bluuebunny/crossref_metadata_2025 huggingface dataset:
The Management of Children Admitted to Child Welfare Services in Ontario: A Review and Discussion of Current Problems and Practices*
Authors: Steinhauer Paul D.
Published: April 2017

Children coming into the care of the Ontario Child Welfare System are generally older and more seriously disturbed. Foster parents and Children's Aid Societies have had to change in order to meet the needs of these troubled children. While the efficacy of foster care continues to be debated, there are ways to improve in-care management including: ways of preventing drift, appropriate assessment of parenting capacity, minimizing emergency placements, and more energetic and focused casework which deals appropriately both with the deficits and distortions internalized in the child as a result of previous damage and with the ongoing interactional stresses operative within the foster family system. The advantages of planned over emergency placements are discussed. The child separated from natural parents will mourn. Foster parents’ and workers’ roles in assisting the Work of mourning in foster children are discussed. Soon after admission to care, the practicality of restoration to the natural family must be assessed, and management should then aim towards restoration or towards freeing the child for adoption or planned permanent foster care, should that represent the least detrimental available alternative. The family court system as presently constituted frequently and unnecessarily undermines rather than protects the adjustment and development of vulnerable children. Mechanisms by which this occurs and some proposed solutions are suggested. The paper concludes by suggesting that the traditional low priority given to child welfare services by governments is unlikely to be altered unless mental health professionals succeed in eliciting considerably more community support for adequate social services than is currently available.
Clinical Utility of Dexamethasone Suppression Testing in the Elderly Depressive: A Case Report*
Authors: Kutcher S.P.
Published: April 2017

The dexamethasone suppression test may be a valuable tool in the assessment, treatment evaluation and maintenance management of depressive illness in old age. A case is presented illustrating these uses of the DST.
Gabaergic Mechanisms and Anxiety: An Overview and a New Neurophysiological Model
Authors: Nestoros Joannis N.
Published: April 2017

GABA is one of the principal inhibitory neurotransmitters in the mammalian brain and an ever increasing wealth of information suggests that GABAergic mechanisms have a special role in the neurophysiology of anxiety. All of the most commonly used antianxiety drugs (the benzodiazepines, the barbiturates, ethanol) selectively enhance only GABA-mediated synaptic transmission. Furthermore, the relative affinities of pharmacologically active benzodiazepines for the benzodiazepine receptor correlate well with their ability to antagonize GABA-modulin (the endogenous inhibitor of GABA receptors) in vitro, as well as with their ability to potentiate GABA-mediated electrically evoked cortical inhibition in vivo. Finally, it is of interest for the neurophysiology of anxiety that repetitive stimulation of the recurrent inhibitory GABAergic pathway in the rat hippocampus leads to a remarkable reduction of the effectiveness of GABA; this elimination of GABAergic “inhibition” is counteracted by antianxiety drugs. On the basis of the above a neurophysiological model of anxiety is proposed.
The Emergence of Psychiatry at McGill
Authors: Cleghorn R.A.
Published: April 2017

Psychiatric services in Canada lagged behind other medical disciplines until World War II emphasized the need for psychiatrists in the Armed Forces. This led to steps being taken to fulfil this need. At McGill, a new Department of Psychiatry, centered at the Allan Memorial, was established in 1943, due to the vision of Dean Jonathan Meakins and the influence of Dr. Wilder Penfield. P. Ewen Cameron was chosen as the first Director and set up services in affiliation with the Royal Victoria Hospital and McGill. His energy and organizational abilities led to the creation of an Institution which had a pathfinder function for post war services in clinical psychiatry, embracing also biological and social research. He soon recruited such able European scholars as Miguel Prados and Karl Stern and shortly thereafter the eminent psychologist R. B. Malmo and as physician endocrinologist, myself. Forward looking programs such as the day hospital, an open door policy, teaching programs and units for research in geriatric psychology and biochemistry were set up. By the 50's, psychiatry units were also established in other general hospitals and a close affiliation with the Verdun Protestant Hospital was fostered. Therefore H.E. Lehmann pushed clinical psychiatry into a new phase, as he led the field in psychopharmacology. Senior staff expanded with the acquisition of Eric Wittkower and V.A. Kral and the psychoanalysts, J. and F. Aufreiter, MacLeod and W.C.M. Scott. The success of the training system was such that able graduates moved to positions of responsibility in the rest of Canada. Furthermore, outstanding research emerged from the work of Lehmann, Kral, Wittkower, Saffron, Sourkes and Birmingham. The emphasis on research had great advantages for the cultivation of an academic atmosphere.
Article
Authors: Lamontagne Yves , Boyer Richard , Lamontagne CÉLine , Giroux Et Jocelyn
Published: April 2017

A survey was conducted in 230 cases of rape and rape attempts heard in the Judicial District of Montreal between January 1975 and May 1978. Data were compiled from the 30 assaults including two or more assaillants. Results show that in cases of rape committed by two men the aggressors are older than gang rapists, meet the victim mainly in her flat or in a bar, and rape her in her own home, in a car or a hotel. In these cases, voyeurism seems to be an important factor since, most of the time, rape is committed by only one of the two aggressors. On the other hand, gang rapists are younger, meet the victim in public places, on the street or when she is hitch-hiking and attack her in one of the aggressors’ house, in public places or on the street. Exhibitionism seems more present in this group of rapists. For both groups the victims are mainly single, younger than the aggressors and have diverse occupations. Finally, regarding the legal outcome half of the subjects were liberated or acquitted in both groups.

