ObjectiveThis study aimed to develop a diagnostic model of multi-kinematic parameters for patients with amnestic mild cognitive impairment (aMCI).MethodIn this cross-sectional study, 94 older adults were included (33 cognitively normal, CN; and 61 aMCI). We conducted neuropsychological battery tests, such as global cognition and cognitive domains, and collected gait parameters by an inertial-sensor gait analysis system. Multivariable regression models were used to identify the potential diagnostic variables for aMCI. Receiver operating characteristic (ROC) curves were applied to assess the (...) diagnostic accuracy of kinematic parameters in discriminating aMCI from healthy subjects.ResultsMultivariable regression showed that multi-kinematic parameters were the potential diagnostic variables for aMCI. The multi-kinematic parameter model, developed using Timed Up and Go (TUG) time, stride length, toe-off/heel stride angles, one-leg standing (OLS) time, and braking force, showed areas under ROC (AUC), 0.96 [95% confidence interval (CI), 0.905–0.857]; sensitivity, 0.90; and specificity, 0.91. In contrast, a single kinematic parameter’s sensitivity was 0.26–0.95 and specificity was 0.21–0.90. Notably, the separating capacity of multi-kinematic parameters was highly similar to Montreal Cognitive Assessment (MoCA; AUC: 0.96 vs. 0.95). Compared to cognitive domain tests, the separating ability was comparable to Auditory Verbal Learning Test (AVLT) and Boston Naming Test (BNT; AUC: 0.96 vs. 0.97; AUC: 0.96 vs. 0.94).ConclusionWe developed one diagnostic model of multi-kinematic parameters for patients with aMCI in Foshan. (shrink)

Diagnostic frameworks are essential to many scientific and technological activities and clinical practice. This study examines the main fundamental aspects of such frameworks. The three components required for all diagnoses are identified and examined, i.e. their normative dimension, temporal nature and structure, and teleological perspective.The normative dimension of a diagnosis is based on (1) epistemic values when associated with Hempel's inductive risk concerning the balance between false‐positive and false‐negative outcomes, leading to probabilistic judgements; and (2) non‐epistemic values when related (...) to ideas such as well‐being, normality, illness, etc, as idealized norms or ideal points of reference.It should be noted that medical diagnoses match the three necessary components, while some essential diagnostic frameworks – the taxonomies ofGordon andNANDA– in nursing lack some components. The main lack is normative as the most popular frameworks in nursing diagnosis seem to be descriptions of observed reality rather than normative and value‐based judgements in which both epistemic and non‐epistemic values may coexist. (shrink)

The aim of the article is to show how the use of diagnostic methods allows identifying patterns and problems of corporations functioning, providing identification of directions and strategies for further development of their business. Theoretical and methodological basis of the research is a scientific works of scientists in the field of business diagnostics and strategic development, who studied diagnostics in the system of responding to business development problems, identifying areas for improving strategic management, financial statements of corporations of Daimler (...) Group (Germany), Tesla Motors (USA) and Toyota Motor (Japan) and own research results. The methodological basis of the study is a set of general and special methods used to achieve the goal of the research and includes: theoretical generalization and synthesis – in analyzing the content of scientific works on business diagnostics and strategic management; observation – to obtain primary information about the state of business of automotive companies in the world; indicator and integrated assessment – to assess the state of business and the effectiveness of strategic management of automotive corporations; information and logical analysis – when determining the issues and patterns of business development of corporations; problem-target method – to justify the choice of business development strategies; causation-result method – to obtain definitive conclusions. The results of the study of the state of business of the world's leading automotive corporations revealed the dependence of business efficiency on the degree of efficiency of strategic management of their activities, and identified types of strategies that will promote further development of automotive corporations – integrated, concentrated, diversified or globalized growth. The practical significance of the obtained results lies in their usefulness for strategic management for Daimler Group, Tesla Motors, Toyota Motor Corporation. (shrink)

A new diagnostic modeling system for automatically synthesizing a deep‐structure model of a student's misconceptions or bugs in his basic mathematical skills provides a mechanism for explaining why a student is making a mistake as opposed to simply identifying the mistake. This report is divided into four sections: The first provides examples of the problems that must be handled by a diagnostic model. It then introduces procedural networks as a general framework for representing the knowledge underlying a skill. (...) The challenge in designing this representation is to find one that facilitates the discovery of misconceptions or bugs existing in a particular student's encoding of this knowledge. The second section discusses some of the pedagogical issues that have emerged from the use of diagnostic models within an instructional system. This discussion is framed in the context of a computer‐based tutoring/gaming system developed to teach students and student teachers how to diagnose bugs strategically as well as how to provide a better understanding of the underlying structure of arithmetic skills. The third section describes our uses of an executable network as a tool for automatically diagnosing student behavior, for automatically generating “diagnostic” tests, and for judging the diagnostic quality of a given exam. Included in this section is a discussion of the success of this system in diagnosing 1300 school students from a data base of 20.000 test items. The last section discusses future research directions. (shrink)

