The Canadian Journal of Psychiatry

To examine the nature and conceptualization of generalized anxiety disorder (GAD) and chronic worry as well as data bearing on the validity of GAD as a distinct diagnosis.

Narrative literature review.

Although a wealth of data have been obtained on the epidemiology, genetics, and nature of GAD, many important questions remain regarding the validity of current conceptual models of pathological worry and the discriminability of GAD from certain emotional disorders (for instance, mood disorders) and higher-order trait vulnerability dimensions (for example, negative affect).

Because the constituent features of GAD are salient to current conceptual models of emotional disorders (for example, models that implicate negative affect or worry/anxious apprehension as vulnerability factors), research on the nature of GAD and its associated features should provide important information on the pathogenesis, course, and cooccurrence of the entire range of anxiety and mood disorders.

To review and examine the clinical and research literature on irritable bowel syndrome (IBS) with a view to establishing the role that psychiatric factors play in the pathogenesis and treatment of this syndrome.

Comorbid psychiatric illness is common with IBS, yet only a small proportion of these patients seek medical attention. Many patients are either satisfied by reassurance or experience symptom relief from medical treatment directed at target symptoms. A small group of patients do not experience much relief, and it is largely this group who come to the psychiatrist's attention. Psychotropic medication is helpful when clinically indicated, and tricyclic antidepressants in small doses (for example, 50 mg) may be helpful for those patients with a pain-predominant pattern of IBS. Psychotherapy (including cognitive, behavioural, relaxation, thermal-biofeedback, insight-oriented therapy, and hypnosis) has been shown to provide relief, although it has often been difficult to differentiate this improvement from a placebo response.

The group of patients with “refractory IBS” used a large amount of health care resources in an attempt to find relief to their distress. Further study is needed to gain a better understanding of which component of psychotherapy is most cost-effective and which patients are most likely to benefit. The large group of those who admit to symptoms compatible with IBS but who do not seek medical attention has to a large extent been excluded from most studies. Exploring this group may provide further insight into this perplexing syndrome.

To see whether classic DSM-III-R criteria for mania are applicable to Indian youngsters and to examine the clinical presentation of mania in an Indian child and adolescent psychiatric sample.

Fifty subjects with a diagnosis of functional psychosis as per the definition in ICD-9 were recruited from the population referred during the study period of approximately one year (n = 840) to the Child and Adolescent Psychiatry (CAP) clinic of the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, South India. The subjects were systematically evaluated using a standardized clinical interview and demographic questionnaire and were classified according to DSM-III-R. The subjects who satisfied DSM-III-R criteria for mania formed the sample for this study.

Twenty-one subjects received a diagnosis of mania according to DSM-III-R. The most common symptoms of mania included pressure of speech, irritability, elation, distractibility, increased self-esteem, expansive mood, flight of ideas, and grandiose delusions. No subject had comorbid attention-deficit hyperactivity disorder (ADHD). Additionally, 13 (61%) of the 21 manic subjects had delusions and/or hallucinations. The other common symptoms included psychomotor agitation, reduced sleep, anger, temper tantrums, decreased concentration, disobedience, aggression, and hyperactivity.

Mania was diagnosable in Indian children and adolescents using classic DSM-III-R criteria. The clinical profile appears to be generally similar to that seen in adults. ADHD is not a comorbid condition. The presence of aggressive or disruptive behaviours and hyperactivity in childhood- and adolescent-onset mania, however, could lead to a misdiagnosis of attention-deficit hyperactivity disorder/conduct disorder (ADHD/CD). Similarly, the presence of psychotic features could lead to a misdiagnosis of schizophrenia.

To compare the psychiatric diagnoses for Asian Canadians admitted to an adolescent inpatient unit with those of their white Canadian peers.

A literature review was first completed and then followed by a hospital file review of the Asian Canadians admitted over a 5-year period to the adolescent inpatient psychiatric unit. The data extracted (relating to psychiatric diagnosis, age, length of stay, referral source, family type, and gender) were then compared with a random sample of white Canadians admitted to the same unit during the same 5-year time frame.

