Pinhas N Dannon

Psychiatry, Psychosomatic Medicine, Addiction Medicine

Associated Prof., MD
39.81

Publications

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    Pinhas N Dannon
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    ABSTRACT: AbstrAct Background: deep transcranial magnetic stimulation (dtMs) is effective in treatment of Major depressive disorder (Mdd), and in re-treatment in case of relapse. Our study evaluates the long-term durability of dtMs in Mdd.
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    Pinhas N Dannon
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    ABSTRACT: Background: While electroconvulsive therapy (ECT) has been used for many years, there is insufficient research regarding the indications for continuation/maintenance (C/M)-ECT, its safety and efficacy, and the characteristics of patients with schizophrenia or schizoaffective disorder who receive multiple ECT sessions. The aims of this study were to characterize a series of patients who received 30 ECT sessions or more, to describe treatment regimens in actual practice, and to examine the results of C/M-ECT in terms of safety and efficacy, especially the effect on aggression and functioning. Methods: We performed a retrospective chart review of 20 consecutive patients (mean age 64.6 years) with schizophrenia (n=16) or schizoaffective disorder (n=4) who received at least 30 ECT sessions at our ECT unit, and also interviewed the treating physician and filled out the Clinical Global Impression-Severity, Global Assessment of Functioning, and the Staff Observation Aggression Scale-Revised. Results: Patients received a mean of 91.3 ECT sessions at a mean interval of 2.6 weeks. All had been hospitalized for most or all of the previous 3 years. There were no major adverse effects, and cognitive side effects were relatively minimal (cognitive deficit present for several hours after treatment). We found that ECT significantly reduced scores on the Staff Observation Aggression Scale-Revised subscales for verbal aggression and self-harm, and improved Global Assessment of Functioning scores. There were reductions in total aggression scores, subscale scores for harm to objects and to others, and Clinical Global Impression-Severity scores, these were not statistically significant. Conclusion: C/M-ECT is safe and effective for chronically hospitalized patients. It improves general functioning and reduces verbal aggression and self-harm. More research using other aggression tools is needed to determine its effects and to reproduce our findings in prospective and controlled studies.
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    ABSTRACT: Major depressive disorder (MDD) is a prevalent and disabling condition, and many patients do not respond to available treatments. Deep transcranial magnetic stimulation (dTMS) is a new technology allowing non-surgical stimulation of relatively deep brain areas. This is the first double-blind randomized controlled multicenter study evaluating the efficacy and safety of dTMS in MDD. We recruited 212 MDD outpatients, aged 22–68 years, who had either failed one to four antidepressant trials or not tolerated at least two antidepressant treatments during the current episode. They were randomly assigned to monotherapy with active or sham dTMS. Twenty sessions of dTMS (18 Hz over the prefrontal cortex) were applied during 4 weeks acutely, and then biweekly for 12 weeks. Primary and secondary efficacy endpoints were the change in the Hamilton Depression Rating Scale (HDRS-21) score and response/remission rates at week 5, respectively. dTMS induced a 6.39 point improvement in HDRS-21 scores, while a 3.28 point improvement was observed in the sham group (p=0.008), resulting in a 0.76 effect size. Response and remission rates were higher in the dTMS than in the sham group (response: 38.4 vs. 21.4%, p=0.013; remission: 32.6 vs. 14.6%, p=0.005). These differences between active and sham treatment were stable during the 12-week maintenance phase. dTMS was associated with few and minor side effects apart from one seizure in a patient where a protocol violation occurred. These results suggest that dTMS constitutes a novel intervention in MDD, which is efficacious and safe in patients not responding to antidepressant medications, and whose effect remains stable over 3 months of maintenance treatment.
