Megan Riddle - Academia.edu (original) (raw)
Papers by Megan Riddle
Journal of eating disorders, Nov 21, 2022
Transgender and gender diverse (TGD) individuals are at increased risk for the development of eat... more Transgender and gender diverse (TGD) individuals are at increased risk for the development of eating disorders, but very little has been published with regards to the unique aspects of their medical care in eating disorder treatment. Providing gender affirming care is a critical component of culturally competent eating disorder treatment. This includes knowledge of gender affirming medical and surgical interventions and how such interventions may be impacted by eating disordered behaviors, as well as the role of such interventions in eating disorder treatment and recovery. TGD individuals face barriers to care, and one of these can be provider knowledge. By better understanding these needs, clinicians can actively reduce barriers and ensure TGD individuals are provided with appropriate care. This review synthesizes the available literature regarding the medical care of TGD patients and those of patients with eating disorders and highlights areas for further research.
Journal of Eating Disorders
A recent article in the Journal of Eating Disorders (10:23, 2022) proposed criteria for “terminal... more A recent article in the Journal of Eating Disorders (10:23, 2022) proposed criteria for “terminal anorexia” with a cited goal of improving access to end-of-life care (Gaudiani et al. in J Eat Disord 10(1):23, 2022). The authors presented three cases in which patients received end-of-life care, including the prescription of medical assistance in dying (MAID), also known as physician-assisted suicide (PAS). The proposed criteria lack the evidence base for adoption and do not acknowledge the compelling evidence that exists surrounding possible prolonged timelines to recovery for some individuals and the nuances of assessing capacity in this population.
Journal of Eating Disorders
Transgender and gender diverse (TGD) individuals are at increased risk for the development of eat... more Transgender and gender diverse (TGD) individuals are at increased risk for the development of eating disorders, but very little has been published with regards to the unique aspects of their medical care in eating disorder treatment. Providing gender affirming care is a critical component of culturally competent eating disorder treatment. This includes knowledge of gender affirming medical and surgical interventions and how such interventions may be impacted by eating disordered behaviors, as well as the role of such interventions in eating disorder treatment and recovery. TGD individuals face barriers to care, and one of these can be provider knowledge. By better understanding these needs, clinicians can actively reduce barriers and ensure TGD individuals are provided with appropriate care. This review synthesizes the available literature regarding the medical care of TGD patients and those of patients with eating disorders and highlights areas for further research.
Journal of Clinical and Translational Science, 2020
Introduction: While previous studies have described career outcomes of physician-scientist traine... more Introduction: While previous studies have described career outcomes of physician-scientist trainees after graduation, trainee perceptions of research-intensive career pathways remain unclear. This study sought to identify the perceived interests, factors, and challenges associated with academic and research careers among predoctoral MD trainees, MD trainees with research-intense (>50%) career intentions (MD-RI), and MD-PhD trainees. Methods: A 70-question survey was administered to 16,418 trainees at 32 academic medical centers from September 2012 to December 2014. MD vs. MD-RI (>50% research intentions) vs. MD-PhD trainee responses were compared by chi-square tests. Multivariate logistic regression analyses were performed to identify variables associated with academic and research career intentions. Results: There were 4433 respondents (27% response rate), including 2625 MD (64%), 653 MD-RI (15%), and 856 MD-PhD (21%) trainees. MD-PhDs were most interested in pursuing academi...
Psychiatry Research, 2014
The ability to exert self-control in the face of appetitive, alluring cues is a critical componen... more The ability to exert self-control in the face of appetitive, alluring cues is a critical component of healthy development. The development of behavioral measures that use disease-relevant stimuli can greatly improve our understanding of cue-specific impairments in self-control. To produce such a tool relevant to the study of eating and weight disorders, we modified the traditional go/no-go task to include food and non-food targets. To confirm that performance on this new task was consistent with other go/no-go tasks, it was given to 147 healthy, normal weight volunteers between the ages of 5 and 30. Highresolution photos of food or toys were used as the target and nontarget stimuli. Consistent with expectations, overall improvements in accuracy were seen from childhood to adulthood. Participants responded more quickly and made more commission errors to food cues compared to nonfood cues (F (1,140)¼ 21.76, P o0.001), although no behavioral differences were seen between low-and high-calorie food cues for this non-obese, healthy developmental sample. This novel food-specific go/no-go task may be used to track the development of self-control in the context of food cues and to evaluate deviations or deficits in the development of this ability in individuals at risk for eating problem behaviors and disorders.
