bluuebunny/crossref_metadata_2025 huggingface dataset:
A Canadian Medical-Psychiatric Inpatient Service*
Authors: Swenson J. Robert , Mai François M.
Published: April 2017

Patients with both psychiatric and medical illnesses present complex and, at times, difficult diagnostic and management problems. Medical-psychiatric units designed to provide integrated medical and psychiatric care have been established in the United States. This paper describes the development and structure of such a unit established at a Canadian general hospital, using psychiatric facilities and resources already in place. A one year review of the characteristics of patients discharged from the service found that their mean length of stay was similar to that of inpatients discharged from the general adult inpatient services, but shorter than that of patients discharged from the psychogeriatric service. Many of these patients had neurological conditions; coexisting affective disorders, substance abuse, organic mental syndromes and somatoform disorders were diagnosed frequently. We believe that a medical-psychiatric inpatient unit can provide integrated care to patients who might otherwise receive less than adequate care.
Prévenir l'exploitation sexuelle des patients: considérations en matière d'éducation*
Authors: Blackshaw Stella L. , Patterson Paul G.R.
Published: April 2017

Ces lignes directrices ont été approuvées par le Conseil d'administration de l'Association des psychiatres du Canada le 12 avril 1992.
A Comparison of the Cost-Effectiveness of Day Treatment and Residential Treatment for Children with Severe Behaviour Problems
Authors: Grizenko Natalie , Papineau Danielle
Published: April 2017

This study compares the cost of treating 23 children admitted to a residential treatment unit in a psychiatric hospital and 23 children admitted to the same unit after it was converted to a day treatment program, through a retrospective chart review. The two groups were similar in age, gender, diagnosis, severity of pathology, family functioning and support, the number of subjects who dropped-out, and treatment outcome. The average length of stay on the unit dropped from 19.6 to 6.1 months, and the average cost of treatment per child decreased from $61,412 to $9,213 (Canadian dollars, adjusted for inflation). The sharp decrease in treatment time with day treatment may be the result of close links with community schools and maintaining the child in the family and community. The cost savings can be attributed to the shorter hospital stays and the lower operating costs of day treatment. Implications of these findings will be discussed with respect to health care policy including the need to raise awareness of day treatment as a cost-effective alternative to residential hospital treatment.
Causes of Child Abuse and Neglect*
Authors: Ney Philip G. , Fung Tak , Wickett Adele Rose
Published: April 2017

This paper is a study of child abuse and neglect from the perspective of the child. Generally, the mistreatment of children was associated with “poor care” from parents, attributed mainly to immaturity, marital problems, alcohol abuse, unemployment, drug abuse and lack of money. Differences in attribution are noted between males and females, and some differences are noted by the age of the child. When factors other than the causes given by the children were taken into account, mistreatment was significantly related to family break-up, as well as long-term disinterest and lack of affection from the parents. When the children were asked for their “worst experience in life,” the most common responses were “abuse” “family break-up,” and for the juvenile offenders “getting charged with a crime”.
Body Image of Children and Adolescents and Its Measurement: An Overview*
Authors: Offman Hilary J. , Bradley Susan J.
Published: April 2017

The lack of a universally accepted definition of body image has impeded our understanding of body image disturbances in children and adolescents. This paper examines the evolution of body image as a multidimensional construct and the difficulties associated with the use of human figure drawing to measure body image. Directions for future research are considered.
The Impact of a Physically III Parent on Adolescents: Cross-Sectional Findings from a Clinic Population*
Authors: Morgan Jane , Sanford Mark , Johnson Coco
Published: April 2017

The degree to which the physical illness of a parent affects adolescents is unknown. This study examines this issue through a cross-sectional survey of patients referred consecutively to an adolescent outpatient psychiatry clinic. Demographic and clinical data concerning symptoms, diagnosis of major depression, peer isolation, and family functioning were collected on all subjects from both the adolescent and a parent (usually the mother). No significant differences were found between the groups on measures of family functioning, peer isolation and major depression. According to both youth and parent report, adolescents with physically ill parents had more somatic symptoms than controls. These findings are discussed in the light of the existing literature and the methodological shortcomings of the study.
Lignes directrices sur l'évaluation et la gestion de la violence familiale*
Authors: Bishop Joan , Patterson Paul
Published: April 2017

Ces lignes directrices ont été approuvées par le Conseil d'administration de l'Association des psychiatres du Canada le 12 avril 1992.
Victims of Violence: Aspects of the “Victim-to-Patient” Process in Women*
Authors: Moscarello Rebeka
Published: April 2017

This paper is an overview of aspects of the victim-to-patient process which reflects the interrelationship between mental health and mental disorder, particularly of women who suffer the sexual assault, sexual abuse, or wife assault. Knowledge of the psychological processes and symptoms aids diagnosis, modifies treatment and the process of recovery following acts of violence.
Psychiatric Services: A Survey of Nursing Homes and Homes for the Aged in Ontario
Authors: Conn David K. , Lee Victoria , Steingart Allan , Silberfeld Michel
Published: April 2017

