National Knowledge and Research Center for Emergency Readiness - Klein, Ehud

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Klein, Ehud

Ehud Klein (Technion) – Public Health and Emergency Medicine

Prof. Ehud Klein graduated from the Hebrew University in Jerusalem and completed his training in Psychiatry at the Rambam Medical center, and a research fellowship at the National Institute of Mental Health in Bethesda Maryland (US). After his return from the US, Professor Klein served several years as deputy Chairman for Research and Academic affairs, and became Chairman of the Department, until his retirement , last year. .

In addition to his clinical position as department head, Professor Klein pursued over the years a rich research career and continues to be an active researcher. His focus of research in the last years has been on traumatic stress  and Post-traumatic stress disorder, and in Transcranial magnetic brain stimulations. Professor Klein is the recipient of numerous research grants and has published extensively in leading journals in his field.

Brief summary of my research on Post-Traumatic Stress Disorder (PTSD).

This incapacitating psychiatric disorder, has been another focus of my research interests in the last years. One of my first studies in this field focused on the development of PTSD in injured traffic accident victims. This prospective study which included about 100 subjects was the  the PhD thesis of I. Arnon  under my supervision. The results showed that about 30% of injured traffic accident victims suffer from PTSD one year after the accident. A Continuation follow up study revealed that  3 years after the accident, as many as 50% of those who had PTSD after 1 year, still had the disorder.  A major part of this work was published in the American Journal of Psychiatry in 1999 with an editorial article discussing our findings. Four additional papers summarizing results from this study were published subsequently. The findings of this study were presented in invited lectures at the World Psychiatric Congress (Madrid 1995), in the 2nd  meeting of the International Society for Traumatic Stress Studies (Jerusalem 1996) and invited lectures and grand rounds in university departments in Israel and abroad. Since this study, a major part of my work in PTSD has focused on vulnerability factors and early predictors of PTSD. This issue is of particular importance since only 20-25% of trauma survivors develop PTSD. Thus early identification of those at risk is crucial for the implementation of early and effective treatment interventions that might prevent chronic morbidity.

One such study done in collaboration with Dr. D. Koren, explored the role of combat related injury in the development of PTSD. In this study soldiers who were injured in war activity during their service in Lebanon, were compared to their peers who were involved in the same events, but were not injured. The results of this study showed that physical injury is a major risk factor for PTSD and that injured soldiers were about 8 times more likely to develop PTSD compared to their non-injured commerades. The study was published in the American Journal of Psychiatry in 2005.

In another prospective study we investigated the role of traumatic memory as a risk factor for PTSD. Two PhD students S. Gill and I. Ben-Ari completed their theses on this topic. Findings from these studies showed that among subjects who survived a traumatic event involving minor head injury, those with memory for the event, had a five-fold higher risk to develop PTSD as compared to those who lacked memory for the event. The results of this study  were presented in the Annual meeting of the International Society for traumatic stress studies in Baltimore USA, and were published in the American Journal of Psychiatry in 2005.

In an additional study which has recently been completed we investigated traumatic exposure and its sequelae in Bedouin servicemen in the Israel Defense Forces. Studies of veterans from ethnic minority backgrounds indicate differential rates of posttraumatic stress disorder (PTSD) and other psychological problems, suggesting that ethnicity increases vulnerability to psychological risk following war-zone duty and negatively impacts vocational, social, physical, and health adjustment. The circumstances of Israel’s Bedouin citizens are especially complex given their Arab ethnicity and Muslim faith. In order to explore the impact of trauma on mental and physical health, functioning and medical services utilization we conducted a cross-sectional study of Bedouin households associated with the IDF in a Galilee community.  Three hundred and seventeen Bedouin veterans and active-duty servicemen, mostly enlisted in combat units, completed the interviews, representing 85% of those identified through door-to-door recruitment and 91% of those who agreed to participate. Traumatic events were reported by 75% of the sample (n=238), mostly combat (89.9%) and car accidents (27.3%). Psychiatric diagnoses determined by the Structured Clinical Interview for DSM-IV Disorders (SCID) were found in 27%. Posttraumatic Stress Disorder (PTSD) was identified in 19.5% of those traumatized and was mostly co-morbid with depression, alcohol abuse or both. Of all traumatized, those with PTSD were more likely to report elevated levels of current depression symptoms (F=121.45, p<.001);  and poor health status (odds ratio [OR]= 17.78; 95% confidence interval [CI], 6.53-47.84; p<.001), associated with significantly higher rates of physician-diagnosed medical conditions, various somatic symptoms, health-related impairment in daily functioning and frequent use of primary and specialty care services. Our findings indicate that trauma exposure is highly prevalent in this sample and that PTSD is associated with significant distress and disability. While rates are comparable to those described in other cohorts of combatants, Bedouins with PTSD were mostly undiagnosed and untreated in spite of severe impairment in health and daily functioning and frequent use of primary care services.

In another study we evaluated the efficacy of early pharmacological treatment  for PTSD prevention in people who have recently been exposed to a traumatic event. This was a randomized controled trial where Escitalopram or placebo treatment is given to trauma survivors within 4 weeks from the traumatic event, for a period of 6 months followed by an additional medication free observation period up to one year after the event. Recruitment was done in four medical centers in Israel

A new line of research in which our group has become involved, is the study of the potential therapeutic effects of Oxitocin in PTSD and social anxiety. This work is done in collaboration with Prof. S. Shamay-Tsori from the Department of psychology at the Haifa University and several studies are under progress.     Over the last years I have been invited to present lectures and chair scientific sessions on risk factors and early predictors of PTSD in several  International meetings such as the Annual meeting of the European Society for Neuropsychopharmacology ( ECNP) in Amsterdam in 2005, the Annual meeting of the American Society for Biological Psychiatry in Toronto in 2006 and the forthcoming World Congress of Biological Psychiatry to be held in Santiago De Chile in April 2007. I have also served as an invited guest editor for a special issue of CNS Spectrums on risk factors and early predictors of PTSD and and authored two book chapters on the role of physical injury as a risk factor for PTSD. In addition I wrote with professor J. Zohar an invited chapter for the Encyclopedia of Stress.(Elsevier, 2nd edition, in press) summerizing PTSD research in Israel in the last three decades,. I am also member of a national committee which is preparing treatment guidelines for PTSD that will serve professionals and therapists who are treating patients with PTSD.   In paralel, to complement our clinical research in PTSD, several preclinical studies were done in collaboration with Prof. Dorit Ben-Shachar, head of our research laboratory on the role of DNA methylation (epigenetic factors) in the vulnerability to PTSD (manuscript no' 81), The differential effects of various types of stress on behavior and neuronal plasticity related genes, the relevance of interaction between norepinephrine and glucocorticoids induced signaling pathways to the pathogenesis of stress related disorders (manuscript no' 99), and the effects of early postnatal interference with the expression of genes regulated by the transcription factor Sp1.