Epistemological reflections about the crisis of the DSM-5 and the revolutionary potential of the RDoC project

This paper tests the predictions of an epistemological model that considered the DSM psychiatric classification (in the neopositivist and neo-Kraepelinian shape introduced by the DSM-III) as a scientific paradigm in crisis. As predicted, the DSM-5 did not include revolutionary proposals in its basic structure. In particular, the possibility of a dimensional revolution has not occurred and early proposals of etiopathogenic diagnoses were not implemented due to lack of specific knowledge in that field. However, conceiving the DSM-5 as a bridge between the present phenomenally based operational diagnostic criteria and the neuro-cognitively based RDoC criteria introduces an internal tension into the system. It is expected that a liberalization of the research criteria will occur, the DSM operational criteria being only one possible way to select research subjects

Wave-Shaped Round Functions and Primitive Groups

Round functions used as building blocks for iterated block ciphers, both in the case of Substitution-Permutation Networks and Feistel Networks, are often obtained as the composition of different layers which provide confusion and diffusion, and key additions. The bijectivity of any encryption function, crucial in order to make the decryption possible, is guaranteed by the use of invertible layers or by the Feistel structure. In this work a new family of ciphers, called wave ciphers, is introduced. In wave ciphers, round functions feature wave functions, which are vectorial Boolean functions obtained as the composition of non-invertible layers, where the confusion layer enlarges the message which returns to its original size after the diffusion layer is applied. This is motivated by the fact that relaxing the requirement that all the layers are invertible allows to consider more functions which are optimal with regard to non-linearity. In particular it allows to consider injective APN S-boxes. In order to guarantee efficient decryption we propose to use wave functions in Feistel Networks. With regard to security, the immunity from some group-theoretical attacks is investigated. In particular, it is shown how to avoid that the group generated by the round functions acts imprimitively, which represent a serious flaw for the cipher

PHILOSOPHY OF CLINICAL PSYCHOPHARMACOLOGY

The renewal of the philosophical debate in psychiatry is one exciting news of recent years. However, its use in psychopharmacology may be problematic, ranging from self-confinement into the realm of values (which leaves the evidence-based domain unchallenged) to complete rejection of scientific evidence. In this paper philosophy is conceived as a conceptual audit of clinical psychopharmacology. Its function is to criticise the epistemological and methodological problems of current neopositivist, ingenuously realist and evidence-servant psychiatry from within the scientific stance and with the aim of aiding psychopharmacologists in practicing a more self-aware, critical and possibly useful clinical practice. Three examples are discussed to suggest that psychopharmacological practice needs conceptual clarification. At the diagnostic level it is shown that the crisis of the current diagnostic system and the problem of comorbidity strongly influence psychopharmacological results, new conceptualizations more respondent to the psychopharmacological requirements being needed. Heterogeneity of research samples, lack of specificity of psychotropic drugs, difficult generalizability of results, need of a phenomenological study of drug-induced psychopathological changes are discussed herein. At the methodological level the merits and limits of evidence-based practice are considered, arguing that clinicians should know the best available evidence but that guidelines should not be constrictive (due to several methodological biases and rhetorical tricks of which the clinician should be aware, sometimes respondent to extra-scientific, economical requests). At the epistemological level it is shown that the clinical stance is shaped by implicit philosophical beliefs about the mind/body problem (reductionism, dualism, interactionism, pragmatism), and that philosophy can aid physicians to be more aware of their beliefs in order to choose the most useful view and to practice coherently. In conclusion, psychopharmacologists already use methodological audit (e.g. statistical audit); similarly, conceptual clarification is needed in both research planning/evaluation and everyday psychopharmacological practice

Psychotic phenomena in Binge Eating Disorder: an exploratory MMPI-2 study

Aim of the studyTo study putative psychotic phenomena in patients with Binge Eating Disorder (BED).Subject or material and methodsSixty patients with a DSM-5 diagnosis of BED were studied. Scores at the Sc, Pa and other subscales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) were used to assess possible psychotic features. Eating phenomena were assessed by the Eating Disorder Inventory-2 (EDI-2). The relationship between them was studied.ResultsMean BMI was 38.24±8.43. The Sc and Pa scales of the MMPI-2 were above the cut-off in, respectively, 43.33% and 46.67% of patients. Regression analyses show that both Sc and Pa had a significant effect on EDI-2 scores, although only the Sc scale remained significant after adjusting for their possible interrelation. More than 40% of patients reported high scores (65 or more) at the following MMPI-2 "psychotic" subscales: Paranoia (Pa), Schizophrenia (Sc), Social Alienation (Sc1), Emotional Alienation (Sc2), and Lack of Ego Mastery, both cognitive and conative (Sc3 & Sc4). Perfectionism, Impulse Regulation, Ascetism, Social Insecurity, Interoceptive Awareness, Ineffectiveness, and Maturity Fears are the EDI-2 scales significantly influenced by the Sc and Pa MMPI-2 scores.DiscussionSeveral putative psychotic phenomena were reported in our sample of binge eaters, and they were related to higher scores on several dimensions of the EDI-2.ConclusionsAt least in some patients, there might be an overlap between some psychotic basic phenomena (disordered sense of basic Self, of bodily experiences, and hyperreflectivity), and those basic disturbances in identity development and Self-schemas which are at the base of eating disorders

The many faces of empathy, between Phenomenology and Neuroscience

The definition of empathy differs among the domains which deal with it. Introduced in medicine and psychology in the late 19th-early 20th century, it received contrasting definitions from philosophers and psychopathologists. The neuroscience paradigm of empathy for pain allowed us to identify two components of empathy, one automatic, bottom-up, and one cognitive, top-down. The role of mirror neurons in this context appears to be central. Empathy is influenced by perception of other, closeness, belonging to a social group, and gender, with women empathizing more than men. The areas involved are the self-other distinction areas (dorsomedial prefrontal cortex and temporoparietal junction), the anterior insula, and the anterior cingulate. The activations identified in the brain allow for better understanding the phenomenon, but not to draw a consensus definition. Rather than providing responses, the neurosciences send back to philosophy new, formidable questions to be asked