Updates in Pharmacologic Strategies in Adult Attention-Deficit/Hyperactivity Disorder
Anbarasan, Deepti; Safyer, Gabriella; Adler, Lenard A
Attention-deficit/hyperactivity disorder (ADHD) significantly worsens quality of life and long-term functional outcomes in adults. Individual impairments in adults with ADHD can be further contextualized within considerable costs to society at large. Food and Drug Administration (FDA) approved stimulants and nonstimulant medications can significantly improve ADHD symptoms in adults. In the past 2Â decades, the United States FDA has expanded approval of pharmacotherapeutic options for adult ADHD. However, limitations still persist in available psychotropics for certain patient populations such as those with comorbid substance use or cardiovascular illness. Clinicians therefore must appreciate several ongoing investigations into medications with unique mechanisms of action. This article reviews the current FDA approved and emerging medication options while providing guidelines for pharmacologic management of adult ADHD.
Successful Use of Electroconvulsive Therapy for Catatonia After Hypoxic-Ischemic Brain Injury [Case Report]
Kim, Katherine; Anbarasan, Deepti; Caravella, Rachel A; Nally, Emma; Ying, Patrick; Gurin, Lindsey
Screening for Adult ADHD
Anbarasan, Deepti; Kitchin, Michael; Adler, Lenard A
PURPOSE OF REVIEW/OBJECTIVE:This review paper aims to update readers on the importance of screening for attention-deficit/hyperactivity disorder (ADHD) in adults and to provide a primer on how best to screen and diagnose this condition in an efficient and reliable manner. RECENT FINDINGS/RESULTS:The ASRS Screening Scale was updated in 2017 to reflect the changes made to identify ADHD based on the DSM-5 criteria and to reflect our understanding that adult ADHD is characterized by executive functioning deficits that are not explicitly reflected in the DSM-5 criteria. The use of the ASRS Screening Scale improves the clinician's ability to rapidly identify adult patients who require a comprehensive evaluation to diagnose ADHD and/or other comorbid psychiatric conditions. The scale has been validated for use in both the general population and in the ADHD specialty treatment population, which supports its use by both general clinicians and mental health clinicians. Identification of adult ADHD is critical due to the profound personal, familial, and societal costs associated with this condition.
Acute Stress Disorder and the COVID-19 Pandemic
Madanes, Sharon B.; Levenson-Palmer, Rose; Szuhany, Kristin L.; Malgaroli, Matteo; Jennings, Emma L.; Anbarasan, Deepti; Simon, Naomi M.
Dimensional structure of posttraumatic stress disorder symptoms after cardiac arrest
Presciutti, Alex; Frers, Amy; Sumner, Jennifer A; Anbarasan, Deepti; Roh, David J; Park, Soojin; Claassen, Jan; Shaffer, Jonathan A; Agarwal, Sachin
BACKGROUND:Considerable evidence suggests that posttraumatic stress disorder (PTSD) is a heterogeneous construct despite often being treated as a homogeneous diagnostic entity. PTSD in response to cardiac arrest is common and may differ from PTSD following other medical traumas. Most patients are amnesic from the cardiac event, and it is unclear if and how certain PTSD symptoms may manifest. METHODS:We examined the latent structure of PTSD symptoms in 104 consecutive cardiac arrest survivors who were admitted to Columbia University Medical Center. PTSD symptoms were assessed via the PTSD Checklist-Specific at hospital discharge. We performed a confirmatory factor analysis (CFA) to compare 4-factor dysphoria, 4-factor numbing, and 5-factor dysphoric arousal models of PTSD with our data. RESULTS:Â (113)â€¯=â€¯151.59,Â pÂ <Â .01, CFIâ€¯=â€¯0.94, RMSEAâ€¯=â€¯0.057, 90% CI: [0.032, 0.081]) as most representative of the data, after considering a between-factor correlation of 0.99 in the 5-factor dysphoric arousal model, and greater fit statistics than the 4-factor dysphoria model. LIMITATIONS/CONCLUSIONS:Certain factors were defined by only two items. Additionally, PTSD was assessed at discharge (medianâ€¯=â€¯21 days); those assessed before 30 days could be displaying symptoms of acute stress disorder. CONCLUSIONS:Our findings suggest that PTSD symptoms after cardiac arrest are best represented by a 4-factor numbing model of PTSD. PTSD assessment and intervention efforts for cardiac arrest survivors should consider the underlying dimensions of PTSD.
