bluuebunny/crossref_metadata_2025 huggingface dataset:
Article
Authors: Gauthier Yvon , Richer Simon , Chartier Pauline , Devisscher Elaine , Fouchard Denise , Lamy Françoise
Published: April 2017

1) In the context of research on disadvantaged children, the authors have concentrated their efforts on the study of the fantasy life of both advantaged and disadvantaged children, at age 4, 5 and 6.

Using a scale of development inspired by Anna Freud's concept of developmental lines, they have found statistically significant major differences in the evolution of the two groups, in studying both their libidinal and ego organizations. Such differences are consistently evident, although in varying degrees through the three years of observation. A minority of the disadvantaged children show good emotional resources in their first nursery years (age 4), and their development remains adequate through first grade. Most of them however present an inadequate development all along and continue in first grade to function at the level of a preœdipal phantasy life which they should have repressed or transformed.

2) A study of plastic productions in first grade (drawings) and of the learning indices which they reflect also reveals important disparities between the two groups. Advantaged children reach a state of serenity which allows them to enter easily into the world of formal learning and latency. Disadvantaged children are still too often under the domination of a dangerous phantasy world which delays their entry into formal learning and makes it problematic.

3) The review of recent literature suggests a pessimistic view about early intervention with disadvantaged children; the authors, however, believe in the necessity of tenaciously pursuing observations of such early interventions and long-term evaluations of results.
Disaster during Psychiatric Treatment: An Intrapsychic Problem for the Physician
Authors: Woods L.W.
Published: April 2017

Medical personnel may be ill-equipped to handle emotional reactions to disasters occurring in practice.

Medical training leads to an unrealistic image of the good, infallible and successful physician, while placing too little emphasis on the inevitability of apparent failure.

Reactions to such situations can be considered as gross stress reactions which may result in defensive therapeutic behaviour, or to career-line changes of reduced clinical responsibility.

It is suggested that a more rational position is available which would relieve guilt and promote a healthier response.
Psychiatry and Ideology
Authors: Paris J.
Published: April 2017

Throughout history psychiatric ideas have been shaped by prevailing ideological frameworks. The development of psychiatric theory and practice has not been a simple progression but has oscillated wildly with each change in the cultural climate. Contemporary psychiatry is divided into a number of ideological camps, each reflecting aspects of the fragmented modern zeitgeist. Allegiance to any one system carries the danger of sacrificing the care of patients to attain theoretical consistency. Psychiatrists must accept the uncertainties of the eclectic position and abandon Utopian attempts to resolve the ambiguities of the human condition.
Family Background and Psychiatric Disorders
Authors: Marriott J. A. S.
Published: April 2017

The admissions to the Psychiatric Unit of the University Hospital of the West Indies during a 15-month period from September 1966 to January 1968 have been reviewed with special reference to family background.

Despite cultural differences the pattern of admissions was very similar to that of psychiatric units in more highly developed countries. The various racial groups in the island were represented and included a high proportion of white alcoholics.

Parental absence in childhood was largely related to social class but there was a definite association between parental absence in childhood and psychologically precipitated depression.
Autonomic Correlates of the Sedation Threshold
Authors: Tan B. K.
Published: April 2017

This study is concerned with the relationship between sedation threshold and autonomic measures in two groups — depressive patients and those suffering from chronic schizophrenia. The sedation threshold was determined according to Shagass' method. In addition, autonomic activity (heart rate, palmar conductance and respiration rate) was simultaneously recorded. There was no evidence of a significant relationship between sedation threshold and autonomic measures. No significant difference in autonomic activity was found between the two groups. Individual differences were shown by each subject having his own idiosyncratic pattern of autonomic activity, regardless of the diagnosis. Consistency of this pattern was found in a substantial proportion of each group. The overall autonomic effect of sodium amytal was insignificant. In particular, the three autonomic measures failed to differentiate between the conditions of rest and sedation, and it was concluded that the sedative influence of sodium amytal is not exerted through a direct action on the autonomic centres. It was suggested that the experimental design would be suitable for comparing the action of sedative and anxiolytic drugs.
Inpatients in Love: Conjoint Therapy of Two Adolescents
Authors: Levy J. , Trossman B. , Kravitz H. , Robertson B. , Dow T.
Published: April 2017

This paper describes two disturbed adolescent inpatients who fell in love and whose management included a series of conjoint therapy sessions. Their dynamics were explored and revealed themes of symbiosis, sadomasochism and identity-diffusion. This exploration led to the rupture of the relationship but it also stirred up multiple conflicts in the ward milieu. Some advantages and disadvantages of this technique are discussed.
Apprentissage de la Psychotherapie en Premiere Annee de Residence: Rôle de la Supervision
Authors: Bury J.A. , Labrie J. , Pomerleau G.
Published: April 2017

This paper is based on the supervision of twenty first-year residents, over a period of three years, within a teaching unit of a traditional psychiatric hospital.

