The differentiation of trait anxiety and depression in nonclinical and clinical populations is addressed. Following the tripartite model, it is assumed that anxiety and depression share a large portion of negative affectivity, but differ with respect to bodily hyperarousal and anhedonia. In contrast to the tripartite model, NA is subdivided into worry and dysthymia, which leads to a four-variable model of anxiety and depression encompassing emotionality, worry, dysthymia, and anhedonia. Item-level confirmatory factor analyses and latent class cluster analysis based on (...) a large nation-wide representative German sample substantiate the construct validity of the model. Further evidence concerning convergent and discriminant validity with respect to related constructs is obtained in two smaller nonclinical and clinical samples. Factors influencing the association between components of anxiety and depression are discussed. (shrink)

We report two studies on the effect of implicitly versus explicitly conveying affirmation and denial problems about conditionals. Recently Evans and Handley (1999) and Schroyens et al. (1999b, 2000b) showed that implicit referencing elicits matching bias: Fewer determinate inferences are made, when the categorical premise (e.g., B) mismatches the conditional's referred clause (e.g., A). Also, the effect of implicit affirmation (B affirms not-A) is larger than the effect of implicit denial (B denies A). Schroyens et al. hypothesised that this interaction (...) is due to uncertainty in the case-wise affirmation of the contrast class of negated elements involved in implicit affirmations. In Experiment 1 we tested this hypothesis by manipulating the set size of the conditional clauses. The results confirm that binary sets, where the contrast class is a singleton, eliminate the differential effect of implicit affirmation and denial. With non-binary sets the interaction is not modulated by the scope of the contrast class (3, 5, 9 elements). Experiment 2 further investigated the role of contrast classes by using class inclusion to construct implicit affirmations (Mammal vs Mammal or Monkey) and implicit denial (No-Mammal vs Mammal or Monkey), in addition to the standard implicit problems mediated by contrast-class inclusion [(No-)Mammal/No-Mammal; Reptile; Snake). Findings indicate that class inclusion (Mammal/Monkey; Reptile/ Snake) only marginally affects performance, and is independent of the type of problem. This would suggest that the implicitness problem-type interaction is dependent on constructing contrast classes. However, the experiment failed to replicate the interaction, even on the subset of problems repeating the abstract letter/number format of Experiment 1. Moreover, with the natural binary set-sizes (vowels/consonants) the implicitness effect was eliminated entirely. (shrink)

According to the three-tier hierarchy of motivational potency in the self system, the self can be divided into individual self, relational self, and collective self, and individual self is at the top of the motivational hierarchy in Western culture. However, the motivational primacy of the individual self is challenged in Chinese culture, which raises the question about whether the three-tier hierarchy of motivational potency in the self system can be differentiated in the collectivist brain. The present study recorded the event-related (...) potentials (ERPs) to evaluate brain responses when participants gambled for individual self, for a close friend (relational self), or for the class (collective self). The ERP results showed that when outcome feedback was positive, gambling for individual self evoked a larger reward positivity compared with gambling for a friend or for the class, while there is no difference between the latter two conditions. In contrast, when outcome feedback was negative, no significant effect was found between conditions. The present findings provide direct electrophysiological evidence that individual self is at the top of the three-tier hierarchy of the motivational system in the collectivist brain, which supports the classical pancultural view that individual self has motivational primacy. (shrink)

