Alok Madan

Houston Methodist Hospital | HOUSTONMETHODIST · Psychiatry

Nurses are at high risk of burnout and subsequent mental health concerns due to problems with overstaffing, immense workload volume, and personal health risks associated with the job. Effective mental health treatments are available but potential barriers to receiving care may prevent nurses from benefiting. The Emotional Health and Well-Being Clin...

Health care workers experience high rates of burnout and psychiatric distress. A large health care system in the southwest United States developed a comprehensive mental health service model for employees. Services offered range from traditional benefits (eg, Employee Assistance Program), resiliency and well-being initiatives, and innovative techno...

Acute phase COVID-19 has been associated with an increased risk for several mental health conditions, but less is known about the interaction of long COVID and mental illness. Prior reports have linked long COVID to PTSD, de- pression, anxiety, obsessive compulsive symptoms, and insomnia. This case report describes a novel presentation of mania ari...

This brief overview highlights the global crisis of perinatal psychiatric illness (PPI). PPI is a major contributor to many adverse pregnancy, childbirth, and childhood development outcomes. It contributes to billions of dollars in spending worldwide each year and has a significant impact on the individual, their family, and their community. It is...

Background: Traumatic life events are associated with the development of psychiatric and chronic medical illnesses. This exploratory study examined the relationship between traumatic life events and the gut microbiota among adult psychiatric inpatients. Methods: 105 adult psychiatric inpatients provided clinical data and a single fecal sample sh...

Background At-home Ketamine-assisted therapy (KAT) with psychosocial support and remote monitoring through telehealth platforms addresses access barriers, including the COVID-19 pandemic. Large-scale evaluation of this approach is needed for questions regarding safety and effectiveness for depression and anxiety. Methods In this prospective study,...

Background Comorbid anxiety and depression are common and are associated with greater disease burden than either alone. Our recent efforts have identified an association between gut microbiota dysfunction and severity of anxiety and depression. In this follow-up, we applied Differential Co-Expression Analysis (DiffCoEx) to identify potential gut mi...

The health care delivery system in the United States, structured to provide single-disease care, presents unique challenges for patients with complex physical and psychiatric comorbidities. Patients in these populations are often referred to multiple specialty clinics, encounter little continuity of care or collaboration among their providers, incu...

A review of high intensity, high dose mentalization-based inpatient psychiatric treatment indicated large effect-size reductions in symptoms of depression, anxiety, somatization, and improving emotion-regulation functioning (Allen et al., 2017). This study examined the impact of pathological personality traits has on baseline symptoms and functioni...

Objective: Individuals with mental illnesses severe enough to require psychiatric hospitalization often have significant trauma histories, have developed maladaptive attachment styles, and experience comorbid somatic distress. Gaining an understanding about the interaction of such factors may lead to prioritizing interventions that target factors t...

This manuscript provides an overview of our efforts to implement an integrated electronic monitoring and feedback platform to increase patient engagement, improve care delivery and outcome of treatment, and alert care teams to deterioration in functioning. Patients First utilizes CareSense, a digital care navigation and data collection system, to i...

Objective The polythetic system used by the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) for diagnosing borderline personality disorders (BPD) is far from optimal; however, accumulated research and clinical data are strong enough to warrant ongoing utilization. This study examined diagnostic efficiency of the nine DSM-IV BPD crite...

Background: Clinical intuition suggests that personality disorders hinder the treatment of depression, but research findings are mixed. One reason for this might be the way in which current assessment measures conflate general aspects of personality disorders, such as overall severity, with specific aspects, such as stylistic tendencies. The goal...

Unstructured: As the demand for telepsychiatry increases during COVID-19, articulating strengths and challenges of telepsychiatry implementation are needed to improve clinical practices long-term. Currently, observations within United States contexts are lacking; therefore, we report on the rapid implementation and workflow experiences as a psychi...

UNSTRUCTURED As the demand for telepsychiatry increases during COVID-19, articulating strengths and challenges of telepsychiatry implementation are needed to improve clinical practices long-term. Currently, observations within United States contexts are lacking; therefore, we report on the rapid implementation and workflow experiences as a psychiat...

Background: Emerging evidence implicates the gut microbiota in central nervous system functioning via its effects on inflammation, the hypothalamic-pituitary axis, and/or neurotransmission. Our understanding of the cellular underpinnings of the brain-gut relationship is based almost exclusively on animal models with some small-scale human studies....

