Medicine and Health Sciences Commons^™

‘Things That You Can’T Really Suppress’: Adverse Childhood Experiences In The Narratives Of People With Opioid Use Disorder, Sydney Silverstein, Josef Rivera, Danielle Gainer, Raminta Daniulaityte

Psychiatry Faculty Publications

While numerous studies have established relationships between Adverse Childhood Experiences (ACEs) and adult substance use, few qualitative studies have explored the differing ways in which experiences of childhood adversity are emplotted into narratives of drug use and recovery. This paper analyzes qualitative data collected as part of a mixed-methods longitudinal study of people with opioid use disorder. Narratives of adverse childhood experiences emerged unprompted. After coding qualitative data for mention of ACEs, we thematically analyzed coded data using a framework of critical phenomenology and constructed a four-part typology to differentiate the ways that ACEs were emplotted into narratives. Our …

Effects Of Telehealth On Dropout And Retention In Care Among Treatment-Seeking Individuals With Substance Use Disorder: A Retrospective Cohort Study, Danielle Gainer, Celeste Wong, Jared A. Embree, Nina Sardesh, Amna Amin, Natalie Lester

Psychiatry Faculty Publications

Background: During the COVID-19 pandemic, telehealth became a widely used method of delivering treatment for substance use disorders (SUD), but its impact upon treatment engagement and dropout remains unknown. Methods: We conducted a retrospective analysis of adult SUD patients (n = 544) between October 2020 and June 2022 among a cohort of treatment-seeking patients at a nonprofit community behavioral health center in Southwestern Ohio. We estimated the likelihood of treatment dropout using survival curves and Cox proportional hazard models, comparing patients who used telehealth with video, telephone, or solely in-person services within the first 14 days of diagnosis. We also …

Beyond Trauma-Informed Care: Insights From A Qualitative Study, Danielle Gainer, Sydney Silverstein, Josef Rivera, Raminta Daniulaityte

Psychiatry Faculty Publications

Background: The impact of opioid use disorder (OUD) upon communities across the United States remains at epidemic levels, with a record number of overdose deaths recorded in 2020. As many communities have responded to this ongoing crisis with evidence-based treatment, harm reduction interventions and pharmacotherapy, recent efforts have focused on trauma-informed approaches to SUD care, taking into account the high prevalence of Adverse Childhood Experiences and related trauma in the lives of people living with OUD (Felliti, 1998; Stein, 2017). However, experiences of trauma and the manifestations of trauma in contemporary experience are never uniform (Maté, 2009). Qualitative research among …

Virtual Is Now Reality: Telehealth To Deliver Care For Substance Use Disorders, Brian Merrill, Danielle Gainer, Brent Schnipke

Psychiatry Faculty Publications

Models of care for substance use disorder (SUD) treatment have traditionally required face-to-face visits, since individuals receive a broad range of services including individual psychotherapy, group therapy, urine drug screens, laboratory testing, dispensation of Medications for Opioid Use Disorder (MOUD), and prescriptions for psychotropic or other medications. However, during the COVID-19 pandemic, telehealth became a more widely used method of delivering healthcare, including for SUD treatment. While the pandemic posed respiratory health concerns to all, individuals with a SUD were additionally vulnerable when attempting to access life-saving medications. An enforcement waiver of both federal and state telehealth rules during the …

Emotion Processing Deficit In Euthymic Bipolar Disorder: A Potential Endophenotype, Preethi V. Reddy, Saravanakumar Anandan, Gopalkumar Rakesh, Venkatarama Shivakumar, Boban Joseph, Sunil Kalmady Vasu, Sri Mahavir Agarwal, Kesavan Muralidharan, Ganesan Venkatasubramanian, Janardhanan C. Narayanaswamy

Psychiatry Faculty Publications

Background: Emotion processing deficits have been described in patients with bipolar disorder (BD) and are considered one of the core cognitive abnormalities in BD with endophenotype potential. However, the literature on specific impairments in emotion processing cognitive strategies (directive/cortical/higher versus intuitive/limbic/lower) in euthymic adult BD patients and healthy first-degree relatives/high-risk (HR) subjects in comparison with healthy controls (HCs) is sparse.

