bluuebunny/crossref_metadata_2025 huggingface dataset:
Joint Custody: Preliminary Impressions
Authors: Awad George Anis
Published: April 2017

Joint custody is currently a popular and debatable issue. It is felt that some of the controversy is due to the lack of agreement on a definition. Following some examples of the differences in personal and judicial definitions of joint custody, a classification of custody is offered. Four types of custody arrangements are described: Absolute Sole Custody, Sole Custody, Non-Alternating Joint Custody (disputed and undisputed) and Alternating Joint Custody (disputed and undisputed). A critical review of the literature follows. Finally, clinical impressions about the two types of joint custody are discussed.
Psychodynamics of Spirit Possession among the Inuit
Authors: Seltzer Allan
Published: April 2017

Three cases of spirit possession were studied to determine common underlying psychodynamic factors. The spirits were believed to represent culture bound defense mechanisms, and attempts at problem solving in individuals suffering from unresolved conflicts. These being anomic anxiety, dependency, sexual identity and aggression. The symptoms, therefore, were considered to be attempts at conflict resolution. Furthermore the psycho-dynamic process is described as a transition phase in psychic development between externalization and internalization of intrapsychic distress or collective versus individual ego solutions to life stress. As such, therapy will be facilitated by knowledge of myths and customs and culturally significant methods of healing.
Mega-Doses of Behaviour Therapy for Treatment-Resistant Agoraphobics*
Authors: Rapp Morton S. , Thomas Martyn R. , Reyes Eleanor C.
Published: April 2017

This was a pilot project set up to test the feasibility of effectively and inexpensively treating agoraphobic patients who had not responded to adequate trials of behaviour therapy (and other therapy) in the past. We employed a quantitatively intensive program of exposure therapy, calisthenics and muscular relaxation, and have explained the rationales for the choice of each treatment. The results were gratifying in four of the five patients, with follow-up to three years.

This pilot project enabled us to set up a cost-effective treatment for all forms of agoraphobia which is as efficient as other programs described. It has also highlighted the fact that some patients exist who may do poorly on schedules of behaviour therapy which are adequate for some patients, and yet may do well if the amount of treatment is drastically increased.
Observations of Child Psychiatry in China*
Authors: Simmons Robert J.
Published: April 2017

Child and adolescent psychiatry in the People's Republic of China is discussed following a brief visit and literature review. The Chinese practice of psychiatry is the same for adults and children, and primarily involves the treatment of severely disturbed patients in psychiatric hospitals. There is also a trend toward movement into the community and the schools as a result of the Chinese focus on Attention Deficit Disorders. Antisocial and delinquent behaviours, developmental problems, relationship and family problems, and reactions to illness and hospitalization are not handled by psychiatrists but by others in the local communities. These problems are managed, however, and with the shortage of child psychiatrists the arrangement may be appropriate.
Psychiatric Training in Gender Specific Psychology and Goals for Women in Therapy*
Authors: Cohen Sharon , Saruk Cynthia , Leichner Pierre , Harper Dan
Published: April 2017

A questionnaire addressing itself to the necessity of psychiatric training in gender specific issues and therapists’ attitudes towards women in treatment was answered by almost half the total number of residents in psychiatric programs across Canada in the spring of 1980. Although the majority felt that training in gender specific psychology was a necessity, our survey indicated only a small proportion of Canadian programs (2 out of the 16 psychiatric schools) have incorporated this into their present curricula. An overview of the survey showed residents to agree with the following attitudes regarding women in therapy: 1) women's conflicts should be considered in the framework of their developmental life cycle and reproductive issues; 2) women do not present the same conflicts, goals and values as men; 3) therapy should help women to become more autonomous and assertive in the home and at work; and 4) women's primary goal should not necessarily be seen as that of caregivers and homemakers. Further, the residents expressed the beliefs that sex role ideology could interfere with therapy and that the “traditional hierarchy of power” should not be replicated between therapist and patient.
Hair Loss in the Course of Lithium Treatment: A Report of Two Cases*
Authors: Yassa Ramzy , Ananth Jambur
Published: April 2017

Two cases of hair loss attributed to lithium therapy are presented. In one case, lithium did not have to be discontinued, and in the other, hair loss led to noncompliance. This side effect is usually benign. Thyroid function tests should always be performed to exclude hypothyroidism as the underlying factor for this symptom.
Psychosocial Aspects of Diabetes Mellitus*
Authors: Rodin Gary M.
Published: April 2017

The significance of emotional factors in diabetes mellitus is reviewed in the light of recent changes in treatment. Newer evidence has not supported the concept of a specific diabetic personality. However, lowered self-esteem and feelings of depression have been found to be common in diabetics and particularly in those with poor control of their illness. Illnesses such as diabetes may be associated with feelings of defectiveness and helplessness about regulating bodily functions and achieving a sense of self-sufficiency. Poor control of diabetes in children appears to be associated with pathological interactions in their families. Also, the course of the illness in most patients is correlated with measures of life stress. Newer treatment modalities offer the possibility for improved metabolic control and perhaps for increased psychological well-being.
Shoplifting: Is There a Specific Psychiatric Syndrome?*
Authors: Bradford John , Balmaceda Rufino
Published: April 2017