At this stage of training the basic difficulty lies in the transition from previous medical training; not only is the formal content quite different, but the learning of a new interpersonal relationship involving doctor and patient and doctor and other members of the team creates a major problem, especially in the context of psychotherapy.

The functions of tutor and supervisor should remain separate, the former dealing with the management of patients, and the latter focusing on the resident-patient relationship.

Common reactions among residents have been observed. They are confronted with two main tasks — working within a team, (which requires a redefinition of professional identity) and being confronted with psychosis, (with the anxiety this unknown provokes and the disruption of the security which was provided by medical school).

In general, the first reaction is an attempt at adjustment adaptation by turning to the medical model. With the help of the supervisor the defensive character of this attitude can be worked through; then follows a pervasive feeling of helplessness, de-developing into a depressive experience, which is considered to be a prerequisite to a dynamic approach with patients. However, individual residents may present different types of behaviour — passivity, opposition, intellectualization or clinging to the medical model.

This crucial phase in the process of supervision cannot easily be distinguished from personal therapy. Successful outcome depends mainly on a supervisory alliance between supervisor and ‘supervisee’, both feeling and assuming a mutual involvement in the task of helping the resident's work with the patient. A new professional identity as therapist is formed by the resident through identification with the supervisor.
Self-Mutilation of the Genitalia by a Female Schizophrenic
Authors: Standage K. F. , Moore J. A. , Cole M. G.
Published: April 2017

A case is described in which self-mutilation of the genitalia by a female patient was associated with the development of schizophrenia. The psychopathology was dominated by sexual themes and resembled reports of patients with erotomania in the setting of a paranoid or schizophrenic psychosis. The literature on genital mutilation by female and male patients is reviewed briefly. It is suggested that such behaviour in women indicates severely disturbed psychosexual development but lacks diagnostic significance.
Religion and Psychiatric Practice
Authors: Runions Rev. J. E.
Published: April 2017

This paper reviews a series of 70 patients who were referred because of the author's known religious commitment. Although few specific conclusions can be drawn, the material presented suggests that the evangelical patient who requests referral to a psychiatrist of a similar religious orientation is most likely to be a depressed woman in her third decade and more likely to be referred by her physician than by her minister.

A history is presented of an eighteen-year-old girl admitted from a protestant Bible school in a hypomanic state. It is suggested that religion plays a normal integrative function in human life when personal qualities of commitment, capacity for relationship and self-giving are common.

The neurotic-defensive uses of religion are many: in this paper the subservience of religion to the mechanisms of denial and regression is noted. The history also illustrates the qualities of religious expression in manic patients — their religious experience is grandiose, self-centered and superficial, representing a form of regressive identification for the patient.
Observation De L'Enfant Dans Un Groupe De Pairs Au Cours De L'Evaluation Clinique
Authors: Villeneuve C. , Maugile D. , Derome T.
Published: April 2017

This paper describes the observation of the child in a peer group as part of his evaluation in a clinical setting. The observation is divided into three parts and done in a play atmosphere. First, the children meet and do craft activities. Afterwards they are left alone in this room and observed from another room; then they are free to do whatever they like, using material selected in advance. Finally the activities are structured by two participant observers.

The observation is particularly useful for evaluating the social functioning of the child and, more especially, his relationships with his peers, which are interpreted only by the traditional method of evaluation. The observation usually corroborates the findings of other sources and also often brings new insights. A better understanding of various aspects of the psychosocial development and of some components of the ego is often revealed. The findings in this paper are illustrated with extracts from case histories.
Activity Patterns and the Use of Space by Patients and Staff on the Psychiatric Ward
Authors: Willer Barry , Stasiak Eugene , Pinfold Peter , Rogers Marjorie
Published: April 2017

The differences between patients and staff in the use of time and space on the ward were much greater than between different patient groups and different staff groups. Patients spent considerably more time involved in isolated behaviours, active and passive, and in mixed active behaviours, while staff spent more time in social activities and looking after ward routine. Also, patients spent a large percentage of their time in the bedrooms and very little in staff offices, while the staff spent a large percentage of time in the offices and very little in the bedrooms.

However, differences between patient groups do exist — chronic patients were more likely to be involved in isolated passive behaviours and spend a larger percentage of time in the bedrooms. Female active patients were more likely to be involved in isolated passive behaviours than male active patients, and were also more likely to be found in their bedrooms. Finally, male patients were liable to be involved in mixed activities, especially industrial therapy.

