Disorder and Deviance:Where to Draw the Boundaries? Dan J. Stein (bio) Keywords mental disorder, definition, deviance, dysfunction, distress Rashed and Bingham (2014) raise the question of whether psychiatry can distinguish between social deviance and psychiatry, and conclude that the “the limit of what society may be willing to accommodate – does not mark the beginning of illness” (254). This question is clearly important to consider, given that many critical of psychiatry have (incorrectly) emphasized that psychiatry is no more than a form of deviance control, and given that some practitioners of psychiatry have (inappropriately) subjected political deviants to medical treatments. Rashed and Bingham review Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV and DSM-5 definitions of mental disorder, and indicate that an evolutionary theoretic approach to defining dysfunction is problematic and should be replaced by an emphasis on distress. They then argue that socially caused distress can be distinguished from socially constitutive distress, that conditions in which distress is socially constituted should not be considered to be mental disorders, and that the appropriate level of response to some personality and sexual disorders is legal or perhaps political rather than medical. This interesting piece raises a number of conceptual and scientific issues that deserve further consideration and clarification. I discuss in turn (1) the nature of linguistic categories, (2) the notion of dysfunction in mental disorder, (3) the nature of socially constituted distress, and (4) whether a number of key personality disorders (e.g., antisocial personality disorder) and sexual disorders (e.g., coercive paraphilic disorder, hypersexual disorder) should indeed be viewed as mental disorders. Concepts of Mental Disorder Proponents of what might be called a classical approach define disorders in terms of necessary and sufficient criteria (Stein 1991, 2008). The definition perhaps most relevant to this piece is Wakefield’s characterization of disorder as a harmful dysfunction (Wakefield 1992). Proponents of a more critical position argue, instead, that definitions of mental disorder differ from time to time and place to place (Stein 1991, 2008). Key for the current piece is the argument that psychiatry cannot, therefore, adequately differentiate mental disorder and other forms of deviance; this argument [End Page 261] has been made by a broad range of critics of psychiatry in general, and of medicalization in particular. Scientific work, however, increasingly emphasizes that linguistic categories are often continuous, with some exemplars typical and others atypical (Lakoff and Johnson 1999). Research has concluded that the linguistic category of birds, for example, is composed of typical exemplars such as robins (which fly) and atypical exemplars such as ostriches (which do not). A range of work in cognitive psychology, linguistics, artificial intelligence, and other branches of cognitive science has emphasized such continua (Stein 2007, 2013). Biologists are certainly able to classify species on the basis of phenotype, or increasingly, on the basis of genotype. At the same time, the concept of species is itself one that has fuzzy boundaries (Hey 2001). Continua of categories and fuzziness of boundaries are relevant to formulating an approach to medical and psychiatric disorders (Stein et al. 2010). Typical disorders may be characterized by features such as the presence of a factor (often external) that disrupts internal homeostasis, the lack of responsibility of the individual for this disruption, and a social role that encourages medical treatment (rather than, say, legal sanction; Stein 2013). However, there are also atypical disorders, whether medical (such as macromastia, which may not involve disruption per se, but which may cause distress and impairment) or psychiatric (such as alcoholism, where the individuals do seem to need to take responsibility for their role in perpetuating the condition). Mental Disorder and Dysfunction Both the fourth and fifth editions of the DSM (DSM-IV and DSM-5) highlight the notion of dysfunction in their definitions of mental disorder. Stein et al. (2010) suggest the term ‘psychobiological dysfunction’ to emphasize the extent to which biological and psychological processes are intertwined. As alluded to, some authors have tried to define dysfunction in terms of necessary and sufficient criteria. Rashed and Bingham reference Bolton’s point (Bolton 2010) that psychological function includes both innate (evolved) and social (cultivated) components...