Methods: We examined facial emotion recognition deficits (FERD) in BD (N = 30), HR (N = 21), and HC (N = 30) matched for age (years), years of education, and sex using computer-administered face emotions–Matching And Labeling …

Adgrl3 (Lphn3) Variants Predict Substance Use Disorder, Mauricio Arcos-Burgos, Jorge I. Vélez, Ariel F. Martinez, Marta Ribasés, Josep A. Ramos-Quiroga, Cristina Sánchez-Mora, Vanesa Richarte, Carlos Roncero, Bru Cormand, Noelia Fernández-Castillo, Miguel Casas, Francisco Lopera, David A. Pineda, Juan D. Palacio, Johan E. Acosta-López, Martha L. Cervantes-Henriquez, Manuel G. Sánchez-Rojas, Pedro J. Puentes-Rozo, Brooke S. G. Molina, Mta Cooperative Group, Margaret T. Boden, Deeann Wallis, Brett Lidbury, Saul Newman, Simon Easteal, James Swanson, Hardip Patel, Nora Volkow, Maria T. Acosta, Francisco X. Castellanos, Jose De Leon

Psychiatry Faculty Publications

Genetic factors are strongly implicated in the susceptibility to develop externalizing syndromes such as attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, and substance use disorder (SUD). Variants in the ADGRL3 (LPHN3) gene predispose to ADHD and predict ADHD severity, disruptive behaviors comorbidity, long-term outcome, and response to treatment. In this study, we investigated whether variants within ADGRL3 are associated with SUD, a disorder that is frequently co-morbid with ADHD. Using family-based, case-control, and longitudinal samples from disparate regions of the world (n = 2698), recruited either for clinical, genetic epidemiological or pharmacogenomic studies of ADHD, we …

Periodic Catatonia Marked By Hypercortisolemia And Exacerbated By The Menses: A Case Report And Literature Review, Samantha Zwiebel, Alejandro G. Villasante Tezanos, Jose De Leon

Psychiatry Faculty Publications

Kahlbaum first described catatonia; later Kraepelin, Gjessing, and Leonhard each defined periodic catatonia differently. A 48-year-old female with catatonia, whose grandmother probably died from it, was prospectively followed for >4 years in a US psychiatric state hospital. Through 4 catatonic episodes (one lasting 17 months) there were menstrual exacerbations of catatonia and increases in 4 biological variables: (1) creatine kinase (CK) up to 4,920 U/L, (2) lactate dehydrogenase (LDH) up to 424 U/L, (3) late afternoon cortisol levels up to 28.0 mcg/dL, and (4) white blood cell (WBC) counts up to 24,200/mm³ with neutrophilia without infections. Records from 17 …

Benzodiazepines Ii: Waking Up On Sedatives: Providing Optimal Care When Inheriting Benzodiazepine Prescriptions In Transfer Patients, Jeffrey Guina, Brian Merrill

Psychiatry Faculty Publications

This review discusses risks, benefits, and alternatives in patients already taking benzodiazepines when care transfers to a new clinician. Prescribers have the decision—sometimes mutually agreed-upon and sometimes unilateral—to continue, discontinue, or change treatment. This decision should be made based on evidence-based indications (conditions and timeframes), comorbidities, potential drug-drug interactions, and evidence of adverse effects, misuse, abuse, dependence, or diversion. We discuss management tools involved in continuation (e.g., monitoring symptoms, laboratory testing, prescribing contracts, state prescription databases, stages of change) and discontinuation (e.g., tapering, psychotherapeutic interventions, education, handouts, reassurance, medications to assist with discontinuation, and alternative treatments).

Benzodiazepines I: Upping The Care On Downers: The Evidence Of Risks, Benefits And Alternatives, Jeffrey Guina, Brian Merrill

Psychiatry Faculty Publications

Benzodiazepines are some of the most commonly prescribed medications in the world. These sedative-hypnotics can provide rapid relief for symptoms like anxiety and insomnia, but are also linked to a variety of adverse effects (whether used long-term, short-term, or as needed). Many patients take benzodiazepines long-term without ever receiving evidence-based first-line treatments (e.g., psychotherapy, relaxation techniques, sleep hygiene education, serotonergic agents). This review discusses the risks and benefits of, and alternatives to benzodiazepines. We discuss evidence-based indications and contraindications, and the theoretical biopsychosocial bases for effectiveness, ineffectiveness and harm. Potential adverse effects and drug-drug interactions are summarized. Finally, both fast-acting/acute …

Dataset On Psychosocial Risk Factors In Cases Of Fatal And Near-Fatal Physical Child Abuse, Mary Clyde Pierce, Kim Kaczor, Deborah Acker, Tina Webb, Allen Brenzel, Douglas J. Lorenz, Audrey Young, Richard Thompson

Psychiatry Faculty Publications

This article presents the psychosocial risk factors identified in the cases of 20 children less than four years of age who were victims of fatal or near-fatal physical abuse during a 12 month period in the Commonwealth of Kentucky. These data are related to the article “History, injury, and psychosocial risk factor commonalities among cases of fatal and near-fatal physical child abuse” (Pierce et al., 2017) [1].