A survey was conducted to determine perceptions and attitudes of psychiatric services available to nursing homes and homes for the aged across Ontario. A questionnaire was sent by mail to medical and nursing directors separately. Thirty-six point eight percent of responders reported that the nursing home residents never receive psychiatric care, and 88.2% of responders estimated the total psychiatric care received by all of their residents per month was five hours or less. Almost three-quarters of the responders stated that they require more psychiatric services. Significantly more nursing directors than medical directors wanted more psychiatric services. Southwestern Ontario, followed by Northern Ontario, had the least perceived availability of a visiting psychiatrist. Perceived availability was greatest in larger urban areas and least in rural areas. The mean percentage of residents perceived to have psychiatric or behavioural problems was 30.5%, while the mean percentage perceived to require psychotropic medication was 37.4%. Physical aggression, wandering and agitation were identified as the behavioural problems of greatest concern to staff. When a visiting psychiatrist is not available, residents sometimes have to travel long distances for psychiatric evaluation. Planning is required to facilitate and encourage the development of efficient and effective psychiatric services for long term care facilities for the elderly.
The Management of a Case of Treatment-Resistant Paraphilia with a Long-Acting LHRH Agonist*
Authors: Dickey Robert
Published: April 2017

A patient with multiple paraphilias who had been treated for several years with sex drive reducing agents (cyproterone acetate and medroxyprogesterone acetate) with little effect on sexual activity or fantasy was offered treatment with long-acting leuprolide acetate, an LHRH agonist. This produced a marked decrease in all reported sexual thoughts and activities with no significant side-effects.
A Preliminary Report on the Discrepancy between Clinical and Test Evaluations of Competence*
Authors: Rutman Deborah , Silberfeld Michel
Published: April 2017

This report demonstrates the discrepancy that can occur between clinical and test evaluations of competence. It presents retrospective examination of 35 assessments of competence performed on 24 subjects by a multidisciplinary competency panel. The findings of the panel are compared with the subjects' results on the Cognitive Competency Test and on the Mini-Mental State Examination. The results show that the multidisciplinary competency panel will more often find subjects competent than indicated by their psychometric test scores. A process approach to the use of tests is recommended. Reliance on tests to decide the outcome of difficult cases does not appear to be warranted.
Behavioural Disturbances in the Demented Elderly: Phenomenology, Pharmacotherapy and Behavioural Management*
Authors: Rapp Morton S. , Flint Alastair J. , Herrmann Nathan , Proulx Guy-Bernard
Published: April 2017

Behavioural disturbances in the demented elderly cause a significant amount of distress both to the patients and their caregivers. This article first summarizes the phenomenology associated with these disturbances. It then deals with the pharmacological methods of reducing these disturbances. Finally, it deals with some of the more recent advances in combining the insights of behavioural modification with those of neuropsychology in finding non pharmacological methods of reducing problematic behaviours. It is stressed that a combination of the two approaches is most likely to be required, and most likely to be successful, in the individual case.
Screening Psychiatric Patients for Axis II Disorders*
Authors: Nussbaum David , Rogers Richard
Published: April 2017

This study examined the usefulness of the SCID-PQ on a sample of 82 inpatients as a screening measure for Axis II disorders. The SCID-PQ proved effective (i.e., resulted in a very low false negatives and moderate false positives) in screening for seven of the 11 DSM-III-R personality disorders. Of the four remaining disorders, minor modifications were suggested which resulted in improved classification rates for dependent and schizoid personality disorders.
Electroconvulsive Therapy
Authors: Enns Murray W. , Reiss Jeffrey P.
Published: April 2017

The following position paper was approved by the Board of Directors of the Canadian Psychiatric Association on September 15,1992.
A Double-Blind Placebo Controlled Trial of Medroxyprogesterone Acetate and Cyproterone Acetate with Seven Pedophiles
Authors: Cooper A.J. , Sandhu S. , Losztyn S. , Cernovsky Z.
Published: April 2017

Seven of ten pedophiles in hospital completed a double-blind, placebo-controlled two-dose comparison of medroxyprogesterone acetate and cyproterone acetate. Sequential measures during the 28 week study were: patient self-reports, nurses' observations, phallometry, hormone levels and side-effects. The drugs, which performed equivalently, reduced sexual thoughts and fantasies, the frequency of early morning erections on awakening, the frequency and pleasure of masturbation, and level of sexual frustration. Penile responses were also reduced but to a lesser degree and were more variable. Serum testosterone FSH and LH all declined during drug administration, but by the end of the final placebo phase had essentially returned to (or exceeded) pre-drug values. Our experience suggests that only a minority of pedophiles are likely to accept libido-reducing drugs.
Schizophrenia and Substance Abuse: Prevalence Issues
Authors: El-Guebaly Nady , Hodgins David C.
Published: April 2017

