Staphylococcus aureus is an opportunistic pathogen capable of causing a variety of diseases including osteomyelitis, endocarditis, infections of indwelling devices and wound infections. These infections are often chronic and highly recalcitrant to antibiotic treatment. Persister cells appear to be central to this recalcitrance. A multitude of factors contribute to S. aureus virulence and high levels of treatment failure. These include its ability to colonize the skin and nares of the host, its ability to evade the host immune system and its (...) development of resistance to a variety of antibiotics. Less understood is the phenomenon of persister cells and their role in S. aureus infections and treatment outcome. Persister cells occur as a sub‐population of phenotypic variants that are tolerant to antibiotic treatment. This review examines the importance of persisters in chronic and relapsing S. aureus infections and proposes methods for their eradication. (shrink)

This paper answers Adorno's question, once asked in a lecture, about whether we, by forbidding the thought of the non-identical, fall in radically completed enlightenment back into the darkest form of mythology. In arguing for this in the question implied observation of enlightenment's fallback, the paper analyses Adorno's and Horkheimer's critique of enlightenment and its relapse due to excluding the non-identical, suggesting that emotions and memory represent this non-identical. As the darkest form of mythology Adorno is referring to is not (...) to be understood as a myth itself but actually happened with the Holocaust, the paper then demonstrates how enlightenment, chiefly its exclusion of the non-identical, led to central conditions of the Holocaust that Adorno named ‘Auschwitz’. As enlightenment, according to Adorno, remains in its relapse, the paper finally discusses how his philosophy after Auschwitz advocates for the reintegration of the non-identical, mainly through the recollection of the past and the remembrance of nature within the subject. (shrink)

An influential interpretation of phenomenology construes Husserl's project as an attempt to generalize the Fregean notion of sense- an attempt to extend Frege's analysis of the structure of meaningful expressions to a more general account of the structure of meaning in experience . Michael Dummett has articulated a broadly Fregean critique of this Husserlian program, arguing that the project is misguided and retrograde-a relapse into the psychologism and idealism that Frege sought to avoid. A defense of Husserl is offered, based (...) in part on key elements of the theory of meaning articulated in his Logical Investigations . But the main aim is neither to acquit nor to convict Husserl of Dummett's charges; rather it is to use the exchange to investigate some of the philosophical commitments of a broadly Husserlian phenomenology. If we are to understand how Husserl avoids psychologism then we must come to terms with the paradoxical idea of an anti-psychologistic investigation of consciousness (an anti-psychologistic psychology). If we are to understand his complex stance toward idealism then we must not only understand the grounds for his rejection of subjective idealism but also be attuned to the other forms of idealism to which his project is committed. In the course of investigating these matters the author considers how Husserl can reply to the charge of explanatory vacuity, and shows that Frege himself recognizes the legitimacy of something like the Husserlian project. (shrink)

BackgroundBeing pregnant is a vulnerable period for women with a history of eating disorders. A central issue in eating disorders is searching control of one’s body and food preferences. Pregnancy implies being increasingly out of control of this. Treatment and targeted prevention start with the patient’s experience. Little is known about how women with a history of eating disorder experience being pregnant.MethodWe interviewed 24 women with a history of eating disorder at the time of pregnancy, recruited from five public pregnancy (...) controls at local family health centers in Norway. Interviews were analyzed by means of ideal type analysis, with a particular focus on how the participants experienced pregnancy and perceived triggers in possible experiences of relapse or worsening during pregnancy. All participants completed the Eating Disorder Examination Questionnaire and were diagnosed by using the Eating Disorder Examination.ResultsOn becoming pregnant, 23 of the 24 participants experienced worsening or relapse of their disorder. This occurred both at first time and after several pregnancies, and either interviewed early or late in pregnancy. Ideal type analyses indicated seven different personal features associated with worsening or relapse: the “chaotic” “rigid” “perfect” “worried” “shameful” “motherhood fearing” and “the mother with lost identity” Perceived triggers of worsening or relapse were: “loss of control” “unpredictability” “competition” “change of appearance” “shame and nausea” and “loss of identity.”ConclusionPregnancy is a vulnerable period for women with a history of eating disorders. A great variation in personal psychological dynamics seems to interact with perceived triggers in worsening or relapse of eating disorder. Our findings have important implications in understanding mechanisms of relapse in pregnancy, preventing relapse and help tailoring adequate intervention. (shrink)

