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Michael Ritsner

Publications and source records attributed to Michael Ritsner.

33 records · Page 2Linked to original sources
PubMed2003

Predicting changes in domain-specific quality of life of schizophrenia patients.

The author sought to determine domain-specific quality of life (QOL) changes over time and to identify predictors of change in life satisfaction among schizophrenia patients. He assessed 148 schizophrenia inpatients at admission and 16 months later. Multiple regression analysis identified predictors of domain-specific changes in QOL from changes in psychopathology, emotional distress, side effects, insight, and stress process-related factors ratings. On the group level, satisfaction with subjective feelings and leisure activities improved significantly during the follow-up period. Individual changes in specific QOL domains are influenced by different patterns of predictors that accounted for 12% to 36% of variance. Emotional distress, paranoid symptoms, side effects, and insight inversely associated with variability of scores in domain-specific QOL. Changes in self-efficacy, self-esteem, and support from others were positively correlated to improvement in QOL domain ratings. Schizophrenia patients may experience improvement in specific QOL domains. Changes in stress process-related factors are stronger predictors of fluctuations in QOL domains than changes in illness symptoms and should be considered when evaluating life satisfaction.

Activities of Daily Living↗
PubMed2003

Satisfaction with quality of life varies with temperament types of patients with schizophrenia.

We sought to explore the relationships of three temperament factors with domain-specific subjective quality of life (QOL) of patients with schizophrenia. Ninety patients with schizophrenia were evaluated using the Quality of Life Enjoyment and Life Satisfaction Questionnaire, the Tridimensional Personality Questionnaire, the Positive and Negative Syndromes Scale, the Distress Scale for Adverse Symptoms, the Insight and Treatment Attitudes Questionnaire, the Insight Self-Report Scale, and standardized questionnaires for self-reported emotional distress and stress process-related variables. Predictors of domain-specific QOL were identified using multiple regression techniques. Temperament factors explain 6% to 16% of variability in QOL domain scores among patients with schizophrenia after controlling for the remaining variables (emotional distress, social support, self-esteem, avoidance coping, age, side effects, and depression). We found that higher levels of novelty seeking are associated with better general QOL, physical health, and more positive subjective feelings, whereas higher levels of reward dependence are related to better satisfaction from social relationships. Higher levels of harm avoidance are associated with poorer satisfaction with general activities, and medication. Thus, temperament factors, as assessed by the Tridimensional Personality Questionnaire, substantially influence satisfaction with life quality in schizophrenia. Novelty seeking, reward dependence, and harm avoidance are associated with different domains of QOL.

Adult↗
PubMed2003

Predictors of quality of life in major psychoses: a naturalistic follow-up study.

BACKGROUND: Improved quality of life (QOL) of patients suffering from major psychoses has become an important treatment goal. We sought to determine predictors of perceived QOL and to explore the changes that occur regarding QOL among individuals with schizophrenia as compared to patients with schizoaffective/mood disorders. METHOD: In a naturalistic longitudinal design, 148 inpatients with schizophrenia and 51 inpatients with schizoaffective/mood disorders (DSM-IV) were tracked for 16 months (SD = 4.6 months). Subjects were assessed at 2 timepoints for psychopathology, stress process-related factors, and perceived QOL, as measured by the Quality of Life Enjoyment and Satisfaction Questionnaire. Predictors of fluctuations in QOL index scores during the follow-up period were identified using multiple regression techniques. RESULTS: We found that poor QOL is not a more severe problem for schizophrenia patients than for schizoaffective/mood disorder patients. Improved QOL of schizophrenia patients is associated with reduced paranoid and distress (obsessiveness, somatization) symptoms and increased self-efficacy and self-esteem ratings. Individual changes in QOL index scores among patients with schizoaffective/mood disorders are associated with changes in depression, sensitivity, expressed emotion, and task-oriented coping scores. CONCLUSION: Predictors of changes in satisfaction with life quality over time among schizophrenia patients are distinct from those associated with schizoaffective/mood disorders. Changes in stress process-related factors, rather than psychopathology, predict change in perceived QOL and should be considered when evaluating QOL outcomes.

Adaptation, Psychological↗
PubMed2003

The attribution of somatization in schizophrenia patients: a naturalistic follow-up study.

