bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical and Demographic Correlates of Neuroleptic Response
Authors: Seeman Mary V.
Published: April 2017

This paper presents evidence that the positive symptoms of schizophrenia respond best to neuroleptics, as do patients with hyperdopaminergic activity (high blink rates, low prolactin levels). Those schizophrenics with defect states, intellectual and neurological impairment, brain atrophy, neuropsychological impairment, and poor school and social premorbid adjustment do not respond as well to dopamine blockers. It has been suggested that this group of schizophrenics do not suffer from a dopamine disturbance.

There is also evidence for the relatively superior response of women, especially premenopausal women. This may be due to several factors but appears to be related to estrogen levels, especially since psychotic symptoms appear, in some women, premenstrually and post-partum, when estrogen levels drop. There is now substantial evidence that estrogens antagonize dopamine in the brain.
Autour des décompensations maniaques
Authors: Lavoie Jean-Guy
Published: April 2017

The author stresses early detection of the premonitory signs of a manic breakdown with a view towards an efficient therapeutic intervention. Some of the most typical signs are described with their corresponding dynamic implication.

The manic-depressive's lack of impulse control often forces a member of the patient's circle to take control.

After a review of the main personality traits belonging to the manic-depressive patient, the author gives a description of the patient's spouse in whom appear similar and complementary elements of the patient's personality.

Finally, some steps are suggested to rationalize treatment. Emphasis is on educational methods combined with lithium therapy within the framework of a therapeutic relationship where the interative dynamic forces are acknowledged.
Sex and Schizophrenia
Authors: Seeman Mary V.
Published: April 2017

This paper summarizes male/female contrasts and speculates on how they may influence onset age and outcome differences in schizophrenia.
Schizophrenia: Sex Differences
Authors: Flor-Henry Pierre
Published: April 2017

This paper reports epidemiological findings which support the hypothesis that the influence of gender on schizophrenia is a significant, transcultural phenomenon. Male/female differences in the illness are discussed with particular attention to age of onset, chronicity and prodromal personality characteristics. Evidence is presented indicating additional male/female contrasts in the incidence of birth complications, seasonality of birth, and birth order. The author refers to cognitive as well as neurobiological differences between the sexes in the general population which can elucidate differences in the nature and expression of schizophrenia.
Tardive Dyskinesia Uncovered After Ingestion of Sominex, an Over-the-Counter Drug
Authors: Jones B. , Lal S.
Published: April 2017

Ingestion of an over-the-counter preparation of diphenhydramine (Sominex®), an anticholinergic antihistamine, induced a dramatic uncovering of generalized tardive dyskinesia in an outpatient on chronic neuroleptic therapy. Failure to obtain a detailed medication history, including that of non-prescription drugs, may lead to incorrect diagnosis and management.
Patterns of Illness among Individuals Reporting High and Low Stress
Authors: Norman G.R. , Mcfarlane A.H. , Streiner D.L.
Published: April 2017

This paper reports the results of a prospective study of 428 adults, which was designed to explore the relationship between social stress and health. Individuals in the study were grouped into cohorts based on the number of stressful events experienced in a 12 month period, and the differences in the quantity and quality of health measures among the cohorts in the same time period explored.

Individuals under stress experienced considerably more illness (assessed by symptoms reported on a health diary and physician visits) than those not under stress. However the quality of these illness episodes were similar in both groups, as measured by the distribution of problems in organ system/body region and diagnostic categories. A second analysis, examining a subgroup of individuals who went from periods of low to high stress came to similar conclusions.

The results suggest that the onset of stressful events is associated with a deterioration of health of a general nature, not associated with particular diseases of body systems.
Post-Traumatic Stress Disorder after Car Accidents
Authors: Kuch Klaus , Swinson Richard P. , Kirby Marlene
Published: April 2017

Survivors of car crashes often suffer from a posttraumatic fear of driving, generalized anxiety and depression. Unremitting pains are also common. As part of a pilot study 30 referred subjects were exposed to imagery of driving and accidents. Seventy-seven percent were phobic of driving. Fifty-three percent responded with increased anxiety to the imagery. Twelve treatment referrals received exposure therapy and six improved markedly. An additional four improved when a Benzodiazepine was added temporarily. Four out of eight subjects lost their unremitting pains along with their fears. When guided imagery evoked intense anxiety this seemed to predict a favourable outcome. A resumption of pleasure trips was a reliable criterion of recovery. The frequency of phobic symptomatology and it's importance to the understanding and management of post-traumatic anxiety states is discussed.
Sixth Cranial Nerve Palsy — Unusual Presenting Symptom of Lithium Toxicity?
Authors: Slonim R. , Mclarty B.
Published: April 2017

