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Lynch ST, Dornbush R, Shahar S, Mansour R, Klepacz L, Primavera LH, Ferrando SJ. Change in Neuropsychological Test Performance Seen in a Longitudinal Study of Patients With Post-acute Sequelae of COVID-19: A 6-Month Follow-up Study. J Acad Consult Liaison Psychiatry 2024:S2667-2960(23)00856-X. [PMID: 38171454 DOI: 10.1016/j.jaclp.2023.12.005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Post-acute sequelae of COVID-19 may include physical, psychiatric, and neurocognitive symptoms. Few studies of cognitive symptoms have been longitudinal, with many following participants briefly after infection and relying on subjective complaints, screening instruments, or computerized testing. This group previously reported diminished neuropsychological (NP) test performance in over half of 60 individuals tested in-person 7 months post-COVID-19, particularly those seeking care for cognitive complaints. The current study describes the initial and 6-month follow-up results of an expanded cohort of 75 participants. OBJECTIVE To measure longitudinal changes in neuropsychological test performance, as well as medical and psychiatric changes, post-COVID-19. METHODS Participants underwent NP, psychiatric, and medical assessments approximately 7 months after acute COVID-19 infection. Sixty-three (84%) returned approximately 6 months later for repeat evaluation. RESULTS At the initial visit, 29 (38.7%) met criteria for low NP performance, and 16 (21.3%) met criteria for extremely low NP performance. At 6-month follow-up, several NP domains that were significantly below normative values at the initial visit were no longer abnormal, with the exception of language. Only measures of delayed memory and fatigue showed significant improvements between the 2 time points. CONCLUSIONS A substantial proportion of individuals recovered from acute COVID-19 infection have persistent neuropsychiatric symptoms over 1 year after infection. While the overall sample in this study showed some improvement in NP test performance relative to norms, only fatigue and delayed memory improved significantly between times 1 and 2. No individual declined in NP test performance, though relatively few individuals made significant clinical improvement, indicating the need for serial neuropsychiatric assessment and treatment supports. Longitudinal follow-up of this cohort is in progress.
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Affiliation(s)
- Sean T Lynch
- Department of Psychiatry and Behavioral Sciences, School of Medicine, New York Medical College, Valhalla, NY; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY
| | - Rhea Dornbush
- Department of Psychiatry and Behavioral Sciences, School of Medicine, New York Medical College, Valhalla, NY; Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY
| | - Sivan Shahar
- Department of Psychiatry and Behavioral Sciences, School of Medicine, New York Medical College, Valhalla, NY; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY
| | - Rayah Mansour
- School of Public Health, New York Medical College, Valhalla, NY
| | - Lidia Klepacz
- Department of Psychiatry and Behavioral Sciences, School of Medicine, New York Medical College, Valhalla, NY; Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY
| | - Louis H Primavera
- School of Health Sciences, Touro College and University System, Valhalla, NY
| | - Stephen J Ferrando
- Department of Psychiatry and Behavioral Sciences, School of Medicine, New York Medical College, Valhalla, NY; Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY.
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Muschel C, Lynch ST, Dornbush R, Klepacz L, Shahar S, Ferrando SJ. Frequency, Characteristics, and Correlates of Cognitive Complaints in a Cohort of Individuals with Post-Acute Sequelae of COVID-19. Brain Sci 2023; 14:3. [PMID: 38275508 PMCID: PMC10813274 DOI: 10.3390/brainsci14010003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Cognitive complaints are among the most frequent symptoms of post-acute sequelae of COVID-19 (PASC). This study aimed to investigate the frequency, characteristics, and clinical correlates of cognitive complaints (CC) in PASC, particularly in relation to objective neuropsychological (NP) performance. METHODS Seventy-four participants underwent psychiatric, medical, and NP testing approximately 7 months after acute COVID-19. The Patient Assessment of Own Functioning Inventory (PAOFI) was used to characterize the frequency and severity of CC in domains of memory, language, and cognitive/executive function. The associations of CC with sociodemographic, medical, psychiatric, and NP variables were assessed utilizing correlational analysis, logistic regression, and pairwise comparisons of those categorized as having CC vs. not having CC. RESULTS Taken together, approximately one-third of the study participants had clinically significant CC. Memory difficulty was the most frequent CC, although all categories were frequently endorsed. Memory and cognitive/executive complaints correlated with NP tests in these and multiple other NP domains. CC were more likely to be under-reported in those with diminished NP performance than over-reported in those without diminished performance. Acute COVID-19 symptom severity, elevated depressive symptoms, and NP tests of diminished attention and psychomotor processing speed were independent predictors of CC in logistic regression. CONCLUSIONS Cognitive complaints after acute COVID-19 should be taken seriously, as they are likely to reflect diminished NP performance, as well as medical, psychiatric, and functional burdens. However, patients with PASC may not accurately identify or characterize objective cognitive difficulties, so programs offering comprehensive care for patients with PASC should offer formal neuropsychological testing.
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Affiliation(s)
- Cayla Muschel
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY 10595, USA; (C.M.); (S.T.L.); (L.K.); (S.S.)
