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Alan Podawiltz, DO

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NCBI: db=pubmed; Term=(podawiltz a[Author]) AND (John Peter Smith[Affiliation] OR JPS Health Network[Affiliation] OR JPS [Affiliation] OR University of North Texas Health Science Center [Affiliation] NOT Japan Pancreas Society[Affiliation])
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Chronic psychological stress suppresses contact hypersensitivity: potential roles of dysregulated cell trafficking and decreased IFN-γ production.

Wed, 01/30/2019 - 07:24
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Chronic psychological stress suppresses contact hypersensitivity: potential roles of dysregulated cell trafficking and decreased IFN-γ production.

Brain Behav Immun. 2014 Feb;36:156-64

Authors: Hall JM, Witter AR, Racine RR, Berg RE, Podawiltz A, Jones H, Mummert ME

Abstract
Increasing evidence shows that psychological stress can have dramatic impacts on the immune system, particularly the cutaneous immune response in dermatological disorders. While there have been many studies examining the impact of acute psychological stress on contact hypersensitivity there are relatively few studies concerning the impact of chronic psychological stress. Furthermore, the local immunological mechanisms by which chronic psychological stress impacts contact hypersensitivity still remain to be explored. Here we show that restraint-induced chronic psychological stress stimulates activation of the hypothalamus-pituitary-adrenal axis and delays weight gain in female BALB/c mice. We observed that chronic psychological stress reduces the cutaneous immune response as evidence by reduced ear swelling. This correlated with a significant decrease in the inflammatory cell infiltrate. On the other hand, chronic psychological stress does not influence T cell proliferation, activation, or sensitivity to corticosterone but does increase CD4(+) and CD8(+) T cell percentages in draining lymph nodes during a contact hypersensitivity reaction. Chronic psychological stress induces a decrease in overall circulating white blood cells, lymphocytes, and monocytes during a contact hypersensitivity reaction suggesting extravasation from the circulation. Finally, we found markedly reduced local IFN-γ production in chronically stressed animals. Based on these findings we propose that chronic psychological stress reduces contact hypersensitivity due to dysregulated cell trafficking and reduced production of IFN-γ.

PMID: 24184400 [PubMed - indexed for MEDLINE]

Psychological Stress and the Cutaneous Immune Response: Roles of the HPA Axis and the Sympathetic Nervous System in Atopic Dermatitis and Psoriasis.

Wed, 01/30/2019 - 07:24
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Psychological Stress and the Cutaneous Immune Response: Roles of the HPA Axis and the Sympathetic Nervous System in Atopic Dermatitis and Psoriasis.

Dermatol Res Pract. 2012;2012:403908

Authors: Hall JM, Cruser D, Podawiltz A, Mummert DI, Jones H, Mummert ME

Abstract
Psychological stress, an evolutionary adaptation to the fight-or-flight response, triggers a number of physiological responses that can be deleterious under some circumstances. Stress signals activate the hypothalamus-pituitary-adrenal (HPA) axis and the sympathetic nervous system. Elements derived from those systems (e.g., cortisol, catecholamines and neuropeptides) can impact the immune system and possible disease states. Skin provides a first line of defense against many environmental insults. A number of investigations have indicated that the skin is especially sensitive to psychological stress, and experimental evidence shows that the cutaneous innate and adaptive immune systems are affected by stressors. For example, psychological stress has been shown to reduce recovery time of the stratum corneum barrier after its removal (innate immunity) and alters antigen presentation by epidermal Langerhans cells (adaptive immunity). Moreover, psychological stress may trigger or exacerbate immune mediated dermatological disorders. Understanding how the activity of the psyche-nervous -immune system axis impinges on skin diseases may facilitate coordinated treatment strategies between dermatologists and psychiatrists. Herein, we will review the roles of the HPA axis and the sympathetic nervous system on the cutaneous immune response. We will selectively highlight how the interplay between psychological stress and the immune system affects atopic dermatitis and psoriasis.

PMID: 22969795 [PubMed]

A review of current bipolar disorder treatment guidelines.

