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Edited by
Allan Young, Institute of Psychiatry, King's College London,Marsal Sanches, Baylor College of Medicine, Texas,Jair C. Soares, McGovern Medical School, The University of Texas,Mario Juruena, King's College London
Major depressive disorder (MDD) is manifested by mood, behavioural, cognitive, and somatic symptoms. This is reflected in the diagnostic criteria of both DSM-5 and ICD-10. Differential diagnosis typically includes the consideration of other mood and psychiatric disorders, neurological, medical and genetic conditions, as well as bereavement. Diagnostic investigations are commonly combined with the evaluation of functioning since the vast majority of MDD patients experience functional impairment. Suicidality is a major challenge in the management of MDD. Rigorous risk assessment, minimisation of risk factors, and promotion of protective factors are essential in suicide prevention. Treatment strategies can be split into acute, continuation, and maintentance phases. Depending on depression severity and other specifiers (e.g., psychosis, risk) both pharmacotherapy and psychotherapy can be efficacious first-line treatment options. Switching or augmenting initial treatment can be considered for non-responders. For continuation and maintenance phases, the primary aim of treatement is prolonging remission, preventing episode recurrence, and restoring psychosocial functioning.
On the basis of Poincaré and Weyl’s view of predicativity as invariance, we develop an extensive framework for predicative, type-free first-order set theory in which $\Gamma _0$ and much bigger ordinals can be defined as von Neumann ordinals. This refutes the accepted view of $\Gamma _0$ as the “limit of predicativity”.
In this paper we study persistence features of topological entropy and periodic orbit growth of Hamiltonian diffeomorphisms on surfaces with respect to Hofer's metric. We exhibit stability of these dynamical quantities in a rather strong sense for a specific family of maps studied by Polterovich and Shelukhin. A crucial ingredient comes from enhancement of lower bounds for the topological entropy and orbit growth forced by a periodic point, formulated in terms of the geometric self-intersection number and a variant of Turaev's cobracket of the free homotopy class that it induces. Those bounds are obtained within the framework of Le Calvez and Tal's forcing theory.
“According to [Bayesian] models” in cognitive neuroscience, says a recent textbook, “the human mind behaves like a capable data scientist.” Do they? That is, do such models show we are rational? I argue that Bayesian models of cognition, perhaps surprisingly, don’t and indeed can’t show that we are Bayes-rational. The key reason is that they appeal to approximations, a fact that carries significant implications. After outlining the argument, I critique two responses, seen in recent cognitive neuroscience. One says that the mind can be seen as approximately Bayes-rational, while the other reconceives norms of rationality.
Uchiyama et al. emphasize that culture evolves directionally and differentially as a function of selective pressures in different populations. Extending these principles to the level of families, lineages, and individuals exposes additional challenges to estimating heritability. Cultural traits expressed differentially as a function of the genetics whose influence they mask or unmask render inseparable the influences of culture and genetics.
Boundaries are defined and maintained to establish and preserve cultural, societal and political integrity. Boundaries change as territorial structures and their related meanings change over time, reflecting the transformation of economic, political, administrative and cultural practices and discourses, and inherent relations of power. The Israeli metropolis of Tel Aviv is no different in this context. The end of World War I and establishment of a British Mandate regime in Palestine resulted in the transformation of political, economic, social and cultural structures. The British Mandate afforded the rise of and development of Tel Aviv from Jaffa's Jewish garden suburb into a separate urban entity. Different internal and external factors affected the delineation of the urban bounds of Tel Aviv following its declaration by the British Mandate government as an autonomous township.
Scholars contend that the reason for stasis in human rights measures is a biased measurement process, rather than stagnating human rights practices. We argue that bias may be introduced as part of the compilation of the human rights reports that serve as the foundation of human rights measures. An additional source of potential bias may be human coders, who translate human rights reports into human rights scores. We first test for biases via a machine-learning approach using natural language processing and find substantial evidence of bias in human rights scores. We then present findings of an experiment on the coders of human rights reports to assess whether potential changes in the coding procedures or interpretation of coding rules affect scores over time. We find no evidence of coder bias and conclude that human rights measures have changed over time and that bias is introduced as part of monitoring and reporting.
This editorial expands on a Praxis article published by Beattie and colleagues in the trainees’ section of this journal. The authors describe an interesting case of anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis, outline the clinical presentation and make suggestions on ways to approach this rare disorder. Here we provide an overview of autoimmune conditions that result in the production of autoantibodies targeting central nervous system proteins mediating autoimmune encephalitis and offer a perspective on approaches to diagnosis and treatment.