Major depression (MD) is a highly heterogeneous diagnostic category. Diverse symptoms such as sad mood, anhedonia, and fatigue are routinely added to an unweighted sum-score, and cutoffs are used to distinguish between depressed participants and healthy controls. Researchers then investigate outcome variables like MD risk factors, biomarkers, and treatment response in such samples. These practices presuppose that (1) depression is a discrete condition, and that (2) symptoms are interchangeable indicators of this latent disorder. Here I review these two assumptions, elucidate (...) their historical roots, show how deeply engrained they are in psychological and psychiatric research, and document that they contrast with evidence. Depression is not a consistent syndrome with clearly demarcated boundaries, and depression symptoms are not interchangeable indicators of an underlying disorder. Current research practices lump individuals with very different problems into one category, which has contributed to the remarkably slow progress in key research domains such as the development of efficacious antidepressants or the identification of biomarkers for depression. The recently proposed network framework offers an alternative to the problematic assumptions. MD is not understood as a distinct condition, but as heterogeneous symptom cluster that substantially overlaps with other syndromes such as anxiety disorders. MD is not framed as an underlying disease with a number of equivalent indicators, but as a network of symptoms that have direct causal influence on each other: insomnia can cause fatigue which then triggers concentration and psychomotor problems. This approach offers new opportunities for constructing an empirically based classification system and has broad implications for future research. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Psychiatric Comorbidity:More Than a Kuhnian AnomalyPeter Zachar (bio)Keywordscomorbidity, classification, epidemiology, differential diagnosis, personality disorderDr. Aragona's article in this issue of Philosophy, Psychiatry, & Psychology makes some important points regarding the relationship between comorbidity rates and the classification system currently used in psychiatry. Particularly persuasive is his claim that observed patterns of comorbidity are, in important respects, consequences of the structure of the classification system. I am not convinced, (...) however, that comorbidity is best conceptualized as an artifact of the taxonic structure of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). Instead, I suggest that the use of dichotomies such as true versus artifactual should be used with caution when psychiatric classification is being discussed.In contrast with the artifact hypothesis, I argue that the phenomena covered by the term "comorbidity" are real, expectable features of the psychiatric domain. They are not the phlogiston and luminiferous ether of psychiatry. I am skeptical of the notion that high comorbidity rates as a whole can be understood as Kuhnian anomalies, or that there is a crisis, or that after a period of revolutionary science a new paradigm would eliminate these 'anomalies.' In short, high rates of comorbidity in psychiatry will not simply disappear once scientists develop a better nosological paradigm. High levels of comorbidity can, however, be both lowered and provided a better, evidence-based conceptual framework.Many Conditions, One OrganIn general medicine, comorbidity conventionally refers to the simultaneous occurrence of two independent disease processes or distinct clinical entities, such as heart disease and liver cancer (Feinstein, 1970; Jablensky 2004). The presence of one disease is supposed to affect the other in such a way that the co-occurrence of the two has implications for prognosis and treatment.Comorbidity in psychiatry is a broader concept, referring to a variety of conditions that overlap in multiple ways. The different kinds of overlap are amenable to detailed empirical analysis (e. g., Klein and Riso 1993; Neale and Kendler 1995). Depressive reactions to primary disorders, attention deficit symptoms associated with mania, panic attacks in the context of severe borderline personality disorder, substance abuse disorders among psychopaths, histrionic dynamics combined [End Page 13] with narcissistic personality traits, and emergent conditions such as schizoaffective disorder are all distinct types of comorbidity. The kinds of overlapping conditions just listed are sometimes termed psychiatric comorbidity. Also important is comorbidity between psychiatric disorders and general medical conditions as is studied in behavioral medicine and health psychology. The crisis, if there is one, is a crisis of comorbidities.The heart disease and liver cancer type of comorbidity as independent organ systems being affected is ruled out a priori in psychiatric comorbidity proper. In psychiatry, "psychopathological disease processes" can all be expected to affect a single organ, namely the brain or, more likely, affect the different systems that are tightly integrated in the brain. The tight integration can make putative comorbid psychiatric disorders difficult to disentangle.It is a widely held consensus that causes, not organ systems, are what matter in comorbidity. In this tradition, Dr. Aragona claims that in general medicine shared symptoms between two diseases (such as fever and fatigue) are not a problem because the diseases are differentiated with respect to etiology; in psychiatry, however, where syndromes are differentiated by a description of symptoms only, symptomatic overlap is a problem.Is descriptive psychopathology, therefore, a root cause of the "crisis of comorbidity" and should it be abandoned in favor of etiological classification? Unfortunately, forcing psychiatric nosology to conform to an etiological paradigm is unlikely to resolve the problem of psychiatric comorbidity. As noted, the problem is one of distinguishing between the different etiological disease processes that are affecting tightly integrated systems in the brain. The brain as a whole is a multilevel, dynamic, and open system, which has an ecology (Zachar 2000). As argued by Kendler (2005) and Schaffner (2002, 2008), it has not thus far, and may never be fully possible to segregate causes and their associated psychiatric disorders into parsimonious etiological packages. In the ecology of neuroscience, causes and effects tend to merge in a continuous series of common pathways.It would be foolish... (shrink)

People high in depressive or anxious symptom severity show repetitive negative thinking, including worry and rumination. They also show various cognitive phenomena, including probability, cost, and interpretation biases. Since there is conceptual overlap between these cognitive biases and repetitive negative thinking – all involve thinking about potential threats and misfortunes – we wondered whether repetitive negative thinking could account for (mediate) these cognitive biases’ associations with depressive and anxious symptom severity. In three studies, conducted in two languages and (...) cultures, cost bias and (in two studies) interpretation bias only predicted symptom severity via worry and repetitive negative thinking; this suggests these biases are actually associated with repetitive negative thinking, rather than with symptoms. In contrast, probability bias showed direct relationships with depressive (all studies) and anxious (two studies) symptom severity, suggesting its relationships with symptoms are partly independent of repetitive negative thinking. These results show the value of studying relationships among the various cognitive features of psychopathology. Furthermore, new interventions which target cognitive biases in depression or anxiety must show that they can improve upon cognitive behavioural therapy, which is already widely available, targets both repetitive negative thinking and probability bias, and is highly effective. (shrink)

Background: Recent research has demonstrated that depressed individuals show impairments in inhibiting irrelevant emotional material, and that these impairments are linked to rumination. Cognitive inhibition, however, is not a unitary construct but consists of several components which operate at different stages of information processing. The present study was designed to assess two components of inhibition and examine their relation to depression and rumination in a sample of clinically depressed and healthy control participants. Methods: Twenty-two individuals diagnosed with a current (...) class='Hi'>depressive episode and 27 never-disordered control participants completed an Emotional Flanker Task to assess individual differences in interference control and a modification of the Working Memory Selection Task to assess individual differences in the ability to discard no longer relevant emotional material from working memory. Participants completed self-report measures to assess depressive symptoms and rumination. Results: Clinically depressed compared to control participants showed significantly reduced interference control of irrelevant negative information. The groups, however, did not differ in their ability to discard no longer relevant negative information from working memory. In contrast, rumination was associated with difficulty removing no longer relevant negative material from working memory but not with deficits in interference control. Conclusions: Results highlight the importance of differentiating among components of inhibition to gain a better understanding of cognitive mechanisms underlying depression and rumination. (shrink)

