Vineeth .John | The University of Texas Health Science Center at Houston (original) (raw)

Papers by Vineeth .John

International Journal of Psychiatry in Medicine, Jan 18, 2023

Objectives During the COVID-19 pandemic, many psychiatry residencies (academic, community, and hy... more Objectives During the COVID-19 pandemic, many psychiatry residencies (academic, community, and hybrid programs) have adopted different learning modalities to preserve a high quality of educational training. There is minimal data on specific program adaptations, related change perspectives, and program type stratification. This study sought to examine trends in curriculum changes in accredited psychiatry residency programs in the United States. Methods Program directors of accredited general psychiatry programs in the United States were surveyed to assess both general program details and changes in educational content, delivery, and perspectives with regard to program curricula. Results A total of 63 program directors out of 264 eligible programs completed the questionnaire (23.9%). There was a significant shift to integrate virtual learning post-pandemic (98.5%) compared to pre-pandemic (3%). However, there was no association between these modality changes and program type ( p = 0.13). Furthermore, changes were noted with respect to didactic content (60%), decreased rotation sites (38%), and increased telemedicine exposure (84%) with no change of wellness days (67%) or protected time (97%). Again, the above changes had no association with program type. Use of virtual educational platforms was described as positive (59.7%) with 9 programs noting a future transition to a hybrid learning model for didactics and grand rounds. Conclusions The findings suggest that pandemic-related curriculum adaptations occurred in all different types of psychiatry residencies and suggest a national trend to continue virtual educational platforms with regard to psychiatry didactics. However, future investigation of effectiveness of virtual learning programs in psychiatry residencies is warranted.

Journal of Nervous and Mental Disease, Dec 1, 2011

The DSM-IV recognizes catatonia as a subtype of schizophrenia characterized by at least two of th... more The DSM-IV recognizes catatonia as a subtype of schizophrenia characterized by at least two of the following: motor immobility, excessive motor activity not influenced by external stimuli, and peculiarities of voluntary movement. Catatonia may also occur secondary to mania, depression, or a general medical condition including encephalitis, focal neurological lesions, metabolic disturbances, and drug intoxications and withdrawals. Benzodiazepines remain the first line of treatment; up to 80% of patients respond promptly to Lorazepam challenge; failure to respond to lorazepam may be followed by electroconvulsive therapy. Atypical antipsychotics may be a new alternative in the treatment of catatonia. Successful reduction of the catatonic symptoms has been demonstrated with atypical antipsychotics. A possible mechanism of action for the efficacy of this class of drugs involves the antagonism of the 5-HT2A receptor. We are now reporting a case of treatment response to risperidone in a patient with chronic catatonia resistant to benzodiazepines.

Journal of Clinical Densitometry, Apr 1, 2018

Depression and osteoporosis are 2 common comorbidities in geriatric patients. There are concerns ... more Depression and osteoporosis are 2 common comorbidities in geriatric patients. There are concerns about the deleterious effects of selective serotonin reuptake inhibitor (SSRI) antidepressant use on bone mineral density (BMD). We examined the association between SSRI use and BMD in elderly women (≥65 yr) referred to a geriatric osteoporosis clinic for bone health evaluation. Cross-sectional analyses using the general linear model were performed on data collected retrospectively from August 2010 to April 2015. A total of 250 women were seen during the study period. Of these, 140 women had complete data on BMD measurements: 22 (15.7%) used an SSRI and 118 (84.3%) did not. The 2 groups, SSRI users and SSRI nonusers, did not differ significantly across any of the covariates tested (age, ethnicity, body mass index, and past and present osteoporosis treatment medications). After adjusting for covariates, there was no difference in the BMDs at the femoral neck (p = 0.887) or the spine (p = 0.275) between the 2 groups. Similarly, no difference was seen in the T-scores between SSRI users and nonusers at the femoral neck (p = 0.924) or at the spine level (p = 0.393). Our study did not show an association between SSRI use and BMD among elderly women referred for bone health evaluation. Other studies in the literature have been inconclusive, and therefore, robust longitudinal studies are needed to further assess the interaction between SSRI use and predictors of fracture such as BMD, bone turnover markers, and genes involved in bone turnover. Until then, clinicians should closely monitor the bone health of long-term SSRI users.

Journal of Affective Disorders, Apr 1, 2019

Background: Major depressive disorder (MDD) is a leading cause of disability worldwide, and over ... more Background: Major depressive disorder (MDD) is a leading cause of disability worldwide, and over half of patients do not achieve symptom remission following an initial antidepressant course. Despite evidence implicating a strong genetic basis for the pathophysiology of MDD, there are no adequately validated biomarkers of treatment response routinely used in clinical practice. Pharmacoepigenetics is an emerging field that has the potential to combine both genetic and environmental information into treatment selection and further the goal of precision psychiatry. However, this field is in its infancy compared to the more established pharmacogenetics approaches.

