Safety of Repeated Administration of Parenteral Ketamine for Depression
Pharmaceuticals
David Feifel, David Dadiomov, Kelly Lee
The objective of this study was to investigate the safety of repeated parenteral ketamine for depression. An electronic survey inquiring about the frequency of adverse events was distributed to providers of parenteral ketamine for depression. In addition, the investigators conducted a search of published studies describing six or more repeated parenteral ketamine treatments administered to individuals for depression, and extracted reported adverse events. The survey was sent to 69 providers, of which 36 responded (52% response rate); after eliminating those that were incomplete, 27 were included in the analysis. The providers in the analysis collectively reported treating 6630 patients with parenteral ketamine for depression, one-third of whom received more than 10 treatments. Only 0.7% of patients experienced an adverse effect that required discontinuation of ketamine. Psychological distress during the treatment was the most frequent cause. Other adverse events were extremely rare (such as bladder dysfunction (0.1%), cognitive decline (0.03%) and psychotic symptoms (0.03%)). Among the 20 published reports of repeated parenteral ketamine treatments, rates of significant adverse events resulting in discontinuation were low (1.2%). The rate of adverse effects reported in the survey and the published literature is low, and suggests that long-term treatment of depression with ketamine is reasonably safe.
Read More
Chapter 3: Laboratory Testing for Substance Use Disorders
Absolute Addiction Psychiatry Review
David Dadiomov
This book serves as a tool for general psychiatrists, medical students, residents, and fellows looking for a clinically relevant and high-yield overview of addiction psychiatry in preparation for their board exams – or for everyday clinical practice. Written by expert educators in addiction psychiatry, the text is organized by substances misused and populations affected. This book serves as both a primary learning tool for those new to the field, as well as a reference for those working in addiction treatment. Each chapter begins with summaries of high yield clinical pearls, followed by general information including treatment, and then ends with accompanying board-style review questions. The scope includes understanding substances of misuse and substance use disorders (SUDs), how to evaluate, diagnose, and monitor SUDs, how to treat SUDs both pharmacologically and behaviorally, and critical information for specific populations of patients.
Read More
Therapeutic Drug Monitoring of Antipsychotics
Current Psychiatry
David Dadiomov
Savvy Psychopharmacology Column in Current Psychiatry
Read More
Dissociating the Clinical Role and Economic Value of Intranasal Esketamine
Journal of Managed Care & Specialty Pharmacy
David Dadiomov
Perspective on Value: Dissociating the Clinical Role and Economic Value of Intranasal Esketamine
Read More
The effects of ketamine on suicidality across various formulations and study settings
Mental Health Clinician
David Dadiomov and Kelly Lee
2019
Suicidality and self-injurious behavior afflict patients with a wide variety of psychiatric illnesses. Currently, there are few pharmacologic treatments for suicidality and self-injurious behavior and none that treat these conditions emergently. Recently, ketamine has demonstrated efficacy in treating both depression and acute suicidal ideation. An increasing usage of ketamine, of a variety of formulations, has been studied for these indications. This article reviews the evidence for use of ketamine in self-injurious behavior and suicidality.
Read More
Using the LACE Score as a Predictor of Clinical Outcomes in Patients Referred for Inpatient Palliative Care Consultation: A Single-Center Experience
American Journal of Hospice and Palliative Medicine
David Dadiomov, Patricia Keefer, and Michael A. Smith
2018
Readmissions and death for palliative care patients are common and costly outcomes for hospitals, patients, and/or caregivers. Predicting which patients are likely to be readmitted or die within 30 days would help allocate resources and aid in patient disposition planning. Few factors have been strongly correlated with predicting which patients will be readmitted or die within 30 days of hospital discharge. The LACE (Length of Stay, Acuity of admission, Charlson comorbidity index, Emergency department use) score has been validated in medical/surgical patients; however, it has not been evaluated in the palliative care population.
Read More