A sense of agency over wilful actions is thought to be dependent on the level of choice and the nature of the outcome. In a preregistered study, we manipulated choice and valence of outcome to assess the relationship between SoA across the depression and psychosis continuum. Participants completed a Libet Clock task, in which they had either a free or forced choice to press one of two buttons and received either a rewarding or punishing outcome. Participants also completed questionnaires on (...) depressive and psychosis-like traits. Rewarding outcomes increased intentional binding. The evidence favoured no effect of choice on average, but this was influenced by inter-individual differences. Individuals reporting more depressive traits had less of a difference in intentional binding between free and forced choice conditions. We show that implicit SoA is sensitive to outcome valence and the effect of choice differs across the depression continuum. (shrink)

Recent studies indicate that indicative conditionals like "If people wear masks, the spread of Covid-19 will be diminished" require a probabilistic dependency between their antecedents and consequents to be acceptable (Skovgaard-Olsen et al., 2016). But it is easy to make the slip from this claim to the thesis that indicative conditionals are acceptable only if this probabilistic dependency results from a causal relation between antecedent and consequent. According to Pearl (2009), understanding a causal relation involves multiple, hierarchically organized conceptual dimensions: (...) prediction, intervention, and counterfactual dependence. In a series of experiments, we test the hypothesis that these conceptual dimensions are differentially encoded in indicative and counterfactual conditionals. If this hypothesis holds, then there are limits as to how much of a causal relation is captured by indicative conditionals alone. Our results show that the acceptance of indicative and counterfactual conditionals can become dissociated. Furthermore, it is found that the acceptance of both is needed for accepting a causal relation between two co-occurring events. The implications that these findings have for the hypothesis above, and for recent debates at the intersection of the psychology of reasoning and causal judgment, are critically discussed. Our findings are consistent with viewing indicative conditionals as answering predictive queries requiring evidential relevance (even in the absence of direct causal relations). Counterfactual conditionals in contrast target causal relevance, specifically. Finally, we discuss the implications our results have for the yet unsolved question of how reasoners succeed in constructing causal models from verbal descriptions. (shrink)

Unlike other creatures, humans developed the ability to cooperate with genetically unrelated strangers and a tendency to comply with social norms. However, humans deviate from social norms in various situations. This study used the modified ultimatum game to explore why humans deviate from social norms and how their prosocial behavior can be promoted. In Study 1, participants were asked to imagine working with an anonymous counterpart to complete a task and obtain a certain amount of money (e.g., ¥10). The computer (...) divided the money randomly in favor of the participant (e.g., 9:1 or 8:2). Participants should decide whether to accept or reject such a self-benefiting division. In the non-risk condition, an absolutely fair redivision of money would take place if participants reject self-benefiting division (e.g. 5:5 or 6:4). By contrast, in the risk condition, other-benefiting redivision of money (e.g., 1:9 or 2:8) would take place if participants rejected the self-benefiting division. Results involving 40 college students showed the main effect of condition. The frequency of accepting self-benefiting division in the risk condition was higher than that in the non-risk condition. As such, compliance with social norms is based on the preservation of material resources. In Study 2, we used economic or moral rewards to compensate for economic loss following compliance with the norm. Results involving 28 college students revealed a significant effect of compensation. The rewards, including moral praise, effectively decreased selfish choices. These findings extend previous studies on social norm compliance by emphasizing the importance of internal, fairness-based balance between material and moral needs, as well as the role of moral praise in promoting prosocial behavior. (shrink)

This article examines how sex differentiation is invoked from body fat with a focus on how various monitoring devices participate in the construction of bodies. By using the concept of ‘local biologies’, denoting the linkage of the body to place with its local physical and social conditions, it argues against the ‘one-size-fits-all’ paradigm of modern medicine and critiques the mechanistic search for regularity in medical research. By looking at medical literature on obesity and how contemporary obesity researchers and clinicians link (...) body fat to sex, local biologies of bodies in a Swedish obesity clinic are contrasted to the universal biologies represented in medical research. The article also provides empirical examples of how fat has the potential to undermine traditional sex and gender binaries. (shrink)

Endothelial cells line the inside of all blood vessels, forming a structurally and functionally heterogenous population of cells. Their complexity and diversity has long been recognized, yet very little is known about the molecules and regulatory mechanisms that mediate the heterogeneity of different endothelial cell populations. The constitutive organ‐ and microenvironment‐specific phenotype of endothelial cells controls internal body compartmentation, regulating the trafficking of circulating cells to distinct vascular beds. In contrast, surface molecules associated with the activated cytokine‐inducible endothelial phenotype play (...) a critical role in pathological conditions including inflammation, tumor angiogenesis, and wound healing. Differentiation of the endothelial cell phenotypes appears to follow similar mechanisms to the differentiation of hematopoietic cells, with the exception that endothelial cells maintain transdifferentiating competence. The present review offers a scheme of endothelial cell differentially expressed endothelial cell molecules as targets for directed therapeutic intervention. (shrink)

