bluuebunny/crossref_metadata_2025 huggingface dataset:
The Clinical Audit in a Psychiatric Setting: Is Big Brother Watching You?
Authors: Thompson M. G. G.
Published: April 2017

This paper summarizes five methods for clinical auditing that are carried out concurrently at the London Psychiatric Hospital. The first type of audit is carried out by the Medical Records Department and consists of a check-off list of items that for accreditation purposes must be included in the record. The second and third types of audit compare the content of the records from samples of similarly diagnosed or treated patients to criteria previously specified by a committee of professionals. The fourth type of audit is really a collection of audits in which each of the clinical departments: Nursing, Social Work, Occupational Therapy, and Psychology, check random samples of files on a monthly basis for the contribution to the record made by their own departmental members. These files are checked against specific questions laid out on a departmental audit form, and feedback is given directly to the departmental member.

The four preceding types of audits all have the advantage of large-scale “screening” of charts. They, however, do not allow for crosschecking recorded data with the condition of the actual patient. The fifth type of audit, the “in-depth single patient care audit” corrects this deficit, and allows for more dialogue with the treatment team. The detailed form that is used for this audit procedure is described in the text. The audit is carried out by a senior clinician from the Department of Medicine in conjunction with a senior member of another discipline. The physician interviews the patient before reading and checking the chart. Both the physician and the senior member of the other clinical department then discuss the charting and the case with the entire treatment team.

This last method of auditing has helped considerably in re-designing a system for charting at London Psychiatric Hospital. The chief drawback of the audit, time consumption, is far outweighed by the advantages that accrue. The procedure affords the unit staff and the auditors opportunities for an ongoing educational experience.
LSD in a Coercive Milieu Therapy Program
Authors: Barker E.T. , Buck M.F.
Published: April 2017

Over a five-year period, thirty patients in a maximum security mental hospital were treated with LSD (500 mcmg. I.M.).

Three different styles of interviewing procedure evolved with experience: a medical model, a “responsible street model”, and a non-directive model. The interviewer's orientation appeared to significantly affect the patient's perception of the LSD experience. Since it was felt by the authors that no one set of biased inputs has any demonstrable merit over any other, (except in satisfying the interviewer), the non-directive model was deemed most reasonable.

Although all patients reported that the experience was of great benefit, no one else could see changes for better — or worse. Chromosomal studies showed the usual increased frequency of breaks. It is noted that cytogenetic experts do not now see this finding as a contraindication to the use of the drug. It was not thought that the LSD administration in hospital was a significant factor leading to use of street drugs after release. The only difference on administration to psychopaths and schizophrenics was that one-third of the psychopaths (6 of 18) acted out by punching or kicking at someone nearby.

When used with the safeguards described, the drug seemed safe and valuable to use in our communities of long-stay patients, because of the high morale engendered.
A Short Encounter with Anna Freud at Berggasse 19
Authors: Fraser George A.
Published: April 2017

This article discusses a short encounter with Dr. Anna Freud in her former consulting office in Vienna at 19 Berggasse in May 1977. Dr. Freud had gone to Vienna for the laying of a marble plaque at the site of the former Belle Vue Hotel where Sigmund Freud had first started his work on the ‘interpretation of dreams’. In 1900 Dr. Sigmund Freud had written to Wilhelm Fliess “Do you suppose that some day a marble tablet will be placed on the house, inscribed with the words:

‘in this house on July 24, 1895,

The Secret of Dreams was revealed to

Dr. Sigmund Freud’

At this moment I see little prospect of it”.

This request was realized on 6 May 1977 and the author who was present at the ceremonies, describes some of the events.
Brain Aging and Alzheimer's Disease*
Authors: Crapper D.R. , Deboni U.
Published: April 2017

The most common cause of senile dementia appears to be a pathological process indistinguishable from that found in presenile dementia of the Alzheimer type. Consideration of the neuropathological changes suggest that this disease may involve the interaction of at least three processes: a viral-like infection, a disorder in the immune system and the neurotoxic effect of an environmental agent. The evidence in support of this hypothesis is reviewed.
Diet in the Management of Hyperkinesis
Authors: Williams J. Ivan , Cram Douglas M.
Published: April 2017

Through the 1970s, Benjamin Feingold has published a series of studies in which he claimed that a diet free of salicylates, artificial food flavours and colours results in a remission of symptoms in 30 to 50 percent of children diagnosed as hyperactive. Parents of hyperactive children have responded strongly to the hypothesis and have requested that their children be placed on the diet. A series of clinical studies of the Feingold diet have produced mixed results. More recently, there have been four sets of experimental studies which have resulted in rigorous tests of the original diet and a modified diet with salicylates included but artificial additives excluded. None of the studies give unqualified support for the hypothesized diet effects, and there are reports which refute the thesis. There are findings which suggest that some hyperactive children (10 to 25 percent), particularly younger ones, respond favourably to a diet free of artificial additives. The lack of conclusive evidence dictates that additional research be conducted to test the hypothesis.
Perceptual Experiences in Anorexia Nervosa and Obesity*
Authors: Garner David M. , Garfinkel Paul E. , Moldofsky Harvey
Published: April 2017

