Patterns of psychiatric hospitalizations among migrant workers and asylum-seekers in Israel: a single hospital archive study, 2005-2011.

Aim: Migrants have increased risk for psychiatric hospitalizations. Over the last decades Israel has become a destination for migration of migrant workers and asylum-seekers.Methods: The current retrospective study retrieved socio-demographic, clinical and migration-related chart data for 117 migrants admitted to a major Israeli psychiatric hospital between 2005-2011, to delineate characteristics and risk-factors for psychiatric hospitalizations. Multivariate logistic regression analyses were performed to predict re-hospitalization.Results: Of the study sample, 61% were single men, 20% had been exposed to trauma, 15% had prior psychiatric hospitalizations and 24% had attempted suicide. Approximately, 76% were involuntarily hospitalized and diagnosed with psychosis. None were diagnosed with PTSD. Approximately, 20% were re-hospitalized. Factors significantly associated with re-hospitalization were male gender (OR = 15.2, 95%, CI 1.8-126.9, p = 0.012), prior psychiatric hospitalization (OR = 15.4, 95% CI 2.1-111.9, p < 0.01), being single (OR = 5.96, 95% CI1.14-31.07, p = 0.03) and traumatic exposure (OR = 4.75, 95% CI: 1.17-19.36, p= 0.03). Shorter duration in Israel, unemployment, asylum-seekers, no temporary-visa and use of restraints were more prevalent among those re-hospitalized.Conclusion: Identification of migrants at risk and trauma-informed, culturally relevant services can reduce hospitalizations.

Medical Cannabis in Parkinson Disease: Real-Life Patients' Experience.

BACKGROUND: The use of medical cannabis (MC) is controversial. Support for its benefits is based on small clinical series. OBJECTIVE: The aim of this study was to report the results of a standardized interview study that retrospectively assessed the effects of MC on symptoms of Parkinson disease (PD) and its adverse effects in patients treated for at least 3 months. METHODS: The survey used telephone interviews using a structured questionnaire based on subjective global impressions of change for various parkinsonian symptoms and yes/no questions on adverse effects. RESULTS: Forty-seven nondemented patients with PD (40 men) participated. Their mean age was 64.2 ± 10.8 years, mean disease duration was 10.8 ± 8.3 years, median Hoehn and Yahr (H&Y) was stage III. The duration of MC use was 19.1 ± 17.0 months, and the mean daily dose was 0.9 ± 0.5 g. The delivery of MC was mainly by smoking cigarettes (38 cases, 80.9%). Effect size (r) improvement for falls was 0.89, 0.73 for pain relief, 0.64 for depression, 0.64 for tremor, 0.62 for muscle stiffness, and 0.60 for sleep. The most frequently reported adverse effects from MC were cough (34.9%) in those who used MC by smoking and confusion and hallucinations (reported by 17% each) causing 5 patients (10.6%) to stop treatment. CONCLUSIONS: Medical cannabis was found to improve symptoms of PD in the initial stages of treatment and did not cause major adverse effects in this pilot, 2-center, retrospective survey. The extent of use and the reported effects lend support to further development of safer and more effective drugs derived from Cannabis sativa.

Deliberate Self-Harm in Older Adults: A General Hospital Emergency Department Survey.

BACKGROUND: Deliberate self-harm (DSH) increases the danger of future suicide death and the risk increases with age. Self-harm in older adults is often associated with greater suicidal intent and lethality. OBJECTIVES: To investigate clinical and psychosocial variables of older patients (age ≥ 65 years) assessed due to DSH, compared with younger adults. METHODS: Patients admitted to the Emergency Department following DSH during an 8 year period were included. RESULTS: Of 1149 participants, 187 (16.6%) were older adults (age ≥ 65) and 962 (83.4%) were younger adults (< 65). The older adults reported DSH closer to mid-day (P < 0.01) and suffered more frequently from adjustment disorder and depression. Personality disorders and schizophrenia were less commonly diagnosed (P < 0.001). Prescription medication (sedatives and hypnotics) were a more frequent means (88% vs. 71%) of DSH among older patients. Younger patients with DSH used over-the-counter medications (21.9% vs. 6.4%) three times more than did the older patients (P < 0.01). Past DSH was significantly more frequent in younger adults. Following DSH the older patients were frequently admitted for further general hospitalization (P < 0.001). CONCLUSIONS: Older adults with DSH are a unique group with different clinical characteristics. There is a need for targeted prevention strategies and education of caregivers regarding DSH in older adults.