Objective: U.S. military special operation forces represent the most elite units of the U.S. Armed Forces. Their selection is highly competitive, and over the course of their service careers, they experience intensive operational training and combat deployment cycles. Yet, little is known about the health-care needs of this unique population. Met...

Background: Despite extensive research and clinical efforts, the suicide rate in the United States continues to rise, driving the need for more research to identify latent factors that increase risk for suicide and to guide treatment decision-making. Methods: The current study examined a large cohort (N = 1,219) of high-risk psychiatric inpatien...

Background: Chronic opiate use leads to a sensitized behavioral response to acute pain, which in turn, leads to escalating doses of opiates. This study was designed to test the hypothesis that chronic opiate usage is also associated with a sensitized neurobiological response to acute pain in individuals that have used prescription opiates for 6 or...

In today’s world of smart-device monitoring systems, clinicians may be lulled into the assumption that we can download software to monitor our patients’ psychological and behavioral functioning with little or no effort or follow-up. This belief is as erroneous as it is tempting; in fact, implementing effective and efficient systems for utilizing pa...

Background: Confusion abounds when differentiating the diagnoses of bipolar disorder (BD) from borderline personality disorder (BPD). This study explored the relative clinical utility of affective instability and self-report personality trait measures for accurate identification of BD and BPD. Methods: Receiver operator characteristics and diagnost...

The habenula is a small midbrain structure that is important for brain signaling and learning from negative events. Thus, the habenula is strongly connected to both the reward system and motor regions. Increasing evidence suggests a role for the habenula in the etiology of psychiatric disorders, including mood and substance use disorders. However,...

Introduction: The habenula (Hb) is a small midbrain structure that signals negative events and may play a major role in the etiology of psychiatric disorders including depression. The lateral Hb has three major efferent connections: serotonergic raphe nuclei, noradrenergic locus coeruleus, and dopaminergic ventral tegmental area/substantia nigra c...

Objective: The Columbia-Suicide Severity Rating Scale is a semistructured, interview-based assessment tool, which is increasingly being used for clinical and research purposes across the globe, despite its limited psychometric evaluation outside of English-speaking populations. The aim of this study was to linguistically adapt the measure and inve...

Background Experts express reluctance to hospitalize patients with borderline personality disorder (BPD) for more than a few days, arguing that extended inpatient care leads to deterioration and adverse events. To date, there is no empirical support for these assertions. Aims The current study examined the assumption of iatrogenic effects among BP...

This chapter briefly reviews the evidence for other posttraumatic stress disorder (PTSD) interventions so as to provide a comprehensive summary of treatment options for the disorder. The appropriate use of evidence-based practices, administered as soon as possible after return from deployment, may offer the best hope for alleviating PTSD and preven...

Background: Pain is often a complaint that precedes total knee arthroplasty (TKA), however the procedure itself is associated with considerable post-operative pain lasting days to weeks which can predict longer-term surgical outcomes. Previously, we reported significant opioid-sparing effects of motor cortex transcranial direct current stimulation...

The use of patient-reported outcomes (PROs) has become increasingly common. They have been used to assess quality of care and to support policy decisions, but the evidence concerning their utility to improve patient outcomes is inconsistent. A better understanding of clinicians' experience with PROs has the potential to improve their effectiveness....

Background and objectives: Opioid use disorder (OUD) is a chronic disorder with relapse based on both desire for reinforcement (craving) and avoidance of withdrawal. The aversive aspect of dependence and relapse has been associated with a small brain structure called the habenula, which expresses large numbers of both opioid and nicotinic receptor...

In an era of health care that is driven by biological and technical advances, there is a need to safeguard the caring component of care, the humanistic part of care. With this in mind, the authors constructed a Patient-Centered Caring model consisting of three overlapping constructs: delivering customer service, understanding the illness experience...

Background HIV-associated vulnerabilities—especially those linked to psychological issues—and limited mental health–treatment resources have the potential to adversely affect the health statuses of individuals. The concept of resilience has been introduced in the literature to shift the emphasis from vulnerability to protective factors. Resilience,...

