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Zvi Zemishlany

Publications and source records attributed to Zvi Zemishlany.

6 recordsLinked to original sources
PubMed2006

Acute intermittent porphyria: psychosis as the only clinical manifestation.

Acute intermittent porphyria (AIP) is the most common of the four forms of neuroporphyria. AIP mimics a variety of disorders and thus poses a diagnostic quagmire. Abdominal pain occurs in 90-95% of the attacks. Some patients develop psychiatric symptoms such as psychosis similar to schizophrenia. The diagnostic difficulty may lead to under-diagnosis of patients who present with strictly psychiatric symptoms. This assumption is supported by a high prevalence of AIP in psychiatric hospitals. Therefore, we encourage a high index of suspicion for AIP in psychiatric patients in order to prevent false psychiatric diagnosis. In addition we discuss psychotropic drugs that may exacerbate acute attacks in undiagnosed patients. We report a case in which the diagnosis of AIP was clouded by the presence of only psychiatric symptoms. The clue for diagnosis was an anamnestic detail of the use of a porphyrogenic drug prior to the admission. The diagnosis of AIP was supported by excess of alpha aminolevulinic acid (ALA) and porphobilinogen (PBG) in urine concomitantly with a decrease in porphobilinogen deaminase (PBGD) activity in erythrocytes. The diagnosis was further strengthened by the fact that the patient's father was identified as an AIP carrier. However, in the absence of typical organic symptoms of porphyria, one cannot definitely rule out the presence of schizophrenia in this patient in addition to AIR

Adult↗
PubMed2003

[Non-compliance with medication as a common reason for admission to a closed psychiatric ward].

Noncompliance with pharmacologic treatment is common amongst patients suffering from chronic diseases. In psychiatric patients compliance is extremely important in order to prevent recurrence of the disease. Recurrence is associated with readmissions and increased costs to the health system. About 70% of patients suffering from schizophrenia will relapse within a year without medication. This study evaluates the causes of admission and diagnoses of 100 patients consecutively admitted to a closed psychiatric ward between 1.4.2000 and 23.6.2000. Fifty- four of these 100 admissions were associated with medication noncompliance in the last year. Noncompliance was not associated with psychiatric diagnosis, gender, type of medication or form of administration of the medication. The problem of noncompliance should be approached on two levels: the doctor-patient relationship and reorganization of mental health services. On the doctor-patient level, the therapist has to maintain a therapeutic alliance with the patient and his family and adjust the medication accordingly, in order to maximize the benefit and minimize side effects. On the health system level, mental health should be included in the National Health Insurance Law and the Health Funds should take responsibility for mental health as in other medical fields. This may enable the psychiatric patients to be under the care of their general practitioner in continuity with the psychiatric hospital. Thereby, resources should be transferred from the psychiatric hospitals to the community. The availability of the psychiatric community services and their links to the general healthcare system would increase compliance and reduce recurrence, readmissions and the stigma of patients suffering from psychiatric disorders.

Female↗
PubMed2002

Sexual function and behavior in social phobia.

BACKGROUND: Social phobia is a type of performance and interpersonal anxiety disorder and as such may be associated with sexual dysfunction and avoidance. The aim of the present study was to evaluate sexual function and behavior in patients with social phobia compared with mentally healthy subjects. METHOD: Eighty subjects participated in the study: 40 consecutive, drug-free outpatients with social phobia (DSM-IV) attending an anxiety disorders clinic between November 1997 and April 1999 and 40 mentally normal controls. The Structured Clinical Interview for DSM-IV Axis I Disorders and the Liebowitz Social Anxiety Scale were used to quantitatively and qualitatively assess sexual function and behavior. RESULTS: Men with social phobia reported mainly moderate impairment in arousal, orgasm, sexual enjoyment, and subjective satisfaction domains. Women with social phobia reported severe impairment in desire, arousal, sexual activity, and subjective satisfaction. In addition, compared with controls, men with social phobia reported significantly more frequent paid sex (p < .05), and women with social phobia reported a significant paucity of sexual partners (p < .05). CONCLUSION: Patients with social phobia exhibit a wide range of sexual dysfunctions. Men have mainly performance problems, and women have a more pervasive disorder. Patients of both genders show difficulties in sexual interaction. It is important that clinicians be aware of this aspect of social phobia and initiate open discussions of sexual problems with patients.

Adult↗
PubMedDate not supplied

Selegiline in the treatment of sexual dysfunction in schizophrenic patients maintained on neuroleptics: a pilot study.

A double-blind, placebo-controlled crossover study was undertaken in 10 neuroleptic-treated male schizophrenic outpatients to assess the effect of coadministration of selegiline 15 mg/day for 3 weeks on their sexual dysfunction. Selegiline was not found to be effective in improving any domain of sexual functioning despite a significant decrease in prolactin levels (P < 0.05). This study emphasizes the complex nature of sexual dysfunction in schizophrenic-treated patients and the need for placebo-controlled trials for this condition.

Adult↗
PubMedDate not supplied

Sildenafil citrate for the sexual dysfunction in antidepressant-treated male patients with posttraumatic stress disorder. A preliminary pilot open-label study.

BACKGROUND: Previous studies have suggested that posttraumatic stress disorder (PTSD) may be associated with pervasive sexual dysfunction. Sildenafil citrate was established as a highly effective and well-tolerated oral agent for the treatment of sexual dysfunction of various etiologies. There are no studies that have examined the efficacy of oral sildenafil in PTSD patients with sexual dysfunction. OBJECTIVE: The current study evaluated the impact of sildenafil added to an ongoing antidepressive treatment in male PTSD patients. METHODS: Ten consecutive male PTSD patients who complained of sexual dysfunction were enrolled in an open-label 4-week fixed-dose study of sildenafil citrate 50 mg/day p.r.n. Patients were evaluated at baseline and after treatment with the Clinician-Administered PTSD Scale (CAPS); sexual function assessments were performed using the International Index of Erectile Function. RESULTS: All patients completed the study and statistically significant improvement was observed in all evaluated domains of sexual functioning: erectile function (53.5%), orgasmic function (40.3%), sexual desire (53%), intercourse satisfaction (82%) and overall satisfaction (57.4%). Oral sildenafil treatment appeared to be well tolerated and no single patient stopped the treatment. Improvements in various CAPS subscales were also obtained; however, there was no significant correlation between improvement in sexual functioning and the changes in CAPS subscale scores. CONCLUSION: Sildenafil seems to be an efficacious, safe and well-tolerated treatment of sexual dysfunction in antidepressant-treated male PTSD patients.

Adult↗