The Canadian Journal of Psychiatry

A case of querulous-litigious delusional disorder successfully treated with low-dose pimozide is reported. A summary of the contemporary literature on this neglected topic is provided.

The more commonly known statistical procedures, such as the t-test, analysis of variance, or chi-squared test, can handle only one dependent variable (DV) at a time. Two types of problems can arise when there is more than one DV: I. a greater probability of erroneously concluding that there is a significant difference between the groups when in fact there is none (a Type I error); and 2. failure to detect differences between the groups in terms of the patterns of DVs (a Type II error). Multivariate statistics are designed to overcome both of these problems. However, there are costs associated with these benefits, such as increased complexity, decreased power, multiple ways of answering the same question, and ambiguity in the allocation of shared variance. This is the first of a series of articles on multivariate statistical tests which will address these issues and explain their possible uses.

Panic disorders in adults have been the object of many studies. They are better known in adolescents but have been noticed insufficiently in children although panic disorder is potentially dangerous at that age. After demographic considerations, the clinical aspects are examined and illustrated using two detailed observations.

Antidepressants reportedly increase appetite, carbohydrate craving and weight in some patients with depression and panic disorder. This paper presents the results of changes in appetite and weight inpatients with panic disorder treated with imipramine, diazepam or placebo in a double-blind prospective study.

Forty-four patients with panic disorder were randomly assigned imipramine, diazepam and placebo. The investigators monitored weight and the patients rated their appetite and cravings during the eight week study. No significant increases in weight or appetite were found in the patients with panic disorder patients.

The Baffin Consultation Service of the Clarke Institute of Psychiatry has been providing psychiatric consultation services to the Baffin Island region of the Eastern Canadian Arctic since 1971. This report describes the background history, development and evolution of the service. Attention is focused on aspects of the consultation visits, educational activities of the project and the development of a mental health network. It is suggested that this is a useful model for the provision of psychiatric services to remote areas with limited resources.

The clinical activities of the Baffin Consultation Service of the Clarke Institute of Psychiatry were examined. Demographic and clinical data are described based on clinical interviews and questionnaire items from 581 initial psychiatric referrals. More women than men were referred to the service; the mean age of the patients seen was 27.3 ± 13.4 years. The majority of referred patients were single and unemployed. The most common reasons for referral were depression, suicidal ideation, suicide attempts and family problems. The major diagnoses made were adjustment reactions and depressive disorders. Treatment was largely carried out in an outpatient setting through local health care professionals. The implications of these findings for this population and the development of community-based intervention programs are discussed.

This report describes mental health issues affecting Inuit women as seen in psychiatric consultation. Recent public and governmental attention has focused on the emotional and behavioural sequelae of rapid cultural change, spousal assault and sexual violence. The process of psychiatric consultant with the Inuit woman patient will be described. The need for innovative, community-based treatment strategies in this population will be emphasized.

In 61 patients with generalized musculoskeletal pain, severity of anxiety and depression correlated significantly with self-reported impact of illness and physician-rated disability. Depression was significantly associated with pain-frequency, whereas anxiety was unrelated. Depressed mood was more closely tied to patients’ ability to function than to their experience of pain.

Quality controls are becoming an important part of our health care system. A medical audit is one way of evaluating quality of care, and this paper describes the results of an audit conducted to investigate the reasons for a prolonged stay on a psychiatric inpatient unit. The results showed a decrease in the mean length of stay over a five year period, although the figure remained substantially above provincial norms. A review of the hospital charts of a random sample of one in six patients whose hospital stay exceeded 30 days was carried out. It revealed that in 50.0% of cases the reasons were “medically acceptable,” in 10.3% the reasons were “medically unacceptable” and in 39.7% the reasons were “social and administrative” and beyond the control of the treating psychiatrist. The implication of these results are discussed.

This study investigated the mental health of Portuguese children in Canada. Preliminary work involved a survey of professionals serving the Portuguese community and the translation and assessment of a standardized child behaviour checklist. Forty-five Portuguese children and 45 non Portuguese children referred to a children's mental health centre were compared on demographic and family indicators and their referral source. There were similar proportions of boys and girls in the two groups, similar types of services were requested, and they had similar treatment histories. The Portuguese children were older at the time of referral and were more likely to be referred by educational agencies than the non Portuguese children. Portuguese families appeared to experience different stresses than non Portuguese families. Implications of these findings for the provision of culturally sensitive interventions for Portuguese children and their families are discussed.

Anorexia nervosa in prepubescent patients is a serious pathology, which is often misunderstood, not exceptional and on the increase. Our study focuses on 13 case histories of children between eight and 12 years of age who met Tanner's first criterion (absence of puberty) and presented a substantial weight loss and a morbid fear of gaining weight. More specifically, we studied in our sample the general epidemiological data, the clinical features related to development (effect on growth, refusal of hydratation), depressive comorbidity and a rather deteriorating evolution for the majority of our patients. Our results were compared with the data from the literature.

A 74 year old woman became progressively confused and developed visual hallucinations and delusions over a six day period, after the institution of routine oral trimethoprim-sulfamethoxazole therapy for a urinary tract infection. The medication was discontinued, and a marked improvement was noted 36 hours later. There was a complete return to normal mental functioning 60 hours after therapy was discontinued. The relationship between the patient's symptoms with the initiation and discontinuation of the medication suggests that the drug had a causal effect.

A study of 174 subjects selected from a Canadian shopping mall revealed an inverse correlation among the males but not among females between body stature and body image parameters related to dieting, body weight and shape (for example, drive for thinness, and body dissatisfaction). These correlations were independent of body weight. Among the females, there was a direct correlation between the Body Mass Index and these body image parameters. Height is generally associated with desirable looks and academic success among men and most likely has a positive effect upon body image. Therefore, males who are dissatisfied with their stature, a feature that is generally not within their control, may attempt to alter an aspect of their body that they can control (for example, weight). This finding may have important implications among males with eating disorders.

Fluoxetine has been reported to have interactions with antipsychotics and other antidepressants with symptoms of toxicity of these drugs. We report a case of a possible interaction with pimozide which led to a potentially life threatening bradycardia. Careful monitoring should be done when these two drugs are prescribed at the same time, especially in the elderly and inpatients with cardiac disease.