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Background and Objectives: Fibromyalgia syndrome (FMS) is defined as a chronic pain syndrome that is characterized by widespread pain, tenderness, and diffuse stiffness. In addition, neuropsychological symptoms such as fatigue, sleep disorders, poor mood, cognitive impairment, and headaches are often reported. Many reports have addressed the coexistence of affective disorders and anxiety with FMS, yet few have focused on its association with obsessive compulsive disorder (OCD). We investigated the occurrence of classical patterns of OCD in participants with FMS and assessed their effect on pain perception and functional impairment. Material and Methods: The research population included 37 patients diagnosed with FMS, treated at the Rheumatology Clinic in the Sheba Medical Center, Tel-Hashomer, Israel. We used validated questionnaires including a demographic questionnaire, a questionnaire on average and maximal pain intensity, the Eysenck Personality Questionnaire-Revised (EPQ-R), the Perceived Stress Scale, the Pain Catastrophizing Scale, the Pain Obsessive questionnaire, and the Yale–Brown Obsessive Compulsive Scale (Y-BOCS). Results: Patients with FMS were found to have intrusive and obsessive thoughts regarding pain for several hours every day, causing a high degree of anxiety and high levels of pain, catastrophizing, and magnification, leading to helplessness and functional impairment. In total, 27% of the patients reported severe malfunction due to pain and pain ideation, and 49% demonstrated mild obsessive compulsive symptoms that were strongly correlated with pain intensity and functional impairment. Conclusions: Obsessive compulsive thinking patterns contribute to pain magnification and to the cognitive aspects of fibromyalgia syndrome. [ABSTRACT FROM AUTHOR]

Purpose: Fibromyalgia affects patients' quality of life. Therefore, an essential part of patients' medical management is to develop appropriate coping strategies. This study aimed to obtain a comprehensive picture of patients' cognitive and behavioural strategies to cope with fibromyalgia. Methods: A qualitative design was conducted based on the grounded theory method. Two focus group discussion sessions were held with 15 Israeli women diagnosed with fibromyalgia. A constant comparative analysis method was utilized. Results: The findings of themes related to women's coping with fibromyalgia included: Emotional coping, with two categories: (a) from repression and despair to acceptance and completion, and (b) a range of negative and positive emotions; Practical coping, with three categories: (a) the agonizing process of receiving/internalizing the diagnosis, (b) living with the symptoms, and (c) changing lifestyle; Coping with the social environment, with three categories: (a) sharing vs. concealing, (b) social connection--disconnection, and (c) environmental resources. In addition, we identified a theme on the patients' perceptions of the causes of their fibromyalgia that effect their coping, with three categories: (a) demanding lifestyle; (b) traumatic life events; and (c) personality trait--perfectionism. Conclusion: It would be desirable for rheumatology units to have an interdisciplinary professional team to work together with patients to consider how best to manage and effectively cope with their condition. [ABSTRACT FROM AUTHOR]

Background: Our aims were to compare fibromyalgia (FM) rate, drug treatment and factors associated with the use of opiates in two ethnic sectors. Methods: A retrospective cross-sectional study in southern district of Israel was performed on diagnosed FM patients in 2019–2020 [7686 members (1.50%)]. Descriptive analyses were conducted and multivariable models for the use of opiates were developed. Results: There were significant differences between the two ethnic groups in FM prevalence at 1.63% and 0.91% in the Jewish and Arab groups, respectively. Only 32% of the patients used recommended medications and about 44% purchased opiates. Age, BMI, psychiatric co-morbidity, and treatment with a recommended drug were similarly associated with an increased risk for opiate use in both ethnic groups. However, male gender was associated with × 2 times reduced risk to use opiates only among the Bedouins (aOR = 0.552, 95%CI = 0.333–0.911). In addition, while in both of ethnic groups the existence of another localized pain syndrome was associated with an increased risk for opiates use, this risk was 4 times higher in the Bedouin group (aOR = 8.500, 95%CI = 2.023–59.293 and aOR = 2.079, 95%CI = 1.556–2.814). Conclusions: The study showed underdiagnosis of FM in the minority Arab ethnicity. Female Arab FM patients in low or high, compared to middle socio-economic status, were a risk group for excess opiate use. Increased use of opiates and very low rate of purchase of recommended drugs point to a lack of effectiveness of these drugs. Future research should assess whether the treatment of treatable factors can reduce the dangerous use of opiates. [ABSTRACT FROM AUTHOR]

