Risk factors for coercion length at psychiatric hospitals in Israel: Relationship with staff.

Background: Coercive interventions continue to be applied frequently in psychiatric care when patients are at imminent risk of harming themselves and/or others. Aim: The purpose of this study was to demonstrate the relationship between the length of coercion and a variety of factors, including the sociodemographic background of patients, their diagnoses and the characteristics of hospital staff. Methods: This is a one-year cross-sectional retrospective study, including records of 298 patients who underwent restraint and/or seclusion interventions in male acute, closed wards in two psychiatric hospitals in Israel. Results: A higher proportion of academic nurses to nonacademic nurses on duty leads to a shorter coercion time (P < 0.000). The number of male staff on duty, without any relation to their level of education, also leads to the shortening of the coercion time. Conclusion: The presence of registered, academic female nurses, male staff on duty and the administration of medication before coercive measures can reduce the length of restriction.

Binocular properties of contrast adaptation in human vision.

Adaptation to contrast has been known and studied for 50 years, and the functional importance of dynamic gain control mechanisms is widely recognized. Understanding of binocular combination and binocular fusion has also advanced in the last 20 years, but aside from interocular transfer (IOT), we still know little about binocular properties of contrast adaptation. Our observers adapted to a high contrast 3.6 c/deg grating, and we assessed contrast detection and discrimination across a wide range of test contrasts (plotted as threshold vs contrast [TvC] functions). For each combination of adapt/test eye(s), the adapted TvC data followed a 'dipper' curve similar to the unadapted data, but displaced obliquely to higher contrasts. Adaptation had effectively re-scaled all contrasts by a common factor Cs that varied with the combination of adapt and test eye(s). Cs was well described by a simple 2-parameter model that had separate monocular and binocular gain controls, sited before and after binocular summation respectively. When these two levels of adaptation were inserted into an existing model for contrast discrimination, the extended 2-stage model gave a good account of the TvC functions, their shape invariance with adaptation, and the contrast scaling factors. The underlying contrast-response function is of almost constant shape, and adaptation shifts it to higher contrasts by the factor log10(Cs) - a 'pure contrast gain control'. Evidence of partial IOT in cat V1 cells supports the 2-stage scheme, but is not consistent with a classic (single-stage) model.

Treatment of Clozapine-Associated Sialorrhea: The Role of Benzamide Derivatives.

PURPOSE: Hypersalivation is one of the most prevalent and distressing adverse effects associated with clozapine treatment. Currently, there is no standard therapeutic approach toward how to overcome it. Clinicians use various medications for managing this adverse effect. However, some of the agents are not effective enough, whereas others can induce other adverse effects. Recently, several reviews have been published on the treatment of clozapine-associated hypersalivation, in which the focus was on drugs from various pharmacological groups, and little attention was paid to drugs from the group of substituted benzamides. The intention of this brief narrative review is to draw the attention of clinicians to the use of the benzamide group for the treatment of this unpleasant adverse effect. METHODS: A MEDLINE search was conducted to identify published treatment studies and case reports in the literature from 2000 to September 2021, concerning a treatment of clozapine-associated hypersalivation, mainly substituted benzamides. RESULTS: Accumulating evidence during the last 2 decades indicates that agents derived from the benzamide group may be effective and safe agents for treatment of clozapine-associated hypersalivation. Whether with a psychotropic effect or without, medications from this group may produce a beneficial response. CONCLUSIONS: Substitute benzamide derivatives have emerged as effective and well-tolerated agents for treatment clozapine-associated hypersalivation.

Curcumin as Add-On to Antipsychotic Treatment in Patients With Chronic Schizophrenia: A Randomized, Double-Blind, Placebo-Controlled Study.