There were far fewer Asian Canadians admitted than would be expected based on Calgary's demographics. There was equal gender representation among those who were admitted, and they tended to be older and to have a greater preponderance of severe psychiatric symptomatology than their white Canadian peers.

This paper adds to previous research in emphasizing that ethnocultural factors play a significant role in the utilization of psychiatric services by immigrant populations.

To investigate differences of expression regarding depressed mood between Japanese and Canadian aged people.

The Zung Self-Rating Depression Scale (SDS) was applied to people aged 65 and over in Ohira, Japan, and Steveston, British Columbia, Canada.

The number of subjects who filled out the SDS completely was 2180 for the Japanese sample and 183 for the Canadian sample. The mean SDS indexes of the Japanese and the Canadian samples were 44.03 and 44.34, respectively. The Canadian sample showed a higher average score in 11 items out of 20, whereas the Japanese sample showed a higher score on only 4 items. The factor analysis of those samples showed only small differences.

The Canadian sample showed a higher average score in more items compared with the Japanese sample. This indicates that Canadian aged people express their depressed moods more clearly and spontaneously than Japanese aged people.

To estimate prospectively the incidence of delirium in psychiatric inpatients and to identify risk factors for delirium in this population.

The subjects were nondelirious patients newly admitted to the Calgary General Hospital. The Delirium Symptom Interview (DSI), the Confusion Assessment Method (CAM), and the Mini-Mental State Examination (MMSE) were used to identify incident cases of delirium. In order to evaluate the potential impact of selection bias, we conducted a supplementary analysis using record linkage to an electronic administrative data base with coverage of the target population.

Of 420 admissions to the hospital, 401 subjects provided informed consent and were not delirious at the time of admission. There were 9 incident cases of delirium. The cumulative incidence rate was, therefore, 2.14 per 100 admissions. The record linkage analysis did not uncover evidence of selection bias. Delirium was associated with a significantly increased length of stay in hospital.

Delirium is an uncommon incident event in the psychiatric inpatient population. The incidence rate reported here may be useful as a benchmark for the identification of excessive rates in other inpatient settings. Since delirium is sometimes related to modifiable therapeutic factors, an excessive rate should prompt a search for its causes.

To explore the effect of chronic institutionalization on cognitive performance in chronic psychiatric patients with emphasis on age disorientation, a phenomenon that was found in previous research to occur in up to 25% of chronic schizophrenic patients.

One hundred and ten chronic psychiatric patients, forming 4 main groups—schizophrenic patients, nonschizophrenic patients, institutionalized, and noninstitutionalized—were examined for age disorientation (inability to give one's chronological age correctly on request), and their Minimental State scores (MMSE) were compared across the 4 groups.

Twelve out of 43 patients (26%) who were institutionalized according to our definition were age-disoriented and had significantly lower MMSE scores than the other 3 groups. The chronic, noninstitutionalized schizophrenic group and the other chronic psychiatric patients, whether they were institutionalized or not, were negative for this phenomenon. One of the 12 age-disoriented patients was age delusional, and 5 of the 12 had a total MMSE score consistent with dementia (21 or lower).

Age disorientation is a specific phenomenon that characterizes a subgroup of chronically ill and institutionalized schizophrenic patients. It is unlikely that chronicity per se or prolonged hospitalization alone will lead to cognitive impairment.

To assess fitness to stand trial, competency to plead guilty, and competency to understand Charter cautions to determine if the level of competency varies across these domains.

The Fitness Interview Test-Revised (FIT-R) and the Test of Charter Comprehension (ToCC) were administered to a group of individuals held on remand for fitness evaluations. Additionally, several questions from the FIT-R that address the ability to make a guilty plea were assessed separately and constituted an individual measure of competency to plead guilty (CoP).

As predicted, the results indicated that the fact that an individual is competent at one juncture in the criminal proceedings does not mean that the individual necessarily is competent at all other stages of the proceedings.

These findings suggest a need for a stage-specific approach to forensic competency assessments, requiring specialized instruments designed to assess the legal issues of competency at the various stages of legal proceedings.