Safety and Efficacy of Medical Cannabis Oil for Behavioral and Psychological Symptoms of Dementia: An-Open Label, Add-On, Pilot Study.

BACKGROUND: Tetrahydrocannabinol (THC) is a potential treatment for Alzheimer's disease (AD). OBJECTIVE: To measure efficacy and safety of medical cannabis oil (MCO) containing THC as an add-on to pharmacotherapy, in relieving behavioral and psychological symptoms of dementia (BPSD). METHODS: Eleven AD patients were recruited to an open label, 4 weeks, prospective trial. RESULTS: Ten patients completed the trial. Significant reduction in CGI severity score (6.5 to 5.7; p <  0.01) and NPI score were recorded (44.4 to 12.8; p <  0.01). NPI domains of significant decrease were: Delusions, agitation/aggression, irritability, apathy, sleep and caregiver distress. CONCLUSION: Adding MCO to AD patients' pharmacotherapy is safe and a promising treatment option.

Individual Psychotherapy ("Talking Therapy"): A Survey of Attitudes among Residents & Specialists in Psychiatry, Israel 2010-2011.

BACKGROUND: Individual psychotherapy is an efficient tool and an integral part of psychiatric treatment. However, its status among psychiatrists in Israel has never been explored. OBJECTIVES: To explore and map the attitudes of psychiatrists in Israel regarding psychotherapy and psychotherapy training during residency, with comparisons between residents vs. specialists, peripheral vs. central institutions and mental health vs. medical centers. METHOD: We conducted a cross-sectional survey to examine the attitudes toward individual psychotherapy. The questionnaire was delivered via email and direct approach to psychiatrists in Israel. RESULTS: The survey was completed by 229 of 1,502 registered psychiatrists (15.3%). While 96% (n=218) had positive attitudes towards psychotherapy, 93.1% (n=215) thought psychotherapy was less available than pharmacotherapy. Psychiatrists from peripheral institutions prefer cognitive behavioral therapy, while psychiatrists from central institutions prefer dynamic psychotherapy. Psychiatrists from mental health centers use more dynamic psychotherapy compared to psychiatrists from medical centers. The number of dynamic psychotherapy treatments psychiatrists delivered during their residencies has been decreasing over time, meaning residents today deliver fewer dynamic psychotherapy treatments compared to the number of treatments specialists delivered during their residencies. Additionally, 97.4% (n=225) believed psychotherapy training should be included in the psychiatric residency and 87.3% thought that the training should be improved to a great extent. CONCLUSIONS: The survey demonstrates mixed but overall positive attitudes towards psychotherapy among psychiatrists in Israel. The findings should be taken into consideration by psychiatrists who design the residency program and by policy makers who are in charge of the mental health reform in Israel, or the psychotherapy usage and therapeutic potential may diminish, as has happened in other countries.

Ultra-Low-Dose Buprenorphine as a Time-Limited Treatment for Severe Suicidal Ideation: A Randomized Controlled Trial.

OBJECTIVE: Suicidal ideation and behavior currently have no quick-acting pharmacological treatments that are suitable for independent outpatient use. Suicidality is linked to mental pain, which is modulated by the separation distress system through endogenous opioids. The authors tested the efficacy and safety of very low dosages of sublingual buprenorphine as a time-limited treatment for severe suicidal ideation. METHOD: This was a multisite randomized double-blind placebo-controlled trial of ultra-low-dose sublingual buprenorphine as an adjunctive treatment. Severely suicidal patients without substance abuse were randomly assigned to receive either buprenorphine or placebo (in a 2:1 ratio), in addition to their ongoing individual treatments. The primary outcome measure was change in suicidal ideation, as assessed by the Beck Suicide Ideation Scale at the end of each of 4 weeks of treatment. RESULTS: Patients who received ultra-low-dose buprenorphine (initial dosage, 0.1 mg once or twice daily; mean final dosage=0.44 mg/day; N=40) had a greater reduction in Beck Suicide Ideation Scale scores than patients who received placebo (N=22), both after 2 weeks (mean difference -4.3, 95% CI=-8.5, -0.2) and after 4 weeks (mean difference=-7.1, 95% CI=-12.0, -2.3). Concurrent use of antidepressants and a diagnosis of borderline personality disorder did not affect the response to buprenorphine. No withdrawal symptoms were reported after treatment discontinuation at the end of the trial. CONCLUSIONS: The time-limited, short-term use of very low dosages of sublingual buprenorphine was associated with decreased suicidal ideation in severely suicidal patients without substance abuse. Further research is needed to establish the efficacy, safety, dosing, and appropriate patient populations for this experimental treatment.

