Ido Lurie

Antibiotic Exposure and the Risk for Depression, Anxiety, or Psychosis: A Nested Case-Control Study

OBJECTIVE Changes in the microbiota (dysbiosis) were suggested to increase the risk of several psychiatric conditions through neurologic, metabolic, and immunologic pathways. Our aim was to assess whether exposure to specific antibiotic groups increases the risk for depression, anxiety, or psychosis. METHOD We conducted 3 nested case-control studies during the years 1995-2013 using a large population-based medical record database from the United Kingdom. The study included 202,974 patients with depression, 14,570 with anxiety, and 2,690 with psychosis and 803,961, 57,862, and 10,644 matched controls, respectively. Cases were defined as individuals aged 15-65 years with any medical Read code for depression, anxiety, or psychosis. Subjects with diagnosis-specific psychotropic prescriptions > 90 days before index date were excluded. For every case, 4 controls were selected using incidence density sampling, matching on age, sex, practice site, calendar time, and duration of follow-up before index date. The primary exposure of interest was therapy with 1 of 7 antibiotic classes > 1 year before index date. Odds ratios (ORs) and 95% CIs were calculated for the association between each psychiatric disorder and exposure to individual classes of antibiotics using conditional logistic regression analysis. The risk was adjusted for obesity, smoking history, alcohol consumption, socioeconomic status, and number of infectious events before diagnosis. RESULTS Treatment with a single antibiotic course was associated with higher risk for depression with all antibiotic groups, with an adjusted OR (AOR) of 1.23 for penicillins (95% CI, 1.18-1.29) and 1.25 (95% CI, 1.15-1.35) for quinolones. The risk increased with recurrent antibiotic exposures to 1.40 (95% CI, 1.35-1.46) and 1.56 (95% CI, 1.46-1.65) for 2-5 and > 5 courses of penicillin, respectively. Similar association was observed for anxiety and was most prominent with exposures to penicillins and sulfonamides, with an AOR of 1.17 (95% CI, 1.01-1.36) for a single course of penicillin and 1.44 (95% CI, 1.18-1.75) for > 5 courses. There was no change in risk for psychosis with any antibiotic group. There was a mild increase in the risk of depression and anxiety with a single course of antifungals; however, there was no increase in risk with repeated exposures. CONCLUSION Recurrent antibiotic exposure is associated with increased risk for depression and anxiety but not for psychosis.

Perceived social support following myocardial infarction and long-term development of frailty

Aim Frailty is a multidimensional geriatric syndrome that indicates increasing vulnerability and decreasing resistance to stressors. Social support (SS) is linked both to cardiovascular disease and to frailty. However, few cohort studies evaluated SS as a potential predictor of frailty, and none involved coronary disease populations. The aim of this study was to evaluate the role of perceived SS (PSS) – a specific component of SS – in the prediction of frailty development in myocardial infarction (MI) survivors, controlling for other psychosocial risk factors. Method A cohort of 558 patients aged ≤65 years, admitted for first-ever MI to hospitals in central Israel, was studied. PSS and other clinical and sociodemographic variables were assessed at baseline. Frailty was assessed via a frailty index of deficit accumulation 10–13 years later. Logistic regression models were constructed to assess the odds ratios (OR) for frailty associated with PSS as well as other covariates. Results At last follow-up, 154 (28%) met the criteria for frailty. In the logistic regression models, higher PSS level was associated with lower frailty risk (unadjusted OR = 0.63, 95%CI 0.53–0.76; multivariable-adjusted OR = 0.80, 95%CI 0.64–0.98). Below average family income, poor self-rated health and higher depression scores were all associated with the development of frailty, in both the unadjusted and adjusted models. Conclusions PSS predicts frailty development post-MI, which has important implications for prognosis and healthcare use.

The association between acculturation patterns and mental health symptoms among Eritrean and Sudanese asylum seekers in Israel.

Past research has documented the role acculturation plays in the process of adjustment to new cultures among migrants. Yet little attention has been paid thus far to the role of acculturation in the context of forced migration. In this study we examined the association between acculturation patterns and mental health symptoms among a convenience sample of Eritrean and Sudanese asylum seekers (n = 118) who accessed health services at the Physicians for Human Rights Open-Clinic in Israel. Participants completed measures on sociodemographic information as well as detention history, mental health symptoms, exposure to traumatic events, and acculturation pattern, in their native language upon accessing services. Consistent with our predictions, findings showed that acculturation predicted depressive symptoms among asylum seekers beyond the effect of history of detention and reports of experiences of traumatic events. Assimilated compared with integrated asylum seekers reported higher depressive symptoms. Findings draw attention to the paradox of assimilation, and the mental health risks it poses among those wishing to integrate into the new culture at the expanse of their original culture. Asylum seekers may be particularly vulnerable to the risks of assimilation in the restrictive policies that characterize many industrial countries in recent years.