The study of language acquisition has a long and contentious history: researchers disagree on what drives this process, the relevant data, and the interesting questions. Here, I outline the Starting Big approach to language learning, which emphasizes the role of multiword units in language, and of coarse-to-fine processes in learning. I outline core predictions and supporting evidence. In short, the approach argues that multiword units are integral building blocks in language; that such units can facilitate mastery of semantically opaque relations between words; and that adults rely on them less than children, which can explain (some of) their difficulty in learning a second language. The Starting Big approach is a theory of how children learn language, how language is represented, and how to explain differences between first and second language learning. I discuss the learning and processing models at the heart of the approach and their cross-linguistic implications.
From the 1960s to the 1980s, in parallel with societal changes from welfarism to the counterculture, the legacy of the child guidance and psychodynamic approaches gave way to more active, transparent and fast-moving therapies. Family/systemic therapy involved the whole family, training practitioners from all disciplines. Cognitive behavioural therapy (CBT) was developed as an alternative effective psychological treatment. A variety of longitudinal and epidemiological research approaches developed, providing a variety of ways of measuring the presence and impact of mental health problems. Conditions such as anorexia of childhood, self-harming and neurodevelopmental disorders – autism and attention deficit hyperactivity disorder (ADHD) – have been identified. Despite attempts to ‘shrink the state’ in the 1980s, a continuing theme has been the recognition of the hidden yet pervasive traumatic impact of maltreatment many children suffer. There is a lifespan impact of adversity on mental and physical health and the need for a trauma-informed care approach.
This article gives a general overview of the current situation in relation to a range of widely recognised and also newly identified types of child maltreatment. The academic and clinical evidence relating to the impact of child maltreatment on the mental and physical health of child victims is substantial and steadily increasing in volume. New types of abuse are being identified, and changing environmental circumstances, which exacerbate the possibility of widely recognised types of child maltreatment occurring, are also being described. These include multi-type maltreatment, female genital mutilation and online child maltreatment. Serious questions may arise regarding neglect of the moral and social development of children and young people who become addicted to online gaming and pornography. Multiple national and local definitions of each of these existing and new forms of maltreatment have been created, some of which are covered here. The impact of these abuses on the physical and mental health and development of child victims in families or settings where abuse or neglect has occurred is discussed.
Fibrocystic liver disease refers to a heterogeneous group of disorders with shared, but also distinct, pathophysiologic and clinical features. Cystic dilatation of intrahepatic bile duct structures and variable degrees of portal fibrosis are the hallmarks of fibrocystic liver disease. In many instances, there are morphologic abnormalities in the kidneys that parallel those of the liver. It has been recognized for centuries that hepatic and renal cysts are seen in the same individuals [1], although it has not always been accepted that they are manifestations of the same diseases. The older literature contains confusing descriptive classifications of fibrocystic diseases, with imprecise and overlapping definitions. Even now, attempts at describing clinical and radiographic features, prognosis, natural history, and treatment are somewhat hampered by reliance on these descriptive reports. However, much of the molecular basis for these disorders has been elucidated, and clinical diagnoses are being modified using more exact genetic criteria. The current consensus is that genetic determinants of differentiation and development of renal tubules and biliary structures result in a broad spectrum of congenital abnormalities grouped under the heading of fibrocystic liver and kidney disease.
Depressive disorders are common conditions with a life prevalence of 15% in high-income countries (1) and significant economic implications for individuals and society. Major depressive disorders have negative repercussions on the overall quality of life of the people affected with an excess number of years lived with a disability (2). Although effective treatment is available, up to 65% of individuals do not fully respond or continue to experience residual symptoms, which contribute to significant disease burden (3). It is essential to improve our understanding of the neuroanatomy of depressive disorders and the functional implications to develop new targets for more efficacious treatments.
