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Pahwa M, McElroy SL, Priesmeyer R, Siegel G, Siegel P, Nuss S, Bowden CL, El-Mallakh RS. KIOS: A smartphone app for self-monitoring for patients with bipolar disorder. Bipolar Disord 2024; 26:84-92. [PMID: 37340215 PMCID: PMC10730767 DOI: 10.1111/bdi.13362] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
OBJECTIVES This study examined the use of a self-monitoring/self-management smartphone application (app) for patients with bipolar disorder. The app was specifically designed with patient-centered computational software system based on concepts from nonlinear systems (chaos) theory. METHODS This was a randomized, active comparator study of use of the KIOS app compared to an existing free app that has high utilization rates known as eMoods, over 52 weeks, and performed in three academic centers. Patients were evaluated monthly utilizing the Bipolar Inventory of Symptoms Schedule (BISS). The primary outcome measure was the persistence of using the app over the year of the study. RESULTS Patients assigned to KIOS persisted in the study longer than those assigned to eMoods; 57 patients (87.70%) in the KIOS group versus 42 (73.69%) in the eMoods group completed the study (p = 0.03). By 52 weeks, significantly more of KIOS group (84.4%) versus eMoods group (54%) entered data into their programs (χ2 = 14.2, df = 1, p = 0.0002). Patient satisfaction for KIOS was greater (F = 5.21, df = 1, 108, p = 0.025) with a standardized effect size (Cohen's d) of 0.41. There was no difference in clinical outcome at the end of the study between the two groups. CONCLUSIONS This is the first randomized comparison study comparing two apps for the self-monitoring/self-management of bipolar disorder. The study revealed greater patient satisfaction and greater adherence to a patient-centered software program (KIOS) than a monitoring program that does not provide feedback (eMoods).
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Affiliation(s)
- Mehak Pahwa
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
| | - Susan L. McElroy
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio
| | - Richard Priesmeyer
- Jurica Professor of Management, Department of Management and Marketing, St Mary’s University, San Antonio, Texas
| | - Gregg Siegel
- Biomedical Development Corporation, San Antonio, Texas
| | | | - Sharon Nuss
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
| | - Charles L Bowden
- Deceased, previously Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Rif S. El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
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Farooqui AA, Fulkerson JM, El-Mallakh RS. Use of botulinum toxin A for depression symptoms in patients with treatment-resistant bipolar illness: A case series. Bipolar Disord 2023; 25:703-707. [PMID: 37926524 DOI: 10.1111/bdi.13389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Ali A Farooqui
- Integrative Psychiatry PLLC, Louisville, Kentucky, USA
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | | | - Rif S El-Mallakh
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
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3
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May P, El-Mallakh RS. Historical Perspective Regarding Health Care of Adults with Neurodevelopmental Disorders. South Med J 2023; 116:964-966. [PMID: 38051172 DOI: 10.14423/smj.0000000000001629] [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: 12/07/2023]
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Ruch TQ, Hoops C, El-Mallakh RS, Terrell C. Protest behaviors among patients placed in seclusion in a psychiatric emergency service. Ann Clin Psychiatry 2023; 35:234-237. [PMID: 37850998 DOI: 10.12788/acp.0124] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND Patients placed in seclusion for behavioral dyscontrol often perceive that the health care team is treating them inappropriately. These patients may express their indignation in many ways. To better characterize these behaviors, we conducted a study of protest behaviors in a psychiatric emergency service. METHODS Video surveillance of seclusion room occupants is routinely reviewed as part of our safety protocol. For 1 month in 2022, we noted the frequency and timing of potential protest behaviors such as disrobing and evacuation. Descriptive statistics were applied. RESULTS A total of 41 seclusion events (8.1%) occurred over the surveillance period, which included 504 initial emergency psychiatric evaluations. Six patients (14.6%) engaged in protest behaviors (all within 5 minutes of being placed in seclusion), including 3 (7.3%) who urinated and 3 (7.3%) who disrobed. One patient urinated almost immediately (2.4%), and another urinated 25 minutes after entering seclusion; the latter was not interpreted as a protest behavior. CONCLUSIONS Immediate behaviors in seclusion that are different from behaviors that led to seclusion can be interpreted as protest behaviors. The 2 most often observed protest behaviors were urination and disrobing.
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Affiliation(s)
- Tyler Q Ruch
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Chelsea Hoops
- University of Louisville Hospital, Louisville, Kentucky, USA
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Christina Terrell
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
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Valvassori SS, Peper-Nascimento J, Aguiar-Geraldo JM, Hilsendeger A, Daminelli T, Juruena MF, El-Mallakh RS, Quevedo J. Biological rhythms are correlated with Na +, K +-ATPase and oxidative stress biomarkers: A translational study on bipolar disorder. J Affect Disord 2023; 340:877-885. [PMID: 37572705 DOI: 10.1016/j.jad.2023.08.042] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/25/2023] [Accepted: 08/07/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is a chronic, severe, and multifactorial psychiatric disorder. Although biological rhythms alterations, sodium potassium pump (Na+, K+-ATPase) changes, and oxidative stress appear to play a critical role in the etiology and pathophysiology of BD, the inter-connection between them has not been described. Therefore this study evaluated the association between biological rhythms, Na+, K+-ATPase, and oxidative stress parameters in BD patients and the preclinical paradoxical sleep deprivation model (PSD). METHODS A translational study was conducted, including a case-control protocol with 36 BD and 46 healthy controls (HC). Subjects completed the Biological Rhythm Interview of Assessment in Neuropsychiatry (BRIAN). In addition, Erythrocyte Na+, K+-ATPase activity, and oxidative and nitrosative stress markers were assessed (4-hydroxynonenal [4-HNE], 8-isoprostane [8-ISO], thiobarbituric acid reactive substances [TBARS], carbonyl, 3-nitrotyrosine [3-nitro]). In the preclinical protocol, the same biomarkers were evaluated in the frontal cortex, hippocampus, and striatum from mice submitted to the PSD. RESULTS BD patients had a significantly higher total score of BRIAN versus HCs. Additionally, individuals with BD showed decreased Na+, K+-ATPase activity and increased oxidative stress parameters compared to HC without psychiatric disorders. This difference was driven by actively depressed BD subjects. The mice submitted to the PSD also demonstrated decreased Na+, K+-ATPase activity and increased oxidative stress parameters. LIMITATIONS BRIAN biological underpinning is less well characterized; We did not control for medication status; Sample size is limited; PSD it is not a true model of BD. CONCLUSIONS The present study found a significant correlation between Na+, K+-ATPase and oxidative stress with changes in biological rhythms, reinforcing the importance of these parameters to BD.
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Affiliation(s)
- Samira S Valvassori
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, The University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil.
| | - Jefté Peper-Nascimento
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, The University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Jorge M Aguiar-Geraldo
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, The University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Amanda Hilsendeger
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, The University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Thiani Daminelli
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, The University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Mario F Juruena
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience-King's College London, London, UK
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, KY, USA
| | - João Quevedo
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, The University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil; Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
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6
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El-Mallakh RS, Doroodgar M, Elsayed OH, Kidambi N. The serotonin theory of depression. Mol Psychiatry 2023; 28:3157. [PMID: 37322061 DOI: 10.1038/s41380-023-02091-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/14/2023] [Accepted: 04/21/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Rif S El-Mallakh
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, 40202, USA.
| | - Masoud Doroodgar
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - Omar H Elsayed
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - Neil Kidambi
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, 40202, USA
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7
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Abuelazm H, Elsayed OH, El-Mallakh RS. Evaluating lumateperone for its use in treating depressive episodes associated with bipolar I or II disorder in adults. Expert Rev Neurother 2023; 23:751-756. [PMID: 37458003 DOI: 10.1080/14737175.2023.2236795] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Lumateperone is a novel antipsychotic medication that has recently received approval by the United States Food and Drug Administration for treatment of major depressive episodes of type I and II bipolar disorder. It is approved for use as monotherapy or as an adjunctive treatment to lithium or valproic acid. AREAS COVERED Clinical trials performed with lumateperone for bipolar disorder were reviewed. Additionally, pharmacodynamic actions of lumateperone are reviewed. Lumateperone is superior to placebo whether used alone or in combination with a mood stabilizer in patients with type I or type II bipolar disorder. It achieves this effect with minimal dopamine blockade-related side effects due to less than 50% dopamine D2 receptor occupancy. While the pharmacodynamic profile of lumateperone is unique, the mechanism of action in bipolar depression remains obscure. EXPERT OPINION Lumateperone is an antipsychotic with full antagonist effects at the post-synaptic D2, and partial agonist effects at the presynaptic D2. This unique profile allows for both antipsychotic and antidepressant effects at the same dose, which does not produce dopamine-related side effects. Consequently, lumateperone is exceptionally well tolerated compared to other antidepressant-acting antipsychotic agents. It is now the only agent approved as an adjunct to the mood stabilizer for bipolar II depression.
