bluuebunny/crossref_metadata_2025 huggingface dataset:
Le droit de refus de traitement chez le patient involontaire: considérations médico-légales
Authors: Morrison Denis
Published: April 2017

Forensic topics are discussed in relation to the right to refuse treatment among involuntary hospitalized patients. A clinical case is reported emphasizing the medical and legal dilemmas which the psychiatrist has to cope with. Different legal procedures are examined and their deficiencies discussed; the right to refuse treatment is discussed with reference to recent cases heard in the U. S., The Charter of Rights of the Canadian Constitution 1981 and the “Charte des droits de la personne du Québec”. The recommended solution in cases of treatment refusal among involuntary patients centers on the judiciary determination of incompetency of such patients.
Faut-il encore enseigner la psychiatrie communautaire au résident en psychiatrie
Authors: Leblanc Jean
Published: April 2017

After having defined his conception of what community psychiatry is, where it is situated in the line of evolution of modern psychiatry, the author weighs the pertinence of teaching residents knowledge pertaining to a sector in full identity crisis. The effort is worthwhile, since this crisis has permitted the community psychiatrist to better define himself namely in regard to the other health professionals, and it is therefore easier to determine what kind of knowledge should be transmitted to the resident in this particular field. A tentative teaching program is outlined. In such a program, education aspects should take precedence of training aspects, making the future psychiatrist more prepared to face eventual changes in that field. Such a program should take place in the final part of the residency course following a solid preparation in basic clinical psychiatric knowledge.
The Grieving Witch: A Framework for Applying Principles of Cultural Psychiatry to Clinical Practice
Authors: Beiser Morton
Published: April 2017

While most psychiatrists would probably agree that culture affects clinical practice, the task of translating this proposition into practical principles remains to be accomplished. This review article examines research findings and, based on this examination, suggests management principles for an episode of illness in a woman of different cultural background than those of her caretakers. The review examines how cultural considerations affect the definition, presentation, causes, diagnosis and treatment of illness.
Affective Disorders in Children and Adolescents: The Dysthymic Disorder Dilemma
Authors: Fine Stuart , Moretti Marlene , Haley Glenn , Marriage Keith
Published: April 2017

From 60 patients referred for assessment of their depressive symptomatology, 13 were found to suffer from major affective disorder and 14 from dysthymic disorder. The results from self-rating scales (the Children's Depression Inventory and the Children's Depression Scale) were compared with the findings from diagnostic interviews (using DSM-III criteria). The large proportion of dysthymic disorders in this sample is compared to the low reported figure in most other samples and some comments about the possible usefulness of this diagnosis are made.
Psychothérapie: La confusion des langues
Authors: Montgrain Noël
Published: April 2017

Psychiatry has to make choices in the wide range of psychotherapies. A good classification however permits to distinguish those that are of personal development, those that have mainly a political significance of those that have really a clinical use. The psychoanalytic model keeps being the most useful one for understanding the psychiatric patients and for their treatment.

Researches should be undertaken to adapt the model to more realistic issues. Short-term analytic psychotherapies should be tested in adapted settings, with emphasis on focal problems, present unconscious stresses and limited goals.
Cushing Disease Presenting as Atypical Psychosis Followed by Sudden Death
Authors: Gerson Stephen N. , Miclat Romeo
Published: April 2017

The authors report a case of Cushing's Disease that first presented as a diagnostically confusing Atypical Psychosis. Sudden death occurred secondary to unexpected gastrointestinal bleed. Pathological findings confirmed the diagnosis. Neurochemical mechanisms for the behavioral aberrations are explored.
Depressed Children of Depressed Parents
Authors: Kashani J.H. , Burk J.P. , Reid J.C.
Published: April 2017

Fifty children whose parents had a diagnosis of affective disorder were given a stuctured diagnostic interview by a child psychiatrist. The parents were also interviewed about their children. Fourteen per cent of the children were found to be depressed. Compared to the remaining children, the depressed children endorsed significantly more symptoms of attention deficit disorder, oppositional disorder, mania, overanxious disorder, phobia, and bulima in the interview. The parent's interview disclosed that the depressed children were abused significantly more than the non-depressed group.
The Insanity Defence
Authors: Milliken A. Donald
Published: April 2017

The recent A.P.A. Statement on the Insanity Defence is a document important to all psychiatrists and medico-legal professionals in North America. Its contents are reviewed and contrasted with current Canadian practice on the insanity defence, as well as the proposals of the Mental Disorder Project of the Canadian Department of Justice. The American Psychiatric Association's proposal on the definition of mental disorder is contrasted with the current practice. It is also suggested that the proposal of the Mental Disorder Project to change the disposition of insanity acquittees will lead to difficulties similar to those which provoked the current crisis in the United States.
Psychiatric Aftercare in a Metropolitan Setting
Authors: Wasvlenki Donald , Goering Paula , Lancee William , Fischer Linda , Freeman Stanley J.J.
Published: April 2017