Wed, 01/30/2019 - 07:24
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A review of current bipolar disorder treatment guidelines.

J Clin Psychiatry. 2012 Mar;73(3):e12

Authors: Podawiltz A

Abstract
With the help of the Texas Implementation of Medication Algorithms (TIMA) and the American Psychiatric Association (APA) practice guidelines, primary care physicians can devise a treatment plan for their patients with bipolar disorder. Clinicians should keep in mind the goals of treatment, engage the patient in the treatment plan, and encourage the patient to keep a mood log and undertake psychoeducation or cognitive therapy. Patients who are unable to participate in treatment, who are suicidal, who have psychotic symptoms, or who require advanced treatments should be referred to a psychiatrist or hospital.

PMID: 22490265 [PubMed - indexed for MEDLINE]

Diagnosing bipolar disorder: signs and symptoms.

Wed, 01/30/2019 - 07:24
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Diagnosing bipolar disorder: signs and symptoms.

J Clin Psychiatry. 2012 Feb;73(2):e06

Authors: Podawiltz A

Abstract
Bipolar disorder occurs in up to 2% of the community, but the prevalence is much higher among first-degree relatives of individuals with bipolar disorder. Following Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria assists clinicians in making an accurate diagnosis of bipolar I or bipolar II disorder and in distinguishing bipolar disorders from other illnesses such as major depressive disorder, medical conditions, and substance use. Additionally, always asking depressed patients about mania and using mnemonics to check for symptoms of mania and major depression can help physicians accurately diagnose and treat bipolar disorder.

PMID: 22401483 [PubMed - indexed for MEDLINE]

Family members of Hispanic military veterans: the risk of major depressive disorder.

Wed, 01/30/2019 - 07:24
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Family members of Hispanic military veterans: the risk of major depressive disorder.

J Clin Psychiatry. 2010 Jul;71(7):e16

Authors: Podawiltz A, Culpepper L

Abstract
The number of Hispanics serving in the US military is expected to grow substantially. Frequent deployments and combat assignments put significant stress on military families, increasing the risk of major depression. The family members of Hispanic military personnel may manifest depression differently than other ethnicities. Hispanics are also less likely to seek help, more likely to seek care from primary care physicians, and less likely to be appropriately diagnosed and treated. Thus, clinicians should be aware of the risk and presentation of major depressive disorder in family members of Hispanic US military veterans.

PMID: 20667286 [PubMed - indexed for MEDLINE]

Learning outcomes from a biomedical research course for second year osteopathic medical students.

Wed, 01/30/2019 - 07:24
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Learning outcomes from a biomedical research course for second year osteopathic medical students.

Osteopath Med Prim Care. 2010 Jul 08;4:4

Authors: Cruser dA, Brown SK, Ingram JR, Podawiltz AL, Dubin BD, Colston JS, Bulik RJ

Abstract
BACKGROUND: A ubiquitous dilemma in medical education continues to be whether and how to integrate research competencies into the predoctoral curriculum. Understanding research concepts is imbedded in the six core competencies for physicians, but predoctoral medical education typically does not explicitly include research education. In an effort to quickly report academic research findings to the field, this is the second in a series of articles reporting the outcomes of a research education initiative at one college of osteopathic medicine. The first article described the competency model and reported baseline performance in applied understanding of targeted research concepts. This second article reports on the learning outcomes from the inaugural year of a course in basic biomedical research concepts.
METHODS: This course consisted of 24 total hours of classroom lectures augmented with web-based materials using Blackboard Vista, faculty moderated student presentations of research articles, and quizzes. To measure changes in applied understanding of targeted research concepts in the inaugural year of the course, we administered a pretest and a posttest to second year students who took the course and to first year students who took an informatics course in the same academic year.
RESULTS: We analyzed 154 matched pretests and posttests representing 56% of the 273 first and second year students. On average, the first year (53) and second year students (101) did not differ in their mean pretest scores. At posttest the second year students showed significant improvement in their applied understanding of the concepts, whereas the first year students' mean posttest score was lower than their mean pretest score.
CONCLUSIONS: This biomedical research course appears to have increased the second year students' applied understanding of the targeted biomedical research concepts. This assessment of learning outcomes has facilitated the quality improvement process for the course, and improved our understanding of how to measure the benefits of research education for medical students. Some of the course content and methods, and the outcome measures may need to be approached differently in the future to more effectively lay the foundation for osteopathic medical students to utilize these concepts in the clinical setting.

