bluuebunny/crossref_metadata_2025 huggingface dataset:
A Longitudinal Investigation of Lithium as a Prophylactic Agent for Recurrent Depressions
Authors: Stancer Harvey C. , Furlong F. Wayne , Godse D. D.
Published: April 2017

Twenty-one patients with recurrent endogenous depressions were treated with lithium carbonate for periods up to two and a half years.

Although depressions did not recur in six of eight patients with non-periodic disorders who were on lithium, the treatment did not reduce the frequency of exacerbation in eleven of thirteen periodic disorders.

Urinary measurements of sodium, potassium 17-ketosteroids, hydroxy-steroids and lithium in several of the patients did not help to differentiate them by their reaction to lithium.

It is concluded that the notion of lithium as an effective prophylactic agent against recurrent depressions, based on decreased frequency or increased interval between episodes, is not supported by this study.
Psychiatric Services in Saskatchewan under Medicare*
Authors: Cassell Wilfred A. , Smith Colin M. , Rankin Maggie Grandy
Published: April 2017

This study has examined the nature and extent of services provided to psychiatric patients under ‘Medicare’. An analysis of the records of 864,128 residents of Saskatchewan revealed that in 1965, 13,950 males and 27,009 females received a psychiatric diagnosis from physicians in private practice. Psychoneurotic conditions were frequent. General practitioners provided the majority of treatment services for this group. Physicians practising in urban areas were found to complete more psychiatric treatment than their rural counterparts. Female patients were found to receive relatively more psychiatric care than males. The latter obtained more consultations, hospital visits and somatic investigations. Lastly, the rate of service was infrequent, averaging less than one treatment session per patient.
Classification Des Medicaments Psychotropes, Nosologie Et Echelles D'Appreciation
Authors: Villeneuve A.
Published: April 2017

Various classifications of psychotropic drugs are currently in use. Generally psychotropic drugs are first classified according to their clinical action, and then divided into subgroups according to their distinctive chemical structure.

Likewise, depending upon the country, there are different classifications of men-tall illnesses which do not always correspond to one another. However, for several years, efforts have been made to standardize these classifications in order to facilitate comparisons of diagnoses on an international level. Moreover, trans-cultural studies have been undertaken in recent years in the field of nosology by means of rating scales.

Rating scales are also used in psycho-pharmacology to assess the change in the mental state during clinical trials. Some of them can be applied to most psychotic states, while others are limited in scope to one nosological entity or to one symptom. Stereotyped profiles, an empiric typology and profiles of drug-responders have been derived from some rating scales. However, the data obtained from these scales and submitted to elaborate statistical analyses are directly dependent upon the accuracy of the clinical assessment. It is clear that no deduction, statistical or other, based upon these scales will yield valid results if the clinical assessment is deficient.

In summary if the clinical observations are adequate the rating scales can provide precious information concerning nosology, diagnosis or symptomatology. They constitute a useful tool in the objective evaluation of more specific effects of drugs and help in their classification.
Drugs and Reality in Captive Society
Authors: Scott George D.
Published: April 2017

The prison world is a captive society with its government, its policies, its sanctions, its language and its customs. It forms part of a greater population of ‘rounders’ who live in free society, are associated with criminal activity and have had previous prison experience.

The rounder justifies his actions with general statements: “there is no really honest man”; “honesty is just a fear of getting caught.” He is prevented from belonging to the free society once it has banished him to prison, and his criminal record and his past associations are never forgotten. He usually lives out his ‘rounder life’ because there is no other society for him. The prison custodial and professional staff are part of the ‘world in opposition’, and the inmate calls them ‘squares’, scoffs at their apparent honesty and well-meaning efforts, feels they are deceitful, untrustworthy and justifiable targets for opportunity, connivance and manipulation.

In parallel, the uses of drugs, chemicals and fermentations in prison have a distinctly different set of values and frame of reference than in free society. These variations and modifications in the use of drugs, together with the role of chemicals and poisons, reflect the ambivalent attitude which the inmate has towards the social system in general.

The Medical Officer must not allow himself to be identified as an inmate man or an institutional man. He cannot be party to any plan or activity either by the administration or the inmate population. He must function only in his role as doctor in the society of antagonists, and use his professional standards and his judgment to carry out his medical duties in his neutral position, to interpret the language of the two societies, one to the other, and prevent both groups from using the medical department for reasons of their own. The Medical Officer is truly the ‘third man’ in the institutional life.
Psychodrama as an Ancillary Therapy on a Psychiatric Ward
Authors: Solomon Martin L. , Solomon Cecile K.
Published: April 2017