Introduction: The exact pathogenesis of fibromyalgia (FM) syndrome is unclear. However, various infectious have been implicated with the development of FM after their acute phase. We aimed to investigate the incidence of FM syndrome among convalesced individuals following hospitalization for Acute Coronavirus Disease-2019 (COVID-19). Methods: We performed a cross-sectional study on patients who were discharged after COVID-19 hospitalization from the Sheba Medical Center, Israel, between July 2020 to November 2020. A phone interview was performed consisting of the following questionnaires: the Fibromyalgia Survey Diagnostic Criteria Questionnaire, Sense of Coherence Questionnaire to evaluate resilience, and the Subjective Traumatic Outlook Questionnaire to assess the associated psychological aspects of the trauma. The incidence of post-COVID FM was calculated and regression models were performed to identify predictors. Results: The study population consisted of 198 eligible patients who completed the phone interview. The median age was 64 (52–72) and 37% were women. The median follow-up was 5.2 months (IQR 4.4–5.8). The incidence of FM was 15% (30 patients) and 87% (172 patients) had at least one FM-related symptom. Female gender was significantly associated with post-COVID FM (OR 3.65, p = 0.002). In addition, high median Subjective Traumatic Outlook scores and low median Sense of Coherence scores were both significantly associated with post-COVID FM (OR 1.19, p<0.001 and OR 0.92, p<0.001, respectively). Conclusions: FM is highly prevalent among COVID-19 convalescent patients. Our finding suggests that a significant subjective traumatic experience and a low resilience are highly associated with post-COVID FM. [ABSTRACT FROM AUTHOR]

Introduction: Major depressive disorder (MDD) is one of the most common mental disorders worldwide, estimated to affect 10–15% of the population per year. Treatment resistant depression (TRD) is estimated to affect a third of these patients who show difficulties in social and occupational function, decline of physical health, suicidal thoughts and increased health care utilization. We describe the prevalence of MDD, TRD and associated healthcare resource utilization in Maccabi Healthcare Services (MHS), a 2.5 million-member state-mandated health service in Israel. Methods: All MHS members with an MDD diagnosis were identified within the years 2017–2018 and prevalence assessed by age, sex and TRD. To assess the incidence of MDD, members aged 18–65 years at the start of any MDD episode were identified between 1st January 2016 and 31st May 2018 with at least one systemic first-line antidepressant treatment within three months before or after the initial episode. Treatment patterns, time on first-line treatment, and healthcare resource utilization were compared by TRD. Results: A total of 4960 eligible MDD patients were identified (median age = 51 years, 65% female), representing a period prevalence of 0.218%, and of those, a high proportion of patients received drug treatment (92%). Among incident MDD cases (n = 2553), 24.4% had TRD. Factors associated with TRD included increasing age and personality disorder. Median time on treatment was 3.7 months (longer for those without TRD than those with) and 81.9% of patients purchased more than one month's supply of therapy. In the year after index, patients with TRD had a significant increased number of visits to primary care physicians, psychiatrists, emergency room visits, general hospitalizations, and psychiatric hospitalizations. Conclusion: Our study shows that prevalence of MDD in Israel is low compared to other countries, however once diagnosed, patients' are likely to receive drug treatment. Among patients diagnosed with MDD, the proportion of TRD is similar to other countries, increases with age and is associated with increased healthcare utilization, therefore should be a focus of continued research for finding effective long term treatment options. [ABSTRACT FROM AUTHOR]