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY 10595, USA;
| | - Sean T. Lynch
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY 10595, USA; (C.M.); (S.T.L.); (L.K.); (S.S.)
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY 10003, USA
| | - Rhea Dornbush
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY 10595, USA;
| | - Lidia Klepacz
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY 10595, USA; (C.M.); (S.T.L.); (L.K.); (S.S.)
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY 10595, USA;
| | - Sivan Shahar
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY 10595, USA; (C.M.); (S.T.L.); (L.K.); (S.S.)
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA
| | - Stephen J. Ferrando
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY 10595, USA; (C.M.); (S.T.L.); (L.K.); (S.S.)
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY 10595, USA;
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Shahar S, Lynch S, Dornbush R, Klepacz L, Smiley A, Ferrando SJ. Frequency and Characteristics of Depression and Its Association with Diminished Quality of Life in a Cohort of Individuals with Post-Acute Sequelae of COVID-19. Neuropsychiatr Dis Treat 2023; 19:2069-2079. [PMID: 37810951 PMCID: PMC10559789 DOI: 10.2147/ndt.s427957] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023] Open
Abstract
Background Approximately one-third of COVID-19 survivors will experience persistent symptoms, which may include neurological and psychiatric disturbances. Previous research has suggested that up to 45% of people develop clinically significant depressive symptoms post-COVID. This study sought to determine frequency, symptom profile, and clinical correlates of depression post-COVID. Methods Seventy-five participants who had recovered from COVID-19 underwent neurocognitive, psychiatric, medical, and cognitive testing/screening. The primary measures of interest in this report included the Patient Health Questionnaire (PHQ-9), a 9-item depression-screening tool, and the Endicott Quality of Life Enjoyment and Satisfaction Questionnaire. Results One-third of study participants screened as positive on the PHQ-9 for clinically significant depression, with the most commonly reported symptom being fatigue, followed by sleep disturbance and poor concentration. Also reported were decreased satisfaction in employment, sexual life, and mood. Depressed patients described greater illness severity during COVID-19 infection and subjective cognitive impairment, which was not found on neurocognitive testing. The only significant predictor of depression was COVID-19 illness severity. Limitations A significant portion of participants was a clinical population with specific post-COVID complaints and was predominately comprised of white females. Formal psychiatric evaluation was not performed. Conclusion Many individuals may experience depression after COVID-19 infection, with symptoms appearing to be predominately somatic in nature and correspond with COVID-19 illness severity.
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Affiliation(s)
- Sivan Shahar
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York City, NY, USA
| | - Sean Lynch
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York City, NY, USA
| | - Rhea Dornbush
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA
| | - Lidia Klepacz
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA
| | - Abbas Smiley
- Department of Surgery, Westchester Medical Center Health System, Valhalla, NY, USA
| | - Stephen J Ferrando
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA
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Thompson M, Ferrando SJ, Dornbush R, Lynch S, Shahar S, Klepacz L, Smiley A. Impact of COVID-19 on employment: sociodemographic, medical, psychiatric and neuropsychological correlates. Front Rehabil Sci 2023; 4:1150734. [PMID: 37496702 PMCID: PMC10368129 DOI: 10.3389/fresc.2023.1150734] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/29/2023] [Indexed: 07/28/2023]
Abstract
Introduction Given the nature of the persistent physical and neuropsychiatric symptoms reported in the literature, among individuals after acute COVID illness; there is growing concern about the functional implications of the Post-Acute Sequelae of COVID-19 (PASC). We aim to evaluate associations of sociodemographic, medical, psychiatric and neuropsychological factors with employment status post COVID-19. Methods 59 participants were administered a neuropsychiatric assessment and queried about employment status and occupational difficulties months after quarantine. Two levels of comparison were conducted: (1) Those who took time off work (TTO) to those with no time off (NTO); (2) Those who reported occupational performance suffered (PS) to those who did not (PDNS). Results TTO vs. NTO exhibited extensive differences across medical, psychiatric and neurocognitive domains. PS vs. PDNS differed on subjective measures of physical and cognitive symptoms, but not on objective testing. Conclusion Individuals who took time off beyond COVID-19 quarantine experience persistent physical, psychiatric, subjective and objective neurocognitive burden. In contrast, occupational impairment appears to reflect subjective complaints, but not objective measures. Clinical implications are discussed.
