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Biomedical subjects

J Rabinowitz

Publications and source records attributed to J Rabinowitz.

At least 55 records · Page 3Linked to original sources
PubMed1997

Clinical pharmacology of filgrastim following high-dose chemotherapy and autologous bone marrow transplantation.

We evaluated the pharmacokinetics and pharmacodynamics of filgrastim during a Phase I study of this cytokine following high-dose chemotherapy and autologous bone marrow transplantation. Serum granulocyte colony-stimulating factor concentrations were determined by ELISA in 21 patients receiving 14-day continuous i.v. filgrastim infusions and 10 patients receiving daily 4-h infusions. Models were developed for filgrastim systemic clearance (Cls) by incorporation of receptor-binding theory. Mean plasma half-life (t1/2) in the 4-h infusion group was 197 min, and the volume of distribution approximated plasma volume. WBC counts transiently fell, then rebounded immediately postinfusion, which correlated with a delay in the disappearance of serum granulocyte colony-stimulating factor. The effect of WBC concentrations on filgrastim Cls was determined in patients receiving continuous infusions by segregation of study periods based on the presence of severe neutropenia. Clearance increased in all 14 patients receiving doses of 4-32 microgram/kg/day during WBC recovery. The effect of WBCs on Cls was described by a differential equation that included a static component and one component that varied with WBC concentration. These data suggest that currently used filgrastim dosing strategies following autologous bone marrow transplantation may be suboptimal.

Adult↗
PubMed1996

Effect of clozapine on physical and verbal aggression.

OBJECTIVE: The hypothesis that clozapine reduced serious physically and verbally aggressive behavior of persons with schizophrenia whose symptoms did not respond to typical neuroleptic treatment was tested. METHOD: Incident reports of aggression and restraint of 75 such inpatients were reviewed for 3 months before clozapine treatment and for 6 months of clozapine treatment. BPRS scores were also examined. Twenty-eight patients with no incidents were removed from study. RESULTS: There were significantly fewer incidents of physical aggression per month per patient on clozapine than before clozapine (mean +/- S.D. = 0.13 +/- 0.25 vs. 0.54 +/- 0.93; t = 3.4, df = 46, p < 0.002) and a similar decline in verbal aggression (0.21 +/- 0.31 vs. 0.73 +/- 0.83; t = 4.3, df = 46, p < 0.000). On clozapine, 49% (n = 23) of patients had fewer incidents of physical aggression, 36% (n = 17) showed no change and 15% (n = 7) showed more. Seventy percent (n = 33) of patients had fewer incidents of verbal aggression, 4% (n = 2) showed no change and 25% (n = 12) had more. During the 3 months before clozapine, 14 patients (30%) were restrained a total of 40 times. During the first 6 months of clozapine treatment, three patients (6%) were restrained a total of six times. There were significant decreases in BPRS hostility, positive, negative and psychosis scores. CONCLUSION: Clozapine appears to reduce serious aggression among some patients.

Adult↗
PubMed1996

Early biochemical signals arise from low affinity TCR-ligand reactions at the cell-cell interface.

The kinetics of acid release by a mixture of T cells and antigen presenting cells were measured with a microphysiometer during a brief exposure to antigenic peptides. We find that some of the early biochemical events that lead to cellular proliferation cause a specific increase in the rate of acid release. The duration of this increase in acid release reflects the life-time of the peptide-MHC complexes. Peptides that form long-lived complexes produce a response that is stable for more than an hour. Serial TCR engagement is suggested by the observation that the amplitude of this stable response can be rapidly shifted up or down with additional agonist peptide or with antibodies that block T cell receptor binding. Cells briefly exposed to a peptide that forms short-lived peptide-MHC complexes produce a response that decays rapidly as peptide is washed away. A quantitative analysis of the kinetics of this decay in acidification demonstrates that intercellular TCR-ligand reactions are rapid, reversible, and of low apparent affinity with < 20% of peptide-MHC ligand bound to a TCR at any one time. These results demonstrate that the fraction of peptide-MHC ligands bound to TCRs at the cell-cell interface is no higher than anticipated from the affinities observed in solution for isolated TCRs and ligands.

