bluuebunny/crossref_metadata_2025 huggingface dataset:
Cotherapy: The Need for Positive Pairing
Authors: Mcmahon Neil , Links Paul S.
Published: April 2017

Therapists who are of the opinion that the cotherapy relationship has minimal therapeutic value, fail to understand the potential of this type of therapy. Cotherapy, in group psychotherapy, is a unique form of therapy with specific implications for therapeutic intervention. This paper will present three hypotheses developed from clinical observations which encourage a re-examination of traditional group perspectives.

First, the authors believe that the development of the cotherapy relationship effects the development of group process. Second, the authors hypothesize that the pairing of the cotherapy relationship is paralleled by the pairing of group participants and finally that pairing in group psychotherapy is positive and can be utilized as an intervention technique.

Although, traditionally, pairing has been viewed as an obstacle to group process, this paper presents the premise that pairing in group psychotherapy should be considered as a positive and necessary occurrence for cotherapy intervention. Six phases of cotherapy development are illustrated to show how the complex aspects of the cotherapy relationship impacts upon the developmental stages of group process. The clinical implications of this perspective may be the beginnings of new therapeutic horizons for cotherapists.
Article
Authors: Lajeunesse C.
Published: April 2017

Summary

While French research is being restructured, psychiatric research, especially biological psychiatry with its clinical component, must seek recognition by the official structures and face a series of administrative difficulties in order to reach its full growth. The Danish, Swedish, British and Belgian psychiatric research organizations possess some particularities that are reviewed.
Play in the Psychotherapy of Selfobject Relating
Authors: Henderson James
Published: April 2017

Current literature dealing with narcissistic character disorder attempts to differentiate between mature relating with consensually validated whole objects and immature, more primitive relating with mirroring and validating selfobjects. In the latter case the object is especially valued for its role in buttressing a damaged or fragile self. The persistence into adult life of this more primitive relating to selfobjects can be viewed as a restitutive attempt, a healing by second intent. Through such a mechanism, attempts are made to make good deficits left by perceived failures of the primary object. These attempts include the setting up of relationships with figures whose empathic capacity is in some way sensed to be corrective, and the setting up of relationships with selfobjects which are in part created by the subject to provide himself with the kind of validating selfobject which has been longed for, yet never experienced.

Winnicott conceives of transitional experience as an intermediate area allowed to the infant between primary creativity and objective perception based on reality testing. Transitional relating usefully clarifies the concept of selfobjects in emphasizing its common features with the transitional object. Transitional objects and selfobjects both contain the idea that the psychic apparatus is equipped with self-healing capacities. They tell us something about the nature of those self-healing capacities. The mental apparatus, as the physical apparatus, can attempt to heal itself in the face of injury or disease. The mechanism of that psychic healing may have to do with the importance of transitional phenomena and illusory experience in permitting the relinquishing of omnipotence and grandiosity which goes hand in hand with the formation and consolidation of the structurally mature self. An understanding of the transitional area can facilitate the therapist's work in helping certain patients overcome immature and fixed character traits often associated with narcissistic psychopathology.

The psychopathology of transitional experience is reviewed and the importance of play in the therapeutic situation is stressed. Evidence is presented for the existence of a common neurophysiological substrate for play and transitional experience. This discovery is deemed evidence supporting our thesis of the importance of the transitional area in fostering psychic growth and in promoting healing in the analytic situation.

Case material is described to illustrate these points. The relationship of psychosomatic symptomatology to transitional experience is discussed and illustrated with clinical case material.
The Mechanism of Neuroleptic Withdrawal
Authors: Eppel Alan B. , Mishra Ram
Published: April 2017

The authors present a case report of a woman who developed marked withdrawl symptoms on withdrawal from Pericyazine. The authors feel that this case adds support to the hypothesis that such withdrawal symptoms are due to cholinergic rebound hypersensitivity.
Ethics in Behaviour Therapy: Historical Aspects and Current Status
Authors: Rapp Morton S.
Published: April 2017

Ethical problems in clinical practice arise when clinicians confront competing value systems. Historically, behaviour therapy has been criticized because of alleged special ethical, moral and legal problems. These problems are no greater or smaller than in other forms of psychotherapeutic practice. But they can differ in emphasis. This article describes partial responses to selected ethical dilemmas facing general psychotherapy, and outlines relatively novel issues raised by certain features of behavior therapy practice.
Psychiatric Assessment of Competency to Care for a New-Born
Authors: Stewart Donna , Gangbar Randy
Published: April 2017

General hospital consultation psychiatrists are sometimes asked to assess the ability of a recently delivered mother to safely care for her new-born at home. There are surprisingly few papers in the literature that deal with this problem. The authors review their experience with 56 women referred by a maternity unit over a 10 year period and discuss the demographic characteristics, diagnosis, management, and outcome of their intervention. They discuss how such an assessment should be carried out and review the literature. Some conclusions are drawn about high risk factors, and the need for early identification of these mother-infant pairs as part of primary prevention. They point out the need to take decisive action when the infant's safety appears to be seriously at risk and note that the mothers and infants in their group have done fairly well during the follow-up period with appropriate treatment, teaching and supervision.
The Clarke Institute Experience with Electroconvulsive Therapy: II. Treatment Evaluation and Standards of Practice
Authors: Martin B.A. , Kramer P.M. , Day D. , Peter A.M. , Kedward H.B.
Published: April 2017

