Pablo Roitman - Academia.edu (original) (raw)

Papers by Pablo Roitman

Research paper thumbnail of Acute Psychosis Triggered by Ovarian Teratoma: The Underdiagnosed yet Treatable Case of Anti-NMDA Receptor Encephalitis

Highlights on Medicine and Medical Research Vol. 6, 2021

Research paper thumbnail of Anti-NMDA Receptor Encephalitis Presenting as an Acute Psychotic Episode in a Young Woman: An Underdiagnosed yet Treatable Disorder

Case Reports in Psychiatry, 2014

Anti-NMDA receptor (NMDAR) encephalitis is a recently identified autoimmune disorder with promine... more Anti-NMDA receptor (NMDAR) encephalitis is a recently identified autoimmune disorder with prominent psychiatric symptoms. Patients usually present with acute behavioral change, psychosis, catatonic symptoms, memory deficits, seizures, dyskinesias, and autonomic instability. In female patients an ovarian teratoma is often identified. We describe a 32-year-old woman who presented with acute psychosis. Shortly after admission, she developed generalized seizures and deteriorated into a catatonic state. Although ancillary tests including MRI, electroencephalogram, and cerebrospinal fluid (CSF) analysis were unremarkable, the presentation of acute psychosis in combination with recurrent seizures and a relentless course suggested autoimmune encephalitis. The patient underwent pelvic ultrasound which disclosed a dermoid cyst and which led to an urgent cystectomy. Plasmapheresis was then initiated, yielding partial response over the next two weeks. Following the detection of high titers of a...

Research paper thumbnail of Preliminary, Open-Label, Pilot Study of Add-On Oral Δ9-Tetrahydrocannabinol in Chronic Post-Traumatic Stress Disorder

Clinical Drug Investigation, 2014

Research paper thumbnail of Early PTSD Symptom Trajectories: Persistence, Recovery, and Response to Treatment: Results from the Jerusalem Trauma Outreach and Prevention Study (J-TOPS)

PLoS ONE, 2013

Context: Uncovering heterogeneities in the progression of early PTSD symptoms can improve our und... more Context: Uncovering heterogeneities in the progression of early PTSD symptoms can improve our understanding of the disorder's pathogenesis and prophylaxis. Objectives: To describe discrete symptom trajectories and examine their relevance for preventive interventions. Design: Latent Growth Mixture Modeling (LGMM) of data from a randomized controlled study of early treatment. LGMM identifies latent longitudinal trajectories by exploring discrete mixture distributions underlying observable data. Setting: Hadassah Hospital unselectively receives trauma survivors from Jerusalem and vicinity. Participants: Adult survivors of potentially traumatic events consecutively admitted to the hospital's emergency department (ED) were assessed ten days and one-, five-, nine-and fifteen months after ED admission. Participants with data at ten days and at least two additional assessments (n = 957) were included; 125 received cognitive behavioral therapy (CBT) between one and nine months. Approach: We used LGMM to identify latent parameters of symptom progression and tested the effect of CBT on these parameters. CBT consisted of 12 weekly sessions of either cognitive therapy (n = 41) or prolonged exposure (PE, n = 49), starting 29.865.7 days after ED admission, or delayed PE (n = 35) starting at 151.8642.4 days. CBT effectively reduced PTSD symptoms in the entire sample. Main Outcome Measure: Latent trajectories of PTSD symptoms; effects of CBT on these trajectories. Results: Three trajectories were identified: Rapid Remitting (rapid decrease in symptoms from 1-to 5-months; 56% of the sample), Slow Remitting (progressive decrease in symptoms over 15 months; 27%) and Non-Remitting (persistently elevated symptoms; 17%). CBT accelerated the recovery of the Slow Remitting class but did not affect the other classes. Conclusions: The early course of PTSD symptoms is characterized by distinct and diverging response patterns that are centrally relevant to understanding the disorder and preventing its occurrence. Studies of the pathogenesis of PTSD may benefit from using clustered symptom trajectories as their dependent variables.

