Psychosis as precipitating trauma for PTSD: a treatment strategy.

Parallels between the experience of living with a psychotic illness and that of PTSD as a response to combat stress are explored, and similarities with respect to a loss of a sense of self are examined. Therapeutic implications of the possible connection between the two disorders are delineated in terms of a three-stage psychosocial recovery model.

Brainstem evoked potentials in panic disorder.

Patient reports and laboratory tests support the notion that panic attacks are generated by stimulation of brainstem nuclei. Scalp-recorded brainstem auditory evoked potentials may serve as a unique measurement strategy for the noninvasive assessment of the role of brainstem functioning in panic disorder. Ipsilateral and contralateral BSAEP recordings were examined in response to separate left and right ear click stimulation in 28 patients with a diagnosis of panic disorder and in 18 normal controls.

Semi-structured depression scale sensitive to change with treatment for use in the elderly.

The construction of a semi-structured interview depression scale that is sensitive to change for use in the elderly is described. Depression items from a well validated diagnostic instrument, the Geriatric Mental State Schedule (GMSS), were used as the core items in the development of the instrument. Improvement in depression in 80 elderly patients was independently assessed with two standard rating scales for depression, the Hamilton Rating Scale for Depression and the Beck Depression Inventory, and by an independent clinician's judgement before and after standard antidepressant treatment.

Designing long-term clinical trials in affective disorders.

Long-term clinical trials in affective disorders have become increasingly important, but their methodology continues to impose a major challenge. An ideal design can be developed but is difficult to implement. The advantages and disadvantages of different designs (mirror image, double-blind study controlled with placebo, and/or standard and discontinuation studies) are described and compared.

Capacity to stand trial: pitfalls of legal interpretation.

Legally, the concept of fitness to stand trial is fixed and absolute. Psychiatrists view fitness as a homeostatic functional capacity. The Ontario Court of Appeal recently set a precedent (Queen versus Taylor) for a standard of fitness to stand trial by interpreting the criteria for unfitness as defined in terms of Section 2 of the Criminal Code.

Structural correlates of neurological signs in Huntington's disease: a quantitative approach.

Huntington's disease (HD) is a genetically transmitted disorder associated with atrophy of the basal ganglia. Studies of the neuroanatomical correlates of HD have focused primarily on the anterior areas of the basal ganglia and on establishing an association between structural changes resulting from the presence and course of the illness. The objective of the present study was to assess the value of measurements of the third ventrical and lentiform regions.

Pharmacological therapy of dysthymia.

For a number of years, dysthymia was considered to be non-responsive to antidepressant treatment. During the last decade, early studies with tricyclic antidepressants (TCAs) demonstrated the superiority of the TCAs over placebo. The side effect profile of the TCAs and the moderate degree of symptomatology resulted in reduced compliance and thus to the clinical impression of lack of efficacy.

Parent-rating and self-report measures in the psychiatric assessment of adolescents.

Thirty adolescents who received a psychiatric diagnosis based on the DSM-III clinical criteria were compared to 28 adolescents who were free of a diagnosis using the same criteria, on a parent-completed questionnaire (Revised Behavior Problem Checklist) and self-report measures (Revised Children's Manifest Anxiety Scale, Children's Depression Inventory, SCL-90-R). The two groups of adolescents were significantly distinguished by scores from the parent questionnaire but not by self-report measures. Possible explanations for the discrepant results are discussed.

Anxiety disorders. Part 1: Diagnosis and treatment.

Anxiety disorders often take second priority in clinical practice because many physicians do not understand them or their treatment. This paper reviews the diagnostic groupings of anxiety disorders according to the American Psychiatric Association's Revised Diagnostic and Statistical Manual of Mental Disorders (DSM 3-R) and discusses differential diagnosis and treatment.

Anxiety disorders. Part 2: Pharmacotherapy with benzodiazepines.

Anxiety disorders can be treated successfully with benzodiazepines. This paper focuses on dispelling the myths and prejudices that surround treatment with these medications.

The challenge of predicting response to stabilising lithium treatment. The importance of patient selection.

Lithium treatment, an approach with well documented efficacy, has recently been losing its treatment value. Lithium continues working, however, for those patients for whom it was proven efficacious; that is, most patients with primary episodic affective disorders. Such responders to lithium prophylaxis can be reliably identified beforehand by a comprehensive clinical assessment.

Pharmacotherapy of attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder, characterized by poor sustained attention, diminished impulse control and excessive physical activity, is found in most cultures and most countries. However, diagnostic terminology and management vary from centre to centre. Pharmacotherapy in conjunction with individual and family therapy is generally accepted as the most effective treatment, while psychostimulants are the drug of choice.

Further evidence for the existence of endogenous serotonin uptake inhibitors and their purification by calmodulin affinity chromatography.

