The Canadian Journal of Psychiatry

To examine the recidivism rates of the various types of adult sex offenders including incest offenders, extrafamilial child molesters, exhibitionists, and rapists.

An examination of the literature over the past 4 decades and the data from our own study group.

Methodological shortfalls and differences across the studies make statistical appraisal of the results difficult. Nevertheless, there is a consensus that incest offenders are less likely to reoffend compared with extrafamilial child molesters. Rapists and exhibitionists are thought to be at a higher risk for recidivism.

A combined actuarial predictive approach in conjunction with empirically guided clinical assessment is probably the best method to predict recidivism of sex offenders.

This paper is the first of a 2-part review on the topic of stalking. It outlines the behaviours involved, epidemiology, motivation of offenders, and mental health consequences for the victim.

Computerized literature searches were used to identify relevant papers from psychiatric and legal journals. Publications by victims' and women's organizations provided additional information.

Up to 1 in 20 women will be stalked during her lifetime. The majority of victims are female, while the offenders are usually male. Stalking behaviours range from surveillance to threatening aggressive or violent acts. The majority of stalking relates to failed intimate relationships. Stalkers may also suffer from erotomania or obsessional love with a primary psychiatric diagnosis. Victims may experience anxiety, depression, guilt, helplessness, and symptoms of posttraumatic stress disorder (PTSD).

Stalking is a serious offence perpetrated by disturbed offenders. It can cause major mental health consequences, which are often poorly understood by society.

This paper is the second of 2 parts reviewing the topic of stalking. It focuses on victims' difficulties with the legal system and the psychotherapeutic tasks for victims and therapists.

Computerized literature searches were used to identify relevant papers from psychiatric and legal journals. Publications by victims' and women's organizations provided additional information.

Victims suffer emotional consequences from being stalked. Additional stress is caused by the legal system's lack of understanding of the causes and consequences of stalking and inadequate and unenforced laws. The treatment of victims requires a comprehensive approach, including education, supportive psychotherapy, and discussion of practical measures. Therapists may over identify with the patient's powerlessness or hesitate to take on a case out of fear of the stalker. Female therapists may protect themselves against the realization of their own vulnerability by blaming the victim, while male therapists may feel defensive or overprotective.

Stalking is a crime with major mental health consequences which is often poorly understood by society. Therapists need to be aware of the victim's emotional reactions, the types of legal and practical supports available, and the possible biases of society. Further education and research should be encouraged.

Faire le point sur l'état des connaissances concernant les méthodes d'évaluation de l'aptitude à subir son procès (ASP). Établir le parallèle entre cet état des connaissances et les résultats d'études portant sur les facteurs associés aux décisions d'aptitude. Décrire les limites inhérentes au domaine de l'ASP.

Recension de la documentation pertinente à partir des bases de données Psychinfo et Medline, de 1967 à 1996 inclusivement.

Dix instruments permettant une collecte systématique d'information auprès des personnes faisant l'objet d'évaluation de l'ASP ont été recensés. Une description et une analyse des qualités psychométriques révèlent qu'ils sont cependant critiquables à certains égards.

Bien que certaines recherches aient montré que le diagnostic soit le facteur le plus fortement associé à la décision d'aptitude, aucun instrument n'intègre une évaluation systématique de la psychopathologie. Or, si l'on tient compte des conséquences possibles des décisions, tant pour l'accusé que pour la société, ces évaluations et les recommandations qui en découlent sont d'une importance capitale.

To compare the characteristics of individuals assessed for fitness to stand trial (FST) with those assessed for criminal responsibility (CR).

This study examines all the consecutive requests of FST or CR addressed to the only forensic psychiatric hospital in the province of Quebec and 2 prisons in the Montreal area over a 1-year period.

In all, 170 FST, 52 CR, and 29 both FST and CR assessment requests were received (251 subjects). Psychiatrists' recommendations and court verdicts of unfitness to stand trial or not criminally responsible on account of mental disorders were mostly related to the presence of a psychotic-spectrum disorder. There is generally a good agreement between psychiatric recommendations and verdicts of the court, with the exception of unfitness recommendations.

Defendants referred for a FST or a CR assessment displayed similar characteristics. However, although subjects with psychotic disorders represented more than one-half of the unfit or not criminally responsible verdicts, most of the subjects with psychoses were found competent to stand trial or responsible.

To determine if there are any potential opportunities for patients to be discharged earlier and to determine what factors are responsible for delays in discharge.

A survey was completed by clinical staff of all patients on the wards of 12 adult psychiatry units in the Greater Vancouver Regional Hospital District (GVRD) for a 1-day period. The survey included a modified Brief Psychiatric Rating Scale (BPRS) and the Discharge Readiness Inventory (DRI). A 1-month follow-up measured discharge and nondischarge outcomes.

