Jose R. Maldonado, MD, FACLP, FACFE

All Publications

• Dextroamphetamine as Adjunctive Pharmacotherapy for Aggression Secondary to Korsakoff Syndrome: A Case Report. Journal of the Academy of Consultation-Liaison Psychiatry Gunther, M., Jiang, S., Maldonado, J. R. 2024

  View details for DOI 10.1016/j.jaclp.2024.02.006

  View details for PubMedID 38417703

• Thalamic deep brain stimulation in traumatic brain injury: a phase 1, randomized feasibility study. Nature medicine Schiff, N. D., Giacino, J. T., Butson, C. R., Choi, E. Y., Baker, J. L., O'Sullivan, K. P., Janson, A. P., Bergin, M., Bronte-Stewart, H. M., Chua, J., DeGeorge, L., Dikmen, S., Fogarty, A., Gerber, L. M., Krel, M., Maldonado, J., Radovan, M., Shah, S. A., Su, J., Temkin, N., Tourdias, T., Victor, J. D., Waters, A., Kolakowsky-Hayner, S. A., Fins, J. J., Machado, A. G., Rutt, B. K., Henderson, J. M. 2023

  Abstract

  Converging evidence indicates that impairments in executive function and information-processing speed limit quality of life and social reentry after moderate-to-severe traumatic brain injury (msTBI). These deficits reflect dysfunction of frontostriatal networks for which the central lateral (CL) nucleus of the thalamus is a critical node. The primary objective of this feasibility study was to test the safety and efficacy of deep brain stimulation within the CL and the associated medial dorsal tegmental (CL/DTTm) tract.Six participants with msTBI, who were between 3 and 18 years post-injury, underwent surgery with electrode placement guided by imaging and subject-specific biophysical modeling to predict activation of the CL/DTTm tract. The primary efficacy measure was improvement in executive control indexed by processing speed on part B of the trail-making test.All six participants were safely implanted. Five participants completed the study and one was withdrawn for protocol non-compliance. Processing speed on part B of the trail-making test improved 15% to 52% from baseline, exceeding the 10% benchmark for improvement in all five cases.CL/DTTm deep brain stimulation can be safely applied and may improve executive control in patients with msTBI who are in the chronic phase of recovery.ClinicalTrials.gov identifier: NCT02881151 .

  View details for DOI 10.1038/s41591-023-02638-4

  View details for PubMedID 38049620

  View details for PubMedCentralID 8126422

• Reliability and Validity of the Spanish Adaptation of the Stanford Proxy Test for Delirium (S-PTDsv) in Two Clinical Communities Infante-Reyes, S., Behn, A., Gonzalez, M., Pintor, L., Franco, E., Araya, P., Maldonado, J. ELSEVIER SCIENCE INC. 2023: S111-S112

  View details for DOI 10.1016/j.jaclp.2023.11.226

  View details for Web of Science ID 001161339100210

• Irreversible Lithium Neurotoxicity: A Review and Case of Toxicity Leading to Bilateral Globus Pallidus Injury Gunther, M., Jiang, S., Maldonado, J. ELSEVIER SCIENCE INC. 2023: S129

  View details for DOI 10.1016/j.jaclp.2023.11.260

  View details for Web of Science ID 001161339100244

• Reliability and validity of the Spanish adaptation of the Stanford Proxy Test for Delirium (S-PTDsv) in two clinical Spanish speaking communities. Journal of the Academy of Consultation-Liaison Psychiatry Sanndy, I., Alex, B., Matías, G., Luis, P., Eduardo, F., Pablo, A., Maldonado, J. R. 2023

  Abstract

  Delirium is the most prevalent neuropsychiatric syndrome experienced by patients admitted to inpatient clinical units, occurring in at least 20% of medically hospitalized patients and up to 85% of those admitted to critical care units. Although current guidelines recommend the implementation of universal prevention strategies, the use of management strategies largely depend on constant surveillance and screening. This allows for the timely diagnosis and the correction of its underlying causes and implementation of management strategies.It was to adapt and analyze the Spanish adaptation of the Stanford Proxy Test for Delirium (S-PTDsv) instrument for its use among Spanish-speaking populations. The S-PTD is an instrument consisting of 13 observational items to be completed by a clinician observer, usually the patient's nurse. The completion of the questionnaire takes about one minute and does not require the active participation of the person evaluated, which has important clinical advantages compared to other available instruments (e.g., the Confusion Assessment Method [CAM]).The psychometric properties of the S-PTDsv were evaluated in a population of 123 patients, using a quantitative, cross-sectional design. All subjects were over 18 years of age and hospitalized in various inpatient medico-surgical and Intensive care Unit services, either to the Barcelona Clinical Hospital (Barcelona, Spain) or the UC-Christus Health Network Clinical Hospital (Santiago, Chile, S.A.). The ultimate diagnosis of delirium was made by a member of the Psychiatry Consult Service, by means of an independent neuropsychiatric evaluation based on the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, published in 2013 and is the latest version of the diagnostic manual. All study tests were performed by study personnel who were blinded to each other's test results and within an hour of each other.In the ROC analysis, the S-PTDsv demonstrated excellent classification qualities when compared with the DSM-5, as the classification gold-standard. Using a cut-off point of ≥3, the S-PTDsv had a sensitivity of 94% and a specificity of 97%. The AUC indicator was equal to 0.95, suggesting the S-PTDsv has an excellent overall performance in accurately identifying cases of Delirium. Accordingly, the S-PTDsv's positive predictive value (PPV) = 0.93, and the negative predictive value (NPV) = 0.97. The internal reliability measured with Cronbach's Alpha was 0.96. Confirmatory factor analysis revealed a one-dimensional structure with high loadings (>0.72), demonstrating that all items similarly contribute to the total diagnostic dimension, suggesting adequate construct validity. This provided evidence of convergent validity.The performance of the S-PTDsv, as compared to a blinded neuropsychiatric assessment based on DSM-5, indicates that it is an effective instrument for the detection of Delirium, in the Spanish speaking populations. These results are comparable and consistent with previously published studies in the English language version.

  View details for DOI 10.1016/j.jaclp.2023.09.004

  View details for PubMedID 37806639

• Bilateral Globus Pallidus Injury in the Setting of Lithium Toxicity: A Case Report JOURNAL OF THE ACADEMY OF CONSULTATION-LIAISON PSYCHIATRY Gunther, M., Jiang, S., Maldonado, J. R. 2023; 64 (5): 484-485

  View details for Web of Science ID 001073580400001

  View details for PubMedID 37689462

• The stanford proxy test for delirium (S-PTD): Research data on new tool for the screening of delirium in all clinical settings Maldonado, J., Alosaimi, F., Infante, S., Benitez-Lopez, M., Sher, Y., Pintor, L., Gonzalez, M. PERGAMON-ELSEVIER SCIENCE LTD. 2023: 20

  View details for DOI 10.1016/j.jpsychores.2023.111282

  View details for Web of Science ID 001041062900048

• An Interdisciplinary Reappraisal of Delirium and Proposed Subtypes JOURNAL OF THE ACADEMY OF CONSULTATION-LIAISON PSYCHIATRY Oldham, M. A., Slooter, A. C., Ely, W., Crone, C., Rosenthal, L. J., Ely, E., Maldonado, J. R. 2023; 64 (3): 248-261

  View details for Web of Science ID 000999622600001

• Bilateral Globus Pallidus Injury in the Setting of Lithium Toxicity: A Case Report. Journal of the Academy of Consultation-Liaison Psychiatry Gunther, M., Jiang, S., Maldonado, J. R. 2023; 64 (5): 484-485

  View details for DOI 10.1016/j.jaclp.2023.04.008

  View details for PubMedID 37689462

• A Retrospective Analysis of Guanfacine for the Pharmacological Management of Delirium. Cureus Jiang, S., Hernandez, M., Burke, H., Spurling, B., Czuma, R., Varghese, R., Cohen, A., Hartney, K., Sullivan, G., Kozel, F. A., Maldonado, J. R. 2023; 15 (1): e33393

  Abstract

  Background Delirium is a syndrome of acute brain failure that represents a change from an individual's baseline cognitive functioning characterized by deficits in attention and multiple aspects of cognition that fluctuate in severity over time. The symptomatic management of delirium's behavioral manifestations remains difficult. The alpha-2 agonists, dexmedetomidine and clonidine, are efficacious, but their potential cardiovascular adverse effects limit their utilization. Guanfacine is an oral alpha-2 agonist with a lower potential for such adverse outcomes; however, its use in delirium has not been studied. Methods A retrospective descriptive analysis of guanfacine for managing hyperactive or mixed delirium at Tampa General Hospital from January 2020 to October 2020 was conducted. The primary outcome was the time reduction in acute sedative administration. Secondary outcomes included renewed participation in physical therapy or occupational therapy (PT/OT), decreased opioid use, and an incidence of cardiovascular adverse effects. Results One hundred forty-nine patients were identified as having received guanfacine for managing delirium during the study period. All experienced a reduction in acute sedative use after the initiation of guanfacine. In 93 patients receiving PT/OT and no longer participating due to behavioral agitation, 74% had a documented renewal of services within four days. Of 112 patients on opioids, 70% experienced a 25% reduction in opioid administration within four days. No patients experienced consecutive episodes of hypotension that required a change in their clinical care. Two patients experienced a single episode of consecutive bradycardia that led to the discontinuation of guanfacine. Conclusions Based on our retrospective study, guanfacine is a well-tolerated medication for the management of delirium. Even in medically and critically ill patients, cardiovascular adverse events were rare with guanfacine. Patients treated with guanfacine experienced decreased acute sedative use for behavioral agitation. Additionally, patients treated with guanfacine received fewer opioids and were better able to participate in PT/OT. Future studies with prospective, randomized, placebo-controlled designs are warranted to evaluate this promising intervention for delirium further.

  View details for DOI 10.7759/cureus.33393

  View details for PubMedID 36751225

• An Interdisciplinary Reappraisal of Delirium and Proposed Subtypes. Journal of the Academy of Consultation-Liaison Psychiatry Oldham, M. A., Slooter, A. J., Ely, E. W., Crone, C., Maldonado, J. R., Rosenthal, L. J. 2022

  Abstract

  An interdisciplinary plenary session entitled "Rethinking and Rehashing Delirium" was held during the 2021 Annual Meeting of the Academy of Consultation-Liaison Psychiatry to facilitate dialogue on the prevalent approach to delirium. Panel members included a psychiatrist, neurointensivist, and critical care specialist, and attendee comments were solicited with the goal of developing a statement. Discussion was focused on a reappraisal of delirium, and in particular its disparate terminology and history in relation to acute encephalopathy. The authors endorse a recent joint position statement that describes acute encephalopathy as a rapidly evolving (< 4 weeks) pathobiological brain process that presents as subsyndromal delirium, delirium, or coma, and suggest the following points of refinement: (1) to suggest that "delirium disorder" describe the diagnostic construct including its syndrome, precipitant(s), and unique pathophysiology, (2) to restrict the term "delirium" to describing the clinical syndrome encountered at the bedside, (3) to clarify that the disfavored term "altered mental status" may occasionally be an appropriate preliminary designation where the diagnosis cannot yet be specified further, and (4) to provide rationale for rejecting the terms acute brain injury, failure, or dysfunction. The final common pathway of delirium appears to involve higher-level brain network dysfunction, but there are many insults that can disrupt functional connectivity. We propose that future delirium classification systems should seek to characterize the unique pathophysiological disturbances ("endotypes") that underlie delirium and delirium's individual neuropsychiatric symptoms. We provide provisional means of classification, in hopes that novel subtypes might lead to specific intervention to improve patient experience and outcomes. This paper concludes by considering future directions for the field. Key areas of opportunity include interdisciplinary initiatives to harmonize efforts across specialties and settings, enhance underrepresented groups in research, integration of delirium and encephalopathy in coding, development of relevant quality and safety measures, and exploration of opportunities for translational science.