In the face of the trend toward brief hospitalization, rising re-admission rates and other indices of poor community adjustment, concern has developed about the adequacy of psychiatric aftercare services. The authors report on a comprehensive study of psychiatric aftercare in a large metropolitan area (population 2.5 million). The study followed prospectively a group of 747 patients, representative of a significant proportion of patients in the care system. The findings document inadequacies in hospital-based discharge planning, unbalanced use of aftercare services and poor patient outcomes six months and two years post-discharge. The study found heavy reliance on medical/therapeutic aftercare services with a relative neglect of housing, vocational/educational, financial and social/recreational services. Despite the large volume of medical/therapeutic service use, the patient group had a high readmission rate, high levels of symptomatology and poor social adjustment on follow-up. The authors suggest that community-based practitioners with specialized training in psychiatric rehabilitation would improve the system of aftercare.
Tardive Dyskinesia: Developmental Factors
Authors: Yassa R. , Ghadirian A.M. , Schwartz G.
Published: April 2017

Tardive dyskinesia (TD) is an involuntary movement disorder predominantly the result of long-term neuroleptic administration. Several factors have been studied with conflicting results. In this paper, the authors compare a group of 17 TD patients with 17 non-TD controls to delineate possible etiological factors in the development of this syndrome. Factors like total neuroleptic and anti-parkinsonian medication intake and organicity were not different in the groups. Only drug-free periods in the past history of TD patients were found to be statistically more significant (P < 0.025) in these patients than in non-TD controls.
ECT in an Acutely Psychotic Pregnant Woman with Actively Aggressive (Homicidal) Impulses
Authors: Varan Lily R. , Gillieson Martin S. , Skene D.S. , Sarwer-Foner Gerald J.
Published: April 2017

The specific use of ECT to control homicidal impulses in a pregnant, acutely psychotic schizophrenic patient is described, with no adverse effects to the mother or the baby. Besides the relative safety of the procedure during pregnancy, the need for monitoring foetal effects is stressed.

Although literature is abundant on various aspects of ECT (1–3) there has been little written on its use in pregnancy (4–6) for its value in treating severe depressive illness or certain types of schizophrenia; without adverse effect to the mother and the baby, and where there is a risk-benefit advantage to its use.

Nineteen hundred and eighty-four marked 50 years in the history of the use of convulsive therapy (Metrazol) since its introduction into the realm of psychiatry by the Hungarian psychiatrist, Ladislas Meduna. Electro-convulsive therapy (ECT) has been the subject of much controversy among the lay public and some professionals alike in recent years, even though it is generally considered to be one of the most effective treatments available in psychiatry. The Canadian Psychiatric Association (7), the American Psychiatric Association (8), and the Royal College of Psychiatrists (U.K.) (9) have made their position clear on the issue. In a recent Canadian survey of the use of ECT, Smith concluded, “Some of the reported rates are below the predicted minimum levels” indicating that “certain patients have been deprived of the most effective treatment available” (10).
In Defence of Sigmund Freud against Masson's Charge of Cowardice
Authors: Morrant J.C.A.
Published: April 2017

In his early paper, “The etiology of hysteria,” Sigmund Freud maintained that patients with hysteria had been sexually abused as young children. He soon ruefully discarded this theory but publicly repudiated it nine years later. In a recent book Jeffrey Masson claims Freud suppressed his seduction theory to prevent professional isolation. I defend Freud's honesty by recalling his unyielding courage when his later theories brought him obloquy and, secondly, by criticizing his early paper. It was written with little psychiatric experience and in it Freud neither defined hysteria nor gave any detailed case histories. He actually claimed that sexual seduction in childhood “caused” not only hysteria but “neurosis of obsessions”, “chronic paranoia” and “other functional psychoses” as welt; this seems excessive. His primitive method of psychoanalysis doubtless suggested to his patients the very “scenes” that shocked him.
Efficacité et cinétique du clorazepate administré en une dose unique quotidienne chez des anxieux
Authors: Duguay Robert , Le Lorier Jacques , Rochefort Jean-Guy , Messier Réjean , Viguié Francis , Adamkiewicz Et Lydia
Published: April 2017

Twelve patients of both sexes (5 women, 7 men; mean age = 39,9) suffering from marked anxiety as defined by DSM III for generalised anxiety (score > 20 on the Hamilton-A scale) but in good physical health, were given 15 mg of clorazepate daily at 8 p.m. for a period of 28 days. Desmethyldiazepam, the active metabolite of clorazepate was measured in blood samples on day 1, 14 and 28 of the experiment as well as the level of anxiety on the Hamilton scale.

Anxiety decreased significantly between day 1 and day 14 (mean score declining from 33,9 to 18,4) and from day 14 to day 28 (mean score 18,4 to 14,7).

