bluuebunny/crossref_metadata_2025 huggingface dataset:
University Students, Mental Health and Development
Authors: Gold J.H.
Published: April 2017

University students of the late 1960s and 1970s have been included in a study of factors affecting their mental health and academic functioning in many countries and cultures. Social change and intergenerational conflict were seen to be almost inseparable as social, economic and political concerns involve both students and their countries. Results of studies at Dalhousie University, six British universities, and the University of Singapore are examined in light of the socioeconomic problems existing at the time. High unemployment of university graduates, a growing factor in developing and developed nations, is pointed to as a major stress during a university education in the late 1970s.
The Superior-Mesenteric-Artery Syndrome
Authors: Froese Arthur P. , Szmuilowicz Julio , Bailey John D.
Published: April 2017

The so-called superior-mesenteric-artery syndrome is not mentioned in psychiatric journals or books. Yet two variations of the condition have been described. In its acute form, it can be mistaken for psychogenic vomiting in anorexic patients, while its chronic intermittent form is readily misdiagnosed as anorexia nervosa. The case report is of a 16-year-old boy admitted for investigation and treatment of severe weight loss. He initially responded to a modified behaviour program, but within days developed an acute small-bowel obstruction. Superior-mesenteric-artery syndrome was diagnosed and he improved with appropriate medical management. This condition needs to be considered by the psychiatrist who otherwise might not differentiate it from the symptoms of anorexia nervosa.
Flight into Femininity
Authors: Steiner Betty W. , Satterberg John A. , Muir Craig F.
Published: April 2017

This paper reports on an unusually interesting group of patients who were seen in the Gender Identity Clinic, Clarke Institute of Psychiatry, during the first two years that it was clinically active. (September 1975 to August 31, 1977). The sample consists of 21 male patients, between the ages of 40 and 65, who diagnostically have been transvestites most of their lives. They present with the request for surgical sex reassignment. This request for surgery comes at a period of “middle-age crisis” in their lives.

A comparison is made between these older male patients and 27 younger male patients seen in the Clinic who also requested surgery. The findings show that the older group tend to be younger at their age of initial cross-dressing, are more socially introverted than the younger transsexuals, and show greater scholastic ability. The most important finding is the predominantly strong heterosexual orientation in these older men when compared with younger gender disordered males. In certain respects these “older” men are rather typical of normal, heterosexual males.

The authors speculate on the findings and suggest that this older male group who request surgical sex reassignment in their middle years, use the desire to “become a woman” as a defence mechanism against an underlying depression. Essentially they are going through the climacteric or “the male menopause”, and should be treated by individual and/or marital therapy (providing the spouse is still living with her husband) together with antidepressant medication, if necessary.
A Case Study in Involuntary Psychiatric Confinement
Authors: Flanagan T.E.
Published: April 2017

Louis Riel was confined against his will in insane asylums from March 6, 1876 to January 23, 1878. Psychiatrists and historians have generally interpreted his certification as an act of benevolence to Riel at a time when he was non compos mentis. However, detailed study of surviving records and manuscript sources shows that the commitment was legally suspect in a number of ways: proper signatures were lacking, pseudonyms were used, records were falsified, and so on. Moreover, while Riel was clearly a religious enthusiast with eccentric ideas, there was no proof that he was dangerous to himself or others at this time. We may thus wish to revise our interpretation of Riel's certification. It was not an act of benevolence but an illegal and unjustifiable deprivation of liberty.
Poppers, A New Recreational Drug Craze*
Authors: Israelstam Stephen , Lambert Sylvia , Oki Gustave
Published: April 2017

The study was conducted to obtain information on the recreational use of the vasodilators (RVs) amyl nitrite and butyl nitrite in Toronto. The results of 70 interviews (40 complete) indicate that sniffing these RVs gives a ‘high’ lasting from a few seconds to a few minutes with headache being the most common side effect. None of the more serious side effects mentioned in the literature were reported. RVs are used chiefly in conjunction with sexual activities and dancing. Their use is currently a craze amongst the male homosexual population.
Medical Students' Views of Psychiatry
Authors: Mccormick W.O. , Voineskos G.
Published: April 2017

Medical students' views of the subjects: Psychiatry, Neurology and Surgery were studied before and after a nine week course which included Psychiatry and Neurology. Surgery was not being taught and was regarded as a control subject. Visual analogue measures of each subject as a career possibility, its importance and its interest were obtained in addition to a ranking for career choice of eight specialties.

In addition, students' attitudes to psychiatrists, neurologists and surgeons (as control) were studied using semantic differential scores.

The scores on the subjects showed changes favourable to Psychiatry after teaching which were not paralleled in Neurology or Surgery. The semantic differential scores clearly discriminated the three specialists; there were small changes after teaching but the broad differences in attitude to the specialists remained.