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Affiliation(s)
- Hagar Abuelazm
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Omar H Elsayed
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Rif S El-Mallakh
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
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8
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Yeske E, McQuaide S, Ruch TQ, Goetz BL, El-Mallakh RS, Terrell CL. Prolonged psychosis with reformulated methamphetamine. Ann Clin Psychiatry 2023; 35:131-132. [PMID: 37074975 DOI: 10.12788/acp.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Affiliation(s)
- Elizabeth Yeske
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Sarah McQuaide
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Tyler Q Ruch
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Brenda L Goetz
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Christina L Terrell
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
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9
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Crump CJ, Good ME, Abuelazm H, El-Mallakh RS. Narrative review of the advances in the pharmacotherapeutic management of juvenile-onset schizophrenia. Expert Opin Pharmacother 2023; 24:1039-1052. [PMID: 37102321 DOI: 10.1080/14656566.2023.2208269] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Schizophrenia usually begins with prodromal symptoms in adolescence. In 39% of patients onset of psychotic symptoms occurs prior to age 19. Advances in the treatment of psychosis with medications over the last decade are reviewed this paper. AREAS COVERED Understanding how to prescribe antipsychotics early in schizophrenia requires understanding of the pathophysiology of the disease. The current structure of the dopamine hypothesis is reviewed. Risperidone, paliperidone, olanzapine, quetiapine, and aripiprazole have become established treatments prior to 2012. Since 2012, lurasidone (2017) and brexpiprazole (2022) have also been approved. Lurasidone was approved based on placebo-controlled studies, but brexpiprazole has been approved on the bases of open safety trials. In comparative trials, aripiprazole was better tolerated and less likely to cause hyperprolactinemia and metabolic abnormalities. EXPERT OPINION Antipsychotics can induce adaptive changes in the brain that predispose patients to future problems such as tardive dyskinesia and supersensitivity psychosis. When pathophysiology of schizophrenia, and a clear understanding of the pharmacology of existing antipsychotics are included in the evidence-based analysis, use of partial agonists, that are less likely to induce adaptive changes in the brain, and less likely to induce metabolic and prolactin side effects, become the preferred agents.
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Affiliation(s)
- Chesika J Crump
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine and University of Louisville Hospital, Louisville, Kentucky, United States
| | - Megan E Good
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine and University of Louisville Hospital, Louisville, Kentucky, United States
| | - Hagar Abuelazm
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine and University of Louisville Hospital, Louisville, Kentucky, United States
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine and University of Louisville Hospital, Louisville, Kentucky, United States
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10
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Campbell M, Julien N, Spratt D, El-Mallakh RS. Statewide Crisis Intervention Team Data. South Med J 2023; 116:382. [PMID: 37011592 DOI: 10.14423/smj.0000000000001537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Affiliation(s)
- MaKayla Campbell
- Department of Psychiatry and Behavioral Sciences University of Louisville School of Medicine Louisville, Kentucky
| | - Nathaniel Julien
- Department of Psychiatry and Behavioral Sciences University of Louisville School of Medicine Louisville, Kentucky
| | - Denise Spratt
- Lieutenant, retired, Louisville (Kentucky) Metro Police Department
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences University of Louisville School of Medicine Louisville, Kentucky
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11
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Mumtaz A, Adigun AO, El-Mallakh RS. Frequency of Modification of Pharmacological Treatment Is Equivalent for Virtual and In-Person Psychiatric Visits. Telemed Rep 2023; 4:44-47. [PMID: 36970220 PMCID: PMC10036074 DOI: 10.1089/tmr.2023.0004] [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] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND During the coronavirus pandemic there was a rapid adoption of telehealth services in psychiatry, which now accounts for 40% of all visits. There is a dearth of information about the relative efficacy of virtual and in-person psychiatric evaluations. METHODS We examined the rate of medication changes during virtual and in-person visits as a proxy for the equivalence of clinical decision-making. RESULTS A total of 280 visits among 173 patients were evaluated. The majority of these visits were telehealth (224, 80%). There were 96 medication changes among the telehealth visits (42.8%) and 21 among the in-person visits (37.5%) (z = -1.4, p = 0.16). CONCLUSION Clinicians were equally as likely to order a medication change if they saw their patient virtually or in person. This suggests that remote assessments yielded similar conclusions to in-person assessments.
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Affiliation(s)
- Amal Mumtaz
- Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, Depression Center, University of Louisville School of Medicine, Louisville, Kentucky
| | - Aisha O. Adigun
- Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, Depression Center, University of Louisville School of Medicine, Louisville, Kentucky
| | - Rif S. El-Mallakh
- Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, Depression Center, University of Louisville School of Medicine, Louisville, Kentucky
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12
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Elsayed OH, El-Mallakh RS. Catatonia Secondary to Depolarization Block. Asian J Psychiatr 2023; 84:103543. [PMID: 37028234 DOI: 10.1016/j.ajp.2023.103543] [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] [Received: 01/10/2023] [Revised: 02/18/2023] [Accepted: 03/13/2023] [Indexed: 04/09/2023]
Abstract
Catatonia is a severe psychomotor disorder that is associated with a 60-fold increased risk of premature death. Its occurrence has been associated with multiple psychiatric diagnoses, the most common being type I bipolar disorder. Catatonia can be understood as a disorder of ion dysregulation with reduced clearance of intracellular sodium ions. As the intraneuronal sodium concentration increases, the transmembrane potential is increased, and the resting potential may ultimately depolarize above the cellular threshold potential creating a condition known as depolarization block. Neurons in depolarization block do not respond to stimulation but are constantly releasing neurotransmitter; they mirror the clinical state of catatonia - active but non-responsive. Hyperpolarizing neurons, e.g., with benzodiazepines, is the most effective treatment.
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Affiliation(s)
- Omar H Elsayed
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Rif S El-Mallakh
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY 40202, USA.
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13
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Pahwa M, Elsayed OH, El-Mallakh RS. The paradox of vanishing lithium. Bipolar Disord 2023; 25:97-98. [PMID: 36907971 DOI: 10.1111/bdi.13306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Affiliation(s)
- Mehak Pahwa
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Omar H Elsayed
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Rif S El-Mallakh
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
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Kidambi N, Elsayed OH, El-Mallakh RS. Xanomeline-Trospium and Muscarinic Involvement in Schizophrenia. Neuropsychiatr Dis Treat 2023; 19:1145-1151. [PMID: 37193547 PMCID: PMC10183173 DOI: 10.2147/ndt.s406371] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/01/2023] [Indexed: 05/18/2023] Open
Abstract
Schizophrenia is a severe mental illness that has its onset in late adolescence or early adulthood and is associated with significant dysfunction across multiple domains. The pathogenesis of schizophrenia remains unknown, but physiologic understanding of the illness has been driven by the dopamine hypothesis. However, acetylcholine (ACh) clearly plays a role with mixed results regarding effect on psychosis. Selective muscarinic M1 and M4 agonists, such as xanomeline, originally developed to aid in cognitive loss with Alzheimer's, showed promise in proof-of-concept study in 20 patients with schizophrenia. Unfortunately, tolerability problems made muscarinic agonists impractical in either condition. However, coadministration of trospium, a lipophobic, non-selective muscarinic antagonist previously used for the treatment of overactive bladder, with xanomeline resulted in a significant reduction of cholinergic adverse effects. A recent randomized, placebo-controlled study of the antipsychotic effects of this combination in 182 patients with acute psychosis revealed improved tolerability with 80% of subjects staying to the end of the 5 weeks study. At the end of the trial, the treatment group saw a -17.4 change in the positive and negative symptom scale (PANSS) score from baseline compared to a -5.9 change in the placebo arm (P < 0.001). Furthermore, the negative symptom subscore, was also superior in the active arm (P < 0.001). These early studies are exciting because they suggest that the cholinergic system may be recruited to treat a severe and disabling disorder with suboptimal treatment options. Xanomeline-trospium combination is currently in phase III studies.
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Affiliation(s)
- Neil Kidambi
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - Omar H Elsayed
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - Rif S El-Mallakh
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, 40202, USA
- Correspondence: Rif S El-Mallakh, Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, 40202, USA, Tel +1 502 588 4450, Fax +1 502 588 9539, Email
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15
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El-Mallakh RS, Belnap A, Iyer S, Schreiber J, Matthews D, Lefler L, Dees D, Bott A, Vanegas-Arroyave N, Wolff A, Pesce U, Farahmand K, Shah C, Lundt L. Telehealth for Assessing and Managing Tardive Dyskinesia: Expert Insights from a Cross-Disciplinary Virtual Treatment Panel. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0234] [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] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Rif S. El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Amy Belnap
- Rocky Mountain Psychiatry, Pocatello, Idaho, USA
- Neurocrine Biosciences, Inc., San Diego, California, USA
| | - Sanjay Iyer
- Memory & Movement Charlotte, Charlotte, North Carolina, USA
| | | | | | - Linda Lefler
- St. Anthony's Hospital and Bayfront Health St. Petersburg, St. Petersburg, Florida, USA
| | - Daniel Dees
- Department of Neurology, University of South Alabama College of Medicine, Mobile, Alabama, USA
| | | | | | - Adam Wolff
- Denver Neurological Clinic, Denver, Colorado, USA
| | - Ulises Pesce
- Department of Psychiatry, University of South Dakota, Vermillion, South Dakota, USA
| | | | - Chirag Shah
- Neurocrine Biosciences, Inc., San Diego, California, USA
| | - Leslie Lundt
- Neurocrine Biosciences, Inc., San Diego, California, USA
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Abstract
22lr14564.
