bluuebunny/crossref_metadata_2025 huggingface dataset:
Sudden Death
Authors: Ellman Jon P.
Published: April 2017

The literature regarding the association of psychosis and/or neuroleptic medication with sudden, unexpected, “autopsy negative” death is surveyed. Richardson's work is reviewed; in particular his conclusion that acid muco-polysaccharide deposition in the cardiovascular systems of his patients was of etiologic significance in their deaths.

A case report follows which supports the association of psychosis and neuroleptic intake with abnormal muco-polysaccharide deposition and sudden death.
A Psychiatric Clinic for the Deaf
Authors: Pyke Jennifer M. , Littmann Sebastian K.
Published: April 2017

From the increasing number of requests being received by the Deafness Clinic (as many in the first three months of 1981 as in the whole of 1980), it would appear there is a sizable minority in Canada for whom psychiatric and mental health services are not easily accessible in their present form. Not only does hearing impairment significantly affect language, communication and social skills acquisition, it also separates persons so affected from services that other Canadians take for granted.
Psychogenic Pseudoseizures in Non-Epileptic Patients
Authors: Guberman A.
Published: April 2017

Twelve non-epileptic patients with psychogenic “convulsive” pseudoseizures were studied to delineate useful diagnostic criteria. Six patients had severe psychological disturbances, a long pseudoseizure history and a poor prognosis, while the other six showed little psychopathology, had undergone a recent emotional trauma to account for their pseudoseizures and had a relatively good prognosis. The characteristics of a typical attack precipitated by suggestion, the ictal or post-ictal EEG and the overall patient profile allowed a definite diagnosis in each case.
Success Conflict 65 Years Later: Contributions and Confusions
Authors: Kirkpatrick David
Published: April 2017

This report traces the diverse pathways along which concepts of success conflict have evolved since Freud considered it 65 years ago. Literature summaries, illustrations and suggestions to researchers, clinicians and conceptual thinkers are offered for establishing a broader, more integrated and more useful understanding of success conflict.
Psychiatric Manpower in Canada — the 1980 Surveys Part I: National and Interprovincial Comparisons
Authors: El-Guebaly N. , Leichner P.
Published: April 2017

The estimation of manpower needs is a complex endeavour due to the multiplicity of variables involved. Part I of this report presents national and interprovincial comparisons of demographic and practice data collected through a questionnaire survey of 1089 psychiatrists listed in the provincial specialists registers (i.e. 51.6% response rate). Of our respondents, 57.9% practice in urban areas of 500,000 inhabitants or more; the male-female ratio is 9 to 1; 37.9% are foreign medical graduates; and 98.5% of the specialists are exam qualified. General adult psychiatry accounts for 57.6% of the time spent in clinical practice and the total professional week is estimated to be 48.9 hours.

The experience gathered towards the design of a monitoring system, the significance of the psychiatrist-to-population ratio, the comparison of our data with other manpower studies and a review of recruitment variables conclude the report.
Training Standards for Career Child Psychiatrists
Authors: Barker Philip
Published: April 2017

The two main components of child psychiatric training should be supervised clinical work of high quality and training in the questing, scientific approach to the subject. These should be combined so that residents consider the assessment and management of all their clinical cases in a critical way, at the same time looking critically also at the pertinent literature. Management and treatment methods should be selected in the context of discussion of the current state of knowledge in the area. Trainees should see and treat children and adolescents of all ages and with the full range of psychiatric disorders. Ten percent of their caseload should consist of mentally retarded children. It may be necessary to teach about some rare syndromes by the use of videotapes. Residents should be familiar with the uses, and drawbacks, of a wide range of therapies, including residential treatment, but can only be expected to develop special expertise in a few. Didactic teaching unrelated to clinical work is probably of limited value.
Biases of Teachers and Trainees in Child Psychiatry
Authors: Fine Stuart , Penfold P. Susan , Krell Robert
Published: April 2017

Teachers are affected by their own training and life experience. Some specific biases are: therapeutic preferences and attitudes to what is normal or abnormal behaviour. It is argued that teachers should be aware of their own biases and that they should know about their trainees’ life experiences and biases too.

Some of the problems as to how child psychiatric trainees practise are emphasized and suggestions are made as to how these may be remedied.
Learning Objectives in Family Therapy Training
Authors: Rubenstein Julian S.
Published: April 2017

Although the place of family therapy in child psychiatry training programs is still somewhat controversial, developments in the field have been incorporated into most programs to a greater or lesser extent. There has always been a major commitment to family therapy supervision in the psychiatry residency at McMaster University. This paper describes the training program which is based on a specific conceptual framework (the McMaster Model of Family Functioning), a clearly articulated approach to treatment (the Problem-Centered Family Therapy Model), and a statement of well-defined learning objectives. There are four levels of training, the first three relate to family therapy skill development, while the fourth addresses the training of supervisors. Trainees progress sequentially through the levels, being required to achieve the objectives of each in turn. The objectives and training format for each level are detailed.
The Existence of the Borderline Diagnosis: Studies on Diagnostic Validity
Authors: Links Paul S.
Published: April 2017

