bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neuroleptic Blood Levels and Clinical Response
Authors: Rockland Lawrence H. 
Published: April 2017

Gas chromatography and radioreceptor assay technologies made possible the measurement of nanogram quantities of neuroleptic in the blood. They revealed large differences in blood concentrations among patients receiving the same oral dose. This led to the hope that measuring neuroleptic concentrations would allow more effective oral dosing for individual psychotic patients. Early attempts to study neuroleptic concentration/clinical response patterns, using chlorpromazine, produced confusing results. Many of the studies had serious design flaws, and were complicated by the many active metabolites of chlorpromazine. Adequate blood level/response studies should use fixed drug dosage schedules, drug-responsive patients, and neuroleptics without active metabolites. Brain concentration of drug is probably better reflected by erythrocyte than by plasma concentration. Therefore, recent investigators have usually used erythrocyte haloperidol or butaperazine concentrations to study level/response relationships. These recent studies strongly suggest an “optimal concentration” level/response pattern for haloperidol and butaperazine. Patients tend to respond best to moderate concentrations of neuroleptic, and non-response can be due to either too low or too high concentrations. In the latter case, decreasing the oral dose should be seriously considered. Blood level findings remain preliminary. The clinician should continue to fine-tune his clinical skills, using neuroleptic blood concentrations to complement his clinical judgment, in the attempt to determine the lowest effective dose for the individual patient.
Risk Research in Affective Disorders and Alcoholism: Epidemiological Surveys and Trait Markers
Authors: El-Guebaly N. 
Published: April 2017

Traditional designs in risk research have been in the form of epidemiologic surveys aimed at assessing a genetic contribution or search for broader indicators of vulnerability, resulting from the interaction of both nature and nurture. Recently, an interest in biological markers has resulted in the search for possible trait markers identifying more specifically, individuals with a life-long risk for an illness that may be expressed or not. The contributions, limitations and evolution of these strategies are reviewed in the syndromes of affective disorders and alcoholism. Recommendations include the use of biotypes rather than phenomenotypes for the diagnosis of the index case. Current promising approaches include the study of pedigrees biased towards a particular variable, a discriminant analysis of the variation in expressivity of the syndrome and the genetic linkage studies. While there is so far no established trait marker, research strategies are emerging and withstanding the test of time. The present technological explosion will undoubtedly further our understanding of risk factors.
Termination in Individual Psychotherapy: A Survey of Residents’ Experience
Authors: De Bosset F. , Styrsky E. 
Published: April 2017

This paper describes the result of a survey on one Canadian Psychiatric Residency Program. Fifty-four percent of the residents responded to the questionnaire enquiring about their experience of termination in long-term psychotherapy. The majority of residents (66%), had ended therapy prior to fifty sessions. In only a small number of terminations the resident felt the patient was ready to terminate (16%) and that therapy had come to a “natural termination”. Therapy often ended prematurely due to the change of setting of the resident, drop-out and other practical circumstances as well as therapeutic impasses. The paper discusses the factors that influence the premature ending of what the residents undertook as long-term psychotherapy and their implications for their training and the patients’ treatment.
Legal Issues in Medical Management of Violent and Threatening Patients
Authors: Dickens Bernard M. 
Published: April 2017

The responsibility of professionals in the medical management of violent and threatening patients is discussed using the Tarasoff case (American) and the Lawson case (Canadian) as landmark cases influencing subsequent jurisprudence.It is becoming increasingly important to be aware of the court's interpretations in such areas as confidentiality, predictions regarding dangerousness, the duty to warn, and the legal duty to strangers to the therapist/patient relationship. A number of other issues relating to the risks involved in management of patients potentially dangerous as a result of the use of drugs are also discussed.
Civil Commitment and Consent for Electroconvulsive Therapy in Ontario
Authors: Martin B.A. , Peter A.M. 
Published: April 2017

