bluuebunny/crossref_metadata_2025 huggingface dataset:
Results of the First Canadian Psychiatric Knowledge Self-Assessment for Residents
Authors: Leichner Pierre , Kalin Rudolf
Published: April 2017

Two 150 multiple choice question examinations in Psychiatry were taken on a voluntary basis by 150 Canadian residents. The goals of these examinations were to promote skills and interest in self-education, provide detailed feedback to the participants, and to study various parameters which might be related to performance.

The residents’ self-assessments prior to the examinations, their year of residency training and age were significant predictors of performance. Being male and having enough time to study were also related to high scores. The methods of instruction as well as the studying variables were not related significantly to performance.

These findings highlight the importance of self-assessments in the process of evaluation and of listening to residents’ self-evaluations and requests for time to study. Increasing the number of self-assessment exercises and clarifying the knowledge requirements for the certification examination are recommended.
Psychiatric Manifestations of Sarcoidosis
Authors: Gilmore Karen , Rudden Marie , Kalman Thomas P.
Published: April 2017

The case of an acutely depressed 34 year old man with a history of systemic sarcoidosis is presented with the question of the psychiatric manifestations of sarcoidosis in mind. The literature on Central Nervous System Sarcoidosis is reviewed and the possibility that this condition may present with psychiatric symptomatology is raised. An emphasis is placed on maintaining a high index of suspicion regarding organic factors in cases such as this, particularly in the setting of a complex, multi-system disease such as sarcoidosis.
Toward Integrating Psyche and Soma: Psychoanalysis and Neurobiology
Authors: Flannery John , Taylor Graeme
Published: April 2017

The brain is the “key organ” for understanding mind/body/illness relationships. During the past two decades neurobiological research has generated a plethora of new data and concepts which have increased tremendously our knowledge of the functioning brain. As a result the psychoanalytic view of the relationship between mind and brain may seem at risk of becoming outmoded. Yet while psychoanalytic theory may no longer be wholly tenable, psychoanalysis continues to offer interesting and heuristically valuable isomorphic models of cortical function. On the other hand neurobiology provides a corrective influence on psychoanalytic concept-building, causing theory to be refined as it is tested against the results of research. One possible result of interdisciplinary cross-fertilization is that a revised theory of the function of dreams and fantasy may throw light on the vicissitudes of somatic experience, and the pathogenesis of psychophysiological disorder.
Women and Depression
Authors: Penfold P. Susan
Published: April 2017

For every male diagnosed as suffering from depression there are two to six females. The reasons for this incidence are examined by looking at diagnostic practices, theories of depression, their validity and applicability to women, and new work which both confirms the high incidence of depression and points to new understanding.

Systems of classification show a striking lack of conceptual clarity. Types of depression are distinguished on the basis of such variables as mood, activity level, severity, presumed genetic or non-genetic origin, and contact with reality. Although ill-defined and misunderstood, nevertheless depression is no myth. Genetic, endocrine, psychodynamic, cognitive, behavioural and social theories of depression all seek to explain the behaviour of the depressed person.

Notwithstanding the relevance, or partial relevance, of some of these theories, there is a major pitfall. The difficulty is typically formulated as a dysfunction of the individual woman, and it is envisaged that treatment should effect some change on her part. The need to change her environment is rarely addressed, her husband seldom included except as a help and support to her, and she is almost never apprised of the role of social structures and her own socialization in creating and perpetuating her distress. New work underscores the difficulties of women's daily experience and its connection to depression. Non-psychiatric women writers, addressing a general audience, have given the best description of women's daily lives and the paths to resentment, misery, frustration, boredom, and fatigue.
LSD and Onset of Schizophrenia
Authors: Roy Alec
Published: April 2017

In a matched controlled study 37 chronic schizophrenics who had taken LSD preceding the onset of their illness were compared with schizophrenics who had not. There were no significant differences between the groups either on age at onset of symptoms or for age at first admission.
Physical Disorders among Emergency Psychiatric Patients
Authors: Carlson Richard J. , Nayar Nath , Suh Matthew
Published: April 2017

An examination of patients with physical disorders requiring immediate treatment or investigation was undertaken in the Psychiatric Emergency Service of the Royal Ottawa Hospital and found to comprise 7% of the patient population, or one visit per day. Those with physical problems differed from the rest of the emergency patients in that a greater number were over age 60 and were diagnosed as alcoholic or chronic organic brain syndrome. Socio-demographic characteristics were examined as well. The presenting problem was accurate regarding a physical basis in only two-thirds and the disorder could, in some way, be related to a psychiatric-diagnosis in 75% of the patients. Emphasis is placed on the fairly high frequency of immediate physical attention required by these patients who come to the psychiatrist.

