1
|
Madaan V, Bhaskar S, Donnelly GAE, Cox DJ. A Randomized, Phase 3, Double-Blind, Crossover Comparison of Multilayer, Extended-Release Methylphenidate (PRC-063), and Lisdexamfetamine in the Driving Performance of Young Adults With ADHD. J Atten Disord 2024; 28:947-956. [PMID: 38404033 PMCID: PMC10981171 DOI: 10.1177/10870547241226634] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To compare PRC-063 (multilayer-release methylphenidate) and lisdexamfetamine dimesylate (LDX) on the driving performance of young adults with attention deficit hyperactivity disorder (ADHD) in a randomized, double-blind, crossover study. METHOD Following up to 21 days of each treatment in each treatment course (PRC-063/LDX or LDX/PRC-063), subjects completed a 15-hour driving simulator laboratory assessment. The primary outcome measure was the Tactical Driving Quotient (TDQ) and the Clinical Global Impressions-Improvement (CGI-I) scale was a secondary outcome measure. RESULTS Forty-four subjects completed the study. PRC-063 and LDX had equivalent effects on driving performance through a 15-hour time period (least square mean difference -0.3 [standard error 1.08], 95% confidence interval [-2.4, 1.8], p = .793). Consistent improvement in CGI-I was observed. The incidence of treatment-emergent adverse events was similar for each treatment sequence. CONCLUSIONS PRC-063 and LDX had comparable effects on driving performance, from 1 through 15 hours, the last time point measured.
Collapse
Affiliation(s)
- Vishal Madaan
- American Psychiatric Association, Washington, DC, USA
| | - Sailaja Bhaskar
- Imbrium Therapeutics L.P., A Subsidiary of Purdue Pharma L.P., Stamford, CT, USA
| | | | - Daniel J. Cox
- University of Virginia Health System, Charlottesville, USA
| |
Collapse
|
2
|
Elnajjar A, Khan M, Foongsathaporn C, Lu F, Madaan V. Non-US International Medical Graduates in Psychiatry Training During the COVID-19 Pandemic: Challenges and Novel Solutions. Acad Psychiatry 2023; 47:205-210. [PMID: 35359249 PMCID: PMC8970639 DOI: 10.1007/s40596-022-01621-4] [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] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 03/07/2022] [Indexed: 05/25/2023]
Affiliation(s)
| | - Manal Khan
- University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - Francis Lu
- University of California, Davis, Sacramento, CA, USA
| | | |
Collapse
|
3
|
De Golia SG, Houston LJ, Madaan V, Zalpuri I, Welton R, Bernstein C, Sengupta S, Chaudhry MA, Sudak DM. The Burden of Leadership: a Survey of Burnout Experiences Among Psychiatry Program Directors. Acad Psychiatry 2023; 47:174-180. [PMID: 35761064 DOI: 10.1007/s40596-022-01675-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The objectives of this study were to examine the prevalence of burnout, specify contributors to and protective factors against burnout, and gather suggestions to improve well-being in psychiatry Program Directors. METHODS A survey regarding burnout and wellness was distributed to psychiatric Program Directors through the email listserv of the American Association of Directors of Psychiatric Residency Training (AADPRT). RESULTS The survey response rate was 273 responses out of 880 members surveyed (31%). The majority of respondents were current residency or fellowship Program Directors or Associate Program Directors or had another current educational role (93%, 227/245). Almost half of current Program Directors or Associate Program Directors reported feeling burned out almost daily or once a week (44%, 93/210). These Program Directors reported a desire to resign (77%), experienced discrimination within the past 5 years (66%), and struggled with finding meaning in their job (44%). The most frequently endorsed contributors to burnout were increasing administrative burden and insufficient support. CONCLUSIONS The survey findings confirm that burnout characteristics are common among respondents, associated with a desire to resign and a struggle to find meaning in the highly demanding position of Program Director or Associate Program Director. Advocacy for resources, decreased administrative overload, and increased protected time would enhance well-being in Program Directors. Most striking was the frequency of discrimination reported and its relationship to burnout. Departments may benefit from a careful review of policies, procedures, and training to decrease hostile workplaces for women, international medical graduate, and under-represented in medicine Program Directors.
