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Lempp T, Neuhoff N, Renner T, Vloet TD, Fischer H, Stegemann T, Zepf FD, Rössner V, Kölch M, Hässler F, Mattejat F, Lehr D, Bachmann CJ. [What do medical students expect of lectures in child and adolescent psychiatry?]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2012; 40:105-12. [PMID: 22354494 DOI: 10.1024/1422-4917/a000157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In child and adolescent psychiatry (CAP) lectures are the most common teaching format for medical students. Besides conveying basic knowledge and skills related to the medical management of children and adolescents with mental health problems, lectures also play a decisive role in the recruitment of future residents for this discipline. Thus, knowledge of the expectations of medical students of lectures is a crucial factor. METHOD 1,029 medical students at ten German medical schools were surveyed with a questionnaire in a cross-sectional design. RESULTS Items perceived as most important were knowledge of disorders (73 %), medical skills in handling children and adolescents (61 %), and differential diagnosis of normal and abnormal child behaviour in children and adolescents (59 %). 71 % set a high value on patient presentation, while 41 % expressed ethical concerns about presenting mentally ill minors in lectures. CONCLUSIONS The expectations of medical students toward CAP lectures are mainly related to the transfer of specialty-related knowledge and generic skills. The important area of teaching attitudes could best be covered via patient presentations, which are desired by most students. However, ethical concerns over patient presentation also need to be discussed with students.
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Affiliation(s)
- Thomas Lempp
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Frankfurt am Main.
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Citrome L, Ketter TA. Teaching the philosophy and tools of evidence-based medicine: misunderstandings and solutions. J Evid Based Med 2009; 2:220-5. [PMID: 21349020 DOI: 10.1111/j.1756-5391.2009.01041.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L Citrome
- New York University School of Medicine, Department of Psychiatry, and the Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA.
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Libal G, Keller F, Fegert JM, Weninger L. [Introduction of the module "Evidence-based Medicine" in Child and Adolescent Psychiatry into the psychiatry block practicum at the University of Ulm]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2009; 37:107-14; quiz 114. [PMID: 19401996 DOI: 10.1024/1422-4917.37.2.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The essential need for the timely availability of additional relevant information has resulted in a focus on "Evidence-based Medicine" (EBM) in medical practice. In Child and Adolescent Psychiatry (CAP) training it is essential to impart knowledge of how to effectively use the available literature, since the evidence for many therapies is still poor. METHOD We modified the "Duke Model" for teaching EBM in CAP to better attune it to the educational needs of a German university. We describe the introduction of the teaching module "Evidence-based Medicine in CAP" in practical clinical training. RESULTS Integrating EBM into mandatory practical training enables the students to deal with problems that directly pertain to patient treatment, thus motivating them to access and read relevant scientific literature. An initial evaluation of this pilot project shows the successful linkage of research with clinical routine and also the conveyance of improved decision making abilities as well as an attitude of life-long learning. CONCLUSIONS Modifying the EBM-module for practical clinical training is an innovative approach to integrating EBM into medical curricula. In the course of a curricular reform, "EBM cross sectional training" for all medical students was introduced into the new curriculum of the Medical School at the University of Ulm.
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Affiliation(s)
- Gerhard Libal
- Universitäre Psychiatrische Kliniken Basel, Klinik für Kinder- und Jugendpsychiatrie
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Citrome L, Ketter TA. Teaching the philosophy and tools of evidence-based medicine: misunderstandings and solutions. Int J Clin Pract 2009; 63:353-9. [PMID: 19222621 DOI: 10.1111/j.1742-1241.2009.02014.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- L Citrome
- New York University School of Medicine, Department of Psychiatry, and the Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA.
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McCarthy M, Abenojar J, Anders TF. Child and adolescent psychiatry for the future: challenges and opportunities. Psychiatr Clin North Am 2009; 32:213-26. [PMID: 19248926 DOI: 10.1016/j.psc.2008.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In this article, the authors focus on three particularly salient sets of issues that face the field of child and adolescent psychiatry as a sub-specialty of general psychiatry today-those related to workforce, public perception, and professional identity. In an article directed at the general psychiatrist, the authors present possibilities for refocusing the activities of the child and adolescent psychiatrist to emphasize consultative and collaborative roles. The authors embrace working in systems of care with communities and families as partners. Finally, they discuss the training implications of such shifts in professional identity, and the need to maintain the centrality of a scientifically-based developmental biopsychosocial formulation.