Introduction: Major depressive disorder (MDD) is one of the most common mental disorders worldwide, estimated to affect 10–15% of the population per year. Treatment resistant depression (TRD) is estimated to affect a third of these patients who show difficulties in social and occupational function, decline of physical health, suicidal thoughts and increased health care utilization. We describe the prevalence of MDD, TRD and associated healthcare resource utilization in Maccabi Healthcare Services (MHS), a 2.5 million-member state-mandated health service in Israel. Methods: All MHS members with an MDD diagnosis were identified within the years 2017–2018 and prevalence assessed by age, sex and TRD. To assess the incidence of MDD, members aged 18–65 years at the start of any MDD episode were identified between 1st January 2016 and 31st May 2018 with at least one systemic first-line antidepressant treatment within three months before or after the initial episode. Treatment patterns, time on first-line treatment, and healthcare resource utilization were compared by TRD. Results: A total of 4960 eligible MDD patients were identified (median age = 51 years, 65% female), representing a period prevalence of 0.218%, and of those, a high proportion of patients received drug treatment (92%). Among incident MDD cases (n = 2553), 24.4% had TRD. Factors associated with TRD included increasing age and personality disorder. Median time on treatment was 3.7 months (longer for those without TRD than those with) and 81.9% of patients purchased more than one month's supply of therapy. In the year after index, patients with TRD had a significant increased number of visits to primary care physicians, psychiatrists, emergency room visits, general hospitalizations, and psychiatric hospitalizations. Conclusion: Our study shows that prevalence of MDD in Israel is low compared to other countries, however once diagnosed, patients' are likely to receive drug treatment. Among patients diagnosed with MDD, the proportion of TRD is similar to other countries, increases with age and is associated with increased healthcare utilization, therefore should be a focus of continued research for finding effective long term treatment options. [ABSTRACT FROM AUTHOR]

Although posttraumatic growth (PTG) has received growing attention, the relationship between PTG and distress remains unclear. This longitudinal study examines the relationship between posttraumatic obsessive-compulsive (OC) symptoms and PTG. Israeli veterans were followed over 17 years using self-report questionnaires of OC symptoms, posttraumatic stress disorder (PTSD), and PTG. Hierarchical regression analyses demonstrated that OC symptoms predicted PTG, even when initial PTG levels and PTSD symptoms were controlled for in the combatants group. These preliminary findings suggest that OC symptoms may play an important role in facilitating psychological growth. Future research is warranted to explore the mechanisms responsible for this relationship. [ABSTRACT FROM AUTHOR]

Problem: The aim of this study was to investigate the prevalence of and the association between endometriosis, fibromyalgia, and autoimmune disease (AID) in a large population database and to describe healthcare resource utilization (HCRU) in affected women. Methods: A retrospective cross‐sectional study was performed using the computerized databases of Maccabi Healthcare Services (MHS), a 2.1‐million‐member healthcare plan in Israel. Age‐sex‐specific point prevalence rates of endometriosis and fibromyalgia were calculated for end of 2015. Socio‐demographic characteristics, HCRU, co‐morbidities, including AID and depression or anxiety were described according to endometriosis/fibromyalgia status and analyzed using ordinary logistic regression models. Results: Among a total population of 781 571 adult women, 6647 were diagnosed with endometriosis (8.5 per 1000) and 25 425 with fibromyalgia (32 per 1000). A total of 401 women (0.5 per 1000) were diagnosed with both conditions. In 2015, the mean age of the women diagnosed with endometriosis and fibromyalgia was 42 and 55 years, respectively. Women with co‐occurrence were characterized by increased HCRU and a high prevalence rate of AID compared to women with no diagnosis of endometriosis/fibromyalgia, with 6.2% diagnosed with inflammatory bowel disease (IBD) vs 1% in the comparison group. The prevalence of fibromyalgia in women with endometriosis was 6%. Adjusted ORs (95% CI) for fibromyalgia among endometriosis patients were 4.1 (2.02‐8.36) for systemic lupus erythematosus (SLE), 3.1 (1.5‐6.2) for Sjögren syndrome, 2.9 (1.87‐4.7) for IBD, 2.1 (1.6‐2.7) for dispensed antidepressants, and 1.7 (1.37‐2.2) for diagnosed anxiety/depression. Conclusion: Co‐occurrence of endometriosis and fibromyalgia is associated with a high burden of AID, anxiety/depression, and HCRU. [ABSTRACT FROM AUTHOR]