Manuel Trujillo | New York University (original) (raw)

Papers by Manuel Trujillo

Research paper thumbnail of Long-acting stimulants for treatment of attention-deficit/hyperactivity disorder: a focus on extended-release formulations and the prodrug lisdexamfetamine dimesylate to address continuing clinical challenges

ADHD Attention Deficit and Hyperactivity Disorders, 2013

Individuals with attention-deficit/hyperactivity disorder (ADHD) show pervasive impairments acros... more Individuals with attention-deficit/hyperactivity disorder (ADHD) show pervasive impairments across family, peer, and school or work functioning that may extend throughout the day. Psychostimulants are highly effective medications for the treatment of ADHD, and the development of long-acting stimulant formulations has greatly expanded the treatment options for individuals with ADHD. Strategies for the formulation of long-acting stimulants include the combination of immediate-release and delayed-release beads, and an osmotic-release oral system. A recent development is the availability of the first prodrug stimulant, lisdexamfetamine dimesylate (LDX). LDX itself is inactive but is cleaved enzymatically, primarily in the bloodstream, to release d-amphetamine (d-AMP). Several clinical trials have demonstrated that long-acting stimulants are effective in reducing ADHD symptoms compared with placebo. Analog classroom and simulated adult workplace environment studies have shown that long-acting stimulants produce symptom reduction for at least 12 h. Long-acting stimulants exhibit similar tolerability and safety profiles to short-acting equivalents. While variations in gastric pH and motility can alter the availability and absorption of stimulants released from long-acting formulations, the systemic exposure to dAMP following LDX administration is unlikely to be affected by gastrointestinal conditions. Long-acting formulations may also improve adherence and lower abuse potential compared with their short-acting counterparts. The development of long-acting stimulants provides physicians with an increased range of medication options to help tailor treatment for individuals with ADHD. Keywords Attention-deficit hyperactivity disorder Á Central nervous system stimulants Á Amphetamines Á Methylphenidate Á Treatment efficacy Á Safety This article is dedicated to the memory of Atilla Turgay.

Research paper thumbnail of Recent cocaine use decreases negative signs in acute schizophrenia: a case study over two consecutive admissions

Research paper thumbnail of Culture and the organization of psychiatric care

Psychiatric Clinics of North America

Health care systems of the 21st century confront the confluence of two important forces that conf... more Health care systems of the 21st century confront the confluence of two important forces that conform their policies regarding culture. On the one hand, population demographics announce increasing diversity; on the other, a rising knowledge base regarding the impact of culture on mental health awaits to be incorporated into actual clinical practices nationwide. As regulators and payors incorporate this knowledge into their practices, standards and guidelines, the dream of mental health cultural parity will come somewhat closer to fulfillment. In this article, we have aimed to review how the integration of developing knowledge and evolving standards may contribute to such fulfillment.

Research paper thumbnail of CULTURE AND THE ORGANIZATION OF PSYCHIATRIC CARE

Psychiatric Clinics of North America, 2001

Health care systems of the 21st century confront the confluence of two important forces that conf... more Health care systems of the 21st century confront the confluence of two important forces that conform their policies regarding culture. On the one hand, population demographics announce increasing diversity; on the other, a rising knowledge base regarding the impact of culture on mental health awaits to be incorporated into actual clinical practices nationwide. As regulators and payors incorporate this knowledge into their practices, standards and guidelines, the dream of mental health cultural parity will come somewhat closer to fulfillment. In this article, we have aimed to review how the integration of developing knowledge and evolving standards may contribute to such fulfillment.

Research paper thumbnail of The short-term treatment of narcissistic and other self-disorders

European Psychiatry, 2007

Research paper thumbnail of Recent cocaine use decreases negative signs in acute schizophrenia: A case study over two consecutive admissions

Biological Psychiatry, 1996

Research paper thumbnail of Comorbidity of cocaine abuse and schizophrenia: An examination of clinical functioning across an acute episode

Biological Psychiatry

analyses failed to yield strong evidence that subject-related and methodological features of the ... more analyses failed to yield strong evidence that subject-related and methodological features of the studies were related to neuropsychological findings. These results are discussed in relation to neuropsychological research, alcoholism, and in the context of other psychopathological disorders. Implications for future research and clinical and policy issues are considered.

