Biomedical subjects

Marnina Swartz

Publications and source records attributed to Marnina Swartz.

6 recordsLinked to original sources

PubMed2005

Assessing cardiovascular risks of olanzapine treatment: a 6-month study versus haloperidol in schizophrenia patients.

The introduction of second generation antipsychotics (SGA) represents a major advance in the treatment of schizophrenia. Concerns about the metabolic and cardiovascular adverse effects of the SGA have been widely disseminated. The benefits and risks of these drugs have been studied with a focus on particular organ systems. A basic principle of prevention is that the intensity of risk-reduction therapy should be adjusted to a individual's absolute risk. Hence, the first step is to assess an individual's risk status. The present study was designed to evaluate whether there is an added cardiovascular disease (CVD) risk in switching schizophrenia patients from typical antipsychotics to the SGA olanzapine. Risk status was determined by a 10-year risk assessment as recommended by the USA National Heart, Lung, and Blood Institute. This was carried out with Framingham scoring to identify individuals whose short-term (10-year) risk warrants consideration of intensive treatment. This risk was calculated for schizophrenia patients who were treated by haloperidol for a minimum period of 6 months and again following 6 months of exposure to olanzapine. Forty-three patients fulfilled inclusion criteria. There were 25 male and 18 female patients (mean age 40.7+/-2.4 years). The mean 10-year percentage risk of CVD for the group while on haloperidol treatment was 4.58+/-0.9 and, after 6 months of exposure to olanzapine, this was reduced to 4.12+/-0.9. Changes in the total risk and each evaluated risk variable were not statistically significant, except for a decrease in resting systolic blood pressure. Switching schizophrenia patients from typical antipsychotic treatment to olanzapine is safe and does not increase the long-term risk of cardiovascular disease.

Adult↗

PubMed2005

Increased risk of attempted suicide among aging holocaust survivors.

OBJECTIVE: Suicide rates are higher in elderly persons than in those at other phase of the life-cycle. The majority of World War II (WWII) veterans and Holocaust survivors still define their war experiences as being the "most significant stressor" of their lives. Aging of survivors is frequently associated with depression, reactivation of traumatic syndromes, physical disorders, loss, and psychological distress, possibly increasing the risk of suicide. The aim of the present study was to investigate, among a large cohort of elderly Holocaust survivors, whether their WWII experiences confer an increased risk of suicidal behavior. METHODS: All medical records of elderly patients admitted to a psychiatric hospital in Israel during a 5-year period were retrospectively evaluated. Suicidal patients were compared with patients who had not attempted suicide. RESULTS: Of 921 eligible patients, 374 were Holocaust survivors; 135 (14.6%) had attempted suicide in the month before admission. Ninety Holocaust survivors (24%) had attempted suicide, versus 45 of the 502 patients (8.2%) with no WWII experience. The risk of attempted suicide among Holocaust survivors was significantly increased. CONCLUSION: Although these findings are from a highly selected sample, we suggest that aging Holocaust survivors are at increased risk of attempting suicide. The growth of the elderly population, of whom many had had traumatic life experiences, emphasizes the need to implement preventive strategies so that suicidal risk may be contained.

Age Factors↗

PubMed2004

Patients' satisfaction with psychiatric inpatient care.

BACKGROUND: Patient satisfaction with medical treatment is important, and although in mental health the literature on the topic is scant, awareness of the issue is rapidly growing. AIM: Evaluation of patient satisfaction among hospitalized psychiatric patients. METHODS: 100 consenting patients (47 men and 53 women) were surveyed and completed a questionnaire regarding satisfaction with psychiatric care. SETTING: Fifty-nine percent of the patients were in a new modern building, 41% were in an older hospital building; 21% were in a psycho-geriatric ward. The various settings allowed comparison across different environments. RESULTS: Most participants expressed mild general satisfaction. The overall rating was 3.40 +/- 0.43 (range 1-5). The ratings were similar regarding the various components of treatment: satisfaction with the nursing staff, physical conditions on the ward and treatment per se. Positive correlation was found between satisfaction with nursing and overall ratings. CONCLUSION: Inpatients were mildly satisfied with treatment. However, no correlation was found between satisfaction and either the type of case manager or the physical conditions in the ward. Further research is needed to characterize specific variables that may influence patient satisfaction with psychiatric care. In addition, the question of whether self-report evaluation questionnaires are appropriate for the inpatient psychiatric population should be addressed.

Adult↗

PubMed2003

Age-related differences in the side effect profile of citalopram.

The authors evaluated the autonomic and cardiovascular side effects of citalopram with particular emphasis on their relation to the age of treated patients. The data that formed the basis for the U.S. Food and Drug Administration approval of citalopram were provided by Lundbeck (Copenhagen, Denmark). This database included placebo-controlled short- and long-term studies in major depressed patients. The list of side effects comprised all "heart rate and rhythm disorders" as well as "autonomic nervous system disorders" that had been reported by at least 5% more than that reported for the placebo group of subjects. The database encompassed 1344 subjects treated with citalopram (20-60 mg/day) for a period of no less than 6 weeks. Statistically significant age-related distribution was found for five side effects: bradycardia, nausea, diarrhea, sweating and headache. Bradycardia was more prevalent in elderly (>65 years) patients as compared to the younger population (2.4% vs. 0.2%, P<.05), whereas gastrointestinal side effects, sweating and headache were less prevalent in the elderly. The age-related differences in the side effect profile may be attributable to altered sensitivity of the serotonergic system.

Adolescent↗

PubMed2003

Aggression: the testosterone-serotonin link.

The relevance of central neurotransmission to aggressive and impulsive behavior has become more evident due to extensive research in humans and animals. Among other findings, there are abundant data relating low serotonergic activity--as measured by low cerebrospinal fluid 5-hydroxyindolacetic acid, and a blunted response of prolactin to fenfluramine--to impulsive behavior. Many studies on testosterone activity show a relation between high plasma levels and a tendency towards aggression. It is hypothesized that the interaction between low serotonin and high testosterone levels in the central nervous system has a significant effect on the neural mechanisms involved in the expression of aggressive behavior. It seems that testosterone modulates serotonergic receptor activity in a way that directly affects aggression, fear and anxiety. Our survey reviews the main findings on serotonin, testosterone and the possible interaction between them with regard to these behavioral phenomena.

Aggression↗

PubMed2002

Suicide in Israel: 1985-1997.

OBJECTIVE: To examine trends in suicide rates in Israel over a 13-year period. METHOD: All cases of autopsy-confirmed suicide in Israel from 1985 to 1997 were retrospectively reviewed. RESULTS: An overall annual increase in suicide rates, with rates in men 3 times higher than those in women, was observed. Suicide rates were highest in the second and third decades of life. Unlike Western countries where gunshot wounds are the most common method of suicide for men and poisoning is most common for women, asphyxiation by hanging was the most common method used by men in Israel, followed by firearm wounds and jumping from heights. In women, however, jumping from heights was the most common method, followed by hanging and poisoning. CONCLUSION: Increasing rates of suicide may be associated with waves of immigration to Israel, increased substance abuse and depression and the political and social climate. Further study to examine the precipitating factors is warranted.

Adolescent↗