Consequently, psychiatric assessment and management is not the priority for this group and other skills of the psychiatrist are necessary in treating the patient.
Alcoholism and the Forensic-Psychiatric Patient: A Comparative Study
Authors: Elliott-Harper C.A. , Harper D.W.
Published: April 2017

A group of male forensic psychiatric patients was compared to groups of non-forensic psychiatric patients, hospitalized alcoholics and general hospital admissions on a modified version of the self-administered Michigan Alcoholism Screening Test. Results indicated more alcoholic related problems in both psychiatric groups than the general hospital group, but less than for the hospitalized alcoholics. The scores of the two psychiatric groups, however, did not differ significantly. It was concluded that alcoholism was non-additively associated with both criminality and psychiatric disturbance. It was suggested that the degree of alcohol related problems in psychiatric populations warrants careful screening and treatment even when alcoholism is not reflected in the psychiatric diagnosis.
Psychiatric Clerkship: A Review of the Concept
Authors: Links Paul S.
Published: April 2017

The concept of psychiatric clerkships as part of undergraduate medical education was examined. All relevant English literature from the last eight years was surveyed and discussed in four parts: 1) The goals and objectives of psychiatric clerkships were examined. The author concluded that there is a need to further differentiate educational goals of the clinical years from the pre-clinical years. Two major requirements for a successful clerkship were patient responsibility and adequate faculty supervision. 2) The significance of the clerkship setting was evident from the survey as settings were found to influence the students’ attitudinal development and also the development of clinical judgement. 3) The effects of psychiatric clerkships on the students, patients, and faculty were discussed and felt to be an area requiring further exploration. 4) The problems of evaluation were addressed. From the survey, it appeared that the clerkship experience was of particular value in modifying student attitudes to mental illness. Attempts to evaluate the acquisition of clinical skills and judgement were reviewed. The paper concluded by outlining areas requiring further exploration and research so that the concept of psychiatric clerkships can be further developed.
Nosology and Statistical Classification
Authors: Hoenig J.
Published: April 2017

There is a fundamental difference between nosology and a statistical classification, and the two should not be confused. The discipline of nosology uses scientific methods to arrive at a classification of psychiatric disorders and is concerned with the validity of its entities. A statistical classification aims to attain the widest compliance in spite of differences in the theoretical orientation of its users. It must therefore be atheoretical, and must represent a widely negotiated agreement between its future users.

The most important statistical classification is the “International Classification of Diseases, Injuries and Causes of Death” (ICD-9) endorsed by the member states of the World Health Organization. The DSM III (Diagnostic and Statistical Manual), a newly accepted classification of the American Psychiatric Association, departs in many ways from the ICD-9, and Canada will have to decide whether adherence to ICD-9 should continue, or be replaced by the adoption of DSM III. Advantages and disadvantages of the DSM III are briefly discussed.
Perception subliminale et niveaux d'activation
Authors: Borgeat François , Chabot Rénald , Et Louis Chaloult
Published: April 2017

L'effet de messages subliminaux auditifs sur le niveau d'activation a été évalué par une étude à double-insu, Vingt sujets volontaires ont été alternativement soumis à des messages subliminaux activateurs et à des messages subliminaux désactivateurs. Les variations du niveau d'activation ont été mesurées par les changements au Mood Adjective Check List. Cinq des six facteurs de ce test visés par le contenu des messages subliminaux ont varié différemment selon la nature de ces messages, et quatre ont répondu d'une façon statistiquement significative. Ces résultats semblent indiquer que des perceptions subliminales auditives peuvent influencer le niveau d'activation. Les auteurs soulèvent plusieurs interrogations, soulignant que les paramètres contrôlant la réponse et la susceptibilité subliminales demeurent largement inconnus et requièrent une investigation systématique.

The influence of the auditory subliminal messages on the level of activation has been evaluated through a double-blind study. Twenty consenting subjects were alternately submitted to activating and deactivating subliminal messages. Activation changes were estimated through the variations in the scores at the Mood Adjective Check List. Five out of this test's six factors concerned by the content of the subliminal messages responded differently according to the nature of these messages; four factors did so to a statistically significant degree. These results tend to indicate that auditory subliminal perceptions can influence the level of activation. The authors raise several questions, especially stressing that the parameters regulating subliminal response and susceptibility remain largely undefined and in need of systematic investigation.
Responses to Methylphenidate and Varied Doses of Caffeine in Children with Attention Deficit Disorder
Authors: Barry D. Garfinkel , Christopher D. Webster , Sloman Leon
Published: April 2017

Six children with the diagnosis of Attention Deficit Disorder were treated as day hospital patients, using different stimulant medication. They were studied in a double-blind crossover experiment in which they received caffeine in low dose or in a high dose. Methylphenidate was added to both dosages, as well as administered alone. Results indicated that caffeine in low dosage when added to methylphenidate was superior to all other treatment conditions. Caffeine in low dosage could not be differentiated from 10 mg of methylphenidate. High dosage caffeine was not different from placebo or no-drug conditions. This study offers evidence to support a curvilinear pattern of dose-response for caffeine, in attenuating the behavioural manifestations of this syndrome.
The Management of Idiopathic Chronic Pain: A Holistic Approach
Authors: Richard H. Brent , Flamm Gerald H.
Published: April 2017