A review of studies of the prevalence of substance abuse among schizophrenics suggest that both demographic and environmental factors are strong determinants of the extent of substance abuse in this population as well as the type of substances used. In a mid-sized Canadian city, a sample of schizophrenic patients referred to a dual diagnoses clinic were administered the Addiction Severity Index. With age and gender included as a factor, no significant differences were found in the choice or length of use of most drugs between diagnostic groups, contrary to some other reports from large urban centres. Compared with a population of a similar age, there were fewer regular and more former drinkers among the schizophrenic patients. The choice of other substances by the sample reflected the pattern of use in the population at large. This approach to prevalence provides a more balanced perspective of the substance abuse by schizophrenics. The major targets for prevention remain the alcohol, caffeine and tobacco consumption.
Changes in Appetite and Weight during the Pharmacological Treatment of Patients with Panic Disorder
Authors: Balon Richard , Yeragani Vikram K. , Pohl Robert , Merlos Barbara , Sherwood Paul
Published: April 2017

Antidepressants reportedly increase appetite, carbohydrate craving and weight in some patients with depression and panic disorder. This paper presents the results of changes in appetite and weight inpatients with panic disorder treated with imipramine, diazepam or placebo in a double-blind prospective study.

Forty-four patients with panic disorder were randomly assigned imipramine, diazepam and placebo. The investigators monitored weight and the patients rated their appetite and cravings during the eight week study. No significant increases in weight or appetite were found in the patients with panic disorder patients.
Psychiatric Consultation in the Eastern Canadian Arctic: III. Mental Health Issues in Inuit Women in the Eastern Arctic
Authors: Abbey Susan E. , Hood Eric , Young L. Trevor , Malcolmson Samuel A.
Published: April 2017

This report describes mental health issues affecting Inuit women as seen in psychiatric consultation. Recent public and governmental attention has focused on the emotional and behavioural sequelae of rapid cultural change, spousal assault and sexual violence. The process of psychiatric consultant with the Inuit woman patient will be described. The need for innovative, community-based treatment strategies in this population will be emphasized.
To What Extent Do Anxiety and Depression Interact with Chronic Pain?
Authors: Kuch Klaus , Cox Brian , Evans Ramon J. , Watson Peter C. , Bubela Constantine
Published: April 2017

In 61 patients with generalized musculoskeletal pain, severity of anxiety and depression correlated significantly with self-reported impact of illness and physician-rated disability. Depression was significantly associated with pain-frequency, whereas anxiety was unrelated. Depressed mood was more closely tied to patients’ ability to function than to their experience of pain.
Un service d'intervention de crise en clinique externe psychiatrique de centre hospitalier général: fonctionnement et clientèle
Authors: Fournier Jean-Pierre , Gagnon Fabien
Published: April 2017

The authors describe an external crisis intervention service in a general hospital. This service is intended for a clientele presenting acute mental health problems, referred, in the majority of cases, from the emergency department. They present demographic data, diagnostic data, data on the factors precipitating the crises and data which can be used to qualify and quantify the clientele. In addition, they describe the therapeutic approach and the treatment philosophy, the number of follow-up sessions, and the guidance provided to the clientele after follow-up. Finally, the authors suggest prerequisites considered essential to the effective operation of a crisis intervention module in an external psychiatric clinic.
Epidemiology of Pathological Gambling in Edmonton
Authors: Bland R.C. , Newman S.C. , Orn H. , Stebelsky G.
Published: April 2017

Thirty lifetime pathological gamblers (DSM-III, no exclusion criteria) were identified when 7,214 randomly selected household residents of Edmonton were interviewed by trained lay interviewers using the Diagnostic Interview Schedule. The lifelong prevalence of pathological gambling was 0.42% (ratio of males to females 3:1). The peak age of onset was 25 to 29 years. Gamblers had high rates of comorbidity with other psychiatric disorders. They were likely to have made suicide attempts (13.3%), to have been convicted of offences (26.7%), to be spouse and child abusers (23.3% and 16.7% respectively) and to have spent long periods unemployed (40%). In addition, 80% had trouble at home or work because of gambling, and 60% borrowed or stole to gamble.
Dimenhydrinate Abuse among Adolescentsa
Authors: Gardner David M. , Kutcher Stan
Published: April 2017

Dimenhydrinate may be a relatively common yet unrecognized substance of abuse among adolescents. Abuse of this drug may present as a psychiatric syndrome, particularly depression. Three cases are presented which illustrate this relationship. A review of the literature is presented and suggestions are made for identifying adolescents who abuse dimenhydrinate.
Pathologie cardio-vasculaire et trouble panique
Authors: Chignon J.M.
Published: April 2017

The relationship between anxiety and cardiovascular function and symptoms has long been of interest, culminating in the recent emphasis on the modulation of cardiovascular response in patients with panic disorder. The relationship between panic disorder and mitral valve prolapse remains controversial. Panic disorder appears to be significantly associated with increased incidence of cardiovascular morbidity. The detection and treatment of panic disorder in patients with cardiovascular risk or diseases could have an important impact on prognosis and quality of life of the patients.
A Checklist for Evaluating the Usefulness of Rating Scales
Authors: Streinmer David L.
Published: April 2017

