bluuebunny/crossref_metadata_2025 huggingface dataset:
Length of Hospitalization Predicted by Self Assessment of Social Competence
Authors: Miller Gary H. , Willer Barry
Published: April 2017

The purpose of the study was to assess the feasibility of using demographic and social competence information to predict length of stay in a psychiatric hospital. The results indicated that social competence variables were much better predictors of length of stay than demographic variables. Moreover, no combination of demographic and social competence variables led to more accurate predictors than social competence information alone.
Geropsychiatry in Indian Culture
Authors: Rao A. Venkoba
Published: April 2017

Geriatric psychiatry will be increasingly important in years to come as the care of the elderly becomes a health problem in India. Those aged 60 and over contribute to 6% of the country's population at present. The life expectancy of an average Indian has increased from 24 years in 1900 to 53 in 1971. Improved health care promises longevity, but social and economic conditions like poverty, breakup of the joint family system and poor services, specifically for the aged, pose a psychiatric threat to them. Organic diseases and affective disorders form the bulk of psychiatric illnesses in the aged. Suggestions for research in areas such as social, cultural and changing attitudes, and national economics, have been suggested as a promising field for preventive geriatric services. Adding life to years is more important than adding years to life. The paper offers some references to the studies on geriatric psychiatry in India and discusses cultural factors affecting the aged.
Arecaidinism: Betel Chewing in Transcultural Perspective
Authors: Burton-Bradley Burton G.
Published: April 2017

Arecaidinism, or betel-nut habituation, has existed since earliest recorded times. The custom is restricted to a large area to the north and north-west of Australia and enters into the daily life of well over 200 million people. The impropriety of interfering with other people's customs, however, has not prevented the imposition of alien values and many believe the practice must be stopped. The arguments advanced against arecaidinism are ostensibly esthetic, addictive and oncogenic in nature, but may have other origins. An account is given of the history, pharmacology, economic aspects, culture functions, psychiatric implications, and an alleged relationship to oral carcinoma in the associated research, all of which indicate a complex habit deeply rooted in the daily living of the peoples concerned. It is inextricably interwoven with the overall patterning of the psychological, social, cultural and economic behaviour. On the evidence there can be little doubt that the betel chewing mixture is a fairly harmless stimulant and addictive agent and that the esthetic and oncogenic arguments remain unsupported by studies with any significant degree of scientific rigour at the present time. The antagonists should look more deeply into their own underlying motivations, the true state of their knowledge and, in the unlikely event of their programs being successful, should ask themselves what is likely to take its place.
Role of Psychiatry in the Phenomenon of Cults
Authors: Levine Saul V.
Published: April 2017

Religious cults and particularly their attraction for young people are receiving increased attention. There is currently considerable controversy about the role of governmental bodies in understanding and regulating cults and their effect on members. Regardless of their effect on the members of the cult or movement, particularly new members who are often adolescents, membership in a cult produces severe familial tensions. The cult members often develop opinions and modes of behaviour so diametrically different from their families of origin that psychiatrists are often consulted with the view to understand, treat and correct what is seen as behavioural aberration by the families. The phenomenon of religious cults does not seem to be of a passing nature and it is therefore imperative that psychiatrists have as comprehensive and clear a knowledge of the concepts and activities of cults, their seeming effects on young people and their families, and some of the reactions they have caused in society.
Relationship between Abortion and Child Abuse
Authors: Ney Philip
Published: April 2017

Although permissive abortion has been advocated on the grounds it will reduce the prevalence of child abuse and infanticide, there is no evidence to prove it has. There is a growing concern that it may have contributed to the problem. This article outlines eight possible methods whereby an increasing rate of abortion will lead to an increasing rate of abuse. There is evidence that an abortion results in depression which hinders mother-infant bonding in a subsequent pregnancy. An abortion of the first pregnancy may interrupt the developing bonding mechanism and interfere with the ability to bond to the next infant. If the hypothesis is correct, medicine by endorsing abortion on request may be jeopardizing the safety and care of a large number of children.
Family Studies and Changing Concepts of Personality Development
Authors: Lidz Theodore
Published: April 2017

