bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychosocial Impact of Craniofacial Deformities Before and after Reconstructive Surgery
Authors: Lefebvre Arlette , Barclay Susan
Published: April 2017

Pre- and post-operative body image, self-confidence and individual and family adjustment were compared in 250 patients (aged 6 weeks to 39 years) with severe craniofacial deformities. Major congenital deformities of genetic or idiopathic etiology were present in 178 patients and 72 had tumours or other late-onset deformities. The patients and/or parents were interviewed by a child psychiatrist and a social worker as part of the routine preoperative assessment. In addition to a semistructured interview protocol, the patients and parents were asked to rate the deformity according to Hay's Scale and, when appropriate, to complete the Piers-Harris Self-esteem Inventory. One and two year post-operative re-evaluations followed the same protocol. The results indicated that the age of the patient, pre-operative expectations and origin of the decision for surgery (particularly in adolescents) are the most significant predictive factors of post-operative psychosocial improvement.
Family of Origin as a Training Resource for Family Therapists
Authors: Braverman Shirley
Published: April 2017

People develop their sense of self and their interpersonal skills in their families of origin. Omitting any focus on the family of origin in training removes a tremendously useful learning resource. The dilemma for the teacher is to find the boundary between teaching and therapy. The author describes her approach and suggests how it can be kept within a teaching framework, be case related and unintrusive.
Impact of an Outpatient Psychiatry Rotation on Family Medicine Residents and Interns
Authors: Dyck Ronald J. , Azim Hassan F.A.
Published: April 2017

The present study examined the relative impact of a training program for Family Medicine Residents and Rotating Interns located in a Psychiatric Walk-In Clinic. Specifically, it was of interest to assess students’ satisfaction with the orientation to the rotation, the degree of involvement in different activities and the amount of supervision received, as well as the skills acquired during the rotation. In addition to the information collected immediately following the rotation, student perceptions of the relative benefits of the rotation to their medical practice and their general attitude toward mental health facilities were obtained in a follow-up survey. The results indicated that students were generally satisfied with their rotation. In particular, their level of satisfaction was related to the exposure to a wide variety of psychiatric patients, the supervision received, and the fulfillment of their expectations of the rotation. The findings also indicated that the training program did not meet all the needs of the students, particularly in the area of the assessment and treatment of couples and families and the utilization of psychotropic medications.
The Amazing Careers of Hincks and Beers
Authors: Griffin John D.
Published: April 2017

The personalities and mental health problems of Clifford W. Beers and Clarence M. Hincks are described. Both became internationally acclaimed leaders in the development of the voluntary mental health movement in the United States and Canada. Both had sudden and dramatic onsets of mental disorder during early adulthood. Both had cyclothymic personalities, the down swings being sufficiently serious to interrupt their work. Beers’ initial breakdown developed into a profound mental illness requiring institutional care for three years. The final diagnosis was manic-depressive psychosis. Hincks was never psychotic although his repeated depressions were often deep and painful. Both were very creative and achieved remarkable success in spite of significant mental health handicaps.
Inclusive Fitness, Altruism and Family Adaptation
Authors: Sloman Leon
Published: April 2017

An integrative model of family functioning is put forward using a sociobiological framework. Three key socio-biological concepts that have a relevance to family interaction are inclusive fitness, altruism, and a struggle for status. The term ‘inclusive fitness’ encompasses the parents’ own fitness and that of their kith and kin. Altruism refers to how parents promote the survival of their progeny and extended family. The struggle for status refers to a struggle for power and prestige. According to the author's hypothesis ‘inclusive fitness’ exerts its influence through the struggle for status which in turn influences the degree of altruism and the level of ‘family adaptation’. The parents’ level of inclusive fitness largely determines the level of family adaptation which in turn influences the growth and individuation of the next generation. A common negative outcome of failure in the struggle for status and power is a displacement of the struggle for power into a family context. Failure in a struggle for status between peer group members would in a pre-technological society probably have reflected a relative lack of fitness. Failure in the struggle for status is likely to generate maladaptive cycles in the family which will lower the inclusive fitness of the parents. A concept of ideal family functioning is derived from sociobiology and specifically related to a high inclusive fitness in the parents. The author argues that sociobiological concepts can contribute to the development of an integrative theory of family behaviour. The clinical implications of this model are explored.
A Search for Congenital Rubella in Psychiatric Day Treatment, Language and Learning Centres
Authors: Feldman Ronald B. , Mendelson Jack , Golick Margie , Rothman Stanley J. , Portnoy Joseph , Eaton William W.
Published: April 2017

