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Biomedical subjects

H Hermesh

Publications and source records attributed to H Hermesh.

At least 37 records · Page 2Linked to original sources
PubMed1999

The effect of vitamin E addition to acute neuroleptic treatment on the emergence of extrapyramidal side effects in schizophrenic patients: an open label study.

The anti-oxidant vitamin E has been reported to be effective in the treatment of tardive dyskinesia. The present open label study examined the effect of supplemental therapy with vitamin E on acute extrapyramidal symptoms and cell enzymes in patients receiving neuroleptic drugs. Thirty-nine hospitalized schizophrenic patients were randomly assigned to two groups: group 1 (n = 20) was treated with neuroleptics, and group 2 (n = 19) with neuroleptics combined with a fixed dose of vitamin E (600 IU/day), administered for two weeks. All patients were assessed with the Simpson-Angus Rating Scale (Simpson and Angus, 1970) for neuroleptic induced Parkinsonism (NIP), Barnes' Akathisia Scale (Barnes, 1989), and Brief Psychiatric Rating Scale: laboratory parameters included serum creatine kinase (CK) activity, serum glutamate oxaloacetic transaminase (SGOT) and white blood cell count (WBC). The addition of vitamin E to neuroleptic agents was associated with a trend (p = 0.08) towards prevention of the emergence of NIP compared to neuroleptic treatment alone. Addition of vitamin E to neuroleptics may reduce the severity of acute NIP in schizophrenic patients.

Adult↗
PubMed1999

Orbitofrontal cortex dysfunction in obsessive-compulsive disorder? II. Olfactory quality discrimination in obsessive-compulsive disorder.

BACKGROUND: Olfactory quality discrimination is a putative marker of orbitofrontal cortex function in mammals. As this portion of the cerebral cortex was repeatedly implicated in the pathophysiology of obsessive-compulsive disorder (OCD) this study was designed in an attempt to quantify this behavioural function in OCD patients. METHODS AND RESULTS: Olfactory quality discrimination was compared in OCD patients and healthy controls. Thirty two subjects participated in the study: 16 (13 women and 3 men) medication free OCD outpatients and 16 sex and age matched healthy controls. Olfactory tests consisted of determination of detection thresholds to isoamyl acetate, and a three way forced choice quality discrimination task, using isoamyl acetate, citral and eugenol as stimuli. No significant differences in sensitivity and performance of the quality discrimination task between the two groups were found. Within the OCD group the more severely affected patients (Y-BOCS>29) performed significantly better than the less severely affected (Y-BOCS<30) patients on the more difficult part of the quality discrimination task. Within this subgroup of patients the correlation between performance on the olfactory task and a previously reported alternation task tended to be negative as compared to a significantly positive correlation in the control group. CONCLUSIONS: It seems that olfactory quality discrimination may prove to be a useful noninvasive marker of prefrontal cortex function in OCD. Furthermore, the organization of functional modules within the orbitofrontal cortex, rather than a simple dysfunction, may prove to characterize OCD.

Adolescent↗
PubMed1999

Orbitofrontal cortex dysfunction in obsessive-compulsive disorder? I. Alternation learning in obsessive-compulsive disorder: male-female comparisons.

BACKGROUND: We have previously reported a significant negative correlation between severity of symptoms and performance of an alternation learning task in female obsessive-compulsive disorder (OCD) patients. The present study was aimed at exploring this relationship between alternation learning and OCD symptom severity in male OCD patients. METHODS AND RESULTS: Eighteen female obsessive-compulsive disorder patients and 14 male non-depressed, drug free, OCD patients participated in the study. Measures of dorsolateral prefrontal function (Wisconsin Card Sorting Test) and orbitofrontal cortex function (object alternation learning) showed no significant differences between the sexes. The relationship between orbitofrontal cortex function and severity of OC symptoms was significantly different between the sexes (z=2.44. P=0.007). While this correlation was negative in the females it was positive in the males. CONCLUSIONS: These results may indicate sexual dimorphism in OCD.