Amino Acid Sequence↗
PubMed1996

Reported comorbidity of mental disorders with substance abuse among psychiatric inpatients in Israel.

In preparation for shifting of care from psychiatric hospital to the community, the prevalence of substance abuse comorbidity among discharged psychiatric patients was studied. Such patients are not usually treated by substance abuse programs or mental health clinics. Data from the Israeli National Psychiatric Case Registry were analyzed on reported substance abuse among all 53,379 psychiatric discharges during 1989-92. The Registry consists of data that physicians are mandated to report on all patients. The authors found that reported substance abuse comorbidity was 13.2% for males and 3.6% for females. Patients with a diagnosis of personality disorder had the most reported substance abuse. Reported drug abuse for males increased with age until age 45, and alcohol abuse until age 65. Drug and alcohol abuse by females is the highest for the patients under age 24 and declines with an increase in age. The results were almost identical for each of the four years studied. The results suggest that developing special outpatient facilities to serve this group will be impractical because of the small numbers. Ways of serving these patients in existing community mental health centers are discussed.

Adolescent↗
PubMed1996

Primary health care physicians' treatment of psychosocial problems: implications for social work.

This study explores the extent to which primary care physicians serve as gatekeepers for the treatment of psychosocial problems and the extent to which they have contact with social workers. We also attempted to identify physician variables related to gatekeeping and amount of contact with social workers. Data from a national study of the role of primary care physicians in Israel were used. About one-third of the physicians had regular contact with social workers, one-quarter had contact less often, and about one-third almost never had contact. Variables associated with gatekeeping for psychosocial problems included having a large caseload, specializing in family medicine, practicing in a rural location, and being under age 55. Variables associated with social work contact were affiliation with the largest health maintenance organization and specialization in family medicine.

Adolescent↗
PubMed1996

Patterns of use and changes in diagnosis during first admission. National Case Register Study.

The goal of this study was to describe patterns of diagnosis and to explore the extent to which diagnosis changes during first-in-life psychiatric admissions. All 2,998 first admissions to Israeli psychiatric wards in 1989 were studied. Diagnosis did not change in at least 60% of the cases. Diagnoses in order of stability were: mental retardation (84%), substance abuse (82%), organic conditions (77.5%), neurotic (75%), schizophrenia (74%), personality disorders (73%), affective (68%), childhood (55%), paranoid (45%) and V-codes (22%). There was less change in diagnosis for patients over 45 (37.5%), than for patients aged 19-44 (43.2%) and 15-18 (57.8%). Diagnoses assigned at admission to first hospitalization are not likely to change during that hospitalization.

Adolescent↗
PubMed1995

Predicting revolving-door patients in a 9-year national sample.

We attempted to predict revolving door (RD) patterns of admission (four or more admissions with less than 2.5 years between consecutive admissions) in a random sample of 10% of all first admissions to psychiatric hospitals and psychiatric wards of general hospitals in Israel from 1983 to 1990 with follow-up into 1993. This included 4570 hospitalizations of 2220 patients. Data were extracted from the National Psychiatric Case Registry of the Ministry of Health. Almost 59% of the sample had only one admission, 41% had two or more, 23% had three or more, and 14% had four or more admissions. Patients with four or more admissions were all RD patients. They had an average of 200 days between admissions. The average number of admissions for RD patients was 6.17, and the average number of years between the first admission and the last admission was 3.28 years. Using discriminant analysis we correctly predicted 73.9% of the non-RD group (about chance level since 80% of the cases were non-RD) and 71.2% of the RD group (considerably better than chance, only 12.0% of the sample were RD). The main predictors of RD in descending order were not being married at the time of first hospitalization, unemployment and more severe initial diagnosis. The minor predictors were older age, more education and longer first admission. Substance abuse, patients ability to care for their affairs, voluntary status of first admission and suicide attempts did not predict RD.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Detecting psychological distress among patients attending secondary health care clinics. Self-report and physician rating.

