The aim of this study was to determine for the first time neurosteroid levels, dehydroepiandroste... more The aim of this study was to determine for the first time neurosteroid levels, dehydroepiandrosterone (DHEA) and DHEA-sulfate (DHEA-S) in particular, in a group of adult patients with autistic disorder and compare these levels with normal healthy individuals. Levels of DHEA, DHEA-S and cortisol were compared between 15 adult drug-free patients with autistic disorder and 13 healthy controls. The Ritvo-Freeman Real-Life Rating Scale (RLRS) and the Overt Aggression Scale (OAS) were assessed as a measure of symptom severity. Significant lower DHEA-S levels were observed in the group with autistic disorder as compared to controls (pb0.05). DHEA-S levels appear to be low in patients with autistic disorder and, while speculative, may play a role in the etiopathophysiology of the disorder.
Can abnormal growth hormone (GH) response to TSH releasing hormone (TRH) differentiate between sc... more Can abnormal growth hormone (GH) response to TSH releasing hormone (TRH) differentiate between schizophrenic probands, their affected first degree relatives and phenotypicaily healthy family members? Five multicase families with schizophrenia were studied-each family consisted of two chronic schizophrenic patients and one first degree healthy relative, TRH tests were performed between 8:00 9:00 am. Thirty minutes after IV line was inserted a basal blood sample was drawn, and thereafter synthetic TRH was administered. Additional blood samples were drawn at 15, 30 and 60 minutes. Plasma GH was carried out by double antibody RIA. The results were: One proband exhibited high basal GH levels (20 ng/ml) and was excluded. The mean baseline GH plasma levels did not differ significantly between the three groups and the controls. Abnormal GH response was observed in 3/4 probands; 3/5 schizophrenic relatives and 3/5 healthy relatives, but in 0/8 of the healthy non.related controls. The magnitude of the abnormal GH response did not differ significantly between the three groups of the families. The frequency of abnormal GH response was significantly higher in the schizophrenic patients (6/9) when compared to healthy non-related control subjects. A trend towards increased frequency of abnormal GH response was observed in healthy family members (3/5) as compared to control subjects. This study confirmed our previous observation of abnormal GH release after TRH challenge in about 50% of the schizophrenic patients with positive family history. The additional finding is increased frequency of GH response to TRH in healthy related controis.
Books of Abstracts of the 16th World Congress of the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP), 2004
The rapidly growing awareness and respect of the social needs and legal rights of the patient in ... more The rapidly growing awareness and respect of the social needs and legal rights of the patient in many countries is a sign of cultural maturity of society at large. However, the implementation of these achievements is especially arduous in the field of psychiatry because often mental patients have cognitive restrictions and/or emotional distress both of which may interfere with the exercise of their civil rights. One focus of this paper is the challenging process of obtaining legally valid consent from a severely ill psychiatric patient for diagnostic procedures and for treatment and also for participation in research projects. This paper also analyzes and discusses the new developments in the health legislation in Israel and focuses on the questions that arise in its application to the field of psychiatry. A recommendation for practical assessment of competence is presented. Systematic studies ofthe application of legal regulation and appropriate modifications are needed.
Gonadotropin-releasing-hormone (GnRH) is a hypothalamic hormone that controls the formation and r... more Gonadotropin-releasing-hormone (GnRH) is a hypothalamic hormone that controls the formation and release of gonadotropins from the pituitary gland (Matsuo et al 1971). GnRH and its synthetic analogues, when given continuously, were shown to induce a reversible state of hypogonadotropic hypogonadism (Belchetz et al 1978). GnRH agonists (GnRH-a) have a wide variety of clinical applications for estrogenand testosteronedependent diseases or conditions, which benefit from the hypogonadotropic hypogonadism state induced by the agonists-e.g., in the treatment of endometriosis and polycystic ovary disease (Freude et al 1988; Shaw 1992) and in the treatment protocol of in vitro fertilization (IVF) (Dor et al 1990). Clinical studies reported depression-like side effects of GnRH-a treatment, including hot flushes, transient headaches, decrease in libido, mild insomnia, chronic fatigue, and depressed mood (Henzl 1988; Erickson and Ory 1989). These were generally attributed a priori to the hypoes...
