bluuebunny/crossref_metadata_2025 huggingface dataset:
Body Image Disturbance in Anorexia Nervosa: Beyond Body Image*
Authors: Warah Aïda
Published: April 2017

In this paper the literature on body image disturbance in anorexic patients is reviewed. After a decade of experimental investigation of body image in anorexia nervosa, where old and new techniques have been used and where a large number of correlations have been identified, what do we really know? The findings have been conflicting but some regularities exist. It is hypothesized that the conflicting results may be related to the presence of different subgroups among anorexics and different types of body image disturbance. Body size estimation is only one dimension of body image perception. likewise, body size overestimation is only one aspect of body image perception. Likewise, body size over-estimation is only one aspect of body image disturbance. Some, but not all anorexics, overestimate their body size, and those who do, seem to have poor prognosis. Body size overestimation is not confined to anorexics. It is not known whether it is a function of a general perceptual/cognitive disorder, but it does seem to be stable over time. The implications of the presence of other psychiatric conditions in anorexic patients are discussed and suggestions for future research and for practice are made.
The Etiology of Nonpsychotic Emotional Illness
Authors: Waring E.M. , Patton D. , Wister A.V.
Published: April 2017

Two hundred and fifty couples in the general population completed self-report questionnaires which measured life events, personality, marital intimacy, and symptoms of non-psychotic emotional illness. Path analysis was utilized to explain the development of symptoms of nonpsychotic emotional illness. Personality traits of neuroticism and extroversion explained most of the variance of symptoms of nonpsychotic emotional illness. Life events played a much smaller but significant role and marital intimacy was a nonsignificant factor. The data support a proneness model for the etiology of nonpsychotic emotional illness.
Anticipatory Nausea and Vomiting: A Form of Chemotherapy Phobia?
Authors: Reesal Robin T. , Bajramovic Hifzija , Mai François
Published: April 2017

This paper proposes that the phenomenon of anticipatory nausea and/or vomiting is a component of a phobic response to chemotherapy. Two cases are presented to highlight the clinical aspects of chemotherapy phobia. The evidence confirming such a diagnosis is put forth as it relates to anticipatory anxiety, phobic response, avoidance behaviour and treatment.
A Case Study: Schizophrenia and Tactile Hallucinations, Treated with Electroconvulsive Therapy
Authors: Salama A. Aziz A. , England Russell D.
Published: April 2017

The authors review the literature on tactile hallucinations. They examine its occurrence in a schizophrenic patient who had poor response to neuroleptic medication, after several admissions to a psychiatric hospital. The patient responded well to electroconvulsive therapy when it was combined with a small dose of a neuroleptic. Due to prolonged use of neuroleptics he developed tardive dyskinesia that responded only to a large dose of lecithin. They discuss the use of electroconvulsive therapy in schizophrenic patients who have shown little or no response to neuroleptics after prolonged use. The case presented showed better clinical response with smaller doses of antipsychotic medication, when combined with electroconvulsive therapy.
Dépressions avec attaques de panique: caractéristiques cliniques et prévalence en milieu hospitalier
Authors: Hardy P. , Feline A. , Bonis M. De , Rigaud A.S. , Epelbaum C.
Published: April 2017

Seventy-three patients successively hospitalized in psychiatry and meeting the criteria of the DSM-III for diagnoses of major depressive episode with or without melancholia (n = 64), dysthymia (n = 5) or adjustment disorder with depressed mood (n = 2) were studied.

Of these 73 patients, 50.7% also exhibited, at the time of their hospitalization, panic disorder as defined by the DSM-III criteria (53.4% having exhibited this disorder at some time in their life).

Moreover, eight of the 73 patients (11%) exhibited, or had exhibited at some time in their life, a “sub-panic” state characterized by recurring rudimentary attacks, while five of the 73 patients (6.8%) exhibited “permanent panic anxiety” tending to fluctuation rather than paroxysm. These two forms of anxiety raise the question of the limits of panic disorder.

The comparison of depressions with and without panic disorder shows an even distribution of endogenous and nonendogenous forms in both groups. Depressions with panic disorder, moreover, registered greater intensity (according to the HDRS score), a higher lever of anxiety (according to the AMDP-AT score), and a higher degree of nervousness (according to the EPI score) than depressions without panic disorder.