A study was conducted to determine the prevalence of psychological distress, as reported by patients and their physicians, in orthopedic, neurology, dermatology, and ophthalmology clinics; to study their accuracy in detecting psychological distress; and to determine if there is any connection among psychological distress, accuracy of detecting distress, and use of mental health and primary health care physicians' prognosis for the somatic complaints. Five hundred and fifty-six patients, ages 18-21, responded to the Psychiatric Epidemiology Research Interview Demoralization Scale (PERI-D), a measure of psychological distress, and to questions about their mental health and use of mental health and primary health services. Physicians, who were blind to patients' responses, were asked to what extent they thought the cause of patients' complaints was physical and to what extent they thought it was psychological in nature, and to prognosticate. Based on the PERI-D, about 25% of patients were distressed, this was less for females than males and varied between clinics. Based on self-reporting, about 14% of patients (males and females) were distressed. Based on physician reporting, about 17% (males less) were distressed. Physicians identified 35% of the PERI-D-distressed cases and 79% of nondistressed cases. About 66% of patients identified their distress and 83% their lack of distress. Increased use of primary health care and mental health care was related to distress. The prognosis was negatively related to distress. Based on this study, there is a need for more attention to psychological distress among secondary health care patients. Patients' ability to identify their distress suggests the importance of involving the patient in the diagnostic process. Correct detection of distress alone does not appear to decrease the use of primary medical and mental health services.

Adolescent↗
PubMed1995

A method for understanding admission decision making in a psychiatric emergency room.

OBJECTIVE: To increase understanding of decisions about inpatient admission, a four-step algorithm was used to examine 2,073 consecutive visits to a public hospital psychiatric emergency room, 684 of which resulted in admission. METHODS: Admission decision outcomes and patient data were cross-tabulated to identify conditions, or rules, under which outcome was almost certain. Discriminant function models were then made of individual clinicians' decision-making process and of individual diagnostic groups. To understand cases not covered in previous steps, a third discriminant function model was constructed. RESULTS: The four-step method successfully predicted outcomes in 85 percent of cases at a minimum of an 80 percent confidence level. The variables of psychosis and violence combined into the most powerful predictor of admission. Twelve rules that applied to 41.4 percent of all cases were found. Eleven models of individual clinicians' decision policies applied to slightly more half of all cases and successfully classified about 95 percent of them. Eleven models of diagnostic groups applied to 93.2 percent of all cases and correctly predicted about 75 percent. The final discriminant model for the 171 cases not covered by the by the first three steps correctly classified about 90 percent of residual cass. CONCLUSIONS: Psychiatric admission decisions are influenced by multiple variables that should be studied by examining general admission criteria and differences between clinicians.

Adolescent↗
PubMed1995

Factors influencing disposition decisions for patients seen in a psychiatric emergency service.

OBJECTIVE: The study examined factors influencing clinicians' decisions about disposition of patients seen in a psychiatric emergency service. METHODS: A stratified random unduplicated retrospective sample of 378 patient records was drawn from the records of 1,823 patients who visited the emergency service of an acute care psychiatric hospital in Israel during a seven-month period. Patients were selected from each of the following dispositions: not admitted (N = 96), discharged after brief observation in the emergency service (N = 90), admitted to a open unit (N = 104), and admitted to a locked unit (N = 88). Data on demographic and clinical characteristics of patients and on some clinician and system variables were analyzed using univariate statistical techniques and stepwise logistic regression. RESULTS: Patients were more likely to be admitted if they were judged by clinicians to be suicidal, had more than three previous hospitalizations, were psychotic, had suicidal behavior as the presenting complaint, and were brought to the hospital involuntarily. Variables favoring assignment to a locked unit were age between 20 and 30, dangerousness to self or others, male gender, and a low Global Assessment of Functioning score. CONCLUSIONS: Patients' level of psychopathology and dangerousness were the primary factors influencing clinicians' decisions about disposition of patients from the emergency service.

Adult↗
PubMed1995

Effects of psychosocial rehabilitation for hospitalized mentally ill homeless persons.

