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Evans SK, Ober AJ, Korn AR, Peltz A, Friedmann PD, Page K, Murray-Krezan C, Huerta S, Ryzewicz SJ, Tarhuni L, Nuckols TK, E Watkins K, Danovitch I. Contextual barriers and enablers to establishing an addiction-focused consultation team for hospitalized adults with opioid use disorder. Addict Sci Clin Pract 2024; 19:31. [PMID: 38671482 PMCID: PMC11046820 DOI: 10.1186/s13722-024-00461-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Hospitalization presents an opportunity to begin people with opioid use disorder (OUD) on medications for opioid use disorder (MOUD) and link them to care after discharge; regrettably, people admitted to the hospital with an underlying OUD typically do not receive MOUD and are not connected with subsequent treatment for their condition. To address this gap, we launched a multi-site randomized controlled trial to test the effectiveness of a hospital-based addiction consultation team (the Substance Use Treatment and Recovery Team (START)) consisting of an addiction medicine specialist and care manager team that provide collaborative care and a specified intervention to people with OUD during the inpatient stay. Successful implementation of new practices can be impacted by organizational context, though no previous studies have examined context prior to implementation of addiction consultation services (ACS). This study assessed pre-implementation context for implementing a specialized ACS and tailoring it accordingly. METHODS We conducted semi-structured interviews with hospital administrators, physicians, physician assistants, nurses, and social workers at the three study sites between April and August 2021 before the launch of the pragmatic trial. Using an analytical framework based on the Consolidated Framework for Implementation Research, we completed a thematic analysis of interview data to understand potential barriers or enablers and perceptions about acceptability and feasibility. RESULTS We interviewed 28 participants across three sites. The following themes emerged across sites: (1) START is an urgently needed model for people with OUD; (2) Intervention adaptations are recommended to meet local and cultural needs; (3) Linking people with OUD to community clinicians is a highly needed component of START; (4) It is important to engage stakeholders across departments and roles throughout implementation. Across sites, participants generally saw a need for change from usual care to support people with OUD, and thought the START was acceptable and feasible to implement. Differences among sites included tailoring the START to support the needs of varying patient populations and different perceptions of the prevalence of OUD. CONCLUSIONS Hospitals planning to implement an ACS in the inpatient setting may wish to engage in a systematic pre-implementation contextual assessment using a similar framework to understand and address potential barriers and contextual factors that may impact implementation. Pre-implementation work can help ensure the ACS and other new practices fit within each unique hospital context.
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Affiliation(s)
- Sandra K Evans
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA.
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Ariella R Korn
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Alex Peltz
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Peter D Friedmann
- Department of Medicine, University of Massachusetts Chan Medical School-Baystate and Baystate Health, 3601 Main Street, 3rd Floor, 01107, Springfield, MA, USA
| | - Kimberly Page
- University of New Mexico Health Sciences Center, 1 University, MSC10 5550, 87133, Albuquerque, NM, USA
| | - Cristina Murray-Krezan
- Departement of Medicine, University of Pittsburgh School of Medicine, 200 Meyran Ave, Suite 300, 15213, Pittsburgh, PA, USA
| | - Sergio Huerta
- University of New Mexico Health Sciences Center, 1 University, MSC10 5550, 87133, Albuquerque, NM, USA
| | - Stephen J Ryzewicz
- Department of Medicine, University of Massachusetts Chan Medical School-Baystate and Baystate Health, 3601 Main Street, 3rd Floor, 01107, Springfield, MA, USA
| | - Lina Tarhuni
- University of New Mexico Health Sciences Center, 1 University, MSC10 5550, 87133, Albuquerque, NM, USA
| | - Teryl K Nuckols
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, 90048, West Hollywood, CA, USA
| | - Katherine E Watkins
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Itai Danovitch
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, 90048, West Hollywood, CA, USA
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Danovitch I, Korouri S, Kaur H, Messineo G, Nuckols T, Ishak WW, Ober A. The addiction consultation service for hospitalized patients with substance use disorder: An integrative review of the evidence. J Subst Use Addict Treat 2024:209377. [PMID: 38657952 DOI: 10.1016/j.josat.2024.209377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION The Addiction Consultation Service has emerged as a model of care for hospitalized patients with substance use disorder. The aim of this integrative review is to characterize the Addiction Consultation Service in general hospital settings, assess its impact on clinical outcomes, identify knowledge gaps, and offer guidance for implementation. METHODS We conducted an integrative review of studies from January 2002 to August 2023, applying specific inclusion criteria to collect study design, service characteristics, staffing models, utilization, and health outcomes. Additionally, a comprehensive quality appraisal was conducted for all studies considered for inclusion. RESULTS Findings from 41 studies meeting inclusion criteria were synthesized and tabulated. Study designs included six reports from three randomized controlled trials, five descriptive studies, and 30 observational studies. The most common study setting was the urban academic medical center. Studies evaluated the structure, process, and outcomes of the Addiction Consultation Service. A majority of studies, particularly those utilizing more rigorous designs, reported positive outcomes involving medication initiation, linkage to post-discharge care, and utilization outcomes. CONCLUSIONS The Addiction Consultation Service care model improves quality of care for hospitalized patients with substance use disorder. Additional research is needed to assess its effectiveness across diverse medical settings, determine the effectiveness of varying staffing models, demonstrate impactful outcomes, and establish funding mechanisms to support sustainability.
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Affiliation(s)
- Itai Danovitch
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, United States of America.
| | - Samuel Korouri
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, United States of America
| | - Harlene Kaur
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, United States of America.
| | - Gabrielle Messineo
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, United States of America
| | - Teryl Nuckols
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, United States of America; RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States of America.
| | - Waguih W Ishak
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, United States of America.
| | - Allison Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States of America.
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IsHak WW, Hamilton MA, Korouri S, Diniz MA, Mirocha J, Hedrick R, Chernoff R, Black JT, Aronow H, Vanle B, Dang J, Edwards G, Darwish T, Messineo G, Collier S, Pasini M, Tessema KK, Harold JG, Ong MK, Spiegel B, Wells K, Danovitch I. Comparative Effectiveness of Psychotherapy vs Antidepressants for Depression in Heart Failure: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2352094. [PMID: 38231511 PMCID: PMC10794938 DOI: 10.1001/jamanetworkopen.2023.52094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/28/2023] [Indexed: 01/18/2024] Open
Abstract
Importance Heart failure (HF) affects more than 6 million adults in the US and more than 64 million adults worldwide, with 50% prevalence of depression. Patients and clinicians lack information on which interventions are more effective for depression in HF. Objective To compare the effectiveness of behavioral activation psychotherapy (BA) vs antidepressant medication management (MEDS) on patient-centered outcomes inpatients with HF and depression. Design, Setting, and Participants This pragmatic randomized comparative effectiveness trial was conducted from 2018 to 2022, including 1-year follow-up, at a not-for-profit academic health system serving more than 2 million people from diverse demographic, socioeconomic, cultural, and geographic backgrounds. Participant included inpatients and outpatients diagnosed with HF and depression, and data were analyzed as intention-to-treat. Data were analyzed from 2022 to 2023. Interventions BA is an evidence-based manualized treatment for depression, promoting engagement in personalized pleasurable activities selected by patients. MEDS involves the use of an evidence-based collaborative care model with care managers providing coordination with patients, psychiatrists, and primary care physicians to only administer medications. Main Outcomes and Measures The primary outcome was depressive symptom severity at 6 months, measured using the Patient Health Questionnaire 9-Item (PHQ-9). Secondary outcomes included physical and mental health-related quality of life (HRQOL), measured using the Short-Form 12-Item version 2 (SF-12); heart failure-specific HRQOL, measured using the Kansas City Cardiomyopathy Questionnaire; caregiver burden, measured with the Caregiver Burden Questionnaire for Heart Failure; emergency department visits; readmissions; days hospitalized; and mortality at 3, 6, and 12 months. Results A total of 416 patients (mean [SD] age, 60.71 [15.61] years; 243 [58.41%] male) were enrolled, with 208 patients randomized to BA and 208 patients randomized to MEDS. At baseline, mean (SD) PHQ-9 scores were 14.54 (3.45) in the BA group and 14.31 (3.60) in the MEDS group; both BA and MEDS recipients experienced nearly 50% reduction in depressive symptoms at 3, 6, and 12 months (eg, mean [SD] score at 12 months: BA, 7.62 (5.73); P < .001; MEDS, 7.98 (6.06); P < .001; between-group P = .55). There was no statistically significant difference between BA and MEDS in the primary outcome of PHQ-9 at 6 months (mean [SD] score, 7.53 [5.74] vs 8.09 [6.06]; P = .88). BA recipients, compared with MEDS recipients, experienced small improvement in physical HRQOL at 6 months (mean [SD] SF-12 physical score: 38.82 [11.09] vs 37.12 [10.99]; P = .04), had fewer ED visits (3 months: 38% [95% CI, 14%-55%] reduction; P = .005; 6 months: 30% [95% CI, 14%-40%] reduction; P = .008; 12 months: 27% [95% CI, 15%-38%] reduction; P = .001), and spent fewer days hospitalized (3 months: 17% [95% CI, 8%-25%] reduction; P = .002; 6 months: 19% [95% CI, 13%-25%] reduction; P = .005; 12 months: 36% [95% CI, 32%-40%] reduction; P = .001). Conclusions and Relevance In this comparative effectiveness trial of BA and MEDS in patients with HF experiencing depression, both treatments significantly reduced depressive symptoms by nearly 50% with no statistically significant differences between treatments. BA recipients experienced better physical HRQOL, fewer ED visits, and fewer days hospitalized. The study findings suggested that patients with HF could be given the choice between BA or MEDS to ameliorate depression. Trial Registration ClinicalTrials.gov Identifier: NCT03688100.
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Affiliation(s)
- Waguih William IsHak
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Michele A. Hamilton
- Smidt Heart Institute, Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Samuel Korouri
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Marcio A. Diniz
- Biostatistics Research Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - James Mirocha
- Biostatistics Research Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Rebecca Hedrick
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Robert Chernoff
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Harriet Aronow
- Department of Nursing Research, Cedars-Sinai Medical Center, Los Angeles, California
| | - Brigitte Vanle
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jonathan Dang
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Gabriel Edwards
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tarneem Darwish
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Gabrielle Messineo
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stacy Collier
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mia Pasini
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - John G. Harold
- Smidt Heart Institute, Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Michael K. Ong
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Brennan Spiegel
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Health System, Los Angeles, California
| | - Kenneth Wells
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Itai Danovitch
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
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Spiegel BMR, Fuller G, Liu X, Dupuy T, Norris T, Bolus R, Gale R, Danovitch I, Eberlein S, Jusufagic A, Nuckols T, Cowan P. Cluster-Randomized Comparative Effectiveness Trial of Physician-Directed Clinical Decision Support Versus Patient-Directed Education to Promote Appropriate Use of Opioids for Chronic Pain. J Pain 2023; 24:1745-1758. [PMID: 37330159 DOI: 10.1016/j.jpain.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 04/26/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Abstract
We compared the effectiveness of physician-directed clinical decision support (CDS) administered via electronic health record versus patient-directed education to promote the appropriate use of opioids by conducting a cluster-randomized trial involving 82 primary care physicians and 951 of their patients with chronic pain. Primary outcomes were satisfaction with patient-physician communication consumer assessment of health care providers and system clinician and group survey (CG-CAHPS) and pain interference patient-reported outcomes measurement information system. Secondary outcomes included physical function (patient-reported outcomes measurement information system), depression (PHQ-9), high-risk opioid prescribing (>90 morphine milligram equivalents per day [≥90 mg morphine equivalent/day]), and co-prescription of opioids and benzodiazepines. We used multi-level regression to compare longitudinal difference-in-difference scores between arms. The odds of achieving the maximum CG-CAHPS score were 2.65 times higher in the patient education versus the CDS arm (P = .044; 95% confidence interval [CI] 1.03-6.80). However, baseline CG-CAHPS scores were dissimilar between arms, making these results challenging to interpret definitively. No difference in pain interference was found between groups (Coef = -0.64, 95% CI -2.66 to 1.38). The patient education arm experienced higher odds of Rx ≥ 90 milligrams morphine equivalent/day (odds ratio = 1.63; P = .010; 95% CI 1.13, 2.36). There were no differences between groups in physical function, depression, or co-prescription of opioids and benzodiazepines. These results suggest that patient-directed education may have the potential to improve satisfaction with patient-physician communication, whereas physician-directed CDS via electronic health records may have greater potential to reduce high-risk opioid dosing. More evidence is needed to ascertain the relative cost-effectiveness between strategies. PERSPECTIVE: This article presents the results of a comparative-effectiveness study of 2 broadly used communication strategies to catalyze dialog between patients and primary care physicians around chronic pain. The results add to the decision-making literature and offer insights about the relative benefits of physician-directed versus patient-directed interventions to promote the appropriate use of opioids.
