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.     

The relationships between body surveillance,body shame,and contextual body concern during sexual activities in ethnically diverse female college students

This study investigated the relationships between body surveillance, body shame, and contextual body image during sexual activity in American female college students of European, African, Asian, and Hispanic/Latina descent (N = 1174). Responses to self-report questionnaires indicated that body surveillance and body shame were significantly positively correlated with contextual body concern during sexual activities for women of all ethnic groups. Examination of direct and indirect effects using structural equation modeling indicated that body shame partially mediated the relationship between body surveillance and contextual body image during sexual activity for the sample as a whole. However, multiple-group analyses (i.e., path invariance tests) showed that some of these relationships differed by ethnic group, with European American women reporting the strongest relationships. Study results generally support the mediational role of body shame, but highlight that the strength of these relationships and means may differ across ethnic groups.     

Positive and negative appraisals of the consequences of activated states uniquely relate to symptoms of hypomania and depression

Individuals may appraise internal states positively or negatively. Positive appraisals involve desiring or pursuing the state or experience, while negative appraisals involve dreading or avoiding the experience. The extent to which individuals make extreme positive or negative appraisals of high, activated, energetic states might determine whether they experience symptoms of high or low mood. This study extends the existing literature by considering the role of opposing appraisals and beliefs about the same internal states and by controlling for the potential correlation between depression and activation symptoms. Extreme, positive and negative appraisals of activated mood states related distinctly to experiences of activation and depression symptoms respectively, in an analogue sample (n=323). Positive appraisals of activated internal states were uniquely associated with elevated activation and hypomania symptoms. Negative appraisals of the same states were uniquely associated with elevated depression symptoms. Opposing appraisals of internal states may underlie mood swing symptoms.     

Lucretius Hebraizant: Spinoza's Reading of Ecclesiastes

Spinoza viewed the book of Ecclesiastes, in its original Hebrew and thus cleared of the interpretations imposed upon it in the guise of translation, as a powerful critique of the two most important variants of the superstition that taught human beings to regard both nature and themselves as degraded expressions of an unattainable perfection. The first was organized around the concept of miracle, the divine suspension of the actual concatenation of things, as if God were an earthly sovereign declaring a state of exception. The second was the apparent opposite of this first, the idea that the concatenation of things has an origin and an end, that is, an order decreed by God. Spinoza reads Ecclesiastes through the lens of Epicurus and Lucretius, as if it were an attempt in the Hebrew idiom, an idiom in certain ways perhaps better suited for this task than either Greek or Latin, to shatter the decrees of destiny and to regard with pleasure those singular things (both human and non‐human) that cannot and need not be made straight.     

Stressful life events, perceived stress, and 12-month course of geriatric depression: direct effects and moderation by the 5-HTTLPR and COMT Val158Met polymorphisms

Although the relation between stressful life events (SLEs) and risk of major depressive disorder is well established, important questions remain about the effects of stress on the course of geriatric depression. Our objectives were (1) to examine how baseline stress and change in stress is associated with course of geriatric depression and (2) to test whether polymorphisms of serotonin transporter (5-HTTLPR) and catechol-O-methyltransferase (COMT Val158Met) genes moderate this relation. Two-hundred and sixteen depressed subjects aged 60 years or older were categorized by remission status (Montgomery-Asberg depression rating scale≤6) at 6 and 12 months. At 6 months, greater baseline numbers of self-reported negative and total SLEs and greater baseline perceived stress severity were associated with lower odds of remission. At 12 months, only baseline perceived stress predicted remission. When we examined change in stress, 12-month decrease in negative SLEs and level of perceived stress were associated with improved odds of 12-month remission. When genotype data were included, COMT Val158Met genotype did not influence these relations. However, when compared with 5-HTTLPR L/L homozygotes, S allele carriers with greater baseline numbers of negative SLEs and with greater decrease in negative SLEs were more likely to remit at 12 months. This study demonstrates that baseline SLEs and perceived stress severity may influence the 12-month course of geriatric depression. Moreover, changes in these stress measures over time correlate with depression outcomes. 5-HTTLPR S carriers appear to be more susceptible to both the effects of enduring stress and the benefit of interval stress reduction.     

Applying Buddhist Practices to Recovery: What I Learned From Skiing With a Little Buddha Wisdom

The author describes how 5 Buddhist practices—enlightenment, compassion, acceptance, mindfulness/meditation, and the spiritual community—can serve as a foundation for an integrated recovery model that incorporates numerous perspectives from the 12‐step program of Alcoholics Anonymous. An application of the model illustrates how it is applied to real‐life recovery.     

Development of abbreviated nine-item forms of the Raven's standard progressive matrices test

The Raven's standard progressive matrices (RSPM) is a 60-item test for measuring abstract reasoning, considered a nonverbal estimate of fluid intelligence, and often included in clinical assessment batteries and research on patients with cognitive deficits. The goal was to develop and apply a predictive model approach to reduce the number of items necessary to yield a score equivalent to that derived from the full scale. The approach is based on a Poisson predictive model. A parsimonious subset of items that accurately predicts the total score was sought, as was a second nonoverlapping alternate form for repeated administrations. A split sample was used for model fitting and validation, with cross-validation to verify results. Using nine RSPM items as predictors, correlations of .9836 and .9782 were achieved for the reduced forms and .9063 and .8978 for the validation data. Thus, a 9-item subset of RSPM predicts the total score for the 60-item scale with good accuracy. A comparison of psychometric properties between 9-item forms, a published 30-item form, and the 60-item set is presented. The two 9-item forms provide a 75% administration time savings compared with the 30-item form, while achieving similar item- and test-level characteristics and equal correlations to 60-item based scores.