Jonathan R Stevens

Baylor College of Medicine, Houston, Texas, United States

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Publications (9)16.36 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Numerous currently available medications that act in the central nervous system can be delivered transdermally. Such medications include cholinesterase inhibitors for dementia, methylphenidate (MPH) for attention-deficit hyperactivity disorder, monoamine oxidase inhibitors (MAOIs) for depression, dopamine agonists for Parkinson disease and restless leg syndrome, and clonidine for attention-deficit hyperactivity disorder and impulse-control disorders. This article aims to review the literature related to transdermal delivery systems from the perspective of clinical practice and research related to their use in the treatment of psychiatric conditions. Most of the currently available transdermal systems have psychotropic properties or utility in the behavioral health arena and, therefore, are of clinical relevance to consultation-liaison psychiatrists or practitioners of psychosomatic medicine. We discuss their efficacy and safety profiles. We provide a table of these agents and their uses. Transdermal delivery (i.e., patches) for medicines with psychotropic properties allows mental health providers to customize therapy for patients by altering the duration of therapy, minimizing first-pass metabolism and the potential for drug-drug interactions, and decreasing the risk for gastrointestinal irritation. Copyright © 2015 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.
    Psychosomatics 04/2015; DOI:10.1016/j.psym.2015.03.007 · 1.67 Impact Factor
  • Jonathan R Stevens · Jefferson B Prince · Laura M Prager · Theodore A Stern
    03/2014; 16(2). DOI:10.4088/PCC.13f01514
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    ABSTRACT: The Black Box Warning (BBW) is the Food and Drug Administration's highest level of drug warning. It signifies that a medication has serious (or potentially life-threatening) side effects and is prominently displayed on a medication's package insert. It literally consists of the medication warning and is surrounded by a bold black border. This article aims to review data related to BBWs on psychotropic medications currently used in clinical practice, with special attention to clinical situations and questions relevant to consultation-liaison psychiatrists. We review 3 clinical advisories or BBWs for psychotropic medications (i.e., antidepressant medication and suicidality in the pediatric population, stimulant medication and sudden death in the pediatric population, and antipsychotic medication and increased mortality in the elderly) and discuss the effect they have had on prescribing practices. We provide a table of current BBWs relevant to psychotropic medications. BBWs can have unintended and far-reaching consequences, albeit with a limited ability to target specific populations and practice patterns. Although it is critical for clinicians to be aware of these serious potential side effects and to inform patients about these warnings, medications with boxed warnings remain Food and Drug Administration-approved and may have critically important therapeutic roles.
    Psychosomatics 12/2013; DOI:10.1016/j.psym.2013.08.009 · 1.67 Impact Factor
  • Jonathan R Stevens · Timothy E Wilens · Theodore A Stern
    01/2013; 15(2). DOI:10.4088/PCC.12f01472
  • Jonathan R Stevens · Jefferson B Prince
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    ABSTRACT: The term psychosis is generally used to describe the abnormal behaviors of children and adolescents with grossly impaired reality testing. This article discusses evaluation of psychotic symptoms in students and psychosocial school interventions for students with psychosis, including the roles of teachers and school administrators. Psychoeducation provided by clinicians and school staff to enhance coping and cognitive strategies is described.
    Child and adolescent psychiatric clinics of North America 01/2012; 21(1):187-200, xi. DOI:10.1016/j.chc.2011.09.008 · 2.88 Impact Factor
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    ABSTRACT: Children and adolescents are being treated increasingly for attention-deficit/hyperactivity disorder (ADHD) with a variety of stimulants in higher than Food and Drug Administration (FDA)-approved doses and in combination with other medications. We sought to determine methylphenidate (MPH) concentrations in children and adolescents treated with high-dose, extended-release osmotic release oral system (OROS) MPH plus concomitant medications, and to examine MPH concentrations with respect to the safety and tolerability of treatment. Plasma MPH concentrations were measured by liquid chromatography-mass spectrometry 4-5 hours after administration of medication in a sample of youths diagnosed with ADHD. These youths were treated naturalistically with higher than FDA-approved doses of OROS MPH in addition to their concomitant medications. Markers of safety and tolerability (e.g., measures of blood pressure and heart rate) were also examined. Among the 17 patients (with a mean age of 16.2 +/- 2 years and a mean number of concurrent medications of 2.23 +/- 0.94), the mean plasma MPH concentration was 28 +/- 9.1 ng/mL, despite a mean daily dose of OROS MPH of 169 +/- 5 mg (3.0 +/- 0.8 mg/kg per day). No patient had a plasma MPH level >or=50 ng/mL or clinical signs of stimulant toxicity. No correlation was found between plasma MPH concentrations and OROS MPH dose or changes in vital signs. High-dose OROS MPH, used in combination with other medications, was not associated with either unusually elevated plasma MPH concentrations or with clinically meaningful changes in vital signs. Study limitations include a single time-point sampling of MPH concentrations, a small sample size, and a lack of outcome measures to address treatment effectiveness.
    Journal of child and adolescent psychopharmacology 02/2010; 20(1):49-54. DOI:10.1089/cap.2008.0128 · 3.07 Impact Factor
  • Source
    Kristin S Russell · Jonathan R Stevens · Theodore A Stern
    The Primary Care Companion to The Journal of Clinical Psychiatry 10/2009; 11(5):258-62. DOI:10.4088/PCC.09r00802
  • Jonathan R Stevens · Oliver Freudenreich · Theodore A Stern
    Psychosomatics 05/2008; 49(3):255-7. DOI:10.1176/appi.psy.49.3.255 · 1.67 Impact Factor
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    ABSTRACT: Prescription drugs have become a major category of abused substances, and there is evidence that the prevalence of prescription drug abuse may soon overtake that of illicit drugs. Study of prescription drugs has been hampered by vague terminology, since prescription drugs are only separated from other drugs of abuse by social and legal constructs. Reviewed herein is published literature on the abuse of four major categories of abused prescription drugs: sedative-hypnotics, stimulants, anabolic steroids, and anticholinergics. The review emphasizes evidence regarding the effects of these drugs on neural systems. Other abused prescription drugs that fall outside of the major categories are also briefly addressed.
    Neuropsychology Review 10/2007; 17(3):363-80. DOI:10.1007/s11065-007-9037-7 · 5.40 Impact Factor

Publication Stats

45 Citations
16.36 Total Impact Points

Institutions

  • 2015
    • Baylor College of Medicine
      Houston, Texas, United States
  • 2013
    • Henry Ford Health System
      Detroit, Michigan, United States
  • 2008
    • Massachusetts General Hospital
      • Department of Psychiatry
      Boston, Massachusetts, United States
  • 2007
    • The University of Arizona
      Tucson, Arizona, United States