Itai Danovitch - Academia.edu (original) (raw)

Papers by Itai Danovitch

The Assessment and Treatment of Addiction, 2019

Cannabis is the most commonly used illicit substance worldwide. Approximately 8%–12% of persons w... more Cannabis is the most commonly used illicit substance worldwide. Approximately 8%–12% of persons who use cannabis will develop cannabis use disorder (CUD) at some point in their life. Several psychosocial treatment methods have shown efficacy in controlled clinical trials, including motivational enhancement therapy, cognitive behavioral therapy, and contingency management. While no pharmacotherapy has been established as broadly effective for CUD, gabapentin and N-acetylcysteine have shown efficacy in single controlled clinical trials, and a number of promising approaches are under study. This article reviews established and emerging pharmacological and psychosocial treatment options for CUD, both alone and with psychiatric comorbidity.

OBJECTIVE: While trazodone is approved for the treatment of depression, the off-label use of this... more OBJECTIVE: While trazodone is approved for the treatment of depression, the off-label use of this medication for insomnia has surpassed its usage as an antidepressant. In this systematic review, we examined the evidence for the efficacy and safety of trazodone for insomnia. METHODS: A literature search was conducted using MEDLINE/PubMed databases from the past 33 years (1983-2016) and the keywords insomnia, trazodone, sedative, treatment, and hypnotics. The results were restricted to English language and human subjects. All randomized clinical trials, meta-analyses, observational studies, and placebo-controlled trials regarding trazodone for the treatment of primary or secondary insomnia were reported, per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The study selection process yielded a total of 45 studies. RESULTS: Evidence for the efficacy of trazodone has been repeatedly demonstrated for primary insomnia, as well as secondary insomnia, ...

Objective: This paper sought to review the impact of depression in patients with comorbid medical... more Objective: This paper sought to review the impact of depression in patients with comorbid medical problems, the importance of bridging the gap between inpatient and outpatient care for medical inpatients with depression (especially for organizations that treat patients in both settings), and the elements necessary to implement a pilot for an outpatient Collaborative Care Management program for patients with depression following medical admissions. Taken into account is the presence of new billing mechanisms and potential cost offsets. Methods: The literature referenced in this paper was identified through a search of online databases, including PubMed and Google Scholar. The data used to analyze cost were drawn from national, publicly available sources, such as the Kaiser Family Foundation, Bureau of Labor Statistics, and the Organisation for Economic Cooperation and Development. Results: Collaborative care is an evidence-based intervention for depression that can aid with successfu...

Objective: This paper sought to identify the instruments used to measure depression in heart fail... more Objective: This paper sought to identify the instruments used to measure depression in heart failure (HF) and elucidate the impact of treatment interventions on depression in HF. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. Studies published from 1988 to 2018 covering depression and HF were identified through the review of the PubMed and PsycINFO databases using the keywords: "depres*" AND "heart failure." Two authors independently conducted a focused analysis, identifying 27 studies that met the specific selection criteria and passed the study quality checks. Results: Patient-reported questionnaires were more commonly adopted than clinician-rated questionnaires, including the Beck Depression Inventory, the Patient Health Questionnaire (PHQ-9), and the Hospital Anxiety and Depression Scale. Six common interventions were observed: antidepressant medications, collaborative care, psychotherapy, exercise, e...

Addiction Research

Objectives: We sought to examine alcohol use disorder (AUD) among general hospital medical inpati... more Objectives: We sought to examine alcohol use disorder (AUD) among general hospital medical inpatients with respect to identification, service utilization, and initiation of medication-assisted treatment. Methods: We performed a retrospective chart review for all adult inpatients over one full calendar year. Subjects were separated into two categories: patients with chart documentation of an AUD diagnosis and those without such documentation. We extracted from the electronic health record and analyzed information on demographics, service utilization, and treatment initiation of medication-assisted treatment for AUD such as naltrexone, disulfiram, or acamprosate. Results: The study revealed three main findings: 1) Less than one percent of patients discharged from the hospital in one full calendar year had an identified AUD diagnosis. 2) Patients with an AUD diagnosis had a significantly higher number of emergency department (ED) visits and longer hospital length of stay (LOS) but did ...