The study of the chronology of the associations between depressions and panic disorder shows that in more than one-half of the cases these disorders began within one month of each other. In one-third of the cases, panic disorder preceded the depressive episode by more than one month. And finally, in just over 10% of the cases, panic disorder appeared more than one month after the beginning of the depressive episode.
Electroconvulsive Therapy in Depression
Authors: Persad E.
Published: April 2017

Electroconvulsive therapy (ECT) has been in use for over 50 years and remains one of the most effective treatments in psychiatry. Effectiveness rates for ECT in depression range between 80% and 90%; no comparative study has shown any other intervention to be superior to ECT. ECT is also recommended for mania, schizophrenia and as a safe treatment for the elderly or medically ill depressed patient. This paper will deal with the use of ECT in depression. The areas to be covered are the clinical indications, the factors predictive of response, the evidence for the efficacy of ECT, as well as theories of the mechanism of its action, side effects and guidelines for prescribing the procedure. Notwithstanding the efficacy, the safety and perhaps an improved public acceptance, some observers have noted that there is a decline in the use of ECT. Others have suggested that such a decline may be evident only in the public sectors such as state and provincial psychiatric hospitals. Ongoing research is necessary to achieve further refinement of ECT, as well as enhance our understanding of this important treatment procedure.
Issues in the Evaluation of a Community Psychogeriatric Service
Authors: Harris A.G. , Marriott J.A.S. , Robertson J.
Published: April 2017

The need for evaluation of community psychogeriatric programs is stressed. The results of the evaluation of an outpatient service, with a liaison component, based in a community general hospital are presented. The use of treatment outcome scales, user satisfaction surveys, and a study of cost effectiveness are discussed. The issues of needs assessment, service models, staffing, target population, and the role of the family physician are addressed. It is recommended that evaluation processes be initiated by psychogeriatric services and that program data collection be developed in a manner that allows for service comparability, the assessment of ongoing community needs and the determining of program effectiveness.
Psychosocial Adjustment and Quality of Life following Heart Transplantation
Authors: Mai Francois M. , Mckenzie F. Neil , Kostuk William J.
Published: April 2017

This article describes the pre-operative psychosocial and quality-of-life adjustment of a consecutive series of 27 heart transplant recipients and the adjustment of the 24 survivors at 12 months follow-up. Pre-operatively, 14 had a psychiatric diagnosis and this figure had dropped to five at 12 months follow-up. Those patients without a psychiatric diagnosis pre-operatively had not developed one at follow-up. There was a significant correlation between pre-operative psychiatric diagnosis and a rating of poor medical compliance. Ratings of physical activity, employment and questionnaire ratings of psychological adjustment also showed highly significant improvement at follow-up and the majority of patients were active sexually. It is concluded that heart transplantation in selected subjects with terminal heart disease results in a substantial improvement in psychosocial adjustment and quality-of-life 12 months following surgery.
A Case of Tourette Syndrome Developing during Haloperidol Treatment
Authors: Karagianis James L. , Nagpurkar Ranjana
Published: April 2017

A ten year old boy developed features of Tourette syndrome while taking haloperidol for behaviour problems. A record of his tics was kept and followed during his admission in hospital. His symptoms worsened as haloperidol was decreased and improved as the haloperidol was increased. The literature regarding tardive Tourette syndrome is reviewed and potential implications of the case are discussed.
Life Events and the Recurrence of Depression
Authors: Ghaziuddin M. , Ghaziuddin N. , Stein G.S.
Published: April 2017

In a study of the prevalence of life events in recurrent depression, 40 patients with recurrent episodes were compared to 33 who were experiencing their first depressive illness. Thirty out of 33 (90.9%) first episode cases experienced life events prior to the onset of illness whereas only 20 out of 40 (50%) of the recurrent group gave such as history. Patients with a first episode had an average of 2.2 life events in the six months prior to onset, whereas recurrent patients experienced average of only 0.8 life events (p < 0.05). Negative as well as exit events were also significantly more frequent among the first episode group. Although life events, age and sex all contributed to the recurrence of depression, most of the variance was not accounted for by any of these factors.
Competence to Consent to Treatment: A Guide for the Psychiatrist
Authors: Draper Ronald. J. , Dawson David
Published: April 2017

During the last decade there has been increasing pressure to legislate legal rights for psychiatric patients especially in relation to consent to treatment. The attempt to subject the irrationality of psychotic illness to the due process of rational laws has caused problems. Revision of the Ontario Mental Health Act (MHA) has already led to situations in which patients are being incarcerated without treatment because of review board decisions regarding dangerousness and competence. The test in the revised MHA is whether the patient is competent to give or withhold consent for treatment. Existing guidelines for determination of competence to consent to treatment rely upon observer judgement and are open to challenge on grounds of subjectivity. The medical directors of the ten Ontario provincial psychiatric hospitals have therefore developed a guide and schema to operationalize the MHA definitions, a novel feature of which is the examination of competence in such a way as to elicit and capture the patient's own responses upon which an objective determination is made.
Aggression in Adolescents: The Role of Social Support and Personality
Authors: Kashani Javad H. , Shepperd James A.
Published: April 2017

A study was conducted to determine the degree to which social support and personality predict the use of reasoning and aggression by adolescents to resolve interpersonal conflict. Although all adolescents appeared to use reasoning to resolve conflict, those with less social support and those exhibiting a forceful personality were more likely to report using verbal and physical aggression to resolve conflict. By contrast, introverted adolescents were less likely to report using verbal aggression to settle their differences. The importance of social support, as well as measures that can be taken by mental health professionals to prevent the use of aggression by adolescents, are discussed.
The Attitudes toward Committal of Patients Hospitalized in a Psychiatric Facility for the First Time
Authors: Conlon P. , Merskey H. , Zilli C. , Frommhold K.
Published: April 2017

