The six most essential questions in psychiatric diagnosis: a pluralogue. Part 4: general conclusion

In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined.     

Those Who Have the Gold Make the Evidence: How the Pharmaceutical Industry Biases the Outcomes of Clinical Trials of Medications

Pharmaceutical companies fund the bulk of clinical research that is carried out on medications. Poor outcomes from these studies can have negative effects on sales of medicines. Previous research has shown that company funded research is much more likely to yield positive outcomes than research with any other sponsorship. The aim of this article is to investigate the possible ways in which bias can be introduced into research outcomes by drawing on concrete examples from the published literature. Poorer methodology in industry-funded research is not likely to account for the biases seen. Biases are introduced through a variety of measures including the choice of comparator agents, multiple publication of positive trials and non-publication of negative trials, reinterpreting data submitted to regulatory agencies, discordance between results and conclusions, conflict-of-interest leading to more positive conclusions, ghostwriting and the use of ??seeding?? trials. Thus far, efforts to contain bias have largely focused on more stringent rules regarding conflict-of-interest (COI) and clinical trial registries. There is no evidence that any measures that have been taken so far have stopped the biasing of clinical research and it??s not clear that they have even slowed down the process. Economic theory predicts that firms will try to bias the evidence base wherever its benefits exceed its costs. The examples given here confirm what theory predicts. What will be needed to curb and ultimately stop the bias that we have seen is a paradigm change in the way that we treat the relationship between pharmaceutical companies and the conduct and reporting of clinical trials.     

The six most essential questions in psychiatric diagnosis: a pluralogue part 3: issues of utility and alternative approaches 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 ?C 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 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, 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.     

A longitudinal investigation of anxiety sensitivity in adolescence

This investigation sought to expand existing knowledge of anxiety sensitivity in a sample of high school students (N = 2,365) assessed over 4 years. The stability of anxiety sensitivity levels across assessment periods was examined, and cluster analyses were used to identify different developmental pathways in levels of anxiety sensitivity. Groups of adolescents with stable low, stable high, and escalating anxiety sensitivity levels were identified. Adolescents with stable high or escalating anxiety sensitivity were significantly more likely to report experiencing a panic attack than individuals with stable low anxiety sensitivity. Results also indicated that Asian and Hispanic adolescents tended to report higher anxiety sensitivity but that their anxiety sensitivity was less strongly associated with panic than that of Caucasian adolescents.     

Individual-collective primacy and ingroup favoritism: enhancement and protection effects

Individual-collective primacy refers to the extent to which people emphasize their individual interests (individual-primacy) vs. the interests of their ingroup (collective-primacy). This study examined the interactive effects of individual-collective primacy, ingroup performance, and outgroup performance on ingroup favoritism. Participants from two cultures completed a measure of their individual vs. collective-primacy orientation. Performance feedback (favorable or unfavorable) for themselves, their ingroup, and the outgroup were manipulated orthogonally. As predicted, greater collective-primacy led to more ingroup favoritism when the ingroup performed better or worse than the outgroup. However, when the ingroup and outgroup both performed well or both performed poorly, the relationship between collective-primacy and ingroup favoritism was not significant. Implications for analyses of ingroup favoritism and cross-cultural differences are discussed.     

The effects of noncontingently available alternative stimuli on functional analysis outcomes

The effects of noncontingently available alternative stimuli on functional analysis outcomes were evaluated for 2 individuals. Results suggested that noncontingent access to preferred items resulted in reduced levels of attention-maintained behavior. The results are interpreted in terms of establishing operations.     

Subliminal Motivation: A Story Revisited

Can people have their motivational states affected subliminally? Two experiments are presented that address this controversial question. In the first, participants watched an episode of The Simpsons television program. Embedded in the program were verbal and pictorial stimuli related to thirst that were presented below conscious awareness. The results show that, compared to their pre‐exposure ratings and compared to a control group, participants became thirstier following exposure. A second experiment replicated this finding and showed that the effect was not a result of straightforward linguistic priming. The implications of the results for subliminal advertising and for theoretical issues of preconscious processing are discussed.     

Do causal attributions mediate the effects of extrinsic rewards on intrinsic interest?

Many investigators have demonstrated that task-contingent extrinsic incentives can reduce an individual's interest in some intrinsically rewarding task. Although it has been widely assumed that this “undermining effect” is mediated by the individual's causal attributions for engaging in the task, there has been little independent verification of this notion. In the present study subjects were asked to perform an inherently interesting problem-solving task. Half of the subjects were told that they could earn money by solving the task successfully (Money condition), whereas the other half were not (Control condition). Consistent with previous research, Money condition subjects expressed less liking for the task. In addition, Many condition participants attributed their task performance to less internal causes. Furthermore, across conditions, subjects who attributed their behavior to less internal causes were less apt to enjoy the task. The present data, therefore, more convincingly implicate the mediating role of causal attributions in the relationship between extrinsic rewards and intrinsic interest. Alternative explanations are discussed.     

On the alleged connection between Moral Evil and human freedom: Response to Nagasawa and Trakakis

In this essay, I respond to two criticisms of my essay, ‘On the Alleged Connection between Moral Evil and Human Freedom’. According to Yujin Nagasawa, I equivocate on the meaning of ‘moral evil.’ I respond by offering what I believe to be an unobjectionable stipulative under-standing of what counts as moral evil which is sufficient for my argument. According to Nick Trakakis, I seriously misunderstand the conception of freedom characteristic of free will theodicists. He suggests that my argument presupposes compatibilism. I respond by showing that my argument does not presuppose the denial of the capacity to have done otherwise.     

DISCOUNTING OF DELAYED FOOD REWARDS IN PIGEONS AND RATS: IS THERE A MAGNITUDE EFFECT?

Temporal discounting refers to the decrease in the present, subjective value of a reward as the time to its receipt increases. Results from humans have shown that a hyperbola-like function describes the form of the discounting function when choices involve hypothetical monetary rewards. In addition, magnitude effects have been reported in which smaller reward amounts are discounted more steeply than larger amounts. The present research examines the cross-species generality of these findings using real rewards, namely food pellets, with both pigeons and rats. As with humans, an adjusting amount procedure was used to estimate the amount of immediate reward judged equal in value to a delayed reward. Different amounts of delayed food rewards (ranging from 5 to 32 pellets in pigeons and from 5 to 20 pellets in rats) were studied at delays varying from 1 s to 32 s. A simple hyperbola, similar to the hyperbola-like mathematical function that describes the discounting of hypothetical monetary rewards in humans, described the discounting of food rewards in both pigeons and rats. These results extend the generality of the mathematical model of discounting. Rates of discounting delayed food rewards were higher for pigeons than for rats. Unlike humans, however, neither pigeons nor rats showed a reliable magnitude effect: Rate of discounting did not vary systematically as a function of the amount of the delayed reward.