SM-5, ICD-11, RDoC and the Future of Psychiatric Classification

2017 ◽  
Vol 41 (S1) ◽  
pp. S31-S31
Author(s):  
M. Maj
Keyword(s):  
Clinical Utility ◽  
Psychiatric Diagnoses ◽  
Diagnostic Categories ◽  
Dsm 5 ◽  
Clinical Phenomenology ◽  
Behavioural Phenotypes ◽  
Competing Interest ◽  
The One ◽  
Definition Of ◽  
Psychiatric Profession

The publication of the DSM-III in 1980 was intended to be a reaction to the evidence of the embarrassingly low reliability of psychiatric diagnoses, which was perceived as a major threat to the credibility of the psychiatric profession. The aims of the DSM-III project were actually two. First, the reliable definition of the diagnostic categories was expected to lead to the collection of research data that would validate those diagnostic entities and in particular elucidate their etiopathogenetic underpinnings. Second, there was an expectation that, by increasing reliability, communication among clinicians would be improved and clinical decisions made more rational. Today, one could say that the first aim of the project has not been achieved, while the fulfilment of the second aim has never been tested appropriately. The crisis of confidence in the DSM paradigm, clearly emerging from the debate following the publication of the DSM-5, has led on the one hand to a renewed emphasis on clinical utility, which is featuring prominently in the ongoing process of development of the ICD-11. On the other hand, it has led to a radical attempt to reform psychiatric nosology starting from neurobiological and behavioural phenotypes. This attempt does have its weaknesses, but may also represent a stimulus to reconceptualize some psychopathological constructs, especially in the area of psychoses, in order to reduce the gap between the level of neuroscience and that of clinical phenomenology.Disclosure of interestThe author has not supplied his declaration of competing interest.

Exact psychiatry: Six axioms

2017 ◽  
Vol 41 (S1) ◽  
pp. S330-S330
Author(s):  
M.L. Vargas
Keyword(s):  
Social Cohesion ◽  
Theoretical Models ◽  
Scientific Discipline ◽  
Brain Diseases ◽  
Cultural Constructs ◽  
Personal Impact ◽  
Health Related ◽  
Clinical Phenomenology ◽  
Competing Interest ◽  
Definition Of

Psychiatry is a clinical technological practice where the rational fundaments, methods and knowledge “corpus” have a scientific nature. The science philosopher Mario Bunge proposes that philosophy, as well as science, may tend to be exact. Philosophy of science is the rational setting where any scientific discipline can ascribe sense to its theoretical models and factual sentences. Axiomatization is the method to exactify a discipline. By axiomatization, we can exactify psychiatry as “medicine of the soma”, therefore avoiding fallacies in the theoretical models we use.ObjectiveTo describe six axioms for the definition of “exact psychiatry” as “medicine of the soma”. Six axioms will be defined and explained. They are ordered attending to hierarchical and historical priority:–axiom of the cultural universal of social cohesion: since the antiquity all cultures have cultural universals which promote social cohesion;–axiom of healing as a form of “isonomia”: health-related cultural constructs are related with help receiving due to body vulnerability. It appears with Hippocratic medicine;–axiom of nosological realism: diseases really exist. They are biological regularities that accelerate death. It appears in the 17th century;–axiom of illness subjectivity: the personal impact of disease is subjective. There exist diseases in patients. It appears in the 20th century;–axiom of the unification of neuroscience: psychiatry and neurology have the same ontological reference, brain diseases. It consolidates in the 21st century;–axiom of clinical phenomenology as the epistemological specificity of psychiatry: clinical phenomenology characterizes “soma” as the referring of psychiatry. The future.Disclosure of interestThe author has not supplied his declaration of competing interest.