    World psychiatry: official journal of the World Psychiatric Association (WPA) 02/2015; 14(1):64. DOI:10.1002/wps.20199
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    ABSTRACT: Problematic Internet use or excessive Internet use is characterized by excessive or poorly controlled preoccupations, urges, or behaviors regarding computer use, and Internet access that leads to impairment or distress. Cross-sectional studies on samples of patients reported high comorbidity of Internet addiction with psychiatric disorders, especially affective disorders (including depression), anxiety disorders (generalized anxiety disorder, social anxiety disorder), and attention-deficit/hyperactivity disorder. We have investigated the association between Internet addiction and social anxiety in 2 samples of 120 university students (60 males and 60 females in each sample). We found a correlation between Internet addiction and social anxiety in the 2 samples (r = 0.411, P < .001; r = 0.342, P < .01) respectively. Secondly, we found no difference between males and females on the level of Internet addiction. Thirdly, we did not find a preference for social networks among participants with high levels of social anxiety. The results of the study support previous evidence for co-occurrence of Internet addiction and social anxiety, but further studies need to clarify this association.
    Annals of Clinical Psychiatry 02/2015; 27(2).
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    ABSTRACT: While electroconvulsive therapy (ECT) has been used for many years, there is insufficient research regarding the indications for continuation/maintenance (C/M)-ECT, its safety and efficacy, and the characteristics of patients with schizophrenia or schizoaffective disorder who receive multiple ECT sessions. The aims of this study were to characterize a series of patients who received 30 ECT sessions or more, to describe treatment regimens in actual practice, and to examine the results of C/M-ECT in terms of safety and efficacy, especially the effect on aggression and functioning. We performed a retrospective chart review of 20 consecutive patients (mean age 64.6 years) with schizophrenia (n=16) or schizoaffective disorder (n=4) who received at least 30 ECT sessions at our ECT unit, and also interviewed the treating physician and filled out the Clinical Global Impression-Severity, Global Assessment of Functioning, and the Staff Observation Aggression Scale-Revised. Patients received a mean of 91.3 ECT sessions at a mean interval of 2.6 weeks. All had been hospitalized for most or all of the previous 3 years. There were no major adverse effects, and cognitive side effects were relatively minimal (cognitive deficit present for several hours after treatment). We found that ECT significantly reduced scores on the Staff Observation Aggression Scale-Revised subscales for verbal aggression and self-harm, and improved Global Assessment of Functioning scores. There were reductions in total aggression scores, subscale scores for harm to objects and to others, and Clinical Global Impression-Severity scores, these were not statistically significant. C/M-ECT is safe and effective for chronically hospitalized patients. It improves general functioning and reduces verbal aggression and self-harm. More research using other aggression tools is needed to determine its effects and to reproduce our findings in prospective and controlled studies.
    Neuropsychiatric Disease and Treatment 01/2015; 11:853-62. DOI:10.2147/NDT.S78919
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    Pinhas N Dannon
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    ABSTRACT: Aims: The International Survey Informing Greater Insights in Opioid Dependence Treatment (INSIGHT) study evaluated the implementation of opioid dependence treatment across different countries to assess treatment delivery, quality of care and outcomes. Methods: A questionnaire-based survey was used to gather data in nine countries across Central and Eastern Europe, South Africa and South-East Asia, from patients with opioid dependence receiving medication-assisted treatment (MAT), healthcare professionals (HCPs) who cared for opioid-dependent patients and opioid users not receiving MAT. Findings: There was substantial variation between countries, but overall results suggest that several aspects of MAT can be improved, such as access to treatment (conditions to start or remain in treatment), quality of care (availability/awareness of treatment options and appropriate medication dosing) and treatment outcomes (on-top use, misuse and diversion). Conclusions: This analysis highlights key priorities that should improve the quality of opioid dependence care and access to treatment. These priorities include: acknowledging opioid dependence as a chronic medical condition requiring long-term treatment; recognition by policymakers of the cost-effectiveness of treatment; making available, to those who want them, psychosocial interventions and educating HCPs to prescribe the safest, least divertible forms of medications available at optimal doses in order to reduce opioid use, misuse and diversion.
    Drugs: Education Prevention and Policy 08/2014; 21(6). DOI:10.3109/09687637.2014.945511
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    ABSTRACT: Tobacco smoking is the leading cause of preventable death in developed countries. Our previous studies in animal models and humans suggest that repeated activation of cue-induced craving networks followed by electromagnetic stimulation of the dorsal prefrontal cortex (PFC) can cause lasting reductions in drug craving and consumption. We hypothesized that disruption of these circuitries by deep transcranial magnetic stimulation (TMS) of the PFC and insula bilaterally can induce smoking cessation.