BMC medical education, Jan 11, 2017
Prior studies have described the career paths of physician-scientist candidates after graduation,... more Prior studies have described the career paths of physician-scientist candidates after graduation, but the factors that influence career choices at the candidate stage remain unclear. Additionally, previous work has focused on MD/PhDs, despite many physician-scientists being MDs. This study sought to identify career sector intentions, important factors in career selection, and experienced and predicted obstacles to career success that influence the career choices of MD candidates, MD candidates with research-intense career intentions (MD-RI), and MD/PhD candidates. A 70-question survey was administered to students at 5 academic medical centers with Medical Scientist Training Programs (MSTPs) and Clinical and Translational Science Awards (CTSA) from the NIH. Data were analyzed using bivariate or multivariate analyses. More MD/PhD and MD-RI candidates anticipated or had experienced obstacles related to balancing academic and family responsibilities and to balancing clinical, research, ...
Sexual dimorphism is the result of a cascade of genes that triggers sex-specific development. The... more Sexual dimorphism is the result of a cascade of genes that triggers sex-specific development. The cascade begins with a primary signal that affects a hierarchy of genes and, through their selective activation and repression, results in the development of an individual of a particular sex. The genes in this regulatory hierarchy are very divergent, with little conservation across taxa. However, homologs of doublesex, a master regulator in the sexdetermining cascade of Drosophila melanogaster, have been found in organisms ranging from nematodes to humans. These homologs are identified by the DM domain, a DNAbinding motif found in genes that function as transcription factors. The DM domain defines an entire family of genes, of which only a select few play a role in sex determination. Here I describe a family of four DM-containing genes in the parasitoid wasp Nasonia vitripennis. Using molecular and computational techniques, I completed the sequence of two previously discovered members of this family and identified two new genes that contain the DM domain. One of these new genes, NvDM4, shows sex-specific expression reminiscent of the doublesex gene, suggesting that it is part of the sex-determination cascade in N. vitripennis. v TABLE OF CONTENTS ABSTRACT iv LIST OF FIGURES vi
Current psychiatry, 2017
Ms. B, age 60, has schizophrenia, which has been stable on clozapine for 2 decades when she is di... more Ms. B, age 60, has schizophrenia, which has been stable on clozapine for 2 decades when she is diagnosed with cancer. How do you manage her psychiatric illness during chemotherapy? CASE Stable with a new diagnosis Ms. B, age 60, has a history of schizophrenia, which has been stable on clozapine, 500 mg/d, for more than 2 decades. After a series of hospitalizations in her 20s and 30s, clozapine was initiated and she has not required additional inpatient psychiatric care. She has been managed in the outpatient setting with standard biweekly absolute neutrophil count (ANC) monitoring. She lives independently and is an active member in her church. After experiencing rectal bleeding, Ms. B is diagnosed with rectal carcinoma and is scheduled to undergo chemotherapy and radiation treatment. How would you manage Ms. B's psychiatric illness at this time? a) continue clozapine and the current monitoring schedule b) continue clozapine and increase ANC monitoring to weekly c) discontinue cl...
CASE Psychotic and reclusive Ms. A, age 51, has schizophrenia and has been doing well living at a... more CASE Psychotic and reclusive Ms. A, age 51, has schizophrenia and has been doing well living at a supervised residential facility. She was stable on haloperidol, 10 mg twice a day, for years but recently became agitated, threatening her roommate and yelling during the night. Ms. A begins to refuse to take her haloperidol. She also refuses to attend several outpatient appointments. As a result, Ms. A is admitted to the psychiatric unit on an involuntary basis. In the hospital, Ms. A rarely comes out of her room. When she does come out, she usually sits in a chair, talking to herself and occasionally yelling or crying in apparent distress. Ms. A refuses to engage with her treatment team and lies mute in her bed when they attempt to interview her. Her records indicate that previous medication trials have included chlorpromazine, fluphenazine, haloperidol, paliperidone, ziprasidone, and quetiapine. Despite her present decompensation, discussion with the clinicians who had previously tre...
