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Gur S, Weizman S, Hermesh H, Matalon A, Meyerovitch J, Krivoy A. Adherence of patients with schizophrenia to hypothyroidism treatment. Glob Ment Health (Camb) 2023; 10:e91. [PMID: 38161742 PMCID: PMC10755369 DOI: 10.1017/gmh.2023.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/05/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024] Open
Abstract
Adherence to prescription medications is critical for both remission from schizophrenia and control of physical comorbidities. While schizophrenia with comorbid hypothyroidism is common, there is little research on adherence to hypothyroidism treatment in this population. The current study used a retrospective, matched case-control design. The cohort included 1,252 patients diagnosed with schizophrenia according to ICD-10 and 3,756 controls matched for gender, age, socioeconomic status and ethnicity without diagnosis of schizophrenia. All data were retrieved from the electronic medical database of a large health maintenance organization. Retrieved data included demographics, thyroid functionality test results and prescribed medications. Measures of adherence to therapy were used for analyses as were data from follow-ups of patients with hypothyroidism. A diagnosis of hypothyroidism was found in 299 patients, 115 of whom were also diagnosed with schizophrenia. The 184 without schizophrenia constituted the control group. No statistically significant differences were found between the two groups regarding prescriptions for L-thyroxin and TSH levels and number of TSH tests. Adherence of patients with schizophrenia to hypothyroidism treatment was found to be as good as that of individuals without a schizophrenia diagnosis.
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Affiliation(s)
- Shay Gur
- Geha Mental Health Center, Petah Tikva, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shira Weizman
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Abarbanel Mental Health Center, Bat Yam, Israel
| | - Haggai Hermesh
- Geha Mental Health Center, Petah Tikva, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Andre Matalon
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Dan-Petah Tikva District, Clalit Health Services, Petah Tikva, Israel
| | - Joseph Meyerovitch
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
- Chief Pediatrician’s Office, Community Division, Clalit Health Services, Tel Aviv, Israel
| | - Amir Krivoy
- Geha Mental Health Center, Petah Tikva, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Krivoy A, Rosenthal G. [PUBLIC EXPENDITURE ON MENTAL HEALTH IN ISRAEL: CALCULATION, ANALYSIS AND INTERNATIONAL COMPARISON]. Harefuah 2023; 162:507-512. [PMID: 37698330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
INTRODUCTION This is the first health economics study to calculate and analyze public expenditure on mental health in Israel from 2019 through 2021. Financing of the NIS 4 billion expenses is divided equally between the health funds and direct financing from the state budget.
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Gur S, Weizman S, Hermesh H, Matalon A, Meyerovitch J, Krivoy A. Comparison of medical treatment of patients with schizophrenia in general practitioners' clinics versus mental health clinics: A cohort study. J Psychosom Res 2023; 171:111383. [PMID: 37269644 DOI: 10.1016/j.jpsychores.2023.111383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 04/30/2023] [Accepted: 05/17/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Individuals with schizophrenia have more cardiometabolic comorbidities than the general population, live about twenty years less and consume more medical services. They are treated at general practitioners' clinics (GPCs) or at mental health clinics (MHCs). In this cohort study we investigated the association between patients' main treatment setting, cardiometabolic comorbidities and medical services utilization. METHODS Demographics, healthcare services utilization, cardiometabolic comorbidities and medication prescriptions of patients with schizophrenia were retrieved from an electronic database for the period 1.1.2011 to 31.12.2012 and compared between patients treated mostly in MHCs (N = 260) and those treated mostly in GPCs (N = 115). RESULTS GPC patients tended to be older (mean age 39.8 ± 13.7 vs. 34.6 ± 12.3 yrs., p < 0.0001), of lower socioeconomic status (42.6% vs 24.6%, p = 0.001) and have more cardiometabolic diagnoses (hypertension: 19.1% vs 10.8%, diabetes mellitus: 25.2% vs 17.0%, p < 0.05) than MHC patients. The former received more cardiometabolic disorder medications and utilized more secondary and tertiary medical services. Charlson Comorbidity Index (CCI) was higher in the GPC group than in the MHC group (1.8 ± 1.9 vs.1.2 ± 1. 6, p < 0.0001). A multivariate binary logistic regression analysis, adjusted for age, sex, SES and CCI found lower adjusted odds ratio for the MHC group versus the GPC group, of visiting an EMD, a specialist or to be hospitalized. CONCLUSIONS The current study highlights the critical importance of integrating GPCs and MHCs, thus offering patients combined physical and mental care at a single location. More studies on the potential benefits of such integration to patients' health are warranted.
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Affiliation(s)
- Shay Gur
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah Tikva, Israel.
| | - Shira Weizman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Abarbanel Mental Health Center, Bat Yam, Israel
| | - Haggai Hermesh
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah Tikva, Israel
| | - Andre Matalon
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Dan-Petah Tikva District, Clalit Health Services, Petah Tikva, Israel
| | - Joseph Meyerovitch
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel and Chief Pediatrician's Office, Community Division, Clalit Health Services, Tel Aviv, Israel
| | - Amir Krivoy
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah Tikva, Israel
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Hochman E, Feldman B, Weizman A, Krivoy A, Gur S, Barzilay E, Gabay H, Levinkron-Fisch O, Lawrence G. Gestational hemodilution as a putative risk factor for postpartum depression: A large-scale nationwide longitudinal cohort study. J Affect Disord 2023; 325:444-452. [PMID: 36610600 DOI: 10.1016/j.jad.2022.12.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 12/25/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND While anemia during pregnancy has been linked to increased postpartum depression (PPD) risk, longitudinal studies on the association between gestational hemodilution, represented by decreased hematocrit (Hct) during the transition from the 1st to 2nd trimester, and PPD risk, are scarce. The current study aimed to investigate this association in a nationwide cohort over the perinatal period. METHODS This retrospective cohort study included 104,715 women who gave birth between January 2008 and December 2015. The cohort was followed up for new-onset PPD during the year post birth and gestational hemodilution was assessed by the change in Hct levels (Δ: 2nd-1st trimester). The cohort was divided into three hemodilution groupings: maximal and minimal 10 % of mothers and intermediate 80 %. Multivariable regression analyses were performed to estimate the association between gestational hemodilution and PPD, adjusting for confounders. RESULTS Among the full cohort, 2.2 % (n = 2263) met the definition of new-onset PPD. Mothers with greater hemodilution had higher rates of PPD: 2.7 % (n = 269) in the maximal hemodilution group, 2.1 % (n = 1783) in the intermediate and 1.9 % (n = 211) in the minimal hemodilution group (p < 0.001). The maximal hemodilution group had higher rates of pre-gestational psychiatric disorders (p < 0.001) and higher adjusted risk for PPD [OR = 1.18, 95 % CI (1.04, 1.35)]. LIMITATIONS Data on iron levels and supplementation were unavailable, thus it could not be adjusted for in the analysis. CONCLUSIONS Women in the top 10th percentile of gestational hemodilution may be at risk for PPD, justifying monitoring of gestational Hct as a biomarker for PPD.
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Affiliation(s)
- Eldar Hochman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah-Tikva, Israel; Laboratory of Molecular Psychiatry, Felsenstein Medical Research Center, Petah-Tikva, Israel.
| | | | - Abraham Weizman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah-Tikva, Israel; Laboratory of Molecular Psychiatry, Felsenstein Medical Research Center, Petah-Tikva, Israel
| | - Amir Krivoy
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah-Tikva, Israel; Laboratory of Molecular Psychiatry, Felsenstein Medical Research Center, Petah-Tikva, Israel; Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, UK
| | - Shay Gur
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah-Tikva, Israel
| | - Eran Barzilay
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Hagit Gabay
- Clalit Research Institute, Ramat Gan, Israel
| | | | - Gabriella Lawrence
- Clalit Research Institute, Ramat Gan, Israel; Braun School of Public Health, Hebrew University - Hadassah Medical Center, Jerusalem, Israel
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Hochman E, Taler M, Flug R, Gur S, Dar S, Bormant G, Blattberg D, Nitzan U, Krivoy A, Weizman A. Serum claudin-5 levels among patients with unipolar and bipolar depression in relation to the pro-inflammatory cytokine tumor necrosis factor-alpha levels. Brain Behav Immun 2023; 109:162-167. [PMID: 36706845 DOI: 10.1016/j.bbi.2023.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/20/2022] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
Accumulating evidence indicates that inflammation and neurovascular unit (NVU) dysfunction contribute to depression via disrupted blood-brain barrier (BBB) integrity. Claudin-5, an endothelial tight-junction protein expressed in the NVU and contributing to BBB integrity, has been implicated in psychiatric disorders, including major depressive disorder (MDD) and schizophrenia. In an animal model of depressive-like behavior, the pro-inflammatory cytokine tumor necrosis factor-alpha (TNF-α) was found to affect BBB permeability and claudin-5 expression of NVU endothelial cells. To the best of the authors' knowledge, this study is the first to assess the relationship between serum claudin-5 and TNF-α levels, during major depressive episodes (MDEs). Serum levels of claudin-5 and TNF-α of 40 patients diagnosed with current MDE [19 with MDD and 21 with bipolar disorder (BD)] and 28 matched healthy controls (HCs) were analyzed. Claudin-5 and TNF-α serum levels in the MDE group were significantly higher than in the HC one. Discrete analysis according to MDE type indicated significantly increased claudin-5 serum levels in BD but not in MDD patients, compared to HCs, even after controlling for confounders. In the MDE group, a significant positive correlation was found between claudin-5 and TNF-α serum levels. In complementary analysis, serum levels of the pro-inflammatory cytokine interleukin-6 were significantly higher among MDE patients compared to HCs, however, no significant correlation was found with claudin-5 levels. In conclusion, as indicated by preclinical studies, our clinical study suggests a possible specific interaction between the NVU/BBB marker claudin-5 and the inflammatory marker TNF-α in the pathogenesis of depression.
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Affiliation(s)
- Eldar Hochman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah-Tikva, Israel; Laboratory of Molecular and Biological Psychiatry, Felsenstein Medical Research Center, Petah-Tikva, Israel.
| | - Michal Taler
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; The Pediatric Molecular Psychiatry Laboratory, Sheba Tel Hashomer Medical Center, Ramat Gan, Israel
| | - Reut Flug
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah-Tikva, Israel
| | - Shay Gur
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah-Tikva, Israel
| | - Shira Dar
- The Pediatric Molecular Psychiatry Laboratory, Sheba Tel Hashomer Medical Center, Ramat Gan, Israel
| | - Gil Bormant
- Geha Mental Health Center, Petah-Tikva, Israel
| | | | - Uri Nitzan
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Amir Krivoy
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah-Tikva, Israel; Laboratory of Molecular and Biological Psychiatry, Felsenstein Medical Research Center, Petah-Tikva, Israel; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Abraham Weizman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah-Tikva, Israel; Laboratory of Molecular and Biological Psychiatry, Felsenstein Medical Research Center, Petah-Tikva, Israel
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Weitman M, Eisenkraft A, TaShma Z, Makarovsky I, Last D, Daniels D, Guez D, Shneor R, Mardor Y, Nudelman A, Krivoy A. Synthesis and preliminary biological evaluation of gabactyzine, a benactyzine-GABA mutual prodrug, as an organophosphate antidote. Sci Rep 2022; 12:18078. [PMID: 36302937 PMCID: PMC9613653 DOI: 10.1038/s41598-022-23141-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/25/2022] [Indexed: 01/09/2023] Open
Abstract
Organophosphates (OPs) are inhibitors of acetylcholinesterase and have deleterious effects on the central nervous system. Clinical manifestations of OP poisoning include convulsions, which represent an underlying toxic neuro-pathological process, leading to permanent neuronal damage. This neurotoxicity is mediated through the cholinergic, GABAergic and glutamatergic (NMDA) systems. Pharmacological interventions in OP poisoning are designed to mitigate these specific neuro-pathological pathways, using anticholinergic drugs and GABAergic agents. Benactyzine is a combined anticholinergic, anti-NMDA compound. Based on previous development of novel GABA derivatives (such as prodrugs based on perphenazine for the treatment of schizophrenia and nortriptyline against neuropathic pain), we describe the synthesis and preliminary testing of a mutual prodrug ester of benactyzine and GABA. It is assumed that once the ester crosses the blood-brain-barrier it will undergo hydrolysis, releasing benactyzine and GABA, which are expected to act synergistically. The combined release of both compounds in the brain offers several advantages over the current OP poisoning treatment protocol: improved efficacy and safety profile (where the inhibitory properties of GABA are expected to counteract the anticholinergic cognitive adverse effects of benactyzine) and enhanced chemical stability compared to benactyzine alone. We present here preliminary results of animal studies, showing promising results with early gabactyzine administration.
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Affiliation(s)
- Michal Weitman
- grid.22098.310000 0004 1937 0503Chemistry Department, Bar Ilan University, 52900 Ramat Gan, Israel
| | - Arik Eisenkraft
- grid.9619.70000 0004 1937 0538The Institute for Research in Military Medicine, The Hebrew University Faculty of Medicine and The IDF Medical Corps, Jerusalem, Israel ,The IDF Medical Corps Headquarters, Ramat Gan, Israel
| | - Zeev TaShma
- The IDF Medical Corps Headquarters, Ramat Gan, Israel
| | - Igor Makarovsky
- grid.22098.310000 0004 1937 0503Chemistry Department, Bar Ilan University, 52900 Ramat Gan, Israel
| | - David Last
- grid.413795.d0000 0001 2107 2845The Advanced Technology Center, Sheba Medical Center, Ramat-Gan, Israel
| | - Dianne Daniels
- grid.413795.d0000 0001 2107 2845The Advanced Technology Center, Sheba Medical Center, Ramat-Gan, Israel
| | - David Guez
- grid.413795.d0000 0001 2107 2845The Advanced Technology Center, Sheba Medical Center, Ramat-Gan, Israel
| | - Ran Shneor
- grid.413795.d0000 0001 2107 2845The Advanced Technology Center, Sheba Medical Center, Ramat-Gan, Israel
| | - Yael Mardor
- grid.413795.d0000 0001 2107 2845The Advanced Technology Center, Sheba Medical Center, Ramat-Gan, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Abraham Nudelman
- grid.22098.310000 0004 1937 0503Chemistry Department, Bar Ilan University, 52900 Ramat Gan, Israel
| | - Amir Krivoy
- The IDF Medical Corps Headquarters, Ramat Gan, Israel ,grid.415340.70000 0004 0403 0450Geha Mental Health Center, Petach-Tikva, Israel
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Perez CSDH, Ciufolini S, Sood PG, Krivoy A, Young AH, Murray RM, Ismail K, Atakan Z, Greenwood K, Smith S, Gaughran F, Juruena MF. Predictive value of cardiometabolic biomarkers and depressive symptoms for symptom severity and quality of life in patients with psychotic disorders. J Affect Disord 2022; 298:95-103. [PMID: 34699852 DOI: 10.1016/j.jad.2021.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/11/2021] [Accepted: 10/20/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients with psychotic disorders show higher rates of the metabolic syndrome (MS) between the cluster of severe mental illnesses. Depressive symptoms can worsen outcomes of individuals with psychotic disorders. However, research on the association between MS and depression in psychotic disorders and their relevance to outcomes is lacking. METHODS We investigated the association between depression and cardiometabolic biomarkers in psychotic disorders and the predictive value of depressive symptoms on psychopathological severity and quality of life (QoL). 406 patients with psychotic disorders were recruited as part of the Improving Physical Health and Reducing Substance Use in Severe Mental Illness randomised controlled trial. Depression, psychotic symptoms, QoL, waist circumference, triglycerides, high-density lipoprotein cholesterol (HDL-C), blood pressure, and fasting glucose of patients were assessed at baseline and 12 months. Sensitivity analyses were conducted to test the effect of treatment. RESULTS More severe baseline symptoms of depression significantly predicted worse 12-month psychotic symptoms and lower mental health related QoL at 12 months. These associations held after controlling for alcohol use, gender, ethnicity, education, and mental health related QoL Baseline. Depressive symptoms also correlated with waist circumference at both baseline and 12 months, after controlling for multiple testing. CONCLUSION Individuals with psychotic disorders experiencing more severe depressive symptoms are more likely to have larger waist circumference contemporaneously and 12 months later, as well as more severe psychotic symptoms and worse QoL at follow-up. This highlights the need for evaluation of strategies to address depression in the management of psychotic disorders.