A search for previously undiagnosed congenital rubella (CR) was made on 672 children who had attended psychiatric day treatment, learning, and speech and language centres. This was done by observing the sero-response of seronegative children to rubella vaccine, since 90% of patients with known CR who are seronegative fail to seroconvert to the vaccine. Of the 225 seronegative children 23 did not seroconvert after a single vaccination. Five of these failed to respond on revaccination. These five children had a high frequency of severe language and learning disability as well as frequent diagnoses of major CNS disorders. It is likely that a far greater number of children in the population studied had CR, since our methods identify only about 20% of those affected. Clinically, a specific diagnosis of CR is helpful in facilitating genetic counselling and in allowing the clinician to offer a more hopeful prognosis.
Age, Age of Onset and Course of Primary Depressive Illness in the Elderly*
Authors: Cole Martin G.
Published: April 2017

Thirty-eight elderly patients with primary depressive illness (Feighner criteria) were followed up for 7–31 months. In the absence of persistent organic signs and severe physical illness, age of onset (first depressive episode after 60) but not age was significantly related to course of illness. Compared to early onset depressives, late onset depressives were more likely to remain completely well during the follow-up period and less likely to have frequent or disabling relapses.
Partial Resolution of Tardive Dyskinesia with Treatment of Co-existing Thyrotoxicosis*
Authors: Leder Robert , Kirch Darrell , Murphy Robert , Clay Keith , Freedman Robert
Published: April 2017

Neuroleptic-induced tardive dyskinesia improved after treatment of thyrotoxicosis. Neuroleptic blood levels indicated that the improvement was not caused by masking of the symptoms by rising drug levels. Dopamine metabolite measurements suggested that the thyrotoxicosis caused an increase in the sensitivity of caudate neurons to dopamine, rather than a change in release of dopamine.
Teaching Some Principles of Individual Psychodynamics through an Introductory Guide to Formulations*
Authors: Cleghorn John M. , Bellissimo Anthony , Will David
Published: April 2017

One objective of psychiatric education can be to help trainees describe and understand major concerns patients experience in their key relationships, inner conflict and sense of self. A precis of major concepts and principles in this area (usually known as psychodynamics) is presented without the metapsychological framework which makes some of the literature difficult to grasp. This is intended to make learning more efficient and to facilitate the formulation of hypotheses about the presence or absence of specific conflicts, and problems in key relationships. We do not propose that these hypotheses necessarily explain psychopathology but that they (a) supplement formal diagnosis; (b) enrich the clinical data base by providing hypotheses which are testable in part by clinical observation and which can be tested scientifically; (c) provide understanding crucial to psychotherapy.
Distribution of Leonhard's Subtypes of Chronic Schizophrenia in Two Cultures*
Authors: Wilson William H. , Ban Thomas A.
Published: April 2017

A comparison of two independent populations of chronic schizophrenic patients, classified on the basis of Leonhard's system, revealed striking similarities in the distribution of subtypes. The findings lend support to the clinical relevance of Leonhard's taxonomy.
Psychiatrie Patients who Discharge Themselves against Medical Advice*
Authors: Phillips M.S. , Ali H.
Published: April 2017

Hospital treatment staff are constantly faced with the problem of psychiatric patients who discharge themselves against medical advice before their treatment is completed. A total of 50 patients who signed themselves out of the 9th floor service of the Clarke Institute of Psychiatry, over a two year period, were analyzed. When compared with a random sample of patients who remained for the duration of their treatment, the authors found the A MA patients to have the following characteristics: The patient is likely to be a young male, admitted as an emergency, remain in hospital for three days or less and have a diagnosis of personality disorder or schizophrenia.

The authors conclude with a number of recommendations to assist in dealing with the problem.
The Clinical Investigation of Dementia
Authors: Martin B.A. , Thompson E.G. , Eastwood M.R.
Published: April 2017

The clinical investigation of 63 patients with a hospital discharge diagnosis of dementia was reviewed. The review focused on the completeness of ancillary investigations to detect treatable causes of dementia, and on the follow-up examination to confirm the diagnosis. Patients admitted to specialized geriatric psychiatry beds were compared to those admitted to other hospital services. The clinical investigation of the groups did not differ significantly with the respect to the search for treatable dementias, and in this series no treatable cases were detected. The non-selective use of a battery of ancillary diagnostic tests is questioned. The most notable finding was the almost uniform absence of follow-up examinations to document progressive deterioration of cognitive function. The indication for such follow-up is discussed in the context of previously reported diagnostic inaccuracy in this syndrome.
Civil Commitment: A Review of Traditional Arrangements in the Provision of Involuntary Hospitalization of the Mentally III
Authors: Strong Howard R.
Published: April 2017

The history of civil commitment procedures is reviewed, with an analysis of the origins of commitment authority. Views contrary to involuntary hospitalization are presented. The author argues for the retention of these procedures, with an emphasis upon the parens patriae approach.
Effect inattendu de la répétition de comportement imaginée*
Authors: Griez E. , Callens Et J.
Published: April 2017

En vue de tester l'efficacité de la répétition de comportement imaginée, 33 sujets répartis en trois groupes furent soumis à une tâche dans une situation de stress de type social. Pour réduire l'anxiété due au stress, les participants du premier groupe avaient été préparés sous relaxation par une répétition de comportement imaginée. Ceux du second groupe n'avaient eu que la relaxation et ceux du troisième aucune préparation.

