bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Marital Intimacy in Psychiatric Help-Seeking
Authors: Chamberlaine Charles , Barnes Susan , Waring Edward M. , Wood Gary , Fry Richard
Published: April 2017

Epidemiological studies have shown that most people with diagnosable psychiatric illnesses do not seek professional help. Symptoms of non-psychotic emotional illness, interpersonal relationship quality and personality traits have demonstrable associations. The influence of these factors on help-seeking was examined by comparing 57 psychiatric outpatients with a community sample of 90 symptomatic individuals on self-report measures of marital intimacy, life events, and personality, while controlling for symptomatology. Compared to non-patients, outpatients reported less intimacy in their marriages across a variety of relationship dimensions on the Waring Intimacy Questionnaire, and scored higher on the Psychoticism scale of the Eysenck Personality Questionnaire. Marital Intimacy level proved to be the best single predictor of patient and non-patient status, suggesting that help-seeking behaviour may be partly motivated by unsatisfactory marriages. The detection of low marital intimacy in these help-seekers might be an indication for prescribing marital therapy.
Progrès récents dans l'étude de l'alcoolisme
Authors: Dongier Maurice
Published: April 2017

The phenomenon of denial of alcohol dependence prevails not only in a majority of alcoholics, but also in the diagnostic and therapeutic behavior of many physicians.

The reasons for this neglect of alcohol abuse are reviewed. In particular, value judgments rather than scientific data seem to lead a number of physicians to share the recent views of the U.S. Supreme Court on primary alcoholism: a “willful misconduct” rather than an illness. This dichotomy between primary and secondary alcoholism, simplistic in itself, is part of current attempts to describe a spectrum of alcoholic disorders, some more social, some more biological. The biological underpinnings of abnormal drinking behaviour include various abnormalities of cerebral neurotransmitters: dopaminergic, serotonergic, GABA and endogenous opiate systems among others. These abnormalities are partly genetically determined, pre-existing to alcohol abuse and explaining why “alcoholism runs in families”, and partly secondary to alcohol abuse. Their understanding may open the road to the use of specific pharmacological adjuvants in alcoholism treatment, in conjunction with psychotherapy, rehabilitation and self-help programs.
Consent to Treat: Clinical and Legal Implications
Authors: Manchanda R. , Fernando M.L.D. , Galbraith D.A.
Published: April 2017

Procedural requirements under the provisions of the Mental Health Act can delay the implementation of treatment for an involuntary psychiatric patient refusing treatment. The authors present such a case where treatment could not be given for nearly two months during which the patient's condition sharply deteriorated. With treatment, the patient improved within two weeks and was allowed to go home. Considerable time and money was spent in the Regional Review Board hearings. The implications of the case are discussed and it is recommended that steps be taken to prevent the interference of a bureaucratic legal system in the day to day practice of psychiatry.
Pediatric Psychopharmacology
Authors: Simeon J.G.
Published: April 2017

This article is a brief and selected overview of pediatric psychopharmacology, a field which links medicine, behavioural sciences, and neurosciences to child psychiatry. It will summarize current knowledge and recent advances related to the indications, effects, limitations and research issues of psychostimulants, antidepressants, antipsychotics, anxiolytics, anticonvulsants and diets used in the treatment of child and adolescent psychiatric disorders.
Development of a Young Man with Prader-Willi Syndrome and Secondary Functional Encopresis
Authors: Carpenter Susan P.C.
Published: April 2017

A case review of a twenty-two year old man suffering from Prader-Willi Syndrome, Secondary Functional Encopresis, mental retardation and aggressive behaviour is presented. Emphasis is made in assessing this man from various developmental perspectives. This includes: personality development, cognitive development, physical abilities, sexual development and family life stage. The role of a psychiatrist in treating this complex problem is established. An eclectic approach to treatment is reviewed using many therapeutic modalities found effective with the mentally handicapped. These modalities include: group therapy, play therapy, individual psychotherapy, behavioural therapy, family therapy, and use of medication. A literature review of Prader-Willi Syndrome is included.
Bulimia and Dissociative States: A Case Report
Authors: Chandarana Praful , Malla Ashok
Published: April 2017

The case history of a 17 year old girl, who initially presented with symptoms of bulimia and later developed dissociative states, is described. The possible relationship between bulimia and dissociative states is discussed in the context of psychometric tests and the underlying family dynamics.
Facteurs de risque et prévention des dyskinésies tardives
Authors: Wolf M.A. , Wertenschlag Et N.
Published: April 2017

Tardive dyskinesia is a frequent complication of a neuroleptic treatment. The physiopathology is unclear and the curative treatments inadequate. This explains the necessity for preventive measures at three levels: the prescription of neuroleptics, the evaluation of risk factors and early diagnosis. An analysis of epidemiological studies allows the evaluation of risk factors published in literature.
The Homeless Mentally III and the Need for a Total Care Environment
Authors: Belcher John R.
Published: April 2017