Desmethyldiazepam reached its maximum blood concentration 2 hours after the first intake of clorazepate. A plateau had been reached at day 14 and remained stable up until day 28, indicating the absence of cumulating effects. The dosage remained the same for all patients during the 28 days of the experiment. There were no drop outs and no undesirable effects.
Personality Diagnosis and Illness Diagnosis
Authors: Brown James H. , Berkal Allen , Barakat Samia , Mcilwraith Robert
Published: April 2017

This case presented with features of affective disorder with psychosis and also of borderline, avoidant and schizotypal personality disorders. During the course of subsequent treatment there was a marked reduction not only in psychotic and depressive features, but also in criteria for personality disorder, especially borderline. Relevant literature is reviewed and the importance of treatable illness as a possible cause of apparent personality disorder is discussed.
Teaching Therapeutic Skills of a Psychological Nature to Future Physicians
Authors: Borgeat François , Gagnon Jacques , Hudon Marcel , Lalonde Pierre , Reid Wilfrid
Published: April 2017

The majority of patients suffering from emotional problems are treated by non psychiatric physicians. In this context, the improvement of health services to those patients requires the involvement of general practitioners trained in appropriate therapeutic skills. At the present, general practitioners often feel unprepared to treat those patients with non-pharmacologic methods and tend to overuse psychotropic medication.

The psychological therapeutic skills expected to be acquired by physicians, are often described in very general terms and remain under evaluated in medical schools. The improvement of these aspects of medical training requires them to be evaluated systematically, similar to the more traditional medical skills and biological knowledge. Such an evaluation is facilitated if the learning objectives are specified.

This paper proposes specific learning objectives describing the psychological therapeutic skills expected from medical students at the end of their studies on the one hand, and from family physicians at the end of their family medicine training on the other. The authors’ goals are to faciliate the discussion of this complex matter between the many medical (psychiatric or not) groups concerned and in this manner, to clarify this issue which is fundamental to the teaching and implementation of the biopsychosocial model in clinical practice.
Medical Treatment of Premenstrual Syndrome
Authors: Keye William R.
Published: April 2017

Treatment of Premenstrual Syndrome has been hampered by the ongoing confusion concerning the etiology of this disorder. Lack of universally accepted diagnostic criteria has been a major factor in the inconclusive and contradictory results of most studies of treatment. Medical treatments which have been used for Premenstrual Syndrome can be divided into three major groups: those that are designed to relieve specific symptoms without attempting to modify the underlying disease process; those that presumably correct what is hypothesized as being the underlying pathophysiology of the disorder; and those that alter the normal ovulatory menstrual cycle. This paper critically reviews a multitude of proposed treatments including psychoactive drugs, diet, exercise, vitamin supplements, hormones and surgery. There is no clear cut evidence of the effectiveness of any of these medical approaches. The emphasis on medical and drug therapies should not discourage physicians from evaluating the effects of psychotherapy on symptom amelioration.
Psychiatry in the Medical Curriculum
Authors: Ney Philip G. , Jones Lynda S.
Published: April 2017

When medical students of three universities, house surgeons, general practitioners, psychiatrists, and surgeons were asked in what order would they rank the importance of various subjects in the medical school education of a general practitioner, there is remarkable agreement regarding the first three. In all, 1402 respondents rank medicine, then pediatrics, then psychiatry as most important. There are differences which reflect cultural and curriculum diversity among the student groups. The majority of respondents believe psychiatry should occupy 11% or more of the curriculum.
Diagnosing Affective Disorder in Adolescents: The Use of the Schedule for Affective Disorders and Schizophrenia
Authors: Kutcher S.P. , Yanchyshyn G. , Cohen Carole
Published: April 2017

The Schedule for Affective Disorders and Schizophrenia was administered to 42 consecutively hospitalized psychiatrically disturbed adolescents. The SADS proved to be a good measure of current affective disorder and also identified a large number of adolescents with a positive past history of affective disorder. These patients had not been so identified by traditional assessment means.

The use of a semi-structured interview is to be encouraged in the assessment period of psychiatrically disturbed adolescents and in further research at attempts to define the parameters of depressive disorders occurring in adolescents.
Psychosomatic Medicine: Past and Present Part I. Historical Background
Authors: Lipowski Z.J.
Published: April 2017

Psychosomatic Medicine as an organized field of scientific inquiry and a mode of approach to patient care has existed for 50 years. It has focused on the study of the interaction of psychosocial and biological factors in health and disease. Despite its relatively recent origin, this field continues a long tradition in Western thought and medicine, one concerned with the reciprocal relationship of mind and body as two integral aspects of the human organism. That tradition goes back to ancient Greece and represents a counterpoint to the dualistic and reductionistic conceptions. Psychosomatic medicine merged as a reaction against them and as an organized attempt to subject various aspects of mind-body relationship in health and disease to scientific inquiry. Three major methodological approaches to such inquiry have been employed: the psychoanalytic, the psychophysiological, and the psychobiological. The author discusses the relative contributions of these approaches in the first phase in the development of psychosomatic medicine, i.e. between circa 1930 and 1960.
Supra-Biological Factors in the Assessment of Males Seeking Penile Prostheses
Authors: Waiters Wendell W.
Published: April 2017