From the perspective of residents treating patients on the psychiatric ward of the Jewish General Hospital, psychodrama was of practical clinical value as an ancillary method for diagnosis, therapy and assessment of behavioural change. It was of value for a majority of the patients who participated actively, being most useful with the adolescent patients. The evaluation of psychodrama was largely contingent upon the therapists receiving feedback from the patients and the ward staff. Certain quantitative and qualitative differences in the patients' psychodramatic experience were linked to a positive therapist assessment of the value of psychodrama.
Violence as a Function of Age and Relationship with Special Reference to Matricide*
Authors: Mohr J. W. , Mcknight C. K.
Published: April 2017

Because of the diffuse picture of psychodynamic explorations in homicide an attempt was made to look at two structural elements, age and relationship, and to apply these considerations to three cases of matricide. Since matricide occurs predominantly in late adolescence the act is often related to impulsivity and explosiveness. We have shown that this did not apply to our cases, nor to the age structure of homicides in general. Because of the nature of the object, the mother is generally seen as the dynamic factor in the situation. These cases, although they confirm the phenomenon of ‘lockage’ which is often observed in close relationship homicides, raise doubts about the object-specificity of this state. Underlying theterm relationship is also the factor of temporal-spatial proximity, which may be a simple probability factor in object choice and has to be considered, although it will not account for a number of incidence distributions. A clearer view of the structure of the various homicide phenomena is needed before causal relationships can be stated with any degree of certainty.
Child Murder by Depressed Parents*
Authors: Rodenburg Martin
Published: April 2017

Although it is common practice to try to assess the risk of suicide in depressed patients the possibility of homicidal tendencies is often overlooked. Homicidal acts are frequently directed towards children by either parents or strangers and there is also a risk that children may be killed by parents suffering from severe depressive illness. It is proposed that early recognition might lead to the prevention of this type of crime.

The terms infanticide, filicide, and neonaticide are used idiosyncratically by the different authors and may therefore be confusing. Infanticide in Canada is a medicolegal term; it indicates a relationship between child murder and child birth. All other cases of child killings are designated as murder.

In Canada there were 1,276 incidents of homicide over a period of five years, (19641968). Of these 141 (11 per cent) were incidents of child murder - child murder being defined as the killing of a person 16 years and under. Seventy-six (54 per cent) of these were caused by parents, 41 were mothers and 35 were fathers. The mothers killed their children only, but 40 per cent of the fathers also murdered their wives. Suicide or attempted suicide following the crime was more likely to occur in those cases where the father was the assailant. Most children killed by their parents are between one and five years of age.

Sixty-five (46 per cent) of child murders were caused by non-relatives and 32 per cent of these assaulted their victims sexually, the crime occurring most frequently in the evening.

The dynamics of child murder by depressed parents has been reviewed. It is proposed that a child is particularly vulnerable when a depressive illness is superimposed upon a constellation of parental factors which can be recognized and specified.
Crisis and Aftermath: Community Psychiatry in Saskatchewan, 1963-69*
Authors: Smith Colin M.
Published: April 2017

In 1962, despite the development of distinotive treatment methods, Saskatchewan had the highest number of patients in mental institutions (per 100,000 population) in the whole of Canada. Between 1963 and 1967 a dramatic reduction to 40 per cent of its previous level occurred in the Saskatchewan mental hospital population. This reduction was associated with tensions within the psychiatric service, in some local communities and amongst the public, and led to three major reviews of the system: by an Ad Hoc Committee (1966), by Dr. Shervert H. Frazier (1967), and by a group of management consultants (1968). A brief outline is given of the changes which took plJace, the tensions which were generated and the three studies which were conducted. This is followed by a description of guidelines to a new Saskatchewan program in which stress is laid upon community involvement, a cybernetic model, a competitive system, participative management. and a problem-solving approach to conflict resolution. It is suggested that the study of the conditions which foster human responsibility and concern for people forms a legitimate subjeot for future research.
Psychiatric Education in the Emergency Room Setting
Authors: Rusk Thomas N.
Published: April 2017

Some background concepts regarding the teaching of clinical psychiatry are briefly reviewed, along with current controversies regarding the content and timing of various aspects of residency training.

The main point made in this paper is that the Emergency Room (ER) is a forum of potentially immense value for the teaching of clinical psychiatry but it is a resource which is largely untapped. A technique which remains unexplored involves the use of video tape in the ER. Research which is currently in the planning stage involves the evaluation of therapist variables as to whether patients follow through with recommendations. Research is urgently needed to determine how effective crisis intervention is, as well as how effective different techniques are, for what type of patient and in what type of crisis. While these questions apply just as urgently to all psychotherapy, the crisis situation lends itself more readily to research in that it is more time limited and the effects of intervention as opposed to other life variables are more obvious than in more long-term psychotherapies. The problem of spontaneous improvement is, of course, still very much present.

The advantages of ER teaching presented in this paper are the following:

I It is an opportunity for participant teaching in a non-dyadic situation.

II Supervision is immediate.

III Post hoc distortion is eliminated, yet it allows traditional supervision in the post interview discussion.

