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.     

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.     

Fundamental properties of the N2pc as an index of spatial attention: effects of masking.

Masking is an important tool in many paradigms used to study the cognitive architecture. The N2pc is an electrophysiological event-related potential (ERP) that has been used as a tool to study the deployment of visual spatial attention. The aim of this paper was to study the effects of masking on the N2pc. Two stimuli were presented on the screen, one to left and one to right of fixation, and subjects reported the identity of one of them. The targets could be discriminated both by their category (letters vs. digit) and by their colour (pink vs. green). Backward masking was produced by presenting a second pair of bilateral stimuli after the offset of the first pair. The second pair of stimuli consisted of characters of the same colour and category as in the first pair. Forward masking was produced by using the very same stimuli as in the backward masking condition, but by instructing subjects to report the second stimulus. The forward mask trials had longer response times compared to no-mask trials, and backward mask trials had even longer response times, and also a higher error rate. Although the different masking procedures lead to clear behavioural effects, the N2pc was not affected, suggesting that the deployment of visual spatial attention, per se, was not affected by pattern masking. A sustained posterior contralateral negativity (SPCN) following the N2pc was also found (300 ms post-target, and beyond), and the amplitude of the SPCN was strongly modulated by the number of presented stimuli and the duration of the SPCN was positively correlated with RT in the behavioural task. We hypothesize that the SPCN reflects neural activity associated with the passage of information through visual short-term memory.     

Visual encoding of patterns is subject to dual-task interference

Two stimuli were presented at varying stimulus onset asynchronies (SOAs), with each stimulus associated with a distinct task. The first stimulus was a tone at one of either two or three frequencies. In two conditions, the task associated with a tone was either a speeded two-alternative discrimination (2AD), or a speeded three-alternative discrimination (3AD) based on the pitch of the tone. In a third condition, subjects were told to ignore the tone. The second stimulus was a briefly exposed study matrix of red and black squares followed by a mask. After a fixed delay, the mask was replaced by a test matrix that was either the same or different from the study matrix. The task associated with the matrices was to indicate, with no speed pressure, whether the study matrix and the test matrix were the same or different. Results from each speeded AD condition showed that subject's accuracy in the matrix task decreased as the SOA between the tone and the study matrix decreased. This effect was larger for the 3AD tone task than with a 2AD tone task. In addition, within each speeded AD condition, longer RTs in the tone task were associated with lower accuracy in the matrix task. None of these effects was evident when the subjects were told to ignore the tone. These results suggest that encoding visual information can be subject to significant capacity limitations imposed by cross-modal multitasking.     

The Yin and Yang of cell cycle progression and differentiation in the oligodendroglial lineage

In white matter disorders such as leukodystrophies (LD), periventricular leucomalacia (PVL), or multiple sclerosis (MS), the hypomyelination or the remyelination failure by oligodendrocyte progenitor cells involves errors in the sequence of events that normally occur during development when progenitors proliferate, migrate through the white matter, contact the axon, and differentiate into myelin-forming oligodendrocytes. Multiple mechanisms underlie the eventual progressive deterioration that typifies the natural history of developmental demyelination in LD and PVL and of adult-onset demyelination in MS. Over the past few years, pathophysiological studies have mostly focused on seeking abnormalities that impede oligodendroglial maturation at the level of migration, myelination, and survival. In contrast, there has been a strikingly lower interest for early proliferative and differentiation events that are likely to be equally critical for white matter development and myelin repair. This review highlights the Yin and Yang principles of interactions between intrinsic factors that coordinately regulate progenitor cell division and the onset of differentiation, i.e. the initial steps of oligodendrocyte lineage progression that are obviously crucial in health and diseases.     

Attention between phenomenology and experimental psychology

It is possible to consider attention as the modulating dimension of consciousness. Understood in this sense, attention can be a privileged theme for relating the first person point of view (conceived as a psycho-phenomenology inspired by the work of Husserl) to the experimental sciences (e.g. psychology, neuropsychology, etc.), which have done a great deal of work on attention. This article will take up in succession some different points of view regarding the status of attention and its structure (e.g. static aspects). It will also consider the dynamic of attention from a micro-genetic point of view as well as a functional point of view. The final section will seek to show not only the unique and original contributions of each perspective, but also each perspective's limitations and biases.     

Assessing personality at risk in personnel selection and development

This paper demonstrates the validity and usefulness of a count technique to screen for potential personality dysfunctioning in NEO‐PI‐R ratings obtained in selection and professional development assessments. The usefulness of this screening technique for Industrial, Work and Organizational (IWO) psychologists is demonstrated in five different samples that were administered the NEO‐PI‐R for selection or development purposes. Three additional samples served as normative data to compute FFM PD count cut‐offs that can be used for selection and career development decisions. Evidence for the construct validity of 6 out of 10 FFM PD counts was provided, and all FFM PD compound scales were significantly related to important criteria, including the final selection decision, the results of a behaviourally oriented selection interview and self‐rated work competencies. The practical utility and limitations of this count technique for personnel selection and development are discussed. Copyright © 2008 John Wiley & Sons, Ltd.     

Item performance in visual word recognition

Standard factorial designs in psycholinguistics have been complemented recently by large-scale databases providing empirical constraints at the level of item performance. At the same time, the development of precise computational architectures has led modelers to compare item-level performance with item-level predictions. It has been suggested, however, that item performance includes a large amount of undesirable error variance that should be quantified to determine the amount of reproducible variance that models should account for. In the present study, we provide a simple and tractable statistical analysis of this issue. We also report practical solutions for estimating the amount of reproducible variance for any database that conforms to the additive decomposition of the variance. A new empirical database consisting of the word identification times of 140 participants on 120 words is then used to test these practical solutions. Finally, we show that increases in the amount of reproducible variance are accompanied by the detection of new sources of variance.     

Can we Build on Social Movement Theories to Develop and Improve Community‐Based Participatory Research? A Framework Synthesis Review

A long‐standing challenge in community‐based participatory research (CBPR) has been to anchor practice and evaluation in a relevant and comprehensive theoretical framework of community change. This study describes the development of a multidimensional conceptual framework that builds on social movement theories to identify key components of CBPR processes. Framework synthesis was used as a general literature search and analysis strategy. An initial conceptual framework was developed from the theoretical literature on social movement. A literature search performed to identify illustrative CBPR projects yielded 635 potentially relevant documents, from which eight projects (corresponding to 58 publications) were retained after record and full‐text screening. Framework synthesis was used to code and organize data from these projects, ultimately providing a refined framework. The final conceptual framework maps key concepts of CBPR mobilization processes, such as the pivotal role of the partnership; resources and opportunities as necessary components feeding the partnership's development; the importance of framing processes; and a tight alignment between the cause (partnership's goal), the collective action strategy, and the system changes targeted. The revised framework provides a context‐specific model to generate a new, innovative understanding of CBPR mobilization processes, drawing on existing theoretical foundations.     

Motivation to hide emotion and children's understanding of the distinction between real and apparent emotions

The authors investigated the extent to which children's understanding of the distinction between real and apparent emotions varied according to the motivation to hide emotions. Children, aged 6-7 and 10-11 years, were read stories designed to elicit either prosocial or self-protective motivated display rules and were asked to predict the facial expressions the protagonists would make to hide felt emotions. Children were found to understand the distinction between real and apparent emotions very well, independently of the type of motivation. Contrary to predictions, boys understood this distinction better than did girls when the motivation to hide positive emotions was prosocial. Children perceived neutralization as the most appropriate strategy to hide felt emotions, followed by masking.