Fundamental neuroscience and the classification of psychiatric disorders

Non-Darwinian views of evolution of nervous systems (e.g., Jacksonian evolution) conceive the present structure of the human brain as composed of a series of additive layers representing successive phylogenetic stages in evolution, layers which remain static after their emergence. In contrast to this view, recent allometric studies clearly show that limbic structures scale with the growth of the human brain (i.e., they do not remain stable but reach the size expected for the brain of a primate with the weight of a human brain). Data also show that limbic structures are significantly involved in cognitive functions such as memory and attention. Hence overlap of lesions in similar brain loci, especially in limbic regions, in both manic-depression and schizophrenia should come as no surprise. In the psychobiological sphere, the need for cognitive perceptual evaluation of the external world and internal state for emotional experience, further to the necessary visceral arousal, leads to a breakdown of the platonic, essentialist position, emotion vs. cognition at the psychological level, a problematic issue for the Kraepelinean view. Neural networks operation depend upon multiple nonlinear processes at the cellular, synaptic and network levels. Afferent input may serve not only to activate, but also to configure them into one of several circuit modes. These networks have been named polymorphic and can, at least to a measure, account for commonalities in lesion sites, in both affective and schizophrenic diseases. It is proposed that fundamental neuroscience should serve as one of the bases for the classification of psychiatric disorders.     

Medical, juridical and ethical problems in permanent vegetative state

Except in the United Kingdom, there are no epidemiological data on permanent vegetative state in Europe over the last 12 years. Transposing the British (and Japanese) data to Switzerland with a population of 7 million, an annual incidence of some 70 cases can be expected and a prevalence of about 200-350 cases. The ethics committees of a number of Anglo-American societies specialized in the field postulate the ending of life-sustaining measures if the diagnosis of permanent vegetative state is definitely established. The medical, legal and ethical grounds for such a postulate are summarized.     

Some problems of defining ethical behavior.

Several issues are raised including: the definition of professional versus commercial standards, restriction on the scope of the professional relationship, the maintenance of test security, the question of to whom to release test scores, test publication and advertising practices, and the problem of client welfare. "Unless we clean house by a tough minded tightening of standards and a more effective campaign against questionable practices engaged in by a few psychologists, all psychologists will suffer by implication in the eyes of the general public." 3 cornerstones of ethical behavior are: high standards of personal competence, painstaking avoidance of misrepresentations, and primary concern for the integrity and welfare of the persons with whom the psychologist works. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The ethical problems of the open label extension study

OBJECTIVE: Comorbidity between anxiety and substance use disorders was examined. The hypothesis was tested that social phobics may report greater problem alcohol use (if alcohol is used to manage social anxiety) while problem use of sedative-hypnotics may be greater in people with panic (who may be over-prescribed anxiolytics because they repeatedly seek medical assistance). METHOD: Self-reported lifetime rates of drug and alcohol problems were assessed with the computerised Diagnostic Interview Schedule-Revised. Subjects were 146 consecutive patients treated for panic disorder (with and without agoraphobia) and social phobia at the Clinical Research Unit for Anxiety Disorders. RESULTS: High prevalences of alcohol problems (three times that expected) and problem use of sedative hypnotics (eight times that expected) were found in all diagnoses. Social phobics exhibited comparatively high rates of problem alcohol use, but no diagnostic specific differences in problem sedative-hypnotic use were found. CONCLUSION: Routine screening for drug and alcohol problems is necessary for patients with anxiety disorders.     

深度学习在磁共振影像脑疾病诊断中的应用

由于脑疾病的发生会对社会产生严重危害,所以脑疾病诊断研究的重要性日益显著. 中国“脑计划”列入“十三五”规划与国务院《“健康中国2023”规划纲要》的印发表明国家对脑疾病诊疗问题的高度重视. 由于磁共振影像的高分辨率及非入侵性等优势使其成为脑疾病研究与临床检查的主要技术手段,为脑疾病诊断提供丰富的数据基础. 深度学习由于其可拓展性与灵活性在各个领域得到广泛应用,展现出巨大的发展潜力. 本文针对深度学习在典型脑疾病诊断中的应用进行综述,结构组织如下：首先对深度学习在自闭症、精神分裂症、阿尔兹海默症三种典型脑疾病诊断上的应用进行了阐述;然后对用于三种脑疾病研究的数据集和已有的开源工具进行了汇总;最后对深度学习在磁共振影像脑疾病诊断应用中的局限性及未来发展方向进行总结与展望.

