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Pahwa M, McElroy SL, Priesmeyer R, Siegel G, Siegel P, Nuss S, Bowden CL, El-Mallakh RS. KIOS: A smartphone app for self-monitoring for patients with bipolar disorder. Bipolar Disord 2024; 26:84-92. [PMID: 37340215 PMCID: PMC10730767 DOI: 10.1111/bdi.13362] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
OBJECTIVES This study examined the use of a self-monitoring/self-management smartphone application (app) for patients with bipolar disorder. The app was specifically designed with patient-centered computational software system based on concepts from nonlinear systems (chaos) theory. METHODS This was a randomized, active comparator study of use of the KIOS app compared to an existing free app that has high utilization rates known as eMoods, over 52 weeks, and performed in three academic centers. Patients were evaluated monthly utilizing the Bipolar Inventory of Symptoms Schedule (BISS). The primary outcome measure was the persistence of using the app over the year of the study. RESULTS Patients assigned to KIOS persisted in the study longer than those assigned to eMoods; 57 patients (87.70%) in the KIOS group versus 42 (73.69%) in the eMoods group completed the study (p = 0.03). By 52 weeks, significantly more of KIOS group (84.4%) versus eMoods group (54%) entered data into their programs (χ2 = 14.2, df = 1, p = 0.0002). Patient satisfaction for KIOS was greater (F = 5.21, df = 1, 108, p = 0.025) with a standardized effect size (Cohen's d) of 0.41. There was no difference in clinical outcome at the end of the study between the two groups. CONCLUSIONS This is the first randomized comparison study comparing two apps for the self-monitoring/self-management of bipolar disorder. The study revealed greater patient satisfaction and greater adherence to a patient-centered software program (KIOS) than a monitoring program that does not provide feedback (eMoods).
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Affiliation(s)
- Mehak Pahwa
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
| | - Susan L. McElroy
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio
| | - Richard Priesmeyer
- Jurica Professor of Management, Department of Management and Marketing, St Mary’s University, San Antonio, Texas
| | - Gregg Siegel
- Biomedical Development Corporation, San Antonio, Texas
| | | | - Sharon Nuss
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
| | - Charles L Bowden
- Deceased, previously Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Rif S. El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
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Ruch T, Nuss S, Yeruva RR, Gao Y, Tegin G, Terrell C, El-Mallakh RS. Inhaled loxapine for acute agitation in a psychiatric emergency service. Ann Clin Psychiatry 2021; 33:162-167. [PMID: 34398731 DOI: 10.12788/acp.0032] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Rapid control of agitation in medical settings is necessary for safety and provision of care. Inhaled loxapine achieves peak plasma levels within 2 minutes of administration and is FDA-approved for managing acute agitation. METHODS We examined the use of inhaled loxapine vs non-parenteral treatment as usual (TAU) in a psychiatric emergency service for consecutive patients with acute agitation or aggression. Data were collected retrospectively. T tests were used for continuous variables and Chi-square tests were used for categorical data. RESULTS A total of 61 patients received inhaled loxapine and 29 received TAU. Time to outcome for patients receiving inhaled loxapine was 21 ± 21 minutes compared with 121 ± 206 minutes for TAU (t =-2.61; P = .014). At outcome, 89% of patients treated with loxapine experienced symptom resolution, compared with 69% of TAU (Chi-square = 17.4, P < .0001). Ten percent of patients receiving loxapine had no change in symptoms and 1% had worsening symptoms vs 14% in the TAU group who experienced no change in symptoms (z = 0.5, not significant), and 17% who described worsening symptoms (z = 6153.9, P < .0001). CONCLUSIONS The rapid absorption of inhaled loxapine is associated with a 6-fold faster and more robust symptom control.
