1. R ESOURCES FOR C LINICAL R EASONING E XERCISE KSOM Psychiatry Clerkship July 2010 Emily Brennan, MLIS

2. Library Webpages  NML homepage → By Subject  Psychiatry subject guide http://norris.usc.libguides.com/psychiatry  Mobile Devices subject guide http://norris.usc.libguides.com/mobiledevices  NML homepage → Students  Student Portal Medicine → Year III-IV → Psychiatry Clerkship 2

3. Formulate Research Question 3  Scenario: Patient diagnosed with schizophrenia is being treated with an antipsychotic drug (risperidone). This drug is causing patient to gain weight. You wonder if nutrition therapy would be effective for weight loss.  Research question: Is nutrition therapy effective in reducing weight gain caused by antipsychotics?

4. Search the Literature 4  PubMed PubMed  MeSH database MeSH database  Tutorials Tutorials  Web of Science Web of Science  Sort by relevance or times cited  Includes meeting abstracts/conference proceedings  PsycINFO PsycINFO

5. Search Strategies 5  PubMed: "Antipsychotic Agents"[Mesh] AND "Weight Gain"[Mesh] AND "Nutrition Therapy"[Mesh]  Web of Knowledge: antipsychotic* AND weight gain AND nutrition therapy  Try searching with synonyms and narrower terms E.g., specific drug names in that drug class

6. Relevant Articles Ball MP, Coons VB & Buchanan RW. (2001). A program for treating olanzapine-related weight gain. Psychiatric Services, 52(7), 967-9. “The patients' weight, body mass index, and psychiatric symptoms were assessed and were compared with those of a matched comparison group who did not attend the Weight Watchers program. Only the men experienced significant weight loss. No correlation was found between weight loss and exercise or change in psychiatric symptoms. “ Blouin M, Binet M, Bouchard RH, Roy MA, Despres JP & Almeras N. (2009). Improvement of metabolic risk profile under second-generation antipsychotics: a pilot intervention study. Canadian Journal of Psychiatry - Revue Canadienne de Psychiatrie, 54(4), 275-9. “This pilot study suggests that patients under SGAs may benefit from a weight management program and improve their metabolic health, as well as their aerobic fitness.” Faulkner G, Soundy AA & Lloyd K. (2003). Schizophrenia and weight management: a systematic review of interventions to control weight. Acta Psychiatrica Scandinavica, 108(5), 324-32. “Both dietary and exercise counselling set within a behavioural modification programme is necessary for sustained weight control.” Mauri M, Castrogiovanni S, Simoncini M, Iovieno N, Miniati M, Rossi A, et al. (2006). Effects of an educational intervention on weight gain in patients treated with antipsychotics. Journal of Clinical Psychopharmacology, 26(5), 462-6. “Educational intervention can be an important tool for the management of weight increase in patients treated with APs.” O'Keefe CD, Noordsy DL, Liss TB & Weiss H. (2003). Reversal of antipsychotic-associated weight gain. Journal of Clinical Psychiatry, 64(8), 907-12. “Some patients who gain weight while taking antipsychotic medications are able to stop gaining and lose weight over time, largely through behavioral interventions. Dietary interventions appear promising and should be explored further to prevent and reverse weight gain.” 6

7. Select 5 Best Articles 7 1. Applicable to your patient 2. Appraise methodology  Simple Method for Evaluating the Clinical Literature Simple Method for Evaluating the Clinical Literature 3. Publication type 4. Currency 5. Times cited (Web of Knowledge)

8. Pyramid of Publication Types Guidelines Systematic Reviews Meta-analysis Randomized Controlled Trials Cohort Studies Case Control Studies Case Series Case Reports Ideas, Editorials, Opinions 8

9. Annotated Bibliography 9  Citation style (e.g. APA)APA  Annotation  Discuss content, usefulness, value of each article  Critical appraisal of methodology Critical appraisal of methodology

10. Personal Reflection  Essay exploring your personal and general reflections on your interaction with the patient (PPI)  Thoughtful, convincing, insightful, and exploratory; represents your personal self awareness; reveals self-learning; emphasizes your personal feelings and emotions 10

11. Clinical Reasoning/Reflection Exercise  Download from  MedWeb Psychiatry Clerkship Manual http://medweb.usc.edu/site/clerkships/psych/general_info _psych.pdf http://medweb.usc.edu/site/clerkships/psych/general_info _psych.pdf  Year III Student Portal – Psychiatry Clerkship tab http://www.usc.edu/hsc/nml/portals/students/yr3-4.html  Due by 6 th week of clerkship 11

12. Questions? Make an apt for a personal consultation! Emily Brennan, MLIS ebrennan@usc.edu 12