Contemporary standards of practice of electroconvulsive therapy with respect to the treatment procedure, clinical indications, and dosage (number of treatments per course) are summarized. The actual clinical practice at one psychiatric hospital over a 16-year period, comprising 22,647 treatments, was compared to those standards. The most significant findings in this series were the over-representation of patients with a diagnosis of schizophrenia and the absence of any clinically significant difference in the treatment dosage for schizophrenia and affective disorders. The significance of these findings is discussed with respect to their identification of patient subgroups that warrant case auditing. In addition, the results are used as a basis for a critical examination of the rationale for the presently recommended maximum treatment dosages.
Residential Treatment of Adolescents: A Treatment Model
Authors: Kennedy Brian
Published: April 2017

This paper outlines a residential treatment model for adolescents. An essential component of this model is its emphasis on rehabilitation. Thus, community involvement and, therefore, treatment within the community is a cornerstone of patient management. The model is currently operating with emotionally disturbed adolescents, some with concurrent chronic medical disabilities. Research protocol, evaluating its effectiveness, is in place and will be documented in a future paper.
Anxiety, Fears and Depression Related to Hysterectomy
Authors: Lalinec-Michaud M. , Engelsmann F.
Published: April 2017

One-hundred and two women undergoing a hysterectomy for reasons other than cancer were interviewed pre-operatively. Fifty-three of them filled out the Spielberger State and Trait Anxiety Scale (STAI). Women who had high anxiety scores were more likely to be depressed, both before and after the operation. Depression occurred also more often in women who had emergency hysterectomies and in women who had expressed, pre-operatively, some fears of possible change in their sexual life after the operation.
First-Cousin Marriages and Psychiatric Morbidity
Authors: Prasad A.J.
Published: April 2017

In a study of first-cousin marriages among the parents of a group of randomly selected schizophrenic and affective disorder patients, there was a significant number of such marriages in the schizophrenic group.
The Impact of Psychotherapists and Primary Physicians on Suicide and Other Violent Deaths in a Rural Area
Authors: Glasser Morton , Amdur Millard J. , Backstrand Jeffrey
Published: April 2017

A northeastern Connecticut area comprising 60,000 people from six small towns and a city of 14,000 was studied as to their suicidal and other violent death rates over a 20-year period (1960–1979). Since there was a 458% increase in the number of practicing psychotherapists and an 82% increase in primary physicians during this period of time, correlations were made to determine whether or not this increase in health professionals diminished the violent death rates. There was no evidence that the increased number of health professionals had an impact on the suicide rate or other violent death rates (p = n.s.). Possible reasons for this are discussed and suggestions made for better utilization of health care workers in preventing suicide and other violent deaths.
Civil Commitment Trends in Ontario: The Effect of Legislation on Clinical Practice
Authors: Martin B.A. , Cheung K.D.
Published: April 2017

The rationale for and history of civil commitment legislation in Ontario are reviewed The civil commitment rate in Ontario from 1926 to 1980 for provincial psychiatric hospitals, and from 1974 to 1980 for all psychiatric inpatient facilities was analyzed to detect variation in the rate over time and with relevant legislation. The findings indicate that mental health legislation has had little effect on commitment practices in Ontario. In addition, the variation in the commitment rate over the period reviewed cannot be ascribed to inconsistent application by physicians. The other variables affecting the rate are discussed in this context. The need for more descriptive studies of the major determinants of the commitment rate is emphasized.
Hysterical Seizures as a Manifestation of “Depression” in Old Age
Authors: Shulman Kenneth I. , Silver Ivan L.
Published: April 2017

A case of hysterical seizures is presented which is ultimately diagnosed as depression and treated successfully with tricyclic antidepressants. The need to re-examine our understanding of illness and the effect of classification on treatment decisions is emphasized.
Desipramine-Induced Delirium at “Subtherapeutic” Concentrations: A Case Report
Authors: Kutcher S.P. , Shulman K.I.
Published: April 2017

An elderly patient treated with low dose Desipramine developed a delirium while her plasma level was in the “subtherapeutic” range. Delirium, which may be induced by tricyclic drug therapy in the elderly, can be caused by tricyclics with low anticholinergic potency. Therapeutic ranges for antidepressants that have been derived from general adult population studies may not be appropriate for the elderly. Further studies of specifically elderly patients are now required to establish safer and more appropriate guidelines for drug therapy.
Premenstrual Syndrome: Single or Multiple Causes?
Authors: Clare Anthony W.
Published: April 2017

The numerous theories of causation of Premenstrual Syndrome have been reviewed. These range from biological to environmental hypotheses. As yet, no clear cut organic or psychological explanation has been found to explain this complicated syndrome. Findings to date suggest that this condition may be the final stage of multiple and interacting social, psychological and biological factors.
Applications cliniques de l'informatique en psychiatrie
Authors: Lesage Jacques
Published: April 2017

La réduction du coût des ordinateurs et l'introduction des micro-ordinateurs amènent une pénétration irréversible de l'informatique dans tous les domaines de la vie occidentale. La recherche en informatique psychiatrique se fait depuis plus de vingt ans. L'ordinateur peut assister le psychiatre dans plusieurs domaines.