Diagnostic testing can be used for many purposes, including testing to facilitate the clinical care of individual patients, testing as an inclusion criterion for clinical trial participation, and both passive and active surveillance testing of the general population in order to facilitate public health outcomes, such as the containment or mitigation of an infectious disease. As such, diagnostic testing presents us with ethical questions that are, in part, already addressed in the literature on clinical care as well as (...) clinical research (such as the rights of patients to refuse testing or treatment in the clinical setting or the rights of participants in randomized controlled trials to withdraw from the trial at any time). However, diagnostic testing, for the purpose of disease surveillance also raises ethical issues that we do not encounter in these settings, and thus have not been much discussed. In this paper we will be concerned with the similarities and differences between the ethical considerations in these three domains: clinical care, clinical research, and public health, as they relate to diagnostic testing specifically. Via an examination of the COVID-19 case we will show how an appeal to the concept of diagnostic justice helps us to make sense of the (at times competing) ethical considerations in these three domains. (shrink)

Diagnosing the Diagnostic and Statistical Manual of Mental Disorders (Karnac, 2014) evaluates the latest edition of the D.S.M.The publication of D.S.M-5 in 2013 brought many changes. Diagnosing the Diagnostic and Statistical Manual of Mental Disorders asks whether the D.S.M.-5 classifies the right people in the right way. It is aimed at patients, mental health professionals, and academics with an interest in mental health. Issues addressed include: How is the D.S.M. affected by financial links with the pharmaceutical industry? To (...) what extent were and should patients involved in revising the classification? How are diagnoses added to the D.S.M.? Does medicalization threaten the idea that anyone is normal? What happens when changes to diagnostic criteria mean that people lose their diagnoses? How important will the D.S.M. be in the future? (shrink)

Ockham’s razor is the idea that simpler hypotheses are to be preferred over more complex ones. In the context of medical diagnosis, this is taken to mean that when a patient has multiple symptoms, a single diagnosis should be sought that accounts for all the clinical features, rather than attributing a different diagnosis to each. This paper examines whether diagnostic parsimony can be justified by reference to probability theory. I argue that while attempts to offer universal justifications of (...) class='Hi'>diagnostic parsimony fail, a more constrained use of this diagnostic principle can be supported. (shrink)

Focusing on computational studies of pericyclic reactions from the late twentieth century into the twenty-first century, this paper argues that computational diagnostics is a key methodological development that characterize the management and coordination of plural approximation methods in computational organic chemistry. Predictive divergence between semi-empirical and ab initio approximation methods in the study of pericyclic reactions has issued in epistemic dissent. This has resulted in the use of diagnostics to unpack computational greyboxes in order to critically assess the effect of (...) specific misrepresentations on predictive accuracy given that approximations and idealizations must be made to render computational models tractable. Furthermore, benchmarking is used to determine the applicability of approximation methods depending on how accurate the results need to be in a given research context. The epistemology of benchmarking consists of the co-generation of data sets in a hybrid computational–experimental form used to standardize computational methods but does not determine a unique quantitative method to be used across computational organic chemistry. (shrink)

Diagnostic self-testing devices are being developed for many illnesses, chronic diseases and infections. These will be used in hospitals, at point-of-care facilities and at home. Designed to allow earlier detection of diseases, self-testing diagnostic devices may improve disease prevention, slow the progression of disease and facilitate better treatment outcomes. These devices have the potential to benefit both the individual and society by enabling individuals to take a more proactive role in the maintenance of their health and by helping (...) society improve health and reduce health costs. However, the full implications of future home-based diagnostic technology for individuals and society remain unclear due to their novelty. We argue that the development of diagnostic tools, especially for home use, will heighten a number of ethical challenges. This paper will explore some of the ethical implications of home-based self-testing diagnostic devices for the autonomous and relational dimensions of the person. This will be facilitated by examining the impact of diagnostic devices for individual autonomy, for the delivery of accurate diagnosis and for the personal significance of the information for the user. The latter will be examined using Charles Taylor's view of personhood and his emphasis on human agency and interpretation. While the ethical issues are not necessarily new, the development of home-based self-testing diagnostic devices will make issues regarding autonomy, accuracy of information and personal significance more and more demanding. This will be the case particularly when an individual's autonomous choices come into conflict with the person's relational responsibilities. (shrink)

