bluuebunny/crossref_metadata_2025 huggingface dataset:
Charles Bonnet Hallucinations: A Case Series*
Authors: Cole Martin G.
Published: April 2017

Charles Bonnet hallucinations are complex visual hallucinations which occur during clear consciousness inpatients who do not suffer from psychosis, substance abuse, sleep disorders, focal neurological lesions or acute eye disease. They are well-defined images of patterns, scenes, animals or humans combined with normal perceptions and elicit a neutral or pleasant emotional response. Because of conflicting reports about cognitive or visual impairments among patients with these hallucinations, I describe the cognitive and visual status of 13 patients. One patient had preserved cognition and vision; three had preserved cognition and impaired vision; three had impaired cognition and preserved vision; and six had both impaired cognition and vision. It is unlikely that cognitive or visual deficits alone caused the hallucinations, but may have contributed to a state of sensory deprivation with visual phenomena.
Psychophysiological Contributions to Phantom Limbs
Authors: Katz Joel
Published: April 2017

Recent studies of amputees reveal a remarkable diversity in the qualities of experiences that define the phantom limb, whether painless or painful. This paper selectively reviews evidence of peripheral, central and psychological processes that trigger or modulate a variety of phantom limb experiences. The data show that pain experienced prior to amputation may persist in the form of a somatosensory memory in the phantom limb. It is suggested that the length and size of the phantom limb may be a perceptual marker of the extent to which sensory input from the amputation stump have re-occupied deprived cortical regions originally subserving the amputated limb. A peripheral mechanism involving a sympathetic-efferent somatic-afferent cycle is presented to explain fluctuations in the intensity of paresthesias referred to the phantom limb. While phantom pain and other sensations are frequently triggered by thoughts and feelings, there is no evidence that the painful or painless phantom limb is a symptom of a psychological disorder. It is concluded that the experience of a phantom limb is determined by a complex interaction of inputs from the periphery and widespread regions of the brain subserving sensory, cognitive, and emotional processes.
A Review of Schizoaffective Disorder: I. Current Concepts*
Authors: Lapensèe Michèle A.
Published: April 2017

This paper reviews recent literature on schizoaffective disorder. Research studies of diagnosis, clinical course and outcome and family history are evaluated. It is concluded that schizoaffective disorder is a heterogeneous category which includes patients with bipolar disorder, schizophrenia, a genetically distinct psychosis and a genetic disposition to both schizophrenia and bipolar disorder.
Child Psychiatry: An Observation*
Authors: Fisher Geoffrey C.
Published: April 2017

The quest for a coherent epistemology in psychiatry has been a challenge for academics and practitioners alike. The question from the perspective of child psychiatry is discussed in this observation.
Pilot Study for the Quebec Child Mental Health Survey: Part II. Correlates of DSM-III-R Criteria among Six to 14 Year Olds*
Authors: Bergeron L. , Valla J.P. , Breton J.J.
Published: April 2017

A pilot study for a Quebec Child Mental Health Survey was completed in 1990 with 139 six to 14 year olds from the general population. The following variables, which were correlated with child psychopathology, were studied for each age group (six to 11 years, 12 to 14 years) and informant (parent, child): child's gender and stressful life events, respondent parent's psychiatric illness, family structure, parent-child relationships, parents' relationship, socioeconomic status, respondent parent's social desirability. Correlations obtained are consistent with those found in the literature. Correlations between the parent's mental health, parent-child relationships and the children's mental health are the most important results of the study.
Waiting List Information Strategies for Child Psychiatry: An Intervention and Measurement Approach
Authors: Parker Kevin C.H. , Froese Arthur P.
Published: April 2017

This paper describes a number of steps we have initiated to study our chronic waiting list problems. We describe a program involving monthly data collection which has enabled us to document the effectiveness of some strategies and predictive variables. During 1989 the data were supplemented with information collected by a questionnaire mailed to every other referral. We found that an initial response to the questionnaire was a powerful predictor of successfully kept first appointments six to 12 months later. The significance of these differences, the impact of our tracking procedures and the issues and causes, along with some strategies, are discussed.
La dysmorphophobie (trouble dysmorphique physique)*
Authors: Filteau M.-J. , Pourcher E. , Baruch P. , Bouchard R.H. , Vincent P.
Published: April 2017

This article reviews the historical and terminological origins of dysmorphophobia from Herodotus to today. It explains the differences pointed out by many authors, including the DSM-III-R, between body dismorphic disorder and delusional disorder somatic type, which are refered to as mono-symptomatic hypochondriacal psychoses in Europe. Epidemiological data, clinical characteristics and outcome are discussed. Explicative theories and neurobiological, developmental and analytical aspects of body image are presented. The association between body dismorphic disorder and other disorders is analyzed, and treatment possibilities are discussed. The authors suggest that body dismorphic disorder be classified with obsessive compulsive disorder, whatever the intensity of symptomatology, rather than with somatoform or delusional disorder, and treated with serotonin uptake inhibitors or neureptics that have been proven to be effective for the treatment of this disorder, such as pimozide.
A Treatment Approach for Patients in Midlife*
Authors: Ellman Jon P.
Published: April 2017