Some evidence is presented that the more favourable changes towards Psychiatry were related to the quality and intensity of teaching.
Study Difficulty
Authors: Handforth James R.
Published: April 2017

Difficulty in concentration is a common functional symptom, and students suffering from a variety of psychiatric conditions are liable to come to the Health Service with study difficulty as their presenting complaint. It then becomes necessary to determine whether this symptom is indeed secondary to some other problem of a situational, developmental, or psychiatric nature, or whether any associated emotional distress is secondary to study difficulties deriving from poor study habits. In this paper a pragmatic distinction has been made between Primary Study Difficulty and Secondary Study Difficulty, and between various subcategories of the latter. Useful as such a classification may be it remains, like most classifications, somewhat arbitrary and artificial. In any given case it is usually possible to relate a student's presenting complaints to a variety of factors, and to discern a subtle intertwining of cognitive and emotional determinants. The diagnostic and remedial needs of students with such problems are therefore best served by a clinic which involves psychiatrists and psychologists working in close collaboration.
“Dislocation of Expectations” (Management of Violence on a General Hospital Psychiatric Unit)
Authors: Noone A.J. , Molnar G. , Hopper-Small C.
Published: April 2017

An approach to the management of potential violence on a General Hospital Psychiatric Unit is described as it evolved following analysis of the successful handling of a series of problem patients. The importance of an attitude of acceptance towards potentially violent persons is emphasized as is an orientation towards prevention. An approach of consistency and directness with enhancement of the patient's positive personality features is favoured. The initial assessment is considered important and clues to the prediction of violence are highlighted, as are aspects of the supervision plan. A specific technique for prevention of violence based on the principle of Dislocation of Expectations, or doing differently than the subject expects, is introduced.
Names and Dream-Work
Authors: Seeman Mary V.
Published: April 2017

Four dreams are reported in which associations leading to previously unacknowledged material were elicited by asking about names. Inquiry into names and distortions of names (rhymes, puns, contractions, initials, visual symbols) is a useful technique in the provocation of emotionally-laden connections. A possible explanation lies in the parallel between naturally occurring name transformations and the dream work of regression, displacement, condensation and symbolization.
The Limits of Munchausen's Syndrome
Authors: Mcdonald A. , Kline S.A. , Billings R.F.
Published: April 2017

The authors review the literature on Munchausen's syndrome and speculate about possible underlying psychological mechanisms. The proposed DSM III classification of factitious illnesses suggets a continuum from hysteria on one end of the spectrum to malingering on the other.

Two case studies are presented which represent variants of this syndrome. Both patients were given a sodium amytal interview, a procedure not previously reported in the Munchausen's literature. The procedure was helpful in eliciting a more accurate history and a clearer sense of the underlying dynamics. Some suggestions for further research are made.
The Psychoanalytic Theory of Depression: Part I — the Major Contributors
Authors: Robertson B.M.
Published: April 2017

This article is the first of a two part review of the psychoanalytic theory of depression.

In this first part of the review the work of the major contributors to the psychoanalytic theory of depression is discussed.

The writings of Abraham, Freud, Rado, Klein, Jacobson, Benedek, Bibring, Spitz, Sandler and Bowlby, among others, are presented and critically reviewed by the author.

The work of these authors has been selected for this review because they have made the most seminal contributions to the development of the psychoanalytic theory of depression.

Necessarily those authors whose contributions have been largely clinical have not been included, the major focus of this review being theoretical.

In reviewing the writings of the major contributions the major themes in the theory of depression can be discussed.

These themes will form the subject of the next paper in this review.
The Influence of the Supervision of Psychotherapy upon being Therapeutic: II: Modes of Influence of the Supervisory Relationship
Authors: Greben Stanley E.
Published: April 2017

Through supervision, the student develops those innate personal characteristics which are highly important in being therapeutic. In making conscious use of “reality identification” by the student with his teacher, we must take care to avoid certain pitfalls. What is not wanted is transference identification. To help avoid this, we must select appropriate teachers as supervisors. The student should also have more than one supervisor, as this tends to protect against the development of over-idealization on the part of the student, and of omnipotence on the part of the teacher.

Personal characteristics of both students and supervisors are extremely important. A good supervisory experience is the most likely vehicle for developing those qualities in the student which will, in time, lead him to function most therapeutically.
Patient Management in Disulfiram Implant Therapy
Authors: Wilson Allan
Published: April 2017

Data from 100 disulfiram implant, placebo, and no-implant control patients demonstrate the effectiveness of the disulfiram implant in keeping the alcoholic dry. However, the superiority of the disulfiram implant group over the placebo group is interpreted as evidence of a pharmacological component to the procedure operating independent of the disulfiramethanol reaction (DER). Hypotheses involving inhibition of aldehyde dehydrogenase or inhibition of dopamine-β-hydroxylase are offered as mechanisms by which the pharmacological effect may be mediated. Finally, in view of the low (approximately 0.5) probability with which a DER follows ingestion of alcohol by a disulfiram implant patient, it is suggested that the approach to patient management should be changed to maximize the effectiveness of the disulfiram implant procedure. Guidelines are given.
A Note on Counter-Transference and Anti-Semitism
Authors: Traub-Werner D.
Published: April 2017

After a brief introduction where the meaning of racism is alluded to, a clinical vignette is presented. A patient who has suppressed her antisemitic feelings is being treated by a Jewish psychiatrist. The therapist's possible counter-transference motives in treating the patient are explored, and a workable solution is offered.
The Incubus Syndrome: A Variant of Erotomania
Authors: Raschka L.B.
Published: April 2017

The term “incubus syndrome” is proposed to describe patients suffering from the delusion that they have been sexually approached at night by an unseen lover.

