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Diagnostic & Treatment Consultations

Expertise in Specialized Clinical Programs
Sport Psychiatry
Sports Psychiatry

Mental Health Wellbeing and Optimization in Athletic Performance.

Alternative treatments
Alternative and Complementary Treatments

An Integrative Approach to Therapeutic Recommendations.

Priority Attention
Concierge Program

Priority Attention.

Complex Cases
Consulting for Treatment Resistant Illnesses (TRI) or Complex Cases

Next Level Recommendations When Common Approaches Failed.

In-Depth Study of Mental Health
Advanced Psychopharmacological Review

In-Depth Study of Mental Health Medication Regimens for Efficacy and Tolerability.

Alternative perspective approach
Interventional Psychiatry Referral

Assessment of Eligibility for Non-Pharmacological Interventions for the Treatment of Illness

Co-occurring conditions
Co-occurring Medical or Neurological Conditions

Assessment of Mental Health in the Context of Serious Physical Illnesses.

Drug Dependence
Medication Assisted Treatments for Addiction

Biological Support for Recovery of Alcohol and Drug Dependence.

Door opener
Medical Review Officer

Trained Examiner of Drug Screens.

Sports Psychiatry
professional sportsman in best shape

Our sports psychiatry and athletes program is dedicated to enhancing professional athlete’s mental health and wellbeing, in support of their athletic performance. We recognize the particular stressors they endure through their careers, and we are mindful of the options that remain available to them without endangering their sports career or performance. We provide mental health screenings, mental health workshops, and evaluations and treatment in accordance with the International Society of Sports Psychiatry.

The international organization called the International Society for Sports Psychiatry (ISSP) (www.TheISSP.org) has over 100 members from Europe to South America to Japan and Australia. The ISSP has become an allied group of the American Psychiatric Association (APA).

Sports psychiatry distinguishes itself from the field of sports psychology - Interventions focus not only on sports performance enhancement, but also on early identification and treatment of psychopathology. Some illnesses may have been present before the person became an athlete or the potential may have been there. Perhaps there is a genetic predisposition to, for example, bipolar disorder. Similarly, it is not uncommon to make a diagnosis of new-onset schizophrenia in a young high school or college athlete, given the demographics of the illness. Involvement in sports may exacerbate some existing illnesses; for example, an anxiety disorder might be exacerbated by the unique pressures of athletic competition.

Other psychopathologies may be engendered through the sport itself: an eating disorder in a gymnast or anabolic steroid abuse in a body builder. There are unique considerations when choosing pharmacological interventions. It is vital to attend to adverse events that may impair athletic performance, such as a tremor or weight gain secondary to specific medications. In addition, sports psychiatrists must be mindful of prescription medications and must keep in mind the banned substances list for each sporting body. A common example: drugs perceived as having performance-enhancing properties, such as psychostimulants for ADHD. Furthermore, sports psychiatrists address concerns that may arise as a result of sports related injuries, such as concussions. Patients may develop symptoms following an injury that could directly impact their brain functioning, or that affects a different part of their body and has profound (and abrupt) consequences on their life outlooks.
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Alternative and Complementary Treatments

In recent years, there has been renewed interest in exploring health and wellbeing through a holistic approach, incorporating Western medicine (with emphasis on allopathic modalities) and other complimentary therapies typically found in the osteopathic, traditional, or natural remedies armamentarium. Integrative psychiatry aims for a well-rounded approach to mental health and well-being, aiming for recovery by first exhausting the healing properties of nutrition, restoration of physiological needs (such as sleep, exercise or movement, sensory integration, and more). While medications may be utilized in the context of integrative mental health, they are considered a second tier adjunct to other interventions that promote health through the body’s natural ability to restore itself.

Medications can be helpful, but may not work as effectively for all patients, or may carry along a set of unwanted side effects. In the integrative approach, and individualized analysis of each person’s genetic vulnerabilities, dietary needs, microbiome health, body composition, and behavioral habits takes place, in order to recommend a series of interventions that may alleviate symptoms or treat illness while avoiding or minimizing the use of psychiatric medications.

