Philosophy of medicine — From a medical perspective

In this commentary on the article by Arthur L. Caplan [1] the philosophy of medicine is viewed from a medical perspective. Philosophical studies have a long tradition in medicine, especially during periods of paradigmatic unrest, and they serve the same goal as other medical activities: the prevention and treatment of disease. The medical profession needs the help of professional philosophers in much the same way as it needs the cooperation of basic scientists. Philosophy of medicine may not deserve the status of a philosophical subspecialty or field, but it so closely linked to the main trends of contemporary medical thinking that it must be regarded as an emerging (or reemerging) medical subdiscipline.     

Somatisierung

Zusammenfassung Somatisierung meint die Erfahrung und den Bericht von k?rperlichen Beschwerden, für die kein hinreichender medizinischer Befund vorliegt, verbunden mit einem hohen Ausma? von organ-medizinischer Hilfesuche. Gegenüber früheren Definitionen, die st?rker auf psychosoziale Faktoren bei der Somatisierung abheben, wird gegenw?rtig eine ausschlie?lich beschreibende Begriffsfestlegung bevorzugt. Somatisierung liegt als Normenvariante bis zur schweren pathologischen Auspr?gung vor. Die ICD-10 fa?t sehr heterogene Krankheitsbilder von Somatisierung in der Klasse der somatoformen St?rungen zusammen. Fraglich ist, ob Somatisierung eher als Proze? denn als diskrete Krankheitseinheit zu konzeptualisieren ist. Somatisierung enth?lt drei Komponenten: Auf der Wahrnehmungsebene erh?hte Sensibilit?t gegenüber K?rpersensationen (“somatosensorische Amplifikation”), auf der Erlebensebene negative Affekte in Form von psychischem und somatischen Distre?erleben, auf der Verhaltensebene inad?quate Inanspruchnahme der Gesundheitsressourcen (“abnormes Krankheitsverhalten”). Trotz z. T. vielversprechender Behandlungsvorschl?te unter verhaltenstherapeutischer, psychodynamischer und psychoedukativer Orientierung erscheint die Prognose von Somatisierung bisher wenig günstig. Es gibt Hinweise, da? der Sicherung der therapeutischen Beziehung besondere Bedeutung für den Behandlungserfolg zukommt.      

On the aim of the theory of verisimilitude

J. P. Z. Bonilla's methodological approach to truthlikeness is evaluated critically. On a more general level, various senses in which the theory of truthlikeness could be seen as a theory concerned with methodology are distinguished, and it is argued that providing speical sciences with methodological tools is unrealistic as an aim of the theory of verisimilitude. Rather, when developing this theory, one should rest contnet with the more modest aim of conceptual analysis, or of providing explications for the relational concept of being closer to the truth. In addition, some remarks will be made on the difficulties which the similarity approach to truthlikeness has in realizing this aim and which are caused by the important role that Hintikka's constituents have in it.     

The mean fundamental frequency in stutterers and nonstutterers during reading and spontaneous speech

Corresponding to the higher tension of muscles involved in speech production, a higher mean fundamental frequency should be expected in stutterers as compared to nonstutterers. It could be shown by the change scores of the mean fundamental frequency from reading to free conversation that stutterers tend to have a higher fundamental frequency during spontaneous speech.     

Loneliness predicts suicidal ideation and anxiety symptoms in long-term childhood cancer survivors

Background/ObjectiveLong-term childhood cancer survivors (CCS) are at risk for adverse late effects. However, not all of them are well understood. The present study addressed loneliness, a previously under-researched mental health risk in cancer survivor populations. We assessed the prevalence of loneliness and its impact on psychological symptoms over time. Method: A registry-based sample of N = 633 adult long-term CCS underwent medical and psychological assessments and took part in a follow-up survey 2.5 years later. Psychological symptoms (somatic, anxiety, depression symptoms, and suicidal ideation) were measured using the Patient Health Questionnaire. We calculated linear regression models of symptoms at follow-up to investigate the impact of loneliness over time (controlling for symptoms at baseline and relevant confounders). Results: Loneliness was reported by 17.70% of CCS. In multivariate linear regression analyses, loneliness was still predictive of more severe anxiety symptoms and suicidal ideation over two years later. Loneliness did not predict somatic and depression symptoms at follow-up (which increased with age). Conclusions: Loneliness affected a significant number of CCS and was a risk factor for persistent anxiety symptoms and suicidal ideation. The extent to which young cancer patients’ re-integration into society is successful could thus have important implications for well-being in adulthood.     