  View details for DOI 10.1016/j.jaclp.2022.07.001

  View details for PubMedID 35840003

• Epidemiology of delirium in hospitalized patients in Latin America: A systematic review. Acta psychiatrica Scandinavica Maximiliano, B., Sebastian, B., Estefania, A., Irma, C., Gutierrez, P., Daniela P, P. l., Roberta, C., Eduardo, T., Jose, M., Felipe, S. 2022

  Abstract

  Accurate epidemiological data are essential for the planning of policies aimed at the identification, prevention, and management of delirium. The reported occurrence of delirium in hospitalized patients varies widely among studies, ranging between 5% to more than 80% in the international literature. The exact occurrence in Latin America is not well described.The aim of this study is to conduct a systematic analysis of the published data on the epidemiology of delirium in hospitalized patients in Latin America.We conducted a systematic review following PRISMA guidelines. Both MEDLINE and LILACS databases were searched for original research articles reporting the occurrence of delirium among adult hospitalized patients in Latin American countries. Studies including pediatric populations were excluded from this analysis. Two authors independently applied eligibility criteria, assessed quality, and extracted data. The corresponding authors of the original articles were contacted to obtain relevant information about the study when this was not present in the published manuscripts.Seven hundred and eighteen original articles were identified. After screening titles and abstracts, 149 studies were included in the final analysis. The occurrence of delirium varied depending on the clinical scenario: (1) in the general medico-surgical wards, it ranged from 2.1% to 60.4%, (2) in the Intensive Care Units (ICUs), from 9.6% to 94.8%, (3) in the post-operatory population, from 5.45% and 52.3%, and (4) it was found to be between 10.7% and 62% in the emergency department setting. The most used delirium assessment tools were the "Confusion Assessment Method" (CAM; in the general population), and the "Confusion Assessment Method for the ICU" (CAM-ICU). Fourteen out of 149 studies were conducted in clinical settings who actively implemented some form of non-pharmacological delirium prevention bundles, most of them as part of ICU sedation-analgesia protocols.Delirium occurs frequently in hospitalized patients in Latin America throughout a variety of clinical scenarios, including ICU, general wards, post-operatory populations, and among the emergency department setting. The CAM and the CAM-ICU are the most used delirium assessment tools. Bundles of non-pharmacological interventions to prevent delirium are not universally implemented.

  View details for DOI 10.1111/acps.13468

  View details for PubMedID 35791060

• The Stanford Proxy Test for Delirium (S-PTD): A new tool for the screening of delirium in the medically-ill - A multicenter validation study Maldonado, J., Benitez-Lopez, M., Alosaimi, F. PERGAMON-ELSEVIER SCIENCE LTD. 2022

  View details for DOI 10.1016/j.jpsychores.2022.110880

  View details for Web of Science ID 000834015800069

• The Stanford ALD-exception protocol: Assessment & outcomes of liver transplant recipients with alcohol-related liver disease and limited sobriety using an adaptation of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) Maldonado, J., Sedki, M., Hussain, F., Goel, A. PERGAMON-ELSEVIER SCIENCE LTD. 2022

  View details for DOI 10.1016/j.jpsychores.2022.110879

  View details for Web of Science ID 000834015800068

• The Validity and Reliability of the Chula COVID-19 Psychosocial Home Isolation Evaluation Tool (CCPHIET) CUREUS JOURNAL OF MEDICAL SCIENCE Thisayakorn, P., Sirinimnualkul, N., Thipakorn, Y., Prasartpornsirichoke, J., Suraphaphairoj, C., Suwanpimolkul, G., Taechawiwat, T., Maldonado, J. R. 2022; 14 (5)

  View details for DOI 10.7759/cureus.25224

  View details for Web of Science ID 000812368100011

• EMTALA Violation? Examining Inequity in the Emergency Transfer of Psychiatric Patients Tatum, J., Ament, A., Schmajuk, M., Sanborn, K., Maldonado, J. ELSEVIER SCIENCE INC. 2022: S96-S97

  View details for DOI 10.1016/j.jaclp.2022.03.199

  View details for Web of Science ID 000872183600193

• Managing Delirium in a patient with Extracorporeal Membrane Oxygenation (ECMO) machine for bridge to lung transplant: A Case report Ha, J., Maldonado, J. ELSEVIER SCIENCE INC. 2022: S68

  View details for DOI 10.1016/j.jaclp.2022.03.141

  View details for Web of Science ID 000872183600135

• The Validity and Reliability of the Chula COVID-19 Psychosocial Home Isolation Evaluation Tool (CCPHIET). Cureus Thisayakorn, P., Sirinimnualkul, N., Thipakorn, Y., Prasartpornsirichoke, J., Suraphaphairoj, C., Suwanpimolkul, G., Taechawiwat, T., Maldonado, J. R. 2022; 14 (5): e25224

  Abstract

  The growing number of cases presenting with COVID-19 during the pandemic has led to a significant shortage of hospital beds. Many patients may not require hospitalization and can be clinically observed in home settings. We have identified a set of psychosocial factors that correlate with unsuccessful home isolation (HI), which in turn might negatively affect the transmission control in the community. Therefore, we developed the Chula COVID-19 Psychosocial Home Isolation Evaluation Tool (CCPHIET), a new screening tool for assessing the psychosocial suitability for HI. This study examines the CCPHIET's validity and reliability.This cross-sectional descriptive study included COVID-19 patients who were deemed to be medically safe for 14-days of HI. The CCPHIET is comprised of eight clinical domains pertinent to HI behavioral compliance and risk for non-adherence. We explored its statistical validity and reliability and discussed the potential utility of this tool.A total of 65 COVID-19 patients participated in this study. Most patients (58.5%) were deemed to be appropriate candidates for HI according to the CCPHIET. The results of this study demonstrate that the CCPHIET has an acceptable content validity (IOC index > 0.5), moderate internal consistency (Cronbach's alpha = 0.611) and substantial to excellent inter-rater reliability (Intraclass correlation coefficient = 0.944, Cohen's kappa= 0.627).CCPHIET is an easy-to-use tool for assessing the psychosocial suitability of patients advised for at-home isolation with mild and asymptomatic COVID-19. Its implementation can assist clinicians in identifying and redirecting resources to patients at the highest risk for breaking quarantine and save on unnecessary, costly absolute institutional quarantine for those deemed to be psychosocially fit for full adherence.

  View details for DOI 10.7759/cureus.25224

  View details for PubMedID 35755514

  View details for PubMedCentralID PMC9217664

• Psychosocial assessment of transplant candidates: Inter-rater reliability and concurrent validity of the Japanese version of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT). Journal of the Academy of Consultation-Liaison Psychiatry Satoko, I., Oshibuchi, H., Tsutsui, J., Kobayashi, S., Takano, K., Sugawara, H., Kamba, R., Akaho, R., Ishida, H., Maldonado, J., Nishimura, K. 2021

  Abstract

  BACKGROUND: The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive instrument developed to provide a standardized, objective, and evidence-based psychosocial evaluation of the main pre-transplant psychosocial risk factors that may influence transplant outcomes.OBJECTIVE: Since established assessment procedures or standardized tools designed to perform pre-solid organ transplant psychosocial evaluation are currently unavailable in Japan, the present study aimed to develop and preliminarily validate the Japanese version of the SIPAT.METHODS: First, the Japanese version of the SIPAT was developed using standard forward-back-translation procedures. Then, the Japanese versions of the SIPAT and the Japanese version of Psychosocial Assessment of Candidates for Transplant (PACT) were retrospectively and blindly applied to 107 transplant cases by 4 independent raters.RESULTS: The interrater reliability of the scores obtained with the Japanese version of the SIPAT was excellent (Pearson's correlation coefficient = 0.86). The concurrent validity of the SIPAT to the PACT for each examiner was substantial (Spearman's rank correlation coefficient = -0.66).CONCLUSION: These findings suggest that the Japanese version of the SIPAT is a promising and reliable instrument. Further research is required to test the predictive validity of the Japanese version of the SIPAT.

  View details for DOI 10.1016/j.jaclp.2021.10.004

  View details for PubMedID 34863909

• Research Needs for Inpatient Management of Severe Alcohol Withdrawal Syndrome An Official American Thoracic Society Research Statement AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE Steel, T. L., Afshar, M., Edwards, S., Jolley, S. E., Timko, C., Clark, B. J., Douglas, I. S., Dzierba, A. L., Gershengorn, H. B., Gilpin, N. W., Godwin, D. W., Hough, C. L., Maldonado, J. R., Mehta, A. B., Nelson, L. S., Patel, M. B., Rastegar, D. A., Stollings, J. L., Tabakoff, B., Tate, J. A., Wong, A., Burnham, E. L., Amer Thoracic Soc Assembly Critica, Assembly Behav Sci Hlth Serv Res, Assembly Nursing 2021; 204 (7): E61-E87

  Abstract

  Background: Severe alcohol withdrawal syndrome (SAWS) is highly morbid, costly, and common among hospitalized patients, yet minimal evidence exists to guide inpatient management. Research needs in this field are broad, spanning the translational science spectrum. Goals: This research statement aims to describe what is known about SAWS, identify knowledge gaps, and offer recommendations for research in each domain of the Institute of Medicine T0-T4 continuum to advance the care of hospitalized patients who experience SAWS. Methods: Clinicians and researchers with unique and complementary expertise in basic, clinical, and implementation research related to unhealthy alcohol consumption and alcohol withdrawal were invited to participate in a workshop at the American Thoracic Society 2019 International Conference. The committee was subdivided into four groups on the basis of interest and expertise: T0-T1 (basic science research with translation to humans), T2 (research translating to patients), T3 (research translating to clinical practice), and T4 (research translating to communities). A medical librarian conducted a pragmatic literature search to facilitate this work, and committee members reviewed and supplemented the resulting evidence, identifying key knowledge gaps. Results: The committee identified several investigative opportunities to advance the care of patients with SAWS in each domain of the translational science spectrum. Major themes included 1) the need to investigate non-γ-aminobutyric acid pathways for alcohol withdrawal syndrome treatment; 2) harnessing retrospective and electronic health record data to identify risk factors and create objective severity scoring systems, particularly for acutely ill patients with SAWS; 3) the need for more robust comparative-effectiveness data to identify optimal SAWS treatment strategies; and 4) recommendations to accelerate implementation of effective treatments into practice. Conclusions: The dearth of evidence supporting management decisions for hospitalized patients with SAWS, many of whom require critical care, represents both a call to action and an opportunity for the American Thoracic Society and larger scientific communities to improve care for a vulnerable patient population. This report highlights basic, clinical, and implementation research that diverse experts agree will have the greatest impact on improving care for hospitalized patients with SAWS.

  View details for DOI 10.1164/rccm.202108-1845ST

  View details for Web of Science ID 000705466800002

  View details for PubMedID 34609257

  View details for PubMedCentralID PMC8528516

• The Use of Physostigmine in the Diagnosis and Treatment of Anticholinergic Toxicity After Olanzapine Overdose: Literature Review and Case Report JOURNAL OF THE ACADEMY OF CONSULTATION-LIAISON PSYCHIATRY Serrano, W., Maldonado, J. 2021; 62 (4): 285-297

  View details for Web of Science ID 000671776700003

• The Use of Physostigmine in the Diagnosis and Treatment of Anticholinergic Toxicity After Olanzapine Overdose: Literature Review and Case Report JOURNAL OF THE ACADEMY OF CONSULTATION-LIAISON PSYCHIATRY Serrano, W., Maldonado, J. 2021; 62 (3): 285-297

  View details for Web of Science ID 000730828300003

• The Psychosocial Assessment of Transplant Candidates: Internal Consistency, Interrater Reliability, and Content Validity of the Thai Version of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT-Thai Version). Transplantation proceedings Thisayakorn, P., Sakunwetsa, D., Tangwongchai, S., Jirakran, K., Lolak, S., Maldonado, J. R. 2021

  Abstract

  BACKGROUND: Standardized pretransplant psychosocial assessment is critically needed in Thailand to optimize medical and psychosocial outcomes after transplantation. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive and evidence-based tool that has demonstrated excellent reliability and predictive value in many psychosocial transplant studies. We translated the SIPAT into Thai and explored the validity and reliability of the SIPAT-Thai version among Thai transplant recipients.METHODS: We translated the original SIPAT into Thai following the World Health Organization's standard forward-backward translation procedure and then cross-sectionally assessed its validity and reliability in 110 Thai solid organ transplant candidates. The correlation between background data, total, and sectional scoring results of SIPAT-Thai were also analyzed.RESULTS: The SIPAT-Thai demonstrated moderate to good reliability, which was represented by internal consistency with a Cronbach alpha of .751 and interrater reliability with a kappa value at 0.767. The index of item-objective congruence value was 0.94, indicating good the content validity.CONCLUSIONS: The SIPAT-Thai was systematically translated and shown to have acceptable validity and a moderate to good reliability index. The use of the SIPAT-Thai would provide a standardized, evidence-based, and a more systematic pretransplant psychosocial evaluation process for transplant candidates in Thailand.