Collapse
Affiliation(s)
| | | | - Vishal Madaan
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Randon Welton
- Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Carol Bernstein
- Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Sourav Sengupta
- University at Buffalo Jacobs School of Medicine, Buffalo, NY, USA
| | | | | |
Collapse
|
4
|
Boland RJ, Dingle AD, Travis MJ, Osborne LM, Shapiro MA, Madaan V, Ahmed I. Using the Psychiatry Resident-In-Training Examination (PRITE) to Assess the Psychiatry Medical Knowledge Milestones in Psychiatry. Acad Psychiatry 2022; 46:331-337. [PMID: 34623622 DOI: 10.1007/s40596-021-01537-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 09/09/2021] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The introduction of the Milestone Project underscored the need for objective assessments of resident progress across the competencies. Therefore, the authors examined the Psychiatry Resident-In-Training Examination (PRITE) utility for measuring improvements in medical knowledge (MK). METHODS The authors compared the mean performance for each MK subcompetency by resident year for all residents taking the PRITE from 2015 to 2017 (18,175 examination administrations). In addition, they surveyed psychiatry residency program directors regarding how well they thought they teach these subcompetencies. RESULTS Increases in MK subcompetencies by resident year were significant for Psychopathology (p < 0.003), Psychotherapy (p < 0.002), and Somatic Therapies (p < 0.000). Development, Clinical Neuroscience, and Practice of Psychiatry did not show statistically significant differences between postgraduate years. Eighty psychiatry program directors responded to the survey and felt optimistic about their ability to teach the Psychopathology, Psychotherapy, Somatic Therapies, and Practice of Psychiatry subcompetencies. CONCLUSIONS The PRITE measured significant improvements in medical knowledge for several of the core subcompetencies. The program director's responses would suggest that the lack of statistically significant differences found for Development and Clinical Neuroscience reflects areas in need of curricular development. The disparity between PRITE performance and program director perception of the Practice of Psychiatry subcompetency may reflect difficulties in defining the scope of this subcompetency. Overall, this suggests that structured examinations help measure improvements in certain subcompetencies and may also help identify curricular needs. However, there may be potential problems with the definition of some subcompetencies.
Collapse
Affiliation(s)
- Robert J Boland
- Baylor College of Medicine and the Menninger Clinic, Houston, TX, USA.
| | - Arden D Dingle
- University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Michael J Travis
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | - Vishal Madaan
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Iqbal Ahmed
- Tripler Army Medical Center Psychiatry Residency Program, Honolulu, HI, USA
| |
Collapse
|
5
|
Gupta R, Madaan V, Kumar S, Govil D. Indocyanine green enhanced near-infrared fluorescence imaging for perfusion assessment of colonic conduit for esophageal replacement: Utility of a novel technique. J Postgrad Med 2021; 67:168-170. [PMID: 34414927 PMCID: PMC8445122 DOI: 10.4103/jpgm.jpgm_1227_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Esophagectomy, followed by esophageal replacement using gastric/colonic conduits, is a complex surgical procedure with significant perioperative morbidity. The most significant and potentially life-threatening complication associated with esophageal replacement is conduit ischaemia, resulting in anastomotic leak and conduit necrosis. Ensuring adequate perfusion of the conduit remains the key to preventing conduit ischaemia. Indocyanine green (ICG) enhanced near-infrared fluorescence imaging is a novel technique which has been used for assessing bowel perfusion. While numerous studies have focused on ICG fluorescence imaging for assessment of gastric conduit perfusion after esophagectomy, data regarding its use for colonic conduits is limited to case reports. ICG fluorescence imaging can help in resolving intraoperative issues by predicting the adequacy of colonic conduit perfusion, thereby preventing postoperative morbidity. To the best of our knowledge, this is the first report in Indian literature describing the utility of ICG fluorescence imaging for assessment of perfusion of colonic interposition.
Collapse
Affiliation(s)
- R Gupta
- Department of Surgical Gastroenterology, Indraprastha Apollo Hospital, New Delhi, India
| | - V Madaan
- Department of Surgical Gastroenterology, Indraprastha Apollo Hospital, New Delhi, India
| | - S Kumar
- Department of Surgical Gastroenterology, Indraprastha Apollo Hospital, New Delhi, India
| | - D Govil
- Department of Surgical Gastroenterology, Indraprastha Apollo Hospital, New Delhi, India
| |
Collapse
|
6
|
Khan M, Madaan V. New Ways to Support the Recruitment of International Medical Graduates During the Pandemic. Acad Med 2021; 96:616. [PMID: 33885408 DOI: 10.1097/acm.0000000000003980] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Manal Khan
- First-year child and adolescent psychiatry fellow, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California;
| | - Vishal Madaan
- Associate professor, University of Virginia Health System, Charlottesville, Virginia
| |
Collapse
|
7
|
McGee ME, Edelsohn GA, Keener MT, Madaan V, Soda T, Bacewicz A, Dell ML. Ethical and Clinical Considerations During the Coronavirus Era. J Am Acad Child Adolesc Psychiatry 2021; 60:332-335. [PMID: 33338576 PMCID: PMC7836851 DOI: 10.1016/j.jaac.2020.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/03/2020] [Accepted: 12/09/2020] [Indexed: 11/15/2022]
Abstract
The practice of child and adolescent psychiatry is evolving during an unprecedented global health catastrophe, the coronavirus disease 2019 (COVID-19) pandemic. As child and adolescent psychiatrists grapple with COVID-19's enormous medical, educational, social, and economic toll, a mental health crisis is co-occurring. Pre-existing disparities are recognized as contributors to the disproportionate impact of the COVID-19 pandemic on racial and ethnic minorities.1 The magnitude of COVID-19's effects on child and family mental health has yet to be fully revealed. child and adolescent psychiatrists are in a unique position to address this mental health crisis. Child and adolescent psychiatrists must stay up-to-date regarding federal, state, local, and institutional mandates, regulations, and policies informed by the Centers for Disease Control and Prevention2 and other public health institutions, while also navigating the ethical dilemmas unique to child and adolescent psychiatry during the coronavirus era.