     

Increasing the impact of cluster analysis research: The case of psychiatric classification.

The publication of the DSM-III by the American Psychiatric Association has fueled interest among psychologists in developing alternative classifications. A popular approach is to use multivariate methods known as cluster analysis to identify clinical syndromes. Empirical clustering techniques offer potential for making diagnoses more objective, reliable, and predictive of outcome from differential treatment. However, problems exist at the interface between this statistical technology and psychiatric classification. To date, cluster-analytic studies have had limited impact on psychiatric nomenclature, and clinicians have not found the cluster-derived syndromes to be relevant to everyday practice. The present authors discuss reasons that underlie the lack of impact and describe directions for upgrading both the scientific quality and clinical acceptance of cluster-analysis research. It is concluded that more emphasis must be placed on fostering the clinical use of empirically derived classifications. (69 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Experimental and ethical problems of evaluating the influence of hypnosis in antisocial conduct.

Attempted to improve the procedures of an earlier experiment concerning the ability of hypnosis to create antisocial behavior. The influences of a personal relationship between S and hypnotist, and of S's knowledge of participation in an experiment, were examined. A measure of an S's moral stance toward the specific antisocial act (selling heroin) was also obtained. Ss were 22 female and 4 male undergraduates in 4 groups. Results suggest that the experimental manipulations were generally successful in deceiving Ss into believing that the antisocial request was separate from an experiment, and that an S's moral stance toward the act may be an important variable in determining compliance with requests to engage in antisocial behavior. The major finding, however, is identification of methodological and ethical problems in research of this kind, and these are considered in some detail. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research selection bias and the prevalence of depressive disorders in psychiatric facilities.

Applied a statistical technique to correct for selection bias in estimating the prevalence of depressive disorders in community mental health centers (CMHCs). Approximately 243 Ss completed the screening instruments at 2 CMHCs. Results indicate that the prevalence of depression in total CMHC populations may approach 44% rather than the 25% derived from a censored sample. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Decision rules for phenomenological classification of psychiatric patients.

Used cluster analysis and related numerical taxonomy methods to identify 8 distinct phenomenological types in the psychiatric population, and prototype patterns for the types are described in terms of the Brief Psychiatric Rating Scale (BPRS) profiles. Numerical methods are provided for classifying individual patients based on similarity to the prototype patterns. Patients can also be classified operationally by simple decision rules involving 2-point code typing of BPRS profile patterns. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The morbidity of insomnia uncomplicated by psychiatric disorders

Efficient superinfection of H9HTLVIIIB cell line (persistently infected with HIVHXB2 strain) with HIVMN strain is reported. The superinfecting viral DNA was found in the chromosomic and extrachromosomic fractions at early stages, but at 48 hours post superinfection, it remained mainly unintegrated. Interestingly, superinfected cells only produced HIVHXB2 in the supernatant and no increase of viral yield of this persistent virus was observed. Remarkably, virions of both strains. HIVHXB2 and HIVMN, were recovered after cocultivating superinfected cells with MT2 cell line. In the extrachromosomic fractions of seven different superinfected subclons of H9HTLVIIIB, viral DNA of the superinfecting HIVMN strain predominated while in the chromosomic fraction, the proportion of superinfecting viral DNA differed. The study of the presence of different integrated and unintegrated genomes in a single cell could be crucial in the understanding of HIV biology.     

Coping in chest pain patients with and without psychiatric disorders.

We first examined relations between psychiatric disorder and coronary heart disease (CHD) in 77 patients presenting with chest pain. The coping profiles of chest pain patients with and without psychiatric disorder and CHD were then compared. Psychiatric patients with no medical illness (n?=?129) were also studied. On the basis of previous research we hypothesized specific coping differences across the groups. As expected, chest pain patients without psychiatric disorder scored significantly higher on a problem-focused coping scale than chest pain patients with psychiatric disorder, who in turn scored higher on this scale than psychiatric patients with no medical illness. The opposite pattern occurred for a measure of wishful thinking. Scores of chest pain patients with psychiatric disorder were higher on a measure of avoidance and lower on a measure of seeking of social supports than those without psychiatric disorder. Scores on a self-blame measure were not different across the groups. The results are discussed in the context of illness behavior and somatization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality disorders and psychiatric symptoms in psoriasis

