[Position paper on physician-patient relationships].
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Humans↗
Biomedical subjects
S Tyano
Publications and source records attributed to S Tyano.
Suicidal adolescents and ego defense mechanisms.
OBJECTIVES: To identify defense mechanisms that characterize adolescents with a range of suicidal behaviors and to differentiate them from nonsuicidal adolescents. METHODS: Fifty-five suicidal adolescent inpatients admitted for a definite suicide attempt were compared with 87 adolescent inpatients who had no history of suicide attempt or ideation and 81 nonpatients. Defense mechanisms were assessed by the Ego Defense Scale (EDS) which is part of a larger semistructured interview, the Child Suicide Potential Scale (CSPS), and by a self-report questionnaire, the Life Style Index (LSI). The CSPS was also used to quantity violent and suicidal behaviors. RESULTS: On the LSI suicidal adolescent patients scored higher on denial, displacement, repression, and total defenses than the nonpatients. On the EDS they scored higher on regression, denial, projection, introjection, repression, and total defenses and lower on sublimation. LSI scores on displacement (higher) and on compensation (lower) distinguished suicidal from nonsuicidal inpatients. Denial and regression correlated positively and sublimation correlated negatively with both suicidal and violent behaviors. Introjection and repression correlated with suicidal behavior only. CONCLUSIONS: Overuse of displacement is connected with increased risk for suicidal and aggressive behaviors, while sublimation is probably a protective factor. In addition, several immature ego defenses possibly amplify aggression, which then is directed against the self by the maladaptive overuse of introjection, displacement, and repression.
Adolescent↗
Iron treatment in children with attention deficit hyperactivity disorder. A preliminary report.
Iron plays a role in the regulation of dopaminergic activity. In the present study, nonanemic children with attention deficit hyperactivity disorder (ADHD) were evaluated with regard to heme and nonheme iron metabolism and the effect of short-term iron administration on behavior. The study group consisted of 14 boys aged 7-11 years. All first underwent testing to rule out other psychiatric and medical problems. The severity of the ADHD symptoms was determined by parent and teacher scores on the Connors Rating Scale. Thereafter, each patient received an iron preparation (Ferrocal), 5 mg/kg/day for 30 days. Blood samples were taken before and after drug administration. Results showed a significant increase in serum ferritin levels (from 25.9 +/- 9.2 to 44.6 +/- 18 ng/ml) and a significant decrease on the parents' Connors Rating Scale scores (from 17.6 +/- 4.5 to 12.7 +/- 5.4). There were no changes in other blood parameters or in the teachers' scores on the rating scale. The effect of iron supplementation on the behavioral and cognitive symptoms in noniron-deficient ADHD children merits further investigation using a placebo-controlled study.
Attention Deficit Disorder with Hyperactivity↗
An open trial of clozapine in neuroleptic-resistant childhood-onset schizophrenia.
BACKGROUND: Studies performed with schizophrenic adults who were resistant to classical neuroleptics showed improvement in 30% of the patients when treated with clozapine. Very early onset schizophrenic patients benefit only partially from conventional antipsychotics and are at increased risk of developing extrapyramidal symptoms; clozapine may offer an alternative treatment for these patients. METHODS: Eleven neuroleptic-resistant children (< 13 years) with schizophrenia were treated with clozapine. Improvement was monitored during the first 16 weeks using the Brief Psychiatric Rating Scale, Positive and Negative Syndrome Scale and Clinical Global Impression. The mean clozapine dosage was 227.3 (s.d. 34.4 mg/day at the end of the 16 weeks. RESULTS: There was an overall statistically significant reduction in all parameters, especially positive symptoms, implying a favourable outcome. Most of the improvement occurred during the first 6 to 8 weeks. The major side-effects were somnolence and drooling (no agranulocytosis). CONCLUSION: Clozapine may be a promising drug for the treatment of resistant childhood-onset schizophrenia.
Adolescent↗
State and trait anxiety in adolescent suicide attempters.
OBJECTIVE: To examine the relationship between anxiety and suicidal behavior in adolescents. METHOD: Forty-six adolescents who had been hospitalized in an inpatient psychiatric unit after a suicide attempt were compared on measures of anxiety and depression with 72 adolescent psychiatric inpatients who had no history of suicide attempts. RESULTS: The suicide attempters exhibited significantly higher levels of both state and trait anxiety. However, when controlling for depression, the attempters did not differ in their level of state anxiety from the nonattempters, but they still manifested significantly higher levels of trait anxiety than nonattempters. CONCLUSIONS: The results suggest that anxiety, both state and trait, is a risk factor for suicidal behavior in adolescents. Yet, only trait anxiety appears to be relatively independent of depression in its effect on suicidal behavior risk. These findings imply that clinicans should take into account anxiety, both state and trait, for assessment and treatment of adolescents at risk for suicidal behavior.
