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Biomedical subjects

M Gelkopf

Publications and source records attributed to M Gelkopf.

At least 19 recordsLinked to original sources
PubMed2001

A naturalistic study on ending blind dosing in a methadone maintenance clinic in Israel.

Since many methadone maintenance treatment (MMT) clinics in the United States do not share with patients, information concerning their methadone dosage, we aimed to investigate the impact of patients being informed of their methadone dosage and the influence of ending blind dosing on treatment outcome. Seventy-four patients who were unaware of their methadone dosage took part in this study. We compared changes in opiate abuse, levels of methadone dosage and patients' perceptions of dosage adequacy before and after they were informed of their dosage. Data on opiate abuse were based upon bi-weekly randomly taken and observed urine tests provided the data on opiate abuse. Records on methadone dosage were kept and a short questionnaire on dosage-related attitudes, devised for this study, was administered. Most patients expressed the desire to know their dosage, but there were no significant changes in opiate abuse, methadone dosage or the patients' perceptions of dosage adequacy after they knew what it was. We conclude that informing patients of their methadone dosage and thereby ending blind dosing does not seem to have any negative effect on treatment outcomes. We believe that this policy is in accord with the patients' rights and expressed will to know their dosage and this justifies putting an end to blind dosing policies.

Chi-Square Distribution↗
PubMed2000

LSD-induced hallucinogen persisting perception disorder treatment with clonidine: an open pilot study.

A pilot open study was conducted in order to evaluate the efficacy of clonidine in the treatment of LSD-induced hallucinogen persisting perception disorder (HPPD). Eight patients fulfilled entrance criteria. All complained of HPPD for at least 3 months and were drug free at least 3 months. They received fixed low doses of clonidine, 0.025 mg, three times a day for 2 months. They were evaluated by the Clinical Global Impression Scale (CGI) and a self-report scale on the severity of symptoms (graded 0-5). Patients scored an average of 5.25 (SD = 0.46) on the CGI and 4 on the self-report scale at baseline, indicating marked psychopathology. One patient dropped out at week 3 and a second patient dropped out at week 5. Of the six patients remaining at the end of 2 months, the average CGI score was 2.5 (SD = 0.55) and the self-report scale score was 2, indicating mild symptomatology. LSD-related flashbacks associated with excessive sympathetic nervous activity may be alleviated with clonidine in some patients.

Adrenergic alpha-Agonists↗
PubMed1999

Characteristics of benzodiazepine abuse in methadone maintenance treatment patients: a 1 year prospective study in an Israeli clinic.

We aimed to study the prevalence patterns and course of benzodiazepine (BZD) abuse in an Israeli methadone maintenance (MMT) clinic using repeated random observed urine analysis as well as self-report data. Lifetime and current prevalence of BZD abuse were found in 66.3 and 50.8% patients, respectively. It was found that 44.6% of patients who abused BZDs during their first month of treatment ceased to do so after 1 year, while 27.4% who had not abused BZDs at the beginning of MMT did so after 1 year in treatment. Flunitrazepam was the most commonly abused BZD (92.9%), followed by diazepam (54.3%) and oxazepam (38.6%). Most of the patients swallowed BZDs (92.8%), 42.9% also smoked or snorted them while 8.6% injected BZDs intravenously. BZDs were used as self-medication for alleviating emotional problems rather than for recreational or other reasons. We conclude that BZD abuse is a significant clinical problem in heroin addicts both before entering and during MMT. MMT may have a positive as well as a negative influence on BZD abuse with the former being more prevalent.

Adult↗
PubMed1999

Correlates of benzodiazepine abuse in methadone maintenance treatment. A 1 year prospective study in an Israeli clinic.

AIMS: This study addressed the following questions for patients after 1 year of methadone maintenance treatment (MMT); (1) What are the demographic features and past history of drug use of benzodiazepine (BZD) abusers? (2) Do BZD abusers abuse more heroin, cocaine and/or cannabis and do they receive a higher methadone dosage level? (3) Do BZD abusers suffer more from hepatitis C (HCV) and do they have more HIV/HCV risk-taking behaviors than non-abusers? (4) Do BZD abusers have more psychopathology and more emotional distress than non-abusers? DESIGN: All 148 patients who completed 1 year of MMT underwent random and twice-weekly observed urine analysis for various drugs of abuse, responded to self-report questionnaires (SCL-90-R; POMS; HIV/HCV risk-taking behaviors), interviews (ASI) and underwent testing for hepatitis C. Abuse in this study is defined as any use during the 12th month of treatment. FINDINGS: After 1 year of MMT, more BZD abusers (n = 63) were single, had spent time in prison, were unemployed and had at least one parent with an addiction problem or mental illness in comparison to non-abusers (n = 85). They had started using heroin and cocaine earlier and currently abused more cocaine, heroin and cannabis. They had significantly more psychopathology and negative mood. They had significantly more HCV and reported more HIV/HCV risk-taking behavior. IMPLICATIONS: We suggest that this group of patients is in need of more intensive pharmacological and psychological treatment.