The dual conditions of homelessness and Serious mental illness are examined in a group of 132 former patients of a state hospital. A naturalistic approach was used in a six-month longitudinal Study that focused on the uniqueness and distinctiveness of a homeless existence. A more total care environment that recognizes a continuous service approach is necessary to meet the challenges presented by this population.
Psychiatry: Mindless or Brainless, Both or Neither?
Authors: Lipowski Z.J.
Published: April 2017

After a period marked by one-sided emphasis on psycho-dynamics and social issues, or what could be called “brainless” psychiatry on account of its relative neglect of cerebral processes, we are witnessing an opposite trend towards extreme biologism or “mindless” psychiatry. The pendulum has swung periodically from one to the other of these reductionists positions throughout the history of psychiatry. The author argues that neither brainless nor mindless psychiatry can do justice to the complexity of mental illness and to the treatment of patients. Psychiatry's distinguishing feature as a clinical discipline is its equal concern with subjective experience, or the mind, and with the body, including brain function, which together constitute a person, a psychiatrist's proper focus of inquiry and intervention. Moreover, a person, viewed as a mindbody complex, is in constant interaction with the environment. It follows that both study of mental illness and clinical practice need to take into account the psychological, the biological and the social aspects. These three aspects are not mutually reducible and are indispensable for the understanding and treatment of the individual patient. Such a comprehensive, biopsychosocial approach provides an antithesis to the reductionistic viewpoints and, in the writer's opinion, is both practically and theoretically most satisfying.
Metachromatic Leukodystrophy (MLD) in Hospitalized Adult Schizophrenic Patients Resistant to Drug Treatment
Authors: Galbraith D.A. , Gordon B.A., , Feleki V. , Gordon N. , Cooper A.J.
Published: April 2017

Metachromatic leukodystrophy (MLD) is a rare inherited neurodegenerative disease associated with a defect in the catabolism of sulphatide (galactocerebroside-sulphate) which accumulates in the nervous system. MLD can be diagnosed biochemically by demonstrating deficiency in the activity of the enzyme arylsulphatase A (ASA) and an excess of sulphatide in urine and tissues.

Cinically adult MLD may present as a schizophrenic-like psychosis, which typically develops years before the onset of neurologial signs which are not inevitable. Urinary ASA was investigated in 99 chronic hospitalized psychiatric patients (including 77 schizophrenics). Thirteen showed reduced ASA activity. Of the nine who were available for further study, only one evinced reduced ASA activity in other tissues (for example, leukocytes and cultured fibroblasts). However, there was no evidence of sulphatidurea with impaired sulphatide hydrolysis in his intact cultured fibroblasts. Therefore, he tested negative for MLD. This biochemical profile is known as pseudosulphatase deficiency. The possible relationship of pseudosulphatase deficiency to schizophrenic-like conditions is discussed.
Use of Neuroleptics after an Episode of Neuroleptic Malignant Syndrome
Authors: Padgett R. , Lipman E.
Published: April 2017

The authors report a case of unequivocal Neuroleptic Malignant Syndrome, in which the patient was successfully rechallenged with a different potent neuroleptic in substantial dosage during the recovery phase. The Neuroleptic Malignant Syndrome did not recur and the patient's psychosis cleared. Reference is made to the relevant world literature.
Trials of Adjunctive Alprazolam in “Negative Symptom” Patients
Authors: Adan Federico , Siris Samuel G.
Published: April 2017

Four case reports are described in which adjunctive alprazolam was administered to schizophrenic or schizoaffective patients who satisfied criteria for the syndrome of “negative symptoms”. The addition of alprazolam to ongoing neuroleptic and antiparkinsonian drug treatment produced substantial clinical benefit in only one of these cases, and that benefit was not replicated in a second trial in this case. These results are discussed in comparison to previously reported findings in other alprazolam-treated “negative symptom” patients.
Pharmacotherapy of the Borderline Patient: A Critical Review and Clinical Guidelines
Authors: Kutcher S.P. , Blackwood D.H.R.
Published: April 2017

The literature on the pharmacotherapy of Borderline Personality Disorder (BPD) is critically reviewed, and suggestions for the appropriate clinical use of psychotropic agents and directions for future research are made.
The Clinician-Investigator Interface in Psychiatry: I — Values and Problems
Authors: Garfinkel Paul E. , Goldbloom David S. , Kaplan Allan S. , Kennedy Sidney H.
Published: April 2017

The two following papers describe some of the benefits and problems involved in integrating clinical and investigative work. It is stressed that there are a number of advantages to such integration. Researchers especially benefit from the proximity to patients and clinicians. Education can be significantly enhanced when researchers and clinicians are in one setting and this can benefit residents, medical students and non-medical health personnel. There are a number of problems to such clinical research in psychiatry. These are discussed especially as they relate to senior faculty and their resistances to research. The shortage of clinician scientists in teaching positions means that most residents are not involved with such people as mentors early in their training and do not consider this as a career option after their residency training. Reductionistic thinking on the part of some researchers and when researchers are not first-rate clinicians both contribute to residents not becoming involved in clinical investigation. Funding policies as well as chairmen's hiring policies also play a role here.
The Clinician-Investigator Interface in Psychiatry: II - The Role of the Clinical Investigation Unit
Authors: Garfinkel Paul E. , Kennedy Sidney H. , Kaplan Allan S. , Goldbloom David S.
Published: April 2017

