bluuebunny/crossref_metadata_2025 huggingface dataset:
The Assessment of Deviant Sexual Arousal as a Function of Intelligence, Instructional Set and Alcohol Ingestion
Authors: Wormith J.S. , Bradford J.M.W. , Pawlak A. , Borzecki M. , Zohar A.
Published: April 2017

Sexual offenders who had been referred for a forensic evaluation were assessed in terms of their deviant sexual arousal by means of standard penile plethysmographic procedures. The sample was divided into Rapist and Nonrapist groups according to their sexual history and criminal charges. Penile circumference responses (PCR) and self-reported arousal to consenting sex, sexual assault, and physical assault were monitored. The assessments were repeated following subject instructions to suppress their arousal and following the ingestion of alcohol. The overall correlation between PCR and self-reported arousal was .65. An Alcohol-by-Offender Type interaction revealed that the lowering effect of alcohol on PCR occurred only among the Nonrapists. The suppression instruction increased Rapists' PCRs to Rape and Physical Assault presentations relative to consenting sexual narrations. When the data were examined in relation to intelligence, low IQ Rapists displayed greater responses to rape than high IQ Rapists. Under the influence of alcohol, low IQ Rapists displayed greater arousal regardless of the stimulus, while high IQ Rapists showed no change, and Nonrapists responded less than they did without alcohol. Comments concerning the accurate assessment of deviant sexual arousal and the identification of precursors to deviant sexual behaviour are made in view of the current findings.
Pathological Habit Disorder?
Authors: Matthews Peter C.
Published: April 2017

This paper outlines a diagnostic entity called ‘Pathological Habit Disorder’ which is suggested for inclusion in the DSM as an Axis II option. Specific areas of concern, either mental (Axis I) or physical (Axis III), would delineate the syndrome. Pathological Habit Disorder (PHD) points to treatment options where the syndrome is wholly or partly habit-driven. Whether the syndrome is habit-driven or not will remain a clinical judgement even though many conditions, previously thought immutable except by medication, are proving accessible to behavioural engineering. In the ICD system, PHD seems to fit in “Special Symptoms or Syndromes not elsewhere Classified”.

It is demonstrably useful to have a diagnosis such as PHD and to incorporate it into the body of medical classification, recognizing current practices for dealing with unwelcome or damaging habits.
Chronic Pain Patients with and without Alexithymia*
Authors: Chaturvedi Santosh K.
Published: April 2017

Chronic pain patients with and without alexithymia have been compared, but no differences were observed as regards demographic variables or pain characteristics. More alexithymic patients had associated physical illness and this was significantly (P < 0.05) different from the control groups. Psychiatric diagnosis was ascribed to only three alexithymic pain patients. It is likely that verbal inexpressivity interferes with the emergence of psychopathology. Lower level of psychopathology could be due to the marked alexithymia in the pain patients of the study group.
The 40 Year Evolution of the First Modern Day Hospital
Authors: Goldman David L.
Published: April 2017

The first modern psychiatric day hospital founded over 40 years ago has gone through a number of re-organizations which reflect utilization patterns representative of day hospitals in general. The author traces chronologically the dynamic movement from self-contained settings emphasizing group integration to expanded structures providing individualized treatment approaches. The day hospital's unique location at the interface of the institution and the community has important implications for today's mental health policy.
Psychiatric Admission of Mentally Ill Mothers with their Infants
Authors: Stewart D.E.
Published: April 2017

There is a greatly increased risk of a woman developing a psychiatric illness requiring hospital admission during the early postpartum period. Admission of the mother has usually meant separating her from her infant at a time when bonding and attachment are developing. Nearly 40 years ago English psychiatrists began admitting infants with their mentally ill mothers, and although the theoretical basis for this is sound, there are few systematic studies of the practical problems encountered, or the outcomes.

This paper compares a group of 32 psychiatrically ill postpartum women who were admitted to a Canadian general hospital psychiatric unit with their infants to a group of 26 psychiatrically ill postpartum women hospitalized on the same unit who refused admission of their infants.

The women admitted with their infants were more likely to be older, living with the infants' father, in a stable residence and job, in hospital for a longer time, and caring for their babies at 2 year follow-up in contrast to the women who were admitted without their infants. The two groups were diagnostically different with joint admission mothers likely to suffer from an affective psychotic illness, while the mothers without infants were more likely to suffer from personality disorder or substance abuse. The effects of mother-infant admission and some of the practical problems encountered are discussed.
Family Background and Physical Health of Adolescents Admitted to an Inpatient Psychiatric Unit, II: Physical Health
Authors: Swart G.T. , Merskey Helen S.
Published: April 2017

The charts of 100 adolescents admitted to a special unit of a provincial psychiatric hospital were reviewed. These patients primarily had a conduct disorder (71.6% of boys and 77.5% of girls) or an affective disorder (6.6% of boys, 15.0% of girls). There was a higher incidence of congenital disorders in the population than expected, suggesting that such disorders may predispose to psychological troubles later in life. Convulsions also occurred more often in this population.