Adolescent↗
Seven-year follow-up of child survivors of a bus-train collision.
OBJECTIVE: To assess the long-term effects of a traumatic bus-train collision and to examine the effect of levels of exposure and immediate reactions on long-term adjustment. METHOD: Seven years after the accident, 389 subjects, all doing compulsory army service, filled out self-report questionnaires assessing symptoms of posttraumatic stress disorder (PTSD), psychiatric symptomatology, and military functioning. In addition, subjects were questioned about their immediate reactions to the traumatic event. RESULTS: The most highly exposed subjects reported the highest levels of somatization, depression, phobic anxiety, and psychoticism and more PTSD symptoms. Acute stress symptoms and manifestations of fear immediately after the accident were strongly related to long-term maladjustment CONCLUSIONS: The results suggest that the investigation and assessment of long-term adjustment after traumatic events should take into account both contextual factors, such as the level of exposure to the event, and personal factors, such as the victims' immediate reactions.
Accidents, Traffic↗
Reduction in serotonin 5HT2 receptor binding on platelets of delinquent adolescents.
The possible involvement of serotonin receptors of the 5HT2 type in aggressive behavior was studied in juvenile delinquents. A group of 28 delinquent adolescents (13-18 years old) who had committed violent crimes was compared with a group of age matched controls. Subjects were drug and medication free during the study. 5HT2 receptors were labeled on platelet membranes using tritiated ketanserin. Receptor binding in the delinquent adolescents was significantly lower than in age matched controls. Mean +/- SD of 76 controls was 32.3 +/- 14.2 fm/mg, compared to 16.6 +/- 8.2 fm/mg in 28 delinquents (P < 0.002, Student's t-test). These results support a role for serotonin in general and 5HT2 receptors in particular in human aggressive behavior.
Adolescent↗
Correlation of suicidal and violent behavior in different diagnostic categories in hospitalized adolescent patients.
OBJECTIVE: To determine the relative importance of aggression and depression in adolescent suicide within different diagnostic categories. METHOD: One hundred sixty-three consecutive admissions to an adolescent psychiatric inpatient unit were assessed using a semistructure diagnostic instrument, the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Scores for depression, suicidal behaviors, and violent behaviors were calculated from this assessment. RESULTS: Anorexia nervosa and conduct disorder patients had the highest suicidal behavior scores. In addition, patients with conduct disorder were significantly more violent than patients with major depressive disorder, and scores on the Violent Behavior Scale correlated with suicidal symptoms but not with depressive symptoms. CONCLUSION: Aggression may be as important in some kinds of suicidal behaviors as is depression. Thus it seems that there are hypothetically at least two types of suicidal behaviors during adolescence: a wish to die (depression) and a wish not to be here for a time (impulse control). The first type of suicidal behavior characterizes that seen in disorders with prominent depression such as major depressive disorder and anorexia nervosa, and the second characterizes disorders of impulse control such as conduct disorder.
Adolescent↗
Defense mechanisms in severe adolescent anorexia nervosa.
OBJECTIVE: To compare ego defense mechanisms in adolescents with anorexia nervosa and other major psychiatric disorders, to defenses in healthy adolescents. METHOD: Thirty-seven patients with anorexia nervosa, 30 with major depressive disorder, 20 with obsessive-compulsive disorder, 53 with borderline personality disorder, 60 with schizophrenia, and 81 healthy controls were assessed with Pfeffer's Ego Defense Scale. RESULTS: Regression, denial, projection, repression, introjection, and total defenses were common to all psychiatric patients and distinguished them from normal adolescents. In addition to these defenses, anorectic patients also used intellectualization more frequently than normal adolescents and psychiatric patients. They used sublimation more than other psychiatric patients. Patients with disorders, apart from obsessive-compulsive disorder, that are considered to be often comorbid with anorexia did not have different defense than schizophrenic patients. CONCLUSIONS: Anorectic adolescents overutilize relatively more mature defenses than do psychiatrically ill adolescents, and they overutilize immature defenses compared with normal adolescents. This combination of mature and immature defenses may be related to the uniquely heterogeneous ego functioning seen in anorectic patients, and it may provide insight into the nature of the psychopathology of anorexia nervosa. It also could have important psychotherapeutic and prognostic value.
Adolescent↗
Life events and severe anorexia nervosa in adolescence.
