Personal reflection.

The author brings an account of his life trajec-tory as a psychiatrist born and working in Pal-estine. The author dives in his early memories, including those of his brother's death, that shaped his character and the way he lives his rejection of occupation and violence. Besides the early institutional beginnings of the TRC Center in West Bank, the author describes the subtle forms of the daily abuse that a doctor working in Palestine must endure.

Sleep deprivation does not work: Epidemiology, impacts and outcomes of incidental and systematic sleep deprivation in a sample of Palestinian detainees.

BACKGROUND: Sleep deprivation (SD) is a method used in the context of interrogations aimed to obtain submission, information and confessions. Its impact on producing false confessions has been documented. Even information obtained is true, it will be unreliable as it cannot be separated with what has been suggested by interrogators. The use of SD has been documented in the interrogation of detainees in Israel and two patterns can be identified: one incidental due to the conditions of detention set out here as secondary sleep deprivation (SSD), and one systematic, intentional and linked to continued interrogation, set out here as primary sleep deprivation (PSD). This paper aims to study the prevalence of PSD and SSD in a sample of Palestinian detainees, compare its usage before and after the 1999 Israeli Supreme Court judgment, and compare the impacts and outcomes of SD. METHOD: The study included a sample of 600 ex-detainees who answered questions related to psychological and coercive methods, subjective psychological impact, clinical measures, psychosocial measures, and medical impact. Classification of SD was built taking into consideration the items related to SD and interrogation. RESULTS: Most detainees reported SSD with around 13% reporting PSD. Prevalence of PSD has been found larger among people over 25 years old who were detained before 1999. Related to the psychological suffering from the overall detention environment including SD, detainees with PSD and SSD reported significantly higher acute and chronic suffering. It has also been found that detainees with PSD reported long term family, social and physical impacts. Regarding the outcome of SD, the number of signed confessions with either true or false statements increases with SD, but in this case, this did not lead neither to a significantly higher number of convictions nor longer sentences. CONCLUSION: Sleep deprivation in the framework of interrogations seems ineffective.

Depression Reduces Accuracy While Parkinsonism Slows Response Time for Processing Positive Feedback in Patients with Parkinson's Disease with Comorbid Major Depressive Disorder Tested on a Probabilistic Category-Learning Task.

Major depressive disorder (MDD) is the most common non-motor manifestation of Parkinson's disease (PD) affecting 50% of patients. However, little is known about the cognitive correlates of MDD in PD. Using a computer-based cognitive task that dissociates learning from positive and negative feedback, we tested four groups of subjects: (1) patients with PD with comorbid MDD, (2) patients with PD without comorbid MDD, (3) matched patients with MDD alone (without PD), and (4) matched healthy control subjects. Furthermore, we used a mathematical model of decision-making to fit both choice and response time data, allowing us to detect and characterize differences between the groups that are not revealed by cognitive results. The groups did not differ in learning accuracy from negative feedback, but the MDD groups (PD patients with MDD and patients with MDD alone) exhibited a selective impairment in learning accuracy from positive feedback when compared to the non-MDD groups (PD patients without MDD and healthy subjects). However, response time in positive feedback trials in the PD groups (both with and without MDD) was significantly slower than the non-PD groups (MDD and healthy groups). While faster response time usually correlates with poor learning accuracy, it was paradoxical in PD groups, with PD patients with MDD having impaired learning accuracy and PD patients without MDD having intact learning accuracy. Mathematical modeling showed that both MDD groups (PD with MDD and MDD alone) were significantly slower than non-MDD groups in the rate of accumulation of information for stimuli trained by positive feedback, which can lead to lower response accuracy. Conversely, modeling revealed that both PD groups (PD with MDD and PD alone) required more evidence than other groups to make responses, thus leading to slower response times. These results suggest that PD patients with MDD exhibit cognitive profiles with mixed traits characteristic of both MDD and PD, furthering our understanding of both PD and MDD and their often-complex comorbidity. To the best of our knowledge, this is the first study to examine feedback-based learning in PD with MDD while controlling for the effects of PD and MDD.

Learning from negative feedback in patients with major depressive disorder is attenuated by SSRI antidepressants.