Two cases characterized by co-existence of erotomania and schizophrenic sexual delusions are described. The patient's behaviour secondary to the delusion is discussed from the point of view of social significance as well as potential dangerousness.
Psychopharmacology Education in Psychiatry
Authors: Garfinkel Paul E. , Cameron Paul , Kingstone Edward
Published: April 2017

This study has documented resident dissatisfaction with education in psychopharmacology in one large university and has proposed several solutions. These include: • increased awareness of standards of knowledge necessary for a consultant. • the establishment of a central educative office of clinical psychopharmacology to encourage dissemination of selected literature and to facilitate residents’ research under supervision. • recognition that not all staff should be considered capable to provide psycho-pharmacology supervision and that each hospital should have a designated psychiatrist with special expertise in psychopharmacology. • developing study groups for the purpose of teaching critical evaluation of the literature. • increasing encouragement for residents’ participating in clinical research. • awareness of residents’ difficulties in learning (emotional illness, rejection of biological therapies, and knowing what is expected or not suited to psychiatry) and appropriate actions to alter these. • increased use of audio aids, self-teaching manuals and journals to augment lectures and texts. • increased emphasis on training selected senior residents in how to teach.
10 Year Survey of Pretrial Examinations in Saskatchewan
Authors: Kunjukrishnan Reghuvaran
Published: April 2017

The results of a survey of pretrial examination cases admitted to the provincial psychiatric hospital in Saskatchewan from 1966 to 1975 are reported. The demographic and psychiatric data and data from the psychiatric reports to the Court are analyzed. Some deficiencies noted in the reports to the Court are discussed and some remedial measures are suggested.
Psychosexual Aspects of the Panic-Fear Personality Types in Asthma
Authors: Dirks Jerald F. , Jones Nelson F. , Fross Kenneth H.
Published: April 2017

Numerous earlier studies have demonstrated the close relationship between MMPI Panic-Fear categories and various medical outcome measures in asthma. The present study relates MMPI Panic-Fear categories to psychosexual development. Specifically, High Panic-Fear patients demonstrate oral preoccupations, Low Panic-Fear patients demonstrate anal preoccupations, while Moderate Panic-Fear patients do not demonstrate pre-Oedipal preoccupations. Thus, MMPI Panic-Fear categories, useful in predicting medical outcome measures, have now been related to developmental levels, with the explanatory power of developmental concepts as well as their implications for psychological treatment.
Name and Identity
Authors: Seeman Mary V.
Published: April 2017

Identity, though complex, can be encoded in a name. The name bears the stamp of the namers’ traditions and their hopes for the child. The infant's characteristics influence the choice to some degree and, to a degree, a name affects the person who bears it. The interface between names and personal identity is illustrated clinically in syndromes of transsexualism and multiple personality, in twinning, and in the development of the ego-ideal.
The Teaching of Formulation: Facts and Deficiencise
Authors: Ben-Aron M. , Mccormick W.O.
Published: April 2017

Reasons are presented for believing that the skill of formulation is inadequately covered in textbooks.

A survey was made of 57 psychiatric training centres in Canada, the U.S.A and the United Kingdom and Republic of Ireland (in which 1324 doctors are trained). Of North American respondents only a minority give written guidelines about how a formulation should be undertaken. In the United Kingdom and Ireland 55% issue written guidelines. Only 31% of all centres polled give references on the topic.

The results are discussed and a brief schema to help trainees formulate cases is proposed.
Some Thoughts on the Social Ecology of Present Day Psychopharmacology
Authors: Minde Klaus K.
Published: April 2017

The present paper discusses some of the questions frequently encountered in the diagnosis and treatment of hyperactive children. The author attempts to order these questions within an ecological frame of reference, using Popper and Eccles’ recent book The Self and its Brain as an evolutionary model. Problems of diagnosis and treatment relating to hyperactivity are given for each evolutionary level and data from the author's own work are cited in support of this model.
A Survey of Alcohol-Related Problems and their Treatment
Authors: Smart Reginald G. , Gillies Marion , Brown Geoff , Blair Nancy L.
Published: April 2017

