Reinforcer pathology,probabilistic choice,and medication adherence in patients with multiple sclerosis

The reinforcer pathology model posits that core behavioral economic mechanisms, including delay discounting and behavioral economic demand, underlie adverse health decisions and related clinical disorders. Extensions beyond substance use disorder and obesity, however, are limited. Using a reinforcer pathology framework, this study evaluates medical adherence decisions in patients with multiple sclerosis. Participants completed behavioral economic measures, including delay discounting, probability discounting, and a medication purchase task. A medical decision-making task was also used to evaluate how sensitivity to mild side effect risk and efficacy contributed to the likelihood of taking a hypothetical disease-modifying therapy. Less steep delay discounting and more intense (greater) medication demand were independently associated with greater adherence to the medication decision-making procedure. More generally, the pattern of interrelations between the medication-specific and general behavioral economic metrics was consistent with and contributes to the reinforcer pathology model. Additional research is warranted to expand these models to different populations and health behaviors, including those of a positive health orientation (i.e., medication adherence).     

A Pathological View of Disease

This paper is a response to Christopher Boorse's recent defense of hisBiostatistical Theory (BST) of health and disease. Boorse maintains that hisconcept of theoretical health and disease reflects the ``consideredusage of pathologists.' I argue that pathologists do not use ``disease' inthe purely theoretical way that is required by the BST. Pathology does notdraw a sharp distinction between theoretical and practical aspects ofmedicine. Pathology does not even need a theoretical concept of disease. Itsfocus is not theoretical, but practical; pathology's goal is to contribute tothe healing of patients. Pathology, even experimental pathology, is notvalue-free. Not only ``disease' but also such terms as ``nerve' and ``organ'are laden with conceptual values.     

Eating pathology in female gymnasts: Potential risk and protective factors

Although participation in sports that emphasize aestheticism, such as women's gymnastics, are associated with higher rates of eating pathology, little is known about the risk and protective factors involved in this process. We established and tested a model proposing that body surveillance and body shame are processes by which pubertal development and training may uniquely contribute to pathological eating by sampling 100 competitive female gymnasts via questionnaires. We further tested whether self-esteem moderated several model relationships. Results demonstrated that pubertal development was associated with higher levels of body surveillance, body shame and disordered eating; whereas greater time spent training was associated with lower levels of body shame and disordered eating. Finally higher self-esteem was associated with lower levels of disordered eating, less body surveillance, and less body shame. Potential risk and protective factors for the development of eating pathology in female gymnasts are discussed.     

Effects of religious stigma and harm on perceived psychopathology

Prior research suggests that assessment of the pathology of religious beliefs is influenced by conventionality and harm, with less conventional and more harmful beliefs resulting in higher pathology ratings. This study, involving 313 participants, investigated levels of pathology assigned to religious beliefs when the beliefs were either helpful or less severely harmful than those used in prior research, and when the associated religion was either stigmatised (Islam) or non-stigmatised (Christianity). Results indicate that an attenuated form of harm results in elevated pathology ratings. Furthermore, religious stigma impacts these perceptions when beliefs are harmful but not when beliefs are helpful. Ratings in the harm condition were higher for Christianity than for Islam, suggesting that perceived pathology of religious beliefs may depend less on general stigma assumptions and more on perceived consistency between harmful beliefs and assumed religious schemata.     

Body checking and avoidance in ethnically diverse female college students

Although body checking and avoidance behaviors are common in women with eating disorders, minimal research has examined the nature or correlates of these behaviors in ethnically diverse female college students without eating disorders. Self-identified European American (n = 268), Asian American (n = 163), Latina (n = 146), and African American (n = 73) women completed self-report measures of body checking and avoidance, thin-ideal internalization, eating pathology, and clinical impairment. Results indicated that European and Asian American women reported significantly more body checking and avoidance than African American and Latina women. Generally, correlates of body checking and avoidance were consistent across ethnic groups: Regression analyses indicated that type of ethnicity predicted body checking and avoidance; and ethnicity, body checking, and body avoidance predicted eating pathology and clinical impairment. These associations suggest that body checking and avoidance are not benign behaviors in diverse nonclinical women.     

