Mordechai Mark

Gender differences in premorbid cognitive performance in a national cohort of schizophrenic patients

Despite significant research, there are still inconsistent findings regarding gender differences in cognitive performance in individuals already diagnosed with schizophrenia; studies have found that males suffering from schizophrenia are more, less or equally impaired compared with females. Gender differences in cognitive performance in individuals suffering from schizophrenia may be influenced by gender differences in premorbid cognitive performance; the very few and very small N studies published indicated that males have a poorer pre-morbid cognitive performance than females. This study examined the gender differences in premorbid cognition, utilizing cognitive assessments performed on female and male adolescents before induction into military service. The Israeli Draft Board Registry, which contains cognitive assessments equivalent to IQ scores on 16-18 year old Israeli adolescents, was linked with the Israeli National Psychiatric Hospitalization Case Registry, which records all psychiatric hospitalizations in the country. Scores on premorbid cognitive performance in schizophrenia were examined in 90 female-male case pairs matched for school attended as a proxy for socio-economic status. The mean age of first hospitalization was 20. 1+/-1.8 years of age for males and 19.6+/-1.8 years of age for females. A repeated-measures ANCOVA with age of first hospitalization and years of formal education as covariates, and controlling for gender differences in cognitive performance in healthy adolescents, revealed a significant difference in pre-morbid cognitive performance between males and females on all four cognitive measures [F(1,87)=8.07, P=0.006] with females scoring lower (worse) than males. In this national cohort, pre-morbid cognition was poorer in female, compared with male, adolescents who will suffer from schizophrenia in the future, a result consistent with some, but not all, similar studies. These results may be valid only for patients with first hospitalization around age 20. Hence, gender differences in premorbid cognition should be taken into account when assessing gender differences in cognition in schizophrenia.

Self-reported drug abuse in male adolescents with behavioral disturbances, and follow-up for future schizophrenia

BACKGROUND The prevalence of illicit drug abuse in persons with schizophrenia is greater then in the general population and has been attributed to self-medication of the symptoms of the illness; however, limited data indicate that drug abuse is already prevalent before the manifestation of psychosis, consistent with the possibility that drug abuse might be associated with increased risk for schizophrenia. METHODS The Israeli Draft Board screens the entire, unselected population of 16- to 17-year-old male adolescents for behavioral or personality disturbances. In a cohort of 270,000 male adolescents screened, 50,413 adolescents were suspected of having behavioral or personality disturbances and were questioned about drug use and abuse. These adolescents were followed for hospitalization for schizophrenia using a national, population-based psychiatric hospitalization registry; 268 of 50,413 (.5%) were hospitalized for schizophrenia over the following 5-11 years. RESULTS The prevalence of self-reported drug abuse in adolescents later hospitalized for schizophrenia was 12.4%, compared with 5.9% prevalence of drug abuse in adolescents not later hospitalized; adjusted RR = 2.016, 95% confidence interval: 1.309-3.104. CONCLUSIONS In this cohort of male adolescents with behavior disturbances, these results further support the hypothesis that drug abuse may be associated with increased risk for future schizophrenia.

REM sleep latency and wakefulness in the first sleep cycle as markers of major depression: a controlled study vs. schizophrenia and normal controls.

INTRODUCTION REM sleep latency is a clinically significant sleep variable that is found to be decreased in several psychiatric disorders. However, it is not known whether alteration of REM sleep latency is similar across disorders. In order to test whether incorporation of wakefulness in the first sleep cycle has a different outcome on REM sleep latency in different clinical groups, the authors have investigated correlation between sleep variables in the first sleep cycle in 25 patients with major depression, 24 patients with chronic schizophrenia, and in 10 healthy subjects. RESULTS REM sleep latency correlates with the duration of wakefulness in the first cycle in patients suffering from chronic schizophrenia and in healthy subjects. This correlation does not hold true in patients suffering from major depression. CONCLUSION Wakefulness incorporated in the first cycle influences REM sleep latency in healthy subjects and in patients suffering from chronic schizophrenia but not in patients suffering from major depression. This finding further supports the evidence that reduced REM sleep latency is a nonflexible marker of depression.