Cet article traite des domaines d'applications de l'ordinateur dans le travail clinique: les tests psychologiques, les entrevues de malades, le diagnostic, les traitements psycho-pharmacologiques et behavioraux, l'évaluation des progrès du malade, l'éducation des professionnels et des malades ainsi que la simulation de modèles psychiques pouvant être utilisés à des fins d'enseignement.

Les problèmes rencontrés lors de l'implantation de tels programmes sont aussi abordés. Nous énumérons des avenues de développement et nous formulons certaines recommandations.
Affective Disorder in an Adolescent
Authors: Fisman Sandra , Max Paul , Woodside D. Blake
Published: April 2017

A case of bipolar disorder presenting in an adolescent girl is presented. Differential diagnosis and treatment is discussed. A number of aspects of this case are outlined including the difficulties of diagnostic accuracy in major disorders of childhood and adolescence, the existence of biological markers, the implication of environmental stressors and cultural-familial factors. An unusual situation of reversal of index case identification is noted.
Pancreatitis following Overdose with Amoxapine and Procyclidine
Authors: Jeffries J.J. , Masson J.
Published: April 2017

A case is described in which a patient developed acute pancreatitis following an overdose of amoxapine and procyclidine. Pancreatitis is not at this time a recognized complication of the use or abuse of these two drugs. Other drugs were used in the medical management of the complications of the overdose, but none of these are drugs known to be associated with pancreatitis. Amoxapine is probably, but not certainly the cause of the pancreatitis. Possible mechanisms for this unusual and serious complication are described.
L'hôpital psychiatrique: d'hier à demain
Authors: Mercier Céline , Harnois Et Gaston P.
Published: April 2017

A study carried out in a psychiatric hospital in the Montreal region reveals that in spite of deinstitutionalization, long-term stay remains an important factor in the use of beds. For some patients the hospital remains a permanent home, either from their first admission or from the time they are institutionalized after multiple admissions. For both in- and out-patients, return to the hospital and long-term care are almost inevitable.

Generally speaking, the services of the hospital are used by the same long-term patients, and this to the extent that the hospital cannot provide services to other establishments or play its second-line role. This is frustrating for other institutions in the network, even though they accept the inevitability of the situation given the lack of adequate community resources for these patients. One of the primary functions of a psychiatric hospital also seems to be to fill in the gaps in the service network. In this regard, its expertise in the field of intervention in chronic psychiatric patients must not be overlooked. Given the current situation, the hospital's responsibility in regard to second-line services cannot be clarified until it has been determined just how much of the responsibility for care of psychiatric patients can be assumed by the community itself.
A Comparison of the Manifest Content in Dreams of Suicidal, Depressed and Violent Patients
Authors: Firth S. Terry , Blouin Jane , Natarajan Cauhalagala , Blouin Arthur
Published: April 2017

The manifest dream content of psychiatric in-patients who had been admitted because of suicidal attempts was compared with three in-patient control groups, patients who had been admitted for: a) depression and suicidal ideation without attempt; b) depression with no suicidal ideation and; c) commission of a violent act without suicidality. Standardized tests of dream content were used as well as the Beck scale for depression and certain subscales of the MMPI. The results confirmed that both suicidal and violent patients have more death content and destructive violence in their dreams, but that this was a function of the severity of depression and certain character traits such as impulsivity rather than being specific to the behaviour itself. The dream content is continuous with, and probably reflects, the waking state in the case of the depressives. On the other hand some of the findings require a more complex dynamic explanation lending some support to the idea that the dream may have an adaptive function.
Suicide and Attempted Suicide: Legal Issues
Authors: Brown James M. , Cornish James , Swart G.T.
Published: April 2017

Canadian Federal and Ontario Provincial statutes are reviewed as they relate to suicide and attempted suicide. Issues addressed include involuntary committal to psychiatric facilities, death by suicide as a legal cause of action, insurance exclusionary clauses and coroner's inquests.
Family Therapy and Schizophrenia: Recent Developments
Authors: Waring Edward M. , Carver Claudia , Moran Pierrette , Lefcoe Daniel H.
Published: April 2017

A review of recent studies of family interaction as a causal factor in the development of schizophrenia suggests a paucity of evidence supporting this point of view. However, research has suggested family variables may influence the course and outcome of schizophrenia. The impact of schizophrenia on the family has recently received more attention.