Non seulement la répétition de comportement n'a pas eu d'influence favorable sur l'efficacité d'exécution de la tâche mais un effet négatif est apparu. Ces résultats sont discutés.
Briquet and Briquet's Syndrome Viewed from France*
Authors: Dongier Maurice
Published: April 2017

Briquet's contributions to the description of hysteria have been almost completely forgotten in France. One may wonder how he, as well as contemporary French psychiatrists, would react to the approach to hysteria introduced and officialized by DSM III. In particular, its fragmentation into syndromes without apparent link to each other (psychogenic amnesia, conversion disorders, histrionic personality disorder, etc.) and its psychological causation, unbalanced by the consideration of organic factors in etiology, may raise questions.

The correlation of conversion disorders with hysterical personality remains a feature of the WHO classification (ICD 9), as well as a feature of French contemporary texts, although it is no longer viewed as a regular association by American psychiatry.

It may be that cultural factors lead, as suggested by Brisset, to a repression of conversion phenomena and of hyperexpressivity of affects replaced by more psychosomatic disorders in many contemporary societies.

Finally, one may question whether the choice of the term “Briquet Syndrome” is appropriate, as many of the patients described by him did not have the chronic and malignant course described by Guze: It tends to limit hysteria to one end (the most severe one) of a spectrum of disorders.
Termination of Pregnancy in Teenagers*
Authors: Krishnamoni D. , Jain S.C.
Published: April 2017

This is a study of some epidemiological aspects of fifty-three unmarried girls, aged sixteen years and under, who were referred for therapeutic termination of pregnancy during the year 1976.

Although the results showed that the overall abortion rate in Canada is much higher than in Newfoundland, the abortion rate in the 14–16 year age group is higher in the Province than in the rest of Canada. Secondly, the abortion rate for the fifteen year age group in this Province is higher than that for the sixteen year old girls, suggesting that more pregnancies in the older age group go to term.

The rate of abortions among some religious denominations is significantly higher than in others. Urban living does not appear to produce an increase in abortion rates in these age groups. Interruption of schooling due to the occurrence of pregnancy is not a cause for concern in about half of this group. There is some evidence in support of the contention that precocious maturation is related to early pregnancy.
Involuntary Hospitalization in Canadian Psychiatric Inpatient Facilities, 1970–1978
Authors: Riley Rodney , Richman Alex
Published: April 2017

This study is concerned with providing quantitative information on involuntary hospitalization of the mentally ill in Canada. It presents national statistical data on involuntary hospitalization to provincial mental and psychiatric hospitals, and psychiatric units of general hospitals for the period 1970–1978. The data used are based on the statistical information on psychiatric in-patients collected by the Mental Health Program of Statistics Canada for the period 1970–1978. The data indicate a moderate decline in involuntary admission rates. Men had consistently higher involuntary admission rates and women had consistently higher voluntary admission rates for the same period. Of the total commitments 22% were to psychiatric units of general hospitals. A high commitment rate was found for the elderly. As this is the first national quantitative analysis, both in Canada and in the international literature, the information presented should provide a useful objective perspective for a historical review of involuntary admissions to mental and psychiatric hospitals and psychiatric units of general hospitals.
The Aging Physician and Retirement
Authors: Grauer H. , Campbell N.M.
Published: April 2017

The attitude of physicians toward retirement was studied using a questionnaire sent to physicians aged 65 and older. The information obtained was supplemented by organizing a study group of interested doctors. Of the 58 respondents whose average age was 71, 54 were still in practice and 65% had no plans for retirement. There was a strong urge to maintain the status quo. The group discussion centered around the loss of control over one's declining practice and the fear of diminishing competence with advancing age. The dedicated lifetime pursuit of a medical practice makes retirement extremely difficult for today's older physician. This study supports surveys on the working life span, longevity and mortality of North American physicians.
Chronic Psychiatric Patients in the Community
Authors: Finlayson R. , Greenland C. , Dawson D. , Blum H. , Pittman G.
Published: April 2017

A feasibility study is presented which describes a cohort of 102 chronic psychiatric patients. The cases were selected on the criterion of four or more new admissions to psychiatric services in the Hamilton-Wentworth region during the year 1977. The group was predominately in the age 20–39 year range and both sexes were represented about equally. The diagnostic labels were personality ‘ disorder, schizophrenia, depression and alcoholism in descending order of frequency. The large majority were socially isolated and had contact with social agencies and the police. Seven deaths occurred in the cohort during the year of study.
The Joint Mature Women's Clinic or Menopause Revisited
Authors: Atchison B. , El-Guebaly N.
Published: April 2017