We tested whether cognitive fusion impairs emotion differentiation and thereby mediates relations between cognitive fusion and depression and panic symptoms among 55 adults, 50.9% women). Using visual stimuli, we elicited multiple emotion states and measured emotional intensity – the subjective emotion intensity of elicited emotions, as well as emotional differentiation – the degree of co-activation of multiple negative emotions when a specific emotion was elicited. First, as hypothesised, we found that cognitive fusion predicted lower levels of emotion differentiation. In contrast, (...) as hypothesised, these effects were significantly greater than the effects of cognitive fusion on emotion intensity. Second, as predicted, MECA, but not SEI, predicted depression and panic symptoms. Finally, we found that MECA mediated the effects of cognitive fusion on depression and panic symptoms. The present findings contribute novel, preliminary empirical insight into associations between cognitive fusion, impaired emotion differentiation and mental ill-health. (shrink)

Previous work has shown that children with dyslexia are impaired in speech recognition in adverse listening conditions. Our study further examined how semantic context and fundamental frequency contours contribute to word recognition against interfering speech in dyslexic and non-dyslexic children. Thirty-two children with dyslexia and 35 chronological-age-matched control children were tested on the recognition of words in normal sentences versus wordlist sentences with natural versus flat F0 contours against single-talker interference. The dyslexic children had overall poorer recognition performance than non-dyslexic (...) children. Furthermore, semantic context differentially modulated the effect of F0 contours on the recognition performances of the two groups. Specifically, compared with flat F0 contours, natural F0 contours increased the recognition accuracy of dyslexic children less than non-dyslexic children in the wordlist condition. By contrast, natural F0 contours increased the recognition accuracy of both groups to a similar extent in the sentence condition. These results indicate that access to semantic context improves the effect of natural F0 contours on word recognition in adverse listening conditions by dyslexic children who are more impaired in the use of natural F0 contours during isolated and unrelated word recognition. Our findings have practical implications for communication with dyslexic children when listening conditions are unfavorable. (shrink)

Investors with a pro-social or sustainability agenda increasingly attempt to influence firm managers to adopt socially responsible behavior, either through positive/reward tactics or negative/punishment tactics. This paper considers how investors can use each approach to differentially influence managers to make more CSR investments. The paper uses game theory with an all-pay contest structure to model how a large institutional investor could reward firms for CSR activities by creating a socially responsible investment fund (reward contest) or punish firms (...) via shareholder activism (punishment contest). We identify conditions under which the punishment contest induces a higher level of CSR activity among firms compared to the reward contest. Managers bearing substantial private costs stemming from the activism is one such condition. Spillover effects are seen as the other managers in the economy engage in CSR to avoid being punished by the investor’s activism. This level of engagement is not the case when rewards are used—only those managers with an expectation of being rewarded increase their CSR activity in that scenario. This suggests, for example, that incorporating thresholds or tiers (e.g. gold, silver, and bronze-level winners) can increase the effectiveness of reward contests. Implications for designing both positive and negative CSR inducements are explored. We also identify the ethical dilemmas that relate to such influence attempts. (shrink)

Hoarding disorder is a psychiatric condition characterized by difficulty discarding items and accumulation of clutter. Although studies have established the negative impact of HD and compulsive hoarding behavior, fewer have examined the impact on quality of life of hoarding behavior independent of obsessive–compulsive disorder. Moreover, specific aspects of QoL such as success in work/academics or satisfaction with interpersonal relationships have not been well-investigated. In this study, we examined, in a sample of 2100 adult participants obtained from Amazon Mechanical Turk, the (...) relationships between hoarding, OCD, and depression symptomatology and four QoL domains derived from a factor analysis of the Quality of Life Inventory. We performed linear regressions to examine associations between psychiatric symptomatology and QoL domains and then conducted mediation analyses to investigate the role of depressive symptomatology in the identified relationships. We found that while hoarding and obsessive–compulsive symptoms were both negatively associated with QoL, they were associated with different domains [hoarding was significantly associated, and was less strongly associated with success or enrichment. Mediation analyses confirmed the role of depression as a complete mediator of hoarding’s effect on total, environment, and family QoL, and as a partial mediator of hoarding’s effect on success and enrichment QoL. Further examination of the relationship between hoarding symptoms and QoL in those with mild, moderate, and severe depression indicated that in those with more severe depression, hoarding was associated with improved QoL, indicating a possible buffering or compensatory effect. The findings suggest a differential impact of hoarding and obsessive–compulsive symptoms on QoL and emphasize the importance of considering co-morbid depressive symptoms in designing more targeted interventions. Future studies should continue to investigate these complex relationships, given the high co-morbidity of hoarding and depression. (shrink)