The author discusses the validity of the borderline concept in terms of the recent empirical research. Five phases of exploration are reviewed; namely, clinical descriptions, laboratory studies, delineation from other disorders, follow-up studies, and family studies. These data are related to the current status of the diagnosis for clinical practice and to areas warranting further research. The conclusions reached show initial support for the validity of the borderline diagnosis. Descriptively, the literature tends to characterize these patients as having impulsivity, heightened affect, mild psychotic reactions and disturbed close relationships. Speculation about possible etiologies is felt to be premature and the identification of meaningful subgroups of patients within this syndrome is not yet possible. Further research using the objective scales in well-defined samples is felt to be required, as are family and prospective follow-up studies.
A Double-Blind Comparison of Fluspirilene and Fluphenazine Decanoate in Schizophrenia
Authors: Russell N. , Landmark J. , Merskey H. , Turpin T.
Published: April 2017

A double-blind comparison of fluspirilene and fluphenazine decanoate in 28 schizophrenic patients over six months showed equal improvement and the same incidence of side-effects in each group of patients. It would be expected from the literature that a better ratio of therapeutic to side-effects would appear with fluspirilene than with fluphenazine. The absence of such an effect in this study may be attributable to an initial lack of familiarity by the investigators with the use of fluspirilene, indicating an important potential variable in the comparison of a new drug with an established one.
Residential Treatment for Disturbed Children: Its Place in the ‘80s
Authors: Barker Philip
Published: April 2017

The value and place of residential treatment for disturbed children and adolescents have been increasingly questioned in recent years. Possible reasons for this are examined. The place of residential treatment, and its value as a specialized form of therapy, are discussed.

The treatment of disturbed young people in residential settings should only be undertaken as part of a wider therapeutic plan. The need for placement away from home, for the protection of the community or for other reasons not directly concerned with the child's treatment, must be distinguished from the need for residential treatment. The rationale and goals of treatment must always be defined in advance, and the needs of the system to which the child belongs must be considered along with those of the presenting patient.
Scales for Measuring Mania
Authors: Ahmed Abul B.M. , Lafferty Dan
Published: April 2017

This paper examines the utility of two scales for mania and the statistical validity of their use in a clinical setting. The literature is reviewed in regard to the present evaluation of accurate clinical scales in this area.
Elective Mutism in a 26 Year Old Deaf Female
Authors: Zondlo Frank C. , Scanlan John M.
Published: April 2017

A profoundly deaf female is evaluated for decreased communication over a thirteen year period. There was a total absence of communication for the last five years and case findings are consistent with the diagnosis of elective mutism. This is the first report of the disorder in a deaf person. Evaluation, differential diagnosis, treatment and prognosis are discussed.
Suicidal Behaviour in Childhood
Authors: Joffe R.T. , Offord D.R.
Published: April 2017

Suicidal behaviour and completed suicide in childhood are becoming increasing clinical and public health problems. A review of the literature of childhood and adolescent suicide, largely confined to children 13 years old or younger, reveals that there are little definitive clinical and demographic data on which to base rational assessment of such children. Furthermore, it seems evident that definitive information on adult suicide cannot be extrapolated directly to children. After review of the accumulated data to date, it is clear that further research is necessary and suggestions are made for two studies which could provide useful information.
The Characterologically Difficult Patient: A Hospital Treatment Model*
Authors: Silver D. , Book H.E. , Hamilton J.E. , Sadavoy J. , Slonim R.
Published: April 2017

A treatment model for the hospitalized borderline patient has evolved from the long-term, intensive treatment of these patients in a psychodynamically oriented setting. Four stages are identified and described. Each has a therapeutic goal and strategy, and repeatedly observable patient responses and staff counter-responses. Although patients vary in the lengths of time in each stage and there is much back and forth between stages, the regularity with which this pattern occurs greatly increases the capacity of the treating personnel to understand and guide the treatment process. The model clarifies perplexing, discouraging, or stale-mating affects and behaviours in the patients, and misleading counter-therapeutic affects and behaviours in the staff. Further, it can predict certain features and, to some extent, probable outcome in any particular course of treatment.
The Multi-Dimensional Inpatient Treatment of Severe Character Disorders*
Authors: Greben Stanley E.
Published: April 2017

Patients with severe character disorders present a special challenge to the clinician. Many can be helped with outpatient psychotherapy, often with the adjunctive use of medication. Some cannot, and need intensive inpatient treatment. An inpatient psychiatric unit in a general hospital is described which has been designed to treat such patients. The treatment makes use of a variety of therapeutic modalities. Psychotherapy is central and essential to the successful functioning of this therapeutic instrument.
An Open Dose Finding Study of Melperone in Treatment of Agitation and Irritability Associated with Dementia*
Authors: Fisher R. , Blair M. , Shedletsky R. , Lundell A. , Napoliello M. , Steinberg S.
Published: April 2017

