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More case reports in child psychiatry needed

Published online by Cambridge University Press:  02 January 2018

Victoria Fernandez*
Affiliation:
South West London and St George's Mental Health NHS Trust, London, UK, email: victoria.fernandez@swlstg-tr.nhs.uk
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Abstract

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Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2014

For some people, case reports and case series are at the cornerstone of medical progress as they permit the discovery of new diseases, unexpected effects of treatments, recognition of rare manifestations of disease, and have a key role in medical education. Although regarded at the bottom of the evidence-based hierarchy, case reports hold advantages over the gold standard of randomised clinical trials. These, although having the power to provide a statistical answer for well-defined clinical questions, are expensive, can take years to conduct and may encounter ethical problems. Moreover, it may be impossible to collect adequate numbers in some rare medical conditions. Case reports can be published quickly by busy clinicians with an invaluable experience working in a naturalistic environment and can offer detailed information on the variables of a particular patient that do not always have space in a clinical trial. Reference Yitschaky, Yitschaky and Zadik1

Authors like Jeniceck Reference Jenicek2 highlight how the concept of evidence-based medicine is intrinsically linked with case reporting as they are often the ‘first line of evidence’ and an active example of deductive reasoning. Let us not forget that the history of modern psychiatry is full of examples – Emil Kraepelin, or Leo Kanner as a representative of child psychiatry – where the detailed study of individual or multiple cases led to the identification and grouping of patterns of symptoms from which the diagnostic categories widely used nowadays were derived.

In my career I have published several cases reports. Each of them has been a reminder of the fact that in our practice, clinicians encounter challenging cases with unusual presentations where there may be limited evidence-based knowledge with which to make management decisions. And it is in these situations where careful consideration, assessment of the clinical picture, history of the symptoms, and discussion and consultation with colleagues and relevant professionals have proved a helpful pragmatic approach in making decisions on how to manage a complex presentation. Reference Fernandez and Davies3

Child psychiatry is a specialty that represents extremely well the complexity of cases with multiple biological and social interactions. My current job at the National Deaf CAMHS is even more representative. One of the challenges when working with deaf children with mental health problems is to produce research applicable to this population, mostly because there is not a consistent profile of a ‘deaf child’: varied causality, including genetic conditions, different levels of deafness, additional special needs, etc. This context makes the need for sharing clinicians' experience through case reports even more relevant.

The guidance on supporting information for appraisal and revalidation issued by the Royal College of Psychiatrists in September 2014 includes a ‘case review or discussion … to demonstrate that you are engaging meaningfully in discussion with your medical and non-medical colleagues in order to maintain and enhance the quality of your professional work.’ 4 But other forums, such as-peer reviewed journals, devote less and less space to case reports, including case reports in child psychiatry, which are almost non-existent in high impact factor journals despite the development in recent years of clear guidelines to ensure rigorous reporting. Reference Gagnier, Kienle, Altman, Moher, Sox and Riley5

Now more than ever, we need case reports to reinvigorate child psychiatry and keep our clinical skills sharp.

References

1 Yitschaky, O, Yitschaky, M, Zadik, Y. Case report on trial: Do you, Doctor, sweat to tell the truth, the whole truth and nothing but the truth? J Med Case Rep 2011; 5: 179.CrossRefGoogle Scholar
2 Jenicek, M. Clinical Case Reporting in Evidence Based Medicine (2nd edn). Oxford University Press, 2001.Google Scholar
3 Fernandez, V, Davies, S. Treatment dilemmas in a young man presenting with narcolepsy and psychotic symptoms. Case Rep Psychiatry 2011; doi: 10.1155/2011/804357.CrossRefGoogle Scholar
4 Royal College of Psychiatrists. Supporting Information for Appraisal and Revalidation: Guidance for Psychiatrists (College Report CR194). Royal College of Psychiatrists, 2014.Google Scholar
5 Gagnier, JJ, Kienle, G, Altman, DG, Moher, D, Sox, H, Riley, D, et al The CARE guidelines: consensus-based clinical case reporting guideline development. J Med Case Rep 2013; 7: 223.CrossRefGoogle ScholarPubMed
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