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Affiliation(s)
- Madison Thompson
- School of Medicine, New York Medical College, Valhalla, NY, United States
| | - Stephen J. Ferrando
- School of Medicine, New York Medical College, Valhalla, NY, United States
- Department of Psychiatry, Westchester Medical Center Health Network, Valhalla, NY, United States
| | - Rhea Dornbush
- School of Medicine, New York Medical College, Valhalla, NY, United States
- Department of Psychiatry, Westchester Medical Center Health Network, Valhalla, NY, United States
| | - Sean Lynch
- School of Medicine, New York Medical College, Valhalla, NY, United States
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel,New York, NY, United States
| | - Sivan Shahar
- School of Medicine, New York Medical College, Valhalla, NY, United States
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, United States
| | - Lidia Klepacz
- School of Medicine, New York Medical College, Valhalla, NY, United States
- Department of Psychiatry, Westchester Medical Center Health Network, Valhalla, NY, United States
| | - Abbas Smiley
- School of Medicine, New York Medical College, Valhalla, NY, United States
- Department of Surgery, Westchester Medical Center Health Network, Valhalla, NY, United States
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Saperia C, Lynch S, Dornbush R, Ferrando SJ. No Difference in Neuropsychiatric PASC Between Vaccinated and Unvaccinated Patients: Further Insights From a Cross-Sectional Study. J Acad Consult Liaison Psychiatry 2023; 64:409-411. [PMID: 37474246 DOI: 10.1016/j.jaclp.2023.04.005] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Corey Saperia
- Department of Psychiatry, New York Medical College at Westchester Medical Center, Valhalla, NY.
| | - Sean Lynch
- Department of Psychiatry, Mount Sinai Beth Israel, New York City, NY
| | - Rhea Dornbush
- Department of Psychiatry, New York Medical College at Westchester Medical Center, Valhalla, NY
| | - Stephen J Ferrando
- Department of Psychiatry, New York Medical College at Westchester Medical Center, Valhalla, NY
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Ferrando SJ, Lynch S, Ferrando N, Dornbush R, Shahar S, Klepacz L. Anxiety and posttraumatic stress in post-acute sequelae of COVID-19: prevalence, characteristics, comorbidity, and clinical correlates. Front Psychiatry 2023; 14:1160852. [PMID: 37333906 PMCID: PMC10272460 DOI: 10.3389/fpsyt.2023.1160852] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/27/2023] [Indexed: 06/20/2023] Open
Abstract
Background Anxiety and post-traumatic stress symptoms have been reported in association with acute and post-acute sequelae of COVID-19 (PASC). Purpose This study aimed to document the cross-sectional prevalence, characteristics and clinical correlates of anxiety and post-traumatic stress in a study of neuropsychiatric sequelae of COVID-19. Method 75 participants recruited from a post-COVID-19 recovery program and the community were assessed for sociodemographic, medical, psychiatric, and neurocognitive symptoms and performance. The generalized anxiety questionnaire-7 (GAD-7) and post-traumatic stress disorder questionnaire for DSM5 (PCL5) were utilized to measure anxiety and PTSD symptoms. Established cutoff scoring for the GAD-7 and algorithm-based scoring of the PCL5 were utilized to determine clinically significant anxiety symptoms and PTSD, respectively. Results The cohort was 71% female, 36% ethnic minority, with the main age of 43.5 years, 80% employment, 40% with the prior psychiatric treatment history and 2/3 seeking post-COVID care for PASC. Clinically significant anxiety symptoms were found in 31% and PTSD was found in 29% of the cohort. Nervousness and excessive worry were the most prominent anxiety symptoms, while changes in mood/cognition and avoidance were most frequent in PTSD. There was a high degree of comorbidity between clinically significant anxiety symptoms, PTSD, depression and fatigue. In logistic regression, acute COVID illness severity, prior psychiatric history, and memory complaints (but not objective neuropsychological performance) predicted clinically significant anxiety symptoms and/or PTSD. Conclusion Clinically significant anxiety and PTSD are found in approximately 1 of 3 individuals after COVID-19 infection. They are highly comorbid with each other as well as with depression and fatigue. All patients seeking care for PASC should be screened for these neuropsychiatric complications. Symptoms of worry, nervousness, subjective changes in mood, and cognition as well as behavioral avoidance are particularly important targets of clinical intervention.
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Affiliation(s)
- Stephen J. Ferrando
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, United States
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, United States
| | - Sean Lynch
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, United States
| | - Nicole Ferrando
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, United States
| | - Rhea Dornbush
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, United States
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, United States
| | - Sivan Shahar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, United States
| | - Lidia Klepacz
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, United States
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, United States
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Groenendaal E, Lynch S, Dornbush R, Klepacz L, Ferrando S. Clinical determinants, patterns and outcomes of antipsychotic medication prescribing in the treatment of schizophrenia and schizoaffective disorder: A naturalistic cohort study. J Psychiatr Res 2023; 158:273-280. [PMID: 36623361 DOI: 10.1016/j.jpsychires.2022.12.044] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 11/18/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Schizophrenia affects individuals, families, and systems, with treatment primarily being antipsychotic medications. Long-acting injectable (LAI) antipsychotics are increasingly being used. This study sought to identify predictors of antipsychotic choice, in terms of formulation (LAI vs oral) and class (FGA vs SGA), and clinical outcomes. METHODS 123 patients who received LAI antipsychotics were diagnosis-matched to patients who received oral antipsychotics. Sociodemographic and clinical factors were extracted from the medical record, including indicators of illness severity. Groups were compared with Chi-Square and t-tests, and logistic regression models were used to identify independent predictors of antipsychotic choice. RESULTS Patients that received LAIs had longer admissions, more complex discharges, and greater illness severity; however, there were no differences in readmission rates. Independent predictors of LAIs included younger age, being single, and longer admission. Patients who received FGA LAIs were more likely to use substances and be undomiciled compared to SGA LAIs, with the only predictor being older age. Oral FGAs were more likely than Oral SGAs to be prescribed to older and female patients, as well as those with co-occurring substance use, complex discharges, and longer admissions. CONCLUSIONS Illness severity and duration of illness appear to drive choice of LAI vs. oral antipsychotic medication and FGA vs. SGA. While LAIs were prescribed to patients with greater illness severity, readmission rates were equivalent to those receiving oral medication, supporting the use of LAI in patients with greater illness severity. Rationales for prescribing LAIs to younger patients and FGAs to older patients are discussed.
