Publications by authors named "Jessica Gannon"

22 Publications

  • Page 1 of 1

Histotripsy Ablation Alters the Tumor Microenvironment and Promotes Immune System Activation in a Subcutaneous Model of Pancreatic Cancer.

IEEE Trans Ultrason Ferroelectr Freq Control 2021 May 6;PP. Epub 2021 May 6.

Pancreatic cancer is a significant cause of cancer-related deaths in the United States with an abysmal 5-year overall survival rate that is under 9%. Reasons for this mortality include the lack of late-stage treatment options and the immunosuppressive tumor microenvironment. Histotripsy is an ultrasound-guided, non-invasive, non-thermal tumor ablation therapy that mechanically lyses targeted cells. To study the effects of histotripsy on pancreatic cancer, we utilized an in vitro model of pancreatic adenocarcinoma and compared the release of potential antigens following histotripsy treatment to other ablation modalities. Histotripsy was found to release immune-stimulating molecules at magnitudes similar to other non-thermal ablation modalities and superior to thermal ablation modalities, which corresponded to increased innate immune system activation in vivo. In subsequent in vivo studies, murine Pan02 tumors were grown in mice and treated with histotripsy. Flow cytometry and rtPCR were used to determine changes in the tumor microenvironment over time compared to untreated animals. In mice with pancreatic tumors, we observed significantly increased tumor-progression-free and general survival, with increased activation of the innate immune system 24 hours post-treatment and decreased tumor-associated immune cell populations within 14 days of treatment. This study demonstrates the feasibility of using histotripsy for pancreatic cancer ablation and provides mechanistic insight into the initial innate immune system activation following treatment. Further work is needed to establish the mechanisms behind the immunomodulation of the tumor microenvironment and immune effects.
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http://dx.doi.org/10.1109/TUFFC.2021.3078094DOI Listing
May 2021

Less is more: Deprescribing anticholinergic medications in persons with severe mental illness.

Ann Clin Psychiatry 2021 05;33(2):80-92

University of Pittsburgh School of Medicine, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA.

Background: Long-term prescribing of anticholinergic medications (ACM) for antipsychotic-associated extrapyramidal symptoms (EPS) is not recommended, yet is widely prevalent. Adverse effects of ACM include memory impairment, dry mouth, constipation, blurred vision, urinary retention, and tachycardia, which can seriously impact quality of life. This quality improvement deprescription project sought to reduce chronic ACM use in patients with serious mental illness (SMI).

Methods: Education directed at psychiatrists combined with clinical pharmacy support for deprescription was used to target clinically stable patients diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder with no EPS and ACM prescriptions of ≥6 months. Scales were used to assess anticholinergic adverse effects, memory impairment, and quality of life. ACMs were tapered and discontinued over 1 to 6 months.

Results: More than 75% of targeted patients successfully tapered or discontinued ACM, which coincided with significant improvements in anticholinergic adverse effects, memory impairment, and quality of life. Approximately 10% of patients were restarted on ACM for re-emergent EPS.

Conclusions: For most clinically stable patients with SMI without EPS, our findings suggest that gradual deprescription of chronic ACM is clinically appropriate, well tolerated, and improves quality of life. A randomized trial could provide more definitive answers.
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http://dx.doi.org/10.12788/acp.0019DOI Listing
May 2021

Establishing an immunocompromised porcine model of human cancer for novel therapy development with pancreatic adenocarcinoma and irreversible electroporation.

Sci Rep 2021 Apr 7;11(1):7584. Epub 2021 Apr 7.

Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, 24061, USA.