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Affiliation(s)
- Malia McCarthy
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, School of Medicine, Medical Investigation of Neurodevelopmental Disorders Institute, Sacramento, CA 95817, USA
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Abstract
OBJECTIVE Given striking advances in translational developmental neuroscience and its convergence with developmental psychopathology and developmental epidemiology, it is now clear that mental illnesses are best thought of as neurodevelopmental disorders. This simple fact has enormous implications for the nature and organization of psychotherapy for mentally ill children, adolescents and adults. METHOD This article reviews the 'trajectory' of psychosocial interventions in pediatric psychiatry, and makes some general predictions about where this field is heading over the next several decades. RESULTS Driven largely by scientific advances in molecular, cellular and systems neuroscience, psychotherapy in the future will focus less on personal narratives and more on the developing brain. In place of disorders as intervention targets, modularized psychosocial treatment components derived from current cognitive-behavior therapies will target corresponding central nervous system (CNS) information processes and their functional behavioral consequences. Either preventive or rehabilitative, the goal of psychotherapy will be to promote development along typical developmental trajectories. In place of guilds, psychotherapy will be organized professionally much as physical therapy is organized today. As with other forms of increasingly personalized health care, internet-based delivery of psychotherapy will become commonplace. CONCLUSION Informed by the new field of translational developmental neuroscience, psychotherapy in the future will take aim at the developing brain in a service delivery model that closely resembles the place and role of psychosocial interventions in the rest of medicine. Getting there will be, as they say, interesting.
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Affiliation(s)
- John S March
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA.
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Falzer PR, Moore BA, Garman DM. Incorporating clinical guidelines through clinician decision-making. Implement Sci 2008; 3:13. [PMID: 18312671 PMCID: PMC2291071 DOI: 10.1186/1748-5908-3-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Accepted: 02/29/2008] [Indexed: 12/04/2022] Open
Abstract
Background It is generally acknowledged that a disparity between knowledge and its implementation is adversely affecting quality of care. An example commonly cited is the failure of clinicians to follow clinical guidelines. A guiding assumption of this view is that adherence should be gauged by a standard of conformance. At least some guideline developers dispute this assumption and claim that their efforts are intended to inform and assist clinical practice, not to function as standards of performance. However, their ability to assist and inform will remain limited until an alternative to the conformance criterion is proposed that gauges how evidence-based guidelines are incorporated into clinical decisions. Methods The proposed investigation has two specific aims to identify the processes that affect decisions about incorporating clinical guidelines, and then to develop ad test a strategy that promotes the utilization of evidence-based practices. This paper focuses on the first aim. It presents the rationale, introduces the clinical paradigm of treatment-resistant schizophrenia, and discusses an exemplar of clinician non-conformance to a clinical guideline. A modification of the original study is proposed that targets psychiatric trainees and draws on a cognitively rich theory of decision-making to formulate hypotheses about how the guideline is incorporated into treatment decisions. Twenty volunteer subjects recruited from an accredited psychiatry training program will respond to sixty-four vignettes that represent a fully crossed 2 × 2 × 2 × 4 within-subjects design. The variables consist of criteria contained in the clinical guideline and other relevant factors. Subjects will also respond to a subset of eight vignettes that assesses their overall impression of the guideline. Generalization estimating equation models will be used to test the study's principal hypothesis and perform secondary analyses. Implications The original design of phase two of the proposed investigation will be changed in recognition of newly published literature on the relative effectiveness of treatments for schizophrenia. It is suggested that this literature supports the notion that guidelines serve a valuable function as decision tools, and substantiates the importance of decision-making as the means by which general principles are incorporated into clinical practice.
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Affiliation(s)
- Paul R Falzer
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT, USA.
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March JS, Szatmari P, Bukstein O, Chrisman A, Kondo D, Hamilton JD, Kremer CME, Kratochvil CJ. AACAP 2005 Research Forum: speeding the adoption of evidence-based practice in pediatric psychiatry. J Am Acad Child Adolesc Psychiatry 2007; 46:1098-1110. [PMID: 17712233 DOI: 10.1097/chi.0b013e318074eb48] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES At the 2005 Annual Meeting of the American Academy of Child and Adolescent Psychiatry (AACAP), the Academy's Workgroup on Research conducted a Research Forum entitled "Increasing Research Literacy Through the Adoption of Evidence-Based Practice (EBP) in Pediatric Psychiatry." METHOD Forum participants focused on speeding the adoption of EBP across five areas: EBP as the preferred heuristic for teaching research literacy, use of EBP in training programs, dissemination of EBP in clinical practice, EBP in partnership with industry, and EBP as a framework for developing practice guidelines. RESULTS EBP provides an easy-to-understand method for accessing and evaluating the research literature and then applying this information to decisions about patient care. Although EBP has been gaining greater visibility in pediatric psychiatry, it is far from the preferred heuristic. To move the field toward fully embracing EBP will require greater understanding of what EBP is (and is not), educating mental health professionals in EBP skills, access to EBP resources, and a commitment to apply EBP to the conceptualization and design of research protocols and practice guidelines. CONCLUSIONS Pediatric psychiatry would benefit from a principled commitment to follow other areas of medicine in adopting EBP.