Adult↗
PubMed1998

Patient outcomes after initiation of Sabbath closure of a methadone maintenance clinic in Israel.

The study examined whether closing of a methadone maintenance clinic in Israel on the Sabbath was associated with adverse patient outcomes. One take-home dose of methadone was given to all patients for that day regardless of whether they had earned take-home privileges. No difference was found in dropout rates for the six-month periods before and after Saturday closure was initiated. Results of random, twice-weekly urinalyses for all patients did not indicate increased use of heroin. The findings suggest that closure of a methadone clinic at least one day a week does not jeopardize patient outcome. Cutting hours of operation would reduce workload and enable clinics to function more economically.

Adult↗
PubMed1995

Hospital at war: treatment changes in mental patients.

The implications of the chemical war threat and the missile attacks during the Gulf War for a medium-sized psychiatric community are analyzed in terms of psychiatric care and management. Changes in medication, physical restraint, and ward transfer were observed for schizophrenic patients in active psychotic phase (n=50), in residual post-active phase (n = 37), and patients with long-term residual type (n = 167). The variables for the first week of the war (n = 250) were compared to those the same week 1 year before (n = 254). Patients in active phase and patients in residual phase received more supplementary treatment and radical changes in treatment; patients in active phase received more treatment reinforcement, as well as physical restraint, compared to patients in phase and residual type patients. Residual type patients remained unchanged on all variables. Residual type patients remained mostly indifferent, while many severely disturbed patients residing in open wards required only minor tranquilizers. Patients in active phase tended to behave very erratically while denying being affected by the war, and patients in residual phase overtly expressed their anxiety and remained in control.

Adult↗
PubMed1995

Partial insanity: when the judiciary and the psychiatric world collide.

The psychiatric and judicial concepts of mental disorders are similar but not always identical. The gap between them creates confusion, a lack of unity and inconsistencies in decision making. This gap needs to be bridged. In the hinterland of these concepts lies a range of psychiatric disturbances such as encapsulated over organized delusional disorders (Paranoia Vera) and life endangering eating disorders (Anorexia Nervosa). When life threatening or criminal responsibility circumstances arise, the dilemma presented to the psychiatrists on the one hand and the judicial system on the other reaches its peak. Presented in the article are aspects of the gray areas of involuntary commitment and criminal responsibility.

Adult↗
PubMed1994

Therapeutic use of humor to improve social support in an institutionalized schizophrenic inpatient community.

We attempted to use passive communal laughter to improve social support within a chronic schizophrenic inpatient population. Two identical wards were compared on classical measures of social support (emotional and functional), social network (size and dispersion), satisfaction, and the nature of the social relationships (source). The experimental group was exposed to video projection of humorous movies four times daily for 3 months, and the control group to video projections of other, assorted movies at the same rate. In the experimental ward a significant improvement was manifest in the category of "distinct individuals supporting each patient." The difference may have been due to an improvement in the relationship with the staff. No improvement was found on any of the other measures. We concluded that the positive atmosphere that humor creates affects the therapeutic alliance between staff and patients but does not affect other social networks because of the regressed nature of the schizophrenics' social relationships.

Adult↗
PubMed1993

Insanity and war: the Gulf War and a psychiatric institution.

The threat of a chemical war has profound impacts on all layers of society. Hospitalized mental patients, as we have observed them, react in more extreme ways than staff members. They may react overanxiously, totally apathetically, or in context-related flights to partial sanity. Denial and projection were heavily used defense mechanisms together with a tendency of the more acute patients to plunge into their bizarre idiosyncratic world, lending strange meanings to what was happening in the world. Many patients were found to have strong narcissistic traits and to invest most of their libidinal energies in their private world. In times of stress this results in even greater social isolation. Different types of patients in different phases of their illness react differently to such overpowering stress, and the way they react illustrates their cognitive, behavioral, and social deficiencies. WWII literature on the reactions of mentally ill patients to "fly-bombing" seem not to take into consideration the different possible reactions of patients. This may be due to a change in emphasis in the care of mentally disturbed individuals in the last two decades. We propose to use even such an extremely stressful situation as a challenge to the mental health profession to further the well-being of their patients.