Most patients (78.3% of boys and 85.0% of girls) had one or more medical diagnoses. Several potentially serious findings (anemia, pregnancy, hepatomegaly, thyroiditis) were first noted on the admission physical examination. Patients with conduct disorder had certain health problems that are likely to be the result of the psychiatric disorder, such as liver function changes in drug and alcohol abusers and abnormal Pap smears in sexually active girls with multiple partners. If these medical conditions are not followed and treated, they have the potential for causing serious problems at a later date. These findings point out the continued need for the expertise of psychiatrists and other physicians in children's mental health facilities.
Biologic Markers and Bipolar Disease in Children
Authors: Woodside Blake , Zilli Cheryl , Fisman Sandra
Published: April 2017

The diagnosis of manic depressive or bipolar disease is difficult in adolescents. Poorly defined nosology, and a high incidence of schizophrenia-like symptoms contribute to this difficulty. The authors discuss the use of the Dexamethasone Suppression Test (DST) in the diagnosis of bipolar disease in adolescents, presenting three case studies. The existence of phase-dependent DST non-suppression is described for the first time in adolescents.
Rebound Psychoses following the Discontinuation of a High Potency Neuroleptic
Authors: Kahne G.J.
Published: April 2017

Increased familiarity with the effects of psychotropic medications has led to modifications in both prescribing habits and length of treatment. The case of a 34 year old woman is presented, in whom the return of psychotic symptoms following the discontinuation of neuroleptic medications is attributed to a rebound phenomena as opposed to a relapse of an underlying chronic illness. The author cites parallel situations previously described in the medical literature and outlines a conceptual framework for the understanding of this phenomenon.
Kurt Schneider's Concepts of Psychopathy and Schizophrenia: A Review of the English Literature
Authors: Crowhurst Brenton , Coles E.M.
Published: April 2017

A conceptual review of Schneider's concepts of psychopathy and the first rank symptoms of schizophrenia, and a critical review of the English research literature relating thereto. It is concluded that some of the criticism of Schneider's concepts is to be attributed to a misunderstanding of what he actually meant.
Family Therapy: Critique from a Feminist Perspective
Authors: Penfold P. Susan
Published: April 2017

Family therapy is a powerful modality which, all too often, is used without awareness of its possible constricting, or even crippling, effects. Textbooks and articles about family therapy focus soley or mainly on the family system alone, thus obscuring the influence of school, workplace, neighborhood, peer group, class, race and sex. Theorists, who are predominantly male, have developed rigid and mechanical concepts which encourage formulations encompassing the family system alone. Power inequalities between men and women are ignored and socially programmed sex roles are reflected and reinforced by theory and practice.

Thus family therapy may function to locate and contain, within the family, difficulties and distress derived from stresses outside the family. The negative effects of traditional sex roles on emotional growth, sexuality and the development of mutually gratifying male-female relationships are never dealt with. As a result, family therapy may contribute to men's straitjacketing and women's oppression.

To fulfill its promise, family therapy research and teaching must move beyond shortsighted and narrowly conceptualized theories which could damage, rather than heal, families who are suffering.
Psychiatry and Chronic Pain
Authors: Merskey H.
Published: April 2017

Pain and chronic pain have been defined by the International Association for the Study of Pain. Psychological mechanisms are recognized in the production of pain, but their importance has probably been overstated. Selection factors have not been attended to sufficiently, and traditional methods which have been relied upon for the diagnosis of hysterical pain have been misleading. Much emotional change seen with pain is a consequence of the physical disorder. Types of illness, seen by psychiatrists working with patients in pain, are described, and brief comments offered on their management.
Assaultive Behaviour: Before it Happens…
Authors: Durivage Antoine
Published: April 2017

This paper reviews risk factors associated with assaultive behaviour. The author will look at specific risk factors to evaluate when assessing patients with an aggressive potential and he will examine patient-staff relationships that might trigger assaultive behaviour. The author believes that a better knowledge of risk factors allows us to develop preventive attitudes, and these will be discussed in the latter part of this paper.
Active Drug Placebo Trial of Methylphenidate — A Clinical Service for Children with an Attention Deficit Disorder
Authors: Fine Stuart , Jewesson Barbara
Published: April 2017

A clinical trial of methylphenidate/placebo on 39 patients is described. Fifteen of 20 parents not keen to give their child methylphenidate did give it, after the trial had shown it was effective. Five out of 19 parents keen to give their child methylphenidate were persuaded not to after it was shown that it was ineffective. Some of the difficulties with the trial are described for example, parents confusing the days the drug is to be given, parents and teachers not filling in the questionnaires and the resistance of certain professionals to giving medication. Patients seem to be more accepting of recommendations to give medication or not, after a medication/placebo trial demonstrated efficacy or lack of efficacy.
Summary of Selected Results
Authors: Offord David R. , Boyle Michael H. , Fleming Jan E. , Blum Heather Munroe , Rae Grant Naomi I.
Published: April 2017

Selected results from the Ontario Child Health Study (OCHS), a cross-sectional community survey of Ontario children four to 16 years of age, are presented in the areas of prevalence, risk indicators and service utilization.