  View details for DOI 10.1016/j.transproceed.2021.02.013

  View details for PubMedID 33741202

• Clinical Profile and Length of Hospital Stay in a Sample of Psychogeriatric Patients Referred to Consultation Liaison Psychiatric Unit. Medicina (Kaunas, Lithuania) Barra, B. J., Varela, L. F., Maldonado, J. R., Calvo, P., Bastidas, A., Sanchez, R., Pintor, L. 2021; 57 (3)

  Abstract

  Background and objectives: There has been a recent increase in older patients admitted to general hospitals. A significant percentage of hospitalized older patients are ≥75 years old, which differ from the patients aged 65 to 74 years old in terms of functional status at patient discharge. This study aims to compare sociodemographic, clinical features, and factors associated with length of hospital stay in youngest-old and oldest-old populations of inpatients referred to the consultation liaison psychiatry unit. Material and methods: This is an observational, cross-sectional, retrospective, and comparative study. We obtained data from a sample of 1017 patients (≥65 years) admitted to a general hospital and referred from different services (medicine, surgery, etc.) to the consultation liaison psychiatry unit. The sample was divided into two groups of patients: youngest-old (65-74 years) and oldest-old (≥75 years). Psychiatric evaluations were performed while the patients were on wards at the hospital. Psychopharmacs were started as needed. A comparative analysis was carried out and predictive factors related to length of hospital stay were calculated. Results: The reference rate to consultation liaison psychiatry unit was 1.45% of the total older patients hospitalized. Our study demonstrates differences between the groups of older people: the oldest-old group were mainly female (p < 0.001), had more previous psychiatric diagnoses (p < 0.001), physical disabilities (p = 0.02), and neurocognitive disorders (p < 0.001), they used more antipsychotics (p < 0.001), and more frequently had a discharge disposition to a nursing home (p = 0.036). The presence of physical disability (beta = 0.07, p < 0.001) and logtime to referral to consultation liaison psychiatry unit (beta = 0.58, p < 0.001) were associated with increased length of hospital stay. Conclusions: Youngest-old and oldest-old people should be considered as two different types of patients when we consider clinical features. The time to referral to consultation liaison psychiatry unit seems to be a relevant factor associated with length of hospital stay.

  View details for DOI 10.3390/medicina57030256

  View details for PubMedID 33799510

• Response to Letter to the Editor re: Correction About the Nursing Delirium Screening Scale (Nu-DESC) in Response to: "A Study of the Psychometric Properties of the "Stanford Proxy Test for Delirium" (S-PTD): A New Screening Tool for the Detection of Delirium" JOURNAL OF THE ACADEMY OF CONSULTATION-LIAISON PSYCHIATRY Maldonado, J. R., Sher, Y. I., Benitez-Lopez, M., Savant, V., Garcia, R., Ament, A., De Guzman, E. 2021; 62 (1): 161-163

  View details for Web of Science ID 000672228200025

• The Use of Physostigmine in the Diagnosis and Treatment of Anticholinergic Toxicity After Olanzapine Overdose: Literature Review and Case Report. Journal of the Academy of Consultation-Liaison Psychiatry Serrano, W. C., Maldonado, J. 2021; 62 (3): 285-297

  Abstract

  Second-generation antipsychotic agents are commonly used by clinicians for the treatment of various psychiatric and medical conditions. Despite their presumed safety, an overdose with olanzapine may lead to the development of anticholinergic toxicity. The anticholinergic toxidrome is characterized by both central and peripheral physical findings. Central anticholinergic syndrome, a term used to describe the symptoms that arise from reduced cholinergic activity in the central nervous system, is characterized primarily by signs and symptoms consistent with hyperactive delirium. Signs of peripheral anticholinergia include mydriasis and blurred vision, tremors, ataxia, fever/hyperthermia, flushed and dry skin, dry oral mucosa, decreased bowel sounds, constipation, and urinary retention, among other symptoms. In extreme cases, central anticholinergic syndrome can be associated with seizures, coma, respiratory failure, and cardiovascular collapse.To provide scientific evidence regarding the efficacy and safety of physostigmine use in cases of anticholinergic toxicity.We conducted a comprehensive review of the published literature on the symptoms, diagnosis, and treatment of anticholinergic toxicity.Currently the recommended treatment for olanzapine overdose, as is the case of most severe anticholinergic toxicity cases, involves supportive care, along with cardiac, neurological, and respiratory status monitoring. In addition, we detail the symptoms characteristic of anticholinergic toxicity, using the case of a patient experiencing central anticholinergic syndrome after an overdose with olanzapine.Physostigmine, a tertiary acetylcholinesterase inhibitor, can be used to assist in the both the diagnosis and management of severe anticholinergic toxicity associated with an olanzapine overdose, which might be applicable to the antimuscarinic toxidrome associated with the ingestion of agents with significant anticholinergic activity.

  View details for DOI 10.1016/j.jaclp.2020.12.013

  View details for PubMedID 34102130

• COVID-19-Associated Hyperactive Intensive Care Unit Delirium With Proposed Pathophysiology and Treatment: A Case Report PSYCHOSOMATICS Sher, Y., Rabkin, B., Maldonado, J. R., Mohabir, P. 2020; 61 (5): 544–50

  View details for Web of Science ID 000575913300013

• Response to Letter to the Editor re: Correction About the Nursing Delirium Screening Scale (Nu-DESC) in Response to: "A Study of the Psychometric Properties of the "Stanford Proxy Test for Delirium" (S-PTD): A New Screening Tool for the Detection of Delirium". Psychosomatics Maldonado, J. R., Sher, Y. I., Benitez-Lopez, M. A., Savant, V., Garcia, R., Ament, A., De Guzman, E. 2020

  View details for DOI 10.1016/j.psym.2020.06.005

  View details for PubMedID 33358005

• When the Patient Says No to Transplant: A Life Well Lived and Well Ended PSYCHOSOMATICS Sher, Y., Mohabir, P. K., Maldonado, J. R. 2020; 61 (4): 379–84

  View details for Web of Science ID 000549388900009

• The Stanford ALD-exception protocol: Assessment & outcomes of Liver transplant recipients with alcohol-related liver disease and limited sobriety using an adaptation of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) Sedki, M., Hussain, F., Goel, A., Maldonado, J. PERGAMON-ELSEVIER SCIENCE LTD. 2020

  View details for DOI 10.1016/j.jpsychores.2020.110080

  View details for Web of Science ID 000543335400097

• The assessment of living donor transplant candidates: The development of the SIPAT-D Maldonado, J., Hussain, F. PERGAMON-ELSEVIER SCIENCE LTD. 2020

  View details for DOI 10.1016/j.jpsychores.2020.110040

  View details for Web of Science ID 000543335400057

• Use of Guanfacine as an alternative to Dexmedetomidine for sedation and agitation management in the Intensive Care Unit Kim, J., van Zyl, E., Benitez-Lopez, M., Sher, Y., Maldonado, J. PERGAMON-ELSEVIER SCIENCE LTD. 2020

  View details for DOI 10.1016/j.jpsychores.2020.110062

  View details for Web of Science ID 000543335400079

• COVID-19-Associated Hyperactive Intensive Care Unit Delirium With Proposed Pathophysiology and Treatment: A Case Report. Psychosomatics Sher, Y., Rabkin, B., Maldonado, J. R., Mohabir, P. 2020

  View details for DOI 10.1016/j.psym.2020.05.007

  View details for PubMedID 32591212

• A Study of the Psychometric Properties of the "Stanford Proxy Test for Delirium" (S-PTD): A New Screening Tool for the Detection of Delirium PSYCHOSOMATICS Maldonado, J. R., Sher, Y. I., Benitez-Lopez, M., Savant, V., Garcia, R., Ament, A., De Guzman, E. 2020; 61 (2): 116–26

  View details for Web of Science ID 000519299000002

• The Psychosocial Assessment of Transplant Candidates: Inter-Rater Reliability and Predictive Value of the Italian Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) PSYCHOSOMATICS Bottesi, G., Granziol, U., Forza, G., Volpe, B., Feltrin, A., Battermann, F., Cavalli, C., Cillo, U., Gerosa, G., Fraiese, A., Rea, F., Loy, M., Maiorano, D., Rizzi, I., Leandro, G., Ferraro, C., Biasi, C., Donato, D., Vidotto, G., Maldonado, J. R. 2020; 61 (2): 127–34

  View details for Web of Science ID 000519299000003

• Genetic disease and intellectual disability as contraindications to transplant listing in the United States: A survey of heart, kidney, liver, and lung transplant programs. Pediatric transplantation Wall, A. n., Lee, G. H., Maldonado, J. n., Magnus, D. n. 2020: e13837

  Abstract

  Discrimination based on disability is prohibited in organ transplantation, yet studies suggest it continues in listing practices for intellectual disability and genetic diseases. It is not known if this differs between adult and pediatric programs, or by organ type. We performed an online, forced-choice survey of psychosocial listing criteria for adult and pediatric heart, kidney, liver, and lung transplant programs in the United States. Of 650 programs contacted, 343 (52.8%) submitted complete. A minority of programs had formal listing guidelines for any condition considered (Down Syndrome, Duchenne Muscular Dystrophy, Becker Muscular Dystrophy, DiGeorge Syndrome, and Wolf Hirschhorn Syndrome; and mild [IQ < 70] and severe [IQ < 35] intellectual disability), although a majority had encountered most. Pediatric programs were significantly (P < .02) more lenient in the level of contraindication to listing for all genetic conditions considered except Duchenne Muscular Dystrophy, and for mild and severe intellectual disability. Level of contraindication differed significantly by organ type (heart, lung, liver, and kidney) for Duchenne Muscular dystrophy (P = <.001), Becker Muscular Dystrophy (P < .001), DiGeorge Syndrome (P < .001), Wolf-Hirschhorn syndrome (P = .0012), and severe intellectual disability (P < .001). There is significant variation among transplant programs in availability of guidelines for as well as listing practices regarding genetic diseases and intellectual disability, differing by both adult vs pediatric program, and organ type. Programs with absolute contraindications to listing for specific genetic diseases or intellectual disability should reframe their approach, ensuring individualized assessments and avoiding elimination of patients based on membership in a particular group.

  View details for DOI 10.1111/petr.13837

  View details for PubMedID 32997378

• A Study of the Psychometric Properties of the "Stanford Proxy Test for Delirium" (S-PTD): ANew Screening Tool for the DetectionofDelirium. Psychosomatics Maldonado, J. R., Sher, Y. I., Benitez-Lopez, M. A., Savant, V., Garcia, R., Ament, A., De Guzman, E. 2019

  Abstract

  BACKGROUND: Delirium is a prevalent neuropsychiatric disorder associated with increased morbidity and mortality. Half the cases remain misdiagnosed.OBJECTIVE: Assess the effectiveness of the Stanford Proxy Test for Delirium (S-PTD) in detecting delirium in an inpatient setting.METHODS: This is a comparison study. Daily assessment with S-PTD, by the patient's nurse, and a neuropsychiatric assessment by a psychiatrist. Assessments were blinded. Inclusion criteria included 18 years or older. Exclusion criteria included patient's or surrogate's unwillingness to participate, inability to consent if a surrogate was not available, and inability to communicate in English or Spanish. A total of 309 patients were approached: 27 declined participation, 4 were excluded, and 278 subjects were followed up throughout their hospital stay. In the end, 78 were excluded for lack of neuropsychiatric assessment, S-PTD, or both. One was excluded for lack of demographic data. The sensitivity and specificity of the S-PTD in detecting delirium when compared with a neuropsychiatric assessment.RESULTS: Participants were on average 60.8 years old and 54.3% were male. Patients who developed delirium were, on average, older (15.12 y, confidence interval: 8.94-21.32). A total of 199 patients were analyzed; 43 patients (21.6%) met criteria for delirium. S-PTD detected 67 days with delirium (16.5%) of 405 hospital days, while neuropsychiatric evaluation identified 83 (20.5%). S-PTD had a sensitivity of 80.72% and a specificity of 90.37%.CONCLUSION: S-PTD is an effective, comprehensive, and simple screening tool for delirium, which is robust despite fluctuating symptoms and lack of cooperation. The use of S-PTD may enhance early diagnosis of delirium.

