The Clinical Features of Paranoia in the 20th Century and Their Representation in Diagnostic Criteria From DSM-III Through DSM-5

This review traces, through psychiatric textbooks, the history of the Kraepelinian concept of paranoia in the 20th century and then relates the common reported symptoms and signs to the diagnostic criteria for paranoia/delusional disorder in DSM-III through DSM-5. Clinical descriptions of paranoia appearing in 10 textbooks, published 1899 to 1970, revealed 11 prominent symptoms and signs reported by 5 or more authors. Three symptoms (systematized delusions, minimal hallucinations, and prominent ideas of reference) and 2 signs (chronic course and minimal affective deterioration) were reported by 8 or 9 of the authors. Four textbook authors rejected the Kraepelinian concept of paranoia. A weak relationship was seen between the frequency with which the clinical features were reported and the likelihood of their inclusion in modern DSM manuals. Indeed, the diagnostic criteria for paranoia/delusional disorder shifted substantially from DSM-III to DSM-5. The modern operationalized criteria for paranoia/delusional disorder do not well reflect the symptoms and signs frequently reported by historical experts. In contrast to results of similar reviews for depression, schizophrenia and mania, the clinical construct of paranoia/delusional disorder has been somewhat unstable in Western Psychiatry since the turn of the 20th century as reflected in both textbooks and the DSM editions

Symptoms of major depression: Their stability, familiality, and prediction by genetic, temperamental, and childhood environmental risk factors

Background: Psychiatry has long sought to develop biological diagnostic subtypes based on symptomatic differences. This effort assumes that symptoms reflect, with good fidelity, underlying etiological processes. We address this question for major depression (MD). Methods: We examine, in twins from a population-based registry, similarity in symptom endorsement in individuals meeting criteria for last-year MD at separate interview waves and in concordant twin pairs. Among individuals with MD, we explore the impact of genetic-temperamental and child adversity risk factors on individual reported symptoms. Aggregated criteria do not separate insomnia from hypersomnia, weight gain from loss, etc. while disaggregated criteria do. Results: In twins with MD at two different waves, the mean tetrachoric correlations (+/- SEM) for aggregated and disaggregated DSM-IV A criteria were, respectively, + 0.31 +/- 0.06 and + 0.34 +/- 0.03. In monozygotic (MZ) and dizygotic (DZ) twin pairs concordant for last-year MD, the mean tetrachoric correlations for aggregated and disaggregated criteria were, respectively, + 0.33 +/- 0.07 and + 0.43 +/- 0.04, and + 0.05 +/- 0.08 and + 0.07 +/- 0.04. In individuals meeting MD criteria, neuroticism predicted the most MD symptoms (10), followed by childhood sexual abuse (8), low parental warmth (6), and genetic risk (4). Conclusions: The correlations for individual depressive symptoms over multiple episodes and within MZ twins concordant for MD are modest suggesting the important role of transient influences. The multidetermination of individual symptoms was further evidenced by their prediction by personality and exposure to early life adversities. The multiple factors influencing symptomatic presentation inMDmay contribute to our difficulties in isolating clinical depressive subtypes with distinct pathophysiologies

Delayed Fight: The World Trade Organization Dispute Settlement Mechanism, Negotiation, and the Transatlantic Conflict Over Commercial Aircraft

For over thirty years, the United States and the European Union have waged a bitter and seemingly eternal political battle over the manufacture and trade of large commercial aircraft. In 2005, they brought this dispute to the World Trade Organization by litigating through its Dispute Settlement Mechanism. With the arrival of decisions from the WTO Dispute Settlement Body, this long-running conflict enters a new phase. This Note proposes that DSM litigation will result in a negotiated settlement between the two parties. Starting with the histories of both the DSM and the LCA industry, it delineates how the WTO has created a system that continually encourages states to settle through the DSM’s textual provisions and extrinsic effects. The Note analyzes why and how a negotiated settlement will come about, building upon the settlement-oriented nature of the DSM and the industry’s history

Psychiatric Genetics: Methods, Findings and Ethical Issues

This talk has 4 major sections. First, I review the basic definition of a complex trait, especially as it applies to psychiatric disorders. Second, I outline the 4 basic paradigms of psychiatric genetics: simple genetic epidemiology, advanced genetic epidemiology, gene-finding methods and molecular genetics. Third, I review a few basic facts about psychiatric genetics - the level of heritabilities found for most common disorders and the difficulties the field has had in obtaining replicated evidence for single gene effects. Finally, I briefly review three conceptual/philosophical issues that relate to psychiatric genetics: i) why do people become much more concerned in learning about possible genetic influences on personality or risk for depression than genes that influence risk for cancer, atherosclerosis or asthma? ii) how have the results of research in behavioral/Psychiatric Genetics impacted on the sense of Parental Responsibility for psychiatric illness in their offspring.

