Louis Trevisan | Creighton University (original) (raw)

Papers by Louis Trevisan

Alcohol misuse in older adults is often underdiagnosed in medical practice. This age group is rap... more Alcohol misuse in older adults is often underdiagnosed in medical practice. This age group is rapidly moving into the treatment realm of the practicing general, geriatric, and addiction psychiatrist.

Psychiatric Services, Aug 1, 2018

The U.S. Department of Veterans Affairs (VA) is shifting its focus from ending veteran homelessne... more The U.S. Department of Veterans Affairs (VA) is shifting its focus from ending veteran homelessness to preventing veteran suicides. With supporting data, this Open Forum argues that VA homelessness services also help address veteran suicides. Analysis of a nationally representative survey of U.S. veterans in 2015 shows that veterans with a history of homelessness attempted suicide in the previous two years at a rate .5.0 times higher compared with veterans without a history of homelessness (6.9% versus 1.2%), and their rates of two-week Psychiatric Services 69:8, August 2018 ps.psychiatryonline.org 937 TSAI ET AL.

Medicine and Science in Sports and Exercise, Apr 1, 1980

American Journal of Psychiatry, Oct 1, 2004

Objective: A family history of alcoholism is a risk factor for the development of ethanol depende... more Objective: A family history of alcoholism is a risk factor for the development of ethanol dependence. Ethanol is an antagonist of the N-methyl-D-aspartate (NMDA) glutamate receptor, and alterations in NMDA receptor function are thought to be involved in ethanol abuse and dependence. The purpose of this study was to determine in healthy individuals with no ethanol dependence whether response to the NMDA receptor antagonist ketamine would differentiate those with a family history of ethanol dependence from those without such a family history. Method: Healthy subjects between the ages of 21 and 30 received 40-minute intravenous infusions of saline, low-dose ketamine (0.1 mg/kg), and high-dose ketamine (0.5 mg/kg) on three separate test days in a randomized order under doubleblind conditions. The healthy individuals with at least one first-degree relative and another first-or second-degree relative with ethanol dependence (N=16) were compared with those who had no family history of ethanol dependence in any firstor second-degree relative (N=29). Outcome measures included the Brief Psychiatric Rating Scale, Clinician-Administered Dissociative States Scale, verbal fluency, Hopkins Verbal Learning Test, a biphasic alcohol effects scale, visual analog scales of mood states, and ketamine levels. Results: During ketamine infusion, individuals with a family history of ethanol dependence showed an attenuated response in terms of perceptual alterations and dysphoric mood relative to those without such a family history. Conclusions: These data suggest that alterations in NMDA receptor function may contribute to subjective response to ethanol and therefore also to the risk of developing alcoholism.

Current Geriatrics Reports, 2021

Purpose of Review The prevalence of alcohol use disorder (AUD) among older adults in the United S... more Purpose of Review The prevalence of alcohol use disorder (AUD) among older adults in the United States is rising, but remains underdiagnosed, underreported, and inadequately managed. This review highlights the medical, social, and cultural factors of AUD in older adults and provides guidelines for its screening, evaluation, and management. Recent Findings The COVID-19 pandemic has created additional challenges and barriers to care, as older adults may have disproportionate worsening of anxiety, depression, and substance use resulting from increased isolation related to physical distancing and shelter-in-place guidelines. Summary All older adults should be routinely screened for AUD with standardized screening tools. If a patient's screening results are positive, a clinician should conduct a brief assessment, which may be supplemented by laboratory tests. Most older adults at risk for alcohol misuse do not need specialized SUD treatment, but most can benefit from Screening, Brief Intervention, and Referral to Treatment (SBIRT) to prevent substance misuse before it occurs. Medications for the treatment of AUD in older adults include naltrexone, acamprosate, disulfiram, gabapentin and topiramate. Psychosocial treatments, including mutual help groups, are equally important.

