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Article ; Online: Subtherapeutic doses of SSRI antidepressants demonstrate considerable serotonin transporter occupancy: implications for tapering SSRIs.

Shapiro, Bryan B

2018 Volume 235, Issue 9, Page(s) 2779–2781

MeSH term(s)	Antidepressive Agents/administration & dosage ; Antidepressive Agents/metabolism ; Brain/diagnostic imaging ; Brain/drug effects ; Brain/metabolism ; Humans ; Serotonin Plasma Membrane Transport Proteins/metabolism ; Serotonin Uptake Inhibitors/administration & dosage ; Serotonin Uptake Inhibitors/metabolism ; Serotonin Uptake Inhibitors/therapeutic use
Chemical Substances	Antidepressive Agents ; Serotonin Plasma Membrane Transport Proteins ; Serotonin Uptake Inhibitors
Language	English
Publishing date	2018-08-10
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	130601-7
ISSN	1432-2072 ; 0033-3158
ISSN (online)	1432-2072
ISSN	0033-3158
DOI	10.1007/s00213-018-4995-4
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Article ; Online: A safety evaluation of aripiprazole in the treatment of schizophrenia.

Preda, Adrian / Shapiro, Bryan B

Expert opinion on drug safety

2020 Volume 19, Issue 12, Page(s) 1529–1538

Abstract: Introduction: Aripiprazole is a third generation antipsychotic approved by the US Food and Drug Administration (FDA) for the treatment of schizophrenia. Aripiprazole is available as oral and long-acting injectable (LAI) depot formulations, with a unique ...

Abstract	Introduction: Aripiprazole is a third generation antipsychotic approved by the US Food and Drug Administration (FDA) for the treatment of schizophrenia. Aripiprazole is available as oral and long-acting injectable (LAI) depot formulations, with a unique mechanism of action comprising partial D Areas covered: We review short-and-long-term clinical trials, meta-analyses of clinical trials and product information pertaining to the safety and efficacy of aripiprazole in adults with schizophrenia. Formulations of aripiprazole reviewed include oral aripiprazole, Aripiprazole monohydrate LAI (Abilify Maintena©) and Aripiprazole lauroxil LAI (Aristada©). Clinical studies and product information were collected from PubMed, Psychinfo, Embase, and other web sources. Expert opinion: Aripiprazole is a generally well-tolerated third-generation antipsychotic with low rates of motor side effects and metabolic adverse effects that occur commonly with several alternative antipsychotics. Akathisia and tremor appear to occur at higher rates with aripiprazole compared to placebo but are still generally uncommon with incidences of 10-11% or less. Uniquely, aripiprazole treatment is associated with reduced serum prolactin levels and QT
MeSH term(s)	Adult ; Antipsychotic Agents/administration & dosage ; Antipsychotic Agents/adverse effects ; Antipsychotic Agents/pharmacology ; Aripiprazole/administration & dosage ; Aripiprazole/pharmacology ; Delayed-Action Preparations ; Drug Administration Schedule ; Humans ; Medication Adherence ; Prolactin/blood ; Schizophrenia/drug therapy ; Schizophrenia/physiopathology
Chemical Substances	Antipsychotic Agents ; Delayed-Action Preparations ; Aripiprazole (82VFR53I78) ; Prolactin (9002-62-4)
Language	English
Publishing date	2020-10-16
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2088728-0
ISSN	1744-764X ; 1474-0338
ISSN (online)	1744-764X
ISSN	1474-0338
DOI	10.1080/14740338.2020.1832990
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Article ; Online: Caffeine Restrictions in Inpatient Psychiatric Settings: Precipitating Withdrawal?

Shapiro, Bryan

Journal of addiction medicine

2019 Volume 14, Issue 4, Page(s) 269–271

Abstract: Caffeine is often restricted in locked inpatient psychiatric facilities based on concern that it may exacerbate clinical symptoms. However, psychiatric inpatients may be at particularly high risk of caffeine withdrawal during psychiatric ... ...

Abstract	: Caffeine is often restricted in locked inpatient psychiatric facilities based on concern that it may exacerbate clinical symptoms. However, psychiatric inpatients may be at particularly high risk of caffeine withdrawal during psychiatric hospitalization, which may cause undue discomfort or distress, limit their engagement in inpatient treatment, and confound the management of psychiatric illness. Psychiatric patients who regularly consume caffeine also possess a degree of caffeine tolerance which may reduce the risk of adverse effects associated with continued inpatient caffeine intake. For these reasons, it appears reasonable to allow caffeine in inpatient psychiatric settings.
MeSH term(s)	Antisocial Personality Disorder ; Caffeine/adverse effects ; Hospitalization ; Humans ; Inpatients ; Substance Withdrawal Syndrome/drug therapy
Chemical Substances	Caffeine (3G6A5W338E)
Language	English
Publishing date	2019-10-16
Publishing country	United States
Document type	Journal Article
ISSN	1935-3227
ISSN (online)	1935-3227
DOI	10.1097/ADM.0000000000000571
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Article ; Online: Establishing Core Symptoms of Acute Serotonin Reuptake Inhibitor Withdrawal: Results from an International Survey of Online Peer-Support Communities.

