All Galen's surviving shorter works on psychology and ethics - including the recently discovered Avoiding Distress, and the neglected Character Traits, extant only in Arabic - are here presented in one volume in a new English translation, with substantial introductions and notes and extensive glossaries. Original and penetrating analyses are provided of the psychological and philosophical thought, both of the above and of two absolutely central works of Galenic philosophy, Affections and Errors and The Capacities of the Soul, by (...) some of the foremost experts in the field. Each treatise has also been subjected to fresh textual study, taking account of the latest scholarly developments, and is presented with accompanying textual discussions, adding greatly to the value and accuracy of the work without detracting from its accessibility to a wider readership. The volume thus makes a major contribution to the understanding of the ancient world's most prominent doctor-philosopher in his intellectual context. (shrink)

This target article considers the ethical implications of providing prenatal diagnosis (PND) and antenatal screening services to detect fetal abnormalities in jurisdictions that prohibit abortion for these conditions. This unusual health policy context is common in the Latin American region. Congenital conditions are often untreated or under-treated in developing countries due to limited health resources, leading many women/couples to prefer termination of affected pregnancies. Three potential harms derive from the provision of PND in the absence of legal and safe (...) abortion for these conditions: psychological distress, unjust distribution of burdens between socio-economic classes, and financial burdens for families and society. We present Iran as a comparative case study where recognition of these ethical issues has led to the liberalization of abortion laws for fetuses with thalassemia. We argue that physicians, geneticists and policymakers have an ethical and professional duty of care to advocate for change in order to ameliorate these harms. (shrink)

In clinical medicine, a diagnosis can offer an explanation of a patient's symptoms by specifying the pathology that is causing them. Diagnoses in psychiatry are also sometimes presented in clinical texts as if they pick out pathological processes that cause sets of symptoms. However, current evidence suggests the possibility that many diagnostic categories in psychiatry are highly causally heterogeneous. For example, major depressive disorder may not be associated with a single type of underlying pathological process, but with a range (...) of different causal pathways, each involving complex interactions of various biological, psychological, and social factors. This paper explores the implications of causal heterogeneity for whether psychiatric diagnoses can be said to serve causal explanatory roles in clinical practice. I argue that while they may fall short of picking out a specific cause of the patient's symptoms, they can nonetheless supply different sorts of clinically relevant causal information. In particular, I suggest that some psychiatric diagnoses provide negative information that rules out certain causes, some provide approximate or disjunctive information about the range of possible causal processes, and some provide causal information about the relations between the symptoms themselves. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hypatia 16.3 (2001) 172-176 [Access article in PDF] Book Review Diagnosis: Difference: The Moral Authority of Medicine Diagnosis: Difference: The Moral Authority of Medicine. By Abby L. Wilkerson. Ithaca: Cornell University Press, 1998. In this compact volume, Abby Wilkerson makes several important contributions to the burgeoning literature of feminist (bio)ethics by providing substantive arguments in support of some of the key intuitive beliefs that are central to (...) much feminist bioethics thinking. Most centrally, she carefully fleshes out a feminist case for re-framing traditional bioethics approaches to the relation between health and justice. Particularly valuable is her richly detailed argument establishing the importance of bringing to the realm of health and health care Iris Marion Young's (1990) important insight that justice involves far more than questions of distribution.At the same time, Wilkerson demonstrates another major feminist tenet: that ethics and epistemology are intimately related. This connection is developed [End Page 172] through a second major theme in which she systematically tracks medicine's tendency to extend its accepted epistemic authority over physical ailments into a general authority over many other aspects of life. She documents examples of medicine's success in leveraging its scientific knowledge about certain aspects of the body into a broader ideological vision through which it claims epistemic authority in the personal and moral realm. By making explicit the gaps between medical knowledge and moral knowledge, she is able to challenge the moral authority and social power that are now granted to medical experts.While these arguments are important, they are not the whole story of the book, for its message is as much about process in bioethics as it is about conclusions. Wilkerson insists that the specific perspective of the theorist affects her/his reasoning. She demonstrates the importance of this fact by using her own distinct position as a bisexual woman to make visible the implicit acceptance and perpetuation of several ideological norms by those in dominant positions in both medicine and bioethics. The central method of the book is what she calls "material-semiotic." It involves the assumption that all human experience is mediated by culture, and the body (specifically the medicalized body) must be recognized as a political site subject to a variety of social values. We must, therefore, attend to the cultural meanings of health and illness and explore the ways that society labels and responds to these conditions. This requires investigation of the specific bodily (material) effects of these meanings in both individual and social experience.The book begins with the epistemological frame of the argument in which Wilkerson claims that medicine is deeply infected by the values and biases of the dominant culture, including its tendencies towards sexist, racist, classist, homophobic, and ablist attitudes. She explores ways in which medical theory and practice stigmatize bodily experiences common to women (in gynecology, obstetrics, and the treatment of victims of sexual or domestic violence). Medicalizing so many aspects of women's experience has the effect of obscuring women's subjective experiences and replacing them with medicine's normative perspectives of appropriate psychological norms. Moreover, the norm of femaleness promoted is a heterosexual, middle class, white variety such that other forms of social difference (e.g., non-white, non-heterosexual) must then also be medicalized and stigmatized; that is, the medical model requires explanations of difference that render pathological most variations on the privileged norm. Hence, alternative sexualities, like differences in class, abilities, race, and gender are interpreted through a medical lens that is thoroughly value-laden. In such ways, the epistemological authority granted to medicine is conflated into an unjustified form of moral authority. Although similar biases are common to every powerful social institution in the United States, they are especially pernicious within medicine because of the enormous influence it exerts in shaping knowledge about the nature of difference between social [End Page 173] groups. This immense social power may be directed towards reducing inequalities and promoting social justice, but, all too often, it is used to convey beliefs and norms that serve the interests of the privileged.Wilkerson's criticism is not reserved... (shrink)

