Avi Ohry

Predictors of PTSD trajectories following captivity: A 35-year longitudinal study

Although war captivity is a potent pathogen for psychiatric illness, little is known about the long-term trajectories of post-traumatic stress disorder (PTSD) among ex-prisoners of wars (ex-POWs). This study aimed to assess the long-term trajectories of PTSD and their predictors following war captivity. Three follow-ups (1991, 2003, 2008) were conducted over 35 years of 164 Israeli ex-POWs and185 comparable combatants from the 1973 Yom Kippur War. Ex-POWs reported higher PTSD rates than controls at all three assessments. Four trajectories of PTSD were identified: chronic PTSD, delayed PTSD, recovery and resilience. The majority of POWs reported delayed PTSD, while the majority of controls were classified as resilient. While PTSD rates remained relatively stable over time among controls, a steep increase in rates was observed among POWs between 1991 and 2003, followed by stabilization in rates between 2003 and 2008. Finally, subjective experience of captivity was the variable that best distinguished between the resilience and PTSD groups of ex-POWs, followed by participation in previous wars and negative life events during childhood. War captivity carries long-lasting psychiatric implications, even decades after release. Aging processes, as well as unique stressors that exist in Israel, may account for the elevated PTSD rates found here.

Alterations of pulmonary function in spinal cord injured patients

The vital capacity and forced expiratory volume are studied in 23 patients with spinal cord injury.

Systemic humoral factors participating in the course of spinal cord injury.

Systemic humoral factors have been studied in traumatic, chronic and acute spinal cord injured patients. Antibodies specific to nervous system autoantigens were detected in a majority of the sera obtained from these patients, at different periods after injury. Limited in vitro sprouting of dorsal root ganglia in chicken embryos was observed in the presence of serum from these patients. The possible association between growth inhibiting factors and the presence of antibodies against nervous tissue autoantigens is discussed.

Conversion motor paralysis disorder: analysis of 34 consecutive referrals

Study design: We present our cumulative experience with patients sustaining the most dramatic type of Conversion Disorder (CD) – Conversion Motor Paralysis.Setting: Rehabilitation departments, Reuth Medical Center, Tel-Aviv and Sheba Medical Center, Tel-Hashomer, Israel.Methods: During the period 1973–2000, 34 patients with neurological symptoms without any anatomical or physiological basis were admitted to both rehabilitation departments. This number consists of less than 1% of the total acute traumatic and non-traumatic spinal cord disorders admitted annually to these centers.Results: Twenty-five of the subjects were men (mean age of 30 years) and nine were women (mean age of 31.4 years). Neurological symptoms included: paraplegia (complete or incomplete) (18), hemiplegia or hemi paresis (11), tetraplegia (complete or incomplete) (three), monoplegia (one), triplegia (one). The final diagnosis on discharge was CD in 30 of the 34 cases, the remaining four being diagnosed as malingering. Functionally, nine patients had a complete recovery, 10 a partial recovery and 15 remained unchanged.Conclusion: Disabled people who experienced traumatic events resulting in various disabilities are admitted usually to a rehabilitation center. However, some of them are later diagnosed as having Conversion Disorder or malingering. We believe that their participation in active regular and integrative rehabilitation process is beneficial to most of them. Most of these patients gain functional independence and return to the main stream of life.

Conversion motor paralysis disorder: overview and rehabilitation model

It is important to consider a differential diagnosis between paralysis on an organic basis and paralysis and disability due to psychological mechanisms in people with physical impairment secondary to trauma, without evidence of organic etiology. We review the most dramatic type of conversion disorder (CD)–‘Conversion Motor Paralysis’. Recent important medical literature concerning the accepted treatment and rehabilitation management will be reviewed and discussed. The inter-disciplinary in-patient team management approach in a rehabilitation setting offers the benefits of a comprehensive assessment and treatment. The diagnosis is temporary and conditional, since there may be a long delay until the appearance of organic findings. A complete medical assessment is essential in order to rule out any possibility of an organic etiology. In as many as 25% to 50% of patients diagnosed as conversion, an organic medical diagnosis was found.