New therapies to treat pancreatic cancer are direly needed. However, efficacious interventions lack a strong preclinical model that can recapitulate patients' anatomy and physiology. Likewise, the availability of human primary malignant tissue for ex vivo studies is limited. These are significant limitations in the biomedical device field. We have developed RAG2/IL2RG deficient pigs using CRISPR/Cas9 as a large animal model with the novel application of cancer xenograft studies of human pancreatic adenocarcinoma. In this proof-of-concept study, these pigs were successfully generated using on-demand genetic modifications in embryos, circumventing the need for breeding and husbandry. Human Panc01 cells injected subcutaneously into the ears of RAG2/IL2RG deficient pigs demonstrated 100% engraftment with growth rates similar to those typically observed in mouse models. Histopathology revealed no immune cell infiltration and tumor morphology was highly consistent with the mouse models. The electrical properties and response to irreversible electroporation of the tumor tissue were found to be similar to excised human pancreatic cancer tumors. The ample tumor tissue produced enabled improved accuracy and modeling of the electrical properties of tumor tissue. Together, this suggests that this model will be useful and capable of bridging the gap of translating therapies from the bench to clinical application.
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http://dx.doi.org/10.1038/s41598-021-87228-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8027815PMC
April 2021

ECT for a pregnant patient with bipolar disorder in the COVID-19 Era: A clinical conundrum.

Bipolar Disord 2021 Feb 16. Epub 2021 Feb 16.

Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

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http://dx.doi.org/10.1111/bdi.13061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8013649PMC
February 2021

Less is more: Deprescribing anticholinergic medications in persons with severe mental illness.

Ann Clin Psychiatry 2021 Feb 1;33(1):e1-e13. Epub 2021 Feb 1.

UPMC Western Psychiatric Hospital, Pittsburgh, PA 15213 USA. EMAIL:

Background: Long-term prescribing of anticholinergic medications (ACM) for antipsychotic-associated extrapyramidal symptoms (EPS) is not recommended, yet is widely prevalent. Adverse effects of ACM include memory impairment, dry mouth, constipation, blurred vision, urinary retention, and tachycardia, which can seriously impact quality of life. This quality improvement deprescription project sought to reduce chronic ACM use in patients with serious mental illness (SMI).

Methods: Education directed at psychiatrists combined with clinical pharmacy support for deprescription was used to target clinically stable patients diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder with no EPS and ACM prescriptions of ≥6 months. Scales were used to assess anticholinergic adverse effects, memory impairment, and quality of life. ACMs were tapered and discontinued over 1 to 6 months.

Results: More than 75% of targeted patients successfully tapered or discontinued ACM, which coincided with significant improvements in anticholinergic adverse effects, memory impairment, and quality of life. Approximately 10% of patients were restarted on ACM for re-emergent EPS.

Conclusions: For most clinically stable patients with SMI without EPS, our findings suggest that gradual deprescription of chronic ACM is clinically appropriate, well tolerated, and improves quality of life. A randomized trial could provide more definitive answers.
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http://dx.doi.org/10.12788/acp.0019DOI Listing
February 2021

Rapid expansion of direct-to-consumer telemental health during the COVID-19 pandemic: A case series.

Ann Clin Psychiatry 2021 02;33(1):27-34

Ambulatory Behavioral Health Informatics, Comprehensive Recovery Services Ambulatory Clinics, UPMC Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213-2593 USA. EMAIL:

Background: The coronavirus disease 2019 (COVID-19) pandemic brought many challenges to patient care delivery. The need for social distancing and relaxing of federal and state telemental health regulations paved the way for widespread adoption of direct-to-consumer (DTC) ambulatory mental health video visits.

Methods: We present cases that demonstrate the use of video visits across 6 clinical areas, each serving a unique population of patients, in a large behavioral health system. The benefits and limitations of this modality are illustrated in children, adults, and older adults with mood disorders, anxiety disorders, intellectual disability, substance use disorders, neurocognitive disorders, and schizophrenia.

Results: Although telephone visits were acceptable and necessary to serve some patients, there are many advantages to video visits in providing best patient care. Education and support for telemental health-delivered to both patients and clinicians-is critical to the success of the DTC model.

Conclusions: DTC telemental health is a widespread clinical tool used during the COVID-19 pandemic. Because this model has many strengths and advantages compared with traditional telemental health delivered in a clinic, regulators and insurers should be open to its continued use postpandemic when clinically appropriate.
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http://dx.doi.org/10.12788/acp.0020DOI Listing
February 2021

Deprescribing anticholinergic medication in the community mental health setting: A quality improvement initiative.