    Biological Psychiatry 06/2014; 76(9). DOI:10.1016/j.biopsych.2014.05.020
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    A Weinstein, L Dinur Klein, P N Dannon
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    ABSTRACT: Gambling behavior is not a unique behavior. There are certain differences in behavior, gambling habits, gambling beliefs, and their reflection in psychosocial life. We have compared three groups of adult male gamblers-sports gamblers (n = 41), machine gamblers (n = 36), and poker gamblers (n = 35)-in regard to measures of personal status and legal-social characteristics. We found no difference between groups in terms of the length of gambling behavior, personal status, or age. We found no legal difference between groups in terms of the number of court cases for debt, stealing, or family court cases. In terms of economic circumstances, sports gamblers suffered more losses than the other groups (p < 0.0001). There were higher rates of bankruptcy among sports gamblers compared with machine gamblers (p < 0.01). Sports gamblers were more likely to borrow money from the black market compared with the other groups (p < 0.01). In terms of mental health, sports and machine gamblers had more suicidal thoughts and gestures than poker gamblers (p < 0.05), whereas the rate of suicide attempts was higher in machine gamblers compared with poker players (p < 0.05). Our results indicated higher vulnerability in sports gamblers in terms of economic problems compared with the other groups, whereas machine gamblers had vulnerability to suicidal thoughts and suicidal attempts compared with poker gamblers.
    Journal of Gambling Behavior 05/2014; DOI:10.1007/s10899-014-9462-5
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    Guy Sender Zahavi, Pinhas Dannon
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    ABSTRACT: Electroconvulsive therapy (ECT) is considered to be one of the most effective treatments in psychiatry. Currently, three medications for anesthesia are used routinely during ECT: propofol, etomidate, and thiopental. The objective of this study was to evaluate the effects of the anesthetics used in ECT on seizure threshold and duration, hemodynamics, recovery from ECT, and immediate side effects. Our study is a retrospective cohort study, in which a comparison was made between three groups of patients who underwent ECT and were anesthetized with propofol, etomidate, or thiopental. The main effect compared was treatment dose and seizure duration. All patients were chosen as responders to ECT. Data were gathered about 91 patients (39 were anesthetized with thiopental, 29 with etomidate, and 23 with propofol). Patients in the thiopental group received a lower electrical dose compared to the propofol and etomidate group (mean of 459 mC compared to 807 mC and 701 mC, respectively, P<0.001). Motor seizure duration was longer in the thiopental group compared to propofol and etomidate (mean of 40 seconds compared to 21 seconds and 23 seconds, respectively, P=0.018). Seizure duration recorded by electroencephalography was similar in the thiopental and etomidate groups and lower in the propofol group (mean of 57 seconds in both groups compared to 45 seconds, respectively, P=0.038). Patients who were anesthetized with thiopental received a lower electrical treatment dose without an unwanted decrease in seizure duration. Thiopental might be the anesthetic of choice when it is congruent with other medical considerations.
    Neuropsychiatric Disease and Treatment 02/2014; 10:383-9. DOI:10.2147/NDT.S58330
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    ABSTRACT: Problematic Internet use (PIU) or Internet Addiction Disorder (IAD) is characterized by excessive or poorly controlled preoccupations, urges, or behaviors regarding Internet use that lead to impairment or distress. Due to the increased use of the Internet over the past 15 years, IAD has attracted attention of researchers and clinicians in the field. Young (1998) and Griffiths (1998; 2000) were the first who defined IAD and have done extensive research. Internet addiction has also attracted increasing coverage in the popular media and among researchers, and this attention has paralleled the growth in computer use and Internet access (Shaw & Black, 2008). Phenomenologically, there appear to be at least three IAD subtypes: excessive gaming-gambling, sexual preoccupations (cybersex), and socializing or social networking, including e-mail and messaging. Internet addicts may use the Internet for extended periods, isolating themselves from other forms of social contact, and focus almost entirely on the Internet rather than broader life events. Adolescents with problematic Internet use showed dysfunctional coping strategies with problems in school and home and showed worse interpersonal relations (Milani, Osualdella, & Di Blasio, 2009).