Catatonia Secondary To Sudden Clozapine Withdrawal: A Case With Three Repeated Episodes And A Literature Review, John Bilbily, Betsy Mccollum, Jose De Leon

Psychiatry Faculty Publications

A literature search identified 9 previously published cases that were considered as possible cases of catatonia secondary to sudden clozapine withdrawal. Two of these 9 cases did not provide enough information to make a diagnosis of catatonia according to the Diagnostic and Statistical Manual, 5th Edition (DSM-5). The Liverpool Adverse Drug Reaction (ADR) Causality Scale was modified to assess ADRs secondary to drug withdrawal. From the 7 published cases which met DSM-5 catatonia criteria, using the modified scale, we established that 3 were definitive and 4 were probable cases of catatonia secondary to clozapine withdrawal. A new definitive case is …

Adverse Childhood Experiences, Support, And The Perception Of Ability To Work In Adults With Disability, Sophia Miryam Schüssler-Fiorenza Rose, Jessica G. Eslinger, Lindsey Zimmerman, Jamie Scaccia, Betty S. Lai, Catrin Lewis, Eva Alisic

Psychiatry Faculty Publications

Objective To examine the impact of adverse childhood experiences (ACEs) and support on self-reported work inability of adults reporting disability.

Participants Adults (ages 18-64) who participated in the Behavioral Risk Factor Surveillance System in 2009 or 2010 and who reported having a disability (n = 13,009).

Design and Main Outcome Measures The study used a retrospective cohort design with work inability as the main outcome. ACE categories included abuse (sexual, physical, emotional) and family dysfunction (domestic violence, incarceration, mental illness, substance abuse, divorce). Support included functional (perceived emotional/social support) and structural (living with another adult) support. Logistic regression was …

Two Sudden And Unexpected Deaths Of Patients With Schizophrenia Associated With Intramuscular Injections Of Antipsychotics And Practice Guidelines To Limit The Use Of High Doses Of Intramuscular Antipsychotics, Nasratullah Wahidi, Katie M. Johnson, Allen Brenzel, Jose De Leon

Psychiatry Faculty Publications

Intravenous haloperidol has been associated with torsades de pointes (TdP). These two sudden deaths were probable adverse drug reactions (ADRs) following intramuscular (IM) antipsychotics. The autopsies described lack of heart pathology and were highly compatible with the possibility of TdP in the absence of risk factors other than the accumulation of antipsychotics with a high serum peak after the last injection, leading to death within hours. The first case was a 27-year-old African-American male with schizophrenia but no medical issues. His death was probably caused by repeated IM haloperidol injections of 10 mg (totaling 35 mg in 2 days). The …

Titrating Clozapine Amidst Recommendations Proposing High Myocarditis Risk And Rapid Titrations, Jose De Leon, Y.-L. Tang, T. Baptista, D. Cohen, P. F. J. Schulte

Psychiatry Faculty Publications

No abstract provided.

Phenoconversion And Therapeutic Drug Monitoring, Jose De Leon

Psychiatry Faculty Publications

No abstract provided.

Catatonia In Older Adult Individuals With Intellectual Disabilities, Megan White, Edward Maxwell, Warren E. Milteer, Jose De Leon

Psychiatry Faculty Publications

Catatonia has been described in children with intellectual disabilities (IDs). These are the first three published cases of catatonia in adults older than 50 years of age with IDs. They were followed using the KANNER scale and, in one case, creatinine phosphokinase (CPK) monitoring. Case 1 is a 67-year-old Caucasian who probably had been having intermittent episodes of undiagnosed catatonia withdrawal for many years. His episodes of agitation and withdrawal behavior responded to lorazepam up to 8 mg/day. Case 2 is a 63-year-old Caucasian male who had probably had undiagnosed catatonic episodes since age 25. An agitation episode that rated …

Translating Pharmacogenetics To Clinical Practice: Do Cytochrome P450 2d6 Ultrarapid Metabolizers Need Higher Atomoxetine Doses?, Jose De Leon

Psychiatry Faculty Publications

No abstract provided.

The Effects Of Antiepileptic Inducers In Neuropsychopharmacology, A Neglected Issue. Part Ii: Pharmacological Issues And Further Understanding, Jose De Leon

Psychiatry Faculty Publications

The literature on inducers in epilepsy and bipolar disorder is seriously contaminated by false negative findings. Part II of this comprehensive review on antiepileptic drug (AED) inducers provides clinicians with further educational material about the complexity of interpreting AED drug-drug interactions.