There is increasing evidence suggesting that the perceptual-cognitive experiences of people with anorexia nervosa and juvenile onset obesity may differ from those of people without eating disorders. The research related to several perceptual-cognitive dimensions is critically examined. These include body image perceptions; perception of hunger and satiety cues; perception of external cues; and certain personality variables which may be related to self-perception. The implications of these perceptual-cognitive variables for the treatment of anorexia nervosa and obesity are discussed. The relative efficacy of some behavioural and medical therapies may be related, in part, to their effects on perceptual-cognitive parameters. Recommendations are also made for investigations to further delineate the role of perceptual-cognitive difficulties in people with eating problems.
Psychiatric Presentation of Epilepsia Cursiva*
Authors: Shale John H. , Murray George B.
Published: April 2017

Coarse brain disease can first present as a behavioural or psychiatric disorder. Partial seizures with complex symptomatology (psychomotor or temporal lobe epilepsy) may offer particular difficulties in differential diagnosis from the “functional psychoses.” The authors report a case of “running epilepsy” (epilepsia cursiva), that first presented as a behavioural problem, and review the literature on this rare form of psychomotor epilepsy.
Therapeutic Trials in Tardive Dyskinesia
Authors: Villeneuve Andre
Published: April 2017

The search for a treatment of tardive dyskinesia has generally been guided by the putative biochemical mechanisms underlying the extrapyramidal disorders, but no markedly effective treatment has yet been found. The currently postulated mechanism in tardive dyskinesia involves namely an imbalance between the central dopamine-acetylcholine systems whose balance may also be influenced by neuroendocrine factors. The agents reported having some clinical efficacy in the management of this neurological complication act on these systems. The clinical investigation for the treatment of tardive dyskinesia is laborious and raises several problems that could account for the unpredictability and the discrepancies in results. These problems can be divided into three broad categories: patient variables, experimental treatment variables and methodological variables. These variables are discussed and some suggestions made.
The Authoritarian Family and its Adolescents
Authors: Danesh Hossain B.
Published: April 2017

Authoritarian Families possess characteristics similar to those of the Authoritarian Personality. They are power oriented, tend to have dichotomous conceptions, have emotional and intellectual rigidity and submit easily to authoritarian forces. The adolescents in such families are deprived of their basic needs for stability, flexibility and guidance. Consequently they feel frustrated and angry. Their anger manifests itself in various forms. A large percentage of these adolescents adopt their parents' attitudes and develop similar authoritarian personality characteristics. The second group are those who experience considerable conflict and tend to become aggressive and hostile in their interpersonal relationships. Still, there are adolescents who become withdrawn, depressed and apathetic and display great difficulty in dealing effectively with the ordinary demands of their lives.

These adolescents and their families are difficult to treat. Several case histories are provided and brief outlines of a treatment approach are given.
La Peinture Libre, Therapeutique Pour Enfants
Authors: Plante Gilles , Cote Helene , Saint-Jean Micheline , Pilic Ivanka
Published: April 2017

Inspired by the work of A. Stern and to make maximum use of our meagre resources, we decided to experiment with free painting exercises as a therapeutic tool for children of a deprived milieu.

In a first experiment, we selected a group of children in regular school who were considered inhibited. After psychiatric and social evaluations, we discovered variable degrees of depression. At the end of the experience of free painting, the depressed traits had disappeared and the children had become more alert and bright.

This result encourages us to press on with overtly depressed children coming to the clinic for treatment. The evaluations were made in the same way as in the first experiment and the sessions of free painting were conducted also in the same way. The results were weak as for the emotional aspect but more positive as for their school functioning.

We believe that free painting may be useful and profitable as a diagnostic aide for a better therapeutic orientation and to avoid long waiting lists.
Insight and Hospital Adjustment
Authors: Roback Howard B. , Abramowitz Stephen I.
Published: April 2017

The relationship between insight and adjustment in schizophrenics was examined. Subjects who scored higher on a paper-and-pencil insight test were rated by hospital staff as better adjusted behaviourally but described themselves as more psychologically distressed than presumably less insightful subjects. Results were discussed in relation to the notion that insight in schizophrenics may intensify subjective distress while conducing to behavioural adaptation.
On Teaching Psychosomatic Medicine
Authors: Martins Clovis
Published: April 2017