Seventeen older patients with a diagnosis of Organic Brain Syndrome were placed on a four-week trial of melperone for treatment of behavioural disturbances associated with dementia. Efficacy evaluation of the drug revealed improved ratings of the patients in the areas of agitation/irritability, anxiety, unsociability, and mental alertness. Thirteen of the fourteen patients who completed the trial were rated generally as showing at least minimal improvement while on the drug. There were no serious side effects noted, with drowsiness the most frequent finding. These favourable results are suggestive of the usefulness of this drug, and point to the need for double-blind, comparative studies.
Psychoses et objets volants non identifiés*
Authors: Mavrakis Daniel , Bocquet Et Jean-Pierre
Published: April 2017

Certaines personnes prétendent être entrées en contact et avoir communiqué avec des occupants d'objets volants d'origine extraterrestre qui les auraient souvent chargés de “missions” concernant la sauvegarde de l'humanité.

Les auteurs, qui en ont observé six, concluent que cinq d'entre elles souffraient de délire paranoïaque pouvant souvent se rapprocher d'une paraphrénie, alors que d'autres cas analogues déjà décrits souffraient de schizophrénie paranoïde.

Leurs convictions inaccessibles à la critique et au raisonnement les aident probablement à rester en dehors du champ psychiatrique.

Cet article ne s'intéresse pas à la réalité de l'existence physique du phénomène et se veut non réductionniste, ne prétendant pas mettre en cause les témoins de tels phénomènes, dont la santé mentale doit être étudiée grâce à un examen mené avec rigueur et impartialité et ne doit pas être évaluée en fonction des préjugés de l'examinateur vis-à-vis des affirmations des témoins.
The Psychology of Women
Authors: Nadelson Carol C.
Published: April 2017

This paper reviews some of the major theoretical perspectives and recent data pertaining to the psychology of women.

In the first section, the author presents classical psychoanalytic theory and reviews the reconsiderations and critiques which were important factors from the early history of psychoanalysis, and continue today. The second section considers whether there are sex differences in psychopathology and, after concluding that there is evidence for this conclusion in some areas, the author presents the various arguments which have been constructed to explain these observations. The final section discusses implications for psychotherapeutic interventions with women. The questions of whether there are benefits or problems in choosing male versus female therapists, and the special aspects of treating women in a current socio-cultural context are elucidated.
Studies in Childhood Bereavement*
Authors: Furman Erna
Published: April 2017

A group of child psychoanalysts, associated with the Cleveland Center for Research in Child Development and the Hanna Perkins Therapeutic Nursery School and Kindergarten, studied 23 children who had lost a parent through death. These children varied greatly in socioeconomic, religious, racial and ethnic background and had suffered bereavement at different points in their development, as early as a few weeks old and as late as 13 years of age. The majority were in individual psychoanalytic treatment, seen 5 times weekly over several years. Some were treated by way of the parent while attending the Hanna Perkins Therapeutic School. The research group compared and discussed the multitude of data with a view to understanding mourning and the effects of bereavement on the personality, with a view to developing techniques in assisting children and families cope with the stress, and with a view to developing some prophylactic measures to minimize pathological resolutions. The results of the research were published in “A Child's Parent Dies” (1).

This paper focuses on sharing those findings which might be helpful to the clinician in the assessment of bereaved patients and in assisting them and their families in the crucial period of parental loss or shortly following it.
The Role of the Mental Health Expert Witness in Family Law Disputes
Authors: Levine Saul V.
Published: April 2017

Mental health professionals are frequently called upon to appear in Family Court as Expert Witnesses in order to help the judge make difficult decisions in disputed cases, involving issues like custody, access and abuse. The adversary system often serves to intimidate or to antagonize the expert witness, or to render his / her judgement as suspect and even invalid.

An approach is suggested in which the expert is designated as an “amicus curiae” (impartial friend of the court), rather than as a “hired gun” by one of the disputants. Even with this procedure, however, the expert witness must possess specific personal and professional characteristics which lend credibility to his/her testimony. The work is difficult, and requires considerable knowledge and skill; the responsibilities are heavy, but the opportunity to do exciting and vital work on behalf of children and families make it more than worthwhile.
Coping with the Negative Therapeutic Response in Psychosocial Problems in Family Medicine*
Authors: Ramesar S. , Mccall M.
Published: April 2017