To watch Dr. Kendler’s presentation, please see the "Google Video posting.":http://video.google.com/videoplay?docid=-3261606556062804269&hl=e

The Development of Self-Confidence in a Novice ESL Teacher

This is a personal paper in which I address the issue of teacher security in the classroom, specifically, the novice ESL teacher\u27s development of self-confidence in his/her role and skill mastery. The paper is based on my second intern- ship as a teacher of English as a Second Language to Haitian refugees. The paper begins with a discussion of basic assumptions about student security and how teacher security is related to it. It goes on to discuss the process of growth of self­confidence from the first teaching internship to the second, comparing skill mastery in the specific areas of developing a student-centered classroom and working creatively without having a required text to fall back on. The discussion of the creation of a student-centered classroom focuses on theuse of: 1) paired activities, Z)role play, 3) group activities, 4) student self-correction, and 5) student feedback

Boning up on osteoporosis - current thinking on management

No Abstract. South African Medical Journal Vol. 96(7) 2006: 604-60

Genetic and environmental components of female depression as a function of the severity of the disorder

Background: Both clinical care and genome-wide studies need to account for levels of severity in the etiology of depression. The purpose of the study is to estimate the genetic and environmental components of female depression as a function of the severity of the disorder. Methods: A genetic and environmental model analysis of depression incidence was made using the IOP Depression Severity Measure (IDSM). Details of lifetime depression incidence was obtained by questionnaire from twins on the DTR registry. Data from 1449 matched female twin pairs in the age range 19-85 years in four ordinal categories of increasing severity were employed in the analysis. Results: Estimates of additive and dominance genetic components of 27% and 25% were found when all three levels of depression were included, and near zero and 33% when the recurrent/severe level was excluded. Shared environmental effects were not significant in either case but the estimate for random environmental effects was greater when the severe level was excluded. Conclusions: These results suggest that the incidence of severe depression is associated with homozygotic alleles and the less severe with heterozygotic alleles. This is in accord with the finding that the hereditary component of severe depression is relatively high and that milder forms are more dependent on life-time environmental factors. Such conclusions have clinical implications for the diagnosis and treatment of the disorder by practicing psychiatrists. They also lead to the importance of focusing future genome-wide and linkage studies on those females with severe levels of depression if progress in identifying genetic risk loci is to be made

ALDH2*2 and peer drinking in East Asian college students

Background: The ALDH2*2 allele (A-allele) at rs671 is more commonly carried by Asians and is associated with alcohol-related flushing, a strong adverse reaction to alcohol that is protective against drinking. Social factors, such as having friends who binge drink, also contribute to drinking in Asian youth. Objectives: This study examined the interplay between ALDH2*2, peer drinking, and alcohol consumption in college students. We hypothesized that the relationship between ALDH2*2 and standard grams of ethanol per month would vary based on the level of peer drinking. Methods: Subjects (N = 318, 63.25% female) were East Asian college students in the United States who reported drinking alcohol. Data were from the freshman year of a university survey that included a saliva DNA sample. ALDH2*2 status was coded ALDH2*2(+) (A/G and A/A genotypes) and ALDH2*2(−) (G/G genotype). Peer drinking was students’ perception of how many of their friends “got drunk”. Results: Main effects of ALDH2*2(−) and having more friends who got drunk were associated with greater alcohol consumption. The ALDH2*2 × peer drunkenness interaction showed a stronger positive association with alcohol consumption for ALDH2*2(−) versus ALDH2*2(+) at increasing levels of peer drunkenness. Follow-up comparisons within each peer drunkenness level identified significantly higher alcohol consumption for ALDH2*2(−) compared to ALDH2*2(+) at the all friends got drunk level. Conclusion: There was evidence of a stronger effect for ALDH2*2(−) compared to ALDH2*2(+) with greater alcohol use when students were more exposed to peer drinking. Findings contribute to a growing literature on the interrelationships between genetic influences and more permissive environments for alcohol consumption