Among the most contentious legal and ethical issues concerning the use of electroconvulsive therapy (ECT) are the criteria for obtaining a valid consent to treatment and its administration to involuntarily hospitalized patients, with or without consent. This paper reviews the consent process, in particular the assessment of competence, as it is affected by the symptoms and clinical circumstances, including civil status, of those patients for whom ECT is prescribed. The ECT caseload at one psychiatric facility was reviewed to determine the diagnosis and civil status of each patient and the source of consent for each course of ECT prescribed over a 10-year period. Significant differences were found in the diagnostic distribution and the source of consent by diagnostic group between the 1,042 courses administered to informal patients and the 249 courses to involuntary patients. The results are discussed in the context of relevant Ontario legislation and hospital policies. Recommendations are made for the improvement of procedural safeguards to protect the autonomy of all patients.
The Microcomputerized Diagnostic Interview Schedule: Clinical use in an Out-patient Setting
Authors: Wyndowe J. 
Published: April 2017

While the validity of the Diagnostic Interview Schedule (DIS) is still controversial, enough data exists to support a trial in a cinical setting. A new microcomputerized version presents the diagnostic profile of the patient within minutes after the interview and reduces the possibility of errors in data collection and transcription, thus making the interview appropriate and available for widespread use. The present study examines the use of this instrument in a psychiatric out-patient department. Forty-one referrals to a psychiatric out-patient department were assessed by each of two methods: the standard problem-oriented non-structured clinical interview (NSI) and the microcomputerized DIS. The mean time taken for the DIS was 111.6 minutes, and patient acceptance of the microcomputerized format was high. The DIS provided a mean of 5.5 diagnoses per person compared to 2.56 for the NSI, but 31.7% of the patients had no clinically significant current DIS diagnosis. Approximately one-half the patients were assigned a diagnosis by the NSI which was beyond the 38 DSM-III diagnoses covered by the DIS. A comparison of the diagnostic results of both interviews reveals large differences in the group, and very little agreement in individual patients. The proportion of patients assigned diagnoses of substance abuse, affective disorder, psychosexual disorder, and personality disorders by each interview were quite different. Many of the patients diagnosed as having primarily Personality Disorder by the NSI were found to have an affective disorder by the DIS. The reasons for these differences and the resulting implications are discussed. This study supports the use of the microcomputerized DIS as a clinically useful adjunct to the diagnostic process.
Controlled Follow-up of Patients Released by a Review Panel at One and Two Years after Separation*
Authors: Ledwidge B. , Glackman W. , Paredes Jaime , Chen R. , Dhami S. , Hansen Margaret , Higenbottam J. 
Published: April 2017

Fifty patients released by the Review Panel are compared with a matched group of 50 patients discharged by the attending physician at one and at two years after separation from hospital. The two groups did not differ with respect to readmission rate or time spent in the community. At two years the physician-discharged patients were functioning better than the Panel-discharged patients in two of the seven areas of functioning; in the other five areas of functioning the adjustment of the two groups did not differ. The implications of these findings for the operation of the Review Panel and for the timely discharge of involuntary patients by attending physicians is discussed.
Longitudinal Evolution of Individuals Having Appealed Their Committal to the C.A.S.
Authors: Ouellet Paul-G. , Picard Sylvie 
Published: April 2017

The longitudinal evolution of 66 patients admitted between 1976 and 1986 at the Centre Hospitalier Robert-Giffard, and who have appealed their case before the Commission des Affaires Sociales (C.A.S.) was studied. After a review of the literature, the authors compare the evolution of the patients whose appeal was accepted and who left the hospital against medical advice to those individuals whose appeal was rejected. The authors wanted to see if the first group of patients had a less favourable short-term and medium term evolution. From a study of the files and of the case notes prepared by the physicians for the C.A.S. hearings, the authors draw a profile of the typical individual of this group and they study the influence of 16 factors of dangerousness on the Commission's decisions. The results show that the short and medium term evolution of the patients who have appealed their case before the Commission does not differ significantly in the area of dangerousness, whether their appeal was accepted or rejected. However, the length of stay of those patients who had to remain in hospital was significantly longer and that may be the reason why the period of time between their discharge and their re-hospitalization was afterwards much longer. In light of these results, the authors comment on the importance given by the Commission to the legalistic rather than therapeutic aspects of cases.
Dysthymia: A Randomized Study of Cognitive Marital Therapy and Antidepressants
Authors: Waring Edward M. , Chamberlaine Charles H. , Mccrank Ernest W. , Stalker Carol A. , Carver Claudia , Fry Richard , Barnes Sue 
Published: April 2017

