bluuebunny/crossref_metadata_2025 huggingface dataset:
Opinions on the Role of the Internship in Psychiatric Postgraduate Education
Authors: Bolton D. , Leichner P.
Published: April 2017

Presently in Canada the value of the straight internship in psychiatry and the need for a mandatory rotation in psychiatry during a rotating internship are sources of active debate between the licensing bodies and psychiatric programs and organizations. The importance of the internship as it pertains to the total psychiatric education process has been discussed in a number of research articles from the United States. The conclusions from these studies range from recommendations that rotating internships be discontinued because they may cause empathic blunting among trainees, to strong endorsements of its necessity. The present study examined residents’ and residency directors’ views of the types of internships in Canada. One hundred and ninety-nine residents and thirteen residency directors completed a questionnaire in 1980. The majority of residents (74.3%) and residency directors (77%) felt that the rotating-mixed internship should be a requirement prior to taking postgraduate training in psychiatry. Most also felt that this type of internship should contain a mandatory one to two months psychiatry rotation. Opinions on the value of the straight internship in psychiatry were mixed for both residents and residency directors. Statistical analyses were carried out comparing the opinions of residents having had a rotating internship versus those having had a straight internship: foreign medical graduates (FMG's) versus Canadian medical graduates (CMG's); and male versus female. As would be expected, the residents who had previously completed a straight internship favoured this type of internship and were more critical of the rotating type. There were no differences in the opinions between foreign medical graduates and Canadian medical graduates or between male and female residents. The authors conclude that a strong value continues to be placed on the rotating internship and hypothesize that the need for a broad medical experience and increased professional maturity may account for this finding. The mixed opinions regarding the straight internship are in keeping with former surveys. The authors conclude that presently straight internships in postgraduate medicine should not be discontinued and that a comprehensive and unified internship program should include as mandatory one to two months training in psychiatry. Further research on the effect of straight and rotating types of internships on clinical competence of residents is necessary.
On Direct Patient Participation in the Cost of Their Psychiatric Care.
Authors: El-Guebaly N. , Prosen H. , Bebchuk W.
Published: April 2017

A review of the relation between insurance and psychiatric services addresses the economic concerns involved. Under third-party reimbursement, a range of predictability and stability of treatment costs is observed; overall cost benefit and effectiveness for a variety of therapeutic procedures is demonstrated and socio-cultural factors play a role in the users demand behaviour. The cost of medical care is a small percentage of the system's total cost and judicious use of psychiatric consultation reduces medical and surgical expenditures.

Inherent difficulties for the profession exist in a universal health care scheme. The acceptability of psychological impairment and the confidentiality dilemma are among the issues reviewed. Further attention must be paid to the therapist's fee, behaviour and income needs A traditional defensiveness regarding these matters should be overcome through a peer review process in order to further delineate responsible financial norms of psychiatric practice.

The “laissez-faire” attitude observed in most of our training programs towards financial matters must be addressed in order to participate effectively in the ongoing sociopolitical dialogue on the funding of healthcare.
Pipotiazine Palmitate, A Long Acting Drug, Indeed: A Case Report
Authors: Hyrman Vaclav
Published: April 2017

A case is presented, in which the extrapyramidal side effects of depot pipotiazine lasted well over 6 months, and possibly the therapeutic effect for almost 12 months following the last injection. The case report illustrates the need for flexible individualized dosage schedules, similar to other neuroleptics.
Early Subjective Response and Prediction of Outcome to Neuroleptic Drug Therapy in Schizophrenia
Authors: Hogan T.P. , Awad A.G. , Eastwood M.R.
Published: April 2017

Events that occur early in the course of neuroleptic treatment, and which may have utility in predicting short-term clinical outcome, were investigated. Such events include the patient's subjective response to drug, early clinical response, and the emergence of side effects. From all the variables examined, early subjective response and symptom change at 24 and 48 hours following initiation of neuroleptic drug therapy were found to be significantly related to short-term outcome. These findings are assessed with respect to their predictive utility and relative contribution to the development of a strategy for individualized drug treatment approaches in schizophrenia.
Prediction of Treatment Response in Schizophrenia: Clinical Use of Neuroleptic Blood Levels
Authors: Tang S.W.
Published: April 2017

The relationship between clinical response and plasma neuroleptic levels in schizophrenia is unclear. A part from the inadequacy of the plasma neuroleptic assay method, resistance to neuroleptic treatment in some schizophrenics presents a serious problem in studies looking into the plasma drug level versus clinical response correlation. Previous studies have suggested a very wide range of plasma neuroleptic levels in responders. At present, plasma neuroleptic level does not predict clinical response in schizophrenics in general, but may have application in special situations such as suspected drug toxicity, neuroleptic resistance or idiosyncratic response to neuroleptic drugs.
Computed Tomographic Brain Studies and Treatment Response in Schizophrenia
Authors: Bird J.M.
Published: April 2017