IV The real, as opposed to the contrived situation, should combine service and teaching.

V The ER is a natural transition zone from the medical to the psychiatric model.

VI Opportunities are provided for rapid resolution of conflict and a sense of mastery.

VII Emphasis on the evaluation of ego strength over and above dynamics and genetics is crucial and productive.

VIII Crisis demands selective focusing, as well as careful and rapid conceptualization of the tactical intervention - good training for any therapy.

IX Real and natural confrontation with social realities is necessary.

X A wide range of diagnostic categories is seen.

XI ER encounters allow teaching of a flexible psychotherapeutic approach appropriate to different problems. This active empathic approach complements the passive analytic one best learned elsewhere.

XII Yet psychoanalytic concepts from psychosexual stages to transference and counter-transference are well demonstrated in the ER.

XIII A different psychiatric role model can be provided for medical students, thus enhancing their motivation for psychosocial concepts. Crisis resolution itself should be a cornerstone of medical student teaching.

XIV The ER is obviously a place to teach crisis intervention, a well-accepted therapeutic endeavour.

XV The involvement of social workers, psychiatrists, psychologists and nurses working together provides an excellent introduction to training in collaborative skills.
Partial Hospitalization*: Concept and Method
Authors: Congdon Roger G.
Published: April 2017

This paper discusses the ambiguities and contradictions which are revealed when a patient is totally hospitalized. The term ‘Partial Hospitalization’ is proposed as being more desirable, even though the patient may require twenty-four hour care at some time. Also discussed is the role of dependency relationships and how these are fostered by the present nomenclature.

The role of the Therapeutic Community approach, in attempting to minimize institutionalization, is proposed as contradictory though desirable for a patient who is placed in a dependency situation by administrative procedures which are probably now outdated.

The various phases of ‘Partial Hospitalization’ are discussed and its best known component, day care, is reviewed in detail.

The proposition is made that, as the separate components of ‘Partial Hospitalization’ cover all that is now provided by psychiatric hospitals, the term ‘inpatient’ should be dropped.
Marijuana and Suggestibility
Authors: Bilash I.S. , Arnold M. , Zell C.
Published: April 2017

Marijuana users were divided into low and high suggestibility groups and interviewed with regard to their marijuana experiences. The two groups could be successfully differentiated in terms of whether first expectations were met and in the frequency of the occurrence of paranoid symptoms.
Audio-Visual Feedback in Group Psychotherapy: A Method Using Tape Recording and ‘Still Colour’ Photographs
Authors: Reckless John B.
Published: April 2017

Videotape is factually accurate but expensive. If used to replay in a group session it interferes with group process, whereas still photographs and audiotapes are inexpensive, unobtrusive and simple to add to the standard psychotherapeutic learning experience. The technique stands as a viable accessory to group therapy treatment.
The Traumatic Syndrome
Authors: Warnes Hector
Published: April 2017

This paper demonstrates both the similarities and the differences between concentration camp survivors and those suffering from other forms of psychiatric reactions resulting from trauma. In the former the systematic degradation, humiliation and persecution over a prolonged period of time, along with a sense of hopelessness and/or helplessness are characteristic features. Found at the other extreme of the spectrum is the acute traumatic event occurring in civil life and resulting in a classical traumatic neurosis but not leading to a total transformation of personality and life style. Between these two forms of psychiatric reactions there are various pathogenetic and pathoplastic mechanisms, sometimes overlapping but showing the underlying dynamic pattern of survival threat.
The Inpatient Service: Therapeutic Community versus Community Therapy
Authors: Freeman S. J. J. , Burch J. D. , Pinto R.
Published: April 2017

The 'therapeutic community' model of ward organization has many advantages and proved to be helpful to a number of patients, who were able to repattern many of their interpersonal and coping techniques in this milieu. This paper is not intended as an attack on this concept of hospital management but rather is an attempt to point out that it is probably not appropriate in certain situations. The first of these occurs when all patients presented to a hospital ward must be admitted for short-term hospital stabilization and subsequent outpatient and/ or community care. The second situation in which the efficacy of the therapeutic community model may be doubted is where there is a surfeit of staff and facilities.

An alternative form of ward organization based on community psychiatry principles is described and some statistical evidence is presented to support the contention that it is the more appropriate model for these situations.
Controlled Evaluation of Intravenous Drugs in the Specific Desensitization of Phobias
Authors: Silverstone J. Trevor , Salkind M.R.
Published: April 2017

The present study was undertaken to compare intravenous methohexitone, given as an adjunct to the behaviour therapy of phobias, with another centrally-acting, rapidly metabolised intravenous agent, propanidid, and also with normal saline. Thirty-five patients were included in the trial, all of whom had had phobic symptoms of at least one year's duration which were seriously interfering with their lives — 15 had specific phobias, 9 had social phobias and 11 had agoraphobia. Treatment consisted of twelve weekly drug-assisted desensitization treatments, using either 1 per cent methohexitone, 2.5 per cent propanidid or normal saline. Within each diagnostic group the drugs were randomly allocated. All treatments were conducted by one of the authors and all assessments by the other (who did not know which of the three preparations the patient had received). In addition to monthly ratings of the phobic symptoms, assessments of anxiety and depression were made, using self-rating scales. Patients were followed up six months after the end of treatment.