The evaluation and treatment of the patient with idiopathic chronic pain traditionally has involved a sequence of studies first by the internist, then the neurologist, and finally the psychiatrist. This has resulted in an overutilization of costly health care services and may paradoxically have helped to promote symptom chronicity. In keeping with recent developments in the field of psychosomatic medicine, a coordinated biopsychosocial approach is advocated with the identification and amelioration of the multiple determinants of symptom formation in each of these interrelated sub-systems. A case is presented in which the application of this holistic approach appeared to help curtail the overuse of health care services and at the same time helped to diminish psychosocial reinforcers in the form of secondary gain.
Psychotherapy with Native Adolescents
Authors: Katz Philip
Published: April 2017

Psychotherapy with native adolescents requires that the therapist learn about a different set of values, develop new communication skills, and re-examine many of his practices. Varying with the individual tribe, the attitudes to time, property and anger may be significantly different from the values of the white culture. Many of the Indian adolescents rely heavily on non-verbal communication, requiring an increased sensitivity by the therapist to this form of communication. The therapist may need to review his office setting, with an eye to making it less alien, and because of the different attitude to time, he may have to adjust the time structure of his practice, often using more than the fifty-minute hour.

Treatment begins with an exploration of Indian- White difficulties, especially the stereotyping of all whites. It then focuses on helping the adolescents to establish their own individual identity, bucking the stereotypes that are projected on them.

Examples are given from the author's own practice with Cree and Saulteaux-Ojibway adolescents.
King Saul: Persecutor or Persecuted?
Authors: Littmann S.K.
Published: April 2017

It is argued that Saul was the victim of Samuel's (and God's) revenge and that his persecution of David had understandable survival value, for David, by having been chosen to replace Saul, was indeed an enemy, though one much invested with love. The tragedy lies in the divine intent of allowing Saul to first become a victorious King, to form very close bonds with both Samuel and David and then to deprive him of all these supports in rapid succession. Despair, paranoia and suicide appear understandable, although perhaps not acceptable.
Acute Schizo-Affective Disorder
Authors: Roy Alec
Published: April 2017

In a matched controlled study, 26 acute schizoaffective patients had significantly more parental loss before 17 years of age than 26 non-depressed schizophrenics. Schizo-affective disorder may occur in schizophrenics with risk factors for depression such as parental loss before 17 years of age.
Part-Time Residency Training
Authors: Fisman Sandra , Ginsburg Lynne
Published: April 2017

The development of part-time training in the United States and Canada is described. The flexibility required for young women physicians who attempt to combine childbearing and career development, together with the increasing number of women entering medicine, underlines the importance of part-time training schedules. A variety of flexible training options have been defined and a set of guidelines has been produced by the Canadian Royal College of Physicians and Surgeons. The experiences of part-time psychiatry residents at Queen's University, Kingston is presented. Thus far this has involved a total of six residents over a four year period, including the authors of this paper. The advantages and disadvantages, viewed from both the resident and system viewpoint, are discussed.
Homicidal Transsexuals: Three Cases
Authors: Milliken A. Donald
Published: April 2017

There are no instances reported of patients who fulfill the diagnostic criteria for transsexualism of also having either homicidal impulses or homicidal attempts. This report describes three such cases; one who murdered, one who attempted murder and has frequent impulses, and one who had impulses and carefully planned to murder, but failed to carry out the act. A relationship between transsexualism and personality disorders, criminality and acting out has been reported previously. These cases add a new facet to this complex relationship.
Psychotherapy Practice and Research: The Interface
Authors: Marziali E.
Published: April 2017

The study of the psychotherapeutic process presents special problems to clinicians and clinician investigators. In the absence of supportive, working relationships between the therapist, patient and investigator, important data about therapeutic transactions cannot be obtained. In addition, we are lacking methodologies for isolating the significant therapeutic factors which explain variations in the outcome of psychotherapy. These problems need to be jointly addressed by clinicians and investigators if we are to advance the theory and practice of psychotherapy.
The Gaslight Syndrome
Authors: Kutcher S.P.
Published: April 2017

The Gaslight Syndrome, a scenario in which one partner of a conjugal unit attempts to have the other labelled insane and institutionalized, is probably more prevalent than is commonly realized. The essential features are: the presence of a sado-masochistic marital relationship, underlying themes of sexual jealousies and the deliberate attempt by the aggressive partner to terminate the relationship by having the spouse declared mentally ill and hospitalized. Psychiatric identification of the phenomenon should allow earlier recognition of it and hopefully prevent possible infringements of a patient's rights.
Inter-Generational Transmission of Incest
Authors: Cooper Ingrid , Cormier Bruno M.
Published: April 2017

The majority of reported incest cases involve sexual relations between one generation and another, the most common being father-daughter incest. The increased availability of clinical data on incest has revealed an aspect of the problem that has received little attention in clinical literature. Incest can involve three generations in a family rather than two. It is possible for incest to be “transmitted” from one generation to the next through several patterns. In some cases, the mother in a family of father-daughter incest has herself been a victim of incest with her own father. With a history of unresolved incest with their own fathers, these women are unable to prevent an incest relationship between their husbands and daughters. Another pattern involves situations where the father in the father-daughter incest relationship has been the victim of father-son incest in his youth.