Two groups of psoriatic outpatients (ns = 192 and 119) were given, respectively, the Million Clinical Multiaxial Inventory-II and Foulds' Delusions-Symptoms-States Inventory. They were compared with dental (n = 192) and with general surgical (n = 190) patients. The psoriatic group presented clearly higher mean scores and frequencies on most of the personality disorder scales. On Foulds' inventory, psoriatic patients showed higher frequencies of neurotic and psychotic class allocations. A cluster analysis of personality scores provided evidence for 4 different personality clusters of patients with psoriasis: (a) Avoidant, Dependent, Schizoid, and Self-defeating (32.2%), (b) Compulsive, Narcissistic, and Aggressive (30.7%), (c) no personality disorder (18.2%), (d) Borderline, Paranoid, and Schizotypal, etc. (18.8%).     

Reinforcement of conversation "operants" in psychiatric patients.

Investigated the hypothesis that opinion statements and information statements could be conditioned to greater frequency in hospitalized psychiatric patients (N = 24) under natural conversation conditions. After a 10-min base-line period, each S's opinion and information statements were positively reinforced for a 20-min conditioning period by means of verbal agreement, enthusiasm, or paraphrase by E. Conditioning effects were achieved for both opinion and information statements. Results are interpreted as demonstrating that verbal "operants" can be conditioned in the verbal behavior of psychiatric patients under natural conversation conditions similar to those in psychotherapy. (French summary) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The value of screening for psychiatric disorders in rheumatology referrals

BACKGROUND: Musculoskeletal complaints are common and often unexplained and often lead to rheumatology referrals. The prevalence of psychiatric disease in patients with musculoskeletal complaints is unknown. OBJECTIVES: To determine the prevalence of common psychiatric disorders among patients referred to a rheumatology clinic and the likelihood of establishing a rheumatic diagnosis if a psychiatric disorder is present. DESIGN: Prospective diagnostic survey. SETTING: Two hospital-based rheumatology clinics and a general medicine clinic. PARTICIPANTS: A consecutive sample of newly referred patients (n = 185) and their rheumatologists (n = 9). INTERVENTION: Before their visit, all patients filled out a self-administered version of PRIME-MD (Primary Care Evaluation of Mental Disorders), a questionnaire that makes Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition: Primary Care Version, diagnoses of depressive, anxiety, and somatoform disorders. After the visit, the study rheumatologists, who were unaware of the PRIME-MD results, completed a questionnaire regarding their diagnostic assessment. These patients were compared with 210 patients with musculoskeletal complaints who were cared for in a general medicine clinic. MAIN OUTCOME MEASURES: Psychiatric and rheumatic disorders. RESULTS: Compared with patients with musculoskeletal complaints in a general medicine clinic, patients referred to a rheumatology clinic had a higher prevalence of psychiatric disease (40% vs 29%; P = .008), had an almost 2-fold higher prevalence of anxiety disorders, and were more likely to have multiple psychiatric disorders (odds ratio = 2.70, 95% confidence interval = 1.50-5.00). The likelihood of a psychiatric disorder differed among patients with connective tissue disease, nonsystemic articular or periarticular disorders, and nonarticular disorders (27%, 38%, 55%, respectively; P = .006). In a best-fitting logistic regression model, psychiatric disorders markedly decreased the likelihood of a connective tissue disease (odds ratio = 0.24, 95% confidence interval = 0.09-0.62). CONCLUSIONS: Forty percent of patients referred to a rheumatology clinic in this study had a psychiatric disorder, and its presence predicted a lower likelihood of a connective tissue disease. Prospective studies are needed to determine if screening for psychiatric disease before referring patients with unexplained musculoskeletal complaints would reduce costs or improve recognition of potentially treatable psychiatric disorders.     

"Some ethical issues in sensitivity training": Response.

M. Lakin's (see record 1970-08359-001) proposals, concerning the ethical issues involved in training group leaders in the human growth potential movement, fails to recognize the importance of human exploration and personal contact over professional credentials. To protect a vulnerable public from incompetence, information should be disseminated to permit individuals to make their own decisions about practitioner trustworthiness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comorbidity of psychiatric and communication disorders in children

The co-occurrence of psychiatric and communication disorders in children is considerable. Many children who are treated by mental health professionals are also in need of speech and language services. This article discusses comorbidity and outlines communication problems that accompany a variety of childhood psychiatric conditions. Empiric studies and clinical impressions of these co-occurring problems are described.