Canadian Journal Of Psychiatry Research Articles

Editorial introductions

Current Opinion in Psychiatry was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of psychiatry is divided into 13 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. Section Editors Nick BourasNick BourasNick Bouras MD. PhD, FRCPsych is Professor Emeritus of Psychiatry at the Institute of Psychiatry, King's College London and currently director of Maudsley International. He was Consultant Psychiatrist, at South London and the Maudsley NHS Trust and Director of the Estia Training and Research and Development Centre from 1982 to 2008. He has been member of several National and International organisations including Chairman, World Psychiatric Association, Section of the Psychiatry of Mental Retardation, Vice President of the European Association of Mental Health in Mental Retardation and Vice President of the International Association for the Scientific Study of Intellectual Disability. His research is focused on health service related topics including, assessment and clinical effectiveness of specialist mental health services, evaluation of multi-professional training methods, social and biological determinants of behaviour in psychiatric patients. He has been Editor and member of the Editorial Board of several journals. He has published extensively in community psychiatry and mental health aspects of people with intellectual disabilities. His two recent books are entitled Intellectual Disability and Ill Health, O’Hara, J., McCarthy, J., Bouras, N (eds.) (2010) published by Cambridge University Press and Mental Health Services for Adults with Intellectual Disability: Strategies and Solutions, Bouras, N and Holt G. (eds.) (2010) a Maudsley Monograph published by Rutledge. Julio Arboleda-FlórezJulio Arboleda-FlórezProfessor Julio Arboleda-Flórez, Canadian, born in Colombia, is a graduate of the Universidad Nacional de Bogotá, Colombia (1964). He did his studies in Psychiatry at the University of Ottawa, Canada in 1970 and in Forensic Psychiatry at the University of Toronto, Canada in 1971. He is a Fellow of the Royal College of Physicians and Surgeons of Canada (FRCPC, 1970), Diploma of the American Board of Forensic Psychiatry (DABFP, 1979) and PhD in Epidemiology (University of Calgary, 1994). Professor Arboleda-Flórez holds a Diplôme de Langue Française from the École Internationale de Langue et Civilization Françaises (Paris, 1984). He is a Member of the American College of Psychiatrists; Distinguished Life Fellow of the American Psychiatric Association; Fellow of the American College of Forensic Psychiatry and of the American Board of Forensic Examiners; Fellow of the Canadian Psychiatric Association and of the Royal Society of Medicine, Honorary Member of the World Psychiatric Association in 1993, Honorary Member of the Asociación Ecuatoriana de Psiquiatría in 1994, Member Emeritus of the Forensic Department, Associaõ Brasileira de Psiquiatria in 1996 and Honorary Life Chairman of the Forensic Section of the World Psychiatric Association in 2008. He is a holder of a Rectoral Medal and is Honorary Professor at the Universidad de Chile; Adjunct Professor, Department of Psychiatry, University of Ottawa and Visiting Professor, Universidad del Bosque, Bogotá, Colombia. Presently, Professor Arboleda-Flórez is Director of the Queen's/PAHO/WHO Regional Unit for Research and Training in Psychiatric Epidemiology; Member of the Nominating Committee and of the Ethics Committee of the World Psychiatric Association; Consultant, WPA Task Force on the Destigmatization of Psychiatry; Member, Panel of Experts – Strategy and Action Plan Mental Health for the Americas of the Pan American Health Organization; Member, Research Ethics Review Board of the Pan American Health Organization; Corresponding Member, Ethics Committee of the American Psychiatric Association, and President of the World Association for Social Psychiatry. He is Temprary Consultant with the World Health Organization, Immediaste Past-President, International Academy of Law and Mental Health and of the Canadian Academy of Psychiatric Epidemiology, and has been chairman of the Province of Ontario, Forensic Psychiatric Services Expert Advisory Panel and member, Ontario Review Board. He is Editor-in-Chief of The Open Law Journal, Member of Editorial Boards of national and international medical journals, Guest Editor on special topics at the Canadian Journal of Psychiatry and Current Opinion in Psychiatry and he acts as Reviewer for research granting bodies. Professor Arboleda-Flórez is an international speaker, researcher on mental health services, psychiatric ethics and psychiatric epidemiology, author of books, multiple chapters and over 200 scientific papers and technical reports on mental health services, public mental health, mental health ethics, forensic psychiatry and psychiatric epidemiology. He is fluent in Spanish, English and French and has reading and oral comprehension in Italian, Portuguese and German.