This study examines the attitudes toward committal of patients admitted to a psychiatric facility for the first time. Sixteen patients, from a group of 28 patients consecutively admitted to hospital on an Ontario Form 1 certificate were able to complete a satisfactory interview. In general, patients viewed the committal procedure favourably. They endorsed medical professionals as being best qualified to institute the committal procedure. A discrepancy between behaviour documented on the committal form and the patients' own perception of their mental state at the time of committal was noted. These findings are discussed with reference to previous research on civil commitment.
Increased Detection of Elevated TSH Using Immunoradiometric Assay
Authors: Little Karley Y. , Kearfott Kelly S. , Castellanos Xavier , Rinker Alan , Whitley Ron
Published: April 2017

Using a highly sensitive immunoradiometric assay, the authors detected an increased rate of elevated thyrotropin in 2,099 patients vs 1,789 patients examined with radioimmunoassay. Closer scrutiny of mood disorder patients with elevations found confirmatory evidence of thyroid dysfunction in most.
Intermittent Lithium Therapy in a Bipolar Patient
Authors: Ananth Jambur , Djenderedjian Armen H. , Kaur Amrit
Published: April 2017

A 35 year old married male who had previously had manic episodes twice, during winter months, was treated with intermittent lithium therapy between November and February of each year and was well for a period of five years. The case report and the findings are discussed to demonstrate the possibility of intermittent lithium therapy in some patients.
Neuroimaging and Affective Disorder in Late Life: A Review
Authors: Morris Pearse , Rapoport Stanley I.
Published: April 2017

Within the past two decades brain imaging techniques have given the clinician access to new anatomical and functional findings for dealing with affective disorder in the older age group. Despite the proliferation of such technology, the significance of findings on computerized axial tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) remains unclear in this patient group. The literature covering old age depression and imaging techniques is reviewed, and problems related to methodology, sample selection, and implications for the direction of future research are discussed. Current evidence particularly suggests that subcortical atrophy may be an important factor in the genesis of affective disorder in old age. The question of cognitive decline in the setting of affective disorder is examined. The use of brain imaging techniques may have particular bearing upon identification of etiology of affective disorder, prediction of treatment response, or risk of relapse.
Death of the Analyst
Authors: Kleinman Irwin
Published: April 2017

This paper assesses the impact that the death of two training analysts had on their analysands. The dependent variable, which is length of analytic training, was chosen because it is objective, easily measured and should reflect the disruption due to an analyst's death. Patients of the deceased analysts had a significantly increased length of training (Fisher's exact probability, p < .02). This work reviews a number of relevant methodological issues and attempts to show how one can examine observable phenomena empirically. It is hoped that clinicians will begin to address how their psychotherapeutic work could be assessed using scientific methodology.
Psychosocial and Erotic Development in Cross-Gender Identified Children
Authors: Zucker Kenneth J.
Published: April 2017

This article reviews certain aspects of psychosocial and erotic development in cross-gender identified children. Consideration is first given to the hypothesis that cross-sex affiliation preference and its attendant social ostracism is one factor that accounts for the presence of behavioural psychopathology in cross-gender identified boys. Next, the strong relation between patterns of childhood sex-typing and later sexual orientation is discussed. It is concluded that more attention should be given to the study of erotic development in its own right.
Preschool Age Children of Divorce: Transitional Phenomena and the Mourning Process*
Authors: Stirtzinger Ruth , Cholvat Lorraine
Published: April 2017

The role of the family home as an attachment object was investigated in 57 preschool age children coping with the stress of a parental divorce. Results indicated that preschool age children of divorce exhibited an increased level of attachment to the family home as compared with children matched for age and socioeconomic status from intact family units who moved away from the family home. In addition, preschool age children who moved from the family home but show a high attachment to it demonstrate better behaviour adjustment than both the groups of children of divorce who showed low attachment after moving from the family home and the group who remained living in the family home after divorce (p < .05).
A Pilot Study of Panic Attacks in a Child and Adolescent Psychiatric Population
Authors: Bradley Susan , Wachsmuth Rod , Swinson Richard , Hnatko Garry
Published: April 2017

This preliminary study examines the prevalence of panic attacks in a child and adolescent psychiatric population through a questionnaire survey of child psychiatrists. Panic attacks were reported in 26% of the sample. The rates varied with patient diagnosis, age, and sex.
Affect Regulation and Psychopathology: Bridging the Mind-Body Gap
Authors: Bradley Susan J.
Published: April 2017

A failure of affect regulation is put forward as central to the development of psychopathology. Giving affect regulation this pivotal role allows one to explain how the various theories of intervention (for example, dynamic, behavioural, medical) can all have relatively similar results. As well, it provides an explanation for the common findings of brain and language dysfunction in psychopathology, the co-occurrence of anxiety disorders in various other mental disorders and the responsiveness of individuals with severe pathology to the affect in their environments. A model is presented linking the reticular, limbic and frontal systems of the brain with the conceptual frameworks used by mental health workers in their efforts to intervene. To illustrate how the model may be used, it is applied to various disorders.
Tardive Dyskinesia: Legal and Preventive Aspects
Authors: Shriqui Christian L. , Bradwejn Jacques , Jones Barry D.
Published: April 2017

