Research Interests: Psychology, Psychiatry, Psychotherapy, Schizophrenia, Treatment Outcome, and 13 moreAdolescent, Medicine, Clinical Practice, Humans, Child, United States, Psychological Intervention, Antipsychotic, Early Diagnosis, Antipsychotic agents, Psychology and Cognitive Sciences, Tic Disorders, and Medical and Health Sciences
Sertraline is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. Although SSRIs are believed to have a milder side effect profile than the tricyclic antidepressants, there are some potentially serious side... more
Sertraline is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. Although SSRIs are believed to have a milder side effect profile than the tricyclic antidepressants, there are some potentially serious side effects. These include hyponatremia, which has been seen with each of the SSRIs. We reviewed the charts of 246 patients treated with sertraline at a veterans' hospital. We obtained values for each patient's basic chemistry panel (sodium, potassium, chloride, glucose, carbon dioxide, blood urea nitrogen, and creatinine) before and after institution of sertraline therapy. We studied the patients' ages and sertraline doses to see if there was a relationship between any laboratory value changes and these variables. We found no relationship between maximum sertraline dose, age, and changes in routine blood chemistry results with the exception of a small (0.5%) contribution of maximum sertraline dose to variance in serum creatinine levels. Sertraline therapy was not noted to cause any significant changes in serum sodium levels.
Research Interests:
Research Interests: Psychiatry, Education, Mental Health, Public Health, Medicine, and 15 moreMedical Students, Humans, Program Development, Substance Abuse, Female, Achievement, Child and Adolescent Psychiatry, Male, Social Environment, Clinical Sciences, Questionnaires, Career Choice, Adult, Psychiatric Quarterly, and internship and residency
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Research Interests: Psychology, Adolescent, Comorbidity, Humans, Child, and 9 moreChildren and Adolescents, Clinical evaluation, Child preschool, Attention deficit disorder with hyperactivity, Psychosocial Intervention, Attention deficit hyperactivity disorder, Psychology and Cognitive Sciences, Central nervous system stimulants, and Medical and Health Sciences
How depressive symptoms manifest: Mood: Depressed, irritable or labile mood Behavior Low frustration tolerance, social withdrawal or somatic complaints interests (stop sports activities etc.) c/o boredom Vegetative symptoms... more
How depressive symptoms manifest: Mood: Depressed, irritable or labile mood Behavior Low frustration tolerance, social withdrawal or somatic complaints interests (stop sports activities etc.) c/o boredom Vegetative symptoms Fatigue or energy, PMR or PMA Sleep disturbance (often hypersomnia) Weight or appetite change, failure to make wt gain concentration or indecisiveness Cognition Feelings of worthlessness/hopelessness or inappropriate guilt Thoughts of death or suicide Criteria for Major Depressive Episode: depressed mood or anhedonia + 4 others
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Mental illness is common National Health and Nutrition Examination Survey (NHANES) from 2001-2004 found that 13% of youth ages 8-15 had a mental illness in the preceding 12 months (assessed 6 major DX) 12-15 y/o had higher rates conduct... more
Mental illness is common National Health and Nutrition Examination Survey (NHANES) from 2001-2004 found that 13% of youth ages 8-15 had a mental illness in the preceding 12 months (assessed 6 major DX) 12-15 y/o had higher rates conduct or mood disorders as compared to ADHD in younger kids Less than 50% received services. Boys and older youth were more likely to seek care. Appropriate use of psychotropics?
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This practice parameter describes the epidemiology, clinical picture, differential diagnosis, course, risk factors, and pharmacological and psychotherapy treatments of children and adolescents with major depressive or dysthymic disorders.... more
This practice parameter describes the epidemiology, clinical picture, differential diagnosis, course, risk factors, and pharmacological and psychotherapy treatments of children and adolescents with major depressive or dysthymic disorders. Side effects of the antidepressants, particularly the risk of suicidal ideation and behaviors are discussed. Recommendations regarding the assessment and the acute, continuation, and maintenance treatment of these disorders are based on the existent scientific evidence as well as the current clinical practice.