This paper discusses a case of neurotoxicity which developed in the course of treatment of bipolar affective disorder with Lithium. It deals with the issues of Lithium levels, concomitant usage of Phenothiazine and addresses the important question of toxicity occurring at normal serum Lithium levels.
Learning to Comprehend the Multiple Perspectives of Psychotherapeutic Interactions
Authors: Levy Joshua
Published: April 2017

This study focuses on an educational experience aimed at preparing the participants to appreciate and comprehend the multiple perspectives of psychotherapeutic interactions. A group of advanced psychiatric residents listened, during four seminars, to a complete psychotherapeutic session conducted by their colleague. The clinical material stimulated them to bring out their own perspectives, which were both complementary to, and different from their colleague's. In the process the participants had the opportunity to experience the complexity of the many-sidedness of the therapeutic interactions. In a well designed program for the learning of psychotherapy, this educational approach is to be integrated with other methods.
Cinderella's Stepmother Syndrome
Authors: Morrison Katalin , Thompson-Guppy Airdrie
Published: April 2017

Society, in times and places, has seemed to perceive stepmothers in a negative way. In the past, many of these women have quietly over-compensated in an effort to find acceptance in their new family situation, but they are now coming forward with their psychological distress. On the surface they may present a clinical picture similar to depressive illness (Dysthymic Disorder or Depressive Neurosis 300.40 in DSM III classification). The symptoms include: preoccupation with position in the family, feelings of anxiety, rejection, ineffectiveness, guilt, hostility and exhaustion, loss of self-esteem and overcompensation. With further exploration it becomes clear that the majority of them are experiencing distress that is normal within the context of their adjustment reaction. Clinical findings are based on two separate studies of twelve and ten patients respectively, where two different professionals found remarkably uniform symptoms which have been conceptualized as a new syndrome. An understanding of the normal adjustment reaction of these stepmothers to a very stressful situation can provide the basis for an effective treatment of their problem.
A Multimodal Approach to the Treatment of Agoraphobia: Four Case Studies
Authors: Jackson Henry J. , Elton Vivienne
Published: April 2017

It is argued that while in vivo exposure methods may be the treatments of choice for the agoraphobic patient, other approaches may be required for complete or significant symptom-removal. Four females, each meeting the DSM—III criteria for a diagnosis of agoraphobic disorder, were treated with in vivo exposure. However, for three of the four patients symptom removal occurred only when other methods were employed on an as-required basis for each particular patient. Two of the four patients were asymptomatic both at post-treatment and follow-ups. Over the course of the treatment, the remaining two patients made gains which were essentially maintained at the follow-ups.
Private Practice: The First Five Years
Authors: Berger J.
Published: April 2017

This is a longitudinal study of all patients seen in the first five years of a private psychiatric practice. At the present time, it is believed to be the only known complete study of patients in a typical private practice. The data from 486 patients has been collected and analyzed and some of the results have been compared to those obtained in other studies. Some significant findings emerged. Depression is the single commonest condition and its frequency was similar to that found in other studies. Psychoses were rare. A large category of patients was described as having a Personality Disorder.

The implications of these and other findings are discussed. The data are relevant to aspects of clinical psychiatry, to the teaching of psychiatry, and to the financial insurance coverage of medical services.
Review Panels for Involuntary Psychiatric Patients: Which Patients Apply?
Authors: Gray J. , Clark A. , Higenbottam J. , Ledwidge B. , Paredes J.
Published: April 2017

This study attempted to identify which involuntary patients apply to Review Panels for discharge. Four hundred and eighty-seven (487) patients who applied for review at a provincial mental hospital during a five-year period were compared, on 27 variables, with 2,966 patients who, although eligible to apply, chose not to do so. The groups differed on nineteen of the twenty-seven variables. Discriminant analysis was used to identify the ten best predictors of who will apply to the Review Panel. The profile thus derived of the Review Panel applicant, may be useful to management teams who could try to formulate a plan that would reduce the probability that the patient will apply.
Suicide Attempters Presenting at an Emergency Department
Authors: Eaton Philip , Reynolds Paul
Published: April 2017

Seven hundred and forty-seven consecutive cases of deliberate self-injury presenting at the Emergency Department of an inner city hospital were rated on Beck's Medical Lethality Scales, the Intent Scale and Poldinger's Risk Scale. In addition, demographic data were collected on each patient.

The results pertaining to the demographic characteristics of the subjects were found to be similar to those reported elsewhere. However, although the overall intent scores were not found to be predictive of the lethality of the method employed, the “objective” circumstances surrounding the attempt were found to be highly related to the risk factor assigned to each patient.

The recommendation is made that specific sub-groups of attempters need to be identified and may warrant specialized intervention strategies.
Identity Theory, Functionalism and Intentionality: Three Modes of Psychological Explanation Used in Psychiatry
Authors: Warme Gordon E.
Published: April 2017

It is argued that there are three modes of psychological explanation that are available and in wide use, but that the three are often unwittingly confounded. These are, identity theory, functionalism and intentionality.