  View details for DOI 10.1016/j.psym.2019.11.009

  View details for PubMedID 31926650

• The Psychosocial Assessment of Transplant Candidates: Inter-Rater Reliability and PredictiveValue of the Italian Stanford Integrated Psychosocial Assessment forTransplantation. Psychosomatics Bottesi, G., Granziol, U., Forza, G., Volpe, B., Feltrin, A., Battermann, F., Cavalli, C., Cillo, U., Gerosa, G., Fraiese, A., Rea, F., Loy, M., Maiorano, D., Rizzi, I., Leandro, G., Ferraro, C., Biasi, C., Donato, D., Vidotto, G., Maldonado, J. R. 2019

  Abstract

  BACKGROUND: The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive instrument developed to accurately assess the main pretransplant psychosocial risk factors that may impact transplant outcomes.OBJECTIVE: As neither established assessment procedures nor standardized tools designed to perform pretransplant psychosocial evaluation are currently available in Italy, the present study was designed to develop and preliminarily validate the Italian version of the SIPAT.METHODS: First, our team developed the Italian version of the SIPAT, following standard forward-back translation procedures. Then, the Italian version of the SIPAT was retrospectively and blindly applied to 118 randomly selected transplant cases (40 heart, 40 lung, and 38 liver) by 2 independent examiners. Information about the patients' final transplant listing recommendation (i.e., listing vs. deferral) was independently collected from the respective transplant teams.RESULTS: The inter-rater reliability of the Italian version of the SIPAT scores was substantial (Cohen's kappa=0.77; P<0.001). Moreover, the predictive value of the SIPAT ratings on the final transplant listing recommendation (i.e., listing vs. deferral) for each examiner was significant (both P<0.05).CONCLUSION: Current findings suggest that SIPAT is a promising and reliable instrument in its Italian version. Given these excellent psychometric characteristics, the use of the SIPAT as part of the pretransplant psychosocial evaluation in Italian medical settings is highly encouraged.

  View details for DOI 10.1016/j.psym.2019.11.008

  View details for PubMedID 31928784

• When the Patient Says No to Transplant: A Life Well Lived and Well Ended. Psychosomatics Sher, Y., Mohabir, P. K., Maldonado, J. R. 2019

  View details for DOI 10.1016/j.psym.2019.10.001

  View details for PubMedID 31739994

• Translation, adaptation, and reliability of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) in the Spanish population. Clinical transplantation Lopez-Lazcano, A. I., Lopez-Pelayo, H., Lligona, A., Sanchez, N., Vilas, V., Priego, A., Sanchez-Gonzalez, R., Rodriguez-Urrutia, A., Quesada-Franco, M., Maldonado, J. R., Pintor, L. 2019

  Abstract

  BACKGROUND: Psychosocial risk factors influence the course of transplantation. Psychosocial evaluation is an important part of pre-transplantation evaluation processes, yet there are no standardised instruments in Spanish.OBJECTIVE: To translate, adapt, and test the reliability of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) in organ and cell transplantation patients in the Spanish context.METHOD: A Spanish version was developed and adapted using WHO's guidelines. The first 30 candidates' SIPAT interviews were recorded and scored by four independent examiners to test the inter-rater reliability. The internal consistency of the SIPAT items was calculated with a sample of 150 heart, liver, and allogeneic haematopoietic stem cell transplant candidates. Evaluations were conducted by SIPAT-trained and transplantation-experienced clinical psychologists and psychiatrists.RESULTS: SIPAT achieved excellent intraclass correlation reliability coefficients between investigators (ICC = 0.93 for the general score and from 0.77-0.94 for domain scores). Good internal consistency was found with a Cronbach's alpha of 0.84 (from 0.69-0.71 for domains).DISCUSSION: This study presents the translated and adapted version of SIPAT. It has been found to have strong inter-rater reliability and good internal consistency. Further research is needed to confirm reliability (e.g.: test-retest) and establish its validity (e.g.: concurrent, predictive). This article is protected by copyright. All rights reserved.

  View details for DOI 10.1111/ctr.13688

  View details for PubMedID 31392778

• Medical Contraindications to Transplant Listing in the USA: A Survey of Adult and Pediatric Heart, Kidney, Liver, and Lung Programs. World journal of surgery Wall, A., Lee, G. H., Maldonado, J., Magnus, D. 2019

  Abstract

  INTRODUCTION: Listing practices for solid organ transplantation are variable across programs in the USA. To better characterize this variability, we performed a survey of psychosocial listing criteria for pediatric and adult heart, lung, liver, and kidney programs in the USA. In this manuscript, we report our results regarding listing practices with respect to obesity, advanced age, and HIV seropositivity.METHODS: We performed an online, forced-choice survey of adult and pediatric heart, kidney, liver, and lung transplant programs in the USA.RESULTS: Of 650 programs contacted, 343 submitted complete responses (response rate=52.8%). Most programs have absolute contraindications to listing for BMI>45 (adult: 67.5%; pediatric: 88.0%) and age>80 (adult: 55.4%; pediatric: not relevant). Only 29.5% of adult programs and 25.7% of pediatric programs consider HIV seropositivity an absolute contraindication to listing. We found that there is variation in absolute contraindications to listing in adult programs among organ types for BMI>45 (heart 89.8%, lung 92.3%, liver 49.1%, kidney 71.9%), age>80 (heart 83.7%, lung 76.9%, liver 68.4%, kidney 29.2%), and HIV seropositivity (heart 30.6%, lung 59.0%, kidney 16.9%, liver 28.1%).CONCLUSIONS: We argue that variability in listing enhances access to transplantation for potential recipients who have the ability to pursue workup at different centers by allowing different programs to have different risk thresholds. Programs should remain independent in listing practices, but because these practices differ, we recommend transparency in listing policies and informing patients of reasons for listing denial and alternative opportunities to seek listing at another program.

  View details for DOI 10.1007/s00268-019-05030-x

  View details for PubMedID 31111229

• Why It is Important to Consider Social Support When Assessing Organ Transplant Candidates? The American journal of bioethics : AJOB Maldonado, J. R. 2019; 19 (11): 1–8

  View details for DOI 10.1080/15265161.2019.1671689

  View details for PubMedID 31647756

• Dissociative Disorders AMERICAN PSYCHIATRIC ASSOCIATION PUBLISHING TEXTBOOK OF PSYCHIATRY, 7TH EDITION Maldonado, J. R., Spiegel, D., Roberts, L. W. 2019: 437–74

  View details for Web of Science ID 000550979400018

• Validation of the Stanford Proxy Test for Delirium (S-PTD) among critical and noncritical patients. Journal of psychosomatic research Alosaimi, F. D., Alghamdi, A., Alsuhaibani, R., Alhammad, G., Albatili, A., Albatly, L., Althomali, B., Aljamaan, F., Maldonado, J. R. 2018; 114: 8–14

  Abstract

  BACKGROUND: The Stanford Proxy Test for Delirium (S-PTD) is a tool developed to be completed by nurses at the end of their shift. It was designed to use the knowledge acquired during a full shift of nurse-patient interaction. The objective of our study was to validate the S-PTD among a mixed sample of patients in both the intensive care unit (ICU) and non-ICU settings.METHODS: A cross-sectional study was conducted in an ICU and three general medical wards in a tertiary care hospital. Patients were independently and blindly assessed for delirium by (1) the patients' primary nurses using the S-PTD at the end of their shift, and (2) a Consultation liaison psychiatrist who conducted a neuropsychiatric evaluation based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).RESULTS: A total 288 patients were included in current analysis. Using the S-PTD, delirium was identified in 72 (25.0%), while an expert neuropsychiatric examination, based on DSM-5 identified delirium in 75 (26.0%) patients. This study demonstrated that the S-PTD has very strong discriminative ability (area under the curve= 0.946, p<0.001). An S-PTD cut-off score ≥3 was associated with an 82.7% sensitivity, an 95.3% specificity, an 86.1% positive predictive value, a 94.0% negative predictive value, and a 92.0% overall diagnostic accuracy. These results were similar in both ICU and general ward patients.CONCLUSION: The S-PTD has excellent sensitivity and specificity in detecting delirium in both ICU and ward patients, even when compared with the gold-standard, a DSM-based neuropsychiatric examination.

  View details for PubMedID 30314583

• Refining Delirium: A Transtheoretical Model of Delirium Disorder with Preliminary Neurophysiologic Subtypes AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY Oldham, M. A., Flaherty, J. H., Maldonado, J. R. 2018; 26 (9): 913–24

  Abstract

  The development of delirium indicates neurophysiologic disruption and predicts unfavorable outcomes. This relationship between delirium and its outcomes has inspired a generation of studies aimed at identifying, predicting, and preventing both delirium and its associated sequelae. Despite this, evidence on delirium prevention and management remains limited. No medication is approved for the prevention or treatment of delirium or for its associated psychiatric symptoms. This unmet need for effective delirium treatment calls for a refined approach. First, we explain why a one-size-fits-all approach based on a unitary biological model of delirium has contributed to variance in delirium studies and prevents further advance in the field. Next, in parallel with the shift from dementia to "major neurocognitive disorder," we propose a transtheoretical model of "delirium disorder" composed of interactive elements-precipitant, neurophysiology, delirium phenotype, and associated psychiatric symptoms. We explore how these relate both to the biopsychosocial factors that promote healthy cognition ("procognitive factors") and to consequent neuropathologic sequelae. Finally, we outline a preliminary delirium typology of specific neurophysiologic disturbances. Our model of delirium disorder offers several avenues for novel insights and clinical advance: it univocally differentiates delirium disorder from the phenotype of delirium, highlights delirium neurophysiology as a treatment target, separates the core features of delirium from associated psychiatric symptoms, suggests how procognitive factors influence the core elements of delirium disorder, and makes intuitive predictions about how delirium disorder leads to neuropathologic sequelae and cognitive impairment. Ultimately, this model opens several avenues for modern neuroscience to unravel this disease of antiquity.

  View details for PubMedID 30017237

• The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT): A Five-year follow up Prospective Study of Medical & Psychosocial Outcomes Maldonado, J., Sher, Y., Benitez-Lopez, M., Hussain, F. PERGAMON-ELSEVIER SCIENCE LTD. 2018: 117

  View details for DOI 10.1016/j.jpsychores.2018.03.096

  View details for Web of Science ID 000433271100099

• Psychosocial Contraindications to Transplant Listing Decisions: A National Survey of USA Solid Organ Transplant Programs Lee, G. H., Wall, A., Magnus, D., Maldonado, J. R. PERGAMON-ELSEVIER SCIENCE LTD. 2018: 115–16

  View details for DOI 10.1016/j.jpsychores.2018.03.091

  View details for Web of Science ID 000433271100094

• Medical Contraindications to Solid Organ Transplant Listing: A Survey of Heart, Liver, Lung and Kidney Programs. Wall, A., Lee, G., Maldonado, J., Magnus, D. WILEY. 2018: 743

  View details for Web of Science ID 000431965403060

• Legal Status, Criminal History, and Substance Use in Listing Decisions. Lee, G., Wall, A., Maldonado, J., Magnus, D. WILEY. 2018: 395–96

  View details for Web of Science ID 000431965401388

• Psychiatric Disorders and Disturbances in Transplant Listing Decisions. Lee, G., Wall, A., Magnus, D., Maldonado, J. WILEY. 2018: 734–35

  View details for Web of Science ID 000431965403036

• Mental health assessment of altruistic non-directed kidney donors: An EAPM consensus statement JOURNAL OF PSYCHOSOMATIC RESEARCH Potts, S., Vitinius, F., Erim, Y., Gazdag, G., Gribble, R., Ismail, S., Massey, E. K., Maldonado, J., Mucsi, I., Novak, M., Niazi, S., Schneeldoth, T. D., Syngelakis, M., Zimbrean, P. 2018; 107: 26–32

  View details for PubMedID 29502760

• Transplant Listing Decisions: A National Survey of Adult and Pediatric Heart, Lung, Liver and Kidney Programs Wall, A., Magnus, D., Lee, G., Maldonado, J. WILEY. 2018: 95

  View details for Web of Science ID 000419034500199

• Delirium pathophysiology: An updated hypothesis of the etiology of acute brain failure. International journal of geriatric psychiatry Maldonado, J. R. 2017

  Abstract

  BACKGROUND: Delirium is the most common neuropsychiatric syndrome encountered by clinicians dealing with older adults and the medically ill and is best characterized by 5 core domains: cognitive deficits, attentional deficits, circadian rhythm dysregulation, emotional dysregulation, and alteration in psychomotor functioning.DESIGN: An extensive literature review and consolidation of published data into a novel interpretation of known pathophysiological causes of delirium.RESULTS: Available data suggest that numerous pathological factors may serve as precipitants for delirium, each having differential effects depending on patient-specific patient physiological characteristics (substrate). On the basis of an extensive literature search, a newly proposed theory, the systems integration failure hypothesis, was developed to bring together the most salient previously described theories, by describing the various contributions from each into a complex web of pathways-highlighting areas of intersection and commonalities and explaining how the variable contribution of these may lead to the development of various cognitive and behavioral dysfunctions characteristic of delirium. The specific cognitive and behavioral manifestations of the specific delirium picture result from a combination of neurotransmitter function and availability, variability in integration and processing of sensory information, motor responses to both external and internal cues, and the degree of breakdown in neuronal network connectivity, hence the term acute brain failure.CONCLUSIONS: The systems integration failure hypothesis attempts to explain how the various proposed delirium pathophysiologic theories interact with each other, causing various clinically observed delirium phenotypes. A better understanding of the underlying pathophysiology of delirium may eventually assist in designing better prevention and management approaches.

