bluuebunny/crossref_metadata_2025 huggingface dataset:
Classification and Associations of Hyprochondriasis in Patients from a Psychiatric Hospital
Authors: Baker Brian , Merskey Harold
Published: April 2017

This study investigated the application of two commonly used classification systems for hypochondriacal patients from a psychiatric hospital as well as other aspects of their condition. Twenty patients with marked hypochondriacal features were examined. One satisfied criteria for the diagnosis of primary hypochondriasis and nine more had secondary diagnoses of hypochondriasis or somatization disorder. It is suggested that a secondary diagnosis of hypochondriasis would be useful for those patients with marked hypochondriacal features who have other psychiatric disorders and are at present excluded from the diagnosis of hypochondriasis in these classification systems.
The Effectiveness of Child Psychiatric Inpatient Care
Authors: Ney Philip G. , Mulvihill Deanna , Hanna Richard
Published: April 2017

After 900 admissions there is evidence that the programme for the inpatient hospitalization of psychiatrically ill children for a pre-determined period, can provide effective treatment. The time limited aspect appears to maximize the utilization of staff and family time. Parents’ reports, rating scale information and assessments of outcome seem to agree that most children benefit. While hospitalizing the most difficult cases, the 29 day stay, 2% referral rate to foster homes and 7% re-admission rate of this unit, compares favourably with other child psychiatric units.
The Long-Term Effect of Lithium Carbonate on Tardive Dyskinesia
Authors: Yassa R. , Archer J. , Cordozo S.
Published: April 2017

Lithium carbonate has been used in the treatment of tardive dyskinesia (TD) with conflicting results. In this study, six patients with a diagnosis of manic depressive illness were followed in the Affective Disorders Clinic of Douglas Hospital for one year. None of the patients showed improvement of their TD in this study. Possible reasons for this lack of response are discussed.
Optimizing the Oral Examination in Medical Education
Authors: Older Jules
Published: April 2017

The oral examination, or viva, is a testing procedure well-suited to psychiatry and the behavioural sciences, but it is a procedure which tests the skill of examiners nearly as much as it does students. Guidelines are suggested to maximize the efficacy of the viva and to minimize its potential weaknesses. The guidelines include: relaxing students, clear thinking, open-ended questions, active probing, calibrating questions to the appropriate level of sophistication, looking for strengths, and encouraging creativity.
Sleep and Violence*
Authors: Raschka L.B.
Published: April 2017

Most violence connected with sleep disorder is assumed to be related to sleep walking. It is less well known that other sleep disorders can also give rise to violence. The role of narcolepsy in car accidents is mentioned. Sleep drunkenness can lead to confusion resulting in violent behaviour especially on forced awakening. This condition is associated to sleep apnea. Primary or central sleep apnea is caused by disorders of the brain stem affecting the respiratory center. Secondary or upper airway sleep apnea can be caused by virtually any condition that results in cessation of the airflow due to occlusion of the upper airway. The author describes one patient who engaged in assaultive behaviour on forced awakening following earlier alcohol consumption. The pathomechanism of violent behaviour generated by a combination of sleep apnea and respiratory pathology is described. The differential diagnosis, prevention and treatment is outlined. The use of polysomnography in diagnosis and the potentially dangerous effects of drugs with respiratory depressing effects is highlighted.
Self-inflicted Enucleation of an Eye: Two Case Reports*
Authors: Ananth Jambur , Kaplan Harriet S. , Lin Keh-Ming
Published: April 2017

There are a number of reports of self-inflicted enucleation of the eye which indicate that this act probably protects the patients from guilt. It appears that religious delusions play a dominant role irrespective of primary diagnosis. Hence, enucleation of an eye may occur in various psychotic syndromes with religious delusions. In this report the history of two patients are presented to suggest that self-enucleation of the eye served as a protection from suicide. The management of these patients includes rapid neuroleptization and a close follow-up with both drug and psychological therapies.
A Catatonic Syndrome Resulting in Death*
Authors: Morrant J.C.A.
Published: April 2017

A patient is described who presented with post-partum catatonic schizophrenia and who later became comatose and died with hyperthermia. The differential diagnosis of catatonic stupor is notoriously difficult. The clinical picture somewhat resembled Stauder's lethal catatonia, doubtless a syndrome secondary to various encephalopathies rather than a disease sui generis. The differential diagnosis is discussed with special emphasis on herpes virus encephalitis and the rare but very important neuroleptic malignant syndrome, which is often unrecognized but for which specific treatment may be available.
Clomipramine Treatment of Repetitive Behavior
Authors: Pulman J. , Yassa R. , Ananth J.
Published: April 2017