It appears that menopause might be characterized by a major feature — change. Research is ongoing in biological, social and psychological areas and hopefully will aid us in achieving a more precise understanding of the characteristics of this subgroup of women at risk for psychiatric morbidity around the time of the menopause. Until the groups surveyed are more stringently defined and we achieve this understanding, it seems reasonable to approach such patients and their experience by individualizing their assessment and management.
Interpretive Psychotherapy with Chronic Pain Patients
Authors: Lakoff R.
Published: April 2017

Patients for whom medical and surgical management has failed to relieve chronic pain were treated in a multimodal programme which included interpretive psychotherapy. Dynamic conflicts were identified in all cases and utilized in the psychotherapy and programme design. Examined in the light of ego functioning, pain that was previously considered intractible, yielded to psychological treatment. Further research is planned to identify the parts played by the different modalities and to study outcome.
Gas Sniffing as a Form of Substance Abuse
Authors: Remington Gary , Hoffman Brian F.
Published: April 2017

The authors review the existing literature on inhalation of gasoline fumes, highlighting the acute and chronic physical and psychological effects. The clinical picture of gas sniffing includes visual hallucinations, changes in consciousness, euphoria, nystagmus, dizziness, weakness and tremors. There is the possibility of rapid recovery, sudden death or brain damage with chronic abuse. When leaded gasoline is abused then blood and urine lead levels and erythrocytic delta-aminolevulinic acid dehydrase (ALAD) levels may be helpful. Although the treatment of acute and chronic gas sniffing syndromes is often supportive and non-specific, when lead levels are high chelated therapy is indicated including British anti-lewisite, calcium disodium versenate or D-penicillamine.

We also report our findings on an isolated native Indian population where intentional gas sniffing has reached epidemic proportions. Ten percent of the total population and 25% of the children between 5 and 15 years of age had been identified as gasoline inhalation abusers. In this population, the most important etiological factors included environmental, family and cultural components. The authors emphasize the need to correct the family and social deficiencies in such communities if the incidence of gas sniffing is to be decreased.
How Alberta Psychiatrists View Commitment Criteria and the Problem of Predicting Dangerousness
Authors: Arboleda-Florez J. , Holly H.
Published: April 2017

Mental health legislation has been under review in many jurisdictions throughout North America and Europe. The thorniest issue to review, practically everywhere, has been that of commitment. The Mental Health Act of Alberta, only 10 years old, is now too in the process of being changed. To help in this process, and on the belief that very seldom psychiatrists as a group are questioned about their opinions on these matters, and yet they are the ones who have to apply the legislation at the practical end, a questionnaire was circulated among Alberta psychiatrists. It aimed at obtaining the psychiatrists’ views on general matters regarding commitment, such as criteria and the appropriate length of commitment, and the degree of legal involvement desired on a commitment decision. The questionnaire also touched on local issues pertaining to the delivery of psychiatric services such as the designation of “facilities”, etc. This paper presents the results as compiled from the replies given by eighty psychiatrists, a 63 percent of those contacted.
Roses in December: Imaginary Companions in the Elderly
Authors: O'Mahony M. , Shulman K. , Silver D.
Published: April 2017

This paper focuses on one mental mechanism used in alleviating distress viz. illusion. Three patients are discussed with particular reference to their use of this mechanism. Some relevant literature is reviewed.
A Two-Year Follow-Up of a Comparative Trial of the Cost-Effectiveness of Home and Hospital Psychiatric Treatment
Authors: Fenton Fred R. , Tessier Lise , Struening E.L. , Smith Frank A. , Benoit Constance , Contandriopoulos Andre-Pierré , Nguyen Hung
Published: April 2017

The manpower and operating cost of home-based treatment was compared with the manpower and operating cost of hospital-based treatment during the second year and at the end of two years of treatment. Of the 155 patients destined to receive inpatient treatment, 76 were randomly assigned to home treatment, 79 to hospital treatment. The two groups were similar as to important social, demographic, and clinical characteristics, including psychiatric diagnosis. The manpower and operating cost of treatment, measured in two ways, was similar in the two groups during the second year. However, over the 2-year period hospital-based treatment of patients in each of the three diagnostic groups was more expensive than home-based treatment. Also, regardless of which treatment was given, the cost of treating schizophrenics was higher than the cost of treating manic-depressives which, in turn, was higher than the cost of treating individuals with depressive neurosis. Treatment failures were discussed. Over the 2-year period, failures in home-based treatment accounted for 39.1% of the total manpower and operating cost of home-based treatment, calculated according to Cost Model 1, and for 67.1% of the cost calculated according to Cost Model 2. The concept of failure in hospital-based treatment is also discussed.
Indian Mental Health: Changes in the Delivery of Care in Northwestern Ontario
Authors: Timpson Joyce B.
Published: April 2017