  View details for PubMedID 29278283

• Psychiatric Aspects of Critical Care Medicine: Update. Critical care clinics Maldonado, J. R. 2017; 33 (3): xiii-xv

  View details for DOI 10.1016/j.ccc.2017.04.001

  View details for PubMedID 28601144

• Delirium after lung transplantation: Association with recipient characteristics, hospital resource utilization, and mortality. Clinical transplantation Sher, Y., Mooney, J., Dhillon, G., Lee, R., Maldonado, J. R. 2017; 31 (5)

  Abstract

  Delirium is associated with increased morbidity and mortality. The factors associated with post-lung transplant delirium and its impact on outcomes are under characterized.The medical records of 163 consecutive adult lung transplant recipients were reviewed for delirium within 5 days (early-onset) and 30 hospital days (ever-onset) post-transplantation. A multivariable logistic regression model assessed factors associated with delirium. Multivariable negative binomial regression and Cox proportional hazards models assessed the association of delirium with ventilator duration, intensive care unit (ICU) length of stay (LOS), hospital LOS and one-year mortality.Thirty six % developed early-onset and 44% - ever-onset delirium. Obesity (OR 6.35, 95% CI 1.61-24.98) and bolused benzodiazepines within the first post-operative day (OR 2.28, 95% CI 1.07-4.89) were associated with early-onset delirium. Early-onset delirium was associated with longer adjusted mechanical ventilation duration (p=0.001), ICU LOS (p<0.001), and hospital LOS (p=0.005). Ever-onset delirium was associated with longer ICU (p<0.001) and hospital LOS (p<0.001). After adjusting for clinical variables, delirium was not significantly associated with one-year mortality (early-onset HR 1.65, 95% CI 0.67-4.03; ever-onset HR 1.70, 95% CI 0.63-4.55).Delirium is common after lung transplant surgery and associated with increased hospital resources. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1111/ctr.12966

  View details for PubMedID 28314081

• Novel Algorithms for the Prophylaxis and Management of Alcohol Withdrawal Syndromes-Beyond Benzodiazepines. Critical care clinics Maldonado, J. R. 2017; 33 (3): 559–99

  Abstract

  Benzodiazepine (BZDP) agents are the standard for the prophylaxis and treatment of all phases of alcohol withdrawal syndrome. However, BZDPs have their drawbacks: cognitive impairment, significant neurologic and medical side effects. There are data suggesting that the alcohol recidivism rate and abuse potential is higher for BZDPs treated patients, compared to alternatives. Clinical and research data demonstrate the efficacy and safety of various pharmacologic alternatives to benzodiazepines for the prevention and management of AWS. This article examines the available published evidence regarding the use of non-BZDP agents compared with conventional treatment modalities. The author's BZDP-sparing protocol is highlighted.

  View details for PubMedID 28601135

• The intensive care delirium research agenda: a multinational, interprofessional perspective. Intensive care medicine Pandharipande, P. P., Ely, E. W., Arora, R. C., Balas, M. C., Boustani, M. A., La Calle, G. H., Cunningham, C. n., Devlin, J. W., Elefante, J. n., Han, J. H., MacLullich, A. M., Maldonado, J. R., Morandi, A. n., Needham, D. M., Page, V. J., Rose, L. n., Salluh, J. I., Sharshar, T. n., Shehabi, Y. n., Skrobik, Y. n., Slooter, A. J., Smith, H. A. 2017

  Abstract

  Delirium, a prevalent organ dysfunction in critically ill patients, is independently associated with increased morbidity. This last decade has witnessed an exponential growth in delirium research in hospitalized patients, including those critically ill, and this research has highlighted that delirium needs to be better understood mechanistically to help foster research that will ultimately lead to its prevention and treatment. In this invited, evidence-based paper, a multinational and interprofessional group of clinicians and researchers from within the fields of critical care medicine, psychiatry, pediatrics, anesthesiology, geriatrics, surgery, neurology, nursing, pharmacy, and the neurosciences sought to address five questions: (1) What is the current standard of care in managing ICU delirium? (2) What have been the major recent advances in delirium research and care? (3) What are the common delirium beliefs that have been challenged by recent trials? (4) What are the remaining areas of uncertainty in delirium research? (5) What are some of the top study areas/trials to be done in the next 10 years? Herein, we briefly review the epidemiology of delirium, the current best practices for management of critically ill patients at risk for delirium or experiencing delirium, identify recent advances in our understanding of delirium as well as gaps in knowledge, and discuss research opportunities and barriers to implementation, with the goal of promoting an integrated research agenda.

  View details for PubMedID 28612089

• Acute Brain Failure: Pathophysiology, Diagnosis, Management, and Sequelae of Delirium. Critical care clinics Maldonado, J. R. 2017; 33 (3): 461–519

  Abstract

  Delirium is the most common psychiatric syndrome found in the general hospital setting, with an incidence as high as 87% in the acute care setting. Delirium is a neurobehavioral syndrome caused by the transient disruption of normal neuronal activity secondary to systemic disturbances. The development of delirium is associated with increased morbidity, mortality, cost of care, hospital-acquired complications, placement in specialized intermediate and long-term care facilities, slower rate of recovery, poor functional and cognitive recovery, decreased quality of life, and prolonged hospital stays. This article discusses the epidemiology, known etiological factors, presentation and characteristics, prevention, management, and impact of delirium.

  View details for PubMedID 28601132

• Frontal Lobe Epilepsy: A Primer for Psychiatrists and a Systematic Review of Psychiatric Manifestations. Psychosomatics Gold, J. A., Sher, Y., Maldonado, J. R. 2016; 57 (5): 445-464

  Abstract

  Frontal lobe epilepsy (FLE) can masquerade as a primary psychiatric condition, be misdiagnosed in-lieu of a true psychiatric disorder, or may be comorbid with psychiatric illness.To (1) qualitatively review psychiatric manifestations of FLE and (2) to systematically review the cases/case series of psychiatric manifestations of FLE presented in the literature to date.A systematic review of the literature was performed following the PRISMA guidelines and using PubMed/Medline, PsychInfo, and Cochrane database of systematic reviews to identify cases and case series of psychiatric manifestations of FLE.A total of 35 separate articles were identified. Further, 17 patients primarily presented with psychosis, 33 with affective symptoms, and 16 with personality changes. Also, 62% of cases were males and 38% were females. Ages ranged from 2-83 years with the average age of 32.7. Prior psychiatric history was reported in 27.3% of cases. Causes of seizure were known in 53%, with the most common causes being dysplasia and tumor. Only 6 cases (<10%) did not have electroencephalographic correlations. Psychiatric manifestations were primarily ictal in 74.3% of the cases. Associated manifestations included motor (63.6%), cognitive (34.8%), and medical (9.0%) findings. Surgery was required in 31.8% of the cases, whereas others were treated with medications alone. All, but 3, patients were seizure free and saw an improvement in symptoms with treatment.Given the complexity and multifunctionality of the frontal lobes, FLE can present with complex, psychiatric manifestations, with associated motor, cognitive, and medical changes; thus, psychiatrists should keep FLE on the differential diagnosis of complex neuropsychiatric cases.

  View details for DOI 10.1016/j.psym.2016.05.005

  View details for PubMedID 27494984

• Suicide Risk Assessment and Management Clinical Manual of Emergency Psychiatry Maldonado, J. R., Garcia, R. edited by Riba, M., Ravindranath, D., Winder, G. S. American Psychiatric Press Inc. 2016; Second
• Delirium: Prevention and Management Protocols in Critical Care Maldonado, J. R. edited by Rodriguez-Villar, S. Marban. 2016; Third: 930–956
• Valproic Acid for Treatment of Hyperactive or Mixed Delirium: Rationale and Literature Review PSYCHOSOMATICS Sher, Y., Cramer, A. C., Ament, A., Lolak, S., Maldonado, J. R. 2015; 56 (6): 615-625

  Abstract

  Delirium is the most often encountered psychiatric diagnosis in the general hospital, with an incidence of up to 82% in the intensive care unit setting and with significant detrimental effects on patients' morbidity and mortality. Antipsychotics are often considered the first-line pharmacological treatment of delirium, but their use may be limited by lack of efficacy, existing contraindications (e.g., prolonged QTc intervals), or resulting side effects (e.g., akathisia). Valproic acid (VPA) is a potential alternative or adjunct treatment. It has multiple mechanisms of action, including effects on neurotransmitter modulation, neuroinflammation, oxidative stress, and transcription, all of which are implicated in the pathophysiology of delirium. Yet, data on the use of this agent in delirium are limited.In this article, we discuss postulated mechanisms of VPA action that provide a theoretical basis for its use in the treatment of hyperactive and mixed type delirium, based on the known and theorized pathophysiology of delirium. We also discuss potential side effects and considerations with use of VPA.VPA has multiple modulatory effects on neurotransmitter systems, inflammation, oxidative stress, and transcriptional changes implicated in pathophysiology of delirium. When carefully chosen, VPA can be an effective and well-tolerated treatment option for the management of hyperactive and mixed type delirium. Randomized controlled trials are needed to establish tolerability and efficacy of VPA for treatment of delirium.

  View details for Web of Science ID 000366315400002

  View details for PubMedID 26674479

• The Stanford Integrated Psychosocial Assessment for Transplantation: A Prospective Study of Medical and Psychosocial Outcomes PSYCHOSOMATIC MEDICINE Maldonado, J. R., Sher, Y., Lolak, S., Swendsen, H., Skibola, D., Neri, E., David, E. E., Sullivan, C., Standridge, K. 2015; 77 (9): 1018-1030

  Abstract

  Psychosocial factors may significantly affect post-transplant outcomes. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) was developed as an assessment tool to enhance the pre-transplant psychosocial evaluation.We identified heart, lung, liver, or kidney transplant recipients assessed with the SIPAT pre-transplantation and transplanted between June 1, 2008, and July 31, 2011, at our institution. We analyzed prospectively accumulated psychosocial and medical outcomes at 1 year of follow-up.217 patients were identified and included in the analysis. The primary outcomes of organ failure and mortality occurred in 12 and 21 patients, respectively, and were not significantly associated with the pre-transplant SIPAT scores. On the other hand, SIPAT scores were significantly correlated with the probability of poor medical and psychosocial outcomes (secondary outcomes). In fact, higher SIPAT scores predicted higher rates of rejection episodes (Spearman ρ = 0.15, 95% 95% confidence interval [CI] = 0.02-0.28, p = .023), medical hospitalizations (ρ = 0.29, 95% CI = 0.16-0.41, p < .001), infection rates (p = .020), psychiatric decompensation (p = .005), and support system failure (area under the curve = 0.70, 95% CI = 0.60-0.79, p < .001). The relationship with nonadherence suggested a trend, but no statistical significance was observed (area under the curve = 0.60, 95% CI = 0.50-0.71, p = .058).Study outcomes suggest that SIPAT is a promising pre-transplantation assessment tool that helps identify candidate's areas of psychosocial vulnerability and whose scores are associated with both psychosocial and medical outcomes after transplantation.

  View details for DOI 10.1097/PSY.0000000000000241

  View details for PubMedID 26517474

• Adjunctive Valproic Acid in Management-Refractory Hyperactive Delirium: A Case Series and Rationale. journal of neuropsychiatry and clinical neurosciences Sher, Y., Miller, A. C., Lolak, S., Ament, A., Maldonado, J. R. 2015; 27 (4): 365-370

  Abstract

  Patients with delirium may fail to respond to standard therapies. Sixteen patients with management-refractory hyperactive delirium responded to adjunctive valproic acid, with complete resolution of hyperactive delirium in 13 cases. A rationale for using valproic acid in such circumstances is discussed.

