Canadian Psychiatric Association journal最新文献

{"title":"The psychiatrist-woman patient relationship.","authors":"M D'Iorio","doi":"10.1177/070674377902400427","DOIUrl":"https://doi.org/10.1177/070674377902400427","url":null,"abstract":"Dear Sir: There have been recent descriptions in the psychiatric literature of the use of Pimozide as an effective, specific treatment in the often refractory condition known as \"monosymptomatic hypochondriacal psychosis\" or MHP (2, 3,4). It has been suggested that this is a form of paranoia, and Kenyon (I) has suggested that not all cases need have hypochondriacal delusions. In particular, the possibility that delusional jealousy might, in some cases, be an analogous disorder, has been mooted. Monosymptomatic psychoses are to be distinguished from neurotically determined dysmorphophobias, as well as from affective illness, schizophrenia and organic brain syndromes. Patients with MHP typically suffer from a chronic somatic delusional system, with little deterioration of thinking or of personality. I would like to report on the successful use of Pimozide in a patient who presented with a monosymptomatic paranoid psychosis which took the form of pathological jealousy. I am not aware of a previous report of this nature. The patient, a 56-year-old, Italian-speaking housewife, suffered from the belief that her husband had been unfaithful to her over a six-year period, and that he intended to marry another woman. This belief was delusional in nature, and could not be altered by the protestations of her husband and family, or by all evidence to the contrary. The symptom had begun abruptly when the patient heard a woman speaking on the radio about her husband's betrayal of her. Thereafter, the patient consistently misinterpreted comments on radio and television, and remarks of relatives, as evidence of her husband's infidelity. Otherwise, she functioned well and coped with everyday activities, although her suspicions seriously interfered with the marital relationship. During the few months prior to admission she had increasingly withdrawn from society because she believed that other people knew of her plight. When admitted to the Toronto General Hospital, the patient was markedly anxious. She was garrulous, with circumstantiality and overinclusiveness, but had no evidence of depressive symptoms, hallucinations or cognitive impairment. On the grounds that she was suffering from a paranoid illness similar to a monosymptomatic psychosis, we decided to initiate treatment with Pimozide, 4 mg once daily. Within a few days the patient became very cheerful, socialized much more freely, and reported a greatly diminished preoccupation with her delusion. One week after treatment was started, she was virtually symptom-free and said she had been mistaken about her husband. She was discharged to a delighted family and her improvement has been sustained over a two-month period. Her social and marital relationships are now quite normal and she continues to take Pimozide 4 mg daily. It therefore seems that Pimozide has been a specific and rapidly effective treatment in a condition which can sometimes be intractable. I would commend a trial of this medication in such case","PeriodicalId":9551,"journal":{"name":"Canadian Psychiatric Association journal","volume":"24 4","pages":"377-8"},"PeriodicalIF":0.0,"publicationDate":"1979-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/070674377902400427","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11670565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minor organic signs.","authors":"M Cole","doi":"10.1177/070674377902400428","DOIUrl":"https://doi.org/10.1177/070674377902400428","url":null,"abstract":"In this respect, I will focus on two of the issues raised in the paper: the over-prescription of drugs and the \"blaming\" of mothers. It comes as no surprise to hear that general practitioners have little time to devote to listening to the problems of their female (or male) patients. It does not follow, however, that the only factor involved in over-prescription is a lack of understanding. The other side of the coin involves the woman herself her particular psychodynamics and often her demands for immediate symptom relief. Society also partly contributes to this. A woman is bombarded all day with commercial messages that have not only shown that there is a rapid solution to every problem of daily living, but that have also created the myth that the world should be a clean, sterile place where everything is in order (there are no germs in the garbage, the floors are always shining, and so forth). Not only should the environment be perfect, but it is assumed that it is the woman's job to maintain this state of perfection. In such a system, there is very little tolerance for anything negative (dirty) which must immediately be corrected by the magic product eliminating all evil. Much the same is carried over on an emotional levelwhen women come asking for a pill which will make them able to cope with the pressures of daily life. This is, of course, not a complete explanation of this complex phenomenon, but illustrates one way in which environment and dynamics interact to produce a given situation. Motherhood is