Inflammatory bowel disease is chronic and incurable. Imperious diarrhea, rectal bleeding, fatigue, and weight loss, the main manifestations, cause a decrease in the quality of the patient’s personal and professional life. The objectives of this study were to identify a possible relationship between early maladaptive schemas and disease activity status using logistic regression, to identify the prevalence of early maladaptive schemes in patients and to propose a psychotherapeutic intervention plan. The following were found in a sample of 46 patients aged (...) 16–76 years. An increase in the domain overvigilance and inhibition score had a significant effect, with an increase of 1.137 CI95% [1.031, 1.254] of the risk of the disease being diagnosed as active. High and very high scores were observed for the emotional deprivation scheme and dependence/incompetence, vulnerability to harm and illness and subjugation schemas. The results show that the proposed model could predict and reconfirm the diagnosis; patients have specific psychotherapeutic needs. The therapeutic goal would be to offer care, empathy and protection, to strengthen self-confidence, to make patients realize that they have the ability to cope, to provide permission, encourage the patient to experiment, and guide the patient to express their anger healthily. The therapy scheme’s intervention could lead to increased long-term disease management capacity and, consequently, reduce costs directly and indirectly caused by this condition. (shrink)

Psychiatric diagnoses are increasingly seen as viable categories around which self and social identities might be drawn. This introduces a new pressure on the “boundary problem” for psychiatry: when members of the public request diagnoses to affirm their self-identities how should we draw the line between mental disorder and normality? If psychiatrists have the authority to recognize and diagnose mental disorder, how can roles as diagnosers and gate-keepers be balanced in a post-stigma era of mental health care? Focusing on the (...) disorder identified would-be patient who would not attract the diagnosis they seek were they not to seek it, this essay explores what it means to have an identity bound to a psychiatric diagnosis and considers a framework for psychiatrists to negotiate clinical encounters that involve the seeking of identity affirming diagnoses. (shrink)

The aim of cognitive diagnosis is to classify respondents' mastery status of latent attributes from their responses on multiple items. Since respondents may answer some but not all items, item-level missing data often occur. Even if the primary interest is to provide diagnostic classification of respondents, misspecification of missing data mechanism may lead to biased conclusions. This paper proposes a joint cognitive diagnosis modeling of item responses and item-level missing data mechanism. A Bayesian Markov chain Monte Carlo method (...) is developed for model parameter estimation. Our simulation studies examine the parameter recovery under different missing data mechanisms. The parameters could be recovered well with correct use of missing data mechanism for model fit, and missing that is not at random is less sensitive to incorrect use. The Program for International Student Assessment 2015 computer-based mathematics data are applied to demonstrate the practical value of the proposed method. (shrink)

