bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic Interviewing with Children: The Use and Reliability of the Diagnostic Coding Form
Authors: Beitchman J.H. , Kruidenier Bastian , Clegg Marjorie , Hood Jane , Corradini Angela
Published: April 2017

There have been few attempts to standardize assessment methods in Child Psychiatry. This paper describes a semi-structured approach to diagnostic interviewing of the child. Thirty-four children six to 13 years of age, and their parents, were interviewed two weeks apart by two different psychiatrists. A diagnostic coding form consisting of 29 clinical symptom items, eight summary items, and nine positive health ratings was used. Three diagnostic items were also included: “severity of clinical condition,” “probability of disorder,” and “adjustment status.” Twelve of the Time 2 interviews with the child and parent were videotaped and rated by three different psychiatrists. Results indicated that summary items had higher reliability than individual symptom items and the three diagnostic items had the highest reliability, suggesting reliability is better for broad classes of behaviour. Interrater reliability was higher for the face-to-face rating than videotaped ratings. This suggests first that face-to-face interviews are reasonably stable over a two week period and second, since videotaped ratings had lowest reliability on items that depended on inferences about the child's feedlings, an important source of variance in assessment may be the clinician's ability to empathize with the child and draw inferences about internal feeling-states. It was concluded that this interview schedule can be a part of routine clinical practice. It ensures a reasonably standard, yet flexible and reliable approach to diagnostic interviewing.
Viewpoint: Development of Mental Health Services and Psychiatry in Canada: Lessons from the Past: Problems of the Present; and the Future
Authors: Roberts C.A.
Published: April 2017

The history of mental health services in Canada has been characterized by great frustration for those dedicated to the development of programs to meet the needs of the mentally ill. Acceptance of these services by the public at large has been limited and characterized by suspicion and lack of trust. In recent decades these two trends have contributed to the present situation in which it is difficult to recruit competent, well-motivated clinical staff for our more isolated mental hospitals and there is increasing emphasis on legalistic aspects of individual civil rights, compulsory treatment and related factors with little attention to the patient's entitlement to and need for adequate treatment.

It is hypothesized that more understanding and progress may come from an insightful review of the historical development of Canadian Mental Health Services and the goals of organized Psychiatry in Canada than will result from developing a defensive and confrontational attitude towards current events in the field.
Article
Authors: Plante Gilles C. , Huberdeau Lucie , Gagnon-W Et Claire
Published: April 2017

What happens to deprived children when they grow up? The authors tried to answer this question by initially selecting 34 subjects clearly identified as suffering a deprivation syndrome in their youth. Following theoretical considerations, the authors formulated hypotheses which they attempted to verify by comparing the nine adult subjects available who had suffered deprivation during their youth with whom they were able to establish contact with nine others diagnosed as neurotic (the control group).

The authors predicted that the deprived subjects would present more disability as adults than the neurotic ones. They were predicted to be more inclined towards delinquency and depression. It was hypothesized that they would not drift into psychosis, psychosomatic illness or become “young chronics”. We did not expect that they would move very much on the social scale.

The authors seized the opportunity to learn more about the satisfaction with the psychiatric interventions experienced during their youth.

In this study, the authors used a questionnaire and four scales of the MMPI to compare the two groups. The deprived subjects demonstrated more maladaptation with a strong tendency towards delinquency and possibly depression. They were not mobile on the social scale, and did not drift into psychosomatic illnesses or become “young chronics” but some psychosis was observed among them.

In the final discussion, the authors discuss the limitations of the study due to the size of the sample and problems of the methodology, along with ways that this could be strengthened in order to more successfully answer some of the questions raised.
AIDS in Infancy: Diagnostic, Therapeutic, and Ethical Problems
Authors: Wittenberg J. , Lazenby A.
Published: April 2017

Congenital AIDS is on the rise and will pose multiple problems to society and to health care workers in particular, as more infants develop the disorder. Differentiation of AIDS from infantile grief reactions is of critical importance, as infants at risk for AIDS lose their mothers who have AIDS. Team approaches are optimal and should include psychiatric perspectives. Issues of diagnosis, maladaptive psychological reactions and ethical dilemmas are discussed and illustrated in a case history.
Child Mistreatment: Possible Reasons for its Transgenerational Transmission
Authors: Ney Philip G.
Published: April 2017

One of the most tragic aspects of child abuse and neglect is that it is so often perpetuated from one generation to another. The reasons that humans do not learn from their tragic past and repeat it have been considered by historians, philosophers, psychiatrists and many others. This article mentions some of the hypotheses that have been put forward to explain the repetition of history. It attemps to establish an alternate hypothesis to explain how and why mistreated children become the perpetrators in the next generation. It suggests that abuse, or neglect requires the participation of a perpetrator, victim and observer. A triquetra of these three rotates with time and circumstance. The recycling of abuse occurs because the individual, at all levels of his being, is attempting to understand the conflicts and consequent disequilibrium that were engendered within him with his early experience. Unfortunately, the re-enactment seldom results in enlightment because there is no one available to comment on the process as it occurs. Psychotherapy for child abuse requires corrective interpretation during a controlled restaging of the major conflicts.
Economic Evaluations in the Canadian Mental Health System II: From Theory to Practice in Mental Health Care*
Authors: Fried Bruce J. , Worthington Catherine , Deber Raisa B.
Published: April 2017