Identity theory explains by viewing psychological events as direct products of design, that is, manifestations of brain events. The stance of functionalism is to study psychological events and those past and current stimuli that evoke them. In other words, functionalism studies the way in which psychological events are programmed. Intentionality approaches psychic events as a product of both conscious and unconscious purposes, beliefs, wishes, reasons and meanings, and concludes that it is of considerable worth to treat persons as intentional systems. It is claimed that the demarcation between these explanatory modes is crucial in psychiatric, and especially psychotherapeutic practice and research.
Two Cases of “Pure” or “Primary” Erotomania Successfully Treated with Pimozide
Authors: Munro Alistair , O'brien James V. , Ross Dawn
Published: April 2017

Erotomania is a mono-delusional disorder which, in its “pure” or “primary” form, should probably belong to the diagnostic category of Paranoia. Traditionally, the prognosis and response to treatment are very poor, but one of the present authors has previously proposed that the condition should respond to pimozide. Case histories of two patients successfully treated with this drug are presented.
Psychosomatic Medicine: Past and Present Part III. Current Research
Authors: Lipowski Z.J.
Published: April 2017

A comprehensive classification of contemporary psychosomatic studies by their subject and methodology, respectively, is presented. Representative examples of the current research in this field are provided. Special emphasis is given to the most prominent areas of investigation, i.e. psychophysiology, psychoendocrinology, psychoimmunology, and studies of the impact of stressful life events on health. The widening scope and diversity of psychosomatic research are underscored by its illustrative examples.
The Use of a Bioimpedance Analyzer in the Measurement of Sexual Arousal in Male Sexual Deviants
Authors: Bradford John M.W.
Published: April 2017

The physiological responses of sexual arousal which have been well described by Masters & Johnson, has led to the objective measure of sexual arousal. Penile tumescence is an accepted and reliable method of evaluating sexual excitability. The correleation between Penile tumescence measure and the subjective assessment of sexual arousal is high and has been reported in the range of 0.55 to 0.74 in various studies. The development of simple and inexpensive transducers for measuring penile tumescence has been a significant factor in the empirical research into sexual offenders and has led to major advances in the identification of deviant sexual arousal. This, in turn, allows more specific treatment strategies to be developed and also provides a method for evaluating and monitoring the response to treatment. Electrical bioimpedance is a technique that enables the non-invasive measurement of blood flow by the quantification of changes in the electrical conductivity of a body segment or a tissue sample and is being adapted for penile tumescence testing.
The DSM-III Distinction between Schizoid and Avoidant Personality Disorders
Authors: Livesley W. John , West Malcolm
Published: April 2017

The DSM-III distinction between schizoid and avoidant personality disorders is examined. This distinction derives from Mi/Ion's bio-social learning theory and his interpretation of Kretschmer's personality types. Kretschmer's depiction of schizoid personality emphasizes the ratio between hyperaesthetic and anaesthetic tendencies. It is argued, therefore, that the division of this continuous distribution into two distinct personality disorders is historically inaccurate. Clinical case material is used to illustrate this misconception.
Suicide: Ethical and Moral Issues from a Theological Perspective
Authors: Best Ernest E.
Published: April 2017

A historical review of the Jewish, Christian, Islamic, Hindu and Buddist attitudes of suicide. The evolution to the contemporary Christian perspective is discussed citing contributions of Aristotle, Augustine, Aquinas and Donne. Issues raised by life-extension technology are discussed.
The Impact of Data-based Program Modifications on the Satisfaction of Outpatients in Group Psychotherapy
Authors: Azim H.F.A. , Joyce A.S.
Published: April 2017

A previous assessment of patient satisfaction in our outpatient clinic indicated that patients in group psychotherapy were relatively dissatisfied with services in contrast to patients receiving other forms of therapy. A rational analysis on the part of program staff identified areas where modifications of the group therapy program could be implemented. These program changes are described. Satisfaction ratings of group therapy patients from a subsequent assessment project were compared to ratings from the initial study. Comparisons indicated that an improvement in the level of satisfaction of group patients was evident, providing support for the view that our program changes had had the desired beneficial impact. Results are discussed with regard to the value of ongoing evaluation and data-based modification of delivery services for the continuing improvement of patient care.
Socialization Scores in Psychiatric Patients and Their Implications for the Diagnosis of Personality Disorders
Authors: Standage Kevin
Published: April 2017

The distribution scores on the Socialization (So) scale of the California Psychologial Inventory was examined in a series of 83 admissions to a general hospital psychiatric service. The series was divided into groups of low and high scorers (Low So and High So).

Low So scorers were younger than high scorers and had a raised mean Neuroticism score. A strong association was found between So scores and the quality of parental care which patients reported receiving from their fathers. Other parental attributes are reported.