For ten years University of Toronto psychiatrists have made regular visits to isolated Indian villages in remote Northwestern Ontario, offering a clinical psychiatric program. Initially, two non-Indian social workers provided ongoing service between the psychiatric visits. Recognizing the difficulty in providing psychotherapy cross-culturally, the members of the treatment team developed the skills of local persons who were not formally trained in the treatment of mental health problems. The paper describes a significant shift in the psychiatric program beginning in 1981. At that time in certain communities local people took over the service, resulting in an increased ability to provide a preventative psychiatric program. Community based workers have dealt more with early marital difficulties, grief reactions, transitional depressive states, and less with major mental illnesses. In the areas which have community based treatment teams, the emphasis in psychiatric service is shifting from direct clinical work to formal teaching and case consultations with the indigenous counsellors. The evidence indicates optimism that the service is reaching more persons before the emergency stage than it did in previous years of the program.
Developmental Stages: An Integrating Theory of Group Psychotherapy
Authors: Mackenzie K. Roy , Livesley W. John
Published: April 2017

The inadequate nature of research into group psychotherapy stems from the lack of a satisfactory general theory that accounts for the group as a social system as well as for the functioning of the individual. A critique is presented of the group-as-whole tradition and a brief introduction given to social system concepts, particularly as they relate to group developmental stages. The idea that groups progress through a series of stages implies the notion of the group as a single entity with its own organizational structure. Specific stages are described through which the group acquires interactional complexity. These are conceptualized as epigenetic phenomena in that the mature structure is attained through an invariate sequence of transformations. Adequate resolution of any one stage is a prerequisite for further development. Group developmental tasks are described for the following stages: Engagement, Differentiation, Individuation, Intimacy, Mutuality and Termination. This set of higher order concepts has been found useful as a theoretical background against which specific group events can be evaluated. By using the idea of stages, the leader can monitor the progress of the group as a unit and compare the activity of any one member with the collectivity.
Behavioural Assessment of Disturbed, Institutionalized Retardates
Authors: Coons W.H. , Haley G.A. , Maharaj N.R.
Published: April 2017

While behavioural assessment has had wide application in a number of educational and treatment settings, relatively little has been done to develop programmes specifically/or use with retardates who have been institutionalized/or the treatment of disturbed behaviour. As a result, the development of appropriate procedures for the latter group requires extrapolation from the use of behavioural techniques in other settings.

The current literature on behavioural assessment stresses the importance of identifying meaningful response units and their controlling variables, if efficacious treatment programmes are to be mounted. To be maximally useful, assessment must provide a relatively simple description in objective, non-inferential terms of how a patient responds to the demands of daily living.

While many reports of treatment programmes focus on the assessment of a single, narrowly defined variable, the occurrence of which can be readily counted, this is not appropriate for the initial assessment procedures of a residential treatment centre. What is required is an omnibus approach which samples the patient's responses to a broad array of environmental situations which are relevant to the centre and its population.

A review of available behavioural scales reveals that there are very few reliable omnibus scales available for use with retardates and none which adequately assesses the behavioural concommitants of disturbed retardates. To deal with this group of patients, it is proposed that, initially, two scales be used to sample both normal and maladaptive behaviour. A number of suggestions have been made for implementing behavioural assessment procedures in residential treatment centres, especially for disturbed retardates.
Passing the Oral Examination for Specialist Qualification in Psychiatry
Authors: Kline Stephen A. , Fleming Sandford , Warme Gordon
Published: April 2017

This paper summarizes a number of considerations in the areas of technique, structure, diagnosis and formulation for candidates attempting to qualify in the psychiatry oral examination.
Improving Interviewing Techniques through the Bug-In-The-Ear
Authors: Salvendy John T.
Published: April 2017

The author describes a simple, efficient and inexpensive tool to improve and accelerate the teaching of interviewing techniques. There are major advantages and some shortcomings to this method. Both are reviewed along with a survey carried out to gauge the experiences of psychiatric residency training programs across the continent with the “bug-in-the-ear”. The author discusses the implications for residents, supervisors and patients and offers suggestions how to make this approach more available to non-using centers.
The Re-Establishment of Trust through Psychotherapy
Authors: Greben Stanley E.
Published: April 2017

In the course of life's experiences mistrust develops in childhood and adulthood. Clinical manifestations of mistrustfulness in patients are discussed.

Successful psychotherapy has as one of its principal goals the re-establishment of trust within the patient. This takes place through the development of trust toward the therapist. This experience serves as a bridge to the re-establishment of trust in others.

Those personal qualities in the therapist which are of the greatest importance in this area are reliability and realistic hopefulness. Being taken seriously and the opportunity to attach to the therapist are also very significant.

The place of the therapist's interventions as well as the relevant significant qualities in the patient are also discussed.

