The Jesalva Algorithm: Introduction

​ I’ve come to refine my treatment approach to my patients in the last 30 years.  I’ve been blessed with the ability to successfully treat most of them who have very complex multiple co-occuring disease states.  I am calling this treatment method “The Jesalva Algorithm.”

​The Jesalva Algorithm is a method of diagnosing and treating patients with complex comorbidities. It is my own personal way of conceptualizing these challenging patients into a framework that is comprehensive yet addresses the unique needs of each individual patient so that they can return to normal functioning in society.
I’m sure that my algorithm is not unique with other psychiatrist’s approach.  I use this in my community which is in the Southern California area encompassing Thousand Oaks, Westlake Village, Malibu, Woodland Hills, Agoura Hills, Camarillo and Simi Valley areas.
However, I do feel that it takes time and effort to obtain the historical information from a patient so that a clinician can have all of the information necessary to make a diagnosis and treatment decision.  This effort takes patience and sometimes intuitiveness on the clinician’s part.  It is these attributes that a clinician needs that make the algorithm unique.
The elements are the following:

1. The patient has to be motivated to change.
2. Comorbidity or co-occurring disorders is the RULE rather than the exception.
3. Screen for the 5 most common disorders in private practice.  They are:
   1. Major Depressive Disorder (MDD)
   2. Bipolar disorder (BPD) including BPD-2, cyclothymic disorder, bipolar spectrum disorder.
   3. Anxiety Disorders
   4. Attention Deficit Hyperactivity Disorder (ADHD)
   5. Substance use disorders:
4. Anxiety is the biggest obstacle in achieving optimal functioning.
5. Treat until the patient is well, that is, to remission.
6. Genomic testing.