Avner Elizur

Sleep Disturbances in Children with Attention-Deficit/Hyperactivity Disorder A Comparative Study with Healthy Siblings

The sleep profiles of 13 children with attention-deficit/hyperactivity disorder (ADHD) who were treated with a fixed dose of methylphenidate for at least 1 month were compared with those of 16 healthy siblings. Sleep disturbances were assessed according to a structured sleep questionnaire, and the severity of ADHD was evaluated via the Conners Parents Teachers Rating Scale. The results indicated that significantly more children with ADHD demonstrated single or multiple sleep disturbances as well as higher rates of specific sleep disorders, such as initial and middle insomnia, compared with their siblings. No correlation was found between the severity of ADHD and disturbed sleep. Sleep duration and satisfaction with sleep were similar in the two groups. These findings raise important questions regarding the association between ADHD and disturbed sleep.

Increased interleukin-1 and interleukin-3 like activity in schizophrenic patients

1. The interleukins play an important role in the development and maintenance of the immune system 2. Decreased cell mediated immunity measures were found in schizophrenic patients. 3. The purpose of the present study was to study the spontaneous production of interleukin-1 (IL-1) and interleukin-3 like activity (IL-3-LA) by human mononuclear cells from schizophrenic patients in comparison to healthy individuals. 4. Interleukin-1 was increased significant by schizophrenic patients as compared to controls. 5. Interleukin-3 like activity was slightly elevated in schizophrenic patients as compared to controls. 6. These findings support the hypothesis of an autoimmune dysfunction in some schizophrenic patients.

Perception of physical pain in accident and suicide attempt patients: Self-preservation vs self-destruction

The perception of physical pain and its relationship to psychological variables were examined in emergency-room (ER) patients who were admitted following suicide attempts or accident injuries, and in a control group of community subjects. Two pain measures, involving electric shocks, were administered to the subjects. Psychological variables included hardiness, body image, body satisfaction feelings about the body, stressful events, anxiety and depression. Suicidal subjects endured the highest number of shocks, scored lowest on the appraisal of pain, and scored lowest on psychological hardiness. Moreover, it was found that, among the suicidal subjects, the more negative the scores of psychological variables, the higher the endurance of pain. In accident victim subjects, the relationships were exactly opposite. These results were interpreted as reflecting two different core attitudes towards life under stressful circumstances: a life-destroying tendency in the suicidal subjects vs. a life-preserving tendency in the accident-victim subjects. These two core attitudes indicate different modes of defense: defensive detachment in the suicidal patients and avoidance of stress in the accident victims.

Autoantibodies to DNA in multicase families with schizophrenia

In an attempt to define the autoimmune status of members of multicase families with schizophrenia, sera of both patients and healthy relatives from 28 such cases were tested for antinuclear antibodies, anti-double-stranded DNA, and anti-single-stranded DNA autoantibodies. These autoantibodies were significantly more frequent in both schizophrenic patients and healthy relatives than in normal subjects. Immunoglobulin (Ig) M anti-DNA antibodies were more common in patients, whereas in healthy relatives, IgG anti-DNA antibodies were more common. No significant differences were found between schizophrenic patients and their healthy relatives. The data indicate that an autoimmune process may be involved in the etiology of a subset of patients with schizophrenia.

The Efficacy of Amitriptyline and Acetaminophen in the Management of Acute Low Back Pain

Thirty-nine patients with acute low back pain were treated with amitriptyline (150 mg/d) or acetaminophen (2,000 mg/d) in a controlled double-blind design for 5 weeks. Both groups revealed mild depression, normal coping, and increased anxiety at the beginning, with significant improvement in anxiety state and pain at the end of treatment. A repeated measures analysis of variance demonstrated that amitriptyline was more effective than acetaminophen in reducing pain intensity from the second week of treatment. Age and depression were the only significant pretreatment predictors of posttreatment pain. The study evaluates the significance of these findings.

Tolerance for physical pain in suicidal subjects

This study investigated the tolerance for physical pain in suicidal subjects. Suicidal, psychiatric nonsuicidal, and normal young males and females were administered pain measures including electric shocks, appraisal of shocks, and a measure of thermal pain. Additional study variables included diagnosis, past suicide attempts, severity of suicidal intent, and length of hospitalization. Suicidal individuals showed higher tolerance for pain and appraised the pain as less intense than the other groups, regardless of diagnosis, length of hospitalization, and motivation to participate in the study. These findings were explained as a result of dissociative processes inherent in the development of suicidal tendencies and in terms of pain management strategies.