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Affiliation(s)
| | - Sean Lynch
- New York Medical College, USA; Mount Sinai Beth Israel, USA
| | - Rhea Dornbush
- New York Medical College, USA; Westchester Medical Center, USA
| | - Lidia Klepacz
- New York Medical College, USA; Westchester Medical Center, USA
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Lynch S, Ferrando SJ, Dornbush R, Shahar S, Smiley A, Klepacz L. Screening for brain fog: Is the montreal cognitive assessment an effective screening tool for neurocognitive complaints post-COVID-19? Gen Hosp Psychiatry 2022; 78:80-86. [PMID: 35930974 PMCID: PMC9359801 DOI: 10.1016/j.genhosppsych.2022.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/14/2022] [Accepted: 07/27/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cognitive complaints are one of the most frequent symptoms reported in post-acute sequelae of COVID-19 (PASC). The Montreal Cognitive Assessment (MoCA) has been used to estimate prevalence of cognitive impairment in many studies of PASC, and is commonly employed as a screening test in this population, however, its validity has not been established. OBJECTIVE To determine the utility of the MoCA to screen for cognitive impairment in PASC. METHODS Sixty participants underwent neuropsychological, psychiatric, and medical assessments, as well as the Montreal Cognitive Assessment, 6-8 months after acute COVID-19 infection. RESULTS The overall sample had a mean score of 26.1 on the MoCA, with approximately one third screening below the cutoff score of 26, similar to the rate of extremely low NP test performance. MoCA score was inversely correlated with fatigue and depression measures and ethnic minority participants scored on average lower, despite similar education and estimated premorbid function. The MoCA had an accuracy of 63.3% at detecting any degree of diminished NP performance, and an accuracy of 73.3% at detecting extremely low NP performance. DISCUSSION/CONCLUSION The MoCA may not be accurate for detecting neither mild nor more severe degrees of diminished NP test performance in PASC. Therefore, patients with persistent cognitive complaints in the setting of PASC who score in the normal range on the MoCA should be referred for formal NP assessment.
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Affiliation(s)
- Sean Lynch
- Department of Psychiatry and Behavioral Sciences, New York Medical College, United States,Department of Psychiatry, Mount Sinai Beth Israel, United States
| | - Stephen J. Ferrando
- Department of Psychiatry and Behavioral Sciences, New York Medical College, United States,Department of Psychiatry, Westchester Medical Center Health System, United States,Corresponding author at: Department of Psychiatry, Westchester Medical Center Health System, New York Medical College, 100 Woods Road, Valhalla, NY 10595, United States of America
| | - Rhea Dornbush
- Department of Psychiatry and Behavioral Sciences, New York Medical College, United States,Department of Psychiatry, Westchester Medical Center Health System, United States
| | - Sivan Shahar
- Department of Psychiatry and Behavioral Sciences, New York Medical College, United States
| | - Abbas Smiley
- Department of Surgery, Westchester Medical Center Health System, United States
| | - Lidia Klepacz
- Department of Psychiatry and Behavioral Sciences, New York Medical College, United States,Department of Psychiatry, Westchester Medical Center Health System, United States
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Farooqi M, Khan A, Jacobs A, D'Souza V, Consiglio F, Karmen CL, Dornbush R, Hasnat GS, Ferrando SJ. Examining the Long-Term Sequelae of SARS-CoV2 Infection in Patients Seen in an Outpatient Psychiatric Department. Neuropsychiatr Dis Treat 2022; 18:1259-1268. [PMID: 35761861 PMCID: PMC9233564 DOI: 10.2147/ndt.s357262] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Received: 01/22/2022] [Accepted: 05/03/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The acute phase of Coronavirus disease-19 (COVID-19) is well known. However, there is now an increasing number of patients suffering from the post-acute sequelae of COVID-19 (PASC Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis), including neuropsychiatric symptoms. The purpose of this report is to describe the sociodemographic, diagnostic and treatment characteristics of patients evaluated in an outpatient psychiatric setting for PASC. METHODS A retrospective review of 30 individuals with documented COVID-19 illness treated at a university hospital-based Post-COVID-19 Recovery Program were referred to an outpatient psychiatric department for consultation and treatment from December 2020 to July 2021. All individuals complained of neuropsychiatric symptoms including anxiety, depression, fatigue and cognitive problems. Data on sociodemographic characteristics, psychiatric diagnosis, prominent psychological themes and treatment prescribed were described and, where applicable, analyzed with SPSS software. RESULTS The study population consisted of patients between 25 and 82 years old, with a predominance of women between 46 and 60 years. Approximately half of the patient population had a primary diagnosis of major depressive disorder, often combined with prominent anxiety. Over two-thirds of the patient population reported a combination of depression, fatigue and cognitive complaints, predominantly memory and slowed processing speed. Prominent stressors and psychological themes included social and occupational decline, isolation, lack of empathy and understanding from family, friends and employers, and apprehension about future ability to return to their baseline level of function. Treatments recommended included individual and group psychotherapy, medication and cognitive rehabilitation. Modafinil and antidepressants, often in combination, were the most commonly used medications, intended to target the pervasive fatigue, depressive, and anxiety these individuals were facing. CONCLUSION Clinical experience from this patient population underscored the significant medical, emotional, neurocognitive and functional sequelae of PASC. Management of these individuals requires a collaborative approach with the availability of psychotherapeutic interventions, pharmacologic treatment, neurocognitive assessment and remediation to address these symptoms.
