Alejandra Elizabeth Morfin Rodriguez, MD

All Publications

• Choosing a Pharmacologic Strategy for Those With a Psychotic Illness: Balancing Efficacy, Tolerability, and Cost. The primary care companion for CNS disorders Lim, C. S., Rodriguez, A. M., Donovan, A. L., Maclaurin, S., Daneshvari, N. O., Stern, T. A. 2025; 27 (5)

  Abstract

  The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

  View details for DOI 10.4088/PCC.25f03983

  View details for PubMedID 41201907

• Ethnoracial disparities in care on a consultation-liaison service at an academic hospital GENERAL HOSPITAL PSYCHIATRY Zambrano, J., Celano, C. M., Onyeaka, H., Rodriguez, A., Shea, T., Ahn-Horst, R., Grossman, M., Mullersman, K., Ordonez, A., Smith, F. A., Beach, S. 2024; 86: 50-55

  Abstract

  There is currently an increasing recognition of and focus on structural and institutional racism and its impacts on health disparities. In psychiatry and mental health, research has focused on racial and ethnic disparities in the availability and utilization of mental health services, care in emergency departments, and inpatient psychiatric services. Little is known about disparities in care on general hospital psychiatry consultation-liaison (CL) services.In this exploratory study, we conducted a retrospective chart review using electronic health record (EHR) data of all adults (≥ 18 years of age) admitted to inpatient medical or surgical floors at an urban academic medical center for whom a psychiatric consultation was requested during the study period. We examined differences by race and ethnicity in: rates of consultation requests; use of legal holds, constant observation, restraints; follow-up by the CL service; and ultimate disposition.The service received 310 unique consults during the study period. Compared to hospital-wide numbers, Black-identifying patients were over-represented in our sample (11.9% vs 6.6%), while Latinx patients were underrepresented (6.1% vs 9.8%). Of the clinical and outcome variables collected, there were higher odds of being placed on a legal hold both prior to (OR 2.6) and after the consult question (OR 2.98) and in the odds of having a one-to-one observer prior to (OR 2.47) and after (OR 2.9) the initial consult visit for Black-identifying patients, when adjusting for confounders. There were no other measurable differences in care or outcomes by racial or ethnic categories.Black-identifying patients may be more likely to receive psychiatric consultation and be placed on legal holds because of a combination of chronic adverse social determinants of health and race-based bias. Conversely, Latinx patients may be less likely to receive psychiatric consultation because of language barriers among other factors. The lack of disparities identified in other domains may be encouraging, but larger studies are needed. Further research is also needed to identify causality and interventions that could help close the gap in care and outcomes for racial and ethnic minorities.

  View details for DOI 10.1016/j.genhosppsych.2023.11.010

  View details for Web of Science ID 001135148100001

  View details for PubMedID 38070241

  View details for PubMedCentralID PMC10843593

• Demographic Features, Physical Examination Findings, and Medication Use in Hospitalized, Delirious Patients With and Without COVID-19 Infection: A Retrospective Study. Journal of the Academy of Consultation-Liaison Psychiatry Beckwith, N., Probert, J., Rosenbaum, B. L., Bains, A., Angelucci, V. C., Morfin Rodriguez, A. E., London, S., Zollman, J. W., Soto Ordoñez, A., Kontos, N., Smith, F. A., Celano, C. M., Beach, S. R. 2023; 64 (1): 35-44