From Benzos to Berries: Treatment Offered at an Aboriginal Youth Solvent Abuse Treatment Centre Relays the Importance of Culture

First Nations and Inuit youth who abuse solvents are one of the most highly stigmatized substance-abusing groups in Canada. Drawing on a residential treatment response that is grounded in a culture-based model of resiliency, this article discusses the cultural implications for psychiatry's individualized approach to treating mental disorders. A systematic review of articles published in The Canadian Journal of Psychiatry during the past decade, augmented with a review of Canadian and international literature, revealed a gap in understanding and practice between Western psychiatric disorder-based and Aboriginal culture-based approaches to treatment and healing from substance abuse and mental disorders. Differing conceptualizations of mental health and substance abuse are discussed from Western psychiatric and Aboriginal worldviews, with a focus on connection to self, community, and political context. Applying an Aboriginal method of knowledge translation-storytelling-experiences from front-line workers in a youth solvent abuse treatment centre relay the difficulties with applying Western responses to Aboriginal healing. This lends to a discussion of how psychiatry can capitalize on the growing debate regarding the role of culture in the treatment of Aboriginal youth who abuse solvents. There is significant need for culturally competent psychiatric research specific to diagnosing and treating First Nations and Inuit youth who abuse substances, including solvents. Such understanding for front-line psychiatrists is necessary to improve practice. A health promotion perspective may be a valuable beginning point for attaining this understanding, as it situates psychiatry's approach to treating mental disorders within the etiology for Aboriginal Peoples.

Delineating Childhood Autism Spectrum Symptoms from a Maladaptive Trait Perspective

Children with autism spectrum disorders comprise a highly heterogeneous group within the DSM-IV (American Psychiatric Association 1994) Pervasive Developmental Disorder section. Inadequate inclusion criteria and indefinite boundaries between different manifestations tend to hamper unambiguous diagnosis within the current DSM-IV taxonomy, resulting in a large group of children diagnosed with pervasive developmental disorder not otherwise specified (Myhr, Canadian Journal of Psychiatry 43:589–595, 1998) or diagnoses that do not comprehensively cover the symptomatology of the individual child. Suggestions for DSM-V include a reconceptualization of the autism spectrum in terms of two distinct symptom dimensions characterized by communication deficits and repetitive behaviours respectively (Swedo 2009) that may provide a more comprehensive description of autism manifestations. The current study corroborates this suggestion and introduces a new perspective on the autism spectrum at a young age, exploring the contribution of specific developmental personality pathology facets in characterizing these underlying dimensions of autism symptoms.