A treatment concept is described based on phase of life developmental theory for certain middle-aged patients encountered in a general hospital setting that — of a midlife crisis unit. Theoretical considerations on the rationale for setting up a midlife crisis unit, a brief description of a pilot unit of this nature during its first year of operation and several clinical vignettes illustrating typical presenting situations are discussed.
Are Too Many Children Being Treated with Methylphenidate?*
Authors: Ruel Jean-M. , Hickey C. Peter
Published: April 2017

A survey was conducted of the use of methylphenidate in British Columbia during a six month period to determine if a disproportionate number of children are being treated with methylphenidate for hyperactivity. The data obtained do not indicate a problem regarding the diagnosis of attention deficit hyperactivity disorder in children. However, the data pertaining to adults indicate that the reasons stated for prescribing methylphenidate are controversial in a significant number of cases.
Post-Traumatic Stress Disorder: An Overview*
Authors: Choy Thomas , De Bosset Farideh
Published: April 2017

An overview of post-traumatic stress disorder, including a brief historical survey, and its epidemiology, nosology, etiology, clinical presentation, treatment, prognosis as well as a short vignette, highlights the fact that this disorder prevails in times of war and peace. Early intervention is emphasized as the key to successful treatment. The timeliness for Canadian mental health professionals to review this disorder is also mentioned.
Risk and Protective Factors Affecting Children in Foster Care: A Pilot Study of the Role of Siblings*
Authors: Thorpe M.B. , Swart G.T.
Published: April 2017

A retrospective chart review of 115 siblings (from 48 families) simultaneously taken into the care of a Children's Aid Society was conducted. These children were a very neglected group at great risk of developing mental illness. There was a significant correlation between the number of symptoms the child had while in the receiving home and the time spent in foster care. Protective factors correlated with fewer symptoms at home but not while the child was in care. Being in care resulted in better performance at school, fewer symptoms and involvement in more extracurricular activities. High risk children made up their losses.

While in foster care, 53% were eventually separated from their siblings. Children were more likely to be separated from their siblings if they were older, their father was physically ill or their parents were separated. Children who were separated from their siblings had more risk factors and placements while in care. However, they had fewer symptoms and better school performance while they were in foster care and fewer symptoms at discharge than the siblings who stayed together.
An Introduction to Multivariate Statistics
Authors: Streiner David L.
Published: April 2017

The more commonly known statistical procedures, such as the t-test, analysis of variance, or chi-squared test, can handle only one dependent variable (DV) at a time. Two types of problems can arise when there is more than one DV: I. a greater probability of erroneously concluding that there is a significant difference between the groups when in fact there is none (a Type I error); and 2. failure to detect differences between the groups in terms of the patterns of DVs (a Type II error). Multivariate statistics are designed to overcome both of these problems. However, there are costs associated with these benefits, such as increased complexity, decreased power, multiple ways of answering the same question, and ambiguity in the allocation of shared variance. This is the first of a series of articles on multivariate statistical tests which will address these issues and explain their possible uses.
Psychiatric Consultation in the Eastern Canadian Arctic: II. Referral Patterns, Diagnoses and Treatment
Authors: Young L. Trevor , Hood Eric , Abbey Susan E. , Malcolmson Samuel A.
Published: April 2017

The clinical activities of the Baffin Consultation Service of the Clarke Institute of Psychiatry were examined. Demographic and clinical data are described based on clinical interviews and questionnaire items from 581 initial psychiatric referrals. More women than men were referred to the service; the mean age of the patients seen was 27.3 ± 13.4 years. The majority of referred patients were single and unemployed. The most common reasons for referral were depression, suicidal ideation, suicide attempts and family problems. The major diagnoses made were adjustment reactions and depressive disorders. Treatment was largely carried out in an outpatient setting through local health care professionals. The implications of these findings for this population and the development of community-based intervention programs are discussed.
Effects of Treatment and Alternative Care on Length of Stay on a General Hospital Psychiatric Unit — Results of an Audit
Authors: Mai François M. , Gosselin Jean-Yves , Varan Lily , Bourgon Luc , Navarro Joaquin Ruiz
Published: April 2017

Quality controls are becoming an important part of our health care system. A medical audit is one way of evaluating quality of care, and this paper describes the results of an audit conducted to investigate the reasons for a prolonged stay on a psychiatric inpatient unit. The results showed a decrease in the mean length of stay over a five year period, although the figure remained substantially above provincial norms. A review of the hospital charts of a random sample of one in six patients whose hospital stay exceeded 30 days was carried out. It revealed that in 50.0% of cases the reasons were “medically acceptable,” in 10.3% the reasons were “medically unacceptable” and in 39.7% the reasons were “social and administrative” and beyond the control of the treating psychiatrist. The implication of these results are discussed.
The Mental Health of Portuguese Children
Authors: Pepler Debra J. , Lessa Iara
Published: April 2017