Some research has identified differences between families of schizophrenics and the families of other diagnostic groups and controls. Whether these studies are beginning to influence the theory and practice of family therapy is discussed. Recent studies suggest the combination of long-acting medication and ‘psychosocial’ interventions may reduce the relapse rate of schizophrenia in the short term. This research suggests that family therapists must re-evaluate their role in the management of schizophrenia.
Cohort Analysis of Ontario Suicide Rates, 1877–1976
Authors: Barnes Rosemary A. , Ennis Jon , Schober Renate
Published: April 2017

Birth cohort studies of suicide rates in Alberta, the United States and Australia indicate that within each generation, suicide rates increase with age. Such studies argue that cohort-specific suicidal risk, together with present high suicide rates among young people predict even higher rates as these generations grow older. Ontario data from a 100-year period demonstrate that within birth cohorts suicide rates consistently increase with age, peak between ages 50 and 70, then decline. Gradual increases in mean suicide rates result in every birth cohort having higher suicide rates than the preceding cohort at almost every age level. These trends combine to produce a regular birth cohort effect and a steady shift in cross-sectional data to higher rates of suicide among younger age groups. Abrupt increases in suicide rates occurring during the Great Depression had only transient effects on birth cohort and cross-sectional curves. Results provide weak support for the hypothesis of cohort-specific suicidal risk and clarify the factors which produce birth cohort effects.
Neuroleptic Blood Levels and Clinical Response
Authors: Rockland Lawrence H.
Published: April 2017

Gas chromatography and radioreceptor assay technologies made possible the measurement of nanogram quantities of neuroleptic in the blood. They revealed large differences in blood concentrations among patients receiving the same oral dose. This led to the hope that measuring neuroleptic concentrations would allow more effective oral dosing for individual psychotic patients.

Early attempts to study neuroleptic concentration/clinical response patterns, using chlorpromazine, produced confusing results. Many of the studies had serious design flaws, and were complicated by the many active metabolites of chlorpromazine.

Adequate blood level/response studies should use fixed drug dosage schedules, drug-responsive patients, and neuroleptics without active metabolites. Brain concentration of drug is probably better reflected by erythrocyte than by plasma concentration. Therefore, recent investigators have usually used erythrocyte haloperidol or butaperazine concentrations to study level/response relationships.

These recent studies strongly suggest an “optimal concentration” level/response pattern for haloperidol and butaperazine. Patients tend to respond best to moderate concentrations of neuroleptic, and non-response can be due to either too low or too high concentrations. In the latter case, decreasing the oral dose should be seriously considered.

Blood level findings remain preliminary. The clinician should continue to fine-tune his clinical skills, using neuroleptic blood concentrations to complement his clinical judgment, in the attempt to determine the lowest effective dose for the individual patient.
Risk Research in Affective Disorders and Alcoholism: Epidemiological Surveys and Trait Markers
Authors: El-Guebaly N.
Published: April 2017

Traditional designs in risk research have been in the form of epidemiologic surveys aimed at assessing a genetic contribution or search for broader indicators of vulnerability, resulting from the interaction of both nature and nurture. Recently, an interest in biological markers has resulted in the search for possible trait markers identifying more specifically, individuals with a life-long risk for an illness that may be expressed or not. The contributions, limitations and evolution of these strategies are reviewed in the syndromes of affective disorders and alcoholism.

Recommendations include the use of biotypes rather than phenomenotypes for the diagnosis of the index case. Current promising approaches include the study of pedigrees biased towards a particular variable, a discriminant analysis of the variation in expressivity of the syndrome and the genetic linkage studies. While there is so far no established trait marker, research strategies are emerging and withstanding the test of time. The present technological explosion will undoubtedly further our understanding of risk factors.
Change with Time in Patients’ Reactions to Committal
Authors: Toews J. , El-Guebaly N. , Leckie A. , Harper D.
Published: April 2017

The influence of time on patients’ reactions to involuntary committal is a variable seldom considered in reports. The reactions to committal of thirty-four subjects interviewed one week/one month/three months/six months post committal are reported. Generally committal was viewed neutrally. The major changes in attitudes related to knowledge of the fact of committal and of rights of appeal. The importance of these findings for the management of committed patients is stressed.
Verapamil in Bipolar Illness
Authors: Solomon Leigh , Williamson Peter
Published: April 2017

The authors report two cases of Bipolar Affective Disorder which were responsive to Lithium therapy in the past, but could no longer be treated with Lithium due to hyperparathyroidism in the first case and noncompliance in the second. In both cases, successful control of hypomania was achieved with Verapamil, but treatment of depression required the addition of Trazodone. The rationale for employing a calcium channel blocking agent, such as Verapamil, in bipolar illness is reviewed.
Termination in Individual Psychotherapy: A Survey of Residents’ Experience
Authors: De Bosset F. , Styrsky E.
Published: April 2017

This paper describes the result of a survey on one Canadian Psychiatric Residency Program. Fifty-four percent of the residents responded to the questionnaire enquiring about their experience of termination in long-term psychotherapy. The majority of residents (66%), had ended therapy prior to fifty sessions. In only a small number of terminations the resident felt the patient was ready to terminate (16%) and that therapy had come to a “natural termination”.