Preliminary data from a randomized study of the effectiveness of combined marital therapy and antidepressant medication in the treatment of dysthymic married women is presented. The study compares doxepin with placebo, and a marital therapy designed to enhance intimacy through facilitating self-disclosure between spouses with a more supportive and educational therapeutic approach. After ten weeks of combined treatment, the dysthymic women show statistically significant improvement on all the depression measures as well as on the intimacy scale. A trend is developing for greater reduction of depressive symptomatology in the group treated with self-disclosure. The evidence appears to suggest the possibility that the presence of a patient's husband as a supportive figure may of itself be a potent therapeutic manoeuvre in the treatment of dysthymic women.
Using the Axis V Scale to Evaluate Therapeutic Outcome of Psychiatric Treatment
Authors: Gordon Richard E. , Plutzky Maximo , Gordon Katherine K. , Guerra Marcelo 
Published: April 2017

This study examined whether the Axis V scale of DSM-III was a useful instrument for coding and evaluating psychiatric patients’ response to treatment. It compared outpatients functional responses to treatment, measured by the Axis V scale used to assess current functioning, with their symptomatic changes. It found that the Axis V scale provided a different dimension of patients’ outcome than the symptomatic one. Overall, only 19% of the patients were rated on Axis V as improved functionally at discharge, as compared to 55% rated as improved symptomatically. However, as outpatients completed more treatment sessions, increasingly larger percentages were rated as improved on the Axis V scale, ranging from 8.5% improved functionally after completing 1–5 sessions to 44.5% improved after 41+ sessions. Symptomatic ratings plateaued after 6–10 sessions, with 80%) of the patients being rated as improved symptomatically after completing treatment, no matter how many more treatment sessions they received before discharge. The report discusses the implications of these findings for assessment of psychiatric patients’ treatment needs, goals of their treatment programs, and evaluation of treatment outcomes.
Bulimia: Independence of Antibulimic and Antidepressant Properties of Desipramine
Authors: Blouin Jane , Blouin Arthur , Perez Edgardo , Barlow Jane 
Published: April 2017

The purpose of this study was to identify variables useful for predicting a positive response to the tricyclic antidepressant desipramine, amongst bulimic subjects. Using a randomized double-blind cross-over design, 24 normal weight bulimics completed a 15-week protocol in which they received either desipramine (150 mg/day)for six weeks, no drug for three weeks, followed by placebo for six weeks, or the reverse sequence. At weeks 0, 2, 4, 6, 9, 11, 13, and 15, each subject was assessed using the EDI, SCL-90, POMS and binge records. The DST, Diagnostic Interview Schedule (DIS), and a personal and family medical-psychiatric history questionnaire were administered at initial assessment, while plasma desipramine levels were obtained at weeks 4 and 13. Responders were defined in terms of both binge frequency reduction, and decrease in depressive symptoms. In the sample of 24 subjects, desipramine was significantly more effective than placebo in reducing the frequency of weekly hinging and vomiting, as well as causing a reduction in the fatigue scale of the POMS. No significant effect of the drug was obtained on the EDI or the SCL-90. In terms of reduction in binge frequency, seven responders were identified; another seven were found to be borderline responders, while 10 were labeled as non-responders. The three groups did not differ in terms of their initial scores on the SCL-90, POMS, DST, DIS results, or psychological subscales of the EDI. However, responders were found to have lower EDI bulimia subscale scores, but a higher frequency of purging episodes than were non-responders. Eight patients were identified as borderline responders with respect to depressive symptoms. They differed from depression non-responders in that they had abnormal DST results, and were more likely to report a family history of depression. These results indicate that the predictors of the antibulimic effect of desipramine in bulimia are independent of its antidepressant properties.
Use of Imagery to Describe Functional Abdominal Pain as an Aid to Diagnosis in a Pediatric Population
Authors: Geist R. 
Published: April 2017

