bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychiatric Disorders in Adopted Children: A Profile from the Ontario Child Health Study
Authors: Lipman Ellen L. , Offord David R. , Racine Yvonne A. , Boyle Michael H.
Published: April 2017

Studies of clinical populations suggest that adopted children are overrepresented among children using mental health facilities, whereas studies using non clinical populations of adopted children have reached mixed conclusions about whether or not there is an increased psychological risk associated with adoption. Data from the Ontario Child Health Study, a community survey of children aged four to 16 years, which included a subpopulation of adopted children, were used to: 1. profile the characteristics of adoptive families; 2. examine the strength of adoptive status as a marker for psychiatric and educational morbidity; and 3. determine the extent to which adoptive status has an independent relationship with psychiatric and educational morbidities. The findings were: 1. adoptive mothers were significantly older than non adoptive mothers, but otherwise adoptive families did not differ significantly from non adoptive families, 2. adoption in boys, but not in girls, was a significant marker for psychiatric disorder and poor school performance; adoption in adolescent girls was a significant marker for substance use; and 3. multivariate analyses demonstrated no independent effect of adoption on psychiatric disorder or poor school performance; for adolescents, adoptive status did have an independent relationship with substance use for girls. The implications of these findings will be discussed.
Assessing Psychopathology in Korean Immigrants: Some Preliminary Results on the SCL-90
Authors: Noh Samuel , Avison William R.
Published: April 2017

The goal of this study was to respond to a pressing need for translated versions of existing measurement scales that can reliably and validly rate degree of psychopathology among various groups of Asian immigrants. Specifically, the study investigated the cross-cultural utility of the Symptom Checklist-90 (SCL-90) by examining scores of community and patient samples of Korean immigrants and comparing them with norms for Americans and for Koreans living in Korea. Several analyses were also performed to establish the cross-cultural utility of the SCL-90. First, the reliability of the Korean version of SCL-90 was compatible with that of the original scale. Second, the scores of patient samples were unequivocally escalated compared with the scores of community samples within each population (Koreans, Korean immigrants and Americans), providing a partial confirmation of the concurrent validity of the SCL-90. Third, the cross-cultural validity of the scale was assessed by examining the scores of the patient samples. As expected, both symptom profiles and symptom levels were virtually invariant in the three patient samples. However, results of the study were clear in demonstrating that the SCL-90 scores of the community sample of Korean immigrants were substantially higher than the community norms of both North American and Korean samples.
La narcose sous barbiturique: mutisme*
Authors: Lavallée J.C. , Tremblay Et M.
Published: April 2017

The authors review the history and current uses of the amytal interview. This technique was quite popular over 50 years ago when it began, but has been ignored for the past ten years. A clinical case of mutism is described in this research to illustrate the usefulness of the amytal interview. In this particular case, the narcosis has permitted the uncovering of delusions and consequently the administration of the appropriate treatment.
Is There a Shared Somatic Disorder? Communication of Non Delusional Symptoms in Nigeria
Authors: Ilechukwu Sunny T.C.
Published: April 2017

In a setting in which somatic symptoms without obvious organic causes are prevalent and in which doctors do not have very convincing explanations to offer, people in prolonged contact with such patients may appear to develop similar symptoms but claim the original patient as the source of their symptoms. At times, it is the original patient that detects the similarity and raises the question of contagion. Based on a study of four Nigerian patients, the author proposes the possible existence of a shared somatic disorder, comparable in many ways to induced psychotic disorder (DSM-III-R) and reopens the discussion on the whole concept of sharing/communication of psychiatric symptoms.
Geriatric Psychiatry: Training Guidelines and Their Application
Authors: Thorpe Lilian , Leclair Ken , Donnelly Martha , Macbeath Lyn
Published: April 2017

Geriatric psychiatry is now a mandatory part of psychiatric residency education in Canada. Educational requirements in geriatric psychiatry were updated by the Royal College of Physicians and Surgeons of Canada in 1988, and guidelines were developed in more detail in 1989 by the Section on Geriatric Psychiatry of the Canadian Psychiatric Association (CPA). These guidelines are presented here together with a survey, conducted in the fall of 1991, of all 16 Canadian psychiatry residency programs. Thirteen of the training centres now require residents to have a formal rotation in geriatric psychiatry, generally three months in length. Residents are exposed to elderly patients in other services, such as consultation/liaison, but these services may not include formal teaching in geriatric psychiatry. Most programs have a seminar series in geriatric psychiatry and have training guidelines similar to those of the CPA. However, it is not clear how closely these are being followed, since it was felt in almost one-third of all programs that there was an insufficient number of teachers to fulfill the training requirements. In addition, a number of training directors felt that the objectives were too comprehensive to be met in the three month period. Earlier studies in the field are reviewed, implications of the current findings are discussed, and suggestions are made for further research.
The Reduction of Violence in a Chronic Psychiatric Inpatient Group: A Social Technique
Authors: Carlile John Batchin
Published: April 2017