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More than one of four children experiences a significant traumatic event before reaching adulthood. 1 These traumas may include events such as child abuse; domestic, community, or school violence; disasters, vehicular or other accidents,... more
More than one of four children experiences a significant traumatic event before reaching adulthood. 1 These traumas may include events such as child abuse; domestic, community, or school violence; disasters, vehicular or other accidents, medical traumas, war, terrorism, ...
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Escitalopram is the selective serotonin reuptake inhibitor (SSRI) most recently approved for use in the United States. It is structurally related to citalopram, but is felt to have a more tolerable side-effect profile than its parent... more
Escitalopram is the selective serotonin reuptake inhibitor (SSRI) most recently approved for use in the United States. It is structurally related to citalopram, but is felt to have a more tolerable side-effect profile than its parent compound. Side effects are not generally serious and include headache, diarrhea, and nausea. While hyponatremia and the syndrome of inappropriate antidiuretic hormone (SIADH) have been associated with treatment with other SSRIs, there has only been one case of escitalopram-induced SIADH reported in the literature to date. We now report another case of a patient who developed SIADH after being treated with escitalopram for 4 weeks. The patient's hyponatremia improved following the discontinuation of escitalopram. Clinicians should be aware of this uncommon but significant side effect of SSRIs and monitor high-risk patients for the development of SIADH.
Research Interests:
Research Interests:
... MD, Mark Godley, Ph.D., Susan Godley, Ph.D., Scott Henggeler, Ph.D., Steven Jaffe, MD, Yifrah Kaminer, MD, Howard Liddle, Ph ... adolescent SUDs requires consideration that the reported domains of dysfunction attributed to substance... more
... MD, Mark Godley, Ph.D., Susan Godley, Ph.D., Scott Henggeler, Ph.D., Steven Jaffe, MD, Yifrah Kaminer, MD, Howard Liddle, Ph ... adolescent SUDs requires consideration that the reported domains of dysfunction attributed to substance use may actually be due to premor-bid or ...
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Enuresis is a symptom that is frequently encountered in child psychiatric evaluations. Careful assessment is required to identify specific urologic, developmental, psychosocial, and sleep-related etiologies. For most children with... more
Enuresis is a symptom that is frequently encountered in child psychiatric evaluations. Careful assessment is required to identify specific urologic, developmental, psychosocial, and sleep-related etiologies. For most children with enuresis, however, a specific etiology cannot be determined. Treatment then involves supportive approaches, conditioning with a urine alarm, or medications--imipramine or desmopressin acetate. The psychosocial consequences of the symptom must be recognized and addressed with sensitivity during the evaluation and treatment of enuresis.
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The purpose of this article is to review the literature on hypothesized behavioral correlates of pharmacotherapy treatment response. A particular focus is placed on what have been referred to as "common factors" across... more
The purpose of this article is to review the literature on hypothesized behavioral correlates of pharmacotherapy treatment response. A particular focus is placed on what have been referred to as "common factors" across mental health treatments, including medication adherence, therapeutic alliance, motivation for behavior change, and expectancies for positive treatment outcomes. These understudied factors may provide unique explanations for mechanisms of symptom change, patient risk as a result of protocol deviation, and attenuated treatment outcomes. A literature search was conducted to evaluate the relationship between treatment processes in pediatric psychiatry and medication adherence, therapeutic alliance, motivation for behavior change, and expectancies for positive treatment outcomes. Substantial variability and room for improvement was identified for each common factor. Behavioral protocols have already been developed to address many aspects of common factors in pediatric psychiatric treatment, but are not yet a part of many practice parameters. Interventions to improve common factors can be used immediately in tandem with psychopharmacological interventions to provide increased symptom relief and reduce patient risk. Furthermore, incorporating instruction in common factors interventions can positively affect training of future providers and enhance understanding of the mechanisms of effect of medications. An increased focus on common factors, with a particular emphasis on quantifying the magnitude and mechanisms of their effects on psychopharmacological interventions stand to benefit child patients, their families, treatment providers, training facilities, and pharmaceutical manufacturers.