Adherence to Medical Cannabis Among Licensed Patients in Israel.

Objectives: To evaluate adherence among Israeli patients who are licensed to use medical cannabis and to identify factors associated with adherence to medical cannabis. Methods: Ninety-five novice licensed patients were interviewed for this cross-sectional study. The questionnaire measured demographics, the perceived patient-physician relationship, and the level of patients' active involvement in their healthcare. In addition, patients were queried about adverse effect(s) and about their overall satisfaction from this medical treatment. Results: Eighty percent (n=76) has been identified as adherent to medical cannabis use. Variables found associated with adherence were "country of origin" (immigrant status), "type of illness" (cancer vs. non-cancer), and "experiencing adverse effect(s)." Three predictors of adherence were found significant in a logistic regression model: "type of illness" (odds ratio [OR] 0.101), patient-physician relationship (OR 1.406), and level of patient activation (OR 1.132). 71.5% rated themselves being "completely satisfied" or "satisfied" from medical cannabis use. Conclusions: Our findings show a relatively high adherence rate for medical cannabis, as well as relative safety and high satisfaction among licensed patients. Additionally indicated is the need to develop and implement standardized education about this evolving field-to both patients and physicians.

Effectiveness and safety of clozapine in elderly patients with chronic resistant schizophrenia.

UNLABELLED: ABSTRACT Background: Recommendations for the treatment of elderly schizophrenia patients are largely based on data extrapolated from studies of antipsychotic medications in younger patient populations. We aimed to evaluate the effectiveness and safety of clozapine monotherapy in a diagnostically homogeneous group of elderly patients suffering from schizophrenia (DSM-IV-TR criteria). METHODS: A retrospective analysis of computerized medical charts of elderly inpatients suffering from schizophrenia treated at our center during the period January 2007-December 2012 was undertaken. Inclusion criteria were: (1) 60 years and older, (2) unsuccessful treatment with at least three different antipsychotic compounds during the last five years prior to the study period. Mortality and re-hospitalization over a five-year period were the pre-defined outcome measures. RESULTS: Of 527 elderly patients suffering from schizophrenia 43 patients, mean age 69.4 ± 8.7 years, were treated with clozapine. There were 19 women and 24 men, mean disease duration was 38.8 years. All had been exposed to at least three first- and second-generation antipsychotics prior to clozapine treatment. Clozapine was very well tolerated by the patients and mortality rate (8/43 (18.6% vs. 87/484 (18%)) was equal to that of other first- and second-generation antipsychotics (p < 0.18). Re-hospitalization rates with clozapine were significantly lower than rates for the five-year period prior to exposure to clozapine (0.41 vs. 3.8; p < 0.001). CONCLUSION: The present study demonstrates that clozapine is efficacious and safe for the treatment of elderly schizophrenia patients. Prospective studies are needed to support these findings.

Acute electroconvulsive therapy followed by maintenance electroconvulsive therapy decreases hospital re-admission rates of older patients with severe mental illness.