Rape committed by two men had never been studied or compared with gang rape up until now. Results of this survey show dynamic and demographic differences between these two groups of sexual delinquents.
Methodological Guidelines for Reading Drug-Evaluation Research
Authors: King Paul R.
Published: April 2017

The present paper discusses methodological issues in psychopharmacological research. The intention is to provide readers of drug-evaluation research with a set of basic guidelines that will assist them to critically evaluate the investigations they encounter in the psychiatric literature. This paper describes the underlying rationale and basic principles associated with applying statistical analyses to drug-evaluation research data, and also addresses 11 additional methodological issues: specification of the research sample with respect to descriptive variables, diagnostic criteria, reliability of the diagnosis, the control group, random assignment of subjects to treatment conditions, blindness, subject attrition, treatment complications and side effects, the power of statistical tests, multivariate statistical analysis, and the reliability of the dependent variable. Evidence is presented to support the premise that there is a need to read drug-evaluation research critically.
Recruitment into Psychiatry: A Study of the Timing and Process of Choosing Psychiatry as a Career
Authors: Cameron P. , Persad E.
Published: April 2017

This is a study of the timing and process of choosing psychiatry as a career. All the psychiatric residents in the Department of Psychiatry, University of Toronto in the academic year 1981–1982 were surveyed. Seventy-eight percent (93 residents) responded. We found that 58.1% had decided to enter psychiatry after graduation from medical school. Of the total group 27% came from family practice programs; 14% of our sample had decided on a career in psychiatry before entering medical school. In our study, 27.9% of the sample decided to choose psychiatry during medical school. The factors which appear influential in determining the choice of psychiatry as a career were interest in psychosocial problems, rejection of other specialties, discovery of prevalence of psychosocial problems in family medicine and other specialties, discovery of effectiveness of psychiatric therapies and the experience of personal psychiatric therapy (23.6%). There is a suggestion that the previous decline in recruitment has been checked and that recruitment is now increasing. The authors discuss recruitment strategies that may increase the selection of the most desirable candidates into psychiatry. If undergraduate teaching emphasized the effectiveness of therapeutic intervention, it is probable that more interested candidates would choose psychiatry earlier.
Clonidine in a Case of Atypical Tic Disorder
Authors: Haskell E.L. , Joffe R.
Published: April 2017

Clonidine hydrochloride was more effective than placebo in the treatment of an atypical tic disorder (1) in a single case study using an A-B-A design. Furthermore, the effect was confined to a narrow dose range.
Psychophysiological Responses to Masked Auditory Stimuli
Authors: Borgeat François , Elie Robert , Chaloult Louis , Chabot Rénald
Published: April 2017

Psychophysiological responses to masked auditory verbal stimuli of increasing intensities were studied in twenty healthy women. Two experimental sessions corresponding to two stimulation contents (neutral or emotional) were conducted. At each session, two different sets of instructions (attending or not attending to stimuli) were used successively. Verbal stimuli, masked by a 40-dB white noise, were presented to the subject at increasing intensities by increments of 5 dB starting at 0 dB. At each increment, frontal EMG, skin conductance and heart rate were recorded. The data were submitted to analyses of variance and covariance. Psychophysiological responses to stimuli below the thresholds of identification and detection were observed. The instruction not to attend the stimuli modified the patterns of physiological responses. The effect of the affective content of the stimuli on responses was stronger when not attending. The results show the possibility of psychophysiological responses to masked auditory stimuli and suggests that psychophysiological parameters can constitute objective and useful measures for research in auditory subliminal perception.
Dear Brutus: Dealing with Unresponsiveness through Supervision
Authors: Greben Stanley E.
Published: April 2017

Psychotherapists often demonstrate unresponsiveness as a result of the influence of the psychotherapy subculture. Psychiatric residents and teachers in examining themselves may find this tendency which can be countered through psychotherapy supervision. The supervisor can help the resident to be more responsive by discussing the prevalence and dangers of unresponsiveness, and by showing example. The supervisor should make appropriate references to his own work as well as to some life experiences. Residents with a variety of backgrounds and interests in psychiatry, and teachers with varied experiences and eclectic orientations are less likely to encourage unresponsiveness than those with a predominating interest in psychotherapy alone. Teaching and supervision can encourage the developing psychotherapist toward a natural and appropriately responsive therapeutic style.
Psychiatric Interviewing and Clinical Skills
Authors: Pollock Daniel C. , Shanley David F. , Byrne P. Niall
Published: April 2017

Does the ability of medical students to assess and relate to their patients through the psychiatric interview reflect in traditional academic achievement scores?

