Psychologists' Perspectives on the Diagnostic Classification of Mental Disorders: Results from the WHO-IUPsyS Global Survey

BACKGROUND/PURPOSE: Revisions are underway for the two major diagnostic classification systems (DCSs) of mental disorders, the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). For the World Health Organization (WHO), improving clinical utility is a major priority for the ICD-11. International clinician surveys are informative in this regard, but such research has not been conducted among psychologists. This study investigates psychologists' views on DCSs in mental health care and how these views differ across countries, regions, and ICD-10 versus DSM-IV users. METHODS: WHO and the International Union of Psychological Science conducted an international online survey examining views of DCSs as part of the ICD revision process. Participants were 2,155 psychologists from 23 national psychological associations around the globe. Items addressed practical and conceptual issues related to DCSs and their clinical use. RESULTS: Majorities of participating psychologists were licensed, seeing patients, made diagnoses, and used a DCS regularly, the slight majority using the ICD-10 most often. The vast majority viewed the primary purpose of DCSs to be informing treatment decisions and facilitating clinical communication. Flexible diagnostic guidelines were preferred to strict criteria. Most respondents agreed that dimensional classification, severity, and functional impairment should be incorporated into a DCS, but with little agreement as to how or why. Significant percentages reported problems with their DCS including cross-cultural applicability, Western bias, stigmatizing terms, and a need for a national DCS. Clinicians favorably evaluated the ease of use and goodness of fit of most diagnoses, but identified some as problematic. There were more differences among regions and countries than between ICD-10 and DSM-IV users. CONCLUSIONS: Overall, psychologists' views reflect favorably upon the current ICD-10 and DSM-IV systems and categories, while also identifying areas for improvement. Findings underscore the priority of clinical utility in a DCS, the diverse purposes it must serve, and professional and cultural differences among its international users. Differences associated with countries/regions, DCSs, and psychologists and psychiatrists may be partially explained by country-level differences in health systems, cultural factors, and psychology. Implications for ICD-11 revisions, field trials, dissemination, and training efforts are discussed

Peer Rejection and Academic Performance in the Link between Aggression and Depressive Symptoms: A Longitudinal Examination of Alternative Developmental Pathways

BACKGROUND: The failure model posits that peer rejection and poor academic performance may account for the longitudinal association between children’s aggressive behavior and subsequent depressive symptoms. However, the theory is unclear and evidence is mixed regarding the temporal sequence, relative magnitude, and possible interaction of these two mediators. Incorporating the functions of aggressive behavior may shed further light on these developmental pathways given that reactive, but not proactive, aggression is particularly associated with depressive symptoms and poor social and academic functioning. The present study investigated alternative pathways from early reactive aggression to subsequent peer rejection, academic performance, and depressive symptoms. METHOD: A school sample of children (N = 963; ages 6-12; 49% female) was assessed annually by their primary classroom teachers over three years. Ratings of proactive and reactive aggression, peer rejection, academic performance, and depressive symptoms were collected. Following an accelerated design, path models were estimated to examine peer rejection and academic performance as developmental pathways from aggression subtypes in first grade to depressive symptoms in fifth grade. Developmental cascade sequences, interactions, and gender differences were also examined. RESULTS: Reactive aggression in first grade predicted peer rejection and poor academic performance in third grade, whereas proactive aggression predicted better academic performance. For girls, proactive aggression predicted lower peer rejection, and the path from reactive aggression to peer rejection was stronger than it was for boys. From third to fifth grade, peer rejection predicted subsequent depressive symptoms for boys only. The direct and moderated academic pathways to depressive symptoms were nonsignificant. CONCLUSIONS: Results provide partial support for the failure model, particularly for the developmental pathways from reactive aggression to peer rejection to depressive symptoms. These findings highlight the importance of reactive aggression and peer functioning as key developmental mechanisms during middle childhood and as possible targets for assessment and intervention in the school context. Early reactive aggression appears to be a central risk factor for social and academic problems, while peer rejection in third grade appears to be a risk factor for depressive symptoms for boys. Limitations and implications for future research are discussed

Imaging Hepatocellular Carcinoma With 68Ga-Citrate PET: First Clinical Experience.

