Social phobia treated as a problem in social functioning: a controlled comparison of two behavioural group approaches.

OBJECTIVE: Treatments for social phobia result typically in significant anxiety and avoidance reduction; the repercussions in terms of social functioning, however, are not clear. This controlled study compared two approaches designed to improve the social functioning of social phobics. METHOD: Sixty-eight socially phobic patients were randomly assigned to two treatments focused on improving interpersonal relationships either with or without social skills training or a waiting list; 60 completed treatment and 59 a 1-year follow-up. Treatment was administered in small groups, 14 sessions altogether. RESULTS: No clinically meaningful change was observed during the waiting period. A statistically significant and equivalent improvement obtained in both treatment conditions. CONCLUSION: Both treatments resulted in reduced anxiety, avoidance, general psychopathology and better social functioning that maintained over follow-up. Continuing improvement in remission rates was noted; fully 60% of the patients no longer fulfilled criteria for social phobia at the end of 1-year follow-up.

Anxiety, significant losses, depression, and irrational beliefs in first-offence shoplifters.

OBJECTIVE: To evaluate the relationship among demographic data, anxiety, significant losses, depression, and irrational beliefs reported by first-offence shoplifters. METHOD: One hundred and six adult shoplifters who were first-time offenders completed a self-administered questionnaire. RESULTS: Men and women were equally likely to be arrested for this offence. The majority of offenders were poor and unemployed. Depression, but not anxiety, was the most common psychiatric disorder associated with shoplifting. Subjects with depression presented the greatest number of irrational beliefs related to shoplifting. CONCLUSIONS: The authors suggest 2 categories of shoplifters: those who shoplift through rational choice; and those for whom shoplifting is a response to depression or leads to the fulfillment of some psychological needs. In conclusion, shoplifting does not have a unitary motive, and the clinical implications are that the affective and cognitive aspects of shoplifters' behaviours must be taken into account.

Effect of pre-conceptional external or internal irradiation of N5 male mice and the risk of leukemia in their offspring.

Male mice of the N5 strain were exposed to a unique external X-ray dose of 500 cGy, or to i.p. injections of tritiated water (HTO) over a 30 day period, which resulted in an estimated total internal exposure of 150 cGy. The paternal X-ray irradiation resulted in a marginally significant (P = 0.07) doubling of the leukemia/lymphoma rate in the offspring, over a 1 year observation period. The constitutive gene expression of granulocyte-macrophage colony stimulating factor (GM-CSF) and tumour necrosis factor (TNF) (two cytokines associated with hematopoiesis and immune response) spontaneously diminished between the ages of 6 months and 12 months in the bone marrows and in the spleens of these mice, and paternal X-ray exposure influenced the statistical significance of this diminution. Male exposure to HTO resulted in a statistically significant several-fold increase of leukemia incidence among the young offspring. However this increase tended to diminish as older mice were observed, and was no longer significant at 1 year of age. The overall leukemia incidence in the offspring of the HTO-exposed fathers was significantly dependent on the maturation stage of the sperm-forming cells during the HTO exposure, which suggests an influence of such an exposure.

The treatment of sexually dysfunctional men without partners: a controlled study of three behavioural group approaches.

BACKGROUND: Models of sex therapy for sexual dysfunction in single men are available, but their value is not well established. This controlled study compared three approaches to the treatment of sexually dysfunctional single men. METHOD: Sixty-nine single men diagnosed as sexually dysfunctional were randomly assigned to treatments focusing on either their sexual dysfunction, their interpersonal problems, a combination of both or a waiting list; 51 completed treatment and 50 the one-year follow-up. Treatment was administered in small groups in 15 weekly sessions and four six-weekly sessions during the first six months of a year-long follow-up. RESULTS: No clinically meaningful change was observed during the waiting period. In contrast, a significant and equivalent improvement was observed in all treatment groups by the end of treatment. However, differences between them were in evidence at 6 and 12 months' follow-up. CONCLUSIONS: Both treatments paying attention to the patients' interpersonal difficulties resulted in significantly better outcomes overall than the approach that concentrated on problems in sexual functioning alone.

[Psychiatric and medical specialists in community health: 2 solitary fields]. / Psychiatres et médecins spécialistes en santé communautaire: deux solitudes.

The fields of psychiatry and community health have much in common. Specialists in these two disciplines do not use sophisticated technology; the results of their research are not spectacular; and psychiatrists, like physicians specializing in community health, have a poor public image. Representatives of these two medical specialties must work more closely together and develop alliances to promote mental health in areas including: behavioral problems in children, alcoholism and substance abuse, adolescent suicide, community integration of the mentally ill, mental health problems among the elderly, and violence and sexual abuse. The author believes these two solitudes must be brought together and a work team established to improve community mental health.

Shoplifting and mental illness.

A survey of 1,649 shoplifting convictions at a Montreal area municipal court found that a relatively low percentage (3.2%) of the cases involved mentally ill patients and that there is a comparatively closer link between shoplifting and affective disorders, alcoholism and drug addiction. The survey also showed that shoplifting is related more to mental illness than to the use of psychotropic drugs. The authors therefore reject the hypothesis of pharmacogenic shoplifting which has been reported in some studies on small numbers of shoplifters.

[Research in psychiatry]. / La recherche en psychiatrie.

The department of psychiatry of the Université de Montréal has now organized a well structured research network in the area of child, adult and forensic psychiatry. The authors summarize the scientific approach according to research in these different sectors and believe that, although research in psychiatry now tends to promote diagnostic and treatment methods based more and more on neuro-sciences, it does not neglect the contribution of psychosocial and clinical aspects without which the human dimensions of mental illness and the objective of improvement of care to patients would be rapidly forgotten on behalf of disembodied research projects completely deprived of the relation with patients.