This paper reports on the extent of alcohol problems in a sample of adults aged 18 and over. The survey was of the household type with personal interviews. The area of the survey is very similar in demographic characteristic to the Province of Ontario as a whole. Of the 993 respondents, 15.3% were abstinent, 56.8% were social drinkers, 25.1% reported some dependency symptoms and 2.8% were problem drinkers. Serious dependency, defined as three or more symptoms or problems, was found in 5.5% of drinkers. They were mostly males, in lower social classes, young or middle-aged and with lower incomes. The most commonly reported symptoms were wishing to stop or cut down on drinking, memory loss after drinking and receiving medical warnings about drinking. Very few dependent or problem drinkers had received any treatment for problem drinking, including both formal and informal treatment. The rate of serious dependent or alcoholic drinking is 55 per 1,000 or about twice as high as expected based on liver cirrhosis or alcohol consumption data for the area surveyed. The results strongly suggest that there is a large number of people with serious alcohol problems who are receiving no treatment for them. There is a need for both more treatment efforts and preventive programs.
Prediction of Discharge from a Psychogeriatric Unit: (Development and Evaluation of the LPRS Prognosis Index)
Authors: Hersch Edwin L. , Merskey Harold , Palmer R. Bruce
Published: April 2017

Data based on the 36-item London Psychogeriatric Rating Scale was statistically analysed in order to select a small number of questions which would discriminate well between those psychogeriatric inpatients who were likely to be discharged in the following six months and those who were not. A very brief Prognosis Index was developed utilizing the five best discriminating items of the LPRS. The content of these indicated that patients who could communicate coherently, made friends and did not threaten others were those most likely to leave hospital.

The predictive accuracy of the index was assessed for the inpatient populations of a 136-bed psychogeriatric unit at three different points in time. The index was found to correctly predict whether or not patients would be discharged within six months in 78–85% of all cases. Correct prediction was generally seen to increase with time. Predictive accuracy reached as high as 96% (25/26) in the sample of acute ward patients examined after eighteen months.

Since discharge was seen to be dependent on the availability of appropriate placements, the predictive accuracy of the Prognosis Index might be seen as surprisingly high. The simplicity and predictive accuracy of the items utilized and the fact that administration and scoring of the index can be done in less than five minutes without cooperation on the part of the patient suggest that the Prognosis Index is a useful measure. The results also emphasize the importance of personal relationships in determining discharge from hospital.
Methylphenidate, Neuroleptics and Dyskinesia-Dystonia
Authors: Husain Arshad , Chapel James , Malek-Ahmadi Parviz
Published: April 2017

Methlyphenidate is one of two stimulant drugs used in the management of the Hyperkinetic Reaction in children. It has been known to have side effects such as dyskinesia, but this case details the emergence of dystonia and dyskinesia when the simultaneous use of methylphenidate and a phenothiazine was followed by withdrawal of the phenothiazine. It is postulated that the use of phenothiazine resulted in a post-synaptic supersensitivity which precipitated dystonia and dyskinesia when phenothiazine was withdrawn and methylphenidate reinstituted. It is also suggested that the phenothiazine dopamine-blocking action may necessitate the use of larger quantities of stimulant in order to produce the desired effect.
The Monitoring of Saliva Drug Levels: Psychiatric Applications
Authors: El-Guebaly N. , Davidson W.J. , Sures H.A. , Griffin W.
Published: April 2017

An overview is presented of the status of human saliva as a clinical monitoring medium in medicine and psychiatry. Despite the present controversy about the reliability of saliva lithium levels, an evaluation of the prospects of saliva for other pharmacokinetic estimations as well is recommended.

The second part of the paper outlines the authors’ attempt to expand the use of saliva monitoring in a depot neuroleptic clinic and a methadone maintenance program. This technique, well accepted by the patient populations, is found useful as a screening tool for drug use and compliance can be checked. It can also be indicated prior to the evaluation of the toxicity of prescribed medication as well as the assessment of drug interaction.

On humanitarian, clinical and economical grounds, further investigation of the clinical applications of saliva in psychiatric practice is warranted.
Training in Large Group Therapy
Authors: Goering Paula , Littman Seb
Published: April 2017

The widespread use of large group-meetings as a treatment modality has exceeded the availability of staff trained in large group methods. The basic elements of an inservice training program are regular attendance by experienced senior staff who serve as role models, the serious and open use of review meetings following each large group meeting, and the establishment of group norms that facilitate functioning. A few crucial norms are identified and their importance is illustrated with examples from large group meetings.
Briquet's Concept of Hysteria: An Historical Perspective
Authors: Mai Francois M. , Merskey Harold
Published: April 2017

Paul Briquet's Traité de l'Hystérie was published in 1859 and is a comprehensive clinical and epidemiological study of 430 patients with hysteria. It was widely known and quoted in its time, but was submerged by the rise of the psychoanalytic concept of hysteria at the end of the 19th century. Briquet's work was resurrected in 1971 with the recommendation that the term Briquet's Syndrome be used for certain forms of hysteria.

This paper translates into English those sections of his monograph devoted to his concept of hysteria and discusses these in an historical framework. Briquet regarded hysteria as a “Neurosis of the Brain” in which a variety of unpleasant environmental events acted upon the “affective part of the brain” in a susceptible and predisposed individual. He considered the brain to be the “seat of hysteria” because it was the source of the multiple manifestations of the condition.