Resolving the Discrepancy in Childhood Bipolar High-Risk Study Findings

Resolving the Discrepancy in Childhood Bipolar High-Risk Study Findings

Emergency Departments Are Underutilized Sites for Suicide Prevention

Each year approximately 1,000,000 people die by suicide, accounting for nearly 3% of all deaths and more than half (56%) of all violent deaths in the world (Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002). Suicide ideation and suicide attempts are strongly linked to death by suicide and powerfully predict further suicidal behavior (Institute of Medicine, 2002). There are an estimated 100–200 suicide attempts for each completed suicide in young people, and 4 attempts for each completed suicide in the elderly (Institute of Medicine, 2002). Emergency departments (EDs) are the most important site, epidemiologically speaking, for treating those who make suicide attempts. EDs in the United States, for example, record over 500,000 suicide-related visits annually (Larkin, Smith, & Beautrais, 2008). The majority of suicide attempt patients are discharged after medical stabilization and psychosocial evaluation, but carry a significant risk of recidivism (Larkin, Smith, & Beautrais, 2008). Similarly, ED patients who present with suicide ideation (without attempt) have risks of returning to the ED with further ideation or with suicide attempts which are as high as those who present with attempts (Larkin, Beautrais, Gibb, & Laing, 2008). In addition, a significant fraction of those who present to EDs for nonmental health reasons often have occult or silent suicide ideation (estimated at 8–12%) (Claassen & Larkin, 2005). The worldwide economic tsunami and sky-rocketing healthcare costs have ensured that mental health-related visits and presentations for suicidal behavior will continue to rise in the foreseeable future. The closure of psychiatric inpatient facilities, reductions in inpatient beds, moves to treat people in the community, and increased costs of general practitioner visits have coincided with – and likely account for – increased ED attendances by psychiatric and suicidal patients who previously might have been admitted or seen in primary care. The ED is now the default, de facto option for urgent and acute contact for suicidal patients within the health system – and in many countries the ED is the only access to 24/7 healthcare (Fields et al., 2001).

Limitations of the Hamilton Anxiety Rating Scale as a Primary Outcome Measure in Randomized, Controlled Trials of Treatments for Generalized Anxiety Disorder

Limitations of the Hamilton Anxiety Rating Scale as a Primary Outcome Measure in Randomized, Controlled Trials of Treatments for Generalized Anxiety Disorder

A Study of the Irish System of Recording Suicide Deaths

A Study of the Irish System of Recording Suicide Deaths

Using Metaanalysis to Evaluate Evidence: Practical Tips and Traps

Although practising evidence-based medicine is the goal of most physicians, it can be a real challenge to sift through the vast body of data to determine the best strategies. Most clinical guidelines regard replicated randomized controlled trials (RCTs), metaanalyses, and systematic reviews as the highest level of evidence to support treatment recommendations. High-quality metaanalyses can overcome many of the drawbacks of individual RCTs and qualitative reviews. They can reduce bias, provide adequate power to demonstrate real differences in outcomes, and resolve the results of inconsistent studies. This paper focuses on basic principles and terms used in metaanalysis, so that clinicians can appropriately evaluate and use their results to guide treatment decisions. (Reprinted with permission from the Canadian Journal of Psychiatry 2005; 50:167–174)

Errors of Logic and Scholarship Concerning Dissociative Identity Disorder

The author reviewed a two-part critique of dissociative identity disorder published in the Canadian Journal of Psychiatry. The two papers contain errors of logic and scholarship. Contrary to the conclusions in the critique, dissociative identity disorder has established diagnostic reliability and concurrent validity, the trauma histories of affected individuals can be corroborated, and the existing prospective treatment outcome literature demonstrates improvement in individuals receiving psychotherapy for the disorder. The available evidence supports the inclusion of dissociative identity disorder in future editions of the Diagnostic and Statistical Manual of Mental Disorders.