Res Social Adm Pharm 2020 Dec 19. Epub 2020 Dec 19.

University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA; University of Pittsburgh Medical Center Western Psychiatric Hospital, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA. Electronic address:

Background: Chronic anticholinergic medication (ACM) prescribing with antipsychotics when no longer clinically indicated can lead to serious side effects and adversely impact patient quality of life.

Objectives: Through modifications of previously described deprescribing strategies undertaken in an academic, schizophrenia clinic, this quality improvement (QI) project aimed to bolster ACM deprescription where clinically appropriate among patients with schizophrenia and other psychiatric disorders at a community mental health center.

Methods: A multidisciplinary team involving clinical pharmacists and psychiatrists created web streaming video medical education accredited modules, supplemented by small groups sessions and case consultations, and provided these to psychiatrists and nurse practitioners at a community mental health center over a one-year period. Electronic medical record reports were also generated, highlighting patients who were receiving one of two ACM used in the clinic: benztropine and/or trihexyphenidyl; these were periodically distributed to support appropriate deprescription. Patient education infographic material focused on ACM were also created and deployed.

Results: One hundred and twenty-six patients were identified as receiving benztropine or trihexyphenidyl in March 2019. One hundred and six (84%) were on one or both of these medications for at least six months. The mean (±SD) age of the study sample was 53.4 (±12.6) years; a third of the sample was over 60 years. Thirty-seven patients, or 29.4%, had their ACM discontinued or the dosage reduced. Deprescription was not associated with age, sex, race, or diagnosis. Deprescription was not associated with antipsychotic polypharmacy, first versus second generation, or oral versus long acting preparation.

Conclusions: These results suggest that deprescription of ACM in a community mental health center can occur with prescriber education and support. However, results from previous stages of this QI project, where much higher rates of deprescription were demonstrated, indicate the important benefit of more direct clinical pharmacist support and involvement in the process.
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http://dx.doi.org/10.1016/j.sapharm.2020.12.010DOI Listing
December 2020

Group teletherapy for first-episode psychosis: Piloting its integration with coordinated specialty care during the COVID-19 pandemic.

Psychol Psychother 2021 06 20;94(2):382-389. Epub 2020 Oct 20.

Comprehensive Recovery Services, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA.

Digital health has emerged in recent years as a tool to optimize care delivery and promote treatment adherence among individuals with first-episode psychosis (FEP). Recent mandates for social distancing and sheltering in place due to the COVID-19 pandemic have catapulted efforts to provide ongoing coordinated specialty care (CSC) on virtual platforms. While prior evidence provides support for the general implementation of virtual individual therapy, there is limited guidance and evidence for the adoption of group teletherapy. Here we describe our efforts to implement group teletherapy for two small cohorts of individuals with FEP receiving care in a coordinated specialty care clinic using methods adopted from Acceptance and Commitment Therapy. We observed high adherence with group visits as well as client satisfaction across groups. Based on our results, we have taken efforts to implement virtual group therapy more permanently in our clinic. Our experience provides guidance and a model for integration of virtual group therapy within CSC. PRACTITIONER POINTS: In-person group therapy can be adapted as an online treatment modality for individuals with first-episode psychosis (FEP). Group teletherapy is both accessible and satisfactory to individuals with FEP. Group teletherapy has potential as a more standard and widespread treatment modality within coordinated specialty care for FEP.
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http://dx.doi.org/10.1111/papt.12310DOI Listing
June 2021

Ensuring care for clozapine-treated schizophrenia patients during the COVID-19 pandemic.

Schizophr Res 2020 08 26;222:499-500. Epub 2020 May 26.

UPMC - Western Psychiatric Hospital, United States of America; University of Pittsburgh, School of Medicine, Department of Psychiatry, United States of America. Electronic address:

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http://dx.doi.org/10.1016/j.schres.2020.05.053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247984PMC
August 2020

Long acting injectable antipsychotic medications: Ensuring care continuity during the COVID-19 pandemic restrictions.

