bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparison of the Efficacy and Safety of Alprazolam and Desipramine in Depressed Outpatients
Authors: Remick Ronald A. , Keller F. Douglas , Buchanan R.A. , Gibson R.E. , Fleming J.A.E.
Published: April 2017

Fifty-two adult depressed outpatients fulfilling Research Diagnostic Criteria for Definite Major Depressive Disorder were enrolled in a double-blind study comparing the antidepressant effects of alprazolam versus desipramine. Twenty-nine patients completed the seven week (one week placebo followed by six weeks of active drug) study. The mean daily dose of alprazolam and desipramine at study termination was 3.34 mg and 192 mg respectively.

Based on psychometric ratings of depression (Hamilton Scale) and severity of illness (Clinical Global Impressions) there was no significant difference between alprazolam and desipramine at the end of six weeks of active drug treatment. Both medications were well tolerated with drowsiness being the most common side effect of alprazolam, and insomnia, dry mouth, and constipation, the complaints most associated with desipramine.
Psychiatric Epidemiology
Authors: Bland Roger C.
Published: April 2017

In this paper, some of the basic concepts of epidemiology are presented. Their applicability to psychiatry is outlined, and the definitions of terms are given. Various methods of epidemiological investigation are discussed.

The background for the development of recent prevalence studies, including advances in diagnostic methods and case ascertainment, are given in some detail, and some recent results are presented. Additional areas of investigation are discussed more briefly.
Secondary Mania with Steroid Withdrawal
Authors: Venkatarangam S.H.M. , Kutcher S.P , Notkin R.M.
Published: April 2017

A case of mania associated with steroid withdrawal is described, and a possible etiology suggested. Milder cases of mood disturbance secondary to steroid withdrawl may be more common than previously recognized.
Drug-Induced Catatonia
Authors: Herrmann Nathan , Lieff Susan J.
Published: April 2017

An 81 year old depressed female is described who developed catatonic-like behaviours while on the combination of the monoamine oxidase inhibitor phenelzine, and the neuroleptic haloperidol. Alternative etiologies, and the roles of the individual agents are discussed. It is suggested that whenever there is evidence of drug-induced catatonia, consideration should be given to stopping all medications.
Beaumont's Contribution to Gastric Psychophysiology: A Reappraisal
Authors: Mai François M.
Published: April 2017

William Beaumont's monograph on the physiology of digestion which was first published in 1833, has become a classic in its field. In a series of experiments over a 10 year period on Alexis St. Martin, a 19 year old Canadian voyageur with a traumatic gastric fistula, Beaumont was the first to describe many important aspects of the digestive process.

In two of the 238 experiments Beaumont noted gastric physiological changes induced by emotional arousal, these being bile reflux and delayed gastric emptying. Elsewhere in the book, but not in experimental context, Beaumont referred to non-specific changes in coloration and secretion of the mucous membrane induced by emotion.

Modern gastric psychophysiological research has shown that emotional arousal increases, and withdrawal decreases, gastric acid secretion. It has also been shown conclusively that emotion can cause a reflux of bile into the stomach and it may delay gastric emptying.

Although the main thrust of Beaumont's work was physiological, he must be credited with being the first investigator to draw attention to the role of emotional arousal in the digestive process.
Characteristics of Patients who Receive Electroconvulsive Therapy
Authors: Malla Ashok K.
Published: April 2017

Case records of all non-forensic psychiatric admissions (n = 5,729), over a three year period, to all the inpatient psychiatric facilities, within one geographic area were studied on a number of demographic, clinical, and treatment characteristics. Patients who had received E. C. T. were compared with those who did not receive this treatment. The results showed that a high proportion (21%) had received E. C. T. In comparison with patients not receiving E. C. T., E. C. T. recipients were significantly older, more often female, had greater number of previous admissions, greater incidence of violent behaviour, and longer stays in hospital. E. C. T. patients did not differ from others on social class, education, and marital status, nor was E. C. T. prescribed more often to patients who had demonstrated suicidal behaviour, even if they had a diagnosis of depression. E. C. T. and non E. C. T. patients received an equal number of psychotropic drugs.
Utilisation de Suggestions Préconscientes et Conscientes Combinées à des Musiques Comme Technique de Relaxation
Authors: Chaloult Louis , Borgeat François , Elie Robert
Published: April 2017

A radio experiment carried out over many years, added to previous clinical tests, has shown a sustained interest of the people for using preconscious (subliminal) suggestions combined with soothing music, as a relaxation technique. The purpose of this study was to compare systematically some combinations with their own components, i.e. the suggestions alone or the music alone. Moreover, drawing inspiration from the works of a Bulgarian psychiatrist, Georgi Lozanov, there were comparisons made of the efficacy of three types of combinations whether they included different kinds of suggestions: preconscious, close to the level of consciousness or conscious. Thirty-five (35) persons were subjected to tests in five experimental sessions, (music alone, three suggestion-music combinations, and suggestions alone), according to a latin-square design (5 × 5). Physiologic and psychologic measurments were used. The physiologic measurements did not show any significant difference between the various treatments. On the other hand, the psychologic measurements favoured the combinations rather than their components alone and specially the combination where suggestions were of an intensity close to the level of consciousness.
Behavioral Abnormalities Commonly Seen in Infancy
Authors: Minde K.
Published: April 2017