“The writers of this book are a dermatologist and a psychiatrist. There are some who regard these specialties as poles apart and consider (to change the plane of the metaphor!) that East is East, medically speaking, and West is West, and never the twain shall meet, the dermatologist being a person who looks at the skin and a psychiatrist a person who looks after mad people. To these we would reply that the dermatologist should learn to look beneath the skin, well beneath, in order to assess the feelings and unconscious motives of his patient which may be expressed, however inadequately, in the skin.”
Hare Krishna Movement: What Attracts the Western Adolescent?
Authors: Kutty Ittamveetil N. , Froese Arthur P. , Rae-Grant Quentin A.F.
Published: April 2017

The HKM is but one of the many Eastern religious beliefs imported into the West. However, because of the way it is practised, it is the one which confronts North American values most directly. It is an offshoot of Hinduism and comprises a wide diversity of beliefs. It attracts many Western youths, much to the anguish of their parents and community leaders. Those who look at the HKM from a Western cultural point of view argue passionately with those who believe in it. The authors, one of whom (I.N.K.) has cultural roots in Hinduism and Western training in child psychiatry, attempt to look at this phenomenon dispassionately and analyze some of the relevant factors which attract Western youth to this culturally alien religion. A brief historical sketch of the HKM is given followed by an account of the significance of religion from a psychoanalytical perspective. The case history of a 15 year old adolescent male is presented and discussed in psychodynamic terms followed by an attempt to understand his attraction to the HKM. The manner in which the HKM met the needs of this adolescent may have implications for the management and understanding of similar cases, especially when professional interventions do not bring about the desired results of solving rather than just suppressing the intense and painful conflicts of development in adolescence.
A Combined Approach to a Medical Problem: The Canadian Back Education Unit
Authors: Robinson G. Erlick
Published: April 2017

The Canadian Back Education Unit represents a team approach to a medical problem. Orthopedic surgeons, psychiatrists, psychologists and physiotherapists give a course of four lectures to patients with low back pain. The patients are taught the anatomy and physiology of their pain, proper postures and exercise, the way in which emotions can complicate their physical problem, and relaxation techniques. Of 934 completing the six-month review course, 77% rated themselves as improved and 96% felt the course had been helpful. There was also found to be a 62% decrease in the number of patients seeing doctors about their back pain.

It is felt that this is a method by which psychiatrists, orthopedic surgeons and paramedical personnel are able to work together to provide an effective and cost-efficient way of helping patients cope with a chronic physical problem.
Electrosleep Therapy: A Controlled Study of its Effects in Anxiety Neurosis
Authors: Von Richthofen C.L. , Mellor C.S.
Published: April 2017

This study has investigated the effects of electrosleep treatment, or cerebral electrotherapy (CET) on the symptoms of ten subjects with anxiety neurosis. A blind crossover experimental design, in which subjects received five consecutive days of active and five days of placebo treatment was employed, the order being counterbalanced. The subjects’ experience of CET, particularly with regard to cutaneous sensation, was identical for both treatment conditions. Anxiety levels were determined pre- and post-treatment using daily psychological and physiological measures. Weekly symptom measures were also obtained before and after each type of treatment and one week and four weeks after the treatment terminated.

The results showed a statistically significant overall improvement in the levels of anxiety, but no difference between placebo and active treatment. Nor was there any significant difference between these two treatment conditions in their effect upon physiological measures made while treatment was in process. There was a post hoc finding of a significant correlation between the overall response to this procedure and extraversion as measured by the Eysenck Personality Inventory (EPI).

The implications of these findings are that the therapeutic effectiveness of CET is attributable to non-specific or placebo components of the treatment, and not to the direct effects of electrical current on the brain.
A Parents’ Group in the Management of Anorexia Nervosa
Authors: Rose Julia , Garfinkel Paul E.
Published: April 2017

Recent reports have suggested that family therapy is useful in the treatment of anorexia nervosa. There are, however, recognized contraindications to family therapy. As we were seeing patients with anorexia nervosa for whom family therapy was not possible, we predicted that the formation of a group for the parents would provide benefit through education, support and insight. The present study was designed to develop and evaluate such a group. We selected parents of ten anorectic patients for whom family therapy was contraindicated. There were two therapists, the unit social worker and a former patient who had successfully overcome the symptoms of anorexia nervosa.

After an 18-month period, the ten couples were sent anonymous questionnaires assessing the group's value. Six indicated positive feelings about the group and felt they had benefited. One couple reported dissatisfaction. Most perceived the group as an important part of the overall treatment.
Mental Competence and Consent to Treatment
Authors: Burra P. , Kimberley R. , Miura C.
Published: April 2017

The issue of mental competence in relation to consent to treatment has been high-lighted in the recently amended Mental Health Act in Ontario. The definition of mental competence in this context, how it is to be determined, and some practical implications of the Section of the Act pertaining to this matter, are discussed. The case history of a young woman is used to illustrate some of the points made.
Parenteral Nutrition outside Hospital: Psychosocial Styles of Adaptation
Authors: Macritchie K.J.
Published: April 2017