A previous publication by our group offers data suggesting that certain personality traits of final year medical students have a fundamental importance in determining a successful performance on a psychiatry rotation. As the literature is vague and contradictory about the relation-ship between the psychiatric interview and clinical performance, a study was developed to determine what outcome variables are associated with the performance of clinical clerks on the Psychiatric Interview’

An attempt was made to develop and test a new scale designed to measure the Psychiatric Interview. The Psychiatric Interview Scale was used to measure performance on 33 final year medical students on a 1 month psychiatry rotation at a University of Toronto teaching hospital, and subsequently, as a basis for analysis and training of these students in interviewing. Inter-rater reliability of the Psychiatric Interview Scale was rho = 0.72 and internal reliability was 0.74. Psychiatric Interview Scores were compared with other achievement scores, and with patients’ ratings of the students interviews. A significant correlation emerged between the Psychiatric interview scores and final clinical examinations, but surprisingly, there was no relationship between the patients’ evaluation of the Psychiatric Interview and the raters’ evaluations and a strongly significant negative correlation between patients’ ratings and clinical scores. The importance of observed psychiatric interviews in teaching and evaluation are discussed along with the interesting implications of the differing evaluations of a successful interview by patients and psychiatrists. The relevance of training in the Psychiatric Interview to general medicine and family practice is emphasized.
Conversion Mutism: Case Report and Discussion
Authors: Thorpe L.U. , Keegan D.L. , Veeman G.A.
Published: April 2017

Conversion mutism is an uncommon disorder that was in the past most frequently reported during wartime. Other than during wartime, young women are the most commonly affected and usually present shortly after a traumatic event. Both psychodynamic and behavioral elements are important etiologically and, thus the treatment should include both psychodynamic and behavioral methods. The patient described in this paper had underlying fears relating to sexual assault as well as behavior ally reinforced perpetuation of her symptom. She regained her speech after four weeks of combined psychodynamic and behavioral therapy.
Use of Psychiatric Services by the Elderly in Canada
Authors: Richman Alex
Published: April 2017

There is increasing emphasis on identifying mental disorders in the elderly and developing appropriate mental health services. However, there are few quantitative studies on service use by the elderly. This paper gives a national perspective on the use of psychiatric services by the aged in Canada, and details two of the health care studies used to assess their mental health needs in southern New Brunswick.

The elderly now make up a higher proportion of the long-term mental hospital population than they did 20 years ago. Despite the increase in number of short-stay general hospital psychiatric units, there are still marked differences in their use by the elderly. There is a marked decrease in short-term psychiatric in-patient care after the sixth decade. As well there are marked regional variations.

The results of a Level of Care Survey in a New Brunswick mental hospital shows the discrepancies between the needs for care and the level of care actually received. In comparison with other patient sub-groups, elderly long-stay mental hospital patients had the highest proportion (79%) deemed suitable for care in alternative settings outside the hosptial.

The anonymized merged statistical file revealed that the elderly mentally ill were more likely to be identified and cared for within non-specialized wards of general hospitals, and least likely to have contact with mental health clinics.

Instead of adding new services to the existing system, reallocation and redirection of existing resources are crucial strategies in improving the mental health services for the elderly. The general hospital is an important area for psychiatric consultation and back-up to primary care services.
Issues in the Therapy of Hearing Children with Deaf Parents
Authors: Frankenburg Frances R. , Sloman Leon , Perry Anna
Published: April 2017

The psychiatric literature on deaf children is sparse. Even less attention has been paid to the more common situation of the hearing child raised by deaf parents. Such a child is deprived of the parents’ hearing and often the parents’ speech. The oldest hearing child in the family often takes on the role of family interpreter which may be a source of both pride and resentment. This can contribute to role reversal leading to a frustration of the child's dependency needs and bitter sibling rivalry. Other problems may result from the parents’ ambivalence towards their child. The available literature is surveyed and case illustrations are provided. Suggestions to therapists working with similar families are made.
First Degree A-V Block in Patients on Lithium Carbonate
Authors: Martin Catherine Anne , Piascik Michael Thomas
Published: April 2017

High doses of lithium in animals and therapeutic doses of lithium in humans caused varied abnormalities in cardiac conduction including A-V block. Five cases of first degree A-V block in patients receiving therapeutic doses of lithium carbonate are reported.
Depression and Carcinoma of the Pancreas
Authors: Joffe R.T. , Adsett C.A.
Published: April 2017

A case report is presented which highlights the association between depression and carcinoma of the pancreas. Clinical and biological aspects of this association are reviewed and discussed.
On Direct Patient Participation in the Cost of Their Psychiatric Care.
Authors: El-Guebaly N. , Prosen H. , Bebchuk W.
Published: April 2017

In the midst of a sociopolitical debate regarding access to health services, an evaluation is required of the therapeutic impact of the direct participation by some patients in the cost of their psychiatric treatment.