Patients with a clinical diagnosis of personality disorder were found in the Low So, but not the High So group.
PréSentation D'Un Cas
Authors: Samson Esther , Picard Et Sylvie
Published: April 2017

Summary

A new case of Capgras’ syndrome is presented with a short review on the subject. Since there are many controversies about the etiology of this syndrome, and since some authors explain it with organic factors, others with psychodynamic factors, or a combination of the two, one should be careful with this syndrome to eliminate the presence of organic factors with a meticulous physical examination and appropriate neuropsychological tests. A thorough examination of early interpersonal relations is necessary to verify psychodynamic hypothesis, the most plausible being the splitting of internalized object representations.
Physically III and Mentally III
Authors: Johnson Robert , Ananth Jambur
Published: April 2017

Undetected physical illnesses in psychiatric patients are common. Why do so many physical illnesses go undetected? These disorders are difficult to detect and need an elaborate consultatory process. Some of the problems may be related to the fact that psychiatrists do not do physical examinations. Clues suggesting an organic etiology may be attributed to psychodynamic issues by many physicians. In this paper, seven case reports are presented to illustrate the following: perform your own physical examination; do not attribute physical signs to dynamic issues; all physical signs should be explained; be alert to atypical presentations; conduct relevant laboratory workup; avoid bias against unattractive patients; and pose specific questions to consultants.
Clomipramine: An Antiobsessive Drug
Authors: Ananth Jambur
Published: April 2017

In the past decade, various investigators have attempted to find new pharmacological agents for the treatment of obsessive disorders. Of these, the drug which has attracted attention and has been most promising is clomipramine. This paper attempts to review the usefulness of clomipramine in the treatment of obsessive disorder. Accidentally, it was discovered that clomipramine was effective in alleviating obsessive symptoms in depressed patients by a Spanish psychiatrist, Lopez-Ibor. Initial studies carried out mainly on patients with major depression reported that obsessive symptomatology benefited with clomipramine therapy. A number of uncontrolled and controlled studies confirmed the efficacy of this drug in obsessive neurosis. The drug improves the obsessive symptoms. Discontinuation of the drug is followed by a relapse. The efficacy, dosage, duration and side effects of treatment with clomipramine are discussed in this paper.
Affective Disorders and Circadian Rhythms
Authors: Hallonquist J.D. , Goldberg M.A. , Brandes J.S.
Published: April 2017

Abnormal circadian rhythms have been associated with affective disorders. A review of this rapidly expanding area of investigation shows that while a clear causal relationship has not yet been proven, a knowledge of the circadian system and its dysfunction can help in understanding unipolar and bipolar depression. Evidence suggests that existing therapies such as lithium and antidepressants act upon the circadian system. Better identification of individuals at risk for affective disorders and the development of new preventive and therapeutic interventions may result from further study of circadian dysfunction.
Suicide and Parasuicide in a Northern Canadian Native Community
Authors: Ross Colin A. , Davis Brian
Published: April 2017

This report describes suicide and parasuicide in a small, remote northern Canadian native community for a three-year period from 1981 to 1984. The overall rate for suicide was 77 per 100,000, with a rate of 241 for male Treaty Indians age 20 - 24. Parasuicide in the form of overdose was epidemic, with a rate of 7,722 per 100,000 in Treaty Indian females age 15 - 19. None of the completed suicides had previous contact with the mental health system or previous parasuicides. The public health implications of these figures are discussed.
Présentation D'Un Cas
Authors: Cournoyer Jocelyne
Published: April 2017

There is evidence that panic disorder and major depression might share some common neurobiological factors. This would be consistent with the fact that most antidepressant drugs are effective in preventing panic attacks.

This is a case report of a 40 year old woman who was suffering from a panic disorder. Following the discontinuation of a long-term lorazepam treatment, she developed severe depressive symptoms. The depressive syndrome improved rapidly with amitriptyline (150 mg/day), but the panic attacks persisted. Twelve weeks later, amitriptyline was replaced by clomipramine (150 mg/day), the dosage of which was increased to 225 mg/day three weeks later. The patient remained anxious with no resolution of her panic attacks. Two weeks later, lithium carbonate (900 mg/day) was added to clomipramine. Sixty hours later, a dramatic improvement was observed. The lithium plasma level was 0.8 mEq/L. Because of some tremors, lithium was discontinued five days later. Within four days, the anxiety as well as the panic attacks reappeared. Lithium carbonate (600 mg/day) was then resumed. Forty-eight hours later, the patient was showing a clinical improvement similar to that observed following the first addition of lithium. She remained symptom free with the maintenance of the drug combination.