Archives of General Psychiatry, May 1, 2006

A history of depression may increase risk for developing Alzheimer disease (AD) later in life. Cl... more A history of depression may increase risk for developing Alzheimer disease (AD) later in life. Clarifying this relation might improve understanding of risk factors for and disease mechanisms in AD. Objective: To systematically review and complete a metaanalysis on the relation of depression and AD. Data Sources: We conducted electronic bibliographic searches of MEDLINE, PsychLit, EMBASE, and BIOSIS using search terms sensitive to studies of etiology combined with searches on terms related to depression and AD and reviewed reference lists of articles. Study Selection: Studies with data contrasting depressed vs nondepressed patients who did and did not later develop AD were included. Studies that related continuous measures of depression and cognitive status were excluded. Data Extraction: Numerical data were independently extracted by 3 reviewers. They also rated studies on a scale that assessed quality indicators for observational studies. Data on the interval between observation of depression and the diagnosis of AD were collected when available. Data Synthesis: Meta-analytic evaluation with randomeffects models resulted in pooled odds ratios of 2.03 (95% confidence interval, 1.73-2.38) for case-control and of 1.90 (95% confidence interval, 1.55-2.33) for cohort studies. Findings of increased risk were robust to sensitivity analyses. Interval between diagnoses of depression and AD was positively related to increased risk of developing AD, suggesting that rather than a prodrome, depression may be a risk factor for AD. Conclusions: A history of depression may confer an increased risk for later developing AD. This relation may reflect an independent risk factor for the disease.

The International Journal of Psychiatry in Medicine

Objectives During the COVID-19 pandemic, many psychiatry residencies (academic, community, and hy... more Objectives During the COVID-19 pandemic, many psychiatry residencies (academic, community, and hybrid programs) have adopted different learning modalities to preserve a high quality of educational training. There is minimal data on specific program adaptations, related change perspectives, and program type stratification. This study sought to examine trends in curriculum changes in accredited psychiatry residency programs in the United States. Methods Program directors of accredited general psychiatry programs in the United States were surveyed to assess both general program details and changes in educational content, delivery, and perspectives with regard to program curricula. Results A total of 63 program directors out of 264 eligible programs completed the questionnaire (23.9%). There was a significant shift to integrate virtual learning post-pandemic (98.5%) compared to pre-pandemic (3%). However, there was no association between these modality changes and program type ( p = 0.1...

The European Journal of Psychiatry, 2019

Background and objectives: Even though love addiction is not recognized by DSM-5 as a specific di... more Background and objectives: Even though love addiction is not recognized by DSM-5 as a specific diagnosis, there is enough literature data to support its characterization as an independent mental disorder. Information on the treatment of love addiction is still scant. Methods: The databases Medline, Embase, and LILACS were searched for literature findings addressing the treatment of love addiction. Results: The currently available therapeutic strategies for love addiction are discussed, as well as some perspectives in the treatment of love addiction from a pharmacological standpoint. Conclusion: There is scant evidence regarding the treatment of love addiction in the medical literature, specially with respect to pharmacological interventions, although several agents may hypothetically be of benefit in this condition. Psychotherapy is often cited as the cornerstone of the treatment of love addiction, but its efficacy has not been properly investigated.

Acta Psychiatrica Scandinavica, 2003

Artificial Intelligence in Medicine, 2014

Objective-Clinicians' attention is a precious resource, which in the current healthcare practice ... more Objective-Clinicians' attention is a precious resource, which in the current healthcare practice is consumed by the cognitive demands arising from complex patient conditions, information overload, time pressure, and the need to aggregate and synthesize information from disparate sources. The ability to organize information in ways that facilitate the generation of effective diagnostic solutions is a distinguishing characteristic of expert physicians, suggesting that automated systems that organize clinical information in a similar manner may augment physicians' decision-making capabilities. In this paper, we describe the design and evaluation of a theoretically driven cognitive support system (CSS) that assists psychiatrists in their interpretation of clinical cases. The system highlights, and provides the means to navigate to, text that is organized in accordance with a set of diagnostically and therapeutically meaningful higher-level concepts. Methods and Materials-To evaluate the interface, 16 psychiatry residents interpreted two clinical case scenarios, with and without the CSS. Think-aloud protocols captured during their interpretation of the cases were transcribed and analyzed qualitatively. In addition, the frequency and relative position of content related to key higher-level concepts in a verbal summary of the