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Affiliation(s)
| | - Simone Ciufolini
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | | | - Amir Krivoy
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Allan H Young
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Khalida Ismail
- Professor of Psychiatry and Medicine, Dept of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, United Kingdom
| | - Zerrin Atakan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings' College London, Denmark Hill, London, United Kingdom
| | - Kathryn Greenwood
- Clinical Research Fellow, Sussex Partnership NHS Foundation Trust, and Hon Senior Research Fellow, School of Psychology, University of Sussex
| | - Shubulade Smith
- Clinical Senior Lecturer, Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London
| | - Fiona Gaughran
- Lead Consultant Psychiatrist, National Psychosis Service, South London and Maudsley NHS Foundation Trust and Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, United Kingdom
| | - Mario F Juruena
- Lead Consultant Psychiatrist, Maudsley Advanced Treatment Service, South London and Maudsley NHS Foundation Trust and Clinical Senior Lecturer in Translational Psychiatry, Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
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Kamhi-Nesher S, Taub S, Halimi S, Frenkel M, Azam M, Bormant G, Isakov H, Radzinsky D, Weizman A, Krivoy A. Clozapine blood level assessment using a point-of-care device: feasibility and reliability. Ther Adv Psychopharmacol 2022; 12:20451253221094435. [PMID: 35720508 PMCID: PMC9201354 DOI: 10.1177/20451253221094435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/29/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Therapeutic drug monitoring (TDM) is useful to assess clozapine adherence and optimize treatment. However, analysis of venous blood levels by liquid chromatography tandem mass spectrometry (LC-MS/MS) is often logistically complicated and process time is prolonged. OBJECTIVE To assess the feasibility and reliability of a new point-of-care device, (MyCare™ Insite), using capillary blood for clozapine therapeutic monitoring. METHODS Matched venous and capillary blood samples were collected from patients treated with clozapine on a stable dose. Samples were analyzed by LC-MS/MS and MyCare Insite Clozapine Test. Clozapine plasma levels were compared between methods using linear regression model. Both patients and treatment team completed questionnaires about the feasibility of blood sampling. RESULTS Of the total sample (44 patients, 61% males, mean age 43 ± 12 years), mean daily clozapine dose was 293 ± 134 mg/day. Linear regression model demonstrated high correlation with R 2 = 0.83 (p < 0.0001) and mean difference of 26 ± 162 ng/ml. More than 60% of the patients found the clozapine TDM to be important. Most of the participants (58%) favored the capillary sampling and 11% claimed that testing method would affect their adherence to TDM. Moreover, a larger portion (72%) strongly preferred to be tested at the office rather than at the lab. CONCLUSIONS The point-of-care device offers an accessible and satisfactory measurement of clozapine blood levels. Both patients and healthcare providers reported preference for capillary sampling as well as for the in-office TDM procedure. The immediate results provided by the device can facilitate rapid and informed clinical decisions and therefore improve clozapine treatment outcomes.
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Affiliation(s)
- Shiri Kamhi-Nesher
- Geha Mental Health Center, 1 Helsinki street, P.O. Box 102, Petah-Tikva 49100, Israel
| | - Sharon Taub
- Geha Mental Health Center, 1 Helsinki street, P.O. Box 102, Petah-Tikva 49100, Israel
| | | | | | - Mahmud Azam
- Geha Mental Health Center, Petah-Tikva, Israel
| | - Gil Bormant
- Geha Mental Health Center, Petah-Tikva, Israel
| | | | | | | | - Amir Krivoy
- Geha Mental Health Center, Petah-Tikva, Israel
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Gaughran F, Stringer D, Wojewodka G, Landau S, Smith S, Gardner-Sood P, Taylor D, Jordan H, Whiskey E, Krivoy A, Ciufolini S, Stubbs B, Casetta C, Williams J, Moore S, Allen L, Rathod S, Boardman A, Khalifa R, Firdosi M, McGuire P, Berk M, McGrath J. Effect of Vitamin D Supplementation on Outcomes in People With Early Psychosis: The DFEND Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2140858. [PMID: 34962559 PMCID: PMC8715346 DOI: 10.1001/jamanetworkopen.2021.40858] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE People with psychotic disorders have an increased risk of vitamin D deficiency, which is evident during first-episode psychosis (FEP) and associated with unfavorable mental and physical health outcomes. OBJECTIVE To examine whether vitamin D supplementation contributes to improved clinical outcomes in FEP. DESIGN, SETTING, AND PARTICIPANTS This multisite, double-blind, placebo-controlled, parallel-group randomized clinical trial from the UK examined adults 18 to 65 years of age within 3 years of a first presentation with a functional psychotic disorder who had no contraindication to vitamin D supplementation. A total of 2136 patients were assessed for eligibility, 835 were approached, 686 declined participation or were excluded, 149 were randomized, and 104 were followed up at 6 months. The study recruited participants from January 19, 2016, to June 14, 2019, with the final follow-up (after the last dose) completed on December 20, 2019. INTERVENTIONS Monthly augmentation with 120 000 IU of cholecalciferol or placebo. MAIN OUTCOMES AND MEASURES The primary outcome measure was total Positive and Negative Syndrome Scale (PANSS) score at 6 months. Secondary outcomes included total PANSS score at 3 months; PANSS positive, negative, and general psychopathology subscale scores at 3 and 6 months; Global Assessment of Function scores (for symptoms and disability); Calgary Depression Scale score, waist circumference, body mass index, and glycated hemoglobin, total cholesterol, C-reactive protein, and vitamin D concentrations at 6 months; and a planned sensitivity analysis in those with insufficient vitamin D levels at baseline. RESULTS A total of 149 participants (mean [SD] age, 28.1 (8.5) years; 89 [59.7%] male; 65 [43.6%] Black or of other minoritized racial and ethnic group; 84 [56.4%] White [British, Irish, or of other White ethnicity]) were randomized. No differences were observed in the intention-to-treat analysis in the primary outcome, total PANSS score at 6 months (mean difference, 3.57; 95% CI, -1.11 to 8.25; P = .13), or the secondary outcomes at 3 and 6 months (PANSS positive subscore: mean difference, -0.98; 95% CI, -2.23 to 0.27 at 3 months; mean difference, 0.68; 95% CI, -0.69 to 1.99 at 6 months; PANSS negative subscore: mean difference, 0.68; 95% CI, -1.39 to 2.76 at 3 months; mean difference, 1.56; 95% CI, -0.31 to 3.44 at 6 months; and general psychopathology subscore: mean difference, -2.09; 95% CI, -4.36 to 0.18 at 3 months; mean difference, 1.31; 95% CI, -1.42 to 4.05 at 6 months). There also were no significant differences in the Global Assessment of Function symptom score (mean difference, 0.02; 95% CI, -4.60 to 4.94); Global Assessment of Function disability score (mean difference, -0.01; 95% CI, -5.25 to 5.23), or Calgary Depression Scale score (mean difference, -0.39; 95% CI, -2.05 to 1.26) at 6 months. Vitamin D levels were very low in the study group, especially in Black participants and those who identified as another minoritized racial and ethnic group, 57 of 61 (93.4%) of whom had insufficient vitamin D. The treatment was safe and led to a significant increase in 25-hydroxyvitamin D concentrations. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, no association was found between vitamin D supplementation and mental health or metabolic outcomes at 6 months. Because so few patients with FEP were vitamin D replete, the results of this study suggest that this group would benefit from active consideration in future population health strategies. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN12424842.
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Affiliation(s)
- Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
- South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
| | - Dominic Stringer
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
- King’s Clinical Trials Unit, King’s College London, London, UK
| | - Gabriella Wojewodka
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
- King’s Clinical Trials Unit, King’s College London, London, UK
| | - Shubulade Smith
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
| | - Poonam Gardner-Sood
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
| | - David Taylor
- South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
| | - Harriet Jordan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
- South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
| | - Eromona Whiskey
- South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
| | - Amir Krivoy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
| | - Simone Ciufolini
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
- South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
| | - Cecilia Casetta
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
- South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
| | - Julie Williams
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
| | - Susan Moore
- Department of Psychiatry, St Vincent’s University Hospital, Dublin, Ireland
- Department of Psychiatry, Royal College of Surgeons, Dublin, Ireland
| | - Lauren Allen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
| | - Shanaya Rathod
- Clinical Trials Facility, Research Department, Tom Rudd Unit, Moorgreen Hospital, Southampton, UK
| | | | - Rehab Khalifa
- Kent and Medway NHS & Social Care Partnership Trust, NHS Trust, London, UK
| | - Mudasir Firdosi
- South West London and St George’s Mental Health NHS Trust, Queen Mary’s Hospital, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
- South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, School of Medicine, Barwon Health, Geelong, Australia
| | - John McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
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10
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Lurie I, Shoval G, Hoshen M, Balicer R, Weiser M, Weizman A, Krivoy A. The association of medical resource utilization with physical morbidity and premature mortality among patients with schizophrenia: An historical prospective population cohort study. Schizophr Res 2021; 237:62-68. [PMID: 34507055 DOI: 10.1016/j.schres.2021.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 07/19/2021] [Accepted: 08/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Schizophrenia patients have shorter life expectancy often owing to preventable physical illnesses and sub-optimal utilization of medical services. However, the association between service-utilization and mortality has not been explored. AIM To assess whether medical service-utilization moderates the association between physical morbidity and premature mortality in a nation-wide cohort. METHODS A population representative database of the largest health provider in Israel was analyzed. All electronic health records of patients with schizophrenia diagnosis (ICD code F.20) (n = 24,679) were followed-up between 2012 and 2015, and compared to the general population (n = 2,232,804), in terms of metabolic and cardiovascular morbidity, all-cause mortality, primary medical and specialist health service-utilization and general hospitalizations. RESULTS Schizophrenia was associated with increased mortality risk (adjusted hazard ratio (aHR) = 3.52, 95%CI 3.35-3.72). Most deaths were related to physical illnesses. Metabolic syndrome components, except chronic hypertension, were more prevalent among patients. They were referred more frequently to primary and less to secondary services (aHR = 1.05, 95%CI 1.04-1.06, aHR = 0.95, 95%CI 0.94-0.97, respectively), with higher hospitalization rates (0.23 ± 0.90 vs 0.10 ± 0.50 per year), and longer mean duration of hospitalization (2.02 ± 10.24 vs 0.68 ± 5.51 days, P < 0.001). More contacts with primary care physicians or specialists positively moderated the association between mortality and metabolic disturbances in patients with schizophrenia; more contacts were associated with better outcomes. CONCLUSIONS An association between premature mortality and metabolic syndrome was found among schizophrenia patients while utilization of primary/secondary medical services moderated the lethal effects of metabolic dysregulation. Increased integrative primary care and a national monitoring system are warranted to reduce mortality rate in this population.
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Affiliation(s)
- Ido Lurie
- Shalvata Mental Health Center, Hod Hasharon, Israel; Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Gal Shoval
- Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petach-Tikva, Israel; Princeton Neuroscience Institute, Princeton University, Princeton, NJ, USA
| | - Moshe Hoshen
- Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel; Department of Bioinformatics, Jerusalem College of Technology, Jerusalem, Israel
| | - Ran Balicer
- Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel; Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Mark Weiser
- Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Psychiatry Division, Sheba Medical Center, Ramat-Gan, Israel
| | - Abraham Weizman
- Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petach-Tikva, Israel
| | - Amir Krivoy
- Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petach-Tikva, Israel; Department of Psychosis Studies, The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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11
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Segev A, Hirsch-Klein E, Kotz G, Kamhi-Nesher S, Halimi S, Qashu K, Schreiber E, Krivoy A. Trends of new-onset psychosis or mania in psychiatric emergency departments during the COVID19 pandemic: a longitudinal comparative study. Sci Rep 2021; 11:21002. [PMID: 34697335 PMCID: PMC8546064 DOI: 10.1038/s41598-021-00310-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/05/2021] [Indexed: 12/13/2022] Open
Abstract
COVID19 infection was associated with possible psychiatric manifestations, including psychosis and mania. In addition, psychiatric disorders might be triggered by severe psychological reactions to the pandemic or the measures taken to contain it. This study aimed to assess the trends of new-onset psychosis/mania during the pandemic timeline. Psychiatric emergency department records during January-July 2019 and 2020 of two regional mental health centers were manually examined. Cases of new-onset psychosis or mania were found in 326 out of 5161 records examined. The ratio of these cases increased by 45.5% in 2020 compared to 2019 (189 out of 2367, 137 out of 2479, respectively, p = 0.001). The peak increase was in April 2020 (9.4% vs. 4.7%, p = 0.015). There was no association between the rise of new-onset psychotic or manic episodes and national incidence of COVID19 cases, as observed during Israel 2nd wave. PCR tests were negative, except a single case. In this study, an increase in new-onset psychosis/mania was identified during the initial phase of the pandemic. Though causality could not be directly inferred, lack of infection symptoms, negative PCR testing and temporal distribution incongruent with COVID19 caseload did not support a direct effect of SARS-CoV-2. Alternative explanations are discussed, such as psychological reaction to stress and preventive measures, as well as case-shifting between different mental health settings.