Tardive dyskinesia is a complication associated with long term neuroleptic drug treatment that can be the object of litigation. Such litigation has occurred recently in the United States, where awards of considerable value have been granted to plaintiffs. Circumstances that can lead to TD litigation are presented as well as guidelines for the prescription of neuroleptics, the prevention of litigation and of the syndrome itself. Five lawsuits associated with TD serve as a backdrop for the discussion.
Attachment Pathology and Low Social Skills in Avoidant Personality Disorder: An Exploratory Study*
Authors: Sheldon Adrienne E.R. , West Malcolm
Published: April 2017

The criterion of desire for affection and acceptance was eliminated from the definition of avoidant personality disorder in the DSM-III-R. But clinical experience in our setting suggests that attachment pathology related to such desires is an important diagnostic feature and a frequent focus of clinical intervention with avoidant individuals. Forty-seven patients receiving a clinical diagnosis of avoidant personality disorder completed a brief questionnaire which rated desire for an attachment relationship, fear of an attachment relationship and level of social skills. The results support our hypotheses that attachment security is distinct from general social skills and that desire for but fear of an attachment relationship is more characteristic of those diagnosed with avoidant personality disorder than a low level of social skills.
Mania-Like Reaction Induced by Benzodiazepine Withdrawal in a Patient with Mental Retardation*
Authors: Ghaziuddin N. , Ghaziuddin M.
Published: April 2017

Symptoms resembling mania following withdrawal of diazepam in a mentally handicapped woman are described. The importance of considering benzodiazepine withdrawal in the assessment of acute behavioural disorders of the mentally handicapped is emphasized. Attention is also drawn to the paucity of research regarding the use of antianxiety drugs in the mentally handicapped.
The Public Image of Psychiatrists
Authors: Lamontagne Yves
Published: April 2017

The image of psychiatry is directly related to the knowledge that the public has of psychiatry and to the psychiatrists role as a “public informer”. The time has come for psychiatrists to organize and have their opinions on all aspects of the mental health care system and mental illness heard in the media.

After a review of different causes of the negative public image of psychiatrists, the reasons for which psychiatrists need to change their public image are outlined with some suggestions for increase public recognition. The importance of developing more research on the effect of mass media on the mental health care system is also outlined.
A Guide to Benzodiazepine Selection. Part I: Pharmacological Aspects*
Authors: Teboul Eric , Chouinard Guy
Published: April 2017

Since absorption rates, volumes of distribution and elimination rates differ greatly among the benzodiazepine derivatives, each benzodiazepine has a unique plasma concentration curve. Although the time to peak plasma levels provides a rough guide, it is not equivalent to the time to clinical onset of effect. Two half-lives can be described: the alpha half-life, the rate of decline in plasma concentrations due to the process of drug redistribution from the central to the peripheral compartment, and the beta half-life, the rate of decline due to the process of drug elimination due to metabolism. The frequent classification of benzodiazepines into long, intermediate, and short-“acting” categories based on their terminal beta half-lives is unfounded; the duration of action is much more dependent on the alpha half-life. Benzodiazepines with short beta half-lives are commonly thought to be preferable because they accumulate less. However, with repeated use, sedation and cognitive neuromotor impairment usually diminish progressively despite stable or even rising benzodiazepine plasma concentrations, whereas anxiolytic effects generally persist over time.
Early Diagnosed Chronic Illness and Mother-Child Relationships in the First Two Years
Authors: Goldberg Susan , Washington Jane , Morris Penny , Fischer-Fay Anneke , Simmons Robert J.
Published: April 2017

As part of a longitudinal study, children in three groups (healthy, n = 33; cystic fibrosis (CF) n = 28; congenital heart disease (CHD) n = 23) were seen between the ages of 12 and 18 months to assess infant-mother attachment and at two years to observe parent-child negotiation of autonomy/dependence in a puzzle task. Although the healthy group included the highest proportion of securely attached infants and the CHD group the lowest, the distribution of attachment patterns did not differ significantly between groups, or between any of the groups and established norms. At two years the healthy children had the most positive experience in the puzzle task while the children in the CF group had the least positive experience. When diagnostic groups were divided according to prior attachment status, the data for the healthy group were consistent with the prediction that securely attached children would have the most positive mother-child interaction at age two. This was not the case in either of the medically diagnosed groups. These data suggest that the influence of the early parent-child relationship may be altered by a child's health status. We may need different models to account for development in healthy and medically compromised children.
Psychiatric Considerations in Premature Birth*
Authors: Wittenberg Jean-V.P.
Published: April 2017

