Aniyizhai Annamalai - Academia.edu (original) (raw)

Papers by Aniyizhai Annamalai

Medical Management of Psychotropic Side Effects, 2017

Creatine kinase (CK) is an enzyme released into serum in response to muscle injury. The prevalenc... more Creatine kinase (CK) is an enzyme released into serum in response to muscle injury. The prevalence and extent of CK elevation depends on the underlying cause.

Medical Management of Psychotropic Side Effects, 2017

It is defined as a decrease in all blood cell lines resulting in anemia, neutropenia, and thrombo... more It is defined as a decrease in all blood cell lines resulting in anemia, neutropenia, and thrombocytopenia. Pathology There is a deficiency of hematopoietic stem cells in the bone marrow due to direct toxicity by external agents, immune destruction of stem cells, or bone marrow replacement by malignancy or fibrosis. Rarely, pancytopenia is congenital. Etiology Acquired pancytopenia is due to drugs (sulfonamides, anticonvulsants), viral infections, and autoimmune disease. It is an expected side effect of chemotherapeutic treatment.

Academic Psychiatry, 2016

Early Intervention in Psychiatry, 2015

Aim-The first-episode psychosis (FEP) represents a critical period to prevent cardiovascular and ... more Aim-The first-episode psychosis (FEP) represents a critical period to prevent cardiovascular and metabolic morbidity decades later. Antipsychotic (AP)-induced weight gain is one modifiable factor in this period. The purpose of this study is to conduct a meta-analysis of AP-induced weight and body mass index (BMI) change in FEP. Methods-A comprehensive literature search identified 28 articles that reported data on APspecific weight or BMI change in FEP. We conducted a meta-analysis of short-and long-term mean weight and BMI differences between placebo and AP medications. We also performed subgroup and meta-regression analysis to examine weight, BMI outcomes and their relationship with location (Asian vs. Western), sponsorship and baseline weight and BMIs. Results-Compared to placebo, AP-caused mean weight gain was 3.22 kg and 1.4 points BMI in the short-term, and 5.30 kg and 1.86 points BMI in the long term. Clinically significant weight gain risk increased about twofold with AP use. Weight gain was associated with duration of AP use. AP medications were associated with more weight gain in Western samples as opposed to Asian samples. Most AP medications were associated with significant body weight gain and BMI increase in FEP patients, except for ziprasidone. Olanzapine and clozapine caused the highest weight gain compared to placebo. Conclusion-Except for ziprasidone, most AP medications were associated with body weight gain and BMI increase in FEP patients. Early and continuing effects of various AP medications on weight gain and BMI increase should be taken into consideration by clinicians.

Psychosomatics, 2015

Background-Patients with schizophrenia have high rates of obesity and cardiovascular morbidity, w... more Background-Patients with schizophrenia have high rates of obesity and cardiovascular morbidity, which are strongly associated with obstructive sleep apnea (OSA). The prevalence and risk factors for OSA are not well studied in patients with schizophrenia. Objective-The purpose of this study was to evaluate the frequency of OSA symptoms in a sample of outpatients with schizophrenia. Methods-This cross-sectional study was a secondary analysis of data generated from an insomnia study that evaluated 175 outpatients with schizophrenia or schizo-affective disorder in a single, large urban community mental health center. Results of scales evaluating insomnia were used to complete the STOP questionnaire, which is a screening tool for OSA validated in surgical populations. Appropriate statistical analysis was done to compare participants across groups. Results-Patients were classified into high risk for OSA (STOP ≥ 2) (57.7%), and low risk for OSA (STOP score < 2) (42.3%). We also identified patients with a known diagnosis of OSA (14.9%). Patients with diagnosed OSA had significantly higher STOP scores (mean 2.7 vs. 1.6 [t = 6.3; p < 0.001]). Only 23.8% of patients in the high-risk group were diagnosed with OSA. Body mass index was significantly higher in the diagnosed group (F[2,169] = 25; p < 0.001) as was diabetes (χ2 [2, N = 175] = 35, p < 0.001). Conclusion-A large number of outpatients with severe mental illness are at high risk for OSA. The STOP questionnaire is easy to use and appears to have a very high clinical utility to detect OSA. Based on our findings, further studies are warranted to validate the tool in patients with severe mental illness.

