Psychiatrist, Child & Adolescent


Park Shore
5150 Tamiami Trl N
Ste 305
Naples, FL 34103
239-263-0133
Locations and availability (1)

Education ?

Medical School
The Medical College of Pennsylvania *
* This information was reported to Vitals by the doctor or doctor's office.

Awards & Distinctions ?

Awards  
Patients' Choice Award (2011 - 2013)
Compassionate Doctor Recognition (2011 - 2013)

Publications & Research

Dr. Schaller has contributed to 24 publications.
Title Do Bartonella Infections Cause Agitation, Panic Disorder, and Treatment-resistant Depression?
Date January 2008
Journal Medgenmed : Medscape General Medicine
Excerpt

INTRODUCTION: Bartonella is an emerging infection found in cities, suburbs, and rural locations. Routine national labs offer testing for only 2 species, but at least 9 have been discovered as human infections within the last 15 years. Some authors discuss Bartonella cases having atypical presentations, with serious morbidity considered uncharacteristic of more routine Bartonella infections. Some atypical findings include distortion of vision, abdominal pain, severe liver and spleen tissue abnormalities, thrombocytopenic purpura, bone infection, arthritis, abscesses, heart tissue and heart valve problems. While some articles discuss Bartonella as a cause of neurologic illnesses, psychiatric illnesses have received limited attention. Case reports usually do not focus on psychiatric symptoms and typically only as incidental comorbid findings. In this article, we discuss patients exhibiting new-onset agitation, panic attacks, and treatment-resistant depression, all of which may be attributed to Bartonella. METHODS: Three patients receiving care in an outpatient clinical setting developed acute onset personality changes and agitation, depression, and panic attacks. They were retrospectively examined for evidence of Bartonella infections. The medical and psychiatric treatment progress of each patient was tracked until both were significantly resolved and the Bartonella was cured. RESULTS: The patients generally seemed to require higher dosing of antidepressants, benzodiazepines, or antipsychotics in order to function normally. Doses were reduced following antibiotic treatment and as the presumed signs of Bartonella infection remitted. All patients improved significantly following treatment and returned to their previously healthy or near-normal baseline mental health status. DISCUSSION: New Bartonella species are emerging as human infections. Most do not have antibody or polymerase chain reaction (PCR) diagnostic testing at this time. Manual differential examinations are of unknown utility, due to many factors such as low numbers of infected red blood cells, the small size of the infecting bacteria, uncertainty of current techniques in viewing such small bacteria, and limited experience. As an emerging infection, it is unknown whether Bartonella occurrence in humans worldwide is rare or common, without further information from epidemiology, microbiology, pathology, and treatment outcomes research. CONCLUSION: Three patients presented with acute psychiatric disorders associated with Bartonella-like signs and symptoms. Each had clear exposure to ticks or fleas and presented with physical symptoms consistent with Bartonella, eg, an enlarged lymph node near an Ixodes tick bite and bacillary angiomatosis found only in Bartonella infections. Laboratory findings and the overall general course of the illnesses seemed consistent with Bartonella infection. The authors are not reporting that these patients offer certain proof of Bartonella infection, but we hope to raise the possibility that patients infected with Bartonella can have a variety of mental health symptoms. Since Bartonella can clearly cause neurologic disorders, we feel the presence of psychiatric disorders is a reasonable expectation.

Title Are Various Babesia Species a Missed Cause for Hypereosinophilia? A Follow-up on the First Reported Case of Imatinib Mesylate for Idiopathic Hypereosinophilia.
Date July 2007
Journal Medgenmed : Medscape General Medicine
Excerpt