Many of the most significant changes in concepts of personality development and maldevelopment derive simply from belated appreciation that the child grows up in a family; and that the child requires considerable positive input from those who raise him to grow into a reasonably integrated person. Only recently have psychiatrists and psychoanalysts begun to focus on the influence of the family transactions throughout the formative years. The paper briefly presents the requisites a family must provide to assure the integrated development of its offspring and groups them under four headings: the parental nurturant functions that change with each phase of the offspring's development; the influence of the dynamic organization of the family on the offspring's intrapsychic structure, affecting self-boundaries, gender identity, superego directives, and so forth; conveying through family transactions the basic social roles and societal institutions to the child; transmitting the instrumental techniques of the culture, and particularly its language with its system of meanings and logic upon which virtually all ego functioning depends. The paper considers the evidence that the “choice of the neurosis” — or more correctly, the choice of the psychiatric syndrome — does not depend only upon fixation at various phases of pre-genital development, but also, and perhaps primarily, upon the panphasic influence of the intrafamilial environment. It is of particular importance to recognize that there is a very direct relationship between the family transactions, the separation-individuation process, boundary formation, the attainment of various degrees of object constancy, problems of splitting, superego directives, and what can be conscious and what need be repressed into the unconscious. The failure to recognize the import of the family has interfered with the formation of an integrated developmental theory that can unite various aspects of the developmental process that have remained more or less isolated from one another — drive theory, object relations, ego psychology, separation-individuation, and cognitive development. Finally the question is raised if in providing guidance to parents we have been amiss in not focusing on such matters as who the parents are, how they relate to one another as well as to the child, the values they communicate by their behaviour — matters that are fundamental and to which almost all else is secondary, but about which relatively little has been said or taught.
Type a Behaviour Pattern: Relationship to Coronary Heart Disease, Personality and Life Adjustment
Authors: Keegan David L. , Sinha Bhirov N. , Merriman John E. , Shipley Carol
Published: April 2017

Sixty male subjects, all under age 60, taken consecutively from a cardiologist's referral practice were studied in terms of A Behaviour pattern using the Rosenman-Friedman Stress Interview. Subsequently they all underwent personality, temperament and life stress assessment by questionnaire using the MMPI, Thurstone Temperament Schedule, Holmes-Rahe Schedule of Recent Experience, Rosenman Life Satisfaction Questionnaire and a number of demographic measures. They were examined medically and divided into coronary heart disease (CHD) and non-coronary heart disease (NCHD) groups.

There were many more A Behaviour subjects reflecting the sampling bias from the cardiologist's practice. There were significantly more A subjects found in the group with CHD than in the NCHD group. A Behaviour subjects were more dissatisfied with their marriages and attainment of life goals and preferred respect and recognition to love and affection. The A Behaviour subjects were considered more open, self-critical, dissatisfied and passive than the non-A cohorts as interpreted from the L, K and Mf scales of the MMPI.

The finding of an association between A Behaviour and CHD validates the research of others. The greater dissatisfaction in certain areas of the A subjects’ lives fits in with other research evidence and is discussed in this vein. The passive, aesthetic interests of A subjects although difficult to explain in the light of the contrasting behaviour style, is discussed with reference to earlier psychoanalytic theories. The lack of psychopathology and personality differences in A subjects points up the difficulty of recognizing the A pattern using personality tests and points to the need of improved behavioural measures.
Replantation Surgery following Self-Inflicted Amputation
Authors: Stewart Donna E. , Lowrey Mark R.
Published: April 2017

Four cases of self-inflicted amputation of the upper limb which were surgically replanted are described. Three of the four patients are psychiatrically well, employed and pleased with the surgical result. The fourth patient committed suicide. The literature on self-mutilation and replantation surgery is reviewed and psychological factors and the role of the psychiatrist in replantation surgery are discussed.
The Early Phase of Psychotherapy with Antisocial Early Adolescents*
Authors: Awad George A.
Published: April 2017

Adolescence is a developmental stage with specific defenses, styles, and ego functions and thus requires a specific psychotherapeutic technique. The task of early adolescence is the establishment of a sense of autonomy during major biological, psychological, familial and social changes. Antisocial behaviour is understood as having multiple etiology and to be a manifestation of different diagnostic entities including reactive disorder, depression, neurosis, narcissistic, impulsive and borderline personalities, or psychosis. The main goal of the early phase of therapy is the establishment of a therapeutic relationship. This is achieved through the therapist's ability to help the adolescent to talk and explore, without fear of exposure, in the context of an active, empathic relationship. Specific guidelines helpful in establishing this relationship in the early phase of adolescent therapy are discussed.
Intellectuality and Emotionality in Psychiatric Residents
Authors: Paris Joel
Published: April 2017

The fully trained psychiatrist must be able to integrate vast amounts of phenomenological data as well as to empathically share feeling states inpatients. Beginning psychiatric residents often lean either towards intellectuality or towards emotionality, tendencies which potentially reinforce splitting within the profession.

