The Science and Ethics of Placebo in Pediatric Psychopharmacology

Pediatric psychopharmacology is a relatively new science. Although the use of psychotropic medications in children has risen in the past decade, there are few standard treatments for serious psychiatric or developmental disorders of childhood. The relative absence of standard treatments is further complicated by the fact that many of the agents used in pediatric psychopharmacology have been adapted from other fields. Therefore, investigators have a responsibility to make incremental progress from concept through pilot studies and large-scale, multisite efficacy and safety trials. Thus, although there is a pressing need to conduct medication trials that can guide clinical practice, there are scientific and ethical considerations to bear in mind when designing clinical trials in pediatric psychopharmacology. This article reviews essential ethical and scientific issues that are relevant to designing clinical trials in children with psychiatric and developmental disorders. Using examples from recently published literature, the article describes the challenges and pitfalls of various clinical trial study designs. The application of sound ethical and scientific principles is necessary to ensure that clinical trials are properly conducted and to guard against ambiguous results that can not guide practice.     

A brief introduction to the work of Jean Laplanche

The author proposes an introduction to the work of Jean Laplanche, a well‐known figure of psychoanalysis who recently passed away. He foregrounds what he views as the three main axes of Laplanche's work: firstly, a critical reading method applied to Freud's texts; secondly, a model of psychic functioning based on translation; and, thirdly, a theory of general seduction. Far from being an abstract superstructure, the theory of general seduction is firmly rooted in the analytic situation, as the provocation of transference by the analyst best illustrates. The analytic situation indeed consists in a revival and a reopening of the ‘fundamental anthropological situation’ which, according to Laplanche, is the lot of every human baby born in a world where he or she is necessarily exposed to the enigmatic and ‘compromised’ messages of the adult other. Thanks to the process of analytic de‐translation, the analysand is therefore granted an opportunity to carry out new translations of the other's enigma – translations or symbolizations that might be more inclusive and less rigid than the pre‐existing ones. Incidentally, such a model brings together the purely psychoanalytic and the psychotherapeutic aspects of the treatment.     

Limitations of the Mnemonic-Keyword Method

The effectiveness of the mnemonic-keyword method was investigated in 4 experiments in which participants were required to learn the lst-language (L₁, Spanish) equivalents of a list of 30 2nd-language words (L₂, Latin). Experiments 1 (adolescents) and 2 (adults) were designed to assess whether the keyword method was more effective than the rote method; the researcher supplied the keyword, and the participants were allowed to pace themselves through the list. Experiments 3 (adolescents) and 4 (adults) were similar to Experiments 1 and 2 except that the participants were also supplied with a drawing that illustrated the relationship between the keyword and the L₁ target word. All the experiments were performed with groups of participants in their classrooms (i.e., not in a laboratory context). In all experiments, the rote method was significantly more effective than was the keyword method.     

Comparing Delay Discounting Rates When Using the Fill-in-the-Blank and Multiple-Choice Methods

Several methods have been devised to measure delay discounting. The present study recruited university students to complete a delay-discounting task involving five different outcomes (finding a dating partner, free cigarettes, winning $100,000, being owed $100,000, and obtaining one's ideal body image) that was administered using either the fill-in-the blank (FITB) or multiple-choice (MC) method. Results showed that the different administration methods sometimes produced significantly different rates of discounting, the direction of which differed by outcome. Hyperbolic discounting and the area under the discounting curve were nearly always significantly correlated when the FITB method was used but were never significantly correlated when the MC method was used. Discounting across the five outcomes produced a two-factor solution when the FITB data were factor analyzed. The MC data were described by a one-factor solution. The present results illustrate that procedural variables have a potentially profound impact on delay-discounting data, and generalizing from studies on delay discounting should be done with caution until those variables are fully understood.     

The Roles of Explanation and Feedback in False Belief Understanding: A Microgenetic Analysis

The authors examined effects of feedback and explanation on false belief performance. Thirty-three children (42–54 months; 15 girls, 18 boys) were randomly assigned to four treatment conditions: explanation, feedback, feedback researcher explains, and feedback child explains. Children completed false belief tasks during pretraining, 8 training sessions, and posttraining across 6 weeks. Language comprehension was assessed at pretraining. The authors hypothesized that children would improve most when training involved feedback and explanation. Generalized estimating equations modeling was used to analyze the data. Children who received feedback and generated explanations for characters’ false beliefs improved across training sessions more so than children in other conditions. Children's explanations for false beliefs also were explored. Implications of the findings are discussed.     

Influence of Levels of Abstractness on Reasoning Ability

Judgment by students of faculty effectiveness have relied, for the most part, on subjectively expressed responses to a series of “effectiveness traits” (cues). Simple averaging schemes have summarized the aggregate judgments, often resulting in (a) treating all cues as if they were of equal importance, and (b) inattention to the effects or measurement of individual differences of judges.

Multiple regression was used in this study to derive (empirically) individual cue utilization patterns (i.e., weights) for 10 effectiveness traits. Ss were compared to their subjectively expressed judgment scheme. Results indicate that Ss were moderately successful in expressing their actual cue utilization patterns; however, different judgment schemes were clearly observed.     

On the nature and standing of psychoanalytic psychotherapy

In this paper, I offer some reflections on the standing of psychoanalytic psychotherapy in the National Health Service (NHS), with special reference to contemporary forms of evidence-based thinking. I consider what may follow when a narrow view of science or psychotherapeutic practice becomes conventional wisdom and assumes dominance. I place stress on the potential loss to NHS psychology and psychiatry if psychoanalytic psychotherapy becomes increasingly marginalized on the one hand, or overly standardized on the other.     

The ecclesiology of Dionysius the Areopagite

This article explores the ecclesiological views of Dionysius the Areopagite through the examination of his Ecclesiastical Hierarchy, where he discusses the hierarchical ranks and sacraments, and of his Letter VIII to monk Demophilus, which is important for Dionysius's understanding of hierarchical organisation and discipline. These issues are put in the context of other important questions of the Areopagite's thought, such as his symbolic theory, the character of deification and the role of knowledge in it. Although the Areopagite is one of the most famous among early Christian Greek thinkers, his ecclesiology is somewhat less familiar, especially in the West. This article tries to fill in that gap, hence it represents a general, introductory outline of Dionysius's ecclesiology, with the aim of making it more accessible to the broader Western readership and to incite further research on the subject.