The psychiatric, psychosocial and medicolegal variables of 50 shoplifters and two comparison groups are described. The shoplifters were found to be an almost identical population when compared to general, (non-forensic) psychiatric outpatients, and differed significantly from a comparison group of general forensic patients excluding shoplifters. A high level of psychosocial stress antedating the shoplifting behaviour was a significant finding. A profile of a typical shoplifter referred for psychiatric examination is a 37 year old married female person, employed at the professional end of the occupational spectrum, who is suffering from a depressive neurosis and who steals an item of insignificant value or use to herself. The psychiatric diagnostic profile supports the lenient legal disposition by the courts.
The Eastern Ontario Survey: A Study of Drug-Treated Psychiatric Problems in the Mentally Handicapped
Authors: Tu Jun-Bi , Smith J. Terry
Published: April 2017

This study surveyed psychiatric problems treated with psychotropic medication among mentally handicapped at five regional centres in Eastern Ontario. Of the 2,158 residents studied, 920 (43%) were identified as problem cases, ranging from 36% to 83% in different institutions. Aggressivity, hyperactivity, and self-injury are the most prevalent conditions among more than thirty problem categories. Analysis of multidimensional contingency tables revealed that each of these three problems is involved with a distinct pattern of interactions with the set of demographic and clinical variables. The diversity of these interaction patterns points out the inadequacy of any unitary hypothesis of the pathogenesis and the inadvisability of adopting over-generalized treatment modalities. It is proposed that rational planning of service should rely on a realistic estimation of individuals’ needs and a better understanding of the scope and nature of the problem.
Abstinence Syndrome from Therapeutic Doses of Oxazepam*
Authors: Wilbur Robert , Kulik A. Vickie
Published: April 2017

A patient developed severe anxiety, moodswing, depression, and thinking disorder 24 hours after abruptly stopping oxazepam, of which he had taken 30 mg 3 times a day for two months, for anxiety and panic attacks. Oxazepam was restarted and tapered off gradually; nevertheless, a relatively severe abstinence syndrome occurred. Muscular fasciculations and moodswing were very marked. The patient also experienced significant anxiety, depression, moodswing, and muscular fasciculations for two months after detoxication from oxazepam. Subsequently, the patient's panic attacks were treated successfully with propranolol hydrochloride. This report concludes with a brief review of the literature on benzodiazepine withdrawal.
Capgras Syndrome in Siblings*
Authors: Pulman J. , Dupont Denyse , Ananth J.
Published: April 2017

The hallmark of the Capgras Syndrome is delusional misidentification of persons, objects or animals. It can occur in organic syndromes and in functional disorders. Hence there are adherents of organic as well as dynamic factors in the genesis of this disorder. The authors report the occurrence of the Capgras Syndrome in a brother and sister and elaborate on the interplay of both genetic and dynamic factors in the etiology.
Fluspirilene Neuroleptic Depot Injections and Indurations*
Authors: Mcgee H.M. , Seeman M.V. , Deck J.H.N.
Published: April 2017

Local reactions at injection sites have limited the use of depot fluspirilene, an otherwise effective treatment for chronic schizophrenia. Thirty-nine reports of fluspirilene-treated patients were analyzed and the patients were examined for indurations. It was found that patients with indurations were given significantly higher doses and volumes of the drug. The mean number of high volume injections (over 3ml) at each site was the most significant differentiating fact or between the two groups: 19 such injections over a twelve month period for those with indurations, as compared to 3 for those without. None of the following variables were significant; age, sex, allergies, or total length of time on the drug. Previous administration of other forms of depot neuroleptics did not differentiate the two groups. Biopsy showed serous atrophy of subcutaneous fat, prominent blood vessels and hemosiderin laden macrophages.
Tardive Dyskinesia in an Outpatient Population: Prevalence and Predisposing Factors*
Authors: Yassa R. , Ananth J. , Cordozo S. , Ally J.
Published: April 2017

One hundred and eighty outpatients at the outpatient services of the Douglas Hospital were evaluated for the presence of tardive dyskinesia. Forty-nine (27%) among them had tardive dyskinesia. In this study, female sex, older age and the current administration of antiparkinsonian medication were found to be significantly related to the occurrence of tardive dyskinesia.
Factors Effecting the Recruitment of Residents: The Residents’ and Residency Directors’ View*
Authors: Mcnevin Stephen , Leichner Pierre
Published: April 2017