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Affiliation(s)
- Tyler Ruch
- University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Sharon Nuss
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Rajashekar Reddy Yeruva
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Yonglin Gao
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Gulay Tegin
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Christina Terrell
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
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Yeruva RR, Shang Y, Schoenbachler B, Nuss S, El-Mallakh RS. Anatomical Association Between Schizophrenia and Cerebellum. Innov Clin Neurosci 2021; 18:47-49. [PMID: 34980994 PMCID: PMC8667695] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The pathogenesis of schizophrenia is rarely attributed to dysfunction of the cerebellum. However, coordination of mental processes might involve the cerebellum and a cortico-cerebellar-thalamic-cortical circuit (CCTCC) that can mediate that process has been proposed. We present the case of a 31-year-old male patient with a family history of psychosis who developed schizophrenia in association with a slow-growing glioblastoma at the left posterior cerebellar pontine angle. Of interest is that his psychosis became refractory after surgical removal of the tumor that had no motor deficit consequences, suggesting that the greater disruption of the CCTCC due to surgical excision might be related to the worsening psychosis. The case supports the hypothesis of cognitive dysmetria and psychosis.
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Affiliation(s)
- Rajashekar Reddy Yeruva
- Dr. Yeruva is with Baylor Scott and White Medical Center in Round Rock, Texas
- Drs. Shang, Schoenbachler, El-Mallakh, and Sharon Nuss are with the University of Louisville School of Medicine in Louisville, Kentucky
| | - Yafei Shang
- Dr. Yeruva is with Baylor Scott and White Medical Center in Round Rock, Texas
- Drs. Shang, Schoenbachler, El-Mallakh, and Sharon Nuss are with the University of Louisville School of Medicine in Louisville, Kentucky
| | - Ben Schoenbachler
- Dr. Yeruva is with Baylor Scott and White Medical Center in Round Rock, Texas
- Drs. Shang, Schoenbachler, El-Mallakh, and Sharon Nuss are with the University of Louisville School of Medicine in Louisville, Kentucky
| | - Sharon Nuss
- Dr. Yeruva is with Baylor Scott and White Medical Center in Round Rock, Texas
- Drs. Shang, Schoenbachler, El-Mallakh, and Sharon Nuss are with the University of Louisville School of Medicine in Louisville, Kentucky
| | - Rif S El-Mallakh
- Dr. Yeruva is with Baylor Scott and White Medical Center in Round Rock, Texas
- Drs. Shang, Schoenbachler, El-Mallakh, and Sharon Nuss are with the University of Louisville School of Medicine in Louisville, Kentucky
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El-Mallakh RS, Nuss S, Gao D, Gao Y, Ahmad SC, Schrodt C, Adler C. Asenapine in the Treatment of Bipolar Depression. Psychopharmacol Bull 2020; 50:8-18. [PMID: 32214517 PMCID: PMC7093720] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Asenapine, a potent serotonin 7 (5-HT7) receptor antagonist, was examined for efficacy as an antidepressant in depressed bipolar subjects. It was predicted that subjects with the genetic variant of the short form of the serotonin transporter (5HTTR) would be more likely to respond. EXPERIMENTAL DESIGN A subset of patients participating in a randomized, placebo-controlled study of the efficacy of asenapine in bipolar I depression also underwent genetic testing for the 5HTTR. Montgomery Åsberg Depression Rating Scale (MADRS) score was ≥ 26 prior to randomization to asenapine or placebo for 8 weeks. Gene testing was performed before breaking the blind. PRINCIPAL OBSERVATIONS Nine patients completing the study also underwent gene testing. At study end, the average MADRS improvement was -19.80 ± SD 8.59 for the 4 people randomized to asenapine and -3.80 ± 9.01 for the 5 people receiving placebo (P = 0.021, t = 2.88). Anxiety, as measured by the Hamilton Anxiety Rating Scale (HAM-A), also improved in asenapine-treated patients (-15.40 ± 6.15 vs. -2.80 ± 7.95, P = 0.023, t = 2.803). Six participants had the short form of the 5HTTR, and it is believed they influenced the significant outcome in this small sample. CONCLUSIONS While this is a very small sample, asenapine appears to have a beneficial effect on both depression and anxiety in depressed bipolar I patients compared to treatment with placebo. Due to the large fraction of subjects with the short form, the hypothesis that the SF-5HTTR might increase asenapine response could not be adequately tested.
