bluuebunny/crossref_metadata_2025 huggingface dataset:
EEG Findings and Language Patterns in Autistic Children: Clinical Correlations
Authors: Dorenbaum David , Mencel Elizabeth , Blume Warren T. , Fisman Sandra
Published: April 2017

Several authors have used the EEG as a diagnostic tool to identify distinctive patterns of cerebral dysfunction in autistic children. However, evidence is needed to support the hypothesis that their level of functioning correlates with their EEG profile. In this study EEG's were obtained in 17 autistic children without sedation and following sleep deprivation. These children were also evaluated in a double blind procedure with regard to their speech and communication abilities. We did not find a statistically significant correlation between EEG changes and speech performance. None of the autistic children using an augmentative system of communication had any EEG abnormalities. However, a normal EEG is not sufficient to predict successful response to communication therapy. Since the effect of sedative drugs on brain electrical activity limits the value of tracings, we recommend the sleep deprivation techniques when “difficult” children have to undergo EEG testing. Parents' or guardians' participation during the procedure is encouraged.
Reibl v. Hughes: The Consent Issue
Authors: Arboleda-Florez J.
Published: April 2017

Inviolability of the person is the basic principle underpinning the concept of consent to treatment. Although it is not a new concept, consent has become a major medico-legal issue because of a shift, within the doctor/patient relationship, towards more autonomy for the patient and less paternalism from the doctor. This change has been given further impetus by legal decisions such as Reibl v. Hughes and Hopp v. Lepp. In this paper the author reviews the nature of the changes and the impact of the legal decisions on the doctor/patient relationship. He concludes that a legal approach to consent is sterile if it is a substitute to open communication between the doctor and the patient, or to their acceptance of a principle of “equality of two participants”. Consent is based on the basic principal of the inviolability of the person, that is, the right, at all times, of every individual not to have his body tampered with without his permission or agreement, and to be the whole decision-maker on matters that affect his physical integrity. This right is not absolute: it may be abrogated by the state for health or judicial reasons, or the person may not be in a position to exercise it, such as when unconscious or because of mental disability. This paper will review present Canadian laws on consent. It will contrast the legal approach to consent to the ethical-humanistic approach which could be developed within the context of the doctor/patient relationship.
Cyproheptadine Dependence Associated with an Atypical Somatoform Disorder
Authors: Craven John L. , Rodin Gary M.
Published: April 2017

A case is described of cyproheptadine dependence in a woman with a persistent belief that she was too thin, and diagnosed with an atypical somatoform disorder. The cyproheptadine was initially prescribed to promote weight gain but its continued use seemed related to other psychological and/ or pharmacological effects. Cognitive impairment was present, possibly as a result of the longstanding cyproheptadine abuse. There have been no previous reports of cyproheptadine dependence or of CNS toxicity from its long-term use.
Thrombocytopenia Associated with Chlorpromazine, Haloperidol and Thiothixene: A Case Report
Authors: Balon Richard , Berchou Richard , Zethelius Magnus
Published: April 2017

Hematological side effects of neuroleptic drugs occur infrequently but remain a potential cause of serious toxicity. A case of recurrent thrombocytopenia due to the repeated exposure to chlorpromazine (twice), haloperidol (four times) and thiothixene (twice) in a 59 year old female treated for schizophrenia is reported. Treatment difficulties and implications of this case are discussed.
Psychodynamic Group Treatment of Young Adult Bulimic Women: Preliminary Positive Results
Authors: O'neil Mary Kay , White Patricia
Published: April 2017

This paper presents preliminary results of symptomatic and behavioral changes and psychodynamic observations for 9 young adult bulimic women treated with psychodynamic group psychotherapy. Pre/post group test results showed significant improvement on all measures of eating pathology, on the EDI ineffectiveness item and the Janis-Field feelings of inadequacy scale as well as on the total score of the Hopkins Symptom checklist. These results were consistent with independent clinical conclusions and with verbal reports of improvements in hinging and purging behaviour. Clinical content shed light on the role of the parents, especially the father, in the development of body-image, sense of adequacy and self-esteem, life goals and feminine identification. The authors conclude that clinical observations to date have yielded interesting psychodynamic hypotheses and the initial symptomatic improvements warrant cautious therapeutic optimism.
Dexamethasone Suppression Test and the Response to Antidepressant Depending on Their Central Monoaminergic Action in Major Depression
Authors: Benkelfat C. , Poirier M.F. , Léouffre P. , Gay C. , Löo H.
Published: April 2017

After 1 mg DST, 25 major depressive patients (DSM-III) received at random either a specific inhibitor of noradrenaline reuptake (Maprotiline) or an inhibitor of serotinin reuptake (Indalpine or Citalopram). After at least 3 weeks of treatment, no difference was found in treatment response between suppressors and non suppressors. This study is unable to confirm the usefulness of the DST in selection of treatment according to its central activity on serotonin or noradrenaline-reuptake.
The Effects of Teaching Medical Students Psychotherapy Skills in the Outpatient Department
Authors: Frank Daniel , Propst Arthur , Goldhamer Paul
Published: April 2017