Five percent to ten percent of all live births are premature. Modern neonatology has dramatically improved survival rates. Morbidity rates, however, are as high as 60%, according to some studies. In this paper, outcome and intervention findings are described. Experiential, familial and socioeconomic factors interact synergistically with preterm birth and biological vulnerability to create cognitive, behavioural and interpersonal disorders. Principles of intervention are suggested, based on promoting organization within the infant and a responsive, active approach in the caregivers.
The Serotonin Hypothesis of Bulimia Nervosa: Theory and Evidence*
Authors: Goldbloom David S. , Garfinkel Paul E.
Published: April 2017

Bulimia nervosa is an eating disorder with multiple causes that has been the object of extensive research since it was first described in 1979. This review evaluates both the theoretical rationale and empirical evidence for a model which suggests that disturbed serotonin activity is involved in the development of this disorder. Limitations of the hypothesis and prospects for the future are considered.
Regionalization of Psychiatric Services for the Elderly
Authors: Shulman Kenneth I.
Published: April 2017

This overview addresses issues related to psychiatric services for the elderly in Canada. The author reviews the developments in the United Kingdom that have led to the establishment of guiding principles which may be applied to the Canadian health care system. These include the clear definition of a target population, a comprehensive approach to services, availability and accessibility, and clear accountability. A model for the establishment of regionalized psychiatric services is proposed, including the integration of hospital-based and community-based services with clearly defined areas of responsibility. In light of the changing demographics in Canada and the prevalence of psychiatric illness in the elderly, this is a matter of growing urgency for the health care system.
Anatomy of a Second Generation Tarasoff Case
Authors: Goldman David L. , Jacob Therese
Published: April 2017

Few medicolegal doctrines have spread so widely and wildly as the Tarasoff duty of professionals to protect potential victims of violence perpetrated by psychiatric patients. Post-Tarasoff decisions have not been limited to identifiable third parties in danger, but in some circumstances have been extended to the community at large. Lipari v. Sears, Roebuck and U.S. is the first of such court rulings to invoke the concept of strict liability for the violent acts of a patient who, in the case presented, randomly fired at club patrons, killing one and wounding many others. A detailed examination of this pivotal and troubling case will facilitate recognition of the inherent complexity associated with subjecting human problems to the legal process.
Article
Authors: Ghaziuddin M.
Published: April 2017

Despite the known association of folie à deux with low intelligence, very few reports of its occurrence in people with documented mental retardation have been published. A case of folie à deux in a 32 year old man with moderate mental retardation is described and the clinical implications discussed. The need for an increased awareness of the existence of mental illness in the mentally handicapped is also emphisized.
The Effect of Sexual Assault on a Small Isolated Community
Authors: Glancy Graham D. , Regehr Cheryl
Published: April 2017

This paper documents the case of one family in which the two young boys were sexually abused by a school principal. Each family member suffered deleterious psychological sequelae as a result of the abuse. Since more than half the boys of one generation in this community were assaulted by the same perpetrator, we have postulated that the whole community suffered from a sense of betrayal, powerlessness and stigmatization.
A Guide to Benzodiazepine Selection. Part II: Clinical Aspects
Authors: Teboul Eric , Chouinard Guy
Published: April 2017

To suit the specific needs of various clinical situations, selection of an appropriate benzodiazepine derivative should be based on consideration of their different pharmacokinetic and pharmacodynamic properties. Benzodiazepine derivatives that are rapidly eliminated produce the most pronounced rebound and withdrawal syndromes. Benzodiazepines that are slowly absorbed and slowly eliminated are most appropriate for the anxious patient, since these derivatives produce a gradual and sustained anxiolytic effect. Rapidly absorbed and slowly eliminated benzodiazepines are usually more appropriate for patients with sleep disturbances, since the rapid absorption induces sleep and the slower elimination rate may induce less tolerance to the sedative effect. Rational selection of a benzodiazepine for the elderly and for the suspected drug abuser is more problematic. The relevant pharmacokinetic and clinical considerations for these users are discussed. Certain derivatives may possess pharmacodynamic properties not shared by the entire benzodiazepine class; empirical studies have suggested the existence of antipanic properties for alprazolam and clonazepam, antidepressant properties for alprazolam, and anti-manic properties for clonazepam and possibly lorazepam.
The Role of Canadian Psychiatry in Dangerous Offender Testimony
Authors: Rogers Richard , Lynett Elizabeth
Published: April 2017

Psychiatrists and psychologists who participate in dangerous offender hearings are accorded “expert status” by the courts for the long term prediction of violent recidivism. The clinical and judicial bases for such involvement are reviewed and critiqued. Given the frailties of our predictive abilities, the most prudent course would be for mental health experts to eschew dangerous offender determinations. Since this alternative appears unlikely, tentative guidelines are offered to reduce grave errors in testimony given at dangerous offender hearings.
Body Dysmorphic Disorder and the DSM-IV: The Demise of Dysmorphophobia
Authors: Munro Alistair , Stewart Mary
Published: April 2017

To some extent, the failure of some authors, reporting on dysmorphophic patients, to specify clearly the level at which the belief is held, has confounded clarification of the phenomenon.

