Showing papers in "Canadian Psychiatric Association journal in 1968"

Adolescent children of concentration camp survivors.

Abstract: On a beaucoup ecrit sur le syndrome du survivant, sequelles chez les survivants des camps de concentration. Nous nous heurtons maintenant aux reactions des tensions chez les enfants adolescents de ...

Stress reactions resulting from the relocation of an aged population.

Abstract: Fifty-four subjects from 64 to 94 years of age were investigated for their stress reactions following their relocation from one site to another. Forty of them, 16 men and 24 women, were psychiatrically normal, while the remainder (eight men and six women) were suffering from a psychosis, which in all cases, except one, was of organic type. There was no statistically significant difference between the ages of the men and women, and of the normals and psychotics. The same was true in the case of the body weight, except that the men weighed more than the women. Plasma corticoid (PC) levels were determined two to nine days before relocation and eight to 17 days afterwards. One-third of the subjects made no complaints in regard to their health within four months of relocation (NC 33%), while the rest either reported symptoms for which there did not appear to be any apparent organic cause (WS 43%) or presented organic signs (OS 24%). Most of the complaints in the WS category were related to the abdomen, while most of those in the OS group were either due to respiratory infections or cardiovascular conditions. The relative percentage of persons falling into these three categories was essentially similar in normal men and in normal women and in psychotic men and psychotic women. However, the psychotics had a significantly higher incidence of OS persons and a significantly lower number of NC subjects than did the normals, while the incidence of WS was essentially the same in these two groups. Following relocation the PC levels increased in normal men, but decreased in normal women. Furthermore, a greater PC increase was observed in men of the OS group than in those of the WS category, who in turn showed a greater increase than the NC males. This was not observed in the women. Men in each of the NC, WS and OS categories had higher PC levels than women of the same category, and psychotics higher than normals. Twenty-five per cent of the normal men died within the first six months of relocation but none of the normal women, a statistically significant difference. Within 23 months of relocation reliably more psychotics died than normals. In conclusion, normal aged men appeared to suffer more from the relocation than normal aged women, and psychotic aged persons more than psychiatrically normal subjects of the same age.

Brief psychotherapies in child psychiatry.

Abstract: L'auteur passe en revue la notion des therapies breves appliquees au domaine de la psychiatrie infantile. Elle examine en particulier les problemes que ce traitement comporte pour une periode de cr...

Bubber behind bars.

Abstract: This paper describes the structure and conceptual foundations of an intensive treatment program operated at the Ontario Hospital, Penetanguishene, a 304-bed maximum security institution which recei...

The chronic patient in the community. A two-year follow up of 338 chronic patients.

Abstract: Three hundred and thirty-eight chronic psychiatric patients were followed up for two years after their discharge. Information was available on all but four patients. During the twenty-four month follow-up period, 11% had died and 25% required readmission. The source of support and living arrangements for the whole group were discussed, and the opinions about the outcome by the informant, psychiatrist, and social worker, were compared, The opinions correlated remarkably well. Characteristics of community care deemed important by the investigators were discussed briefly.

Twenty-five and thirty-five year follow up of first admissions to mental hospital.

Abstract: This has been a report of a study designed to assess the feasibility of long-term follow-up studies on Prince Edward IslandCohorts of patients first admitted to the Island's only mental hospital d

Suppression studies in affective disorders.

Abstract: Canad. Psychiat. Ass. J. Vol. 13 (1968) (30) it was not long before the side effects of these compounds aroused the interest of psychiatrists because they produced all the psychological manifestations described in the naturally occurring endocrine disorders. Since then the two disciplines of psychiatry and endocrinology have drawn closer together. There is now a great deal of evidence to show that not only do administered steroids and endocrine diseases involving the adrenal cortex produce psychological symptoms (58) but that emotional illnesses produce changes in the plasma and urinary corticosteroid levels. In 1904 the idea of a neurohormone was suggested by T. R. Elliott (20) when he reported that sympathetic nerves released a substance like adrenaline at their endings. Cannon (12) later established verification of this suggestion and said that adrenaline was secreted by animals in response to fear and rage. Since then a great deal of investigation has gone into finding a possible relationship between biogenic amines and human emotions. The comparatively recent observation that the metabolism of noradrenaline, dopamine and serotonin could be influenced by psychopharmacological agents has stimulated research interest and important new information has been gathered about the cerebral amines and their function (68). Hormonal investigations into the affective disorders have principally centered around the activity of the adrenal cortex and the catecholamines. The authors feel that these hormone systemS! are disturbed in a particular direction, so in this paper they wish to propose the following hypothesis with regard to the biochemical disturbances in psychotic depression:

Psychotic reactions during amitriptyline therapy.