Four brief case reports are presented from a series of Balint-type seminars on psychosocial problems at a university Family Medicine Centre. These cases illustrate the difficulties encountered by family practitioners when faced with a negative therapeutic response. When confronted by this outcome, it is important for the physician to define the dependency relationship which exists between himself/herself and the patient. It is often necessary to negotiate an explicit therapeutic contract. In doing so the physician should consider his own limitations of time, expertise and inclination and gather enough information to allow him to identify the focus of therapy and to consider his options for dealing with that specific focus.
The Mental Status Examination for Dementia: A Review of Practice in a Psychiatric Hospital*
Authors: Martin B.A. , Peter A.M. , Eastwood M.R.
Published: April 2017

The mental status examinations of 63 patients with a hospital discharge diagnosis of dementia were reviewed. The examination and documentation of most areas of cognitive function were found to be incomplete in the majority of cases. The need for a complete examination of cognitive function is discussed in relation to the natural history of dementia and in the context of recent developments in the classification of organic mental disorders.
Emotional Aspects of Arm or Leg Amputation in Children*
Authors: Turgay Atilla , Sonuvar Birsen
Published: April 2017

A clinical study of nine children between the ages of 4 and 15, who had undergone arm or leg amputation is presented. The emotional reactions of all those involved — the child, family, and the treatment team — are described. Amputation creates extreme stress in all participants in the procedure. Some similarities were found in the defensive mechanisms and stages experienced by the child, the family and the members of the treatment team.
Current Trends in Consultation-Liaison Psychiatry*
Authors: Lipowski Z.J.
Published: April 2017

Consultation-liaison psychiatry has grown rapidly and become a subspecialty of psychiatry in the past decade. The author reviews the history of this field at the interface of psychiatry and medicine, offers its definition, and discusses current trends pertaining to the organization of liaison services and to the teaching and research activities of liaison psychiatrists. He concludes that a liaison service has become a recognized division of a general hospital psychiatric unit for the provision of psychiatric consultation and teaching to the nonpsychiatric departments of the hospital.

Consultation-liaison psychiatry (or liaison psychiatry for short) has emerged in the past decade as a subspecialty of psychiatry, one concerned with mental health problems among medical and surgical patients. Diagnosis, treatment, study and prevention of psychiatric disorders in those patients constitute the proper domain of liaison psychiatry. I will review in this article the major current trends in this field as they pertain to matters of organization, education, and research. A brief historical note and a definition of liaison psychiatry will introduce my review.
Two Year Follow-Up Study of an Outreach Program in Geriatric Psychiatry*
Authors: Houston Fred
Published: April 2017

In Canada and the U.S. the percentage of elderly people is increasing and more funds are being spent on institutional programs. Yet many are not so impaired that they cannot be looked after by relatives.

A number of community outreach programs are available.

From an inpatient psychogeriatric unit in Hamilton Provincial Hospital an outreach program is described. A follow-up study was done during a 2 year period by contacting the referral sources. The 24.7% who had been admitted were compared with the 75.9% who remained in the community. While patients’ relatives and referring sources were mostly pleased with the assessments, and those patients not admitted were less institutionalized, those admitted with affective disorder showed a higher recovery rate than those remaining in the community. The total number admitted to hospital showed a lower mortality rate than those not admitted, even though the latter were considered less mentally ill because of the criteria for admission to the hospital.
A Comparison between Australasian and Canadian Candidates on Common Examinations in Psychiatry*
Authors: Skakun E.N. , Ball R. , Mcleod W.R.
Published: April 2017

Multiple choice examinations designed by the Royal College of Physicians and Surgeons of Canada were administered to candidates eligible for certification in the specialty of Psychiatry and to candidates in Australia and New Zealand who were eligible for certification by the Royal Australian and New Zealand College of Psychiatrists.

Results indicated that two national groups of candidates performed similarly on these common examinations. Comparison of the item analysis based on the two different groups of candidates revealed that most of the items were comparable in difficulty and discrimination. Because of the similar performance of the candidates, the stable cross-national statistical characteristics displayed by the items, and the confirmation of the relevance of the items by Australasian and Canadian content experts, it was concluded that the test items are suitable for testing the knowledge of both Australasian and Canadian candidates. The study recommends that the work begun by the working meetings dealing with international sharing of test materials and sponsored by the CIBA Foundation be continued.
Problem Behaviours Encountered by Families Living with a Schizophrenic Member*
Authors: Runions Joanne , Prudo Raymond
Published: April 2017

Attention is focused on the problem behaviours encountered by relatives of schizophrenic patients. Seventy families, members of the “Friends of Schizophrenics” association completed a questionnaire aimed at eliciting specific problem behaviours from the perspective of the relative. By far, the most frequent problems were concerned with the ‘negative’ symptoms of schizophrenia while the problems found most difficult to manage included those to do with insight compliance and ‘positive’ symptoms.
Enuresis: A New Look at Stimulant Therapy*
Authors: Diamond John M. , Stein Jonathan M.
Published: April 2017

