bluuebunny/crossref_metadata_2025 huggingface dataset:
Brain Imaging in Functional Mental Disorders
Authors: Young Trevor , Williamson Peter
Published: April 2017

The application of brain imaging techniques to psychiatry is reviewed with respect to computerized tomography (CT), EEG topography, positron emission tomography (PET), and magnetic resonance imaging (MRI). While early computerized tomography studies have suggested structural abnormalities in schizophrenia, more recent studies have shown that most schizophrenics and patients with other disorders have normal CT scans. EEG topography and positron emission tomography have not been evaluated as fully as computerized tomography. However, preliminary studies indicate some functional abnormalities in schizophrenia and affective disorders compared to normal controls. Magnetic resonance imaging shows promise but has had only a limited application to date in psychiatry.
Report: Conference on Key Issues in Post-Graduate Psychiatric Education in Canada
Authors: Paris J. , Kravitz H. , Prince R.
Published: April 2017

At a national conference in 1985, the Royal College guidelines for post-graduate training in psychiatry in Canada were reviewed. The topics considered included geriatrics, consultation-liaison, chronic care, out-patient, and psychotherapy training, as well as pre-licensure requirements and examinations. The recommendations will be used by the Royal College in reformulating its requirements for pychiatric residency programs.
Types of Marital Intimacy and Prevalence of Emotional Illness
Authors: Waring E.M. , Patton David , Ann Neson Carol , Linker Winnie
Published: April 2017

Epidemiological research has demonstrated that married individuals generally experience better emotional health than the single, divorced and widowed. The married populations in these studies were not evaluated on the basis of the quality of their marital relationships. Research on the interpersonal quality of marital relationships in the general married population has rarely been reported in the psychiatric literature.

A sample of the general married population (n = 250 couples) completed a self-report questionnaire which measures the quality and the quantity of intimacy in marriage. Four types of marital patterns were operationally defined by total intimacy score, pattern of scale profile, and social desirability scores. The relative frequencies of these types of marriages are reported. The prevalence of symptoms of non-psychotic, emotional illness in one or both spouses in the four categories of marriage is reported.

Thirty-one percent (31%) of the couples report marriages with absent and/or deficient intimacy. Couples with “absent and/or deficient” marital intimacy had a significantly higher proportion of spouses with symptoms of non-psychotic emotional illness.

This study suggests that previous research may have confounded the variables of marital status and marital quality in the study of psychiatric disorder. These studies may have under-estimated the positive effect of an “optimally” intimate relationship.
Suicidal Behavior in Chronic Schizophrenic Patients: A Follow-up Study
Authors: Roy Alec , Schreiber Judy , Mazonson Anne , Pickar David
Published: April 2017

A follow-up study was carried out of suicidal behavior among 127 chronic schizophrenic patients. We were able to obtain follow-up information for 100 of the 127 patients (78.7%). Over the mean follow-up time of 4½ years, 6 of these 100 patients (6%) had committed suicide and 16 other patients (16%) had attempted suicide. Chronic schizophrenic patients who attempted suicide during the follow-up period, compared with those who did not, had had significantly more psychiatric admissions. Using the data obtained at the time of the index admission we were unable to accurately predict the 6 schizophrenic patients who were known to have subsequently committed suicide.
Article Commentary: Research Priorities in Mental Health
Authors: Campbell Dugal
Published: April 2017

Setting research priorities becomes necessary when the demand for research funds outstrips the supply; because it is impossible to do everything some topics must be chosen as more promising and pertinent than others. This paper proposes a scheme for estimating the relative merits of different branches of research within the whole field of mental health. The scheme for assessing the claims of each area is based upon three factors: the need for research in a particular topic (using data about prevalence of disorders; the costs attributable to disorders; and the like); the possibilities of doing good science; the estimated time to a clinical payoff It is argued that reasonable assessments of these three factors can be combined to give a relative weight to any particular research area. The judgements of relative weight can be progressively improved as more data becomes available. The argument is put that one way to obtain more funds for mental health research overall is to improve the ordering of the different areas within the field of mental health. Once mental health has its house in order it will be better equipped to make the case for mental health research.
Electroconvulsive Therapy: Contemporary Standards of Practice
Authors: Martin B.A.
Published: April 2017

Electroconvulsive therapy (ECT) has retained an important but controversial position in contemporary psychiatric therapeutics. Out-dated standards of clinical practice regarding its technical administration, clinical indications, and dosage continue to influence the present use of ECT. Insofar as present knowledge permits, this paper describes optimum clinical standards for the use of ECT in contemporary practice. Where knowledge is insufficient to permit articulation of absolute standards, guidelines for its clinical use are presented. Particular emphasis is placed upon a narrow definition of the clinical indications for ECT, clearly linked to its demonstrated effectiveness and potential benefit in excess of its risks to any given patient. The technical administration of the procedure is described in detail with particular emphasis on the pre-treatment protocol, including consent, and the treatment dosage, including stimulus waveform, electrode placement, and number of treatments per course. The major deficiencies in knowledge are identified.
Polypharmacy in Psychiatry: Update and Future Trends
Authors: Rapp Morton S.
Published: April 2017