Empirical clinical concepts regarding the need for a direct payment of treatment by the patient have evolved. Initial rigorous practice systems have lead to more flexible methods allowing for the recognition of third-party financing. Psychoanalytic theory has addressed the issue most extensively, but other conceptual frameworks have reached similar conclusions as well.

The experimental evidence to either support or refute the position that the direct payment of a fee has a beneficial effect on therapeutic outcome remains limited. The focus has been on studying the impact of fee manipulation, but a tested correlation of other motivators such as patient's insight, therapist's attitudes and behaviour and social pressures is mostly lacking. Two patient populations appear to be delineated. Fee participation is of particular value to the financially secure and to the educated while patients in need of less intensive involvement, with reality testing disturbance and limited insight benefit particularly from third party insurance. Different patient populations should have the right to choose different payment options.
Comparative Dexamethasone Suppression Test Measurements in Bulimia, Depression and Normal Controls
Authors: Musisi S. , Garfinkel P.
Published: April 2017

Twenty bulimics, 20 depressives and 20 normal controls were studied using the Dexamethasone Suppression Test (DST) as defined by Carroll et al. Their past psychiatric and family histories were compared. We found that actively bulimic subjects had a rate of DST non-suppression of 20%, and that 20% of them had a past history of a major depressive disorder. Forty per cent had a history of alcoholism and I or antisocial personality in a first degree relative, but only 5% had a positive family history of affective disorder. These rates were significantly lower than those found in the depressed group except for the family history of alcoholism and/or antisocial personality for which there was no significant difference. We identified a subgroup of bulimic DST non-suppressors who, like patients with melancholia, were characterized by past history of major depressive illness and high rates of family history of affective disorder, alcoholism and/or antisocial personality in first degree relatives. This group responded to antidepressant medications in a manner similar to depressed patients.
Electroconvulsive Therapy in a Major Teaching Hospital: Diagnoses and Indications
Authors: Bland Roger C. , Brintnell Sharon
Published: April 2017

The use of ECT over an eleven year period in the University of Alberta Hospitals is reviewed. Five percent of patients received ECT, the mean number of treatments per course was 5.2, and the most frequent type of treatment was bilateral ECT. Discharge diagnoses showed that three-quarters of the patients had affective psychoses and one-fifth were schizophrenic. All patients had had a mandatory consultation before treatment and the most frequent reasons for choosing ECT were given as: failed antidepressant treatment, previous good response to ECT, failure to respond to other treatment, uncontrollable delusions or psychotic behavior, acute suicidal risk requiring a rapid response, and adverse reaction to medication.

The mandatory consultation process has worked well and has helped to clarify the situations where ECT may be used with benefit. It is hoped that this may assist those who may be responsible for defining guidelines for the use of ECT.
The Classification of Personality Disorder: I. The Choice of Category Concept
Authors: Livesley W. John
Published: April 2017

Some common clinical statements about patients with personality disorder are examined for their implications in the choice of category concepts for classifying personality. Clinicians seem to assume that personality categories are imprecise and that membership is probabilistic. These assumptions run counter to those of current classifications. The fact that most cases of personality disorder show features of more than condition creates difficulties for categorical systems. Dimensional systems are frequently proposed as a solution to this problem. Such an approach is rejected at the present time since there is no consensus regarding basic dimensions. Polythetic and prototype categories are examined as alternatives. It is suggested that prototype categorization provides an approach that is more in accord with clinical judgement. This approach, based upon Wittgenstein's concept of family resemblances, is better able to accommodate the imprecise or fuzzy nature of personality categories, although it does require some modification to the way categories are defined, and to the way diagnostic reliability is assessed.
The Classification of Personality Disorder: II. The Problem of Diagnostic Criteria
Authors: Livesley W. John
Published: April 2017

Although operational definitions have led to improved reliability of psychiatric diagnoses generally, this is not the case for personality disorders. It is suggested that this is due to a failure to develop definitions composed of criteria that can be reliably identified. Instead, extensive use is made of traits and other dispositions as criteria for assessing these conditions despite an extensive literature indicating that trait judgements are unreliable. The reasons for the low reliability of trait judgements are discussed, and the use of behavioral criteria is advocated as one way to increase diagnostic reliability. The results of a preliminary investigation show that the reliabilities of clinicians’ judgements of the behaviors associated with Schizoid, Histrionic, and Compulsive Personality Disorders are comparable to the reliabilities of their judgements of the traits associated with these conditions. These results support the feasibility of developing behavioral criteria for assessing personality.
Neuroleptic-Induced Skin Pigmentation in Chronic Hospitalized Schizophrenic Patients
Authors: Ban Thomas A. , Guy William , Wilson William H.
Published: April 2017