This paper follows from a previous paper which described the basic approaches to economic evaluation of health programs. The discussion in this paper builds and discusses the theoretical and practical concerns felt by practitioners and analysts about economic evaluations in mental health care. Two examples of economic evaluations that compare the costs of hospital care and community-based care are presented to illustrate some of the limitations of economic evaluation. Discussion also focuses on the difficulties involved in developing and conducting economic analyses in the mental health field, as well as problems faced in trying to generalize from one study setting to others.
Premenstrual Depression in Women with a History of Affective Disorder: Mood and Attentional Processes*
Authors: Mcmillan Marcia J. , Ghadirian A. Missagh , Pihl Robert O.
Published: April 2017

Survey studies have pinpointed high concordance rates between affective disorder and premenstrual depression. This relationship was investigated in women with a history of both disorders. Sixteen subjects rated symptoms daily during one menstrual cycle, and were assessed on measures of mood and selective attention pre– and postmenstrually. Prospective ratings confirmed premenstrual depression in only eight of the subjects. These subjects demonstrated a significant premenstrual elevation in dysphoric affect, yet exhibited a dysphoric attentional bias both pre– and postmenstrually. These data do not suggest an interactive relationship between affective disorder and premenstrual depression along the particular cognitive dimension of study.
Father-Daughter Incest: 25 years of Experience of Psychoanalytic Psychotherapy with the Victims
Authors: Bigras Julien
Published: April 2017

This study deals with the immediate and long lasting effects of father-daughter incest through the psychoanalytic-psychotherapeutic investigation of, firstly, a group of 12 adolescent girls during the violent crisis created by the sudden revelation of incest and, secondly, a group of 12 adult former victims with no apparent crisis in their development, the incest having remained unrevealed. Having been a practioner of psychoanalytic psychotherapy with the victims of paternal incest for the last 25 years the author's main concern in this study is to try to establish the basic theoretical issues that would favour a better understanding of incestuous trauma and a more effective approach to its treatment.
Neuroendocrine Probes as Biological Markers of Affective Disorders: New Directions*
Authors: Brown Gregory M.
Published: April 2017

Numerous endocrine abnormalities are found in depressive illness and, among these, several have been proposed as useful markers in diagnosis, prediction of treatment response, monitoring treatment outcome or in understanding of etiology. This paper reviews five endocrine systems — the hypothalamic-pituitary-adrenal axis, hypothalamic-pituitary-thyroid axis, growth hormone regulation, prolactin regulation and pineal function, in which such abnormalities have been reported.

The dexamethasone suppression test (DST) results are affected by a variety of other diseases and confounding conditions. Furthermore, variability in dexamethasone availability has recently been shown to be an important factor, influencing post-DST cortisol levels. Refined tests, taking into account all these factors, or alternative tests of hypothalamic-pituitary-adrenal function may lead to improved clinical utility.

Pineal function is now the focus of considerable investigation. Low nocturnal output of melatonin is found in unipolar and bipolar affective disorder and is normalized by treatment with antidepressant drugs which block re-uptake of noradrenaline. These findings support the hypothesis of noradrenergic abnormality in depression. In seasonal affective disorder there is evidence for a phase delay in the melatonin rhythm which may be a key factor in the seasonal disorder. Effective light therapy causes a phase advance in the abnormal melatonin rhythm. Whether the normalization of the melatonin rhythm is instrumental in producing the antidepressant effect is yet to be determined.

There are wide spread neuroendocrine abnormalities in depressive illness. These abnormalities encompass many different pituitary hormones, as well as the pineal. Major theories of affective disorder attribute the mood and visceral changes to disruption in central neurotransmitter regulation or to altered central regulation of body rhythms, or to both. It is thought that disruption of these central systems give rise not only to the mood and visceral changes, but to the accompanying changes in endocrine regulation.

Current diagnostic practice is to use clinical history and observation to identify typical forms of depression. Such an approach to diagnosis is less useful in delineating atypical, borderline or sub-clinical affective disorder. For these reasons, the endocrine changes have been proposed as biological markers to be used as clinical aids in diagnosis, prediction of treatment response, monitoring treatment outcome and in understanding etiology.