Individuals with serious mental illness (SMI) experience significant comorbid chronic pain (CP). Little is known about CP management in psychiatric inpatient settings. To address this gap in clinical practice, the authors developed CP management group psychotherapy for adult inpatients with SMI. In this report, the authors highlight (1) the theoret...

Objective.: Cognitive behavioral therapy has been shown to be effective for treating chronic pain, and a growing literature shows the potential analgesic effects of minimally invasive brain stimulation. However, few studies have systematically investigated the potential benefits associated with combining approaches. The goal of this pilot laborato...

Objective: Distinguishing depressive episodes due to bipolar disorder (BD) or major depressive disorder (MDD) solely on clinical grounds is challenging. We aimed at comparing resting-state functional connectivity (rsFC) of regions subserving emotional regulation in similarly depressed BD and MDD. Method: We enrolled 76 in-patients (BD, n = 36; M...

The authors summarize findings from a multiyear research project designed primarily to investigate outcomes of intensive, psychotherapeutic hospital treatment lasting several weeks. Patients are assessed with well-established measures at admission, and their progress is reassessed biweekly up to discharge. A follow-up component was added recently t...

Serious mental illness (SMI) is disabling, and current interventions are ineffective for many. This exploratory study sought to demonstrate the feasibility of applying topological data analysis (TDA) to resting-state functional connectivity data obtained from a heterogeneous sample of 235 adult inpatients to identify a biomarker of treatment respon...

Objective: This prospective open effectiveness trial examined symptom change trajectories and rates of remission from depression and anxiety in an intensive multimodal inpatient treatment for adults with serious mental illness (SMI). Patient baseline characteristics were examined as mediators/moderators of treatment response. Methods: Adult inpa...

Background: Available treatments for chronic pain (CP) are modestly effective or associated with iatrogenic harm. Transcranial direct current stimulation (tDCS) is a minimally-invasive brain stimulation technique that may be an effective, adjunctive treatment to non-opioid therapies. In this randomized control trial (RCT), we compare adjunctive ac...

Background: This study assessed the incremental validity of the Personality Inventory for DSM-5 (PID-5) beyond the impact of demographic, burden of illness, five-factor model of personality, and DSM-5 personality disorder criteria with respect to associations with admission psychiatric symptoms and functional disability. Methods: Psychiatric inp...

Suicide is a leading cause of death in America, with over 40,000 reported suicides per year. Mental illness is a major risk factor for suicidality. This study attempts to validate findings of volumetric differences from studies on suicidality. Psychiatric inpatients classified as having mildly severe or severe depression were separated into two gro...

Objective: Accurate prediction of suicide remains elusive due to lack of predictive measures. Given the Columbia-Suicide Severity Rating Scale's (C-SSRS) emerging "gold-standard" status for risk assessment, studies are needed to assess its psychometric properties, particularly predictive validity. The current study adds to the limited literature b...

Recently, the National Institute of Mental Health (NIMH) introduced the Research Domain Criteria (RDoC) initiative to address two major challenges facing the field of psychiatry: (1) the lack of new effective personalized treatments for psychiatric disorders, and (2) the limitations associated with categorically defined psychiatric disorders. Altho...

Tracking adolescent outcomes after inpatient hospitalization is important in informing clinical care for this age group, as inpatient care is one of the most expensive treatment modalities. This study examined 4 incentive strategies used to maintain adolescent participation in follow-up research (at 6, 12, and 18 mo) after their discharge from the...

Objective: Individuals with serious mental illness (SMI) experience significant comorbid somatic complaints. Little is known about response to integrated inpatient care that addresses psychiatric and general medical needs among individuals with SMI. Methods: Latent growth curve analyses were used to model somatic symptom trajectories across adul...

Study design: Randomized, controlled pilot trial. Objective: The present study is the first randomized, double-blind, sham-controlled pilot clinical trial of tDCS for pain and PCA opioid usage among patients receiving spine surgery. Summary of background data: Lumbar spinal surgeries are common, and while pain is often a complaint that precede...

There is little consensus regarding outcomes assessment in borderline personality disorder treatment trials, making comparisons of results and meta-analytic studies difficult and far less generalizable. The current article highlights a range of measures frequently employed and puts forth a set of recommendations for a core battery of outcome measur...

The authors examined the reliability and concurrent validity of a modified version of the Stressful Life Events Screening Questionnaire (SLESQ) in a sample of 1,517 psychiatric inpatients characterized by serious mental illness. The scale showed a high level of internal consistency as well as a readily interpretable factor structure that differenti...

