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The literature on persistent antidepressant withdrawal symptoms is sparse. This systematic review is the first to examine the prevalence, duration, severity, risk/protective factors and treatment strategies for post-acute withdrawal syndrome (PAWS) following the discontinuation of antidepressant medications.
Methods
We searched PubMed, Web of Science and PsycInfo, focusing on newer-generation antidepressants. The electronic database search was complemented with handsearching reference lists of pivotal studies. We included original studies in adults reporting on PAWS and providing data about epidemiology and clinical management of withdrawal symptoms persisting for at least 6 weeks.
Results
The literature search yielded 1286 results, with 26 records assessed for eligibility, and seven studies fulfilled our selection criteria. Prevalence data were sparse, with one small cohort study reporting a 15% prevalence rate for PAWS in patients with panic disorder and agoraphobia. The duration of PAWS varied considerably across studies, ranging from 1.5 to 166 months. Long-term paroxetine use emerged as a potential risk factor for the development of PAWS. There was no reliable evidence to support the effectiveness of various treatment strategies, including the reinstatement of antidepressant medication, the use of benzodiazepines and the provision of cognitive-behavioral therapy.
Conclusions
The current evidence on PAWS is sparse and predominantly of low certainty. The presence of withdrawal symptoms, lasting several months and possibly even years in some patients, underscores the need for further research with rigorous methodology. Large prospective cohort studies are needed to assess the epidemiology of PAWS, while randomized controlled trials are quired to test the efficacy of clinical interventions to treat PAWS.
This chapter studies how property rights are protected and recognized in common law. In doctrine, substantive rights are not recognized expressly but indirectly. Rights are recognized via doctrines that prohibit wrongs to rights. Common law protects rights in this manner for practical reasons. Courts are better equipped to enforce duties between rights-holders and aggressors than they are to work out the full scope of rights, and when the law prohibits wrongs to rights, it leaves to people the freedom to do whatever does not violate the prohibitions. To secure rights, however, legal duties and prohibitions are structured as seems likely to secure rights. This chapter illustrates nuisance and tort suits over train sparks. Both doctrines secure to owners and occupants rights to use land. The harm, interference, and unreasonability elements of nuisance are structured to secure use rights, and sparks doctrine rules out contributory negligence to secure the same use rights. This way of thinking about rights and wrongs goes against contemporary law and economic scholarship, and this chapter contrasts law and economic studies of rights with the approach developed in this chapter.
Eggleston claims that my account of harm suffers from more problems than his preferred account. I clarify my account, and explain how his account suffers from some of the supposed problems he charges my account with. Sinnott-Armstrong suggests that his contrastivist approach is preferable to my contextualism. I clarify the role of linguistic context, and suggest that our positions are quite close to each other. Mason worries that my scalar approach does not properly accommodate the notions of blame and moral responsibility. I maintain that such notions have only a derivative status, but are nonetheless important, and I suggest fruitful avenues for the scalar consequentialist to pursue. Kagan claims that the addition of a contextualist account of “right” renders my view not importantly different from maximizing or satisficing views. I explain why this is mistaken, and why neither maximizing nor satisficing versions of rightness can explain its supposed moral significance.
Melina Constantine Bell (2021) argues that J. S. Mill's harm principle permits society to coercively interfere with the use of bigoted insults, since these insults are harmful on “a more expansive, modern, conception of harm.” According to Bell, these insults are harmful in virtue of their contributing to detrimental objective states like health problems. I argue that people with illiberal dispositions might have intense and sustained negative subjective reactions to behavior that the harm principle ought to protect, reactions intense enough to affect their health or other objective interests. Bell's way of thinking about harm therefore has illiberal implications. Yet I agree with her that bigoted insults should be regarded as harmful. I therefore propose an alternative way of understanding harm according to which subjective pain is a harm when it is intentionally caused.
An important strand of argument in Alastair Norcross's Morality by Degrees: Reasons without Demands is the rejection of the standard account of harm, which underwrites non-comparative statements of the form “act A harms person X.” According to Norcross, the correct account of harm is a contextualist one that only underwrites comparative statements of the form “act A results in a worse world for X than alternative act B, and a better world than alternative act C.” This article criticizes Norcross's contextualist account and his rejection of the standard account. It follows that moral theorists of all kinds should not be deterred by Norcross's arguments from continuing to rely on the standard account and using it to non-comparatively categorize some acts as harmings.
Daniel Immerman has recently put forward a novel account of harm, the Worse than Nothing Account. We argue that this account faces fatal problems in cases in which an agent performs several simultaneous actions. We also argue that our criticism is considerably more powerful than another one that has recently been advanced.
A broad consensus has emerged in recent years that although rumours, conspiracy theories and fabricated information are far from new, in the changed structure and operating mechanisms of the public sphere today we are faced with something much more challenging than anything to date, and the massive scale of this disinformation can even pose a threat to the foundations of democracy. However, the consensus extends only to this statement, and opinions differ considerably about the causes of the increased threat of disinformation, whom to blame for it, and the most effective means to counter it. From the perspective of freedom of speech, the picture is not uniform either, and there has been much debate about the most appropriate remedies. It is commonly argued, for example, that the free speech doctrine of the United States does not allow for effective legal action against disinformation, while in Europe there is much more room for manoeuvre at the disposal of the legislator.