Abstract: In the past decade amitriptyline has been established as an effective and safe antidepressant drug. Serious psychiatric side-effects with amitriptyline are generally considered rare and have been reported only infrequently. A review of the literature revealed at least four types of such reactions: excitement or hypomania, schizophrenic exacerbations, acute brain syndromes and acute depersonalization. The most common reactions are states of paradoxical excitement, ranging from restless agitation (1) or euphoria (1, 4, 15) to hypomania (1, 5, 6,9, 10, 17, 19), mania (1, 11, 16, 21), or panic (8, 10). The reported incidence of such reactions to amitriptyline in available series ranged from 2/~ (6) to 7% (1). It is said that schizophrenic psychotic reactions can be provoked in 'borderline' individuals treated with amitriptyline (2, 3). Most of the published reports describe the worsening of chronic schizophrenic illnesses (4, 11, 18), or the occurrence of paranoid trends in chronic senile psychosis (9). There have been infrequent reports of various forms of acute brain syndrome, including instances of delirium-confusion (3, 12, 14), or visual hallucinatory phenomena (13). There have also been rare reports of transient depersonalization and derealization in non-psychotic, depressed out-patients given initial doses of amitriptyline (7, 20). There is a common clinical impression that latent psychosis may be uncovered during amitriptyline treatment for depression, although the idea is not well documented in the literature. We have recently encountered two such cases. The patients had not been hospi-

High dosage trifluoperazine in schizophrenia. Comparison of the efficacy of high and usual doses of trifluoperazine in the treatment of chronic schizophrenics.

Abstract: range for the majority was 40-55. One patient was below the age of 40, and two were above the 55 level. The diagnosis for all patients was schizophrenia. The SUbtype was not considered to be important, especially at this stage in their psychosis. Length of illness with one exception (13 years) was in the 20-25 year range. Three patients were not receiving medication at the time the project was instituted, but even these three had received phenothiazine medication at intervals. The remainder were receiving phenothiazines. Twenty-two of the group were being treated with trifluoperazine. Two groups matched by pairs for age, length of illness, clinical SUbtype and general behaviour were made by a staff member not involved in the assessments during the study. The assignment of these groups to high and usual dosage was made by the pharmacist who set up the individual medication according to the schedule described below. Each patient received two capsules identical in appearance each day. For a two week period prior to the initiation of the program all medication for the patients involved was discontinued. Upon a patient's entry into the study an evaluation was made of his current clinical status, using Lorr's (1) Multidimensional Rating Scale for rating psychiatric patients. For the following week placebo capsules were given twice daily to each patient, at which time a second evaluation was made. From this point on the double-blind technique was followed. The 'usual dosage' group remained on a dosage of 10 mgms. daily throughout, whereas the 'high dosage' group had their dosage increased by increments of 20 mgms. daily every two weeks until a

Combined Psychotherapy and Deconditioning of a Child's Phobia*:

Abstract: A four and one-half year old child with a crippling fear of bees was successfully treated by a combination of psychotherapy and behaviour therapy. The case illustrates that the etiology and treatment may be viewed equally well from two theoretical points of view. Carl was referred by his general practitioner because of his fear of bees, which had lasted for eighteen months and increased in intensity to the point where he screamed when a bee flew by him, and generalizing to become a fear of any flying insects. This fear began when three year old Carl was crawling through the grass and was stung on his thumb by a bee. The parents later found him in great distress with the swollen thumb. Thinking that it had been broken they rushed him to emergency where it was X-rayed, an event which Carl recollects very vividly. Subsequently he was frightened of all bees, then flies, then he began to avoid the flowers in the garden and in time it was hard to get him outside at all. His father, a gardener by trade found his behaviour very irritating and would shout at his son when the child became frightened. By the time Carl was seen he had accumuiated many neurotic symptoms including a fear of tractors, fear of monsters;' nightmares, banging his head on his pillow, infantile behaviour, blanket clinging and poor eating habits. He had always been a sensitive and inquisitive child. However, apart from difficulty in toilet training, his early development was fairly normal. When examined he had an average I.Q., was anxious, hyperactive, friendly to the exam-

Experimental geriatrics. Selection and prediction of therapeutic responsiveness in geriatric patients.

Abstract: For the past five years we have been engaged in research at the Douglas Hospital to develop a method which would enable the clinician to predict therapeutic responsiveness in a given geriatric patient. Since predictions can only be properly applied to classes of individuals who are, within limits, homogeneous with respect to a set of characteristics, one must therefore employ procedures to determine which characteristics are to be used in categorizing particular classes within a given population. In Phase I of this study the following approaches of classifying geriatric patients were attempted: groups based on nosological entities; on the basis of characteristic clusters of psychopathological symptoms; by their response to a particular psychological test; by their 'response profile' to a battery of psychometric tests; and by their response to a pharmacological load. Phase II was primarily concerned in testing to what extent the prediction of responsiveness was valid. This paper is restricted to findings based only on the hospitalized psychotic geriatric patients and is primarily concerned with the following: the approach, methods and results of Phase I; assessing and comparing how a clinical rating scale, various psychometric tests, and pharmacological loads can best characterize classes of geriatric patients for purposes of specific behavioural, psychological and diagnostic criterion categories; and establishing meaningful relationships

Sensitivity to a phenothiazine (butaperazine).

Abstract: A second study of butaperazine on twenty-two patients compared to a previous group of twenty-four patients revealed rather similar results Twenty of the subjects were involved in both studies, wit

The use of imipramine in the treatment of enuresis. A review of the literature.

Abstract: Forty studies reporting the use of imipramine in the treatment of enuresis have been reviewed. All twenty-three of the uncontrolled studies report various degrees of success, and eleven of seventeen controlled studies also report successful results. The conclusion is that imipramine has a varied but statistically significant anti-enuretic effect on children.

African ethnopsychiatry in the field.

Abstract: Dans les cultures primitives de l'Afrique, il est presque impossible de separer l'anthropologie, la psychologie et la psychiatrie. Par suite de l'acculturation et de l'adculturation, on fait moins ...

Cross-Cultural Studies of Symptomatology in Schizophrenia*:

Abstract: This paper is an attempt to review some of the main cross-cultural studies of symptomatology in schizophrenia. Although it is shown that there are cultural variations of symptomatology, the reliabi...

The children's pathology index.

Abstract: Investigation into the nature and treatment of emotional disorders in children requires reliable and valid measuring instruments.The Children's Pathology Index is described. It consists of 38 five-item categories and may be administered in 20 to 30 minutes by child-care staff. Little training is required, results from four raters are pooled and raters may be changed on subsequent occasions.Factor analysis yields four factors I) Disturbed Behaviour Towards Adults; II) Neurotic Constriction; III) Destructive Behaviour; IV) Disturbed Self Perception. Results demonstrate satisfactory reliability for all four factors and adequate validity studies have been made for Factor I.The subjects were boys and girls aged 6–12 years, of different diagnostic categories, most of whom were admitted because of acting out behaviour disorders.Comments are made on the usefulness of Factor I estimates in assessing social acceptability of children whatever the other difficulties present or the diagnosis made.

Alterations of sleep pattern in psychiatric disorder.