The paper describes an informal, open trial of the effect of clomipramine on 8 patients with repetitive behaviors which were not part of a classical obsessive-compulsive neurosis. Six chronic schizophrenics had obsessions, compulsions and rituals in addition to their schizophrenic symptoms. Four of the six showed reduction in the repetitive behavior with clomipramine. Two cases in which the target symptom and overall clinical picture had little in common with obsessive compulsive neurosis, are reported in detail. Both improved with clomipramine. It is suggested that clomipramine may be useful in the treatment of a broad range of psychiatric disorders characterized by repetitive mental or behavioural phenomena, but which do not fulfill criteria for obsessive-compulsive neurosis.
Psychodynamic Aspects of Occupational Stress
Authors: Wasylenki Donald A.
Published: April 2017

Freud described work as that which attaches the individual most firmly to reality. Many patients present to psychiatrists with disturbances in the capacity to work. This paper reviews common psychodynamic constellations in such patients in the belief that depth psychological approaches should complement recent person-environment fit considerations.

Work inhibitions may arise from repressed aggression and/or sexuality displaced onto occupational tasks. Fear of success may be rooted in both oedipal and pre-oedipal conflicts. Work compulsion may evince attempts to appease a harsh super-ego. Chronic job dissatisfaction often arises from maladaptive attempts to regulate self-esteem. More importantly however, these disturbances frequently arise from interacting dynamic factors which must be carefully attended to by clinicians.
Reflections on the Current Psychiatric Consultation and Referral Pattern and on the State of the Art, at Oxford Regional Centre, An Adult Mental Retardation Facility
Authors: Russell Axel
Published: April 2017

This paper investigates the utilization pattern of the psychiatric consultation and referral service provided by the author in an Adult Mental Retardation Facility over a three-year period. The services, their history and locale are described against a background of changes in attitudes towards the problems of the retarded. Rising interest by psychiatrists in the field is placed in context. A spectrum of variables is used for a statistical analysis of factors (Chi2) influencing psychiatric referrals or non-referrals of all new admissions over the period indicated (N = 98). Against a background of increasing normalization and de-institutionalization, the character and composition of the shrinking institutional population has changed. Administration and direct-care staff are now confronted with management and care problems of lower functioning retardates, presenting difficult-to-manage behaviours and severe, often multiple, handicaps. Several factors with resource and care implications are considered, affecting institutionalized as well as community placed retardates, especially in hard economic times. Findings are discussed; recommendations are made concerning the application of scarce psychiatric resources to meet changing psychiatric needs of the population, maximize services and continue community directed normalization efforts. Some caveats are sounded and further research suggested.
Suicide in Recurrent Affective Disorder Patients
Authors: Roy Alec
Published: April 2017

In a matched controlled study manic depressive patients who suicided were compared with those who did not suicide. Significantly more of those who suicided lived alone, had early parental loss, had attempted suicide in the past, and were depressed and suicidal at their last admission. The period after discharge was found to be a time of increased risk.
Conjugal Psychiatric Hospitalization
Authors: Hoffman Norman D.
Published: April 2017

A heterosexual couple, both with multiple prior hospitalizations, was hospitalized in the same room at the Douglas Hospital, Montreal. Both patients had previously been extremely difficult to treat. While this approach was instituted with wariness by the ward's staff, the hospitalization proved to be highly beneficial for the couple as well as having certain positive effects on the ward in general. It is suggested that this therapeutic approach be considered in certain specialized cases.
Depression and its Treatment in Alcoholics: A Review
Authors: O'sullivan Karl
Published: April 2017

The relationship between Affective Disorder and Alcoholism is complex and has been studied extensively. Increased rates of depression are reported in alcoholics and in families of alcoholics. Some studies report that drinking behaviour may be influenced by the coexistence of depressive disorder while others indicate that depressed mood has little impact on the course and treatment of alcoholism.

Some people who are depressed turn to alcohol as a form of self-medication and many of these have positive results from it, both due to the pharmacological effects of the drug and the self-limiting nature of most depressive episodes. Those with more severe depression, however, are less likely to benefit in this way. Excessive alcohol taken under such circumstances results in diminishing returns; alcohol becomes more of a contributor to the problem than a solution to it.

There is no convincing evidence that drugs including anti-depressants and lithium are effective in the treatment of depressed alcoholics, except for those minority of patients where the diagnosis of primary affective disorder can be established. In such cases the indications for lithium and anti-depressant usage are similar as for non alcoholics with affective disorder.