Conceptually, recognition claims a cardinal role in many prominent philosophical theories. Kant, in the Critique of Pure Reason, uses the German word Rekognition—a term that in many ways has no antecedent in prior tradition—to signify the identification, the grasping of, a unified meaning through thought. However, it is through Hegel that a substantial step in practical philosophy is taken, and recognition is put into dialogue with self-consciousness and freedom. Hegel uses the German word Anerkennung, in the period of Jena Realphilosophie, (...) to mean the "real" actualization of freedom through a struggle which leads to two different levels of recognition: legal and moral—their forms constituted by love... (shrink)

Preimplantation genetic diagnosis (PIGD) goes some way to meeting the clinical, psychological and ethical problems of antenatal testing. We should guard, however, against the assumption that PIGD is the answer to all our problems. It also presents some new problems and leaves some old problems untouched. This paper will provide an overview of how PIGD meets some of the old problems but will concentrate on two new challenges for ethics (and, indeed, law). First we look at whether we should (...) always suppose that it is wrong for a clinician to implant a genetically abnormal zygote. The second concern is particularly important in the UK. The Human Fertilisation and Embryology Act (1990) gives clinicians a statutory obligation to consider the interests of the future children they help to create using in vitro fertilisation (IVF) techniques. Does this mean that because PIGD is based on IVF techniques the balance of power for determining the best interests of the future child shifts from the mother to the clinician? (shrink)

Lennard Davis’s Biocultural Critique of the alleged certainty of diagnosis (Davis Journal of Bioethical Inquiry 7:227−235, 2010) makes errors of fact concerning psychiatric diagnostic categories, misunderstands the role of power in the therapeutic relationship, and provides an unsubstantiated and vague alternative to the management of psychological distress via a conceptually outdated model of the relationships between physical and psychological disease and illness. This response demonstrates that diagnostic knowledge vouchsafes legitimate power to physicians, and via them relief to patients who (...) suffer from psychological distress. The history of medicine and psychiatry demonstrates that psychiatric diagnosis shares many features with physical diagnosis, while there is also reason to believe that the two types will continue to be distinct in some respects. Diagnostic categories in psychological medicine, like those in physical medicine, are provisional, probabilistic, and often uncertain. These features do not detract from the dependence on diagnosis of therapeutic efficacy in both domains. (shrink)

Current symptom-based DSM and ICD diagnostic criteria for mental disorders are prone to yielding false positives because they ignore the context of symptoms. This is often seen as a benign flaw because problems of living and emotional suffering, even if not true disorders, may benefit from support and treatment. However, diagnosis of a disorder in our society has many ramifications not only for treatment choice but for broader social reactions to the diagnosed individual. In particular, mental disorders impose a (...) sick role on individuals and place a burden upon them to change; thus, disorders decrease the level of respect and acceptance generally accorded to those with even annoying normal variations in traits and features. Thus, minimizing false positives is important to a pluralistic society. The harmful dysfunction analysis of disorder is used to diagnose the sources of likely false positives, and propose potential remedies to the current weaknesses in the validity of diagnostic criteria. (shrink)

The dark house.--The cell.--The endocrine glands.--Human types.--The brain and central nervous system.--Medical psychology.--Different paths to truth.--Consciousness.--The Vedânta.--Yoga.--Higher states of consciousness.--Religion.--Buddhism.--Christ and Buddha.--The church.--Mystical Christianity.--'If there had been a candle ... '--Bibliography (p. [251]-255).

Friedrich Nietzsche thought that philosophers were deeply mistaken about the nature and sources of philosophical activity. Where others took themselves to be motivated by a desire to know the truth, Nietzsche charged that his fellow philosophers, motivated by a pathological set of psychological and physiological characteristics, did little more than sublimate and rationalize their own prejudices. In this thesis, I sketch out in further detail and defend the plausibility and significance of this Nietzschean diagnosis of philosophers. I argue that (...) since Nietzsche’s view of philosophers both offers a compelling explanation of some phenomena in contemporary philosophical practice and, were it true, would have significant upshot for how and even whether philosophy should be practiced, we philosophers ought to begin taking it seriously. (shrink)