Patients with specific phobias fared best, 9 out of the 13 who completed being considered to be markedly improved. Although the numbers are small there was a suggestion that patients receiving the two active drugs did better than those on the placebo. While methohexitone and propanidid were similarly effective, recovery time was much more rapid with propanidid. No patient in the specific phobia group relapsed significantly during the six months follow-up period. Furthermore, as the phobia improved the general anxiety level fell. Few depressive symptoms arose during successful desensitization, and there was no evidence of symptom substitution.

Patients with social phobias and agoraphobia did far less well. In neither case did the active drugs appear to possess any advantage over placebo. Furthermore, of the 7 patients with agoraphobia who had improved, 4 relapsed within six months.

It was concluded that drug-assisted desensitization is likely to be of greatest benefit in the management of specific phobias, with propanidid being the drug of choice.
Mechanisms of Stalemate in Conjoint Marital Therapy
Authors: Aldous N. R.
Published: April 2017

When a married couple discuss matters which are independent of societally-reinforced marital role performance unique opportunities arise for enhancement of each other's personal growth or for collusive participation in anxiety-reducing but growth-limiting experiences. The notion has been advanced in this paper that the latter process can be conveniently described in terms of a series of mechanisms of statement which form a rough counterpart (for the couple) of defence mechanisms for the individual. Exposure and exploration of these mechanisms becomes the starting point for the work of conjoint marital therapy. Discussion of the subsequent evolution of the treatment is not within the scope of this paper.
Psychiatric Assessment of Mental Cruelty
Authors: Bezeredi Tibor
Published: April 2017

Since the introduction of mental cruelty as grounds for divorce in Canada, psychiatrists have become involved as expert witnesses in divorce cases. While the psychiatrist should decline when it conflicts with his ethics, personal and professional reputation, it is possible and desirable for him to distinguish when there is just reason for giving testimony. The practical assessment list provided may be useful for this purpose.
Article
Authors: Plante Gilles , Côté Hélène , Pilic Ivanka
Published: April 2017

The authors describe a group of inhibited children from an impoverished milieu, randomly selected from four schools. Televised evaluations were used to examine the children, and the parents were evaluated by the social workers. Among twenty evaluated children, three were found to be normal and the rest were inhibited at minus 2 degrees.

Almost half these children showed depressive traits. The families lived in deprivation. In half the families there was alcoholism and the fathers were absent. The parents saw themselves as excessively strict but the children, for the most part, were not able to verbalize how they perceived their parents. In spite of the deprivation of these families the parents still aspire to middle-class values for their children and push them in this direction, and this increases their inhibition. An attempt is now being made to stimulate them: eight have been invited to regular free painting sessions, and the others will form a control group for a further study in which the efficacy of this technique will be measured.
Mesoridazine and Chlorpromazine in the Treatment of Alcohol Withdrawal Syndrome
Authors: Frost J.B.
Published: April 2017

Forty patients admitted for the treatment of alcohol withdrawal were placed on either chlorpromazine or mesoridazine on a double-blind basis. No significant difference in rate or degree of improvement between the two groups was noted and both groups showed an improvement which was more marked in the first week of treatment. There were few significant side effects from either drug. Improvement on either therapeutic regime is predictable and both are effective in relieving or lessening agitation, tremulousness, hallucinations and anxiety in patients recovering from acute alcohol intoxication.
Psychodrame Libre Ou a Theme Induit
Authors: Lavallée J. , Lapierre Y.D.
Published: April 2017

A comparative study of two methods of initiating a psychodrama session is reported. The treatment course with 24 neurotic outpatients comprised six weekly sessions of psychodrama.

This study demonstrates that patients participating in psychodrama sessions where the theme is introduced by the therapist do so more actively than do patients treated in a group where the psychodramatic theme results from the preliminary group discussion. The affective component of the participation of the former group was also more pronounced as they were either warmer or more aggressive than the group where the theme arose from the group discussion.