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Affiliation(s)
- Brennan M R Spiegel
- Department of Medicine, Division of Health Services Research, Cedars-Sinai, Los Angeles, California.
| | - Garth Fuller
- Department of Medicine, Division of Health Services Research, Cedars-Sinai, Los Angeles, California
| | - Xiaoyu Liu
- Department of Medicine, Division of Health Services Research, Cedars-Sinai, Los Angeles, California
| | - Taylor Dupuy
- Department of Medicine, Division of Health Services Research, Cedars-Sinai, Los Angeles, California
| | - Tom Norris
- American Chronic Pain Association, Rocklin, California
| | - Roger Bolus
- Research Solutions Group, Encinitas, California
| | - Rebecca Gale
- Department of Medicine, Division of Health Services Research, Cedars-Sinai, Los Angeles, California
| | - Itai Danovitch
- Department of Psychiatry and Behavioral Health, Cedars-Sinai, Los Angeles, California
| | - Sam Eberlein
- Department of Medicine, Division of Health Services Research, Cedars-Sinai, Los Angeles, California
| | - Alma Jusufagic
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Teryl Nuckols
- Department of Medicine, Division of General Internal Medicine, Cedars-Sinai, Los Angeles, California
| | - Penney Cowan
- American Chronic Pain Association, Rocklin, California
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Ober AJ, Osilla KC, Klein DJ, Burgette LF, Leamon I, Mazer MW, Messineo G, Collier S, Korouri S, Watkins KE, IsHak W, Nuckols T, Danovitch I. Pilot randomized controlled trial of a hospital-based substance use treatment and recovery team (START) to improve initiation of medication for alcohol or opioid use disorder and linkage to follow-up care. J Subst Use Addict Treat 2023; 150:209063. [PMID: 37156424 DOI: 10.1016/j.josat.2023.209063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/06/2022] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES We conducted a pilot randomized controlled trial (RCT) to explore whether a hospital inpatient addiction consult team (Substance Use Treatment and Recovery Team [START]) based on collaborative care was feasible, acceptable to patients, and whether it could improve uptake of medication in the hospital and linkage to care after discharge, as well as reduce substance use and hospital readmission. The START consisted of an addiction medicine specialist and care manager who implemented a motivational and discharge planning intervention. METHODS We randomized inpatients age ≥ 18 with a probable alcohol or opioid use disorder to receive START or usual care. We assessed feasibility and acceptability of START and the RCT, and we conducted an intent-to-treat analysis on data from the electronic medical record and patient interviews at baseline and 1-month postdischarge. The study compared RCT outcomes (medication for alcohol or opioid use disorder, linkage to follow-up care after discharge, substance use, hospital readmission) between arms by fitting logistic and linear regression models. FINDINGS Of 38 START patients, 97 % met with the addiction medicine specialist and care manager; 89 % received ≥8 of 10 intervention components. All patients receiving START found it to be somewhat or very acceptable. START patients had higher odds of initiating medication during the inpatient stay (OR 6.26, 95 % CI = 2.38-16.48, p < .001) and being linked to follow-up care (OR 5.76, 95 % CI = 1.86-17.86, p < .01) compared to usual care patients (N = 50). The study found no significant differences between groups in drinking or opioid use; patients in both groups reported using fewer substances at the 1-month follow-up. CONCLUSIONS Pilot data suggest START and RCT implementation are feasible and acceptable and that START may facilitate medication initiation and linkage to follow-up for inpatients with an alcohol or opioid use disorder. A larger trial should assess effectiveness, covariates, and moderators of intervention effects.
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Affiliation(s)
- Allison J Ober
- RAND Corporation, Santa Monica, CA, United States of America.
| | - Karen C Osilla
- Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - David J Klein
- RAND Corporation, Santa Monica, CA, United States of America
| | - Lane F Burgette
- RAND Corporation, Santa Monica, CA, United States of America
| | - I Leamon
- RAND Corporation, Santa Monica, CA, United States of America
| | - Mia W Mazer
- Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | | | - Stacy Collier
- Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Samuel Korouri
- Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | | | - Waghui IsHak
- Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Teryl Nuckols
- Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Itai Danovitch
- Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
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IsHak WW, Garcia P, Pearl R, Dang J, William C, Totlani J, Danovitch I. The Impact of Psilocybin on Patients Experiencing Psychiatric Symptoms: A Systematic Review of Randomized Clinical Trials. Innov Clin Neurosci 2023; 20:39-48. [PMID: 37387703 PMCID: PMC10306375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Objective This systematic review aims to evaluate the impact of psilocybin on patients experiencing psychiatric symptoms, with a focus on health-related quality of life (HRQoL) and safety. Method of Research Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the PubMed database and identified studies published from January 2011 to December 2021 pertaining to the impact of psilocybin on psychiatric symptoms. Two authors independently conducted a focused analysis and reached a final consensus on five studies meeting the specific selection criteria. Study bias was addressed using the Cochrane risk of bias tool. Results The impact of psilocybin on psychiatric symptoms was examined in five randomized controlled trials (RCTs). Four studies administered 1 to 2 doses of psilocybin, with doses ranging from 14mg/70kg to 30mg/70kg, and one study administered a fixed dose of 25mg to all participants. Administration of psilocybin resulted in significant and sustained reduction in symptoms of anxiety and depression, enhanced sense of wellbeing, life satisfaction, and positive mood immediately after psilocybin administration and up to six months after conclusion of treatment. All studies included some form of psychotherapy, and none reported serious adverse effects. Conclusion RCTs show the efficacy of psilocybin in the treatment of anxiety and depression symptoms, as well as improvement in HRQoL, and no serious side effects. However, additional research is necessary to characterize predictors of treatment response, patient screening requirements, effectiveness in broader clinical populations, and guidelines for psilocybin-assisted psychotherapy.
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Affiliation(s)
- Waguih William IsHak
- Drs. IsHak, Pearl, Dang, and Danovitch and Ms. William are with Cedars-Sinai Medical Center in Los Angeles, California
- Dr. IsHak is also with David Geffen School of Medicine at the University of California, Los Angeles in Los Angeles, California
| | | | - Rachel Pearl
- Drs. IsHak, Pearl, Dang, and Danovitch and Ms. William are with Cedars-Sinai Medical Center in Los Angeles, California
| | - Jonathan Dang
- Drs. IsHak, Pearl, Dang, and Danovitch and Ms. William are with Cedars-Sinai Medical Center in Los Angeles, California
| | - Catherine William
- Drs. IsHak, Pearl, Dang, and Danovitch and Ms. William are with Cedars-Sinai Medical Center in Los Angeles, California
| | - Jayant Totlani
- Mr. Totlani is with Western University of Health Sciences in Pomona, California
| | - Itai Danovitch
- Drs. IsHak, Pearl, Dang, and Danovitch and Ms. William are with Cedars-Sinai Medical Center in Los Angeles, California
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Anwar F, Sparrow NA, Rashid MH, Guidry G, Gezalian MM, Ley EJ, Koronyo-Hamaoui M, Danovitch I, Ely EW, Karumanchi SA, Lahiri S. Systemic interleukin-6 inhibition ameliorates acute neuropsychiatric phenotypes in a murine model of acute lung injury. Crit Care 2022; 26:274. [PMID: 36100846 PMCID: PMC9469063 DOI: 10.1186/s13054-022-04159-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 09/04/2022] [Indexed: 11/10/2022] Open
Abstract
Acute neuropsychiatric impairments occur in over 70% of patients with acute lung injury. Mechanical ventilation is a well-known precipitant of acute lung injury and is strongly associated with the development of acute delirium and anxiety phenotypes. In prior studies, we demonstrated that IL-6 mediates neuropathological changes in the frontal cortex and hippocampus of animals with mechanical ventilation-induced brain injury; however, the effect of systemic IL-6 inhibition on structural and functional acute neuropsychiatric phenotypes is not known. We hypothesized that a murine model of mechanical ventilation-induced acute lung injury (VILI) would induce neural injury to the amygdala and hippocampus, brain regions that are implicated in diverse neuropsychiatric conditions, and corresponding delirium- and anxiety-like functional impairments. Furthermore, we hypothesized that these structural and functional changes would reverse with systemic IL-6 inhibition. VILI was induced using high tidal volume (35 cc/kg) mechanical ventilation. Cleaved caspase-3 (CC3) expression was quantified as a neural injury marker and found to be significantly increased in the VILI group compared to spontaneously breathing or anesthetized and mechanically ventilated mice with 10 cc/kg tidal volume. VILI mice treated with systemic IL-6 inhibition had significantly reduced amygdalar and hippocampal CC3 expression compared to saline-treated animals and demonstrated amelioration in acute neuropsychiatric behaviors in open field, elevated plus maze, and Y-maze tests. Overall, these data provide evidence of a pathogenic role of systemic IL-6 in mediating structural and functional acute neuropsychiatric symptoms in VILI and provide preclinical justification to assess IL-6 inhibition as a potential intervention to ameliorate acute neuropsychiatric phenotypes following VILI.
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Chernoff RA, Messineo G, Kim S, Pizano D, Korouri S, Danovitch I, IsHak WW. Psychosocial Interventions for Patients With Heart Failure and Their Impact on Depression, Anxiety, Quality of Life, Morbidity, and Mortality: A Systematic Review and Meta-Analysis. Psychosom Med 2022; 84:560-580. [PMID: 35354163 DOI: 10.1097/psy.0000000000001073] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this systematic review and meta-analysis was to evaluate the ability of psychosocial interventions to reduce depression and anxiety, improve quality of life, and reduce hospitalization and mortality rates in patients with heart failure. METHODS Studies of psychosocial interventions published from 1970 to 2021 were identified through four databases (PubMed, Ovid MEDLINE, PsycINFO, Cochrane). Two authors independently conducted a focused analysis and reached a final consensus on the studies to include, followed by a quality check by a third author. A risk of bias assessment was conducted. RESULTS Twenty-three studies were identified, but only 15 studies of mostly randomized controlled trials with a total of 1370 patients with heart failure were included in the meta-analysis. Interventions were either cognitive behavioral therapy (CBT) or stress management. The pooled intervention effect was in favor of the intervention for depression (combined difference in standardized mean change [DSMC]: -0.41; 95% confidence interval [CI] = -0.66 to -0.17; p = .001) and anxiety (combined DSMC: -0.33; 95% CI = -0.51 to -0.15; p < .001) but was only a trend for quality of life (combined DSMC: 0.14; 95% CI = -0.00 to 0.29; p = .053). Evidence was limited that interventions produced lower rates of hospitalization (5 of 5 studies showing a beneficial effect) or death (1 of 5 with a beneficial effect). CONCLUSIONS CBT and stress management interventions significantly reduced depression and anxiety compared with control conditions. CBT significantly improved quality of life compared with controls, but stress management did not. Longer treatment duration seemed to be an important factor related to treatment success.
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Affiliation(s)
- Robert Alan Chernoff
- From the Department of Psychiatry and Behavioral Neurosciences (Chernoff, Messineo, Pizano, Korouri, Danovitch, IsHak), and Biostatistics Core (Kim), Cedars-Sinai Medical Center, Los Angeles, CA
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Bhalla IP, Siegel K, Chaudhry M, Li N, Torbati S, Nuckols T, Danovitch I. Involuntary Psychiatric Hospitalization: How Patient Characteristics Affect Decision-Making. Psychiatr Q 2022; 93:297-310. [PMID: 34536188 DOI: 10.1007/s11126-021-09939-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 10/20/2022]
Abstract
Emergency department (ED) psychiatrists face the consequential decision to pursue involuntary inpatient psychiatric admission. Research on the relationship between patient characteristics and the decision to pursue involuntary psychiatric admission is limited. Using data from 2017 to 2018 at an urban Los Angeles hospital, we used generalized linear mixed effects models to compare patients who were involuntarily admitted to inpatient psychiatry to patients who were discharged from the ED. Of 2,448 patients included in the study, 1,217 (49.7%) were involuntarily admitted to inpatient psychiatry and 1,231 (50.3%) were discharged. After controlling for sociodemographic characteristics, admitted patients were more likely to have been brought in by police, have had an organized suicide plan or recent attempt, physical signs of harm, psychosis, depression or hopelessness, lack social support, have diagnoses of schizophrenia or bipolar disorder, and be administered injectable psychotropic medications. Stimulant use, a diagnosis of anxiety or developmental disorders, and recent medical ED utilization were associated with discharge. Psychiatrists pursued involuntarily psychiatric hospitalization based on factors potentially indicative of dangerousness, leaving patients, particularly those with recent substance use, without immediate access to treatment. Policies should focus on increasing follow up to high quality, voluntary outpatient mental health care.
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Affiliation(s)
- Ish P Bhalla
- National Clinician Scholars Program At UCLA Funded By Cedars-Sinai Medical Center and the David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. .,Cedars-Sinai Medical Center, Los Angeles, CA, USA. .,David Geffen School of Medicine At UCLA, Department of General Internal Medicine, Los Angeles, CA, USA.
| | - Keith Siegel
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Ning Li
- David Geffen School of Medicine At UCLA, Department of General Internal Medicine, Los Angeles, CA, USA
| | - Sam Torbati
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
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10
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Birckhead B, Eberlein S, Alvarez G, Gale R, Dupuy T, Makaroff K, Fuller G, Liu X, Yu KS, Black JT, Ishimori M, Venuturupalli S, Tu J, Norris T, Tighiouart M, Ross L, McKelvey K, Vrahas M, Danovitch I, Spiegel B. Home-based virtual reality for chronic pain: protocol for an NIH-supported randomised-controlled trial. BMJ Open 2021; 11:e050545. [PMID: 34130965 PMCID: PMC8207994 DOI: 10.1136/bmjopen-2021-050545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Chronic pain is highly prevalent and associated with a large burden of illness; there is a pressing need for safe, home-based, non-pharmacological, interventions. Virtual reality (VR) is a digital therapeutic known to be effective for acute pain, but its role in chronic pain is not yet fully elucidated. Here we present a protocol for the National Institute of Health (NIH) Back Pain Consortium (BACPAC) VR trial that evaluates the effectiveness of three forms of VR for patients with chronic lower back pain (cLBP), a highly prevalent form of chronic pain. METHODS AND ANALYSIS The NIH BACPAC VR trial will randomise 360 patients with cLBP into one of three arms, each administered through a head-mounted display: 1) skills-based VR, a program incorporating principles of cognitive behavioural therapy, mindful meditation and physiological biofeedback therapy using embedded biometric sensors; 2) distraction-based VR, a program using 360-degree immersive videos designed to distract users from pain; and 3) sham VR, a non-immersive program using two-dimensional videos within a VR headset. Research participants will be monitored for 12 weeks using a combination of patient-reported outcomes administered via REDCap (Research Electronic Data Capture), wearable sensor data collected via Fitbit Charge 4 and electronic health record data. The primary outcome will be the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference scale. Secondary outcomes will include PROMIS Anxiety, PROMIS Sleep Disturbance, opioid prescription data and Pain Catastrophizing Scale Short Form. A subgroup analysis will explore patient level predictors for VR efficacy. ETHICS AND DISSEMINATION Ethics approval was obtained from the Institutional Review Board of Cedars-Sinai Health System in April 2020. The results will be disseminated in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04409353.