Psychoactive drug combinations continue to be controversial. The concept of “polypharmacy”, a pejorative and meaningless term, nevertheless gave rise to useful surveys on combined drug use, to methods of monitoring and controlling multiple drug use, and to a small number of studies which imply that a few psychoactive drug-drug combinations are rational. This paper updates the contributions to these areas since two major reviews of the subject were published in the early 1980's. It highlights common pitfalls in the survey-taking process. Finally, it suggests future useful avenues of study and research, wherein it, is hoped that the studies will be more rational than the term “polypharmacy”.
Three Simultaneous Major Sleep Disorders
Authors: Douglass Alan B. , Hays Peter
Published: April 2017

A patient with complex symptomatology is described. Progress in the diagnosis of sleep disorders gradually led to successful diagnosis-based treatment.
Psychological Factors in the Choice of Psychiatry as a Career
Authors: Frank Hallie , Paris Joel
Published: April 2017

A survey of psychiatrists and non-psychiatrists in a medical faculty examined questions bearing on two hypotheses, that psychiatrists choose their career either to heal themselves or to heal their families. The results provided some support for the psychiatrist as a “wounded healer”. The findings did not appear to be an artifact of more psychiatrists having been in therapy. The results were the same whether or not psychiatrists specialized in psychotherapy.
DSM-III: Problems in Diagnosis of Paranoia and Obsessive-Compulsive Disorder
Authors: Ross Colin A. , Siddiqui A.R. , Matas Manuel
Published: April 2017

The diagnoses of paranoia and obsessive-compulsive disorder are not adequately dealt with either conceptually or phenomenologically in DSM-III. A case of monosymptomatic hypochondriacal psychosis illustrating this point is presented. The question of whether this disorder should be diagnosed as paranoia, obsessive-compulsive disorder or an atypical affective disorder is discussed.
Resident Training in Chronic Care and Rehabilitation
Authors: Packer Samuel
Published: April 2017

Although the Royal College requires that residents receive training in the rehabilitation of psychiatric patients, much leeway has been given to individual departments of psychiatry as to program content. This has often led to inadequate training since residents may be exposed to chronic patients without any training in rehabilitation. In order to meet this deficiency McGill University and the University of Toronto have developed specific program requirements. These are described below.
Impaired Interns and Residents
Authors: Hurwitz T.A. , Beiser M. , Nichol H. , Patrick L. , Kozak J.
Published: April 2017

In 1981 a study was undertaken to determine intern and resident psychological well-being and identify those house staff who were psychologically impaired. Fourteen percent of house staff were found to be impaired. Single females and house staff who were chronically fatigued or socially isolated were at highest risk for impairment. Impairment arose out of the interaction between sleep and social deprivation and individual vulnerability. Minor tranquillizers, but not alcohol, were used as a coping response to impairment.
Mood, Depressive Illness and Gait Patterns
Authors: Sloman L. , Pierrynowski M. , Berridge M. , Tupling S. , Flowers J.
Published: April 2017

This study measures the ground force patterns of 87 normal, older adults. It tests the hypothesis that there is a relation between a subject's mood as measured by the Beck Inventory, and the ground reaction forces as measured by a force plate during normal gait. Results showed that the push-off force in the posterior and downward directions was correlated with the expression of mood state. Lower mood individuals demonstrated a smaller push-off force and these ground force patterns of low mood state subjects resembled the patterns found in a previous study of clinically depressed patients. It is suggested that gait measurement could provide a sensitive index of level of depression in a clinical population.
PRN Medication for Psychiatric Inpatients
Authors: Craven John L. , Voore Peter M. , Voineskos George
Published: April 2017

Little is known about the extent of the use of prn psychotropic medication in psychiatric inpatient units. A survey of the prn prescription and administration of psychotropic drugs in a psychiatric teaching hospital revealed that a large number of inpatients were prescribed and administered such drugs on a prn basis. Although 50% of the prescriptions were never administered, only 25% were actively discontinued by physicians. A diagnosis of personality disorder was the factor most frequently associated with the rate of prn prescriptions and of administrations. A large number of prn prescriptions had no instructions for indications, minimum time spacing between doses or maximum daily dosage. It is suggested that hospitals monitor the prn use of psychotropic medications in their inpatient units, and explore the reasons for such use. Psychotropic drug use on a prn basis should preferably be reserved for emergencies, and the instructions of prn prescriptions should be clear and detailed.
The Difficult Inpatient: Identification and Response by Staff
Authors: Gallop R. , Wynn F.
Published: April 2017