Decisions about the choice of treatment to be offered the alcoholic must be made as quickly and as accurately as possible and can only be done after a careful assessment, which may include hospitalization. It is worth noting that the pharmacologically induced depression of heavy drinking and the depression associated with the withdrawal phase may be clinically similar to the depression of primary affective disorder.
A Study of the Reliability of the Clinical Oral Examination in Psychiatry
Authors: Leichner Pierre , Sisler George C. , Harper Dan
Published: April 2017

A study of the variability between raters in scoring an oral clinical examination in psychiatry in the format of the certification by the Royal College of Physicians and Surgeons of Canada is reported. A video-taped examination from another centre was rated independently by academic psychiatrists, nonacademic psychiatrists and residents. Considerable inter-rater differences between and within these groups were found. In particular, the averaging of the marks of pairs of raters as occurs in the actual certification resulted in the outcome depending to a considerable degree on the chance pairings of raters. These findings support a number of previous studies and emphasize the need to train examiners and to develop clearer rating criteria.
An Investigation of Role-Taking in Histrionic Personalities
Authors: Standage Kevin , Bilsbury Christopher , Jain Subhash , Smith Deborah
Published: April 2017

Gough's theory that psychopathy stems from a deficiency in role taking, the ability to perceive and evaluate one's own behaviour as it is perceived and evaluated by others in the same culture, was tested. The Socialization scale, developed by Gough to assess role taking, was administered to a group of 20 female psychiatric patients with histrionic personality disorders, and a control group of female depressives of similar age and intelligence. Socialization scores of the histrionic personalities were significantly lower, indicating impaired role taking, and this difference was not attributable to depression of mood. The Socialization scale was a better discriminator between the groups than the scales of two other personality inventories or a test to elicit meta-impressions.
An Indian Community with a High Suicide Rate — 5 Years After
Authors: Fox Joseph , Manitowabi Daniel , Ward J.A.
Published: April 2017

This report deals with the five year follow-up after a suicide epidemic on a Manitoulin Island Indian Reserve in 1974 and 1975. In the succeeding years, the suicide rate has dropped to a tenth of the level of the epidemic and has reached the levels for the rest of Manitoulin Island including the White and Native population. There has been a corresponding drop in the rate of violent death and of the number of suicide attempts. It is suggested that the multi-dimensional prevention and intervention measures reported here have contributed to a significant improvement in present conditions.
Boredom in Psychiatric Practice
Authors: Morrant J.C.A.
Published: April 2017

This paper discusses some of the causes of boredom in psychiatric practice. It also describes how many psychiatric conditions can have boring facets to them, which can lead to difficulties in treatment and “burn-out” in the therapist. Finally, some practical suggestions are given to help avoid and deal with boredom.
The Psychopharmacological Treatment of Depression in the Medically III Patient*
Authors: Ban Thomas A. , Guy William , Wilson William H.
Published: April 2017

With the introduction of effective antidepressants, pharmacotherapy has not been limited exclusively to the psychiatrically ill, but has been expanded to include medically ill patients exhibiting depressive symptomatology as well. This has led to problems in diagnostic differentiation and, just as important, problems with interactions resulting from multiple medications. By describing the coexistence of depressive symptomatology in a large variety of physical illness, the physician is alerted to the complexities of psychiatric illness in the medically ill patient as well as the caution necessitated by the polypharmacotherapy required in this population.
Body Image Perception and Preference in Anorexia Nervosa
Authors: Buree Barbara , Papageorgis Demetrios , Solyom Leslie
Published: April 2017

Nineteen female anorexics (10 restrictors and 9 with episodes of bulimia) and 19 matched normal weight females participated in a study of dimensions of body image perception and preference. Nineteen silhouettes which varied systematically in size of breasts, abdomen, buttocks, and legs were sorted according to perceived similarity and ordered according to preference by the subjects. Subjects also selected the silhouette which resembled themselves most. Multidimensional scaling analyses were performed. Five dimensions of perception were interpreted: four dealt with size of buttocks and abdomen and one with breast size. The perceptual dimensions were similar for both groups. No group differences were found regarding body image preference. Preference ratings of own body silhouette were lower for anorexic restrictors than for bulimic anorexics and normals. Thus, a distorted body image and a thin body ideal may not be as critical to anorexia nervosa as has been assumed.
Patients’ Attitudes at the Time of Their Commitment
Authors: Toews J. , El-Guebaly N. , Leckie A. , Harper D.
Published: April 2017

The discussion concerning who should be committed and by whom, has dominated the psychiatric literature for many years (1). More recently, the issue of whether committal allows merely for incarceration in the least restrictive alternative or whether it also entitles patients to be treated against their will, if necessary, has also received attention (2–5). As yet, few studies have attempted to define the characteristics of the committed population (6–11). Even fewer studies have attempted to define what patients themselves thought of their committal to hospital (12–15) and for the most part, have not obtained their opinions regarding the broader issues of committal that are being debated in the professional literature. This study seeks to elicit the opinions of patients in these matters.
The Clarke Institute Experience with Electroconvulsive Therapy: I. Development of a Clinical Audit Procedure
Authors: Kramer P.M. , Martin B.A.
Published: April 2017

