bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychosocial Adjustment of the Offspring of Psychiatric Inpatients
Authors: El-Guebaly N. , Offord D.R. , Sullivan K.T. , Lynch G.W.
Published: April 2017

While there is a growing body of literature describing the plight of being the child of a particular diagnostic group of psychiatrically ill parents, little is yet known about the comparable vulnerability of the children of various diagnostic groups.

This study includes data collected on 90 psychiatric inpatients, their spouses and children. For each consecutive admission of fifteen male and fifteen female alcoholics with a child less than age 21, a schizophrenic and a depressive parent were matched by sex, age and time of admission. Data were collected on the parents and their children from the patient's chart and through a structured interview with the spouse. A medical history, Rutter's parental questionnaire on children's behaviour and the Randall-McClure behaviour checklist were filled out on 231 children.

Some of the findings of the study include that the adjustment of the children based on checklist information is not affected by the psychiatric diagnosis of the parents; controlling for sibship size is important in this type of research; the boys of sick fathers score almost two times higher on the checklists compared to the boys of sick mothers. The results argue for the provision of coordinated services between adult and child psychiatry departments for the children of the psychiatrically ill parents.
Social Class, Symptom Type and the Utilization of Children's Psychiatric Services
Authors: Beitchman Joseph
Published: April 2017

This paper examines three aspects of the distribution and use of children's psychiatric services in Canada under National Health Insurance. These are: 1) Class disparities in the utilization rates of these services; 2) The extent to which those children most in need of treatment are receiving it; and 3) The extent of unmet need for psychiatric services for children 17 years of age and under in the Ottawa-Carleton region.

The subjects of this investigation were 96 children between the ages of 6.5 and 12 years who have attended the Children's Services at the Royal Ottawa Hospital.

The results indicate that class disparities in the distribution of services were the reverse of those typically found under private fee-for-service arrangements. The high social class had the lowest proportionate use and the welfare classes the highest. In addition, there was a significant association between social class and age for the boys only; the higher the social class, the younger the boy at the time of referral.

Almost two-thirds of this sample were found to have antisocial and aggressive disorders. Consistent with estimates of the high rates of these disorders in the general population, this suggests that a proportionate number of those children most in need of treatment are receiving it.

For children 17 years of age and under, the one-year treated prevalence of disorder in the Ottawa-Carleton region was estimated to be .95%. Though higher than reports from other sources, it is clear that free medical care alone is not sufficient to bridge the gap between estimates of the true prevalence and treated prevalence of childhood psychiatric disorder.

These findings are discussed in terms of the importance of non-economic factors as determinants of the distribution and use of children's psychiatric services. As well, the importance of referral practice, especially for the lower social classes is commented upon. Finally, suggestions are made for further research.
This Child is Mine!
Authors: Krell Robert
Published: April 2017

In Canada and the United States there are over one million divorces annually involving at least that number of children. Divorce frequently involves matters of access and custody. Lawyers acting on behalf of their clients may request psychiatric consultation as to the emotional stability of the client. In custody cases, the child or children may be evaluated by a child psychiatrist.

In a divorce action between two adults, it may be valid for the psychiatrist to see one party to the dispute and offer a psychiatric opinion. In custody matters, a psychiatrist must see both parties to the dispute as well as the children. If only one parent is seen it is almost impossible to offer expert testimony.

Divorce proceedings result from marital incompatibility. The deficits attributed to each spouse in the marital relationship do not necessarily bear upon the ability to be a parent. Yet in custody contests, frequently the two qualities of suitability for marriage and suitability for parenting are confused. When a child psychiatrist is involved, he or she is asked to comment not only on the emotional stability or problems of the child but also on the fitness of the parents. If each parent has a child psychiatrist involved in the evaluation, the adversary position is fortified and the possibilities for compromise are jeopardized.

Since the children are invariably traumatized, guilt-ridden and insecure, it is important that the child psychiatrist attempts to minimize the vindictiveness and anger which are inherent in some custody disputes. By acting in the child's interests, and guiding the lawyers to allow one child psychiatrist to perform the total evaluation, some loosening of an adversarial stance is likely, and new possibilities for negotiation and compromise are created.

The structuring of such an evaluation must be completed before any member of the family is seen. A case illustration is provided to point out the nature of the requests made of the lawyers and techniques used in negotiations.