Collapse
Affiliation(s)
- Maria E. McGee
- Creighton University School of Medicine and Catholic Health Initiatives Health, Omaha, Nebraska,Correspondence to Maria E. McGee, MD, MS, MPH, Creighton University Medical Center, Education Building, 7710 Mercy Road, Suite 601, Omaha, NE 68124
| | - Gail A. Edelsohn
- Community Care Behavioral Health Organization, UPMC Insurance Services Division, Pittsburgh, Pennsylvania
| | | | - Vishal Madaan
- University of Virginia Health System, Charlottesville
| | - Takahiro Soda
- Duke University School of Medicine, Durham, North Carolina
| | | | - Mary Lynn Dell
- Children’s Hospital New Orleans and Tulane University, Louisiana
| |
Collapse
|
8
|
Affiliation(s)
- Vishal Madaan
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, Charlottesville
| | - Daniel J Cox
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, Charlottesville
| |
Collapse
|
9
|
Pierre JM, Mahr F, Carter A, Madaan V. Underrepresented in Medicine Recruitment: Rationale, Challenges, and Strategies for Increasing Diversity in Psychiatry Residency Programs. Acad Psychiatry 2017; 41:226-232. [PMID: 27052504 DOI: 10.1007/s40596-016-0499-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 01/27/2016] [Indexed: 06/05/2023]
Affiliation(s)
- Joseph M Pierre
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Fauzia Mahr
- Penn State College Of Medicine, Hershey, PA, USA
| | - Andrea Carter
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Vishal Madaan
- University of Virginia Health System, Charlottesville, VA, USA
| |
Collapse
|
10
|
Dingle A, DeJong S, Madaan V, Ascherman L. Teaching Ethics in Child and Adolescent Psychiatry: Vignette-Based Curriculum. MedEdPORTAL 2016; 12:10418. [PMID: 31008198 PMCID: PMC6464473 DOI: 10.15766/mep_2374-8265.10418] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/13/2016] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Ethics is an integral component of child and adolescent psychiatry. While ethics can seem abstract or philosophical, its tenets are fundamental to the practice of medicine. Understanding relevant ethical principles shapes how practitioners make decisions in all activities, including clinical, administrative, research, and scholarly. METHODS Using the American Academy of Child and Adolescent Psychiatry (AACAP) Code of Ethics as the framework, these vignettes serve as stimulus material to help teach the ethical principles relevant to child and adolescent psychiatry practice. Each vignette briefly describes a clinical situation in practice, followed by questions and possible appropriate responses. The teacher's guide includes a discussion of the relevant ethical principles and perspectives on how to think about the issues involved. A supplementary overview of ethical issues in child and adolescent psychiatry and a list of resources are also provided. RESULTS We and other child and adolescent psychiatrists have used this curriculum at professional organizational meetings, in residency programs, and in teaching medical students with positive learner responses. DISCUSSION This curriculum was developed by members of the AACAP Ethics Committee with input from the entire committee in an effort to produce material that was easy to use and provided valuable content about an essential aspect of practice that is relevant to all practitioners at all levels. While designed for child and adolescent psychiatrists, the content is relevant to all physicians working with children, adolescents, and families.
Collapse
Affiliation(s)
- Arden Dingle
- Professor of Psychiatry, University of Texas Rio Grande Valley School of Medicine
| | - Sandra DeJong
- Assistant Professor of Psychiatry, Harvard Medical School
| | - Vishal Madaan
- Assistant Professor of Psychiatry, University of Virginia School of Medicine
| | - Lee Ascherman
- Professor of Psychiatry, University of Alabama at Birmingham
| |
Collapse
|
11
|
Abstract
Initiatives to develop better-tolerated, more efficacious pharmacological agents with improved drug delivery systems have driven recent research in attention-deficit hyperactivity disorder (ADHD). While stimulants are the primary pharmacotherapy for ADHD, these drugs have a limited duration of action and a subset of patients will either fail to respond to these medications or have side effects that preclude their use. The development of atomoxetine, the first nonstimulant approved for ADHD, has been followed by additional innovative research, such as the methylphenidate transdermal system, modafinil, NRP-104 and cholinergic agents. This review highlights some of the recent trends in ADHD treatment and the current status of promising treatment options that may help to shape the future of ADHD treatment.