The reduction of the total psychopathology was not significantly different in the two groups.
A Gender Identity Project
Authors: Steiner Betty W. , Zajac A. S. , Mohr J. W.
Published: April 2017

A Gender Identity Project was established to study people who present with the chief complaint of transsexualism. A multidisciplinary approach was chosen and patients were investigated from the genetic, neuroendocrinological, psychological, and social aspects. The organization of the project and the protocol for evaluation of the patients are outlined. The investigators hope that almost all cases seen for evaluation, including those who dropped out and those who have been rejected in the process, will be seen for follow-up and that this will provide some indication of how to help these people. The findings of the study, together with reports on the studies which arose as extensions of the original investigation, will be reported in subsequent publications.
The Measurement of Retrograde Post-Traumatic Amnesia
Authors: Blomert D. M. , Sisler G. C.
Published: April 2017

Retrograde amnesia is the inability to recall events which occurred immediately before head trauma or other acute brain insult. It is one aspect of a larger entity — posttraumatic amnesia — seen in some head injuries, and represents a defect in the consolidation of memories. Previous studies of retrograde amnesia have produced conflicting findings regarding its characteristics.

A study was undertaken to identify the characteristics of retrograde amnesia, its relationship to anterograde amnesia, and the problems of its measurement.

Forty-eight patients with head injuries admitted to the Emergency Department of the Winnipeg General Hospital were interviewed to identify all subjects meeting certain criteria regarding age, education, and so on, and twenty-five met the criteria and were included in the sample. Each subject was interviewed at least twice until the retrograde amnesia had reached a stable minimum. The duration of retrograde and anterograde amnesia as well as immediate and short-term memory were assessed.

It was found that the duration of retrograde amnesia was directly related to the duration of the anterograde amnesia and to the duration of hospitalization.

Some problems involved in measurement are discussed.
Possible Interaction of Environmental and Biological Factors in the Etiology of Schizophrenia: Review and Integration
Authors: Strahilevitz Meir
Published: April 2017

Possible interactions of genetic and environmental factors in the etiology of schizophrenia are discussed.

Studies on the significance of genetic-constitutional and environmental factors in determining specificity of behavioural and biochemical responses to stressors in humans and experimental animals are reviewed.

Studies of stress in schizophrenia are also revieweed and their possible relationships discussed.

Hypotheses related to the interaction of environmental factors and genetic constitutional factors in the production of acute schizophrenic psychosis in genetically predisposed people are presented. Research studies supporting such hypotheses are reviewed and discussed.

It is proposed that environmental pressures, by inducing a physiological state of stress or other biochemical physiological alterations, may be etiologically related to the development of acute schizophrenic psychosis by:

• Producing chemical substances that act as inducers of enzymes, in particular transmefhylating enzymes and those involved in the production of proteins, which may be related to the etiology of schizophrenia;

• Activating autoimmune processes which may be related to the etiology of schizophrenia;

• Changing levels of brain amines;

•Altering the permeability of the blood-brain barrier.
Psychiatry and Oncology: A Review
Authors: Brown J. H. , Varsamis J. , Toews J. , Shane M.
Published: April 2017

There are complex relationships between cancer and mental state, of which the most readily understandable are the psychological reactions of patients with established malignant disease. More speculative, and difficult to study, is the possibility that psychological states may predispose to the development of cancer. Currently, theoretical and research interest centres on a third topic — the high frequency of cases in which an underlying malignant disease presents as a ‘functional’ psychiatric illness, usually a depression. The suggestion is made that this may eventually be explained by an immunological mechanism.
Psychiatrists and Psychiatry Residents in Canada: A Compilation of Canada Manpower Data and Suggestions for Further Study
Authors: Thomson Michael J. C.
Published: April 2017

The study of psychiatric manpower needs is both important and difficult. Some previously available data on the numbers of psychiatrists in each province of Canada are examined in conjunction with one new item relating to the number of residents in each Canadian university department of psychiatry. Unfortunately, no clear-cut conclusions can be drawn, ‘but some suggestions are made for further studies. Probably more questions are raised than answered, but this reflects the state of our current knowledge or lack of it.

The data show that there are currently (fall 1973) 1,614 psychiatrists in Canada compared with 1,478 in 1971; 944 in 1966 and 549 in 1961. There was thus a net increase of 929 (169.2 percent) psychiatrists in Canada between 1961 and 1971. Even allowing for the increase in the size of population, the ratio of 1 psychiatrist: 33,200 of population in 1961 decreased (improved) to 1 psychiatrist: 14,600 of population in 1971, which represents a 56.0 percent change.

There were 549 residents in Canadian university departments of psychiatry in the fall of 1973. This level if maintained, would double the number of practising psychiatrists in Canada in 14 years. However, this also assumes that all residents complete their training and continue practising in Canada, that none of the existing Canadian psychiatrists retire or leave the country, and no immigrant psychiatrists arrive in Canada. These assumptions are unlikely, but accurate data are not available to correct them.

McGill and the University of Toronto departments of psychiatry are dominant and they are currently (fall 1973) training 45.3 percent of all Canadian psychiatry residents (McGill 20.5 percent and Toronto 24.8 percent).