Research paper thumbnail of Emergency psychiatry in the twenty-first century

The contributors to this issue address some of the essential components of state of art emergency... more The contributors to this issue address some of the essential components of state of art emergency care delivery, be it in an emergency room, crisis center, private office, on site in the community, or on an inpatient unit in a hospital. Kimberly Nordstrom, MD, JD, and Michael H. Allen, MD, present some general principles of emergency care delivery regardless of site of delivery. They focus on the review of risk factors for outpatient violence (diagnosis, the presence of positive symptoms, substance abuse and dependence) as an essential component of maintaining risk-awareness. They also review management measures that can prevent or help manage unexpected violence situations in outpatient practice or clinic settings, such as the use of panic-buttons, a written emergency plan appropriately rehearsed, and other means. David Baron, MSEd, DO, and colleagues discuss the evalu-ation and management of substance abuse emergencies. This article focuses on the clinical evaluation and initial t...

Research paper thumbnail of Some effects of folate deficiency on mentals status in street dwelling homeless mentally ill

Research paper thumbnail of P02-444 - A Controlled Randomized Study on the Efficacy of Short-Term Dinamic Psychotherapy in Borderline Personality Disorders (BPD). Preliminary Results

Research paper thumbnail of The sodium amytal interview as a therapeutic modality

Current psychiatric therapies, 1978

Research paper thumbnail of Haloperidol Blood Levels in Acute Mania With Psychosis

Journal of Clinical Psychopharmacology, 2001

In this study, the authors examined the relationship between steady-state haloperidol blood level... more In this study, the authors examined the relationship between steady-state haloperidol blood levels and clinical response in patients with acute psychotic mania. Fifty-four inpatients with acute mania were randomly assigned to receive either haloperidol 25 mg/day or haloperidol 5 mg/day. Each subject also received a concomitant medication: lorazepam 4 mg/day, lithium, or placebo. The relationship between steady-state haloperidol blood levels and clinical improvement was studied using analysis of covariance. There was wide interindividual variation in the haloperidol blood level-dose ratio. Haloperidol blood levels (log-transformed) were found to significantly correlate with clinical response in acute mania. Low-dose haloperidol with concomitant lithium may produce an optimal response in acute mania. Haloperidol blood levels may be clinically useful in identifying patients who are nonresponsive because of low drug levels and, hence, in enhancing optimal haloperidol dosing for acute mania with psychosis.

Research paper thumbnail of Comorbidity of cocaine abuse and schizophrenia: An examination of clinical functioning across an acute episode

Biological Psychiatry, 1994

analyses failed to yield strong evidence that subject-related and methodological features of the ... more analyses failed to yield strong evidence that subject-related and methodological features of the studies were related to neuropsychological findings. These results are discussed in relation to neuropsychological research, alcoholism, and in the context of other psychopathological disorders. Implications for future research and clinical and policy issues are considered.

Research paper thumbnail of Some effects of folate deficiency on mentals status in street dwelling homeless mentally ill

Biological Psychiatry, 1994

Research paper thumbnail of Educating Psychiatry Residents About Cultural Aspects of Care: A Qualitative Study of Approaches Used by U.S. Expert Faculty

Academic Psychiatry, 2013

Almost no literature compares current approaches to teaching cultural issues across U.S. psychiat... more Almost no literature compares current approaches to teaching cultural issues across U.S. psychiatry residency programs; the authors addressed this comparison. The authors administered semistructured interviews of 20 instructors with substantial experience in the teaching of cultural issues in U.S. psychiatry residency programs, regarding the content, teaching techniques, institutional context, and evaluation of their curricula over time. Approaches varied according to the local populations served and the background of the instructors, all of whom were either cross-trained in social sciences and humanities or were themselves ethnic, racial, or sexual minorities. Common themes emerged, including the use of experiential approaches, the lack of integration of cultural issues into clinical supervision or courses on other topics, and the absence of formal course evaluation. Findings indicate a need for integration of cultural concepts into a variety of settings throughout residency, for development of faculty who are cross-trained in social sciences and humanities, and for curriculum-evaluation strategies.