A survey of the opinions of Canadian psychiatric residents (N = 199) and their residency directors (N = 13) was conducted regarding six hypothesized reasons for the decline in psychiatric career choice by medical students. The residents felt that the adverse effects of undergraduate education and the negative socialization experience in medical school were particularly important. Of less importance was the competition from family practice programs and medical school admission policies that pre-screened biosocial students out. Little importance was attached to the relatively low financial benefits of this specialty and to new immigration laws. The experience of negative socialization was found to be significantly more important to Canadian medical school graduates than foreign graduates. The residency directors placed less emphasis on the importance of undergraduate education than did the residents.
Effectiveness of Cognitive Mediation and Behaviour Modification with Hospitalized Hyperactives*
Authors: Konstantareas M. Mary , Homatidis Soula
Published: April 2017

This study examined the efficacy of behaviour modification and cognitive mediation in treating two groups of hyperactive boys in day treatment. The study marks a departure from other research in two main areas: a) the severity of the children's symptomatology was such that it necessitated their removal from school; b) the interventions employed were intensive and of long duration (10 months), as opposed to the brief, short-term efforts commonly reported. Multiple outcome measures were employed to assess the effectiveness of each of the behavioural treatments. The children were administered a battery of tests shortly after their admission and again prior to discharge, 10 months later. Six main areas, considered relevant to the syndrome of hyperactivity, were tapped. These were: impulsivity, motor activity, sustained attention, self-concept, field-dependence/independence, and an overall hyperactivity rating independently assessed by a clinician. Results indicated that the two groups of children made comparable gains in each of the main areas studied. Moreover, the children of both groups were considered sufficiently improved by their clinical team to be discharged back to the regular school system.
Psychological Support of Oncology Nurses: A Role for the Liaison Psychiatrist
Authors: Taerk Gary
Published: April 2017

This paper describes the working of an oncology nurses coping group which functioned under the guidance of a consultation-liaison psychiatrist at the Toronto General Hospital. Nurses were helped to deal more effectively with the many and varied stresses which they face in treating patients with cancer. As a result ward atmosphere, patient care and inter-staff communication improved. The success of the group was due to a number of factors that included the high motivation of the staff the high level of stress on the ward, the support of the head nurse and the consistent relationship of the consulting psychiatrist.

A series of cases are presented to illustrate these points.
The Special Patient on the Medical/Surgical Ward
Authors: Friedman Jerry A.
Published: April 2017

The “special” or favoured patient may play a very important role in the ward milieu. Such patients are discussed in terms of their adaptive function for medical and nursing staff in dealing with feelings of pessimism, anger and guilt. The attitudes of protectiveness and infantilization and staff dissention make the task of the psychiatrist hazardous when consultation is requested.

Two clinical examples are discussed: one in which the issue of “specialness” was overlooked, and one in which it was dealt with.

The consulting psychiatrist's own reactions of anger and therapeutic nihilism may alert him to such a patient. Intervention must take into account the trust implied in being asked to see a “special” patient and the tremendous emotional investment on the part of the staff. The consultant should use his own reactions to the patient to help staff identify the feelings aroused in them by such patients. Meeting with the staff collectively to share concerns and resolve conflict is productive and should be encouraged.
Cortisol Secretion and DST in Affective Disorders — Methodological Concerns
Authors: Prabhu V. , El-Guebaly N.
Published: April 2017

In the wake of a large number of studies seeking biological markers for a variety of psychiatric disorders including affective disorders, the enthusiasm over Cortisol Secretion and Dexamethasone Suppression test lead the authors to review critically the data collected so far. The research designs involved, the samples studied and the reliability of the data collected along major variables such as diagnostic criteria, sampling characteristics, procedural differences, length of follow-up and the role of environmental stressors were evaluated. A useful exercise was to compare the literature published in the 50's and 60's with the more recent publications.

The potential usefulness of DST as a diagnostic and management tool remains open for scrutiny. Whether the abnormalities in cortisol levels and DST responses evidenced by many researchers are an epiphenomenon or have a diagnostic and management value still remains unclear. From their analysis, the authors point out the lack of well controlled sequential studies using standardized procedures, and large age specific samples. Difficulty arising from the use of various terminologies and criteria for diagnosis of depressive disorders is recognized. The limitations of the use of DST in general clinical practice along with directions for future research are outlined.
Social Support and Post Hospital Outcome for Depressed Women
Authors: Goering P. , Wasylenki D. , Lancee W. , Freeman S.J.J.
Published: April 2017

In a larger follow-up study of discharged patients, a subgroup of 87 women with non-psychotic disorders had an unexpectedly poor outcome at six months with regard to readmissions, symptoms and social adjustment. The only factor which distinguished those who had been readmitted was lack of social support. Lack of social support was also related to poor symptom and social adjustment outcomes. There were considerable difficulties with social functioning independent of high symptoms. The adequacy of aftercare services is questioned in the light of these findings.
Psychological, Hormonal, and Weight Disturbances in Functional Amenorrhea
Authors: Brown Edward , Bain Jerald , Lerner Paul , Shaul David
Published: April 2017