The purpose of the study was to study the influence of life events on adolescent patients suffering from anorexia nervosa. Twenty one hospitalized adolescent inpatients with severe anorexia nervosa were compared with 79 adolescent nonanorectic psychiatric inpatients and 40 healthy adolescents for stressful life events throughout their lives. The nonanorectic patients suffered from schizophrenia, affective disorders, anxiety disorders, borderline personality disorder or conduct disorder. The assessment of the contribution of life events to the development of anorexia and the control mental disorders was based on semistructured interviewing of the patients, their parents and the patients' therapists. The instrument used was that developed by Pfeffer. The anorectic patients showed significantly higher negative life event scores than healthy controls in all the areas of life events examined. In addition, they showed significantly more negative life events concerning parents than patients in the other psychiatric diagnostic categories. These findings have relevance for the growing literature on the association between eating disorders and certain forms of child abuse.
Adolescent↗
The role of the Israel Psychiatric Association at a time of health reform.
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Ethics, Medical↗
Platelet monoamine oxidase activity in neuroleptic-naive schizophrenic patients: lack of influence of chronic perphenazine treatment.
We investigated the possible relationship between schizophrenia, neuroleptic treatment, and platelet monoamine oxidase (MAO) activity. Platelet MAO activity was similar in neuroleptic-naive schizophrenic patients and healthy controls and was not affected by chronic (10-week) perphenazine treatment. A relationship between platelet MAO activity and central disturbances in schizophrenia remains uncertain.
Adult↗
Cultural effects on eating attitudes in Israeli subpopulations and hospitalized anorectics.
We assessed eating attitudes and body image using the Eating Attitudes Test-26 (EAT: Garner & Garfinkel, 1979) and a 17-item body image scale in Israeli Jewish female high school populations in five distinct residential settings (kibbutz, moshav, city, and 2 different boarding schools); in five ethnically distinct Arab female high school populations (Muslim, Christian, Druze, Circassian, and Bedouin); and in a group of hospitalized adolescent girls with anorexia nervosa. We hypothesized that the attitudes of the adolescent females most exposed to Western body shape ideals and simultaneously undergoing role conflict between traditional and modern images of the female role would most resemble attitudes of anorectics. This was partly supported by the findings. Ethnic differences also emerged in attitude toward food. All the Arab populations except the Circassian showed strong Western influences in their attitudes toward eating and body image and thus may well be prone to epidemics of anorexia and similar eating disorders in the near future. Kibbutz girls were most similar to the anorectic group.
Adolescent↗
Child and adolescent psychiatry and aggression.
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Adolescent↗
[Postpartum blues and depression].
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Depression↗
Reduced total complement haemolytic activity in schizophrenic patients.
Serum concentrations of the third and fourth components of the complement system and total complement haemolytic activity were measured in 167 psychiatric patients. Total complement haemolytic activity was decreased in chronic schizophrenic patients as compared to healthy controls and bipolar patients. The relatively diminished total haemolytic activity was not attributable to drug treatment. It is not clear if the reduced total haemolytic activity is an epiphenomenon or related to the involvement of an autoimmune process in the pathophysiology of schizophrenia.
Autoimmune Diseases↗
Fears of death in suicidal and nonsuicidal adolescents.
Suicidal, psychiatric, and normal adolescent girls and boys, ages 15-17 years, participated in a study on five types of death fears. A mixed within-between multivariate analysis of variance (5 factors x 3 groups) yielded significant interactive effects of indicating that there were different profiles of fears among the three groups: Relative to the other groups, suicidal adolescents displayed little differentiation between facets of fear, with differences in the magnitude of fear limited to the intrapersonal facets. Correlates of fear varied between groups: Fear was positively correlated with suicidality in normal subjects, negatively correlated with suicidality among suicidal ones, and unrelated to suicidality in the psychiatric group. It is suggested that fear of death is processed and experienced differently by suicidal and nonsuicidal adolescents to serve as a facilitator or inhibitor of suicidal behavior.
Adolescent↗
Cytokine production in anorexia nervosa.
The capacity of peripheral blood mononuclear cells (PBMCs) of anorexia nervosa (AN) patients to produce interleukin-1 (IL-1), interleukin-2 (IL-2), and interleukin-3-like activity (IL-3-LA) was studied. A significantly lower (-49%, p < 0.005) capacity to synthesize IL-2 and an almost significantly impaired ability (-35%, p = 0.058) to release IL-3-LA by PBMCs of AN patients was found, as compared with cells of the control group. IL-1 production, either spontaneous or after stimulation with lipopolysaccharide (LPS), did not differ significantly between AN patients and healthy subjects. The lessened capacity to produce IL-2 was accompanied by an enhanced stimulatory activity of the patient sera on the production of this cytokine by PBMCs of healthy subjects. It is therefore suggested that the serum of AN patients contains a stimulatory factor or factors for cytokine production that compensates for the lower production of cytokines by AN PBMCs. Such a compensatory mechanism may explain why AN patients do not have an higher susceptibility to infections.
Adolescent↗