This reading list is produced by The King's Fund Information and Library Service. The items on th... more This reading list is produced by The King's Fund Information and Library Service. The items on this list are selected only from items held by the Information and Library Service or are freely available on the Internet. It does not aim to be comprehensive, or to be a 'recommended reading list'-but to give an indication of the sorts of resources The King's Fund can make available on this topic.

Journal of General Internal Medicine, 2008

Carcinomatous polyarthritis (CP) is a rare paraneoplastic disorder that has been associated with ... more Carcinomatous polyarthritis (CP) is a rare paraneoplastic disorder that has been associated with a variety of solid tumors. It presents in a similar manner to other polyarticular disorders and often precedes detection of the underlying malignancy, making recognition critical. CP responds to the treatment of the neoplastic process. We present a patient who initially presented with asymmetric inflammatory polyarthritis who was later diagnosed with bronchogenic carcinoma. Following the case report we present our learning objectives, which include the differential diagnosis of inflammatory polyarthritis, diagnostic approach to CP, and features that distinguish it from other more common causes of polyarthritis. We conclude with a brief discussion of the pathophysiology and management of CP.

Many drugs besides psychotropic medications are associated with hematologic abnormalities. One or... more Many drugs besides psychotropic medications are associated with hematologic abnormalities. One or more cell lines may be affected depending on the drug and its mechanism of action. Drug-induced blood dyscrasias occur infrequently other than when associated with chemotherapy. The exact incidence varies with each medication.

Diabetes mellitus (DM) prevalence is reported as high as 10% in the general population and is eve... more Diabetes mellitus (DM) prevalence is reported as high as 10% in the general population and is even higher in those with mental illness. An elevated blood sugar is seen in almost 20% patients with serious mental illness [1]. The cutoffs for accepted and commonly used measures to diagnose DM are shown in the section on diagnosis later.

Physicians should play a central role in delivering effective physical activity interventions for... more Physicians should play a central role in delivering effective physical activity interventions for their patients with serious mental illness. Despite clear recommendations for frequency and amount of physical activity and effective interventions to support patients in meeting these goals, it still is not the standard of care in primary care to routinely assess physical activity and advice or assist in treatment planning. These health promotion activities are even less likely to occur during psychiatric visits. Given their role as a trusted source of health information, physicians have an obligation to assess their patients' exercise habits and inform them of the risks of living a sedentary lifestyle. This approach is critical to help stem the rising tide of deaths around the world due to chronic diseases, which are closely associated with a sedentary lifestyle and which are highly prevalent among individuals with serious mental illness. Active involvement by community mental hea...

Background Refugees are frequently not immune to vaccine-preventable infections. Adherence to con... more Background Refugees are frequently not immune to vaccine-preventable infections. Adherence to consensus guidelines on vaccination and infectious diseases screening among refugees resettling in the U.S. is unknown. We sought to determine rates of vaccine completion and infectious diseases screening in refugees following resettlement. Methods We conducted a retrospective cohort study of refugees resettling in a region in the U.S. using medical data from June 2013–April 2015. We determined the proportion of vaccine-eligible refugees vaccinated with measles-mumps-rubella (MMR), hepatitis A/B, tetanus, diphtheria, and acellular pertussis (Tdap), and human papillomavirus (HPV) following resettlement. We also determined the proportion of refugees who completed HIV and hepatitis C (HCV) screening. Results One hundred and eleven subjects were included, primarily from Iraq (53%), Afghanistan (19%), and Eritrea (11%). Of the 84 subjects who were vaccine-eligible, 78 (93%) initiated and 42 (50%...

This chapter is an overview of general principles of prescribing psychotropic medications in peop... more This chapter is an overview of general principles of prescribing psychotropic medications in people with preexisting medical conditions. Effects of failure in major organ systems that affect drug absorption, metabolism, and excretion are reviewed.

Extrapyramidal symptoms (EPS) refer to movement disorders that result from lesions in the basal g... more Extrapyramidal symptoms (EPS) refer to movement disorders that result from lesions in the basal ganglia and its connections, due to interference with dopaminergic transmission. Antipsychotics are a common cause of EPS.