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Research Interests:
... authors, and the AACAP Work Group on Quality Issues: William Bernet, MD, Oscar Bukstein, MD, and Heather Walter, Co-Chairs, and R. Scott Benson, MD, Allan Chrisman, MD, Tiffany Farchione, MD, Laurence Greenhill, MD, John Hamilton, MD,... more
... authors, and the AACAP Work Group on Quality Issues: William Bernet, MD, Oscar Bukstein, MD, and Heather Walter, Co-Chairs, and R. Scott Benson, MD, Allan Chrisman, MD, Tiffany Farchione, MD, Laurence Greenhill, MD, John Hamilton, MD, Helene Keable, MD, Joan ...
Research Interests:
Escitalopram is the selective serotonin reuptake inhibitor (SSRI) most recently approved for use in the United States. It is structurally related to citalopram, but is felt to have a more tolerable side-effect profile than its parent... more
Escitalopram is the selective serotonin reuptake inhibitor (SSRI) most recently approved for use in the United States. It is structurally related to citalopram, but is felt to have a more tolerable side-effect profile than its parent compound. Side effects are not generally serious and include headache, diarrhea, and nausea. While hyponatremia and the syndrome of inappropriate antidiuretic hormone (SIADH) have been associated with treatment with other SSRIs, there has only been one case of escitalopram-induced SIADH reported in the literature to date. We now report another case of a patient who developed SIADH after being treated with escitalopram for 4 weeks. The patient's hyponatremia improved following the discontinuation of escitalopram. Clinicians should be aware of this uncommon but significant side effect of SSRIs and monitor high-risk patients for the development of SIADH.
Research Interests:
Escitalopram is the selective serotonin reuptake inhibitor (SSRI) most recently approved for use in the United States. It is structurally related to citalopram, but is felt to have a more tolerable side-effect profile than its parent... more
Escitalopram is the selective serotonin reuptake inhibitor (SSRI) most recently approved for use in the United States. It is structurally related to citalopram, but is felt to have a more tolerable side-effect profile than its parent compound. Side effects are not generally serious and include headache, diarrhea, and nausea. While hyponatremia and the syndrome of inappropriate antidiuretic hormone (SIADH) have been associated with treatment with other SSRIs, there has only been one case of escitalopram-induced SIADH reported in the literature to date. We now report another case of a patient who developed SIADH after being treated with escitalopram for 4 weeks. The patient's hyponatremia improved following the discontinuation of escitalopram. Clinicians should be aware of this uncommon but significant side effect of SSRIs and monitor high-risk patients for the development of SIADH.
We developed a questionnaire regarding issues in psychiatric residency training and distributed it to the chief residents at all United States general psychiatry residency training programs. We hoped to examine psychiatry residency... more
We developed a questionnaire regarding issues in psychiatric residency training and distributed it to the chief residents at all United States general psychiatry residency training programs. We hoped to examine psychiatry residency program characteristics and see if any particular characteristics had a significant relationship to improved success in the 1994 National Residency Matching Program (NRMP) results. We found that those programs with six or more PGY-1 positions available in the NRMP, those programs with an associated child and adolescent psychiatry residency training program, and those programs offering a research elective had a higher PGY-1 match through the NRMP than programs without these features.
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Meperidine is widely used for pain control in the hospital setting. It is also known for its propensity to cause mental status changes in renally and hepatically impaired patients. A case is reported of a 37-year-old man with chronic... more
Meperidine is widely used for pain control in the hospital setting. It is also known for its propensity to cause mental status changes in renally and hepatically impaired patients. A case is reported of a 37-year-old man with chronic renal failure maintained on peritoneal dialysis in whom delirium developed when he was treated with meperidine not only on one occasion but also on two subsequent admissions. The pharmacology of meperidine is reviewed and the implications of using the medication in patients with renal impairment are discussed.
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Laparoscopic cholecystectomy was performed on a pregnant woman at 18 weeks of gestation without complications. Considering the risk/benefit ratio, laparoscopic cholecystectomy in pregnant women is preferable to conventional cholecystectomy.