Neurogastroenterology & Motility
BACKGROUND Previous studies show some patients with functional gastrointestinal disorders (disord... more BACKGROUND Previous studies show some patients with functional gastrointestinal disorders (disorders of gut-brain interaction) may be at risk for or already have an eating disorder (ED). Avoidant/restrictive food intake disorder (ARFID) (ED not primarily motivated by body shape/weight concerns) may be particularly relevant but previous studies have been unable to fully apply diagnostic criteria. This study aimed to determine the frequency and nature of the full spectrum of ED symptoms, among adults with disorders of gut-brain interaction. METHODS Adults with disorders of gut-brain interaction (n = 99, 77.1% female, ages 18-82 years) from academic medical center gastroenterology clinics completed a modified ARFID Canadian Paediatric Surveillance Program Questionnaire, the ED Examination Questionnaire (EDE-Q), and other self-report measures of depression, generalized anxiety, and pain interference. KEY RESULTS Of the 93 participants who completed the measures, 37 (39.8%) had ARFID symptoms and 12 (12.9%) had clinically significant shape/weight-motivated ED symptoms (EDE-Q-Global ≥4.0). Exploratory comparisons among ARFID, shape/weight-motivated ED, and no-ED groups revealed that ARFID symptom presence was associated with lower body mass index (BMI), and shape/weight-motivated ED presence was associated with higher depression, anxiety, and pain interference. However, the majority (86%) of patients with ARFID symptoms had a BMI >18.5 kg/m2 . CONCLUSIONS & INFERENCES The full spectrum of ED symptoms was frequent among patients with disorders of gut-brain interaction, particularly ARFID symptoms. Further research is needed to understand risk and maintenance factors to inform prevention and intervention efforts.
Academic Psychiatry
Leaders are generally perceived to be charismatic extroverts, able to walk into a room and captur... more Leaders are generally perceived to be charismatic extroverts, able to walk into a room and capture a crowd’s attention [1]. Personable and outgoing, these individuals appear in many ways the antithesis of the quiet introvert. Approximately one-third to one-half of the population exhibits a preference for introversion, yet introverts are underrepresented in leadership roles [2]. Introverts also contend with strong cultural bias against their promotion to leadership positions. A 2006 survey revealed that 65% of senior corporate executives viewed introversion as a barrier to leadership, and only 6% believed that introverts make more effective leaders [3]. This bias does not just exist in corporate America. Medical education is increasingly incorporating teaching strategies that require group work and “thinking aloud” models of training, which may disadvantage introverted learners who prefer solitary learning and deliberate reflection [4]. Introverted students tend to have overall lower evaluations related to interpersonal behavior during clerkship rotations [4]. Focus groups of introverted medical students reveal the following themes: feeling like misfits, struggling to get a word into conversation, questioning a need to change their identity to achieve success in school, and being judged as underperformers [4]. Because of these challenges, introverts are more likely to experience stress and burnout during medical school than their extroverted counterparts [5]. This has important implications for introverted individuals whose professional identity and leadership potential may be significantly impacted by these early experiences in their training [1]. Social scientists have increasingly recognized the value and unique perspective that introverts bring to leadership roles. A 2011 study examining leadership style and productivity showed that teams with proactive employees were more productive when led by an introvert as compared to an extrovert [6]. Jim Collins, a business consultant who studied highperforming companies, determined that many of those leaders were known for drive and humility rather than charisma or gregariousness [7]. Similarly, a separate review of 15 metaanalytic studies found conscientiousness to be a more consistent predictor of job performance across occupations than extroversion [8]. These results suggest that introverts can bring significant worth to a leadership position. While this article will focus primarily on the strengths of introverts, we do not intend to minimize the strengths of extroverts, as leaders or otherwise. In fact, data would suggest that teams work best when introverts and extroverts are able to work together [6]. Ultimately, we believe that encouraging leadership in introverts represents an opportunity to enrich leadership in academic psychiatry.
Journal of Hospital Medicine, 2017
Journal of hospital medicine, Jan 9, 2016
Personality disorders are pervasive patterns of maladaptive behaviors, thoughts, and emotions tha... more Personality disorders are pervasive patterns of maladaptive behaviors, thoughts, and emotions that often go unrecognized and can wreak havoc in the patient's interpersonal life. These inflexible patterns of managing the world can be disruptive when an individual is admitted to the hospital, causing distress for both the patient who lacks the skills to deal with the expectations of the hospital environment and the treatment team who can feel ill equipped to manage such behavior. Having a personality disorder has implications for an individual's healthcare outcomes; those with a personality disorder have a life expectancy nearly 2 decades shorter than the general population for a multitude of reasons, among them trouble interacting with the healthcare system. Although a diagnosis of a specific personality disorder may be difficult to make on an acute care unit, identification of dysfunctional personality structures can provide opportunity for better management of an individual...