Collapse
Affiliation(s)
- Vishal Madaan
- Child and Adolescent Psychiatry, Creighton University-University of Nebraska Medical Center, Omaha, NE, USA.
| | | | | | | |
Collapse
|
12
|
Abstract
The Bhagavad Gita is based on a discourse between Lord Krishna and Arjuna at the inception of the Kurukshetra war and elucidates many psychotherapeutic principles. In this article, we discuss some of the parallels between the Gita and contemporary psychotherapies. We initially discuss similarities between psychodynamic theories of drives and psychic structures, and the concept of three gunas. Arjuna under duress exhibits elements of distorted thinking. Lord Krishna helps remedy this through a process akin to Cognitive Behavioral Therapy (CBT). We ascertain the analogies between the principles of Gita and CBT, grief emancipation, role transition, self-esteem, and motivation enhancement, as well as interpersonal and supportive psychotherapies. We advocate the pragmatic application of age old wisdom of the Gita to enhance the efficacy of psychotherapeutic interventions for patients from Indian subcontinent and to add value to the art of western psychotherapies.
Collapse
Affiliation(s)
- Subhash C Bhatia
- Department of Psychiatry, Creighton University School of Medicine, Omaha, NE, USA
| | | | | | | | | |
Collapse
|
13
|
Abstract
Lisdexamfetamine (LDX) has been a recent addition to the treatment armamentarium for Attention Deficit Hyperactivity Disorder (ADHD). It is unique among stimulants as it is a prodrug, and has been found to be safe and well-tolerated medication in children older than 6 years, adolescents and adults. It has a smooth onset of action, exerts its action up to 13 hours and may have less rebound symptoms. LDX has proven to be effective in the treatment of ADHD in placebo controlled trials, and improved performance in simulated academic and work environments have been noticed. Both stimulant-naïve and stimulant-exposed patients with ADHD appear to benefit from LDX. It has also shown some promise in improving emotional expression and executive function of patients with ADHD. Adverse effects such as decrease in sleep, loss of appetite and others have been reported with LDX use, just as with other stimulant formulations. Since most such studies exclude subjects with preexisting cardiac morbidity, prescribing precautions should be taken with LDX in such subjects, as with any other stimulant. Study subjects on LDX have been reported to have low scores on drug likability scales, even with intravenous use; as a result, LDX may have somewhat less potential for abuse and diversion. There is a need for future studies comparing other long acting stimulants with LDX in ADHD; in fact clinical trials comparing LDX with OROS (osmotic controlled-release oral delivery system) methylphenidate are currently underway. Furthermore, the utility of this medication in other psychiatric disorders and beyond ADHD is being investigated.
Collapse
Affiliation(s)
- Vishal Madaan
- Department of Psychiatry and Neurobehavioral Sciences, Division of Child and Family Psychiatry, University of Virginia Health System, Charlottesville, VA, USA
| | | | | | | |
Collapse
|
14
|
Kepple AL, Irvine Jr JN, Madaan V. Diagnosis of Depression in Adolescents Following Traumatic Fracture. Prim Care Companion CNS Disord 2012; 14:11m01309. [DOI: 10.4088/pcc.11m01309] [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] [Received: 10/19/2011] [Accepted: 04/12/2012] [Indexed: 10/27/2022] Open
|
15
|
Bestha DP, Madaan V. Clonidine and auditory hallucinations. Innov Clin Neurosci 2012; 9:10. [PMID: 23074695 PMCID: PMC3472898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
16
|
Madaan V, Bestha DP. By fault or by default. Front Psychiatry 2012; 3:27. [PMID: 22470356 PMCID: PMC3311267 DOI: 10.3389/fpsyt.2012.00027] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 03/08/2012] [Indexed: 11/17/2022] Open
Affiliation(s)
- Vishal Madaan
- Child and Family Psychiatry, Psychiatry and Neurobehavioral Sciences, University of Virginia Health System Charlottesville, VA, USA
| | | |
Collapse
|
17
|
Madaan V, Dewan V, Ramaswamy S, Sharma A. Behavioral manifestations of sturge-weber syndrome: a case report. Prim Care Companion J Clin Psychiatry 2011; 8:198-200. [PMID: 16964314 PMCID: PMC1557469 DOI: 10.4088/pcc.v08n0402] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2005] [Accepted: 12/23/2005] [Indexed: 10/20/2022]
Abstract
Sturge-Weber syndrome is a neurocutaneous syndrome that manifests with vascular malformations involving the brain, eye, and skin. We report the case of an elderly patient suffering from Sturge-Weber syndrome who presented with episodic "angry" slapping symptoms to a psychiatric facility. A detailed history, physical and mental-state examination, and elaborate neuropsychological, neuroimaging, and laboratory assessment were undertaken. Clinically, the "angry" slapping episodes were diagnosed as complex partial seizures that improved in frequency with an increase in the dose of the antiepileptic medication. We also have attempted to identify the pathophysiology of such behavioral episodes in Sturge-Weber syndrome. This case report underlines the need for detailed laboratory and neuroimaging work-up in the elderly presenting with atypical symptoms. It also emphasizes the need for identification of and differentiation between similar atypical presentations and appropriate management of resources by the medical staff.