The Clinical Investigation Unit has served as a natural focus for clinical research; as such it has a number of advantages and specific problems. On such units a variety of themes may occur. Some of these have the potential to interfere with the integration of clinical and research work. These include the theme that the research itself is therapy, or that research will find all the answers. Both may result in problems for the functioning of the ward. Most problematic of all is the theme that research is harmful and exploitative. Optimally, the unit develops an attitude that the research is compatible with excellent patient care. Problems of patients, staff, ethical issues, admissions policies and problems of the clinician-scientists are reviewed with recommendations on how to minimize difficulties.
Mental Hospital Depopulation in Canada: Patient Perspectives
Authors: Herman Nancy J. , Smith Colin M.
Published: April 2017

This paper reviews briefly the history of mental health depopulation in Canada over the past 30 years. The term “deinstitutionalization” is often used but is unsatisfactory. Using an exploratory, qualitative, methodological approach, data were collected on the problems encountered by a disproportionate, stratified random sample of 139 formerly institutionalized patients living in various geographical locales in Eastern Canada. Adopting a symbolic interactionist theoretical approach, this study, in an effort to fill a neglect in the literature, attempted to discover what the everyday world(s) of Canadian ex-mental patients was really like. Problems encountered related to stigma, poor housing, lack of back living skills, poverty, unemployment and aftercare. Quotations from patients are provided to illustrate such themes. The findings are discussed.
Intérêt de l'information médicale au patient institutionnalisé
Authors: Peretti S.C. , Wolf M.A. , Garneau Y.
Published: April 2017

Medical information given to patients, notably to psychiatric patients, is guided by laws. Before starting any treatment the patient's informed consent is needed. One of the criteria of validity for such a consent is adequate information of the subject.

This study shows that certain factors interfere with the institutionalized patient's initial knowledge about medication, hospitalization and illness. It points out that learning is diminished by two factors: the diagnostic of schizophrenia and the length of stay in the hospital. However learning is not changed by severity of symptoms. On the other hand the initial knowledge level is diagnosis independent but altered in case of intense psychiatric symptomatology. Possible explanations of these data are discussed.

In conclusion, the importance of the variable of learning capacity is shown in the practice of the informed consent for psychiatric patients. The learning capacity must be taken into account when the patient is informed. Finally, additional research on that subject is indicated particularly concerning the persons disabled by schizophrenia.
Multiple Personality Disorder: An Analysis of 236 Cases
Authors: Ross Colin A. , Norton G. Ron , Wozney Kay
Published: April 2017

The authors collected a series of 236 cases of multiple personality (MPD) reported to them by 203 psychiatrists, clinical psychologists and other health care professionals. MPD patients experienced extensive sexual (79.2%) and physical (74.9%) abuse as children. They had been in the health care system for an average of 6.7 years before being diagnosed with MPD and had an average of 15.7 personalities at the time of reporting. The most common alter personalities were a child personality (86.0%), a personality of a different age (84.5%), a protector personality (84.0%), and a persecutor personality (84.0%). Patients MPD are highly suicidal with 72% attempting suicide and 2.1% being successful. The patients frequently received diagnoses for other mental disorders. The most common previous diagnoses were for affective disorders (63.7%), personality disorders (57.4%), anxiety disorders (44.3%), and schizophrenia (40.8%).
Blindness and Anorexia Nervosa
Authors: Mcfarlane A.C.
Published: April 2017

Two cases of anorexia nervosa in blind patients are reported. They demonstrate that blind children experience many developmental problems which are thought to be important in the etiology of anorexia nervosa. Similarly, blind children are unusually susceptible to misperceive their body size and weight. The apparent absence of a strong association between congenital blindness and anorexia nervosa challenges the presumed aetiological link between disturbed body image and identity diffusion, and anorexia nervosa.
Long-Term Follow-up of Depressive Pseudodementia of the Aged
Authors: Kral Vojtech A. , Emery Olga B.
Published: April 2017

Forty-four elderly patients of both sexes (mean age 76.5 years) suffering from depressive pseudodementia were intensively treated for the depression. When that cleared up, cognitive function reverted to premorbid level. Patients were regularly interviewed and retested at six months intervals for four to 18 years (average 8). Some patients experienced, during the follow-up period, a recurrence of the depression for which they were again successfully treated. At the end of the observation period, 39 of the 44 patients (89%) had developed a dementia syndrome of the Alzheimer type.
Hyponatremic Seizure following ECT
Authors: Finlayson A.J.R. , Vieweg W.V.R. , Wilkey W.D. , Cooper A.J.
Published: April 2017

