Research ethics and the principle of Justice as Fairness – A restatement

In my recent article, I addressed the question of whether a potential categorical exclusion of decisionally impaired patients from non-therapeutic medical research would be inaccordance with the Principle of Justice as Fairness. I came to the conclusion that a categorical exclusion of decisionally impaired persons from relevant research projects may collide with Rawls’s understanding of Justice as Fairness. Derek Bell has criticized my paper by denying that it is legitimate to apply Rawls to this bioethical problem. In my restatement I try to show that an extrapolation of John Rawls’s thought to such bioethical cases is possible, because Rawls himself has written that his orientation towards decisionally non-impaired persons is an idealized situation that allows extrapolations. In a second part I try to show that Bell hasroughly misunderstood my concept of “presumed consent” which I make a prerequisite for the legitimisation of research on decisionally impaired persons. In using advance consent as a proposal for resolving the problem, Bell has indirectly confirmed my approach because he is using a similar construct of consent, which operates with similar hypotheses and probabilities of error. I see here no categorical difference between Bell’s conclusion and my discussion. Thus, Bell’s reply does not represent a refutation of my thoughts, but rather it is a para phrased confirmation of my central theses. I conclude by showing the relevance of Rawls, pointing out that the discussion between Bell and me illustrates how Rawls’s concept of reflective equilibrium is an appropriate approach to finding a solution to this bioethical problem. This revised version was published online in June 2006 with corrections to the Cover Date.     

REBT in Italy: Dissemination and Integration with Constructivism and Metacognition

This paper describes and critically discusses how rational emotive behavior therapy (REBT) spread among Italian cognitive psychotherapists. In the 1980s Cesare De Silvestri, with the help of Carola Schimmelpfennig, Franco Baldini, and Mario Di Pietro, brought REBT to Italy and eagerly disseminated it. In addition, De Silvestri cooperated with the two leading figures in the Italian clinical cognitive movement, Vittorio Guidano and Gianni Liotti. Guidano and Liotti applied the ABC framework to their constructivist version of cognitive therapy. Given that the large majority of Italian cognitive therapists adopted Guidano and Liotti’s approach, they all started applying the ABC framework and are still applying it today. However, Italian therapists adapted the ABC framework to their constructivist training. For example, Guidano and Liotti interpreted the ABC framework as aimed at promoting cognitive and emotional awareness in clients, while they considered the ‘disputing’ phase to be not compatible with the constructivist principles they held. They also encouraged the application of John Bowlby’s ideas to REBT and the use of life experience report techniques in the ABC. Sandra Sassaroli and Roberto Lorenzini applied George Kelly’s “laddering” technique to the ABC framework, a technique more focused on dilemmatic structures than on REBTian dysfunctional thought. Caselli investigated REBT’s influence on Adrian Wells’ metacognitive version of the ABC. Finally, Ruggiero and Ammendola have made a strong call for “back to Ellis”. This implies that any innovation should involve a more stringent and faithful application of REBT principles.     

Visual acuity and stimulus area

Summary In measuring the distance at which we can observe the fine details of the three stimuli shown in Fig. 3 (striped squares, whose areas are 25, 5 and 1 cm²), we obtain that visual acuity is inversely proportional to the area of the stimulus. Furthermore, visual acuity increases (decreases) in the same way as decreases (increases) the area of the stimulus. This relation should be expressed by an hyperbolic function.

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Zusammenfassung Wenn man den Abstand mißt, aus dem die feinen Einzelheiten der drei gestreiften Quadrate von 25, 5 und 1 cm² in Abb. 3 eben erkennbar sind, ergibt es sich, daß die Sehschärfe umgekehrt proportional der Reizfläche ist, das heißt, daß sie mit zunehmender Reizfläche abnimmt und mit abnehmender zunimmt. Diese Abhängigkeit kann als hyperbolische Funktion dargestellt werden.