The authors studied functional secondary amenorrhea in young women. There was a high incidence of weight disturbance. Hormone assays demonstrated a diminution of hypothalamic-pituitary function in the underweight group. The findings from psychiatric interviews and psychological testing revealed the prevalence of psychopathology with disorders of self concept, confusion of body image, faulty mechanisms of defence in dealing with affects and impulses and disturbances of interpersonal relationships. The onset of amenorrhea was often related to situations of stress. The results suggested that psycholgical factors were primary in the development of functional secondary amenorrhea.
Familial Fugue — a Case Report
Authors: Mckinney K.A. , Lange M.M.
Published: April 2017

A case of fugue with a familial pattern is presented. A review of the pertinent literature has been made. A “learned” basis to the development of fugue in the case presented is considered.
Psychoses with Propranolol: A Case Report
Authors: Prakash Rudra , Campbell Thomas W. , Petrie William M.
Published: April 2017

Functional and organic psychoses have been reported in association with propranolol therapy. The authors report a rare occurrence of both types of psychoses in the same individual at two different times during propranolol therapy.
ECT as a form of Restraint
Authors: Jeffries J.J. , Rakoff V.M.
Published: April 2017

ECT is controversial as a form of therapy, with lay and psychiatric objectors. Restraint is also controversial, though often necessary. The Ontario Mental Health Act of 1978 allows the psychiatrist to restrain patients without consent if there is risk of physical danger. The act mentions “chemical and mechanical” means. ECT is not dealt with as a form of restraint. A case is described of a manic male who during 2 episodes of psychosis presented a serious threat of assault to staff. The next of kin was reluctant to sign consent for “treatment” because of fear of the patient's later resentment. An application to the Review Board for permission to treat would have taken a week. On both occasions attempts to control the patient with chemotherapy were totally unsuccessful despite the use of rapid neuroleptization, paraldehyde, barbiturates and mechanical restraints. In both admissions 4 ECT given over 2 days produced rapid behavioural control. ECT was then discontinued because the patient declined to give consent for ECT as treatment and he no longer presented a threat. Medical and legal consultation were necessary and the consensus was that ECT as restraint may be justified on the basis of clinical judgment. In such cases ECT is safer, more reliable and more humane than chemotherapy or mechanical restraints. The authors discuss the current public and professional antipathy towards ECT. There is risk of death for the patient in circumstances where legal barriers prevent the appropriate use of electro-shock and a U.S. case is mentioned. There is a clear need for further public and professional education. Provincial legislation should be drafted so as to clearly permit the use of ECT in involuntary patients who present an acute, severe risk of injury to themselves or others.
Risk Factors for Depression in Canadians
Authors: Roy Alec , Kennedy Sidney
Published: April 2017

In a matched controlled study 72 Canadian patients with a major depressive episode were compared with non-depressed and never depressed orthopedic patients. Significantly more of the depressives had parental loss before 17 years of age, a poor marriage before the onset of depression and a family history of depression.
Grief Reactions to Perinatal Death — a Follow-Up Study
Authors: Laroche C. , Lalinec-Michaud M. , Engelsmann F. , Fuller N. , Copp M. , Mcquade-Soldatos L. , Azima R.
Published: April 2017

Thirty mothers who experienced a perinatal death were offered crisis intervention aimed at facilitating their grief process at a few days, 3 weeks and 3 months after the loss. Evaluaticn of maternal grief reactions and their general psychological adjustment took place at these 3 early contacts and 1 to 2 years later. This last assessment included a semi-structured clinical interview and a number of self-rating scales (Life Events Schedule, Beck Depression Inventory (BDI) and a Mourning Scale). Six of the 30 mothers showed inappropriate grief reactions at the 3 week and 3 month assessment. By the long term follow up only 1 of these 6 displayed depression or other psychiatric disorder. Three other women not identified as high risk candidates by the 3 month evaluation developed high BDI scores and clinical depressions at the 1 to 2 year assessment. Variables associated with abnormal grief and depression such as social support systems, communication between the parents, maternal dreams, and hospital practices were examined and discussed indicating possibilities for future research.
Listening in Family Psychotherapy*
Authors: Falconer C.W.
Published: April 2017

The author describes with clinical examples why the neglected tool of listening is of vital importance in supervising and practising family psychotherapy. This neglect is highlighted as a possible side effect of focussing exclusively on the use of one way mirrors and video equipment in teaching family psychotherapy.
Robert Gardiner Hill and the Non-Restraint Movement*
Authors: Jones Kingsley
Published: April 2017

An account is given of the professional life of Robert Gardiner Hill before and after the publication in 1839 of his lecture on the Total Abolition of Restraint in the Treatment of the Insane. The lecture is summarized and an attempt is made to evaluate his work which has been overshadowed by that of John Connolly.