  Abstract

  Delirium is common in the setting of infection with severe acute respiratory syndrome coronavirus 2. Anecdotal evidence and case reports suggest that patients with delirium in the setting of Coronavirus 2019 (COVID-19) may exhibit specific features, including increased tone, abulia, and alogia.To determine whether differences exist in sociodemographic and medical characteristics, physical examination findings, and medication use in delirious patients with and without COVID-19 infection referred for psychiatric consultation.We undertook an exploratory, retrospective chart review of 486 patients seen by the psychiatry consultation service at a tertiary care hospital from March 10 to May 15, 2020. Delirious patients were diagnosed via clinical examination by a psychiatric consultant, and these patients were stratified by COVID-19 infection status. The strata were described and compared using bivariate analyses across sociodemographic, historical, objective, and treatment-related variables.A total of 109 patients were diagnosed with delirium during the study period. Thirty-six were COVID-19+. Median age was 63 years and did not differ between groups. COVID-19+ patients with delirium were more likely to present from nursing facilities (39% vs 11%; Fisher's exact test; P = 0.001) and have a history of schizophrenia (11% vs 0%; Fisher's exact test; P = 0.011). Myoclonus (28% vs 4%; P = 0.002), hypertonia (36% vs 10%; P = 0.003), withdrawal (36% vs 15%; P = 0.011), akinesia (19% vs 6%; P = 0.034), abulia (19% vs 3%; P = 0.004), and alogia (25% vs 8%; P = 0.012) were more common in COVID-19+ patients. COVID-19+ delirious patients were significantly more likely to have received ketamine (28% vs 7%; P = 0.006), alpha-adrenergic agents besides dexmedetomidine (36% vs 14%; P = 0.014), and enteral antipsychotics (92% vs 66%; P = 0.007) at some point.Patients with COVID-19 delirium referred for psychiatric consultation are more likely to reside in nursing facilities and have a history of schizophrenia than delirious patients without COVID-19. Patients with delirium in the setting of COVID-19 may exhibit features consistent with akinetic mutism. Psychiatrists must assess for such features, as they may influence management choices and the risk of side effects with agents commonly used in the setting of delirium.

  View details for DOI 10.1016/j.jaclp.2022.07.010

  View details for PubMedID 35948255

  View details for PubMedCentralID PMC9357932

• A qualitative analysis of adolescent motherhood within the broader family context in Peru FAMILY RELATIONS Levey, E. J., Rodriguez, A. E., Chang, A. R., Rondon, M. B., Sanchez, M., Harrison, A. M., Gelaye, B., Becker, A. E. 2024; 73 (2): 1046-1066

  Abstract

  The purpose of this study was to characterize the impact of adolescent pregnancy on families and describe the needs of adolescent mothers and their infants in order to assess the need for intervention and identify potential intervention targets.Adolescent mothers and their offspring face an increased risk of mental health problems. Adolescent mothers and their families also face significant resource constraints; 95% live in low- and middle-income countries (LMICs). Cost-effective interventions are needed to improve outcomes for this vulnerable group.This qualitative study conducted in Lima, Peru, consisted of four clinician focus groups and 18 in-depth interviews with adolescent mothers and their family members. Data were coded thematically, and direct content analysis was employed.The study identified the following issues facing adolescent parents: the transition to parenthood, the need for family support, difficulty accessing support, the difficulty for family members of providing support, and ideas about responsibility and adolescent autonomy.Overall, these findings demonstrate the need for interventions that engage families and address barriers to accessing support, including relationship conflict and differing beliefs about responsibility and autonomy.Interventions are needed for adolescent mothers in LMICs that mobilize family support. Clinicians who care for these patients need to be aware of the family context and the resources available where they practice.

  View details for DOI 10.1111/fare.12904

  View details for Web of Science ID 000994505300001

  View details for PubMedID 38523658

  View details for PubMedCentralID PMC10957107

• Deconstructing Cultural Aspects of Mental Health Care in Hispanic/Latinx People. Psychiatric annals Forcén, F. E., Vélez Flórez, M. C., Bido Medina, R., Zambrano, J., Pérez, J. H., Rodríguez, A. M., Santos, L. H. 2023; 53 (3): 127-132

  Abstract

  In the United States, 18.9% of the population identifies as Hispanic or Latin. The culture of these communities is as diverse, heterogenous, and rich as the history of this population. Culture shapes the perception of symptoms and psychiatric disorders. To provide culturally sensitive care, it is relevant to understand the history of these communities in the US, recognize cultural humility, and acknowledge aspects and values (eg, culturally bound syndromes, familism, paternalism, stigma of mental illness, machismo, immigration) inherent to the cultural experience and unique barriers to care. Incorporating these aspects into clinical practice is essential for positive outcomes. The purpose of this article is to give a brief historical context, encourage cultural humility, and describe cultural aspects that are essential when providing culturally sensitive care to the Hispanic and Latinx community in the US.