To date, several reports have confirmed the beneficial effect of adding lithium to a tricyclic antidepressant drug in resistant major depression. However, we believe that the present case reprot is the first one documenting the augmentation of a tricyclic antidepressant drug by lithium in a patient suffering from a panic disorder.
Chronic Central Anticholinergic Toxicity in Manic Depressive Illness Mimicking Dementia
Authors: Moreau A. , Jones B.D. , Banno V.
Published: April 2017

Acute anticholinergic delirium has been reported to occur following ingestion of antidepressants, neuroleptics and antiparkinsonian drugs in toxic and therapeutic doses. A case is described of a chronic central anticholinergic syndrome in a patient receiving a combination of such drugs. This chronic anticholinergic toxicity was superimposed on manic depressive illness which resulted in incorrect diagnoses including schizophrenia and dementia and, accordingly, improper management. Diagnosis of central anticholinergic toxicity may be overlooked in psychiatric patients because the symptoms of toxicity can be incorrectly ascribed to psychiatric, illness. It may also be overlooked in elderly patients who are prone to demonstrate confusion and problems with memory. The recognition of this syndrome in the patient reported, at least nine years after it developed, led to appropriate management which ultimately resulted in a dramatic change in her ability to function.
Family Dysfunction and the Psychological Impact of Child Sexual Abuse
Authors: Pelletier Guy , Handy Lee C.
Published: April 2017

This paper presents the view that family dysfunction in intra- and extra-familial child sexual abuse can be considered apart from the sexual trauma and can be seen as having important independent psychological consequenses. Family dynamics are discussed as they relate to both types of sexual abuse and as they relate to the context of disclosure of the events. A direct link is suggested between such dynamics and the psychological problems experienced by the child victims. Recommendations for research and therapy are also made.
Clinical Aspects and Treatment of Rapid Cycling Mood Disorders
Authors: Levy J. Mark , Remick Ronald A.
Published: April 2017

Eight female patients with rapid cycling mood disorders (at least four discrete affective episodes per year) were examined from a clinical perspective.

Assessment suggested several different etiologies to the rapid cycling pattern in these patients. These included that the rapid mood swings were: a natural expression of the affective disorder, tricyclic induced, a result of frequent medication changes and/or poor medication compliance, and a combination of the aforementioned etiologies.

All patients were helped significantly with treatment. Treatment was individualized for each patient's unique illness and possible etiological factors in the rapid cycling. Treatment strategies and guidelines include: i) A psychotherapeutic approach involving the patient and his family which emphasizes the lengthy nature of treatment before expected results; ii) The necessity of rigorous drug adherence, in) The sole use of “high dose” lithium therapy (> 1.2 MEQ/L) in some patients, and the consideration of “high dose” lithium in conjunction with tricyclics, MAO inhibitors or “adjuvant” medication in certain bipolar II patients; iv) The discontinuation of tricyclics in bipolar l rapid cyclers;v) The combination of lithium salts and carbamazepine or the use of carbamazepine alone in selected patients.
Pseudocyesis: An Overview
Authors: Small Gary W.
Published: April 2017

The author reviews the medical literature on pseudocyesis, the condition where a nonpregnant woman believes she is pregnant and has objective signs of pregnancy. The disorder involves both psychological and neuroendocrine mechanisms and is related to other conditions varying in severity from fleeting fears and wishes in healthy women to pathological changes in neuroendocrine functions in others. The notion that the condition is a heterogeneous one, closely related to other more common disorders, is emphasized.
The Role of the Psychotherapies in the Practice of Psychiatry the Position of the Canadian Psychiatric Association
Authors: Katz Philip
Published: April 2017

This paper was prepared by the Scientific Council chaired by Dr. D.J. McClure and approved by the Board of Directors of the Canadian Psychiatric Association in June 1985.
Child Psychiatrists in the 90's: Who will want us, who will Need Us
Authors: Rae-Grant Quentin
Published: April 2017

Child Psychiatry is now a well recognized and established sub-speciality in Canada. It has gone through a period of vigorous and healthy growth. Like psychiatry in general it now faces a number of challenges which provide potential threat but which may lead to better definition of priorities and of its most effective function.

Other disciplines, medical and non-medical, increasingly compete for a place on the therapeutic spectrum. Within psychiatry the rhetoric between different schools of thought provides ammunition for those who have no use for any form of psychiatry however it may be provided.

The challenge is to develop more effective ways of using the skills of the child psychiatrist within a recognition that the number of practitioners will never approach what would be required to have child psychiatry alone cover the treatment needs of children and adolescents. The field requires the adoption of a more flexible metaphor for training and practice with competence in the different schools of theory and of therapy. Attention needs to be paid to the consumer movement, to the impact of better informed parents and public and to the developing of a parsimonious and selective approach to the use of scarce professional time.

The healthy growth of research in child psychiatry is a development long overdue and places the discipline on a scientific rather than a clinical practice base. At a time when funding and the cost of health care are crucial issues the development of a secure knowledge base, efficient methods of service delivery and the integration with other mental health care providers are opportunities and grounds for optimism about the future of the sub-speciality.
Overrepresentation of Adopted Children Attending a Children's Mental Health Centre
Authors: Jerome Laurence
Published: April 2017

A retrospective analysis was made of case records of children attending a Children's Mental Health Centre during the years 1959 to 1973. Annual comparisons were made between the numbers of adopted, children seen in the province of Ontario and within the clinic setting. The results indicated that over a fifteen year period the adopted children in the clinic were seen with twice the expected annual incidence predicted from the community rates.

