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Article ; Online: Optimizing Medication Treatment of Opioid Use Disorder During COVID-19 (SARS-CoV-2).

Leppla, Idris E / Gross, Marielle S

Journal of addiction medicine

2020 Volume 14, Issue 4, Page(s) e1–e3

Abstract: The COVID-19 health crisis joined, rather than supplanted, the opioid crisis as the most acutely pressing threats to US public health. In the setting of COVID-19, opioid use disorder treatment paradigms are being disrupted, including the fact that ... ...

Abstract	: The COVID-19 health crisis joined, rather than supplanted, the opioid crisis as the most acutely pressing threats to US public health. In the setting of COVID-19, opioid use disorder treatment paradigms are being disrupted, including the fact that methadone clinics are scrambling to give "take-home" doses where they would typically not. The rapid transition away from in-person examination, dosing and group therapy in an era of social isolation calls for adjustments to clinical practice, including emphasizing patient-provider communication, favoring new inductees on buprenorphine and leveraging technology to optimize safety of medication treatment.
MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections/epidemiology ; Coronavirus Infections/prevention & control ; Humans ; Infection Control/organization & administration ; Narcotic Antagonists/therapeutic use ; Opiate Substitution Treatment/methods ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/epidemiology ; Opioid-Related Disorders/psychology ; Organizational Innovation ; Pandemics/prevention & control ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/prevention & control ; Public Health ; SARS-CoV-2 ; Substance Abuse Treatment Centers/methods ; Substance Abuse Treatment Centers/organization & administration ; Substance Abuse Treatment Centers/trends ; United States/epidemiology
Chemical Substances	Narcotic Antagonists
Keywords	covid19
Language	English
Publishing date	2020-05-25
Publishing country	United States
Document type	Journal Article
ISSN	1935-3227
ISSN (online)	1935-3227
DOI	10.1097/ADM.0000000000000678
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Dissociative identity precipitated by emergence from general anesthesia: A case report and analytical framework.

Kirschen, Gregory W / Shorey, Mary E / Han, Joan / Leppla, Idris / Masear, Courtney G / Robinson, Jennifer

Psychiatry research case reports

2023 Volume 2, Issue 2

Abstract: Background: Dissociative identity disorder (DID) is a complex and controversial psychiatric condition in which one person maintains at least two separate and distinct personalities. Patients with DID often report a history of childhood abuse and may ... ...

Abstract	Background: Dissociative identity disorder (DID) is a complex and controversial psychiatric condition in which one person maintains at least two separate and distinct personalities. Patients with DID often report a history of childhood abuse and may have other comorbid psychiatric conditions. Psychosocial stressors may be triggers for DID inception or recurrence. While anesthetic agents, in particular ketamine, may induce a temporary dissociative state, it has not yet been reported that anesthesia can precipitate a dissociative identity. Case report: We report a case of a woman with a history of childhood sexual abuse and past suicide attempt who experienced an episode of dissociative identity on emergence from anesthesia. The episode resolved within 90 minutes and the patient was discharged home safely on hospital day two. Conclusion: This case adds to the literature of potentially precipitating factors of DID and we provide a unifying mechanistic hypothesis linking anesthesia to functional brain connectivity.
Language	English
Publishing date	2023-07-26
Publishing country	Netherlands
Document type	Journal Article
ISSN	2773-0212
ISSN (online)	2773-0212
DOI	10.1016/j.psycr.2023.100152
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Article ; Online: Optimizing Medication Treatment of Opioid Use Disorder During COVID-19 (SARS-CoV-2)

Leppla, Idris E. / Gross, Marielle S.

Journal of Addiction Medicine

2020 Volume 14, Issue 4, Page(s) e1–e3

Keywords	Pharmacology (medical) ; Psychiatry and Mental health ; covid19
Language	English
Publisher	Ovid Technologies (Wolters Kluwer Health)
Publishing country	us
Document type	Article ; Online
ISSN	1932-0620
DOI	10.1097/adm.0000000000000678
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Optimizing Medication Treatment of Opioid Use Disorder During COVID-19 (SARS-CoV-2)

Leppla, Idris E / Gross, Marielle S

J Addict Med

Abstract	: The COVID-19 health crisis joined, rather than supplanted, the opioid crisis as the most acutely pressing threats to US public health. In the setting of COVID-19, opioid use disorder treatment paradigms are being disrupted, including the fact that methadone clinics are scrambling to give "take-home" doses where they would typically not. The rapid transition away from in-person examination, dosing and group therapy in an era of social isolation calls for adjustments to clinical practice, including emphasizing patient-provider communication, favoring new inductees on buprenorphine and leveraging technology to optimize safety of medication treatment.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #268088
Database	COVID19

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Article ; Online: Extended Requirement of Granulocyte Colony-Stimulating Factor for Clozapine-Associated Neutropenia.