This study investigated the mental health of Portuguese children in Canada. Preliminary work involved a survey of professionals serving the Portuguese community and the translation and assessment of a standardized child behaviour checklist. Forty-five Portuguese children and 45 non Portuguese children referred to a children's mental health centre were compared on demographic and family indicators and their referral source. There were similar proportions of boys and girls in the two groups, similar types of services were requested, and they had similar treatment histories. The Portuguese children were older at the time of referral and were more likely to be referred by educational agencies than the non Portuguese children. Portuguese families appeared to experience different stresses than non Portuguese families. Implications of these findings for the provision of culturally sensitive interventions for Portuguese children and their families are discussed.
Tarasoff in the Canadian Context: Wenden and the Duty to Protect
Authors: Truscott Derek , Crook Kenneth H.
Published: April 2017

The precedent-setting 1976 US court decision of Tarasoff v. Regents of the University of California established a “duty to protect” whereby psychotherapists are held responsible to protect the potential victims of their clients’ violent behaviour. The purpose of this article is to review and discuss this duty in the context of Canadian law and the 1991 Alberta court decision of Wenden v. Trikha, Royal Alexandra Hospital and Yaltho. The current Canadian interpretation of the duty to protect and guidelines for avoiding such liability are presented.
L'influence des médias sur la santé mentale
Authors: Lamontagne Yves
Published: April 2017

The author summarizes different research findings which have evaluated the influence of the media on the mental health of children, adolescents and adults. After this review of the literature, strategies are proposed to improve the promotion of mental health in the media. Also the importance of collaboration between health professionals and broadcasters in this process is highlighted. Concrete examples are reported such as the communication programs which have been developed by the Quebec Mental Illness Foundation and the Quebec Psychiatrists’ Association.
Changes to the Criminal Code Provisions for Mentally Disordered Offenders and their Implications for Canadian Psychiatry
Authors: Davis Simon
Published: April 2017

Bill C-30, implemented in February 1992, made a number of significant changes to the Criminal Code provisions concerning the assessment, treatment and disposition of mentally disordered persons charged with a crime, including persons considered to be unfit to stand trial or pleading insanity. The changes deal mainly with procedural law and the civil rights of persons being assessed or held in custody, and put limits on where, how long and for what purpose persons may be detained. The new law abolishes the automatic, indeterminate detention of persons found unfit to stand trial or not criminally responsible on account of mental disorder. The changes may mean that the forensic psychiatric route is now a more “attractive option” for defendants. The new law may create administrative problems for clinicians by leading to increased requests for psychiatric assessments while at the same time constraining the assessment process.
Mentally Retarded Patients on General Hospital Psychiatric Units
Authors: Addington Donald , Addington Jean M. , Ens Irene
Published: April 2017

Difficulties in the placement of two recurrently assaultive mentally retarded men who had been admitted to acute admission units for assessment led staff to hypothesize that mentally retarded patients were being inappropriately diverted into psychiatric services. To test this hypothesis, the charts of all mentally retarded patients admitted over two years were reviewed retrospectively. Contrary to expectations, there was no difference between the average length of stay of the mentally retarded patients and a comparison group of psychiatric patients. Furthermore, the mentally retarded patients presented with a full range of Axis I disorders, schizophrenia being the most common. It was concluded that, in general, the acute psychiatric services were being used appropriately for this group of mentally retarded patients.
Dosaging Patterns in Schizophrenia with Depot, Oral and Combined Neuroleptic Therapy
Authors: Remington Gary J. , Prendergast Peter , Bezchlibnyk-Butler Kalyna Z.
Published: April 2017

A group of patients with chronic schizophrenia were evaluated according to the form of neuroleptic treatment they were receiving: depot, oral or combined (depot/oral or oral/oral). The patients treated with the combined therapy received significantly higher dosages of neuroleptic than those treated with either depot or oral therapy, which did not differ from each other. Daily maintenance dosages were generally well above recent guidelines.
L'effet des troubles de la personnalité sur la réponse au traitement béhavioural-cognitif du trouble panique avec agoraphobie
Authors: Marchand André , Wapler Michel
Published: April 2017

This study measures the effect of personality disorders on the efficacy of treatment of agoraphobia. Forty-one patients suffering from panic disorder with agoraphobia are evaluated for the presence of a personality disorder (according to DSM-III-R criteria) before the onset of treatment. The treatment consists in 14 sessions of behavioural cognitive therapy. Various measures of agoraphobic avoidance are obtained before (pre-test) and after the end of treatment (post-test, three month follow-up). Effect of treatment reaches statistical and clinical significance for all patients. Grouping of patients according to presence or absence of personality disorder shows no significant difference between the groups before or after treatment on scores of agoraphobia. A subgroup of patients with dependent personality disorder does not differ on measures of agoraphobic avoidance from patients without personality disorders or with other personality disorders. The discussion points out methodological limitations, differences in our study from other studies regarding the effect of personality on the treatment outcome of panic disorder with agoraphobia, as well as possibilities for future studies.
Recent Trends in Mental Health Services in Italy: An Analysis of National and Local Data
Authors: De Salvia Domenico , Barbato Angelo
Published: April 2017