The six month prevalence of one or more of four psychiatric disorders (conduct disorder, hyperactivity, emotional disorder, and somatization), in children four to 16 years of age, in Ontario was 18.1%. The highest rate was in 12 to 16 year old girls, and the lowest rate in four to 11 year old girls. Co-morbidity among these four disorders was high while the proportion of disorders identified by more than one respondent was low. Psychiatric disorders co-occurred significantly with other morbidities in children, including poor school performance, chronic health problems, substance use and suicidal behaviour. Chronic medical illness in the child as well as single parent status, living in a family on social assistance and residing in subsidized housing, were all strong indicators of increased rates of psychiatric disorders in children. Specialized mental health/social services, over a six month period, reached fewer than one of five children with psychiatric disorders, as measured in the study. In contrast, ambulatory medical care (primarily visits to family doctors and pediatricians) served almost 60% of Ontario children four to 16 years old, over the same six month period. The results are compared with those in the literature.
Adaption of Recent Soviet Jewish Immigrants and their Children to Toronto
Authors: Barankin Tatyana , Konstantareas M. Mary , De Bosset Farideh
Published: April 2017

This retrospective study examined the prevalence of depression and psychosomatic disorders among Soviet Jewish immigrants, and how such problems might have affected their children's adaptation. A 36-item English and Russian questionnaire was sent to 452 Soviet Jewish immigrants, requesting information on possible problems they or their children had had during the first three years after immigration. Ninety people responded, 78% of whom had children. Immigrants with depression and psychosomatic illness reported greater behaviour, academic, peer interaction, and child-parent difficulties in their children. Those who were married, were proficient in English, were professionals in the USSR and/or Canada and who had supportive friends, were more likely to adapt well. Because of the low response rate, the failure to validate the questionnaire, and the possible overrepresentation of professionals the findings are presented as preliminary pending further exploration. They are discussed for their relevance to the early identification of difficulties in immigrants and their children, and to the need for timely and informed intervention.
Teenage Mothers and Their Children: Risks and Problems: A Review
Authors: Hechtman Lily
Published: April 2017

Adolescent mothers and their offspring are a high risk group broth physically and emotionally. Poverty, malnutrition, complications of pregnancy, emotional problems such as depression, drug and alcohol use, are all risks for the mother. Children are also at greater risk for physical, cognitive and emotional problems.

It is therefore important to identify factors which influence outcome on adolescent mothers and their children in order to suggest interventions which will more positively affect the physical and psychological health of this increasing population.
The Development of Defenses in Childhood
Authors: Schibuk Margaret , Bond Michael , Bouffard Rachelle
Published: April 2017

The authors review empirical studies of defense mechanisms and suggest that this concept can be operationalized to permit an investigation of the chronology of the development of defense in childhood. Studies on the coping and defense patterns of normal children are compared with studies that attempt to explain defense patterns in disturbed children and adults. It is argued that empirical study of the development of defense in the normal child will help to determine the validity of theoretical psychoanalytic speculations derived from the retrospective reconstruction of defenses that might have existed in the childhood of ill adults. An attempt is made to place our knowledge of the development of defense in childhood into the context of our knowledge of cognitive development. The authors review the research that attempts direct empirical assessment of defenses in childhood, and make suggestions for how such research could be furthered. It is argued that it may be possible to construct a schedule for the early maturation of defense, and to identify how this changes with pathology, gender, and family context. Such a schedule would be fundamental to our understanding of normality, and the role of regression and precocity in pathology.
Étude des facteurs de prédiction de l'ajustement à l'hémodialyse chronique: revue de littérature et orientations futures*
Authors: Caron Chantal
Published: April 2017

Little is yet known about predictive factors of adjustment to hemodialysis. This paper reports on a review of 45 articles published between 1966 and 1986, and focused on three issues: (1) the definition of the adjustment to chronic hemodialysis according to compliance, social and vocational rehabilitation and psychological adjustment; (2) the way adjustment is objectively and subjectively evaluated; (3) the predictive factors of a good adjustment to hemodialysis which are: an internal locus of control, defense mechanisms such as denial, repression and projection, and family factors as a good parental relationship and optimistic and positive interactions. Demographic factors (age, sex, education, IQ) are not found to be associated with adjustment. In conclusion, the author derives from the literature four specific landmarks for future research.
Examining the Needs of Youth in Secure Custody: Why We Need to “Recreate the Wheel” in Canadian Juvenile Justice*
Authors: Leschied Alan W. , Thomas Ken E.
Published: April 2017