Leppla, Idris E / Nucifora, Frederick C / Sedlak, Thomas W

Journal of clinical psychopharmacology

2019 Volume 39, Issue 2, Page(s) 169–172

MeSH term(s)	Aged ; Clozapine/administration & dosage ; Clozapine/adverse effects ; Female ; Granulocyte Colony-Stimulating Factor/administration & dosage ; Humans ; Neutropenia/drug therapy ; Schizophrenia/blood ; Schizophrenia/drug therapy
Chemical Substances	Granulocyte Colony-Stimulating Factor (143011-72-7) ; Clozapine (J60AR2IKIC)
Language	English
Publishing date	2019-02-27
Publishing country	United States
Document type	Case Reports ; Letter
ZDB-ID	604631-9
ISSN	1533-712X ; 0271-0749
ISSN (online)	1533-712X
ISSN	0271-0749
DOI	10.1097/JCP.0000000000001017
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Article ; Online: Prevalence and Improvement of Caine-Positive Wernicke-Korsakoff Syndrome in Psychiatric Inpatient Admissions.

Lin, Shihong / Leppla, Idris E / Yan, Haijuan / Probert, Julia M / Randhawa, Privia A / Leoutsakos, Jeannie-Marie S / Probasco, John C / Neufeld, Karin J

Psychosomatics

2019 Volume 61, Issue 1, Page(s) 31–38

Abstract: Background: Wernicke-Korsakoff Syndrome (WKS) resulting from thiamine deficiency is classically defined as including encephalopathy, ataxia, and ophthalmoplegia. Only 16% of autopsy-confirmed patients with WKS exhibit all three signs. Caine-positive WKS ...

Abstract	Background: Wernicke-Korsakoff Syndrome (WKS) resulting from thiamine deficiency is classically defined as including encephalopathy, ataxia, and ophthalmoplegia. Only 16% of autopsy-confirmed patients with WKS exhibit all three signs. Caine-positive WKS criteria include two or more of the following: nutritional deficiency, delirium or mild memory impairment, cerebellar dysfunction/ataxia, and oculomotor abnormalities. Objective: We describe Caine-positive WKS prevalence among psychiatric inpatients and compare pretreatment-versus-posttreatment neurocognitive improvement to an unaffected group. Methods: This 6-month quality-improvement evaluation included two-stage screening for Caine-positive WKS, administering high-dose intravenous thiamine (day 1: 1200 mg; days 2-4: 200 mg) with reexamination on day 5. We used descriptive statistics and fitted random effects models to examine rate-of-change differences in pre-/posttreatment Montreal Cognitive Assessment (MoCA), delayed 5-item recall, and gait/coordination scores between treated Caine-positive patients with WKS and untreated Caine-negative patients. Results: Of 262 patients, 32 (12%) had Caine-positive WKS; 17 (53%) used alcohol currently. Treated Caine-positive WKS (n = 26) versus Caine-negative comparison (n = 34) before and after treatment observed a mean change (standard deviation) in the MoCA score of 3.6 (2.5) versus 1.8 (2.5) (P < 0.01); 5-item recall: 1.8 (1.4) versus 0.5 (1.4) (P < 0.001); gait/coordination scores: -0.6 (1.2) versus -0.1 (0.6) (P < 0.001). Oculomotor abnormalities were infrequent (n = 4 in Caine-positive WKS, n = 2 in Caine-negative comparison groups). Conclusions: Caine-positive WKS prevalence among psychiatric inpatients was 12%; only half used alcohol. Patients treated with high-dose thiamine demonstrated clinically significant neurocognitive improvement.
MeSH term(s)	Adult ; Alcoholic Korsakoff Syndrome/diagnosis ; Alcoholic Korsakoff Syndrome/drug therapy ; Alcoholic Korsakoff Syndrome/epidemiology ; Alcoholic Korsakoff Syndrome/physiopathology ; Ataxia/physiopathology ; Brain Diseases/physiopathology ; Cerebellar Diseases/physiopathology ; Delirium/physiopathology ; Female ; Hospitalization ; Humans ; Korsakoff Syndrome/diagnosis ; Korsakoff Syndrome/drug therapy ; Korsakoff Syndrome/epidemiology ; Korsakoff Syndrome/physiopathology ; Male ; Malnutrition/epidemiology ; Mass Screening ; Memory Disorders/physiopathology ; Mental Status and Dementia Tests ; Middle Aged ; Ocular Motility Disorders/physiopathology ; Ophthalmoplegia/physiopathology ; Prevalence ; Thiamine/therapeutic use ; Thiamine Deficiency/drug therapy ; Thiamine Deficiency/physiopathology ; Thinness/epidemiology ; Treatment Outcome ; Vitamin B Complex/therapeutic use ; Weight Loss
Chemical Substances	Vitamin B Complex (12001-76-2) ; Thiamine (X66NSO3N35)
Language	English
Publishing date	2019-08-14
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	209487-3
ISSN	1545-7206 ; 0033-3182
ISSN (online)	1545-7206
ISSN	0033-3182
DOI	10.1016/j.psym.2019.08.002
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Zs.A 440: Show issues