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Affiliation(s)
- John S March
- Drs. March, Chrisman, and Kondo are with the Department of Psychiatry, Duke University Medical Center, Durham, NC; Dr. Szatmari is with the Department of Psychiatry at McMaster University, Hamilton, Ontario; Canada; Dr. Bukstein is with Western Psychiatric Institute and Clinic, University of Pittsburgh; Dr. Hamilton is with The Permanente Medical Group of California; Dr. Kremer is with Pfizer, Inc.; Dr. Kratochvil is with the Department of Psychiatry, University of Nebraska Medical Center, Omaha..
| | - Peter Szatmari
- Drs. March, Chrisman, and Kondo are with the Department of Psychiatry, Duke University Medical Center, Durham, NC; Dr. Szatmari is with the Department of Psychiatry at McMaster University, Hamilton, Ontario; Canada; Dr. Bukstein is with Western Psychiatric Institute and Clinic, University of Pittsburgh; Dr. Hamilton is with The Permanente Medical Group of California; Dr. Kremer is with Pfizer, Inc.; Dr. Kratochvil is with the Department of Psychiatry, University of Nebraska Medical Center, Omaha
| | - Oscar Bukstein
- Drs. March, Chrisman, and Kondo are with the Department of Psychiatry, Duke University Medical Center, Durham, NC; Dr. Szatmari is with the Department of Psychiatry at McMaster University, Hamilton, Ontario; Canada; Dr. Bukstein is with Western Psychiatric Institute and Clinic, University of Pittsburgh; Dr. Hamilton is with The Permanente Medical Group of California; Dr. Kremer is with Pfizer, Inc.; Dr. Kratochvil is with the Department of Psychiatry, University of Nebraska Medical Center, Omaha
| | - Allan Chrisman
- Drs. March, Chrisman, and Kondo are with the Department of Psychiatry, Duke University Medical Center, Durham, NC; Dr. Szatmari is with the Department of Psychiatry at McMaster University, Hamilton, Ontario; Canada; Dr. Bukstein is with Western Psychiatric Institute and Clinic, University of Pittsburgh; Dr. Hamilton is with The Permanente Medical Group of California; Dr. Kremer is with Pfizer, Inc.; Dr. Kratochvil is with the Department of Psychiatry, University of Nebraska Medical Center, Omaha
| | - Douglas Kondo
- Drs. March, Chrisman, and Kondo are with the Department of Psychiatry, Duke University Medical Center, Durham, NC; Dr. Szatmari is with the Department of Psychiatry at McMaster University, Hamilton, Ontario; Canada; Dr. Bukstein is with Western Psychiatric Institute and Clinic, University of Pittsburgh; Dr. Hamilton is with The Permanente Medical Group of California; Dr. Kremer is with Pfizer, Inc.; Dr. Kratochvil is with the Department of Psychiatry, University of Nebraska Medical Center, Omaha
| | - John D Hamilton
- Drs. March, Chrisman, and Kondo are with the Department of Psychiatry, Duke University Medical Center, Durham, NC; Dr. Szatmari is with the Department of Psychiatry at McMaster University, Hamilton, Ontario; Canada; Dr. Bukstein is with Western Psychiatric Institute and Clinic, University of Pittsburgh; Dr. Hamilton is with The Permanente Medical Group of California; Dr. Kremer is with Pfizer, Inc.; Dr. Kratochvil is with the Department of Psychiatry, University of Nebraska Medical Center, Omaha
| | - Charlotte M E Kremer
- Drs. March, Chrisman, and Kondo are with the Department of Psychiatry, Duke University Medical Center, Durham, NC; Dr. Szatmari is with the Department of Psychiatry at McMaster University, Hamilton, Ontario; Canada; Dr. Bukstein is with Western Psychiatric Institute and Clinic, University of Pittsburgh; Dr. Hamilton is with The Permanente Medical Group of California; Dr. Kremer is with Pfizer, Inc.; Dr. Kratochvil is with the Department of Psychiatry, University of Nebraska Medical Center, Omaha
| | - Christopher J Kratochvil
- Drs. March, Chrisman, and Kondo are with the Department of Psychiatry, Duke University Medical Center, Durham, NC; Dr. Szatmari is with the Department of Psychiatry at McMaster University, Hamilton, Ontario; Canada; Dr. Bukstein is with Western Psychiatric Institute and Clinic, University of Pittsburgh; Dr. Hamilton is with The Permanente Medical Group of California; Dr. Kremer is with Pfizer, Inc.; Dr. Kratochvil is with the Department of Psychiatry, University of Nebraska Medical Center, Omaha
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Chrisman AK, Enderlin HT, Landry KL, Colvin JS, DeJohn MR. Teaching evidence-based medicine pediatric psychopharmacology: integrating psychopharmacologic treatment into the broad spectrum of care. Child Adolesc Psychiatr Clin N Am 2007; 16:165-81, x. [PMID: 17141123 DOI: 10.1016/j.chc.2006.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pediatric psychopharmacology is taught at the Duke University Hospital Child and Adolescent Psychiatry Residency Training Program within the context of an evidence-based medicine model. The basic goal of the course is to develop competence in the psychopharmacologic management of psychiatric problems of children and adolescents as part of a biopsychosocial/developmental model of care. Associated with this over-arching goal is the demonstration of specific attitudes, knowledge, and skills. This article discusses the educational model with examples and each of these goals in depth.