Cognitive styles may correlate with neurophysiological indicators, such as hemispheric dominance and the augmenting-reducing dimension. There may also be sex differences in cognition; if so, they would have to be taken into account as more women enter psychiatric training. A theoretical understanding of individual differences in students provides a basis for the pedagogical correction of biases.

Overly intellectual residents may be organically or psychodynamically oriented. In either case they favour theory over concrete experience, and there are difficulties in mobilizing their empathic capacities. Identification with empathic teachers and a focus in supervision on the perception and integration of more stimuli, especially nonverbal cues, are important correctives.

Overly emotional residents identify excessively with their patients and tend to have problems with boundaries. An augmenting tendency, leading to stimulus overload, can be controlled by teaching residents how to structure and set limits. Identification with the supervisor is aided by clear boundaries in the supervisory relationship.

In both cases the resident's strengths must not be denigrated while correcting his weaknesses. Examples of learning problems in both kinds of residents are given, with discussion of supervisory pitfalls.
A Profile of the Child Psychiatric Population of Newfoundland
Authors: Kotsopoulos S. , Nandy S.
Published: April 2017

All referrals during the year 1977 to the only child psychiatric facility in the Province of Newfoundland and Labrador were investigated on a number of variables. Two hundred and two children were referred. This was considered a very low rate of referrals. Distance of the child's residence beyond the range of 50 kilometres from the unit was negatively associated to referrals. Lack of parental employment was not associated with increased rate of referrals. Children from the outlying regions of the Province were unlikely to come from broken families. Academic failure was common among those referred. Few differences were observed in the clinical diagnoses between those referred from the Avalon Peninsula and the regions lying further away. As compared to another Canadian province, Ontario, (Ottawa-Carleton region) (2), fewer aggressive children were referred in Newfoundland. Some implications of these findings for the practice of child psychiatry in the Province were discussed.
Pharmacotherapy for Autistic Children: A Summary of Research
Authors: Campbell Magda , Cohen Ira L. , Anderson Lowell T.
Published: April 2017

An overview of research involving pharmacotherapy in infantile autism is presented. Methodological issues relating to experimental design, rating instruments and ecological factors are considered. Classification of infantile autism and diagnostic problems are discussed. Research investigations conducted in order to define diagnostic subgroups in the etiologically heterogeneous population of autistic children are described. An attempt is made to relate biochemical findings to clinical drug response. Recent findings are presented indicating that a potent neuroleptic is able to yield simultaneously significant decrease of behavioural symptoms and improved learning under both clinical and laboratory conditions. The drug can be effective in conservative doses and administered over a period of 14 weeks without untoward effects. New research plans are introduced where attentional learning will be assessed in an operant conditioning paradigm using automated procedures.
A Survey of Referral Problems to a Psychiatric Preschool Program: Patient Characteristics and Therapeutic Considerations
Authors: Beitchman Joseph H. , Murray Charles , Minty Gillian
Published: April 2017

This study provides a detailed account of the nature of referral problems found in a consecutive series of 90 cases admitted to a psychiatric preschool treatment program. The characteristics of the sample, including age, sex, and ordinal position of the children are described. The type of presenting problems and such features of the child as speech and language function and intelligence are included as well. The characteristics of the parents are also included, such as their social class and their marital and psychiatric status.

These results are understood in the context of a developmental-interactional frame of reference, such that four categories of problems can be identified: 1) those children with organic/constitutional difficulties; 2) those children with mild developmental difficulties that put them in conflict with their parents’ or teachers’ expectations; 3) those children whose problems are reactive to family conflict and marriage breakdown; and 4) those marginally coping parents who decompensate when their preschooler reactivates unresolved internal conflicts of their own, which are then projected onto the child who becomes the identified patient.

The nature and details of the treatment program are described with particular reference to the four categories of problems identified. The unique advantage of a program such as this, and the difficulties providing service and continuity of care for these children and families are highlighted. The importance of an integrated and comprehensive approach which coordinates the educational, social and psychiatric services is emphasized if preventive psychiatry is to retain its meaning and fulfill its mandate.
Schizophrenia: Group Support for Relatives
Authors: Thornton John F. , Plummer Elizabeth , Seeman Mary V. , Littmann Sebastian K.
Published: April 2017

This paper outlines the organization and evolution of educational-support groups for the families and friends of schizophrenic patients. The organization involved three phases of expanding services to this target population. Our findings are that: a) relatives experience stage-specific reactions to the fact of schizophrenia in the family; b) topic areas for discussion tend to be the same in different groups; c) as total attendance grows (larger groups), individual attendance rate drops; d) the groups tend to evolve into self-led committees; e) the maximum benefit from the groups, as reported by the participants, is the opportunity to share common, painful experiences. Future goals lie in the encouragement of relative-run community organizations for schizophrenia and the clarification of the role of families in the development and course of the illness.
Double Blind Study of Lecithin in Patients with Alzheimer's Disease
Authors: Fisman M. , Merskey H. , Helmes E. , Mccready J. , Colhoun E.H. , Rylett B.J.
Published: April 2017