Most behavioral abnormalities in infants up to 36 months reflect a disturbance in the relationship between the caretaking environment and the infant. This does not allow their inclusion in present-day classification manuals. The present paper gives a brief description of twelve behavioral conditions frequently seen by the practicing infant psychiatrist. The epidemiology, clinical course, symptomatology and outcome of each condition is described and suggestions for treatment are made.
Medical Students' Attitude towards Psychiatry
Authors: Das Mohan P. , Chandrasena Ranjith D.
Published: April 2017

The attitudes of medical students are important as they influence recruitment to psychiatry. In order to better understand the attitudes of medical students towards psychiatry and the impact of psychiatric clerkship, the authors administered a questionnaire eliciting information regarding demographic data, attitudes and career choices to third year medical students of the University of Ottawa, at the beginning and end of their four week psychiatric clerkship. The data suggests that the students found their clerkship experience valuable and rewarding and expressed an interest in knowing more about psychiatry. The students' perception of the various aspects of their clinical practice of psychiatry became more positive after the clerkship. The authors have identified the positive and negative experiences the students had during their clerkship and postulate that the change in attitude is directly due to their clerkship experience.
Traitement de la Schizophrénie: Vers une Nouvelle Synthèse des Données
Authors: Sidoun Paul , Lalonde Et Pierre
Published: April 2017

One can say that a new approach of long-term treatment of schizophrenia is born. In the last years many authors developed a psychoeducational point of view based on the concept of expressed emotions. These works are quite unknown by the French psychiatrists.

However, this new way of treating schizophrenics is a very complete pattern. It includes and integrates many datas from psychophysiology to family functioning and seems very promising.

The main studies are presented and discussed here.
The Clinical and Forensic Psychiatric Issues of Retifism
Authors: Kunjukrishnan R. , Pawlak A. , Varan Lily R.
Published: April 2017

The literature on the etiological theories, clinical manifestations and treatment of retifism (foot fetishism) and fetishisms in general are briefly reviewed. The case of a 27 year old married male foot-fetishist is presented with emphasis on the psychosexual development leading to the specific sexual deviation. The specific behavioural treatment consisted of covert aversive conditioning using self-reports of sexual urges and psychophysiological monitoring as objective measures of therapeutic change. The theoretical basis for the therapeutic response is discussed.
Delusional Double Mourning: A Complication of Bereavement in Dementia
Authors: Herrmann Nathan , Grek Adrian
Published: April 2017

We describe two elderly patients with senile dementia who presented with the delusion that a parent had died within weeks of the actual death of a spouse. These fixed, systematized, and persistent beliefs do not correspond to the delusions of dementia or of the bereaved elderly that have been previously described. The phenomenology and implications of these “delusions of double mourning” are discussed.
Predictors of Suicide in Borderline Personality Disorder
Authors: Paris Joel , Nowlis David , Brown Ronald
Published: April 2017

One hundred patients with borderline personality disorder who were followed for a mean of 15 years were compared with 14 borderline patients who committed suicide. The most significant predictors of completed suicide were previous attempts and higher education.
Dépression Majeure Chez L'Enfant: Validation du Syndrome et Traitement Pharmacologique
Authors: Goulet Jean
Published: April 2017

The concept of childhood depression has been the object of controversies over many years. Recent developments have permitted rapid progress in many areas of research.

The author offers an update on the validity of the diagnosis of major depression in childhood and on pharmacological treatment. He then attempts to delineate the uses and limitations of this therapeutic approach. In the latter part, practical advice on the use of drugs in childhood depression is given.
Validity of the GHQ-30 in a Nigerian Medical Outpatient Clinic
Authors: Oduwole O.O. , Ogunyemi A.O.
Published: April 2017

Basic mental health vital statistics are scarce in developing countries. Scarcer still are validated psychological survey instruments which can be used in these settings. A method of dealing with such scarcity is through the validation of instruments developed elsewhere. One such instrument is Goldberg GHQ-30. The 30-item General Health Questionnaire was used by the authors as a screening instrument for emotional disorder in a general medical outpatient clinic. The GHQ-30 misclassified 32.3% of the respondents, a majority of whom were false-positives. There is a tendency for the misclassified respondents to suffer from chronic physical ailments, and to be older. The GHQ-30 appears not to have high specificity (65%) and sensitivity (73%). The predictive value (53.3%) of a positive finding by this screening instrument in this population is also low. Informed consent was obtained from participating subjects.
Geriatric Psychiatry Training in Canada: Current Teaching Facilities and Resources
Authors: Agbayewa M. Oluwafemi , Walker John R. , Leichner Pierre , Siddiqui A.R.
Published: April 2017