A psychiatric clerkship which emphasizes a clinical exposure to the conduct of outpatient psychodynamic psychotherapy is described and evaluated. Compared to more traditional inpatient based clerkships, an outpatient psychotherapy-oriented clerkship attracts significantly greater numbers of students. In addition, medical students taking such a rotation rate its educational value on its completion significantly more positively compared to other clerkship sites. Finally, students taking the psychotherapy oriented clerkship opt for psychiatry as a specialty significantly more frequently than students taking the more traditional clerkships. The impact of such a learning experience on interpersonal skills with non-psychiatric, medical patients is also discussed.
Relationship Between Dysfunctional Cognitions and Depressive Subtypes
Authors: Norman William H. , Miller Ivan W. , Keitner Gabor I.
Published: April 2017

The results of this study suggest that the relationship between cognitions and severity of depression hypothesized by cognitive theorists may be relevant only to a subgroup of depressives. In a sample of 40 inpatients with major depression who received the Dexamethasone Suppression Test (DST), scores on the Dysfunctional Attitude Scale were equivalent in suppressor and nonsuppressor groups, as well as in melancholic and nonmelancholic depressive groups. Neither was there a difference between suppressors and nonsuppressor s on measures of depression. However, in the nonmelancholic group, there was a significant relationship between dysfunctional cognitions and severity of depression. This relationship was not found in the melancholic group. Finally, independent of diagnostic and biological subtype, patients with elevated levels of dysfunctional cognitions when compared with the remaining sample revealed greater severity of depression, more days in hospital and more readmissions to hospital.
Neither Lions Nor Tigers: Disorders which Lie between Schizophrenia and Affective Disorder
Authors: Munro A.
Published: April 2017

Are schizophrenia and major affective disorders truly distinct conditions? The answer remains debatable, but it is suggested that lack of recognition of intermediate disorders is a factor in preventing an authoritative answer to the question.
A Clinical Trial of Buspirone and Diazepam in the Treatment of Generalized Anxiety Disorder*
Authors: Ross Colin A. , Matas Manuel
Published: April 2017

In double-blind trials with hundreds of patients, buspirone has proven to be as effective an anxiolytic as the benzodiazepines. It causes less sedation and motor impairment than diazepam, and may be particularly useful in geriatric patients. We conducted a 4 week double-blind, randomized trial of buspirone versus diazepam and placebo in thirty adult outpatients with generalized anxiety disorder. Maximum doses were 40 mg of diazepam or buspirone or eight placebo tablets a day. There were no significant differences in outcome between the three groups on any physician or subject measures. Some implications of this finding are discussed.
The Classification of Disturbed Personality Functioning in Early Adolescence
Authors: Korenblum M. , Golombek H. , Marton P. , Stein B.
Published: April 2017

This study describes disturbed personality functioning in early adolescence. A non-clinical sample of 63 thirteen year olds underwent a semi-structured psychiatric interview as part of a longitudinal study investigating the relationship between competence in personality functioning and development. The presence of personality disturbance was determined by two psychiatrists who rated the adolescents on a personality functions scale. The raters then described the type of disturbance using Axis II of DSM-III as a guideline.

Forty-six percent of the sample were found to have some degree of disturbed personality functioning. Of these, over one-half fell into a cluster comprised of avoidant, dependent, compulsive, or passive-aggressive types, while another third were characterized by antisocial tendencies. Severity of disturbance was not related to type of disturbance.

Ratings of behaviour by teachers and parents supported the division of subjects with personality dysfunction into two broad groups: an anxious, fearful, “quiet” cluster; and a group of more “acting out”, disturbing individuals. However, parents and teachers could not distinguish the “quiet” group from teenagers who were free of disturbed personality functioning.

These data indicate that it is possible to classify a segment of a non-clinical population of young adolescents who had personality dysfunction using Axis II of DSM-III as a guideline. Furthermore, such a group of teenagers is not homogeneous. They distribute themselves into internalizing and externalizing clusters.
Delusional Disorder in Mother and Daughter: Case Report*
Authors: Stein Murray B. , Forbes R.D.
Published: April 2017

The occurrence of delusional disorder in a mother-daughter pair is described. The significance of this report is discussed in light of recent family studies of this disorder, and in reference to treatment implications.
Porphyria and Psychosis: A Case Report*
Authors: Grabowski John , Yeragani Vikram K.
Published: April 2017

This article reports the case of a 41 year old female with a history of acute intermittent porphyria who presented with exacerbation of a chronic psychotic illness. Though the evaluative studies for an acute porphyric episode were negative, psychological testing was consistent with an organic patchy cognitive decline. This finding is discussed in relation to the reported assymetric neuropathic lesions reported in porphyria.
Hypofrontality in Schizophrenia: A Review of the Evidence*
Authors: Williamson Peter
Published: April 2017

