CLINICAL AND EDUCATIONAL MATERIAL

Evidence based psychiatry, databases, and journals

More specifically evidence based psychiatry is relatively hard to come by on the web. Perhaps the most useful site is that of the Centre for Evidence Based Mental Health (http://cebmh.warne.ox.ac.uk/cebmh) in Oxford. The Cochrane Collaboration (www.cochrane.org) also has a Depression Anxiety & Neurosis Group, a Dementia Group, and a Schizophrenia Group, all with high quality systematic review abstracts available free online. Clinical Evidence (www.clinicalevidence.com) also allows access to reviews of similar quality by subscription—or free if you are an NHS professional in the United Kingdom. Access is also free or at greatly reduced cost to many of the poorer countries in the world.

For anyone carrying out a literature search, Psycinfo, produced by the American Psychological Association, is a database of psychiatric and psychologically oriented literature similar to Medline but with access to books from 1987 and article titles going back to 1887. Psycinfo is usually available through university libraries (in the United Kingdom through BIDS (www.bids.ac.uk)).

The best of a number of journal directories is provided by Psycline (www.psycline.org). Most journals now offer online abstract, full text, and table of contents by email. There is a welcome trend of some journals providing free full text access to back issues. Table 2 lists some of the more popular journals.

Other general sites

One of the most educational general psychiatry sites is Internet Mental Health (www.mentalhealth.com) maintained by Philip Long. It contains descriptions of mental disorders based on Diagnostic and statistical manual of mental disorders, fourth edition, and International classification of diseases, as well as numerous well organised links, including to patient information booklets. Sadly, a subscription is now required for the online diagnosis program. Mental Help Net (http://mentalhelp.net) is another huge site with a good set of links. Other useful starting places for psychiatry links are www.psychiatrist.com and About Mental Health Resources (http://mentalhealth.miningco.com).

Self assessment is available through the psychiatry web site of the New York University School of Medicine (www.med.nyu.edu/Psych/itp.html). This site has over 200 multiple choice questions that can be marked on line. A good portal for French psychiatry is Psydoc-France (http://psydoc-fr.broca.inserm.fr).

PATIENT INFORMATION

The vast American Mental Help Net (http://mentalhelp.net) is probably one of the largest web sites for patients although the sheer amount of information available here may be overwhelming. A high quality British patient web site is the National electronic Library for Mental Health (www.nelmh.org), part of NHS Direct UK. At present there are only sections on depression, suicide, and schizophrenia but these are detailed and supplemented with video material. This web site will be expanding to include a broad range of mental health topics, as well as a section for professionals, with a stringent editorial policy. The American Psychiatric Association (www.psych.org) and Royal College of Psychiatrists (www.rcpsych.ac.uk) sites have carefully selected links to patient information. There are also disorder specific sites for patients at www.schizophrenia.com and the UK based Depression Alliance (www.depressionalliance.org). For lighter relief, you can listen to “radio shows” on a variety of mental health topics such as lying, borderline personality disorder, and pain at the Infinite Mind (www.lcmedia.com/mindprgm.htm).

PROFESSIONAL ORGANISATIONS

Most of the principal professional organisations in psychiatry, neuropsychiatry, and psychology now have web sites. Table 1 lists the main ones, which usually have links to forthcoming meetings, press releases, etc.

PSYCHIATRY NEWS

If you want to be kept informed about conferences and recent developments, the American Psychiatric Association web site will take you to their free full text Psychiatric News (http://pn.psychiatryonline.org). Good quality, weekly psychiatric news and conference reports are also available at Medscape Psychiatry & Mental Health (http://psychiatry.medscape.com) (you need to log in with a password but the service is free).

NEUROPSYCHIATRY

There are rather fewer resources specifically dedicated to neuropsychiatry and neuropsychology. www.Neuropsychology.co.uk contains conference and departmental information for neuropsychologists in the United Kingdom. NeuroPsychiatry Reviews (www.neuropsychiatryreviews.com) provides three articles a month on neuropsychiatry topics such as poststroke anxiety disorder and psychopathology in cerebellar degeneration. Those involved in neuropsychiatry research may be particularly interested in functional imaging web sites. The Wellcome Department of Imaging Neuroscience (www.fil.ion.ucl.ac.uk) maintains a site that includes, among other things, downloadable statistical parametric mapping software. The fMRI Data Center (www.fmridc.org) is a relatively new web site based in the United States and designed as a repository for complete functional magnetic resonance imaging (fMRI) datasets that can be requested to “interpret, analyse, and replicate” studies. The Face Recognition Home Page (www.cs.rug.nl/∼peterkr/FACE/face.html) takes you to all things face related such as pages on prosopagnosia and face databases. A good set of links to visual science web sites can be found at www.visionscience.com.

ANTIPSYCHIATRY

Anyone interested in antipsychiatry material can start at the Citizen Commission on Human Rights (www.cchr.org) where you can read articles entitled Psychiatry betraying and drugging children and Psychiatry destroying religion, creating evil. At Alternative Mental Health Online (www.alternativementalhealth.com/) the treatment of mental illness by solving “nutritional problems, allergies, glandular ailments, heavy metal poisoning, and infections” is discussed.

CYBERCHONDRIA AND ILLNESS TRANSMISSION THROUGH THE INTERNET

Although not yet in the Oxford English Dictionary, the word “cyberchondria” has been coined to describe the excessive use of internet health sites to fuel health anxiety.³ Hypochondriasis is a distressing condition where uncontrollable anxiety about the seriousness of physiological symptoms leads to the persistent seeking of reassurance and medical investigation. Medical information, as well as misinformation, has always been available to those who want it. However, the vast amount of accessible and instant information about symptoms, investigations, and personal stories of illness now on the internet is unprecedented. Additionally, a number of “online diagnosis” sites such as www.medical-library.org or popular CD ROM based tools such as Dr Schueler’s Home Medical Advisor provide interactive advice on specific symptoms. These resources have the potential to empower patients to deal with their own minor symptoms but may also generate consultations that may not have otherwise taken place. Studies that have looked at the provision of information for minor symptoms have suggested that consultation rates are not greatly affected.^4,5 These studies may have found an increase in health anxiety in some patients counterbalanced by a decrease in consultation by others.⁶

On a more sinister note, Elaine Showalter has proposed in her book Hystories⁷ that the internet offers a new route for the spread of illness—the spread of pathogenic ideas, a means of transmission that she proposes can fuel epidemics of conditions such as the Gulf War syndrome and myalgic encephalomyelitis.

The internet, like any significant technological advance, has been promoted as a mainly positive force in medicine. As time passes, it is likely that its potential to damage human health will also become clearer. The overall balance of good and harm remains to be seen.