Genetic moderation of experience of reward in response to environmental stimuli is relevant for the study of many psychiatric disorders. Experience of reward, however, is difficult to capture, as it involves small fluctuations in affect in response to small events in the flow of daily life. This study examined a momentary assessment reward phenotype in relation to the catechol-O-methyl transferase (COMT) Val158Met polymorphism. A total of 351 participants from a twin study participated in an Experience Sampling Method (...) procedure to collect daily life experiences concerning events, event appraisals, and affect. Reward experience was operationalized, as the effect of event appraisal on positive affect (PA). Associations between COMT Val 158Met genotype and event appraisal on the one hand and PA on the other were examined using multilevel random regression analysis. Ability to experience reward increased with the number of ‘Met’ alleles of the subject, and this differential effect of genotype was greater for events that were experienced as more pleasant. The effect size of genotypic moderation was quite large: subjects with the Val/Val genotype generated almost similar amounts of PA from a ‘very pleasant event’ as Met/Met subjects did from a ‘bit pleasant event’. Genetic variation with functional impact on cortical dopamine tone has a strong influence on reward experience in the flow of daily life. Genetic moderation of ecological measures of reward experience is hypothesized to be of major relevance to the development of various behavioral disorders, including depression and addiction. Neuropsychopharmacology (2008) 33, 3030–3036; doi:10.1038/sj.npp.1301520; published online 8 August 2007.. (shrink)

In current mental health care psychiatric conditions are defined as compilations of symptoms. These symptom-based disease categories have been severely criticised as contingent and boundless, facilitating the rise to epidemic proportions of such conditions as depression. In this article we look beyond symptoms and stress the role of epidemiology in explaining the current situation. By analysing the parallel development of cardiovascular disease and depression management in Finland, we argue, firstly, that current mental health care shares with the medicine of chronic (...) somatic conditions an attachment to risk factor epidemiology, which accentuates risk and prevention in disease management. However, secondly, due to the symptom-based definitions of psychiatric conditions, depression management cannot differentiate properly between symptoms, signs and risk factors such as, for example, cardiovascular medicine, but treats symptoms as signs or risk factors in contexts of treatment and prevention. Consequently, minor at-risk conditions have become difficult to separate from proper cases of depression. (shrink)

Despite external environmental changes in walking, such as manipulating gait speed, previous studies have shown that the underlying muscle synergy structures (synergy weights or vectors) rarely vary. The purpose of this study is to examine if external environmental changes to the walking task influence muscle synergies in children with cerebral palsy (CP) and/or typical development (TD). To identify muscle synergies, we extracted muscle synergies from eight children with CP and eight age-matched TD in three treadmill walking conditions, e.g., baseline (adjusted (...) to individual comfortable walking speed), variable speed (VS), or restricted foot width (RW). Then, we grouped similar muscle synergies using k-mean clustering and discriminant analyses from all datasets of individual synergy structures. Proportion tests exhibited six clusters of muscle synergies predominantly arising from children with CP and four clusters from children with TD. Also, the proportion of muscle synergies was significantly different in four of the CP-preferred clusters across conditions. Specifically, the proportion of the baseline condition was significantly different from VS and RW conditions in one and two clusters, respectively. The proportion was significantly different between VS and RW conditions in four clusters. Cadence and step lengths differed across conditions but not groups which makes the group differences in proportion even more notable. In contrast, step width, while significantly lower in CP, did not differ across conditions. Our findings demonstrate that muscle synergies in children with CP are more sensitive to changes in the external walking environment than in typically developing children. (shrink)

Psychopathy is a personality disorder characterized by emotional deficits and a failure to inhibit impulsive behavior and is often subdivided into “primary” and “secondary” psychopathic subtypes. The maladaptive behavior related to primary psychopathy is thought to reflect constitutional “fearlessness,” while the problematic behavior related to secondary psychopathy is motivated by other factors. The fearlessness observed in psychopathy has often been interpreted as reflecting a fundamental deficit in amygdala function, and previous studies have provided support for a low-fear model of psychopathy. (...) However, many of these studies fail to use appropriate screening procedures, use liberal inclusion criteria, or have used unconventional approaches to assay amygdala function. We measured brain activity with BOLD imaging in primary and secondary psychopaths and non-psychopathic control subjects during Pavlovian fear conditioning. In contrast to the low-fear model, we observed normal fear expression in primary psychopaths. Psychopaths also displayed greater differential BOLD activity in the amygdala relative to matched controls. Inverse patterns of activity were observed in the anterior cingulate cortex (ACC) for primary versus secondary psychopaths. Primary psychopaths exhibited a pattern of activity in the dorsal and ventral ACC consistent with enhanced fear expression, while secondary psychopaths exhibited a pattern of activity in these regions consistent with fear inhibition. These results contradict the low-fear model of psychopathy and suggest that the low fear observed for psychopaths in previous studies may be specific to secondary psychopaths. (shrink)

ObjectiveThe aim of this study was to investigate possible associations between obstructive sleep apnea and fatigue. This naturally led to considering the association between OSA and excessive sleepiness, depression, and anxiety.BackgroundOSA is a highly prevalent sleep disorder, associated with a risk of hypertension, cardiovascular events, daytime sleepiness, poor cognitive function, and sudden death during sleep. Both excessive sleepiness, fatigue, and symptoms of depression are frequently reported.Method5,464 patients referred to a university hospital for obstructive sleep apnea underwent standard respiratory polygraphy. The (...) severity of OSA was defined as either mild, moderate, or severe, using the apnea–hypopnea index. Validated questionnaires were used to assess excessive sleepiness, pathological fatigue, depression, and anxiety.ResultsNearly 70% of the patients were men, and median age was 50 years. One in three had moderate-to-severe OSA. Excessive sleepiness and pathological fatigue were present in 43 and 39%, respectively. The prevalence of possible depression and anxiety was 19 and 28%, respectively. The proportion of patients with male sex, obesity, and excessive sleepiness increased with the severity of OSA. In contrast, the proportion of patients with pathological fatigue did not increase with OSA severity, and there was a decrease in depression and anxiety with increasing OSA severity.ConclusionOur study reports that pathological fatigue, as well as anxiety and depression, did not increase with OSA severity, whereas excessive sleepiness did. Knowledge concerning conditions related to OSA severity may be indicative of pretest probability of OSA and thus change the priority for polygraphy. Furthermore, the high prevalence rates of fatigue, anxiety, and depression among these patients warrant further investigations. (shrink)

