History Of Clinical Practice Research Articles

From Plant to Chemistry: Sources of Active Opioid Antinociceptive Principles for Medicinal Chemistry and Drug Design.

Pain continues to be an enormous global health challenge, with millions of new untreated or inadequately treated patients reported annually. With respect to current clinical applications, opioids remain the mainstay for the treatment of pain, although they are often associated with serious side effects. To optimize their tolerability profiles, medicinal chemistry continues to study novel ligands and innovative approaches. Among them, natural products are known to be a rich source of lead compounds for drug discovery, and they hold potential for pain management. Traditional medicine has had a long history in clinical practice due to the fact that nature provides a rich source of active principles. For instance, opium had been used for pain management until the 19th century when its individual components, such as morphine, were purified and identified. In this review article, we conducted a literature survey aimed at identifying natural products interacting either directly with opioid receptors or indirectly through other mechanisms controlling opioid receptor signaling, whose structures could be interesting from a drug design perspective.

History of anatomy and its involvement with medical science and practice: Historical review

The medical practice starts from Patient’s discomfort in his body structures due to distortion in morphology. This is located and examined by clinician so, medical practice and Anatomical knowledge are hand and gloves with each other. It is evident from history of Anatomy that Anatomy has been discovered by practicing physicians and surgeons. That clearly indicate that they could make the medical practice only after exploring the Anatomy. The source of knowledge of Anatomy were animal or human being as is evident from this review. The medical practice might have been started from evolution of human-being. Earlier some people were exploring the herbal medicine on the results of experiments on themselves for the effect of these medicines to treat their own discomforts. When it shewed the impact, they chose it to treat others for the same discomfort. That time they might not be knowing Anatomy but it was an empirical result. As the location of discomforts was associated with remedy so, this might have involved Anatomy. History of clinical practice and thereby Anatomy is as old as 1600BC. Earliar the people experimented on animals and then on cadavers and executed criminals. Then came different Anatomical Laws governing the use of cadavers. Now, current scenario is that there is lack of cadevers all over the world. To compensate for this, new methods including anatomage table, models and charts have been used to teach anatomy. But these novel methods can only supplement and cannot replace cadaveric dissections. It is very essential to know how Anatomy evolved and took present shape. This encouraged the author to review history of Anatomy and correlate with the simultaneously running clinical practice. The development of Anatomy has been presented along with its advancement with development of science and technology involved with medical education and clinical practice. Thus, Anatomy is not merely an academic subject in medical education rather Anatomy is needed to grasp all the subjects of medical education used to develop clinical skill for clinical practice. This has also been supported by history of Anatomy as all other subjects of medical education evolved from Anatomy. The interwoven interrelations between these subjects with clinical practice are essential as revealed by history of Anatomy to analyse the diagnosis and treatment.

Trends in Research on Art Therapy Indexed in the Web of Science: A Bibliometric Analysis.

Aim: Despite the increase in international research in art therapy, few studies have been developed with a bibliometric approach which describe the situation regarding this area of knowledge. Thus, the aim of this study is to describe and contextualize international scientific production in the visual arts modality in the context of artistic therapies, to offer a broader and more in-depth vision of the structure of this area of knowledge through of a bibliometric analysis of the publications indexed in the core collection of the Web of Science.Methods: This is a retrospective, exploratory and descriptive, cross-sectional study to analyze the bibliographic data retrieved from the databases of the core collection. The analysis parameters included the data corresponding to the production according to type of document, country, journal, and institution. In addition, the main lines of research were located and classified and the subject matter of the most cited articles in each of them was summarized. Four periods were selected, between 1994 and 2020, to facilitate the thematic analysis and offer an evolutionary perspective of art therapy research.Results: A total of 563 works were published, in 250 journals, in the 63 years between 1958, when the first document was published, and April 2021. The annual growth rate was 7.3% with a mean average of 8.7 publications per year, and 83.13% of the published works were articles. A total of 1,269 authors from 56 countries were counted. The mean number of citations per document was 5.6 and the mean number of citations per document and year was 0.6. The main research domains were psychology and/or rehabilitation and the highest production on this topic was concentrated in only three journals. In general, a high degree of variability was observed in the study topics and numerous theoretical and methodological articles. The most used visual arts modalities were in the main drawing, painting and photography.Conclusion: This work did not find previous existence of any bibliometric analysis on the international scientific production in art therapy. In general terms, there has been a substantial growth in the number of publications on the subject over the last decade. However, this research area does not appear to have peaked, but, on the contrary, is still growing and progressing despite its long history in clinical practice.