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Affiliation(s)
- Rif S El-Mallakh
- El-Mallakh, MD, Nuss, MS, D. Gao, MD, Y. Gao MD, Surriya Ahmad, MD, Schrodt, BS, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. D. Gao, MD, Post Doctoral Fellow at University of Louisville, Current Address: College of Integrative Medicine Fujian University of Traditional Chinese Medicine Fuzhou, Fujian, China. Adler, MD, Department of Psychiatry University of Cincinnati Cincinnati, Ohio
| | - Sharon Nuss
- El-Mallakh, MD, Nuss, MS, D. Gao, MD, Y. Gao MD, Surriya Ahmad, MD, Schrodt, BS, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. D. Gao, MD, Post Doctoral Fellow at University of Louisville, Current Address: College of Integrative Medicine Fujian University of Traditional Chinese Medicine Fuzhou, Fujian, China. Adler, MD, Department of Psychiatry University of Cincinnati Cincinnati, Ohio
| | - Dong Gao
- El-Mallakh, MD, Nuss, MS, D. Gao, MD, Y. Gao MD, Surriya Ahmad, MD, Schrodt, BS, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. D. Gao, MD, Post Doctoral Fellow at University of Louisville, Current Address: College of Integrative Medicine Fujian University of Traditional Chinese Medicine Fuzhou, Fujian, China. Adler, MD, Department of Psychiatry University of Cincinnati Cincinnati, Ohio
| | - Yonglin Gao
- El-Mallakh, MD, Nuss, MS, D. Gao, MD, Y. Gao MD, Surriya Ahmad, MD, Schrodt, BS, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. D. Gao, MD, Post Doctoral Fellow at University of Louisville, Current Address: College of Integrative Medicine Fujian University of Traditional Chinese Medicine Fuzhou, Fujian, China. Adler, MD, Department of Psychiatry University of Cincinnati Cincinnati, Ohio
| | - Surriya Colleen Ahmad
- El-Mallakh, MD, Nuss, MS, D. Gao, MD, Y. Gao MD, Surriya Ahmad, MD, Schrodt, BS, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. D. Gao, MD, Post Doctoral Fellow at University of Louisville, Current Address: College of Integrative Medicine Fujian University of Traditional Chinese Medicine Fuzhou, Fujian, China. Adler, MD, Department of Psychiatry University of Cincinnati Cincinnati, Ohio
| | - Clare Schrodt
- El-Mallakh, MD, Nuss, MS, D. Gao, MD, Y. Gao MD, Surriya Ahmad, MD, Schrodt, BS, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. D. Gao, MD, Post Doctoral Fellow at University of Louisville, Current Address: College of Integrative Medicine Fujian University of Traditional Chinese Medicine Fuzhou, Fujian, China. Adler, MD, Department of Psychiatry University of Cincinnati Cincinnati, Ohio
| | - Caleb Adler
- El-Mallakh, MD, Nuss, MS, D. Gao, MD, Y. Gao MD, Surriya Ahmad, MD, Schrodt, BS, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. D. Gao, MD, Post Doctoral Fellow at University of Louisville, Current Address: College of Integrative Medicine Fujian University of Traditional Chinese Medicine Fuzhou, Fujian, China. Adler, MD, Department of Psychiatry University of Cincinnati Cincinnati, Ohio
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Ali ZA, Nuss S, El-Mallakh RS. Antidepressant discontinuation in treatment resistant depression. Contemp Clin Trials Commun 2019; 15:100383. [PMID: 31193850 PMCID: PMC6543016 DOI: 10.1016/j.conctc.2019.100383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/28/2019] [Accepted: 05/15/2019] [Indexed: 12/28/2022] Open
Abstract
Treatment-resistant depression (TRD) is a growing problem in psychiatric practice with some 15–20% of depressed patients becoming chronically depressed and perhaps as many as 40% in tertiary settings. Several groups have championed the idea that TRD may be attributed to the long-term treatment with antidepressant drugs (AD). Subjects with the short form of the serotonin transporter gene (both heterozygotes and homozygotes) have an increased risk for depression in the setting of adversity compared to people with the long form. Moreover, these same individuals have a reduced likelihood of responding well to antidepressants, with reports of no response, delayed response, and increased side effects. This hypothesis needs to be examined in a randomized clinical trial. The study will examine the effect of discontinuation versus continuation of serotonergic antidepressants on disease progression in patients with treatment resistant depression. We will recruit 30 subjects and assess the depressive symptoms and disease progression. Genetic testing will be performed to optimize clinical outcome in both groups, but will also be used to evaluate if the short form of the serotonin transporter predicts disease progression and long-term antidepressant treatment response.