Academic-State Hospital Collaboration for a Rehabilitative Model of Care

Academic-State Hospital Collaboration for a Rehabilitative Model of Care

Postdisharge Follow-Up: Research and Practice Disconnect

Back to table of contents Next article Taking IssueFull AccessPostdisharge Follow-Up: Research and Practice DisconnectCarol E. Adair M.Sc., Ph.D.,Carol E. Adair M.Sc., Ph.D.Search for more papers by this author,Published Online:1 Dec 2007AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In this month's issue Stein and colleagues show that only 30% and 49% of Medicaid-enrolled adults hospitalized for psychiatric care in one mid-Atlantic state received aftercare within seven and 30 days of discharge, respectively. African Americans, those with co-occurring disorders, and those discharged against medical advice had increased risk of lack of timely aftercare. The authors concluded, "Efforts to improve follow-up utilization should target higher-risk individuals while developing and evaluating interventions to address specific barriers among these groups."These findings come as no surprise. Many studies have documented risk factors for poor aftercare, and broad searches of academic and "grey literature" still yield typical ranges from 41% to 96% for 30-day follow-up (even lower for seven-day follow-up)—values that vary unacceptably. Even so, in the context of performance report cards, some providers are reporting very high follow-up rates (up to 100% for the 30-day indicator).There is a marked disconnect between research and practice here. Clearly some organizations have found ways to improve follow-up rates. However, only a few quality improvement projects are reported. They rarely describe how the aftercare levels were achieved, and rigor is suboptimal, limiting validity, generalizability, and opportunities for best practice dissemination. In addition, much research on the topic remains descriptive (analyses of administrative data); such studies are also very limited for illuminating the mechanisms that produce better follow-up. Although these analyses will continue to be helpful for monitoring, substantial improvement of practice will depend on rigorous studies of innovative interventions.The attachment of timely aftercare to the performance imperative seems to have motivated improvement in some organizations but not all. We may also need to shift away from a focus on those "at risk" toward greater recognition that a psychiatric hospitalization is a very serious event, sufficient in itself to justify everyone's being seen within a short time after discharge, regardless of individual characteristics. It may be that we need to "up the ante" by attaching timely aftercare to the patient safety imperative. This is not unreasonable given the evidence that postdischarge suicides tend to cluster in the first week. For example, it may be necessary to define timely aftercare as a universal standard of care for all psychiatric admissions and to define failure to provide aftercare as a health care error (of omission). In research, we probably need to spend less time describing levels of and risk factors for poor aftercare and more time designing and testing innovative interventions aimed at ensuring universal follow-up for all persons admitted for a psychiatric illness and documenting their outcomes.Department of Psychiatry and Community Health Sciences, University of Calgary, Alberta, Canada FiguresReferencesCited byDetailsCited ByEfficacy of continuous follow-up for preventing the involuntary readmission of psychiatric patients in Japan: A retrospective cohort study16 January 2012 | International Journal of Social Psychiatry, Vol. 59, No. 3Predictors of Psychiatric Aftercare among Formerly Hospitalized Adolescents23 June 2016 | The Canadian Journal of Psychiatry, Vol. 57, No. 11Returning Home in Systems of Care24 November 2008 | Journal of Emotional and Behavioral Disorders, Vol. 17, No. 3 Volume 58Issue 12 December, 2007Pages 1521-1521PSYCHIATRIC SERVICES December 2007 Volume 58 Number 12 Metrics PDF download History Published online 1 December 2007 Published in print 1 December 2007

The Canadian Journal of Psychiatry in 2007: Thanks to Our Reviewers in 2006

<i>The Canadian Journal of Psychiatry</i> in 2007: Thanks to Our Reviewers in 2006

Applying the Concepts from Maslow in a Large U.S. Hospice Program

Journal of Palliative MedicineVol. 9, No. 5 Guest EditorialsApplying the Concepts from Maslow in a Large U.S. Hospice ProgramLaurel HerbstLaurel HerbstSearch for more papers by this authorPublished Online:13 Oct 2006https://doi.org/10.1089/jpm.2006.9.1049AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Applying the Concepts from Maslow in a Large U.S. Hospice Program." , 9(5), pp. 1049–1052FiguresReferencesRelatedDetailsCited bySimüle hastalar: onları ne motive eder ve ihtiyaçları nedir?30 April 2018 | Tıp Eğitimi DünyasıSpiritual Dimensions of Pain and Suffering13 June 2019Developing a hierarchy of needs for Type 1 diabetes28 August 2013 | Diabetic Medicine, Vol. 31, No. 1Spiritual Dimensions of Pain and Suffering29 November 2011Why do women write personal blogs? Satisfying needs for self-disclosure and affiliation tell part of the storyComputers in Human Behavior, Vol. 28, No. 1Mapping hospice patients' perception and verbal communication of end-of-life needs: an exploratory mixed methods inquiry27 January 2011 | BMC Palliative Care, Vol. 10, No. 1The Opportunity for Psychiatry in Palliative Care1 November 2008 | The Canadian Journal of Psychiatry, Vol. 53, No. 11 Volume 9Issue 5Oct 2006 InformationCopyright 2006, Mary Ann Liebert, Inc.To cite this article:Laurel Herbst.Applying the Concepts from Maslow in a Large U.S. Hospice Program.Journal of Palliative Medicine.Oct 2006.1049-1052.http://doi.org/10.1089/jpm.2006.9.1049Published in Volume: 9 Issue 5: October 13, 2006PDF download