The child psychiatrist, in remaining child-focused, is in a unique position to avoid representing one side to the conflict and to provide the court with an evaluation which will aid the judge to make an informed decision.
Monosymptomatic Hypochondriacal Psychoses
Authors: Munro Alistair
Published: April 2017

Monosymptomatic hypochondriacal psychoses are akin to paranoia. Although presenting with a variety of delusional complaints in individual cases, the condition appears to represent a relatively discrete diagnostic entity. It is less rare than usually thought, but those afflicted frequently go to the physical specialties, whose treatment does not benefit them. It is important to recognize the illness, since there is tentative evidence that it may respond to treatment with pimozide.
Treatment of Minimal Brain Dysfunction in a Young Adult*
Authors: Packer Samuel
Published: April 2017

A discussion of the clinical picture and treatment of minimal brain dysfunction in post adolescence is presented. Small amounts of methylphenidate appear to have a salutary effect on symptoms such as irritability, moodiness, restlessness and poor concentration.
The Certification Examination
Authors: Leichner Pierre P.
Published: April 2017

Almost half the candidates of the 1976-77 certification examination in psychiatry answered a questionnaire seeking their opinions about the examination after they had experienced it. Opinions varied markedly depending upon whether the candidates were taking the examination for the first time or whether they were repeating it. The first-time group had the highest passing rate. This group also tended to feel adequately trained towards the examination and to like its present format. Those candidates who were repeating the examination tended to feel inadequately prepared and disliked the present format.

Half the candidates in this sample had negative comments about this experience. A high level of anxiety and preoccupation with the examination were most often commented upon. A number of candidates did however find it easier and more fair than they had expected.

The candidates, after taking the examination, tended as a group to feel better prepared and more positive toward the examination than the fourth year residents about to take the examination.

The recommendations suggested focused on changing the task and image of the Board of Examiners, improving the examination and improving examination passing skills.
Evaluating the Competence of Psychotherapists
Authors: Sakinofsky Isaac
Published: April 2017

Pressure is increasing to develop methods for evaluating the competence of psychotherapists, not only in the field of education but also in clinical practice. The skills required of a psychotherapist have not yet been defined clearly, and are probably specific to kinds of patient and types of problem. However, there is a consensus that the capacity to establish a trusting relationship and to demonstrate concern, are essential. This relationship provides a “power-base” from which to influence the patient through a variety of elements which include “interpretation”, modeling, and identification. Psychoanalysts assert that the “working through” of the transference is essential, but this is disputed by others.

The evidence regarding the value of experience as a psychotherapist is unclear. Again there are conflicting reports. It appears that reasonable competence in technique can be acquired (through modeling) within the first year of training. It may be that the reason why experience does not emerge more strikingly as a positive factor, is that in the published material the more experienced psychotherapists treated the more difficult patients, and therefore the outcome of their treatment suffered.

This paper touches on recent approaches at McMaster University to evaluate the competence of trainees; one by setting instructional objectives in family therapy, the other by means of a process analysis of videotaped interviews, in which residents and their supervisors participated. A single simulated patient was interviewed at two points in time, to indicate change and development in the psychotherapeutic techniques of the trainees.
Practising Psychiatrists’ Views of the Certification Examination in Psychiatry
Authors: Persad E. , Garfinkel P.
Published: April 2017

This report is based on a survey of all those postgraduates in psychiatry who graduated from the training program at the University of Toronto between the years 1966–1976. We were interested in obtaining the views of our colleagues about the Certification Examination in Psychiatry, because it was our impression that there has been a great deal of dissatisfaction with the examination procedure over the years. A total of 238 questionnaires were sent out and 140 replies were received. Our analysis indicated that 90% of those responding had been successful in the certification examination, but 85.3% were dissatisfied with the examination process. It is significant that 85.3% of our sample felt that some form of certification procedure was necessary. The certification procedure is designed to determine whether an adequately trained physician is “safe and competent” to practise as a specialist in psychiatry. The examination's ability to assess areas of psychiatric practice (somatic and social therapies, interview and diagnostic technique, research and teaching skills) were also evaluated.

The Royal College has made changes in the examination procedure over the last few years, for example the changeover to complete multiple choice questions was well received by our sample. Other suggested changes are examined in terms of our colleagues’ enthusiasm for their in-corporation into the examination procedure.
Quality Assurance Strategies in U.S. and Canadian Psychiatry
Authors: Firth S.T. , Lazare S.
Published: April 2017

Quality Assurance Strategies in Psychiatry and Medicine in general have developed rapidly and have been applied widely in the last few years, particularly in the United States. This paper reviews some of those developments both from a methodological and a socio-political point of view. The relevance to the Canadian scene is evaluated, and it is concluded that, although quality assurance is now accepted as an obligation of the health profession, some of the strategies being widely applied in the United States are of questionable value in themselves, and some, particularly cost control techniques, would seem to be irrelevant to the Canadian health field which already has a variety of checks and balances in its universal health insurance system. Though cost control and quality control logically overlap, at times they are allowed to merge and cause conceptual confusion. Finally, as systems are developed in Canada, it is suggested that a means of self-assessment be built in so that the validity and reliability are not in doubt.
Civil Commitment Practices in 1977: Troubled Semantics and/or Troubled Psychiatry
Authors: Page Stewart , Firth John
Published: April 2017

