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Ojo, K Y; Balasubramaniam, M; Gurin, L; Mitra, P
Introduction: The prevalence of attention deficit hyperactivity disorder (ADHD) in older adults is estimated to be between 1.5 - 3.3 % across studies (Kooji et al, 2016). Older adults constitute a group in which ADHD is frequently underdiagnosed, undertreated, and often overlooked in both clinical practice and research. It is believed that older adults may have experienced longitudinal impact and a lifelong consequences of ADHD symptoms, in the absence of support for their problems in child- or adulthood (Michielson et al, 2015). Nadeau reported that age related cognitive changes, worsening physical health, and the lack of structure that often comes with retirement frequently tend to perpetuate symptoms of inattention (Nadeau, 2018). We present the case of an elderly man with ADHD. This will be followed by a review of the literature on ADHD in older adults.
Method(s): Case of Mr. R: We present the case of Mr. R, a 75-year old man who presented for evaluation of cognitive complaints. He reported chronic difficulties with attention and concentration, with recent worsening of focus, attention, concentration, and memory. Assessment consisted of evaluation of the patient, collateral information from his wife, brain imaging, and neuropsychological testing. His presentation was felt to be consistent with chronic untreated ADHD, now superimposed with mild cognitive changes across other domains. A trial of low dose methylphenidate was associated with marked improvement in his ability to focus, to follow conversations, and his working memory. The subjective changes were corroborated on the Montreal cognitive assessment (MOCA) which showed improvement in his scores, especially in the area of attention. Electronic searches of The Cochrane Central Register of Controlled Trials and the standard bibliographic databases PubMed, MEDLINE, EMBASE, and PsycINFO will be performed for papers which focus on ADHD in older adults. Keywords include "late life," "elderly," "aged," "senior citizen," or "geriatric" combined with the keywords "ADHD" or "attention deficit," Original research, case reports, and reviews will be included.
Result(s): Preliminary search conducted yielded five papers. Data from the included papers will be extracted. The epidemiology of ADHD in older adults will be discussed. This will be followed by a description of diagnostic assessment and diagnostic issues specific to older adults. The impact of ADHD in older adults will be outlined, which emphasis on its difference from that in the younger population. This will be followed by treatment considerations unique to older adults. Finally, the relationship between ADHD and cognitive impairment will be explored.
Conclusion(s): ADHD is frequently underdiagnosed and undertreated in older adults. Timely and accurate diagnosis followed by treatment results in significant improvement in symptoms and functionality. This research was funded by: None
ISSN: 1545-7214
CID: 4387942

Session 204 [Meeting Abstract]

Popeo, D; Karp, J; Mitra, P; Diaz, N
At the beginning of a career in academic psychiatry, new attending psychiatrists do not have all the skills necessary to advance towards promotion. For instance, attendings are most likely well versed in reading and perhaps in writing medical literature, but may not have the knowledge, skills or attitudes to provide a meaningful peer review to a publication. Aside from providing an important, meaningful service to medical science, reviewing articles prior to publication can allow novice researchers and writers to gain important skills in writing for publication and critical thinking. It also allows one to keep up to date on the latest science, and build your CV. This interactive workshop will give participants the opportunity to work in small groups to review an article, present their evaluation and compare their findings with experts.Dr. Nery Diaz and Dr. Paroma Mitra will discuss the basic process of peer review, why participants should accept requests to review articles and provide a "how to" guide. Then, participants will form small groups and group review a section of an article using the guidelines discussed previously. After, the groups will report out their findings. The results from the official review of the article will be shared so that participants can compare findings. Dr. Jordan Karp will provide insights into the process of publication from the viewpoint of a member of the editorial board of the American Journal of Geriatric Psychiatry. Finally, Dr. Popeo will provide a brief summary.
ISSN: 1545-7214
CID: 4387932

HIV Neurocognitive Disorders

Chapter by: Mitra, Paroma; Sharman, Tariq
in: StatPearls by
Treasure Island FL : StatPearls Publishing, 2020
pp. -
CID: 4403202

Narcissistic Personality Disorder

Chapter by: Mitra, Paroma; Fluyau, Dimy
in: StatPearls by
Treasure Island FL : StatPearls Publishing, 2020
pp. -
CID: 4403192