Advances in Medical Education and Practice, 2014
As the health care delivery landscape changes, medical schools must develop creative strategies f... more As the health care delivery landscape changes, medical schools must develop creative strategies for preparing future physicians to provide quality care in this new environment. Despite the growing prominence of the patient-centered medical home (PCMH) as an effective model for health care delivery, few medical schools have integrated formal education on the PCMH into their curricula. Incorporating the PCMH model into medical school curricula is important to ensure that students have a comprehensive understanding of the different models of health care delivery and can operate effectively as physicians. The authors provide a detailed description of the process by which the Weill Cornell Community Clinic (WCCC), a student-run free clinic, has integrated PCMH principles into a service-learning initiative. The authors assessed patient demographics, diagnoses, and satisfaction along with student satisfaction. During the year after a PCMH model was adopted, 112 students and 19 licensed physicians volunteered their time. A review of the 174 patients seen from July 2011 to June 2012 found that the most common medical reasons for visits included management of hypertension, hyperlipidemia, diabetes, gastrointestinal conditions, arthritis, anxiety, and depression. During the year after the adoption of the PCMH model, 87% were very or extremely satisfied with their care, and 96% of the patients would recommend the WCCC to others. Students who participate in the WCCC gain hands-on experience in coordinating care, providing continuity of care, addressing issues of accessibility, and developing quality and safety metrics. The WCCC experience provides an integrative model that links service-learning with education on health care delivery in a primary care setting. The authors propose that adoption of this approach by other student-run clinics provides a substantial opportunity to improve medical education nationwide and better prepare future physicians to practice within this new model of health care delivery.
Science, 2010
Parasitoid Wasp Genomes Parasitoid wasps, which prey on and reproduce in host insect species, pla... more Parasitoid Wasp Genomes Parasitoid wasps, which prey on and reproduce in host insect species, play important roles in plant herbivore interactions, and may provide valuable tools in the biological control of pest species. The Nasonia Genome Working Group (p. 343 ; see the news story by Pennisi ) presents the genome of three very closely related species: Nasonia vitripennis, N. giraulti , and N. longicornis . The findings document rapid evolution between a host and endosymbiont that can cause nuclear-cytoplasmic incompatibilities that may affect speciation.
Protein Science, 2008
Protein cysteine thiols can be divided into four groups based on their reactivities: those that f... more Protein cysteine thiols can be divided into four groups based on their reactivities: those that form permanent structural disulfide bonds, those that coordinate with metals, those that remain in the reduced state, and those that are susceptible to reversible oxidation. Physicochemical parameters of oxidationsusceptible protein thiols were organized into a database named the Balanced Oxidation Susceptible Cysteine Thiol Database (BALOSCTdb). BALOSCTdb contains 161 cysteine thiols that undergo reversible oxidation and 161 cysteine thiols that are not susceptible to oxidation. Each cysteine was represented by a set of 12 parameters, one of which was a label (1/0) to indicate whether its thiol moiety is susceptible to oxidation. A computer program (the C4.5 decision tree classifier re-implemented as the J48 classifier) segregated cysteines into oxidation-susceptible and oxidation-non-susceptible classes. The classifier selected three parameters critical for prediction of thiol oxidation susceptibility: (1) distance to the nearest cysteine sulfur atom, (2) solvent accessibility, and (3) pKa. The classifier was optimized to correctly predict 136 of the 161 cysteine thiols susceptible to oxidation. Leave-one-out cross-validation analysis showed that the percent of correctly classified cysteines was 80.1% and that 16.1% of the oxidation-susceptible cysteine thiols were incorrectly classified. The algorithm developed from these parameters, named the Cysteine Oxidation Prediction Algorithm (COPA), is presented here. COPA prediction of oxidation-susceptible sites can be utilized to locate protein cysteines susceptible to redox-mediated regulation and identify possible enzyme catalytic sites with reactive cysteine thiols.
Neuropsychopharmacology, 2013
Fear extinction learning, the ability to reassess a learned cue of danger as safe when it no long... more Fear extinction learning, the ability to reassess a learned cue of danger as safe when it no longer predicts aversive events, is often dysregulated in anxiety disorders. Selective serotonin reuptake inhibitors (SSRI's) enhance neural plasticity and their ability to enhance fear extinction learning may explain their anxiolytic properties. Caloric restriction (CR) has SSRI-like effects on neural plasticity and anxiety-related behavior. We implemented CR in mice to determine its effects on conditioned-fear responses. Wild type and serotonin transporter (SERT) knockout mice underwent CR for 7 days leading to significant weight loss. Mice were then tested for cued fear learning and anxiety-related behavior. CR markedly enhanced fear extinction learning and its retention in adolescent female mice, and adults of both sexes. These effects of CR were absent in SERT knockout mice. Moreover, CR phenocopied behavioral and molecular effects of chronic fluoxetine, but there was no additive effect of CR in fluoxetine-treated mice. These results demonstrate that CR enhances fear extinction learning through a SERT-dependent mechanism. These results may have implications for eating disorders such as anorexia nervosa (AN), in which there is a high prevalence of anxiety before the onset of dietary restriction and support proposals that in AN, CR is a motivated effort to control dysregulated fear responses and elevated anxiety.