Transcultural issues in diagnostic process

2016 ◽  
Vol 33 (S1) ◽  
pp. S23-S24
Author(s):  
M. Kastrup
Keyword(s):  
Cultural Values ◽  
Cultural Context ◽  
Value Systems ◽  
Treatment Modalities ◽  
Diagnostic Process ◽  
Diagnostic Systems ◽  
Ethical Guidelines ◽  
Diagnostic Categories ◽  
Competing Interest ◽  
Psychiatric Profession

Diagnostic systems and methods must respond to patients’ diversity in expressions of mental distress, social and cultural context and the meanings given to illness. Due to increasing migration and globalisation the challenge of considering diagnosis in the context of culture has become increasingly significant in Europe. And globalization has further led to changes in value systems and our awareness of patients with ethnic minority background.Over recent decades, there has been an increasing development of psychiatric diagnosing with nosological categorisation combined with multi-axial schemas. Diagnosis, besides identifying a disorder and distinguishing one disorder from another disorder - differential diagnosis, has also an aim to include an overall understanding of the patient's situation.We witness an upsurge in the attention paid to the cultural limitations to psychiatric diagnostic practice and treatment modalities. Guidelines for the psychiatric profession are in critical focus from a transcultural perspective. Some claim their universality independent of cultural context; others find cultural adaptation useful and necessary.Do the diagnoses and clinical and ethical guidelines give meaning in the cultural setting? Are they compatible with the cultural values of the therapist and those of the patient and the family? Several sources claim the biomedical paradigm for being Western with insufficient consideration of the socio-political context.The cultural formulation developed as part of DSM-IV and now DSM-5 is one model to support a systematic review of culture and context in psychiatric diagnosing.The paper will discuss the advantages and shortcomings of current diagnostic categories and guidelines vis-à-vis the universe of traumatized refugees with other ethnic backgrounds.URL:http://www.mariannekastrup.dk/Disclosure of interestThe author has not supplied his declaration of competing interest.

scholarly journals What is a mental disorder? An exemplar-focused approach

2021 ◽  
pp. 1-8
Author(s):  
Dan J. Stein ◽  
Andrea C. Palk ◽  
Kenneth S. Kendler
Keyword(s):  
Mental Disorder ◽  
Clinical Utility ◽  
Careful Consideration ◽  
Diagnostic Validity ◽  
Philosophy Of Psychiatry ◽  
Practical Judgment ◽  
Dsm 5 ◽  
Practical Guidelines ◽  
Definition Of ◽  
Practical Implications

Abstract The question of ‘what is a mental disorder?’ is central to the philosophy of psychiatry, and has crucial practical implications for psychiatric nosology. Rather than approaching the problem in terms of abstractions, we review a series of exemplars – real-world examples of problematic cases that emerged during work on and immediately after DSM-5, with the aim of developing practical guidelines for addressing future proposals. We consider cases where (1) there is harm but no clear dysfunction, (2) there is dysfunction but no clear harm, and (3) there is possible dysfunction and/or harm, but this is controversial for various reasons. We found no specific criteria to determine whether future proposals for new entities should be accepted or rejected; any such proposal will need to be assessed on its particular merits, using practical judgment. Nevertheless, several suggestions for the field emerged. First, while harm is useful for defining mental disorder, some proposed entities may require careful consideration of individual v. societal harm, as well as of societal accommodation. Second, while dysfunction is useful for defining mental disorder, the field would benefit from more sharply defined indicators of dysfunction. Third, it would be useful to incorporate evidence of diagnostic validity and clinical utility into the definition of mental disorder, and to further clarify the type and extent of data needed to support such judgments.

Philosophical Issues in Psychiatry IV

2017 ◽  
Keyword(s):  
Steering Committee ◽  
Psychiatric Research ◽  
Psychiatric Diagnoses ◽  
Foreseeable Future ◽  
Philosophy Of Psychiatry ◽  
Psychiatric Nosology ◽  
Dsm 5 ◽  
Wide Range ◽  
Continuous Improvement Model ◽  
Definition Of