Over the past forty-five years, there has been a progressive refinement of the standards of practice of electro-convulsive therapy (ECT). The need to review contemporary practice patterns to maintain and further improve those standards is discussed. In this context, the respective roles of medical audits and surveys of practice are described and the methodology of recent surveys critically examined. A procedure for the collection of reliable and complete data on the more than 22,000 treatments administered at one psychiatric hospital is described as the essential element of both an accurate survey of practice and a clinical audit. The audit is designed to retrospectively review and prospectively monitor the practice of ECT to identify the areas of conformity with and divergence from current standards of practice. It is recommended that this kind of audit procedure be an integral part of the present day administration of ECT. It is also suggested as a paradigm for hospital practice auditing with potential application to other specific treatments.
Article
Authors: Hodgins Sheilagh , HÉBert Et Jacques
Published: April 2017

The study presented here aims to gather descriptive information which would be useful to the development of research hypotheses, policies, and treatment programmes for persons suffering from mental illness who commit crimes.

The project tracked a cohort of 225 persons for the seven to nine years after they had been judged unfit to stand trial or not guilty by reason of insanity. A comparison is made here between the cases treated in a maximum security hospital and those treated in other hospitals.

The population studied is characterised principally by its misery. The majority are individuals who have been diagnosed as psychotic, who have few, if any, personal or social resources and who live on the edge of society.

Thirty-six percent of these cases were treated in a security hospital. Of all the variables studied, only a few distinguished these cases: the place and type of crime of which they were initially accused, the length of out-patient treatment, the type of residence once released from hospital, and the occupation.

Questions are raised with respect to appropriate treatments for such persons.
Criteria for Selecting Residents: A Reassessment
Authors: Ross Colin A. , Leichner Pierre
Published: April 2017

A questionnaire was distributed to the 16 directors of psychiatry residency programs and to 199 psychiatry residents in Canada. Both groups were asked to assess the importance of 32 criteria for selecting residents on a scale of 1 to 5, and to rank order 8 selection criteria. Our results confirmed previous investigators’ findings that the personal interview and letters of recommendation are the most valued tools. Yet neither have been demonstrated to have predictive value. This lack of predictive value is discussed in the context of research into improving resident selection techniques. A multi-centre study of resident selection is proposed.
Diet and Monoamine Oxidase Inhibitors: A Re-Examination
Authors: Sullivan Elizabeth A. , Shulman Kenneth I.
Published: April 2017

Monoamine oxidase inhibitors (MAOIs) are attracting renewed attention as effective antidepressants for refractory depressions, particularly among the elderly. However, widespread fears concerning the interactions of MAOIs with tyramine-containing foods have led to the development of long and complicated diets. These diets have served as an obstacle to the ready use of MAOIs, yet very little systematic or critical review of the basis for food restriction has been undertaken.

An international survey of MAOI diets was conducted and from the diets collected, foods were categorized according to frequency of restriction on the diet lists. On the basis of this survey and a critical review of the literature it was determined that only four foods clearly warrant absolute prohibition: aged cheese, pickled fish (herring), concentrated yeast extracts and broad bean pods. While there is insufficient evidence to prohibit alcohol completely (even chianti wine) true moderation must apply. It is suggested that a radically simplified diet should be investigated on a prospective basis.
An Assessment Approach to Couples with Sexual Problems
Authors: Watters W.W. , Askwith J. , Cohen M. , Lamont J.A.
Published: April 2017

We have described the assessment approach to couples with sexual complaints used in the McMaster Human Sexuality Clinic. Our approach takes into account a number of individual factors including intrapersonal and biological ones as well as issues of sexual socialization, gender role socialization and sexual orientation. Couple factors include relationship factors as well as factors dealing with sexual behaviours, attitudes and responses.

In our view, the issues of sexual socialization and gender role socialization needs special emphasis in assessing such couples. We stress as well that the dichotomy between organic and functional is a misleading one and that for each individual and couple, any biological factors and the many supra-biological factors listed above, must be prioritized in terms of their role in symptom production. Such apriority list can then be used to map out treatment strategies.
Marital Adjustment and Fatherhood
Authors: Robson B. , Mandel D.
Published: April 2017

This paper examines the relationship between marital stability and fathers’ bonding to their first born infants. Current literature reports on the significant and unique influence of the father on his developing infant (1–7) and the influence of the father on the mother-infant bond (8,9). Some authors (10–12) suggest that prematurity, the type of delivery, or a father's presence or absence at the birth, influences his engrossment or bonding and later caretaking behaviour. However, little attention has been given to other factors such as the father's personality, education, previous experience with child care or his relationship with his spouse.