Journal of eating disorders, Nov 21, 2022
Transgender and gender diverse (TGD) individuals are at increased risk for the development of eat... more Transgender and gender diverse (TGD) individuals are at increased risk for the development of eating disorders, but very little has been published with regards to the unique aspects of their medical care in eating disorder treatment. Providing gender affirming care is a critical component of culturally competent eating disorder treatment. This includes knowledge of gender affirming medical and surgical interventions and how such interventions may be impacted by eating disordered behaviors, as well as the role of such interventions in eating disorder treatment and recovery. TGD individuals face barriers to care, and one of these can be provider knowledge. By better understanding these needs, clinicians can actively reduce barriers and ensure TGD individuals are provided with appropriate care. This review synthesizes the available literature regarding the medical care of TGD patients and those of patients with eating disorders and highlights areas for further research.
Journal of Eating Disorders
A recent article in the Journal of Eating Disorders (10:23, 2022) proposed criteria for “terminal... more A recent article in the Journal of Eating Disorders (10:23, 2022) proposed criteria for “terminal anorexia” with a cited goal of improving access to end-of-life care (Gaudiani et al. in J Eat Disord 10(1):23, 2022). The authors presented three cases in which patients received end-of-life care, including the prescription of medical assistance in dying (MAID), also known as physician-assisted suicide (PAS). The proposed criteria lack the evidence base for adoption and do not acknowledge the compelling evidence that exists surrounding possible prolonged timelines to recovery for some individuals and the nuances of assessing capacity in this population.
Journal of Eating Disorders
Transgender and gender diverse (TGD) individuals are at increased risk for the development of eat... more Transgender and gender diverse (TGD) individuals are at increased risk for the development of eating disorders, but very little has been published with regards to the unique aspects of their medical care in eating disorder treatment. Providing gender affirming care is a critical component of culturally competent eating disorder treatment. This includes knowledge of gender affirming medical and surgical interventions and how such interventions may be impacted by eating disordered behaviors, as well as the role of such interventions in eating disorder treatment and recovery. TGD individuals face barriers to care, and one of these can be provider knowledge. By better understanding these needs, clinicians can actively reduce barriers and ensure TGD individuals are provided with appropriate care. This review synthesizes the available literature regarding the medical care of TGD patients and those of patients with eating disorders and highlights areas for further research.
Journal of Clinical and Translational Science, 2020
Introduction: While previous studies have described career outcomes of physician-scientist traine... more Introduction: While previous studies have described career outcomes of physician-scientist trainees after graduation, trainee perceptions of research-intensive career pathways remain unclear. This study sought to identify the perceived interests, factors, and challenges associated with academic and research careers among predoctoral MD trainees, MD trainees with research-intense (>50%) career intentions (MD-RI), and MD-PhD trainees. Methods: A 70-question survey was administered to 16,418 trainees at 32 academic medical centers from September 2012 to December 2014. MD vs. MD-RI (>50% research intentions) vs. MD-PhD trainee responses were compared by chi-square tests. Multivariate logistic regression analyses were performed to identify variables associated with academic and research career intentions. Results: There were 4433 respondents (27% response rate), including 2625 MD (64%), 653 MD-RI (15%), and 856 MD-PhD (21%) trainees. MD-PhDs were most interested in pursuing academi...
Psychiatry Research, 2014
The ability to exert self-control in the face of appetitive, alluring cues is a critical componen... more The ability to exert self-control in the face of appetitive, alluring cues is a critical component of healthy development. The development of behavioral measures that use disease-relevant stimuli can greatly improve our understanding of cue-specific impairments in self-control. To produce such a tool relevant to the study of eating and weight disorders, we modified the traditional go/no-go task to include food and non-food targets. To confirm that performance on this new task was consistent with other go/no-go tasks, it was given to 147 healthy, normal weight volunteers between the ages of 5 and 30. Highresolution photos of food or toys were used as the target and nontarget stimuli. Consistent with expectations, overall improvements in accuracy were seen from childhood to adulthood. Participants responded more quickly and made more commission errors to food cues compared to nonfood cues (F (1,140)¼ 21.76, P o0.001), although no behavioral differences were seen between low-and high-calorie food cues for this non-obese, healthy developmental sample. This novel food-specific go/no-go task may be used to track the development of self-control in the context of food cues and to evaluate deviations or deficits in the development of this ability in individuals at risk for eating problem behaviors and disorders.