Ventricular enlargement has been described in chronic schizophrenia since 1927. The CT Scan has stimulated considerable interest and studies have shown that 50% of chronic schizophrenics and up to 20% of acute schizophrenics have enlarged ventricles. Widening of cortical sulci, cerebellar atrophy, third ventricular enlargement and reversed hemispheric assymetry have also been reported. Ventricular enlargement seems to both predate the development of psychosis and to develop further during the course of the illness. Twin studies indicate that ventricular enlargement may be the result both of genetic vulnerability and of environmental onslaught. The other abnormalities may be secondary. Schizophrenics without ventricular enlargement show disturbances of a range of Dopamine-related variables. Schizophrenics with ventricular enlargement show some evidence of serotonin and noradrenaline cell loss.

Very few published papers address the issue of treatment response. These seem to demonstrate a relationship between enlargement and poor response to neuroleptic medication. Schizophrenics with very large ventricles may also be particularly sensitive to the adverse effects of neuroleptics.

It is not yet clear that the CT Scan may be used to identify patients unlikely to respond to medication. Long term prospective studies are required.
Suicide Attempters, Ideators and Risk-Taking Propensity
Authors: Silberfeld M. , Streiner B. , Ciampi A.
Published: April 2017

The personality dimensions related to risk-taking propensity in suicide patients were sought. Two dimensions, responsibility and self-esteem, were helpful in distinguishing between suicide involved patients, and non-suicide related cases.
Myoclonus, Hyperreflexia and Diaphoresis in Patients on Phenelzine-Tryptophan Combination Treatment
Authors: Levy Alan B. , Bucher Patricia , Votolato Nicholas
Published: April 2017

Three cases are presented on patients on an MAOI who developed a transient syndrome of myoclonus, hyperreflexia, jaw quivering, teeth chattering and diaphoresis after L-Tryptophan was added. Caution is advised when considering the addition of a serotonergic agent to MAOTs.
Management of the Repeatedly Suicidal Patient
Authors: Ennis Jon , Barnes Rosemary , Spenser Helen
Published: April 2017

Although repetitive suicidal behaviour is commonly encountered, a relatively small number of very difficult patients engage in it. These individuals suffer primarily from severe personality disorders, as well as alcoholism and drug abuse. They are at high risk for eventual suicide. Although as a group they receive a great deal of hospital treatment, inpatient management is fraught with difficulties. Extended inpatient treatment is unlikely to be of benefit and may perpetuate the behaviour by leading to regression and excessive dependence on hospitalization. A model of management is described which couples the use of a brief-stay, crisis, inpatient unit and community-based outpatient treatment. Communication between institutions and agencies involved in the patient's care as well as coordination of services is essential. Acceptance by therapists of the risk of suicide and the realistic limitations to meeting these patients’ needs can help such patients assume more responsibility and independence.
A Comparison of the Safety and Efficacy of Alprazolam and Desipramine in Moderately Severe Depression
Authors: Remick Ronald A. , Fleming J.A.E. , Buchanan R.A. , Keller F.D. , Hamilton P. , Loomer F. , Miles J.E.
Published: April 2017

Fifty-four patients (34 outpatients, 20 inpatients)fulfilling Research Diagnostic Criteria for Definite Major Depressive Disorder were enrolled in a double-blind study comparing the antidepressant effects of alprazolam versus desipramine. The mean daily dose of alprazolam and desipramine at study termination was 3.78mg and 208mg respectively. As there were no significant demographic or clinical differences between outpatients and inpatients, both groups were combined in data analysis.

Using the Hamilton Depression Rating Scale (HAM-D) both drug groups showed highly significant improvement beginning with the first week of active drug treatment. HAM-D scores continued to decrease through study termination (six weeks of active drug). There were no significant differences when comparing alprazolam and desipramine (outpatients, inpatients, or both groups combined) on any of the subjective or objective psycho-metrics used in this study. Clinically, only twelve of thirty-four outpatients (35.3%) were felt to be “markedly or moderately” improved, suggesting that neither the outpatient alprazolam nor desipramine patients did particularly well with drug treatment.

In terms of drug safety there was no difference between the alprazolam and desipramine in the number of excessive or serious drug side effects. However, five of twenty-nine alprazolam patients had to discontinue therapy because of excessive drowsiness, and two of the alprazolam outpatients had motor vehicle accidents directly related to this adverse event.