Collapse
|
18
|
|
19
|
Abstract
Driving is a complex task that can be a significant challenge for individuals with attention-deficit/hyperactivity disorder (ADHD). A slight lapse in attention or inhibition while driving (not uncommon in individuals with ADHD) can result in hazardous consequences for these individuals and their families. This is also an interesting clinical scenario for the treating physician, who is always trying to optimize the various treatment options for the patient. Despite such potentially perilous consequences for society, this subject only recently has received researchers' attention. This review paper highlights the psychological differences between drivers with and without ADHD and examines differences between these groups in various driving simulation models. Research updates involving pharmacologic and nonpharmacologic interventions are discussed at length. Although the long-term effects of such interventions may not be clearly defined, there is enough evidence to suggest the public health significance of such interventions for optimally managing adult symptoms of ADHD.
Collapse
Affiliation(s)
- Daniel J Cox
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, Charlottesville, VA, USA.
| | | | | |
Collapse
|
20
|
Abstract
Risperidone is one of the early second-generation antipsychotics that came into the limelight in the early 1990s. Both the oral and long-acting injectable formulations have been subject to numerous studies to assess their safety, efficacy, and tolerability. Risperidone is currently one of the most widely prescribed antipsychotic medications, used for both acute and long-term maintenance in schizophrenia. Risperidone has better efficacy in the treatment of psychotic symptoms than placebo and possibly many first-generation antipsychotics. Risperidone fares better than placebo and first-generation antipsychotics in the treatment of negative symptoms. Risperidone's long acting injectable preparation has been well tolerated and is often useful in patients with medication nonadherence. Risperidone has a higher risk of hyperprolactinemia comparable to first-generation antipsychotics (FGAs) but fares better than many second-generation antipsychotics with regards to metabolic side effects. In this article, we briefly review the recent literature exploring the role of risperidone formulations in schizophrenia, discuss clinical usage, and highlight the controversies and challenges associated with its use.
Collapse
Affiliation(s)
- Vishal Madaan
- University of Virginia Health System, Charlottesville, VA, USA
| | | | | | | | | |
Collapse
|
21
|
Domnitei D, Madaan V. New and extended-action treatments in the management of ADHD: a critical appraisal of lisdexamfetamine in adults and children. Neuropsychiatr Dis Treat 2010; 6:273-9. [PMID: 20520740 PMCID: PMC2877609 DOI: 10.2147/ndt.s3328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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] [Indexed: 11/23/2022] Open
Abstract
Treatment guidelines from the American Academy of Child and Adolescent Psychiatry and the American Academy of Pediatrics state that stimulant medications have the most evidence for safety and efficacy in the treatment of childhood attention deficit hyperactivity disorder (ADHD). Longer-acting stimulants are thus considered as first-line for management of ADHD symptoms. Over the years, concerns about the abuse potential of stimulants have led to the development of alternative formulations of these agents. One such recent development, lisdexamfetamine (LDX) was FDA approved for treating ADHD in children in early 2007 and in adults in early 2008. LDX is a prodrug, which when orally ingested, is converted to l- lysine and active d-amphetamine, which is responsible for its therapeutic activity. This unique formulation may lead to a possible reduction of the abuse potential, by bypassing the first-pass metabolism. In fact, a statistically significant difference for the 'liking' effects on the Drug Questionnaire Response has been reported with intravenous LDX compared to d-amphetamine. LDX appears to have an efficacy and tolerability profile comparable to other extended-release stimulant formulations used to treat ADHD, but reduced potential for abuse-related liking effects when compared to equivalent amounts of immediate-release d-amphetamine. The most common adverse events include decreased appetite, insomnia, upper abdominal pain, headache, irritability, weight loss, and nausea.