Birtchnell (1)

Dysmorphophobia is a controversial term. It is not a phobia, reliable data on it are few, and many authors write about it without attempting to define it. DSM-III-R introduced the term “body dysmorphic disorder” to describe a non-psychotic condition in which there is pathological preoccupation with physical appearance and with the intention of replacing the term “dysmorphophobia”. However, psychiatrists continue to use the word dysmorphophobia, often unaware that it may have several distinct meanings.

This article, 1. demonstrates the current confusion in terminology, 2. elaborates on DSM-III-R's concept of body dysmorphic disorder, and 3. suggests refinements for the DSM-IV description.
Abuse Histories in 102 Cases of Multiple Personality Disorder
Authors: Ross Colin A. , Miller Scott D. , Bjornson Lynda , Reagor Pamela , Fraser George A. , Anderson Geri
Published: April 2017

The authors interviewed 102 individuals with clinical diagnoses of multiple personality disorder at four centres using the Dissociative Disorders Interview Schedule. The patients reported high rates of childhood trauma: 90.2% had been sexually abused, 82.4% physically abused, and 95.1% subjected to one or both forms of child abuse. Over 50% of subjects reported initial physical and sexual abuse before age five. The average duration of both types of abuse was ten years, and numerous different perpetrators were identified. Subjects were equally likely to be physically abused by their mothers or fathers. Sexual abusers were more often male than female, but a substantial amount of sexual abuse was perpetrated by mothers, female relatives, and other females. Multiple personality disorder appears to be a response to chronic trauma originating during a vulnerable period in childhood.
Psychiatric Patients and the Federal Election
Authors: Jaychuk G. , Manchanda R.
Published: April 2017

A questionnaire was sent to all eligible voters at the St. Thomas Psychiatric Hospital prior to the November 1988 election. It measured political awareness and knowledge. A further subgroup of patients who were eligible to vote but chose not to be enumerated were also questioned to explore their reasons for not voting.

The results showed patients had a high level of knowledge about our political process. We conclude that previous laws banning voting by psychiatric patients were unnecessarily discriminatory and efforts should be made to give voting rights to patients in other countries where they are not allowed to vote.
Heterogeneity in Responses to Cancer. Part II: Sexual Responses
Authors: Johnstone Beverly G.M. , Silberfeld Michel , Chapman Judy-Anne , Phoenix Candice , Sturgeon Jeremy F.G. , Till James E. , Sutcliffe Simon B.
Published: April 2017

Heterogeneity in psychosexual responses to disease-specific diagnosis is demonstrated for two groups of cancer patients with testis cancer and Hodgkin's disease who are comparable in prognosis and treatment intensity. The two groups of patients and their partners are shown to differ in their ability to recover from psychiatric problems associated with the diagnosis and/or treatment of cancer.
Benzodiazepines: Abuse and New Use
Authors: Warneke Lorne B.
Published: April 2017

Both abuse and new uses for benzodiazepines are reviewed. The pharmacology of benzodiazepines is summarized and statistics regarding their general use are given. The question of benzodiazepine abuse is reviewed in some detail and the question of rebound, recurrence of symptoms and physiological withdrawal is differentiated. Benzodiazepines are regarded as a very safe class of drugs and the abuse potential is felt to be negligible provided that they are prescribed for appropriate conditions and monitored carefully. The dangers of alternatives to benzodiazepines such as alcohol or barbiturates is emphasized. New uses for benzodiazepines are reviewed including the use of benzodiazepines in panic disorder, as well as an adjunct in the therapy of mania and some psychotic states. Rational prescribing of benzodiazepines is encouraged and the attitude that these are dangerous and addictive drugs is discouraged and put into perspective.
DSM-III: Use of the Multiaxial Diagnostic System in Clinical Practice*
Authors: Bassett Anne S. , Beiser Morton
Published: April 2017

The authors report on the use of the DSM-III, several years after its introduction, in the clinical diagnosis of 154 subjects with first onset psychosis. Clinicians usually assigned Axis I diagnoses but used the remainder of the multiaxial system less than one time in three; if a standard recording form was in place, the multiaxial system was used more often. Trainees used the DSM-III most, followed by psychiatrists affiliated with a university and community based clinicians. Agreement between researchers and clinicians on diagnoses was fair to poor. The authors discuss the implications of the acceptance of the complex diagnostic system in routine clinical practice.
New Uses of Countertransference for the Inpatient Treatment of Borderline Personality Disorder*
Authors: Rosenbluth Michael
Published: April 2017

The author describes the uses of countertransference for the inpatient treatment of borderline personality disorder. Differences from usage in the dyadic outpatient situation are noted. In particular, the countertransference induced in staff may provide a crucial signal function reflecting the patient-ward system. Understanding these feelings provides information not only about the patient's inner world but also about general system features such as the staff's needs, therapeutic capacity and unresolved feelings from previous borderline patients. The signal function may also have diagnostic and treatment implications. A conceptualization of counter-transference that encompasses the unique system aspects of inpatient psychiatry is helpful in the care of borderline patients.
Psychogenic Voice Disorders: Literature Review and Case Report
Authors: Matas Manuel
Published: April 2017

