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Biomedical subjects

J Zohar

Publications and source records attributed to J Zohar.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Brain imaging and its clinical application in psychiatry].

The common structural and functional brain imaging techniques are described from a practical, clinical point of view. The clinical indications for brain imaging in psychiatry are reviewed in relation to the specific limitations and advantages of each technique. The clinical applications of computerized tomography (CT), magnetic resonance imaging (MRI) and single photon emission computerized tomography (SPECT) are discussed in relation to the differential diagnosis between organic and functional psychiatric disorders. In a 55-year-old man with late onset of behavioral changes but without neurological signs the application of structural brain imaging (CT and MRI) in case management was demonstrated. The imaging findings involved the differential diagnosis between depression and focal brain lesions. In a 38-year-old man with personality changes and depression following a traumatic brain injury, time interval repeated functional brain imaging (SPECT) was used. Brain imaging reflected improvement in clinical status following treatment and was able to differentiate between reversible and permanent traumatic brain injuries. The superior yield of time interval repeated functional imaging in diagnosis and management of postconcussion syndrome is discussed.

Adult↗
PubMed1997

[The serotonin syndrome].

The frequent use of selective, serotonin reuptake inhibitors has increased the risk of the serotonin syndrome. This condition is related to stimulation of 5HT1A receptors and is characterized by agitation, confusion, tremor, fever and shivering. A 29-year-old woman and a 69-year-old man with the syndrome are reported. The importance of early diagnosis and treatment is emphasized, and aspects of the syndrome in patients with obsessive-compulsive disorder are presented.

Adult↗
PubMed1997

Emergence of kleptomania during treatment for depression with serotonin selective reuptake inhibitors.

Kleptomania, one of the rare impulse-control disorders, is characterized by an irresistible impulse to steal objects not needed for personal use or monetary value. There is a comorbidity between mood disorders, eating disorders, anxiety disorders, personality disorders, and kleptomania. Several recent case reports have suggested that serotonin reuptake inhibitors could be effective in the treatment of obsessive-compulsive spectrum disorders and specifically in kleptomania. We describe three depressed patients who paradoxically experienced kleptomanic behavior during treatment with serotonin selective reuptake inhibitors.

Aged↗
PubMed1997

A general hospital study of attempted suicide in adolescence: age and method of attempt.

Attempted suicide in adolescence is a major health problem and recent reports indicate a dramatic increase in the frequency of attempted and completed suicide among adolescents. The aim of this study was to evaluate the characteristics of adolescent admissions with attempted suicide in a large general hospital. The files of all children and adolescents admitted due to a suicide attempt between the years 1984 and 1994 were examined retrospectively, with regard to age, sex, method of attempt, season, year and length of hospitalization. Four hundred and four admissions with attempted suicide were recorded. The majority (83.7%) were females and drug overdose was the most common (92.8%) method used. Thirty patients (7.5%) repeated the attempt during the study period. No specific time of the year was associated with an increase in adolescent suicide attempt admissions. The most remarkable finding was that younger adolescents had a higher probability of performing a violent suicide attempt. Hypotheses for these trends are examined together with possible ramifications for treatment provision.

Adolescent↗
PubMed1997

Epidemiology of obsessive-compulsive disorder: a world view.

The worldwide prevalence of obsessive-compulsive disorder (OCD) is approximately 2% of the general population. Symptoms of OCD include fear of contamination by dirt or germs; constant checking; repetitive, intrusive thoughts of a somatic, aggressive, or sexual nature; extreme slowness; and an inordinate concern with orderliness and symmetry. Differential diagnosis is sometimes complicated by the overlap between OCD and obsessive-compulsive personality disorder (OCPD). The most common complication of OCD is depression. However, while both serotonergic and nonserotonergic antidepressants are effective in treating patients with depression, only serotonergic medications are effective in treating OCD patients. Because OCD patients often attempt to conceal their symptoms, it is incumbent on clinicians to screen for OCD in every mental status examination, since appropriate treatment can often result in improved quality of life.

Adult↗
PubMed1996

Alternation learning in obsessive-compulsive disorder.