Human trafficking affects millions of people globally, disproportionately harming women, girls and marginalized groups. Yet one of the main sources of data on global trafficking, the annual Trafficking in Persons (TIP) Reports, is susceptible to biases because report rankings are tied to political outcomes. The literature on human rights measurements has established two potential sources of bias. The first is the changing standards of accountability, where more information and increased budgets change the standard to which countries are held over time. The second is political biases in reports, which are amended to comply with the interests of the reporting agency. This letter examines whether either of these biases influence the TIP Reports. In contrast to other country-level human rights indicators, the State Department issues both narratives and rankings, which incentivizes attempts to influence the rankings based on political interests. The study uses a supervised machine-learning algorithm to examine how narratives are translated into rankings, to determine whether rankings are biased, and to disentangle whether bias stems from changing standards or political interests. The authors find that the TIP Report rankings are more influenced by political biases than changing standards.
An understanding of the current state of mental health services in the United Arab Emirates (UAE) from a clinical perspective is an important step in advising government and stakeholders on addressing the mental health needs of the fast-growing population. We conducted a retrospective study of data on all patients admitted to a regional psychiatric in-patient unit between June 2012 and May 2015. More Emiratis (UAE nationals) were admitted compared with expatriates. Emiratis were diagnosed more frequently with substance use disorders and expatriates with stress-related conditions. Psychotic and bipolar disorders were the most common causes for admission and had the longest in-patient stays; advancing age was associated with longer duration of in-patient stay.
A number of philosophers draw a close analogy between scientific modeling and fiction, often appealing to Kendall Walton’s make-believe view. I assess the models-fictions analogy from a cognitive angle, suggesting that from this perspective it appears relatively weak. More specifically, I argue that, on the one hand, the appeal to Walton is appropriate inasmuch as his view fits well with how modelers employ the imagination. On the other hand, what makes Walton’s view attractive as an account of the cognitive aspects of modeling makes it less attractive as an account of fiction.
Personality disorders are prevalent in 6–10% of the population, but their risk for cause-specific mortality is unclear. The aim of the study was to assess the association between personality disorders diagnosed in late adolescence and all-cause as well as cause-specific (cardiovascular-related, external-related) mortality.
Methods
We performed a longitudinal study on a historical prospective cohort based on nationwide screening prior to recruitment to the Israeli army. The study participants were 16–19-year-old persons who attended the army screening (medical and cognitive, including screening for psychiatric disorders) between 1967 and 2006. Participants were followed from 1967 till 2011.
Results
The study included 2 051 606 subjects, of whom 1 229 252 (59.9%) were men and 822 354 (40.1%) were women, mean age 17.36 years. There were 55 508 (4.5%) men and 8237 (1.0%) women diagnosed with personality disorders. The adjusted hazard ratio (HRs) for coronary, stroke, cardiovascular, external-related causes and all-cause mortality among men with personality disorders were 1.34 (1.03–1.74), 1.82 (1.20–2.76), 1.45 (1.23–1.71), 1.41 (1.30–1.53) and 1.44 (1.36–1.51), respectively. The absolute rate difference for all-cause mortality was 56.07 and 13.19 per 105 person-years among men and women, respectively. Among women with personality disorders, the adjusted HRs for external-related causes and all-cause mortality were 2.74 (1.87–4.00) and 2.01 (1.56–2.58). Associations were already evident within 10 years of follow-up.
Conclusions
Personality disorder in late adolescence is associated with increased risk of cardiovascular, external- and all-cause mortality. Increased cardiovascular mortality is evident before the age of 40 years and may point to the importance of lifestyle education already in youth.
Clients and therapists often have different perspectives on their therapeutic alliance (TA), affecting the process and outcome of therapy. The aim of the present meta-analysis was to assess the mean differences between clients’ and therapists’ estimations of TA among clients with severe disturbances, while focusing on two potential moderators: client diagnosis and alliance instrument.
Method:
We conducted a systematic literature search of studies examining both client perspective and therapist perspective on TA in psychotherapy among people with schizophrenia spectrum disorders, personality disorders, and substance misuse disorders. We then analyzed the data using a random-effects meta-analytic model with Cohen’s d standardized mean effect size.
Results:
Heterogeneity analyses (k = 22, Cohen’s d = −.46, 95% confidence interval = .31–1.1) produced a significant Q-statistic (Q = 94.96) and indicated high heterogeneity, suggesting that moderator analyses were appropriate.
Conclusions:
Our findings show that the type of TA instrument moderates the agreement on TA between client and therapist, but there was no indication of the client’s diagnosis moderating the effect. The agreement between client and therapist estimations seems to be dependent on the instrument that is used to assess TA. Specific setting-related instruments seem to result in higher agreement between clients’ and therapists’ estimations than do more general instruments that are applied to assess TA.