Introduction to the Special Issue on Interoception and Suicidality

Empirically informed theories of suicide highlight the importance of identifying factors that lead from suicide ideation to suicidal behavior. Interoceptive dysfunction may be one such differentiating factor. Interoceptive dysfunction refers to a disconnection from the internal sensations of the body, which can cause difficulty in truly understanding and knowing one’s own body. Specifically, interoceptive dysfunction may lead to such disconnection from the self that the body comes to be seen as “other” and potentially even “nonhuman.” A burgeoning body of research supports these theoretical links and also highlights the need for methodologically rigorous studies that employ careful measurement of these constructs. Thus, this special section is devoted to articles that advance the understanding of the relationship between interoception and suicidality. A more nuanced understanding of the relationship between interoceptive dysfunction and suicidality is critical for improving suicide prevention and treatment efforts.     

New trends in philosophy of psychiatry

The concept of mental disorder is often defined by reference to the notion of mental dysfunction, which is in line with how the concept of disease in somatic medicine is often defined. However, the notions of mental function and dysfunction seem to suffer from some problems that do not affect models of physiological function. Functions in general have a teleological structure; they are effects of traits that are supposed to have a particular purpose, such that, for example, the heart serves the goal of pumping blood. But can we single out mental functions in the same way? Can we identify mental functions scientifically, for instance, by applying evolutionary theory? Or are models of mental functions necessarily value-laden? I want to identify several philosophical problems regarding the notion of mental function and dysfunction and point out some possible solutions. As long as these questions remain unanswered, definitions of mental disorder that rest upon the concept of mental dysfunction will lack a secure foundation.     

Can we define mental disorder by using the criterion of mental dysfunction?

The concept of mental disorder is often defined by reference to the notion of mental dysfunction, which is in line with how the concept of disease in somatic medicine is often defined. However, the notions of mental function and dysfunction seem to suffer from some problems that do not affect models of physiological function. Functions in general have a teleological structure; they are effects of traits that are supposed to have a particular purpose, such that, for example, the heart serves the goal of pumping blood. But can we single out mental functions in the same way? Can we identify mental functions scientifically, for instance, by applying evolutionary theory? Or are models of mental functions necessarily value-laden? I want to identify several philosophical problems regarding the notion of mental function and dysfunction and point out some possible solutions. As long as these questions remain unanswered, definitions of mental disorder that rest upon the concept of mental dysfunction will lack a secure foundation.     

High illness loads (physical and social) do not always force high levels of mass religiosity

The hypothesis that high levels of religiosity are partly caused by high disease loads is in accord with studies showing that societal dysfunction promotes mass supernaturalism. However, some cultures suffering from high rates of disease and other socioeconomic dysfunction exhibit low levels of popular religiosity. At this point, it appears that religion is hard pressed to thrive in healthy societies, but poor conditions do not always make religion popular, either.     

Harmful dysfunction and the search for value neutrality in the definition of mental disorder: response to Wakefield, part 2

Wakefield's claims to have identified and objective scientific component of mental disorders in the concept of dysfunction are examined in light of previous attempts to state a value free concept of mental disorders. The harmful dysfunction concept of dysfunction is not value free because it confounds cause and purpose in a specious use of evolutionary theory and because evolutionary theory cannot reliably supply standards for when a function is broken. Harmful dysfunction analysis collapses into a value-laden concept of mental disorders and serves the untoward goal of promoting the status quo in the modern DSMs. If the concept of dysfunction were taken seriously and rigorously defined, then it might be possible to separate what is medical from what is not in the domain of mental disorders.     

Negative urgency: a personality predictor of externalizing behavior characterized by neuroticism, low conscientiousness, and disagreeableness

Negative urgency, the tendency to act rashly when distressed, is characterized by high Neuroticism, low Conscientiousness, and low Agreeableness. Because of this set of characteristics, the authors hypothesized that (1) negative urgency (NU) is a particularly important predictor of externalizing dysfunction; (2) traits that reflect primarily high Neuroticism predict internalizing dysfunction; and (3) traits that reflect primarily low Conscientiousness predict those types of externalizing dysfunction that include intense affect less strongly than does NU. In three studies, the authors showed that negative urgency concurrently predicted alcohol dependence symptoms in disordered women, drinking problems and smoker status in preadolescents, and aggression, risky sex, illegal drug use, drinking problems, and conduct disordered behavior in college students. High Neuroticism traits predicted internalizing dysfunction but predicted none of these externalizing criteria beyond negative urgency. Low Conscientiousness did not add to prediction from negative urgency, except in a few cases. The tendency toward affect-driven rash action may underlie many externalizing behaviors.     