This article deals with the involvement of the law in the psychiatric treatment of minors through... more This article deals with the involvement of the law in the psychiatric treatment of minors through the directives it gives with regards to examination, diagnosis, treatment and hospitalization of minors. In recent years changes have been made in the law dealing with these issues. These were set out in the 1995 amendments to two laws: "The Law of the Treatment and Supervision of Minors" and "the Law of the Treatment of the Mentally Ill". The amendments include changes in the procedural processes as well as the introduction of concepts which did not exist in the previous laws. Since these amendments have begun to be put into practice, the therapeutic system has discovered that problems have arisen in two areas--the conceptual and the practical--of the instructions of the new laws. These problems arise out of the difficulty in understanding what the laws actually say, difficulties in executing the laws, and a special clumsiness which causes it to miss its objective t...
The Israel journal of psychiatry and related sciences, 2000
The 1996 Israel Law for Patients' Rights, Sections 21 and 22, introduces to the field of heal... more The 1996 Israel Law for Patients' Rights, Sections 21 and 22, introduces to the field of health legislation two new entities: internal examination committees and quality-control committees. The former are to be established when there is a need to investigate unusual, irregular or exceptional events related to diagnosis and/or treatment. Furthermore, the 1996 Law directs the internal examination committee to reveal its findings to the patient or to his representatives. This approach has evoked strong controversy up until the present time. On the other hand, the quality-control committees which produce privileged information have been smoothly integrated into psychiatric practice. This paper presents the history of the creation of these two committees based on law, and examines their effect on the daily practice of medicine and the reaction of the physicians' guild to their activation. It also discusses the effect of the implementation of these committees on the level of mutua...
Theory of mind (ToM) abilities of children with schizophrenia, children with high functioning aut... more Theory of mind (ToM) abilities of children with schizophrenia, children with high functioning autism, and normally developing children, matched on mental age (MA), verbal MA, and performance MA, were compared. Both clinical groups were matched on chronological age as well, whereas the normally developing children were younger. A fact belief task, a value belief task, a deception task, and a false belief task were administered. The three groups did not differ on the fact belief task. Children with autism performed more poorly than normally developing children on value belief and false belief tasks, and more poorly than individuals with schizophrenia on the deception task. Children with schizophrenia performed more poorly than normally developing children only on the false belief task. Overall, the group with autism passed significantly fewer tasks compared to the normally developing group. ToM abilities correlated with verbal abilities for individuals with autism. The ToM abilities of children with paranoid schizophrenia and children with undifferentiated or disorganized schizophrenia did not differ. Findings strengthen the notion of a limited understanding of ToM in schizophrenia, and support the notion that ToM deficits, although more severe in autism, are not unique to autism.
The emotional consequences of elective surgery to children and to their parents have not been suf... more The emotional consequences of elective surgery to children and to their parents have not been sufficiently studied. The aim of the present study was to prospectively assess the prevalence and severity of post-traumatic, anxiety and depressive symptoms in this population. Forty children and adolescents consecutively admitted for elective surgery in a general hospital participated in the study. Their parents were also assessed. The assessments were made on the day of admission and surgery, and 1 and 6 months after the surgery. Minor post-traumatic symptoms of the children were noted at the first and second assessments, decreasing significantly at the 6-month assessment. Further, the prevalence of children with elevated post-traumatic symptoms decreased significantly between the first and second assessments. Parents scored highest for anxiety and depression at the first assessment. Their symptoms, however, decreased significantly within 1 month. A significant decrease between the first and second assessments was also noted in the prevalence of parents with elevated anxiety symptoms. At the 1- and 6-month follow-up assessments, there was a significant correlation between the children's symptoms and their parents'. Mild post-traumatic symptoms may accompany paediatric elective surgery and persist for at least 1 month. Parents may also manifest anxiety and depressive symptoms, which may diminish earlier, that is, immediately after the surgery or within 1 month.