Schizophr Res 2020 08 7;222:532-533. Epub 2020 May 7.

Western Psychiatric Hospital - University of Pittsburgh Medical Center, United States of America; University of Pittsburgh, School of Medicine, Department of Psychiatry.

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http://dx.doi.org/10.1016/j.schres.2020.05.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203049PMC
August 2020

Three recommendations for addressing the ongoing lithium underutilization crisis in bipolar disorder.

Authors:
Jessica M Gannon

Bipolar Disord 2021 02 28;23(1):84-85. Epub 2020 Apr 28.

Western Psychiatric Hospital of the University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

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http://dx.doi.org/10.1111/bdi.12914DOI Listing
February 2021

Racial Differences in S100b Levels in Persons with Schizophrenia.

Psychiatr Q 2020 03;91(1):137-145

Western Psychiatric Hospital, University of Pittsburgh Medical Center, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.

The calcium-binding protein S100b is secreted by glial cells in the brain and is also expressed by melanocytes. In nanomolar concentrations, S100b is considered to be a neurotrophic factor, but in micromolar concentrations, it is thought to reflect CNS injury and inflammation. Seen as a potential biomarker in traumatic brain injury, meta-analytic data from several studies report that S100b levels are significantly higher in persons with long standing schizophrenia, but also among first-episode patients compared to healthy control subjects. However, ethnic or racial differences are typically not mentioned when reporting levels of S100b. We assessed serum S100b levels in persons with schizophrenia (n = 136) who were participants in two independent research studies using the same enzyme-linked immunoassay (ELISA). African-American subjects had significantly higher levels of S100b (41.9 pg/ml ± 62.2) than Caucasian subjects (24.9 pg/ml ± 45.4) in the combined dataset (Mann-Whitney U = 1307, p < 0.001), as well as in each independent study. There were no significant differences in S100b levels between men and women. No significant correlations were observed between S100b levels and demographic or clinical variables. These data suggest that ethnicity or race should be given serious consideration when studying and interpreting S100b levels in persons with schizophrenia.
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http://dx.doi.org/10.1007/s11126-019-09687-4DOI Listing
March 2020

Learner neglect on clinical placements: A medical student's perspective.

Med Teach 2020 09 7;42(9):1067-1068. Epub 2019 Oct 7.

Bart's and the London School of Medicine and Dentistry, London, UK.

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http://dx.doi.org/10.1080/0142159X.2019.1671583DOI Listing
September 2020

Addressing clozapine under-prescribing and barriers to initiation: a psychiatrist, advanced practice provider, and trainee survey.

Int Clin Psychopharmacol 2019 09;34(5):247-256

Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA.

Clozapine use has declined, despite its superior antipsychotic efficacy in treatment-resistant schizophrenia. Implications for clozapine underutilization include suboptimal treatment outcomes and increased hospitalizations. Many barriers preventing the use of clozapine have been described in the literature, including suboptimal knowledge and poor perceptions. The aim of this study was to assess psychiatry prescribers' perception and knowledge of clozapine. A survey was distributed to advanced practice providers, psychiatrists, and trainees (i.e. residents and fellows) at 10 medical centers within the US and Canada. The survey asked respondents about their perception of clozapine use and assessed their pharmacotherapeutic knowledge of clozapine. Two hundred eleven individual submitted completed surveys of a possible 1152; a response rate of 18.3%. There were no statistically significant differences between the advanced practice provider plus psychiatrist groups and the trainee group for most perception (eight of nine) and knowledge (eight of nine) questions. The knowledge questions with the lowest scores pertained to clozapine reinitiation and myocarditis. The majority of all respondents (144, 68.2%) felt that clozapine prescribing was a burden. Findings of this study support the need for continued clozapine education regardless of a prescriber's age/experience. Future studies to assess barriers to clozapine prescribing should extend beyond academic centers.
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http://dx.doi.org/10.1097/YIC.0000000000000269DOI Listing
September 2019

Effects of a standardized extract of Withania somnifera (Ashwagandha) on depression and anxiety symptoms in persons with schizophrenia participating in a randomized, placebo-controlled clinical trial.