A group of 72 chronic psychiatric inpatients comprised of the most violent and the least violent patients on a long term unit were studied prospectively for one year. The impact of increasing the doctor-patient contact in the second six months on the frequency of violent episodes was studied. The contact was brief and structured. Changes in staff, medication and the number of family visits were not found to be significant. The increased in contact seemed to have been highly significant. Violent episodes were reduced by 82% and had completely ceased by the last month of the study.
Mood Disorders: Developmental and Precipitating Events
Authors: Alnæs Randolf , Torgersen Svenn
Published: April 2017

A consecutive sample of 298 mainly non psychotic outpatients was classified according to DSM-III criteria. The differences in the reports from childhood and the precipitating events among the various subgroups of mood disorders (bipolar disorder, major depression, cyclothymic disorder, dysthymic disorder) and a residual group of patients with other mental disorders were examined. The patients in the non bipolar group reported more traumatic childhood experiences than the patients in the bipolar group. Precipitating events among patients in the group with major depression consisted more often of acute external stressors. Developmental factors and precipitating events in adulthood seem to be relevant in differentiating between the depressive disorders. The study supports the validity of the unipolar-bipolar distinction. The cyclothymic group seem to be a special variant of the major mood disorders.
The Benefits of Clomipramine-Fluoxetine Combination in Obsessive Compulsive Disorder
Authors: Browne Michael , Horn Edward , Jones Terence T.
Published: April 2017

We report the benefits of clomipramine-fluoxetine combination in four cases of severe obsessive compulsive disorder. In two cases, the combination was effective when either drug used singly was ineffective. In the other two cases, fluoxetine adjunct produced benefits with no additional side effects.
Offenses and Defenses against Patients: A Psychoanalyst's View of the Borderline between Empathic Failure and Malpractice
Authors: Sloane John A.
Published: April 2017

The behaviour of physicians is increasingly coming under scrutiny and attack, both from patients and from institutions that represent the public interest. This social process is partly a necessary and healthy quest for healing and partly a retaliatory response to inevitable failures on the part of physicians to live up to the standards expected of them. The process can assume such ruthless and pervasive forms that physicians are becoming exposed to impossible demands and even abuse at the hands of those they are trying to help. As a result, many physicians become defensive, withdrawing from patient care or reasserting their own needs in regressive ways that further offend or injure their patients. This increases public anxiety and outrage resulting in regressive and even violent “solutions” creating a vicious cycle in which mutual trust and respect is eroded and true health eludes our grasp.

Physicians who practise psychotherapy are particularly aware of such regressive emotional pressures and therefore their experience can be taken as a bellwether of social change. Stirred by recent encounters with colleagues who have undergone public inquisition, humiliation and punishment, and drawing on personal clinical experience with patients whose regressive self-expression could at times be considered “borderline”, the author attempts to understand the nature of the emotional forces being experienced by members of the profession at large. As in therapy, so in social change; the outcome depends on how well we understand, contain and channel the powerful feelings that underlie whatever actions are taken. Failure to do so makes the situation worse, while recognition of empathic failure at all levels can provide an opportunity for healing and for reintegration rather than polarization of opposing forces at the border between what is acceptable and what is not.
Psychiatric Networks: They Make Sense, But do They Work?
Authors: Kates Nick , Humphrey Barrie
Published: April 2017

With a trend toward coordinated networks of mental health services, it is necessary to be able to assess their impact. This paper outlines an approach to network analysis, using a variety of methodologies to come up with a composite picture. Areas to examine include the network processes, such as its goals, functions, structures, outcomes, and the satisfaction of all involved.
New Onset Rapid Cycling Bipolar Disorder in an 87 Year Old Woman
Authors: Gnam William , Flint Alastair J.
Published: April 2017

New onset rapid cycling bipolar disorder is rare in late life. The authors report the case of an 87 year old woman who first developed this disorder at age 82 and was successfully treated with valproate and L-thyroxine. The contribution of aging, hypothyroidism and stroke to the etiology of this woman's disorder is discussed. The pharmacological management of rapid cycling bipolar disorder in the elderly is also reviewed.
Attachment and Conduct Disorder: The Response Program
Authors: Holland Roy , Moretti Marlene M. , Verlaan Vince , Peterson Sherri
Published: April 2017

An increasing number of youths are being identified as suffering from behavioural problems that cause difficulties in their family and peer relations which in turn reduces their chances of academic and vocational success. There is growing concern regarding their level of aggressiveness. The common diagnosis given to these disaffiliated youths is conduct disorder. To date, most treatment programs for conduct disorder have been unsuccessful. A review of recent studies indicates that the disruption of attachment may be an important feature that underlies the wide range of symptoms that are typically found in youths with conduct disorder. A community-oriented program designed to ensure long term care for these youths is described in this paper, and the findings of a six month follow-up evaluation are presented. Results indicated that communities, caregivers, and youths responded positively to the program; caregivers reported significant reductions in a broad range of psychiatric symptoms in youths, and youths reported a significant reduction in symptoms of conduct disorder.
Anxiety and Depression in Patients with Abdominal Bloating
Authors: Song Ji-Yung , Merskey Harold , Sullivan Stephen , Noh Sam
Published: April 2017