The technique of installing penile prostheses for treatment of erectile dysfunction in the male is becoming increasingly popular, particularly, but by no means exclusively in the cases of impotence in which biological factors are clearly implicated. The literature to date fails to take into account suprabiological factors such as the nature of the couple's sexual relationship and more particularly the sexual myths that shape their sexual behaviour. The author evaluated eight couples in which the male was seeking a penile prostheses and in all eight couples a variety of sexual myths had contributed to major sexual problems for the couple, even before the onset of the erectile dysfunction. A plea is made for discarding the false dichotomy or “organic” versus “functional”, in favour of a list of etiological factors including the biological ones as well as suprabiological ones. Also, the installation of penile implants should only be considered after a full investigation of the couple's sexuality by a competent sex therapist and only when other forms of couple/sex therapy have failed.
Telepsychiatry: Psychiatric Consultation through two-way television. A controlled study.
Authors: Dongier M. , Tempier R. , Lalinec-Michaud M. , Meunier D.
Published: April 2017

Telepsychiatry (consultation carried out through 2-way interactive television) has been the object of a number of trials in the past twenty years, but to our knowledge there is no previous control study which compares CCTV and face-to-face interviews. Various aspects of the interviews carried out on CCTV were rated on a 5-point scale in questionnaires filled out by: (a) patients; (b) consultees and; (c) consultants. No significant difference was elicited with control interviews in respect to patients’ diagnosis, age and sex. CCTV interview ratings by consultee and consultant were rated only slightly below those of the control group. Such findings should encourage a broader application of interactive CCTV, particularly as a complement to live consultations in distant areas.
The Inpatient Psychiatric Unit as Consultation Service
Authors: Roy-Byrne Peter , Pynoos Robert S. , Glick Ira D.
Published: April 2017

In response to the changing role of the hospital in the mental health care system, the authors propose a new model for inpatient psychiatric units — that of consultants to outpatient therapists and community and mental health agencies. They discuss key aspects of an inpatient hospitalization that facilitate the tasks of expanded diagnostic evaluation and treatment assessment, and present several cases to illustrate how information and perspectives gleaned from the evaluation can be effectively conveyed to both patient and outpatient therapist, so that it optimizes care of the patient after discharge.
A Role for Catecholamines in the Pathogenesis of Neuroleptic Malignant Syndrome
Authors: Schibuk Margaret , Schachter Debbie
Published: April 2017

The authors present a case report in which an agitated response to antidepressants preceded the neuroleptic malignant syndrome (NMS). In a review of 64 cases of NMS in the literature, they found that 80% were described as agitated prior to the development of the syndrome. Polypharmacy was common. A review of the literature on theories of pathogenesis involving sympathetic amines other than dopamine is presented to explain this phenomena. It is suggested that these toxic reactions to medication can be interpreted as resulting from a relative NE/DA excess, in which antidepressants increase the numerator, while neuroleptics functionally decrease the denominator. It is recommended that where an agitated response to antidepressants is observed, neuroleptics should be used only with considerable caution.
A Preliminary Outcome Study of a Community Group Treatment Programme for Emotionally Disturbed Adolescents
Authors: Blackman Maurice , Pitcher Sherry , Rauch Francey
Published: April 2017

The treatment of adolescents with psychiatric disturbance remains a highly unsuccessful area. Empirical research is limited and treatment decisions are often based on theoretical bias rather than proven results. This study reports on the results of a multivariate analysis of pre- and post-individual and family measures on patients in a community based day and evening programme. The programme utilized a broad range of treatment modalities including group and family therapy and chemotherapy. An accredited educational programme was also provided to the patients attending the day programme.

The results of this study showed that adolescents were referred to either the day or evening programme components based on level of acting out behaviour rather than on DSM III diagnosis. Adolescents reported significant positive changes at post testing in all areas, but this improvement was not endorsed by parents. Although therapists perceived considerable improvement in their families after treatment, this improvement did not show up on the family assessment measure chosen.

The findings of the study endorse the need for further empirical research in adolescent treatment and underscores the fallacy of relying on anecdotal evidence to report treatment results. Questions are raised as to the operational usefulness of the present DSM III criteria in making treatment decisions and the validity of associating individual dysfunction with family dysfunction. Some question as to the sensitivity of the family measure used was also raised.

