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Stein DJ, Nielsen K, Hartford A, Gagné-Julien AM, Glackin S, Friston K, Maj M, Zachar P, Aftab A. Philosophy of psychiatry: theoretical advances and clinical implications. World Psychiatry 2024; 23:215-232. [PMID: 38727058 PMCID: PMC11083904 DOI: 10.1002/wps.21194] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Abstract
Work at the intersection of philosophy and psychiatry has an extensive and influential history, and has received increased attention recently, with the emergence of professional associations and a growing literature. In this paper, we review key advances in work on philosophy and psychiatry, and their related clinical implications. First, in understanding and categorizing mental disorder, both naturalist and normativist considerations are now viewed as important - psychiatric constructs necessitate a consideration of both facts and values. At a conceptual level, this integrative view encourages moving away from strict scientism to soft naturalism, while in clinical practice this facilitates both evidence-based and values-based mental health care. Second, in considering the nature of psychiatric science, there is now increasing emphasis on a pluralist approach, including ontological, explanatory and value pluralism. Conceptually, a pluralist approach acknowledges the multi-level causal interactions that give rise to psychopathology, while clinically it emphasizes the importance of a broad range of "difference-makers", as well as a consideration of "lived experience" in both research and practice. Third, in considering a range of questions about the brain-mind, and how both somatic and psychic factors contribute to the development and maintenance of mental disorders, conceptual and empirical work on embodied cognition provides an increasingly valuable approach. Viewing the brain-mind as embodied, embedded and enactive offers a conceptual approach to the mind-body problem that facilitates the clinical integration of advances in both cognitive-affective neuroscience and phenomenological psychopathology.
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Affiliation(s)
- Dan J Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Kris Nielsen
- School of Psychology, Te Herenga Waka-Victoria University of Wellington, Wellington, New Zealand
| | - Anna Hartford
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Anne-Marie Gagné-Julien
- Centre for Research in Ethics, Canada Research Chair in Epistemic Injustice and Agency, Université du Québec à Montréal, Montreal, Canada
| | - Shane Glackin
- Department of Sociology, Philosophy and Anthropology, University of Exeter, Exeter, UK
| | - Karl Friston
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Peter Zachar
- Department of Psychology, Auburn University Montgomery, Montgomery, AL, USA
| | - Awais Aftab
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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2
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Jerotic S, Ignjatovic N, Maric NP, Nesic J, Jovandic Z, Latas M, Nestorovic M, Jevtovic M, Aftab A. A Comparative Study on Mental Disorder Conceptualization: A Cross-Disciplinary Analysis. Community Ment Health J 2024; 60:813-825. [PMID: 38319528 DOI: 10.1007/s10597-024-01240-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024]
Abstract
The conceptualization of mental disorders varies among professionals, impacting diagnosis, treatment, and research. This cross-disciplinary study aimed to understand how various professionals, including psychiatrists, psychologists, medical students, philosophers, and social sciences experts, perceive mental disorders, their attitudes towards the disease status of certain mental states, and their emphasis on biological versus social explanatory attributions. A survey of 371 participants assessed their agreement on a variety of conceptual statements and the relative influence of biological or social explanatory attribution for different mental states. Our findings revealed a consensus on the need for multiple explanatory perspectives in understanding psychiatric conditions and the influence of social, cultural, moral, and political values on diagnosis and classification. Psychiatrists demonstrated balanced bio-social explanatory attributions for various mental conditions, indicating a potential shift from the biological attribution predominantly observed among medical students and residents in psychiatry. Further research into factors influencing these differing perspectives is necessary.
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Affiliation(s)
- Stefan Jerotic
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia.
