CAGE questions. CONCLUSIONS: A substantial number of older adolescents and young adults evaluated at a primary care center may have alcohol misuse. Instruments with higher sensitivity may be preferable in screening procedures for alcohol misuse. Responses suggestive of problematic drinking should be confirmed during the second post-screening stage with a more detailed discussion about patterns of use, problems related to drinking, and symptoms of alcohol use disorder. Further studies of prevention interventions in adolescents and young adults are needed.

Adolescent↗
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Demographic and clinical features of adolescents and young adults with alcohol-related disorders admitted to the psychiatric emergency room.

OBJECTIVES: To determine the incidence of alcohol related problems (ARP) among adolescents admitted to the Psychiatric Emergency Room (PER) and to describe the demographic and clinical characteristics. METHODS: The study was a retrospective review of admissions to the PER, where we reviewed the psychiatric records of all of the 14-30 year olds admitted to the PER during the three-month period between April 1st, 2003 and June 30th, 2003. Demographic and clinical data of subjects with and without ARP were compared. RESULTS: During the three-month time period, 108 patients between the age of 14 and 30 were admitted to the PER. 14 (13.2%) of these had ARP, and ARP tended to occur more in males (chi2 = 3.81; df=l; p = 0.05). The number of psychiatric diagnoses among those who had ARP was significantly higher than among those who did not have ARP (t = -3.12; df=104; p = 0.002). ARP were found to be associated with personality disorder and misuse of other substances. 37.5% of those adolescents and young adults with ARP had a personality disorder, while 13% of those without ARP had a personality disorder (chi2 = 4.64; df=1; p = 0.03). 50% of those with ARP consumed (an)other substance/s, while 12.0% of those patients without ARP consumed (an)other substance/s (chi2 = l2.48; df=1; p < 0.001). Of the female adolescents and young adults with ARP, 50% were admitted to PER after an episode of self-poisoning. CONCLUSION: ARP in young adults admitted to the PER for acute psychiatric care are associated with greater psychiatric comorbidity, especially personality disorders. In females, ARP may be associated with an increased risk for self-poisoning. Adequate detection of ARP in the PER could promote earlier specific interventions specifically tailored to ARP among adolescents and young adults.

Adolescent↗
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Self complexity of suicidal adolescents.

UNLABELLED: This study examined the positive and negative self-complexity of suicidal adolescents. METHODS: Thirty-two Israeli suicidal inpatients, thirty-two nonsuicidal inpatients and thirty-two control participants completed scales on self-complexity and suicidal tendencies. Self-complexity was based on Linville's measure and revealed four different aspects of self-complexity: number of positive/negative traits, number of positive/negative/neutral self-aspects, amount of redundancy of the positive/negative traits and subjective similarity between each two self-aspects. RESULTS: In comparison with both psychiatric and control, the suicidal self was characterized by the highest number of negative traits and negative self-aspects. In comparison with control, the suicidal self was characterized by the highest number of positive categories and the lowest number of neutral categories and redundancy in the positive traits. No significant differences were found between the suicidal and the psychiatric in the number of positive and neutral self-aspects and in the level of redundancy of the positive traits. After Bonferroni post-hoc correction for multiple testing, the effects for the number of negative traits (F = 28.53; p < .001), the number of negative self-aspects (F = 15.59; p < .001) and the number of neutral self-aspects (F = 28.14;p < .001) were still significant. CONCLUSIONS: The suicidal self is characterized by flooding of the negative aspects and a high differentiation of the positive ones. The suicidal self should be taken into consideration in both assessment and treatment of adolescents suicidality.

Adolescent↗