June 1996, Volume 41, Number 5
Gender and Affect in Schizophrenia
Donald Addington, MBBS, MRCPsych, FRCPC, Jean Addington, PhD, Scott Patten, MD,
PhD
Objective:
The objective of this study was to test the hypothesis that males with schizophrenia have
more negative symptoms and females with schizophrenia have more depressive symptoms.
Previous studies examining gender differences in negative and depressive symptoms in
schizophrenia have been inconclusive, being limited by retrospective design and lack of
suitable assessment instruments.
Method:
A consecutive series of 113 consenting inpatients meeting DSM-III-R criteria for
schizophrenia (45 females, 68 males) were assessed using reliable measures of depression
and negative symptoms. Negative symptoms were assessed by the Positive and Negative
Syndrome Scale and depression by the Calgary Depression Scale for Schizophrenia.
Ninety-two of the subjects were reassessed 3 months later.
Results:
There were no differences in levels of negative or depressive symptoms between men and
women.
Conclusions:
Within the limitations of the study, the results do not support the hypothesis of sex
differences in negative and depressive symptoms in schizophrenia.
(Can J Psychiatry 1996;41:265-268)
Key Words:
schizophrenia, sex, depression, negative symptoms
AIDS Knowledge and High-Risk Behaviour in the
Chronic Mentally Ill
Henry T Chuang, MD, FRCPC, Mark Atkinson, PhD
Objective:
To ascertain the degree of HIV-risk knowledge among patients attending a downtown
program and to identify the extent of high-risk behaviour for HIV infection.
Method:
A total of 151 patients were selected at the Calgary Community Mental Health Clinic (N =
110) and the nearby Self Help Association (N = 41). Most of the subjects were being treated
for either schizophrenia (n = 69), bipolar disorder (n = 37), or unipolar mood disorder (n =
35). Questionnaires included a 10-item instrument that assessed subjects' knowledge about
HIV or AIDS and another 10-item tool that assessed the high-risk situations patients might
have encountered over the past month or past year.
Results:
Although the percentage of subjects erring on questions about AIDS knowledge was
smaller when compared with previous studies, a significant number of subjects believed
that one could acquire AIDS by donating blood, and 25% did not think that having only
one unsafe sexual contact would make them vulnerable to HIV infection. At least 50% of
the participants have had sex with at least one partner in the past year, and 33% of the
participants indicated that they would not insist that they or their partners wear a condom.
Conclusions:
This Canadian study confirms the need for psychiatrists and mental health workers to
continue to explore high-risk behaviour in the chronic mentally ill population and to
further educate these patients through the development of prevention and risk-reduction
strategies.
(Can J Psychiatry 1996;41:269-272)
Key Words:
chronic mental illness, AIDS knowledge, high-risk behaviour
Development of a Policy on Sexuality for Hospitalized
Chronic Psychiatric Patients
Steven J Welch, PhD, Gerrit W Clements, LLB
Objective:
This paper describes the need for and development of a policy on patient sexuality
implemented at a provincial psychiatric hospital.
Method:
The need for a policy was assessed by reviewing the literature and interviewing a sample of
chronic psychiatric patients. Development of the policy involved surveying 38 Canadian
psychiatric hospitals in search of an existing policy to use as a model, as well as soliciting
input from a variety of stakeholders and 2 lawyers.
Results:
Both the literature review and patient interviews indicated that a substantial number of
hospitalized chronic psychiatric patients are sexually active. Neither the literature nor the
survey of Canadian psychiatric hospitals revealed an existing policy to use as a model.
Consequently, a policy was drafted by a task force composed of stakeholders and 2 lawyers.
Characteristics of the policy, possibly the first in Canada, are described. The legal basis for
the sexual rights of patients is discussed, and the mechanisms for protecting patients from
harm are also described.
Conclusion:
Fundamentally, a policy must balance the patient's right to sexual intimacy in a dignified
setting with the hospital administration's duty to take reasonable steps to protect patients
from harm.
(Can J Psychiatry 1996;41:273-279)
Key Words:
policy on patient sexuality, sexual rights, legal arguments
Use of Cytokines in Clozapine-Induced
Agranulocytosis
Ian Chin-Yee, MD, FRCPC, Kalyna Bezchlibnyk-Butler, BSc, BPharm, Lillian Wong, RN,
BScN
Objective:
To report and review the use of cytokines for the treatment of clozapine-induced
neutropenia.