Suicide by definition is a purposeful and intentional act of self-slaughter and, as such, has not... more Suicide by definition is a purposeful and intentional act of self-slaughter and, as such, has not the intrinsic characteristics of an accident. The latter is an unexpected, non-intentional act. Nevertheless, in Israel, on various occasions during the last decade, suicide has been accepted by the courts as a compensatable work accident. A series of cases is presented, together with detailed discussion of the role of the psychiatric expert when dealing with this specific medico-legal issue.
Blood samples were collected during routine follow-up visits between 8 to 9 AM from nine children... more Blood samples were collected during routine follow-up visits between 8 to 9 AM from nine children suffering from Tourette's disorder, aged 10-16 years (mean +-SD, 12-. 1.8 years), after obtaining informed consent from them and their parents. All nine children met DSM-III-R criteria for Tourette's disorder. Five of
Distribution of antibodies to herpes simplex type 1 (HSV1), Epstein-Barr virus (EBV), cytomegalov... more Distribution of antibodies to herpes simplex type 1 (HSV1), Epstein-Barr virus (EBV), cytomegalovirus (CMV) and measles virus (MV) was studied in sera and cerebrospinal fluids (CSF) of 41 patients with schizophrenia, 27 patients with primary" affective disorders and 25 control patients with neurological diseases. No significant differences in distribution and mean geometric titers (GMT) of ~ntibodies to HSV1 between the psychiatric and control groups were found. Distribution and GMT of antibodies to EBV were highly significant in psychiatric patients as compared to controls with highest titers in the affective disorder group. Antibodies to HSV1 were present in 15 CSF specimens of psychiatric patients with reduced CSF/serum ratio in 4, and low levels of antibodies were detected in 8 control patients. Antibodies to EBV-VCA were detected in 4 CSFs of psychiatric patients. Total protein levels were determined in CSF specimens and no correlation with antibodies was found. No significant differences in distribution of antibodies to CMV or 3/IV in the three study groups were found. No antibodies to CMV were demonstrated in CSFs and in one specimen from a patient and two controls antibodies to MV were detected. Introduefion Search for possible viral etiology of slowly progressing central nervous system disorders, which are also accompanied by prominent psychotic symptoms, led to the discovery of the role of conventional and non-conventionM viruses in such
Journal of Child and Adolescent Psychopharmacology, 2006
Background and purpose: Childhood-onset schizophrenia (COS) is a clinically severe form of schizo... more Background and purpose: Childhood-onset schizophrenia (COS) is a clinically severe form of schizophrenia, which causes severe impairment to cognitive, linguistic, and social development. There are few prospective and retrospective open clinical trials of risperidone and olanzapine in COS. In this open-label, randomized, prospective study, we compared the tolerability and effectiveness of risperidone versus olanzapine in the treatment of COS patients. Methods: The study population consisted of 25 children with COS (mean age 11.09 ± 1.55 years). After an evaluation, patients received risperidone (0.25-4.5 mg/day, mean dose 1.62 ± 1.02 mg/day) or olanzapine (2.5-20 mg/day, mean dose 8.18 ± 4.41 mg/day) for 12 weeks, with weekly evaluations. Results: Both groups showed comparable significant (p < 0.001) within-group improvement from baseline to endpoint (LOCF) in Positive and Negative Symptoms Scale (PANSS) total and subscale scores. Of the olanzapine-treated children, 11 (91.7%) completed the 12 weeks of the study, whereas in the risperidone-treated children only 9 (69.2%) did. No significant differences between risperidone-treated children and olanzapine-treated children were observed on Barnes Akathisia Rating Scale (BAS) and Simpson-Angus Scale (SAS) rating scales. Both treatment groups showed significant (p < 0.001) increase in weight from baseline to endpoint. Conclusion: Our open-label, small-scale comparative study suggests that both risperidone and olanzapine appear to be efficacious antipsychotic medications in COS, with a slight nonsignificant advantage of olanzapine in the dropout rate.
