Canadian Psychiatric Association journal最新文献

The so-called superior-mesenteric-artery syndrome is not mentioned in psychiatric journals or books. Yet two variations of the condition have been described. In its acute form, it can be mistaken for psychogenic vomiting in anorexic patients, while its chronic intermittent form is readily misdiagnosed as anorexia nervosa. The case report is of a 16 year old boy admitted for investigation and treatment of severe weight loss. He initially responded to a modified behaviour program, but within days developed an acute small-bowel obstruction. Superior-mesenteric-artery syndrome was diagnosed and he improved with appropriate medical management. This condition needs to be considered by the psychiatrist who otherwise might not differentiate it from the symptoms of anorexia nervosa.

A review of the case books of 868 patients who had been admitted into a psychiatric hospital from January 1, 1970, to December 31, 1973, was carried out for consistency in the pattern of diagnosis by the same or different psychiatrists. Of these, 16.5% had a revision in diagnosis. The pertinent literature was reviewed. The possible factors that contribute to the observed inconsistency in diagnosis in this and other investigations are discussed. It is concluded that the problems as reflected in the significant change in diagnosis in this study are multifactorial. It is suggested that these problems may be related to the unknown etiology of the functional psychoses and the absence of identifiable specific lesions.

Although there is a large literature pertaining to the use of the dream in psychoanalysis, there is no systematic approach to working with dreams in psychotherapy. This communication seeks to present some guidelines for the use of the dream in psychotherapy. Reference is made to the significant difference in the "dimensions" of psychoanalysis as compared to psychotherapy. A distinction is drawn between the use of the dream in supportive psychotherapy as contrasted with insight-oriented psychotherapy. In the former, the dream--if used at all--serves supportive functions; in the latter, the goals are to develop better awareness by the patient of himself. Understanding of the dream is reached by inserting it into the context of the patient's psychological life; however, what is actually communicated to the patient will be keyed to the psychologic surface that the patient presents.

In this article, the author explores the relationship between the lawyer as advocate and the psychiatrist as expert. He argues that the role of the psychiatrist in aiding the Court in the determination of relevant issues is one of increasing importance. Often the diagnostic opinions offered by the psychiatrist border on conclusory legal determination. As such, those opinions must necessarily be subjected to the testing of adversarial processes. The role of the psychiatrist is to proffer a relevant opinion while nevertheless realizing that the inexact nature of the science limits the use such an opinion may have. The lawyer as adversary must subject that opinion to as rigorous an examination as possible. This examination is not an affront to the psychiatrist but rather an attempt to explore and expose the definitiveness of that opinion. It is through this combination of realized opinionating and adversarial examination that relevant legal-medical determinations can best be made within the confines of our existing judicial mode of dispute settlement.

Theoretical accounts of the origins of gender identity disturbance are reviewed and then followed by a description of the establishment of a child and adolescent gender identity clinic. Clinical impressions of 16 gender disturbed patients are presented and the position is taken that most patients manifested a confused, as opposed to fixed, core gender identity.