bluuebunny/crossref_metadata_2025 huggingface dataset:
Planning Mental Health Services: I. Background and Key Issues*
Authors: Wasylenki Donald , Goering Paula , Macnaughton Eric
Published: April 2017

Planning mental health services is a complex task requiring an understanding of background developments and key issues related to mental health services. In Canada, the deinstitutionalization of patients attempted to shift the locus of care from provincial psychiatric hospitals to general hospital psychiatric units. This resulted in the isolation of provincial psychiatric hospitals, general hospital psychiatric units and community mental health programs, with little overall accountability for the services provided — three solitudes. To move toward the creation of responsible, integrated systems a number of issues must be addressed: target population(s); the roles of provincial psychiatric and general hospitals; community support services; continuity of care; co-morbidity; consumerism; and methods of integration. In the development of a comprehensive mental health plan, each issue should be recognized and decisions made which are in keeping with current knowledge. A companion report will survey Canadian initiatives in mental health planning and discuss approaches to many of the issues identified.
Caractéristiques psychométriques de la version canadienne-française d'une échelle de satisfaction pour patients hospitalisés en psychiatrie
Authors: Perreault Michel , Leichner Pierre , Sabourin Stéphane , Gendreau Pierre
Published: April 2017

This paper presents the results of a content and convergent validity study of the French-Canadian version of a standardized satisfaction scale for hospitalized psychiatric patients. One hundred and twenty-two patients underwent an interview during which they completed the translated version of the Client Satisfaction Questionnaire, developed by Distephano et al, and answered open-ended questions on their satisfaction with the services they received. The results revealed strong correlations between these measures of satisfaction and a high level of internal consistency for the Distefano scale, suggesting satisfactory psychometric characteristics for this French version. As for the original questionnaire, the factorial structure yielded at least two distinct satisfaction dimensions. These results, and those of the content analysis, based on answers from the open-ended questions, helped to identify aspects mentioned by the patients but not covered by the items included in the satisfaction scales. The units' cleanliness, therapists' work and attitudes and privacy on the units are examples of these dimensions.
Child Psychiatry and Early Intervention: II. The Internalizing Disorders*
Authors: Beitchman J.H. , Inglis Alison , Schachter Debbie
Published: April 2017

This paper uses the concepts introduced in the paper Child Psychiatry and Early Intervention: I. The Aggregate Burden of Suffering to review the internalizing disorders of childhood. This review surveys the internalizing disorders from the point of view of early intervention, for their prevalence, course, risk, early indicators, associated impairment, and responses to intervention. In general, the internalizing disorders have little effect on the community. When coupled with other disorders such as conduct disorder, or when dealing with suicide, the community's concern for these disorders increases and allocation of resources to target populations who are at risk becomes an important public health goal.
Child Psychiatry and Early Intervention: III. The Developmental Disorders*
Authors: Beitchman J.H. , Inglis Alison , Schachter Debbie
Published: April 2017

This paper is the third in a series of four using the concepts introduced in the paper Child Psychiatry and Early Intervention: I. The Aggregate Burden of Suffering. This paper reviews the developmental disorders of childhood to set priorities for early intervention programs. This review discusses the prevalence, course, risk, early indicators, associated impairments, and responses to intervention. The specific developmental disorders, especially learning disabilities, have a significant impact on community resources. Since the developmental disorders are easily recognized among preschool children, early intervention is feasible. However, successful interventions have yet to be demonstrated. Priority should be given to the development of effective interventions. There is a great need for research studies on the effects and effectiveness of early intervention with these individuals.
Child Psychiatry and Early Intervention: IV. The Externalizing Disorders*
Authors: Beitchman J.H. , Inglis Alison , Schachter Debbie
Published: April 2017

This paper is the last in a series of four using the concept of the aggregate burden of suffering to -review the major psychiatric disorders of childhood. This paper reviews the externalizing disorders of childhood to prioritize early intervention programs. The paper discusses the prevalence, course, risk and early indicators, associated impairments, and responses to intervention. The externalizing disorders affect the individual, family and community and are thought to result in the greatest aggregate burden of suffering of all the childhood mental disorders. Early intervention is advocated and will likely need to be intense and long term for this group of children. The need for research into efficient and effective programs is emphasized.
Seasonality in Psychiatry — A Review*
Authors: Fossey Emma , Shapiro Colin M.
Published: April 2017

This paper reviews the literature pertaining to seasonal patterns in psychiatric illnesses. Evidence on the season of birth phenomenon suggests that a greater risk of pre-, peri-, or post-natal damage is associated with the winter months. There is currently insufficient evidence to pinpoint the exact mechanism involved or to ascertain whether the mechanism is common to each condition. Studies of seasonal patterns of incidence of psychiatric disorders have highlighted the role of seasonally regulated environmental factors on internal biological processes. There is growing evidence that serotonin is involved in a variety of psychiatric disorders. Seasonal patterns have been observed in processes involving serotonergic functioning. Furthermore, it has been postulated that these processes may be influenced by photoperiod, suggesting that the seasonal patterns of incidence of several psychiatric conditions may share a common neurophysiological substrate.
Advances in Diagnosis and Treatment of Anorexia Nervosa and Bulimia Nervosa*
Authors: Kennedy Sidney H. , Garfinkel Paul E.
Published: April 2017