Clinical Nurse Specialist, 2012

Is your older patient using or abusing drugs or alcohol? This video reviews how general psychiatr... more Is your older patient using or abusing drugs or alcohol? This video reviews how general psychiatrists can provide effective intervention when a substance abuse problem is identified.

Oxford Medicine Online, 2016

This chapter reviews an under-recognized aspect of geriatrics. The elderly population is growing ... more This chapter reviews an under-recognized aspect of geriatrics. The elderly population is growing in number, as is the proportion of aging baby-boomers at high risk for pain medication misuse and opioid use disorders. Given the widespread use of opioids in pain management, one can expect that problems with opioid use will increase among the elderly in the coming years. We describe the magnitude of the problem and discuss the importance of risk-stratification to identify which older patients are at elevated risk to develop problems with opioids. We examine the role of opioids in chronic pain treatment and the pitfalls of their use in the elderly. Finally, we provide general guidelines for the treatment of pain medication misuse and/or an opioid use disorder in the elderly. Opioid medication misuse and use disorders should be on every practitioner’s radar as a possible reason for problems surfacing in the elderly patient.

Community Mental Health Journal

Pediatrics, 1991

The opinions (level of agreement) of high school varsity football players with regard to reported... more The opinions (level of agreement) of high school varsity football players with regard to reported effects of anabolic steroids were assessed before and after two different education interventions. Lectures and handouts of a balanced education program (potential risks and benefits) were compared with a risks-only (negative or "scare tactics") presentation, in a controlled manner. Those receiving the balanced review significantly increased their agreement with 5 of 10 targeted adverse effects, while no change occurred for any risks among those taught by the negative intervention. A teaching model that only emphasizes the untoward consequences of anabolic steroids is ineffective, even in the short-term. A balanced education approach can improve understanding of the potential adverse effects of these drugs. Additional strategies may be required to change young athletes' attitudes toward anabolic androgenic steroid use.

MedEdPORTAL, 2017

Introduction: High-fidelity mannequin-based simulation is frequently used to compliment medical s... more Introduction: High-fidelity mannequin-based simulation is frequently used to compliment medical student education during clinical clerkships. However, psychiatric educators have not broadly adopted this modality, focusing rather on standardized patient actors. We developed and delivered a simulation case involving a patient with alcohol withdrawal and lithium toxicity followed by a debriefing session to medical students at the end of their psychiatric clerkship. Methods: The case involves a 40-year-old male truck driver with a history of bipolar disorder who presents to the emergency room after a truck accident. The patient is in alcohol withdrawal, which responds to benzodiazepines. A workup reveals that the patient also has lithium toxicity related to the co-ingestion of lithium and naproxen for pain. Participants learn to evaluate and treat alcohol withdrawal, consider medical comorbidities and legal consequences, and complete a brief intervention for substance use. This case requires a simulation mannequin. Results: To date, 150 second-, third-, and fourth-year medical students have participated in this case and 76 have been surveyed. Participants have provided a postsession rating of 4.49 on a 5-point Likert scale (1 = strongly disagree and 5 = strongly agree) on a question about enjoyment, and 3.93 on a question about confidence with evaluation and treatment of patients in alcohol withdrawal. Discussion: Psychiatric education currently underutilizes mannequin-based simulation compared to other medical disciplines. Mannequin simulation is feasible and effective in psychiatric education, especially in cases involving medical complexity, as shown in this novel case involving a patient with alcohol withdrawal and lithium toxicity.

Annals of the New York Academy of Sciences, 1994

Studies of the basic neurobiology of drug addiction, including alcoholism, should be given a high... more Studies of the basic neurobiology of drug addiction, including alcoholism, should be given a high priority for two reasons. First, from a clinical perspective, drug abuse continues to exact enormous human and financial costs on society, yet all currently available treatments for drug addiction are notoriously ineffective. The search for a better understanding of the neurobiological mechanisms underlying the addictive actions of drugs of abuse and of the genetic factors that contribute to addiction will result in crucial advances in our ability to treat and prevent drug addiction. Second, from a basic neuroscience perspective, study of the neurobiology of drug addiction offers a unique opportunity to establish the biological basis of a complex and clinically relevant behavioral abnormality. This is based largely on the availability of good animal models of drug addiction, which make it possible to study the detailed underlying mechanisms involved. Advances made in the field of drug addiction should provide important insights into mechanisms involved in other neuropsychiatric disorders, for which animal models are much less straightforward and much more difficult to interpret.