Re: Motivation and Mechanism in Motor Vehicle Collisions

This article comments on a paper by Dumais et al. (Psychiatric Risk Factors for Motor Vehicle Fatalities in Young Men, Canadian Journal of Psychiatry, November 2005). It is posited that the original authors did not discuss the possible underlying mechanisms leading to fatal collisions, and that they did not make mention of a key Axis I diagnosis strongly associated with motor vehicle crashes: Attention Deficit-Hyperactivity Disorder (ADHD). Demographic details of the accidents could provide information about the underlying mechanisms involved in motor vehicle crashes. It is unclear from the description of the methodology whether information concerning the nature or circumstances of these deaths was available. Importance of a careful evaluation of possible comorbidities in categorical diagnoses with the potential for problem driving lies in the emerging literature about the protective value of medications for managing impulsive and aggressive behavior patterns.

What’s in a Word? Addiction Versus Dependence in DSM-V

What’s in a Word? Addiction Versus Dependence in DSM-V

Where Is the Research on Homeless Persons and Suicide?

Back to table of contents Previous article Next article Taking IssueFull AccessWhere Is the Research on Homeless Persons and Suicide?Richard C. Christensen M.D., M.A.,Lorrie K. Garces M.D.,Richard C. Christensen M.D., M.A.Search for more papers by this author,Lorrie K. Garces M.D.Search for more papers by this author,Published Online:1 Apr 2006AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This past year, in our work with homeless persons suffering the effects of mental illness and addiction, a young man took his life under our watch. Ironically, it came at a time when he appeared very stable: he had just obtained housing, had recently started a new job, and was abstinent from all substances, and his symptoms of schizophrenia were seemingly well controlled. But his extended time on the streets and in the shelters had clearly branded him with a devastating affliction. Years of obtaining his drugs as a prostitute had scorched his psyche with indelible memories and intolerable images of violence and exploitation. At the beginning stages of his treatment, he had revealed a nightmarish existence of homelessness, hopelessness, and unmitigated shame that had led to multiple attempts to end his life.Drawing upon our collective, albeit anecdotal, clinical experiences, we have found that most of the homeless persons we evaluate acknowledge having suicidal thoughts or plans during some stage of their painful odyssey. Far too many, whether or not they are in formal treatment, have made serious attempts to kill themselves. Nearly all meet the classic criteria that place them into that nebulous category of being a high suicide risk: social isolation, serious mental illnesses, active substance use, extreme poverty, and previous attempts. But our work engages only the survivors. Also important is the larger challenge of adequately assessing the prevalence of suicide among homeless persons, whose desperation frequently goes unrecognized and whose actual cause of death remains unclear.It can be strongly argued that a review of the current literature reveals an overall paucity of research addressing the issue of suicide among homeless adults. One might speculate, perhaps, that so little information is available because of onerous methodological or complicated research design issues. Nevertheless, what does a clinician answer when asked where suicide ranks as a cause of death in this population? Are there particular risk profiles of homeless individuals who completed suicide that can be used by clinicians or shelter providers to identify those most in need of intervention? Indeed, do we even have a reasonable, evidence-based estimate of how many homeless persons die each year in this country from ultimate and irrevocable acts of self-destruction? We know of one such person. We are desperate to prevent others from a similar fate. With so many vulnerable lives at stake, the call for clinically applicable research could not be more urgent.associate professor and director, community psychiatry programfellow in community psychiatry, department of psychiatry, University of Florida College of Medicine FiguresReferencesCited byDetailsCited ByInformation and communication technologies, e-Health and homelessness: A bibliometric review25 June 2019 | Cogent Psychology, Vol. 6, No. 1Frontiers in Psychiatry, Vol. 10An Observational Study of Suicide Death in Homeless and Precariously Housed People in Toronto19 May 2017 | The Canadian Journal of Psychiatry, Vol. 62, No. 7Clínica y Salud, Vol. 27, No. 2Engagement and Retention of Suicide Attempters in Clinical ResearchCrisis, Vol. 31, No. 2International Journal of Mental Health Nursing, Vol. 18, No. 1 Volume 57Issue 4 April, 2006Pages 447-447PSYCHIATRIC SERVICES April 2006 Volume 57 Number 4 Metrics PDF download History Published online 1 April 2006 Published in print 1 April 2006

