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Gerlach M.,University of Wurzburg | Greenhill L.,NYS Psychiatric Institute | Warnke A.,University of Wurzburg
Psychiatric Drugs in Children and Adolescents: Basic Pharmacology and Practical Applications | Year: 2014

This book offers a comprehensive survey of the current state of knowledge in the field of neuro-psychopharmacology in childhood and adolescence. In the first part, the essentials of neuro-psychopharmacology are presented in order to provide a deeper understanding of the principles and particularities in the pharmacotherapy of children and adolescents. This part includes information on neurotransmitters and signal transduction pathways, molecular brain structures as targets for psychiatric drugs, characteristics of psychopharmacological therapy in children and adolescents, ontogenetic influences on pharmacokinetics and pharmacodynamics, and pharmacotherapy in the outpatient setting. The part on classes of psychiatric medications, which covers antidepressants, antipsychotics, anxiolytics and sedative-hypnotics, mood stabilizers, and psychostimulants and other drugs used in the treatment of attention-deficit/hyperactivity disorder, provides sufficient background material to better understand how psychoactive drugs work, and why, when, and for whom they should be used. For each drug within a class, information on its mechanisms of action, clinical pharmacology, indications, dosages, and cognate issues are reviewed. In the third part, the disorder-specific and symptom-oriented medication is described and discerningly evaluated from a practical point of view, providing physicians with precise instructions on how to proceed. Psychiatric Drugs in Children and Adolescents includes numerous tables, figures and illustrations and offers a valuable reference work for child and adolescent psychiatrists and psychotherapists, pediatricians, general practitioners, psychologists, and nursing staff, as well as teachers. © 2014 Springer-Verlag Wien. All rights are reserved.

Padilla A.,University of Massachusetts Medical School | Benjamin S.,University of Massachusetts Medical School | Lewis-Fernandez R.,NYS Psychiatric Institute
Academic Psychiatry | Year: 2016

Objective: Culturally appropriate tools for patient assessment are needed to train psychiatric residents. An objective structured clinical examination (OSCE) can be a helpful tool for evaluating trainees in the psychiatry milestones pertaining to cultural competency. Methods: Seventeen psychiatry residents and fellows at the University of Massachusetts participated in two small-group OSCE exercises to learn cultural interviewing using the DSM-5 Cultural Formulation Interview. Trainee groups presented a cultural formulation and received feedback. Participants were surveyed about their comfort with cultural interviewing before and after the exercise. Results: Paired t tests (N = 16) showed that mean level of comfort with the Cultural Formulation Interview increased by a mean of 0.5 points after training (t = 3.16, df = 15, p < 01 95 % CI = 163-837). Discussion: The UMass culturally appropriate assessment OSCE enhanced psychiatric trainees' comfort with culturally appropriate interviewing using the Cultural Formulation Interview. © 2016 Academic Psychiatry.

Shortreed S.M.,McGill University | Laber E.,University of Michigan | Lizotte D.J.,University of Michigan | Stroup T.S.,NYS Psychiatric Institute | And 2 more authors.
Machine Learning | Year: 2011

This paper highlights the role that reinforcement learning can play in the optimization of treatment policies for chronic illnesses. Before applying any off-the-shelf reinforcement learning methods in this setting, we must first tackle a number of challenges. We outline some of these challenges and present methods for overcoming them. First, we describe a multiple imputation approach to overcome the problem of missing data. Second, we discuss the use of function approximation in the context of a highly variable observation set. Finally, we discuss approaches to summarizing the evidence in the data for recommending a particular action and quantifying the uncertainty around the Q-function of the recommended policy. We present the results of applying these methods to real clinical trial data of patients with schizophrenia. © 2010 The Author(s).

Fallon B.A.,NYS Psychiatric Institute | Pavlicova M.,Biostatistics | Coffino S.W.,Columbia University | Brenner C.,Lamont Doherty Earth Observatory
Clinical Infectious Diseases | Year: 2014

Background. As the incidence of Lyme disease (LD) has increased, a number of " Lyme specialty laboratories" have emerged, claiming singular expertise in LD testing. We investigated the degree of interlaboratory variability of several LD serologic tests - whole cell sonicate (WCS) enzyme-linked immunosorbent assay (ELISA), immunoglobulin M (IgM) and immunoglobulin G (IgG) Western blots (WBs), and an ELISA based on the conserved sixth region of variable major protein-like sequence expressed (C6) - that were performed at 1 university laboratory, 1 commercial laboratory, and 2 laboratories that specialize in LD testing. Methods. Serum samples from 37 patients with posttreatment Lyme syndrome, as well as 40 medically healthy controls without prior LD, were tested independently at the 4 laboratories. Results. In general, there was little difference among the laboratories in the percentage of positive test results on the ELISAs and IgG WBs, although the number of discordant results was often high. When in-house criteria for positivity were used at the 2 specialty laboratories, specificity at 1 laboratory declined considerably on both the IgM and IgG WBs. The Centers for Disease Control and Prevention (CDC) 2-tiered criteria improved overall concordance. At the 2 laboratories that performed the C6 ELISA, the percentage of positive tests was comparable to that of the WCS ELISA while providing higher specificity. The IgM WB performed poorly in our patient population of individuals with later-stage illness, a result consistent with previous studies. Conclusions. Although there was surprisingly little difference among the laboratories in percentage of positive results on most assays using CDC criteria, interlaboratory variability was considerable and remains a problem in LD testing. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.

Carmel J.B.,Burke Cornell Medical Research Institute | Carmel J.B.,City University of New York | Kim S.,Columbia University | Brus-Ramer M.,Columbia University | And 3 more authors.
European Journal of Neuroscience | Year: 2010

Rats are used to model human corticospinal tract (CST) injury and repair. We asked whether rats possess the ability to orient their paw to the reaching target and whether the CST mediates this skill, as it does in primates. To test this ability, called preshaping, we trained rats to reach for pieces of pasta oriented either vertically or horizontally. We measured paw angle relative to the target and asked whether rats used target information attained before contact to preshape the paw, indicating feed-forward control. We also determined whether preshaping improved with practice. We then selectively lesioned the CST in the medullary pyramid contralateral to the reaching forepaw to test whether preshaping relies on the CST. Rats significantly oriented their paw to the pasta orientation before contact, demonstrating feed-forward control. Both preshaping and reaching efficiency improved with practice, while selective CST lesion abrogated both. The loss of preshaping was greatest for pasta oriented vertically, suggesting loss of supination, as seen with human CST injury. The degree of preshaping loss strongly correlated with the amount of skill acquired at baseline, suggesting that the CST mediates the learned component of preshaping. Finally, the amount of preshaping lost after injury strongly correlated with reduced retrieval success, showing an important functional consequence for preshaping. We have thus demonstrated, for the first time, preshaping in the rat and dependence of this skill on the CST. Understanding the basis for this skill and measuring its recovery after injury will be important for studying higher-level motor control in rats. © 2010 The Authors. European Journal of Neuroscience © 2010 Federation of European Neuroscience Societies and Blackwell Publishing Ltd.

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