This paper reviews trends in Italian mental health services after the implementation of the 1978 Mental Health Act. Data available at the national level on public and private inpatient services, community mental health centres, residential and day care facilities are presented and discussed. Findings from two case-register areas, where comprehensive community services according to the Mental Health Act have been implemented, are discussed. Public mental hospitals are no longer used for psychiatric treatment, except for a small number of long stay patients. General hospital psychiatric units are the only setting in the public sector where psychiatric patients can be admitted. In private mental hospitals, the number of residents has decreased, while admissions have remained stable. However, community services are unevenly distributed and residential facilities are generally lacking. Little is known about quality of care provided, although data from some pilot studies are encouraging. Stable admission rates to forensic mental hospitals suggest that the criminalization of mentally ill has not increased. The effect of changing patterns of mental health care on suicide rates are discussed.
Four Cases of Supposed Multiple Personality Disorder: Evidence of Unjustified Diagnoses
Authors: Freeland A. , Manchanda R. , Chiu S. , Sharma V. , Merskey H.
Published: April 2017

Four cases are presented in which an unjustified diagnosis of multiple personality disorder was made. These cases are used to illustrate the concern that some cases of multiple personality disorder may be the result of misdiagnosis by both patients and clinicians.
A Diagnostic and Therapeutic N-of-1 Randomized Trial
Authors: Cook Deborah J. , Guyatt Gordon H. , Davis Clive , Willan Andrew , Mcilroy William
Published: April 2017

The objective of this paper is to study the effect of amitriptyline on a young woman with symptoms of lightheadedness, palpitations, somnolence and fatigue. We conducted a single case (N-of-1) randomized trial including three pairs of treatment periods. Each pair included one four-week period when the patient was receiving amitriptyline and one four-week period when the patient was receiving placebo. The clinical setting was a secondary care internal medicine practice. During active treatment periods, amitriptyline was given in a dose of 100 mg each evening. Efficacy symptoms included lightheadedness, headaches and somnolence/fatigue. Side-effects of dry mouth and constipation were also monitored. Each symptom was rated on a seven point scale in which higher numbers denoted fewer symptoms. For the combined efficacy score, the mean difference in scores and the associated standard error was in favour of amitriptyline. The most profound effect was on sleepiness. These differences represent clinically important treatment effects. Dry mouth and constipation were worse on the active drug, but differences did not reach statistical significance. Our experience suggests the usefulness of N-of-1 randomized trials in outpatient medical practice, including psychiatric practice.
Revue du syndrome de Kleine-Levin: vers une approche intégrée
Authors: Lemire Isabelle
Published: April 2017

Kleine-Levin syndrome is a characterized by a periodic hypersomnia crisis as well as dietary and variable significant psychic symptoms. Its rarity makes its definition and study complex. Many etiologies have been considered, especially regarding a hypothalamic dysfunction. Physiological, radio-logic, anatomical and Polysomnographic studies have not shown clearly conclusive results, but the syndrome appears to be related to affective disorders. This hypothesis is supported by the findings of a positive therapeutic response to lithium. However, we are interested in the related psychological factors, whether they are primary or secondary. A clinical case illustrates these factors, and a basic neuropsychiatric intervention concept is proposed.
The Greater Vancouver Mental Health Service Society: 20 Years' Experience in Urban Community Mental Health
Authors: Sladen-Dew Nicholas , Bigelow Douglas A. , Buckley Ralph , Bornemann Stephen
Published: April 2017

Caring for people in the community with persistent and disabling mental illnesses presents a major challenge to government, planners and mental health professionals. The success with which mentally disabled people are integrated into community life says much about the society in which we live. This article describes the experience of the Greater Vancouver Mental Health Service Society in offering community-based mental health services to persons with schizophrenia and other major mental disorders over the past 20 years. The key to its success lies in a decentralized, relatively non hierarchical organizational structure which allows committed and skilled multidisciplinary teams to work with patients and their families in their community. The resulting services are fully integrated within the fabric of the community and are responsive to local needs. Partnerships among professionals, patients, families and community agencies result in work that is creative, productive and effective.
The Teaching of Case Formulation in Canada
Authors: Fleming J.A.E. , Patterson P.G.R.
Published: April 2017