Biological and epidemiological phenomena are often measured with error or imperfectly captured in data. When the true state of this imperfect measure is a confounder of an outcome exposure relationship of interest, it was previously widely believed that adjustment for the mismeasured observed variables provides a less biased estimate of the true average causal effect than not adjusting. However, this is not always the case and depends on both the nature of the measurement and confounding. We describe two sets of (...) conditions under which adjusting for a non-deferentially mismeasured proxy comes closer to the unidentifiable true average causal effect than the unadjusted or crude estimate. The first set of conditions apply when the exposure is discrete or continuous and the confounder is ordinal, and the expectation of the outcome is monotonic in the confounder for both treatment levels contrasted. The second set of conditions apply when the exposure and the confounder are categorical. In all settings, the mismeasurement must be non-differential, as differential mismeasurement, particularly an unknown pattern, can cause unpredictable results. (shrink)

The challenge of accommodating difference has traditionally proved highly problematic for cosmopolitanism proposals, given their inherently universalistic thrust. Today, however, we are acutely aware that in failing to give difference its due, we stand to perpetrate a significant injustice through negating precisely what differentiates diverse groupings and confers on them their identity. Moreover, in an increasingly pluralistic and multicultural world it has become clear that doing justice to difference is an essential prerequisite for the internal flourishing as well as peaceable (...) coexistence of diverse cultural and other groupings. Accordingly, as a corrective for the homogenising presuppositions of highly a universalistic and decontextualised template like the Habermasian, the present paper defends the need for a situated, dialogical approach that can not only accommodate difference but also treat it as a resource for promoting mutual understanding and potentially transformative learning. In thus defending the merits of a situated, dialogical template, the present paper also seeks to shed light on the conditions of its possibility. To this end, I argue the need to transcend significant structural limitations inherent in the Habermasian discourse model, while aspring to preserve and enhance its distinctive strengths. Accordingly, I press the case for a thoroughgoing reappropriation of such core Habermasian tenets as the symmetrical reciprocity requirement, the anticipation of consensus as outcome, and a one-sided emphasis on argumentative deliberation as the sole acceptable means of achieving this. Proceeding thus, I defend the merits of a situated cosmopolitanism grounded in plurivocal transformative dialogue as a counterbalance to an unqualified universalism. Correlatively, I defend openness to otherness under appropriately structured dialogical conditions as the primary prerequisite for a viable cosmopolitanism capable of meeting the needs of an increasingly pluralistic and globalised world. In the process, some notable points of contrast with Richard Shapcott's dialogical template are identified. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:On the Importance of Conceptual ContrastsMadness, Reason, and Mad PrideAwais Aftab, MD (bio)Garson (2023) offers an engaging historical and philosophical discussion around the importance Late Modern thinkers assigned to the task of differentiating madness from idiocy (or more specifically, to the tripartite distinction of sanity, madness, and idiocy). Based on this analysis, Garson’s identifies the need to offer a positive account of mental illness—one that does not define the (...) essence of mental illness exclusively as the absence, lack, or failure of the power of reasoning. Following the Late Modern thinkers (Locke, Kant, Wigan, and Heinroth), Garson concludes that madness is infused with reason, and what characterizes madness is the presence of reason in an altered and mutated form. This is all worth taking seriously. My own assessment of this historical and philosophical material nonetheless differs from that of Garson. To recognize madness as possessing reason within it in an altered form may be of less profound significance than he thinks it is. Garson’s discussion commendably highlights the importance of making conceptual contrasts explicit in definitional debates, and this should indeed lead us to search for contrasts that are more philosophically illuminating (what is better will depend on the context of inquiry). However, in my view, the recognition of madness as altered reason neither reframes the project of defining “mental disorder” nor does it provide an intellectual scaffolding for mad activism.The significance of “madness contains reason within in but in an altered or perverse form” is difficult to translate into contemporary scientific terms, and the fuzziness and historical baggage around the terms “madness,” “reason,” and “perversion” does not make it easy. “Mental disorder” or “psychopathology” means to us something quite different than what madness meant to Late Modern thinkers, and while “madness” remains a popular term in philosophical literature, there is no clarity on the nature of overlap between the domain of madness and the domain of conditions currently classified by the diagnostic manuals. Mental disorders, as currently conceptualized, include a motley of conditions that were previously characterized using terms such as idiocy, madness, neuroses, and psychopathic personalities. [End Page 297]From our contemporary vantage point, to compare idiocy and madness is to make a distinction within the domain of psychopathology. We are comparing two groups of psychiatric conditions. The lessons we derive from this comparison do not necessarily extrapolate well to a comparison of mental disorders with something outside the domain of psychopathology. To the extent that psychopathology is inclusive of both idiocy and madness, psychiatric disorders both contain and do not contain “reason” within them. The domain is heterogenous in this regard, and broad generalizations about the nature of reason in the mental disorders would be simplistic at best and inaccurate at worst. Other distinctions that we have made within the domain of psychopathology have included organic versus functional, neurosis versus psychosis, categories versus continua, and distinctions used within nosology have included operationalized criteria versus phenomenology, idiographic versus nomothetic, medical versus non-medical, description versus explanation, and so on (Aftab & Ryznar, 2021; Zachar, Banicki, & Aftab, 2023), all of which have the potential to offer a positive account of some aspect of psychopathology.It is worth nothing that the distinction between “absence of reason” versus “perversion of reason” is analogous to the common distinction between absence of function and altered function in patho-physiology. Such a distinction exists for almost every function that exists. Consider vision: absence of vision (blindness) and altered vision (illusions, distortions, hallucinations). Consider hypoesthesia (reduced sense of touch) and paraesthesia (altered sense of touch—tingling, pricking, burning, etc.). Garson alludes to diminished sexual capacity versus paraphilia as an analogy, but he does not seem to appreciate that the analogy applies much more broadly. Is the distinction between absence of reason versus perversion of reason of any greater significance than the distinction between blindness and hallucination? If we were to say, “What distinguishes hallucination from blindness is not the failure, absence, or lack of sight, but its presence—albeit in a perverse and mutated form,” how profound would it really be for our notions of disorder? Or imagine some Late Modern physician saying that a disturbance of speech and... (shrink)