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Affiliation(s)
- Rif S El-Mallakh
- Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky.,Corresponding author: Rif S. El-Mallakh, MD, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, 401 East Chestnut St, Ste 610, Louisville, KY 40202
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17
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Crump CJ, Litteral CA, Elsayed OH, El-Mallakh RS. Pimavanserin for bipolar disorder. Bipolar Disord 2022; 24:697-699. [PMID: 35167172 DOI: 10.1111/bdi.13191] [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] [Received: 11/01/2021] [Revised: 01/31/2022] [Accepted: 02/11/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Chesika Judyth Crump
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Carleigh A Litteral
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Omar H Elsayed
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Rif S El-Mallakh
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
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Arabadjief MA, Elsayed OH, Bashir S, Gundumalla MR, Menefee DS, Bergman CL, Moulana NZ, El-Mallakh RS. Chlordiazepoxide-induced delirium in a patient undergoing alcohol withdrawal: a case report. J Med Case Rep 2022; 16:269. [PMID: 35799217 PMCID: PMC9261023 DOI: 10.1186/s13256-022-03456-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/13/2022] [Indexed: 12/28/2022] Open
Abstract
Background Ethanol dependence is associated with a discontinuation withdrawal delirium. Chlordiazepoxide is frequently successfully used in its treatment. Case presentation A 27-year-old, Caucasian female with ethanol dependence who had objective symptoms of withdrawal experienced worsening of her delirium after administration of chlordiazepoxide, but improved with lorazepam and cleared with discontinuation of benzodiazepine administration. Conclusions Worsening of delirium appears to be related to the specific use of chlordiazepoxide, but the mechanism of this effect is not clear. While this case does not alter the standard care of ethanol dependence, it does alert clinicians that our treatment approach may not be fully benign.
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Affiliation(s)
- Melissa A Arabadjief
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, USA
| | - Omar H Elsayed
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, USA
| | - Sabina Bashir
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, USA
| | - Meenakshi R Gundumalla
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, USA
| | - Derek S Menefee
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, USA
| | - Cody L Bergman
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, USA
| | - Nayeem Z Moulana
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, USA
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, 401 East Chestnut Street, Suite 610, Louisville, KY, 40241, USA.
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Ali Z, El-Mallakh RS. Suicidal Depression in Ancient Egypt. Arch Suicide Res 2022; 26:1607-1623. [PMID: 33502962 DOI: 10.1080/13811118.2021.1878079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the oldest record of a depressed individual contemplating suicide. METHOD A directed review of ancient Egyptology literature of translations and discussion regarding a papyrus that is approximately 4,000 years old. RESULTS The content of the document is consistent with a man going through a severe depression and is contemplating suicide. However, this does not appear to be a suicide note, but more of an ancient example of 'journaling' or working through the thoughts of suicide and its possible consequences to the man's eternal life in the afterworld. CONCLUSIONS Presentation of depression, the reasons for considering suicide, and the process by which an individual works through those thoughts have not varied significantly over the past 4,000 years.
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Gao Y, Mack AA, Litteral C, Delamere NA, El-Mallakh RS. NMDA receptor inhibition prevents intracellular sodium elevations in human olfactory neuroepithelial precursors derived from bipolar patients. Sci Rep 2022; 12:10437. [PMID: 35729322 PMCID: PMC9213398 DOI: 10.1038/s41598-022-14187-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/02/2022] [Indexed: 11/24/2022] Open
Abstract
Dysregulation of ion flux across membranes and glutamate-induced excitotoxicity appear to be important pathophysiologic abnormalities in bipolar illness. Understanding ion control and responses to ionic stress is important to decipher the pathogenesis of this disorder. Monensin alone significantly increased [Na]i in ONPs from bipolar individuals (5.08 ± 0.71 vs baseline 3.13 ± 0.93, P = 0.03) and AP5 had no effect (2.0 ± 1.2 vs baseline 3.13 ± 0.93, P = 0.27). However, the combination of AP5 and monensin resulted in normalization of [Na]i (3.25 ± 1.28 vs baseline 3.13 ± 0.93, P = 0.89). This effect was not observed in cells from non-bipolar individuals (monensin alone, 1.72 ± 1.10 vs baseline 2.42 ± 1.80, P = 0.25; AP5 alone, 1.37 ± 0.74 vs baseline 2.42 ± 1.80; AP5 combined with monensin, 1.53 ± 0.98 vs baseline 2.42 ± 1.80, P = 0.31). Sodium regulation is central to neuronal function and may be disturbed in patients with bipolar disorder. Monensin is an ionophore, meaning that it incorporates itself into the membrane and allows sodium to enter independent of cellular membrane proteins. While the mechanism remains obscure, the observation that the NMDA receptor antagonist, AP5, normalizes [Na]i only in olfactory neuroepithelial precursors obtained from bipolar illness may provide novel insights into ion regulation in tissues from subjects with bipolar illness.
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Affiliation(s)
- Yonglin Gao
- Department of Psychiatry and Behavioral Sciences, Mood Disorders Research Program, Depression Center, University of Louisville School of Medicine, Louisville, KY, USA
| | - Aaron A Mack
- Department of Psychiatry and Behavioral Sciences, Mood Disorders Research Program, Depression Center, University of Louisville School of Medicine, Louisville, KY, USA
| | - Carleigh Litteral
- Department of Psychiatry and Behavioral Sciences, Mood Disorders Research Program, Depression Center, University of Louisville School of Medicine, Louisville, KY, USA
| | - Nicholas A Delamere
- Department of Physiology, University of Arizona, PO Box 245051, Tucson, AZ, 85724-5051, USA
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, Mood Disorders Research Program, Depression Center, University of Louisville School of Medicine, Louisville, KY, USA.
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Elsayed OH, Pahwa M, El-Mallakh RS. Pharmacologic Treatment and Management of Bipolar Disorder in Adolescents. Expert Opin Pharmacother 2022; 23:1165-1179. [PMID: 35621334 DOI: 10.1080/14656566.2022.2083954] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The importance of the appropriate therapeutic interventions in children and adolescents with bipolar disorder (BD) cannot be overstated since treatment choices and their consequences may have effects into adulthood. AREAS COVERED Randomized clinical trials (RCTs) investigating treatment of mania, bipolar depression, and maintenance in adolescents with BD are reviewed. When RCTs are not available or are inadequate, naturalistic data or open studies are also reviewed. EXPERT OPINION Efficacy and safety of pharmaceutical agents in adolescents with BD appear to mirror adults with BD. Lithium/mood stabilizers are preferred first line agents over antipsychotic medications, but the latter are second line agents particularly in bipolar depression. When lithium is used, serum levels approaching 1.0 mEq/L are reasonable since younger people appear to require/tolerate higher levels. Among the antipsychotics, quetiapine appeared to be minimally better than risperidone while risperidone was associated with greater adverse events. Antipsychotics with antidepressant activity in adults, also appear to have antidepressant effects in youths. Use of antidepressants in bipolar depression is generally not recommended although it may be reasonable in specific clinical situations. The similarities between adolescent and adult outcomes suggest that it is reasonable to utilize adult data to aid with clinical decision making in adolescents with BD, especially when pediatric-specific data are unavailable.
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Affiliation(s)
- Omar H Elsayed
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Kentucky USA
| | - Mehak Pahwa
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Kentucky USA
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Kentucky USA
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22
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El-Mallakh RS, Gao Y, Roberts M, Hamlyn J. Sleep deprivation is associated with increased circulating levels of endogenous ouabain: Potential role in bipolar disorder. Psychiatry Res 2022; 309:114399. [PMID: 35078006 DOI: 10.1016/j.psychres.2022.114399] [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] [Received: 02/06/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 11/30/2022]
Abstract
Endogenously produced cardiac glycosides, like endogenous ouabain (EO), are putative hormones that have been implicated in the pathophysiology of bipolar disorder. Individuals with bipolar disorder appear to be unable to sufficiently upregulate production of EO in situations of increased need. This study was performed to determine the effect of sleep deprivation on the circulating levels of EO. Plasma EO concentrations were measured by ouabain-radioimmunoassay in heterozygote Na,K-ATPase a2 knockout (KO) mice, which have been used as an animal model of mania, and wildtype siblings at baseline and after sleep fragmentation utilizing the moving bar method. a2 KO animals had elevated endogenous ouabain concentrations compared to wild type controls (0.82 ± SD 0.22 nM vs 0.26 ± 0.02, P = 0.03). Sleep fragmentation increased ouabain concentrations in wild type mice (0.53 ± 0.08 nM sleep fragmentation vs 0.26 ± 0.02 nM baseline, P = 0.04), but not in a2 KO mice (0.60 ± 0.07 nM sleep fragmentation vs 0.82 ± 0.22 nM baseline, P > 0.05). These studies demonstrate that sleep disturbance can increase EO in control mice but animals that exhibit some manic behaviors are unable to increase EO production.
