Geha Mental Health Center

Petah Tikva, Ireland

Geha Mental Health Center

Petah Tikva, Ireland
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Yadid Gal G.,Bar - Ilan University | Sudai E.,Bar - Ilan University | Maayan R.,Tel Aviv University | Gispan I.,Bar - Ilan University | And 2 more authors.
Neuroscience and Biobehavioral Reviews | Year: 2010

Conventional substance-abuse treatments have only had limited success especially for drugs such as cocaine, methamphetamine and nicotine. Newer data have begun to shed light on the complexity of the addictive process and new treatment approaches, including interference with brain neurosteroids, to attenuate drug-seeking behavior, are in advanced stages of development. Neurosteroids are synthesized in the brain and peripheral tissues, from cholesterol or steroidal precursors imported from peripheral sources. The most abundant neurosteroids in the human body are DHEA and its sulfate ester, DHEAS. These neurosteroids can act as modulators of neurotransmitter receptors, such as γ-aminobutyric-acid-type A (GABAA), NMDA, and sigma-1 receptors which may contribute to apparent enduring behavioral manifestations facilitated by substances of abuse. Neurosteroid concentrations respond to environmental and behavioral circumstances, such as stress and mood, both which are involved in the progression of substance use that advance substance addiction.This article reviews the current literature pertaining to neurosteroids and substances of abuse, focusing on DHEA, and discusses its role in drug-seeking behavior as suggested by preclinical observations. © 2010 Elsevier Ltd.


Abramovitch A.,Harvard University | Abramovitch A.,Tel Aviv University | Dar R.,Tel Aviv University | Hermesh H.,Geha Mental Health Center | And 2 more authors.
Journal of Neuropsychology | Year: 2012

Research implicates frontostriatal pathophysiology in both attention deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). Nevertheless, ADHD is characterized with frontostriatal hypoactivity and OCD with hyperactivity. Furthermore, both disorders seem to lie on opposite ends of a clinical impulsive-compulsive continuum. While never having directly been compared, and despite these differences, OCD and ADHD appear to share similar neuropsychological impairments especially in executive functions. This study aimed at comparing adults with OCD and adults with ADHD on neuropsychological measures and behavioural impulsivity and OC measures. Thirty OCD, 30 ADHD, and 30 matched healthy control (HC) participants were administered a comprehensive neuropsychological battery and completed several questionnaires. The groups were compared on all neuropsychological and clinical measures and correlations between neuropsychological and clinical symptoms were computed. The ADHD and OCD groups performed more poorly than HC on all neuropsychological domains and most domain subtests. The ADHD group reported significantly higher impulsivity than the OCD group. OCD patients did not differ from HC on behavioural impulsivity. A unique dissociation was found between impulsivity and response inhibition where both clinical groups showed similar response inhibition deficit, but differed significantly on impulsivity. Moreover, a negative association between OC symptoms and response inhibition and a bias in self-perception of impulsivity was found only in the OCD group. We propose an executive overload model of OCD that views neuropsychological impairments in OCD as an epiphenomenon, according to which continuous attempts to control automatic processes are associated with obsessive thoughts overflow that causes an overload on the executive system. ©2011 The British Psychological Society.


Schwartz-Lifshitz M.,Geha Mental Health Center | Zalsman G.,Geha Mental Health Center | Zalsman G.,Tel Aviv University | Giner L.,University of Seville | Oquendo M.A.,Columbia University
Current Psychiatry Reports | Year: 2012

Every year, suicide is among the top 20 leading causes of death globally for all ages. Unfortunately, suicide is difficult to prevent, in large part because the prevalence of risk factors is high among the general population. In this review, clinical and psychological risk factors are examined and methods for suicide prevention are discussed. Prevention strategies found to be effective in suicide prevention include means restriction, responsible media coverage, and general public education, as well identification methods such as screening, gatekeeper training, and primary care physician education. Although the treatment for preventing suicide is difficult, follow-up that includes pharmacotherapy, psychotherapy, or both may be useful. However, prevention methods cannot be restricted to the individual. Community, social, and policy interventions will also be essential. © Springer Science+Business Media, LLC 2012.


Amitai M.,Geha Mental Health Center
Harefuah | Year: 2012

Autism spectrum disorders (ASD) include several clinically different disorders. Despite the impression that in recent years there has been a rise in the incidence of this disorder, it seems that the apparent rise stems from the widening of diagnostic criteria rather than from a true rise in disorder incidence. Notwithstanding the wide range of clinical symptoms, reliabLe information on the etiology of this disorder is lacking. However, new data points to an important genetic component and to structural changes in the brain. There is a wide range of comorbidities with additional neurodevelopmental disorders. The currently offered treatment is multi-disciplinary and includes primarily behavioral therapy and symptomatic treatment with psychotropic drugs.