A case is presented in which a hyperactive child with secondary enuresis had a dramatic response to both syndromes of methylphenidate therapy. A review of the literature reveals a paucity of controlled studies on the drug treatment of secondary enuresis. Although the deep sleep theory of enuresis is not applicable to primary enuresis, the authors consider its applicability to secondary enuresis, and point out the need for further studies on the treatment of secondary enuresis.
Neuroleptics under High Risk Conditions*
Authors: Oyewumi L. K.
Published: April 2017

A critical review of various high risk situations in which neuroleptics could be used and have been used in clinical practice is presented. These high risk situations include: women of child bearing age (pregnant women, lactating and/or nursing mothers), the two extremes of life (children and the elderly), patients with sexual dysfunction, patients with tardive dyskinesia, non-psychotic psychiatric patients, physically ill and suicidal patients. The extraordinary applications of these drugs, such as for rapid tranquilization and megadose regimens are examined. The author provides guidelines for the use of neuroleptics in these clinical situations.
Pierre Briquet: 19th Century Savant with 20th Century Ideas*
Authors: Mai François M.
Published: April 2017

This paper describes what is known about Briquet's life and character based on obituaries published in medical literature shortly after his death. It reviews his later writings on hysteria and integrates these with the Treatise published in 1859. Finally it summarizes the opinions of his immediate successors such as Charcot, Richer, de la Tourette and Janet; all of whom referred favourably to Briquet in the course of their writings on hysteria.
Electroconvulsive Therapy and the Seizure Threshold*
Authors: Martin B.A. , Strigler S. , Bezchlibnyk K. , Harris-Brandts G.E.
Published: April 2017

The use of a pulsatile square wave stimulus for a large series of electroconvulsive treatments under conditions of routine clinical practice is compared to the equivalent experience with a sine wave stimulus. The literature indicates that both waveforms are equally effective convulsants. However, in this series, the induction of a convulsion was found to be much more difficult with the pulsatile square wave such that the rate of failure to convulse was four times that compared to sine wave stimulation. A number of variables that may affect the seizure threshold during ECT were examined. It is concluded that the benefit obtained by reducing the electrical energy transmitted to the patient with the pulsatile stimulus offsets the difficulty encountered in reaching the seizure threshold.
Preparation for the Certification Examination*
Authors: Tohen Mauricio , Frankenburg Frances R.
Published: April 2017

The authors present their view of the oral certification examination of the Royal College. They found that preparation for the examination was educational, and that the examination itself was fair. Some suggestions to prospective candidates are offered.
Psychotherapy of the Characterologically Difficult Patient
Authors: Silver Daniel
Published: April 2017

The increasing number of characterlogically difficult patients in psychiatric practices has produced a plethora of theoretical formulations, treatment strategies and techniques. The major shifts in theoretical emphasis from drive theory to object relations theories and self-psychology has encouraged many psychiatrists to treat these patients in psychotherapy. The heterogeneity and variability of clinical profiles represented in this group of patients, however, still prevents prescription of “the” treatment of choice for this patient population.

A major focus on treatment considerations in this paper is the assessment process with emphasis on determining the capacities for inter-personal relationships, psychological mindedness, empathy and psychological soothing of self and others. The advisability of establishing a “contract” as a prerequisite to treatment is suggested as an important factor in determining outcome. Other particular treatment issues are addressed such as frequency of sessions, “secrets”, premature provocation of intense affect, medications, consultations, hospitalization, self-mutilation, substance abuse and indications for termination. The complex vissicitudes of the transference and countertransference processes with this group of patients is pointed out especially those feelings of helplessness and range sometimes experienced in the countertransference. Long term intensive psychotherapy with many of these patients probably still belongs to the area of therapeutic heroics. Hard evidence for good and poor outcome is scarce and therapeutic zeal is too often based on anecdotal testimonial from adherents of one approach or another.
Affective Disorder, Paranatal and Educational Factors in the Offspring of Bipolar Manic-Depressives
Authors: Waters Brent , Marchenko Irene , Smiley Donna
Published: April 2017

Fifty-five of the 58 adult offspring of 17 bipolar manic-depressives were studied. Fifty-three were interviewed and some data were available on the two who had committed suicide. A detailed educational history and pregnancy and birth (paranatal) history were obtained and were corroborated by records where available. Thirty-two percent of the offspring met RDC criteria for major affective disorder, and 13 percent for minor affective disorder. Paranatal and educational problems, separately and together, were not associated with an enhanced risk to affective disorder, however they were significantly associated with an earlier onset to affective disorder. This association may be partly due to a relatively lower IQ among the early onset subjects.
Utilization of Psychotropic Drugs in Saskatchewan: 1977–1980
Authors: Power Bob , Downey Winanne , Schnell Bruce R.
Published: April 2017

Psychotropic drug use in Saskatchewan during 1977, 1978, 1979 and 1980 was determined. Approximately one in five prescriptions dispensed was for a psychotropic. About 20% of the population received psychotropic drugs in each year but use has declined slightly, especially that of tranquilizers. Psychotropic use increased with the patient's age and nearly two-thirds were women.

