bluuebunny/crossref_metadata_2025_split huggingface dataset:
Two Year Follow-Up Study of an Outreach Program in Geriatric Psychiatry*
Authors: Houston Fred 
Published: April 2017

In Canada and the U.S. the percentage of elderly people is increasing and more funds are being spent on institutional programs. Yet many are not so impaired that they cannot be looked after by relatives. A number of community outreach programs are available. From an inpatient psychogeriatric unit in Hamilton Provincial Hospital an outreach program is described. A follow-up study was done during a 2 year period by contacting the referral sources. The 24.7% who had been admitted were compared with the 75.9% who remained in the community. While patients’ relatives and referring sources were mostly pleased with the assessments, and those patients not admitted were less institutionalized, those admitted with affective disorder showed a higher recovery rate than those remaining in the community. The total number admitted to hospital showed a lower mortality rate than those not admitted, even though the latter were considered less mentally ill because of the criteria for admission to the hospital.
A Comparison between Australasian and Canadian Candidates on Common Examinations in Psychiatry*
Authors: Skakun E.N. , Ball R. , Mcleod W.R. 
Published: April 2017

Multiple choice examinations designed by the Royal College of Physicians and Surgeons of Canada were administered to candidates eligible for certification in the specialty of Psychiatry and to candidates in Australia and New Zealand who were eligible for certification by the Royal Australian and New Zealand College of Psychiatrists. Results indicated that two national groups of candidates performed similarly on these common examinations. Comparison of the item analysis based on the two different groups of candidates revealed that most of the items were comparable in difficulty and discrimination. Because of the similar performance of the candidates, the stable cross-national statistical characteristics displayed by the items, and the confirmation of the relevance of the items by Australasian and Canadian content experts, it was concluded that the test items are suitable for testing the knowledge of both Australasian and Canadian candidates. The study recommends that the work begun by the working meetings dealing with international sharing of test materials and sponsored by the CIBA Foundation be continued.
Psychotherapy of the Characterologically Difficult Patient
Authors: Silver Daniel 
Published: April 2017

The increasing number of characterlogically difficult patients in psychiatric practices has produced a plethora of theoretical formulations, treatment strategies and techniques. The major shifts in theoretical emphasis from drive theory to object relations theories and self-psychology has encouraged many psychiatrists to treat these patients in psychotherapy. The heterogeneity and variability of clinical profiles represented in this group of patients, however, still prevents prescription of “the” treatment of choice for this patient population. A major focus on treatment considerations in this paper is the assessment process with emphasis on determining the capacities for inter-personal relationships, psychological mindedness, empathy and psychological soothing of self and others. The advisability of establishing a “contract” as a prerequisite to treatment is suggested as an important factor in determining outcome. Other particular treatment issues are addressed such as frequency of sessions, “secrets”, premature provocation of intense affect, medications, consultations, hospitalization, self-mutilation, substance abuse and indications for termination. The complex vissicitudes of the transference and countertransference processes with this group of patients is pointed out especially those feelings of helplessness and range sometimes experienced in the countertransference. Long term intensive psychotherapy with many of these patients probably still belongs to the area of therapeutic heroics. Hard evidence for good and poor outcome is scarce and therapeutic zeal is too often based on anecdotal testimonial from adherents of one approach or another.
Utilization of Psychotropic Drugs in Saskatchewan: 1977–1980
Authors: Power Bob , Downey Winanne , Schnell Bruce R. 
Published: April 2017