A survey of Canadian psychiatry residency programs requested information on training activities in geriatric psychiatry. Fourteen out of sixteen programs responded. On average ten hours of didactic instruction were provided per year over the four years of the residency program. Only one program had no facility that provided a rotation in geriatric psychiatry. The majority of programs have policies that encourage exposure of trainees to the care of the elderly. There is a concentration of teachers of this sub-specialty in a minority of centres. These findings are discussed in the light of current and future needs in the care of the elderly. Recommendations for meeting these are proposed.
Length of Stay, Short Stay Units and Psychiatric Emergency Admissions
Authors: Baker Brian , Rochon James
Published: April 2017

Length of stay information was collected from 1,364 individuals over a one year period for five general hospitals in a major metropolitan area. The current set of data represents homogeneity in the nature of admissions and the type of facilities examined. Three of the hospitals operated short stay units. Significant differences in the total length of stay were observed according to age, sex and presence of psychosis but there were no unequivocal distinctions between short stay and conventional hospitals.
The French Connection: Folie à Quatre
Authors: Moss Philippa A. , Pearce Patricia A.
Published: April 2017

A socially isolated family in which the three children shared their mother's delusional beliefs is reported. After separation, the children rapidly adjusted to normal school and foster family life. Difficulties in establishing the family's true identity and problems raised in reuniting the family, while the mother was felt to be concealing her remaining delusions, are discussed.
Family Background and Physical Health of Adolescents Admitted to an Inpatient Psychiatric Unit, I: Principal Caregivers
Authors: Merskey Helen S. , Swart G.T.
Published: April 2017

A retrospective chart review of 100 consecutive adolescents discharged from a provincial psychiatric hospital adolescent unit was conducted. At the time of admission, eighty-four percent no longer lived with one or both of the biological parents. The children remained with the mother more often than with the father. However, boys who had lost their principal male caregiver more often acquired a new one, compared with girls. The latter tended to remain more in a single-mother home. Thirty jour patients were no longer in the care of either parent at admission.

Seventy jour had a conduct disorder. Members of this group were more likely to have lost one or both parents. Recent loss of a parent seemed to be related to a combined diagnosis of depression and conduct disorder. Parental loss was not prominent among one class of the patients with conduct disorder — those with under-socialized aggressive disorders. The latter were often still in their intact biological family of origin, and in four instances they presented serious cases of aggressive actions in the absence of any history of parental deprivation.
DSM-III in Residency Training: Results of a Canadian Survey
Authors: Velamoor V.R. , Waring E.M. , Fisman S. , Cernovsky Z. , Brownstone D.
Published: April 2017

The authors surveyed directors of residency training as well as residents across Canada to determine the extent to which DSM-III has been incorporated into the Canadian psychiatric residency training programs, how this has been accomplished, and the respondents' assessment of certain effects of DSM-III on residency training. This study is a replication of an earlier study done by another team in the United States. Our study indicates that, in most cases, the attitude towards DSM-III was positive: 100 % of respondents described the system as useful or somewhat useful in the training settings. The most frequently selected positive features were its value as a common language, an aid in differential diagnosis, its empirical approach and specificity or clarity of the criteria. The criticisms frequently centred on the DSM-III's potential to induce a false impression of all encompassing theoretical knowledge, to be misused in a mechanistic manner as a “cookbook”, and on the DSM-III's inadequacy with some patients (for example, children, neurotic disorders, and personality disorders).
Opinion: consentement éclairé et capacité en pratique clinique psychiatrique (une perspective québécoise)
Authors: Morrison Denis
Published: April 2017

This paper on informed consent and psychiatry, asks the fundamental question if informed consent doctrine applies or not to psychiatric practice. In a dialectic between systems of thought in psychiatry and law, the author stresses the importance of particular clinical situations which can be addressed or not in terms of application of informed consent doctrine. The purpose of the paper is not to give a final answer but to bring questions and stimulate thought.
Organic Affective Disorder and Vascular Dysregulation in Systemic Lupus Erythematosus
Authors: Honer William G. , Prohovnik Isak
Published: April 2017

A case is reported in which an exacerbation of systemic lupus erythematosus presented as an organic depressive disorder with psychotic features. Brain imaging using regional cerebral blood flow techniques demonstrated vascular dysregulation in the left frontal lobe of this patient. The implications for understanding the pathogenesis of psychiatric disorders in lupus are discussed.
Phototherapy for Depressive Disorders: A Review
Authors: Lam Raymond W. , Kripke Daniel F. , Gillin J. Christian
Published: April 2017

The use of bright light (phototherapy) for psychiatric disorders has recently generated much interest among researchers and the lay population. The authors review the treatment studies of phototherapy for seasonal and non-seasonal depressive disorders, and the empirical evidence for theories of the psychophysiology of phototherapy. Although its mechanism of action remains to be explained, phototherapy appears to be a safe and effective treatment for seasonal depression and a promising treatment for non-seasonal depression. Further questions and future research directions are presented.
DSM-III-R and the Phenomenology of Childhood Bereavement: A Review
Authors: Vida Stephen , Grizenko Natalie
Published: April 2017

The literature on the phenomenology of childhood bereavement is reviewed.