It is universally accepted that informed consent to participate in medical research should be given by subjects. People have the fundamental human right to freely choose, without coercion or withholding of information necessary to make a reasonable choice, whether they will undergo any risks associated with a research project. United States researchers have known for some time that they have the duty to inform potential subjects of the nature of proposed research and the risks and possible benefits, and to seek (...) consent. Investigators also have the duty to design the research so that it will be scientifically valid while minimizing foreseeable and avoidable harms. (shrink)

Normal 0 false false false EN-MY X-NONE AR-SA Normal 0 false false false EN-MY X-NONE AR-SA /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:24.0pt; mso-para-margin-right:0cm; mso-para-margin-bottom:0cm; mso-para-margin-left:0cm; mso-para-margin-bottom:.0001pt; text-align:justify; line-height:200%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:24.0pt; mso-para-margin-right:0cm; mso-para-margin-bottom:0cm; mso-para-margin-left:0cm; mso-para-margin-bottom:.0001pt; text-align:justify; line-height:200%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; (...) mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;}This study explores the significance of the family factors on drug use and its effects on relapse. In this respect, the effects of parental substance use , family conflict , and family structure are discussed in this research. The family, as a fundamental social unit of society, can be expected to exert remarkable influences on the development of social behaviors such as adolescent substance use and also relapse ADDIN EN.CITE Rouholamini 2002 90 90 90 32 Rouholamini,S Formative research on familial characteristics of drug users in Iran Master 2002 New Haven Yale (Rouholamini, 2002) . Since nearly 90% of drug abusers in Iran live with a family member ADDIN EN.CITE Mokri 2002 6 6 6 17 Mokri, A A brief overview of the status of drug abuse in Iran Archives of Iranian Medicine 184-190 5(3) 2002 (Mokri, 2002) , therefore family has an important role to reduce the high rates of relapse after detoxification. Therefore, this study considers three factors: Parental substance use , Family Conflict , and Family Structure. The objective of this study is to examine the effects of family factors on relapse behavior among male adolescent opiate users in Kerman. In this research 226 adolescents between the ages of 13 to 20 were selected based on ten rehabilitation centers to answer the Self-administered questionnaire. Results showed that there were important relationships between these factors with relapse in adolescents. The study proposes some suggestions in order to prevent relapse after treatment in adolescents. (shrink)

BackgroundEvidence suggests that organizational models that provide care interventions including patient support programs may increase patient adherence to multiple sclerosis therapies by providing tailored symptom management, informational support, psychological and/or social support, lifestyle changes, emotional adjustment, health education, and tailored coaching, thus improving patients' overall quality of life across the disease course.ObjectiveThe main objective of this study was to describe MS patients' self-reported experience of a nurse-led, telephone-based PSP and to explore its potential role in improving disease and therapy management (...) skills.MethodsSurvey data were analyzed from a subset of patients relapsing–remitting MS using interferon beta-1a already registered in the adveva® PSP from three Italian multiple sclerosis centers with a consolidated experience in RRMS disease, treatment management, and PSP programs.ResultsIn total, 244 patient data at baseline were analyzed, of which 115 had a follow-up of at least 6 months. Results from this study provide an early view into the role of this PSP in improving the patients reported overall experience regarding disease management and injectable therapy, thus potentially ameliorating treatment adherence and decreasing health care cost. Moreover, study findings confirm the role of providing a patient-focused support by addressing non-medication-related topics in the PSP consultations. Indeed, patients involved in the adveva® PSP program reported a better psychological status in the follow up as demonstrated by an increased optimism regarding their future, tolerance of disease uncertainty, and their perceived ability to benefit from external help and social support.ConclusionsAs such, it is reasonable to conclude that the involvement in the adveva® PSP and the PSP's assistance in guiding patients on proper treatment self-management techniques is of great value to patients as it might contribute to improving engagement in their health care journey in terms of perceived self-care skills, emotional coping toward the future and the unpredictability of the disease course and their general attitudes toward the injection itself, involving pain tolerance. (shrink)

Converging data from different disciplines are showing the role of classical conditioning processes in the elaboration of human and animal behavior to be larger than previously supposed. Restricted views of classically conditioned responses as merely secretory, reflexive, or emotional are giving way to a broader conception that includes problem-solving, and other rule-governed behavior thought to be the exclusive province of either operant conditiońing or cognitive psychology. These new views have been accompanied by changes in the way conditioning is conducted and (...) evaluated. Data from a number of seemingly unrelated phenomena such as relapse to drug abuse by postaddicts, the placebo effect, and the immune response appear to involve classical conditioning processes. Classical conditioning, moreover, has been found to occur in simpler and simpler organisms and recently even demonstrated in brain slices and in utero. This target article will integrate the several research areas that have used the classical conditioning process as an explanatory model; it will challenge teleological interpretations of the classically conditioned CR and offer some basic principles for testing conditioning in diverse areas. (shrink)