BACKGROUND: Introduction of old and new generations of antipsychotics leads to significant improvements in the positive symptoms of schizophrenia. However, negative symptoms remain refractory to conventional trials of antipsychotic therapy. Recently, there were several open clinical human trials with curcumin. Curcumin is a natural polyphenol, which has a variety of pharmacological activities, including antioxidative and neuroprotective effects. The studies showed that curcumin improved the negative symptoms of schizophrenia. The purpose of our study was to examine the efficacy of curcumin as an add-on agent to regular antipsychotic medications in patients with chronic schizophrenia. METHODS: Thirty-eight patients with chronic schizophrenia were enrolled in a 24-week, double-blind, randomized, placebo-controlled study. The subjects were treated with either 3000 mg/d curcumin or placebo combined with antipsychotics from January 2015 to February 2017. The outcome measures were the Positive and Negative Symptoms Scale (PANSS) and the Calgary Depression Scale for Schizophrenia. RESULTS: Analysis of variance showed significant positive changes in both groups from baseline to the end of the study in all scales of measurement. There was a significant response to curcumin within 6 months in total PANSS (P = 0.02) and in the negative symptoms subscale (P = 0.04). There were no differences in the positive and general PANSS subscales, and the Calgary Depression Scale for Schizophrenia scores between the treatment and placebo groups. No patient complained of any adverse effect. CONCLUSIONS: The promising results of curcumin as an add-on to antipsychotics in the treatment of negative symptoms may open a new and safe therapeutic option for the management of schizophrenia. However, these results should be replicated in further studies.ClinicalTrials.gov Identifier: NCT02298985.

Managing an Agent's Self-Presentational Strategies During an Interaction.

In this paper we present a computational model for managing the impressions of warmth and competence (the two fundamental dimensions of social cognition) of an Embodied Conversational Agent (ECA) while interacting with a human. The ECA can choose among four different self-presentational strategies eliciting different impressions of warmth and/or competence in the user, through its verbal and non-verbal behavior. The choice of the non-verbal behaviors displayed by the ECA relies on our previous studies. In our first study, we annotated videos of human-human natural interactions of an expert on a given topic talking to a novice, in order to find associations between the warmth and competence elicited by the expert's non-verbal behaviors (such as type of gestures, arms rest poses, smiling). In a second study, we investigated whether the most relevant non-verbal cues found in the previous study were perceived in the same way when displayed by an ECA. The computational learning model presented in this paper aims to learn in real-time the best strategy (i.e., the degree of warmth and/or competence to display) for the ECA, that is, the one which maximizes user's engagement during the interaction. We also present an evaluation study, aiming to investigate our model in a real context. In the experimental scenario, the ECA plays the role of a museum guide introducing an exposition about video games. We collected data from 75 visitors of a science museum. The ECA was displayed in human dimension on a big screen in front of the participant, with a Kinect on the top. During the interaction, the ECA could adopt one of 4 self-presentational strategies during the whole interaction, or it could select one strategy randomly for each speaking turn, or it could use a reinforcement learning algorithm to choose the strategy having the highest reward (i.e., user's engagement) after each speaking turn.

Association between mental disorders, cognitive disturbances and vitamin D serum level: Current state.

BACKGROUND & AIMS: Vitamin D deficiency has been identified as a global problem. Approximately 14% of the world population has inadequate vitamin D levels. This vitamin has been usually associated with bone disorders such as rickets, osteomalacia, and osteoporosis. However, these disorders present only a small part of all the disturbances which can be induced by its deficiency. Low serum vitamin D is associated with development of cardiovascular diseases, hypertension, neurodegenerative diseases, diabetes mellitus, metabolic syndrome and even cancer. This vitamin may be an important factor in the development of psychiatric illnesses, therefore clinicians should not leave this serious issue unresolved. The aim of this review is to describe the current data concerning the association between vitamin D serum levels, cognition and mental disorders. METHODS: We conducted a systematic bibliographical research, of PubMed, MedLine literature and Cochrane database without language restriction to identify all publications concerning this issue from 1995 to the first quarter of 2017. RESULTS: We found 48,937 articles concerning vitamin D, published during the last 22 years and 3 months (1995-2017). We selected only those publications focused on the association between vitamin D serum deficiency and mental disturbances (depression, schizophrenia, cognitive disturbances, attention deficit disorder, and autism). One hundred and sixty-seven papers were found suitable to our selection criteria. Careful evaluation of the relevant literature demonstrates that addition of vitamin D to conventional antidepressive agents can improve antidepressive effect in contrast to placebo. Regarding other mental conditions there are no clear-cut conclusions. CONCLUSIONS: An association between low vitamin D serum levels and different mental disorders was found. Yet, nonetheless there is no clear consensus that addition of vitamin D improves or is related to a beneficial effect on mental health. More randomized clinical control trials should be performed in order to reach evidence based conclusions.

