Isheeta Zalpuri

All Publications

• Sexual Health in Child and Adolescent Psychiatry: Multi-Site Implementation Through Synchronized Videoconferencing of an Educational Resource Using Standardized Patients FRONTIERS IN PSYCHIATRY Drozdowicz, L., Gordon, E., Shapiro, D., Jacobson, S., Zalpuri, I., Stewart, C., Lewis, A., Robinson, L., Myint, M., Daniolos, P., Williamson, E. D., Pleak, R., Graeff Martins, A., Gleason, M., Galanter, C. A., Miller, S., Stubbe, D., Martin, A. 2020; 11: 593101

  Abstract

  Objective: Matters of sexuality and sexual health are common in the practice of child and adolescent psychiatry (CAP), yet clinicians can feel ill-equipped to address them with confidence. To address this gap in training and practice, we developed, implemented, and evaluated an educational module enhanced by videotaped depictions of expert clinicians interacting with professional actors performing as standardized patients (SPs). Methods: We developed an educational resource highlighting common issues of sexual health relevant to CAP practice, including sexual development, psychotropic-related side effects, and sexuality in children with autism. We wrote original scripts, based on which two clinicians interacted with three SPs. Digital recordings were edited to yield 5 clips with a cumulative running time of 20 min. The clips were interspersed during a 90-min session comprising didactic and interactive components. Due to the COVID-19 pandemic, we used synchronous videoconferencing, which allowed content dissemination to several training programs across the country. Results: We recruited 125 learners from 16 CAP training programs through the American Academy of CAP's Alliance for Learning and Innovation (AALI). Routine inquiry into adolescent patients' sexual function was uncommon, reported by only 28% of participants, with "awkward" and "uncomfortable" the most common terms mentioned in reference to the clinical task. The didactic intervention led to measurable improvements after 2 weeks in skills and knowledge (p = 0.004) and in attitudes (p < 0.001). The three items with the greatest improvement were: (a) availability of developmentally tailored resources; (b) comfort in addressing sexual development with underage patients; and (c) with parents or guardians of neuroatypical or developmentally disabled patients (p < 0.001 for each). Conclusions: A sexual health curriculum enriched by video-based examples can lead to measurable improvement in outcomes pertinent to the clinical practice of CAP. These educational materials are available for distribution, use and adaptation by local instructors. Our study also provides proof-of-principle for the use of multisite educational initiatives in CAP through synchronized videoconferencing.

  View details for DOI 10.3389/fpsyt.2020.593101

  View details for Web of Science ID 000595599700001

  View details for PubMedID 33329142

  View details for PubMedCentralID PMC7716796

• Child and adolescent asynchronous technology competencies for clinical care and training: Scoping review. Families, systems & health : the journal of collaborative family healthcare Hilty, D. M., Zalpuri, I., Torous, J., Nelson, E. L. 2020

  Abstract

  Objective: Asynchronous technologies such as mobile health, e-mail, e-consult, and social media are being added to in-person and synchronous service delivery. To ensure quality care, clinicians need skills, knowledge, and attitudes related to technology that can be measured. This study sought out competencies for asynchronous technologies and/or an approach to define them. Methods: This 6-stage scoping review of Pubmed/Medline, APA PsycNET, PsycINFO and other databases was based on a broad research question, "What skills are needed for clinicians and trainees to provide quality care using asynchronous technologies for children and adolescents, and how can they be made measurable to implement, teach and evaluate?" The search focused on key words in 4 concept areas: (a) competencies; (b) asynchronous technology; (c) synchronous telepsychiatry, telebehavioral or telemental health; and (d) clinical. The screeners reviewed the full-text articles based on inclusion (mesh of the key words) and exclusion criteria. Results: From a total of 5,877 potential references, 2 authors found 509 eligible for full text review and found 110 articles directly relevant to the concepts. Clinical studies discuss clinical, technical and administrative workflow rather than competencies, though behavioral health professions' position statements advise on adapting care and training. Existing technology competencies for video, social media, mobile health, and other asynchronous technologies were used to build a framework. Training, faculty development, and organizational suggestions are suggested. Conclusions: Research is needed on how to implement and evaluate asynchronous competencies to ensure quality clinical care and training, which is a paradigm shift for participants. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

  View details for DOI 10.1037/fsh0000536

  View details for PubMedID 33151726

• Trainees on Technological Terrain: a Video Vignette-Based Tool to Teach E-Professionalism. Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry Zalpuri, I., Domakonda, M., Wrzosek, M., DeJong, S. 2020

  View details for DOI 10.1007/s40596-020-01325-7

  View details for PubMedID 33058052

• Clinical Conundrum: How do you treat youth with depression and a family history of bipolar disorder? BIPOLAR DISORDERS Angal, S., DelBello, M., Zalpuri, I., Singh, M. K. 2019; 21 (4): 383?86

  View details for DOI 10.1111/bdi.12788

  View details for Web of Science ID 000473072200014

• Pharmacological Approaches for Treating Suicidality in Adolescents EVIDENCE-BASED TREATMENT APPROACHES FOR SUICIDAL ADOLESCENTS: TRANSLATING SCIENCE INTO PRACTICE Zalpuri, I., Singh, M. K., Berk, M. 2019: 293?331

  View details for Web of Science ID 000550052900011

• Principles of Treatment of Mood Disorders Across Development CLINICAL HANDBOOK FOR THE DIAGNOSIS AND TREATMENT OF PEDIATRIC MOOD DISORDERS Zalpuri, I., Singh, M., Singh, M. K. 2019: 83?104