Velo-cardio-facial syndrome ( VCFS ) is caused by a microdeletion in the long arm of chromosome 2... more Velo-cardio-facial syndrome ( VCFS ) is caused by a microdeletion in the long arm of chromosome 22 and is associated with an increased frequency of schizophrenia and bipolar mood disorder. The purpose of this study was to investigate the genetic, physical, developmental and psychiatric features of schizophrenic patients with VCFS microdeletion. It describes the clinical findings in four schizophrenic inpatients with the characteristic chromosomal deletion. The four patients displayed delayed motor development, language deficits, learning disabilities, mental retardation, early age of onset, chronic and disabling course of illness and poor response to classical neuroleptic drugs and electroconvulsive therapy. Two patients benefited from treatment with clozapine. We suggest that schizophrenic patients with a history of delayed motor development, early onset of the disorder, history of learning disability, mental retardation, congenital cardiac anomalies and/or hypernasal speech should be screened for the velo-cardiofacial syndrome deletion. The implications of this study for psychiatric phenotype, nosology, disease mechanism, and possible new treatments in the future are discussed. gnatia, small mouth and minor ear anomalies (see 0920-9964/99/$ -see front matter
Theory of mind (ToM) abilities of children with schizophrenia, children with high functioning aut... more Theory of mind (ToM) abilities of children with schizophrenia, children with high functioning autism, and normally developing children, matched on mental age (MA), verbal MA, and performance MA, were compared. Both clinical groups were matched on chronological age as well, whereas the normally developing children were younger. A fact belief task, a value belief task, a deception task, and a false belief task were administered. The three groups did not differ on the fact belief task. Children with autism performed more poorly than normally developing children on value belief and false belief tasks, and more poorly than individuals with schizophrenia on the deception task. Children with schizophrenia performed more poorly than normally developing children only on the false belief task. Overall, the group with autism passed significantly fewer tasks compared to the normally developing group. ToM abilities correlated with verbal abilities for individuals with autism. The ToM abilities of children with paranoid schizophrenia and children with undifferentiated or disorganized schizophrenia did not differ. Findings strengthen the notion of a limited understanding of ToM in schizophrenia, and support the notion that ToM deficits, although more severe in autism, are not unique to autism.
Progress in Neuro-Psychopharmacology and Biological Psychiatry, 2009
Objective: Accumulating data indicate the involvement of the serotonergic system in adolescent ag... more Objective: Accumulating data indicate the involvement of the serotonergic system in adolescent aggression. The aim of this study was to examine the platelet-poor plasma (PPP) serotonin (5-HT) levels among delinquent adolescent boys with conduct disorder (CD) in comparison with normal controls. Method: PPP 5-HT levels were measured in 16 male delinquent CD adolescents from a correctional facility and in 14 normal male adolescent controls. Severity of aggressive behavior was assessed by the Child Behavior Checklist (CBCL) and the Overt Aggression Scale (OAS). Results: Delinquent CD adolescents had higher PPP 5-HT levels (about 3-fold) than the normal controls (27.68 ± 32.29 vs. 7.76 ± 4.23 ng/ml, respectively, p = 0.027). In the delinquent CD adolescents a significant correlation was found between the PPP 5-HT levels and the CBCL and OAS aggressive scores (r = 0.68, p = 0.0034 and r = 0.59, p = 0.016, respectively). Conclusions: Juvenile delinquency is associated with high PPP 5-HT levels. Modulation of 5-HT neurotransmission may have a role in the symptomatology and treatment of severe adolescent CD.
Journal of the American Academy of Child & Adolescent Psychiatry, 1994
Very early onset schizophrenic patients only partially benefit from conventional antipsychotic tr... more Very early onset schizophrenic patients only partially benefit from conventional antipsychotic treatment and are at increased risk for developing tardive dyskinesia (TD). Clozapine, which lacks extrapyramidal side effects including TD, has been proved effective for adult schizophrenic patients who are resistant to other neuroleptics. Clozapine, therefore, may offer an alternative treatment for these patients. The authors report four successful trials of clozapine in children aged 10 to 12 years old with schizophrenia, the youngest group reported on to date, who were unresponsive to conventional neuroleptic treatment.