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Affiliation(s)
- Ziad A. Ali
- Corresponding author. University of Louisville, Department of Psychiatry and Behavioral Sciences, 401 East Chestnut Street, Suite 610, Louisville, KY, 40202, United States.
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Terrell C, Brar K, Nuss S, El-Mallakh RS. Resource Utilization with the Use of Seclusion and Restraint in a Dedicated Emergency Psychiatric Service. South Med J 2018; 111:703-705. [PMID: 30392009 DOI: 10.14423/smj.0000000000000885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES There is a dearth of data regarding the use of emergency interventions in dedicated emergency psychiatric service settings, and reliable data are needed. This article describes the frequency and duration of the use of seclusion and restraint for imminent or existing agitation, aggression, or violence in a dedicated emergency psychiatric service located within an academic university hospital and staffed by sufficient numbers of trained personnel. METHODS We performed a retrospective chart review of 6 months' visits to a dedicated emergency psychiatric service. RESULTS Men outnumbered women with a 1.6 ratio of visits. Of 2843 subjects, 425 (14.6%) received emergent medication for anxiety (n = 90), substance withdrawal (n = 28), or agitation (n = 290). Physical interventions were used in 3.4%; 96 (3.3%) were secluded, and 9 (0.3%) were restrained. The average duration of seclusion was (mean ± standard deviation) 58.7 ± 37.4 minutes and for restraint 63.2 ± 23.4 minutes. Each episode of seclusion or restraint required approximately 3 hours of staff time. CONCLUSIONS The use of an intervention such as seclusion in >3% and restraint in 0.3% of patients represents the use of seclusion and restraint in a dedicated psychiatric emergency service with personnel trained to minimize the use of seclusion and restraint.
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Affiliation(s)
- Christina Terrell
- From the Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
| | - Kanwar Brar
- From the Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
| | - Sharon Nuss
- From the Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
| | - Rif S El-Mallakh
- From the Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
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El-Mallakh RS, Brar K, Watkins C, Nuss S, O'Connor SS, Gao Y, Wright JH. Association Between Low Barometric Pressure and Completed Suicides. Am J Psychiatry 2017; 174:905. [PMID: 28859507 DOI: 10.1176/appi.ajp.2017.17020154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rif S El-Mallakh
- From the Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville
| | - Kanwar Brar
- From the Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville
| | - Claire Watkins
- From the Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville
| | - Sharon Nuss
- From the Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville
| | - Stephen S O'Connor
- From the Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville
| | - Yonglin Gao
- From the Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville
| | - Jesse H Wright
- From the Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville
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Daviss WB, Perel JM, Brent DA, Axelson DA, Rudolph GR, Gilchrist R, Nuss S, Birmaher B. Acute antidepressant response and plasma levels of bupropion and metabolites in a pediatric-aged sample: an exploratory study. Ther Drug Monit 2006; 28:190-8. [PMID: 16628130 DOI: 10.1097/01.ftd.0000197093.92559.7a] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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: 11/25/2022]
Abstract