The current study reviews the personal characteristics of 32 consecutive admissions to a secure custody centre in one southwest Ontario jurisdiction under the Young Offenders Act. Results indicated that there was considerable variability amongst the group regarding court history and the seriousness of the charge on which committal was made. Background history data suggested that the problems of youths committed to secure custody reflect considerable difficulties within families and school. The discussion questions whether the youths in this group are better served through the dispositions emphasizing custody-deterrence or rehabilitation-treatment. Implications for young offender policy are also presented.
EEG Mapping Applications in Psychiatric Disorders*
Authors: Williamson P.C. , Kaye H.
Published: April 2017

A number of techniques have been developed for EEG mapping in recent years. The clinical and research applications of these techniques in psychiatry are reviewed with regard to schizophrenia, affective disorders, learning disorders, dementia, psychopharmacology and ruling out neurological disorders. Limitations and advantages of EEG mapping as well as its relation to other imaging techniques are discussed.
Trichotillomania in a Ten Year Old Boy: Gender Identity Issues Formulated in Terms of Individual and Family Factors*
Authors: Schnurr R.G. , Davidson S.
Published: April 2017

The case study of a ten year old boy who presented with trichotillomania and symptoms of gender identity confusion is described and formulated in terms of the individual and family factors involved. This approach is presented as more tangible and useful than the traditional method using psychoanalytic theory.
Benzodiazepines and Catatonia: A Case Report*
Authors: Harris Dale , Menza Matthew A.
Published: April 2017

The case history of a patient with presumed psychogenic catatonia who responded dramatically to two mg of IM lorazepam is presented. This patient, who had been largely mute and immobile for over a week despite neuroleptic therapy, became freely conversant and mobile within 30 minutes of the administration of lorazepam. This response was repeated the next day after the patient had again become mute and immobile. Catatonia and its diverse etiologies are discussed, with an emphasis on its syndromic nature. The literature on the response of catatonia to the benzodiazepines is reviewed and it is suggested that a trial of benzodiazepines may be helpful in both the evaluation and long term management of patients with catatonia.
Psychoanalytic Contributions to Psychotherapy: Clinical Empathy
Authors: Berger David M.
Published: April 2017

The concept of empathy has become a central issue in the debate between classical psychoanalysts and self psychologists. If one recognizes that dilemma is central to the human condition and that the two competing schools of psychoanalysis emphasize opposite sides of several parameters that are fraught with dilemma, it is possible to view them both as empathic. Three levels of empathy are discussed: empathizing with the patient's story as it stands; discovering new themes hidden away in the patient's narrative; and discovering significant patterns in the patient-therapist relationship itself. The concept of therapy as a self-correcting process that approaches but never quite attains objective accuracy is emphasized.
Differentiation between Schizoid and Avoidant Personalities: An Empirical Test*
Authors: Overholser James C.
Published: April 2017

A number of authors have questioned the rationale for subdividing the DSM-II schizoid diagnosis into three separate personality disorders in DSM-III, the schizoid, avoidant, and schizotypal. The present study was designed to explore differences between psychiatric patients with schizoid and avoidant personalities as compared to psychiatric controls with no personality disorder. Differences were examined on demographic data, self-report measures, and clinical information. A Multivariate Analysis of Variance (MANOVA) revealed a significant overall effect for groups across MMPI subscales. However, subsequent univariate Analyses of Variance (ANOVA's) revealed that almost all differences were between the two personality disorder groups as compared to the psychiatric controls. Contrary to expectations, schizoid and avoidant personalities were found to display equivalent levels of anxiety, depression, and psychotic tendencies as compared to psychiatric control patients. No meaningful distinctions were found between the avoidant and the schizoid personalities. Results are discussed in terms of problems with the assessment methods and the diagnostic criteria.
Methylphenidate Treatment of Bulimia Nervosa after Surgery*
Authors: Messner Edward
Published: April 2017

Methylphenidate (MPT) was prescribed four days after an uncomplicated appendectomy in a 27 year old woman who had suffered from bulimia nervosa (BN) for at least nine years. Before the onset of appendicitis, her bingeing and self-induced vomiting had occurred several times daily. With MPT the patient reported a calm emotional state and an absence of temptation to binge or to induce vomiting. Previously published reports of treatment of BN with MPT could not be found. This may be the first. Vulnerability to surgical disorders and to postoperative complications as well as the safety and efficacy of MPT in patients suffering from BN deserve further study.
Development of Sexuality in Female Children and Adolescents*
Authors: Whitfield Margaret
Published: April 2017

Female sexuality (meaning sexual desire, excitement and orgasm) has been of considerable interest in psychiatry. Women's efforts to define and legitimize their own experience of their sexuality have increased in the past 25 years. However, the integration of these new views into the body of psychiatric (especially psychoanalytic) theory has not occurred very actively or successfully. Very little is known about the development of sexuality in childhood and adolescence. This paper looks at various behaviours, interests and events in women's lives that might reveal something about the development of their sexuality. The literature on female masturbation is reviewed and some sex differences highlighted. The literature on interest in babies, the wish to have babies, and menarche is explored for possible associations with sexuality. Rather than sexuality being a central organizer of experience, it seems quite possible that experience is an organizer of sexuality. Therefore, to better understand female sexuality we need to consider the impact of experiences during childhood and adolescence.
Four Cases of Progressive Supranuclear Palsy in Patients Exposed to Organic Solvents*
Authors: Mccrank E. , Rabheru K.
Published: April 2017

Four cases are described in which Progressive Supranuclear Palsy (PSP) is associated with the use of organic solvents. Two of them are a housewife and an ex-banker who had multiple exposure to insecticides (with organic solvent base), followed years later with a diagnosis of PSP.