Rating scales of various sorts are very useful for both clinical and research purposes. However, they vary greatly regarding their reliability, validity, and utility. This article provides a guide for people who need to evaluate scales, either to incorporate them into their own research or clinical activities, or to determine if the results of studies which use scales are meaningful. The different types of reliability and validity are discussed and guidelines are offered to evaluate how well these were assessed. Finally, other aspects of scales which can affect their usefulness, such as completion time, training, and scoring ease, are discussed.
La psychiatrie de consultation-liaison: une étude prospective en milieu hospitalier général
Authors: Michalon Max
Published: April 2017

This study was conducted in Halifax, Nova Scotia, in a 740 bed university general hospital. For a period of two years, a prospective collection of data on 692 psychiatric consultations showed that 60% of all consultations came from internal medicine departments. Medical and psychiatric comorbidity was found in 50% of the patients; depression was diagnosed in 27.5% of the cases but schizophrenia in only 1.7%. Suicidal ideation was reported by 24% of the patients, 11.6% of them wishing to die imminently. More than 50% of suicidal patients were under 35 years of age; 42% of them were dependent on alcohol. Almost 30% of the patients seen in consultation admitted to being addicted to alcohol, 22% to benzodiazepines and 14% to illicit drugs. Among the ex-alcoholic patients, a significant dependence in benzodiazepine use was found. The patients with addictions to street drug had a greater suicide risk and were at the same time abusing alcohol. This paper will describe the overall functioning of a consultation-liaison psychiatric service and will analyze the impact of psycho-active substance abuse in a general hospital setting. The results will be compared with those in the literature.
The Geographical Distribution of Psychiatrists in Canada: Unmet Needs and Remedial Strategies
Authors: El-Guebaly N. , Kingstone E. , Rae-Grant Q. , Fyfe I.
Published: April 2017

Many efforts are underway to rationalize the process of manpower planning in psychiatry. A wide variation in the geographic distribution of psychiatrists remains. A multidimensional assessment of the needs of a population is recommended, based on the epidemiology of mental disorders, professional and institutional needs, consumer estimates, and the requirements of subgroups.

Counting the number of vacant positions for psychiatrists can be misleading. Professional norms for the optimal access of a population to psychiatric services and standards for the quantity and/or quality of services provided need to be developed. Potential outcome measures are suggested, along with a three-tiered system of estimating geographic needs.

Deterrent factors to an optimal geographic distribution of most professionals are reviewed, along with factors specific to our residency training programs. In the short term, the benefits and limitations of recruiting foreign-trained psychiatrists are compared with those of recruiting Canadian specialists. Complementary long term strategies include the provision of financial incentives, optimal working conditions, relevant training and maintenance of competence issues, and community support.
Misidentification Delusions, Facial Misrecognition, and Right Brain Injury
Authors: Silva J. Arturo , Leong Gregory B. , Wine David B.
Published: April 2017

Individuals suffering from misidentification syndromes may present with right hemispheric pathology and deficits in facial recognition. In addition, misidentification delusions have been associated with aggressive behaviour. The possible linkage between misidentification phenomena, facial recognition, and aggression is discussed, illustrated by the case of a patient suffering from an organic delusional disorder.
Placebo Response in Refractory Tardive Akathisia
Authors: Remington Gary , Fornazzari Luis , Sethna Rustom
Published: April 2017

A double-blind, crossover drug trial with a patient with treatment-resistant tardive akathisia is described. The finding of a placebo response was unexpected, but emphasizes the value of such an approach in refractory cases.
L'examen oral de certification en psychiatrie
Authors: Poitras Robert
Published: April 2017

This paper first describes interviewing techniques and oral presentations made by candiates to the examiners. It then describes the factors related to a failing score on the oral certification examination. The author draws conclusions regarding the difference between the corporation examination, which gives candidates the right to practise, and the Royal College examination or that of the American Board of Psychiatry and Neurology, where the candidates chose whether or not they wish to take the examination.
Treatment of Non Specific Dyssomnia with Simple Stimulus Control Procedures in a Child with Down's Syndrome
Authors: Allison David B. , Burke John C. , Summers Jane A.
Published: April 2017

Nonaversive behavioural interventions were used successfully to treat a disrupted sleep pattern in a child with Down's syndrome. A quasi-experimental single-case design was employed to evaluate the treatment efficacy. During the first phase of treatment, the mother implemented a structured bedtime routine and the child was no longer allowed to engage in activities while in bed. During the second phase, a stimulus control paradigm was employed in which a nearly life-sized rag doll was substituted for the mother in bed. Finally, the mother gradually withdrew from the child's bed and room. During baseline, the child spent an average of only six percent of the night sleeping alone. By the second phase, this rose to a mean of 26%. By the end of treatment this was increased to a mean of 78.2 %. The increase was accompanied by collateral decreases in crying and distress. Improvements were maintained at follow-up.
A Comparison of the Demography, Clinical Profile and Treatment of Adopted and Non Adopted Children at a Children's Mental Health Centre
Authors: Jerome Laurence
Published: April 2017