The term “hypnozoite” is derived from the Greek words hypnos and zoon. Hypnozoites are dormant forms in the life cycles of certain parasitic protozoa that belong to the Phylum Apicomplexa and are best known for their probable association with latency and relapse in human malarial infections caused by Plasmodium ovale and P. vivax. Consequently, the hypnozoite is of great biological and medical significance. This, in turn, makes the origin of the name “hypnozoite” a subject of interest. Some “missing” history that (...) is now placed on record shows that Miles B. Markus coined the term “hypnozoite”. While a PhD student at Imperial College London, he carried out research that led to the identification of an apparently dormant form of Cystoisospora. In 1976, he speculated: “If sporozoites of Isospora can behave in this fashion, then those of related Sporozoa, like malaria parasites, may have the ability to survive in the tissues in a similar way.” He adopted the term “hypnozoite” for malaria in 1978 when he wrote in a little-known journal that this name would “… describe any dormant sporozoites or dormant, sporozoite-like stages in the life cycles of Plasmodium or other Haemosporina.” At that time, the existence of a hypnozoite form in the life cycle of Plasmodium was still a hypothetical notion. In 1980, however, Wojciech A. Krotoski published details concerning his actual discovery of malarial hypnozoites, an event of considerable importance. (shrink)

_Covert treatment raises a number of ethical and practical issues in psychiatry. Viewpoints differ from the standpoint of psychiatrists, caregivers, ethicists, lawyers, neighbours, human rights activists and patients. There is little systematic research data on its use but it is quite certain that there is relatively widespread use. The veil of secrecy around the procedure is due to fear of professional censure. Whenever there is a veil of secrecy around anything, which is aided and abetted by vociferous opposition from some (...) sections of society, the result is one of two: 1) either the activity goes underground or 2) it is reluctantly discarded, although most of those who used it earlier knew it was needed. Covert treatment has the dubious distinction of suffering both such secrecy and disapproval. Covert treatment has a number of advantages and disadvantages in psychotic disorders. The advantages are that it helps solve practical clinical problems; prevents delays in starting treatment, which is associated with clinical risks and substantial costs; prevents risk of self-destructive behaviour and/or physical assault by patient; prevents relapse; and prevents demoralization of staff. The disadvantages are that it maybe used with malafide intent by caregivers with or without the complicity of psychiatrists; it may be used to force conformity in dissenters; and the clinician may land himself in legal tangles even with its legitimate use. In addition, it may prevent insight, encourage denial, promote unhealthy practices in the treating staff and prevent understanding of why noncompliance occurs in the first place. Some support its use in dementia and learning disorders but oppose it in schizophrenia. The main reason is that uncooperative patients of schizophrenia (and related psychoses) are considered to be those who refuse treatment but retain capacity; while in dementia and severe learning disorder, uncooperative patients are those who lack capacity. This paper disputes this contention by arguing that although uncooperative patients of schizophrenia (and related psychoses) apparently retain capacity, it is limited, in fact distorted, since they lack insight. It presents the concept of insight-unconsciousness in a patient of psychosis. Just as an unconscious patient has to be given covert medical/surgical treatment, similarly an insight-unconscious patient with one of the different psychoses (in the acute phase or otherwise) may also have to be given covert treatment till he regains at least partial insight. It helps control psychotic symptoms and assists the patient in regaining enough insight to realize he needs treatment. Another argument against covert treatment is that people with schizophrenia have the capacity to learn and therefore can learn that they are required to take medications, but if medications are given covertly it may well fuel their paranoia. However, it should be noted that the patient who has lack of insight cannot learn unless he regains that insight, and he may need covert treatment to facilitate this process. Covert treatment can fuel the paranoia, true, but it can also control the psychotic symptoms sufficiently so that regular treatment can be initiated. In a patient who refuses to accept that he is sick and when involuntary commitment is not an option to be considered, covert treatment is the only option, apart from physical restraint. Ultimately, a choice has to be made between a larger beneficence (control of symptoms and start of therapy) and a smaller malevolence (necessary therapy, but without the patient's knowledge and consent). A number of practical clinical scenarios are outlined wherein the psychiatrist should adopt covert treatment in the best interests of the patient. Ethical issues of autonomy, power, secrecy and malafide intent arise; each of these can be countered only by non-malfeasance (above all, do no harm) under the overarch of beneficence (even above that, dare to care). An advance directive with health care proxy that sanctions covert treatment is presented. Questions raised by the practical clinical scenarios are then answered. The conclusions are as follows: covert treatment, i.e, temporary treatment without knowledge and consent, is seldom needed or justified. But, where needed, it remains an essential weapon in the psychiatrist's armamentarium: to be used cautiously but without guilt or fear of censure. However, the psychiatrist must use it very judiciously, in the rarest of rare cases, provided: i) he is firmly convinced that it is needed for the welfare of the patient; ii) it is the only option available to tide over a crisis; iii) continuing efforts are made to try and get the patient into regular psychiatric care; iv) the psychiatrist makes it clear that its use is only as a stop-gap; v) he is always alert to the chances of malevolence inherent in such a process and keeps away from conniving or associating with anything even remotely suspicious; and vi) he takes due precautions to ensure that he does not land into legal tangles later. The need of the hour is to explore in greater detail the need and justification for covert treatment, to lay out clear and firm parameters for its legitimate use, follow it up with standard literature and, finally, to establish clinical practice guidelines by unconflicted authors. The term "covert treatment" is preferable to "surreptitious prescribing"; they should not be used synonymously, the latter term being reserved for those cases where there is malafide intent._. (shrink)