Trust breeds trust, connection with others and, thence personal security. This is a basic goal of psychotherapy.
An Effective Therapeutic Intervention with Adolescent In-Patients in Love
Authors: Collins Rex
Published: April 2017

Easson noted in 1967 how little had been published on intimate (frequently sexual) involvements between adolescents in in-patient settings and remarked how staff attitudes and countertransference feelings frequently resulted in an unsatisfactory resolution of such occurrences. Since that time the literature has remained sparse, yet the phenomenon and the problem of how best to deal with it persists.

The present case study of two female in-patients “in love” attempts to demonstrate the usefulness of a simple and presumably infrequently used mode of intervention in promoting therapeutic growth and facilitating ward management. Rather than attempting to separate the two patients and deal with issues of their relationship individually, the existence of the relationship was acknowledged and accepted, and conjoint meetings which explored its troublesome aspects were held with them and their respective therapists.

Provocative behaviour on the ward diminished, some insights were gained and their separation due to the discharge of one of them was effected with minimum turmoil.

While certain factors specific to the case may have contributed to the outcome, the success of the intervention, nonetheless, warrants further application and study in the clinical arena.
Stimulant Medications in Adults with Attention Deficit Disorder
Authors: Gauthier M.
Published: April 2017

The long-term prospective studies done in the last two decades on children suffering from attention deficit disorder with hyperactivity (ADD-H) give evidence of persistent disability in a majority of them when they reach adulthood. The literature on the use of stimulant medication in adults suffering from attention deficit disorder, residual type (ADD-R), is critically reviewed. After optimistic case reports two controlled double-blind studies have recently showed contradictory results. Some adults appear clearly to be helped by stimulant medication, but more investigations, especially with children diagnosed in childhood and followed-up, are needed before any firm conclusion can be made about the usefulness or non-usefulness of stimulants in ADD-R. There, as it is the case in childhood, medication might be insufficient by itself and might have to be associated with other forms of treatment.
Barriers to Care
Authors: Eisenberg Leon
Published: April 2017

In elevating cost containment to a first principle, the current political debate about health policy in the U.S. and Canada has lost sight of what should be its primary concern: the health status of the population. The two need not be incompatible. Many current medical procedures are of uncertain value for health and entail sizable costs. The application of the knowledge obtained through randomized clinical trials to the practice of medicine can improve public health and at the same time save money for needed health purposes.

Technology has come to dominate medical vision and has created conceptual barriers to responsive medical care. Doctors must attend to the illness experience of the patient as well as disease in organs and tissues. The limits of the biomedical model in psychiatry are illustrated by means of a hypothetical instrument: the PET/NMR cephaloscope. Clinical experience in psychiatry makes it abundantly clear that family and cultural environment are decisive determinants of functional status, even in disease conditions with a major organic component.
Vers une redéfinition de la psychiatrie communautaire au Québec*
Authors: Lesage Alain , Lamontagne Et Yves
Published: April 2017

Community Psychiatry is in troubled waters in Quebec. Overwhelmed by their caseloads, community clinics do not see the end of the tunnel with their new long-term mentally-ill patients. The painful reality of the new asylum in the community raises questions about Community Psychiatry despite its remarkable progress. The authors analyze the state of the art about schizophrenia, which is mainly related to chronic mental patients and point out the discrepancy between the original ideals of Community Psychiatry and the clinical reality. They develop the four following propositions to redefine Community Psychiatry in the actual context: recognize the need for the asylum as a process; tolerate the paradox of the multidisciplinary work; narrow the target population and the type of therapy offered; and secure continuity with the community.
Abortion and Subsequent Pregnancy
Authors: Bradley Christine F.
Published: April 2017

Two hundred and fifty-four women were followed from the second trimester of pregnancy until twelve months postpartum. Of these women, twenty-eight had had a prior therapeutic abortion and 216 women had no previous abortion. During their pregnancy and the postpartum period, the women completed a series of psychological and attitudinal measures. Analysis revealed that there were no significant differences between the two groups in terms of their demographic status, their obstetric experience or attitudes towards labour and birth. The study failed to demonstrate a relationship between anxiety during pregnancy and a prior abortion, nor were there any indications of inadequate maternal functioning.

Women who had a prior abortion scored higher on the autonomy and nurturance subscales of the Personality Research Form, and had higher levels of depressive affect in the third trimester of pregnancy and in the postpartum period.
Countertransference and Supervision: A Discussion of Some Dynamics from the Point of View of the Supervisee*
Authors: Gauthier M.
Published: April 2017

Although the important role of supervision in the training of psychotherapists is generally well recognized, it does remain a neglected topic in daily psychiatric practice. An overview of the abundant literature written on the subject shows the paucity of papers that take the perspective of the supervisee and subjectively describe the experience.