     

On Simultaneous Masking in the Visual Field

The concept of simultaneous masking in visual field is discussed, in the light of classical examples, of the various kinds of the phenomenon, of a modal completion, of the figure/ground phenomenon, of ambiguous and reversible figures, of mimicry and camouflage and eventually of the complexity of the stimulus. There is some reference to masking in auditory field. The “reality” of the masked configuration is discussed, drawing the conclusion that it is perceptually unreal. The fact that the masking phenomenon cannot take place without comparison between two perceptual acts – what we see at one moment and what we see a moment after LATER – and the fact that the masked configuration pops out with some surprise, lead to the conclusion that simultaneous masking in visual field is not a bare perceptual phenomenon, but a psychological process not unlike insight     

Narrative accounts of illness in schizophrenia: association of different forms of awareness with neurocognition and social function over time

Awareness of illness in schizophrenia reflects complex storied understanding of the impact of the disorder upon one’s life. Individuals may be aware of their illness in different ways and this may be related to their functioning. A total of 76 adults with schizophrenia were assessed for their awareness of illness, neurocognition, social cognition, and social function concurrently and social function was also assessed at three later time points. A cluster analysis revealed 3 groups: generally full awareness, generally limited awareness, and superficial awareness. Comparisons between these profiles revealed the superficial group had poorer executive function, emotion recognition ability, and capacity for social relationships than the full awareness group, yet had better verbal memory and more social contacts than the limited awareness group. These results suggest assessing the narrative qualities of awareness of illness may reveal unique links with cognition and function, and this may have implications for interventions.     

Activation of CB1 specifically located on GABAergic interneurons inhibits LTD in the lateral amygdala

Previously, we found that in the lateral amygdala (LA) of the mouse, WIN55,212-2 decreases both glutamatergic and GABAergic synaptic transmission via activation of the cannabinoid receptor type 1 (CB1), yet produces an overall reduction of neuronal excitability. This suggests that the effects on excitatory transmission override those on inhibitory transmission. Here we show that CB1 activation by WIN55,212-2 and Delta(9)-THC inhibits long-term depression (LTD) of basal synaptic transmission in the LA, induced by low-frequency stimulation (LFS; 900 pulses/1 Hz). The CB1 agonist WIN55,212-2 blocked LTD via G(i/o) proteins, activation of inwardly rectifying K+ channels (K(ir)s), inhibition of the adenylate cyclase-protein kinase A (PKA) pathway, and PKA-dependent inhibition of voltage-gated N-type Ca2+ channels (N-type VGCCs). Interestingly, WIN55,212-2 effects on LTD were abolished in CB1 knock-out mice (CB1-KO), and in conditional mutants lacking CB1 expression only in GABAergic interneurons, but were still present in mutants lacking CB1 in principal forebrain neurons. LTD induction per se was unaffected by the CB1 antagonist SR141716A and was normally expressed in CB1-KO as well as in both conditional CB1 mutants. Our data demonstrate that activation of CB1 specifically located on GABAergic interneurons inhibits LTD in the LA. These findings suggest that CB1 expressed on either glutamatergic or GABAergic neurons play a differential role in the control of synaptic transmission and plasticity.     

Psychogenic and organic amnesia: a multidimensional assessment of clinical, neuroradiological, neuropsychological and psychopathological features

Psychogenic amnesia is a complex disorder characterised by a wide variety of symptoms. Consequently, in a number of cases it is difficult distinguish it from organic memory impairment. The present study reports a new case of global psychogenic amnesia compared with two patients with amnesia underlain by organic brain damage. Our aim was to identify features useful for distinguishing between psychogenic and organic forms of memory impairment. The findings show the usefulness of a multidimensional evaluation of clinical, neuroradiological, neuropsychological and psychopathological aspects, to provide convergent findings useful for differentiating the two forms of memory disorder.     

New strategies in the assessment of psychological factors affecting medical conditions

In this article, we examine research that may lead to a better assessment of psychological factors affecting medical conditions. We performed a review of the psychosomatic literature using both Medline and manual searches. We selected papers that were judged to be relevant to new strategies of assessment, with particular reference to the use of the Diagnostic Criteria for Psychosomatic Research. We assessed 8 areas concerned with the assessment of psychological factors in the setting of medical disease: hypochondriasis, disease phobia, persistent somatization, conversion symptoms, illness denial, demoralization, irritable mood, and Type A behavior. A new subclassification of the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-V]; not yet published) category of psychological factors affecting physical conditions appears to be feasible and may provide the clinician with better tools for identifying psychological distress.