Canadian Psychiatric Association journal最新文献

A pilot study was carried out to see what levels of agreement on the diagnosis of the different types of personality disorder, described by Schneider, could be obtained by observers with different amounts of clinical experience. Audio-recordings of eight patients were examined by 10 raters, who represented three levels of experience. Two patients had the same diagnosis made by 80 percent of the raters and these cases seemed best described as "typical". In all the cases agreement was increased when a second choice diagnosis was permitted. Significantly greater agreement was recorded by clinical clerks than by psychiatrists or psychiatric residents, though this was probably due to their making use of fewer of the types. It seemed probable that some types were less likely than others to be used for a first choice diagnosis. It is recommended that the most typical patients be employed in research in the field of the personality disorders if high diagnostic reliability is required.

The early concepts of family influences in the development of schizophrenic illness have been reviewed. The empirical research which these concepts generated has failed in large measure to confirm many of these hypotheses, but has demonstrated reliable and valid differences between families of schizophrenics and those of patient and non-patient controls. However, these empirical findings have had little impact to date on family therapy as it is practised, and the failure to confirm theoretical concepts from psychoanalysis, systems, and communication theories has not led to a re-examination of family therapy and its theoretical basis. The author suggests that the empirical research on family influences in schizophrenia and particularly those factors which precipitate and perpetuate schizophrenic symptomatology can be applied to evaluation of schizophrenics and their families, specific family therapy with families of schizophrenics, and particularly suggest that evaluative research on the effectiveness of family therapy in schizophrenia will be necessary for family therapy to become more than a highly fascinating and experimental technique in the total management of schizophrenic patients.

The author has reviewed in this paper the difficulties in developing a more generally accepted test of criminal responsibility. Such difficulties are more clearly seen when studying the applicability of the criminal responsibility test in Canadian law, Section 16, which the author describes as a disguised M'Naghten rule. Finally it is agrued that, because of the strictures encountered in the application of M'Naghten, some alternative routes have been developed at the courtroom level, notably Section 215 of the Criminal Code which deals with provocation. Section 215 gives legal footing to emotional conditions, producing an impairment in an accused's ability to form intent.

The authors describe a systematic approach to the process of formulation. Four interlocking phases are considered. The longitudinal data collection evaluate the patient's developmental journey. The cross-sectional evaluation includes careful consideration of phenomenological and dynamic factors. The integrative evaluation of these factors permits the construction of both a dynamic and a phenomenological diagnosis. Finally, in hypothesizing a tentative prognosis, we attemt to predict the capacity and quality of a person's potential change and readjustment.