Methodological Considerations in the Neuropsychological Study of Central Nervous System Underarousal with a Specific Emphasis on Coma

Several obstacles exist that impede the scientific study of pathological underarousal (stupor and coma). For instance, there is a lack of a clear, rational, standardized taxonomy with which to describe the phenomenon. Moreover, there is considerable confusion of the construct of arousal with other neurobehavioral constructs. The field also suffers from a general lack of acceptably reliable and valid instruments, especially measures of long-term outcome. Additionally, current treatments for chronic pathological underarousal are frequently presumptive and applied haphazardly, and thus do little to elucidate the process of recovery. It is suggested that biomedical and neuropsychological approaches to the study and treatment of pathological underarousal are complementary and that it is useful to view pathological underarousal as a behavioral, as well as a medical, phenomenon.     

An overview of malingering and deception in neuropsychiatric cases

Forensic practitioners must shoulder special responsibilities when evaluating over-stated pathology (e.g., malingering) as well as simulated adjustment. Such determinations may modify or even override other clinical findings. As a result, practitioners must be alert to their own misassumptions that may unintentionally bias their conclusions about response styles. Detection strategies for malingering—based on unlikely or markedly amplified presentations—are highlighted in this article. Given page constraints, assessment methods for feigning are succinctly presented with their applications to administrative, civil, and criminal referrals.     

Emotion dysregulation and adolescent psychopathology: a prospective study

Background

Emotion regulation deficits have been consistently linked to psychopathology in cross-sectional studies. However, the direction of the relationship between emotion regulation and psychopathology is unclear. This study examined the longitudinal and reciprocal relationships between emotion regulation deficits and psychopathology in adolescents.

Methods

Emotion dysregulation and symptomatology (depression, anxiety, aggressive behavior, and eating pathology) were assessed in a large, diverse sample of adolescents (N = 1065) at two time points separated by seven months. Structural equation modeling was used to examine the longitudinal and reciprocal relationships between emotion dysregulation and symptoms of psychopathology.

Results

The three distinct emotion processes examined here (emotional understanding, dysregulated expression of sadness and anger, and ruminative responses to distress) formed a unitary latent emotion dysregulation factor. Emotion dysregulation predicted increases in anxiety symptoms, aggressive behavior, and eating pathology after controlling for baseline symptoms but did not predict depressive symptoms. In contrast, none of the four types of psychopathology predicted increases in emotion dysregulation after controlling for baseline emotion dysregulation.

Conclusions

Emotion dysregulation appears to be an important transdiagnostic factor that increases risk for a wide range of psychopathology outcomes in adolescence. These results suggest targets for preventive interventions during this developmental period of risk.     

The pathology of validity

Stephen Read has presented an argument for the inconsistency of the concept of validity. We extend Read’s results and show that this inconsistency is but one half of a larger problem. Like the concept of truth, validity is infected with what we call semantic pathology, a condition that actually gives rise to two symptoms: inconsistency and indeterminacy. After sketching the basic ideas behind semantic pathology and explaining how it manifests both symptoms in the concept of truth, we present cases that establish the indeterminacy of validity and that link this indeterminacy with the concept’s inconsistency. Our conclusion is that an adequate treatment of the semantic pathology thus revealed must deal with both of its symptoms. Further, it must extend to the occurrences of this condition elsewhere: in the concept of truth, in the other central semantic notions, and even in certain philosophical concepts outside semantics.     

特殊类型子宫平滑肌瘤

绝大多数子宫平滑肌瘤为普通型,但有些子宫平滑肌瘤的组织形态或生长方式类似于平滑肌肉瘤,却又不具有典型恶性的组织学特征,这些特殊类型的子宫平滑肌瘤大多表现出良好的临床经过,预后较好,但偶有多次复发甚至恶变。