PLOS ONE

Objectives Heart Failure is a chronic syndrome affecting over 5.7 million in the US and 26 millio... more Objectives Heart Failure is a chronic syndrome affecting over 5.7 million in the US and 26 million adults worldwide with nearly 50% experiencing depressive symptoms. The objective of the study is to compare the effects of two evidence-based treatment options for adult patients with depression and advanced heart failure, on depressive symptom severity, physical and mental health related quality of life (HRQoL), heart-failure specific quality of life, caregiver burden, morbidity, and mortality at 3, 6 and 12-months. Methods Trial design. Pragmatic, randomized, comparative effectiveness trial. Interventions. The treatment interventions are: (1) Behavioral Activation (BA), a patient-centered psychotherapy which emphasizes engagement in enjoyable and valued personalized activities as selected by the patient; or (2) Antidepressant Medication Management administered using the collaborative care model (MEDS). Participants. Adults aged 18 and over with advanced heart failure (defined as New ...

Journal of Hospital Medicine

Journal of Hospital Medicine, Dec 6, 2017

General Hospital Psychiatry

This editorial describes an effort by 9 consultation-liaison (C-L) psychiatry service leaders in ... more This editorial describes an effort by 9 consultation-liaison (C-L) psychiatry service leaders in the United States to incorporate routine performance measurement into their service workflows. Although C-L psychiatry is an essential clinical service in general hospitals, performance metrics for this service have not been broadly accepted or implemented. Meanwhile, the performance metrics that have been developed rely on an investment in resources and/or new workflows that C-L psychiatry services may not be prepared to make on a widespread level. Our group sought to determine the feasibility of incorporating routine performance measurement into the workflows of a diverse sample of C-L psychiatry services using only existing resources via three collection methods: timestamp review, chart auditing, and survey administration. No methods were broadly successful across the 9 services. We argue that for routine performance measurement to gain wider traction in the field of C-L psychiatry, the ready availability-or automatability-of performance data must be taken into account.

BACKGROUND: Use of electronic cigarettes (e-cigarettes) has increased substantially in recent yea... more BACKGROUND: Use of electronic cigarettes (e-cigarettes) has increased substantially in recent years. Marketed as a safer alternative to conventional tobacco cigarettes, the safety profile of e-cigarettes is now being questioned. Importantly, the clinical consequences of e-cigarette use remain poorly characterized. METHODS: Using data from the electronic health record (EHR), we identified a cohort of e-cigarette users and never-smokers in the region of central Los Angeles. Using information extracted from the EHR, we assessed temporal trends in the demographic characteristics of e-cigarette users, including race/ethnicity and location of residence. We also used data on urgent medical visits (i.e. emergency department encounters and hospital admissions) occurring during the study period (January 2014 to January 2020) and employed a negative binomial regression model to compare healthcare utilization rates between e-cigarette users and never-smokers. RESULTS: We identified a total of 6...

American Journal of Gastroenterology

Journal of Addiction Medicine

JMIR Mental Health

BackgroundTherapeutic virtual reality (VR) has emerged as an efficacious treatment modality for a... more BackgroundTherapeutic virtual reality (VR) has emerged as an efficacious treatment modality for a wide range of health conditions. However, despite encouraging outcomes from early stage research, a consensus for the best way to develop and evaluate VR treatments within a scientific framework is needed.ObjectiveWe aimed to develop a methodological framework with input from an international working group in order to guide the design, implementation, analysis, interpretation, and communication of trials that develop and test VR treatments.MethodsA group of 21 international experts was recruited based on their contributions to the VR literature. The resulting Virtual Reality Clinical Outcomes Research Experts held iterative meetings to seek consensus on best practices for the development and testing of VR treatments.ResultsThe interactions were transcribed, and key themes were identified to develop a scientific framework in order to support best practices in methodology of clinical VR t...