Refugee Health Care

Introduction (definition of refugees, the global burden of refugees, UN resettlement process, the... more Introduction (definition of refugees, the global burden of refugees, UN resettlement process, the role of national and local resettlement agencies, and recent trends in refugee arrivals).- Psychosocial determinants of health.- Initial refugee screening.- Immunizations.- Tuburculosis.- Parasitic infections.- Viral hepatitis.- Malaria.- Sexually transmitted diseases.- Chronic diseases.- Prevalence of mental health disorders.- Screening for mental illness.- Treatment of mental illness.- Refugee womens health.- Health issues in refugee children.- Forensic evaluation of asylum seekers.- Violence and refugees.- Future of refugee health care.

Open Forum Infectious Diseases, 2017

diarrhea in 8 (53.3%), constipation in 3 (20%), rectal bleeding in 2 (13.3%), palpable abdominal ... more diarrhea in 8 (53.3%), constipation in 3 (20%), rectal bleeding in 2 (13.3%), palpable abdominal mass in 5 (33%), hepatomegaly in 3 (20%) splenomegaly in 3 (20%), ascites in 5 (33.3%) and four (26.6%) had family history of TB. BAAR test was positive in 6 (40%) A positive culture was obtained in 7 patients (46%) four were M. bovis and the rest M. tuberculosis. Only in three patients underwent Xpert TB test which resulting positive. Eight patients (53%) had enlarged intra-abdominal lymph nodes, abdominal mass in 6 (40%); ascites in 5 (33.3%) and calcifications in 4 (26.6%). Chest X-ray was abnormal in three patients. Five patients (33.3%) were admitted with the diagnosis of lymphoma and one with Crohn´s disease. Twelve children underwent laparotomy. Eight developed bowel perforation and all required intestinal resection. Three were multidrug-resistant. Five patients had immunodeficiency. Duration of treatment was 18 to 24 months. None of the children died. Conclusion. The diagnosis of abdominal tuberculosis may be especially challenging as lack of suspicion often leads to delayed diagnosis and if not treated early can lead to very severe complications, so the clinician should have a high level of suspicion for early diagnosis and appropriate treatment. Disclosures. All authors: No reported disclosures.

Medical Management of Psychotropic Side Effects, 2017

Medical Management of Psychotropic Side Effects, 2017

Creatine kinase (CK) is an enzyme released into serum in response to muscle injury. The prevalenc... more Creatine kinase (CK) is an enzyme released into serum in response to muscle injury. The prevalence and extent of CK elevation depends on the underlying cause.

Medical Management of Psychotropic Side Effects, 2017

It is defined as a decrease in all blood cell lines resulting in anemia, neutropenia, and thrombo... more It is defined as a decrease in all blood cell lines resulting in anemia, neutropenia, and thrombocytopenia. Pathology There is a deficiency of hematopoietic stem cells in the bone marrow due to direct toxicity by external agents, immune destruction of stem cells, or bone marrow replacement by malignancy or fibrosis. Rarely, pancytopenia is congenital. Etiology Acquired pancytopenia is due to drugs (sulfonamides, anticonvulsants), viral infections, and autoimmune disease. It is an expected side effect of chemotherapeutic treatment.

Academic Psychiatry, 2016

Early Intervention in Psychiatry, 2015

Aim-The first-episode psychosis (FEP) represents a critical period to prevent cardiovascular and ... more Aim-The first-episode psychosis (FEP) represents a critical period to prevent cardiovascular and metabolic morbidity decades later. Antipsychotic (AP)-induced weight gain is one modifiable factor in this period. The purpose of this study is to conduct a meta-analysis of AP-induced weight and body mass index (BMI) change in FEP. Methods-A comprehensive literature search identified 28 articles that reported data on APspecific weight or BMI change in FEP. We conducted a meta-analysis of short-and long-term mean weight and BMI differences between placebo and AP medications. We also performed subgroup and meta-regression analysis to examine weight, BMI outcomes and their relationship with location (Asian vs. Western), sponsorship and baseline weight and BMIs. Results-Compared to placebo, AP-caused mean weight gain was 3.22 kg and 1.4 points BMI in the short-term, and 5.30 kg and 1.86 points BMI in the long term. Clinically significant weight gain risk increased about twofold with AP use. Weight gain was associated with duration of AP use. AP medications were associated with more weight gain in Western samples as opposed to Asian samples. Most AP medications were associated with significant body weight gain and BMI increase in FEP patients, except for ziprasidone. Olanzapine and clozapine caused the highest weight gain compared to placebo. Conclusion-Except for ziprasidone, most AP medications were associated with body weight gain and BMI increase in FEP patients. Early and continuing effects of various AP medications on weight gain and BMI increase should be taken into consideration by clinicians.