This paper reviews four areas of research into anorexia nervosa (AN) and bulimia nervosa (BN). First, in terms of diagnosis, the psychological concerns about weight and shape are now addressed in BN, bringing it more in line with the related disorder, anorexia nervosa. Second, studies of psychiatric comorbidity confirm the overlap between eating disorders and depression, obsessive compulsive disorder, substance abuse, and personality disorder. Nevertheless, there are reasons to accept the distinct qualities of each syndrome, and eating disorders are not merely a variant of these other conditions. Third, treatment advances in BN involve mainly cognitive-behavioural or interpersonal psycho-therapies and pharmacotherapies primarily with antidepressants. The effect of combining more than one approach is beginning to be addressed. Finally, outcome studies involving people with both AN and BN have shown that the disorders “cross over” and that both conditions have a high rate of relapse. A renewed interest in the treatment of AN is needed.
A Review of Schizoaffective Disorder: II. Somatic Treatment*
Authors: Lapensèe Michèle A.
Published: April 2017

Studies on the response of schizoaffective patients to somatic treatments are reviewed. Research suggests that in many cases the response of schizoaffective disorder to pharmacological intervention is similar to that of primary affective disorder. However, it is necessary to take into account the heterogeneity of the category when treating patients. The drugs used most frequently are lithium, neuroleptics (antipsychotics), antidepressants and anticonvulsants. Often a combination of drugs is found to be more effective than a single drug. Electroconvulsive therapy has been found to be very effective in the treatment of schizoaffective depression.
De la schizophrénie à la maladie de Wilson*
Authors: Saint-Laurent Marie
Published: April 2017

An 18 year-old male first presented a clinical picture of acute psychosis with two reccurences at ages 22 and 23. The diagnosis made at that time was paranoid schizophrenia. Twelve years after his first psychiatric hospitalization, it was discovered that he was suffering from Wilson's disease. In retrospect, the clinical picture was atypical, notably with an important neurologic involvement mainly parkinsonism almost uncontrollable and aggravated with neuroleptics.

The chelating treatment with d-penicillamine resulted in partial improvement of the neurological involvement because the extrapyramidal and neurovegetative symptoms persisted. The psychiatric symptoms improved with fewer neuroleptics than during the 12 previous years. However, neuroleptics had to be continued because of the delay in diagnosing the illness, which diminished the efficiency of the single chelating treatment. The clinical presentation and therapeutic response of this patient strongly suggest a link between the cerebral intoxication by copper and the psychiatric symptoms.
L'interaction mère-enfant et la genèse du soi chez le nourrisson*
Authors: Spooner Diane , Ricard Marcelle , Saucier Jean-Francois
Published: April 2017

The mother is the principal care-giving partner of the infant and an important source for the development of self-awareness and self-esteem. The importance of the early relational experiences of the nursing infant with its mother has been widely emphasized by the psychoanalytical approach. Through this special interaction with the parent, the infant gradually internalizes images leading to the individuated self and to self-love. The purpose of this paper is to present succinctly some of the broad theoretical positions regarding the forming of the self in the nursing infant, first within the “classical” psychoanalytical current, then under the impact of more recent research in experimental psychology which have given rise to new syntheses. Empirically, the capacity for self-recognition may be observed during early childhood by means of a child's reactions in front of the mirror; therefore, the work dealing with this phenomenon will be discussed briefly.
Misdirected Attachment Behaviour — An Unusual Outcome of Repeated Hospitalization?*
Authors: Evans Jane , Rowe Peter , Davidson Simon
Published: April 2017

This paper describes an infant with multiple congenital anomalies who developed an unusual reaction to recurrent hospitalization before age two. After spending much of her first year in hospital, she protested strongly whenever she left the hospital. We report the evolution and treatment of this patient's misdirected attachment behaviour.
Child and Adult Psychiatry: Comparison and Contrast*
Authors: Steinhauer Paul D. , Bradley Susan J. , Gauthier Yvon
Published: April 2017

Since its development from general psychiatry, child psychiatry has been influenced by its close involvements with the child guidance movement and pediatrics and by the age of its patient population. This has led it to evolve in ways quite distinct from adult psychiatry, so much so that at times the understanding and relationship between the two disciplines has been somewhat strained. This paper relates the development of child psychiatry to its history, its tasks and its patient population, highlighting some of the major differences between child and adult psychiatry. It then looks at why research in child psychiatry has lagged behind research in adult psychiatry. It concludes by discussing tensions between the two disciplines, and why it serves the interests of both professions as well as those of our patients, that a better understanding and collaboration between them be established.
Guidelines for the Evaluation and Management of Family Violence*
Authors: Bishop Joan , Patterson Paul G.R.
Published: April 2017