Nasrulla, I; Balasubramaniam, M; Mitra, P; Dhar, R
Clinical assessment in geriatric psychiatry is complex. It involves detection of subtle signs, separation of psychiatric symptoms from co-occurring medical and neurological manifestations, and work with families. Rating scales are a useful complement to clinical skills in ensuring all relevant questions have been asked, objectively detecting the presence or absence of an illness, quantifying its severity, as well as tracking response to treatment, and the course of an illness over time. This presentation will touch upon multiple available rating scales, with focus on the ones which will be of use to the busy clinician. The first section of the presentation will be a discussion on rating scales for depression, namely the Geriatric Depression Rating Scale (GDS), the Cornell Scale for Depression in Dementia (CSDD), the Hamilton Depression Scale (HDS), and the Montgomery Asberg Depression Rating Scale (MADRS). In the next section, we will describe an overview of the various types of assessment scales for dementia, such as the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), St. Louis University Mental Status Exam (SLUMS), Alzheimer's Disease Assessment Scale - Cognitive sub-scale (ADAS-cog), and the Modified Mini-Mental State Examination (3-MS). The third section of the presentation will constitute a discussion of rating scales to detect neuropsychiatric disturbances, such as the Neuropsychiatry Inventory (NPI), the Neurobehavioral Rating Scale (NBRS), and the Cohen Mansfield Agitation Inventory (CMAI). The final section will be a discussion of common rating scales used in assessing anxiety such as the Geriatric Anxiety Inventory (GAI) and the Geriatric Anxiety Scale (GAS). This section will also explore caregiver burden scales, with focus on the Zarit Caregiver Burden Interview. Every sub-section of the presentation will provide an overview of the literature and comparison in terms of clinical utility, practicality, and psychometric properties. Since primary care physicians provide majority of the medical care for the elderly, screening tools for primary care that can be incorporated in a busy clinical practice will also be discussed.
ISSN: 1545-7214
CID: 3790662

The Current Role of Medical Simulation in Psychiatry

Chapter by: Mitra, Paroma; Fluyau, Dimy
in: StatPearls by
Treasure Island FL : StatPearls Publishing, 2019
pp. -
CID: 4244582

Antipsychotics for Amphetamine Psychosis. A Systematic Review

Fluyau, Dimy; Mitra, Paroma; Lorthe, Kervens
Background: Among individuals experiencing amphetamine psychosis, it may be difficult to rule out schizophrenia. The use of antipsychotics for the treatment of amphetamine psychosis is sparse due to possible side effects. Some arguments disfavor their use, stating that the psychotic episode is self-limited. Without treatment, some individuals may not fully recover from the psychosis and may develop full-blown psychosis, emotional, and cognitive disturbance. This review aims to investigate the clinical benefits and risks of antipsychotics for the treatment of amphetamine psychosis. Methods: Electronic search on trials on antipsychotic drugs for amphetamine psychosis from their inception to November 2018 was conducted in PubMed, Scopus, Google Scholar, EBSCOhost, ProQuest, Cochrane Review Database, Medline Ovid, and EMBASE following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The Cochrane risk-of-bias tool assessed the risk of bias, the methodological quality of individual trials was assessed by the Oxford Quality Scoring System, and the quality of evidence for recommendations was judged by the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). The results were synthesized qualitatively and quantitatively. Results: The investigation of six randomized controlled trials of 314 participants showed that aripiprazole, haloperidol, quetiapine, olanzapine, and risperidone were able to reduce or control the psychotic episode (positive and negative symptoms) induced by amphetamine use with no adverse event. Although the side-effect profile of these agents varied, no drug was clinically superior to others. Conclusions: This review suggests that antipsychotics seem to be efficacious for amphetamine psychosis on both positive and negative symptoms. Practitioners need to tailor their use based on risks for side effects individually.
PMID: 31681046
ISSN: 1664-0640
CID: 4179172


Mitra, Paroma; Balasubramaniam, Meera; Dhar, Romika; Chang, Beverly
ISSN: 1064-7481
CID: 3132512

Altered Synchronous Gamma Oscillatory Activity in Schizophrenics, Bipolars, and First Degree Relatives under ASSR [Meeting Abstract]

Chandrasekaran, Arjun; Mears, Ryan; Tandon, Neeraj; Mudan, Anita; Bhojraj, Tejas; Mangipudi, Vikas; Mitra, Paroma; Nordin, Mae; Wojcik, Joanne; McInnis, Melvin; Boutros, Nashaat; Pearlson, Godfrey; Sweeney, John; Tammingas, Carol; Thakar, Gunvant; Keshavan, Matcheri
ISSN: 0006-3223
CID: 2835142