This paper examines the practice of involuntary mental hospitalization through examination of criteria used for commitment in a sample of 200 civil commitment certificates. Special reference is made, following previous research, to criteria used to describe the person deemed dangerous to himself or to others. The relevance of the findings of present practices in mental health is discussed. New procedures which facilitate presentation of factual evidence, and which eliminate gratuitous information, are required without delay.
On Knowing what you are Not Supposed to Know and Feeling what you are Not Supposed to Feel
Authors: Bowlby John
Published: April 2017

Much psychopathology stems from“impressions, scenes and experiences” of childhood having, apparently, been forgotten yet continuing to influence thought, feeling and action. The problem of how best to conceptualize the processes responsible for shutting memories away is eased by drawing on the findings and concepts of cognitive psychology.

In explaining both the nature of the material shut away and the causes of its being so, attention is called to the role that a child's parents play, wittingly or unwittingly. Children not infrequently observe scenes their parents would prefer they did not observe; they form impressions their parents would prefer they did not form; and they have experiences their parents would like to believe they have not had. Examples are given of parents who seek to disconfirm their child's observations of events, to disapprove or condemn their natural emotional responses to distressing situations, and who discourage their children from registering aspects of their (the parents’) personalities and behaviour. Pressure exerted on the children to conform to their parents’ wishes can be crude or subtle, but its effectiveness depends always on the child's insistent desire to be loved and protected.
Depression, Witchcraft Beliefs and Super-Ego Development in Pre-Literate Societies
Authors: Murphy H.B.M.
Published: April 2017

When guilt feelings and self-accusations made their first appearance as symptoms of depression in Europe and Africa, as noted in a previous paper, this followed a period of heightened witchcraft beliefs in both locations and was sometimes first noticed in the form of voluntary witchcraft confessions, raising the question of a possible connection between the two types of change. Using the concepts of “group ego” and “group super-ego” to which Eric Wittkower has contributed, it is suggested that the heightened witchcraft beliefs were a defence against an individualizing change which would eventually lead to the inward turning of aggression and reproach and hence to the symptoms mentioned.
Some Determinants of Affective Symptoms in Epileptics
Authors: Roy Alec
Published: April 2017

Forty-two epileptics were given a psychiatric interview and completed five questionnaires. Current affective symptoms were significantly associated with a past history of neurotic disorder but not with temporal lobe epilepsy.
The Psychoanalytic Theory of Depression: Part II — the Major Themes
Authors: Robertson B.M.
Published: April 2017

In this second part of a review of the psychoanalytic theory of depression the major themes of the theory, as they appear in the works of the major contributors, are discussed.

It is difficult to approach the complexities and ambiguities of psychoanalytic theory in general, and the theory of depression in particular, without an historical perspective. Accordingly, the author decided to group the major themes of the theory under three headings: Instinct Theory, Structural Theory, Object Relations Theory.

The themes included under Instinct Theory are constitutional factors, aggression and orality.

Under the heading of Structural Theory those themes associated with the ego, with the concepts of narcissism and the self, and finally those associated with the superego are discussed.

It is of note that under narcissism the work of both Kohut and Kernberg is considered, including its relevance to any investigation of depression.

The concepts of object loss and object failure are discussed under the heading of Object Relations Theory.

It is suggested that a psychoanalytic approach has much to offer both the clinician and the researcher in their attempts to develop a comprehensive theory to explain the protean manifestations of human depression.
Neurological Soft Signs and Psychopathology: Incidence in Diagnostic Groups
Authors: Cox Stephen M. , Ludwig Arnold M.
Published: April 2017

In earlier studies the authors have reported impairments of cortical function in the parietal and frontal lobes of schizophrenic patients. In this study these results are pursued. The performance of different groups of psychiatric patients with respect to individual neurological soft signs rather than combined cortical function scores, was studied. The potential influence of psychotropic drugs on the significant findings was also analyzed. The results show that specific individual neurologic soft signs are significantly more frequently present in schizophrenics than in either controls or in other psychiatric groups. Additionally, there was no statistical evidence of psychotropic drug effects on the findings.
To be or not to be a Psychiatric Chief Resident: Factors in Selection
Authors: Lowy Frederick H. , Thornton John F.
Published: April 2017

The issues involved in selecting a psychiatric chief resident have been examined. Problems associated with this position include poorly defined objectives and role; lack of training for the job; a marginal position at the interface of groups that at times are in conflict, leading to situations of divided loyalties and unrealistic performance expectations. Qualities seen as desirable in a chief resident have been discussed. In addition to the usual personal qualities which command respect these include organizing ability, leadership potential, mediation skills, the capacity for self direction and humour. Factors which make the position attractive and factors relevant to appropriate evaluation are considered.

