Interactions of staff and residents with pharmaceutical industry: a survey of psychiatric training program policies.

OBJECTIVES: In response to perceived controversies regarding interactions between physicians and the pharmaceutical industry, we undertook a study to look at the relationship between Canadian psychiatry training programs and the pharmaceutical industry. METHODS: The authors distributed a survey to the residency program directors and chief residents of the 16 psychiatry training programs in Canada. RESULTS: Of respondents, 75 per cent were either unaware of or noted an absence of policies or guidelines regarding interactions with the pharmaceutical industry in their training programs; 70 per cent viewed staff psychiatrists and residents to be at least 50 per cent familiar with the Canadian Medical Association's policy summary; and 74 per cent were unaware of any structural teaching regarding potential conflicts of interest between psychiatry and the pharmaceutical industry. A significant number of respondents perceived occasional excessive influence by the pharmaceutical industry on residents' training. CONCLUSIONS: Despite concerns about potential conflicts of interest, there are a few guidelines in most psychiatry training programs in Canada regarding the relationship between physicians and the pharmaceutical industry.

Family functioning in subjects with pseudoseizures and epilepsy.

The purpose of this study was to identify differences in family functioning between subjects with pseudoseizures and their families, and control subjects with epilepsy. Thirty-one adult subjects with pseudoseizures and 31 controls with intractable epilepsy, whose diagnoses were confirmed using video-EEG, were recruited from the epilepsy unit of a tertiary care hospital over a 4-year period. Each study participant and their first-degree adult family members completed two standardized questionnaires designed to measure family functioning: the McMaster Family Assessment Device (FAD) and the Beavers Self-Report Family Inventory (SFI). Individuals with pseudoseizures, when compared with epileptic subjects, exhibited significantly elevated scores in three scales of the FAD and in one scale of the SFI, indicating greater psychopathology within the family, as perceived by the individual. Statistically significant differences with the FAD were on measures of affective involvement (p = .044), communication (p = .004), and general functioning (p = .013). The SFI revealed significantly greater difficulty with conflict (p = .050). No differences were noted between subjects with both pseudoseizures and epilepsy and subjects with pseudoseizures alone. In comparison with the families of the epileptic group, the families of subjects with pseudoseizures displayed statistically significant elevations in their responses on the roles scale (p = .003) of the FAD. The responses of the family members did not differ in regard to the role they assumed within the family unit (i.e., spouse, parent). In summary, individuals with pseudoseizures view their families as being more dysfunctional, particularly in the area of communication, whereas their family members perceived difficulties in defining roles. This suggests that family education and interventions focusing on these areas, may be an important aspect of the treatment of patients with pseudoseizures.

Child and adolescent bipolar disorder.

The present paper provides an overview of child and adolescent bipolar disorder for paediatricians. Epidemiology, premorbid characteristics, clinical characteristics, differential diagnosis, comorbidity, course, prognosis and multimodal treatment are reviewed. The rate of child and adolescent bipolar disorder appears to be increasing. It manifests with symptoms consistent with the developmental level of the patient, which can make diagnosis difficult. Compounding the diagnostic difficulty is the frequent presence of comorbid conditions. Early recognition and treatment are critical given the severe morbidity associated with this condition. Thus, it is essential that paediatricians and other primary care physicians are familiar with this disorder to recognize its presence and activate appropriate multimodal treatment.

Early onset major depressive disorder.

The present paper provides an overview of the clinical diagnosis and presentation, epidemiology, coexisting problems, and treatment issues of child and adolescent depressive disorders, with a focus on major depressive disorder (MDD). Depression is a common and potentially debilitating disorder for youth; has significant comorbid, behavioural and systemic sequelae; and is associated with a significant suicidal risk. Although rigorous study of psychosocial and pharmacological treatment modalities is in its infancy, current treatment is also informed by judicious and patient-specific clinical judgment. In view of the duration of MDD, remission and recurrence rates, morbidity, and potential chronicity of impaired psychosocial functioning, both active treatment and research involving MDD are indicated.

A review of the psychobiology and pharmacotherapy of posttraumatic stress disorder.

OBJECTIVE: To review the literature on certain psychobiologic elements of posttraumatic stress disorder (PTSD) as they pertain to possible pharmacotherapeutic interventions. METHOD: The literature pertaining to the neuroanatomical, neurochemical, and cellular elements was reviewed. As well, both controlled and uncontrolled studies of pharmacotherapy in PTSD were analyzed. RESULTS: The literature suggests that the stress response triggers certain neuromodulators with subsequent psychoneurological restructuring; that various antidepressants have been demonstrated to be effective for treatment of criterion B symptoms; that, to date, a single antidepressant has been demonstrated to be effective in a controlled trial for criterion C symptoms; and that, to date, in controlled trials, antidepressants and a benzodiazepine have proved effective for criterion D symptoms. CONCLUSION: Currently, a comprehensive approach requires multimodel understanding and multimodal treatment.

Dissociative experiences among psychiatric inpatients.

The Dissociative Experiences Scale was administered to 299 inpatients on an acute care general adult psychiatric ward over a 2-year period. The average score was 14.6, which is significantly higher than the mean for the general population. About one in six inpatients reported very high scores above 50 on the seven most common items in the scale, indicating a high level of dissociative psychopathology. Based on the responses to four items which form a scale factor called Activities of Dissociated States, an estimate is made that 6%-8% of general adult inpatients may have multiple personality disorder. Dissociative psychopathology is common on inpatient units.

The frequency of multiple personality disorder among psychiatric inpatients.

OBJECTIVE: A 2-year study was undertaken to determine the frequency of multiple personality disorder among general adult psychiatric inpatients. METHOD: All individuals admitted to two 23-bed acute care wards in a teaching hospital in Winnipeg, Man., were screened with the Dissociative Experiences Scale. Individuals with prior diagnoses of multiple personality disorder were excluded. All subjects scoring 20 or higher on the Dissociative Experiences Scale were interviewed with the Dissociative Disorders Interview Schedule. Then subjects with a diagnosis of multiple personality disorder and comparison subjects were interviewed by a clinician who was blind to all research data. RESULTS: A total of 299 subjects completed the Dissociative Experiences Scale and 80 received a structured diagnostic interview. Ten subjects (3.3%) had clinically confirmed multiple personality disorder. CONCLUSIONS: If these results are replicated and accepted, multiple personality disorder will become a serious consideration in the differential diagnosis of many psychiatric patients.

Dissociation in alternative healers and traditional therapists: a comparative study.

Nineteen psychiatry residents were compared to 12 community-based alternative healers on the Dissociative Experiences Scale and the Dissociative Disorders Interview Schedule. Neither group showed evidence of extensive psychopathology. However, the alternative healers reported more Schneiderian symptoms, extrasensory experiences, and secondary features of multiple personality disorder. Among the healers, these experiences did not seem to be indicative of psychopathology, and were in fact valued and sought after. Dissociative experiences are not necessarily indicators of psychiatric disorder in nonclinical groups.