Several authors, particularly in the psychoanalytic literature, have suggested or supported the concept of “absence of grief” in children, based on the postulate that children are unable to tolerate the intense affects of mourning. More recently, systematic studies of nonclinical samples of bereaved children have found “absence of grief” to be uncommon, with most children in fact showing features such as sadness, crying, irritability, and a wide variety of other affective and behavioural symptoms. There does not appear to be a coherent syndrome of childhood bereavement, although tentative associations have been found between some phenomenological features and various child-related, family-related, societal, and circumstantial factors. The level of overall psychological adjustment after parental loss is both variable and controversial. Several tentative predictors of adverse reactions have been described.

The possible place of childhood bereavement in current nosology is discussed. Preliminary evidence suggests that the phenomenology of childhood bereavement differs considerably from the DSM-III-R description of “uncomplicated bereavement.” Recent evidence suggests that the DSM-III-R concept of uncomplicated bereavement needs to be expanded to include many of the affective and behavioural features of childhood bereavement, although confirmatory controlled research is required. Suggestions for improvement of research designs are made.
Suicide Notes in Adolescence
Authors: Posener Joel A. , Lahaye André , Cheifetz Philip N.
Published: April 2017

Suicide rates for adolescents have shown a substantial increase over the past 30 years, but there is little information regarding the clinical status of adolescents who end their lives. In the adult literature, one avenue to understanding the psychologic condition immediately prior to the self-destructive act has been the study of suicide notes, and the present study constitutes the first systematic investigation of notes left by children or adolescents. Records of death were examined in the Office of the Coroner, City of Montreal, and all suicides between ages 10 and 20 were identified for the years 1978 to 1982. Seventeen individuals who left notes were identified, comprising 10% of the population of suicides. Suicides who left notes did not differ from the total group in age and sex distribution but were more likely to choose shooting as a method. The content of the notes was studied in terms of 11 variables which had proven characteristic of suicide notes in the adult literature, and the results were compared to those reported for adults. In general, our results support a psychoanalytic perspective which understands suicide as resulting from an ambivalent attachment to an object, loss of the object, internalization, and the direction of aggression against the self. Cases appeared to fall into two clusters. Older adolescents were more concrete, left specific instructions, did not address the note, did not give a reason for the act, and tended to choose intoxication as a method. Younger adolescents were less concrete, less likely to leave specific instructions, addressed the note to their parents, explained the act, and chose firearms as the method of self-destruction. Implications for a developmental understanding of suicide are discussed.
Violent Behaviour and Psychiatric Diagnosis in Female Offenders
Authors: Brownstone D.Y. , Swaminath R.S.
Published: April 2017

This retrospective study attempts to describe a cohort of female offenders admitted to the Forensic Unit at St. Thomas Psychiatric Hospital between January 1981 and December 1985. During this period there were 91 female admissions; 47 were sent from courts on a Warrant of Remand for psychiatric assessment, 30 under the Warrant of the Lieutenant Governor, 5 under Probation Orders, and the remaining 9 were sent from prison or a detention centre after assessment by a physician. The study has yielded some interesting findings with respect to the relationship between violent crime and particular psychiatric diagnoses, age at admission and type of crime committed, and age at admission and psychiatric diagnoses. We found that an early age of onset of criminal behaviour tends to be associated with personality disorder, while women over 30 were often diagnosed as having a psychotic disorder. We did not, however, find any association between age at first crime and age at index admission with the type of crime committed.
A Psychiatric Intensive Care Unit in a Psychiatric Hospital
Authors: Musisi Seggane M. , Wasylenki Donald A. , Rapp Morton S.
Published: April 2017

This paper describes the operation of a psychiatric intensive care unit in a provincial psychiatric hospital. Its introduction led to a decrease in staff and patient accidents, a decrease in constant observation and seclusion hours, and a decrease in the number of nursing hours lost to injuries at work. It had no effect on nursing absenteeism. The ICU was well liked by nursing staff who preferred to work in its more consistent and controlled environment. In addition, it was also felt that the ward environment in other parts of the hospital became more therapeutic. We therefore conclude that psychiatric ICU's are useful additions to psychiatric settings with important cost and patient care implications.
Suicidal Attempts by Ingestion of Various Substances in 2050 Children and Adolescents in Greece
Authors: Papathomopoulos Evangelos , Vlachos Pavlos , Kalamara Demetra , Papadatos Constantinos
Published: April 2017

This study investigates suicidal attempts by ingestion of drugs or other chemicals in 2050 children and adolescents (312 boys and 1738 girls) under seventeen years of age as seen over a six year period, 1977–1982, at the Poison Control Center, “P.A. Kyriakou” Children's Hospital, Athens, Greece.