Twenty subjects who had been on Long Term Parenteral Nutrition outside hospital for varying periods were studied. The study dealt with examination of factors which determined success or problems in adaptation to the regimen. Two subgroups with distinctive coping styles were identified. The first was characterized by a high degree of dependence on the external environment. The second, in contrast, was characterized by a behavioural pattern of assumption of personal responsibility for gratification of needs, less dependence on the external environment and a need to have life well organized and under control. Males in middle age appeared to adapt more readily than those in the younger or older age group. Women experienced a more profound disturbance of body image than men. Individuals in stable relationships with supportive families adapted better and had fewer complications and readmissions to hospital. The presence of chronic illness before the institution of LTPN appeared to facilitate a better adaptation to the regimen than that found after sudden bowel loss due to intra-abdominal castastrophe in previously healthy individuals.
The “One Day at a Time” Syndrome in Post-Transplant Evolution: The Regressive Megalomanic Model versus the Progressive Hypomanic Model
Authors: Lefebvre Paul , Crombez Jean Charles
Published: April 2017

After kidney transplantation patients experience an initial period of euphoria which is usually followed by a phase of disillusionment and depression. At this point the “one day at a time syndrome” appears as an attitude of adaptation and defense. It is proposed that there are two dynamically and prognostically different varieties of this syndrome: A first type represents a regressive megalomanic defense whereby depressive anxiety concerning the rejection of the part-self represented by the graft is conscious but depressive anxiety concerning the eventual death of the whole self is omnipotently denied. This variety of the syndrome is related to a more negative prognosis both psychologically and somatically. The second type of the “one day at a time syndrome” is a progressive hypomanic defense whereby depressive anxiety concerning the rejection of the part-self represented by the graft is present and conscious but relative and does not preclude the conscious depressive anxiety concerning the eventual death of the whole self, which once acknowledged can gradually be mastered, permitting the pursuit of as pleasurable a life as possible. This variety of the syndrome is prognostically more favourable both physically and psychologically.
Consultation-Liaison Psychiatry in a Chronic Care Hospital: The Consultation Function
Authors: Wasylenki Donald , Harrison Mary Kay
Published: April 2017

This paper describes psychiatric consultations in a chronic care and rehabilitation hospital It reports that although 60% of consultation requests were for depression, only 8.6% of patients seen received a diagnosis of Affective Disorder. Many patients seen, 51.4%, did not receive a formal psychiatric diagnosis and were found to present problems in adapting to chronic disabling illnesses. These problems included difficulties with convalescent and rehabilitative tasks, manifested by pathological behaviours such as persistent denial and pseudo-independence, as well as characteristic reactions to specific catastrophic illnesses. It is important to recognize that in this population psychotropic medication should be used judiciously, and interpersonal and milieu approaches should be emphasized. It is also important for the psychiatric consultant to maintain an optimistic, therapeutic attitude in what often seem to be rather foreboding consultation settings.
Fluphenazine Resistant Psychosis
Authors: Brent Richard , Kalman Thomas
Published: April 2017

A fifty year old female chronic schizophrenic was admitted to hospital following a relapse of her psychosis. She had previously responded well to treatment with trifluoperazine but because of her history of medication non-compliance, a trial of fluphenazine enanthate was instituted. Despite the close chemical similarity between trifluoperazine and fluphenazine the patient failed to respond to the latter in either its oral or depot intramuscular form. Although it is not unusual for a patient to respond to one antipsychotic and not to another, the above case of intra-class non-responsiveness is indeed rare and not readily explained. We present this unusual case and discuss some possible explanations.
The Capgras Syndrome: Two Case Reports and a Review
Authors: Quinn Declan
Published: April 2017

The Capgras syndrome is reviewed and two case reports are described. While the Capgras syndrome is frequently considered to be a rather rare psychiatric syndrome, the author questions this and feels that the syndrome is more common than previously thought. Original explanations of this syndrome usually involved dynamic interpretations, but recently there have been many reports to suggest an organic lesion as being the main contributing factor. The mechanism involved seems to be a generalized dysfunction of the non-dominant cerebral hemisphere. It is suggested that any patient presenting with this syndrome be thoroughly evaluated for an underlying organic lesion before dynamic interpretations are used to explain this syndrome. Brief mention is made of two other syndromes which also involve misidentification and are also considered to be organic in origin.
Syndrome of Inappropriate Secretion of Anti-Diuretic Hormone in a Patient Treated with Haloperidol
Authors: Husband Carol , Mai Francois M. , Carruthers George
Published: April 2017

A case report of a patient who presented with the syndrome of inappropriate secretion of antidiuretic hormone is described. She had become rapidly comatose while on a psychiatric inpatient unit for treatment of a monosymptomatic delusional psychosis. Although increased water intake and the concurrent administration of diuretics were aggravating factors, haloperidol was considered to be the primary etiological agent in this case.
Developmental Considerations of Anorexia Nervosa and Obesity
Authors: Bruch Hilde
Published: April 2017