This paper was researched before the author came to North America. A library request to check that no recent work had appeared on the history of the restraint controversy produced two papers published in 1978. One roundly advocates restraint (1) the other acknowledges its widespread practice in Canada (2).
General Papers
Authors: Lamontagne Yves
Published: April 2017

Since the last decade, behavior therapy techniques have been used for a variety of psychiatric problems. This paper summarizes the therapeutic indications where behavior therapy appears to be the treatment of choice as well as those where behavioral techniques can be an adjunct. Contra-indications are described and examples of different combinations of treatment are reported.
Nine Psychiatric Inpatients who Leaped from a Height*
Authors: Small Gary W. , Rosenbaum Jerrold F.
Published: April 2017

The authors describe nine psychiatric inpatients from the same hospital who leaped from a height. Common features included youth, social isolation, diagnosis of schizophrenia, and chronic psychosis despite neuroleptic therapy. All had prolonged hospitalizations and a history of assaults, suicide attempts, or both. The authors suggest that these characteristics in conjunction with a recent change in hospital treatment plan or loss of social sup-ports may identify patients at high-risk for violent self-destructive acts.
The Neurological Examination in Child Psychiatry: A Review of Its Uses*
Authors: Szatmari P. , Taylor D.C.
Published: April 2017

This review is an attempt to evaluate critically some of the recent literature on the clinical utility of the neurological examination in child psychiatric practice. Three separate but related issues are discussed; the accuracy of the examination in assessing cerebral dysfunction, the strength of the association between neurological signs and behaviour disorders and finally the clinical significance of this association. It is pointed out that not all neurological signs are of equal significance, but that developmental neurological signs which indicate cerebral immaturity are weakly associated not only with hyperactivity, but possibly with other behaviour disorders as well. Some of the methodological weaknesses in this literature are pointed out. Recent studies of children with motor impairment (clumsiness) are briefly mentioned as a potentially more fruitful avenue of research. It is concluded that the neurological examination may be useful in identifying sub-groups of behaviourally disturbed children who differ from other children with behaviour disorders in terms of etiology, prognosis or treatment needs. Unfortunately, little work has been done in this specific area and further research is needed.
Organic Brain Syndromes: New Classification, Concepts and Prospects
Authors: Lipowski Z.J.
Published: April 2017

The concept, definitions and classification of organic mental disorders have been radically revised in DSM-III, the new American classification. Seven organic brain syndromes have been included and their diagnostic criteria explicitly formulated. The boundary between so-called functional and organic mental disorders has been blurred. The author discusses these changes in the light of growing importance of organic psychiatry due to aging of the population and the high incidence and prevalence of organic mental disorders in the elderly.
Fathers Absent and Present
Authors: Adams Paul L.
Published: April 2017

Hindering and obfuscating psychiatric scholarship about the father's role, whether he is present or absent, are several widespread notions and practices — including conceptual, assumptive, attitudinal, methodologic and technical matters. Discussed are eleven barriers to research: patriarchal ideology, preference for studying individual and dyad instead of family systems, preference for considering adults not children, overly rigid definition of parental roles, choosing not longitudinal but onetime cross-sectional study, reasoning about linear cause and effect, focus on attitudes not overt behavior, failure to control for adequate number of variables, neglect of adequate sampling procedures, confusing correlation with causation and an overemphasis on obvious pathology.

The father, present or absent, may be salient or insignificant in the life of a child. If salient, the father's role may promote health and growth or may be largely pathogenic. The conclusion holds that an irreducible family unit may consist of only one pair: caretaker/child.
Long Term Mental Illness in Canada: An Epidemiological Perspective on Schizophrenia and Affective Disorders
Authors: Bland R.C.
Published: April 2017

Canadian national data on psychiatric illness are combined with results from outcome studies to derive figures for the incidence, expectancy, prevalence, prevalence of marked disability, use of institutions and loss of the work force as a result of schizophrenia and affective psychoses. It is hoped that this can be of assistance in planning services and that it will stimulate more direct research into the nature and the scope of the social, psychiatric and economic impact of these illnesses.
Genetic Counselling: Its Need in Psychiatry and the Directions it Gives for Future Research
Authors: Stancer Harvey C. , Wagener Diane K.
Published: April 2017

The methods for investigating the extent to which genetic factors can influence vulnerability to psychiatric illness are, in increasing order of precision: family, twin, and adoption studies. The evidence from these studies is in support of a gene-environment interaction for schizophrenia and the affective disorders. While the family study method cannot supply precise etiological data, the empirically derived information can be used by the genetic counsellor to provide empirical risk estimates to the counsellee. The psychiatrist, geneticist, and social worker make an appropriate team for reliable genetic counselling. The clinician must determine the precise psychiatric diagnoses in family members which the geneticist may use to estimate risk. The social worker can follow-up the counselling session or sessions to assess the counsellees’ understanding of what has been told to them. It is stressed that while genetic counselling should be available, clinical judgement should be exercised to ensure its appropriate use.
Gender and Psychiatric Clerkship Performance
Authors: Keitner Gabor I. , Baldwin Lawrence M. , Mckendall Miriam J.
Published: April 2017