    Behavioral Addictions: Criteria, Evidence and Treatment, Edited by Rosenberg, 01/2014: chapter 5; Elsevier.
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    ABSTRACT: Problematic Internet use (PIU) or Internet Addiction Disorder (IAD) is characterized by excessive or poorly controlled preoccupations, urges, or behaviors regarding Internet use that lead to impairment or distress. Due to the increased use of the Internet over the past 15 years, IAD has attracted attention of researchers and clinicians in the field. Young (1998) and Griffiths (1998; 2000) were the first who defined IAD and have done extensive research. Internet addiction has also attracted increasing coverage in the popular media and among researchers, and this attention has paralleled the growth in computer use and Internet access (Shaw & Black, 2008). Phenomenologically, there appear to be at least three IAD subtypes: excessive gaming-gambling, sexual preoccupations (cybersex), and socializing or social networking, including e-mail and messaging. Internet addicts may use the Internet for extended periods, isolating themselves from other forms of social contact, and focus almost entirely on the Internet rather than broader life events. Adolescents with problematic Internet use showed dysfunctional coping strategies with problems in school and home and showed worse interpersonal relations (Milani, Osualdella, & Di Blasio, 2009). IAD can also be explained by a need to “escape from oneself,” which may account for the excessive playing of Internet games (Kwon, Chung, & Lee, 2011).
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    P. Dannon
    Value in Health 11/2013; 16(7):A682. DOI:10.1016/j.jval.2013.08.2014
  • Oded Rosenberg, Limor Klein Dinur, Pinhas N Dannon
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    ABSTRACT: In the past decade, we have witnessed the emergence of pharmacological treatments for pathological gambling with some success but many question marks. We aimed to explore pharmacological treatments that have been previously explored with some success, with the intent of comparing their efficacy and pave the way to larger placebo-controlled trials. In this study, we allocated 78 patients to 4 different types of psychotropic medications: naltrexone, topiramate, bupropion, and escitalopram. We treated patients for more than 2 years, with additional 2-year follow-ups without medication. The sample was evaluated using the 21-item Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Global Assessment of Functioning, and the Visual Analog Scale to measure general well-being before enrollment as well as at 1 month, 6 months, 24 months, and 48 months after beginning medication treatment. During the first 2 years of treatment, 34 patients dropped out, with one more dropping out during the additional 2 years of follow-up. Significant improvement on all rating scales was seen in all groups after 2 years, except HAMD in the group that received topiramate.We found the naltrexone-treated group of patients to have a statistically significant lower dropout rate compared with other groups, statistically significant lower HAMD scores in comparison to the group treated with bupropion, statistically significant lower Hamilton Anxiety Rating Scale score compared to the groups treated with escitalopram and topiramate, and significantly higher Visual Analog Scale scores compared to the groups treated with bupropion and topiramate. Pathological gambling is essentially a biopsychological disorder that may be attenuated provided that patients adhere to medication. In our study, among 4 medications with different mechanisms of action, naltrexone was found to be the most effective. Placebo-controlled studies involving large numbers of subjects are required before naltrexone's efficacy can be established.
    Clinical neuropharmacology 03/2013; 36(2):42-5. DOI:10.1097/WNF.0b013e31828740ea
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    ABSTRACT: Pathological gambling (PG) disorder occurs when a person gambles repetitively despite severe negative effects on important aspects of life. PG tends to be a heterogonous disorder in which patients differ with respect to type and intensity of gambling behavior, psychiatric comorbidity, family history, age at onset and gender. Gamblers may accordingly be classified into three subtypes: the “impulsive”, “obsessive-compulsive” and “addicted” subtypes.Aimsto characterize a sample of Italian PG pathological gamblers and assess the prevalence of the various gambling subtypes in this population.Methods52 outpatients (44 men, 9 women), diagnosed with PG according to DSM IV-TR and SOGS criteria, were administered the Dannon Ainhold Gambling Scale (DAGS), which assesses the presence of the disorder and is useful for patient subtyping.Results37 gamblers enrolled in our study played one specific kind of game, while 15 played multiple games. 30 patients played slot machines, 18 sport betting, 11 casino and card games, 14 bingo and scratch cards. According to DAGS, 5 (9,6%) patients belonged to the “addicted” subtype, 4 (7,7%) to the “obsessive-compulsive” subtype and 9 (17,3%) to the “impulsive” subtype. 15 (28,8%) gamblers were classified as “addicted-impulsive” subtype, 10 (19,2%) as “addicted-obsessive-impulsive” subtype, while 9 (17,3%) did not belong to any specific subtype though they displayed a tendency for one of the subtypes.ConclusionDAGS allows to identify three major subtypes of gamblers and also considers possible combinations between the different subtypes. An evaluation of these aspects could be useful in treatment options based on patient subtype.