This book contains, in addition to an introduction, sixteen chapters, each with its own introduction and discussion, that review various issues within psychiatric nosology from clinical, historical and particularly philosophical perspectives. The contributors to this book include major psychiatric researchers, clinicians, historians and especially nosologists (including several leaders of the DSM-5 effort and the DSM Steering Committee that will be guiding future revisions in DSM for the foreseeable future), psychologists with a special interest in psychiatric nosology and philosophers with a wide range of orientations. The book is organized into four major sections. The first explores the nature of psychiatric illness and the ways in which define it including clinical and psychometric perspectives. The second section examines problems in the reification of psychiatric diagnostic criteria, the problem of psychiatric epidemics and the nature and definition of individual symptoms. The third session explores the concept of epistemic iteration as a possible governing conceptual framework for the revision efforts for official psychiatric nosologies such as DSM and ICD and the problems of validation of psychiatric diagnoses. The final session explores how we might move from the descriptive to the etiologic in psychiatric diagnoses, the nature of progress in psychiatric research and the possible benefits of moving to a living document (or continuous improvement) model for psychiatric nosologic systems. The organization of the book—with its introduction and comments—well captures the dynamic cross-disciplinary interactions that characterize the best work in the philosophy of psychiatry.

Understanding functional illiteracy from a policy, adult education, and cognition point of view: Towards a joint referent framework

2019 ◽  
Vol 30 (2) ◽  
pp. 109-122
Author(s):  
Aleksandar Bulajić ◽  
Miomir Despotović ◽  
Thomas Lachmann
Keyword(s):  
Adult Education ◽  
Operational Definition ◽  
Literacy Skills ◽  
Point Of View ◽  
Industrialized Countries ◽  
Functional Illiteracy ◽  
Scale Levels ◽  
Components Of Reading ◽  
The One ◽  
Definition Of

Abstract. The article discusses the emergence of a functional literacy construct and the rediscovery of illiteracy in industrialized countries during the second half of the 20th century. It offers a short explanation of how the construct evolved over time. In addition, it explores how functional (il)literacy is conceived differently by research discourses of cognitive and neural studies, on the one hand, and by prescriptive and normative international policy documents and adult education, on the other hand. Furthermore, it analyses how literacy skills surveys such as the Level One Study (leo.) or the PIAAC may help to bridge the gap between cognitive and more practical and educational approaches to literacy, the goal being to place the functional illiteracy (FI) construct within its existing scale levels. It also sheds more light on the way in which FI can be perceived in terms of different cognitive processes and underlying components of reading. By building on the previous work of other authors and previous definitions, the article brings together different views of FI and offers a perspective for a needed operational definition of the concept, which would be an appropriate reference point for future educational, political, and scientific utilization.

Democracy and Political Culture

2019 ◽  
Author(s):  
Ross McKibbin
Keyword(s):  
Political Culture ◽  
Case Studies ◽  
Social System ◽  
Political System ◽  
Democratic Politics ◽  
Social Structures ◽  
The Political ◽  
The Subject ◽  
The One ◽  
Definition Of

This book is an examination of Britain as a democratic society; what it means to describe it as such; and how we can attempt such an examination. The book does this via a number of ‘case-studies’ which approach the subject in different ways: J.M. Keynes and his analysis of British social structures; the political career of Harold Nicolson and his understanding of democratic politics; the novels of A.J. Cronin, especially The Citadel, and what they tell us about the definition of democracy in the interwar years. The book also investigates the evolution of the British party political system until the present day and attempts to suggest why it has become so apparently unstable. There are also two chapters on sport as representative of the British social system as a whole as well as the ways in which the British influenced the sporting systems of other countries. The book has a marked comparative theme, including one chapter which compares British and Australian political cultures and which shows British democracy in a somewhat different light from the one usually shone on it. The concluding chapter brings together the overall argument.