The differentiation of the distinct clinical syndrome of anorexia nervosa from atypical cases is based on the following distinguishing features: a relentless pursuit of thinness; an almost delusional disturbance of body image; an inability to correctly identify hunger from other bodily or tension states; a lack of an identity awareness; and a paralyzing sense of ineffectiveness. This sense of ineffectiveness, pervasive of all thought and action, is connected with the perception of the self as acting only in response to the demands of others and is camouflaged by negativism and defiance. The core developmental issues of being unable to experience the control over one's own body and of lacking the conviction of living one's own life are based on the severe deficits in autonomy and initiative, originating from the distortion and mislabeling of feelings, sensation and moods in early childhood. The treatment process focuses on evoking awareness in these patients of their impulses, feelings and needs as originating within themselves as an essential step in the development of a sense of competence and self-esteem.
The Psychiatric Training of Medical Students
Authors: Voineskos G. , Greben S.E. , Lowy F.H. , Smith R.L. , Steinhauer P.D.
Published: April 2017

Undergraduate psychiatric education should be concerned mostly with those aspects of psychiatry required for the proper practice of medicine. Psychiatric concepts and techniques are applicable to all medical practice and relevant to the daily work of every physician or surgeon. Therefore, in the psychiatric training of medical students the focus should be primarily on teaching “psychiatry of medical practice” and much less on teaching “specialty psychiatry. “

The teaching of psychiatry for medical practice will be best accomplished by selecting patients who are more like those the student will see later on as a practising physician. A systematic effort should be made to develop joint teaching with other departments, if we are to hope that students will carry over the approach we teach them to other subjects of medicine. Counselling and psychotherapy are essential skills for every physician or surgeon; medical students should be taught these skills by psychiatrists who are not just skilled psychotherapists but are also comfortable in their role as physicians in view of the importance of this role for the development of the identity of the medical student as a physician.

The quality of the psychiatric training of medical students is dependent to a large extent on the priority accorded to undergraduate teaching by the department of psychiatry; competing activities, however, can result in undergraduate teaching being given less than top priority. Long-standing difficulties which psychiatry and psychiatrists experience in the medical school may impede undergraduate psychiatric education; these difficulties can be lessened by the closer involvement of psychiatrists with other physicians in the clinical and educational programs.
Selectivity of Treatment Modalities
Authors: Chess Stella
Published: April 2017

Consensus as to diagnostic definitions and criteria in Child Psychiatry is recent. Traditional “treatment” has been direct psychotherapy of child patient and mother. Despite growing precision of enologic concepts and expansion of therapeutic approaches, many centres continue to define therapy in terms of their available techniques rather than the actual needs of the child.

A brief review and definition of the major clinical syndromes is given. A glossary of therapeutic modalities and their description is provided. Selection of treatment interventions is discussed in terms of diagnosis, severity, strengths of child patient, and the environmental modifications possible. Case illustrations are given. Periodic reassessment is essential to reselect therapeutic goals and determine choice as well as simultaneity versus sequentiality of therapeutic interventions.
Les besoins de la clientèle psychiatrique en préventions secondaire et tertiaire: Le point de vue d'un clinicien
Authors: Grantham Harry
Published: April 2017

The concept of need, discussed from many points of view, remains necessary to the planning of health services. The author tries to define psychiatric needs in a clinical perspective, limiting his approach to secondary and tertiary prevention. The critical points supporting the clinical decision permit the choice of fundamental criteria which allow one to identify and describe the psychiatric needs of a given population. Using this methodology a typology of those needs is formulated in a way which is acceptable in a multidisciplinary approach.
The First Few Minutes
Authors: Morrant J.C.A.
Published: April 2017

Within the first few seconds usually of meeting a new patient, the therapist has formed an impression of the likely diagnosis and difficulties that lie ahead during psychotherapy. There are many clues about a patient given by the person, if anyone, accompanying him or her; by the patient's style of greeting; dress and jewellery; type of voice, and so on. Many of these clues, and the inferences that are preconsciously or consciously made from them, are described and discussed. The first impression is probably correct and may correlate well with an assessment made after many hours’ work with a patient.
Stopping Life-Sustaining Medical Treatment: Psychiatric Considerations in the Termination of Renal Dialysis
Authors: Rodin G.M. , Chmara J. , Ennis J. , Fenton S. , Locking H. , Steinhouse K.
Published: April 2017

Data are presented regarding the decision by medical staff and by patients to discontinue renal dialysis. Some relevant issues regarding the patients are discussed, including their mental competence, underlying motivation and psychiatric state. Also some of the medical factors involved in the decision to stop treatment are considered. Emphasis is placed on the importance of the patient's sense of active participation and involvement in his treatment. Mention is made of the importance of interventions to decrease the psychological morbidity in survivors of patients who stop dialysis.
On the Diversity of Visual Hallucinations
Authors: Raschka L.B. , Schlager F.M.
Published: April 2017