Research paper thumbnail of Assessment of spirituality and its relevance to addiction treatment

Journal of Substance Abuse Treatment

The prominence of Twelve-Step programs has led to increased attention on the putative role of spi... more The prominence of Twelve-Step programs has led to increased attention on the putative role of spirituality in recovery from addictive disorders. We developed a 6-item Spirituality Self-Rating Scale designed to reflect a global measure of spiritual orientation to life, and we demonstrated here its internal consistency reliability in substance abusers on treatment and in nonsubstance abusers. This scale and the measures related to recovery from addiction and treatment response were applied in three diverse treatment settings: a general hospital inpatient psychiatry service, a residential therapeutic community, and methadone maintenance programs. Findings on these patient groups were compared to responses given by undergraduate college students, medical students, addiction faculty, and chaplaincy trainees. These suggest that, for certain patients, spiritual orientation is an important aspect of their recovery. Furthermore, the relevance of this issue may be underestimated in the way tr...

Research paper thumbnail of Brain SPECT Imaging in Complex Psychiatric Cases: An Evidence-Based, Underutilized Tool

The Open Neuroimaging Journal, 2011

Over the past 20 years brain Single Photon Emission Computed Tomography (SPECT) imaging has devel... more Over the past 20 years brain Single Photon Emission Computed Tomography (SPECT) imaging has developed a substantial, evidence-based foundation and is now recommended by professional societies for numerous indications relevant to psychiatric practice. Unfortunately, SPECT in clinical practice is utilized by only a handful of clinicians. This article presents a rationale for a more widespread use of SPECT in clinical practice for complex cases, and includes seven clinical applications where it may help optimize patient care.

Research paper thumbnail of The relationship of patient-therapist interaction to outcome in brief psychotherapy

Psychotherapy: Theory, Research, Practice, Training, 1991

... LEIGH McCULLOUGH ARNOLD WINSTON Beth Israel Medical Center BARRY A. FARBER FRANKLIN PORTER Co... more ... LEIGH McCULLOUGH ARNOLD WINSTON Beth Israel Medical Center BARRY A. FARBER FRANKLIN PORTER Columbia University JEROME POLLACK WILLIAM VINGIANO MICHAEL LAIKIN MANUEL TRUJILLO Beth Israel Medical Center ...

Research paper thumbnail of A treatment algorithm for attention deficit hyperactivity disorder in cocaine‐dependent adults: A one‐year private practice study with long‐acting stimulants, fluoxetine, and bupropion

Substance Abuse, 1999

A subgroup of adults in private treatment for cocaine dependence in remission reported a therapeu... more A subgroup of adults in private treatment for cocaine dependence in remission reported a therapeutic effect from cocaine during the initial phases of cocaine addiction and, also, met DSM-IV criteria for ADHD. We report evidence that study subjects probably medicated their ADHD symptoms with cocaine and describe a 1-year treatment algorithm featuring long-acting stimulants that was effective in the management of their ADHD and cocaine dependence. Nineteen stable patients in full remission from all substance dependence were entered into an open label, prospective, treatment trial for ADHD. The treatment schedule consisted of the progressive introduction-and discontinuation of ineffective medication-of each of several medications in the following order: fluoxetine, bupropion, pemoline, sustained-release methylphenidate, dextroamphetamine spansules, and methamphetamine gradumets. Treatment of ADHD was successful. Several treatment regimens, especially those including long-acting stimulants, alone or in combination with other agents, were highly effective. All but 1 of the 19 subjects had a fully effective response for at least 1 full year. Mean UTAH scale scores were 7.4 before any medications were administered and 1.6 at the end of the study. Treatment proved successful in suppressing ADHD symptoms, with minimal cocaine slips or side effects.

Research paper thumbnail of The Effects of Confrontation and Clarification on Patient Affective and Defensive Responding

Psychotherapy Research, 1992

This study examined the effects of therapist confrontations and clarifica-tions on patient defens... more This study examined the effects of therapist confrontations and clarifica-tions on patient defensive and affective responding in short-term dynam-ic psychotherapy. Four videotaped therapy sessions from each of 16 patients were coded on a per-minute basis for the occurrence of selected ...