Treatment Planning for Person-Centered Care: The Road to Mental Health and Addiction Recovery

Back to table of contents Previous article Next article Book ReviewsFull AccessTreatment Planning for Person-Centered Care: The Road to Mental Health and Addiction RecoveryMichael E. Rutter, Ph.D.Michael E. RutterSearch for more papers by this author, Ph.D.Published Online:1 Nov 2005https://doi.org/10.1176/appi.ps.56.11.1464AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Many practitioners consider treatment planning to be a time-consuming paper exercise that they are mandated to perform to meet requirements of administrators and accreditation bodies. Treatment planning is often cynically regarded as irrelevant to what really takes place in the treatment context and virtually inconsequential with respect to outcome. In Treatment Planning for Person-Centered Care: The Road to Mental Health and Addiction Recovery, authors Neal Adams, M.D., M.P.H., and Diane Grieder, M.Ed., cogently describe and advocate for an alternative perspective: a recovery-based model with the treatment plan serving as a working and dynamic road map to help clients achieve personally meaningful goals.Adams and Grieder suggest that person-centered service planning lies at the core of a paradigm shift in which the standard of mental health and addiction care calls for full participation by consumers. The person-centered approach eschews the traditional medical model as paternalistic and often insensitive to the client's world view. Borrowing heavily from the affirming humanistic values of psychiatric rehabilitation and the recovery movement, the person-centered approach emphasizes the development of partnerships between clients and providers. All aspects of person-centered treatment planning rely on shared decision making and client-defined outcomes. Furthermore, the authors posit, this process promotes client choice, empowerment, resilience, and self-reliance.Readers of Treatment Planning for Person-Centered Care are guided through each step of creating a person-centered treatment plan. Separate chapters cover assessment, establishment of goals, development of objectives, identification of interventions, and evaluation of progress. The chapter on assessment contains excellent outlines for developing narrative summaries or case formulations that form the foundation of the treatment plan. The discussion of goals, objectives, and interventions clearly elucidates the contrast between these elements of the treatment plan within the familiar problem-oriented medical record and the person-centered approach.Rather than relying on cookie-cutter plans whose primary target is to reduce the symptoms that make up the client's diagnosis, person-centered treatment plans are holistic, are highly individualized, and identify positive outcomes based on clients' strengths and available supports. According to the book's authors, goals and objectives should be written in the client's own words whenever possible. Interventions and outcomes must be consistent with the client's readiness to acknowledge problems and make changes. Throughout the book, the authors stress the need for culturally competent clinical practice and the consideration of co-occurring mental health and addictive disorders.Although there is a respectable effort to bridge the gap between the theoretical and the practical, the authors are not entirely successful in this regard; they could have made the connections between the principles of person-centered treatment planning and the few case examples more explicit.The authors are candid in their identification of possible barriers to effective implementation of the person-centered approach, namely systemic resistance in mental health treatment programs and a lack of training, knowledge, and skills on the part of service providers. Clearly the success of this approach depends on the presence of compatible values and competencies that truly support client empowerment, partnership, hope, and recovery. It is unfortunate that at this juncture, the authors' position, although exciting and a potential stimulus for much needed change, does not have an empirical basis.These limitations notwithstanding, I strongly recommend this book to mental health administrators, supervising clinicians, and others who are concerned with continually improving the quality of their treatment planning process. It would be an outstanding resource for training candidates who are pursuing professional degrees in mental health and addiction treatment.Dr. Rutter is assistant professor of counseling and human services at Canisius College in Buffalo, New York.by Neal Adams, M.D., M.P.H., and Diane Grieder, M.Ed.; Burlington, Massachusetts, Elsevier Science Publishing, 2004, 320 pages, $59.95 FiguresReferencesCited byDetailsCited By“I see your punitive measure and I raise you a person-centered bar”: Supervisory Strategies to Promote Adoption of Person-Centered Care10 February 2021 | Community Mental Health Journal, Vol. 57, No. 8Pathways to Recovery among Homeless People with Mental Illness: Is Impulsiveness Getting in the Way?25 November 2019 | The Canadian Journal of Psychiatry, Vol. 65, No. 7Written plans: an overlooked mechanism to develop recovery-oriented primary care for depression?Australian Journal of Primary Health, Vol. 20, No. 3 Volume 56Issue 11 November 2005Pages 1464-1465 Metrics History Published online 1 November 2005 Published in print 1 November 2005