While cross-sectional imaging with computed tomography (CT) and magnetic resonance imaging is the primary method for diagnosing hepatocellular carcinoma (HCC), they provide little biological insight into this molecularly heterogeneous disease. Nuclear imaging tools that can detect molecular subsets of tumors could greatly improve diagnosis and management of HCC. To this end, we conducted a patient study to determine whether HCC can be resolved using 68Ga-citrate positron emission tomography (PET). One patient with recurrent HCC was injected with 300 MBq of 68Ga-citrate and imaged with PET/CT 249 minutes post injection. Four (28%) of 14 hepatic lesions were avid for 68Ga-citrate. One extrahepatic lesion was not PET avid. The average maximum standardized uptake value (SUVmax) for the lesions was 7.2 (range: 6.2-8.4), while the SUVmax of the normal liver parenchyma was 4.7 and blood pool was 5.7. The avid lesions were not significantly larger than the quiescent lesions, and a prior contrast CT showed uniform enhancement among the lesions, suggesting that tumor signals are due to specific binding of the radiotracer to the transferrin receptor, rather than enhanced vascularity in the tumor microenvironment. Further studies are required in a larger patient cohort to verify the molecular basis of radiotracer uptake and the clinical utility of this tool

Repeated games for eikonal equations, integral curvature flows and non-linear parabolic integro-differential equations

The main purpose of this paper is to approximate several non-local evolution equations by zero-sum repeated games in the spirit of the previous works of Kohn and the second author (2006 and 2009): general fully non-linear parabolic integro-differential equations on the one hand, and the integral curvature flow of an interface (Imbert, 2008) on the other hand. In order to do so, we start by constructing such a game for eikonal equations whose speed has a non-constant sign. This provides a (discrete) deterministic control interpretation of these evolution equations. In all our games, two players choose positions successively, and their final payoff is determined by their positions and additional parameters of choice. Because of the non-locality of the problems approximated, by contrast with local problems, their choices have to "collect" information far from their current position. For integral curvature flows, players choose hypersurfaces in the whole space and positions on these hypersurfaces. For parabolic integro-differential equations, players choose smooth functions on the whole space

Problematic, absent and stigmatizing diagnoses in current mental disorders classifications: Results from the WHO-WPA and WHO-IUPsyS Global Surveys

This study examined English- and Spanish-speaking psychologists' and psychiatrists' opinions regarding problematic, absent and stigmatizing diagnoses in current mental disorders classifications (ICD-10 and DSM-IV), and their perceived need for a national classification of mental disorders. Answers to open-ended questions included in WHO-WPA and WHO-IUPsyS surveys were examined using an inductive content-analysis method. A total of 3,222 participants from 35 countries were included. The most problematic diagnostic group was personality disorders, especially among psychiatrists, because of poor validity and lack of specificity. Complex posttraumatic stress disorder was the most frequent diagnosis suggested for inclusion, mainly by psychologists, to better account for the distinct processes and consequences of complex trauma. Schizophrenia was the diagnosis most frequently identified as stigmatizing, particularly by psychiatrists, due to lack of public understanding or knowledge about the diagnosis. Of the 14.4% of participants who perceived a need for a national classification system, two-thirds were from Africa or Latin America. The rationales provided were that mental disorders classifications should consider cultural and socio-historical diversity in the expression of psychopathology, differences in the perception of what is and is not pathological in different nations, and the existence of culture-bound syndromes. Implications for ICD-11 development and dissemination are discussed. © 2014 Asociación Española de Psicología Conductual

Melting mud in Earth's mantle

Melting of subducted sediment remains controversial, as direct observation of sediment melt generation at mantle depths is not possible. Geochemical fingerprints provide indirect evidence for subduction delivery of sediment to the mantle; however, sediment abundance in mantle-derived melt is generally low (0%–2%), and difficult to detect. Here we provide evidence for melting of subducted sediment in granite sampled from an exhumed mantle section. Peraluminous granite dikes that intrude peridotite in the Oman–United Arab Emirates ophiolite have U-Pb ages of 99.8 ± 3.3 Ma that predate obduction. The dikes have unusually high oxygen isotope (δ18O) values for whole rock (14–23‰) and quartz (20–22‰), and yield the highest δ18O zircon values known (14–28‰; values relative to Vienna standard mean ocean water [VSMOW]). The extremely high oxygen isotope ratios uniquely identify the melt source as high-δ18O marine sediment (pelitic and/or siliciceous mud), as no other source could produce granite with such anomalously high δ18O. Formation of high-δ18O sediment-derived (S-type) granite within peridotite requires subduction of sediment to the mantle, where it melted and intruded overlying mantle wedge. The granite suite described here contains the highest oxygen isotope ratios reported for igneous rocks, yet intruded mantle peridotite below the Mohorovičić seismic discontinuity, the most primitive oxygen isotope reservoir in the silicate Earth. Identifying the presence and quantifying the extent of sediment melting within the mantle has important implications for understanding subduction recycling of supracrustal material and effects on mantle heterogeneity over time.National Geographi

Consumption of cocoa flavanols results in acute improvements in mood and cognitive performance during sustained mental effort