Research paper thumbnail of Long-acting stimulants for treatment of attention-deficit/hyperactivity disorder: a focus on extended-release formulations and the prodrug lisdexamfetamine dimesylate to address continuing clinical challenges

ADHD Attention Deficit and Hyperactivity Disorders, 2013

Individuals with attention-deficit/hyperactivity disorder (ADHD) show pervasive impairments acros... more Individuals with attention-deficit/hyperactivity disorder (ADHD) show pervasive impairments across family, peer, and school or work functioning that may extend throughout the day. Psychostimulants are highly effective medications for the treatment of ADHD, and the development of long-acting stimulant formulations has greatly expanded the treatment options for individuals with ADHD. Strategies for the formulation of long-acting stimulants include the combination of immediate-release and delayed-release beads, and an osmotic-release oral system. A recent development is the availability of the first prodrug stimulant, lisdexamfetamine dimesylate (LDX). LDX itself is inactive but is cleaved enzymatically, primarily in the bloodstream, to release d-amphetamine (d-AMP). Several clinical trials have demonstrated that long-acting stimulants are effective in reducing ADHD symptoms compared with placebo. Analog classroom and simulated adult workplace environment studies have shown that long-acting stimulants produce symptom reduction for at least 12 h. Long-acting stimulants exhibit similar tolerability and safety profiles to short-acting equivalents. While variations in gastric pH and motility can alter the availability and absorption of stimulants released from long-acting formulations, the systemic exposure to dAMP following LDX administration is unlikely to be affected by gastrointestinal conditions. Long-acting formulations may also improve adherence and lower abuse potential compared with their short-acting counterparts. The development of long-acting stimulants provides physicians with an increased range of medication options to help tailor treatment for individuals with ADHD. Keywords Attention-deficit hyperactivity disorder Á Central nervous system stimulants Á Amphetamines Á Methylphenidate Á Treatment efficacy Á Safety This article is dedicated to the memory of Atilla Turgay.

Research paper thumbnail of Recent cocaine use decreases negative signs in acute schizophrenia: a case study over two consecutive admissions

Research paper thumbnail of Culture and the organization of psychiatric care

Psychiatric Clinics of North America

Health care systems of the 21st century confront the confluence of two important forces that conf... more Health care systems of the 21st century confront the confluence of two important forces that conform their policies regarding culture. On the one hand, population demographics announce increasing diversity; on the other, a rising knowledge base regarding the impact of culture on mental health awaits to be incorporated into actual clinical practices nationwide. As regulators and payors incorporate this knowledge into their practices, standards and guidelines, the dream of mental health cultural parity will come somewhat closer to fulfillment. In this article, we have aimed to review how the integration of developing knowledge and evolving standards may contribute to such fulfillment.

Research paper thumbnail of CULTURE AND THE ORGANIZATION OF PSYCHIATRIC CARE

Psychiatric Clinics of North America, 2001

Health care systems of the 21st century confront the confluence of two important forces that conf... more Health care systems of the 21st century confront the confluence of two important forces that conform their policies regarding culture. On the one hand, population demographics announce increasing diversity; on the other, a rising knowledge base regarding the impact of culture on mental health awaits to be incorporated into actual clinical practices nationwide. As regulators and payors incorporate this knowledge into their practices, standards and guidelines, the dream of mental health cultural parity will come somewhat closer to fulfillment. In this article, we have aimed to review how the integration of developing knowledge and evolving standards may contribute to such fulfillment.

Research paper thumbnail of The short-term treatment of narcissistic and other self-disorders

European Psychiatry, 2007

Research paper thumbnail of Recent cocaine use decreases negative signs in acute schizophrenia: A case study over two consecutive admissions

Biological Psychiatry, 1996

Research paper thumbnail of Comorbidity of cocaine abuse and schizophrenia: An examination of clinical functioning across an acute episode

Biological Psychiatry

analyses failed to yield strong evidence that subject-related and methodological features of the ... more analyses failed to yield strong evidence that subject-related and methodological features of the studies were related to neuropsychological findings. These results are discussed in relation to neuropsychological research, alcoholism, and in the context of other psychopathological disorders. Implications for future research and clinical and policy issues are considered.