Posttraumatic stress and depressive symptoms characterize cardiac arrest survivors' perceived recovery at hospital discharge
Presciutti, Alex; Verma, Jayati; Pavol, Marykay; Anbarasan, Deepti; Falo, Cristina; Brodie, Daniel; Rabbani, Leroy E; Roh, David J; Park, Soojin; Claassen, Jan; Agarwal, Sachin
OBJECTIVE:To test the hypothesis that posttraumatic stress and depressive symptoms, not cognitive or functional impairment, are associated with cardiac arrest survivors' negative recovery perceptions at hospital discharge. METHODS:Prospective observational cohort of cardiac arrest patients admitted between 9/2015-5/2017. Survival to discharge with sufficient mental status to complete a psychosocial interview was the main inclusion criterion. Perceived recovery was assessed through the question, "Do you feel that you have made a complete recovery from your arrest?" The following measures were examined as potential correlates of perceived recovery: Repeatable Battery for Assessment of Neuropsychological Status, Modified Lawton Physical Self-Maintenance Scale, Barthel Index, Modified Rankin Scale, Cerebral Performance Category, Center for Epidemiological Studies-Depression (CES-D), and PTSD Checklist-Specific (PCL-S). Logistic regression evaluated associations between perceived recovery and potential correlates of recovery. RESULTS:64/354 patients (58% men, 48% white, mean age 52â€¯Â±â€¯17) were included. 67% (nâ€¯=â€¯43) had a negative recovery perception. There were no differences among patients' cognitive and functional domains. In individual models, patients with higher PCL-S and CES-D scores were more likely to have a negative recovery perception after adjusting for age and gender (OR: 1.2, 95% CI [1.1, 1.4], pâ€¯=â€¯0.003) and (OR: 1.1, 95% CI [1.0, 1.1], pâ€¯=â€¯0.05). CONCLUSIONS:Within one month after a cardiac arrest event, survivors' negative recovery perceptions are associated with psychological distress.
Women have worse cognitive, functional, and psychiatric outcomes at hospital discharge after cardiac arrest
Agarwal, Sachin; Presciutti, Alex; Verma, Jayati; Pavol, Marykay A; Anbarasan, Deepti; Brodie, Daniel; Rabbani, Leroy E; Roh, David J; Park, Soojin; Claassen, Jan; Stern, Yaakov
AIM/OBJECTIVE:To examine gender differences among cardiac arrest (CA) survivors' cognitive, functional, and psychiatric outcomes at discharge. METHODS:This is a prospective, observational cohort of 187 CA patients admitted to Columbia University Medical Center, considered for Targeted Temperature Management (TTM), and survived to hospital discharge between September 2015 and July 2017. Patients with sufficient mental status at hospital discharge to engage in the Repeatable Battery for Neuropsychological Status (RBANS), Modified Lawton Physical Self-Maintenance Scale (M-PSMS), Cerebral Performance Category Scale (CPC), Center for Epidemiological Studies Depression Scale (CES-D), and Post-Traumatic Stress Disorder Checklist - Civilian Version (PCL-C) were included. Fisher's exact, Wilcoxon Rank Sum, and regression analysis were utilized. RESULTS:80 patients (38% women, 44% white, mean age 53â€¯Â±â€¯17â€¯years) were included. No significant gender differences were found for age, race, Charlson Comorbidity Index, premorbid CPC or psychiatric diagnoses, arrest related variables, discharge CPC, or PCL-C scores. Women had significantly worse RBANS (64.9 vs 74.8, pâ€¯=â€¯.01), M-PSMS (13.6 vs 10.6, pâ€¯=â€¯.02), and CES-D (22.8 vs 14.3, pâ€¯=â€¯.02) scores. These significant differences were maintained in multivariate models after adjusting for age, initial rhythm, time to return of spontaneous circulation, and TTM. CONCLUSIONS:Women have worse cognitive, functional, and psychiatric outcomes at hospital discharge after cardiac arrest than men. Identifying factors contributing to these differences is of great importance in cardiac arrest outcomes research.