Prompted by the Council on Education and Professional Liaison of the Canadian Psychiatric Association, the authors surveyed the program directors and senior residents of departments of psychiatry on the teaching of case formulation skills in Canada. The results showed that case formulation is taught formally in most departments and that students are expected to demonstrate these skills throughout their training. However, less than one-half of the teaching programs provide guidelines for case formulation. The residents, who expected case formulation skills to be assessed in the oral examinations of the Royal College, were unanimous in their view that the process should be standardized and that guidelines be provided. Both the program directors and the residents favoured a biopsychosocial format for recording case formulation, but they did not agree on the content of an ideal formulation.
Family Factors in Adolescent Unipolar Depression
Authors: Marton P. , Maharaj S.
Published: April 2017

This paper reviews the current literature on the contribution of family factors to unipolar depression among adolescents. Research which examined the following factors was reviewed and evaluated: genetic transmission, parental depression, parental death, quality of attachment and family interaction. Studies had to meet the following criteria to be included: publication must have been between the years 1985 and 1992; the evaluation had to be empirical with some form of control; a dependent measure of family characteristics or functioning; the adolescent had to be between the ages of 13 to 19; and the adolescent had to meet the recognizable criteria for unipolar depression.

Recent literature suggests that adolescents suffering from depression share a number of risk factors: a family history of affective disorder, inept or inadequate parenting, abrasive interactions within the family and insecure attachments. At this time, there is no evidence that these aversive interactions predate the disorder. Weaknesses in the current literature are identified and strategies for improving future research are proposed.
A Psychiatric Follow-Up Study of Adoptees
Authors: Kotsopoulos Sottois , Walker Selena , Copping Winona , Coté André , Stavrakaki Chryssoula
Published: April 2017

This is a five year follow-up study of adopted children and adolescents. Thirty-five adoptees and 23 control subjects were assessed. Five years earlier, the initial sample consisted of 57 pairs of adoptees and controls. The study showed that both adopted and control subjects were improved at the follow-up assessment and that there were no significant differences in clinical diagnoses and social adaptation between the groups. Compared with the controls, the adoptees were scored higher on a behaviour scale (Revised Behavior Problem Checklist) by parents. Adoption by the sixth month of age was associated with better overall psychosocial functioning. Significantly more adoptees were not living with their adoptive families. Factors associated with outcome are discussed.
Evaluation of the Original Ontario Child Health Study Scales
Authors: Boyle Michael H. , Offord David R. , Racine Yvonne , Sanford Mark , Szatmari Peter , Fleming Jan E.
Published: April 2017

This article presents evaluative information on the use of the original Ontario Child Health Study scales to serve as ordinal-level measures of conduct disorder, hyperactivity and emotional disorder among children in the general (non clinic) population. Problem checklist assessments were obtained from parents and teachers of children aged six to 16 and youth aged 12 to 16 drawn from a general population (n = 1,751); and a mental health clinic sample (n = 1,027) in the same industrialized, urban setting. The results showed that the original OCHS scales possess adequate psychometric properties to be used as ordinal-level measures of disorder. Correlations between individual items and their hypothesized scales were very strong, indicating convergent validity, while correlations between the same items and other (non hypothesized) scales were lower, indicating discriminant validity. Item analyses indicated that individual scale items possess both convergent and discriminant validity. Although the scales were skewed to the positive end of the continuum, they demonstrated good internal consistency (all estimates ≥ 0.74) and test-retest (all estimates ≥ 0.65) reliability. Finally, three different validity analyses confirmed hypotheses about how the original OCHS scales should perform if they provide useful measures of disorder.
Parent Training and Social Skills Training for Children with Attention-Deficit Hyperactivity Disorder: How can They be Combined for Greater Effectiveness?
Authors: Cousins Lorne S. , Weiss Gabrielle
Published: April 2017

Attention-deficit hyperactive disorder (ADHD) is a chronic and treatment-refractory syndrome affecting academic, social and emotional adjustment in children. Stimulant medication is the treatment of choice and is often paired with psychosocial treatment. However, no single treatment modality alleviates the symptoms or improves the negative peer status of these children in their social ecology over the long term. This article reviews two psychosocial treatments used for ADHD, parent training and social skills training and suggests ways that these two components may be combined for greater effectiveness by encouraging the parent to: 1. learn more about the importance of developing social competence and positive peer status; 2. use incidental teaching and self-evaluation strategies; 3. become strategic organizers of the child's social life; and 4. become case managers to facilitate more consistency between the significant adults in the child's social environment.
Trouble Panique et Alcoolisme: Influence de la Comorbidité
Authors: Chignon J.M. , Lépine J.P.
Published: April 2017

Both epidemiological and clinical studies have demonstrated a high prevalence of panic disorder among alcoholic patients. In contrast, little attention has been given to studying alcohol abuse and/or dependence in patients suffering from panic disorder. One hundred and fifty-five consecutive referrals for treatment for panic disorder were interviewed using a modified version of the Schedule for Affective Disorders and Schizophrenia—Lifetime Version, modified for the study of anxiety disorders. Thirty-two patients (20.7%) had a lifetime history of alcohol abuse and/or dependence. Although the lifetime comorbidity rate of either agoraphobia and/or social phobia seems without any influence on the risk of alcohol-related disorder, alcoholic patients suffering from panic disorder appear to be more likely to have a history of depression and other addictive disorders. The majority of patients with primary alcoholism were male, and those who became alcoholics after they developed panic disorder were more likely to be female. The comparison between patients with primary and secondary alcoholism did not indicate any difference in the comorbidity rate with other psychiatric disorders nor the severity of panic disorder.
Cluster Suicide in Rural Western Canada
Authors: Davies David , Wilkes T. Christopher R.
Published: April 2017