A retrospective analysis of adopted and non adopted children attending a children's mental health centre between 1959 and 1973 indicated a higher than expected number of males and a significantly higher number of professional fathers than expected in the adopted group. A sub-group of adopted children identified as having learning problems by reports of the parents and teachers had a different pattern of test scores on the Wechsler Intelligence Scale for Children from a non adopted group, who were also selected for learning difficulties. On the parent's and clinician's ratings, the adopted group had more parent-identified hyperactivity symptoms and clinicians’ diagnoses of hyperactivity. Treatment data indicated that they used more stimulant medication; this was particularly significant for the early adoptees. The early adoptees were considered to be more hyperactive by their parents than the late adoptees. The late adoptees were more impaired on psychometric testing than those placed early, before six months of age. These findings are discussed in relation to possible explanations for the higher than expected prevalence of adoptees seen in clinical populations.
La Détresse Psychologique dans la Population du Québec non Institutionnalisée: Résultats Normatifs de L'enquête Santé Québec
Authors: Boyer Richard , Préville Michel , Légaré Gilles , Valois Pierre
Published: April 2017

Based on the results of the Santé Québec survey, this article describes the normative values of the psychological distress indices developed as part of the Santé Québec survey (IDPESQ-29 and IDPESQ-14) for the reference population as a whole, women and men separately, and for certain age groups.
Aims and Methodological Problems in Multimodal Treatment Studies
Authors: Hechtman Lily
Published: April 2017

The paper outlines the growing acceptance and use of multimodal treatment approaches to treat a variety of psychiatric disorders in childhood and adolescence. It then explores some of the problems of multimodal treatment studies. Problems in assessing outcome of efficacy of the interventions, particularly as they pertain to specific interventions and particular areas of functioning are discussed as well as the issues of appropriate control and comparison groups. The problems with regard to appropriate control and comparison groups are explored with respect to diagnosis and interventions. Finally, an ongoing multimodal treatment study of children with attention deficit hyperactive disorder is used to illustrate how some of the problems described can be solved.
Anorexia Nervosa and Depression in a Woman Blind since the Age of Nine Months
Authors: Sharp Clifford W.
Published: April 2017

A woman aged 58 who has been blind since the age of nine months presented with major depression and a 40 year history of an eating disorder characterized by a restriction of food intake and body disparagement. The case is additional evidence that a specifically visual body image is not essential for the development of anorexia nervosa and supports the view that the concept of body image is unnecessary and unproductive in eating disorders. Greater emphasis should be placed on attitudes and feelings toward the body, and the possibility of an eating disorder should be considered in cases of older women with an atypical presentation.
Therapist-Patient Sexual Contact: A Non Consensual, Inherently Harmful Activity
Authors: Baylis Françoise
Published: April 2017

Therapist-patient sexual contact is unethical, whether it is the patient or the therapist who attempts to sexualize the therapeutic relationship. Therapist-patient sexual contact is non consensual; patients cannot provide a morally valid consent to sexual relations with their therapist because the key elements of a morally valid consent — intentionality, substantial understanding, substantial voluntariness and autonomous authorization — cannot be met. As well, therapist-patient sexual contact harms patients, patients' families, and the profession. The most significant harm caused is experienced by the patients, the majority of whom are women.
Du Changement par la Formation Balint: Expérience avec des Résidents en Médecine Familiale
Authors: Laperriére Serge , Turgeon Jean
Published: April 2017

The article is about the change observed in participants in a training course by the Balint groups. The authors' experiment is aimed at residents in family medicine. It involves both the psychiatrist and physician, leader and participant. Psychic functioning as a process is applied to presentation, discussions and leadership. The optimum clinical understanding of this training strives for development within the group itself. The authors consider two factors that come into play: symbolization and awareness. These concepts are developed to support the notion of a global approach.
Adrenal Gland Weight and Suicide
Authors: Stein Eleanor , Mccrank Ernest , Schaefer Betsy , Goyer Robert
Published: April 2017

The purpose of this study is to determine if there is an anatomical correlate, namely adrenal hypertrophy, among people who have commited suicide. The adrenal weights and other relevant information were collected prospectively from 118 consecutive coroner's cases of sudden death in the province of Ontario. No statistically significant difference was found between the adrenal weights of those who had committed suicide, whether violent or non violent, and those dying suddenly of causes not self-inflicted. This was true irrespective of the age of the subjects, their sex or the centre at which the autopsy was performed. This finding does not support the findings of an earlier report of increased adrenal weight in successful suicides. The incidental finding of increased adrenal weight in all subjects is of some significance.
Determination of Financial Competence in Consultation-Liaison Psychiatry
Authors: Toffoli Nadia D. , Herrmann Nathan
Published: April 2017