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Affiliation(s)
- Rif S El-Mallakh
- Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, 401 East Chestnut Street, Suite 610, Louisville, KY 40202, USA.
| | - Yonglin Gao
- Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, 401 East Chestnut Street, Suite 610, Louisville, KY 40202, USA
| | - Michael Roberts
- Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, 401 East Chestnut Street, Suite 610, Louisville, KY 40202, USA
| | - John Hamlyn
- Department of Physiology, School of Medicine, University of Maryland Baltimore, 685 West Baltimore Street, Baltimore, MS 21201, USA
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El-Mallakh RS, Sampath VP, Horesh N, Lichtstein D. Endogenous Cardiac Steroids in Bipolar Disorder: State of the Art. Int J Mol Sci 2022; 23:ijms23031846. [PMID: 35163766 PMCID: PMC8836531 DOI: 10.3390/ijms23031846] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 02/04/2023] Open
Abstract
Bipolar disorder (BD) is a severe psychiatric illness with a poor prognosis and problematic, suboptimal, treatments. Treatments, borne of an understanding of the pathoetiologic mechanisms, need to be developed in order to improve outcomes. Dysregulation of cationic homeostasis is the most reproducible aspect of BD pathophysiology. Correction of ionic balance is the universal mechanism of action of all mood stabilizing medications. Endogenous sodium pump modulators (collectively known as endogenous cardiac steroids, ECS) are steroids which are synthesized in and released from the adrenal gland and brain. These compounds, by activating or inhibiting Na+, K+-ATPase activity and activating intracellular signaling cascades, have numerous effects on cell survival, vascular tone homeostasis, inflammation, and neuronal activity. For the past twenty years we have addressed the hypothesis that the Na+, K+-ATPase-ECS system may be involved in the etiology of BD. This is a focused review that presents a comprehensive model pertaining to the role of ECS in the etiology of BD. We propose that alterations in ECS metabolism in the brain cause numerous biochemical changes that underlie brain dysfunction and mood symptoms. This is based on both animal models and translational human results. There are data that demonstrate that excess ECS induce abnormal mood and activity in animals, while a specific removal of ECS with antibodies normalizes mood. There are also data indicating that circulating levels of ECS are lower in manic individuals, and that patients with BD are unable to upregulate synthesis of ECS under conditions that increase their elaboration in non-psychiatric controls. There is strong evidence for the involvement of ion dysregulation and ECS function in bipolar illness. Additional research is required to fully characterize these abnormalities and define future clinical directions.
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Affiliation(s)
- Rif S. El-Mallakh
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY 40202, USA
- Correspondence: (R.S.E.-M.); (D.L.)
| | - Vishnu Priya Sampath
- Department of Medical Neurobiology, Faculty of Medicine, The Institute for Medical Research, Israel-Canada, Hadassah Medical School, The Hebrew University, Jerusalem 9112102, Israel; (V.P.S.); (N.H.)
| | - Noa Horesh
- Department of Medical Neurobiology, Faculty of Medicine, The Institute for Medical Research, Israel-Canada, Hadassah Medical School, The Hebrew University, Jerusalem 9112102, Israel; (V.P.S.); (N.H.)
| | - David Lichtstein
- Department of Medical Neurobiology, Faculty of Medicine, The Institute for Medical Research, Israel-Canada, Hadassah Medical School, The Hebrew University, Jerusalem 9112102, Israel; (V.P.S.); (N.H.)
- Correspondence: (R.S.E.-M.); (D.L.)
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24
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Tegin G, Gao Y, Hamlyn JM, Clark BJ, El-Mallakh RS. Inhibition of endogenous ouabain by atrial natriuretic peptide is a guanylyl cyclase independent effect. PLoS One 2021; 16:e0260131. [PMID: 34793577 PMCID: PMC8601428 DOI: 10.1371/journal.pone.0260131] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 11/03/2021] [Indexed: 12/15/2022] Open
Abstract
Background Endogenous ouabain (EO) and atrial natriuretic peptide (ANP) are important in regulation of sodium and fluid balance. There is indirect evidence that ANP may be involved in the regulation of endogenous cardenolides. Methods H295R are human adrenocortical cells known to release EO. Cells were treated with ANP at physiologic concentrations or vehicle (0.1% DMSO), with or without guanylyl cyclase inhibitor 1,2,4 oxadiazolo[4,3-a]quinoxalin-1-one (ODQ). Cyclic guanosine monophosphate (cGMP), the intracellular second messenger of ANP, was measured by a chemiluminescent immunoassay and EO was measured by radioimmunoassay of C18 extracted samples. Results EO secretion is inhibited by ANP treatment, with the most prolonged inhibition (90 min vs ≤ 60 min) occurring at physiologic ANP concentrations (50 pg/mL). Inhibition of guanylyl cyclase with ODQ, also reduces EO secretion. The inhibitory effects on EO release in response to cotreatment with ANP and ODQ appeared to be additive. Conclusions ANP inhibits basal EO secretion, and it is unlikely that this is mediated through ANP-A or ANP-B receptors (the most common natriuretic peptide receptors) or their cGMP second messenger; the underlying mechanisms involved are not revealed in the current studies. The role of ANP in the control of EO synthesis and secretion in vivo requires further investigation.
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Affiliation(s)
- Gulay Tegin
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky, United States of America
| | - Yonglin Gao
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky, United States of America
| | - John M. Hamlyn
- Department of Physiology, School of Medicine, University of Maryland, Baltimore, Mississippi, United States of America
| | - Barbara J. Clark
- Department of Biochemistry and Molecular Genetics, University of Louisville, Louisville, Kentucky, United States of America
| | - Rif S. El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky, United States of America
- * E-mail:
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Hawkins EM, Coryell W, Leung S, Parikh SV, Weston C, Nestadt P, Nurnberger JI, Kaplin A, Kumar A, Farooqui AA, El-Mallakh RS. Effects of somatic treatments on suicidal ideation and completed suicides. Brain Behav 2021; 11:e2381. [PMID: 34661999 PMCID: PMC8613439 DOI: 10.1002/brb3.2381] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/14/2021] [Accepted: 09/14/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE This work was undertaken to define and characterize the role of currently available somatic treatments in psychiatry in either increasing or reducing the risk for suicide. METHODS Members of the Suicide Prevention Task Group of the National Network of Depression Centers performed a literature review of somatic treatments known to increase or reduce the risk for suicide. The reviews ventured to include all relevant information about the risk for both suicide ideation and completed suicides. RESULTS Lithium and clozapine are the only two somatic treatments that have high-quality data documenting their antisuicide effects in mood disorders and schizophrenia, respectively. Lithium discontinuation is also associated with increased suicide risk. Ketamine and esketamine may have a small, but immediate, antisuicide effect. Despite the recent Food and Drug Administration approval of esketamine use in depressed suicidal patients, the small disproportional overrepresentation of suicide in subjects who had received esketamine versus placebo (3 vs. 0 among > 3500 subjects) requires ongoing evaluation. The purported antisuicide effect of electroconvulsive therapy is based on low-quality data. The effect of antidepressants is not at all clear. There appears to be direct evidence for antidepressants increasing suicidal ideation and the risk for suicide over the short-term in young people, but indirect (low quality) evidence that antidepressants reduce suicide risk over the long term. CONCLUSIONS Clinicians have an expanding pharmacopeia to address suicide potential in their patients. Some of the agents with documented antisuicide effects may also increase suicidality under specific circumstances.
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Affiliation(s)
- Elise M Hawkins
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
| | - William Coryell
- Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Stephen Leung
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Cody Weston
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John I Nurnberger
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Adam Kaplin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anupama Kumar
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ali A Farooqui
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
| | -
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
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Ruch T, Nuss S, Yeruva RR, Gao Y, Tegin G, Terrell C, El-Mallakh RS. Inhaled loxapine for acute agitation in a psychiatric emergency service. Ann Clin Psychiatry 2021; 33:162-167. [PMID: 34398731 DOI: 10.12788/acp.0032] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Rapid control of agitation in medical settings is necessary for safety and provision of care. Inhaled loxapine achieves peak plasma levels within 2 minutes of administration and is FDA-approved for managing acute agitation. METHODS We examined the use of inhaled loxapine vs non-parenteral treatment as usual (TAU) in a psychiatric emergency service for consecutive patients with acute agitation or aggression. Data were collected retrospectively. T tests were used for continuous variables and Chi-square tests were used for categorical data. RESULTS A total of 61 patients received inhaled loxapine and 29 received TAU. Time to outcome for patients receiving inhaled loxapine was 21 ± 21 minutes compared with 121 ± 206 minutes for TAU (t =-2.61; P = .014). At outcome, 89% of patients treated with loxapine experienced symptom resolution, compared with 69% of TAU (Chi-square = 17.4, P < .0001). Ten percent of patients receiving loxapine had no change in symptoms and 1% had worsening symptoms vs 14% in the TAU group who experienced no change in symptoms (z = 0.5, not significant), and 17% who described worsening symptoms (z = 6153.9, P < .0001). CONCLUSIONS The rapid absorption of inhaled loxapine is associated with a 6-fold faster and more robust symptom control.
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Affiliation(s)
- Tyler Ruch
- University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Sharon Nuss
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Rajashekar Reddy Yeruva
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Yonglin Gao
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Gulay Tegin
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Christina Terrell
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
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Yeruva RR, Shang Y, Schoenbachler B, Nuss S, El-Mallakh RS. Anatomical Association Between Schizophrenia and Cerebellum. Innov Clin Neurosci 2021; 18:47-49. [PMID: 34980994 PMCID: PMC8667695] [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: 06/14/2023]
Abstract
The pathogenesis of schizophrenia is rarely attributed to dysfunction of the cerebellum. However, coordination of mental processes might involve the cerebellum and a cortico-cerebellar-thalamic-cortical circuit (CCTCC) that can mediate that process has been proposed. We present the case of a 31-year-old male patient with a family history of psychosis who developed schizophrenia in association with a slow-growing glioblastoma at the left posterior cerebellar pontine angle. Of interest is that his psychosis became refractory after surgical removal of the tumor that had no motor deficit consequences, suggesting that the greater disruption of the CCTCC due to surgical excision might be related to the worsening psychosis. The case supports the hypothesis of cognitive dysmetria and psychosis.