Adult↗
PubMed1998

Bone age in adolescents with schizophrenia and obsessive-compulsive disorder.

The bone age (BA), height and weight of 20 adolescents with schizophrenia and 21 matched adolescents with obsessive-compulsive disorder (COD) were measured. The BA of the schizophrenic patients was significantly higher than their chronological age (CA)(p < 0.05), while the OCD subjects' BA was non-significantly lower than their CA. In addition, the difference between CA and BA (delta ages) in the schizophrenic adolescents was significantly different from the delta ages of the OCD adolescents (p , 0.05). Gender did not significantly affect BA or delta ages. A positive correlation (r = 0.5, p < 0.01) was obtained between CA and delta ages in the schizophrenic patients but not in the OCD patients. Both groups were within the normal range of weight and height percentiles.

Adolescent↗
PubMed1998

Recurrence pattern of serum creatine phosphokinase levels in repeated acute psychosis.

BACKGROUND: Elevated serum creatine phosphokinase (CPK)MM level is frequently found in acute psychosis. Theories relate this CPKemia to psychomotor agitation and medication. We hypothesized that psychosis-related CPKemia observed in individual patients is relatively consistent. METHODS: Ninety psychotic patients were studied; 83% were schizophrenics (Brief Psychiatric Rating Scale scores > or = 40) whose serum CPKMM levels were recorded during two or more different acute psychoses. The serum CPKMM levels used were the maximal levels monitored during the beginning of each hospitalization. The last CPK measurement in a circumscribed period was defined as the index serum CPK level (IndCPK). The mean of all other individual maximal CPK measurements during other psychotic episodes was defined as the average CPK (AvgCPK). RESULTS: Multiple linear regression analysis showed a significant correlation of natural logarithm (Ln) of (IndCPK with Ln(AvgCPK), as well as with gender (coefficient = .65 and .63, p < .0001 and p < .01, respectively). There were significantly higher IndCPK levels among male patients than among female patients (p < or = .001). A relatively consistent individual pattern of serum CPKMM levels during repeated acute psychotic episodes was observed. CONCLUSIONS: Serum CPKMM levels and gender were found to be good predictors of maximal serum CPKMM levels during every repeated acute psychotic episode. High IndCPK levels are probably risk factors for neuroleptic malignant syndrome.

Acute Disease↗
PubMed1998

Elevated serum creatine kinase activity in adolescent psychiatric inpatients on admission.

Studies in adults have indicated a significant relationship between high serum creatine kinase levels on admission and acute psychosis. However, data on children are sparse. The files of 183 hospitalized children and adolescents (93 boys, 90 girls) with severe psychiatric disorders were reviewed for serum creatine kinase activity on admission, psychomotor agitation, Clinical Global Impression Score, need for intramuscular injection, number of neuroleptic medications and presence of neuroleptic malignant syndrome. Serum creatine kinase levels > 201 IU/ml were considered abnormal. Boys had significantly higher creatine kinase activity than girls. Division of the cohort by diagnosis yielded significantly higher levels in those with schizophrenia, affective disorders and mental retardation. Higher levels were also associated with higher Clinical Global Impression score on admission, use of injections and physical restraint, and nonresponse to neuroleptic medication. There were no cases of neuroleptic malignant syndrome. This first large-scale investigation of serum creatine kinase activity in young psychiatric inpatients shows a significant association between high creatine kinase activity and acute psychosis, similar to that in adults. Furthermore, high creatine kinase levels on admission are predictive of the severity of the psychosis, but are not associated with neuroleptic malignant syndrome. Because psychotic adolescents with high admission creatine kinase levels tend to be nonresponders, clinicians should consider the early use of atypical antipsychotics in this subgroup.

Adolescent↗
PubMed1998

Application of models of working at the interface between primary care and mental health services in Israel.