To improve the performance and job satisfaction of chief residents, the following points are suggested:

• The expectations related to the position should be clarified in terms of specific objectives when the candidate is selected or elected.

• Whom he reports to and whom he works for should be clear.

• Before, or soon after, assuming office the chief resident should have exposure to teaching or supervision in group dynamics, consultation skills and mental health administration.
Psychiatric Audits: The Ontario Scene
Authors: Awad A.G. , Durost H.B. , Gray J. , Kugelmass M. , Smith Christine
Published: April 2017

Results of a survey conducted early in 1978, about the state of psychiatric audits in Ontario, are presented and discussed. Of the facilities that responded 66% reported the existence of an audit system for psychiatric care. The picture that evolves from the survey shows that audits are comprehensive in only 52% of Ontario facilities, more so in the provincial psychiatric hospitals than in psychiatric units in general hospitals. The audits are multidisciplinary in 64% of all facilities. While only 50% of facilities involved in audits felt that audits have a positive impact on improvement of psychiatric care, 71% were positive that audits have contributed to continuing staff education.

The authors report their experience in introducing a criteria audit system. Factors influencing the selection, as well as advantages and criticisms of this model are discussed.
Emotional Stresses on the Psychotherapist
Authors: Whitfield Margaret D.
Published: April 2017

The practice of psychotherapy is a stressful occupation, both emotionally and physically. Becoming a better psychotherapist probably results in increasing the stress rather than decreasing it. If we do not recognize this we will respond in ways that are damaging either to our patients or to ourselves. Rather than attempting to be emotional supermen or superwomen, therapists need to be aware of their own needs and limitations and plan both their private and work lives accordingly.
Relationships between Premorbid Personalities and Unipolar Depressions
Authors: Hays Peter
Published: April 2017

One hundred and fifty consecutive patients with unipolar psychotic (“endogenous”) depression were investigated to illuminate any relationships existing between premorbid personality traits and the development of depressive illness. In some cases personality and psychological stress appeared to combine to produce depression, while in others physical stresses appeared to be the principal etiological agents, and to operate in the absence of personality and psychological factors. The contribution of these different factors to causation are discussed and explored.
Treatment of Tardive Dyskinesia with Dihydrogenated Ergot Alkaloids (Hydergine) a Pilot Study
Authors: Mohamed S.N. , Kazarian S. , Merskey H. , Thompson M.G.G.
Published: April 2017

Five patients with abnormal involuntary movements of tardive dyskinesia were treated with dihydrogenated ergot alkaloids (Hydergine) in doses of 3 to 4 milligrams a day for six weeks. Blind ratings of standard videotape recordings indicated significant differences between the patients. Worsening occurred in three patients during treatment and to a lesser extent after treatment; improvement during treatment appeared in one patient and more sustained improvement in one patient.
Outpatient Groups for Schizophrenia ” Ensuring Attendance*
Authors: Seeman Mary V.
Published: April 2017

This paper describes the author's experience with outpatient groups in schizophrenia and explores the process of ensuring active attendance. Necessary ingredients are the provision of immediate, tangible rewards to patients and therapists, constancy, flexibility, and the long-term benefits of social learning.
Neuropsychiatrie and Electroencephalographic Aspects in the Diagnosis of Complex Partial Seizures
Authors: Remick Ronald A. , Wada Juhn A. , Miles James E.
Published: April 2017

The authors review from a psychiatric perspective some of the electroencephalographic techniques that may assist the clinician in diagnosing complex partial seizures (temporal lobe epilepsy). Routine scalp electroencephalograms may not detect temporal lobe EEG abnormalities, leading to the false impression of pseudo or hysterical seizures.

Knowledge of the advantages of a sleep recording, specialized EEG electrodes (nasopharyngeal, sphenoidal), and natural or pharmacological activation techniques will increase one's diagnostic acumen. The authors discuss the appropriate use of these methods and their relevance to psychiatry.
The Completion of Training in Psychiatry: A Transitional Phase
Authors: Smith Vivien
Published: April 2017

The transition from psychiatric residency into practice is a phase of psychiatric training which has received insufficent attention, both in the literature, and in psychiatric training programs. This paper describes some of the changes which occur within the person during this transition phase and points to the need for more discussion of this vital period in the making of a psychiatrist.
Continuing Medical Education: Viewpoints of Canadian Psychiatric Residents
Authors: Ivey J. , Leichner P. , Kalin R.
Published: April 2017

Continuing Medical Education (CME), relicensure and recertification are controversial issues for physicians today. The viewpoints of 142 Canadian psychiatric residents from 12 training centres across Canada were surveyed. The majority (73%) of the residents did not think that CME would pose a problem for them after certification. In fact, a large majority (77%) felt CME should be required after certification. Close to half of the residents favoured monitoring of CME by the Canadian Psychiatric Association. In contrast to these results, few favoured mandatory recertification. A formal relicensure examination was strongly repudiated. Individual reading and self-assessments as well as clinically oriented courses and workshops were the favoured methods of CME.