Terms such as open source and various modifications including open content and more generally openness have been mobilized with increasing frequency in recent years to describe many different collaborative and not-for-profit projects, products, services, and business models. Typically associated with the computer and internet industry, openness has in recent years assumed something of the status of a nascent movement. Whatever this movement is, whatever qualities it embodies and possibilities it enables, it is still in the process of its emergence. This (...) presents particular difficulties for understanding openness insofar as emergent practices are by definition not yet stabilized. This paper is an attempt to discern the nascent forms of stability already extant in the emerging world of openness. We begin with a brief history culminating in the near future. We then summarize the limited conclusions of an initial inquiry into these emerging openness practices which we have conducted in the context of an orientation for inquiry recently put forward by Paul Rabinow and Gaymon Bennett. The bulk of the paper is devoted to elaborating openness equipment in terms of the analytic and synthetic categories made available by Rabinow and Bennett's Diagnostic of Equipmental Platforms. On the basis of this inquiry we return in the final section to reflection on the Diagnostic itself in an attempt to critically delineate its positive and negative usages for our inquiry. (shrink)

Diagnostic errors are more frequently a result of the clinician's failure to combine medical knowledge adequately than of data inaccuracy. Diagnostic reasoning studies are valuable to understand and improve diagnostic reasoning. However, most diagnostic reasoning studies are characterized by some limitations which make these studies seem more simple than diagnostic reasoning in real life situations actually is. These limitations are connected both to the failure to acknowledge components of knowledge used in clinical practice as well (...) as to acknowledge the physician-patient relationship's influence on clinical knowledge and on the reasoning process itself. In addition the modes of reasoning described in these studies frequently is oversimplified. In this paper three simplistic and competing models of diagnostic reasoning are analyzed and criticized, followed by an evaluation of two alternative models proposing a combined view. (shrink)

The dispute over Socrates’ apparent endorsement of hedonism in the Protagoras has persisted for ages among scholars and students of Plato’s work. The solution to the query concerning the seriousness and sincerity of Socrates’ argument from hedonism established in the dialogue is of considerable importance for the interpretation of Plato’s overall moral theory, considering how blatantly irreconcilable the defense of this doctrine is with Plato’s other early dialogues. In his earlier works, Socrates puts supreme importance on virtue and perfection of (...) the soul, so the puzzle apparent in the Protagoras merits a thorough examination.Several scholars have argued that, since Socrates’ defense of hedonism in this work clashes significantly with his views on morality in other dialogues, Socrates must only have been defending hedonism ironically, or with the intention of “diagnosing” his opponent’s point of view. In this paper, I examine the approaches according to which Socrates didn’t in fact mean to defend hedonism, but merely used it as a diagnostic tool; I argue that there is no compelling evidence for this resolution of Socrates’ defense of hedonism, and that the views that attempt to defend it really have no convincing grounds for it apart from the desire to reconcile the Protagoras with other Socratic dialogues. (shrink)

The complexity of cognitive emulation of human diagnostic reasoning is the major challenge in the implementation of computer-based programs for diagnostic advice in medicine. We here present an epistemological model of diagnosis with the ultimate goal of defining a high-level language for cognitive and computational primitives. The diagnostic task proceeds through three different phases: hypotheses generation, hypotheses testing and hypotheses closure. Hypotheses generation has the inferential form of abduction (from findings to hypotheses) constrained under the criterion of (...) plausibility. Hypotheses testing is achieved by a deductive inference (from generated hypotheses to expected findings), followed by an eliminative induction, constrained under the criterion of covering, which matches expected findings against patient''s findings to select the best explanation. Hypotheses closure is a deductive-inductive type of inference very similar to the inferences operating in hypotheses testing. In this case induction matches the consequences of the generated hypotheses against the patient''s characteristics or preferences under the criterion of utility. By using the language exploited in this epistemological model, it is possible to describe the cognitive tasks underlying the most influential knowledge-based diagnostic systems. (shrink)

Background Most studies on medical reasoning focus on contemporary allopathic practitioners. Here, the significance of diagnostic sense in Nizāmī ‘Arūzī’s Four Discourses (Chahār Maqāle), an influential text that circulated widely throughout the Islamic world, is explored. Methods After a brief introduction, key passages are translated on how doctors should cultivate analytical skills. Results Nizāmī ‘Arūzī cites three sources of diagnostic authority: (1) education in the texts of medical experts, (2) formal logic and (3) belief in the power of (...) God. Conclusions ‘Arūzī’s methods, though rooted in a religious faith that may seem foreign to contemporary doctors and educators, has much to recommend regarding its clarity of approach, its high ethical standards and expectations of doctors, and its commitment to best practices for the patient. Crosscultural studies of medical education and professionalism can offer valuable insights by demonstrating how doctors across history and geography have grappled with the common concerns of diagnosis and treatment. (shrink)