Eighteen patients with a syndrome of abdominal bloating and discomfort were examined to explore the relationship between their symptoms and their emotional problems. They were compared with 33 patients with Crohn's disease and 38 normal, healthy volunteers. Using the Hospital Anxiety and Depression Scale, patients with bloating were found to resemble patients with Crohn's disease. Both groups showed increased anxiety and depression. After controlling for age, sex, education, occupation, personality variables and childhood experience, there was a trend towards more anxiety in the bloating group compared with normal subjects and a significant difference for depression. These characteristics appear to be related to the effects of the illness or to selection, but not to personality or childhood experience. Although psychiatric problems are common among patients with abdominal bloating and pain who stay in touch with a clinic, they are not the primary cause of the disorder.
Housing for People with Mental Illnesses: A Comparison of Models and an Examination of the Growth of Alternative Housing in Canada
Authors: Trainor John N. , Morrell-Bellai Tammy Lee , Ballantyne Ron , Boydell Katherine M.
Published: April 2017

The decrease over the past three decades in institutional care for people with mental illness has not been matched by the adequate development of specialized housing in the community. Broadly speaking, two major models of housing have emerged in the past 30 years: custodial and alternative. Large custodial settings, including boarding houses, nursing homes and special care homes, are typically not associated with residents' satisfaction or a positive outcome. Alternative housing refers to a range of models, including halfway houses, group homes, co-ops and supported housing. It is associated with better residents' outcomes. This paper briefly compares the two models and examines key issues in alternative housing and its development in Canada.
Les manifestations psychiatriques dans la démence: perspective phénoménologique
Authors: Paquette Isabelle
Published: April 2017

The study of psychiatric manifestations in dementia has long been overshadowed by the more classical manifestations of the disease, such as memory loss and other cognitive deficits. In recent years, however, psychiatric symptoms as part of the demential process have attracted interest and research has become more specific. Clinicians are faced with diagnostic, treatment and management difficulties related to affective or psychotic symptoms, which account for much distress and morbidity. Several studies indicate that the prevalence of psychiatric manifestations in clinical populations of patients suffering from dementia is high: 15% to 30% for hallucinations, 15% to 30% for delusions, ten percent to 20% for major depression and 40% to 50% for depressed mood. These figures tend to confirm the hypothesis that psychiatric features in dementia are neither infrequent nor atypical. Thus, researchers have sought to link psychotic or depressive symptomatology with several clinical characteristics of dementia, namely stage, severity, prognosis or cognitive dysfunction. Some recent studies involving extensive neuropsychological evaluations indicate that subgroups of patients can be defined according to psychiatric criteria, as well as cognitive or neurological criteria. Unfortunately, results are inconsistent. Some of the contradictions in the literature are related to poorly defined terms and symptoms, a lack of reliable operational criteria, absence of validation of instruments and scales and heterogeneity of the populations studied. Ambiguous syndromes, such as pseudodementia, while illustrative of certain clinical situations, have not been helpful in categorizing demented patients. The author suggests that research focused on specific and clearly defined psychiatric symptoms in dementia will better serve our comprehension of mixed syndromes.
Screening for Alcoholism in General Hospitals
Authors: Dongier Maurice , Hill Jeanne-Marie , Kealey Sheila , Joseph Lawrence
Published: April 2017

In a recently completed study at the North Bay Psychiatric Hospital, a tertiary resource serving a population of about 600,000 in Northern Ontario, systematic screening on admission showed a very high proportion of past or present alcoholism. Fifty-seven percent of the patients were identified as having a life prevalence of (current or past) alcohol-related problems through a combination of a questionnaire and a liver function test. This figure is much higher than what is generally observed in mental hospitals. Does it reflect a widespread prevalence of alcoholism in Northeastern Ontario or is it distorted by the pattern of referral to the North Bay Psychiatric Hospital which typically serves an underprivileged segment of the population ? In an attempt to answer this question, this study was carried out in general hospitals (medical and surgical wards). It confirms a higher prevalence of alcohol-related problems (biological, psychological and/or social) in Northern Ontario general hospitals, compared with Southern Ontario general hospitals, using identical methods of screening and assessment in both populations. The regional difference (odds ratio) is more evident in higher social classes. A diagnosis of alcohol abuse or dependence (currently active or in remission) was confirmed in 83.5% of the cases with positive screening who underwent the Diagnostic Interview Schedule (revised). This is a robust confirmation of the value of screening. These findings confirm the importance of systematic screening for alcoholism in general hospitals.
Stressful Life Events Associated with Adolescent Suicide Attempts
Authors: Adams Dalia M. , Overholser James C. , Spirito Anthony
Published: April 2017