Our recommendations arising from this survey are threefold. CME should remain a voluntary activity. The Canadian Psychiatric Association should be the monitoring body for CME for psychiatrists, and finally, indivdual readings and self-assessments should be used increasingly in providing CME.
Assessment, Commitment and Motivation in Marital Therapy
Authors: Rosenbluth M. , Cameron P.M.
Published: April 2017

The importance of a discrete assessment phase in the treatment of people with marital problems is emphasized. The consequence of such a phase in terms of clarification of treatment selection and engagement is discussed.

Examples are presented which demonstrate the importance of attending to the factors of commitment to the marriage and motivation and capacity to work in therapy.

Attention to these issues facilitates proper treatment planning designed to best suit the couple's specific therapeutic needs.
The Resident and the Borderline In-patient: A Supervisor's Perspective
Authors: Sadavoy J. , Silver D. , Book H.
Published: April 2017

The problems of residents working intensively with borderline inpatients in a general hospital psychiatric unit are described. The resident feels pressure because of inexperience with intensive psychotherapy, and the high visibility of working in a closely supervised team setting. The borderline patient baffles the resident with his defensive activity characterized by splitting, erotization, idealization, and negative therapeutic response. These difficulties complicate supervision, necessitating the supervisor's alertness to being caught in team splits or collusion with the resident's unrealistic hopefulness or nihilism. Supervision must actively address the resident's countertransference and the supervisor's counter-responses. Clinical vignettes illustrate the various problems.
Aro Village System of Community Psychiatry in Perspective
Authors: Jegede R. Olukayode
Published: April 2017

The Aro Village system of community psychiatry was started in Nigeria in 1954 by Dr. T.A. Lambo with the aim of making use of traditional sociocultural resources of the community in the treatment of mentally sick persons. The history of the program is presented, and advantages and disadvantages are discussed. In addition, the future role of the program in the health care delivery system of Nigeria is discussed with emphasis on how to guarantee the continuing relevance of the village scheme to the socioeconomic realities of a changing society.
Some Recent Observations on the Pathogenesis of Anorexia Nervosa
Authors: Garfinkel Paul E.
Published: April 2017

Studies of diagnostic subtypes within the anorexia nervosa syndrome has given rise to the differentiation of a bulimic subgroup as distinct from the restrictive type of anorexia nervosa. The bulimic subtype is characterized by the use of vomiting and laxatives to induce weight loss; a display of impulse-related behaviours; extraversion and sexual activity in contrast to the isolation of the restrictive group; and a family history of obesity in the mother, all suggesting a subcategory within the primary anorexia nervosa syndrome.

Investigation of behaviours and attitudes related to anorexia nervosa in a group of dancers disclosed a significantly elevated attitude toward food and body image characteristic of anorexia nervosa in this group and ten times the expected prevalence of the disorder itself. This is suggestive of the relative importance of cultural pressures towards thinness and anorexia nervosa in certain populations as one factor amongst others in the multi-determined origin of this condition. This cultural pressure is consistent with a disturbance of body image perception in anorexia nervosa. This disturbance seems to be stable in the same individual over a period of one year, is related to a poor prognosis and is correlated with measures of psychopathology including helplessness, depression and anhedonia. It is also correlated with a satiety defect as reflected in a failure to develop an aversion to sucrose when directly tested.
The Current Level of Psychodynamic Knowledge of Candidates for the Canadian Certification Examination in Psychiatry
Authors: Warme Gordon E.
Published: April 2017

Candidates at the certification examination in psychiatry of the Royal College of Physicians and Surgeons of Canada are noted by the author to have a lesser degree of psychodynamic sophistication than might be expected of psychiatric specialists. To test this hypothesis a number of sample questions were administered to examinees and their answers suggest that they do indeed perform less well than might have been hoped. It is argued that the examination procedure may be a legitimate instrument for rectifying this situation.
Continuing Education for Psychiatrists: Report on Canadian Psychiatric Association Questionnaire
Authors: Thompson M.G.G. , Toews J. , Lundgren J.M.
Published: April 2017