Journal of the American Academy of Child & Adolescent Psychiatry, 2002

Journal of Nervous & Mental Disease, 2011

The DSM-IV recognizes catatonia as a subtype of schizophrenia characterized by at least two of th... more The DSM-IV recognizes catatonia as a subtype of schizophrenia characterized by at least two of the following: motor immobility, excessive motor activity not influenced by external stimuli, and peculiarities of voluntary movement. Catatonia may also occur secondary to mania, depression, or a general medical condition including encephalitis, focal neurological lesions, metabolic disturbances, and drug intoxications and withdrawals. Benzodiazepines remain the first line of treatment; up to 80% of patients respond promptly to Lorazepam challenge; failure to respond to lorazepam may be followed by electroconvulsive therapy. Atypical antipsychotics may be a new alternative in the treatment of catatonia. Successful reduction of the catatonic symptoms has been demonstrated with atypical antipsychotics. A possible mechanism of action for the efficacy of this class of drugs involves the antagonism of the 5-HT2A receptor. We are now reporting a case of treatment response to risperidone in a patient with chronic catatonia resistant to benzodiazepines.

Journal of Affective Disorders, 2019

Background: Major depressive disorder (MDD) is a leading cause of disability worldwide, and over ... more Background: Major depressive disorder (MDD) is a leading cause of disability worldwide, and over half of patients do not achieve symptom remission following an initial antidepressant course. Despite evidence implicating a strong genetic basis for the pathophysiology of MDD, there are no adequately validated biomarkers of treatment response routinely used in clinical practice. Pharmacoepigenetics is an emerging field that has the potential to combine both genetic and environmental information into treatment selection and further the goal of precision psychiatry. However, this field is in its infancy compared to the more established pharmacogenetics approaches.

Journal of Psychopharmacology, Jun 12, 2013

Key characteristics of cocaine dependence include attentional bias to cocaine cues and impaired i... more Key characteristics of cocaine dependence include attentional bias to cocaine cues and impaired inhibitory control. Studies suggest that serotonin modulates both cocaine cue reactivity and inhibitory control. We investigated effects of the selective serotonin reuptake inhibitor escitalopram on cocaine cue reactivity and inhibitory processes in cocaine-dependent subjects. In a double-blind placebo-controlled design, cocaine-dependent subjects received placebo (n=12) or escitalopram (n=11; 10 mg on days 1-3, 20 mg on days 4-24 and 10 mg on days 25-28) orally, once daily for 4 weeks. The cocaine Stroop and immediate memory task (IMT) were administered at baseline, days 1, 4, 11, 18 and 25 after placebo or escitalopram initiation. There were no significant between-group differences in baseline performance on the cocaine Stroop task or the IMT. On day 1 (acute phase), escitalopram produced a significantly greater decrease from baseline than placebo in attentional bias measured by cocaine Stroop task 5 hours post-dose. No significant changes from baseline in attentional bias were observed on subsequent test days (chronic phase). Inhibitory control as measured by IMT commission error rate was not significantly different between two groups in either the acute or chronic phase. Consistent with preclinical data, serotonin-modulating drugs like escitalopram may have acute effects on cocaine cue reactivity in human cocaine users.

Bipolar Disorders, Aug 1, 2004

Objectives: To evaluate the point prevalence of the metabolic syndrome in patients with schizoaf... more Objectives: To evaluate the point prevalence of the metabolic syndrome in patients with schizoaffective disorder – bipolar type.Methods: Consenting patients who were participants in an ongoing clinical trial of adjunctive topiramate treatment for schizoaffective disorder, bipolar type were evaluated at baseline for the point prevalence of the metabolic syndrome. The criteria for the metabolic syndrome included: (a) waist circumference > 102 cm (40 inches) in males, or > 88 cm (35 inches) in females; (b) fasting serum triglyceride levels ≥ 150 mg/dL; (c) fasting high density lipoproteins (HDL) cholesterol <40 mg/dL in men or <50 mg/dL in women; (d) blood pressure ≥ 130/85 mmHg; and (e) fasting glucose ≥ 110 mg/dL. Subjects who had at least three of these five criteria were defined as meeting criteria for the metabolic syndrome.Results: Thirty‐six subjects (males = 15, females = 21) were evaluated, and three were excluded for missing data. Among those 33 subjects with complete data, 14 subjects (42.4%, males = 7, females = 7, African Americans = 6, Caucasians = 8) met criteria for the metabolic syndrome. Not unexpectedly, those with the metabolic syndrome were significantly more likely to be obese, and have significantly higher mean systolic and diastolic blood pressure, mean fasting triglyceride levels and larger mean waist circumferences, and significantly lower HDL cholesterol levels; and a trend toward higher fasting blood glucose levels. Furthermore, the fasting mean total cholesterol in those with the metabolic syndrome was 217 mg/dL (±46).Conclusions: This preliminary report suggests that the point prevalence of the metabolic syndrome in patients with schizoaffective disorder appears to be higher than that reported in the general population of the USA. Targeted weight reduction and life style change strategies (increased exercise, smoking cessation, stress reduction) may provide useful interventions to decrease the morbidity and mortality that accompanies the presence of the metabolic syndrome in patients with psychiatric illnesses.