Collapse
Affiliation(s)
- Diana Domnitei
- Department of Psychiatry, Creighton University Medical Center, Omaha, NE, USA
| | | |
Collapse
|
22
|
|
23
|
Bestha D, Yang B, Madaan V. Brivaracetam. DRUG FUTURE 2010. [DOI: 10.1358/dof.2010.35.3.1445302] [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: 04/08/2023]
|
24
|
|
25
|
|
26
|
Kratochvil CJ, May DE, Silva SG, Madaan V, Puumala SE, Curry JF, Walkup J, Kepley H, Vitiello B, March JS. Treatment response in depressed adolescents with and without co-morbid attention-deficit/hyperactivity disorder in the Treatment for Adolescents with Depression Study. J Child Adolesc Psychopharmacol 2009; 19:519-27. [PMID: 19877976 PMCID: PMC2830214 DOI: 10.1089/cap.2008.0143] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [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: 11/12/2022]
Abstract
OBJECTIVE In the Treatment for Adolescents with Depression Study (TADS), fluoxetine (FLX) and the combination of fluoxetine with cognitive-behavioral therapy (COMB) had superior improvement trajectories compared to pill placebo (PBO), whereas cognitive-behavioral therapy (CBT) was not significantly different from PBO. Because attention-deficit/hyperactivity disorder (ADHD) and major depressive disorder (MDD) frequently co-exist, we examined whether ADHD moderated these outcomes in TADS. METHOD A total of 439 adolescents with MDD, 12-17 years old, were randomized to FLX, CBT, COMB, or PBO. Random coefficients regression models examined depression improvement in 377 depressed youths without ADHD and 62 with ADHD, including 20 who were treated with a psychostimulant. RESULTS Within the ADHD group, the improvement trajectories of the three active treatments were similar, all with rates of improvement greater than PBO. For those without ADHD, only COMB had a rate of improvement that was superior to PBO. CONCLUSIONS Co-morbid ADHD moderated treatment of MDD. CBT alone or FLX alone may offer benefits similar to COMB in the treatment of MDD in youths with co-morbid MDD and ADHD, whereas monotherapy may not match the benefits of COMB for those without ADHD. The ADHD subgroup analysis presented in this paper is exploratory in nature because of the small number of youths with ADHD in the sample. CLINICAL TRIAL REGISTRY www.clinicaltrials.gov Identifier: NCT00006286. The TADS protocol and all of the TADS manuals are available on the Internet at https://trialweb.dcri.duke.edu/tads/index.html .
Collapse
Affiliation(s)
| | - Diane E. May
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Vishal Madaan
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska
| | - Susan E. Puumala
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska
| | - John F. Curry
- Duke University Medical Center, Durham, North Carolina
| | - John Walkup
- Johns Hopkins University, Baltimore, Maryland
| | - Hayden Kepley
- University of North Carolina at Wilmington, Wilmington, North Carolina
| | | | - John S. March
- Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
27
|
Kratochvil CJ, Vaughan BS, Barker A, Corr L, Wheeler A, Madaan V. Review of pediatric attention deficit/hyperactivity disorder for the general psychiatrist. Psychiatr Clin North Am 2009; 32:39-56. [PMID: 19248915 DOI: 10.1016/j.psc.2008.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Attention deficit/hyperactivity disorder (ADHD) is a common and impairing psychiatric condition, affecting significant numbers of children and adolescents. General psychiatrists serve, both by choice and out of necessity, in the assessment and treatment of children and adolescents who have ADHD and in the education of patients and their families. For many clinicians, however, there are numerous unanswered questions regarding the diagnosis and therapeutic interventions for ADHD. This article provides general psychiatrists with a practical overview and update on the assessment, diagnosis, and treatment of pediatric ADHD. Background information, recent relevant research, current evidence-based practice guidelines, and tips for clinical practice are reviewed in this article. The information is presented in a question-answer format.
Collapse
Affiliation(s)
- Christopher J Kratochvil
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Nebraska Medical Center, 985581 Nebraska Medical Center, Omaha, NE 68198-5581, USA.
| | | | | | | | | | | |
Collapse
|
28
|
Madaan V, Kratochvil C. Publishing as Resident Education: The ASCP Model Psychopharmacology Curriculum. Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)71172-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The ACGME has defined six core competencies for residents, including medical knowledge, practice-based learning and improvement, professionalism, and interpersonal and communication skills. While clinical learning and experience contribute to improving interpersonal skills, professionalism, and general medical knowledge, residents and training programs struggle with educational models that help address more rigorous education in evidence-based medicine and scholarly projects. In this regard, we developed a collaborative academic project for a resident and faculty member that exemplifies these ACGME requirements in a practical and purposeful manner. This project was aimed to enhance the resident's psychopharmacology knowledge, learn evidence based child psychiatry, and develop writing and editing skills; a means to improve clinical as well as academic abilities.One senior faculty member and one child psychiatry resident were invited to become section editors for the child and adolescent section of the American Society of Clinical Psychopharmacology Model Psychopharmacology Curriculum for psychiatry residents. Authors from various university programs nationally, prepared or revised lectures based on their expertise and areas of interest. The authors were provided with as much support and assistance as they desired from the section editors. The resident author/editor met in person with the faculty to plan the project and routinely throughout the process, with frequent e-mail communication throughout the writing and editorial work. After submission of lectures, the section was reviewed and revised by the resident and faculty editors, and submitted for publication. This mentorship experience with psychopharmacology curriculum is an exciting tool that will continue through biennial revisions.