This paper focuses on a series of adolescent suicides which occurred in a small rural community in Western Canada between December 1989 and June 1990. Risk factors for adolescent suicide and recent epidemiological data on cluster suicide are reviewed and discussed. The circumstances of the five adolescent suicides are then discussed, and the question of whether or not this was a cluster suicide is considered. This article supports the view that suicide is an abnormal response to stress or loss and emphasizes the role of genetic psychophysiological predisposition.
Homicide, Schizophrenia and Substance Abuse or Dependency
Authors: Beaudoin Marie Nathalie , Hodgins Sheilagh , Lavoie François
Published: April 2017

Few studies have extensively studied the aggressive behaviours of mentally disordered offenders. This investigation compared 14 schizophrenics found not guilty of homicide by reason of insanity (NGRI) with 12 schizophrenics convicted of homicide. A comparison group of 15 homicide offenders with no major mental disorder was used. Drug and alcohol consumption, previous history of aggression against others as well as mental health were assessed using standardized, reliable, valid instruments. Significantly more of the inmates with no major mental disorder were diagnosed as having a history of drug or alcohol abuse or dependency (60%) than the NGRI schizophrenics (35.7%). In addition, both groups of convicted homicide offenders were more likely to have committed homicide under the influence of drugs or alcohol than the NGRI group. No significant difference distinguished the groups for the mean number of aggressive incidents. The subjects found NGRI assaulted more often during an acute phase of mental illness than the convicted schizophrenics. Although both groups appeared to have a similar number of hospitalizations, most of the hospitalizations of the convicted schizophrenics occurred after the crime.
A Review of the Amendments to the Criminal Code of Canada (Mental Disorder)
Authors: Swaminath R.S. , Norris P.D. , Komer W.J. , Sidhu G.
Published: April 2017

On February 4, 1992, Bill C-30, an Act to Amend the Criminal Code of Canada (Mental Disorder), the National Defence Act and the Young Offenders Act, was officially proclaimed. The authors provide an overview of this legislation and raise some concerns regarding certain sections of the Criminal Code.
Auditory Hallucinations Suppressed by Etizolam in a Patient with Schizophrenia
Authors: Benazzi Franco , Mazzoli Marco , Rossi Emanuela
Published: April 2017

A patient presented with a 15 year history of schizophrenia with auditory hallucinations. Though unresponsive to prolonged trials of neuroleptics, the auditory hallucinations disappeared with etizolam.
Étude des troubles des conduites alimentaires dans une population d'adolescentes souffrant de diabète insulino-dépendant
Authors: Vila Gilbert , Nollet-Clemencon Chantal , Vera Luis , Crosnier Héléne , Robert Jean-Jacques , Mouren-Simeoni Marie-Christine
Published: April 2017

The existence of a relationship between Insulin-Dependent Diabetes and eating disorders has recently been observed, but its prevalence and impact on somatic functioning remain poorly understood. These dimensions were evaluated in a population of 52 insulin-dependent diabetic adolescent girls and compared with evaluations of matched subjects from the general population. Results showed that the occurence of anorexia nervosa is rare, the occurence of unspecified eating disorders is frequent (35%) and the occurence of bulimia nervosa is nearly six percent. Poor metabolic control as reflected in blood levels of glycosylated hemoglobin (HBA1C) was found in bulimic subjects and a tendency to be overweight was found in subjects with an unspecified eating disorder. Since such disorders frequently involve dietary restrictions, the role of a restrictive pattern in the occurence of eating disorders is raised.
Stability of Positive and Negative Symptoms in Schizophrenia
Authors: Malla Ashok K. , Norman Ross M.G. , Williamson Peter
Published: April 2017

Fifty-nine DSM-III-R schizophrenic outpatients were assessed for positive and negative symptoms using Andreasen's Scale for Assessment of Positive Symptoms (SAPS) and the Scale for Assessment of Negative Symptoms (SANS). Reevaluation of these patients 12 months later revealed a moderate degree of stability for both SAPS and SANS total scores and most of their subscales. Only the subscale scores for apathy and bizarre behaviour failed to show a significant correlation in stability in 12 months. The results are discussed in the context of the reported literature.
Regression of Thyrotoxic Ophthalmopathy following Lithium Withdrawal
Authors: Byrne Alan P. , Delaney W.J.
Published: April 2017