A common difficulty of the supervisory process appears to be the management of the therapist's feelings both in his relationship with the patient and with the supervisor. This problem is approached from the point of view of the supervisee, using a group perspective. A clinical vignette, from a supervised individual psychotherapy process illustrates how supervision is a mourning process where frustrations and losses abound. The difficult task of working through these conflictual feelings is fundamental for the supervisee if he wants to learn from the experience. Within this painful process (and to avoid it) many defensive mechanisms are often used and are described by the author along with some of their possible psycho dynamics.
Clinical and Biological Correlates of Sleep Deprivation in Depression*
Authors: Joffe R.T. , Brown P.
Published: April 2017

Sleep deprivation is reported to have therapeutic effectiveness in depressive illness. Furthermore, the response to sleep deprivation has important research implications. Recent conceptual advances, resulting in increased understanding of the role of abnormal biological rhythms and neurotransmitter function of the pathophysiology of affective disorder, highlight the future role of sleep deprivation in the research and treatment of these disorders.
The Effects of Timolol Maleate on Subjective and Physiological Components of Air Travel Phobia
Authors: Campos Peter E. , Solyom Leslie , Koelink Anthony
Published: April 2017

Twenty-one monophobic patients with moderately severe fear of flying were exposed to two 40 minute challenge flights after taking either Timolol 20mg/day or placebo. Heart rate, blood pressure, subjective ratings of anxiety, fear and palpitation and Hamilton Anxiety Scale ratings were made at the predetermined assessment intervals. Post-treatment global ratings of improvement were provided by patients and the attending psychiatrist. Results showed that heart rate significantly increased from baseline with placebo while Timolol successfully inhibited tachycardia during the challenge flights. Subjective ratings of anxiety, fear and palpitations did not show any drug group differences. These variables, however, showed a nonsignificant decrease from outgoing to return flight assessments after an initial significant increase from baseline scores. Hamilton Anxiety Scale ratings showed a significant decrease from baseline to post-treatment assessments, irrespective of drug group. Global improvement ratings revealed no significant differences between drug groups. Overall ratings by the psychiatrist were generally more positive than patients’ ratings, with the difference between the two sources of assessment reaching significance only in the placebo group. Disregarding group membership, heart rate was positively and significantly correlated with subjective ratings of fear, but not with palpitations or ratings of overall anxiety.
A Comparative Study of Filicidal and Abusive Mothers
Authors: Husain Arshad , Daniel Anasseril
Published: April 2017

It is generally believed that some abusive parents if untreated eventually kill their children and “the murder of a child is the final chapter in his history of maltreatment.” Yet only few authors have investigated the homicide of abused children. In this paper the authors report on a study of 8 filicidal and 52 abusive mothers referred to them by courts for pre-trial psychiatric evaluation. They found that there were significant differences between the two groups in that all (100%) of the filicidal women suffered from a major psychiatric illness before and at the time of committing the murder of their child while only 4 (7.7%) abusive mothers had a major psychiatric illness (x2 = 24.41, df = 1, p <.001). They conclude from this study that the filicidal mothers are different from abusive mothers and that the risk of fatality as a complication of child abuse increases significantly when the mental illness is present in the mother. They point to the implications of their findings for child protection and intervention procedures and suggest that one should act very vigorously and take the child into protective custody when the mother is found to have a major psychiatric illness.
The Psychiatric Aspect of Hypophosphatemia
Authors: Nanji Amin A.
Published: April 2017

A patient who developed a psychotic state in association with hypophosphatemia is presented. There was no evidence for other causes of psychosis and the clinical features disappeared with phosphate replacement. It is suggested that hypophosphatemia be considered in a patient with an unexplained acute psychosis.
The Question of Lithium/Neuroleptic Toxicity
Authors: Jeffries Joel , Remington Gary , Wilkins Judy
Published: April 2017

The question of lithium-haloperidol incompatibility has been debated for a number of years now. The difficulty remains in distinguishing a combined toxicity syndrome, rather than toxicity to either agent alone. The authors reviewed a further case of adverse drug response following the concomitant use of lithium and haloperidol. It is their conclusion that a combined toxicity syndrome does exist, although it remains for future investigations to determine whether this effect is additive or synergistic. Finally, the possibility of underlying organic susceptibility is raised with reference to the case presented here.
Evaluation of our Patients; Our Pupils; and Ourselves
Authors: Dewhurst W.G.
Published: April 2017

Respectfully dedicated to the memory of Robert Orville Jones, Psychiatrist Extraordinary, A Great Canadian, A Distinguished Internationalist, And Our First President.
The Teaching of Psychotherapy in Canadian Psychiatric Residency Programs: Residents’ Perceptions
Authors: Pérez E.L. , Krul L.E. , Kapoor R.
Published: April 2017

In order to determine the residents’ perceptions toward their psychotherapy training, a questionnaire was distributed to 400 residents in the 16 Canadian psychiatric residency programs. The main areas studied were: i) the resident's demographic and educational characteristics; ii) the residency program characteristics; iii) the type of training available in different psychotherapeutic modalities; iv) the analysis of quality and quantity of attention given to different elements of psychotherapy supervision (patient assessment, diagnostic formulation of treatment approach and goals); v) the degree of importance attributed by the residents to the above mentioned elements of psychotherapy supervision; and vi) the residents’ perception of their supervisor's attributes (examples: teaching ability and rapport).