The effectiveness of a psychosocial rehabilitation program in preventing further hospitalization among a group of hospitalized severely mentally ill homeless persons in Israel was evaluated. The program includes inpatient and community residential phases designed to help the participants gradually become more independent. All clients (N = 98) discharged from the inpatient phases to supervised or independent community residences since 1982 were followed until December 31, 1992, to determine changes in hospitalization rates. The average follow-up time was six years. The percentage of time clients were hospitalized dropped from 64.9 percent before discharge to the community residences to 12 percent between discharge and follow-up.

Adaptation, Psychological↗
PubMed1995

Effectiveness of clozapine in hospitalised people with chronic neuroleptic-resistant schizophrenia.

BACKGROUND: Clozapine's effectiveness in reducing symptoms and facilitating discharge among patients with chronic schizophrenia who were resistant to neuroleptics was studied. METHOD: All 169 such patients in a public psychiatric hospital were given clozapine. BPRS ratings (0-5 scale) were completed before treatment and 21 months later. Patients were followed for about 2.5 years. RESULTS: Clozapine was discontinued in 37.8% of cases due to non-compliance, non-response, or side-effects. At follow-up 41% of clozapine recipients and 25.9% of the drop-outs were discharged and remained so, and 33% of recipients and 24.1% of drop-outs were being prepared for discharge. Longer treatment was associated with more improvement. Decline in average BPRS total scores of recipients was significantly more than drop-outs (32.7, s.d. 16.8 v. 12.1, s.d. 14.1, d.f. = 155, t = 7.5, P = 0.000). CONCLUSIONS: Clozapine appears to be effective for treating some chronic neuroleptic nonresponding schizophrenic patients.

Adolescent↗
PubMed1995

Pain complaints and psychological distress among soldiers in specialty military medical clinics.

PURPOSE: This paper explores: (1) the relationship of pain complaints and psychological distress among orthopedic, dermatology, ophthalmology, and neurology outpatients, (2) the ability of patients with pain complaints and their physicians to detect patients' psychological distress, and (3) the connection between type of pain, prognosis as rated by physician, and patient's use of military primary health care and mental health treatment. METHOD: Five hundred fifty-six soldiers in compulsory service in the Israel Defence Forces, ages 18 to 21, responded to the PERI-D (Psychiatric Epidemiological Research Interview Demoralization Scale), a measure of psychological distress, and questions about presenting medical complaint and use of mental health and primary health services. Military specialist physicians, who were blind to patients' responses, were asked the extent to which they thought that the cause of the patients' complaints were physical or psychological and to prognosticate. RESULTS: Almost 47% of soldiers attended clinics due to pain. In descending order were limb pain (42.5%), headache (29.1%), lower-back pain (24.5%), and right arm pain (3.8%). Right arm complainers were the most distressed and the heaviest users of primary health care and got the lowest prognosis, yet the physicians did not detect any psychological distress in this group. The least distressed and lowest users of medical services were patients with limb pain. There was a positive linear relationship between psychological distress and use of primary health care. There was a negative linear relationship between distress and prognosis. The patients' ability to detect psychological distress was better than that of the physicians. Physicians tended to find more cases of psychological distress than did the PERI-D in lower-back pain and limb pain patients. Psychologically distressed headache and limb pain patients reported using significantly more primary health care than non-distressed patients with similar pain complaints. CONCLUSIONS: Special attention to psychological distress among pain complainers in military secondary health care clinics is needed. Such attention may reduce the use of primary health care and may have implications for improving prognoses.

Adolescent↗
PubMed1995

Differential use of admission status in a psychiatric emergency room.