This paper discusses the findings of a pilot study of the phenomenology of the “difficult” psychiatric inpatient. Twenty-five nurses and 12 psychiatric residents were asked to identify and describe the behaviours or characteristics of patients they found difficult. In addition, subjects were asked to describe behaviours and feelings they experienced when treating or caring for a specific difficult patient. Content analysis revealed similar diagnostic categories of patients identified as difficult. While feelings of incompetence and lack of control were aroused in both nurses and residents their expression and identified origins pointed to some interesting differences. Nurses’ responses were more personalized and affect-laden. Residents tended to blame the system and remain more objective.
Folie à Deux in Two Sisters: Case Report from Nigeria
Authors: Ilechukwu S.T.C. , Okyere E.
Published: April 2017

A case of folie à deux in two sisters from Nigeria is presented. The illness arises in a setting of multiple object losses, and social isolation, which left the two sisters most vulnerable. The more passive sister picks up some of the symptoms of her previously ill sister and they join in destructive activity which brings them to the hospital. Transcultural aspects are emphasized.
Mental Changes Associated with Tocainide, a New Antiarrhythmic
Authors: Bikadoroff Serge
Published: April 2017

A case is reported in which tocainide, a relatively new cardiac antiarrhythmic for oral use, is believed to have caused a delirium.

The patient had been admitted to a coronary intensive care unit for the treatment of ventricular arrhythmia and had developed confusion, impairment in concentration and severe anxiety. Her EEG was compatible with metabolic encephalopathy.

The clinical picture varied with the use of tocainide so closely that it appeared to be the most likely cause of the delirium. Other factors were taken into consideration but did not seem to adequately disprove this impression.

Tocainide has been known to cause minor, transient and treatable side effects in the form of gastrointestinal and central nervous symptoms — mainly nausea, tremor and dizziness. There have also been three case reports of paranoid psychoses.

It is suggested that psychiatrists be aware of the above complications as they may have occasion to see patients taking tocainide, especially in consultation-liaison work. A table with the more common side effects and their frequencies is included.
Affective Disorder and Homicide: A Case of Familial Filicide Theoretical and Clinical Considerations
Authors: Bourget Dominique , Bradford John M.W.
Published: April 2017

This paper discusses a case of maternal homicide which occurred in the course of a major affective disorder. The relationship between mental illness and criminality is reviewed with a particular emphasis on affective disorder in relation to filicide. A number of significant issues are dealt with including consequences of failure to elicit positive family history of affective disorder, suicide and filicide. Indeed, a history of familial double filicide raises the question of possible hereditary influences. The significance of hypochondriacal symptomatology in the course of the illness and the role of steroids in precipitating or aggravating a psychotic depression also need to be explored. It primarily addresses the importance of prevention and recognition of risk factors associated with child murder committed by depressed parents.
Schizophrenia-Like Psychosis Associated with Vein of Galen Malformation: A Case Report
Authors: Aleem Asaf , Knesevich Mary Ann
Published: April 2017

A 34 year old patient presented with a schizophrenialike clinical picture, and was later found to have a large vein of Galen Arteriovenous Malformation (AVM). There are reports in the literature suggesting that vein of Galen AVMs are associated with psychiatric symptoms. However, the clinical pictures tend to be non specific. We discuss the relevance of the association of vein of Galen AVMs with schizophrenia-like symptomatology.
Do Oriental Psychiatric Patients receive Different Dosages of Psychotropic Medication when Compared with Occidentals
Authors: Rosenblat Rebecca , Tang Siu Wa
Published: April 2017

The literature suggests the possibility of different drug dosage requirements between patients of different ethnic origins. This study thereby attempted to investigate the average dosages of psychotropic medications being prescribed for Orientals versus Occidentals using a retrospective drug history review and an international opinion survey.

The retrospective drug history review compared drug dosages for four commonly used psychotropic medications in well matched Oriental and Occidental populations. Data from this review showed that final/maintenance dosages of amitriptyline were significantly lower for Orientals than Occidentals.

The opinion survey assessed the responses of psychiatrists in the Orient, as well as in North America, with respect to average dosages prescribed for the two populations; their beliefs in possible variability and causes underlying the variability. Data indicated that significantly lower dosages of chlorpromazine, phenelzine, diazepam, and chlordiazepoxide are being prescribed for Orientals as compared with Occidentals.

Beliefs in differences were dependent upon the degree of exposure to Orientals. Suggested etiological factors underlying the variability were usually related to drug metabolism, side effects, and body weight. In both types of studies, Orientals appeared to have lower prescribed dosages than Occidentals. The lower dosages, however, appeared to be a function of the physician's experience in treating the Oriental population.
Case Report: A Psychotherapeutic Group for Men
Authors: Swenson J.R. , Elliott D.
Published: April 2017

Little has been written on group therapy designed to treat a group of all male patients. A group of male outpatients followed in individual psychotherapy were identified who shared several personality traits and faced similar psychosocial problems. These patients were 20 to 40 years old, unmarried, the majority unemployed and lacking heterosexual relationships. This report examines characteristics of these patients, themes arising during group sessions, aspects of group composition, techniques used in therapy and the outcome of various patients after six months of therapy.
A Case of Charles Bonnet Syndrome with Musical Hallucinations
Authors: Patel Hiten C. , Keshavan Matcheri S. , Martin Steven
Published: April 2017

