Estimaciones e Implicaciones de la Prevalencia del Trastorno Obsesivo-Compulsivo: ¿Trastorno habitual con una distribución cosmopolita o estrategia infrecuente con una distribución septentrional?

DSM-V estimates the prevalence of Obsessive Compulsive Personality Disorder (OCPD) to fall between 2.1 and 7.9 percent, making it one of the most prevalent personality disorders in the general population. Yet, obsessive prevalence is reported without its significance being appreciated. After reviewing the estimates of several studies, this paper pursues the theme of obsessive prevalence, showing why it was ignored, how it changes etiological assumptions, and, in turn, how newly generated etiologies engender the understanding of obsessive prevalence. High prevalence, when paired with high heritability, undermines psychoanalytic etiologies and invalidates psychiatric classification, suggesting that OCPD is a rare type, rather than a common disorder. Following this, evolutionary theory is used to illustrate the conditions from which this rare phenotype arose, and the mechanistic laws that maintain it within its present proportions. As treated within the discussion section, high prevalence, when contextualized within an evolutionary explanatory paradigm, suggests an ecologically determined biogeography of OCPD.El DSM-V estima que la prevalencia del trastorno obsesivo-compulsivo oscila entre el 2,1 y el 7,9 por ciento, lo que lo convierte en uno de los trastornos de personalidad de mayor prevalencia en la población general. Sin embargo, la prevalencia del trastorno se suele publicar sin valorar las implicaciones de este hecho. Tras la revisión de las estimaciones que aparecen en varios estudios, este artículo analiza por qué se ha ignorado la prevalencia de este trastorno, cómo cambia este hecho los supuestos etiológicos y el modo en que las nuevas etiologías propuestas ayudan a comprender la prevalencia del trastorno obsesivo-compulsivo. La elevada prevalencia unida a la alta heredabilidad ponen en tela de juicio la etiología psicoanalítica e invalidan la clasificación psiquiátrica, y además sugieren que el trastorno obsesivo-compulsivo no es común, sino infrecuente. Siguiendo esta línea argumental, se utiliza la teoría evolucionista para ilustrar las condiciones bajo las que surge este fenotipo infrecuente y las leyes mecanicistas que lo mantienen en sus actuales proporciones. Tal y como se plantea en la discusión, cuando la elevada prevalencia del trastorno obsesivo-compulsivo se contextualiza dentro de un paradigma evolucionista, aflora la existencia de una biogeografía ecológicamente determinada de este trastorno

Acceptance of Digital Health Technologies in Palliative Care Patients

BACKGROUND: Digital health technologies have potential to transform palliative care (PC) services. The global aging population poses unique challenges for PC, which digital health technologies may help overcome. Evaluation of attitudes and perceptions combined with quantification of prior use habits favor an understanding of psychological barriers to PC patient acceptance of digital health technologies including artificial intelligence (AI). OBJECTIVES: We aimed to evaluate the attitudes and perceptions of PC patients regarding a broad range of digital health technologies used in their routine monitoring and treatment and identify barriers to use. METHODS: We used a 39-item questionnaire to evaluate acceptance and use of smartphone-based electronic patient report outcome measures, wearables, AI, data privacy, and virtual reality (VR) in 29 female and male PC inpatients. RESULTS: A majority of patients indicated an interest in (69.0%) and positive attitude toward (75.9%) digital health technologies. Nearly all (93.1%) patients believe that digital health technologies will become more important in medicine in the future. Most patients would consider using their smartphone (79.3%) or wearable (69.0%) more often for their health. The most feasible technologies were smartphones, wearables, and VR. Barriers to acceptance included unfamiliarity, data security, errors in data interpretation, and loss of personal interaction through AI. CONCLUSION: In this patient survey, acceptance of new technologies in a PC patient population was high, encouraging its use also at the end-of-life

Biodiversity assessment of tropical shelf eukaryotic communities via pelagic eDNA metabarcoding

