The Canadian Journal of Psychiatry

This article examines the relationship between psychiatric disorder and the use of tobacco, alcohol, marijuana and hard drugs during adolescence. The sample of 1,302 adolescents aged 12 to 16 came from households selected by stratified, cluster and random sampling of the 1981 Canada Census. Symptom checklists were used to approximate diagnoses of conduct disorder, attention deficit disorder and emotional disorder. Logistic regression analyses indicated that conduct disorder was strongly related to all types of substance use and that emotional disorder was related to the use of tobacco, alcohol and hard drugs. These relationships were true for the adolescents' self-assessments only; the parents' assessments of psychiatric disorder were not related to the adolescents' reports of substance use.

While the loss of a parent during childhood may put a person at risk for depression, many studies have failed to confirm the importance of this risk factor. Nevertheless, the relationship between the loss of a parent and depression is of clinical importance. This paper reviews studies of the loss of a parent as a risk factor for depression. In addition, relevant data from these studies were pooled using meta-analytic techniques. It was found that for females there was a significant association between the loss of one's mother before age 11 and depression, and that losing one's mother during early childhood may double their risk of depression.

The behaviour profiles of 176 mentally retarded individuals from two reception centres and nine group homes were assessed. The correlations between behaviour and age, sex, degree of mental retardation, etiology of mental retardation and medical diagnosis were assessed using the Revised Child Behaviour Profile. The severity of behaviour disturbance did not vary with age or medical diagnosis. The moderately retarded subjects presented with more severe behaviour problems, such as aggression, than the severely mentally retarded subjects. The variable most predictive of behavioural problems was etiology of the disorder. Individuals with Down's syndrome had significantly fewer behaviour disturbances and those with autism and pervasive developmental disorder had significantly more behaviour disturbances than other subjects. A psychiatric disorder was found in 10.2% of the sample. The implications of these findings are discussed with respect to public policy.

Mentally ill offenders are especially difficult patients to rehabilitate. Although group therapy is a universal method of treating these patients, their ability to benefit from group therapy has not been proven. The authors studied a group of patients held on Warrants of the Lieutenant Governor to assess their personality characteristics and their ability to develop group dynamics which are beneficial in other patient populations. The findings were that forensic patients have personality characteristics which preclude the development of these therapeutic dynamics.

Two patients suffering from severe obsessive-compulsive disorder which had proven refractory to clomipramine and/or phenelzine treatment were successfully treated with fluoxetine, a new drug with a strong serotonin uptake inhibiting action. Outcome of treatment was measured on psychometric tests including the Leyton Obsessive Inventory, Hopkins Symptom Checklist-90, Beck Depression Inventory, and daily self-reports of the duration and degree of discomfort of their most severe obsessions. The delay in responding to fluoxetine, the continuing improvement even after one year on the drug, and the prompt relapse with abrupt withdrawal of treatment were noted.

The validity of a self-administered, computerized version of the National Institute of Mental Health Diagnostic Interview Schedule (DIS) was evaluated with a group of 41 psychiatric inpatients. Each patient was administered the computerized DIS (C-DIS) and a semi-structured clinical interview using the symptom checklist developed by Helzer et al. The concordance between the C-DIS and symptom checklist was comparable to that found in earlier studies of the original DIS. The overall distribution of kappas was also similar to those of previous studies. Overall, the results suggest that computerized administration may be a feasible alternative to face-to-face administration of the DIS.

Pathological gambling was officially defined and recognized as a psychiatric illness by the American Psychiatric Association in 1980. This survey reports the results of a province-wide study in Quebec based on telephone interviews using standardized assessment instruments with 1,002 subjects. The current prevalence of pathological gambling is 1.2%. The results also show that 88% of the respondents have gambled at least once in their life. The implications of these results for the prevention and treatment of this debilitating disorder are discussed.

This study is a review of the psychiatric and neurological effects of solvent inhalation on a group of 22 patients with chronic histories of solvent abuse, primarily toluene-based solvents. The findings suggest that the chronic inhalation of toluene-based adhesives can produce a paranoid psychosis which may persist. Other findings were a high incidence of temporal lobe epilepsy and decrease in IQ. We suggest that the psychiatric and neurological sequelae of chronic solvent abuse are serious and potentially irreversible. Toluene is felt to be a major factor in the morbidity associated with chronic solvent abuse, and attention is drawn to the necessity for educational programs in this area. The burden caused by the resulting psychiatric problems resulting from solvent abuse may have implications for health care budgets.

In this study, the repeat utilization of child psychiatric emergency services was examined. There are patients who use psychiatric emergency services repeatedly, and these patients represent a significant proportion of child psychiatric emergencies seen in emergency rooms. Repeat patients were more likely to threaten to harm others, have a diagnosis of adjustment disorder, conduct or oppositional disorder and be under the care of a child welfare agency. They were significantly more likely than the one-time patients to be less compliant with outpatient follow-up, admitted to hospital more often, needed more social support and had greater difficulty remaining in a residential treatment setting. Intervention in the emergency room did not appear to change the way they used emergency services.

The process and outcome of discharge planning were examined at a large provincial psychiatric hospital. Two hundred patients were studied to determine whether or not they received services from the agencies to which they were referred after discharge. In addition, patients who were rehospitalized within three months of discharge were identified in order to determine whether they differed from the rest of the cohort.

Eighty-three percent of the patients for whom referrals were made sought help from at least one aftercare service or community agency, suggesting that there is considerably more aftercare in the community than has previously been documented. The implications of these findings for treatment, research and policy planning are discussed.

This study compares the paired serum and salivary Cortisol levels of 60 children and adolescents, obtained while performing a routine Dexamethasone Suppression Test. The results reveal significant correlations between serum and salivary cortisol levels in both drug-free (r = 0.90, p <.001) and medicated patients (r = 0.81, p < .0001). Multiple regression analysis suggests that, while the slopes of the two regression curves are parallel (0.15 < p < 0.20), the intercepts are significantly different (p < 0.05). This study supports the use of salivary measures of cortisol for children and adolescents. The authors suggest care in the use these measures while the patient is taking psychotropic medication.

The potentiation of fluoxetine by buspirone is described in three cases of treatment-resistant depression. All three patients improved markedly with very few side-effects from the medication. The possibility of synergy between drugs that affect serotonin reuptake inhibition, 5HT_1A receptors and 5HT₂ receptors is discussed.

Malgré les développements récents de la psychopharmacologie et une meilleure compréhension des tableaux d'agitation chez les patients en psychiatrie, l'utilisation des procédures d'isolement et de contention demeure un sujet de pratique quotidienne. On s'arrête peu ou pas à son enseignement de façon formelle. La littérature est quasi exempte de ces sujets et elle n'a connu son essor que dans les suites de procédures légales entamées par des patients qui ont forcé les praticiens à s'arrêter à l'analyse de ces moyens d'intervention.

L'article donnera un reflet succint de la littérature des dernières années qui débouche davantage sur le volet normatif qui devrait régir ces procédures, et une courte analyse de l'impact systémique des procédures.

La révision ou la prise de conscience de certaines de ces variables permettra peut-être un meilleur recul des cliniciens face à l'utilisation de procédures qui sont malheureusement encore aujourd'hui à la source de décès dans la pratique psychiatrique.