Re: Case Reports as Letters Should Stay in The Canadian Journal of Psychiatry

Re: Case Reports as Letters Should Stay in <i>The Canadian Journal of Psychiatry</i>

A Memoir of a Sojourn as Editor of The Canadian Journal of Psychiatry

I am delighted and honoured to be part of the celebration of the 50th anniversary of the publication of The Canadian Journal of Psychiatry. It is also an honour to accompany the recollections of former editors Fred Lowy and Quentin Rae-Grant. One of my enduring memories of my time as editor was the assistance that I could call on from members of the Canadian psychiatric community, the Editorial Board, and the previous editor, Fred Lowy. My time as editor, which spanned more than a decade and a half, was a period of activity, work, and fulfillment. Let me first discuss the structure of the Journal and its relation to the Association as it was when I started and as it was when I left. To begin with, the editor had full control over what happened at the Journal: a glass wall existed between the Journal and the Association, although both bodies occupied small offices in an area about the size of a 1 - or 2-bedroom apartment on the ground floor of a small apartment house-cumoffice building in the centre of Ottawa. I must point out that the Association itself was still quite young and feeling its way, numbers in psychiatry had not yet begun to swell, and the place of psychiatry in medicine was still being worked out and was often felt to be problematic. Where editorial issues were concerned, the relation between the Journal and the Board was always cordial and respectful. That is to say, the Association never took any sort of proprietary approach to material published in the Journal. The Board chair at the time was Stan Greben, and he always respected our autonomy. Next in line were the managing editor of the Journal and the executive secretary of the Association. A certain amount of jostling went on as to whether the Association's executive had a supervisory position vis-a-vis the Journal. However, this never affected the editorial process. My predecessor, Fred Lowy, gave me several insights into the relation between the Journal and the Association. Fred told me that, despite any disputes with the Association, there was never any attempt to influence the Journal 's direction, policy, and decisions. In all the years during which I was associated with the Journal and the Association, this continued to be true-which is not to say that this relatively hands-off policy kept the Board chair, the president, other members of the Association, and the executive director from giving advice. Moreover, that advice was almost always positive. In addition to our managing editor, we had an assistant who acted as a copy reader as well as a secretary. There was also a book review editor who was chosen from Ottawa because of the need to visit the office and assign book reviews. When I began my tenure as editor, the Journal dimensions were less than three-quarters those of the current publication, and there was little variation in the cover colour. No headlines appeared on the cover, which was, as I recall, a conservative grey. The matter of the publication's size preoccupied the creative efforts of the editor, the managing editor, and the printing house. The current dimensions were finally adopted to position the Journal as a contemporary journal. With a change in dimensions, its appearance became more consistent with that of other evolving journals. The increased size also improved the readability of figures and tables. As well, the name was changed. The Canadian Psychiatric Association Journal, La Revue de l'Association des Psychiatres du Canada became The Canadian Journal of Psychiatry, La Revue Canadienne de Psychiatrie. The name change was accomplished without any difficulty and introduced at the beginning of the publishing year. In time, cover space was used to identify and highlight an issue's articles and themes; small changes followed in accordance with evolving trends in the field of publishing. For a long time, a big problem was the need to have the Journal 's cover appear in consistent colours from issue to issue; for some reason this was not an easy task, but eventually, standardization was achieved. …