The case of a bipolar patient who developed thyrotoxicosis with severe exophthalmos while on lithium therapy is described. The patient had required two surgical decompressions of the right orbit to relieve pressure, which occurred secondary to progression of the exophthalmos, and was scheduled for further surgery. Lithium therapy was discontinued because of poor compliance to the medication and intolerable polyuria. The exophthalmos improved dramatically within 72 hours of the withdrawal of lithium. A severe form of exophthalmos resulting from lithium therapy has not been described in the literature. The case described here adds to the body of information about the possible causes of thyrotoxic ophthalmopathy.
Iron Overload and Psychiatric Illness
Authors: Cutler Paul
Published: April 2017

Seven patients with varying psychiatric disorders were found to have iron overload as manifested by abnormal serum ferritin, transferrin saturation index (TSI), or excessive urinary iron. All possible sources of secondary iron overload were ruled out. The patients were treated with the specific iron chelator, deferoxamine, given IM for seven to 22 weeks which resulted in significant clinical improvements. These cases indicate a need to be aware that disordered iron metabolism is a somatic cause of psychiatric illness and that there is clinical improvement upon lowering elevated iron levels in patients with iron overload.
Capacity to Stand Trial: Pitfalls of Legal Interpretation
Authors: Greenberg David M.,
Published: April 2017

Legally, the concept of fitness to stand trial is fixed and absolute. Psychiatrists view fitness as a homeostatic functional capacity. The Ontario Court of Appeal recently set a precedent (Queen versus Taylor) for a standard of fitness to stand trial by interpreting the criteria for unfitness as defined in terms of Section 2 of the Criminal Code. They held that only a factual understanding of these criteria is required by the courts. A person suffering from acute psychotic symptoms with delusions which relate to the subject matter of the trial, who act contrary to their best interests and who are disruptive in their behaviour to the orderly flow of the trial may still fulfill the criteria for fitness to stand trial. The writer illustrates some important implications of this decision and suggests recommendations to current legal interpretations of a clinical capacity.
Effects of Neuroleptic Reduction in Schizophrenic Outpatients Receiving High Doses
Authors: Leblanc Gérard , Cormier Hugues , Gagné Marie-Andrée , Vaillancourt Sylvie
Published: April 2017

This paper presents an open study which evaluated the clinical effects of a partial and progressive reduction in neuroleptic medication in 32 outpatients suffering from schizophrenia who were receiving high doses (equivalent of ≥ 18 mg of oral haloperidol per day; EHL). After an observation period of twelve weeks, each subject's dose of neuroleptics was reduced by 50% at the rate of 10% every four weeks. Patients were receiving a mean of 62 mg per day EHL at the beginning of the study and 30 mg per day EHL at the completion of the study. After the reduction, the following was observed: 1. a significant but modest change in psychopathology: a decrease in negative symptoms and in the total score on Brief Psychiatric Rating Scale; and 2. a significant increase in tardive dyskinesia symptoms. Six subjects relapsed but five of them recovered without increasing their reduced medication. Results of this study are discussed in the context of trying to find a minimal maintenance dose in the treatment of schizophrenia. The relative paucity of change despite a large reduction in medication argues for réévaluation of dosage in patients on high or very high doses of neuroleptics. The results suggest that many patients taking high doses could be maintained on significantly lower doses of neuroleptics. With gradual reduction of medication it would seem that many patients who are receiving a high dose of neuroleptic can achieve a lower dose than their current maintenance level.
Comportements violents et intimidants des patients psychiatriques au moment de l'hospitalisation
Authors: Moamaï J. , Moamaï N.
Published: April 2017

The dangerousness of the mentally ill patient is still unknown. This study assesses the actual prevalence of violent and intimidating behaviours in psychiatric patients at the time of their admission, or in the days leading up to their admission to a Quebec hospital. These behaviours have been measured on a six-point scale whose reliability for this population is appropriate. The consecutive sample consists of 383 adult admissions, and the results show that 83.0 percent of the involuntary admissions and 40.7 percent of the voluntary admissions manifested violent or intimidating behaviours at the time of hospitalization. The results support the clinical experience that psychiatric patients often exhibit this type of behaviour on admission.
Psychological Risk Factors for Dissociation and Self-Mutilation in Female Patients with Borderline Personality Disorder
Authors: Zweig-Frank Hallie , Paris Joel , Guzder Jaswant
Published: April 2017

The purposes of this study were to determine whether or not dissociation in female patients suffering from personality disorder is related to sexual and physical abuse or to abuse parameters and whether or not self-mutilation in the personality disorders is related to psychological risk factors or to dissociation. The sample was divided into 78 borderline and 72 nonborderline personality disorders. Psychological risk factors were measured through histories of childhood sexual abuse, physical abuse and separation or loss as well as scores on the Parental Bonding Index. Dissociation was measured by the Dissociative Experiences Scale. On the diagnostic interview, 48 subjects scored positive for self-mutilation. Dissociative Experiences Scale scores were associated with a borderline diagnosis but not with childhood sexual abuse or physical abuse. The parameters of abuse were not related to dissociation. Subjects who mutilated themselves had higher rates of both childhood sexual abuse and dissociation in univariate analyses. However, in multivariate analyses only diagnosis was significant. None of the other psychological risk factors were significantly linked to self-mutilation. The findings do not support theories that dissociation and self-mutilation in borderline personality disorder are associated with childhood trauma.
Psychological Risk Factors and Self-Mutilation in Male Patients with Bpd
Authors: Zweig-Frank Hallie , Paris Joel , Guzder Jaswant
Published: April 2017

