Double-blind, controlled trial of inositol treatment of depression.

OBJECTIVE: CSF levels of inositol have been reported to be lower than normal in depressed subjects. The authors administered inositol to depressed patients in a double-blind, controlled trial. METHOD: Under double-blind conditions, 12 g/day of inositol (N = 13) or placebo (N = 15) was administered to depressed patients for 4 weeks. RESULTS: The overall improvement in scores on the Hamilton Depression Rating Scale was significantly greater for inositol than for placebo at week 4. No changes were noted in hematology or in kidney or liver function. CONCLUSIONS: This may be the first use of the precursor strategy for a second messenger rather than a neurotransmitter in treating depression. Although inositol had a significant antidepressant effect in this study, replication is crucial.

Disabling compulsions in 11 mentally retarded adults: an open trial of clomipramine SR.

BACKGROUND: Clinicians and researchers who work with mentally retarded subjects have reported on the frequent exhibition of mental disorders and behavioral problems in this population. Rituals are often among the disturbances described. We decided to treat disabling cleaning and collecting compulsions in mentally retarded adults with clomipramine 75 mg/day, sustained release (SR) preparation. METHOD: The 8-week trial included 11 subjects, mean age of 24.1 years (range, 21-27) with a mean +/- SD I.Q. of 65.0 +/- 11.0. The majority of subjects (N = 9) were occupied with washing rituals that took hours to complete. Subjects were started on a schedule of 32.5 mg of clomipramine SR once daily for 1 week, then received 75 mg SR once daily for an additional 7 weeks. RESULTS: Improvement was assessed by using the National Institute of Mental Health Global Obsessive Compulsive Scale and the Global Improvement score of the Yale-Brown Obsessive Compulsive Scale. Statistically significant reduction in severity of rituals (p < .05) was found at the trial's completion. CONCLUSION: Once-daily clomipramine SR 75 mg is effective in treating adults with mental retardation and disabling rituals.

Maintaining schizophrenic patients on benzodiazepines.

The role of benzodiazepines (BZDs) in the treatment of schizophrenia is widely researched since the sixties. Nevertheless the role of BZD's as sole agents for the maintainance phase in pharmacotherapy of schizophrenic patients received little attention. We have conducted a retrospective review of all medical records of ambulatory schizophrenic patients in an out-patient setting receiving only BZD maintainance treatment. Three factors characterized these patients: long duration of illness, few hospitalizations and a relatively low dose response to BZD's.

Survey of patient satisfaction in adult psychiatric outpatient clinics.

A client satisfaction survey was undertaken in two adult psychiatric outpatient clinics. The anonymous self-report questionnaire covering demographic, setting and satisfaction with service variables was endorsed by 203 participants. The mean age of the subjects was 42.5 +/- 19 years, with a small majority (58.6%) of females. Overall satisfaction with psychiatric care was high (79.8%). None of the demographic or setting variables correlated significantly with satisfaction. Psychoeducation was significantly correlated with level of satisfaction with services. These findings further emphasize the importance of psychoeducation by service providers in mental health.

The impact of the Gulf War on the mental health of schizophrenic patients.

The Gulf War, which took place during January-February 1991, strongly affected the lives of Israeli civilians. The missiles that landed on the home front were a threat to the entire civilian population, thus differentiating the Gulf War from prior Israeli wars (Danon and Shemer 1991). This was similar to the London blitz during World War II (Scoville 1942).

Lifelong posttraumatic stress disorder: evidence from aging Holocaust survivors.

Despite the fact that 50 years have passed since the Nazi regime and the Holocaust the psychic sequelae are far from being overcome. The majority of Holocaust survivors and World War II veterans still list their experiences as the "most significant stressors" of their lives. The literature provides ample evidence that posttraumatic stress disorder among survivors persists into old age. However, there is still a need to define the differences in frequency, clinical presentation, severity, and comorbid conditions among aging Holocaust survivors. Age at the time of trauma, cumulative lifetime stress, and physical illness are reported to have a positive association with more severe posttraumatic symptomatology. The presence of comorbid Axis i psychiatric disorders (Diagnostic and Statistical Manual [DSIVI]), has been the focus of research by our group, demonstrating that their interaction with earlier trauma leads to a course of chronic, debilitating disease. Despite reactivation of traumatic symptoms during aging and continuous mental suffering, the majority of Holocaust survivors show good instrumental coping and preserved functioning.

The assassination of Yitzhak Rabin. Its impact on therapists and patients.

The tragedy of the assassination of the prime minister, Yitzhak Rabin, affected the entire population, regardless of individual mental states. The event influenced the therapeutic situation and gave rise to questions of the limitations and boundaries of treatment. The patients reacted and coped with greater or lesser intensity, according to their abilities, as did the rest of the population. The therapists encountered difficulties in their efforts to continue routine work while dealing with the influence of the event on the patients and on themselves. The attempts of an out-patient clinic to work and deal with these issues are discussed.

[Between "transparent room" and "sealed room:" professional confidentiality and therapeutic judgement].

