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1.
P. Gerrans 《Biology & philosophy》2007,22(1):35-56
Delusions are currently characterised as false beliefs produced by incorrect inference about external reality (DSM IV). This
inferential conception has proved hard to link to explanations pitched at the level of neurobiology and neuroanatomy. This
paper provides that link via a neurocomputational theory, based on evolutionary considerations, of the role of the prefrontal
cortex in regulating offline cognition. When pathologically neuromodulated the prefrontal cortex produces hypersalient experiences
which monopolise offline cognition. The result is characteristic psychotic experiences and patterns of thought. This bottom-up
account uses neural network theory to integrate recent theories of the role of dopamine in delusion with the insights of inferential
accounts. It also provides a general model for evolutionary psychiatry which avoids theoretical problems imported from evolutionary
psychology. 相似文献
2.
《World psychiatry》2022,21(2):272
Patient‐reported helpfulness of treatment is an important indicator of quality in patient‐centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post‐traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community epidemiological surveys – 17 in high‐income countries (HICs) and 13 in low‐ and middle‐income countries (LMICs) – carried out as part of the World Health Organization (WHO)’s World Mental Health (WMH) Surveys. Respondents were asked whether treatment of each disorder was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Across all surveys and diagnostic categories, 26.1% of patients (N=10,035) reported being helped by the very first professional they saw. Persisting to a second professional after a first unhelpful treatment brought the cumulative probability of receiving helpful treatment to 51.2%. If patients persisted with up through eight professionals, the cumulative probability rose to 90.6%. However, only an estimated 22.8% of patients would have persisted in seeing these many professionals after repeatedly receiving treatments they considered not helpful. Although the proportion of individuals with disorders who sought treatment was higher and they were more persistent in HICs than LMICs, proportional helpfulness among treated cases was no different between HICs and LMICs. A wide range of predictors of perceived treatment helpfulness were found, some of them consistent across diagnostic categories and others unique to specific disorders. These results provide novel information about patient evaluations of treatment across diagnoses and countries varying in income level, and suggest that a critical issue in improving the quality of care for mental disorders should be fostering persistence in professional help‐seeking if earlier treatments are not helpful. 相似文献
3.
T. M. Murphy N. Mullins M. Ryan T. Foster C. Kelly R. McClelland J. O'Grady E. Corcoran J. Brady M. Reilly A. Jeffers K. Brown A. Maher N. Bannan A. Casement D. Lynch S. Bolger A. Buckley L. Quinlivan L. Daly C. Kelleher K. M. Malone 《Genes, Brain & Behavior》2013,12(1):125-132
Recently, a significant epigenetic component in the pathology of suicide has been realized. Here we investigate candidate functional SNPs in epigenetic‐regulatory genes, DNMT1 and DNMT3B, for association with suicide attempt (SA) among patients with co‐existing psychiatric illness. In addition, global DNA methylation levels [5‐methyl cytosine (5‐mC%)] between SA and psychiatric controls were quantified using the Methylflash Methylated DNA Quantification Kit. DNA was obtained from blood of 79 suicide attempters and 80 non‐attempters, assessed for DSM‐IV Axis I disorders. Functional SNPs were selected for each gene (DNMT1; n = 7, DNMT3B; n = 10), and genotyped. A SNP (rs2424932) residing in the 3′ UTR of the DNMT3B gene was associated with SA compared with a non‐attempter control group (P = 0.001; Chi‐squared test, Bonferroni adjusted P value = 0.02). Moreover, haplotype analysis identified a DNMT3B haplotype which differed between cases and controls, however this association did not hold after Bonferroni correction (P = 0.01, Bonferroni adjusted P value = 0.56). Global methylation analysis showed that psychiatric patients with a history of SA had significantly higher levels of global DNA methylation compared with controls (P = 0.018, Student's t‐test). In conclusion, this is the first report investigating polymorphisms in DNMT genes and global DNA methylation quantification in SA risk. Preliminary findings suggest that allelic variability in DNMT3B may be relevant to the underlying diathesis for suicidal acts and our findings support the hypothesis that aberrant DNA methylation profiles may contribute to the biology of suicidal acts. Thus, analysis of global DNA hypermethylation in blood may represent a biomarker for increased SA risk in psychiatric patients. 相似文献
4.
Ingrid Melle 《World psychiatry》2013,12(1):16-21
In the afternoon of July 22, 2011, Norwegian Anders Behring Breivik killed 77 persons, many of them children and youths, in two separate events. On August 24, 2012, he was sentenced to 21 years in prison. Breivik went through two forensic evaluations: the first concluded that he had a psychotic disorder, thus being legally unaccountable, whereas the second concluded that he had a personality disorder, thus being legally accountable. This article first describes Breivik's background and his crimes. This is followed by an overview of the two forensic evaluations, their methods, contents and disagreements, and how these issues were handled by the court in the verdict. Finally, the article focuses on some lessons psychiatrists can take from the case. 相似文献
5.