Antipsychotika und sexuelle Dysfunktion

Antipsychotic drugs are used in the treatment of psychotic symptoms in schizophrenia and affective disorders. A direct correlation between increased dopaminergic activity and increased sexual desire and sexual activity is well documented in animal experiments and from observations in humans. Comparatively little researched and recognized is pharmacologically induced sexual dysfunction. In contrast to the antipsychotic effect and extrapyramidal motor side effects, no dose–response relationships are known for sexual side effects. This may be due to the fact that antipsychotics act at different levels in the sexual experience. Sexual dysfunction may be present on social, psychological, central nervous system and peripheral–organic levels, respectively. These levels are closely associated with each other and influence each other. Therefore, sexual dysfunction is generally a combination of dysfunctions at several of these levels. For a variety of reasons, there are no generally accepted standards for a healthy and fulfilling sex life. As a treating physician, the fact that sexual disorders are also not a rare phenomenon in mentally and physically healthy people should be kept in mind and that patients with schizophrenia regardless of the etiology of the sexual dysfunction may also benefit from sexual medicine or specific psychotherapeutic treatment.     

Hormones and Cognition: Current Concepts and Issues in Neuropsychology

This article provides an extensive and comprehensive review of the effects of hormones on cognition. Studies detailing specific neurocognitive functions affected by variation in hormone levels across the life span are presented. Dysregulation of hormone levels is considered from models of both normal and diseased functioning. Patterns of cognitive dysfunction are described for a range of syndromes involving the neuroendocrine system, and evidence of specific neurophysiological mechanisms that can account for these findings is outlined. This review includes discussion of treatment outcomes and the permanency of endocrine-related cognitive dysfunction. The authors present a set of guidelines for clinical neuropsychologists to use for assessment of patients with neuroendocrine system dysfunction. Clinical and methodological issues in research and treatment settings are discussed.     

CD4＋调节性T细胞与多脏器功能障碍综合征免疫功能紊乱

免疫功能紊乱是多脏器功能不全综合征发生的重要原因之一,其机制仍不明了。本文概述CD4＋调节性T细胞在免疫紊乱发生机制中的作用,及其潜在的治疗价值,拓宽MODS的免疫调节治疗的思路。     

Development of norms for executive functions in typically-developing Indian urban preschool children and its association with nutritional status

Executive functions (EFs) are essential and important for achieving success in children’s everyday lives and play a fundamental role in children’s cognitive, academic, social, emotional and behavioral functioning. A cross-sectional study was carried out to develop age- and sex-specific norms for EFs using the Behavior Rating Inventory of Executive Function – Preschool Version (BRIEF-P) among 2- to 5-year-olds from urban Bangalore, India. In addition, the association between EFs and anthropometric measures, a marker of nutritional status, is also examined. Primary caregivers of 412 children, equally distributed by age and sex, participated. Raw scores for each domain and indices were converted to standard t-scores and percentiles were computed. A t-score at or above 63 corresponding to the 90th percentile was considered as the cutoff for executive dysfunction in this sample. The prevalence of executive dysfunction is 10% based on the Global Executive Composite score of the BRIEF-P. The cutoff score for identifying executive dysfunction using existing United States (US) norms is higher compared to the cutoff score obtained in the current study. Therefore, using US norms for Indian children could result in the prevalence of executive dysfunction been underestimated. Multiple linear regression analysis revealed that stunted and underweight children have significantly elevated EF scores after adjusting for age, sex and socioeconomic status (SES; p < .01). A greater understanding of EFs in preschool children is important for the early identification of executive dysfunction and implementing interventions to improve their future prospects. This study also shows that undernourished children are more likely to have executive dysfunction.     