This study was designed to examine the types of stressful events that are related to adolescent suicidal behaviour. Adolescent inpatients who attempted suicide and a control group of high school students were compared on various types of stressors. The stressors were categorized according to their type (for example, discrete events versus chronic strains) and source (for example, family or friends). Compared to high school controls, adolescents who attempted suicide reported elevated levels of major negative events and exit events. Both chronic strains and discrete stressors were related to an increased severity of depression and suicidal ideation. The results support the notion that increased stress is related to adolescent suicidal behaviour. Different approaches to categorizing stress may improve the understanding of the relationship between stressful life events and suicide. Also, sex differences may influence the relationship between life stress and suicidal feelings.
The use of Chloral Hydrate and Sodium Amytal during Clozapine Initiation
Authors: Dickson Ruth A. , Williams Richard , Dalby J. Thomas
Published: April 2017

Sedative hypnotics are frequently a necessary adjunctive to neuroleptic treatment. The recently released antipsychotic agent clozapine poses a challenge in this regard since the manufacturer advises caution when using clozapine with patients receiving benzodiazepines. The effectiveness of alternate agents sodium amytal and chloral hydrate when initiating clozapine was evaluated in a group of 15 patients suffering from schizophrenia. These medications were observed to be both safe and effective.
Autoerotic Asphyxial Deaths: Analysis of Nineteen Fatalities in Alberta, 1978 to 1989
Authors: Tough Suzanne C. , Butt John C. , Sanders Gary L.
Published: April 2017

This paper presents an unusual form of sexual (masturbatory) activity and brings this unusual cause of death to wider medical attention and understanding. All 19 cases of auto-erotic asphyxial death that occurred between 1978 and 1989 in the province of Alberta, Canada were reviewed. The fatal victim of auto-erotic asphyxia is typically a single male aged 15 to 29 years. Autoerotic sexual activity is typically performed in isolation; often there is evidence of repetitive practice. The accidental death usually results when the “safety” mechanism designed to alleviate neck compression fails. Often the first sign of the activity (usually a surprise to family and friends) is death itself. Physicians who are alert to the practice may suggest counselling when patients present with sexual concerns, unusual marks around the neck or evidence of abrasions to limbs suggesting bondage or other masochistic practices.
Regression in the Service of the Superego: The Do's and Don'ts of Stepwise Multiple Regression
Authors: Streiner David L.
Published: April 2017

Stepwise multiple regression is a very powerful but often misused technique. It can be used to find a set of independent variables which can predict some outcome. However, there are problems when the results of a stepwise solution are used to try to explain or understand the dependent variable. This paper discusses the different types of stepwise regressions, some of the legitimate and illegitimate uses of this technique, some of the difficulties encountered when trying to interpret the results and other solutions to the problems posed by using them.
Fitness and Competency Issues in Canadian Criminal Courts: Elucidating the Standards for Mental Health Professionals
Authors: Whittemore Karen E. , Ogloff James R.P.
Published: April 2017

The issue of competency arises at various stages of criminal proceedings in an effort to protect those individuals who are unable to participate in the legal process. The competency question is a legal issue ultimately decided by a judge. However, mental health professionals are often called upon to provide insight into an individual's level of competence. To date, the standards by which an individual is found competent have remained far from clear. This creates a problem for clinicians who are requested to make competency evaluations. This article addresses the competency issues as they arise at various stages of legal proceedings in order to determine the standards that are applied by the courts. Furthermore, given the importance placed on mental health evaluations of competency, the role of mental health practitioners will be addressed as it pertains to the competency question at each juncture in the criminal justice system.
Clinical and Demographic Characteristics of Voluntary and Involuntary Psychiatric inpatients
Authors: Tremblay Paul F. , King Paul R. , Baines G. Richard
Published: April 2017

Voluntary and involuntary psychiatric inpatients were compared on demographic, social and clinical characteristics. Chi-squared tests of independence revealed significant differences in age and financial support based on status at admission. No significant differences were found with respect to diagnostic category. It was concluded that demographic, social and clinical characteristics do not clearly discriminate between voluntary and involuntary inpatients.
The Treatment of Depression with Group Behavioural-Cognitive Therapy and Imipramine
Authors: Stravynski A. , Verreault R. , Gaudette G. , Langlois R. , Gagnier S. , Larose M.
Published: April 2017

Twenty-four outpatients meeting DSM-III-R criteria for major depression were assigned to group behavioural-cognitive therapy either with or without antidepressant medication (imipramine). Eighteen patients completed 15 weekly sessions of treatment. Equivalent improvement was observed in both regimens after treatment. The results essentially maintained at six months follow-up. This suggests that a group format of behavioural-cognitive therapy is a viable therapeutic intervention for outpatients diagnosed as suffering from major depression. However, the addition of imipramine to group behavioural-cognitive therapy did not enhance the outcome.
The Epidemiology of Parasuicide in Edmonton
Authors: Bland Roger C. , Newman Stephen C. , Dyck Ronald J.
Published: April 2017