Perceived professional competence in spiritual care and predictive role of spiritual intelligence in Iranian nursing students

Aim/objectiveThe aim of this study was to identify the relationship between perceived competence in spiritual care and spiritual intelligence among nursing students. BackgroundOne of the most important duties of nurses is to pay attention to the spiritual needs of patients and provide them with proper spiritual care. Therefore, professional competence in this area is essential for nurses and nursing students. Also, spiritual intelligence is a factor influencing the caring behaviors of nurses. DesignA cross-sectional and correlational study Settings/ParticipantsThis study was included 510 undergraduate nursing students in two public faculties of nursing in Iran in the 2018-2019 academic year. MethodsThe samples were selected using a census method. A demographic information questionnaire, the valid and reliable Iranian questionnaire of nurses' competencies in spiritual care and the spiritual intelligence self-report inventory (SISRI) were used to collect data. ResultsA significant positive correlation was found between nursing students’ competence in spiritual care and spiritual intelligence (p < 0.001, r = 0.26). No significant differences were found between the mean competence scores of spiritual care in terms of demographic characteristics. There were significant differences between the mean spiritual intelligence score in terms of age, marital status, history of clinical practice and academic year. The regression model indicated that for increased rates of spiritual intelligence, professional competence in spiritual care would rise as much as 0.39. ConclusionSpiritual intelligence can affect the competence of nursing students in providing spiritual care to patients. Therefore, to promote students' spiritual intelligence, appropriate plans with the aim of promoting the level of critical thinking and spiritual self-awareness are recommended.

High rate of self-improving phenotypes in children with non-syndromic congenital ichthyosis: case series from south-western Germany.

Non-syndromic congenital ichthyosis describes a heterogeneous group of hereditary skin disorders associated with erythroderma and scaling at birth. Although both severe and mild courses are known, the prediction of the natural history in clinical practice may be challenging. To determine clinical course and genotype-phenotype correlations in children affected by non-syndromic congenital ichthyosis in a case series from south-western Germany. We performed a retrospective observational study of 32 children affected by non-syndromic congenital ichthyoses seen in our genodermatosis clinic between 2011 and 2020. Follow-ups included assessment of weight and severity of skin involvement utilizing a modified Ichthyosis Area Severity Index (mIASI). mIASI was calculated as a sum comprising the previously published IASI score and an additional novel score to evaluate palmoplantar involvement. Linear regression was assessed using Pearson correlation, and statistical analysis was performed using the Wilcoxon-Mann-Whitney test. This study included 23 patients with autosomal recessive congenital ichthyosis, seven with keratinopathic ichthyosis and two with harlequin ichthyosis. Cutaneous manifestations improved in more than 70% of the children during the follow-up. Especially in patients with mutations in ALOXE3 and ALOX12B, mIASI scores dropped significantly. The most common phenotype observed in this study was designated 'mild fine scaling ichthyosis'. Severe palmoplantar involvement occurred in patients with KRT1 and ABCA12 mutations; most patients demonstrated hyperlinearity as a sign of dryness and scaling. Weight was mainly in the normal range and negatively correlated with the severity of skin involvement. Congenital ichthyosis that self-improves and evolves with mild fine scaling ichthyosis was the most common phenotype observed in our patients. This type might be underdiagnosed if the genetic diagnosis is not performed in the first year of life. mIASI is an easy and fast instrument for scoring disease severity and adding additional points for palmoplantar involvement might be valuable.

A Network Pharmacology Approach to Predict the Proangiogenesis Mechanism of Huangqi-Honghua Herb Pair after Cerebral Ischemia.

Objective Huangqi-Honghua herb pair is known for its medicinal value to treat Qi deficiency and blood stasis syndrome with a long history in clinical practice. To understand its possible mechanism in a systematic study, a network pharmacological method was addressed. Methods Detailed information on the HH compounds was obtained from two public databases, and oral bioavailability (OB) and drug-like (DL) of the compounds were evaluated. A correlation between HH compounds, its potential targets, and known targets was extrapolated, and the herb-compound-target-disease (H-C-T-D) network was established. Next, the pathway enrichment and essential genes were analyzed. Then, three key genes (VEGFA, VEGFR2, and eNOS), highly associated with angiogenesis, were screened and verified through western blot assay. Results Out of 276 compounds, 21 HH compounds and 78 target genes regulating the major pathways associated with CI in the network are analyzed. The bioactive compounds in HH were active in various signal transduction pathways such as the toll-like receptor signaling pathway, VEGF signaling pathway, TNF signaling pathway, and HIF-1 signaling pathway are important pathways that may regulate anti-inflammatory, antiapoptotic, immune correlation, and antioxidative effects. The core genes are PTGS2, TNF, NOS2, IL6, BCL2, IL1B, SOD2, NOS3, SOD1, MMP9, and VEGFA. The in vitro results suggested that HH treatment could significantly elevate the expression of proangiogenic genes such as VEGFA, VEGFR2, and eNOS compared with OGD groups. Conclusions Our results predict that HH may regulate the expression of VEGFA, VEGFR2, and eNOS via the VEGF and HIF-1 signaling pathway to promote angiogenesis and alleviate cerebral ischemia injury.

