During the Holocaust and since the establishment of the state of Israel in 1948, Jews and Israeli... more During the Holocaust and since the establishment of the state of Israel in 1948, Jews and Israelis were repeatedly exposed to traumatic events. This has made Israel a live laboratory for the research of trauma and posttraumatic stress disorder (PTSD). The horrors of the Holocaust and its emotional scars in the survivors, followed by seven wars and waves of terror have unfortunately served as an experimental field for the study of trauma and its consequences. This article reviews key findings from studies done in Israel on trauma and PTSD during the last 3 decades and highlights their contribution to the existing body of knowledge in this field.
Eating disorders may be associated with alterations in sleep. There is evidence that some bulimia... more Eating disorders may be associated with alterations in sleep. There is evidence that some bulimia nervosa (BN) patients have sleep abnormalities. No studies of their sleep-wake cycles in a natural environment have as yet been reported. The purpose of this study was to evaluate an objective and subjective sleep-wake cycle of BN compared to a healthy age-equated control group (CON). Twenty-nine BN female and eighteen CON subjects were recruited. Sleep-wake patterns were monitored using ambulatory monitoring, mini-actigraphs (Min-Act), for 1 week. Each subject completed self-report questionnaires. The self-reporting questionnaires revealed that BN complained of significantly more sleep disturbances than CON. The ambulatory sleep data revealed significant differences between BN and CON in sleep onset and offset time. BN had sleep onset and sleep offset of 1 hr later, which may be connected to binge-purge patterns during the day. It is suggested that future research should focus on BN after remission.
This experiment examined the hypothesis that schizophrenics are less able than normals to make us... more This experiment examined the hypothesis that schizophrenics are less able than normals to make use of information concerning self movement when performing auditory localization tasks, and, therefore apply an alternative localization strategy, probably involving use of the pinnae. In this study three groups (healthy controls, schizophreniform patients and chronic schizophrenics) were compared in four experimental conditions: (1) head-movement and free pinnae; (2) static head and free pinnae; (3) head movement and covered pinnae; and (4) static head and covered pinnae. All subjects perform better with head movement than without it, with pinnae than with covered ones. Schizophreniform patients were affected more than normals by pinnae covering. This difference did not reach significance when normals were compared with chronic schizophrenics. A pronounced susceptibility to pinnae manipulation, correlated with medication level, appeared in the combined patient group in the moving condition. It was suggested that schizophreniform subjects, as compared to healthy controls are more depended on pinnae generated information for auditory localization and less able to compensate for its absence with movement generated information. The possibility that the effect is related to psychosis as such, rather than to schizophrenia in particular, was considered.
The risk of developing PTSD following a traumatic experience depends on several vulnerability fac... more The risk of developing PTSD following a traumatic experience depends on several vulnerability factors that may be classified into three distinct categories: pre-traumatic, peri-traumatic, and posttraumatic vulnerability factors. Accordingly, while we attempted to create a profile of the high-risk PTSD patient, the following factors should be included, among others: small hippocampus, previously altered HPA axis, vulnerable genetic profile, associated body injury, increased post-trauma noradrenergic activity. Some protective factors have been identified and included, but are not limited to coping, resources (e.g., social support, self-esteem, optimism), and finding meaning. Finally, human beings are resilient and in general are able to cope with adverse situations. Therefore, discovering possible resilience factors may assist in identifying the patients at risk and may contribute to developing the strategies to prevent the development of PTSD.
This study was conducted to further evaluate HPA axis activity by the measurement of plasma ACTH ... more This study was conducted to further evaluate HPA axis activity by the measurement of plasma ACTH and cortisol and ACTH corticotropin-releasing hormone (CRH) in the cerebrospinal fluid (CSF) of nervous and normal dogs
Immediate-release (IR) benzodiazepines have a short duration of therapeutic effect and are genera... more Immediate-release (IR) benzodiazepines have a short duration of therapeutic effect and are generally less effective for anxiety than selective serotonin reuptake inhibitors in reducing concomitant depressive symptomatology. Common criticisms of benzodiazepines also include the patient's tendency to develop a tolerance to the anxiolytic effect and a dependence on the drug itself. The newer extended-release (XR) benzodiazepine formulation was designed to increase efficacy, duration of therapeutic effect, tolerance, compliance, and ease of discontinuation. The XR benzodiazepine alprazolam has shown efficacy in panic disorder and generalized anxiety disorder comparable to the older benzodiazepine formulations. Pharmacokinetic data show that the XR formulation has a longer therapeutic effect compared with IR formulations, which reduces the potential for breakthrough anxiety symptoms. Data also indicate that the XR formulation has less abuse liability than the IR formulation. This article reviews the efficacy, safety, and discontinuation data from clinical trials of IR and XR benzodiazepines in the treatment of anxiety disorders and provides guidelines to minimize the risk of withdrawal syndrome during benzodiazepine discontinuation.
