Showing papers in "The Canadian Journal of Psychiatry in 1989"

Multiple personality disorder: an analysis of 236 cases.

Abstract: The authors collected a series of 236 cases of multiple personality (MPD) reported to them by 203 psychiatrists, clinical psychologists and other health care professionals. MPD patients experienced extensive sexual (79.2%) and physical (74.9%) abuse as children. They had been in the health care system for an average of 6.7 years before being diagnosed with MPD and had an average of 15.7 personalities at the time of reporting. The most common alter personalities were a child personality (86.0%), a personality of a different age (84.5%), a protector personality (84.0%), and a persecutor personality (84.0%). Patients MPD are highly suicidal with 72% attempting suicide and 2.1% being successful. The patients frequently received diagnoses for other mental disorders. The most common previous diagnoses were for affective disorders (63.7%), personality disorders (57.4%), anxiety disorders (44.3%), and schizophrenia (40.8%).

Asperger's syndrome: a review of clinical features

Abstract: The term Asperger's Syndrome (AS) refers to a clinical picture characterized by social isolation in combination with odd and eccentric behaviour. While the syndrome has been recognized for some time, diagnostic criteria for the disorder have not yet been established or evaluated. The objective of this paper is to describe some of the clinical features of AS. Twenty-eight children and adolescents with AS were compared to a group of psychiatric outpatients (matched on age and sex) who were also socially impaired. The AS subjects showed a range of social impairments essentially different than those seen in the control group. The sex ratio, family history, and presence of neurologic disease in some AS cases, suggest that the etiology of the disorder is similar to that in autism. The methodological limitations of the study are discussed, and a revised set of diagnostic criteria are proposed for AS.

Summary of selected results

Abstract: Selected results from the Ontario Child Health Study (OCHS), a cross-sectional community survey of Ontario children four to 16 years of age, are presented in the areas of prevalence, risk indicators and service utilization. The six month prevalence of one or more of four psychiatric disorders (conduct disorder, hyperactivity, emotional disorder, and somatization), in children four to 16 years of age, in Ontario was 18.1%. The highest rate was in 12 to 16 year old girls, and the lowest rate in four to 11 year old girls. Co-morbidity among these four disorders was high while the proportion of disorders identified by more than one respondent was low. Psychiatric disorders co-occurred significantly with other morbidities in children, including poor school performance, chronic health problems, substance use and suicidal behaviour. Chronic medical illness in the child as well as single parent status, living in a family on social assistance and residing in subsidized housing, were all strong indicators of increased rates of psychiatric disorders in children. Specialized mental health/social services, over a six month period, reached fewer than one of five children with psychiatric disorders, as measured in the study. In contrast, ambulatory medical care (primarily visits to family doctors and pediatricians) served almost 60% of Ontario children four to 16 years old, over the same six month period. The results are compared with those in the literature.

Long-term follow-up of depressive pseudodementia of the aged.

Abstract: Quarante-quatre malades âges, des deux sexes (âge moyen 76,5 ans) atteints de pseudo-demence depressive ont subi un traitement intensif pour la depression. Apres disparition de cette derniere, la fonction cognitive est revenue au niveau premorbide

Marital intimacy in parents of exceptional children.

Abstract: The purpose of this study was to examine the role of perceived parenting stress and parental depression on marital intimacy between parents of handicapped children versus developmentally normal children, and to investigate discrepancies between husbands' and wives' reports of marital intimacy. The parents of 31 autistic children, 31 Down Syndrome children and 62 developmentally normal children, matched for both mental and chronological age were studied. Results indicated significantly greater stress and depression, as well as lower marital intimacy for mothers of autistic children than mothers of normal children, and significantly greater stress than mothers of Down Syndrome children who fell somewhere between other groups of parents in all three measures. Fathers of autistic children experienced significantly higher parenting stress than the other groups, as well as lower marital intimacy but there were no differences amongst fathers on measures of depression. Low scores on subscales of identity and comp...

Mentally retarded adolescent sex offenders. A survey and pilot study.

Abstract: There is not a great deal of empirical research on adolescent sex offenders and even less on mentally retarded adolescent sex offenders. This study provides some preliminary data in this area. Resu...

The individual and society.

Abstract: Etude du role du psychiatre dans le conflit qui oppose l'individu a la societe. Ce role est envisage aussi dans les cas de cooperation entre psychiatres et institutions gouvernementales (armee…)

Prediction of Regrets in Postoperative Transsexuals

Abstract: This study investigated whether heterosexual males are more likely to regret sex reassignment surgery than homosexual males or females. Subjects were 111 postoperative transsexuals who had been sur...