Considerable caution should be exercised in making comparisons with other drug utilization studies. There may be substantial differences in the drugs selected for study, the categorization of these drugs, and the methodology used to analyze drug use. Also, most studies are based on data that is from a decade old or older. Moreover, most if not all other studies on drug use are based on sample surveys (from different sampling universes), whereas the present study is based on the entire population. Nevertheless, some generalizations may be valid.

Since non-formulary drugs are excluded, the findings should be regarded as conservative. Examples of non-formulary drugs considered to be psychotropic include antispasmodic / tranquilizer / sedative combinations (example: Librax, Donnatal), combination hypnotics (example: Tuinal, Mandrax), and some combination analgesics (example: propoxyphene compounds, pentazocine compound, oxycodone compound).
Seizures Associated with High Maprotiline Serum Concentrations
Authors: Molnar George
Published: April 2017

Maprotiline is a tetracyclic antidepressant which appears to have accounted for a relatively large proportion of the seizures associated with antidepressant use. The literature proposes two mechanisms of seizure induction: interaction with other medications and concomitant medical conditions lowering the seizure threshold. Observations during a study of maprotiline blood levels suggest that elevated serum concentrations achieved with therapeutic doses may also be linked to the seizure-induction mechanism. Monitoring of maprotiline blood levels may help to identify patients at risk.
Note Historique
Authors: Postel J.
Published: April 2017

Summary

The purpose of this paper is to investigate Philippe Pinel's psychiatric experience, his practice in “la maison de santé Belhomme” and his first publications which were concerned with the treatment of mental patients and appeared in “La Gazette de Santé” which he edited between 1785 and 1789. During that time, the main preoccupation of the future head doctor of “La Salpétrière” had been to ensure the application and the development of moral treatment, in its practical modalities as well as its theoretic rationalization. Meanwhile, the institutional aspect of this therapy had the upper hand over the individual cure. This evolution brought Pinel and his successors to neglect the latter. In this connection we can regret that Philippe Pinel did not continue to have more private practice for this allowed him to follow first his experience and research (individual cure) in this field of rational psychotherapy, that of moral treatment.
Self-Esteem in Psychotherapy
Authors: Sniderman Marlaina Sacks
Published: April 2017

Self-esteem is a concept which is central to our understanding of a person's sense of well-being. Impairments to self-esteem due to the effects of past experience coupled with the impact of present circumstances often precipitate the entry into psychotherapy. The psychotherapy situation itself can be a potent source of self-esteem for both patient and therapist because it involves the two major factors that energize self-esteem needs: engagement in an important activity and involvement in an intimate relationship. This paper suggests that whether or not they are the focus of the therapy, self-esteem needs can be exacerbated due to the context of the situation and the fit between patient and therapist, as well as the transference and countertransference.
An Essay on Contemporary Dynamic Psychiatry
Authors: Warme Gordon E.
Published: April 2017

Psychodynamic theory is less well understood than one would wish, especially because of the centrality of dynamic theories in understanding a host of psychiatric disorders.

The key psychodynamic notion is that psychiatric symptoms can be explained as manifestations of an unconscious purpose or strategy. The theoretical term that best encompasses this notion is “intentionality”, a theoretical option that has, in many psychiatric circumstances, the greatest predictive and explanatory powers. Other more or less loosely related dynamic theories are the theory of the Oedipus complex, developmental theory, the theory of transference and the extraclinical theory.

New theoretical paradigms are currently competing for explanatory priority, a development which reflects a healthy maturity in psychodynamic science, and which may mean that a new and superordinate theoretical paradigm is about to emerge. At a time of theoretical ferment it is particularly important that the theoretical underpinning of dynamic psychiatry be clearly explicated and the author claims that theoretical role for intentionality.
A Possible Indication for Red Cell Lithium Determinations: A Case Report
Authors: Yassa Ramzy , Nair Vasavan , Kraus Daniel J.
Published: April 2017

The recommended prophylactic lithium levels in the treatment of manic depressive patients differ from study to study.

In this paper, we present a patient who was maintained euthymic on lower plasma levels than those recommended. However, we theorize that the reason for this may be due to the fact that she had a high RBC/plasma ratio. We recommend that in those patients whose plasma lithium levels are consistently low, this point should be kept in mind before considering them as noncompliant.
Use of Psychostimulants in Medically Ill Patients with Neurological Disease and Major Depression
Authors: Kaufmann M.W. , Cassem N.H. , Murray G.B. , Jenike M.
Published: April 2017