In the framework of a multi-national collaborative study carried out in eight countries, 768 chronic hospitalized schizophrenic patients were surveyed. Skin pigmentation was found to be present in 13 patients (1.7%), that is, within the same range (1–2.9%) of the initial reports. While the mean age and mean duration of hospitalization in the skin-pigmented population was slightly higher and larger than in the total population of our survey, no definitive relationships between sex, diagnosis, drugs and dosage of medication were revealed.
Sex-Role Ideology among Self-Identified Psychotherapists
Authors: Harper Dan W. , Leichner Pierre P. , Mccrimmon Elaine
Published: April 2017

Analysis of the sex-role ideology of 1,258 self-identified psychotherapists from nine occupations indicated that: a) the sample was representative; b) as a group, self-identified psychotherapists were moderately feminist; c) there were significant differences among occupations; and d) results were not due solely to the effects of age or sex distributions among occupations.
A Case Report of Obstructive Sleep Apnea in a Patient with Bipolar Affective Disorder
Authors: Fleming J.A.E. , Fleetham J.A. , Taylor D.R. , Remick R.A.
Published: April 2017

A patient with a bipolar mood disorder developed obstructive sleep apnea which altered the clinical presentation of the mood disorder and affected compliance with prophylactic treatment. Significant improvements in the management of her mood disorder and in her life adjustment followed surgical relief of the upper airway obstruction.
Antiparkinsonian Medication Withdrawal in the Treatment of Tardive Dyskinesia: A Report of Three Cases
Authors: Yassa R.
Published: April 2017

Three patients are presented in whom TD either disappeared (2 cases) or improved (one case) after discontinuing antiparkinsonian medication without changing the concurrent neuroleptic treatment. In addition, two of the patients presented some “complications” secondary to the TD in the form of frequent falling, psychosocial impairment and suicidal ruminations. The implications of these findings are discussed in the light of the current literature.
Psychiatry and Social Challenge
Authors: Brown Wm. T.
Published: April 2017

Respectfully dedicated to the memory of Dr. F.W. Hanley, Master Teacher, Exemplary Clinician, Noble Human Being.
Effects of a Psychiatric Rotation on Psychiatric Knowledge and Attitudes towards Psychiatry in Rotating Interns
Authors: Agbayewa M.O. , Leichner P.P.
Published: April 2017

The attitudes of trainees toward Psychiatry affect their career choice and ability to properly identify and manage emotional disorders in their patients. These attitudes are determined by several factors which include preclinical and clinical training among others. We report here a study of the attitude of interns toward psychiatry using the 30 item attitude toward psychiatry (ATP-30) scale.

The ATP-30 and a multiple choice questionnaire examination (MCQE) in psychiatry were completed by 96 interns at the beginning and end of their compulsory four week psychiatry rotation.

The degree of satisfaction of the trainees was rated in four areas — orientation, teaching/learning experience, overall rating of rotation and relevance of rotation to career choice. There was no significant change in the mean ATP-30 scores (N = 55) during the four week rotation, but the MCQE scores (N = 74) improved significantly (P < 0.0001). A repeated analysis of variance for the four satisfaction variables by change score in MCQE and change score in ATP-30 did not show any significant main effects or significant interactions between these change scores except with relevance of rotation.

Reasons for the absence of changes in the ATP-30 scores during this rotation were explored. The implications of the improved knowledge during this rotation are also discussed. We also conclude that attitudinal change and knowledge are two independent factors which should be assessed independently in trainees.
Psychosomatic Medicine: Past and Present Part II. Current State
Authors: Lipowski Z.J.
Published: April 2017

The first historical phase of psychosomatic medicine was largely dominated by the psychoanalytic approach to research and theory. The current phase has shown a radical shift away from that approach. It has focused on the study of the physiological mechanisms mediating between psychological states and body functions in health and disease, and on the role of personally meaningful life events and psychophysiological responses to them in the etiology, course, and outcome of a wide range of physical illnesses. The concepts of psychosocial stress, psychophysiological response specificity, coping, adaptation, and social supports predominate in psychosomatic theory. Research has grown in scope, diversity, and methodological sophistication. Concurrently, clinical application and the psychosomatic approach to patient care has expanded in the form of consultation-liaison psychiatry and behavioural medicine. The author reviews the current state of the field in its scientific and clinical aspects, and offers definitions delineating its scope.
Postgraduate Medical Training, Stress, and Marriage
Authors: Kelner Merrijoy , Rosenthal Carolyn
Published: April 2017