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Affiliation(s)
- Rajashekar Reddy Yeruva
- Dr. Yeruva is with Baylor Scott and White Medical Center in Round Rock, Texas
- Drs. Shang, Schoenbachler, El-Mallakh, and Sharon Nuss are with the University of Louisville School of Medicine in Louisville, Kentucky
| | - Yafei Shang
- Dr. Yeruva is with Baylor Scott and White Medical Center in Round Rock, Texas
- Drs. Shang, Schoenbachler, El-Mallakh, and Sharon Nuss are with the University of Louisville School of Medicine in Louisville, Kentucky
| | - Ben Schoenbachler
- Dr. Yeruva is with Baylor Scott and White Medical Center in Round Rock, Texas
- Drs. Shang, Schoenbachler, El-Mallakh, and Sharon Nuss are with the University of Louisville School of Medicine in Louisville, Kentucky
| | - Sharon Nuss
- Dr. Yeruva is with Baylor Scott and White Medical Center in Round Rock, Texas
- Drs. Shang, Schoenbachler, El-Mallakh, and Sharon Nuss are with the University of Louisville School of Medicine in Louisville, Kentucky
| | - Rif S El-Mallakh
- Dr. Yeruva is with Baylor Scott and White Medical Center in Round Rock, Texas
- Drs. Shang, Schoenbachler, El-Mallakh, and Sharon Nuss are with the University of Louisville School of Medicine in Louisville, Kentucky
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Dobbins K, Addison C, Roque A, El-Mallakh PL, El-Mallakh RS. Cost-Savings Associated with Reductions in Public Service Utilization with Provision of Permanent Supported Housing in Midsized City in the United States. Psychiatr Q 2021; 92:833-841. [PMID: 33190213 DOI: 10.1007/s11126-020-09716-7] [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] [Indexed: 10/23/2022]
Abstract
Severe and persistent mental illnesses are frequently associated with homelessness and extensive use of public services. Cost savings after the provision of permanent supportive housing (PSH) have been examined in large metropolitan areas but not in medium-sized communities. Administrative and clinical data were collected to determine use of public services, such as use of emergency services, inpatient psychiatric and medical services, and correctional facilities, in the year preceding and the year subsequent to placement in PSH. Costs of the housing and the utilized services were also calculated. Ninety-one subjects were in housing first (HF) programs and 19 were in treatment first (TF) programs. Overall there was a net cost savings of over $1.2 million or $6134/consumer/year of PSH. Nearly all cost savings were in reduced service utilization which implies prevention of both medical and psychiatric morbidity. In HF the average per patient cost savings ($21,082.12) was not significantly greater than TF ($12,907.29; p = 0.33). Provision of PSH in a mid-sized city provides significant cost savings.
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Affiliation(s)
- Kathy Dobbins
- Wellspring, PO Box 1927, Louisville, KY, 40201-1927, USA
| | - Carey Addison
- Family Health Centers, Inc, 712 East Muhammad Ali Blvd, Louisville, KY, 40202, USA
| | - Autumn Roque
- Center for Mindfulness and CBT, 10845 Olive Blvd, St. Louis, MO, 63141, USA
| | | | - Rif S El-Mallakh
- Department of Psychiatry, University of Louisville School of Medicine, Louisville, KY, 40202, USA.
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Abstract
INTRODUCTION Research into the pharmacologic management of bipolar type I illness continues to progress. AREAS COVERED Randomized clinical trials performed with type I bipolar disorder in the years 2015 to August 2020 are reviewed. There are new indications for the use of cariprazine, for bipolar mania and depression, and a long-acting injectable formulation of aripiprazole has also been approved for relapse prevention in bipolar illness. Most of the randomized clinical trials are effectiveness studies. EXPERT OPINION Over the 20 years from 1997 through 2016, the use of lithium and other mood stabilizers has declined by 50%, while the use of both second-generation antipsychotics (SGAs) and antidepressants has increased considerably. Over the same time period (1990-2017), disability-adjusted life years (DALYs) increased by 54.4%, from 6.02 million in 1990 to 9.29 million in 2017 which is greater than the 47.74% increase in incidence of the disease, suggesting that the changes in prescribing patterns have not been helpful for our patients. Furthermore, recent effectiveness studies continue to confirm the superiority of lithium and other mood stabilizers in the management of bipolar illness for both psychiatric and medical outcomes, reaffirming their role as foundational treatments in the management of type I bipolar disorder. Clinicians need to reassess their prescribing habits.
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Affiliation(s)
- Ahmad Sleem
- Mood Disorders Research Program, Depression Center Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Rif S El-Mallakh
- Mood Disorders Research Program, Depression Center Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
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Bowden CL, Priesmeyer R, Tohen M, Singh V, Calabrese JR, Ketter T, Nierenberg A, Thase ME, Siegel G, Siegel LH, Mintz J, El-Mallakh RS, McElroy SL, Martinez M. Development of a Patient-Centered Software System to Facilitate Effective Management of Bipolar Disorder. Psychopharmacol Bull 2021; 51:8-19. [PMID: 34092819 PMCID: PMC8146566] [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: 06/12/2023]
Abstract
OBJECTIVE Self-management of bipolar disorder (BD) is an important component of treatment. METHODS We developed a patient-centered computational software system based on concepts from nonlinear systems (chaos) theory with mobile access to assist in managing BD known as KIOS. KIOS tracks interacting symptoms to determine theprecise state of a BD patient. Once the patient's state is identified and the trajectory of the patient established, specific advice is generated to help manage the course of the disease. KIOS also provides analytics that can be used by clinicians and researchers to track outcomes and the course of illness. A 12-week field test was completed. RESULTS In 20 BD subjects, use of KIOS was associated with improvements in primary symptom categories of BD. Usability and generated advice were rated as a median of 6 out of a maximum of 7. CONCLUSIONS The KIOS focus on change illuminates problems in the same way that humans experience them, implying that the future state will be consequent to changes made to impact the current state. Randomized clinical trial is indicated.
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Affiliation(s)
- Charles L Bowden
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Richard Priesmeyer
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Mauricio Tohen
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Vivek Singh
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Joseph R Calabrese
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Terry Ketter
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Andrew Nierenberg
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Michael E Thase
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Gregg Siegel
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Leslie H Siegel
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Jim Mintz
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Rif S El-Mallakh
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Susan L McElroy
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Melissa Martinez
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
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Lee TT, Durham ME, Demick DS, Reynolds SB, El-Mallakh RS. Increased infection rates associated with second-generation antipsychotics. Ann Clin Psychiatry 2021; 33:53-55. [PMID: 33577268 DOI: 10.12788/acp.0017] [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: 11/20/2022]
Affiliation(s)
| | | | | | | | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, 40202 USA. EMAIL:
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Abstract
Background Bipolar disorder is a severe psychiatric illness with poor prognosis and problematic and suboptimal treatments. Understanding the pathoetiologic mechanisms may improve treatment and outcomes. Discussion Dysregulation of cationic homeostasis is the most reproducible aspect of bipolar pathophysiology. Correction of ionic balance is the universal mechanism of action of all mood stabilizing medications. Recent discoveries of the role of endogenous sodium pump modulators (which include ‘endogenous ouabain’) in regulation of sodium and potassium distribution, inflammation, and activation of key cellular second messenger systems that are important in cell survival, and the demonstration that these stress-responsive chemicals may be dysregulated in bipolar patients, suggest that these compounds may be candidates for the coupling of environmental stressors and illness onset. Specifically, individuals with bipolar disorder appear to be unable to upregulate endogenous ouabain under conditions that require it, and therefore may experience a relative deficiency of this important regulatory hormone. In the absence of elevated endogenous ouabain, neurons are unable to maintain their normal resting potential, become relatively depolarized, and are then susceptible to inappropriate activation. Furthermore, sodium pump activity appears to be necessary to prevent inflammatory signals within the central nervous system. Nearly all available data currently support this model, but additional studies are required to solidify the role of this system. Conclusion Endogenous ouabain dysregulation appears to be a reasonable candidate for understanding the pathophysiology of bipolar disorder.