This report on the CPA Questionnaire on Continuing Education represents the answers of a sample of 485 of the 1,360 certified psychiatrists belonging to the Association. A total of 72.6% of the sample lived in urban centres with populations greater than 200,000; 28.9% worked in solo practice, but only 7.4% worked in settings where no other psychiatrists were present. The amount of time spent in continuing education activities was found to vary inversely with the distance that had to be travelled to major educational centres. Nevertheless, there were no psychiatrists that did not partake in some continuing education activities. Ninety-three percent read journals, 99% went to meetings, and 96% used consultation with other psychiatrists; 99% stated that these activities were useful. The favourite methods were reading and consultation. Eighty percent of the sample spent more than 41 hours per month in continuing education activities. Sixty-five percent stated that they would like a voluntary credit award system instituted. It is concluded that Canadian psychiatrists do spend a great deal of time in continuing education activities and believe that this is of value to their professional work.
Sleep Deprivation: Outcome of Controlled Single Case Studies of Depressed Patients*
Authors: Knowles J.B. , Southmayd S.E. , Delva N. , Prowse A. , Maclean A.W. , Cairns J. , Letemendia F.J. , Waldron J.
Published: April 2017

Six drug-free depressed patients, each of whom acted as their own control, were studied for eleven consecutive days during which they were twice deprived of sleep for either 36 or 40 hours. The sequence of events was baseline (3 days), SD, recovery (3 days), SD, recovery (3 days). Blind ratings of clinical state were made on the basis of four-hourly interviews (standardized for each case), which were videotaped; sleep was monitored by conventional electrophysiological methods. Sleep deprivation had a beneficial, but transient, effect on four of the six patients studied. Changes in sleep were unrelated to changes in clinical state.
Psychogeriatric Care in the General Hospital*
Authors: Sadavoy Joel
Published: April 2017

This study examines treatment outcome in 52 psychogeriatric patients to help determine the role of the general hospital in psychiatric care of the elderly. The author reviewed the charts of all patients 65 years of age and over admitted to the psychiatric ward from 1974 to 1978.

Approximately 80% of this group showed symptom remission. Treatment failures correlated closely with the presence of major organic brain syndrome. Despite an average age of 73.4 years and a high proportion of widowed patients only 10 patients needed new placements on discharge.

The author discusses the reluctance of general hospitals to treat the psychogeriatric patient despite the high success rate, the merits of such an active treatment approach and the effect of short-term therapy programs on the treatment of this group.
Clinical Data from a Psychiatric Service to a Group of Native People*
Authors: Pelz M. , Merskey H. , Brant C. , Patterson P.G.R. , Heseltine G.F.D.
Published: April 2017

Clinical data are reported from a psychiatric service to Native Canadian patients, mainly Cree Indians. Eighteen out of 41 had a clinical diagnosis of depression, three of mania and only one of schizophrenia. Thirty-seven percent used alcohol to excess but alcoholism was rarely the primary diagnosis. Reasons are given for the belief that schizophrenia has been over-diagnosed in Native populations in the past.

Seventy-eight percent spoke Cree/Inuit as their primary language.

The patients usually held their parents in high regard despite often reporting that they were alcoholic. In reply to tentative enquiries into feelings about their Native identity, only 5% of the patients indicated a preference for another identity, but this figure is only considered to give a minimum estimate of the possible dissatisfaction with being Native in Canada today.
Controversial Issues of the Pharmacotherapy of the Hyperactive Child
Authors: Weiss Gabrielle
Published: April 2017

This paper, which forms part of a symposium on Paediatric Psychopharmacology, selects for discussion certain practical and theoretical issues related to the use of Stimulant Therapy for Hyperactive Children. The particular issues selected relate to important clinical questions, most of which have been the focus of recent research. Amongst the controversial issues chosen for discussion is the fact that while the short term effect of stimulants on symptoms of the hyperactive syndrome is well established, the long term efficacy and the effect of stimulants on improving the prognosis of this syndrome remains uncertain. It is concluded that the large body of research on the use of stimulants for hyperactive children has finally answered some long standing questions, but many gaps of knowledge remain and further research is required.
The Belittled Wife: Social, Legal and Psychotherapeutic Considerations
Authors: Gold Judith H. , Gold, Ll.B Edgar
Published: April 2017

Forty years ago Horney and Thompson each wrote about the inferior role of women in marriage based on sociocultural situations. The present day message of equality has had variable effects with the result that many women complain of the belittling opinions and actions of their male partners when they attempt to become self-assertive. Equality in marriage in Canada is more established in law than socially today. Dual career marriages often illustrate this dichotomy as the husband's career takes precedence over that of the wife. The therapist plays an important role in the resolution of the ambivalent feelings of both partners.
The Autoscopic Phenomenon: Case Report and Review of Literature
Authors: Abd El Aziz A. Salama
Published: April 2017

This paper presents the case report of a 28-year-old man with a rare form of autoscopy. His appearance when he was admitted suggested the possibility of “flash back,” due to his long history of abuse of psychotomimetic amphetamines and LSD. The complete psychiatric history and evaluation made it clear that the diagnosis should be that of schizophrenia. He was described as a solitary, withdrawn person, who had lost drive and was emotionally blunted. He often experienced feelings of unreality and appeared to be almost continually deluded and hallucinated. His main delusions were centered on the phenomenon of “autoscopy.” The uniqueness of this case is the patient's delusion of watching himself on a television screen acting as one of the “stars.”
Treatment of Neuroleptic-Induced Leukopenia with Lithium Carbonate
Authors: Yassa R. , Ananth J.
Published: April 2017

