[A FOLLOW-UP OF FACTORS ASSOCIATED WITH READMISSION OF PATIENTS IN BEER SHEVA MENTAL HEALTH CENTER DURING 2015 - 2018].

INTRODUCTION: In recent years, there is a significant increase in the "revolving door" phenomenon, when patients, discharged from psychiatric hospitals, return to hospitalization in less than a month. During the last decade, experience with clinical activity at the Beer- Sheva Mental Health Center raised a question regarding whether there is a similar trend in our center as well.

[NONINVASIVE BRAIN STIMULATION IN NEUROPSYCHIATRIC DISORDERS].

INTRODUCTION: Noninvasive brain stimulation is a growing field of treatment for many neuropsychiatric problems. In this review, several of the more common brain stimulation devices are presented. Specifically, we will review Transcranial Magnetic Stimulation (TMS), Transcranial Direct Current Stimulation (tDCS), Alternating Current Stimulation (ACS), Infrared Stimulation, Electroencephalography Neurofeedback (EEG-NF) and functional Magnetic Resonance Imagining Neurofeedback (fMRI-NF). We will outline some of the properties of these devices including the mechanism, side effect profile, using sham for research and major future developments.

[FUNCTIONAL SOMATIC SYNDROMES AMONG ETHIOPIAN IMMIGRANTS IN ISRAEL].

INTRODUCTION: The psychiatric classifications of disease (DSMIV; ICD-10) relate to a family of high incidence somatoform disorders whose use isn't uniform and cannot be measured. DSM-5 presents the term "cultural conceptualization of distress", which attempts to describe the cultural construct and its influences on mental distress and symptom presentation. Somatization among immigrants poses a diagnostic, treatment and research challenge due to cultural differences such as wrong understanding of their symptoms that may lead to misdiagnosis and to prescribing wrong and possibly harmful treatment and unnecessary hospitalization. This challenge is greater when encountering Ethiopian new immigrants due to the significant doctor-patient cultural gaps on one hand, and the community's heterogeneity, on the other. The Integrative Culture Sensitive Assessment and Treatment Model helps structure the diagnostic and treatment processes appropriately. METHODS: Two culture-related functional somatic disorders are presented, alongside with their diagnosis and treatment: The "Ken-Ken" syndrome (worms in the ear) - where the patient complains worms have entered her ear and head influencing her daily functioning, and the "prolonged pregnancy" syndrome, where the menopausal woman believes she is pregnant for many years and that the fetus "has turned into bone". DISCUSSION: This article presents the somatization mechanism via two culture-related case studies of Ethiopian new immigrants to Israel suffering from emotional distress via culturally different symptomatology. It further presents an integrated cultural oriented treatment approach as a way to reduce overuse of primary and secondary medical services.

Food insecurity and mental health: a pilot study of patients in a psychiatric emergency unit in Israel.

The objective of this study was to examine food insecurity among psychiatric patients and as a concern for mental health practitioners. Food security and psychological distress were measured among 113 patients hospitalized in a psychiatric emergency unit. Of 113 respondents 67 (59.3%) enjoyed food security and 46 (40.7%) lacked food security. Food insecure respondents showed a higher level of psychological distress than food secure respondents. A large proportion of in-patients may be suffering food insecurity which is negatively associated with their psychological well being. Mental health practitioners need to be aware of the potential association of food insecurity and mental distress among psychiatric patients.

Repetitive transcranial magnetic stimulation of the right dorsolateral prefrontal cortex in posttraumatic stress disorder: a double-blind, placebo-controlled study.