Therapy often ended prematurely due to the change of setting of the resident, drop-out and other practical circumstances as well as therapeutic impasses.

The paper discusses the factors that influence the premature ending of what the residents undertook as long-term psychotherapy and their implications for their training and the patients’ treatment.
Children who Lie: A Review of the Literature
Authors: Chagoya Leopoldo , Schkolne Theo
Published: April 2017

In this paper we review 18 years of literature on the causes and management of lying in children. Developmental, psychoanalytic, interactional and sociological frames of reference have been applied in different papers to understand this phenomenon of childhood and adolescence. In recent years, some experimental studies confirm developmental concepts, yet others suggest that children of the eighties are changing in their moral development. The scarcity of references on the management of lying as a symptom is noted.
The Use of Tryptophan in Normal-Weight Bulimia
Authors: Cole W. , Lapierre Y.D.
Published: April 2017

Animal studies have implicated serotonin in the regulation of eating behavior. Hypothalamic serotonin receptor sites have been postulated to explain the inhibitory effect of serotonin on feeding behavior. This case study reports on the successful diminution of bingeing behavior in a normal weight bulimic female who was administered oral tryptophan, a serotonin precursor. The patient received a six week trial of tryptophan at a daily dosage of 20 mg/kg. A cessation of both the urge to binge and the behavior itself was noted. These preliminary findings are consistent with animal models suggesting the regulation of satiety is dependent on the inhibitory action of serotonin. Implications for the treatment of bulimic individuals are discussed.
Legal Issues in Medical Management of Violent and Threatening Patients
Authors: Dickens Bernard M.
Published: April 2017

The responsibility of professionals in the medical management of violent and threatening patients is discussed using the Tarasoff case (American) and the Lawson case (Canadian) as landmark cases influencing subsequent jurisprudence.

It is becoming increasingly important to be aware of the court's interpretations in such areas as confidentiality, predictions regarding dangerousness, the duty to warn, and the legal duty to strangers to the therapist/patient relationship. A number of other issues relating to the risks involved in management of patients potentially dangerous as a result of the use of drugs are also discussed.
The Art of Pharmacotherapy in Depressed Outpatients
Authors: Bassett Anne S. , Remick Ronald A. , Beiser Morton , Miles James E. , Wilt Frances
Published: April 2017

There is an art to prescribing medications to depressed patients. Both patient and therapist/actors are important to a successful outcome with appropriate timing and prescribing of treatment. Two case reports are provided as examples. Specific strategies used by experienced clinicians are presented in the discussion.
The Dexamethasone Suppression Test and the Children's Depression Inventory in Psychiatric Disorders in Children
Authors: Woodside D. Blake , Brownstone Desi , Fisman Sandra
Published: April 2017

This open study attempts to evaluate the usefulness of objective diagnostic tests in the child and adolescent age group. Fifty-eight children admitted to a Child and Adolescent Psychiatric service were administered the Dexamethasone Suppression Test (DST), the Children's Depression Inventory (CDI) or both. Rates of DST non-suppression were significantly elevated in children with major affective disorders (10/12) and in children suffering from adjustment disorders (3/18). Children with major depressions and conduct disorders both showed elevated scores on the CDI(p < 0.025), and these two groups did not significantly differ from each other on this measure. The implications of these findings for future research are discussed.
Civil Commitment and Consent for Electroconvulsive Therapy in Ontario
Authors: Martin B.A. , Peter A.M.
Published: April 2017

Among the most contentious legal and ethical issues concerning the use of electroconvulsive therapy (ECT) are the criteria for obtaining a valid consent to treatment and its administration to involuntarily hospitalized patients, with or without consent. This paper reviews the consent process, in particular the assessment of competence, as it is affected by the symptoms and clinical circumstances, including civil status, of those patients for whom ECT is prescribed.

The ECT caseload at one psychiatric facility was reviewed to determine the diagnosis and civil status of each patient and the source of consent for each course of ECT prescribed over a 10-year period. Significant differences were found in the diagnostic distribution and the source of consent by diagnostic group between the 1,042 courses administered to informal patients and the 249 courses to involuntary patients. The results are discussed in the context of relevant Ontario legislation and hospital policies. Recommendations are made for the improvement of procedural safeguards to protect the autonomy of all patients.
Some Calculations on the Prevalence of Dementia in Canada
Authors: Jeans E.R. , Helmes E. , Merskey H. , Robertson J. Mcd. , Rand K.A.
Published: April 2017