Our understanding of marine communities and their functions in an ecosystem relies on the ability to detect and monitor species distributions and abundances. Currently, the use of environmental DNA (eDNA) metabarcoding is increasingly being applied for the rapid assessment and monitoring of aquatic species. Most eDNA metabarcoding studies have either focussed on the simultaneous identification of a few specific taxa/groups or have been limited in geographical scope. Here, we employed eDNA metabarcoding to compare beta diversity patterns of complex pelagic marine communities in tropical coastal shelf habitats spanning the whole Caribbean Sea. We screened 68 water samples using a universal eukaryotic COI barcode region and detected highly diverse communities, which varied significantly among locations, and proved good descriptors of habitat type and environmental conditions. Less than 15% of eukaryotic taxa were assigned to metazoans, most DNA sequences belonged to a variety of planktonic “protists,” with over 50% of taxa unassigned at the phylum level, suggesting that the sampled communities host an astonishing amount of micro‐eukaryotic diversity yet undescribed or absent from COI reference databases. Although such a predominance of micro‐eukaryotes severely reduces the efficiency of universal COI markers to investigate vertebrate and other metazoans from aqueous eDNA, the study contributes to the advancement of rapid biomonitoring methods and brings us closer to a full inventory of extant marine biodiversity

Depression and anxiety in glioma patients

Glioma patients carry the burden of having both a progressive neurological disease and cancer, and may face a variety of symptoms, including depression and anxiety. These symptoms are highly prevalent in glioma patients (median point prevalence ranging from 16% to 41% for depression and 24% to 48% for anxiety when assessed by self-report questionnaires) and have a major impact on health-related quality of life and even overall survival time. A worse overall survival time for glioma patients with depressive symptoms might be due to tumor progression and/or its supportive treatment causing depressive symptoms, an increased risk of suicide or other (unknown) factors. Much is still unclear about the etiology of depressive and anxiety symptoms in glioma. These psychiatric symptoms often find their cause in a combination of neurophysiological and psychological factors, such as the tumor and/or its treatment. Although these patients have a particular idiosyncrasy, standard treatment guidelines for depressive and anxiety disorders apply, generally recommending psychological and pharmacological treatment. Only a few non-pharmacological trials have been conducted evaluating the efficacy of psychological treatments (e.g., a reminiscence therapy-based care program) in this population, which significantly reduced depressive and anxiety symptoms. No pharmacological trials have been conducted in glioma patients specifically. More well designed trials evaluating the efficacy of (non-)pharmacological treatments for depressive and anxiety disorders in glioma are urgently needed to successfully treat psychiatric symptoms in brain tumor patients and to improve (health-related) quality of life

Evidence for a subcortical origin of mirror movements after stroke: A longitudinal study

Following a stroke, mirror movements are unintended movements that appear in the non-paretic hand when the paretic hand voluntarily moves. Mirror movements have previously been linked to overactivation of sensorimotor areas in the non-lesioned hemisphere. In this study, we hypothesized that mirror movements might instead have a subcortical origin, and are the by-product of subcortical motor pathways upregulating their contributions to the paretic hand. To test this idea, we first characterized the time course of mirroring in 53 first-time stroke patients, and compared it to the time course of activities in sensorimotor areas of the lesioned and non-lesioned hemispheres (measured using functional MRI). Mirroring in the non-paretic hand was exaggerated early after stroke (Week 2), but progressively diminished over the year with a time course that parallelled individuation deficits in the paretic hand. We found no evidence of cortical overactivation that could explain the time course changes in behaviour, contrary to the cortical model of mirroring. Consistent with a subcortical origin of mirroring, we predicted that subcortical contributions should broadly recruit fingers in the non-paretic hand, reflecting the limited capacity of subcortical pathways in providing individuated finger control. We therefore characterized finger recruitment patterns in the non-paretic hand during mirroring. During mirroring, non-paretic fingers were broadly recruited, with mirrored forces in homologous fingers being only slightly larger (1.76 times) than those in non-homologous fingers. Throughout recovery, the pattern of finger recruitment during mirroring for patients looked like a scaled version of the corresponding control mirroring pattern, suggesting that the system that is responsible for mirroring in controls is upregulated after stroke. Together, our results suggest that post-stroke mirror movements in the non-paretic hand, like enslaved movements in the paretic hand, are caused by the upregulation of a bilaterally organized subcortical system