Successful Use of Escitalopram for the Treatment of Visual Hallucinations in Patients With Parkinson Disease.

INTRODUCTION: Patients with Parkinson disease (PD) frequently experience visual hallucinations (VH). Visual hallucinations are most often viewed as an adverse effect of antiparkinsonian treatment. Possible treatments for this disturbance include a reduction of antiparkinsonian medications, adding atypical antipsychotics, or cholinesterase inhibitors. Some studies demonstrated that selective serotonin reuptake inhibitors may be an optional treatment for patients experiencing psychosis or agitation in dementia. Currently, there is no standard recommended treatment for VH in patients with PD. We present here our clinical experience with escitalopram (selective serotonin reuptake inhibitor) for treating this disturbance. METHODS: Thirteen patients with PD (8 men and 5 women; age range 67-83 years) experiencing VH were openly treated with escitalopram 10 or 15 mg/d as add-on. Efficacy was assessed at baseline, then after 4 and 8 weeks of treatment using Clinical Global Impression-Severity and Clinical Global Impression-Improvement. RESULTS: At the end of the 4th week of treatment, of 13 patients, 11 subjects demonstrated improvement, and in only 2 patients were there no changes in their condition. After an additional 4 weeks, 2 of the responders showed very significant improvement, 6 demonstrated much improvement, and 3 patients demonstrated minimal improvement. Only 1 patient showed no change in his condition. One additional patient stopped taking escitalopram after 5 weeks because of an absence of improvement in his state. CONCLUSIONS: Escitalopram was well tolerated as treatment of VH in PD patients. This medication could be a promising optional therapy for this disturbance; however, further randomized controlled and bigger studies are necessary.

Donepezil as Add-on Treatment for Resistant Obsessive-Compulsive Disorder: Retrospective Case Series.

UNLABELLED: Obsessive-compulsive disorder (OCD) is one of the most common and disabling psychiatric disorders. Treatment with serotonin selective reuptake inhibitors (SSRIs) shows significant improvement; however, residual symptoms remain in most patients despite continued adequate OCD treatment. For patients exhibiting partial or no response to multiple SSRIs, augmentation strategies are usually recommended. Here, we introduce a retrospective consecutive sample of aged patients with resistant OCD treated with donepezil augmentation to regular pharmacotherapy. METHODS: Ten patients (5 males, 5 females; mean [SD] age, 63.8 [7.5] years), suffering from resistant OCD, were openly treated with donepezil 10 mg/d as add-on. Efficacy was assessed at baseline and after 8 weeks of treatment using the Yale-Brown Obsessive Compulsive Scale, Clinical Global Impression-Severity, and Clinical Global Impression-Improvement. RESULTS: The treatment was generally well tolerated without adverse events. In all patients, mean (SD) Yale-Brown Obsessive Compulsive Scale scores diminished from 27.3 (4.3) points at baseline to 16.9 (4.5) points at week 8 (P < 0.0001). Mean (SD) Clinical Global Impression-Severity scores diminished from 5.5 (0.7) points to 3.1 (1.0) points, (P < 0.001). According to Clinical Global Impression-Improvement, 7 patients demonstrated "very much" or "much" improvement and 3 patients did not demonstrate any improvement. CONCLUSIONS: Donepezil was a well-tolerated add-on to regular pharmacotherapy in treatment-resistant OCD patients in this small cases series. Donepezil could be a promising optional therapy for patients suffering from resistant OCD, but further randomized controlled studies are necessary.

Double-Blind, Randomized, Placebo-Controlled Trial of Metoclopramide for Hypersalivation Associated With Clozapine.

