Psychosis as a transdiagnostic and extended phenotype in the general population

A large body of research indicates that weak expressions of positive psychotic symptoms (“psychotic experiences”) can be measured in the general population, and likely represent the behavioural manifestation of distributed multifactorial (genetic and non‐genetic) risk for psychosis. Psychotic experiences are a transdiagnostic phenomenon: the majority of individuals with these experiences have a diagnosis of non‐psychotic disorder, particularly common mental disorder, in which psychotic experiences predict greater illness severity and poorer treatment response. Some of the people with common mental disorder and psychotic experiences will present to mental health services meeting criteria for “clinical high risk”. Treatment of the transdiagnostic dimension of psychosis in individuals with common mental disorder who meet “clinical high risk” criteria thus may improve outcome (which cannot be interpreted as prevention of “schizophrenia”). Subthreshold psychotic experiences are transitory in about 80% of individuals, while around 20% go on to develop persistent psychotic experiences and 7% a psychotic disorder, with an annual transition rate of 0.5‐1%. Persistence is associated, on the one hand, with environmental exposures, particularly childhood trauma, and, on the other, with network‐type dynamic interactions between psychotic experiences themselves (e.g., interactions between hallucinatory experiences and delusional ideation) and between symptom dimensions (e.g., interactions between affective symptoms and psychotic experiences, or interactions between subthreshold negative symptoms and psychotic experiences). The study of psychotic experiences is helping to elucidate the mechanisms by which environmental and genetic influences shape the transdiagnostic expression of psychosis proneness, that is mostly transitory but may first become persistent over time and eventually give rise to transition to a psychotic disorder.     

Psychotic experiences as a predictor of the natural course of suicidal ideation: a Swedish cohort study

Psychotic experiences are far more prevalent in the population than psychotic disorders and are associated with a wide range of depressive, anxiety and behavioral disorders, as well as increased risk for psychotic disorder. Recently, psychotic experiences have been highlighted as a potentially valuable clinical marker of risk for suicidal behavior. There have been few studies to date, however, to assess psychotic experiences as a predictor of suicidality over time. We wished to assess whether young persons with suicidal ideation at baseline assessment who reported psychotic experiences were at higher risk for persistence of suicidal ideation at follow‐up than young persons who also reported suicidal ideation at baseline but who did not report co‐occurring psychotic experiences. A total of 2,263 adolescents were assessed at age 13 to 14 years for psychotic experiences, suicidal ideation and internalizing and externalizing psychopathology. Participants were re‐assessed at ages 16 to 17 years and 19 to 20 years. Among 13‐ to 14‐year olds with suicidal ideation, co‐occurring psychotic experiences did not predict an increased odds of persistence of suicidal ideation to age 16 to 17 years (OR=0.94, 95% CI: 0.19‐4.78). Among 16‐ to 17‐year olds with suicidal ideation, however, co‐occurring psychotic experiences predicted a 6‐fold increased odds of persistence of suicidal ideation to age 19 to 20 years (OR=5.53, 95% CI: 1.33‐23.00). Psychotic experiences are an important but under‐recognized marker of risk for persistence of suicidal ideation, in particular from mid‐adolescence. An increased emphasis on the clinical assessment of psychotic experiences in mental health services should be a priority.     

Discursive constructions of race talk among Black men and women living in the United States

Race talk within discourse analytic traditions have largely focused on the discursive construction of racism in majority groups. This article extends this work by examining how Black adults discursively engaged in race talk. Across focus groups, two conversations emerged: explanations of racialized experiences and how racialized experiences should be dealt with. In explanations of racialized experiences, participants highlighted their own negative behaviours or constructed experiences as imprecise or an artefact of ignorance. These discourses functioned to circumvent inequitable relations premised on White normativity. In explanations of how racialized experiences should be dealt with, participants constructed themselves as having responsibilities, downplayed their racialized experiences or framed them as inevitable. Each of these discourses functioned to construct racialization as something that could be corrected through good behaviour or they placed ideological limits for what is possible for Blacks in society. Implications for the existing literature on race talk are discussed.     

Facets of patient complaints: pain, suffering, and the importance of consideration

Patient complaints, as it has often been recognized, serve to express multiple and varied experiences and needs. A number of options for filing complaints and a variety of ways for doing so have arisen recently, among which are ethics committees, support groups, palliative care units, and complaint examination committees. Today patients have many occasions for expressing their experiences, talking about distressing incidents, and making their needs known. Three orally related experiences are examined here, both from the viewpoint of the patient and in light of their cultural meanings: pain, suffering, and the importance of consideration. These are three expectations of care providers, but also three experiences that dispose patients to rethink their individuality and their relationships with others, to take stock of their pasts, and to reflect on who they are and who they want to become. The experience of illness has thus become pivotal in the process of constructing individual identity.     