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Affiliation(s)
- Muhammad Farooqi
- Department of Psychiatry, Westchester Medical Center Health System-New York Medical College, New York, NY, USA
| | - Anum Khan
- Department of Psychiatry, Westchester Medical Center Health System-New York Medical College, New York, NY, USA
| | - Asaf Jacobs
- Department of Psychiatry, Westchester Medical Center Health System-New York Medical College, New York, NY, USA
| | - Vanessa D'Souza
- Department of Psychiatry, Westchester Medical Center Health System-New York Medical College, New York, NY, USA
| | - Faith Consiglio
- Department of Psychiatry, Westchester Medical Center Health System-New York Medical College, New York, NY, USA
| | - Carol L Karmen
- Department of Psychiatry, Westchester Medical Center Health System-New York Medical College, New York, NY, USA
| | - Rhea Dornbush
- Department of Psychiatry, Westchester Medical Center Health System-New York Medical College, New York, NY, USA
| | | | - Stephen J Ferrando
- Department of Psychiatry, Westchester Medical Center Health System-New York Medical College, New York, NY, USA
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Ferrando SJ, Dornbush R, Lynch S, Shahar S, Klepacz L, Karmen CL, Chen D, Lobo SA, Lerman D. Neuropsychological, medical and psychiatric findings after recovery from acute COVID-19: A cross-sectional study. J Acad Consult Liaison Psychiatry 2022; 63:474-484. [PMID: 35085824 PMCID: PMC8786396 DOI: 10.1016/j.jaclp.2022.01.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/07/2022] [Accepted: 01/15/2022] [Indexed: 02/06/2023]
Abstract
Background Objective Methods Results Conclusion
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Ferrando SJ, Klepacz L, Lynch S, Shahar S, Dornbush R, Smiley A, Miller I, Tavakkoli M, Regan J, Bartell A. Psychiatric emergencies during the height of the COVID-19 pandemic in the suburban New York City area. J Psychiatr Res 2021; 136:552-559. [PMID: 33158555 PMCID: PMC7992036 DOI: 10.1016/j.jpsychires.2020.10.029] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND This report characterizes patients presenting for psychiatric emergencies during the COVID-19 pandemic and describes COVID-19-related stressors. METHODS Patients seen for emergency psychiatric evaluation during the height of the COVID-19 period (March 1-April 30, 2020; N = 201) were compared with those in the immediate Pre-COVID-19 period (January 1-February 28, 2020; N = 355), on sociodemographic characteristics, psychiatric diagnoses, symptoms, and disposition. Patients tested positive for COVID-19 were compared with those that tested negative on the same outcomes. Prevalence and nature of COVID-19-stressors that influenced the emergency presentation were rated. OUTCOME The most common psychiatric diagnoses and presenting symptoms during both periods were depression and suicidal ideation. Comparing the Pre-COVID-19 and COVID-19 periods, a significant decline in emergency psychiatric volume was observed in children and adolescents (C/A), but not adults. COVID-19 period C/A patients had more new onset disorders and were more likely to be admitted to inpatient care, but were less likely to present with suicide attempts, impulse control disorders and agitation/aggression. Adults were more likely to have no access to outpatient care, present with anxiety disorders, and were also more likely to be admitted for inpatient care. COVID-19 directly affected the psychiatric emergency in 25% of patients, with the more severe stressors triggered by fear of COVID infection (including psychosis), actual COVID infection in self or family members, including death of a loved one. COVID-positive patients were more likely to have psychosis, including new-onset, and were less likely to be depressed/suicidal compared to their COVID-negative counterparts. CONCLUSION This report demonstrates the need for emergency psychiatric services throughout the COVID-19 pandemic and the need for clinical and diagnostic COVID-19 screening of psychiatric emergency patients. New and severe pathology underscore the need for enhanced outpatient access to tele-mental health, crisis hotline and on-line psychotherapeutic services, as well as psychiatric inpatient services with capacity to safely care for COVID-19 patients.
