bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychiatric Education in the Emergency Room Setting
Authors: Rusk Thomas N. 
Published: April 2017

Some background concepts regarding the teaching of clinical psychiatry are briefly reviewed, along with current controversies regarding the content and timing of various aspects of residency training. The main point made in this paper is that the Emergency Room (ER) is a forum of potentially immense value for the teaching of clinical psychiatry but it is a resource which is largely untapped. A technique which remains unexplored involves the use of video tape in the ER. Research which is currently in the planning stage involves the evaluation of therapist variables as to whether patients follow through with recommendations. Research is urgently needed to determine how effective crisis intervention is, as well as how effective different techniques are, for what type of patient and in what type of crisis. While these questions apply just as urgently to all psychotherapy, the crisis situation lends itself more readily to research in that it is more time limited and the effects of intervention as opposed to other life variables are more obvious than in more long-term psychotherapies. The problem of spontaneous improvement is, of course, still very much present. The advantages of ER teaching presented in this paper are the following: I It is an opportunity for participant teaching in a non-dyadic situation. II Supervision is immediate. III Post hoc distortion is eliminated, yet it allows traditional supervision in the post interview discussion. IV The real, as opposed to the contrived situation, should combine service and teaching. V The ER is a natural transition zone from the medical to the psychiatric model. VI Opportunities are provided for rapid resolution of conflict and a sense of mastery. VII Emphasis on the evaluation of ego strength over and above dynamics and genetics is crucial and productive. VIII Crisis demands selective focusing, as well as careful and rapid conceptualization of the tactical intervention - good training for any therapy. IX Real and natural confrontation with social realities is necessary. X A wide range of diagnostic categories is seen. XI ER encounters allow teaching of a flexible psychotherapeutic approach appropriate to different problems. This active empathic approach complements the passive analytic one best learned elsewhere. XII Yet psychoanalytic concepts from psychosexual stages to transference and counter-transference are well demonstrated in the ER. XIII A different psychiatric role model can be provided for medical students, thus enhancing their motivation for psychosocial concepts. Crisis resolution itself should be a cornerstone of medical student teaching. XIV The ER is obviously a place to teach crisis intervention, a well-accepted therapeutic endeavour. XV The involvement of social workers, psychiatrists, psychologists and nurses working together provides an excellent introduction to training in collaborative skills.
Partial Hospitalization*: Concept and Method
Authors: Congdon Roger G. 
Published: April 2017

This paper discusses the ambiguities and contradictions which are revealed when a patient is totally hospitalized. The term ‘Partial Hospitalization’ is proposed as being more desirable, even though the patient may require twenty-four hour care at some time. Also discussed is the role of dependency relationships and how these are fostered by the present nomenclature. The role of the Therapeutic Community approach, in attempting to minimize institutionalization, is proposed as contradictory though desirable for a patient who is placed in a dependency situation by administrative procedures which are probably now outdated. The various phases of ‘Partial Hospitalization’ are discussed and its best known component, day care, is reviewed in detail. The proposition is made that, as the separate components of ‘Partial Hospitalization’ cover all that is now provided by psychiatric hospitals, the term ‘inpatient’ should be dropped.
The Inpatient Service: Therapeutic Community versus Community Therapy
Authors: Freeman S. J. J. , Burch J. D. , Pinto R. 
Published: April 2017

The 'therapeutic community' model of ward organization has many advantages and proved to be helpful to a number of patients, who were able to repattern many of their interpersonal and coping techniques in this milieu. This paper is not intended as an attack on this concept of hospital management but rather is an attempt to point out that it is probably not appropriate in certain situations. The first of these occurs when all patients presented to a hospital ward must be admitted for short-term hospital stabilization and subsequent outpatient and/ or community care. The second situation in which the efficacy of the therapeutic community model may be doubted is where there is a surfeit of staff and facilities. An alternative form of ward organization based on community psychiatry principles is described and some statistical evidence is presented to support the contention that it is the more appropriate model for these situations.
Controlled Evaluation of Intravenous Drugs in the Specific Desensitization of Phobias
Authors: Silverstone J. Trevor , Salkind M.R. 
Published: April 2017