PMID: 20609258 [PubMed]

Treatment-resistant depression in Hispanic patients.

Wed, 01/30/2019 - 07:24
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Treatment-resistant depression in Hispanic patients.

J Clin Psychiatry. 2010 Jun;71(6):e12

Authors: Podawiltz A, Culpepper L

Abstract
About one-third of patients treated with antidepressants do not respond to initial treatment, and Spanish-speaking Hispanic patients with major depression may exhibit a worse response to initial medication than English-speaking patients. Patients and clinicians should be resolute and patient as different regimens are tried throughout the course of treatment. Other options include electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation, and the medicinal food L-methylfolate.

PMID: 20573322 [PubMed - indexed for MEDLINE]

Psychotherapy for major depressive disorder in Latinos.

Wed, 01/30/2019 - 07:24
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Psychotherapy for major depressive disorder in Latinos.

J Clin Psychiatry. 2010 May;71(5):e11

Authors: Podawiltz A, Culpepper L

Abstract
Latino patients often prefer psychotherapy to pharmacotherapy for the treatment of depression. Psychotherapies, such as cognitive-behavioral therapy and interpersonal therapy, have been found to be effective treatments for patients with depression, particularly for Latino patients. Clinicians should be respectful of the core values of family, respect, identity, and spirituality in Latino cultures and should modify psychotherapies accordingly.

PMID: 20492848 [PubMed - indexed for MEDLINE]

Medical therapy for major depressive disorder in Latinos.

Wed, 01/30/2019 - 07:24
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Medical therapy for major depressive disorder in Latinos.

J Clin Psychiatry. 2010 Apr;71(4):e08

Authors: Podawiltz A, Culpepper L

Abstract
Latino patients require special considerations due to cultural beliefs, inadequate antidepressant response, increased placebo response, and adherence problems. Current evidence-based guidelines for the diagnosis and treatment of depression are generally applicable to a Hispanic population, but no separate recommendations for the treatment of major depressive disorder in Hispanic veterans or their families exist. More research is needed on depression in Hispanic patients in order to establish treatment guidelines specific to this population.

PMID: 20409442 [PubMed - indexed for MEDLINE]

Biomedical research competencies for osteopathic medical students.

Wed, 01/30/2019 - 07:24
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Biomedical research competencies for osteopathic medical students.

Osteopath Med Prim Care. 2009 Oct 13;3:10

Authors: Cruser DA, Dubin B, Brown SK, Bakken LL, Licciardone JC, Podawiltz AL, Bulik RJ

Abstract
BACKGROUND: Without systematic exposure to biomedical research concepts or applications, osteopathic medical students may be generally under-prepared to efficiently consume and effectively apply research and evidence-based medicine information in patient care. The academic literature suggests that although medical residents are increasingly expected to conduct research in their post graduate training specialties, they generally have limited understanding of research concepts.With grant support from the National Center for Complementary and Alternative Medicine, and a grant from the Osteopathic Heritage Foundation, the University of North Texas Health Science Center (UNTHSC) is incorporating research education in the osteopathic medical school curriculum. The first phase of this research education project involved a baseline assessment of students' understanding of targeted research concepts. This paper reports the results of that assessment and discusses implications for research education during medical school.
METHODS: Using a novel set of research competencies supported by the literature as needed for understanding research information, we created a questionnaire to measure students' confidence and understanding of selected research concepts. Three matriculating medical school classes completed the on-line questionnaire. Data were analyzed for differences between groups using analysis of variance and t-tests. Correlation coefficients were computed for the confidence and applied understanding measures. We performed a principle component factor analysis of the confidence items, and used multiple regression analyses to explore how confidence might be related to the applied understanding.
RESULTS: Of 496 total incoming, first, and second year medical students, 354 (71.4%) completed the questionnaire. Incoming students expressed significantly more confidence than first or second year students (F = 7.198, df = 2, 351, P = 0.001) in their ability to understand the research concepts. Factor analyses of the confidence items yielded conceptually coherent groupings. Regression analysis confirmed a relationship between confidence and applied understanding referred to as knowledge. Confidence scores were important in explaining variability in knowledge scores of the respondents.
CONCLUSION: Medical students with limited understanding of research concepts may struggle to understand the medical literature. Assessing medical students' confidence to understand and objectively measured ability to interpret basic research concepts can be used to incorporate competency based research material into the existing curriculum.