  View details for DOI 10.1176/appi.neuropsych.14080190

  View details for PubMedID 25803136

• Prospective Validation Study of the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) in Medically Ill Inpatients: A New Scale for the Prediction of Complicated Alcohol Withdrawal Syndrome ALCOHOL AND ALCOHOLISM Maldonado, J. R., Sher, Y., Das, S., Hills-Evans, K., Frenklach, A., Lolak, S., Talley, R., Neri, E. 2015; 50 (5): 509-518

  Abstract

  The prevalence of alcohol use disorders (AUDs) among hospitalized medically ill patients exceeds 40%. Most AUD patients experience uncomplicated alcohol withdrawal syndrome (AWS), requiring only supportive medical intervention, while complicated AWS occurs in up to 20% of cases (i.e. seizures, delirium tremens). We aimed to prospectively test and validate the Prediction of Alcohol Withdrawal Severity Scale (PAWSS), a new tool to identify patients at risk for developing complicated AWS, in medically ill hospitalized patients.We prospectively considered all subjects hospitalized to selected general medicine and surgery units over a 12-month period. Participants were assessed independently and blindly on a daily basis with PAWSS, Clinical Institute Withdrawal Assessment-Alcohol, Revised (CIWA-Ar) and clinical monitoring throughout their admission to determine the presence and severity of AWS.Four hundred and three patients were enrolled in the study. Patients were grouped by PAWSS score: Group A (PAWSS < 4; considered at low risk for complicated AWS); Group B (PAWSS ≥ 4; considered at high risk for complicated AWS). The results of this study suggest that, using a PAWSS cutoff of 4, the tool's sensitivity for identifying complicated AWS is 93.1% (95%CI[77.2, 99.2%]), specificity is 99.5% (95%CI[98.1, 99.9%]), positive predictive value is 93.1% and negative predictive value is 99.5%; and has excellent inter-rater reliability with Lin's concordance coefficient of 0.963 (95% CI [0.936, 0.979]).PAWSS has excellent psychometric characteristics and predictive value among medically ill hospitalized patients, helping clinicians identify those at risk for complicated AWS and allowing for prevention and timely treatment of complicated AWS.

  View details for DOI 10.1093/alcalc/agv043

  View details for Web of Science ID 000363934400004

  View details for PubMedID 25999438

• Prolonged neuropsychiatric effects following management of chloroquine intoxication with psychotropic polypharmacy. Clinical case reports Maxwell, N. M., Nevin, R. L., Stahl, S., Block, J., Shugarts, S., Wu, A. H., Dominy, S., Solano-Blanco, M. A., Kappelman-Culver, S., Lee-Messer, C., Maldonado, J., Maxwell, A. J. 2015; 3 (6): 379-387

  Abstract

  Susceptibility to quinoline antimalarial intoxication may reflect individual genetic and drug-induced variation in neuropharmacokinetics. In this report, we describe a case of chloroquine intoxication that appeared to be prolonged by subsequent use of multiple psychotropic medications. This case highlights important new considerations for the management of quinoline antimalarial intoxication.

  View details for DOI 10.1002/ccr3.238

  View details for PubMedID 26185633

• The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT): A Two-Year Follow-Up of a Prospective Study of Medical & Psychosocial Outcomes 35th Annual Meeting and Scientific Sessions of the International-Society-for-Heart-and-Lung-Transplantation Maldonado, J. R., Sher, Y., Tobon, A. ELSEVIER SCIENCE INC. 2015: S174–S174

  View details for Web of Science ID 000353251500449

• Acute Brain Failure: Identification & Management Handbook of Consultation-Liaison Psychiatry Maldonado, J. R. edited by Leigh, H., Streltzer, J. Springer. 2015; Second: 157–188
• Delirium Psychiatric Care of the Medical Patient Maldonado, J. R. edited by Fogel, B., Greenberg, D. Oxford University Press. 2015; Third
• Hypnosis in Psychosomatic Medicine Psychiatric Care of the Medical Patient Maldonado, J. R. edited by Fogel, B., Greenberg, D. Oxford University Press. 2015; Third
• An Insatiable Desire for Tofu: A Case of Restless Legs and Unusual Pica in Iron Deficiency Anemia PSYCHOSOMATICS Sher, Y., Maldonado, J. R. 2014; 55 (6): 680-685

  View details for Web of Science ID 000346182000019

  View details for PubMedID 25497506

• The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer. BMC medicine 2014; 12: 141-?

  Abstract

  Delirium is a common and serious problem among acutely unwell persons. Although linked to higher rates of mortality, institutionalisation and dementia, it remains underdiagnosed. Careful consideration of its phenomenology is warranted to improve detection and therefore mitigate some of its clinical impact. The publication of the fifth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5) provides an opportunity to examine the constructs underlying delirium as a clinical entity.Altered consciousness has been regarded as a core feature of delirium; the fact that consciousness itself should be physiologically disrupted due to acute illness attests to its clinical urgency. DSM-5 now operationalises 'consciousness' as 'changes in attention'. It should be recognised that attention relates to content of consciousness, but arousal corresponds to level of consciousness. Reduced arousal is also associated with adverse outcomes. Attention and arousal are hierarchically related; level of arousal must be sufficient before attention can be reasonably tested.Our conceptualisation of delirium must extend beyond what can be assessed through cognitive testing (attention) and accept that altered arousal is fundamental. Understanding the DSM-5 criteria explicitly in this way offers the most inclusive and clinically safe interpretation.

  View details for DOI 10.1186/s12916-014-0141-2

  View details for PubMedID 25300023

  View details for PubMedCentralID PMC4177077

• The "Prediction of Alcohol Withdrawal Severity Scale" (PAWSS): Systematic literature review and pilot study of a new scale for the prediction of complicated alcohol withdrawal syndrome. Alcohol Maldonado, J. R., Sher, Y., Ashouri, J. F., Hills-Evans, K., Swendsen, H., Lolak, S., Miller, A. C. 2014; 48 (4): 375-390

  Abstract

  To date, no screening tools for alcohol withdrawal syndromes (AWS) have been validated in the medically ill. Although several tools quantify the severity of AWS (e.g., Clinical Institute Withdrawal Assessment for Alcohol [CIWA]), none identify subjects at risk of AWS, thus missing the opportunity for timely prophylaxis. Moreover, there are no validated tools for the prediction of complicated (i.e., moderate to severe) AWS in the medically ill.Our goals were (1) to conduct a systematic review of the published literature on AWS to identify clinical factors associated with the development of AWS, (2) to use the identified factors to develop a tool for the prediction of alcohol withdrawal among patients at risk, and (3) to conduct a pilot study to assess the validity of the tool.For the creation of the Prediction of Alcohol Withdrawal Severity Scale (PAWSS), we conducted a systematic literature search using PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines for clinical factors associated with the development of AWS, using PubMed, PsychInfo, MEDLINE, and Cochrane Databases. Eligibility criteria included: (i) manuscripts dealing with human subjects, age 18 years or older, (ii) manuscripts directly addressing descriptions of AWS or its predisposing factors, including case reports, naturalistic case descriptions, and all types of clinical trials (e.g., randomized, single-blind, or open label studies), (iii) manuscripts describing characteristics of alcohol use disorder (AUD), and (iv) manuscripts dealing with animal data (which were considered only if they directly dealt with variables described in humans). Obtained data were used to develop the Prediction of Alcohol Withdrawal Severity Scale, in order to assist in the identification of patients at risk for complicated AWS. A pilot study was conducted to assess the new tool's psychometric qualities on patients admitted to a general inpatient medicine unit over a 2-week period, who agreed to participate in the study. Blind to PAWSS results, a separate group of researchers retrospectively examined the medical records for evidence of AWS.The search produced 2802 articles describing factors potentially associated with increased risk for AWS, increased severity of withdrawal symptoms, and potential characteristics differentiating subjects with various forms of AWS. Of these, 446 articles met inclusion criteria and underwent further scrutiny, yielding a total of 233 unique articles describing factors predictive of AWS. A total of 10 items were identified as correlated with complicated AWS (i.e., withdrawal hallucinosis, withdrawal-related seizures, and delirium tremens) and used to construct the PAWSS. During the pilot study, a total of 68 subjects underwent evaluation with PAWSS. In this pilot sample the sensitivity, specificity, and positive and negative predictive values of PAWSS were 100%, using the threshold score of 4.The results of the literature search identified 10 items which may be correlated with risk for complicated AWS. These items were assembled into a tool to assist in the identification of patients at risk: PAWSS. The results of this pilot study suggest that PAWSS may be useful in identifying risk of complicated AWS in medically ill, hospitalized individuals. PAWSS is the first validated tool for the prediction of severe AWS in the medically ill and its use may aid in the early identification of patients at risk for complicated AWS, allowing for prophylaxis against AWS before severe alcohol withdrawal syndromes develop.

  View details for DOI 10.1016/j.alcohol.2014.01.004

  View details for PubMedID 24657098

• Dissociative Disorders Psychiatry Maldonado, J. R., Spiegel, D. edited by Tasman, A., Lieberman, J., Riba, M. Wiley. 2014; Fourth
• Dementia: Diagnosis & Management Handbook of Consultation-Liaison Psychiatry Sher, Y. I., Maldonado, J. R. edited by Leigh, H., Streltzer, J. Springer. 2014; Second
• Hypnosis Psychiatry Maldonado, J. R., Spiegel, D. edited by Tasmana, A., Kay, J., Lieberman, J., First, M., Riba, M. Wiley. 2014; Fourth
• Neuropathogenesis of Delirium: Review of Current Etiologic Theories and Common Pathways. American journal of geriatric psychiatry Maldonado, J. R. 2013; 21 (12): 1190-1222

  Abstract

  Delirium is a neurobehavioral syndrome caused by dysregulation of neuronal activity secondary to systemic disturbances. Over time, a number of theories have been proposed in an attempt to explain the processes leading to the development of delirium. Each proposed theory has focused on a specific mechanism or pathologic process (e.g., dopamine excess or acetylcholine deficiency theories), observational and experiential evidence (e.g., sleep deprivation, aging), or empirical data (e.g., specific pharmacologic agents' association with postoperative delirium, intraoperative hypoxia). This article represents a review of published literature and summarizes the top seven proposed theories and their interrelation. This review includes the "neuroinflammatory," "neuronal aging," "oxidative stress," "neurotransmitter deficiency," "neuroendocrine," "diurnal dysregulation," and "network disconnectivity" hypotheses. Most of these theories are complementary, rather than competing, with many areas of intersection and reciprocal influence. The literature suggests that many factors or mechanisms included in these theories lead to a final common outcome associated with an alteration in neurotransmitter synthesis, function, and/or availability that mediates the complex behavioral and cognitive changes observed in delirium. In general, the most commonly described neurotransmitter changes associated with delirium include deficiencies in acetylcholine and/or melatonin availability; excess in dopamine, norepinephrine, and/or glutamate release; and variable alterations (e.g., either a decreased or increased activity, depending on delirium presentation and cause) in serotonin, histamine, and/or γ-aminobutyric acid. In the end, it is unlikely that any one of these theories is fully capable of explaining the etiology or phenomenologic manifestations of delirium but rather that two or more of these, if not all, act together to lead to the biochemical derangement and, ultimately, to the complex cognitive and behavioral changes characteristic of delirium.

  View details for DOI 10.1016/j.jagp.2013.09.005

  View details for PubMedID 24206937

• Broken Heart Syndrome (Takotsubo Cardiomyopathy) Triggered by Acute Mania: A Review and Case Report PSYCHOSOMATICS Maldonado, J. R., Pajouhi, P., Witteles, R. 2013; 54 (1): 74-79

  View details for PubMedID 22795622

• Benzodiazepine loading versus symptom-triggered treatment of alcohol withdrawal: a prospective, randomized clinical trial GENERAL HOSPITAL PSYCHIATRY Maldonado, J. R., Nguyen, L. H., Schader, E. M., Brooks, J. O. 2012; 34 (6): 611-617

  Abstract

  The objectives were to compare the efficacy of a benzodiazepine loading versus a symptom-triggered protocol in the management of alcohol withdrawal.We conducted a prospective, randomized, controlled trial including 47 consecutive patients admitted to one of two tertiary care medical centers who developed alcohol withdrawal syndrome. Patients were randomly assigned to either a benzodiazepine loading protocol or a symptom-triggered treatment protocol. The Clinical Institute Withdrawal Assessment for Alcohol-Revised scale (CIWA-Ar) was recorded throughout the length of stay, along with measures of autonomic system functioning.The average rate of change of CIWA-Ar scores was -1.5 ± 1.3 for the symptom-triggered group and -2.3 ± 2.5 for the loading group. Average rate of change for systolic blood pressure was -2.7 ± 5.3 for the symptom-triggered group and -2.3 ± 6.4 for the loading group. There was no significant difference between the rates of change for either group on either measure. Similarly, there was no significant difference in total benzodiazepine use between groups. Within 72 h of treatment, 69.6% of patients in the loading group were free of withdrawal symptoms versus 41.7% in the symptom-triggered group, a difference not reaching statistical significance.This study did not reveal clear evidence of a clinical advantage for choosing either treatment method.

