Psychiatry clerkship: a review of the concept

The concept of psychiatric clerkships as part of undergraduate medical education was examined. All relevant English literature from the last eight years was surveyed and discussed in four parts: 1) The goals and objectives of psychiatric clerkships were examined. The author concluded that there is a need to further differentiate educational goals of the clinical years from the pre-clinical years. Two major requirements for a successful clerkship were patient responsibility and adequate faculty supervision. 2) The significance of the clerkship setting was evident from the survey as settings were found to influence the students' attitudinal development and also the development of clinical judgement. 3) The effects of psychiatric clerkships on the students, patients, and faculty were discussed and felt to be an requiring further exploration. 4) The problems of evaluation were addressed. From the survey, it appeared that the clerkship experience was of particular value in modifying student attitudes to mental illness. Attempts to evaluate the acquisition of clinical skills and judgement were reviewed. The paper concluded by outlining areas requiring further exploration and research so that the concept of psychiatric clerkships can be further developed.     

Psychiatry in chronic pain: A review and update

As the field of pain management nears the halfway point of the Congressionally declared “Decade of Pain Control and Research,” the prevalence of chronic pain and disability related thereto continue to escalate. In the context of rising costs and suffering associated with persistent pain worldwide, the chronic pain research community has increasingly recognized and investigated the role of the cognitive and affective dimensions of pain. In this paper, the authors review psychologic aspects of pain, psychopathology in chronic pain syndromes, suicidality in this population, and the use of psychotropic medications for treatment in these patients. Where possible, the authors have outlined limitations of previous research in these areas, and have highlighted and described recent studies that have addressed these perceived shortcomings. The role of the psychiatrist in the treatment of patients with chronic pain is reviewed.     

The history of parkinsonism: Descriptions in ancient Indian medical literature

The clinical syndrome of parkinsonism was identified in ancient India even before the period of Christ and was treated methodically. The earliest reference to bradykinesia dates to 600 bc . Evidences prove that as early as 300 bc , Charaka proposed a coherent picture of parkinsonism by describing tremor, rigidity, bradykinesia, and gait disturbances as its components. The scenario was further developed by Madhava, Vagbhata, and Dalhana all through history. The 15th‐century classic “Bhasava rajyam” introduced the term kampavata, which may be regarded as an ayurvedic analogue of parkinsonism. The pathogenesis of kampavata centered on the concept of imbalance in the vata factor, which controls psychomotor activities. The essential element in therapy was the administration of powdered seed of Mucuna pruriens, or atmagupta, which as per reports, contains 4%?6% of levodopa. In addition to proving the existence and identification of parkinsonism in ancient India, the study points to the significance of ancient Indian Sanskrit works in medical history. © 2013 Movement Disorder Society     

Mayo Seminars in Psychiatry: dopamine and schizophrenia--a review.

Considerable evidence exists linking dopamine with schizophrenia. Other neurotransmitters including acetylcholine, serotonin and gamma-aminobutyric acid (GABA) are also being implicated. Neurotransmitters act via receptors on brain cells and evidence suggests that antipsychotic drugs exert their therapeutic actions and produce side effects by receptor blockade.     

Single-enhancing CT lesions in Indian patients with seizures: a review

Single enhancing CT lesions are the commonest radiological abnormality in Indian patients with new-onset partial seizures. In few patients the lesions may be 'tuberculoma' (especially in presence of evidence of tuberculosis elsewhere). However, histopathological studies have proved that neurocysticercosis is the most frequent cause for these lesions. Acute inflammation in and around the cerebral lesions of cysticercosis manifests as acute seizure disorder. These cysticercal granulomas represent 'colloidal' and 'nodular-granular' stages of Escobar's pathological classification of natural evolution of a parenchymal cysticercus cyst. In 8-12 weeks time majority of these lesions spontaneously disappear, few may calcify. As albendazole therapy is of controversial value, these patients, possibly, need to be treated only with antiepileptic drugs. Associated seizure disorder is also benign in nature and remit in majority within 6-8 months, recurrences are usually infrequent. Antiepileptic drug may be withdrawn once follow-up CT scan shows resolution of the lesion. If seizures recur after resolution of the lesion, CT lesion persists or CT lesion calcified, a long-term (2-3 years) antiepileptic therapy may be required. The single enhancing CT lesions which persist despite anticysticercal or antituberculous therapy may need histopathological evaluation to establish the correct diagnosis.     

Cerebrovascular diseases: a review of the Indian experience in the last 35 years

The relevant literature on cerebrovascular diseases from the Indian subcontinent in the last 35 years has been reviewed. Most of the data available are from retrospective studies carried out in various large urban hospitals. The incidence of stroke reported is less when compared with western figures, which may be a reflection of the population at risk. The incidence of stroke in the young Indians below the age of 40 years is higher compared to other countries, which again may be a statistical aberration or may be due to local aetiological factors. Ischaemic cerebrovascular complications of pregnancy and puerperium occur frequently, but the total picture is probably the same as elsewhere in the world.     

Viewpoint: Methodological Issues in Psychiatry: Psychiatry as an Empirical Science

The paper reflects the empirical position of psychiatry as a research discipline. Principles of empirical research are discussed, such as the generation of empirical hypotheses, the falsification of hypotheses, the logical structure of theories, etc. It is discussed to what extent these principles can be transferred to psychiatric research.

Articles published in the Viewpoint section of this Journal may not meet the strict editorial and scientific standards that are applied to major articles in The World Journal of Biological Psychiatry. In addition, the Viewpoints expressed in these articles do not necessarily represent those of the Editors or the Editorial Board.