An 86-year-old woman with visual impairment who developed a vivid, visual hallucinatory state in clear sensorium is described. This picture conforms to the description of Charles Bonnet Syndrome. She also experienced musical hallucinations. The role of sensory deprivation in the pathogenesis of this syndrome is discussed.
The Girl who Cried Wolf: Pseudologia Phantastica and Sexual Abuse
Authors: Matas M. , Marriott A.
Published: April 2017

There has been an explosion of interest recently in sexual abuse and incest, with reported causal links to a wide variety of psychiatric disorders. The integrity of Freud's seduction theory has been challenged by Jeffrey Masson and sexual abuse activists. What is the position of a therapist who finds out that a patient's reports of incest and sexual abuse turn out to be fabrications?

These issues are presented and discussed in the context of a brief, illustrative case history. There is also a review of the concept of “pseudologia fantastica”, as well as a brief review of a feminist critique of Freudian theory.
Persons Discharged from Warrants of the Lieutenant Governor*
Authors: Phillips Michael S. , Landau Tammy , Osbourne Catherine
Published: April 2017

The authors compiled demographic, psychiatric, and criminological information on persons who were held on warrants of the Lieutenant Governor in Ontario. These warrants were vacated between the period 1969–1982. Of the entire population of 296 such persons, 46% were held as being Unfit to Stand Trial, 51% were Not Guilty by Reason of Insanity, and the remainder were Mentally Ill prisoners. Separate analyses were conducted with the Unfit sample. The average length of confinement on a warrant was 7 years.
Short-term Economic Change and the Utilization of Mental Health Facilities in a Metropolitan Area*
Authors: Trainor John , Boydell Katherine , Tibshirani Robert
Published: April 2017

The relationship between economic change and mental disorder has been examined by several investigators over the past century. The purpose of this paper is to explore this basic relationship and determine its direction in a large Metropolitan area. A time series analysis was undertaken to investigate whether or not unemployment and indicators of mental health are related over time. Trends in the following four indicators of mental health were examined:

1. Number of admissions to all psychiatric facilities serving Metropolitan Toronto.

2. Number of admissions to one provincial psychiatric hospital (Queen Street Mental Health Centre) in Toronto, which serves a chronic population.

3. Number of discharges from Queen Street Mental Health Centre.

4. Number of admissions plus those assessed and not admitted to Queen Street Mental Health Centre.

In order to assess the possible delayed effects of unemployment, correlation analyses were computed for several lag times. “Lag time” is defined here as the time delay between unemployment and its potential effects on mental health indicators. Lag times used were zero, three, six and twelve months. The best equation found was for a six month lag, indicating an inverse relationship; as unemployment increases, admissions and discharges decrease.

Results suggest that there are no simple relationships between the dependent and independent variables. Observed trends may be due to much wider exogenous factors such as hospital capacity and changing admission criteria.
Relating Axes IV and V of DSM-III to Clinical Severity of Psychiatric Disorders*
Authors: Gordon Richard E. , Gordon Katherine K.
Published: April 2017

This study examined DSM-III Axes IV and V scores and their ratio among patients in different psychiatric treatment settings. Inpatients’ scores and ratios were worse than those of outpatients; longer-term inpatients’ scores and ratios were worse than those of shorter-term ones; and chronically ill state hospital inpatients’ were the worst.
A Critique of the Principles of the Young Offenders Act*
Authors: Awad George A.
Published: April 2017

A unique feature of the Young Offenders Act is a section on the Principles of the Act. The principles clearly focus on the responsibility of young offenders, their legal rights, and the protection of society. The focus on the due process of the law is a welcome addition to the Juvenile Justice system. However, these principles do not recognize any other rights for adolescents, downgrade the importance of their needs, and do not take into account the cognitive, psychological and social functioning of adolescents. In addition, the principles implicitly reverse those important principles that have guided our society and the clinical process for more than a century; namely, a shift from a “therapeutic state” to a “legalistic state”, the roles of institutions in our society, and the adultomorphization of adolescence.
The Review Panel Process: Interpretation of the Findings and Recommendations*
Authors: Paredes J. , Ledwidge B. , Beyerstein D. , Cashore J. , Higenbottam J.
Published: April 2017

In a series of three studies, the present authors and others in this research group have examined the Review Panel process: (a) before the hearing (which patients apply for a hearing?); (b) at the hearing (how do the patients released by the Panel differ from those retained by the Panel and; (c) after the hearing, how are the Panel-released patients faring one and two years after being released by the Panel, compared to patients released by the attending psychiatrist?) In the present paper, the findings of these three studies are summarized and an attempt is made to explain the findings, some of which are surprising (for example, the 35% disagreement between Panel and attending physician with respect to suitability for discharge and the finding that Panel-released patients survive as long in the community as do physician-discharged patients).