Differences between the staff of different wards in the use of time and space were small — the staff of the female wards spent more time in the dining rooms while those of the chronic ward were usually involved in isolated passive behaviours. Differences between male and female staff were similar to differences between male and female patients. Female staff spent more time in their own ‘territory’ (the staff offices) and they were more often observed in isolated passive behaviour. Male staff were more likely to be involved in mixed activities with patients, especially industrial therapy.

The activity patterns of the various locations were very similar across the wards although marked differences existed between staff and patients. Patients used bedrooms for isolated passive behaviours and staff used bedrooms for talking and routine. Staff were much more likely to use sitting rooms for social behaviour than were patients. Washrooms were used by both staff and patients for isolated active behaviours, such as reading.
The Use of Non-Professional Change Agents in an Institution
Authors: Robinson G. Erlick , Alboim Naomi
Published: April 2017

The Toronto General Hospital is a 1,200 bed hospital in the core of downtown Toronto. Its Youth Worker Project, begun in 1971, consists of a five-member team of nonprofessionals with varying backgrounds. Their work encompasses four main areas — service, education, research and evaluation, and community involvement.

The project was originally designed as a response to the crisis regarding drug-hurt youth but the goals have gradually broadened until the workers now act as ombudsmen to patients of all ages. Its function is to attempt to ensure that everyone is aware of the availability of treatment necessary to attain the optimum level of total personal health. The workers are involved in direct patient contact in the emergency department, on the hospital wards and in the outpatient department. They do their own case findings as well as act on referrals. The youth workers have also been involved in educational programs for both hospital staff and workers in the community. They have become active members of the Community Psychiatry program.

This paper describes the development and evolution of the project to its present stage. Initial problems and ongoing areas of concern relating to the existence of such an unconventional project in the midst of a large institution are discussed. More and more the term ‘youth worker’ has become a misnomer and should be replaced by ‘people worker’. This development reflects the essential component of the project — the awareness of ever changing needs and the flexibility to respond to them.
L'Intention Paradoxale Et Techniques Comportementales Similaires En Psychotherapie a Court Terme
Authors: Hand I. , Lamontagne Y.
Published: April 2017

The logotherapeutic technique of paradoxical intention and several behaviour therapy techniques use almost identical ways in treating patients with phobias, obsessions and other anxiety states. These consist of confronting the patient with his anxiety and/or avoidance (ritual), eliciting situations, discouraging overreaction to symptoms and encouraging alternative activities. Patients learn different ways of coping during the confrontation (exposure) trials, and therapists also use a variety of ways to motivate the patients

Frankl has claimed for many years that humour is a particularly helpful device to motivate patients for such a treatment and to get them to do the exercises properly. It was found in a group experiment with behaviour therapy for agoraphobics that patients in groups used humour spontaneously as one of their main coping mechanisms. The use of humour as an auxiliary in paradoxical intention and behaviour therapy techniques is therefore reconsidered, with particular emphasis on Frankl's theoretical framework.
On Being a Foreign Psychiatric Resident
Authors: Cheng Louis Y.
Published: April 2017

The problems of foreign residents in psychiatry in Canada are examined under the general headings of communication difficulties, cultural differences, personal and professional problems. It is emphasized that each resident presents his unique combination of problems and possesses positive values of his culture-shift which are potentially contributory to better empathy with patients. About 25 percent to 50 percent of residents in psychiatry in Canada are foreign medical graduates.
Community Psychiatry — A Hard Look at Feasibility toward a Socioanalytic Understanding
Authors: Henderson James
Published: April 2017

This paper has reviewed the concept of community transference and has discussed its relation with the use of illusory phenomena in alleviating the discomfort of maintaining object-relatedness (23), and with nonpathological paranoia as a practically universal phenomenon of human groups (19-21). The importance of community transference in contemporary psychiatry is discussed and its challenge is described to the community psychiatrist who aspires to a clearer definition of his professional role. Training programs for community mental health personnel are proposed as a pragmatic response to a call for effective parsimonious services, and as a plausible alternative to woolly notions of the large scale prevent-ability of mental illness.
Child Psychiatry and Pediatrics: An Integrated Approach
Authors: Levine Saul V. , Froese Arthur P. , Stewart Donald A.
Published: April 2017

Traditional child psychiatry cannot meet the heavy demands placed upon it for service, partly because of its anachronistic theoretical and clinical approaches. In an innovative multidisciplinary program the authors have attempted to overcome some of these problems by integrating mental health teams in the pediatric outpatient department, where the action is. It has been found that teaching and practise in both specialties are enhanced by this approach, and may have significant implications for training programs and clinical work.
Emergency Psychiatric Admission to the General Hospital a Formulation of the Process
Authors: Bartolucci G. , Goodman J.T. , Streiner D.L.
Published: April 2017