Alprazolam appeared as effective as desipramine in the pharmacotherapy of this group of depressed outpatient and inpatients. Alprazolam appeared well-tolerated by most subjects although drowsiness was a common — and at times serious — medication side effect.
The Neonatal Narcotic Abstinence Syndrome: A Brief Review
Authors: Calabrese J.R. , Gulledge A. Dale
Published: April 2017

Because substance abuse experts are not available in many institutions, the consulting psychiatrist is required to diagnose and manage conditions such as the neonatal narcotic abstinence syndrome, which is readily recognized and treated. The authors discuss morbidity due to this syndrome in neonates born to narcotic addicted mothers. The clinical usefulness of neonatal narcotic abstinence scales is reviewed, with special reference to their application in treatment. The dosing of various drugs currently in use is also discussed.
Progestogens in the Treatment of Male Sex Offenders: A Review
Authors: Cooper Alan J.
Published: April 2017

The literature on the progestogens, medroxyprogesterone acetate (MPA) and cyproterone acetate (CPA), which are currently used in the treatment of deviant male hyper sexuality, is reviewed. There are few adequately controlled trials, but clinical observations suggest that the drugs are reasonably effective in suppressing libido and sexual arousal in men. They are approximately equipotent and equivalent in this respect, but differ somewhat in their pharamcology.

When used in conjunction with other measures, especially psychotherapy, they may benefit some sex offenders. The best results are likely in self-referred, non-recidivist hypersexuals, with good social supports and who are motivated for treatment. The need for long-term placebo and comparison trials is stressed.
Family Violence and Psychiatric Disorder
Authors: Bland Roger , Orn Helene
Published: April 2017

The relationship between family violence and psychiatric disorders was examined using standardized diagnostic interviews of 1200 randomly selected residents of a large Canadian city. The results showed that higher than expected proportions of those exhibiting violent behavior had a psychiatric diagnosis and the rate of violent behaviors in those with diagnoses (54.4%) significantly (p < .0001) exceeds the rate in the remainder of the sample (15.5%). Particularly high rates of violence are found in those where alcoholism is combined with antisocial personality disorder and/or recurrent depression (80–93%). Also at high risk for violence are those who have made suicide attempts (over 50%) and those who have been arrested for non-traffic offences (two-thirds). These data suggest that psychiatric disorders have a strong relationship to violent behavior, and are not in agreement with the predominantly sociological explanations of family violence.
Prevention in High Risk Children of Depressed Parents
Authors: Laroche Catherine
Published: April 2017

Opportunities for prevention of psychopathology in children and families are often overlooked in the treatment of the depressed adult patient. Research and clinical findings are reviewed which highlight the impact on children and the family of depressed parents. They range from illness serious enough to require hospitalization to cases in which depression has not yet been diagnosed. These findings are used as guidelines for the development of preventive and therapeutic interventions for all family members.
Psychiatry, Civil Liberty, and Involuntary Treatment
Authors: Hoaken P.C.S.
Published: April 2017

Growing concern for involuntary patients’ civil rights has engendered criticism of psychiatry. Critics have disputed the reality of mental illness and have alleged that psychotic disturbances result from diagnostic “labels”. Media accounts continue to depict the psychotically ill as abused victims rather than as patients requiring treatment. In the face of such attacks, psychiatrists need public suppport from their medical colleagues as well as from members of the lay public.

The historical and socioeconomic factors germane to psychiatry are reviewed in an attempt to understand the current dispute about involuntary treatment. It is argued that the concept of civil liberty requires consideration of psychological freedom. Since psychotic patients are without psychological freedom, it is meaningless to respect their apparent liberty at the expense of allowing them to go untreated. Those who refuse treatment for what are deemed to be irrational reasons should receive treatment involuntarily. If society cannot trust psychiatrists to make such treatment decisions, the courts should make them.
Interviewing Skills in Relation to Psychiatric Residency
Authors: Mccready J.R. , Waring E.M.
Published: April 2017

A review of the literature suggests that the teaching of interviewing skills in psychiatry residency programs has been largely ignored. The consequences of poor interviewing, the characteristics of good interviewing, and what is known about effective training techniques for the mastery of clinical interviewing are reviewed. The relevance of psychiatric training is discussed. Issues which warrant further research are presented.
Erotic Transferences
Authors: Frayn Douglas H. , Silberfeld Michel
Published: April 2017

Erotic transferences occur on a spectrum reflecting the ease or difficulty of their management. They represent sexualized re-enactments of important childhood relationships. This phase in psychotherapy may be a transient developmental feature or in some instances, assume a formidable resistance to further insightful work. Two case illustrations are given to indicate the breadth of this spectrum. Reasons are discussed for such differences in erotic transferences and their resolutions.
To Reduce or to Integrate: Psychiatry's Dilemma
Authors: Lipowski Z.J.
Published: April 2017

Three conceptual approaches to psychiatry may be distinguished: the somatic (biological); the psychological (psychodynamic, psychosocial); and the integrative (holistic, biopsychosocial). The first two emerged in the early nineteenth century, the third — in this century. All three continue to vie for influence today. The author traces their historical precursors and discusses their current state. He argues that psychiatrists need to apply methodological reductionism but adopt an integrative orientation in theory and clinical practice.
Anticonvulsant Medications: An latrogenic Cause of Tic Disorders
Authors: Burd Larry , Kerbeshian Jack , Fisher Wayne , Gascon Generoso
Published: April 2017

