Combining naltrexone and clonidine under general anesthesia is being used to shorten opiate detox... more Combining naltrexone and clonidine under general anesthesia is being used to shorten opiate detoxification. This study determined the one-year relapse rate of persons detoxified using this ultrarapid method in conjunction with naltrexone maintenance and counseling. Structured telephone interviews were held with 83 out of a random sample of 113 male patients who were detoxified via the ultrarapid method more than one year before the interview (average 1.5 years) and their significant others. Relapse was defined as at least two weeks of daily opiate use. According to patients and significant others, 57 percent of patients had not relapsed. This rate is better than rates obtained in studies of other detoxification methods.
Recently proposed criteria for remission by a &am... more Recently proposed criteria for remission by a 'Remission in Schizophrenia Working Group' have generated considerable interest. We assessed rates, predictors, and correlates of remission in a sample of patients with first-episode schizophrenia treated with injectable, long-acting risperidone. This allowed us to examine remission among patients known to be receiving medication. This was a single-site open-label study in which 50 newly diagnosed cases of schizophreniform disorder or schizophrenia aged 16 to 43 years were treated with injectable, long-acting risperidone 25-50 mg every 2 weeks for 2 years. Remission, according to Remission in Schizophrenia Working Group criteria, was achieved in 64% of the patients. Of those achieving remission, 97% maintained this status until study completion. Remission was associated with greater improvements in other symptom domains, insight, and social and occupational functioning. Patients in remission received lower doses of antipsychotic medication, had fewer extrapyramidal symptoms, and a more favorable attitude toward medication. The results of this open-label study suggest that a majority of first-episode patients who receive long-acting injectable antipsychotic medication may achieve sustained remission. Double-blind-controlled studies using long-acting injectable antipsychotics in early psychosis are warranted to further test this.
The premorbid intellectual, language, and behavioral functioning of patients hospitalized for sch... more The premorbid intellectual, language, and behavioral functioning of patients hospitalized for schizophrenia, schizoaffective disorder, or nonpsychotic bipolar disorder was compared with that of healthy comparison subjects. The Israeli Draft Board Registry, which contains measures of intellectual, language, and behavioral functioning for the unselected population of 16- to 17-year-olds, was merged with the National Psychiatric Hospitalization Case Registry, which contains diagnoses for all patients with psychiatric hospitalizations in Israel. The database was used to identify adolescents with no evidence of illness at their draft board assessment who were later hospitalized for nonpsychotic bipolar disorder (N=68), schizoaffective disorder (N=31), or schizophrenia (N=536). The premorbid functioning of these subjects was compared to that of nonhospitalized individuals matched for age, gender, and school attended at the time of the draft board assessment. The diagnostic groups of hospitalized subjects were also compared. Relative to the comparison subjects, subjects with schizophrenia showed significant premorbid deficits on all intellectual and behavioral measures and on measures of reading and reading comprehension. Subjects with schizophrenia performed significantly worse on these measures than those with a nonpsychotic bipolar disorder, who did not differ significantly from the comparison subjects on any measure. Subjects with schizoaffective disorder performed significantly worse than the comparison subjects only on the measure of nonverbal abstract reasoning and visual-spatial problem solving and performed significantly worse than subjects with nonpsychotic bipolar disorder on three of the four intellectual measures and on the reading and reading comprehension tests. The results support a nosologic distinction between nonpsychotic bipolar disease and schizophrenia in hospitalized patients.