Hypersalivation is a frequent, disturbing, and uncomfortable adverse effect of clozapine therapy that frequently leads to noncompliance. The aim of this study was to examine the efficacy of metoclopramide (dopamine D2 antagonist, antiemetic medication) as an option for management of hypersalivation associated with clozapine (HAC). A 3-week, double-blind, placebo-controlled trial was conducted in university-based research clinics from January 2012 to May 2014, on 58 inpatients treated with clozapine who were experiencing hypersalivation. The subjects were randomly divided into placebo and metoclopramide groups. The starting dose was 10 mg/d. Participants who did not respond were up-titrated 10 mg/d weekly to a total of 30 mg/d during the third week. The number of placebo capsules was increased accordingly up to 3 capsules per day. Primary outcome was the change from baseline to the end of study in the severity of hypersalivation as measured with the Nocturnal Hypersalivation Rating Scale and the Drooling Severity Scale. Secondary outcomes included Clinical Global Impression of Improvement scale and adverse effect scales. Significant improvement on the Nocturnal Hypersalivation Rating Scale was demonstrated in the metoclopramide group from the end of the second week (P < 0.004), and on the Drooling Severity Scale (P < 0.02) in the third week. Clinical Global Impression-Improvement scale scores revealed major improvement. Twenty subjects (66.7%) treated with metoclopramide reported significant decline or total disappearance of HAC in comparison to 8 patients (28.6%) who received placebo (P = 0.031). No adverse effects to metoclopramide were reported. Metoclopramide was found to be safe and effective for the treatment of HAC.

Amisulpride as add-on treatment for resistant obsessive-compulsive disorder: retrospective case series.

UNLABELLED: Obsessive-compulsive disorder (OCD) is one of the most common and disabling psychiatric disorders. Treatment with selective serotonin reuptake inhibitors (SSRIs) shows significant improvement; however, residual symptoms remain in most patients despite continued treatment. For partial or nonresponding patients to multiple SSRIs, augmentation strategies are usually recommended. Here we present a consecutive sample of patients with resistant OCD treated with amisulpride augmentation to SSRIs. METHODS: We present 10 patients (5 males, 5 females) experiencing resistant OCD. Subjects were treated openly for 6 weeks with amisulpride 200 mg/d as add-on, excluding 1 patient who was treated with only 100 mg/d due to acute extrapyramidal adverse effect on a larger dose. Efficacy was assessed at baseline and after 6 weeks of treatment using the Yale-Brown Obsessive-Compulsive Scale, Clinical Global Impression-Severity, and Clinical Global Impression-Improvement. RESULTS: The treatment was generally well tolerated without serious events. In all patients, average Yale-Brown Obsessive-Compulsive Scale scores diminished from 25.3 ± 5.96 points at baseline to 12.2 ± 5.98 at the sixth week (P < 0.0005). Of 10 patients, 7 had significant and partial improvement, and 3 patients did not demonstrate any improvement. CONCLUSIONS: Treatment-resistant OCD patients positively responded and well tolerated amisulpride add-on to their ongoing regular pharmacotherapy. This case series demonstrates that amisulpride could be a promising optional therapy for patients who have resistant OCD. Further randomized controlled studies are necessary.

Tardive dyskinesia (syndrome): Current concept and modern approaches to its management.

Tardive dyskinesia is a serious, disabling and potentially permanent, neurological hyperkinetic movement disorder that occurs after months or years of taking psychotropic drugs. The pathophysiology of tardive dyskinesia is complex, multifactorial and still not fully understood. A number of drugs were tried for the management of this motor disturbance, yet until now no effective and standard treatment has been found. It is very disappointing to realize that the introduction of antipsychotics from the second generation has not significantly decreased the prevalence and incidence of tardive dyskinesia. Therefore, the management of this motor disturbance remains an actual topic as well as a challenge for clinicians. This review summarizes recent relevant publications concerning the treatment of tardive dyskinesia.

Curcumin as an add-on to antidepressive treatment: a randomized, double-blind, placebo-controlled, pilot clinical study.