“So far as it is known, the proportion of successful and unsuccessful adoptions does not seem unsatisfactory. This result is in accordance with clinical experience which does not suggest that an undue proportion of adopted children are referred to child guidance clinics.”

Bowlby (1951)
Male Adolescent Sexual Offenders: The Offender and the Offense
Authors: Saunders Elisabeth , Awad George A. , White Georgina
Published: April 2017

A group of male adolescent sexual offenders were divided into three groups: Courtship Disorders (Exhibitionism, Toucherism and Obscene Phone Calls), Sexual Assaults, and Pedophilic Offenses. Group I offenders tended to come from a less disorganized family background, were better adjusted to school and in the community and were seen by clinicians as less seriously disturbed than the adolescents in the other two groups. In addition, these adolescents did not experience the offense as a sexual act. Group II offenders (Sexual Assaulters) came from a more disturbed family background characterized by a high rate of long-term parent-child separations, committed more violent offenses and had a higher frequency of intellectual functioning in the Borderline Range of Intelligence. Group III offenders (Pedophilic Offenses) were Canadian born, had witnessed physical violence between their parents, were described as having been infants who did not enjoy being cuddled and had siblings who were truant. This study suggests that classifying adolescent sexual offenders along the line suggested in adult literature seems to be justified.
Autistic Children Grow Up: An Eight to Twenty-Four Year Follow-Up Study
Authors: Wolf L. , Goldberg B.
Published: April 2017

Eighty questionnaires were sent to parents and/or caregivers of autistic persons diagnosed between 1960–73 at CPRI, a regional assessment and treatment centre. The objective was to determine their present place of residence, functioning ability, language development, program involvement, and seizure activity. The results of this study support evidence that more than 50 percent require long-term institutional care; almost one-third suffer epileptic seizures; there is a persistence of symptoms and difficulty in gaining useful speech; few live independently or are capable of employment.
A Brief Story about Dr. Hermine Hug-Hellmuth
Authors: Maclean George
Published: April 2017

Dr. Hermine Hug-Hellmuth was the world's first practicing child psychoanalyst. From this vantage point of being the first person to apply psychoanalysis to the treatment of children, she was also the first person to make use of systematic child observation from a psychoanalytic point of view (1). In addition Dr. Hug-Hellmuth was among the very first of the lay adherents to psychoanalysis to practice psychoanalysis (2). Further, she was one of the first women to obtain a doctorate degree in physics from the University of Vienna. We see that in all these aspects, as a woman, with a lay education, practicing psychoanalysis with children and employing psychoanalytic child observation, she was the first, or among the very first. In this perspective her pioneer status becomes understood to be very important. Others followed and psychoanalysis grew and flourished as did the contributions and the stature of those who would become giants of psychoanalytic history. In part, it was in the shadows of these later giants that the memory of Dr. Hug-Hellmuth has faded.
Consultations Psychiatriques dans un Hôpital Général
Authors: Sirois François , Laperrier Serge , Rousseau Et Louis
Published: April 2017

A statistical analysis of psychiatric referrals for in-patients in a urban general hospital are presented: Data are compared to reports from the last twenty years. Significant differences for age, sex and diagnosis are noted. These are attributed to the specific vocation of the hospital as a chest and cardio center for eastern Quebec. The discussion deals with various aspects of the clinical material. References from out-patient clinics are not included.
The Tilted Family
Authors: Falconer Clark W. , Ross Colin A.
Published: April 2017

This paper is a report on clinical observations of a particular family constellation which has seldom been discussed in terms of its theoretical and therapeutic importance. We outline the possible effects on families of having same-gender children. Four case examples are given to highlight how this issue can be of value in assessment and treatment.
Is there a Relationship between Sexual Abuse or Incest and Eating Disorders?
Authors: Sloan G. , Leichner P.
Published: April 2017

The significance of sexual conflicts in many patients with eating disorders has been well documented. However, even when these have been considered to have some degree of etiological importance, the occurrence of actual sexual trauma or incest in the early lives of these patients has been generally neglected in the literature.

