Editorial Credits/ Crédits éditorials

Subscription Rates /Prix d'abonnements

Advertising Rates / Tarifs publicitaires (PDF)

Editorial
Canadian Journal of Psychiatry: New Editor and New Policies
Joel Paris, MD
(PDF)

Guest Editorial
Risk Assessment in Psychiatric Practice
Kenneth Hashman, MD, FRCPC, DABPN
(PDF)

In Review
The Canadian Contribution to Violence Risk Assessment: History and Implications for Current Psychiatric Practice
Hy Bloom, LLB, MD, Christopher Webster, PhD, Stephen Hucker, MB, Karen De Freitas, MD
(PDF)

The Clinical Use of Risk Assessment
Graham D Glancy, MB, ChB, FRCPsych, FRCPC, Gary Chaimowitz, MB, ChB, FRCPC
(PDF)

The State of Contemporary Risk Assessment Research
Michael A Norko, MD, Madelon V Baranoski, PhD
(PDF)

Review Paper
Community Treatment Orders: Profile of a Canadian Experience
Ann-Marie A O’Brien, MSW, RSW, Susan J Farrell, PhD, CPsych*
(PDF)

International Dosage Differences in Fluoxetine Clinical Trials
Scott Patten, MD, Andrea Cipriani, MD, Paolo Brambilla, MD3, Michela Nosè, MD, Corrado Barbui, MD
(PDF)

Original Research
Panic-Agoraphobic Spectrum and Light Sensitivity in a General Population Sample in Italy
Letizia Bossini, MD, Mirko Martinucci, MD, Katia Paolini, MD, Paolo Castrogiovanni, MD
(PDF)

Psychotic Disorders Clinic and First-Episode Psychosis: A Program Evaluation
Suzanne Archie, MD, FRCPC, Jane Hamilton Wilson, RN, Kevin Woodward, BSc, Heather Hobbs, RN, Shelley Osborne, RN, Jean McNiven, RN
(PDF)

Screening for Mild Cognitive Impairment: Comparing the SMMSE and the ABCS
D William Molloy, MB, MRCPI, FRCPC, Timothy IM Standish, David L Lewis, PhD
(PDF)

Attention-Deficit Hyperactivity Disorder With and Without Obsessive–Compulsive Behaviours: Clinical Characteristics, Cognitive Assessment, and Risk Factors
Paul Daniel Arnold, MD, FRCPC, Abel Ickowicz, MD, FRCPC, Shirley Chen, MD, MPH, Russell Schachar, MD, FRCPC
(PDF)

Brief Communication
Validation de la version française de l’inventaire de détresse péritraumatique
Louis Jehel, MD, PhD, Alain Brunet, PhD, Sabrina Paterniti, MD, PhD, Julien D Guelfi, MD, Pr
(PDF)

Book Reviews
(PDF)

The Confinement of the Insane: International Perspectives, 1800–1965
Review by
Laurence Jerome, MD

Suicide in Children and Adolescents
Review by
Paul S Links, MD, FRCPC

Letters to the Editor
(PDF)

A Novel Form of Treatment Resistance in Anorexia Nervosa

Capgras Syndrome in the Modern Era: Self Misidentification on an ID Picture

Effectiveness of Risperidone in Delirium

Family-Oriented Rehabilitation for Unexplained Chronic Pain

Hypokalemia from Risperidone and Quetiapine Overdose

A Renewed Interest in Day Treatment

Quetiapine Therapy for Corticosteroid-Induced Mania

Letters to the Editor

A Novel Form of Treatment Resistance in Anorexia Nervosa

Dear Editor: Treatment refusal, which often involves resistance to feeding, is common in patients with anorexia nervosa (AN) (1–5). We report the first case of a patient with AN who tied a knot at the gastric end of a feeding tube to avoiding being fed

Case Report

A single woman, aged 19 years, was admitted as an emergency to the medical ward of our hospital for feeding and medical management of severe malnutrition, dehydration, and acute renal failure due to AN. Her admission height and weight were 172 cm and 37.7 kg (body mass index 12.7 kg/m2). One year before admission, her weight had been 63.3 kg (body mass index 21.4 kg/m2). Over the year, she had increased her exercise, decreased her food intake, and increased her use of laxatives. We estimated that her average daily food intake for the last 3 months was 300 to 500 kcal. During the week before admission, she experienced weakness, persistent light-headedness, and difficulty completing her usual activities of daily living.

After admission, her electrolyte and urea levels returned to normal, but she did not gain weight. She began nasogastric tube feeding on the fourth day of hospitalization, with her daily caloric intake being increased to 2480 kcal. Her anxiety increased coincident with increased feeding, and she complained of losing control. The nasogastric tube was flushed regularly with sterile water, but during one of the scheduled flushes, the nurse was not able to push water through the tube. Numerous attempts to reestablish the patency of the tube by exerting increased pressure and with infusion of pancreatic enzymes failed. When the tube was removed for inspection, a knot was present at the tube’s distal end. The knot was difficult to see because its diameter was almost the same as the rest of the tube. The patient denied tampering and said, “My stomach made this.”

The patient would have had to remove the tube, tie the knot, and reinsert it herself to make a knot at its gastric end. Normally, blockage at the distal end of a feeding tube is assumed to be caused by solidification of the formula. If attempts to clear an apparently blocked nasogastric tube fail, the tube should be removed and closely inspected for the presence of such a knot.

References

1. Goldner EM, Birmingham CL, Smye V. Addressing treatment refusal in AN: clinical, ethical, and legal considerations. In: Garner DM, Garfinkel PE, editors. Handbook of treatment for eating disorders. New York: Guilford; 1997. p 450–61.

2. Kaplan AS, Garfinkel PE. Difficulties in treating patients with eating disorders: a review of patient and clinical variables. Can J Psychiatry 1996;44:665–70.

3.Hébert PC, Weingarten MA. The ethics of forced feeding in anorexia nervosa. CMAJ 1991;144:141–4.

4.MacDonald C. Treatment resistance in anorexia nervosa and the pervasiveness of ethics in clinical decision making. Can J Psychiatry 2002;47:267–70.

5.Chial HJ, McAlpine DE, Camilleri M. Anorexia nervosa: manifestations and management for the gastroenterologist. Am J Gastroenterol 2002;97:255–69.

Andrei V Krassioukov, MD C Laird Birmingham, MHSc, MD, FRCPC, FACP, ABIM
Vancouver, British Columbia