The extent to which the legal status of a first psychiatric admission-voluntary or involuntary-pr... more The extent to which the legal status of a first psychiatric admission-voluntary or involuntary-predicted the legal status and number of future admissions was examined among patients with schizophrenia. Data on all patients in Israel who had a nonforensic first admission between 1978 and 1992 and a diagnosis of schizophrenia (N=9,081) were extracted from the national psychiatric hospitalization case registry. Also obtained from the registry was information about the patients' subsequent hospitalizations through 1995, demographic data, and diagnosis. Analyses adjusted for time since first admission, age at first admission, country of origin, and religion. The first admission of 12.9 percent of the patients was involuntary. The legal status of the first admission was not related to the number of readmissions. However, female patients whose first admission was involuntary were 4.1 times more likely to have an involuntary second admission than female patients whose first admission was voluntary; these odds were 3.4 for males. Further analysis examined the percentage of involuntary admissions among all hospitalizations of the 3,420 patients who had four or more admissions (chronic patients). Among the chronic patients who had an involuntary first admission, 41 percent of subsequent admissions were involuntary. This figure was significantly lower among the chronic patients who had a voluntary first admission-13 percent. The percentage of involuntary admissions was not related to the number of admissions. The strong association of involuntary legal status at first admission with involuntary status at second admission and with the number of involuntary admissions over time suggests that involuntary first admission might be an important factor in assessing whether patients are likely to be readmitted involuntarily.
Journal of Clinical Psychopharmacology, Jun 1, 2006
The Positive and Negative Symptom Scale (PANSS) and Clinical Global Impression (CGI-S) item for s... more The Positive and Negative Symptom Scale (PANSS) and Clinical Global Impression (CGI-S) item for severity are used together to measure severity of psychotic illness. PANSS is the "gold standard" measure of efficacy, but it is not always feasible to use, yet the CGI-S requires validation. To examine the overlap between PANSS and CGI-S. The overlap of the PANSS and CGI-S were examined using data from 7 large antipsychotic clinical trials (n = 4287). Regression analysis identified 21% to 60% overlap of the measures depending on the trial and measurement point. The pooled study mean PANSS value corresponding with a CGI-S of 2, 3, and 4 were 67.1 (n = 799), 79.6 (n = 1645), and 92.4 (n = 1056), respectively. A decrease of 1 on the CGI-S corresponded to a 20% decline on the PANSS. Of the 37 planned comparisons in these studies, there was an agreement between the PANSS and CGI-S on change from baseline to end point on 32 comparisons and on dichotomized change variables (PANSS > or =-20% and CGI-S > or =-1 point) on 31 comparisons. The differences in the remaining comparisons would not have changed the conclusions of the studies. The positive and disorganized PANSS scales were the most closely related to the CGI-S, followed by hostility and negative scale with almost no association with anxiety/depression. The CGI-S and PANSS are correlated but are not synonymous. Both measures, however, show substantial agreement in detecting change, and the CGI-S shows overlap with the core symptoms of schizophrenia.
The goal of the current study was to compare premorbid behavioral and cognitive functioning betwe... more The goal of the current study was to compare premorbid behavioral and cognitive functioning between co-twins discordant for psychotic disorder and between these pairs of twins and pairs of twins with no psychotic disorders. The authors linked data from the Israeli Draft Board Registry, which contains cognitive and behavioral assessments of all 16-17-year-old male Israeli twins, with data from the National Psychiatric Hospitalization Case Registry. Pairs of male twins who were healthy at the time of testing but discordant for psychoses later on were compared with one another and with pairs of healthy male twins. The affected twins performed significantly worse than healthy twins on measures of individual autonomy, social functioning, and physical activity and nonsignificantly worse on measures of abstract reasoning. There were no significant differences in cognitive or behavioral scores between the co-twins who did or did not develop psychotic disorders. The authors conclude that these findings underscore the familial nature of behavioral and cognitive deficits antecedent to psychoses.
The study attempted to determine the proportion of primary care physicians who treat depression a... more The study attempted to determine the proportion of primary care physicians who treat depression and their characteristics. Data were from 677 respondents to a national survey of primary care physicians in Israel. Twenty-two percent always treated depression, 36.6 percent usually did, 28.6 percent sometimes did, and 12.6 percent never did. Logistic regression found that, compared with physicians who sometimes or never treated depression, those who always or usually treated depression treated more medical conditions, regarded themselves as the medical system's first contact for patients with psychosocial problems, had more frequent contact with social workers, and were more likely to have specialized in family medicine.