Unfortunately a number of university departments did not or were unable to supply information on the number of psychiatry residents in training in past years, which makes a comprehensive study impossible.
Objectifying the Single Case Study
Authors: Meikle Stewart , Wenger Larry , Gerritse Richard
Published: April 2017

The group comparison type of investigation and the traditional case study are both criticized as being of limited value to the clinician faced with an individual patient. A plea is made for a compromise in which individually tailored assessment devices are designed for particular cases and are then subjected to statistical procedures analysing the results. In this way the requirements of relevance and objectivity may both be satisfied. The approach is illustrated by means of a single case study of depression and the results and implications are discussed.
Kleine-Levin Syndrome in a Female Patient
Authors: Takrani Lal B. , Cronin Denis
Published: April 2017

A female patient suffering from Kleine-Levin Syndrome is described. The clinical picture of hypersomnia with compulsive eating, leading to obesity, coupled with a marked change in personality make-up (characterized by episodes of confusion, perplexity, disorientation, tension, irritability and depression, in addition to violent outbursts of aggression when her demands were not instantly met) led to the conclusion that the symptom complex presenting had an organic etiology and was akin to that described in the Kleine-Levin Syndrome. The neuropathological findings are reported.
Psychiatry in Ethiopia
Authors: Lippman David
Published: April 2017

Ethiopia, the third most populous country in Africa, having about 27 million people, has a mental health system involving two psychiatric hospitals and six psychiatrists. The author worked as a psychiatrist for six months in the Addis Ababa psychiatric hospital and obtained statistics relating to the patients consulting the outpatient department. Age, sex, occupation, religion, place of origin, alcohol and chat (a local stimulant) usage, diagnosis and previous treatment data were recorded for all the 281 patients evaluated during one 5 1/2 day week. These data are described and analysed, and examples and comments are given additionally on the frequency of some neurological syndromes and the rarity of depression. This latter finding is then discussed in the light of several of the conspicuous oral trends in the upbringing of children and also in the adult life of Ethiopian society.
Roadblocks and Stopgaps: A Review of Factors Obstructing the Development of Comprehensive Child Mental Health Services
Authors: Rae-Grant Naomi I.
Published: April 2017

Even under conditions which might be considered ideal for the development of a comprehensive system of services for disturbed children and adolescents (adequate financial resources, good recruitment and training programs and collaboration between different government departments concerned with youth), there are factors which mitigate against the development of a logical service system.

Program development is groomed by its historical background, coloured by prevailing societal attitudes toward children and skewed by the existing funding mechanisms.

The case records of children and adolescents referred for assistance in residential treatment placement over a five-year period are analysed in terms of previous interventions. It is evident that the multifaceted nature of the family, social, treatment, and educational needs of children are tackled piecemeal; each agency bringing its resources to bear only on one aspect of the child's functioning and extruding the child when its repertoire of child altering behaviour is exhausted or deemed ineffective; at this point referral is made to another agency or system, resulting in a discontinuous, frequently ineffectual series of “helping” efforts.

Understanding, modifying and coordinating service development will require interactive planning between all the caring, treatment, and educational systems on behalf of the child population.
Psychiatric Diagnosis in Toronto, New York and London
Authors: Duckworth G.S. , Kedward H.B. , Eastwood M.R. , Allodi F. , Woogh C. , Meier R.
Published: April 2017

National statistics of mental illness suggest great differences in morbidity patterns between Canada, the USA and the UK, with the highest rates of illness occurring in Canada. Statistically, Canada and the US possess higher rates of schizophrenia and diseases of the senium but lower rates of affective illnesses than the UK. The US-UK study demonstrated that when the diagnostic process was standardized, the differences between the two countries disappeared. This paper examines a sample of 255 Canadian patients hospitalized in Toronto and compares the results of standardized techniques of diagnosis with the routine hospital diagnoses of the same patients. Conclusions of the study were fourfold. First, psychiatric diagnoses made by standardized techniques can achieve a high degree of reliability as measured either by inter-rater comparisons of item ratings (92 percent) and diagnoses (80 percent) or by correlation with computer diagnoses obtained by the CATEGO program (75 percent). Second, comparisons of project consensus diagnoses with routine hospital diagnoses revealed that agreement between the two was highest in Toronto, lowest in New York and intermediate in London. Third, a comparison of the project diagnoses of psychogeriatric patients in the three centres revealed no differences in morbidity between the three countries. Finally, the fallacy of generalizing from studies in one country which have not controlled for diagnosis to populations in other countries, is exposed.
Recent Changes in the Emotional Reactions of Therapeutic Abortion Applicants
Authors: Meikle Stewart , Robinson Carol , Brody Harry
Published: April 2017