It is proposed that human beings can suffer from several kinds of visual hallucinations based on different pathomechanisms simultaneously or in an intercurrent fashion. The authors review several types of visual hallucinations in relation to their case study. Included are the phantom vision, the irritative and the release type hallucinations according to Cogan, and the entoptic images.
Core Group: A Psychotherapeutic Model in an Outpatient Clinic
Authors: De Bosset Farideh
Published: April 2017

This paper describes the working structure of an outpatient clinic for patients suffering from a variety of chronic mental disorders. The strength and success of our work in terms of tertiary preventive care has been due to developing a working alliance with a number of patients, thus forming the core group within each group, around which the larger group can function.
On the Recording of Mental Illness for Civil Commitment
Authors: Mccready J. , Merskey H.
Published: April 2017

The survey of 102 consecutive certificates for involuntary admission and a review of the case material demonstrated that in 78 cases the form was completed adequately. In 13 cases full description of evidence of mental disorder was lacking on the certificate but after reviewing the cases it, would appear that clear evidence of mental disorder was probably present at the time of certification. In this survey, suicidal or homicidal risk alone was not considered evidence of mental disorder. In the final 11 cases the grounds for diagnosing mental disorder rested upon the presence of phenomena like anger, alcoholism, or mild mental retardation or the presence of a personality disorder, all of these being associated with risk to the patient or another person. Compelling evidence for the necessity of psychiatric commitment in these complex situations cannot be described briefly; thus it does not appear that an altered certification form would solve the problem.
Arson: A Clinical Study
Authors: Bradford John M.W.
Published: April 2017

Psychiatric, psychosocial and medicolegal issues related to 34 arsonists and 50 controls are described. Arson was most frequently committed by males who suffered from personality disorder, mental retardation or depressive neurosis. Poor school and work records also characterized their background when compared to the control forensic psychiatric patients. The offence more frequently occurred within a one mile radius of their own home in residential property. Revenge or a “cry for help” was the most frequent motivation for the firesetting activity.
Early Parental Loss and Suicidal Ideation in University Students
Authors: Adam K.S. , Lohrenz J.G. , Harper D. , Streiner D.
Published: April 2017

This study examined the relationship of early parental loss to suicidal ideation and suicide attempts in a group of university students attending a university mental health clinic. Seventy-five subjects with a history of parental loss before the age of 16 were compared to a control group of 61 subjects from intact homes for the presence of suicidal ideation and overt suicidal behaviour. Subjects with a history of early loss demonstrated significantly more suicidal ideation and more had made suicide attempts than had subjects from intact homes, and this relationship was even more marked when the consequences of the loss in terms of the subsequent family environment were considered. Where the loss resulted in the long-term disruption of family life, suicidal trends were prominent; where the family life stabilized, they were minimal. Suicidal ideation and suicide attempts occurred significantly more often among female subjects than males, and the loss of father and both parents was in excess of loss of mother among those with significant suicidal ideation. The findings support the hypothesis that early parental loss, under certain conditions, is a significant variable in the predisposition to suicidal behaviour and suggest avenues for further research.
Help for Families of Suicide: Survivors Support Program
Authors: Rogers J. , Sheldon A. , Barwick C. , Letofsky K. , Lancee W.
Published: April 2017

The Survivors Support Program attempts preventive intervention with a high risk population. As with most preventive efforts in psychiatry, it is difficult to predict who will be most at risk, what services will best meet their needs, and what positive effects are due to the services.

To answer these questions through properly controlled and designed experimental programs conforming to scientific methodology would require the investment of much time, personnel and money. To postpone attempts at intervention until answers are provided by such experimental programs would be to ignore the evidence of common sense and clinical experience.

The Survivors Support Program demonstrates that a volunteer self-referral service, organized through professional liaison with a community organization and committed to providing service and gathering information, can suggest interim answers to the questions while providing support and counselling to a needy population.
Resident Training Systems and Family Systems Training: Limits of Compatibility
Authors: Feldman Ronald B. , Feldman Sandra
Published: April 2017

Resident training systems as presently organized limit our ability to train family therapists. They present the resident with major identity and instrumental problems. Some of these problems are described and suggestions for change are made.
La psychiatrie pendant l'internat précédant la licence
Authors: Smart Marlene , Douglass Alan , Bland Roger
Published: April 2017

Ce document a été rédigé pour la Commission d'éducation et de relations professionnelles de l'Association des psychiatres du Canada, présidé par le Dr John Toews, et approuvé par le Conseil d'administration de l'APC en mai 1982.
A Study of Young-Age and Mid-Life Homicidal Women Admitted to a Psychiatric Hospital for Pre-Trial Evaluation*
Authors: Husain Arshad , Anasseril Daniel E. , Harris Phillip W.
Published: April 2017