A literature search was conducted on studies of new drugs used with patients with schizophrenia reported by U.S. and non-U.S. researchers from 1966–1993, yielding 41 U.S., and a total of 24 other non-U.S. studies, among them 11 British studies. Results of the U.S. and non-U.S. studies were pooled separately and compared. Among several comparable conditions discussed, the lack of any data on suicides in the U.S. studies was observed. For a second statistical analysis of suicide rates ‘person-years’ were calculated to (...) adjust for differing washout durations. The results obtained include findings that the percentage of patients relapsing in U.S. studies was slightly lower than in non-U.S. studies ; the percentage of patients dropping out in U.S. studies was higher than in non-U.S. studies ; known location of dropout patients in U.S. studies was 1.7%, compared to 2.6% in non-U.S. studies. The most interesting finding was that no suicides were reported in U.S. studies, compared to 0.6% of patients reported in British studies. Some U.S. studies used ‘challenge doses’, such as amphetamines or L-dopa; no non-U.S. studies reported their use. Compared to U.S. studies, those by non-U.S., and particularly British, researchers appeared to report adverse events in their studies. ‘Challenge’ drugs were not used; suicides were reported. It is estimated that the probability that no patients suicided who participated in the U.S. is small—one in 500. (shrink)

Recent experiments have shown that when individuals with a substance use disorder are confronted with drug-related cues, they exhibit an automatically activated tendency to approach these cues. The strength of the drug approach bias has been associated with clinically relevant measures, such as increased drug craving and relapse, and activations in brain reward areas. Retraining the approach bias by means of cognitive bias modification has been demonstrated to decrease relapse rates in patients with an alcohol use disorder and to reduce (...) alcohol cue-evoked limbic activity. Here, we review empirical and theoretical literature on the drug approach bias and explore two distinct models of how the drug approach bias may be embodied. First, we consider the “biological meaning” hypothesis, which grounds the automatic approach bias in the natural meaning of the body. Second, we consider the “sensorimotor hypothesis,” which appeals to the specific sensorimotor loops involved in the instantiation of addictive behaviors as the basis of the automatic approach bias. In order to differentiate between the adequacies of these competing explanations, we present specific, predictions that each model should make. (shrink)

A prominent number of contemporary theories of emotional experience—understood as occurrent, phenomenally conscious episodes of emotions with an affective character that are evaluatively directed towards particular objects or states of affairs—are motivated by the claim that phenomenally conscious affective experience, when appropriate, grants us epistemic access not merely to features of the experience but also to features of the object of experience, namely its value. I call this the claim of affect as a disclosure of value. The aim of this (...) paper is to clarify the sort of assumptions about experience that we ought to avoid if we want to be able to argue that for the claim of affect as a disclosure of value. There are two core arguments in this paper. First, I argue that Mark Johnston’s account of affect as a disclosure of value, due to its naïve realist commitments, relapses into a position that is vulnerable to the same objection put forward by some naïve realists against intentionalist accounts of perceptual experience. Second, I argue that Michelle Montague’s account, due to its phenomenal intentionalist commitments, relapses into a position that is vulnerable to the same objections put forward against qualia theories of the phenomenal character of perceptual experience. The upshot of the paper is that the core assumptions embedded in the three dominant models of experience—namely naïve realism, different versions of intentionalism, and qualia theory—are problematic as found in contemporary accounts of affect as a disclosure of value. (shrink)