A review of the relationship between anticonvulsant medications and tics is presented. Data on 5 patients in whom anticonvulsants, either caused tics or exacerbated existing tic disorders is discussed. Discontinuation of the medication resulted in a decrease in the frequency of tickings in all patients. The effects of anticonvulsants on the reticular system are discussed. It is felt that it may be important for clinicians to consider carefully the use of barbiturate anticonvulsants, especially phenobarbital, in children with tics or a family history of tics. Tic disorders caused or exacerbated by exposure to anticonvulsant medications appear to be more common than previously reported, and in some patients the tics may not remit with discontinuation of the medication.
Énoncé De Principe
Authors: Katz Philip
Published: April 2017

Ce document a été rédigé pour la Commission scientifique présidée par le docteur D.J. McClure, et approuvé par le Conseil d'administration de l'APC en juin 1985.
Adolescents’ Perception of Self and of Immediate Environment by Parental Marital Status: A Controlled Study
Authors: Saucier Jean-François , Ambert Anne-Marie
Published: April 2017

Most studies on children of “broken families” are based on small and unrepresentative samples, are limited to children of divorce and do not control for basic demographic variables. In order to do a survey with fewer methodological deficiencies, we managed to obtain a completely representative sample of a francophone urban population attending High School I, II and III, with the reasonable sample size of 1519 subjects and including 72 subjects from widowed families in addition to 174 children of divorce; furthermore, we were able to control for the following eight demographic variables: father's and mother's occupation, mother's work, respondent's, father's and mother's age, family size, and respondent's rank of birth.

When comparing children from legally intact, widowed, and divorced families, on a wide range of psychosocial variables, we found that on the average, divorce is associated with the greatest disadvantage in children, followed by widowhood; children belonging to intact families show the least disadvantage. Besides, when comparing girls and boys, we did not find striking differences between them in divorced families, but, on the other hand, we found striking differences in widowed families, boys being at much more disadvantage than girls.

It is concluded that on the average a family breakup should be considered as a serious risk factor for teenagers and that clinicians would be well advised to monitor the situation carefully when aware of an impending family breakup.
The Dyslexia-Emotional Dyad: Implications for Diagnosis and Treatment
Authors: Kline Carl L.
Published: April 2017

Extensive experience with dyslexic children indicates that developmental language problems and emotional problems represent a dyad rather than a dichotomy. An attempt is made to place this complex and extensive problem into meaningful perspective. When accurate diagnosis and carefully formulated treatment plans are effectively blended, success in helping these often hapless children is greatly enhanced. Some important guidelines, derived from clinical experiences, are indicated to be valuable in understanding and helping patients with these multi-faceted problems.
A Study of Disturbed and Non Disturbed Adolescents: The Toronto Adolescent Longitudinal Study. I
Authors: Golombek H. , Marton P. , Stein B. , Korenblum M.
Published: April 2017

The Toronto Adolescent Longitudinal Study was undertaken to examine personality development in a non-clinical sample of children from ages 10 through 19. Fifty-nine boys and girls, selected to represent the full range of behavior presentation in regular classrooms, have participated throughout the complete study. Each year the students and at least one parent participated in a full day evaluation during which a comprehensive battery of measures was administered to assess their psychosocial characteristics. Some exemplary results are presented regarding the personality functioning and associated characteristics of the group at age 13. Our results lead us to conclude that adolescence should not be considered as a homogeneous developmental stage. Young adolescents can be differentiated along a dimension of competence in personality functioning which is associated with differences in their clinical presentation, self concept and behavior patterns.
Controlled Prospective Fifteen Year Follow-Up of Hyperactives as Adults: Non-Medical Drug and Alcohol Use and Anti-Social Behaviour
Authors: Hechtman Lily , Weiss Gabrielle
Published: April 2017

This is a fifteen year prospective controlled study of the non-medical drug and alcohol use and antisocial behaviour of 61 hyperactives, and 41 matched control subjects, (mean age 25 years). The data was collected from detailed interviews with the subjects as well as computerized court records to verify subjects reports. Generally hyperactives did not differ significantly from controls on current drug and alcohol use and antisocial behaviour. However one sees trends of greater drug alcohol and antisocial involvement in the hyperactive group. All the subjects who have antisocial behaviour at 15 year follow-up (mean age 25) had early and persistent histories of antisocial behaviour beginning at initial assessment (mean age 8) or at 5 year follow-up (mean age 13). However many hyperactives do not continue their antisocial behaviour into adulthood (mean age 25). There thus appears to be a small subgroup of hyperactive subjects who have more negative outcomes with significantly greater social, emotional and psychological difficulties. It is this subgroup which we need to identify early and treat vigorously.
Comparison of Self-Rated and Observer-Rated Scales in DSM-III Borderline Personality Disorder
Authors: Snyder Scott , Pitts Wesley M.
Published: April 2017