JEROME C WAKEFIELD 《World psychiatry》2007,6(3):149-156
What do we mean when we say that a mental condition is a medical disorder
rather than a normal form of human suffering or a problem in living? The status
of psychiatry as a medical discipline depends on a persuasive answer to this
question. The answers tend to range from value accounts that see disorder
as a sociopolitical concept, used for social control purposes, to scientific
accounts that see the concept as strictly factual. I have proposed a hybrid
account, the harmful dysfunction (HD) analysis, that incorporates both value
and scientific components as essential elements of the medical concept of
disorder, applying to both physical and mental conditions. According to the
HD analysis, a condition is a disorder if it is negatively valued ("harmful")
and it is in fact due to a failure of some internal mechanism to perform a
function for which it was biologically designed (i.e., naturally selected).
The implications of this analysis for the validity of symptom-based diagnostic
criteria and for challenges in cross-cultural use of diagnostic criteria are
explored, using a comparison of the application of DSM diagnostic criteria
in the U.S. and Taiwan. 相似文献
6.
Lewis-Fernández R Guarnaccia PJ Martínez IE Salmán E Schmidt A Liebowitz M 《Culture, medicine and psychiatry》2002,26(2):199-223
This article examines a clinicalsample of 66 Dominican and Puerto Ricansubjects who reported ataques de nerviosand also psychiatric disorder, and disentanglesthe phenomenological experiences of ataquede nervios, panic attacks, and panic disorder. In-depth cultural interviews assessed thesymptomatic phenomenology of ataqueepisodes from the local perspective as well asin terms of key panic features, such asrecurrence, rapid peaking of symptoms, and lackof provocation. Independent diagnosticassessments of panic attacks and disorder werealso used to establish the phenomenologicaloverlap between ataque and panic. Ourfindings indicate that 36 percent ofataques de nervios fulfill criteria for panicattacks and between 17 percent and 33 percentfor panic disorder, depending on the overlapmethod used. The main features distinguishingataques that fulfill panic criteria fromataques that do not include whether theepisodes were provoked by an upsetting event inthe person's life and the rapidity of crescendoof the actual attack. A key finding is thatataques often share individualphenomenological features with panic episodes,but that these features usually do not ``runtogether' during the ataque experience.This confirms previous findings thatataque is a more inclusive construct thanpanic disorder. The importance of thesefindings for the clinical diagnosis andtreatment of persons with ataques isdiscussed. 相似文献
7.
This preliminary, community-based study examines major stressors identified by Iraqw and Datoga women of Mbulu District, Tanzania, and describes steps in creating a culturally specific questionnaire to assess mental health burdens. This area of Tanzania is remote, with limited access to goods and services, and is undergoing dramatic social and economic changes. Iraqw and Datoga reside in close proximity and often intermarry but have different cultural and subsistence responses to this rapid social change. Data were collected from May to October 2002, with 49 Datoga women and 64 Iraqw women interviewed. In-home interviews were conducted to have women (1) free-list their primary concerns and (2) answer questions from a translated (in Datoga and Iraqw) and modified standardized mental health questionnaire. Both groups of women identified hunger, the lack of animals, particularly cattle, and health/illnesses as the most common major stressors. Other frequently cited stressors included crop failure, general fears of violence, paying taxes, and no money for basic needs. Additional refinements are required for the mental health questionnaire, with strengths and limitations discussed. Such data, while preliminary, augment efforts to analyze the emotional burdens associated with dramatic social change. 相似文献
8.
Cynthia J. Tsay 《The Yale journal of biology and medicine》2013,86(2):245-254
Julius Wagner-Jauregg, a preeminent Austrian psychiatrist was awarded the Nobel
Prize in Medicine in 1927 for the development of malaria therapy for the
treatment of neurosyphilis, or general paresis of the insane. Despite being only
one of three psychiatrists to win a Nobel Prize, he has faded from public
consciousness and his name recognition pales in comparison to his contemporary
and fellow Austrian, Sigmund Freud. This paper explores his contributions to the
field of biological psychiatry and also touches upon reasons, such as the
growing bioethics movement, his controversial affiliation with the Nazi Party,
and the evolution of neurosyphilis, that explain why Wagner-Jauregg is not more
widely celebrated for his contributions to the field of psychiatry, even though
his malarial treatment could be considered the earliest triumph of biological
psychiatry over psychoanalysis. 相似文献
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