The Canadian Journal of Psychiatry

The epidemiology of dementia in Canada is not known. However, we report figures on the frequency of dementia in institutions in Ontario based upon the use of a multidimensional observation scale for the assessment of the elderly. These findings on institutionalized patients can be extrapolated to the whole elderly population, but the procedure is clearly too conservative by comparison with findings in other countries and in the light of the known occurrence of numbers of demented patients outside institutions. Ratios in different sutidies for the numbers of patients with dementia outside institutions and within institutions range from 1:1 to 6:1. Using a ratio of 2:1 and applying it to age specific population figures, a prevalence of dementia in Canada of 222,324 for those over 65 is obtained with a rate of 9.4% in that age group. When the figures projected in this way are compared with five epidemiological studies for the rate of dementia elsewhere, the Canadian figure which we have obtained ranks fourth out of six. This estimate provides potential figures on which to base the planning of services, provided that the inferential nature of the estimates is fully recognized.

A model for the effect of child-parent relationships on later adult marital quality was tested by questionnaire in 124 general practice patients. Recollections of parental care and overprotection measured by the PBI correlated significantly with Locke- Wallace measures of marital quality primarily in females. Correlations were larger in a homogeneous group where previous marriages and emotional illness were eliminated, and in those who had experienced, childhood separations from parents. The results are consistent with an interactive model where the quality of childhood experience determines the quality of adult marriages primarily when separation experiences have been present.

While the validity of the Diagnostic Interview Schedule (DIS) is still controversial, enough data exists to support a trial in a cinical setting. A new microcomputerized version presents the diagnostic profile of the patient within minutes after the interview and reduces the possibility of errors in data collection and transcription, thus making the interview appropriate and available for widespread use. The present study examines the use of this instrument in a psychiatric out-patient department.

Forty-one referrals to a psychiatric out-patient department were assessed by each of two methods: the standard problem-oriented non-structured clinical interview (NSI) and the microcomputerized DIS. The mean time taken for the DIS was 111.6 minutes, and patient acceptance of the microcomputerized format was high. The DIS provided a mean of 5.5 diagnoses per person compared to 2.56 for the NSI, but 31.7% of the patients had no clinically significant current DIS diagnosis. Approximately one-half the patients were assigned a diagnosis by the NSI which was beyond the 38 DSM-III diagnoses covered by the DIS.

A comparison of the diagnostic results of both interviews reveals large differences in the group, and very little agreement in individual patients. The proportion of patients assigned diagnoses of substance abuse, affective disorder, psychosexual disorder, and personality disorders by each interview were quite different. Many of the patients diagnosed as having primarily Personality Disorder by the NSI were found to have an affective disorder by the DIS. The reasons for these differences and the resulting implications are discussed. This study supports the use of the microcomputerized DIS as a clinically useful adjunct to the diagnostic process.

This study was conducted to determine if a relationship exists between social support and agoraphobia. Married agoraphobic women from a support group for phobics were compared with married, non-agoraphobic women from Family Practice clinics, and social support factors were examined. The agoraphobic women were found to perceive their husbands as less supportive. As well, there were important reductions in network size and network support in these agoraphobic women.

This article aims to clarify and organize the recent advances in research on the central action mechanism of lithium. It begins by tackling the process of cellular transport of the cation, then it moves on to describe the effects of lithium on ionic distribution and on membranous functioning in general. Neurotransmission in this article is the object of a more detailed study. The metabolism of neurotransmitters (and their disturbances) is first discussed. The emphasis is placed on certain current domains, the gabaergic system in particular. Neurotransmitters, by themselves, do not satisfy any longer the curiosity of biologists. Technological progress has given these scientists access to the intimate functioning of receptors and to their natural support system, the membrane. The stabilizing effect of lithium is mentioned often. Initially seen at a superficial level, it leads to a study of the mechanisms of the transference of information from the receptor to the cell. The membranous phospholipids and the enzymatic systems controlling the metabolism of the second messengers (cyclic nucleotides but also calcium) will provide as many potential targets to the action of lithium.