The aging of our population will require physicians to become more aware of the issues surrounding the determination of financial competence. This retrospective study involved the review of 46 medical or surgical patients in a university teaching hospital that were referred to the psychiatric consultation-liaison team for assessment of financial competency. Charts were reviewed for completeness of documentation using suggested criteria for determination of financial competence. The study found that while many criteria were frequently documented, documentation was incomplete for important criteria, such as calculating abilities, judgement, the patient's appreciation of the consequences of financial competence, presence of delusions with regard to finances and the patient's awareness of debt. Concerns are expressed regarding a physician's ability to recall details pertaining to cases before a tribunal without complete and careful documentation. The importance of establishing formal criteria for the determination of financial competence is also discussed.
Le rôle de la famille dans le développement du trouble de la personnalité limite
Authors: Gagnon Pierre
Published: April 2017

The role of family in the development of borderline personality disorder is examined with an emphasis on dimensions of family functioning. A synthesis of theoretical concepts implicating such factors, derived mostly from psychoanalysis, is proposed with an emphasis on separation-individuation, early frustrations, regression to recognition memory, oscillations in attachment and social influences. Empirical studies are reviewed. Affective neglect and parental overprotection are often cited, although dysfunctional behaviour control may have a regulatory effect on these factors and a crucial impact on psychic reality of the patient recalling his childhood.
Prediction of Adjustment from Preschool to Middle Childhood
Authors: Beitchman J.H. , Wild Jennifer , Hood Jane
Published: April 2017

This study identified predictor variables associated with outcome in middle childhood in a clinical preschool sample. These variables were examined in relation to functional level at outcome. At Time 1 the sample consisted of 129 children admitted to a psychiatric preschool program; 82 of these children comprised the follow-up sample at Time 2. The results indicated that the variables significantly associated with each child's outcome were IQ, the presence of diagnosis at Time 1 and the length of time each child was in the treatment program. Different predictors were important for different outcomes and a given predictor variable was not equally salient across all levels of outcome.
Life Events in Borderline Personality Disorder
Authors: Labonte Edith , Paris Joel
Published: April 2017

In order to examine the role of life events in the clinical presentation of borderline personality disorder, the Life Experience Survey was given to three groups of subjects; one consisting of patients suffering from borderline personality disorder and two consisting of control subjects for the purpose of comparison. The results showed that patients suffering from borderline personality disorder did not experience a greater number of life events, but those life events that they did report were related to their psycho-pathology, which were, in turn, associated with the break-ups of important relationships or with effects of impulsive actions.
Mécanisme d'action des antidépresseurs
Authors: Llorca P.M. , Reine G. , Wolf M.A.
Published: April 2017

Modifications in noradrenergic and serotonergic systems are involved in the central mechanism of action of antidepressants. Most antidepressants (electroconvulsive therapy included) induce a desensitization of the β-noradrenergic receptor, as shown by a decrease in noradrenalin-stimulated cAMP production. Down-regulation of the β receptor is often associated with desensitization, as well as modifications in the activity of the serotonergic system, among which alterations in 5-HT2 receptors are frequent. Finally, complex interactions between noradrenergic and serotonergic receptors may also contribute to the pharmacological effect of long term antidepressive treatment.
Is 5HT1A Receptor Subsensitivity a Trait Marker for Late Luteal Phase Dysphoric Disorder? A Pilot Study
Authors: Yatham Lakshmi N.
Published: April 2017

Prolactin responses to buspirone challenges were examined in seven women with late luteal phase dysphoric disorder and the same number of healthy controls. The responses were found to be blunted during the follicular phase in the women with LLPDD suggesting that 5-HT1A receptor subsensitivity is perhaps a trait rather than a state marker for LLPDD.
Have the Invisible Children Become Visible?
Authors: Vanharen James , Laroche Catherine , Heyman Marsha , Massabki Albert , Colle Lois
Published: April 2017

Over the past 30 years much information has been collected on children whose parents suffer from psychiatric illness. Research has shown that many of these children are at high risk for significant psychopathology but there have been few investigations examining whether or not they are being identified and are receiving mental health care. The purpose of this pilot study was to investigate to what extent the children of psychiatrically ill adult patients are identified and referred to the mental health services. Results of structured interviews with the patients indicate that a considerable number had school-aged children and that in many instances no inquiry had been made concerning the children's psychological health. Although some of the children were reported to have received treatment, few had been referred by their parents’ psychiatrists. Recommendations to improve the identification and treatment of such children are outlined in this study.
New Perspectives on the Clinical Neurobiology of Treatment Response in Schizophrenia
Authors: Honer William G.
Published: April 2017