Similarily, there is a paucity of research on the effect of the birth of the infant on the marital bond. Einzig (13), Wente and Crockenberg (14) and Dyer (15) suggest that the transition to parenthood is a crisis in the family life and can lead to disruption in the husband-wife relationship. With the apparent increase in family instability in the last decade as marked by the rising divorce rate (16), it seems crucial to explore what correlation, if any, exists between marital condition and a father's relationship to his newborn infant.
Patients who Complain of Social Dysfunction as Their Main Problem: I. Clinical and Demographic Features
Authors: Greenberg David , Stravynski Ariel
Published: April 2017

Patients attending a clinic for behavioral psychotherapy included 46 whose main complaint was social dysfunction. Certain demographic variables and clinical features were found to predominate in this sub-group who meet all the criteria for avoidant personality disorder in the DSM-III. The significance of these findings is discussed, including their implications for diagnosis and management.
Parent's Perceived Responsibility for Children's Problems
Authors: Susan Penfold P.
Published: April 2017

Beliefs about parents’ influence on their children's behaviour have developed over the last 300 years. During this century multiple socio-economic, ideological and technological changes have combined to leave expert and lay person alike in a sea of confusion and ambiguity about optimal parent-child relationships. While fashions in child rearing change, the mother is usually accorded responsibility for the child's behaviour and social skills. In this study parents attending a multidisciplinary pediatric clinic were asked their opinion of the source of their child's emotional or behavioural problem. Describing confusion and conflicting advice, most parents had concluded that the problem had multiple roots. Between male and female parents, however, a marked difference was evident in the attribution of responsibility to themselves or their spouses and in their formulation of the nature of parental deficiencies.
Family Breakdown and its Effects on Emotional Disorders in Children
Authors: Shamsie Jalal
Published: April 2017

The increase in the incidence of divorce and some of its causes are discussed. The literature relating to the effects of divorce on the emotional health of children is reviewed. It is suggested that the increase of divorce may account for the recent increase in certain emotional disorders in children. Various strategies to protect the children from the adverse effects of divorce are discussed.
Schizophrenia: An Amotivational Syndrome in Men
Authors: Lewine Richard
Published: April 2017

A series of studies of the phenomenology and biochemistry of schizophrenia suggests that the fundamental nature of schizophrenia differs in men and women. In men, schizophrenia appears to be an amotivational syndrome possibly mediated by dopaminergic underactivity; in women, schizophrenia is perhaps best conceptualized as an affective disorder variant.
Psychopathology in the Offspring of Parents with Bipolar Affective Disorders
Authors: Laroche C. , Cheifetz P. , Lester E.P. , Schibuk L. , Ditommaso E. , Engelsmann F.
Published: April 2017

Thirty-nine children from intact families with a manic-depressive parent were evaluated by a semi-structured clinical interview and a number of rating scales for the presence or absence of psychopathology. This sample represents a larger one than in an earlier study, which showed minimal offspring psychopathology compared with reports of other investigators. The current study also examines the inter-relationships between the presence or absence of offspring psychopathology with both genetic loading and a number of psychosocial variables including measures of parental marital adjustment, severity and chronicity of proband parent illness and early exposure of children to parental illness.

Nine of the thirty-nine children, (23%) received a positive DSM-III diagnosis, with depression of the dysthymic type being the most common. There was no significant correlation between genetic loading and offspring psychopathology. However, there were significant associations between children with psychopathology and paternal marital dissatisfaction and the age and chronicity of illness of the proband parent as compared with the children with no psychopathology.
Evaluating Attitudes of Child Psychiatry Residents to Psychotropic Medication: Implications for Training
Authors: Schachar Russell J.
Published: April 2017

The attitudes of child psychiatry residents toward the use of psychotropic medication in child psychiatric practice were studied. Eighteen residents underwent a semi-structured interview that covered their experience in child psychiatry, beliefs about etiology of child psycho-pathology, preferences for treatment, attitude toward and experience with drugs in treating childhood disturbances. The residents favored a psychosocial view of the etiology of child disturbance and preferred family therapy to other forms of treatment. Six had never treated a child with medication and most were uncertain about indications for drug use and felt they had less than average or poor skills in this area. Seven residents, who did not attend department psychopharmacology seminars and had little clinical experience with drugs, had a strong antipathy toward their use. Experience with and attitude toward drug use could not be predicted from the residents’ appraisal of their own competence in this field, their experience in child psychiatry, their appreciation of the biological contributions to child psychopathology, or their future practice plans.
Is There an Obsessive Psychosis? Aetiological and Prognostic Factors of an Atypical Form of Obsessive-Compulsive Neurosis
Authors: Solyom L. , Dinicola V.F. , Phil M. , Sookman D. , Luchins D.
Published: April 2017

The study explores whether an atypical form of obsessional illness can be delineated and separated from the conventional form of obsessive-compulsive neurosis (OCN). From a group of 45 obsessive patients, 8 were selected on the basis of 3 criteria: (a) presence of a severely debilitating main obsessive symptom; (b) bordering on the delusional; (c) no schizophrenic symptoms. Assessment and outcome measures included the Psychiatric Questionnaire, the Leyton Obsessional Inventory, Fear Survey Schedule, and IPAT Self-Analysis Form. Self-assessment forms allowed patients to make social adjustment and neurotic symptom ratings. In a multi-modal approach, patients were assigned to behavioural and pharmacological treatments on the basis of severity. Reassessment took place after 50 sessions of therapy.