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Affiliation(s)
- Brandon Birckhead
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sam Eberlein
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Genie Alvarez
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Rebecca Gale
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Taylor Dupuy
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Katherine Makaroff
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Garth Fuller
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Xiaoyu Liu
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kyung-Sang Yu
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Biomedical Sciences, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - J T Black
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mariko Ishimori
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Swamy Venuturupalli
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Joseph Tu
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Tom Norris
- American Chronic Pain Association, Rocklin, California, USA
| | - Mourad Tighiouart
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Lindsey Ross
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Karma McKelvey
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mark Vrahas
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Itai Danovitch
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Brennan Spiegel
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
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11
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IsHak WW, Korouri S, Darwish T, Vanle B, Dang J, Edwards G, Black JT, Aronow H, Kimchi A, Spiegel B, Hedrick R, Chernoff R, Diniz MA, Mirocha J, Manoukian V, Harold J, Ong MK, Wells K, Hamilton M, Danovitch I. Personalized treatments for depressive symptoms in patients with advanced heart failure: A pragmatic randomized controlled trial. PLoS One 2021; 16:e0244453. [PMID: 33412562 PMCID: PMC7790529 DOI: 10.1371/journal.pone.0244453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 12/08/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives Heart Failure is a chronic syndrome affecting over 5.7 million in the US and 26 million adults worldwide with nearly 50% experiencing depressive symptoms. The objective of the study is to compare the effects of two evidence-based treatment options for adult patients with depression and advanced heart failure, on depressive symptom severity, physical and mental health related quality of life (HRQoL), heart-failure specific quality of life, caregiver burden, morbidity, and mortality at 3, 6 and 12-months. Methods Trial design. Pragmatic, randomized, comparative effectiveness trial. Interventions. The treatment interventions are: (1) Behavioral Activation (BA), a patient-centered psychotherapy which emphasizes engagement in enjoyable and valued personalized activities as selected by the patient; or (2) Antidepressant Medication Management administered using the collaborative care model (MEDS). Participants. Adults aged 18 and over with advanced heart failure (defined as New York Heart Association (NYHA) Class II, III, and IV) and depression (defined as a score of 10 or above on the PHQ-9 and confirmed by the MINI International Neuropsychiatric Interview for the DSM-5) selected from all patients at Cedars-Sinai Medical Center who are admitted with heart failure and all patients presenting to the outpatient programs of the Smidt Heart Institute at Cedars-Sinai Medical Center. We plan to randomize 416 patients to BA or MEDS, with an estimated 28% loss to follow-up/inability to collect follow-up data. Thus, we plan to include 150 in each group for a total of 300 participants from which data after randomization will be collected and analyzed. Conclusions The current trial is the first to compare the impact of BA and MEDS on depressive symptoms, quality of life, caregiver burden, morbidity, and mortality in patients with depression and advanced heart failure. The trial will provide novel results that will be disseminated and implemented into a wide range of current practice settings. Registration ClinicalTrials.Gov Identifier: NCT03688100.
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Affiliation(s)
- Waguih William IsHak
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- * E-mail:
| | - Samuel Korouri
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Tarneem Darwish
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Brigitte Vanle
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Jonathan Dang
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Gabriel Edwards
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Jeanne T. Black
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Harriet Aronow
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Asher Kimchi
- Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Brennan Spiegel
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
- UCLA Fielding School of Public Health, Los Angeles, CA, United States of America
| | - Rebecca Hedrick
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Robert Chernoff
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Marcio A. Diniz
- Biostatistics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - James Mirocha
- Biostatistics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Vicki Manoukian
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - John Harold
- Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Michael K. Ong
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- UCLA Fielding School of Public Health, Los Angeles, CA, United States of America
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Kenneth Wells
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- UCLA Fielding School of Public Health, Los Angeles, CA, United States of America
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Michele Hamilton
- Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Itai Danovitch
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
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12
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Hedrick R, Korouri S, Tadros E, Darwish T, Cortez V, Triay D, Pasini M, Olanisa L, Herrera N, Hanna S, Kimchi A, Hamilton M, Danovitch I, IsHak WW. The impact of antidepressants on depressive symptom severity, quality of life, morbidity, and mortality in heart failure: a systematic review. Drugs Context 2020; 9:2020-5-4. [PMID: 32788920 PMCID: PMC7398616 DOI: 10.7573/dic.2020-5-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/05/2020] [Accepted: 06/12/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The purpose of this paper is to review the literature on the impact of antidepressants on depressive symptom severity, quality of life (QoL), morbidity, and mortality in patients with heart failure (HF). METHODS Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies published from December 1969 to December 2019 that pertain to depression and HF were identified through the use of the PubMed and PsycINFO databases, using the keywords: 'antidepressant*' and 'heart failure.' Two authors independently conducted a focused analysis and reached a final consensus on 17 studies that met the specific selection criteria and passed the study quality checks. RESULTS Studies varied in types of antidepressants used as well as in study designs. Ten studies were analyzed for the impact of antidepressant medications on depressive symptom severity. Five of these were randomized controlled trials (RCTs), out of which sertraline and paroxetine showed a significant reduction in depressive symptoms despite the small samples utilized. Four of the 17 studies addressed QoL as part of their outcomes showing no difference for escitalopram (RCT), significantly greater improvements for paroxetine controlled release (RCT), statistical significance for sertraline compared to control (pilot study), and showing significant improvement before and after treatment (open-label trial) for nefazodone. Thirteen of the 17 studies included measures of morbidity and mortality. Although early analyses have pointed to an association of antidepressant use and mortality particularly with fluoxetine, the reviewed studies showed no increase in mortality for antidepressants, and secondary analyses showed improved mortality in patients who achieved remission of depressive symptoms. CONCLUSION Out of the various antidepressants studied, which included sertraline, paroxetine, escitalopram, citalopram, bupropion, nefazodone, and nortriptyline, selective serotonin reuptake inhibitors seem to be a safe treatment option for patients with depression and HF. However, due to the variety of study designs as well as the mixed results for each antidepressant, more information for reducing depression severity, morbidity, and mortality and improving quality of life in patients with HF should be examined using robust large sample RCTs.
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Affiliation(s)
- Rebecca Hedrick
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Samuel Korouri
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Emile Tadros
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tarneem Darwish
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Veronica Cortez
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Desiree Triay
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mia Pasini
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Linda Olanisa
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nathalie Herrera
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sophia Hanna
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Asher Kimchi
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michele Hamilton
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Itai Danovitch
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Waguih William IsHak
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Psychiatry, David Geffen School of Medicine, Los Angeles, CA, USA
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13
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Ishak WW, Edwards G, Herrera N, Lin T, Hren K, Peterson M, Ngor A, Liu A, Kimchi A, Spiegel B, Hedrick R, Chernoff R, Diniz M, Mirocha J, Manoukian V, Ong M, Harold J, Danovitch I, Hamilton M. Depression in Heart Failure: A Systematic Review. Innov Clin Neurosci 2020; 17:27-38. [PMID: 32802590 PMCID: PMC7413333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Objective: This paper sought to identify the instruments used to measure depression in heart failure (HF) and elucidate the impact of treatment interventions on depression in HF. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. Studies published from 1988 to 2018 covering depression and HF were identified through the review of the PubMed and PsycINFO databases using the keywords: "depres*" AND "heart failure." Two authors independently conducted a focused analysis, identifying 27 studies that met the specific selection criteria and passed the study quality checks. Results: Patient-reported questionnaires were more commonly adopted than clinician-rated questionnaires, including the Beck Depression Inventory, the Patient Health Questionnaire (PHQ-9), and the Hospital Anxiety and Depression Scale. Six common interventions were observed: antidepressant medications, collaborative care, psychotherapy, exercise, education, and other nonpharmacological interventions. Except for paroxetine, selective serotonin reuptake inhibitors failed to show a significant difference from placebo. However, the collaborative care model including the use of antidepressants showed a significant decrease in PHQ-9 score after one year. All of the psychotherapy studies included a variation of cognitive behavioral therapy and patients showed significant improvements. The evidence was mixed for exercise, education, and other nonpharmacological interventions. Conclusion: This study suggests which types of interventions are more effective in addressing depression in heart failure patients.
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Affiliation(s)
- Waguih William Ishak
- Drs. IsHak, Edwards, Herrera, Lin, Spiegel, Hedrick, Chernoff, Diniz, Danovitch; Mr. Mirocha and Mr. Peterson; and Ms. Hren, Ms. Nigor, Ms. Liu, and Ms. Manoukian and are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Drs. Ishak, Spiegel, and Ong are with the David Geffen School of Medicine at UCLA in Los Angeles, California
- Drs. Kimchi, Harold, and Hamilton are with the Smidt Heart Institute, Cedars-Sinai Medical Center in Los Angeles, California
| | - Gabriel Edwards
- Drs. IsHak, Edwards, Herrera, Lin, Spiegel, Hedrick, Chernoff, Diniz, Danovitch; Mr. Mirocha and Mr. Peterson; and Ms. Hren, Ms. Nigor, Ms. Liu, and Ms. Manoukian and are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Drs. Ishak, Spiegel, and Ong are with the David Geffen School of Medicine at UCLA in Los Angeles, California
- Drs. Kimchi, Harold, and Hamilton are with the Smidt Heart Institute, Cedars-Sinai Medical Center in Los Angeles, California
| | - Nathalie Herrera
- Drs. IsHak, Edwards, Herrera, Lin, Spiegel, Hedrick, Chernoff, Diniz, Danovitch; Mr. Mirocha and Mr. Peterson; and Ms. Hren, Ms. Nigor, Ms. Liu, and Ms. Manoukian and are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Drs. Ishak, Spiegel, and Ong are with the David Geffen School of Medicine at UCLA in Los Angeles, California
- Drs. Kimchi, Harold, and Hamilton are with the Smidt Heart Institute, Cedars-Sinai Medical Center in Los Angeles, California
| | - Tiffany Lin
- Drs. IsHak, Edwards, Herrera, Lin, Spiegel, Hedrick, Chernoff, Diniz, Danovitch; Mr. Mirocha and Mr. Peterson; and Ms. Hren, Ms. Nigor, Ms. Liu, and Ms. Manoukian and are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Drs. Ishak, Spiegel, and Ong are with the David Geffen School of Medicine at UCLA in Los Angeles, California
- Drs. Kimchi, Harold, and Hamilton are with the Smidt Heart Institute, Cedars-Sinai Medical Center in Los Angeles, California
| | - Kathryn Hren
- Drs. IsHak, Edwards, Herrera, Lin, Spiegel, Hedrick, Chernoff, Diniz, Danovitch; Mr. Mirocha and Mr. Peterson; and Ms. Hren, Ms. Nigor, Ms. Liu, and Ms. Manoukian and are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Drs. Ishak, Spiegel, and Ong are with the David Geffen School of Medicine at UCLA in Los Angeles, California
- Drs. Kimchi, Harold, and Hamilton are with the Smidt Heart Institute, Cedars-Sinai Medical Center in Los Angeles, California
| | - Michael Peterson
- Drs. IsHak, Edwards, Herrera, Lin, Spiegel, Hedrick, Chernoff, Diniz, Danovitch; Mr. Mirocha and Mr. Peterson; and Ms. Hren, Ms. Nigor, Ms. Liu, and Ms. Manoukian and are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Drs. Ishak, Spiegel, and Ong are with the David Geffen School of Medicine at UCLA in Los Angeles, California
- Drs. Kimchi, Harold, and Hamilton are with the Smidt Heart Institute, Cedars-Sinai Medical Center in Los Angeles, California
| | - Ashley Ngor
- Drs. IsHak, Edwards, Herrera, Lin, Spiegel, Hedrick, Chernoff, Diniz, Danovitch; Mr. Mirocha and Mr. Peterson; and Ms. Hren, Ms. Nigor, Ms. Liu, and Ms. Manoukian and are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Drs. Ishak, Spiegel, and Ong are with the David Geffen School of Medicine at UCLA in Los Angeles, California
- Drs. Kimchi, Harold, and Hamilton are with the Smidt Heart Institute, Cedars-Sinai Medical Center in Los Angeles, California
| | - Angela Liu
- Drs. IsHak, Edwards, Herrera, Lin, Spiegel, Hedrick, Chernoff, Diniz, Danovitch; Mr. Mirocha and Mr. Peterson; and Ms. Hren, Ms. Nigor, Ms. Liu, and Ms. Manoukian and are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Drs. Ishak, Spiegel, and Ong are with the David Geffen School of Medicine at UCLA in Los Angeles, California
- Drs. Kimchi, Harold, and Hamilton are with the Smidt Heart Institute, Cedars-Sinai Medical Center in Los Angeles, California
| | - Asher Kimchi
- Drs. IsHak, Edwards, Herrera, Lin, Spiegel, Hedrick, Chernoff, Diniz, Danovitch; Mr. Mirocha and Mr. Peterson; and Ms. Hren, Ms. Nigor, Ms. Liu, and Ms. Manoukian and are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Drs. Ishak, Spiegel, and Ong are with the David Geffen School of Medicine at UCLA in Los Angeles, California
- Drs. Kimchi, Harold, and Hamilton are with the Smidt Heart Institute, Cedars-Sinai Medical Center in Los Angeles, California