The relationship of self-rated to observer-rated scales has been infrequently studied in patients with DSM-III defined borderline personality disorder. This study was designed to derminine a) the amount of correlation between these two types of rating scales in borderline patients and b) whether borderline patients scored significantly higher than dysthymic controls on self or observer-rated scales. Results indicated that self-rated scale scores were higher within the borderline group. Self and observer-rated scales were highly correlated within the borderline group. Borderline patients did not differ from controls when scores of self and observer-rated scales were compared between groups. The relationship of these results to previous findings was equivocal.
Psychiatric Residents’ Experience and Career Interest in Geriatric Psychiatry: Implications for Training Programs
Authors: Walker J.R. , Siddiqui A.R. , Leichner P.P. , Agbayewa M.O.
Published: April 2017

A survey of residents’ experience and career interest in geriatric psychiatry was carried out in Canadian training centres. Residents’ exposure to specific training experiences in geriatric psychiatry has been steadily increasing, although a large proportion of residents continue to report insufficient amount of experience and supervision in this area. Residents viewed geriatric psychiatry as involving special skills and knowledge and half were in favour of a compulsory rotation in this area. Geriatric psychiatry was an infrequent career choice along with other areas of psychiatry that have had difficulty in recruiting. Alternative approaches to service provision and recommendations for meeting the manpower needs are discussed.
Borderline Personality Disorder in the Elderly: A Case Study
Authors: Siegel Daniel J. , Small Gary W.
Published: April 2017

Little is known about the natural history of Borderline Personality Disorder (BPD) among the aged. A case is presented of a 69-year-old woman who met six of the eight DSM-III criteria for the diagnosis of BPD, The case suggests that features of BPD persist throughout life and may worsen with the stresses associated with aging.
Iatrogenic Parkinsonism in Huntington's Chorea
Authors: Moss Jay H. , Stewart Donna E.
Published: April 2017

This case report describes a 63 year old woman with a nineteen year history of Huntington's Chorea who had been successfully treated with tetrabenazine for 9 years. During a hospital admission for an unrelated medical illness, she was given two doses of chlorpromazine 25 mg for a vascular headache and within hours became mute, extremely rigid, and unable to move or swallow. The consultation psychiatrist confirmed the diagnosis of severe drug-induced parkinsonism by intramuscular injection of benztropine mesylate which resulted in a dramatic immediate improvement. Both chlorpromazine and tetrabenazine were discontinued and the patient's severe parkinsonian symptoms completely abated on oral benztropine mesylate. Tetrabenazine alone, was restarted after 48 hours to control her Huntington's Chorea and there was no recurrence of parkinsonism. (Past history revealed the patient to have tolerated the same doses of chlorpromazine and tetrabenazine when given separately.)

Previous literature reports concurrent safe use of antipsychotics with tetrabenazine, but this case report would suggest caution, and early discontinuance in the event of parkinsonism.
The Relationship of Childhood Experience to the Quality of Marriage
Authors: Truant G.S. , Herscovitch J. , Lohrenz J.G.
Published: April 2017

A model for the effect of child-parent relationships on later adult marital quality was tested by questionnaire in 124 general practice patients. Recollections of parental care and overprotection measured by the PBI correlated significantly with Locke- Wallace measures of marital quality primarily in females. Correlations were larger in a homogeneous group where previous marriages and emotional illness were eliminated, and in those who had experienced, childhood separations from parents. The results are consistent with an interactive model where the quality of childhood experience determines the quality of adult marriages primarily when separation experiences have been present.
Are Schizophreniform Symptoms Present in Attenuated Form in Children with Tourette Disorder and Other Developmental Disorders
Authors: Kerbeshian Jacob , Burd Larry
Published: April 2017

Childhood schizophrenia ia an increasingly difficult disorder to identify. We review the DSM-III criteria for schizophrenia and raise the possibility that schizophreniform symptoms may be present in children with Tourette disorder to identify. We review the DSM-III criteria for seen in Tourette disorder that resemble the symptoms of schizophrenia are discussed and data from selected patients are presented. This data is presented to assist clinicians in making more appropriate diagnoses (that is, avoiding the incorrect diagnosis of schizophrenia) and in refining distinctions between the symptoms of schizophrenia seen in childhood and similar symptoms seen in other developmental disorders, especially Tourette disorder.
The Inpatient Treatment of the Borderline Personality Disorder: A Critical Review and Discussion of Aftercare Implications
Authors: Rosenbluth Michael
Published: April 2017

The literature on inpatient treatment of adult borderline personality disorder is reviewed. The controversy regarding the use or avoidance of the regression which can accompany hospitalization is discussed. It is suggested that this literature is not specific enough. There is insufficient attention to definition of terms, clinical heterogeneity and the longitudinal course of the illness. As well, the ahistoric approach to the hospitalization of these patients serves to reinforce characteristic ego deficits. Recommendations regarding the use of long or short-term length of hospital stay are not substantiated by formal research. It is suggested that greater emphasis be placed on aftercare issues. The stabilization of the patient, outpatient therapist, and aftercare system are described as important goals of inhospital care.
Predictors of Psychopathology in Children of Patients with Major Affective Disorders
Authors: Kashani Javad H. , Beck Niels C. , Burk Jeffrey P.
Published: April 2017