The aim of this study was to determine for the first time neurosteroid levels, dehydroepiandroste... more The aim of this study was to determine for the first time neurosteroid levels, dehydroepiandrosterone (DHEA) and DHEA-sulfate (DHEA-S) in particular, in a group of adult patients with autistic disorder and compare these levels with normal healthy individuals. Levels of DHEA, DHEA-S and cortisol were compared between 15 adult drug-free patients with autistic disorder and 13 healthy controls. The Ritvo-Freeman Real-Life Rating Scale (RLRS) and the Overt Aggression Scale (OAS) were assessed as a measure of symptom severity. Significant lower DHEA-S levels were observed in the group with autistic disorder as compared to controls (pb0.05). DHEA-S levels appear to be low in patients with autistic disorder and, while speculative, may play a role in the etiopathophysiology of the disorder.
Can abnormal growth hormone (GH) response to TSH releasing hormone (TRH) differentiate between sc... more Can abnormal growth hormone (GH) response to TSH releasing hormone (TRH) differentiate between schizophrenic probands, their affected first degree relatives and phenotypicaily healthy family members? Five multicase families with schizophrenia were studied-each family consisted of two chronic schizophrenic patients and one first degree healthy relative, TRH tests were performed between 8:00 9:00 am. Thirty minutes after IV line was inserted a basal blood sample was drawn, and thereafter synthetic TRH was administered. Additional blood samples were drawn at 15, 30 and 60 minutes. Plasma GH was carried out by double antibody RIA. The results were: One proband exhibited high basal GH levels (20 ng/ml) and was excluded. The mean baseline GH plasma levels did not differ significantly between the three groups and the controls. Abnormal GH response was observed in 3/4 probands; 3/5 schizophrenic relatives and 3/5 healthy relatives, but in 0/8 of the healthy non.related controls. The magnitude of the abnormal GH response did not differ significantly between the three groups of the families. The frequency of abnormal GH response was significantly higher in the schizophrenic patients (6/9) when compared to healthy non-related control subjects. A trend towards increased frequency of abnormal GH response was observed in healthy family members (3/5) as compared to control subjects. This study confirmed our previous observation of abnormal GH release after TRH challenge in about 50% of the schizophrenic patients with positive family history. The additional finding is increased frequency of GH response to TRH in healthy related controis.
Books of Abstracts of the 16th World Congress of the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP), 2004
The rapidly growing awareness and respect of the social needs and legal rights of the patient in ... more The rapidly growing awareness and respect of the social needs and legal rights of the patient in many countries is a sign of cultural maturity of society at large. However, the implementation of these achievements is especially arduous in the field of psychiatry because often mental patients have cognitive restrictions and/or emotional distress both of which may interfere with the exercise of their civil rights. One focus of this paper is the challenging process of obtaining legally valid consent from a severely ill psychiatric patient for diagnostic procedures and for treatment and also for participation in research projects. This paper also analyzes and discusses the new developments in the health legislation in Israel and focuses on the questions that arise in its application to the field of psychiatry. A recommendation for practical assessment of competence is presented. Systematic studies ofthe application of legal regulation and appropriate modifications are needed.
Gonadotropin-releasing-hormone (GnRH) is a hypothalamic hormone that controls the formation and r... more Gonadotropin-releasing-hormone (GnRH) is a hypothalamic hormone that controls the formation and release of gonadotropins from the pituitary gland (Matsuo et al 1971). GnRH and its synthetic analogues, when given continuously, were shown to induce a reversible state of hypogonadotropic hypogonadism (Belchetz et al 1978). GnRH agonists (GnRH-a) have a wide variety of clinical applications for estrogenand testosteronedependent diseases or conditions, which benefit from the hypogonadotropic hypogonadism state induced by the agonists-e.g., in the treatment of endometriosis and polycystic ovary disease (Freude et al 1988; Shaw 1992) and in the treatment protocol of in vitro fertilization (IVF) (Dor et al 1990). Clinical studies reported depression-like side effects of GnRH-a treatment, including hot flushes, transient headaches, decrease in libido, mild insomnia, chronic fatigue, and depressed mood (Henzl 1988; Erickson and Ory 1989). These were generally attributed a priori to the hypoes...
