The Canadian Journal of Psychiatry

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.

Though there are major limitations in present knowledge regarding the psycho- and physio-pathology and prognostic indices of the syndromes produced by the after effects of severe non-progressive cerebral disease in adults, an early poor prognosis on the basis of prolonged coma, a picture of dementia, or relapse following improvement, is often proven wrong. Treatable decompensation may temporarily interrupt the course of improvement. The patient and family require the hopeful co-operative efforts of family physicians, psychiatrist and other specialists, psychologists, and paramedical remedial therapists to achieve maximum freedom from disabling symptoms and social adaption.

This has been a report of a study designed to assess the feasibility of long-term follow-up studies on Prince Edward Island.

Cohorts of patients first admitted to the Island's only mental hospital during the early nineteen-thirties and early nineteen-forties were followed in retrospect in order to determine, a) the course and outcome of the major disorders over periods ranging up to thirty-five years and, b) the long-term effects of these disorders upon the families of the patients.

Needed information was gathered through a review of hospital records, a search for death records and community interviews.

The results of the study suggest that lifetime prognosis in the absence of modern treatment methods may be even worse than believed by most professionals working in the field. As might be expected the outlook was found to be particularly grave for schizophrenia.

Success in following up a very high proportion of the cases over several decades supports the belief that Prince Edward Island offers unusual opportunities for studies of this kind.

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.

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.

Drawing our inspiration from the work of Levy (3) and from a brief research made in Notre-Dame Hospital, we present a schema of a crisis oriented therapy in six weekly sessions.

First session: the patient is informed about our brief and intensive program of therapy. He is then invited to give a detailed account of his recent crisis in order to relive it intensively in the presence of an understanding therapist. Tranquillizing medication is then prescribed.

Second session: the therapist conducts a deep exploration of the patient's fear of losing control over his impulses: a clear distinction is made between thought and action. Then an investigation is made about the patient's milieu, in order to measure its pathogenic potential. If information is not satisfactory, an investigation should be made immediately at the patient's home, because the background information is essential.

Third session: a complete exploration is made about the preceding crises and particularly the warning symptoms so as to find a common pattern and to help the patient recognize the onset of a crisis. The therapist makes then his first interpretation, comparing the many crises and noticing certain links between them. Finally, the patient is invited to make some plans for the future to be discussed in following sessions.

Fourth session: the therapist explores deeply the factors, conscious and unconscious, responsible for the crises. If he feels he has obtained a reasonable confirmation of one of his hypotheses, he gives then a dynamic interpretation but in general (not direct) and without insisting if the patient evades it. The last part of the session is given to concrete problems of readaptation.

Fifth session: an enquiry is done about a few current situations which are distressing for the patient, the therapist tries to discover with the patient the means to transform these situations and he helps the patient ‘rehearse’ his new behaviour for the next time he will have to face it. Finally the therapist tries to detect the effects of his dynamic interpretation: if the patient has gained insight, then he could state it more directly.

Sixth session: a general review is made of the affects of medication, interpretations and ‘rehearsals’. The essential is to communicate to the patient an experimental mentality in his interpersonal relations, so he could try many techniques to improve difficult situations. The session is terminated by a discussion about concrete plans of reorganization. A follow-up appointment is given in two months.

These notes present a very sketchy attempt to integrate three techniques: psychiatric treatment, Freudian psychodynamics and learning theory in a crisi situation. Now it remains to test the precise conditions in which this technique will be successful.