bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacité et cinétique du clorazepate administré en une dose unique quotidienne chez des anxieux
Authors: Duguay Robert , Le Lorier Jacques , Rochefort Jean-Guy , Messier Réjean , Viguié Francis , Adamkiewicz Et Lydia 
Published: April 2017

Twelve patients of both sexes (5 women, 7 men; mean age = 39,9) suffering from marked anxiety as defined by DSM III for generalised anxiety (score > 20 on the Hamilton-A scale) but in good physical health, were given 15 mg of clorazepate daily at 8 p.m. for a period of 28 days. Desmethyldiazepam, the active metabolite of clorazepate was measured in blood samples on day 1, 14 and 28 of the experiment as well as the level of anxiety on the Hamilton scale.Anxiety decreased significantly between day 1 and day 14 (mean score declining from 33,9 to 18,4) and from day 14 to day 28 (mean score 18,4 to 14,7).Desmethyldiazepam reached its maximum blood concentration 2 hours after the first intake of clorazepate. A plateau had been reached at day 14 and remained stable up until day 28, indicating the absence of cumulating effects. The dosage remained the same for all patients during the 28 days of the experiment. There were no drop outs and no undesirable effects.
Teaching Therapeutic Skills of a Psychological Nature to Future Physicians
Authors: Borgeat François , Gagnon Jacques , Hudon Marcel , Lalonde Pierre , Reid Wilfrid 
Published: April 2017

The majority of patients suffering from emotional problems are treated by non psychiatric physicians. In this context, the improvement of health services to those patients requires the involvement of general practitioners trained in appropriate therapeutic skills. At the present, general practitioners often feel unprepared to treat those patients with non-pharmacologic methods and tend to overuse psychotropic medication. The psychological therapeutic skills expected to be acquired by physicians, are often described in very general terms and remain under evaluated in medical schools. The improvement of these aspects of medical training requires them to be evaluated systematically, similar to the more traditional medical skills and biological knowledge. Such an evaluation is facilitated if the learning objectives are specified. This paper proposes specific learning objectives describing the psychological therapeutic skills expected from medical students at the end of their studies on the one hand, and from family physicians at the end of their family medicine training on the other. The authors’ goals are to faciliate the discussion of this complex matter between the many medical (psychiatric or not) groups concerned and in this manner, to clarify this issue which is fundamental to the teaching and implementation of the biopsychosocial model in clinical practice.
Diagnosing Affective Disorder in Adolescents: The Use of the Schedule for Affective Disorders and Schizophrenia
Authors: Kutcher S.P. , Yanchyshyn G. , Cohen Carole 
Published: April 2017

The Schedule for Affective Disorders and Schizophrenia was administered to 42 consecutively hospitalized psychiatrically disturbed adolescents. The SADS proved to be a good measure of current affective disorder and also identified a large number of adolescents with a positive past history of affective disorder. These patients had not been so identified by traditional assessment means. The use of a semi-structured interview is to be encouraged in the assessment period of psychiatrically disturbed adolescents and in further research at attempts to define the parameters of depressive disorders occurring in adolescents.
A Preliminary Outcome Study of a Community Group Treatment Programme for Emotionally Disturbed Adolescents
Authors: Blackman Maurice , Pitcher Sherry , Rauch Francey 
Published: April 2017