The effective therapeutic response to dextroamphetamine and methylphenidate by five depressed patients with neurological disease is described. In four of these patients tricyclic antidepressants had to be discontinued due to the concomitant deterioration of their cognitive functions, and in one case they were not used due to cardiovascular complications. There was a rapid remission of depressive symptomatology with no adverse side effects, consistent with the findings of other investigators. The possible association of right hemisphere strokes and depression is also discussed. Further evaluation of the therapeutic role of psychostimulants in the treatment of depressed patients with structurally-compromised brain function is recommended.
The Process Model of Family Functioning
Authors: Steinhauer P.D. , Santa-Barbara J. , Skinner H.
Published: April 2017

The Process Model of Family Functioning differs from the McMaster Model of Family Functioning and their common source, the Family Categories Schema, by its increased emphasis on the dynamic interaction between the major dimensions of family functioning, and by its stress on the interface between intrapsychic subsystems and the interpersonal dimensions of the family system. A model of family process rather than family structure, it defines six universal criteria of family functioning. It describes the processes involved in each along with the content components and the critical aspects of each. A self-report test developed from the model (FAM-III) is being widely used both as a research tool and as a clinical adjunct. Tests to define its validity and reliability continue.
Clinical Applications of the Process Model of Family Functioning*
Authors: Steinhauer P.D.
Published: April 2017

This paper discusses clinical applications of the Process Model of Family Functioning. It provides a framework for conducting and systematically recording a family assessment, and can help clinicians achieve and use improved control of clinical sessions to increase their diagnostic and therapeutic effectiveness. Ways of using FAM-III, a self-report test derived from the model, to confirm or amplify a clinical assessment and to assist or monitor therapeutic interventions are discussed. Viewing psychological and family systems theories as complementary, the model provides a rationale for integrating both sets of theories to achieve a more pluralistic view of pathogenesis and a more selective choice of therapies. An extended example illustrates the concurrent use of individual and family therapies. Other topics discussed include the role of family strengths, the derivation of therapeutic goals, moving from content to perceive underlying structure and process, making the conceptual. shift from group-of-two to conceptualizing the family as a group (system) in equilibrium.
Economic Constraints and Quality Assurance in Mental Health Services: Sensitive Indicators*
Authors: El-Guebaly N. , Papineau D.
Published: April 2017

Clinicians in the field of mental health are met with the dual challenge of increased accountability and shrinking resources. Funds are often allocated through the use of crude administrative monitors. This is of little solace to the clinician faced with unmet patients’ wants and needs. A set of clinical monitors is outlined requiring the practitioner's cooperation. The presentation of an accurate composite picture is a must in the process of resource allocation. Such clinical monitors include the analysis of characteristics of patients such as the repeaters at emergency, “the revolving door” pool of patients and those falling in between networks. Reviews of waiting lists and lengths of stay, an evaluation of nursing care variables, the auditing of the choice of therapeutic modalities and the use of restraints are other suggested contributors to the assessment of service needs.
Treatment Noncompliance as a Function of Therapist Attributes and Social Support
Authors: Dyck Ronald J. , Joyce Anthony S. , Azim Hassan F.A.
Published: April 2017

Premature termination of short-term psychotherapy was examined as a function of therapist and social support variables. Patient perceived therapist competence, knowledge, relaxed manner, understanding of the help wanted, attitude, acceptance, listening ability, and sensitivity differentiated Continuers from Terminators. Although few of the social support variables were related to the mode of treatment termination, Continuers were found to be more likely than Terminators to have discussed attendance at the Clinic with others, especially family members. These findings were discussed in terms of their relevance to treatment of the emotionally ill and to the training of clinicians.
Psychotherapy with the Boring Patient
Authors: Taylor Graeme J.
Published: April 2017

Boredom is an unpleasant affective state which may be evoked by monotonous sensory input and reduction of an individual's internal instinctual and fantasy activity. Certain difficult patients have the capacity to evoke boredom in their psychotherapists and unless technical modifications are used, therapy quickly reaches an impasse and may be terminated on the grounds that the patient is ‘not psychologically-minded.’ Chronically boring patients have an impaired capacity for symbolization and can be identified by their non-symbolic communicative style. This reflects an inner struggle with primitive mental states due to fixation at, or regression to, the paranoid-schizoid developmental position. The patient may use projective identification to discharge unbearable psychic tension into the therapist whose boredom is partly a defense against this. Alternatively, the patient may create impenetrable barriers with language by making ‘attacks on linking’ which are tantamount to attacks on the therapist's peace of mind. The therapist should initially interpret the form and function of the patient's communications rather than the contents. In a manner comparable to a mother's interaction with her young child, the therapist can help the patient acquire a greater capacity for symbolization, including the ability to accurately label and verbalize different affective experiences. Careful analysis of the countertransference will identify the patient's projective identifications, provide valuable information about the patient's primitive mental life, and prevent anti-therapeutic projective counter-identifications. The patient will become less boring as he learns to use symbols and as his primitive anxieties are resolved.
Preparing the Conference Paper
Authors: Older Jules
Published: April 2017