State responses to the recent ‘crisis’ caused by misinformation in social media have mainly aimed to impose liability on those who facilitate its dissemination. Internet companies, especially large platforms, have deployed numerous techniques, measures and instruments to address the phenomenon. However, little has been done to assess the importance of who originates disinformation and, in particular, whether some originators of misinformation are acting contrary to their preexisting obligations to the public. My view is that it would be wrong to attribute only to social media a central or exclusive role in the new disinformation crisis that impacts the information ecosystem.
This essay considers how the fact that some morally innocent person is nevertheless a threat to others can bear on the permissibility of health policies that harm some to protect others. Two types of innocent threats are distinguished. In the case of abortion, it is argued that even if the embryo/fetus were a person, abortion could be permissible to protect a woman’s life, health, or bodily autonomy. Whether there nevertheless should be time limits on abortions and what surprising form such limits might take are also considered. In the case of pandemics, it is suggested that discussions of health policies should, but often do not, distinguish morally between innocent threats and their potential victims as well as between providing benefits to people and preventing harms to them. The essay also examines discussions of pandemics by health professionals that make use of the trolley problem, the doctrine of double effect, and related philosophical distinctions.
The words ‘nature’ and ‘environment’ have different senses and referents. The idea of the environment is keyed to what surrounds us, and we can speak of natural and built environments as well as others. This book is concerned with ethical questions about the environment. Many of these concern problems that occur at different scales and cause harms of various types. Environmental problems can be viewed from technological, economic, religious, and aesthetic perspectives, among others. No single perspective provides the sole correct or exhaustive way of viewing environmental problems. There is an ethical dimension to most environmental problems and that is the focus of this book.
The chapter discusses the position of victims in international criminal justice and the evolution of their status and modalities of their involvement in the administration of justice by international criminal jurisdictions, with a particular focus on the legal regime of the International Criminal Court (ICC). The chapter highlights the centrality of victims as the core constituency of international criminal law and the mismatch between this aspiration and the limited recognition of their agency and rights before the UN ad hoc tribunals. It then examines how the ICC’s architects have sought to bridge this gap in the Court’s Statute and Rules of Procedure and Evidence. The ICC’s legal framework is unprecedented in this respect. Over and above the protective measures necessary on account of their engagement in the proceedings, it granted victims extensive rights to participate and be legally represented at different stages the ICC proceedings as well as the autonomous right to obtain reparations. The chapter surveys the key challenges this ambitious scheme has raised, as far as the admission of victims to participate, the organisation of their legal representation, and the implementation of reparations are concerned, and solutions that have been developed in the Court’s practice to date.
This chapter deals with all manner of state-derived prohibitions. Ancient states prohibited a broad variety of behaviours, threatening punishment for those who would transgress boundaries. The logic of prohibition was wide-ranging: from the marking of spaces, objects and officials as somehow distinct from the rest of ‘society’, leading factions within ancient states sought to preserve and protect their individual prerogatives. They also sought to reinforce their claims to leadership by incentivizing subjects to settle their disputes in state-sanctioned venues. The evidence for such prohibitions is extensive, but did they add up to something that we might legitimately call ‘social control’? Did ancient states succeed at inducing subject populations to accept their claims to rule? If so, how? This chapter suggests that the logic of prohibition was a site of contestation for both statecraft and subject-craft.
There is a general consensus that personality disorders (PDs) share a general factor (g-PD) overlapping with the general factor of psychopathology (p-factor). The general psychopathology factor is related to many social dysfunctions, but its nature still remains to some extent ambiguous. We posit that hostile attributions may be explanatory for the factor common for all PDs, i.e., interpersonal problems and difficulty in building long-lasting and satisfying relationships of all kinds. Thus, the main objective of the current project was to expand the existing knowledge about underlying factors of g-PD with regard to hostile attributions. We performed a cross-sectional study on a representative, community sample of Poles (N = 1031). Our hypotheses were primarily confirmed as hostile attributions predicted p-factor. However, the relation was positive only for hostile attributions related to ambiguous situations involving relational harm and physical harm done by female authorities and negative in case of hostile attributions in situations involving physical harm done by peers. Additionally, paranoia-like thoughts strongly related to hostile attributions and independently predicted g-PD. The results contribute to the current discussion on the nature of the g-PD, confirm that hostile attributions and paranoia are a crucial aspect of personality pathology, and indicate the importance of working on these cognitions in the course of therapeutic work.