Abstract: Summary and Conclusions A survey of the sleep pattern change of 87 women patients admitted to an acute psychiatric ward of the Ontario Hospital, Toronto was reported. An alteration of sleep pattern is common to all psychiatric diagnostic categories and the specific symptoms of Evening Insomnia, Morning Insomnia, Frequent Wakening, Light Sleep, Sleep during the Day and Shortening of the total Sleep time is common to all of them. Evening insomnia, light sleep and shortness of sleep are related to the estimated severity of depression while evening insomnia alone was related to the estimated anxiety level. A total increase in sleep symptoms is related significantly to both the estimated depth of depression and the estimated height of anxiety. Shortening of the sleep time and evening insomnia are significantly increased in suicidal patients although changes in the quantity of dreams and increases of nightmares was not. The total sleep symptom score failed to achieve a level of significance. A change in the quantity of dreaming was related to the diagnosis of depression, especially psychotic depression, but not to depression depth, anxiety level, suicidal tendencies or age. Nightmares increased with a diagnosis of psychotic or neurotic depression, with the estimated level of depression but not with the estimated anxiety level or suicidal tendency. Nightmares significantly decrease with age. The factors of anxiety and depressive affect, suicidal tendencies and other like parameters may promise a more significant relationship to sleep disorder than the diagnostic category. The recall of dreams appears to be of more importance for the diagnostic categorization of depressive states than other sleep symptoms.

Lack of psychotomimetic effect of para-methoxyphenylethylamine and 3,4-dimethoxyphenethylamine in man.

Abstract: Among the agents reported to produce catatonia in animals are 3,4,5-trimethoxyphenylethylamine (mescaline), 3,4dimethoxyphenylethylamine (DMPEA) and 4-methoxyphenylethylamine (MPEA). Ernst (2, 3), who first drew attention to their catatonic potential, pointed out that para-hydroxy analogues of these p-methoxy compounds do not exhibit this property. Michaux and Verly (6 ) confirmed Ernst’s work and reported that in mice MPEA is the most active of the three derivatives, followed by D.\\IPEA and mescaline. Since mescaline is an hallucinogenic agent in humans, it is of interest to know whether the other two para-methoxy compounds have any psychotomimetic action. Both MPEA and DMPEA (4, 8) have been reported to be present in schizophrenic urine, although this finding has been disputed (1, 7). Two groups have recently shown that DMPEA is not psychotomimetic ( 5 , 9). W e now report a lack of activity for MPEA and confirm the lack of activity for DMPEA in humans. Sixteen subjects without history of mental illness, emotional disturbance, or previous psychotomimetic experience were given MPEA, DMPEA, mescaline and placebo in a double blind, randomized manner using.a Latin square research design. The drugs were administered orally in capsule form on a 5.0 mg/kilo body weight basis. A battery ’Assistant Professor D . of Pysckiatry Faculty of Medicine University ’of Z t i s h Columbia ’ Vancouver, B.C., &d Consultant in Chemotherap;, Riverview Hospital, Essondale, B.C. aAssoc:ate Professor, Kinsmen Laboratory of Neurological Research, Dept. of Psychiatry, Facu.ty of Medicine, University of British Columbia, Vancouver 8, B.C. 3Dept. of Psychology, Riverview Hospital, Essondale. B C.

A survey of postgraduate psychiatric education in Canada, 1966-1967.

Abstract: Our Canadian programs produce about 100 psychiatrists a year and are likely to do so for the next three or four. There are approximately 4,400 medical students in the country at present (5). If we use Funkenstein's figure of 10% of medical students and Clarke and Fish's figure of 11.4% of residents opting for psychiatry it means an indigenous pool of 400 students or 100 a year (4). This number can be increased by foreign medical graduates, reduction in Certification and Fellowship failures, reducing the brain-drain, and inducing Canadian graduates to return home. The country-needs another 785 psychiatrists immediately to attain a 1:10,000 ratio of psychiatrists to population. At the present rates of psychiatrist production and population growth the manpower picture would improve only very slowly. It appears that the capacity of present training programs is not adequate to meet national requirements even if enough trainees were available to fill them. The time is ripe for imaginative and novel solutions to this problem.

Psychotic reactions in college students.

Abstract: L'article ci-dessus presente certains aspects du taux de frequence, de la nature et de l'issue des reactions psychotiques chez les etudiants du niveau collegial. L'article passe egalement en revue ...