BACKGROUND: Knowledge is limited concerning somatic symptoms that cannot be accounted for by detectable somatic illness among schizophrenia patients. This study aimed to explore the prevalence, correlates, and predictors of somatization among schizophrenia patients. METHOD: Initial data on all consecutively admitted adult patients with DSM-IV schizophrenia, schizoaffective disorder, major depressive disorder, or bipolar disorder were collected between August 1998 and August 2000. Standardized measures of psychopathology, somatization, emotional distress, adverse effects, insight, and stress process-related (psychosocial) variables were administered to 237 schizophrenia patients at admission and at least 12 months thereafter (N = 148). Partial correlation and multiple regression analyses were performed. RESULTS: The frequency of somatization, defined as the presentation of 5 or more medically unexplained somatic symptoms (Somatic Symptom Index-5), among the inpatient population (27%) did not change significantly after at least 12 months (30%; p =.61). Regression analysis showed that somatization scores were best predicted by the combination of scores for emotional distress attributed to psychopathology and side effects, expressed emotion, and insight. This combined model explains at least 40% of the variance in somatization scores. Self-esteem and social support showed negative association with somatization scores. Somatization scores were not associated with gender, age, education, age at onset, observed severity of psychopathology, subtype and duration of illness, number of admissions and treatment settings, or type and dose of antipsychotic agents. CONCLUSIONS: Somatization is a prevalent problem among schizophrenia patients and is associated with emotional distress attributed to psychopathology, side effects of antipsychotic agents, and family members' attitudes toward schizophrenia patients. This study suggests that insight, self-esteem, and social support may protect against somatization in schizophrenia patients.

Adult↗
PubMed2002

An association of CAG repeats at the KCNN3 locus with symptom dimensions of schizophrenia.

BACKGROUND: In 1999 Cardno et al reported that long CAG repeats in the calcium-activated potassium channel gene hSKCa3/KCNN3 are associated with higher negative symptom dimension scores in schizophrenia patients. There has been no attempt to replicate the results. In this study, we investigated whether a symptom polymorphism of schizophrenia is associated with both the CAG repeat numbers and the difference in allele sizes. METHODS: We tested the association of CAG repeats with symptom models of schizophrenia in 117 unrelated Jewish patients. A multivariate analysis (MANOVA) of two models of schizophrenia with the repeat distribution and the difference in allele sizes was performed. RESULTS: We found a significant positive association of the number of CAG repeats with negative syndrome, anergia, activation, and paranoid symptoms. In addition, nonparanoid schizophrenia patients who had differences in allele sizes were characterized by earlier onset of illness. CONCLUSIONS: The study supports the hypothesis that the combined effect of long CAG repeats and the differences in allele sizes contribute to symptom expression of schizophrenia, particularly on the anergia-activation-paranoid axis.

Adolescent↗
PubMed2002

The impact of side-effects of antipsychotic agents on life satisfaction of schizophrenia patients: a naturalistic study.

This study compared the impact of side-effects of antipsychotic treatment, clinical and psychosocial factors on the subjective quality of life (QOL) of hospitalized patients. We surveyed 161 patients meeting DSM-IV criteria for schizophrenia stabilized on conventional and atypical antipsychotic drugs using standardized measures of adverse events, psychopathology, psychosocial variables, and perceived QOL. We found that patients with adverse events reported less satisfaction with life domains of subjective feelings and general activities than asymptomatic patients. Patients treated with conventional and novel antipsychotic agents had comparable QOL ratings. Multiple regression analysis showed total variance in QOL ratings as follows: psychosocial factors, 20.9%; clinical symptoms and associated distress, 10.1%; adverse effects, 3.2%. Thus, medication side-effects influence subjective quality of life of schizophrenia inpatients significantly less than other clinical and psychosocial factors. Patient's subjective response to these events rather than their number is more predictive of QOL.

Adult↗
PubMed2002

Schizophrenic patients who smoke have a faster finger tapping rate than non-smokers.

The increased rate of smoking in schizophrenia patients remains unexplained and may reflect attempts at self-treatment. The effect sought from smoking may be related to nicotine's stimulating action. We tested this hypothesis by examining the relationship between smoking status and finger tapping rate, a measure of central processing, in schizophrenia patients treated with atypical antipsychotics. Smokers showed significantly faster finger tapping rates than non-smokers. This was not related to clinical state, illness chronicity, medication side-effects, antipsychotic dose or plasma concentrations. Nicotine can improve central processing in medicated schizophrenia patients and this may constitute part of the incentive for smoking.

Adult↗
PubMed2002

Neural network identification of high-risk suicide patients.

