May 1996, Volume 41, Number 4
A Critical Review of Recovered Memories in
Psychotherapy: Part I -- Trauma and Memory
Joel Paris, MD
Objective:
The theoretical basis of the use of recovered memories in psychotherapy will be critically
examined.
Method:
Literature will be reviewed on the nature of normal memory, and on the relationship of
trauma to memory.
Results:
Normal memories are surprisingly inaccurate. There is little evidence that normal
memories can be repressed. There is no evidence that trauma makes repression more
likely.
Conclusions:
"Recovery" of repressed memories is not consistent with the findings of empirical research.
(Can J Psychiatry 1996;41:201-205)
Key Words:
trauma, memory, psychotherapy
A Critical Review of Recovered Memories in
Psychotherapy: Part II --Trauma and Therapy
Joel Paris, MD
Objective:
The clinical implications of the use of recovered memories in psychotherapy will be
examined.
Method:
The paper will review the relationship of trauma to psychopathology and discuss how
traumatic histories might be dealt with in therapy.
Results:
Trauma is a risk factor for psychopathology, but is only one of many etiological factors in
mental disorders. The search for recovered memories in psychotherapy could present
dangers for patients.
Conclusions:
The most reliable memories of trauma are those that have been present throughout the
patient's life.
(Can J Psychiatry 1996;41:206-210)
Key Words:
trauma, memory, psychotherapy
The Characteristics and Intervention Histories of
Incarcerated and Conduct-Disordered Youth
Jalal Shamsie, MB, FRCPC, Hayley Hamilton, MA, and Cynthia Sykes, MPhil
Objectives:
1) To determine if incarcerated youth and conduct-disordered youth in treatment display
similar risk factors associated with chronicity of antisocial behaviour; 2) to determine if
incarcerated youth had experienced high numbers of interventions by many different
agencies as has been reported for conduct-disordered youth in treatment.
Method:
The files of 25 conduct-disordered youth in treatment and 25 incarcerated youth were
examined to extract all relevant data.
Results:
Incarcerated youth were similar to conduct-disordered youth with regard to the number of
symptoms of disruptive behaviour disorders, age of onset of behavioural problems, and
family backgrounds. Both groups had high numbers of interventions and agencies in their
histories. Interventions began earlier for the conduct-disordered youth.
Conclusion:
The distinction between conduct-disordered youth who are treated and youth who are
incarcerated may be arbitrary and accidental. Given the similarity in the clinical
characteristics, incarcerated youth should be offered help that is similar to that offered to
conduct-disordered youth. Such help may lower the rate of recidivism.
(Can J Psychiatry 1996;41:211-216)
Key Words:
conduct disorder, treatment, posttreatment follow-up, continuum of care, early
identification
Suicide in Old Age: A Tragedy of Neglect
Geoffrey Duckworth, MD, PhD, Dip, Psych, FRCPC, Hazel McBride BA, BEd, MA, PhD,
OTC
Objective:
To investigate the incidence and treatment of depression in geriatric suicide.
Method:
All coroners' records, autopsy and police reports for suicide victims aged 65+ in Ontario (n
= 543) over 3 years were examined.
Results:
Over 80% of the elderly who committed suicide received no psychiatric referral. Of the
sample, 87% were untreated while only 13% received antidepressants. Tricyclics, which
are lethal in overdose, were the drugs of choice. None of the sample was treated with the
safer specific serotonin reuptake inhibitors (SSRIs). Females were 3 times as likely to be
treated as were males, and those seeing psychiatrists were 4 times more likely to be treated
with antidepressants than those seeing general practitioners (GPs). The physically ill were
rarely treated.
Conclusions:
These findings suggest that early geropsychiatric assessment and vigorous treatment could
prevent many suicides in old age.
(Can J Psychiatry 1996;41:217-222)
Key Words:
suicide, geriatric, diagnoses, depression, treatment, antidepressants, physical illness,
referral, stigma
Occurrence and Effects of Personality Disorders in
Depression: Are They the Same in the Old and
Young?
M Oluwafemi Agbayewa, MB
Objectives:
To determine the frequency and effects of personality disorders on episodes of depression
in elderly and young inpatients. Personality disorders are common and may affect the
prognosis of Axis I disorders.
Methods:
Clinical records of 89 elderly inpatients and a matched comparison group of 119 young
inpatients were reviewed to confirm the diagnosis of a major depressive episode according
to the DSM-III-R criteria. The frequency of personality disorder diagnoses in the 2 groups
was determined. Within each group, severity, functioning, and treatment were compared
between those with and without personality disorders.
Results:
Personality disorders were diagnosed more frequently in the young (40.3%) than in the
elderly (27%). Both rates were similar to previous reports. Cluster C disorders were the
most common personality disorders found in the elderly, compared to cluster B disorders
in the young. Personality disorder in the young was associated with longer episodes of
depression (P = 0.035) and poorer family relations (P < 0.001); whereas in the elderly,
personality disorder was associated with more severe episodes (P = 0.014).