This paper reviews and evaluates published data on five such endocrine measures.
Motivation for Motherhood and the Experience of Pregnancy
Authors: Robinson Gail Erlick , Stewart Donna E.
Published: April 2017

It is frequently assumed that becoming a mother is an essential step in the development of female identity. Although female hormones may increase a woman's readiness to care for an infant, there is no clear cut evidence of a hormonal basis for maternal feelings. A woman's desire to have and raise children is affected by cultural expectations and opportunities. Current analytical thinking, while viewing reproductive choice as being an important component of feminine identity, does not emphasize the necessity of having a child to feel feminine. Once pregnant, the woman works through issues related to body image, relationship with mother and husband, concerns for the fetus, fears about the future and her new vision of herself.
Structured Interviews and the Diagnosis of Personality Disorders*
Authors: Standage Kevin
Published: April 2017

Structured interviews were developed to improve the reliability of the diagnosis of personality disorders, as it has occurred in other areas of psychopathology. Several such interviews are described in this review, which draws together reports scattered across a wide literature. The appearance of structured interviews in Britain reflected the early interest there in the special problems associated with diagnosing personality disorders, whereas in America their development had to await publication of the DSM-III. Studies using these techniques have illustrated important aspects of clinical diagnosis and can be expected to assign value to the diagnosis of personality disorders in the future.
Qui Sont Les Patients Traités en Clinique Externe Avec des Doses Élevées de Neuroleptiques?
Authors: Leblanc Gérard , Cormier Hugues J. , Vaillancourt Sylvie , Gagné Marie-Andrée , Gingras Christian
Published: April 2017

The use of high doses of neuroleptics (NL) in treatment of chronic psychosis is a controversial subject in the literature. In this context, it is surprising to note the lack of objective data about the prevalence and the consequences concerning this mode of prescription when treating people suffering from severe mental disorders. This study describes the clientele exposed to high doses of NL from an outpatient clinic of a psychiatric hospital. The equivalent of 18 mg or more of haloperidol per day was used as the high dose criterion.

Overall, we observed the use of NL in all diagnostic categories and the frequent use of polypharmacy in patients treated with NL. Among the 435 patients receiving NL, 26.4% had high dose prescriptions (two men for every woman). Most of these high dose NL subjects had a diagnosis of schizophrenic disorder (87.9%). Fifty-one of them had been receiving high doses for six months or more and 39 of them agreed to meet our research team. The mean age of these subjects was 37.2 years and the mean dose was 63.5 mg haloperidol equivalent/day. Thirty-five subjects were diagnosed as chronic schizophrenic disorder and four as schizoaffective disorder. Nineteen patients had tardive dyskinesia. In two out of three cases the high dose perscription began during hospitalization and the main reason was presence of severe psychotic symptoms.

Significant positive correlations were found between parkinsonian symptoms and negative symptoms of schizophrenia as well as psychosocial dysfunctions on 39 subjects. These findings support the hypothesis that the use of high doses of NL contribute to the negative symptoms and the psychosocial dysfunctions.

The implications of these findings relating to assessment and treatment of schizophrenic outpatients are discussed.
The Remitting Atypical Psychoses: Clinical and Nosologic Considerations
Authors: Remington G. , Menuck M. , Schmidt P. , Legault S.
Published: April 2017

There exists in the literature a group of nonorganic psychoses which appear to have no obvious relationship to either schizophrenia or affective illness. Diagnostic terminology to classify these atypical psychoses has been varied, although features in common can be identified. For example, they often are associated with antecedent personality problems, acute onset, florid and mixed symptomatology, brief duration, and full remission with a return to premorbid level of functioning. Case material reflecting these types of psychoses is presented here, and is discussed with reference to the nosologic status of these atypical psychoses.
Prophylactic Medication for Unipolar Depressive Illness: The Place of Lithium Carbonate in Combination with Antidepressant Medication
Authors: Kim Hae R. , Delva Nicholas J. , Lawson J.S.
Published: April 2017

A meta-analysis of the controlled clinical trials comparing the efficacy of combined lithium-imipramine therapy with each drug alone in the prevention of relapse in patients with unipolar depressive illness shows the combination to be superior to lithium alone (for any relapse, p < 0.05; for specifically depressive relapse, p < 0.025) and imipramine alone (for any relapse, p < 0.025; for specifically depressive relapse, p < 0.05). The issue of statistical power in studies of this kind is discussed. A single case of unipolar depressive illness is described, in which combined lithiumtranylcypromine therapy was superior to either drug alone. A combination of lithium and an antidepressant should be considered for any patient suffering from this condition who fails to remain well on either drug alone.
Dorothea Dix and Her Two Missions of Mercy in Nova Scotia
Authors: Goldman David L.
Published: April 2017

Dorothea Lynde Dix, 19th century defender of the rights of the mentally ill to hospital care, holds a significant place in the history of Nova Scotia. Her two major accomplishments in this province include laying the groundwork for its first psychiatric hospital and the outfitting of treacherous Sable Island with rescue equipment to aid ships stranded off its shore. The techniques that Miss Dix employed in these missions parallel those she successfully used in the establishment of psychiatric hospitals in a number of American states. It will be argued that her influence has been a positive one on the treatment of the mentally ill particularly in light of the failures of the deinstitutionalization movement.
Le Problème des Troubles de la Personnalité en Psychiatrie
Authors: Denis Jean-Francois
Published: April 2017