This study compared the performance of male and female medical students on a psychiatric clerkship rotation. The women performed at a higher level than the men, although the difference was not significant. In general, the men scored significantly higher on national standardized medical examinations. Correlations between psychiatric clerkship evaluations and national examinations were low, suggesting that the two measures are independent. These findings for psychiatric clerkship are consistent with those for clerkships in medicine, surgery and obstetrics, implying that female clinical clerks are just as capable as male clinical clerks in providing high quality medical care.
A Fifteen-Year Psychogeriatric Patient Follow-Up Study
Authors: Grauer H. , Mueller D. , Zelnicker R.
Published: April 2017

Two hundred and ninety-one patients, with an average age of 69 in 1965, referred to a psychogeriatric clinic were studied. All but 20 were traced. 167 died and 104 remained alive. 73 were institutionalized. Medical, psychiatric and social data was available for all. Using mortality tables, we calculated the time of death for each patient. The group that exceeded their life expectancy was compared to the group that died prematurely. Significant positive correlations with longevity were self-referral, higher education, skilled work, independent income and absence of dementia. Females and orphans also lived longer. Living alone, dependency on children and conflict with one's spouse predisposed to institutionalization. Curiously, the hardships of being in wartime Europe and/or in a concentration camp increased life expectancy and mitigated against institutionalization. An attempt is made to correlate our findings with other studies and to explain our results.
Treatment of Immigrant Indian Patients
Authors: Ananth Jambur
Published: April 2017

When immigrant Indian patients develop psychiatric illness, they face many disadvantages such as the lack of family support and shame for becoming sick. In treating them, a knowledge of their cultural values and communication, is necessary. While taking history, reluctance of these patients to discuss sexual and aggressive feelings should be respected. Patients’ harmony with the family and significant others is the goal of treatment rather than the patients’ growth; interdependence and not independence is favored. Free expression of emotions create a dysphoric milieu. A careful assessment of psychopathology and dynamics and psychotherapy integrating these cultural factors is important to promote changes that are therapeutic.
The Prescription of Psychotherapy*
Authors: Freebury D.R.
Published: April 2017

This paper outlines a format for the evaluation of patients for whom intensive dynamic psychotherapy is being considered as a treatment modality. Such an evaluation includes a traditional descriptive diagnostic assessment leading to the establishment of a conventional nosological diagnosis. This is followed by a descriptive, developmental evaluation which pays close attention to the levels of ego development, at the same time attempting to assess the mutual influences between it and several other important lines of development which may not all have reached similar phases of maturation. The assessment is completed by the psychodynamic evaluation of the patient and a table is presented outlining a series of contrasting clinical findings which either favour the use of intensive, uncovering psychotherapy or mitigate against it. It is proposed that these factors, when taken into account with the degree and the duration of the presenting problems, provide useful guidelines for the prescription not only of intensive psychodynamic psychotherapy, but also of a whole variety of psychotherapeutic approaches. A second table illustrates how this integration assists in the prescription of the appropriate psychotherapeutic approach.
Amoxapine Failure — a Neuroleptic Property?*
Authors: Signer Stephen F. , Billings Ronald F.
Published: April 2017

Amoxapine, a member of the dibenzoxazepine drugs which includes loxapine, has recently been introduced/or the treatment of depression. We present five cases of amoxapine failure after an initial good response, which showed severe deterioration with an increase in dosage. The dopamine-blocking effects of amoxapine metabolites are discussed. The mechanism of failure may be related to either the appearance of akinetic depression or a strong neuroleptic effect.
The Use of Carbamazepine as an Adjunctive Medication in the Treatment of Affective Disorders: A Clinical Report
Authors: Kwamie Yosef , Persad Emmanuel , Stancer Harvey
Published: April 2017

This is a report of an open clinical trial of Carbamazepine in the treatment of patients who suffered from affective disorders and who did not have an adequate response to Lithium or other medications. Our findings suggest that Carbamazepine can be a useful adjunctive medication when used in combination with Lithium and other psychotropic medications. The characteristics of the patients who responded were examined. The clinical state of the patients at the point of intervention varied; eight patients were manic and four patients were depressed. Four patients were judged to have had markedly effective responses, four showed an effective response and in four there was a slightly effective response. From the duration of the trials it was evident that in cases where Carbamazepine produced a good response its effect was seen as early as two weeks. The mean daily dose used varied from 300–1300 mgs. Because of the open nature of this trial, Carbamazepine was not withdrawn except in one instance.
Diet and Drug Interactions in the Treatment of Mental Illness — a Review
Authors: Awad A.G.
Published: April 2017