Psychosomatics, 2015

Background-Patients with schizophrenia have high rates of obesity and cardiovascular morbidity, w... more Background-Patients with schizophrenia have high rates of obesity and cardiovascular morbidity, which are strongly associated with obstructive sleep apnea (OSA). The prevalence and risk factors for OSA are not well studied in patients with schizophrenia. Objective-The purpose of this study was to evaluate the frequency of OSA symptoms in a sample of outpatients with schizophrenia. Methods-This cross-sectional study was a secondary analysis of data generated from an insomnia study that evaluated 175 outpatients with schizophrenia or schizo-affective disorder in a single, large urban community mental health center. Results of scales evaluating insomnia were used to complete the STOP questionnaire, which is a screening tool for OSA validated in surgical populations. Appropriate statistical analysis was done to compare participants across groups. Results-Patients were classified into high risk for OSA (STOP ≥ 2) (57.7%), and low risk for OSA (STOP score < 2) (42.3%). We also identified patients with a known diagnosis of OSA (14.9%). Patients with diagnosed OSA had significantly higher STOP scores (mean 2.7 vs. 1.6 [t = 6.3; p < 0.001]). Only 23.8% of patients in the high-risk group were diagnosed with OSA. Body mass index was significantly higher in the diagnosed group (F[2,169] = 25; p < 0.001) as was diabetes (χ2 [2, N = 175] = 35, p < 0.001). Conclusion-A large number of outpatients with severe mental illness are at high risk for OSA. The STOP questionnaire is easy to use and appears to have a very high clinical utility to detect OSA. Based on our findings, further studies are warranted to validate the tool in patients with severe mental illness.

This reading list is produced by The King's Fund Information and Library Service. The items on th... more This reading list is produced by The King's Fund Information and Library Service. The items on this list are selected only from items held by the Information and Library Service or are freely available on the Internet. It does not aim to be comprehensive, or to be a 'recommended reading list'-but to give an indication of the sorts of resources The King's Fund can make available on this topic.

Journal of General Internal Medicine, 2008

Carcinomatous polyarthritis (CP) is a rare paraneoplastic disorder that has been associated with ... more Carcinomatous polyarthritis (CP) is a rare paraneoplastic disorder that has been associated with a variety of solid tumors. It presents in a similar manner to other polyarticular disorders and often precedes detection of the underlying malignancy, making recognition critical. CP responds to the treatment of the neoplastic process. We present a patient who initially presented with asymmetric inflammatory polyarthritis who was later diagnosed with bronchogenic carcinoma. Following the case report we present our learning objectives, which include the differential diagnosis of inflammatory polyarthritis, diagnostic approach to CP, and features that distinguish it from other more common causes of polyarthritis. We conclude with a brief discussion of the pathophysiology and management of CP.

Many drugs besides psychotropic medications are associated with hematologic abnormalities. One or... more Many drugs besides psychotropic medications are associated with hematologic abnormalities. One or more cell lines may be affected depending on the drug and its mechanism of action. Drug-induced blood dyscrasias occur infrequently other than when associated with chemotherapy. The exact incidence varies with each medication.

Diabetes mellitus (DM) prevalence is reported as high as 10% in the general population and is eve... more Diabetes mellitus (DM) prevalence is reported as high as 10% in the general population and is even higher in those with mental illness. An elevated blood sugar is seen in almost 20% patients with serious mental illness [1]. The cutoffs for accepted and commonly used measures to diagnose DM are shown in the section on diagnosis later.