Amongst its many other notable contributions, Briquet's study finally laid to rest hysteria's historic association with physical disease of the female genitalia.
Neurosyphilis in a Young Man
Authors: Hoffman Brian F.
Published: April 2017

New cases of neurosyphilis are comparatively rare. The epidemiology and clinical presentation of neurosyphilis are described. The article describes the presentation of general paresis in a 34 year old man, 10 years after he had been ineffectively treated with penicillin for secondary syphilis. The various laboratory tests for syphilis are reviewed. The Venereal Disease Research Laboratories (VDRL) is currently the best screening test and the Fluorescent Treponema Antibody-Absorption Test (FTA-ABS) is the current recommended specific test for syphilis. Central nervous system involvement is confirmed in the laboratory by a positive VDRL on the cerebrospinal fluid. Physicians should be on the alert for this cause of dementia which may, once again, be increasing in frequency.
Benzodiazepine Withdrawal
Authors: Lapierre Y.D.
Published: April 2017

This report summarizes pertinent biochemical, pharmacological and clinical information on the effects of abrupt cessation of benzodiazepine therapy. The need to discriminate between distress (anxiety) due to recurrences, rebound phenomena and withdrawal syndromes is emphasized. Although the longer-acting benzodiazepines are less likely to be followed by serious withdrawal reactions, abrupt cessation of drug administration in any dependent high-dose patient should be avoided.
Treatment Approach in a Child with Hysterical Seizures Superimposed on Partial Complex Seizures
Authors: Parraga Humberto C. , Kashani Javad H.
Published: April 2017

This article reports the case of a 9½ year old child with a history of psychomotor epilepsy which was uncontrolled by multiple anticonvulsant medications. When admitted to the psychiatric inpatient service, he was treated with a combination of pharmacological, behavioural and psychodynamically oriented approaches. A period of intensive family counseling was conducted to clarify the parents’ concerns about causality of the seizures and methods for dealing with them. This combined approach led to a complete cessation of reported seizures and a decreased number and dosage of anticonvulsant medications.

The authors discuss the reluctance of some physicians to accept the co-existence of neurogenic and psychogenic seizures in a given patient.

Patients with pharmacologically uncontrolled seizures must be identified and accurately diagnosed (neurogenic and/or psychogenic) to prevent complications such as over-medication and to administer appropriate treatment. Multiple disciplinary therapy including psychodynamic, pharmacological, behavioural and educational approaches should be implemented.
Article
Authors: Montplaisir Jacques , Barbezieux Et Maurice
Published: April 2017

Five non-narcoleptic hypersomniac patients were given GHB (3.0 to 4.5 g per os) at night. Four patients reported a persistent improvement of their daytime sleepiness as a result of this treatment. Nocturnal polygraphic recordings were performed in all patients before and after GHB. The durations of sleep and of waking times were reduced after GHB while there was an increase of stages 3 and 4 during the first third of the night. It is possible that the increase in delta wave sleep early in the night is responsible for a re-establishment of a normal distribution of subsequent sleep stages and thus produces a more recuperative sleep.
Schizophrenia: Sociocultural Factors
Authors: Bland Roger C. , Orn Helen
Published: April 2017

Social factors in an incidence by first admission group of forty-three carefully rediagnosed schizophrenic patients, who were the subject of a long term follow-up, were examined. The findings were:

— Schizophrenics are predominantly lower social class

— Drift from higher to lower social class prior to the onset of illness was not substantiated

— Families of origin were predominantly lower social class

— Patients were likely to have lower grade occupations than their fathers despite both frequently being lower social class

— An excess of urban resident patients, but many of them came from rural resident families

— Immigrants as a whole are not over-represented

— Minority immigrant groups and minority language groups were over-represented

— ‘At risk’ immigrant profile is: male, single, recent immigrant, eastern European origin, non-English speaking, poorly educated, in a lower grade occupation than his father.
The Thought-Stopping Technique: A Treatment for Different Types of Ruminations?
Authors: Parenteau Pierre , Lamontagne Yves
Published: April 2017

Thought-stopping, a simple behavioural technique, can be of help in the treatment of different ruminative processes such as ruminations, phobias of internal stimuli, smoking and sexual deviations. After reviewing the research data, although they claim that more controlled studies are mandatory, the authors believe that thought-stopping can be beneficial in clinical practice under certain conditions. They advise clinicians to use the technique described by Wolpe and Lazarus and they discourage the use of relaxation prior to thought-stopping. Tape-recorded instructions are not recommended in order to maximize the patient-doctor relationship. Finally, if good results are not obtained after a maximum of six sessions of therapy, other forms of treatment should be considered.
Implications of Certain Dreams Reported by Patients in a Bulimic Phase of Anorexia Nervosa
Authors: Levitan Harold L.
Published: April 2017