Method:
Case report and review of literature.
Results:
Cytokines, granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage
colony-stimulating factor (GM-CSF), appear to shorten the duration of clozapine-induced
neutropenia.
Conclusions:
G-CSF or GM-CSF therapy should be considered in patients with profound neutropenia of
prolonged duration (high-risk neutropenia).
(Can J Psychiatry 1996;41:280-284)
Key Words:
clozapine, neutropenia, G-CSF, review
Psychopathology in Offspring of Mothers with
Borderline Personality Disorder: A Pilot Study
Margaret Weiss, MD, PhD, Phyllis Zelkowitz, EdD, Ronald B Feldman, MD, Judy Vogel, MD,
Marsha Heyman, MD, Joel Paris, MD
Objective:
Children of mothers with borderline personality disorder (BPD) were hypothesized to be at
greater risk for psychopathology, particularly impulse spectrum disorders, than children of
mothers with other personality disorders.
Method:
Twenty-one index children were compared with 23 children of mothers with a
nonborderline personality disorder. Diagnoses were obtained using the Kiddie Schedule for
Affective Disorders and Schizophrenia-Episodic Version (KSADS-E) and the Child
Diagnostic Interview for BPD (CDIB), and functioning was rated with the Child Global
Assessment Schedule (CGAS). Physical, sexual, and verbal abuse, as well as family violence
and placements, were also assessed.
Results:
The children of the borderline mothers, as compared with controls, had more psychiatric
diagnoses, more impulse control disorders, a higher frequency of child BPD, and lower
CGAS scores. There were no differences between the groups for trauma.
Conclusion:
The offspring of borderline mothers are at high risk for psychopathology.
(Can J Psychiatry 1996;41:285-290)
Key Words:
child borderline personality disorder, trauma, high-risk offspring
Le perfectionnisme : Aspects conceptuels et cliniques
Christo Todorov, MD, MSc, Andrée Bazinet, MD
Objective:
Study of the concept of perfectionism and its phenomenology, etiology, and treatment.
Methods:
Review of the literature, phenomenological, and clinical analyses.
Results:
The International Classification of Diseases introduced the notion of perfectionism into
psychiatric discourse in 1977. In DSM-III, DSM-III-R, and DSM-IV, perfectionism is a
diagnostic criterion of obsessive-compulsive disorder, but has never been defined in the
psychiatric literature. We differentiate normal perfectionism and pathological
perfectionism, which is of some psychiatric interest: normal perfectionism is manifested
according to the aptness of the target and its sociocultural value, and is therefore selective
and flexible, whereas pathological perfectionism is the compulsive pursuit of a performance
level not required by the circumstances and idiosyncratic in nature. Its symptomatology
may resemble that of obsessive-compulsive disorder, but is actually quite different:
whereas obsessive-compulsive symptoms are absurd and the product of ego-dystonic
compulsion, pathological perfectionism is experienced as a personal obligation, and retain
an identifiable cultural objective.
Conclusions:
The phenomenology of the normal and abnormal manifestations of perfectionism is well
defined. While pathological perfectionism and obsessive-compulsive disorder are similar
and may even share a common etiology, they should be considered 2 distinct clinical
entities. The therapeutic approaches to pathological perfectionism remain empirical.
(Can J Psychiatry 1996;41:291-298)
The Current Status of Seizure Duration in the
Practice of Electroconvulsive Therapy
Fiore R Lalla, MD, CM, Thomas Milroy, MD, FRCP
Objective:
To critically review data relating the seizure duration in electroconvulsive therapy (ECT)
to its therapeutic effect in the treatment of depressive illness.
Method:
The authors used MEDLINE, PSYCHINFO on CDROM, and their own knowledge of the
literature to find studies or reviews concerning the role of seizure duration in ECT efficacy.
Results:
Rigorous studies cast doubt on the usefulness of seizure duration as a clinical marker.
Some medications that decrease seizure time have deleterious treatment effects but also
affect other seizure dynamics. Several medications dramatically shorten seizures but have
no influence on treatment efficacy.
Conclusion:
The guidelines of ECT seizure length are arbitrary, suggesting exaggerated durations for
ECT treatment.
(Can J Psychiatry 1996;41:299-304)
Key Words:
electroconvulsive therapy, seizure duration, efficacy, medication, anesthesia, lidocaine,
caffeine, benzodiazepines