  View details for DOI 10.1016/j.genhosppsych.2012.06.016

  View details for Web of Science ID 000310672100005

  View details for PubMedID 22898443

• The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT): A New Tool for the Psychosocial Evaluation of Pre-Transplant Candidates PSYCHOSOMATICS Maldonado, J. R., Dubois, H. C., David, E. E., Sher, Y., Lolak, S., Dyal, J., Witten, D. 2012; 53 (2): 123-132

  Abstract

  While medical criteria have been well established for each end-organ system, psychosocial listing criteria are less standardized. To address this limitation, we developed and tested a new assessment tool: the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT).The SIPAT was developed from a comprehensive review of the literature on the psychosocial factors that impact transplant outcomes. Five examiners blindly applied the SIPAT to 102 randomly selected transplant cases, including liver, heart, and lung patients. After all subject's files had been rated by the examiners, the respective transplant teams provided the research team with the patient's outcome data.Univariate logistic regression models were fit in order to predict the transplant psychosocial outcome (positive or negative) using each rater's SIPAT scores. These results show that SIPAT scores are highly predictive of the transplant psychosocial outcome (P < 0.0001). The instrument has excellent inter-rater reliability (Pearson's correlation coefficient = 0.853), even among novice raters.The SIPAT is a comprehensive screening tool to assist in the psychosocial assessment of organ transplant candidates. Its strengths includes the standardization of the evaluation process and its ability to identify subjects who are at risk for negative outcomes after the transplant, in order to allow for the development of interventions directed at improving the patient's candidacy. Our goal is that the SIPAT, in addition to a set of agreed upon minimal psychosocial listing criteria, would be used in combination with organ-specific medical listing criteria in order to establish standardized criteria for the selection of transplant recipients.

  View details for PubMedID 22424160

• Empirical findings on legal difficulties among practicing psychiatrists ANNALS OF CLINICAL PSYCHIATRY Reich, J. H., Maldonado, J. 2011; 23 (4): 297-307

  Abstract

  This article reviews the published literature on areas of legal difficulty among practicing psychiatrists.A literature search using PubMed identified studies of malpractice lawsuits or medical board discipline of psychiatrists between 1990 and 2009. Eight studies of physician discipline in the United States and one from the United Kingdom were identified. Information from 3 insurance companies and 3 sets of aggregated insurance company data also were available. One follow-up study of hospitalized psychiatric patients also was reviewed.Studies of medical board discipline indicate that, compared with other specialties, psychiatrists are at an increased risk of disciplinary action. Psychiatrists who were female, board certified, and in practice for a short period of time had a lower chance of medical board discipline. Psychiatry claims accounted for a very small proportion of overall malpractice claims and settlements. The amount of patient disability secondary to alleged malpractice was the most important variable predicting insurance payout.Psychiatrists appear to be disciplined by medical boards at an above-average frequency compared with other medical specialties. However, few malpractice suits reach the courts, and psychiatry represents a very small proportion of overall physician malpractice claims and dollars of settlement.

  View details for Web of Science ID 000297034500009

  View details for PubMedID 22073387

• An Approach to the Patient with Substance Use and Abuse MEDICAL CLINICS OF NORTH AMERICA Maldonado, J. R. 2010; 94 (6): 1169-?

  Abstract

  Substance use is ubiquitous among medically ill patients. The 2008 National Survey on Drug Abuse and Health survey estimated that 20.1 million Americans aged 12 years or older (8% of the US population) had used an illicit drug during the preceding month. Some licit substances also create havoc. The survey found that slightly more than half (56%) of Americans reported being current drinkers of alcohol. A total of 6.2 million (2.5%) Americans used prescription-type psychotherapeutic drugs for nonmedical purposes and 70.9 million Americans (or 28.4%) used tobacco during the survey period. Substance abuse problems were diagnosed in up to 36% of medically hospitalized patients for whom a psychiatric consultation was requested. Given how prevalent the use of substances is among the medically ill and their potential effect on comorbid medical conditions, it is important for physicians to be mindful of their prevalence and presentation. This article covers the presenting symptoms of intoxication and withdrawal states, addresses the acute management of the most commonly encountered substances, and summarizes all others in a table.

  View details for DOI 10.1016/j.mcna.2010.08.010

  View details for Web of Science ID 000284079600009

  View details for PubMedID 20951277

• Post-traumatic stress disorder (PTSD) is not a contraindication to gastric bypass in veterans with morbid obesity SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Ikossi, D. G., Maldonado, J. R., Hernandez-Boussard, T., Eisenberg, D. 2010; 24 (8): 1892-1897

  Abstract

  The veteran population is routinely screened for post-traumatic stress disorder (PTSD). The prevalence of obesity in this population continues to increase. We examined whether weight loss outcomes in veterans with PTSD is comparable to results in veterans who do not suffer from PTSD, after gastric bypass. We also examined the effect of bariatric surgery on PTSD symptoms.This retrospective review of prospective data compares veterans with and without PTSD who underwent laparoscopic gastric bypass. Differences between the means of age, initial BMI, and percent excess weight loss were compared between the groups using a Student's t test. Pearson's chi(2) was used to evaluate the relationship between a diagnosis of PTSD, major depressive disorder (MDD), and other Axis I psychiatric disorders. A similar analysis was done to assess for a relationship between PTSD and obesity-related comorbidities, including diabetes mellitus (DM), hypertension (HTN), hyperlipidemia, and GERD.We identified 24 patients who had gastric bypass and a diagnosis of PTSD before surgery and compared them to those without PTSD. Both groups had a similar mean age and initial BMI. There was no significant difference between the percent excess weight lost after 1 year follow-up between the PTSD group (66%) and the non-PTSD group (72%) (p = 0.102). In assessing comorbid conditions, we found a significant association between the diagnosis of PTSD and MDD (p = 0.002), PTSD and other Axis I disorders (p = 0.004), and PTSD and GERD (p = 0.002). However, we saw no significant association between PTSD and DM (p = 0.977), HTN (p = 0.332), and obstructive sleep apnea (OSA) (p = 0.676). The severity of PTSD symptoms fluctuated in the postoperative period.Veterans with PTSD have comparable weight loss to those without PTSD after gastric bypass. In addition, surgery does not seem to have an adverse effect on PTSD symptoms, although PTSD symptomatology tends to fluctuate over time. Further study in this patient population is warranted.

  View details for DOI 10.1007/s00464-009-0866-8

  View details for Web of Science ID 000279488400015

  View details for PubMedID 20063014

• The Impact of Depression in Heart Disease CURRENT PSYCHIATRY REPORTS Sher, Y., Lolak, S., Maldonado, J. R. 2010; 12 (3): 255-264

  Abstract

  Depression and heart disease affect millions of people worldwide. Studies have shown that depression is a significant risk factor for new heart disease and that it increases morbidity and mortality in established heart disease. Many hypothesized and studied mechanisms have linked depression and heart disease, including serotonergic pathway and platelet dysfunction, inflammation, autonomic nervous system and hypothalamic-pituitary-adrenal axis imbalance, and psychosocial factors. Although the treatment of depression in cardiac patients has been shown to be safe and modestly efficacious, it has yet to translate into reduced cardiovascular morbidity and mortality. Understanding the impact and mechanisms behind the association of depression and heart disease may allow for the development of treatments aimed at altering the devastating consequences caused by these comorbid illnesses.

  View details for DOI 10.1007/s11920-010-0116-8

  View details for Web of Science ID 000289731700015

  View details for PubMedID 20425289

• Current approaches to the recognition and treatment of alcohol withdrawal and delirium tremens: "old wine in new bottles" or "new wine in old bottles". Primary care companion to the Journal of clinical psychiatry Stern, T. A., Gross, A. F., Stern, T. W., Nejad, S. H., Maldonado, J. R. 2010; 12 (3)

  View details for DOI 10.4088/PCC.10r00991ecr

  View details for PubMedID 20944765

• Dexmedetomidine and the Reduction of Postoperative Delirium after Cardiac Surgery PSYCHOSOMATICS Maldonado, J. R., Wysong, A., van der Starre, P. J., Block, T., Miller, C., Reitz, B. A. 2009; 50 (3): 206-217

  Abstract

  Delirium is a neurobehavioral syndrome caused by the transient disruption of normal neuronal activity secondary to systemic disturbances.The authors investigated the effects of postoperative sedation on the development of delirium in patients undergoing cardiac-valve procedures.Patients underwent elective cardiac surgery with a standardized intraoperative anesthesia protocol, followed by random assignment to one of three postoperative sedation protocols: dexmedetomidine, propofol, or midazolam.The incidence of delirium for patients receiving dexmedetomidine was 3%, for those receiving propofol was 50%, and for patients receiving midazolam, 50%. Patients who developed postoperative delirium experienced significantly longer intensive-care stays and longer total hospitalization.The findings of this open-label, randomized clinical investigation suggest that postoperative sedation with dexmedetomidine was associated with significantly lower rates of postoperative delirium and lower care costs.

  View details for Web of Science ID 000267537700004

  View details for PubMedID 19567759

• Aspects to consider when evaluating a live organ donor Focus: The Journal of Lifelong Learning in Psychiatry Maldonado JR 2009; VII (3)
• Delirium risk factors and treatment algorithm Focus: The Journal of Lifelong Learning in Psychiatry Maldonado JR 2009; VII (3)
• Pathoetiological Model of Delirium: a Comprehensive Understanding of the Neurobiology of Delirium and an Evidence-Based Approach to Prevention and Treatment 20th United States Psychiatric and Mental Health Congress Maldonado, J. R. W B SAUNDERS CO-ELSEVIER INC. 2008: 789-?

  Abstract

  Delirium is the most common complication found in the general hospital setting. Yet, we know relatively little about its actual pathophysiology. This article contains a summary of what we know to date and how different proposed intrinsic and external factors may work together or by themselves to elicit the cascade of neurochemical events that leads to the development delirium. Given how devastating delirium can be, it is imperative that we better understand the causes and underlying pathophysiology. Elaborating a pathoetiology-based cohesive model to better grasp the basic mechanisms that mediate this syndrome will serve clinicians well in aspiring to find ways to correct these cascades, instituting rational treatment modalities, and developing effective preventive techniques.

  View details for DOI 10.1016/j.ccc.2008.06.004

  View details for Web of Science ID 000260863000007

  View details for PubMedID 18929943

• Delirium following abrupt discontinuation of fluoxetine CLINICAL NEUROLOGY AND NEUROSURGERY Blum, D., Maldonado, J., Meyer, E., Lansberg, M. 2008; 110 (1): 69-70

  Abstract

  Sudden discontinuation of serotonin reuptake inhibitors (SRI) can lead to a number of psychological (e.g., nervousness, anxiety, crying spells, psychomotor agitation, irritability, depersonalization, decreased mood, memory disturbances, confusion, decreased concentration, and/or slowed thinking) and somatic (e.g., nausea, dizziness, headache) symptoms. Recent studies have shown that withdrawal symptoms are common with paroxetine, venlafaxine and fluvoxamine, but relatively rare and mild with fluoxetine cessation, likely as a result of its longer half-life. We report an unusual case of a patient who developed delirium after abrupt discontinuation of fluoxetine.