OBJECTIVES: Depression is a widespread mental disorder in which nearly half of the affected people have recurrent symptoms. Drug combinations may produce cumulative adverse effects, especially in elderly and physically ill patients. It was demonstrated that curcumin possesses antidepressive activity in various animal models of depression, and a combination of curcumin with some antidepressants potentiates the antidepressive effect of these agents. We sought to evaluate the efficacy of curcumin as an antidepressive agent in a combination with other antidepressants in patients with major depression. METHODS: Forty patients with a first episode of depression participated in a 5-week, double-blind, randomized, placebo-controlled study. The subjects were treated with either 500-mg/d curcumin or placebo together with antidepressants (escitalopram or venlafaxine) during August 2010 until June 2011. The outcome measures were Clinical Global Impression-Severity Scale, Hamilton Depression Rating Scale, and Montgomery-Asberg Depression Rating Scale. RESULTS: Analysis of variance showed significant positive changes in both groups from baseline to the end of the study in all scales of measurement. These changes became significant from the first visit after 7 days of treatment. There was no difference between curcumin and placebo, which means negative results. However, the patients in the curcumin group demonstrated a trend to a more rapid relief of depressive symptoms in comparison to those in the placebo group. None of the patients complained of any adverse effect during the study. CONCLUSIONS: Although there is no definitive proof that curcumin can induce an earlier beneficial effect of antidepressive agents, it seems like an extended study is needed to prove it, using higher therapeutic doses of curcumin.

A psychoanalytic clinician looks at diagnostic labels and diagnostic classification systems.

As psychoanalytic clinicians, we do not believe that assessment should be diagnosis based. However, we are supportive of attempts to create a diagnostic classification system that reflects something essential about human nature and also serves clinical purposes. In this article, we present a psychoanalytic diagnostic scheme that combines a more descriptive characterological diagnosis with a more structural level of personality organization diagnosis. The scheme is applied to a clinical case and then we discuss it in terms of the functions such a scheme provides for assessment.

When we were comrades together: a note on the language of assessment.

From a psychoanalytic perspective, the assessor is seen as more than a gatherer of data; he or she is viewed as a source of information independent of the tests as well as a potential vehicle of change. To effect these functions, the assessor needs to pay close attention to the language he or she uses in interaction with the patient. In this article, I present a case and then discuss it in terms of the role of language in the assessor-patient relationship: specifically, how the language used facilitated the establishing of a working alliance, the promoting of a meaningful dialogue, and eventually led to a deeper understanding of the patient.

Red beavers and building bridges between assessment and treatment.

In this article, I present a case involving early object loss in which I both assessed the patient and treated her. Assessment revealed a particular object relational defensive structure-a false self. The concept false self was then used as a bridge to treatment. The case is discussed from several perspectives including the clinical inference process, the relationship between assessment and treatment, and the vicissitudes of early object loss.

On developing a clinical sense of self.

It was Donald Winnicott who first described the mutual impact of mother and infant on each one's developing sense of self. It is my experience that something of the same occurs in the patient-clinician relationship. As the patient's sense of self evolves in the therapeutic relationship, the therapist's professional sense of self also develops in the context of this relationship. Herein, I describe a case in which I both assessed and treated a patient and recognized later the deep impact the experience had on my professional sense of self.

From Freud to Gehrig to Rapaport to DiMaggio.

Lacking the size, talent, and speed to play shortstop for the New York Yankees, I chose instead to become a psychologist/psychoanalyst. Yet, baseball and psychoanalysis share much in common. Each is played in the inner diamonds of one's mind, values the past and what is passing, and requires a strong work ethic. Both are timeless and involve an almost boring leisureliness between occasional moments of crisis. Then too, each calls for an attitude of consistency and patience and a responsibility to do one's best. From my parents and brother to my wife and son and his family, from my teachers and supervisors to my colleagues, and from Menninger to the Society for Personality Assessment (SPA), I feel deeply grateful for the partners and teammates I have and have had.

Further thoughts on an experiential psychoanalytic approach to the Rorschach.

On the basis of the work of Schachtel and Mayman, the author previously outlined an experiential approach to the Rorschach that differed from both an empirical approach and a more classic psychoanalytic approach originally proposed by Rapaport. Herein, the author further describes that approach by focusing on the person of the assessor as he or she goes about interpreting a protocol. Borrowing from the treatment literature, the author discusses the processes involved, including the need to immerse oneself in the raw data, the internal split between the experiencing self and the observing self, and the role of empathy and reflection.