The present study was undertaken to compare intravenous methohexitone, given as an adjunct to the behaviour therapy of phobias, with another centrally-acting, rapidly metabolised intravenous agent, propanidid, and also with normal saline. Thirty-five patients were included in the trial, all of whom had had phobic symptoms of at least one year's duration which were seriously interfering with their lives — 15 had specific phobias, 9 had social phobias and 11 had agoraphobia. Treatment consisted of twelve weekly drug-assisted desensitization treatments, using either 1 per cent methohexitone, 2.5 per cent propanidid or normal saline. Within each diagnostic group the drugs were randomly allocated. All treatments were conducted by one of the authors and all assessments by the other (who did not know which of the three preparations the patient had received). In addition to monthly ratings of the phobic symptoms, assessments of anxiety and depression were made, using self-rating scales. Patients were followed up six months after the end of treatment. Patients with specific phobias fared best, 9 out of the 13 who completed being considered to be markedly improved. Although the numbers are small there was a suggestion that patients receiving the two active drugs did better than those on the placebo. While methohexitone and propanidid were similarly effective, recovery time was much more rapid with propanidid. No patient in the specific phobia group relapsed significantly during the six months follow-up period. Furthermore, as the phobia improved the general anxiety level fell. Few depressive symptoms arose during successful desensitization, and there was no evidence of symptom substitution. Patients with social phobias and agoraphobia did far less well. In neither case did the active drugs appear to possess any advantage over placebo. Furthermore, of the 7 patients with agoraphobia who had improved, 4 relapsed within six months. It was concluded that drug-assisted desensitization is likely to be of greatest benefit in the management of specific phobias, with propanidid being the drug of choice.
Article
Authors: Plante Gilles , Côté Hélène , Pilic Ivanka 
Published: April 2017

The authors describe a group of inhibited children from an impoverished milieu, randomly selected from four schools. Televised evaluations were used to examine the children, and the parents were evaluated by the social workers. Among twenty evaluated children, three were found to be normal and the rest were inhibited at minus 2 degrees. Almost half these children showed depressive traits. The families lived in deprivation. In half the families there was alcoholism and the fathers were absent. The parents saw themselves as excessively strict but the children, for the most part, were not able to verbalize how they perceived their parents. In spite of the deprivation of these families the parents still aspire to middle-class values for their children and push them in this direction, and this increases their inhibition. An attempt is now being made to stimulate them: eight have been invited to regular free painting sessions, and the others will form a control group for a further study in which the efficacy of this technique will be measured.
Psychodrame Libre Ou a Theme Induit
Authors: Lavallée J. , Lapierre Y.D. 
Published: April 2017

A comparative study of two methods of initiating a psychodrama session is reported. The treatment course with 24 neurotic outpatients comprised six weekly sessions of psychodrama. This study demonstrates that patients participating in psychodrama sessions where the theme is introduced by the therapist do so more actively than do patients treated in a group where the psychodramatic theme results from the preliminary group discussion. The affective component of the participation of the former group was also more pronounced as they were either warmer or more aggressive than the group where the theme arose from the group discussion. The reduction of the total psychopathology was not significantly different in the two groups.
The Measurement of Retrograde Post-Traumatic Amnesia
Authors: Blomert D. M. , Sisler G. C. 
Published: April 2017

Retrograde amnesia is the inability to recall events which occurred immediately before head trauma or other acute brain insult. It is one aspect of a larger entity — posttraumatic amnesia — seen in some head injuries, and represents a defect in the consolidation of memories. Previous studies of retrograde amnesia have produced conflicting findings regarding its characteristics. A study was undertaken to identify the characteristics of retrograde amnesia, its relationship to anterograde amnesia, and the problems of its measurement. Forty-eight patients with head injuries admitted to the Emergency Department of the Winnipeg General Hospital were interviewed to identify all subjects meeting certain criteria regarding age, education, and so on, and twenty-five met the criteria and were included in the sample. Each subject was interviewed at least twice until the retrograde amnesia had reached a stable minimum. The duration of retrograde and anterograde amnesia as well as immediate and short-term memory were assessed. It was found that the duration of retrograde amnesia was directly related to the duration of the anterograde amnesia and to the duration of hospitalization. Some problems involved in measurement are discussed.
Possible Interaction of Environmental and Biological Factors in the Etiology of Schizophrenia: Review and Integration
Authors: Strahilevitz Meir 
Published: April 2017

Possible interactions of genetic and environmental factors in the etiology of schizophrenia are discussed.Studies on the significance of genetic-constitutional and environmental factors in determining specificity of behavioural and biochemical responses to stressors in humans and experimental animals are reviewed.Studies of stress in schizophrenia are also revieweed and their possible relationships discussed.Hypotheses related to the interaction of environmental factors and genetic constitutional factors in the production of acute schizophrenic psychosis in genetically predisposed people are presented. Research studies supporting such hypotheses are reviewed and discussed.It is proposed that environmental pressures, by inducing a physiological state of stress or other biochemical physiological alterations, may be etiologically related to the development of acute schizophrenic psychosis by:• Producing chemical substances that act as inducers of enzymes, in particular transmefhylating enzymes and those involved in the production of proteins, which may be related to the etiology of schizophrenia;• Activating autoimmune processes which may be related to the etiology of schizophrenia;• Changing levels of brain amines;•Altering the permeability of the blood-brain barrier.
Psychiatrists and Psychiatry Residents in Canada: A Compilation of Canada Manpower Data and Suggestions for Further Study
Authors: Thomson Michael J. C. 
Published: April 2017