Shapiro, Bryan / Kramer, Eric / Khoury, Dina / Preda, Adrian

Pharmacopsychiatry

2023 Volume 56, Issue 4, Page(s) 133–140

Abstract: Background: Serotonin reuptake inhibitor (SRI) antidepressants are commonly associated with withdrawal reactions. The Discontinuation Emergent Signs and Symptoms (DESS) checklist has been considered the gold standard research and screening tool for SRI ... ...

Abstract	Background: Serotonin reuptake inhibitor (SRI) antidepressants are commonly associated with withdrawal reactions. The Discontinuation Emergent Signs and Symptoms (DESS) checklist has been considered the gold standard research and screening tool for SRI withdrawal but has several limitations, including its length, lack of specificity, and omission of baseline symptom and symptom severity scores, making it impractical for use in clinical or research settings. We investigated the prevalence and severity of common SRI withdrawal symptoms to determine whether a very small subset of symptoms can capture most occurrences of SRI withdrawal. Methods: We surveyed 344 members of online peer-support communities aged 18-65, reporting withdrawal symptoms after chronic SRI treatment. The severity of nine common withdrawal symptoms was evaluated at baseline and during the withdrawal period. Results: Dizziness, brain zaps, irritability/agitation, and anxiety/nervousness demonstrated the largest increase in severity during withdrawal relative to baseline. Nearly all (97.7%) of the 344 subjects and all (100%) 153 subjects with relatively low baseline symptom scores (total<5) reported a worsening of one of these four symptoms. The presence of a baseline anxiety disorder did not affect rates of withdrawal-emergent anxiety/nervousness. Conclusion: Nearly all surveyed subjects reported worsening either of dizziness, brain zaps, irritability/agitation, or anxiety/nervousness in acute withdrawal. A screening test incorporating these four core symptoms may be sufficiently sensitive to rule out SRI withdrawal and may be valuable in clinical and research settings. Incorporating withdrawal symptom severity may further enhance specificity.
MeSH term(s)	Humans ; Selective Serotonin Reuptake Inhibitors/adverse effects ; Dizziness/drug therapy ; Antidepressive Agents/therapeutic use ; Substance Withdrawal Syndrome/epidemiology ; Substance Withdrawal Syndrome/drug therapy ; Brain
Chemical Substances	Selective Serotonin Reuptake Inhibitors ; Antidepressive Agents
Language	English
Publishing date	2023-05-30
Publishing country	Germany
Document type	Journal Article
ZDB-ID	605670-2
ISSN	1439-0795 ; 0720-4280 ; 0176-3679
ISSN (online)	1439-0795
ISSN	0720-4280 ; 0176-3679
DOI	10.1055/a-2078-4593
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Article ; Online: Bilateral Sequential Spontaneous Otogenic Pneumocephalus, Lessons in Pathophysiology, and Management of a Rare Case.

Shapiro, Scott B / Lipschitz, Noga / Tumlin, Parker / Krueger, Bryan / Forbes, Jonathan / Samy, Ravi N

Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology

2020 Volume 41, Issue 10, Page(s) 1387–1390

Abstract: Objective: Report the details of an unusual case of initially unilateral intradural spontaneous otogenic pneumocephalus in which the patient developed contralateral pneumocephalus after surgical repair of temporal bone and dural defects on the initial ... ...