Psychiatric patients with personality disorders are among the most difficult because of the counter-transferential strain they put on clinicians and the paucity of specific treatment. The author develops the point that personality disorders are not diseases as implied in Axis I disorders, but social illness syndromes which depict systemic problems in which clinicians can be engulfed and entrapped. The difficult patient does not exist in isolation, a victim of his own drives and psyche, but rather is a specific socio-cultural actor living and emerging from a particular environmental context. Personality disorders are considered to be interpersonal patterns in which a person's debilitating behaviour elicits complementary behaviour that reinforces the original behaviour. Within a systems perspective, there is not a disordered personality so much as a disordering system of relationships. As with families and society, healers too become involved in the vicious cycle of personality disorders if they fail to see the manipulative interpersonal devices used by these patients. If clinicians accept too naively the lay person's simplistic belief that personality disorders are diseases to be treated by psychiatrists, they run the risk of fostering inappropriate passivity in patients in the face of life demands. Overindulgence and angry rejection are the two major pitfalls often seen in clinical practice.

The approach proposed here may seem conterintuitive in laying stress on the need to actively resist the temptation to take over reponsibility for a patient's life. There is a difference between a behaviour that a patient's illness (Axis I disorder) prevents him from controlling and an impulsive deliberate behaviour stemming from character pathology. It is a logical error to deal with personality disorders in the same manner and with the same conceptual terminology as for depressive and psychotic disorders. Principles of management are detailed and can be summarized as a kind firmness to bring back patients to take on their own responsibilities.
Bouffée Délirante in Jamaican Adolescent Siblings
Authors: Roberts Nasreen
Published: April 2017

The high incidence of brief schizophrenia-like psychosis in developing countries is well documented in the literature. This paper presents two cases of bouffée délirante found in Jamaican adolescent sibs who had recently immigrated to Canada and discusses the importance of accurate diagnosis, in view of prognosis and treatment, for this disorder.
Propranolol and Depression: Evidence from the Antihypertensive Trials
Authors: Patten Scott B.
Published: April 2017

The relationship between propranolol and depression is a subject of controversy. Numerous case reports suggest that propranolol can cause depression, but two small prospective trials have failed to confirm this. The contemporary psychiatric literature is divided as to whether propranolol can cause depression. This study addresses this issue by re-analyzing side effect data from clinical trials of propranolol as an antihypertensive agent. A literature review was carried out and the data were analyzed using meta-analytic statistical techniques. Propranolol was found to cause depression as a side effect with a statistically greater frequency than the control medications used in these trials. As other side effects of propranolol include fatigue, diminished energy, decreased libido, anorexia and poor concentration, it is suggested that propranolol is a cause of organic mood disorder, depressed type.
Polydipsia and Hyponatremia Induced by Multiple Neuroleptics but Not Molindone
Authors: Glusac Earl , Patel Hiten , Josef Norma C. , Yeragani Vikram K.
Published: April 2017

A 37 year old patient with chronic schizophrenia developed polydipsia and hyponatremia induced by several neuroleptics. We treated the patient successfully with molindone. The etiology of polydipsia with hyponatremia is discussed.
Depression in the Community: Findings from the Stirling County Study
Authors: Murphy Jane M.
Published: April 2017

Depression and anxiety disorders were studied in a longitudinal investigation of a general population. These disorders were identified through responses given in a structured psychiatric interview carried out as part of the Stirling County Study. A 16 year follow-up indicated that depression carried a significantly worse prognosis than anxiety, as measured in terms of mortality risk and the likelihood of becoming a chronic or recurrent illness. When morbidity and mortality information were brought together, it was found that 82 % of those who were depressed at the beginning of the study had a poor outcome. This suggests that depressions found in the community, where most of them remain untreated, are similar in seriousness to those seen by psychiatrists in outpatient clinics and mental hospitals. It seems likely that general physicians can play a useful role in caring for such depressions, especially if physicians become alerted to the risks associated with these illnesses.
Native Ethics and Rules of Behaviour
Authors: Brant Clare C.
Published: April 2017

Psychiatrists assessing Native children and adolescents often find them passive, difficult to assess and not forthcoming. This behaviour, which actually reflects the influence of Native culture, is often misinterpreted by clinicians unfamiliar with that culture as evidence of psychopathology. Patterns of conflict suppression, conflict projection and the humiliating superego are described and placed in their historical and cultural perspective, where they originated as techniques of ensuring the group unity and cohesion essential for survival in a hostile environment. Failure to recognize and understand such cultural influences can lead to errors in diagnosis and treatment that can turn what was intended as a helpful encounter into a destructive one.
Sample Size and Power in Psychiatric Research*
Authors: Streiner David L.
Published: April 2017