Academic Psychiatry

The use of standardized patients in medical education is longstanding [1]. Training with standard... more The use of standardized patients in medical education is longstanding [1]. Training with standardized patients has been shown to be effective [2] and correlates with high learner satisfaction [3]. It has also been shown to prepare students for effectively communicating difficult topics such as delivering bad news [4]. The use of standardized patients is of particular interest in psychiatry given the nuanced interviews that are conducted, the importance of the mental status exam and the need to observe and interpret subtle facial expressions and body language cues. Educators have used standardized patients to train students in the evaluation of alcohol use disorder [5], suicide risk assessment [6], and end of life care [7]. A recent study demonstrated the utility of SPs in training students to manage difficult clinical situations including depression/ suicidal ideation, somatoform disorder, anxiety disorder, and borderline personality disorder [8]. High fidelity manikin–based simulation has become increasingly popular in medical education, particularly in anesthesia and emergency medicine [9–11]. Given the propensity to rely on the patient interview and mental status examination, psychiatry educators tend to prefer standardized patients over manikin-based simulation [12]. A 2016 systematic review of simulation activities in undergraduate psychiatry found 63 publications meeting inclusion criteria with 48 using standardized patients, 16 using online or virtual models, and only one using manikin-based simulation [12]. Unlike standardized patients, however, manikin-based simulation can represent the physiologic aspects of a patient’s illness and demonstrate real-time autonomous reactions to interventions and therapies [13]. There is a paucity of literature on the use of manikin-based simulation in psychiatry education. Two such studies looked at altered mental status and various scenarios involving drug and alcohol use. Both studies found significant changes in survey responses after the sessions [14, 15]. A detailed manikin-based simulation case involving alcohol withdrawal and lithium toxicity, demonstrating the utility of this technology for psychiatry clerkship education, has previously been published [16]. The primary aim of this study is to assess and compare the educational utility–particularly the acceptability to learners and the effectiveness at improving confidence in clinical skills–of two simulation modalities for teaching basic psychiatric concepts to clerkship medical students: traditional standardized patients vs manikin-based simulation.

Medicine and Science in Sports and Exercise

…, 2007

Rationale A growing number of investigators are studying ketamine effects in healthy human subjec... more Rationale A growing number of investigators are studying ketamine effects in healthy human subjects, but concerns remain about its safety as a research tool. Therefore, it is timely to revisit the safety of subanesthetic doses of ketamine in experimental ...

The American Journal of Geriatric Psychiatry

Administration and Policy in Mental Health and Mental Health Services Research

The American Journal of Geriatric Psychiatry

The American journal on addictions, Jan 18, 2018

While alcohol use disorder is prevalent in U.S. veterans, little is known about the nature and de... more While alcohol use disorder is prevalent in U.S. veterans, little is known about the nature and determinants of predominant trajectories of alcohol consumption in this population. The objective of the current study was to identify predominant trajectories of alcohol consumption over a 4-year period, and baseline determinants of these trajectories in veterans. Data were analyzed from the National Health and Resilience in Veteran Study, which surveyed a nationally representative sample of 3,157 veterans (Wave 1). Assessments (Waves 2 and 3) were conducted every 2 years thereafter. Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test-Consumption, a brief alcohol screen for identifying problematic drinking based on alcohol consumption. Wave 1 sociodemographic, military, health, and psychosocial variables were examined as possible determinants of trajectories of alcohol consumption. Latent growth mixture modeling revealed that a four-class model best fit th...