The treatment of adolescents with psychiatric disturbance remains a highly unsuccessful area. Empirical research is limited and treatment decisions are often based on theoretical bias rather than proven results. This study reports on the results of a multivariate analysis of pre- and post-individual and family measures on patients in a community based day and evening programme. The programme utilized a broad range of treatment modalities including group and family therapy and chemotherapy. An accredited educational programme was also provided to the patients attending the day programme. The results of this study showed that adolescents were referred to either the day or evening programme components based on level of acting out behaviour rather than on DSM III diagnosis. Adolescents reported significant positive changes at post testing in all areas, but this improvement was not endorsed by parents. Although therapists perceived considerable improvement in their families after treatment, this improvement did not show up on the family assessment measure chosen. The findings of the study endorse the need for further empirical research in adolescent treatment and underscores the fallacy of relying on anecdotal evidence to report treatment results. Questions are raised as to the operational usefulness of the present DSM III criteria in making treatment decisions and the validity of associating individual dysfunction with family dysfunction. Some question as to the sensitivity of the family measure used was also raised. The study outlined strengths and weaknesses in the present treatment programme and underscored the importance of further evaluative research, if the treatment of adolescents with psychiatric disturbance is to become successful.
A Cohort through the Revolving Door
Authors: Woogh Carolyn M. 
Published: April 2017

In this study a cohort of 1722 patients first admitted to all three psychiatric facilities in a small urban area were followed for up to seven years. Seventy-nine percent had non-psychotic diagnoses. Of the total cohort, 7%(n=120) were readmitted more than three times — these patients were more likely to be male, young and unemployed, but of similar education level to age-sex matched single admission controls. Fifty three per cent (n=49) of this group were not psychotic (most were alcholics or personality disorders) and again were more likely to be males, young and unemployed than age-sex matched non-psychotic single admission controls. Efforts to further evaluate the characteristics of the multiplyreadmitted cohort were thwarted for a number of reasons. Information about individuals within a system are essential for further epidemiological study but require a better data base and prospective monitoring of patient careers.
On the Differences in the Historical Development of Psychoanalysis in the United States and Canada
Authors: Sarwer-Foner Gerald J. 
Published: April 2017

Psychoanalysis developed differentially in Canada and the United States. In the United States it was geared to the model of having only physicians train in psychoanalysis, which was followed from the very beginning but in Canada the standard of the international Psycho-Analytic Association was used allowing the training of some lay analysts as well as physicians. In Canada; though very Freudian, a more integrated view of many different schools of psychoanalysis was taught as adjuncts to the Freudian view, this being based to a large degree on the British psychoanalytic model. The American Psychoanalytic suffered many splits on the issues on social factors and to some degree on political issues in the twenties and the thirties. This was avoided by the Canadian societies and institutes. The main similarities and differences in historical development are outlined and discussed.
Personal Therapy and the Student Therapist
Authors: Glass Judy 
Published: April 2017

The effect of a therapist's personal psychotherapy on patient therapy outcome appears to be mixed. Some studies have shown that experienced, analysed therapists obtain better clinical results, but experience seems to be the important factor. Others have found no difference regardless of the therapist's personal therapy. Considerations favoring personal therapy include: awareness of the unconscious and of countertransference, increased empathy, minimizing blind spots, validating theory and method by first hand experience, and understanding how one's own defenses interfere with the therapeutic process. Those against personal therapy affirm there is no direct effect on competence, and there may even be detrimental effects (during residency); for example, inexperienced therapists in personal therapy appear to be less available to their patients because of their own preoccupations. Students’ tendencies to identify with their analysts and pressure to conform in an analytic milieu might tend to decrease the number of therapists with varied orientations. The boundary between supervision and personal therapy is often unclear. In both, similar techniques may be used, but the goal of supervision should be to help the student to understand emotional problems and resistances which might interfere with the therapeutic process. Supervisors should make a compromise between purely didactic and therapeutic approaches. Despite the lack of conclusive evidence, supervisors should be encouraged to be less neutral and give advice and information to trainees who are in need of or who ask about personal therapy. “Physician, heal thyself” Book of Luke, 4:23
Psychosis Resulting in Suicide in a Patient with Primary Hyperparathyroidism
Authors: Öztunç Sueda , Guscott Richard G. , Soni Jorge , Steiner Meir 
Published: April 2017