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Affiliation(s)
- Aviv Segev
- Shalvata Mental Health Center, Alyat Hanoar 13th St., Hod Hasharon, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Psychosis, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Efrat Hirsch-Klein
- Shalvata Mental Health Center, Alyat Hanoar 13th St., Hod Hasharon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gershon Kotz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Be'er Yaakov Mental Health Center, 1st Rabin Av., Be'er Ya'akov, Israel
| | - Shiri Kamhi-Nesher
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Geha Mental Health Center, 1st Helsinki St., Petach Tikva, Israel
| | - Shikma Halimi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Geha Mental Health Center, 1st Helsinki St., Petach Tikva, Israel
| | - Khalil Qashu
- Shalvata Mental Health Center, Alyat Hanoar 13th St., Hod Hasharon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ephraim Schreiber
- Shalvata Mental Health Center, Alyat Hanoar 13th St., Hod Hasharon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Krivoy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Psychosis, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- Geha Mental Health Center, 1st Helsinki St., Petach Tikva, Israel
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12
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Krivoy A, Shrot S, Avrahami M, Fischel T, Weizman A, Mardor Y, Guez D, Daniels D, Katelaris A, Last D, Hoffmann C. Brain Motor Region Diffusion Tensor Imaging in Patients with Catatonic Schizophrenia: A Case-Control Study. Isr Med Assoc J 2021; 23:625-630. [PMID: 34672443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Only a small proportion of schizophrenia patients present with catatonic symptoms. Imaging studies suggest that brain motor circuits are involved in the underlying pathology of catatonia. However, data about diffusivity dysregulation of these circuits in catatonic schizophrenia are scarce. OBJECTIVES To assess the involvement of brain motor circuits in schizophrenia patients with catatonia. METHODS Diffusion tensor imaging (DTI) was used to measure white matter signals in selected brain regions linked to motor circuits. Relevant DTI data of seven catatonic schizophrenia patients were compared to those of seven non-catatonic schizophrenia patients, matched for sex, age, and education level. RESULTS Significantly elevated fractional anisotropy values were found in the splenium of the corpus callosum, the right peduncle of the cerebellum, and the right internal capsule of the schizophrenia patients with catatonia compared to those without catatonia. This finding showed altered diffusivity in selected motor-related brain areas. CONCLUSIONS Catatonic schizophrenia is associated with dysregulation of the connectivity in specific motoric brain regions and corresponding circuits. Future DTI studies are needed to address the neural correlates of motor abnormalities in schizophrenia-related catatonia during the acute and remitted state of the illness to identify the specific pathophysiology of this disorder.
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Affiliation(s)
- Amir Krivoy
- Geha Mental Health Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petah Tikva, Israel
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Shai Shrot
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Diagnostic Imaging, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Matan Avrahami
- Geha Mental Health Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tsvi Fischel
- Geha Mental Health Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Weizman
- Geha Mental Health Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Mardor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Advanced Technology Center, Sheba Medical Center, Tel Hashomer, Israel
| | - David Guez
- Advanced Technology Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Dianne Daniels
- Advanced Technology Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Athos Katelaris
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
| | - David Last
- Advanced Technology Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Chen Hoffmann
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Diagnostic Imaging, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Taub S, Krivoy A, Whiskey E, Shergill SS. New approaches to antipsychotic medication adherence - safety, tolerability and acceptability. Expert Opin Drug Saf 2021; 21:517-524. [PMID: 34541978 DOI: 10.1080/14740338.2021.1983540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Antipsychotic pharmacotherapy is considered a first-line treatment in schizophrenia-related disorders and is associated with favorable prognosis and lower mortality rates. However, low adherence rates present a major clinical challenge. In this paper, we will review contemporary approaches to improve adherence to antipsychotic treatment, considering their mechanism of action, safety, tolerability and acceptability. AREAS COVERED Novel pharmacological delivery methods included different routes of administration of registered medications (such as intramuscular clozapine preparation and transdermal asenapine), modifications of existing compounds (such as 3-monthly injectable formulation of paliperidone palmitate), and increased interest in oral long-acting medication formulations (such as with penfluridol). In addition, we reviewed innovative technology to monitor adherence, based on the use of electronic digital medicine systems and ingestible sensors. EXPERT OPINION All of these diverse approaches were clinically relevant in enhancing treatment adherence and found to be safe and tolerable. The place of each approach is predicated on a personalized approach in each patient, and future research could usefully use large comparative studies to establish robust treatment guidelines. The implementation of new and varied approaches to antipsychotic treatment adherence is welcomed and have the potential to make a significant impact on morbidity in this often difficult-to-treat population.
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Affiliation(s)
- Sharon Taub
- Geha Mental Health Center, Petach-Tikva, Israel
| | - Amir Krivoy
- Geha Mental Health Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eromona Whiskey
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,National Psychosis Unit, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sukhi S Shergill
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,National Psychosis Unit, South London and Maudsley NHS Foundation Trust, London, UK.,Kent and Medway Medical School, Canterbury, UK
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14
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Avrahamy H, Shoval G, Hoshen M, Balicer RD, Kamhi-Nesher S, Zalsman G, Weizman A, Krivoy A. Association between Adherence to SSRI Treatment and Mortality among Individuals with Metabolic Syndrome Components. Pharmacopsychiatry 2021; 54:232-239. [PMID: 33853176 DOI: 10.1055/a-1425-7246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Depression and anxiety have been associated with type 2 diabetes mellitus and metabolic syndrome, major causes of cardiovascular morbidity and mortality. The effect of antidepressants in this association is unknown. This study aimed to examine the association between adherence to selective serotonin receptor inhibitors (SSRIs) and all-cause mortality among individuals with metabolic syndrome components (hypertension, obesity, and diabetes mellitus). METHODS Data on 201 777 patients who were prescribed SSRIs during the years 2008-2011 were analyzed retrospectively. Adherence was measured using prescription purchase records. The moderating effect of SSRI and statin adherence on the association between metabolic syndrome load and mortality hazard risk (HR) during the study period were analyzed. The Cox-proportional hazard model adjusted to background variables was used to this end. RESULTS During the study period, the maximal metabolic load was associated with mortality HR=1.89 (95% CI: 1.79-2) compared to participants without metabolic risk factors. A slight reduction in mortality HR was demonstrated among those with low and moderate SSRI adherence rates. Adherence to statins was negatively associated with the risk of mortality across all levels of adherence. A significant association (r=0.214, p<0.01) was found between adherence to statins and adherence to SSRIs, with higher rates of adherence to statins across all metabolic load categories. DISCUSSION While a high metabolic load is associated with a higher risk of mortality, adherence to SSRIs only partially moderated the risk of mortality, in contrast to the protective effect of statins. Adherence differences to statins and SSRIs among individuals prescribed both medications merit further investigation.
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Affiliation(s)
| | - Gal Shoval
- Geha Mental Health Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.,Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel
| | - Moshe Hoshen
- Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel
| | - Ran D Balicer
- Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel.,Public Health Department, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shiri Kamhi-Nesher
- Geha Mental Health Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Gil Zalsman
- Geha Mental Health Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Abraham Weizman
- Geha Mental Health Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.,Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petah Tikva, Israel
| | - Amir Krivoy
- Geha Mental Health Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.,Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel.,Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
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15
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Hochman E, Feldman B, Weizman A, Krivoy A, Gur S, Barzilay E, Gabay H, Levy J, Levinkron O, Lawrence G. Development and validation of a machine learning-based postpartum depression prediction model: A nationwide cohort study. Depress Anxiety 2021; 38:400-411. [PMID: 33615617 DOI: 10.1002/da.23123] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 11/13/2020] [Accepted: 11/21/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Currently, postpartum depression (PPD) screening is mainly based on self-report symptom-based assessment, with lack of an objective, integrative tool which identifies women at increased risk, before the emergent of PPD. We developed and validated a machine learning-based PPD prediction model utilizing electronic health record (EHR) data, and identified novel PPD predictors. METHODS A nationwide longitudinal cohort that included 214,359 births between January 2008 and December 2015, divided into model training and validation sets, was constructed utilizing Israel largest health maintenance organization's EHR-database. PPD was defined as new diagnosis of a depressive episode or antidepressant prescription within the first year postpartum. A gradient-boosted decision tree algorithm was applied to EHR-derived sociodemographic, clinical, and obstetric features. RESULTS Among the birth cohort, 1.9% (n = 4104) met the case definition of new-onset PPD. In the validation set, the prediction model achieved an area under the curve (AUC) of 0.712 (95% confidence interval, 0.690-0.733), with a sensitivity of 0.349 and a specificity of 0.905 at the 90th percentile risk threshold, identifying PPDs at a rate more than three times higher than the overall set (positive and negative predictive values were 0.074 and 0.985, respectively). The model's strongest predictors included both well-recognized (e.g., past depression) and less-recognized (differing patterns of blood tests) PPD risk factors. CONCLUSIONS Machine learning-based models incorporating EHR-derived predictors, could augment symptom-based screening practice by identifying the high-risk population at greatest need for preventive intervention, before development of PPD.
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Affiliation(s)
- Eldar Hochman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Geha Mental Health Center, Petah-Tikva, Israel.,Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petah-Tikva, Israel
| | | | - Abraham Weizman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Geha Mental Health Center, Petah-Tikva, Israel.,Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petah-Tikva, Israel
| | - Amir Krivoy
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Geha Mental Health Center, Petah-Tikva, Israel.,Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petah-Tikva, Israel.,Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, UK
| | - Shay Gur
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Geha Mental Health Center, Petah-Tikva, Israel
| | - Eran Barzilay
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Hagit Gabay
- Clalit Research Institute, Ramat Gan, Israel
| | - Joseph Levy
- Clalit Research Institute, Ramat Gan, Israel
| | | | - Gabriella Lawrence
- Clalit Research Institute, Ramat Gan, Israel.,Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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16
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Hess S, Krivoy A, Bar-Zeev Y, Faerman A. [PREVALENCE OF TOBACCO SMOKING AMONG MENTAL HEALTH INPATIENTS IN ISRAEL]. Harefuah 2021; 160:98-103. [PMID: 33760411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Tobacco smoking is the worldwide leading preventable cause of morbidity [1]. The prevalence of current smoking among individuals with mental illnesses is more than twice as that of the general population [2]. Despite it being a primary cause of morbidity and mortality in Israel too, there is little information and research on the features of smoking among people with mental illnesses in Israel. OBJECTIVES To present an up-to-date estimation of the prevalence of smoking among hospitalized patients with mental illness in Israel and to compare the prevalence of comorbidities among smokers and non-smokers in this population. METHODS Analyzing data obtained from an electronic medical-records database, consisting of 4646 patients with mental illness, aged 18-90 years, who were hospitalized at Geha Mental Health Center during 2005-2013. RESULTS The smoking rate among hospitalized patients with mental illness was significantly higher than the general population (51.3% versus 19.7%, respectively). The smoking rate among male hospitalized patients with mental illness was higher than that of the females (58.2% versus 42.7%, respectively), however, the difference between men and women is smaller compared to this difference in the general population. Smoking rates were highest among those with personality disorder (65.1%), bipolar disorder (58.8%) and schizophrenia (53.81%). The prevalence of comorbid substance use (alcohol or drug abuse) among hospitalized patients with mental illness was found to be higher in the smokers group than in the non-smokers group (37.4% versus 4.6%, respectively, p<0.0001). CONCLUSIONS The prevalence of smoking among hospitalized patients with mental illness in Israel is 2.74 times that of the general population in 2013, in line with the reported worldwide rate. In addition, among hospitalized patients with mental illness the prevalence of comorbid substance use (alcohol or drug abuse) was higher among the smokers than among the non-smokers.
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Affiliation(s)
- Shmuel Hess
- Lev-Hasharon Medical Center, Pardesiya, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Krivoy
- Lev-Hasharon Medical Center, Pardesiya, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London UK
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, the Hebrew University of Jerusalem-Hadassah Medical Organization, Ein Karem, Jerusalem, Israel
| | - Afik Faerman
- Department of Psychology, Palo Alto University, CA, USA &Psychiatry and Behavioral Sciences, Stanford University, CA, USA
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17
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Krivoy A, Whiskey E, Webb-Wilson H, Joyce D, Tracy DK, Gaughran F, MacCabe JH, Shergill SS. Outcomes in treatment-resistant schizophrenia: symptoms, function and clozapine plasma concentrations. Ther Adv Psychopharmacol 2021; 11:20451253211037179. [PMID: 34676067 PMCID: PMC8524694 DOI: 10.1177/20451253211037179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/16/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Clozapine is the only medication licenced for treating patients with treatment-refractory schizophrenia. However, there are no evidence-based guidelines as to the optimal plasma level of clozapine to aim for, and their association with clinical and functional outcome. OBJECTIVE We assessed the relationship between clinical and functional outcome measures and blood concentrations of clozapine among patients with treatment-refractory psychosis. METHODS Data were reviewed in 82 patients with treatment-refractory psychosis admitted to a specialised tertiary-level service and treated with clozapine. Analysis focussed on the relationship between clozapine and norclozapine plasma concentrations and the patient's clinical symptoms and functional status. RESULTS Clinical symptom improvement was positively correlated with norclozapine plasma concentrations and inversely correlated with clozapine to norclozapine plasma concentrations ratio. Clozapine concentrations showed a bimodal association with clinical improvement (peaks around 350 and 660 ng/ml). Clinical symptom improvement correlated with functional outcomes, although there was no significant correlation between the latter and clozapine or norclozapine plasma concentrations. CONCLUSION Clozapine treatment was associated with optimal clinical improvement at two different peak plasma concentrations around 350 and 650 ng/ml. Clinical improvement was associated with functional outcome; however, functionality was not directly associated with clozapine concentrations. A subset of patients may require higher clozapine plasma concentrations to achieve clinical improvement.
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Affiliation(s)
- Amir Krivoy
- Geha Mental Health Center, Petach-Tikva, Israel
| | - Eromona Whiskey
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Henrietta Webb-Wilson
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Dan Joyce
- National Institute of Health Research Oxford Health Biomedical Research Center and Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Derek K Tracy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Fiona Gaughran
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - James H MacCabe
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sukhwinder S Shergill
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
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18
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Taub S, Hoshen M, Balicer R, Kamhi-Nesher S, Weizman A, Krivoy A. Metabolic predictors for mortality among patients treated with long-term clozapine - A longitudinal study. Eur Neuropsychopharmacol 2020; 41:63-69. [PMID: 32981820 DOI: 10.1016/j.euroneuro.2020.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/03/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023]
Abstract
Clozapine is the only antipsychotic compound indicated for refractory-schizophrenia. However, it is associated with emergent metabolic dysregulation and cardiovascular risk which may lead to mortality. In this study we aimed to explore predictors for mortality in a large cohort of schizophrenia patients treated with long-term clozapine, using the electronic medical records of the largest health care provider in Israel. Among 27,929 patients diagnosed with schizophrenia, 1817 were prescribed clozapine during the years 2012-2014. We compared patients who survived (n=1705) and patients who died (n=112) during the 3-year follow-up period. Socio-demographic background, cardiovascular morbidity, medication prescriptions and health-care utilization were compared between groups. Cox proportional hazard models were used to assess the association of variables with survival. Chronic hypertension was found to be the only metabolic factor associated with significant hazard ratio (HR) for mortality (HR: 1.55 95% CI: 1.03-2.34). Moreover, those who died had more prevalent ischemic heart disease (14% vs 3%, p<0.005) as well as more frequent hospitalizations (0.01±0.02 vs 0.11±0.18 average per month, p<0.005), for longer periods (2.22±9.87 vs 20.38±33.76 days per month, p<0.005). Among those who died, less patients received prescriptions of statins for hyperlipidemia (13.7% vs. 52.9% in survivors, p<0.005) and hypoglycemics for diabetes mellitus (16.3% vs. 67.1% in survivors, p<0.005). Inadequate treatment of metabolic syndrome, under chronic clozapine treatment, was found to be an independent predictor for mortality. Adequate rigorous regimen for diagnosis and treatment of metabolic risk factors, especially hyperlipidemia and diabetes mellitus, might lower complications rate and prolong life expectancy among this population.