Journal of Psychiatric Practice, 2001

Obesity and associated medical conditions may have an impact on morbidity and even mortality in p... more Obesity and associated medical conditions may have an impact on morbidity and even mortality in patients with psychiatric disorders. The authors present the results of a survey of the prevalence of obesity and selected medical conditions among 420 consecutively admitted psychiatric inpatients at a long-stay facility and compare these data with those reported in the literature. Female psychiatric subjects had considerably higher rates of being either overweight or obese (69%) as compared to women in the general U.S. population (51%). Male psychiatric subjects did not differ significantly from their counterparts in the general population in being overweight or obese (nearly 55%). The majority of psychiatric subjects with essential hypertension, diabetes mellitus, dyslipidemias, cardiovascular disease, or sleep apnea were either overweight or obese (72%-87%). In this cross-sectional study, no associations could be deduced between psychotropic drug classes and specific medical conditions. No specific psychiatric diagnostic category was associated with a significantly greater prevalence of any specific medical condition, except that subjects with schizoaffective disorder appeared to have a higher prevalence of type II diabetes mellitus (11.6%). Subjects with predominant substance or alcohol abuse or dependence disorders had a lower prevalence of obesity and associated medical conditions. Obesity-either independently or additively along with a sedentary lifestyle, unhealthy dietary habits, and nicotine dependence-may have a serious impact on coexisting medical comorbidity in psychiatric patients. Judicious monitoring for obesity and rapid pharmacological and nonpharmacological intervention, where appropriate, by concerned clinicians may improve several coexisting medical conditions in psychiatric patients and thereby improve patients' overall quality of life.

Anesthesia and analgesia, Jul 6, 2016

The clinical relevance of chronic exposure to selective serotonin reuptake inhibitors (SSRIs) to ... more The clinical relevance of chronic exposure to selective serotonin reuptake inhibitors (SSRIs) to transfusion in surgical patients is unclear. We conducted a prospective cohort study involving patients undergoing cardiac, vascular, spinal, and intracranial surgery at 2 academic medical centers. Medication use, demographics, comorbidities, and laboratory values were determined at baseline by patient interview and review of medical records. The primary outcome was transfusion of any hemostatic allogeneic blood product (i.e., fresh frozen plasma, platelets, and/or cryoprecipitate) through postoperative day 2. The study sample consisted of 767 patients; 364 patients (47.5%) underwent cardiac surgery and the remainder underwent noncardiac surgery. Eighty-eight patients (11.5%) used SSRIs preoperatively. Among cardiac patients, the absolute number of allogeneic transfusions was higher for SSRI users than nonusers (2 [0-6] vs 0 [0-2], median [25%-75%], respectively, P = 0.008), and a simila...

Journal of Psychiatric Practice, 2016

The goal of this review was to consolidate the evidence concerning the efficacy of botulinum toxi... more The goal of this review was to consolidate the evidence concerning the efficacy of botulinum toxin type A (onabotulinumtox-inA) in depression. Methods: We searched MEDLINE, EMBASE, Cochrane, and Scopus through May 5, 2014, for studies evaluating the efficacy of botulinum toxin A in depression. Only randomized controlled trials were included in the metaanalysis. A pooled mean difference in primary depression score, and pooled odds ratio for response and remission rate with 95% confidence interval (CI) were estimated using the random-effects model. Heterogeneity was assessed using Cochran Q test and χ 2 statistic. Results: Of the 639 articles that were initially retrieved, 5 studies enrolling 194 subjects (age 49±9.6 y) were included in the systematic review, and 3 randomized controlled trials enrolling 134 subjects were included in the meta-analysis. The meta-analysis showed a significant decrease in mean primary depression scores among patients who received botulinum toxin A compared with placebo (−9.80; 95% CI, −12.90 to −6.69) with modest heterogeneity between the studies (Cochran Q test, χ 2 =70). Response and remission rates were 8.3 and 4.6 times higher, respectively, among patients receiving botulinum toxin A compared with placebo, with no heterogeneity between the studies. The 2 studies excluded from the meta-analysis also found a significant decrease in primary depression scores in patients after receiving botulinum toxin A. A few subjects had minor side effects, which were similar between the groups receiving botulinum toxin and those receiving placebo. Conclusions: This study suggests that botulinum toxin A can produce significant improvement in depressive symptoms and is a safe adjunctive treatment for patients receiving pharmacotherapy for depression. Future trials are needed to evaluate the antidepressant effect per se of botulinum toxin A and to further elucidate the underlying antidepressant mechanism of botulinum toxin A.