Alcohol misuse in older adults is often underdiagnosed in medical practice. This age group is rap... more Alcohol misuse in older adults is often underdiagnosed in medical practice. This age group is rapidly moving into the treatment realm of the practicing general, geriatric, and addiction psychiatrist.

Psychiatric Services, Aug 1, 2018

The U.S. Department of Veterans Affairs (VA) is shifting its focus from ending veteran homelessne... more The U.S. Department of Veterans Affairs (VA) is shifting its focus from ending veteran homelessness to preventing veteran suicides. With supporting data, this Open Forum argues that VA homelessness services also help address veteran suicides. Analysis of a nationally representative survey of U.S. veterans in 2015 shows that veterans with a history of homelessness attempted suicide in the previous two years at a rate .5.0 times higher compared with veterans without a history of homelessness (6.9% versus 1.2%), and their rates of two-week Psychiatric Services 69:8, August 2018 ps.psychiatryonline.org 937 TSAI ET AL.

Medicine and Science in Sports and Exercise, Apr 1, 1980

American Journal of Psychiatry, Oct 1, 2004

Objective: A family history of alcoholism is a risk factor for the development of ethanol depende... more Objective: A family history of alcoholism is a risk factor for the development of ethanol dependence. Ethanol is an antagonist of the N-methyl-D-aspartate (NMDA) glutamate receptor, and alterations in NMDA receptor function are thought to be involved in ethanol abuse and dependence. The purpose of this study was to determine in healthy individuals with no ethanol dependence whether response to the NMDA receptor antagonist ketamine would differentiate those with a family history of ethanol dependence from those without such a family history. Method: Healthy subjects between the ages of 21 and 30 received 40-minute intravenous infusions of saline, low-dose ketamine (0.1 mg/kg), and high-dose ketamine (0.5 mg/kg) on three separate test days in a randomized order under doubleblind conditions. The healthy individuals with at least one first-degree relative and another first-or second-degree relative with ethanol dependence (N=16) were compared with those who had no family history of ethanol dependence in any firstor second-degree relative (N=29). Outcome measures included the Brief Psychiatric Rating Scale, Clinician-Administered Dissociative States Scale, verbal fluency, Hopkins Verbal Learning Test, a biphasic alcohol effects scale, visual analog scales of mood states, and ketamine levels. Results: During ketamine infusion, individuals with a family history of ethanol dependence showed an attenuated response in terms of perceptual alterations and dysphoric mood relative to those without such a family history. Conclusions: These data suggest that alterations in NMDA receptor function may contribute to subjective response to ethanol and therefore also to the risk of developing alcoholism.

Current Geriatrics Reports, 2021

Purpose of Review The prevalence of alcohol use disorder (AUD) among older adults in the United S... more Purpose of Review The prevalence of alcohol use disorder (AUD) among older adults in the United States is rising, but remains underdiagnosed, underreported, and inadequately managed. This review highlights the medical, social, and cultural factors of AUD in older adults and provides guidelines for its screening, evaluation, and management. Recent Findings The COVID-19 pandemic has created additional challenges and barriers to care, as older adults may have disproportionate worsening of anxiety, depression, and substance use resulting from increased isolation related to physical distancing and shelter-in-place guidelines. Summary All older adults should be routinely screened for AUD with standardized screening tools. If a patient's screening results are positive, a clinician should conduct a brief assessment, which may be supplemented by laboratory tests. Most older adults at risk for alcohol misuse do not need specialized SUD treatment, but most can benefit from Screening, Brief Intervention, and Referral to Treatment (SBIRT) to prevent substance misuse before it occurs. Medications for the treatment of AUD in older adults include naltrexone, acamprosate, disulfiram, gabapentin and topiramate. Psychosocial treatments, including mutual help groups, are equally important.