The psychodynamics of these patterns of inter-generational transmission of incest are described, with clinical examples from the authors’ work, as well as from the literature.
Brief Marital Therapy Outcome: Personality Correlates
Authors: Mendonca J.D. , Lumley P. , Hunt A.
Published: April 2017

The purpose of the study was to investigate with regression analyses the relationship between personality and background variables and outcome of brief marital therapy. Twenty personality dimensions from the Personality Research Form and data on age, education, number of previous unions, number of children and number of sessions were used as independent variables. The dependent variable was provided by ratings of overall improvement in affective communication: sexual, verbal, and social, provided by clinical records of 30 couples. The main result was that only the husband's traits were found to be important correlates of improvement in affective communication of both husbands and wives. The important traits involved husband's cognitive efficiency in the area of reflection and accurate judgement of situations, submissiveness, and sensitivity to social approval of his behaviour. The number of individual therapy sessions given to wives was also a notable predictor of improvement. Other personality and background variables were not significantly related to outcome.
Follow-Up Study of Memory Deficits after ECT
Authors: Shellenberger Wallace , Miller Marvin J. , Small Iver F. , Milstein Victor , Stout James R.
Published: April 2017

Twenty-four patients received ECT induced by either alternating sine wave or brief pulsed-square wave stimulus and were evaluated at follow-up for clinical functioning and subjective memory loss. The hypothesis of less memory loss in the group receiving a weaker stimulus (pulsed-square wave) was not supported. The two treatment groups and a group of controls showed no significant differences on the memory test. On measures of clinical functioning the sine wave group scored better on every measure than the square wave group, although not significantly better.
Undinism: The Fetishization of Urine
Authors: Denson Raymond
Published: April 2017

The origins of the term undinism are traced and a case history presented. The various forms of urolagnia are described and proposals made for precise use of existing terminology. An hypothesis to explain the prevalence of fetishism is outlined and illustrated by reference to the case history.
The Certification Examination: Opinions of Royal College Examiners
Authors: Prosen Harry , Leichner Pierre , Harper Dan
Published: April 2017

There has been increasing concern among candidates and psychiatrists regarding the Canadian written and oral certification examinations. Views of candidates and psychiatrists have been obtained. The results presented in this survey were obtained through a questionnaire that was completed by 64 past and present Royal College examiners. General support for the establishment of guidelines for the selection of examiners, for increased emphasis on the use of in-training evaluations and for the need of clear operational criteria for examiners and candidates was voiced. Finally, the evaluation model that most responding examiners favoured included re-introducing one part essay into the written examination. Overall, although finding it exhausting, most examiners enjoy examining and are satisfied with the present system. Recommendations concerning improvements to the present system are presented.
Acute Paranoid Reaction (Bouffée Délirante) in Canada
Authors: Allodi F.
Published: April 2017

The syndrome of acute paranoid reaction is studied within the Canadian context. The main purpose of the study is to clarify its nosology and diagnostic criteria so that its diagnosis becomes more reliable and true epidemiological rates may be established.

The historical development of the concept is briefly outlined in a review of the world literature, with particular attention being paid to its defining characteristics. The differential diagnosis with schizophrenia and paranoid states is of great importance given the different prognosis and treatment. Evidence from the literature is presented to show the role of sociocultural factors in the causation and diagnosis of this syndrome.

Canadian data of first admissions to mental hospitals with diagnoses of reactive psychosis, including acute paranoid reaction type, for the years 1969–1973, in selected provinces, are presented. Rates of reactive psychoses as proportions of all admissions and all admission psychoses are compared with rates available for other European and Third World countries. Canadian national rates are lower and it is argued that the lower incidence is partly attributable to misdiagnosis which in turn is due to psychiatric training and to the neglect of the role attributed to sociocultural factors in the genesis of this condition.
Sous-groupes dans le domaine des états-limites
Authors: Stone Michael H.
Published: April 2017

The currently most popular definitions of “borderline” are those of Kernberg, Gunderson and Spitzer (now incorporated into the DSM-III). The Kernberg criteria define a level of function (between “Neurotic” and “Psychotic”); the Gunderson criteria, a more narrowly circumscribed clinical syndrome, phenomenologically distinct from schizophrenia and from the psychoneuroses. The DSM-III criteria are derived from these and other sources and define a broad domain that includes the other usages of “borderline.”

