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Dr. Maldonado is the John & Terry Levin Family Professor of Medicine at Stanford University School of Medicine. He also serves as Chief of the Division of Medical Psychiatry, Medical Director of the Consultation Psychiatry Service, and Chief of Critical Care Psychiatry at Stanford University Medical Center. Dr. Maldonado is board certified in Adult Psychiatry, Consultation-Liaison Psychiatry, Forensic Psychiatry, Addiction Medicine, and Forensic Medicine. His research lab developed the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) a tool created to assess the psychosocial candidacy of organ transplant and ventricular assisted devices (VADs) candidates. In addition, his research has led the field of Consultation-Liaison Psychiatry & Psychosomatic Medicine in the development of tools for the prediction and assessment of various neuropsychiatric disorders; including the Stanford Proxy Test of Delirium (S-PTD), a tool for the timely and accurate diagnosis of delirium in all clinical settings, from general medico-surgical units to the critical care setting; the Stanford Algorithm for Predicting Delirium (SAPD), a tool to help predict patients at risk for developing delirium; and the Prediction of Alcohol Withdrawal Severity Scale (PAWSS). His team has developed management protocols and algorithms for the prevention and treatment of delirium; as well as novel pharmacological techniques (benzodiazepine-sparing protocol) for the prophylaxis and treatment of complicated alcohol withdrawal syndromes.Dr Maldonado has been the recipient of multiple awards and recognitions, including: the 2004 – Dlin/Fischer Award for significant achievement in clinical research from the Academy of Psychosomatic Medicine for work on reduction of post-operative and critical care delirium; the 2009 – Dorfman Award for Best Original Research from the Academy of Psychosomatic Medicine for development of the Stanford Integrate Psychosocial Assessment for Transplantation (SIPAT); the 2014 – Dlin/Fischer Award for significant achievement in clinical research from the Academy of Psychosomatic Medicine for the development of the Prediction of Alcohol Withdrawal Severity Scale (PAWSS); the 2014 – Herbert Spiegel Award for Hypnosis Research from the Department of Psychiatry at Columbia University & New York State Psychiatric Institute; the 2016 – Sawlow Memorial Award on Neuroscience from the Oregon Health & Science University for his work on the pathophysiology and management of delirium; the 2017 – Franz-Köhler-Inflammation-Award from the German Society of Anesthesiology and Intensive Care Medicine (DGAI) for extraordinary achievements in research on inflammation and its relationship to the pathophysiology of delirium; and the 2018 – Eleanor and Thomas P. Hackett Memorial Award by the Academy of Consultation-Liaison Psychiatry, the Academy’s highest honor, for distinctive achievements in CLP training, research, clinical practice, and leadership.
His research interests include: delirium, alcohol withdrawal in the medically-ill, solid organ transplantation, and the medical use of hypnosis. For the last 24 years he has been studying the psychosocial aspects of solid organ and composite tissue transplantation; which has led to the development of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) to assess the psychosocial candidacy of organ transplant and ventricular assisted devices (VADs). Over the last 20 years he has studied the diagnosis, neurobiology, prevention and management of delirium; developing prevention and treatment protocols, and writing numerous manuscripts and chapters in the topic. More recently, his research team has developed a new tool for the timely and accurate diagnosis of delirium: the Stanford Proxy Test of Delirium (S-PTD) and a tool to help predict those patients at risk for developing delirium, the Stanford Algorithm for Predicting delirium (SAPD). Over the last 6 years, Dr Maldonado has led his research team in studying the neuropathophysiology of alcohol withdrawal syndrome and its relationship to delirium tremens. This eventually led to the development of a new tool for the prediction of patients at risk of severe AWS: the Prediction of Alcohol Withdrawal Severity Scale (PAWSS); and novel pharmacological techniques for the prophylaxis and treatment of complicated alcohol withdrawal syndromes.
Treatment of Alcohol Withdrawal Syndrome With Alpha-2 Agonists and/or Anticonvulsants
Complicated alcohol withdrawal syndrome (AWS) increases morbidity and mortality of
hospitalized, medically ill patients. The Psychosomatic Medicine Service is commonly
consulted to assist in the management of these patients when admitted to medical/surgical
units. During the last 15 months, the investigators have implemented a benzodiazepine-sparing
management approach with very positive clinical outcomes. The BZDP-sparing protocol consists
of a combination of alpha-2 agonist and/or anticonvulsant agents; all currently being used
for the management of other medical conditions. This project intends to collect and analyze
the data of all subjects managed with this approach to better understand its effectiveness
and assess for potential adverse effects.