Clinical Nurse Specialist, 2012

Is your older patient using or abusing drugs or alcohol? This video reviews how general psychiatr... more Is your older patient using or abusing drugs or alcohol? This video reviews how general psychiatrists can provide effective intervention when a substance abuse problem is identified.

Oxford Medicine Online, 2016

This chapter reviews an under-recognized aspect of geriatrics. The elderly population is growing ... more This chapter reviews an under-recognized aspect of geriatrics. The elderly population is growing in number, as is the proportion of aging baby-boomers at high risk for pain medication misuse and opioid use disorders. Given the widespread use of opioids in pain management, one can expect that problems with opioid use will increase among the elderly in the coming years. We describe the magnitude of the problem and discuss the importance of risk-stratification to identify which older patients are at elevated risk to develop problems with opioids. We examine the role of opioids in chronic pain treatment and the pitfalls of their use in the elderly. Finally, we provide general guidelines for the treatment of pain medication misuse and/or an opioid use disorder in the elderly. Opioid medication misuse and use disorders should be on every practitioner’s radar as a possible reason for problems surfacing in the elderly patient.

Community Mental Health Journal

Pediatrics, 1991

The opinions (level of agreement) of high school varsity football players with regard to reported... more The opinions (level of agreement) of high school varsity football players with regard to reported effects of anabolic steroids were assessed before and after two different education interventions. Lectures and handouts of a balanced education program (potential risks and benefits) were compared with a risks-only (negative or "scare tactics") presentation, in a controlled manner. Those receiving the balanced review significantly increased their agreement with 5 of 10 targeted adverse effects, while no change occurred for any risks among those taught by the negative intervention. A teaching model that only emphasizes the untoward consequences of anabolic steroids is ineffective, even in the short-term. A balanced education approach can improve understanding of the potential adverse effects of these drugs. Additional strategies may be required to change young athletes' attitudes toward anabolic androgenic steroid use.

MedEdPORTAL, 2017

Introduction: High-fidelity mannequin-based simulation is frequently used to compliment medical s... more Introduction: High-fidelity mannequin-based simulation is frequently used to compliment medical student education during clinical clerkships. However, psychiatric educators have not broadly adopted this modality, focusing rather on standardized patient actors. We developed and delivered a simulation case involving a patient with alcohol withdrawal and lithium toxicity followed by a debriefing session to medical students at the end of their psychiatric clerkship. Methods: The case involves a 40-year-old male truck driver with a history of bipolar disorder who presents to the emergency room after a truck accident. The patient is in alcohol withdrawal, which responds to benzodiazepines. A workup reveals that the patient also has lithium toxicity related to the co-ingestion of lithium and naproxen for pain. Participants learn to evaluate and treat alcohol withdrawal, consider medical comorbidities and legal consequences, and complete a brief intervention for substance use. This case requires a simulation mannequin. Results: To date, 150 second-, third-, and fourth-year medical students have participated in this case and 76 have been surveyed. Participants have provided a postsession rating of 4.49 on a 5-point Likert scale (1 = strongly disagree and 5 = strongly agree) on a question about enjoyment, and 3.93 on a question about confidence with evaluation and treatment of patients in alcohol withdrawal. Discussion: Psychiatric education currently underutilizes mannequin-based simulation compared to other medical disciplines. Mannequin simulation is feasible and effective in psychiatric education, especially in cases involving medical complexity, as shown in this novel case involving a patient with alcohol withdrawal and lithium toxicity.

Annals of the New York Academy of Sciences, 1994

Studies of the basic neurobiology of drug addiction, including alcoholism, should be given a high... more Studies of the basic neurobiology of drug addiction, including alcoholism, should be given a high priority for two reasons. First, from a clinical perspective, drug abuse continues to exact enormous human and financial costs on society, yet all currently available treatments for drug addiction are notoriously ineffective. The search for a better understanding of the neurobiological mechanisms underlying the addictive actions of drugs of abuse and of the genetic factors that contribute to addiction will result in crucial advances in our ability to treat and prevent drug addiction. Second, from a basic neuroscience perspective, study of the neurobiology of drug addiction offers a unique opportunity to establish the biological basis of a complex and clinically relevant behavioral abnormality. This is based largely on the availability of good animal models of drug addiction, which make it possible to study the detailed underlying mechanisms involved. Advances made in the field of drug addiction should provide important insights into mechanisms involved in other neuropsychiatric disorders, for which animal models are much less straightforward and much more difficult to interpret.