The following guidelines were approved by the Board of Directors of the Canadian Psychiatric Association on April 12, 1992.
Social Risk Factors for Borderline Personality Disorder: A Review and Hypothesis*
Authors: Paris Joel
Published: April 2017

A number of behaviours associated with borderline personality disorder (including attempted suicide, suicide, substance abuse, and antisocial behaviour) are on the increase among the young. The common factor in these disorders is impulsiveness. Evidence is reviewed suggesting that social disintegration reduces the threshold of impulsive behaviours. It is proposed that this is the mechanism through which social risk factors effect the prevalence and morbidity of borderline personality. A number of ways of testing this hypothesis are suggested.
Depression and Level of Functioning in Patients with Rheumatoid Arthritis*
Authors: Beckham Jean C. , D'amico Cynthia J. , Rice J. Russell , Jordan John S. , Divine George W. , Brook W. Blair
Published: April 2017

This study examined the degree to which depression is related to physical and psychosocial dysfunction. The Beck Depression Inventory and the Sickness Impact Profile were administered to 34 patients with rheumatoid arthritis. Information on the demographic variables (age and employment status) and medical status variables (duration of disease and functional classification) were collected for each patient. Regression analyses revealed that depression was an important predictor of total, physical and psychosocial sickness-related behavioural dysfunction. The proportion of variance attributed to depression was moderate to large and was significant even after controlling for important demographic and medical status variables. These results suggest that depression is an important factor to be considered when evaluating the clinical significance of physical and psychosocial dysfunction in patients with rheumatoid arthritis.
Adult Children of Alcoholics in Treatment Programs for Anxiety Disorders and Substance Abuse*
Authors: El-Guebaly Nady , Staley Douglas , Leckie Alison , Koensgen Stuart
Published: April 2017

Studies of the first-degree relatives of patients with alcoholism and anxiety disorders have identified a significant overlap of these disorders. Forty percent of the patients in an outpatient anxiety disorder program were adult children of alcoholics (ACOA), a proportion similar to that found in the substance abuse program. The ACOAs in both programs were younger, had higher co-dependency scores and were younger when they had their first psychiatric contact than the controls. The adult children of alcoholics who had anxiety disorders were more likely to be female and their alcoholic parents were less likely to have had psychiatric antecedents to alcoholism. Aside from substance abuse, similarities in socio-demographic variables and the impact of the parents' alcoholism were noted, reinforcing the hypothesis that vulnerabilities to anxiety disorders and alcoholism overlap.
Augmentation of Valproate with Lithium in a Case of Rapid Cycling Affective Disorder*
Authors: Sharma Verinder , Persad Emmanuel
Published: April 2017

Rapid cycling affective disorder is characteristically unresponsive to conventional interventions. In bipolar rapid cycling affective disorder, the manic episodes may be controlled with either neuroleptics or electroconvulsive therapy, but the depressive episodes are highly intractable. This report describes the successful treatment of a patient with a bipolar rapid cycling affective disorder using a combination of valproic acid and lithium carbonate.
The Assessment of Dimensions Relevant to Adult Reciprocal Attachment*
Authors: West Malcolm , Sheldon-Keller Adrienne
Published: April 2017

The development and potential clinical uses of the Adult Attachment Dimensions Questionnaire is described. The seven scales of the Adult Attachment Dimensions Questionnaire relate to the aspects of a relationship formed to promote and maintain security. The underlying theory is founded on John Bowlby's work on the attachment behavioural system. The empirical validation was accomplished through three studies involving a clinical group and a non clinical group in a hospital setting and respondents to a community survey. Psychometric validation included measures of internal reliability, test-retest reliability, and construct validity through factor analysis. The resultant 35 item questionnaire should be useful to both clinicians and researchers interested in the characterization of the attachment system for adults.
Un inventaire pour l'évaluation de la dangerosité des patients psychiatriques*
Authors: Millaud F. , Roy R. , Gendron P. , Aubut Et J.
Published: April 2017

Les auteurs proposent dans cet article un inventaire destiné à une évaluation systématisée de la dangerosité des patients psychiatriques. Cet outil est décrit comme qualitatif et individualisé; son utilisation est précisée dans la clinique psychiatrique et dans le contexte des questions de prédiction de comportements violents. Les perspectives de recherche qualitive et quantitative sont évoquées également.
Review of Studies of Risk and Protective Factors for Psychopathology in Children
Authors: Grizenko Natalie , Fisher Christina
Published: April 2017