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Affiliation(s)
- Sharon Taub
- Geha Mental Health Center, Petach-Tikva, Israel.
| | - Moshe Hoshen
- Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel
| | - Ran Balicer
- Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel; Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel
| | - Shiri Kamhi-Nesher
- Geha Mental Health Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Abraham Weizman
- Geha Mental Health Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Felsenstein Medical Research Center, Petah Tikva, Israel
| | - Amir Krivoy
- Geha Mental Health Center, Petach-Tikva, Israel; Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
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19
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Malkosh-Tshopp E, Ratzon R, Gizunterman A, Levy T, Ben-Dor DH, Krivoy A, Lubbad N, Kohn Y, Weizman A, Shoval G. The association of non-suicidal self-injurious and suicidal behaviors with religiosity in hospitalized Jewish adolescents. Clin Child Psychol Psychiatry 2020; 25:801-815. [PMID: 32419474 DOI: 10.1177/1359104520918354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Religiosity may be a potent protective factor against self-injurious and suicidal behaviors. However, no previous study has addressed this relationship in adolescent psychiatric population. This study aimed to examine the association between religiosity and non-suicidal self-injurious (NSSI) and suicidal behaviors, among hospitalized Jewish adolescents. This is a cross-sectional study of 60 hospitalized Jewish adolescents in two mental health centers. They were evaluated for religiosity, NSSI, and suicidal behaviors. The following religiosity measures were found to be protective against NSSI: a higher degree of adherence to religious practices (extrinsic measure) (beta = -0.083, p = .006), a higher level of belief in religious principles (intrinsic measure) (beta = -0.063, p = .008) and a self-reported higher religious affinity (χ2 = 7.64, p = .022). The severity of suicidal ideation inversely correlated with the extrinsic measure (standardized beta = -0.2, t = -2.5, p = .015) and with self-reported degree of religious affinity (analysis of variance, F = 3.5, p = .035). History of transition in religious affinity was associated with worse suicidal ideation (3.77 ± 1.8 vs. 2.26 ± 1.99, t = -3.25, p = .004) and with suicide attempts (OR = 3.89 (95% CI: 1.08 - 14.03), p = .004); however, these relationships were mediated by history of abuse. This study provides first evidence of a protective effect of some religiosity measures on NSSI and suicidal behaviors in hospitalized Jewish adolescents.
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Affiliation(s)
- Efrat Malkosh-Tshopp
- The Donald Cohen Child and Adolescent Psychiatry Department, Jerusalem Mental Health Center, Eitanim Psychiatric Hospital, Israel
| | - Roy Ratzon
- Geha Mental Health Center, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Alex Gizunterman
- The Donald Cohen Child and Adolescent Psychiatry Department, Jerusalem Mental Health Center, Eitanim Psychiatric Hospital, Israel
| | - Tomer Levy
- Geha Mental Health Center, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - David H Ben-Dor
- Geha Mental Health Center, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Amir Krivoy
- Geha Mental Health Center, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Nesrin Lubbad
- Geha Mental Health Center, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yoav Kohn
- The Donald Cohen Child and Adolescent Psychiatry Department, Jerusalem Mental Health Center, Eitanim Psychiatric Hospital, Israel.,Hebrew University-Hadassah School of Medicine, Israel
| | - Abraham Weizman
- Geha Mental Health Center, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Gal Shoval
- Geha Mental Health Center, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
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20
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Gur S, Taler M, Bormant G, Blattberg D, Nitzan U, Vaknin-Dembinsky A, Brill L, Krivoy A, Weizman A, Hochman E. Lack of association between unipolar or bipolar depression and serum aquaporin-4 autoantibodies. Brain Behav Immun 2020; 88:930-934. [PMID: 32380273 DOI: 10.1016/j.bbi.2020.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022] Open
Abstract
Aquaporin-4 (AQP4), an astrocyte water channel protein, is the target antigen of serum immunoglobulin G (IgG) autoantibody in neuromyelitis optica spectrum disorders (NMOsd), a group of inflammatory, demyelinating diseases of the central nervous system. Recently, a reduction in blood vessels coverage by AQP4-immunoreactive astrocytes was demonstrated in depressed patients, indicating a role for AQP4 in mood disorders. Moreover, a possible association between depression and serum AQP4-IgG was suggested in a case report of a treatment resistant depression (TRD) patient diagnosed with NMOsd with positive serum AQP4 autoantibodies. We investigated, for the first time, the presence of serum AQP4-IgG in patients with unipolar and bipolar depression and healthy controls (HCs). In this multicenter study, 25 major depressive disorder (MDD) and 25 bipolar disorder (BD) patients, during an acute major depressive episode (MDE), and 30 matched HCs were screened for the presence of serum AQP4-IgG, using a cell-based assay. The MDE patients underwent a repeated AQP4-IgG assessment at a 3-month follow-up visit. The MDE group (N = 50) had illness duration of 12.7 years (SD = 10.5), 12% of them were psychotropic medication-free and 26% were defined as TRD. All MDE patients and HCs, including three BD patients who experienced a manic switch, were seronegative for AQP4-IgG at baseline and follow-up assessments. In conclusion, contrary to our hypothesis, AQP4 autoantibodies were not detected in serum of unipolar and bipolar depressed patients. However, AQP4 may still play a role in the pathogenesis of mood disorders through different mechanisms of action such as altered brain AQP4 expression.
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Affiliation(s)
- Shay Gur
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah-Tikva, Israel
| | - Michal Taler
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petah-Tikva, Israel
| | - Gil Bormant
- Geha Mental Health Center, Petah-Tikva, Israel
| | | | - Uri Nitzan
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Adi Vaknin-Dembinsky
- Department of Neurology and Laboratory of Neuroimmunology, and the Agnes-Ginges Center for Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Livnat Brill
- Department of Neurology and Laboratory of Neuroimmunology, and the Agnes-Ginges Center for Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amir Krivoy
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah-Tikva, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petah-Tikva, Israel; Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Abraham Weizman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah-Tikva, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petah-Tikva, Israel
| | - Eldar Hochman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah-Tikva, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petah-Tikva, Israel.
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21
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Eisenkraft A, Krivoy A. Providing protection to patients with chronic respiratory diseases in a toxic industrial compound scenario. Am J Disaster Med 2020; 14:157-165. [PMID: 32421847 DOI: 10.5055/ajdm.2019.0327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In case of dispersion of toxic industrial compounds (TICs), patients with chronic respiratory diseases would be highly endangered, as they would be unable to use the standard-issue Chemical-Biological-Radio-Nuclear (CBRN) mask. Therefore, we defined guidelines to deliver the appropriate respiratory protection devices to this sub-population of patients. METHODS We used the Israel Ministry of Health Registry to analyze and define chronic respiratory disease patients, both hospitalized and at home, according to their ventilatory and supportive needs. We then identified the gaps in the current available protection measures, and performed a set of in vitro, in vivo, and human studies, aimed to validate the provided tailored solutions and to develop a flow chart and a set of guidelines to be used as requested. RESULTS Chronic respiratory disease patients were subdivided into three distinct groups. We found that standard oxygen and ventilator tubes do not compromise the protection factor afforded by standard protection hoods. We further developed a CBRN filter adaptor, enabling the use of standard-issued CBRN filter with all ventilators. These experiments have led to the development of a flow chart and guidelines to allow both the Military and the Civil Health authorities dis-tributing the most appropriate respiratory protection devices to patients with chronic respiratory diseases. CONCLUSIONS As TIC incidents occur mostly in fixed facilities, both local and national authorities can use our ap-proach in preparing for such an incident.
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Affiliation(s)
- Arik Eisenkraft
- Israel Defense Force Medical Corps Headquarters, Tel Hashomer, Ramat-Gan, Israel; The Faculty of Medicine, Institute for Research in Military Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amir Krivoy
- Israel Defense Force Medical Corps Headquarters, Tel Hashomer, Ramat-Gan, Israel; Sackler Faculty of Medi-cine, Geha Mental Health Center, Petach-Tikva, Tel-Aviv University, Tel-Aviv, Israel
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22
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Gaughran F, Stringer D, Berk M, Smith S, Taylor D, Whiskey E, Landau S, Murray R, McGuire P, Gardner-Sood P, Wojewodka G, Ciufolini S, Jordan H, Clarke J, Allen L, Krivoy A, Stubbs B, Lowe P, Arbuthnott M, Rathod S, Boardman A, Firdosi M, McGrath JJ. Vitamin D supplementation compared to placebo in people with First Episode psychosis - Neuroprotection Design (DFEND): a protocol for a randomised, double-blind, placebo-controlled, parallel-group trial. Trials 2020; 21:14. [PMID: 31907006 PMCID: PMC6945550 DOI: 10.1186/s13063-019-3758-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 09/26/2019] [Indexed: 12/12/2022] Open
Abstract
Background People experiencing their first episode of psychosis are often deficient in vitamin D. Observational studies have reported an association between low vitamin D concentrations and poorer subsequent health outcomes in psychosis. A vitamin D deficiency in neonates and children has been linked to a later increased risk of schizophrenia and psychotic-like experiences. This trial aims to examine the effect of high-dose vitamin D supplementation on outcomes in early psychosis. We hypothesise that vitamin D supplementation will be associated with better mental health outcomes. Methods/design The DFEND study is a multicentre double-blind placebo-controlled parallel-group trial of vitamin D supplementation in people with early psychosis. Patients with an ICD-10 diagnosis of functional psychosis will be randomised in a 1:1 ratio to receive either 120,000 IU/month of vitamin D (cholecalciferol) or a matched placebo for 6 months. The primary outcome is the total Positive and Negative Syndrome Scale (PANSS) score at the 6-month follow-up for all patients. Secondary outcomes include assessment of mood (Calgary Depression Scale), general function (Global Assessment of Functioning), cardiovascular risk (body mass index, waist circumference, C-reactive protein, cholesterol and HbA1c) and vitamin D levels at the 6-month follow-up. Additionally, 3- and 6-month total PANSS scores will be analysed for those with inadequate vitamin D levels at the baseline. Discussion The DFEND study is the first trial to examine whether vitamin D supplementation in early psychosis is associated with better mental health outcomes. The findings of this study may help to resolve the clinical equipoise regarding the benefits and cost-effectiveness of routine vitamin D supplementation in people with psychosis. Trial registration ISRCTN, ISRCTN12424842. Registered on 25 February 2015.
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Affiliation(s)
- Fiona Gaughran
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK. .,South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK.
| | - Dominic Stringer
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Michael Berk
- Deakin University and Barwon Health, Ryrie Street, Geelong, Victoria, 3220, Australia
| | - Shubulade Smith
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - David Taylor
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Eromona Whiskey
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Robin Murray
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Philip McGuire
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Poonam Gardner-Sood
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Gabriella Wojewodka
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Simone Ciufolini
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Harriet Jordan
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Jessie Clarke
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Lauren Allen
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Amir Krivoy
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Brendon Stubbs
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Philippa Lowe
- Carer Expert and Chair of Trustees, Rethink Mental Illness, 89 Albert Embankment, London, SE1 7TP, UK
| | | | - Shanaya Rathod
- Clinical Trials Facility, Research Department, Tom Rudd Unit, Moorgreen Hospital, Southampton, SO3 03J, UK
| | - Andrew Boardman
- Cheshire & Wirral Partnership NHS Trust, Churton House, Countess of Chester Health Park, Chester, CH2 1BQ, UK
| | - Mudasir Firdosi
- South West London and St George's Mental Health NHS Trust, Queen Mary's Hospital, Roehampton Lane, London, SW15 5PN, UK
| | - John J McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, 4076, Australia.,Queensland Brain Institute, University of Queensland, Brisbane, QLD, 4072, Australia.,National Centre for Register-Based Research, Aarhus University, 8000, Aarhus C, Denmark
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23
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Turniansky H, Ben-Dor D, Krivoy A, Weizman A, Shoval G. A history of prolonged childhood sexual abuse is associated with more severe clinical presentation of borderline personality disorder in adolescent female inpatients - A naturalistic study. Child Abuse Negl 2019; 98:104222. [PMID: 31639585 DOI: 10.1016/j.chiabu.2019.104222] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 09/21/2019] [Accepted: 09/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Borderline personality disorder (BPD) is associated with high rates of suicidal and self-injurious behaviors and a substantial proportion of BPD patients have a history of trauma, particularly childhood sexual abuse (CSA). OBJECTIVE To compare the clinical presentation severity in female adolescent inpatients with BPD with and without history of prolonged CSA. PARTICIPANTS AND SETTING Female adolescent BPD patients admitted to a psychiatric inpatient unit. METHODS A retrospective analysis of records of the inpatients, divided into two groups: with (n = 38) and without (n = 40) a history of prolonged CSA. Prolonged CSA was defined as sexual abuse continuing for at least 3 months. Demographic and clinical data, including number and duration of psychiatric hospitalizations until the age 19, non-suicidal self-injury (NSSI), suicide attempts, cigarette smoking, alcohol and drug use, and sexual impulsivity were compared between the two groups. RESULTS The BPD + prolonged CSA group had a larger duration of the first psychiatric hospitalization, number of hospitalizations and cumulative length of hospitalizations compared with the control group. Furthermore, the BPD + prolonged CSA group had a higher number of suicidal attempts, and higher rates of severe NSSI events, cigarette smoking, alcohol use, and sexual impulsivity. CONCLUSIONS This study demonstrated for the first time that adolescent female BPD inpatients with a history of prolonged CSA, manifest more severe clinical presentation compared to those without prolonged CSA. Hence, it appears essential to encourage therapists to inquire about history of CSA and refer adolescent female BPD inpatients with prolonged CSA to appropriate intensive therapy.