This paper reviews the possible role of frontal lobe dysfunction in the pathophysiology of schizophrenia. Pathological, computerized axial tomography (CAT) scan and magnetic resonance imaging (MRI) studies have indicated that a substantial number of schizophrenic patients show structural abnormalities in the frontal lobe areas and other parts of the brain. In some cases, these changes can be correlated with negative symptoms. Attempts to study frontal lobe function with neuropsychological tests, topographic EEG, cerebral blood flow (CBF) and positron emission tomography (PET) scans have also indicated that a substantial number of schizophrenics show abnormalities compared to normal controls. However, these abnormalities can be seen to some degree in other conditions. As well, patients early in the course of their illness tend not to show frontal lobe functional abnormalities. The implications of these findings for current theories of schizophrenia are discussed.
The Relationship Between Anxiety and Depression in Children: Rating Scales and Clinical Variables*
Authors: Stavrakaki C. , Vargo B. , Boodoosingh L. , Roberts N.
Published: April 2017

The present study examined the relationship between anxiety and depression in children in the context of proposed adult models. The results support the qualitative distinction between anxious and depressed patient groups on subsets of rating scale measures and clinical variables. In contrast to anxious children who were younger, (day patients) had been ill for longer than one year, presented with behavioral problems, and were low on observer ratings of depressive symptoms; depressed children were older, (inpatients) had been ill for less than one year, presented with emotional problems and were high on observer ratings of both anxious and depressive symptoms. The finding that the older depressed children were concurrently anxious while the younger anxious children were not concurrently depressed is discussed from the viewpoint of a hypothesized temporal sequence between anxiety and depression. The implication of this and other related findings are discussed in regard to their importance for differential diagnosis and prognosis.
A Grand Mal Seizure Associated with Desipramine and Haloperidol*
Authors: Mahr Gregory C. , Berchou Richard , Balon Richard
Published: April 2017

Authors describe a case of grand mal seizure associated with administration of desipramine and haloperidol.

Neuroleptic induced inhibition of desipramine metabolism is discussed as a possible explanation of unusually high desipramine plasma level of 610 ng/ml at the day of seizure.
Canadian Psychiatric Association Guidelines in Relating to the Pharmaceutical Industry
Authors: Carter Ivan E.
Published: April 2017

This paper was prepared for the Professional Standards and Practice Council, then chaired by Dr. Nady el-Guebaly and now chaired by Dr. Werner Pankratz, and approved in principle by the Board of Directors of the Canadian Psychiatric Association in October 1984. Final approval by the Executive on May 21st, 1986.
The Relationship between Family Functioning and Demographic Characteristics in an Epidemiological Study*
Authors: Maziade Michel , Bernier Hugues , Thivierge Jacques , Côté Robert
Published: April 2017

This paper reports on the characteristics of two dimensions (behavior control and communication) of the McMaster Model of Family Functioning (MMFF) as assessed through the MMFF semi-structured interview in families of the normal nonclinical population of Quebec City (N= 118). Interrater reliability as well as scores distribution are reported. Particular attention is given to the absence of association found between family functioning and socioeconomic status. Exploratory data about the relationship between parental conflict and family functioning are also discussed in terms of future inquiries in child psychiatric epidemiology.
The Assessment of Custody and Access Disputes in Cases of Sexual Abuse Allegations*
Authors: Awad George A.
Published: April 2017

Sexual abuse allegations directed at one parent can arise in the context of custody and access disputes. The role of the clinician, when such allegations occur, is to provide an assessment of the total situation, taking the allegations into account. To assess the probability that sexual abuse has occurred involves a thorough assessment of the accuser, the accused, the accusation, the child, and different family subsystems. Particular attention should be paid to interviewing the young child with detailed focus on the interviewing process, how the interviews are reported and what conclusions may be drawn from them. Following a thorough assessment, the clinician may reach one of three conclusions: that the sexual abuse has probably occurred, has probably not occurred, or is unsure. A strong caution is given against becoming entangled in an endless process of trying to find out whether the allegations are true or false. Whatever conclusions are reached are but one factor in the recommendation regarding custody and/or access. Ultimately the recommendation will be made according to the best interests of the child, taking into account the child's relationships and attachments, as well as the sexual abuse allegations.
Alprazolam Effects in Children with Anxiety Disorders*
Authors: Simeon J.G. , Ferguson H.B.
Published: April 2017