  View details for DOI 10.3928/00485713-20230215-02

  View details for PubMedID 37781171

  View details for PubMedCentralID PMC10540642

• Manifestations of Intergenerational Trauma During the Perinatal Period Among Adolescent Mothers in Lima, Peru: A Qualitative Analysis. Journal of child & adolescent trauma Levey, E. J., Chang, A. R., Sanchez, M. L., Harrison, A. M., Rodriguez, A. E., Gelaye, B., Rondon, M. B. 2023; 16 (1): 21-30

  Abstract

  Adverse childhood experiences have a lasting impact on health across the life course. The perinatal period offers a unique opportunity to rework problematic dynamics in families experiencing intergenerational trauma. This study explores the family dynamics that are activated during the perinatal period and considers the potential for intervention with adolescent parents and their families in Lima, Peru. This narrative analysis was part of a broader study that included focus groups and in-depth interviews. Of the ten adolescent mothers interviewed, four narratives were selected for presentation in this manuscript. These particular narratives were selected to illustrate the diversity of the experiences among this group and for the exceptional level of detail provided about their life experiences and family relationships. Narrative excerpts were analyzed in the context of the entire interview and the aggregate content of other interviews in order to explore both explicit and implicit meanings. This study identified critical relational shifts among adolescent parents and their families during the perinatal period. In one instance, adolescent parenthood created an opportunity for the family to come together. In the other cases, conflict escalated, relations grew distant, or both. These narrative data demonstrate that intergenerational trauma can interfere with family relationships in the context of adolescent pregnancy and prevent adolescent parents from accessing needed support from their families. Intervention with families could address the impact of trauma and improve communication and collaboration.

  View details for DOI 10.1007/s40653-022-00477-y

  View details for PubMedID 36776635

  View details for PubMedCentralID PMC9908777

• Racial And Ethnic Disparities in Care in the Psychiatry Consult Service at an Academic Hospital Zambrano, J., Onyaeka, H., Rodriguez, A., Grossman, M. N., Ordonez, A., Smith, F. A., Beach, S. R. ELSEVIER SCIENCE INC. 2022: S219-S220

  View details for DOI 10.1016/j.jaclp.2022.10.221

  View details for Web of Science ID 001080360300218

• Characteristics of COVID-associated versus Other Deliria: A Retrospective Chart Review of 152 Inpatient Psychiatric Consultations in 2020 Beckwith, N., Probert, J., Rosenbaum, B., Bains, A., London, S., Angelucci, V., Zollman, J., Ordonez, A., Rodriguez, A., Onyeaka, H., Kontos, N., Smith, F., Celano, C., Beach, S. ELSEVIER SCIENCE INC. 2022: S89

  View details for DOI 10.1016/j.jaclp.2022.03.184

  View details for Web of Science ID 000872183600178

• Algebraic formulas characterizing an alternative to Guyton's graphical analysis relevant for heart failure. American journal of physiology. Regulatory, integrative and comparative physiology Stiles, T. W., Morfin Rodriguez, A. E., Mohiuddin, H. S., Lee, H., Dalal, F. A., Fuertes, W. W., Adams, T. H., Stewart, R. H., Quick, C. M. 2021; 320 (6): R851-R870

  Abstract

  Although Guyton's graphical analysis of cardiac output-venous return has become a ubiquitous tool for explaining how circulatory equilibrium emerges from heart-vascular interactions, this classical model relies on a formula for venous return that contains unphysiological assumptions. Furthermore, Guyton's graphical analysis does not predict pulmonary venous pressure, which is a critical variable for evaluating heart failure patients' risk of pulmonary edema. Therefore, the purpose of the present work was to use a minimal closed-loop mathematical model to develop an alternative to Guyton's analysis. Limitations inherent in Guyton's model were addressed by 1) partitioning the cardiovascular system differently to isolate left ventricular function and lump all blood volumes together, 2) linearizing end-diastolic pressure-volume relationships to obtain algebraic solutions, and 3) treating arterial pressures as constants. This approach yielded three advances. First, variables related to morbidities associated with left ventricular failure were predicted. Second, an algebraic formula predicting left ventricular function was derived in terms of ventricular properties. Third, an algebraic formula predicting flow through the portion of the system isolated from the left ventricle was derived in terms of mechanical properties without neglecting redistribution of blood between systemic and pulmonary circulations. Although complexities were neglected, approximations necessary to obtain algebraic formulas resulted in minimal error, and predicted variables were consistent with reported values.

  View details for DOI 10.1152/ajpregu.00260.2019

  View details for PubMedID 33596744