| | - Brennan Spiegel
- Drs. IsHak, Edwards, Herrera, Lin, Spiegel, Hedrick, Chernoff, Diniz, Danovitch; Mr. Mirocha and Mr. Peterson; and Ms. Hren, Ms. Nigor, Ms. Liu, and Ms. Manoukian and are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Drs. Ishak, Spiegel, and Ong are with the David Geffen School of Medicine at UCLA in Los Angeles, California
- Drs. Kimchi, Harold, and Hamilton are with the Smidt Heart Institute, Cedars-Sinai Medical Center in Los Angeles, California
| | - Rebecca Hedrick
- Drs. IsHak, Edwards, Herrera, Lin, Spiegel, Hedrick, Chernoff, Diniz, Danovitch; Mr. Mirocha and Mr. Peterson; and Ms. Hren, Ms. Nigor, Ms. Liu, and Ms. Manoukian and are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Drs. Ishak, Spiegel, and Ong are with the David Geffen School of Medicine at UCLA in Los Angeles, California
- Drs. Kimchi, Harold, and Hamilton are with the Smidt Heart Institute, Cedars-Sinai Medical Center in Los Angeles, California
| | - Robert Chernoff
- Drs. IsHak, Edwards, Herrera, Lin, Spiegel, Hedrick, Chernoff, Diniz, Danovitch; Mr. Mirocha and Mr. Peterson; and Ms. Hren, Ms. Nigor, Ms. Liu, and Ms. Manoukian and are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Drs. Ishak, Spiegel, and Ong are with the David Geffen School of Medicine at UCLA in Los Angeles, California
- Drs. Kimchi, Harold, and Hamilton are with the Smidt Heart Institute, Cedars-Sinai Medical Center in Los Angeles, California
| | - Marcio Diniz
- Drs. IsHak, Edwards, Herrera, Lin, Spiegel, Hedrick, Chernoff, Diniz, Danovitch; Mr. Mirocha and Mr. Peterson; and Ms. Hren, Ms. Nigor, Ms. Liu, and Ms. Manoukian and are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Drs. Ishak, Spiegel, and Ong are with the David Geffen School of Medicine at UCLA in Los Angeles, California
- Drs. Kimchi, Harold, and Hamilton are with the Smidt Heart Institute, Cedars-Sinai Medical Center in Los Angeles, California
| | - James Mirocha
- Drs. IsHak, Edwards, Herrera, Lin, Spiegel, Hedrick, Chernoff, Diniz, Danovitch; Mr. Mirocha and Mr. Peterson; and Ms. Hren, Ms. Nigor, Ms. Liu, and Ms. Manoukian and are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Drs. Ishak, Spiegel, and Ong are with the David Geffen School of Medicine at UCLA in Los Angeles, California
- Drs. Kimchi, Harold, and Hamilton are with the Smidt Heart Institute, Cedars-Sinai Medical Center in Los Angeles, California
| | - Vicki Manoukian
- Drs. IsHak, Edwards, Herrera, Lin, Spiegel, Hedrick, Chernoff, Diniz, Danovitch; Mr. Mirocha and Mr. Peterson; and Ms. Hren, Ms. Nigor, Ms. Liu, and Ms. Manoukian and are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Drs. Ishak, Spiegel, and Ong are with the David Geffen School of Medicine at UCLA in Los Angeles, California
- Drs. Kimchi, Harold, and Hamilton are with the Smidt Heart Institute, Cedars-Sinai Medical Center in Los Angeles, California
| | - Michael Ong
- Drs. IsHak, Edwards, Herrera, Lin, Spiegel, Hedrick, Chernoff, Diniz, Danovitch; Mr. Mirocha and Mr. Peterson; and Ms. Hren, Ms. Nigor, Ms. Liu, and Ms. Manoukian and are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Drs. Ishak, Spiegel, and Ong are with the David Geffen School of Medicine at UCLA in Los Angeles, California
- Drs. Kimchi, Harold, and Hamilton are with the Smidt Heart Institute, Cedars-Sinai Medical Center in Los Angeles, California
| | - John Harold
- Drs. IsHak, Edwards, Herrera, Lin, Spiegel, Hedrick, Chernoff, Diniz, Danovitch; Mr. Mirocha and Mr. Peterson; and Ms. Hren, Ms. Nigor, Ms. Liu, and Ms. Manoukian and are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Drs. Ishak, Spiegel, and Ong are with the David Geffen School of Medicine at UCLA in Los Angeles, California
- Drs. Kimchi, Harold, and Hamilton are with the Smidt Heart Institute, Cedars-Sinai Medical Center in Los Angeles, California
| | - Itai Danovitch
- Drs. IsHak, Edwards, Herrera, Lin, Spiegel, Hedrick, Chernoff, Diniz, Danovitch; Mr. Mirocha and Mr. Peterson; and Ms. Hren, Ms. Nigor, Ms. Liu, and Ms. Manoukian and are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Drs. Ishak, Spiegel, and Ong are with the David Geffen School of Medicine at UCLA in Los Angeles, California
- Drs. Kimchi, Harold, and Hamilton are with the Smidt Heart Institute, Cedars-Sinai Medical Center in Los Angeles, California
| | - Michele Hamilton
- Drs. IsHak, Edwards, Herrera, Lin, Spiegel, Hedrick, Chernoff, Diniz, Danovitch; Mr. Mirocha and Mr. Peterson; and Ms. Hren, Ms. Nigor, Ms. Liu, and Ms. Manoukian and are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Drs. Ishak, Spiegel, and Ong are with the David Geffen School of Medicine at UCLA in Los Angeles, California
- Drs. Kimchi, Harold, and Hamilton are with the Smidt Heart Institute, Cedars-Sinai Medical Center in Los Angeles, California
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Edwards G, Nuckols T, Herrera N, Danovitch I, Ishak WW. Improving Depression Management in Patients with Medical Illness Using Collaborative Care: Linking Treatment from the Inpatient to the Outpatient Setting. Innov Clin Neurosci 2019; 16:19-24. [PMID: 32082938 PMCID: PMC7006865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objective: This paper sought to review the impact of depression in patients with comorbid medical problems, the importance of bridging the gap between inpatient and outpatient care for medical inpatients with depression (especially for organizations that treat patients in both settings), and the elements necessary to implement a pilot for an outpatient Collaborative Care Management program for patients with depression following medical admissions. Taken into account is the presence of new billing mechanisms and potential cost offsets. Methods: The literature referenced in this paper was identified through a search of online databases, including PubMed and Google Scholar. The data used to analyze cost were drawn from national, publicly available sources, such as the Kaiser Family Foundation, Bureau of Labor Statistics, and the Organisation for Economic Cooperation and Development. Results: Collaborative care is an evidence-based intervention for depression that can aid with successful transition of care as patients move from the inpatient to the outpatient setting. It can be considered cost-effective when treating a panel of patients that falls below the recommended caseload for a single case manager (i.e., 19-46 billed encounters, depending on the payer mix), particularly when considering the savings from a reduced length of stay associated with well-controlled depressive symptoms. Conclusion: Organizations should consider implementing collaborative care management for patients with depression to improve depression outcomes, reduce costs, and prepare themselves for a health financing environment that rewards value.
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Affiliation(s)
- Gabriel Edwards
- Drs. Edwards, Herrera, Danovitch, and IsHak are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Dr. Nuckols is with the Division of General Internal Medicine, Cedars-Sinai Medical Center in Los Angeles, California
- Dr. IsHak is with the David Geffen School of Medicine at UCLA in Los Angeles, California
| | - Teryl Nuckols
- Drs. Edwards, Herrera, Danovitch, and IsHak are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Dr. Nuckols is with the Division of General Internal Medicine, Cedars-Sinai Medical Center in Los Angeles, California
- Dr. IsHak is with the David Geffen School of Medicine at UCLA in Los Angeles, California
| | - Nathalie Herrera
- Drs. Edwards, Herrera, Danovitch, and IsHak are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Dr. Nuckols is with the Division of General Internal Medicine, Cedars-Sinai Medical Center in Los Angeles, California
- Dr. IsHak is with the David Geffen School of Medicine at UCLA in Los Angeles, California
| | - Itai Danovitch
- Drs. Edwards, Herrera, Danovitch, and IsHak are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Dr. Nuckols is with the Division of General Internal Medicine, Cedars-Sinai Medical Center in Los Angeles, California
- Dr. IsHak is with the David Geffen School of Medicine at UCLA in Los Angeles, California
| | - Waguih William Ishak
- Drs. Edwards, Herrera, Danovitch, and IsHak are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center in Los Angeles, California
- Dr. Nuckols is with the Division of General Internal Medicine, Cedars-Sinai Medical Center in Los Angeles, California
- Dr. IsHak is with the David Geffen School of Medicine at UCLA in Los Angeles, California
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Affiliation(s)
| | - Itai Danovitch
- National Clinician Scholars Program and David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bhalla); Cedars-Sinai Medical Center, Los Angeles (Bhalla, Danovitch). Francine Cournos, M.D., and Stephen M. Goldfinger, M.D., are editors of this column
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Spiegel B, Fuller G, Lopez M, Dupuy T, Noah B, Howard A, Albert M, Tashjian V, Lam R, Ahn J, Dailey F, Rosen BT, Vrahas M, Little M, Garlich J, Dzubur E, IsHak W, Danovitch I. Virtual reality for management of pain in hospitalized patients: A randomized comparative effectiveness trial. PLoS One 2019; 14:e0219115. [PMID: 31412029 PMCID: PMC6693733 DOI: 10.1371/journal.pone.0219115] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 06/06/2019] [Indexed: 12/15/2022] Open
Abstract
Objectives Therapeutic virtual reality (VR) has emerged as an effective, drug-free tool for pain management, but there is a lack of randomized, controlled data evaluating its effectiveness in hospitalized patients. We sought to measure the impact of on-demand VR versus “health and wellness” television programming for pain in hospitalized patients. Methods We performed a prospective, randomized, comparative effectiveness trial in hospitalized patients with an average pain score of ≥3 out of 10 points. Patients in the experimental group received a library of 21 VR experiences administered using the Samsung Gear Oculus headset; control patients viewed specialized television programming to promote health and wellness. Clinical staff followed usual care; study interventions were not protocolized. The primary outcome was patient-reported pain using a numeric rating scale, as recorded by nursing staff during usual care. Pre- and post-intervention pain scores were compared immediately after initial treatment and after 48- and 72-hours. Results There were 120 subjects (61 VR; 59 control). The mean within-subject difference in immediate pre- and post-intervention pain scores was larger in the VR group (-1.72 points; SD 3.56) than in the control group (-0.46 points; SD 3.01); this difference was significant in favor of VR (P < .04). When limited to the subgroup of patients with severe baseline pain (≥7 points), the effect of VR was more pronounced vs. control (-3.04, SD 3.75 vs. -0.93, SD 2.16 points; P = .02). In regression analyses adjusting for pre-intervention pain, time, age, gender, and type of pain, VR yielded a .59 (P = .03) and .56 (P = .04) point incremental reduction in pain versus control during the 48- and 72-hour post-intervention periods, respectively. Conclusions VR significantly reduces pain versus an active control condition in hospitalized patients. VR is most effective for severe pain. Future trials should evaluate standardized order sets that interpose VR as an early non-drug option for analgesia.
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Affiliation(s)
- Brennan Spiegel
- Cedars-Sinai Health System, Division of Health Services Research, Department of Medicine, Los Angeles, CA, United States of America
- Cedars-Sinai Graduate Program, Division of Health Delivery Science, Los Angeles, CA, United States of America
- * E-mail:
| | - Garth Fuller
- Cedars-Sinai Health System, Division of Health Services Research, Department of Medicine, Los Angeles, CA, United States of America
| | - Mayra Lopez
- Cedars-Sinai Health System, Division of Health Services Research, Department of Medicine, Los Angeles, CA, United States of America
| | - Taylor Dupuy
- Cedars-Sinai Health System, Division of Health Services Research, Department of Medicine, Los Angeles, CA, United States of America
| | - Benjamin Noah
- Cedars-Sinai Health System, Division of Health Services Research, Department of Medicine, Los Angeles, CA, United States of America
| | - Amber Howard
- Cedars-Sinai Health System, Division of Health Services Research, Department of Medicine, Los Angeles, CA, United States of America
| | - Michael Albert
- Cedars-Sinai Health System, Division of Health Services Research, Department of Medicine, Los Angeles, CA, United States of America
| | - Vartan Tashjian
- Cedars-Sinai Health System, Division of Health Services Research, Department of Medicine, Los Angeles, CA, United States of America
| | - Richard Lam
- Cedars-Sinai Health System, Division of Health Services Research, Department of Medicine, Los Angeles, CA, United States of America
| | - Joseph Ahn
- Cedars-Sinai Health System, Division of Health Services Research, Department of Medicine, Los Angeles, CA, United States of America
| | - Francis Dailey
- Cedars-Sinai Health System, Division of Health Services Research, Department of Medicine, Los Angeles, CA, United States of America
| | - Bradley T. Rosen
- Cedars-Sinai Health System, Division of Health Services Research, Department of Medicine, Los Angeles, CA, United States of America
- Inpatient Specialty Program, Cedars-Sinai Health System, Los Angeles, CA, United States of America
| | - Mark Vrahas
- Department of Orthopaedics, Cedars-Sinai Health System, Los Angeles, CA, United States of America
| | - Milton Little
- Department of Orthopaedics, Cedars-Sinai Health System, Los Angeles, CA, United States of America
| | - John Garlich
- Department of Orthopaedics, Cedars-Sinai Health System, Los Angeles, CA, United States of America
| | - Eldin Dzubur
- Cedars-Sinai Health System, Division of Health Services Research, Department of Medicine, Los Angeles, CA, United States of America
| | - Waguih IsHak
- Department of Psychiatry, Cedars-Sinai Health System, Los Angeles, CA, United States of America
| | - Itai Danovitch
- Department of Psychiatry, Cedars-Sinai Health System, Los Angeles, CA, United States of America
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Birckhead B, Khalil C, Liu X, Conovitz S, Rizzo A, Danovitch I, Bullock K, Spiegel B. Recommendations for Methodology of Virtual Reality Clinical Trials in Health Care by an International Working Group: Iterative Study. JMIR Ment Health 2019; 6:e11973. [PMID: 30702436 PMCID: PMC6374734 DOI: 10.2196/11973] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Therapeutic virtual reality (VR) has emerged as an efficacious treatment modality for a wide range of health conditions. However, despite encouraging outcomes from early stage research, a consensus for the best way to develop and evaluate VR treatments within a scientific framework is needed. OBJECTIVE We aimed to develop a methodological framework with input from an international working group in order to guide the design, implementation, analysis, interpretation, and communication of trials that develop and test VR treatments. METHODS A group of 21 international experts was recruited based on their contributions to the VR literature. The resulting Virtual Reality Clinical Outcomes Research Experts held iterative meetings to seek consensus on best practices for the development and testing of VR treatments. RESULTS The interactions were transcribed, and key themes were identified to develop a scientific framework in order to support best practices in methodology of clinical VR trials. Using the Food and Drug Administration Phase I-III pharmacotherapy model as guidance, a framework emerged to support three phases of VR clinical study designs-VR1, VR2, and VR3. VR1 studies focus on content development by working with patients and providers through the principles of human-centered design. VR2 trials conduct early testing with a focus on feasibility, acceptability, tolerability, and initial clinical efficacy. VR3 trials are randomized, controlled studies that evaluate efficacy against a control condition. Best practice recommendations for each trial were provided. CONCLUSIONS Patients, providers, payers, and regulators should consider this best practice framework when assessing the validity of VR treatments.