Meditation and psychotherapy.

Abstract: Meditation has been increasingly recommended as a practice with potential psychotherapeutic benefit. This paper provides a description of meditative practice and discusses selected issues related t...

Relationship between psychiatric illness and conduct disorder in adolescents.

Abstract: Ninety-six psychiatrically ill adolescents admitted to an adolescent inpatient service were systematically assessed to determine the morbidity of conduct disorder (CD), with other Axis I psychiatric disorders. Twenty-six (27%) met DSM-111 criteria for CD in addition to other Axis I disorders. A CD diagnosis was significantly associated with substance abuse, and attention deficit disorder with hyperactivity. Although CD was found in 21 % of depressives it was more commonly found inpatients with psychotic disorders (25 %) and bipolar (42 %) disorders. These findings suggest that CD may be commonly found in a variety of adolescent psychiatric disorders. The implications of this finding for pharmacologic treatment of CD, the clinical assessment of the CD patient, and possible relationships between CD and adolescent psychiatric disorders are discussed.

Psychiatry: mindless or brainless, both or neither?

Abstract: After a period marked by one-sided emphasis on psycho-dynamics and social issues, or what could be called “brainless” psychiatry on account of its relative neglect of cerebral processes, we are wit...

Evaluation of buspirone as an antianxiety agent: buspirone and diazepam versus placebo.

Abstract: Buspirone has previously been demonstrated to be efficacious in the treatment of anxiety. This four-week double-blind parallel study compared buspirone to diazepam and placebo in the treatment of 119 outpatients diagnosed as having generalized anxiety disorder. After a seven-day placebo washout period, eligible patients were randomized to one of three treatment groups. Buspirone (5 mg) and diazepam (5 mg) were administered BID and individually titrated to an optimal therapeutic dose by the end of week two. Buspirone and diazepam were equally effective in reducing Hamilton Anxiety (HAM-A) total and psychic factor scores from baseline values. Buspirone alone was significantly better than placebo in reducing the HAM-A somatic factor score. Sixty-seven percent of both active treatment groups who were classified as "ill" on the baseline global psychopathology rating scale achieved a "not ill" status by study end. There were no significant differences between treatment groups at endpoint on the 56-item Symptom Checklist self-rating scale. Buspirone was demonstrated to be as effective as diazepam in relieving anxiety in this outpatient sample.

Phototherapy for Depressive Disorders: A Review*:

Abstract: The use of bright light (phototherapy) for psychiatric disorders has recently generated much interest among researchers and the lay population. The authors review the treatment studies of phototherapy for seasonal and non-seasonal depressive disorders, and the empirical evidence for theories of the psychophysiology of phototherapy. Although its mechanism of action remains to be explained, phototherapy appears to be a safe and effective treatment for seasonal depression and a promising treatment for non-seasonal depression. Further questions and future research directions are presented.

Predictors of Suicide in Borderline Personality Disorder

Abstract: One hundred patients with borderline personality disorder who were followed for a mean of 15 years were compared with 14 borderline patients who committed suicide. The most significant predictors of completed suicide were previous attempts and higher education.

Teenage mothers and their children: risks and problems: a review.

Abstract: Adolescent mothers and their offspring are a high risk group broth physically and emotionally. Poverty, malnutrition, complications of pregnancy, emotional problems such as depression, drug and alcohol use, are all risks for the mother. Children are also at greater risk for physical, cognitive and emotional problems. It is therefore important to identify factors which influence outcome on adolescent mothers and their children in order to suggest interventions which will more positively affect the physical and psychological health of this increasing population.

Psychiatry and chronic pain.

Abstract: Pain and chronic pain have been defined by the International Association for the Study of Pain. Psychological mechanisms are recognized in the production of pain, but their importance has probably been overstated. Selection factors have not been attended to sufficiently, and traditional methods which have been relied upon for the diagnosis of hysterical pain have been misleading. Much emotional change seen with pain is a consequence of the physical disorder. Types of illness, seen by psychiatrists working with patients in pain, are described, and brief comments offered on their management.

The Impact of Group Therapy for Adult Survivors of Childhood Sexual Abuse

Abstract: This article reports on 95 women who were referred to an outpatient psychiatry clinic for group therapy for adult survivors of childhood sexual abuse Criteria for exclusion in group therapy are ou

Drug therapy in schizophrenia--variability of outcome and prediction of response.