International Journal of Psychiatry in Medicine, Jan 18, 2023

Objectives During the COVID-19 pandemic, many psychiatry residencies (academic, community, and hy... more Objectives During the COVID-19 pandemic, many psychiatry residencies (academic, community, and hybrid programs) have adopted different learning modalities to preserve a high quality of educational training. There is minimal data on specific program adaptations, related change perspectives, and program type stratification. This study sought to examine trends in curriculum changes in accredited psychiatry residency programs in the United States. Methods Program directors of accredited general psychiatry programs in the United States were surveyed to assess both general program details and changes in educational content, delivery, and perspectives with regard to program curricula. Results A total of 63 program directors out of 264 eligible programs completed the questionnaire (23.9%). There was a significant shift to integrate virtual learning post-pandemic (98.5%) compared to pre-pandemic (3%). However, there was no association between these modality changes and program type ( p = 0.13). Furthermore, changes were noted with respect to didactic content (60%), decreased rotation sites (38%), and increased telemedicine exposure (84%) with no change of wellness days (67%) or protected time (97%). Again, the above changes had no association with program type. Use of virtual educational platforms was described as positive (59.7%) with 9 programs noting a future transition to a hybrid learning model for didactics and grand rounds. Conclusions The findings suggest that pandemic-related curriculum adaptations occurred in all different types of psychiatry residencies and suggest a national trend to continue virtual educational platforms with regard to psychiatry didactics. However, future investigation of effectiveness of virtual learning programs in psychiatry residencies is warranted.

Journal of Nervous and Mental Disease, Dec 1, 2011

The DSM-IV recognizes catatonia as a subtype of schizophrenia characterized by at least two of th... more The DSM-IV recognizes catatonia as a subtype of schizophrenia characterized by at least two of the following: motor immobility, excessive motor activity not influenced by external stimuli, and peculiarities of voluntary movement. Catatonia may also occur secondary to mania, depression, or a general medical condition including encephalitis, focal neurological lesions, metabolic disturbances, and drug intoxications and withdrawals. Benzodiazepines remain the first line of treatment; up to 80% of patients respond promptly to Lorazepam challenge; failure to respond to lorazepam may be followed by electroconvulsive therapy. Atypical antipsychotics may be a new alternative in the treatment of catatonia. Successful reduction of the catatonic symptoms has been demonstrated with atypical antipsychotics. A possible mechanism of action for the efficacy of this class of drugs involves the antagonism of the 5-HT2A receptor. We are now reporting a case of treatment response to risperidone in a patient with chronic catatonia resistant to benzodiazepines.

Journal of Clinical Densitometry, Apr 1, 2018

Depression and osteoporosis are 2 common comorbidities in geriatric patients. There are concerns ... more Depression and osteoporosis are 2 common comorbidities in geriatric patients. There are concerns about the deleterious effects of selective serotonin reuptake inhibitor (SSRI) antidepressant use on bone mineral density (BMD). We examined the association between SSRI use and BMD in elderly women (≥65 yr) referred to a geriatric osteoporosis clinic for bone health evaluation. Cross-sectional analyses using the general linear model were performed on data collected retrospectively from August 2010 to April 2015. A total of 250 women were seen during the study period. Of these, 140 women had complete data on BMD measurements: 22 (15.7%) used an SSRI and 118 (84.3%) did not. The 2 groups, SSRI users and SSRI nonusers, did not differ significantly across any of the covariates tested (age, ethnicity, body mass index, and past and present osteoporosis treatment medications). After adjusting for covariates, there was no difference in the BMDs at the femoral neck (p = 0.887) or the spine (p = 0.275) between the 2 groups. Similarly, no difference was seen in the T-scores between SSRI users and nonusers at the femoral neck (p = 0.924) or at the spine level (p = 0.393). Our study did not show an association between SSRI use and BMD among elderly women referred for bone health evaluation. Other studies in the literature have been inconclusive, and therefore, robust longitudinal studies are needed to further assess the interaction between SSRI use and predictors of fracture such as BMD, bone turnover markers, and genes involved in bone turnover. Until then, clinicians should closely monitor the bone health of long-term SSRI users.

Journal of Affective Disorders, Apr 1, 2019

Background: Major depressive disorder (MDD) is a leading cause of disability worldwide, and over ... more Background: Major depressive disorder (MDD) is a leading cause of disability worldwide, and over half of patients do not achieve symptom remission following an initial antidepressant course. Despite evidence implicating a strong genetic basis for the pathophysiology of MDD, there are no adequately validated biomarkers of treatment response routinely used in clinical practice. Pharmacoepigenetics is an emerging field that has the potential to combine both genetic and environmental information into treatment selection and further the goal of precision psychiatry. However, this field is in its infancy compared to the more established pharmacogenetics approaches.