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Affiliation(s)
- Brandon Birckhead
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, United States
| | - Carine Khalil
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, United States.,Laboratoire Interdisciplinaire de Recherche Appliquée en Économie de la Santé, Paris Descartes University, Paris, France
| | - Xiaoyu Liu
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, United States.,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Samuel Conovitz
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, United States.,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Albert Rizzo
- Institute for Creative Technologies, University of Southern California, Los Angeles, CA, United States
| | - Itai Danovitch
- Department of Psychiatry, Cedars-Sinai Health System, Los Angeles, CA, United States
| | - Kim Bullock
- Department of Psychiatry, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Brennan Spiegel
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, United States.,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
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Lee CK, Melmed GY, Mann A, Danovitch I, Hedrick R, McGovern DPB, Targan S, Shih D, Vasiliauskas E, IsHak WW, Feldman E. A Multidisciplinary Approach to Biopsychosocial Care for Adults With Inflammatory Bowel Disease: A Pilot Study. Inflamm Bowel Dis 2018; 24:2550-2554. [PMID: 29920581 DOI: 10.1093/ibd/izy215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study reports on the logistics and feasibility of a novel multidisciplinary approach to biopsychosocial care at a tertiary adult inflammatory bowel disease (IBD) center. METHODS Consecutive patients referred for a new IBD consultation completed the following self-assessments: the Short Form-12, the Patient Reported Outcome Measurement Information System (PROMIS) Global Health Scale, the World Health Organization Disability Assessment Schedule 2.0, and the PROMIS-29. These measures were scored at the time of appointment check-in by a trained licensed clinical social worker (SW), and those scoring 1.5 standard deviations below the population mean were targeted for SW assessment and intervention at the point of care; patients or providers could also request a SW evaluation even if cutoffs were not met. In this stepped-care model, the SW could refer to same-day on-site psychiatry services or outside interventions and services. In addition, we implemented a 12-month curriculum with a monthly didactic and case-based education seminar for health care providers who interact with patients with IBD. RESULTS Between February 2014 and May 2015, 110 patients (53% male; mean age, 42 years) completed a self-assessment. All patients completed their self-assessment within 10 minutes. Of these, 36.4% (40/110) were targeted for SW assessment and intervention. The SW interventions were grouped into 4 categories: psychological education and coping tools for symptom management and emotional wellness (n = 30); psychotherapy referrals (n = 30); financial/governmental programs (n = 11); and psychiatry referrals for consultation and/or medication prescription (n = 21). The educational seminars were highly rated by participating providers. CONCLUSIONS A multidisciplinary biopsychosocial approach to adult IBD care is feasible. Education for providers and close coordination across specialties are critical to the success of a multidisciplinary biopsychosocial program.
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Affiliation(s)
- Chang Kyun Lee
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California.,Center for Crohn's and Colitis, Division of Gastroenterology, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Gil Y Melmed
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California
| | - Amy Mann
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California
| | - Itai Danovitch
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California
| | - Rebecca Hedrick
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California
| | - Dermot P B McGovern
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California
| | - Stephan Targan
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California
| | - David Shih
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California
| | - Eric Vasiliauskas
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California
| | - Waguih William IsHak
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward Feldman
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California
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Hassamal S, Miotto K, Dale W, Danovitch I. Tramadol: Understanding the Risk of Serotonin Syndrome and Seizures. Am J Med 2018; 131:1382.e1-1382.e6. [PMID: 29752906 DOI: 10.1016/j.amjmed.2018.04.025] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/02/2018] [Accepted: 04/02/2018] [Indexed: 11/19/2022]
Abstract
Tramadol is commonly prescribed for pain control because it presents a lower risk for addiction and respiratory depression compared to other opioids. However, tramadol's serotonin and norepinephrine reuptake inhibitory effects result in a unique adverse effect profile. Two such adverse events are serotonin syndrome and seizures. The prevalence of tramadol-induced serotonin syndrome and seizures is modest in the general population, but if left untreated, the morbidity and mortality can be high; therefore, prompt recognition and management is essential. Various risk factors such as medical comorbidities, use or abuse of supratherapeutic doses of tramadol, and concomitant administration of proconvulsant serotonergic cytochrome P-450 inhibitors will help clinicians identify individuals at an elevated risk for serotonin toxicity and seizures. Serotonin syndrome and seizures can be effectively treated by administering benzodiazepines, providing supportive care, and discontinuing tramadol and other contributing agents. Cyproheptadine should be administered in moderate to severe cases of serotonin syndrome. Our objective is to summarize the literature on the pharmacology, epidemiology, risk factors, clinical presentations, and evidence-based management of tramadol-related seizures and serotonin syndrome.
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Affiliation(s)
- Sameer Hassamal
- Department of Supportive Care Medicine, City of Hope, Duarte, Calif.
| | - Karen Miotto
- David Geffen School of Medicine at UCLA, Semel Institute of Neuroscience and Human Behavior, Los Angeles, Calif
| | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, Calif
| | - Itai Danovitch
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, Calif
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Bart R, Ishak WW, Ganjian S, Jaffer KY, Abdelmesseh M, Hanna S, Gohar Y, Azar G, Vanle B, Dang J, Danovitch I. The Assessment and Measurement of Wellness in the Clinical Medical Setting: A Systematic Review. Innov Clin Neurosci 2018; 15:14-23. [PMID: 30588362 PMCID: PMC6292717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We conducted a systematic review of the published literature relating to the assessment and measurement of wellness in order to answer the following questions: 1) What is the working definition of wellness? 2) What wellness assessment instruments have been evaluated or applied in medical settings? 3) How valid, reliable, and accessible are these wellness assessment tools? The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for this systematic review. Studies published from1990 to 2016 on wellness assessment were identified through Medline and PsycINFO using the following keywords: "assessment" OR "evaluation" OR "measurement" AND "wellness" OR "wellbeing." Two authors independently conducted a focused analysis then reached a consensus on 23 studies that met the specific selection criteria. This review revealed that there is a lack of uniform definition of wellness. The studies utilizing wellness assessment tools demonstrate strongest reliability values for the following instruments: Wellness Evaluation of Lifestyle, Five-factor Wellness Evaluation of Lifestyle, Perceived Wellness Survey, the Optimal Living Profile, and the Body-Mind-Spirit Wellness Behavior and Characteristic Inventory. However, there is insufficient evidence to support the clinical utility of a single particular wellness instrument. Properly defining wellness might help drive the development and validation of more precise assessment and measurement methods. This could reinforce interventions that promote wellness.
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Affiliation(s)
- Ryan Bart
- Dr. Bart is with Western University of Health Sciences and Cedars-Sinai Medical Center, in Los Angeles, California
- Drs. IsHak, Abdelmesseh, Vanle, Dang, and Danovitch and Mses. Ganjian, Abdelmesseh, and Gohar are with the Cedars-Sinai Medical Center, in Los Angeles, California
- Mr. Jaffer is a medical student at Faculty of Medicine Cairo University in Cairo, Egypt and Cedars-Sinai Medical Center, in Los Angeles, California
- Ms. Hanna is with California State University Long Beach, in Long Beach, California
- Ms. Azar is with Loma Linda University in Loma Linda, California
| | - Waguih William Ishak
- Dr. Bart is with Western University of Health Sciences and Cedars-Sinai Medical Center, in Los Angeles, California
- Drs. IsHak, Abdelmesseh, Vanle, Dang, and Danovitch and Mses. Ganjian, Abdelmesseh, and Gohar are with the Cedars-Sinai Medical Center, in Los Angeles, California
- Mr. Jaffer is a medical student at Faculty of Medicine Cairo University in Cairo, Egypt and Cedars-Sinai Medical Center, in Los Angeles, California
- Ms. Hanna is with California State University Long Beach, in Long Beach, California
- Ms. Azar is with Loma Linda University in Loma Linda, California
| | - Shaina Ganjian
- Dr. Bart is with Western University of Health Sciences and Cedars-Sinai Medical Center, in Los Angeles, California
- Drs. IsHak, Abdelmesseh, Vanle, Dang, and Danovitch and Mses. Ganjian, Abdelmesseh, and Gohar are with the Cedars-Sinai Medical Center, in Los Angeles, California
- Mr. Jaffer is a medical student at Faculty of Medicine Cairo University in Cairo, Egypt and Cedars-Sinai Medical Center, in Los Angeles, California
- Ms. Hanna is with California State University Long Beach, in Long Beach, California
- Ms. Azar is with Loma Linda University in Loma Linda, California
| | - Karim Yahia Jaffer
- Dr. Bart is with Western University of Health Sciences and Cedars-Sinai Medical Center, in Los Angeles, California
- Drs. IsHak, Abdelmesseh, Vanle, Dang, and Danovitch and Mses. Ganjian, Abdelmesseh, and Gohar are with the Cedars-Sinai Medical Center, in Los Angeles, California
- Mr. Jaffer is a medical student at Faculty of Medicine Cairo University in Cairo, Egypt and Cedars-Sinai Medical Center, in Los Angeles, California
- Ms. Hanna is with California State University Long Beach, in Long Beach, California
- Ms. Azar is with Loma Linda University in Loma Linda, California
| | - Marina Abdelmesseh
- Dr. Bart is with Western University of Health Sciences and Cedars-Sinai Medical Center, in Los Angeles, California
- Drs. IsHak, Abdelmesseh, Vanle, Dang, and Danovitch and Mses. Ganjian, Abdelmesseh, and Gohar are with the Cedars-Sinai Medical Center, in Los Angeles, California
- Mr. Jaffer is a medical student at Faculty of Medicine Cairo University in Cairo, Egypt and Cedars-Sinai Medical Center, in Los Angeles, California
- Ms. Hanna is with California State University Long Beach, in Long Beach, California
- Ms. Azar is with Loma Linda University in Loma Linda, California
| | - Sophia Hanna
- Dr. Bart is with Western University of Health Sciences and Cedars-Sinai Medical Center, in Los Angeles, California
- Drs. IsHak, Abdelmesseh, Vanle, Dang, and Danovitch and Mses. Ganjian, Abdelmesseh, and Gohar are with the Cedars-Sinai Medical Center, in Los Angeles, California
- Mr. Jaffer is a medical student at Faculty of Medicine Cairo University in Cairo, Egypt and Cedars-Sinai Medical Center, in Los Angeles, California
- Ms. Hanna is with California State University Long Beach, in Long Beach, California
- Ms. Azar is with Loma Linda University in Loma Linda, California
| | - Yasmine Gohar
- Dr. Bart is with Western University of Health Sciences and Cedars-Sinai Medical Center, in Los Angeles, California
- Drs. IsHak, Abdelmesseh, Vanle, Dang, and Danovitch and Mses. Ganjian, Abdelmesseh, and Gohar are with the Cedars-Sinai Medical Center, in Los Angeles, California
- Mr. Jaffer is a medical student at Faculty of Medicine Cairo University in Cairo, Egypt and Cedars-Sinai Medical Center, in Los Angeles, California
- Ms. Hanna is with California State University Long Beach, in Long Beach, California
- Ms. Azar is with Loma Linda University in Loma Linda, California
| | - Gezelle Azar
- Dr. Bart is with Western University of Health Sciences and Cedars-Sinai Medical Center, in Los Angeles, California
- Drs. IsHak, Abdelmesseh, Vanle, Dang, and Danovitch and Mses. Ganjian, Abdelmesseh, and Gohar are with the Cedars-Sinai Medical Center, in Los Angeles, California
- Mr. Jaffer is a medical student at Faculty of Medicine Cairo University in Cairo, Egypt and Cedars-Sinai Medical Center, in Los Angeles, California
- Ms. Hanna is with California State University Long Beach, in Long Beach, California
- Ms. Azar is with Loma Linda University in Loma Linda, California
| | - Brigitte Vanle
- Dr. Bart is with Western University of Health Sciences and Cedars-Sinai Medical Center, in Los Angeles, California
- Drs. IsHak, Abdelmesseh, Vanle, Dang, and Danovitch and Mses. Ganjian, Abdelmesseh, and Gohar are with the Cedars-Sinai Medical Center, in Los Angeles, California
- Mr. Jaffer is a medical student at Faculty of Medicine Cairo University in Cairo, Egypt and Cedars-Sinai Medical Center, in Los Angeles, California
- Ms. Hanna is with California State University Long Beach, in Long Beach, California
- Ms. Azar is with Loma Linda University in Loma Linda, California
| | - Jonathan Dang
- Dr. Bart is with Western University of Health Sciences and Cedars-Sinai Medical Center, in Los Angeles, California
- Drs. IsHak, Abdelmesseh, Vanle, Dang, and Danovitch and Mses. Ganjian, Abdelmesseh, and Gohar are with the Cedars-Sinai Medical Center, in Los Angeles, California
- Mr. Jaffer is a medical student at Faculty of Medicine Cairo University in Cairo, Egypt and Cedars-Sinai Medical Center, in Los Angeles, California
- Ms. Hanna is with California State University Long Beach, in Long Beach, California
- Ms. Azar is with Loma Linda University in Loma Linda, California
| | - Itai Danovitch
- Dr. Bart is with Western University of Health Sciences and Cedars-Sinai Medical Center, in Los Angeles, California
- Drs. IsHak, Abdelmesseh, Vanle, Dang, and Danovitch and Mses. Ganjian, Abdelmesseh, and Gohar are with the Cedars-Sinai Medical Center, in Los Angeles, California
- Mr. Jaffer is a medical student at Faculty of Medicine Cairo University in Cairo, Egypt and Cedars-Sinai Medical Center, in Los Angeles, California
- Ms. Hanna is with California State University Long Beach, in Long Beach, California
- Ms. Azar is with Loma Linda University in Loma Linda, California
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Vanle B, Olcott W, Jimenez J, Bashmi L, Danovitch I, IsHak WW. NMDA antagonists for treating the non-motor symptoms in Parkinson's disease. Transl Psychiatry 2018; 8:117. [PMID: 29907742 PMCID: PMC6003962 DOI: 10.1038/s41398-018-0162-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/13/2018] [Accepted: 04/21/2018] [Indexed: 12/02/2022] Open
Abstract
Among patients with Parkinson's disease (PD), depression is prevalent and disabling, impacting both health outcomes and quality of life. There is a critical need for alternative pharmacological methods to treat PD depression, as mainstream antidepressant drugs are largely ineffective in this population. Currently, there are no recommendations for the optimal treatment of PD neuropsychiatric symptoms. Given the dual antidepressant and anti-dyskinetic effects of ketamine and other N-methyl-D-aspartate (NMDA) antagonists for PD, this review aims to examine the current evidence of NMDA antagonists for treating neuropsychiatric symptoms, including memantine, amantadine, ketamine, dizoclopine, and d-cycloserine. A comprehensive literature search was conducted using the PubMed database. We also searched the following databases up to March 1, 2018: Ovid MEDLINE, PsycINFO, CINAHL, Google Scholar, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. The following keywords were used: NMDA antagonist and Parkinson's disease. Two authors independently reviewed the articles identified from the search using specific selection criteria, focusing on studies of mood, psychiatric condition, depression, cognition, and quality of life, and the consensus was reached on the 20 studies included. There is a preliminary evidence that NMDA antagonists may modulate psychiatric symptoms in PD. However, current evidence of psychiatric symptom-modifying effects is inconclusive and requires that further trials be conducted in PD. The repurposing of old NMDA antagonists, such as ketamine for depression and newer therapies, such as rapastinel, suggests that there is an emerging place for modulating the glutamatergic system for treating non-motor symptoms in PD.