The other two are of lithographers, both of whom worked at the same industrial firm where solvent exposure took place with subsequent development of PSP. The hypothesis that PSP is linked to an environmental toxin is supported by these cases.
Psychological Management of Victims of Sexual Assault
Authors: Moscarello Rebeka
Published: April 2017

Sexual assault, as a crime of violence, induces a life crisis which inflicts major psychological and physiological trauma upon the victim. Lack of mutual consent is present in all sexual assaults. Post-traumatic symptoms occur immediately and for a large percentage of victims this trauma is not integrated for many years. Symptoms include the classic triad of post-traumatic stress symptoms of haunting, intrusive recollections, numbing or constriction of feelings and focus and lowered threshold of anxious arousal subsequent to experiencing intense fear, terror and loss of control. Long term effects include anxiety, depression, phobic reactions to situations reminiscent of the sexual assault, sexual dysfunction, impaired social adjustment and diminished capacity to enjoy life. Post-traumatic stress responses, symptomatology, psychodynamics and management of the victim of recent and nonrecent sexual assault are reviewed.
Cholecystokinin-Tetrapeptide Induces Panic Attacks in Patients with Panic Disorder
Authors: Bradwejn Jacques , Koszycki Diana , Meterissian Greg
Published: April 2017

Cholecystokinin-tetrapeptide (CCK-4) and placebo were injected to 11 panic disorder patients. CCK-4 induced a panic attack identical to spontaneous panic attacks in all patients; placebo did not induce any attacks. The role of CCK-4 in anxiety disorders is discussed.
Children who Survived Japanese Concentration Camps: Clinical Observations and Therapy
Authors: Krell Robert
Published: April 2017

The majority of children who survived concentration camps have remained silent about their experiences. Their memories, rather than fading with time, have intensified. In the 1970s previously silent Jewish child survivors declared themselves through books and films. Child survivors of Dutch origin who were the victims of Japanese concentration camps are similarly emerging from silence. Parents and even psychiatrists do not credit child survivors with their ability to remember. As a result, child survivors have difficulty verifying their memories and have spoken very little about them. The numbers of patients with this particular childhood experience are increasing as noted in Dutch clinics devoted to the care of victims of war. This paper focuses on two such patients in order to alert North American psychiatrists to their existence and to crucial aspects of their care.
The Criminalization of the Mentally III
Authors: Hoffman Brian F.
Published: April 2017

This paper presents three patients with manifest psychotic illnesses who were directed into the legal system when they committed criminal acts. All of the patients were ordered to attend a psychiatrist for the year they waited for trial. All three patients pleaded guilty; two were put on probation with continuing psychiatric attendance, a condition of probation, and the other was given an absolute discharge when the court was assured that the patient would remain in treatment.

Two of the patients who had previously been noncompliant with psychiatric treatment became very compliant and cooperative as a result of the court process and probation order. The third patient was compliant and cooperative both before and after the legal proceedings. All three patients were embarrassed by the criminal charges and disliked the legal process. Since civil commitment laws have changed, psychiatrists must not abandon the seriously mentally ill but should be willing to treat patients backed up by a probation order. The cooperation of medical and legal professionals is in the patients' interest.
Adolescent Couple Suicide: Literature Review
Authors: Milin Robert , Turgay Atilla
Published: April 2017

A suicide pact is a mutual arrangement between two people to kill themselves at the same time, usually in the same place. A summary of the highlights from a literature survey on suicide pacts with a major focus on high risk factors is presented in this paper. The victims of suicide pacts are usually the spouses over age 50. The instigator is usually a depressed male with a history of self-destructive behaviour. In many cases the presence of an overdependent relationship, and a threat to the maintenance of closeness are strongly associated with the attempt. Since there were no adolescent couple suicide pacts in the literature, a case of a serious adolescent couple suicide attempt assessed and treated by the authors is reported here. The dynamics of this case are compared to the findings, the studies and case reports on adult suicide pacts.
Substance Abuse and Mental Disorders: The Dual Diagnoses Concept
Authors: El-Guebaly N.
Published: April 2017