Ann Clin Psychiatry 2019 05;31(2):123-129

Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213 USA. E-MAIL:

Background: Extracts of Withania somnifera (WSE), or Ashwagandha, has traditionally been used as an adaptogen in Ayurvedic medicine, and evidence suggests that it may have efficacy in the treatment of psychiatric disorders, including schizophrenia. This secondary analysis reviewed change in depression and anxiety symptoms in a study using WSE as an adjunctive treatment in patients with schizophrenia experiencing an exacerbation of positive symptoms.

Methods: We enrolled patients with schizophrenia in a 12-week, randomized, placebo-controlled, double-blind study. Active treatment was with 1,000 mg of standardized WSE. This analysis reviewed outcomes for 66 patients with depression and anxiety symptoms by examining the singleitem depression and anxiety-depression cluster subscores extracted from the Positive and Negative Syndrome Scale.

Results: Medium effect sizes of 0.683 (95% confidence interval [CI], 0.16 to 1.21) and 0.686 (95% CI, 0.16 to 1.21) favoring WSE over placebo were observed for depression single-item and anxiety-depression cluster scores, respectively. Adverse events were mild and transient.

Conclusions: Our findings suggest that WSE may hold promise in the treatment of depression and anxiety symptoms in schizophrenia. While the mechanism of its clinical efficacy requires more exploration, the data suggest.
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May 2019

Adjunctive Use of a Standardized Extract of Withania somnifera (Ashwagandha) to Treat Symptom Exacerbation in Schizophrenia: A Randomized, Double-Blind, Placebo-Controlled Study.

J Clin Psychiatry 2018 07 10;79(5). Epub 2018 Jul 10.

Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

Objective: To determine if adjunctive treatment with a standardized extract of Withania somnifera (WSE), with known anti-inflammatory and immunomodulating properties, improves psychopathology and stress in patients with schizophrenia or schizoaffective disorder (DSM-IV-TR).

Methods: Patients experiencing an exacerbation of symptoms were assigned to WSE (1,000 mg/d) or placebo for 12 weeks, added to their antipsychotic medication, in a random-assignment, double-blind, placebo-controlled study conducted from April 2013 to July 2016. Primary outcomes were change from baseline to end of treatment on the Positive and Negative Syndrome Scale (PANSS total, positive, negative, and general symptoms) between treatment groups. Secondary outcomes evaluated stress and inflammatory indices using the Perceived Stress Scale (PSS), S100 calcium-binding protein B (S100B), and C-reactive protein (CRP).

Results: Sixty-six randomized patients (n = 33 per group) provided efficacy data. Beginning at 4 weeks and continuing to the end of treatment, WSE produced significantly greater reductions in PANSS negative, general, and total symptoms (Cohen d: 0.83, 0.76, 0.83), but not positive symptoms, when compared to placebo. PSS scores improved significantly with WSE treatment compared to placebo (Cohen d: 0.58). CRP and S100B declined more in the WSE group but were not significantly different from placebo. Adverse events were mild to moderate and transient; somnolence, epigastric discomfort, and loose stools were more common with WSE. No significant between-treatment differences were noted in body weight, vital signs, or laboratory measures, which remained stable.

Conclusions: This early study suggests that adjunctive treatment with a standardized extract of Withania somnifera provides significant benefits, with minimal side effects, for negative, general, and total symptoms and stress in patients with recent exacerbation of schizophrenia.

Trial Registration: ClinicalTrials.gov identifier: NCT01793935.
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http://dx.doi.org/10.4088/JCP.17m11826DOI Listing
July 2018

Initial Cross-Over Test of A Positive Allosteric Modulator of Alpha-7 Nicotinic Receptors to Aid Cessation in Smokers With Or Without Schizophrenia.

Neuropsychopharmacology 2018 05 29;43(6):1334-1342. Epub 2017 Nov 29.