Even the narrower definitions of borderline describe a collection of conditions heterogeneous with respect to hereditary, constitutional and psychosocial factors. Genetic, biochemical and clinical research suggests the appropriateness of dividing the borderline domain into a variety of sub-types. The largest proportion of borderline cases are effective (with prominent depressive symptoms; occasionally, with cyclothymic or hypomanic symptoms). Of these, some show strong “endogenous” features, as well as family pedigrees of manic-depressive illness. This category includes many patients with anorexia nervosa or with agoraphobia. In others, the affective symptoms seem more related to severe psychosocial stresses in early life (including physical abuse, parental deprivation, or incest). Smaller proportions within the borderline domain are occupied by schizotypal cases (many with hereditary linkage to core schizophrenia), or by organic cases (including temporal lobe epilepsy, or minimal brain damage, giving rise to the “episodic dyscontrol” syndrome).

Biochemical and nerophysiological markers that may be useful in distinguishing among the borderline subtypes include measure of platelet MA O-activity, of dexamethasone suppression, of R.E.M. latency, motion-sickness susceptibility and of average evoked response to photic stimulation.

Attention to subtypes is important in considering optimal treatment for borderline patients. Not all respond to analytically-oriented psychotherapy alone. Those with severe affective symptoms often require antidepressant medication or lithium. Affectively ill borderlines usually have a better prognosis than schizotypals. In cases of episodic dyscontrol, anti-epileptic drugs may be useful.
Depression in Children and Adolescents with Malignancy*
Authors: Kashani J. , Hakami N.
Published: April 2017

This is a prospective and retrospective study of 35 children and adolescents with cancer treated at a pediatric Hematology-Oncology division. Using DSM-III diagnostic criteria for Major Depressive Episode, 17% of the sample were found to be depressed. This study also describes some of the distinguishing characteristics of adults and children with cancer. For example, of particular note in this study was the apparent nonchalance of younger children diagnosed as having cancer. The children also, however, demonstrated anger more frequently, which is not a common finding in adult patients with cancer.
Consultation Liaison Training in Canadian Psychiatric Residency Programs
Authors: Oluwafemi Agbayewa M. , Perez Edgardo
Published: April 2017

Canadian Psychiatry Residency programs were surveyed through questionnaires to determine the status of Consultation Liaison Training (CLT) for the year 1979/80.

Virtually all the programs offered CLT as lecture/seminars and clinical postings. The majority of residents who received CLT were in their first and second years, with the average trainee spending less than 6% of total clinical training time in Consultation Liaison work. About 9% of the total core teaching time was devoted to Consultation Liaison Psychiatry (CLP) and related topics.

Canadian medical students are exposed to CLP in various forms during their training. There is little interdisciplinary collaboration or post-residency fellowships in CLP at this time.

The authors suggest that CLT be offered in the last two years of training when the trainee can be an effective consultant with a consolidated identity as physician and psychiatrist. They also recommend an increase in interdepartmental collaboration and further development of post-residency fellowships in Consultation Liaison Psychiatry.
Course and Outcome in Affective Disorders
Authors: Bland Roger C. , Orn Helene
Published: April 2017

One hundred and two of 108 patients who were successive first lifetime admissions for affective disorders between 1961 and 1965, and whose charts fulfilled Feighner criteria for primary affective disorders, were followed up in 1978–1980. Such studies from the onset of illness or first admission are rare.

Seventy-five patients had depressions only, and of these 41 were non-recurrent; 27 had manic episodes, but only 9 of these had manic and depressive episodes, and 17 had unipolar mania, which in 6 was non-recurrent (one patient had a single mixed episode).

Sex ratios varied, with a large female excess in the single episode depressions, to a male excess in those with both manic and depressive episodes.

Outcome after 15 years was examined on scales for economic productivity, social adjustment and psychiatric condition; summed for a combined outcome measure. Results from a previous study of schizophrenic patients were used for comparison. Patient groups were schizophrenic, single episode depression, recurrent depression, and mania ± depression. On all measures, schizophrenic patients had the worst outcome, single episode depression the best, with the recurrent depressives and manias ± depressions in an intermediate position and differing little from each other.