In a pilot study, 20 interviews were conducted with married female interns and residents and their spouses in order to explore both positive effects of spousal support and negative effects of additional role obligations during medical training. The marital state has been shown to be related to lowered levels of stress. Past studies of medical marriage have focused on male physicians and their wives. However, marriage and parenthood impact differently on women than men, and thus on women physicians. To explore these differences, our findings are contrasted with findings on male medical students and their wives by R. Coombs. Compared to our subjects, Coombs found spouses were either housewives or held lower level jobs rather than demanding careers, and consequently our subjects experienced greater difficulty meeting demands of everyday life (cooking, cleaning, child care). Coombs’ wives showed greater vicarious identification with the goals and satisfactions of the physician in-training; greater feelings of obligation to nurture, support and make sacrifices on behalf of their spouses; and less resentment toward the current system of medical training. They stressed the nurturing aspect of marital support rather than instrumental aspects. Subjects in both studies feared growing apart but while Coombs’ wives feared being outgrown intellectually, our husbands were critical of their wives’ narrowness of interests. Subjects in both studies believed marriage provided benefits (intimacy, support, affection, sex) but also complained of the negative impact of exhausting and emotionally draining medical training. Implications of findings for reducing the stress of medical training are discussed.
Excessive Concern about AIDS in Two Bisexual Men
Authors: Lippert Gerard P.
Published: April 2017

The Acquired Immune Deficiency Syndrome (AIDS) has become an increasingly common cause of severe morbidity and death among homosexual men. As such it has become a major source of concern to this group. In this paper I report the cases of two bisexual men who developed a severe illness characterized by fatigue, malaise and infirmity for which no physical etiology could be determined despite extensive and complete investigations. At psychiatric consultation it became apparent that each man had a mental disorder, one symptom of which was an excessive and groundless concern that he suffered from AIDS. These men both received appropriate psychiatric treatment consisting of psychotropic medication and short-term psychotherapy. This resulted in the remission of the mental disorder, resolution of the overconcern about AIDS and the return to good physical health. Also discussed is the connection between the symptom of overconcern about AIDS and the concept of hypochondriasis.
Male and Female Mania
Authors: Kubacki Andrzej
Published: April 2017

A total of 74 manic or hypomanic episodes were scrutinized in 31 probands (18 women and 13 men), followed over the years by the author on an outpatient basis. These turned out to herald bipolar affective illness in some 70 percent of males and almost 40% of females. Unipolar mania occurred twice as often in men, as it did in women (38,4% vs. 22,2%). Men tended to be younger (only 30% aged 45 or older), than women (almost a half in the menopausal age bracket).

One third of all female probands (and over 46% of those under age 45) manifested their manic episodes in connection with childbirth (gestational mania). As a paradoxical, acute grief reaction (“funeral mania”), the syndrome under scrutiny, occurred in about 1/7 of the men, and more than 1/4 of the women. Significant medico-surgical problems were found to accompany or precede female mania twice as often, compared to male cases (61,1% vs. 30,7%); and clinical confusion or other indices of “organicity” were present in 2/3 of the women, and less than a half (46,1%) of the men.

Over half the male probands demonstrated either an inverted sexual attraction, or hypogonadism; and four out of 13 males were aged 45 or older. The above findings are tentatively related to gender differential in cerebral hemispheric specialization.
Suicidal Patients and the Ethics of Medicine
Authors: Sakinofsky Isaac , Swart Greta T.
Published: April 2017

The moral values of contemporary society present a turmoil of pluralistic, often confusing values. In the face of these, what should be the proper attitude of the physician towards the suicidal patient? Should he (she) support the patient's autonomous right to make such a decision independently, or should he use his professional influence to try to sustain the patient's life? This paper discusses the social and religious roots of today's medical dilemma and tries to help the health professional to avoid the pitfalls of simplistic solutions which do not take account of clinical experience.
Moral Philosophy and Suicide
Authors: Narveson Jan
Published: April 2017

There are two main moral issues regarding suicide: first, whether suicide is morally permissible, and if so, in what circumstances; and second, whether a person who knows that someone is contemplating or attempting suicide has an obligation to intervene and if so, how strong that obligation is. With respect to the first issue, it is difficult to resist the conclusion that suicide is not wrong in itself. To characterize suicide as murder of one's self is incorrect. Even if people who commit suicide deprive the community of some good, there is no general duty to provide good services to others. Theological objections to suicide are not persuasive. And suicide could be rational. For example, if one's scheme of values is to maximize the overall value of experience, and if at some point in the future negative value outweighs positive value, suicide would be rationally indicated. With respect to intervention, different considerations apply to persons involved with someone contemplating or attempting suicide, professionals, and the general public. Those who are involved have their own lives to live and need not alter them even when another person's life is at stake. Professionals should not become paternalistic authorities who keep subjects alive against their will and miserable for indefinite periods. The general public has only a weak duty to save strangers from suicide.
The Place of Attachment in the Life Events Model of Stress and Illness
Authors: West Malcolm , Livesley W. John , Reiffer Linda , Sheldon Adrienne
Published: April 2017

Recent evidence indicates that perceived adequacy of support has substantial predictive power for the subsequent onset of minor psychiatric symptoms. Such findings suggest that social support is not purely a properly of the environment, but is also a function of personality. The problem, however, with a re-emphasis on personality variables is that any one of scores of dimensions can be chosen for study. This paper argues that precision may be gained by conceptualizing personality variables in terms of basic behavioral systems that have been extensively investigated in ethological and developmental studies. One such basic system is attachment. The present paper discusses the relevance of attachment theory for understanding susceptibility to stress and individual differences in the use of social support during times of stress.
Folie à Deux Revisited
Authors: Munro Alistair
Published: April 2017