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Affiliation(s)
- Brigitte Vanle
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Medical College of Wisconsin, Wausau, WI, USA.
| | - William Olcott
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jaime Jimenez
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Luma Bashmi
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Itai Danovitch
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Waguih William IsHak
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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22
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Mosher H, Herzig SJ, Danovitch I, Boutsicaris C, Hassamal S, Wittnebel K, Dashti A, Nuckols T. The Evaluation of Medical Inpatients Who Are Admitted on Long-term Opioid Therapy for Chronic Pain. J Hosp Med 2018; 13:249-255. [PMID: 29240853 DOI: 10.12788/jhm.2889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Individuals who are on long-term opioid therapy (LTOT) for chronic noncancer pain are frequently admitted to the hospital with acute pain, exacerbations of chronic pain, or comorbidities. Consequently, hospitalists find themselves faced with complex treatment decisions in the context of uncertainty about the effectiveness of LTOT as well as concerns about risks of overdose, opioid use disorders, and adverse events. Our multidisciplinary team sought to synthesize guideline recommendations and primary literature relevant to assessing medical inpatients on LTOT, with the objective of assisting practitioners in balancing effective pain treatment and opioid risk reduction. We identified no primary studies or guidelines specific to assessing medical inpatients on LTOT. Recommendations from outpatient guidelines on LTOT and guidelines on pain management in acute-care settings include the following: evaluate both pain and functional status, differentiate acute from chronic pain, investigate the preadmission course of opioid therapy, obtain a psychosocial history, screen for mental health conditions, screen for substance use disorders, check state prescription drug monitoring databases, order urine drug immunoassays, detect use of sedative-hypnotics, and identify medical conditions associated with increased risk of overdose and adverse events. Although approaches to assessing medical inpatients on LTOT can be extrapolated from related guidelines, observational studies, and small studies in surgical populations, more work is needed to address these critical topics for inpatients on LTOT.
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Affiliation(s)
- Hilary Mosher
- Department of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Iowa City VA Medical Center, Iowa City, Iowa, USA
| | - Shoshana J Herzig
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Itai Danovitch
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Christina Boutsicaris
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sameer Hassamal
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Karl Wittnebel
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Azadeh Dashti
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Teryl Nuckols
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
- RAND Corporation, Santa Monica, California, USA
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23
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Shapiro BB, Hedrick R, Vanle BC, Becker CA, Nguyen C, Underhill DM, Morgan MA, Kopple JD, Danovitch I, IsHak WW. Cryptococcal meningitis in a daily cannabis smoker without evidence of immunodeficiency. BMJ Case Rep 2018; 2018:bcr-2017-221435. [PMID: 29374632 DOI: 10.1136/bcr-2017-221435] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Cryptococcal meningitis is a life-threatening condition most commonly observed in immunocompromised individuals. We describe a daily cannabis smoker without evidence of immunodeficiency presenting with confirmed Cryptococcus neoformans meningitis. An investigation of cannabis samples from the patient's preferred dispensary demonstrated contamination with several varieties of Cryptococcus, including C. neoformans, and other opportunistic fungi. These findings raise concern regarding the safety of dispensary-grade cannabis, even in immunocompetent users.
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Affiliation(s)
- Bryan B Shapiro
- Department of Psychiatry and Human Behavior, UC Irvine Medical Center, Orange, California, USA.,Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Rebecca Hedrick
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Brigitte C Vanle
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Courtney A Becker
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Chris Nguyen
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - David M Underhill
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Margie A Morgan
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Joel D Kopple
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA.,David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Itai Danovitch
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Waguih William IsHak
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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IsHak WW, Steiner AJ, Klimowicz A, Kauzor K, Dang J, Vanle B, Elzahaby C, Reid M, Sumner L, Danovitch I. Major Depression Comorbid with Medical Conditions: Analysis of Quality of Life, Functioning, and Depressive Symptom Severity. Psychopharmacol Bull 2018; 48:8-25. [PMID: 29382957 PMCID: PMC5765436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The presence of Major Depressive Disorder (MDD) is often comorbid in patients with a variety of general medical conditions (GMCs) which could lead to less favorable outcomes. OBJECTIVE The goal of this analysis is to examine functional outcomes of QOL and functioning before and after antidepressant treatment among patients with MDD with and without GMCs. METHODS We performed a secondary analysis based on the STAR*D database. The analysis included two patient groups from the STAR*D trial: 1,198 patients comorbid with MDD and GMCs (MDD + GMC) and 1,082 patients with MDD and no GMCs (MDDnoGMC), as defined by the Cumulative Illness Rating Scale. We analyzed depressive symptom severity, functioning and quality of life (QOL) before and after level 1 treatment with citalopram. RESULTS At baseline, the MDD + GMC group had significantly lower QOL (p < 0.001) and functioning (p = 0.001) than the MDDnoGMC group, although depressive symptom severity was not significantly different. Following antidepressant treatment, QOL, functioning and depressive symptom severity significantly improved for both MDD + GMC and MDDnoGMC groups. However, patients with MDD + GMC were more likely to experience severe impairments in QOL in (56.8% vs. 43.5% for MDDnoGMC, p < 0.001) and functioning (42.5% vs. 29.3% for MDDnoGMC, p < 0.001) following treatment. The remission rate was significantly lower for MDD + GMC (30.6% vs. 41.1% for MDDnoGMC, p < 0.001). CONCLUSIONS Our findings suggest that antidepressant treatment had a positive impact on patients with and without GMCs. However, those with GMCs experienced not only a lower remission rate, but also continued to experience more significantly severe impairments in QOL and functioning.
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Affiliation(s)
- Waguih William IsHak
- Drs. IsHak, Dang, Vanle, Elzahaby, Reid, Sumner, Danovitch, and Ms. Klimowicz, Kauzor, Cedars-Sinai Medical Center, Los Angeles, California, USA. Dr. Steiner, University of California, Los Angeles, California, USA. Ms. Klimowicz, Western University of Health Sciences, California, USA. Ms. Kauzor, California State University, Northridge, California, USA
| | - Alexander J Steiner
- Drs. IsHak, Dang, Vanle, Elzahaby, Reid, Sumner, Danovitch, and Ms. Klimowicz, Kauzor, Cedars-Sinai Medical Center, Los Angeles, California, USA. Dr. Steiner, University of California, Los Angeles, California, USA. Ms. Klimowicz, Western University of Health Sciences, California, USA. Ms. Kauzor, California State University, Northridge, California, USA
| | - Anna Klimowicz
- Drs. IsHak, Dang, Vanle, Elzahaby, Reid, Sumner, Danovitch, and Ms. Klimowicz, Kauzor, Cedars-Sinai Medical Center, Los Angeles, California, USA. Dr. Steiner, University of California, Los Angeles, California, USA. Ms. Klimowicz, Western University of Health Sciences, California, USA. Ms. Kauzor, California State University, Northridge, California, USA
| | - Kaitlyn Kauzor
- Drs. IsHak, Dang, Vanle, Elzahaby, Reid, Sumner, Danovitch, and Ms. Klimowicz, Kauzor, Cedars-Sinai Medical Center, Los Angeles, California, USA. Dr. Steiner, University of California, Los Angeles, California, USA. Ms. Klimowicz, Western University of Health Sciences, California, USA. Ms. Kauzor, California State University, Northridge, California, USA
| | - Jonathan Dang
- Drs. IsHak, Dang, Vanle, Elzahaby, Reid, Sumner, Danovitch, and Ms. Klimowicz, Kauzor, Cedars-Sinai Medical Center, Los Angeles, California, USA. Dr. Steiner, University of California, Los Angeles, California, USA. Ms. Klimowicz, Western University of Health Sciences, California, USA. Ms. Kauzor, California State University, Northridge, California, USA
| | - Brigitte Vanle
- Drs. IsHak, Dang, Vanle, Elzahaby, Reid, Sumner, Danovitch, and Ms. Klimowicz, Kauzor, Cedars-Sinai Medical Center, Los Angeles, California, USA. Dr. Steiner, University of California, Los Angeles, California, USA. Ms. Klimowicz, Western University of Health Sciences, California, USA. Ms. Kauzor, California State University, Northridge, California, USA
| | - Christina Elzahaby
- Drs. IsHak, Dang, Vanle, Elzahaby, Reid, Sumner, Danovitch, and Ms. Klimowicz, Kauzor, Cedars-Sinai Medical Center, Los Angeles, California, USA. Dr. Steiner, University of California, Los Angeles, California, USA. Ms. Klimowicz, Western University of Health Sciences, California, USA. Ms. Kauzor, California State University, Northridge, California, USA
| | - Mark Reid
- Drs. IsHak, Dang, Vanle, Elzahaby, Reid, Sumner, Danovitch, and Ms. Klimowicz, Kauzor, Cedars-Sinai Medical Center, Los Angeles, California, USA. Dr. Steiner, University of California, Los Angeles, California, USA. Ms. Klimowicz, Western University of Health Sciences, California, USA. Ms. Kauzor, California State University, Northridge, California, USA
| | - Lekeisha Sumner
- Drs. IsHak, Dang, Vanle, Elzahaby, Reid, Sumner, Danovitch, and Ms. Klimowicz, Kauzor, Cedars-Sinai Medical Center, Los Angeles, California, USA. Dr. Steiner, University of California, Los Angeles, California, USA. Ms. Klimowicz, Western University of Health Sciences, California, USA. Ms. Kauzor, California State University, Northridge, California, USA
| | - Itai Danovitch
- Drs. IsHak, Dang, Vanle, Elzahaby, Reid, Sumner, Danovitch, and Ms. Klimowicz, Kauzor, Cedars-Sinai Medical Center, Los Angeles, California, USA. Dr. Steiner, University of California, Los Angeles, California, USA. Ms. Klimowicz, Western University of Health Sciences, California, USA. Ms. Kauzor, California State University, Northridge, California, USA
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25
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Steiner AJ, Recacho J, Vanle B, Dang J, Wright SM, Miller JS, Kauzor K, Reid M, Bashmi LE, Mirocha J, Danovitch I, IsHak WW. Quality of Life, Functioning, and Depressive Symptom Severity in Older Adults With Major Depressive Disorder Treated With Citalopram in the STAR*D Study. J Clin Psychiatry 2017; 78:897-903. [PMID: 28858443 DOI: 10.4088/jcp.16m11335] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/17/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Major depressive disorder (MDD) can substantially worsen patient-reported quality of life (QOL) and functioning. Prior studies have examined the role of age in MDD by comparing depressive symptom severity or remission rates between younger and older adults. This study examines these outcomes before and after SSRI treatment. On the basis of prior research, we hypothesized that older adults would have worse treatment outcomes in QOL, functioning, and depressive symptom severity and that nonremitters would have worse outcomes. METHODS A retrospective secondary data analysis was conducted from the National Institute of Mental Health-funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (July 2001-September 2006). We analyzed data for 2,280 nonpsychotic adults with DSM-IV-TR-defined MDD who received citalopram monotherapy. Older adults were classified as adults aged 65 years and above. All subjects completed patient-reported QOL, functioning, and depressive symptom severity measures at entry and exit. Subjects included 106 older adults and 2,174 adults < 65. MDD remission status posttreatment was also determined. RESULTS Both older adults and adults < 65 experienced significant improvements and medium to large treatment responses across QOL, functioning, and depressive symptom severity (P < .001). Older adults had smaller treatment effect sizes for all outcomes, particularly functioning. Conversely, mean change scores from entry to exit were equivalent across all outcomes. Remitters at exit had significantly better responses to treatment than nonremitters for the majority of outcomes. CONCLUSION Findings suggest that older adults and younger adults have comparable treatment responses to citalopram monotherapy, with significant improvements in patient-reported depressive symptom severity, functioning, and QOL. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00021528.
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Affiliation(s)
- Alexander J Steiner
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jennifer Recacho
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Brigitte Vanle
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jonathan Dang
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Stephanie M Wright
- Department of Pediatrics, Children's Hospital, Los Angeles, California, USA
| | - Justin S Miller
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kaitlyn Kauzor
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mark Reid
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Luma E Bashmi
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - James Mirocha
- Biostatistics Core, Research Institute and Clinical & Translational Science Institute (CTSI), Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Itai Danovitch
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Waguih William IsHak
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, 8730 Alden Dr, Thalians E-132, Los Angeles, CA 90048. .,Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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26
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Jaffer KY, Chang T, Vanle B, Dang J, Steiner AJ, Loera N, Abdelmesseh M, Danovitch I, Ishak WW. Trazodone for Insomnia: A Systematic Review. Innov Clin Neurosci 2017; 14:24-34. [PMID: 29552421 PMCID: PMC5842888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE: While trazodone is approved for the treatment of depression, the off-label use of this medication for insomnia has surpassed its usage as an antidepressant. In this systematic review, we examined the evidence for the efficacy and safety of trazodone for insomnia. METHODS: A literature search was conducted using MEDLINE/PubMed databases from the past 33 years (1983-2016) and the keywords insomnia, trazodone, sedative, treatment, and hypnotics. The results were restricted to English language and human subjects. All randomized clinical trials, meta-analyses, observational studies, and placebo-controlled trials regarding trazodone for the treatment of primary or secondary insomnia were reported, per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The study selection process yielded a total of 45 studies. RESULTS: Evidence for the efficacy of trazodone has been repeatedly demonstrated for primary insomnia, as well as secondary insomnia, including for symptoms that are a result of depression, dementia, and being a healthy man. Earlier studies (1980-2000) focused on utilizing trazodone at high doses (≥100mg/d) for the treatment of insomnia among the depressed population; however, since the 2000s, the utility of trazodone has been expanded to treat secondary insomnia among the non-depressed population as well. The side effects are dose-dependent, and the most common is drowsiness. CONCLUSION: A review of the literature suggests that there are adequate data supporting the efficacy and general safety of the low-dose use of trazodone for the treatment of insomnia.