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Article ; Online: Clinical Approach to Personality Change Due to Another Medical Condition.

Leppla, Idris / Fishman, Daniel / Kalra, Inder / Oldham, Mark A

Journal of the Academy of Consultation-Liaison Psychiatry

2020 Volume 62, Issue 1, Page(s) 14–21

Abstract: Background: Medical personality change (MPC) is a codable diagnosis (i.e., F07.0) that deserves ...

Abstract	Background: Medical personality change (MPC) is a codable diagnosis (i.e., F07.0) that deserves consideration when a patient is inexplicably no longer "acting like him/herself." Its presentation ranges from subtle to severe and is often characterized by bafflingly poor judgment and impairment in several aspects of a person's life. Despite the global impact that MPC can have on a patient's functioning, occupation, and relationships, this condition receives far less clinical consideration than better known syndromes such as depression or anxiety and is often likely incorrectly formulated as such. Objective/methods: This article provides a clinically focused review of MPC. We review its clinical assessment followed by a review of its subtypes, which we have categorized to reflect the behavioral correlates of known frontotemporal-subcortical circuits. These include the apathetic type (ventromedial prefrontal cortex), the labile and disinhibited types (orbitofrontal cortex), and the aggressive and paranoid types (medial temporal lobes). Results: For each of these 3 categories, we describe the clinical presentation and review management strategies. For each category, we focus on 3 common causes for MPC-traumatic brain injury, Huntington disease, and brain tumors-which we have selected because clinical features of MPC due to these conditions generalize to many other etiologies of MPC. Conclusions: MPC warrants clinical attention for the range of dysfunction and distress it can cause. It also deserves further scientific study to better characterize its phenotypes, to tailor instruments for its clinical assessment, and to identify effective treatments.
MeSH term(s)	Anxiety Disorders ; Humans ; Male ; Personality ; Personality Disorders/diagnosis ; Prefrontal Cortex ; Temporal Lobe
Language	English
Publishing date	2020-09-12
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	2667-2960
ISSN (online)	2667-2960
DOI	10.1016/j.psym.2020.08.003
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Clinical Approach to Personality Change Due to Another Medical Condition.

Leppla, Idris / Fishman, Daniel / Kalra, Inder / Oldham, Mark A

Psychosomatics

2020

Abstract: Background: Medical personality change (MPC) is a codable diagnosis (i.e., F07.0) that deserves ...

Abstract	Background: Medical personality change (MPC) is a codable diagnosis (i.e., F07.0) that deserves consideration when a patient is inexplicably no longer "acting like him/herself." Its presentation ranges from subtle to severe and is often characterized by bafflingly poor judgment and impairment in several aspects of a person's life. Despite the global impact that MPC can have on a patient's functioning, occupation, and relationships, this condition receives far less clinical consideration than better known syndromes such as depression or anxiety and is often likely incorrectly formulated as such. Objective/methods: This article provides a clinically focused review of MPC. We review its clinical assessment followed by a review of its subtypes, which we have categorized to reflect the behavioral correlates of known frontotemporal-subcortical circuits. These include the apathetic type (ventromedial prefrontal cortex), the labile and disinhibited types (orbitofrontal cortex), and the aggressive and paranoid types (medial temporal lobes). Results: For each of these 3 categories, we describe the clinical presentation and review management strategies. For each category, we focus on 3 common causes for MPC-traumatic brain injury, Huntington disease, and brain tumors-which we have selected because clinical features of MPC due to these conditions generalize to many other etiologies of MPC. Conclusions: MPC warrants clinical attention for the range of dysfunction and distress it can cause. It also deserves further scientific study to better characterize its phenotypes, to tailor instruments for its clinical assessment, and to identify effective treatments.
Language	English
Publishing date	2020-09-12
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	209487-3
ISSN	1545-7206 ; 0033-3182
ISSN (online)	1545-7206
ISSN	0033-3182
DOI	10.1016/j.psym.2020.08.003
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 440: Show issues