From Epidemiology to Daily Life: Linking Daily Life Stress Reactivity to Persistence of Psychotic Experiences in a Longitudinal General Population Study

Subclinical psychotic experiences at the level of the general population are common, forming an extended psychosis phenotype with clinical psychosis. Persistence of subclinical experiences is associated with transition to later mental disorder. Increased daily life stress reactivity is considered an endophenotype for psychotic disorders. We examined, in a longitudinal framework, whether baseline momentary assessment markers of stress reactivity would predict persistence of subclinical psychotic experiences over time. In a general population sample of female twins (N = 566), the Experience Sampling Method (ESM; repetitive random sampling of momentary emotions, psychotic experiences and context) was used to assess (emotional and psychotic) daily life stress reactivity. Persistence of subclinical psychotic experiences was based on the Community Assessment of Psychic Experiences (CAPE), assessed three times over 14 months post-baseline. It was investigated whether baseline daily life emotional and psychotic stress reactivity predicted persistence of psychotic experiences over time. Higher levels of emotional stress reactivity (a decrease in positive and an increase in negative affect in response to stress), and increased psychotic reactivity to daily stress was found in individuals with persistent psychotic experiences over time compared to individuals with transient psychotic experiences. The results suggest that markers of daily life stress reactivity may predict “macro-level” persistence of normally transient expression of psychotic liability over time. Linking daily life markers of altered reactivity in terms of emotions and psychotic experiences to longitudinal persistence of psychotic experiences, associated with increased risk of transition to overt mental disorder, may contribute to earlier and more accurate diagnosis of risk.     

早期负性经历的表观遗传学研究进展

表观遗传学（epigenetics）是指不涉及DNA序列改变、可以通过有丝分裂和减数分裂进行遗传的基因表达变化的遗传学分支领域。目前研究主要集中在DNA甲基化、组蛋白密码、染色质重塑和非编码RNA调控等方面。早期负性经历是指个体出生早年所经历的不良生活事件,还包括个体出生前所经历的负性生活事件。大量研究表明早期负性经历对个体成年后的行为会造成明显影响。本文将综述早期负性经历中表观遗传的各种机制。     

A person-centered exploration of children of immigrants’ social experiences and their school-based well-being

This study aimed to explore commonalities among discrimination, stereotyping, and peer-related social experiences of children of immigrants, and to see if these experiences might relate to children’s school-based well-being. Two age-based cohorts of 294 children and their immigrant parents from Portugal, the Dominican Republic, and Cambodia were interviewed. Person-centered analyses resulted in four unique clusters of children’s social experiences. Notably, children in clusters with positive views of cultural in-group and out-group members also reported positive school-based well-being. Person-centered analyses on parent variables found three clusters based on parents’ ethnic/racial socialization practices. There was no overlap between parent and child clusters, indicating unique profiles between parent socialization and child social experiences within immigrant families. Implications of connections among social experiences and school-based emotional well-being for children of immigrants are discussed.     

Identity,community and care in online accounts of hereditary colorectal cancer syndrome

Sociological literature has explored how shifts in the point at which individuals may be designated as diseased impact upon experiences of ill health. Research has shown that experiences of being genetically “at risk” are shaped by and shape familial relations, coping strategies, and new forms of biosociality. Less is known about how living with genetic risk is negotiated in the everyday and over time, and the wider forms of identity, communities and care this involves. This article explores these arrangements drawing on online bloggers’ accounts of Familial Adenomatous Polyposis (FAP). We show how accounts of genetic risk co-exist with more palpable experiences of FAP in everyday life, notably the consequences of prophylactic surgeries. We consider how the act of blogging represents but also constitutes everyday experiences of hereditary cancer syndrome as simultaneously ordinary and exceptional, and reflect on the implications of our analysis for understanding experiences of genetic cancer risk.     

A Systematic Review of Patients’ Experiences in Communicating with Primary Care Physicians: Intercultural Encounters and a Balance between Vulnerability and Integrity

Communication difficulties persist between patients and physicians. In order to improve care, patients’ experiences of this communication must be understood. The main objective of this study is to synthesize qualitative studies exploring patients’ experiences in communicating with a primary care physician. A secondary objective is to explore specific factors pertaining to ethnic minority or majority patients and their influence on patients’ experiences of communication. Pertinent health and social sciences electronic databases were searched systematically (PubMed, Cinahl, PsychNet, and IBSS). Fifty-seven articles were included in the review on the basis of being qualitative studies targeting patients’ experiences of communication with a primary care physician. The meta-ethnography method for qualitative studies was used to interpret data and the COREQ checklist was used to evaluate the quality of included studies. Three concepts emerged from analyses: negative experiences, positive experiences, and outcomes of communication. Negative experiences related to being treated with disrespect, experiencing pressure due to time constraints, and feeling helpless due to the dominance of biomedical culture in the medical encounter. Positive experiences are attributed to certain relational skills, technical skills, as well as certain approaches to care privileged by the physician. Outcomes of communication depend on patients’ evaluation of the consultation. Four categories of specific factors exerted mainly a negative influence on consultations for ethnic minorities: language barriers, discrimination, differing values, and acculturation. Ethnic majorities also raised specific factors influencing their experience: differing values and discrimination. Findings of this review are limited by the fact that more than half of the studies did not explore cultural aspects relating to this experience. Future research should address these aspects in more detail. In conclusion, all patients seemed to face additional cultural challenges. Findings provide a foundation for the development of tailored interventions to patients’ preferences, thus ensuring more satisfactory experiences. Health care providers should be sensitive to specific factors (cultural and micro-cultural) during all medical encounters.     

