Prof. Yuly Bersudesky
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Associate Professor
Department :
Psychiatry
Beer-Sheva Mental Health Center
Room :
Phone :
Email :
yuly@bgu.ac.il
Office Hours :
Education
M.D. Kirghiz State Medical Institute (1984); Ph.D. Moscow Institute of Psychiatry (1990).
Research Interests
Investigator-Initiated Clinical Trials
Clinical trials of psychotropic medications are notoriously complicated and difficult to carry out properly. The stage has been largely taken over by the large pharmaceutical companies, and many clinicians' experience with clinical trials is primarily based on participation in these large, multi-center, centrally managed studies. I have, however, led a number of important, independent clinical trials.
The most creative of these studies examined not a pharmacological preparation, but rather a dietary intervention based on restriction of dietary inositol in an attempt to enhance the therapeutic effects of lithium treatment. In a paper which also reported upon a dietary intervention in rats (another example of a behavioral psychopharmacological study, as mentioned above), positive results were reported from an open clinical trial in which fifteen lithium treated bipolar patients followed a diet which was 90% free of inositol. The inositol-deficient diet had a major effect in reducing the severity of affective symptoms in 10 of the patients (including 5 of 6 rapid cyclers) within the first 7 to 14 days of treatment.
Alona Shaldubina, Ziva Stahl, Mariala Furszpan, William T Regenold, Joseph Shapiro, Robert H Belmaker, Yuly Bersudsky (2006). Inositol deficiency diet and lithium effects. Bipolar disorders, 8 (2): 152-9
Some of the newer prophylactic treatments proposed for bipolar disorder are expensive anti-convulsant medications such as lamotrigine. We wondered whether other anti-convulsants – even an older, inexpensive one – might also be effective as a bipolar prophylactic. In a double-blind placebo-controlled crossover study (add-on to current therapy design) involving 23 patients, we found that phenytoin had a significant effect. This study has profound implications clinically, economically (being out of patent and therefore quite inexpensive) and theoretically: among the anticonvulsants, phenytoin may be the most specific blocker of voltage-activated sodium channels.
Mishory A, Winokur M, Bersudsky Y. (2003). Prophylactic effect of phenytoin in bipolar disorder: a controlled study. Bipolar Disorders 5: 464-467
A third clinical trial which we carried out investigated another "old", inexpensive drug – the classic neuroleptic clotiapine, whose chemical structure is similar to clozapine. Fifty-eight severe chronic actively psychotic schizophrenia patients received either clotiapine or chlorpromazine in a double-blind crossover design study lasting six months. Clotiapine was significantly superior to chlorpromazine on all three outcome measures for hospitalized patients (no differences were found in a smaller group of hostel-dwelling patients). This study's importance goes beyond the specific contribution of reawakening interest in clotiapine, and speaks to the importance of "practical" clinical trials – investigations which compare active treatments, rather than the drug-industry standard of active vs placebo conditions.
Geller V, Gorzaltsan I, Shleifer T, Belmaker RH, Bersudsky Y. (2005). Clotiapine compared with chlorpromazine in chronic schizophrenia. Schizophrenia Research, 80: 343-347.
Contributions to Behavioral Psychopharmacology: Knock Out Mice
Animal models of major mental illnesses remain a critical part of the effort to understand the underlying pathogenesis of these diseases. I am proud to be considered a researcher who has the skills to span the entire bench-to-bedside spectrum of research possibilities.
Lithium inhibits inositol monophosphatase and also reduces inositol transporter function. Previous studies in our labs have shown that heterozygous inositol transporter knockout mice showed reductions of 15-37% in brain inositol levels, but showed none of
Research Projects
Computerized neuropsychological testing of euthymic bipolar patients as compared to people with MCI (co-investigators Yamima Osher, PhD, and Dr. T. Dwolatzky). Projected completion 2009.
Clinical Trial: Oxygen therapy in schizophrenia. Projected completion 2010.
Behavioral pharmacology of lithium. Projected completion 2010.
Rapid tryptophan depletion in amphetamine hyperactivity model of mania. Projected completion 2010.