At one point in time, it was noted that five of six patients on an inpatient unit for eating disorders revealed an early history of sexual abuse or incest. These five cases are described. A parallel is drawn between the psychological problems experienced by victims of childhood sexual abuse and by patients with anorexia nervosa and/or bulimia. Our suspicion that these experiences may not be atypical led to the present article, which has implications for the investigation and management of eating-disordered patients.
Tricyclic Antidepressant Agranulocytosis
Authors: Gravenor D.S. , Leclerc J.R. , Blake G.
Published: April 2017

Severe neutropenia is an unusual complication of antidepressant therapy. We report a case of agranulocytosis due to clomipramine, and discuss principles of management.
The Will as a Vehicle of Family Dynamics
Authors: Schneiderman Gerald
Published: April 2017

The will is an instrument of generational transfer and change. In addition to the realistic decision making processes that go into the writing of a will, family dynamics play a role in this deliveration. This paper will describe a family where a surviving parent changed her will since she claimed that two of her three children were not showing her adequate love and respect. In brief family therapy and with legal support, the will was changed to its original form, dividing the estate equally. No changes were facilitated in family atmosphere or style. Several months later her eldest son's child was referred for treatment because of a behaviour problem at school and this family entered into family treatment. The family had to deal with the emotional disengagement of the grandmother. In addition, her oldest son's sadness, disappointment in his mother's behaviour, which was reflected in the grandson's symptomatology were worked through as well as structural changes to help build an organized family with a tradition based on integrity, trust, and respect. Family dynamics and changes in wills will be discussed.
Multiculturalism and Canadian Psychiatry: Opportunities and Challenges
Authors: Lin Tsung-Yi
Published: April 2017

In this lecture, the writer calls the attention of Canadian psychiatrists to the unparalleled opportunities the national policy of multiculturalism has for clinical and research activities. Using illustrations from three important fields in psychiatry — epidemiology, psychopharmacology and psychotherapy, he points out the roles socio-cultural factors play in generating ethnic differences which deserve to be given serious scientific attention for both the understanding of causative factors and the treatment of mental disorders. He emphasizes that medical universalism and ethnocentricism have no place in Canadian psychiatry, and that the next phase of Canadian psychiatry should focus on cultural relevancy based on cultural relativism and equal participation of all cultures and ethnic groups.
Teaching Psychotherapy to Future Non Psychiatric Physicians: A Survey of the Canadian Experiences
Authors: Borgeat François , Bernazzani Odette
Published: April 2017

The majority of patients consulting for mental health problems are treated by non psychiatric physicians (1). Thus, the teaching of therapeutic skills of a psychological nature to future physicians takes on a considerable importance. A survey bearing on the objectives, methods, orientations and problems related to the teaching of psychotherapy for non psychiatric physicians has been conducted in the departments of psychiatry of Canadian medical schools. That survey indicates that the Canadian experience remains presently limited and confronted with many obstacles at the practical and psychological levels. The coordinators of undergraduate psychiatric education in Canada are almost unanimous to underline the necessity of providing physicians with some training in psychotherapy but also to deplore the actual state of development of that teaching.
Desipramine Plasma Concentration and Therapeutic Response in Elderly Depressives: A Naturalistic Pilot Study
Authors: Kutcher S.P. , Shulman K.I. , Reed K.
Published: April 2017

This naturalistic pilot study of desipramine hydrochloride treatment in elderly DSM III diagnosed depressives demonstrated that therapeutic response was related to desipramine plasma levels and that a desipramine plasma concentration of 200 nmol/l significantly differentiated responders from non-responders. Plasma concentrations of 2-Hydroxydesipramine were not related to therapeutic response. This finding suggests that monitoring of desipramine plasma levels has utility in certain clinical situations. Further fixed dosage studies are necessary to confirm these initial results.
An Epidemiological Study of Electroconvulsive Therapy: Rate and Diagnosis
Authors: Malla Ashok
Published: April 2017

Five thousand, seven hundred and twenty-nine consecutive admissions to the three general hospitals and the mental hospital in St. John's, Newfoundland, Canada, were examined retrospectively for the use of electroconvulsive therapy (ECT). The proportion of patients admitted who received ECT (rate), and the number of treatments per admission were recorded. Rate of ECT, expressed as percentage of patients admitted, was assessed for all hospitals separately and compared on legal status and diagnosis. One thousand, two hundred and thirty-six (21.5%) patients admitted, received ECT with little variation over a three year period. The rate was higher for the general hospitals and for voluntary patients. ECT was used in a very high proportion of patients with diagnoses of depression (50%), mania (20%), schizophrenia (36%), and neurotic disorders (20%). These findings are discussed in the context of the overall trend of a low utilization of ECT elsewhere, and the previous research evidence of limited indications for ECT.
Nurses’ Response to Doctors’ Orders for Close Observation
Authors: Aidroos Nafees
Published: April 2017

Informal observation seemed to show that doctors’ orders for close observation were treated in a manner different from other orders for patient care. A subsequent formal study involved 26 nurses over a four-month period. Data was collected by direct observation and through brief interviews with the nurses.

A shift or part-shift involving a nurse and his patient on close observation was defined as the observation unit. Only 23% of the 284 observation units complied approximately with hospital policies for close observation. Forty-one percent of the observation units were recorded as totally non-compliant. No observation unit fulfilled the policy requirements in the strictest sense. Nurses provided close observation for almost as many patients on general observation as they gave general observation to those for whom close observation had been ordered.