Department of Pharmacology and Toxicology, Virginia Commonwealth University School of Medicine, Richmond VA, USA.

Preclinical research shows that compounds acting at α7 nicotinic receptors (nAChRs) can reduce nicotine self-administration, suggesting that a positive allosteric modulator (PAM) of α7 receptors, JNJ-39393406, may aid smoking cessation. Moreover, individuals with schizophrenia, who have very high rates of smoking, have reduced expression of α7 nAChRs and may particularly benefit from this compound. In two parallel studies using a within-subject cross-over design, 36 healthy smokers (Study 1) and 62 smokers with schizophrenia (Study 2), both groups high in quit interest, attempted to initiate quitting temporarily during each of two 3-week phases. Treatments were the α7 nicotinic receptor PAM JNJ-39393406 (100 mg b.i.d.) or placebo (double-blind, counter-balanced). In each phase, all smoked ad lib with no drug on week 1 or during dose run-up on week 2, and then tried to quit every day during week 3. Abstinence (confirmed by CO <5 p.p.m.) and smoking reduction (CO <8), as well as cigarettes/day (in Study 1), were assessed daily (Monday-Friday) each quit week and compared between conditions. Secondary outcomes included abstinence symptoms (withdrawal and craving) and cognitive test responding (N-back; continuous performance task). In both studies, compared with placebo, active JNJ-39393406 did not increase the number of abstinent days nor reduce total smoking exposure. We also found no significant improvements in craving, withdrawal, or cognitive function. With this dose and study duration, our findings do not support further testing of this α7 nAChR PAM compound for possible efficacy in smoking cessation, in smokers with or without schizophrenia.
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http://dx.doi.org/10.1038/npp.2017.292DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5916362PMC
May 2018

Reducing Anticholinergic Medication Burden in Patients With Psychotic or Bipolar Disorders.

J Clin Psychiatry 2017 Nov/Dec;78(9):e1270-e1275

Western Psychiatric Institute and Clinic of UPMC, Pittsburgh, Pennsylvania, USA.

Objective: Anticholinergic medications are prescribed to treat extrapyramidal side effects (EPS) associated with antipsychotics. Anticholinergic medications cause several side effects and can often be withdrawn during the maintenance phase of antipsychotic treatment without EPS reemergence. The purpose of this quality improvement (QI) project was to reduce anticholinergic medication burden and improve quality of life in patients with severe mental illness.

Methods: Patients with DSM-IV-TR-diagnosed schizophrenia, schizoaffective disorder, and bipolar disorders in an outpatient psychiatric clinic who were prescribed benztropine were identified, screened for anticholinergic side effects by the treating psychiatrist, and referred to an on-site clinical pharmacist for a comprehensive medication review. Anticholinergic side effects, cognitive impairment, and impact on quality of life were assessed using a Likert scale. Recommendations for potential medication changes were discussed with the prescriber. Initial and follow-up assessments were conducted over 1-8 months to identify improvements in side effects and quality of life.

Results: Twenty-nine patients were assessed from November 2014 to December 2015. Patients were receiving from 1 to 6 medications with anticholinergic properties (median = 3 medications). Of the 29 patients, 19 were recommended for a medication change, with 13 having 1 or more anticholinergic medications discontinued and 6 having the dose decreased. A significant reduction in anticholinergic side effects and improvements in memory and quality of life were observed for these patients (P ≤ .05).

Conclusions: In this interdisciplinary, collaborative QI project, patients whose anticholinergic burden was reduced experienced a significant improvement in side effects, memory, and quality of life.
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http://dx.doi.org/10.4088/JCP.16m11269DOI Listing
April 2019

Long-acting risperidone injections in a pregnant patient with bipolar disorder.

Bipolar Disord 2017 11 9;19(7):606-607. Epub 2017 Nov 9.

Western Psychiatric Institute and Clinic of UPMC, Pittsburgh, PA, USA.

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http://dx.doi.org/10.1111/bdi.12572DOI Listing
November 2017

Evaluation of Branched-Narrative Virtual Patients for Interprofessional Education of Psychiatry Residents.