A structured approach is used to review the rapid progress in neurobiology related to treatment response in schizophrenia. Findings are presented and discussed according to the molecular, cellular and regional levels of brain organization. The genotype-phenotype structure is used to consider potential interactions between genes, clinical manifestations of the illness and treatment response. The integration of neurobiological research into the future development of new treatment strategies for schizophrenia holds significant promise.
Antiparkinsonian Drugs in the Treatment of Neuroleptic-Induced Extrapyramidal Symptoms
Authors: Bezchlibnyk-Butler Kalyna Z. , Remington Gary J.
Published: April 2017

Most patients on neuroleptic therapy experience extrapyramidal symptoms in one form or another during treatment. While the risk of extrapyramidal symptoms appears diminished with the newer and “atypical” neuroleptics (for example, risperidone, remoxipride, clozapine), it is not eliminated. It is essential that the treating clinician monitor for such side effects since if they are left untreated they can be an ongoing source of discomfort to the patient and may affect compliance with therapy. Antiparkinsonian medication represents the mainstay of treatment for neuroleptic-induced extrapyramidal symptoms. Their clinical use is reviewed here with reference to mode of action, indications, choice, side-effects and precautions.
Mood Swings in Patients with Panic Disorder
Authors: Bowen Rudy , South Maxine , Hawkes Judy
Published: April 2017

Depression is frequently found in patients with panic disorder. It is known that patients suffering from panic disorder and depression have more severe symptoms of anxiety and avoidance and respond less well to treatment with antidepressants. The General Behaviour Inventory, an instrument that identifies subjects with subsyndromal and syndromal recurrent mood disorders was completed by 108 patients in a panic disorder program. Thirty-four percent (n = 37) were classified as suffering from a mood disorder. Of the mood disordered patients, 25 of 37(68%) (23% of the total) were classified as suffering from bipolar or cyclothymic mood disorder.
A Thirty-Year Retrospective Study of Hospitalization among Severely Mentally III Patients
Authors: Mercier Céline , Renaud Claude , King Suzanne
Published: April 2017

This study examines the effects of deinstitutionalization policies on psychiatric hospitalization rates over a thirty-year period. It is based on a retrospective study of successive hospitalizations in severely disabled patients. The data indicate that in any five-year period these patients still spend over 20% of their time in hospital. For patients who have stayed for a total of more than one year every five years in hospital, the average length of stay has been decreasing far less rapidly in the last fifteen years than it had previously. Patients who were first admitted after 1971 spent proportionally as much time in hospital as those whose first stay was earlier. These results show that the groups primarily affected by deinstitutionalization are those who were first hospitalized prior to the 1970s and those who are the heaviest hospital users. However, the data from the patients admitted since the seventies seem to reveal that the process of change may have reached its limits.
Attempted Suicide Using Insulin by a Non Diabetic: A Case Study Demonstrating the Acute and Chronic Consequences of Profound Hypoglycemia
Authors: Cooper A.J.
Published: April 2017

This paper describes the case of a non diabetic physician with a prior psychiatric history in which there was overwhelming biochemical and clinical evidence that he had attempted suicide by injecting himself with an overdose of insulin. He was extensively monitored from the time of his admission to hospital in a coma, until he fully recovered consciousness 30 days later and during the next eight months of his rehabilitation. This case attests to the high level of morbidity which might follow profound hypoglycemia. It also illustrates some putative psychodynamics of suicidal behaviour — notably ambivalence and denial (at the time of writing, the patient never acknowledged that he had overdosed with insulin). A selective review on some of the more recent literature on the neuropathological effects of insulin overdose and profound hypoglycemia is presented.
Désinstitutionalisation de déficients mentaux sévères: impact sur la prescription des neuroleptiques
Authors: Boucher Colette , Morin Luc , Dubois André
Published: April 2017

The neuroleptic medication prescribed over a period of 12 years for three groups of severely developmentally handicapped patients is analyzed retrospectively. The average daily doses prescribed for two groups of patients, deinstitutionalized either to foster homes or group homes, are compared to those prescribed for a third group of patients who were not deinstitutionalized. The results show that deinstitutionalization had no impact on the prescribing of neuroleptics, regardless of the type of residence: group home or foster home. The results show, moreover, that for the three groups of patients, time spent without medication decreased significantly over the 12 years of this study. These results are discussed in relation to the problem of the patients' social reintegration into the community.
Figuring Out Factors: The Use and Misuse of Factor Analysis
Authors: Streiner David L.
Published: April 2017

Factor analysis is a technique which is designed to reveal whether or not the pattern of responses on a number of tests can be explained by a smaller number of underlying traits or factors. Similarly, it can be used to indicate whether or not the various items on a questionnaire can be grouped into a few clusters with each cluster reflecting a different construct. As with all multivariate statistical tests, it is quite powerful and can provide much information about the instruments being used. Similarly, there are many ways it can be abused and misinterpreted. This paper will explain the basics of factor analysis and provide some guidelines relating to how the results should be reported.
Research Funding of Psychiatric Disorders in Canada: A Snapshot, 1990–1991
Authors: Lam Raymond W. , El-Guebaly Nady
Published: April 2017