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Affiliation(s)
- Rif S El-Mallakh
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, 401 East Chestnut Street, Suite 610, Louisville, KY, 40202, USA.
| | - Yonglin Gao
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, 401 East Chestnut Street, Suite 610, Louisville, KY, 40202, USA
| | - Pan You
- Xiamen Xianyue Hospital, 399 Xianyue Road, Xiamen, China
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El-Mallakh RS, Ali Z. Extra-synaptic modulation of GABA A and efficacy in bipolar disorder. Med Hypotheses 2021; 147:110501. [PMID: 33515862 DOI: 10.1016/j.mehy.2021.110501] [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] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/22/2020] [Accepted: 01/08/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Bipolar disorder type I is a severe psychiatric condition that leads to significant morbidity and mortality and whose treatment remains suboptimal. Its pathophysiology involves disturbance in the control of ionic fluxes so that when patients are either manic or depressed, the resting membrane potential of neurons is more depolarized than normal. Available mood stabilizers have a shared mechanism of normalizing ion flux by compensating for ionic abnormalities, and normalizing membrane potential. HYPOTHESIS Agents that significantly potentiate extrasynaptic GABAA receptors are expected to be particularly effective in hyperpolarizing resting membrane potential in bipolar patients, thereby normalizing their membrane potential. DISCUSSION New neuroactive steroid-like agents are being tested in humans for depression and insomnia. These agents include brexanolone, ganaxolone, and gaboxadol. Brexanolone has been approved for the treatment of postpartum depression, ganaxolone is being studied for treatment-resistant depression, and gaboxadol development for the treatment of insomnia has been abandoned due to narrow therapeutic index. In addition to the current studies, these agents are expected to have particular efficacy in acute and prophylactic management of bipolar I disorder by hyperpolarizing the resting potential of neurons and antagonizing one of the most reproducible demonstrated biologic abnormalities of this illness.
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Affiliation(s)
- Rif S El-Mallakh
- Mood Disorders Research Program, Depression Center Department of Psychiatry and Behavioral Sciences University of Louisville School of Medicine, 401 East Chestnut Street, Suite 610 Louisville, Kentucky 40202, USA.
| | - Ziad Ali
- Department of Psychiatry, University of Kentucky College of Medicine, The Medical Center of Bowling Green, Bowling Green, KY, USA
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Abstract
BACKGROUND Use of kratom is increasing in the United States due to its perceived safety as a botanical product. This review provides salient information about kratom for the practicing clinician. METHODS We conducted a literature search of MedLine, UpToDate, and Google using the terms "kratom" and "Mitragyna speciosa" for articles published within the last 10 years. RESULTS We reviewed > 500 articles. Kratom is derived from the Mitragyna speciosa plant of Southeast Asia. It has grown in popularity within the United States due to its dual effects of acting as a stimulant at low doses and acting as an opioid-like substance at higher dosages. The 2 major active ingredients in kratom, mitragynine and 7-OH mitragynine, act as partial agonists at the mu-opioid receptor. While adverse consequences are normally mild, there are several potentially serious adverse effects, including respiratory depression, especially with chronic, high-dose usage. Furthermore, in case reports, concomitant use of kratom with other substances has been linked to seizures. Unfortunately, an increasing number of deaths have been linked to kratom usage. Six states have made it illegal to possess or sell kratom. CONCLUSIONS Kratom is an emerging drug of abuse in the United States. Its use is increasing in individuals who may seek to experience an opioidlike "high" as well as to help reduce withdrawal effects from other opioids.
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Affiliation(s)
| | | | | | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School, of Medicine, Louisville, KY 40202 USA. E-MAIL:
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El-Mallakh RS. William A. F. Browne: Earliest Documented Use of Rehabilitative Art in Great Britain. Art Therapy 2020. [DOI: 10.1080/07421656.2020.1814093] [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: 10/23/2022]
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El-Mallakh RS, Goetz B, Nuru M, Weegens R, Yazdani U, Terrell C. Insurance expansion associated with reduced use of emergency psychiatric services. Am J Emerg Med 2020; 40:220-221. [PMID: 32505471 DOI: 10.1016/j.ajem.2020.05.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, United States of America.
| | - Brenda Goetz
- Seven Counties Services, Louisville, KY, United States of America
| | - Mohammed Nuru
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, United States of America
| | - Ryan Weegens
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, United States of America
| | - Urooj Yazdani
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, United States of America
| | - Christina Terrell
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, United States of America
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Abstract
Coronavirus Diseases-2019 (COVID-19) has caused a large global outbreak and has been declared as a pandemic by the World Health Organization (WHO). It has been proposed that COVID-19-related hyperinflammation and dysregulated immune response might play a critical role in developing a cytokine storm which usually progresses to a life-threatening acute lung injury or acute respiratory distress syndrome in infected individuals. Lidocaine, a local analgesic and anti-arrhythmic, is known for its anti-inflammatory actions and has been used to reduce cough and improve respiratory symptoms in severe asthmatic patients. It has a demonstrated safety profile. It is proposed that nebulized lidocaine might be beneficial in reducing cytokines, protecting patients' lungs and improving outcomes in COVID-19 patients when administered via inhalation as an adjunctive treatment for severe respiratory symptoms in patients fighting the novel Coronavirus. Additional investigation is warranted.
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Affiliation(s)
- Ziad A Ali
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, 401 East Chestnut Street, Suite 610, Louisville, KY 40202, United States.
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, 401 East Chestnut Street, Suite 610, Louisville, KY 40202, United States.
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Ramesh J, Parthasarathy LK, Janckila AJ, Begum F, Murugan R, Murthy BPSS, El-Mallakh RS, Parthasarathy RN, Venugopal B. Characterisation of ACP5 missense mutations encoding tartrate-resistant acid phosphatase associated with spondyloenchondrodysplasia. PLoS One 2020; 15:e0230052. [PMID: 32214327 PMCID: PMC7098635 DOI: 10.1371/journal.pone.0230052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/23/2019] [Accepted: 02/20/2020] [Indexed: 11/21/2022] Open
Abstract
Biallelic mutations in ACP5, encoding tartrate-resistant acid phosphatase (TRACP), have recently been identified to cause the inherited immuno-osseous disorder, spondyloenchondrodysplasia (SPENCD). This study was undertaken to characterize the eight reported missense mutations in ACP5 associated with SPENCD on TRACP expression. ACP5 mutant genes were synthesized, transfected into human embryonic kidney (HEK-293) cells and stably expressing cell lines were established. TRACP expression was assessed by cytochemical and immuno-cytochemical staining with a panel of monoclonal antibodies. Analysis of wild (WT) type and eight mutant stable cell lines indicated that all mutants lacked stainable enzyme activity. All ACP5 mutant constructs were translated into intact proteins by HEK-293 cells. The mutant TRACP proteins displayed variable immune reactivity patterns, and all drastically reduced enzymatic activity, revealing that there is no gross inhibition of TRACP biosynthesis by the mutations. But they likely interfere with folding thereby impairing enzyme function. TRACP exists as two isoforms. TRACP 5a is a less active monomeric enzyme (35kD), with the intact loop peptide and TRACP 5b is proteolytically cleaved highly active enzyme encompassing two subunits (23 kD and 16 kD) held together by disulfide bonds. None of the mutant proteins were proteolytically processed into isoform 5b intracellularly, and only three mutants were secreted in significant amounts into the culture medium as intact isoform 5a-like proteins. Analysis of antibody reactivity patterns revealed that T89I and M264K mutant proteins retained some native conformation, whereas all others were in “denatured” or “unfolded” forms. Western blot analysis with intracellular and secreted TRACP proteins also revealed similar observations indicating that mutant T89I is amply secreted as inactive protein. All mutant proteins were attacked by Endo-H sensitive glycans and none could be activated by proteolytic cleavage in vitro. In conclusion, determining the structure-function relationship of the SPENCD mutations in TRACP will expand our understanding of basic mechanisms underlying immune responsiveness and its involvement in dysregulated bone metabolism.
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Affiliation(s)
- Janani Ramesh
- Department of Medical Biochemistry, Dr. ALM-PGIBMS, University of Madras, Madras, India
| | - Latha K. Parthasarathy
- Department of Psychiatry, University of Louisville School of Medicine, Louisville, KY, United States of America
| | - Anthony J. Janckila
- Department of Microbiology and Immunology, University of Louisville, School of Medicine, Louisville, KY, United States of America
| | - Farhana Begum
- Department of Medical Biochemistry, Dr. ALM-PGIBMS, University of Madras, Madras, India
| | - Ramya Murugan
- Department of Medical Biochemistry, Dr. ALM-PGIBMS, University of Madras, Madras, India
| | - Balakumar P. S. S. Murthy
- Department of Vascular and Endovascular Sciences, Tamilnadu Government Multi Super Speciality Hospital, Chennai, India
| | - Rif S. El-Mallakh
- Department of Psychiatry, University of Louisville School of Medicine, Louisville, KY, United States of America
| | - Ranga N. Parthasarathy
- Department of Medical Biochemistry, Dr. ALM-PGIBMS, University of Madras, Madras, India
- Department of Psychiatry, University of Louisville School of Medicine, Louisville, KY, United States of America
- Department of Psychiatry, Molecular Biology and Biochemistry, University of Louisville School of Medicine, Louisville, KY, United States of America
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Ali Z, Roque A, El-Mallakh RS. A unifying theory for the pathoetiologic mechanism of tardive dyskinesia. Med Hypotheses 2020; 140:109682. [PMID: 32200182 DOI: 10.1016/j.mehy.2020.109682] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/06/2020] [Accepted: 03/15/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Chronic treatment with dopamine D2 receptor antagonists has been proposed to lead to dopamine receptor supersensitivity. Frequently, this is conceptualized as upregulation or changes in the structure or function of the post-synaptic D2 receptor. However, the measured 1.4-fold increase in D2 receptor density and the lack of actual receptor supersensitivity are probably inadequate to explain outcomes such as tardive dyskinesia (TD) and dopamine supersensitivity psychosis. HYPOTHESIS Recent data suggest that TD may result from a combination of presynaptic, synaptic, and postsynaptic changes. DISCUSSION Presynaptic increase in dopamine release occurs when super-therapeutic blockade of postsynaptic D2 receptors results in excess synaptic unbound dopamine which ultimately ends up being reuptaken by the presynaptic neuron through the dopamine transporter. The increased availability of recycled dopamine results in higher vesicular dopamine concentrations. Since the quantity of neurotransmitter released (known as quanta) is determined by the number of presynaptic neurotransmitter vesicles, the increase in the number (concentration) of dopamine molecules in the vesicles results in a higher concentration of synaptic dopamine with successive depolarization events. Synaptic changes such as the appearance of perforated synapses which is an early step in new synapse formation have been shown in animal models of TD. Finally, postsynaptic increases in D2 receptor expression without demonstration of increased sensitivity or potency has been demonstrated. CONCLUSION TD likely develops due to changes across the synapse and terminology such as 'dopamine receptor supersensitivity' can be misleading. 'Synaptic upregulation' may be a more correct term.
