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evidence based psychiatry

Discussion in 'Psychiatry' started by gyri, Nov 25, 2003.

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  1. gyri

    gyri Member 7+ Year Member

    Oct 29, 2002
    I'd really appreciate it if people would provide links to or citations for (or even just a push in the general direction of) good quality journal articles on good quality studies of different psychiatric therapies, both pharmaco- AND psycho-.

    I am going into psychiatry, and I'd like to have a better handle on what has been studied and what has been shown to work.

    I would also like to have some rebuttals handy for the folks out there (some of whom I seem to be related to) who are skeptical that "psychiatry really works" and that "psychiatric patients really do get better."

    Thanks in advance to all who can help!
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  3. Thewonderer

    Thewonderer Senior Member 10+ Year Member

    Oct 20, 2001
    I am not too sure if I understand you. American Journal of Psychiatry and Journal of Clinical Psychiatry are two big journals in the field.

    ACP Journal club promotes evidence-based medicine and does reviews on articles published. Not sure how many psych articles they manage to review

    Lastly, psych is just a field that has not lent itself well to evidence-based medicine. There is certain amount of subjectivity in psych eveluation and even more in psychotherapy, especially psychoanalysis (people just do it differently from one to another). Secondly, patient recruitment is a big big issue in psych. In cardiology, you see randomized, control trials involving 2000+ patients easily. But in psych, recruitment is hard due to the stigma associated with psych illnesses. Coupled with the fact that many pts are paranoid schizophrenia, you aren't going to convince them to enter your study. Also, patients simply do not stay that many days in the hospital (insurance would not pay for it) and many hospitals are moving psych inpt to outpt where it brings them more revenues. Once that move is made, with only 24 inpt beds available, you cannot recruit the number you need to truly randomize the population.

    However, that does not mean the field does not need EBM. in fact, it needs but that will be up to future researchers to do the necessary pt recruitment.
  4. gyri

    gyri Member 7+ Year Member

    Oct 29, 2002
    I understand the pitfalls of research in psych...but I'm pretty sure that throughout medical school, I have heard things like, "DBT has been shown to be effective in borderline patients," or "psychotherapy [CBT?] combined with meds to tx depression has been shown to be more effective than either alone," or "no one antidepressant is more effective than others...prescribe based on side effect profiles." So it seems like, however sparse, there must be some developing body of psychiatric literature that attempts to use high[er] level evidence.

    Just wanting some articles to read about such studies...

    does anyone remember reading anything particularly interesting or encouraging? What are therapies that have been studied well and shown to work?

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