The epidemiology of dementia in Canada is not known. However, we report figures on the frequency of dementia in institutions in Ontario based upon the use of a multidimensional observation scale for the assessment of the elderly. These findings on institutionalized patients can be extrapolated to the whole elderly population, but the procedure is clearly too conservative by comparison with findings in other countries and in the light of the known occurrence of numbers of demented patients outside institutions. Ratios in different sutidies for the numbers of patients with dementia outside institutions and within institutions range from 1:1 to 6:1. Using a ratio of 2:1 and applying it to age specific population figures, a prevalence of dementia in Canada of 222,324 for those over 65 is obtained with a rate of 9.4% in that age group. When the figures projected in this way are compared with five epidemiological studies for the rate of dementia elsewhere, the Canadian figure which we have obtained ranks fourth out of six. This estimate provides potential figures on which to base the planning of services, provided that the inferential nature of the estimates is fully recognized.
The Microcomputerized Diagnostic Interview Schedule: Clinical use in an Out-patient Setting
Authors: Wyndowe J.
Published: April 2017

While the validity of the Diagnostic Interview Schedule (DIS) is still controversial, enough data exists to support a trial in a cinical setting. A new microcomputerized version presents the diagnostic profile of the patient within minutes after the interview and reduces the possibility of errors in data collection and transcription, thus making the interview appropriate and available for widespread use. The present study examines the use of this instrument in a psychiatric out-patient department.

Forty-one referrals to a psychiatric out-patient department were assessed by each of two methods: the standard problem-oriented non-structured clinical interview (NSI) and the microcomputerized DIS. The mean time taken for the DIS was 111.6 minutes, and patient acceptance of the microcomputerized format was high. The DIS provided a mean of 5.5 diagnoses per person compared to 2.56 for the NSI, but 31.7% of the patients had no clinically significant current DIS diagnosis. Approximately one-half the patients were assigned a diagnosis by the NSI which was beyond the 38 DSM-III diagnoses covered by the DIS.

A comparison of the diagnostic results of both interviews reveals large differences in the group, and very little agreement in individual patients. The proportion of patients assigned diagnoses of substance abuse, affective disorder, psychosexual disorder, and personality disorders by each interview were quite different. Many of the patients diagnosed as having primarily Personality Disorder by the NSI were found to have an affective disorder by the DIS. The reasons for these differences and the resulting implications are discussed. This study supports the use of the microcomputerized DIS as a clinically useful adjunct to the diagnostic process.
Day Treatment of Alcoholism: An Outcome Study
Authors: Malla Ashok K.
Published: April 2017

Thirty-seven (27 male and 10 female) alcoholics, treated in a brief day program, were assessed on a number of alcohol related and psychosocial variables 15 months following the initial treatment. Thirty percent (30%) remained totally abstinent, another 30% reduced their drinking to less than 10%, and 35% showed a moderate reduction of 10 to 50% in their pre-treatment drinking. Significant reduction was reported by these patients in their utilization of health services for purposes of detoxification, psychiatric treatment, visits to the family physician, and emergency department. Improvement was also reported on employment status, legal problems, general emotional state and some symptoms suggestive of depression. These findings are discussed in the light of the viability of cost effective day treatment programs for alcoholism within the context of general hospital psychiatric services.
Premature Discharges: A Comparative Study
Authors: Chandrasena Ranjith
Published: April 2017

One hundred and ninety-eight AMA and 81 AWOL discharged patients were compared with a control group of 256 inpatients. Each group had sociodemographic and clinical characteristics which were predictors of their hospitalization outcome and both AMA/AWOL discharges were at high risk of readmission in the short and long-term following their discharge. These patients occupy a significant amount of hospital resources and have an adverse effect on ward milieu. Their management raises moral, ethical and medicolegal concerns. The data offers a Canadian perspective to the literature and discusses reasons for possible differences between AMA and AWOL discharges. Some remedial measures for the caring of these “revolving door patients” are suggested.
Lithium and Memory: A Review
Authors: Ananth J. , Ghadirian A.M. , Engelsmann F.
Published: April 2017

This paper reviews systematic clinical studies suggesting memory and cognitive impairment inpatients suffering from unipolar and bipolar affective disorders treated with lithium. A number of studies failed, however, to demonstrate lithium induced memory deficits. Thus, the results of studies were equivocal. This lack of empirical consensus was in part due to the heterogeneity of samples and a variety of methodological and design problems. The definition of short- and long-term memory was often arbitrary and lacked standard criteria. Some studies revealed a stability of the memory test scores over time and showed that subjective complaints of memory impairment were correlated with depression. The authors also reviewed studies examining the effects of lithium on cognition and memory of healthy control subjects. In animal research it was difficult at times to distinguish between toxic and pharmacologic effects of lithium. There is a need for prospective studies of the effect of lithium in large samples of patients using refined memory tests.
Controlled Follow-up of Patients Released by a Review Panel at One and Two Years after Separation*
Authors: Ledwidge B. , Glackman W. , Paredes Jaime , Chen R. , Dhami S. , Hansen Margaret , Higenbottam J.
Published: April 2017

Fifty patients released by the Review Panel are compared with a matched group of 50 patients discharged by the attending physician at one and at two years after separation from hospital. The two groups did not differ with respect to readmission rate or time spent in the community. At two years the physician-discharged patients were functioning better than the Panel-discharged patients in two of the seven areas of functioning; in the other five areas of functioning the adjustment of the two groups did not differ.