The objective of this study was to examine some of the characteristics of parasiticides in Edmonton and to calculate rates of parasuicide. The method involved examining all records of parasuicides attending the University of Alberta Hospitals for a six month period (20% of all parasuicides in Edmonton are treated at the University of Alberta Hospitals). The results indicated that 58% of 275 subjects were single. The most frequent method (88.6%) of parasuicide was overdose. The peak age group was 25 to 29 years of age. The age range was 12 to 80 years (six percent < 15 years), mean age 30.2. The female to male ratio (cases) was 1.6:1; 30.2% were admitted; 46.5% received psychiatric emergency consultation; 41% had made a previous parasuicide. Calculated rates of parasuicide in Edmonton were at 448/100,000/year for those 15 years and older (men 357, women 534). The overall rate is higher than that found in any centre in the WHO/EURO investigation. The conclusion is that parasuicide presents a significant public health problem, and a cost burden on the health care system.
Predicting Outcome in a Multimodal Day Treatment Program for Children with Severe Behaviour Problems
Authors: Grizenko Natalie , Sayegh Liliane , Papineau Danielle
Published: April 2017

The demand for day treatment programs for children with severe behaviour problems has greatly increased in the past decade. The objective of this study is to identify characteristics of children who benefit most from such a program. The sample consisted of 63 children, aged five to 13, assessed at admission and discharge from the program. Outcome measures included behavioural improvement and school reintegration. At admission, multivariate analyses revealed that children who made the greatest behavioural improvements had less severe behaviour problems, lower IQ scores and more disturbed family functioning. Children reintegrated into regular classes after discharge were younger at admission, had better reading skills, no attention deficit hyperactivity disorder and little parental marital discord. Findings suggest that successful outcome can be predicted from characteristics of children at intake. A multimodal approach is needed to address the different problem areas in a child's life.
A Comparison of American and Canadian Teachers' Knowledge and Attitudes towards Attention Deficit Hyperactivity Disorder (Adhd)
Authors: Jerome Laurence , Gordon Michael , Hustler Paul
Published: April 2017

The purpose of this study was to compare and contrast American and Canadian teachers' knowledge and attitudes regarding ADHD. Both samples completed a self report questionnaire. The first part determined the demographic background of the teachers. The second section consisted of 20 true/false questions concerning ADHD intended to assess teachers' general knowledge of the essential concepts involved in the diagnosis and treatment of the disorder. The results indicated that both samples had little in-service training regarding ADHD. Despite this, most teachers regarded ADHD as a valid diagnosis with educational implications and wanted more formal training. While most teachers did well on knowledge-based questions regarding the etiology and educational implications of the condition, many still perceived non-medical therapies such as diets as being effective. Many regarded the condition as being outgrown at adolescence. Significantly, only 14%. of the teachers had been involved in the diagnosis and ongoing monitoring of medication by outside professionals. The implications of improved in-service training for all professionals involved with children with ADHD are discussed.
The Role of Marital Therapy in the Treatment of Depressed Married Women
Authors: Waring E. M.
Published: April 2017

The absence of a close, confiding relationship has been identified as a vulnerability factor to depression for women under adverse circumstances. Marital discord has also been identified as a risk factor in initiating and sustaining depression in women. Recent research has suggested that marriages with a depressed spouse are associated with lack of intimacy and decreased self-disclosure. This paper reviews three controlled outcome studies which demonstrate that marital therapy in combination with antidepressant medication is not indicated for hospitalized women with major affective disorder but either alone or in combination with antidepressants, marital therapy is a viable treatment for outpatient women who are suffering from depression.
Factors Complicating the Diagnosis of Depression in Cerebrovascular Disease, Part I — Phenomenological and Nosological Issues*
Authors: Ramasubbu Rajamannar , Kennedy Sidney H.
Published: April 2017

Depression is frequently associated with cerebrovascular disease. Early detection and intervention in depression may enhance rehabilitation potential. Difficulties encountered by clinicians in identifying depression in patients with cerebrovascular disease are numerous. This two part review focuses on issues related to the diagnosis of depression with emphasis on recognition of depressive symptoms and their relevance to the diagnosis of depressive syndromes in the presence of vascular lesions and associated neurological deficits. Furthermore, the value of diagnostic instruments and biological markers in identifying depression following stroke has been critically evaluated. In this first part of this two part paper, phenomenological and nosological aspects are considered with an emphasis on symptom profile, significance of vegetative symptoms and other related emotional responses such as catastrophic reaction, emotionalism and apathy in the diagnosis of depression following stroke. The applicability of diagnostic subcategories to define depressive syndromes associated with cerebrovascular disease and its clinical relevance is also discussed. The authors stress that knowledge on phenomenology of depression and other emotional responses related to cerebrovascular disease will facilitate better understanding of its clinical presentation and may improve diagnostic acumen.
The Impact of Pain and Impaired Role Performance on Distress in Persons with Cancer
Authors: Lancee W.J. , Vachon M.L.S. , Ghadirian P. , Adair W. , Conway B. , Dryer D.
Published: April 2017