Archives of General Psychiatry, May 1, 2006

A history of depression may increase risk for developing Alzheimer disease (AD) later in life. Cl... more A history of depression may increase risk for developing Alzheimer disease (AD) later in life. Clarifying this relation might improve understanding of risk factors for and disease mechanisms in AD. Objective: To systematically review and complete a metaanalysis on the relation of depression and AD. Data Sources: We conducted electronic bibliographic searches of MEDLINE, PsychLit, EMBASE, and BIOSIS using search terms sensitive to studies of etiology combined with searches on terms related to depression and AD and reviewed reference lists of articles. Study Selection: Studies with data contrasting depressed vs nondepressed patients who did and did not later develop AD were included. Studies that related continuous measures of depression and cognitive status were excluded. Data Extraction: Numerical data were independently extracted by 3 reviewers. They also rated studies on a scale that assessed quality indicators for observational studies. Data on the interval between observation of depression and the diagnosis of AD were collected when available. Data Synthesis: Meta-analytic evaluation with randomeffects models resulted in pooled odds ratios of 2.03 (95% confidence interval, 1.73-2.38) for case-control and of 1.90 (95% confidence interval, 1.55-2.33) for cohort studies. Findings of increased risk were robust to sensitivity analyses. Interval between diagnoses of depression and AD was positively related to increased risk of developing AD, suggesting that rather than a prodrome, depression may be a risk factor for AD. Conclusions: A history of depression may confer an increased risk for later developing AD. This relation may reflect an independent risk factor for the disease.

The International Journal of Psychiatry in Medicine

Objectives During the COVID-19 pandemic, many psychiatry residencies (academic, community, and hy... more Objectives During the COVID-19 pandemic, many psychiatry residencies (academic, community, and hybrid programs) have adopted different learning modalities to preserve a high quality of educational training. There is minimal data on specific program adaptations, related change perspectives, and program type stratification. This study sought to examine trends in curriculum changes in accredited psychiatry residency programs in the United States. Methods Program directors of accredited general psychiatry programs in the United States were surveyed to assess both general program details and changes in educational content, delivery, and perspectives with regard to program curricula. Results A total of 63 program directors out of 264 eligible programs completed the questionnaire (23.9%). There was a significant shift to integrate virtual learning post-pandemic (98.5%) compared to pre-pandemic (3%). However, there was no association between these modality changes and program type ( p = 0.1...

The European Journal of Psychiatry, 2019

Background and objectives: Even though love addiction is not recognized by DSM-5 as a specific di... more Background and objectives: Even though love addiction is not recognized by DSM-5 as a specific diagnosis, there is enough literature data to support its characterization as an independent mental disorder. Information on the treatment of love addiction is still scant. Methods: The databases Medline, Embase, and LILACS were searched for literature findings addressing the treatment of love addiction. Results: The currently available therapeutic strategies for love addiction are discussed, as well as some perspectives in the treatment of love addiction from a pharmacological standpoint. Conclusion: There is scant evidence regarding the treatment of love addiction in the medical literature, specially with respect to pharmacological interventions, although several agents may hypothetically be of benefit in this condition. Psychotherapy is often cited as the cornerstone of the treatment of love addiction, but its efficacy has not been properly investigated.

Acta Psychiatrica Scandinavica, 2003

Artificial Intelligence in Medicine, 2014

Objective-Clinicians' attention is a precious resource, which in the current healthcare practice ... more Objective-Clinicians' attention is a precious resource, which in the current healthcare practice is consumed by the cognitive demands arising from complex patient conditions, information overload, time pressure, and the need to aggregate and synthesize information from disparate sources. The ability to organize information in ways that facilitate the generation of effective diagnostic solutions is a distinguishing characteristic of expert physicians, suggesting that automated systems that organize clinical information in a similar manner may augment physicians' decision-making capabilities. In this paper, we describe the design and evaluation of a theoretically driven cognitive support system (CSS) that assists psychiatrists in their interpretation of clinical cases. The system highlights, and provides the means to navigate to, text that is organized in accordance with a set of diagnostically and therapeutically meaningful higher-level concepts. Methods and Materials-To evaluate the interface, 16 psychiatry residents interpreted two clinical case scenarios, with and without the CSS. Think-aloud protocols captured during their interpretation of the cases were transcribed and analyzed qualitatively. In addition, the frequency and relative position of content related to key higher-level concepts in a verbal summary of the