Psychotropic drug use in Saskatchewan during 1977, 1978, 1979 and 1980 was determined. Approximately one in five prescriptions dispensed was for a psychotropic. About 20% of the population received psychotropic drugs in each year but use has declined slightly, especially that of tranquilizers. Psychotropic use increased with the patient's age and nearly two-thirds were women. Considerable caution should be exercised in making comparisons with other drug utilization studies. There may be substantial differences in the drugs selected for study, the categorization of these drugs, and the methodology used to analyze drug use. Also, most studies are based on data that is from a decade old or older. Moreover, most if not all other studies on drug use are based on sample surveys (from different sampling universes), whereas the present study is based on the entire population. Nevertheless, some generalizations may be valid. Since non-formulary drugs are excluded, the findings should be regarded as conservative. Examples of non-formulary drugs considered to be psychotropic include antispasmodic / tranquilizer / sedative combinations (example: Librax, Donnatal), combination hypnotics (example: Tuinal, Mandrax), and some combination analgesics (example: propoxyphene compounds, pentazocine compound, oxycodone compound).
Note Historique
Authors: Postel J. 
Published: April 2017

Summary The purpose of this paper is to investigate Philippe Pinel's psychiatric experience, his practice in “la maison de santé Belhomme” and his first publications which were concerned with the treatment of mental patients and appeared in “La Gazette de Santé” which he edited between 1785 and 1789. During that time, the main preoccupation of the future head doctor of “La Salpétrière” had been to ensure the application and the development of moral treatment, in its practical modalities as well as its theoretic rationalization. Meanwhile, the institutional aspect of this therapy had the upper hand over the individual cure. This evolution brought Pinel and his successors to neglect the latter. In this connection we can regret that Philippe Pinel did not continue to have more private practice for this allowed him to follow first his experience and research (individual cure) in this field of rational psychotherapy, that of moral treatment.
An Essay on Contemporary Dynamic Psychiatry
Authors: Warme Gordon E. 
Published: April 2017

Psychodynamic theory is less well understood than one would wish, especially because of the centrality of dynamic theories in understanding a host of psychiatric disorders. The key psychodynamic notion is that psychiatric symptoms can be explained as manifestations of an unconscious purpose or strategy. The theoretical term that best encompasses this notion is “intentionality”, a theoretical option that has, in many psychiatric circumstances, the greatest predictive and explanatory powers. Other more or less loosely related dynamic theories are the theory of the Oedipus complex, developmental theory, the theory of transference and the extraclinical theory. New theoretical paradigms are currently competing for explanatory priority, a development which reflects a healthy maturity in psychodynamic science, and which may mean that a new and superordinate theoretical paradigm is about to emerge. At a time of theoretical ferment it is particularly important that the theoretical underpinning of dynamic psychiatry be clearly explicated and the author claims that theoretical role for intentionality.
A Possible Indication for Red Cell Lithium Determinations: A Case Report
Authors: Yassa Ramzy , Nair Vasavan , Kraus Daniel J. 
Published: April 2017

The recommended prophylactic lithium levels in the treatment of manic depressive patients differ from study to study. In this paper, we present a patient who was maintained euthymic on lower plasma levels than those recommended. However, we theorize that the reason for this may be due to the fact that she had a high RBC/plasma ratio. We recommend that in those patients whose plasma lithium levels are consistently low, this point should be kept in mind before considering them as noncompliant.
Analysis of Emotional status during the Hospital Treatment of a Borderline Patient
Authors: Marziali E. , Hamilton J. , Sadavoy S. , Book H. , Sadavoy J. , Silver D. 
Published: April 2017

This single case study illustrates a methodology for identifying recurrent pathological emotional states in a hospitalized, borderline patient. Parallel therapeutic inputs are delineated and examined in terms of patient-specific responses. The results indicate that ratings of nursing notes recorded across three periods of hospitalization can reliably isolate the patient's most salient and debilitating emotional states. State-specific therapeutic interventions are extracted and their effectiveness noted. The analyses illustrate clinical phenomena which are congruent with what is known about borderline symptomatology. In addition, the study locates therapeutic errors which often occur when working with difficult patients.
Article
Authors: Lamontagne Yves , Boyer Richard , Lamontagne CÉLine , Giroux Et Jocelyn 
Published: April 2017