- Clinic for Psychiatry, University Clinical Centre of Serbia, Pasterova 2, Belgrade, 11000, Serbia.
| | - Natalija Ignjatovic
- Faculty of Philosophy, Department of Psychology, University of Belgrade, Belgrade, Serbia
| | - Nadja P Maric
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
- Institute of Mental Health, Belgrade, Serbia
| | - Janko Nesic
- Institute of Social Sciences, Belgrade, Serbia
| | | | - Milan Latas
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
- Clinic for Psychiatry, University Clinical Centre of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Milica Nestorovic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Milica Jevtovic
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| | - Awais Aftab
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, US
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3
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Kreienkamp J, Bringmann LF, Engler RF, de Jonge P, Epstude K. The Migration Experience: A Conceptual Framework and Systematic Scoping Review of Psychological Acculturation. PERSONALITY AND SOCIAL PSYCHOLOGY REVIEW 2024; 28:81-116. [PMID: 37571846 PMCID: PMC10851656 DOI: 10.1177/10888683231183479] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
ACADEMIC ABSTRACT One of the key challenges to researching psychological acculturation is the immense heterogeneity in theories and measures. These inconsistencies make it difficult to compare past literature, hinder straightforward measurement selections, and stifle theoretical integration. To structure acculturation, we propose to utilize the four basic aspects of human experiences (wanting, feeling, thinking, and doing) as a conceptual framework. We use this framework to build a theory-driven assessment of past theoretical (final N = 92), psychometric (final N = 233), and empirical literature (final N = 530). We find that the framework allows us to examine and compare past conceptualizations. For example, empirical works have understudied the more internal aspects of acculturation (i.e., motivations and feelings) compared with theoretical works. We, then, discuss the framework's novel insights including its temporal resolution, its comprehensive and cross-cultural structure, and how the framework can aid transparent and functional theories, studies, and interventions going forward. PUBLIC ABSTRACT This systematic scoping review indicates that the concept of psychological acculturation can be structured in terms of affect (e.g., feeling at home), behavior (e.g., language use), cognition (e.g., ethnic identification), and desire (e.g., independence wish). We find that the framework is useful in structuring past research and helps with new predictions and interventions. We, for example, find a crucial disconnect between theory and practice, which will need to be resolved in the future.
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Affiliation(s)
| | - Laura F. Bringmann
- University of Groningen, The Netherlands
- Interdisciplinary Center Psychopathology and Emotion Regulation, Groningen, The Netherlands
| | | | - Peter de Jonge
- University of Groningen, The Netherlands
- Interdisciplinary Center Psychopathology and Emotion Regulation, Groningen, The Netherlands
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4
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van der Tuin S, Hoekstra RHA, Booij SH, Oldehinkel AJ, Wardenaar KJ, van den Berg D, Borsboom D, Wigman JTW. Relating stability of individual dynamical networks to change in psychopathology. PLoS One 2023; 18:e0293200. [PMID: 37943819 PMCID: PMC10635522 DOI: 10.1371/journal.pone.0293200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 10/07/2023] [Indexed: 11/12/2023] Open
Abstract
One hypothesis flowing from the network theory of psychopathology is that symptom network structure is associated with psychopathology severity and in turn, one may expect that individual network structure changes with the level of psychopathology severity. However, this expectation has rarely been addressed directly. This study aims to examine (1) the stability of individual contemporaneous symptom networks over a one-year period and (2) whether network stability is associated with a change in psychopathology. We used daily diary data of n = 66 individuals, located along the psychosis severity continuum, from two separate 90-day periods, one year apart (t = 180). Based on the newly developed Individual Network Invariance Test (INIT) to assess symptom-network stability, participants were divided into two groups with stable and unstable networks and we tested whether these groups differed in their absolute change in psychopathology severity. The majority of the sample (n = 51, 77.3%) showed a stable network over time while most individuals showed a decrease in psychopathological severity. We found no significant association between a change in psychopathology severity and individual network stability. Our results call for further critical evaluation of the association between networks and psychopathology to optimize the implementation of clinical applications based on current methods.