The basic pharmacology of induction is reviewed including the cytochrome P450 (CYP) isoenzymes, the Uridine Diphosphate Glucuronosyltransferases (UGTs), and P-glycoprotein (P-gp). CYP2B6 and CYP3A4 are very sensitive to induction. CYP1A2 is moderately sensitive while CYP2C9 and CYP2C19 are only mildly sensitive. CYP2D6 cannot be induced by medications. Induction of UGT and P-gp are poorly understood. The induction of metabolic …

Clozapine For Treatment-Resistant Bipolar Disorder: A Systematic Review, Xian-Bin Li, Yi-Lang Tang, Chuan-Yue Wang, Jose De Leon

Psychiatry Faculty Publications

Objective

To evaluate the efficacy and safety of clozapine for treatment-resistant bipolar disorder (TRBD).

Methods

A systematic review of randomized controlled studies, open-label prospective studies, and retrospective studies of patients with TRBD was carried out. Interventions included clozapine monotherapy or clozapine combined with other medications. Outcome measures were efficacy and adverse drug reactions (ADRs).

Results

Fifteen clinical trials with a total sample of 1,044 patients met the inclusion criteria. Clozapine monotherapy or clozapine combined with other treatments for TRBD was associated with improvement in: (i) symptoms of mania, depression, rapid cycling, and psychotic symptoms, with many patients with TRBD achieving …

Caffeine Consumption In A Long-Term Psychiatric Hospital: Tobacco Smoking May Explain In Large Part The Apparent Association Between Schizophrenia And Caffeine Use, Manuel Arrojo-Romero, Carmen Armas Barbazán, Javier D. López-Moriñigo, Ramón Ramos-Rios, Manuel Gurpegui, José M. Martinez-Ortega, Dolores Jurado, Francisco J. Diaz, Jose De Leon

Psychiatry Faculty Publications

This study further explores the association between schizophrenia and caffeine use by combining two prior published Spanish samples (250 schizophrenia outpatients and 290 controls from the general population) with two Spanish long-term inpatient samples from the same hospital (145 with schizophrenia and 64 with other severe mental illnesses). The specific aims were to establish whether or not, after controlling for confounders including tobacco smoking, the association between schizophrenia and caffeine is consistent across schizophrenia samples and across different definitions of caffeine use. The frequency of caffeine use in schizophrenia inpatients was not significantly higher than that in non-schizophrenia inpatients (77%, …

Is Psychiatry Only Neurology? Or Only Abnormal Psychology? Déjà Vu After 100 Years, Jose De Leon

Psychiatry Faculty Publications

Forgetting history, which frequently repeats itself, is a mistake. In General Psychopathology, Jaspers criticised early 20th century psychiatrists, including those who thought psychiatry was only neurology (Wernicke) or only abnormal psychology (Freud), or who did not see the limitations of the medical model in psychiatry (Kraepelin). Jaspers proposed that some psychiatric disorders follow the medical model (Group I), while others are variations of normality (Group III), or comprise schizophrenia and severe mood disorders (Group II). In the early 21st century, the players' names have changed but the game remains the same. The US NIMH is reprising both Wernicke's brain mythology …

The Effects Of Antiepileptic Inducers In Neuropsychopharmacology, A Neglected Issue. Part I: A Summary Of The Current State For Clinicians, Jose De Leon

Psychiatry Faculty Publications

The literature on inducers in epilepsy and bipolar disorder is seriously contaminated by false negative findings. This is part i of a comprehensive review on antiepileptic drug (AED) inducers using both mechanistic pharmacological and evidence-based medicine to provide practical recommendations to neurologists and psychiatrists concerning how to control for them. Carbamazepine, phenobarbital and phenytoin, are clinically relevant AED inducers; correction factors were calculated for studied induced drugs. These correction factors are rough simplifications for orienting clinicians, since there is great variability in the population regarding inductive effects. As new information is published, the correction factors may need to be modified. …

Horror Vacui: Emptiness Might Distinguish Between Major Suicide Repeaters And Nonmajor Suicide Repeaters: A Pilot Study, Hilario Blasco-Fontecilla, Enrique Baca-Garcia, Philippe Courtet, Rebeca Garcia Nieto, Jose De Leon

Psychiatry Faculty Publications

No abstract provided.