The present study reports on variables associated with psychopathology in children of patients hospitalized with major affective disorders. The primary instrument used in this investigation was a structured diagnostic interview that was completed by a child psychiatrist. Univariate and multivariate statistical analyses of these data suggest that severity of parental psychopathology (as measured by a higher score on the SCL-90 and a longer stay in the hospital) and the report of child abuse were associated with general childhood psychopathology. The significance of these and other findings are discussed.
Pédopsychiatrie et dérmatologie: présentation d'un cas de dermite atopique*
Authors: Breton Jean-Jacques , Latour Et Robert
Published: April 2017

As consultants in child psychiatry to the Dermatological service of a large pediatric hospital, the authors, like other clinicians, think that psychological factors have an effect upon the course of atopic dermatitis.

They present the case of a child showing the existence of three important psychological factors. These are a closed parents-child relationship, conflict around aggressiveness and the meaning of somatic regressions.

Finally, while referring to the literature, they discuss the way these factors might operate in the course of the disease.
Combler les besoins de services de santé mentale des personnes atteintes de schizophrénie
Authors: Cormier Hugues J. , Borus Jonathan F. , Reed Robert B. , Pinard Gilbert , Lessard Et Richard
Published: April 2017

The present study aimed to identify the needs and describe the use of twenty mental health services in a population of chronic schizophrenic patients living in two regions in Quebec (Estrie and Centre-Sud). An attempt was also made to determine the principal reasons for which some services were not being used when they were identified as clinically required. The population considered was composed of the patients (N = 88) who had been discharged from the psychiatric care units of five general hospitals over a period of five months in 1982, and for whom the attending psychiatrist could confirm with certainty a diagnosis of chronic schizophrenia in accordance with the criteria of DSM-III. Medical files of these patients were reviewed, and the patients and psychiatrists themselves were interviewed separately regarding the patients’ needs and use of twenty mental health services over the period from the seventh to the twelfth month after discharge from hospital. Results of the study show that services which were most often identified as clinically required were: 1) taking of neuroleptics, 2) organization of leisure activities, 3) case management, and 4) individual supportive therapy. At the same time, results indicate a poor fit between needs and use for most of rehabilitation and psychosocial services. The main reasons for non-use of services which were identified as clinically required are also presented. The implications of these results for the organization of mental health services for persons suffering from chronic schizophrenia are discussed, especially the importance of case management services.
The Case for Psychiatric Record Linkage*
Authors: Woogh C.M.
Published: April 2017

Evaluation of regional psychiatric services is essential for effective and economical planning and requires a complete and accurate source of data about individuals in the system. Routinely collected statistics describe only events, and cannot link data about individuals over time. This is possible with record linkage systems (or case registers) which are systematic standardized data collections about individuals’ contacts with specified facilities over time. Such data bases have a wide range of clinical, epidemiological and administrative functions. The confidentiality of such systems is of paramount importance and is maintained by several safeguards. There are numerous technical considerations in establishing and operating record linkage systems. A wide variety of studies have been produced from systems around the world. An ongoing collection of linked data is required for many types of research and particularly for service evaluation. In times of cost constraints and diminishing resources, it is essential to deliver psychiatric services in the most effective and cost efficient manner possible.
Cyclothymic Disorder and Bromocriptine: Predisposing Factors for Postpartum Mania?*
Authors: Raymond Lake C. , Reid Audrey , Martin Cynthia , Chernow Bart
Published: April 2017

Women are most susceptible to psychotic reactions during the postpartum period, a time of intense psychological and physiological stress. Mania and depression are particularly common at this time, especially in women with past or family histories of major or minor affective disorders, specifically cyclothymia and dysthymia. Close attention after childbirth is warranted to alleviate and prevent these episodes in such women. Sympathomimetic drugs such as bromocriptine and the over-the-counter diet aids, which are linked to the induction of manic episodes, are frequently used in the puerperal period and may act as catalysts. This case report documents a postpartum manic episode in a cyclothymic woman who was prescribed bromocriptine, a dopamine agonist, for prevention of lactation.
Loi québécoise sur la protection du malade mental: modifications souhaitables*
Authors: Morissette Louis
Published: April 2017

The author first draws the origins, in Québec, of the law concerning the safety of mental patients. Then, he discusses the essential elements (dangerousness, custody) of the law now in force, and he insists on its deficiencies (treatment, competency)

The principles of liberty, integrity and right to refuse treatment are then studied in relation to the acutely ill patient who is kept in custody because of his illness and his potential dangerousness.

