- adult ADHD
- early onset psychosis
- Play therapy
- Therapies for adults with ADHD
Clinical Assistant Professor, Psychiatry and Behavioral Sciences - Child and Adolescent Psychiatry
Boards, Advisory Committees, Professional Organizations
President Elect, CAL-ACAP (2021 - Present)
Co-Chair, C.A.R.E. (Committee for Anti- Racism and Equity: sub committee of CALACAP (2020 - 2021)
Member, NC-ROCAP (2017 - Present)
Member, AACAP (2000 - Present)
Board Certification: American Board of Psychiatry and Neurology, Child and Adolescent Psychiatry (2003)
Board Certification: American Board of Psychiatry and Neurology, Psychiatry (2002)
Residency: Cleveland Clinic Foundation (2000) OH
Fellowship: Harbor UCLA Medical Center (2002) CA United States of America
MBBS, Grant Medical College, Mumbai, India, Medicine (1992)
Community and International Work
STAM (Stanford team at Mills) program, San Mateo, CA
Provide care to the acute psychiatric conditions in the adolescent
Mills-Peninsula health system
13-17 year old with complex psychiatric diagnoses
Opportunities for Student Involvement
Treatment Outcomes in an Adult Attention Deficit Hyperactivity Disorder Clinic With a Focus on Executive Functioning and Sluggish Cognitive Tempo.
2020; 12 (8): e9814
Aim Executive function (EF) is considered a core attention deficit hyperactivity disorder (cADHD) symptom in adults and, more recently, sluggish cognitive tempo (SCT). Despite considerable controversy around the role of SCT symptoms in the diagnosis of attention deficit hyperactivity disorder (ADHD), some scholars have suggested that SCT symptoms are a subset of the ADHD syndrome, whereas others have suggested that SCT is an entirely unique type of attention disorder. Therefore, we looked to characterize the impact of treatment as usual (TAU) with medication and psychoeducation on the functional impairments related to EF and SCT, and related functional impairments in adults with ADHD. We aim to clarify if the combination of TAU and modular ADHD therapy (TAUTx) further improves these symptoms. The goal is to assess the validity of self-reporting assessment of symptoms adopted in the present for the monitoring of treatment in this population. Methods We implemented the inclusion and exclusion criteria at the onset of the clinic. This prospective cohort case series study is designed to see the difference with self-reporting scales for EF, SCT, and cADHD symptoms in TAU and TAUTx. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist was used to provide transparency in reporting the data. Results Adults with ADHD showed a significant improvement with TAU in EF (p=0.001), cADHD (p=0.007), and SCT (p=0.002). Furthermore, TAUTx improved areas of EF (p=0.001), cADHD (p=0.004), and SCT (p=0.002). We saw a significant benefit from starting/optimizing medications in the treatment of ADHD along with psychoeducation. Self-reporting scales appeared to be reliable for monitoring the symptoms of ADHD and related dysfunction and were consistent with the Clinical Global Impressions Scale. Conclusions Adult ADHD patients reported significant benefit from TAU for aspects of impairment in EF and SCT. They require ongoing medication prescribing and "tailoring" through optimization. Psychoeducation is an effective form of therapy in these patients with or without the addition of adult ADHD modular therapy. Self-reporting is valid for monitoring and providing transparency in patient care.
View details for DOI 10.7759/cureus.9814
View details for PubMedID 32953325
View details for PubMedCentralID PMC7494416
Non-epileptic Seizures versus Frontal Lobe Epilepsy in an Adolescent: A Case Report.
2019; 11 (9): e5732
Multiple inpatient psychiatric hospitalizations can be due to system issues, patient complexity, family dynamics, and misdiagnoses to name a few. This study highlights a diagnostically challenging case and how that, in itself, contributed to hospital admissions. Although 18 months elapsed from the time of the initial presentation to the diagnosis of non-epileptic seizures (NES), the suspicion of the diagnosis may have been made earlier by clinicians. The evidence for seizures of post-ictal confusion followed by lethargy, amnesia for the event, and response to an anti-seizure medication only could have provided a higher index of suspicion for NES. Many health care providers will argue that this will create over-diagnoses of NES and usage of anti-epileptic medications. While reviewing the literature on NES, it was noted that frontal lobe epilepsy (FLE) causing psychiatric comorbidities has been poorly studied. Furthermore, this case highlights that within the field of child psychiatry, the same clinical presentation can be interpreted differently. This case helps us understand how eliciting clinical information to enable the timely ordering of imaging could help in diagnoses. This may help set up clinical guidelines for NES for the mental health providers to facilitate improvement in diagnoses and treatment.
View details for DOI 10.7759/cureus.5732
View details for PubMedID 31700761
View details for PubMedCentralID PMC6822563
Towards a neuroanatomy of autism: A systematic review and meta-analysis of structural magnetic resonance imaging studies
2008; 23 (4): 289-299
Structural brain abnormalities have been described in autism but studies are often small and contradictory. We aimed to identify which brain regions can reliably be regarded as different in autism compared to healthy controls.A systematic search was conducted for magnetic resonance imaging studies of regional brain size in autism. Data were extracted and combined using random effects meta-analysis. The modifying effects of age and IQ were investigated using meta-regression.The total brain, cerebral hemispheres, cerebellum and caudate nucleus were increased in volume, whereas the corpus callosum area was reduced. There was evidence for a modifying effect of age and IQ on the cerebellar vermal lobules VI-VII and for age on the amygdala.Autism may result from abnormalities in specific brain regions and a global lack of integration due to brain enlargement. Inconsistencies in the literature partly relate to differences in the age and IQ of study populations. Some regions may show abnormal growth trajectories.
View details for DOI 10.1016/j.eurpsy.2007.05.006
View details for Web of Science ID 000257916400009
View details for PubMedID 17765485
Schizotypal cognitions as a predictor of psychopathology in adolescents with mild intellectual impairment
BRITISH JOURNAL OF PSYCHIATRY
2007; 191: 484-492
There is evidence to suggest that among young people with mild intellectual disability there are those whose cognitive difficulties may predict the subsequent manifestation of a schizophrenic phenotype. It is suggested that they may be detectable by simple means.To gain adequate cooperation from educational services, parents and students so as to recruit a sufficiently large sample to test the above hypothesis, and to examine the hypothesis in the light of the findings.The sample was screened with appropriate instruments, and groups hypothesised as being likely or not likely to have the phenotype were compared in terms of psychopathology and neuropsychology.Simple screening methods detect a sample whose psychopathological and neuropsychological profile is consistent with an extended phenotype of schizophrenia.Difficulties experienced by some young people with mild and borderline intellectual disability are associated with enhanced liability to schizophrenia. Clinical methods can both identify those with this extended phenotype and predict those in whom psychosis will occur.
View details for DOI 10.1192/bjp.bp.106.033514
View details for Web of Science ID 000251872400004
View details for PubMedID 18055951