Identifying and Addressing Barriers to Treatment Decision‐making in Bipolar II Disorder: Clinicians’ Perspective

Objective

Treatment decision‐making in bipolar II disorder is complex due to limited evidence on treatment efficacy and potentially burdensome side‐effects of options. Thus, involving patients and negotiating treatment options with them is necessary to ensure that final treatment decisions balance both clinician and patient preferences. This study qualitatively explored clinician views on (a) effective treatment decision‐making, unmet patient needs for (b) decision‐support and (c) information.

Method

Qualitative semi‐structured interviews with 20 practising clinicians (n = 10 clinical psychologists, n = 6 general practitioners, n = 4 psychiatrists) with experience treating adult outpatients with bipolar II disorder were conducted. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Self‐report professional experience, and clinician preferences for patient decision‐making involvement were also assessed.

Results

Qualitative analyses yielded two inter‐related themes: (a) challenges and barriers to decision‐making and (b) facilitators of clinician decision‐making. Symptom severity, negative family attitudes, system‐based factors, and information gaps were thought to pose challenges to decision‐making. By contrast, decision‐making was supported by patient information, family involvement and patient‐centredness, and a strong therapeutic relationship. Clinician views varied depending on their professional background (medical vs clinical psychologist), patient involvement preferences, and whether the clinician was a bipolar specialist.

Conclusions

Whilst clinicians uniformly recognise the importance of involving patients in informed treatment decision‐making, active patient participation is hampered by unmet informational and decision‐support needs. Current findings inform a number of bipolar II disorder‐specific, clinician‐endorsed strategies for facilitating patient decision‐making, which can inform the development of targeted patient decision‐support resources for use in this setting.     

Cognitive outcomes of pediatric stroke

A limited number of longitudinal studies have investigated long-term neuropsychological development in the pediatric stroke population. This study retrospectively examines cognitive outcomes in 41 children with a history of stroke, with reference to age at stroke, laterality, region and mechanism of stroke. In the course of recovery, neuropsychological measures of intellectual functioning and memory were administered at two time points, whilst executive functioning, attention and academic skills were administered at one time point. As predicted, children with stroke performed significantly worse compared to normative expectations on all neuropsychological measures. Up to two thirds of children scored in the borderline impaired and impaired ranges on at least one domain of cognition. Performance on intellectual and memory assessment remained relatively stable over time. Younger age at stroke was found to be associated with poorer intellectual functioning. No effects of laterality of stroke on neuropsychological performance over time were found. Children with subcortical stroke demonstrated a greater improvement in immediate memory over time than children with cortical stroke. These findings reveal that children with stroke display long-term cognitive difficulties that typically remain stable over time. Attention and academic skills are particularly vulnerable to impairment. Further evidence that age at stroke is a significant factor in terms of cognitive outcome is provided, in support of the “early vulnerability” position.     

Bilingual comparison of Mandarin and English cognitive bias tasks

Most research into cognitive biases has used Western samples, despite potential East-West socio-cultural differences. One reason is the lack of appropriate measures for non-Westerners. This study is about cross-linguistic equivalence which needs to be established before assessing cross-cultural differences in future research. We developed parallel Mandarin and English measures of interpretation bias and attention bias using back-translation and decentering procedures. We assessed task equivalence by administering both sets of measures to 47 bilingual Mandarin-English speakers. Interpretation bias measurement was similar and reliable across language versions, confirming suitability of the Mandarin versions for future cross-cultural research. By contrast, scores on attention bias tasks did not intercorrelate reliably, suggesting that nonverbal stimuli such as pictures or facial expressions of emotion might present better prospects for cross-cultural comparison. The development of the first set of equivalent measures of interpretation bias in an Eastern language paves the way for future research investigating East-West differences in biased cognition.     

Rejecting the Urge to Theorise in Fallacy Inquiry

In this paper, I examine the incessant call to theory that is evident in fallacy inquiry. I relate the motivations for this call to a desire to attain for fallacy inquiry certain attributes of the theoretical process in scientific inquiry. I argue that these same attributes, when pursued in the context of philosophical inquiry in general and fallacy inquiry in particular, lead to the assumption of a metaphysical standpoint. This standpoint, I contend, is generative of unintelligibility in philosophical discussions of rationality. I claim that this same unintelligibility can be shown to characterise fallacy inquiry, an example of the study of argumentative rationality. The context for my claim is an examination of the theoretical pronouncements of two prominent fallacy theorists, John Woods and Douglas Walton, in relation to the argument from ignorance fallacy. My conclusion takes the form of guidelines for the post-theoretical pursuit of fallacy inquiry.     