Research paper thumbnail of Head Injury and Loss of Consciousness Raise the Likelihood of Developing and Maintaining PTSD Symptoms

Journal of Traumatic Stress, 2013

Mild traumatic brain injury has been associated with higher prevalence of posttraumatic stress di... more Mild traumatic brain injury has been associated with higher prevalence of posttraumatic stress disorder (PTSD). The extent to which head injury or loss of consciousness predicts PTSD is unknown. To evaluate the contribution of head injury and loss of consciousness to the occurrence of PTSD, we made a longitudinal evaluation of 1,260 road accident survivors admitted to the emergency department with head injury (n = 287), head injury and loss of consciousness (n = 115), or neither (n = 858). A telephone‐administered posttraumatic symptoms scale inferred PTSD and quantified PTSD symptoms at 10 days and 8 months after admission. The study groups had similar heart rate, blood pressure, and pain levels in the emergency department. Survivors with loss of consciousness and head injury had higher prevalence of PTSD and higher levels of PTSD symptoms, suggesting that patients with head injury and loss of consciousness reported in the emergency department are at higher risk for PTSD.

Research paper thumbnail of Anti-NMDA-receptor encephalitis presenting as postpartum psychosis in a young woman, treated with rituximab

Annals of Saudi Medicine, 2012

N-methyl D-aspartate (NMDA) receptors are ligand-gated cation channels whose function centers aro... more N-methyl D-aspartate (NMDA) receptors are ligand-gated cation channels whose function centers around synaptic transmission and plasticity. 1 The receptors are heteromers of NR1 subunits that bind glycine and NR2 (A, B, C, or D) subunits that bind glutamate. NR1 and NR2 combine to form receptor subtypes, and their pharmacological properties include localization and the ability to interact with intracellular messengers; they also have the ability to interact with intracellular messengers. 2 Hyperactivity of these NMDA receptors results in neuropsychiatric excitotoxicity, which can manifest clinically as epilepsy, dementia, and stroke; whereas hypoactivity produces symptoms of schizophrenia. 3 Anti-N-methyl-Daspartate (anti-NMDA)-receptor encephalitis is a recently described neurological condition with antibodies against NR1-NR2 heteromers. It is composed of a well-defined set of clinical features that have been characterized in adults, frequently in young women, with teratomas of the ovary who develop changes of mood, behavior, and personality, resembling acute psychosis. 4 The clinical picture usually progresses to include seizures, a decreased level of consciousness, dyskinesias, autonomic instability, and hypoventilation. 5 Removal of the teratoma, immunotherapy, plasma exchange, in

Research paper thumbnail of Acute Psychosis Triggered by Ovarian Teratoma: The Underdiagnosed yet Treatable Case of Anti-NMDA Receptor Encephalitis

Highlights on Medicine and Medical Research Vol. 6, 2021

Research paper thumbnail of Anti-NMDA Receptor Encephalitis Presenting as an Acute Psychotic Episode in a Young Woman: An Underdiagnosed yet Treatable Disorder

Case Reports in Psychiatry, 2014

Anti-NMDA receptor (NMDAR) encephalitis is a recently identified autoimmune disorder with promine... more Anti-NMDA receptor (NMDAR) encephalitis is a recently identified autoimmune disorder with prominent psychiatric symptoms. Patients usually present with acute behavioral change, psychosis, catatonic symptoms, memory deficits, seizures, dyskinesias, and autonomic instability. In female patients an ovarian teratoma is often identified. We describe a 32-year-old woman who presented with acute psychosis. Shortly after admission, she developed generalized seizures and deteriorated into a catatonic state. Although ancillary tests including MRI, electroencephalogram, and cerebrospinal fluid (CSF) analysis were unremarkable, the presentation of acute psychosis in combination with recurrent seizures and a relentless course suggested autoimmune encephalitis. The patient underwent pelvic ultrasound which disclosed a dermoid cyst and which led to an urgent cystectomy. Plasmapheresis was then initiated, yielding partial response over the next two weeks. Following the detection of high titers of a...

Research paper thumbnail of Preliminary, Open-Label, Pilot Study of Add-On Oral Δ9-Tetrahydrocannabinol in Chronic Post-Traumatic Stress Disorder

Clinical Drug Investigation, 2014

Research paper thumbnail of Early PTSD Symptom Trajectories: Persistence, Recovery, and Response to Treatment: Results from the Jerusalem Trauma Outreach and Prevention Study (J-TOPS)