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Affiliation(s)
- Sara van der Tuin
- University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Centre Psychopathology and Emotion regulation, University of Groningen, Groningen, The Netherlands
| | - Ria H. A. Hoekstra
- Department of Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
| | - Sanne H. Booij
- University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Centre Psychopathology and Emotion regulation, University of Groningen, Groningen, The Netherlands
- Center for Integrative Psychiatry, Lentis, Groningen, The Netherlands
| | - Albertine J. Oldehinkel
- University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Centre Psychopathology and Emotion regulation, University of Groningen, Groningen, The Netherlands
| | - Klaas J. Wardenaar
- University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Centre Psychopathology and Emotion regulation, University of Groningen, Groningen, The Netherlands
| | - David van den Berg
- Department of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Denny Borsboom
- Department of Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
| | - Johanna T. W. Wigman
- University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Centre Psychopathology and Emotion regulation, University of Groningen, Groningen, The Netherlands
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5
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Gómez-Carrillo A, Kirmayer LJ. A cultural-ecosocial systems view for psychiatry. Front Psychiatry 2023; 14:1031390. [PMID: 37124258 PMCID: PMC10133725 DOI: 10.3389/fpsyt.2023.1031390] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/08/2023] [Indexed: 05/02/2023] Open
Abstract
While contemporary psychiatry seeks the mechanisms of mental disorders in neurobiology, mental health problems clearly depend on developmental processes of learning and adaptation through ongoing interactions with the social environment. Symptoms or disorders emerge in specific social contexts and involve predicaments that cannot be fully characterized in terms of brain function but require a larger social-ecological view. Causal processes that result in mental health problems can begin anywhere within the extended system of body-person-environment. In particular, individuals' narrative self-construal, culturally mediated interpretations of symptoms and coping strategies as well as the responses of others in the social world contribute to the mechanisms of mental disorders, illness experience, and recovery. In this paper, we outline the conceptual basis and practical implications of a hierarchical ecosocial systems view for an integrative approach to psychiatric theory and practice. The cultural-ecosocial systems view we propose understands mind, brain and person as situated in the social world and as constituted by cultural and self-reflexive processes. This view can be incorporated into a pragmatic approach to clinical assessment and case formulation that characterizes mechanisms of pathology and identifies targets for intervention.
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Affiliation(s)
- Ana Gómez-Carrillo
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, QC, Canada
- Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Laurence J. Kirmayer
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, QC, Canada
- Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
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6
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Platt B. Understanding emotion processing in offspring of mothers with depression - A commentary on Burkhouse and Kujawa (2023). J Child Psychol Psychiatry 2023; 64:608-610. [PMID: 36796785 DOI: 10.1111/jcpp.13769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/18/2023]
Abstract
In the JCPP Annual Research Review, Burkhouse and Kujawa (Journal of Child Psychology and Psychiatry, 2022) report a systematic review of 64 studies assessing the association between maternal depression and neural and physiological markers of children's emotion processing. This comprehensive review makes a novel contribution to models of transgenerational depression with important implications for future research in this field. In this commentary I reflect more generally on the role of emotion processing in the transmission of depression from parents to children and the clinical implications of neural and physiological studies.
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Affiliation(s)
- Belinda Platt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital LMU Munich, Munich, Germany
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7
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Fried EI. Studying Mental Health Problems as Systems, Not Syndromes. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2022. [DOI: 10.1177/09637214221114089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite decades of clinical, sociopolitical, and research efforts, progress in understanding and treating mental health problems remains disappointing. I discuss two barriers that have contributed to a problematic oversimplification of mental illness. The first is diagnostic literalism, mistaking mental health problems (complex within-person processes) for the diagnoses by which they are classified (clinically useful idealizations to facilitate treatment selection and prognosis). The second is reductionism, the isolated study of individual elements of mental disorders. I propose conceptualizing people’s mental health states as outcomes emerging from complex systems of biological, psychological, and social elements and show that this systems perspective explains many robust phenomena, including variability within diagnoses, comorbidity among diagnoses, and transdiagnostic risk factors. It helps us understand diagnoses and reductionism as useful epistemological tools for describing the world, rather than ontological convictions about how the world is. It provides new lenses through which to study mental illness (e.g., attractor states, phase transitions), and new levers to treat them (e.g., early warning signals, novel treatment targets). Embracing the complexity of mental health problems requires opening our ivory towers to theories and methods from other fields with rich traditions, including network and systems sciences.