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Affiliation(s)
- Hila Turniansky
- Geha Mental Health Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Child and Adolescent Psychiatric Division, the Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, 5262000, Israel.
| | - David Ben-Dor
- Geha Mental Health Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Amir Krivoy
- Geha Mental Health Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Felsenstein Medical Research Center, Petah Tikva, Israel; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Abraham Weizman
- Geha Mental Health Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Felsenstein Medical Research Center, Petah Tikva, Israel.
| | - Gal Shoval
- Geha Mental Health Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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24
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Shoval G, Balicer RD, Feldman B, Hoshen M, Eger G, Weizman A, Zalsman G, Stubbs B, Golubchik P, Gordon B, Krivoy A. Adherence to antidepressant medications is associated with reduced premature mortality in patients with cancer: A nationwide cohort study. Depress Anxiety 2019; 36:921-929. [PMID: 31332883 DOI: 10.1002/da.22938] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/24/2019] [Accepted: 05/25/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Depression and anxiety are common in cancer and antidepressants (AD) are efficacious treatment. The relationship between AD adherence and mortality in cancer is unclear. This study aimed to evaluate the association between adherence to AD and all-cause mortality in a population-based cohort of patients with cancer. MATERIALS AND METHODS We conducted a 4-year historical prospective cohort study including 42,075 patients with cancer who purchased AD at least once during the study period. Adherence to AD was modeled as nonadherence (<20%), poor (20-50%), moderate (50-80%), and good (>80%) adherence. We conducted multivariable survival analyses adjusted for demographic and clinical variables that may affect mortality. RESULTS During 1,051,489 person-years at risk follow-up, the adjusted hazard ratios (HR) for mortality were 0.89 (95% confidence interval [CI]: 0.83-0.95), 0.77 (95% CI: 0.66-0.72), and 0.80 (95% CI: 0.76-0.85) for the poor, moderate, and good adherence groups, respectively, compared to the nonadherent group. Analysis of the entire sample and a subgroup with depression, for cancer subtypes, revealed similar patterns for breast, colon, lung, and prostate cancers, but not for melanoma patients. Multivariate predictors of premature mortality included male gender (HR 1.48 [95% CI: 1.42-1.55]), current/past smoking status (HR 1.1, [95% CI: 1.04-1.15]; P < .0001), low socioeconomic status (HR 1.1, [95% CI: 1.03-1.17]; P < .0001) and more physical comorbidities. CONCLUSIONS The present study is the first to demonstrate that higher adherence to AD is associated with a decrease of all-cause mortality in a large nationwide cohort of cancer patients. Our data add to the pressing need to encourage adherence to AD among cancer patients.
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Affiliation(s)
- Gal Shoval
- Chief Physician Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel.,Child and Adolescent Division, Geha Mental Health Center, Petah Tiqva, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran D Balicer
- Chief Physician Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel.,Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Becca Feldman
- Chief Physician Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Moshe Hoshen
- Chief Physician Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Gilad Eger
- Child and Adolescent Division, Geha Mental Health Center, Petah Tiqva, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Weizman
- Child and Adolescent Division, Geha Mental Health Center, Petah Tiqva, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, New York
| | - Gil Zalsman
- Child and Adolescent Division, Geha Mental Health Center, Petah Tiqva, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, New York.,Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pavel Golubchik
- Child and Adolescent Division, Geha Mental Health Center, Petah Tiqva, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barak Gordon
- Medical Corps, Israel Defense Forces, Tel Aviv, Israel.,Department of Family Medicine, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Amir Krivoy
- Chief Physician Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel.,Child and Adolescent Division, Geha Mental Health Center, Petah Tiqva, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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25
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Krivoy A, Joyce D, Tracy D, Gaughran F, MacCabe J, Lally J, Whiskey E, Sarkar SN, Shergill SS. Real-World Outcomes in the Management of Refractory Psychosis. J Clin Psychiatry 2019; 80. [PMID: 31556974 DOI: 10.4088/jcp.18m12716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 05/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Clozapine is the only medication approved for those patients with schizophrenia who do not achieve a clinical response to standard antipsychotic treatment, yet it is still underused. Furthermore, in the case of a partial or minimal response to clozapine treatment, there is no clarity on the next pharmacologic intervention. METHODS The National Psychosis Service is a tertiary referral inpatient unit for individuals with refractory psychosis. Data from 2 pooled data sets (for a total of 325 medical records) were analyzed for treatment trajectories between admission and discharge (2001-2016). Effectiveness of pharmacologic treatment was determined using change in symptoms, assessed using the Operational Criteria (OPCRIT) system applied retrospectively to the medical records. Analysis was focused on identifying the optimal medication regimens impacting clinical status during the admission. RESULTS Less than a quarter of the patients were on clozapine treatment at the time of admission; this rate increased to 63.4% at the time of discharge. Initiating clozapine during admission (n = 136) was associated with a 47.9% reduction of symptoms as reflected by their OPCRIT score. In cases in which clozapine monotherapy did not achieve sufficient improvement in symptoms, the most effective clozapine augmentation strategy was adding amisulpride (n = 22, 60.8% reduction of symptoms), followed by adding a mood stabilizer (n = 36, 53.7% reduction). A less favorable option was addition of quetiapine (n = 15, 26.7% reduction). CONCLUSIONS Many people with longer-term and complex refractory illness do respond to clozapine treatment with suitable augmentation strategies when necessary. Furthermore, it is possible to advance clozapine prescribing in these complex patients when they are supported by a skilled and dedicated multidisciplinary team. The optimal therapeutic approach relies on confirmation of diagnosis and compliance and optimization of clozapine dose using therapeutic drug monitoring, followed by augmentation of clozapine with amisulpride or mood stabilizers. There is some preliminary evidence suggesting that augmentation strategies may impact differentially depending on the symptom profile.
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Affiliation(s)
- Amir Krivoy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO63, De Crespigny Park, London SE5 8AF, UK. .,National Psychosis Service, South London, and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Dan Joyce
- Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Derek Tracy
- Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Oxleas NHS Foundation Trust, Green Parks House, Orpington, Kent, London, United Kingdom
| | - Fiona Gaughran
- National Psychosis Service, South London, and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - James MacCabe
- National Psychosis Service, South London, and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - John Lally
- Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.,Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland
| | - Eromona Whiskey
- National Psychosis Service, South London, and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - S Neil Sarkar
- Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Central and North West London NHS Foundation Trust, London, United Kingdom
| | - Sukhwinder S Shergill
- National Psychosis Service, South London, and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Krivoy A, Hoshen M, Fischel T, Taler M, Segev A, Weizman A. [THERE IS ROOM FOR IMPROVEMENT: THE RATE OF CLOZAPINE USE AMONG PATIENTS WITH SCHIZOPHRENIA IN ISRAEL]. Harefuah 2019; 158:449-452. [PMID: 31339244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND About a third of schizophrenia patients would not have sufficient clinical response to antipsychotic treatment. The only drug approved for this population is clozapine, yet worldwide reports suggest underuse of clozapine and significant delay in initiating treatment. OBJECTIVES To assess, for the first time in Israel, the rate of clozapine use in patients with schizophrenia. METHODS A retrospective cohort study of "Clalit Health Services" electronic records was conducted. People diagnosed with schizophrenia (F.20 ICD 10 code) who had at least one prescription filled for clozapine were followed up between 2012 and 2014. RESULTS Of 28,983 people diagnosed with schizophrenia, clozapine was prescribed and purchased by 1817 (6.5%) patients during the study period. In addition, 60% of patients with clozapine had polytherapy with other antipsychotic compound or lithium. Polytherapy was associated with HR of 2.1 for morality during the follow-up period. CONCLUSIONS Clozapine is underutilized in Israel, similar to reports from other countries. Moreover, the data suggests that when treatment is given it is not optimized, as reflected by high rates of polytherapy associated with increased mortality. Using therapeutic drug monitoring, now available in Israel, for clozapine might increase clozapine dosage optimization.
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Affiliation(s)
- Amir Krivoy
- Geha Mental Health Center, Petach-Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
- Biological Psychiatry Lab, Felsentsein Medical Research Centre, Petach-Tikva, Israel
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Moshe Hoshen
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel-Aviv, Israel
| | - Tsvi Fischel
- Geha Mental Health Center, Petach-Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Michal Taler
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
- Biological Psychiatry Lab, Felsentsein Medical Research Centre, Petach-Tikva, Israel
| | - Aviv Segev
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
- Shalvata Mental Health Centre, Hod-Hasharon, Israel
| | - Abraham Weizman
- Geha Mental Health Center, Petach-Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
- Biological Psychiatry Lab, Felsentsein Medical Research Centre, Petach-Tikva, Israel
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27
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Daod E, Krivoy A, Shoval G, Zubedat S, Lally J, Vadas L, Weizman A, Reshef A, Bloch B. Psychiatrists' attitude towards the use of clozapine in the treatment of refractory schizophrenia: A nationwide survey. Psychiatry Res 2019; 275:155-161. [PMID: 30913436 DOI: 10.1016/j.psychres.2019.03.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/17/2019] [Accepted: 03/18/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Clozapine is the most effective treatment for refractory schizophrenia, yet it remains underused in clinical practice. The current study examined the awareness, familiarity and attitude of a nationwide sample of Israeli psychiatrists regarding the use of clozapine. METHODS Data were collected using questionnaires, completed by 295 psychiatrists. Participants were asked to score questions regarding clozapine procedures; familiarity with guidelines, drug properties, prescription and attitude towards specialized clozapine resources. RESULTS About half (53.3%) of the psychiatrists reported initiating treatment with clozapine according to the guidelines, whereas 33% reported that they administered clozapine only after three or more unsuccessful antipsychotic treatments. Surprisingly, availability of specialized resources for clozapine treatment (such as clozapine clinics) was associated with delayed initiation of clozapine treatment, and a lower rate of clozapine administration. Barriers to clozapine use included concerns about patient adherence, side effects and partial compliance with the required blood monitoring. CONCLUSIONS Delaying or avoiding clozapine treatment to potentially eligible patients, despite familiarity with the drug efficacy and treatment guidelines, is a major mental health concern. However, executive allocation of resources to support the use of clozapine may be ineffective in promoting clozapine use.
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Affiliation(s)
- Essam Daod
- Psychiatry department, Emek Medical Center, Afula, Israel
| | - Amir Krivoy
- Geha Mental Health Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel; Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.
| | - Gal Shoval
- Geha Mental Health Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Salman Zubedat
- Physiology department, Faculty of medicine, Technion, Haifa, Israel
| | - John Lally
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland; Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; St Vincent's Hospital Fairview, Dublin, Ireland
| | - Limor Vadas
- Psychiatry department, Emek Medical Center, Afula, Israel
| | - Abraham Weizman
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Alon Reshef
- Psychiatry department, Emek Medical Center, Afula, Israel
| | - Boaz Bloch
- Psychiatry department, Emek Medical Center, Afula, Israel
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28
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Shlosberg D, Amit BH, Zalsman G, Krivoy A, Mell H, Lev-Ran S, Shoval G. Cognitive Impairments in Abstinent Male Residents of a Therapeutic Community for Substance-Use Disorders: A Five-Year Retrospective Study. Subst Use Misuse 2019; 54:538-548. [PMID: 30729882 DOI: 10.1080/10826084.2018.1517800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Prior studies of residual cognitive deficits in abstinent substance-use disorder (SUD) patients, exhibited conflicting reports and a substantial patient selection bias. The aim of this study was to test the cognitive function of a sample of chronic abstinent SUD patients in a therapeutic-community. METHODS The IntegNeuroTM cognitive test battery was used for a retrospective cross-sectional study of cognitive functioning of an unselected sample (n = 105) of abstinent male residents of a therapeutic-community. The results were compared to a large age-, gender-, and education-matched normative cohort. RESULTS A significant negative deviance from the normal cohorts' mean was present in most of the cognitive test results and in all the cognitive domains that were tested. The most substantial deficit was found in the executive function domain (d = 1.02, 95%CI (±0.11)). Correct identification of facial emotions was significantly lower selectively in expressions of disgust and sadness. Substance-use starting at an early age (12.4 ± 0.8 years) was associated with lower performance in tests of sustained attention and impulsivity as well as with varied ability to identify correctly "negative" emotions in the emotion identification domain. CONCLUSIONS This 5-year retrospective study demonstrates substantial cognitive impairments in an unselected sample of abstinent SUD patients. Impairment in multiple cognitive domains may lower the probability for remission and successful social integration. Early-age substance initiation may be associated with larger impairments in cognitive performance.
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Affiliation(s)
- Dan Shlosberg
- a Child and Adolescent Division, Geha Mental Health Center , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Ben H Amit
- a Child and Adolescent Division, Geha Mental Health Center , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Gil Zalsman
- a Child and Adolescent Division, Geha Mental Health Center , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Division of Molecular Imaging and Neuropathology, Department of Psychiatry , Columbia University , New York , New York , USA
| | - Amir Krivoy
- a Child and Adolescent Division, Geha Mental Health Center , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Haim Mell
- d Therapy and Rehabilitation Unit, Israel Anti-Drug Authority , Jerusalem , Israel
| | - Shaul Lev-Ran
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,e Outpatient Addiction Clinic, Lev Hasharon Medical Center , Israel
| | - Gal Shoval
- a Child and Adolescent Division, Geha Mental Health Center , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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29
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Barzilay R, Israel N, Krivoy A, Sagy R, Kamhi-Nesher S, Loebstein O, Wolf L, Shoval G. Predicting Affect Classification in Mental Status Examination Using Machine Learning Face Action Recognition System: A Pilot Study in Schizophrenia Patients. Front Psychiatry 2019; 10:288. [PMID: 31133892 PMCID: PMC6512891 DOI: 10.3389/fpsyt.2019.00288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 04/12/2019] [Indexed: 11/24/2022] Open
Abstract
Classifying patients' affect is a pivotal part of the mental status examination. However, this common practice is often widely inconsistent between raters. Recent advances in the field of Facial Action Recognition (FAR) have enabled the development of tools that can act to identify facial expressions from videos. In this study, we aimed to explore the potential of using machine learning techniques on FAR features extracted from videotaped semi-structured psychiatric interviews of 25 male schizophrenia inpatients (mean age 41.2 years, STD = 11.4). Five senior psychiatrists rated patients' affect based on the videos. Then, a novel computer vision algorithm and a machine learning method were used to predict affect classification based on each psychiatrist affect rating. The algorithm is shown to have a significant predictive power for each of the human raters. We also found that the eyes facial area contributed the most to the psychiatrists' evaluation of the patients' affect. This study serves as a proof-of-concept for the potential of using the machine learning FAR system as a clinician-supporting tool, in an attempt to improve the consistency and reliability of mental status examination.
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Affiliation(s)
- Ran Barzilay
- Geha Mental Health Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, United States
| | - Nadav Israel
- The Blavatnik School of Computer Science, Tel Aviv University, Tel Aviv, Israel
| | - Amir Krivoy
- Geha Mental Health Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roi Sagy
- Geha Mental Health Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shiri Kamhi-Nesher
- Geha Mental Health Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Loebstein
- Geha Mental Health Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Wolf
- The Blavatnik School of Computer Science, Tel Aviv University, Tel Aviv, Israel
| | - Gal Shoval
- Geha Mental Health Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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30
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Zohar N, Hochman E, Katz N, Krivoy A, Weizman A, Barzilay R. Association between Elevated C-Reactive Protein and Manic Polarity in Acute Psychiatric Inpatients with Affective Symptomatology. Neuropsychobiology 2018; 76:166-170. [PMID: 29902794 DOI: 10.1159/000489783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/02/2018] [Indexed: 11/19/2022]
Abstract
The interplay between the immune system and behaviour is of increasing interest in psychiatry research. Specifically, accumulating data points to a link between inflammation and psychopathology, including affective symptomatology. We investigated the association between inflammation and affective polarity in psychiatric inpatients who were hospitalized due to an affective exacerbation. Data was collected retrospectively and comparisons were made between manic and depressed patients. C-reactive protein (CRP), a general laboratory marker of immune activation and inflammation, was used as a non-specific inflammatory biomarker. Age, smoking and body mass index were considered covariates. Manic polarity (n = 89) was associated with statistically significant elevated CRP levels compared to depressed polarity (n = 44, 56%; p = 0.036), after controlling for covariates. No differences were observed in CRP levels across Diagnostic and Statistical Manual of Mental Disorders-IV Edition-Text Revised psychiatric diagnoses. These findings suggest a transdiagnostic association between inflammation and manic polarity in affective inpatients.