One barrier to interpreting past studies of cognition and major depressive disorder (MDD) has been the failure in many studies to adequately dissociate the effects of MDD from the potential cognitive side effects of selective serotonin reuptake inhibitors (SSRIs) use. To better understand how remediation of depressive symptoms affects cognitive function in MDD, we evaluated three groups of subjects: medication-naïve patients with MDD, medicated patients with MDD receiving the SSRI paroxetine, and healthy control (HC) subjects. All were administered a category-learning task that allows for dissociation between learning from positive feedback (reward) vs. learning from negative feedback (punishment). Healthy subjects learned significantly better from positive feedback than medication-naïve and medicated MDD groups, whose learning accuracy did not differ significantly. In contrast, medicated patients with MDD learned significantly less from negative feedback than medication-naïve patients with MDD and healthy subjects, whose learning accuracy was comparable. A comparison of subject's relative sensitivity to positive vs. negative feedback showed that both the medicated MDD and HC groups conform to Kahneman and Tversky's (1979) Prospect Theory, which expects losses (negative feedback) to loom psychologically slightly larger than gains (positive feedback). However, medicated MDD and HC profiles are not similar, which indicates that the state of medicated MDD is not "normal" when compared to HC, but rather balanced with less learning from both positive and negative feedback. On the other hand, medication-naïve patients with MDD violate Prospect Theory by having significantly exaggerated learning from negative feedback. This suggests that SSRI antidepressants impair learning from negative feedback, while having negligible effect on learning from positive feedback. Overall, these findings shed light on the importance of dissociating the cognitive consequences of MDD from those of SSRI treatment, and from cognitive evaluation of MDD subjects in a medication-naïve state before the administration of antidepressants. Future research is needed to correlate the mood-elevating effects and the cognitive balance between reward- and punishment-based learning related to SSRIs.

Depression impairs learning, whereas the selective serotonin reuptake inhibitor, paroxetine, impairs generalization in patients with major depressive disorder.

To better understand how medication status and task demands affect cognition in major depressive disorder (MDD), we evaluated medication-naïve patients with MDD, medicated patients with MDD receiving the selective serotonin reuptake inhibitors (SSRI) paroxetine, and healthy controls. All three groups were administered a computer-based cognitive task with two phases, an initial phase in which a sequence is learned through reward-based feedback (which our prior studies suggest is striatal-dependent), followed by a generalization phase that involves a change in the context where learned rules are to be applied (which our prior studies suggest is hippocampal-region dependent). Medication-naïve MDD patients were slow to learn the initial sequence but were normal on subsequent generalization of that learning. In contrast, medicated patients learned the initial sequence normally, but were impaired at the generalization phase. We argue that these data suggest (i) an MDD-related impairment in striatal-dependent sequence learning which can be remediated by SSRIs and (ii) an SSRI-induced impairment in hippocampal-dependent generalization of past learning to novel contexts, not otherwise seen in the medication-naïve MDD group. Thus, SSRIs might have a beneficial effect on striatal function required for sequence learning, but a detrimental effect on the hippocampus and other medial temporal lobe structures is critical for generalization.

Cross-national comparison of Middle Eastern university students: help-seeking behaviors, attitudes toward helping professionals, and cultural beliefs about mental health problems.

This study is the first to use identical data collection processes and instruments in Egypt, Kuwait, Palestine, and Israeli Arab communities regarding help-seeking behaviors and attitudes towards perceived cultural beliefs about mental health problems. Data is based on a survey sample of 716, undergraduate students in the 4 countries, 61% female and 39% male. Results indicate that respondents within the various countries, based on nationality, gender and level of education, vary in terms of recognition of personal need, beliefs about mental health problems (i.e. stigmatization), and the use of traditional healing methods versus modern approaches to psychiatric therapy. The conclusion discusses differences between our respondents' expectations and prevailing mental health service provision and delivery.

Tomorrow's players under occupation: an analysis of the association of political violent with psychological functioning and domestic violence, among Palestinian youth.

A 2005 survey of 2,328 youth (ages 12 to 18) in the West Bank, Palestine, revealed an association between exposure to politically violent events, domestic violence, and school violence and with psychological symptomatology. Results also found associations between family violence, family economic status, and psychological symptomatology. Respondents reported low levels of family functioning. Data revealed some geographic variability in experiences of politically violent events, domestic violence, school violence, and psychological symptomatology. Implications for practice are discussed.

Psychological symptomatology among Palestinian male and female adolescents living under political violence 2004-2005.

The aim of the study was to investigate gender differences in relation to exposure to domestic violence, political violence, family relations and psychological symptomatology in Palestinian adolescents. The sample consisted of 1766 adolescents, males (54.1%) and females (45.9%), residents of West Bank cities subjected to violent political conflict. Participants completed a self-report questionnaire consisting of the following measures: demographic variables, domestic violence, political violence events, the McMaster Family Assessment Device, and the Brief Symptom Inventory (BSI) psychological symptomatology. Results indicated that whereas there was no significant difference in the level of exposure to political violence between boys and girls, female adolescents exhibited higher levels of psychological symptoms compared to their male counterparts. Girls also reported higher levels of exposure to domestic violence and lower levels of family function than boys.