The effect of Ondansetron on memory in schizophrenic patients.

It has been well established that patients with schizophrenia have impaired cognitive function on neuropsychological tasks related to memory. Previous studies also suggest serotonin's central role in memory. This double-blind crossover study aimed to explore the effect of Ondansetron, a selective serotonin 3 receptor (5-HT(3)) antagonist, on a variety of memory tasks in schizophrenic patients. Clozapine-treated schizophrenic patients in remission (N=21) were randomly treated with Ondansetron or placebo and then evaluated at three consecutive points. These evaluations included clinical measures (including Positive and Negative Syndrome Scale for Schizophrenia, Clinical Global Impression and Extrapyramidal Symptoms Rating Scale) and neuropsychological measures (including Digit Span, Paired Association, Rey-Osterich Complex Figure Test, Digit Symbol and the Rivermead Behavioral Memory Tests). Ondansetron, when compared with placebo, did not affect the above clinical measures and most of the neuropsychological tests. Short-term administration of Ondansetron, however, was associated with significantly improved visuo-spatial memory as measured by the Rey-Osterich Complex Figure Test. These preliminary results suggest Ondansetron's possible role in enhancement of memory function in schizophrenia.

Perception of dyadic relationship and emotional states in patients with affective disorder.

BACKGROUND: Previous research has shown that interpersonal processes play a significant role in the development and maintenance of affective disorders. In this study, this claim was further investigated by comparing the perception of the dyadic relationship and judgment of other's emotions in affective disorder patients. METHOD: The sample included 39 couples (n=39 couples) with one of the partners suffering from an affective disorder and currently either in an acute or remitted depressive state. All participants completed four instruments, measuring the perceived quality of the dyadic relationship and the perception of other's emotions as reflected by judgments of facial expressions line drawings. RESULTS: While the level of marital satisfaction was found to be lower in the acute than in the remitted group both for ill partners and their spouses, spouses in both the acute and remitted group tended to be more critical of their ill partners. Patients who were depressed judged facial expressions significantly less positively than did remitted patients. Judgments of negative emotions were highly correlated between partners in the acute group, but uncorrelated in the remitted group. Acutely depressed patients were less sensitive to invitation than remitted patients, while their spouses displayed the opposite pattern. CONCLUSION: The present results shed further light on the interpersonal dynamics between depressed patients and their spouses by underscoring differences between couples with a remitted vs. acutely depressed partner in their perception of the dyadic unit and their judgments of facial emotions. LIMITATIONS: Longitudinal research is needed, in which the same patients are tested during periods of remission and acute episodes, as well as research investigating the role of patient gender in the perception of facial expressions of emotions.

Group interpersonal psychotherapy for patients with major depression disorder - pilot study.

BACKGROUND: This study evaluated the effectiveness of group interpersonal psychotherapy (IPT-G) for patients suffering from moderate to severe major depressive disorder (MDD), and who responded to antidepressant drugs during the acute phase treatment. METHODS: Subjects were allocated into two groups: in the study group subjects entered IPT-G while in the comparison group subjects continued with standard treatment. All subjects were assessed five times during and 6 months after the termination of the IPT-G in a double-blind, matched-control design. RESULTS: Subjects who participated in the IPT-G demonstrated significant improvement of their depressive symptoms compared to those who received the standard treatment both during the group therapy and in a 6-month follow-up period. CONCLUSIONS: Our preliminary results suggest that IPT in a group setting might be effective for a subset of patients who respond to antidepressant medication. LIMITATIONS: Small group of patients, lack of different types of treatment as control groups.

Comparison of the attitudes of Israeli therapists and lay persons to ethical dilemmas in psychotherapy.

The issues of confidentiality and boundaries cause ethical dilemmas for psychotherapists. We investigated whether therapists have ethical attitudes to confidentiality and boundaries that are unique to their professional group compared with lay persons and whether gender or professional characteristics are associated with these attitudes. Clinical vignettes capturing ethical dilemmas regarding confidentiality and boundaries were presented to 93 psychotherapists of different professional backgrounds (professional group) and 55 staff and students from the fields of law and the humanities (lay group). In general, the lay group showed a greater tendency to maintain confidentiality than the professional group. Regarding boundaries, the majority of psychotherapists were against initiating any sexual relationship with current patients, former patients, students, or supervisees; the differences between the groups in this area were statistically significant. The vast majority of therapists (96.7%) disapproved of accepting money in advance compared with only 54.4% of the lay group. Analysis of the psychotherapists by professional background revealed that for the majority of the vignettes, there was no difference in attitude to confidentiality and boundaries between psychiatrists, psychologists, and social workers. The present study shows that therapists have different ethical codes from nontherapists regarding the issues of boundaries and the treatment contract. Therapists are stricter than nontherapists regarding issues of boundaries but less strict regarding issues of confidentiality, and there are some minor differences in the attitudes to these issues among different types of therapists.