BMC medical education, Jan 11, 2017
Prior studies have described the career paths of physician-scientist candidates after graduation,... more Prior studies have described the career paths of physician-scientist candidates after graduation, but the factors that influence career choices at the candidate stage remain unclear. Additionally, previous work has focused on MD/PhDs, despite many physician-scientists being MDs. This study sought to identify career sector intentions, important factors in career selection, and experienced and predicted obstacles to career success that influence the career choices of MD candidates, MD candidates with research-intense career intentions (MD-RI), and MD/PhD candidates. A 70-question survey was administered to students at 5 academic medical centers with Medical Scientist Training Programs (MSTPs) and Clinical and Translational Science Awards (CTSA) from the NIH. Data were analyzed using bivariate or multivariate analyses. More MD/PhD and MD-RI candidates anticipated or had experienced obstacles related to balancing academic and family responsibilities and to balancing clinical, research, ...
Sexual dimorphism is the result of a cascade of genes that triggers sex-specific development. The... more Sexual dimorphism is the result of a cascade of genes that triggers sex-specific development. The cascade begins with a primary signal that affects a hierarchy of genes and, through their selective activation and repression, results in the development of an individual of a particular sex. The genes in this regulatory hierarchy are very divergent, with little conservation across taxa. However, homologs of doublesex, a master regulator in the sexdetermining cascade of Drosophila melanogaster, have been found in organisms ranging from nematodes to humans. These homologs are identified by the DM domain, a DNAbinding motif found in genes that function as transcription factors. The DM domain defines an entire family of genes, of which only a select few play a role in sex determination. Here I describe a family of four DM-containing genes in the parasitoid wasp Nasonia vitripennis. Using molecular and computational techniques, I completed the sequence of two previously discovered members of this family and identified two new genes that contain the DM domain. One of these new genes, NvDM4, shows sex-specific expression reminiscent of the doublesex gene, suggesting that it is part of the sex-determination cascade in N. vitripennis. v TABLE OF CONTENTS ABSTRACT iv LIST OF FIGURES vi
Current psychiatry, 2017
Ms. B, age 60, has schizophrenia, which has been stable on clozapine for 2 decades when she is di... more Ms. B, age 60, has schizophrenia, which has been stable on clozapine for 2 decades when she is diagnosed with cancer. How do you manage her psychiatric illness during chemotherapy? CASE Stable with a new diagnosis Ms. B, age 60, has a history of schizophrenia, which has been stable on clozapine, 500 mg/d, for more than 2 decades. After a series of hospitalizations in her 20s and 30s, clozapine was initiated and she has not required additional inpatient psychiatric care. She has been managed in the outpatient setting with standard biweekly absolute neutrophil count (ANC) monitoring. She lives independently and is an active member in her church. After experiencing rectal bleeding, Ms. B is diagnosed with rectal carcinoma and is scheduled to undergo chemotherapy and radiation treatment. How would you manage Ms. B's psychiatric illness at this time? a) continue clozapine and the current monitoring schedule b) continue clozapine and increase ANC monitoring to weekly c) discontinue cl...
CASE Psychotic and reclusive Ms. A, age 51, has schizophrenia and has been doing well living at a... more CASE Psychotic and reclusive Ms. A, age 51, has schizophrenia and has been doing well living at a supervised residential facility. She was stable on haloperidol, 10 mg twice a day, for years but recently became agitated, threatening her roommate and yelling during the night. Ms. A begins to refuse to take her haloperidol. She also refuses to attend several outpatient appointments. As a result, Ms. A is admitted to the psychiatric unit on an involuntary basis. In the hospital, Ms. A rarely comes out of her room. When she does come out, she usually sits in a chair, talking to herself and occasionally yelling or crying in apparent distress. Ms. A refuses to engage with her treatment team and lies mute in her bed when they attempt to interview her. Her records indicate that previous medication trials have included chlorpromazine, fluphenazine, haloperidol, paliperidone, ziprasidone, and quetiapine. Despite her present decompensation, discussion with the clinicians who had previously tre...