Collapse
|
29
|
Madaan V. Risperidone: A review of efficacy studies in adolescents with schizophrenia. Drugs Today (Barc) 2009; 45:55-62. [DOI: 10.1358/dot.2009.45.1.1315074] [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: 10/20/2022]
|
30
|
|
31
|
Madaan V, Chauhan M, Wilson D. Glutamatergic NMDA receptors as targets for the therapy of depression. DRUG FUTURE 2009. [DOI: 10.1358/dof.2009.034.03.1340034] [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: 10/20/2022]
|
32
|
Abstract
BACKGROUND Childhood-onset schizophrenia is a serious, chronic and disabling illness that can significantly affect the quality of life of the affected individuals and their families. The affected children commonly show significant premorbid developmental impairment and social abnormalities that may provide an early clinical clue to pursue treatment. Until recent times, treatment approaches for childhood schizophrenia were derived from the adult population. However, given the unique developmental challenges in the pediatric population, this extrapolation may not hold true. OBJECTIVE This review encompasses and elaborates on the efficacy, safety and tolerability data available at present for both typical and atypical antipsychotics for treatment of childhood schizophrenia. METHOD A literature search was conducted on PUBMED with special emphasis on double-blind placebo-controlled studies in childhood schizophrenia. Data from similar studies presented in recent meetings were also added to the review. CONCLUSIONS Recent research in pediatric psychopharmacology has led to the Food and Drug Administration's approval of two atypical antipsychotics for the treatment of schizophrenia. Although data in this age group are still sparse, research in this unique population has grown over the years.
Collapse
Affiliation(s)
- Vishal Madaan
- Creighton University Medical Center, Department of Psychiatry, 3528, Dodge Street, Omaha, NE 68131, USA.
| | | | | |
Collapse
|
33
|
Abstract
Stimulants are extremely effective and safe and have been the mainstay for the pharmacological treatment of attention deficit hyperactivity disorder (ADHD) for many years. However, there have been some concerns regarding their abuse, especially by teenagers and young adults. Lisdexamfetamine was recently approved for the treatment of ADHD in 6-12-year-olds and provides a novel approach to the treatment of ADHD. Lisdexamfetamine is a prodrug comprised of dextroamphetamine covalently attached to an essential amino acid, L-lysine. Following oral administration, the amide linkage between the two molecules is enzymatically hydrolyzed in the gastrointestinal tract, thus releasing active dextroamphetamine, which mediates the therapeutic effect in a fashion similar to other stimulants. The parent drug does not bind to sites responsible for the reuptake of norepinephrine and dopamine in vitro. Lisdexamfetamine does not produce high dextroamphetamine levels when injected or snorted, and thus may have lower abuse potential compared to conventional stimulants. Lisdexamfetamine appears to have efficacy and tolerability comparable to other extended-release stimulant formulations used to treat ADHD, but reduced potential for abuse-related liking effects. Compared to equivalent amounts of immediate-release dextroamphetamine.
Collapse
Affiliation(s)
- Vishal Madaan
- Department of Psychiatry, Creighton University/University of Nebraska Medical Center, Omaha, NE, USA.
| |
Collapse
|
34
|
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a common and impairing psychiatric condition that affects significant numbers of children, adolescents and adults. Clinicians in a variety of practice settings (hospital, outpatient, residential, research) strive to diagnose, treat and monitor ADHD in an efficient and evidence-based manner. Tools that facilitate the gathering and interpretation of information from a variety of sources can effectively augment a diagnostic assessment, and can also be useful for longitudinal monitoring. Multiple assessment tools are available, with varying degrees of psychometric validity, clinical utility and overall feasibility (time and cost). This review provides an overview of several available ADHD rating scales and continuous performance tests, and offers a discussion of potential strengths and weaknesses of the instruments. While these tools do not in and of themselves make a diagnosis of ADHD, they can certainly assist in the diagnostic assessment, be crucial in assessing the efficacy of medications in clinical trials, and be a useful adjunct in the clinical management of ADHD.
Collapse
Affiliation(s)
- Vishal Madaan
- Creighton University/University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | | | | | | | | |
Collapse
|
35
|
Abstract
On an average, 4% of medical students from medical schools in the United States choose psychiatry as an option. Although in recent years psychiatry residency match statistics have improved, in general terms it is less competitive to enter this specialty. Most psychiatrists practice as generalists, either in private practice or in the public mental health system. There are marked shortages in child psychiatry and in upcoming new subspecialties. There are ongoing efforts to enhance the core competency of psychiatrists-in-training, with particular emphasis on research literacy to foster lifelong learning skills and (for some) to stimulate interest in a research career track. This article chronicles the trajectory of workforce development and professional growth in psychiatry.
