From bridges to super-highways: transmitting meaning within and between professions, and across time and space--beginning the process.

As development of health informatics, including electronic patient records, proceeds apace there is an innate tendency to focus on acute and primary care, and upon bio-pathological data sets. This is where virtually all research and investment is being directed. However, the core purpose of health care (and mental health care in particular) is to improve and maintain the individual's functioning and sense of well-being, not simply to eliminate adverse pathology. It is therefore vital for health care records to contain subjective, descriptive, and self-expressed components if the record is to have true health meaning. This in turn raises challenges about meaning and context, terms and language. Most informatic systems run the risk of being Islands of Automation, linked at best by bridges conveying data sets rather than knowledge. If health informatics is really to serve people and their health, attention needs to be given to developing the recording, communication, and understanding of perception through shared meaning. Only then will informatics systems be full supporters of the people's health, and record system linkages become Super-Highways of Knowledge between patients and their supporting professionals.

Defining the role of pet animals in psychotherapy.

The literature now contains more than 1000 references to the use of a variety of animals in therapy. The terms used include Pet Therapy, Pet Assisted Therapy, Pet Facilitated Therapy. They reflect lack of agreement as to the role and effectiveness of animal use. Most are anecdotal descriptive studies lacking in scientific methodology. There are almost none in the psychiatric literature despite repeated claims of effectiveness in treating mental and emotional illness. This paper provides a review for the psychiatrist. It describes the development and use of rating scales to generate numerical values for statistical analysis, from videotaped observations of pet therapy sessions. Blind ratings yielded high inter-rater correlations. Although a pilot study, the results indicate the feasibility of designing definitive studies to evaluate the claims of animal enthusiasts. Valuable insights were gained which help to clarify the respective roles of animals and therapists.

Competence to consent to treatment: a guide for the psychiatrist.

During the last decade there has been increasing pressure to legislate legal rights for psychiatric patients especially in relation to consent to treatment. The attempt to subject the irrationality of psychotic illness to the due process of rational laws has caused problems. Revision of the Ontario Mental Health Act (MHA) has already led to situations in which patients are being incarcerated without treatment because of review board decisions regarding dangerousness and competence. The test in the revised MHA is whether the patient is competent to give or withhold consent for treatment. Existing guidelines for determination of competence to consent to treatment rely upon observer judgement and are open to challenge on grounds of subjectivity. The medical directors of the ten Ontario provincial psychiatric hospitals have therefore developed a guide and schema to operationalize the MHA definitions, a novel feature of which is the examination of competence in such a way as to elicit and capture the patient's own responses upon which an objective determination is made.

The chronically mentally ill: planning a future.

The plight of the chronically mentally ill in contemporary society is explored. Appropriate treatment strategies identified require organizational changes at both local and provincial levels, and altered management philosophies. The criteria used in major studies to define the study population are identified and epidemiological data provided to illustrate the numbers and disposition of sufferers of "Prolonged Functional Disabilities caused by or aggravated by Severe Mental Disorder." Operational and research data from a regional psychiatric research service confirm that many patients formerly considered chronically institutionalized can be successfully discharged when goal-oriented multidisciplinary methods are introduced. External inhibiting factors are identified which society must address. Psychiatry must embrace and develop the new philosophies. Rational planning based upon patient need will require changes in the present vertical hierarchical structure of health care organization. Some elements of a strategic planning model are identified.

Brain-type creatine phosphokinase serum levels before and after ECT.

Brain-type creatine phosphokinase isoenzyme (CPK BB) was measured by radioimmunoassay in the serum of 31 depressed patients undergoing bilateral ECT. Samples were taken shortly before and at one hour, two hours, and six hours following ECT. ECT did not cause a significant alteration in serum CPK BB concentration during the six hours following the treatment. Similarly, there was no difference in mean pre-ECT concentration of serum CPK BB between patients receiving the first ECT of their current admission and those receiving subsequent treatments. These findings do not support suggestions that ECT causes alteration in permeability of the blood-brain barrier, nor that it causes detectable brain injury.

Vocabulary deficit and abstraction impairment in hospitalized alcoholics.

The use of a standard intelligence test for detecting cognitive impairment has been re-examined in a cohort of 506 hospitalized alcoholics. The value of Vocabulary scores as indicators of original intelligence was tested by formulating the hypothesis that Vocabulary scores would remain constant despite increasing degrees of alcohol-induced cerebral dysfunction. Subjects were assigned to non-dysfunctional, minimal and severe dysfunctional groups on the basis of psychometric testing and their Wechsler Vocabulary scores categorized as either 'abstract' 'concrete' or 'wrong'. Significant linear deficits in Vocabulary score and loss of abstract ability correlated with increasing dysfunction, irrespective of age but with greater frequency in females.