Weight History in Clinical Practice: The State of the Science and Future Directions.

Eliciting a weight history can provide clinically important information to aid in treatment decision-making. This view is consistent with the life course perspective of obesity and the aim of patient-centered care, one of six domains of health care quality. However, thus far, the value and practicality of including a weight history in the clinical assessment and treatment of patients with obesity have not been systematically explored. For these reasons, the Clinical Committee of The Obesity Society established a task force to review and assess the available evidence to address five key questions. It is concluded that weight history is an essential component of the medical history for patients presenting with overweight or obesity, and there are strong and emerging data that demonstrate the importance of life stage, duration of exposure to obesity, maximum BMI, and group-based trajectory modeling in predicting risk for increased morbidity and mortality. Consideration of these and other patient-specific factors may improve risk stratification and clinical decision-making for screening, counseling, and management. Recommendations are provided for the key elements that should be included in a weight history, and several needs for future clinical research are outlined.

Disconnects in Physician and Patient Perceptions of COPD Disease Assessment

SESSION TITLE: Patient Safety and Quality Improvement SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 31, 2017 at 02:45 PM - 04:15 PM PURPOSE: Recent changes to the ABCD assessment tool of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy for COPD emphasize the importance of patient symptoms and exacerbation history for pharmacotherapy decision-making, with spirometry remaining essential for diagnosis. Physician alignment with these evidence-based recommendations requires not only clinical skills and competence, but also good communication with patients. This study was designed to assess perceptions among physicians and their own COPD patients on specific aspects of patient assessment. METHODS: Surveys were completed by 17 physicians (10 pulmonologists, 7 primary care physicians) and 40 of their patients with a diagnosis of COPD. The surveys included items for both groups to report their perceptions on spirometry utilization, COPD symptom assessment, and exacerbation history. The study was conducted in the context of a quality improvement medical education program for providers affiliated with health systems in Alabama and Florida. RESULTS: Physicians reported ordering spirometry at higher rates than their patients reported receiving spirometry: 88% of physicians, but only 35% of patients, reported ordering and receiving spirometry at diagnosis, respectively (P < 0.001). Only 38% of patients reported having spirometry within the past year; 47% and 53% of physicians reported ordering spirometry during routine monitoring and acute change in symptoms, respectively. Few physicians reported routinely using a validated tool to assess COPD symptoms: 6% reported using such tools “always” or “most of the time”; 41% “sometimes”; and 53% “never” or “rarely”. However, the majority of patients (60%) reported that their providers asked about COPD symptoms “at every visit”. Although 82% of physicians reported asking about COPD exacerbations at “every visit” or at “most visits”, physicians underestimated the proportion of patients who reported having had ≥ 2 COPD exacerbations in the past year (36% vs 60%, P = 0.087). CONCLUSIONS: Using a detailed survey of patients with COPD and their physicians, we found substantial discordances in physician and patient perceptions of clinical assessment in areas that are key for appropriate COPD treatment and management decisions. CLINICAL IMPLICATIONS: Practical strategies are needed to support utilization of spirometry and validated COPD symptom assessment tools, and to improve assessment of COPD exacerbation history in clinical practice. DISCLOSURE: Fernando Martinez: Grant monies (from industry related sources): Afferent, AstraZeneca, Bayer, Bioscale/ProterrixBio, Boehringer Ingelheim, GlaxoSmithKline, Consultant fee, speaker bureau, advisory committee, etc.: Afferent, AstraZeneca, Boehringer Ingelheim, Columbia University, ConCert, Genentech/Roche, Gilead, GlaxoSmithKline, Methodist Hospital, National Association for Continuing Education, New York University, Peer View, Puerto Rican Respiratory Society, Respiration Day/Chiesi, Stromedix/Biogen, WebMD/MedScape, Western Connecticut Health Network , Other: Stromedix/ Biogen Byron Thomashow: Consultant fee, speaker bureau, advisory committee, etc.: Boehringer Ingelheim MeiLan Han: Consultant fee, speaker bureau, advisory committee, etc.: AstraZeneca, Sunovion, GlaxoSmithKline, Boehringer Ingelheim, Novartis The following authors have nothing to disclose: Laura Simone, Jeffrey Carter, Kathleen Moreo, Tamar Sapir No Product/Research Disclosure Information

Total Flavonoids of Drynariae Rhizoma Prevent Bone Loss Induced by Hindlimb Unloading in Rats.

