Marc Gelkopf

Characteristics of benzodiazepine abuse in methadone maintenance treatment patients: a 1 year prospective study in an Israeli clinic

We aimed to study the prevalence patterns and course of benzodiazepine (BZD) abuse in an Israeli methadone maintenance (MMT) clinic using repeated random observed urine analysis as well as self-report data. Lifetime and current prevalence of BZD abuse were found in 66.3 and 50.8% patients, respectively. It was found that 44.6% of patients who abused BZDs during their first month of treatment ceased to do so after 1 year, while 27.4% who had not abused BZDs at the beginning of MMT did so after 1 year in treatment. Flunitrazepam was the most commonly abused BZD (92.9%), followed by diazepam (54.3%) and oxazepam (38.6%). Most of the patients swallowed BZDs (92.8%), 42.9% also smoked or snorted them while 8.6% injected BZDs intravenously. BZDs were used as self-medication for alleviating emotional problems rather than for recreational or other reasons. We conclude that BZD abuse is a significant clinical problem in heroin addicts both before entering and during MMT. MMT may have a positive as well as a negative influence on BZD abuse with the former being more prevalent.

School-Based Intervention for the Treatment of Tsunami-Related Distress in Children: A Quasi-Randomized Controlled Trial

Background: On December 26, 2004, a tsunami hit the southern coast of Sri Lanka, leaving thousands dead and injured. Previous research has found significant mental health problems among children exposed to major disasters. School-based universal interventions have shown promise in alleviating distress and posttraumatic symptomatology in children and adolescents. This study evaluated the efficacy of a school-based intervention in reducing stress-related symptomatology among Sri Lankan children exposed to the tsunami. Methods: In a quasi-randomized controlled trial 166 elementary school students (ages 9–15) with significant levels of tsunami exposure and previous traumatic background were randomly assigned to a 12-session structured program ‘ERASE Stress Sri Lanka’ (ES-SL) or to a waiting list (WL) religious class control group. Students were assessed 1 week prior and 3 months after the intervention on measures of posttraumatic symptomatology [including posttraumatic stress disorder (PTSD) and severity of posttraumatic symptomatology], depression, functional problems, somatic problems and hope. Results: This study shows a significant reduction on all outcome variables. PTSD severity, functional problems, somatic complaints, depression and hope scores were all significantly improved in the ES-SL group compared to the WL group. No new cases of PTSD were observed in the experimental group. Conclusion: This study adds to the growing body of evidence suggesting the efficacy of school-based universal approaches in helping children in regions touched by war, terror and disaster and suggests the need to adopt a two-stage approach toward dealing with trauma-exposed students, namely, starting with a universal intervention followed by targeted specialized interventions for those still suffering from posttraumatic distress.

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 effect of humorous movies on inpatients with chronic schizophrenia.

We assessed the impact of humorous movies on psychopathology, anxiety, depression, anger, social functioning, insight, and therapeutic alliance in schizophrenia inpatients. Twenty-nine psychiatric inpatients in open wards participated in the study. The study group viewed humorous and the control group viewed neutral movies daily for 3 months. Participants were assessed before and after viewing movies with the Positive and Negative Symptom Scale, Calgary Depression Scale, the State-Trait Anxiety Inventory, the State-Trait Anger Expression Inventory-2, the Multinomah Community Ability Scale, the Insight and Treatment Attitude Questionnaire, and the Working Alliance Inventory. Reduced levels of psychopathology, anger, anxiety, and depression symptoms and an improvement in social competence were revealed in the study group. No changes were observed in treatment insight or working alliance. Video films are a practical and cost-efficient means of entertainment that seem to have a positive effect on patient morale, mood, and mental status.

Multi-Modal Weight Control Intervention for People with Persistent Mental Disorders

Obesity, a major problem worldwide, is more prevalent among people with schizophrenia. This study examined the effect of behavior intervention, nutritional information and physical exercise on the body mass index (BMI) and weight of people who were hospitalized with persistent DSM-IV schizophrenia and schizoaffective disorders. Fifty nine inpatients with a BMI greater than 25 participated, (28 intervention group; 31 control group). Significant reductions in BMI and weight were observed in the intervention group after 3 months and were maintained 1-year post study [F(1,52) = 6.1, p = .017) and F(1,52) = 3.7, P = .006, respectively]. If provided with adequate information and an appropriate framework, people with persistent schizophrenia can significantly reduce BMI and weight and maintain the loss.