Rethinking interhemispheric imbalance as a target for stroke neurorehabilitation

© 2019 American Neurological Association Objective: Patients with chronic stroke have been shown to have failure to release interhemispheric inhibition (IHI) from the intact to the damaged hemisphere before movement execution (premovement IHI). This inhibitory imbalance was found to correlate with poor motor performance in the chronic stage after stroke and has since become a target for therapeutic interventions. The logic of this approach, however, implies that abnormal premovement IHI is causal to poor behavioral outcome and should therefore be present early after stroke when motor impairment is at its worst. To test this idea, in a longitudinal study, we investigated interhemispheric interactions by tracking patients’ premovement IHI for one year following stroke. Methods: We assessed premovement IHI and motor behavior five times over a 1-year period after ischemic stroke in 22 patients and 11 healthy participants. Results: We found that premovement IHI was normal during the acute/subacute period and only became abnormal at the chronic stage; specifically, release of IHI in movement preparation worsened as motor behavior improved. In addition, premovement IHI did not correlate with behavioral measures cross-sectionally, whereas the longitudinal emergence of abnormal premovement IHI from the acute to the chronic stage was inversely correlated with recovery of finger individuation. Interpretation: These results suggest that interhemispheric imbalance is not a cause of poor motor recovery, but instead might be the consequence of underlying recovery processes. These findings call into question the rehabilitation strategy of attempting to rebalance interhemispheric interactions in order to improve motor recovery after stroke. Ann Neurol 2019;85:502–513

The Continuum of Conscientiousness: The Antagonistic Interests among Obsessive and Antisocial Personalities

The five factor trait of conscientiousnessis a supertrait, denoting on one hand a pattern of excessive labor, rigidity, orderliness and compulsivity,and on the other hand a pattern of strict rectitude, scrupulosity, dutifulness and morality. In both respects the obsessive-compulsive personality is conscientious; indeed, it has been labeled a disorder of extreme conscientiousness (Widiger et al., 2009). Antisocial personality disorder, in the present paper, is described as occupying the opposite end of the conscientiousness continuum. The antisocial is impulsive rather than compulsive, illicit rather than licit, and furtive rather than forthright.After clinically comparing the obsessive and antisocial personalities, the present paper invokes evolutionary theory to explain their resultant behavioral, ideological, political and demographic differences

Beyond birth order: The biological logic of personality variation among siblings

Notwithstanding their relatedness, siblings vary as much as strangers with respect to personality traits. Attempting to explain this paradox across many publications, Frank J. Sulloway invokes evolutionary theory, specifically emphasizing Malthusian competition and referencing the concept of adaptive radiation, which produced beak variation among Darwinian finches as they spread across the Galapagos Archipelago. However, Sulloway understands birth order and other familial dynamics to create personality variation among siblings, using evolutionary concepts only as illustrative comparisons. The present paper argues that Sulloway mistook a literal truth for an analogy. Sibling personality variation does not mirror a process of evolution, it is a process of evolution. Substituting the macroevolutionary process of adaptive radiation for the microevolutionary process of adaptive diversification, and emphasizing the perpetuation of genetic material above the survival of the organism, sibling personality variation is herein explained as a hedge against lineage extinction. Unable either to predict environmental challenges or create pluripotent offspring, parents diversify their brood and thereby diversify their risk. As discussed, sibling personality variation as an ontogenetic process of adaptation remains relevant, but only in so far as it augments a primary genetic process of evolution