Folie à deux (shared paranoid disorder) is misleadingly defined in DSM-III. It is not an illness in itself, but a phenomenon associated with delusional psychiatric illnesses. There are two main types of folie à deux. An updated nomenclature is proposed.
Is Chronic Pain a Variant of Depressive Illness? A Critical Review
Authors: Gupta Madhulika A.
Published: April 2017

A critical review of the literature on the association of chronic pain of obscure origin and depression suggests the following: the nosological confusion in defining these two commonly occurring symptom complexes; poor sampling methods and widely ranging selection criteria; occasional lack of appropriate controls and use of unreliable instruments to measure pain and depression; and the frequently erroneous assumption that response of the pain to “antidepressant” medications implies that pain is masquerading some form of depression. All of the above observations lead to incomparable and sometimes opposing conclusions regarding the nature of the association between these two common symptom complexes.

Some widespread recurring clinical features of the various studies include; a premorbid history of perfectionistic traits, an apparently minor precipitating event; and pain involving the head, face and musculoskeletal system. Otherwise, chronic pain of obscure origin appears to be a multifactorial and multifaceted problem, with each patient requiring a complete physical and psychosocial evaluation. Further understanding of this group of disorders requires studies of specific chronic pain syndromes using proper controls.
Force-Feeding: The Physician's Dilemma
Authors: Kleinman Irwin
Published: April 2017

The right to treatment and the right to refuse treatment are parallel legal rights which, when in opposition, pose a dilemma. In this paper the issues surrounding the possible force-feeding of a hunger striker are examined together with the pertinent legal precedents and possible courses of action. Although the discussion is particularly relevant to hunger strikers, the principles may be applicable to other circumstances.
The Thompson-Patterson Scale of Psychosocial Development: I. Theoretical Basis
Authors: Thompson Michael G.G. , Patterson Paul G.R.
Published: April 2017

This paper presents a theoretical framework for describing childhood psychopathology in terms of coping styles and introduces a scale to measure psychosocial development in young children. It is hypothesized that coping styles characteristic of specific stages of development evolve in a predictable sequence with treatment. The term coping style rather than disorder is used to reflect the opinion that the child's behaviour constitutes an attempt to find a solution to difficulties encountered during the normal course of psychosocial development. These styles of relating are not static. The coping styles are presumed to arise from partial blocks† to normal development during the period of early attachment and separation and individuation. A computer scored behaviour rating instrument, the Thompson-Patterson Scale, allows for the determination of the child's predominant coping style at a particular point in time. Clinical work and research has shown the utility of this paradigm and supports the hypothesis that changes in pathological behaviour patterns which emerge during treatment are predictable.
Acute Paranoid Disorder and Klinefelter's Syndrome
Authors: Stein Murray B. , Siddiqui A.R.
Published: April 2017

A twenty-five-year old man presented with an acute paranoid disorder, and was subsequently diagnosed as having Klinefelter's Syndrome. Our review of previous reports suggests that the literature pointing out a particular association between Klinefelter's and schizophrenia may be misleading. In fact, Klinefelter's patients are liable to suffer from schizophrenia, paranoid disorders, or possibly other disorders.
Pregnancy and Birth Complications in Antisocial Adolescents and Their Siblings
Authors: Szatmari Peter , Reitsma-Street Marge , Offord David R.
Published: April 2017

The authors compared the frequency of pregnancy and birth complications (PBC) from hospital records in antisocial adolescents and their same-sexed siblings who were relatively clear of antisocial behaviour. Probands, as a group, were not more likely to have had more PBC than their siblings, however, if there was a difference in complication frequency, it was usually the proband who was affected. The only effect of PBC within a pair was on the school performance and reading achievement of the proband. These results suggests that PBC may provide a marker for a subgroup of antisocial youth with a different etiology than similarly disturbed adolescents without PBC.
Bupropion Effects in Attention Deficit and Conduct Disorders
Authors: Simeon J.G. , Ferguson H.B. , Van Wyck Fleet J.
Published: April 2017