Addiction of the variety discussed in this chapter, is a condition that by its very nature compromises decision-making capacity across the decisional spectrum. The impairment is present not only at moments of withdrawal and intoxication, but at all stages of the active addictive cycle, as long as the pathological dispositions to overvalue addictive drugs remain entrenched and operative. In light of this entrenched and pervasive reorientation in pathological values, it seems reasonable to question the unilateral presumption of capacity for cases (...) of this sort. The reason is that there is an important, but restricted, sense in which the addicted individuals in question are not ‘responsible’ for their decisions regarding drug use. The high likelihood of relapse means that, as a clinical matter of fact, they are usually not accountable. At the same time, clinical experience also suggests that we should treat addicted individuals as if they are responsible because that empowerment is crucial to their recovery. In the end, there is probably only one safe course of action to take when faced with such a difficult situation. This is to suspend the unilateral global presumption of capacity and instead assess decision-making capacity on a case-by-case basis, with careful monitoring and encouragement. (shrink)

In this article, we present for the first time Schelling’s early critique of absolute idealism within his middle metaphysics (1804–1820), which has great relevance and influence on the subsequent course of German philosophy, and, more broadly considered, on later systematic thinking about the categories of unity and duality. We aim to show how Schelling defends a form of metaphysical duality, from 1804 onwards, without relapsing into a stronger Kantian dualism. In this sense, our author rejects both the dualism between nature (...) and spirit, necessity and freedom, as well as the monist-immanent metaphysical stance later associated with Hegelian panlogism. Against Hegel, Schelling increasingly vindicates the reality of the finite and degrades the infinite to mere ideality in a movement that resembles later existentialism. Furthermore, we defend Schelling against the accusation of irrationalism that sections of Hegelianism formulated against him and present the concept of infinity without the notion of totality, which he thinks of, much like Fichte, in the light of the concept of an ‘infinite task’. Schelling’s later criticisms of Hegel are shown to be influenced by his early idealist critique of the period at hand. (shrink)

The Dutch animal production sector faces significant pressure for change. We discuss a project for the design of a sustainable husbandry system for pigs. Named after the Greek hero Hercules, the project aimed for structural changes in both animal and crop production. However, instead of changing the course of the river, the project ended up merely adapting its flow. The Hercules project ran into difficulties typical for projects aiming at reflexive modernization. It relapsed from an effort for reflexive modernization to (...) ecological modernization, by ultimately leaving the structural features of the sociotechnical regime intact. We show how this resulted from the biases and limitations implied by existing institutions, in which the project was unavoidably embedded. We introduce the idea of reflexive design, as “doing” reflexive modernization, which implies working on action and structure at the same time. A number of recommendations are given for reflexive design projects like this. (shrink)

Refusing treatment for potentially curable childhood cancers engenders much discussion and debate. I present a case in which the competent parents of a young Amish child with acute myeloid leukemia deferred authority for decision making to the child’s maternal grandfather, who was vocal in his opposition to treatment. I analyze three related concerns that distinguish this case from other accounts of refused treatment.First, I place deference to grandparents as decision makers in the context of surrogate decision making more generally.Second, the (...) maternal grandfather’s ardent refusal of treatment and his rationale appeared to be inconsistent with the beliefs expressed by other family members and by members of the same Amish community, leading members of the medical team to question whether refusal of treatment should be treated differently when it appears to be based on the idiosyncratic beliefs of an individual rather than on community-wide values.Third, the medical team perceived tension and dissension between the nonverbal behavior of some family members and the verbal statements made by the maternal grandfather, leading the team to question the parents’ true wishes and debate how to weigh nonverbal and indirect forms of communication.Finally, building upon the conclusions of these queries, I explore whether, if the child’s prognosis was less favorable or if he were to relapse later, the maternal grandfather should have been permitted to drive a decision to refuse further treatment. (shrink)

A “cocaine vaccine” is a promising immunotherapeutic approach to treating cocaine dependence which induces the immune system to form antibodies that prevent cocaine from crossing the blood brain barrier to act on receptor sites in the brain. Studies in rats show that cocaine antibodies block cocaine from reaching the brain and prevent the reinstatement of cocaine self administration. A successful phase 1 trial of a human cocaine vaccine has been reported. The most promising application of a cocaine vaccine is to (...) prevent relapse to dependence in abstinent users who voluntarily enter treatment. Any use of a vaccine to treat cocaine addicts under legal coercion raises major ethical issues. If this is done at all, it should be carefully trialled first, and only after considerable clinical experience has been obtained in using the vaccine to treat voluntary patients. There will need to be an informed community debate about what role, if any, a cocaine vaccine may have as a way of preventing cocaine addiction in children and adolescents. (shrink)