The observed upward trend in the incidence of many cancers is expected to continue for the next 20 years despite monumental basic research efforts. There are interpersonal and intrapsychic complications associated with cancer and its treatment leading to considerable distress which, in extreme cases, becomes clinical depression and anxiety. Pain and impaired role performance have been cited as being important sources of distress in people with cancer. This paper presents data from a community sample of 1,309 people living with cancer in Prince Edward Island, Manitoba and Quebec and examines risk factors for cancer-related distress. In the model tested in this paper, pain and other symptoms and treatment side-effects as well as cancer-related fears were seen to have direct and indirect effects on psychological symptoms of distress. Impaired role performance was a central mediator for the indirect effects. The model explained 34% of the variance in distress scores (General Health Questionnaire) and was equally applicable to all three study sites, both male and female subjects, rural and urban settings, and to all stages of illness. Pain was the single most important explanatory variable. Impaired role performance had a negative effect on distress over and above the effect of pain. The results suggest that interventions directed at reducing distress in cancer should also address interpersonal issues such as the impact of the illness on family, social network and work.
Borderline Personality Disorder and Substance Abuse: Consequences of Comorbidity
Authors: Links Paul S. , Heslegrave Ronald J. , Mitton Janice E. , Van Reekum Robert , Patrick Jayne
Published: April 2017

The objective of this paper was to examine the prognostic significance of borderline personality disorder (BPD) and substance abuse in a cohort of former inpatients screened for BPD and followed up prospectively seven years after the index admission. The impact of comorbidity on borderline psychopathology, impulsivity and psychosocial functioning was examined. The original cohort was assembled between April 1983 and December 1985. Admissions were screened for borderline characteristics which resulted in a sample of 130 subjects, 88 of whom were positive for BPD based on the Diagnostic Interview for Borderlines. At seven years follow-up, 81 out of 130 (62.3%) subjects were re-interviewed. Six (4.6%) had committed suicide, two (1.5%) were deceased and 41 (31.6%) were lost to follow-up. The subjects with BPD and substance abuse were significantly differentiated from subjects with BPD only, substance abuse only and neither disorder on the basis of demonstrating more borderline psychopathology and more self-destructive and suicidal thoughts and behaviours. Probands with initial diagnoses of BPD and substance abuse were twice as likely to be diagnosed BPD on follow-up as probands with initial diagnosis of BPD only (relative risk = 2.19, 95% CI, 1.21 to 3.97). These findings and other research suggest that patients with comorbid BPD and substance abuse should be encouraged to focus on their abuse problems as a priority.
A Neural Network Model of Cortical Information Processing in Schizophrenia II - Role of Hippocampal-Cortical Interaction: A Review and a Model
Authors: Chen Eric Y.H.
Published: April 2017

This paper considers the relevance of hippocampal dysfunction to symptom production in schizophrenia with the help of an integrative computational model of cortical processing. First, evidence for involvement of the hippocampus was systematically reviewed. Then, a neural network model of hippocampal-cortical interaction was proposed. The effects of a dysfunction in hippocampal-cortical interaction were explored through simulation experiments. Neural network simulation demonstrated that when the hippocampal function of classification and reduction of overlap in input is sub-optimal, increasing correlation among input patterns compromised storage capacity of the cortical network. Hippocampal dysfunction predisposes to the emergence of spurious retrieval states in cortical information processing. This provides a model for psychotic symptom formation in schizophrenia.
Psychiatrists' Attitudes to Multiple Personality Disorder: A Questionnaire Study
Authors: François M. Mai
Published: April 2017

Objective

To assess the attitudes of a random sample of Canadian psychiatrists to Multiple Personality Disorder (MPD) and assess the relative prevalence of the condition in three comparable cities in Ontario.

Method

A questionnaire was sent to all psychiatrists who were members of the Canadian Psychiatric Association and who were resident in Ottawa, Kingston and London. Questions were asked on the respondent's personal clinical experience of MPD and his/her attitude to this condition. Some personal and demographic questions were also included.

Results

180 out of 294 questionnaires (61.2%) were returned. The existence of MPD was doubted by 27.8% of psychiatrists who responded to the questionnaire, with a significantly higher proportion in London than in Kingston or in Ottawa. A substantial majority in all three cities agreed that media publicity and the psychiatrist's own belief system affected the prevalence of MPD.