Children with overanxious and/or avoidant disorder (DSM-III) were treated with alprazolam (Xanax, Upjohn) to determine its safety, clinical and cognitive effects. Ten male and two female patients (age range 8.8 to 16.5 years; mean 11.5)participated in an open clinical trial consisting of a baseline placebo period (1 week), alprazolam therapy (4 weeks), a drug-tapering period (1 week), and a post-drug placebo period (1 week). There was a drug-free follow-up approximately 4 weeks after termination of the study. Dosages were individually adjusted and the daily maximum ranged from 0.50 mg to 1.5 mg. Evaluations included clinical assessments, parent, teacher and self ratings, and cognitive tests. Clinical global improvement with alprazolam therapy was marked in 1 patient, moderate in 6, minimal in 4, and none in 1. Clinician ratings indicated significant improvements of anxiety, depression, and psychomotor excitation. Parent questionnaires indicated significant improvements of anxiety and hyperactivity while teacher questionnaires showed significant improvement of an anxious-passive factor. Significant improvements in the paired associate learning tasks, maze task and the block design tasks were maintained after drug withdrawal suggesting a practice effect. Adverse effects were infrequent, mild and transient. There were no clinically significant changes of laboratory values, blood pressure, pulse or respiration during the 4 weeks of alprazolam administration. Body weight increased significantly (mean increase was 0.87 kg). Double-blind trials with alprazolam are recommended in child psychiatry disorders.
Integrating Systems Theory and Attachment Theory: The Use of Radio Communication to Modify Attachments in a Patient with Psychogenic Vomiting*
Authors: Dickman David , Prieto Pablo
Published: April 2017

A case is presented that shows the usefulness of integrating systems theory and attachment theory in the formulation and treatment of a clinical problem. The 5 year old son of East Indian immigrants presented with persistent psychogenic vomiting associated with pathological family attachments. It was evident that the precarious family equilibrium was stabilized by the child's psychogenic vomiting. The therapeutic team suggested to the family that their problems might be more satisfactorily resolved if the mother and child maintained their link by two-way radio. Three weeks later the vomiting had ceased, the child no longer felt that he needed the radio and both parents had established new patterns of relating to their child, whose attendance and peer socialization at school showed marked improvement. To some extent the rapid resolution of the problems was facilitated by the cultural strengths of the family.
Epilepsy-Aphasia Syndrome in Children: An Unusual Presentation to Psychiatry*
Authors: White H. , Sreenivasan U.
Published: April 2017

This paper describes the psychiatric and clinical manifestations of the epilepsy-aphasia syndrome which occurs in children. In 1957, Landau and Kleffner reported the development of receptive and expressive aphasia at 5 to 6 years of age, in six children with normal language development at that time. Since this first report, further accounts of acquired language disabilities associated with EEG abnormalities have appeared. However, the clinical syndrome remains ill defined and its pathophysiology is poorly understood.

There are no reported cases of this syndrome presenting initially to psychiatry. This paper reports a child who presented to psychiatry with severe aggression associated with the clinical syndrome of epilepsy-aphasia. The discussion examines the relationships between the aggressive behavior and the EEG findings and aphasia.
An Epidemiologic Study of Adolescent Suicide*
Authors: Cheifetz Philip N. , Posener Joel A. , Lahaye André , Zajdman Michael , Benierakis Constantin E.
Published: April 2017

This study investigated suicides by persons aged ten to nineteen during the years 1978 to 1982 in the City of Montreal. Records of death in the Office of the Coroner, City of Montreal, were examined and suicides designated according to standard criteria. Age, sex, method of suicide, and month of death were noted. Mean incidence of suicide for the entire sample was 5.92 per 100,000 population. The mean figure for males was 9.52 and for females 2.32, with the incidence greater among males in each of the five years. Incidence of suicide in the fifteen to nineteen year old group was approximately ten times that in the ten to fourteen year old group, a difference which was constant across sex and across the five year period. Among boys, hanging was the most frequent method of suicide, with firearms second, and jumping from a height or in front of a vehicle third. Among girls, drug intoxication was most common, with firearms and jumping ranking second and third respectively. No monthly periodicity was found. The epidemiology of adolescent suicide in Montreal appears to be similar to that reported in other locations.
Language Delay and Hyperactivity in Preschoolers: Evidence for a Distinct Subgroup of Hyperactives*
Authors: Beitchman Joseph , Tuckett Martha , Batth Susan
Published: April 2017

The possibility of a separate subgroup of language-delayed hyperactive preschoolers was explored. Cognitive and demographic variables of a series of cases at the Royal Ottawa Hospital Preschool Program were examined. A group of language-delayed hyperactive preschoolers was compared with a non-language delayed group of hyperactives and a non-hyperactive clinical comparison group. Significant differences between the language-delayed hyperactives and the two comparison groups were found on such variables as IQ, expressive language, receptive language, and visual-motor integration. The evidence presented supports the possibility of a separate subroup of hyperactive preschoolers with language delay and hyperactivity. The implications for both practice and theory are discussed and suggestions are made for further research.
Allergic Skin Eruption with Desipramine Treatment*
Authors: Joffe Russell T. , Richter Margaret A.
Published: April 2017

Four cases of allergic skin rash with desipramine treatment are described. Clinical implications of these findings are discussed.
Manic-like Reaction Induced by Lorazepam Withdrawal*
Authors: Lapierre Y.D. , Labelle A.
Published: April 2017

The benzodiazepine withdrawal symptoms are presented here. The psychotic reactions to benzodiazepine withdrawal are seldom described in the literature. We report a case of acute manic-like reaction induced by sudden lorazepam withdrawal. The sudden release of catecholamines following abrupt cessation of short half-life benzodiazepine is suggested as underlying mechanism for such reaction.
Magnetic Resonance Imaging in Psychiatry*
Authors: Conlon P. , Trimble M.R.
Published: April 2017