Academic Psychiatry

The use of standardized patients in medical education is longstanding [1]. Training with standard... more The use of standardized patients in medical education is longstanding [1]. Training with standardized patients has been shown to be effective [2] and correlates with high learner satisfaction [3]. It has also been shown to prepare students for effectively communicating difficult topics such as delivering bad news [4]. The use of standardized patients is of particular interest in psychiatry given the nuanced interviews that are conducted, the importance of the mental status exam and the need to observe and interpret subtle facial expressions and body language cues. Educators have used standardized patients to train students in the evaluation of alcohol use disorder [5], suicide risk assessment [6], and end of life care [7]. A recent study demonstrated the utility of SPs in training students to manage difficult clinical situations including depression/ suicidal ideation, somatoform disorder, anxiety disorder, and borderline personality disorder [8]. High fidelity manikin–based simulation has become increasingly popular in medical education, particularly in anesthesia and emergency medicine [9–11]. Given the propensity to rely on the patient interview and mental status examination, psychiatry educators tend to prefer standardized patients over manikin-based simulation [12]. A 2016 systematic review of simulation activities in undergraduate psychiatry found 63 publications meeting inclusion criteria with 48 using standardized patients, 16 using online or virtual models, and only one using manikin-based simulation [12]. Unlike standardized patients, however, manikin-based simulation can represent the physiologic aspects of a patient’s illness and demonstrate real-time autonomous reactions to interventions and therapies [13]. There is a paucity of literature on the use of manikin-based simulation in psychiatry education. Two such studies looked at altered mental status and various scenarios involving drug and alcohol use. Both studies found significant changes in survey responses after the sessions [14, 15]. A detailed manikin-based simulation case involving alcohol withdrawal and lithium toxicity, demonstrating the utility of this technology for psychiatry clerkship education, has previously been published [16]. The primary aim of this study is to assess and compare the educational utility–particularly the acceptability to learners and the effectiveness at improving confidence in clinical skills–of two simulation modalities for teaching basic psychiatric concepts to clerkship medical students: traditional standardized patients vs manikin-based simulation.

Medicine and Science in Sports and Exercise

…, 2007

Rationale A growing number of investigators are studying ketamine effects in healthy human subjec... more Rationale A growing number of investigators are studying ketamine effects in healthy human subjects, but concerns remain about its safety as a research tool. Therefore, it is timely to revisit the safety of subanesthetic doses of ketamine in experimental ...

The American Journal of Geriatric Psychiatry

Administration and Policy in Mental Health and Mental Health Services Research

The American Journal of Geriatric Psychiatry

The American journal on addictions, Jan 18, 2018

While alcohol use disorder is prevalent in U.S. veterans, little is known about the nature and de... more While alcohol use disorder is prevalent in U.S. veterans, little is known about the nature and determinants of predominant trajectories of alcohol consumption in this population. The objective of the current study was to identify predominant trajectories of alcohol consumption over a 4-year period, and baseline determinants of these trajectories in veterans. Data were analyzed from the National Health and Resilience in Veteran Study, which surveyed a nationally representative sample of 3,157 veterans (Wave 1). Assessments (Waves 2 and 3) were conducted every 2 years thereafter. Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test-Consumption, a brief alcohol screen for identifying problematic drinking based on alcohol consumption. Wave 1 sociodemographic, military, health, and psychosocial variables were examined as possible determinants of trajectories of alcohol consumption. Latent growth mixture modeling revealed that a four-class model best fit th...