A survey was conducted in 230 cases of rape and rape attempts heard in the Judicial District of Montreal between January 1975 and May 1978. Data were compiled from the 30 assaults including two or more assaillants. Results show that in cases of rape committed by two men the aggressors are older than gang rapists, meet the victim mainly in her flat or in a bar, and rape her in her own home, in a car or a hotel. In these cases, voyeurism seems to be an important factor since, most of the time, rape is committed by only one of the two aggressors. On the other hand, gang rapists are younger, meet the victim in public places, on the street or when she is hitch-hiking and attack her in one of the aggressors’ house, in public places or on the street. Exhibitionism seems more present in this group of rapists. For both groups the victims are mainly single, younger than the aggressors and have diverse occupations. Finally, regarding the legal outcome half of the subjects were liberated or acquitted in both groups. Rape committed by two men had never been studied or compared with gang rape up until now. Results of this survey show dynamic and demographic differences between these two groups of sexual delinquents.
Psychiatric Interviewing and Clinical Skills
Authors: Pollock Daniel C. , Shanley David F. , Byrne P. Niall 
Published: April 2017

Does the ability of medical students to assess and relate to their patients through the psychiatric interview reflect in traditional academic achievement scores? A previous publication by our group offers data suggesting that certain personality traits of final year medical students have a fundamental importance in determining a successful performance on a psychiatry rotation. As the literature is vague and contradictory about the relation-ship between the psychiatric interview and clinical performance, a study was developed to determine what outcome variables are associated with the performance of clinical clerks on the Psychiatric Interview’ An attempt was made to develop and test a new scale designed to measure the Psychiatric Interview. The Psychiatric Interview Scale was used to measure performance on 33 final year medical students on a 1 month psychiatry rotation at a University of Toronto teaching hospital, and subsequently, as a basis for analysis and training of these students in interviewing. Inter-rater reliability of the Psychiatric Interview Scale was rho = 0.72 and internal reliability was 0.74. Psychiatric Interview Scores were compared with other achievement scores, and with patients’ ratings of the students interviews. A significant correlation emerged between the Psychiatric interview scores and final clinical examinations, but surprisingly, there was no relationship between the patients’ evaluation of the Psychiatric Interview and the raters’ evaluations and a strongly significant negative correlation between patients’ ratings and clinical scores. The importance of observed psychiatric interviews in teaching and evaluation are discussed along with the interesting implications of the differing evaluations of a successful interview by patients and psychiatrists. The relevance of training in the Psychiatric Interview to general medicine and family practice is emphasized.
Use of Psychiatric Services by the Elderly in Canada
Authors: Richman Alex 
Published: April 2017

There is increasing emphasis on identifying mental disorders in the elderly and developing appropriate mental health services. However, there are few quantitative studies on service use by the elderly. This paper gives a national perspective on the use of psychiatric services by the aged in Canada, and details two of the health care studies used to assess their mental health needs in southern New Brunswick. The elderly now make up a higher proportion of the long-term mental hospital population than they did 20 years ago. Despite the increase in number of short-stay general hospital psychiatric units, there are still marked differences in their use by the elderly. There is a marked decrease in short-term psychiatric in-patient care after the sixth decade. As well there are marked regional variations. The results of a Level of Care Survey in a New Brunswick mental hospital shows the discrepancies between the needs for care and the level of care actually received. In comparison with other patient sub-groups, elderly long-stay mental hospital patients had the highest proportion (79%) deemed suitable for care in alternative settings outside the hosptial. The anonymized merged statistical file revealed that the elderly mentally ill were more likely to be identified and cared for within non-specialized wards of general hospitals, and least likely to have contact with mental health clinics. Instead of adding new services to the existing system, reallocation and redirection of existing resources are crucial strategies in improving the mental health services for the elderly. The general hospital is an important area for psychiatric consultation and back-up to primary care services.
On Direct Patient Participation in the Cost of Their Psychiatric Care.
Authors: El-Guebaly N. , Prosen H. , Bebchuk W. 
Published: April 2017