In their article on the limited duty to reinterpret genetic variants, Watts and Newson argue that clinical labs are not morally obligated to conduct routine reinterpretation despite its potential clinical and personal value.1 We endorse the authors’ argument for a circumscribed duty to reclassify genomic variants in certain cases, including to promote diagnostic equity for racial and ethnic minority populations that have been historically excluded from and exploited by genomic research and medicine. However, given the history and resilience of (...) scientific racism, the use of socially constructed racial and ethnic categories to enhance diagnostic equity raises several ethical and practical challenges. In the short term, using socially constructed racial and ethnic categories to identify patients for variant reclassification is a practical approach for addressing concerns of diagnostic equity. In contrast, diagnostic accuracy depends on patients’ genetic similarity to reference genomes, rather than their socially determined race or ethnicity.2 Thus, in the long term, securing both diagnostic equity and diagnostic accuracy through targeted variant reclassification will require a shift away from relying on race and ethnicity and towards assessing genetic similarity. Critically, the identification of patients for genomic variant reclassification using socially constructed race or ethnicity runs the risk of perpetuating the harmful …. (shrink)

Conversation analysts have noted that, in psychotherapy, formulations of the client's talk can be a vehicle for offering a psychological interpretation of the client's circumstances. But we notice that not all formulations in psychotherapy offer interpretations. We offer an analysis of formulations that are diagnostic: that is, used by the professional to sharpen, clarify or refine the client's account and make it better able to provide what the professional needs to know about the client's history and symptoms. In doing (...) so, these formulations also have the effect of shepherding the client's account towards subsequent therapeutic interpretation. In a coda, we notice that sometimes the formulations are designed discreetly. We examine one such discreet formulation in detail, and show how its very ambiguity can lead to its failure as a diagnostic probe. (shrink)

BackgroundThe present study aimed at assessing the diagnostic properties of the Montreal Cognitive Assessment in non-demented ALS patients and at exploring the MoCA administrability according to motor-functional status.MaterialsN = 348 patients were administered the MoCA and Edinburgh Cognitive and Behavioural ALS Screen. Administrability rates and prevalence of defective MoCA scores were compared across King’s and Milano-Torino clinical stages. Regression models were run to test whether the non-administrability of the MoCA and a defective score on it were predicted, net of (...) the ECAS-Total, by disease duration, ALS Functional Rating Scale-Revised and progression rate, computed as /disease duration. Intrinsic and post-test diagnostics were tested against a below-cut-off ECAS-total score.ResultsThe 79.9% of patients successfully underwent the MoCA, whose administrability rates decreased with advanced clinical stages, at variance with its defective score prevalence. The probability of the FAB not being administrable was predicted only by lower ALSFRS-R-bulbar and-upper-limb scores; no motor features, but the ECAS-Total, predicted a defective MoCA performance. The MoCA showed high accuracy and good intrinsic and post-test properties—being slightly more specific than sensitive.DiscussionIn non-demented ALS patients, the MoCA is featured by optimal diagnostics as a screener for cognitive impairment, especially for ruling-out its occurrence, as long as patients are in the early stages of the disease and have sufficiently spared bulbar and upper-limb functions. (shrink)

Visual aids can improve comprehension of risks associated with medical treatments, screenings, and lifestyles. Do visual aids also help decision makers accurately assess their risk comprehension? That is, do visual aids help them become well calibrated? To address these questions, we investigated the benefits of visual aids displaying numerical information and measured accuracy of self-assessment of diagnostic inferences (i.e., metacognitive judgment calibration) controlling for individual differences in numeracy. Participants included 108 patients who made diagnostic inferences about three medical (...) tests on the basis of information about the sensitivity and false-positive rate of the tests and disease prevalence. Half of the patients received the information in numbers without a visual aid, while the other half received numbers along with a grid representing the numerical information. In the numerical condition, many patients --especially those with low numeracy-- misinterpreted the predictive value of the tests and profoundly overestimated the accuracy of their inferences. Metacognitive judgment calibration mediated the relationship between numeracy and accuracy of diagnostic inferences. In contrast, in the visual aid condition, patients at all levels of numeracy showed high-levels of inferential accuracy and metacognitive judgment calibration. Results indicate that accurate metacognitive assessment may explain the beneficial effects of visual aids and numeracy --a result that accords with theory suggesting that metacognition is an essential part of risk literacy. We conclude that well-designed risk communications can inform patients about health-relevant numerical information while helping them assess the quality of their own risk comprehension. (shrink)