Predicting Actual Weight from Self-Report Data

Due to reasons of economy of time and ease of data collection, researchers increasingly use self-report weight as a substitute for measured or actual weight. Little research has been done on the inclusion of attitudinal scales and other self-report data in improving prediction of actual weight. The present study examined self-report data as well as actual weight for a sample of 946 young women inductees to the Israel Defense Forces. The results showed that self-reported weight is the best predictor of actual weight, but indicators such as the Eating Attitudes Scale (EAT), body image, and ideal weight are significant predictors also. In addition, the correlation between actual weight and difference weight (reported weight-actual weight) was negative (-.37) indicating that the heavier people tend to underreport their weight.

Prior hospitalization and age as predictors of mental health resource utilization in Israel

A two-part demand model based on data from a psychiatric case registry was estimated in order to search for predictors of hospital-based psychiatric care utilization. Using only age as an independent variable, explanation of future resource utilization is considerably weaker than when number of cumulative days of psychiatric hospital-based service use during the previous five years is also included. Only a small marginal gain is achieved by also adding diagnoses. Prospective remuneration by capitating sick funds according to age and past hospital-based service utilization records is recommended to avoid the twin pitfalls of cream-skimming and a distorted allocation of resources for psychiatric services.

Sensitivity, Specificity, and Positive Predictive Value as Measures of Prediction Accuracy: The Case of the Eat-26

Recently, investigators have identified several levels of severity among people suffering from eating disorders. One of the more commonly used scales for screening people with eating disorders is the 26-item version of the Eating Attitudes Test (EAT-26). Although decisions such as assigning individuals to treatment and control groups are often determined by the score on the EAT-26, researchers have not examined the sensitivity, specificity, and positive predictive value of the scale. In the present study, 231 female soldiers from a sample of 1,112 were interviewed and studied so as to determine the accuracy of decisions based on the EAT-26. Findings showed that the scale does poorly in identifying the most severe cases of eating disorders, but is better in identifying the milder case. The implications of the findings are discussed.

Malingering in the clinical setting: practical suggestions for intervention.

The complex nature of malingering observed in the military is examined, and a practical approach to the handling of such behaviour in the clinical setting is outlined. The complementary tasks of the mental health professional, the primary care physician, and other community agents are discussed.

Patterns of use and changes in diagnosis during first admission. National Case Register Study.

The goal of this study was to describe patterns of diagnosis and to explore the extent to which diagnosis changes during first-in-life psychiatric admissions. All 2,998 first admissions to Israeli psychiatric wards in 1989 were studied. Diagnosis did not change in at least 60% of the cases. Diagnoses in order of stability were: mental retardation (84%), substance abuse (82%), organic conditions (77.5%), neurotic (75%), schizophrenia (74%), personality disorders (73%), affective (68%), childhood (55%), paranoid (45%) and V-codes (22%). There was less change in diagnosis for patients over 45 (37.5%), than for patients aged 19-44 (43.2%) and 15-18 (57.8%). Diagnoses assigned at admission to first hospitalization are not likely to change during that hospitalization.

True Conversive Hallucinations

A case of true conversive hallucinations in a 19-year-old female soldier is described. This phenomenon is rare and should be distinguished from psychotic or dissociative states.

DEBATE REAWAKENED: PREMORBID FACTORS FOR SOLDIERS WITH REFRACTORY POSTTRAUMATIC STRESS DISORDER '

Soldiers with severe Posttraumatic Stress Disorder who did not respond favourably to the front echelon treatment units, were treated in a rear echelon treatment centre, named Combat Fitness Retraining Unit, an alternative to psychiatric hospitalization. The soldiers were given individual clinical interviews; their combat potential scores were measured to tap premorbid factors which may have contributed to the development of symptoms. Analysis indicated that (1) in the clinical interview subjects showed clear interpersonal, school, family, and army adjustment problems prior to the trauma, (2) soldiers with Posttraumatic Stress Disorder treated in the rear unit tended to come from the lower end of the military combat potential level. Ramifications of these findings were carefully elucidated.