The challenge of accommodating difference has traditionally proved highly problematic for cosmopolitanism proposals, given their inherently universalistic thrust. Today, however, we are acutely aware that in failing to give difference its due, we stand to perpetrate a significant injustice through negating precisely what differentiates diverse groupings and confers on them their identity. Moreover, in an increasingly pluralistic and multicultural world it has become clear that doing justice to difference is an essential prerequisite for the internal flourishing as well as peaceable (...) coexistence of diverse cultural and other groupings. Accordingly, as a corrective for the homogenising presuppositions of highly a universalistic and decontextualised template like the Habermasian, the present paper defends the need for a situated, dialogical approach that can not only accommodate difference but also treat it as a resource for promoting mutual understanding and potentially transformative learning.In thus defending the merits of a situated, dialogical template, the present paper also seeks to shed light on the conditions of its possibility. To this end, I argue the need to transcend significant structural limitations inherent in the Habermasian discourse model, while aspring to preserve and enhance its distinctive strengths. Accordingly, I press the case for a thoroughgoing reappropriation of such core Habermasian tenets as the symmetrical reciprocity requirement, the anticipation of consensus as outcome, and a one-sided emphasis on argumentative deliberation as the sole acceptable means of achieving this. Proceeding thus, I defend the merits of a situated cosmopolitanism grounded in plurivocal transformative dialogue as a counterbalance to an unqualified universalism. Correlatively, I defend openness to otherness under appropriately structured dialogical conditions as the primary prerequisite for a viable cosmopolitanism capable of meeting the needs of an increasingly pluralistic and globalised world. In the process, some notable points of contrast with Richard Shapcott's dialogical template are identified. (shrink)

This paper presents a view of melancholy based on Kierkegaard's insight of the self, showing that this dimension of depression is anticipatory of threat to well-being. The view of self, contrasted with a view presuming a connection between two factors only — body and mind — has a third factor or ethico-spiritual element. Taken as an explanatory category, this factor allows for making a distinction between melancholy as crisis and melancholy as ailment, and has implication detecting and treating the latter. (...) That is, in the initial patient-physician dialogue, the physician might be expected to indicate whether she/he is open to consider the possibility of a third factor as an explanatory category in the formation of self-hood. Such indication would provide for patients with an inkling of their own condition, a basis for making a choice about whom they will accept as caregiver. (shrink)

In our globalized and interconnected world, companies are increasingly donating substantial amounts to good causes around the globe. Many companies choose to donate “at home” while others give to causes in faraway places where recipients are in dire need of support. Interestingly, past research on corporate donations has neglected the question of whether consumers differentially reward companies for geographically varying allocations of donation budgets. Through a mixed methods approach, this paper remedies this gap by developing and empirically testing a (...) conceptual framework of consumers’ preferences for geographically varying allocations of corporate donation budgets. In a first step, two preliminary field studies involving real donations explored customers’ preferences for donation allocations varying in geographical focus. A qualitative focus group study then investigated underlying rationales to inform the research and led to the development of hypotheses. Subsequently a large-scale between-subjects scenario experiment tested the predictions. Overall, results indicate that, in contrast with current managerial practice, customers prefer companies that split donations equally between domestic and foreign recipients or even donate only abroad. (shrink)