PMID: 19825171 [PubMed]

Practical strategies for diagnosing and treating depression in women at midlife and beyond: chronic depression.

Wed, 01/30/2019 - 07:24
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Practical strategies for diagnosing and treating depression in women at midlife and beyond: chronic depression.

J Clin Psychiatry. 2009 Jan;70(1):e03

Authors: Podawiltz A

Abstract
Dysthymic disorder is a mild but chronic depression that can be difficult for physicians to treat because patients with dysthymic disorder have a high risk of relapse. Guidelines for treating dysthymic disorder suggest treatment with antidepressants, especially selective serotonin reuptake inhibitors, and psychotherapy. A variety of antidepressants and psychotherapies have shown efficacy in trials, and treatment must be tailored to the individual patient.

PMID: 19222978 [PubMed - indexed for MEDLINE]

Do atypical antipsychotics effectively treat co-occurring bipolar disorder and stimulant dependence? A randomized, double-blind trial.

Wed, 01/30/2019 - 07:24
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Do atypical antipsychotics effectively treat co-occurring bipolar disorder and stimulant dependence? A randomized, double-blind trial.

J Clin Psychiatry. 2008 Aug;69(8):1257-66

Authors: Nejtek VA, Avila M, Chen LA, Zielinski T, Djokovic M, Podawiltz A, Kaiser K, Bae S, Rush AJ

Abstract
OBJECTIVES: The primary objective was to compare the efficacy and tolerability of quetiapine and risperidone in the treatment of mood symptoms, drug cravings, and drug use in outpatients with concurrent DSM-IV-defined bipolar I or II disorder and cocaine or methamphetamine dependence.
METHOD: Men and women of all ethnic origins, 20 to 50 years of age, were eligible to participate. Persons were excluded if they were inpatients, met DSM-IV criteria for substance-induced mood disorder, had any other substance dependence, were euthymic or suicidal, had any life-threatening illnesses, or were currently receiving antipsychotic medications. Duration of the trial was 20 weeks. Study participants attended weekly visits and were evaluated for mood symptoms, drug cravings, drug use, and medication side effects. Treatment outcomes were analyzed using linear mixed models. Fixed-effects terms for medication group, study week, and group-by-study-week were included in the models. The study was conducted between October 2002 and November 2006.
RESULTS: Of 124 consenting outpatients, an evaluable sample of 80 patients who attended baseline and at least 1 follow-up study visit was formed. The mean +/- SD exit dose for quetiapine was 303.6 +/- 151.9 mg/day and 3.1 +/- 1.2 mg/day for risperidone. Both quetiapine (N = 42) and risperidone (N = 38) significantly improved manic and depressive symptoms and reduced drug cravings (p < .0005) compared to baseline. Decreased drug cravings were related to less frequent drug use (p = .03). The 2 medications did not significantly differ in their effects on mood symptoms, drug craving, or drug use.
CONCLUSIONS: Relative to baseline mood and drug-craving status, both quetiapine and risperidone were associated with manic, mixed, and depressive symptom improvement and reduced drug cravings. Both medications were well tolerated. The interpretation of these results is limited by the absence of a placebo control.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00227123.

PMID: 18681757 [PubMed - indexed for MEDLINE]