ABSTRACTDiagnostic self‐testing devices are being developed for many illnesses, chronic diseases and infections. These will be used in hospitals, at point‐of‐care facilities and at home. Designed to allow earlier detection of diseases, self‐testing diagnostic devices may improve disease prevention, slow the progression of disease and facilitate better treatment outcomes. These devices have the potential to benefit both the individual and society by enabling individuals to take a more proactive role in the maintenance of their health and by helping society (...) improve health and reduce health costs. However, the full implications of future home‐based diagnostic technology for individuals and society remain unclear due to their novelty.We argue that the development of diagnostic tools, especially for home use, will heighten a number of ethical challenges. This paper will explore some of the ethical implications of home‐based self‐testing diagnostic devices for the autonomous and relational dimensions of the person. This will be facilitated by examining the impact of diagnostic devices for individual autonomy, for the delivery of accurate diagnosis and for the personal significance of the information for the user. The latter will be examined using Charles Taylor's view of personhood and his emphasis on human agency and interpretation.While the ethical issues are not necessarily new, the development of home‐based self‐testing diagnostic devices will make issues regarding autonomy, accuracy of information and personal significance more and more demanding. This will be the case particularly when an individual's autonomous choices come into conflict with the person's relational responsibilities. (shrink)

Experimental philosophy’s much-discussed ‘restrictionist’ program seeks to delineate the extent to which philosophers may legitimately rely on intuitions about possible cases. The present paper shows that this program can be (i) put to the service of diagnostic problem-resolution (in the wake of J.L. Austin) and (ii) pursued by constructing and experimentally testing psycholinguistic explanations of intuitions which expose their lack of evidentiary value: The paper develops a psycholinguistic explanation of paradoxical intuitions that are prompted by verbal case-descriptions, and presents (...) two experiments that support the explanation. This debunking explanation helps resolve philosophical paradoxes about perception (known as ‘arguments from hallucination’). (shrink)

In this commentary we describe the interplay between 1) contemporary popular and professional understandings of “risk” and “normality” in health and healthcare, and 2) the promotion by state and market forces of individual self-regulation of health. We draw upon the work of critical theorists who have described the relationship between risk, fear, and the notion of “normal” in health discourse to argue that these factors act, primarily via the popular media, to shape the discourse on, and overuse of, diagnostic (...) tests in Canada. (shrink)

Within child and adolescent psychiatry, there are a number of potential dilemmas pertaining to diagnosis, treatment, the protection of the child, as well as the child's own developing intelligence and moral judgement. Diagnostic Dilemmas in Child and Adolescent Psychiatry is the first in the IPPP series to explore this highly complex topic.

Diagnostic devices do more than just passively register facts. They intervene in the situations in which they are put to use. The question addressed here is what this general remark may imply in specific cases. To answer this question a specific case is being analysed: that of the blood sugar measurement device that people with diabetes may use to monitor their own blood sugar levels. This device not only allows the patients concerned to better approach normal blood sugar levels, (...) but alters what counts as normal in the first place. Using the device may shift people's attention away from their physical sensations towards the numbers measured, but it may also help them to increase their own physical self-awareness. Self-monitoring finally (something that the devices have made possible) makes patients less dependent on professionals, but it requires them to engage in self-disciplining and binds them to the outcomes of their measurement activities: their own blood sugar levels. (shrink)

Transcranial magnetic stimulation (TMS) of the visual cortex can induce phosphenes as can non-diagnostic ultrasound, the latter while participants have closed their eyes during Stimulation. Here we sought to study potential alteration of a visual target (a white crosshair) due to application of diagnostic ultrasound to the visual cortex. We applied a randomized series of actual or sham diagnostic ultrasound to the visual cortex of healthy participants while they stared at a visual target, with the ultrasound device (...) placed where TMS elicited phosphenes. These participants observed percepts 7 out of 10 times, consisting of extra or extensions of lines relative to the original crosshair, and additional colors. Observation of a percept occurred an average of 53.7 +/- 2.6% of the time over the course of the experiment for these participants. In contrast, 7 out of 10 participants exposed to sham-only diagnostic ultrasound observed comparable percepts an average of 36.3 +/ 1.9% of the time, a statistically significant difference (p < 0.00001). Moreover, on average, participants exposed to a combination of sham and actual ultrasound reported a net increase of 47.9 percentage points in the likelihood that they would report a visual effect by the end of the experiment. Our experiment demonstrated that a random combination of sham-only and actual diagnostic ultrasound applied to the visual cortex of participants increased the likelihood that they would observe visual effects, but not the type of effects, with that likelihood increasing over the course of the experiment. From this we conclude that repeated exposures by diagnostic ultrasound made the visual cortex more responsive to stimulation of their visual cortex by the visual target. These observations, consistent with other’s observation of effects of diagnostic ultrasound stimulation of human motor cortex and amygdala, as well as the FDA approved nature of diagnostic ultrasound, may lead to increased study of diagnostic ultrasound applied to human brain. (shrink)