The Wisconsin Card Sorting Test (WCST) and an alternation learning task were administered to 15 women with obsessive-compulsive disorder (OCD) and 15 age-, sex-, education-, and intelligence-matched healthy controls. OCD patients were significantly slower on the WCST as compared to the controls. Their performance on the alternation learning task was impaired relative to the control group, though this difference was diminished when we used education as a covariate. We found a significant positive correlation between performance on the alternation task and severity of symptoms in the OCD group. Performance of similar alternation tasks is impaired by damage to the orbitofrontal cortex in nonhuman primates. Therefore the data presented support the hypothesis of orbitofrontal cortex dysfunction in OCD.

Adult↗
PubMed1996

The pathogenesis and treatment of obsessive-compulsive disorder.

The outlook for patients with obsessive-compulsive disorder (OCD) began to change in the early 1980s with the introduction of clomipramine (CMI), a serotonergic antidepressant. The observation that only drugs with a serotonergic profile are effective in OCD has been the basis for the serotonergic hypothesis of OCD. The serotonin-selective reuptake inhibitors are effective alternatives for CMI and can be used when the patient cannot use or tolerate CMI. In this review, we examine the pathophysiology of OCD, based on drug response profile, peripheral markers of serotonergic function, pharmacologic challenge studies, and neuroimaging. We also consider the medications found to be effective in OCD, the length of treatment, with special regard for maintenance therapy, and such issues as the approach for the treatment-resistant patient, augmentation strategies, and nonpharmacological treatments.

Clinical Trials as Topic↗
PubMed1996

New developments in obsessive-compulsive disorder research: implications for clinical management.

Over the past decade, epidemiological, phenomenological, pharmacological, neurobiological, brain imaging and genetic research has contributed to a substantial change in our understanding of obsessive-compulsive disorder (OCD). Once regarded as a rare psychodynamic illness, OCD is now recognized as a common condition affecting 2-3% of the population. Better recognition combined with the demonstrated efficacy of serotonin reuptake inhibitors, such as clomipramine and the selective serotonin reuptake inhibitors (SSRIs), has dramatically improved the prognosis of this disorder, which exacts a considerable personal and economic burden. While the aetiology is still not understood, increasingly sophisticated research techniques are enabling us to begin to uncover the underlying pathophysiology of this illness. This paper reviews some of the recent developments which have enhanced our understanding of OCD and considers their potential impact on clinical management.

Evaluation Studies as Topic↗
PubMed1996

Paroxetine versus clomipramine in the treatment of obsessive-compulsive disorder. OCD Paroxetine Study Investigators.

BACKGROUND: The aim was to assess the effect of a flexible dose of paroxetine, compared with clomipramine and placebo, in obsessive-compulsive disorder (OCD). METHOD: In a multinational randomised study, 406 subjects with OCD of at least six months duration received double-blind medication for up to 12 weeks. Doses were adjusted according to therapeutic effect and side-effects. Primary efficacy measures were the Yale-Brown Obsessive-Compulsive Scale and the National Institute of Mental Health Obsessive-Compulsive Scale. Secondary efficacy measures were the Montgomery-Asberg Depression Rating Scale, Symptom Check-List (90), Clinical Global Impression, and Patients Global Evaluation. RESULTS: Paroxetine was significantly more effective than placebo, and of comparable efficacy to clomipramine. Paroxetine had significantly superior tolerability to clomipramine on three measures: CGI efficacy index, anticholinergic adverse events, and adverse events leading to withdrawal. CONCLUSION: Paroxetine is as effective as clomipramine in the treatment of OCD. The comparable efficacy and better tolerability of paroxetine suggest that it would be an appropriate treatment for OCD.

Adolescent↗
PubMed1996

Is caffeine involved in the pathogenesis of combat-stress reaction?

The role of caffeine in the pathogenesis of combat-stress reaction is discussed in light of the expanding literature on caffeine's influence on stress reactions in animals and in humans, and in regard to the two clinical entities concerning caffeine: caffeinism and caffeine withdrawal. It is proposed that caffeine is a contributing factor to the development of combat-stress reaction and that the use of decaffeinated coffee in military settings might reduce the prevalence of the various anxiety reactions, including combat-stress reaction.

Caffeine↗
PubMed1994

Olfactory sensitivity in major depressive disorder and obsessive compulsive disorder.

