The Canadian Journal of Psychiatry

Interpersonal psychotherapy (IPT), a time-limited psychotherapy, was developed in the 1970s as a treatment for outpatient adults with major depression. It since has grown in its range of research applications and in its clinical accessibility.

Review of recent research and educational developments on IPT.

IPT has demonstrated efficacy in randomized controlled trials for major depression in various patient populations and in patients with bulimia. It showed no advantages in treating 2 substance abuse samples. Numerous further studies are underway. Growing numbers of clinicians are learning IPT.

At a time when both research developments and economic pressures are increasing interest in time-limited psychotherapies, IPT is expanding in both the research and clinical domains.

To evaluate the relationships between asthma and type and incidence of psychiatric problems in a pediatric population.

A series of 93 children and adolescents with asthma presenting during a 1-year period to a pediatric pneumology and allergy service was studied. Their psychopathological problems were compared with those of 93 children with insulin-dependent diabetes mellitus (IDDM). Various questionnaires were completed by the patients: the Child Depression Inventory (CDI), the State-Trait Anxiety Inventory for Children (STAIC), and the Coopersmith Self-Esteem Inventory (SEI). Their parents were administered the Child Behavior Checklist (CBCL). The patients were examined using the revised Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-R).

There were more symptoms in the asthma group than in the IDDM group, as indicated by total CBCL scores, internalization and externalization CBCL subscores, and the STAIC scores. Asthma was often associated with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) psychiatric disorders. We found 30 anxiety disorders, 5 affective disorders, and 6 disruptive behaviour disorders. Asthmatic children did not seem to be more depressed than the IDDM group, and their self-esteem, overall, was good. However, the asthma subgroup presenting with psychiatric disorders had poorer self-esteem and social competence. Adolescents did not seem to suffer more psychiatric disturbances than did younger patients. Girls did not suffer more psychiatric disturbances than did boys.

Asthma appears to be associated both with higher overall incidence of psychiatric problems than in IDDM and with particular categories of psychiatric problems. In particular, the problems include anxiety disorders, internalizing symptoms, and disruptive behaviours.

To determine the prevalence of and factors associated with mental health service use in the past year among respondents with an alcohol or other drug use disorder in a general population survey of Ontario adults.

Data were obtained from the 1990/1991 Mental Health Supplement to the Ontario Health Survey, which used the University of Michigan Composite International Diagnostic Interview (UM-CIDI). The current study examined 436 respondents aged 15–64 years who met Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria for a substance use disorder in the past year. The 82 respondents who used services for a mental health or substance abuse problem during the past year were compared with the 354 nonusers. Illness severity, disability, health beliefs and attitudes, and predisposing or enabling factors were examined in bivariate and logistic regression analyses.

Twenty-two percent of respondents used services in the past year. Having concurrent disorders (comorbidity), troubled relationships with others, and dysfunction in main activity, feeling comfortable talking to a professional about mental health problems, being older and an urban resident, not working or being in school, and having a biological parent with an alcohol or drug problem were all associated with service use.

The results suggest that individual determinants, such as severity of illness, disability, attitudes, and predisposing or enabling variables, all have a role in predicting service use among individuals in the general population who suffer from alcohol and other drug disorders.

This study was designed to test the hypothesis that adolescents who perceive their attachment figures as unavailable (low felt security) would be overrepresented in the case group of adolescents with a history of suicidal behaviours.

One hundred and eighty-seven adolescents in psychiatric treatment participated in this retrospective case-comparison study of attachment-felt security and history of suicidal behaviours. All participants completed the following measures: Adolescent Attachment Questionnaire, Perceived Social Support From Friends Scale, Rosenberg Self-Esteem Scale, Beck Hopelessness Scale, the depression syndrome scale of the Youth Self Report, and Adam's Suicidal Ideation and Behavior protocol.

The comparison group comprised 101 adolescents who had never experienced suicidal ideation or behaviour; the case group included 86 adolescents with a history of suicidal behaviour. We found that perceived unavailability and high levels of depressive symptomatology were predictive of suicidal behaviours. We also found a strong association between being older and having high levels of angry distress in adolescents with a history of suicidal behaviours.

The advantage of including an assessment of parent-adolescent attachment with clinical adolescents is noted.

Le refus du patient d'être traité est une situation à laquelle le psychiatre est confronté couramment dans sa pratique. Au Québec, en 1990, une nouvelle loi est venue changer radicalement la situation, en introduisant au code civil une disposition imposant le recours à l'intervention judiciaire pour traiter contre son gré une personne jugée inapte à consentir. Dans le présent article, nous proposons un bilan accompagné d'une enquête menée auprès des patients et des psychiatres traitants qui ont eu recours à cette disposition du code civil.

Ainsi, 39 sujets refusant catégoriquement un traitement ont été amenés en cours. A un sous-groupe de ces patients, nous avons proposé un entretien basé sur le DAI (questionnaire sur l'attitude à l'égard des médicaments) sur le CGI (impression clinique globale), et sur 2 questionnaires conçus spécifiquement pour répondre à des questions sur l'expérience au tribunal des patients et des psychiatres traitants.

Les résultats de cette enquête montrent que les patients ont un souvenir plutôt désagréable de leur expérience en cour. Cependant, l'alliance thérapeutique est demeurée inchangée même après la procédure. Les médecins sont unanimes à dire que les patients n 'auraient pas pu présenter un état clinique suffisamment amélioré pour quitter l'hôpital s'ils n 'avaient pas reçu de traitement médicamenteux, par suite de ce jugement. L'analyse de la dissociation entre la perception des patients et celle des médecins est comparée à celle des résultats issus d'études antérieures conduites aux États-Unis.

Tout en étant une recherche modeste, cette étude porte sur une situation délicate, difficile et de plus en plus fréquente. Elle propose d'étudier plus à fond d'autres voies que le recours au tribunal.

To review the need for a wide range of living arrangements and community support services for individuals with developmental disability (DD) and behavioural problems and for their caregivers.

An analysis of a 1-year caseload of a consulting psychiatrist to 2 community support agencies for individuals with DD.

Of the individuals seen with DD and behavioural problems, one-half needed a different living arrangement, immediately in many cases. Living arrangements and support services are extensively deficient. Correcting these deficiencies requires the concerted involvement of local, provincial, and federal governments as well as of community groups and agencies.