Canadian Psychiatric Association journal最新文献

There has been much criticism of the format and process of the certification examination in psychiatry, and some of this is based on lack of information regarding the history of the specialty certification procedures, the Royal College of Physicians and Surgeons and the Board of Examiners. In this first of three reports the history of the Royal College as the certifying organization is traced, and the relevant College structures are briefly described, including the Specialty Committee on Psychiatry which is instrumental in appointing the clinical examiners. The clinical examiners since 1965 are identified.

Detailed clinical records were kept on a series of 55 agoraphobic patients who presented to a general hospital psychiatric practice over a 3 year period. A review of the records revealed that 91% of these patients were diagnosed as suffering from a unipolar or bipolar primary affective disorder. The anxiety and phobic symptoms tended to mask the presence of the affective disorder. This observation is consistent with most of the published data on the agoraphobic syndrome. It could also explain the inconsistent effects of treatment of agoraphobia compared with simple phobias. The possible biological and psychological connections between primary affective disorders and the agoraphobic syndrome are discussed.

The authors review the literature on Munchausen's syndrome and speculate about possible underlying psychological mechanisms. The proposed DSM III classification of factitious illnesses suggests a continuum from hysteria on one end of the spectrum to malingering on the other. Two case studies are presented which represent variants of this syndrome. Both patients were given a sodium amytal interview, a procedure not previously reported in the Munchausen's literature. The procedure was helpful in eliciting a more accurate history and a clearer sense of the underlying dynamics. Some suggestions for further research are made.

Quality Assurance Strategies in Psychiatry and Medicine in general have developed rapidly and have been applied widely in the last few years, particularly in the United States. This paper reviews some of those developments both from a methodological and a socio-political point of view. The relevance to the Canadian scene is evaluated, and it is concluded that, although quality assurance is now accepted as an obligation of the health profession, some of the strategies being widely applied in the United States are of questionable value in themselves, and some, particularly cost control techniques, would seem to be irrelevant to the Canadian health field which already has a variety of checks and balances in its universal health insurance system. Though cost control and quality control logically overlap, at times they are allowed to merge and cause conceptual confusion. Finally, as systems are developed in Canada, it is suggested that a means of self-assessment be built in so that the validity and reliability are not in doubt.

No analysis of Canadian certification examinations in psychiatry has previously been published although analyses of the American Board of Psychiatry and Neurology and the British Membership examinations are available. Because candidates, directors of residency training, mental health planners and consumers are all interested in who passes and who fails the certification examinations, available examination data for English speaking candidates are analyzed. Successful candidates are more likely to be younger; to have attended medical schools in English speaking countries (in North America, the British Isles, or the "old Dominions"); to have placed in the upper two-thirds of their medical school class; to have entered psychiatric training soon after graduating from medical school and then to have completed their training without interruption. Some limitations of the examinations and the problem of candidates who fail are briefly discussed.

This paper examines the practice of involuntary mental hospitalization through examination of criteria used for committment in a sample of 200 civil commitment certificates. Special reference is made, following previous research, to criteria used to describe the person deemed dangerous to himself or to others. The relevance of the findings of present practices in mental health is discussed. New procedures which facilitate presentation of factual evidence, and which eliminate gratuitous information, are required without delay.

This article is the first of a two part review of the psychoanalytic theory of depression. In this first part of the review the work of the major contributors to the psychoanalytic theory of depression is discussed. The writings of Abraham, Freud, Rado, Klein, Jacobson, Benedek, Bibring, Spitz, Sandler and Bowlby, among other, are presented and critically reviewed by the author. The work of these authors has been selected for this review because they have made the most seminal contributions to the development of the psychoanalytic theory of depression. Necessarily those authors whose contributions have been largely clinical have not been included, the major focus of this review being theoretical. In reviewing the writings of the major contributions the major themes in the theory of depression can be discussed. These themes will form the subject of the next paper in this review.