The conclusions drawn by study are susceptible to two types of errors. The more familiar one occurs when it is believed that there was a true difference between the groups or an association between two variables, when in fact this observation was due to chance (a Type I error). The second potential error consists of falsely concluding that there was no difference or association when indeed there was one (a Type II error). Most researchers know that the probability of a Type I error can be controlled by the setting of a. level of statistical significance; however, many are unaware of methods to control or estimate Type II errors, based on estimates of an appropriate sample size. This paper discusses techniques researchers can use to calculate the sample sizes required for studies, and the effects of sample sizes which are too small or too large. If it is too small, there is an increased risk of a Type II error, whereas if it is too large, there may be a needless waste of time, money, and effort. The paper also discusses how readers of research articles can determine whether or not negative findings reported by a study are a true reflection of the lack of any difference between groups, or a result of insufficient sample size.
Chronic Fatigue Syndrome and the Psychiatrist*
Authors: Abbey Susan E. , Garfinkel Paul E.
Published: April 2017

The number of patients who are identified as having chronic fatigue syndrome (CFS) has increased, and as a result, chronic fatigue syndrome has received widespread attention. Research has demonstrated that cognitive, affective and behavioural symptoms are prominent in CFS. Psychiatrists are therefore being asked to participate in the assessment and management of patients with this syndrome. This paper will provide an overview of the clinical characteristics of CFS and the current empirical findings related to its pathology, and will conclude with a discussion of the management of these patients.
The Head Injured Adolescent: A Case Report and Review of the Issues*
Authors: Reiter Sharon , Kutcher S.P.
Published: April 2017

Closed head injuries in adolescents are a common problem with potentially disastrous consequences to multiple areas of functioning. Through a case presentation and literature review, this paper considers treatment issues and research applications in an adolescent population with closed head injuries. Suggestions for understanding the symptom constellations are made and directions for future research and service delivery are given.
Successful Fluvoxamine Treatment of a Case of Refractory Obsessive-Compulsive Disorder*
Authors: Solyom Leslie , Solyom Carol A.E.
Published: April 2017

Fluvoxamine, a potent and selective serotonin uptake inhibitor, effectively reduced compulsive handwashing and other rituals in a patient previously refractory to behaviour therapy, clomipramine, MAO inhibitors and other pharmacotherapy. Treatment effect was delayed but broadly patholytic, reducing anxiety and depression scores as well as ratings of obsessiveness.
Pediatric Bone Marrow Transplants: Psychological Aspects
Authors: Mcconville Brian J. , Steichen-Asch Paule , Harris Richard , Neudorf Stephen , Sambrano James , Lampkin Beatrice , Bailey Diana , Fredrick Beth , Hoffmann Claudia , Woodman Donna
Published: April 2017

On a pediatric bone marrow transplant unit, hematologistoncologists, nurses, social workers, psychiatrists, psychologists, and others on the team deal with children and adolescents whose cancers are either treatable by marrow transplantation or are ultimately fatal. Contrary to original assumptions, many children and families cope well, especially in relatively uncomplicated cases with good outcome. Treatment may include direct psychotherapeutic intervention with the child and family, as well as use of psychopharmacologic agents such as antidepressants or anxiolytics for frank psychiatric disorders. Psychotherapists often have to function adjunctively with other staff members in their interactions with the patient and the family. A stress disorder model appears to best explain child, parent and family reactions to bone marrow transplantation. Given the medical severity and complexity of the conditions treated, and the approximately equal rates of overall success and failure, a supportive consultative approach is usually most helpful for child patients, parents and staff throughout the procedure. A retrospective study of the children treated over seven years in a tertiary pediatric hospital bone marrow transplant unit is presented. The level of child, parent, and family psychopathology was usually mild to moderate, but there were clear differences between patients. Mothers were more supportive than fathers under this extreme type of stress. Prospective longitudinal studies of children and families are needed to establish causal chains and optimal therapeutic interventions.
A Genotype-Phenotype Research Strategy for Schizophrenia*
Authors: Honer W.G. , Bassett A.S. , Kopala L. , Kennedy J.L.
Published: April 2017

A research strategy which integrates known biological aspects of schizophrenia is proposed. The strategy includes genotype and phenotype components and emphasizes interactions. Its central feature is the comprehensive diagnostic assessment of patients with schizophrenia. Clinical and laboratory based methodologies are applied within the genotype and phenotype components of the strategy. Examples of research from each area and the potential interactions with other aspects of the strategy are presented. The expectation is that a greater understanding of the pathophysiology of schizophrenia will result from the application of the genotype-phenotype strategy and that consequently more efficacious treatments will ultimately be developed.
HIV Transmission: Ethical and Legal Considerations in Psychotherapy
Authors: Kleinman Irwin
Published: April 2017