Neurogastroenterology & Motility
BACKGROUND Previous studies show some patients with functional gastrointestinal disorders (disord... more BACKGROUND Previous studies show some patients with functional gastrointestinal disorders (disorders of gut-brain interaction) may be at risk for or already have an eating disorder (ED). Avoidant/restrictive food intake disorder (ARFID) (ED not primarily motivated by body shape/weight concerns) may be particularly relevant but previous studies have been unable to fully apply diagnostic criteria. This study aimed to determine the frequency and nature of the full spectrum of ED symptoms, among adults with disorders of gut-brain interaction. METHODS Adults with disorders of gut-brain interaction (n = 99, 77.1% female, ages 18-82 years) from academic medical center gastroenterology clinics completed a modified ARFID Canadian Paediatric Surveillance Program Questionnaire, the ED Examination Questionnaire (EDE-Q), and other self-report measures of depression, generalized anxiety, and pain interference. KEY RESULTS Of the 93 participants who completed the measures, 37 (39.8%) had ARFID symptoms and 12 (12.9%) had clinically significant shape/weight-motivated ED symptoms (EDE-Q-Global ≥4.0). Exploratory comparisons among ARFID, shape/weight-motivated ED, and no-ED groups revealed that ARFID symptom presence was associated with lower body mass index (BMI), and shape/weight-motivated ED presence was associated with higher depression, anxiety, and pain interference. However, the majority (86%) of patients with ARFID symptoms had a BMI >18.5 kg/m2 . CONCLUSIONS & INFERENCES The full spectrum of ED symptoms was frequent among patients with disorders of gut-brain interaction, particularly ARFID symptoms. Further research is needed to understand risk and maintenance factors to inform prevention and intervention efforts.
Academic Psychiatry
Leaders are generally perceived to be charismatic extroverts, able to walk into a room and captur... more Leaders are generally perceived to be charismatic extroverts, able to walk into a room and capture a crowd’s attention [1]. Personable and outgoing, these individuals appear in many ways the antithesis of the quiet introvert. Approximately one-third to one-half of the population exhibits a preference for introversion, yet introverts are underrepresented in leadership roles [2]. Introverts also contend with strong cultural bias against their promotion to leadership positions. A 2006 survey revealed that 65% of senior corporate executives viewed introversion as a barrier to leadership, and only 6% believed that introverts make more effective leaders [3]. This bias does not just exist in corporate America. Medical education is increasingly incorporating teaching strategies that require group work and “thinking aloud” models of training, which may disadvantage introverted learners who prefer solitary learning and deliberate reflection [4]. Introverted students tend to have overall lower evaluations related to interpersonal behavior during clerkship rotations [4]. Focus groups of introverted medical students reveal the following themes: feeling like misfits, struggling to get a word into conversation, questioning a need to change their identity to achieve success in school, and being judged as underperformers [4]. Because of these challenges, introverts are more likely to experience stress and burnout during medical school than their extroverted counterparts [5]. This has important implications for introverted individuals whose professional identity and leadership potential may be significantly impacted by these early experiences in their training [1]. Social scientists have increasingly recognized the value and unique perspective that introverts bring to leadership roles. A 2011 study examining leadership style and productivity showed that teams with proactive employees were more productive when led by an introvert as compared to an extrovert [6]. Jim Collins, a business consultant who studied highperforming companies, determined that many of those leaders were known for drive and humility rather than charisma or gregariousness [7]. Similarly, a separate review of 15 metaanalytic studies found conscientiousness to be a more consistent predictor of job performance across occupations than extroversion [8]. These results suggest that introverts can bring significant worth to a leadership position. While this article will focus primarily on the strengths of introverts, we do not intend to minimize the strengths of extroverts, as leaders or otherwise. In fact, data would suggest that teams work best when introverts and extroverts are able to work together [6]. Ultimately, we believe that encouraging leadership in introverts represents an opportunity to enrich leadership in academic psychiatry.
Journal of Hospital Medicine, 2017
Journal of hospital medicine, Jan 9, 2016
Personality disorders are pervasive patterns of maladaptive behaviors, thoughts, and emotions tha... more Personality disorders are pervasive patterns of maladaptive behaviors, thoughts, and emotions that often go unrecognized and can wreak havoc in the patient's interpersonal life. These inflexible patterns of managing the world can be disruptive when an individual is admitted to the hospital, causing distress for both the patient who lacks the skills to deal with the expectations of the hospital environment and the treatment team who can feel ill equipped to manage such behavior. Having a personality disorder has implications for an individual's healthcare outcomes; those with a personality disorder have a life expectancy nearly 2 decades shorter than the general population for a multitude of reasons, among them trouble interacting with the healthcare system. Although a diagnosis of a specific personality disorder may be difficult to make on an acute care unit, identification of dysfunctional personality structures can provide opportunity for better management of an individual...