Drug-diet interactions in the treatment of mental illness are reviewed from two perspectives: the potential effects of drugs on a person's nutritional status, and the effect of diet on drug action through modification of its absorption or various stages of its metabolism. As mental illness is often chronic and recurrent, requiring long-term drug therapy, it is important to become aware of the effects of drugs and their possible interactions with other important factors such as food.
Énoncé De Principe
Authors: Patterson P. , Toews J. , Leichner P. , Hildahl Et K.
Published: April 2017

Le présent document a été rédigé pour la Commission d'éducation et de liaison présidée par le Dr. John Toews, et approuvé par le Conseil d'administration de l'Association des psychiatres du Canada en juin 1984.
The Behavioural Sciences and Undergraduate Education in Psychiatry
Authors: Rakoff Vivian
Published: April 2017

The Behavioural Sciences are becoming increasingly important in medical education and in medical treatment. But medical students and the profession generally, appear to have difficulty accepting behavioural sciences as a valid part of the curriculum and in the practice of medicine. One of the reasons for this may be related to a narrow definition of the physician's social role in the years following the adoption of the Flexner Report in 1911 which emphasized the model of the physician/scientist. The perennial model of the physician occupying a social role in which science is used to increase and rationalize responsiveness to suffering has been eroded in favour of the pursuit of the scientific as the essential goal of medicine. The newer, “softer”, sciences of anthropology, ecology, economics, psychology and sociology have not fitted into the professional self-perception of the medical role. Furthermore, some departments of behavioural science have adopted an intellectual stance at times antagonistic to the rest of the medical school emphasizing the shortcomings of the profession in its delivery of health care. The aspirant medical student may have been disaffected by teachers who do not embody acceptable role models. Students should receive specific instructions in the social role of the physician, physicians should be actively involved in teaching the behavioral sciences and the curriculum should at all times emphasize the relevance of the behavioural sciences to the daily practice of medicine.
Forensic Psychiatric Assessments in the Northwest Territories
Authors: Seltzer A. , Langford A.
Published: April 2017

This paper is an analysis of the psychosocial and forensic factors leading to legal referrals to a northern mental health service. It was found, not surprisingly, that most criminal acts were associated with alcoholism, personality disorders, and low socioeconomic status. Young native males figured prominently in both violent and property crimes. Rape offenses and major psychopathology appeared to be more common among Inuit referrals.

The influence of rapid culture change and psychosocial and biologic predisposition to the deleterious effects of alcohol were considered relevant criminogenic factors. It was also felt that the high Inuit referral rate might have been related to their willingness to accept consultation and discuss symptoms of mental illness.
Electroconvulsive Therapy: A Canadian Perspective
Authors: Smith W. Edwin , Richman Alex
Published: April 2017

Recent ECT practices in Canada are reviewed from a historical perspective with respect to specific criticisms. Utilization is decreasing; utilization rates vary widely between Provinces and between regions; disproportionate numbers of females have been receiving ECT; a substantial group of patients diagnosed as neurotic and schizophrenic continue to receive ECT; criteria and guidelines for its use are not consistently applied.

Expected rates of ECT used are estimated, based on theory and practice as well as on published data on the epidemiology of affective disorders. Data on actual Canadian usage are reviewed and compared with an estimated minimum ratio of 30–45+ cases per year of non bi-polar depression per 100,000 population requiring ECT. Results show that there may be a substantial number of patients in some Provinces for whom ECT is the best available treatment and who are not receiving it.

There is some ethical concern associated with possible under-use of ECT as the best therapy available for certain patient groups. Clinical cases and patterns of care should be reviewed at the hospital level to determine how best to effect improvements in the use of this treatment.
Mental Illness and the Media: An Assessment of Attitudes and Communication
Authors: Matas M. , El-Guebaly N. , Peterkin A. , Green M. , Harper D.
Published: April 2017

Media coverage of psychiatric issues will reflect or influence public perceptions of the mentally ill. In order to explore the relationship between psychiatry and the media, an altitudinal questionnaire was administered to a systematic sample of 20 reporters, 20 psychiatrists, 20 medical outpatients with no psychiatric history, and 40 psychiatric inpatients. In addition, 4 psychiatric patients who had personal experience with media coverage were interviewed to determine the impact. Their stories are presented as clinical vignettes. The results of the questionnaire survey show that media reporters are no less accepting of mental illness than the other groups. A regression analysis of altitudinal predictors elicit education as more significant than age and media exposure. Yet low scores for the coverage by the media of mental illness were given by all groups with psychiatrists tending to be most critical Reasons offered by reporters included “sensationalism sells” along with cost and time factors. Recommendations for both reporters and psychiatrists groups were collated, aiming at improving communication and ensuring a more positive emphasis and greater accuracy of media coverage of mental health issues.
A Community-Centred Alcoholism Assessment/Treatment Service: A Descriptive Study
Authors: Malla Ashok K. , Rush Brian , Gavin Mike , Cooper Gerry
Published: April 2017