Compassion protects against vital exhaustion and negative emotionality

Motivation and Emotion - We investigated (i) the predictive relationships of compassion with negative emotionality (a marker of susceptibility to stress) and vital exhaustion (a marker of chronic...     

Empirically based dimensions of externalizing symptoms in children and adolescents: a multitrait-multisource approach

The present study sought to refine knowledge about the structure underlying externalizing dimensions. From a “top-down” ICD/DSM-based perspective, externalizing symptoms can be categorized into attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). From a “bottom-up” developmental theory-based perspective, disruptive behaviors can be meaningfully described as aggressive (AGG) and rule-breaking (RB) behaviors. We analyzed five large data sets comprising externalizing symptom ratings obtained with a screening instrument using different sources (parents, teachers, self-ratings) from different samples. Using confirmatory factor analyses, we evaluated several factor models (unidimensional; correlated factors; bifactor (S-1) models) derived from an ICD/DSM- and theory-based perspective. Our optimally fitting models were assessed for measurement invariance across all sources, sample settings, and sex. Following several model-based criteria (model fit indices; factor loadings; omega statistics; model parsimony), we discarded our models stepwise and concluded that both the ICD/DSM-based model with three correlated factors (ADHD, ODD, CD) and the developmental theory-based model with three correlated factors (ADHD, AGG, RB) displayed a statistically sound factor structure and allowed for straightforward interpretability. Furthermore, these two models demonstrated metric invariance across all five samples and across sample settings (community, clinical), as well as scalar invariance across sources and sex. While the dimensions AGG and RB may depict a more empirically coherent view than the categorical perspective of ODD and CD, at this point we cannot clearly determine whether one perspective really outperforms the other. Implications for model selection according to our model-based criteria and clinical research are discussed.

     

On the Links Between Attachment Style, Parental Rearing Behaviors, and Internalizing and Externalizing Problems in Non-Clinical Children

  We sought to investigate the relationships between negative family factors such as insecure attachment and adverse parental rearing, and internalizing and externalizing symptoms in a large sample of non-clinical children (N = 237) aged 9 to 12 years. All children completed a set of self-report questionnaires including a single-item measure of attachment style towards the mother and the father as well as an index of perceived parental rearing behaviors. Further, measures of internalizing symptoms (e.g., anxiety and depression) and externalizing symptoms (e.g., aggression) were completed. Results showed that perceived rearing behaviors of both mother and father (in particular rejection and anxious rearing) consistently accounted for a significant proportion of the variance in internalizing and externalizing symptoms. Attachment style was found to play a less prominent role. Some support for gender-specific relationships was found, indicating that the presence of negative family factors in fathers had more impact on symptoms in boys, whereas the presence of such factors in the mothers had more influence on symptoms in girls. Altogether, these results suggest that in addition to common pathways by which both parents promote psychopathological symptoms in children, there may also be separate pathways by which the father or the mother may have a unique impact on the development of such symptoms in boys or girls respectively.     

The effect of question repetition within interviews on young children's eyewitness recall

This study investigated the influence of question repetition and question type (answerable, unanswerable, or opinion seeking) on children's recall. A total of 136 children (5-, 7-, and 9-year-olds) watched a live 15-min presentation. One week later, the children were asked 20 questions that were repeated an additional two times within the interview. Accuracy of children's responses to unanswerable questions declined with repetition. Children were more likely to change a response to an unanswerable question than to an answerable question. Overall, children maintained the same answers to only three-quarters of the repeated questions. The most common pattern of change was for children to change their answer the second time a question was asked and then to maintain that answer when questioned again. The high percentage of changed answers within a single interview has important implications for forensic interviewing.