Adaptation, Psychological↗
PubMed1993

Laughter in a psychiatric ward. Somatic, emotional, social, and clinical influences on schizophrenic patients.

The study was designed to explore the potential therapeutic effects of humor on hospitalized schizophrenics. For this purpose, in the first stage, we conducted a review of findings in regard to physical health, emotions, psychiatric state, and social behavior. In the second stage, we carried out an experiment with 34 resident patients in two chronic schizophrenic wards who were exposed to 70 movies during 3 months. The experimental group was exposed to humorous movies only, and the control group to different kinds of movies. Before and after the exposure to films for 3 months, both groups were tested on different health, emotional, social, and clinical measures using the Cognitive Orientation of Health Questionnaire, the Shalvata Symptom Rating Scale, blood pressure, heart rate, Perceived Verbal and Motor Aggression (rated by nurses), the Multiple Affect Adjective Check List, the Social Support Questionnaire 6, and the Brief Psychiatric Rating Scale (BPRS; rated by psychiatrists). Covariance analyses yielded significant reductions in Perceived Verbal Hostility, BPRS scales (total score, anxiety/depression), and significant increases in BPRS (activation) and degree of staff support experienced by the patients. The results indicate that the effects of exposure to humor may be mediated by the effects on the staff of the incidental exposure to humorous films.

Adult↗
PubMed1992

Short term versus long term psychotherapy in opioid dependence: a pilot study.

A multicenter prospective open study was performed in order to compare the effectiveness of 2 modalities of individual dynamic psychotherapy in a group of recently detoxified opioid dependent patients. Thirty four patients were assigned to receive either short-term dynamic psychotherapy (ST) or long-term dynamic psychotherapy (LT); both modalities were offered along with drug counselling. At the end of the treatment, the short term therapy group was followed up for 2 years, while the long term therapy group continued the follow up for one year, due to the different time span of the treatment approaches. Dropout rates for ST (47%) and LT (53%) patients were similar, and the re-entry rate for the ST group was superior (62.5% vs. 28.5%). Short term interventions appear to be at least as effective as long term interventions, and have the advantage of a high rate of program re-entry. Further studies conducted on larger samples are needed.

Adult↗
PubMed1992

A naltrexone double blind placebo controlled study in Israel.

In a double blind study, out of 31 newly abstinent patients who underwent opioid free detoxification, 15 were started on the opiate antagonist Naltrexone for 2 months, and 16 were put on placebo for the same period. Given Naltrexone's known efficacy in blocking euphorigenic effects of opioid intake, and in decreasing cravings for the drug, the authors have tried to assess eventual drug taking, specifically in the context of suburban housing projects, and evaluate the rate of retention in a rehabilitative program for both the Naltrexone and placebo groups. An Opioid free condition was followed up for a year, also respecting double blind conditions. Naltrexone did not appear to be superior to the placebo with regards to retention rate. In the Naltrexone group (n = 15), 9 finished the two-month treatment, and 8 remained opioid-free for a year. In the placebo group (n = 16), 8 finished the 2 month trial and 6 remained opioid-free for a year. Naltrexone blocked opioid-induced euphoria and decreased the craving for opium, but it did not inhibit drug usage. The retention rate registered during the course of the study, as well as an opioid-free condition in the follow-up year, correlated with a patient profile defined by good social functioning and stable relationships. The inherent methodological limitations of this study did not allow for the discrimination of the role of non-pharmacological factors, such as psychotherapy, supportive family framework, community assistance, and staff motivation, concerning the clinical results. Further investigation of Naltrexone in larger samples is needed.

Adult↗
PubMed1991

[Munchausen syndrome: need for centralized administrative health-care management].

The clinical picture of Munchausen syndrome is that of feigned or self-induced illness with the aim of being hospitalized and/or receiving unnecessary medical interventions, peregrination from 1 hospital to another, and disruptive behavior when hospitalized. These patients are a danger to themselves and heavily burden inpatient facilities that care for them. We present a case that illustrates the problems of diagnosing and managing such patients. We stress the need for adequate centralization and distribution of the relevant information concerning these patients.

Adult↗