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Affiliation(s)
- Stephen J. Ferrando
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA,New York Medical College, Valhalla, NY, USA,Corresponding author. Department of Psychiatry, Westchester Medical Health System, New York Medical College, 100 Woods Road, Valhalla, NY, 10595, USA
| | - Lidia Klepacz
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA,New York Medical College, Valhalla, NY, USA
| | - Sean Lynch
- New York Medical College, Valhalla, NY, USA
| | | | - Rhea Dornbush
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA,New York Medical College, Valhalla, NY, USA
| | - Abbas Smiley
- New York Medical College, Valhalla, NY, USA,Department of Surgery, Westchester Medical Center Health System, Valhalla, NY, USA
| | - Ivan Miller
- New York Medical College, Valhalla, NY, USA,Department of Emergency Medicine, Westchester Medical Center Health System, Valhalla, USA
| | - Mohammad Tavakkoli
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA,New York Medical College, Valhalla, NY, USA
| | - John Regan
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA
| | - Abraham Bartell
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA,New York Medical College, Valhalla, NY, USA
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12
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Rahmat S, Velez J, Farooqi M, Smiley A, Prabhakaran K, Rhee P, Khan M, Dornbush R, Ferrando S, Smolin Y. Post-traumatic stress disorder can be predicted in hospitalized blunt trauma patients using a simple screening tool. Trauma Surg Acute Care Open 2021; 6:e000623. [PMID: 33880413 PMCID: PMC7993304 DOI: 10.1136/tsaco-2020-000623] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) has debilitating psychiatric and medical consequences. The purpose of this study was to identify whether PTSD diagnosis and PTSD symptom scale score (PTSD severity) could be predicted by assessing peritraumatic experiences using a single question or screening tools at different time points in patients hospitalized after admission to the hospital after significant physical trauma, but with stable vitals (level II trauma). METHODS Patients completed the 'initial question' and the National Stressful Events Survey Acute Stress Disorder Scale (NSESSS) at 3 days to 5 days after trauma (NSESSS-1). The same scale was administered 2 weeks to 4 weeks after trauma (NSESSS-2). The Posttraumatic Stress Disorder Symptoms Scale Interview for DSM-5 (PSSI-5) was administered 2 months after trauma. PTSD diagnosis and PTSD severity were extracted from the PSSI-5. Linear multivariate regression analyses were used to establish whether scores for NSESSS-1 or NSESSS-2 predicted PTSD diagnosis/PTSD severity. Non-linear multivariate regression analyses were performed to better understand the relationship between NSESSS-1/NSESSS-2 and PTSD diagnosis/PTSD severity. RESULTS A single question assessing the experience of fear, helplessness, or horror was not an effective tool for determining the diagnosis of PTSD (p=0.114) but can be a predictor of PTSD severity (p=0.039). We demonstrate that administering the NSESSS after either 3 days to 5 days (p=0.008, p<0.001) or 2 weeks to 4 weeks (p=0.039; p<0.001) can predict the diagnosis of PTSD and PTSD severity. Scoring an NSESSS above 14/28 (50%) increases the chance of experiencing a higher PTSD severity substantially and linearly. DISCUSSION Our initial question was not an effective predictor of PTSD diagnosis. However, using the NSESSS at both 3 days to 5 days and 2 weeks to 4 weeks after trauma is an effective method for predicting PTSD diagnosis and PTSD severity. Additionally, we show that patients who score higher than 14 on the NSESSS for acute stress symptoms may need closer follow-up. LEVEL OF EVIDENCE Level III, prognostic.
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Affiliation(s)
- Saad Rahmat
- Department of Psychiatry and Behavioral Sciences, Westchester Medical Center, Valahlla, NY, USA
| | - Jessica Velez
- Department of Surgery, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Muhammad Farooqi
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
| | - Abbas Smiley
- Department of Surgery, New York Medical College, Valhalla, New York, USA
| | - Kartik Prabhakaran
- Department of Surgery, Westchester Medical Center Health Network, Valhalla, New York, USA
- Department of Surgery, New York Medical College, Valhalla, New York, USA
| | - Peter Rhee
- Department of Surgery, Westchester Medical Center Health Network, Valhalla, New York, USA
- Department of Surgery, New York Medical College, Valhalla, New York, USA
| | - Maria Khan
- New York Medical College, St. Vincent's Medical Center, Yonkers, New York, USA
| | - Rhea Dornbush
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
| | - Stephen Ferrando
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
| | - Yvette Smolin
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
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Ferrando SJ, Klepacz L, Lynch S, Tavakkoli M, Dornbush R, Baharani R, Smolin Y, Bartell A. COVID-19 Psychosis: A Potential New Neuropsychiatric Condition Triggered by Novel Coronavirus Infection and the Inflammatory Response? Psychosomatics 2020; 61:551-555. [PMID: 32593479 PMCID: PMC7236749 DOI: 10.1016/j.psym.2020.05.012] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Stephen J Ferrando
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York.