An attempt is made to demonstrate the interrelationship between the phenomena which occur in repetitive dreams and the processes which are involved in the creation of symptoms in several patients with the anorexia nervosa syndrome who were studied during a prolonged bulimic phase. The outstanding feature of the repetitive dreams was the undisguised and unrestricted instinctual expression which they contained. The dreams were divided into three main categories: dreams of violence in which the dreamer is depicted as the aggressor; dreams of violence in which the dreamer is described as victim; and finally, sexual dreams which are frankly incestuous. The failure of the dreaming ego to repress the powerful aggressive and sexual drives is accompanied by a concomitant failure of the waking ego in various manifestations of defensive processes. This failure operates within the intrapsychic realm and is accompanied by the utilization of a supplementary process such as bulimia involving the mobilization of resources from the outside world.
Therapeutic Outcome in Anorexia Nervosa
Authors: Crisp A.H.
Published: April 2017

There are no controlled studies of the outcome of treatment for anorexia nervosa. An early study showed that biologically recovered anorectics were, as a group, socially phobic four years following the completion of treatment. This position is more sophisticated and mature than that at the time of their original anorexia and one shared by many “normal” people. A recent study evaluated treatment in terms of strict criteria for good outcome: all the patients had been severely ill with anorexia nervosa when first seen. Four to seven years later, 84% were holding a body weight above the pubertal threshold but of these, 2% were obese and 18% were well below average adult weight. Sixty-four percent, therefore, were sustaining a normal and stable body weight and the majority of these had regular menses. Quite a number were preoccupied with body shape, but their psychosocial adjustment was reasonable. In contrast, 14% had remained severely ill and only 2% had died. These findings suggest that treatment aims at altering the long term cause of the disorder for the better is probably effective in (a) helping about 20 to 30% of the population to recover who would not otherwise have done so; and(b) in preventing some deaths.
Medical and Social Factors Associated with Psychological Distress in a Sample of Community Aged
Authors: Luke Elizabeth , Norton William , Denbigh Kathryn
Published: April 2017

Two hundred persons over 80 in two urban communities were interviewed. Of those interviewed, 21% evidenced psychological impairment as defined by the presence of at least one of the following self-report symptoms: 1) depression; 2) periods of inability to function; 3) suicidal ideation; 4) alcohol problems and 5) use of psychotropic medication. A profile of the psychologically impaired group compared to the psychologically healthy showed that accidents (mostly falls), eye problems and few social contacts were significantly associated with impairment. Approximately 75% had some restrictions on activity due to physical health problems. Social isolation was marked: 54% either had no children or saw them less than once a month; 38% visited with close friends or relatives less than once a month; 19% were rated as having very little or no social support; and 23% socialized beyond the household less than once a week. Social interaction was the strongest predictor of psychological well-being (Affect Balance Scale) in a multiple regression analysis that included physical health and socioeconomic variables. Questions about service needs and utilization indicated unmet needs in the areas of transportation, house maintenance, medical services, and a regular visiting service.
Depression Associated with Cimetidine
Authors: Billings R.F. , Tang S.W. , Rakoff V.M.
Published: April 2017

Over the past three years we have seen twelve patients who have become depressed while taking cimetidine. Clinically the depression is similar to that seen in a Primary Affective Disorder. Two representative cases are presented. It is suggested that cimetidine has precipitated a depressive reaction in vulnerable patients. Tricyclic antidepressants are effective in relieving the depression. It is postulated that cimetidine, by blocking H2 receptors in the CNS, produces an imbalance between1 and H2. This imbalance may be an etiological factor in precipitating the depression. Tricyclic antidepressants have little effect on H2 but are potent H1 receptor blockers. This H1 blockade could restore the balance between H1 and H2, thereby relieving the depression.
Antisocial Adolescents: Our Treatments do not Work — Where do we go from Here?
Authors: Shamsie S. Jalal
Published: April 2017

The dramatic increase in antisocial adolescent behaviour is shown through statistics outlining the increase in juvenile crime for Canada, the United States and the United Kingdom. This paper presents a review of evaluative studies of conventional treatments available for antisocial adolescents. Studies involving Case Work, Individual Psychotherapy, Behaviour Modification, Group Counselling, Family Therapy, Milieu Therapy and Therapeutic Community are discussed. Findings indicate that, in general, these treatments are inadequate for the rehabilitation needs of adolescents with conduct disorders. One question arising from this review is whether the unsatisfactory results with present treatment approaches may be due to the perception of antisocial behaviour as a sickness rather than a lack of socialization. The Social Learning Theory is investigated as a means for teaching social norms. A number of studies are cited as showing the effectiveness of social learning types of programs.