Child psychiatry is increasingly focusing on early identification of children at risk and the importance of prevention. Our review attempts to summarize recent studies regarding risk and protective factors in children and address the areas of difficulty inherent in this type of research. Recommendations for future research study design will be discussed.
The Role of Stress in Interpreting the Dexamethasone Suppression Test
Authors: Blouin Jane , Spindler Eric , Perez Edgardo , Blouin Arthur , Hotz Steven , Hakkaku Joanne
Published: April 2017

Stress has been implicated as a major confounding factor in the interpretation of Dexamethasone Suppression Test (DST) results. This study was designed to examine the effects of stress on DST results. Fifty patients with high levels of acute, chronic, and environmental stress participated in the study. Each patient was given a comprehensive psychiatric and psychological assessment, a routine administration of dexamethasone, and blood tests of cortisol values. The results indicate that the three measures of stress do not appear to affect levels of cortisol suppression, however, all three measures of stress predicted depression. As expected, DST cortisol levels were related to depression. Results are discussed in terms of their implications for understanding the associations among stress, depression and DST results.
Successful Treatment of Litigious Paranoia with Pimozide
Authors: Ungvari Gabor S. , Hollokoi Rudolf I.M.
Published: April 2017

A case of querulous-litigious delusional disorder successfully treated with low-dose pimozide is reported. A summary of the contemporary literature on this neglected topic is provided.
Attaques de panique et troubles panique chez l'enfant
Authors: Vila G. , Mouren-Simeoni M.C.
Published: April 2017

Panic disorders in adults have been the object of many studies. They are better known in adolescents but have been noticed insufficiently in children although panic disorder is potentially dangerous at that age. After demographic considerations, the clinical aspects are examined and illustrated using two detailed observations.
Acute Psychosis Associated with Oral Trimethoprim-Sulfamethoxazole Therapy
Authors: Gregor James C. , Zilli Cheryl A. , Gotlib Ian H.
Published: April 2017

A 74 year old woman became progressively confused and developed visual hallucinations and delusions over a six day period, after the institution of routine oral trimethoprim-sulfamethoxazole therapy for a urinary tract infection. The medication was discontinued, and a marked improvement was noted 36 hours later. There was a complete return to normal mental functioning 60 hours after therapy was discontinued. The relationship between the patient's symptoms with the initiation and discontinuation of the medication suggests that the drug had a causal effect.
Possible Interaction between Fluoxetine and Pimozide Causing Sinus Bradycardia
Authors: Ahmed Iqbal , Dagincourt Paul G. , Miller Lawrence G. , Shader Richard I.
Published: April 2017

Fluoxetine has been reported to have interactions with antipsychotics and other antidepressants with symptoms of toxicity of these drugs. We report a case of a possible interaction with pimozide which led to a potentially life threatening bradycardia. Careful monitoring should be done when these two drugs are prescribed at the same time, especially in the elderly and inpatients with cardiac disease.
Chronic Schizophrenia and Idiopathic Parkinson's Disease
Authors: Lam Raymond W.
Published: April 2017

A case is reported of a patient with autopsy-confirmed idiopathic Parkinson's disease in addition to chronic paranoid schizophrenia. Difficulties in the diagnosis and management of these two conditions are described. Because of the treatment implications, clinicians should be aware that idiopathic Parkinson's disease and schizophrenia can coexist.
Training Psychiatric Residents to Work with Primary Care Physicians: Results of a National Survey
Authors: Kates Nick
Published: April 2017

To assess the preparation of residents in psychiatry for working with family physicians, a questionnaire was sent to the directors of Canada's 16 psychiatry residency programs. The results of the study are presented with recommendations for improving this aspect of training.
Comprehensive Community Care without Long Stay Beds in Mental Hospitals: Trends from an Italian Good Practice Area
Authors: Lesage Alain D. , Tansella Michele
Published: April 2017

Despite the scientific evidence that long stays in mental hospitals are clinically deleterious, inhumane and probably not cost-effective, this practice still occurs in most Western countries. The continued use of long stay beds in mental hospitals is a policy decided by many authorities, including psychiatrists. Alternatives to the mental hospital exist and may limit the use of hospital beds through comprehensive community care that also includes proper residential provisions. Alternatives may also decrease, but not impede the tendency to chronicity in some patients, who become long term users of these community services. Italy passed a law in 1978 prohibiting admissions to mental hospitals and encouraging the development of community care. In South Verona, Italy, the policy has been properly implemented and evaluated. Data from the case register and intensive studies of a cohort of patients will be used to show that long stay hospitalization can be discontinued while meeting the needs of the most severely handicapped patients. Implications of South Verona's experience for future training of psychiatrists will also be discussed.
Le développement de l'enfant: premières influences, premières étapes et les fondements de la psychothérapie
Authors: Gauthier Yvon
Published: April 2017