In the early 1950s, the Chinese communist party promoted a massive Learning-from-the-Soviet-Union Campaign and made Pavlov’s reflexology the political-academic orthodoxy in physiology, medical science and psychology. In the late 1950s, however, while Pavlov’s theory was continuously advocated by physiologists and medical scientists, it suffered a major setback in psychology as Pavlovian psychology was criticized as being bourgeois and reactionary. How was it possible for such sheer contrast across disciplines to take place within a few years? This paper argues that the (...) greater ideologization of Pavlovian psychology was conditioned by a number of factors: the Sino-Soviet relations, the shifting Chinese communist policies, professional practices, local social conditions, disciplinary cultures and discursive performances. This historical reconstruction rejects a homogenizing view of the relation between politics and science in the Maoist China, and demonstrates ways in which historical localities and dynamics ruptured the overarching political context. (shrink)

Selected as a Financial Times Best Book of 2013Governments today in both Europe and the United States have succeeded in casting government spending as reckless wastefulness that has made the economy worse. In contrast, they have advanced a policy of draconian budget cuts--austerity--to solve the financial crisis. We are told that we have all lived beyond our means and now need to tighten our belts. This view conveniently forgets where all that debt came from. Not from an orgy of government (...) spending, but as the direct result of bailing out, recapitalizing, and adding liquidity to the broken banking system. Through these actions private debt was rechristened as government debt while those responsible for generating it walked away scot free, placing the blame on the state, and the burden on the taxpayer. That burden now takes the form of a global turn to austerity, the policy of reducing domestic wages and prices to restore competitiveness and balance the budget. The problem, according to political economist Mark Blyth, is that austerity is a very dangerous idea. First of all, it doesn't work. As the past four years and countless historical examples from the last 100 years show, while it makes sense for any one state to try and cut its way to growth, it simply cannot work when all states try it simultaneously: all we do is shrink the economy. In the worst case, austerity policies worsened the Great Depression and created the conditions for seizures of power by the forces responsible for the Second World War: the Nazis and the Japanese military establishment. As Blyth amply demonstrates, the arguments for austerity are tenuous and the evidence thin. Rather than expanding growth and opportunity, the repeated revival of this dead economic idea has almost always led to low growth along with increases in wealth and income inequality. Austerity demolishes the conventional wisdom, marshaling an army of facts to demand that we austerity for what it is, and what it costs us. (shrink)

Hierarchy is a difficulty for theories of equality, and especially those that define equality in relational or social terms. In ideal egalitarian circumstances it seems that hierarchies should not exist. However, a liberal egalitarian defence of some types of hierarchies is common. Hierarchies of esteem have no further consequences than praise or admiration for valued individual features. Hierarchies of status, with differential reward, can, it is often argued, also be justified when they serve a justified social purpose and (...) meet conditions of genuine equality of opportunity. However, group hierarchies remain problematic, and evidence suggests that they are pervasive in human societies above a subsistence level of production. It has also been argued that group hierarchies are impossible to eliminate, and enormous cost is associated with attempting, and failing, to remove them. However, the perspective of ‘real-world’ political philosophy suggests measures to mitigate group hierarchy, starting with those that are either the easiest to address, the most damaging, or the most consequential. (shrink)

Luck egalitarians equalize the outcome enjoyed by people who exemplify the same degree of distributive desert by removing the influence of luck. They also try to calibrate differential rewards according to the pattern of distributive desert. This entails that they have to decide upon, among other things, the rate of reward, i.e., a principled way of distributing rewards to groups exercising different degrees of the relevant desert. However, the problem of the choice of reward principle is a (...) relatively and undeservedly neglected issue among luck egalitarians. The main goal of this paper is to highlight the importance and difficulty of this problem, and to elaborate upon G. A. Cohen's community-oriented response to it. In the last section, I provide a taxonomy of distributive pluralism, contrasting Cohen’s view with other (not so genuine) pluralisms - especially with all-things-considered varieties - while trying to motivate readers to adopt the more robust form of pluralism. (shrink)

Autistic-spectrum conditions and psychotic-spectrum conditions (mainly schizophrenia, bipolar disorder, and major depression) represent two major suites of disorders of human cognition, affect, and behavior that involve altered development and function of the social brain. We describe evidence that a large set of phenotypic traits exhibit diametrically opposite phenotypes in autistic-spectrum versus psychotic-spectrum conditions, with a focus on schizophrenia. This suite of traits is inter-correlated, in that autism involves a general pattern of constrained overgrowth, whereas schizophrenia involves undergrowth. These disorders also (...) exhibit diametric patterns for traits related to social brain development, including aspects of gaze, agency, social cognition, local versus global processing, language, and behavior. Social cognition is thus underdeveloped in autistic-spectrum conditions and hyper-developed on the psychotic spectrum.;>We propose and evaluate a novel hypothesis that may help to explain these diametric phenotypes: that the development of these two sets of conditions is mediated in part by alterations of genomic imprinting. Evidence regarding the genetic, physiological, neurological, and psychological underpinnings of psychotic-spectrum conditions supports the hypothesis that the etiologies of these conditions involve biases towards increased relative effects from imprinted genes with maternal expression, which engender a general pattern of undergrowth. By contrast, autistic-spectrum conditions appear to involve increased relative bias towards effects of paternally expressed genes, which mediate overgrowth. This hypothesis provides a simple yet comprehensive theory, grounded in evolutionary biology and genetics, for understanding the causes and phenotypes of autistic-spectrum and psychotic-spectrum conditions. (shrink)