bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
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.
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

Summary 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.
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.
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.
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.
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.
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.
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.