Results of analysis of variance statistics indicated that the atypical group had a more malignant form of illness, with more varied and severe obsessions. A poorer prognosis for the atypical group was indicated by: greater social maladjustment, poor employment records, illness of longer duration showing no remissions despite more courses of treatment, and poor response to treatment throughout. The atypical group manifested fewer characteristic features of OCN (example: fewer precipitating events). On the other hand, schizophrenia was not imputed, although delusion-like experiences in the atypical group suggest a psychotic form of illness. The term “obsessive psychosis” suggested by Strauss (1) and recently investigated by Weiss et al (2), and Robinson et al (3) is proposed for our atypical group.

Results are compared with those of other investigators. It is concluded that the delineation of a subgroup of obsessional illness is desirable for research and therapy, since a form of atypical obsessional illness or obsessive psychosis can be differentiated on aetiological, phenomenological and prognostic factors.
The Resident as a Teacher: A Neglected Role
Authors: Kates N.S. , Lesser A.L.
Published: April 2017

Residents are frequently requested to take on teaching responsibilities, especially with medical students, but they receive little formal preparation for this role. This paper reviews some of the problems residents may face when teaching and describes a training workshop designed to enhance the teaching skills of residents. The workshop is based around a simulated teaching event that focuses on the organizational and practical, as well as didactic tasks involved in supervision of a clinical clerk. Such a workshop helps the resident to identify and prepare for some of the problems they may encounter and provides them with an opportunity to develop new skills that will improve the quality of their teaching.
Premenstrual Syndromes: Past and Future Research Strategies
Authors: Rubinow David R. , Hoban Christine , Roy-Byrne Peter , Grover Gay N. , Post Robert M.
Published: April 2017

Premenstrual Syndrome remains a poorly understood controversial disorder largely because of the errors in design found in research into this subject. The first task is to clearly define the entity to be studied. It is necessary to look at the nature, intensity and time of occurrence of symptoms in relation to menstruation. One must further differentiate the appearance of symptoms premenstrually from the premenstrual exacerbation of symptoms present throughout the menstrual cycle. Research has clearly shown the superiority of prospective versus retrospective data in establishing a linkage between symptoms and menstruation.

Premenstrual Syndrome research offers a unique opportunity to study classical psychiatric disorders. A relationship appears to exist between this syndrome and major affective disorders. Studies of the appearance or exacerbation of mood disturbances in relation to the menstrual cycle may inform us about the development, course and vicissitudes of psychiatric illness.
The Clinical Diagnosis and Classification of Premenstrual Changes
Authors: Halbreich Uriel , Endicott Jean , Lesser Juliet
Published: April 2017

Recent interest in premenstrual changes and increasing referrals for treatment when such is warranted, bring to focus the need for accurate definition of the problem and a reliable procedure for clinical and research assessments of premenstrual phenomena. A definition is suggested and the steps taken to establish the diagnosis of the various premenstrual subtypes are described. The suggested classification may contribute to differential treatment modalities for each subtype.
Violence and Youth
Authors: Shamsie S. Jalal
Published: April 2017

Violence is looked at from ethological, biological and anthropological points of view. The family is examined to determine the roots of violence. Various prospective studies are reviewed to assess the role of temperament, social, familial and economic factors facilitating the development of antisocial and violent behaviour in the youth.

There is also a look at the violence committed by groups, nations or governments in the name of God, flag or a just cause. The role that mental health professionals could play in preventing the development of violent behaviour is discussed.
A Monozygotic Twin Pair Discordant for Anorexia Nervosa
Authors: Elbadawy M.H.F. , Cliffe M.J. , James P.T.
Published: April 2017

This case study describes a female monozygotic twin-ship in which one of the twins presented with anorexia nervosa. The case supports the suggestion from the few such discordant pairs previously reported that the affected twin tends to have been relatively disadvantaged from an early age and to be the less dominant of the pair. A review of previously reported cases suggests a concordance rate for anorexia nervosa of about 50% in female MZ twin pairs. Some methodological problems associated with the derivation of such estimates are noted.
Variables Affecting the Decision Making of a Review Panel
Authors: Higenbottam J. , Ledwidge B. , Paredes J. , Hansen M. , Kogan C. , Lambert Linda Anne
Published: April 2017