Demographic, clinical, psychosocial and cultural data were presented and discussed.

It is the authors' opinion that more attention should be paid to the increased incidence of suicidal attempts in younger persons and therefore the urgent need for early recognition and prevention of this event is necessary. This is the first broad study of its kind in Greece which reflects a segment of the psycho-biosocial developments in this country.
Regional Cerebral Glucose Metabolism in Three Sets of Identical Twins with Psychotic Symptoms
Authors: Clark C. , Klonoff H. , Tyhurst J.S. , Li D. , Martin W. , Pate B.D.
Published: April 2017

Three sets of young identical twins where at least one had a psychotic episode were assessed in terms of psychiatric and psychological status and integrity of cerebral structure and metabolism. The psychiatric diagnoses for each set were normal/schizophrenia, prodromal/schizophrenia and schizoaffective/schizoaffective. The latter two sets were reexamined two years after the initial assessment. The data are considered from a case study perspective. Reduced cerebral metabolism was found for at least one region on eight of nine scans of patients with a psychotic history. On seven of the nine scans, glucose metabolism in the orbital frontal cortex was reduced. These findings are discussed with respect to previous studies of glucose metabolism inpatients with schizophrenia, metabolic similarities found in normal identical twins and the known functional specialization of the orbital frontal cortex.
Factitious AIDS in a Psychiatric Inpatient
Authors: Silva J. Arturo , Leong Gregory B. , Weinstock Robert , Ready David J.
Published: April 2017

This article reports the case of a 28 year-old female presenting to a psychiatric inpatient unit with depression and a history of acquired immune deficiency syndrome (AIDS). Although medical assessment was negative for AIDS, psychiatric evaluation and psychological testing were consistent with a presentation of factitious disorder. This case illustrates the need to be on the alert for individuals admitted to psychiatric units who report they have AIDS or its related conditions.
Attempted Murder of a Newborn: A Case History
Authors: Cherland E. , Matthews P.C.
Published: April 2017

In this report we have examined the evaluation of a teenage mother who has attempted murder of her newborn. We have also assessed her for competency to mother the infant she attempted to murder and reassessed the outcome a year later. We argued in this case that with sufficient supervision and psycho-social counselling she could be given the possibility of parenting her infant. Upon follow-up a year later we found the child and mother to be supported within an extended family group and the mother managing the needs of her infant.
L'homicide chez le patient psychotique: une étude de 24 cas en vue d'une prédiction à court terme
Authors: Millaud Frédéric
Published: April 2017

This research analyses retrospectively a population of 24 psychotic patients, hospitalized in a maximum security institution for the criminality insane and who have committed or attempted to commit murder.

The main focus is on finding the clinical elements which are associated with increased homicidal risk, in the short term.

With that aim in mind, nine patients that were in contact with a mental health professional, during the month preceding the homicide, were studied more specifically. It seems that in addition to the elements usually described in the literature, the association of depressive and paranoid features in the psychotic is a risk factor for homicide in the short term.
Conflit armé et trauma: une étude clinique chez des enfants réfugiés latino-américains
Authors: Rousseau Cécile , Corin Ellen , Renaud Claude
Published: April 2017

This exploratory research on psychic consequences of armed conflicts has been carried out in Montreal on 30 latin-americans, eight to 12 year-old refugees.

The principal objective was to assert the importance of traumas intensity, accumulation and age of occurence on the level and type of symptomatology (introversion-extroversion). Using two types of methodologies, clinical scales and in a more exploratory way, projective instruments to study the intra-psychic dynamic underlying the symptomatology observed. The children were classified according to trauma intensity and for this purpose, a trauma scale was defined with latin-american informants.

ACHENBACH and DOMINIQUE clinical evaluation scales were appplied to the measure of clinical symptomatology. These instruments were analysed as a function of the symptoms intensity and type. Among results, the accumulation and intensity of traumas were found to be in significant correlation with anxio-depressive symptoms, as reported by the children with interiorization symptoms in ACHENBACH. The predominance of interiorization is discussed. The analysis of the TAT, based on objective indicators, brought out a light frequency of violent themes in relations with the clinical symptomatology.