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Affiliation(s)
- Eiko I. Fried
- Department of Clinical Psychology, Leiden University
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8
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Wigman JTW, van der Tuin S, van den Berg D, Muller MK, Booij SH. Mental health, risk and protective factors at micro- and macro-levels across early at-risk stages for psychosis: The Mirorr study. Early Interv Psychiatry 2022; 17:478-494. [PMID: 36198658 DOI: 10.1111/eip.13343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 02/16/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The clinical staging model states that psychosis develops through subsequent stages of illness severity. To better understand what drives illness progression, more extensive comparison across clinical stages is needed. The current paper presents an in-depth characterization of individuals with different levels of risk for psychosis (i.e., different early clinical stages), using a multimethod approach of cross-sectional assessments and daily diary reports. METHODS Data came from the Mirorr study that includes N = 96 individuals, divided across four subgroups (n1 = 25, n2 = 27, n3 = 24, and n4 = 20). These subgroups, each with an increasing risk for psychosis, represent clinical stages 0-1b. Cross-sectional data and 90-day daily diary data on psychopathology, well-being, psychosocial functioning, risk and protective factors were statistically compared across subgroups (stages) and descriptively compared across domains and assessment methods. RESULTS Psychopathology increased across subgroups, although not always linearly and nuanced differences were seen between assessment methods. Well-being and functioning differed mostly between subgroup 1 and the other subgroups, suggesting differences between non-clinical and clinical populations. Risk and protective factors differed mostly between the two highest and lowest subgroups, especially regarding need of social support and coping, suggesting differences between those with and without substantial psychotic experiences. Subgroup 4 (stage 1b) reported especially high levels of daily positive and negative psychotic experiences. CONCLUSIONS Risk for psychosis exists in larger contexts of mental health and factors of risk and protection that differ across stages and assessment methods. Taking a broad, multi-method approach is an important next step to understand the complex development of youth mental health problems.
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Affiliation(s)
- Johanna T W Wigman
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Psychiatry, Rob Giel Onderzoekscentrum, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sara van der Tuin
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - David van den Berg
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, The Netherlands.,Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Merel K Muller
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sanne H Booij
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Faculty of Behavioural and Social Sciences, Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands.,Center for Integrative Psychiatry, Lentis, Groningen, The Netherlands
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9
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Hsu KJ, Mullarkey M, Dobias M, Beevers CG, Björgvinsson T. Symptom-Level Network Analysis Distinguishes Unique Associations of Repetitive Negative Thinking and Experiential Avoidance with Depression and Anxiety in a Transdiagnostic Clinical Sample. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10323-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Haeffel GJ, Jeronimus BF, Fisher AJ, Kaiser BN, Weaver LJ, Vargas I, Goodson JT, Soyster PD, Lu W. The Hierarchical Taxonomy of Psychopathology (HiTOP) Is Not an Improvement Over the DSM. Clin Psychol Sci 2022; 10:285-290. [PMID: 36299281 PMCID: PMC9596130 DOI: 10.1177/21677026211068873] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
In their response to our article (both in this issue), DeYoung and colleagues did not sufficiently address three fundamental flaws with the Hierarchical Taxonomy of Psychopathology (HiTOP). First, HiTOP was created using a simple-structure factor-analytic approach, which does not adequately represent the dimensional space of the symptoms of psychopathology. Consequently, HiTOP is not the empirical structure of psychopathology. Second, factor analysis and dimensional ratings do not fix the problems inherent to descriptive (folk) classification; self-reported symptoms are still the basis on which clinical judgments about people are made. Finally, HiTOP is not ready to use in real-world clinical settings. There is currently no empirical evidence demonstrating that clinicians who use HiTOP have better clinical outcomes than those who use the Diagnostic and Statistical Manual of Mental Disorders (DSM). In sum, HiTOP is a factor-analytic variation of the DSM that does not get the field closer to a more valid and useful taxonomy.