Recent research on child development and on infant-mother psychotherapy is reviewed. The problem of continuity or discontinuity of early patterns is thus brought out, as well as the possibility of change under the influence of environmental modifications or in psychotherapy. After briefly presenting the most often proposed mechanisms to explain change, the possibility is suggested that such change could be better conceptualized by using fundamental modes of development that can be particularly observed in mother-infant or parent-young child interaction.
The Hamilton (McMaster) Psychiatric Network: The Evolution of an Integrated Network of Psychiatric Services
Authors: Kates Nick , Adsett Alex , Bellissimo Tony , Levine Len , Humphrey Barrie
Published: April 2017

For 25 years, the Hamilton-Wentworth region has had a well integrated network of psychiatric services. The initial impetus for its establishment came from the founders of the Department of Psychiatry at McMaster University in 1967. They envisaged a regional network of services that integrated the resources of a community-focused university department with those of local community agencies and other mental health care professionals. Over the years, the evolution of the network has been shaped by changes in the size and composition of the faculty, the emergence of additional clinical services and community programs, new directions in the field of psychiatry and changing economic forces and social values.
Clinical Electroencephalography in a Psychiatric Service
Authors: Fenton George W. , Standage Kevin
Published: April 2017

An audit of the use of clinical electroencephalography in a psychiatric service was carried out by examining the referrals for an EEG from the service over one year (11% of all referrals), comparing them with matched patient controls, rating the EEGs blindly and estimating the clinical value of the investigation for each patient; 37% were abnormal, 19% anomalous and 44% normal. The following two clusters of symptoms and signs were associated with EEG referral — the patients with “organic” mental state phenomena and/or CNS signs; EEG usually abnormal and the patients with behavioural changes that raise the suspicion of an organic process but, taken alone, are not compelling evidence of such (for example, impulsive behaviour, acute and atypical psychoses, perceptual or behavioural phenomena of the type associated with temporal lobe epilepsy in the absence of frank complex partial seizures); EEG usually normal or anomalous. Ninety-two percent of EEGs were judged to be of clinical value; 53% positive and 39% negative. Eight percent of referrals made no contribution to the clinical evaluation.
Child Survivors of the Holocaust — Strategies of Adaptation
Authors: Krell Robert
Published: April 2017

Child survivors have only recently been recognized as a developmentally distinct group with psychological experiences different from older survivors. The wartime circumstances of Nazi persecution caused enforced separation from family and friends, and all the survivors experienced persecution in the form of physical and emotional abuse, starvation and degradation, and were witnesses to cruelty. This paper is based on information from interviews and therapy with 25 child survivors, the majority of whom were not patients. Coping strategies are discussed in terms of their survival value in wartime and post-war adaptive value. Three themes which reverberate throughout the lives of child survivors, now adults, are discussed in greater detail: bereavement, memory and intellect. The fact that the majority of child survivors live normal and creative lives provides an opportunity to learn what factors have served them over 40 years, to provide the resilience and strength to cope after such a shattering beginning.
Measuring Self-Perceived Role Competence among First Nations and Non Native Children
Authors: Beiser Morton , Lancee William , Gotowiec Andrew , Sack William , Redshirt Roy
Published: April 2017

The objective of this research is to develop and test measures of self-perceived academic and social competence among First Nations and non native children. The method used is the analysis of psychometric properties of scales derived from questionnaires administered to First Nations children four culture areas of North America, as well as comparison samples of non native children. The results consist of the reliability coefficients, which fall into a satisfactory range; an internal consistency which increases with age; an agreement between self- and teacher-rated competence which is higher for non native than for native children. In the second grade, the competence scores of the native and non native children were equal. Thereafter, the scores of the native children either declined or remained static, while the non native scores tended to increase. In conclusion, the Flower of Two Soils scales are suitable for children from elementary schools, from First Nations and the majority culture. As children mature, the assessments of competence become an increasingly stable part of their repertoire of self-percepts; asynchronous socialization may adversely affect self-perceived competence.
A Comparison of Day Treatment and Outpatient Treatment for Children with Disruptive Behaviour Problems
Authors: Grizenko Natalie , Papineau Danielle , Sayegh Liliane
Published: April 2017

The authors explored the relative merits of outpatient and day treatment for 30 children with severe behaviour problems. The effectiveness of treatment on behaviour, self-perception, and social and family functioning was assessed. Day treatment was found to be more effective in reducing behaviour problems, alleviating depressive symptoms, increasing social skills and improving family functioning.
Pharmacotherapy of Attention-Deficit Hyperactivity Disorder
Authors: Simeon Jovan G. , Wiggins Doreen M.
Published: April 2017

Attention-deficit hyperactivity disorder, characterized by poor sustained attention, diminished impulse control and excessive physical activity, is found in most cultures and most countries. However, diagnostic terminology and management vary from centre to centre. Pharmacotherapy in conjunction with individual and family therapy is generally accepted as the most effective treatment, while psychostimulants are the drug of choice. The results of clinical studies with indications, contraindications and side-effects are reviewed. The use of alternative pharmacotherapy for those who do not respond to treatment and long term therapy is discussed. The need for careful diagnosis and patient management is emphasized.
The Wing of Madness: The Illness of Vincent van Gogh
Authors: Morrant J.C.A.
Published: April 2017