Magnetic resonance imaging (MRI) is a relatively new radiological technique that may be useful in the study of psychiatric illness. MRI gives detailed structural information about the brain and also allows quantification of functional change. Current areas of study relevant to psychiatry include: schizophrenia, dementia, epilepsy and, to a lesser extent, alcohol and affective disorders. The authors review the basic principles of MRI, discuss the recent application to psychiatry, indicate its potential advantages and comment on the current limitations of this imaging modality.
Belegaled: Mental Health and the Law in the United States, 1986
Authors: Rappeport Jonas R.
Published: April 2017

Kenneth Gray, an attorney as well as a psychiatrist, was the leader in the development of law and psychiatry in Canada prior to his death in 1970. He lived during the post WWII years which saw a phenomenal growth of psychiatry as well as the beginnings of the modern era of a renewed concern for human rights. This later concern has caused the belegalment of many areas of psychiatric practice.

Kenneth Gray would have to learn a new set of rules for commitment, the use of ECT and informed consent. He would discover that a patient has a right to treatment that must be buttressed by an individual treatment plan. He would discover that a committed patient has a right to refuse treatment and that some courts in the United States have said that anti-psychotic medications are mind-altering and thus an invasion of the patients 1st amendment rights. He would see untreated refusing patients languishing in the hospital or the homeless mentally ill on the streets because of restrictive commitment laws. As an attorney he would also be concerned about the proposed solution to the homeless, outpatient commitment.

He certainly would have been impressed with some of the recent decisions in the United States on our duty to warn or protect known and unknown victims. Seeing patients’ advocates on the hospital wards would be a real surprise to him. These controls on the practice of psychiatry for the protection of our patients cut both ways. Dr. Gray's medical/legal education would be tested to its full.
Improving the Income Support of the Chronically Mentally Ill: A Model Program to Address the Needs of the Ex-Psychiatric Patient
Authors: Boydell Katherine M. , Trainor John N.
Published: April 2017

Interest in developing support services for the long-term mentally ill has increased in recent years. One of the most important aspects of support essential to the basic community survival of the chronic patient is income maintenance. Unfortunately, support in this area has been declining for this population.

The purpose of this paper is to briefly outline the decline in the overall well-being of patients who rely on social assistance, describe a model income maintenance program established in a provincial psychiatric hospital, and, to evaluate the program's success in alleviating the financial problems of the long-term mentally ill.

The income maintenance program described has proven to be a successful method of improving the economic situation of the long-term mentally ill. In its first 30 months of operation, the income status of over 3,000 patients has been systematically reviewed and 77% of those eligible have been converted to higher social assistance rates. The conversion has resulted in a 30 to 40% increase in income for the patients involved. The program has also contributed to improved relations with hospital staff and social assistance offices.
Symptom Patterns of Alcoholism in a Northern Ontario Population
Authors: Merskey H. , Brant C.C. , Malla A. , Helmes E. , Mohr V.
Published: April 2017

Alcoholism is noted to be a common problem in Canada and particularly in native populations. We report here a survey of the frequency of evidence of alcoholism over a period of four months in a relatively isolated Northern Ontario population in which more than 80% were either status Indians or of partly Indian origin. Using questionnaire methods, “definite” alcoholism was found to affect 27% of adults seen at a clinic and probable alcoholism affected another 20%. This gives a minimum prevalence of 14.6% of the local adult population over a four month period on the basis merely of examination of less than one third of the adults in the community. Blackouts, tremors, bad temper, chest pain, unsteadiness, loss of appetite, vomiting, sadness and stomach pain occurred significantly more often in the alcoholic patients. Stomach pain, loss of appetite and vomiting were less prominent with alcoholism in this population than in a Southern population. The findings indicate the importance in general practice of looking for alcoholism, the ease with which this may be undertaken with a few very simple short questions and the importance of some characteristic patterns, especially blackouts, shakiness and unsteadiness as one pattern and stomach pain and other gastro-intestinal symptoms as another pattern.
Some Determinants of Individual Differences in the Behaviour of Children of Parentally Deprived Parents
Authors: Sigal John J. , Meislova Jana , Beltempo Joseph , Silver Daniel
Published: April 2017

Parents who had been placed in an orphanage as children rated the behaviour of all their children who were between the ages of 6–18 years on a children's behaviour survey instrument. All families were intact and the parents had not requested professional help for marital problems. A significant number of relationships were found between parental background variables and higher reported levels of conflict with siblings and with parents, dependent-unassertive behaviour, and undemandingness in the children. Although sampling difficulties preclude generalization, the results suggest that repercussion of events in the lives of the first and second generation that are usually pathogenic may be seen in the third generation, even when the second generation may not be grossly adversely affected. These events most frequently related to individual differences in the third generation in the area of undercontrol of aggression directed toward parents and siblings.
Capgras’ Syndrome: A Synthesis of Various Viewpoints
Authors: Koritar Endre , Steiner Warren
Published: April 2017