This research indicates the relevance of projective instruments to the study of traumatic response.
Anorexia Nervosa and Bulimia in Males: Lessons from a Low-risk Population
Authors: Steiger Howard
Published: April 2017

The literature on anorexia nervosa and bulimia in male patients was reviewed with the intention of (a) identifying differences that may exist between male and female sufferers, and (b) isolating, through a study of etiological factors in the low-risk (male) group, those factors that may be specific in the etiology of these disorders in both sexes. Current knowledge suggests that fundamental male-female differences do not exist as far as the etiology or symptomatology of these disorders is concerned. Given such similarities, the lower incidence among males suggests biological, social and intrapsychic determinants, that can be conceived to be more active in female versus male populations.
Pharmacological Management of Refractory Depression
Authors: Kennedy Sidney H. , Joffe Russell T.
Published: April 2017

Managing patients with “treatment resistant depression” offers a major challenge to clinical psychiatrists, psychopharmacologists, and others. Firstly, patient heterogeneity must be recognized in terms of symptom presentation, biological variables, co-morbidity with other psychiatric and medical disorders and associated personality disorder. Secondly, a rigorous approach to the treatment resistant patient must allow for adequate individual and combination therapies including heterocyclic agents, monoamine oxidase inhibitors, electroconvulsive therapy, and augmentation with lithium carbonate or thyroid hormone. The novel antidepressant therapies have not so far altered the relapsing course of depressive illness for many patients.
Implications for Clinical Services, Research and Training
Authors: Grant Naomi Rae , Offord David R. , Blum Heather Munroe
Published: April 2017

The Ontario Child Health Study (OCHS) described in the companion paper (1) confirms the fact that psychiatric disorders among children and adolescents are prevalent, that comorbidity and associated impairements are common and that only a minority of children are seen by any definite mental health or social service.

The current assessment and treatment methods and the present service system leave the majority of children unserved. Children and their families suffer a good deal before they are adequately diagnosed and treated, and treatment service delivered on a one-by-one basis are expensive.

The OCHS data, has, it follows, important implications for clinical work, for mental health service planning, for further research and for training in child and adolescent psychiatry. This paper does not address all the implications of the OCHS in these areas but does attempt to address those which follow from the summary of the OCHS data described in (1).
Mentally Retarded Adolescent Sex Offenders. A Survey and Pilot Study
Authors: Gilby Rhonda , Wolf Lucille , Goldberg Benjamin
Published: April 2017

There is not a great deal of empirical research on adolescent sex offenders and even less on mentally retarded adolescent sex offenders. This study provides some preliminary data in this area. Results of a survey of the extent and types of sexual problems evident amongst groups of mentally retarded and intellectually normal adolescents (N = 196), seen at an assessment and treatment centre in southwestern Ontario during a 14 month period is presented. In addition three groups of ten adolescents each (mentally retarded and intellectually normal sex offenders and one group of mentally retarded non-offenders with behavioural problems) were investigated to gain a more indepth perspective of characteristics of these adolescents and their backgrounds. Considering the high recidivism rate for these groups, indications for treatment are discussed with special consideration for the mentally retarded offenders.
The “Marathon Assessment” in Child Psychiatry: A Service to Underserviced Areas
Authors: Krell Robert , Lem Meng-Eng
Published: April 2017

The University of British Columbia Child and Family Psychiatry Outpatient Department has, since 1974, conducted intensive child psychiatry assessments of patients referred from outlying areas.

The marathon assessment, as we have called it, requires up to three days during which clinic staff conduct interviews with the referred patient and family, and perform specific investigations as necessary.

By the end of the third day, the clinic team presents its findings and recommendations to the family, and by phone and letter to the referral source with arrangement for follow-up by physicians and/or mental health clinics in the patient's geographic region.

The marathon evaluation has proven a worthy alternative to outreach visits by a travelling child psychiatrist and to inpatient hospital evaluations. The reasons for the advantages are enumerated.
Predicting Suicide Behaviours in Incarcerated Settings*
Authors: Arboleda-Florez J. , Holley H.
Published: April 2017

Attempts to predict suicide behaviours have produced a number of useful clinical tools. Unfortunately, these have been largely designed with a specific psychiatric population or institutional setting in mind and are not easily transferred to an incarcerated setting. In 1983 the authors developed a suicide checklist which could be used to aid screening of new admissions to Remand Centres in the Province of Alberta. Studies completed to date have revealed this checklist to be a practical and reliable method of standardizing the suicide screening process. This paper presents findings from a study designed to evaluate the predictive power (discriminant validity) of the checklist. A stepwise multivariate framework is used to assess the overall ability of checklist items to discriminate a high risk group. As well, the relative importance of specific socio-demographic, clinical and historical variables is assessed. Data were collected on a cohort of consecutive admissions to the Edmonton Remand Centre during 1986.

Findings reveal that marital status is the only direct statistical predictor of suicide risk. Inmates who had divorced or separated from a spouse were more likely to be active suicide risks at some time during their remand than those who were married or single. Symptom score was found to be generally predictive, however, closer assessment revealed this relationship to be heterogeneous across subgroups defined on the basis of certain criminological variables. The model which allowed for the interaction of clinical with criminological variables correctly discriminated 100% of the active suicide risks and 63 % of inmates who had a prior history of suicide behaviours. The practical implications of these findings for suicide screening are discussed.
Drug Therapy in Schizophrenia — Variability of Outcome and Prediction of Response*
Authors: Awad A. George
Published: April 2017