Studies examining associations between antidepressant response and plasma levels of bupropion and its metabolites have yielded contradictory findings. There have been no such studies in youth. This study explored such associations in 8 boys and 8 girls, age 11 to 17 years, all prescribed bupropion sustained release (SR) for major depression (n = 6) or depressive disorder not otherwise specified (n = 10) as part of a pharmacokinetic (PK) study. All were started on morning doses of bupropion SR of 100 mg/day, and most eventually had doses increased to 200 mg/day because of inadequate clinical response. After taking prescribed dose of bupropion SR at least 14 days (median = 21 days), subjects had steady-state serial plasma levels of bupropion and its metabolites measured during a 24-hour period after morning doses. A total of 9 subjects underwent these PK assessments on doses of 100 mg/day, and 6 underwent these on doses of 200 mg/day, with 4 studied on both doses. In this 24-hour assessment, the treating psychiatrist rated subjects' antidepressant response using the Clinical Global Impression's Improvement scale (CGI-I), blind to plasma levels, but informed by child and parent rating scales of depressive symptoms and clinical interviews. Relative to 7 nonresponders, 9 responders (CGI-I < or = 2) had significantly higher mean areas under concentration curves for bupropion (P = 0.03), threohydrobupropion (P = 0.02), and erythrohydrobupropion (P = 0.02), and especially hyroxybupropion (P = 0.006). Plasma levels 7.5 hours after morning doses reaching the following cut points discriminated responders from nonresponders: bupropion > or = 37 ng/mL (P = 0.001), hydroxybupropion > or = 575 ng/mL (P = 0.003), threohydrobupropion > or = 240 ng/mL (P = 0.009), or erythrohydrobupropion > or = 45 ng/mL (P = 0.009). These preliminary findings suggest that plasma levels of bupropion and metabolites, particularly hydroxybupropion, may predict acute antidepressant response in depressed youths taking bupropion SR.
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Affiliation(s)
- W Burleson Daviss
- Western Psychiatric Institute and Clinic, Pittsburgh, PA, and the University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Tacke M, Szymanowski H, Schulze C, Nuss S, Wehrwein E, Leidenberger S, Oelfke U. SU-FF-T-294: Monte Carlo Simulations of the Dosimetric Characteristics of a New Multileaf Collimator. Med Phys 2005. [DOI: 10.1118/1.1998023] [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: 11/07/2022] Open
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Axelson DA, Perel JM, Birmaher B, Rudolph G, Nuss S, Yurasits L, Bridge J, Brent DA. Platelet serotonin reuptake inhibition and response to SSRIs in depressed adolescents. Am J Psychiatry 2005; 162:802-4. [PMID: 15800159 DOI: 10.1176/appi.ajp.162.4.802] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [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: 12/01/2022]
Abstract
OBJECTIVE The authors examined platelet serotonin reuptake inhibition and response to selective serotonin reuptake inhibitor (SSRI) treatment in depressed adolescents. METHOD Twenty-three depressed adolescents participating in pharmacokinetic studies of SSRIs had platelet serotonin reuptake measured before and after 14-28 days of treatment. The Clinical Global Impression (CGI) improvement rating was determined on the basis of all clinical information and was performed blind to the platelet data. RESULTS Improvement in depressive symptoms as rated with the CGI improvement subscale was significantly associated with the percentage change in platelet serotonin reuptake inhibition from pre- to posttreatment. Improvement in depression was also associated with absolute decrease in platelet serotonin reuptake when adjusted for the magnitude of baseline reuptake. CONCLUSIONS Platelet serotonin reuptake inhibition may be an appropriate surrogate biological marker for the pharmacodynamic activity of SSRIs in depressed adolescents.