An LQ Approach to Active Control of Vibrations in Helicopters

1996 ◽  
Vol 118 (3) ◽  
pp. 482-488 ◽  
Author(s):  
Sergio Bittanti ◽  
Fabrizio Lorito ◽  
Silvia Strada
Keyword(s):  
Optimal Control ◽  
Active Control ◽  
Linear Quadratic ◽  
Control Effort ◽  
Vibration Effect ◽  
Suitable Definition ◽  
Lq Optimal Control ◽  
The One ◽  
Definition Of ◽  
And Control

In this paper, Linear Quadratic (LQ) optimal control concepts are applied for the active control of vibrations in helicopters. The study is based on an identified dynamic model of the rotor. The vibration effect is captured by suitably augmenting the state vector of the rotor model. Then, Kalman filtering concepts can be used to obtain a real-time estimate of the vibration, which is then fed back to form a suitable compensation signal. This design rationale is derived here starting from a rigorous problem position in an optimal control context. Among other things, this calls for a suitable definition of the performance index, of nonstandard type. The application of these ideas to a test helicopter, by means of computer simulations, shows good performances both in terms of disturbance rejection effectiveness and control effort limitation. The performance of the obtained controller is compared with the one achievable by the so called Higher Harmonic Control (HHC) approach, well known within the helicopter community.

scholarly journals Beyond Classical Definition: The Non-definition of Gamification

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Mario S. Staller ◽  
Swen Koerner
Keyword(s):  
Empirical Investigation ◽  
Working Life ◽  
Pedagogical Practice ◽  
Police Recruits ◽  
Design Elements ◽  
The Subject ◽  
Anchor Points ◽  
The One ◽  
Definition Of ◽  
Game Elements

AbstractGamification is regularly defined as the use of game elements in non-gaming contexts. However, discussions in the context of the pedagogical value of gamification suggest controversies on various levels. While on the one hand, the potential is seen in the design of joyful learning environments, critics point out the pedagogical dangers or the problems related to optimizing working life. It becomes apparent that the assumptions guiding action on the subject matter of gamification in educational contexts differ, which leads to different derivations for pedagogical practice—but also allows for different perspectives on initially controversial positions. Being aware of these assumptions is the claim of a reflexive pedagogy. With regard to the pedagogical use of gamifying elements and their empirical investigation, there are three main anchor points to consider from a reflexive stance: (a) the high context-specificity of the teaching undertaken and (b) the (non-)visibility of the design elements and (c) the (non-)acceptance of the gamified elements by the students. We start by providing a discussion of the definitional discourse on what is understood as gamification leading to our argument for a non-definition of gamification. We describe the potential of this non-definition of gamification and exemplify its use in a gamified concept of teaching police recruits professional reflexivity. The concept features the narrative of a potential crime that has been undertaken and that students decide for themselves if they want to engage with it.

scholarly journals The contribution of resident physicians to hospital productivity

2021 ◽  
Author(s):  
Maria J. Perez-Villadóniga ◽  
Ana Rodriguez-Alvarez ◽  
David Roibas
Keyword(s):  
Production Functions ◽  
Weighted Sum ◽  
Main Hypothesis ◽  
Resident Physicians ◽  
Suitable Parameter ◽  
Functional Forms ◽  
The One ◽  
Definition Of ◽  
Hospital Productivity ◽  
Natural Hypothesis

AbstractResident physicians play a double role in hospital activity. They participate in medical practices and thus, on the one hand, they should be considered as an input. Also, they are medical staff in training and, on the other hand, must be considered as an output. The net effect on hospital activities should therefore be empirically determined. Additionally, when considering their role as active physicians, a natural hypothesis is that resident physicians are not more productive than senior ones. This is a property that standard logarithmic production functions (including Cobb–Douglas and Translog functional forms) cannot verify for the whole technology set. Our main contribution is the development of a Translog modification, which implies the definition of the input “doctors” as a weighted sum of senior and resident physicians, where the weights are estimated from the empirical application. This modification of the standard Translog is able, under suitable parameter restrictions, to verify our main hypothesis across the whole technology set while determining if the net effect of resident physicians in hospitals’ production should be associated to an output or to an input. We estimate the resulting output distance function frontier with a sample of Spanish hospitals. Our findings show that the overall contribution of resident physicians to hospitals’ production allows considering them as an input in most cases. In particular, their average productivity is around 37% of that corresponding to senior physicians.

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