In the midst of a sociopolitical debate regarding access to health services, an evaluation is required of the therapeutic impact of the direct participation by some patients in the cost of their psychiatric treatment. Empirical clinical concepts regarding the need for a direct payment of treatment by the patient have evolved. Initial rigorous practice systems have lead to more flexible methods allowing for the recognition of third-party financing. Psychoanalytic theory has addressed the issue most extensively, but other conceptual frameworks have reached similar conclusions as well. The experimental evidence to either support or refute the position that the direct payment of a fee has a beneficial effect on therapeutic outcome remains limited. The focus has been on studying the impact of fee manipulation, but a tested correlation of other motivators such as patient's insight, therapist's attitudes and behaviour and social pressures is mostly lacking. Two patient populations appear to be delineated. Fee participation is of particular value to the financially secure and to the educated while patients in need of less intensive involvement, with reality testing disturbance and limited insight benefit particularly from third party insurance. Different patient populations should have the right to choose different payment options.
Electroconvulsive Therapy in a Major Teaching Hospital: Diagnoses and Indications
Authors: Bland Roger C. , Brintnell Sharon 
Published: April 2017

The use of ECT over an eleven year period in the University of Alberta Hospitals is reviewed. Five percent of patients received ECT, the mean number of treatments per course was 5.2, and the most frequent type of treatment was bilateral ECT. Discharge diagnoses showed that three-quarters of the patients had affective psychoses and one-fifth were schizophrenic. All patients had had a mandatory consultation before treatment and the most frequent reasons for choosing ECT were given as: failed antidepressant treatment, previous good response to ECT, failure to respond to other treatment, uncontrollable delusions or psychotic behavior, acute suicidal risk requiring a rapid response, and adverse reaction to medication. The mandatory consultation process has worked well and has helped to clarify the situations where ECT may be used with benefit. It is hoped that this may assist those who may be responsible for defining guidelines for the use of ECT.
Effects of a Psychiatric Rotation on Psychiatric Knowledge and Attitudes towards Psychiatry in Rotating Interns
Authors: Agbayewa M.O. , Leichner P.P. 
Published: April 2017

The attitudes of trainees toward Psychiatry affect their career choice and ability to properly identify and manage emotional disorders in their patients. These attitudes are determined by several factors which include preclinical and clinical training among others. We report here a study of the attitude of interns toward psychiatry using the 30 item attitude toward psychiatry (ATP-30) scale. The ATP-30 and a multiple choice questionnaire examination (MCQE) in psychiatry were completed by 96 interns at the beginning and end of their compulsory four week psychiatry rotation. The degree of satisfaction of the trainees was rated in four areas — orientation, teaching/learning experience, overall rating of rotation and relevance of rotation to career choice. There was no significant change in the mean ATP-30 scores (N = 55) during the four week rotation, but the MCQE scores (N = 74) improved significantly (P < 0.0001). A repeated analysis of variance for the four satisfaction variables by change score in MCQE and change score in ATP-30 did not show any significant main effects or significant interactions between these change scores except with relevance of rotation. Reasons for the absence of changes in the ATP-30 scores during this rotation were explored. The implications of the improved knowledge during this rotation are also discussed. We also conclude that attitudinal change and knowledge are two independent factors which should be assessed independently in trainees.
Male and Female Mania
Authors: Kubacki Andrzej 
Published: April 2017