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Affiliation(s)
| | | | - Aaron J. Fisher
- Department of Psychology, University of California, Berkeley
| | - Bonnie N. Kaiser
- Department of Anthropology and Global Health Program, University of California, San Diego
| | | | - Ivan Vargas
- Department of Psychology, University of Arkansas
| | - Jason T. Goodson
- PTSD Clinical Team, VA Salt Lake City Health Care Systems, Salt Lake City, Utah
| | | | - Wei Lu
- Carver School of Medicine, University of Iowa Hospitals and Clinics
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11
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Belvederi Murri M, Grassi L, Caruso R, Nanni MG, Zerbinati L, Andreas S, Ausín B, Canuto A, Härter M, Lopez MM, Weber K, Wittchen HU, Volkert J, Alexopoulos GS. Depressive symptom complexes of community-dwelling older adults: a latent network model. Mol Psychiatry 2022; 27:1075-1082. [PMID: 34642459 DOI: 10.1038/s41380-021-01310-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/23/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022]
Abstract
Late-life depression has multiple, heterogeneous clinical presentations. The aim of the study was to identify higher-order homogeneous clinical features (symptom complexes), while accounting for their potential causal interactions within the network approach to psychopathology. We analyzed cross-sectional data from community-dwelling adults aged 65-85 years recruited by the European MentDis_ICF65+ study (n = 2623, mean age 74, 49% females). The severity of 33 depressive symptoms was derived from the age-adapted Composite International Diagnostic Interview. Symptom complexes were identified using multiple detection algorithms for symptom networks, and their fit to data was assessed with latent network models (LNMs) in exploratory and confirmatory analyses. Sensitivity analyses included the Partial Correlation Likelihood Test (PCLT) to investigate the data-generating structure. Depressive symptoms were organized by the Walktrap algorithm into eight symptom complexes, namely sadness/hopelessness, anhedonia/lack of energy, anxiety/irritability, self-reproach, disturbed sleep, agitation/increased appetite, concentration/decision making, and thoughts of death. An LNM adequately fit the distribution of individual symptoms' data in the population. The model suggested the presence of reciprocal interactions between the symptom complexes of sadness and anxiety, concentration and self-reproach and between self-reproach and thoughts of death. Results of the PCLT confirmed that symptom complex data were more likely generated by a network, rather than a latent-variable structure. In conclusion, late-life depressive symptoms are organized into eight interacting symptom complexes. Identification of the symptom complexes of late-life depression may streamline clinical assessment, provide targets for personalization of treatment, and aid the search for biomarkers and for predictors of outcomes of late-life depression.
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Affiliation(s)
- Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Rosangela Caruso
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Maria Giulia Nanni
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Luigi Zerbinati
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Sylke Andreas
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Institute for Psychology, Universität Klagenfurt, A-9020, Klagenfurt, Austria
| | - Berta Ausín
- School of Psychology, Personality, Evaluation and Clinical Psychology Department, University Complutense of Madrid, Campus de Somosaguas s/n, 28223, Madrid, Spain
| | - Alessandra Canuto
- Division of Institutional Measures, University Hospitals of Geneva, 1208, Geneva, Switzerland
| | - Martin Härter
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Manuel Muñoz Lopez
- School of Psychology, Personality, Evaluation and Clinical Psychology Department, University Complutense of Madrid, Campus de Somosaguas s/n, 28223, Madrid, Spain
| | - Kerstin Weber
- Division of Institutional Measures, University Hospitals of Geneva, 1208, Geneva, Switzerland
| | - Hans-Ulrich Wittchen
- Clinical Psychology & Psychotherapy RG, Department of Psychiatry & Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Jana Volkert
- Department of Psychosocial Prevention, University of Heidelberg, Bergheimer Str. 54, 69115, Heidelberg, Germany.,Institute of Psychology, University of Kassel, Holländische Str. 36-38, 34127, Kassel, Germany
| | - George S Alexopoulos
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, USA.