Combining naltrexone and clonidine under general anesthesia is being used to shorten opiate detox... more Combining naltrexone and clonidine under general anesthesia is being used to shorten opiate detoxification. This study determined the one-year relapse rate of persons detoxified using this ultrarapid method in conjunction with naltrexone maintenance and counseling. Structured telephone interviews were held with 83 out of a random sample of 113 male patients who were detoxified via the ultrarapid method more than one year before the interview (average 1.5 years) and their significant others. Relapse was defined as at least two weeks of daily opiate use. According to patients and significant others, 57 percent of patients had not relapsed. This rate is better than rates obtained in studies of other detoxification methods.
Recently proposed criteria for remission by a &am... more Recently proposed criteria for remission by a 'Remission in Schizophrenia Working Group' have generated considerable interest. We assessed rates, predictors, and correlates of remission in a sample of patients with first-episode schizophrenia treated with injectable, long-acting risperidone. This allowed us to examine remission among patients known to be receiving medication. This was a single-site open-label study in which 50 newly diagnosed cases of schizophreniform disorder or schizophrenia aged 16 to 43 years were treated with injectable, long-acting risperidone 25-50 mg every 2 weeks for 2 years. Remission, according to Remission in Schizophrenia Working Group criteria, was achieved in 64% of the patients. Of those achieving remission, 97% maintained this status until study completion. Remission was associated with greater improvements in other symptom domains, insight, and social and occupational functioning. Patients in remission received lower doses of antipsychotic medication, had fewer extrapyramidal symptoms, and a more favorable attitude toward medication. The results of this open-label study suggest that a majority of first-episode patients who receive long-acting injectable antipsychotic medication may achieve sustained remission. Double-blind-controlled studies using long-acting injectable antipsychotics in early psychosis are warranted to further test this.
The premorbid intellectual, language, and behavioral functioning of patients hospitalized for sch... more The premorbid intellectual, language, and behavioral functioning of patients hospitalized for schizophrenia, schizoaffective disorder, or nonpsychotic bipolar disorder was compared with that of healthy comparison subjects. The Israeli Draft Board Registry, which contains measures of intellectual, language, and behavioral functioning for the unselected population of 16- to 17-year-olds, was merged with the National Psychiatric Hospitalization Case Registry, which contains diagnoses for all patients with psychiatric hospitalizations in Israel. The database was used to identify adolescents with no evidence of illness at their draft board assessment who were later hospitalized for nonpsychotic bipolar disorder (N=68), schizoaffective disorder (N=31), or schizophrenia (N=536). The premorbid functioning of these subjects was compared to that of nonhospitalized individuals matched for age, gender, and school attended at the time of the draft board assessment. The diagnostic groups of hospitalized subjects were also compared. Relative to the comparison subjects, subjects with schizophrenia showed significant premorbid deficits on all intellectual and behavioral measures and on measures of reading and reading comprehension. Subjects with schizophrenia performed significantly worse on these measures than those with a nonpsychotic bipolar disorder, who did not differ significantly from the comparison subjects on any measure. Subjects with schizoaffective disorder performed significantly worse than the comparison subjects only on the measure of nonverbal abstract reasoning and visual-spatial problem solving and performed significantly worse than subjects with nonpsychotic bipolar disorder on three of the four intellectual measures and on the reading and reading comprehension tests. The results support a nosologic distinction between nonpsychotic bipolar disease and schizophrenia in hospitalized patients.