Journal of the American Academy of Child & Adolescent Psychiatry, 2002

Journal of Nervous & Mental Disease, 2011

The DSM-IV recognizes catatonia as a subtype of schizophrenia characterized by at least two of th... more The DSM-IV recognizes catatonia as a subtype of schizophrenia characterized by at least two of the following: motor immobility, excessive motor activity not influenced by external stimuli, and peculiarities of voluntary movement. Catatonia may also occur secondary to mania, depression, or a general medical condition including encephalitis, focal neurological lesions, metabolic disturbances, and drug intoxications and withdrawals. Benzodiazepines remain the first line of treatment; up to 80% of patients respond promptly to Lorazepam challenge; failure to respond to lorazepam may be followed by electroconvulsive therapy. Atypical antipsychotics may be a new alternative in the treatment of catatonia. Successful reduction of the catatonic symptoms has been demonstrated with atypical antipsychotics. A possible mechanism of action for the efficacy of this class of drugs involves the antagonism of the 5-HT2A receptor. We are now reporting a case of treatment response to risperidone in a patient with chronic catatonia resistant to benzodiazepines.

Journal of Affective Disorders, 2019

Background: Major depressive disorder (MDD) is a leading cause of disability worldwide, and over ... more Background: Major depressive disorder (MDD) is a leading cause of disability worldwide, and over half of patients do not achieve symptom remission following an initial antidepressant course. Despite evidence implicating a strong genetic basis for the pathophysiology of MDD, there are no adequately validated biomarkers of treatment response routinely used in clinical practice. Pharmacoepigenetics is an emerging field that has the potential to combine both genetic and environmental information into treatment selection and further the goal of precision psychiatry. However, this field is in its infancy compared to the more established pharmacogenetics approaches.

Journal of Psychopharmacology, Jun 12, 2013

Key characteristics of cocaine dependence include attentional bias to cocaine cues and impaired i... more Key characteristics of cocaine dependence include attentional bias to cocaine cues and impaired inhibitory control. Studies suggest that serotonin modulates both cocaine cue reactivity and inhibitory control. We investigated effects of the selective serotonin reuptake inhibitor escitalopram on cocaine cue reactivity and inhibitory processes in cocaine-dependent subjects. In a double-blind placebo-controlled design, cocaine-dependent subjects received placebo (n=12) or escitalopram (n=11; 10 mg on days 1-3, 20 mg on days 4-24 and 10 mg on days 25-28) orally, once daily for 4 weeks. The cocaine Stroop and immediate memory task (IMT) were administered at baseline, days 1, 4, 11, 18 and 25 after placebo or escitalopram initiation. There were no significant between-group differences in baseline performance on the cocaine Stroop task or the IMT. On day 1 (acute phase), escitalopram produced a significantly greater decrease from baseline than placebo in attentional bias measured by cocaine Stroop task 5 hours post-dose. No significant changes from baseline in attentional bias were observed on subsequent test days (chronic phase). Inhibitory control as measured by IMT commission error rate was not significantly different between two groups in either the acute or chronic phase. Consistent with preclinical data, serotonin-modulating drugs like escitalopram may have acute effects on cocaine cue reactivity in human cocaine users.

Bipolar Disorders, Aug 1, 2004

Objectives: To evaluate the point prevalence of the metabolic syndrome in patients with schizoaf... more Objectives: To evaluate the point prevalence of the metabolic syndrome in patients with schizoaffective disorder – bipolar type.Methods: Consenting patients who were participants in an ongoing clinical trial of adjunctive topiramate treatment for schizoaffective disorder, bipolar type were evaluated at baseline for the point prevalence of the metabolic syndrome. The criteria for the metabolic syndrome included: (a) waist circumference > 102 cm (40 inches) in males, or > 88 cm (35 inches) in females; (b) fasting serum triglyceride levels ≥ 150 mg/dL; (c) fasting high density lipoproteins (HDL) cholesterol <40 mg/dL in men or <50 mg/dL in women; (d) blood pressure ≥ 130/85 mmHg; and (e) fasting glucose ≥ 110 mg/dL. Subjects who had at least three of these five criteria were defined as meeting criteria for the metabolic syndrome.Results: Thirty‐six subjects (males = 15, females = 21) were evaluated, and three were excluded for missing data. Among those 33 subjects with complete data, 14 subjects (42.4%, males = 7, females = 7, African Americans = 6, Caucasians = 8) met criteria for the metabolic syndrome. Not unexpectedly, those with the metabolic syndrome were significantly more likely to be obese, and have significantly higher mean systolic and diastolic blood pressure, mean fasting triglyceride levels and larger mean waist circumferences, and significantly lower HDL cholesterol levels; and a trend toward higher fasting blood glucose levels. Furthermore, the fasting mean total cholesterol in those with the metabolic syndrome was 217 mg/dL (±46).Conclusions: This preliminary report suggests that the point prevalence of the metabolic syndrome in patients with schizoaffective disorder appears to be higher than that reported in the general population of the USA. Targeted weight reduction and life style change strategies (increased exercise, smoking cessation, stress reduction) may provide useful interventions to decrease the morbidity and mortality that accompanies the presence of the metabolic syndrome in patients with psychiatric illnesses.