This report describes the investigation of a spontaneous grand mal seizure in a 55-year old woman, being treated with drugs and ECT for depression. The spontaneous seizure was due to hyponatremia caused by self-induced water intoxication, although psychotropic medication may have contributed by lowering the seizure threshold. The diagnosis of hyponatremia is discussed.
Adolescent Personality Development: Three Phases, Three Courses and Varying Turmoil. Findings from the Toronto Adolescent Longitudinal Study
Authors: Golombek H. , Marton P. , Stein B.A. , Korenblum M.
Published: April 2017

The Toronto Adolescent Longitudinal Study was launched in 1977 to examine personality development in a non-clinical sample of children from ages ten through 19 over an eight year period. Following a description of their conceptualized model of personality and of the nature of the study, the authors summarize their findings which suggest new perspectives in three areas of adolescent personality development: 1) the subphases of adolescence, 2) the routes of passage through which adolescents proceed, and 3) adolescent turmoil.
Marital Intimacy in Parents of Exceptional Children
Authors: Fisman Sandra N. , Wolf Lucille C. , Noh Samuel
Published: April 2017

The purpose of this study was to examine the role of perceived parenting stress and parental depression on marital intimacy between parents of handicapped children versus developmentally normal children, and to investigate discrepancies between husbands' and wives' reports of marital intimacy. The parents of 31 autistic children, 31 Down Syndrome children and 62 developmentally normal children, matched for both mental and chronological age were studied. Results indicated significantly greater stress and depression, as well as lower marital intimacy for mothers of autistic children than mothers of normal children, and significantly greater stress than mothers of Down Syndrome children who fell somewhere between other groups of parents in all three measures. Fathers of autistic children experienced significantly higher parenting stress than the other groups, as well as lower marital intimacy but there were no differences amongst fathers on measures of depression. Low scores on subscales of identity and compatibility for mothers implying low self esteem contributed significantly to the lowered perception of marital intimacy. Implications for intervention, based on these findings, are discussed.
Joint Custody: Historical, Legal, and Clinical Perspectives with Emphasis on the Situation in Canada
Authors: Fidler Barbara J. , Saunders Elisabeth , Freedman Elaine , Hood Eric
Published: April 2017

The search for ways to mitigate the effects of family breakdown on parents and children includes legislative and clinical efforts which to some extent influence each other. In the past year much public interest has been aroused in Canada, and particularly in Ontario, in the issue of legislative changes which would make joint custody the usual or “preferred” legal disposition of custody cases. This paper provides a discussion of the legislated preference, or “rebut-table presumption” of joint custody from a historical, legal and clinical point of view.

Definition and elaboration of what joint custody is from the legal and practical perspectives is provided with an emphasis on Canadian laws and practice. The legal rights of the non-custodial parent are explained, and relevant case law is highlighted. The relationship between joint custody, support orders and relitigation rates are elaborated. Following this is a critical overview of the empirical research on joint custody as it relates to the adjustment of children and parent satisfaction is included.

It is concluded that while there is little question that shared parenting can be beneficial to children, the enthusiasm of legislators for joint custody has not been supported by empirical data. It is necessary to examine under what circumstances and for which kinds of parents and children joint custody might be beneficial since it is unlikely that one solution will fit the needs of all families and all stages of family life.
The Role of Child Psychiatrists as Consultants to Day Cares
Authors: Weiss Jacqueline , Laroche Catherine
Published: April 2017

An increasing number of mothers of preschool children in Canada (either by choice or economic necessity) have entered the workforce. It is estimated for example that 58–80% of mothers of preschool children are working. In Canada in 1986, 51.6% of women in the workforce had children under the age of five (1).

It is beyond the scope and intent of this paper to discuss the merits (or possible harm) of day care per se. The aim of this paper is to discuss aspects of the quality of day care, and how this might be improved by child psychiatrists being involved in day care centres and in their organization. Few would doubt that the emotional climate and the development of trusting relationships to significant others, in the first year of life, are essential determinants of the healthy personality. Hence the quality of the day care experience of small children is an essential area of study for the child psychiatrist which is as yet insufficiently recognized.

This paper discusses what has been learned from the literature and from experience as a consultation-liaison child psychiatrist to a day care centre. A case example illustrates some of the important issues.
Tricyclic Antidepressants: Contemporary Issues for Therapeutic Practice
Authors: Pollock Bruce G. , Perel James M.
Published: April 2017

The clinical pharmacology of tricyclic antidepressants is reviewed, with an emphasis on recent findings. These medications have become the treatment of choice for the majority of depressed patients. Their efficacy is limited by lack of vigor and precision in dosage. Pharmacokinetic aspects are addressed which affect the rationale for selective use and interpretation of plasma concentration monitoring. These include nonlinearity, active metabolites, plasma protein binding and age effects. Specific indications for therapeutic drug monitoring occur with patients who fail to respond, those at risk because of age, medical condition or polypharmacy, and to check compliance. Integration of knowledge concerning pharmacokinetics and plasma levels with clinical response will aid in making appropriate pharmacotherapeutic decisions.
Economic Evaluations in the Canadian Mental Health System I: Theory behind Economic Evaluation*
Authors: Fried Bruce J. , Worthington Catherine , Deber Raisa B.
Published: April 2017