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Affiliation(s)
- Karim Yahia Jaffer
- Mr. Jaffer is with the Faculty of Medicine, Cairo University, Egypt. Ms. Chang is with the University of California Los Angeles, Los Angeles, California. Dr. Vanle, Dr. Dang, Ms. Loera, Dr. Abdelmesseh, and Dr. Danovitch are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California. Dr. Steiner is with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California. Dr. IsHak is with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Tiffany Chang
- Mr. Jaffer is with the Faculty of Medicine, Cairo University, Egypt. Ms. Chang is with the University of California Los Angeles, Los Angeles, California. Dr. Vanle, Dr. Dang, Ms. Loera, Dr. Abdelmesseh, and Dr. Danovitch are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California. Dr. Steiner is with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California. Dr. IsHak is with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Brigitte Vanle
- Mr. Jaffer is with the Faculty of Medicine, Cairo University, Egypt. Ms. Chang is with the University of California Los Angeles, Los Angeles, California. Dr. Vanle, Dr. Dang, Ms. Loera, Dr. Abdelmesseh, and Dr. Danovitch are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California. Dr. Steiner is with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California. Dr. IsHak is with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Jonathan Dang
- Mr. Jaffer is with the Faculty of Medicine, Cairo University, Egypt. Ms. Chang is with the University of California Los Angeles, Los Angeles, California. Dr. Vanle, Dr. Dang, Ms. Loera, Dr. Abdelmesseh, and Dr. Danovitch are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California. Dr. Steiner is with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California. Dr. IsHak is with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Alexander J Steiner
- Mr. Jaffer is with the Faculty of Medicine, Cairo University, Egypt. Ms. Chang is with the University of California Los Angeles, Los Angeles, California. Dr. Vanle, Dr. Dang, Ms. Loera, Dr. Abdelmesseh, and Dr. Danovitch are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California. Dr. Steiner is with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California. Dr. IsHak is with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Natalie Loera
- Mr. Jaffer is with the Faculty of Medicine, Cairo University, Egypt. Ms. Chang is with the University of California Los Angeles, Los Angeles, California. Dr. Vanle, Dr. Dang, Ms. Loera, Dr. Abdelmesseh, and Dr. Danovitch are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California. Dr. Steiner is with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California. Dr. IsHak is with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Marina Abdelmesseh
- Mr. Jaffer is with the Faculty of Medicine, Cairo University, Egypt. Ms. Chang is with the University of California Los Angeles, Los Angeles, California. Dr. Vanle, Dr. Dang, Ms. Loera, Dr. Abdelmesseh, and Dr. Danovitch are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California. Dr. Steiner is with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California. Dr. IsHak is with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Itai Danovitch
- Mr. Jaffer is with the Faculty of Medicine, Cairo University, Egypt. Ms. Chang is with the University of California Los Angeles, Los Angeles, California. Dr. Vanle, Dr. Dang, Ms. Loera, Dr. Abdelmesseh, and Dr. Danovitch are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California. Dr. Steiner is with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California. Dr. IsHak is with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Waguih William Ishak
- Mr. Jaffer is with the Faculty of Medicine, Cairo University, Egypt. Ms. Chang is with the University of California Los Angeles, Los Angeles, California. Dr. Vanle, Dr. Dang, Ms. Loera, Dr. Abdelmesseh, and Dr. Danovitch are with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California. Dr. Steiner is with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California. Dr. IsHak is with the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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Goldenberg M, Reid MW, IsHak WW, Danovitch I. The impact of cannabis and cannabinoids for medical conditions on health-related quality of life: A systematic review and meta-analysis. Drug Alcohol Depend 2017; 174:80-90. [PMID: 28319753 DOI: 10.1016/j.drugalcdep.2016.12.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/17/2016] [Accepted: 12/19/2016] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The use of cannabis or cannabinoids to treat medical conditions and/or alleviate symptoms is increasingly common. However, the impact of this use on patient reported outcomes, such as health-related quality of life (HRQoL), remains unclear. METHODS We conducted a systematic review and meta-analysis, employing guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We categorized studies based on design, targeted disease condition, and type of cannabis or cannabinoid used. We scored studies based on quality and risk of bias. After eliminating some studies because of poor quality or insufficient data, we conducted meta-analyses of remaining studies based on design. RESULTS Twenty studies met our pre-defined selection criteria. Eleven studies were randomized controlled trials (RCTs; 2322 participants); the remaining studies were of cohort and cross-sectional design. Studies of cannabinoids were mostly RCTs of higher design quality than studies of cannabis, which utilized smaller self-selected samples in observational studies. Although we did not uncover a significant association between cannabis and cannabinoids for medical conditions and HRQoL, some patients who used them to treat pain, multiple sclerosis, and inflammatory bower disorders have reported small improvements in HRQoL, whereas some HIV patients have reported reduced HRQoL. CONCLUSION The relationship between HRQoL and the use of cannabis or cannabinoids for medical conditions is inconclusive. Some patient populations report improvements whereas others report reductions in HRQoL. In order to inform users, practitioners, and policymakers more clearly, future studies should adhere to stricter research quality guidelines and more clearly report patient outcomes.
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Affiliation(s)
| | | | - Waguih William IsHak
- Cedars-Sinai Medical Center, Los Angeles, CA, United States; David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
| | - Itai Danovitch
- Cedars-Sinai Medical Center, Los Angeles, CA, United States
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Tashjian VC, Mosadeghi S, Howard AR, Lopez M, Dupuy T, Reid M, Martinez B, Ahmed S, Dailey F, Robbins K, Rosen B, Fuller G, Danovitch I, IsHak W, Spiegel B. Virtual Reality for Management of Pain in Hospitalized Patients: Results of a Controlled Trial. JMIR Ment Health 2017; 4:e9. [PMID: 28356241 PMCID: PMC5390112 DOI: 10.2196/mental.7387] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 02/16/2017] [Accepted: 02/21/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Improvements in software and design and reduction in cost have made virtual reality (VR) a practical tool for immersive, three-dimensional (3D), multisensory experiences that distract patients from painful stimuli. OBJECTIVE The objective of the study was to measure the impact of a onetime 3D VR intervention versus a two-dimensional (2D) distraction video for pain in hospitalized patients. METHODS We conducted a comparative cohort study in a large, urban teaching hospital in medical inpatients with an average pain score of ≥3/10 from any cause. Patients with nausea, vomiting, dementia, motion sickness, stroke, seizure, and epilepsy and those placed in isolation were excluded. Patients in the intervention cohort viewed a 3D VR experience designed to reduce pain using the Samsung Gear Oculus VR headset; control patients viewed a high-definition, 2D nature video on a 14-inch bedside screen. Pre- and postintervention pain scores were recorded. Difference-in-difference scores and the proportion achieving a half standard deviation pain response were compared between groups. RESULTS There were 50 subjects per cohort (N=100). The mean pain reduction in the VR cohort was greater than in controls (-1.3 vs -0.6 points, respectively; P=.008). A total of 35 (65%) patients in the VR cohort achieved a pain response versus 40% of controls (P=.01; number needed to treat=4). No adverse events were reported from VR. CONCLUSIONS Use of VR in hospitalized patients significantly reduces pain versus a control distraction condition. These results indicate that VR is an effective and safe adjunctive therapy for pain management in the acute inpatient setting; future randomized trials should confirm benefit with different visualizations and exposure periods. TRIAL REGISTRATION Clinicaltrials.gov NCT02456987; https://clinicaltrials.gov/ct2/show/NCT02456987 (Archived by WebCite at http://www.webcitation.org/6pJ1P644S).
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Affiliation(s)
- Vartan C Tashjian
- Cedars-Sinai Medical Center, Health Services Research, Los Angeles,CA, CA, United States
| | - Sasan Mosadeghi
- Cedars-Sinai Medical Center, Health Services Research, Los Angeles,CA, CA, United States
| | - Amber R Howard
- Cedars-Sinai Medical Center, Health Services Research, Los Angeles,CA, CA, United States
| | - Mayra Lopez
- Cedars-Sinai Medical Center, Health Services Research, Los Angeles,CA, CA, United States
| | - Taylor Dupuy
- Cedars-Sinai Medical Center, Health Services Research, Los Angeles,CA, CA, United States
| | - Mark Reid
- Cedars-Sinai Medical Center, Health Services Research, Los Angeles,CA, CA, United States
| | - Bibiana Martinez
- Cedars-Sinai Medical Center, Health Services Research, Los Angeles,CA, CA, United States
| | - Shahzad Ahmed
- Cedars-Sinai Medical Center, Health Services Research, Los Angeles,CA, CA, United States
| | - Francis Dailey
- Cedars-Sinai Medical Center, Health Services Research, Los Angeles,CA, CA, United States
| | - Karen Robbins
- Cedars-Sinai Medical Center, Health Services Research, Los Angeles,CA, CA, United States
| | - Bradley Rosen
- Cedars-Sinai Medical Center, Health Services Research, Los Angeles,CA, CA, United States
| | - Garth Fuller
- Cedars-Sinai Medical Center, Health Services Research, Los Angeles,CA, CA, United States
| | - Itai Danovitch
- Cedars-Sinai Medical Center, Health Services Research, Los Angeles,CA, CA, United States
| | - Waguih IsHak
- Cedars-Sinai Medical Center, Health Services Research, Los Angeles,CA, CA, United States
| | - Brennan Spiegel
- Cedars-Sinai Medical Center, Health Services Research, Los Angeles,CA, CA, United States
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Danovitch I, Kan D. The Addiction Benefits Scorecard: A Framework to Promote Health Insurer Accountability and Support Consumer Engagement. J Psychoactive Drugs 2017; 49:122-131. [DOI: 10.1080/02791072.2017.1296210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Itai Danovitch
- Chairman and Associate Professor, Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David Kan
- Assistant Clinical Professor, Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA
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IsHak WW, Collison K, Danovitch I, Shek L, Kharazi P, Kim T, Jaffer KY, Naghdechi L, Lopez E, Nuckols T. Screening for depression in hospitalized medical patients. J Hosp Med 2017; 12:118-125. [PMID: 28182810 DOI: 10.12788/jhm.2693] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Depression among hospitalized patients is often unrecognized, undiagnosed, and therefore untreated. Little is known about the feasibility of screening for depression during hospitalization, or whether depression is associated with poorer outcomes, longer hospital stays, and higher readmission rates. We searched PubMed and PsycINFO for published, peer-reviewed articles in English (1990-2016) using search terms designed to capture studies that tested the performance of depression screening tools in inpatient settings and studies that examined associations between depression detected during hospitalization and clinical or utilization outcomes. Two investigators reviewed each full-text article and extracted data. The prevalence of depression ranged from 5% to 60%, with a median of 33%, among hospitalized patients. Several screening tools identified showed high sensitivity and specificity, even when self-administered by patients or when abbreviated versions were administered by individuals without formal training. With regard to outcomes, studies from several individual hospitals found depression to be associated with poorer functional outcomes, worse physical health, and returns to the hospital after discharge. These findings suggest that depression screening may be feasible in the inpatient setting, and that more research is warranted to determine whether screening for and treating depression during hospitalization can improve patient outcomes. Journal of Hospital Medicine 2017;12:118-125.
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Affiliation(s)
- Waguih William IsHak
- Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences, Los Angeles, CA, USA
- Cedars-Sinai Medical Center, Department of Health Sciences, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Katherine Collison
- Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences, Los Angeles, CA, USA
- Purdue University, West Lafayette, Indiana, USA
| | - Itai Danovitch
- Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences, Los Angeles, CA, USA
| | - Lili Shek
- Cedars-Sinai Medical Center, Department of Internal Medicine, Los Angeles, CA, USA
| | - Payam Kharazi
- Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences, Los Angeles, CA, USA
| | - Tae Kim
- Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences, Los Angeles, CA, USA
- Western University, Los Angeles, CA, USA
| | - Karim Y Jaffer
- Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences, Los Angeles, CA, USA
- Cairo University School of Medicine, Cairo, Egypt, USA
| | - Lancer Naghdechi
- Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences, Los Angeles, CA, USA
- Western University, Los Angeles, CA, USA
| | - Enrique Lopez
- Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences, Los Angeles, CA, USA
| | - Teryl Nuckols
- Cedars-Sinai Medical Center, Division of General Internal Medicine, Los Angeles, CA, USA
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Dascal J, Reid M, IsHak WW, Spiegel B, Recacho J, Rosen B, Danovitch I. Virtual Reality and Medical Inpatients: A Systematic Review of Randomized, Controlled Trials. Innov Clin Neurosci 2017; 14:14-21. [PMID: 28386517 PMCID: PMC5373791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objective: We evaluated the evidence supporting the use of virtual reality among patients in acute inpatient medical settings. Method: We conducted a systematic review of randomized controlled trials conducted that examined virtual reality applications in inpatient medical settings between 2005 and 2015. We used PsycINFO, PubMed, and Medline databases to identify studies using the keywords virtual reality, VR therapy, treatment, and inpatient.Results: We identified 2,024 citations, among which 11 met criteria for inclusion. Studies addressed three general areas: pain management, eating disorders, and cognitive and motor rehabilitation. Studies were small and heterogeneous and utilized different designs and measures. Virtual reality was generally well tolerated by patients, and a majority of studies demonstrated clinical efficacy. Studies varied in quality, as measured by an evaluation metric developed by Reisch, Tyson, and Mize (average quality score=0.87; range=0.78-0.96). Conclusion: Virtual reality is a promising intervention with several potential applications in the inpatient medical setting. Studies to date demonstrate some efficacy, but there is a need for larger, well-controlled studies to show clinical and cost-effectiveness.