The author finally formulates some suggestions for a law that will protect not only society but also the mental patients.
Tricyclic Maintenance Therapy in Unipolar Depression
Authors: Kleinman Irwin , Schachter Debbie
Published: April 2017

The risk of recurrence of depression must be balanced against the problems and risks of maintenance therapy. The goal of maintenance therapy is to prevent new episodes of depression. A review of the literature reveals that the existing data does not provide sufficient evidence to demonstrate the usefulness of tricyclic maintenance therapy. Nonetheless, it would be premature to conclude that this type of treatment is not useful. Further studies of maintenance therapy are indicated and should include a continuation period of at least 16 weeks during which patients are symptom free (that is, Global Assessment Scale 71 or more). In the interim, each patient should be evaluated individually to determine the optimum duration of treatment.
The Course of Depression in Elderly Outpatients
Authors: Magni Guido , Palazzolo Orazio , Bianchin Gianluigi
Published: April 2017

Sixty-four elderly outpatients diagnosed according to the criteria of DSM-III as having affective disorders were submitted to follow-up study for 6–24 months (mean 15 months). Twenty patients (31%) were in good health throughout follow-up, fourty-four patients (69%) remained more or less chronically ill. The prognosis was better in patients diagnosed as having “adjustment disorder with depressed mood” and “dysthymic disorder”; when onset was late, and when there were no signs of organic brain C.N.S. damage.
A Sleep Laboratory Evaluation of the Long-Term Efficacy of Zopiclone
Authors: Fleming Jonathan A.E. , Bourgouin Jean , Hamilton Peter
Published: April 2017

Six patients between the ages of 25 and 59, with chronic, primary insomnia received the new, non-benzodiazepine, hypnotic zopiclone continuously for 17 weeks after a drug free interval of 12 nights. To qualify for the study, sleep efficiency, determined by a sleep study on two, consecutive, placebo-controlled nights, had to be less than 75%. Patients evaluated their sleep by questionnaire and had sleep studies completed throughout active treatment.

Zopiclone (7.5 mg) increased sleep efficiency by decreasing sleep latency, wakefulness after sleep onset and increasing total sleep time. Sleep architecture was minimally affected by zopiclone treatment; no significant changes in delta or REM sleep were observed.

The commonest side effect was a bitter or metallic taste. No significant changes in biological functioning were noted throughout the study period. These findings indicate that zopiclone is a safe and effective hypnotic medication which maintains its effectiveness with protracted use.
Who Gets What Treatment and Why
Authors: Shamsi S. Jalal
Published: April 2017

Planning of treatment in psychiatry does not receive the same careful attention that is given to formulation and diagnosis. Very often the choice of the format and the orientation of the treatment is determined by the personal preference of the therapist. It is suggested that proven effectiveness of the treatment for the condition presented by the patient should be given a priority. Where no treatment is proven to be superior, such considerations as parsimony and availability of expertise should be taken into account.
Delusional (Paranoid) Disorders: Etiologic and Taxonomic Considerations. I. The Possible Significance of Organic Brain Factors in Etiology of Delusional Disorders
Authors: Munro Alistair
Published: April 2017

The term “Paranoid Disorders” is used vaguely and indiscriminately by many authors. This article provides brief working descriptions of a small number of paranoid/delusional conditions and, making reference to the author's series of monodelusional disorders, describes certain organic brain factors which appear to be surprisingly common in the background of these cases. It is hypothesized that the group of paranoid/delusional disorders may be linked to schizophrenia, especially of the paranoid type: however, in the paranoid/delusional disorders, hereditary schizophrenic factors may be weak and adverse organic brain factors relatively much stronger.
An Outcome Study Comparing Refusers and Acceptors of Treatment for Alcoholism
Authors: Malla Ashok
Published: April 2017

Fifteen matched pairs of alcoholics who had either refused or completed day treatment were reassessed sixteen months after the initial assessment. The treated group had improved significantly more than the untreated group on measures related directly to alcohol abuse, in their utilization of inpatient psychiatric services, and the use of family physician's services. The treated group had also used disulfiram for significantly longer periods of time. The treatment refusers had nonetheless achieved statistically significant, albeit modest, reduction in their consumption of alcohol compared to their pre-assessment levels. Both groups showed equal amount of change on a number of psychosocial measures, such as employment, use of minor tranquilizers and non-prescription drugs, legal problems and symptoms of depression. These findings are discussed in the context of the effectiveness of a day program, the use of disulfiram and certain pretreatment characteristics of the patient.
Psychiatric Consultation Services in an Oncology Hospital
Authors: Ramsay D. , Deachman M. , Silberfeld M.
Published: April 2017

Psychosocial oncology has become an area of considerable interest over the past ten to fifteen years. There has been little written about the development of psychiatric services or the profile of such services to this population. This paper describes the historical evolution of a psychiatric consultation service in a cancer hospital and provides a statistical analysis of the patient population and services provided. The special need for continuity of care and a comprehensive biopsychosocial approach is elaborated and clinical examples are reported. Finally, directions for the future development of this kind of service are suggested.
Clinical Neuroscience Approaches in Psychiatry
Authors: Morihisa John M.
Published: April 2017