One of the most important aspects of human rights law for children is the recognition that the state has positive obligations to protect them from harm, including harm suffered in the home. Child protection is one of the most important areas for protecting children’s rights, but also one of the most difficult. As well as the right to protection from harm, children and parents also have a right to protection of their family life together. This chapter considers the extent to which the law and process of child protection protect the rights of children at risk from harm. It considers the importance of supporting families and the difficulty of deciding when to intervene. It then considers child protection proceedings and the extent to which children’s rights are protected in the law concerning child protection orders. Finally, it considers children’s own perspectives and the extent to which they are heard in the process.
Health interventions are purposeful activities intended to improve health. They may involve treatment or care of the ill, or health promotion to prevent disease and illness. Complex health interventions have multiple components interacting with each other and with the context of delivery. Evaluation is important to ensure that complex health interventions are effective in achieving their intended outcomes, represent good value for money and cause minimal harm. Evaluation is also important to detect if interventions reduce or increase health inequalities. Intervention effects are not always obvious. They can easily be confused with other changes that occur. Hence, there is a need for evaluation to use rigorous methods to distinguish the ‘signal’ of intervention effects from the ‘noise’ of other effects in the absence of intervention. Evaluation should provide evidence to inform policy. If not based on evidence, there is a risk that policies may not achieve their intended effects or may create harms.
Legal rules aimed at compensation for the harm caused by a particular state, individual, or legal entity (for example, oil pollution of the sea due to a tanker accident) are well studied and constantly used in scientific literature and international law practice. Meanwhile, every year, the number of cases of harm when the particular guilty party cannot be established grows; this is why it is almost impossible to compensate for the harm caused. Such cases include collisions of satellites causing space debris; the consequences of climate change for agriculture, forestry, and the health of citizens; and the pollution of the World Ocean with plastic debris, ballast water, and abandoned nets.
There are more such cases at the national level. After studying acts of international environmental law, national legislation, and several examples from judicial practice, we show that compensation for the harm caused to life, health, or property in the absence of a particular harm-doer is difficult or impossible to prove. This is why actions that can prevent subjectless environmental harm are taken at the national level in certain countries by developing measures to mitigate and adapt to climate change, licensing space activities, and taking preventive measures against the formation of plastic debris and its pollution of the seas, etc. This trend should be continued, and the experience gained by certain states should be used in developing new acts of international environmental law. This will ensure the next step towards preventing environmental harm where it is impossible to establish the doer’s name.
The harm principle sets a limit on the justified legal and social control of individuals. The principle also provides a widely accepted justification for such control. This chapter critically reviews John Stuart Mill’s understanding of the harm principle and the considerations he advanced in its support. It also draws on other discussions of the principle to assess its plausibility in general. Mill took the harm principle to be the sole ground for justified interference with the liberty of individuals, but less restrictive defenses of the principle are available. The content of the harm principle, on any of its formulations, is shaped by the characterization of harm that figures in it. A good characterization of harm should be both descriptively accurate and morally appealing, but these two desiderata can pull in opposing directions. This chapter argues that the characterization of harm that figures in the harm principle must advert to the grounds that justify the principle, but these grounds are multiple and can come into conflict. Mill presents both an autonomy argument and a social learning argument in support of the harm principle, but the ground of autonomy can speak in favor of interference in cases where the social learning argument speaks against it. The chapter concludes with a brief discussion of harm, speech and offense.
Proponents of the harm principle often appeal to a notion of personal sovereignty in setting out their position. This notion helps to fix the application of the harm principle. Critics of the harm principle seize on this point and argue that, once a principle of sovereignty is introduced, it can do all the work that needs doing. Appeals to harm become otiose. Further, the critics contend, the harm principle cannot explain the impermissibility of certain “harmless” wrongs, such as those involved in harmless trespass. This chapter assesses this sovereignty-centered critique of the harm principle. It argues that neither the harm principle nor the sovereignty principle enjoys priority over the other. The two principles complement each other with neither meriting a privileged position. The chapter then discusses the content and stringency of the sovereignty principle, and its relation to the Volenti Maxim, which holds that a person is not harmed or wronged by that to which they consent. The critical discussion of the Volenti Maxim, in turn, reveals limits to the sovereignty principle.
This article examines ‘parental harm’ – a harm that occurs when a parent loses or faces the threat of losing a child. We contend that the manipulation and severing of relationships between parents and children has played a central role in war and oppression across historical contexts. Parental harm has long-term and pervasive effects and results in complex legacies for carers and their communities. Despite its grave impact, there is little research within International Relations into parental harm and understanding of its effects. We conceptualise parental harm through two frames – the ‘harm of separation’ and ‘harm to the ability to parent’ – and theorise gendered dimensions of how it is perpetuated and experienced. As such, we advance feminist understandings of family as a gendered institution that shapes the conduct of war and institutionalises racialised oppression. Our conception of parental harm offers novel insights into the relationship between intimate relations, the family, and state power and practices. We illustrate our conceptual arguments through two examples: the control and manipulation of family in antebellum slavery in the United States and the targeting of Tamil children in disappearances in Sri Lanka. These examples demonstrate the pervasiveness of parental harm across contexts and forms of violence.