OBJECTIVE: The efficacy of repetitive transcranial magnetic stimulation (rTMS) of the right prefrontal cortex was studied in patients with posttraumatic stress disorder (PTSD) under double-blind, placebo-controlled conditions. METHOD: Twenty-four patients with PTSD were randomly assigned to receive rTMS at low frequency (1 Hz) or high frequency (10 Hz) or sham rTMS in a double-blind design. Treatment was administered in 10 daily sessions over 2 weeks. Severity of PTSD, depression, and anxiety were blindly assessed before, during, and after completion of the treatment protocol. RESULTS: The 10 daily treatments of 10-Hz rTMS at 80% motor threshold over the right dorsolateral prefrontal cortex had therapeutic effects on PTSD patients. PTSD core symptoms (reexperiencing, avoidance) markedly improved with this treatment. Moreover, high-frequency rTMS over the right dorsolateral prefrontal cortex alleviated anxiety symptoms in PTSD patients. CONCLUSIONS: This double-blind, controlled trial suggests that in PTSD patients, 10 daily sessions of right dorsolateral prefrontal rTMS at a frequency of 10 Hz have greater therapeutic effects than slow-frequency or sham stimulation.

Food insecurity among psychiatric patients and welfare clients in Israel.

BACKGROUND: Twenty-two percent of households in Israel experience food insecurity, and it is especially widespread in socio-economically distressed strata. Although their low socio-economic status renders psychiatric patients at risk for food insecurity, this issue has thus far been ignored in both practice and research. OBJECTIVE: To explore food insecurity among psychiatric patients in comparison with welfare-services clients in order to raise awareness of food insecurity in this population. METHOD: 114 respondents were recruited from among patients admitted to the emergency room and hospitalized in a mental health center in Beer Sheva; 555 respondents were recruited from among low-income clients of welfare service agencies in the Beer Sheva area. All respondents were surveyed with a self-report questionnaire and with the Food Security Core Survey Module (FSCSM). RESULTS: Forty percent of psychiatric patients and 59% of welfare-services clients reported food insecurity. The use of formal and informal support systems was lower among food-insecure psychiatric patients than among food-insecure welfare clients. CONCLUSIONS: Psychiatric patients appear to be a risk population for food insecurity; therefore planned interventions and specific food programs are called for.

Beneficial effects of caloric vestibular stimulation on denial of illness and manic delusions in schizoaffective disorder: a case report.

INTRODUCTION: Preliminary data suggests that caloric vestibular nerve stimulation (CVS) single session application of cold water to the left ear induces a clinically significant, short-lived beneficial effect on specific types of illness denial (i.e., anosognosia) and delusions (i.e., somatic type). METHODS: We recently studied the effect of left versus right ear ice water (4°C) CVS on delusions and insight of illness in a patient with manic episode due to schizoaffective disorder. The patient was evaluated at baseline, immediately after the CVS, and then at 20 minutes, 60 minutes, and 24 hours. The method was first applied to one ear and 4 days later to the other. To assess whether the effect is specific to mania we employed the same procedure in two other patients with schizophrenia who also demonstrated delusions and impaired insight. RESULTS: All three patients showed a difference favoring left versus right ear CVS that was maintained for 20 minutes, and diminished over a 60 minute period. EEG analyses showed a numerically non-significant increase in bilateral frontal and central alpha EEG band activation (more pronounced in the right hemisphere) with left but not right ear CVS 5 minutes after the CVS, and that diminished after 20 minutes. DISCUSSION: The results suggest that left versus right CVS may have a short lived beneficial effect on manic delusions and insight of illness that seem to appear in other types of psychoses (i.e., schizophrenia). CONCLUSION: These preliminary results suggest that single session CVS may have short lived beneficial effects in mania and perhaps in other types of psychoses. Further research is mandatory.

Repetitive transcranial magnetic stimulation in the treatment of depression in adolescents: an open-label study.