| | - Lidia Klepacz
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York
| | - Sean Lynch
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York
| | - Mohammad Tavakkoli
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York
| | - Rhea Dornbush
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York
| | - Reena Baharani
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York
| | - Yvette Smolin
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York
| | - Abraham Bartell
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York
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Wormser GP, Weitzner E, Dornbush R, Visintainer P. Reply to Crawford. Clin Infect Dis 2015; 61:1209-10. [PMID: 26129750 DOI: 10.1093/cid/civ533] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Rhea Dornbush
- Department of Psychiatry, New York Medical College, Valhalla, New York
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15
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Weitzner E, McKenna D, Nowakowski J, Scavarda C, Dornbush R, Bittker S, Cooper D, Nadelman RB, Visintainer P, Schwartz I, Wormser GP. Long-term Assessment of Post-Treatment Symptoms in Patients With Culture-Confirmed Early Lyme Disease. Clin Infect Dis 2015; 61:1800-6. [PMID: 26385994 DOI: 10.1093/cid/civ735] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/12/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lyme disease patients with erythema migrans are said to have post-treatment Lyme disease symptoms (PTLDS) if there is persistence of subjective symptoms for at least 6 months following antibiotic treatment and resolution of the skin lesion. The purpose of this study was to characterize PTLDS in patients with culture-confirmed early Lyme disease followed for >10 years. METHODS Adult patients with erythema migrans with a positive skin or blood culture for Borrelia burgdorferi were enrolled in a prospective study beginning in 1991 and followed up at 6 months and annually thereafter to determine the long-term outcome of this infection. The genotype of the infecting strain of B. burgdorferi was evaluated in subjects with PTLDS. RESULTS One hundred twenty-eight subjects with culture-confirmed early Lyme disease, of whom 55% were male, were followed for a mean ± SD of 14.98 ± 2.71 years (median = 15 years; range = 11-20 years). Fourteen (10.9%) were regarded as having possible PTLDS, but only 6 (4.7%) had PTLDS documented at their last study visit. Nine (64.3%) had only a single symptom. None of the 6 with PTLDS at their last visit was considered to be functionally impaired by the symptom(s). PTLDS was not associated with a particular genotype of B. burgdorferi. CONCLUSIONS PTLDS may persist for >10 years in some patients with culture-confirmed early Lyme disease. Such long-standing symptoms were not associated with functional impairment or a particular strain of B. burgdorferi.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ira Schwartz
- Department of Microbiology and Immunology, New York Medical College, Valhalla
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16
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Wormser GP, Weitzner E, Dornbush R, Visintainer P. Reply to Greenberg. Clin Infect Dis 2015; 61:1765-6. [DOI: 10.1093/cid/civ706] [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: 11/14/2022] Open
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17
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Wormser GP, Weitzner E, McKenna D, Nadelman RB, Scavarda C, Molla I, Dornbush R, Visintainer P, Nowakowski J. Long-term assessment of health-related quality of life in patients with culture-confirmed early Lyme disease. Clin Infect Dis 2015; 61:244-7. [PMID: 25888674 DOI: 10.1093/cid/civ277] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 02/18/2015] [Indexed: 11/13/2022] Open
Abstract
The health-related quality of life of 100 subjects with culture-confirmed early Lyme disease enrolled in a prospective study with annual follow-up visits was evaluated using the 36-Item Short Form General Health Survey version 2 (SF-36v2) questionnaire at 11-20 years after diagnosis. The mean summary scores of physical and mental health were similar to those of the general population.
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Affiliation(s)
| | | | | | | | | | | | - Rhea Dornbush
- Department of Psychiatry, New York Medical College, Valhalla
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18
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Kaplan RF, Trevino RP, Johnson GM, Levy L, Dornbush R, Hu LT, Evans J, Weinstein A, Schmid CH, Klempner MS. Cognitive function in post-treatment Lyme disease: do additional antibiotics help? Neurology 2003; 60:1916-22. [PMID: 12821733 DOI: 10.1212/01.wnl.0000068030.26992.25] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND It is controversial whether additional antibiotic treatment will improve cognitive function in patients with post-treatment chronic Lyme disease (PTCLD). OBJECTIVE To determine whether antibiotic therapy improves cognitive function in two randomized double-blind placebo-controlled studies of patients with PTCLD. METHODS A total of 129 patients with a physician-documented history of Lyme disease from three study sites in the northeast United States were studied. Seventy-eight were seropositive for IgG antibodies against Borrelia burgdorferi, and 51 were seronegative. Patients in each group were randomly assigned to receive IV ceftriaxone 2 g daily for 30 days followed by oral doxycycline 200 mg daily for 60 days or matching IV and oral placebos. Assessments were made at 90 and 180 days after treatment. Symptom severity was measured from the cognitive functioning, pain, and role functioning scales of the Medical Outcomes Study (MOS). Memory, attention, and executive functioning were assessed using objective tests. Mood was assessed using the Beck Depression Inventory and Minnesota Multiphasic Personality Inventory. RESULTS There were no significant baseline differences between seropositive and seronegative groups. Both groups reported a high frequency of MOS symptoms, depression, and somatic complaints but had normal baseline neuropsychological test scores. The combined groups showed significant decreases in MOS symptoms, higher objective test scores, and improved mood between baseline and 90 days. However, there were no significant differences between those receiving antibiotics and placebo. CONCLUSION Patients with post-treatment chronic Lyme disease who have symptoms but show no evidence of persisting Borrelia infection do not show objective evidence of cognitive impairment. Additional antibiotic therapy was not more beneficial than administering placebo.