Laser ablation is effective for temporal lobe epilepsy with and without mesial temporal sclerosis if hippocampal seizure onsets are localized by stereoelectroencephalography
Youngerman, Brett E; Oh, Justin Y; Anbarasan, Deepti; Billakota, Santoshi; Casadei, Camilla H; Corrigan, Emily K; Banks, Garret P; Pack, Alison M; Choi, Hyunmi; Bazil, Carl W; Srinivasan, Shraddha; Bateman, Lisa M; Schevon, Catherine A; Feldstein, Neil A; Sheth, Sameer A; McKhann, Guy M
OBJECTIVE:Selective laser amygdalohippocampotomy (SLAH) using magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is emerging as a treatment option for drug-resistant mesial temporal lobe epilepsy (MTLE). SLAH is less invasive than open resection, but there are limited series reporting its safety and efficacy, particularly in patients without clear evidence of mesial temporal sclerosis (MTS). METHODS:We report seizure outcomes and complications in our first 30 patients who underwent SLAH for drug-resistant MTLE between January 2013 and December 2016. We compare patients who required stereoelectroencephalography (SEEG) to confirm mesial temporal onset with those treated based on imaging evidence of MTS. RESULTS:Twelve patients with SEEG-confirmed, non-MTS MTLE and 18 patients with MRI-confirmed MTS underwent SLAH. MTS patients were older (median age 50 vs 30Â years) and had longer standing epilepsy (median 40.5 vs 5.5Â years) than non-MTS patients. Engel class I seizure freedom was achieved in 7 of 12 non-MTS patients (58%, 95% confidence interval [CI] 30%-86%) and 10 of 18 MTS patients (56%, 95% CI 33%-79%), with no significant difference between groups (odds ratio [OR] 1.12, 95% CI 0.26-4.91, PÂ =Â .88). Length of stay was 1Â day for most patients (range 0-3Â days). Procedural complications were rare and without long-term sequelae. SIGNIFICANCE/CONCLUSIONS:We report similar rates of seizure freedom following SLAH in patients with MTS and SEEG-confirmed, non-MTS MTLE. Consistent with early literature, these rates are slightly lower than typically observed with surgical resection (60%-80%). However, SLAH is less invasive than open surgery, with shorter hospital stays and recovery, and severe procedural complications are rare. SLAH may be a reasonable first-line surgical option for patients with both MTS and SEEG confirmed, non-MTS MTLE.
Changes in Neutrophil Count After Antipsychotic Prescription Among a Retrospective Cohort of Patients With Benign Neutropenia
Campion, Paul; Campion, Gabriel; Anbarasan, Deepti
BACKGROUND: There is a paucity of literature regarding the effect of antipsychotics on absolute neutrophil count (ANC) of patients with benign neutropenia (BN). We evaluated the change in ANC after atypical antipsychotic prescription (excluding clozapine) in a retrospective cohort of 22 patients with BN. METHODS/PROCEDURES: Records of all patients with BN who were prescribed antipsychotics and who had ANC measured before and during antipsychotic treatment were obtained from Bronx VA Medical Center between 2005 and 2015 (inclusive). Twenty-two patients met criteria for inclusion. Individual and group mean ANC were calculated before treatment and during treatment. A paired, two-tailed t test was performed on the group ANC means. RESULTS: The group mean pretreatment ANC was 1.24 +/- 0.220 K/cmm, and the mean ANC during the time of antipsychotic prescription increased to 1.40 +/- 0.230 K/cmm, with a P value of 0.0045, t value of 3.18, degrees of freedom equal to 21, and 95% confidence interval of 1.30 to 1.49 K/cmm. CONCLUSIONS: There was a statistically significant increase in ANC among our cohort during the time of antipsychotic prescription. All BN patients who were prescribed antipsychotics maintained a stable neutrophil count, with none of the 22 patients with BN in this study developing agranulocytosis during treatment. Although this study is limited by a low patient count as well as other demographic factors, these findings provide initial evidence regarding the safety of prescribing atypical antipsychotics to BN patients. Further studies are needed to replicate these findings and assess for effects of individual medications.
Anton syndrome as a result of MS exacerbation
Kim, Nina; Anbarasan, Deepti; Howard, Jonathan