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Affiliation(s)
- David A Axelson
- Western Psychiatric Institute and Clinic, 3811 O'Hara St., Pittsburgh, PA 15213, USA
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Daviss WB, Perel JM, Rudolph GR, Axelson DA, Gilchrist R, Nuss S, Birmaher B, Brent DA. Steady-state pharmacokinetics of bupropion SR in juvenile patients. J Am Acad Child Adolesc Psychiatry 2005; 44:349-57. [PMID: 15782082 DOI: 10.1097/01.chi.0000153225.26850.26] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [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: 11/25/2022]
Abstract
OBJECTIVE To examine the steady-state pharmacokinetic properties of bupropion sustained release (SR) and their potential developmental differences in youths. METHOD Eleven boys and eight girls aged 11 to 17 years old were prescribed bupropion SR monotherapy for attention-deficit/hyperactivity disorder (n = 16) and/or depressive disorders (n = 16). Bupropion SR was given in morning doses of 100 mg/day (n = 11) or 200 mg/day (n = 8) for 14 days or less, with five subjects studied on both doses. All subjects had blood draws from an intravenous port every 1 to 3 hours for 24 hours after their usual morning doses. Pharmacokinetic variables were determined by noncompartmental and compartmental analyses for bupropion and metabolites, respectively. RESULTS Bupropion and its metabolites exhibited linear pharmacokinetics. Areas under the concentration curves for the hydroxybupropion, threohydrobupropion, and erythrohydrobupropion were 20, 12, and 2.7 times higher, respectively, than for bupropion. Relative to adults, the mean half-lives of bupropion (12.1 hours) and threohydrobupropion (26.3 hours) were significantly shorter, and areas under the concentration curve ratios of metabolites to bupropion were 19% to 80% higher. CONCLUSIONS Youths metabolize bupropion SR faster to hydroxybupropion and other active metabolites than adults. Until the clinical importance of bupropion's metabolites is clarified, bupropion SR should be given in divided doses to youths, as the manufacturer recommends for adults taking higher doses.
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Affiliation(s)
- W Burleson Daviss
- Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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Abstract
OBJECTIVE To determine the pharmacokinetics of sertraline in adolescents and assess its effect on a surrogate marker of serotonin transport. METHOD Pharmacokinetic parameters of a single 50-mg dose of sertraline were determined in 10 adolescents. Steady-state withdrawal kinetics were determined in 12 adolescents taking 50 mg/day and in 6 adolescents taking 100 to 150 mg/day. Platelet serotonin reuptake was measured before and after 2 weeks of daily 50-mg dosing. RESULTS The mean steady-state half-life of 50 mg was significantly shorter (15.3 +/- 3.5 hours) than the single-dose half-life (26.7 +/- 5.2 hours; t = 6.4, p < .001) and the steady-state half-life at 100 to 150 mg/day (20.4 +/- 3.4 hours; t = 2.9, p = .01). Platelet serotonin reuptake was inhibited by 61 +/- 15% after approximately 2 weeks of sertraline 50 mg/day. CONCLUSIONS The half-life of sertraline 50 mg becomes significantly shorter from the initial dose to steady-state, and many adolescents may benefit from twice-per-day dosing. The steady-state half-life increases as the dose increases. The moderate levels of platelet reuptake inhibition at 50 mg/day indicate that most adolescents may need sertraline doses higher than 50 mg/day to attain a therapeutic response.
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Affiliation(s)
- David A Axelson
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, PA 15213, USA.
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Nuss S, Franco T. Nursing: an international perspective. Nebr Nurse 2001; 34:27. [PMID: 11998678] [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: 02/24/2023]
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Nuss S, Kincaid CR. Serotonin discontinuation syndrome: does it really exist? W V Med J 2000; 96:405-7. [PMID: 10771628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Treatment guidelines for depression have typically focused on diagnosis, how to initiate antidepressants, and duration of therapy, while very little is discussed about discontinuing treatment. With the advent of the serotonin-specific reuptake inhibitors (SSRIs), there is now growing evidence to support a "discontinuation syndrome" associated with withdrawal of therapy. This article describes two cases and presents a review of the literature.