Success has also been achieved with antisocial adolescents in a behavioural-employment intervention program; this area is also explored. The impact of evaluative studies on clinical practice is reported as minimal. Some of the reasons which could explain this lack of impact are explored. The paper emphasizes the need for discarding those treatments which have been shown to be ineffective and adopting those which show promise.
A Critique of Volunteer-Staffed Suicide Prevention Centres
Authors: Hirsch Solomon
Published: April 2017

This study compares the Los Angeles Suicide Prevention Center program with that of the Samaritan Centre in the London area. The author interviewed senior personnel and reviewed the training program for volunteers in both centres. He also monitored calls but was prohibited from listening in on the callers’ conversation in the Samaritan program due to their strict policy of confidentiality and anonymity. The purpose of the study was to learn the nature of the calls with special emphasis on suicide risk and degree of crisis; to assess the functioning of the volunteers in detail and compare it with professionals; to assess the usefulness of the programs in lowering the suicide rate and in other functions, particularly dealing with crises and case finding. It was found that the involvement with callers is very similar in both centres; that only a small percentage of callers had a significant suicidal drive; that many of the callers were in crisis and a useful service was provided for them; that the line was frequently abused and misused; that the volunteers coped extremely well with disturbed callers even though their responses were often different from professionals. There is no evidence that these and similar, primarily telephone, services lower the suicide rate; they seem to be more effective as crisis centres than as suicide prevention centres.
Hope, Loss, and Entitlement: Lessons from the Oncology Situation
Authors: Silberfeld Michel
Published: April 2017

The dialectic of three concepts — hope, loss and entitlement — are used to explain the dilemmas faced by patients with chronic, often fatal illness. Among the dilemmas considered are the questions of denial and uncertainty. These are seen in the light of what hope entails as a risk. A clinical vignette is presented for illustration.
Alexithymic Characteristics in Patients with Inflammatory Bowel Disease
Authors: Taylor Graeme , Doody Kenneth , Newman Alvin
Published: April 2017

Twenty patients with inflammatory bowel disease and twenty psychoneurotic patients were studied to assess differences in psychopathology, verbal expression and fantasy formation. The method combined clinical observation, self-assessment questionnaires and quantified projective tests. The psychoneurotic patients showed a higher level of psychopathology, were more verbally expressive, more able to verbalize emotion, and better able to modulate their emotions. Differences in fantasy formation were not found. The results provide partial support for the concept of alexithymia (pensée opératoire), a cluster of cognitive traits which have been reported in many psychosomatic patients.
Psychoanalysis, Dreaming and the Rem State: A Clinical Vignette
Authors: Berger David M.
Published: April 2017

This presentation examines the effect of the discovery of the REM state on the role of the psychotherapist. A clinical illustration serves as the point of departure. A dream fragment which might be explained in terms of the activation-synthesis hypothesis is shown to connect with conflicts in a way that this hypothesis cannot encompass. Freudian theory requires modification in its explanation of what instigates dreams and in its explanations of energy and drive. The therapist's interventions, to the extent that they imply causation to the dream or an energy transformation, also require modification. At the same time psychoanalytic theory does provide a unique understanding of sequential clinical events. The pitfalls of focusing solely on dreams are discussed. Finally, the tentative findings from the REM laboratory concerning the function of dreams are shown to fit nicely with the use to which dreams have been put by psychoanalytic therapists.
The Chronic Mental Patient: The Position of the Canadian Psychiatric Association
Authors: Watt J.A. , El-Guebaly N.
Published: April 2017

This paper was prepared for the Professional Standards and Practice Council, chaired by Dr. N. el-Guebaly, and approved by the Board of Directors of the Canadian Psychiatric Association in May 1981.
A Study of Homicide: The Validity of Predictive Test Factors
Authors: Mcdonald Angus , Paitich Daniel
Published: April 2017

This study is a retrospective comparison of the psychological test findings within four groups, including 61 murderers, 42 assaulters, 71 perpetrators of theft, and 24 unemployed non-criminal controls. Psychological test findings did not discriminate very well among these groups. Some purported hostility scales, such as the Elizur Hostility Scale, the DeVos Hostility Scale, and Megargee's Overcontrolled-Hostility Scale, did not discriminate at all. The 16 Personality-Factor Questionnaire was particularly unhelpful, rating all four groups as having above-average emotional stability. One must conclude that individual psychological test factors are of little value in predicting violent behaviour. Further research is being undertaken to separate the murder group into motivational sub-categories.
Polypsychopharmacy Revisited
Authors: Rapp Morton S. , Kaplan Allan
Published: April 2017

In this paper, polypsychopharmacy is defined, noting variations of definition in the medical literature. We show that the high incidence rates are not dependent only on the physician's behaviour. Much of the medical literature is hostile to the use in psychiatry of two-drug combinations, and this hostility is based on three assumptions about drug use. We find little evidence to support these assumptions. Attempts to reduce the incidence of polypsychopharmacy may be simply irrelevant. We list several two-drug combinations which are of value in psychiatry, and then return to two questions:

1) Why is there so little research into two-drug combinations, considering their high incidence of use?

2) Why does this high incidence persist in the absence of good supportive evidence of its value?

