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  Mens Sana Monographs
A Monograph Series Devoted To The Understanding Of Medicine, Mental Health, Man, Mind, Music And Their Matrix
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   2010| January-December  | Volume 8 | Issue 1  
    Online since January 9, 2010

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Of Sophists and Spin-Doctors: Industry-Sponsored Ghostwriting and the Crisis of Academic Medicine
Leemon McHenry
January-December 2010, 8(1):129-145
DOI:10.4103/0973-1229.58824  PMID:21327175
Ghostwriting for medical journals has become a major, but largely invisible, factor contributing to the problem of credibility in academic medicine. In this paper I argue that the pharmaceutical marketing objectives and use of medical communication firms in the production of ghostwritten articles constitute a new form of sophistry. After identifying three distinct types of medical ghostwriting, I survey the known cases of ghostwriting in the literature and explain the harm done to academic medicine and to patients. Finally, I outline steps to address the problem and restore the integrity of the medical literature.
  9 13,376 209
The Noncompliant Patient in Psychiatry: The Case For and Against Covert/Surreptitious Medication
KS Latha
January-December 2010, 8(1):96-121
DOI:10.4103/0973-1229.58822  PMID:21327173
Nonadherence to treatment continues to be one of psychiatry's greatest challenges. To improve adherence and thus improve the care of patients, clinicians and patients' family members sometimes resort to hiding medication in food or drink, a practice referred to as covert/ surreptitious medication. The practice of covert drug administration in food and beverages is well known in the treatment of psychiatrically ill world-wide but no prevalence rates exist. Covert medication may seem like a minor matter, but it touches on legal and ethical issues of a patient's competence, autonomy, and insight. Medicating patients without their knowledge is not justifiable solely as a shortcut for institutions or families wishing to calm a troublesome patient and thus alleviate some of the burdens of care giving. The paramount principle is ensuring the well-being of a patient who lacks the competence to give informed consent. Ethically, covert/surreptitious administration can be seen as a breach of trust by the doctor or by family members who administer the drugs. Covert medication contravenes contemporary ethical practice. Legally, treatment without consent is permissible only where common law or statute provides such authority. The practice of covert administration of medication is not specifically covered in the mental health legislation in developing countries. Many of the current dilemmas in this area have come to public attention because of two important developments in medical ethics and the law - the increasing importance accorded to respect for autonomy and loss of the parens patriae jurisdiction of the courts [parens patriae means 'parent of the country'; it permitted a court to consent or refuse treatment on behalf of an 'incapacity', or alternatively to appoint a guardian with such powers].
  9 19,066 209
The Pharmacotherapy of Alcohol Dependence: A State of the Art Review
Avinash De Sousa
January-December 2010, 8(1):69-82
DOI:10.4103/0973-1229.58820  PMID:21327171
The psychopharmacology of alcohol dependence is today poised at interesting crossroads. Three major drugs Naltrexone, Disulfiram and Acamprosate have been tried and tested in various trials and have many meta-analyses each to support them. While Naltrexone may reduce craving, Acamprosate scores on cost effectiveness worldwide with Disulfiram being an alcohol deterrent drug. Studies support, refute and criticize the use of each of these drugs. Combining one or more of them is also a trend seen. The most important factor in efficacy has been the combination of psychosocial treatment with medication. Studies from the early 1970s to date have been reviewed and the findings presented in a manner useful for the busy clinician to judge the best pharmacological option in the management of alcohol dependence. The role of depot disulfiram, naltrexone, and medications like Topiramate and SSRIs under research for alcohol dependence, are also addressed.
  7 8,615 326
Modern Medicine: Towards Prevention, Cure, Well-being and Longevity
Ajai R Singh
January-December 2010, 8(1):17-29
DOI:10.4103/0973-1229.58817  PMID:21327168
Modern medicine has done much in the fields of infectious diseases and emergencies to aid cure. In most other fields, it is mostly control that it aims for, which is another name for palliation. Pharmacology, psychopharmacology included, is mostly directed towards such control and palliation too. The thrust, both of clinicians and research, must now turn decisively towards prevention and cure. Also, longevity with well-being is modern medicine's other big challenge. Advances in vaccines for hypertension, diabetes, cancers etc, deserve attention; as also, the role of meditation, yoga, spirituality etc in preventing disease at various levels. Studies on longevity, life style changes and healthy centenarians deserve special scrutiny to find what aids longevity with wellbeing. A close look at complementary and alternative medicine is needed to find any suitable models they may have, cutting aside their big talk and/or hostility towards mainstream medical care. Medicine is a manifestation of the human eros, and should not become a means of its thanatos. It must realise its true potential, so that eros prevails, and thanatos prevails only ultimately, not prematurely.
  6 10,283 389
Psychopharmacology Today: Where are We and Where Do We Go From Here?