The study outlined strengths and weaknesses in the present treatment programme and underscored the importance of further evaluative research, if the treatment of adolescents with psychiatric disturbance is to become successful.
Clients’ Satisfaction Survey in a Psychiatric Inpatient Population Attached to a General Hospital
Authors: Sishta S.K. , Rinco S. , Sullivan J.C.F.
Published: April 2017

A clients’ satisfaction survey was undertaken on the population of a psychiatric inpatient facility in a general hospital setting. The responses were analysed statistically and the results showed that the patients were highly satisfied with the services provided. The results are reviewed within the context of the literature available, and the methodological issues involved are discussed. It is felt that existing questionnaires need to be further refined to make them more sensitive to dissatisfaction felt by patients.
The Rational Use of Psychotropic Drugs in Pregnancy and Postpartum
Authors: Robinson Gail Erlick , Stewart Donna E. , Flak Edred
Published: April 2017

When a pregnant woman or nursing mother requires psychotropic medication, one must consider the effect of such medications on the fetus or baby. The authors review the evidence for teratogenic effects of such drugs given during pregnancy, toxic or withdrawal effects in the newborn and dangers to the breast-fed baby. Suggestions are made for judicious use of psychotropic drugs in pregnant or nursing women.
The Use of Surveys as a Critical Tool in Consultation: The Coronary Primary Prevention Trial
Authors: Rogers J. , Cochrane J. , Barwick C.
Published: April 2017

Selected findings from each of three surveys administered to the staff of the Canadian site of the Coronary Primary Prevention Trial during a consulting assignment are provided to illustrate the benefits of using surveys in Mental Health consultation. As demonstrated, survey results can assist the consultant to identify and prioritize staff concerns, convince management of the need for action and direct and monitor consulting activities over time.
A Cohort through the Revolving Door
Authors: Woogh Carolyn M.
Published: April 2017

In this study a cohort of 1722 patients first admitted to all three psychiatric facilities in a small urban area were followed for up to seven years. Seventy-nine percent had non-psychotic diagnoses. Of the total cohort, 7%(n=120) were readmitted more than three times — these patients were more likely to be male, young and unemployed, but of similar education level to age-sex matched single admission controls. Fifty three per cent (n=49) of this group were not psychotic (most were alcholics or personality disorders) and again were more likely to be males, young and unemployed than age-sex matched non-psychotic single admission controls.

Efforts to further evaluate the characteristics of the multiplyreadmitted cohort were thwarted for a number of reasons. Information about individuals within a system are essential for further epidemiological study but require a better data base and prospective monitoring of patient careers.
On the Differences in the Historical Development of Psychoanalysis in the United States and Canada
Authors: Sarwer-Foner Gerald J.
Published: April 2017

Psychoanalysis developed differentially in Canada and the United States. In the United States it was geared to the model of having only physicians train in psychoanalysis, which was followed from the very beginning but in Canada the standard of the international Psycho-Analytic Association was used allowing the training of some lay analysts as well as physicians. In Canada; though very Freudian, a more integrated view of many different schools of psychoanalysis was taught as adjuncts to the Freudian view, this being based to a large degree on the British psychoanalytic model.

The American Psychoanalytic suffered many splits on the issues on social factors and to some degree on political issues in the twenties and the thirties. This was avoided by the Canadian societies and institutes. The main similarities and differences in historical development are outlined and discussed.
Imipramine-Flupenthixol Decanoate Interaction
Authors: Cook Peter E. , Dermer Stanley W. , Cardamone Joey
Published: April 2017

The authors describe a case in which flupenthixol decanoate and imipramine were co-administered to a patient with schizophrenia, resulting in extremely high levels of imipramine and its metabolite, desipramine. The literature on the co-administration of neuroleptics and antidepressants is reviewed and guidelines for limiting possible iatrogenic effects of the combination are suggested.
The Dilemma of Howard Hughes: Paradoxical Behavior in Compulsive Disorders
Authors: Brownstein M. , Solyom L.
Published: April 2017

The history of Howard Hughes illustrates an unusual variant or end state of obsessive-compulsive neurosis in which a germ phobia coincides with the deliberate avoidance of cleaning and neglect of personal hygiene. We have reported on three patients who share similar symptomatology. In these cases, the coincidence of personal filthiness and a germ phobia appear paradoxical.
Catatonic Schizophrenia: An International Comparative Study
Authors: Chandrasena Ranjith
Published: April 2017

Thirty-five hospitalized catatonic schizophrenic patients from Sri Lanka were compared with 22 patients in the U. K. and 13 in Canada. The phenomenology was established using the Present State Examination. Results suggest that ethnicity, chronicity of illness and reception of neuroleptic treatment may influence the lower prevalence of catatonic symptoms among the U.K. and Canadian schizophrenics. Onset of illness appears to be among young adults and mutism, stupor, mannerisms, stereotypes and negativism were the common catatonic symptoms observed.
The Sleep of Remitted Bipolar Depressives: Comparison with Sex and Age-Matched Controls
Authors: Knowles J.B. , Cairns J. , Maclean A.W. , Delva N. , Prowse A. , Waldron J. , Letemendia F.J.
Published: April 2017

The sleep of 10 bipolar patients was recorded for five consecutive nights following their recovery from a depressive episode. In all respects except the number of arousals, their sleep did not differ reliably from that of 10 sex and age-matched control subjects. We conclude that sleep measures are unlikely to be useful as trait markers of a depressive diathesis in bipolar disorder.
Personal Therapy and the Student Therapist
Authors: Glass Judy
Published: April 2017

The effect of a therapist's personal psychotherapy on patient therapy outcome appears to be mixed. Some studies have shown that experienced, analysed therapists obtain better clinical results, but experience seems to be the important factor. Others have found no difference regardless of the therapist's personal therapy.