BACKGROUND AND AIM: Global warming is increasingly affecting human populations. Occupational heat stress occurs frequently, however little is known regarding potential long-term adverse health effects of chronic occupational heat exposure. In other recent work, we examined associations of lifetime occupational heat exposure and colorectal cancer in a large Spanish multi-case-control study (MCC-Spain). We observed no clear evidence for associations with ever occupational heat exposure overall, though there were some positive associations observed among women in the highest categories of lifetime cumulative exposure and duration. Here we extend work to examine potential associations with stomach cancer. METHOD: Data from a total of 459 incident stomach cancer cases and a common set of 3,440 matched controls recruited from 10 regions from 2008-2013 in MCC-Spain were examined. The Spanish job exposure matrix, MatEmEsp, was used to assign heat exposure estimates to participant lifetime occupational history. Three exposure indices were constructed: ever vs. never, duration (years), and cumulative exposure. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) adjusting for 5-year age group, sex, education, body mass index, cigarette smoking status, and family history of stomach cancer. RESULTS: Overall, 53.9% included cases and 37.7% of controls were ever occupationally exposed to heat. There was a positive association of ever occupational heat exposure and stomach cancer overall (odds ratio (OR) 1.45; 95% CI 1.10, 1.90). ORs were also elevated in the medium (OR 1.52; 95% CI 1.06, 2.17) and highest tertiles of lifetime cumulative exposure (OR 1.62; 95% CI 1.12, 2.34) (p trend 0.05), as well as of duration of exposure (ORs 1.88; 1.24, 2.86 and 1.41; 0.98, 2.03 respectively) (p trend = 0.02). CONCLUSIONS: Preliminary findings provide some evidence for a positive association of occupational heat exposure and stomach cancer risk in MCC-Spain; findings are being extended in a pooled analysis of data from three case-control studies.
There are substantial educational inequalities in AMI incidence in Norway, especially for women aged 35-69. Relative inequalities did not change from 2001 to 2009.
Read moreCentral to many psychological schools of thought is the notion that self-reflection leads to self-insight which, in turn, leads to enhanced well-being. However, empirical research has found that although self-insight is typically associated with well-being, self-reflection is frequently not associated with self-insight or well-being. Past attempts to understand this conundrum have tended to focus on the role of ruminative self-refection. Using a different approach this study investigates the roles of dysfunctional attitudes and positive core self-evaluations. Using data from 227 participants, two key findings are reported: first, dysfunctional attitudes suppress the relationship between self-reflection and self-insight; and second, positive core self-evaluations mediate the relationship between self-insight and subjective well-being. These two findings imply that a path exists from self-reflection to subjective well-being through self-insight and positive core self-evaluations. This path model was found to be a good fit. Implications for future research and positive psychological practice are discussed.
Read moreVitamins B2 and B6 are cofactors in the kynurenine pathway. Many of the kynurenines are neuroactive compounds with immunomodulatory effects. In the present study, we aimed to investigate plasma concentrations of vitamins B2 and B6 as determinants of kynurenines and two markers of interferon-γ-mediated immune activation (kynurenine:tryptophan ratio (KTR) and neopterin). We measured the concentrations of vitamins B2 and B6 vitamers, neopterin, tryptophan and six kynurenines (i.e. kynurenine, anthranilic acid, kynurenic acid, 3-hydroxykynurenine, 3-hydroxyanthranilic acid and xanthurenic acid) in plasma from 7051 individuals. Dietary intake of vitamins B2 and B6 was assessed using a validated FFQ. Associations were investigated using partial Spearman's correlations, generalised additive models, and segmented or multiple linear regression. The B2 vitamer, riboflavin, was positively associated with 3-hydroxyanthranilic acid and xanthurenic acid, with correlation coefficients, as obtained by segmented regression, of 0·20 (95 % CI 0·16, 0·23) and 0·24 (95 % CI 0·19, 0·28), at riboflavin concentrations below the median value (13·0 nmol/l). The vitamin B6 vitamer, pyridoxal 5'-phosphate (PLP), was positively associated with most kynurenines at PLP concentrations < 39·3-47·0 nmol/l, and inversely associated with 3-hydroxykynurenine with the association being more prominent at PLP concentrations < 18·9 nmol/l. Riboflavin and PLP were associated with xanthurenic acid only at relatively low, but normal concentrations of both vitamers. Lastly, PLP was negatively correlated with neopterin and KTR. These results demonstrate the significant and complex determination of kynurenine metabolism by vitamin status. Future studies on B-vitamins and kynurenines in relation to chronic diseases should therefore integrate data on relevant biomarkers related to B-vitamins status and tryptophan metabolism.