Experimental evidence suggests the occurrence of endogenous antidepressant-like compounds in the brain, blood plasma, and urine. After extensive purification by calmodulin-sepharose affinity chromatography, and further purification of the urine-derived sample by exclusion chromatography, at least three distinctive fractions have been identified. These fractions effectively inhibited serotonin uptake, imipramine, and/or paroxetine binding, and they apparently contained some compounds that were recognized by the anti-imipramine or anti-paroxetine antibodies.

A comparison of sexual victimization in the childhoods of pedophiles and hebephiles.

The association between perpetration of sexual abuse and the offender's own victimization as a child has been well documented in the literature. Various researchers have examined this relationship by assessing the exclusiveness of the sexual abuser's behavior, the gender of his victims and the gender of his own childhood abuser. This study was designed to assess the differences between pedophiles and hebephiles in features of their own childhood victimization.

Use of anxiolytics in children.

Anxiety disorders are among the most frequent of childhood psychiatric disorders. These disorders can persist from childhood and adolescence into adulthood, resulting in impaired functioning at home, school or work. Some anxiety disorders like generalized or separation anxiety are acute requiring urgent, short-term treatment.

Reversible monoamine oxidase-A inhibitors in panic disorder.

Monoamine oxidase (MAO) inhibitors are known to be effective in panic disorder, but a high incidence of adverse reactions have limited their use. The new, selective, and reversible MAO-A inhibitors exemplified by brofaromine and moclobemide do not require dietary restrictions, have fewer drug interactions, and are better tolerated. This paper reports a randomized, double-blind, 8-week trial in which the efficacy and safety of brofaromine was compared to clomipramine in patients with panic disorder with or without agoraphobia.

An open study of oral flesinoxan, a 5-HT1A receptor agonist, in treatment-resistant depression.

Flesinoxan, a full 5-HT1A receptor agonist, was administered (4-8 mg) to treatment-resistant depressed patients in an open study. Safety and tolerance of the substance appeared satisfactory. Headache, dizziness and nausea were the most frequently reported side effects.

The placebo problem in child and adolescent psychiatry.

This paper is part of a special section on 'psychopharmacotherapy in children'. In contrast to adult psychiatry, research of placebo uses and effects in child and adolescent psychiatry is practically nonexistent, except in the context of clinical drug trials. Any type of therapy in pedopsychiatry may have positive or negative placebo effects, not only on the patients but also on their parents, teachers and therapists.

A dose-finding study with remoxipride in the acute treatment of schizophrenic patients.

Two hundred and forty-two patients with acute schizophrenia were enrolled in a double-blind, comparative, dose-finding study of a novel antipsychotic, remoxipride. Remoxipride was evaluated in a low (30 to 90 mg), medium (120 to 240 mg) and a high (300 to 600 mg) dose range and compared with a haloperidol (15 to 45 mg), which was administered to a similar group of patients. The results support the antipsychotic effect of remoxipride, with maximum efficacy occurring at daily doses between 120 mg and 600 mg.

Incest perpetrators. Their assessment and treatment.

The multitude of articles published in the last decade in the area of intrafamilial sexual abuse highlight the complexity of the issue--both its assessment and treatment. Although no unique profile of an incest perpetrator exists, a review of studies revealed problems in the areas of sexual satisfaction, psychological functioning, interpersonal relationships, and family of origin. As well, incest families have been reported to be dysfunctional, with power imbalances; control struggles; indirect, unclear communication; and inappropriate coalitions among family members.

Substance abuse and criminal behavior.

As forensic psychiatry develops as a clinical subspecialty, clinical skill in understanding, treating, and predicting violent behavior will become more important. This article addresses the importance of understanding the relationship between substance abuse and violent behavior. This article also discusses morbidity and mortality in substance abuse, the demographics of substance abuse and criminality, and the clinical aspects of the forensic psychiatric evaluation.

A double-blind placebo-controlled comparison of moclobemide and amitriptyline in the treatment of depression.

The objective of this study was to determine if moclobemide is an effective treatment for depression and if it is well tolerated by patients. A randomized, double-blind placebo-controlled trial was conducted in a tertiary ambulatory clinic which treats depression. Fifty-five patients participated.

Abduction during custody and access disputes.

In recent years abductions during divorce custody and access disputes have received greater attention from both the lay and medical press. However, little has been written on the psychopathology of the abductors or the impact on children of being kidnapped by a parent. In this study 20 cases of abduction, involving 20 parents and 37 children, were examined after the children had been located and returned to the custodial parent.

The paraphilias: a multiplicity of deviant behaviours.

The DSM-II and DSM-III both allow for multiple diagnoses. The DSM-III acknowledges that a patient may have multiple paraphilias but the true nature and extent of the multiplicity has only been documented recently. In order to study the degree of crossover between the various paraphiliac acts, a study of men who admitted to at least one paraphilia was conducted.