The literature regarding the decision-making process leading to psychiatric hospitalization in a general hospital is reviewed. On the basis of the limited data available in the literature, a decision-making model is proposed, based on variables relating to the clinician, the patient and the situational context.
The Efficacy of Electrosleep Therapy
Authors: Templer Donald I.
Published: April 2017

A review of the literature on the efficacy of electrosleep therapy is presented. The vast majority of non-double-blind based reports are very optimistic about its effectiveness, but the inferences from the double-blind based research are much less positive. It is concluded that the efficacy of electrosleep therapy has not yet been satisfactorily demonstrated.
Lynching: A Psychiatrist's View
Authors: Raschka L.B.
Published: April 2017

Lynching is seen as a transient collective psychosis which develops in a pathogenic environment. It is the culmination of a process which can be interrupted by preventive action on several levels. Predisposing factors can be recognized on three levels: those pertaining to the life situation; those pertaining to group dynamics; and those pertaining to individual characteristics of group members. Predisposing factors pertaining to the life situation include: forced inactivity; confinement to close quarters; emotional dependence on the group; perceived hostility on the part of the authorities; sudden and unexplained changes in the behaviour of powerful controlling persons; and lack of reliable information regarding the future in the outside world. Predisposing group dynamic factors include: the emotional contagion of ill-defined fear; aimless anger; helplessness; strong group indentification and heightened suggestibility. Predisposing factors pertaining to group members include: individual character traits, mental symptoms, youth, previous traumatic experiences and morally deviant or inconsistent leadership.
A Developmental Hierarchy of Dyadic Relationships
Authors: Nichol Hamish
Published: April 2017

With the work of Mahler, Bowlby and others it has been increasingly recognized in recent years that there is a sequential progression in the nature of the first dyadic relationship which forms the basis for the type and quality of subsequent interpersonal transactions. Four levels of development of the dyadic relationship may be recognized.

To begin with the infant is in a state of not recognizing the existence of the other individual — the autistic phase. At the toddler stage there is awareness of a separateness of physical attributes between the child and the significant other, but the persistence of the symbiotic belief that there is substantial co-extension of mental processes between the two. With further separation and individuation in the preschool and early school-aged child, a period of magical thinking prevails for varying durations in the child, in which there is an attempt made to retain an omnipotent control of the thinking of the significant other by the mechanism of projection of thought. In the mid-elementary school-aged child the decentering process emphasized by Piaget, together with the emerging capacity for making allowance for the context within which events occur, leads to the dyadic relationship being seen by the child as being mediated through the transactions of two autonomous mental apparatuses.

Dependent upon the quality of the first dyadic relationships, the nature of the communication which occurs in them, of traumatic psychological events and of the integrity of the integrated forces of personality formation, residues of earlier modes of perceiving the dyadic relationship may be encountered. Examples of these in adolescent and adult patients are given.

The recognition of the possibility of shifts in the perception of the levels of the dyadic relationship is of importance in the conduct of individual psychotherapy, as the therapist can then deal more realistically with such topics as the establishment of goals, the management of the modes and quality of communication, as well as of transference and counter-transference relationships. This is particularly true of the treatment of patients with poorly integrated personalities. The fluctuations referred to are seen most dramatically with some schizophrenic patients.
Psychotherapy in Eating Disorders
Authors: Bruch H.
Published: April 2017

This paper emphasizes that neither obesity nor severe malnutrition represents a uniform clinical psychiatric picture. The therapist must always pay attention to and integrate the various factors involved in eating disorders such as the underlying personality problems, resolution of the interactional conflicts within the family and correction of the abnormal nutritional states.

The similarities and differences of both obesity and anorexic states are described. Primary or typical anorexia nervosa is differentiated from the atypical kinds. The importance of early developmental factors of how the child differentiates inner and outer stimuli, the appropriate or inappropriate responses to these and the manner in which these early experiences later affect somatic, social and psychological self concepts are discussed.

Various parameters and modalities of treatment are described based on the author's long-term experiences with a large number of patients.
Police Negotiations: A New Role for the Community Psychiatrist
Authors: Pearce K. I. , Macmillan Harold
Published: April 2017

This paper reviews the type of individual who might be involved in a hostage situation and police negotiations. It singles out those clinical characteristics which are important in determining the management of the negotiations, and in doing so adds a plea for psychiatrists to become involved in an advisory role. By pointing out the need for psychiatrists and police to review some of the problems and determine a common approach before the situations arise, an additional characteristic is added to the role description of the community psychiatrist.
The Trauma of Being Psychotic: A Neglected Element in the Management of Chronic Schizophrenia?
Authors: Jeffries J.J.
Published: April 2017