Superficial and systemic diagnosis of family The distinction between two types of diagnosis of family was inspired by the concept of surface and source features of personality by R.B. Cattell. By means of existing psychological questionnaires we can only know the surface of consciously available mental phenomena. The same is true in the diagnosis of family. The McMaster model of family, systemic in its assumptions, developed research tools giving access only to the surface of the phenomena. Although (...) they are divided into certain thematic categories they do not reveal what is really important in the family system. In this article, the author, after a detailed discussion of one of the tests based on the McMaster theoretical model, is attempting to identify the source features of the family, hereinafter called systemic traits. In this research the exploration factor analysis was used. Three perspectives of the opinion of the family were maintained. Factor analysis allowed identification of three factors for each perspective of the family assessment. Confirmative analysis proved a satisfactory match. The accuracy of the identified systemic model was then tested by a confirmation study. The authors also prepared a provisional questionnaire for measuring these systemic traits of the family. The tool proved to be promising and the work worth continuing. Incidentally, it turned out that the characteristics of the family system are relatively independent of personality traits of family members. (shrink)

The history of medical and professional ethics has largely been a history of attempts to identify, articulate, and defend principles that explain when and why certain actions, institutions, health care professionals, and particular decisions count as right or wrong, just or unjust, virtuous or vicious. Medical ethics has been dominated by principlism. However, so-called moral particularists have forcefully attacked the dominance of principle-based normative theories. The particularist critique of traditional moral theory derives from the rejection of the claim that the (...) normative content of ethics and medical... (shrink)

"Well over one half of this brilliant new Monograph constitutes a major sequel to Professor Grunbaum's highly influential 1984 book The Foundations of Psychoanalysis: A Philosophical Critique, which was labeled "magisterial" by Frank J. Sulloway, and "the most important book ever written on Freud's status as a scientist" by J. Allan Hobson. The importance of the present Monograph lies in the extent to which the author now goes beyond that earlier volume to offer new original ideas on fundamental themes." "Validation (...) in the Clinical Theory of Psycho-analysis: A Study in the Philosophy of Psycho-analysis contains Adolf Grunbaum's new basic critique of the psychoanalytic theory of transference in its role of an etiologic theory; it turns out that etiologic transference interpretations rest on fallacious causal inferences from so-called "meaning connections" between mental states: moreover, just these unsound inferences are the stock-in-trade of the "hermeneutic" reconstruction of psychoanalysis, which charges Freud with a "scientistic self-misunderstanding."" "This volume joins the issue with Marshall Edelson's defenses of the investigative viability of the single-subject case study method. As a spin-off from the import of the serious placebo challenge to psychoanalysis, this Monograph presents the author's widely recognized new account of the placebo concept across all of medicine and psychotherapy. Whereas Foundations of Psychoanalysis objected that Freud's dream theory was evidentially ill-founded, the burden of the present book is to give two new basic reasons for presuming the theory to be false. It also develops the import of the author's appraisal of psychoanalytic theory for the scrutiny of Freud's triadic psychology of religious belief in theism." "Since Sir Karl Popper's most detailed charge of pseudoscience against psychoanalysis in 1983 could not be examined for inclusion in the 1984 book, the present monograph shows in what ways it is wide of the mark as an incoherent diagnosis of the scientific liabilities of psychoanalytic theory. In addition, four important papers that had antedated Foundations by a few years and were scattered over diverse publications have been updated and integrated with the other chapters herein."--BOOK JACKET.Title Summary field provided by Blackwell North America, Inc. All Rights Reserved. (shrink)

After defining the concept of error as it applies to Roentgen semiotics, we present a typology of the sources of semiotic error in clinical practice. It is a typology based on clinical observation, with the Peircean Categories and the triadic structure of Roentgen signs as organizing principles. This is followed by a review of a general psychological typology of the sources of human error. We conclude with the demonstration of a Category preserving correspondence between psychologic and semiotic sources of error. (...) Thus, independently derived and empirically based typologies of psychologic and semiotic error are shown to have the same categorical structure. (shrink)

I argue for a new interpretation of Locke’s account of akrasia. On this interpretation, akrasia occurs on Locke’s account because certain cognitive biases endemic to the human mind dispose us to privilege present over future happiness. As a result, we end up irrationally pursuing present pleasure and the removal of present pain even as we simultaneously judge that doing so runs contrary to our own greater good. In this sense, I argue that Locke seeks to diagnose akrasia by identifying its (...) underlying psychological causes. (shrink)