Twenty-one patients with a diagnosis of Alzheimer's disease completed a double blind trial on lecithin 25 g daily. Equal improvement was noted in both the lecithin and placebo groups. Serum levels of lecithin measured 12-14 hours after its administration were also not increased compared with the levels in control patients. These findings of the ineffectiveness of lecithin inpatients with Alzheimer's disease are discussed in relation to the literature on this subject.
Medical Detoxification Admissions during the Manitoba Beer and Liquor Strikes of 1978
Authors: Harper Dan W. , Macrae Linda , Elliott-Harper Catherine
Published: April 2017

Admission rates to a medical detoxification ward of a general hospital were examined for periods during a beer and a liquor strike and equivalent length periods before and after each strike. They were also compared to analogous periods during a non-strike year. Results indicated that admissions were lowered during the liquor but not the beer strike, a finding which is consistent with an earlier report that overall alcohol consumption was lowered during the liquor but not the beer strike. This finding indicates that there is a positive association between amount of alcohol consumed by the general public and an index of severe alcohol abuse. No subgroup of the detoxification population was identified as being responsible for the reduced admissions.
Cults and Mental Health: Clinical Conclusions
Authors: Levine Saul V.
Published: April 2017

The field of cults and their relation to psychological and psychiatric disorder is reft with rhetoric and opinion. There has been a particular dearth of documentation and substantiated data supporting psychiatric opinion.

As a result of considerable research, clinical work, and an extensive literature review, certain conclusions or strongly suggested positions are enunciated. An attempt is made to substantiate each of the ten assertions based on existing data, in the hope that they will clarify the muddy area, make clinical positions and interventions more soundly based, and inspire debate and heuristic efforts.
Managing Desperate Emotional Behaviour with Hypnosis
Authors: Swartz Conrad
Published: April 2017

When no other psychotherapy or pharmacotherapy could prevent debilitation or institutionalization consequent to longstanding frequent repeated maladaptive behaviour, hypnosis has been observed to be effective in suitable patients. As documentation, three cases of such chronic severe behaviour which have been encountered by the author are described; each had been regarded as hopelessly unmanageable by the primary physicians at the time of referral for hypnotherapy. Relevant to their suitability for hypnosis, all three patients were able to understand normal speech without difficulty, were able to concentrate well, and were agreeable to using hypnosis.
A Clinical Approach to Brief Dynamic Psychotherapies in Child Psychiatry
Authors: Maclean George , Macintosh Bette-Ann , Taylor Eithne , Gerber Marilen
Published: April 2017

This paper reviews the position of brief psychotherapies in child psychiatry. Brief psychotherapy with children and families has received less attention than similar work with individual adults. After reviewing literature on brief dynamic psychotherapy with children and their families, the authors, describe an approach which developed in an outpatient child psychiatry team. After a brief assessment, a focal hypothesis and plan of treatment are concluded. A decision is made as to which unit (the family group, an individual, or a combination of individuals) would be most strategic to treat. The authors coin the phrase “focal treatment unit” to express this concept.
Exorcism and Possession in Psychotherapy Practice
Authors: Henderson James
Published: April 2017

There has been an evolution in the layman's concept of mental disorder. Medieval belief in possession by demons and witches gave way to a 19th century medical model and more recently classical psychoanalytic formulations. Concurrently professional helping endeavour has moved increasingly from a more traditionally medical to psychotherapeutic process, and from a classical psychotherapeutic process wherein the therapist remained to a degree unresponsive and detached to a more modern emphasis on such qualities as empathy, sensitivity, reliability, and optimism as ingredients of successful psychotherapeutic practice. Freud's account of Haizmann's demonological neurosis usefully formulates the possession concept in psychological terms. However, recent developments in psychotherapeutic practice argue for a validity in the possession model of psychological distress. The possessing forces of object relations psychology are of course not the possessing demons and witches of medieval times but the possessing good and bad objects of early intrapsychic life set up through processes of introjection and incorporation in response to frustration in the early infant-mother relationship. Points of similarity in this comparison should not obscure features of contrast — there is no place for histrionic manipulation nor for a moralistic attitude in the practice of psychotherapy.