A hypothesis is put forward in regards to what is called “chronic schizophrenia” that those observations which suggest a continuing disease process may turn out not to be intrinsic facets of schizophrenia as a neurochemical instability but rather neurotic reactions to the acute schizophrenic process. The hypothesis goes on to suggest that this reaction to the acute psychosis is such as to constitute a traumatic neurosis and that while controlling the psychosis with an “umbrella” of major tranquilizers, it is possible to resolve this neurosis. Resolution of the neurosis requires a particular approach to therapy. This is a hypothesis which is very much open to experimental examination and one which may, if proven, markedly affect the post-psychosis management of schizophrenia.
Alcoholism and Gun Control
Authors: El-Guebaly N. , Lee M.
Published: April 2017

The recurring dilemma of having to deal with an intoxicated person in possession of a gun uttering homicidal or suicidal threats along with the current debate on gun control prompted this controlled survey of the characteristics of individuals with problems arising from the joint abuse of alcohol and possession of a gun.

A comparison of the data point to violence as being the most significant differentiating variable involved. This violent potential was reflected by the presence among the alcoholics involved of more past and present antisocial traits, a higher rating on the Nicol's scale of violence, more offences committed against the person and homicidal behaviour. The availability of a gun was a significant factor. No correlation was found between the severity of the drinking problem and the risk of dangerous handling of a gun.

The need for more stringent gun controls is supported but their implications to the physician and especially the psychiatrist as a potential guarantor for a licence application ought to be further explored by the professional bodies involved.
Alpha and EMG Feedback Training in the Prevention of Drug Abuse: A Controlled Study
Authors: Lamontagne Yves , Beauséjour René , Annable Lawrence , Tétreault Léon
Published: April 2017

Seventy-five college students who were regular drug users were randomly assigned to five experimental groups: alpha feedback, EMG feedback, joked feedback, no-feedback and no-treatment. All treated subjects participated in twelve 30-minute training sessions, four in the laboratory and eight at the college, over a period of four weeks.

At the end of the final session, the alpha group had a significantly higher adjusted mean alpha level than the EMG and no-feedback groups but this disappeared during follow-up. The EMG group had a significantly lower adjusted mean EMG value than the alpha, no-feedback and no-treatment groups, which was maintained during follow-up while feedback was present and, to a less substantial degree, when feedback was not present. There were no significant differences between treatment groups as regards the adjusted mean alcohol or cigarette consumption and sleep parameters.

Concerning drug use, among medium users (6–13 times monthly), the EMG feedback group had a consistently significantly lower adjusted mean drug use after treatment and at the one- and three-month follow-ups than the no-treatment group. Among high users, subjects who received feedback (alpha, EMG or joked) tended to reduce their drug use compared to pre-treatment levels, whereas those in the no-feedback or no-treatment groups experienced an increase.

Since drug use was the only variable appreciably influenced by feedback training, the results tend to suggest that EMG feedback could serve as a means for the prevention of drug abuse, particularly for patients where anxiety is a predisposing factor.
Confidentiality and the Mental Health Professional
Authors: Weisstub David N.
Published: April 2017

Although the Canadian common law provides neither a courtroom privilege to psychiatrists nor a general right of privacy, it is argued that the traditional approaches to the issue are defensible. The confidential relationships between the therapist and his patient are so diverse that simple or general solutions are to be discouraged. The fiduciary relationship is sufficiently well defined that where serious breaches of confidence occur the courts may be expected to afford a just remedy.
Utilization of an Evening/Night Hospital: First Two Years of Operation
Authors: Ratcliffe William D. , Nixon G. William , Dyck Ronald J. , Azim Hassan F. A.
Published: April 2017

This study examined the utilization of an integrated evening/night hospital by 234 psychiatric patients referred to the hospital during its first two years of operation. Neither age, sex, marital status, referral source or diagnosis were related to utilization. However, patients whose previous treatment involved traditional psychiatric care, either inpatient or outpatient, were less frequently admitted and less likely to complete the program once admitted, than were those patients reporting either day hospitalization or no treatment prior to their admission.

There were steady increases in the number of referrals, number of different referring agents, average length of stay and average daily census as the program matured during the first two years of operation. While these data indicated an increase in the utilization of the evening portion of the program, there was a commensurate decrease in the utilization of the night portion of the program. As a result, the provision of overnight accommodation has been discontinued altogether.
The Impact of Government Insurance on a Psychiatric Clinic
Authors: Stein Samuel , Eaton William W. , Beck Philip , Fletcher Ailie C.
Published: April 2017

This paper considers the impact of a state medical insurance system on the structure of psychiatric services. The tendency of the upper socioeconomic classes to use private practitioners, and the lower classes to use public clinics, is examined before and after the imposition of the medical insurance system in Quebec in 1970. Data from one public clinic reveal a significant rise in the socioeconomic status of patients after Medicare. Alternative interpretations for the change in the clinic population are explored.
Classification of Depressive States
Authors: Lehmann Heinz E.
Published: April 2017