Background: When infertility is diagnosed, physicians have the difficult task to break bad news. Their communication skills play a central role in improving patients' coping abilities and adherence to infertility treatments. However, specific guidelines and training courses on this topic are still lacking. The aim of the present study is to provide some practical advice for improving breaking bad news in infertility diagnosis through a systematic literature review of qualitative and quantitative studies. Methods: Electronic searches were performed in the (...) MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Psychology and Behavioral Sciences Collection databases. All articles focusing on the communication of the diagnosis of infertility were included. The main findings of each included article were then summarized. Results: Literature search identified 11,838 references that were screened for eligibility. Full texts of 81 articles were retrieved, and their analysis led to the inclusion of 4 articles, which treated the theme of communication of infertility only partially. The main addressed aspects concerning the communication of the infertility diagnosis were the following: the value that patients give to healthcare professionals' communication skills; the importance of giving clear information on diagnostic procedures and treatments in order to decrease patients' anxiety; and the importance of involving both partners. Conclusions: This review pointed out that the communication of the infertility diagnosis is still underinvestigated. Specific guidelines are currently not available, but other protocols could be used. Taking into account the principal aspects of communication highlighted with this review, in this study, we suggested an adaptation of the original SPIKES protocol that could be used by healthcare professionals for the communication of the infertility status. (shrink)

In cases of depression where linguistic meaning has collapsed, there is good reason to believe that a long-term strategy for recovery must include rehabilitating the depressive person's capacity for meaningful speech. This requires that the patient participate actively in interpreting her own pain. In this essay, I argue that medical diagnosis can tempt patients, particularly women, to circumvent this process of interpretation. To explain this danger, I draw on Julia Kristeva's clinical analyses of depression and recent studies on the (...) correlation between depression and self-silencing. (shrink)

The diagnosis of schizophrenia causes no end of contention. Controversial for almost as long as it has been classified, schizophrenia has been called "the sacred symbol of psychiatry", "the sublime object of psychiatry", and simply a "scientific delusion". Calls have been made to "reconstruct" schizophrenia, "reconceive" schizophrenia, and simply dispense with the term altogether.Meanwhile, high-profile psychiatrists promote the view that schizophrenia is a brain disease, although neither of these...

A Democratic Mind: Psychology and Psychiatry with Fewer Meds and More Soul focuses on how an individual lives her life, and on the extent of harm that an individual can inflict on herself or others. In this book, I.W. Charny provides a new lens for understanding regular people rather than treatments that alleviate symptoms.

IntroductionMother–child interactions during the first years of life have a significant impact on the emotional and cognitive development of the child. In this work, we study how a prenatal diagnosis of malformation may affect maternal representations and the quality of these early interactions. To this end, we conducted a longitudinal observational study of mother–child interactions from the gestational stage until the baby completed 12 months of age.Participants and MethodsWe recruited 250 pregnant women from a local university hospital. Among them, (...) 50 mother–infant dyads participated in all stages of the study. The study group consisted of 25 pregnant women with fetuses with some structural alteration and the control group consisted of 25 pregnant women with fetuses without structural anomalies. We collected obstetric and socio demographic data and pregnancy outcomes. Anxiety and depressive state data were collected using the COVI and Raskin Scales. We video-recorded the mother–infant interactions during several stages, including when the child was a newborn and when the child was 2, 4, 6, 9, and 12 months of age. The quality of the mother infant interactions were measured using the Coding Interactive Behavior. The interactive moments recorded on video was composed of three different activities, each one lasting appoximately 3 min, which included Free Interaction, where the mother was instructed to interact “as usual” without any toy, Toy Interaction, where the mother and baby played with a puppv, and Song Interaction, where the mother and baby interacted while the mother sang the “Happy Birthday” song.ResultsIn the gestational phase, there was a significant difference between the groups with respect to anxiety and depression scores, which were significantly higher for the study group. In the postnatal phase, we found significant differences between the groups with respect to CIB scales after the child completed 6 months of age: the study group presented significantly higher values of Maternal Sensitivity at 6 months of age, of Baby Involvement at 9 and 12 months of age, and of Dyadic Reciprocity at 6, 9, and 12 months of age, while the control group presented significantly higher values of Withdrawal of the Baby at 6 months of age, and of Dyadic Negative States at 6 and 9 months of age.ConclusionThe support offered by the study favored the mother–infant bond and had a positive effect on the quality of interaction during the first year of life, despite the presence of prenatal diagnosis. (shrink)