Children with Attention Deficit and/or Conduct Disorders were treated with bupropion, a new antidepressant, to determine its clinical, cognitive, and EEG effects. Seventeen male patients (age range 7 to 13.4 years; mean 10.4) participated in an open clinical trial consisting of a baseline placebo period (4 weeks), bupropion therapy (8 weeks), and post-drug placebo (2 weeks). Evaluations included clinical assessments, parents, teachers, and self-ratings; cognitive tels and blood level measurements of bupropion. Fifteen patients received a daily maximum of 150 mg, one received 100 mg and one 50 mg. Clinical global improvement with bupropion therapy was marked in 5 patients, moderate in 7, mild in 2, and none in 3. The Children's Psychiatric Rating Scale indicated improvements of hyperactivity, withdrawal, anxiety, hostility/uncooperativeness, sleep disorder, antisocial behaviour, neuroticism, depression and eating disturbance. Parents’ Questionnaires indicated significant improvements of conduct disorder, anxiety, hyperactivity, muscle tension andpsychosomaticism. While no single cognitive test showed significant improvement, all nine tests changed in the positive direction. Adverse effects were infrequent, transient and mild. There were no clinically significant changes of the laboratory values and vital signs. Two weeks following bupropion discontinuation, clinical global improvement was maintained in 8 patients, 7 showed relapses, while 2 remained unimproved. Analyses of computerized EEG revealed that degree of clinical improvement was indexed by baseline EEG parameters and that there were significant bupropion effects on EEG measures. Double-blind trials of bupropion are recommended in child psychiatry disorders.
Dysthymic Disorder and Rheumatic Pain Modulation Disorder (Fibrositis Syndrome): A Comparison of Symptoms and Sleep Physiology
Authors: Gupta Madhulika A. , Moldofsky Harvey
Published: April 2017

It has been suggested that “fibrositis” or rheumatic pain modulation disorder (RPMD) is a varient of depressive illness. Both disorders are associated with abnormalities in sleep physiology. Since the clinical features of RPMD do not meet all the criteria for a major depressive disorder, the symptoms and sleep phsyiology in subjects with dysthmic disorder (DSM III criteria) (N = 6), and RMPD (N = 6) were compared, in order to determine the similarity between the two groups. The sleep physiology in dysthymic disorder was first examined over three consecutive nights since a systematic evaluation of the sleep physiology in this group of disorders has not yet been reported. All dysthymic patients showed episodic bursts of high-amplitude (75–150 microvolts) theta (3–5 Hz) bursts in stage 2 sleep, and REM onset latency was abbreviated only on night 2. The theta bursts have not been previously reported, and may be an early marker of disorganization of non-REM sleep in the dysthymic subjects. The comparison of the two groups revealed that RPMD subjects reported more pre- and post-sleep pain (p < 0.01), lighter sleep (p < 0.01), and more physical ailments during sleep (p < 0.01), and had more alpha (7–11.5 Hz) in non-REM sleep (p < 0.01). The dysthymic subjects who reported deeper sleep (p < 0.01), had a greater sleep continuity disturbance with longer stage 2 onset latency (p < 0.05), fewer hours of sleep (p < 0.05), more wakefulness after sleep onset (p < 0.05), more awakenings per hour of sleep (p < 0.01) and more stage changes per hour of sleep (p < 0.01), and showed theta bursts in stage 2 (p < 0.01). The distinctive symptoms and sleep physiologies in the two groups suggest that the two disorders are not related.
The Use of Mass Media in Mental Health
Authors: Lamontagne Yves , Verreault Richard
Published: April 2017

This paper summarizes the theoretical aspects and the experimental studies on the efficacy of mass media in mental health information campaigns. In theory, most authors agree to give mental health information to the lay public but they caution against the overestimation of the power of mass media. Regarding research on the use of mass media in mental health very few experimental studies have been published and they refer mainly to primary prevention with children. The authors discuss reasons which may explain the mental health professionals’ lack of interest in this area of research, suggest new approaches for the elaboration of educational programs for the population and emphasize the importance of secondary and tertiary prevention.
Regional Review Boards of Ontario: A Medico-Legal Review
Authors: Chandrasena Ranjith , Smith Selwyn
Published: April 2017

The functioning of the Regional Review Boards of Ontario (RRB) or their equivalents in other provinces has not been previously reviewed. This study reviews socio-demographic and clinical data of 248 patients seen between 1974 and 1983 by the RRB. The RRB heard 132 applications as 116 were withdrawn. The results are compared with 173 matched inpatient controls. Applications by psychiatrists were infrequently withdrawn or revoked. Long delays between the time of application and the hearing, and a trend towards increasing numbers of applications were noted. Schizophrenia and affective disorder were the most prevalent diagnosis with alcohol abuse and organic brain syndrome being less common among applicants. An increase in duration of stay and transfer to chronic care institutions were found among applicants. Results suggest that RRB's are not ‘rubber stamping bodies’ and should be more readily available and should have increased public accountability. Future changes to the Mental Health Act should be based on scientific data.
Unexplained Seizure in Anorexia Nervosa
Authors: Roberts Avalon , Mandin H. , Roxburgh P.
Published: April 2017

A grand mal seizure occurred in a young woman in the weight gain phase of treatment of anorexia nervosa. The etiology of this seizure is explored and suggestions are made for the avoidance of this potential hazard in behavioural reward programs based on contingent weight gain.
The Neuroleptic Malignant Syndrome: A Review
Authors: Lazarus Arthur
Published: April 2017

An overview of the neuroleptic malignant syndrome (NMS) is presented. Its clinical manifestations, pathogenesis, and current treatment are discussed. An increased appreciation of the syndrome may result in more timely interventions and reduce morbidity and mortality in this disorder.