Thus, in terms of the course of the illness over a period as long as 15 years, patients do not clearly fall into recurrent depressions (recurrent uhipolars) and manic depressives (bipolars), a large number being nonrecurrent depressions, which form a distinct group on the outcome measures. Although the affective disorders have a better long-term outcome than schizophrenia, they do produce definite morbidity, more so in the recurrent than non-recurrent disorders.
Admission of Whole Families
Authors: Dydyk Barbara , French Glenn , Gertsman Cynthia , Morrison Noreen
Published: April 2017

This is a program description of a short-term residential unit in which whole families are assessed and treated. This unit provides an alternative treatment format for exploring situations where removal of the child appears to be the only remaining option. It also provides an in-depth consultation for agencies who are “stuck” in their treatment of family systems and allows for the teaching of family systems intervention techniques in a non-threatening way. It also allows an opportunity for an external system to reframe, what are, to the involved clinician, impasses with clinical problems. The program, because of its structure, introduces anxiety and tension into systems with chronic mental health problems. It, therefore, serves as, not a panacea, but as an adjunct to more traditional treatment for rigid and resistant systems.
Denial of Pregnancy and Childbirth
Authors: Finnegan P. , Mckinstry E. , Robinson G. Erlick
Published: April 2017

The authors report three cases of denial of pregnancy and childbirth. Although the information available in these cases is limited an attempt is made to formulate the psychodymanics with reference being made to both the literature on the psychology of pregnancy and neonaticide.
Length of the Y Chromosome and Chromosomal Variants in Inpatient Children with Psychiatric Disorders: Two Studies
Authors: Mcconville B.J. , Soudek D. , Sroka H. , Coté J. , Boag L. , Berry J.
Published: April 2017

In a study of 41 inpatient boys with psychiatric disorders, it was found that this group had significantly increased length of the long arm of the Y chromosome (Yq+) as compared to a normal control group. The length of the Y chromosome in the inpatient group correlated with psychiatric symptom severity, hyperactivity, parental psychopathology and paternal alcoholism. A further study of minor chromosomal variants in 56 inpatient boys and girls revealed no differences in individual or pooled variants in the patient group, as compared to the control group. However, those in the patient group with one or more variants showed more severe psychiatric and other psychosocial symptoms than those in the group without variants. Those who had both longer Y chromosomes and a minor chromosomal variant had more severe psychiatric symptom severity.
On Evaluating Patient Satisfaction: Methodological Issues
Authors: El-Guebaly N. , Toews J. , Leckie A. , Harper D.
Published: April 2017

The survey of patient satisfaction with the mental health services provided is recommended but involves a methodological dilemma. Concerns include a definition problem, the delineation of a representative sample, the selection of a survey technique and the type of questions to be used. A literature review and the authors’ own experience with the process are presented.

The investigation of patient satisfaction while, as yet, limited in the critical information it can provide for the evaluation of services, will help pinpoint areas where the most patient dissatisfaction exists. The process can also be useful therapeutically, but patient satisfaction, although an important outcome measure, is not systematically related to other measures of treatment success. Methodological suggestions to improve the validity of the data gathered conclude the paper.
Limitation of Freedom of Movement in Adult Psychiatric Units
Authors: Sreenivasan Uma
Published: April 2017

This paper reviews the restrictions placed on patients’ freedom of movement in non-psychiatric as well as psychiatric health care facilities and the methods used are outlined. Concern for the health and safety of the patient has always been the justification for steps taken by physicians that may be seen as restrictive. Modern realities necessitate that each psychiatric facility should develop specific policies and guidelines in the interests of patients and staff. Recommendations and suggestions for policy statements suitable for adult psychiatric units are described.
Italian Validation of the Symptom Rating Test (SRT) and Symptom Questionnaire (SQ)*
Authors: Fava Giovanni A. , Kellner Robert , Perini Giulia I. , Fava Maurizio , Michelacci Laura , Munari Franca , Evangelisti Liliana Pasquali , Grandi Silvana , Bernardi Manuela , Mastrogiacomo Ismaele
Published: April 2017

Two self-rating scales of psychological distress, the Symptom Rating Test (SRT) and the Symptom Questionnaire (SQ), have been validated in translations in Italy. They were administered in several studies to psychiatric patients (neurotics and depressives), matched controls, and patients suffering from various organic illnesses (dermatologic disorders, hypertension, secondary amenorrhea and patients undergoing amniocentesis). The SRT and the SQ sensitively discriminated between psychiatric patients and normals, between different levels of psychological distress in several of the somatic illnesses, and detected significant changes in the psychological status of patients participating in medical procedures such as amniocentesis. The scales were found to be useful in research in psychiatry and psychosomatic medicine.

The findings suggest that the Italian translations are valid and sensitive scales of distress and can apparently be used as effectively in research as the original. They are likely to be of value in cross-cultural research in Canada. Both scales may be helpful in the psychological assessment of Italian immigrants in North America and Australia, especially in those whose English is poor.
Medical Certification of the Mentally III: A Protection for the Individual's Rights*
Authors: Milliken A. Donald
Published: April 2017

Physicians have been criticized for abusing the civil rights of the mentally ill by their methods of committal. To see if such criticism is justified in Canada, a review was conducted of all the major legal journals to identify cases in which it was alleged that physicians had wrongfully certified a patient. These cases are outlined, and, when considered along with the scientific literature, show no justification to support allegations of abuse, but rather show that physicians act with care and concern on behalf of their patients.
The DSM-III in Canada: A Survey
Authors: Junek R.W.
Published: April 2017

A survey of the membership of the Canadian Psychiatric Association (CPA) was completed for the Scientific Council to discover, first, the reaction of the members to the Diagnostic and Statistical Manual, Third Edition (DSM-III) and second, the support given to the CPA Policy of not endorsing a particular classification system. A total of 26.3% responded.