Stanford is currently not accepting patients for this trial.
For more information, please contact SPECTRUM, .
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A Pilot Study of "Stanford Proxy Test for Delirium" (S-PTD)
Although there are several tools available for the screening of delirium among the medically
ill, they all have some limitations. First, none of the available tools have been validated
against newly developed and published DSM-5 (Diagnostic and Statistical Manual) or ICD-10
(International Statistical Classification of Diseases and Related Health Problems) criteria.
Additionally, all the screening/diagnostic tools presently available have the same
limitation, they all require significant patient involvement and participation (e.g.,
questions and activities) in order to complete the assessment. By definition, delirium is a
neuropsychiatric disorder characterized by disturbance in attention and awareness, and
additional disturbance in cognition (e.g., memory deficit, disorientation), language,
visuospatial ability, or perception. The intrinsic characteristics of delirium seem to
interfere with the patient's ability to participate and complete many of the tasks associated
with delirium evaluation itself. Finally, most available tools seem to narrowly focus on some
neurocognitive areas of delirium, but not being comprehensive enough.
In contrast, the S-PTD is designed so it can be completed by the nursing staff caring for the
patients, the medical personnel most intimately involved with the care and aware of the
behaviors exhibited by the patient during the course of their hospital stay. The idea is that
nurses will complete the screening tool (hence the term "by proxy"), based on the behaviors
and interactions observed during the course of a conventional "nursing shift", to determine
whether the patient meets current neuropsychiatric criteria for the diagnosis of delirium.
The "Prediction of Alcohol Withdrawal Severity Scale" (PAWSS)
Although there are several tools that can be used to evaluate the severity of ongoing alcohol
withdrawal syndrome (AWS), there is no available tool that can predict which patients are at
risk for developing AWS at the time admission, before the patient has developed AWS.
Unfortunately, there are severe symptoms of alcohol withdrawal (e.g., seizures) which may
develop early in the hospitalization, and before the development of other systemic symptoms
which may warn medical personnel of the possibility of impeding alcohol withdrawal (e.g.,
autonomic instability, delirium). The goal of this study is to evaluate the psychometric
properties (e.g., predictive validity) of a new tool, the Prediction of Alcohol Withdrawal
Severity Scale (PAWSS), on identifying which patients are at risk for developing complicated
AWS (i.e., seizures, hallucinosis, delirium tremens) among hospitalized, medically ill
Is Dexmedetomidine Associated With a Lower Incidence of Postoperative Delirium When Compared to Propofol or Midazolam in Cardiac Surgery Patients
The purpose of this chart review study is to determine whether the use of dexmedetomidine, a
selective α2-adrenergic receptor agonist with sedative, analgesic, and antinociceptive
properties, would be associated with a lower incidence of delirium when compared to propofol
and midazolam. We hypothesize that sedation with dexmedetomidine following cardiac surgery
with CPB will be associated with a lower incidence of postoperative delirium.
Valproic Acid for Treatment of Hyperactive or Mixed Delirium in ICU
Delirium is the most often encountered psychiatric diagnosis in the general hospital, with
incidence up to 85% in the intensive care unit (ICU) setting and with significant
consequences on patients' morbidity and mortality. Currently, although not FDA approved,
antipsychotics are often considered the first-line pharmacological treatment. However, there
can be limitations to their use, including side effects or lack of efficacy. Valproic acid
(VPA) is one of the alternatives at times used in such patients which from limited case
series data appears to be helpful and tolerated. VPA can provide relief from agitation that
poses a threat to the safety and recovery of the patient. Moreover, mechanistically it
addresses the neurochemical and cellular abnormalities inherent in delirium (it has
NMDA-antagonist, anti-dopaminergic, GABAergic,anti-inflammatory, anti-apoptotic, and histone
deacetylase inhibitor properties, among others). The purpose of this study is to evaluate the
efficacy and tolerability of the VPA in the first known to us randomized controlled trial.
Stanford is currently not accepting patients for this trial.
For more information, please contact Shengchun Wang, Ph.D, 518-334-2513.
A Comparison of Lorazepam and Diazepam in the Treatment of Alcohol Withdrawal
The purpose of this study is to compare the efficacy of two commonly used medications in the
treatment of alcohol withdrawal, diazepam and lorazepam.