Interactional Aspects of Oral Examinations

Abstract: Cet article explore 1) la relation interpersonnelle dans la rencontre examinateur-examine et 2) certaines questions inherentes a la procedure de l'examen.Les mecanismes utilises par le candidat dan...

A two-year clinical experience with lithium.

Abstract: A two year clinical experience with lithium has been described. Our results can be summarized as follows: Effect on active mania Over seventy per cent of the manic patients in this study were controllable with lithium alone. An additional twenty per cent with severe mania had to be stabilized by haloperidol, but were maintained by lithium once the acute phase subsided. When a patient maintained on lithium shows prodromal symptoms of hypomania an increase in the dose of lithium is often, and for some patients regularly, an effective control for the incipient manic attack. Some patients required periodic treatment for residual depression. Decreasing the dose of lithium, and adding an anti-depressant has been found to be effective, even in some cases where an antidepressant alone had previously failed to prevent repeated depressions. Merely decreasing the dose of lithium was not found to be effective. Those who relapsed completely tended to be more hostile and suspicious, and in the authors' experience, ultimately showed schizophrenic features. One relapse, especially when subsequent to the patient's discontinuing his own medication, does not mean that the patient cannot thereafter, be stabilized on lithium. One relapse should not be taken to mean ultimate failure, when a decrease in severity or frequency of attacks would be a worthwhile goal.

Stages in the therapy of hospitalized acting-out adolescents.

Abstract: La combinaison de plusieurs facteurs rend difficile et decourageant le traitement de l'adolescent dyssocial. Il est mieux d entreprendre un tel traitement dans un milieu controle. On peut differenc...

Dynamics and treatment of foster children.

Abstract: Meeting, Quebec City, 1967. 'Assistant Professor, Department of Psychiatry, University of Manitoba, Winnipeg, Man. Canad, Psychiat, Ass. J. Vol. 13 (1968) \"Every child who comes into care is disturbed and requires treatment, and is entitled to treatment, either psychotherapy or case work.\" This statement is being heard ever more frequently in child welfare circles and it is long overdue, for if there is one area where prophylaxis can be practised, it is in the care of foster children. Inherent in the placement of a child in a home, other than that of his parents, are certain psychodynamic constellations, which unless dealt with in psychotherapy or case work, will lead on to the establishment of psychopathological defences or patterns. The foster home placement begins with a handicap as the child is almost invariably already traumatized, either by the parental neglect that so often is the cause of his removal or by the painful separation from parents and family. As the child takes stock of his new environment, one major question comes into focus \"Why am I here, and not in my own home?\" That is the key question and it is with the answer to that question that he especially needs help. If the placement was necessitated by parental illness or death, much will depend on the age of the child. A young child is egocentric, i.e. he assumes that the world centres around him, and therefore he is responsible for all that happens, such as his parent's illness or death. Not really understanding illness or death, his initial interpretation will be that he has been abandoned by his parents because he wasn't lovable enough or worthy enough or good enough to keep them around. These feelings will dominate his unconscious self-evaluation for the rest of his life. DYNAMICS AND TREATMENT OF FOSTER CHILDREN*

The discharged chronic patient's utilization of health resources: a preliminary report.

Abstract: The results of this preliminary study suggest that chronic psychiatric patients upon returning to the community do not pose a burden to physicians. This would appear to apply for at least a two-year period. In the present sample of 211 patients those relatively few exceptions tended to be individuals who developed illnesses requiring either surgical intervention or hospitalization for a major medical condition. One question that arises from the low utilization observed in the present study involves the adequacy of follow-up medical care received by these patients. This area poses problems for future investigation involving clinical work in the field.

Psychiatry and the pre-school age child.

Abstract: Meeting, Quebec, 1967. 'Hospital for Sick Children, Toronto, West End Creche Treatment Centre, Toronto. Canad. Psychiat, Ass. r, Vol. 13 (1968) With the change of attitude toward psychiatry, there is an increasing number of children of pre-school age being brought to us for consultation. They form a group of their own within our practice which is most interesting because it offers us a direct look at the early environment of the child and the development of his personality. The work with the pre-school child differs both in diagnostic evaluation and in therapy.