The implications of these findings for the operation of the Review Panel and for the timely discharge of involuntary patients by attending physicians is discussed.
The Prospect of Surrogate Mothering: Clinical Concerns
Authors: Steadman Jennifer H. , Mccloskey Gillian Tennant
Published: April 2017

There have been, in the last decade, approximately 500 surrogate births in the United States and the demand is increasing. The average cost is $25,000 and as there is no regulatory legislation in place, each arrangement is covered by a private legal contract. There is little reliable data regarding any member of the “incubating family”, or on the adopting couple. This paper is an attempt to point out the potential hazards, based on a theoretical and clinical appreciation of child and adult biopsychosocial processes. The authors advocate careful longitudinal study of all children and adults involved in this complex reproductive alternative.
Gender Dysphoria in a Child with True Hermaphroditism
Authors: Zucker Kenneth J. , Bradley Susan J. , Hughes Helen E.
Published: April 2017

This case report describes the psychosexual development of a child with true hermaphroditism who was assigned to the male sex at birth, but reassigned to the female sex at age two months. Given this child's excessive exposure to male sex hormone in utero, relative to physically normal females, one would predict a biological predisposition to behave in a masculine manner. This has occurred since two years of age. In addition, this child has had periodic episodes of gender disturbance, dysphoria, and ambivalence. In contrast, a physically normal fraternal twin sister has been conventionally feminine. A number of psychosocial factors appeared to have exacerbated the biologic predisposition to behave in a masculine manner, and thus may have been responsible for “pushing” this child into varying degrees of gender identity conflict. These included a closer father-daughter than mother-daughter relationship, parental tolerance of cross-gender behavior, and a mother who has been psychologically disturbed since the birth of her children. The heuristic value of this case will be discussed in relation to contemporary models of psychosexual development which emphasize the interaction of biological and psychosocial factors.
Obsessive Disorder with Self-Mutilation: A Subgroup Responsive to Pharmacotherapy*
Authors: Primeau Francois , Fontaine Rejean
Published: April 2017

Obsessive-compulsive disorder (OCD) can be considered a complex entity with possibly different subgroups responsive to specific treatment. This article presents two cases of OCD with self-mutilation, successfully treated with serotonergic antidepressants. The authors discuss a sub-group of OCD patients whose rituals present as self-destructive behavior and are responsive to pharmacotherapy.
Longitudinal Evolution of Individuals Having Appealed Their Committal to the C.A.S.
Authors: Ouellet Paul-G. , Picard Sylvie
Published: April 2017

The longitudinal evolution of 66 patients admitted between 1976 and 1986 at the Centre Hospitalier Robert-Giffard, and who have appealed their case before the Commission des Affaires Sociales (C.A.S.) was studied.

After a review of the literature, the authors compare the evolution of the patients whose appeal was accepted and who left the hospital against medical advice to those individuals whose appeal was rejected. The authors wanted to see if the first group of patients had a less favourable short-term and medium term evolution. From a study of the files and of the case notes prepared by the physicians for the C.A.S. hearings, the authors draw a profile of the typical individual of this group and they study the influence of 16 factors of dangerousness on the Commission's decisions.

The results show that the short and medium term evolution of the patients who have appealed their case before the Commission does not differ significantly in the area of dangerousness, whether their appeal was accepted or rejected. However, the length of stay of those patients who had to remain in hospital was significantly longer and that may be the reason why the period of time between their discharge and their re-hospitalization was afterwards much longer.

In light of these results, the authors comment on the importance given by the Commission to the legalistic rather than therapeutic aspects of cases.
Dysthymia: A Randomized Study of Cognitive Marital Therapy and Antidepressants
Authors: Waring Edward M. , Chamberlaine Charles H. , Mccrank Ernest W. , Stalker Carol A. , Carver Claudia , Fry Richard , Barnes Sue
Published: April 2017

Preliminary data from a randomized study of the effectiveness of combined marital therapy and antidepressant medication in the treatment of dysthymic married women is presented. The study compares doxepin with placebo, and a marital therapy designed to enhance intimacy through facilitating self-disclosure between spouses with a more supportive and educational therapeutic approach.