Disorder as harmful dysfunction: a conceptual critique of DSM-III-R's definition of mental disorder.

The Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM-III-R) operationally defines disorder essentially as "statistically unexpectable distress or disability." This definition is an attempt to operationalize 2 basic principles: that a disorder is harmful and that a disorder is a dysfunction (i.e., an inability of some internal mechanism to perform its natural function). However, the definition fails to capture the idea of "dysfunction" and so fails to validly distinguish disorders from nondisorders, leading to invalidities in many of DSM-III-R's specific diagnostic criteria. These problems with validity are traced to DSM-III-R's strategies for increasing reliability.     

Impact of fathers on daughters' age at menarche: a genetically and environmentally controlled sibling study

Girls growing up in homes without their biological fathers tend to go through puberty earlier than their peers. Whereas evolutionary theories of socialization propose that this relation is causal, it could arise from environmental or genetic confounds. To distinguish between these competing explanations, the authors used a genetically and environmentally controlled sibling comparison design to examine the effects of differential exposure to family disruption/father absence in a community sample of sister pairs. As specified by evolutionary causal theories, younger sisters had earlier menarche than their older sisters in biologically disrupted families (n = 68) but not biologically intact families (n = 93). This effect was superseded, however, by a large moderating effect of paternal dysfunction. Younger sisters from disrupted families who were exposed to serious paternal dysfunction in early childhood attained menarche 11 months earlier than either their older sisters or other younger sisters from disrupted families who were not exposed to such dysfunction. These data suggest that early exposure to disordered paternal behavior, followed by family disruption and residential separation from the father, can lead to substantially earlier menarche.     

Short-term memory impairment in vestibular patients can arise independently of psychiatric impairment,fatigue, and sleeplessness

Vestibular dysfunction is associated with visual short-term memory impairment; however, it remains unclear if this impairment arises as a direct result of the vestibular dysfunction or is a consequence of comorbid changes in mood, affect, fatigue, and/or sleep. To this end, we assessed the concurrence and interdependence of these comorbidities in 101 individuals recruited from a tertiary balance clinic with a neuro-otological diagnosis. Over fifty per cent of the sample showed reduced visuospatial short-term memory, 60% and 37% exceeded cut-off on the Beck Anxiety and Depression Inventories, respectively, 70% exceeded cut-off on the Fatigue Severity Scale, 44% reported daytime sleepiness on the Epworth Sleepiness Scale, and 78% scored above cut-off on the Pittsburgh Sleep Quality Index. The high concurrence of these symptoms gives reason to infer the existence of a vestibular cognitive affective syndrome. Structural equation modelling indicated that the significant statistical association between general unassisted posture (a marker of chronic vestibular dysfunction and strong predictor of falls risk) and short-term memory was not mediated by mood and wakefulness. Instead, the memory impairment related more directly to vestibular dysfunction. From a rehabilitation perspective, the implication is that if the vestibular disorder is treated successfully then the memory problem will likewise improve.     

Attention deficit hyperactivity disorder and the frontal lobe syndrome.

The usefulness of frontal lobe (FL) dysfunction as a conceptual model for Attention Deficit Hyperactivity Disorder (ADHD) was investigated. Twenty-four ADHD and 24 normal control (NC) children were tested using two batteries of tasks. The first was sensitive to FL deficits in motor control and problem solving skills. The second consisted of memory tasks sensitive to temporal lobe dysfunction. ADHD children differed significantly from NCs on measures of FL function, but not on tests of temporal lobe functions. Where norms were available for normal children on the same FL tests, ADHDs performed like 6- to 7-year-olds, despite their mean age of 10 years and minimum age of 8 years. The differential performance of ADHDs on tasks sensitive to FL and temporal lobe dysfunction supports the hypothesis that ADHD deficits are analogous to FL dysfunction and demonstrates that the children's deficits do not reflect generalized cognitive impairment.     