In spite of the proven benefits of neuroleptics in reducing acute psychotic symptoms and in preventing relapse in schizophrenic patients, not all schizophrenics benefit equally from neuroleptic therapy. Predictors of response include: demographics, clinical characteristics, neurologic soft signs, neurocognitive functioning, morphologic brain changes, drug blood levels, indices of blockade of the dopamine receptors, subjective response to medications as well as early symptomatic improvement. Methodological difficulties in outcome research in drug therapy are reviewed. No single factor has been identified as a reliable predictor of drug response, and it is unlikely that such a single predictor will prove useful in a heterogeneous illness such as schizophrenia. This paper reviews the factors, which have been suggested as useful in developing better understanding of variability of drug response among schizophrenics.
Insurability of the Psychiatrically Ill or those with a past History of Psychiatric Disorder
Authors: Hoaken P.C.S. , Sishta S.K.
Published: April 2017

This paper was prepared for the Professional Standards and Practice Council, chaired by Dr. Werner J. Pankratz. It was approved by the Board of Directors of the Canadian Psychiatric Association on September 27, 1988.
La règle du consentement éclairé et ses impasses en psychiatrie*
Authors: Garneau Yvon , Diener Jean-Martin
Published: April 2017

Every medical intervention is submitted to the rule of informed consent. Over the years, criteria of consent validity and exception situations have been defined. After a discussion of the difficult application of the informed consent rule in psychiatry, this article suggests an analysis of the motivations of a refusal of neuroleptic medication in 20 psychotic patients of a psychiatric hospital. The irrational motivations of refusal (particularly, denial and delusional ideation) have been evoked much more often then rational motivations (therapeutic inefficiency, secondary effects). The authors question the denial as a sufficient reason to declare a psychotic patient incompetent to consent. The consequences of the refusal of the neuroleptic treatment in some patients, mainly the risk of criminalisation, are discussed.
Evaluation of Buspirone as an Antianxiety Agent: Buspirone and Diazepam versus Placebo*
Authors: Pecknold John C. , Matas Manuel , Howarth Brian G. , Ross Colin , Swinson Richard , Vezeau Claude , Ungar Wendy
Published: April 2017

Buspirone has previously been demonstrated to be efficacious in the treatment of anxiety. This four-week double-blind parallel study compared buspirone to diazepam and placebo in the treatment of 119 outpatients diagnosed as having generalized anxiety disorder. After a seven-day placebo washout period, eligible patients were randomized to one of three treatment groups. Buspirone (5 mg) and diazepam (5 mg) were administered BID and individually titrated to an optimal therapeutic dose by the end of week two. Buspirone and diazepam were equally effective in reducing Hamilton Anxiety (HAM-A) total and psychic factor scores from baseline values. Buspirone alone was significantly better than plecebo in reducing the HAM-A somatic factor score. Sixty-seven percent of both active treatment groups who were classified as “ill” on the baseline global psychopathology rating scale achieved a “not ill” status by study end. There were no significant differences between treatment groups at endpoint on the 56-item Symptom Checklist self-rating scale. Buspirone was demonstrated to be as effective as diazepam in relieving anxiety in this outpatient sample.
The Therapeutic Alliance: A Psychoanalytic Perspective*
Authors: Freebury D. Ray
Published: April 2017

Psychoanalysis has long distinguished between the transference neurosis and that part of the communication between therapist and patient which depends upon a relatively intact part of the patient's ego. It has been proposed that it is this capacity of the patient that sustains the difficult work of dealing with communications which are the consequence of transference, and which often threaten the viability of the treatment. This quality has been referred to variously as the unobjectionable positive transference, rational transference, mature transference, therapeutic alliance and working alliance.

The ever broadening scope of Psychoanalysis, along with our greater knowledge of early childhood development, has enhanced our understanding of the many influences affecting the treatment alliances. Newer views of the transference, which stress the significance of the therapists' contributions to the therapeutic dyad, make it clear that the therapeutic alliance can no longer be explained as some simple, reality based, conflict free, motivating force. It involves, rather, a complex interaction of several factors, to each of which one must add the therapists' reciprocal reactions. Psychotherapy outcome research will need to take all of these factors into consideration.
Survey of Diurnal Weight Gain and Urine Volume in Chronic Schizophrenia*
Authors: Vieweg W.V.R. , Godleski L.S. , Hundley P.L. , Yank G.R.
Published: April 2017

We found diurnal weight gain to be abnormal among 39 chronic schizophrenic patients. The patients were weighed and urine samples obtained weekly for three weeks at 7 a.m. and 4 p. m. We normalized the dirunal weight gain (NDWG) as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and then dividing the result by the 7 a.m. weight. NDWG was 2.075 ± 1.331% for the 38 study patients, .631 ± .405% for 16 acutely psychotic controls and. 511 ± .351% for 29 normals. Seventy-seven percent of the study patients had abnormal NDWG values and 62 % were polyuric. NDWG related to urine volume (n = 39, r = .356, p = .026) with the variability in urine excretion explaining 13% of the variability in NDWG. We discuss factors that may have contributed to our findings.
Physician Recruitment in Ontario Provincial Psychiatric Hospitals
Authors: Draper R. , Galbraith D. , Frost B.
Published: April 2017