This article deals with the involvement of the law in the psychiatric treatment of minors through... more This article deals with the involvement of the law in the psychiatric treatment of minors through the directives it gives with regards to examination, diagnosis, treatment and hospitalization of minors. In recent years changes have been made in the law dealing with these issues. These were set out in the 1995 amendments to two laws: "The Law of the Treatment and Supervision of Minors" and "the Law of the Treatment of the Mentally Ill". The amendments include changes in the procedural processes as well as the introduction of concepts which did not exist in the previous laws. Since these amendments have begun to be put into practice, the therapeutic system has discovered that problems have arisen in two areas--the conceptual and the practical--of the instructions of the new laws. These problems arise out of the difficulty in understanding what the laws actually say, difficulties in executing the laws, and a special clumsiness which causes it to miss its objective t...
The Israel journal of psychiatry and related sciences, 2000
The 1996 Israel Law for Patients' Rights, Sections 21 and 22, introduces to the field of heal... more The 1996 Israel Law for Patients' Rights, Sections 21 and 22, introduces to the field of health legislation two new entities: internal examination committees and quality-control committees. The former are to be established when there is a need to investigate unusual, irregular or exceptional events related to diagnosis and/or treatment. Furthermore, the 1996 Law directs the internal examination committee to reveal its findings to the patient or to his representatives. This approach has evoked strong controversy up until the present time. On the other hand, the quality-control committees which produce privileged information have been smoothly integrated into psychiatric practice. This paper presents the history of the creation of these two committees based on law, and examines their effect on the daily practice of medicine and the reaction of the physicians' guild to their activation. It also discusses the effect of the implementation of these committees on the level of mutua...
Theory of mind (ToM) abilities of children with schizophrenia, children with high functioning aut... more Theory of mind (ToM) abilities of children with schizophrenia, children with high functioning autism, and normally developing children, matched on mental age (MA), verbal MA, and performance MA, were compared. Both clinical groups were matched on chronological age as well, whereas the normally developing children were younger. A fact belief task, a value belief task, a deception task, and a false belief task were administered. The three groups did not differ on the fact belief task. Children with autism performed more poorly than normally developing children on value belief and false belief tasks, and more poorly than individuals with schizophrenia on the deception task. Children with schizophrenia performed more poorly than normally developing children only on the false belief task. Overall, the group with autism passed significantly fewer tasks compared to the normally developing group. ToM abilities correlated with verbal abilities for individuals with autism. The ToM abilities of children with paranoid schizophrenia and children with undifferentiated or disorganized schizophrenia did not differ. Findings strengthen the notion of a limited understanding of ToM in schizophrenia, and support the notion that ToM deficits, although more severe in autism, are not unique to autism.
The emotional consequences of elective surgery to children and to their parents have not been suf... more The emotional consequences of elective surgery to children and to their parents have not been sufficiently studied. The aim of the present study was to prospectively assess the prevalence and severity of post-traumatic, anxiety and depressive symptoms in this population. Forty children and adolescents consecutively admitted for elective surgery in a general hospital participated in the study. Their parents were also assessed. The assessments were made on the day of admission and surgery, and 1 and 6 months after the surgery. Minor post-traumatic symptoms of the children were noted at the first and second assessments, decreasing significantly at the 6-month assessment. Further, the prevalence of children with elevated post-traumatic symptoms decreased significantly between the first and second assessments. Parents scored highest for anxiety and depression at the first assessment. Their symptoms, however, decreased significantly within 1 month. A significant decrease between the first and second assessments was also noted in the prevalence of parents with elevated anxiety symptoms. At the 1- and 6-month follow-up assessments, there was a significant correlation between the children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s symptoms and their parents&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;. Mild post-traumatic symptoms may accompany paediatric elective surgery and persist for at least 1 month. Parents may also manifest anxiety and depressive symptoms, which may diminish earlier, that is, immediately after the surgery or within 1 month.