Economic evaluation is becoming an increasingly important part of the evaluation of health and mental health services. Current models for conducting economic evaluation, including cost-effectiveness analysis, cost-benefit analysis, and cost-utility analysis, have great potential for improving the quality of decision-making and for making mental health programs more effective and efficient. This paper presents the basic economic theory underlying the various forms of economic evaluation and provides general guidelines for developing and conducting an economic analysis of a health program.
Focal Family Therapy Outcome Study I: Patient and Family Functioning*
Authors: Levene Judith E. , Newman Francis , Jefferies J.J.
Published: April 2017

This pilot study compared the efficacy of two models of family therapy plus medication in the treatment of ten schizophrenic patients previously considered poor responders to neuroleptics alone. Focal Family Therapy (FFT), a limited psychodynamic model, was compared with Supportive Management Counselling (SMC), an educative, problem-solving approach. Family treatment was begun during admission to hospital and continued for up to six months post-discharge. Patient and family measures were administered on assessment, termination, and at three, six and 12 month follow-up interviews. Our data suggest that patients in both groups improved significantly following treatment on measures of social functioning and community tenure. The average increase in amount of time out of hospital was a full year, compared to previous rates. Patients receiving FFT demonstrated significantly greater improvement in symptoms, compared to patients in the SMC group. On average, families scored in the normal range on the family functioning measure at assessment and upon termination of treatment.
Admitting Whole Families: An Alternative to Residential Care
Authors: Dydyk Barbara J. , French Glenn , Gertsman Cynthia , Morrison Noreen , O'neill Irene
Published: April 2017

This paper is an examination of the effectiveness of a programme (described in detail elsewhere) designed to admit whole families for short-term intensive assessment and treatment. The goals of this programme are to eliminate residential care for symptomatic children who are admitted with their families to this service, to decrease the length of stay of the symptomatic child in residential treatment, if this is required following admission of the whole family to this unit, and to provide these services at costs comparable to or less than that currently being spent with conventional residential treatment. Results stemming from a number of pre- and post-treatment measures indicate that one half of children initially assessed and recommended for inpatient treatment had successfully avoided inpatient treatment for six months following admission of their family to this unit. For children recommended for residential care after admission of their families to the family unit, a reduction of approximately 35% of total time in residence occurred (when compared with a comparison group). A cost saving of over $12,000 per case was realized as a result of admission of the whole family when compared with residential treatment.
The Impact of Group Therapy for Adult Survivors of Childhood Sexual Abuse*
Authors: Carver Claudia M. , Stalker Carol , Stewart Elizabeth , Abraham Betsy
Published: April 2017

This article reports on 95 women who were referred to an outpatient psychiatry clinic for group therapy for adult survivors of childhood sexual abuse. Criteria for exclusion in group therapy are outlined and the format of the group therapy is described. Those who completed the groups are compared to dropouts. The group's effectiveness was evaluated using measures of psychiatric symptomatology (SCL 90), depression (Zung Self-Report Depression Scale), and self-esteem (Texas Social Behaviour Inventory) with a pre/post test design. Clients' evaluation questionnaires were also used. Group therapy was found to be effective in reducing symptomatology and change was in the expected direction in terms of depression and self-esteem.
Effects of ECT on Prolactin, LH, FSH and Testosterone in Males with Major Depressive Illness*
Authors: Cooper A.J. , Finlayson R. , Velamoor V.R. , Magnus R.V. , Cernovsky Z.
Published: April 2017

Fourteen males with major depressive illness (DSM-III) received a course of electroconvulsive therapy (ECT). Serum prolactin (PRL), luteinizing hormone (LH), follicle stimulating hormone (FSH) and testosterone (T), were measured 15 minutes before and 15 minutes after each treatment. The severity of depression was assessed with the Hamilton Rating Scale for Depression (HRSD) two to three days before the first and two to three days following the last treatment. Post-ECT levels of PRL and LH were significantly higher than pre-ECT levels across every treatment. Changes in FSH and testosterone were not significant. There were no relationships between hormone levels (first versus last ECT) and severity of depression, including sexual functioning.