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12
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Abstract
Why has computational psychiatry yet to influence routine clinical practice? One reason may be that it has neglected context and temporal dynamics in the models of certain mental health problems. We develop three heuristics for estimating whether time and context are important to a mental health problem: Is it characterized by a core neurobiological mechanism? Does it follow a straightforward natural trajectory? And is intentional mental content peripheral to the problem? For many problems the answers are no, suggesting that modeling time and context is critical. We review computational psychiatry advances toward this end, including modeling state variation, using domain-specific stimuli, and interpreting differences in context. We discuss complementary network and complex systems approaches. Novel methods and unification with adjacent fields may inspire a new generation of computational psychiatry.
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Affiliation(s)
- Peter F Hitchcock
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, Rhode Island 02912, USA; ,
| | - Eiko I Fried
- Department of Clinical Psychology, Leiden University, 2333 AK Leiden, The Netherlands;
| | - Michael J Frank
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, Rhode Island 02912, USA; ,
- Carney Institute for Brain Science, Brown University, Providence, Rhode Island 02192, USA
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13
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Schleim S. Why mental disorders are brain disorders. And why they are not: ADHD and the challenges of heterogeneity and reification. Front Psychiatry 2022; 13:943049. [PMID: 36072457 PMCID: PMC9441484 DOI: 10.3389/fpsyt.2022.943049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Scientific attempts to identify biomarkers to reliably diagnose mental disorders have thus far been unsuccessful. This has inspired the Research Domain Criteria (RDoC) approach which decomposes mental disorders into behavioral, emotional, and cognitive domains. This perspective article argues that the search for biomarkers in psychiatry presupposes that the present mental health categories reflect certain (neuro-) biological features, that is, that these categories are reified as biological states or processes. I present two arguments to show that this assumption is very unlikely: First, the heterogeneity (both within and between subjects) of mental disorders is grossly underestimated, which is particularly salient for an example like Attention Deficit/Hyperactivity Disorder (ADHD). Second, even the search for the biological basis of psychologically more basic categories (cognitive and emotional processes) than the symptom descriptions commonly used in mental disorder classifications has thus far been inconclusive. While philosophers have discussed this as the problem of mind-body-reductionism for ages, Turkheimer presented a theoretical framework comparing weak and strong biologism which is more useful for empirical research. This perspective article concludes that mental disorders are brain disorders in the sense of weak, but not strong biologism. This has important implications for psychiatric research: The search for reliable biomarkers for mental disorder categories we know is unlikely to ever be successful. This implies that biology is not the suitable taxonomic basis for psychiatry, but also psychology at large.
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Affiliation(s)
- Stephan Schleim
- Theory and History of Psychology, Faculty of Behavioral and Social Sciences, Heymans Institute for Psychological Research, University of Groningen, Groningen, Netherlands
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14
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Gallagher S. Integration and Causality in Enactive Approaches to Psychiatry. Front Psychiatry 2022; 13:870122. [PMID: 35859602 PMCID: PMC9289159 DOI: 10.3389/fpsyt.2022.870122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 06/10/2022] [Indexed: 01/30/2023] Open
Abstract
In this paper I address what has been called the integration problem in psychiatry. This problem is tied to conceptions of causality and explanatory levels in our understanding of mind. I take an interdisciplinary enactive perspective to develop a 3-fold method for exploring the dynamics of integration, based on a concept of dynamical causation and a non-hierarchical (level-free) notion of gestalt. I also consider Autism Spectrum Disorder (ASD) as a test case.
