Hamilton Psychiatric Hospital

1. Both clinicians and consumers identified the importance of maintaining relationships and experiencing success as helpful in building and nurturing hope for consumers. 2. To provide holistic care, clinicians need to discuss spirituality and meaning with clients. 3. Because being hopeful is an active process, clinicians need to talk to clients about hope, openly, realistically, and strategically.

To describe the development, future challenges, and directions of geriatric psychiatry in Canada. This review and description of geriatric psychiatry was developed in the context of the criteria established by the Royal College of Physicians and Surgeons of Canada for subspecialization applications. Information from key informants, both nationally and internationally, was combined with a review of relevant literature in the field. Canada has provided important contributions to the field of geriatric psychiatry in Canada and abroad. The increased needs of older persons with severe mental illness and their families, combined with a significant body of knowledge and therapeutic options, provide an important foundation for further development. Subspecialization in geriatric psychiatry as part of the overall development of psychiatry in Canada is proposed as critical to meeting the challenges of our aging population.

To review the various pharmacological and nonpharmacological factors associated with the induction of rapid cycling in bipolar mood disorder, and to introduce the idea that parturition may also have a role. Factors known to contribute to bipolar mood disorder rapid cycling include antidepressant agents, female gender and middle age. Currently, there is evidence that hypothyroidism may also play a role. A critical review of the literature was undertaken. Caution should be exercised in the use of antidepressants in patients with bipolar mood disorders.

Substantial psychological and neurobehavioural evidence is available to support the hypothesis that traumatic brain injury (TBI) is a risk factor for subsequent psychiatric disorders. However, studies utilizing established psychiatric diagnostic schemes to study these outcomes after TBI are scarce, and no studies have included an assessment of personality disorders in addition to the major psychiatric disorders. This study utilizes structured psychiatric interviews to measure the prevalence of DSM-III(R) disorders in a sample of 18 subjects derived from a TBI rehabilitation programme. Results revealed high rates for major depression, bipolar affective disorder, generalized anxiety disorder, borderline and avoidant personality disorders. Co-morbidity was also high. A preliminary study of postulated predictive factors revealed possible roles for sex and for initial severity of injury. The study supports the association between TBI and psychiatric disorder, and suggests the need for monitoring, for prevention, and for treatment of psychiatric disorders after TBI.

The differential diagnosis of borderline personality disorder (BPD) continues to be a major focus of Axis II diagnostic screening decisions in most mental health facilities. This study examined the utility of the revised Personality Diagnostic Questionnaire (PDQ-R) BPD (borderline personality disorder) scale (Hyler, Reider, Williams, et. al., 1988a; Hyler, Skodol, Kellman, Oldham, & Rosnick, 1990) as a diagnostic screening instrument for psychiatric patients. The PDQ-R was administered to three patient groups (inpatient acute treatment, inpatient short-stay assessment, outpatient assessment) which differed in base rate for BPD. Three cut-off scores for the PDQ-R BPD scale were compared for efficacy of predicting borderline status for individual patients in each of the three groups, with psychiatrist-assigned diagnoses used as the criterion. This study demonstrates that it is possible to maximize the efficacy of the PDQ-R BPD scale as a diagnostic screening instrument by adjusting the cut-off score for specific patient populations.

Clinically depressed and nondepressed individuals completed a deployment-of-attention task developed by I. H. Gotlib, A. L. McLachlan, and A. N. Katz (1988). Results indicated that the clinically depressed individuals perform the task in an unbiased fashion, attending equally to positive-, negative-, and neutral-content stimuli. In contrast, the nondepressed individuals demonstrated a "protective" bias against the perception of negative stimuli by avoiding such material in favor of positive or neutral stimuli. Overall, the results of this study suggest that clinically depressed individuals do not show an attentional bias toward negative information, but rather, fail to demonstrate the positive or protective bias that is evident in nondepressed individuals.