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Implicated in autoimmune encephalitis, neuromyotonia and genetic forms of autism, here we report that contactin-associated protein-like 2 (CNTNAP2) contains a potential autoepitope within the extracellular region. CNTNAP2 sequence-similar... more
Implicated in autoimmune encephalitis, neuromyotonia and genetic forms of autism, here we report that contactin-associated protein-like 2 (CNTNAP2) contains a potential autoepitope within the extracellular region. CNTNAP2 sequence-similar regions (CSSRs) from human pathogens were identified. Sera from autistic and control children were obtained and analyzed for the presence of antibodies able to bind CSSRs. One such candidate CSSR was evaluated for evidence of autoimmune responses to CNTNAP2 in a mouse model of acute infection. Autistic and control children sera contained antibodies able to discrete regions of CNTNAP2. In a murine model of acute infection, a CSSR derived from the N-terminal extracellular region of CNTNAP2 resulted in anti-CNTNAP2 antibody production, proinflammatory cytokine elevation, cerebellar and cortical white matter T-cell infiltration as well as motor dysfunction. Taken together, these data suggest that CNTNAP2 contains a potential autoepitope within the extr...
PRACTICE PARAMETER FOR THE PSYCHIATRIC ASSESSMENT AND MANAGEMENT OF PHYSICALLY ILL CHILDREN AND ADOLESCENTS ABSTRACT This practice parameter describes the psychiatric assessment and management of physically ill children and adolescents. It reviews the epidemiology, clinical presentation, assessme...more
Research Interests:
Research Interests:
Research Interests: Psychotherapy, Evidence Based Medicine, Adolescent, Humans, Child, and 12 moreBest practice, Follow-up studies, Mental Disorders, Children and Adolescents, Parents, Combination drug therapy, Psychotropic Drugs, Medical Treatment, Combined Modality Therapy, Psychology and Cognitive Sciences, Psychiatric disorder, and Medical and Health Sciences
This parameter reviews the current state of the prevention and management of child and adolescent aggressive behavior in psychiatric institutions, with particular reference to the indications and use of seclusion and restraint. It also... more
This parameter reviews the current state of the prevention and management of child and adolescent aggressive behavior in psychiatric institutions, with particular reference to the indications and use of seclusion and restraint. It also presents guidelines that have been developed in response to professional, regulatory, and public concern about the use of restrictive interventions with aggressive patients with regard to personal safety and patient rights. The literature on the use of seclusion, physical restraint, mechanical restraint, and chemical restraint is reviewed, and procedures for carrying out each of these interventions are described. Clinical and regulatory agency perspectives on these interventions are presented. Effectiveness, indications, contraindications, complications, and adverse effects of seclusion and restraint procedures are addressed. Interventions are presented to provide more opportunities to promote patient independence and satisfaction with treatment while diminishing the necessity of using restrictive procedures.
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Research Interests:
This summary of the practice parameters describes the diagnosis, treatment, and prevention of conduct disorder in children and adolescents. The rationales for these recommendations are based on a review of the scientific literature and... more
This summary of the practice parameters describes the diagnosis, treatment, and prevention of conduct disorder in children and adolescents. The rationales for these recommendations are based on a review of the scientific literature and clinical consensus, which are contained in the complete document. Clinical features of youths with conduct disorder include predominance in males, low socioeconomic status, and familial aggregation. Important continuities to oppositional defiant disorder and antisocial personality disorder have been documented. Extensive comorbidity, especially with other externalizing disorders, depression, and substance abuse, has been documented and has significance for prognosis. Clinically significant subtypes exist according to age of onset, overt or covert conduct problems, and levels of restraint exhibited under stress. To be effective, treatment must be multimodal, address multiple foci, and continue over extensive periods of time. Early treatment and prevention seem to be more effective than later intervention.
Research Interests: Adolescent, Child Behavior, Child, Child Sexual Abuse, Cognitive Therapy, and 15 moreCognitive behavior therapy, Child Psychiatry, Child and Adolescent Psychology, Depressive Disorder, Children and Adolescents, Adult, Biological treatment, Behavior Problems, Adolescent Psychiatry, Clinical Presentation, Clinical Protocols, Cognitive Skills, Adolescent Behavior, Attempted Suicide, and Child preschool
Electroconvulsive therapy (ECT) may be an effective treatment for adolescents with severe mood disorders and other Axis I psychiatric disorders when more conservative treatments have been unsuccessful. ECT may be considered when there is... more
Electroconvulsive therapy (ECT) may be an effective treatment for adolescents with severe mood disorders and other Axis I psychiatric disorders when more conservative treatments have been unsuccessful. ECT may be considered when there is a lack of response to two or more trials of pharmacotherapy or when the severity of symptoms precludes waiting for a response to pharmacological treatment. The literature on ECT in adolescents, including studies and case reports, was reviewed and then integrated into clinically relevant guidelines for practitioners. Mood disorders have a high rate of response to ECT (75-100%), whereas psychotic disorders have a lower response rate (50-60%). Consent of the adolescent's legal guardian is mandatory, and the patient's consent or assent should be obtained. State legal guidelines and institutional guidelines must be followed. ECT techniques associated with the fewest adverse effects and greatest efficacy should be used. The presence of comorbid psychiatric disorder is not a contraindication. Systematic pretreatment and posttreatment evaluation, including symptom and cognitive assessment, is recommended.