Suicide by definition is a purposeful and intentional act of self-slaughter and, as such, has not... more Suicide by definition is a purposeful and intentional act of self-slaughter and, as such, has not the intrinsic characteristics of an accident. The latter is an unexpected, non-intentional act. Nevertheless, in Israel, on various occasions during the last decade, suicide has been accepted by the courts as a compensatable work accident. A series of cases is presented, together with detailed discussion of the role of the psychiatric expert when dealing with this specific medico-legal issue.
Blood samples were collected during routine follow-up visits between 8 to 9 AM from nine children... more Blood samples were collected during routine follow-up visits between 8 to 9 AM from nine children suffering from Tourette's disorder, aged 10-16 years (mean +-SD, 12-. 1.8 years), after obtaining informed consent from them and their parents. All nine children met DSM-III-R criteria for Tourette's disorder. Five of
Distribution of antibodies to herpes simplex type 1 (HSV1), Epstein-Barr virus (EBV), cytomegalov... more Distribution of antibodies to herpes simplex type 1 (HSV1), Epstein-Barr virus (EBV), cytomegalovirus (CMV) and measles virus (MV) was studied in sera and cerebrospinal fluids (CSF) of 41 patients with schizophrenia, 27 patients with primary" affective disorders and 25 control patients with neurological diseases. No significant differences in distribution and mean geometric titers (GMT) of ~ntibodies to HSV1 between the psychiatric and control groups were found. Distribution and GMT of antibodies to EBV were highly significant in psychiatric patients as compared to controls with highest titers in the affective disorder group. Antibodies to HSV1 were present in 15 CSF specimens of psychiatric patients with reduced CSF/serum ratio in 4, and low levels of antibodies were detected in 8 control patients. Antibodies to EBV-VCA were detected in 4 CSFs of psychiatric patients. Total protein levels were determined in CSF specimens and no correlation with antibodies was found. No significant differences in distribution of antibodies to CMV or 3/IV in the three study groups were found. No antibodies to CMV were demonstrated in CSFs and in one specimen from a patient and two controls antibodies to MV were detected. Introduefion Search for possible viral etiology of slowly progressing central nervous system disorders, which are also accompanied by prominent psychotic symptoms, led to the discovery of the role of conventional and non-conventionM viruses in such
Journal of Child and Adolescent Psychopharmacology, 2006
Background and purpose: Childhood-onset schizophrenia (COS) is a clinically severe form of schizo... more Background and purpose: Childhood-onset schizophrenia (COS) is a clinically severe form of schizophrenia, which causes severe impairment to cognitive, linguistic, and social development. There are few prospective and retrospective open clinical trials of risperidone and olanzapine in COS. In this open-label, randomized, prospective study, we compared the tolerability and effectiveness of risperidone versus olanzapine in the treatment of COS patients. Methods: The study population consisted of 25 children with COS (mean age 11.09 ± 1.55 years). After an evaluation, patients received risperidone (0.25-4.5 mg/day, mean dose 1.62 ± 1.02 mg/day) or olanzapine (2.5-20 mg/day, mean dose 8.18 ± 4.41 mg/day) for 12 weeks, with weekly evaluations. Results: Both groups showed comparable significant (p < 0.001) within-group improvement from baseline to endpoint (LOCF) in Positive and Negative Symptoms Scale (PANSS) total and subscale scores. Of the olanzapine-treated children, 11 (91.7%) completed the 12 weeks of the study, whereas in the risperidone-treated children only 9 (69.2%) did. No significant differences between risperidone-treated children and olanzapine-treated children were observed on Barnes Akathisia Rating Scale (BAS) and Simpson-Angus Scale (SAS) rating scales. Both treatment groups showed significant (p < 0.001) increase in weight from baseline to endpoint. Conclusion: Our open-label, small-scale comparative study suggests that both risperidone and olanzapine appear to be efficacious antipsychotic medications in COS, with a slight nonsignificant advantage of olanzapine in the dropout rate.