This paper explores some of the similarities and differences between hysteria and hypochondriasis and suggests that voice disorders are a prototype of disorders which reflect the intricate interplay of emotional, cognitive and physiological functions. Speech production requires the involvement of various systems of the body, including the central nervous system, respiratory and vocal systems. Voice disorders can take many different forms and can be caused by a variety of factors. A review of the relevant literature is presented along with a clinical case record of a woman with hysterical dysarthria.
Recent Developments in Attachment Theory and Research
Authors: Goldberg Susan
Published: April 2017

The history and development of attachment theory are reviewed. Research has focused on four major patterns of attachment in infancy: one pattern of secure attachment and three patterns of insecure attachment (avoidant, resistant, and disorganized). These patterns have been shown to reflect different histories of parent-child interaction and affected subsequent development up to age eight. More recently, methods have been developed for identifying similar patterns of attachment in preschoolers, five to seven year olds and adults. Future research is likely to focus on the development of attachment patterns and their transmission from one generation to another. New data on the relationship between attachment and behaviour problems has generated mutual respect and collaboration between clinicians and researchers.
Children, Families and the Cycle of Disadvantage
Authors: Schorr Lisbeth B.
Published: April 2017

It is possible to reduce rates of school dropout, teenage pregnancy, arrests for violent crime, and long term dependence on welfare. Programs that have improved outcomes among children in disadvantaged families provide access to an array of services cross professional and bureaucratic boundaries, emphasize relationships of trust and respect, are deeply, rooted in the community, are family focused, and recognize the distinctive needs of those most at risk. If health, mental health, social service and education programs with these attributes are to reach the large numbers who need them, the systems within which these programs operate must be restructured.
Guilt Loops
Authors: Pickering M. Ruth
Published: April 2017

Overlooking the role of parental guilt in recurrent parent-child conflict may limit effective interventions in family therapy. This paper presents a conceptual model of the role of parental guilt in the maintenance of recurrent dysfunctional sequences of parent-child conflict. The cybernetic model of guilt loops provides a framework for understanding and intervening in recurrent escalating parent-child conflict which is characterized by ambiguous, inconsistent limit-setting and consequences. Interventions based on guilt loops address the interaction between parental guilt and dysfunctional behaviour sequences and broaden the scope of possible interventions for the therapist. A clinical example illustrates the use of this model.
Psychiatric Consultation with Children in Underserviced Areas: Lessons from Experiences in Northern Ontario
Authors: Dubois John R. , Nugent Kevin , Broder Elsa
Published: April 2017

There are only 350 child psychiatrists in Canada. It is therefore unrealistic to expect them to be able to provide sufficient direct treatment, even in small densely populated communities with abundant resources. Such expectations are even more unrealistic in underserviced, sparsely populated areas. A review of the literature on psychiatric consultation in underserviced areas is presented along with a description of the consultation process, taking advantage of the “multiplier effect.” Some of the realities of mental health consultation in underserviced areas are discussed, stressing the importance of consultation as a way of professional life. Some guidelines for the psychiatric consultant are outlined which would enhance the “multiplier effect.” It is maintained that the training of psychiatric residents should include a supervised experience consulting in underserviced areas. Finally, it is hoped that psychiatric training programs, funding bodies, hospitals, and agencies, will recognize the value of this use of psychiatric expertise.
The Relationship of Suicide Rates to Sociodemographic Factors in Canadian Census Divisions
Authors: Hasselback Paul , Lee Kiang I. , Mao Yang , Nichol Richard , Wigle Donald T.
Published: April 2017

The correlates of suicide rates were determined by conducting a multivariate study of sociodemographic indicators and suicide rates of 261 Canadian census divisions. Twenty-one sociodemographic variables were entered into a stepwise multiple linear regression to develop a model for suicide rates. The important variables were mortality rate for all causes of death, the age. of the population, average family income, population density, proportion with no religious affiliation, proportion of Francophones, unemployment, immigration, proportion of Native people, a regional effect for British Columbia and the north, and growth by mobility, explaining 62% of the observed variation. This spatial ecologic analysis highlights the importance of cultural differences in explaining the variation of suicide rates. The analysis supports the previously found negative relationship between income and suicide while contrasting from previous studies in determining a inverse relationship with unemployment and an inverse relationship with the age distribution.
Therapy Begins at Home: The Psychiatric House Call
Authors: Kates Nick , Webb Steve , Lepage Patricia
Published: April 2017

The house call is a valuable but underused component of community psychiatric care. A review of home visits conducted by the staff of a community mental health service over a 12 month period identified four situations in which a home visit is useful: getting reluctant patients to enter therapy, conducting a comprehensive assessment, strengthening a support network, and maintaining patients in the community when their condition has deteriorated. Making psychiatric house calls requires some additional skills on the part of therapists and offers residents valuable training experience.
Validity of the Computerized DIS for Diagnosing Psychiatric Inpatients
Authors: Robert D. Levitan , Arthur G. Blouin , Joaquin R. Navarro , Hill James
Published: April 2017