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This practice parameter describes the assessment and treatment of children and adolescents with substance use disorders and is based on scientific evidence and clinical consensus regarding diagnosis and effective treatment as well as on... more
This practice parameter describes the assessment and treatment of children and adolescents with substance use disorders and is based on scientific evidence and clinical consensus regarding diagnosis and effective treatment as well as on the current state of ...
Research Interests: Mental Health, Health Care, Juvenile Justice, Juvenile Delinquency, Cultural Competence, and 15 moreEvaluation, Treatment, Policy Development, Evidence, Public Health, Continuing Medical Education, Identification, Substance Abuse, Social Services, The, Substance Dependence, Mental health services, Ethical Issues, Suicide Attempt, and Substance-Related Disorders
This practice parameter reviews the topic of psychiatric consultation to schools. The review covers the history of school consultation and current consultative models; the process of developing a consultative relationship; school... more
This practice parameter reviews the topic of psychiatric consultation to schools. The review covers the history of school consultation and current consultative models; the process of developing a consultative relationship; school administrative procedures, personnel, and milieu; legal protections for students with mental disabilities; and issues typically arising in consultative situations. The objective of the parameter is to provide an introduction to the special vocabulary, knowledge, and skills that are important prerequisites for successful consultation in school settings.
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This practice parameter describes treatment with stimulant medication. It uses an evidence-based medicine approach derived from a detailed literature review and expert consultation. Stimulant medications in clinical use include... more
This practice parameter describes treatment with stimulant medication. It uses an evidence-based medicine approach derived from a detailed literature review and expert consultation. Stimulant medications in clinical use include methylphenidate, dextroamphetamine, mixed-salts amphetamine, and pemoline. It carries FDA indications for treatment of attention-deficit/hyperactivity disorder and narcolepsy.
Research Interests: Evidence Based Medicine, Adolescent, Literature Review, Brain, Humans, and 15 moreChild, Behavior Therapy, Case Study, Focus, Behavioral and Developmental Pediatrics, Adult, Empirical evidence, Amphetamines, Medical Records, Methylphenidate, Child preschool, Attention deficit disorder with hyperactivity, Attention deficit hyperactivity disorder, Central nervous system stimulants, and Medical and Health Sciences
To investigate the concurrent validity and reliability of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), a short structured diagnostic interview for DSM-IV and ICD-10 psychiatric disorders in... more
To investigate the concurrent validity and reliability of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), a short structured diagnostic interview for DSM-IV and ICD-10 psychiatric disorders in children and adolescents. Participants were 226 children and adolescents (190 outpatients and 36 controls) aged 6 to 17 years. To assess the concurrent validity of the MINI-KID, participants were administered the MINI-KID and the Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) by blinded interviewers in a counterbalanced order on the same day. Participants also completed a self-rated measure of disability. In addition, interrater (n = 57) and test-retest (n = 83) reliability data (retest interval, 1-5 days) were collected, and agreement between the parent version of the MINI-KID and the standard MINI-KID (n = 140) was assessed. Data were collected between March 2004 and January 2008. Substantial to excellent MINI-KID to K-SADS-PL concordance was found for syndromal diagnoses of any mood disorder, any anxiety disorder, any substance use disorder, any ADHD or behavioral disorder, and any eating disorder (area under curve [AUC] = 0.81-0.96, kappa = 0.56-0.87). Results were more variable for psychotic disorder (AUC = 0.94, kappa = 0.41). Sensitivity was substantial (0.61-1.00) for 15/20 individual DSM-IV disorders. Specificity was excellent (0.81-1.00) for 18 disorders and substantial (> 0.73) for the remaining 2. The MINI-KID identified a median of 3 disorders per subject compared to 2 on the K-SADS-PL and took two-thirds less time to administer (34 vs 103 minutes). Interrater and test-retest kappas were substantial to almost perfect (0.64-1.00) for all individual MINI-KID disorders except dysthymia. Concordance of the parent version (MINI-KID-P) with the standard MINI-KID was good. The MINI-KID generates reliable and valid psychiatric diagnoses for children and adolescents and does so in a third of the time as the K-SADS-PL.