A uniform classification of depressive states is still far from being complete and generally accepted, although improved and expanding treatment modalities today require valid homogeneous groupings more urgently than ever before. Semantic clarification is needed regarding many terms, for instance that of psychotic depression which is used by many as being synonymous with endogenous. Many attempts of establishing solid categories of depression by sophisticated statistical analysis have failed to yield definitive results, although several independent studies of this kind have produced suggestive evidence for the existence of a type of depression that may be equated with the classic endogenous depression. However, most efforts to demonstrate a clear bimodal distribution of depressive states and establish a category of neurotic depression have failed. These difficulties have prompted such compromise diagnostic labels as endoreactive or endogenomorphous. Genetic research has contributed to the only unequivocal diagnosis in this field: that of bipolar depression. A distinction between necessary and sufficient depressive symptoms is being proposed in this paper; and Foulds and Bedford's category of dysthymic disorders, which includes anxiety and depression, opens an interesting new perspective. The time-honoured diagnosis of involutional melancholia will no longer be included in the new editions of DSM III and ICD9 which are now being prepared. Current active research into the pathophysiology of depression and the biochemical disorders associated with it are likely to produce in the near future biological criteria for diagnosis and prognosis of depression that will be more operational than the traditional clinical features.
Education in Psychotherapy: Challenges and Pitfalls
Authors: Salvendy John T.
Published: April 2017

This paper concentrates on some shortcomings in the present training in psychotherapy. By centering out crucial foci of intervention it attempts to contribute to an improvement in the educational program. It points out that neither the length of the residency curriculum nor academic and/or clinical expertise are guarantees for psychotherapeutic skills. The significance of the teaching milieu on the orientation, the intensity and quality of the learning opportunities provided is described. Administrative aspects from the psychotherapy teacher's point of view are examined. The controversy around cognitive versus experiential aspects of supervision is discussed. The supervisor's role and the various supervision modalities are commented upon. The author recommends to pay attention to some neglected issues in supervision and to heed the resident's feedback. Other aspects of a comprehensive training in psychotherapy are touched upon. The author concludes with a caveat. Psychotherapy will be endangered by changes in our society unless the teaching of it will be of high standards to assure viability in competition with other treatment modalities.
Life without Eating or Drinking
Authors: Macritchie K.J.
Published: April 2017

Total Parenteral Nutrition is no longer a short-term life-saving therapy, but can now provide an alternative permanent nutritional route following loss of small bowel function. Patients placed on the regimen go through several stages during adaptation. Those who have suffered from a chronic debilitating small bowel disease and have previously undergone multiple resections with poor residual nutritional intake, adapt more readily to the regimen than those who have suffered from the combined physical and psychological trauma of sudden massive loss of bowel. The technique has been successful in maintaining one individual in the group studied in good nutritional balance outside hospital for a period of eight years (13). This has been due to combined advances in medical surgical and pharmaceutical techniques (8). Further refinement of the nutritional support system utilized is needed to reduce the duration of the feeding process with the aim of minimizing sleep interruption and resultant fatigue. In elective consideration for TPN, assessment of both personality structure and domestic environmental support is advisable, since the patient generally does not do well in an unsupportive environment with resultant complications and frequent re-hospitalization. Conjoint training of a spouse or family member is essential; and introduction to another patient who has previously adapted well is beneficial. Later, a close liaison should be established with a Home Alimentation Nurse (8-10). The psychiatrist has a potential role in advising the gastroenterologist regarding the suitability of the individual being considered for elective total parenteral nutrition. He has a more definite role in the management of the psychological disturbance, frequently observed as depression, following surgery or later, when it appears secondary to the problems imposed by an altered modus vivendi. The group poses a further special challenge to the psychiatrist due to the unavailability of the normal route of administration of psychotropic drugs when they are indicated.

In addition to the attainment of a relatively normal survival of individuals who have sustained complete loss of small bowel function, TPN offers vistas for research into body nutrition requirements (11) and demands further extensive detailed psychosocial studies of this unique group of individuals.
William Henry Jackson (1861-1952): Riel's Secretary
Authors: Greenland Cyril , Griffin John D.
Published: April 2017

Although there have been many studies of the trial of Louis Riel, following the 1885 rebellion, much less attention has been paid to the fate of his secretary William Henry Jackson, who was charged with “treason-felony” and found not guilty, reason of insanity. In an effort to throw some new light on this neglected aspect of medico-legal history, this paper describes the intense political and religious relationship between Riel and his secretary which culminated in the onset of Jackson's mental illness.