Attachment, borderline personality, and romantic relationship dysfunction

Previous studies have implicated attachment and disturbances in romantic relationships as important indicators for Borderline Personality Disorder (BPD). The current research extends our current knowledge by examining the specific associations among attachment, romantic relationship dysfunction, and BPD, above and beyond the contribution of emotional distress and nonromantic interpersonal functioning in two distinct samples. Study 1 comprised a community sample of women (N = 58) aged 25-36. Study 2 consisted of a psychiatric sample (N = 138) aged 21-60. Results from both Study 1 and Study 2 demonstrated that (1) attachment was specifically related to BPD symptoms and romantic dysfunction, (2) BPD symptoms were specifically associated with romantic dysfunction, and (3) the association between attachment and romantic dysfunction was statistically mediated by BPD symptoms. The findings support specific associations among attachment, BPD symptoms, and romantic dysfunction.     

Subtyping obsessive-compulsive disorder: neuropsychological correlates

We administered neuropsychological measures considered sensitive to prefrontal dysfunction (both orbitofrontal and dorsolateral prefrontal neocortex) to obsessive-compulsive disorder (OCD) patients and control subjects. OCD subjects exhibited performance deficits, in comparison to community controls, on three measures sensitive to orbitofrontal neocortex dysfunction. Contrary to expectation, OCD patients also exhibited performance deficits on measures sensitive to dorsolateral prefrontal neocortex dysfunction. However, distinct neurocognitive profiles emerged when we examined the impact of comorbid schizotypal personality features on neuropsychological test performance. Primary OCD patients displayed impaired performance on measures sensitive to orbitofrontal dysfunction; however, they did not differ from control subjects on tests of dorsolateral function. OCD subjects presenting with schizotypal personality features performed poorly not only on tests sensitive to orbitofrontal dysfunction, but also on tests sensitive to dorsolateral dysfunction. Findings suggest that OCD can be subdivided into clinical subtypes, and distinct prefrontal subsystems may be differentially involved in these subtypes.     

Re-examining the Epidemiology of Sensory Regulation Dysfunction and Comorbid Psychopathology

The aims of this study were threefold: (1) to compare prevalence of sensory regulation dysfunction based on previously established criteria to rates established with a more representative community sample of 796 4-year-olds; (2) to examine ethnic/racial and gender differences in prevalence according to the different criteria; and (3) to examine the co-occurrence of sensory regulation dysfunction and preschool psychiatric disorders. Prevalence rates ranged from 3.4% (current criteria) to 15.6% (previous criteria). In contrast to previous studies with less representative samples, there were no significant ethnic or racial differences using the current criteria. Boys were more likely to have sensory regulation dysfunction than girls according to all criteria. Depending upon impairment criteria used, 33–63% of children meeting criteria for sensory dysregulation also had a psychiatric disorder; 37–67% had only a sensory dysregulation disorder, indicating that sensory regulation dysfunction exists independent of psychiatric disorder, and is also a significant risk factor for disorder.     

Neurobiological models of attention-deficit/hyperactivity disorder: a brief review of the empirical evidence

Attention-deficit/hyperactivity disorder (ADHD) is a psychiatric disorder characterized by inattention, impulsivity, and overactivity that begins in childhood. While considerable research has focused on the neurobiological substrates of this disorder, the specific nature of the brain dysfunction in ADHD has remained elusive. However, early data from pharmacological treatment studies, as well as from basic research in animals and humans, initially led several investigators to develop neurobiological models of ADHD. These models of ADHD and more recent evidence from neuropsychological, neuroimaging, neurochemical, and genetic research are briefly reviewed. While not completely consistent, the empirical data suggest that dysfunction in prefrontal-striatal neural circuits, as well as in brain stem catecholamine systems that innervate these circuits, may underlie the executive function deficits in ADHD.     

Tardive dyskinesia and perceptual dysfunction

There is equivocal evidence for a relationship between neuroleptic-induced tardive dyskinesia and central nervous system (CNS) dysfunction. Using the Bender-Gestalt test as the dependent measure, we hypothesized that a group of chronic schizophrenic patients with tardive dyskinesia would show more perceptual dysfunction than those without. Our results supported this hypothesis. CNS dysfunction is discussed in terms of a possible predisposition to tardive dyskinesia.