A case is described to illustrate these points.
Sexual Disorders in the Course of Clomipramine Treatment: A Report of Three Cases
Authors: Yassa R.
Published: April 2017

Clomipramine, a tricyclic antidepressant, has been used in the treatment of obsessive neurosis successfully. In the course of treatment with this medication, sexual disorders in the form of decreased libido and impotence were noticed in three patients whose cases are reported. These disturbances occurred in the first week and lasted during the course of treatment. Upon withdrawal of the medication, the side effects disappeared. These side effects seem to be more common than is usually thought. The physician should be alerted to them as they can be a source of noncompliance.
Comparison of Pimozide and Chlorpromazine in Acute Schizophrenia
Authors: Pecknold J.C. , Mcclure D.J. , Allan T. , Wrzesinski L.
Published: April 2017

A four week double-blind study comparing pimozide and chlorpromazine was designed to test the hypothesis that pimozide, a powerful dopamine receptor blocker, is more effective in the treatment of acute schizophrenia than chlorpromazine. Twenty patients, 13 males and 7 females ranging in age from 21 to 53 years (mean age 33 years) admitted to St. Mary's Hospital with acute schizophrenia were placed on the study. They were treated on an individual titrated dosage of either chlorpromazine 300 mg to 2100 mg, or pimozide 10 to 70 mg. The results revealed that on the Brief Psychiatric Rating Scale, the chlorpromazine group significantly improved after one week, whereas the pimozide group showed no statistical improvement until the third week. By the end of the study no significant differences were apparent between the two groups. In the Clinical Global Impression Scale, a significant difference between the two groups was found at week 4 showing a greater improvement in the chlorpromazine group. In terms of adverse reactions, the chlorpromazine group had significantly fewer extrapyramidal symptoms than the pimozide group (Simpson and Angus Scale) and in addition 15 adverse reactions were noted for the pimozide group as compared with 8 for the chlorpromazine group. This study shows that chlorpromazine has an earlier onset of action than pimozide in the acute schizophrenic patient despite the fact that it has a weaker effect on the dopamine receptor than has pimozide.

In view of this finding, the dopamine theory of schizophrenia should be critically re-examined.
Key Aspects of the Oral Examination
Authors: Berger Joseph
Published: April 2017

This paper reviews the conduct, examination responses, and key areas of interests that examiners have in the oral part of Psychiatric Board Certification examinations. Candidates are offered norms for performance and a practical guide to an examination.
Two Sisters Folie à Deux: A Case of Attempted Suicide
Authors: Salama Abd El Aziz A. , Wilson Robert
Published: April 2017

A case of Folie à Deux in two sisters is presented, in which the distortion of reality did not arise from one sister influencing the other, but from the fact that both already possessed repressed psychotic mental contents which erupted earlier in one and later in the other, and ended in a conjoint determined suicidal attempt.
Monosymptomatic Hypochondriacal Psychosis: A Diagnostic Checklist Based on 50 Cases of the Disorder
Authors: Munro Alistair , Chmara Joanne
Published: April 2017

The authors present a checklist of symptoms and characteristics of monosymptomatic hypochondriacal psychosis, based on a unique series of 50 cases of the disorder. The condition appears to be a subtype of paranoia. Pimozide is reported to be an effective treatment in a majority of cases.
Agoraphobia
Authors: Rapp Morton S. , Thomas Martyn R.
Published: April 2017

The authors focus on the nature of agoraphobia and on treatments for it. A variety of myths about agoraphobia are examined such as those concerning the patient's childhood, sexual development, and marital history, and the conclusion is that none of these helps in understanding the nature of the condition. The recent notion that agoraphobia is merely a form of endogenous depression is refuted.

Of the four traditional languages of psychiatry, the medical and behavioural models are currently more in vogue than the genetic or psychoanalytic, but there are limitations in all models. It is shown why the behavioural therapies for agoraphobia may not be as universally helpful as implied by the recent research literature. The apparent success of both pharmacotherapy and behaviour therapy leaves models of agoraphobia which are at variance with each other, and the authors suggest possible lines of research which might resolve the contradiction.
Training in Child Psychiatry: Some Problems, Areas of Controversy and Some Attempted Solutions
Authors: Steinhauer Paul D.
Published: April 2017

This paper discusses the essential components of child psychiatric training, considering priorities and the arguments for and against a pluralistic approach to training. It explores what aspects in the training of child psychiatrists should prepare them to make a contribution different from that of other members of the child mental health team. Other issues discussed include the balance between academic and clinical work, development of the capacity for clinical thinking, and the teaching of child development and psychiatric aspects of mental retardation.
Psychiatric Manpower in Ontario: Part I: A Survey and Recommendations
Authors: Cleghorn J.M. , Miller G.H. , Humphrey B.C. , Lesser A.L.
Published: April 2017