It was noted that 66.6% had studied the DSM-III in detail. Whereas the ICD-9 and DSM-II were the most used systems in the past (28.5% and 25.9% respectively), first choice systems for the future were DSM-III, 42.0% and ICD-9, 16.3%. Furthermore, the DSM-III was recommended to be used as the sole system to various associations, (Statistics Canada, Royal College, Medical Council of Canada and Postgraduate Programs) 45.9% to 51.4%, depending on which association (vs. 8.7% to 13.4% for the ICD-9). Of those responding to the question, 70.8% had a favourable impression of the DSM-III and a similar percentage wanted an ICD-10 which would incorporate features of the DSM-III. A survey of directors of postgraduate psychiatric training programs gave similar results.

A total of 54.8% of the members supported changing the CPA “non-endorsement” policy. As well, 39.7% voted to maintain the policy and 5.5% did not respond.

The survey provides information for the CPA in its consideration of policy about the use of classification systems. Should the policy be changed, and one system endorsed, the DSM-III receives the most support.
Psychiatrie Illness in African Students: “Brain Fag” Syndrome Revisited*
Authors: Jegede R. Olukayode
Published: April 2017

For 20 years, since Prince originally introduced it, the term “brain fag syndrome” has been used to describe a variety of symptoms frequently reported by students in Africa. In this paper the author questions the validity of the use of the term on the basis of clinical evidence afforded by his work and reports in the literature. It is concluded that brain fag syndrome is a misnomer and that more specific diagnostic terms such as anxiety neurosis and depressive neurosis should be used in its place.
Today's Resident — Tomorrow's Psychiatrist*
Authors: Leichner Pierre , Harper Dan
Published: April 2017

A survey of 201 Psychiatry residents in Canada was conducted to obtain the opinions of today's residents on a number of controversial issues which may reflect their development as tomorrow's psychiatrist. Generally, this group of residents felt that an internship and training in Neurology and Internal Medicine should be a requirement for residents. Research, psychoanalysis and personal therapy were seen as non-essential assets to the training of a psychiatrist. These residents also showed a definite willingness to learn about the treatment of the seriously mentally ill and the chronic patient by making a rotation in a mental hospital a requirement during their training. The majority felt strongly that their professional identity was primarily that of a physician and were most supportive of a biopsychosocial model as basic to both practice and research in Psychiatry. They acknowledged that role diffusion was a problem in Psychiatry. They saw themselves as different from psychologists, social workers and psychiatric nurses in their ability to develop a differential diagnosis, to arrive at a diagnosis, to prescribe chemotherapy, to decide the necessity for admission, to act as therapeutic team leaders and bear the final medicolegal responsibility. Practising psychotherapy was not seen as a differentiating factor.

These results would seem to indicate that most of these future psychiatrists are developing their interest in a direction compatible with the predictions of educators who see tomorrow's psychiatrist as more of a psychobi-ologist. Their role definition is very much in keeping with the recommendations of administrators in view of the manpower shortage. However, before rejoicing at this apparent trend one must remember that once out of training psychiatrists may drift towards endeavours that are more rewarding ideologically and financially. Fee schedules and working environments need to be changed in order to support this change in focus. Another concern is that this direction may weaken the psychological basis of our profession.
Pharmacotherapy and Suicide Risk in Schizophrenia
Authors: Hogan Thomas P. , Awad A.G.
Published: April 2017

The authors examined drug prescribing patterns and incidence of side effects in schizophrenic patients who committed suicide as compared with a matched control group. The groups did not differ in type of drug prescribed, though patients in the suicide group received significantly higher doses of fluphenazine enanthate. Extrapyramidal reactions occurred more frequently among the patients in the suicide group in the thirty days preceding suicide, and autonomic side effects less frequently, than in control patients for a corresponding period prior to discharge. The authors conclude that the probability of suicide is not related to the type of drug prescribed.
The Relationship between Senile Dementia (Alzheimer Type) and Depression
Authors: Kral V.A.
Published: April 2017

The symptomatology and treatment of the various types of depressions found in Alzheimer patients are briefly described as well as a discussion of some of the interesting theoretical problems that are posed.
Insomnia: I. Classification, Assessment and Pharmaceutical Treatment*
Authors: Cleghorn J.M. , Kaplan R.D. , Bellissimo A. , Szatmari P.
Published: April 2017