The extent to which the legal status of a first psychiatric admission-voluntary or involuntary-pr... more The extent to which the legal status of a first psychiatric admission-voluntary or involuntary-predicted the legal status and number of future admissions was examined among patients with schizophrenia. Data on all patients in Israel who had a nonforensic first admission between 1978 and 1992 and a diagnosis of schizophrenia (N=9,081) were extracted from the national psychiatric hospitalization case registry. Also obtained from the registry was information about the patients' subsequent hospitalizations through 1995, demographic data, and diagnosis. Analyses adjusted for time since first admission, age at first admission, country of origin, and religion. The first admission of 12.9 percent of the patients was involuntary. The legal status of the first admission was not related to the number of readmissions. However, female patients whose first admission was involuntary were 4.1 times more likely to have an involuntary second admission than female patients whose first admission was voluntary; these odds were 3.4 for males. Further analysis examined the percentage of involuntary admissions among all hospitalizations of the 3,420 patients who had four or more admissions (chronic patients). Among the chronic patients who had an involuntary first admission, 41 percent of subsequent admissions were involuntary. This figure was significantly lower among the chronic patients who had a voluntary first admission-13 percent. The percentage of involuntary admissions was not related to the number of admissions. The strong association of involuntary legal status at first admission with involuntary status at second admission and with the number of involuntary admissions over time suggests that involuntary first admission might be an important factor in assessing whether patients are likely to be readmitted involuntarily.
Journal of Clinical Psychopharmacology, Jun 1, 2006
The Positive and Negative Symptom Scale (PANSS) and Clinical Global Impression (CGI-S) item for s... more The Positive and Negative Symptom Scale (PANSS) and Clinical Global Impression (CGI-S) item for severity are used together to measure severity of psychotic illness. PANSS is the "gold standard" measure of efficacy, but it is not always feasible to use, yet the CGI-S requires validation. To examine the overlap between PANSS and CGI-S. The overlap of the PANSS and CGI-S were examined using data from 7 large antipsychotic clinical trials (n = 4287). Regression analysis identified 21% to 60% overlap of the measures depending on the trial and measurement point. The pooled study mean PANSS value corresponding with a CGI-S of 2, 3, and 4 were 67.1 (n = 799), 79.6 (n = 1645), and 92.4 (n = 1056), respectively. A decrease of 1 on the CGI-S corresponded to a 20% decline on the PANSS. Of the 37 planned comparisons in these studies, there was an agreement between the PANSS and CGI-S on change from baseline to end point on 32 comparisons and on dichotomized change variables (PANSS > or =-20% and CGI-S > or =-1 point) on 31 comparisons. The differences in the remaining comparisons would not have changed the conclusions of the studies. The positive and disorganized PANSS scales were the most closely related to the CGI-S, followed by hostility and negative scale with almost no association with anxiety/depression. The CGI-S and PANSS are correlated but are not synonymous. Both measures, however, show substantial agreement in detecting change, and the CGI-S shows overlap with the core symptoms of schizophrenia.
The goal of the current study was to compare premorbid behavioral and cognitive functioning betwe... more The goal of the current study was to compare premorbid behavioral and cognitive functioning between co-twins discordant for psychotic disorder and between these pairs of twins and pairs of twins with no psychotic disorders. The authors linked data from the Israeli Draft Board Registry, which contains cognitive and behavioral assessments of all 16-17-year-old male Israeli twins, with data from the National Psychiatric Hospitalization Case Registry. Pairs of male twins who were healthy at the time of testing but discordant for psychoses later on were compared with one another and with pairs of healthy male twins. The affected twins performed significantly worse than healthy twins on measures of individual autonomy, social functioning, and physical activity and nonsignificantly worse on measures of abstract reasoning. There were no significant differences in cognitive or behavioral scores between the co-twins who did or did not develop psychotic disorders. The authors conclude that these findings underscore the familial nature of behavioral and cognitive deficits antecedent to psychoses.
The study attempted to determine the proportion of primary care physicians who treat depression a... more The study attempted to determine the proportion of primary care physicians who treat depression and their characteristics. Data were from 677 respondents to a national survey of primary care physicians in Israel. Twenty-two percent always treated depression, 36.6 percent usually did, 28.6 percent sometimes did, and 12.6 percent never did. Logistic regression found that, compared with physicians who sometimes or never treated depression, those who always or usually treated depression treated more medical conditions, regarded themselves as the medical system's first contact for patients with psychosocial problems, had more frequent contact with social workers, and were more likely to have specialized in family medicine.
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Papers by Jonathan Rabinowitz