Anticardiolipin antibodies are elevated in drug-free, multiply affected families with schizophrenia

The objective of this study was to measure anticardiolipin antibodies in patients and healthy relatives in multicase families with schizophrenia. Twenty-eight (28) multicase families with schizophrenia were examined. One hundred three drug-free patients and 66 first-degree relatives consented to evaluation by DSM-III-R criteria. Criteria for patient definition included the following: age ≥16, a confirmed hospital diagnosis of schizophrenia, knowledge of biological parents, and consent to participate. Additional data were drawn from family history and medical records. Serum samples were tested separately for IgG and IgM anticardiolipin by enzyme-linked immunosorbent assay (ELISA) and designated positive/negative by comparison to the reactivity of an age-matched control group. IgG anticardiolipin antibodies were significantly more common in both patients and relatives compared to controls. IgM anticardiolipin antibodies were significantly more common in patients. In 75% of families at least one member was anticardiolipin positive and this positivity correlated with patient positivity. The relevance of anticardiolipin antibodies in both patients and healthy relatives of some multicase families to the pathogenesis of schizophrenia is discussed.

The effectiveness of olanzapine in treatment-refractory schizophrenia when patients are nonresponsive to or unable to tolerate clozapine

OBJECTIVE This multicenter, open-label study was designed to assess the efficacy and tolerability of olanzapine in patients with chronic schizophrenia who are resistant to therapy with classic neuroleptic agents and are either not responsive to or unable to tolerate clozapine. METHODS Patients received olanzapine orally once daily for 18 weeks at doses ranging from 5 to 25 mg. The primary efficacy measure was change in the total score on the Positive and Negative Syndrome Scale (PANSS) from baseline to end point. Secondary efficacy measures were the total score on the Brief Psychiatric Rating Scale (BPRS); the PANSS positive, negative, general psychopathology, and mood subscores; and the Clinical Global Impression improvement score. Also recorded were spontaneously reported adverse events; extrapyramidal symptoms (assessed by the Abnormal Involuntary Movement Scale, Simpson-Angus Scale, and Barnes Akathisia Scale); vital signs; and clinical laboratory test results. RESULTS Forty-eight patients were treated with olanzapine; of these, 45 were assessable over the full 18-week study period. Total scores on the PANSS and BPRS were reduced from baseline by an average of 17.7 (14.2%) and 9.8 points (20.2%), respectively. Eighteen patients (40.0%) experienced a treatment response, defined as a reduction in PANSS total score of > or = 20%. A total of 25 patients (55.6%) achieved a similar reduction in BPRS total score. Significant reductions were seen in both the positive and negative symptom scores on the PANSS (P < 0.001). Olanzapine was well tolerated, with minimal treatment-emergent adverse events or clinically relevant changes in vital signs or clinical laboratory test results. No clinically significant blood dyscrasias were observed in olanzapine-treated patients, including those who had discontinued clozapine because of treatment-associated leukopenia or neutropenia. CONCLUSION The results of this study suggest that olanzapine may be of benefit in patients who are refractory to or unable to tolerate clozapine.

Inositol treatment of alzheimer's disease: A double bund, cross-over placebo controlled trial

1. A double-blind controlled crossover trial of 6 gm of inositol daily vs glucose for one month each was carried out in 11 Alzheimer patients. 2. Overall CAMCOG scores showed a trend for greater improvement with inositol that was not significant. 3. Language and orientation improved significantly more on inositol than on placebo. There were no serious side effects. 4. Higher doses of inositol should be studied in Alzheimers Disease for longer periods.

Platelet Autoantibodies in Dementia and Schizophrenia

Platelets isolated from blood of demented and schizophrenic patients were found to bear surface antibodies at a considerably higher titer than those found on platelets from normal age-matched groups or patients with affective disorders. The platelet count in demented and schizophrenic patients correlated inversely with the level of the platelet associated antibodies (PAA) which suggested an autoimmune route of opsonization. In most individual cases of dementia or schizophrenia PAA and platelet count were found to oscillate with time between high PAA-low platelet number and low PAA-high platelet number in approximately inverse correlation. PAA isolated from demented patients were found to cross-react with platelets from normals and with brain tissue from rats. Furthermore, molecular weights of specific brain antigens were identified by binding to PAA. These observations support the possibility that PAA might be implicated in the etiology of some mental dysfunctions associated with dementia and schizophrenia.