Journal of Psychiatric Practice, 2001

Obesity and associated medical conditions may have an impact on morbidity and even mortality in p... more Obesity and associated medical conditions may have an impact on morbidity and even mortality in patients with psychiatric disorders. The authors present the results of a survey of the prevalence of obesity and selected medical conditions among 420 consecutively admitted psychiatric inpatients at a long-stay facility and compare these data with those reported in the literature. Female psychiatric subjects had considerably higher rates of being either overweight or obese (69%) as compared to women in the general U.S. population (51%). Male psychiatric subjects did not differ significantly from their counterparts in the general population in being overweight or obese (nearly 55%). The majority of psychiatric subjects with essential hypertension, diabetes mellitus, dyslipidemias, cardiovascular disease, or sleep apnea were either overweight or obese (72%-87%). In this cross-sectional study, no associations could be deduced between psychotropic drug classes and specific medical conditions. No specific psychiatric diagnostic category was associated with a significantly greater prevalence of any specific medical condition, except that subjects with schizoaffective disorder appeared to have a higher prevalence of type II diabetes mellitus (11.6%). Subjects with predominant substance or alcohol abuse or dependence disorders had a lower prevalence of obesity and associated medical conditions. Obesity-either independently or additively along with a sedentary lifestyle, unhealthy dietary habits, and nicotine dependence-may have a serious impact on coexisting medical comorbidity in psychiatric patients. Judicious monitoring for obesity and rapid pharmacological and nonpharmacological intervention, where appropriate, by concerned clinicians may improve several coexisting medical conditions in psychiatric patients and thereby improve patients' overall quality of life.

Anesthesia and analgesia, Jul 6, 2016

The clinical relevance of chronic exposure to selective serotonin reuptake inhibitors (SSRIs) to ... more The clinical relevance of chronic exposure to selective serotonin reuptake inhibitors (SSRIs) to transfusion in surgical patients is unclear. We conducted a prospective cohort study involving patients undergoing cardiac, vascular, spinal, and intracranial surgery at 2 academic medical centers. Medication use, demographics, comorbidities, and laboratory values were determined at baseline by patient interview and review of medical records. The primary outcome was transfusion of any hemostatic allogeneic blood product (i.e., fresh frozen plasma, platelets, and/or cryoprecipitate) through postoperative day 2. The study sample consisted of 767 patients; 364 patients (47.5%) underwent cardiac surgery and the remainder underwent noncardiac surgery. Eighty-eight patients (11.5%) used SSRIs preoperatively. Among cardiac patients, the absolute number of allogeneic transfusions was higher for SSRI users than nonusers (2 [0-6] vs 0 [0-2], median [25%-75%], respectively, P = 0.008), and a simila...

Journal of Psychiatric Practice, 2016

The goal of this review was to consolidate the evidence concerning the efficacy of botulinum toxi... more The goal of this review was to consolidate the evidence concerning the efficacy of botulinum toxin type A (onabotulinumtox-inA) in depression. Methods: We searched MEDLINE, EMBASE, Cochrane, and Scopus through May 5, 2014, for studies evaluating the efficacy of botulinum toxin A in depression. Only randomized controlled trials were included in the metaanalysis. A pooled mean difference in primary depression score, and pooled odds ratio for response and remission rate with 95% confidence interval (CI) were estimated using the random-effects model. Heterogeneity was assessed using Cochran Q test and χ 2 statistic. Results: Of the 639 articles that were initially retrieved, 5 studies enrolling 194 subjects (age 49±9.6 y) were included in the systematic review, and 3 randomized controlled trials enrolling 134 subjects were included in the meta-analysis. The meta-analysis showed a significant decrease in mean primary depression scores among patients who received botulinum toxin A compared with placebo (−9.80; 95% CI, −12.90 to −6.69) with modest heterogeneity between the studies (Cochran Q test, χ 2 =70). Response and remission rates were 8.3 and 4.6 times higher, respectively, among patients receiving botulinum toxin A compared with placebo, with no heterogeneity between the studies. The 2 studies excluded from the meta-analysis also found a significant decrease in primary depression scores in patients after receiving botulinum toxin A. A few subjects had minor side effects, which were similar between the groups receiving botulinum toxin and those receiving placebo. Conclusions: This study suggests that botulinum toxin A can produce significant improvement in depressive symptoms and is a safe adjunctive treatment for patients receiving pharmacotherapy for depression. Future trials are needed to evaluate the antidepressant effect per se of botulinum toxin A and to further elucidate the underlying antidepressant mechanism of botulinum toxin A.