The study of psychiatric manpower needs is both important and difficult. Some previously available data on the numbers of psychiatrists in each province of Canada are examined in conjunction with one new item relating to the number of residents in each Canadian university department of psychiatry. Unfortunately, no clear-cut conclusions can be drawn, ‘but some suggestions are made for further studies. Probably more questions are raised than answered, but this reflects the state of our current knowledge or lack of it. The data show that there are currently (fall 1973) 1,614 psychiatrists in Canada compared with 1,478 in 1971; 944 in 1966 and 549 in 1961. There was thus a net increase of 929 (169.2 percent) psychiatrists in Canada between 1961 and 1971. Even allowing for the increase in the size of population, the ratio of 1 psychiatrist: 33,200 of population in 1961 decreased (improved) to 1 psychiatrist: 14,600 of population in 1971, which represents a 56.0 percent change. There were 549 residents in Canadian university departments of psychiatry in the fall of 1973. This level if maintained, would double the number of practising psychiatrists in Canada in 14 years. However, this also assumes that all residents complete their training and continue practising in Canada, that none of the existing Canadian psychiatrists retire or leave the country, and no immigrant psychiatrists arrive in Canada. These assumptions are unlikely, but accurate data are not available to correct them. McGill and the University of Toronto departments of psychiatry are dominant and they are currently (fall 1973) training 45.3 percent of all Canadian psychiatry residents (McGill 20.5 percent and Toronto 24.8 percent). Unfortunately a number of university departments did not or were unable to supply information on the number of psychiatry residents in training in past years, which makes a comprehensive study impossible.
Roadblocks and Stopgaps: A Review of Factors Obstructing the Development of Comprehensive Child Mental Health Services
Authors: Rae-Grant Naomi I. 
Published: April 2017

Even under conditions which might be considered ideal for the development of a comprehensive system of services for disturbed children and adolescents (adequate financial resources, good recruitment and training programs and collaboration between different government departments concerned with youth), there are factors which mitigate against the development of a logical service system. Program development is groomed by its historical background, coloured by prevailing societal attitudes toward children and skewed by the existing funding mechanisms. The case records of children and adolescents referred for assistance in residential treatment placement over a five-year period are analysed in terms of previous interventions. It is evident that the multifaceted nature of the family, social, treatment, and educational needs of children are tackled piecemeal; each agency bringing its resources to bear only on one aspect of the child's functioning and extruding the child when its repertoire of child altering behaviour is exhausted or deemed ineffective; at this point referral is made to another agency or system, resulting in a discontinuous, frequently ineffectual series of “helping” efforts. Understanding, modifying and coordinating service development will require interactive planning between all the caring, treatment, and educational systems on behalf of the child population.
Psychiatric Diagnosis in Toronto, New York and London
Authors: Duckworth G.S. , Kedward H.B. , Eastwood M.R. , Allodi F. , Woogh C. , Meier R. 
Published: April 2017

Summary National statistics of mental illness suggest great differences in morbidity patterns between Canada, the USA and the UK, with the highest rates of illness occurring in Canada. Statistically, Canada and the US possess higher rates of schizophrenia and diseases of the senium but lower rates of affective illnesses than the UK. The US-UK study demonstrated that when the diagnostic process was standardized, the differences between the two countries disappeared. This paper examines a sample of 255 Canadian patients hospitalized in Toronto and compares the results of standardized techniques of diagnosis with the routine hospital diagnoses of the same patients. Conclusions of the study were fourfold. First, psychiatric diagnoses made by standardized techniques can achieve a high degree of reliability as measured either by inter-rater comparisons of item ratings (92 percent) and diagnoses (80 percent) or by correlation with computer diagnoses obtained by the CATEGO program (75 percent). Second, comparisons of project consensus diagnoses with routine hospital diagnoses revealed that agreement between the two was highest in Toronto, lowest in New York and intermediate in London. Third, a comparison of the project diagnoses of psychogeriatric patients in the three centres revealed no differences in morbidity between the three countries. Finally, the fallacy of generalizing from studies in one country which have not controlled for diagnosis to populations in other countries, is exposed.
Amitriptyline Blood Levels and Relapse
Authors: Furlong F.W. , Sellers E.M. , Kapur B.M. 
Published: April 2017