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Affiliation(s)
- S Nuss
- Dept. of Medicine, Robert C. Byrd Health Sciences Center of West Virginia University, Morgantown, USA
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Lebeau L, Nuss S, Schultz P, Oudet P, Mioskowski C. Self-assembly of soluble proteins on functionalized lipid layers: a tentative correlation between the fluidity properties of the lipid film and protein ordering. Chem Phys Lipids 1999; 103:37-46. [PMID: 10701078 DOI: 10.1016/s0009-3084(99)00089-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
New series of amphiphilic structures are designed to exhibit various fluidity properties when spread at the air-water interface. The influence of the molecular structure of these lipids on the process of two-dimensional (2D) crystallization of the B subunit of DNA gyrase, a soluble protein, is investigated in terms of size of the crystals produced, protein ordering, and crystallization kinetics. Whereas no difference is observed concerning the mean size of the protein 2D crystals obtained on the different lipid supports, the ultimate protein ordering observable by electron microscopy using the negative-staining technique is more regularly attained with some of these new lipids. The most interesting point results from large discrepancies in crystallization kinetics as highly-ordered protein 2D crystals form within 6-24 h depending on the lipid layer structure. Thus, these new lipids reveal of special interest when studying proteins that suffer from extended incubation time at 4 degrees C or higher temperature and lose their functionality.
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Affiliation(s)
- L Lebeau
- Université Louis Pasteur, Laboratoire de Synthèse Bioorganique associé au CNRS, Illkirch, France.
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Nuss S, Mioskowski C, Lebeau L. Synthesis of new fluidity-enhanced amphiphilic compounds for soluble protein two-dimensional crystallization purpose. Chem Phys Lipids 1999; 103:21-35. [PMID: 10701077 DOI: 10.1016/s0009-3084(99)00088-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The synthesis of new amphiphilic compounds is described. The structures are rationally designed for soluble protein two-dimensional (2D) crystallization purpose. Special attention is devoted to fluidity properties expected of resulting monolayers. A series of 13 compounds was prepared containing unsaturated, branched or fluorinated alkyl chains. Structures are either symmetrical or dissymmetrical and present a hydroxyl group as polar head, eventually complemented with two other 'secondary' hydrophilic functions.
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Affiliation(s)
- S Nuss
- Laboratoire de Synthèse, Bioorganique associé au CNRS, Université Louis Pasteur, Illkirch, France
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Halperin AK, Elnicki DM, Palmer HC, See CJ, Nuss S, Kolar MM, Bell D. Appalachian perspective on modifiable risk factors in coronary artery disease: how well are we doing? South Med J 1999; 92:174-89. [PMID: 10071664 DOI: 10.1097/00007611-199902000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite recognition of modifiable risk factors and available and effective life-style and pharmacologic therapies, many individuals have unrecognized or untreated risk factors for coronary artery disease. METHODS Using MEDLINE, we searched for relevant review articles and clinical trials related to hypertension, hyperlipidemia, diabetes mellitus, smoking, physical activity, obesity, and psychologic risk factors for coronary artery disease. We carefully reviewed the literature and statistics on modifiable risk factors and identified appropriate physician interventions. RESULTS A large amount of information is available on coronary artery disease and modifiable risk factors. Much of the data focuses on diagnosis and treatment to goal. CONCLUSIONS Coronary artery disease remains the number one cause of death in the United States and West Virginia, even though specific guidelines have been established for detection and treatment. The medical community needs to be more aggressive in managing modifiable risk factors.
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Affiliation(s)
- A K Halperin
- Department of Medicine, West Virginia University, Morgantown 26506-9160, USA
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Abstract
Maternal cell contamination in amniotic fluid samples is easily detected by in situ hybridization if the karyotype of the fetus differs from the karyotype of the mother. One out of two amniotic fluid samples appears to contain more than 20% maternal cells. Bloody samples often contain even more than 50% maternal cells. Maternal cells can also be identified on the basis of their nuclear morphology. Maternal cell contamination is regularly observed in pregnancies with an anterior placenta, whereas it is rare in posterior placenta pregnancies. The maternal cells are therefore thought to be artificially introduced into the amniotic fluid sample, as a result of placental bleeding during amniocentesis. The implications of maternal cell contamination for prenatal diagnosis using uncultured amniotic fluid samples are discussed.
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Affiliation(s)
- S Nuss
- Institut für Humangenetik und Anthropologie, Universität Heidelberg, Germany
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