Alterations in plasma endocannabinoid concentrations among individuals with major depression treated with electroconvulsive therapy.

The role of the endocannabinoid system (ECS) in depression and suicidality has recently emerged. The purpose of the study was to identify changes in plasma endocannabinoid concentrations of several endocannabinoids and correlate them with depressive symptoms and suicidality in patients with severe major depression undergoing electroconvulsive therapy (ECT). The study included 17 patients that were evaluated in four visits at different stages of therapy. At each visit depression, anxiety and suicidality symptoms were assessed and blood samples collected. Several endocannabinoid concentrations increased following six sessions of ECT, as 2-AG (p < 0.05) and LEA (p < 0.01), and following twelve sessions of ECT, as 2-AG (p < 0.05), AEA (p < 0.05), LEA (p < 0.05) and DH-Gly (p < 0.05). Endocannabinoids also correlated with symptoms of depression, anxiety and suicidality at baseline and at the sixth ECT session. Finally, we found one endocannabinoid, l-Gly, that differentiated between remitted and not-remitted patients at the seventh and thirteenth ECT sessions (p < 0.05). Our findings suggest that depression is markedly related to imbalance of the endocannabinoid system, and further regulated by ECT. Plasma endocannabinoids could be promising biomarkers for detection of depression response and remission.

[SEXUAL TRAUMA INQUIRY DURING PSYCHIATRIC HOSPITALIZATION IN ISRAEL: FACILITATORS AND BARRIERS TO IMPLEMENTATION OF TRAUMA-INFORMED CARE].

INTRODUCTION: A history of sexual trauma (ST) and, especially, of childhood sexual abuse (CSA) is common among men and women with mental disorders. The estimated prevalence ranges between one-third to two-thirds of psychiatric patients who have experienced sexual trauma. These survivors are at increased risk for developing psychiatric disorders, including schizophrenia and bipolar disorder. Despite the great prevalence of sexual trauma and its mental implications, it remains under-diagnosed and under-recognized within the mental health system in Israel, as well as worldwide. This is due to the absence of a suitably comprehensive procedure for taking patient histories that will uncover sexual trauma. A history of sexual trauma also has implications for the course of the illness and prognosis. Trauma-informed treatment for survivors can reduce symptoms and alleviate mental suffering even many years after the traumatic events.

The Impact of 'Being There': Psychiatric Staff Attitudes on the Use of Restraint.

The practice of mechanically restraining psychiatric patients is constantly under debate, and staff attitudes are considered a central factor influencing restraining practices. The aim of this study was to explore associations between psychiatric staff members' presence and participation in incidences of restraint and attitudes towards mechanical restraints. METHODS: Staff members (psychiatrists, nurses, paramedical staff; N = 143 working in a government psychiatric hospital in Israel) completed a questionnaire including personal information, participation in incidents of restraint and attitudes towards mechanical restraints. Items were categorized into the following categories: security and care; humiliation and offending; control; order; education and punishment. RESULTS: Compared to those who were not present during restraint, staff members who were present agreed significantly less with statements indicating that restraints are humiliating and offending and agreed more with statements indicating that restraints are used primarily for security and care (p < .05). Among those present in incidences of restraint, staff members who physically participated in restraint agreed significantly more with statements indicating that restraints are a means for security, care and order, and less with statements indicating restraints are humiliating and offending, compared to those present but not physically participating in restraint (p < .05). CONCLUSIONS: These findings highlight the importance of proximity of staff members to incidences of restraints. This may have implications in understanding the professional and social discourse concerning mechanical restraints.

Enhancing the Safety Climate and Reducing Violence Against Staff in Closed Hospital Wards.

This study examined the effectiveness of an intervention program to enhance unit safety climate and minimize employee risk of injury from patient violence. The intervention program, including a 3-day workshop, was offered to personnel on maximum security units of an Israeli psychiatric hospital. Safety climate was examined before and after the implementation of the intervention, and incidents of patient violence were investigated. Six months after the intervention, a significant improvement in employees' perceptions of management's commitment to safety as well as a marginally significant improvement in communication about safety issues were found. This study demonstrated that an intervention program to enhance safety climate was associated with a decrease in the number of aggressive incidents. The researchers concluded that this intervention program is likely to return a sense of safety to workers and reduce workplace violence.

Short-term Focused Inpatient Treatment Combined with Sensory Regulation of Sexual Trauma Victims - Summary of 100 First Hospitalizations.

