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Validation of a novel Psychosis-Implicit Association Test (P-IAT) as a diagnostic support tool

Kirschenbaum, Michael A; Lopez, Leonardo V; de Filippis, Renato; Ali, Asra F; Millner, Alexander J; Nock, Matthew K; Kane, John M
Despite significant advances in early-intervention services for psychosis, delays in identifying patients continue to impede the delivery of prompt and effective treatments. We sought to develop and preliminarily validate a self-administered psychosis implicit association task (P-IAT) as a screening and diagnostic support tool for identifying individuals with psychotic illness in community settings. The P-IAT is a response latency task, designed to measure the extent to which individuals implicitly associate psychosis-related terms with the "self." The P-IAT was administered to 57 participants across 3 groups: healthy controls (N=19), inpatients hospitalized with active psychosis (N=19), and outpatients with psychotic disorders (N=19). Mean D-scores (the output of the task) differed significantly between the illness groups and healthy controls (Mann-Whitney U=138, p<.001). A receiver operating curve was plotted to assess the performance of D-scores in predicting a psychosis diagnosis, yielding an area under the curve of 0.81. When participant D-scores exceeded -0.24, the test achieved a specificity of 100% (sensitivity: 47%), with all 18 participants scoring above this threshold belonging to the illness groups. The discriminant performance of the P-IAT suggests its potential to augment existing screening instruments and inform referral decision making, particularly in settings with limited access to specialist providers.
PMID: 35660967
ISSN: 1872-7123
CID: 5279532

Risperidone- and paliperidone-induced hepatotoxicity: Case report and review of literature

Khorassani, Farah; Sousonis, Frances; Lopez, Leonardo V
PURPOSE/OBJECTIVE:A case of hepatotoxicity likely due to use of risperidone and paliperidone is reported. SUMMARY/CONCLUSIONS:A 23-year-old man with schizophrenia was admitted to an inpatient psychiatric unit after an exacerbation of mental illness secondary to medication nonadherence. During 13 days of treatment with risperidone, the patient's liver enzyme levels rose sharply, so antipsychotic therapy was switched to oral paliperidone. After a 5-day downward trend in liver enzyme levels, a dose of intramuscular paliperidone was administered to augment oral paliperidone therapy. After 10 days of paliperidone use, abnormally high liver enzyme levels were again noted; both oral and intramuscular paliperidone therapy were discontinued and haloperidol was initiated, with complete resolution of liver enzyme abnormalities within approximately 4 weeks. Scoring of this case using the algorithm of Naranjo et al indicated probable associations between risperidone use and hepatotoxicity (a score of 7) and paliperidone use and hepatotoxicity (a score of 8). To our knowledge, this is the first case report describing a patient who developed hepatotoxicity during risperidone use that did not remit with a switch to paliperidone therapy. CONCLUSION/CONCLUSIONS:Findings of this case suggest that patients who develop hepatotoxicity with use of risperidone may also do so with paliperidone use; this, in turn, suggests that both risperidone and its metabolite are capable of causing hepatotoxicity. Patients who develop hepatotoxicity in response to risperidone or paliperidone therapy may benefit from treatment with an alternative antipsychotic with a different chemical structure.
PMID: 32699878
ISSN: 1535-2900
CID: 4551222

Health Disparities in Black Patients with Severe Mental Illness and the Role of Structural Racism

Asonye, Uzoamaka; Apping, Nicholas; Lopez, Leonardo, V; Popeo, Dennis M.
ISSN: 0048-5713
CID: 5263762

Supatherapeutic Serum Clozapine Concentration After Transition From Traditional to Electronic Cigarettes

Khorassani, Farah; Kaufman, Milena; Lopez, Leonardo V
PMID: 29901566
ISSN: 1533-712x
CID: 3162392

Characteristics of Patients Involved in Physical Assault in an Acute Inpatient Psychiatric Setting