Ethnic disparities in mental health treatment gap in a community-based survey and in access to care in psychiatric clinics

Background: Contrasting social status of ethnic groups differentially impacts the use of psychiatric services, including in Israel, despite its universal health system. However, relevant studies are limited. Aims: To examine ethnic differences in mental health treatment gap and in access to specialized care. Methods: Data were gathered from two sources. Study I included Mizrahi (Jews of North African/Asian origin, socially disadvantaged, n = 136) and Ashkenazi (Jews of European American origin, socially advantaged, n = 69) who were diagnosed with common mental disorders in the preceding 12 months in the Israeli component of the World Mental Health Survey. Study II included Mizrahi (n = 133) and Ashkenazi (n = 96) service users entering ambulatory mental health care. Results: Study I showed that the treatment gap was larger among Mizrahi compared with Ashkenazi respondents (28% standard error (SE) = 4.1 and 45% SE = 6.2, respectively, sought services) following adjustment for sociodemographic confounders (adjusted odds ratio (AOR) = 2.28, 95% confidence interval (CI) = 1.1–4.8). Study II showed that the access to specialized care lagged over a year among 40% of service users of both ethnic groups. No significant ethnic differences emerged in variables related to delay in accessing care. Conclusions: Treatment gap was larger among ethnically disadvantaged compared with the advantaged group. However, once in treatment, service users of both ethnic groups report similar barriers to care.

Anti-depressant therapy and cancer risk: A nested case-control study

UNLABELLED Previous studies demonstrated a possible association between anti-depressant therapy with selective serotonin reuptake inhibitors (SSRI) and tricyclic anti-depressants (TCA), several genetic and hormonal pathways and cancer risk, with inconsistent results. Exposure to serotonin-norepinephrine reuptake inhibitors (SNRI) was not studied extensively. We sought to evaluate the association between exposure to SSRIs, TCAs and SNRIs and the five most common solid tumors. We conducted nested case-control studies using a large UK population-representative database. Cases were those with any medical code for the specific malignancy. For every case, four controls matched on age, sex, practice site, and duration of follow-up before index date were selected using incidence-density sampling. Exposure of interest was SSRI, SNRI or TCA therapy before index date. Odds ratios (ORs) and 95% CIs were estimated for each anti-depressant class using conditional logistic-regression analysis, adjusted for potential confounders, such as obesity, smoking history and alcohol consumption. RESULTS 109,096 cancer patients and 426,402 matched controls were included. Current SSRI users with treatment initiation>one year before index date had modestly higher risk for lung and breast cancers with ORs of 1.27 (95% CI 1.16-1.38) and 1.12 (95% CI 1.06-1.18), respectively. Among current TCA users, there was a higher risk only for lung cancers with OR of 1.45 (95% CI 1.31-1.6). There was no statistically significant association between current SNRI therapy and cancer risk. DISCUSSION Treatment with SSRI and TCA might be associated with increased lung cancer risk. SSRI therapy might be associated with modest increase in breast cancer risk.

Comprehension and companionship in the emergency department as predictors of treatment adherence.

Objective: Lack of adherence to recommended treatment poses major clinical and economic challenges for psychiatry, and requires further examination. In this pilot study, we aimed to prospectively investigate the association between the level of understanding of psychiatric emergency department (ED) discharge recommendations and the presence of a companion with short-term treatment adherence. Method: Sixty subjects were evaluated twice: upon ED discharge and a month later. Instruments included a structured questionnaire based on the MacArthur Competence Assessment Tool for Treatment, Mini Mental State Examination, and corroboration of data with the computerized hospital medical file. In order to control for the possibility that evaluation of the understanding of recommendations might positively influence adherence, the 60 subjects were randomly assigned into 50 who were interviewed with the full survey tool and 10 who were not asked questions about their understanding of treatment and/or follow-up recommendations. Results: Understanding of discharge recommendations and the presence of a companion enhanced adherence. Conclusions: This preliminary study suggests that ensuring patients’ understanding of treatment recommendations and encouraging the company of patients are achievable, practical strategies that may improve adherence and thereby promote better outcomes.