INTRODUCTION: In 2001 we reported the first case of use of imatinib mesylate (Gleevec) for treatment of idiopathic hypereosinophilia syndrome (HES). These findings have been replicated in some patients with HES. After 1 year of taking imatinib, the patient stopped this medication, and during the last 5 years the patient has not experienced a relapse. He has, however, recently been diagnosed with babesiosis. This new diagnosis might relate to his HES. METHODS: After 6 years we decided to follow up on this patient's treatment. We interviewed the patient, his son, his aunt, and 2 consulting physicians and also reviewed relevant laboratory results to determine whether his HES had returned and whether his residual morbidity had changed. RESULTS: The patient has had no relapse of HES and his eosinophil counts have remained low-normal. He was recently diagnosed with babesiosis, and was prescribed atovaquone and azithromycin with a significant decrease in morbidity. His eosinophil cationic protein levels have also fallen to low-normal since starting atovaquone and azithromycin. DISCUSSION: New Babesia species are emerging as human infections. Most do not have available antibody or polymerase chain reaction diagnostic testing at this time. Manual differential examinations are of variable utility due to low numbers of infected red blood cells, suboptimal technique, and limited experience. Therefore, a diagnosis might need to be empirical at times, and should be based on signs and symptoms. CONCLUSION: The patient has not relapsed in the 5 years that he has not been taking imatinib. Babesiosis should be added to the many possible causes of HES. It is unknown how often babesiosis causes HES as well as what percentage of HES patients have babesiosis.

Title Escitalopram in Adolescent Major Depression.
Date June 2006
Journal Medgenmed : Medscape General Medicine
Excerpt

Escitalopram is the purified functional isomer contained in citalopram. Escitalopram is now prescribed in 26 countries. In the United States, the only US Food and Drug Administration (FDA)-approved selective serotonin reuptake inhibiter (SSRI) for adolescents is fluoxetine. However, in clinical practice all antidepressants are used in adolescents. Five patients had parents who opted for the use of escitalopram instead of other treatments. Reasons included poor response and side effects from other SSRIs. Specifically, escitalopram was considered possibly less likely to cause obesity than paroxetine. It also caused a lower frequency of akathisia than fluoxetine, more stable blood levels over years than sertraline, very low drug interactions, and a low onset of anxiety if using a 5-mg starting dose. Although studies in adolescents are very limited for escitalopram, its parent medication--citalopram--has been used in over 40 million patients. Parents and adolescent patients should be made aware of all antidepressant options, if psychopharmacology is indicated. In some patients, escitalopram may have use.

Title Low-dose Tiagabine Effectiveness in Anxiety Disorders.
Date May 2006
Journal Medgenmed : Medscape General Medicine
Excerpt

BACKGROUND: Gamma-aminobutyric acid (GABA), the predominant inhibitory neurotransmitter of the central nervous system, is involved in the pathophysiology of a wide variety of disorders, including anxiety. Tiagabine hydrochloride acts as a selective GABA reuptake inhibitor (SGRI). METHODS AND RESULTS: Consecutive patients were offered tiagabine in 1-mg incremental doses for the treatment of anxiety, primarily generalized anxiety disorder. Individuals failing anxiety treatment with benzodiazepines, selective serotonin reuptake inhibitors, and buspirone, and/or with a strong family or personal history of substance abuse were allowed trials. The SGRI tiagabine improved anxiety and was well tolerated by adult patients with generalized anxiety disorder as well as one patient with anxiety secondary to acute antidepressant withdrawal. One disinhibition treatment failure is also discussed. CONCLUSION: In acute anxiety treatment, very low initial dosing with gradual increases may be sufficient for anxiety effects, when compared with the higher doses of tiagabine used in epilepsy treatment. Tiagabine may be useful in the treatment of generalized anxiety disorder.

Title Same Use in Children and Adolescents.
Date January 2005
Journal European Child & Adolescent Psychiatry
Title Factor Structures of Taiwanese Teachers' Ratings of Adhd: a Comparison with U.s. Studies.
Date November 2004
Journal Journal of Learning Disabilities
Excerpt

The purpose of this study was to compare factor structures from Taiwanese teachers' ratings with diagnostic definitions of attention-deficit/hyperactivity disorder (ADHD) as described in the DSM-III-R, DSM-IV, and ICD-10; to examine how factor structures of Taiwanese teachers' ratings of ADHD symptoms compare with factor structures reported in research using school-based American participants; and to examine gender differences. One hundred and twenty-one homeroom teachers from six public elementary schools in Taipei County, Taiwan, rated two boys and two girls randomly selected from their homerooms using the ADHD checklist. Findings from this study support the concurrent validity of the DSM-IV ADHD factor structures of hyperactivity-impulsivity and inattention. Comparability of these findings with school-based U.S. studies suggests the cross-cultural congruency of behaviors associated with ADHD.