Velo-cardio-facial syndrome ( VCFS ) is caused by a microdeletion in the long arm of chromosome 2... more Velo-cardio-facial syndrome ( VCFS ) is caused by a microdeletion in the long arm of chromosome 22 and is associated with an increased frequency of schizophrenia and bipolar mood disorder. The purpose of this study was to investigate the genetic, physical, developmental and psychiatric features of schizophrenic patients with VCFS microdeletion. It describes the clinical findings in four schizophrenic inpatients with the characteristic chromosomal deletion. The four patients displayed delayed motor development, language deficits, learning disabilities, mental retardation, early age of onset, chronic and disabling course of illness and poor response to classical neuroleptic drugs and electroconvulsive therapy. Two patients benefited from treatment with clozapine. We suggest that schizophrenic patients with a history of delayed motor development, early onset of the disorder, history of learning disability, mental retardation, congenital cardiac anomalies and/or hypernasal speech should be screened for the velo-cardiofacial syndrome deletion. The implications of this study for psychiatric phenotype, nosology, disease mechanism, and possible new treatments in the future are discussed. gnatia, small mouth and minor ear anomalies (see 0920-9964/99/$ -see front matter
Theory of mind (ToM) abilities of children with schizophrenia, children with high functioning aut... more Theory of mind (ToM) abilities of children with schizophrenia, children with high functioning autism, and normally developing children, matched on mental age (MA), verbal MA, and performance MA, were compared. Both clinical groups were matched on chronological age as well, whereas the normally developing children were younger. A fact belief task, a value belief task, a deception task, and a false belief task were administered. The three groups did not differ on the fact belief task. Children with autism performed more poorly than normally developing children on value belief and false belief tasks, and more poorly than individuals with schizophrenia on the deception task. Children with schizophrenia performed more poorly than normally developing children only on the false belief task. Overall, the group with autism passed significantly fewer tasks compared to the normally developing group. ToM abilities correlated with verbal abilities for individuals with autism. The ToM abilities of children with paranoid schizophrenia and children with undifferentiated or disorganized schizophrenia did not differ. Findings strengthen the notion of a limited understanding of ToM in schizophrenia, and support the notion that ToM deficits, although more severe in autism, are not unique to autism.
Progress in Neuro-Psychopharmacology and Biological Psychiatry, 2009
Objective: Accumulating data indicate the involvement of the serotonergic system in adolescent ag... more Objective: Accumulating data indicate the involvement of the serotonergic system in adolescent aggression. The aim of this study was to examine the platelet-poor plasma (PPP) serotonin (5-HT) levels among delinquent adolescent boys with conduct disorder (CD) in comparison with normal controls. Method: PPP 5-HT levels were measured in 16 male delinquent CD adolescents from a correctional facility and in 14 normal male adolescent controls. Severity of aggressive behavior was assessed by the Child Behavior Checklist (CBCL) and the Overt Aggression Scale (OAS). Results: Delinquent CD adolescents had higher PPP 5-HT levels (about 3-fold) than the normal controls (27.68 ± 32.29 vs. 7.76 ± 4.23 ng/ml, respectively, p = 0.027). In the delinquent CD adolescents a significant correlation was found between the PPP 5-HT levels and the CBCL and OAS aggressive scores (r = 0.68, p = 0.0034 and r = 0.59, p = 0.016, respectively). Conclusions: Juvenile delinquency is associated with high PPP 5-HT levels. Modulation of 5-HT neurotransmission may have a role in the symptomatology and treatment of severe adolescent CD.
Journal of the American Academy of Child & Adolescent Psychiatry, 1994
Very early onset schizophrenic patients only partially benefit from conventional antipsychotic tr... more Very early onset schizophrenic patients only partially benefit from conventional antipsychotic treatment and are at increased risk for developing tardive dyskinesia (TD). Clozapine, which lacks extrapyramidal side effects including TD, has been proved effective for adult schizophrenic patients who are resistant to other neuroleptics. Clozapine, therefore, may offer an alternative treatment for these patients. The authors report four successful trials of clozapine in children aged 10 to 12 years old with schizophrenia, the youngest group reported on to date, who were unresponsive to conventional neuroleptic treatment.
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Papers by Tamar Mozes