Demand for psychiatric services is rising in part because many former patients are now in the community and the development of community services has not kept pace. Needs perceived by psychiatrists and family physicians are congruent with each other and with the many job opportunities for psychiatrists which now exist. In five years there will be an increase in attrition of psychiatrists by retirement at the same time as the demand for service by the high utilizers — the young middle age group — will increase. The number of psychiatric training positions funded by the Ministry of Health has diminished. The influx of foreign medical graduates on whom one-third of services depend has been severely curtailed. The net result of these trends, if unmodified, will be higher population-to-psychiatrist ratios, decline in quality, decline in effectiveness, and a decline in the availability of services.
Differences in Suicide Rates: An Examination of Under-Reporting*
Authors: Malla Ashok , Hoenig John
Published: April 2017

A search of death certificates in the Registrar of Births and Deaths in Newfoundland was conducted covering the period of 1974 to 1978. In addition to 103 cases of suicide recorded on the certificates, in 104 cases no cause of death was recorded. The latter were further investigated through records of the forensic pathologist to determine the causes of death. Out of these, 14 cases were found to be unequivocal suicides and in 58 cases, cause of death was undetermined, or not investigated. These were added to the reported suicides (103) to provide a maximum possible correction for under-reporting. The suicide rate in Newfoundland still remains less than half the national rate in spite of the correction for underreporting. Implications of these findings are discussed in the light of reported research literature in this field, and social factors in the province.
Insomnia: II. Assessment and Treatment of Chronic Insomnia*
Authors: Cleghorn J.M. , Bellissimo A. , Kaplan R.D. , Szatmari P.
Published: April 2017

Evidence for non-pharmacological effects of hypnotics on sleep is presented. This suggests that behavioural variables may be involved in the regulation of sleep onset in insomnia. Chronic ‘true’ insomnia is described in terms of precipitating events: fixed behavioural patterns which perpetuate it and the disordered timing of electrophysiological and hormonal events. Specific behavioural factors relevant to an individual patient's insomnia must be identified. The factors are: (i) the patient's expectations of the experience of going to sleep and his / her belief that he can or cannot control the onset of sleep, (ii) the patients’ personal theory of the cause of the problem, (iii) what the patient says to himself privately about the problem, (iv) the presence of stimuli in the sleep setting which arouse the patients including objects, persons and behavioural rituals.

Treatment requires that patients be taught special skills, individually tailored to the specific behavioural variables found to perpetuate their insomnia. Non specific ‘placebo’ effects are also involved as is the case with drug administration.

Patients who fail to respond to treatment may have a masked disturbance of circadian rhythms. This recent observation requires the addition of new approaches to assessment and treatment.
Hypomania and Marital Conflict*
Authors: Lesser Arthur L.
Published: April 2017

The author treated seven bipolar patients over seven years whose presenting problems were chronic marital conflict. The bipolar diagnosis had previously been made in only one case. Conjoint or family assessment was essential for accurate diagnosis. Lithium was the comer-stone of treatment and the best results were obtained with bipolar patients who were lithium compliant and whose marital conflict was resolved in conjoint therapy. Marital conflict clearly preceded the bipolar disorder and was not prototypical. Neither a family systems model nor a psychopharmacological model alone were sufficient for treatment. The diagnosis of bipolar disorder must be considered with chronic marital conflict.
Hysteria: The History of an Idea
Authors: Merskey H.
Published: April 2017

Hysteria has long been recognized as a condition involving multiple somatic symptoms and resulting from a state of the emotions. By the time of Charcot, it became possible to attribute a hysterical symptom to an idea. It appears that the first detailed statement to this effect was made by Russell Reynolds (1) and it was adopted by Charcot (2), particularly because of his experience that hypnosis could be used to suggest hysterical symptoms. These concepts provided the starting point for Freud's theories.
Electroconvulsive Therapy and the Stimulus Waveform*
Authors: Harris-Brandts G.E. , Martin B.A.
Published: April 2017

The amount of electrical energy transmitted to the patient while inducing a seizure during electroconvulsive therapy (ECT) may vary considerably depending on the waveform of the electrical stimulus. The majority of ECT equipment used in the past employed a sinusoidal waveform for the stimulus. Advances in waveform technology have led to the development of pulsatile waveforms which are effective convulsants requiring a fraction of the electrical energy transmitted by the sinusoidal waveform. This paper summarizes the clinically relevant advances in waveform technology. The therapeutic principle of using the minimum effective dosage is emphasized.
Les suicides et les tentatives de suicide reliés à la prestation de soins médicaux: étude des poursuites judiciaires intentées au Québec entre 1968 et 1977*
Authors: Deschamps Pierre
Published: April 2017

This study analyzes 39 malpractice suits based on suicide attempts of hospital patients in Quebec between the years 1968 and 1977. Both the age and sex of the victims, as well as the pathology involved, the site of occurrence, the technique used and the foreseeability of the event are examined.