The concept of “dual diagnoses” is reviewed along with its clinical implications. Prevalence studies report substance abuse in psychiatric populations as ranging between 20% and 75%, depending on reporting, demographic variables and the community availability of substances. On the other hand, 20% to 65% of alcoholics entering rehabilitation suffer from another major psychiatric disorder. The clinical impact of dual diagnoses involves the development and expression of psychiatric disorders depending on the choice of drugs, the severity of psychopathology and risk of assaultive behaviour, possible misdiagnosis such as the confusion between alcoholism and affective disorders, the increased use of psychiatric resources including emergency, an earlier onset of symptomatology and poorer prognosis. The evolutionary impact of the concept, reflected in successive psychiatric diagnostic classifications, is discussed along with its bridging influence between the fields of mental health and addictionology. Appropriate assessment tools along with treatment strategies are suggested. Effective features of a group process include a nonconfrontational approach with emphasis on education, an expectation of abstinence as a goal, a discussion of diagnoses and medication and lastly particular attention to vocational rehabilitation and constructive use of leisure time.
Pharmacothérapie Pour Contrôler L'agitation Chez Les Patients Ayant des Déficits Cognitifs
Authors: Hottin Paule
Published: April 2017

Agitation is a difficult problem to manage when patients suffer from cognitive impairment of varied etiology. In this article, the author proposes a combination of trazodone and tryptophan as a therapeutic possibility. The author presents an illustrative case. The patient was a 67 year old woman with a left cerebrovascular accident and a global aphasia who presented behaviour problems: she was restless, agitated, noisy, aggressive, screaming, howling and crying. In spite of treatment with neuroleptic, anxiolytic and antidepressive medication, behaviour did not improve. The use of a combination of trazodone and tryptophan was successful.
Major Depression and Agoraphobia in Patients with Angiographically Normal Coronary Arteries and Panic Disorder
Authors: Beitman Bernard D. , Mukerji Vaskar , Lamberti Joseph W. , Schmid Lynette , Kushner Matt
Published: April 2017

Patients with panic disorder and/or agoraphobia appearing in psychiatric settings report rates for lifetime major depression between 24% and 91 %. Between 40% and 90% of patients with panic disorder in psychiatric populations report concomitant agoraphobia. A recent study of panic disorder subjects appearing in an outpatient cardiology clinic confirmed the strong link between panic and depression but found only a weak association between panic disorder and agoraphobia. In order to test the reliability of these outpatient cardiology findings, the authors studied major depression and agoraphobia in patients with angiographically normal coronary arteries and panic disorder. Twelve of the 32 (37.5%) panic disorder subjects reported a lifetime history of major depression (nine current, three past only). Only two of the 32 (six percent) reported any phobic avoidance. This study confirms the previous findings which suggest that major depression is common in cardiology populations with panic disorder and that phobic avoidance is uncommon in this group.
Contributions of Epidemiology to Psychiatric Thought
Authors: Leighton Alexander H.
Published: April 2017

As a result of trying to apply both science and humanism to psychological problems, psychiatry is exposed to a welter of confusing issues in which science and intuition are pitted against each other. A growing awareness of the importance of quantification in clinical research and theory construction is having the effect of increasing the polarization.

It is suggested in this paper that Karl Jaspers' formulation of ërklaren and verstehen provide a conceptual frame by which orderly relationships can replace much of the confusion and polarization. It is further suggested that this line of thought can be implemented and developed by the use of epidemiologic strategies. Historic and recent examples from the literature are provided in order to illustrate how this can be done.
Correlates of Emotional Disorder from a Community Survey
Authors: Links Paul S. , Offord David R. , Boyle Michael H.
Published: April 2017

This report examines the correlates of emotional disorder (ED) for children in the community. The following models were used to examine the correlates of ED: 1. the variables predicting the presence or absence of ED; 2. the variables predicting the presence or absence of ED when controlling for coexisting hyperactivity and conduct disorder; and 3. the correlates of pure ED versus pure hyperactivity, and pure ED versus pure conduct disorder. Data from the Ontario Child Health Study, a community survey of children aged four to 16 years in the province of Ontario, were used. Many of the correlates proposed in the literature as variables that differentiate children with ED from normal children were supported using the first two models. Only one correlate was found which differentiated pure ED from pure hyperactivity, and no correlates differentiated children with pure ED from children with pure conduct disorder.
Social Phobia and Clonazepam
Authors: Ontiveros Alfonso , Fontaine Rejean
Published: April 2017

Five patients meeting the DSM-III-R criteria for social phobia, without any other psychiatric diagnosis, were treated with clonazepam, a high potency benzodiazepine. All patients improved markedly within four weeks. By the end of the eighth week of treatment, a marked improvement of their symptoms was reported. The adverse effects were minimal at an average dose of 3 mg per day. The authors suggest that clonazepam is a safe and effective medication in the treatment of social phobia. Moreover, clonazepam is easier to use as compared to other drugs which are used (atenolol, phenelzine, alprazolam).
Children's Observations of Violence: II. Clinical Implications for Children's Mental Health Professionals
Authors: Hurley D.J. , Jaffe P.
Published: April 2017