Abdominal pain is a common presenting complaint among children and adolescents. Although psychological factors may be involved, their role is not clear and a diagnosis of functional pain is often made only after extensive investigations. Specific psychological characteristics have been associated with abdominal pain in children, but little is known about the nature of the pain itself. A retrospective study was undertaken to characterize the subjective experience and description of abdominal pain in patients hospitalized for investigation of abdominal pain.Thirty subjects with proven inflammatory bowel disease (IBD) and 32 diagnosed as having functional abdominal pain (FAP) were studied. The age, sex distribution, and duration of the pain in these groups were similar. Seven (23%) patients with IBD used imagery to describe their pain in contrast to 25 (78%) of those with FAP (P < 0.01). Neither age nor duration of pain was associated with the use of imagery. The use of imagery was significantly associated with the diagnosis of FAP (P<0.01). A more detailed characterization of the way patients describe abdominal pain might assist in diagnosing its etiology.
Working in Arctic and Sub-Arctic Conditions: Mental Health Issues
Authors: Cochrane Jeanette J. , Freeman S.J.J. 
Published: April 2017

As Canada expands its activities in the North, it becomes necessary to understand the mental, emotional and health consequences of working in harsh, isolated environments. This paper reviews the pertinent literature and reports on a study, commissioned by Environment Canada, of the working conditions of meteorological technicians in 33 isolated stations who were surveyed by questionnaire. Numerous personal interviews and visits to five Arctic stations were also carried out. GHQ scores of psychological distress were significantly higher than in a Saskatchewan community sample but not higher than in male air transport shift workers in Ontario. Sleep disturbances and anergia were the two most prominent symptoms in our sample. The literature also stressed these symptoms as well as alcoholism and a number of curious cognitive phenomena. The importance and problems of group functioning are stressed. Our subjects showed fewer problems than the literature would have predicted, but it is generally agreed that there are few, if any, irreversible sequela of life in the North.
Prevalence of Psychiatric Disorders and Suicide Attempts in a Prison Population
Authors: Bland Roger C. , Newman Stephen C. , Dyck Ronald J. , Orn Helene 
Published: April 2017

A survey was conducted in which 180 randomly selected male prisoners ages 18 to 44 were interviewed using the Diagnostic Interview Schedule and other questionnaires. A comparison was made with 1,006 similarly aged male residents of Edmonton who were interviewed using the same instruments. Compared to the general population, prisoners were less likely to be married and were less well educated. There was a higher proportion of Native Indians in the prison sample and lower proportions of Oriental and other racial groups. Prisoners were twice as likely to have a lifetime psychiatric disorder compared with the general population, and all individual disorders investigated were more common in the prison population. Six month prevalence showed even greater rates compared with the general population, indicating recent symptoms. The number of individual disorders per prisoner was also higher than for the general population. Lifetime suicide attempts were seven times more frequent in prisoners than in the general population.
A Comparison of Borderline and Schizophrenic Patients for Childhood Life Events and Parent-Child Relationships*
Authors: Byrne C.P. , Velamoor V.R. , Cernovsky Z.Z. , Cortese L. , Losztyn S. 
Published: April 2017