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Affiliation(s)
- Allan K Chrisman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke Child & Family Study Center, 718 Rutherford Street, Durham, NC 27705, USA.
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Abstract
Currently our field is actively involved in developing new ways to characterize and treat children and adolescents with psychiatric disorders and in evaluating the effects of our therapies. We also are beginning to examine the effectiveness of our teaching methods. This article presents evidence for, ideas about, and a philosophy to guide individuals who are privileged to train child psychiatrists in psychotherapies. Specifically, it discusses the issues of the evidence base for diagnosis and for nonspecific and specific active elements of child psychotherapy. Evidence for methods of training is presented. The article addressed the need for supervising psychiatrists to keep abreast of developments in teaching methods so that we can best train competent, curious, and compassionate child psychiatrists.
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Affiliation(s)
- Margo Thienemann
- Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5719, USA.
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Martin A, Srihari V. Geometrically evident: framing studies using the Graphic Appraisal Tool for Epidemiology (GATE). J Am Acad Child Adolesc Psychiatry 2006; 45:1521-6. [PMID: 17135998 DOI: 10.1097/01.chi.0000237707.50884.c2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Andrés Martin
- Yale Child Study Center, New Haven, CT 06520-7900, USA.
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Affiliation(s)
- John D Hamilton
- Dr. Hamilton is with The Permanente Medical Group of California, Inc., Sacramento, CA, and Kellogg College, University of Oxford.
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March JS, Klee BJ, Kremer CME. Treatment benefit and the risk of suicidality in multicenter, randomized, controlled trials of sertraline in children and adolescents. J Child Adolesc Psychopharmacol 2006; 16:91-102. [PMID: 16553531 DOI: 10.1089/cap.2006.16.91] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to examine the balance between the benefits of treatment and the risk of suicidality in children and adolescents in multicenter, randomized, controlled trials of sertraline versus placebo. METHOD The published literature was searched for multicenter, randomized, placebo-controlled trials of sertraline for pediatric mental disorders. Four trials were identified: Two (pooled) in pediatric major depressive disorder (MDD; Wagner 2003) and two in obsessive-compulsive disorder (OCD; March et al. 1998; POTS Team 2004). Using intent-to-treat (ITT) analysis populations, the authors calculated the number needed to treat (NNT) for response and remission and the number needed to harm (NNH) for suicidality, and their ratio, for each clinical trial. RESULTS NNTs ranged from 2 to 10, indicating clinically meaningful benefits. Benefit was greater for OCD than for MDD, and for adolescents as compared with children in MDD. No age effect was apparent for OCD. Suicidality was reported in 8 patients (5 assigned to sertraline and 3 assigned to placebo). All but 1 (a placebo-treated patient in the Pfizer OCD trial) were enrolled in the sertraline MDD trial. The NNH for suicidality in MDD was 64. Treatment emergent suicidality was more common in children (NNH 28.7) than in adolescents (NNH 706.3). Because no patient developed suicidality in sertraline-treated OCD patients, the NNH for sertraline in OCD approaches infinity. CONCLUSIONS With the stipulation that doctor and patient preferences necessarily play a critical role in the choice of treatment, NNT to NNH ratios indicate a positive benefit-to-risk ratio for sertraline in adolescents with MDD and in patients of all ages with OCD.
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Affiliation(s)
- John S March
- Department of Psychiatry and Behavioral Sciences, Duke Child and Family Study Center, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Srihari V, Martin A. Gained in translation: evidence-based medicine meets pediatric psychopharmacology. Child Adolesc Psychiatr Clin N Am 2006; 15:263-87. [PMID: 16321734 DOI: 10.1016/j.chc.2005.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Evidence-based medicine (EBM) represents a powerful model for clinicians to translate everyday clinical tasks of finding and applying scientific literature into explicit and systematic steps. This article uses a question about treating adolescent depression to illustrate this approach in the context of a particular patient and his family. By helping the clinician apply population data to the 'bedside', EBM can supplement information from individual patient narratives and can facilitate informed decisions.
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Affiliation(s)
- Vinod Srihari
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06508, USA
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