OBJECTIVE: This open-label pilot study examined repetitive transcranial magnetic stimulation as a possible treatment of adolescent resistant depression. METHOD: Nine adolescents (aged 16-18 years) with severe resistant depression (determined by SCID) were recruited, and their depression, suicidality, and cognitive functions were evaluated before, during, and after a course of twenty 10-Hz, 2-second trains (intertrain intervals of 58 seconds) given over 20 min/d over 14 working days. RESULTS: Lower levels of depression with progression in therapy were recorded by both the Beck Depression Inventory and Child Depression Rating Scale measures (F1.7,14.01 = 4.52, P < 0.05; F4,32 = 6.645, P < 0.01, respectively). Three patients reached the primary outcome measure of less than 30% reduction in their Child Depression Rating Scale. The effect on suicidality was not significant. Side effects were considered mild. CONCLUSIONS: Repetitive transcranial magnetic stimulation might be a possible therapy for adolescent depression. Our preliminary findings warrant double-blind, controlled studies.

Right prefrontal TMS versus sham treatment of mania: a controlled study.

OBJECTIVE: Left prefrontal transcranial magnetic stimulation (TMS) has been reported to have ECT-like effects in depression and we therefore planned a study of TMS in mania. Sixteen patients completed trial of right versus left prefrontal TMS at 20 Hz, 2-sec duration per train, 20 trains per day for 10 treatment days. Mania was evaluated using the Mania Scale, the Brief Psychiatric Rating Scale and the Clinical Global Impression. Significantly more improvement was observed in patients treated with right prefrontal TMS than with left prefrontal. We now report a follow-up study of right active TMS versus right sham TMS with the same indications and parameters. METHODS: Twenty-five patients entered and 19 completed right TMS versus sham right TMS. RESULTS: Right TMS was no more effective than sham TMS. CONCLUSIONS: It is possible that the previous results were due to an effect of left TMS to worsen mania. Alternatively, it is noted that the present patient group had much more psychosis than the previous study of TMS in mania, and depression studies have reported that psychosis is a poor prognostic sign for TMS response.

COMT: a common susceptibility gene in bipolar disorder and schizophrenia.

A variety of psychiatric illnesses, including schizophrenia and bipolar disorder, have been reported in patients with microdeletion on chromosome 22q11-a region which includes the catechol-O-methyltransferase (COMT) gene. The variety of psychiatric manifestations in patients with the 22q11 microdeletion and the role of COMT in the degradation of catecholamine neurotransmitters may thus suggest a general involvement of the COMT gene in psychiatric diseases. We have previously reported on a significant association between a COMT haplotype and schizophrenia. In this study, we attempt to test for association between bipolar disorder and the polymorphisms implicated in schizophrenia. The association between COMT and bipolar disorder was tested by examining the allele and haplotype found to be associated with schizophrenia. A significant association between bipolar disorder and COMT polymorphisms was found. The estimated relative risk is greater in women, a result consistent with our previous findings in schizophrenia. We suggest that polymorphisms in the COMT gene may influence susceptibility to both diseases--and probably also a wider range of behavioral traits.

A highly significant association between a COMT haplotype and schizophrenia.

Several lines of evidence have placed the catechol-O-methyltransferase (COMT) gene in the limelight as a candidate gene for schizophrenia. One of these is its biochemical function in metabolism of catecholamine neurotransmitters; another is the microdeletion, on chromosome 22q11, that includes the COMT gene and causes velocardiofacial syndrome, a syndrome associated with a high rate of psychosis, particularly schizophrenia. The interest in the COMT gene as a candidate risk factor for schizophrenia has led to numerous linkage and association analyses. These, however, have failed to produce any conclusive result. Here we report an efficient approach to gene discovery. The approach consists of (i) a large sample size-to our knowledge, the present study is the largest case-control study performed to date in schizophrenia; (ii) the use of Ashkenazi Jews, a well defined homogeneous population; and (iii) a stepwise procedure in which several single nucleotide polymorphisms (SNPs) are scanned in DNA pools, followed by individual genotyping and haplotype analysis of the relevant SNPs. We found a highly significant association between schizophrenia and a COMT haplotype (P=9.5x10-8). The approach presented can be widely implemented for the genetic dissection of other common diseases.