Nine previously depressed patients who had responded either to amitriptyline, nortriptyline, or ECT, according to defined criteria, were followed for six months on either 150 mg. or 75 mg. amitriptyline daily, double blind. Blood amitriptyline and nortriptyline levels were measured by gas chromatography over six months, and clinical measures were performed. The range of blood concentration of amitriptyline and nortriptyline was as would be expected from the literature. Two patients relapsed within six months and both were in the 150 mg. dose group. Of the two relapsed patients one showed the highest blood levels of the group, often beyond the range which could be calculated, and the other showed very low blood levels. Analysis of the clinical scores and blood levels for the whole group did not reveal any relationship between variations in blood level and depression ratings from month to month, or any other information as to what dose or blood level produced optimal results for the patients who did not relapse. This study tends to support the view that lack of effectiveness may be associated with too high or too low blood levels; that relapse may also be associated with very high or very low blood levels; and that the use of even rough measuring of blood levels could indicate which alternative was more likely in a given individual. In this study the group on 75 mg. amitriptyline daily did better than the group on 150 mg. daily in terms of relapse. Most studies of the significance of tricyclic antidepressant blood levels have focused on the acute response over short intervals, usually six weeks, and used nortriptyline; this study focuses on relapse over six months and measures blood levels of amitriptyline and nortriptyline resulting from oral amitriptyline.
A Two-Dose Dexamethasone Suppression Test in Patients with Psychiatric Illness
Authors: Shulman Ralph , Diewold Patricia 
Published: April 2017

After exposure to a low and high dose dexamethasone regime, 11 of 34 acute psychiatric inpatients demonstrated abnormal dexamethasone suppression characterized by morning and/or mid-afternoon escape from suppression. This abnormality of suppression was found in primary depression, in mania, and in acute schizophrenia. In primary depression, the presence of abnormal dexamethasone suppression failed to discriminate “endogenous” depressed from “other depressed” subjects. Because nonsuppression to a high dose of dexamethasone is also found in patients with ectopic ACTH secretion and in patients with autonomous adrenal tumors, caution is necessary in the interpretation of nonsuppression which persists after recovery from psychiatric illness. As patients with Cushing's syndrome of uncertain etiology may be referred to a psychiatrist for a diagnostic evaluation, the psychological correlates of abnormal dexamethasone suppression need to be established with greater certainty.
Home Care Treatment of Acutely ILL Psychiatric Patients: A One Year Follow-up
Authors: Smith F.A. , Fenton F. R. , Benoit C. , Barzell E. , Tessier L. 
Published: April 2017

This paper presents the results of one year of Home Care treatment of 77 acutely ill psychiatric patients. Home Care treatment was successful in 83.1% of 77 patients during the first year. Since only four patients failed during the second six months of treatment, hospitalization was effectively prevented, and not delayed, during the first year of treatment. Finally, a history of previous psychiatric hospitalization is not an accurate predictor of success or failure in the patients receiving Home Care treatment in this study. It appears more likely that the psychosocial supports available to the patient, and the relationship between the patient, his family and the Home Care treatment team, are more important in determining the success or failure of treatment at home.
Criteria for Early Diagnosis of Brain Dysfunction
Authors: Lazor Alina , Chandler Dorothy 
Published: April 2017

This paper is concerned with the early identification in the pre-school years of those symptoms considered to be significant for the diagnosis of minimal brain dysfunction (MBD) (6). The history through the sixties and seventies shows a growing concern on the part of psychiatrists, neurologists and psychologists for the identification of those symptoms significant for the diagnosis of MBD (1,3,6–8,23). The paucity of follow-up studies and our own concerns regarding the diagnosis of brain dys-functioning led to a follow-up study on forty children diagnosed in pre-school years. The original diagnosis was made on a cluster of symptoms classified as primary, secondary and tertiary. Primary symptoms are neurological signs. The secondary symptoms are defensive mechanisms against the intrapsychic problems such as fears, compulsiveness, etc. Some symptoms may be either primary or secondary, e.g. distractibility, mood fluctuation. Tertiary symptoms are the results of the inability to interpret and respond to the social situation effectively again because of the organic dysfunctioning and the child's reaction to the rejection and hostility which he engenders by his own inappropriate social behaviour and emotional responses, such as, diffusely hostile attitude or over-dependence. The study showed that in that group of forty, thirty seven or 93.7% had positive neurological signs, with three or more occurring frequently. Psychiatric diagnostic evaluation shows severe personality deviation in thirty-seven cases. On psychological testing sixty percent were dull normal or above (above 80 I.Q.) and forty percent below normal. Examination of school placement reveals that only thirty percent are in regular classes and the remainder in special classes. The findings confirm that the diagnosis can be made in pre-school years on the basis of behavioural symptoms in the presence of neurological signs. The neurological impairment is permanent and the dysfunctioning affects emotional, social and intellectual functioning. The severity of the dysfunctioning of the family affected the child's rate of improvement.