The authors review the literature on Capgras’ Syndrome and note that there has been little attempt to integrate the various etiological theories into a cohesive synthesis which accounts for both the organic and the psychodynamic theories. It is proposed that Capgras’ Syndrome represents a nonspecific symptom of regression to an early developmental stage characterized by archaic modes of thought, resulting from a relative activation of primitive brain centres. Thus, either psychological regression alone or organic disorders that compromise higher cerebral functioning may result in Capgras’ Syndrome. Two cases are presented for discussion and elaboration of these concepts.
Criminalization of the Mentally Ill: Part II. Initial Detention
Authors: Arboleda-Florez J. , Holley H.L.
Published: April 2017

In 1939 Penrose explained the correlation between crime and mental illness in terms of an administrative rather than an etiological link. Penrose's theory encompasses the idea that social standards for defining aberrant behaviour change as do the administrative facilities designed to control such behaviour. Social groups cope with individuals who display undesirable behaviour in one of two ways. They define the behaviour as incompetent and invoke the mental health system or they define the behaviour as criminal and employ the jail. Penrose documented an inverse relationship between these facilities whereby the population of mental hospitals increases as the population of jails decreases, and vice versa, depending on the prevailing laws, funding or stage of development of either system. The actual size of the population requiring institutional care, however, remains stable forcing individuals to transmigrate from one system to the other in order to obtain institutional support. Over the past two decades, increasing numbers of mentally ill have found their way into jails, however, little systematic evidence has been produced to document the process followed by these individuals as they move through the justice-correctional system, or how their psychiatric needs are met.

The authors have conducted a prospective longitudinal investigation to document the transmigration † of mental patients through the criminal justice system and have followed a cohort of individuals arrested in the City of Calgary during the month of October, 1984. Arresting officers were asked to complete a special study form to identify individuals who, in their perception, displayed mentally disordered behaviour during the arrest. Arrest reports were also collected and demographic, clinical, and legal outcome variables were abstracted from the computerized files of the Department of the Solicitor General of Alberta.
Three Cases of Suicide in Chinese-Canadian Women
Authors: Lalinec-Michaud M.
Published: April 2017

This article purports to draw attention to the particular phenomenology of depression and suicide in Chinese. Three case histories are presented. The patients were all women in their forties, first-generation immigrants having resided for more than 20 years in Canada. These cases illustrate the significance of certain cultural factors in the understanding of depression in Chinese patients, namely: the importance of somatization, the familial reaction of denial or rejection to mental illness, the rigidity of the traditional family structure. The authors discuss the role played by conflicts of culture in the greater vulnerability to depression in Chinese middle-aged women.
Psychiatric Short-Stay Units across Canada
Authors: Schwarz Conrad J.
Published: April 2017

The limited literature on brief hospitalization programs raised questions about the actual extent of use of this process in Canada. Inquiry was first made to all Health Ministers, University Department Heads and Section Chairmen. A questionnaire was mailed to the hospitals identified and this also requested any supplementary names of units known to the respondents. Initially, 22 hospitals were named as having short-stay units, but eight of these proved not to have one. Basic data on the 14 units actually found is provided. It is suggested that units of this type could be separated into two main groups according to the rate of discharge of patients directly into the community. Those with a high community discharge rate might be called Short-Stay Treatment Units and those with a lower community discharge rate might be known as Assessment Units. The former tend to have fewer admissions per bed, lower occupancy rates, somewhat longer LOS and location in or near the main psychiatric inpatient unit. These factors tend to be reversed in the latter.
Grandchildren of Survivors: Can Negative Effects of Prolonged Exposure to Excessive Stress be Observed Two Generations Later?
Authors: Sigal John J. , Dinicola Vincenzo F. , Buonvino Michael
Published: April 2017

Some studies have demonstrated negative psychological repercussions on children of parents who experienced extreme, prolonged stress. To determine whether such effects might continue in the third generation, we examined the presenting complaints of patients in a child psychiatry clinic who could be reliably identified as: (i) children whose parents were native born but who had at least one grandparent who was a survivor of the Nazi persecution (Index 1, N = 58); (ii) other children who had at least one parent and one grandparent who was a survivor (Index 2, N = 11); (iii) children of other immigrant grandparents (N = 28); (iv) children with four native born grandparents (N = 30). All other grandparents and parents were native born. All families were of the same ethnic group. Index 2 children manifested more difficulties related to school performance, but the small size of the sample precludes generalization. Although the Index 1 children did not have different types of behavioural disturbances, the size of the Index (1 + 2) group (N = 69) relative to the comparison groups was 300% greater than expected on the basis of community population estimates. Implications of this finding are discussed.
A Double Blind Comparison of Alprazolam and Amitriptyline Hydrochloride in the Treatment of Nonpsychotic Depression
Authors: Singh A.N. , Nair N.P.V. , Suranyi-Cadotte B. , Schwartz G. , Lizondo E.
Published: April 2017