  View details for DOI 10.1016/j.clineuro.2007.08.016

  View details for Web of Science ID 000252799500013

  View details for PubMedID 17913343

• Pathoetiological model of delirium: a comprehensive understanding of the neurobiology of delirium and an evidence-based approach to prevention and treatment. Crit Care Clin Maldonado JR. 2008; 24 (4): 789-856
• Delirium in the acute care setting: characteristics, diagnosis and treatment. Crit Care Clin. Maldonado JR. 2008; 24 (4): 657-722
• Antidepressant and statin interactions: A review and case report of simvastatin and nefazodone-induced rhabdomyolysis and transaminitis PSYCHOSOMATICS Karnik, N. S., Maldonado, J. R. 2005; 46 (6): 565-568

  View details for Web of Science ID 000233116900009

  View details for PubMedID 16288136

• Social support and maladaptive coping as predictors of the change in physical health symptoms among persons living with HIV/AIDS AIDS PATIENT CARE AND STDS Ashton, E., Vosvick, M., Chesney, M., Gore-Felton, C., Koopman, C., O'Shea, K., Maldonado, J., Bachmann, M. H., Israelski, D., Flamm, J., Spiegel, D. 2005; 19 (9): 587-598

  Abstract

  This study examined social support and maladaptive coping as predictors of HIV-related health symptoms. Sixty-five men and women living with HIV/AIDS completed baseline measures assessing coping strategies, social support, and HIV-related health symptoms. The sample was primarily low-income and diverse with respect to gender, ethnicity, and sexual orientation. Three, 6, and 12 months after completing baseline assessments, physical health symptoms associated with HIV disease were assessed. After controlling for demographic characteristics, CD4 T-cell count, and baseline HIV-related health symptoms, individuals reporting lower increase in HIV-related health symptoms used less venting (expressing emotional distress) as a strategy for coping with HIV. However, when satisfaction with social support was added to the model, the use of this coping strategy was no longer significant, and individuals reporting more satisfying social support were more likely to report lower increase in their HIV-related health symptoms, suggesting that social support is a robust predictor of health outcomes over time independent of coping style and baseline medical status. These findings provide further evidence that social support can buffer deleterious health outcomes among individuals with a chronic illness. Future research needs to examine mediating pathways that can explain this relationship.

  View details for Web of Science ID 000232058300006

  View details for PubMedID 16164385

• Differences between long- and short-acting benzodiazepines in the management of alcohol withdrawal J Psychosomatic Research Maldonado JR, Brooks JO, Nguyen LH, Schader M 2005; 58: S61
• Alpha-2 agonist induced sedation prevents ICU delirium in post-cardotomy patients J Psychosomatic Research Maldonado JR, Wysong A, van der Starre PJ, Block T, Reitz B 2005; 58: S61
• Dissociative States in Personality Disorders Textbook of Personality Disorders; Oldham JM, Skodol AE, Bender DS (eds) Maldonado JR, Spiegel D 2005: 493-521
• Dexmedetomidine: can it reduce the incidence of ICU delirium? Psychosomatics Maldonado JR, van der Starre PJ, Block T, Wysong A 2004; 45 (2): 173
• Post-Operative Sedation and the Incidence of Delirium and Cognitive Deficits in Cardiac Surgery Patients Anesthesiology Maldonado JR, van der Starre PJ, Block T, Wysong A 2003; 99: 465
• Selective attention as possible mechanism of symptom production in conversion disorders J Psychosom Research Maldonado JR, Jasiukaitis P 2003; 55: 140
• Evidence of decreased incidence of extra-pyramidal symptoms with intravenous haloperidol J Psychosom Research Maldonado JR, Kang H 2003; 55: 140-141
• Hypnosis Psychiatry, Second Edition; Tashman A, Kay J, Lieberman J (eds) Maldonado JR, Spiegel D 2003: 1807-1837
• Clinical implications of the recognition and management of delirium in general medical and surgical wards Psychosomatics Maldonado JR, Dhami N, Wise L 2003; 44 (2): 157-158
• Predictors of quality of life in HIV-infected individuals: the effects of immunological status and depression J Psychosom Research Maldonado JR, Israelski D, Diamond S, Chapman A, Koopman C, Spiegel D 2003; 55: 140
• Recognition and management of delirium in the medical and surgical intensive care wards J Psychosom Research Maldonado JR, Dhami N 2003; 55 (2): 150
• Dissociative Disorders Psychiatry; Tashman A, Kay J, Lieberman J (eds) Spiegel D, Maldonado JR 2003: 1452-1470
• Postoperative sedation and the incidence of delirium and cognitive deficits in cardiac surgery patients Annals of Neurology Maldonado JR, van der Starre PJ, Block T, Wysong A 2003; 54: S27-28
• Ethical and psychosocial challenges in liver transplantation J Psychosom Research Withers NW, Hilsabeck RC, Maldonado JR 2003; 55: 116
• Liver Transplantation in alcoholic liver disease: selection and outcome J Psychosom Research Maldonado JR 2003; 55: 115-116
• Clinical and Financial Implications of the Timely Recognition and Management of Delirium in the Acute Medical Wards J Psychosom Research Maldonado JR, Wise L 2003; 55 (2): 151
• The role of the novel anesthetic agent dexmedetomidine on reduction of the incidence of ICU delirium in postcardiotomy patients J Psychosom Research Maldonado JR, Wysong A, van der Starre PJ 2003; 55 (2): 150
• Factitious Disorder-By-Proxy: when parents deceive their children?s doctors American Journal of Forensic Psychiatry Maldonado JR 2003; 24 (1): 1-22
• Clinical characteristics, pathophysiology, and treatment of Conversion Disorders: A research based approach Psychosomatics Maldonado JR, Spiegel D 2003; 44 (2): 165
• Ethical and clinical implications of liver transplantation in patients on methadone maintenance therapy J Psychosom Research Maldonado JR 2003; 55: 116
• Psychosomatic aspects in liver disease J Psychosom Research Withers NW, Maldonado JR, Hilsabeck RC, Dishman B 2003; 55: 115
• Acute stress reactions following the assassination of Mexican presidential candidate Colosio 13th Annual Meeting of the International-Society-for-Traumatic-Stress-Studies Maldonado, J. R., Page, K., Koopman, C., Butler, L. D., Stein, H., Spiegel, D. JOHN WILEY & SONS INC. 2002: 401–5

  Abstract

  Considerable evidence suggests that exposure to traumatic events increases the risk of developing anxiety-spectrum disorders in response to later traumatization. We conducted a survey in Guadalajara, Mexico to assess factors associated with acute stress reactions to the assassination of a political figure. Participants included 86 adults who completed the Stanford Acute Stress Reaction Questionnaire (SASRQ) and measures of the perceived impact of the assassination, exhibited emotional behavior following the assassination, and had exposure to a specific prior disaster (a gas pipeline explosion). The results suggest that acute stress reactions can occur in response to an assassination, and that those most susceptible are those most emotionally invested, those who engage in emotional behavioral responses, and those whose lives have been affected by a previous potentially traumatic event.

  View details for Web of Science ID 000177968900008

  View details for PubMedID 12392228

• Dissociative Disorders Textbook of Psychiatry, Fourth Edition; Talbot J, Yudosky S (Eds.) Maldonado JR, Spiegel D 2002: 709-742
• Hypnosis Textbook of Psychiatry, Fourth Edition; Talbot J, Yudosky S (Eds.) Maldonado JR, Spiegel D 2002: 1461-1516
• When patients deceive doctors: a review of Factitious Disorders American Journal of Forensic Psychiatry Maldonado JR 2002; 23 (2): 29-58
• Performance improvement: increasing recognition and treatment of postoperative delirium. Progress in cardiovascular nursing SHINN, J. A., Maldonado, J. R. 2000; 15 (3): 114-115

  View details for PubMedID 10951955

• Conversion Disorder Review of Psychiatry-Volume 20: Somatoform and Factitious Disorders; Phillips KA (Ed.) Maldonado JR, Spiegel D 2000: 95-128
• Intravenous versus oral haloperidol: An evaluation of the incidence of extra-pyramidal symptoms Psychosomatics Maldonado JR 2000; 41 (2): 169-170
• Immunological status versus depression as predictors of quality of life in HIV-infected individuals Immunological status versus depression as predictors of quality of life in HIV-infected individuals Maldonado JR, Koopman C, Spiegel D 2000; 41 (2): 186
• Treatment of Dissociative Disorders A Guide to Treatments That Work, 2nd Edition; Nathan PE, Gorman JM (Eds.) Maldonado JR, Butler L, Spiegel D 2000: 463-496
• The Relationship Between Pain and Coping Styles Among HIV-Positive Men and Women Psychology and Health Hart S, Gore-Felton C, Maldonado J, Lagana L, Koopman C, Blake-Mortimer J, Israelski D, Spiegel D 2000; 15: 869-879
• Hypnosis Effective Treatments for PTSD; Foa EB, Keane TM, Friedman MJ (Eds.) Cardeña E, Maldonado, J, van der Hart O, Spiegel D 2000: 247-279
• Medical Hypnosis Psychiatric Care of the Medical Patient.; Stoudemire A (Ed) Maldonado JR, Spiegel D 2000: 73-90
• The relationship between pain and coping styles among HIV-positive men and women PSYCHOLOGY & HEALTH Hart, S., Gore-Felton, C., Maldonado, J., Lagana, L., Blake-Mortimer, J., Israelski, D., Koopman, C., Spiegel, D. 2000; 15 (6): 869-879

  View details for Web of Science ID 000165761600011

• Dissociation Encyclopedia of Stress; Fink G (Ed) Maldonado JR 2000: 714-722
• Diagnoses of children and adolescents on initial presentation to a Nigerian outpatient psychiatry clinic INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY Lustig, S. L., Maldonado, J. R. 1999; 45 (3): 190-197

  Abstract

  Child and adolescent psychiatry is an underdeveloped specialty in Nigeria, relegated by more entrenched cultural systems, such as traditional healers and syncretic churches, to merely an auxiliary role in child mental health care. Little is therefore known about the epidemiology of childhood disorders as encountered in psychiatric settings. We reviewed the outpatient psychiatric clinic's patient register at the Psychiatric Hospital of Uselu in Benin City, Nigeria, over a twenty-four week period. Fifty-three patients who presented in the twenty-four week index period had definite diagnoses indicated in the register. Of these, 68% had diagnoses denoting significant behavioral disturbances that would motivate their visit to allopathic hospitals after other, more culturally sanctioned healers were of little help. Our findings are compared with similar studies in other cultures.

  View details for Web of Science ID 000083061600006

  View details for PubMedID 10576085

• Dissociative Disorders Textbook of Psychiatry; Talbot J, Yudosky S Spiegel D, Maldonado JR 1999: 711-738
• La Hipnosis y los Trastornos Posttraumáticos Anales de Psicologia Cardeña E, Maldonado JR, Spiegel, D 1999; 15 (1): 147-155
• Diagnoses of children and adolescents on initial presentation to a Nigerian outpatient psychiatry clinic Inter J Soc Psychiatr Lustig SL, Maldonado JR 1999; 45 (3): 190-197
• Immunological status vs. depression as predictors of quality of life in HIV-infected individuals Psychosomatics Maldonado JR, Koopman C, Gore-Felton C, Diamond S, Chapman A, Spiegel D 1999; 40 (2): 160
• Hypnosis Textbook of Psychiatry; Talbot J, Yudosky S (Eds.) Spiegel D, Maldonado JR 1999: 1243-1247
• Manual of Psychiatric Care in the General Hospital: Assesment Tools and Drug Treatment Recommendations & Protocols. Department of Pharmacy, Stanford Health Services. Maldonado JR 1998
• Trauma, Dissociation and Hypnotizability Trauma, Memory and Dissociation; Marmar R, & Bremmer D. (Eds.) Maldonado JR, Spiegel D 1998: 57-106
• Treatment of Dissociative Disorders A Guide to Treatments That Work; Nathan PE, Gorman JM (Eds.) Maldonado JR, Butler L, Spiegel D 1998: 423-446
• Conversion disorder: Are the symptoms the result of pure psychology or true physiological changes? Psychosomatics Maldonado JR 1997; 38 (2): 190-191
• Liver transplantation for alcoholic liver disease: selection and outcome. Clinics of North America: Clinics in Liver Disease W.B.Saunders Co. Maldonado JR, Keeffe EB 1997; 1 (2): 305-321,
• Treatment of dissociative disorders in Nathan PE, & Gorman JM (Eds.) A Guide to Treatments That Work. Oxford Press Maldonado JR, Butler L, Spiegel D. 1997: 423-446
• Hypnosis for Psychiatric Disorders Current Psychiatric Therapy II: Dunner, D (ed) Maldonado JR, Spiegel D 1996: 600-608
• Hypnosis in Tashman A, Kay J, & Lieberman J. (Eds.) Psychiatry. Philadelphia, PA: W. B. Saunders Company Maldonado JR, Spiegel, D 1996: 1475-1499
• The Psychophysiology of Conversion Disorders Psychosomatics Maldonado JR 1996; 37 (2): 216-217
• Hypnosis Psychiatry; Tashman A, Kay J, & Lieberman J. (Eds.) Maldonado JR, Spiegel D 1996: 1475-1499
• Using Hypnosis Women Molested in Childhood; Classen C. (Ed.) Maldonado JR, Spiegel D 1995: 163-186
• Treatment of Post Traumatic Stress Disorder Dissociation: Clinical, Theoretical and Research Perspectives; Lynn SJ, & Rhue J. (Eds.) Maldonado JR, Spiegel D 1994: 215-241