BACKGROUND: Treatment of sexual trauma victims may be fraught with crises. In situations of de-compensation, the frequency of suicide attempts is high, and ambulatory treatment may not always provide the required response. In extreme cases, either in close proximity to the sexual offence or even years later, a more intense intervention is needed. This includes removing sexual trauma victims from their daily lives and hospitalization. Caregivers debate the type of hospitalization needed and the best type of treatment in times of decompensation and dissociation. METHOD: This paper depicts a hospitalization model in Israel that has been created to provide a unique and focused solution for sexual trauma victims. The psychological principle of the hospitalization is based on Mann's shortterm dynamic psychotherapy method. The patients are integrated in an acute psychiatric ward in which a variety of psychopathologies, men and women, are treated. RESULTS: The paper summarizes findings and understandings from the first 100 hospitalizations. The author's main conclusion is that sexual trauma victims need a focused specialized treatment plan to best deal with their complex issues and that hospitalization should be minimized to two weeks. CONCLUSIONS: The author's main recommendation is that funding must be allocated for hospital beds for sexual trauma victims in each region in the country to produce adequate continuity of care for these patients.

Late-onset psychosis and risedronate treatment for osteoporosis.

As women age and enter menopause, they are sometimes more susceptible than men to certain physical and mental disorders such as osteoporosis and late-onset schizophrenia. Risedronate (Actonel©) is a bisphosphonate used for the treatment of osteopenia. Early initiation of pharmacotherapy for osteopenia is recommended to prevent greater bone loss. The most common side effects of risedronate include fever and flu-like symptoms, hypocalcemia, bone and joint pain, peripheral edema, fatigue, change in bowel movements, osteonecrosis of the jaw, and atrial fibrillation. Though reports in the professional literature of psychotic reactions to risedronate are scant, there have been FDA reports as well as patient discussions of psychiatric side effects from this medication on popular websites. We report the case of M, age 59, who was treated with risedronate for osteoporosis, and was subsequently diagnosed with atypical psychosis after other organic causes were excluded. Though it is conceivable that age-related psychosocial and physical factors triggered late-onset schizophrenia, the temporal relationship between the termination of treatment with risedronate and the improvement in her mental state suggests that the risedronate might have triggered a psychotic reaction that resolved following cessation of treatment.

Control: patients' aggression in psychiatric settings.

Psychiatric patient assaults on staff are a serious problem, affecting staff, patients, and organizations. To understand the etiology of aggressive events, researchers have documented characteristics of aggressive patients, their victims, and to a lesser degree, the patient-provider interaction. Missing in the literature is how staff's different perceptions of aggressive incidents might impact their reactions. In this study, we conducted in-depth, semistructured interviews with 11 health care professionals working in a psychiatric ward in one Israeli psychiatric hospital. Through content analysis, we revealed two main themes: patients' and providers' controllability over patients' aggression. From the intersection of these two themes, four prototypes of the aggressive encounter emerged: the power struggle, the therapeutic encounter, inverse power relations, and victim-to-victim encounters, each distinctively characterized by different emotional, cognitive, and behavioral responses. We discuss our findings in light of attribution theory, which carries important theoretical and practical implications for handling aggression.

Management of the suicidal patient in the era of defensive medicine: focus on suicide risk assessment and boundaries of responsibility.

Suicide is universal within the range of human behaviors and is not necessarily related to psychiatric morbidity, though it is considerably more prevalent among psychiatric patients. Considering the limitations of medical knowledge, psychiatrists cope with an unfounded and almost mythical perception of their ability to predict and prevent suicide. We set out to compose a position paper for the Israel Psychiatric Association (IPA) that clarifies expectations from psychiatrists when treating suicidal patients, focusing on risk assessment and boundaries of responsibility, in the era of defensive medicine. The final draft of the position paper was by consensus. The IPA Position Paper established the first standard of care concerning expectations from psychiatrists in Israel with regard to knowledge-based assessment of suicide risk, elucidation of the therapist's responsibility to the suicidal psychotic patient (defined by law) compared to patients with preserved reality testing, capacity for choice, and responsibility for their actions. Therapists will be judged for professional performance rather than outcomes and wisdom of hindsight. This paper may provide support for psychiatrists who, with clinical professionalism rather than extenuating considerations of defensive medicine, strive to save the lives of suicidal patients.

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.

Angiotensin converting enzyme gene insertion/deletion polymorphism: case-control association studies in schizophrenia, major affective disorder, and tardive dyskinesia and a family-based association study in schizophrenia.

Angiotensin converting enzyme (ACE) is a candidate gene for psychiatric disorders. We examined the frequency of a functional insertion/deletion (I/D) polymorphism in the 16th intron of the ACE gene (located on chromosome 17q23) in groups of patients with schizophrenia (n = 104 and 113), major depression (n = 55), and bipolar disorder (n = 87) compared to healthy control subjects (n = 87). There was no evidence for allelic or genotypic association of the polymorphism with any of the disorders or with tardive dyskinesia (TD) in patients with schizophrenia. In a sample of nuclear families (n = 61) made up of one or more patients with schizophrenia recruited with their parents, there was no evidence for biased transmission of ACE I/D alleles. Particularly in the case of schizophrenia, these findings do not support an association of the ACE I/D polymorphism with the phenotypes examined.