Based on the findings and the interpretation placed on them, the authors make a series of recommendations with respect to the operation of Panels, the management of defiant involuntary patients and future research in this area.
Fire Fetishism, Diagnostic and Clinical Implications: A Review of Two Cases*
Authors: Bourget D. , Bradford John
Published: April 2017

From the 19th century and early writings on the subject, psychosexual factors have been reported to play a role in pyromania. After a brief review of the literature on firesetting and pyromania, two cases of arsonists are presented in which fire appears to be part of a fetish. Full sexual behaviours assessments were completed, therefore providing objective findings. Both subjects were treated for the sexual deviation associated with the acts of arson and showed significant changes in their sexual functioning. This paper deals with the issues of identification and management of such conditions.
Psychiatric Disorder and Poor School Performance among Welfare Children in Ontario
Authors: Offord David R. , Boyle Michael H. , Jones Beverly R.
Published: April 2017

Parental welfare status was found to be a marker for identifying a group of children with an increased prevalence of psychiatric disorder and poor school performance. The marker was particularly strong for psychiatric disorder in young boys and for poor school performance in young girls. For instance, the prevalence rates of psychiatric disorder, in the 6 to 11 age group, for welfare and non-welfare boys, were 40.0% and 13.9%, respectively; and for poor school performance in welfare and non-welfare girls, 27.8% and 6.1%, respectively.

The relationship between different measures of psychosocial disadvantage and these child deficits was examined. Multivariate analyses revealed, for example, that parental welfare status made an independent contribution to the prediction of psychiatric disorder and was a more powerful predictor of poor school performance in girls compared to boys. The implications of these and other results are discussed.
Strategic Family Therapy Interventions with Deaf Member Families*
Authors: Sloman Leon , Springer Steven
Published: April 2017

A deviance based model of deafness is compared with one based on ethnicity. The function of inadequate communication in deaf member families is explored. Techniques of intervention are examined with a focus on three strategic interventions namely: 1) circular interviewing; 2) positive connotation; and, 3) use of rituals. Case histories are provided.
Assessing the Credibility of Young Children's Allegations of Sexual Abuse: Clinical Issues*
Authors: Klajner-Diamond Halina , Wehrspann William , Steinhauer Paul
Published: April 2017

In assessing the credibility of young children's (ages 2–7) allegations of sexual abuse clinicians need to know how dynamics of sexual abuse affect disclosure, what situations are most commonly associated with fictitious allegations and how the child's developmental stage affects disclosures. Understanding these issues allows for clear decision making. A clear decision making process flows naturally from an understanding of these issues.
A Case of Atypical Psychosis Associated with Alexithymia and a Left Fronto-Temporal Lesion: Possible Correlations
Authors: Blackshaw Stella , Bowen Rudradeo C.
Published: April 2017

The case history is presented of a man with an atypical psychosis and classical clinical features of alexithymia. On his last admission, the patient presented with starvation and hypernatremic coma. A CT scan, which was done because of the coma, revealed a large left fronto-temporal arachnoid cyst. The significance of this finding is reviewed in the light of previously suggested organic bases for alexithymia and related syndromes. Although the symptom of alexithymia is present, the patient's other symptoms do not fit readily into existing diagnostic categories and the resulting diagnostic dilemma is discussed.
Treatment of Tardive Dyskinesia: Preliminary Report on Use of Tetrabenazine
Authors: Watson Michael W.B. , Skelton David , Jamali Fakhreddin
Published: April 2017

Tetrabenazine has been used for treatment of tardive dyskinesia sporadically over the past twenty years. Dose has usually been decided empirically without assaying blood levels. This report describes 23 cases treated successfully with tetrabenazine. Our method of measuring levels of tetrabenazine and its metabolites in biological samples is described briefly.
Psychiatric Complications of Surgery in the Male
Authors: Steinberg Paul
Published: April 2017

Four male patients with severe personality disturbance are described in whom surgery on their genital or perineal areas is followed or preceded by increased psychiatric symptomatology. In one case where adequate historical detail was available, the psycho dynamics of the case, including the unconscious meaning of surgery to the patient, are formulated. Suggestions are made on how to identify and manage such patients.
Criminalization of the Mentally Ill: Part I. Police Perceptions
Authors: Holley H.L. , Arboleda-Florez J.
Published: April 2017

This paper reports the findings from Phase I of an ongoing prospective, longitudinal study of mentally ill offenders. The study documents the nature, extent and location of mentally ill offenders in the criminal justice system in Southern Alberta, evaluates mechanisms which are used to identify mentally ill offenders in need of treatment, identifies existing psychiatric services available within the criminal justice system and documents their psychiatric service utilization patterns. A study cohort of 611 was identified at their time of arrest and followed through the justice process from initial detention until final release.

