Avraham Bleich

Elevated levels of serum interleukin-1β in combat-related posttraumatic stress disorder

Levels of serum interleukin-1 beta (IL-1 beta) and soluble interleukin-2 receptor (sIL-2R) were assessed in 19 male patients with combat-related posttraumatic stress disorder (PTSD) in comparison to 19 age- and sex-matched healthy volunteers. Serum IL-1 beta levels (but not sIL-2R) were significantly higher (p < .001) in the PTSD patients than in the controls. IL-1 beta levels did not correlate with cortisol levels, severity of PTSD, anxiety, depressive symptoms, or alexithymia score; however, they did correlate significantly (r = .54, p < .005) with the duration of PTSD symptoms. It is possible that desensitization of the hypothalamic-pituitary-adrenal axis in chronic PTSD patients counteracts the stimulatory effect of IL-1 beta on cortisol secretion.

Suicidal behavior, depression, and conduct disorder in hospitalized adolescents.

Abstract A childhood version of the Schedule for Affective Disorders and Schizophrenia (K-SADS) was used to assess 140 consecutive admissions to an adolescent psychiatric inpatient unit. Depression scale scores were correlated with the suicidality scale scores. Suicidality scores on the K-SADS were higher in adolescents diagnosed as having conduct disorder (CD) than in those diagnosed as having major depressive disorder (MDD), even though the CD patients were less depressed than the MDD patients. Aggression and impulsivity may be factors as important as depression in some kinds of suicidal behaviors. A hypothesis is suggested to explain the interrelationship among depression, aggression, and suicidal behavior.

Increased serotonin 5-HT2 receptor binding on blood platelets of suicidal men.

In search of a physiological marker of depression and suicidal behavior, serotonin receptors of the 5-HT2 type were studied on platelet membranes from 19 control and 22 suicidal subjects. All were young, drug — and medication free men (18–21-years-old). 5-HT2 receptor binding was assayed using tritiated ketanserine at two concentrations. Receptor binding in the suicidal subjects was significantly higher than controls at both concentrations, the mean difference being around 50%. A similar difference between patients with major depressive disorder and matched controls has been observed previously. These findings support the use of 5-HT2 receptors on platelets as a research and diagnostic tool in depression and suicide.

Protective factors and predictors of vulnerability to chronic stress: A comparative study of 4 communities after 7 years of continuous rocket fire

Many communities across the world are chronically exposed to extreme violence. Responses of residents from a city and rural community in Southern Israel, both exposed to 7 years of daily mortar fire, were compared to residents from demographically, socio-economically and geographically comparable non-exposed control samples to examine protective factors and predictors of vulnerability to chronic war-related attacks. Samples from a highly exposed city (Sderot) and a highly exposed rural community region (Otef Aza), along with a demographically comparable comparison non-exposed city (Ofakim) and non-exposed rural community region (Hevel Lachish), were obtained in 2007 using Random Digit Dialing. In total, 740 individuals (81.8% participation rate) were interviewed about trauma exposure, mental health, functioning and health care utilization. In the highly exposed city of Sderot, 97.8% of residents had been in close proximity to falling rockets; in the highly exposed rural community region of Otef Aza, 95.5% were similarly exposed. Despite exposure to chronic rocket attacks, residents of Otef Aza evidenced little symptomatology: only one person (1.5%) reported symptoms consistent with probable posttraumatic stress disorder (PTSD) and functioning levels did not differ from those of non-exposed communities. In contrast, posttraumatic stress (PTS), distress, functional impairment and health care utilization were substantially higher in the highly exposed city of Sderot than the other three communities. Lack of resources was associated with increased vulnerability among city residents; predictors of PTS across all samples included being female, older, directly exposed to rockets, history of trauma, suffering economic loss, and lacking social support. Increased community solidarity, sense of belonging and confidence in authorities may have served a protective function for residents of rural communities, despite the chronic attacks to which they were exposed.

Is terror gender-blind? Gender differences in reaction to terror events

ObjectiveThis study examines gender differences in posttraumatic vulnerability in the face of the terror attacks that occurred during the Al-Aqsa Intifada. In addition, the contribution of level of exposure, sense of safety, self-efficacy, and coping strategies is assessed.MethodParticipants were 250 men and 262 women, who constitute a representative sample of Israels adult population. Data were collected via a structured questionnaire consisting of 51 items that were drawn from several questionnaires widely used in the study of trauma.ResultsThe findings indicate that women endorsed posttraumatic and depressive symptoms more than men and that, generally, their odds of developing posttraumatic stress symptoms are six times higher than those of men. Results also revealed that womens sense of safety and self-efficacy are lower than mens and that there are gender differences in coping strategies in the face of terror.ConclusionsGender differences in vulnerability to terror may be attributable to a number of factors, among these are womens higher sense of threat and lower self-efficacy, as well as their tendency to use less effective coping strategies than men. Level of exposure to terror was ruled out as a possible explanation for the gender differences in vulnerability.

