The British Journal of Psychiatry (2002) 181: 262-263
© 2002 The Royal College of Psychiatrists
Finding the Evidence: A Gateway to the Literature in Child and Adolescent Mental Health (2nd edn)
Laurence Jerome, Consultant Psychiatrist in Community Practice and Consultant
Psychiatrist to the Amethyst (ADHD) Provincial Demonstration School
Ministry of Education, London, Ontario, Canada
EDITED BY SIDNEY CROWN and ALAN LEE
Edited by Angela Scott, Mike Shaw & Carol Joughin. London: Gaskell.
2001. 204 pp. £18.00 (pb). ISBN 1 901242 68 4
This second edition of Finding the Evidence was published in
October 2001: the first edition is already available online, at
http://www.focusproject.org.uk,
under completed work and available resources. As the editors comment in their
introduction, this is a living document and it is hoped that
this version will be updated with new material every 6 months. The editors
also hope to arrange for cited articles to be critically appraised and posted
on the web. The ultimate aim is that fulltext articles will be available
through internet links.
This work in progress consists of a guide to current
evidence-based medicine for clinical practice. Two methods were used in its
compilation. First, electronic search strategies were applied to identify
relevant systematic reviews, meta-analyses and practice parameters of clinical
guidelines. Second, experts were asked to choose non-systematic reviews,
cutting-edge and classic papers and books. The experts were asked to address
two critical questions about their particular field of expertise: What
are the latest developments in understanding the management of the
condition? and What are the key messages from new research that
are not being widely used?
Part 1 of the book provides a description of terms for conducting an
electronic search, as well as a guide to searching and a summary of a search
strategy. In part 2 evidence is reviewed by clinical category. There are
sections on emotional, physical and sexual abuse, attention-deficit
hyperactivity disorder, bullying, conduct disorders and juvenile delinquency,
and deliberate self-harm. The review continues with eating disorders,
elimination and emotional disorders. Gender identity disorders, paediatric
liaison, pervasive developmental disorders, post-traumatic stress disorder and
psychoses are considered, as are substance misuse and tic disorders. A section
is devoted to treatment approaches, which covers psychotherapeutic and
psychopharmacological evidence reviews. Another section deals with emerging
data-sets, where current evidence is not as well developed. The penultimate
section includes assessment, attachment disorders, electroconvulsive therapy,
mental health and deafness, and the mental health of children and adolescents
from ethnic minorities. The final section is devoted to a review of service
development and legal issues. Appendices contain further information on search
strategies, randomised controlled trials for systematic reviews and
meta-analyses, and critical appraisal tools. For the interested reader, FOCUS
provides useful links to other evidence-based medicine resources that expand
the information in the book.
The value of this publication lies in both its up-to-the-minute review of
current data and the critical questions considered by the experts. The quality
of evidence in child psychiatry is not as well developed as in other medical
disciplines, and there is a relative lack of systematic reviews, meta-analyses
and clinical guidelines. The role of the expert in developing an overall
formulation and the raising of critical questions is often still primary in
setting the gold standard. However, some of the topic areas covered here lack
expert critical comments on the current literature. Treatment categories such
as psychopharmacology and psychotherapy appear to be covered briefly and in an
undifferentiated manner and might well have benefited from sub-categorisation.
The 38 contributors to this work have done a good job in developing an initial
database that will hopefully grow and may well become the first port of call
for an up-to-date clinical review of the evidence. That this
will be useful to carers and relatives, as the editors hope, seems to be less
realistic, as their needs are likely to be quite different from those of
clinicians. A book to be recommended for the academic library and the
individual academic, this is of less immediate value for front-line
clinicians.