Psychiatrists, particularly psychotherapists, have access to the most intimate details of patients' lives. As a result, psychiatrists may face a number of ethical dilemmas, particularly when the issue of potential human immunovirus (HIV) transmission is involved. This paper examines the principle and the limits of confidentiality, and outlines various ways to resolve situations in which there is a conflict between the risk of HIV being transmitted to the unsuspecting public and the principle of confidentiality. Psychiatrists should not assume that patients engaged in high risk behaviour that may be self-destructive fully understand the risks involved. An educational approach may be warranted with these patients, even though such an approach would not be consistent with non directive therapy.
Electroconvulsive Therapy Training in Canada: A Survey of Senior Residents in Psychiatry
Authors: Goldbloom David S. , Kussin Dennis J.
Published: April 2017

Despite the enduring use and efficacy of electroconvulsive therapy (ECT) over the last half century, training in the theory and administration of ECT in the United States and the United Kingdom has been substandard and erratic. This survey of senior residents across Canada reveals limitations in the ECT training received by Canadian psychiatrists and the need to set academic standards.
Studies of the Effectiveness of Day Treatment Programs for Children*
Authors: Sayegh Liliane , Grizenko Natalie
Published: April 2017

Day treatment programs for children are based on the need for more intensive therapeutic treatments for children who do not respond to outpatient programs. Day treatment costs less than hospitalization, does not disrupt family, peer or community ties, and do not result in the child's dependence on them. The authors review studies on the effectiveness of day treatment programs. Findings are discussed and methodological questions are raised for future evaluative research.
Treatment-Resistant Depression: A Survey of Practice Habits of Canadian Psychiatrists
Authors: Chaimowitz G.A. , Links P.S. , Padgett R.W. , Carr A.C.
Published: April 2017

Treatment-resistant depression is a fascinating yet poorly defined condition. The various management strategies in use are a source of controversy. The objective of this survey was to determine how Canadian psychiatrists treat patients with “intractable depression.” This information may be used to plan future research into the management of treatment-resistant depression. It may also provide information about the practices of Canadian psychiatrists and help direct residency training.

Confidential questionnaires were mailed to all psychiatrists residing in Canada registered with the Canadian Psychiatric Association. Respondents indicated that 12.4% of their depressed patients were “resistant to treatment.” Respondents were asked to rank a list of treatment choices in the order they would use them to treat patients with treatment-resistant depression. Ninety-five point eight percent of respondents used tricyclics as the first treatment of choice. Almost equal portions of respondents chose a second tricyclic, a monoamine oxidase inhibitor (MAOI) or a combination of lithium and tricyclics as their treatment of second choice.
Youth with Conduct Disorder: A Challenge to be Met
Authors: Shamsie Jalal , Hluchy Cathy
Published: April 2017

Conduct disorder is one of the most common psychiatric disorders in children and adolescents between the ages of four and 16. This paper summarizes the literature on conduct disorder, from definition and diagnosis to treatment and prevention. In addition, it reports on the deliberations and recommendations of a group of clinicians and researchers who met at a retreat to discuss ways to improve the quality of treatment and develop prevention strategies for youth with conduct disorder. This retreat was held under the auspices of the Institute for the Study of Antisocial Behaviour in Youth.
The Infant Psychiatrist and the Transplant Team
Authors: Pinard Louis , Minde Klaus
Published: April 2017

This case presentation delineates one possible role the infant psychiatrist can play in the care of infants suffering from severe medical illnesses who are hospitalized for long periods. It describes the process of liaison with many professional groups who treat such children, highlights some of the difficulties inherent in this work and provides some possible answers to such problems.
Minors' Right to Psychiatric Treatment
Authors: Froese Arthur P.
Published: April 2017

This article provides a selected overview of the rights of minors under the Mental Health Act (Ministry of Health) and the Child and Family Services Act (Ministry of Community and Social Services) in the province of Ontario. Although the paper addresses specific issues related to mental health regulations as they apply to children and adolescents in Ontario, similar arguments apply to the regulations in most provinces. Specifically the paper raises some legal and ethical questions regarding minors' right to treatment. It is suggested that the legislation may impede access to treatment in some instances.
Electric Stimulus Energy and the Clinical Response to Electroconvulsive Therapy
Authors: Bean G.J. , Marchese V. , Martin B.A.
Published: April 2017

The relationship between electric stimulus energy and clinical response was examined in depressed patients receiving electroconvulsive therapy (ECT) under routine clinical conditions with a protocol which dichotomized the stimulus energy by patient age. There was no significant difference in the number of treatments and cumulative seizure duration between groups. The results support the observation that the stimulus energy may contribute to the therapeutic effect of ECT. Reduction of that energy in order to minimize side-effects may compromise the therapeutic effectiveness. The implications for dosage strategies in routine clinical practice are discussed.
A Plea for Paraphrenia
Authors: Munro Alistair
Published: April 2017