Abstract: In spite of the proven benefits of neuroleptics in reducing acute psychotic symptoms and in preventing relapse in schizophrenic patients, not all schizophrenics benefit equally from neuroleptic therapy. Predictors of response include: demographics, clinical characteristics, neurologic soft signs, neurocognitive functioning, morphologic brain changes, drug blood levels, indices of blockade of the dopamine receptors, subjective response to medications as well as early symptomatic improvement. Methodological difficulties in outcome research in drug therapy are reviewed. No single factor has been identified as a reliable predictor of drug response, and it is unlikely that such a single predictor will prove useful in a heterogeneous illness such as schizophrenia. This paper reviews the factors, which have been suggested as useful in developing better understanding of variability of drug response among schizophrenics.

A prospective study of patient assaults on nursing staff in a psychogeriatric unit.

Abstract: A 27 month prospective study concerned with aspects of patient-nurse assaults on the geriatric unit (three wards) of a Canadian provincial mental hospital was conducted. The findings were compared with those for the other words. The incidence of assaults was approximately the same in both areas (0.24-0.25 assaults/occupied bed/year respectively). In the former, the commonest diagnoses associated with assaultiveness were dementia followed by schizophrenia and in the rest of the hospital, schizophrenia. However, when base rates of assaultiveness were calculated allowing for the disproportionate number of patients with these conditions, mental retardation, and dementia were approximately twice as likely to be related to assaultiveness as schizophrenia; regardless of where the patients were located. In the geriatric unit attacks were more likely when patients were being physically guided or led and during the administration of drugs; elsewhere whilst physical restraints were being applied. In both hospital areas a comparatively small number of patients accounted for a disproportionate number of assaults and a few nurses were attacked repeatedly. The majority of episodes were trivial but in isolated cases personnel were off work for several months. The discussion focuses on the possibility of generalizing results.

Adaption of recent Soviet Jewish immigrants and their children to Toronto.

Abstract: This retrospective study examined the prevalence of depression and psychosomatic disorders among Soviet Jewish immigrants, and how such problems might have affected their children's adaptation. A 36-item English and Russian questionnaire was sent to 452 Soviet Jewish immigrants, requesting information on possible problems they or their children had had during the first three years after immigration. Ninety people responded, 78% of whom had children. Immigrants with depression and psychosomatic illness reported greater behaviour, academic, peer interaction, and child-parent difficulties in their children. Those who were married, were proficient in English, were professionals in the USSR and/or Canada and who had supportive friends, were more likely to adapt well. Because of the low response rate, the failure to validate the questionnaire, and the possible overrepresentation of professionals the findings are presented as preliminary pending further exploration. They are discussed for their relevance to the early identification of difficulties in immigrants and their children, and to the need for timely and informed intervention.

Personality dysfunction in depressed adolescents.

Abstract: The personality characteristics of 35 consecutively assessed adolescents who met the DSM-III criteria for a current depressive disorder were assessed using independent structured interviews and paper and pencil measures. Sixty-five percent of the sample met the criteria for an Axis II personality disorder. The single most common diagnosis was borderline personality disorder (30%). Depressed adolescents with a concurrent personality disorder were less self-confident, displayed more neuroticism, and were emotionally reliant on others. They also demonstrated greater cognitive distortion. Teenagers who present with a depressive disorder warrant a comprehensive personality assessment. The combination of affective and personality disorder in such patients is associated with attitudes and interpersonal problems which should be therapeutically addressed in addition to symptomatic treatment of the depressed mood. Clinicians should be aware that depressed adolescents with personality disorder may be more likely to make a suicide attempt. Language: en

Mental hospital depopulation in Canada: patient perspectives.

Abstract: This paper reviews briefly the history of mental health depopulation in Canada over the past 30 years. The term "deinstitutionalization" is often used but is unsatisfactory. Using an exploratory, qualitative, methodological approach, data were collected on the problems encountered by a disproportionate, stratified random sample of 139 formerly institutionalized patients living in various geographical locales in Eastern Canada. Adopting a symbolic interactionist theoretical approach, this study, in an effort to fill a neglect in the literature, attempted to discover what the everyday world(s) of Canadian ex-mental patients was really like. Problems encountered related to stigma, poor housing, lack of back living skills, poverty, unemployment and aftercare. Quotations from patients are provided to illustrate such themes. The findings are discussed.

Psychiatric admission of mentally ill mothers with their infants.