OBJECTIVES: Electroconvulsive therapy (ECT) is a highly effective treatment for patients with severe mental illness (SMI). Maintenance ECT (M-ECT) is required for many elderly patients experiencing severe recurrent forms of mood disorders, whereas M-ECT for schizophrenia patients is a poorly studied treatment. We report on the outcomes in aged patients with SMI: schizophrenia and severe affective disorders treated by M-ECT of varying duration to prevent relapse after a successful course of acute ECT. The study measured the effectiveness of M-ECT in preventing hospital readmissions and reducing admission days. METHOD: A retrospective chart review of 42 consecutive patients comparing the number and length of psychiatric admissions before and after the start of M-ECT was used. We analyzed diagnoses, previous ECT treatments, number of ECT treatments, and number and length of psychiatric admissions before and after M-ECT. RESULTS: Mean age in our sample was 71.5 (6.9) years. Twenty-two (52%) patients experienced severe affective disorders and 20 (48%) experienced schizophrenia. Patients were administered 92.8 (85.9) M-ECT treatments. Average duration of the M-ECT course was 34 (29.8) months. There were on average 1.88 admissions before M-ECT and only 0.38 admissions in the M-ECT period (P < 0.001). Duration of mean hospitalization stay decreased from 215.9 to 12.4 days during the M-ECT (P < 0.01). CONCLUSIONS: Our findings suggest that acute ECT followed by M-ECT is highly effective in selected elderly patients with SMIs.

Amisulpride for older patients with long-standing schizophrenia.

A large and growing number of older people across the world experience schizophrenia. Recommendations for their treatment are largely based on data extrapolated from studies of the use of antipsychotic medications in younger populations. The present study was designed to evaluate the efficacy and safety of amisulpride monotherapy in a diagnostically homogeneous group of elderly patients without cognitive impairment experiencing schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for schizophrenia). Mortality and rehospitalization for a 5-year period were the predefined outcome measures. We conducted a retrospective chart review of all elderly (60 years and older) schizophrenia patients treated in a large tertiary care center. Of the 527 elderly schizophrenia patients for a 5-year period (2007-2013), 30 patients, mean (SD) age of 67.5 (5.8) years, were treated with amisulpride monotherapy. There were 19 women and 11 men in the analyzed group. Mean duration of disease was 34.4 years. All had been exposed to at least 3 first- and second-generation antipsychotics before amisulpride treatment. Amisulpride was very well tolerated by the patients, and mortality rate (10% vs 19%) was significantly lower than that of other first- and second-generation antipsychotics (P < 0.02). Rehospitalization rates with amisulpride were significantly lower than those with other second-generation antipsychotics (P < 0.001). We tentatively conclude that our preliminary results demonstrate that amisulpride is an efficacious and safe atypical antipsychotic for the treatment for elderly schizophrenia patients.

Psychosocial and medical aspects of older suicide completers in Israel: a 10-year survey.

OBJECTIVES: The rate of completed suicide among the elderly continues to be the highest of any age group worldwide. The aim of the present study was to investigate the sociodemographic data, mental and physical health characteristics, and suicide methods of the elderly population who completed suicide in Israel. METHODS: A national retrospective record-based case series study of consecutive elder (50 years or older) suicide completers who had undergone autopsy over a 10-year period was conducted. RESULTS: Three hundred and fourteen consecutive records of suicide completers, 69.6% males, and mean age 64.7 were analyzed. The largest group (38%) emigrated from the Former Soviet Union and 19% emigrated from East Europe. Immigrants from East Europe committed suicide at an older age. Hanging was the predominant suicide method. Jumping from height increased more than threefold in the 'old-old'(older than 75 years) group. Hanging and firearms were more frequently used by males. Females were more likely to employ poisoning and suffocation. A significant minority (30%) had been diagnosed as suffering from psychiatric morbidity. Most common diagnoses were depression and alcohol abuse or dependence. Physical disorders (mainly cardiovascular disease and malignancy) were present in 27% of cases. Subjects with psychiatric illness were more likely to complete suicide at a younger age compared with subjects with physical illness. CONCLUSIONS: Findings of male predominance, psychiatric morbidity, and physical illness are consistent with previously published studies. Immigrants from East Europe completed suicide at an older age and the older victims had used more lethal methods of suicide.

Risk of prostate cancer in patients with schizophrenia.