Clinicians who deal with psychotic patients see individuals whose illness is similar to schizophrenia, but whose symptoms are less florid, and deterioration less severe, than in schizophrenia. The diagnosis of atypical psychosis or psychotic disorder NOS is not satisfactory since it lumps disparate conditions together, whereas the term “paraphrenia” can include such illnesses. Paraphrenia is a well-established concept that was ignored in the DSM-III and the DSM-III-R and may be excluded from the ICD-10. There is a need to re-establish the diagnosis, for accurate diagnostic purposes and for future research of the paranoid/delusional disorders.
Psychiatric and Neurological Effects of Chronic Solvent Abuse
Authors: Byrne Alan , Kirby Brendan , Zibin Terry , Ensminger Shauna
Published: April 2017

This study is a review of the psychiatric and neurological effects of solvent inhalation on a group of 22 patients with chronic histories of solvent abuse, primarily toluene-based solvents. The findings suggest that the chronic inhalation of toluene-based adhesives can produce a paranoid psychosis which may persist. Other findings were a high incidence of temporal lobe epilepsy and decrease in IQ. We suggest that the psychiatric and neurological sequelae of chronic solvent abuse are serious and potentially irreversible. Toluene is felt to be a major factor in the morbidity associated with chronic solvent abuse, and attention is drawn to the necessity for educational programs in this area. The burden caused by the resulting psychiatric problems resulting from solvent abuse may have implications for health care budgets.
Salivary Cortisol in Children: Correlations with Serum Values and Effect of Psychotropic Drug Administration
Authors: Blake Woodside D. , Winter Kathy , Fisman Sandra
Published: April 2017

This study compares the paired serum and salivary Cortisol levels of 60 children and adolescents, obtained while performing a routine Dexamethasone Suppression Test. The results reveal significant correlations between serum and salivary cortisol levels in both drug-free (r = 0.90, p <.001) and medicated patients (r = 0.81, p < .0001). Multiple regression analysis suggests that, while the slopes of the two regression curves are parallel (0.15 < p < 0.20), the intercepts are significantly different (p < 0.05). This study supports the use of salivary measures of cortisol for children and adolescents. The authors suggest care in the use these measures while the patient is taking psychotropic medication.
Prefrontal Lobotomy and Hypofrontality in Patients with Schizophrenia: An Integration of the Findings*
Authors: Goumeniouk A.D. , Clark C.M.
Published: April 2017

A case of a schizophrenic patient who suffered a frontal lobotomy is presented as the impetus for a discussion of an alternative neurobiologic model of schizophrenia to integrate the findings of prefrontal lobotomy and “hypofrontality”. The proposal that primary temporolimbic pathology may result in secondary hypofunction in the prefrontal lobes is examined in light of current structural neuropathology evidence. Directions for future research suggested by such a model are explored.
The Paraphilias: A Multiplicity of Deviant Behaviours*
Authors: Bradford John M.W. , Boulet J. , Pawlak A.
Published: April 2017

The DSM-II and DSM-III both allow for multiple diagnoses. The DSM-III acknowledges that a patient may have multiple paraphilias but the true nature and extent of the multiplicity has only been documented recently. In order to study the degree of crossover between the various paraphiliac acts, a study of men who admitted to at least one paraphilia was conducted. A proportional index of multiple deviation was obtained. In addition, the mean number of admitted sexually deviant incidents per paraphilic category was computed as an estimate of the extent of deviant acts committed by this population. The results indicated that paraphiliacs tend to have multiple types of sexual aberrations as well as a high frequency of deviant acts per individual.
Psychiatric Morbidity in Patients with HIV Infection
Authors: Chuang Henry T. , Jason Gregor W. , Pajurkova Eva M. , Gill M. John
Published: April 2017

A psychiatric examination was conducted on 144 patients at various stages of HIV infection and on 29 controls found to be seronegative. One-half of the control group had at least one DSM-III-R Axis I diagnosis, most commonly cannabis abuse, alcohol abuse, or adjustment disorder. Compared to this baseline, HIV-infected subjects had higher rates of adjustment disorder. AIDS patients were also more likely to suffer from organic mental disorder. The rate of unemployment increased as the disease progressed. Major depression was seen in only ten patients, and there were no differences between controls and HIV-infected subjects. Formal assessment of mood state and feelings of pessimism also showed no differences among the groups. The importance of helping improve the patient's lifestyle through the control of alcohol and drug abuse is underscored.
Proportion of Unmarried Siblings of Homosexual and Non Homosexual Gender-Dysphoric Patients*
Authors: Blanchard Ray , Sheridan Peter M.
Published: April 2017