Abstract: There is a greatly increased risk of a woman developing a psychiatric illness requiring hospital admission during the early postpartum period. Admission of the mother has usually meant separating her from her infant at a time when bonding and attachment are developing. Nearly 40 years ago English psychiatrists began admitting infants with their mentally ill mothers, and although the theoretical basis for this is sound, there are few systematic studies of the practical problems encountered, or the outcomes. This paper compares a group of 32 psychiatrically ill postpartum women who were admitted to a Canadian general hospital psychiatric unit with their infants to a group of 26 psychiatrically ill postpartum women hospitalized on the same unit who refused admission of their infants. The women admitted with their infants were more likely to be older, living with the infants' father, in a stable residence and job, in hospital for a longer time, and caring for their babies at 2 year follow-up in contrast to the women who were admitted without their infants. The two groups were diagnostically different with joint admission mothers likely to suffer from an affective psychotic illness, while the mothers without infants were more likely to suffer from personality disorder or substance abuse. The effects of mother-infant admission and some of the practical problems encountered are discussed. Language: en

Assaultive behaviour: before it happens....

Abstract: This paper reviews risk factors associated with assaultive behaviour. The author will look at specific risk factors to evaluate when assessing patients with an aggressive potential and he will examine patient-staff relationships that might trigger assaultive behaviour. The author believes that a better knowledge of risk factors allows us to develop preventive attitudes, and these will be discussed in the latter part of this paper.

Parent satisfaction in a child psychiatric service.

Abstract: The development and use is reported of a client satisfaction questionnaire to be answered by parents of children and adolescents referred to an outpatient psychiatric program. The structure of the questionnaire and the results from a first application are reported. It is suggested that a client satisfaction questionnaire may become an important feedback instrument useful for service planning.

Predicting suicide behaviours in incarcerated settings.

Abstract: Attempts to predict suicide behaviours have produced a number of useful clinical tools. Unfortunately, these have been largely designed with a specific psychiatric population or institutional setti...

Attachment theory and brief psychotherapy: applying current research to clinical interventions

Abstract: Recent advances in attachment research provide a framework for defining the content and process of brief psychotherapy with adults. Attachment theory emphasizes a number of issues crucial to therapeutic work. Specifically, attachment relationships are enduring components of a individual's pattern of interpersonal behaviours. Functionally, attachment relationships address security needs. Insecure attachment arises from a representational model based on feared loss of the attachment figure, which predisposes the individual to have little confidence in the attachment figure's availability, responsiveness, and permanence. Behavioural responses to insecure attachment can lead to specific patterns of interpersonal relationships which, in turn, strengthen the representational model. Thus, a relatively stable, self-reinforcing system evolves and results in a consistent inability to experience security within attachment relationships. In this article, the authors describe the current framework for understanding adult attachment relationships and present clinical vignettes illustrating the saliency of attachment theory to common clinical presentations. The goal of the clinical intervention is defined as increasing the "permeability" of the individual's working model of attachment through affective and cognitive re-assessment of attachment experiences and expectations. Finally, the utility of this approach in evaluating the outcome and effectiveness of psychotherapy is highlighted.

Bulimia and dissociative states: a case report.

Abstract: The case history of a 17 year old girl, who initially presented with symptoms of bulimia and later developed dissociative states, is described. The possible relationship between bulimia and dissociative states is discussed in the context of psychometric tests and the underlying family dynamics.

A psychiatric intensive care unit in a psychiatric hospital

Abstract: This paper describes the operation of a psychiatric intensive care unit in a provincial psychiatric hospital. Its introduction led to a decrease in staff and patient accidents, a decrease in constant observation and seclusion hours, and a decrease in the number of nursing hours lost to injuries at work. It had no effect on nursing absenteeism. The ICU was well liked by nursing staff who preferred to work in its more consistent and controlled environment. In addition, it was also felt that the ward environment in other parts of the hospital became more therapeutic. We therefore conclude that psychiatric ICU's are useful additions to psychiatric settings with important cost and patient care implications.

Intravenous chlorimipramine therapy in obsessive-compulsive disorder.

Abstract: A brief summary of the etiological factors and pharmacological approaches to therapy of obsessive-compulsive disorder is given. Evidence for the serotonergic hypothesis is reviewed. Three case reports of patients with severe OCD who had not responded to traditional chemotherapeutic approaches and electroconvulsive therapy are presented. All three responded to a series of 14 intravenous chlorimipramine infusions with a maximum dose of 350 mgms per infusion. The technique of infusion therapy and possible mechanisms of action are discussed. It is concluded that OCD is no longer accepted as a rare disorder and that effective treatment exists. For patients who do not respond to oral chlorimipramine, the treatment of choice, intravenous chlorimipramine is suggested as a viable alternative.