Read more<p>Supplementary Figure 1: Pooled adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the association between intake of proton-pump inhibitors and gastric cancer, stratified by H. pylori infection and socioeconomic status (SES).</p>
Read moreDSM-IV categorized obsessive-compulsive disorder (OCD) as an anxiety disorder, body dysmorphic disorder (BDD) as a somatoform disorder, and trichotillomania as an impulse control disorder not elsewhere classified. In DSM-5, these three disorders, together with hoarding disorder and excoriation (skin picking) disorder, which are new disorders in DSM-5, are classified together in a new chapter of obsessive-compulsive and related disorders. In this paper we consider some of the relevant considerations at play in making this change, some of the potential advantages and disadvantages of this new chapter, and a number of potential research and clinical misconceptions about the new chapter. Keywords: DSM-IV, obsessive-compulsive and related disorders.
Read more<p>Supplementary Table 4: Pooled adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the association between intake of proton-pump inhibitors and gastric cancer from the leave-one-out meta-analysis.</p>
Read more<p>Supplementary Table 2: Questionnaire items used to assess exposure for each study included in the analysis.</p>
Read more<p>Supplementary Table 1: Main characteristics of the studies included in the analysis.</p>
Read moreThere is moderate quality evidence for the efficacy of hydrocortisone for the prevention of PTSD development in adults. We found no evidence to support the efficacy of propranolol, escitalopram, temazepam and gabapentin in preventing PTSD onset. The findings, however, are based on a few small studies with multiple limitations. Further research is necessary in order to determine the efficacy of pharmacotherapy in preventing PTSD and to identify potential moderators of treatment effect.
Read more<p>Supplementary Table 4: Pooled adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the association between intake of proton-pump inhibitors and gastric cancer from the leave-one-out meta-analysis.</p>
Read more<div>AbstractBackground:<p>A potential association between proton-pump inhibitors (PPI) and gastric cancer remains undefined. Thus, we aimed to evaluate such association within the Stomach cancer Pooling (StoP) Project.</p>Methods:<p>Data from five case–control studies of the StoP Project were included (1,889 cases and 6,517 controls). We assessed the impact of different exposure definitions, specifically any reported use of PPIs and exposure definitions based on the duration of PPI intake. Additionally, we modeled the dose–response relationship between the cumulative duration of PPI intake and gastric cancer.</p>Results:<p>Significant associations between PPI intake and gastric cancer, both overall and in the stratified analyses, were limited to exposure definitions based on short durations of intake. The overall odds ratio (OR) for any reported PPI intake was 1.78 [95% confidence interval (CI): 0.76–4.14]. In the dose–response analysis, the ORs of gastric cancer were found to be higher for short durations of PPI intake (6 months: OR 3.26; 95% CI: 2.40–4.42; one year: OR 2.14; 95% CI: 1.69–2.70; 2 years: OR 1.50; 95% CI: 1.22–1.85; 3 years: OR 1.27; 95% CI: 1.03–1.56), with the association becoming not significant for durations longer than 3 years.</p>Conclusions:<p>Our findings suggest that the observed association between PPIs and gastric cancer might be mainly due to reverse causality.</p>Impact:<p>The results of this study suggest that PPIs are a safe therapeutic choice regarding their effect on the occurrence of gastric cancer.</p></div>
Read more<p>Supplementary Table 1: Main characteristics of the studies included in the analysis.</p>
Read moreOur findings indicate that plasma neopterin, KTR, and CRP are associated with a significantly increased risk of overall cancer. Our study revealed novel evidence regarding the role of IFN-γ-induced inflammation in human carcinogenesis.
Read moreThe functional BDNF polymorphism influences brain volume in regions associated with memory and regulation of sensorimotor control, with the Met rs6265 allele potentially being more beneficial to these functions in the elderly.
Read moreThese preliminary findings suggest that the BDNF p.Met66 allele and childhood trauma may not be associated with reduced structural volumes in AUD. Other genetic contributors should be investigated in future studies.
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