Free T4 (fT4) measurement provides a more sensitive test of thyroid function than the commonly used T4. Recent commercial development of fT4 kit assays has made fT4 assessment widely available. Evaluation of the fT4 Amerlex kit in 26 lithium-treated patients illustrates its utility as a sensitive laboratory test of thyroid function in this group of patients. This finding together with fT4's known superiority over T4 in identifying thyroid dysfunction suggests that fT4 should replace T4 estimations in the routine monitoring of thyroid function in lithium-treated patients.

With up to 50% of psychiatric patients refusing medication at some time during therapy, non-compliance can become a major treatment difficulty. This problem is compounded by the countertransference responses evoked within the therapists, and their tendency to react solely with information and exhortation rather than attempting to view non-compliance psychodynamically.

When exploring with empathic concern, a number of common dynamic issues can be seen as playing a major role in drug refusal. Commonly at work are issues relating to projection, denial, identification, and transference difficulties that emerge in a relationship where a therapist offers a patient a pill.

A survey of psychiatrists and non-psychiatrists in a medical faculty examined questions bearing on two hypotheses, that psychiatrists choose their career either to heal themselves or to heal their families. The results provided some support for the psychiatrist as a “wounded healer”. The findings did not appear to be an artifact of more psychiatrists having been in therapy. The results were the same whether or not psychiatrists specialized in psychotherapy.

Childhood schizophrenia ia an increasingly difficult disorder to identify. We review the DSM-III criteria for schizophrenia and raise the possibility that schizophreniform symptoms may be present in children with Tourette disorder to identify. We review the DSM-III criteria for seen in Tourette disorder that resemble the symptoms of schizophrenia are discussed and data from selected patients are presented. This data is presented to assist clinicians in making more appropriate diagnoses (that is, avoiding the incorrect diagnosis of schizophrenia) and in refining distinctions between the symptoms of schizophrenia seen in childhood and similar symptoms seen in other developmental disorders, especially Tourette disorder.

This paper deals with patients who attempt suicide, focusing on their evaluation in the emergency room. It is suggested that as the actual risk of completed suicide in suicide attempters is low, the evaluating psychiatrist might preferentially focus on assessing the patient's motivation for self-destructive behaviour. Recent studies are reviewed which demonstrate a linkage between self-destructive acts and the status of relationships with significant others. An illustrative case history is presented.

A case is described of cyproheptadine dependence in a woman with a persistent belief that she was too thin, and diagnosed with an atypical somatoform disorder. The cyproheptadine was initially prescribed to promote weight gain but its continued use seemed related to other psychological and/ or pharmacological effects. Cognitive impairment was present, possibly as a result of the longstanding cyproheptadine abuse. There have been no previous reports of cyproheptadine dependence or of CNS toxicity from its long-term use.

The diagnoses of paranoia and obsessive-compulsive disorder are not adequately dealt with either conceptually or phenomenologically in DSM-III. A case of monosymptomatic hypochondriacal psychosis illustrating this point is presented. The question of whether this disorder should be diagnosed as paranoia, obsessive-compulsive disorder or an atypical affective disorder is discussed.

Hematological side effects of neuroleptic drugs occur infrequently but remain a potential cause of serious toxicity. A case of recurrent thrombocytopenia due to the repeated exposure to chlorpromazine (twice), haloperidol (four times) and thiothixene (twice) in a 59 year old female treated for schizophrenia is reported. Treatment difficulties and implications of this case are discussed.

Although the Royal College requires that residents receive training in the rehabilitation of psychiatric patients, much leeway has been given to individual departments of psychiatry as to program content. This has often led to inadequate training since residents may be exposed to chronic patients without any training in rehabilitation. In order to meet this deficiency McGill University and the University of Toronto have developed specific program requirements. These are described below.

This paper presents preliminary results of symptomatic and behavioral changes and psychodynamic observations for 9 young adult bulimic women treated with psychodynamic group psychotherapy. Pre/post group test results showed significant improvement on all measures of eating pathology, on the EDI ineffectiveness item and the Janis-Field feelings of inadequacy scale as well as on the total score of the Hopkins Symptom checklist. These results were consistent with independent clinical conclusions and with verbal reports of improvements in hinging and purging behaviour. Clinical content shed light on the role of the parents, especially the father, in the development of body-image, sense of adequacy and self-esteem, life goals and feminine identification. The authors conclude that clinical observations to date have yielded interesting psychodynamic hypotheses and the initial symptomatic improvements warrant cautious therapeutic optimism.