Diagnosing agoraphobia in the context of panic disorder: examining the effect of DSM-IV criteria on diagnostic decision-making

A diagnostic and statistical manual (DSM)-IV diagnosis of agoraphobia in the context of panic disorder (PD) is based on three nosologically sufficient criteria: (1) avoidance, (2) use of companions, and (3) endurance of situations despite distress. Therefore, an agoraphobia diagnosis can be made across an extremely broad range of cases including when there are no avoidance behaviors (e.g., the patient endures the situation). It was hypothesized that clinicians do not weight these criteria equally and that the DSMs individual, sufficient criteria lead to poor inter-rater reliability. Clinicians (N=48) rated hypothetical patients with symptom profiles emphasizing each of these three criteria. Consistent with expectation, clinicians differentially weighted these criteria. Avoidance was relatively more apt to produce a diagnosis when only one criterion was emphasized in clinical vignettes. Inter-rater reliability was poor in instances when only one sufficient criterion was highlighted. Knowledge concerning DSM criteria resulted in a greater rate of agoraphobia endorsement, but knowledge did not account for the overall pattern of findings.     

Prefrontal brain activity predicts temporally extended decision-making behavior

Although functional neuroimaging studies of human decision-making processes are increasingly common, most of the research in this area has relied on passive tasks that generate little individual variability. Relatively little attention has been paid to the ability of brain activity to predict overt behavior. Using functional magnetic resonance imaging (fMRI), we investigated the neural mechanisms underlying behavior during a dynamic decision task that required subjects to select smaller, short-term monetary payoffs in order to receive larger, long-term gains. The number of trials over which the longterm gains accrued was manipulated experimentally (2 versus 12). Event-related neural activity in right lateral prefrontal cortex, a region associated with high-level cognitive processing, selectively predicted choice behavior in both conditions, whereas insular cortex responded to fluctuations in amount of reward but did not predict choice behavior. These results demonstrate the utility of a functional neuroimaging approach in behavioral psychology, showing that (a) highly circumscribed brain regions are capable of predicting complex choice behavior, and (b) fMRI has the ability to dissociate the contributions of different neural mechanisms to particular behavioral tasks.     

Semantic gender assignment regularities in German

Gender assignment relates to a native speaker's knowledge of the structure of the gender system of his/her language, allowing the speaker to select the appropriate gender for each noun. Whereas categorical assignment rules and exceptional gender assignment are well investigated, assignment regularities, i.e., tendencies in the gender distribution identified within the vocabulary of a language, are still controversial. The present study is an empirical contribution trying to shed light on the gender assignment system native German speakers have at their disposal. Participants presented with a category (e.g., predator) and a pair of gender-marked pseudo-words (e.g., der Trelle vs. die Stisse) preferentially selected the pseudo-word preceded by the gender-marked determiner "associated" with the category (e.g., masculine). This finding suggests that semantic regularities might be part of the gender assignment system of native speakers.     

Beyond the Obvious: Chronic Vividness of Imagery and the Use of Information in Decision Making

The authors investigate two competing hypotheses about how chronic vividness of imagery interacts with the vividness and salience of information in decision making. Results from four studies, covering a variety of decision domains, indicate that chronic imagery vividness rarely amplifies the effects of vivid and salient information. Imagery vividness may, in fact, attenuate the effects of vivid and salient information. This is because, relative to nonvivid imagers, vivid imagers rely less on information that appears obvious and rely more on information that seems less obvious. This tendency is so robust that vividness of imagery may amplify the effects of vivid information only when this information is the only information available in the decision field. The findings seem to reflect vivid imagers' tendency to totally immerse themselves in a decision problem and scrutinize the available information creatively.     

循证医学的辩证思维

随着临床医学的发展,临床医生面临着从理论知识加个人经验的医学模式向以科学证据为基础的医学模式转变。越来越多的卫生政策和诊疗指南的制定需要以高质量的研究结果为依据,如随机对照研究的结果,特别是随机对照研究的系统综述结论。循证医学模式要求医生在临床工作中不断提出问题并通过严格的科研设计来回答这些问题,同时强调不断进行知识更新,掌握最新研究证据以指导其临床工作。同时政府部门也鼓励发展循证医疗,因为它可通过研究有效的诊疗手段来提高卫生保健的效率。此外还有迹象表明法律决策过程中要参考是否遵循了研究证据和临床指南。知情的服务对象也促使临床工作者寻求研究证据作为依据,为了提高服务质量并且充分把握特殊专业领域的现状,临床工作者也需要不断了解新的依据信息。在众多的研究信息中,我们应对每项证据的研究方法、研究对象及观察的终点进行认真分析,确定该结论是否真实并适合我们的实际,从而制定有据可查的诊疗方案。     

