|LETTER TO EDITOR
|Year : 2018 | Volume
| Issue : 2 | Page : 158-159
Case report guidelines and informed consent
Ritambhara Y Mehta
Department of Psychiatry, Government Medical College, Surat, Gujarat, India
|Date of Web Publication||30-Nov-2018|
Ritambhara Y Mehta
Department of Psychiatry, Government Medical College, Surat, Gujarat
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mehta RY. Case report guidelines and informed consent. Ann Indian Psychiatry 2018;2:158-9
“Annals of Indian Psychiatry” is a new and emerging IPS-WZ journal. Similarities in the two case reports in recently released issue Vol. 2 January–June 2018 are striking, reading them one after the other. Some important aspects noticed are put here as suggestions.
One is of childhood-onset schizophrenia (COS) and the second is of childhood disintegrative disorder (CDD)., Yes, both are uncommon, less frequent, and warrant reporting. Children, who develop normally up to a certain age and then deteriorate, have definite neuropsychiatric overlays, each affecting the other sphere, making it very challenging to diagnose and treat as well. Both case reports are focusing on reaching the diagnosis, and both have their patient very young, 13 and 8 years, respectively.
Elucidating differential diagnoses for reporting of rare conditions, the CARE guidelines are available. Internationally, CARE statement and checklist is used as reporting guideline for case reports, published in 2013–2014 simultaneously in seven journals including BMJ. It can be accessed from www.equator-network.org. The CARE guidelines and checklist covers 13 areas (with subdivisions) starting from title, through sections of case writing up to informed consent. For the 8th section of diagnostic assessment-related case reports, the following areas need clarity, depending on the emphasis of the report:
- 8a – Diagnostic methods (such as physical examination, laboratory testing, imaging, and surveys)
- 8b – Diagnostic challenges (such as access, financial, or cultural)
- 8c – Diagnostic reasoning including other diagnoses considered
- 8d – Prognostic characteristics (such as staging in oncology) where applicable.
Both these cases have an emphasis on diagnosis and diagnostic difficulties, making diagnostic reasoning important. Both cases are written in detail; while COS case has a detailed and systematic discussion of differential diagnosis, investigating for each, step by step, ruling out each differential diagnosis gradually and justifying the diagnosis of COS, the case of CDD is more detailed in phenomenology and management, but does not approach D/Ds at all, except reporting one investigation of abnormal MRI, which leaves many questions in the mind of the reader. For example, in case of CDD, especially as the onset is delayed, after 6 years, was epilepsy or subacute sclerosing pan encehalitis ruled out? Electroencephalogram was done or not? Were there any other neuroviral etiologies ruled out? Were viral antibody titers done? Were childhood metabolic or lipid storage diseases considered? Were white matter or myelin sheath degeneration disorders such as leukodystrophy ruled out?
The increasing right-based ethical standards has made informed consent a must. In both the cases, the child being symptomatic either with gross motor, speech problems, and bladder–bowel control loss or with behavioral disturbances parental consent becomes necessary.
It is important for authors, reviewers, and editors, that as part of the protection of research participants, ICMJE guidelines and guidelines on informed consent in sections 28, 29, and 30 Declaration of Helsinki, revised, 2013 are followed., Ethically, children cannot give consent, only legal guardians can. If a child is in the age group of 12 years or above and can understand or has good intellectual capacity to understand the aspects of research and the implications of taking part in research, the assent from the adolescent as well as consent from a legal guardian is taken.
These aspects can affect the journal standards, and hence, the authors, reviewers, and editors must be vigilant in these aspects. The only intention of this writing is to improve the journal standards, and nothing else.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Khar PB, Bhatankar SS, Santre MS, Pawar AV. Childhood – Onset schizophrenia: A diagnostic challenge. Ann Indian Psychiatry 2018;2:55-7. [Full text]
Patel KH, Samani MJ. Childhood disintegrative disorder. Ann Indian Psychiatry 2018;2:61-2. [Full text]
Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D, et al.
The CARE guidelines: Consensus-based clinical case reporting guideline development. BMJ Case Rep 2013;2013. pii: bcr2013201554.
Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals Updated, ICMJE Guidelines; December, 2017. Available from: http://www.icmje.org/icmje-recommendations.pdf
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World Medical Association. World medical association declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA 2013;310:2191-4.