Sanghani, Sohag N; Marsh, Akeem N; John, Majnu; Soman, Arya; Lopez, Leonardo V; Young, Yolana A; Russ, Mark J
BACKGROUND: Although aggressive behavior in psychiatric settings is a major concern, very few studies have focused exclusively on physical assault in a general inpatient psychiatric population. OBJECTIVES: This study had 3 main goals: (1) to evaluate the prevalence of assaultive behavior in an acute psychiatric hospital; (2) to identify the clinical and socio-demographic factors associated with assaultive behavior during hospitalization; and (3) to explore whether a diagnosis of schizophrenia spectrum disorder increases the risk of assaultive behavior. METHODS: We conducted a retrospective chart review of patients admitted to acute units in a psychiatric hospital between 2009 and 2012. A subset of occurrence reports identified by a multidisciplinary team as "physical assault" was included in the analysis. Using logistic multivariate regression analysis, these patients were compared with a randomly selected nonassaultive control group, matched for length of stay to identify factors associated with assaultive behavior. RESULTS: Of 757 occurrence reports, 613 met criteria for significant assault committed by 356 patients over 309,552 patient days. The assault incident density was 1.98 per 1000 patient days. In the logistic regression model of best fit, the factors significantly associated with assaultive behavior were age, legal status, and substance use. A diagnosis of schizophrenia spectrum disorder was not significantly associated with assaultive behavior. CONCLUSIONS: Clinicians should take extra precautions for involuntarily admitted young patients with a history of substance use, as they are more likely to exhibit assaultive behavior. A diagnosis of schizophrenia spectrum disorder in itself is not significantly associated with assaultive behavior. Screening instruments such as the Dynamic Appraisal of Situational Aggression may be useful in assessing risk of assault.
PMID: 28749830
ISSN: 1538-1145
CID: 2650042

Accuracy of Clinician Assessments of Medication Status in the Emergency Setting: A Comparison of Clinician Assessment of Antipsychotic Usage and Plasma Level Determination

Lopez, Leonardo V; Shaikh, Atef; Merson, Jonathan; Greenberg, Jessica; Suckow, Raymond F; Kane, John M
PURPOSE/OBJECTIVE:The present study aimed to assess the level of agreement between clinicians' routine assessments of medication status and plasma levels of commonly prescribed antipsychotic medications in patients presenting to an emergency room with an exacerbation of psychosis. METHODS:We studied 105 patients presenting to an emergency room and admitted to an inpatient psychiatric unit with a diagnosis of schizophrenia, schizoaffective disorder, bipolar I disorder, or psychotic disorder not otherwise specified and a prior outpatient medication regimen including risperidone, olanzapine, quetiapine, aripiprazole, or paliperidone. Plasma levels of antipsychotics were drawn and sent to a specialty laboratory for testing. FINDINGS/RESULTS:Of the 97 patients with usable samples, 33 (34%) were found to have therapeutic antipsychotic levels. Of these, 22 were judged by emergency room staff to be taking their medications at the appropriately prescribed doses, whereas 11 were judged not to be taking medication at all. Sixty-four patients were found to have subtherapeutic antipsychotic levels, 31 of whom had been assessed to be taking medication as prescribed. Emergency assessment of medication status predicted therapeutic and nontherapeutic antipsychotic levels at rates of 41.5% and 75%, respectively. Emergency staff assessment was statistically independent from the likelihood of having a therapeutic antipsychotic level. IMPLICATIONS/CONCLUSIONS:In patients presenting to emergency rooms with exacerbations of psychosis who are subsequently admitted to an inpatient facility, common assessments of medication status are frequently misleading. Readily available methods for rapidly measuring antipsychotic plasma levels in clinical settings are needed for clinicians to make reliable assessments.
PMID: 28353490
ISSN: 1533-712x
CID: 3003312

A Randomized Comparison of Aripiprazole and Risperidone for the Acute Treatment of First-Episode Schizophrenia and Related Disorders: 3-Month Outcomes

Robinson, Delbert G; Gallego, Juan A; John, Majnu; Petrides, Georgios; Hassoun, Youssef; Zhang, Jian-Ping; Lopez, Leonardo; Braga, Raphael J; Sevy, Serge M; Addington, Jean; Kellner, Charles H; Tohen, Mauricio; Naraine, Melissa; Bennett, Natasha; Greenberg, Jessica; Lencz, Todd; Correll, Christoph U; Kane, John M; Malhotra, Anil K
Research findings are particularly important for medication choice for first-episode patients as individual prior medication response to guide treatment decisions is unavailable. We describe the first large-scale double-masked randomized comparison with first-episode patients of aripiprazole and risperidone, 2 commonly used first-episode treatment agents. One hundred ninety-eight participants aged 15-40 years with schizophrenia, schizophreniform disorder, schizoaffective disorder or psychotic disorder Not Otherwise Specified, and who had been treated in their lifetime with antipsychotics for 2 weeks or less were randomly assigned to double-masked aripiprazole (5-30 mg/d) or risperidone (1-6 mg/d) and followed for 12 weeks. Positive symptom response rates did not differ (62.8% vs 56.8%) nor did time to response. Aripiprazole-treated participants had better negative symptom outcomes but experienced more akathisia. Body mass index change did not differ between treatments but advantages were found for aripiprazole treatment for total and low-density lipoprotein cholesterol, fasting glucose, and prolactin levels. Post hoc analyses suggested advantages for aripiprazole on depressed mood. Overall, if the potential for akathisia is a concern, low-dose risperidone as used in this trial maybe a preferred choice over aripiprazole. Otherwise, aripiprazole would be the preferred choice over risperidone in most situations based upon metabolic outcome advantages and some symptom advantages within the context of similar positive symptom response between medications.
PMID: 26338693
ISSN: 1745-1701
CID: 3004292