OBJECTIVES: To examine the rate of prostate cancer in a cohort of schizophrenia in-patients in the PSA-era as compared to expected rates. There is conflicting evidence on the relative risk of prostate cancer in men with schizophrenia. METHODS: the study sample was comprised of schizophrenia patients who had been admitted to a tertiary care mental health center between 1990 and 2011. The data for the sample was cross-referenced with the National Cancer Registry. Analyses of Standardized Incidence Rates (SIR) for prostate cancer and for lung cancer (representing an organ system not sensitive to sex hormones) were performed. RESULTS: Of 4,326 schizophrenia patients included in the present study, 181 (4.2%) were diagnosed with cancer at any site. Only 10 of these patients were diagnosed with prostate cancer. This reflects a reduced risk; SIR of 0.56 (95% CI 0.27-1.03). In the same cohort, 33 schizophrenia patients were diagnosed with lung cancer presenting a SIR of 1.43 (95% CI 0.98-2.01) in this sample. CONCLUSIONS: The present study suggests a reduced rate of prostate cancer in patients admitted for schizophrenia. There are several possible explanations for this finding including chronic state of hyperprolactinemia induced by antipsychotic drugs.

[Survival following the first admission in an integrated dual disorders treatment ward (IDDTW): preliminary results from a cohort study].

BACKGROUND: Dual disorders (co-occurring severe mental illness [SMI] and substance abuse disorders in the same person) are extremely common among patients receiving mental health services. Dual disorders are associated with increased all-cause mortality, as compared with patients with SMI. Scientific evidence is lacking on the survival of dual disorders subjects, who had psychiatric inpatient care. OBJECTIVE: To determine the long term survival rates of patients after the first admission in an IDDTW and to identify their baseline predictors. METHODS: The charts of 258 subjects admitted to IDDTW during the period 2002-2004 were assessed at least 8 years after the first admission. Psychiatric diagnoses were established and grouped according to the International Statistical Classification of Diseases and Related Health Problems 10th edition (ICD-10). The Kaplan-Meier survival analysis was used to estimate the cumulative survival rates, and the predictive values of different variables were assessed by Cox proportional-hazards regression model. RESULTS: The cumulative 1-, 2-, 4-, 6- and 8-year survival rates of all subjects were 98.06%, 96.51%, 91.47, 86.43% and 81.78%, respectively, without statistically significant differences between subgroups of psychiatric diagnoses. Multivariate Cox regression analysis revealed that the age at death was the only independent predictor of all-cause mortality (hazard ratio = .96; 95% confidence interval .93 to .99; p < .009). CONCLUSIONS: Those of young age are at a particularly low risk of long term survival. More targeted health care is required to address the specific needs of this vulnerable subgroup. Further research of survival into specific risk groups is required.

Debunking the placebo effect in depression: the effect of patient and investigator expectation on escitalopram efficacy.

In approximately half of the major depressive disorder (MDD) antidepressant trials published in the last decade, 30% or more of the patients assigned to the placebo arm showed clinically significant improvements. Attempts to reduce the placebo effect in a variety of ways have proven mostly unsuccessful. The aim of this study was to determine whether trial design has an effect on the efficacy outcome in a mock placebo versus escitalopram treatment of adult outpatients with MDD. An 8-week study was designed to evaluate the placebo effect on the response to fixed doses of escitalopram (10 and 20 mg/day) in patients with MDD. The variables affecting placebo response evaluated were as follows: patient expectation, rater expectation, three different outcome measures and the number of visits during the study. Investigators were blinded to the inclusion and exclusion criteria. Forty patients were randomized to receive what they and their treating physicians conceived of as double-blind treatment. The mean age of the patients in the group was 45.1 years, 19 women (47.5%) and 21 men. The mean change from baseline to week 8 in the Montgomery-Åsberg Depression Rating Scale total score was -13.7 for participants with 'monthly' visits and -12.9 for the 'fortnightly' group (P=0.75). In each group, 14/16 responders and their physicians thought that they were receiving active treatment. Of 22 nonresponsive patients, 17 thought that they had been receiving placebo. The pharmacological effect of escitalopram observed in the present study is almost identical to that observed in open-label studies, even when patients and clinicians are misled by the study design, placebo presence or raters' blindability.

Real-life decision making of Serious Mental Illness patients: Opt-in and opt-out research participation.