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Affiliation(s)
- Ziad Ali
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, United States.
| | - Autumn Roque
- Center for Mindfulness and CBT, 10845 Olive Blvd, St. Louis, MO 63141, United States.
| | - Rif S El-Mallakh
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, United States
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El-Mallakh RS, Nuss S, Gao D, Gao Y, Ahmad SC, Schrodt C, Adler C. Asenapine in the Treatment of Bipolar Depression. Psychopharmacol Bull 2020; 50:8-18. [PMID: 32214517 PMCID: PMC7093720] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Asenapine, a potent serotonin 7 (5-HT7) receptor antagonist, was examined for efficacy as an antidepressant in depressed bipolar subjects. It was predicted that subjects with the genetic variant of the short form of the serotonin transporter (5HTTR) would be more likely to respond. EXPERIMENTAL DESIGN A subset of patients participating in a randomized, placebo-controlled study of the efficacy of asenapine in bipolar I depression also underwent genetic testing for the 5HTTR. Montgomery Åsberg Depression Rating Scale (MADRS) score was ≥ 26 prior to randomization to asenapine or placebo for 8 weeks. Gene testing was performed before breaking the blind. PRINCIPAL OBSERVATIONS Nine patients completing the study also underwent gene testing. At study end, the average MADRS improvement was -19.80 ± SD 8.59 for the 4 people randomized to asenapine and -3.80 ± 9.01 for the 5 people receiving placebo (P = 0.021, t = 2.88). Anxiety, as measured by the Hamilton Anxiety Rating Scale (HAM-A), also improved in asenapine-treated patients (-15.40 ± 6.15 vs. -2.80 ± 7.95, P = 0.023, t = 2.803). Six participants had the short form of the 5HTTR, and it is believed they influenced the significant outcome in this small sample. CONCLUSIONS While this is a very small sample, asenapine appears to have a beneficial effect on both depression and anxiety in depressed bipolar I patients compared to treatment with placebo. Due to the large fraction of subjects with the short form, the hypothesis that the SF-5HTTR might increase asenapine response could not be adequately tested.
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Affiliation(s)
- Rif S El-Mallakh
- El-Mallakh, MD, Nuss, MS, D. Gao, MD, Y. Gao MD, Surriya Ahmad, MD, Schrodt, BS, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. D. Gao, MD, Post Doctoral Fellow at University of Louisville, Current Address: College of Integrative Medicine Fujian University of Traditional Chinese Medicine Fuzhou, Fujian, China. Adler, MD, Department of Psychiatry University of Cincinnati Cincinnati, Ohio
| | - Sharon Nuss
- El-Mallakh, MD, Nuss, MS, D. Gao, MD, Y. Gao MD, Surriya Ahmad, MD, Schrodt, BS, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. D. Gao, MD, Post Doctoral Fellow at University of Louisville, Current Address: College of Integrative Medicine Fujian University of Traditional Chinese Medicine Fuzhou, Fujian, China. Adler, MD, Department of Psychiatry University of Cincinnati Cincinnati, Ohio
| | - Dong Gao
- El-Mallakh, MD, Nuss, MS, D. Gao, MD, Y. Gao MD, Surriya Ahmad, MD, Schrodt, BS, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. D. Gao, MD, Post Doctoral Fellow at University of Louisville, Current Address: College of Integrative Medicine Fujian University of Traditional Chinese Medicine Fuzhou, Fujian, China. Adler, MD, Department of Psychiatry University of Cincinnati Cincinnati, Ohio
| | - Yonglin Gao
- El-Mallakh, MD, Nuss, MS, D. Gao, MD, Y. Gao MD, Surriya Ahmad, MD, Schrodt, BS, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. D. Gao, MD, Post Doctoral Fellow at University of Louisville, Current Address: College of Integrative Medicine Fujian University of Traditional Chinese Medicine Fuzhou, Fujian, China. Adler, MD, Department of Psychiatry University of Cincinnati Cincinnati, Ohio
| | - Surriya Colleen Ahmad
- El-Mallakh, MD, Nuss, MS, D. Gao, MD, Y. Gao MD, Surriya Ahmad, MD, Schrodt, BS, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. D. Gao, MD, Post Doctoral Fellow at University of Louisville, Current Address: College of Integrative Medicine Fujian University of Traditional Chinese Medicine Fuzhou, Fujian, China. Adler, MD, Department of Psychiatry University of Cincinnati Cincinnati, Ohio
| | - Clare Schrodt
- El-Mallakh, MD, Nuss, MS, D. Gao, MD, Y. Gao MD, Surriya Ahmad, MD, Schrodt, BS, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. D. Gao, MD, Post Doctoral Fellow at University of Louisville, Current Address: College of Integrative Medicine Fujian University of Traditional Chinese Medicine Fuzhou, Fujian, China. Adler, MD, Department of Psychiatry University of Cincinnati Cincinnati, Ohio
| | - Caleb Adler
- El-Mallakh, MD, Nuss, MS, D. Gao, MD, Y. Gao MD, Surriya Ahmad, MD, Schrodt, BS, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. D. Gao, MD, Post Doctoral Fellow at University of Louisville, Current Address: College of Integrative Medicine Fujian University of Traditional Chinese Medicine Fuzhou, Fujian, China. Adler, MD, Department of Psychiatry University of Cincinnati Cincinnati, Ohio
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Affiliation(s)
- Kathy M Vincent
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine , Louisville, KY, USA
| | - Maureen Ryan
- Psychiatry, Robley Rex VA Medical Center , Louisville, KY, USA
| | - Emma Palmer
- James L. Winkle College of Pharmacy, University of Cincinnati , Cincinnati, OH, USA
| | - Jeramie L Rosales
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine , Louisville, KY, USA
| | - Steven Lippmann
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine , Louisville, KY, USA
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine , Louisville, KY, USA
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Affiliation(s)
- Ziad Ali
- Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Cunyet Tegin
- Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Rif S. El-Mallakh
- Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
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Abstract
BACKGROUND Asenapine is a novel antipsychotic that has demonstrated efficacy in controlling psychosis in schizophrenia and mania in bipolar illness. It must be administered as a sublingual formulation because it is nearly completely metabolized in the first pass through the liver. Recently, a transdermal formulation of asenapine has been approved for schizophrenia by the Food and Drug Administration. METHODS A systematic review of transdermal asenapine was done utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model. DISCUSSION There are several formulations of transdermal asenapine but only Secuado® has been approved for clinical use. Total bioavailability is 35%. Peak plasma concentration (Cmax) is 4 ng/mL and occurs within 1 hr (Tmax); elimination half-life (t1/2) is 24 hrs (range 13.4 to 39.2 h). Asenapine is highly bound (95%) to albumin and α1-acid glycoprotein. It has a unique receptor profile in which it functions as an antagonist at multiple receptors with affinity that is higher than D2 (Ki = 1.3) including D3, D4, 5HT2A, 5HT2C, 5HT2B, 5HT7, 5HT6, H1, and α2. This profile suggests that asenapine may be of particular value off label for bipolar depression, anxiety, and aggression. Transdermal asenapine was only tested in one randomized, placebo-controlled study of acute psychosis in schizophrenia. It was superior to placebo at week 6 with nearly one-third of patients experiencing >30% improvement in total PANSS score which translates in a number needed to treat (NNT) of 9.
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Affiliation(s)
- Brennan Carrithers
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky40202, USA
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky40202, USA
- Correspondence: Rif S El-Mallakh Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, 401 East Chestnut Street, Suite 610, Louisville, Kentucky40202, USATel +1 502 588 – 4450Fax +1 502 588 - 9539 Email
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Abstract
Objectives: Schizophrenia is a severe psychiatric illness that has been purported to be causally related to in utero infection of neurotropic organisms. For obvious ethical reasons, this hypothesis has never been tested prospectively in humans. However, with the recent introduction of Zika virus into the New World offers the opportunity to test the hypothesis of infection in schizophrenia.Methods: This is a directed review examining the hypothesis. The literature relevant to Zika virus transmission in the New World, its biology and neurotropy is reviewed.Results: Zika virus has been associated with a wide variety of neural tube and neuroanatomical abnormalities. In its original range, Zika is only infrequently associated with congenital anomalies, but in the New World, where the majority of the population has not developed immunity, infections are associated with a wide range of neurologic abnormalities.Conclusions: The current outbreak of Zika virus in the Western Hemisphere, offers the opportunity to prospectively examine the congenital infection hypothesis of the pathogenesis of schizophrenia.