In The Mysterious Relations to the East, Lin Ma takes a stance against a recent trend to see in Heidegger a thinker whose thought has been formed in an 'intercultural dialogue' with the Asian, Oriental tradition of thinking. In fact, Lin Ma demonstrates, words like 'Morning-Land', 'Orient', 'East' or 'Asia' can be shown to refer in each case to the beginning of philosophy in preSocratic, Greek thought. Thus to speak of the "mysterious relations [of philosophy] to the East" is not (...) to speak of a relation of European philosophy with other traditions of thinking, but rather concerns an investigation into the very roots of European philosophy itself. Despite Heidegger's concerns with the possibility of 'inter-cultural' dialogue, as evidenced, for example, in A Dialogue on Language Between a Japanese and an Inquirer, such a dialogue has to be questioned in its very possibility in order to avoid relapsing into the universalistic language of metaphysics. (shrink)

Depression is a highly recurrent disorder with limited treatment alternatives for reducing risk of subsequent episodes. Acceptance and commitment therapy (ACT) and attention bias modification (ABM) separately have shown some promise in reducing depressive symptoms. This study investigates (a) if group-based ACT had a greater impact in reducing residual symptoms of depression over a 12-month follow-up than a control condition, and (b) if preceding ACT with ABM produced added benefits. This multisite study consisted of two phases. In phase 1, participants (...) with a history of depression, currently in remission (N= 244), were randomized to either receive 14 days of ABM or a control condition. In phase 2, a quasi- experimental design was adopted, and only phase-1 participants from the Sørlandet site (N= 124) next received an 8-week group-based ACT intervention. Self-reported and clinician-rated depression symptoms were assessed at baseline, immediately after phase 1 and at 1, 2, 6, and 12 months after the conclusion of phase 1. At 12-month follow-up, participants who received ACT exhibited fewer self-reported and clinician-rated depressive symptoms. There were no significant differences between ACT groups preceded by ABM or a control condition. There were no significant differences between ACT groups preceded by ABM or a control condition. Group-based ACT successfully decreased residual symptoms in depression over 12 months, suggesting some promise in preventing relapse. (shrink)

Substance use disorders (SUDs) constitute a growing global health crisis, yet many limitations and challenges exist in SUD treatment research, including the lack of objective brain-based markers for tracking treatment outcomes. Electroencephalography (EEG) is a neurophysiological technique for measuring brain activity, and although much is known about EEG activity in acute and chronic substance use, knowledge regarding EEG in relation to abstinence and treatment outcomes is sparse. We performed a scoping review of longitudinal and pre-post treatment EEG studies that explored (...) putative changes in brain function associated with abstinence and/or treatment in individuals with SUD. Following PRISMA guidelines, we identified studies published between January 2000 and March 2022 from online databases. Search keywords included EEG, addictive substances (e.g., alcohol, cocaine, methamphetamine), and treatment related terms (e.g., abstinence, relapse). Selected studies used EEG at least at one time point as a predictor of abstinence or other treatment-related outcomes; or examined pre- vs. post-SUD intervention (brain stimulation, pharmacological, behavioral) EEG effects. Studies were also rated on the risk of bias and quality using validated instruments. Forty-four studies met the inclusion criteria. More consistent findings included lower oddball P3 and higher resting beta at baseline predicting negative outcomes, and abstinence-mediated longitudinal decrease in cue-elicited P3 amplitude and resting beta power. Other findings included abstinence or treatment-related changes in late positive potential (LPP) and N2 amplitudes, as well as in delta and theta power. Existing studies were heterogeneous and limited in terms of specific substances of interest, brief times for follow-ups, and inconsistent or sparse results. Encouragingly, in this limited but maturing literature, many studies demonstrated partial associations of EEG markers with abstinence, treatment outcomes, or pre-post treatment-effects. Studies were generally of good quality in terms of risk of bias. More EEG studies are warranted to better understand abstinence- or treatment-mediated neural changes or to predict SUD treatment outcomes. Future research can benefit from prospective large-sample cohorts and the use of standardized methods such as task batteries. EEG markers elucidating the temporal dynamics of changes in brain function related to abstinence and/or treatment may enable evidence-based planning for more effective and targeted treatments, potentially pre-empting relapse or minimizing negative lifespan effects of SUD. (shrink)