BACKGROUND: Patients' decisions in relation to participation in clinical research depend on individual values and relevant outcomes. Presenting possible decisions by way of defaults (opt-in or opt-out) has been used to achieve desired outcomes. Our objective was to characterize patients willing to participate in clinical research and to assess the impact of defaults on patients with Serious Mental Illness (schizophrenia, schizoaffective disorder, major depression and bipolar disorder; SMI) during the decision process. METHODS: Patients with SMI were requested to accept or reject participation in a novel drug treatment study using either the (1) opt-in condition, wherein they were told that our center's policy is not to include them in drug studies; (2) the opt-out condition, wherein they were told that our center's policy is to include them in drug studies; and the (3) neutral condition that required patients to state their preference with no prior information. RESULTS: 311 patients with SMI completed the brief questionnaire within 48 hours of admission to a psychiatric ward. There were 227 (73%) patients suffering from schizophrenia and schizoaffective disorder, 40 (13%) suffering from bipolar disorder and 44 (14%) suffering from major depressive disorder. There were 156 men (50%) and 155 women in the sample, mean age 47.8±16.2 years. In the opt-in condition, 58% abstained, while 42% opted-in (p=0.003). In the opt-out condition, 58% participated, while 42% opted-out. In the neutral condition 51% indicated willingness to participate, 33% refused and 16% were undecided. The "willing" patient was characterized by younger age, previous hospitalizations, affective illness and more comorbid physical disorders. CONCLUSION: Taken together these findings reveal the "profile" of patients with SMI willing to participate in clinical research and demonstrate an increase in participation preferences through the use of defaults.

Evaluating the clinical impact of involuntary admission to a specialized dual diagnosis ward.

BACKGROUND: We aimed to identify characteristics and outcomes of involuntary and voluntary admissions of dual-diagnosis patients in a single, large mental health center in Israel. METHODS: Using a retrospective chart review methodology, 24 patient records were reviewed spanning a period of five years; clinical and demographic variables of voluntary and involuntary admissions were compared. RESULTS: No significant differences were found in sociodemographic characteristics, admission diagnosis and length of hospitalization between the two types of admission. A smaller proportion of patients discharged from involuntary admissions were in remission compared to those discharged from voluntary admission. Nevertheless, involuntary admissions were associated with longer time to next hospitalization. LIMITATIONS: The data were based on a small number of patients in a single ward, thus the generalizability of the results is uncertain. CONCLUSIONS: The finding of the current study that involuntary admission leads to longer tenure in the community suggests that there may be clinical advantages to involuntary admissions for certain dual diagnosis patients.

[Impact of chronic hepatitis C virus (HCV) on survival of schizophrenic patients with co-occurring substance use disorders followed for ten years].

BACKGROUND: Despite disproportionately high rates of HCV infection among patients with schizophrenia and co-occurring substance use disorders, to date, scientific evidence for their survival is lacking. AIM: The objective of this study was to compare long term survival among this population with and without persisting HCV. METHODS: Charts of 212 subjects admitted during a period from January 1, 2002 to December 31, 2005 were assessed. Psychiatric diagnoses have been established according to international classification of diseases and health related problems--10th edition (ICD-10). The Kaplan-Meier survival analysis was used to estimate the cumulative survival rates. The association between HCV and mortality was estimated using the Cox proportional hazard regression models, with adjustments for potential confounders. The main outcome was all-cause mortality. Median observation time was 10.0 years. RESULTS: Period prevalence of HCV was 16.0%. Total all-cause, unadjusted mortality was 50.0% in populations with HCV versus 12.9% in populations without HCV (p < .00001, log rank test]. In Cox regression, mortality was higher for the population with HCV (adjusted hazard ratio = 2.07; 95% confidence interval = 1.4-3.0, p < .0001. CONCLUSION: The high mortality of schizophrenic dual disorders patients with HCV necessitates new approaches to secondary and tertiary prevention to reduce the burden of chronic liver disease and to improve survival for those who already have evidence of liver disease. The strong adverse effect of HCV on survival should encourage clinical trials including schizophrenic patients with dual disorders, to ascertain whether patients benefit from treatment choices. It is essential that adequate resources and strategies are targeted to the schizophrenic patients with dual disorders with HCV.