The purpose of this study was to determine whether or not self-mutilation in patients with personality disorders is related to other psychological risk factors, dissociation or diagnosis. The sample included 61 subjects with borderline personality disorder and 60 subjects with nonborderline personality disorder; 32 subjects with borderline personality disorder reported self-mutilation. Psychological risk factors were measured through histories of childhood sexual abuse, physical abuse and separation or loss as well as through scores on the Parental Bonding Index. Dissociation was measured by the Dissociative Experiences Scale. There were no relationships between any of the psychological risk factors and self-mutilation. Subjects who mutilated themselves had higher scores on the Dissociative Experiences Scale in univariate analysis but the scores in multivariate analyses dissociation did not discriminate between subjects who mutilated themselves and those who did not. The results do not support the theory that abuse and dissociation account for self-mutilation in the personality disorders.
Depression and Hopelessness in Children with Disruptive Behaviour Disorders
Authors: Grizenko Natalie , Pawliuk Nicole
Published: April 2017

The purpose of this study was to investigate the prevalence of depression in a day treatment compared to a control population of children and to determine whether or not day treatment is effective in normalizing depression and hopelessness. Twenty-five control children, matched by age and sex, were compared on self-report measures of depression and hopelessness to 25 children admitted to day treatment. Pre-post treatment comparisons were also made for day treatment children. Day treatment children at admission scored significantly higher on both depression and hopelessness than control children. Only boys in day treatment improved significantly at the time of their discharge. Children with disruptive behaviour disorders also experienced significant feelings of depression and hopelessness. Day treatment was effective in reducing these feelings to “normal” levels in boys only; girls continued to experience severe negative life events beyond their control.
The Borderline Family in the Borderline Child — Understanding and Managing the Noise
Authors: Stirtzinger Ruth , Mishna Faye
Published: April 2017

This paper demonstrates the particular functions of noise communication in a borderline child and family. Analysis shows noise to have a primary role for the individuals and the family in protecting self, promoting attachment, defending against the experience of emptiness and depletion and communicating lack of attunement. Treatment objectives were to foster the development of a more differentiated and cohesive self for the individuals and the family.
Familial Risk Factors Associated with Intrafamilial and Extrafamilial Sexual abuse of three to Five Year Old Girls
Authors: Mian Marcellina , Marton Peter , Lebaron Deborah , Birtwistle David
Published: April 2017

This study intended to identify familial risk factors which differentiate sexually abused young girls from nonabused girls and, further, young victims of intrafamilial from those of extrafamilial sexual abuse. The subjects were 112 girls aged three to five years and their families. Forty-two were the victims of intrafamilial sexual abuse and 28 were victims of extrafamilial sexual abuse while 42 girls were not the victims of abuse. The three groups of girls were matched for age. Comparisons indicated that the families of abused girls had less harmony and stability in the marital unit and were headed by less competent parents. Mothers in both abuse groups were significantly more likely to have experienced sexual abuse as children. For all comparisons, the intrafamilial group showed greater disadvantage and dysfunction than the extrafamilial group. The intrafamilial group was differentiated from the extrafamilial group by worse spousal relationships, inadequate boundaries in parent-child behaviour, father's history of physical abuse as a child and violent behaviour as an adult and maternal disapproval of the child victim. These findings suggest that child sexual abuse is related to a longstanding collection of interconnected adult personal and relational deficiencies which result in inadequate parenting for the young victim.
The Relationship between Life Events during Adolescence and Affect and Personality Functioning
Authors: Stein Bernard A. , Marton Peter , Golombek Harvey , Korenblum Marshall
Published: April 2017

Bowlby's concept of the internal working model is useful in conceptualizing how a child develops a sense of self and security through the availability of significant relationships. The lack of secure attachments may lead to dysphoric moods and poor personality functioning. We have shown that a proportion of teenagers develop dysphoria as well as personality disturbance during adolescence. A study sample of 59 youths was examined at early, middle and late adolescence. Ratings were made of affect, attitudes and personality functions. At the same time, information was obtained about family status and functioning. Results showed that certain family and life events were more strongly correlated with changes in affect in early adolescence. These affects were both internalized and externalized. Middle adolescence appeared to be quiescent, without any correlations with affect or personality problems. In late adolescence, there were correlations between family changes and personality dysfunction as well as dysphoria. This shows that family changes which threaten the availability of significant attachment figures are linked to emotional and behavioural disturbance in early adolescence and personality and emotional disturbance in late adolescence.