A case is reported of a patient presenting to the psychiatric unit of our hospital with symptoms of depression and found to have an organic psychosis. On routine SMA-12 investigation (12 channel auto analyzer), elevated serum calcium was detected on admission leading to the diagnosis of primary hyperparathyroidism (PHPT). The surgical removal of a parathyroid adenoma was followed by a rapid return of biochemical abnormalities to normal ranges. In spite of appropriate psychiatric management and fluctuations in the patient's clinical condition, the organic psychosis was unaltered and culminated in suicide 4 months after admission.
Psychiatric Training and the Trainee: Is there a Fit?
Authors: Persad E. , Cameron P. 
Published: April 2017

This data would suggest that psychiatric training programs may not be organized according to the interest or needs of many trainees. The emphasis on fulltime research in neurobiological psychiatry is centre stage in most programs, and yet according to our survey, few residents view this as a desirable career path. Our data from 8 years of trainees at the University of Toronto indicates that a new model of training streams would best suit the needs of the trainee, the profession and the community. This report is a continuation of a study into the recruitment process. An earlier report was published in the Canadian Journal of Psychiatry Vol. 29, December 1984. Our present data is on two groups of trainees as well as from faculty.
Psychological Patterns in Donor Insemination Couples
Authors: Berger David M. , Eisen Abraham , Shuber Jack , Doody Kenneth F. 
Published: April 2017

One hundred and twenty couples applying for DI or involved in the procedure were seen in consultation or therapy at various stages. The clinical findings provide evidence that both partners experience conflict in two areas. The discovery of infertility generates transient impotence, loss of self-esteem and withdrawal in husbands, and anger, guilt and a wish to make reparations in wives. The DI procedure itself evokes oedipal conflicts. Clinical vignettes have been presented to illustrate these patterns and to provide evidence for the view that couples should recognize, discuss and come to terms with the conflicts generated by the discovery of infertility before tackling DI and the conflicts this procedure evokes. Although secrecy is advocated by most DI couples and physicians, a questionnaire study of 76 couples in our unit disclosed that many individuals consider it psychologically useful to discuss their infertility problems with others. Although secrecy may be useful, it may also, through the indirect sanction of denial and negation, interfere with the couple's acknowledging and discussing their problems. One useful purpose of a psychiatric assessment is that it can promote such acknowledgement and discussion. Conflict needs to be distinguished from psychopathology which may be the outcome of unresolved conflict.
Some Psychodynamics of Non-Compliance
Authors: Book Howard E. 
Published: April 2017

With up to 50% of psychiatric patients refusing medication at some time during therapy, non-compliance can become a major treatment difficulty. This problem is compounded by the countertransference responses evoked within the therapists, and their tendency to react solely with information and exhortation rather than attempting to view non-compliance psychodynamically. When exploring with empathic concern, a number of common dynamic issues can be seen as playing a major role in drug refusal. Commonly at work are issues relating to projection, denial, identification, and transference difficulties that emerge in a relationship where a therapist offers a patient a pill.
General Papers
Authors: Lavoie Richard , Mercier Et Céline 
Published: April 2017

A study conducted in a Montreal area psychiatric institution focuses on the impact of chronic patients on in-patients services delivery system. This article shows a disarticulation of the system, from the first to the second line and within the second line. The authors suggest that when the length of stay is extended beyond a certain time frame, it becomes increasingly difficult to reconcile continuity and complementarity of services: by congesting the system, chronic psychiatric population is decreasing the accessibility of services.
The Detection of Psychiatric Morbidity and Associated Factors in Patients with Rheumatoid Arthritis
Authors: Chandarana P.C. , Eals M. , Steingart A.B. , Bellamy N. , Allen S. 
Published: April 2017