Part I on this study focusses on the period of arrest. More specifically, police perceptions of disturbed behaviour are examined. The prevalence of police-identified offenders is reported and police judgments regarding possible causes of disturbed behaviour (that is, mental illness, drugs, alcohol) and recommendations for psychiatric treatment are examined. Discrepancies between official recommendations made by police to a bail magistrate (and recorded on the arrest report) and unofficial recommendations collected as part of the study are explained in terms of differing decision-making models; clinical versus legal. Finally, the importance of police perceptions concerning the presence of mental illness as opposed to substance abuse are identified as important factors which influence the decision to recommend psychiatric examinations.
The Lateralization of Atypical Facial Pain
Authors: Lam Raymond W. , Remick Ronald A.
Published: April 2017

Various theories have been proposed to explain the reported predominance of left-sided symptoms in patients with conversion disorders, psychogenic symptoms, and chronic pain. In a population of 110 patients with atypical facial pain (AFP), there were no significant differences in the side of pain or lateralization of pain between psychiatric and non-psychiatric patients. A non-significant trend to left-sided pain in psychiatric patients was found if only those patients with lateralized pain were examined. The significance of these results to etiological theories of chronic pain lateralization is discussed.
Treatment of Bulimia with Desipramine: A Double-Blind Crossover Study
Authors: Barlow Jane , Blouin Jane , Blouin Arthur , Perez Edgardo
Published: April 2017

The purpose of this study was to evaluate the effect of desipramine, a tricyclic antidepressant with relatively specific noradrenergic effects, on bulimic behaviour, eating attitudes, and mood. Using a double-blind crossover design, 47 normal weight bulimics were randomly assigned to receive either desipramine (150 mg/day)for six weeks, no drug for three weeks, followed by placebo for six weeks, or the reverse sequence. At weeks 0, 2, 4, 6, 9, 11, 13, and 15, each subject was assessed using the EDI, SCL-90, POMS and binge records. Plasma desipramine levels were obtained at weeks 4 and 13. Twenty-four subjects completed the entire fifteen week protocol, while 23 dropped out. Desipramine was significantly more effective than placebo in reducing the frequency of weekly hinging, weekly vomiting, and the fatigue scale of the POMS. No significant effect of the drug was obtained on the EDI or the SCL-90. The clinical effect was modest. Desipramine's antibulimic effects were not associated with an alleviation of depressive symptoms.
Delusional (Paranoid) Disorders: Etiologic and Taxonomic Considerations. II. A Possible Relationship between Delusional and Affective Disorders
Authors: Munro Alistair
Published: April 2017

Paranoid (delusional) disorders are usually thought to overlap with schizophrenic disorders, and there may be a continuum, especially with paranoid schizophrenia. There is also some recent evidence of an overlap with affective disorders. This article refers to the author's series of monodelusional disorders, emphasizing certain mood concomitants, and discussing the implications of these for delusional disorders in general.
Psychiatric Consultation in a General Hospital
Authors: Pablo Renato Y. , Lamarre C.J.
Published: April 2017

The psychiatrist's role in the therapeutic management of a wide range of hospitalized persons is now recognized. This study investigated the extent and the pattern of consultations among the medical specialties (medicine, surgery, obstetrics/gynecology, family practice, pediatrics and psychiatry) in a large teaching hospital over a one year period. Among the specialties consultations were requested most often from within the same specialty; for example, medicine sought 64.4% consults from medicine. The proportion of patients with an associated psychiatric diagnosis in each of the specialties ranged from 2 to 21%. Psychiatric consultations on these patients ranged from 5 to 13 per hundred (medicine = 12, surgery = 8.9, family practice -13.2 and pediatrics = 5). Consultations rates reported in previous studies were also reviewed. Factors that may contribute to the generally low rate of psychiatric consultation and the implications for providing better care are then discussed.
Psychiatric Consultation-Liaison Services to an Obstetrics and Gynecology Department
Authors: Stewart D.E. , Lippert G.P.
Published: April 2017

This paper describes the psychiatric consultation-liaison services provided to an Obstetrics and Gynecology Department. Clinical services are provided both by program consultation and by individual inpatient and outpatient referral. Clinical problems in obstetrics and gynecology that result in psychiatric referral are discussed. Research interests which play an important role in the program are described. Educational activities are directed toward ward and clinic staff, undergraduate medical students, residents and the practising specialist.