Laughter in a psychiatric ward. Somatic, emotional, social, and clinical influences on schizophrenic patients.

The study was designed to explore the potential therapeutic effects of humor on hospitalized schizophrenics. For this purpose, in the first stage, we conducted a review of findings in regard to physical health, emotions, psychiatric state, and social behavior. In the second stage, we carried out an experiment with 34 resident patients in two chronic schizophrenic wards who were exposed to 70 movies during 3 months. The experimental group was exposed to humorous movies only, and the control group to different kinds of movies. Before and after the exposure to films for 3 months, both groups were tested on different health, emotional, social, and clinical measures using the Cognitive Orientation of Health Questionnaire, the Shalvata Symptom Rating Scale, blood pressure, heart rate, Perceived Verbal and Motor Aggression (rated by nurses), the Multiple Affect Adjective Check List, the Social Support Questionnaire 6, and the Brief Psychiatric Rating Scale (BPRS; rated by psychiatrists). Covariance analyses yielded significant reductions in Perceived Verbal Hostility, BPRS scales (total score, anxiety/depression), and significant increases in BPRS (activation) and degree of staff support experienced by the patients. The results indicate that the effects of exposure to humor may be mediated by the effects on the staff of the incidental exposure to humorous films.

Is Humor Only Fun, an Alternative Cure or Magic? the Cognitive Therapeutic Potential of Humor

The paper deals with the therapeutic potential of humor, emphasizing in particular its properties as a tool of cognitive therapy. The variety, commonness and pervasiveness of the claims about the beneficial effects of humor justify the need to examine these effects in view of modern findings. The first part is devoted to reviewing studies describing the contributions of humor to physical well-being, such as reducing pain, decreasing proneness to heart disease and enhancing immunological responses. The effects are positive but weak and may be considered as belonging to the background factors promoting physical health. The second part is devoted to reviewing studies describing the contributions of humor to psychological well-being, mainly its emotional effects, such as reducing tension and aggression or enhancing social feelings, and its cognitive effects, such as mental flexibility, shifting, playfulness, optimism and distancing. The next sections deal with reviewing the presumed clinical effects of humor, focusing on the processes through which it has been claimed to contribute to facilitating individual and group psychotherapy. The clinical effects depend upon integrating humor into the overall therapy. In the last section an attempt is made to present a cognitive model which, by showing how humor coalesces the emotional and cognitive effects, may account for the diverse curative effects of humor.

Munchausen By Proxy Syndrome: The triad of abuse, self-abuse, and deception

The Munchausen By Proxy Syndrome (MbPS) is a complicated phenomenon whereby a peculiar threefold relationship between perpetrator, victim, and medical staff develops. This triad is based on abuse of the child, deception of the doctor, and, in many cases, self-abuse or passivity of the victim towards the perpetrators deeds. We have analyzed the interrelationship between the perpetrator, the victim, and the medical authority, in light of the mothers pathology.

Idiopathic pruritus in psychiatric inpatients: an explorative study

UNLABELLED Pruritus is an annoying physical symptom, frequently related to mental states. Dermatologic treatment commonly includes psychotropic medications. AIMS This study aimed to investigate idiopathic pruritus (IP) in psychiatric patients, its demographic characteristics and its relationship to psychiatric diagnoses, psychosocial stress, medication use, drug use and psychological characteristics. METHODS The study population included 100 psychiatric inpatients. Study data were acquired by means of structured patient interview using standardized questionnaires. RESULTS IP was experienced by 42% of the subjects, 34% of the men and 58% of the women (P=.03). The presence of IP was found to be related to psychosocial stress with a prevalence of 48.5% among those without adequate social support and 29.5% among those with adequate social support (P=.02) and with a prevalence of 48.5% of those without regular employment and 16.7% among subjects who were employed (P=.01). A trend of reduced prevalence of IP (14%) was found among patients treated with tricyclic antidepressants compared with 48% of those treated with other antidepressants (P=.09). No significant correlation was found with other medications or psychiatric diagnoses. IP was found in 76% of regular users of opioids. IP was more frequent in patients with higher scores on the anger-trait measure (P=.02) and on the angry temperament measure (P=.02) and ruminative catastrophization (P=.04). DISCUSSION The high incidence of itching among psychiatric inpatients necessitates awareness of the treating psychiatrist to this potential discomfort. Examination, diagnosis and treatment when needed can relieve the physical symptoms, which may also have an emotional effect on the patient.