The emotional status of one hundred women applying for therapeutic abortions during 1967/68 was compared with that of 100 more recent applicants in 1975. The Minnesota Multiphasic Personality Inventory of the two groups reveals a significant reduction in psychopathology amongst the more recent applicants. This difference remains when group differences in age are controlled, and applies when married and single subgroups are considered separately. These results are interpreted as suggesting that the generally more liberal social atmosphere surrounding present-day abortions is reducing psychological stress among women undergoing this procedure.
Amitriptyline Blood Levels and Relapse
Authors: Furlong F.W. , Sellers E.M. , Kapur B.M.
Published: April 2017

Nine previously depressed patients who had responded either to amitriptyline, nortriptyline, or ECT, according to defined criteria, were followed for six months on either 150 mg. or 75 mg. amitriptyline daily, double blind. Blood amitriptyline and nortriptyline levels were measured by gas chromatography over six months, and clinical measures were performed. The range of blood concentration of amitriptyline and nortriptyline was as would be expected from the literature.

Two patients relapsed within six months and both were in the 150 mg. dose group. Of the two relapsed patients one showed the highest blood levels of the group, often beyond the range which could be calculated, and the other showed very low blood levels. Analysis of the clinical scores and blood levels for the whole group did not reveal any relationship between variations in blood level and depression ratings from month to month, or any other information as to what dose or blood level produced optimal results for the patients who did not relapse.

This study tends to support the view that lack of effectiveness may be associated with too high or too low blood levels; that relapse may also be associated with very high or very low blood levels; and that the use of even rough measuring of blood levels could indicate which alternative was more likely in a given individual. In this study the group on 75 mg. amitriptyline daily did better than the group on 150 mg. daily in terms of relapse.

Most studies of the significance of tricyclic antidepressant blood levels have focused on the acute response over short intervals, usually six weeks, and used nortriptyline; this study focuses on relapse over six months and measures blood levels of amitriptyline and nortriptyline resulting from oral amitriptyline.
A Two-Dose Dexamethasone Suppression Test in Patients with Psychiatric Illness
Authors: Shulman Ralph , Diewold Patricia
Published: April 2017

After exposure to a low and high dose dexamethasone regime, 11 of 34 acute psychiatric inpatients demonstrated abnormal dexamethasone suppression characterized by morning and/or mid-afternoon escape from suppression. This abnormality of suppression was found in primary depression, in mania, and in acute schizophrenia. In primary depression, the presence of abnormal dexamethasone suppression failed to discriminate “endogenous” depressed from “other depressed” subjects.

Because nonsuppression to a high dose of dexamethasone is also found in patients with ectopic ACTH secretion and in patients with autonomous adrenal tumors, caution is necessary in the interpretation of nonsuppression which persists after recovery from psychiatric illness. As patients with Cushing's syndrome of uncertain etiology may be referred to a psychiatrist for a diagnostic evaluation, the psychological correlates of abnormal dexamethasone suppression need to be established with greater certainty.
Home Care Treatment of Acutely ILL Psychiatric Patients: A One Year Follow-up
Authors: Smith F.A. , Fenton F. R. , Benoit C. , Barzell E. , Tessier L.
Published: April 2017

This paper presents the results of one year of Home Care treatment of 77 acutely ill psychiatric patients. Home Care treatment was successful in 83.1% of 77 patients during the first year. Since only four patients failed during the second six months of treatment, hospitalization was effectively prevented, and not delayed, during the first year of treatment.

Finally, a history of previous psychiatric hospitalization is not an accurate predictor of success or failure in the patients receiving Home Care treatment in this study. It appears more likely that the psychosocial supports available to the patient, and the relationship between the patient, his family and the Home Care treatment team, are more important in determining the success or failure of treatment at home.
Speed in Test Performance in Relation to Depressive Illness and Age
Authors: Weckowicz T. E. , Nutter R. W. , Cruise D. G. , Yonge K. A. , Cairns M.
Published: April 2017

The results of multivariate statistical tests indicate that depression specifically affects performance on speed tests in counterdistinction to power tests.
Criteria for Early Diagnosis of Brain Dysfunction
Authors: Lazor Alina , Chandler Dorothy
Published: April 2017

This paper is concerned with the early identification in the pre-school years of those symptoms considered to be significant for the diagnosis of minimal brain dysfunction (MBD) (6). The history through the sixties and seventies shows a growing concern on the part of psychiatrists, neurologists and psychologists for the identification of those symptoms significant for the diagnosis of MBD (1,3,6–8,23). The paucity of follow-up studies and our own concerns regarding the diagnosis of brain dys-functioning led to a follow-up study on forty children diagnosed in pre-school years. The original diagnosis was made on a cluster of symptoms classified as primary, secondary and tertiary. Primary symptoms are neurological signs. The secondary symptoms are defensive mechanisms against the intrapsychic problems such as fears, compulsiveness, etc. Some symptoms may be either primary or secondary, e.g. distractibility, mood fluctuation. Tertiary symptoms are the results of the inability to interpret and respond to the social situation effectively again because of the organic dysfunctioning and the child's reaction to the rejection and hostility which he engenders by his own inappropriate social behaviour and emotional responses, such as, diffusely hostile attitude or over-dependence.