Carbamazepine has recently been reported to have therapeutic potential in mania. We studied carba... more Carbamazepine has recently been reported to have therapeutic potential in mania. We studied carbamazepine plus haloperidol v placebo plus haloperidol in excited psychoses in a controlled double-blind design. Twenty-three patients completed five weeks of carbamazepine-haloperidol therapy, and 20 patients placebo-haloperidol therapy. Brief Psychiatric Rating Scale ratings showed superior improvement in the group receiving carbamazepine plus haloperidol. This benefit was as apparent in excited schizophrenia as in mania. No unusual toxicity was observed because of the combination of haloperidol with carbamazepine.
Alprazolam treatment is effective for panic disorder, but its major disadvantages include possibl... more Alprazolam treatment is effective for panic disorder, but its major disadvantages include possible dependence and withdrawal symptoms upon discontinuation. The authors report three cases in which carbamazepine, a clinically effective anticonvulsant without abuse potential, successfully attenuated alprazolam withdrawal symptoms.
International Journal of Psychiatry in Medicine, Aug 1, 2011
Background: Traumatic injuries are usually associated with increased secretion of pro-inflammator... more Background: Traumatic injuries are usually associated with increased secretion of pro-inflammatory cytokines, and are sometimes followed by the development of acute stress symptoms (ASS) and posttraumatic stress symptoms (PTSS). Aims: To measure serum pro- and anti-inflammatory cytokines in accident casualties and to associate it with ASS at hospitalization, and with PTSS 1 month later. Methods: Participants were 48 patients, aged 20–60, hospitalized following various orthopedic injuries including bone fractures, and 13 healthy volunteers matched for gender. At hospitalization (Time 1), 30 ml heparinized venous blood were drawn and cytokines levels in serum were assessed; participants filled out the Acute Stress Disorder Inventory (ASDI), COPE, and injury-related questionnaires. One month later (Time 2), 26 participants filled out the Posttraumatic Disorder Symptom Scale (PDS). Results: High serum levels of IL-6, IL-8, and TGF-β and low levels of serum IL-4 and IL-10 were found in injured patients as compared with controls. When controlling for age and severity of injury in the regression analysis, higher levels of IL-6 and IL-8 and lower TGF-β were predicted by higher ASS and higher use of and emotion-focused coping. Higher PTSS scores at Time 2 were predicted by higher levels of IL-8, lower levels of TGF-β, and higher ASS measured at Time 1. Conclusions: High levels of the pro-inflammatory cytokine IL-6 and IL-8 and lower levels of the regulatory cytokine TGF-β should be further assessed as a possible risk factor or a bio-marker of PTSS in accident casualties.
During the Holocaust and since the establishment of the state of Israel in 1948, Jews and Israeli... more During the Holocaust and since the establishment of the state of Israel in 1948, Jews and Israelis were repeatedly exposed to traumatic events. This has made Israel a live laboratory for the research of trauma and posttraumatic stress disorder (PTSD). The horrors of the Holocaust and its emotional scars in the survivors, followed by seven wars and waves of terror have unfortunately served as an experimental field for the study of trauma and its consequences. This article reviews key findings from studies done in Israel on trauma and PTSD during the last 3 decades and highlights their contribution to the existing body of knowledge in this field.
Eating disorders may be associated with alterations in sleep. There is evidence that some bulimia... more Eating disorders may be associated with alterations in sleep. There is evidence that some bulimia nervosa (BN) patients have sleep abnormalities. No studies of their sleep-wake cycles in a natural environment have as yet been reported. The purpose of this study was to evaluate an objective and subjective sleep-wake cycle of BN compared to a healthy age-equated control group (CON). Twenty-nine BN female and eighteen CON subjects were recruited. Sleep-wake patterns were monitored using ambulatory monitoring, mini-actigraphs (Min-Act), for 1 week. Each subject completed self-report questionnaires. The self-reporting questionnaires revealed that BN complained of significantly more sleep disturbances than CON. The ambulatory sleep data revealed significant differences between BN and CON in sleep onset and offset time. BN had sleep onset and sleep offset of 1 hr later, which may be connected to binge-purge patterns during the day. It is suggested that future research should focus on BN after remission.
This experiment examined the hypothesis that schizophrenics are less able than normals to make us... more This experiment examined the hypothesis that schizophrenics are less able than normals to make use of information concerning self movement when performing auditory localization tasks, and, therefore apply an alternative localization strategy, probably involving use of the pinnae. In this study three groups (healthy controls, schizophreniform patients and chronic schizophrenics) were compared in four experimental conditions: (1) head-movement and free pinnae; (2) static head and free pinnae; (3) head movement and covered pinnae; and (4) static head and covered pinnae. All subjects perform better with head movement than without it, with pinnae than with covered ones. Schizophreniform patients were affected more than normals by pinnae covering. This difference did not reach significance when normals were compared with chronic schizophrenics. A pronounced susceptibility to pinnae manipulation, correlated with medication level, appeared in the combined patient group in the moving condition. It was suggested that schizophreniform subjects, as compared to healthy controls are more depended on pinnae generated information for auditory localization and less able to compensate for its absence with movement generated information. The possibility that the effect is related to psychosis as such, rather than to schizophrenia in particular, was considered.