Embodied Knowledge and Making Sense of Prenatal Diagnosis

Open-ended, qualitative interviews with women to whom amniocentesis was offered were analyzed to understand how women made sense of these tests. We found that women, whether tested or not, negotiated with biomedical information. They transformed it through identifiable processes, then wove it with their own instincts and beliefs and with their personal experiences, thereby creating embodied knowledge on which their decisions were based. Women who were and were not tested may have differed from each other when categorized on the basis of a final, binary choice, but they were more alike than unalike in reaching this point. The apparent importance of embodied knowledge suggests the critical role of the listening activities of the genetic counselor and of awareness of the validity and importance of women's complementary ways of knowing and doing in understanding the uses and meanings of prenatal genetic testing.     

消费者产品质量知觉研究

本文探讨了品牌、产地、价格、服务及消费者的知识经验对消费者产品质量知觉的影响。结果表明：１、品牌、产地、服务对消费者的产品质量知觉有显著影响;２、消费者对名牌产品的质量知觉显著高于不知名品牌,对进口产品质量知觉显著高于国产产品,对服务好的产品质量知觉显著高于服务差的产品;３、知识经验丰富的消费者的产品质量知觉易受品牌的影响,而知识经验不足的消费者的产品质量知觉易受价格、服务的影响。     

The influence of adults' actions on children's inferences about word meanings

This article first establishes the effect of adults' actions on children's inferences about the shape and material of solid objects, based on data from Japanese 2-, 4-, and 6-year-olds. Japanese 2-year-olds are already sensitive to adults' actions in making inferences, and children become more adept at this as they become older. The invariance of the phenomenon of the effect of actions is then discussed in terms of three of its aspects: across age groups, across languages (the universality of the effect), and across tasks in lexical development. It is suggested that while specific linguistic characteristics (e.g., the means of individuation of entities), and complexity of object shape probably influence the effect of actions, action effects may have a potentially invariant/universal aspect.     

Structuring Case-Based Ethics Training: How Comparing Cases and Structured Prompts Influence Training Effectiveness

This study examined how structuring case-based ethics training, either through (a) case presentation or (b) prompt questions, influences training outcomes. Results revealed an interaction between case presentation and prompt questions such that some form of structure improved effectiveness. Specifically, comparing cases led to greater sensemaking strategy use and decision-ethicality when trainees considered unstructured rather than structured prompts. When cases were presented sequentially, structuring prompts improved training effectiveness. Too much structure, however, decreased future ethical decision making, suggesting that there can be too much of a good thing when structuring case-based ethics education. Implications for designing ethics training programs are discussed.     

Decision Strategies and the Confidence–Accuracy Relationship in Face Recognition

The decision strategy used to select a choice set from an array of alternative options is known to affect the composition of the final choice set. Specifically, individuals incorporate more answers into their choice set when it is created by eliminating implausible items than when the set is created through the inclusion of plausible options. This difference is accounted for in a decision framework that posits a general reluctance to change the status quo (i.e., actively include or exclude an item). We extended this work to investigate, not only the decisions themselves, but also metacognitive judgments (i.e., confidence in the accuracy of the choice set). In two face recognition experiments, we tested the impact of decision strategy (Experiment 1) and confidence judgment strategy (Experiment 2) on the confidence–accuracy relationship. In Experiment 1, participants completed two blocks of recognition trials, one under inclusion (marking previously seen faces) and one under elimination (marking previously unseen faces) instructions. We observed superior resolution (i.e., discrimination between correct and incorrect) for inclusion trials, but only when they were completed prior to use of the elimination strategy. In Experiment 2, all participants completed face recognition trials under inclusion instructions, but we manipulated the strategy used to assess confidence. Again, we observed a significant impact of strategy on confidence–accuracy resolution. Thus, we observed that both the strategy employed to reach a decision and that employed to assess confidence affected the confidence–accuracy relationship. We discuss theoretical and applied (particularly for eyewitness identification and multiple‐choice testing) implications. Copyright © 2012 John Wiley & Sons, Ltd.