Based on the finding that lithium carbonate administration can stimulate leukocyte production, six patients were treated with neuroleptic and other drug-induced granulocytopenia with lithium carbonate. The average total leukocyte count of 2500/mm3 increased to 4566/mm3. Similarly the average neutrophil count of 1028/mm3 increased to 2893/mm3 after lithium therapy. In all six patients, neutrophils decreased upon discontinuation of lithium. On the other hand, total WBC count of 4566/mm3 decreased to 2650/mm3, and the total neutrophil count of 2893/mm3 decreased to 966/mm3 after four weeks without lithium. The results suggest that lithium carbonate is effective in the treatment of drug-induced leukopenia.
The Doctor-Lawyer Dilemma: A Problem of Mental Set (an examination of the doctor-lawyer interface in civil cases)
Authors: Henderson James
Published: April 2017

Clinical psychiatrists often try to avoid medicolegal collaboration because pragmatic difficulties and philosophical differences combine with a sense of diminishing return to make it seem an unproductive area of professional activity. There is a need for rapprochement in the working relationship of lawyers and physicians. In an attempt to facilitate such rapprochement several sources of potential conflict which currently exist are delineated. Differences in subject matter and in methodology are important. Differences in philosophy of practice contribute to a sense of strain and the very nature of the adversarial courtroom situation offends many physicians who fail to appreciate its potential virtues. Lawyers and physicians differ in their approaches to decision-making processes in ways that are mutually vexatious.

Some suggestions are reiterated which, if more widely practised, could help us collaborate more effectively with our legal colleagues to the ultimate betterment of our patients and clients.
Perceptions and Attitudes of Hyperactive Children and their Mothers regarding Treatment with Methylphenidate
Authors: Cohen Nancy J. , Thompson Lynda
Published: April 2017

Fifteen hyperactive children and their mothers were interviewed regarding their knowledge, perception, and attitudes toward treatment with methylphenidate 6 months after commencing a stimulant regime with the child. Measures of locus of control and self-esteem were also administered to the child. The results indicated that mothers and children agreed on the effects of medication and knowledge about the cause of hyperactivity. Both mothers and children had mixed feelings about medication. Most of the children felt that continuing with this treatment was important and seemed to be more concerned than their mothers over negative consequences if medication was stopped. Although it has been suggested that impaired self-esteem may be a consequence of children seeing improved behaviour as a result of medication rather than self-control, the results indicated an increase in both self-esteem and internal, locus of control during the 6-month period of the study.
The Phenomenology of Bipolar I Manic-Depressive Illness
Authors: Wilson Lawrence G. , Rosenthal Norman E. , Dunner David L.
Published: April 2017

There have been several advances in the knowledge of the phenomenology of Bipolar Manic-Depressive Illness in the past decade. Studies of groups of carefully diagnosed bipolar patients have characterized features of the course of illness, the presence and prognostic influence of psychotic features, the influence of stressful life events, features of social adjustment and aspects of personality and long-term functioning. Similar studies of bipolar illness in non-western cultures would be of interest.
A Trouble in the Brain-Mind: Self-Description of a Depressive Episode
Authors: Lehmann H.E.
Published: April 2017

A scientist patient who suffered a depressive episode describes its course and treatment with unusual clarity and objectivity.
The Professional Woman as Patient: A Review and an Appeal
Authors: Myers Michael F.
Published: April 2017

The unique problems that the professional woman brings to therapy are presented here. It is the author's contention that the career woman's difficulties are not adequately realized or understood by many male therapists. Many of these patients are disappointed with or highly critical of their therapy with male psychiatrists. Two sub-groups of professional women are described: the married professional woman and the unattached professional woman. There are critical sex-role related issues and countertransference problems which arise with the male therapist: professional woman patient dyad. Other implications for male psychiatrists are outlined and suggestions offered toward therapist enlightenment.
Autonomy in Mothers with Careers
Authors: Robinson G. Erlick , Perrotta Marie , Burne Susan
Published: April 2017

We analyzed questionnaires filled out by 23 mothers with careers and rated them as to degrees of autonomy: 26% received a ‘1’ (least autonomous) rating, 39% a 2’, 22% a ‘3’ and 4% (1 person) received a “4’ (most autonomous).

