Director:
Professor R.N. Melmed

Clinical Service:
The Unit specializes in the diagnosis and management of stress reactions in patients presenting to the medical clinic or admitted to the medical wards. These clinical problems often have the character of intractable symptoms and suffering that is mostly un- or only partially responsive to medical therapy. This poor reaction to treatment may give the treating physicians the impression that the underlying medical problem may be unresponsive or deteriorating and possibly lead to treatment interventions that may be more dangerous to the patient. In the majority of cases, the program of therapy, based on Cognitive Behavioral principles, is short term; i.e. 4 to 6 weeks only. The objective is to restore the patient in this time to an acceptable level of function, while providing an educational program that allows him or her to manage stress situations more effectively in the future.

Medical Education:
As psychosomatic problems are universally poorly diagnosed and treated in the arena of general medicine, Prof. Melmed has undertaken a complete reevaluation of this field over the last 15 years, particularly as it related to general medical practice. The main aim here was to describe the principle processes mediating psychosomatic influences on the body and reformulate the whole field in terms of physiological and biological mechanisms, including the psychological aspects. The result is a 400-page, single-authored book entitled "Mind, Body and Medicine: an Integrative Text", which was published by Oxford University Press (USA)in the spring of 2001. This is the first book of its kind in this field, and it is hoped that it will be adopted as a text by students, doctors and nurses interested in psychosomatic and stress medicine.
In parallel with this, for the last three years, Prof. Melmed has conducted with Hannah Kedar of the Medical Education Unit of the Hebrew University-Hadassah Medical School, 2 two-week electivesa year, for 6th year medical students on Stress Medicine (stress here meaning both for the patient and the doctor). The emphasis is on the practical management of clinical problems, and the subjects include: the physiology and mechanisms of stress reactions with clinical examples; dealing with chronic and intractable medical problems (cancer, chronic renal failure, Parkinsonism, etc.) - including meetings with patients; difficult communication situations such as dealing with anger, aggression, bereavement and breaking bad news - including role-playing in simulated situations. Student assessment of this program has been consistently enthusiastic.


Research Activities:

A. An extended 10-year exploration has culminated in the development of a sensitive, reliable technique to allow the physiological quantitation of emotion as measured by autonomic sympathetic responses. This unique methodology was developed and standardized in Prof. Melmed's laboratory, by adapting a commercially available computerized biofeedback system to measure emotion-related sympathetic activity through changes in palmar electrodermal activity.

B. This technique has been used to explore the role of psychoneurological influences in eating behavior and body weight regulation. We have been able to show a significant relationship between emotional tension and body weight, in addition to the influence of eating and body weight on emotional state, suggesting that we tend to eat to our level of emotional comfort.

C. This work formed the basis of a collaborative research project during Prof. Melmed's sabbatical in 2000 at the Institute of Neurology and Neurosurgery, London, between Prof. Melmed and Professors C. Mathias, R. Dolan, and Dr. H. Critchley, of the Functional Imaging Laboratory and the Autonomic Unit. They undertook both PET and fMRI studies in human subjects, utilizing the experimental paradigm developed in Prof. Melmed's laboratory, to determine the influence of body weight on the activity of brain (limbic) structures mediating emotion. This data is presently under analysis.

Tel: (02) 6778401