Eighty-six patients with a confirmed diagnosis of rheumatoid arthritis were surveyed to assess the extent of psychiatric morbidity as indicated by two screening questionnaires, the General Health Questionnaire and the Hospital Anxiety and Depression Scale. In addition to an investigation of the concordance of the screening questionnaires, a description of demographic characteristics and measures of disability were taken. Disability due to arthritis was indicated by measures of years of chronicity, pain, duration of morning stiffness, functional level, active treatment involvement, and presence of coexisting medical problems. The relationship of physical symptoms to level of psychiatric distress was investigated. Psychiatric cases were identified using recommended cut off scores on results of the screening questionnaires. GHQ cut off scores of 6/7 identified as “cases” 31.8% of the sample. HADS subscale cut off scores of 8/9 identified 21.4% of subjects with “anxiety” and 19.0% with “depression “ scores in the morbid range. Nineteen percent of patients were found to have scores on both tests concurrently in the pathological range.
A Rural Child Psychiatry Day Treatment Centre: Systemic Perspective*
Authors: Greenfield Brian 
Published: April 2017

The author presents the complexities of directing a DTC (Day Treatment Center) in a rural setting. These complexities are explored from the pespective of system's theory. The various systems contained within the DTC are in dynamic equilibrium with each other as well as with various community groups. Changes in any one system have significant impact on the groups the system impinges on. As an example, the DTC had not functioned well for a period of time prior to the author's arrival. During that period the staff communicated poorly among themselves, resulting in conflicts between the teaching and non-teaching staff. When these conflicts were resolved the well-established incompatibilities and stresses within the system of the non-teaching staff surfaced. In the process of this conflict resolution the DTC was reorganized. New groups were established to access children at primary and secondary levels of medical prevention. Rapport with other systems in the community improved. Consequently, with better communication between groups of staff and with the community, the treatment of the children could be more effective.
Transsexualism: Syndrome or Symptom?
Authors: Dolan Jeremiah D. 
Published: April 2017

The desire to identify with and assume the role of the opposite gender has been present with us since antiquity. Unfortunately, the syndrome of transsexualism as defined by the DSM-III encompasses many individuals who are seeking a gender change perhaps allowing reassignment to take place when not indicated. This paper reviews the major classifications applied to the condition of transsexualism and a new model of classification for individuals with Gender Dysphoria is outlined. It will be shown that by subdividing the condition into those with the hypothesized syndrome (primary (true) transsexualism, or the symptom, secondary transsexualism) a better understanding of gender dysphoria is achieved. By applying this new model of classification, a management/treatment protocol is outlined which is helpful in dealing with the gender dysphoric patient.
Personnalité passive-agressive et personnalité dépendante — état actuel de la question
Authors: Goulet Jean 
Published: April 2017

The author makes a critical review of the literature concerning dependant and passive-aggressive personalities. After putting them in a historic perspective, he presents the various etiologic hypotheses. Special attention is given to the clinical and therapeutic aspects. The author concludes that despite the supposed high incidence of these two personality disorders, the reliability of the diagnoses and the natural history of the disorders remain to be explored in a prospective and systematic manner, before definite conclusions can be drawn regarding therapy.
Satanism in a Psychiatric Adolescent Population
Authors: Bourget Dominique , Gagnon André , Bradford John M.W. 
Published: April 2017

In a university affiliated adolescent psychiatric facility, providing approximately 250 consultations per year, an unsuspectedly high prevalence of preoccupation with “satanism ” was found in referred adolescents. Interested by the phenomenon, the authors have identified and documented eight cases in an attempt to isolate common characteristics among the cases. Initially a link between the marginal cult belief and general maladjustment was hypothesized, specifically delinquent behaviour. The study confirmed this trend and showed a significant impairment in the social adjustment of these adolescents. One of the most striking findings was the high prevalence of family disruption and parental abuse. Furthermore, a wide range of psychiatric symptoms were found in our subjects. This study raises concerns over the psychological development of adolescents who are subject to high levels of psychosocial stress. It will hopefully encourage further work in the area of increased susceptibility towards beliefs and indoctrination.
Case of Atypical Depression
Authors: Minde K. , Burra P. , Persad E. , Dinsdale H. , Brouillette J. 
Published: April 2017