The goal of this study is to understand how different admission statuses of varying degrees of restrictiveness (informal, voluntary, emergency admission, and involuntary admission on medical certification) are used in the psychiatric emergency room. The study included 656 consecutively admitted patients from a psychiatric emergency room over 28 months. Data were analyzed univariately and using two discriminant function models. Only six (0.9%) patients were informal admissions. Voluntary admissions (24.9%, n = 163) tended to be for patients with affective disorders, those who were self-referred, suicidal risks, those who had a marital or family problem, and those who were over age 60. Nonvoluntary admissions (74.2%) tended to be for patients with schizophreniform symptoms and those referred by police or court. Involuntary admission on medical certification (53.2%, n = 349) tended to be for patients who were family referred, younger than 20 years old, had social interpersonal nonfamily stressors, were suicidal risks, were or had been married, had organic psychotic disorder, history of violence, and manic episode or schizophrenia. Emergency admission patients (21%, n = 138) were characterized by being between 40 to 50 years old, having a diagnosis of psychoactive substance abuse, having previous outpatient treatment, and having been referred by emergency service. The major difference between involuntary admissions and voluntary was that the former were more often actively psychotic or referred by police or court. The major difference between emergency admission and involuntary admission on medical certification seemed to be that patients with a more available support system, whose primary diagnoses was not substance abuse and who were suicidal, were preferred for involuntary admission on medical certification.

Adolescent↗
PubMed1994

Understanding who improves after psychiatric hospitalization.

This study attempts to identify variables associated with improved functioning after psychiatric hospitalization. The relationship between 25 clinical and demographic variables and improvements and functioning at discharge of 309 consecutive patients in an open ward over 2 years were studied using stepwise logistic regression. Measures of patients functioning at discharge were score above or below 50 on the (Global Assessment of Functioning scale) (GAF) and 3-point scale of functioning 1 week after discharge (needs constant supervision, functions independently at home, functions on the job). We created a logistic regression model of outcome based on the information available at admission and one based also on information at time of discharge (i.e., medication, therapy and length of stay etc.). Discharge models predicted 6-10% better than admission models. Discharge models correctly predicted whether GAF level was above 50 in 72% of the cases and return to preadmission functioning in 71% of the cases. We also created a model of functioning at discharge using a hierarchical logistic regression model. It correctly predicted 74% of the lowest level of functioning, 47% of the middle level and 68% of the highest level. The best predictors of improved functioning after discharge were preadmission levels of functioning, psychotherapy in hospital, absence of organic brain syndrome, attendance at occupational therapy and hospitalization less than 4 months. Diagnosis had almost no discernible effect on outcome of hospitalization.

Activities of Daily Living↗
PubMed1994

Guide to identifying and correcting decision making errors in mental disability practice.

Presented is a practical and theoretical guide to help practitioners identify and alleviate decision making errors. Common decision making and judgment errors are inventoried and presented as deviations from the scientific method. Also presented is evidence of judgmental inaccuracies in critical areas. A modus operandi called the "lab report" method is offered as a way to avoid making some of these errors. The lab report method is a way of conducting forensic evaluations in a more rational and scientific way, in much the same way as a good researcher would conduct a study. Using this method the clinician, like the researcher, uses clearly articulated alternative hypotheses with specifically operationalized measures. Data are collected in a systematic way to test each hypothesis, and consistent feedback is sought. Throughout the paper the scientific method is reviewed; evidence of problems applying it in clinical practice are presented, as are ways of overcoming these problems.

Dangerous Behavior↗
PubMed1994

Elevated endogenous serum macrophage colony-stimulating factor in the early stage of fungemia following bone marrow transplantation.

Murine studies have reported elevated serum macrophage colony-stimulating factor (M-CSF) concentrations in animals inoculated with fungus; however, the human cytokine response to fungemia has not been described. Endogenous M-CSF serum concentrations were measured in 18 autologous bone marrow transplant patients with positive blood fungal cultures. Seventeen of the 18 patients received the same high-dose chemotherapy regimen with autologous hematopoietic support. M-CSF concentrations were determined in serum samples obtained 1 week before and within 2 days of the first positive blood culture. Serum M-CSF rose more than three-fold in a majority of patients at the time of positive culture in contrast to concentrations obtained in the previous week (medians 11.1 and 2.8 ng/mL, respectively; p = 0.001). Median values at the time of positive blood culture were also significantly higher than those obtained in a matched control group of patients without positive blood cultures (n = 18; median 2.60 ng/mL; p = 0.001). These data demonstrate that endogenous serum M-CSF is elevated in the early stages of human systemic fungal infection and thus may have important diagnostic and therapeutic implications.

Adult↗