By way of examples, there is a strong association between diet and mental illness. Nutritional deficiencies can affect the onset, severity and duration of the psychiatric symptoms. Research shows the strongest link of diet with depression, bipolar disorder, schizophrenia and OCD. Patients are notably deficient in a variety of nutrients, minerals and omega 3 fatty acids. Similarly, some disorders respond well to particular types of exercise or movement routines; sensory modalities can be adjusted to provide symptom relief, and techniques such as biofeedback may assist the patient in self-regulating emotions and their physiological responses. Mindfulness, accupuncture, and many other techniques can be incorporated into a specifically tailored individualized plan.
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Concierge Programs: Priority Attention

Aconcierge-style practice totes the benefits of highly personalized, professional service over a high volume of cases. In a nutshell: it’s quality over quantity. In place of an insurance-driven practice, physicians who opt to provide concierge services typically offer full-service treatment to a select small group of patients that enroll in the program. Membership incurs in a monthly or yearly fee, but enjoys a number of benefits that come with that membership. Individualized care is stressed over time-efficient or service-driven management, whereby assessments may be shortened, there might be delays in scheduling, and clients may be assigned to multiple providers according to availability.

Priority attention

The upfront cost has been generally associated with an audience of the “elite”—executives and professionals that have the funds to pay for the added benefits. However, concierge programs may be comparable in expenses to their traditional counterparts, and the advantages and flexibility of treatment add value to the investment.

More time, More individualized attention, More accessibility.

Consultants will have fewer cases, which leaves more time and resources for each individual client. Enhanced attention comes about as a result of limited workloads, which ensures each client’s needs are given adequate attention. The consultant is able to work more closely with each person, with scheduled appointments occurring sooner and longer. Same-day and next-day appointments are readily scheduled, and personal replies are given in a timely manner. Oftentimes, calls and personal requests from patients are prioritized.

Your team, your needs, first.

Consulting concierge programs are often opted into by athletic programs, corporate teams, and large legal firms. It is a way to develop a relationship that builds upon itself, by establishing clear demands, availability, and priorities.
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Consulting for Treatment Resistant Illnesses (TRI)
or Complex Cases

Our Treatment Resistant Illnesses program focuses on providing relief to patients who have had several unsuccessful attempts at managing their symptoms. Up to 30% of mental illnesses may not respond to conventional therapies and require intensive management through medications that require close monitoring (e.g. clozapine), combinations of treatments, or even interventional new methods.

When treatments such as medication and therapy aren’t able to relieve the symptoms of depression, anxiety, OCD, bipolar, schizophrenia, or another mental health condition, there are other options available. A psychiatrist might suggest more advanced pharmacological options, including combination treatments or new medications recently found in the scientific evidence. They might also suggest certain procedures or interventions, such as electroconvulsive therapy (ECT) or other forms of brain stimulation. Brain stimulation therapies involve stimulating or touching the brain directly with electricity, magnets or implants.

Treatment refractory individuals have been found to have a significantly longer duration of symptoms during their first hospitalization, a greater severity of symptoms 12 months after stabilization, and poor psychosocial functioning 12 months after stabilization. The duration of symptoms before treatment suggests that an untreated illness may lead to treatment resistance.

If you have been following your treatment plan in accordance with what your doctor prescribed, but symptoms persist, you might benefit from an evaluation to investigate: if a different or superimposed diagnosis needs to be considered, if new or different therapeutic alternatives exist, or if your current treatment plan can be optimized to provide better symptom relief.
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Advanced Psychopharmacological Review

Many patients with mental health illnesses feel as though they’ve been on a carousel of revolving medication trials: they are often switched from one medication to another after failing to experience relief, or medications are just added on top of one another resulting in burdensome medication regimens. They often feel they are being prescribed blindly, or ‘’experimentally’’, without true understanding of the reasons for treatment failure, the symptomatic needs, and the individual body’s ability to respond to certain drugs. They feel they have tried ‘’everything’’ in the psychiatrists’ toolbox. Concurrently, even the most experienced and knowledgeable clinician has encountered a patient whose illness is difficult to treat, or who, despite once being responsive to a treatment alternative, has ceased to experience relief from it.