After a trial lasting less than half an hour, Jackson was committed to the “Selkirk Asylum” under a warrant of the then Lieutenant-Governor. Two weeks before Riel was executed, Jackson escaped from hospital and made his way into the U.S.A. No attempt was made to capture him. Jackson, having changed his name to Honoré Jaxon, became a labour organizer. He died in the psychopathic ward of Bellevue Hospital in New York on 10th January, 1952 at the age of ninety.
Notes on the Treatment of Anhedonia*
Authors: Shoichet Roy P. , Oakley Anne
Published: April 2017

This paper discusses the concept of anhedonia defined as the inability to experience pleasure. Many authors have noted the presence of anhedonia as a personality feature in patients with schizophrenia and other disorders. Anhedonia apparently begins early in life in relation to pathological reactions within the core family. Many authors feel that anhedonia is closely associated with poor premorbid adjustment, interpersonal incompetence and chronicity, and mediates towards poor prognosis.

The authors feel that interpretive forms of psychotherapy and psychoactive medication are not particularly effective in the treatment of anhedonic patients. They propose a selection of intellectual, physical and social activities as a more direct attack on this problem of anhedonia. Through these activities the patients are able to gain a tangible experience of pleasure while developing more effective interpersonal skills. The response of patients to activities also provides material for structured forms of psychotherapy and the combination and interaction of activity therapy and traditional psychotherapy is considered to be effective in many anhedonic patients.
Evaluation of Clinical Competence in Psychiatry by the Royal College Examination
Authors: Mclean Peter , Fleming Jonathan
Published: April 2017

One hundred and seven psychiatric residents, postgraduate program directors and Royal College Examiners returned questionnaires which inquired into the areas of training programs, interim performance checks and the Certification Examination. There was relatively little dissatisfaction expressed with the written examination. However, most residents, program directors and examiners felt there were better ways to evaluate clinical competence than by means of the oral examination which was considered to lack validity and reliability. Respondents were very constructive in the suggestions they offered which focused on two main areas: the need to provide examiners with a larger work sample of a candidate's performance (for example, through a sample of the candidate's treatment audio-visual tapes), and the desirability of explicit performance criteria from the Royal College as to their expectations in the areas of knowledge, skill, judgment and ethics, so that the examination could be the final step in a shaping process rather than a high risk, single trial, pass/fail situation.
Deployment, Supervision and Decision-Making of Residents in an Emergency Psychiatric Service
Authors: Finlayson A.J.R. , Bartolucci G. , Streiner D.L.
Published: April 2017

A lessening of personal discomfort felt by residents on-call in the Emergency Psychiatric Service has resulted from changes in the frequency of being on-call, exclusion of beginning residents from duty and arranging for the presence of a faculty psychiatrist for one or two hours during each on-call period. Coincidental significant reductions in the number of cases admitted to hospital and reductions in the proportion of discrepancies between diagnoses made by the emergency resident and those made later by inpatient unit staff have been described. The relationship of the changes in resident experience to the reduction in admissions and decreased proportion of diagnostic discrepancy has been discussed using a model of the process of emergency psychiatric admission described earlier by Bartolucci et al. (1). Less isolation, anxiety and some increased experience on the part of the psychiatric residents on duty in the Emergency Psychiatric Service results in greater awareness and better appraisal of the nonmedical aspects of psychiatric emergencies.
A Socio-Psychiatric Profile of Emergency Service Patients
Authors: Suh M. , Carlson R.
Published: April 2017

A study of patients using the psychiatric emergency services of the Royal Ottawa Hospital was undertaken to determine their demographic and clinical characteristics, correlations between the two and comparisons with other studies. Special clinical forms of every fifth patient seen were analyzed and the data presented. These data are useful in the planning of and establishing and operating a psychiatric emergency service with an attached short-term inpatient unit, as well as assessing the feasibility and value of crisis intervention and brief psychotherapy in treating patients quickly.
The Induction of Acute Psychosis in a Group Setting
Authors: Powell Craig
Published: April 2017

The case histories of two patients are described, each of whom suffered a severe psychotic decompensation, one apparently schizophreniform and the other affective, after attending a seven day marathon group conducted by a charismatic, aggressive leader. The work of Yalom and Lieberman is reviewed, with regard to leader and participant characteristics in encounter group casualties. Drawing upon the work of Bion and Kernberg, a specific means for the induction of psychosis is suggested, involving primitive splitting and the projection of “all bad” self-object constellations within a group setting.
The Relationship between Agoraphobia and Primary Affective Disorders
Authors: Bowen R.C. , Kohout J.
Published: April 2017

Detailed clinical records were kept on a series of 55 agoraphobic patients who presented to a general hospital psychiatric practice over a 3 year period. A review of the records revealed that 91% of these patients were diagnosed as suffering from a unipolar or bipolar primary affective disorder. The anxiety and phobic symptoms tended to mask the presence of the affective disorder. This observation is consistent with most of the published data on the agoraphobic syndrome. It could also explain the inconsistent effects of treatment of agoraphobia compared with simple phobias. The possible biological and psychological connections between primary affective disorders and the agoraphobic syndrome are discussed.
The Influence of the Supervision of Psychotherapy upon being Therapeutic: I: Introduction and Background to the Supervisory Relationship
Authors: Greben Stanley E.
Published: April 2017

In individual psychotherapy which derives from psychoanalysis, the most important teaching tool is individual supervision. This is in keeping with the fact that close person-to-person contact between student and teacher is the most effective mode of teaching in a university.