Of the 327 patients surveyed, 42% were ready for discharge at the time of the assessment, and 37% of those who were ready were not discharged within 2 weeks. Delayed patients had significantly higher scores for disorientation, hallucinations, conceptual disorganization, and manifest psychopathology and significantly lower scores for Community Adjustment Potential (CAP) (P < 0.05). The most frequent reasons given for delays were ongoing medication adjustment, behaviour stabilization, and discharge planning. Patients who were delayed were more likely to need services, to need or be waitlisted for a residential placement, to be a client of the community-based mental health team that provides ongoing support to clients living in the community, to have a diagnosis of schizophrenia, and to have had no previous psychiatric hospital admission.

The removal of all barriers to delays would reduce lengths of stay by 11% for this sample of patients. This would require a shift of about 42 out of 327 beds to an alternate level of care. These “earlier discharge patients” will need ongoing medication and behaviour monitoring through a variety of community services.

Various clinical studies have documented associations between alcohol consumption and depressive disorders. In some circumstances, alcohol ingestion may cause or worsen depression, whereas in other circumstances the direction of causal effect may be reversed. The objective of this study was to evaluate associations between alcohol consumption and major depression in the Canadian population.

Data from the Canadian National Population Health Survey (NPHS) were analyzed. This survey, conducted by Statistics Canada in 1994, used a probability sample of 17 626 subjects. The NPHS included measures of alcohol ingestion and a diagnostic screen for major depression (Composite International Diagnostic Interview [CIDI] Short Form).

Subjects reporting any drinking in the year preceding the interview were more likely to have experienced an episode of major depression during that time than subjects reporting no drinking. Subjects reporting maximal ingestions of 5 or more drinks (and especially 10 or more drinks) on at least 1 occasion during the preceding year were also at greater risk of major depression than nondrinking subjects or subjects reporting smaller maximal ingestions. Neither the average amount consumed daily nor the frequency of drinking was associated with major depression.

In the general population, there is no simple relationship between the quantity or frequency of alcohol consumption and the prevalence of major depression. Any drinking and maximal consumption on I occasion, however, are related to the prevalence of major depression. Further research is needed to delineate causal mechanisms so that clinical and public-health interventions can be formulated.

To identify the diagnostic subtypes of eating disorders (EDs), the psychiatric comorbid diagnoses, and associated specific and nonspecific psychopathology in a series of 120 adolescents undergoing standardized assessment for an ED.

Consecutive patients referred to our large pediatric hospital for ED assessment completed a semistructured diagnostic interview for children and adolescents. The following self-report scales were administered to assess specific and nonspecific psychopathology: the Children's Depression Inventory (CDI), the Brief Symptom Inventory (BSI), the Eating Disorder Inventory 2 (EDI-2), and the Family Assessment Measure (FAM-III) of family functioning.

Female subjects with a mean age of 14.5 years and a mean body mass index (BMI) of 18.1 comprised 93% of the sample. The restrictive subtypes of anorexia nervosa (AN) (43%) and eating disorder not otherwise specified (EDNOS) (16%) were the most common diagnoses. Patients with restricting symptoms (R) could be grouped together because they were more similar to each other with respect to self-report symptoms of psychopathology than they were to patients with binge/purge (B/P) symptoms and vice versa. Patients with R endorsed significantly fewer subjective symptoms, both ED-specific and nonspecific, and rated their families' functioning better than did B/P patients. Comorbid, current major depressive disorders and dysthymic disorders occurred in 66% of subjects, but depressive, dysthymic, and oppositional disorders occurred in 96% of those with B/P symptoms. Severity of the CDI was the best single discriminator between R and B/P subjects.

Adolescents with EDs in the early stage of their illness are similar to adults with EDs in the following ways: they meet the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for subtypes of EDs (excluding amenorrhea) and commonly have comorbid psychiatric disorders, especially depressive disorders. Patients with B/P symptoms can be distinguished from restricting subjects because they endorse significantly more ED-specific and nonspecific psychopathology and have a higher frequency of comorbid Axis I diagnoses (especially depressive disorders) than restricting patients. Oppositional defiant disorder (ODD) occurs more commonly in adolescents with EDs associated with B/P symptoms.

To determine the rates of antidepressant and antipsychotic use in the treatment of schizophrenia.

The primary therapists at 8 community mental health centres in a metropolitan Canadian city completed a survey questionnaire for all of their active clients. Information was collected about diagnoses, medication treatments, and clinical variables.

There were 3555 clients, 1552 (43.7%) of which had a diagnosis of schizophrenia. Of clients with schizophrenia, 94% were prescribed antipsychotic medications, and 11.6% of these were also prescribed antidepressant medications. There were differences between the combination-treatment group and the antipsychotic-alone group in gender ratio, rates of concurrent diagnoses of mood disorder, level of current functioning, and total number of hospitalizations.

In this community-based sample of clients with schizophrenia, antidepressants and antipsychotics are commonly prescribed in combination, even though the rate of concurrent mood disorders diagnoses is low. Further studies should clarify the efficacy and indications for antidepressant use in this population.