The six most essential questions in psychiatric diagnosis: a pluralogue part 1: conceptual and definitional issues in psychiatric diagnosis

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.     

The relationship between post-trauma problem reporting and carer quality of life after severe head injury

Abstract

Head injury is a significant cause of death and disability. This study examined the quality of life of carers of individuals following severe head injury from the acute neurosurgical care period to one year post discharge from hospital. The contribution of patterns of problem reporting by patients and their carers to quality of life was examined. Carer psychosocial adjustment and individual quality of life evaluations were significantly poorer than general population levels and did not change over a one year period. However, significant increases in the number of problems reported were noted over time. No significant differences were found between patients and carers in the numbers of problems identified at each of three assessments, although the level of agreement about problems identified was quite low. Female patients reported significantly more problems than male patients. Carer problem reporting was found to significantly predict carer quality of life and psychosocial functioning to a greater extent than patient problem reporting, a pattern which emerged after the patient had been discharged from hospital. The study demonstrates increasing problem profiles and differing perceptions of patients and carers over time. Combined with a lack of improvement in carer quality of life over a one year recovery period, this highlights the need for longer-term professional support and advice services aimed at both patients and carers.     

Meta-Analysis and Construct Validity

It is argued that meta-analysis is a fundamental tool in any construct valida- tion effort. Meta-analytic resuits provide the stable and precise estimates of relationships between variables that are needed for causal modeling and the- ory development. A review of the application of meta-analysis to the area of employment validities is used to show the theoretical and applied benefits this tool can bring to construct validation research. The case is also made that meta-analyses focused on the criterion side of prediction equations would lead to enhanced knowledge of the construct validity of criteria.     

The Parentification Inventory: Development,Validation, and Cross-Validation

Abstract

This study hypothesized that subjects who strongly endorse unrealistic beliefs about intimate relationships would score higher on a measure of exposure to popular romantic media than subjects who do not. The relationship between exposure to media and satisfaction with one's current intimate relationship was also explored. Results for the 109 adult subjects support the hypothesis (r=.18, p<.05). There was also a trend for married women who were more exposed to the popular romantic media to be less satisfied with their current intimate relationships (r=? .26, p<.10). These results would seem to have significant psychological and social implications.     

Illness, phenomenology, and philosophical method

In this article, I propose that illness is philosophically revealing and can be used to explore human experience. I suggest that illness is a limit case of embodied experience. By pushing embodied experience to its limit, illness sheds light on normal experience, revealing its ordinary and thus overlooked structure. Illness produces a distancing effect, which allows us to observe normal human behavior and cognition via their pathological counterpart. I suggest that these characteristics warrant illness a philosophical role that has not been articulated. Illness can be used as a philosophical tool for the study of normally tacit aspects of human existence. I argue that illness itself can be integral to philosophical method, insofar as it facilitates a distancing from everyday practices. This method relies on pathological or limit cases to illuminate normally overlooked aspects of human perception and action. I offer Merleau-Ponty’s analysis of the case of Schneider as an example of this method.     

Taking personality selection bias seriously in animal cognition research: a case study in capuchin monkeys (Sapajus apella)

In most experimental work on animal cognition, researchers attempt to control for multiple interacting variables by training subjects prior to testing, allowing subjects to participate voluntarily, and providing subjects with food rewards. However, do such methods encourage selection bias from subjects’ personalities? In this study, we trained eighteen zoo-housed capuchin monkeys (Sapajus apella) for two experiments, under conditions of positive reinforcement (i.e. food rewards) and free-choice participation. Using a combination of behavioral and rater-based methods, we identified and validated five personality dimensions in these capuchins (Assertiveness, Openness, Neuroticism, Sociability, and Attentiveness). Scores on Openness were positively related to individual differences in monkey task participation, reflecting previous work showing that such individuals are often more active, curious, and willing to engage in testing. We also found a negative relationship between scores on Assertiveness and performance on tasks, which may reflect the trade-offs between speed and accuracy in these animals’ decision-making. Highly Assertive individuals (the most sociable within monkey groups) may also prioritize social interactions over engaging in research. Lastly, monkeys that consistently participated and performed well on both tasks showed significantly higher Openness and lower Assertiveness compared to others, mirroring relationships found between personality, participation, and performance among all participants. Participation and performance during training was clearly biased toward individuals with particular personalities (i.e. high Openness, low Assertiveness). Results are discussed in light of the need for careful interpretation of comparative data on animal cognition and the need for researchers to take personality selection bias more seriously.     

So many options,so little control: Abstract representations can reduce selection demands to increase children’s self-directed flexibility

Children often struggle to behave flexibly when they must use self-directed goals (e.g., doing homework without prompting) rather than externally driven goals (e.g., cleaning up when told). Such struggles may reflect the demands of selecting among many potential options, as required for self-directed control. The current study tested whether (a) 6-year-old children show difficulty in selecting among competing semantic representations, (b) providing category labels designed to reduce selection demands improves performance, and (c) such benefits transfer to self-directed flexibility. Selection was measured using the blocked cyclic naming task for the first time with children. Pictures were named repeatedly in either homogeneous blocks from the same category (e.g., all animals), which create high selection demands due to spreading semantic activation and engage effortful cognitive control, or mixed blocks with each picture from a different category. Children showed robust difficulty in selecting among options, as indexed by response time (RT) differences between homogeneous and mixed blocks. Providing subcategory labels designed to reduce selection demands by distinguishing among same-category items (e.g., “A cow is a farm animal. A cat is a pet.”) improved selection. Providing superordinate categories (e.g., “A cow is an animal. A cat is an animal.”) also improved selection, but these benefits were less robust, and subcategory labels led to greater benefits than superordinate category labels on a subsequent verbal fluency task. These results support a role for subcategory representations in reducing selection demands to aid self-directed flexibility while suggesting that some children may use superordinate category labels to activate subcategory representations on their own.     

The Evidence Base for Occupational Therapy in Mental Health: More Systematic Reviews Are Needed

To shape its work, the Research Centre for Occupation & Mental Health is interested in research priorities. Systematic reviews develop an overview of the research available about an intervention, which can provide evidence to underpin practice. They also however, identify gaps in the knowledge base and so are useful for research-prioritization exercises. A rigorous literature search identified only four systematic reviews about occupational therapy in mental health, which suggests that more are needed to underpin practice. This article also explains a six-stage process for conducting a systematic review that can be used by occupational therapists in mental health.