Research paper thumbnail of Emergency psychiatry in the twenty-first century

The contributors to this issue address some of the essential components of state of art emergency... more The contributors to this issue address some of the essential components of state of art emergency care delivery, be it in an emergency room, crisis center, private office, on site in the community, or on an inpatient unit in a hospital. Kimberly Nordstrom, MD, JD, and Michael H. Allen, MD, present some general principles of emergency care delivery regardless of site of delivery. They focus on the review of risk factors for outpatient violence (diagnosis, the presence of positive symptoms, substance abuse and dependence) as an essential component of maintaining risk-awareness. They also review management measures that can prevent or help manage unexpected violence situations in outpatient practice or clinic settings, such as the use of panic-buttons, a written emergency plan appropriately rehearsed, and other means. David Baron, MSEd, DO, and colleagues discuss the evalu-ation and management of substance abuse emergencies. This article focuses on the clinical evaluation and initial t...

Research paper thumbnail of Some effects of folate deficiency on mentals status in street dwelling homeless mentally ill

Research paper thumbnail of P02-444 - A Controlled Randomized Study on the Efficacy of Short-Term Dinamic Psychotherapy in Borderline Personality Disorders (BPD). Preliminary Results

Research paper thumbnail of The sodium amytal interview as a therapeutic modality

Current psychiatric therapies, 1978

Research paper thumbnail of Haloperidol Blood Levels in Acute Mania With Psychosis

Journal of Clinical Psychopharmacology, 2001

In this study, the authors examined the relationship between steady-state haloperidol blood level... more In this study, the authors examined the relationship between steady-state haloperidol blood levels and clinical response in patients with acute psychotic mania. Fifty-four inpatients with acute mania were randomly assigned to receive either haloperidol 25 mg/day or haloperidol 5 mg/day. Each subject also received a concomitant medication: lorazepam 4 mg/day, lithium, or placebo. The relationship between steady-state haloperidol blood levels and clinical improvement was studied using analysis of covariance. There was wide interindividual variation in the haloperidol blood level-dose ratio. Haloperidol blood levels (log-transformed) were found to significantly correlate with clinical response in acute mania. Low-dose haloperidol with concomitant lithium may produce an optimal response in acute mania. Haloperidol blood levels may be clinically useful in identifying patients who are nonresponsive because of low drug levels and, hence, in enhancing optimal haloperidol dosing for acute mania with psychosis.

Research paper thumbnail of Comorbidity of cocaine abuse and schizophrenia: An examination of clinical functioning across an acute episode

Biological Psychiatry, 1994

analyses failed to yield strong evidence that subject-related and methodological features of the ... more analyses failed to yield strong evidence that subject-related and methodological features of the studies were related to neuropsychological findings. These results are discussed in relation to neuropsychological research, alcoholism, and in the context of other psychopathological disorders. Implications for future research and clinical and policy issues are considered.

Research paper thumbnail of Some effects of folate deficiency on mentals status in street dwelling homeless mentally ill

Biological Psychiatry, 1994

Research paper thumbnail of Educating Psychiatry Residents About Cultural Aspects of Care: A Qualitative Study of Approaches Used by U.S. Expert Faculty

Academic Psychiatry, 2013

Almost no literature compares current approaches to teaching cultural issues across U.S. psychiat... more Almost no literature compares current approaches to teaching cultural issues across U.S. psychiatry residency programs; the authors addressed this comparison. The authors administered semistructured interviews of 20 instructors with substantial experience in the teaching of cultural issues in U.S. psychiatry residency programs, regarding the content, teaching techniques, institutional context, and evaluation of their curricula over time. Approaches varied according to the local populations served and the background of the instructors, all of whom were either cross-trained in social sciences and humanities or were themselves ethnic, racial, or sexual minorities. Common themes emerged, including the use of experiential approaches, the lack of integration of cultural issues into clinical supervision or courses on other topics, and the absence of formal course evaluation. Findings indicate a need for integration of cultural concepts into a variety of settings throughout residency, for development of faculty who are cross-trained in social sciences and humanities, and for curriculum-evaluation strategies.