Recent advances in the clinical neurosciences have begun to expand and change our understanding of how the brain functions. As further neuroscientific principles are delineated we may gain insights into the underlying pathophysiology of some psychiatric disorders and through this new understanding we may be able to define new therapeutic interventions. Two illustrative examples of neuroscientific research are discussed and reviewed both in terms of the promises and dangers inherent in these new approaches to the mind.
A Neurodiagnostlc Approach to Schizophrenia
Authors: Cleghorn J.M.
Published: April 2017

This article presents the perspective that cognitive and sensorimotor abnormalities are as much a part of the pathology of schizophrenia as are the symptoms. It is hypothesized that all these features cluster together in recognizable patterns. The proximate mechanisms of the abnormalities are proposed to involve anatomical and chemical lesions in a variety of locations in the brain. The functioning of widely distributed neuronal systems is thus interrupted. An approach to the assessment and interpretation of neurocognitive abnormalities is outlined. Distinct deficits require differential rehabilitation strategies.
Le médecin Face aux Certificats D'invalidité: Attitudes et Comportements Préconisés
Authors: Monday Jacques , Therrien Sylvie , Duguay Monique , Lapierre Guy
Published: April 2017

Five attitudes and predicted behaviors characterize the physicians' responses (strategies) to invalidity certificates. These are: 1- scientific objectivation; 2- complicity (meaning: always completing the certificates without objective preoccupations of any kind); 3- socio political (meaning: influenced by the physician's ideas concerning ways the society should consider the non-working people: permissive or repressive); 4- negotiation (implicating a psychobiosocial approach to the patient and the problem); 5- indifference (never completing certificates, referring this role to someone else). Our recent survey (September 1986) including 92 physicians of a General Hospital (Cité de la Santé) in Laval demonstrates a preponderant attitude, the “socio political” one (A3). But, it has no relation to the preponderant predicted behavior which is the negotiation (C4), characterizing a psychobiosocial approach to the patient and the problem. This behavior has been chosen in a statistically significant way. Nevertheless, there is a relation between the attitude A1: scientific objectivation and the corresponding predicted behavior C1: scientific objectivation. Notions of rationability, professionalism and sociable desirability are evoked as explanations of these results.
Carbohydrate Craving and Increased Appetite Associated with Antidepressant Therapy
Authors: Yeragani Vikram K. , Pohl Robert , Aleem Asaf , Balon Richard , Sherwood Paul , Lycaki Helene
Published: April 2017

The symptom of carbohydrate craving and increased appetite (CHH) was studied in 180 outpatients receiving antidepressant treatment. One hundred and fifty-eight of these patients had a DSM-III diagnosis of panic disorder and 17, major depression. The incidence of CHH was similar in both diagnostic groups. Thus, antidepressant treatment is associated with CHH in patients with diagnoses, other than depression. Desipramine was least likely to induce CHH compared to imipramine, amitriptyline and doxepin. Most patients who developed CHH on imipramine no longer experienced this side effect when switched to desipramine. CHH was not more frequent among women and not associated with antidepressant dosage or treatment response. Histamine H-1 receptor blockade may be an important factor in the etiology of CHH.
The Psychiatric Acute Observation Unit in a General Hospital
Authors: Birnie William A. , Matsuno Kiyoko
Published: April 2017

A general hospital based psychiatric acute observation and treatment unit is described, and its operation over a one year period is reviewed. This seven-bed unit is designed to provide constant nursing observation and management, as well as intensive psychiatric treatment, in a secure, safe, and quiet environment for the most acutely psychiatrically ill patients. During the year under review, the unit had 330 admissions. Demographic, clinical, and treatment data are presented, and management of disturbed behavior, staff selection, and acceptance of the unit are discussed.
Diagnosis and Treatment of Monosymptomatic Hypochondriacal Psychosis in Chronic Renal Failure
Authors: Matas Manuel , Robinson Cynthia
Published: April 2017

The authors describe a case of a patient who presents with a delusional interpretation of a somatic symptom, uremic pruritus.

The literature on the diagnosis and treatment of monosymptomatic hypochondriacal psychosis (MHP) is reviewed and discussed. There is an effective treatment available for this disabling condition — a neuroleptic agent called pimozide, which appears to have a selective ability to block central dopaminergic receptors.
Kluver Bucy Syndrome with Severe Amnesia Secondary to Herpes Encephalitis
Authors: Conlon P. , Kertesz A. , Mount J.
Published: April 2017

The authors present a case of Kluver Bucy syndrome with severe amnesia secondary to herpes encephalitis. The clinical features, neuropsychological test results and magnetic resonance images in this case also elucidate important aspects of limbic system pathology that are discussed in light of the literature.