Siblings of schizophrenic patients--a review.

The families of patients with schizophrenia carry an enormous emotional and social burden. This article is a historical review of the study of the well siblings of schizophrenic individuals. The early investigations (1950s-1970s) were based on the theory of familial transmission of schizophrenia and focused on siblings from the aspect of their susceptibility to the disease. Many claimed that even siblings who did not develop full blown schizophrenia still suffered from considerable psychiatric disorders that were attributable to pathological familial psychodynamics. Case control studies were used to explain how some well siblings "escaped" the pathological family network. With the introduction of the concept of family burden in the late 1960s, research shifted to the emotional impact of growing up with a schizophrenic brother or sister. This was accompanied by the emergence of self-help groups and published case histories of siblings themselves. In the early 1980s, the data were essentially descriptive. Investigators studied sibling shame, poor self-esteem and feelings of stigmatization. Different patterns of coping with the subjective burden were distinguished. More recently, greater efforts have been made to systematically define the variables associated with the burden experienced by siblings. To answer the many still outstanding questions, further studies are needed based on a longitudinal design and homogeneous samples. For example: Are sibling's personal relationships outside the family affected? Does the sibling place within the family affect his or her reaction to the sick brother or sister? Does guilt play a role? What type of intervention is needed? With the increasing role of the community in the management of the mentally ill, such research has become very important.

Perception of ill spouse and dyadic relationship in couples with affective disorder and those without.

BACKGROUND: This study compares the perception of spouses and the quality of the dyadic relationship of patients with severe affective disorders in remission with healthy couples. METHOD: The sample included spouses of patients between the ages of 20 and 65 who had been hospitalized with severe affective illness and who were currently in remission (depressive, n=23; bipolar, n=11) and a control group matched by socioeconomic status. Both groups completed three instruments measuring the quality of the dyadic relationship, attributed characteristics of the spouse and non-formal social support. RESULTS: The spouses of patients, as compared to spouses of controls, scored lower on consensus, unity and expressions of affection in their marital relationship, ranked their ill spouses lower on the positive qualities and higher on the negative qualities and reported receiving less emotional and practical support. LIMITATIONS: The limitations of the study are the small sample size and cross sectional design. CONCLUSIONS: The results suggest that severe affective disorders are associated with marital dysfunction, even during periods of symptom remission.

EEG abnormalities in clozapine-treated schizophrenic patients.

A prospective study of EEG findings and occurrence of seizures in patients with refractory schizophrenia treated with clozapine has been conducted. Pretrial EEG and EEG under treatment at a fixed dose of clozapine 300 mg/day were performed. Fifteen patients entered the study, four patients were withdrawn because of side effects or poor compliance. EEG abnormalities appeared in seven of the 11 patients who completed the study (64%): generalized slowing in six of them and epileptic activity in two (one patient had both types of change). None of the patients developed clinical seizures. EEG abnormalities were more frequently observed in those with better clinical response to clozapine and/or shorter duration of disease, although these findings were not statistically significant. We conclude that EEG abnormalities occur frequently (64%) in schizophrenic patients who receive clozapine. However, the EEG changes do not necessarily predict the occurrence of convulsions.

Interdependency of lithium ratio, plasma lithium level and clinical state in patients with affective disorders.

The interrelationship between lithium ratio, lithium plasma level and the different clinical phases of 31 patients with bipolar affective disorder has been investigated. the interdependency of these variables was followed longitudinally during different phases of the illness while under lithium therapy. Although positive correlations between lithium ratio and lithium plasma levels were evident, the lithium ratio values in the euthymic group were significantly higher than those in the manic and depressive groups, independently of the plasma lithium level. Our data suggested that RBC/plasma lithium ratio might be a sensitive state dependent index in affective bipolar illness.

Sulpiride-induced hyperprolactinemia and impotence in male psychiatric outpatients.

The relationship between erectile dysfunction and sulpiride stimulatory effect on prolactin secretion was studied in 13 married male psychiatric outpatients. The patients population was comprised of 2 groups: patients with anxiety disorders resistant to minor tranquilizers who were treated with sulpiride up to 200 mg/day, and schizophrenic patients treated with sulpiride 600 mg/day. All the patients were maintained on maximal dose for a period of 3 weeks. Sexual function and blood prolactin levels were monitored once weekly. The patients who developed impotence were maintained on higher doses of sulpiride and exhibited higher prolactin levels in comparison to the potent patients. Restoration of potency was observed after reduction or discontinuation of sulpiride treatment. It is concluded that sulpiride induced impotence is associated with hyperprolactinemia.