Research paper thumbnail of Assessment of spirituality and its relevance to addiction treatment

Journal of Substance Abuse Treatment

The prominence of Twelve-Step programs has led to increased attention on the putative role of spi... more The prominence of Twelve-Step programs has led to increased attention on the putative role of spirituality in recovery from addictive disorders. We developed a 6-item Spirituality Self-Rating Scale designed to reflect a global measure of spiritual orientation to life, and we demonstrated here its internal consistency reliability in substance abusers on treatment and in nonsubstance abusers. This scale and the measures related to recovery from addiction and treatment response were applied in three diverse treatment settings: a general hospital inpatient psychiatry service, a residential therapeutic community, and methadone maintenance programs. Findings on these patient groups were compared to responses given by undergraduate college students, medical students, addiction faculty, and chaplaincy trainees. These suggest that, for certain patients, spiritual orientation is an important aspect of their recovery. Furthermore, the relevance of this issue may be underestimated in the way tr...

Research paper thumbnail of Brain SPECT Imaging in Complex Psychiatric Cases: An Evidence-Based, Underutilized Tool

The Open Neuroimaging Journal, 2011

Over the past 20 years brain Single Photon Emission Computed Tomography (SPECT) imaging has devel... more Over the past 20 years brain Single Photon Emission Computed Tomography (SPECT) imaging has developed a substantial, evidence-based foundation and is now recommended by professional societies for numerous indications relevant to psychiatric practice. Unfortunately, SPECT in clinical practice is utilized by only a handful of clinicians. This article presents a rationale for a more widespread use of SPECT in clinical practice for complex cases, and includes seven clinical applications where it may help optimize patient care.

Research paper thumbnail of The relationship of patient-therapist interaction to outcome in brief psychotherapy

Psychotherapy: Theory, Research, Practice, Training, 1991

... LEIGH McCULLOUGH ARNOLD WINSTON Beth Israel Medical Center BARRY A. FARBER FRANKLIN PORTER Co... more ... LEIGH McCULLOUGH ARNOLD WINSTON Beth Israel Medical Center BARRY A. FARBER FRANKLIN PORTER Columbia University JEROME POLLACK WILLIAM VINGIANO MICHAEL LAIKIN MANUEL TRUJILLO Beth Israel Medical Center ...

Research paper thumbnail of A treatment algorithm for attention deficit hyperactivity disorder in cocaine‐dependent adults: A one‐year private practice study with long‐acting stimulants, fluoxetine, and bupropion

Substance Abuse, 1999

A subgroup of adults in private treatment for cocaine dependence in remission reported a therapeu... more A subgroup of adults in private treatment for cocaine dependence in remission reported a therapeutic effect from cocaine during the initial phases of cocaine addiction and, also, met DSM-IV criteria for ADHD. We report evidence that study subjects probably medicated their ADHD symptoms with cocaine and describe a 1-year treatment algorithm featuring long-acting stimulants that was effective in the management of their ADHD and cocaine dependence. Nineteen stable patients in full remission from all substance dependence were entered into an open label, prospective, treatment trial for ADHD. The treatment schedule consisted of the progressive introduction-and discontinuation of ineffective medication-of each of several medications in the following order: fluoxetine, bupropion, pemoline, sustained-release methylphenidate, dextroamphetamine spansules, and methamphetamine gradumets. Treatment of ADHD was successful. Several treatment regimens, especially those including long-acting stimulants, alone or in combination with other agents, were highly effective. All but 1 of the 19 subjects had a fully effective response for at least 1 full year. Mean UTAH scale scores were 7.4 before any medications were administered and 1.6 at the end of the study. Treatment proved successful in suppressing ADHD symptoms, with minimal cocaine slips or side effects.

Research paper thumbnail of The Effects of Confrontation and Clarification on Patient Affective and Defensive Responding

Psychotherapy Research, 1992

This study examined the effects of therapist confrontations and clarifica-tions on patient defens... more This study examined the effects of therapist confrontations and clarifica-tions on patient defensive and affective responding in short-term dynam-ic psychotherapy. Four videotaped therapy sessions from each of 16 patients were coded on a per-minute basis for the occurrence of selected ...