Research Interests: Psychometrics, Personality Assessment, Adolescent, Humans, Child, and 15 morePersonality Assessment Inventory, Female, Male, Mental Disorders, Children and Adolescents, International Classification of Diseases, Questionnaires, Reproducibility of Results, Sensitivity and Specificity, Area Under Curve, Psychiatric Status Rating Scales, Personality Inventory, Psychology and Cognitive Sciences, Reliability and validity, and Medical and Health Sciences
Research Interests: Cell Differentiation, Humans, Child, Cerebral Cortex, Mice, and 15 moreFemale, Animals, Male, Interpersonal Relations, Neurons, Analysis of Variance, Glial Fibrillary Acidic Protein, Glia, Exploratory Behavior, Social Behavior Disorders, Neurosciences, Gene Expression Regulation, Interleukin, Autistic disorder, and Child preschool
Sertraline is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. Although SSRIs are believed to have a milder side effect profile than the tricyclic antidepressants, there are some potentially serious side... more
Sertraline is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. Although SSRIs are believed to have a milder side effect profile than the tricyclic antidepressants, there are some potentially serious side effects. These include hyponatremia, which has been seen with each of the SSRIs. We reviewed the charts of 246 patients treated with sertraline at a veterans' hospital. We obtained values for each patient's basic chemistry panel (sodium, potassium, chloride, glucose, carbon dioxide, blood urea nitrogen, and creatinine) before and after institution of sertraline therapy. We studied the patients' ages and sertraline doses to see if there was a relationship between any laboratory value changes and these variables. We found no relationship between maximum sertraline dose, age, and changes in routine blood chemistry results with the exception of a small (0.5%) contribution of maximum sertraline dose to variance in serum creatinine levels. Sertraline therapy was not noted to cause any significant changes in serum sodium levels.
Research Interests:
Research Interests:
A new Child and Adolescent Psychiatry in Medical Education (CAPME) Task Force, sponsored by the Association for Directors of Medical Student Education in Psychiatry (ADMSEP), has created an inter-organizational partnership between child... more
A new Child and Adolescent Psychiatry in Medical Education (CAPME) Task Force, sponsored by the Association for Directors of Medical Student Education in Psychiatry (ADMSEP), has created an inter-organizational partnership between child and adolescent psychiatry (CAP) educators and medical student educators in psychiatry. This paper outlines the task force design and strategic plan to address the long-standing dearth of CAP training for medical students. The CAPME ADMSEP Task Force, formed in 2010, identified common challenges to teaching CAP among ADMSEP's CAPME Task Force members, utilizing focus-group discussions and a needs-assessment survey. The Task Force was organized into five major sections, with inter-organizational action plans to address identified areas of need, such as portable modules and development of benchmark CAP competencies. The authors predict that all new physicians, regardless of specialty, will be better trained in CAP. Increased exposure may also improve recruitment into this underserved area.
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Sheehan et al. Table 1. Overview of Structured Diagnostic Interviews in Psychiatry"' Interview Raier Qiui ¡ i ficas ¡чп> Formal Designed For Dunn ion (Minutes) Time Frame Diagnostic Oulpul PS E - DIS : S ADS ' SCI D Cl... more
Sheehan et al. Table 1. Overview of Structured Diagnostic Interviews in Psychiatry"' Interview Raier Qiui ¡ i ficas ¡чп> Formal Designed For Dunn ion (Minutes) Time Frame Diagnostic Oulpul PS E - DIS : S ADS ' SCI D Cl DF MINI" Trained menial health Closed-ended; Medical and ...