In the new debate about economic planning, the question of whether new forms of comprehensive planning might inadvertently encourage a relapse into authoritarianism must be central. The article analyzes the proposal of a “Participatory Economy” because it is the most sophisticated model for comprehensive planning without the need for centralized institutions. Planning is carried out in a participatory manner, enabling worker and consumer councils to coordinate their interrelated economic activities themselves. The danger of a relapse into authoritarianism appears to be (...) averted. However, the paper argues that the Participatory Economy doesn’t live up to the goal it set for itself to a satisfying degree, because it requires more centralized institutions than it initially suggests. Centralization tendencies arise for strong normative reasons and are therefore difficult to avoid. Even worse, council-democratic remedies to centralization tendencies don’t offer an easy answer, as these remedies come with their own set of problems. (shrink)

Research in the philosophy of addiction commonly explores how agency is impacted in addiction by focusing on moments of apparent loss of control over addictive behavior and seeking to explain how such moments result from the effects of psychoactive substance use on cognition and volition. Recently, Glackin et al. (2021) have suggested that agency in addiction can be helpfully analyzed using the concept of affordances. They argue that addicted agents experience addiction-related affordances, such as action possibilities relating to drugs, drug (...) paraphernalia, and drug-related activities, as aberrantly salient motivations for action. Building on this approach, we present a novel two-tiered affordance model of addiction. In doing so, we suggest that what is significant about the addicted person’s world is not simply what affordances are experienced as salient, but also the way in which the addicted person’s world is shaped by a dominant concern. It is not only that addiction-related affordances become more prominent as addiction progresses but that one’s plurality of concerns become monopolized by and funneled through addiction. Our model endorses Glackin et al.’s idea that addiction-related affordances become aberrantly salient, while proposing why they become and remain so. This way of viewing agency in addiction also brings to light important implications for recovery and treatment. For, if an addicted person adopts a new, even “socially approved,” dominant concern, there is a risk that the shape of addiction is preserved, even though the content changes, leaving an individual at the risk of addiction substitution or relapse. (shrink)

Research findings on addiction are contradictory. According to biographical records and widely used diagnostic manuals, addicts use drugs compulsively, meaning that drug use is out of control and independent of its aversive consequences. This account is supported by studies that show significant heritabilities for alcoholism and other addictions and by laboratory experiments in which repeated administration of addictive drugs caused changes in neural substrates associated with reward. Epidemiological and experimental data, however, show that the consequences of drug consumption can significantly (...) modify drug intake in addicts. The disease model can account for the compulsive features of addiction, but not occasions in which price and punishment reduced drug consumption in addicts. Conversely, learning models of addiction can account for the influence of price and punishment, but not compulsive drug taking. The occasion for this target article is that recent developments in behavioral choice theory resolve the apparent contradictions in the addiction literature. The basic argument includes the following four statements: First, repeated consumption of an addictive drug decreases its future value and the future value of competing activities. Second, the frequency of an activity is a function of its relative (not absolute) value. This implies that an activity that reduces the values of competing behaviors can increase in frequency even if its own value also declines. Third, a recent experiment (Heyman & Tanz 1995) shows that the effective reinforcement contingencies are relative to a frame of reference, and this frame of reference can change so as to favor optimal or suboptimal choice. Fourth, if the frame of reference is local, reinforcement contingencies will favor excessive drug use, but if the frame of reference is global, the reinforcement contingencies will favor controlled drug use. The transition from a global to a local frame of reference explains relapse and other compulsive features of addiction. (shrink)

I argue that addiction is not a chronic, relapsing, neurobiological disease characterized by compulsive use of drugs or alcohol. Large-scale national survey data demonstrate that rates of substance dependence peak in adolescence and early adulthood and then decline steeply; addicts tend to “mature out” in their late twenties or early thirties. The exceptions are addicts who suffer from additional psychiatric disorders. I hypothesize that this difference in patterns of use and relapse between the general and psychiatric populations can be explained (...) by the purpose served by drugs and alcohol for patients. Drugs and alcohol alleviate the severe psychological distress typically experienced by patients with comorbid psychiatric disorders and associated problems. On this hypothesis, consumption is a chosen means to ends that are rational to desire: Use is not compulsive. The upshot of this explanation is that the orthodox view of addiction as a chronic, relapsing neurobiological disease is misguided. I delineate five folk psychological factors that together explain addiction as purposive action: strong and habitual desire; willpower; motivation; functional role; and decision and resolve. I conclude by drawing lessons for research and effective treatment. (shrink)