It is argued that the relatively greater increases of LH than FSH is due to an acute antidopaminergic action of ECT which acts selectively on the secretion of the former. The blunted testosterone response to the increase of gonadotropins may be due to ECT-induced hyperprolactinemia.
Organic Mania Induced by Phenytoin: A Case Report*
Authors: Patten S.B. , Klein G.M. , Lussier C. , Sawa R.
Published: April 2017

Organic Mood Disorder of the manic type is a syndrome which resembles a manic episode but is due to a specific organic factor. Organic mania may be associated with a variety of physical illnesses such as temporal lobe epilepsy, multiple sclerosis, neoplasms and hyperthyroidism. In addition, organic mania can be associated with drugs including L-dopa, decongestants, sympathomimetics, steroids, baclofen withdrawal, cimetidine, and possibly captopril. This report describes a case of a 74 year old female who presented with a full syndrome of mania soon after being started on Phenytoin. Neither the clinical picture, Mini-mental state score, nor EEG findings were suggestive of delirium. The syndrome resolved soon after the phenytoin was discontinued. This case suggests that phenytoin should be added to the list of medications capable of producing Organic Mood Syndrome, manic type.
La dépression percue par le public et la dépression décrite par le DSM-III sont-elles les mêmes?*
Authors: Kovess Vivianne , Murphy H.B.M. , Tousignant Et M.
Published: April 2017

The public usage of the word depression does not correspond to the descriptions of depression proposed by classifications such as the DSM-III. Data from the pilot survey of Santé-Québec covering 3,291 persons distributed in two areas, one rural (D.S.C. of Rimouski) and other urban (D.S.C. of Verdun), allow to compare the use of the term depression between an informant reporting on a family member when this expression is included in a list of chronic illnesses, and an informant reporting on a self-administered questionnaire, symptoms similar to the diagnostics of depression and dysthymia of the DSM-III. Result show a low degree of correspondance between the term of depression as used by laypersons and as applied by medicine (14%); the small overlap mainly concerns the serious cases. Depression in its lay usage is refering less often to the psychic manifestations of the medical depression, i.e. lack of positive experiences, hopelessness, boredom, but it is often applied to persons who are not able any more to achieve social roles. The usage of the lay label varies according to sex and rural-urban origin. It applies more often to urban women under 40, even though these women are not showing the DSM-III signs of depression. On the other hand, rural men are almost never associated with this label even though a certain proportion meet the DSM-III criteria for depression. The discussion offers explanations for the different use of the label in urban and rural areas.
Psychostimulants in Psychiatry
Authors: Warneke Lorne
Published: April 2017

The use of the psychostimulants in psychiatry is reviewed. A brief historical perspective on dextroamphetamine is presented, and a brief review of the psychopharmacology of dextroamphetamine, methylphenidate and magnesium pemoline is given. The literature on the use of stimulants in the treatment of resistant depression, apathetic geriatric patients and patients medically ill with a secondary depression is summarized and two case histories given to illustrate the clinical usefulness of the stimulants. The literature on the use of stimulants as an adjunct to antidepressant therapy and as a diagnostic test is also discussed. Finally the use of stimulants in obsessional illness and adult attention deficit disorder is summarized. The writer concludes by commenting that the stimulants have a very useful role in the treatment of certain categories of depression as well as other psychiatric syndromes and such patients should not be deprived of symptom relief by these drugs. The approach to therapy should be much the same as the use of analgesics for chronic pain sufferers.
Effect of Concurrent Medical Illness on Dexamethasone Suppression Test Results in Depressed Inpatients
Authors: Cooke Robert G. , Warsh Jerry J. , Stancer Harvey C. , Hasey Gary M. , Jorna Thecla , Langlet Francoise
Published: April 2017

A retrospective evaluation of the clinical records of 138 depressed patients, who received the dexamethasone suppression test (DST) as part of a standardized physical and psychiatric assessment protocol, revealed that 60 had acute, chronic (mild or severe), stable or remitted medical conditions. The proportion of DST nonsuppressors did not differ between depressed subjects with medical conditions (45 % nonsuppressors) and those without (34.6% nonsuppressors; p > 0.2). However, all of the six subjects with acute or chronic-severe medical conditions were found to be nonsuppressors (p = 0.003). These results may help clarify the medical exclusion criteria for the clinical application of the DST.
Pensée formelle, opérations logico-discursives et schizophrénie: étude expérimentale d'un cas clinique
Authors: de Bonis Monique , Epelbaum Catherine , Féline André , Grize Jean-Blaise , Hardy Patrick , Somogyi Maria
Published: April 2017

This study, based on a single case experimental design, examined logical reasoning in a schizophrenic meeting the DSM-III criteria. The quantitative assessment carried out by 32 psychiatrists on a rating scale for logical thinking disorders (nine items, six points) of the retranscribed clinical interview showed 1. that the assessments varied in a statistically significant way according to items and psychiatrists, and that these variations were independent of their degree of experience — the correlations between the different items of the rating scale proved to be weak and not significantly different from zero; and 2. the study of the most contradictory statements carried out by a logician using reasoning analysis procedures concluded that there were in fact logical relationships between the subjects the schizophrenic talked about.