PLoS ONE, 2013

Context: Uncovering heterogeneities in the progression of early PTSD symptoms can improve our und... more Context: Uncovering heterogeneities in the progression of early PTSD symptoms can improve our understanding of the disorder's pathogenesis and prophylaxis. Objectives: To describe discrete symptom trajectories and examine their relevance for preventive interventions. Design: Latent Growth Mixture Modeling (LGMM) of data from a randomized controlled study of early treatment. LGMM identifies latent longitudinal trajectories by exploring discrete mixture distributions underlying observable data. Setting: Hadassah Hospital unselectively receives trauma survivors from Jerusalem and vicinity. Participants: Adult survivors of potentially traumatic events consecutively admitted to the hospital's emergency department (ED) were assessed ten days and one-, five-, nine-and fifteen months after ED admission. Participants with data at ten days and at least two additional assessments (n = 957) were included; 125 received cognitive behavioral therapy (CBT) between one and nine months. Approach: We used LGMM to identify latent parameters of symptom progression and tested the effect of CBT on these parameters. CBT consisted of 12 weekly sessions of either cognitive therapy (n = 41) or prolonged exposure (PE, n = 49), starting 29.865.7 days after ED admission, or delayed PE (n = 35) starting at 151.8642.4 days. CBT effectively reduced PTSD symptoms in the entire sample. Main Outcome Measure: Latent trajectories of PTSD symptoms; effects of CBT on these trajectories. Results: Three trajectories were identified: Rapid Remitting (rapid decrease in symptoms from 1-to 5-months; 56% of the sample), Slow Remitting (progressive decrease in symptoms over 15 months; 27%) and Non-Remitting (persistently elevated symptoms; 17%). CBT accelerated the recovery of the Slow Remitting class but did not affect the other classes. Conclusions: The early course of PTSD symptoms is characterized by distinct and diverging response patterns that are centrally relevant to understanding the disorder and preventing its occurrence. Studies of the pathogenesis of PTSD may benefit from using clustered symptom trajectories as their dependent variables.

Research paper thumbnail of Head Injury and Loss of Consciousness Raise the Likelihood of Developing and Maintaining PTSD Symptoms

Journal of Traumatic Stress, 2013

Mild traumatic brain injury has been associated with higher prevalence of posttraumatic stress di... more Mild traumatic brain injury has been associated with higher prevalence of posttraumatic stress disorder (PTSD). The extent to which head injury or loss of consciousness predicts PTSD is unknown. To evaluate the contribution of head injury and loss of consciousness to the occurrence of PTSD, we made a longitudinal evaluation of 1,260 road accident survivors admitted to the emergency department with head injury (n = 287), head injury and loss of consciousness (n = 115), or neither (n = 858). A telephone‐administered posttraumatic symptoms scale inferred PTSD and quantified PTSD symptoms at 10 days and 8 months after admission. The study groups had similar heart rate, blood pressure, and pain levels in the emergency department. Survivors with loss of consciousness and head injury had higher prevalence of PTSD and higher levels of PTSD symptoms, suggesting that patients with head injury and loss of consciousness reported in the emergency department are at higher risk for PTSD.

Research paper thumbnail of Anti-NMDA-receptor encephalitis presenting as postpartum psychosis in a young woman, treated with rituximab

Annals of Saudi Medicine, 2012

N-methyl D-aspartate (NMDA) receptors are ligand-gated cation channels whose function centers aro... more N-methyl D-aspartate (NMDA) receptors are ligand-gated cation channels whose function centers around synaptic transmission and plasticity. 1 The receptors are heteromers of NR1 subunits that bind glycine and NR2 (A, B, C, or D) subunits that bind glutamate. NR1 and NR2 combine to form receptor subtypes, and their pharmacological properties include localization and the ability to interact with intracellular messengers; they also have the ability to interact with intracellular messengers. 2 Hyperactivity of these NMDA receptors results in neuropsychiatric excitotoxicity, which can manifest clinically as epilepsy, dementia, and stroke; whereas hypoactivity produces symptoms of schizophrenia. 3 Anti-N-methyl-Daspartate (anti-NMDA)-receptor encephalitis is a recently described neurological condition with antibodies against NR1-NR2 heteromers. It is composed of a well-defined set of clinical features that have been characterized in adults, frequently in young women, with teratomas of the ovary who develop changes of mood, behavior, and personality, resembling acute psychosis. 4 The clinical picture usually progresses to include seizures, a decreased level of consciousness, dyskinesias, autonomic instability, and hypoventilation. 5 Removal of the teratoma, immunotherapy, plasma exchange, in