[Perceptions of mental illness in Quebec residents]. / Perceptions des Québécois à l'égard de la maladie mentale.

A transverse survey was conducted with 772 Quebecers in September 1992. Its purpose was to evaluate the level of awareness of the general public about mental illness, the general knowledge of these illnesses and their treatments and the attitudes towards mentally ill patients. Results show that half of the interviewed subjects still feel that they are not informed enough about mental illness and even well informed people have a poor general knowledge of mental illnesses and their treatments. Finally, more than 65% of the surveyed population show positive attitudes towards psychiatric patients, which seems to be an improvement in comparison with the past years. The author believes that physicians should give more information on mental illness and particularly on the role of drugs in the treatment of mentally ill patients. It seems also important to put more emphasis on information to low and middle class people.

[Influence of mass media on mental health]. / L'influence des médias sur la santé mentale.

The author summarizes different research findings which have evaluated the influence of the media on the mental health of children, adolescents and adults. After this review of the literature, strategies are proposed to improve the promotion of mental health in the media. Also the importance of collaboration between health professionals and broadcasters in this process is highlighted. Concrete examples are reported such as the communication programs which have been developed by the Quebec Mental Illness Foundation and the Quebec Psychiatrists' Association.

[Medical marketing in the media]. / Le marketing médical dans les médias.

The mass-media monopolize an important part of the lay public attention and intellectual energy and yet physicians do not seem very convinced that they must implicate themselves socially and participate in the education of the general public. Two reasons explain the lack of physicians' participation in the media. These are: the lack of interest and the lack of experience. Yet more and more studies underline the importance for health professionals to make more use of the mass-media in educating, supporting and informing the population on all aspects related to health matters. Thus the medical profession must collaborate more closely with the mass-media. Accordingly, physicians must jump at the opportunity to make every positive action known to the population instead of showing off in the media only their corporative or financial interests. They must also intervene each time that matters related to either health or illness are criticized or denounced in the media. As long as the medical profession is not conscious of the importance of judicious use of the media and of assuring its professional and social credibility, surveys will continue to put physicians in the public eye primarily on an individual basis and only in the last instance as a group.

The public image of psychiatrists.

The image of psychiatry is directly related to the knowledge that the public has of psychiatry and to the psychiatrists role as a "public informer". The time has come for psychiatrists to organize and have their opinions on all aspects of the mental health care system and mental illness heard in the media. After a review of different causes of the negative public image of psychiatrists, the reasons for which psychiatrists need to change their public image are outlined with some suggestions for increase public recognition. The importance of developing more research on the effect of mass media on the mental health care system is also outlined.

[The young homeless of Montreal: a longitudinal study]. / Les jeunes itinérants de Montréal: une enquête transversale.

A transverse survey conducted in 142 young homeless (age: 18-30) shows that they mainly come from broken families where alcoholism, violence and mental illness hold an important place. Regarding work, the majority of the surveyed homeless have not worked more than 24 months in all their life and have nearly continuously been on welfare; those who had jobs lost them much more because of their alcohol or drug use and their problems of interpersonal relationships than because of unemployment. On a personal level, these young adults are particularly battling against two major problems: alcoholism and drug addiction, and mental illness. Although 23% of the surveyed subjects have already been hospitalized in psychiatry, the majority of these young homeless have never received any psychiatric care. Nevertheless, they show mental health problems which are often mistakenly dismissed as the effects of alcoholism or chronic drug abuse. The authors believe that means of detection and adequate treatment must be developed for this growing population instead of thinking of social measures which would only give the young homeless a meal and protection from the elements.

Clinical phobias and avoidant personality disorder among alcoholics admitted to an alcoholism rehabilitation setting.

One hundred seventy-three abstinent patients were screened for phobias and avoidant personality disorder. Ninety-six patients were interviewed and diagnosed by two independent assessors who were in agreement on 74% of the diagnoses. In DSM-III terms, over half of the sample (51.4%) met criteria for agoraphobia (8.5%), social phobia (7.8%) and avoidant personality disorder (35.1%). More than 70% of the patients in each diagnostic category were men. For the vast majority of the patients in the sample the disorder preceded the abuse of alcohol which was used by at least 40% of them to relieve their distress in the past. For many it had still a moderating effect on distress at the present but appeared to be mainly used out of "psychological dependence".

The use of mass media in mental health.

This paper summarizes the theoretical aspects and the experimental studies on the efficacy of mass media in mental health information campaigns. In theory, most authors agree to give mental health information to the lay public but they caution against the overestimation of the power of mass media. Regarding research on the use of mass media in mental health very few experimental studies have been published and they refer mainly to primary prevention with children. The authors discuss reasons which may explain the mental health professionals' lack of interest in this area of research, suggest new approaches for the elaboration of educational programs for the population and emphasize the importance of secondary and tertiary prevention.

Private exposure and covert sensitization in the treatment of exhibitionism.

The present report describes the treatment of a long standing exhibitionism case by covert sensitization and private exposure in front of his wife within an A-BC-B-BC-C single case experimental design. The therapeutic phase of the treatment lasted 10 weeks. Results show that the combination of covert sensitization and private exposure seems to be an interesting technique for married exhibitionists and their wives. Covert sensitization was used to eliminate deviant fantasies and private exposure seemed to have rendered exhibitionism socially acceptable. The various measures of subjective responses indicated that there were no exhibitionist activities during baseline and treatment nor during the year's follow-up, and the patient has been asymptomatic for more than 2 years, as confirmed by a recent follow-up visit. Controlled studies with larger groups of patients are now needed to prove the efficacy of this active, nonaversive and economical treatment for exhibitionists and their wives.