Recruitment of Physicians/Psychiatrists to staff the Ontario Provincial Psychiatric Hospitals remains an ongoing problem despite the introduction of measures such as University Affiliation and Incentive Grants. Historically there has been heavy reliance upon Foreign Medical Graduates (GOFM's) who have been denied the possibility of professional mobility and advancement because of restrictive licences. Recent changes in regulations have severely restricted the recruitment of GOFM's. During 1987, details of all physicians employed in the provincial hospitals during the preceeding five years were entered into a computerized data base. This paper presents some initial analyses which indicate that Canadian graduates have provided low levels of service, especially outside major urban centres, quite insufficient to replace the GOFM's. These findings raise urgent social and professional concerns.
Personality Dysfunction in Depressed Adolescents
Authors: Marton P. , Korenblum M. , Kutcher S. , Stein B. , Kennedy B. , Pakes J.
Published: April 2017

The personality characteristics of 35 consecutively assessed adolescents who met the DSM-III criteria for a current depressive disorder were assessed using independent structured interviews and paper and pencil measures. Sixty-five percent of the sample met the criteria for an Axis II personality disorder. The single most common diagnosis was borderline personality disorder (30%). Depressed adolescents with a concurrent personality disorder were less self-confident, displayed more neuroticism, and were emotionally reliant on others. They also demonstrated greater cognitive distortion. Teenagers who present with a depressive disorder warrant a comprehensive personality asessment. The combination of affective and personality disorder in such patients is associated with attitudes and interpersonal problems which should be therapeutically addressed in addition to symptomatic treatment of the depressed mood. Clinicians should be aware that depressed adolescents with personality disorder may be more likely to make a suicide attempt.
AIDS: Clinical and Ethical Issues on a Psychiatric Unit*
Authors: Hoffman Brian F. , Arthurs Karen , Lunn Sandy , Meyers Linda , Trimnell Jean , Farcnik Karl
Published: April 2017

Using a case illustration, this paper describes how AIDS has affected psychiatric practice on an inpatient unit. The clinical, ethical and administrative issues are discussed from a multi-disciplinary perspective.

The issues are discussed as 1. clinical issues (diagnostic and management), 2. effects on ward milieu, 3. staff issues, 4. family counselling and discharge planning and 5. administrative issues. It is important for inpatient staff to discuss these issues and develop clinical guidelines and administrative procedures that will help staff provide the highest level of care possible. Because every patient is potentially an HIV carrier, many of the solutions developed around AIDS related concerns should apply to all patients on a psychiatric ward.
Intravenous Chlorimipramine Therapy in Obsessive-Compulsive Disorder*
Authors: Warneke Lorne
Published: April 2017

A brief summary of the etiological factors and pharmacological approaches to therapy of obsessive-compulsive disorder is given. Evidence for the serotonergic hypothesis is reviewed. Three case reports of patients with severe OCD who had not responded to traditional chemotherapeutic approaches and electroconvulsive therapy are presented. All three responded to a series of 14 intravenous chlorimipramine infusions with a maximum dose of 350 mgms per infusion. The technique of infusion therapy and possible mechanisms of action are discussed. It is concluded that OCD is no longer accepted as a rare disorder and that effective treatment exists. For patients who do not respond to oral chlorimipramine, the treatment of choice, intravenous chlorimipramine is suggested as a viable alternative.
Infertility by Choice or by Nature
Authors: Stewart Donna E. , Robinson Gail Erlick
Published: April 2017

Sexually active women have only recently had the ability to make a conscious decision to delay or refrain from bearing children. This is not only the result of the availability of effective contraceptive methods but also due to attitudinal changes in society and individuals. These reproductive choices may result, for some women, in conflict over the use of contraceptives, and the decision or timing of pregnancy. However, infertility imposed by nature in the form of inability to conceive, miscarriage or stillbirth removes the woman's sense of control over this important aspect of her life and frequently results in severe distress. The psychological issues surrounding these reproductive choices and events are reviewed and discussed.
Dépistage des troubles des conduites alimentaires chez une population d'étudiantes de niveau collégial: corrélation avec deux caractéristiques psychosociales*
Authors: Ratté Carole , Pomerleau Guy , Lapointe Et Claude
Published: April 2017

The aims of this study were to measure the extent of severe eating disorders among female college students, to verify if there is a correlation with two indicators of “pressure to perform” while evaluating a screening instrument. Of 1144 female students, 16.3% scored 20 or above on the EAT-26 scale. Interviews allowed to determine that the positive predictive value of the EAT-26 when coupled with a low self-reported weight is considerably heightened. It was possible to estimate that over the last three years one girl out of 12 has presented severe eating disorders and one in 65 has suffered from anorexia nervosa. The EAT score was significantly correlated with the mother's level of schooling but not with the student's academic discipline.