Conclusion

These results confirm that there is a split in the profession regarding belief in the existence of MPD as a diagnosis.
Clomipramine Treatment and Behaviour Therapy with Agoraphobic Women
Authors: David G. Johnston , Iris E. Troyer , Stan F. Whitsett , Thomas Dalby J.
Published: April 2017

The separate and combined effects of clomipramine hydrochlorzide and behaviour therapy on agoraphobic symptoms were investigated in a 28-week placebo-controlled double-blind clinical trial. One hundred and eight women diagnosed as agoraphobic were randomly assigned to one of four treatment conditions: clomipramine alone, behaviour therapy alone, clomipramine and behaviour therapy or placebo. Sixty women completed the assigned treatment. Clomipramine was prescribed in weekly increments to a maximum of 300 mg per day, with a mean dosage at week 8 of 94.6 mg per day. Behaviour therapy focused on graded in vivo exposure therapy. Assessments of patients were performed at six points prior to and during the trial and included standardized questionnaires, daily diaries and a Behavioral Approach Test. Significant main effects for both clomipramine and behaviour therapy on 15 and 12 of the dependent measures respectively were found but no interaction of treatments emerged.
A Clinical Study of Clozapine Treatment and Predictors of Response in a Canadian Sample
Authors: William G. Honer , William Macewan G. , Kopala Lili , Altman Siemion , Chisholm-Hay Sherri , Singh Kulbir , Geoffrey N. Smith , Ehmann Thomas , Ganesan Soma , Lang M.
Published: April 2017

Objective

To study the clinical response to clozapine in patients with refractory schizophrenia.

Method

Open trial of clozapine in 61 consecutively-treated patients.

Results

Following clozapine, the level of function of patients was improved relative to admission (p = 0.0001) and to the highest level in the previous year (p = 0.0001). Severity of illness was decreased (p = 0.0001). Overall, 31% of the patients were classified as responders to clozapine and the responders were all identified by 32 weeks of treatment. Poor functioning in the previous year was associated with less favourable response. At a mean interval of 26 months following discharge, 72% of the patients were continuing clozapine treatment.

Conclusions

This open trial of patients who were treated consecutively indicates a comparable degree of response to clozapine as observed in controlled clinical trials, and that level of functioning in the previous year was the best predictor of response.
Direct Cost of Depression: Analysis of Treatment Costs of Paroxetine versus Imipramine in Canada
Authors: Lapierre Yvon , Bentkover Judith , Schainbaum Sandra , Manners Steven
Published: April 2017

Objective

To assess the potential economic impact of new and more expensive antidepressants on the overall cost of treatment using cost-effectiveness analysis.

Method

For this analysis, a computerized decision tree of clinical practice was developed to model the 12-month treatment of moderate to severe depression in Canada. To complete the model, data were obtained from physician panels, the Ontario Ministry of Health, and clinical comparative trials of paroxetine, a selective serotonin reuptake inhibitor, and Imipramine, a tricyclic antidepressant.

Results

The overall cost of treatment when paroxetine 30 mg per day was used first-line was found to be lower than when generic imipramine was used as the initial therapy ($1697 versus $1793). The higher drug cost of paroxetine ($1.69 per day) versus imipramine ($0.05 per day) was offset by a higher rate of treatment failures with the tricyclic necessitating an alternate therapy, additional physician visits and/or hospitalization. Sensitivity analysis of key variables determined that drug price and relapse rates after discontinuation were relatively insensitive predictors of the overall cost of care. More important was the continuation rate while on different therapies.

Conclusion

Paroxetine demonstrated a cost-benefit relative to Imipramine when the continuation rate was ≥ 47%. Clinical trials of paroxetine have reported continuation rates of 41% to 65%, suggesting that paroxetine is a cost-effective alternative to Imipramine in the 1-year management of patients with moderate to severe depression.
Pharmacologie Expérimentale et Clinique des Psychostimulants
Authors: Bourin Michel , Le Melledo Jean-Michel , Malinge Myriam
Published: April 2017

Objectif

Expliquer à l'aide d'études animales le mode d'action des psychostimulants.

Méthode

Une revue de la littérature psychiatrique sur l'usage des psychostimulants chez l'enfant et l'adulte.

Résultats

En étudiant la littérature psychiatrique, il s'avère que 50 ans après l'introduction de l'amphétamine en clinique, les psychostimulants sont des médicaments utilisés, notamment le méthylphénidate, dans le traitement de l'hyperactivité de l'enfant avec ou sans déficit de l'attention. En revanche, chez l'adulte les psychostimulants cherchent encore leur voie, malgré des études dans le traitement de la dépression et d'autres maladies mentales. Seule la narcolepsie semble être justifiable de tels produits.

Conclusion

La preuve est largement faite de l'utilité des psychostimulants chez l'enfant. Chez l'adulte, ils pourraient être utiles à condition de mieux étudier les symptômes cibles.
Views on Classification and Diagnosis of Eating Disorders
Authors: Garfinkel Paul E , Kennedy Sidney H , Kaplan Allan S
Published: April 2017

Objective

To highlight developments in the taxonomy of eating disorders since Russell's original description of bulimia nervosa (BN) in 1979 and through 3 versions of the Diagnostic and Statistical Manual.

Method

Criteria for anorexia nervosa (AN), BN and binge eating disorder (BED) are systematically described.