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Affiliation(s)
- Nitzan Zohar
- Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eldar Hochman
- Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nachum Katz
- Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Krivoy
- Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Weizman
- Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Barzilay
- Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Lifespan Brain Institute, Children's Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and UPenn Medicine, Philadelphia, Pennsylvania, USA
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31
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Shvartzman Y, Krivoy A, Valevski A, Gur S, Weizman A, Hochman E. Adjunctive antidepressants in bipolar depression: A cohort study of six- and twelve-months rehospitalization rates. Eur Neuropsychopharmacol 2018; 28:353-360. [PMID: 29449055 DOI: 10.1016/j.euroneuro.2018.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/04/2017] [Accepted: 01/26/2018] [Indexed: 12/16/2022]
Abstract
Although antidepressants (ADs) are widely used in bipolar depression, there is weak evidence for their effectiveness and safety in this condition. Furthermore, there is a paucity of studies on the risk-benefit ratio of AD maintenance treatment in bipolar disorder (BD). We compared rehospitalization rates of patients with BD-I depressive episode who were discharged with mood stabilizers (MSs) and/or atypical antipsychotics (AAPs) with or without adjunctive AD. Ninety-eight patients with BD-I who were hospitalized with a depressive episode between 2005 and 2013 were retrospectively followed for 6-months and 1-year rehospitalization rates, as well as time to rehospitalization, according to treatment at discharge: MSs and/or AAPs with or without AD. Multivariable survival models adjusted for covariates known to influence rehospitalization were conducted. Six-months and 1-year rehospitalization rates were significantly lower in the adjunctive-AD treatment group compared to the no-AD group (9.2% vs. 36.4%, P = .001, power = 0.87 and 12.3% vs. 42.4%, P = .001, power = 0.89, respectively). Time to rehospitalization within 6-months and 1-year was significantly longer in the adjunctive-AD treatment group (169.9 vs 141 days, P = .001 and 335.6 vs 252.3 days, P = .001, respectively). Adjunctive-AD treatment at discharge reduced significantly the adjusted risk of rehospitalization within 6-months (HR = 0.081, 95% CI: 0.016-0.412, P = 0.002) and 1-year (HR = 0.149, 95% CI: 0.041-0.536, P = 0.004). Moreover, adjunctive-AD treatment did not increase rehospitalization rates of manic episode. In conclusion, adjunctive-AD therapy to MS/AAP at discharge from BD-I depressive episode hospitalization is associated with a lower rate of and a longer time to rehospitalization during a 1-year follow up period.
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Affiliation(s)
- Yahav Shvartzman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Amir Krivoy
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petach-Tikva, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petach-Tikva, Israel
| | - Avi Valevski
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petach-Tikva, Israel
| | - Shay Gur
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petach-Tikva, Israel
| | - Abraham Weizman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petach-Tikva, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petach-Tikva, Israel
| | - Eldar Hochman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petach-Tikva, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petach-Tikva, Israel
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Krivoy A, Hochman E, Sendt KV, Hollander S, Vilner Y, Selakovic M, Weizman A, Taler M. Association between serum levels of glutamate and neurotrophic factors and response to clozapine treatment. Schizophr Res 2018; 192:226-231. [PMID: 28599751 DOI: 10.1016/j.schres.2017.05.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/07/2017] [Accepted: 05/30/2017] [Indexed: 12/17/2022]
Abstract
Clozapine is the only available therapy for about 30% of schizophrenia patients otherwise refractory to antipsychotics. Unfortunately, the mechanism of action of the drug is still unknown and there are no biomarkers that can predict a positive response to clozapine. We aimed to examine serum neurotrophins and glutamate levels as putative biomarkers for clozapine response based on the hypothesized mode-of-action of the compound. Blood samples of 89 chronic schizophrenia patients maintained on clozapine were analyzed in a cross-sectional design. Serum brain derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), neurotrophic growth factor (NGF), glial derived neurotrophic factor (GDNF) and glutamate were determined. Differences between responders and non-responders to clozapine and correlation between clinical and biological measures were analyzed. Our sample consisted of 54 (61%) responders and 35 (39%) non-responders. Responders had higher mean BDNF levels than non-responders (2066±814 vs. 1668±820pg/ml, p<0.05. respectively) and higher serum glutamate levels (1.61±2.2 vs. 0.66±0.9pg/ml, respectively, p<0.05). Furthermore, there was a significant correlation between serum glutamate levels and positive symptoms among the clozapine-responder group (rho=0.47, p<0.005). High serum levels of BDNF and glutamate were associated with response to clozapine, while glutamate levels correlated with the psychosis severity in clozapine responders only. Large-scale, prospective longitudinal studies are needed to support these findings and the assumption that serum glutamate and BDNF can discriminate between clozapine responders and non-responders.
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Affiliation(s)
- Amir Krivoy
- Geha Mental Health Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petach-Tikva, Israel; Department of Psychosis Studies, Institute Of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Eldar Hochman
- Geha Mental Health Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petach-Tikva, Israel
| | - Kyra-Verena Sendt
- Department of Psychosis Studies, Institute Of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sarah Hollander
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petach-Tikva, Israel
| | - Yael Vilner
- Geha Mental Health Center, Petach-Tikva, Israel
| | - Mirjana Selakovic
- Department of Psychiatry, Sismanoglio General Hospital, Athens, Greece
| | - Abraham Weizman
- Geha Mental Health Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petach-Tikva, Israel
| | - Michal Taler
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petach-Tikva, Israel
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33
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Gur S, Weizman S, Stubbs B, Matalon A, Meyerovitch J, Hermesh H, Krivoy A. Mortality, morbidity and medical resources utilization of patients with schizophrenia: A case-control community-based study. Psychiatry Res 2018; 260:177-181. [PMID: 29202380 DOI: 10.1016/j.psychres.2017.11.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/05/2017] [Accepted: 11/15/2017] [Indexed: 02/02/2023]
Abstract
Patients with schizophrenia have higher level of mortality and physical comorbidity compared to control population. However the association to primary-, secondary- and tertiary-medical resources utilization is not clear. We used a retrospective community-based cohort of patients with schizophrenia (n=1389; age 37.53 years, 64.3% males) and, age-, gender-, and socioeconomic status-matched controls (n=4095; age 37.34 years; 64.3% males) who were followed-up for nine years. Mortality rate of patients was almost twice as high as that of matched controls (7% versus 3.8%). Diagnoses of ischemic heart disease and hypertension were more prevalent among controls than patients (8.2% versus 5%, and 21.6% versus 15.8%, respectively). Tertiary medical resources utilization was higher among patients with schizophrenia than control population (mean hospital admissions per year: 0.2 versus 0.12, emergency department visits: 0.48 versus 0.36). Patients that died were more likely to have cardiovascular disease, to be admitted to general hospital and to spend more days in hospital than patients that did not die. There is a discrepancy between lower rates of cardiovascular disease diagnoses but higher rates of mortality and tertiary medical resources utilization among patients with schizophrenia when compared to control population. This may stem from an under-diagnosis and, eventually, under-treatment of these patients.
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Affiliation(s)
- Shay Gur
- Geha Mental Health Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shira Weizman
- Geha Mental Health Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom
| | - Andre Matalon
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Joseph Meyerovitch
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Medicine Wings, community division, Clalit Health Services, Tel Aviv, Israel
| | - Haggai Hermesh
- Geha Mental Health Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Krivoy
- Geha Mental Health Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom.
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Lowe P, Krivoy A, Porffy L, Henriksdottir E, Eromona W, Shergill SS. When the drugs don't work: treatment-resistant schizophrenia, serotonin and serendipity. Ther Adv Psychopharmacol 2018; 8:63-70. [PMID: 29344345 PMCID: PMC5761908 DOI: 10.1177/2045125317737003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/05/2017] [Indexed: 12/13/2022] Open
Abstract
Treatment-resistant schizophrenia is a serious clinical problem. We adopt a systems-level approach positing a greater role for cognitive control mechanisms in the development of psychotic symptoms and illustrate the clinical application of this via a case report of treatment-resistant patients treated successfully with adjunct pro-cognitive serotonergic medication.
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Affiliation(s)
- Penelope Lowe
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, UK
| | - Amir Krivoy
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Lilla Porffy
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Erna Henriksdottir
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, UK. University of Iceland, Iceland
| | - Whiskey Eromona
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, UK. Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Sukhwinder S Shergill
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, UK. Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Krivoy A, Onn R, Vilner Y, Hochman E, Weizman S, Paz A, Hess S, Sagy R, Kimhi-Nesher S, Kalter E, Friedman T, Friedman Z, Bormant G, Trommer S, Valevski A, Weizman A. Vitamin D Supplementation in Chronic Schizophrenia Patients Treated with Clozapine: A Randomized, Double-Blind, Placebo-controlled Clinical Trial. EBioMedicine 2017; 26:138-145. [PMID: 29226809 PMCID: PMC5832639 DOI: 10.1016/j.ebiom.2017.11.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND While accumulating evidence suggests that vitamin D deficiency may be involved in the risk to develop schizophrenia and its outcome, there are no studies on vitamin D supplementation in this context. We sought to assess the effect of vitamin D supplementation on psychiatric, cognitive and metabolic parameters in chronic clozapine-treated schizophrenia patients. METHODS This eight-week, randomized, double-blind, placebo-controlled clinical trial, recruited schizophrenia patients who had been maintained on clozapine treatment for at least 18weeks and had low levels of vitamin D (<75nmol/l) and total PANSS scores >70 (to ascertain the presence of residual symptoms). Patients were randomly allocated to either weekly oral drops of vitamin D (14,000IU) or placebo and subsequently assessed at two-week intervals for psychosis severity, mood, cognition and metabolic profile. RESULTS Twenty four patients were randomly assigned to vitamin D (aged 39.4±9.6years, 75% males) and the other 23 patients to the placebo arm (aged 42.5±11.2years, 60.9% males). After eight weeks, the vitamin D group exhibited a significant increase in vitamin D levels (31.4 vs -0.4nmol/l, p<0.0001). There was no significant effect of vitamin D on psychotic, depressive or metabolic parameters. However, in the vitamin D group, there was a trend towards improved cognition (effect size=0.17, significance lost following Bonferroni correction). CONCLUSIONS Vitamin D supplementation was associated with a trend towards improved cognition, but did not affect psychosis, mood or metabolic status. It is possible that the robust decrease in the PANSS scores in both groups may have obscured an effect of vitamin D supplementation.
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Affiliation(s)
- Amir Krivoy
- Geha Mental Health Center, Petah-Tikva, Israel; Sacker Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petah-Tikva, Israel; Institute of Psychiatry, Psychology and Neuroscience, King's college London, London, UK.
| | - Roy Onn
- Geha Mental Health Center, Petah-Tikva, Israel; Sacker Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yael Vilner
- Geha Mental Health Center, Petah-Tikva, Israel
| | - Eldar Hochman
- Geha Mental Health Center, Petah-Tikva, Israel; Sacker Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petah-Tikva, Israel
| | - Shira Weizman
- Geha Mental Health Center, Petah-Tikva, Israel; Sacker Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Amir Paz
- Geha Mental Health Center, Petah-Tikva, Israel; Sacker Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Shmuel Hess
- Geha Mental Health Center, Petah-Tikva, Israel; Sacker Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Roi Sagy
- Sacker Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel; Brill Mental Health Center, Tel-Aviv, Israel
| | - Shiri Kimhi-Nesher
- Geha Mental Health Center, Petah-Tikva, Israel; Sacker Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Ehud Kalter
- Geha Mental Health Center, Petah-Tikva, Israel; Sacker Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Tal Friedman
- Geha Mental Health Center, Petah-Tikva, Israel; Sacker Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | | | - Gil Bormant
- Geha Mental Health Center, Petah-Tikva, Israel
| | - Sharon Trommer
- Sacker Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Avi Valevski
- Geha Mental Health Center, Petah-Tikva, Israel; Sacker Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Abraham Weizman
- Geha Mental Health Center, Petah-Tikva, Israel; Sacker Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petah-Tikva, Israel
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Krivoy A, Stubbs B, Balicer RD, Weizman S, Feldman B, Hoshen M, Zalsman G, Hochman E, Shoval G. Low adherence to antidepressants is associated with increased mortality following stroke: A large nationally representative cohort study. Eur Neuropsychopharmacol 2017; 27:970-976. [PMID: 28886897 DOI: 10.1016/j.euroneuro.2017.08.428] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/20/2017] [Accepted: 08/20/2017] [Indexed: 01/10/2023]
Abstract
Post stroke depression is common and pervasive. In the general population, there has been some controversy that antidepressant (AD) medication is associated with premature mortality. Data is still lacking regarding the association between adherence to antidepressants (AD) and all-cause mortality. In this retrospective analysis of a population-based cohort of patients, 32,361 post-stroke patients who purchased at least one AD were followed for all-cause mortality over 4-years. Adherence to AD was measured as a ratio between dispensed and prescribed durations and was modeled as: non-adherence (<20%, n=8619), poor (20-50%, n=5108), moderate (50-80%, n=5656), and good (>80%, n=12,978) adherence. Multivariable survival analyses, adjusted for demographic and clinical variables including physical comorbidities known to influence mortality, were conducted. Unadjusted mortality rates were 16.5%, 20.2%, 22.2% and 23.7% in those classified as non-adherent, poor, moderate and good adherence respectively (χ2=174.6, p<0.0001). In the adjusted model, the non-adherent and poor adherence groups had significantly increased mortality Hazard Ratios (HR) of 1.25 (95% CI: 1.17-1.33) and 1.17 (95% CI: 1.09-1.26) respectively compared to the good adherence group. This nationally representative data suggests that poor adherence to AD is associated with increased all-cause mortality among people who had a stroke. Given our findings and the high prevalence of anxiety and depression along with AD effectiveness, efforts to promote AD adherence in this population may be warranted in clinical practice.
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Affiliation(s)
- Amir Krivoy
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel; Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom
| | - Ran D Balicer
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel; Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Shira Weizman
- Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Becca Feldman
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel
| | - Moshe Hoshen
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel
| | - Gil Zalsman
- Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY, USA
| | - Eldar Hochman
- Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Shoval
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel; Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shoval G, Stubbs B, Balicer RD, Feldman B, Hoshen M, Zalsman G, Sagy R, Hochman E, Weizman A, Krivoy A. Low adherence to antidepressants is associated with increased mortality in Parkinson disease patients. Parkinsonism Relat Disord 2017; 43:92-96. [PMID: 28797565 DOI: 10.1016/j.parkreldis.2017.07.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/14/2017] [Accepted: 07/31/2017] [Indexed: 01/24/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the relationship between adherence to antidepressants (AD) and all-cause mortality in a population-based cohort of patients with Parkinson's Disease (PD). METHODS From a database of more than 4 million people, 8553 patients with PD who purchased an AD at least once between the years 2008-2011 were retrospectively followed for all-cause mortality over 4-years. Adherence was measured as a ratio between dispensed and prescribed durations and was modeled as: non-adherence (<20%, n = 1566), poor (20%-50%, n = 1184), moderate (50%-80%, n = 1584), and good (>80%, n = 4219) adherence. Multivariable survival analyses adjusted for demographic and clinical variables including physical comorbidities known to influence mortality were conducted, however there was no adjustment for other psychiatric disorders and medications. RESULTS Unadjusted mortality rates were 20.4%, 25.1%, 23.4% and 25.6% in those classified as non-adherent, poor, moderate and good adherence respectively (χ2 = 18.45, p < 0.0001). The non-adherent and poor adherence groups had significantly increased adjusted mortality hazard ratios (HR) of 1.43 (CI: 1.26-1.62) and 1.26 (CI: 1.1-1.44) respectively compared to the good adherence group. Using the same model, the adjusted HR for death among males was 1.49 [95% CI: 1.36-1.62] compared to females. People with PD and Charslon's Comorbidity Index score of 3-4 (HR 1.3, P < 0.001) and 5+ (HR 1.78, P < 0.001) were more likely to die than those with 0-2 comorbidities. CONCLUSIONS Our findings suggest that poor adherence to AD is associated with increased all-cause mortality in people with PD. Given the high prevalence of depression and AD effectiveness, efforts to promote adherence should be prioritized in clinical practice.
