"Selflessness" in the service of the ego: contributions, limitations and dangers of Buddhist psychology for western psychotherapy.

Buddhist psychology has now gained some credence in the West and is starting to exert a growing influence both on various areas of medicine and well-established Western psychotherapies. We reviewed key texts of both the Eastern and Western Buddhist literature, with particular emphasis on recent well-established Western authors. The Buddhist concept of "selflessness" is often perceived by Westerners as a recommendation for the dissolution of their ego and its propelling forces in their competitive societies, instead of an invitation to dispel the artificial compactness of their "I." With the notions of "Self" and "No self" placed at the interface of Buddhist psychology and Western psychotherapies, this article: (i) attempts a description of the pros and cons of the two approaches and (ii) points at a probably greater therapeutic potential when the two work hand in hand rather than as antagonists. Some of the limitations resulting from such a joint approach will also be highlighted.

Treatment of the psychiatric manifestations of Huntington's disease: a review of the literature.

OBJECTIVE: To review the clinical management of the psychiatric aspects of Huntington's disease (HD), namely the mood disorders, psychotic disorders, anxiety symptoms, sleep disorders, disorders of sexuality, and the behavioural changes of apathy, irritability, and aggression. Emphasis is on pharmacologic and psychotherapeutic intervention strategies. In addition, the role of psychiatric intervention in presymptomatic testing is explored. METHOD: English language literature on the pharmacologic and psychotherapeutic management of the psychiatric manifestations of HD between 1976 and 1996 was critically reviewed. RESULTS: Few sound studies address the clinical management of the psychiatric aspects of HD; thus, only the broadest conclusions can be drawn. Pharmacologic strategies for the treatment of psychiatric aspects of HD were organized according to the therapeutic agent and class, and psychotherapeutic strategies were discussed. CONCLUSION: The clinical management of the psychiatric manifestations of HD requires much more complete and systematic study before any definite conclusions as to efficacy of various approaches can be drawn.

Effects of light therapy on neuropsychological function and mood in seasonal affective disorder.

To date, little attention has been paid to changes in neuropsychological function in seasonal affective disorders (SAD). In this study, we investigated the performance of 30 patients with SAD on a wide range of cognitive variables before and after 2 weeks of light treatment with either white or placebo red light, as well as later in the summertime. Performance of subjects with SAD on neuropsychological tests was compared with a group of 29 age- and education-matched healthy control subjects. The most consistent deficits associated with SAD were on tests of cognitive failures, visual memory, and visual-construction skills. In contrast to specific bright light effects on psychiatric measures, reports of cognitive failures did not change with either light treatment. Visual memory and constructional deficits responded nonspecifically to treatment with either white or the presumed placebo red light. Surprisingly, visual memory deficits were seen again in the summer, at a time when mood, cognitive failures, and other cognitive functions appeared at normal levels. These data suggest that cognitive functioning is affected by SAD. In addition, light treatment may have differential effects on mood and cognition.

Multicenter, placebo-controlled study of fluoxetine in seasonal affective disorder.

OBJECTIVE: The authors investigated the efficacy and safety of fluoxetine in the treatment of winter seasonal affective disorder. METHOD: Sixty-eight outpatients who met the DSM-III-R criteria for recurrent major depressive episodes, seasonal (winter) pattern, were randomly assigned to 5 weeks of treatment with fluoxetine, 20 mg/day (N = 36), or placebo (N = 32). The outcome measures included the 29-item modified Hamilton Depression Rating Scale, administered by experienced clinicians, and the self-rated Beck Depression Inventory; adverse events and safety data were also recorded. Clinical response was defined as a greater than 50% reduction in depression score between baseline and study termination. RESULTS: Both groups showed significant improvement. The fluoxetine group had lower depression scores at termination than the placebo group, but these differences did not achieve statistical significance. However, the rate of clinical response in the fluoxetine group (59%) was superior to that in the placebo group (34%). Post hoc analyses showed that the greatest fluoxetine responses were in the most markedly depressed patients and that overall response was greater for patients studied later in the season. Fluoxetine was well tolerated, and few subjects dropped out because of adverse events. CONCLUSIONS: On the basis of clinical response rate, fluoxetine appears to be an effective, well-tolerated treatment for seasonal affective disorder. Because the differences between fluoxetine and placebo in the continuous outcome measures did not reach statistical significance, further studies with larger study groups and longer treatment periods are required to conclusively demonstrate efficacy of fluoxetine for seasonal affective disorder.

Hormonal responses to dl-fenfluramine challenge are not blunted in seasonal affective disorder.

Prolactin and cortisol responses to acute challenge with dl-fenfluramine (60 mg PO) were examined in 10 (6 women and 4 men) patients with seasonal affective disorder (SAD) and the same number of age, gender, menstrual status, and season matched healthy controls. Neither prolactin nor cortisol response was different in SAD patients in comparison to controls. The reasons for discrepancy in findings between studies are discussed.

[Consultation-liaison psychiatry: a prospective study in a general hospital milieu]. / La psychiatrie de consultation-liaison: une étude prospective en milieu hospitalier général.

This study was conducted in Halifax, Nova Scotia, in a 740 bed university general hospital. For a period of two years, a prospective collection of data on 692 psychiatric consultations showed that 60% of all consultations came from internal medicine departments. Medical and psychiatric comorbidity was found in 50% of the patients; depression was diagnosed in 27.5% of the cases but schizophrenia in only 1.7%. Suicidal ideation was reported by 24% of the patients, 11.6% of them wishing to die imminently. More than 50% of suicidal patients were under 35 years of age; 42% of them were dependent on alcohol. Almost 30% of the patients seen in consultation admitted to being addicted to alcohol, 22% to benzodiazepines and 14% to illicit drugs. Among the ex-alcoholic patients, a significant dependence in benzodiazepine use was found. The patients with addictions to street drug had a greater suicide risk and were at the same time abusing alcohol. This paper will describe the overall functioning of a consultation-liaison psychiatric service and will analyze the impact of psycho-active substance abuse in a general hospital setting. The results will be compared with those in the literature.

Factors affecting length of stay in a psychiatric intensive care unit.

As a response to the challenge posed by an increasing number of agitated and violent patients, there is in Canada a growing number of psychiatric intensive care units (PICUs), in both general and psychiatric hospital settings. In this article, the functioning of such a unit in a general hospital context is reviewed. Statistically significant changes in average length of stay (LOS) were observed, with an increase from 5.8 to 7.3 days over the period studied. The factors influencing the functioning and LOS of this PICU are analyzed. A possible "deskilling" of the staff in other wards is discussed, and alternative explanations are hypothesized in an attempt to shed light on the interaction between this unit and its environment.