Results

While criteria for AN remain largely unchanged between DSM-III-R and DSM-IV, the subclassification of binge/purge and restricter subgroups endorses previous research findings. For BN, the definition of “binge” has occupied considerable attention both in quantitative and qualitative terms. The arbitrary choice of 2 episodes per week as a minimum frequency is also discussed in light of recent data from the Ontario Health Supplement. A third eating disorder, BED, is now included in the appendix of DSM-IV under Eating Disorders — Not Otherwise Specified category. The potential overlap between this disorder and nonpurging BN is discussed. Finally, the relationship between eating disorders and other psychiatric disorders including depression, schizophrenia, obsessional, and conversion disorders is considered as well as the continuum from preoccupation with weight to eating disorder.

Conclusion

While significant advances have been made in understanding and classifying eating disorders during the past 15 years, further empirical work is necessary to clarify areas of uncertainty.
The Five-Factor Model of Personality in Borderline and Nonborderline Personality Disorders
Authors: Zweig-Frank Hallie , Paris Joel
Published: April 2017

Objective

The purpose of this study was to examine to what extent the phenomena associated with a diagnosis of borderline personality disorder (BPD) can be described by the five-factor model of personality.

Method

The sample consisted of female patients with BPD (n=29) and a control group with a mixture of nonborderline personality disorders (n=30). All subjects were given the NEO-PI-R.

Results

Borderline patients differed from community norms on all five factors, and were particularly high on Neuroticism, and particularly low on Agreeableness. The scores on the five factors did not differ significantly between the 2 clinical groups. Two facets of the conscientiousness scale (competence and deliberation) were significantly lower in the BPD group.

Conclusions

Dimensional profiles only partially account for the clinical symptomatology seen in formally diagnosed cases of BPD.
Treatment of Acute Bipolar Depression: A Review of the Literature
Authors: Srisurapanont Manit , Yatham Lakshmi N , Zis Athanasios P
Published: April 2017

Objective

Our goal was to ascertain the efficacy of various antidepressant treatments for acute bipolar depression.

Method

English articles that reported on the efficacy of antidepressant treatments in bipolar depression were located by computerized Medline and manual search. These studies were systematically reviewed and response rates for each treatment were computed.

Results

The available data suggest that mood stabilizers, MAOIs, cyclic antidepressants, and ECT are all effective in treating bipolar depression. All antidepressant treatments with the exception of mood stabilizers have been reported to induce a manic/hypomanic switch.

Conclusions

It is recommended that mood stabilizers may be the first step of treatment, followed by the addition of an antidepressant, especially a cyclic antidepressant. The specific symptoms profile of individual patients, such as anergic or psychotic features, may indicate more specific treatment options. ECT is an important measure for those who are pharmacotherapy-resistant or psychotic.
Tardive Dyskinesia: A Review
Authors: Latimer Paul R
Published: April 2017

Objective:

To review recent research findings on tardive dyskinesia (TD) with relevance to clinical practice.

Method:

TD is a syndrome of involuntary movements that can occur in association with chronic neuroleptic use. It is of unknown pathophysiology. It can be irreversible, is cosmetically disfiguring, and can be functionally disabling.

Results:

There is as yet no treatment of demonstrated efficacy for TD. It is an iatrogenic disorder whose incidence is increased by age and total cumulative dose of typical neuroleptics. It has been the source of successful litigation in some jurisdictions but, until very recently, there has been no effective antipsychotic agent without this effect.

Conclusion:

This litigation in some jurisdictions has been a major impetus to the development of novel antipsychotic agents. It is less well known that a similar, possibly identical, movement disorder occurs spontaneously particularly in the elderly and inpatients with schizophrenia, and that TD is often reversible.
Manganese Provision in Parenteral Nutrition: An Update
Authors: Livingstone Callum
Published: April 2017

Manganese (Mn) is an essential micronutrient required for the activity of metalloenzymes. It is an essential component of parenteral nutrition (PN), but requirements are low. Mn status is difficult to assess, with the commonest method being measurement of its concentration in whole blood. This method has limitations, including artifactually high concentrations resulting from contamination of specimen tubes. Mn toxicity is a well‐recognized complication of PN, the risk of which increases if there is cholestasis or if the patient has received high doses. It usually presents with parkinsonian‐like symptoms but may be detected presymptomatically as hypermanganesemia or as increased signal intensity of the basal ganglia upon T1‐weighted magnetic resonance imaging. Caution is necessary when providing Mn for patients on long‐term PN (>1 month). It is advisable to withhold supplementation if hypermanganesemia or cholestasis develops. Deficiency of Mn is rare in patients treated with PN. PN regimens are contaminated with Mn in amounts likely to meet requirements. Consequently, it is debated whether PN should be routinely supplemented with Mn. The currently recommended dose of Mn in adults treated with PN is 55 μg/d, but the doses provided by most currently available multi–trace element products exceed this. In response to calls for new products to be developed, 2 new multi–trace element products are currently available in Europe that provide Mn doses of 55 μg/d. Once these products are in general use, it is likely that the incidence of Mn toxicity will decrease.