The results are discussed in relation to the methodology of assessing formal thought in schizophrenia.
Some Factors Relating to Satisfactory Post-Discharge Community Maintenance of Chronic Psychotic Patients
Authors: Fernando M.L.D. , Velamoor V.R. , Cooper A.J. , Cernovsky Z.
Published: April 2017

The length of time a group of 70 psychiatric patients could be maintained in the community following discharge from a provincial hospital was found to be significantly related to post-discharge compliance with medication and to the level of discharge planning (well planned versus unplanned, or patient prematurely self-discharged against medical advice). Various demographic and clinical variables were unrelated to the length of post-discharge survival in the community.
A Brief Note on Serum Calcium Levels in Schizophrenics and Controls
Authors: Khan A. , Tupling D.
Published: April 2017

The present investigation examined the relationship between serum calcium levels and schizophrenic disorder. Unlike earlier studies a wider range of diagnoses was surveyed, subjects were limited to first time admission, and the relationship of socio-demographic factors to the hypothesized biological risk factor was assessed. Analysis revealed no significant differences in levels of serum calcium between schizophrenics and four nonschizophrenic comparison groups, nor were any one of several socio-demographic factors found to correlate significantly with serum values. Some risk factors, however, differentiated between schizophrenics and nonschizophrenics. They were being single, poor employment history, and reason for admission. A more promising avenue for further research in the area is outlined.
The Impact of the Amended Ontario Mental Health Act (Bill 7) on Patients Discharging Themselves from Hospital against Medical Advice (AMA): A Preliminary Study
Authors: Fernando M.L.D. , Cooper A.J. , Cernovsky Z. , Bailey C. , Velamoor V.R.
Published: April 2017

Bill 7, the most recent amendment to the Ontario Mental Health Act was introduced in December 1986. It has resulted in some major changes to the practice of psychiatry, especially in provincial hospitals. We compared patients who had discharged themselves against medical advice (AMA) during the six months before the Bill was enacted, with those who discharged themselves AMA in the 12 months following. Significantly more patients discharged themselves AMA in the post- than the pre-Bill period. The majority of these were potentially treatable, acutely ill individuals with schizophrenia or affective disorder. We argue that Bill 7 has largely failed in its objective to improve the overall “quality of care” to psychiatric patients, at least in the short term.
Postpartum Psychiatric Disorders
Authors: Steiner Meir
Published: April 2017

The literature on postpartum psychiatric disorders (PPD) is reviewed with particular reference to recent advances in the field. Despite the prevailing tendency to consider PPD as a manifestation of other pre-existing psychiatric disorders (i.e. affective, schizophreniform, organic, neurotic, etc.) a growing number of studies point to the uniqueness and specificity of postpartum symptomatology. Theories of etiology, psychosocial as well as biological, are still wide-ranging and unconvicing. Attempts to predict PPD and/or to identify mothers-to-be at risk are based largely on retrospective studies or else are hindered by the use of nonspecific instruments. Society's implicit belief in the “joys of motherhood” may have further contributed to the obscurity surrounding these frequently occurring disorders. Interventions follow conventional methods of psycho- and pharmacotherapy but the multidisciplinary treatment approach especially for women with acute PPD who require hospital admission is gaining wider acceptance. The inpatient psychiatric mother-baby intensive care unit model is part of this approach.
Aspects contemporains de la psychiatrie en Chine Populaire
Authors: Stip Emmanuel
Published: April 2017

Psychiatry in Communist China is at a delicate phase where it is drawn both to modern Western medicine and to the wealth of traditional medicine. This is conveyed through accounts of some present-day situations as seen by the author during stays in Peking and Shanghai. After the treatment provided in various hospitals for acute-care and chronic-care patients is described, we are introduced to the organization of mental health at the various levels of hospital and external structures. A general survey of the research being done in epidemiology, neurology and traditional medicine at the Peking Research Centre is also presented. The novel nosography reveals one particular entity: phasophrenia, described as a stereotyped and recurring acute psychotic episode that responds poorly to neuroleptic chemotherapy. Finally, the medico-legal aspects of psychiatry and the effects of the new birth-rate policy are briefly discussed.
Fatal Attraction: The Ethical and Clinical Dilemma of Patient-Therapist Sex
Authors: Carr Melanie , Robinson G. Erlick
Published: April 2017

This article reviews the existing literature on the subject of patient-therapist sexual contact. Seven point one percent to 10.9% of male therapists and 1.9% to 3.5% of female therapists admit to engaging in intimate contact with patients. Offenders tend to justify their behaviour as being at least innocuous if not beneficial for the patients. The consequences to the patients include increased psychological and psychosomatic complaints, greater mistrust and anger towards men, hospitalization and suicide. Transference and countertransference issues which account for this behaviour are explored as is the issue of post-termination involvement. Education of physicians and residents concerning the temptations and dangers of this type of contact is strongly recommended.
Women as Torture Victims
Authors: Allodi F. , Stiasny S.
Published: April 2017

This paper reports a retrospective study of the frequency, severity, modalities and mental health consequences of torture in 28 Latin American refugee women in Toronto. The data on these women and a comparison group of male torture victims were retrieved from case records in a hospital outpatient clinic.