The authors compared a group of young female homicidal offenders with a group of middle-aged homicidal women as to demographic data, psychopathology, physical disorders and type of victims chosen. Young women tend to have low socioeconomic status, have antisocial personality disorder, and I or schizophrenia as psychiatric diagnoses and most likely kill their children, while midlife women tend to have slightly higher socioeconomic status, suffer from affective disorder and alcoholism and have more frequent physical disorders and most likely murder their spouses. A significant finding noted among mid-life women is the high frequency of physical abuse by husbands who later become their homicide victims. Treatment implications of these findings are noted.
Negative Impact of Computerized Record Keeping in a Psychiatric Department*
Authors: Mclean J.D. , Kapkin I.A.
Published: April 2017

A general hospital psychiatric inpatient department which had been regarded as efficient and effective in its functioning, underwent rapid deterioration after the introduction of a computerized system of charting and record keeping.

The deterioration was attributed to: 1) Impeded communication among the staff; 2) Loss of time available for patient care; 3) Staff frustration with the system and subsequent feelings of anger and helplessness being communicated to the patients.

The authors describe the development of this deterioration and discuss possible psychodynamic factors and suggested corrective-preventative measures.
Psychotherapy and Pharmacotherapy: The Challenge of Integration*
Authors: Goldhamer Paul M.
Published: April 2017

The use of psychotherapy and pharmacotherapy in combination remains a neglected area of study. In spite of evidence validating the combined treatment psychiatrists often avoid this approach. When combined treatment is employed insufficient attention may be devoted to the important interactive effects.

Patients may react to the prescription of medication with a variety of transference feelings such as acceptance, rejection, manipulation and narcissistic injury. Discussion of interpersonal issues precipitated by the use of medication can improve not only the doctor-patient alliance but also the patient's symptomatic experience.

The initiation or discontinuation of medications must be carried out with sufficient attention to the patient's realistic concerns and transference distortions. The neglect of a negative transference reaction aroused by the prescription of a medication can result in a resistance to treatment. Case examples and discussion in the article illustrate such phenomena.

Psychiatrists need to be aware that their decision to prescribe medication may be influenced by their own unconscious conflicts surrounding the use of medication. They may prescribe or fail to prescribe motivated by their latent fantasies.

Attention to the interactive effects of combined therapy is viewed as essential in order to aid patients in the dual goals of symptom alleviation and enrichment of interpersonal experience.
Psychiatric Disorders Associated with Atypical Facial Pain
Authors: Remick Ronald A. , Blasberg Bruce , Campos Peter E. , Miles James E.
Published: April 2017

Atypical facial pain (AFP) patients classically present with a chronic discomfort that is neither anatomic nor dermatomal in distribution. Neuropsychiatric assessment of 68 patients with AFP indicated that 46 (68%) had a specific psychiatric disorder by DSM-III criteria. A wide spectrum of psychiatric disorders was present. The authors emphasize that psychiatric assessment of patients with AFP should be an integral part in early assessments of this disorder, rather than relying on psychiatric opinions after extensive dental and other invasive procedures have been tried in vain and often to the detriment of the patient. Comments on the excellent prognosis in treating the psychiatric syndromes associated with AFP are made.
Tourette's Syndrome and Anophthalmia in a Girl: Complex Differential Diagnosis*
Authors: Parraga Humberto C. , Butterfield Patrick T.
Published: April 2017

This is a report of a 15 year old girl with anophthalmia who met the DSM-HI criteria for Tourette's Syndrome (TS). The case presented a complex differential diagnosis with previous diagnoses of behaviour disorder and schizophrenia, complicated by the issues of blindness, pharmacological, and environmental factors.

Once the diagnosis was made, and due to intricate biopsychosocial interactions, a comprehensive treatment approach was adopted with good results.

The authors comment on the non-existence of studies about the incidence of TS in blind children and recommend the discrimination between the motor behaviour of the tic disorder versus mannerisms associated with blindness. Thus a reasonable degree of suspicion is warranted in the treatment of blind children with severe behavioural disturbances.
A Symptom Based Approach to the Diagnosis of Schizophrenia*
Authors: Packer S. , Engelsmann F.
Published: April 2017

This study reviews the attempts of Carpenter et al to develop valid diagnostic criteria of schizophrenia by means of a flexible 12 point system of signs and symptoms based on the IPSS. The authors applied the 12–point system to 67 inpatients and obtained different levels of certainty in identifying proportions of schizophrenic and non-schizophrenic patients: 80% of clinically diagnosed schizophrenic patients obtained 5 or more points. Kappa statistics revealed a 0.59 proportion of agreement in excess to chance between clinical and experimental diagnosis of schizophrenia, indicating the clinical usefulness of the 12 point system.
Syndrome of Inappropriate Secretion of Antidiuretic Hormone in Association with Chlorpromazine Ingestion*
Authors: Tildesley Hugh D. , Toth Ellen , Crockford Peter M.
Published: April 2017