Considerations favoring personal therapy include: awareness of the unconscious and of countertransference, increased empathy, minimizing blind spots, validating theory and method by first hand experience, and understanding how one's own defenses interfere with the therapeutic process.

Those against personal therapy affirm there is no direct effect on competence, and there may even be detrimental effects (during residency); for example, inexperienced therapists in personal therapy appear to be less available to their patients because of their own preoccupations. Students’ tendencies to identify with their analysts and pressure to conform in an analytic milieu might tend to decrease the number of therapists with varied orientations.

The boundary between supervision and personal therapy is often unclear. In both, similar techniques may be used, but the goal of supervision should be to help the student to understand emotional problems and resistances which might interfere with the therapeutic process. Supervisors should make a compromise between purely didactic and therapeutic approaches.

Despite the lack of conclusive evidence, supervisors should be encouraged to be less neutral and give advice and information to trainees who are in need of or who ask about personal therapy.

“Physician, heal thyself”

Book of Luke, 4:23
Psychosis Resulting in Suicide in a Patient with Primary Hyperparathyroidism
Authors: Öztunç Sueda , Guscott Richard G. , Soni Jorge , Steiner Meir
Published: April 2017

A case is reported of a patient presenting to the psychiatric unit of our hospital with symptoms of depression and found to have an organic psychosis.

On routine SMA-12 investigation (12 channel auto analyzer), elevated serum calcium was detected on admission leading to the diagnosis of primary hyperparathyroidism (PHPT). The surgical removal of a parathyroid adenoma was followed by a rapid return of biochemical abnormalities to normal ranges. In spite of appropriate psychiatric management and fluctuations in the patient's clinical condition, the organic psychosis was unaltered and culminated in suicide 4 months after admission.
Electroconvulsive Therapy and Brain Damage: The Ontario Supreme Court Hearing of the Evidence
Authors: Martin B.A. , Jacobsen P.M.
Published: April 2017

The issue of whether electroconvulsive therapy (ECT) causes brain damage was examined by the Supreme Court of Ontario when an involuntarily hospitalized patient attempted to overturn a treatment order for ECT made by a review board. The Ontario Mental Health Act (MHA) specifically prohibits the authorization of psychosurgery by a review board. In this case, the patient argued that the board had exceeded its jurisdiction in authorizing ECT because ECT fell within the definition of psychosurgery in the Ontario MHA. This paper reviews the legal issues involved and summarizes the most substantive evidence presented for and against any causal association between ECT and demonstrable brain damage. The judicial decision upholding the treatment order is discussed.
Mental Illness and the Media: Part II. Content Analysis of Press Coverage of Mental Health Topics
Authors: Matas M. , El-Guebaly N. , Harper D. , Green M. , Peterkin A.
Published: April 2017

The public image of psychiatry has been tarnished in recent years. In order to determine the extent to which press coverage has contributed to negative attitudes towards psychiatry, we conducted a content analysis of a random selection of newspaper articles which appeared over a twenty-year period in two different newspapers. We found that although there had been some minor, cosmetic changes over the years, such as more appropriate headlines and more direct quotes from psychiatric experts, on the whole, content and attitudes had changed very little. An accuracy check of media reporting of forensic cases over a 20-year period revealed that when reporters have access to written material, the accuracy levels are greatly improved.
Depression in Dialysis Patients: A Review of Psychological Factors
Authors: Israel Mimi
Published: April 2017

A review of the literature reveals that the incidence and prevalence of depression among dialysis patients is unknown but that estimates may vary from 20 to 50 percent. Diagnostic and methodological problems related to the population are examined and the notion that depression in this population may represent a qualitatively different entity, is evaluated. Finally, several theoretical models of depression are described and their particular relevance to depression among dialysis patients is discussed.
Personality Functioning and Clinical Presentation in Early Adolescence. II
Authors: Stein B.A. , Golombek H. , Marton P. , Korenblum M.
Published: April 2017

This study describes the presentation of early adolescents on clinical examination and its relation to personality function competence. As part of a longitudinal study 63 non-clinical subjects at age 13 underwent a semi-structured psychiatric interview. On the basis of their responses their phenomenology, attitudes, defence mechanisms and degree of relatedness to significant others were assessed independently and blindly by two psychiatrists. Our findings show that a significant minority of early adolescents have a definite personality function disturbance and that these adolescents differ from their more competent peers on a number of characteristics identifiable in a clinical interview. Such a relationship was observed in boys as well as girls, with girls presenting no greater amount of turmoil than boys. These results indicate that adolescents cannot be adequately described as a homogeneous group. Differences in individual personality functioning result in differences in the presentation and internal experience of the early adolescent.
Considerations in Community Mental Health Programming for Youth
Authors: Macleod R.J. , Parker Z.
Published: April 2017

