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doi: 10.1177/070674379103600102pmid: 2029681
This overview addresses issues related to psychiatric services for the elderly in Canada. The author reviews the developments in the United Kingdom that have led to the establishment of guiding principles which may be applied to the Canadian health care system. These include the clear definition of a target population, a comprehensive approach to services, availability and accessibility, and clear accountability. A model for the establishment of regionalized psychiatric services is proposed, including the integration of hospital-based and community-based services with clearly defined areas of responsibility. In light of the changing demographics in Canada and the prevalence of psychiatric illness in the elderly, this is a matter of growing urgency for the health care system.
El-Guebaly, N.; Beausejour, P.; Woodside, B.; Smith, D.; Kapkin, I.
doi: 10.1177/070674379103600103pmid: 2029689
A systematic effort is underway to rationalize the planning of physician supply. This paper summarizes the current methodologies available and focuses on the attempts to determine the optimal psychiatrist-to-population ratio in Canada. The impact of several variables influencing this ratio is discussed. An outline of the correlation between target physician supply and requirements of future trainees is presented. While the relevant methodology is rapidly evolving, an improved process of data collection is urgently required. A number of challenges for our profession lay ahead, such as the need for sensitive and reliable measures of the adequacy of psychiatrist and subspecialist supply and public issues arising from the poor geographic distribution of psychiatric manpower.
Stein, B.A.; Golombek, H.; Marton, P.; Korenblum, M.
doi: 10.1177/070674379103600104pmid: 2029678
Non clinical adolescents in a longitudinal study were examined at ages 16 and 18 to see whether or not there were changes in personality functioning, attitudes and affect over time, and whether or not these were related to each other. Personality functioning remained fairly consistent at both ages, with marked personality problems occurring in about one out of seven. As a group, the older adolescents demonstrated more anxiety and depression, as well as changes in certain attitudes such as more curiosity and interest in people. For individual adolescents it was found that there was considerable predictability of affect and attitudes at age 18 from the presentation at age 16. Furthermore, a relative increase in the amount of anger in middle adolescence was a predictor of personality problems in late adolescence.
Awad, A. George; Darby, Padraig L.; Garfinkel, Paul E.
doi: 10.1177/070674379103600105pmid: 2029679
A survey among psychiatric residents about their satisfaction with and concerns about their training in psychopharmacology was conducted. One hundred and seventy responders (61%) from ten post-graduate psychiatric programs in Canada completed the questionnaire. The questionnaire assessed the residents' satisfaction with the training they had received over the previous six months as well as over their entire residency period. The questionnaire enquired specifically about the quantity and quality of supervision in the use of different medications for different therapeutic purposes. It also looked at the quality of supervision of drug therapies within hospital services, inpatient, outpatient, consultation and emergency services. Residents also were asked about coverage of specific topics and ranked different methods of learning. The survey uncovered a number of deficiencies mostly related to the teaching of basic psychopharmacology, integration of psychopharmacological and psychosocial issues and the lack of teaching of clinical appraisal of recent advances. Factors that may have contributed to the development of such deficiencies as well as specific recommendations are discussed.
Korzekwa, Marilyn; Steiner, Meir; Links, Paul; Eppel, Alan
doi: 10.1177/070674379103600106pmid: 2029680
The relationship between borderline personality disorders (BPD) and major depressive disorder (MDD) continues to be controversial. A reliable biological marker for depressed BPD patients would not only support the diagnosis but could also help in predicting treatment outcome. A large sample of psychiatric patients was screened and data on the Dexamethasone Suppression Test (DST) were obtained for 67 patients who met the criteria for BPD by scoring 7 or greater on the Diagnostic Interview for Borderlines. The DST was positive in 23.9% of the cases. Fifty cases of BPD also met the Research Diagnostic Criteria for MDD. The DST was positive in 26.0%. Of the 50 patients with MDD, 34 also met the criteria for endogenous depression. Only 17.6% of this subgroup had positive results on the DST. The low sensitivity and specificity of the DST for depression in BPD patients suggests that the DST is not a useful test in differentiating BPD patients with MDD from those without MDD. The possible reasons for the DST not being useful in this population are discussed. These findings raises further questions about the nature of the depression suffered by BPD patients.
Goldman, David L.; Jacob, Therese
doi: 10.1177/070674379103600107pmid: 2029682
Few medicolegal doctrines have spread so widely and wildly as the Tarasoff duty of professionals to protect potential victims of violence perpetrated by psychiatric patients. Post-Tarasoff decisions have not been limited to identifiable third parties in danger, but in some circumstances have been extended to the community at large. Lipari v. Sears, Roebuck and U.S. is the first of such court rulings to invoke the concept of strict liability for the violent acts of a patient who, in the case presented, randomly fired at club patrons, killing one and wounding many others. A detailed examination of this pivotal and troubling case will facilitate recognition of the inherent complexity associated with subjecting human problems to the legal process.
Dobkin, Patricia; Dongier, Maurice; Cooper, Douglas; Hill, Jeanne-Marie
doi: 10.1177/070674379103600108pmid: 1674224
The prevalence of alcoholism is generally underestimated in patients in private practices, general hospitals and psychiatric institutions. Even though the World Health Organization has advocated the concurrent use of laboratory test results and questionnaires for screening, these methods are seldom used together. In this study, patients admitted consecutively to the North Bay Psychiatric Hospital were screened for alcoholism using the Michigan Alcoholism Screening Test (MAST) and gamma-glutamyl-transferase plasma level. Unexpectedly, 56.7% of the entire sample were identified as possible alcoholics; of these, 73.5% were men and 26.5% were women. When rates for men and women were looked at separately, it was found that 66.2% of the men and 40.6% of the women were alcoholic.Participants who tested positive on one or both of the screening tests were offered a more complete evaluation of their drinking behaviour. A diagnosis of alcoholism was confirmed in 88.2% of the patients who agreed to participate further. The question remains whether the high prevalence rates found are a function of the particular sample studied (i.e., patients in a hospital which typically serves a socially disadvantaged sector of the population) or reflects a feature of the general population in this catchment area. A study is currently underway in general hospitals of North Eastern Ontario in an attempt to answer this question.
Silva, J. Arturo; Leong, Gregory B.; Longhitano, Maria; Botello, Timothy E.
doi: 10.1177/070674379103600109pmid: 2029683
A case of Capgras syndrome in a pregnant patient is described. In addition to perceiving living family members as impostors, she believed that there was a double or twin of her fetus. She conceptualized her “twins” differently than the way she viewed doubles of family members. Her fetus may represent the youngest “person” to have been duplicated. The relationship of Capgras syndrome to misidentification phenomena is discussed.
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