This paper explores the factors that contribute to the degree of a mood disorder patient’s self- insight, defined here as her understanding of the particular contingencies of her life that are responsive to her personal identity, interpersonal relationships, illness symptoms, and the relationship between these three necessary components of her lived experience. I consider three factors: (i) the Diagnostic Statistical Manual of Mental Disorders (DSM), (ii) the DSM culture, and (iii) the cognitive architecture of the self. I argue that the (...) symptom-based descriptions of mood disorders which eliminate the subjective features of the patient’s illness experience, in conjunction with the features of the DSM-culture and the cognitive biases that guide the patient, contribute to the impoverishment of her self-insight. The resulting impoverished self-insight would prevent her from developing resourceful responses to her interpersonal problems. In analyzing how these factors combine to influence the patient’s self-insight, I distinguish the therapeutic impact of receiving a psychiatric diagnosis, which facilitates patient’s clinical treatment, from its reflective impact, how the diagnosis informs the patient’s reflection on who she is, how her mental disorder is expressed, and how her interpersonal relationships proceed. I substantiate my argument by considering a patient’s memoir of psychopathology. (shrink)

Gender Identity Disorder is classified as a mental illness and included in the DSM-IV and ICD-10. It will also be included in the DSM-V. The psychiatric diagnosis, in spite of some apparent advantages, has significant psychological and social adverse implications. This paper discusses some of the main epistemological reasons to consider gender variance as a mental disorder. It will also evaluate whether reasons of other kinds may justify the inclusion of gender variance amongst mental illnesses.

Epistemologists typically assume that the acquisition of knowledge from testimony is not threatened at the stage at which audiences interpret what proposition a speaker has asserted. Attention is instead typically paid to the epistemic status of a belief formed on the basis of testimony that it is assumed has the same content as the speaker’s assertion. Andrew Peet has pioneered an account of how linguistic context sensitivity can threaten the assumption. His account locates the threat in contexts in which an (...) audience’s evidence under-determines which proposition a speaker is asserting. I argue that Peet’s epistemic uncertainty account of the threat is mistaken and I propose an alternative. The alternative locates the threat in contexts that provide factors that give audiences a mistaken psychological certainty or confidence that a speaker has asserted a proposition she has not. (shrink)

ObjectiveGonadotoxicity is considered one of the most distressing side effects of cancer treatment. Although fertility preservation can be a valid solution, it also involves a challenging process. A clear understanding of the features of women who decide to pursue fertility preservation after cancer diagnosis is missing. The purpose of the present study was therefore to analyze the personality profile of female patients referred to oncofertility prior to gonadotoxic treatment.MethodsFifty-two female cancer patients took part in the study. The Temperament and (...) Character Inventory-Revised, the Response Evaluation Measure-71, the Beck Depression Inventory, and the State-Trait Anxiety Inventory-Y Form were administered to examine personality characteristics, defense mechanisms, depression and anxiety symptoms.ResultsCompared with reference data of the Italian population, our sample reported significantly lower scores in Harm Avoidance and trait anxiety, and significantly higher levels of mature defense mechanisms. Most of the patients reported low scores in immature defense mechanisms, depression, and trait anxiety, and medium scores in state anxiety.ConclusionsOur findings suggest that these women display functional personality traits and defensive style, in association with low levels of depression and trait anxiety. These features may enable a proactive attitude to cancer and the ability to make long-term plans. This may favor psychological adjustment to cancer and a projection toward the future. (shrink)

An important international discussion began because of some pioneer studies carried out by Young (1996a) on the internet addiction disorder (IAD). In the fifth and most recent version of the Diagnostic, and Statistical Manual of Mental Disorders (DSM) there is no mention of this disorder and among researchers there are basically two opposite positions. Those who are in favor of a specific diagnosis and those who are claiming the importance of specific criteria characterizing this behavior and the precise role (...) it has in the patient’s life. The aim of the present paper is to answer the question whether it is possible or not to formulate diagnoses of internet-related disorders. We revised literature on the history of diagnostic criteria, on neurocognitive evidence, on the topic debate and on IAD instrumental measures. We found that the disorder was not univocally defined and that the construct was somehow too broad and generic to be explicative for a diagnosis. Indeed, the models are borrowed from other addiction pathologies and they are often formulated before the development of internet as intended in current society. In conclusion, we think we need a more innovative, integrated and comprehensive model for an IAD diagnosis. (shrink)

