“We Need a Journal of Practical Psychiatry”, He said…

The other day one of my residents remarked that “We need a Journal of Practical Psychiatry,” or something like that in order to more effectively guide psychiatrists in the every day clinical world in which we practice, specifically consultation psychiatry. He doesn’t have anything against theory or research psychiatry.

I tend to agree with him. Realizing he was just pulling what he thought was an imaginary journal name off the top of his head to illustrate what he meant, I googled “The Journal of Practical Psychiatry” on a whim.

I found it, much to my surprise. Well, I sort of found it. Actually what I discovered was an old journal called “The Journal of Practical Psychiatry and Behavioral Health (JPPBH)”. It was published between 1995 and 1999. My immediate thought was, “that’s not a very long life for a journal.”

In fact, the JPPBH lives on in the Journal of Psychiatric Practice. Those of us in academia have full electronic access to it through an institutional subscription, though it is designed for psychiatrists and psychologists in private practice.

I’m not trying to fuel any “town and gown” conflict, but I had a quick look at the July 2013 issue which contained an intriguing article, “The 100 Top-Cited Articles Published in Psychiatric Journals” by Shahrzad Mazahri, MD, PhD [1]. The list was what I wanted to see, after all, but there was a problem.

The table containing the list was illegible. Also, the original articles were classified into several categories including “medical psychiatry”…but none of the articles fit that category, though, of course, that was not the author’s fault.

However, the top ten list of most influential journals was legible and included Psychosomatic Medicine, the journal of the American Psychosomatic Society (AMS), an international society which has been more focused on research. Somehow, Psychosomatics, the journal of the Academy of Psychosomatic Medicine (APM, traditionally an organization of very practical psychiatrists working as consultants in general hospitals), didn’t make the cut. Dang. The Journal of Psychiatric Practice is not on the list, either.

It’s a bit ironic that the AMS periodical is listed in a practical journal, since the AMS has been informally distinguished from the APM (and maybe by extension, its journal Psychosomatics) by the more practical focus of the latter.

The AMS and the APM made a formal agreement to collaborate more closely at the 2006 APM Annual Meeting in Tucson, Arizona. The theme of the meeting was “Defining the Scope of Psychosomatic Medicine.” By the way, the 2013 Annual Meeting is also in Tucson, see the APM web site for details, Academy of Psychosomatic Medicine — Home Page.

The impression that the field was dichotomized into research and practical applications was noted by members of both organizations. This was highlighted at the 2006 APM Annual Meeting, an important milestone because it was three years after the Psychosomatic Medicine subspecialty status was approved by the Accreditation Council of Graduate Medical Education (ACGME). I think it was during either the Presidential Address or the Presidential Symposium, one speaker remarked that practitioners of “…psychosomatic medicine may well be lost in thought while…C-L psychiatrists are lost in action.”

I can think of another practical journal, Annals of Clinical Psychiatry, and not just because it published a case report I wrote about sedative-hypnotic-induced withdrawal catatonia [2]. In fact, there’s a very practical article in the very same issue about how to distinguish neuroleptic malignant syndrome (NMS) from serotonin syndrome [3].

I almost forgot the article I wrote on Maintenance of Certification (MOC) and Maintenance of Licensure (MOL), published by The Carlat Report: Psychiatry [4]. The Carlat Report is a very practical subscription monthly, mainly for mental health care professionals in private practice, but also very useful for academicians.

The bottom line is we need both theory and practical application, knowledge on the right thing to do and instruction on how to do the thing right.

We need the inspiration for the music…and the performance.

References:

1. Mazhari, S. (2013). “The 100 top-cited articles published in psychiatric journals.” J Psychiatr Pract 19(4): 327-338.
An examination of top-cited articles is a tool that can be used to identify and monitor outstanding scientific research. The goal of this study was to identify and analyze the characteristics of the 100 top-cited articles published in international journals dedicated to psychiatry. The Science Citation Index Expanded provided by the Thomson Reuters Institute for Scientific Information Web of Knowledge was searched in December, 2011, and 128 journals were identified in the subject category “Psychiatry.” Each journal was searched on the Web of Science under “Publication Name” and the results were sorted by category “Times Cited.” The 100 top-cited articles were recorded, and the list was analyzed with regard to journals, number of citations, authors, year, institution, and country of origin. The original research articles of the 100 top-cited articles were classified into one of five categories: scale/measurement, descriptive/epidemiology, mechanism, management, and imaging. The 100 top-cited articles were cited between 26,578 and 781 times; they were published between 1957 and 2005, with the largest number (35) published in the 1990s. The articles appeared in 24 journals, with more than half published in the Archives of General Psychiatry (56), followed by the American Journal of Psychiatry (6), and Psychological Medicine (6). Articles that dealt with the development, application, or validity of measurements led the list of top-cited psychiatric publications (43) and had a significantly higher number of citations compared with the rest of the articles. The time and language of publication, field of study, country of origin, and journal in which the paper appeared are possible determinants of the likelihood of citation and impact. (Journal of Psychiatric Practice 2013;19:327-338).

2. Amos, James J., M.D., (2012). “Lorazepam withdrawal-induced catatonia.” Annals of Clinical Psychiatry 24(2).
Catatonia can be associated with a number of medical and psychiatric disorders including sedative-hypnotic withdrawal. The mechanism is unclear but may involve γ-aminobutyric acid (GABA) transmission changes. I report a case of lorazepam withdrawal-induced catatonia in a postsurgical patient who had been taking lorazepam at home as prescribed by her psychiatrist. This case begs the question of whether to continue previously prescribed benzodiazepines in the intensive care unit (ICU) postoperatively in light of a recent study showing that lorazepam administration in this context is an independent risk factor for delirium.

3. Perry, P. J. and C. A. Wilborn (2012). “Serotonin syndrome vs neuroleptic malignant syndrome: A contrast of causes, diagnoses, and management.” Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists 24(2): 155-162.
BACKGROUND: Serotonin syndrome (SS) and neuroleptic malignant syndrome (NMS) are uncommon but potentially life-threatening adverse reactions associated with psychotropic medications. Polypharmacy and the similar presentation of SS and NMS make diagnosis of the 2 syndromes problematic. METHODS: A MEDLINE search was performed for the period 1960 to 2011 for case reports, review articles, and studies pertaining to SS and NMS. RESULTS: The majority of available literature on SS and NMS consists of case reports, case-control studies, and retrospective reviews. In addition, diagnostic criteria have been developed to aid in the diagnosis and management of SS and NMS. CONCLUSIONS: SS presents as mental status changes, autonomic nervous system disturbances, neurologic manifestations, and hyperthermia. Similarly, NMS presents as muscle rigidity, hyperpyrexia, mental status changes, and autonomic instability. However, the clinical laboratory profile of elevations in creatine kinase, liver function tests (lactate dehydrogenase, aspartate transaminase), and white blood cell count, coupled with a low serum iron level, distinguishes NMS from SS among patients taking neuroleptic and serotonin agonist medications simultaneously. For both SS and NMS, immediate discontinuation of the causative agent is the primary treatment, along with supportive care. For NMS, dantrolene is the most effective evidence-based drug treatment whereas there are no evidence-based drug treatments for SS. A 2-week washout of neuroleptic medication minimizes the chance of recurrence.

4. Amos, J. J., M.D., (2013). Maintenance of Certification and Maintenance of Licensure, The Carlat Report: Psychiatry. 11.

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Comments

  1. Mary Brandes says:

    Have you listened to the Vivaldi Sonata in D major for lute or guitar? The second movement is a very favorite of mine.

    Like

    • Mary,

      Help me find a YouTube video of such a sonata and I will dedicate it to you! All I could find was one that sounds like it was cut off, http://www.youtube.com/watch?v=JG0qW9NIrmc and another in which a gentleman plays the instrument known as la telefona de polia (telephone pole), which drags on for more than 10 minutes!

      In fact, I know as much about classical music as I know about interior design or Break-Dancing Koala Bears–another way of saying I know nothing whatever about it. I heard the one in this post on the radio while driving to work.

      Mary, you must write something to educate me so I can post it with your favorite version of the Vivaldi Sonata in D major for lute or guitar, second movement–without the telephone pole! Maybe a reader could help us find a proper rendition a la YouTube.

      It’s wonderful to hear from you,

      J. Amos, MD

      Like

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