Thomas L Schwartz
January-December 2010, 8(1):6-16
DOI:10.4103/0973-1229.58816  PMID:21327167
Since the 1950s we have had the same three neurotransmitters to work with to treat depression, one transmitter for psychoses, three for anxiety. We have developed newer drugs that are more tolerable, but we have not developed drugs that are better in efficacy. The last 50-60 years should be considered the decades that allowed us to treat a greater number of patients with safer and more tolerable drugs. We have also decreased stigma and allowed primary care clinicians to become more comfortable treating the mentally ill. We clearly treat more patients than before, and sometimes are now accused of over-prescribing wantonly as our drugs are safer. Without any clear blockbuster new drug ready to be added to our armamentarium, what can we do as psychopharmacologists today, and tomorrow, to obtain better results? This introductory manuscript will attempt to provide an overview of ideas so that an adept, well-rounded clinician might be able to obtain better outcomes despite using neurotransmitter pharmacodynamics that have been around since the 1950s. Finally, I will comment on the psychotropic pipeline, which may be added to our armamentarium in the future.
  4 7,515 334
Lactating Mother and Psychotropic Drugs
BM Tripathi, Pradipta Majumder
January-December 2010, 8(1):83-95
DOI:10.4103/0973-1229.58821  PMID:21327172
Usage of psychotropics during pregnancy and lactation has always been a topic of debate and controversy. The debate stems from the potential adverse effects on the growing fetus or infants due to the transfer of psychotropic drugs through placenta or breast milk of mothers receiving them; and the problem of discontinuing psychotropics in lactating mother considering chances of relapse. However, most of the psychotropics are found to be relatively safe when used cautiously during the lactation phase. This article describes available data on the use of psychotropics in lactating mothers, in particular, in relation to the safety profile of infants.
  2 7,310 231
The Geriatric Population and Psychiatric Medication
Sannidhya Varma, Himanshu Sareen, JK Trivedi
January-December 2010, 8(1):30-51
DOI:10.4103/0973-1229.58818  PMID:21327169
With improvement in medical services in the last few years, there has been a constant rise in the geriatric population throughout the world, more so in the developing countries. The elderly are highly prone to develop psychiatric disorders, probably because of age related changes in the brain, concomitant physical disorders, as well as increased stress in later life. Psychiatric disorders in this population may have a different presentation than in other groups and some of psychopathologies might be mistaken for normal age related changes by an unwary clinician. Therefore the need of the day is to train psychiatrists and physicians to better recognize and manage mental disorders in this age group.
  2 9,476 293
Overlap of Autism and Seizures: Understanding Cognitive Comorbidity
Neha Khetrapal
January-December 2010, 8(1):122-128
DOI:10.4103/0973-1229.58823  PMID:21327174
This article introduces the concept of 'cognitive comorbidity,' which lays emphasis on common cognitive deficits that cut across different disorders. The concept is illustrated with the help of two commonly reported overlapping conditions (autism and epilepsy). It is further explained by concentrating on two important cognitive processes of facial emotional recognition and emotional memory, shown to be compromised in both conditions; and their underlying neural substrates. Cognitive comorbidity is then contrasted with 'comorbidity,' a term which is more commonly used for describing cognitive disorders. The paper closes by providing directions for rehabilitative and theoretical efforts that could be inspired by the newly introduced concept.
  2 5,117 190
Weight-Gain in Psychiatric Treatment: Risks, Implications, and Strategies for Prevention and Management
Amresh Shrivastava, Megan E Johnston
January-December 2010, 8(1):53-68
DOI:10.4103/0973-1229.58819  PMID:21327170
Weight-gain in psychiatric populations is a common clinical challenge. Many patients suffering from mental disorders, when exposed to psychotropic medications, gain significant weight with or without other side-effects. In addition to reducing the patients' willingness to comply with treatment, this weight-gain may create added psychological or physiological problems that need to be addressed. Thus, it is critical that clinicians take precautions to monitor and control weight-gain and take into account and treat all problems facing an individual. In this review, we examine some of the key issues surrounding weight-gain in individuals suffering from mental disorders for contemporary practitioners in community clinics. We describe some factors known to make certain patients more susceptible to treatment-induced weight-gain and mechanisms implicated in this process. We also highlight a few psychological and pharmacological interventions that have proven effective in weight management. Importantly, we provide critical steps for management and prevention of weight-gain and related issues in the clinical practice of psychopharmacology.
  1 8,451 222
Dr. Bagadia, Sir, is No More
Ajai R Singh
January-December 2010, 8(1):3-5
  - 3,933 122
Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications
Chittaranjan Andrade
January-December 2010, 8(1):146-150
  - 6,906 136
MSM 2010 Theme Monograph Psychopharmacology Today

January-December 2010, 8(1):1-2
  - 3,536 152
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