Amit B.H.,Geha Mental Health Center | Amit B.H.,Tel Aviv University | Weizman A.,Geha Mental Health Center | Weizman A.,Tel Aviv University
Depression Research and Treatment | Year: 2012

While studies in the past have focused more on treatment of the manic phase of bipolar disorder (BD), recent findings demonstrate the depressive phase to be at least as debilitating. However, in contrast to unipolar depression, depression in bipolar patients exhibits a varying response to antidepressants, raising questions regarding their efficacy and tolerability. Methods. We conducted a MEDLINE and Cochrane Collaboration Library search for papers published between 2005 and 2011 on the subject of antidepressant treatment of bipolar depression. Sixty-eight articles were included in the present review. Results. While a few studies did advocate the use of antidepressants, most well-controlled studies failed to show a robust effect of antidepressants in bipolar depression, regardless of antidepressant class or bipolar subtype. There was no significant increase in the rate of manic/hypomanic switch, especially with concurrent use of mood stabilizers. Prescribing guidelines published in recent years rely more on atypical antipsychotics, especially quetiapine, as a first-line therapy. Conclusions. Antidepressants probably have no substantial role in acute bipolar depression. However, in light of conflicting results between studies, more well-designed trials are warranted. © 2012 Ben H. Amit and Abraham Weizman.


Hochman E.,Geha Mental Health Center
The Journal of clinical psychiatry | Year: 2014

About 45% of civilians who died by suicide had contact with a doctor within 1 month of death. Thus, educating primary care physicians (PCP) to detect and mitigate depression is an important suicide-prevention strategy. However, the PCP consulting rate before suicide has not been examined in a military population. We investigated the utilization of primary health care and mental health services by active-duty military personnel suicide cases prior to death in comparison to matched military controls. All suicides (N = 170) were extracted from a cohort of all active-duty Israeli military male personnel between 2002 and 2012. Applying a retrospective, nested case-control design, we compared primary care services utilization by suicide cases with demographic and occupationally matched military controls (N = 500). Whereas 38.3% of suicide cases contacted a PCP within the last month before death, only 27.6% of suicide cases contacted a mental health specialist during their entire service time. The PCP contact rate within 1 month before death or index day did not differ between suicide cases and military controls (38.3% vs. 33.8%, χ2 1 = 1.05, P = .3). More suicide cases contacted a mental health specialist within service time than did military controls (27.6% vs. 13.6%, χ2 1 = 10.85, P = .001). Even though PCP contact rate by military personnel who died by suicide is slightly lower than that reported for civilians who died by suicide prior to their death, it is higher than mental health specialist contact rate and higher than that by age-matched civilians who died by suicide. These results imply that PCPs education is a viable approach to suicide prevention in a military setting. © Copyright 2014 Physicians Postgraduate Press, Inc.


Manor I.,Geha Mental Health Center | Rubin J.,Alcobra Inc. | Daniely Y.,Alcobra Ltd. | Adler L.A.,New York University
Postgraduate Medicine | Year: 2014

Objective: To assess the first-dose effectiveness and tolerability of metadoxine extended release (MDX) in adults with predominantly inattentive attention-deficit/hyperactivity disorder (ADHD-PI). Methods: In this double-blind, placebo-controlled, crossover study, adults with ADHD-PI were randomized 1:1:1 to receive a single dose of MDX 1400 mg, MDX 700 mg, and placebo (ClinicalTrials.gov identifier: NCT01685281). The primary efficacy end point was the mean change in the Test of Variables of Attention (TOVA) ADHD score from baseline to 3 to 5 hours after drug administration. Secondary assessments included TOVA subscores, TOVA response rates (defined as an increase of 0.8 points in the TOVA ADHD score), and the Cambridge Neuropsychological Automated Test Battery. Safety assessments included adverse events and vital signs. Results: The intention-to-treat population included 36 patients (52.8% men; mean age, 32 years). The efficacy of MDX 1400 mg was demonstrated by a statistically significant difference in the mean (± SD) change in the TOVA ADHD score at baseline to 3 to 5 hours after drug administration compared with placebo (2.0 [4.2]; P = 0.009). The TOVA response time variability subscore was significantly different between MDX 1400 mg and placebo (mean difference, 7.9 [19.2] points; P = 0.022). Significantly more adults responded to single-dose MDX 1400 mg versus placebo (97.1% vs 71.4%, P = 0.006). There were no statistically significant differences between MDX 700 mg and placebo on any measures. Exploratory analyses of the Cambridge Neuropsychological Automated Test Battery did not yield significant findings. Fatigue and headache were the 2 most frequently reported adverse events. There were no clinically significant abnormalities in laboratory values, vital signs measurements, Columbia–Suicide Severity Rating Scale scores, or electrocardiographic parameters. Conclusions: Single-dose MDX 1400 mg significantly improved sustained and selective attention in adults with ADHD-PI as measured by the TOVA ADHD score 3 to 5 hours after drug administration. Single doses of MDX 700 and 1400 mg were well tolerated. © Postgraduate Medicine.