In a six week, double-blind, parallel study of alprazolam and amitriptyline hydrochloride in 130 outpatients suffering from moderate to severe nonpsychotic depression, alprazolam was as effective as amitriptyline hydrochloride in relieving depressive symptoms and significantly more effective in relieving symptoms of anxiety and somatization. Alprazolam showed an earlier onset of activity in most measurements of efficacy and produced fewer side effects than amitriptyline hydrochloride. Anticholinergic side effects were reported more frequently by patients taking amitriptyline hydrochloride, while drowsiness was reported more frequently by patients taking alprazolam. At the end of the study, the average daily doses were 2.4 mg alprazolam and 135 mg amitriptyline hydrochloride. The Hamilton Psychiatric Rating Scale for Depression, Hamilton Anxiety Rating Scale, Physician's Global Impressions, Patients’ Global Impressions, Hopkins Self-Rating Symptom Scale, and Symptom and Side Effects Checklist were evaluated at the end of weeks 1, 2, 3 and 6 to determine and compare the efficacy and safety of the two study drugs.
Role Reversal in Folie À Deux
Authors: Bankier Robert G.
Published: April 2017

An unusual case of folie à deux involving a husband and wife is described. During their illness a reversal of the original dominant/submissive roles occurred with almost tragic results. Traditional criteria for diagnosis are discussed and treatment approaches re-examined.
The Psychiatrist's Role in Determining Competency to Consent in the General Hospital
Authors: Lippert G.P. , Stewart D.E.
Published: April 2017

In the general hospital, consultation-liaison psychiatrists are frequently consulted regarding issues of competency to consent to medical and surgical procedures and treatments. It is necessary that psychiatrists practicing in this setting have a thorough awareness of both the legal aspects of competency and consent and the clinical situations which can arise. In this paper we discuss the legal basis for consent and various definitions proposed for mental competency to consent to treatment. We describe a number of typical situations which lead to psychiatric consultation and suggest an appropriate approach to their resolution.
Research in Consultation-Liaison Psychiatry: The Toronto General Hospital Experience
Authors: Rodin G. , Craven J. , Littlefield C. , Taerk G. , Isbister S.
Published: April 2017

Research that has developed in association with the consultation-liaison service at the Toronto General Hospital is reviewed in this paper. The value of systematic investigation in the consultation-liaison setting is addressed. Such approaches may be necessary to establish consultation-liaison psychiatry as a theoretical discipline which can advance knowledge in addition to enhancing patient care.
Alcohol and Drug Problems: A Challenge to Consultation-Liaison Psychiatry
Authors: Glaser Frederick B.
Published: April 2017

Although alcohol and drug problems are prevalent in the population at large and among patients in general hospitals, they have not been a major concern of consultation-liaison psychiatry. A setting in which all psychiatric consultations are directed to such problems, the Clinical Institute of the Addiction Research Foundation, is described, and parameters of its consultation experience are explored. It is suggested that dealing with alcohol and drug problems should become an integral aspect of consultation-liaison psychiatry. Such a development may prove to be especially fruitful in teaching a comprehensive approach to patient care.
An Inpatient Programme for Persistent Somatizers
Authors: Lipowski Z.J.
Published: April 2017

Somatization, defined as a transient or persistent tendency to experience and communicate psychological distress in the form of somatic symptoms and to seek medical help for them, represents a common problem in clinical practice. A comprehensive inpatient rehabilitation program for somatizing patients has been developed at the Clarke Institute in Toronto and is described in detail. It involves concurrent application of psychiatric, psychological, social, and medical therapies.
Characteristics of Borderline Personality Disorder: A Canadian Study
Authors: Links Paul S. , Steiner Meir , Offord David R. , Eppel Alan
Published: April 2017

This study presents data on a Canadian sample of inpatients with the diagnosis of Borderline Personality Disorder (BPD). Inpatients with BPD were compared to inpatients with borderline traits. The results indicate that the BPD inpatients have a chronic severe disorder, which onsets in adolescence, and are likely to have suffered early deprivation or abuse.
Responses and Behaviour of Patients with Borderline Personality Disorder during Semi-Structured Interviews
Authors: Mitton Jan , Huxley Gail
Published: April 2017

The researchers investigated the behaviour of the Borderline Personality Disorder (BPD)patient, based on observations during structured interviews, to test the hypothesis that these patients are frequently more hostile, aggressive, demanding and manipulative in an interview situation, as has been reported in the literature. These patients were compared to a similar group which had been identified as having BPD traits. The findings suggest that the BPD patients respond with more helplessness and anxiety, that they are more reliable, and that they do not differ significantly in displays of negative behavior during the interview.
Can Psychological Assessment Address Borderline Phenomena?
Authors: Wallace Jean E. , Martin Sandie
Published: April 2017

Literature about psychological test findings in borderline disorders reflects changes in the meaning of the term and can be confusing when viewed from today's prespective. Most descriptions have referred to a concept of borderline schizophrenia. This paper reviews psychological assessment of borderline patients by means of the Rorschach, by using WAIS/Rorschach patterns, and, post-DSM-III, by using the MMPI. It focuses on the Rorschach's sensitivity to several dimensions relevant to borderline pathology.