Treatment non-response among high-risk, psychiatric patients exposes those suffering to suicidal risk as well as persistent social and occupational difficulties. Strategies for identification of treatment non-response are limited. Diagnostic efficiency of a self-report, cross-cutting symptom measure was assessed as a marker of treatment non-respons...

Background: Ventricular assist device (VAD) recipients are at high risk of depression and anxiety, and poor psychosocial functioning is associated with worse medical outcomes. Purpose: We present a case of a 31-year-old depressed patient who demonstrated passive suicidal behavior through multiple episodes of noncompliance, including temporarily...

Objective: Polypharmacy is common and especially challenging in the context of borderline personality disorder in light of impulsivity and self-harm associated with the disorder, risk of adverse drug-drug interactions, and financial burden. Reduction in polypharmacy could be conceptualized as a high priority in the treatment of borderline personal...

Judicious selection of potential liver transplant candidates and close monitoring of progress are essential to successful outcomes. Pretransplant psychosocial evaluations are the norm, but the relationship between psychosocial (and neurocognitive status) and longer term medical outcomes is understudied. This exploratory study sought to examine the...

This study examined changes in health-related quality of life in adult inpatients with serious mental illness engaged in a 6- to 8-week intensive treatment program. Admission and discharge assessment with the MOS 36-item Short-Form Health Survey was completed (June 2010-June 2012) for 410 adults aged 18-68 years. Paired t tests and effect size esti...

Management of suicide-related behaviors in a hospital is challenging. This article (1) describes integration of an electronic suicide risk notification system to improve assessment of psychiatric inpatients, (2) details the manner in which these alerts complement standard of care, and (3) provides support of using aggregate data to inform administr...

Given variable response to psychotropic intervention, this case highlights the potential of pharmacogenomics to inform medical decision-making in a male with atypical psychosis and depression with longer-standing attentional difficulties. Likely because of his specific COMT polymorphism and intermediate metabolizing liver enzymes, when the patient'...

Routine assessment of psychiatric patient outcomes is rare, despite growing evidence that feedback to clinicians and patients concerning patient progress improves treatment outcomes. The authors present a case in which real-time feedback proved beneficial in the treatment of a woman with a personality disorder admitted for inpatient treatment due t...

Objective: Depression among weight loss surgery (WLS) candidates is common. Anxiety in this population is less studied. Untreated anxiety persists post-surgery and is associated with poor surgical outcomes. The current study sought to explore the nature of anxiety in WLS candidates. Given shared symptoms of anxiety and obesity, we hypothesized tha...

Objective Patient satisfaction is a commonly used measure of healthcare quality. Limited research exists among psychiatric inpatients, especially adolescents, who pose unique challenges. This study sought to (1) concurrently assess adolescents’ and parents’ satisfaction with treatment and (2) compare their perspectives’ association with treatment o...

Objective: The authors previously demonstrated an 82.3% reduction in seclusion and restraint use at an inpatient psychiatric facility, largely attributable to changes to the physical environment. This study investigated whether the reduction was sustained over time. Methods: This follow-up study examined archival data by using a longer preinterv...

Patient satisfaction is increasingly used as an indicator of health care quality. Few measures are available to assess characteristics unique to inpatient psychiatric hospitals, especially those that provide longer-term care. Furthermore, there is limited guidance on how to utilize patient satisfaction data to guide quality improvement initiatives....

Objective The objective of this study is to assess clinical variables that may be associated with risk for opioid misuse in individuals with chronic pancreatitis.DesignThis study utilized a descriptive, quasi-experimental, cross sectional design.Setting and PatientsThree hundred seven individuals with nonalcoholic chronic pancreatitis engaged in ch...

Background A single session of left prefrontal rTMS has been shown to have analgesic effects, and to reduce post-operative morphine use. We sought to test these findings in a larger sample, and try and see if multiple sessions had additive analgesic benefit. Methods 108 patients undergoing laparoscopic gastric bypass surgery received two sessions...

Food cravings are common, more prevalent in the obese, and may differ in those who pursue surgical treatment for obesity. Food craving tools are most often validated in non-clinical, non-obese samples. In this retrospective study, 227 bariatric surgery candidates at a large medical center completed the Food Cravings Questionnaire-Trait (FCQ-T). The...

