Clinical Associate Professor, Psychiatry and Behavioral Sciences - Child and Adolescent Psychiatry
Clinical Associate Professor, Pediatrics - Cardiology
Fellowship: Stanford University Pain Management Fellowship (2011) CA
Professional Education: Nova Southeastern University Office of the Registrar (2010) FL
Internship: Lucile Packard Children's Hospital (2010) CA
A Case of Abulia From Left Middle Cerebral Artery Stroke in an Adolescent Treated Successfully With Short Duration Olanzapine.
; 43 (3): 86–89
Abulia is defined as a pathological state of amotivation, apathy, and global absence of willpower. It presents with a challenging array of overlapping symptoms, making effective identification and treatment difficult.We describe the first known report of an adolescent with a ventricular assist device who developed abulia following a left middle cerebral artery (MCA) stroke who responded successfully to treatment with olanzapine.The neurobiological etiology of abulia is still unclear but is postulated to be related to deficits in the dopaminergic reward circuitry in the frontal-subcortical-mesolimbic regions. There have been reports of poststroke patients with abulia being treated by modulating this dopamine circuitry and in some cases with short-term low-dose olanzapine.Further research is needed to develop a better understanding of the pathophysiology of abulia leading to more effective treatment algorithms including more specific diagnostic tools and effective pharmacological interventions.
View details for DOI 10.1097/WNF.0000000000000389
View details for PubMedID 32384311
- A Framework for Navigating Requests for Nondisclosure in Pediatric Palliative Care CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2021; 9 (3): 296-307
Feasibility of assessing adolescent and young adult heart transplant recipient mental health and resilience using patient-reported outcome measures.
Journal of the Academy of Consultation-Liaison Psychiatry
BACKGROUND: Although adolescents and young adults (AYA) may be particularly prone to mental health symptoms following heart transplant, screening practices are variable. This study examined the feasibility of using patient-reported outcome (PRO) measures to assess mental health, functional status, and resiliency in post-transplant AYA patients.METHODS: Patients transplanted between ages 15-25 years at three centers completed six PRO instruments via web-based platforms: PROMIS instruments for anxiety, depression, satisfaction with social roles, and physical functioning; the Posttraumatic Stress Diagnostic Scale for DSM-V (PDS-5); and the Connor-Davidson Resilience Scale-10 (CD-RISC-10). Feasibility (completion, time to completion, and measure missingness) and PRO results were described and compared between congenital heart disease (CHD) and cardiomyopathy (CM) patients.RESULTS: Nineteen patients (median age at transplant 17.7 years [IQR 16.3,19.2 years], 84% male) were enrolled at an average of 3 ± 1.8 years post-transplant. Enrollment was 90% among eligible patients. Measure missingness were zero. The average completion time was 12 ± 15 minutes for all instruments. Timely PRO completion was facilitated by in-clinic application. The PRO results indicated that 9 patients (47%) had at least mild PTSD symptoms (≥11 points on PDS-5). Among them, 4 patients had scores >28 suggestive of probable PTSD. Two (11%) and 6 (32%) patients had anxious and depressive symptoms, respectively. The CM cohort had a higher median PDS-5 score than that of the CHD subgroup (11.0 vs 6.0; p = 0.015). Twelve (63%) had resiliency scores that were lower than the population average. No significant differences were found in PRO results between CM and CHD patients apart from the PTSD assessment.CONCLUSIONS: This novel PRO-based approach to psychiatric screening of AYA patients after transplant appears feasible for assessing mental health, functional status, and resiliency, with excellent enrollment and completion rates. These instruments characterized the burden of mental health symptoms within this AYA heart transplant cohort, with a high prevalence of PTSD symptoms. Resiliency scores were lower than in a comparison population. Electronically- administered PRO administration could facilitate more consistent mental health screening in this at-risk group.
View details for DOI 10.1016/j.jaclp.2021.08.002
View details for PubMedID 34438097
An exploratory assessment of pediatric patient and parent needs after implantable cardioverter defibrillator implant.
Pacing and clinical electrophysiology : PACE
Placement of an ICD is often accompanied by psychological adjustment issues in pediatric patients and their parents. While anxiety, depression, and lowered QOL have been seen in these patients, no studies have investigated patient or parent reported needs. This exploratory study describes the needs of pediatric ICD patients and parents and assesses whether patient factors of age, gender, depression, and anxiety are associated with specific needs.ICD patients ages 8-21 and their parents completed a needs analysis survey assessing various domains of functioning. Patients also completed self-reported measures of depression and anxiety.Thirty-two patients (28% female) and their parents (72% mothers) completed the survey. Patients' most frequently endorsed needs involved educational issues: understanding their cardiac event/diagnosis (34%), medications (34%), and how the ICD would change their lifestyle (31%). Parents' most frequently endorsed needs involved family issues; almost half of parents (47%) were concerned about their children's frustration with their overprotectiveness and 28% were concerned with their child feeling depressed or anxious. Patients who reported feeling overprotected (12.1 ± 3.4 vs 17.4 ± 3.5 years, p = .001) were significantly younger than those who did not. Experiencing peer issues was more frequently endorsed by females than males (33% of females vs 4% of males, p = .026).ICD patients and parents endorsed markedly different needs. Patients focused on understanding their ICD, while parents were more focused on their children's emotional needs. Novel ways of educating patients about their device and clinic based screenings of emotional functioning may serve to meet these needs. This article is protected by copyright. All rights reserved.
View details for DOI 10.1111/pace.13876
View details for PubMedID 31971265