The study showed that in that group of forty, thirty seven or 93.7% had positive neurological signs, with three or more occurring frequently. Psychiatric diagnostic evaluation shows severe personality deviation in thirty-seven cases. On psychological testing sixty percent were dull normal or above (above 80 I.Q.) and forty percent below normal. Examination of school placement reveals that only thirty percent are in regular classes and the remainder in special classes. The findings confirm that the diagnosis can be made in pre-school years on the basis of behavioural symptoms in the presence of neurological signs. The neurological impairment is permanent and the dysfunctioning affects emotional, social and intellectual functioning. The severity of the dysfunctioning of the family affected the child's rate of improvement.
Chinese Approach to Mental Health Service
Authors: Leung Sophia M.R. , Miller Milton H. , Leung S. Wah
Published: April 2017

This paper reviews the health care approaches in the People's Republic of China where life style, political leadership, grass roots health programs and patriotic zeal are a unified endeavour. Certain assumptions underlying North American health practices come into particular focus. Specifically, the Chinese experiences raise doubt about the value of a professionally oriented emphasis in health care and deny the worth of health programs which are not woven into the social, economic, political and ethical activities of society. How effective can our free standing groups of health professionals be in practising prevention, in enlisting public involvement in their own health care and in helping to co-ordinate needed public, private and governmental joint endeavours required for the enhancement of people's health?

The Chinese maintain that the key to all health and mental health care advances is social and economic reform, grass roots programs and most importantly, a self-reliance strategy with an intense personal motivation to produce change in one's way of life. Professional responsibility worthy of public trust would be achieved only insofar as professional efforts facilitate these three areas of development.

Material for this presentation is drawn from a total of six recent visits to the People's Republic of China and from personal discussions with' representatives of several delegations of health leaders during their Vancouver visits. Programs in the Shanghai Mental Hospital are described along with some reference to an interview with Dr. George Hatem (Ma Hai Teh), the distinguished physician who directed the programs which resulted in the virtual eradication of veneral diseases.
The Link Between Hysterectomy and Depression
Authors: Turpin Theodore J. , Heath David S.
Published: April 2017

This paper reviews the current literature on the possible link between hysterectomy and depression. Psychological hypotheses for such a link are discussed. The literature is divided fairly evenly into those papers which support a definite association between hysterectomy and post-operative depression and those which refute any such link. A summary of these papers is given with a critical discussion of the various methodologies and operational definitions used.

No clear-cut association can be found on review of these studies, but in those papers which do suggest an association, the risk factors of a history of pre-operative depression, no organic uterine pathology and hysterectomy in young women of child bearing age are common to most. The point is made that depression occurring after hysterectomy is more likely to be associated with the social and psychological consequences of organ removal than with the operative procedure itself, and therefore, one may not expect the condition to become clinically obvious for anywhere from six months to two years post-operatively.

The authors conclude that care should be taken in performing hysterectomy where the indications are equivocal, especially if the above alleged risk factors are present. A plea is made for more research in this area to determine whether hysterectomy is a factor in the etiology of depression in some women, and if so, which women are at risk.
Manic Depressive Illness in Adolescence and Childhood: Review and Case Report
Authors: Coll Patrick G. , Bland Roger
Published: April 2017

The literature on this topic from its inception by Kraepelin is reviewed. While Kraepelin and the French school always recognized juvenile mania, the Anglo-American school has no such unanimity of opinion. Less than 100 cases are described in the world literature. In Canada affective psychoses are rarely diagnosed under age 10 and of all affective psychoses admitted to institutions less than 5% are under age 20. The differences between child and adult mania are outlined.

It is proposed that manic-depressive illness occurs in children but is not diagnosed more often because of its dissimilar presentation to the adult form and doubts about its existence in childhood.

The case history of a 14 year old boy who presented in a hypomanic state is described. There was a strong family history of affective disorder. Both his parents and his half-sister were already on lithium for manic-depressive illness.
The Canadian Certification Examination in Psychiatry: II: Who Passes and who Fails
Authors: Lowy F.H. , Dongier M.
Published: April 2017

No analysis of Canadian certification examinations in psychiatry has previously been published although analyses of the American Board of Psychiatry and Neurology and the British Membership examinations are available. Because candidates, directors of residency training, mental health planners and consumers are all interested in who passes and who fails the certification examinations, available examination data for English speaking candidates are analyzed. Successful candidates are more likely to be younger; to have attended medical schools in English speaking countries (in North America, the British Isles, or the “old Dominions”); to have placed in the upper two-thirds of their medical school class; to have entered psychiatric training soon after graduating from medical school and then to have completed their training without interruption. Some limitations of the examinations and the problem of candidates who fail are briefly discussed.