The concept that borderline disorders can include mild forms of affective and schizophrenic illness was examined by applying a Rorschach content scoring system to a borderline sample. The findings demonstrate Rorschach ability to identify borderline subtypes and offer independent validation of affective and schizotypal subtypes in the borderline realm.
Biological Markers in Borderline Personality Disorders: An Overview
Authors: Steiner Meir , Links Paul S. , Korzekwa Marilyn
Published: April 2017

The state of knowledge in the area of suggested biological markers that may delineate subpopulations of patients with borderline personality disorders (BPD) is reviewed.

There is widespread disagreement as to the specificity of these markers. The clinical implications of Axis I — Axis II, state vs. trait, acute vs. chronic, and definite vs. probable diagnoses, all seem to contribute to the confusion in this area.

Some patients with BPD and with schizotypal personality disorders (SPD) share neuroendocrine abnormalities with affective disorders (AD) and schizophrenic (SCH)patients respectively. This interface and/or potential overlap between personality disorders (PD) and the major mental disorders is discussed with special reference to the DST, TRH/TSH test, and REM latency which have already been established as valuable biological markers for certain subtypes of depression. In contrast, biologic abnormalities observed in chronic schizophrenia are also present in some SPD patients. Current data are supportive of the hypothesis that some PD patients are independent whereas others are genetically related to the major mental disorders.
Time-Limited, Group Psychotherapy for Borderline Patients
Authors: Blum Heather Munroe , Marziali Elsa
Published: April 2017

Preparation for treatment, group process and time boundaries are presented as components of a treatment model designed to respond to specific problems inherent in the nature of borderline personality disorder. A pilot study of the proposed treatment model is underway and one case illustration from this study is described to illustrate the adaptation to this treatment of a borderline patient with an extensive prior history of individual treatment.
Severe Obsessive-Compulsive Syndrome in a 10 year old: a 3 year Follow-Up
Authors: Desmarais Paul-André , Lavallé Yvon-Jacques
Published: April 2017

Obsessive-Compulsive Disorder is rare in children but when present, its very nature is so pervasive and so complex that the therapy must be specially tailored to fit the distinct character of the young patient. We report the course and treatment of one case; then we discuss the interplay of implicit as well as explicit factors in the active process of alleviating dysfunctional behavior.
Primary Prevention: Implications for the Child Psychiatrist
Authors: Rae-Grant Naomi I.
Published: April 2017

This paper emphasizes the importance of primary prevention, reviews some of the conceptual underpinnings of the subject, considers promising intervention programs which could be utilized now, discusses the current state of research in the field and suggests roles for the psychiatrist.
The Agreement between Behaviour Checklists and Structured Psychiatric Interviews for Children
Authors: Brunshaw Jacqueline M. , Szatmari Peter
Published: April 2017

There are few reports in the literature on the agreement between structured interviews and behaviour checklists in terms of specific diagnostic categories. The objective of this paper is to see how this agreement varies by source of information and diagnosis. One hundred children and their parents referred to a mental health clinic were given the Diagnostic Interview for Children and Adolescents (DICA). Parents and teachers also completed a checklist, the Survey Diagnostic Instrument, a modification of the Child Behaviour Checklist. Using likelihood ratios, the parent checklist agreed best with the parent interview, regardless of diagnosis. Among DSM-III diagnoses, the combined disorder anxiety-depression obtained the highest agreement with the DICA, attention deficit disorder with hyperactivity the next, and conduct disorder the lowest. For screening purposes, combining the parent and teacher checklists appears best, while, for diagnostic purposes, using the parent checklist alone may suffice. Nevertheless, positive predictive values remain low and may remain an inherent limitation of any checklist.
Completed Suicide in Youth
Authors: Hoberman Harry M. , Garfinkel Barry D.
Published: April 2017

The purpose of this study was to collect descriptive information on a large number of children, adolescents and young adults who had committed suicide. The medical examiner's records for deaths of persons 25 and under from non-natural causes were reviewed; 656 youth suicides were identified. Children, adolescents and young adults who committed suicide were most likely to be older males with a current psychiatric disorder, usually an affective disorder or alcohol or drug abuse. Suicides appeared to be impulsive and triggered by age-normative precipitants. Sex, age and cohort differences are presented. Results are evaluated in light of previous research.
A Survey of Child Psychiatry Teaching in Canada
Authors: Macleod R.J.
Published: April 2017

This article describes the findings of a survey of Child Psychiatry Training Programs conducted by the Education and Training Committee of the Canadian Academy of Child Psychiatry.

The objectives of the Committee are identified to include teaching programs for career trainees, residents in general psychiatry, and special groups such as pediatric and family medicine residents. Information obtained on available programs for each group is outlined.