The purpose of this study is to develop and evaluate two diagnostic classification models (DCMs) for scoring ordinal item data. We first applied the proposed models to an operational dataset and compared their performance to an epitome of current polytomous DCMs in which the ordered data structure is ignored. Findings suggest that the much more parsimonious models that we proposed performed similarly to the current polytomous DCMs and offered useful item-level information in addition to option-level information. We then performed (...) a small simulation study using the applied study condition and demonstrated that the proposed models can provide unbiased parameter estimates and correctly classify individuals. In practice, the proposed models can accommodate much smaller sample sizes than current polytomous DCMs and thus prove useful in many small-scale testing scenarios. (shrink)

Decision theory cannot be a purely formal theory, free of all metaphysical assumptions and ascertainments. It must instead rely upon the end user for the wisdom it takes to prime the decision formalism – with principles and assumptions about the metaphysics of the application context – so that the formalism in its turn can generate good advice. Appreciating this idea is fundamental to understanding the true rivalry between evidential decision theory (EDT) and causal decision theory (CDT) in specific cases. I (...) shall argue that no decision theory can deliver a verdict unless assumptions are made about the degrees of freedom in the context of decision, that EDT and CDT disagree fundamentally about how to diagnose the degrees of freedom in any given situation, and that from this fundamental disagreement flow their surface disagreements in iconic cases. (shrink)

People with mental illnesses have higher prevalence and mortality rates with regard to common somatic diseases and causes of death, such as cardio-vascular conditions or cancer. One factor contributing to this excess morbidity and mortality is the sub-standard level of physical healthcare offered to the mentally ill. In particular, they are often subject to diagnostic overshadowing: a tendency to attribute physical symptoms to a pre-existing diagnosis of mental illness. This might be seen as an unfortunate instance of epistemic bad (...) luck, where particular features of a group of patients make a timely and correct diagnosis unlikely. While this can explain some cases of diagnostic overshadowing, I argue that in other cases, epistemic injustice is involved. Analyzing the case of diagnostic overshadowing, I distinguish two kinds of testimonial injustice. For one, there are classic cases of transactional testimonial injustice resulting from prejudices against the mentally ill. In addition, there are cases of structural testimonial injustice resulting from features of health care systems. To overcome diagnostic overshadowing, remedies on the individual as well as structural level are thus needed. (shrink)

In most areas of medicine, the physician's primary task is to diagnose the patient's presenting problem by correctly identifying the underlying pathology causing that problem. Diagnoses are established through a process of correlating the information obtained from an interview with the patient about his history of illness and circumstances, with additional evidence of the underlying disease derived from physical examination findings and/or the results of laboratory investigations and diagnostic imaging. In contemporary health care, various movements that call for a (...) shift in clinical care away from underlying disease pathology toward understanding people and their experience of disease are receiving growing... (shrink)

Two facets of diagnostic reasoning related to scientific thinking are recognizing the difference between confounded and unconfounded evidence and selecting appropriate interventions that could provide learners the evidence necessary to make an appropriate causal conclusion (i.e., the control-of-variables strategy). The present study investigates both these abilities in 3- to 6-year-old children (N= 57). We found both competence and developmental progress in the capacity to recognize that evidence is confounded. Similarly, children performed above chance in some tasks testing for the (...) selection of a controlled test of a hypothesis. However, these capacities were unrelated, suggesting that preschoolers’ nascent understanding of the control-of-variables strategy may not be driven by a metacognitive understanding that confounded evidence does not support a unique causal conclusion, and requires further investigation. (shrink)

Next SectionThe current focus on early intervention trials in Alzheimer's disease research raises particular ethical issues. These arise out of problems of validating study results and translating them into general practice for one thing and out of unwanted effects of an uncertain diagnosis for diagnosed people for another. The first addresses the demands of scientific research compared to those of medical practice, questioning how the medical value of clinical trials is evaluated. The second relates the scientific and medical value of (...) early intervention trials to the normative value of an uncertain diagnosis. Are people who are diagnosed with a potential early form of AD in clinical studies patients proper—although they would not have been diagnosed with the given “disease” in non-research-oriented medical settings? The very problem of framing this question in terms of diagnostic misconceptions connects conceptual with ethical issues of research into preclinical stages of neurodegenerative diseases. (shrink)