Olfactory sensitivity to two odorants, isoamyl acetate and androsterone, was assessed in 14 obsessive compulsive disorder (OCD) patients, nine major depressive disorder (MDD) patients, and 16 sex- and age-matched healthy controls. Tests were performed during a drug-free period, and 3 and 6 weeks after initiation of antidepressant drug therapy. No difference in olfactory sensitivity, to either odorant, was found between OCD patients and controls at any time. In MDD patients, a significant increase in the sensitivity to isoamyl acetate was observed 6 weeks after initiation of treatment, compared to controls.

Adult↗
PubMed1994

Compulsive exhibitionism successfully treated with fluvoxamine: a controlled case study.

BACKGROUND: Paraphilias are psychosexual disorders that are usually conceptualized as deviant in nature. Yet in some cases, paraphilia can be conceptualized as an obsessive compulsive disorder. METHOD: We describe an exhibitionist treated under partial single-blind conditions (patient was blind to placebo but was aware he was receiving desipramine and fluvoxamine) with the serotonin selective reuptake inhibitor fluvoxamine, followed by desipramine and a placebo that looked like fluvoxamine, in an ABACA design. He was serially assessed with the Yale-Brown Obsessive Compulsive Scale. RESULTS: Fluvoxamine eliminated the undesired impulse and behavior without affecting sexual desire. Desipramine and single-blind fluvoxamine-placebo treatment were both associated with relapses. CONCLUSION: A subset of paraphiliacs may be suffering from obsessive-compulsive-related disorders and may benefit from serotonergic agents.

Adult↗
PubMed1993

A double-blind, placebo-controlled study of fluoxetine in patients with DSM-III-R obsessive-compulsive disorder. The Lilly European OCD Study Group.

We have studied the effect of three fixed daily doses of fluoxetine in patients with obsessive-compulsive disorder (OCD) diagnosed according to DSM-III-R. Two hundred and fourteen patients were evaluated in an 8-week double blind, placebo-controlled study. A statistically significantly greater number of fluoxetine-treated patients achieved the prospectively defined criteria for clinical response when compared to placebo treatment. There was a statistically significant overall difference in the PGI rating of symptom change (P = 0.045) and a marginally significant difference (P = 0.089) in the CGI severity rating between groups. Pairwise comparison against placebo showed a marginally statistically significantly greater improvement (P = 0.059) in Y-BOCS-Total score for patients receiving fluoxetine 60 mg daily, and a significantly higher response rate in patients receiving fluoxetine 40 mg or 60 mg daily (P < 0.05). One hundred and sixty one patients continued to a 16-week extension evaluation. There was no significant difference in the rate of reporting of any individual adverse event between placebo and fluoxetine, and the rate of discontinuation due to adverse events was low (< 6% in each study phase). This study supports the growing evidence for the safety and efficacy of fluoxetine in the treatment of OCD.

Adolescent↗
PubMed1993

Emergence of depressive symptoms during treatment for panic disorder with specific 5-hydroxytryptophan reuptake inhibitors.

Selective serotonin reuptake inhibitors (SSRI) have been established as effective drugs in the treatment of depressive and anxiety disorders. However, there are also reports that they can induce depressive symptoms and suicidal thoughts in patients. Eighty of 230 patients who met the DSM-III-R criteria for panic disorder received, during the course of treatment, fluvoxamine (a selective serotonin reuptake inhibitor) at a dose level between 50-200 mg/day. The patients were clinically evaluated for a history of affective disorder and for the presence of affective symptoms before the treatment and for emergence of depressive symptoms during the treatment. Seven of the 80 patients (9%) developed symptoms of depression despite a good antianxiety response. Five of the 7 patients received fluvoxamine as second choice after tricyclic antidepressants (TCA). These patients had no history of affective disorder, and no symptoms of depression were present before the treatment with fluvoxamine. The depressive symptoms abated after the fluvoxamine was discontinued and TCA or clonazepam was prescribed. The depressive symptoms reappeared when fluoxetine was administered. None of these 7 patients developed depressive symptoms while treated with TCA or clonazepam. Among the 150 patients treated with TCA and benzodiazepines, not a single case of depression was seen in patients without a previous history of depression. These results suggest a vulnerability among some of panic disorder patients to noradrenergic-serotonergic imbalance caused by SSRI, which has to be taken into clinical consideration.

Adult↗