A patient is described who was found to have the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in association with chlorpromazine ingestion. Electrolyte abnormalities should be considered in patients who demonstrate behavioral changes while on chlorpromazine.
Depression in Canadian General Practice Attenders
Authors: Barnes Gordon E. , Prosen Harry
Published: April 2017

In this study, depression among patients visiting general practitioners was examined by administering a short self-report measure of depression to 1,250 patients visiting 37 general practitioners in three Canadian centres (Winnipeg, Brandon and Virden). According to scores on the CES-D scale, 66.8% of the patients were judged to be normal, 11.8% were experiencing mild depression, 13.3% moderate depression and 8.1% were experiencing fairly severe depression. Depression scores were highest among female patients, patients who lived in Winnipeg, patients who were unemployed and patients who were divorced or separated.
The Use of Intravenous Chlorimipramine in the Treatment of Obsessive Compulsive Disorder*
Authors: Warneke Lorne B.
Published: April 2017

Obsessional disorder has always remained a difficult illness for psychiatrists to treat with response to therapy, both psychotherapy and chemotherapy, being low.

A review of the traditional approaches to the treatment of obsessional disorder is done, including a brief review of the literature on intravenous chlorimipramine. Five case histories of patients with previously non-responsive obsessional disorder are summarized. All five cases were treated in hospital with a series of infusions of intravenous chlorimipramine. The drug and route of administration was extremely well tolerated with rapid and dramatic relief of obsessional symptoms as well as improvement of mood in all cases. The theoretical action of chlorimipramine is discussed as well as possible reasons why the intravenous route appears to be superior to the oral form.
Whatsoever Things are True: Ways, Means and Values in Modern Psychiatry
Authors: Runions J. Ernest
Published: April 2017

Epistemology and ethics are fundamental disciplines to understanding the nature of the medical enterprise. Values of truth, goodness, faith and love dominate the knowledge and practise of medicine. Each epistemological model of truth (truth as useful, truth as correspondence to fact, and truth as coherence) has strengths and weaknesses in guiding us in the scientific method in medicine. Dialectic skills are also important epistemological tools in exploring truth in relationship to diagnosis and treatment. By dialectic and analogy we approach the good as we explore and debate available technique and desirable goal.

All of the doctor's scientific discipline and technical skill must be brought to bear within a relationship. It is here that the medical enterprise becomes intensely concerned with ethics. Most ethicists describe the doctor-patient relationship as a fiduciary relationship in which the doctor commits himself to his patient in faithfulness. The doctor-patient relationship is a special form of the “I-Thou relationship” grounded not only in trust but also in love.
Residents Training in the Mental Status Examination
Authors: Ross Colin A. , Leichner Pierre
Published: April 2017

One hundred and ninety-two Canadian psychiatry residents (43% of the total Canadian resident population) completed a questionnaire concerning their training in and use of the mental status examination (MSE). Residents perceive a number of deficiencies in their training for the mental status examination. They employ a wide variation in tests, and show a lack of sophistication in how to test for special dysfunctions.

We discuss these data in the context of accumulated research on MSE. It should be possible to provide more systematic training in the MSE and we suggest modifications in resident training which might produce a more uniform and reliable MSE.
The Patient and the Dying Psychiatrist
Authors: Meloche Monique
Published: April 2017

In the last few years a great deal of attention has been paid to the dying patient and his relatives, but very little to the illness of the psychiatrist, particularly when it is of a terminal nature. This paper is about Jean Caron, M.D., a psychiatrist who suffered from leukemia, and his patients some of whom came to learn about it in an indirect fashion and others in a more open way. The knowledge of his illness and oncoming death, while first experienced as severe shock, became therapeutically useful in relieving previous losses and abandonments and completing unfinished mourning. It appears possible to mourn a person who is still living and through his help, mourn previous losses while this person is mourning his own life.
Endogenous Opiates and Schizophrenia: Directions in Clinical Research
Authors: Goldbloom David S.
Published: April 2017

In the past decade both basic and clinical research on endogenous opiates has involved many aspects of medicine. This review focusses on the clinical literature that relates physiology and pathophysiology of the endogenous opiates to schizophrenia. Three major investigative approaches are described and their results evaluated. These approaches include assays of endogenous opiates in the context of clinical illness and use of exogenous opiates as well as exogenous opiate antagonists in the treatment of clinical illness. Current understanding at both the basic science and clinical research levels does not allow firm conclusions about the role of endogenous opiates in schizophrenia; however, the evolution of the growing understanding is used by the author to provide a speculative hypothesis.