The risk of developing PTSD following a traumatic experience depends on several vulnerability fac... more The risk of developing PTSD following a traumatic experience depends on several vulnerability factors that may be classified into three distinct categories: pre-traumatic, peri-traumatic, and posttraumatic vulnerability factors. Accordingly, while we attempted to create a profile of the high-risk PTSD patient, the following factors should be included, among others: small hippocampus, previously altered HPA axis, vulnerable genetic profile, associated body injury, increased post-trauma noradrenergic activity. Some protective factors have been identified and included, but are not limited to coping, resources (e.g., social support, self-esteem, optimism), and finding meaning. Finally, human beings are resilient and in general are able to cope with adverse situations. Therefore, discovering possible resilience factors may assist in identifying the patients at risk and may contribute to developing the strategies to prevent the development of PTSD.
This study was conducted to further evaluate HPA axis activity by the measurement of plasma ACTH ... more This study was conducted to further evaluate HPA axis activity by the measurement of plasma ACTH and cortisol and ACTH corticotropin-releasing hormone (CRH) in the cerebrospinal fluid (CSF) of nervous and normal dogs
Immediate-release (IR) benzodiazepines have a short duration of therapeutic effect and are genera... more Immediate-release (IR) benzodiazepines have a short duration of therapeutic effect and are generally less effective for anxiety than selective serotonin reuptake inhibitors in reducing concomitant depressive symptomatology. Common criticisms of benzodiazepines also include the patient's tendency to develop a tolerance to the anxiolytic effect and a dependence on the drug itself. The newer extended-release (XR) benzodiazepine formulation was designed to increase efficacy, duration of therapeutic effect, tolerance, compliance, and ease of discontinuation. The XR benzodiazepine alprazolam has shown efficacy in panic disorder and generalized anxiety disorder comparable to the older benzodiazepine formulations. Pharmacokinetic data show that the XR formulation has a longer therapeutic effect compared with IR formulations, which reduces the potential for breakthrough anxiety symptoms. Data also indicate that the XR formulation has less abuse liability than the IR formulation. This article reviews the efficacy, safety, and discontinuation data from clinical trials of IR and XR benzodiazepines in the treatment of anxiety disorders and provides guidelines to minimize the risk of withdrawal syndrome during benzodiazepine discontinuation.
Carbamazepine has recently been reported to have therapeutic potential in mania. We studied carba... more Carbamazepine has recently been reported to have therapeutic potential in mania. We studied carbamazepine plus haloperidol v placebo plus haloperidol in excited psychoses in a controlled double-blind design. Twenty-three patients completed five weeks of carbamazepine-haloperidol therapy, and 20 patients placebo-haloperidol therapy. Brief Psychiatric Rating Scale ratings showed superior improvement in the group receiving carbamazepine plus haloperidol. This benefit was as apparent in excited schizophrenia as in mania. No unusual toxicity was observed because of the combination of haloperidol with carbamazepine.
Alprazolam treatment is effective for panic disorder, but its major disadvantages include possibl... more Alprazolam treatment is effective for panic disorder, but its major disadvantages include possible dependence and withdrawal symptoms upon discontinuation. The authors report three cases in which carbamazepine, a clinically effective anticonvulsant without abuse potential, successfully attenuated alprazolam withdrawal symptoms.
International Journal of Psychiatry in Medicine, Aug 1, 2011
Background: Traumatic injuries are usually associated with increased secretion of pro-inflammator... more Background: Traumatic injuries are usually associated with increased secretion of pro-inflammatory cytokines, and are sometimes followed by the development of acute stress symptoms (ASS) and posttraumatic stress symptoms (PTSS). Aims: To measure serum pro- and anti-inflammatory cytokines in accident casualties and to associate it with ASS at hospitalization, and with PTSS 1 month later. Methods: Participants were 48 patients, aged 20–60, hospitalized following various orthopedic injuries including bone fractures, and 13 healthy volunteers matched for gender. At hospitalization (Time 1), 30 ml heparinized venous blood were drawn and cytokines levels in serum were assessed; participants filled out the Acute Stress Disorder Inventory (ASDI), COPE, and injury-related questionnaires. One month later (Time 2), 26 participants filled out the Posttraumatic Disorder Symptom Scale (PDS). Results: High serum levels of IL-6, IL-8, and TGF-β and low levels of serum IL-4 and IL-10 were found in injured patients as compared with controls. When controlling for age and severity of injury in the regression analysis, higher levels of IL-6 and IL-8 and lower TGF-β were predicted by higher ASS and higher use of and emotion-focused coping. Higher PTSS scores at Time 2 were predicted by higher levels of IL-8, lower levels of TGF-β, and higher ASS measured at Time 1. Conclusions: High levels of the pro-inflammatory cytokine IL-6 and IL-8 and lower levels of the regulatory cytokine TGF-β should be further assessed as a possible risk factor or a bio-marker of PTSS in accident casualties.
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Papers by Ehud Klein