The particular challenges of providing mental health programs which engage youth and offer effective and acceptable services are discussed. The paper identifies and discusses the guiding principles for development of a comprehensive and integrated multiservice centre for the varied needs of youth. The program focuses on problems occurring as part of the normal developmental process as well as on the needs of emotionally disturbed or mentally ill youth. The place of such a program within the context of the community is identified with the responsibility for indirect consultation and effective community liaison being stressed. An established program based on this model is described.
Prevalence of Psychoactive Medication in Children and Adolescents
Authors: Quinn Declan M.P.
Published: April 2017

Prevalence studies in Psychopharmacology are few and have many methodological flaws. This study examines the prevalence of psychoactive drugs in children and adolescents. Contrary to other studies, central nervous system stimulants are not the most widely prescribed psychoactive drugs in childhood and adolescence, but rather, minor tranquilizers, sedatives and hypnotics are the most widely prescribed psychoactive drugs. While this study overcomes some of the flaws of previous studies further studies regarding the prevalence of use of psychoactive drugs in childhood and adolescence are recommended.
Emotional and Physical Health Problems of Battered Women
Authors: Jaffe Peter , Wolfe David A. , Wilson Susan , Zak Lydia
Published: April 2017

The present study focused on the emotional and physical health problems of battered women by comparing a sample of residents in shelters with a group of women in the community matched for family income, length of marriage, and number of children on the General Health Questionnaire. The results indicated that battered women report a significantly higher level of somatic complaints, anxiety, and depression. These effects tended to be associated with other life stressors and children with serious behavior problems. The implications of the study are discussed in terms of assessing the needs of battered women and their children as well as being vigilant for family violence as an etiological factor for other presenting problems.
Psychiatric Training and the Trainee: Is there a Fit?
Authors: Persad E. , Cameron P.
Published: April 2017

This data would suggest that psychiatric training programs may not be organized according to the interest or needs of many trainees.

The emphasis on fulltime research in neurobiological psychiatry is centre stage in most programs, and yet according to our survey, few residents view this as a desirable career path.

Our data from 8 years of trainees at the University of Toronto indicates that a new model of training streams would best suit the needs of the trainee, the profession and the community.

This report is a continuation of a study into the recruitment process. An earlier report was published in the Canadian Journal of Psychiatry Vol. 29, December 1984. Our present data is on two groups of trainees as well as from faculty.
The Clinical Oral Examination in Psychiatry: Association between Subscoring and Global Marks
Authors: Leichner Pierre , Sisler George C. , Harper Dan
Published: April 2017

Fifteen academic psychiatrists rated a videotaped clinical oral examination done in the Royal College format. In addition to assigning an overall mark, the raters completed a detailed scoring form. The ratings of the case presentation and discussion accounted for most of the variance in the overall mark. The rating of the interview difficulty and establishment of rapport were weaker predictors. Implication of these findings for the trainees and the examiners are discussed.
Portrayal of Mental Illness in Canadian Newspapers
Authors: Day David M. , Page Stewart
Published: April 2017

The present article reports results from a content analysis of 103 newspaper reports taken from eight major Canadian newspapers, and selected at random from the Canadian Newspaper Index. The portrayal of mental illness and mentally ill persons in these reports was compared with that in samples of articles taken from two comparison mental health publications not receiving popular circulation. As compared with these latter publications, the content analysis indicated that the newspapers portrayed mental illness and the mentally ill in a manner which could be described as essentially pejorative, thus seeming to support frequent observations and complaints from the mental health establishment about inadequate or unfair coverage of mental illness in the popular print media. At the same time, the newspaper medium appeared to present more favourable images of nontraditional (example: community-based) mental health practices, than of traditional (example: hospital-based) practices. Implications of such results for the attitudes and beliefs of the general public vis-À-vis mental illness are offered, with special reference to the influence of the print media.
Psychological Patterns in Donor Insemination Couples
Authors: Berger David M. , Eisen Abraham , Shuber Jack , Doody Kenneth F.
Published: April 2017

One hundred and twenty couples applying for DI or involved in the procedure were seen in consultation or therapy at various stages. The clinical findings provide evidence that both partners experience conflict in two areas. The discovery of infertility generates transient impotence, loss of self-esteem and withdrawal in husbands, and anger, guilt and a wish to make reparations in wives. The DI procedure itself evokes oedipal conflicts. Clinical vignettes have been presented to illustrate these patterns and to provide evidence for the view that couples should recognize, discuss and come to terms with the conflicts generated by the discovery of infertility before tackling DI and the conflicts this procedure evokes.