Drynariae Rhizoma is a kidney-tonifying herb that has a long history in clinical practice for the treatment of bone fractures and joint diseases in China. Flavonoids are considered to be its major active ingredients and are reported to ease bone loss in ovariectomized rats. However, the beneficial effects of the total flavonoids of Drynariae Rhizoma on osteoporosis caused by microgravity or mechanical inactivity remain unknown. This study assessed the effects of total Drynariae Rhizoma flavonoids (DRTF, Qihuang, Beijing, China, national medicine permit No. Z20030007, number of production: 04080081, content of DRTF ≥80%) against bone loss induced by simulated microgravity. A hindlimb unloading tail-suspended rat model was established to determine the effect of DRTF on bone mineral density (BMD), biomechanical strength and trabecular bone microarchitecture. Twenty-eight male Sprague–Dawley rats were divided into four groups: the baseline, control, hindlimb unloading with vehicle (HLU), and hindlimb unloading treated with DRTF (HLU–DRTF, 75 mg/kg/day) groups. Oral DRTF was administered for 4 weeks. The underlying mechanisms of the DRTF actions on disuse-induced osteoporosis are discussed. The results showed that DRTF treatment significantly increased the BMD and mechanical strength of tail-suspended rats. Enhanced bone turnover markers with HLU treatment were attenuated by DRTF administration. Deterioration of trabecular bone induced by HLU was prevented through elevated bone volume/tissue volume (BV/TV), trabecular number (Tb. N), trabecular thickness (Tb. Th) and decreased trabecular separation (Tb. Sp). The present study provides the first evidence that DRTF prevents bone loss induced by HLU treatment, indicating its potential application in the treatment of disuse-induced osteoporosis.

Le retour aux sources. Points de vue sur l’histoire sociale de la psychiatrie et de la maladie mentale

ObjectivesThis article describes the work of a researcher in history. Its purpose is to describe certain manners of envisaging the history of psychiatry as a social history of healthcare sciences and practices. MethodThe history of schizophrenia is used to show how it is possible to move on from the history of clinical practice to a social history of the patients concerned, making use in particular of the vast body of archives provided by patient files. ResultsThe article comprises several parts providing methodological proposals for a social history of psychiatry. The starting point is a broad perusal of the archives enabling the identification of little-known facts. The aims are as follows: to construct a “polyphonic” history of the psychiatric institution, to integrate the memory issues that pervade the medical professions, to propose a change of scale and a change of viewpoint on the history of clinical practice by highlighting its iatrogenic effects, and to make use of delusional writings and what Michel de Certeau has called “revenance” in admission interviews, the overall aim being to produce sources for a history of day-to-day psychiatry. DiscussionThe author distances himself from two theoretical positions: the anti-psychiatric approach, which has led to widespread criticism concerning existence of schizophrenia, and the “naturalist” approach, which tends to objectify scientific categories, and reserves the constructionist approach for ephemeral psychiatric pathologies. Equally distanced from these two types of approach, there is and intermediate approach aiming to construct a social history of clinical practice, using the different clinical categories and their implications for patients’ lives. ConclusionsSchizophrenia, whatever its status in the field of psychiatric knowledge, should not be omitted from the history of mental illness. Using the vast corpus of archives, and implementing the methods of social history centered on the patients, a different history of the advent and diffusion of schizophrenia can be written.

A medical social work perspective on rehabilitation.

This paper introduces a biopsychosocial model for use as a tool by medical social workers and other rehabilitation professionals for the descriptive analysis of the case history and follow-up of patients needing rehabilitative support. The model is based on action theory and emphasizes the demands on evidence-based clarification of the interplay between a subject's contextual life situation, their ability to act in order to realize their goals, and their emotional adaptation. Using clinical experience and literature searches, a standard operations procedure to adequately document the case history in clinical practice is suggested, thus providing strategies through which the work of medical social workers can be based on evidence. Some specific areas of concern for the medical social worker within the rehabilitation of disabled people are highlighted.