“Geneticization” is a term used to describe the ways in which the science of genetics is influencing society at large and medicine in particular; it has important implications for the process of diagnostics. Because genetic diagnostics produces knowledge about genetic disease and predisposition to disease, it is essentially influenced by these innovations in the disease concept. In this paper, I argue that genetic diagnostics presents new ethical challenges not because the diagnostic process or method in genetic diagnostics is ethically (...) different in kind from traditional medical diagnostics, but because it relies on a neo-ontological concept of disease in a context of genetic reductionism. Geneticization has not produced a radically new concept of disease, however, but has introduced innovations into the classical ontological concept of disease. When this new concept of disease is held in tandem with genetic reductionism, we are led to the absurd conclusion that disease is the very essence of the human being. I argue that neither the neo-ontological concept of disease nor genetic reductionism is necessary for a proper understanding of genetic diagnostics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Diagnostic WannabesJennifer Radden, PhD (bio)Saunders explores challenges for the clinician faced with self-styled sufferers from attention deficit hyperactivity disorder, post-traumatic stress disorder, bipolar disorder, autism spectrum disorder (ASD), and fibromyalgia. The diagnostic system was not meant to be used as “a scaffold for identity,” she points out. Yet wannabe patients now step into the clinic wielding self-proclaimed diagnoses as social identities. Saunders explains the context where such (...) phenomena arise, and offers guidelines for clinicians addressing this new reality. To do so, she enlists Rashed’s innovative normative approach to the so-called boundary problem of assigning, and providing justification for, the contested line between normal and disordered. The boundary problem itself seems to rise to prominence during our current era of increasingly dimensional thinking, it is worth noting, with psychiatric diagnoses taken to refer to points on a continuum, rather than to discrete categorical disease entities.On the likely sources of these ‘diagnostic’ social identities, as well as reasons why certain diagnoses attach to them more commonly than others, Saunders points to social trends (including what she asserts to be a “post-stigma” cultural environment), the failure of efforts to identify neurobiological markers for psychiatric disorder, the ubiquity of social media, the algorithms themselves, and the hyperconnected existence of contemporary times. Such narratives also offer the comforts of a sense of belonging and explanations for perceived inadequacies, she rightly observes.Despite today’s virtual and other inducements, the problem introduced here is not an entirely new one. The first part of the seventeenth century in Europe saw an apparent “epidemic” of what was known as “melancholy,” a condition associated with the spleen, whose symptoms loosely resembled those of today’s depression and anxiety. Much of this suffering was undeniably real, but much was a fashionable, identity-conferring pose. “Every distemper of the body now is complicated with spleen,” the poet John Donne ironically observes in a letter dated 1622, “and when we were young men we scarce ever heard of the spleen. In our declinations now, every accident is accompanied with heavy clouds of melancholy”1 (Gosse, 2019). By then, the Melancholic Man (or homo melancholicus), with his surfeit of spleen, was an unmistakable character type—or social identity, as we would now say. Recognized and saluted in centuries-long literary and illustrative traditions, the type was an anchoring element of the humoral medicine which, despite the gradual emergence of more empirical science, had endured since Galenic times.Melancholy’s closest descendants, affective depressive and anxiety disorders, are today less evident among the troubling identities Saunders discusses—somewhat preempted, she points out, by more cognitively-based diagnoses such as ASD. [End Page 279] This is itself an ironic reminder of the vagaries of cultural attitudes, cautioning us to remember the broader context where these particular social identities are selected for emulation and adoption.The lure of the melancholy man’s2 social identity is well understood: already normalized, within the humoral system in which excess black bile afflicted roughly one in four people, it had been valorized for centuries—arguably by Aristotelian writing (in the dubious ‘Problems’), during the Renaissance by Ficino, and Shakespeare—even by Freud in his 1916 ‘Mourning and Melancholia.’ Through most of Western history, the positive attributes and benefits of the dark moods of melancholy have needed no further explaining or justifying. They glow with glamorous associations.Applying Rashed’s conditions for appropriately acknowledging and recognizing the fit of a person’s chosen social identity, Saunders‘ guidance for clinicians clarifies boundary matters. And it illustrates how to understand, regulate and communicate the appropriate norms in ways that can dissuade those whose personal growth and mental health are not served by claiming such identities.With at least some of the popular social identities Saunders describes, I think we can helpfully continue the comparison with the homo melancholicus. For the ‘neurodiversity’ rhetoric of our own times contains forces promoting both the normalization and the valorization of syndromes such as ASD. Pointing to analogies with differences of gender, ethnicity and culture, neurodiversity theorizing argues for a respect for, and appreciation of, difference. Mental or cognitive variations are equally natural and valuable, it is... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Diagnostic Criteria, Psychological Tests, and Ratings Scales: Extending the HistoryPeter Zachar, PhD (bio)Le moigne narrates a history of the development of psychiatric ratings scales as hybrids between psychological tests and diagnostic categories. In his telling, psychological tests seek to quantify population-based traits on which every person has a position and which tend to be conceptualized as being stable. Personality traits are often conceptualized as dispositions. Diagnostic (...) categories represent not trait-like properties of populations but episodic states consisting of clusters of symptoms experienced by individuals with disorders. Ratings, scales, he notes, are hybrids between the two. They are used to quantify psychiatric symptom clusters so that change over time can be measured. Le Moigne argues that these distinctions were initially suggested during the development of measures that could assess outcomes in psychopharmacological treatment studies.With respect to depression, Le Moigne writes that in the 1970s and 1980s something akin to depressive personality was reconceptualized as a temperament. A key move, somewhat reflective of Kraepelin’s notion of a depressive temperament, was to view a dysthymic temperament as both a predisposing factor and an attenuated form of depression. Thus, an episodic state commandeered the predisposing–dispositional role that was assigned to stable personality traits.This conceptual shift allowed test-like ratings scales to be seen as useful for quantifying not just stable traits, but salient features of episodic states that are potentially subject to change in response to interventions. To put it another way, in the development of a psychological test, one goal is to have high test-retest reliability (i.e., stability of measurement). With rating scales used to measure change, one wants the scores to not be as stable; ideally the scores on the later assessments will be lower. According to Le Moigne, when dysthymia was subsequently placed on axis I of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III (as a syndrome) and segregated from personality disorders which were placed on axis II, personality traits were evicted from the conceptualization of depressive disorders.One perennial feature of psychiatry and psychology is that even if an older idea is superseded [End Page 253] in the view of some thinkers, it can still attract adherents. Indeed, interest in understanding a relationship between personality and attenuated states did not fully disappear. For example, based on research in genetics, the schizophrenia spectrum concept included not only schizophrenia, but also milder conditions such that were conceptualized as personality disorders; that is, schizotypal personality disorder and paranoid personality disorder (Kety, Rosenthal, Wender, & Schulsinger, 1971).During the development of the DSM-IV, some people wanted to add depressive personality disorder to the manual (Phillips, Hirschfeld, Shea, & Gunderson, 1995). It seems to have become a territorial dispute between mood disorder specialists and personality disorder specialists The mood disorders specialists challenged the personality disorder specialists to differentiate depressive personality disorder from early onset, chronic dysthymia. They were able to do so by using criteria such as critical, blaming, and derogatory toward self. After the mood disorders work group proposed incorporating some of those criteria into a revised criteria set for dysthymia, the two sets overlapped. The result was the old criteria for dysthymia were printed in DSM-IV and criteria for depressive personality disorder and the revised criteria for dysthymia were both placed in the appendix.In the DSM-5, Axis II was eliminated and personality disorders were placed alongside all the syndromic symptom clusters at the same level. Even so, interest in attenuated presentations as personality-related lingered still. During the development of the DSM-5 there was some thought to using diagnostic spectra as a meta-structure for organizing the manual (Andrews et al., 2009). One idea was to move some personality disorders into a best fitting spectrum, akin to attenuated forms. This did occur with schizotypal personality disorder which is both in the DSM-5 chapter on schizophrenia and in the chapter on personality disorder. In the schizophrenia chapter it is positioned as the earliest emerging disorder on the spectrum. There was also some interest in grouping avoidant personality disorder with the anxiety disorders, but the evidence supporting such a change was not available.These issues may... (shrink)

Scientific and medical practice both relate to and differ from each other, as do discussions of how to handle decisions under uncertainty in the laboratory and clinic respectively. While studies of science have pointed out that scientific practice is more complex and messier than dominant conceptions suggest, medical practice has looked to the rigour of scientific and statistical methods to address clinical uncertainty. In this article, we turn to epistemological studies of the laboratory to highlight how clinical practice already has (...) strategies for dealing with messiness. We draw on Hans-Jo ̈rg Rheinberger’s Toward a History of Epistemic Things, in which he invokes the metaphor of a spider’s web to explain the role of tacit practices in experimental biochemistry for helping practitioners manage messiness. We argue that diagnostic practices in clinical medicine employ similar, albeit codified, procedures to evaluate epistemic significance, ensure sensitivity to the unforeseen, and allow focused grounds for action. We consider three practices: (a) the pre-set structure of medical records, ensuring broad coverage in initial anamnesis, (b) the use of lists of differential diagnoses and ongoing ‘anchoring and adjusting’ as inquiry progresses, and (c) shared decision-making as an occasion to synthesize empirical evidence and reopen inquiry for potential missed information. We end by suggesting that while philosophy of medicine may learn from laboratory epistemology, the sciences may learn something from medical practice. (shrink)