The supervisor's first task is to transmit a body of knowledge, about psychotherapy, to the student. His second task is to give the student the benefit of his experience around clinical problems or questions. His third task is to assist the student in the development of certain attitudes which are valuable and even essential for a psychotherapist. This latter task is accomplished largely via “reality identification”.
Incidence of Psychiatric Treatment of Adolescents
Authors: Nichol Hamish
Published: April 2017

The characteristics of adolescents aged 15–19 years who received psychiatric treatment for the first time in British Columbia in 1966 are considered. Females predominated substantially over males, as did those living in urban areas over those in rural ones. Somatic, psychological, behavioural and suicidal presenting problems were commoner in females, with delinquent and academic ones being more frequent in males. Depression, psycho-neurosis and personality disorders were commoner in females. Medication was used in conjunction with psychotherapy more frequently in females. Long-term psychotherapy (more than 16 visits to a psychiatric facility) was employed in only 3 percent of females and 2 percent of males. Psychiatrists provided the greatest amount of care given. The hypothesis that females from rural areas living in the city constitute a vulnerable group of individuals more likely than their adolescent peers to seek psychiatric care requires evaluation in a further study.
Evidence of Brain Dopamine Deficiency in Schizophrenia
Authors: Chouinard Guy , Jones Barry D.
Published: April 2017

It is proposed that the increased dopamine function suggested by the dopamine hypothesis of schizophrenia is a dopaminergic postsynaptic receptor supersensitivity resulting from a dopamine deficiency. In support of this, three double-blind controlled studies conducted on drugs which alter brain dopaminergic activity in a manner different from that of classic neuroleptics are reported. 1) α-methyldopa-neuroleptic interaction proved efficacious for schizophrenic positive symptoms but only on a short-term basis. 2) Rubidium improved negative symptoms rapidly, and in contrast has a late onset of action on positive symptoms of schizophrenia. 3) Tryptophan-benserazide was efficacious in controlling both negative and positive symptoms of schizophrenia (although less so than chlorpromazine). It is concluded that currently accepted modes of pharmacological therapy (classical neuroleptics) are in the short-term controlling the dopamine supersensitivity secondary to a deficiency, but contributing in the long-term to increase the dopamine deficiency, and so exacerbate the supersensitivity. More effective forms of treatment may involve the use of agents which alter dopamine activity without inducing dopamine supersensitivity.
The Referring Therapist's Expectations of Inpatient Treatment: Some Atypical Variants
Authors: Miach A. , Elliott J. , Cava J.
Published: April 2017

The authors examined, over a three month period, modes of referral for inpatient treatment to a general psychiatric institute. What became apparent were several unconscious or unexpressed motivators in the therapist's referral which were noted as “unusual” or “atypical”. These were identified and quantified into a list of atypical variations of the standard referral, which is presented, together with a description of each, and illustrative case material. The authors note there is a practical relevance to this, in that for each atypical variant there are pitfalls and potential for mismanagement, which if not recognized could well lead to a deleterious outcome for the patient and the therapists involved.
Re-Examination of the Clinical Mental Status Examination
Authors: Rapp Morton S.
Published: April 2017

The traditional “mental status examination”, as taught in medical school, is critically reviewed. The disparity between what is practised and what is preached, is outlined. Specific tests alleged to give information about mental function are discussed, and their clinical utility is found to be debatable.

It is concluded that the reliability and validity of the mental status examination would be well worth testing. Alternatively, more use should be made of standarized tests which are now in the hands of clinical psychologists.
Aggressive Preschoolers: A Pilot Study
Authors: Kligman David H. , Szmuilowicz Julio , Choptiany Elaine , Sameshima Toyoko
Published: April 2017

The authors studied the relationship between the level of aggressivity in 12 aggressive preschoolers and five hypothesized pathogenic variables: constitutional, lack of maternal attunement to the child's needs, passive experience of aggression, parental overindulgence and the presence of a precipitant. The data tend to support a strong predictive association between the pathogenic variables as a group and the level of aggressivity, although the results must be regarded as preliminary because of the small number of cases.