Presentations at many psychology and psychiatry conferences are ponderous monologues overfilled with information in a format designed for readers, not listeners. Seven ways are suggested to improve the conference paper, and in doing so, to improve the chances of survival (or at least the quality of life) of those who attend them.
Rapid, Psychopharmacologically Induced Improvement Can Produce New Psychological Symptoms
Authors: Sporty Lawrence D. , Plon Lawrence
Published: April 2017

The advent of improved diagnostic criteria, coupled with a refined psychotropic armamentarium, can now produce rapid clinical improvements in clinical psychiatric conditions for which both patients and therapist may be unprepared. The following case report illustrates this problem which will become increasingly important in the practice of psychiatry as further improvements in psychopharmacological therapy occurs.
Beyond the Best Interest of the Child: Ten Years Later
Authors: Awad George Anis
Published: April 2017

The book “Beyond The Best Interest Of the Child” advocated major changes in understanding and implementing child placements, through general principles and guidelines and through specific recommendations. After ten years of clinical experience with child placements, a reassessment of the book is attempted. It is felt that the main principles and guidelines espoused are useful and are an improvement over the previous guidelines. However, the specific recommendations were felt to be less useful and are not necessarily the logical consequences of the principles and guidelines.
Sexual Offenders, Violence and Testosterone: A Clinical Study
Authors: Bradford John Mcd. W. , Mclean D.
Published: April 2017

Sexual assault has increased steadily over the last decade. Attempts at a more accurate evaluation of the violent sexual offender have included studies looking for correlation between plasma testosterone and high levels of sexual violence. The present study failed to replicate these findings, however, it confirmed the known association between violence and alcoholism. The significant association between a psychiatric diagnosis of depressive neurosis and low plasma testosterone levels was an associated finding.
Analysis of Emotional status during the Hospital Treatment of a Borderline Patient
Authors: Marziali E. , Hamilton J. , Sadavoy S. , Book H. , Sadavoy J. , Silver D.
Published: April 2017

This single case study illustrates a methodology for identifying recurrent pathological emotional states in a hospitalized, borderline patient. Parallel therapeutic inputs are delineated and examined in terms of patient-specific responses.

The results indicate that ratings of nursing notes recorded across three periods of hospitalization can reliably isolate the patient's most salient and debilitating emotional states. State-specific therapeutic interventions are extracted and their effectiveness noted. The analyses illustrate clinical phenomena which are congruent with what is known about borderline symptomatology. In addition, the study locates therapeutic errors which often occur when working with difficult patients.
Fluctuations in Mood and Psychological Distress during the Menstrual Cycle
Authors: O'neil Mary Kay , Lancee William J. , Freeman Stanley J.J.
Published: April 2017

This paper examines fluctuations in mood and symptoms associated with psychological distress during the phases of the menstrual cycle in two samples of university women. The first (Study I) sample of women (N = 162) was randomly selected from the University population. The second sample (Study II) was women (N = 138) who attended a psychiatric clinic. The subjects completed a questionnaire which included measures of depression, anxiety and general psychological distress. Information about the menstrual cycle and contraceptive pills was elicited from the subjects who were unaware that affect during the menstrual cycle was being studied. In study I there were no significant differences in depression, anxiety or psychological distress between phases of the cycle. The results of study II indicated that even in a group of women with emotional problems, it was not possible to demonstrate an increase in the average severity of mood disturbance or psychological distress during any phase of the menstrual cycle. It was concluded that in general, university women between the ages of 18–30 who are mostly single, nulliparous, with or without significant psychopathology, seeking or not seeking psychiatric help do not experience significant or disruptive fluctuations in mood and symptoms of psychological distress during the phases of the menstrual cycle. Women who are afflicted with distressing and incapacitating cyclical fluctuations are best studied as a vulnerable subgroup.
Deterioration of Mood and Elevation of Anxiety in Compulsive Ritualising
Authors: Van Den Hout Marcel A. , Hessels Kees
Published: April 2017

To account for the so called anxiety elevating compulsions and Beech's contention that mood deteriorates through ritualising, two hypotheses were formulated and tested. In line with our expectation, the data suggested that compulsions may (i) not only serve to reduce actual anxiety, but may also prevent anxiety that patients believe to occur in case of not ritualising and that (ii) compulsive patients are most troubled by negative self statements immediately after ritualising and least so in case of not ritualising. It is argued that these findings do not contradict the anxiety reduction model.
Fathers in the Newer Family Forms: Male or Female?
Authors: Agbavewa M. Oluwafemi
Published: April 2017

Current social trends have produced significant changes in the family system, with the emergence of newer family forms — single parent and homosexual families. The author used the example of a six year old boy in a female homosexual family to discuss the theories of sex role development. The literature on father-absence and the converging roles of father and mother, men and women, were reviewed with suggestions that women may function as fathers in the newer family forms. Longitudinal studies of children in these newer family forms are needed to define the implications of these social changes for personality development theories and mental health care delivery.