Advances in Medical Education and Practice, 2014
As the health care delivery landscape changes, medical schools must develop creative strategies f... more As the health care delivery landscape changes, medical schools must develop creative strategies for preparing future physicians to provide quality care in this new environment. Despite the growing prominence of the patient-centered medical home (PCMH) as an effective model for health care delivery, few medical schools have integrated formal education on the PCMH into their curricula. Incorporating the PCMH model into medical school curricula is important to ensure that students have a comprehensive understanding of the different models of health care delivery and can operate effectively as physicians. The authors provide a detailed description of the process by which the Weill Cornell Community Clinic (WCCC), a student-run free clinic, has integrated PCMH principles into a service-learning initiative. The authors assessed patient demographics, diagnoses, and satisfaction along with student satisfaction. During the year after a PCMH model was adopted, 112 students and 19 licensed physicians volunteered their time. A review of the 174 patients seen from July 2011 to June 2012 found that the most common medical reasons for visits included management of hypertension, hyperlipidemia, diabetes, gastrointestinal conditions, arthritis, anxiety, and depression. During the year after the adoption of the PCMH model, 87% were very or extremely satisfied with their care, and 96% of the patients would recommend the WCCC to others. Students who participate in the WCCC gain hands-on experience in coordinating care, providing continuity of care, addressing issues of accessibility, and developing quality and safety metrics. The WCCC experience provides an integrative model that links service-learning with education on health care delivery in a primary care setting. The authors propose that adoption of this approach by other student-run clinics provides a substantial opportunity to improve medical education nationwide and better prepare future physicians to practice within this new model of health care delivery.
Science, 2010
Parasitoid Wasp Genomes Parasitoid wasps, which prey on and reproduce in host insect species, pla... more Parasitoid Wasp Genomes Parasitoid wasps, which prey on and reproduce in host insect species, play important roles in plant herbivore interactions, and may provide valuable tools in the biological control of pest species. The Nasonia Genome Working Group (p. 343 ; see the news story by Pennisi ) presents the genome of three very closely related species: Nasonia vitripennis, N. giraulti , and N. longicornis . The findings document rapid evolution between a host and endosymbiont that can cause nuclear-cytoplasmic incompatibilities that may affect speciation.
Protein Science, 2008
Protein cysteine thiols can be divided into four groups based on their reactivities: those that f... more Protein cysteine thiols can be divided into four groups based on their reactivities: those that form permanent structural disulfide bonds, those that coordinate with metals, those that remain in the reduced state, and those that are susceptible to reversible oxidation. Physicochemical parameters of oxidationsusceptible protein thiols were organized into a database named the Balanced Oxidation Susceptible Cysteine Thiol Database (BALOSCTdb). BALOSCTdb contains 161 cysteine thiols that undergo reversible oxidation and 161 cysteine thiols that are not susceptible to oxidation. Each cysteine was represented by a set of 12 parameters, one of which was a label (1/0) to indicate whether its thiol moiety is susceptible to oxidation. A computer program (the C4.5 decision tree classifier re-implemented as the J48 classifier) segregated cysteines into oxidation-susceptible and oxidation-non-susceptible classes. The classifier selected three parameters critical for prediction of thiol oxidation susceptibility: (1) distance to the nearest cysteine sulfur atom, (2) solvent accessibility, and (3) pKa. The classifier was optimized to correctly predict 136 of the 161 cysteine thiols susceptible to oxidation. Leave-one-out cross-validation analysis showed that the percent of correctly classified cysteines was 80.1% and that 16.1% of the oxidation-susceptible cysteine thiols were incorrectly classified. The algorithm developed from these parameters, named the Cysteine Oxidation Prediction Algorithm (COPA), is presented here. COPA prediction of oxidation-susceptible sites can be utilized to locate protein cysteines susceptible to redox-mediated regulation and identify possible enzyme catalytic sites with reactive cysteine thiols.
Neuropsychopharmacology, 2013
Fear extinction learning, the ability to reassess a learned cue of danger as safe when it no long... more Fear extinction learning, the ability to reassess a learned cue of danger as safe when it no longer predicts aversive events, is often dysregulated in anxiety disorders. Selective serotonin reuptake inhibitors (SSRI's) enhance neural plasticity and their ability to enhance fear extinction learning may explain their anxiolytic properties. Caloric restriction (CR) has SSRI-like effects on neural plasticity and anxiety-related behavior. We implemented CR in mice to determine its effects on conditioned-fear responses. Wild type and serotonin transporter (SERT) knockout mice underwent CR for 7 days leading to significant weight loss. Mice were then tested for cued fear learning and anxiety-related behavior. CR markedly enhanced fear extinction learning and its retention in adolescent female mice, and adults of both sexes. These effects of CR were absent in SERT knockout mice. Moreover, CR phenocopied behavioral and molecular effects of chronic fluoxetine, but there was no additive effect of CR in fluoxetine-treated mice. These results demonstrate that CR enhances fear extinction learning through a SERT-dependent mechanism. These results may have implications for eating disorders such as anorexia nervosa (AN), in which there is a high prevalence of anxiety before the onset of dietary restriction and support proposals that in AN, CR is a motivated effort to control dysregulated fear responses and elevated anxiety.