These data suggest that in most cases nurses use something other than doctors’ orders to determine the observation needs of their patients.

The author suggests that doctors’ orders for close and general observation be abandoned and that only orders for constant observation be retained, in conformity with what is already going on.
A Psychiatric Intensive Care Unit in a General Hospital Setting
Authors: Warneke L.
Published: April 2017

A twelve month period of the functioning of a psychiatric intensive care unit in a general hospital is reviewed. The unit has actually been functioning for about three and a half years. Although there were growing pains initially, the unit has become an integral part of the psychiatric inpatient service. It serves to provide intensive care to acutely inpatients and provides a safe, secure environment. It also reduces the number of disturbed patients on the two general units. Very disturbed patients are expertly managed by the staff and a surprisingly low percentage of patients have to be transferred to the local mental hospital under certification.

The experience demonstrates that a psychiatric intensive care unit based on a general medical intensive care unit model can function well with benefit both to patients and staff.
Combination of Trazodone and Phenothiazines: A Possible Additive Hypotensive Effect
Authors: Asayesh K.
Published: April 2017

Trazodone a triazolepyridine derivative is known for its therapeutic effect in the treatment of depression since early 60's. It has little catecholamine potentiation or anticholinergic action. It has been reported to have less severe cardiotoxic effect. Mild or transient as well as orthostatic hypotension may be its main cardiovascular complication.

Additive hypotensive side effect following combined use of Trazodone and Phenothiazine in two hospitalized patients was observed and documented. Each case is detailed. While the mechanism of action of both agents and their effect on α 1 and α 2 adrenergic receptors has been described, some suggestions are made to explain a possible mechanism for the observed side effect. This finding might be implemented into further research work.
Geriatrie Referrals to a Psychiatric Consultation-Liaison Service
Authors: Mainprize E. , Rodin G.
Published: April 2017

Geriatric patients constitute a significant proportion of referrals to a psychiatric consultation-liaison service, accounting for 29% of referrals in the present study. Organic mental disorders, the most common psychiatric diagnosis, were identified in 51% of geriatric referrals. The next most common psychiatric conditions were affective disorders and adjustment disorders, each of which were diagnosed in 17% of geriatric referrals. Transfers to in-patient psychiatry were unusual and the most common recommendations were for psychotropic medications, further medical investigations, and for psychosocial and behavioural interventions to be carried out by the ward staff. Although more specialized psychogeriatric units and community treatment resources are necessary, it is likely that the general hospital setting will continue to be important in the diagnostic assessment and short-term management of medical-psychiatric problems in the elderly.
Does the Use of Phenobarbital as an Anticonvulsant Permanently Exacerbate Hyperactivity?
Authors: Burd Larry , Kerbeshian Jacob , Fisher Wayne
Published: April 2017

Data is presented on 12 patients in whom phenobarbital, when used as an anticonvulsant medication, either precipitated hyperactivity or permanently exacerbated existing hyperactivity. Discontinuation of the medication resulted in a decrease in hyperactivity in all patients. None of the patients returned to a pre-drug level of activity. The effect of phenobarbital on the reticular system is discussed. It is important for clinicians to carefully consider the potential side-effects of the use of phenobarbital in children in whom overactivity is a problem. Ascertaining whether hyperactivity has been caused or exacerbated by exposure to phenobarbital may be important in the differential diagnosis of hyperactivity.
Was Queen Victoria Depressed? 1. Natural History and Differential Diagnosis of Presenting Problem
Authors: Powles William E. , Alexander Mary G.
Published: April 2017

For some years we have speculated as to whether Queen Victoria suffered a definable psychiatric illness in her notorious and prolonged seclusion after the Prince Consort's death. We here summarize criteria for grief and depression from three authorities. Against these, we examine the natural history of the Queen's bereavement and restitution. We find that her suffering and her portrayal of the role of widow were related to her personal style and were culturally accepted. Her self-esteem, ego functions, and object relatedness were preserved. While some clinicians might favour a diagnosis of Dysthymic Disorder, we find the evidence strongly in favour of an intense, prolonged, normal human grief (Uncomplicated Bereavement of DSM III) coloured by a romantic and histrionic personal style. Intensity and duration do not, in this case, establish a diagnosis of depression.
Sadistic Homosexual Pedophilia: Treatment with Cyproterone Acetate: A Single Case Study
Authors: Bradford John Mcd.W. , Pawlak Anne
Published: April 2017

This single case study demonstrates the effects of antiandrogen treatment on a subject with a very serious sexual deviation and a poor prognosis. It assesses the effects of cyproterone acetate (CPA) on an individual with a serious chronic organic brain syndrome combined with sadistic homosexual pedophilia. Furthermore, this individual had failed to respond to a behavioural treatment program and long-term milieu therapy. Finally, this case study is the first report of CPA differentially affecting penile responses to deviant and non-deviant stimuli.