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Affiliation(s)
- R F Kaplan
- University of Connecticut School of Medicine, Farmington, USA.
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Wormser GP, Ramanathan R, Nowakowski J, McKenna D, Holmgren D, Visintainer P, Dornbush R, Singh B, Nadelman RB. Duration of antibiotic therapy for early Lyme disease. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 2003; 138:697-704. [PMID: 12729423 DOI: 10.7326/0003-4819-138-9-200305060-00005] [Citation(s) in RCA: 220] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Treatment of patients with early Lyme disease has trended toward longer duration despite the absence of supporting clinical trials. OBJECTIVE To evaluate different durations of oral doxycycline treatment and the combination of oral doxycycline and a single intravenous dose of ceftriaxone for treatment of patients with early Lyme disease. DESIGN Randomized, double-blind, placebo-controlled trial. SETTING Single-center university hospital. PATIENTS 180 patients with erythema migrans. INTERVENTION Ten days of oral doxycycline, with or without a single intravenous dose of ceftriaxone, or 20 days of oral doxycycline. MEASUREMENTS Outcome was based on clinical observations and neurocognitive testing. Efficacy was assessed at 20 days, 3 months, 12 months, and 30 months. RESULTS At all time points, the complete response rate was similar for the three treatment groups in both on-study and intention-to-treat analyses. In the on-study analysis, the complete response rate at 30 months was 83.9% in the 20-day doxycycline group, 90.3% in the 10-day doxycycline group, and 86.5% in the doxycycline-ceftriaxone group (P > 0.2). The only patient with treatment failure (10-day doxycycline group) developed meningitis on day 18. There were no significant differences in the results of neurocognitive testing among the three treatment groups and a separate control group without Lyme disease. Diarrhea occurred significantly more often in the doxycycline-ceftriaxone group (35%) than in either of the other two groups (P < 0.001). CONCLUSIONS Extending treatment with doxycycline from 10 to 20 days or adding one dose of ceftriaxone to the beginning of a 10-day course of doxycycline did not enhance therapeutic efficacy in patients with erythema migrans. Regardless of regimen, objective evidence of treatment failure was extremely rare.
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Affiliation(s)
- Gary P Wormser
- Division of Infectious Diseases, New York Medical College, Room 245, Munger Pavilion, Valhalla, New York 10595, USA
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Caracci G, Migone P, Dornbush R. Phencyclidine in an East Harlem psychiatric population. J Natl Med Assoc 1983; 75:869-74. [PMID: 6631993 PMCID: PMC2561503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The use of phencyclidine (PCP) was investigated in the psychiatric population of an East Harlem, New York, hospital. Sixty-eight consecutive PCP-user admissions were interviewed through a 77-item questionnaire. The patient population served by the facility was 48 percent Hispanic and 32 percent black. The sample of PCP users was 86 percent black. This suggests that, in this area, either more blacks use PCP, or nonblack PCP users seek psychiatric help less frequently than black users. This study emphasizes the many problems affecting the sample population and shows evidence that a large portion of the sample is at risk to develop psychiatric symptoms.
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Abstract
The effects of naloxone on memory were studied in 26 healthy male volunteers. Either placebo, or 10 mg, or 20 mg of naloxone was given iv on separate occasions. Ten minutes after each injection, the subjects listened to 8 lists of words (10 words on each list). Immediate recall, delayed recall, and delayed recognition were not affected by naloxone within 60 minutes of its administration. These results provide no support for the hypothesis that edorphins play a role in the short-term auditory memory in man.
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Volavka J, Mallya A, Bauman J, Pevnick J, Cho D, Reker D, James B, Dornbush R. Hormonal and other effects of naltrexone in normal men. Adv Exp Med Biol 1979; 116:291-305. [PMID: 224675 DOI: 10.1007/978-1-4684-3503-0_17] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Volavka J, Feldstein S, Abrams R, Dornbush R, Fink M. EEG and clinical change after bilateral and unilateral electroconvulsive therapy. Electroencephalogr Clin Neurophysiol 1972; 32:631-9. [PMID: 4121514 DOI: 10.1016/0013-4694(72)90100-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abstract
Memory deficit persists as the principal undesirable side effect of convulsive therapy. In an attempt to minimize this deficit Lancaster, Steinert and Frost (1958) introduced unilateral electrode placement to the non-dominant hemisphere as an alternative to the standard bilateral placement of electrodes. They suggested that clinical improvement with unilateral placement was the same as for bilateral ECT, but that memory impairment was less severe.
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Abrams R, Volavka J, Roubicek J, Dornbush R, Fink M. Lateralized EEG changes afterunilateral and bilateral eectroconvulsive therapy. Dis Nerv Syst 1970; 31:28-33. [PMID: 5489384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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