BACKGROUND: A history of medically serious suicide attempts (MSSA) has been considered a major risk factor for suicide. Backpropagation (BP) neural networks (NN) successfully detected patient files of patients who had committed MSSA but failed to identify MSSA patients when trained with data collected during face-to-face interviews. PRIMARY OBJECTIVES: To develop an expert support system for the detection of suicide risk in patients with major psychiatric disorders using fuzzy adaptive learning control networks (FALCON) and BP enhanced with fuzzy logic neural networks. METHODS AND PROCEDURES: We used four types of input sets: (a) the most significant variables as defined by Garson's calculation of trained BP; (b) variables identified by logistic regression; (c) variables considered significant by experienced clinicians; or (d) the variables considered definitive by the computer programmer. In addition, the complete set of 59 input variables was used. The target variable was the existence of prior MSSA. EXPERIMENTAL INTERVENTIONS: Four training trials were performed with each input set (75% of the data was used for training and 25% for testing). Data was collected from 197 (50 MSSA, 147 non-MSSA) patients hospitalized at Sha'ar Menashe Mental Health Centre. MAIN OUTCOMES AND RESULTS: BP enhanced with fuzzy logic achieved the most accurate results with the three variables chosen by the programmer (mean +/- SD; sensitivity=97% +/- 3.4%, specificity=69.2% +/- 6.9%), and FALCON trained with 15 variables chosen by an expert clinician obtained the highest sensitivity and specificity (mean +/- SD; sensitivity=94% +/- 6.9%, specificity=69% +/- 6.9%). CONCLUSIONS: A combined system of BP enhanced with fuzzy logic and FALCON may improve the detection rate of MSSA patients during patient interviews. A prospective validation study testing a combined system across 1, 2 and 5-year spans may provide a reliable instrument to aid in the detection of suicide prone psychiatric patients.

Adult↗
PubMed2002

Fluvoxamine augmentation of olanzapine in chronic schizophrenia: pharmacokinetic interactions and clinical effects.

Olanzapine is a substrate of the cytochrome P450 enzyme (CYP) 1A2. In this study, pharmacokinetic interactions and clinical effects of adding the CYP1A2 inhibitor fluvoxamine to steady-state olanzapine was examined in patients suffering from schizophrenia. Eight patients had been treated for at least 3 months with 10 to 20 mg/day olanzapine. Fluvoxamine (100 mg/day) was added (week 0) to the olanzapine treatment and continued for 8 weeks. Concentrations of olanzapine and its metabolite N-desmethylolanzapine and of fluvoxamine were analyzed at weeks 0, 1, 4, and 8. Addition of fluvoxamine resulted in a 12% to 112% ( < 0.01) increase of olanzapine from 31 +/- SD 15 ng/mL (week 0) to 56 +/- 31 ng/mL (week 8) in all patients. N-desmethylolanzapine concentrations were not significantly changed ( > 0.05). Fluvoxamine concentrations were 48 +/- 26 ng/mL on week 1 and 83 +/- 47 ng/mL on week 8. It is concluded that fluvoxamine affects olanzapine degradation and thus increases olanzapine concentrations. Although the combination was well tolerated in this sample and the negative symptom response appeared to be favorable in at least five patients, the combination therapy of olanzapine and fluvoxamine should be used cautiously and should be controlled by therapeutic drug monitoring to avoid olanzapine-induced side effects or intoxications.

Adult↗
PubMed2002

A computerized patient information system in a psychiatric hospital.

The authors describe a computerized patient information system at a psychiatric hospital in Israel. The system is a fully implemented work instrument that promotes clinical safety and cost containment. It allows interactive online consultations, clinical cross-checking, the production of computerized reports and schedules, fast response to laboratory results, and safer drug administration, all of which help improve the quality of care. Cost savings have been achieved in areas such as pharmacy and food distribution. The initial investment in the system was $400,000, which is expected to be recouped after 11.4 years.

Computers↗
PubMedDate not supplied

Longitudinal assessment of coping abilities at exacerbation and stabilization in schizophrenia.

BACKGROUND: Coping strategies play an important role in one's ability to adapt to stressful life conditions such as schizophrenia. To better understand the nature of various coping mechanisms at various stages in schizophrenia, this study examined task-, emotion-, and avoidance-oriented coping strategies and explored associated clinical factors at exacerbation and stabilization phases of the illness. METHOD: Patients with schizophrenia were examined twice (at exacerbation phase, N = 237 and at stabilization phase, N = 148) with the Coping Inventory for Stressful Situations, and standardized measures of psychopathology and emotional distress severity, side effects, insight, self-constructs, social support, and quality of life. Multiple regression analysis was performed with coping strategies as dependent variables at exacerbation and stabilization including analysis of any change during the 16-month follow-up period. RESULTS: Analysis indicated that emotion coping strategies were used more at exacerbation than at stabilization phase. Regression analysis demonstrated emotional distress to be a strong predictor of emotion-oriented coping, with self-efficacy and social support being the best predictors of task and avoidance coping strategies, respectively. Individual changes in these variables also appear to be important predictors for fluctuations of these coping strategies over time. Severity of symptoms accounted for 3.5% and 5.5% to 9% of the total variance of emotion- and task-oriented coping strategies, respectively. CONCLUSIONS: Emotion, task, and avoidance coping strategies and their predictors are influenced and may vary over the course of schizophrenia illness. Experienced emotional distress, self-efficacy, and social support are the best predictors of coping strategies both at exacerbation and stabilization phases of illness.