Recommendations for the monitoring of serum concentrations of antipsychotic drugs in the treatment of schizophrenia

Lopez, Leonardo V; Kane, John M
PMID: 26455671
ISSN: 1555-2101
CID: 3003302

Addressing population heterogeneity and distribution in epidemics models using a cellular automata approach

López, Leonardo; Burguerner, Germán; Giovanini, Leonardo
BACKGROUND:The spread of an infectious disease is determined by biological and social factors. Models based on cellular automata are adequate to describe such natural systems consisting of a massive collection of simple interacting objects. They characterize the time evolution of the global system as the emergent behaviour resulting from the interaction of the objects, whose behaviour is defined through a set of simple rules that encode the individual behaviour and the transmission dynamic. METHODS:An epidemic is characterized trough an individual-based-model built upon cellular automata. In the proposed model, each individual of the population is represented by a cell of the automata. This way of modeling an epidemic situation allows to individually define the characteristic of each individual, establish different scenarios and implement control strategies. RESULTS:A cellular automata model to study the time evolution of a heterogeneous populations through the various stages of disease was proposed, allowing the inclusion of individual heterogeneity, geographical characteristics and social factors that determine the dynamic of the desease. Different assumptions made to built the classical model were evaluated, leading to following results: i) for low contact rate (like in quarantine process or low density population areas) the number of infective individuals is lower than other areas where the contact rate is higher, and ii) for different initial spacial distributions of infected individuals different epidemic dynamics are obtained due to its influence on the transition rate and the reproductive ratio of disease. CONCLUSIONS:The contact rate and spatial distributions have a central role in the spread of a disease. For low density populations the spread is very low and the number of infected individuals is lower than in highly populated areas. The spacial distribution of the population and the disease focus as well as the geographical characteristic of the area play a central role in the dynamics of the desease.
PMID: 24725804
ISSN: 1756-0500
CID: 3004282

Plasma levels of second-generation antipsychotics and clinical response in acute psychosis: a review of the literature

Lopez, Leonardo V; Kane, John M
OBJECTIVE:The objective of the study is to assess the relationships between plasma concentrations (Cps) of second-generation antipsychotics (SGAs) and clinical outcome in order to establish the clinical value of therapeutic drug monitoring. METHOD/METHODS:In April 2012, we searched PubMed and MEDLINE databases for English-language articles using the keywords risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, paliperidone, iloperidone, asenapine, lurasidone, therapeutic drug monitoring, serum level, and plasma level. One hundred and ninety-one articles were retrieved from the initial search. Articles were selected for inclusion if they involved an attempt to correlate Cps with efficacy measures, if they were prospective in nature, and if they examined patients experiencing an acute exacerbation of a psychotic illness. Ultimately 11 articles were selected. RESULTS:Of the nine compounds involved in the search, only four were included in relevant articles, and only two of these were involved in multiple trials. No studies involving the most recently developed compounds (paliperidone, iloperidone, asenapine, and lurasidone) were identified. Studies varied widely in methodology, with only four studies adopting a fixed-dose model. Results differed considerably between studies regarding both clinical and adverse effects, with 6 of the 11 studies revealing a positive correlation between Cps and response. CONCLUSIONS:The utility of therapeutic drug monitoring of SGAs (other than clozapine) remains an open question, although limited evidence from fixed-dose studies is encouraging. We discuss the potentially significant clinical value of antipsychotic Cps and the consequent need for further research in this area.
PMID: 23664462
ISSN: 1573-2509
CID: 3003292