While overall success rates of bariatric surgery are high, approximately 20% of patients either regain or never lose the expected amount of weight. The purpose of this study was to determine whether, after gastric-bypass surgery, the degree of weight loss can be differentiated based on the neural response to food cues. In this functional MRI study,...

Pain is common and multifactorial among patients with chronic pancreatitis. Underrecognized and undertreated psychosocial comorbidity can exacerbate pain experience. Excess inpatient service utilization within this patient population prompted a performance improvement initiative at a large academic medical center. An interprofessional treatment app...

Objective: Repetitive transcranial magnetic stimulation (rTMS) has been shown to effectively treat depression, and its potential value in pain management is emphasized by recent studies. Transcranial magnetic stimulation (TMS)-evoked activity in the prefrontal cortex may be associated with corticolimbic inhibitory circuits capable of decreasing pa...

Background: Although pain is often a symptom that precedes total knee arthroplasty (TKA), the procedure itself is associated with considerable postoperative pain lasting days to weeks. Postoperative pain control is an important factor in determining recovery time, hospital length of stay, and rehabilitation success. Several brain stimulation techn...

Included, you will find the following ten articles: (1) “Prevalence of chest pain, depression, somatization, anxiety, global distress, and substance use among cardiac and pulmonary rehabilitation patients” by E. Serber and colleagues, (2) “Pain narratives in breast cancer survivors” by P. Peretti-Watel and colleagues, (3) “Presurgical weight is ass...

Context: Little systematic research has been conducted to understand pain among persons with end-stage liver disease, especially among liver transplant candidates. Appropriate pain assessment and management are important areas of consideration as treatment options are limited. Objective: To describe the nature of chronic pain in patients with en...

Objective. The present study was conducted to determine if depressive symptoms were associated with variability in pain perception and quality of life among patients with nonalcohol-related chronic pancreatitis. Methods. The research design was cross-sectional, and self-report data was collected from 692 patients with nonalcohol-related, intractabl...

Breast cancer is a leading cancer diagnosis among women worldwide, with more than 210,000 new cases and 40,000 deaths per year in the United States. Pain, anxiety, and depression can be significant factors during the course of breast cancer. Pain is a complex experience with sensory, affective, and cognitive dimensions. While depression and anxiety...

Psychosocial factors of cardiovascular disease receive a preponderance of attention. Little attention is paid to psychosocial factors of pulmonary disease. This paper sought to describe psychosocial characteristics and to identify differences between cardiac and pulmonary patients entering a phase II rehabilitation program. Parametric and nonparame...

The prospect of and the evaluative period for transplantation can be stressful for individuals with heart failure (HF). Little is known about the impact of psychosocial factors on service utilization and health outcomes. The current study examined the impact of depression, dysthymia, and anxiety on two-yr hospitalization and mortality among 96 indi...

Although Native Hawaiians and Pacific Islanders exhibit the highest rates of obesity and associated chronic diseases of any racial/ethnic group, they remain vastly underrepresented in health research. In a cross-sectional survey of college students (N = 402) we examined BMI and health outcomes in an ethno-racially diverse rural sample of Native Haw...

In selected patients with chronic pancreatitis, total pancreatectomy with islet autotransplantation can be effective for the treatment of intractable pain while ameliorating postoperative diabetes. Improved quality of life scores and decreased daily narcotic use, as indicators of successful pain relief, are expected after total pancreatectomy. Thes...

Unlabelled: Several brain stimulation technologies are beginning to evidence promise as pain treatments. However, traditional versions of 1 specific technique, transcranial direct current stimulation (tDCS), stimulate broad regions of cortex with poor spatial precision. A new tDCS design, called high definition tDCS (HD-tDCS), allows for focal del...

Narcissistic personality disorder (NPD) is characterized by an unrealistic need for admiration, lack of empathy toward others, and feelings of superiority. NPD presents a unique and significant challenge in clinical practice, particularly in medical settings with limited provider contact time, as health professionals treat individuals who often req...

The use of institutional measures of control such as seclusion and restraint within psychiatric hospitals is common and arguably countertherapeutic; however, little is known about how best to reduce the use of these measures. The development and implementation of new institutional strategies to reduce the use of seclusion and restraint are importan...