Conclusions:
These findings suggest that the frequency and effects of personality disorders on the
depressed patient may differ according to age.
(Can J Psychiatry 1996;41:223-226)
Key Words:
personality disorders, depression, hospitalized, old age, young, comparison
From Evidence to Conclusions in Psychiatric Research
Dan Bilsker, PhD
Objective:
To identify problems in the derivation of conclusions from evidence in psychiatry research.
Method:
The scientific model of falsificationism is described as determining the logical requirements
for proving conclusions from research evidence. Common types of problematic conclusions
are identified, and examples from the current research literature are given.
Results:
Poorly formed conclusions are based on inadequate hypotheses, ambiguously phrased,
blind to negative findings, fallacious in logic, or neglectful of alternative explanations.
Conclusions:
The risks of accepting poorly formed conclusions are premature closure of scientific
investigations, poor basis for decisions in psychiatric practice, and provision of
misinformation to patients. It is recommended that practitioners be attentive to this aspect
of critically appraising research.
(Can J Psychiatry 1996;41:227-232)
Key Words:
critical appraisal, evidence-based, conclusions
A Review of the Psychobiology and Pharmacotherapy
of Posttraumatic Stress Disorder
Laurence Katz BA, MD, William Fleisher MD, FRCPC, Kevin Kjernisted MD, FRCPC, Paul
Milanese MD, FRCPC
Objective:
To review the literature on certain psychobiologic elements of posttraumatic stress disorder
(PTSD) as they pertain to possible pharmacotherapeutic interventions.
Method:
The literature pertaining to the neuroanatomical, neurochemical, and cellular elements was
reviewed. As well, both controlled and uncontrolled studies of pharmacotherapy in PTSD
were analyzed.
Results:
The literature suggests that the stress response triggers certain neuromodulators with
subsequent psychoneurological restructuring; that various antidepressants have been
demonstrated to be effective for treatment of criterion B symptoms; that, to date, a single
antidepressant has been demonstrated to be effective in a controlled trial for criterion C
symptoms; and that, to date, in controlled trials, antidepressants and a benzodiazepine
have proved effective for criterion D symptoms.
Conclusion:
Currently, a comprehensive approach requires multimodel understanding and multimodal
treatment.
(Can J Psychiatry 1996;41:233-238)
Key Words:
posttraumatic stress disorder, psychobiology, pharmacotherapy
A Double-Blind, Multicentre Study of Paroxetine and
Maprotiline in Major Depression
Ulrich Schnyder, MD, Annemarie Koller-Leiser, BPharm
Objective:
This study was performed to compare the clinical efficacy, side effects, and safety of
paroxetine and maprotiline, the latter being the most frequently prescribed antidepressant
in Switzerland.
Method:
Seventy-one patients (in and outpatients) with major depression were randomly allocated
to treatment with paroxetine (20 to 40 mg daily) or with maprotiline (50 to 150 mg daily).
Efficacy was measured by means of the Hamilton Psychiatric Rating Scale for Depression,
the Montgomery-Asberg Depression Rating Scale, the Clinical Global Impression, and the
Hopkins Symptom Checklist.
Results:
The 2 components showed a similar efficacy. The adverse effect profile was comparable in
the 2 treatment groups, although the findings showed a nonsignificant trend pointing in the
direction of lower side effects with paroxetine.
Conclusion:
In the moderate dose regimens tested, the 2 components seemed to be of similar efficacy,
with comparable profiles of side effects and safety.
(Can J Psychiatry 1996;41:239-244)
Key Words:
antidepressants, serotonin reuptake inhibitors, paroxetine, maprotiline, major depression,
clinical efficacy, side effects, safety
Syndrome de Capgras : Perspectives ouvertes par la
neuropsychologie cognitive
Jacques B Debruille, MD, PhD and Emmanuel Stip, MD, MSc, CSPQ
Objective:
To examine the way in which certain concepts regarding the physiopathology of Capgras'
syndrome (1) have been tested neuropsychologically.
Methods:
Data consist of approximately 30 studies selected for their relevance to the cerebral stages
of face processing in patients with schizophrenia, patients with Capgras' syndrome and
normal subjects.
Results:
Study of this work shows: a) that with respect to patients, authors have focused on the
stage of treatment corresponding to the facial recognition phase per se; b) but that it is also
possible to study the phase corresponding to knowledge and beliefs relative to individuals
and to evaluate the existence of the cleavage proposed by numerous psychodynamicians.
Conclusions:
Views from the field of neuropsychology, like those from the field of psychodynamics, can
therefore be tested. By offering a means of developing testable predictions in experimental
protocols, cognitive neuro- psychology methods will, in short, make it possible to reject
erroneous concepts and demonstrate accurate ones. Limited here to the example of
Capgras' syndrome, we advocate that the same methods be applied to Capgras' syndrome
as to each symptom of schizophrenia.
(Can J Psychiatry 1996;41:245-250)