  View details for Web of Science ID 000550988100006

• Social Media and Networking Competencies for Psychiatric Education: Skills, Teaching Methods, and Implications. Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry Zalpuri, I., Liu, H. Y., Stubbe, D., Wrzosek, M., Sadhu, J., Hilty, D. 2018

  View details for PubMedID 30284148

• Therapeutic Assignments: Piloting a Way for Medical Students on the Psychiatry Clerkship to Interact with Patients Beyond the Initial Interview. Academic psychiatry Zalpuri, I., Dvir, Y. 2017

  View details for DOI 10.1007/s40596-017-0734-0

  View details for PubMedID 28589326

• Treatment of psychiatric symptoms among offspring of parents with bipolar disorder. Current treatment options in psychiatry Zalpuri, I., Singh, M. K. 2017; 4 (4): 341?56

  Abstract

  Bipolar disorder is highly familial and has a protracted and diagnostically confusing prodrome. This review critically evaluates recently published literature relevant to the treatment of psychiatric symptoms in high-risk offspring of parents with Bipolar Disorder.Non-pharmacological treatment options including psychotherapy, resilience promotion through good sleep, diet, and exercise hygiene, and omega-3 fatty acid supplementation are important first line interventions for high-risk offspring. There has been some success in treating this population with open-label trials with mood stabilizers and atypical antipsychotics; however, these results have not been replicated in randomized controlled trails.Despite some progress in early identification of symptoms in offspring of parents with Bipolar Disorder, there is scarce evidence supporting the treatment of these high-risk youth to prevent psychiatric symptoms from progressing to threshold bipolar or other psychiatric disorders. There is a need for prospective and randomized trials and research that identifies reliable biomarkers to individualize treatments for these youth.

  View details for PubMedID 29503793

  View details for PubMedCentralID PMC5831272

• Does psychosis increase the risk of suicide in patients with major depression? A systematic review JOURNAL OF AFFECTIVE DISORDERS Zalpuri, I., Rothschild, A. J. 2016; 198: 23-31

  Abstract

  Over the years studies have shown conflicting results about the risk of suicide in psychotic depression (MD-psych). To understand this association, we undertook a comprehensive review of the literature to ascertain whether individuals with MD-psych have higher rates of completed suicides, suicide attempts or suicidal ideation compared to those with non-psychotic depression (MD-nonpsych).We searched Pubmed, PsycINFO and Ovid in English language, from 1946-October 2015. Studies were included if suicidal ideation, attempts or completed suicides were assessed.During the acute episode of depression, patients with MD-psych have higher rates of suicide, suicide attempts, and suicidal ideation than patients with MD-nonpsych, especially when the patient is hospitalized on an inpatient psychiatric unit. Studies done after the acute episode has resolved are less likely to show this difference, likely due to patients having received treatment.Diagnostic interviews were not conducted in all studies. Many studies did not report whether psychotic symptoms in MD-psych patients were mood-congruent or mood-incongruent; hence it is unclear whether the type of delusion increases suicide risk. Studies did not describe whether MD-psych patients experienced command hallucinations encouraging them to engage in suicidal behavior. Only 24 studies met inclusion criteria; several of them had small sample size and a quality score of zero, hence impacting validity.This review indicates that the seemingly conflicting data in suicide risk between MD-psych and MD-nonpsych in previous studies appears to be related to whether one looks at differences during the acute episode or over the long-term.

  View details for DOI 10.1016/j.jad.2016.03.035

  View details for Web of Science ID 000375058100003

  View details for PubMedID 26998793

• Relationship between serum uric acid level and cardiometabolic risks in nondiabetic patients with schizophrenia INTERNATIONAL CLINICAL PSYCHOPHARMACOLOGY Rajan, S., Zalpuri, I., Harrington, A., Cimpeanu, C., Song, X., Fan, X. 2016; 31 (1): 51-56

  Abstract

  This study examined the relationship between serum levels of uric acid and insulin resistance and metabolic syndrome in nondiabetic patients with schizophrenia. Outpatients diagnosed with schizophrenia or schizoaffective disorder participated in a multicenter, cross-sectional study. Fasting blood samples were obtained to determine serum levels of metabolic measures. A total of 135 patients were recruited for the study. A significant positive relationship was found between serum levels of uric acid and the homeostasis model of assessing insulin resistance (log transformed, r=0.394, P<0.001), and a significant negative relationship was found between serum levels of uric acid and low-density lipoprotein particle size (log transformed, r=-0.306, P=0.001) after controlling for potential confounding variables. Hierarchical multiple regression suggested that serum uric acid level is a significant predictor of insulin resistance (P=0.001) and of low-density lipoprotein particle size (P<0.015). Further, logistic regression showed that serum uric acid levels strongly predicted the condition of metabolic syndrome (odds ratio 0.630, 95% confidence interval 0.463-0.856, P=0.003). This study suggested that uric acid may be a clinically useful biomarker to indicate cardiometabolic risks in nondiabetic patients with schizophrenia.

  View details for DOI 10.1097/YIC.0000000000000107

  View details for Web of Science ID 000366691200007

  View details for PubMedID 26550697

• Decisional Capacity in Pregnancy: A Complex Case of Pregnancy Termination PSYCHOSOMATICS Zalpuri, I., Byatt, N., Gramann, S. B., Dresner, N., Brendel, R. 2015; 56 (3): 292-297

  View details for Web of Science ID 000354405900009

  View details for PubMedID 25591494

  View details for PubMedCentralID PMC4400254