An investigation of neuronal integrity in severe paediatric traumatic brain injury.

Magnetic Resonance Spectroscopy (MRS) and its association with neuropsychological functioning was examined in the chronic injury phase of paediatric traumatic brain injury (TBI). Fifteen children, aged 10-16 years, with severe TBIs were compared with 15 controls, matched for age and gender. The TBI group was found to have significantly lower levels of -acetyl aspartate (NAA) and Choline (Cho) in the right frontal lobe and generally displayed reduced performances on neuropsychological tests. A correlation between metabolites and reaction times was also obtained. Findings indicate a role of proton MRS as a measure of neuronal integrity following severe paediatric TBI and suggest a potential association of MRS with specific neuropsychological impairments.     

The effect of prosody on conceptual combination

Research into people's comprehension of novel noun-noun phrases has long neglected the possible influences of prosody during meaning construction. At the same time, work in conceptual combination has disagreed about whether different classes of interpretation emerge from single or multiple processes; for example, whether people use distinct mechanisms when they interpret octopus apartment as property-based (e.g., an apartment with eight rooms) or relation-based (e.g., an apartment where an octopus lives). In two studies, we manipulate the prosodic emphasis patterns of novel noun-noun combinations (placing stress on the modifier noun, the head noun, or dual stress on both nouns) and ask participants to generate an interpretation for the novel phrase. Results show that people are faster to generate property-based interpretations when dual emphasis stresses both nouns equally, with prosody having little effect on the speed of relation-based interpretations. These findings highlight a role for prosody during meaning construction and underline important differences between relation- and property-based interpretations that are difficult to reconcile with unitary process views of conceptual combination.     

A Multi‐Method,Multi‐Hazard Approach to Explore the Uniqueness of Terrorism Risk Perceptions and Worry1

Developing ways to manage terrorism effectively requires a better understanding of how the public perceives this threat. In the present study, Canadians' perceptions of terrorism risk and 4 other hazards were assessed using a word‐association technique and rating scales reflecting key cognitive dimensions of risk (threat, uncertainty, control) and worry reactions. Data were collected in a national telephone survey. Canadians perceived terrorism as posing a lower threat, as more uncertain, and as less controllable, compared to the other hazards. Positive associations of perceived threat and of perceived uncertainty with worry about terrorism were observed. However, perceived control was unexpectedly positively associated with worry about terrorism. The findings also suggest that additional social contextual factors should be examined in future research.     

Neuroticism and the Architecture of the Self: Exploring Neuroticism as a Moderator of the Impact of Ideal Self‐Discrepancies on Emotion

ABSTRACT Two studies examined the moderating role of neuroticism in discrepancy‐emotion relations. In Study 1, neuroticism, self‐discrepancies, and depression were measured. Multiple regression analyses revealed a significant interaction between neuroticism and ideal self‐discrepancies such that the magnitude of ideal self‐discrepancies was a stronger predictor of depression for people high in neuroticism than people low in neuroticism. Study 2 used an experimental paradigm to test the same hypothesis. Participants were randomly assigned to an ideal self‐discrepancy salience condition or a control condition in which ideal self‐discrepancies were not made salient. A significant interaction between self‐discrepancy condition and neuroticism emerged such that the ideal self‐discrepancy condition produced higher dejection‐related affect relative to the control condition for people high in neuroticism compared to people low in neuroticism.     

Should I trust you? Autistic traits predict reduced appearance‐based trust decisions

Facial impressions of trustworthiness guide social decisions in the general population, as shown by financial lending in economic Trust Games. As an exception, autistic boys fail to use facial impressions to guide trust decisions, despite forming typical facial trustworthiness impressions (Autism, 19, 2015a, 1002). Here, we tested whether this dissociation between forming and using facial impressions of trustworthiness extends to neurotypical men with high levels of autistic traits. Forty‐six Caucasian men completed a multi‐turn Trust Game, a facial trustworthiness impressions task, the Autism‐Spectrum Quotient, and two Theory of Mind tasks. As hypothesized, participants’ levels of autistic traits had no observed effect on the impressions formed, but negatively predicted the use of those impressions in trust decisions. Thus, the dissociation between forming and using facial impressions of trustworthiness extends to the broader autism phenotype. More broadly, our results identify autistic traits as an important source of individual variation in the use of facial impressions to guide behaviour. Interestingly, failure to use these impressions could potentially represent rational behaviour, given their limited validity.