e-mail: ns@mblcommunications.com

 

Dr. Sussman is editor of Primary Psychiatry as well as professor of psychiatry and interim chairman in the Department of Psychiatry at the New York University School of Medicine in New York City.

Dr. Sussman reports no affiliation with or financial interest in any organization that may pose a conflict of interest.


 

The function of any medical journal is to provide readers with information that can be translated into better understanding their patients, their illnesses, and the most effective ways to prevent or treat those conditions. As editor of Primary Psychiatry, I endeavor each month to ensure that the content of the publication is accurate and balanced. Topics for issues and individual articles are selected based on their merits. Despite the efforts of myself and the editorial staff, there is much more that clinicians need to know than we can print or put on our Website. Thus, like our readers, I am constantly looking for sources of easily accessed information that may be relevant to clinical decision making, teaching, and writing. 

One problem that I encounter with many psychiatry Websites is a content bias. Most contain information that is unduly weighted toward therapeutic areas or disease states that are associated with medications that are still on patent. I have been searching for a Website that I can log onto every morning, or whenever I want to scope out what is new in the field. For the most part, I have set up Google alerts to notify me about reports involving topics I follow.

However, just last week I was pleasantly surprised when my colleague at the New York University School of Medicine, David L. Ginsberg, MD, alerted me to a Website I had never visited called MedlinePlus.1 There is no advertising on this Website. The home page has a feature on current health news, which provides access to late-breaking articles of interest. A person can search for specific topics as well. For example, I was interested in anticonvulsants and birth defects, mainly because these drugs are frequently used to treat bipolar disorder. My search directed me to a very helpful article2 from a neurology journal that I would not otherwise run across. I read the following:

“The finding of worse anatomic and neurodevelopmental outcomes following fetal valproate exposure in multiple studies suggests that it poses a special risk. Thus, it seems prudent not to use valproate as a first choice antiepileptic drug in women of childbearing age. When valproate is employed in women of childbearing potential, dosage should be kept as low as possible since its effect appears to be dose dependent…. Lamotrigine and carbamazepine may have a specific risk for cleft lip/palate but with an overall modest risk for major malformations.”

MedlinePlus gathers information from National Library of Medicine, the National Institutes of Health, and other government agencies and health-related organizations. Preformulated MEDLINE searches are included and link to medical journal articles. There are numerous links to other sites that are very useful. To test the Website, I clicked on the topic “Panic Disorder” on the link to ClinicalTrials.gov. It provided specific information about 36 clinical trials that are currently recruiting subjects. This Website will prove very helpful for clinicians who want to refer patients to research protocols.

While I hope that readers continue to consider Primary Psychiatry and its Website3 as a regular source of information, the fact is that in the Internet age, no single Website can provide comprehensive access to emerging clinical and research publications. I would appreciate readers letting me know of Websites that they find helpful, and in a future issue we can publish a list of these sites.

I want call attention to a review article in this issue by Jagoda Pasic, MD, and colleagues, discussing factitious disorders, a puzzling, curious, but nevertheless serious illness. Patients with factitious disorder perplex caregivers in terms of accounting for the patient’s motivation in feigning illness, making the diagnosis, and determining how to treat the disorder once it is recognized. As the authors note, these cases are especially challenging in the initial, emergency department setting, where clinicians have no access to historic data. Even if factitious illness is suspected, genuine illness needs to ruled out. The authors present two patients who sought emergency psychiatric care and discuss diagnostic and treatment issues. They offer psychological explanations for staff and clinicians’ reactions and suggest interventions that may prove useful in the emergency setting.

I also want to welcome David N. Neubauer, MD, who, starting with this issue, will contribute a regular column entitled “Clinical Updates in Sleep Medicine.” Dr. Neubauer is associate director of the Johns Hopkins Sleep Disorders Center and assistant professor in the Department of Psychiatry at the Johns Hopkins University School of Medicine in Baltimore, Maryland.

Finally, I would like to thank the excellent and hard work of our peer reviewers, without whom we could not maintain the high standards of the journal. PP

References

1.    MedLinePlus. Available at: http://medlineplus.gov. Accessed December 10, 2008.
2.    Meador KJ, Pennell PB, Harden CL, et al. Pregnancy registries in epilepsy: a consensus statement on health outcomes. Neurology. 2008;71(14):1109-1117.
3.    Primary Psychiatry. Available at: www.primarypsychiatry.com. Accessed December 16, 2008.