Acad Psychiatry 2017 Feb 14;41(1):71-75. Epub 2016 Mar 14.

University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA.

Objective: This pilot study evaluated the utility of branched-narrative virtual patients in an interprofessional education series for psychiatry residents.

Methods: Third-year psychiatry residents attended four interprofessional education advanced psychopharmacology sessions that involved completion of a branched-narrative virtual patient and a debriefing session with a psychiatric pharmacist. Pre- and post-assessments analyzed resident learning and were administered around each virtual patient. Simulation 4 served as a comprehensive review. The primary outcome was differences in pre- and post-assessment scores. Secondary outcomes included resident satisfaction with the virtual patient format and psychiatric pharmacist involvement.

Results: Post-test scores for simulations 1, 2, and 3 demonstrated significant improvement (p < 0.05) from pre-test scores. Scores for simulation 4 did not retain significance. Resident satisfaction with the branched-narrative virtual patient format and psychiatric pharmacist involvement was high throughout the series (100 %; n = 18).

Conclusions: Although there are important methodological limitations to this study including a small sample size and absence of a comparator group, this pilot study supports the use of branched-narrative virtual patients in an interprofessional education series for advanced learners.
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http://dx.doi.org/10.1007/s40596-016-0531-1DOI Listing
February 2017

An association between the use of hypnotics and quit status in the treatment of nicotine dependence with varenicline in bipolar disorder.

J Clin Psychopharmacol 2015 Apr;35(2):199-200

Department of Psychiatry Western Psychiatric Institute and Clinic University of Pittsburgh Medical Center University of Pittsburgh School of Medicine Pittsburgh, PA Department of Psychiatry Centre for Addiction and Mental Health University of Toronto Toronto, Ontario, Canada Department of Psychiatry Western Psychiatric Institute and Clinic University of Pittsburgh School of Medicine Pittsburgh, PA Department of Psychiatry Western Psychiatric Institute and Clinic University of Pittsburgh Medical Center University of Pittsburgh School of Medicine Pittsburgh, PA

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http://dx.doi.org/10.1097/JCP.0000000000000272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4344405PMC
April 2015

Subtle changes in thyroid indices during a placebo-controlled study of an extract of Withania somnifera in persons with bipolar disorder.

J Ayurveda Integr Med 2014 Oct-Dec;5(4):241-5

Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pennsylvania, USA.

Laboratory indices of thyroid function (TSH, Free T4, and T3) were measured in a randomized clinical trial in which Ashwagandha (ASW) was used to improve cognitive function in patients with bipolar disorder. This was done in light of a case-report of ASW-associated thyrotoxicosis, and data from mice administered ASW that showed significant increases in thyroxine levels. Ten (of the original 60) patients showed abnormal results in one of the thyroid measures either at the beginning or end of the 8-week study. One ASW- treated patient had subclinical hypothyroidism (TSH - 5.7 mIU/L) at baseline that normalized, and all three ASW treated patients experienced T4 increases from baseline (7%, 12%, and 24%). Six of 7 placebo-assigned patients showed decreases in T4 from baseline (4% to 23%), and one patient's TSH moved from the normal to subclinical hypothyroid range (6.96 mIU/L). As thyroid indices were done for safety, and not the primary goal of the original study, only 16.7% had abnormal thyroid indices, and as there was no sub-stratification for treatment assignment by thyroid status, unequal numbers of subjects received ASW (n = 3) or placebo (n = 7). In spite of these limitations, the subtle laboratory changes noted in thyroid indices in an 8-week study suggest that ASW may increase thyroxine levels, and therefore vigilance regarding hyperthyroidism may be warranted. Nonetheless, the thyroid enhancing properties of ASW may also represent a clinical opportunity for the treatment of subclinical hypothyroidism, and these results suggest the need for further study of the effects of ASW on thyroid indices, especially in those with bipolar and unipolar mood disorders.
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http://dx.doi.org/10.4103/0975-9476.146566DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296437PMC
January 2015