This paper briefly describes some aspects of Vincent van Gogh's life and attitudes. It discusses absinthe and several psychodynamic factors that may have contributed to his psychotic episodes at Aries, when he cut off his ear. It discusses Vincent's descriptions of his illness, especially at Saint Rémy de Provence and concludes that he probably suffered from partial complex seizures (temporal lobe epilepsy) with manic depressive mood swings aggravated by absinthe, brandy, nicotine and turpentine.
Le consentement éclairé: un atout pour la psychothérapie?
Authors: Marta Jan , Lowy Frederick H.
Published: April 2017

Is it desirable to extend the practice of explicit informed consent to psychotherapy? Is it possible? How? This article offers preliminary answers to these questions following a literature review and reflection on the theory of informed consent and psychotherapy. It explores the advantages and the possibility of using explicit informed consent in place of the implicit consent obtained currently. Explicit consent for psychotherapy would be interactive, iterative, repeated and revocable. It would take into account specific characteristics of psychotherapy, such as the fact that it is a process rather than a procedure, its relative unpredictability, the active part the patient plays in treatment, and the importance of the unconscious, transference and counter-transference. It would have the advantages of respecting the patients’ autonomy without sacrificing their well-being, of having meaning not only for medico-legal protocols but for the patient, and would improve satisfaction with and the efficacy of psychotherapy as a treatment modality. The proposed model provides direction for future research, both empirical and theoretical.
Homicide Followed by Suicide: A Quebec Case Series, 1988–1990
Authors: Buteau Jacques , Lesage Alain D. , Kiely Margaret C.
Published: April 2017

Homicide followed by suicide is a rare but tragic event. Psychiatrists and mental health professionals are often called upon to comment publicly on the event or to help the “hidden victims,” the survivors of the tragedy. There were 39 such cases in Quebec between 1988 and 1990, and they have been reviewed through the examination of the coroner's files. The epidemiological rates of homicide, suicide, homicide-suicide and the sociodemographic and clinical characteristics of the perpetrators and victims are presented and compared with the international literature. Sociological and psychopathological hypotheses are presented with a special reference to the possibility of various subgroups of perpetrators. Research needs to be pursued along the lines of more detailed case studies of psychopathological characteristics using the psychological autopsy approach. The reconstruction of the couple's relationship and of the final circumstances leading up to the tragedy may provide warning indices that could be helpful in preventing such tragedies.
Complex Visual Hallucinations in Macular Degeneration
Authors: Lalla Daniel , Primeau François
Published: April 2017

A previously healthy elderly patient with a recent onset of macular degeneration presented for evaluation of elaborate complex visual hallucinations. The patient's psychiatric evaluation and level of cognitive functioning were normal. A diagnosis of organic hallucinosis secondary to macular degeneration was made, and the hallucinations ceased with increased sensory stimulation in the hospital. Numerous diagnoses were considered and are discussed, including Charles Bonnet hallucinations and peduncular hallucinosis.
Misdiagnosis of Bipolar Affective Disorder as Personality Disorder
Authors: Tyrer Stephen P. , Brittlebank Andrew D.
Published: April 2017

Patients with longstanding recurrent behavioural disturbance, unstable interpersonal relationships and periodic affective symptoms are often diagnosed as having a cluster B personality disturbance using DSM-III-R criteria. Two women are described who were diagnosed as having a personality disorder on several admissions to hospital, but in whom closer inquiry revealed evidence of bipolar affective disorder. Since treatment with lithium and adjunctive mood-stabilizing drugs neither patient has required further admissions to hospital within the past five years.
Survey of Community Adjustment of Previously Institutionalized Developmentally Disabled Persons
Authors: Fotheringham John B. , Abdo Karim , Ouellette-Kuntz Hélène , Wolfgarth Art
Published: April 2017

A survey was conducted of the community adjustment of 108 developmentally disabled (mentally retarded) persons who had spent at least three years in an institution in southeastern Ontario. On average, they had resided 3.5 years in the community, were 40 years of age, with a mental age of five years and a median IQ of 41, and most had one or more moderate to severe physical disabilities. During their most recent year living in the community it was found that their daily living skills remained unchanged compared with their skill level in the year prior to community placement. As well, the community staff rated them as average in level of performance and amount of supervision required compared with others of similar ability. About one third were found to have a moderate to severe behavioural/psychiatric problem with aggressive disruptive behaviour being most frequent. Of the two-thirds capable of being interviewed, over three-quarters expressed satisfaction with their present living, work, education and recreation environment and had no desire to return to the institution. Most had few if any meaningful relationships with non developmentally disabled persons other than caregivers. Support agency staff and psychiatric consultants identified additional service needs for those with behavioural/psychiatric problems who may be placed in the community.
The Need for Research and Ethical Safeguards in Special Populations
Authors: Milliken A. Donald
Published: April 2017