This study was designed to identify the variables that influence a review panel's decision to discharge or detain an involuntary patient. A group of fifty patients consecutively discharged by the review panel of a provincial mental hospital were compared according to thirty-five variables, with a group of forty-five patients consecutively detained by the panel. The variable set included information on the patient's psychiatric history, current hospitalization and treatment as well as ratings of dangerousness, insight and psychopathology, as reflected in the attending physician's case summary prepared for the review panel. The released and detained groups were found to be remarkably similar. They differed on ten of the thirty-five variables measured, but they did not differ on some variables that one would expect to form the basis of the panel's decision, including diagnosis and a history of suicide attempts. On the other hand, when the predictive value of the variable set as a whole was examined using discriminant analysis, the results indicated that there was a substantial amount of predictability to the review panel process. The group membership of 77.5% of the patients can be predicted from only nine variables that contribute to the discriminant function. The results will be of interest to clinicians who deal with review panels on a regular basis and the findings have implications for other practical issues including discharge planning and readiness for community living.
Therapeutic Considerations with the Language Impaired Preschool Child
Authors: Beitchman J.H.
Published: April 2017

This paper examines the relevance of language impairment to the development of psychiatric disorders of childhood. The literature showing a relationship between language impairment and psychiatric disorders is briefly reviewed. Although deficiencies of both expressive and receptive language have been associated with psychiatric disorder, this discussion focuses on disturbances of “receptive language”. Some cases are described which illustrate the connections between deficient receptive language and disturbances of development. These disturbances of development range from excessive temper tantrums, with defiant and oppositional behavior, to mannerisms, the insistence on sameness and frank autistic symptoms. These disorders are understood in a developmental context in which deficiencies of receptive language are seen to interfere with the normal unfolding of the child's developing individuation, autonomy and independence. Depending on the severity of the language disorder and the responsivity of the environment, this results in a continuum of behavioral problems with oppositional and defiant behaviour at one end, and mannerisms and autistic symptoms on the other end. The implications for therapy and long term development are discussed.
The Dexamethasone Suppression Test in a General Hospital Psychiatric Setting
Authors: Warneke Lorne B.
Published: April 2017

The use of the dexamethasone suppression test in a general hospital setting is discussed with a review of some of the literature pertaining to the test. The test was performed on a series of 47 patients where there was a high index of suspicion that depression was present. Of the patients with a final diagnosis of depression, 77% had a nonsuppressive DST. There were no false positives. Bipolar depressed patients were more likely to be nonsuppressors than unipolar patients.
Correlation of Cigarette-Induced Increase in Serum Nicotine Levels with Arginine Vasopressin Concentrations in the Syndrome of Self-Induced Water Intoxication and Psychosis (SIWIP)
Authors: Vieweg W.V.R. , David J.J. , Rowe W.T. , Peach M.J. , Veldhuis J.D. , Spradlin W.W.
Published: April 2017

Ten patients [9 men and 1 woman; mean age 42.4 ± 8.5 (± SD) years] who were smokers and who suffered the complications of self-induced water intoxication and psychosis (SIWIP) (8 patients with schizophrenic disorders, 1 patient with manic-depressive illness, 1 patient with dementia) are reported. Each patient underwent serial determinations of parameters of water metabolism including plasma and urine osmolality and plasma arginine vasopressin (AVP). The syndrome of inappropriate antidiuresis (SIAD) was found in each patient. Because of the reported effect that cigarette smoking has on anti-diuresis, we correlated serum nicotine (NIC) levels with plasma and urine osmolality, AVP, and 24-hour urine volume (24°-UV). We found no relationship between NIC and plasma or urine osmolality, AVP, or 24°-UV. In the presence of SIWIP and SIAD, we infer the limbic-hypothalamic neurotransmitters in these psychotic patients are sufficiently powerful in stimulating both compulsive water drinking and inappropriate release of AVP so as to overshadow any effects that NIC may have on water metabolism.
Education and Forensic Psychiatry
Authors: Gunn John
Published: April 2017

With the world-wide increase in more expansion in Forensic Psychiatry, the author discusses developments in this field in Britain and sets out models for future development, particularly as it refers to the training of young psychiatrists interested in this field. In addition, there is a discussion of the academic and research endeavours.
Multiple Attempters of Suicide Presenting at an Emergency Department
Authors: Reynolds Paul , Eaton Philip
Published: April 2017

As part of a study involving seven hundred and forty-seven (747) consecutive cases of self-injury presenting at the emergency department of an inner city hospital, data pertaining to a multiple attempt group of ninety-nine subjects were compared with the data pertaining to first attempters. All subjects were rated on Beck's Lethality Scales, Intent Scale and Hopelessness Scale. In addition, a standard interview was conducted to provide psychosocial information.