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Affiliation(s)
- Julieta Dascal
- All authors are from Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences in Los Angeles, California
| | - Mark Reid
- All authors are from Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences in Los Angeles, California
| | - Waguih William IsHak
- All authors are from Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences in Los Angeles, California
| | - Brennan Spiegel
- All authors are from Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences in Los Angeles, California
| | - Jennifer Recacho
- All authors are from Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences in Los Angeles, California
| | - Bradley Rosen
- All authors are from Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences in Los Angeles, California
| | - Itai Danovitch
- All authors are from Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences in Los Angeles, California
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Goldenberg M, IsHak WW, Danovitch I. Quality of life and recreational cannabis use. Am J Addict 2016; 26:8-25. [PMID: 28000973 DOI: 10.1111/ajad.12486] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/28/2016] [Accepted: 12/04/2016] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Cannabis is now the most commonly used illicit drug in the United States and use is increasing. Frequent cannabis use has been associated with adverse social and health effects. We sought to evaluate the relationship between recreational cannabis use and Quality of Life (QoL), a person-centered measure that characterizes the overall sense of health and wellbeing. We hypothesized that QoL would be unchanged or increased among recreational cannabis users, who did not meet criteria for a Cannabis Use Disorder (CUD) and that QoL would be lower among those who met criteria for a CUD. METHODS We conducted a systematic review, employing guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The results were categorized into tables and identified trends. RESULTS Fourteen studies met our pre-defined selection criteria. The studies were heterogeneous and their quality was low. With one exception, we did not identify any population for whom cannabis use was associated with improved QoL. QoL was lower in persons who used cannabis heavily, or who met criteria for CUD. However, this association was inconsistent and the magnitude was weaker than the relationship between QoL and use of other addictive substances (including tobacco and illicit drugs). CONCLUSION In this systematic review, heavy cannabis use or CUD was associated with reduced QoL. It is unknown whether reduced QoL drives cannabis use, or whether cannabis use can lead to reduced QoL. Prospective studies are needed to evaluate the causal relationship between cannabis and QoL. SCIENTIFIC SIGNIFICANCE Furthering the understanding of the relationship between cannabis and QoL can inform public policy, prevention efforts, outcomes, and an objective understanding of the effects of cannabis users. (Am J Addict 2017;26:8-25).
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Affiliation(s)
| | - Waguih William IsHak
- Cedars-Sinai Medical Center, Los Angeles, California.,Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California
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Goldenberg M, Hassamal S, IsHak WW, Haglund M, Miotto K, Danovitch I. A Call to Action: The Active Role Psychiatrists and the DEA Must Take to Decrease Harm from Psychotropic Drugs Acquired via the Internet. J Clin Psychiatry 2016; 77:e1495. [PMID: 28076677 DOI: 10.4088/jcp.15cr10606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Matthew Goldenberg
- Department of Psychiatry, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Sameer Hassamal
- Department of Psychiatry, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Waguih William IsHak
- .,Department of Psychiatry, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Margaret Haglund
- Department of Psychiatry, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Karen Miotto
- Department of Psychiatry, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Itai Danovitch
- Department of Psychiatry, Cedars Sinai Medical Center, Los Angeles, California, USA
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Hassamal S, Haglund M, Wittnebel K, Danovitch I. A preoperative interdisciplinary biopsychosocial opioid reduction program in patients on chronic opioid analgesia prior to spine surgery: A preliminary report and case series. Scand J Pain 2016; 13:27-31. [DOI: 10.1016/j.sjpain.2016.06.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 12/21/2022]
Abstract
Abstract
Background
Spine surgery candidates are commonly treated with long-term opioid analgesia. However, chronic opioid analgesia is associated with poor pain control, psychological distress, decreased functional status and operative complications. Therefore, our medical centre piloted an outpatient biopsychosocial interdisciplinary opioid reduction program for spine surgery candidates on chronic opioid analgesia.
Methods
Our case series reviews the outcomes of the first 5 interdisciplinary program completers. Data was collected on admission to the program, preoperatively at completion of the program, and 1 month postoperatively. We recorded changes in pain interference scores, physical functioning, and symptoms of depression and anxiety as captured by the Patient-Reported Outcome Measurement Information System (PROMIS-29) Profile.
Results
The mean duration of the preoperative opioid reduction program was 6–7 weeks. The mean morphine equivalent daily dose (SD) decreased from 238.2 (226.9) mg on admission to 157.1 (161.0) mg preoperatively and 139.1 (84.0) mg one month postoperatively. Similarly, the mean pain interference score (SD) decreased from 72.4 (5.1) on admission to 66.5 (6.9) preoperatively and 67.7 (5.4) one month postoperatively. The preoperative opioid dose and pain interference scores decreased in all 5 patients, but one month postoperatively increased in one patient related to a surgical complication. Pre- and postoperative depression, anxiety and fatigue improved in all patients. Satisfaction with participation in social roles, sleep disturbances, and physical functioning improved in most patients.
Conclusions
Pre- and post-operative pain improved despite the opioid dose being tapered. These preliminary data suggest that a short-term outpatient preoperative interdisciplinary biopsychosocial opioid reduction program is safe, feasible, and improves patient-centred outcomes.
Implications
Our preliminary data support the rationale for expansion of the opioid reduction program; opioid use and pain should be evaluated in all surgical candidates. These findings need to be replicated in larger studies.
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Affiliation(s)
- Sameer Hassamal
- Department of Addiction Psychiatry , University of California Los Angeles/Kern Medical , Bakersfield, CA , United States
- Department of Psychiatry and Neurology , University of California Riverside , Riverside, CA , United States
| | - Margaret Haglund
- Department of Psychiatry and Behavioral Neurosciences , Cedars-Sinai Medical Center , Los Angeles, CA , United States
| | - Karl Wittnebel
- Department of Internal Medicine , Cedars-Sinai Medical Center , Los Angeles, CA , United States
| | - Itai Danovitch
- Department of Psychiatry and Behavioral Neurosciences , Cedars-Sinai Medical Center , Los Angeles, CA , United States
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Abstract
Post-traumatic stress disorder is highly prevalent among individuals who suffer from opioid use disorder. Compared to individuals with opioid use disorder alone, those with post-traumatic stress disorder have a worse course of illness, occupational functioning, and physical health. The neurobiological pathways underlying each disorder overlap substantially, and there are multiple pathways through which these disorders may interact. This narrative review explores evidence underpinning 3 explanatory perspectives on comorbid post-traumatic stress disorder and opioid use disorder: The opioid susceptibility model (a.k.a.: the Self-Medication Hypothesis), the post-traumatic stress disorder susceptibility model, and the common factors model. Diagnostic implications, treatment implications, and directions for future research are discussed.
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Affiliation(s)
- Itai Danovitch
- a Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center , Los Angeles , California , USA
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Maher DP, Kissen M, Danovitch I, Yumul R, Louy C. Perioperative substance use disorder, opioid diversion, and opioid misuse by a medical professional undergoing orthopedic surgery. J Opioid Manag 2014; 10:437-440. [PMID: 25531961 DOI: 10.5055/jom.2014.0240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 10/16/2014] [Accepted: 11/03/2014] [Indexed: 06/04/2023]
Abstract
Patients with substance use disorders can present challenges for effective perioperative pain management. Healthcare professionals with substance abuse disorders requiring medical treatment and pain management represent a unique subpopulation. The authors present a case of a nurse undergoing an orthopedic surgical procedure who was found with two large, organized tackle boxes of opioid medication in her hospital room. Although the incidence of substance use disorders in healthcare professionals is thought to be equivalent to the general population, the presentation, substances of choice, and inciting factors are unique. Further, treatment options available to such individuals have been established and proven successful.
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Affiliation(s)
- Dermot P Maher
- Resident, Department of Anesthesia and Pain Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Michael Kissen
- Resident, Department of Anesthesia and Pain Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Itai Danovitch
- Chairman, Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Roya Yumul
- Program Director, Department of Anesthesia and Pain Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Charles Louy
- Director, Inpatient Pain Services, Department of Anesthesia, Cedars-Sinai Medical Center, Los Angeles, California
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Affiliation(s)
| | - Itai Danovitch
- Cedars-Sinai Medical Center; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Waguih William IsHak
- Cedars-Sinai Medical Center; David Geffen School of Medicine at UCLA; Los Angeles California
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Abstract
Within the United States there exists a profound discrepancy between the significant public health problem of substance abuse and the access to treatment for addicted individuals. Part of the insufficient access to treatment is a function of relatively low levels or professional experts in addiction medicine. Part of the low levels of professional addiction experts is the result of inadequate addiction medicine training of medical students and residents. This article outlines deficits in addiction medicine training among medical students and residents, yet real change in the addiction medicine training process will always be subject to the complexity of producing alterations across multiple credentialing institutions as well as the keen competition between educators for “more time” for their particular subject. Other hurdles include the broad-based issue of stigma regarding alcoholism and other substance abuse that likely impact all systems that regulate physician addiction medicine training. As noted in the discussion of psychiatry residency, even psychiatry residents manifest stigma regarding substance abusing patients. Five currently active processes may allow for fundamental change to the inertia in physician addiction medicine training while also potentially impacting stigma: 1. We appear to be at the beginning of the integration of addiction into traditional medicine through the formation of a legitimized addiction medicine subspecialty. 2. The training of primary care trainees and practitioners in the use of SBIRT is accelerating, thus creating another process of addiction integration into traditional medicine. 3. The PCMH is being established as a model for primary care 4. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) became effective for group health care plan years beginning on or after July 1, 2010; thereby, substance abuse benefits and cost are to be the same as general medical or surgical benefits. 5. The equalizer is prescription drug abuse, which is increasing recognition of addiction among populations where it was previously ignored or denied. The first three activities will create a medical office “experience” that is largely unknown but carries the power to change the perception of addiction: patients visiting their primary care physicians, who then screen them for addiction problems and give the same attention to treatment and prevention of addiction problems as they might give to treatment and prevention of cardiovascular disease and other medical issues. The personal experience of the aforementioned medical scene by members of US society may also provide a very positive impact on psychiatrists, including those who specialize in addiction medicine. It is quite possible that the recognition of addiction medicine as a traditional medical subspecialty as well as the integration of addiction throughout medicine will precede any substantive change in the integration of mental health care with the rest of medicine. Yet, any integration of addiction within the entire field of medicine may open a path for mental health to follow. Psychiatrists, including those who are addiction experts, need to be a part of this new medical integration process. Being a part of new treatment models is why we proposed six future skillsets for psychiatrists who specialize in addiction. The selection of these proposed skillsets anticipates an integrated health care team utilizing some form of a patient-centered approach-three are skillsets that are already required, while the last three address new skillsets that will be helpful in working with the integrative health care team model. Whatever form the future of addiction care takes, psychiatrists who specialize in addiction medicine can provide positive and core contributions as expert addiction and mental health consultants including: 1. How does one screen for major depression and/or an anxiety disorder and also determine a diagnosis? 2. In prescribing, what constitutes legitimate follow-up of patients on antidepressants and antianxiety agents, including how to avoid additional substance abuse problems when prescribing sedative-hypnotics? 3. When and how should patients be referred to a psychiatrist? Finally, it is important to note that any of the potential changes described in this article need to influence only 10% of the approximately 17 million current heavy drinkers to seek treatment to equal the approximately 1.7 million heavy drinkers who are now in treatment, let alone any of the approximately 50 million current at-risk drinkers, virtually none of whom are in treatment. Among other social changes that will alter the future of addiction treatment, the integration of addiction into traditional medicine may go a long way in altering the current ratios of who seeks treatment and is willing to participate in treatment.
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Affiliation(s)
- Ernest Rasyidi
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
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Danovitch I, Mariani JJ. Expanding treatment potential for substance use disorders. Psychiatr Clin North Am 2012; 35:xiii-xiv. [PMID: 22640770 DOI: 10.1016/j.psc.2012.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Itai Danovitch
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
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Abstract
The treatment of cannabis dependence can be viewed as a cup half empty or half full. On the one hand, few people who might benefit from treatment actually receive it. Among those who undergo treatment in randomized trials, long-term abstinence is achieved by fewer than 20%. Moderate use goals have been associated with decreases in consequences, but the differential impact of such goals on the long-term course of cannabis dependence is unknown. Optimal duration of treatment is unclear, and certain populations, particularly patients with co-occurring disorders, have not been studied adequately. Twelve-step programs are low cost, effective for other substance use disorders, and readily available in most regions of the world. However, their role and efficacy in cannabis dependence has not been examined. Finally, effective pharmacologic treatments are under development, but none have yet been firmly established. On the other hand, psychotherapeutic strategies used to treat other substance use disorders can be effective for cannabis dependence. A recent meta-analysis of psychosocial interventions for illicit substance use disorders found that treatments for cannabis dependence had comparatively larger effect sizes than treatments for other substance use disorders. Combination therapies have proven most effective, particularly those that begin with a motivational intervention, utilize incentives to enhance the commitment to change, and teach behavioral and cognitive copings skills to prevent relapse. Among adolescents, family engagement and collaboration with community stakeholders adds substantial value. Although only 9% of cannabis users develop cannabis dependence, the volume of people who smoke cannabis ensures that the total number of people in need of help is larger than the capacity of substance abuse specialty services. Thus, although efforts to refine and improve the efficacy of treatment interventions continue, innovations that increase the availability and accessibility of treatment are also needed. Computer- and phone-based interventions, social media, and brief interventions that can be implemented in primary care settings are areas that may hold promise for reaching at-risk populations. Adolescents and persons with co-occurring mental illness are at particularly high risk of cannabis dependence, and may suffer disproportionately from cannabis’s adverse effects. As in the treatment of other substance use disorders, there is a need for a continuing care model with long-term follow-up that extends past the periods typically evaluated in treatment studies. Additionally, there is a need for further investigation of genetic underpinnings and endophenotypes underlying cannabis dependence to identify neurobiological mechanisms for targeted intervention. One benefit of the societal focus on cannabis has been a prominent increase in research covering everything from the basic science to public health impact of cannabis. Over the next decade, physicians who provide treatment for individuals with cannabis dependence are likely to see their armamentarium of effective interventions expand, to the ultimate betterment of patients, their families, and society at large.
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Affiliation(s)
- Itai Danovitch
- Chairman, Department of Psychiatry and Behavioral Neurosciences, Director, Addiction Psychiatry, Cedars-Sinai Medical Center, 8730 Alden Dr., C-301, Los Angeles, CA 90048, (310) 423-8198,
| | - David A. Gorelick
- Chemistry and Drug Metabolism Section, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health and Adjunct Professor of Psychiatry, University of Maryland School of Medicine, 251 Bayview Boulevard, suite 200, Baltimore, MD 21224, (443) 740-2526,
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Danovitch I. Who needs medical students? Assoc Med J 2001. [DOI: 10.1136/sbmj.01025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Danovitch I, Danovitch I, Yamey G, Wilkes M. Genesis, the voice of students. Wjm's new student section will be vital reading for physicians. West J Med 2001; 174:86. [PMID: 11156900 PMCID: PMC1071254 DOI: 10.1136/ewjm.174.2.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affiliation(s)
- I Danovitch
- University of California, Los Angeles School of Medicine Los Angeles, CA, USA.
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