Three Patients Needing High Doses Of Valproic Acid To Get Therapeutic Concentrations, James Jackson, Betsy Mccollum, Judy Ognibene, Francisco J. Diaz, Jose De Leon

Psychiatry Faculty Publications

Valproic acid (VPA) can autoinduce its own metabolism. Cases requiring VPA doses >4000 mg/day to obtain therapeutic plasma concentrations, such as these 3 cases, have never been published. Case 1 received VPA for seizures and schizophrenia and had >50 VPA concentrations in 4 years. A high dose of 5,250 mg/day of VPA concentrate was prescribed for years but this dose led to an intoxication when switched to the enterocoated divalproex sodium formulation, requiring a normal dose of 2000 mg/day. VPA metabolic capacity was significantly higher (t = -9.6; df = 6.3, p < 0.001) during the VPA concentrate therapy, possibly due to autoinduction in that formulation. Case 2 had VPA for schizoaffective psychosis with 10 VPA concentrations during an 8-week admission. To maintain a VPA level ≥50 μg/mL, VPA doses increased from 1500 …

Clinical Applications Of Cyp Genotyping In Psychiatry, Edoardo Spina, Jose De Leon

Psychiatry Faculty Publications

A critical review of the limited available evidence and the authors’ experience and judgment are used to summarize the role of cytochrome P450 (CYP) genetic variants in the pharmacokinetics of and clinical response to psychotropic medications. CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6 and CYP3A4 genetic polymorphisms and their contributions to the metabolism of psychotropic drugs are reviewed. CYP1A2, CYP2B6 and CYP3A4 genotyping have limited current clinical utility. CYP2C9 genotyping has no utility in psychiatry. Psychiatrists should master tricyclic antidepressant (TCA) prescription, and if they use TCAs, they should have expertise in CYP2D6 and CYP2C19 genotyping and in TCA therapeutic drug monitoring …

Focusing On Drug Versus Disease Mechanisms And On Clinical Subgrouping To Advance Personalised Medicine In Psychiatry, Jose De Leon

Psychiatry Faculty Publications

Personalised medicine has finally been featured in psychiatric journals, but psychiatrists have mainly focused on the promise of using disease mechanisms to personalise treatment. Psychiatric disorders such as schizophrenia and depression are not diseases, in the medical sense, and are probably more like syndromes. Instead of spending much time and effort focusing on the mechanisms of diseases that may instead be syndromes, the author believes that psychiatrists should (1) learn more about personalising prescription via drug mechanisms, a pharmacological approach to personalised medicine; and (2) reconsider prior attempts by traditional clinical psychopharmacologists to use sophisticated clinical approaches that try to …

Qt Interval Prolongation Associated With Intramuscular Ziprasidone In Chinese Patients: A Case Report And A Comprehensive Literature Review With Meta-Analysis, Xian-Bin Li, Yi-Lang Tang, Wei Zheng, Chuan-Yue Wang, Jose De Leon

Psychiatry Faculty Publications

Intramuscular (IM) ziprasidone has been associated with QTc interval prolongations in patients with preexisting risk factors. A 23-year-old male Chinese schizophrenia patient experienced an increase of QTc interval of 83 milliseconds (ms) after receiving 20 mg IM ziprasidone (baseline and increased QT/QTc were, respectively, 384/418 and 450/501). This was rated as a probable adverse drug reaction (ADR) by the Liverpool ADR causality assessment tool. A systematic review including all types of trials reporting the effect of IM ziprasidone on the QTc interval prolongation identified 19 trials with a total of 1428 patients. Mean QTc change from baseline to end of …

Pharmacokinetic And Pharmacodynamic Interactions Between Antiepileptics And Antidepressants, Domenico Italiano, Edoardo Spina, Jose De Leon

Psychiatry Faculty Publications

INTRODUCTION: Antiepileptic-antidepressant combinations are frequently used by clinicians; their pharmacokinetic (PK) and pharmacodynamic (PD) drug interactions (DIs) have not been well studied but are frequently likely to be clinically relevant.

AREAS COVERED: This article provides a comprehensive review of PK DIs between antiepileptics and antidepressants. In the absence of PD DI studies, PD information on pharmacological mechanisms and studies on efficacy and safety of individual drugs are reviewed.

EXPERT OPINION: The clinical relevance of the inductive properties of carbamazepine, phenytoin, phenobarbital and primidone and the inhibitory properties of valproic acid and some antidepressants are well understood; correction factors are provided …

Paradoxes Of Us Psychopharmacology Practice In 2013: Undertreatment Of Severe Mental Illness And Overtreatment Of Minor Psychiatric Problems, Jose De Leon

Psychiatry Faculty Publications

No abstract provided.

False Negative Studies May Systematically Contaminate The Literature On The Effects Of Inducers In Neuropsychopharmacology. Part Ii: Focus On Bipolar Disorder, Jose De Leon

Psychiatry Faculty Publications

No abstract provided.