Title Topiramate Leukopenia on Clozapine.
Date May 2004
Journal European Child & Adolescent Psychiatry
Title Quetiapine Treatment of Adolescent and Child Tic Disorders. Two Case Reports.
Date April 2003
Journal European Child & Adolescent Psychiatry
Title Brief Report: Citalopram in Child and Adolescent Depression with Anxiety.
Date March 2002
Journal Medgenmed : Medscape General Medicine
Title Case Report: Rapid and Complete Control of Idiopathic Hypereosinophilia with Imatinib Mesylate.
Date March 2002
Journal Medgenmed : Medscape General Medicine
Excerpt

In this case report, we report what we believe to be the first case of imatinib mesylate or STI-571 (Novartis) use for treatment of idiopathic hypereosinophilia syndrome (HES). HES is often a fatal illness, damaging the heart, nervous system, lungs, liver, and kidneys. It is often treated with interferon-alpha. In this patient, it was combined with hydroxyurea, and we believe it saved his life. However, he experienced many common side effects, such as a profound intractable headache, severe fatigue, and concentration difficulties. After years on hydroxyurea and interferon-alpha, the severity of these side effects motivated us to try a trial of imatinib mesylate. Its use was followed by an abrupt remission of HES in a few weeks, with no significant side effects.

Title Modafinil in Fibromyalgia Treatment.
Date January 2002
Journal The Journal of Neuropsychiatry and Clinical Neurosciences
Title Mercury and Fish Oil Supplements.
Date January 2002
Journal Medgenmed : Medscape General Medicine
Title Oros Medications Confounding Kidney Stone Diagnosis.
Date January 2002
Journal Medgenmed : Medscape General Medicine
Title Critical Use of Venlafaxine Serology to Uncover Genetic Rapid Metabolism.
Date June 2001
Journal The Journal of Neuropsychiatry and Clinical Neurosciences
Title Progesterone Organogel for Premenstrual Dysphoric Disorder.
Date June 2000
Journal Journal of the American Academy of Child and Adolescent Psychiatry
Title Treating Comorbid Adhd, Major Depression, and Panic.
Date December 1999
Journal The Journal of Neuropsychiatry and Clinical Neurosciences
Title Garcinia Cambogia for Weight Loss.
Date July 1999
Journal Jama : the Journal of the American Medical Association
Title Quetiapine for Refractory Mania in a Child.
Date May 1999
Journal Journal of the American Academy of Child and Adolescent Psychiatry
Title Carbamazepine and Methylphenidate in Adhd.
Date February 1999
Journal Journal of the American Academy of Child and Adolescent Psychiatry
Title Sildenafil Citrate for Ssri-induced Sexual Side Effects.
Date January 1999
Journal The American Journal of Psychiatry
Title Treatment of a Case of Comorbid Bipolar Disorder and Attention-deficit/hyperactivity Disorder.
Date August 1998
Journal The Journal of Neuropsychiatry and Clinical Neurosciences
Title When Fluvoxamine Treats Only Depression and Clomipramine Treats Only Obsessive-compulsive Disorder--combine Them?
Date June 1998
Journal The Journal of Neuropsychiatry and Clinical Neurosciences
Title Liquid Medication Preparations.
Date May 1998
Journal Journal of the American Academy of Child and Adolescent Psychiatry
Title Selegiline for the Delivery of Small Doses of Amphetamine.
Date July 1997
Journal The Journal of Neuropsychiatry and Clinical Neurosciences

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