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Affiliation(s)
- Gal Shoval
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel; Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom
| | - Ran D Balicer
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel; Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Becca Feldman
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel
| | - Moshe Hoshen
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel
| | - Gil Zalsman
- Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY, USA
| | - Roi Sagy
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eldar Hochman
- Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Weizman
- Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Krivoy
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel; Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Porras-Segovia A, Krivoy A, Horowitz M, Thomas G, Bolstridge M, Ion D, Shergill SS. Rapid-onset clozapine-induced loss of glycaemic control: case report. BJPsych Open 2017; 3:138-140. [PMID: 28507773 PMCID: PMC5425930 DOI: 10.1192/bjpo.bp.117.004481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED Clozapine has proved to be an effective antipsychotic for the treatment of refractory schizophrenia - characterised by the persistence of symptoms despite optimal treatment trials with at least two different antipsychotics at adequate dose and duration - but its use is hampered by adverse effects. The development of clozapine-induced diabetes is commonly considered to arise as part of a metabolic syndrome, associated with weight gain, and thus evolves slowly. We present the case of an individual with refractory schizophrenia and metformin-controlled diabetes who developed rapid-onset insulin-dependent hyperglycaemia immediately after starting clozapine. Given the refractory nature of his illness, the decision was made to continue clozapine and manage the diabetes. This case supports the existence of a more direct mechanism by which clozapine alters glycaemic control, aside from the more routine slow development of a metabolic syndrome. DECLARATION OF INTEREST S.S.S. is supported by a European Research Council Consolidator Award (Grant Number 311686) and the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. The funders had no role in study design, data collection, data analysis, data interpretation or writing of the report. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
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Affiliation(s)
| | - Amir Krivoy
- , MD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Psychosis Unit, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust London, London, UK
| | - Mark Horowitz
- , MBBS PhD, National Psychosis Unit, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust London, London, UK
| | - George Thomas
- , BSc, Hull York Medical School, University of York, York, UK
| | - Mark Bolstridge
- , MBCHP MRCPsych, National Psychosis Unit, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust London, London, UK
| | - Dragos Ion
- , RMN, National Psychosis Unit, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust London, London, UK
| | - Sukhwinder S Shergill
- , PhD FRCPsych, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Psychosis Unit, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust London, London, UK
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Adamson J, Lally J, Gaughran F, Krivoy A, Allen L, Stubbs B. Correlates of vitamin D in psychotic disorders: A comprehensive systematic review. Psychiatry Res 2017; 249:78-85. [PMID: 28081455 DOI: 10.1016/j.psychres.2016.12.052] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 12/16/2016] [Accepted: 12/30/2016] [Indexed: 12/30/2022]
Abstract
People with psychosis have high prevalence of low vitamin D levels but the correlates and relevance of this deficiency are unclear. A systematic search of major databases from inception to 03/2016 was undertaken investigating correlates of vitamin D in people with psychosis. Data was summarised with a best evidence synthesis. Across 23 included studies (n=1770 psychosis, n=8171 controls) a mean difference in vitamin D levels between both groups of -11.14ng/ml±0.59 was found. 53 unique correlations between vitamin D and outcomes in people with psychosis were identified. The evidence base was broadly equivocal although season of blood sampling (67% of studies found a positive correlation with warmer seasons) and parathyroid hormone (100% of studies found a negative correlation) were associated with vitamin D levels. The most commonly non-correlated variables were: BMI (83% found no correlation), age (73%), gender (86%), smoking (100%), duration of illness (100%) and general assessment of functioning score (100%). In conclusion, whilst many unique correlates have been investigated, there is weak and inconclusive evidence regarding the consistency and meaning of the correlates of vitamin D levels in people with psychosis. Future longitudinal studies should consider the correlates of vitamin D in people with psychosis.
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Affiliation(s)
- James Adamson
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom.
| | - John Lally
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom; Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Fiona Gaughran
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom
| | - Amir Krivoy
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom
| | - Lauren Allen
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom
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Kočovská E, Gaughran F, Krivoy A, Meier UC. Vitamin-D Deficiency As a Potential Environmental Risk Factor in Multiple Sclerosis, Schizophrenia, and Autism. Front Psychiatry 2017; 8:47. [PMID: 28396640 PMCID: PMC5366333 DOI: 10.3389/fpsyt.2017.00047] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/08/2017] [Indexed: 12/18/2022] Open
Abstract
In this short review, we want to summarize the current findings on the role of vitamin-D in multiple sclerosis (MS), schizophrenia, and autism. Many studies have highlighted hypovitaminosis-D as a potential environmental risk factor for a variety of conditions such as MS, asthma, cardiovascular disease, and, more recently, psychiatric diseases. However, whether hypovitaminosis-D is a potential causative factor for the development or activity in these conditions or whether hypovitaminosis-D may be due to increased vitamin-D consumption by an activated immune system (reverse causation) is the focus of intense research. Here, we will discuss current evidence exploring the role of vitamin-D in MS, schizophrenia, and autism and its impact on adaptive and innate immunity, antimicrobial defense, the microbiome, neuroinflammation, behavior, and neurogenesis. More work is needed to gain insight into its role in the underlying pathophysiology of these conditions as it may offer attractive means of intervention and prevention.
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Affiliation(s)
- Eva Kočovská
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London , London , UK
| | - Fiona Gaughran
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, National Psychosis Service, South London and Maudlsey NHS Foundation Trust , London , UK
| | - Amir Krivoy
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, National Psychosis Service, South London and Maudlsey NHS Foundation Trust , London , UK
| | - Ute-Christiane Meier
- Neuroinflammation and Psychoimmunology Group, Department of Neuroscience and Trauma, Barts and The London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London , London , UK
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Abstract
Ribonucleoprotein (RNP) complexes from CRISPR-Cas systems have attracted enormous interest since they can be easily and flexibly reprogrammed to target any desired locus for genome engineering and gene regulation applications. Basis for the programmability is a short RNA (crRNA) inside these complexes that recognizes the target nucleic acid by base pairing. For CRISPR-Cas systems that target double-stranded DNA this results in local DNA unwinding and formation of a so-called R-loop structure. Here we provide an overview how this target recognition mechanism can be dissected in great detail at the level of a single molecule. Specifically, we demonstrate how magnetic tweezers are applied to measure the local DNA unwinding at the target in real time. To this end we introduce the technique and the measurement principle. By studying modifications of the consensus target sequence, we show how different sequence elements contribute to the target recognition mechanism. From these data, a unified target recognition mechanism can be concluded for the RNPs Cascade and Cas9 from types I and II CRISPR-Cas systems. R-loop formation is hereby initiated on the target at an upstream element, called protospacer adjacent motif (PAM), from which the R-loop structure zips directionally toward the PAM-distal end of the target. At mismatch positions, the R-loop propagation stalls and further propagation competes with collapse of the structure. Upon full R-loop zipping conformational changes within the RNPs trigger degradation of the DNA target. This represents a shared labor mechanism in which zipping between nucleic acid strands is the actual target recognition mechanism while sensing of the R-loop arrival at the PAM-distal end just verifies the success of the full zipping.
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Affiliation(s)
- M Rutkauskas
- Molecular Biophysics Group, Institute for Experimental Physics I, Universität Leipzig, Leipzig, Germany
| | - A Krivoy
- Molecular Biophysics Group, Institute for Experimental Physics I, Universität Leipzig, Leipzig, Germany; Skolkovo Institute of Science and Technology, Skolkovo, Russia
| | - M D Szczelkun
- DNA-Protein Interactions Unit, School of Biochemistry, University of Bristol, Bristol, United Kingdom
| | - C Rouillon
- Molecular Biophysics Group, Institute for Experimental Physics I, Universität Leipzig, Leipzig, Germany.
| | - R Seidel
- Molecular Biophysics Group, Institute for Experimental Physics I, Universität Leipzig, Leipzig, Germany.
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Hochman E, Krivoy A, Schaffer A, Weizman A, Valevski A. Antipsychotic adjunctive therapy to mood stabilizers and 1-year rehospitalization rates in bipolar disorder: A cohort study. Bipolar Disord 2016; 18:684-691. [PMID: 27933713 DOI: 10.1111/bdi.12459] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 11/12/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Antipsychotic adjunctive therapy to mood stabilizers (MSs) may improve relapse prevention; however, only a few naturalistic studies, reflecting more generalizable bipolar disorder (BD) samples, support this notion. We compared the 1-year rehospitalization rates of manic patients with bipolar I disorder (BD-I) who were discharged with MS (lithium or valproate) monotherapy or with adjunctive atypical or typical antipsychotic therapy. METHODS A total of 201 patients with BD-I who were hospitalized with manic episodes between 2005 and 2013 were retrospectively followed for 1-year rehospitalization rates according to treatment at discharge: MS monotherapy, MS with atypical antipsychotics, and MS with typical antipsychotics. Additionally, time to rehospitalization during the 1-year period after discharge was compared between treatment groups. Multivariable survival analyses adjusted for covariates known to influence rehospitalization were conducted. RESULTS Rehospitalization rates within 1 year were significantly lower in the MS with atypical antipsychotics group (6.3%) compared to the MS monotherapy group (24.3%, P=.008) and to the MS with typical antipsychotics group (20.6%, P=.02). Time to rehospitalization was significantly longer for the MS with atypical antipsychotics group (345.5 days) compared to the MS monotherapy group (315.1 days, P=.006) and to the MS with typical antipsychotics group (334.1 days, P=.02). The MS with atypical antipsychotics group had a significantly reduced adjusted risk of rehospitalization (hazard ratio=0.17, 95% confidence interval: 0.05-0.61, P=.007) compared to the MS monotherapy group. CONCLUSIONS Atypical antipsychotic adjunctive therapy to MSs may be more effective than MS monotherapy in preventing rehospitalization during the 1-year period after a BD manic episode.
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Affiliation(s)
- Eldar Hochman
- Geha Mental Health Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petach-Tikva, Israel
| | - Amir Krivoy
- Geha Mental Health Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petach-Tikva, Israel
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Abraham Weizman
- Geha Mental Health Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petach-Tikva, Israel
| | - Avi Valevski
- Geha Mental Health Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Schapir L, Lahav T, Zalsman G, Krivoy A, Sever J, Weizman A, Shoval G. Cigarette Smoking, Alcohol and Cannabis Use in Patients With Pervasive Developmental Disorders. Subst Use Misuse 2016; 51:1415-20. [PMID: 27248185 DOI: 10.3109/10826084.2016.1170146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES This study aimed to examine the rates of cigarette smoking, alcohol and cannabis use among patients with pervasive developmental disorder (PDD), in order to determine whether they are relatively protected from developing substance-related addictive behaviors. METHODS This case-control study included 85 patients diagnosed with PDD and 85 age- and gender-matched nonpsychotic psychiatric patients without PDD. Data were collected from the patients' electronic medical records and included demographic and psychiatric parameters, as well as data on smoking, alcohol, and cannabis use. RESULTS A lower rate of cigarette smoking was found among patients diagnosed with PDD in comparison to those without PDD [20.0% vs. 52.9% respectively, p < .001). The likelihood of smoking in PDD was found to be 3.57-fold lower than in psychiatric controls [OR = 3.57 (95% CI 1.69-7.14), p = .001]. A multivariate analysis showed that after adjusting for age, comorbid diagnoses and use of an antipsychotic medications, this effect was even more robust with the likelihood of smoking in PDD decreasing even more substantially compared to controls [OR = 8.33 (95% CI 2.86-25), p < .001]. A similar finding was noted when comparing the prevalence of alcohol and cannabis use between the two groups [OR 6.67 (95%CI 1.30-33.33), p = .02 and 5.55 (95%CI 1.30-25), p = .01, respectively]. CONCLUSIONS PDD is associated with 5-8-fold lower adjusted risk of smoking, alcohol and cannabis use compared to other non-psychotic psychiatric patients. Further research should elucidate the neurobiological and psychosocial mechanisms underlying the apparent addiction protective properties of PDD.
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Affiliation(s)
- Lior Schapir
- a Child and Adolescent Division , Geha Mental Health Center , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Tal Lahav
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Gil Zalsman
- a Child and Adolescent Division , Geha Mental Health Center , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Department B , Geha Mental Health Center , Petah Tikva , Israel.,d Division of Molecular Imaging and Neuropathology , Columbia University , New York , NY , USA.,e Felsenstein Medical Research Center , Tel Aviv University , Petah Tikva , Israel
| | - Amir Krivoy
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Department B , Geha Mental Health Center , Petah Tikva , Israel.,e Felsenstein Medical Research Center , Tel Aviv University , Petah Tikva , Israel
| | - Jonathan Sever
- a Child and Adolescent Division , Geha Mental Health Center , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Abraham Weizman
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Department B , Geha Mental Health Center , Petah Tikva , Israel.,e Felsenstein Medical Research Center , Tel Aviv University , Petah Tikva , Israel
| | - Gal Shoval
- a Child and Adolescent Division , Geha Mental Health Center , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Shalit N, Barzilay R, Shoval G, Shlosberg D, Mor N, Zweigenhaft N, Weizman A, Krivoy A. Characteristics of Synthetic Cannabinoid and Cannabis Users Admitted to a Psychiatric Hospital: A Comparative Study. J Clin Psychiatry 2016; 77:e989-95. [PMID: 27379411 DOI: 10.4088/jcp.15m09938] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/18/2015] [Indexed: 10/21/2022]
Abstract
BACKGROUND Psychotic and affective exacerbations associated with synthetic cannabinoid (SC) use are becoming an emerging concern in psychiatric hospitals. However, data are lacking regarding whether clinical manifestations of SC use differ from those associated with cannabis use. OBJECTIVE Our aim was to explore the unique profile of SC users admitted to a mental health center in terms of demographic, clinical, and physiologic variables in comparison to cannabis users. METHODS We retrieved retrospective data of patients admitted to a mental health center between October 2007 and May 2014 who self-reported recent use of SC (n = 60) and patients who were cannabis users (positive carboxy-tetrahydrocannabinol urine test at admission) without a history of SC use (n = 163). Clinical measures included hospitalization length, number of previous hospitalizations, Positive and Negative Syndrome Scale (PANSS) scores, psychiatric status at admission, and relevant physiologic and laboratory parameters. RESULTS Hospitalized SC users were younger than hospitalized cannabis users (n = 163) (30.46 ± 7.83 years versus 34.67 ± 10.07 years, U₂₂₃ = 3,781.5, P = .009, respectively). SC patients had longer hospitalizations compared to cannabis users (43.45 ± 54.02 days versus 22.91 ± 31.36 days, U₂₁₉ = 5,701.5, P = .005, respectively), had more previous hospitalizations (3.73 ± 5.05 versus 1.98 ± 5.12, U₂₂₃ = 6,284, P < .001, respectively), and were more likely to be hospitalized by criminal court order (36.7% [n = 22] versus 19.9% [n = 32], χ²₂ = 7.136, P = .028, respectively). SC patients presented with a more severe clinical picture manifested by higher total PANSS scores (82.53 ± 23.05 versus 69.98 ± 19.94, t₉₁ = -2.696, P = .008) in a subset of patients with PANSS scores assessed within a week from admission (n = 30 in the SC group and n = 63 in the cannabis group). No differences were found in physiologic or laboratory measures on admission between the SC and cannabis groups. CONCLUSIONS Patients admitted following use of SC are generally younger males who have higher severity of psychotic symptoms at admission, are more likely to be admitted by criminal court order, and require longer hospitalization periods in comparison to cannabis users.