The combination of well articulated consumer requests, interested gynecologists and obstetricians, broadened gynecology residency training objectives, and greater involvement of consultation-liaison psychiatrists suggests a promising future for psychosomatic obstetrics and gynecology.
Psychiatric Consultations in Rheumatology: A Review of 100 Cases
Authors: Darby Padraig L. , Schmidt Peter J.
Published: April 2017

Consultation-liaison psychiatry has contributed much to our understanding of the psychological complications of physical illness, both in general responses to illness and in particular problems related to specific diseases. We reviewed 100 psychiatric consultations from a specialized rheumatology unit. Eighty percent of the consultations consisted of patients with systemic lupus erythematosus (36%), rheumatoid arthritis (29%), and fibrositis (15%). The majority of S.L.E. patients had organic brain syndromes related to central nervous system involvement or corticosteroids, while the majority of rheumatoid arthritis patients had a depressive diagnosis. Fibrositis patients showed no specific psychiatric diagnosis. Some future areas of research for consultation-liaison psychiatry in this area are suggested.
Consent in Psychiatry
Authors: Florez J. Arboleda
Published: April 2017

This paper was prepared for the Professional Standards and Practice Council chaired by Werner Pankratz, M.D. and approved by the Board of Directors of the Canadian Psychiatric Association on September 15th, 1987.
Faking Sexual Preference
Authors: Kaine Alan , Crim M. , Mersereau Guyon
Published: April 2017

Erectile assessments of sexual preference have been found quite reliable. Their validity, however, has been questioned with some findings that are at variance with the clinical data. These apparently distorted results could be either false positive or false negative responses. The former may be due to faking, which is the act of feigning a spurious positive response to a non-preferred stimulus, and the latter could be from suppressing, which is producing a spurious negative response to one's natural sexual preference.

In this study, phallometric testing with a mercury-in-rubber strain gauge and Model 240 Parks Plethysmograph was used in conjunction with a mid-lumbar pressure sensor. Twenty subjects, half of whom were sex offenders, were tested with visual and audiovisual stimuli depicting male and female models at various ages and degrees of sexual development. Other testing included self-report questionnaires and estimates of age and sexual development.

It was found that both groups significantly reduced penile tumescence when instructed to suppress to their stated sexual preference in the audiovisual series. A significant reduction was also obtained in suppressing to the category to which they had a maximum response in the same series. When both groups were instructed to fake to a non-preferred stimulus, the levels of arousal generated were quite variable and not significantly different from those obtained before instruction. Extraneous movement as measured by the lumbar pressure device was markedly greater in our three incest offenders. The meaning of this finding is unclear.

Sex offenders as a group were found to be significantly more variable in their responses than controls. In the sex offender group, alcoholics had a significantly lower maximum response, but no such affect of alcohol was found in the control group.
Moderating the Morbidity of Divorce
Authors: Rae-Grant Quentin , Robson Bonnie E.
Published: April 2017

Divorce is frequent in our society. It is a “marker” of high stress periods that precede and follow it. The events surrounding it have clear negative effects on the physical and mental health of all those involved. The issues and the reactions, different for fathers and mothers and for children, are determined by the sex and developmental stage. The effects are interactive and events subsequent to the divorce influence the restoration of competent functioning. This paper examines these differential effects, methods of helping in the resolution process and opportunities of preventive work with this high risk population.
Two Subgroups of Hyperactives as Adults: Correlations of Outcome
Authors: Greenfield Brian , Hechtman Lily , Weiss Gabrielle
Published: April 2017

This prospective study explored the association of continuing symptoms of the hyperactive syndrome with adult outcome. A fifteen year follow-up compared 61 hyperactive subjects and 41 matched controls. Outcome measures examined included continuing symptoms of the hyperactive syndrome, antisocial behaviour, substance use, and emotional difficulties. Two subgroups of the hyperactive population were identified. Those hyperactive subjects with moderate or severe continuing symptoms were characterized by significant emotional difficulties, alcohol use, and antisocial behaviour. By contrast, hyperactive subjects with none or only mild continuing symptoms at follow-up did not have other difficulties in psychosocial functioning, and were, in addition, similar to the control group in many respects. The importance of continuing symptoms in determining the adult outcome of children with a diagnosis of ADDH is discussed. Accordingly, the need for comprehensive early, and ongoing interventions is emphasized.
The Foster Care Research Project: Summary and Analysis
Authors: Steinhauer P.D. , Johnston M. , Snowden M. , Santa-Barbara J. , Kane B. , Barker P. , Hornick J.P.
Published: April 2017

This paper analyzes and summarizes five more detailed papers describing the Foster Care Research Project (F.C.R.P.). This compared two (individual and group) models of foster care as to their effects on foster parent satisfaction, placement breakdowns and several indices of children's adjustment in care. The group model is described and contrasted with other “extended family” models, and the results of the project, which were mixed, are summarized. A critique of the experimental design suggests why clinical gains noted in the children were not borne out experimentally. Following a clinician's analysis of the process by which the group model operated (illustrated by clinical vignettes), the paper ends by describing the content and process of two support groups for the natural children of the foster parents.
Multiple Personality Disorder in Childhood
Authors: Vincent M. , Pickering M. Ruth
Published: April 2017