Optimism During Hospitalization for First Acute Myocardial Infarction and Long-Term Mortality Risk: A Prospective Cohort Study

Objective: To assess the association between dispositional optimism, defined as generalized positive expectations about the future, and long‐term mortality in young survivors of myocardial infarction (MI). Patients and Methods: A subcohort of 664 patients 65 years and younger, drawn from the longitudinal Israel Study of First Acute Myocardial Infarction, completed an adapted Life Orientation Test (LOT) questionnaire during their index hospitalization between February 15, 1992, and February 15, 1993. Additional sociodemographic, clinical, and psychosocial variables were assessed at baseline; mortality follow‐up lasted through December 31, 2015. Cox proportional hazards regression models were fit to assess the hazard ratios for mortality associated with LOT‐derived optimism. Results: The mean age of the participants was 52.4±8.6 years; 98 (15%) were women. The median follow‐up period was 22.4 years (25th‐75th percentiles, 16.1–22.8 years), during which 284 patients (43%) had died. The mean LOT score was 16.5±4.1. Incidence density rates for mortality in increasing optimism tertiles were 25.4, 25.8, and 16.0 per 1000 person‐years, respectively (P<.01). With sequential adjustment for sociodemographic, clinical, and psychosocial variables, a decreased mortality was associated with the upper tertile (adjusted hazard ratio, 0.67; 95% CI, 0.47–0.95). A nonlinear inverse relationship was observed using spline analysis, with the slope increasing sharply beyond the median LOT score. Conclusion: Higher levels of optimism during hospitalization for MI were associated with reduced mortality over a 2‐decade follow‐up period. Optimism training and positive psychology should be examined as part of psychosocial interventions and rehabilitation after MI.

Exposure to Trauma and Forced Migration: Mental Health and Acculturation Patterns Among Asylum Seekers in Israel

Immigration is a process of loss and change which entails significant sociopsychological stress and possible effects on the mental health of immigrants. Over the last few decades, the State of Israel has become a target for forced migration. Since 2006 specifically, asylum seekers from East Africa (mainly Eritrea and Sudan) have been arriving in Israel.

Cardiovascular mortality and related risk factors among persons with schizophrenia: a review of the published literature.

Although persons with schizophrenia (PWS) are entitled to health care and medical preventive and curative treatments in accordance with the same standards as other persons, they suffer from excess mortality compared with the general population. The main cause of natural premature death of PWS is attributed to cardiovascular disorders (CVD). We reviewed the studies of PWS, their risk factors and CVD mortality. In every study, PWS have increased risk of CVD mortality. Additionally, most but not all of the studies found increased CVD behavioral risk factors (i.e., smoking, sedentary life style/less physical activity, increased body mass index (BMI)) in PWS. In order to promote better health care to this population, we propose general recommendations to service users and their families, general and mental health professionals and policy makers. Severe mental illness such as schizophrenia should be addressed as a “risk equivalent” for CVD. Awareness of this association should be implemented in routine psychiatric and general medicine practice as well as at national levels for policy makers. Cardiovascular morbidity and mortality should be referred to as a measure of quality of care. Better communication between different physicians and other health care providers, who treat PWS, should be encouraged. This can be accompanied with technological advances (i.e., unified electronic medical record). Understanding of suggested treatment and adherence to recommendations in PWS may be improved by if relatives and friends accompany the patient in medical settings.

Sleep Disorders Among Holocaust Survivors

Second World War (WWII) ended in 1945, but for the Holocaust survivors (HS) the traumatic aftereffects regarding sleep and its disorders lingered through the decades.This chapter reviews selected publications regarding sleep, sleep disturbances, and nightmares. They are reviewed by period of publication: short- (within 10 years of WWII), middle- and late-term (since 2000). The studies were conducted in different countries, with different subgroups of HS, in different contexts (clinical settings, pension claims, community surveys and sleep laboratories), and with different methods of problem ascertainment.Most, but not all of the studies that were reviewed found that disturbances of different types characterize the sleep of HS. They seemed to have been present over the course of time, since the end of WWII to six decades afterwards. Some studies found those disturbances in the absence of clinical disorders but, probably, in the presence of subclinical conditions. Notably, both sexes reported equal frequencies of sleep disturbances (differences between the sexes were negligible), although PTSD and depression (frequent disorders among HS) are more frequent in women.Of the different contexts in which studies were conducted, the sleep laboratory provided the single most direct and detailed source of information. Findings included: (a) long-standing changes in sleep architecture, e.g., decreased REM sleep, and (b) contrasting patterns of dreaming and recalling among better-adjusted and poorly-adjusted survivors. However, since these studies were based on small samples and excluded HS with a psychiatric diagnosis, no generalization is possible with reference to larger and heterogeneous HS groups.