    European Psychiatry 12/2012; 27:1. DOI:10.1016/S0924-9338(12)74243-8
  • Oded Rosenberg, Limor Dinur Klein, Pinhas N Dannon
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    ABSTRACT: Five pathological gamblers received deep transcranial magnetic stimulation (DTMS). Evaluations included rating scales and collateral anamnesis. Despite initial improvement in ratings, collateral anamnesis demonstrated failure to respond. DTMS to the pre-frontal cortex using an H1 coil was an ineffective treatment. Our study is preliminary, and additional studies are required.
    10/2012; 206(1). DOI:10.1016/j.psychres.2012.09.045
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    ABSTRACT: Background: Football (soccer) betting, as a strategic form of betting, became one of the favorite wagers for pathological gamblers. Previous studies demonstrated the psychological and biological significance of the 'illusion of control' (personal control) and 'near miss' results in gambling. In our study, we explored whether knowledge and expertise of pathological sports gamblers can ensure a successful bet. Sample and Methods: Participants were divided into three groups of individuals - pathological gamblers, amateurs and laypersons - and were asked to predict in advance the general result and the exact result of football matches in the European Champions League Round of 16. Results: The 165 participants included 53 pathological sports gamblers (52 males and 1 female), 78 laypersons (45 females and 33 males) and 34 amateurs (all males). After a thorough statistical analysis, we found no significant differences between the groups, no matter what kind of previous knowledge they had acquired. Conclusion: This study demonstrates that the 'illusion of control' of pathological gamblers, attained by knowledge of the game and its latest data and information (especially in a strategic gamble as football betting), has no factual background. Moreover, our study demonstrates without a doubt that there is no significant difference between the male pathological sports gamblers group and the male/female laypersons group.
    Psychopathology 08/2012; 46(1). DOI:10.1159/000338614
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    ABSTRACT: About 25% of schizophrenia patients with auditory hallucinations are refractory to pharmacotherapy and electroconvulsive therapy. We conducted a deep transcranial magnetic stimulation (TMS) pilot study in order to evaluate the potential clinical benefit of repeated left temporoparietal cortex stimulation in these patients. The results were encouraging, but a sham-controlled study was needed to rule out a placebo effect. A total of 18 schizophrenic patients with refractory auditory hallucinations were recruited, from Beer Yaakov MHC and other hospitals outpatient populations. Patients received 10 daily treatment sessions with low-frequency (1 Hz for 10 min) deep TMS applied over the left temporoparietal cortex, using the H1 coil at the intensity of 110% of the motor threshold. Procedure was either real or sham according to patient randomization. Patients were evaluated via the Auditory Hallucinations Rating Scale, Scale for the Assessment of Positive Symptoms-Negative Symptoms, Clinical Global Impressions, and Quality of Life Questionnaire. In all, 10 patients completed the treatment (10 TMS sessions). Auditory hallucination scores of both groups improved; however, there was no statistical difference in any of the scales between the active and the sham treated groups. Low-frequency deep TMS to the left temporoparietal cortex using the protocol mentioned above has no statistically significant effect on auditory hallucinations or the other clinical scales measured in schizophrenic patients. Clinicaltrials.gov identifier: NCT00564096.
    Annals of General Psychiatry 05/2012; 11:13. DOI:10.1186/1744-859X-11-13
  • Roman Gersner, Oded Rosenberg, Pinhas N Dannon
    05/2012; 9(3):269-278. DOI:10.2217/cpr.12.23
  • Oded Rosenberg, Pinhas N Dannon
    03/2012; 9(2):125-127. DOI:10.2217/cpr.12.6

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