James H. Brown

Electroconvulsive Therapy in the Treatment of Depression: The Impact on Length of Stay

It has been reported that one advantage to administering electroconvulsive therapy (ECT) for the treatment of depression is that it results in shorter hospitalizations than alternative treatments. The generality of this finding was assessed in the present study, which comprised a retrospective review of 192 admissions for depression. It was found that the prompt initial decision to administer ECT did not reduce the overall length of hospital stays. In fact, patients who were discharged after an initial medication trial actually had shorter admissions than patients treated promptly with ECT. Nevertheless, one subgroup of patients--those who were started on medications, but who were later switched to ECT--had very long admissions. Whether the prompt initiation of ECT will reduce the average length of stay at any individual institution may depend on the numbers of patients who fall into this latter category. This number, in turn, appears to vary widely across institutions.

Psychiatry and oncology: a review.

There are complex relationships between cancer and mental state, of which the most readily understandable are the psychological reactions of patients with established malignant disease. More speculative, and difficult to study, is the possibility that psychological states may predispose to the development of cancer. Currently, theoretical and research interest centres on a third topic — the high frequency of cases in which an underlying malignant disease presents as a ‘functional’ psychiatric illness, usually a depression. The suggestion is made that this may eventually be explained by an immunological mechanism.

The Antidepressant Effect of β-Adrenoreceptor Subsensitivity: A Brief Review and Clinical Implications*

This paper reviews briefly the very common finding in chronic antidepressant use, of subsensitivity of the β-adrenoreceptor-linked cyclic AMP system. This subsensitivity is observed with a number of different antidepressant treatments, including pharmacological, electrical and sleep deprivation. The subsensitivity requires intact noradrenergic and serotonergic systems, functionally linking the two neurotransmitters most often implicated in depression. Thyroid hormones and estrogens also cause subsensitivity, while the opposite effect is seen with Reserpine and Propranolol. A modified conditioning/sensitization model is proposed, implicating psychosocial stressors with a biological inability to down-regulate β-adrenoreceptors.

Psychiatric patients in the general hospital casualty service. Report of a study.

Data are presented regarding the psychiatric patients seen in the Casualty-Emergency Service of the Winnipeg General Hospital during a fifteen-day period, and this group is compared with the general casualty intake, and to a lesser extent with the population of the area served. The psychiatric patients had a higher proportion of: 1) admissions to hospital 2) females 3) persons aged 40 - 49 4) persons divorced or legally separated 5) newcomers to the Province 6) visits between 2:00 a.m. and 6:00 a.m. In the psychiatric group there was a preponderance of women among those diagnosed as neurotic and of men among those diagnosed as alcoholic. These findings are discussed and compared with those in the literature.

Suicide and prevention centres

Summary Suicide and parasuicide rates have been underestimated in the past although there is evidence to show that the individuals in the official statistics are representative of the suicidal population as a whole. Both medical and non-medical agencies are involved in suicide prevention and while their effectiveness is uncertain their efforts should be judged by the same criteria with the whole spectrum ideation taken into account.

Suicide prevention. Review and evaluation.

The interdependence of suicide prevention and crisis intervention is discussed and the development of telephone crisis-intervention/suicide-prevention services is described. Studies of the effectiveness of various types of services are reviewed and discussed and suggestions made for future research.

The role of anonymity in suicidal contacts with a crisis intervention centre.

In follow-up studies of telephone crisis centres the clients who choose to remain anonymous cannot be included in any follow-up group. It is therefore important to try to determine if there are some ways in which the anonymous group is unrepresentative of the total sample. The results of this study indicate that tha anonymous group tend to be more lonely and more likely to withhold information than the non-anonymous group. However, it would seem that follow-up studies would not be seriously invalidated by the non-availability of the anonymous group. A possible explanation of the role of anonymity in suicidal calls is presented, and the results are further discussed in terms of a counselling approach for anonymous suicidal callers and implications for further research.

Personality diagnosis and illness diagnosis.

This case presented with features of affective disorder with psychosis and also of borderline, avoidant and schizotypal personality disorders. During the course of subsequent treatment there was a marked reduction not only in psychotic and depressive features, but also in criteria for personality disorder, especially borderline. Relevant literature is reviewed and the importance of treatable illness as a possible cause of apparent personality disorder is discussed.