This paper discusses the clinical implications of our current knowledge about children exposed to violence. It highlights a number of typical case scenarios in which mental health professionals have responded inadequately to the issue of violence. Alternative strategies for assessing and treating children exposed to violence are offered which have both therapeutic and preventative value. Finally, a family based assessment and treatment approach, which may be appropriate in a number of cases, is suggested.
Lithium Carbonate Augmentation of Desipramine in Refractory Depression*
Authors: Dallal Abdallah , Fontaine Rejean , Ontiveros Alfonso , Elie Robert
Published: April 2017

An open clinical study with 20 consecutive outpatients suffering from major depression with melancholia (DSM-III) was carried out. All patients were resistant to desipramine after at least six weeks of treatment. A significant improvement was found in 13 of the 20 patients when lithium carbonate was added. Among the responder patients, five improved in the first week of lithium augmentation, while eight others improved after one week of lithium. The mechanism of action of the lithium augmentation effect in tricyclic-resistant depressed patients is discussed in view of our findings. We suggest that the unified 5-HT/NE hypothesis used in affective disorder could be applied in drug refractory depression.
An Update on the Epidemiology of Schizophrenia*
Authors: Beiser Morton , Iacono William G.
Published: April 2017

This report summarizes research in epidemiology and related areas which addresses as yet unresolved issues in schizophrenia. These include the nature of the disorder, environmental and psychosocial risk factors and differences in the course of illness. Unravelling the complexities of etiology, course and appropriate treatment calls for an integration of biological and psychosocial paradigms. The review also illustrates that a broad-based view can generate fruitful hypotheses as well as important alternative explanations for research findings.
La manie chez les personnes âgées: une revue de la littérature*
Authors: Fortin Lucie
Published: April 2017

Very little has been written about mania in the elderly population. Most authors of the 1960s and 1970s situate the age of onset of affective disorders well before the geriatric period. In the 1980 some authors reached quite different conclusions about the age of onset. One study calculated an increased frequency of manic psychosis with advanced age. However, it seems difficult to compare these studies. A few cases of primary mania in the elderly have been published and it is important that more of these cases be reported. Mania diagnosis in this group of patients is not easy to make: past history may be difficult to assess, false first diagnosis may still occur in some cases, the course and the presentation of the illness may be less typical, there may be a picture of pseudodementia, confusion, depressed mood, etc. Mania may be secondary to physical illness (organic affective syndrome). Moreover, a frank manic picture may be mistaken for dementia (or for organic brain syndrome) even if it is indeed a primary affective illness.
Biomedical Variables in the Eating Disorders*
Authors: Kaplan Allan S.
Published: April 2017

Anorexia nervosa and bulimia nervosa are complex psychosomatic illnesses for which there may be significant biomedical diatheses and sequelae. This paper reviews these biomedical variables, focusing on the medical and nutritional assessment and management of patients with eating disorders and the medical complications that arise in these patients. The paper then examines the relationship between medical illness and eating disorders, including the medical misdiagnoses often given to these patients and the way in which a chronic medical condition such as diabetes mellitus predisposes a patient to an eating disorder. The relationship between eating disorders and pregnancy is also discussed. Through an understanding of these biomedical issues, iatrogenesis can be prevented and treatment can be improved.
Psychiatric Aspects of Lung Transplant*
Authors:   The Toronto Lung Transplant Group, Craven John
Published: April 2017

Psychiatric problems in a consecutive series of lung transplant applicants (n=116), candidates (n=57) and recipients (n=42) are reported. Fifty percent of all the applicants for lung transplantation reported a history of psychiatric disorder including organic brain syndrome (19%), major depressive episode (16%), panic or anxiety disorder not otherwise specified (11%) and alcohol or substance abuse (11%). In most cases, psychiatric problems had occurred in these patients as a complication of endstage lung disease. The most common new diagnoses in candidates awaiting surgery were adjustment disorder with anxious mood and anxiety disorders. Organic brain syndromes developed in over 50% of the recipients during the first two post-operative weeks. The type and prevalence of these disorders have implications for the management of lung transplant patients and those with chronic pulmonary disease.
The Dexamethasone Suppression Test in Borderlines: Is it Useful?
Authors: Korzekwa Marilyn , Steiner Meir , Links Paul , Eppel Alan
Published: April 2017

The relationship between borderline personality disorders (BPD) and major depressive disorder (MDD) continues to be controversial. A reliable biological marker for depressed BPD patients would not only support the diagnosis but could also help in predicting treatment outcome. A large sample of psychiatric patients was screened and data on the Dexamethasone Suppression Test (DST) were obtained for 67 patients who met the criteria for BPD by scoring 7 or greater on the Diagnostic Interview for Borderlines. The DST was positive in 23.9% of the cases. Fifty cases of BPD also met the Research Diagnostic Criteria for MDD. The DST was positive in 26.0%. Of the 50 patients with MDD, 34 also met the criteria for endogenous depression. Only 17.6% of this subgroup had positive results on the DST. The low sensitivity and specificity of the DST for depression in BPD patients suggests that the DST is not a useful test in differentiating BPD patients with MDD from those without MDD. The possible reasons for the DST not being useful in this population are discussed. These findings raises further questions about the nature of the depression suffered by BPD patients.
An Unusual Case of Pica
Authors: Solyom Carol , Solyom Leslie , Freeman Richard
Published: April 2017