Although secrecy is advocated by most DI couples and physicians, a questionnaire study of 76 couples in our unit disclosed that many individuals consider it psychologically useful to discuss their infertility problems with others. Although secrecy may be useful, it may also, through the indirect sanction of denial and negation, interfere with the couple's acknowledging and discussing their problems. One useful purpose of a psychiatric assessment is that it can promote such acknowledgement and discussion. Conflict needs to be distinguished from psychopathology which may be the outcome of unresolved conflict.
Clinical Guidelines for Management of Patients under Lieutenant Governor's Warrants
Authors: Akhtar Syed Naveed
Published: April 2017

This paper examines three categories of mentally abnormal offenders who are held under Lieutenant Governor's Warrants. It explores the psychiatric-legal issues in cases of pre-trial (not fit to stand trial) and post-trial (not guilty by reason of insanity) L. G. W.'s. An attempt is made to provide a structure for such psychiatric-legal evaluations. Clinical guidelines are offered about the objectives, the assumptions and the criteria which form the basis of such evaluations. Suggestions are made for collection of relevant data which should inform psychiatric and legal judgement-making in this area. The role of the psychotropic medication in N.G.I. cases is discussed. It is recommended that whenever medically feasible, a controlled drug-free trial should be carried out in N. G.I. cases prior to their final release, in order to unambiguously establish their need for medication.
Chemical Restraint
Authors: Rapp M.S.
Published: April 2017

There are clinical and medico-legal implications to the forced administration of neuroleptic medication to actively resisting, aggressive psychiatric patients. However, there is little information on how frequently this occurs. This survey of its incidence on an acute admission ward demonstrates that “chemical restraint” as defined, is uncommon, considering the characteristics of this patient population. It is nearly always a response to threatened or actual violence towards others. The survey discovered, unexpectedly, that there were considerable differences in the actual measures used and in drug doses used during the event, between two wards of the same treatment unit. A prospective study might correlate the different patterns with degree of success, as well as address other questions, the resolution of which would lead to better quality of care.
Article
Authors: Wolf Marc Alain
Published: April 2017

This article aims to clarify and organize the recent advances in research on the central action mechanism of lithium. It begins by tackling the process of cellular transport of the cation, then it moves on to describe the effects of lithium on ionic distribution and on membranous functioning in general. Neurotransmission in this article is the object of a more detailed study. The metabolism of neurotransmitters (and their disturbances) is first discussed. The emphasis is placed on certain current domains, the gabaergic system in particular. Neurotransmitters, by themselves, do not satisfy any longer the curiosity of biologists. Technological progress has given these scientists access to the intimate functioning of receptors and to their natural support system, the membrane. The stabilizing effect of lithium is mentioned often. Initially seen at a superficial level, it leads to a study of the mechanisms of the transference of information from the receptor to the cell. The membranous phospholipids and the enzymatic systems controlling the metabolism of the second messengers (cyclic nucleotides but also calcium) will provide as many potential targets to the action of lithium.
Some Psychodynamics of Non-Compliance
Authors: Book Howard E.
Published: April 2017

With up to 50% of psychiatric patients refusing medication at some time during therapy, non-compliance can become a major treatment difficulty. This problem is compounded by the countertransference responses evoked within the therapists, and their tendency to react solely with information and exhortation rather than attempting to view non-compliance psychodynamically.

When exploring with empathic concern, a number of common dynamic issues can be seen as playing a major role in drug refusal. Commonly at work are issues relating to projection, denial, identification, and transference difficulties that emerge in a relationship where a therapist offers a patient a pill.
Risk versus Motivation: The Emergency Room Treatment of Attempted Suicide
Authors: Robertson Brian M. , Campbell Wayne , Elva Crawford N.
Published: April 2017

This paper deals with patients who attempt suicide, focusing on their evaluation in the emergency room. It is suggested that as the actual risk of completed suicide in suicide attempters is low, the evaluating psychiatrist might preferentially focus on assessing the patient's motivation for self-destructive behaviour. Recent studies are reviewed which demonstrate a linkage between self-destructive acts and the status of relationships with significant others. An illustrative case history is presented.
Psychiatry and Family Medicine: The McMaster Approach
Authors: Kates Nick , Lesser Art , Dawson Dave , Devine John , Wakefield Jackie
Published: April 2017

Family physicians may spend up to 50% of their time dealing with emotional problems but will refer less than 10% of these cases for psychiatric treatment. This paper describes an approach developed at McMaster University which emphasizes the importance of understanding the needs of family physicians and helping them make optimum use of available psychiatric services. Such an approach aims at increasing the comfort and expertise of family physicians in handling the problems they see on a regular basis, involving them actively in their patient's care after a referral, and offering relevant services that supplement those of the family physician, while monitoring and correcting problems that can arise when the two specialities work together. The implications that this has on the training of family medicine and psychiatry residents are discussed as well as ways in which continuing education can be provided for family physicians in community practice.