another topic which has aroused increasing interest in the last decades as we begin to look more at child development. Dr. Stephenson's statement that everything is blamed on mothers is not an accurate reflection of our current state of knowledge. We know from Chess's work that children's temperamental variables are important and from Rutter, that \"mothers\" are not necessarily the biological mothers, but whoever the child","PeriodicalId":9551,"journal":{"name":"Canadian Psychiatric Association journal","volume":"24 4","pages":"378-9"},"PeriodicalIF":0.0,"publicationDate":"1979-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/070674377902400428","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11670566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Canadian certification examination in psychiatry. I: Historical notes.","authors":"F H Lowy,&nbsp;R O Jones","doi":"10.1177/070674377902400401","DOIUrl":"https://doi.org/10.1177/070674377902400401","url":null,"abstract":"<p><p>There has been much criticism of the format and process of the certification examination in psychiatry, and some of this is based on lack of information regarding the history of the specialty certification procedures, the Royal College of Physicians and Surgeons and the Board of Examiners. In this first of three reports the history of the Royal College as the certifying organization is traced, and the relevant College structures are briefly described, including the Specialty Committee on Psychiatry which is instrumental in appointing the clinical examiners. The clinical examiners since 1965 are identified.</p>","PeriodicalId":9551,"journal":{"name":"Canadian Psychiatric Association journal","volume":"24 4","pages":"275-84"},"PeriodicalIF":0.0,"publicationDate":"1979-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/070674377902400401","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11588567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between agoraphobia and primary affective disorders.","authors":"R C Bowen,&nbsp;J Kohout","doi":"10.1177/070674377902400407","DOIUrl":"https://doi.org/10.1177/070674377902400407","url":null,"abstract":"<p><p>Detailed clinical records were kept on a series of 55 agoraphobic patients who presented to a general hospital psychiatric practice over a 3 year period. A review of the records revealed that 91% of these patients were diagnosed as suffering from a unipolar or bipolar primary affective disorder. The anxiety and phobic symptoms tended to mask the presence of the affective disorder. This observation is consistent with most of the published data on the agoraphobic syndrome. It could also explain the inconsistent effects of treatment of agoraphobia compared with simple phobias. The possible biological and psychological connections between primary affective disorders and the agoraphobic syndrome are discussed.</p>","PeriodicalId":9551,"journal":{"name":"Canadian Psychiatric Association journal","volume":"24 4","pages":"317-22"},"PeriodicalIF":0.0,"publicationDate":"1979-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/070674377902400407","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11671758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The limits of Munchausen's syndrome.","authors":"A McDonald,&nbsp;S A Kline,&nbsp;R F Billings","doi":"10.1177/070674377902400408","DOIUrl":"https://doi.org/10.1177/070674377902400408","url":null,"abstract":"<p><p>The authors review the literature on Munchausen's syndrome and speculate about possible underlying psychological mechanisms. The proposed DSM III classification of factitious illnesses suggests a continuum from hysteria on one end of the spectrum to malingering on the other. Two case studies are presented which represent variants of this syndrome. Both patients were given a sodium amytal interview, a procedure not previously reported in the Munchausen's literature. The procedure was helpful in eliciting a more accurate history and a clearer sense of the underlying dynamics. Some suggestions for further research are made.</p>","PeriodicalId":9551,"journal":{"name":"Canadian Psychiatric Association journal","volume":"24 4","pages":"323-8"},"PeriodicalIF":0.0,"publicationDate":"1979-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/070674377902400408","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11671759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality assurance strategies in U.S. and Canadian psychiatry.","authors":"S T Firth,&nbsp;S Lazare","doi":"10.1177/070674377902400406","DOIUrl":"https://doi.org/10.1177/070674377902400406","url":null,"abstract":"<p><p>Quality Assurance Strategies in Psychiatry and Medicine in general have developed rapidly and have been applied widely in the last few years, particularly in the United States. This paper reviews some of those developments both from a methodological and a socio-political point of view. The relevance to the Canadian scene is evaluated, and it is concluded that, although quality assurance is now accepted as an obligation of the health profession, some of the strategies being widely applied in the United States are of questionable value in themselves, and some, particularly cost control techniques, would seem to be irrelevant to the Canadian health field which already has a variety of checks and balances in its universal health insurance system. Though cost control and quality control logically overlap, at times they are allowed to merge and cause conceptual confusion. Finally, as systems are developed in Canada, it is suggested that a means of self-assessment be built in so that the validity and reliability are not in doubt.