A deep psychopharmacological review allows for careful detailing of drug choice, dosing, and combination trials; and then analyses it against biological considerations such as genetic profiles, development, physiological functions, and more. Furthermore, advanced psychopharmacologists are equipped to properly analyse medication levels in blood, recommend scientifically-sound medication combinations (based on gene transcription, neurotransmitter pathways, synaptic receptors and functions), and are comfortable prescribing less common but more effective medications such as clozapine or new psychotropics that have come into the market in recent years. Bottom line, there is certainly an alternative that has not been tried that has solid potential to be helpful, for those who need it the most.
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Interventional Psychiatry Referral

Throughout the years, psychiatry has made great advancements in the development of medications for the treatment of a wide range of mental health disorders. Unfortunately, however, current pharmacotherapies are often ineffective in treating such conditions, or they come at a cost of intolerable side effects to the patient. Even when combining psychotropics (medications that alter a person’s mental state and are used in the management of mental illnesses), or combining medications and psychotherapies, of to 30% of patients with severe presentations of illness may continue to experience debilitating and unremitting symptoms. These treatment-resistant and treatment-intolerant patients are often referred for neuromodulatory interventions such as transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), vagus nerve stimulation (VNS) and deep brain stimulation (DBS). Some also consider infusion (or inhaled) therapies such as the use of ketamine within this interventional family of treatments.

Interventional psychiatry is an emerging subspecialty that, based on years of neuroscience research, utilizes technologies to identify dysfunctional brain circuitry underlying psychiatric disorders and apply brain stimulation techniques to modulate that circuitry. Recently, techniques have been refined and vastly improved, and new treatments have been developed, and novel therapeutic targets have been explored.

Despite grossly misrepresented in the popular media, these treatment alternatives are based on procedures that are not (ECT, TMS) or minimally (ketamine infusion, VNS, and DBS) invasive, performed in controlled environments, and not painful at all. Furthermore, they often result in a much faster and robust response than observed with other treatment modalities, and allow for a less aggressive use of medications. A referral for these options requires careful screening of eligibility criteria, presence of relative or absolute contraindications, and connection with an experienced provider in the specific modality for the specific protocol required in each patient’s illness.
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Co-occurring Medical
or Neurological Conditions

MPsychosomatic medicine is an interdisciplinary medical field exploring the relationships among social, psychological, and behavioral factors on bodily processes and quality of life in humans and animals. The academic forebear of the modern field of behavioral medicine and a part of the practice of consultation-liaison psychiatry, psychosomatic medicine integrates interdisciplinary evaluation and management involving diverse specialties, which include psychiatry, psychology, neurology, internal medicine, surgery, allergy, dermatology and psychoneuroimmunology.

Clinical situations where mental processes act as a major factor affecting medical outcomes are areas where psychosomatic medicine has competence. Patients with psychiatric illnesses may also be at higher risk for the development of certain medical problems. These medical problems impact mental or emotional conditions. Furthermore, complex drug interactions between general medical drugs and psychotropics need to be taken into account.

Our consultations for Severe Medical Comorbidities and HIV focuses on helping physicians navigate and guide them through the management of coexisting mental and emotional symptoms that often accompany other chronic medical conditions. Systemic illnesses such as HIV, cancer, or autoimmune diseases affect multiple dimensions of mental wellbeing and other bodily functions simultaneously. Successful management of all aspects of health depends on delicate management of the conditions and of the multiple treatments the patient is often receiving. Integration of neurological, immunological, endocrine, cardiovascular systems, and others is key in order to restore functioning and quality of life.
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Medication Assisted Treatments for Addiction