BACKGROUND Therapeutic virtual reality (VR) has emerged as an efficacious treatment modality for ... more BACKGROUND Therapeutic virtual reality (VR) has emerged as an efficacious treatment modality for a wide range of health conditions. However, despite encouraging outcomes from early stage research, a consensus for the best way to develop and evaluate VR treatments within a scientific framework is needed. OBJECTIVE We aimed to develop a methodological framework with input from an international working group in order to guide the design, implementation, analysis, interpretation, and communication of trials that develop and test VR treatments. METHODS A group of 21 international experts was recruited based on their contributions to the VR literature. The resulting Virtual Reality Clinical Outcomes Research Experts held iterative meetings to seek consensus on best practices for the development and testing of VR treatments. RESULTS The interactions were transcribed, and key themes were identified to develop a scientific framework in order to support best practices in methodology of clinic...

Harvard Review of Psychiatry

The American Journal of Medicine

Tramadol is commonly prescribed for pain control because it presents a lower risk for addiction a... more Tramadol is commonly prescribed for pain control because it presents a lower risk for addiction and respiratory depression compared to other opioids. However, tramadol&amp;#39;s serotonin and norepinephrine reuptake inhibitory effects result in a unique adverse effect profile. Two such adverse events are serotonin syndrome and seizures. The prevalence of tramadol-induced serotonin syndrome and seizures is modest in the general population, but if left untreated, the morbidity and mortality can be high; therefore, prompt recognition and management is essential. Various risk factors such as medical comorbidities, use or abuse of supratherapeutic doses of tramadol, and concomitant administration of proconvulsant serotonergic cytochrome P-450 inhibitors will help clinicians identify individuals at an elevated risk for serotonin toxicity and seizures. Serotonin syndrome and seizures can be effectively treated by administering benzodiazepines, providing supportive care, and discontinuing tramadol and other contributing agents. Cyproheptadine should be administered in moderate to severe cases of serotonin syndrome. Our objective is to summarize the literature on the pharmacology, epidemiology, risk factors, clinical presentations, and evidence-based management of tramadol-related seizures and serotonin syndrome.

Translational psychiatry, Jan 15, 2018

Among patients with Parkinson's disease (PD), depression is prevalent and disabling, impactin... more Among patients with Parkinson's disease (PD), depression is prevalent and disabling, impacting both health outcomes and quality of life. There is a critical need for alternative pharmacological methods to treat PD depression, as mainstream antidepressant drugs are largely ineffective in this population. Currently, there are no recommendations for the optimal treatment of PD neuropsychiatric symptoms. Given the dual antidepressant and anti-dyskinetic effects of ketamine and other N-methyl-D-aspartate (NMDA) antagonists for PD, this review aims to examine the current evidence of NMDA antagonists for treating neuropsychiatric symptoms, including memantine, amantadine, ketamine, dizoclopine, and d-cycloserine. A comprehensive literature search was conducted using the PubMed database. We also searched the following databases up to March 1, 2018: Ovid MEDLINE, PsycINFO, CINAHL, Google Scholar, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews....

Inflammatory bowel diseases, Jan 15, 2018

This study reports on the logistics and feasibility of a novel multidisciplinary approach to biop... more This study reports on the logistics and feasibility of a novel multidisciplinary approach to biopsychosocial care at a tertiary adult inflammatory bowel disease (IBD) center. Consecutive patients referred for a new IBD consultation completed the following self-assessments: the Short Form-12, the Patient Reported Outcome Measurement Information System (PROMIS) Global Health Scale, the World Health Organization Disability Assessment Schedule 2.0, and the PROMIS-29. These measures were scored at the time of appointment check-in by a trained licensed clinical social worker (SW), and those scoring 1.5 standard deviations below the population mean were targeted for SW assessment and intervention at the point of care; patients or providers could also request a SW evaluation even if cutoffs were not met. In this stepped-care model, the SW could refer to same-day on-site psychiatry services or outside interventions and services. In addition, we implemented a 12-month curriculum with a monthl...

BMJ case reports, Jan 26, 2018

Cryptococcal meningitis is a life-threatening condition most commonly observed in immunocompromis... more Cryptococcal meningitis is a life-threatening condition most commonly observed in immunocompromised individuals. We describe a daily cannabis smoker without evidence of immunodeficiency presenting with confirmed meningitis. An investigation of cannabis samples from the patient's preferred dispensary demonstrated contamination with several varieties of , including , and other opportunistic fungi. These findings raise concern regarding the safety of dispensary-grade cannabis, even in immunocompetent users.