This paper reports on a grand round presentation of a psychiatric case history of a young woman who showed frequently changing symptoms compatible with a major depressive disorder. She also presented with auditory hallucinations and grand mal seizures. All her symptoms were refractory to a wide range of pharmacotherapy and ECT. In the paper, senior clinicians in neurology, psychopharmacology, psychiatry and social work discuss the phenomenology and possible treatment of this clinical picture. They emphasize the dangers associated with single minded psychopharmacological treatment of an atypical depression and delineate the importance of “organic” symptoms in mental disorders. A twelve month follow-up of the case is provided.
Dyskinésie Tardive: Mise a Jour
Authors: Shriqui Christian L. 
Published: April 2017

Tardive Dyskinesia (TD) is a neurological syndrome associated with long-term use of antipsychotic drug treatment (APD). Its significant prevalence (estimated 15–20%) and potential irreversibility are a major concern in psychiatry. The clinical picture is characterized by involuntary repetitive movements of choreoathetotic and dystonic nature varying in location and intensity. The individual outcome of TD is unpredictable but recent long-term studies give reason for prudent optimism. All neuroleptics are involved in the disorder, numerous risk factors have been suggested; advancing age is the only one which has a clearly definite role. Even though several hypotheses have been suggested, the pathophysiology of the disorder remains a mystery. Informed consent is discussed in this update with regard to the legal implications of the disorder. Because of lack of effective treatment, prevention of TD is essential. The present treatment of choice is gradual reduction (and ideally discontinuance) of APD treatment when possible.
Reflections on the Epistemology of Psychiatry
Authors: Yonge Keith A. 
Published: April 2017

A re-examination of the theoretical basis of our practice of psychiatry (that is, its epistemology) reveals the insufficiency of the empirical, inductive approach which we have come to regard, too myopically, as the sine qua non of our science. Traditionally in psychiatry, the discipline of philosophy, of which epistemology is one of its major fields of endeavour, has generally come to be regarded as irrelevant or unreliable as a source of true knowledge. But an objective look at our variegated practice of psychiatry — roughly divided into two groups — the biological on the one side and the psychosocial on the other — reveals a glaring lack of integration, cohesion, or synthesis in basic theory. While analysis is the prime modus operandi of science, synthesis is the main objective of philosophy. While we subscribe to various operational theories to explain how our various procedures work, we lack an overarching, unified, general theory to subsume them. Hence we lack a truly holistic concept of the person who is our patient. In this we are much in need of the discipline of philosophy, which promotes clarity of thought, breadth of comprehension, and systematic (logical) reasoning. Psychiatrists acquire more of this philosophic expertise through collaboration with professional philosophers (epistemologists in particular) and through the introduction into our graduate psychiatric training programs of some specific course content from the literature of philosophy. As a preliminary suggestion for this, an “Annotated Reading List” is appended.
Treatment Resistant Depression: A Clinical Perspective*
Authors: Macewan G. William , Remick Ronald A. 
Published: April 2017

One hundred and fourteen patients with a diagnosis of “treatment resistant depression” (TRD) were assessed and treated at a Mood Disorders Clinic. Diagnostically, 52 (45.6%) subjects met criteria for bipolar disorder, 49 (42.9%) for recurrent depression, and 13 (11.4%) patients did not fulfill diagnostic criteria for affective disorder which explained their treatment resistance. With appropriate, individualized treatment, 59 of 98 (60.2%) patients had complete symptom remission based on clinical and psychometric ratings (initial Ham-D 26.7, final Ham-D 5.9). Eighteen of 98 patients had partial remission (final Ham-D 15.9) with vigorous pharmacological interventions, and 8 subjects exhibited “absolute” TRD (final Ham-D 23.4). The results suggest the value of specialized mood disorder services. The partial and absolute TRD's were more likely to be older, received more Axis II diagnoses, and had previous histories of drug or alcohol abuse.