Insomnia is a public health problem because of its high prevalence, the risk of hypnotic drug abuse, and self medication combined with alcohol and other nonprescription chemicals. Clinical experience has given rise to a descriptive classification of the insomnias many of which are secondary to medical disease. The information now available allows us to suggest a systematic approach to the assessment of insomnia emphasizing its history, events associated with sleep onset, observable behaviour and experience associated with interruptions in sleep. This paper attempts to organize the present state of knowledge in a format that can be taught to general physicians who deal with the most insomnia patients.
Psychological Determinants of a Medical Career*
Authors: Paris J. , Frank H.
Published: April 2017

To test the hypothesis that reparation for childhood experience is a factor in the choice of a medical career, a questionnaire was given to first year students in medicine, with first year law students as a control group. When students who chose the same occupation as their parents were eliminated from the sample, male medical students were more likely to have experienced illness in the family during childhood than male law students. Both male and female law students were more likely to have experienced legal problems in the family during childhood.
Where Did All the “No-Shows” Go?*
Authors: Lefebvre Arlette , Sommerauer John , Cohen Nancy , Waldron Suzanne , Perry Isobel
Published: April 2017

This pilot study examines the demographic profile, referral source, and presenting symptom of 40 families whose child was referred to and accepted for assessment by the Outpatient Psychiatry Department of The Hospital for Sick Children, but who ended up cancelling their initial assessment interview when an appointment time was set. These “No-Show” cases constitute a relatively small (13.6%) proportion of the total population accepted for assessment. The “No-Show” families did not differ markedly from the general intake population in terms of age, and presenting problem. However, girls, suburban residence and lower class background were more prevalent in the “No-Show” group. The length of time spent on the waiting list was given most frequently as the primary reason for cancelling the appointment.
Studies in Hysteria
Authors: Guze Samuel B.
Published: April 2017

This paper describes how the idea of substituting “Briquet Syndrome” for “Hysteria” developed. It emphasizes the need to base the diagnosis firmly on clinical features and also the value of differentiating “polysymptomatic” forms (Briquet Syndrome) from “conversion” symptoms (unexplained neurological symptoms). Other studies have shown that there is a preponderance of Briquet's Syndrome in women, and that female relatives of patients have an increased prevalence of Briquet's Syndrome, while male relatives have an increased prevalence of antisocial personality and of alcoholism. Conversely, a study of female relatives of a male prison population reveals a high prevalence of Briquet's Syndrome amongst them.

It is suggested that the association between Briquet's Syndrome and antisocial personality may explain many clinical and epidemiologic observations.
The Assessment of Depression in Normal Adolescents — A Comparison Study
Authors: Yanchyshyn Gordon W. , Robbins Douglas R.
Published: April 2017

This pilot study addressed two questions. The first was whether the combination of an observer scale (Hamilton Rating Scale) and a self-rating scale (Carroll Self-Rating Scale, modelled after the Hamilton) can make a valid distinction between the frequency and severity of depressive symptomatology in adolescents not referred for treatment, and psychiatric inpatients. The second was whether Major Depressive Disorder (MDD) could be recognized and diagnosed in “non-patient” adolescents using this interview and rating scale approach.

The median Hamilton and Carroll scores of the school students differed significantly from those of the in-patients, though the scores alone did not correspond with the presence or absence of MDD. Only 1 of the 26 (3.8%) tenth grade “students interviewed appeared to have MDD, compared with 9 of 33 (27%) adolescent inpatients studied previously with the same methodology. The strength and limitations of this interview and assessment approach are discussed.
Story Telling: A Creative Therapeutic Technique
Authors: Stirtzinger Ruth M.
Published: April 2017

This paper describes the “mutual story telling” therapy as it is used to aid the young child Joshua in finding healthy ways of dealing with conflicts that cause disruptions in his home and school life.

In this therapeutic process, Joshua's stories illustrate growth in ability to integrate good and bad parts of himself, to acknowledge his own anger and to express it without fear of annihilation; to feel the ego strength necessary to allow him to explore his external world.
Unusual Side Effects of Clomipramine Associated with Yawning
Authors: Mclean J.D. , Forsythe R.G. , Kapkin I.A.
Published: April 2017

Although there have been previous reports of decreased sexual capacity as a side effect of anti-depressants (1–3), the authors know of no previous records of increased capacity of the type described in the following reports, or of reports of side effects associated with yawning. Observation of unusual yawning-associated side effects is now reported, in order to alert clinicians to a possible side effect that can influence patient-compliance with the prescribed medication regimen.
Psychiatric Private Practice Profiles in Quebec and Ontario
Authors: Paris Joel , Lasry Jean-Claude , Greben Stanley , Sterner Irit
Published: April 2017

A questionnaire study of psychiatrists’ private practices in Quebec and Ontario demonstrated differences between the two provinces and between opted-in and opted-out psychiatrists in Ontario. The results suggest that there continues to be two kinds of psychiatry practiced: analytically oriented psychiatry and general psychiatry. The private practice sector seems to be more accessible to the educated.