Fifteen patients with DSM-III diagnoses of borderline personality disorder and 14 schizophrenics were administered two questionnaires by an interviewer blind to the diagnoses. The questionnaires were the Childhood Life Events and Family Characteristics Questionnaire and the Parental Bonding Instrument. A scale to monitor denial was also included. Borderlines, when compared with schizophrenics, reported having significantly more childhood sexual and physical abuse, more early separation from their mothers, more paternal criminality, and also more paternal overprotection and less maternal care. When compared with normal population data, they received significantly less care and were significantly more overprotected by both parents.
Effets d'une éducation au traitement neuroleptique chez de jeunes psychotiques
Authors: Goulet Jean , Lalonde Pierre , Lavoie Germain , Jodoin François 
Published: April 2017

This study verifies the effect of the neuroleptic treatment teaching module, the French translation of the Medication Management Module produced by the social skills training programs. Twenty patients from an outpatient clinic (with schizophreniform or schizoaffective schizophrenia) were assigned at random to a test group (n = 10)ora control group (n = 10). The pre-test evaluation found that the two groups were the same with regard to 13 significant parameters. The experimenters used French translations of well-known instruments, and the double-blind method was applied to their respective observations throughout the study. Results were obtained by applying the neuroleptic treatment teaching module three hours per week for two to three months. The post-test evaluation revealed that patients who had been exposed to the education module had an improved understanding of schizophrenia and the medication required to treat it than patients who had not been exposed. The dose of medication prescribed between pre- and post-test evaluations were able to more effectively stabilize patients who had received education than patients who had not. Nevertheless, the education module continues to have no significant effect on the symptomatology (according to the Brief Psychiatric Rating Scale) and final SAS-II social scores of schizophrenics.
Evidence-Based Psychiatry
Authors: Elliot M. Goldner , Bilsker Dan 
Published: April 2017

Objective To apply the evidence-based medicine paradigm to the domain of psychiatric practice and to bring out the consequences for psychiatry of this approach in order to foster the emergence of an evidence-based psychiatry. Method The basic assumptions of traditional and evidence-based paradigms, as delineated by the Evidence-Based Working Group, are used to structure an exploration of the evidence-based approach to psychiatry. Theoretical and practical issues are considered and an example of evidence-based decision making is given. Results An evidence-based approach to psychiatry is described as one that emphasizes the importance of systematic observation and the use of rules of evidence in hypothesis testing. It is suggested that psychiatrists using this approach will be in a position to provide superior patient care. Discussion The application of scientific method to psychiatric problems is discussed as the essence of an evidence-based approach. The common error of “scientism” is described. The authors identify advantages and limitations of an evidence-based approach to psychiatric practice and advocate a decision-making process that balances individualized clinical acumen (phronesis) and information derived from empirical study of groups of patients (techne).
Prevalence of Dissociative Symptoms and Disorders in an Adult Psychiatric Inpatient Population in Canada
Authors: Sheila A. Horen , Pierre P. Leichner , Stuart Lawson J. 
Published: April 2017

Objective This study attempted to estimate the prevalence of dissociative symptoms and disorders in a Canadian adult psychiatric inpatient population and also attempted to determine the extent to which dissociative disorders were recognized by the attending clinical staff. Method All appropriate and consenting adult psychiatric inpatients at the Kingston Psychiatric Hospital in Kingston, Ontario, were given the Dissociative Experiences Scale. Patients scoring 25 or greater were interviewed with the Dissociative Disorders Interview Schedule and the Structured Clinical Interview for DSM-IV Dissociative Disorders. Admission or discharge diagnoses data were used to determine whether or not dissociative disorders were being recognized. Results A total of 48 patients completed the Dissociative Experiences Scale and 14 (29%) scored 25 or greater. The prevalence of dissociative disorders in this hospital population was estimated to be 17%. Dissociative identity disorder was found in six percent, dissociative amnesia in eight percent and dissociative disorder not otherwise specified in two percent of the population. These disorders tended to be under-recognized. Conclusion Research on more extensive populations is required to establish the true prevalence of dissociative symptoms and disorders in psychiatric inpatients.