</p>","PeriodicalId":9551,"journal":{"name":"Canadian Psychiatric Association journal","volume":"24 4","pages":"309-15"},"PeriodicalIF":0.0,"publicationDate":"1979-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/070674377902400406","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11331152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Canadian certification examination in psychiatry. II: Who passes and who fails.","authors":"F H Lowy,&nbsp;M Dongier","doi":"10.1177/070674377902400402","DOIUrl":"https://doi.org/10.1177/070674377902400402","url":null,"abstract":"<p><p>No analysis of Canadian certification examinations in psychiatry has previously been published although analyses of the American Board of Psychiatry and Neurology and the British Membership examinations are available. Because candidates, directors of residency training, mental health planners and consumers are all interested in who passes and who fails the certification examinations, available examination data for English speaking candidates are analyzed. Successful candidates are more likely to be younger; to have attended medical schools in English speaking countries (in North America, the British Isles, or the \"old Dominions\"); to have placed in the upper two-thirds of their medical school class; to have entered psychiatric training soon after graduating from medical school and then to have completed their training without interruption. Some limitations of the examinations and the problem of candidates who fail are briefly discussed.</p>","PeriodicalId":9551,"journal":{"name":"Canadian Psychiatric Association journal","volume":"24 4","pages":"284-92"},"PeriodicalIF":0.0,"publicationDate":"1979-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/070674377902400402","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11671755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Civil commitment practices in 1977: troubled semantics and/or troubled psychiatry.","authors":"S Page,&nbsp;J Firth","doi":"10.1177/070674377902400409","DOIUrl":"https://doi.org/10.1177/070674377902400409","url":null,"abstract":"<p><p>This paper examines the practice of involuntary mental hospitalization through examination of criteria used for committment in a sample of 200 civil commitment certificates. Special reference is made, following previous research, to criteria used to describe the person deemed dangerous to himself or to others. The relevance of the findings of present practices in mental health is discussed. New procedures which facilitate presentation of factual evidence, and which eliminate gratuitous information, are required without delay.</p>","PeriodicalId":9551,"journal":{"name":"Canadian Psychiatric Association journal","volume":"24 4","pages":"329-35"},"PeriodicalIF":0.0,"publicationDate":"1979-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/070674377902400409","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11671760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The psychoanalytic theory of depression. Part I--The major contributors.","authors":"B M Robertson","doi":"10.1177/070674377902400412","DOIUrl":"https://doi.org/10.1177/070674377902400412","url":null,"abstract":"<p><p>This article is the first of a two part review of the psychoanalytic theory of depression. In this first part of the review the work of the major contributors to the psychoanalytic theory of depression is discussed. The writings of Abraham, Freud, Rado, Klein, Jacobson, Benedek, Bibring, Spitz, Sandler and Bowlby, among other, are presented and critically reviewed by the author. The work of these authors has been selected for this review because they have made the most seminal contributions to the development of the psychoanalytic theory of depression. Necessarily those authors whose contributions have been largely clinical have not been included, the major focus of this review being theoretical. In reviewing the writings of the major contributions the major themes in the theory of depression can be discussed. These themes will form the subject of the next paper in this review.</p>","PeriodicalId":9551,"journal":{"name":"Canadian Psychiatric Association journal","volume":"24 4","pages":"341-52"},"PeriodicalIF":0.0,"publicationDate":"1979-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/070674377902400412","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11671762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Position paper on \"withholding treatment\".","authors":"J A Tibbles","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":9551,"journal":{"name":"Canadian Psychiatric Association journal","volume":"24 4","pages":"376"},"PeriodicalIF":0.0,"publicationDate":"1979-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11375366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}