Forty-two percent of the residents completed the questionnaire. Residents mentioned that the most adequate supervision was for long-term individual psychotherapy cases and that behavioral and group therapy supervision was the least adequate. The three most essential qualities in a supervisor's profile were judged to be: a) capacity for the development of a good rapport with the trainee; b) ability to pinpoint residents’ psychotherapy shortcomings and his willingness to help residents to overcome them; c) ability to teach. Three factors that significantly influenced the trainees perception of their psychotherapy training were: i) resident's age, ii) a seminar in individual psychotherapy in the residency core program; iii) having received more than one hour weekly of psychotherapy supervision. The understanding of patient's psychodynamics was the most adequately taught element during psychotherapy supervision.

The authors discuss briefly some recommendations for the teaching of psychotherapy in Canadian residency programs.
Boom Town Mental Health
Authors: Bland Roger C. , Orn Helene , Sinha Birendra
Published: April 2017

Population surveys were conducted, examining non-psychotic psychiatric symptoms, life events, and problems in community living in Primrose, a community experiencing rapid growth in anticipation of the construction of a heavy oil extraction plant, and in Wolf Creek, a stable rural town.

Psychiatric symptom levels were lower in the boom town than in Wolf Creek, but the Primrose symptom levels were comparable to those in Saskatchewan. More life events were experienced by Primrose residents who, despite lower symptom levels, had seen their physician more often for minor illnesses. The complaints about living in the town of Primrose matched those of boom town residents from elsewhere.

There was no evidence to support the popular view that living in a boom town creates more nonpsychotic psychiatric symptomatology. The higher proportion of the boom town population using physician services for minor illnesses, the higher level of life events reported, and the high frequency of reported problems for families living in the boom town support suggestions that stress is associated with these conditions.
Combining Motherhood with Psychiatric Training and Practice
Authors: Stewart Donna E. , Robinson Gail Erlick
Published: April 2017

Psychiatric residency or practice is difficult to combine with motherhood. The experiences of 82 women psychiatrists surveyed in the last year (47 residents and 35 staff doctors) are reviewed in a number of related areas — the difficulties of pregnancy, maternity leave, child rearing and the conflicts between motherhood and practicing psychiatry. Part-time residency is explored from both the resident's and hospital's perspective. Suggestions to make practice or residency more compatible with child rearing are discussed. Other issues such as work-based day care, realistic tax credit for child care expenses, and the difficulties of obtaining reliable and good home help and child care are reviewed.

There are numerous conflicts for women psychiatrists who work while their children are young and these problems need to be acknowledged and addressed by the profession. It is noteworthy that as well as a supportive spouse and good child care, the attitudes of colleagues and supervisors and the need for good role models were frequently cited as being critical to the success of combining a psychiatric career with motherhood. As more women enter the profession (approximately 50% of psychiatric residents in Canada are now female, and more than 50% of them plan to combine children with their profession at some stage of their career) the need to find creative and workable solutions to these problems becomes more pressing.
Recovery and Regression in Concentration Camp Survivors: A Psychodynamic Re-Evaluation
Authors: Berger David M.
Published: April 2017

This paper focuses on the adaptive capacity of survivors, and, by reframing the psychodynamics of the “survivor syndrome”, employing Object Relations theory and Self Psychology, attempts to shed light on the recovery process and the subsequent regressive responses in later life. Historically, an understanding of the survivor syndrome was impeded by the severity and uniqueness of the trauma. Survivors demonstrated symptoms that were not always congruent with the established diagnosis “traumatic neurosis”, and conventional psychoanalytic psychotherapy which aimed at lifting the repression of the persecution often failed. Despite reports of “late” physiologic sequelae, recent work has focused on the survivor's capacity to recover. Survival during the persecution entailed maintaining perceptual defences, maintaining an attachment to the world and the objects in it, and despite the fragmenting effect of these two sets of mechanisms, maintaining an integrated sense of self. Three clinical vignettes are presented to demonstrate that during the-recovery process a degree of reversal of the survival mechanisms was necessary. This required taking into oneself or acknowledging the anger evoked by the persecution, which, associated with the fragmenting effect of the persecution on the sense of self, often resulted in guilt and self-loathing, and affected the vicissitudes of the survivor's personal story. Often the self-self object function required bolstering by particular relationships. The triggers for later regression responses in survivors are events that evoke rage or serve as a symbolic bridge to memories of the persecution, and life changes that generate altered relationships that had served a self-selfobject function. Attending to the state of internalized objects as well as the self-cohesive contribution of relationships may benefit survivors.