Canadian Psychiatric Association journal最新文献

The authors present a method of reporting and evaluating a formulation. The reporting of a formulation includes a summary introduction, biological considerations, psychosocial considerations and hypothesis construction. Three sample formulations are scrutinized and specific critical evaluations offered. The subsequent reformulations are presented.

Electroconvulsive therapy is a treatment procedure in psychiatry which has frequently come under considerable critical scrutiny. This paper describes its use mainly in a postgraduate institute of psychiatry and, for comparative purposes, two other types of psychiatric facilities in Toronto. The treatment is given conservatively, varying to hospital, and is prescribed for 11 percent of patients at a postgraduate institute. However, it is used largely for those with depressive disorders as recommended in standard textbooks. Diagnosis and age are the key variables affecting ECT prescription. It is suggested that ECT practice is effective by and large and now efforts should concentrate on making it efficient.

A discrepancy is identified between the increase in inpatient admissions and of outpatient contacts of Treaty Indians in Saskatchewan from 1967 to 1976. This is the reverse of the trend in the non-Treaty Indian population, and represents a contradictory effect to the intention of the Community Psychiatry Program of the province's government. No major diagnostic differences were at statistically significant levels, which might have accounted for the higher inpatient admission rates and the relatively lower outpatient contact rates of Treaty Indians. This is an interesting example of the use of governmental statistics and a promising one for the identification and solution of problems in health care delivery.

A case of addiction to Diazepam is reported. Severe withdrawal symptoms such as tremulousness, irritability, increased psychomotor activity, generalized muscle cramps, photophobia, retro-orbital pains and insomnia are described. Visual hallucinations, illusions, and paranoid features are also present in this case. Detoxification and management were accomplished by gradual withdrawal and the addition of another tranquilizer, anticonvulsant and muscle relaxant. The author reviews other such reports of abuse and addiction in the literature which call for wide recognition of the addictive properties of Diazepam and for restrictions on its indiscriminate prescription by physicians.

In recent years, more women have pursued careers in business and the traditionally male professions. Those that have succeeded live with a high degree of environmental stress. Since some of them are now consulting psychiatrists it is important that the psychiatrist be able to differentiate difficulties which have a cultural basis from those stemming from individual psychodynamics. Cultural stresses have been reviewed under three headings: inaccurate stereotypes; inadequate cultural supports; and role overload. It has been suggested that contact with her peer group is extremely important for this type of woman patient. The peer group provides both support and a frame of reference within which individual problems may be understood.

The diagnosis of chronic pain cases is now an important problem for psychiatrists and many authors have presented strong evidence for the influence of psychological factors in chronic pain conditions. The author is reporting his experience with 75 consecutive out-patient consultations. Many of the patients were foreign-born and had significant language difficulties. The main diagnostic technique described is the use of sodium amytal given intravenously over a 45 minute-period while the patient is examined physically and psychologically; his responses noted during light, midrange and deeper levels of sodium amytal sedation. Most patients fell comfortably into one of the following diagnostic groups: psychogenic regional pain, organic pain, mixed group (organic plus psychogenic regional pain), and malingering. The author suggests that sodium amytal helps to overcome language barriers, reduces the time required for proper assessment and allows the patient and the examiner to appreciate more precisely, the level of pain and the limits of physical performance as well as permitting an effective exploration of important psychodynamic issues.