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Article ; Online: Raltegravir treatment intensification does not alter cerebrospinal fluid HIV-1 infection or immunoactivation in subjects on suppressive therapy.

Dahl, Viktor / Lee, Evelyn / Peterson, Julia / Spudich, Serena S / Leppla, Idris / Sinclair, Elizabeth / Fuchs, Dietmar / Palmer, Sarah / Price, Richard W

The Journal of infectious diseases

2011 Volume 204, Issue 12, Page(s) 1936–1945

Abstract: Background: Despite suppression of plasma human immunodeficiency virus type 1 (HIV-1) RNA by antiretroviral therapy to levels below clinical assay detection, infection and immune activation may persist within the central nervous system and possibly lead ...

Abstract	Background: Despite suppression of plasma human immunodeficiency virus type 1 (HIV-1) RNA by antiretroviral therapy to levels below clinical assay detection, infection and immune activation may persist within the central nervous system and possibly lead to continued brain injury. We hypothesized that intensifying therapy would decrease cerebrospinal fluid (CSF) infection and immune activation. Methods: This was a 12-week, randomized, open-label pilot study comparing addition of the integrase inhibitor raltegravir to no treatment augmentation, with an option for rollover to raltegravir. CSF and plasma were analyzed for HIV-1 RNA using a single-copy assay. CSF and blood immune activation was assessed by neopterin concentrations and CD4(+) and CD8(+) T-cell surface antigen expression. Results: Primary analysis compared 14 intensified (including rollovers) to 9 nonintensified subject experiences. Median HIV-1 RNA levels in all samples were lower in CSF (<.3 copies/mL) than in plasma (<.9 copies/mL; P < .0001), and raltegravir did not reduce HIV-1 RNA, CSF neopterin, or CD4(+) and CD8(+) T-cell activation. Conclusions: Raltegravir intensification did not reduce intrathecal immunoactivation or alter CSF HIV-1 RNA levels in subjects with baseline viral suppression. With and without raltegravir intensification, HIV RNA levels in CSF were very low in the enrolled subjects. Clinical Trials Registration. NCT00672932.
MeSH term(s)	ADP-ribosyl Cyclase 1/metabolism ; Anti-Retroviral Agents/administration & dosage ; Anti-Retroviral Agents/immunology ; Anti-Retroviral Agents/therapeutic use ; CD4 Lymphocyte Count ; CD4-Positive T-Lymphocytes/metabolism ; CD8-Positive T-Lymphocytes/metabolism ; Female ; HIV Infections/blood ; HIV Infections/cerebrospinal fluid ; HIV Infections/drug therapy ; HIV Infections/immunology ; HIV-1 ; HLA-DR Antigens/metabolism ; Humans ; Male ; Middle Aged ; Neopterin/blood ; Neopterin/cerebrospinal fluid ; Pilot Projects ; Pyrrolidinones/administration & dosage ; Pyrrolidinones/immunology ; Pyrrolidinones/therapeutic use ; RNA, Viral/blood ; RNA, Viral/cerebrospinal fluid ; Raltegravir Potassium ; Receptors, CCR5/metabolism
Chemical Substances	Anti-Retroviral Agents ; HLA-DR Antigens ; Pyrrolidinones ; RNA, Viral ; Receptors, CCR5 ; Raltegravir Potassium (43Y000U234) ; Neopterin (670-65-5) ; ADP-ribosyl Cyclase 1 (EC 3.2.2.6)
Language	English
Publishing date	2011-10-21
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	3019-3
ISSN	1537-6613 ; 0022-1899
ISSN (online)	1537-6613
ISSN	0022-1899
DOI	10.1093/infdis/jir667
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