A total of 74 manic or hypomanic episodes were scrutinized in 31 probands (18 women and 13 men), followed over the years by the author on an outpatient basis. These turned out to herald bipolar affective illness in some 70 percent of males and almost 40% of females. Unipolar mania occurred twice as often in men, as it did in women (38,4% vs. 22,2%). Men tended to be younger (only 30% aged 45 or older), than women (almost a half in the menopausal age bracket). One third of all female probands (and over 46% of those under age 45) manifested their manic episodes in connection with childbirth (gestational mania). As a paradoxical, acute grief reaction (“funeral mania”), the syndrome under scrutiny, occurred in about 1/7 of the men, and more than 1/4 of the women. Significant medico-surgical problems were found to accompany or precede female mania twice as often, compared to male cases (61,1% vs. 30,7%); and clinical confusion or other indices of “organicity” were present in 2/3 of the women, and less than a half (46,1%) of the men. Over half the male probands demonstrated either an inverted sexual attraction, or hypogonadism; and four out of 13 males were aged 45 or older. The above findings are tentatively related to gender differential in cerebral hemispheric specialization.
Is Chronic Pain a Variant of Depressive Illness? A Critical Review
Authors: Gupta Madhulika A. 
Published: April 2017

A critical review of the literature on the association of chronic pain of obscure origin and depression suggests the following: the nosological confusion in defining these two commonly occurring symptom complexes; poor sampling methods and widely ranging selection criteria; occasional lack of appropriate controls and use of unreliable instruments to measure pain and depression; and the frequently erroneous assumption that response of the pain to “antidepressant” medications implies that pain is masquerading some form of depression. All of the above observations lead to incomparable and sometimes opposing conclusions regarding the nature of the association between these two common symptom complexes. Some widespread recurring clinical features of the various studies include; a premorbid history of perfectionistic traits, an apparently minor precipitating event; and pain involving the head, face and musculoskeletal system. Otherwise, chronic pain of obscure origin appears to be a multifactorial and multifaceted problem, with each patient requiring a complete physical and psychosocial evaluation. Further understanding of this group of disorders requires studies of specific chronic pain syndromes using proper controls.
Types of Marital Intimacy and Prevalence of Emotional Illness
Authors: Waring E.M. , Patton David , Ann Neson Carol , Linker Winnie 
Published: April 2017

Epidemiological research has demonstrated that married individuals generally experience better emotional health than the single, divorced and widowed. The married populations in these studies were not evaluated on the basis of the quality of their marital relationships. Research on the interpersonal quality of marital relationships in the general married population has rarely been reported in the psychiatric literature. A sample of the general married population (n = 250 couples) completed a self-report questionnaire which measures the quality and the quantity of intimacy in marriage. Four types of marital patterns were operationally defined by total intimacy score, pattern of scale profile, and social desirability scores. The relative frequencies of these types of marriages are reported. The prevalence of symptoms of non-psychotic, emotional illness in one or both spouses in the four categories of marriage is reported. Thirty-one percent (31%) of the couples report marriages with absent and/or deficient intimacy. Couples with “absent and/or deficient” marital intimacy had a significantly higher proportion of spouses with symptoms of non-psychotic emotional illness. This study suggests that previous research may have confounded the variables of marital status and marital quality in the study of psychiatric disorder. These studies may have under-estimated the positive effect of an “optimally” intimate relationship.
Mental Changes Associated with Tocainide, a New Antiarrhythmic
Authors: Bikadoroff Serge 
Published: April 2017

A case is reported in which tocainide, a relatively new cardiac antiarrhythmic for oral use, is believed to have caused a delirium. The patient had been admitted to a coronary intensive care unit for the treatment of ventricular arrhythmia and had developed confusion, impairment in concentration and severe anxiety. Her EEG was compatible with metabolic encephalopathy. The clinical picture varied with the use of tocainide so closely that it appeared to be the most likely cause of the delirium. Other factors were taken into consideration but did not seem to adequately disprove this impression. Tocainide has been known to cause minor, transient and treatable side effects in the form of gastrointestinal and central nervous symptoms — mainly nausea, tremor and dizziness. There have also been three case reports of paranoid psychoses. It is suggested that psychiatrists be aware of the above complications as they may have occasion to see patients taking tocainide, especially in consultation-liaison work. A table with the more common side effects and their frequencies is included.