After ten weeks of combined treatment, the dysthymic women show statistically significant improvement on all the depression measures as well as on the intimacy scale. A trend is developing for greater reduction of depressive symptomatology in the group treated with self-disclosure. The evidence appears to suggest the possibility that the presence of a patient's husband as a supportive figure may of itself be a potent therapeutic manoeuvre in the treatment of dysthymic women.
Residents Performance on the Mental Status Examination
Authors: Ross Colin A. , Leichner Pierre
Published: April 2017

Twenty-six residents watched a videotape of the mental status examination of a psychotic patient, then wrote their assessment of the patient's mental status. The residents’ reports were independently graded by the authors. The residents’ marks were compared to performance on departmental oral examinations. Results showed that global or qualitative assessment of mental status performance was reliable. Excellent inter-rater reliability was achieved when the assessment criteria for sub-items of the mental status were well defined.
Using the Axis V Scale to Evaluate Therapeutic Outcome of Psychiatric Treatment
Authors: Gordon Richard E. , Plutzky Maximo , Gordon Katherine K. , Guerra Marcelo
Published: April 2017

This study examined whether the Axis V scale of DSM-III was a useful instrument for coding and evaluating psychiatric patients’ response to treatment. It compared outpatients functional responses to treatment, measured by the Axis V scale used to assess current functioning, with their symptomatic changes. It found that the Axis V scale provided a different dimension of patients’ outcome than the symptomatic one.

Overall, only 19% of the patients were rated on Axis V as improved functionally at discharge, as compared to 55% rated as improved symptomatically. However, as outpatients completed more treatment sessions, increasingly larger percentages were rated as improved on the Axis V scale, ranging from 8.5% improved functionally after completing 1–5 sessions to 44.5% improved after 41+ sessions. Symptomatic ratings plateaued after 6–10 sessions, with 80%) of the patients being rated as improved symptomatically after completing treatment, no matter how many more treatment sessions they received before discharge.

The report discusses the implications of these findings for assessment of psychiatric patients’ treatment needs, goals of their treatment programs, and evaluation of treatment outcomes.
Fiscal and Service Analyses in General Hospital Psychiatry
Authors: Kline Stephen A. , Moldofsky Harvey
Published: April 2017

Fiscal matters were analyzed in four specialized programmes of the Department of Psychiatry at the Toronto Western Hospital in order to plan for service and academic activities. The resultant analysis allowed for the establishment of criteria for growth and the evaluation of clinical service performance and goals.
Psychosis and Positron Tomography
Authors: Seeman Mary V. , Seeman Philip
Published: April 2017

The new technology of positron emission tomography (PET) offers hope in developing objective biological indices and correlates of various psychotic states, including schizophrenia. PET is of the order of a million to a billion times more sensitive than MRI (magnetic resonance imaging) and is now successfully measuring the densities of various brain neurotransmitter receptors in health and disease. PET data in schizophrenia patients confirm that delusions and hallucinations are controlled by neuroleptics when the D2 dopamine receptors are specifically blocked. D1 receptors are not involved. The elevation of D2 receptors as a possible basis for psychotic symptoms needs additional investigation because of technical difficulties which need to be resolved. The rapid development of PET indicates its promise for differential diagnosis as well as its value in treating the psychoses.
Delirium: 100 Cases
Authors: Sirois François
Published: April 2017

One hundred consecutive cases of delirium seen in a psychiatric consultation service of a general hospital are discussed. Two thirds of the patients came from pneumology and cardiology since the hospital serves as a regional thoracic center. The frequency of delirium was 12.6% of consultations: three men were seen for every one woman; 80% of cases were over fifty years of age. The clinical aspects of delirium are studied according to DSM-HI criteria to evaluate: a) the frequency of the symptoms, b) the temporal course of the disorder, c) any clinical characteristic of delirium linked with potential etiological factors, d) the role of anxiety.
Aids Alarm: A Case Study
Authors: Mcmillan Janette , Noone Joseph , Tombaugh Tom
Published: April 2017

Acquired Immune Deficiency Syndrome (AIDS) has made a wide impact not limited to those persons who have or are likely to contact it. A case history of a man with a near-delusional belief he had AIDS is presented to exemplify the individual issues that concern about AIDS may raise. Thorough exploration of the dynamic interplay of biological, psychological and social factors is recommended in each case before reassurance may be effective. Psychiatric consultation should assist in developing optimal intervention in each individual case.
Delusional Depression following Benzodiazepine Withdrawal
Authors: Keshavan M.S. , Moodley P. , Eales M. , Joyce E. , Yeragani V.K.
Published: April 2017

Withdrawal from long-term treatment with benzodiazepines was followed in three patients by a severe delusional depression. The delusional depression may be related to the neurotransmitter changes accompanying benzodiazepine withdrawal. Caution should be exercised in long-term use of benzodiazepines in susceptible individuals.
Intractable Depression and Pseudodementia: A Report of Two Cases
Authors: Fisman M.
Published: April 2017

Two cases are presented to illustrate some of the issues that arise in the management of patients diagnosed as suffering from the dementia syndrome of depression (Pseudodementia). Case 1 illustrates the dilemma of relatively normal autopsy findings in the brain in a patient presenting with a history of depression and dementia. Case 2 deals with a patient successfully treated for depression 14 years after the diagnosis of presenile dementia. Issues raised include the problem of labelling and the Rip Van Winkle situation of unanticipated recovery 14 years after this diagnosis was made. A planned approach to the treatment of pseudodementia systematically exploring available treatment options is recommended.