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Affiliation(s)
- Johnathan Pierson
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA
| | - Rajashekar Reddy Yeruva
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA
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Tegin C, Canan F, El-Mallakh RS. The 2nd to 4th digit ratios (2D:4D) in patients with bipolar disorder. J Affect Disord 2019; 259:27-30. [PMID: 31437697 DOI: 10.1016/j.jad.2019.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/31/2019] [Revised: 08/02/2019] [Accepted: 08/12/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The ratio of the index finger to the ring finger (2D:4D) is a reflection of the intrauterine hormonal environment and a lower ratio has been shown to be associated with male gender, impulsive behaviors, substance abuse, and aggression. Bipolar illness is characterized by increased impulsivity and increased rates of co-morbid substance abuse, but the 2D:4D ratios have not been examined in this disorder. METHODS We measured digit length of both hands in subjects with bipolar disorder and age- and gender-matched non-bipolar controls (n = 50 in each group). Diagnosis was confirmed with structured diagnostic interviews (MINI) and all subjects also completed Barratt Impulsivity Scale-version 11. RESULTS The patients did not vary significantly from the controls in demographic variables. Subjects with bipolar disorder had a higher right hand 2D:4D ratio compared to controls (0.967 ± .029 vs. 0.953 ± .035, t = 2.18, p = .03). Despite clearly higher measures of impulsivity in the bipolar group, no relationship could be documented between digit ratio and measures of impulsivity in either group. However, the right hand 2D:4D ratios and total impulsivity scores predicted bipolar disorder diagnosis status. LIMITATIONS The predominantly white racial composition of the study sample may limit generalizability to other groups. Only three patients were diagnosed with bipolar type 2, limiting the generalizability of the findings to all bipolar disorder types. CONCLUSIONS The data confirm previous observations of increased measures of impulsivity in euthymic bipolar individuals, and suggest that the mechanism of this increased impulsivity is different than in impulsivity seen in other conditions such as personality disorders.
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Affiliation(s)
- Cuneyt Tegin
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Fatih Canan
- The Altshuler Center for Education & Research at Metrocare Services, Dallas, TX, USA; Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
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Mack AA, Gao Y, Ratajczak MZ, Kakar S, El-Mallakh RS. Review of animal models of bipolar disorder that alter ion regulation. Neurosci Biobehav Rev 2019; 107:208-214. [PMID: 31521699 DOI: 10.1016/j.neubiorev.2019.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 08/05/2019] [Accepted: 09/11/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Accurate modeling of psychiatric disorders in animals is essential for advancement in our understanding and treatment of the severe mental illnesses. Of the multiple models available for bipolar illness, the ones that disrupt ion flux are currently the only ones that meet the three criteria for validity: face validity, construct validity, and predictive validity. METHODS A directed review was performed to evaluate animal models for mania in which ion dysregulation was the key intervention. RESULTS Three models are identified. All focus on disruption of the sodium potassium pump. One is pharmacologic and requires surgical insertion of an intracerebroventricular (ICV) cannula and subsequent administration of ouabain. Two are genetic and are based on heterozygote knockout (KO) of the alpha2 or alpha3 subunits of the sodium pump. Alpha2 KOs are believed to have altered glial function, and they do not appear to have a full array of manic symptoms. Alpha3 KOs appear to be the best characterized animal model for bipolar disorder currently available. CONCLUSION Animal models that disrupt ion regulation are more inclined to model both mania and depression; and are thus the most promising models available. However, other models are important for demonstrating mechanisms in important pathophysiologic aspect of bipolar disorder.
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Affiliation(s)
- Aaron A Mack
- University of Louisville School of Medicine, Department of Psychiatry and Behavioral Medicine, Louisville, KY, USA.
| | - Yonglin Gao
- University of Louisville School of Medicine, Department of Psychiatry and Behavioral Medicine, Louisville, KY, USA
| | - Mariusz Z Ratajczak
- University of Louisville School of Medicine, Department of Medicine, Louisville, KY, USA
| | - Sham Kakar
- University of Louisville School of Medicine, Department of Physiology, Louisville, KY, USA
| | - Rif S El-Mallakh
- University of Louisville School of Medicine, Department of Psychiatry and Behavioral Medicine, Louisville, KY, USA
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Ali ZA, Nuss S, El-Mallakh RS. Antidepressant discontinuation in treatment resistant depression. Contemp Clin Trials Commun 2019; 15:100383. [PMID: 31193850 PMCID: PMC6543016 DOI: 10.1016/j.conctc.2019.100383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/28/2019] [Accepted: 05/15/2019] [Indexed: 12/28/2022] Open
Abstract
Treatment-resistant depression (TRD) is a growing problem in psychiatric practice with some 15–20% of depressed patients becoming chronically depressed and perhaps as many as 40% in tertiary settings. Several groups have championed the idea that TRD may be attributed to the long-term treatment with antidepressant drugs (AD). Subjects with the short form of the serotonin transporter gene (both heterozygotes and homozygotes) have an increased risk for depression in the setting of adversity compared to people with the long form. Moreover, these same individuals have a reduced likelihood of responding well to antidepressants, with reports of no response, delayed response, and increased side effects. This hypothesis needs to be examined in a randomized clinical trial. The study will examine the effect of discontinuation versus continuation of serotonergic antidepressants on disease progression in patients with treatment resistant depression. We will recruit 30 subjects and assess the depressive symptoms and disease progression. Genetic testing will be performed to optimize clinical outcome in both groups, but will also be used to evaluate if the short form of the serotonin transporter predicts disease progression and long-term antidepressant treatment response.
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Affiliation(s)
- Ziad A. Ali
- Corresponding author. University of Louisville, Department of Psychiatry and Behavioral Sciences, 401 East Chestnut Street, Suite 610, Louisville, KY, 40202, United States.
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El-Mallakh RS, Rhodes TP, Dobbins K. The Case for Case Management in Schizophrenia. Prof Case Manag 2019; 24:273-276. [PMID: 31369493 DOI: 10.1097/ncm.0000000000000385] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Rif S El-Mallakh
- Rif S. El-Mallakh, MD, received his MS in biology and his MD degrees from the University of Illinois. He completed a medical internship and 1 year of a neurology residency before completing an adult psychiatry residency at the University of Connecticut. Dr El-Mallakh received his board certification in psychiatry in 1990. He spent 3 years as a clinical research fellow with the late Dr Richard Wyatt's Neuropsychiatry Branch Laboratory at the NIMH. He joined the faculty of the Department of Psychiatry at the University of Louisville in 1992, where he is a Professor and Director of the Mood Disorders Research Program, University of Louisville School of Medicine Department of Psychiatry University of Louisville School of Medicine, Louisville, Kentucky. T. Patrick Rhodes, MSSW, LCSW, earned his master's degree from the University of Louisville Kent School of Social Work. For 30 years Patrick has worked in inpatient settings as a case manager and overseen the operations in a transitional housing program and crisis services for adults with severe mental illness (SMI). Currently, he oversees Wellspring supportive services for adults with SMI. Katharine Dobbins, MSSW, LCSW, received her master's degree in Social Work from the University of Louisville Kent School of Social Work. She has more than 35 years of experience in the development, provision, and management of services to the severely mentally ill. Katharine has worked in community mental health, inpatient services, private practice and for the past decade has served as the CEO of Wellspring, Inc., a nonprofit organization in Louisville, Kentucky, which provides supportive housing, crisis stabilization, and a range of recovery services to approximately 1,000 adults with mental illness annually
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El-Mallakh RS, Watkins J. Prolactin Elevations and Permeability Glycoprotein. Prim Care Companion CNS Disord 2019; 21. [PMID: 31106995 DOI: 10.4088/pcc.18nr02412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/05/2019] [Indexed: 10/26/2022] Open
Abstract
Objective To examine the role of permeability glycoprotein (P-gp) and its substrates in the mechanism of hyperprolactinemia. Data Sources PubMed and Google Scholar were queried with the search term permeability glycoprotein crossed with antipsychotic, neuroleptic, prolactin, risperidone, paliperidone, and amisulpride. The searches were performed in early 2018 with no date restrictions. Study Selection All references cited in PubMed were examined (108), but only the first 40 references of each search in Google Scholar (total of approximately 30,000 hits) for a total of 240 were examined. Approximately 100 references were felt to be relevant. Data Extraction Information regarding mechanism of action and clinical relevance was extracted as appropriate for the discussion. Results Risperidone, paliperidone, and amisulpride are associated with higher prolactin levels than would be anticipated from striatal dopamine receptor occupancy studies. This elevation occurs because the levels of these antipsychotics are higher in the anterior pituitary than in parts of the brain protected by the blood-brain barrier and P-gp. P-gp has high affinity to all these antipsychotics and selectively removes them from the brain and concentrates them in the blood draining the hypothalamus, allowing greater dopamine receptor blockade in the cells in the anterior pituitary that produce prolactin. Conclusions The anatomy of the portal circulation, the presence of P-gp, and the high affinity of this protein to risperidone, paliperidone, and amisulpride all conspire to concentrate the antipsychotic concentration in the anterior pituitary to levels higher than in other parts of the brain, with consequent increase of prolactin above expectations.
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Affiliation(s)
- Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, 401 East Chestnut St, Ste 610, Louisville, KY 40202. .,Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Justin Watkins
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
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