This paper presents the case of a 29 year old woman who compulsively ate rocks and pebbles, a habit developed in childhood. Extensive psychometric testing did not demonstrate phobias, obsessions, tendency to increased anxiety, depression or anorexic or bulimic disorder. The development of pica is partially explained by a childhood eating disorder, obsessive personality traits, cultural factors and specific (personality induced) stresses. Stress-reducing measures were successful in eliminating the eating disorder.
The Case of Valentine Shortis — Yesterday and Today
Authors: Friedland Martin L.
Published: April 2017

Valentine Shortis, a young Irish immigrant, was convicted of murder in Quebec in 1895. His insanity defence was unsuccessful in spite of psychiatric evidence given by the leading psychiatrists in Canada. Shortis spent the next 42 years in custody. The case provides a good vehicle for exploring a number of aspects of the history of psychiatry, the insanity defence, and the treatment of the criminally insane in Canada. Comparisons are made with the insanity defence and the treatment of the criminally insane today.

This paper was originally presented as the 1989 Kenneth G. Gray Memorial Lecture, which was based in part on the author's book, The Case of Valentine Shortis: A True Story of Crime and Politics in Canada, University of Toronto Press, 1986.
A Cross-Cultural Study of Major Depression and Family Functioning
Authors: Keitner Gabor I. , Fodor Judit , Ryan Christine E. , Miller Ivan W. , Bishop Duane S. , Epstein Nathan B.
Published: April 2017

Patterns of family functioning in families with a depressed member from two cultures (North America and Hungary) were compared. In both cultural settings, families with a depressed member reported poorer family functioning than the control families. Comparisons between the two depressed groups, however, showed that the response to family dysfunction by the two cultures differed. While depressed families in Hungary reported difficulties in setting family rules and boundaries, those in North America experienced impaired functioning in solving problems, communicating, being involved with each other, and in overall functioning. These results are discussed in terms of the interplay between culture, depression and family functioning.
Spouse Assault on Mentally Disordered Wives
Authors: Carlile John Batchin
Published: April 2017

To assess the prevalence and associated features of wife assault in psychiatric patients, 152 married women who had a psychiatric disorder and who were consecutively seen at or admitted to a psychiatric unit were assessed using a structured questionnaire. Forty-nine percent of the patients had been assaulted by their husbands. There was a significant relationship between hospital admission and recent assault. Parental violence and whether or not the husband had a criminal record were strongly related to wife assault. The wives' responses to the assaults were investigated.
The Dangerousness Criterion for Civil Commitment: The Problem and a Possible Solution*
Authors: Brouillette Marie-Josée , Paris Joel
Published: April 2017

The dangerousness criterion for civil commitment fails to specify which mental disorders justify commitment. This ambiguity is highlighted by the fact that there are patients with personality disorders or substance abuse who may be dangerous but for whom we have few effective treatments. A possible solution might be provided by adopting the American Psychiatric Association guidelines which consider severity of mental disorder and treatability in its criteria.
The Prevalence and Correlates of Behaviour Problems in Learning Disabled Children
Authors: Schachter Debbie Carol , Pless I. Barry , Bruck Maggie
Published: April 2017

A retrospective cross sectional study of the prevalence of emotional problems among 502 learning disabled children seen in a specialized learning centre was conducted. Learning disabled children, diagnosed by an experienced clinician, were tested for emotional disturbances using the Child Behavior Checklist. The prevalence of behaviour problems among these children was 43%. This was much higher than the ten percent expected when this measure is used in a general population. There was no greater frequency of behaviour problems in children referred by teachers than in those referred by parents. Results of logistic regression analyses reveal that children who were adolescents, from non intact families, or from lower social class backgrounds had an increased odds of having behaviour problems. The implications of these findings are examined, especially in light of possible methodological problems including selection bias, which may account for the association between emotional problems and learning disabilities found in other studies.
Resilience and Vulnerability in Long Term Outcome of Attention Deficit Hyperactive Disorder
Authors: Hechtman Lily
Published: April 2017

Follow-up studies of children with attention deficit hyperactive disorder show that they continue to have problems with restlessness, over-activity, impulsive behaviour and inattention, often resulting in serious academic, social and emotional problems in adolescence. Outcome in adulthood generally falls into three groups: fairly normal outcome, persistent attentional, social, emotional and impulse problems, and serious psychiatric and/or social pathology. Factors affecting outcome include characteristics related to the child (for example, health, temperament, IQ) and characteristics of the family (for example, socioeconomic status, emtional and psychological aspects of the family, family composition and structure, and the larger social and physical environment.