Ethical issues in research on sensitive topics: participants' experiences of distress and benefit

While many studies ask participants to disclose sensitive information or to participate in emotionally arousing tasks, little is known about participants' subjective experiences of discomfort and benefit. Ethics review committees, therefore, have little information about participant experiences to guide their informed decision-making. We asked undergraduate females about their experiences in a study that included an experimental session, interviews, and self-report measures on sensitive topics. We examined results overall, and compared the responses of individuals with and without childhood abuse experiences. Participants who had experienced child abuse were more likely to report distress due to remembering the past, but also more likely to report that participation was helpful. Implications for future research, and recommendations for review boards, are discussed.     

‘Do you remember the first time?’ Host plant preference in a moth is modulated by experiences during larval feeding and adult mating

In insects, like in other animals, experience‐based modulation of preference, a form of phenotypic plasticity, is common in heterogeneous environments. However, the role of multiple fitness‐relevant experiences on insect preference remains largely unexplored. For the multivoltine polyphagous moth Spodoptera littoralis we investigated effects of larval and adult experiences on subsequent reproductive behaviours. We demonstrate, for the first time in male and female insects, that mating experience on a plant modulates plant preference in subsequent reproductive behaviours, whereas exposure to the plant alone or plant together with sex pheromone does not affect this preference. When including larval feeding experiences, we found that both larval rearing and adult mating experiences modulate host plant preference. These findings represent the first evidence that host plant preferences in polyphagous insects are determined by a combination of innate preferences modulated by sensory feedback triggered by multiple rewarding experiences throughout their lifetime.     

Who gets more out of sport? The role of value and perceived ability in flow and identity-related experiences in adolescent sport

Sport is a context that provides positive developmental benefits to adolescents. However, these benefits are not distributed equally to all participants. This study examined whether the motivational constructs of attainment value and ability self-concept were related to positive developmental experiences in sport, and tested intensity of participation as a moderator of this relation. A sample of 1,628 students (954 grade 9, 674 grade 12) reported their developmental experiences in sport in two domains: identity formation and flow. Higher levels of attainment value and ability self-concept in sport were related to more identity and flow experiences. In addition, intensity of participation moderated the links between attainment value and identity and flow, and ability self-concept and identity, for older students. Placing higher value on sport was most strongly related to older students’ positive experiences at higher levels of involvement. This study contributes to understanding the role of individual differences in developmental experiences in sport.     

Modulation of aggressive behaviour by fighting experience: mechanisms and contest outcomes

Experience in aggressive contests often affects behaviour during, and the outcome of, later contests. This review discusses evidence for, variations in, and consequences of such effects. Generally, prior winning experiences increase, and prior losing experiences decrease, the probability of winning in later contests, reflecting modifications of expected fighting ability. We examine differences in the methodologies used to study experience effects, and the relative importance and persistence of winning and losing experiences within and across taxa. We review the voluminous, but somewhat disconnected, literature on the neuroendocrine mechanisms that mediate experience effects. Most studies focus on only one of a number of possible mechanisms without providing a comprehensive view of how these mechanisms are integrated into overt behaviour. More carefully controlled work on the mechanisms underlying experience effects is needed before firm conclusions can be drawn.Behavioural changes during contests that relate to prior experience fall into two general categories. Losing experiences decrease willingness to engage in a contest while winning experiences increase willingness to escalate a contest. As expected from the sequential assessment model of contest behaviour, experiences become less important to outcomes of contests that escalate to physical fighting.A limited number of studies indicate that integration of multiple experiences can influence current contest behaviour. Details of multiple experience integration for any species are virtually unknown. We propose a simple additive model for this integration of multiple experiences into an individual's expected fighting ability. The model accounts for different magnitudes of experience effects and the possible decline in experience effects over time.Predicting contest outcomes based on prior experiences requires an algorithm that translates experience differences into contest outcomes. We propose two general types of model, one based solely on individual differences in integrated multiple experiences and the other based on the probability contests reach the escalated phase. The difference models include four algorithms reflecting possible decision rules that convert the perceived fighting abilities of two rivals into their probabilities of winning. The second type of algorithm focuses on how experience influences the probability that a subsequent contest will escalate and the fact that escalated contests may not be influenced by prior experience. Neither type of algorithm has been systematically investigated.Finally, we review models for the formation of dominance hierarchies that assume that prior experience influences contest outcome. Numerous models have reached varied conclusions depending on which factors examined in this review are included. We know relatively little about the importance of and variation in experience effects in nature and how they influence the dynamics of aggressive interactions in social groups and random assemblages of individuals. Researchers should be very active in this area in the next decade. The role of experience must be integrated with other influences on contest outcome, such as prior residency, to arrive at a more complete picture of variations in contest outcomes. We expect that this integrated view will be important in understanding other types of interactions between individuals, such as mating and predator-prey interactions, that also are affected significantly by prior experiences.     