Some Problems of the Lower Extremity in Patients with Spinal Cord Injuries

Spinal cord injury (SCI) is devastating, leaving patients wholly or partly paralyzed. Health care providers who care for SCI patients during the acute or chronic phases are faced with different phenomena in the lower extremities of these subjects. In this article, the authors review the relevant changes associated with SCI. Preventive measures of these medical complications are directed according to the specific cause. Early comprehensive rehabilitation carried out by a specialized team prevents complications while enhancing functional gains.

The needs and unique problems facing spinal cord injured persons after limb amputation

Among hundreds of spinal cord injured patients (SCIP) who have been rehabilitated in the Sir Ludwig Guttmann Spinal Čord Injury Unit at the Sheba Medical Centre, Tel Hashomer; we only found six patients who had lost one or more limbs (upper or lower limbs). Although many plastic and orthopaedic surgeons regard paralytic limbs as useless appendages, we cannot agree with this erroneous viewpoint and we find that the clinical and psychological effects of the absence of limb(s) are tremendous. The six case reports are given together with a brief review of the relevant literature.

Electrodiagnostic investigation of the motor neuron and spinal reflex arch (H-reflex) in spinal cord injury

Twenty patients with spinal cord injury underwent serial electromyographic examinations. Fibrillation potentials and positive waves were noted in six patients in the spinal shock phase. In another subject, these potentials were found 27 months after injury. Our finding of significant slowing in the NCV of both nerves, indicates that lower motor neurons are indeed affected by upper motor neuron lesions.The H-reflex studies showed an increase in the mean H/M ratio. This may indicate an increase of reflex motor neuron excitability. No clear correlation was found between this increase and the degree of clinical spasticity. With repeat investigations, after a period of physical activity, a trend to reduction of the H/M ratio was noted with no clinical confirmation of reduction in spasticity.These findings emphasise the need for not assigning diagnostic terms to EMC abnormalities, but rather identifying them as neurophysiological changes which must be interpreted in the light of the clinical picture.

The Toll of War Captivity: Vulnerability, Resilience, and Premature Aging

It is apparent from clinical experience and the literature that persons, who experience severe physical or mental trauma, are susceptible to premature aging (or psychological symptomatology). Long-term follow-up of repatriated prisoners of war also confirm this observation. Coping with physical and mental sequelae of captivity means a constant struggle to maintain some kind of “homeostasis.” Often, this delicate equilibrium fails. Claude Bernard stated that “To have a free life, independent of the external environment, requires a constant internal environment” (Bernard, 1957, P. 8). This is the underlying principle of homeostasis. When it collapses due to “wear and tear” processes, premature aging/morbidity process takes place.

The implications of war captivity and long-term psychopathology trajectories for telomere length

BACKGROUND Previous findings have demonstrated the link between trauma, its psychopathological aftermath and cellular aging, as reflected in telomere length. However, as long-term examinations of psychopathology following trauma are scarce, very little is known regarding the repercussions of depression and PTSD trajectories of psychopathology for telomeres. The current study examined the implications of war captivity and depression/PTSD trajectories on telomere length. METHODS Ninety-nine former prisoners of war (ex-POWs) from the 1973 Yom Kippur War were evaluated for depression and PTSD at 18, 30, 35 and 42 years after the war. Data on leukocyte telomere length of ex-POWs and 79 controls was collected 42 years after the war. RESULTS Ex-POWs had shorter telomeres compared to controls (Cohens d=.5 indicating intermediate effect). Ex-POWs with chronic depression had shorter telomeres compared to those with delayed onset of depression (Cohens d=4.89), and resilient ex-POWs (Cohens d= 3.87), indicating high effect sizes. PTSD trajectories were not implicated in telomere length (Partial eta2=.16 and p=.11). CONCLUSION The findings suggest that the detrimental ramifications of war captivity are extensive, involving premature cellular senesces. These findings further point to the wear-and-tear effect of long-term depression, but not PTSD, on telomere length. Explanations for the findings are discussed.