Editing The Canadian Journal of Psychiatry 1995–2004

Over the period 1995 to 2004,1 had the privilege of being the editor-in-chief of the now 50-year-old Canadian Journal of Psychiatry. These years abounded with changes and challenges. What we published in the Journal reflected what was happening in psychiatry, and in society as a whole. My term spanned the transition from the 20th to the 21 st century, which was anticipated with substantial anxiety in respect to computer systems. (Nothing happened!) Somewhat later, the dot-corn bubble did burst and bring reality into this increasingly important field. The events of September 11, 2001, shocked North America with experiences suffered by many in other parts of the world but new to this region. The pace of life in general has accelerated over these years. Similarly, there has been an acceleration of communication by e-mail, cellphones, and pagers, all of which require immediate response. The demand to increase performance each year is creating an atmosphere of increased tension and anxiety, with stress leave being the politically correct response to those affected. This labelling, however, is a refusal to acknowledge the high percentages who suffer mental illness over their lifetime. This also reflects the reality that stigma remains vigorous, despite commendable efforts by individuals and organizations to educate and enlighten the public. The persistence of stigma associated with mental illness also indicates that, like it or not, psychiatry is still not highly respected in the medical-hospital culture. During my years as editor-in-chief, the practice of psychiatry changed radically. Longer-stay beds were closed or transferred to general hospitals. These financially driven requirements have led to a revolving-door syndrome characterized by repeated admissions and swamped emergency rooms. (This is not to oppose the concept of reintegration but to politely suggest that some individuals still require a longer stay, particularly since community services that have been put in place do not consistently meet the needs of the chronically ill.) Community treatment orders have addressed this issue, with considerable success reported so far. Further, the advent of new medications with fewer immediate side effects virtually requires their use in serious mental illness. The shortage of beds has led to the use of multiple medications (and, unfortunately, to a decline in the personal aspect of treatment, as indicated by this direct quote from a psychiatrist with a long-term patient: If you want psychotherapy, go to a psychotherapist). The bottom line in today's psychiatry is defined by more patients, fewer staff, and increased medication-to the point that medications introduced primarily for one condition are now used for many and the link between diagnosis and selected treatment has become blurred across schizophrenia, affective disorders, dementia, and the treatment of troublesome youth. If there is a problem there must be a pill! Those psychiatrists who continue to provide psychotherapy and psychoanalysis face a dilemma. The public perception of psychiatry is still that of the couch, yet the value of what we provide is demeaned by the widespread acceptance of counsellors (with training and practice unspecified) for any and every need for personal care. Allied to this change has been the increasing influence of administration on clinical service provision, best demonstrated by the concept expressed in the 1991 Barer-Stoddard report (1) that doctors drive the cost of health care, so fewer doctors must equal less cost. The result of cutting back medical school places despite dire predictions of disaster is only now being fully felt by the public. Both the number of doctors and the hours they can practise have been constrained in favour of other priorities and compete with the considerable value of newer diagnostic tests. Similar are the measures of psychiatrists' performance, such as a length-of-stay that is often shorter than needed for medication to be effective. …