April 1996, Volume 41, Number 3
Research Training and Productivity Among Faculty:
The Canadian Association of Professors of Psychiatry
and the Canadian Psychiatric Association Survey
Nady el-Guebaly, MD and Mark Atkinson, PhD
Objective:
This survey assesses the research training and productivity of academic faculty in
Canadian departments of psychiatry and compares the findings with those of colleagues in
the United States.
Method:
A questionnaire was adapted to suit the Canadian milieu and was distributed to a target
population of 2484, including a core 522 full-time faculty.
Results:
The response rate among full-time faculty was 65%, but only 26.5% for clinical and
adjunct faculty. A small proportion (16%) of our MD and a greater proportion (57%) of
our PhD respondents were included in a fairly lenient definition of researcher.
Departments seek to recruit PhDs with an active involvement in research. Overall there
appear to be more similarities than differences in research interests with our colleagues in
the United States. The pharmaceutical industry was the most frequently mentioned source
of research funding for MDs, while the availability of a mentor was perceived as the most
influential factor determining the choice of a research career.
Conclusions:
Recommendations include adequate exposure to research during medical school and
residency as well as appropriate inducements for the recruitment and retention of
practising researchers.
(Can J Psychiatry 1996;41:144-149)
Physician Resource Variables and Their Impact on
the Future Pool of Research Expertise Among
Psychiatrists: The Canadian Association of Professors
of Psychiatry and Canadian Psychiatric Association
Survey
Nady el-Guebaly, MD and Mark Atkinson, PhD
Objective:
To assess the impact of the increased proportion of female psychiatrists and trainees, the
rapid reduction of international medical graduates allowed in the country, and the
expanding number of practitioners with subspecialization on the future pool of psychiatrist
researchers in Canadian academic departments of psychiatry.
Method:
A questionnaire was adapted to suit the Canadian milieu and distributed to a target
population of 2484, including a core of 522 full-time faculty.
Results:
Female psychiatrists responding to the questionnaire reported less research involvement
overall than their male counterparts. International medical graduates with both
undergraduate and residency training abroad reported more research interests than other
graduate categories. Respondents training in a subspecialty showed no difference in
research commitment.
Conclusions:
Concerted efforts must be made to recruit, support, and retain female researchers.
Particular attention must be paid to developing research expertise among Canadian
medical graduates. The trend towards subspecialization influences only the selection of
research topic.
(Can J Psychiatry 1996;41:150-155)
Psychiatric Practice for the Coming Decade
David S Goldbloom, MD, FRCPC and Paul E Garfinkel, MD, FRCPC
Objective:
To identify important trends and themes that will affect psychiatric training and practice.
Method:
Selective literature review and reflections by the authors.
Results:
Three principal themes are elucidated relating to empiricism and integration,
accountability and collaboration, and training and the public trust.
Conclusions:
There must be debate and action on these and other themes to maintain the relevance of
psychiatry to its changing context.
(Can J Psychiatry 1996;41:156-160)
Clozapine: Current Status and Role in the
Pharmacotherapy of Schizophrenia
Gary J Remington, MD, PhD, Donald Addington MB, Evan J Collins, MD, Barry D Jones,
MD, Pierre Lalonde, MD, Duncan J MacCrimmon, MD, and G William MacEwan, MD
Objective:
This study evaluates clozapine and its present role in the pharmacotherapy of
schizophrenia.
Method:
Clozapine's current clinical status is reviewed, as is its position with respect to other
treatment options.
Results:
Clozapine represents the prototype of "atypical" neuroleptics, with evidence of clinical
efficacy in both positive and negative symptoms, as well as a diminished risk of
extrapyramidal side effects. It is the only neuroleptic to date that has established itself as
having little, if any, risk of tardive dyskinesia. More recent research has focused on its
potential for overall savings in health care costs, as well as possible benefits in the area of
neuropsychological functioning.
Conclusion:
Evidence suggesting that the course of schizophrenia can be altered by effective treatment
favours a systematic approach that optimizes treatment options. While clozapine does not
represent a 1st-line agent because of its risk of agranulocytosis, it has an integral role to
play in treatment-resistant schizophrenia or in individuals experiencing intolerable side
effects with conventional neuroleptics.
(Can J Psychiatry 1996;41:161-166)
Competency Assessments: Perceptions at Follow-up
Kathleen Carlin, RN, MSC, Michel Silberfeld, MD, MSC, FRCPC, Raisa B Deber, PhD, and
Frederick Lowy, MD, FRCPC
Objectives:
To report on the perceptions of assessment of competency and its consequences on a group
of clients and significant others at follow-up.
Methods:
Ninety-five interviews were conducted using a carefully developed semistructured
telephone interview of 24 clients and 71 family/caregivers, representing the perceptions of
about 80 clients.
Results:
There was general satisfaction in the competency assessment process. There was a
perception that interests and rights were protected. Clients were seen to be less involved in
all spheres of decision making rergardless of capacity outcome. Clients and families were
satisfied with how decisions were made.
Conclusions:
Follow-up study of competency assessment does not support the conclusions previously
drawn based on court record studies that assessments are deleterious and frequently result
in violations of rights.
(Can J Psychiatry 1996;41:167-174)
Characteristics of Psychogeriatric Patient Visits to a
General Hospital Emergency Room
Richard W Shulman, MD, Peter Marton, PhD, Anne Fisher, RN, MScN, and Carole Cohen,
MD
Objective:
This study describes psychogeriatric patients who visit the Emergency Room (ER) in a
teaching hospital with a comprehensive psychogeriatric service.
Method:
A survey assessing demographic and clinical characteristics was completed for every
psychiatric ER patient during a 2-year period.
Results:
One hundred and seventy-three ER patients aged over 60 (mean age 71.2) were assessed.
Fifty-three percent were previously known to the psychogeriatric service. The majority of
these previously known psychogeriatric patients who used the ER suffered from mood
disorders. The majority of new psychogeriatric patients seen in the ER had an organic
brain syndrome (OBS).
Conclusions:
Few OBS patients who visited the ER were previously known to the psychogeriatric
service, but many new OBS patients accessed the psychogeriatric service via the ER. For
patients with mood disorders, particularly if suicidal, the ER was used as part of their
service delivery system.
(Can J Psychiatry 1996;41:175-180)
Syndrome de Capgras : Évolution des hypothèses
Jacques B Debruille, MD, PhD et Emmanuel Stip, MD, MSc, CSPQ
Objective:
To trace the evolution of hypotheses concerning Capgras' syndrome.
Methods:
The data consist of slightly over 60 studies published between 1866 and 1994 which were
selected in terms of their innovative nature and relevance to the clinical description of the
syndrome and to psychodynamic, neurological and neuropsychological interpretations.
Results:
Two partially overlapping major stages can be identified in the evolution of hypotheses
regarding the mechanisms of the syndrome. The 1st, beginning in 1923, is characterized by
the predominance of psychodynamic interpretations. The 2nd, resulting from the
observation of organic dysfunctions in a high percentage of cases, is distinguished by the
advent of neurological interpretations, and by a few mixed hypotheses.
Conclusions:
Overall, this review highlights the broad diversity of viewpoints concerning the syndrome.
It will be used as a basis for the following study, which is designed to show that it is possible
to test each of the viewpoints experimentally.
(Can J Psychiatry 1996;41:181-187)