This paper describes socio-demographic, alcohol-related, legal, medical, behavioural and treatment characteristics of 407 patients with problems of alcoholism / drug abuse assessed over a period of three years in a community oriented assessment and treatment program. The results show that patients entering this program represent a cross section of alcoholics in the area. These patients are similar to those entering traditional outpatient and residential facilities on most demographic variables; severity of alcoholism, length of history, and previous treatment experience. However, they are slightly younger and differ significantly from the others on their sources of referral. Over the three year period a significant change has occurred in the relationship between the program and the sources of referral. The implications of these findings for planning comprehensive treatment services for alcoholism are discussed.
Tourette Syndrome, Atypical Pervasive Developmental Disorder and Ganser Syndrome in a 15-Year-Old, Visually Impaired, Mentally Retarded Boy
Authors: Burd Larry , Kerbeshian Jacob
Published: April 2017

This is a case report of a 15-year-old visually impaired, mentally retarded male who presents with symptoms consistent with Tourette Syndrome, a Syndrome of approximate answers (Ganser's Syndrome) and Atypical Pervasive Developmental Disorder.

The authors feel that this follow-up on the case presented earlier by Parraga and Butterfield raises the possibility of a link between a number of the symptoms of adult schizophrenia, appearing in attenuated form in these two cases, and Tourette Syndrome.
Compliance to Referrals from the Psychiatric Emergency Room
Authors: Blouin Arthur , Perez Edgardo , Minoletti Alberto
Published: April 2017

Factors affecting compliance to referrals in the psychiatric emergency room (ER) were studied in a sample of 468 patients referred for ambulatory care. Compliance was defined as attendance at the first appointment. The overall compliance rate was 59%. Compliance rates were higher among those patients who were receiving psychiatric treatment (active) when they visited the ER. Those in treatment tended to have either Schizophrenic or Personality Disorders with fewer social supports. Different factors affected those in treatment and those not in treatment. The results suggest that those not in treatment would comply more frequently with specific instructions outlining the benefits of psychiatric follow-up.
Altered Amitriptyline Kinetics in a Depressed Patient with Porto-Caval Anastomosis
Authors: Hrdina P.D. , Lapierre Y.D. , Koranyi E.K.
Published: April 2017

A case of altered kinetics of amitriptyline in a patient with porto-caval anastomosis and liver cirrhosis who showed an unusually strong sedative response to the drug, is presented. Therapy with tricyclic antidepressants should be initiated with lower doses and adjusted by plasma level monitoring inpatients with liver by-pass.
Depressive Illnesses in Children and Adolescents: A Review of Current Concepts
Authors: Mcconville B.J. , Bruce R.T.
Published: April 2017

Considerable progress has been made in our understanding of depressive illnesses in childhood and adolescence, especially over the last several years.

A number of major books on the subject have now appeared, along with a large number of individual papers. This paper attempts to summarize current knowledge, and indicates developmental, age-related and other issues which still require further study.
Unilateral ECT: Advantages and Efficacy in the Treatment of Depression
Authors: Fontaine Réjean , Young Trevor
Published: April 2017

Electroconvulsive therapy is an efficacious treatment for some acute or drug resistant psychiatric disorders. However, there is some concern with memory impairment and brain damage and in order to decrease these complications, some changes to the technical aspect of electroconvulsive therapy were implemented during the last few decades. One of the major changes is the use of unilateral electrical stimulation on the non-dominant hemisphere which leads to less memory impairment and faster recovery time of cognitive functions. However, for optimal efficacy several variables have to be understood and integrated: electrodes placement, interelectrodes distance, waveform stimuli.
Patients who Complain of Social Dysfunction as Their Main Problem: II. Comparison with Other Outpatients Seen for Behavior Therapy
Authors: Stravynski Ariel , Greenberg David
Published: April 2017

Forty socially dysfunctional patients (avoidant personality disorder, DSM-III) and 76 other patients also seen for behavioral psychotherapy rated 30 items from the Social Situations Questionnaire on dimensions of distress and frequency of involvement. A discriminant function analysis showed that socially dysfunctional patients formed a distinct group as compared with other patients on ratings of distress. The main characteristics were over initiating social contact and carrying on a conversation with people one does not know. The separation between groups on the rating of frequency of involvement was less clear cut with some degree of overlap. The differences were in interactions with relative strangers and making decisions affecting them. A subsequent classification of cases using the derived discriminant function validated the above findings.
Capgras Syndrome—The Many Avenues to Delusional Misinterpretation
Authors: Pellettier John R. , Bartolucci Giampiero , Wallace Jean
Published: April 2017

The case of a 47 year old woman with Capgras’ Syndrome is presented. Despite her misinterpretation of acoustic and visual clues, multiple investigations and extensive neuropsychological testing failed to implicate an organic basis upon which to explain her delusional belief. The authors conclude that single explanatory hypotheses — psychological or neurological — may preclude an appreciation for the heterogeneity of the syndrome.