Psychiatric morbidity is common in primary care, a large proportion being treated without specialist referral. A significant proportion may be undetected or inadequately treated. This article describes current models of mental health services (MHS) working at the interface between primary care and MHS with review of data regarding these models and discussion of the application of these models to the Israeli health system. The shifted out-patient model, primarily provided by psychiatrists independent of the Primary and Secondary Care Teams, would seem to increase access to psychiatric services, increase treated prevalence of the disorders and attract a similar population to hospital out-patient services. The psychiatric community liaison model aims to improve primary care practitioner detection and management skills, might reduce referrals to psychiatrists with similar patient outcome and enables treatment of patients unwilling to see a mental health professional (MHP). The attached MHP Model would allow access to a greater range of psychosocial interventions provided by a primary care team member. The community mental health team, currently a model not in practise in Israel, provides a single point of referral for multidisciplinary care but has shown varying patterns of integration and responsiveness to primary care. Other interfaces of collaboration such as Balint groups and education are also discussed.

Forecasting↗
PubMed1997

Bruxism secondary to antipsychotic drug exposure: a positive response to propranolol.

We present two cases of acute nocturnal bruxism occurring as an early side effect of antipsychotic drug treatment. The development of bruxism was coupled with the appearance of neuroleptic-induced akathisia. Both complications were relieved after the beta-adrenergic blocker propranolol was added, suggesting the involvement of the adrenergic and serotonergic central nervous systems, besides the dopaminergic system, in the pathogenesis of bruxism. The positive response of iatrogenic bruxism to propranolol implies that propranolol also deserves a trial for the treatment of noniatrogenic nocturnal bruxism.

Adrenergic beta-Antagonists↗
PubMed1996

Cytokine production in obsessive-compulsive disorder.

Cytokine production was previously demonstrated to be reduced in untreated major affective patients. In addition, recovery from depression following clomipramine (CMI) treatment was accompanied by the restoration of interleukin-1 beta (IL-1 beta) and interleukin-3-like activity (IL-3-LA) to normal range. In the present study we assessed the in vitro production of IL-1 beta IL-2, and IL-3-LA by peripheral blood mononuclear cells (PBMC) in 11 nondepressed patients with obsessive compulsive disorder (OCD) before and after 8 weeks of CMI treatment. Results were compared with those of 11 healthy subjects. CMI treatment induced a significant improvement in OCD symptoms. No alteration was observed in cytokine production in OCD patients before treatment as compared to control subjects. Moreover, 8 weeks of drug treatment had no effect on cytokine production. In conclusion, OCD per se, as well as CMI treatment, have no effect on interleukin production as measured in this study.

Adult↗
PubMed1996

Fluvoxamine treatment in clozapine-induced obsessive-compulsive symptoms in schizophrenic patients.

Interest in the association of obsessive-compulsive (OC) symptoms and schizophrenia has been reawakened since the introduction of clozapine for treatment of schizophrenia. We describe the appearance of this disorder and examine the efficacy of adding fluvoxamine to ongoing clozapine treatment of the OC and schizophrenic symptoms. Four patients with DSM-III-R schizophrenic disorder, in whom OC symptoms appeared during the course of clozapine treatment, are reported. In two patients, fluvoxamine, a serotonin-selective reuptake inhibitor (SSRI), was added to clozapine under open-trial conditions. The patients were serially assessed by using the Brief Psychiatric Rating Scale, Yale-Brown Obsessive-Compulsive Scale, and Scale for the Assessment of Negative Symptoms. The de novo occurrence and eventual spontaneous reduction of OC symptoms were noted in two schizophrenic patients treated with clozapine. In the other two patients, one with previous and the other with a family history of OC disorder, the addition of fluvoxamine to clozapine was effective in eliminating the OC symptoms. A concomitant improvement in the schizophrenic symptomatology was seen as well. It appears that disabling OC symptoms may occur as in response to clozapine treatment in chronic drug-resistant schizophrenic patients. Some of the latter may benefit from the addition of an SSRI to the ongoing clozapine regimen.