Abstract	Objective: Report the details of an unusual case of initially unilateral intradural spontaneous otogenic pneumocephalus in which the patient developed contralateral pneumocephalus after surgical repair of temporal bone and dural defects on the initial side. Discuss the lessons learned concerning management and pathophysiology of this rare case. Patient: A 73-year-old male presenting with bilateral retro-orbital pain and headache was found to have unilateral intradural pneumocephalus in the temporal lobe with an adjacent defect in the temporal bone. Intervention: Surgical repair of the initial defect in the temporal bone and dura via a middle cranial fossa approach with obliteration of the mastoid cavity. Results: The patient's symptoms and degree of pneumocephalus on first affected side decreased initially after surgery. Two weeks after surgery he developed worsening pneumocephalus on the contralateral side in the temporal and frontal lobes with weakness and mild somnolence. This side was repaired via a similar technique without mastoid obliteration. Two weeks after surgery the patient recovered to normal level of consciousness with mild residual weakness. Conclusions: Spontaneous otogenic intradural pneumocephalus is an extremely rare but serious condition related to defects in the temporal bone and dura. The precise mechanism by which this occurs is poorly understood. This unusual case where there were bilateral defects presenting with spontaneous otogenic pneumocephalus in sequence illustrates that it represents a rare sequelae of processes which thin the skull base. These processes should be addressed in addition to acute management of the defect and intracranial air.
MeSH term(s)	Aged ; Cranial Fossa, Middle ; Humans ; Male ; Pneumocephalus/diagnostic imaging ; Pneumocephalus/etiology ; Pneumocephalus/surgery ; Skull Base/diagnostic imaging ; Skull Base/surgery ; Temporal Bone/diagnostic imaging ; Temporal Bone/surgery ; Temporal Lobe
Language	English
Publishing date	2020-10-12
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2036790-9
ISSN	1537-4505 ; 1531-7129
ISSN (online)	1537-4505
ISSN	1531-7129
DOI	10.1097/MAO.0000000000002827
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Zs.A 1554: Show issues

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Article ; Conference proceedings: Bilateral Sequential Spontaneous Otogenic Pneumocephalus: Lessons in Pathophysiology and Management

Shapiro, Scott B. / Lipschitz, Noga / Tumlin, Parker / Krueger, Bryan / Forbes, Jonathan A. / Samy, Ravi N.

Journal of Neurological Surgery Part B: Skull Base

2020 Volume 81, Issue S 01

Event/congress	30th Annual Meeting North American Skull Base Society, La Cantera Resort & Spa San Antonio, Texas, 2020-02-07
Language	English
Publishing date	2020-02-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article ; Conference proceedings
ZDB-ID	2654269-9
ISSN	2193-634X ; 2193-6331
ISSN (online)	2193-634X
ISSN	2193-6331
DOI	10.1055/s-0040-1702585
Database	Thieme publisher's database

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Zs.A 3425: Show issues

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Article: [No title information]

Shapiro, Bryan / Kramer, Eric / Khoury, Dina / Preda, Adrian

Pharmacopsychiatry

2023 Volume 56, Issue 04, Page(s) 133–140

Abstract	Background: Serotonin reuptake inhibitor (SRI) antidepressants are commonly associated with withdrawal reactions. The Discontinuation Emergent Signs and Symptoms (DESS) checklist has been considered the gold standard research and screening tool for SRI withdrawal but has several limitations, including its length, lack of specificity, and omission of baseline symptom and symptom severity scores, making it impractical for use in clinical or research settings. We investigated the prevalence and severity of common SRI withdrawal symptoms to determine whether a very small subset of symptoms can capture most occurrences of SRI withdrawal. Methods: We surveyed 344 members of online peer-support communities aged 18–65, reporting withdrawal symptoms after chronic SRI treatment. The severity of nine common withdrawal symptoms was evaluated at baseline and during the withdrawal period. Results: Dizziness, brain zaps, irritability/agitation, and anxiety/nervousness demonstrated the largest increase in severity during withdrawal relative to baseline. Nearly all (97.7%) of the 344 subjects and all (100%) 153 subjects with relatively low baseline symptom scores (total<5) reported a worsening of one of these four symptoms. The presence of a baseline anxiety disorder did not affect rates of withdrawal-emergent anxiety/nervousness. Conclusion: Nearly all surveyed subjects reported worsening either of dizziness, brain zaps, irritability/agitation, or anxiety/nervousness in acute withdrawal. A screening test incorporating these four core symptoms may be sufficiently sensitive to rule out SRI withdrawal and may be valuable in clinical and research settings. Incorporating withdrawal symptom severity may further enhance specificity.
Keywords	selective serotonin reuptake inhibitors (ssris) ; serotonin ; mood disorders ; discontinuation of drugs
Language	English
Publishing date	2023-05-30
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	605670-2
ISSN	1439-0795 ; 0176-3679 ; 0720-4280
ISSN (online)	1439-0795
ISSN	0176-3679 ; 0720-4280
DOI	10.1055/a-2078-4593
Database	Thieme publisher's database

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Zs.A 481: Show issues

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Article ; Online: Case report: response to the ERK1/2 inhibitor ulixertinib in BRAF D594G cutaneous melanoma.

Wolfe, Zachary / Friedland, Julie C / Ginn, Sarah / Blackham, Aaron / Demberger, Lauren / Horton, Morgan / McIntosh, Alyson / Sheikh, Hina / Box, Jessica / Knoerzer, Deborah / Federowicz, Bryan / Stuhlmiller, Timothy J / Shapiro, Mark / Nair, Suresh

Melanoma research

2022 Volume 32, Issue 4, Page(s) 295–298

Abstract: Melanoma is characterized by oncogenic mutations in pathways regulating cell growth, proliferation, and metabolism. Greater than 80% of primary melanoma cases harbor aberrant activation of the mitogen-activated protein kinase kinase/extracellular-signal- ... ...