Psychoanalyst Dr. Elizabeth Zetzel (1) stated “The healthy woman should be able to combine successful marriage and motherhood with some sort of personal career.” It would seem that the woman who is most effective at doing so is one who is highly autonomous and, therefore, feels free to construct a non-traditional role for herself. Unfortunately, in our study, these women were very much in the minority. In keeping with our hypothesis, the mere fact that a woman is combining a career and family is not a guaranteed indicator that she is highly autonomous.
Prevalence and Correlates of Nonpsychotic Psychiatric Symptoms in the General Population
Authors: D'Arcy Carl
Published: April 2017

This paper reports on the results of a large scale mail questionnaire survey of the prevalence, as well as some social/psychological correlates, of nonpsychotic psychiatric symptoms in the general population of the Province of Saskatchewan. The level of nonpsychotic psychiatric symptoms was measured using the 30-item General Health Questionnaire (GHQ) developed by Goldberg. The respondent group (2000+, 53% of the available sample) was reasonably representative of the provincial population and forms a good basis for generalization.

Data analysis shows that women report a higher level of symptoms than men. There were also significant age variations:for women there was a general decline in mean scores from younger to older age categories with the possible exception of the oldest age group, over 70, in which we see a slight increase; for men, there was a pronounced U-shaped distribution with both younger and older age groups exhibiting high levels of symptomatology. In addition to age and sex, general health, relationships with spouse and others, and a sense of control over one's life experiences were found to be correlated with symptom reporting, underscoring the negative effects of ill health and the inequities in social systems as well as the positive value of good interpersonal relationships.

Saskatchewan symptom reporting levels were found to be similar to those reported in Australian and British population samples. These other studies also showed higher levels of symptom reporting infernales than in males.

The GHQ data were also factor analyzed to reveal sets or clusters of symptoms. The analysis showed that “anxiety” and “depression” were the major dimensions of the GHQ lending credence to the suggestion that psychiatric screening scales tend to measure “de-morale-ization,” that is, anxiety, sadness, helplessness/hopelessness and a lack of self-esteem.
Is Stuttering a Contraindication to Psychotherapy?
Authors: Butany V. , Persad E.
Published: April 2017

This is a case report of a patient who stutters and was treated for problems of self-esteem with focused brief psychotherapy. The literature by and large is against the use of individual psychotherapy for neurotic problems in patients who stutter. The countertransference may account for the unwarranted pessimism in the literature about such patients. In this case the successful resolution of countertransference feelings facilitated the achievement of the goals of therapy. Further reports on such treatment attempts are warranted. Speech therapy may be facilitated by brief focused psychotherapy for the stutterer.
An Investigation of the Possible Inverse Relationships between the Occurrence of Rheumatoid Arthritis, Osteoarthritis and Schizophrenia
Authors: Mohamed S.N. , Merskey H. , Kazarian S. , Disney T.F.
Published: April 2017

One hundred and eleven inpatients with schizophrenia and 51 with other psychiatric conditions were compared for the frequency of rheumatoid arthritis, other connective tissue disorders and other physical illness. Evidence both of rheumatoid arthritis and osteoarthritis was significantly less in the schizophrenia group. Latex Agglutination Tests were positive to the same extent in both groups. One possible explanation of the findings is that they are due to the reduced frequency of trauma or stress to the joints in schizophrenic inpatients, many of whom lived in hospital, compared with the control group. Other explanations are also considered.
Forensic Psychiatric Assessment in Selected Canadian Cities
Authors: Webster C.D. , Menzies R.J. , Butler B.T. , Turner R.E.
Published: April 2017

Forensic psychiatrists in six Canadian municipalities completed a single-page form following each court-ordered assessment conducted during the month of July 1978. A total of 248 cases accumulated during the study period. During the following 18 months researchers collected court dispositions on the sample. With data from all six cities pooled, 85% of patients were found fit to stand trial. Almost all, 96%, were accorded a diagnosis with 39% classified as psychotic. Overall the examining psychiatrists considered 36% to be dangerous to others in the future. When psychiatrists recommended a custodial setting, in 73% of cases the person was incarcerated. Recommendations for hospitalization were observed in 59% of cases.

Although the data would seem to suggest that judges take psychiatrists’ recommendations into account, the investigators were nonetheless struck by the general lack of communication between clinic and court. They offer a number of suggestions for improvement.
The Mental Hospital and its Environment
Authors: Mohelsky H.
Published: April 2017

This paper examines the task and functioning of a contemporary mental institution. The author, drawing from his experience, explores the world within such an institution whose purpose often contradicts the officially stated one. This world with its own assumptions is a creation in response to needs and anxieties of its participants. In the face of rapid shifts and increasing complexity in institutional environments, the capability to change becomes critical. Real change is impossible unless the underlying assumptions of an institution are recognized, understood and dealt with.
Family Therapy Training: Learning an Attitude
Authors: Berman Graham
Published: April 2017

The learning process is differentiated from the curriculum content. It is suggested that family therapy will be more effectively learned by identification with competent models than by following a consciously organized curriculum.