Patients and therapists are concerned with the complexities of protecting medical confidentiality. The traditional perception of protection of patient confidentiality is that the individual's interest in protecting his confidentiality may conflict with the public's need for information, especially in cases involving possible danger. In fulfilling his dual role of representing both the patient and the public, the therapist acts according to existing laws and regulations. We describe 3 cases in which refraining from providing the Army with information in accordance with the law was recognized in retrospect as having caused the patient suffering, and even danger. It is recommended that the therapist's judgement be considered in addition to other legal criteria for determining whether or not to protect patient confidentiality.

Screening for Human T-cell Lymphotrophic Virus type-I (HTLV-I) infection in high risk schizophrenic patients.

The Mashhadi-Jewish community originating in Iran is a closed and ethnically segregated population with a unique history and a high rate of intra-familial marriage among its members. High infection rate (23%) by Human T-Lymphotrophic Virus type-I (HTLV-I) was found in this population. The known modes of HTLV-I transmission are by sexual intercourse, from mother to child in breast milk, via blood transfusion, and by sharing of needles by parenteral drug users. In the present study we examined the presence of HTLV-I infection in high-risk psychiatric patients of Iranian origin in order to evaluate the infection rate in socially isolated subjects. We screened and examined all (N=42) Iranian-born schizophrenic patients in our center, of whom 17 were Mashhadi subjects (7 females, 10 males, mean age 48.7±13.2 years), and 25 were born in Iran in other cities than Mashhad (12 females, 13 males, mean age 43.2±11.9). Blood samples were tested for HTLV-I antibodies by particle agglutination test. The polymerase chain reaction (PCR) was used to detect HTLV-I proviral DNA sequences from peripheral blood mononuclear cells. One Mashhadi-born Jew (5.9%) was seropositive and PCR-positive for HTLV-I. None of the schizophrenic non-Mashhadi Iranian subjects was positive for HTLV-I by either method. This infection rate in schizophrenic patients of Mashhadi origin is significantly lower than rates reported for the normal Mashhadi community. We suggest that the relative isolation imposed by the stigma associated with mental illness and recurrent psychiatric hospitalizations serve to protect this sub-group from HTLV-I infection.

The therapist and the patient: coping with noncompliance.

In the mental health clinic, the psychotherapist must cope with a multitude of diagnostic and therapeutic challenges. Extensive efforts are expended in reaching a diagnosis and a decision regarding treatment. Despite these efforts, the patient may fail to comply with the recommendations for treatment. Noncompliance has a wide variety of manifestations. One of the major reasons for noncompliance concerns the relationship between the patient and the physician, forcing the therapist to take an active part. Manifestations of noncompliance usually arouse countertransference reactions in therapists, who feel that this behavior exemplifies a lack of trust in them and in the corpus of knowledge they represent. Unique to the therapist's work in the mental health clinic is the need that sometimes arises to begin intervention before a basis for treatment has been established or an initial treatment contract achieved. In certain cases, observation is the only psychotherapeutic intervention possible. Much time may elapse until a therapeutic contract is established, and sometimes it is not established at all.

Hoarding--what does it mean?

Collecting is a normal phenomenon, in contrast with pathological collecting, or hoarding. Is hoarding a different phenomenon, or an extreme aspect existing on the same spectrum of behavior? How may these phenomena be understood when they are part of everyone's repertoire on one hand, but may be symptomatic of a grave disturbance on the other hand. An overview and a discussion of hoarding are presented.

Holocaust survivors hospitalized for life: the Israeli experience.

The Holocaust was the most traumatic experience to occur in the 20th century. The present study aims to assess elderly Holocaust survivors in a long-stay psychiatric setting. Data concerning hospitalized survivors were gathered from medical records, repeated interviews (Structured Clinical Interview for DSM-III [SCID]) with patients, and family interviews. Subjects were all inpatients at Israel's largest psychiatric hospital, Abarbanel Mental Health Center. Patients hospitalized in the same setting who did not undergo the Holocaust were the comparison group. Of the center's 670 beds, 74 (11%) are designated for psychogeriatric patients. Forty-four (59.5%) patients in the psychogeriatric section are Holocaust survivors. There were 41 women and three men in our series. Mean age of the group was 76.2 years (range, 54 to 92). The most frequent diagnosis was schizophrenia (22 of 44). Nearly 30% had been hospitalized chronically since the Holocaust. Mean current hospitalization time was 11.2 years (range, 1 to 45). The frequent diagnosis in the comparison group was also schizophrenia (20 of 30), but indexes of chronicity were more favorable. The severity and the chronic, deteriorating course of illness in this subgroup of survivors may be due to the massive life-long psychologic disintegration imposed by the Holocaust.

The "re-entry group"--a transitional therapeutic framework for mentally ill patients discharged from the hospital to community clinics.

An effective transition of the psychiatric patient from the hospital to the community clinic is vital to the continuity of care. This study shows a short-term group, the "re-entry group," to be more effective in this transition than are patients discharged from a psychiatric hospital by the traditional process. We used a psychoeducational approach to facilitate active participation and compliance with outpatient therapy. Outcome variables included absorption of patients into the clinic, continued therapy, compliance with treatment, rehospitalization, level of knowledge regarding illness and medication, quality of rehabilitation, and attitude towards treatment.