Asenapine for elderly bipolar manic patients.

BACKGROUND: Bipolar disorder (BPD) in the elderly is probably heterogeneous and its etiopathogenesis is complex. The data for the treatment of late-life BPD are limited. Asenapine is approved in the United States for acute treatment of manic or mixed episodes of bipolar I disorder with or without psychotic features. AIM: We report the results of acute treatment with asenapine in elderly patients with BPD. METHOD: Elderly patients (N=11), mean age: 67.7 ± 6.1 years, consecutively admitted to the psychogeriatric ward due to acute bipolar mania were treated by asenapine 10mg/BID monotherapy for 4 weeks. Safety and tolerability assessments included adverse events (AEs), laboratory values, and anthropometric measures. Response, a secondary assessment, was measured as change in Young Mania Rating Scale (YMRS) total score from baseline to week 4. RESULTS: One patient developed a rash on day 6 of treatment and one patient developed peripheral edema on day 14 of treatment. Both AEs resolved rapidly following discontinuation of asenapine. Only mild sedation was reported by three patients. In all cases, mean (± SD) change (improvement) in YMRS total score at week 4 was -21.4 ± 12.9 and 7/11 (63.6%) of patients remitted (YMRS≤12). CONCLUSION: In this small open-label study of elderly patients with bipolar mania, acute treatment with asenapine was well tolerated and effective.

Venlafaxine or a second SSRI: Switching after treatment failure with an SSRI among depressed inpatients: a retrospective analysis.

BACKGROUND: Approximately 50% of patients with major depressive disorder (MDD) do not respond after adequate first-line treatment with a selective serotonin reuptake inhibitor (SSRI). Special interest is paid to whether specialist level inpatient psychiatric care results differ from community studies. AIM: To compare switching alternatives after treatment failure with an SSRI; switching to venlafaxine (Dexcel Pharma Israel) versus switching to another SSRI in depressed inpatients. METHOD: A retrospective register study of inpatients was undertaken in a psychiatric tertiary care university center serving an urban catchment area in Israel with a population of more than 900,000. RESULTS: A total of 401 MDD inpatients were assigned to antidepressant treatment. Of these, 232 records (47 venlafaxine, 185 SSRI) were included in the analysis. Patients assigned to venlafaxine treatment were older (mean age 64.3 ± 15 years versus 53.6 ± 17; p<0.01) and had more comorbid physical disorders (80% versus 57%; p<0.001). In the primary analysis, there was no statistical difference between groups in reduction in CGI-S total scores. The secondary end point of achieving a CGI-S score of 2 or less (1 = normal, not at all ill or 2 = borderline mentally ill) was statistically significantly better for the venlafaxine treated inpatients (P=0.02). AEs were reported less than 10% of patients in both groups. CONCLUSION: Patients who remain severely depressed following treatment with an SSRI may gain benefit from the dual-action drug venlafaxine, rather than switching to another SSRI. These findings need to be further supported by prospective studies.

The role of environmental influences on schizophrenia admissions in Israel.

OBJECTIVE: The role of environmental factors in hospitalization of patients with schizophrenia is incompletely understood. This study attempts to relate the pattern of hospital admissions to environmental variables such as season and to social factors such as nationally celebrated holidays. METHODS: Charts of all adults (n = 4,331) with a discharge diagnosis of schizophrenia admitted to the Abarbanel Mental Health Centre (Bat Yam, Israel) between 1 January 2001 and 31 December 2005 were reviewed. Hospitalizations were classified by gender, first or repeat admission, month and season of admission, and whether or not the admission coincided with a major Jewish holiday period. RESULTS: There was a significant reduction (p < 0.05) in first admissions for men during April, the month corresponding to Passover, the most widely celebrated holiday in Israel. This pattern was not seen for women or for repeat admissions. There was no significant effect of the season upon admission rates, using two different methods of defining the season. CONCLUSIONS: This study demonstrated significant monthly variability in admission rates and a possible protective effect of a widely celebrated public religious holiday. A consistent effect of season upon rates of admission was not found. Future studies need to identify which specific social factors exert a protective or harmful effect and study how knowledge of these effects can be translated into clinical practice.