Of the total suicide attempt population, 14% can be considered chronic. The multiple attempters were found to show more chronicity in their symptomatology, poorer coping histories, a positive family history of suicidal behaviour and a positive history of alcohol and drug abuse, all at a statistically significant level compared with first-time attempters. The multiple attempters also tend to show higher lethality and depression ratings, less impulsiveness and are significantly more often admitted to the in-patient unit following the attempt, than first attempters. Their intent scores were significantly related to their sense of hopelessness, which may be a reflection of their basic feelings of inadequacy.

It was concluded that the multiple or “chronic” attempter differed sufficiently from the first-time attempter to warrant special intervention strategies.
Limbic System Dysfunction as a Factor in Some Schizophreniform Psychoses: Case Report and Overview
Authors: Maccrimmon D.J. , Jones G.B.
Published: April 2017

A case is presented of a young woman whose schizophreniform psychosis was unresponsive to neuroleptic treatment, but who subsequently responded well to Carbamazepine. Several converging lines of investigation, suggesting an underlying Limbic System dysfunction, are discussed. Background to the Limbic System concept is provided.
The Thompson-Patterson Scale of Psychosocial Development: II. Investigation of its Use in the Assessment of Preschool Children
Authors: Hoffer Mayer , Thompson Michael G.G.
Published: April 2017

The Thompson-Patterson Scale of Psychosocial Development (TP) is a parent interview questionnaire, each item scored on a 3 point scale and computer analyzed to yield a histogram profile consisting of 11 scale scores. Eight of these scales measure coping styles characteristic of sequential stages of psychosocial development and the remaining 3 are symptom scales. A pilot study was conducted to assess the usefulness of the TP as a diagnostic and therapeutic assessment instrument for preschoolers. The results indicated the following: i) a “healthy” profile emerged in the control group ii) a significant difference existed in the initial assessment profiles of the clinic and control groups; iii) the control group profiles were stable over the period of study; and iv) the profiles of the clinic group showed a movement towards health with treatment that reflected changes in the clinical status of the children. The promising results of this preliminary study suggest there is value in further investigation of the TP scale as an instrument for the dynamic developmental assessment of preschool children.
The Benefit of Lithium Carbonate Adjunct in Refractory Depression — Fact or Fiction?
Authors: Kantor David , Mcnevin Stephen , Leichner Pierre , Harper Dan , Krenn Marlene
Published: April 2017

Our group attempted to validate previous claims of rapid success with lithium carbonate adjunct therapy in antidepressant-resistant depression. Seven depressed patients volunteered for a study of placebo controlled, double-blind design. During their treatment on general hospital psychiatric wards, these patients received antidepressant medication for a period of at least 21 days. While continuing to receive antidepresant medication after the 21 day period, four of the patients then received lithium carbonate, and three received placebo. This combination pharmacological therapy continued for a 48 hour period. After this time, six of the seven patients showed no significant improvement. The remaining patient, who had received lithium carbonate, improved markedly over the 48 hour period. However, this patient relapsed within one week.

A review of the two most extensive studies claiming significant results with the lithium carbonate adjunct therapy was performed. We feel that they, as presented, leave serious doubt as to the validity of their conclusions.

We conclude that on the basis of our work up to this point in time and the analysis of previous reports claiming otherwise, no valid evidence exists for a consistent therapeutic effect of lithium carbonate adjunct in antidepressant-resistant depression.

It was also found that methodologic contamination necessitated the exclusion of an additional six patients from the double-blind trial. We conclude that in order to objectively examine the rapidly expanding field of biological psychiatry, teaching of clinical staff in basic research procedure should be stressed as apart of routine ward orientation.
The Impact of Temperament in a School Setting: An Epidemiological Study
Authors: Boudreault Maurice , Thivierge Jacques
Published: April 2017

The authors present the results of an epidemiological study on a large non-clinical population-based sample of French speaking seven year-old children (N = 596) whose aim was to verify if a relation exists between temperament and outward-type or inward-type behavior problems in school. The Thomas and Chess’ Parent Temperament Questionnaire, filled out twice by the parents over a four-week interval, was used to determine temperament. The Conners Teacher Questionnaire, filled out twice by the teachers over a four-week interval, was used to determine behavior problems in school. Five points emerge from this study. First, “difficult” temperament ‘per se’ is not associated either with outward-type or inward-type behavior problems in school. Second, a temperamental pattern of high activity and high approach with new stimuli predisposes boys to present outward-type behavior problems in school. Third, the temperamental traits of low adaptability or withdrawal with new stimuli predisposes girls to inward-type behavior problems in school. Fourth, the study demonstrates the importance of verifying if the associations between temperament and behavior problems are stable since, in the comparisons between results of the test with those of the retest, several of the associations found in one occasion failed to be replicated at the other. Fifth, the different influences of temperament according to sex emphasize the need to study boys and girls separately. Future studies should take into account interactions between parents/teachers and child temperament since these sex-related different influences of temperament could be related to the sex-related different attitudes of caretakers.