Although mental illness accounts for up to 14% of total direct health care costs and an estimated cost of over five billion dollars annually, research funding of psychiatric disorders is regarded as underfunded relative to other biomedical research. This study was conducted to determine the amount of funds allotted to the research of specific psychiatric disorders in Canada. Data was obtained from a national database of peer-reviewed health research funding. Based on the title of the research grant, all projects that pertained to psychiatric disorders were identified and classified according to diagnosis. Research funding for psychiatric disorders totalled $16,391,000 from 1,990 to 1991, or 3.7% of all biomedical research funding for that period. The relative contributions of federal, provincial and private (nonprofit) agencies to the funding total were 54%, 39% and 8%, respectively. Research funding for mental illness remains disproportionately low relative to other medical illnesses. The role of private nonprofit agencies, in particular, is much more limited for psychiatric disorders than for other identified medical illnesses. These data suggest that increased attention to research advocacy is required to increase psychiatric research support. Advocacy strategies should include: 1. publicizing the value and scope of psychiatric research in Canada; 2. working to de-stigmatize mental illness; 3. strengthening personal and professional affiliations with patient advocacy groups; 4. increasing the number and the qualifications of psychiatric researchers; 5. improving the scientific quality of research programs; and 6. organizing national research collaborations.
Presumptions Respecting Mental Competence
Authors: Madigan Kevin V. , Checkland David , Silberfeld Michel
Published: April 2017

This paper addresses the role(s) played by presumptions regarding mental competence in the context of clinical assessment of decision-making capacity. In particular, the issue of whether or not the usual common law presumption of competence is appropriate and applicable in cases of reassessment of persons previously found incompetent is discussed. Arguments can be made for either retaining a presumption of competence or adopting a presumption of incompetence in reassessment cases. In addressing the issue and the arguments, the authors conclude that the question is really a public policy issue which requires legislative resolution. In writing this paper, the authors have drawn on their joint clinical experience at the Baycrest Competency Clinic. Though the authors' jurisdiction is the province of Ontario, their intent is to raise awareness and to prompt consideration of this issue both inside and outside Ontario.
Do Therapist Experience, Diagnosis and Functional Level Predict Outcome in Short Term Psychotherapy?
Authors: Propst Arthur , Paris Joel , Rosberger Zeev
Published: April 2017

The purpose of this study was to investigate the effects of clinical diagnosis, functional level and therapist experience on the outcome of brief psychotherapy. Patients (N = 123) were clinically diagnosed and assigned to either a psychiatrist, psychiatry resident, family practice resident or medical student. Global Assessment of Functioning (GAF) scores and the Global Severity Index (GSI) of the SCL-90 were rated at baseline, at the end of therapy and at six month follow-up. The Client Satisfaction Questionnaire was also scored after therapy. All groups of patients improved significantly. Neither therapist type and diagnostic category nor their interaction were related to outcome GAF or to GSI. Patients improved irrespective of their baseline symptom severity. Satisfaction with therapy was highly related to increased functioning and decreased symptom severity. The number of therapy sessions attended by patients was modestly related to outcome and patient satisfaction. The results suggest that many diagnostic groups benefit from brief psychotherapy administered by therapists of varying experience. Furthermore, the results support the practice of having medical students conduct psychotherapy under supervision during their training.
Do Child and/or Parent Bereavement Programs Work?
Authors: Schneiderman Gerald , Winders Patricia , Tallett Susan , Feldman William
Published: April 2017

Bereavement programs for children and parents are becoming popular since there are more and more neonatal intensive care programs, pediatric oncology programs and pediatric intensive care programs offering these services. This paper addresses the following question: Do bereavement programs work? An overview of the literature dating back to 1964 was undertaken. Only papers dealing with treatment were reviewed. Randomized controlled trials were selected as presenting the best evidence for or against program effectiveness. Methodologic features such as description of the sample, comparability of treatment and control groups, description of the intervention, use of objective, valid, reproducible and blinded outcome measures, sample size calculations, thoroughness of follow-up and attention to clinical as well as statistical significance were assessed. Four randomized controlled trials were found in the literature search. Two of the studies showed benefit, two did not. All four suffered significant methodologic flaws. At this time it is unclear as to whether or not bereavement programs help families. Given the high costs of health care, it is important that studies be done to determine which families are likely to benefit from bereavement programs and what type of program is effective.
Fluphenazine Treatment of DSM-III-R Male Schizophrenic Patients among the Xhosa
Authors: Landmark Johan , Merskey Harold , Cernovsky Zack Z.
Published: April 2017

A comparison of fluphenazine decanoate depot injection used alone and fluphenazine decanoate with fluphenazine HCl i.m. was undertaken in South African Xhosa patients with schizophrenia diagnosed according to DSM-III-R. The combined treatment significantly shortened the length of hospital stay to a mean of 30.5 days from a mean of 40.7 days for the single therapy group. The combined treatment group also obtained significantly higher improvement ratings one week after the start of treatment than the single treatment patients.