The mental health impact of terrorism in Israel: A repeat cross-sectional study of Arabs and Jews

Objective:  Since September 2000 Israeli society has been subjected to numerous deadly terror attacks. Few studies have studied the comparative mental health vulnerability of minorities and majorities to continuous terror attacks.

Emotional Impact of Exposure to Terrorism Among Young-Old and Old-Old Israeli Citizens

OBJECTIVE Since September 2000, continuous terrorist attacks have exposed Israeli society to trauma, and the impact of these events on the mental health of the elderly Israeli population remains unclear. The authors sought to assess the prevalence of posttraumatic stress-related symptoms of distress, depression, optimism, self-efficacy, and sense of safety of the young-old and old-old Jewish population after 19 months of intense terrorism in Israel, in order to identify correlates of the psychological sequelae and compare symptoms and coping methods of these populations with those of younger adults. METHODS Authors did a telephone survey using stratified sampling with a national sample of young-old (65-74 years old), old-old (>74 years old) and a comparison group of younger adults (18-64 years old). RESULTS No difference was found in the level of exposure, traumatic stress symptoms, including probable PTSD, except for a nonsignificant tendency toward more depersonalization and emotional numbness in the elderly group, a tendency toward more sleeplessness, more re-experiencing of unwanted thoughts, hyperarousal, fewer avoidance symptoms, and less disengagement-coping in the old-old group. Younger adults were found to be significantly more optimistic. Young-old and old-old people used cigarettes/alcohol and tranquilizers more often to cope with the situation, and old-old people who used disengagement-coping felt less helped by it. CONCLUSIONS Young-old and old-old people do not differ significantly from the younger adult population with regard to their response to 19 months of intense and recurrent terrorism.

Treatment of benzodiazepine dependence in methadone maintenance treatment patients: a comparison of two therapeutic modalities and the role of psychiatric comorbidity.

Objective: Therapeutic approaches for benzodiazepine (BZD) dependence in patients in methadone maintenance treatment (MMT) have met with limited success. Clonazepam detoxification (CDTX) and clonazepam maintenance treatment (CMT) were compared in an open, clinical naturalistic study on such patients. Methods: Benzodiazepine dependent patients substituted their BZD of abuse for clonazepam and were then either detoxified (CDTX) or a maintenance dose was reached and maintained (CMT). Patients were considered as failing the trial if they either abused BZDs (CDTX group) or abused BZDs over the maintenance dose (CMT group). Treatment outcome was evaluated based upon self and staff reports over 1 year after beginning treatment. Axis I and II psychiatric diagnosis was assessed and methadone dosage and history of abuse was recorded. Results: In the CDTX group, 9/33 (27.3%), were BZD-free after 2 months. In the CMT group, 26/33 (78.8%) refrained from abusing additional BZDs over the maintenance dose after 2 months. The same success rate remained over the entire year. Survival analysis showed CMT to be more successful than the CDTX. Axis I psychiatric comorbidity was found to be positively related to treatment success in the CMT group while axis II antisocial personality disorder was found to be negatively related to treatment success in that group. It had no impact in the CDTX group. Conclusions: Maintenance strategy with clonazepam is a useful BZD treatment modality for BZD-dependent MMT patients with a long-term history of abuse and previous attempts at detoxification. Psychiatric comorbidity may have an important role in choosing the adequate treatment modality and influencing treatment outcome.

Prolonged Fear of AIDS as an Early Symptom of Schizophrenia

A modern complaint--fear of AIDS--is making its way into the world of psychopathology and is becoming a symptom of a wide range of psychiatric disorders, including severe ones. We present a case of a young man who developed a pathological bizarre preoccupation of having AIDS and underwent various unnecessary medical procedures, until finally he was diagnosed as suffering from a paranoid schizophrenic disorder. With the high media profile that AIDS has achieved in recent years, it is expected that AIDS has become the object of psychopathological processes. However, the length of time elapsed between the onset of symptoms and the appropriate psychiatric diagnosis, despite being examined by other medical professionals, is surprising. The discussion focuses on the diagnostic questions and on issues related to primary and secondary psychiatric prevention.