The results support the hypotheses implicit in the scanty literature available that the frequency and effects of torture in women differ from those found in men. Infernale victims, as in their male counterparts, the severity of the torture was related to the degree of their political involvement. However, torture was more frequently sexual, and its consequences more often affected the women's sexual adaptation.
Canadian Projections of Cases Suffering from Alzheimer's Disease and Senile Dementia of Alzheimer Type over the Period 1986–2031
Authors: Gautrin Denyse , Froda Sorana , Tetreault Hugues , Gauvreau Denis
Published: April 2017

Alzheimer's disease (AD) is characterized by irreversible changes in cognitive and intellectual functions, accompanied by progressive memory loss, and described by neurochemical and neuropathological impairments. The classic term Alzheimer's disease applies to presenile dementia, while all of the syndromes that share the distinctive signs of AD are known as senile dementia of the Alzheimer type (SDAT). In Canada, as in several other industrialized countries, we are seeing a rapid growth of the elderly population. The renewed interest in AD and SDAT is partly attributable to the view that the increasing percentage of sufferers will have a significant socioeconomic impact. Few attempts have been made to project the number of cases of SDAT in Canada. In assessing the prevalence of SDAT in an over 65 population, a rate of 2.5% (or 3%) is commonly applied. This rate corresponds to one half the estimated prevalence rate for all severe types of dementia, using an average of the rates arrived at by some ten studies. The authors dispute this approach: i. the assumption that 50% of dementia cases will be AD is not verified for all populations; ii. the use of a single prevalence rate for everyone over age 65 is rather uninformative; and iii. the combining of results from various sources is questionable given the possible lack of consistency in the following respects: diagnostic criteria, methods of investigation, effort made to recruit cases, and representativeness of the groups studied. In this article, prevalence rates by age group have been inferred based on two Finnish studies conducted in the 1980s on the prevalence of AD in the general population. The prevalence rates obtained were: one percent for ages 65 to 74, four percent for ages 75 to 84, and 10.5% for ages 85 and over. When these rates are applied to the projected population for the years 1986 to 2031 (Statistics Canada), the result is an estimated 73,696 cases occurring in 1986, and 215,847 cases in 2031. This procedure takes into account variation due to the age and heterogeneity of the population, and the authors consider these projections to be the most accurate assessment to date of the scope of the problem of SDAT in Canada.
Homicidal Parents
Authors: Bourget Dominique , Bradford John M.W.
Published: April 2017

This paper describes a series of 13 cases of parents who have killed their children. A review of the literature suggests that child murder is infrequent and committed in most instances by the parents. Most attention has been directed to the universal phenomenon of child abuse. The killing of a child in our culture is viewed much more seriously than the killing of a newborn infant, legally defined as infanticide. Only a few authors have reported on the former, and their studies tend to demonstrate that a higher proportion of these crimes are perpetrated by mothers. Homicidal behaviour in parents may also be associated with common forms of psychiatric disorders and may manifest as the extended suicide phenomenon (homicide reported with major depressive illness). Attributes of both parents and the children are also significant factors to be considered. In a retrospective study the relevant demographic and clinical data of a series of 13 cases are reviewed. The diagnostic classification using DSM-III-R is discussed in detail. A higher incidence of maternal perpetrators was found and is consistent with previous studies. Exposure to a variety of psychosocial stresses appears to have been a major factor. Similarly the suicidal history and behaviour of the subjects is significant. Affective disorder appears to be an important diagnostic category. Finally, the role of psychiatric and other social agencies is considered in relation to the murder of children. A better understanding of this phenomenon is indicated in order to help us deal with families at risk.
Valproic Acid and Panic Disorder
Authors: Primeau Francois , Fontaine Rejean , Beauclair Linda
Published: April 2017

Valproic acid (VA), an anticonvulsant which increases GABAergic transmission was given to patients suffering from recurrent panic attacks. Ten consecutive outpatients were included in this study. After a seven day placebo washout period, patients were given a dose of 500 mg/day, which was gradually increased to a maximum of 2250 mg/day. A significant improvement was found in the symptomatology of patients as measured on the Clinical Global Impression Scale for panic severity (p < 0.001), the Hamilton Psychiatric Rating Scale for Anxiety (p < 0.001) and the panic factor of the SCL-90 (p < 0.05). These findings support the hypothesis that VA is useful in the treatment of panic disorders. Further research should be carried out to assess its efficacy and safety.
Psychiatric Residents' Educational Experiences and Attitudes toward Eating Disorders
Authors: Ghadirian A. Missagh , Leichner Pierre
Published: April 2017

Our study of 180 psychiatric residents from all 16 Canadian psychiatric training centres showed that only 22.2% found university teaching on eating disorders adequate. Eighty-nine percent believed formal instruction on anorexia nervosa (AN) and bulimia nervosa (BN) should be made mandatory. Significantly more female than male residents were interested in AN and BN patients. The authors suggest special attention be given to residents' curriculum on the subject.