Adult↗
PubMed1996

Severe withdrawal akathisia following neuroleptic discontinuation successfully controlled by clozapine.

Akathisia is one of the most distressing side effects of neuroleptic treatment. It is usually managed by manipulating the neuroleptic dose and administering anti-akathisic compounds (beta-blockers, anticholinergics, serotonin antagonists). However, the pathophysiological background of withdrawal akathisia which follows the discontinuation of neuroleptic treatment remains unclear, and there is as yet no adequate treatment. We report a case of severe withdrawal akathisia associated with suicidal and autoaggressive behaviour during a gradual transition from perphenazine/trihexyphenidyl to clozapine. The akathisia was effectively managed by titration of clozapine (maximum dose 200 mg/day) Thereafter, reduction of the clozapine dose resulted in a recurrence of the akathisia, and the resumption of clozapine dose was accompanied by full amelioration of symptoms. We suggest that the antiserotonergic properties of clozapine were responsible for its anti-akathisic effect. Differences in the treatment of acute and withdrawal types of akathisia are emphasized.

Adult↗
PubMed1996

A combined clinical approach to treating and understanding prolonged combat stress reaction.

Over the last decade combat stress reaction (CSR) has received increasing attention in Israel and abroad. The treatment of prolonged CSR is known to be complicated and unrewarding, and the majority of cases became chronic. The authors describe the difficulties of diagnosing delayed and prolonged CSR and present a model of combined treatment approach through a case study.

Adult↗
PubMed1995

First month of neuroleptic treatment in schizophrenia: only partial normalization of the late positive components of visual ERP.

In a previous study we recorded visual event-related potentials (ERP) in drug-naive schizophrenics during passive-attention and active-attention tasks. Patients, compared to normal controls, had much lower late positive components (LPC) in both sessions, but nearly normal LPC increase from passive to active task. The present sample consisted of drug-naive and drug-free patients who were tested before and during the first month of neuroleptic treatment. Neuroleptics initiated gradual amelioration of psychiatric symptoms expressed by reduced Brief Psychiatric Rating Scale (BPRS) scores. Schizophrenics compared to controls showed a session-related increase in LPC amplitude, but this process of LPC recovery was too minor to fully normalize the low LPC amplitudes in patients. Furthermore, the treatment either did not improve or even reduce the LPC reaction to the active-attention task. These findings indicate that normalization of low LPC in schizophrenia might require a long period of treatment, and that patients' reduced LPC reactivity to the task might be contributed, rather than treated, by neuroleptics.

Adult↗
PubMed1995

Cyproheptadine treatment in neuroleptic-induced akathisia.

BACKGROUND: Cyproheptadine, an antiserotonergic agent, was used to treat neuroleptic-induced akathisia. METHOD: In an open clinical trial 17 neuroleptic-treated patients with akathisia were administered cyproheptadine (16 mg/day) over 4 days. Assessment of akathisia, psychosis and depression were monitored by BAS, BPRS and HAM-D. RESULTS: All subjects showed improvement in the severity of akathisia, which in the majority (15/17) was of a marked degree. There was no aggravation of psychosis or depression. Symptoms of akathisia returned when cyproheptadine was discontinued. CONCLUSIONS: Cyproheptadine may be useful in neuroleptic-induced akathisia.

Akathisia, Drug-Induced↗
PubMed1994

T-cell subsets in acute psychotic schizophrenic patients.

Two-color flow cytometric analysis was performed on peripheral blood lymphocytes of 16 untreated schizophrenic patients during an acute psychotic attack and 16 healthy control subjects to evaluate differences in T-cell subpopulations. In schizophrenic patients, we observed decrease in CD4+ 2H4+ (suppressor-inducer) and CD8+ 2H4+ (suppressor-effector) T-cell subsets. The selective loss of 2H4+ cell markers both on helper and suppressor T cells was not correlated to the severity of the acute psychosis. Our results may indicate a mechanism of an immune disequilibrium in schizophrenic patients during an acute psychotic attack.

Acute Disease↗