Cocoa flavanols (CF) positively influence physiological processes in ways that suggest their consumption may improve aspects of cognitive function. This study investigated the acute cognitive and subjective effects of CF consumption during sustained mental demand. In this randomized, controlled, double-blinded, balanced, three period crossover trial 30 healthy adults consumed drinks containing 520 mg, 994 mg CF and a matched control, with a three-day washout between drinks. Assessments included the state anxiety inventory and repeated 10-min cycles of a Cognitive Demand Battery comprising of two serial subtraction tasks (Serial Threes and Serial Sevens), a Rapid Visual Information Processing (RVIP) task and a mental fatigue scale, over the course of 1 h. Consumption of both 520 mg and 994 mg CF significantly improved Serial Threes performance. The 994 mg CF beverage significantly speeded RVIP responses but also resulted in more errors during Serial Sevens. Increases in self-reported mental fatigue were significantly attenuated by the consumption of the 520 mg CF beverage only. This is the first report of acute cognitive improvements following CF consumption in healthy adults. While the mechanisms underlying the effects are unknown they may be related to known effects of CF on endothelial function and blood flow

Exploiting transient protein states for the design of small-molecule stabilizers of mutant p53

The destabilizing p53 cancer mutation Y220C creates an extended crevice on the surface of the protein that can be targeted by small-molecule stabilizers. Here, we identify different classes of small molecules that bind to this crevice and determine their binding modes by X-ray crystallography. These structures reveal two major conformational states of the pocket and a cryptic, transiently open hydrophobic subpocket that is modulated by Cys220. In one instance, specifically targeting this transient protein state by a pyrrole moiety resulted in a 40-fold increase in binding affinity. Molecular dynamics simulations showed that both open and closed states of this subsite were populated at comparable frequencies along the trajectories. Our data extend the framework for the design of high-affinity Y220C mutant binders for use in personalized anticancer therapy and, more generally, highlight the importance of implementing protein dynamics and hydration patterns in the drug-discovery process

Chemistry of hydrogen oxide radicals (HO_x) in the Arctic troposphere in spring

We use observations from the April 2008 NASA ARCTAS aircraft campaign to the North American Arctic, interpreted with a global 3-D chemical transport model (GEOS-Chem), to better understand the sources and cycling of hydrogen oxide radicals (HO_x≡H+OH+peroxy radicals) and their reservoirs (HO_y≡HO_x+peroxides) in the springtime Arctic atmosphere. We find that a standard gas-phase chemical mechanism overestimates the observed HO_2 and H_2O_2 concentrations. Computation of HO_x and HO_y gas-phase chemical budgets on the basis of the aircraft observations also indicates a large missing sink for both. We hypothesize that this could reflect HO_2 uptake by aerosols, favored by low temperatures and relatively high aerosol loadings, through a mechanism that does not produce H_2O_2. We implemented such an uptake of HO_2 by aerosol in the model using a standard reactive uptake coefficient parameterization with γ(HO_2) values ranging from 0.02 at 275 K to 0.5 at 220 K. This successfully reproduces the concentrations and vertical distributions of the different HO_x species and HO_y reservoirs. HO_2 uptake by aerosol is then a major HO_x and HO_y sink, decreasing mean OH and HO_2 concentrations in the Arctic troposphere by 32% and 31% respectively. Better rate and product data for HO_2 uptake by aerosol are needed to understand this role of aerosols in limiting the oxidizing power of the Arctic atmosphere

Effect of vegetation cover and sediment type on 3D subsurface structure and shear strength in saltmarshes

Funder: Queen Mary; Id: http://dx.doi.org/10.13039/100009148Abstract: The vulnerability of saltmarshes to lateral erosion at their margin depends on the local biogeomorphological properties of the substrate. In particular, the 3D architecture of pore and root systems is expected to influence shear strength, with repercussions for the wider‐scale stability of saltmarshes. We apply X‐ray computed microtomography (μCT) to visualize and quantify subsurface structures in two UK saltmarshes at Tillingham Farm, Essex (silt/clay rich substrate) and Warton Sands (sand‐rich substrate), with four types of ground cover: bare ground, Spartina spp, Salicornia spp and Puccinellia spp. We extracted μCT structural parameters that characterize pore and root morphologies at each station, and compared them with field measurements of shear strength using a principal component analysis and correlation tests. The 3D volumes show that species‐dependent variations in root structures, plant colonization events and bioturbation activity control the morphology of macropores, while sediment cohesivity determines the structural stability and persistence of these pore structures over time, even after the vegetation has died. Areas of high porosity and high mean pore thickness were correlated to lower values of shear strength, especially at Tillingham Farm, where well‐connected vertical systems of macropores were associated with current or previous colonization by Spartina spp. However, while well‐connected systems of macropores may lower the local deformation threshold of the sediment, they also encourage drainage, promote vegetation growth and reduce the marsh vulnerability to hydrodynamic forces. The highest values of shear strength at both sites were found under Puccinellia spp, and were associated with a high density of mesh‐like root structures that bind the sediment and resist deformation. Future studies of marsh stability should ideally consider time series of vegetation cover, especially in silt/clay‐dominated saltmarshes, in order to consider the potential effect of preserved buried networks of macropores on water circulation, marsh functioning and cliff‐face erosion