GLOBAL PSYCHIATRY ARCHIVES

As part of the intention to document the recent and current history of psychiatry, I was asked to present memories of my involvement in psychiatry over the past 50 years. Reviewers suggested that I should start this personal history of psychiatry with a summary of my curriculum vitae because this will make it easier to place the events I describe into their historical context. Here it goes, then.

Medical education curricula, from around the world, have often neglected psychiatry as a subject of importance in undergraduate medical training.
In India, the scenario has not been different from the rest of the world. The National Mental Health Survey done in India, recently, estimates a treatment gap of around 80–85% for various mental illnesses. This provides a strong case to strengthen the undergraduate psychiatry curricula since it would help tackle the treatment gap of common mental disorders in the community.
Further, a strong educational foundation with meaningful inclusion of mental health and well-being, will also make the trainee aware of their own mental well-being and better help seeking behaviour in the medical student. In this article, we look to review the evolution of undergraduate medical education in India.

Background
There is evidence of a progressive increase in the number of Randomized Controlled Trials (RCTs) in the area of psychiatry. However, some areas of psychiatry receive more attention from researchers potentially to the detriment of others.


Methods
Aiming to investigate main gaps for RCTs in psychiatry, the present bibliometric study analysed the bi-annual and five-year rates of RCTs in the main database of medical studies (Pubmed) over the 1999–2018 period (n = 3,449). This analysis was carried out using the ICD-10 mental and behavioural chapter. ICD-10, was the edition of the manual used throughout the above period.


Results
Overall, after 16 years of considerable increase in the bi-annual absolute number of RCTs, there has been a slowdown in the last 4 years, similar to other medical areas. Affective, organic and psychotic disorders, and depression, schizophrenia and dementia were the top studied groups and disorders respectively – ahead of other groups/diagnoses. For substance use disorders, there has been a decrease of RCT in the last 5 years, in line with the fall of alcohol use disorder in the ranking of most studied disorders. Delirium and mild cognitive disorder are both ascending in this ranking. Personality disorders and mental retardation stand out as the least studied groups over the whole assessment period.


Conclusion
Novel treatments, ease of access to patient populations, and ‘clinical vogue’, seem to be more important in guiding the undertaking of RCTs than the actual need as indicated by prevalence and/or burden of disorders and public health impact. Regarding specific disorders, acute/transient psychosis; mixed anxiety and depression; adjustment disorder; dissociative and conversion disorders; somatization; hypochondria; and neurasthenia, would deserve future RCTs. Clinical researchers and editors of scientific journals should give special attention to the less studied areas and disorders, when considering conducting and publishing RCT studies, respectively.










 

Many books and other published recommendations provide a large, sometimes excessive amount of information to be included, and of mistakes to be avoided in research papers for academic journals. However, there is a lack of simple and clear recommendations on how to write such scientific articles. To make life easier for new authors, we propose a simple hypothesis-based approach, which consistently follows the study hypothesis, section by section throughout the manuscript: The introduction section should develop the study hypothesis, by introducing and explaining the relevant concepts, connecting these concepts and by stating the study hypotheses to be tested at the end. The material and methods section must describe the sample or material, the tools, instruments, procedures and analyses used to test the study hypothesis. The results section must describe the study sample, the data collected and the data analyses that lead to the confirmation or rejection of the hypothesis. The discussion must state if the study hypothesis has been confirmed or rejected, if the study result is comparable to, and compatible with other research. It should evaluate the reliability and validity of the study outcome, clarify the limitations of the study and explore the relevance of the supported or rejected hypothesis for clinical practice and future research. If needed, an abstract at the beginning of the manuscript, usually structured in objectives, material and methods, results and conclusions, should provide summaries in two to three sentences for each section. Acknowledgements, declarations of ethical approval, of informed consent by study subjects, of interests by authors and a reference list will be needed in most scientific journals.