The Status of Medical Education: A Medical Student's Viewpoint

Any educational process involves four distinct stages: the selection of goals, the selection of learning experiences, the organization of these experiences and the evaluation of achievement. If the results of evaluation are unsatisfactory, then the goals were unrealistic, the learning experiences were inadequate, or the experiences were poorly organized.The characteristics of the good physician and the recognition of these in candidates for medical education are matters of great interest. Does a student learn because he has good teachers or because he has proper motivation for success? Is it possible for one to teach another, and if so, what is the best technique of instruction? How can the student best be evaluated?Medical education is in a state of rapid change, but changes of significance will not occur until the quality of the teachers is improved and the barriers of departmental organization are removed, thus putting the students'' instruction in the hands of persons unbiased by concentration on a small field of endeavour.     

Critical survey of mycological research and literature for the years 1946–1956 in Ireland

Summary 1. The various types of fungi isolated from cases of ringworm in the North of Ireland during the ten-year period 1946 to 1956 are described.2. Our own personal experiences in the North of Ireland with these fungi are given.3. The experiences of colleagues in Eire as represented by their writings are summarized.     

Gaining the upper hand: Economic mobility among immigrant and domestic minorities

Labour market experiences of three immigrant minorities in the United States are reviewed and contrasted with the three principal theories bearing on ethnic poverty and economic mobility: cultural assimilation, human capital acquisition, and industrial restructuring. Although there is support for each, they do not account satisfactorily for the experiences of many ethnic groups, in particular those who have progressed on the basis of socially embedded small entrepreneurship. An alternative conceptualization is suggested by these experiences that highlights the significance of community level variables and, in particular, alternative sources of social capital. The character of these processes is examined. Its implications for theories and policy towards ethnic minorities are discussed.     

Explaining Differences in Repatriation Experiences: The Discovery of Coupled and Decoupled Systems

We report the results of a four-year, multiphase study on the overseas assignment at General Motors Corporation (GM). Our objective is to explain variation in the repatriation experiences of International Service Personnel (ISPs). While our principal focus is the documentation of an inductive discovery process facilitated through interviews with a wide variety of GM employees, we also present a preliminary test of an explanatory hypothesis. The hypothesis states that variation in repatriation experiences is related directly to variation in the structure and ideology of organizational units that send and receive ISPs. Units with direct linkages between GM's domestic and overseas operations (coupled systems) are associated with a pro-international ideology and positive ISP repatriation experiences. Units with no administrative or operational linkages between the domestic and overseas arenas (decoupled systems) are associated with an anti-international ideology and negative ISP repatriation experiences. Our findings suggest that the structural and ideological properties of organizational units affect both repatriation from overseas assignments and ISP career paths.     

REFLECTIVE EQUILIBRIUM AND EMPIRICAL DATA: THIRD PERSON MORAL EXPERIENCES IN EMPIRICAL MEDICAL ETHICS

In ethics, the use of empirical data has become more and more popular, leading to a distinct form of applied ethics, namely empirical ethics. This ‘empirical turn’ is especially visible in bioethics. There are various ways of combining empirical research and ethical reflection. In this paper we discuss the use of empirical data in a special form of Reflective Equilibrium (RE), namely the Network Model with Third Person Moral Experiences. In this model, the empirical data consist of the moral experiences of people in a practice. Although inclusion of these moral experiences in this specific model of RE can be well defended, their use in the application of the model still raises important questions. What precisely are moral experiences? How to determine relevance of experiences, in other words: should there be a selection of the moral experiences that are eventually used in the RE? How much weight should the empirical data have in the RE? And the key question: can the use of RE by empirical ethicists really produce answers to practical moral questions? In this paper we start to answer the above questions by giving examples taken from our research project on understanding the norm of informed consent in the field of pediatric oncology. We especially emphasize that incorporation of empirical data in a network model can reduce the risk of self‐justification and bias and can increase the credibility of the RE reached.