Adaptation, Psychological↗
PubMedDate not supplied

Decreased platelet peripheral-type benzodiazepine receptors in persistently violent schizophrenia patients.

Peripheral-type benzodiazepine receptors (PBR) have been shown to be sensitive to stressful conditions. This study aimed to explore a possible association of platelets PBR binding with aggressive behavior and homicidal history in schizophrenia patients. The authors compared [(3)H] PK 11195 binding to platelet membrane among 11 currently aggressive schizophrenia patients, 15 schizophrenia patients with homicidal history, 14 nonaggressive schizophrenia patients, and 15 healthy volunteers. Subjects were assessed for aggressive behavior, psychopathology, anxiety, anger, and emotional distress using standardized instruments. We found that currently aggressive patients had significantly lower (-30%) platelet PBR density (B(max)), and scored significantly higher on hostility, anxiety, state anger, and emotional distress compared to homicidal and nonaggressive schizophrenia patients and healthy controls. Predominance of positive or negative symptoms, homicidal or suicidal attempt history, emotional distress levels, and conventional or atypical antipsychotic therapy is not associated with the expression of platelet PBR binding sites. Significant negative correlations emerged between PBR density and scores for aggressive behavior, hostility and anxiety. Thus, decreased platelet PBR density in aggressive schizophrenia patients is associated with higher scores for overt aggression, hostility and anxiety, but independent of illness subtype, homicidal and suicidal attempt history, distress level and type of antipsychotic treatment.

Adult↗
PubMedDate not supplied

Assessing psychological distress in psychiatric patients: validation of the Talbieh Brief Distress Inventory.

The present study examined the psychometric properties of the Talbieh Brief Distress Inventory (TBDI), a 24-item self-report instrument used to measure psychological distress, for use in psychiatric patients. A case-control and partly longitudinal design was used to test the TBDI among 431 psychiatric outpatients and inpatients and 197 gender- and age-matched nonpatients. All respondents were interviewed using the ICD-10 Symptom Checklist, and patients additionally with psychopathology rating scales. Internal consistency of the TBDI distress index was 0.92. A cutoff of 2.0 was associated with 96% sensitivity and 56% specificity. Mean TBDI scores were significantly lower for nonpatients than for both outpatients and inpatients, and for schizophrenic patients compared with patients suffering from schizoaffective/mood disorders and from neurotic/personality disorders. The TBDI shows good capacity to discriminate levels and symptoms of distress between control subjects and mentally ill patients. The TBDI is a brief, valid, and useful tool for stress-related research that allows comparison of the psychological responsiveness of distinct patients and groups of patients and facilitates assessment of distress levels across cultural or language barriers.

Adolescent↗
PubMedDate not supplied

Age differences in stress process of recent immigrants.

In the present study we sought to examine whether age affects the relationship between stress/social support and psychological distress in community residents in Israel who recently emigrated from the former Soviet Union (FSU). A cross-sectional and partly longitudinal design was used to compare emotional distress, stressor, and social support measures in three age groups (18 to 29, 30 to 59, and 60 to 86 years) of adult immigrants (N = 563). Age-related differences in the parameters of interest and their changes over time were examined with analysis of variance (ANOVA), t tests, and multiple regression analyses. We found that older immigrants reported higher levels of health-related stressors, but did not differ on total social support from younger immigrants. Specific predictors of elevated distress differed by age. For the youngest cohort, these included climate changes and anxiety for the future. For the middle-aged immigrants, these included female gender, lower education, unemployment, and longer time in Israel. For the oldest immigrants, predictors of distress included being divorced, separated, or widowed, and perceiving long-time residents of Israel as hostile. Only the middle-aged cohort showed a significant decline in levels of perceived stressors and distress during a 1-year follow-up. Thus, age differences in the stress process of recent immigrants are associated with age-specific perceived adjustment difficulties and demographic characteristics.

Adolescent↗