Review: Chinese herbs as alternatives to antibiotics in feed for swine and poultry production: Potential and challenges in application

Gong, J., Yin, F., Hou, Y. and Yin, Y. 2014. Chinese herbs as alternatives to antibiotics in feed for swine and poultry production: Potential and challenges in application. Can. J. Anim. Sci. 94: 223–241. Traditional Chinese medicine (TCM) has a long history of clinical practice, and its own theoretical framework focused on functions at the whole-body level. However, due to cultural differences, TCM has not been fully recognized in Western countries. With the recent development of the theory of whole-body systems biology and “-omics”, there is a new opportunity to study TCM and to close the gap between TCM and Western medicine, because of the similarity in the theoretical foundations between TCM and whole-body systems biology. The uniqueness of TCM theory and practice is the approach to maintain and restore the body balance as a whole with no or little unfavourable side effects. Recent studies have also shown that Chinese herbs used as feed additives can modulate nutritional metabolism, immune responses, and intestinal health of food-producing animals, demonstrating good potential as substitutes for dietary antibiotics. Nonetheless, some issues need to be addressed before Chinese herbs can reach their full application. This article has critically reviewed recent progresses in scientific research of Chinese herbs as feed additives and their potential to replace dietary antibiotics. Possible challenges in future application for swine and poultry production are also discussed.

Review: Chinese herbs as alternatives to antibiotics in feed for swine and poultry production: Potential and challenges in application

Gong, J., Yin, F., Hou, Y. and Yin, Y. 2014. Chinese herbs as alternatives to antibiotics in feed for swine and poultry production: Potential and challenges in application. Can. J. Anim. Sci. 94: 223-241. Traditional Chinese medicine (TCM) has a long history of clinical practice, and its own theoretical framework focused on functions at the whole-body level. However, due to cultural differences, TCM has not been fully recognized in Western countries. With the recent development of the theory of whole-body systems biology and “-omics”, there is a new opportunity to study TCM and to close the gap between TCM and Western medicine, because of the similarity in the theoretical foundations between TCM and whole-body systems biology. The uniqueness of TCM theory and practice is the approach to maintain and restore the body balance as a whole with no or little unfavourable side effects. Recent studies have also shown that Chinese herbs used as feed additives can modulate nutritional metabolism, immune responses, and intestinal health of food-producing animals, demonstrating good potential as substitutes for dietary antibiotics. Nonetheless, some issues need to be addressed before Chinese herbs can reach their full application. This article has critically reviewed recent progresses in scientific research of Chinese herbs as feed additives and their potential to replace dietary antibiotics. Possible challenges in future application for swine and poultry production are also discussed.

Ursolic Acid Suppresses Interleukin-17 (IL-17) Production by Selectively Antagonizing the Function of RORγt Protein

Th17 cells have recently emerged as a major player in inflammatory and autoimmune diseases via the production of pro-inflammatory cytokines IL-17, IL-17F, and IL-22. The differentiation of Th17 cells and the associated cytokine production is directly controlled by RORγt. Here we show that ursolic acid (UA), a small molecule present in herbal medicine, selectively and effectively inhibits the function of RORγt, resulting in greatly decreased IL-17 expression in both developing and differentiated Th17 cells. In addition, treatment with UA ameliorated experimental autoimmune encephalomyelitis. The results thus suggest UA as a valuable drug candidate or leading compound for developing treatments of Th17-mediated inflammatory diseases and cancer.

Pharmacodynamic Studies of Chinese Medicine at Levels of Whole Animal, Cell and Molecular Models

Traditional Chinese medicine (TCM) has undergone a long history of clinical practice, which can arrive at ideal therapeutic effects by regulating the body's overall function. However, the complex nature of TCM determines a difficult study on the mechanism and material base of TCM. The current investigations of TCM indicate that the development of modern biotechnology will offer a strong arm in the process of the study. This review focused on the application of the modern biotechnology, including transgenic, gene knockout, cell membrane chromatography (CMC), molecular biochromatography (MBC), gene chips, proteomics, etc. in the research of pharmacodynamic effects of TCM at levels of whole animal, cell and molecular models over the past decade. The whole animal models established by the transgenic and gene knockout technology can truly reflect the characteristics of the target gene activity. Thereby the created animal model could share the pathology of maximum degree of approximation. Cellular models are especially suitable for the situation that functional proteins, enzymes, or drug targets are difficult to separate, or the characteristics of the drugs are unidentified. The utilization of MBC can not only achieve high-throughput screening, but also directly detect the chemical composition of the active components relative to the receptors. Based on the remarkable progress of genomics and proteomics and the technique of gene chips, the bioactive components of TCM can be screened through observing the changes of genes or proteins before and after the compounds acting on the cells.