To compare the effects of metadoxine extended release (ER) with those of placebo on inattentive (IA) versus hyperactive-impulsive (H-I) symptoms and predominantly inattentive (PI) versus combined type (CT) subtype in adults with attention-deficit/hyperactivity disorder (ADHD). This was a 1:1 randomized, double-blind, parallel-design study of metadoxine ER 1400 mg/day for 6 weeks in 120 adults with ADHD. Efficacy measures were baseline to end-of-treatment changes in Conners' Adult ADHD Rating Scale-Investigator Rated (CAARS-INV) Total ADHD Symptoms scores with adult ADHD prompts, the Test of Variables of Attention ADHD scores, and response rates (≥ 25% or ≥ 40% improvement in CAARS-INV Total ADHD Symptoms score). Results: There was a significant decrease in CAARS-INV Total ADHD Symptoms scores in patients with ADHD-PI taking metadoxine ER (40%) compared with those taking placebo (21%) (P < 0.05), while the decrease for patients with ADHD-CT was not significant (27% vs 26%). Similarly, there was a significant decrease in IA scores in patients with ADHD-PI (metadoxine ER, 50% vs placebo, 23%; P < 0.005), while the change in patients with ADHD-CT was not significant. There was no significant difference in percent decreases seen in H-I scores for patients with PI or ADHD-CT. Significantly higher response rates at both cutoffs (ie, 25% and 45% improvement) were seen in the metadoxine ER group compared with the placebo group in CAARS-INV Total ADHD Symptoms scores in patients with ADHD-PI, but not those with ADHD-CT. Test of Variables of Attention ADHD scores were significantly decreased in the metadoxine ER group compared with the placebo group for patients with ADHD-PI, but not those with ADHD-CT. These data suggest that metadoxine ER is selectively efficacious for treating IA symptoms in adults with ADHD-PI. Trial registration: www.ClinicalTrials.gov identifier NCT01243242.


Schlossberg K.,Geha Mental Health Center
The Israel journal of psychiatry and related sciences | Year: 2010

In the past all psychopathologies were viewed as caused by the environment. Later on case-control and family-based studies of major psychiatric disorders found genetic associations, but in many cases these findings did not survive replications. A gene-environment approach gave new hope for possible associations. Gene environment correlations emphasized that the relationship are bidirectional. However, recent meta-analyses raised doubts about the consistency of these findings as well. The review summarizes the current view on the environmental factors in the major psychopathologies.


Amitai M.,Geha Mental Health Center | Amitai M.,Tel Aviv University | Apter A.,Tel Aviv University | Apter A.,The Feinberg Child Study Center
International Journal of Environmental Research and Public Health | Year: 2012

Purpose: The present review summarizes the updated literature on the social aspects of suicidal behavior and prevention in adolescents. Recent findings: The predictive role of psychiatric disorders and past history are well recognized in adolescent suicide, but the role of social and cultural factors is less clear. Studies have focused on the importance of ethnicity, gender, family characteristics, and socioeconomic status. More recently, attention has been addressed to broader social risk factors, such as bullying in adolescents, suicide contagion, sexual orientation, and the popular media. Further empirical evidence is needed to advance our understanding of suicidal youth, develop better assessment tools, and formulate effective prevention and treatment programs. Summary: Suicidal behavior remains an important clinical problem and major cause of death in youth. Social factors may be at least as important as genetics. Advancing our understanding of underlying cultural and sociological issues in youth suicide will help clinicians achieve more efficient prediction, prevention and treatment. © 2012 by the authors; licensee MDPI, Basel, Switzerland.

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