Abstract	Melanoma is characterized by oncogenic mutations in pathways regulating cell growth, proliferation, and metabolism. Greater than 80% of primary melanoma cases harbor aberrant activation of the mitogen-activated protein kinase kinase/extracellular-signal-regulated kinase (MEK/ERK) pathway, with oncogenic mutations in BRAF, most notably BRAF V600E, being the most common. Significant progress has been made in BRAF-mutant melanoma using BRAF and MEK inhibitors; however, non-V600 BRAF mutations remain a challenge with limited treatment options. We report the case of an individual diagnosed with stage III BRAF D594G-mutant melanoma who experienced an extraordinary response to the ERK1/2 inhibitor ulixertinib as fourth-line therapy. Ulixertinib was obtained via an intermediate expanded access protocol with unique flexibility to permit both single-agent and combination treatments, dose adjustments, breaks in treatment to undergo surgery, and long-term preventive treatment following surgical resection offering this patient the potential for curative treatment.
MeSH term(s)	Aminopyridines ; Cell Line, Tumor ; Humans ; MAP Kinase Signaling System ; Melanoma/genetics ; Mitogen-Activated Protein Kinase Kinases ; Mutation ; Protein Kinase Inhibitors/pharmacology ; Protein Kinase Inhibitors/therapeutic use ; Proto-Oncogene Proteins B-raf ; Pyrroles ; Skin Neoplasms/drug therapy ; Melanoma, Cutaneous Malignant
Chemical Substances	Aminopyridines ; Protein Kinase Inhibitors ; Pyrroles ; ulixertinib (16ZDH50O1U) ; BRAF protein, human (EC 2.7.11.1) ; Proto-Oncogene Proteins B-raf (EC 2.7.11.1) ; Mitogen-Activated Protein Kinase Kinases (EC 2.7.12.2)
Language	English
Publishing date	2022-05-12
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	1095779-0
ISSN	1473-5636 ; 0960-8931
ISSN (online)	1473-5636
ISSN	0960-8931
DOI	10.1097/CMR.0000000000000830
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Article ; Online: Depression.

McCarron, Robert M / Shapiro, Bryan / Rawles, Jody / Luo, John

Annals of internal medicine

2021 Volume 174, Issue 5, Page(s) ITC65–ITC80

Abstract: Most psychiatric care is delivered in primary care settings, where depression is the most common presenting psychiatric symptom. Given the high prevalence of depression worldwide and the well-established consequences of untreated depression, the ability ... ...

Abstract	Most psychiatric care is delivered in primary care settings, where depression is the most common presenting psychiatric symptom. Given the high prevalence of depression worldwide and the well-established consequences of untreated depression, the ability of primary care clinicians to effectively diagnose and treat it is critically important. This article offers up-to-date guidance for the diagnosis and treatment of major depressive disorder, including practical considerations for delivering optimal and efficient care for these patients.
MeSH term(s)	Antidepressive Agents/therapeutic use ; Depression/diagnosis ; Depression/therapy ; Depressive Disorder, Major/diagnosis ; Depressive Disorder, Major/therapy ; Diagnosis, Differential ; Humans ; Mass Screening/methods ; Primary Health Care ; Psychiatric Status Rating Scales ; Risk Factors
Chemical Substances	Antidepressive Agents
Language	English
Publishing date	2021-05-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/AITC202105180
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Article ; Online: Case of significantly delayed divalproex-induced thrombocytopaenia.

Park, Andrew / Shapiro, Bryan / Hedayati, Bobak / Faziola, Lawrence

BMJ case reports

2019 Volume 12, Issue 12

Abstract: We describe a 48-year-old male patient on long-term divalproex treatment for bipolar disorder who developed grade II thrombocytopaenia after approximately 18 years of therapy. Abrupt cessation of divalproex led to immediate platelet level reconstitution. ...

Abstract	We describe a 48-year-old male patient on long-term divalproex treatment for bipolar disorder who developed grade II thrombocytopaenia after approximately 18 years of therapy. Abrupt cessation of divalproex led to immediate platelet level reconstitution.
MeSH term(s)	Antimanic Agents/adverse effects ; Bipolar Disorder/diagnosis ; Bipolar Disorder/drug therapy ; Humans ; Male ; Middle Aged ; Thrombocytopenia/chemically induced ; Time Factors ; Valproic Acid/adverse effects
Chemical Substances	Antimanic Agents ; Valproic Acid (614OI1Z5WI)
Language	English
Publishing date	2019-12-02
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2019-231968
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