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HIV and AIDS in Older Adults: Neuropsychiatric Changes

Mitra, Paroma; Jain, Ankit; Kim, Katherine
PURPOSE OF REVIEW/OBJECTIVE:Patients diagnosed with HIV can now survive well into their old age. Aging with HIV is not only associated with comorbid medical illnesses but also with neuropsychiatric conditions that can range from cognitive changes to severe behavioral manifestations. This paper reviews mood, anxiety, and cognitive changes in older patients with HIV, as well as some of the treatment challenges in this population. RECENT FINDINGS/RESULTS:Most recent findings show that untreated HIV illness over a long period of time may further worsen both preexisting neuropsychiatric illness and may cause new onset behavioral and cognitive symptoms. HIV induces immune phenotypic changes that have been compared to accelerated aging Low CD 4 counts and high viral counts are indicative of poor prognosis. Evaluation for potential HIV infections may be overlooked in older adults and require screening. Older adults experience accelerated CD4 cell loss. Older adults endorsing new onset mood or cognitive changes must be screened for HIV infection. New onset neurobehavioral symptoms should be carefully screened for and treated simultaneously in patients with HIV infection.
PMID: 35809165
ISSN: 1535-1645
CID: 5280722

Selective serotonin reuptake inhibitors in the treatment of depression, anxiety, and post-traumatic stress disorder in substance use disorders: a Bayesian meta-analysis

Fluyau, Dimy; Mitra, Paroma; Jain, Ankit; Kailasam, Vasanth Kattalai; Pierre, Christopher G
PURPOSE/OBJECTIVE:Examine SSRIs' efficacy in treating depression, anxiety, PTSD, and substance use in individuals with addiction. METHODS:From their inception until August 6, 2021, we searched Google Scholar, PubMed, Scopus, OVID MEDLINE, and Academic Search Complete. We included randomized controlled trials (RCTs) and omitted open-label studies. Bayesian analysis was performed. Bayes factor (BF) established efficacy and tau (τ) statistical heterogeneity. The RoB2 method assessed potential biases. Subgroup analysis was carried out to determine SSRI performance. Treatment duration, SSRI dosage, and attrition rate were all examined in meta-regression. RESULTS:We investigated 64 RCTs with 6128 participants. SSRIs reduced depressive symptoms in opioid, alcohol, cocaine, cannabis, and nicotine use disorders (d = 0.353, BF > 99); social anxiety symptoms in alcohol use disorder (d = 0.875, BF > 99); and generalized anxiety symptoms in opioid, alcohol, cocaine, marijuana, and nicotine use disorders (d = 0.346, BF = 4.236). Evidence for PTSD was inconclusive. SSRIs facilitated abstinence for opioid, alcohol, cocaine, cannabis, and nicotine use (d = 0.325, BF > 99); reduced craving for alcohol, cocaine, and nicotine use (d = 0.533, BF = 24.129); and reduced alcohol use (d = 0.452, BF > 99) and cocaine use (d = 0.255, BF = 3.87). Fluoxetine showed the highest antidepressant effect. There was no effect of attrition rate, SSRI dosage, or treatment length on SSRI's efficacy. CONCLUSIONS:Results support the use of SSRIs to treat substance use, depression, and anxiety in individuals with addiction. PROTOCOL REGISTRATION/UNASSIGNED:PROSPERO registration number: CRD42020164944.
PMID: 35246699
ISSN: 1432-1041
CID: 5174792

Substance Use in Older Adults

Chapter by: Mitra, Paroma
in: Substance and Non-Substance Related Addictions: A Global Approach by
[S.l.] : Springer International Publishing, 2022
pp. 39-48
ISBN: 9783030848330
CID: 5459962

Older Adult Patients with Both Psychiatric and Substance Abuse Disorders: Prevalence and Health Service Use

Chapter by: Jain, Ankit; Mitra, Paroma
in: Essential Reviews in Geriatric Psychiatry by
[S.l.] : Springer International Publishing, 2022
pp. 417-420
ISBN: 9783030949594
CID: 5500802

Five-Year Alcohol and Drug Treatment Outcomes of Older Adults Versus Middle-Aged and Younger Adults in a Managed Care Program

Chapter by: Mitra, Paroma
in: Essential Reviews in Geriatric Psychiatry by
[S.l.] : Springer International Publishing, 2022
pp. 421-424
ISBN: 9783030949594
CID: 5500992

Screening and Brief Intervention for Substance Misuse Among Older Adults: The Florida BRITE Project

Chapter by: Mitra, Paroma
in: Essential Reviews in Geriatric Psychiatry by
[S.l.] : Springer International Publishing, 2022
pp. 431-436
ISBN: 9783030949594
CID: 5501032

Treatment of Late-Life Depression Complicated by Alcohol Dependence

Chapter by: Mitra, Paroma
in: Essential Reviews in Geriatric Psychiatry by
[S.l.] : Springer International Publishing, 2022
pp. 425-429
ISBN: 9783030949594
CID: 5501212

Naltrexone as an Adjunctive Treatment for Older Patients with Alcohol Dependence

Chapter by: Mitra, Paroma
in: Essential Reviews in Geriatric Psychiatry by
[S.l.] : Springer International Publishing, 2022
pp. 413-416
ISBN: 9783030949594
CID: 5501232

A systematic review and meta-analysis of the risk of dementia associated with benzodiazepine use, after controlling for protopathic bias

Chapter by: Mitra, Paroma
in: Essential reviews in geriatric psychiatry by Tampi, Rajesh R [Ed]; Tampi, Deena J [Ed]; Young, Juan J [Ed]; Balasubramaniam, Meera [Ed]; Joshi, Pallavi [Ed]
Cham, Switzerland: Springer Nature Switzerland AG; Switzerland, 2022
pp. 35-38
ISBN: 978-3-030-94959-4
CID: 5377592

Treatment of Patients with Mental Illness Amid A Global COVID-19 Pandemic

Jain, Ankit; Sahu, Kamal Kant; Mitra, Paroma
A newly discovered coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the ongoing pandemic of coronavirus disease 2019 (COVID-19), which is not only physically challenging but also has many subtle and overt mental impacts. The concern of being infected, lack of antiviral agents, preventive strategies of social distancing, and home isolation have created unrest in the society. The way of reacting to emergencies varies from individual to individual, and that this variability lies in our unique personality traits. The COVID-19 pandemic is testing the mental stability of all of us, and hence it is crucial to recognize the vulnerable population and support them to prevent or minimize the catastrophe like post-traumatic stress disorder (PTSD), emotional trauma, and suicides. In this context, the role of psychiatrists, psychotherapists, and other mental healthcare providers is indispensable.
PMID: 33973210
ISSN: 0065-2598
CID: 4878302