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Affiliation(s)
- Shaun Gallagher
- Department of Philosophy, University of Memphis, Memphis, TN, United States.,School of Liberal Arts, University of Wollongong, Wollongong, NSW, Australia
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15
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Bringmann LF, Albers C, Bockting C, Borsboom D, Ceulemans E, Cramer A, Epskamp S, Eronen MI, Hamaker E, Kuppens P, Lutz W, McNally RJ, Molenaar P, Tio P, Voelkle MC, Wichers M. Psychopathological networks: Theory, methods and practice. Behav Res Ther 2021; 149:104011. [PMID: 34998034 DOI: 10.1016/j.brat.2021.104011] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 11/05/2021] [Accepted: 11/27/2021] [Indexed: 12/19/2022]
Abstract
In recent years, network approaches to psychopathology have sparked much debate and have had a significant impact on how mental disorders are perceived in the field of clinical psychology. However, there are many important challenges in moving from theory to empirical research and clinical practice and vice versa. Therefore, in this article, we bring together different points of view on psychological networks by methodologists and clinicians to give a critical overview on these challenges, and to present an agenda for addressing these challenges. In contrast to previous reviews, we especially focus on methodological issues related to temporal networks. This includes topics such as selecting and assessing the quality of the nodes in the network, distinguishing between- and within-person effects in networks, relating items that are measured at different time scales, and dealing with changes in network structures. These issues are not only important for researchers using network models on empirical data, but also for clinicians, who are increasingly likely to encounter (person-specific) networks in the consulting room.
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Affiliation(s)
- Laura F Bringmann
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), P.O. Box 30.001 (CC72), 9700 RB, Groningen, the Netherlands; University of Groningen, Faculty of Behavioural and Social Sciences, Department of Psychometrics and Statistics, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands.
| | - Casper Albers
- University of Groningen, Faculty of Behavioural and Social Sciences, Department of Psychometrics and Statistics, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands
| | - Claudi Bockting
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Denny Borsboom
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Eva Ceulemans
- KU Leuven, Faculty of Psychology and Educational Sciences, Leuven, Belgium
| | - Angélique Cramer
- RIVM National Institute for Public Health and the Environment, the Netherlands
| | - Sacha Epskamp
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Markus I Eronen
- Department of Theoretical Philosophy, University of Groningen, the Netherlands
| | - Ellen Hamaker
- Department of Methodology and Statistics, Utrecht University, the Netherlands
| | - Peter Kuppens
- KU Leuven, Faculty of Psychology and Educational Sciences, Leuven, Belgium
| | - Wolfgang Lutz
- Department of Psychology, University of Trier, Germany
| | | | - Peter Molenaar
- Department of Human Development and Family Studies, The Pennsylvania State University, USA
| | - Pia Tio
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Department of Methodology and Statistics, Tilburg University, Tilburg, the Netherlands
| | - Manuel C Voelkle
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), P.O. Box 30.001 (CC72), 9700 RB, Groningen, the Netherlands
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16
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Jerotic S, Aftab A. Scientific pluralism is the only way forward for psychiatry. Acta Psychiatr Scand 2021; 143:537-538. [PMID: 33988863 DOI: 10.1111/acps.13298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Stefan Jerotic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Awais Aftab
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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17
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Riese H, Wichers M. Comment on: Eronen MI (2019). The levels problem in psychopathology. Psychol Med 2021; 51:525-526. [PMID: 31875795 PMCID: PMC7958480 DOI: 10.1017/s0033291719003623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/22/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Harriëtte Riese
- University of Groningen, Universitair Medisch Centrum Groningen, Department of Psychiatry, Interdisiplinary, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
| | - Marieke Wichers
- University of Groningen, Universitair Medisch Centrum Groningen, Department of Psychiatry, Interdisiplinary, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
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18
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Affiliation(s)
- Eiko I. Fried
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
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