Collapse
Affiliation(s)
- Peter F Buckley
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta, GA, USA.
| | | |
Collapse
|
36
|
Abstract
The American Board of Psychiatry and Neurology (ABPN) is a nonprofit organization founded in 1934 to serve the public interest and promote excellence in the practice of psychiatry and neurology. The ABPN is one of 24 American Board of Medical Specialties boards that have helped develop processes that identify qualified specialists through rigorous credential and training requirements and successful completion of respective certification examinations. The ABPN has had an enormous influence on the practice of psychiatry in America and the world and this influence continues to grow. Here we provide an historical overview of the ABPN, its formation, mission, roles, and changes that have taken place over the years in the certification, recertification, and maintenance of certification process.
Collapse
Affiliation(s)
- Stephen C Scheiber
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 East Ontario Street, Suite 7-200, Chicago, IL 60611, USA
| | | | | |
Collapse
|
37
|
Abstract
There has been a recent increase in recognition and diagnosis of pediatric bipolar disorder (PBD), along with an increase in prescriptions for psychotropic medications for treating children suffering from this chronic, potentially disabling disorder. Lithium remains the only FDA-approved mood stabilizer for use in children > 12 years of age and along with valproic acid and carbamazepine, forms the triad of traditional mood stabilizers used for initiation of treatment for PBD. There has been a recent surge in the use of atypical antipsychotics in PBD, which may be due to their relative ease of administration and lack of requirement for serum level monitoring. A combination of traditional mood stabilizers along with atypical antipsychotics is commonly used in clinical practice, despite a lack of compelling empirical data. Although there is an urgent need for controlled studies on the available treatment options and strategies in PBD, recent expert consensus guidelines and emerging controlled pharmacotherapy data on PBD will lay the platform for future scientific research in the area.
Collapse
Affiliation(s)
- Vishal Madaan
- Creighton University/University of Nebraska Medical Center, Omaha, NE 68131, USA
| | | |
Collapse
|
38
|
|
39
|
Padala PR, Qadri SF, Madaan V. Aripiprazole for the treatment of Tourette's disorder. Prim Care Companion J Clin Psychiatry 2006; 7:296-9. [PMID: 16498492 PMCID: PMC1324961 DOI: 10.4088/pcc.v07n0605] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Accepted: 09/26/2005] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Tourette's disorder is a neuropsychiatric syndrome that manifests with motor and vocal tics, including coprolalia. This article presents a report of successful treatment of these tics with aripiprazole in 2 consecutive patients with Tourette's disorder. METHOD After an informed consent was obtained from the subjects, approval for this retrospective case series was sought from the Institutional Review Board. A detailed history was obtained and physical and mental state examination was performed for each patient. Tic severity was assessed using the Yale Global Tic Severity Scale. Aripiprazole was started at a low dose (5 mg/day) and titrated. The severity of tics was monitored during follow-up. RESULTS The 2 individuals presented in these case reports tolerated aripiprazole well and showed a clinically significant decrease in tic frequency and severity. CONCLUSIONS Aripiprazole, a newer atypical antipsychotic with a unique pharmacodynamic profile, appears to be efficacious in treatment of tics in Tourette's disorder, thus impressing upon the need for placebo-controlled trials in the management of this neuropsychiatric syndrome.
Collapse
|
40
|
Ramaswamy S, Madaan V, Qadri F, Heaney CJ, North TC, Padala PR, Sattar SP, Petty F. A primary care perspective of posttraumatic stress disorder for the Department of Veterans Affairs. Prim Care Companion J Clin Psychiatry 2005; 7:180-7; quiz 188-9. [PMID: 16163401 PMCID: PMC1192436 DOI: 10.4088/pcc.v07n0407] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Accepted: 05/17/2005] [Indexed: 10/20/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a major mental disorder associated with significant morbidity, psychosocial impairment, and disability. The diagnosis of PTSD can be missed in a primary care setting, as patients frequently present with somatic complaints or depression and are often reluctant to discuss their traumatic experiences. As recent studies of veterans returning from the Gulf War and the Iraqi War suggest high rates of PTSD, the U.S. Department of Veterans Affairs (VA) Hospitals are gearing up to face this challenge. It is important to screen these veterans for symptoms of PTSD and make an appropriate referral if required. In this article, we attempt to review PTSD with a special focus on the VA population. In addition to discussing the epidemiology, diagnosis, and treatment options for PTSD, we also suggest screening questions for both combat-related and military sexual trauma-related PTSD.
Collapse
Affiliation(s)
- Sriram Ramaswamy
- Department of Mental Health and Behavioral Sciences, Omaha Veterans Affairs Medical Center, Omaha, Nebraska 68105, USA.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Sharma A, Madaan V, Petty F. Propranolol treatment for neuroleptic-induced akathisia. Prim Care Companion J Clin Psychiatry 2005; 7:202-3. [PMID: 16163405 PMCID: PMC1192441 DOI: 10.4088/pcc.v07n0412b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|