Self-diagnosis in psychiatry is where individuals diagnose themselves rather than rely upon official diagnosticians to supply a psychiatric diagnosis. The accuracy of self-diagnosis is a contested topic. In this paper, I outline what arguments are needed to see self-diagnosis as accurate and how different approaches to self-diagnosis require different arguments. I show how different arguments are required to justify accuracy for an autistic individual judging they are autistic compared to non-autistic individuals judging they are not (...) autistic. Different arguments are required if a self-diagnosing individual accepts or rejects official diagnostic criteria. Finally, different arguments are required depending upon whether diagnoses are seen as objective entities, the product of theoretical virtues or practically useful groupings. All these approaches require unique arguments to justify the accuracy of self-diagnosis. Identifying the required arguments for different approaches is a stepping stone toward establishing whether those arguments and which of those arguments can be successfully justified. (shrink)

BackgroundThe diagnosis and treatment of cancer are associated with psychological distress that often leads to a significant reduction in emotional and physical well-being and quality of life. Early detection of psychological distress is therefore important. This study aims to assess the psychological distress of inpatient cancer patients using routine clinical data. Furthermore, variables and problems most strongly associated with psychological distress should be identified.Materials and MethodsN = 1,869 inpatients were investigated using the National Comprehensive Cancer Network Distress Thermometer and (...) problem checklist to assess distress as well as multiple possible problem areas. Visceral oncological cancer was the most common tumor diagnosis, followed by skin cancer and urological cancer.Results65.9% of the sample experienced high levels of distress. Female sex, stage 4 of disease, and visceral and head and neck cancer emerged as risk factors for high distress. A younger age was significantly correlated with higher distress. The most frequently self-reported problems were fears, worry, and fatigue. Patients with all 3 of these problems had 24 times higher risk [odds ratio = 23.9] for high levels of distress than patients without these problems. Women reported significantly more practical, emotional, and physical problems than men. Younger and middle-aged patients reported increased levels of practical, family, and emotional problems compared with older patients.DiscussionAlmost two-thirds of the sample reported high levels of distress. The most frequently reported problem areas were emotional and physical problems. These results can help to identify patients with high risk for psychological distress and, therefore, be used to optimize psychosocial and psycho-oncological care for patients with cancer. (shrink)

In the context of psychiatric diagnosis, operationists claim that mental disorders are nothing more than the satisfying of objective diagnostic criteria, whereas realists claim that mental disorders are latent entities that are detected by applying those criteria. The implications of this distinction are substantial in actual clinical situations, such as in the co-occurrence of disorders that may interfere with one another's detection, or when patients falsify their symptoms. Realist and operationist conceptions of diagnosis may lead to different clinical (...) decisions in these situations, affecting treatment efficacy and ultimate patient outcomes. (shrink)

Probably the main purpose of reproductive technologies is to enable people who choose to do so to avoid the birth of a baby with a disabling condition. However the conditions women want information about and the ‘price’ they are willing to pay for obtaining that information vary enormously. Individual women have to arrive at their own prenatal testing choices by ‘trading off’ means and ends in order to resolve the dilemmas facing them. We know very little about how individuals make (...) these trade-offs, so it is difficult to predict how new technologies will affect their choices and preferences. Uptake decisions can be expected to change, especially in the group of women who now are put off by some aspect of the current screening approach, where the avoidance of miscarriage risk may have provided a kind of ‘psychological shelter’, protecting a lot of people from having to make other decisions. Technologies such as Pre-implantation Genetic Diagnosis may remove a second ‘psychological shelter’ because they offer the means of avoiding the birth of an affected child without terminating a pregnancy. Even if new technologies will make some decisions easier in terms of their cognitive demands, they will also create new dilemmas and decision making will not necessarily become less stressful in emotional terms. Key challenges concern information and decision-making. (shrink)

A team of professionals considers whether a patient in her early 50s is developing Alzheimer’s. The patient is not experiencing the memory symptoms typical of that disease, with so far a few years of sporadic attentional lapses as the predominant cognitive complaint. Her most dramatic symptom is her impression that two versions of her husband live with her. One is her real husband, the other a “fake.” There is no elaborated story about who the fake is or why he is (...) there, and there is little in the way of behavior consistent with the idea. To the patient, there is a vague sense that her husband doesn’t belong in the house, but no clearly articulated... (shrink)