The Maia Institute offers assessment and treatment recommendations for patients suffering from substance use disorders to include medications used in the treatment of addictions. The services are geared towards opioid addiction, offering recommendations such as buprenorphine (Suboxone) treatment, a treatment method administers strategically-determined doses of buprenorphine to clients to stave off noxious symptoms of opioid withdrawal. This treatment offers several advantages over other comparable treatment modalities, such as methadone, including:

Medication assited treatments

Buprenorphine is long-lasting; therefore, dosing schedules are simple for clients to keep up with; The likelihood of overdosing on buprenorphine is slim; By suppressing distracting withdrawal symptoms, clients are able to focus more on making positive lifestyle changes. The Maia Institute recognizes that overcoming addiction is a rewarding, albeit a mentally and physically challenging, process. Therefore, our Addictions Consultations validates client experiences while also striving to provide recovery by transforming addiction into life-long patterns of healthy behavior.

Medication-Assisted Treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders. Research shows that when treating substance-use disorders, a combination of medication and behavioral therapies is most successful.

Medication-Assisted Treatment (MAT) is a form of pharmacotherapy and refers to any treatment for a substance use disorder that includes a pharmacologic intervention as part of a comprehensive substance abuse treatment plan with an ultimate goal of patient recovery with full social function.

In the US, MAT has been demonstrated to be effective in the treatment of alcohol dependence with Food and Drug Administration approved drugs such as disulfiram, naltrexone and acamprosate; and opioid dependence with methadone, naltrexone and buprenorphine.

As part of a comprehensive treatment program, MAT has been shown to:

  • Improve survival
  • Increase retention in treatment
  • Decrease hepatitis and HIV seroconversion
  • Decrease criminal activities
  • Increase employment
  • Improve birth outcomes with perinatal addicts
Medications for Alcohol Dependence
Medications for Opioid Dependence

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Medical Review Officer

AMedical Review Officer (MRO) M.R.O. is defined by 49-CFR part 40 – Section 1.2 as, “A licensed physician responsible for receiving laboratory results generated by an agency’s drug testing program, who has knowledge of substance abuse disorders, and has appropriate medical training to interpret and evaluate an individual’s positive test result, together with his or her medical history and all other relevant biomedical information.” MROs are authorized to perform MRO services with respect to all covered employees, wherever they are located (i.e. across state or international boundaries).

Medical review officer

As an MRO, a physician acts as an independent and impartial "gatekeeper" and advocate for the accuracy and integrity of the drug testing process. This means the MRO must be knowledgeable about and have clinical experience in controlled substance abuse disorders, including detailed knowledge of alternative medical explanations for laboratory-confirmed drug test results. The MRO needs to be knowledgeable about issues relating to adulterated and substituted specimens as well as the possible medical causes of specimens having an invalid result. The MRO provides a quality assurance review of the drug testing process for the specimens under purview, determines if there is a legitimate medical explanation for laboratory confirmed positive, adulterated, substituted, and invalid drug test results, ensures the timely flow of test results and other information to employers, and protects the confidentiality of the drug testing information.

The Medical Review Officer (MRO) field is complex and rapidly evolving due to technical advances, regulatory changes, and new patterns of abuse. Testing for substances of abuse is now the rule, rather than the exception, in settings as diverse as the workplace, the doctor's office, and many schools throughout the country. The Drug-Free Workplace Act affects all federal agencies. Mandatory alcohol and drug testing is now required of all intrastate truckers, commercial driver's license holders, and other transportation workers. Joint government agreements between the United States, Canada, and Mexico monitor truckers crossing international borders. Federal regulations require MRO qualification and requalification training, followed by certification and recertification by a nationally recognized Medical Review Officer Certification board every 5 years.

Like all other service providers, an MRO performs an important function in the DOT safety program; as such, it is important for the physician to be knowledgeable about and fully understand the DOT MRO guidelines and agency regulations. Therefore, the MRO should be familiar with 49 CFR Part 40 while paying particular attention to the following:


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