We offer tentative responses to these questions, and conclude that since multiple drug use is as likely to be of value in psychiatry as in any other branch of medicine, research into specific drug-combinations is overdue.
Psychodynamics and Aging
Authors: Wasylenki Donald A.
Published: April 2017

Freud felt that by age 50 the mental processes had lost so much elasticity as to make psychological treatment inadvisable. Subsequent workers have been less pessimistic about the potential for conflict resolution in old age. This paper presents three case vignettes to explore psychodynamic aspects of the aging process. Issues discussed include inevitable losses, grief reactions, difficulties with restitution, structural alterations, redistribution of libido and the use of regression rather than repression as a mechanism of defense. Patients such as these are often diagnosed as depressed or demented and treated with psychotropic drugs. Interpersonal psychotherapeutic approaches can be much more effective.
Reflections on Alzheimer's Disease
Authors: Kushnir S.L.
Published: April 2017

As longevity increases, society will face a silent epidemic of idiopathic dementias. The concept, Alzheimer's disease, reflects a cumbersome and vaguely-defined cluster of signs, symptoms and other variables which might more appropriately be labelled as the idiopathic dementias, Alzheimer-type or IDAT. Diagnosis, which is made by exclusion and treatment, primarily custodial, demonstrates the complex nature and unfortunate prognosis of the problem. Dramatic progress, nevertheless, has been made in various scientific aspects of the issue, namely, in histology, genetics and neurochemistry. The resulting evidence warrants further speculation on the role of central cholinergic neurotransmission in cognitive functioning.
Electroconvulsive Therapy in Patients on Anticoagulants
Authors: Alexopoulos George S. , Nasr Huoshang , Young Robert C. , Wikstrom Thomas R. , Holzman Stephen R.
Published: April 2017

Despite studies in the early literature showing that ECT may lead to CNS bleeding, it is unclear whether unmodified ECT increases the risk for hemorrhage in patients taking anticoagulants. The authors report two cases of depressed patients who required ECT while on coumarin derivatives. Both patients were switched to heparin. Heparin's short duration of action allowed temporary discontinuation 6–8 hours prior to each ECT with return of coagulation function close to normal when the stimulus was administered. No complications were observed in any of the patients. The authors believe that this technique minimizes any possible risks from ECT in patients on anticoagulants.
Homosexuality, Sexual Dysfunction, and Incest in Male Identical Twins
Authors: Myers Michael F.
Published: April 2017

This paper describes a set of adult male monozygotic twins concordant for homosexuality. When initially seen they were living together in a highly ambivalent incestual relationship. Both were dysfunctional sexually (impotent) outside the twinship. Individual and conjoint therapy has assisted each of them with separation and the establishment of more appropriate and sexually functional love relationships.
Comparisons: Indian and Non-Indian Use of Psychiatric Services
Authors: Fritz Wayne , D'Arcy Carl
Published: April 2017

Major differences were found between the Saskatchewan Indian and non-Indian populations in regard to the prevalence of psychiatric disorders, their rates of treatment and the mix of inpatient and outpatient services they receive. Diagnostic and treatment differences between the two populations were more pronounced in the “private” than in the “public” treatment sector. These findings are discussed in relation to demographic, socioeconomic and cultural differences between Indian and non-Indian populations and to size and organizational differences between the “public” and “private” treatment sectors.
Sexual Dysfunction and Clomipramine
Authors: Quirk Keith C. , Einarson Thomas R.
Published: April 2017

Three cases of orgasmic inhibition by clomipramine are reported, one in a male and two infernales. All were depressed patients with obsessive-compulsive features. Orgasmic dysfunction manifested shortly after beginning clomipramine therapy despite a return of libido as the depression lifted. Two of these patients switched to desipramine which led to a resolution of sexual dysfunction while maintaining the patients depression free. The third patient manipulated dosage times to diminish the orgastic problem.

Strong anticholinergic and/or anti-adrenergic properties of clomipramine are suspected to underlie the development of this problem.
Occasional Verse
Authors: Ross Colin A.
Published: April 2017

This novel and sensitive portrayal of a typical experience in an outpatient department was written by a Resident in psychiatry following a six month's rotation in that department.
Trends in Adolescent Psychopathology
Authors: Stein B.A. , Elliott K.C. , Mckeough M.J.
Published: April 2017

Clinicians are reluctant to diagnose severe mental disturbances in adolescents. The psychoanalytic literature on adolescent turmoil has de-emphasized the phenomenology of the clinical picture leading to diagnostic difficulties. Several studies have shown that symptomatic adolescents for the most part continue to demonstrate disturbances in adulthood. This paper reports on the population of adolescents admitted to an inpatient unit and compares it with a population admitted three years earlier. There was an increase in the number of referrals indicating a greater demand for service by the community. The patient population showed a significant trend toward more serious psychiatric disturbance, psychoses and personality disorders, with far fewer adjustment reactions. There was also a great increase in the number of re-admissions which again reflects severity of illness. Antidepressants continue to be infrequently used. Major tranquilizers were used less frequently and with greater specificity in both psychoses and personality disorders. Major implications for identifying and treating recurrent psychiatric illnesses in adolescents are discussed.