Who will bell the cat? A call for a new approach for validating blood pressure measuring devices

Blood pressure (BP) measurement should be the foundation stone on which all decisions in hypertension, be they in practice or in research, are dependent. If BP measurement is inaccurate, it follows that all decisions will be flawed. Yet the history of clinical practice and scientific research is replete with examples of disregard for the accuracy of BP measurement. Recognizing that the commonest measurement in medicine is often inaccurate, clinical scientists and the scientific hypertension organizations have made recommendations over the years to improve the technique of measurement and the accuracy of BP measuring devices. The discipline of validating BP measuring devices has developed from primitive origins with adhoc protocols to the latest revision of the European Society of Hypertension International Protocol (ESH International Protocol), which is now available on-line (www.dableducational.org) [1].

Reimagining Nursing's Place in the History of Clinical Practice

This work posits how medical history might be conceptualized if nurses and nursing history was used as the analytical lens. Nursing is seen not as a separate part or subsection of medical history, but rather one that is deeply embedded in the relationships and social order of clinical practice. Nursing is an analytical category in and of itself. By approaching nursing as such a category, we enlarge "new notions of historical significance" to encompass personal, political, public, and private activities that constitute medical experiences.

Pediatric Health : A Translational Pipeline for the Pediatrician in a New Era of Health Care Discovery

Pediatric Health is a new journal that targets a wide range of individuals who provide care to children, and the launch of this journal comes at a unique crossroads in the history of clinical practice. For many years, pediatric journals have generally been considered as either ‘academic’ journals, where those individuals who work in an academic environment (typically medical schools and universities) report new research, or ‘practical’ journals, where review articles focus on topics of interest to the general pediatrician. As an individual who has practiced in both kinds of settings, I can attest to the fact that it is only too infrequent that an article or paper that appeals to one audience will simultaneously hold the interest of the other. This is not a criticism of either group, but simply an observation borne by experience: the concerns of the general pediatrician and the academic physician–scientist have historically seldom overlapped. Nonetheless, pediatricians have continued to provide outstanding care to our children, and academicians have generated new knowledge that has advanced that care, often in dramatic ways. So what is changing today? Are we truly at a historical crossroad in the way we deliver clinical care? Increasingly, it has been recognized that the translation of basic laboratory and clinical research into clinical practice has not been as seamless or straightforward as might be hoped. Out of this concern grew the NIH Roadmap Initiative [1]. The basic tenet of this initiative is that efforts must be made to catalyze changes in the way that we transform our new scientific knowledge into tangible benefits for patients. Developed with input from key leaders in academia, industry, government and the public, the NIH Roadmap provides a framework of priorities which must be met in order to optimize not only the NIH research portfolio, but, by extension, other biomedical research as well. The NIH Roadmap

Genetic Counseling in Psychiatry

While psychiatrists may commonly discuss family history in clinical practice, there has been little systematic research documenting the role and effectiveness of genetic counseling for psychiatric disorders. In the coming years, the expected identification of susceptibility genes for psychiatric disorders may bring new opportunities and expectations from patients and families for the clinical translation of research findings in psychiatric genetics. We review evidence for possible increasing demand for genetic counseling, particularly if specific genes related to psychiatric disorders are identified. We then explore both the potential role of genetic counseling for psychiatric disorders and the issues involved in conveying genetic information in the clinical setting. Further research regarding the effectiveness of counseling interventions, as well as additional efforts directed at genetics education for clinicians, will be needed if emerging advances in genetic research are to be incorporated into clinical practice.

Pityriasis rosea-like eruptions due to mustard oil application

A young man employed in a construction company, presented with cutaneous lesions clinically simulating pityriasis rosea. Satisfactory and complete response to corticosteroids and antihistamines was followed by recurrence. Multiple recurrences within a short span of time arose a suspicion of alternative diagnosis. Site visit helped us to rule out occupational contact dermatitis. Further history taking revealed that he was recently using mustard oil for body massage. Subsequent patch testing confirmed contact hypersensitivity to mustard oil. Avoidance of the contact with mustard oil arrested appearance of further skin lesions. We stress the importance of taking a good history in clinical practice in disclosing a possible contactant.