The study discusses the two main criteria that are used by the courts to determine liability for such occurrences, that is the foreseeability of the attempt and the possibility of its prevention. This is followed by an outline of the different factors that are considered by the courts in determining liability, such as the nature of the illness, the behavior of the patient, the site of hospitalization and the type of surveillance prescribed and exercised.

This analysis illustrates the difficulty in predicting the behavior of suicidal patients. In addition, as demonstrated, it is often impossible to prevent these patients from committing suicide. In conclusion, it is important to recognize the difficulties facing those who do decide to sue, difficulties stemming from the requirement of proving fault on the part of the doctor or the hospital staff in either not foreseeing the event or in not prescribing appropriate measures so as to prevent its occurrence.
Pre-Existing Uninhibited Bladder Facilitating Drug-Induced Enuresis: Four Case Reports*
Authors: Schwarcz Glenn
Published: April 2017

The author presents four cases of antipsychotic drug-induced enuresis preceded by occult symptoms of mild uninhibited bladder. Pre-existing uninhibited bladder may facilitate some cases of antipsychotic drug-induced enuresis.
The Treatment of Kleine-Levin Syndrome with Lithium*
Authors: Goldberg Mark A.
Published: April 2017

A case of Kleine-Levin Syndrome without megaphagia is described in an adolescent male who responded well to lithium treatment. Seventy-two hours of sleep monitoring during a typical attack revealed decreased stages three and four but no sleep-onset REM period. Recent reports, including the present one, strongly suggest that Lithium Carbonate may be the treatment of choice for the Kleine-Levin Syndrome.
Carbamazepine in the Treatment of Aggressive Behavior in Schizophrenic Patients: A Case Report
Authors: Yassa R. , Dupont D.
Published: April 2017

Carbamazepine has been used in the treatment of temporal lobe epilepsy since 1963. It has also been found effective in the treatment of psychiatric disorders accompanying epilepsy. Patients with nonspecific EEG abnormalities without overt epilepsy but with behavioral problems, including gross psychopathology and violent behavior, improve on carbamazepine. These findings prompted us to use it in the treatment of aggressive behavior in a schizophrenic patient. Due to the frequency and severity of aggressive behavior in this patient, maintenance ECT was given. However, when carbamazepine was instituted, ECT was discontinued and the patient has been virtually free from aggressive behavior since this medication has been instituted. The authors conclude that carbamazepine may be used in the treatment of aggressive behavior in schizophrenic patients.
And They Lived Happily Ever After: Marriage Concepts of Older Adolescents
Authors: Robson B.E.
Published: April 2017

Children of divorced parents are themselves more likely to divorce. The transmission hypothesis has been variously explained by the role model learning, high risk mate selection, increased individual psychopathology and more recently by the explanation of the family's positive sanction of divorce. Conversely, studies without matched controls of adolescents’ reaction to parents’ separation and their own future marriage indicate that these adolescents are wary of marriage, planning to delay marriage until their late 20's or 30's and highly concerned with partner choice. A study of 18 and 19 year old college students (N = 140) was undertaken to see if the attitudes expressed by those from divorced families are unique to this group or representative of the attitude of the general teenage population towards marriage. The students completed the Tamashiro Marriage Concepts questionnaire and a demographic/social questionnaire. The majority, over 90%, scored on the first two stages of marriage concepts (magical or idealized conventional) consistent with previous findings for this age group. A sub sample of 17 adolescents with divorced parents was compared with 17 matched controls. No significant difference was found in marriage concepts, attitudes or social variables including predicted marital age, dating patterns and sexual experience. Thus older adolescents despite their previous experience tend to be less mature in cognitive style in their attitude to marriage than one would expect at this stage of ego development and, therefore, are at high risk for divorce with early marriage. Further, those adolescents whose background includes the experience of a parental separation and divorce show no difference in their attitude to marriage from their peers.
Teaching and Research in Emergency Psychiatry
Authors: Mcpherson David E.
Published: April 2017