This paper was prepared for the Council on Professional Standards and Practice. It was approved by the Board of the Canadian Psychiatric Association on April 3, 1993.
Therapeutic Efficacy of Specific Serotonin Reuptake Inhibitors (SSRIs) in Dysthymia
Authors: Ravindran A.V. , Bialik R.J. , Lapierre Y.D.
Published: April 2017

Pharmacological treatment of dysthymia is a contentious issue mainly because of the traditional view that this disorder has characterological origins and responds to psychotherapy. However, Akiskal's subtyping of primary dysthymia, which was based in part on its response to older antidepressants, can assist in the prediction of responses to antidepressants. Specific serotonin reuptake inhibitors (SSRIs) have equal efficacy but fewer adverse effects and greater tolerability than older antidepressants. Therefore, SSRIs appear to be a viable treatment option for these patients although there are few documented systematic studies of the use of these agents in primary dysthymia. An open study was conducted to determine the efficacy of fluoxetine in primary dysthymia (DSM-IH-R and Akiskal's criteria). A good response was observed in the subaffective subtype but not in the character spectrum group. Overall, the antidepressant was tolerated well, with significant adverse effects reported and responders showing reductions in both depressive and anxious symptoms. These initial findings indicate a potential role for SSRIs in the pharmacotherapy of dysthymia.
Syndrome de personnalité organique dans la sclérose en plaque et influence du stress sur les poussées
Authors: Stip Emmanuel , Truelle Jean-Luc
Published: April 2017

This study focuses on a sample of 35 patients who had recently suffered an attack of multiple sclerosis. They were first subjected to the so-called life stress method in order to look for a connection between life stresses and the attacks of multiple sclerosis. The sample was compared with a paired control population composed of patients recruited from admission departments and medical emergency departments. The AMDP psychopathological evaluation method was applied to the sample, to establish a characteristic mental profile of these patients.

Three types of results are highlighted. First, the comparison of the event scores shows a significant difference between the population of patients suffering from an outbreak of multiple sclerosis and the control population. A connection between “life stresses” and the triggering of the outbreaks of multiple sclerosis is therefore mentioned and discussed. Second, the application of the system of the Association de méthodologie et de documentation psychiatrique brings out a mental profile common to patients suffering from multiple sclerosis, consisting of a very specific association of mood disorders: dysphoria, euphoria and mania on the one hand, and depression, anxiety and dramatization on the other, with relative anosognosia. The correlation between dysphoria, the syndrome's principal characteristic, and the event score adds another argument in favour of the connection between life stresses and the evolution of the disease. The main components of this mental profile are primarily correlated with the existence of a neuropsychology suggestive of a medial basal frontal syndrome. These mental disorders, which compose a relatively characteristic profile of multiple sclerosis, are therefore probably related, not to psychological phenomena but, essentially, to the brain lesions of the disease. A final behavioural characteristic, common to the different patients of this population, is the unawareness of a possible relationship between life events and the disease, very similar to what is described in “operational thinking”, a symptom which is part of the classic symptomatology of psychosomatic disorders.
Validation d'une échelle d'attitudes alimentaires auprès d'une population québécoise francophone
Authors: Leichner Pierre , Steiger Howard , Puentes-Neuman Guadalupe , Perreault Michel , Gottheil Neil
Published: April 2017

The Eating Attitudes Test (EAT-26) is one of the most frequently used screening questionnaires for anorexia and bulimia nervosa for use with clinical and general populations. Although the psychometric qualities of the instrument have been reported for the English version, little has been done to date to validate a French version. A french version of the EAT-26 was distributed to anglophone students and francophone students, as well as anglophone and francophone patients.

Overall, the results demonstrated that the authors' French version has the same psychometric characteristics as the English version when used with clinical and non clinical populations. The overall test and its subscales differentiated between patients and non patients similarly in both linguistic groups. The internal consistency of the two versions, as assessed by Cronbach's alpha, was comparable. Among female high-school students, 14.1% of the anglophone students and 14.3% of the francophone students scored above the cutoff score for significant eating disorders behaviour.
Case Report of a Person with Down's Syndrome and Multiple Personality Disorder
Authors: Fotheringham John B. , Thompson Freda
Published: April 2017

A case is presented of an individual with Down's syndrome and multiple personality disorder. No such cases were found in a review of the literature. Three other individuals with Down's syndrome are also discussed whose symptoms range from experiencing imaginary friends to experiencing borderline multiple personality disorder. In all these cases the imaginary friends became more evident and resistive of diversion as the levels of stress increased. We speculate that experiencing imaginary friends progresses to experiencing multiple personality disorder in some individuals as personal stress increases. These cases also indicate that limited cognitive development does not preclude individuals from presenting with imaginary friends or multiple personality disorder.
An Evaluation of Legal Outcome following Pretrial Forensic Assessment
Authors: Arboleda-Flórez J. , Holley H.L. , Williams J. , Crisanti A.
Published: April 2017