Multiple Personality Disorder (M.P.D.) has been diagnosed in adults and adolescents at an almost exponential rate over the last 10 years in contrast to the previous 100 years. Childhood M.P.D., a more recently recognized entity, has been identified both by retrospective patient reports and actual child case reports, of which we were able to note 12 in total, 4 of which may be more accurately described as “incipient M.P.D.” Given the apparently rapid response to treatment compared to adults and the high morbidity caused by the adult form of the disorder, the authors recommend a “high index of suspicion” and the use of screening questionnaires to detect cases of M.P.D. in high risk populations of children. Although the natural history of M.P.D. is not known, early identification and treatment could lower the number of cases of childhood M.P.D. that become established as adult cases and decrease the associated morbidity of the disorder in both children and adults. More research is needed to establish prevalence, etiology and effective treatment methods.
Teaching Child and Family Assessment Skills to Medical Students during Brief Outpatient Clinic Experience
Authors: Carter Ivan
Published: April 2017

This paper describes a teaching process in which two 4th year medical students learn a family approach to problem solving during a short clerkship of twelve hours spread over four weekly sessions. A clinical-educational process is described, alternating “content” and “process” roles are defined, and the use of a dual earphone communication system is explained. It is suggested that this teaching system could have a wide field of application.
Carbamazepine in Psychiatry: A Review
Authors: Israel M. , Beaudry P.
Published: April 2017

Carbamazepine is a tricyclic compound structurally related to imipramine that has been used since the 1960's for the treatment of trigeminal neuralgias and then approved as an anticonvulsant in the U.S. in 1974. In the last decade the use of carbamazepine has been expanded to include the treatment of certain disorders of mood and behaviour. In this paper possible clinical applications of carbamazepine in psychiatry are reviewed along with its pharmacokinetic and pharmacodynamic profile. Also discussed are adverse reactions and drug interactions which are relevant to its use.
Toward Mastery of Psychotic Symptoms: A Group Phenomenon
Authors: Seeman Mary V.
Published: April 2017

This paper describes a long-term, weekly, outpatient group for the management of recurrent psychotic manifestations. Emphasis is on the development of individual strategies that attenuate symptom distress and reinforce the sense of mastery. Illustrations are drawn from events occurring over the course of the life of the group.
Month of Birth and Schizophrenia in Alberta
Authors: Newman Stephen C. , Bland Roger C.
Published: April 2017

Numerous studies have demonstrated that a greater than expected number of schizophrenics are born during the winter months. The present investigation examined this phenomenon in Alberta. The study population consisted of 1,101 schizophrenic patients admitted to either of the two provincial mental hospitals during 1976–1983 and who were born in Canada. After controlling for year of birth, no seasonality effect was found.
A Clinical Study of Violence in Patients Referred on a Form I to a General Hospital Psychiatric Unit
Authors: Cooper A.J.
Published: April 2017

A retrospective examination of all patients referred by the emergency department of a medium sized general hospital for a mandated Form I psychiatric assessment during a 12 month period was conducted. The principal aim was an analysis of the clinical phenomena and especially the antecedents and course of violent behaviour (following admission and throughout the hospital stay) which in the majority of cases was the reason for the referral. Thirty percent had behaved violently prior to admission but within 24 hours all had settled and during the remainder of their hospital stay were indistinguishable from the generality of the ward population (for example, non-violent). Two-thirds of the patients were non-psychotic; that is, not suffering from a major mental illness; nevertheless, they required a disproportionate amount of time and effort in initial management. A high proportion had several prior admissions to the psychiatric ward, particularly for alcohol misuse and/or a personality disorder.
Les Jeunes Itinérants de Montréal: Une Enquête Transversale
Authors: Lamontagne Yves , Garceau-Durand Yvette , Elie Robert , Blais Et Suzanne
Published: April 2017

A transverse survey conducted in 142 young homeless (age: 18–30) shows that they mainly come from broken families where alcoholism, violence and mental illness hold an important place. Regarding work, the majority of the surveyed homeless have not worked more than 24 months in all their life and have nearly continuously been on welfare; those who had jobs lost them much more because of their alcohol or drug use and their problems of interpersonal relationships than because of unemployment. On a personal level, these young adults are particularly battling against two major problems: alcoholism and drug addiction, and mental illness. Although 23% of the surveyed subjects have already been hospitalized in psychiatry, the majority of these young homeless have never received any psychiatric care. Nevertheless, they show mental health problems which are often mistakenly dismissed as the effects of alcoholism or chronic drug abuse. The authors believe that means of detection and adequate treatment must be developed for this growing population instead of thinking of social measures which would only give the young homeless a meal and protection from the elements.
Testosterone Treatment of an XXYY Male Presenting with Aggression: A Case Report
Authors: Sourial Nabil , Fenton Fred
Published: April 2017

A hypogonadal male with 48 XXYY Karyotype — a rare Klinefelter's syndrome variant — is presented with review of the literature. Cautious initiation of testosterone replacement therapy to our patient was associated with sexual maturation and, interestingly enough, disappearance of his longstanding aggressive fantasies and behaviors towards females. An explanatory hypothesis is proposed and clues for early detection of the syndrome are suggested.