Physicians should play a central role in delivering effective physical activity interventions for... more Physicians should play a central role in delivering effective physical activity interventions for their patients with serious mental illness. Despite clear recommendations for frequency and amount of physical activity and effective interventions to support patients in meeting these goals, it still is not the standard of care in primary care to routinely assess physical activity and advice or assist in treatment planning. These health promotion activities are even less likely to occur during psychiatric visits. Given their role as a trusted source of health information, physicians have an obligation to assess their patients' exercise habits and inform them of the risks of living a sedentary lifestyle. This approach is critical to help stem the rising tide of deaths around the world due to chronic diseases, which are closely associated with a sedentary lifestyle and which are highly prevalent among individuals with serious mental illness. Active involvement by community mental hea...

Background Refugees are frequently not immune to vaccine-preventable infections. Adherence to con... more Background Refugees are frequently not immune to vaccine-preventable infections. Adherence to consensus guidelines on vaccination and infectious diseases screening among refugees resettling in the U.S. is unknown. We sought to determine rates of vaccine completion and infectious diseases screening in refugees following resettlement. Methods We conducted a retrospective cohort study of refugees resettling in a region in the U.S. using medical data from June 2013–April 2015. We determined the proportion of vaccine-eligible refugees vaccinated with measles-mumps-rubella (MMR), hepatitis A/B, tetanus, diphtheria, and acellular pertussis (Tdap), and human papillomavirus (HPV) following resettlement. We also determined the proportion of refugees who completed HIV and hepatitis C (HCV) screening. Results One hundred and eleven subjects were included, primarily from Iraq (53%), Afghanistan (19%), and Eritrea (11%). Of the 84 subjects who were vaccine-eligible, 78 (93%) initiated and 42 (50%...

This chapter is an overview of general principles of prescribing psychotropic medications in peop... more This chapter is an overview of general principles of prescribing psychotropic medications in people with preexisting medical conditions. Effects of failure in major organ systems that affect drug absorption, metabolism, and excretion are reviewed.

Extrapyramidal symptoms (EPS) refer to movement disorders that result from lesions in the basal g... more Extrapyramidal symptoms (EPS) refer to movement disorders that result from lesions in the basal ganglia and its connections, due to interference with dopaminergic transmission. Antipsychotics are a common cause of EPS.

Refugee Health Care

Introduction (definition of refugees, the global burden of refugees, UN resettlement process, the... more Introduction (definition of refugees, the global burden of refugees, UN resettlement process, the role of national and local resettlement agencies, and recent trends in refugee arrivals).- Psychosocial determinants of health.- Initial refugee screening.- Immunizations.- Tuburculosis.- Parasitic infections.- Viral hepatitis.- Malaria.- Sexually transmitted diseases.- Chronic diseases.- Prevalence of mental health disorders.- Screening for mental illness.- Treatment of mental illness.- Refugee womens health.- Health issues in refugee children.- Forensic evaluation of asylum seekers.- Violence and refugees.- Future of refugee health care.

Open Forum Infectious Diseases, 2017

diarrhea in 8 (53.3%), constipation in 3 (20%), rectal bleeding in 2 (13.3%), palpable abdominal ... more diarrhea in 8 (53.3%), constipation in 3 (20%), rectal bleeding in 2 (13.3%), palpable abdominal mass in 5 (33%), hepatomegaly in 3 (20%) splenomegaly in 3 (20%), ascites in 5 (33.3%) and four (26.6%) had family history of TB. BAAR test was positive in 6 (40%) A positive culture was obtained in 7 patients (46%) four were M. bovis and the rest M. tuberculosis. Only in three patients underwent Xpert TB test which resulting positive. Eight patients (53%) had enlarged intra-abdominal lymph nodes, abdominal mass in 6 (40%); ascites in 5 (33.3%) and calcifications in 4 (26.6%). Chest X-ray was abnormal in three patients. Five patients (33.3%) were admitted with the diagnosis of lymphoma and one with Crohn´s disease. Twelve children underwent laparotomy. Eight developed bowel perforation and all required intestinal resection. Three were multidrug-resistant. Five patients had immunodeficiency. Duration of treatment was 18 to 24 months. None of the children died. Conclusion. The diagnosis of abdominal tuberculosis may be especially challenging as lack of suspicion often leads to delayed diagnosis and if not treated early can lead to very severe complications, so the clinician should have a high level of suspicion for early diagnosis and appropriate treatment. Disclosures. All authors: No reported disclosures.

Medical Management of Psychotropic Side Effects, 2017