The validity of a self-administered, computerized version of the National Institute of Mental Health Diagnostic Interview Schedule (DIS) was evaluated with a group of 41 psychiatric inpatients. Each patient was administered the computerized DIS (C-DIS) and a semi-structured clinical interview using the symptom checklist developed by Helzer et al. The concordance between the C-DIS and symptom checklist was comparable to that found in earlier studies of the original DIS. The overall distribution of kappas was also similar to those of previous studies. Overall, the results suggest that computerized administration may be a feasible alternative to face-to-face administration of the DIS.
Early Rehospitalization
Authors: Katherine M. Boydell , Samuel A. Malcolmson , Sikerbol Kate
Published: April 2017

The process and outcome of discharge planning were examined at a large provincial psychiatric hospital. Two hundred patients were studied to determine whether or not they received services from the agencies to which they were referred after discharge. In addition, patients who were rehospitalized within three months of discharge were identified in order to determine whether they differed from the rest of the cohort.

Eighty-three percent of the patients for whom referrals were made sought help from at least one aftercare service or community agency, suggesting that there is considerably more aftercare in the community than has previously been documented. The implications of these findings for treatment, research and policy planning are discussed.
Isolement et contentions: revue de littérature et focus sur leurs impacts et les normes qui les régissent
Authors: Begin Simon
Published: April 2017

Malgré les développements récents de la psychopharmacologie et une meilleure compréhension des tableaux d'agitation chez les patients en psychiatrie, l'utilisation des procédures d'isolement et de contention demeure un sujet de pratique quotidienne. On s'arrête peu ou pas à son enseignement de façon formelle. La littérature est quasi exempte de ces sujets et elle n'a connu son essor que dans les suites de procédures légales entamées par des patients qui ont forcé les praticiens à s'arrêter à l'analyse de ces moyens d'intervention.

L'article donnera un reflet succint de la littérature des dernières années qui débouche davantage sur le volet normatif qui devrait régir ces procédures, et une courte analyse de l'impact systémique des procédures.

La révision ou la prise de conscience de certaines de ces variables permettra peut-être un meilleur recul des cliniciens face à l'utilisation de procédures qui sont malheureusement encore aujourd'hui à la source de décès dans la pratique psychiatrique.
Case Reviews in the Family Physician's Office*
Authors: Kates Nick , Craven Marilyn , Webb Steve , Low James , Perry Kitty
Published: April 2017

The majority of patients with emotional or psychiatric disorders are treated in the primary care setting without psychiatric input. Psychiatrists need to find ways of helping family physicians manage these patients without necessarily taking over their care. One way of achieving this is for a psychiatric consultant to visit the family physician's office on a regular basis to discuss the physician's problem cases. This paper describes such a pilot project, outlines the kinds of problems family physicians discussed and recommendations that were made, and discusses the benefits of this collaborative approach.
Bulimia Nervosa and Acne May be Related: A Case Report*
Authors: Gupta Madhulika A. , Gupta Aditya K. , Ellis Charles N. , Voorhees John J.
Published: April 2017

Acne is a very common, often cosmetically disfiguring, cutaneous condition of adolescence that is associated with increased sebaceous gland activity. We present the case of a patient with bulimia who reported that the negative effect of acne on her appearance increased her body image concerns and exacerbated her eating disorder. Improvement of the acne was associated with a significant improvement in her eating disorder. Eating disordered patients may go on restrictive diets in order to control their acne since levels of androgens, which are one of the primary stimulants of sebaceous gland activity, are lower in starvation. As a significant number of adolescents with eating disorders also develop acne, it is important for the clinician to be aware of this previously unreported association between acne and eating disorders, and to evaluate the impact of acne upon the patient's body image and eating behaviour.
Atypical Affective Disorder with Episodic Dyscontrol: A Case of von Economo's Disease (Encephalitis Lethargica)*
Authors: Dolan Jeremich D. , Kamil Rifaat
Published: April 2017

The case is described of a patient with atypical affective disorder, episodic behavioural dyscontrol and parkinsonism resulting from presumed encephalitis lethargica. EEG abnormalities were found which were compatible with a post-encephalitic state and suggestive of epileptiform complications. Poor or deleterious response to neuroleptics, sleep disorder, and parkinsonism are features that may allow recognition of this illness in a psychiatric setting.
Somatose, psychose et relations d'objet*
Authors: Lavoie J.G.
Published: April 2017

This paper presents a case who successively suffered from regional ileitis followed by a reactive psychosis. The author looks at the object relations of a patient afflicted by a narcissistic defect. The fundamental narcissistic disorder models the object relations of the somatic patient and of the psychotic patient. Less différenciation is found in the object representation of the psychotic patient. A comparison is suggested for the two modes of relating to objects.