This paper constitutes the first stage of data analysis in a larger controlled study designed to assess the effect of a forensic psychiatric assessment on legal disposition defined in three ways: 1. the number of days spent in custody prior to trial; 2. the number of sentenced days of incarceration; and 3. the conviction rate. A historical cohort design was used to follow two cohorts of individuals remanded, pretrial, to Southern Alberta Provincial Correctional Centres between 1988 and 1989. The study cohort consisted of all offenders detained who received a forensic psychiatric assessment. The comparison cohort consisted of a random sample of persons detained who did not undergo a forensic assessment. Because of small numbers, individuals below the age of 18 and women were excluded from study. This paper compares socio-legal characteristics of study and comparison subjects in order to better understand forensic psychiatric referral patterns and identify potentially confounding factors that would need to be controlled in subsequent analyses of legal outcomes. No differences were noted with respect to educational level but forensic subjects were found to be slightly older (average of 31 years compared to 29 years). Aboriginal peoples (Native Indian, Inuit and Metis) were three times more common among non-forensic offenders. Forensic patients were more likely to have had a prior forensic assessment but less likely to have a prior criminal detention. In addition, forensic patients were three times more likely to be charged with a crime against a person and counted more offenses in the target episode than comparison subjects. The under-representation of Aboriginal peoples in the forensic cohort is discussed in light of the knowledge that mental illnesses are over-represented among native peoples and Aboriginal peoples are over-represented among criminal populations. The next phase of the analysis will compare legal outcomes controlling for differences in age, ethnicity, prior forensic assessments, prior detentions and violent index crimes.
Présentation d'un cas: l'encéphalopathie des boxeurs
Authors: Rochon Michelle
Published: April 2017

A 68-year-old man presents slight memory problems and behavioural change over a period of a year. A history of boxing is identified. Neuropsychological examination confirms slight frontal cognitive damage and damage at the level of the motor signs of the upper left hemicorpus. This symptomatology should, in differential diagnosis, raise the possibility of chronic punch-drunk syndrome. Further studies should be done to better document this little-characterized clinical entity and arrive at a clearer definition of this syndrome.
Shoplifting and Mental Illness
Authors: Lamontagne Yves , Carpentier Normand , Hetu Céline , Lacerte-Lamontagne Céline
Published: April 2017

A survey of 1,649 shoplifting convictions at a Montreal area municipal court found that a relatively low percentage (3.2%) of the cases involved mentally ill patients and that there is a comparatively closer link between shoplifting and affective disorders, alcoholism and drug addiction. The survey also showed that shoplifting is related more to mental illness than to the use of psychotropic drugs. The authors therefore reject the hypothesis of pharmacogenic shoplifting which has been reported in some studies on small numbers of shoplifters.
I: Models and Guiding Principles
Authors: Minde K.
Published: April 2017

This article reviews some concepts the author believes will guide scientific and clinical work in child psychiatry during the next 25 years. Specifically, it is postulated that the traditional biopsychosocial model may have to be expanded to look at ways we can understand transactional events versus nonshared family characteristics, the development of internal representations and risk factors versus risk carriers.
Psychiatric Disorders of Children “in Care”: Methodology and Demographic Correlates
Authors: Stein Eleanor , Rae-Grant Naomi , Ackland Susan , Avison William
Published: April 2017

This paper examines psychiatric symptoms and disorders in children in the care of a Children's Aid Society. Youth, caretaker and teacher scores on the Standardized Clinical Information System questionnaire were correlated with demographic and maltreatment data gathered from the files of children from a Children's Aid Society. Mean externalizing and internalizing scores for the study group were significantly elevated above the norm on the youth, caretaker and teacher reports; externalizing more so than internalizing. Forty-one percent to 63% of the children studied scored in the pathological range for one or more disorders. Conduct disorder was the most common disorder (30% to 50%). Within the study sample, temporary wards and children with a history of having been abused had more elevated scores. The authors conclude that children in foster care have significant psychiatric morbidity reflective of the extreme adversity and maltreatment they have experienced.
Factors Associated with Dropout from Group Psychotherapy with Depressed Adolescents
Authors: Gilbert Merv , Fine Stuart , Haley Glenn
Published: April 2017

Attempts to determine the characteristics of those individuals who drop out from psychotherapy have yielded few consistent findings. Clinically depressed adolescents who completed a course of brief group therapy were compared with those who failed to complete treatment. Although no differences were found on a number of clinical and demographic variables, those who dropped out were more likely to be one grade behind in school and to have a history of alcohol and/or drug abuse. The implications of these findings for research and practice are discussed.