Among the siblings of homosexuals, a lack of sexual and romantic interest in women may be independent of erotic feelings for men. This study investigated the sexual histories of siblings of gender-dysphoric outpatients. The patients were classified into three groups: non homosexual males, homosexual males and homosexual females. Their siblings consisted of 301 brothers and 284 sisters over the age of 25. Logistic regression showed that the brothers of the homosexual male patients were significantly less likely to have been married, either legally or common-law, than the brothers of the other gender-dysphoric groups, even with age and relative birth order taken into account. This finding suggests that the low propensity for long term heterosexual relationships seen in homosexual male gender-dysphoric patients also tends to appear in their brothers.
Behavioural Problems among Preschool Age Children in Shanghai: Analysis of 3,000 Cases
Authors: Xin Ren'e , Chen Shou Kang , Tang Hui Qin , Lin Xia Feng , Mcconville B.J.
Published: April 2017

This paper reports the preliminary findings of an epidemiological study of 3,000 children ages four and five in the Shanghai area. Associations were investigated between problems in the narrow band syndromes of the Achenbach Child Behavior Checklist and certain sociodemographic variables (a one-child family, other social circumstances related to the family). No strong evidence emerged of a distinct psychopathology associated with children from single-child families, although there was a significant correlation between being an only child and having social withdrawal problems. Delinquent behaviour and hyper activity were more frequent among boys, while somatic complaints, schizoid or anxious, and depression were more frequent among girls. A four year follow-up study of 433 children from the original group who continued to have problems showed a marked increase in hyperactive syndrome problems; this suggests the existence of a clinically identifiable group of behaviourally disturbed children. Early identification allows for early treatment and comparison of the relative efficacy of early and late treatment approaches.
Planning Mental Health Services: II. Current Canadian Initiatives*
Authors: Goering Paula , Wasylenki Donald , Macnaughton Eric
Published: April 2017

A brief overview of recent policy developments across Canada and a discussion of the common themes and challenges they address demonstrates the scope of activity in this field. The federal level of mental health planning and a summary of recent of policy developments in each province are described. Significant progress has been made in Canada in the development of mental health services since deinstitutionalization. Major challenges remain, however, which are being addressed to varying degrees across the country. The challenges related to the key issues of major mental illness, integration and consumerism are illustrated.
Substance Abuse among Adolescents with Chronic Mental Illnesses: A Pilot Study of Descriptive and Differentiating Features*
Authors: Kutcher S. , Kachur E. , Marton P. , Szalai J. , Jaunkalns R.
Published: April 2017

Twenty-six adolescents with a chronic mental illness (schizophrenia or schizoaffective disorder of at least 1.5 years' duration) were assessed for the presence or absence of comorbid substance abuse. The two groups were compared on a number of variables believed to identify or predict substance abuse. The substance abusing subgroup were significantly different in levels of social functioning, school achievement, premorbid substance abuse, having parents or siblings who abused substances, dysfunctional families, cigarette smoking, number of hospital admissions, and emergency room visits. These findings are discussed in the context of clinical issues regarding the management of adolescents with chronic mental illnesses.
Intensive Early Exposure to Geriatric Psychiatry in Residency Training: Impact on Career Choice and Practice*
Authors: Herrmann N. , Shulman K.I. , Silver I.L.
Published: April 2017

The authors examined the impact of intensive early exposure to geriatric psychiatry on the career choice of trainees. All psychiatrists who had completed a six month inpatient rotation on a general hospital psychogeriatric unit as part of their first year of residency were interviewed three to 12 years later with a questionnaire designed to elicit practice patterns, prior interest in geriatrics, and the major influences of the rotation. Nine of 16 trainees had spent more than 50% of their time since graduation treating elderly patients. Those surveyed who were not practicing geriatrics spontaneously reported positive influences of the rotation on psychiatry training in general. The nature of geriatric psychiatry and the clinical issues, as well as the supervisors and educational activities were rated as the most important influences of the rotation. Early experience in psychogeriatrics seems valuable for subspecialty recruitment as well as general psychiatry training.
Evolving Misidentification Syndromes and Facial Recognition Deficits*
Authors: Silva J. Arturo , Leong Gregory B. , Wine David B. , Saab Sammy
Published: April 2017

In this paper, the authors report the case of a 33 year old man with several misidentification delusions involving the self. Evidence suggests that one type of misidentification delusion may evolve into another type. Neuropsychological testing further suggests that misidentification delusions may be associated with subtle abnormalities in facial recognition abilities and with non dominant cerebral compromise.
Cognitive-Behavioural Treatment of Panic Disorder during Pregnancy and Lactation*
Authors: Robinson Lynne , Walker John R. , Anderson Donna
Published: April 2017

The treatment of panic disorder during pregnancy and lactation poses special problems. It is important that both the practitioner and patient consider a number of issues to find the most appropriate treatment for the patient. New cognitive-behavioural treatment options often circumvent the problems of pharmacotherapy for pregnant or lactating women while providing therapeutic benefits which are at least equivalent.