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Affiliation(s)
- Nadav Shalit
- Geha Mental Health Center and Sackler Faculty of Medicine, Tel Aviv University, 1 Helsinki St, Petach-Tikva, 49100, Israel. .,Geha Mental Health Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel.,Drs Shalit and Barzilay contributed equally to this work
| | - Ran Barzilay
- Geha Mental Health Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel.,Felsenstein Medical Research Center, Petach-Tikva, Israel.,Drs Shalit and Barzilay contributed equally to this work
| | - Gal Shoval
- Geha Mental Health Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Dan Shlosberg
- Geha Mental Health Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Nofar Mor
- Geha Mental Health Center, Petach-Tikva, Israel
| | | | - Abraham Weizman
- Geha Mental Health Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel.,Felsenstein Medical Research Center, Petach-Tikva, Israel
| | - Amir Krivoy
- Geha Mental Health Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel.,Felsenstein Medical Research Center, Petach-Tikva, Israel
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45
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Krivoy A, Balicer RD, Feldman B, Hoshen M, Zalsman G, Weizman A, Shoval G. Adherence to antidepressants is associated with lower mortality: a 4-year population-based cohort study. J Clin Psychiatry 2016; 77:e566-72. [PMID: 27136668 DOI: 10.4088/jcp.14m09531] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 05/18/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Despite the growing use of antidepressants and the potential grave consequences of inadequate treatment, little is known about the impact of adherence to antidepressant treatment on mortality in the general population. The objective of this study was to evaluate the association between adherence to antidepressants and all-cause mortality in a population-based cohort. METHODS Data were extracted from the electronic medical record database of the largest health provider in Israel (53% of the nation's population) on a total of 251,745 patients aged 40 years and above who filled an antidepressant prescription at least once between 2008 and 2011. The main outcome measure was all-cause mortality during the study period. Adherence was measured as a continuous variable representing possession ratio (duration of filled antidepressant divided by duration of prescribed antidepressant). A polynomial model of proportional hazard Cox regression for multivariable survival analysis was used, adjusting for demographic and clinical variables that affect mortality. RESULTS The association between adherence and the hazard ratio (HR) for mortality follows a quadratic model in which the lowest HR (0.66 [95% CI, 0.64-0.69]) is at a level of 60% adherence in respect to nonadherence. CONCLUSIONS Adherence to antidepressants is significantly associated with a corresponding decrease in the risk of mortality, controlling for relevant covariates. Physicians from all disciplines should actively improve their patients' adherence to antidepressants since their persistent use is associated with increased survival.
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Affiliation(s)
- Amir Krivoy
- Geha Mental Health Center, PO Box 102, Petah Tiqva 49 100, Israel
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46
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Hollander S, Hochman E, Shoval G, Taler M, Trommer S, Hermesh H, Weizman A, Krivoy A. The association between serum creatine kinase, mood and psychosis in inpatients with schizophrenia, bipolar and schizoaffective disorders. Psychiatry Res 2016; 238:333-337. [PMID: 27086253 DOI: 10.1016/j.psychres.2016.01.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 11/19/2015] [Accepted: 01/26/2016] [Indexed: 01/05/2023]
Abstract
Previous studies demonstrated levels of serum CK (sCK) in the majority of patients undergoing acute psychosis. Records of 1054 patients hospitalized in Geha Mental Health Center during the study period were analyzed. Of them, 743 have been diagnosed with schizophrenia (Sz), 170 with schizoaffective disorder (SzA), and 158 with bipolar disorder (BP-I). Baseline sCK and PANSS values were obtained from each patient upon admission. Our results show that LnsCK is higher in patients with BP-I in comparison with patients with SZ, but not significantly different compared to patients with SzA. A multivariate analysis using linear regression model in which LnsCK was predicted by factors such as PANSS-total and sub-scores, IM injection, BMI, gender, and age among patients at each admission, revealed that PANSS-depression was inversely associated with LnsCK level in SzA and BP-I and not in SZ. A positive association was found between PANSS-total and sCK in SzA and BP-I; however, PANSS-positive scores correlated with sCK only in SzA. After controlling for confounders, it seems that sCK level is associated with the both affective and psychotic components. Serum CK may serve as a biomarker for affective exacerbation rather than psychosis.
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Affiliation(s)
| | - Eldar Hochman
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Geha Mental Health Center, Israel
| | - Gal Shoval
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Geha Mental Health Center, Israel
| | - Michal Taler
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Israel
| | - Sharon Trommer
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Haggai Hermesh
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Geha Mental Health Center, Israel
| | - Abraham Weizman
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Geha Mental Health Center, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Israel
| | - Amir Krivoy
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Geha Mental Health Center, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Israel
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47
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Hochman E, Valevski A, Onn R, Weizman A, Krivoy A. Seasonal pattern of manic episode admissions among bipolar I disorder patients is associated with male gender and presence of psychotic features. J Affect Disord 2016; 190:123-127. [PMID: 26497765 DOI: 10.1016/j.jad.2015.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/29/2015] [Accepted: 10/02/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bipolar I disorder (BD-I) patients demonstrate disrupted chronobiology expressed as seasonal variation in mood symptoms. The seasonal pattern (SP) specifier of mood disorders was recently extended by the DSM-5, to be applied to manic episodes. However, the significance of seasonality of manic episodes for the course of BD-I is unknown. In the present study we sought to identify clinical and demographic features that discriminate between BD-I patients with and without SP of manic admissions. METHODS BD-I patients (n=148) admitted at least twice with the same mood exacerbation type, were retrospectively followed between 2005 and 2013. Demographic and clinical characteristics were compared between BD-I patients with or without SP of manic admissions. RESULTS SP of manic episode admissions, found in 31 (26%) of 117 BD-I patients with repeated manic episode admissions, was associated with higher rates of male gender (p=0.01), presence of psychotic features (p=0.01) and comorbid substance use disorder (p<0.05) compared to patients without SP. In a multivariate analysis, SP of manic episode admissions was associated with the presence of psychotic features (OR 8.42, 95% CI: 1.05-67.65, p<0.05) and male gender (OR 3.23, 95% CI: 1.08-9.65, p<0.05), but not with comorbidity of substance use disorder (OR 1.79, 95% CI: 0.71-4.50, p=0.24). LIMITATIONS Seasonal psychological/environmental factors contributing to the emergent of mood episodes could not be ruled out. CONCLUSIONS Our results suggest that SP of manic admissions is associated with male gender and the presence of psychotic features, thus might be associated with more severe form of the disorder.
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Affiliation(s)
- Eldar Hochman
- Geha Mental Health Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Avi Valevski
- Geha Mental Health Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Roy Onn
- Geha Mental Health Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Abraham Weizman
- Geha Mental Health Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petach-Tikva, Israel
| | - Amir Krivoy
- Geha Mental Health Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petach-Tikva, Israel
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Barzilay R, Lobel T, Krivoy A, Shlosberg D, Weizman A, Katz N. Elevated C-reactive protein levels in schizophrenia inpatients is associated with aggressive behavior. Eur Psychiatry 2015; 31:8-12. [PMID: 26657596 DOI: 10.1016/j.eurpsy.2015.09.461] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/28/2015] [Accepted: 09/29/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND An association between inflammation and behavioral domains of mental disorders is of growing interest. Recent studies reported an association between aggression and inflammation. In this study, we investigated the association between aggressive behavior and inflammatory markers in schizophrenia inpatients. METHODS Adult schizophrenia inpatients without affective symptoms (n=213) were retrospectively identified and categorized according to their C-reactive protein measurement at admission as either elevated (CRP>1 mg/dL; n=57) or normal (CRP<1 mg/dL; n=156). The following indicators of aggression were compared: PANSS excitement component (PANSS-EC), restraints and suicidal behavior during hospitalization. Univariate comparisons between elevated and normal CRP levels were performed and multivariate analysis was conducted to control for relevant covariates. RESULTS CRP levels significantly correlated with other laboratory markers indicating increased inflammation including leukocyte count and neutrophil to lymphocyte ratio (r=0.387, P<0.0001 and r=0.356, P<0.0001) respectively. Inpatients with elevated C-reactive protein displayed increased aggressive behavior compared to patients with normal CRP levels (<1 mg/dL). This was manifested by higher rates of restraint during hospitalization (χ(2)=5.22, P=0.031) and increased PANSS-EC score (U=5410.5, P=0.012). Elevated CRP levels were not associated with suicidal behavior. Multivariate analysis revealed that higher PANSS-EC score was associated with elevated CRP after controlling for the covariates age, sex, BMI and smoking. CONCLUSION This study identified a potential biological correlate (inflammation) of a specific behavioral endophenotype (aggression) in schizophrenia inpatients.
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Affiliation(s)
- R Barzilay
- Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, 1 Helsinki St., 4910002 Petah-Tikva, Israel; Neurosciences laboratory, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - T Lobel
- Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, 1 Helsinki St., 4910002 Petah-Tikva, Israel
| | - A Krivoy
- Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, 1 Helsinki St., 4910002 Petah-Tikva, Israel
| | - D Shlosberg
- Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, 1 Helsinki St., 4910002 Petah-Tikva, Israel
| | - A Weizman
- Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, 1 Helsinki St., 4910002 Petah-Tikva, Israel
| | - N Katz
- Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, 1 Helsinki St., 4910002 Petah-Tikva, Israel
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49
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Krivoy A, Balicer RD, Feldman B, Hoshen M, Zalsman G, Weizman A, Shoval G. The impact of age and gender on adherence to antidepressants: a 4-year population-based cohort study. Psychopharmacology (Berl) 2015; 232:3385-90. [PMID: 26093655 DOI: 10.1007/s00213-015-3988-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 06/06/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Impaired adherence is common among patients using antidepressant drugs (ADs). However, few studies investigated the role of age and gender in adherence to AD and finding conflict. OBJECTIVE This study aimed to determine how gender and age impact adherence to AD in a large-scale cohort. METHODS We conducted a historical cohort study (N = 310,994 individuals) that claimed AD prescriptions during a 4-year period. Adherence was defined as the ratio between the duration of claimed AD prescriptions and the duration of continuously prescribed AD. RESULTS Substantial differences in the mean adherence to AD were noted throughout the lifespan, ranging from 0.38 (first decade) to 0.63 (tenth decade). Average adherence was significantly higher for males aged 20-40 years than for females of that age, but this relationship reversed later in life (50-70 years). A regression analysis model of adherence as the dependent variable showed a significant interaction between age and gender variables (beta = 0.001, p < 0.0001). CONCLUSIONS This study demonstrates the effect of age and gender, and their interaction, on adherence to AD across the entire life span. The marked age- and modest, yet significant, gender-related effects should be taken into consideration when targeting impaired adherence to these commonly prescribed medications.
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Affiliation(s)
- Amir Krivoy
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel
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Krivoy A, Balicer RD, Feldman B, Hoshen M, Zalsman G, Weizman A, Shoval G. Authors' reply. Br J Psychiatry 2015; 207:270. [PMID: 26329569 DOI: 10.1192/bjp.207.3.270a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Amir Krivoy
- Amir Krivoy, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. ; Ran D. Balicer, Clalit Research Institute, Tel Aviv, Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel; Becca Feldman, Moshe Hoshen, Clalit Research Institute, Tel Aviv, Israel; Gil Zalsman, Geha Mental Health Center, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, and Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, USA; Abraham Weizman, Geha Mental Health Center, Petah Tiqva, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Gal Shoval, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran D Balicer
- Amir Krivoy, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. ; Ran D. Balicer, Clalit Research Institute, Tel Aviv, Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel; Becca Feldman, Moshe Hoshen, Clalit Research Institute, Tel Aviv, Israel; Gil Zalsman, Geha Mental Health Center, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, and Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, USA; Abraham Weizman, Geha Mental Health Center, Petah Tiqva, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Gal Shoval, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Becca Feldman
- Amir Krivoy, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. ; Ran D. Balicer, Clalit Research Institute, Tel Aviv, Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel; Becca Feldman, Moshe Hoshen, Clalit Research Institute, Tel Aviv, Israel; Gil Zalsman, Geha Mental Health Center, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, and Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, USA; Abraham Weizman, Geha Mental Health Center, Petah Tiqva, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Gal Shoval, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Hoshen
- Amir Krivoy, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. ; Ran D. Balicer, Clalit Research Institute, Tel Aviv, Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel; Becca Feldman, Moshe Hoshen, Clalit Research Institute, Tel Aviv, Israel; Gil Zalsman, Geha Mental Health Center, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, and Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, USA; Abraham Weizman, Geha Mental Health Center, Petah Tiqva, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Gal Shoval, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Zalsman
- Amir Krivoy, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. ; Ran D. Balicer, Clalit Research Institute, Tel Aviv, Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel; Becca Feldman, Moshe Hoshen, Clalit Research Institute, Tel Aviv, Israel; Gil Zalsman, Geha Mental Health Center, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, and Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, USA; Abraham Weizman, Geha Mental Health Center, Petah Tiqva, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Gal Shoval, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Weizman
- Amir Krivoy, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. ; Ran D. Balicer, Clalit Research Institute, Tel Aviv, Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel; Becca Feldman, Moshe Hoshen, Clalit Research Institute, Tel Aviv, Israel; Gil Zalsman, Geha Mental Health Center, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, and Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, USA; Abraham Weizman, Geha Mental Health Center, Petah Tiqva, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Gal Shoval, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Shoval
- Amir Krivoy, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. ; Ran D. Balicer, Clalit Research Institute, Tel Aviv, Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel; Becca Feldman, Moshe Hoshen, Clalit Research Institute, Tel Aviv, Israel; Gil Zalsman, Geha Mental Health Center, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, and Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, USA; Abraham Weizman, Geha Mental Health Center, Petah Tiqva, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Gal Shoval, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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