Psychiatric emergency departments are playing an increasingly important role in the delivery of mental health care. However, despite a number of recent articles and books on the subject of emergency psychiatry, there is still a marked discrepancy between the service function of an emergency unit and the training and research possibilities it can offer. Five major educational opportunities in such a unit are outlined, and a comprehensive training programme designed to maximize the emergency room experience for students and residents is described. A number of clinical research questions are also raised. Unfortunately, there are significant attitudinal and organizational problems involved in upgrading the academic level of an emergency service. Some of the specific difficulties are pointed out and possible ways of trying to overcome these obstacles are suggested.
The Integrated Use of Individual and Family Psychotherapy
Authors: Steinhauer P.D. , Tisdall G.W.
Published: April 2017

For almost thirty years after the development of family therapy, the concurrent use of family and individual psychotherapy was seen as incompatible by leading proponents of each modality. Although recently the literature has revealed an increased willingness to utilize family and individual therapies concurrently, the decision for or against any such combination has been left largely to the intuition or bias of the individual clinician. This paper suggests the concurrent use of family and individual psychotherapies when disturbances of family structure and interaction co-exist with, reinforce, and are maintained by largely ego-syntonic internalized psychopathology (that is, the character defences of individual family members). It provides a rationale for integrating the concurrent therapies, and uses clinical examples to illustrate how each can potentiate the other. There is a discussion of indications and contraindications for the integrated use of concurrent family and individual therapy. From their attempts to apply these principles, the authors conclude that the experience for the family, the individual and the therapists is that the selective and integrated use of concurrent family and individual therapies can achieve more than can either therapy alone — the whole is greater than the sum of the parts.
The Interaction with Allied Non-Medical Professions: The Canadian Psychiatric Association's Guidelines: The Position of the Canadian Psychiatric Association
Authors: El-Guebaly N.
Published: April 2017

While psychiatrists employ skills common to other professionals in areas that are not the sole prerogative of psychiatry (1,2), the challenges of this position paper are to define the unique qualifications psychiatrists possess in comparison to other mental health professionals, to reflect awareness of social, governmental priorities in health care, to avoid vested professional interest.
The Development of Psychiatric Research in Canada up to 1964
Authors: Cleghorn R.A.
Published: April 2017

Systematic developments in psychiatry came later than in modern medicine, in Canada as elsewhere. Empirical discoveries of significance for the latter occurred in the 18th century, those for psychiatry only in the 20th, depending on much more sophisticated technology. The emergence of an appreciation of emotion as a central factor in mental illness was spurred initially by Freud and then emphasized by the social disasters of two world wars. Physical methods of therapeutic value were followed by the application of chemical agents having phrenotropic effects. From such developments and the devising of chemical methods for the deeper understanding of body chemistry have emerged a psychiatry closer to the medical model. Simultaneously more sophisticated attitudes and criteria have risen. All these changes have depended in large measure on the application of research methods. The early employment of research in the Canadian scene are examined up to 1964 for those centers which have led the way.
Factors Influencing Length of Stay in Psychiatric Day Care
Authors: Romney D.M.
Published: April 2017

The goal of the present study was to discover the factors which influence psychiatric day care patients to remain in treatment. Of the numerous variables examined, three accounted for 65 percent of the variance. They were prior duration of the disorder which accounted for about half, followed by patients’ satisfaction with treatment, and age. Contrary to previous findings, patients’ initial expectations and whether or not they were confirmed played no part in their decision to remain in treatment.
Patient Care Review: Results of the Canadian Psychiatric Association Hospital Survey
Authors: Thompson Michael G.G. , Toews John , Lundgren Jane
Published: April 2017

This paper is a report of the Education and Professional Liaison Council of the Canadian Psychiatric Association on the results of its questionnaire to 104 psychiatric hospital facilities in Canada on the extent, type and usefulness of patient care review procedures. The results indicate that the majority of hospitals appear to have initiated one or more patient care review activities within the last decade and have been carrying these out on a regular basis. These procedures have been considered useful for patient care and for continuing medical education. Both the frequency of patient care review activity and the type of procedure used, however, are directly related to the number of psychiatrists present in the center, with those hospitals having the least resources indicating little or no activity.
Leonhard's Classification of the Chronic Schizophrenias*
Authors: Ban Thomas A. , Guy William , Wilson William H.
Published: April 2017

The conceptual development of Leonhard's classification of the chronic schizophrenias is outlined. The recognition within that classification of the importance of the polarity dimension has led to the identification of two distinct populations — atypical nonsystematic and typical systematic schizophrenia — each with a variety of different subtypes. It is hoped that recognition and validation of this group of illnesses which, for three-quarters of a century, have been called “schizophrenia” will provide a basis for meaningful biological research. Increasing interest in the system has already produced an awareness that future progress in the understanding of mental illness will greatly depend upon re-establishing the central place of psychopathology in psychiatric research.