Adorno's first musical monograph, his book on Wagner, represents his most consistent effort to apply commodity analysis to one of the seminal oeuvres of cultural modernity. The notion of commodity character and the associated concept of phantasmagoria are to fulfil the function of mediation between the more narrowly conceived technical analysis of Wagner's music and the disclosure of its aesthetic-social substance, providing the ultimate social ground for their unity. This project, however, fails. Commodity analysis proves to be radically vague, incapable (...) of disclosing the historical specificity of the music dramas either in respect of the tradition of Vienna classicism, or the ensuing development of aesthetic modernism. At the same time its application is burdened by contradictions. Ultimately, Adorno's critical interpretation relapses into a form of ideology critique the simplifications of which he originally attempted to overcome. (shrink)

This paper presents four arguments in favour of respecting Ulysses Contracts in the case of individuals who suffer with severe chronic episodic mental illnesses, and who have experienced spiralling and relapse before. First, competence comes in degrees. As such, even if a person meets the usual standard for competence at the point when they wish to refuse treatment (time 2), they may still belesscompetent than they were when they signed the Ulysses Contract (time 1). As such, even if competent at (...) time 1andtime 2, there can still be a disparity between thelevelsof competence at each time. Second, Ulysses Contracts are important to protect people’smost meaningfulconcerns. Third, on the approach defended, the restrictions to people’s liberty would be temporary, and would be consistent with soft paternalism, rather than hard paternalism: the contracts would be designed in such a way that individuals would be free to change their minds, and to change or cancel their Ulysses Contracts later. Finally, even if one rejects the equivalence thesis (the claim that allowing harm is as bad as doing harm), this is still consistent with the claim that, inparticular cases, it can be as wrong toallowa harm as to do a harm. Nevertheless, controversies remain. This paper also highlights several safeguards to minimise risks. Ultimately, we argue that people who are vulnerable to spiralling deserve a way to protect their autonomy as far as possible, using Ulysses Contracts when necessary. (shrink)

We study smoking-cessation apps in order to formulate a framework for ethical evaluation, analyzing apps as ‘medium’, ‘market’, and ‘genre’. We center on the value of user autonomy through truthfulness and self-understanding. Smoking-cessation apps usually communicate in an anonymous ‘app voice’, with little presence of professional or other identified voices. Because of the fast-and-frugal communication, truthfulness is problematic. Messages in the ‘quantification’ modules may be read as deceitfully accurate. The app voice frames smoking as a useless, damaging habit indicative of (...) weakness of will, in a ‘cold-turkey’ frame of individual mind-over-body heroism. Thus apps contribute to a stigmatization of smokers and culpabilization of relapses. The potential to support user autonomy through diverse meaningful voices and personalized communication remains yet unused. (shrink)

In this two-part analysis, I analyze Marc Lewis’s arguments against the brain-disease view of substance addiction and for a developmental-learning approach that demedicalizes addiction. I focus especially on the question of whether addiction is a medical disorder. Addiction is currently classified as a medical disorder in DSM-5 and ICD-10. It is further labeled a brain disease by NIDA, based on observed brain changes in addicts that are interpreted as brain damage. Lewis argues that the changes result instead from normal neuroplasticity (...) and learning in response to the intense rewards provided by addictive substances, thus that addiction is not a brain disease and by implication not a medical disorder at all. I argue that even if one accepts Lewis’s reinterpretation of the brain evidence, his conclusions do not follow. Relying on my harmful-dysfunction analysis of medical disorder, I defend the view that substance addiction is in fact a medical disorder and a brain disorder. In Part 1, I identify five arguments Lewis puts forward against the brain-disease view and evaluate them as arguments that addiction is not a disorder: Addiction is not a chronic, relapsing condition; There is no clear boundary between addiction and other strong desires; Negative consequences are not unique to disorders; The brain disease model does not account for behavioral addictions; and, Addiction is like love. I argue that Lewis’s arguments are invalid because they fail to take account of the context of addiction and its relation to biological design. (shrink)

ObjectiveTo elucidate the clinical, radiologic characteristics of Leber’s hereditary optic neuropathy (LHON) associated with the other diseases.Materials and methodsClinical data were retrospectively collected from hospitalized patients with LHON associated with the other diseases at the Neuro-Ophthalmology Department at the Chinese People’s Liberation Army General Hospital (PLAGH) from December 2014 to October 2018.ResultsA total of 13 patients, 24 eyes (10 men and 3 women; mean age, 30.69 ± 12.76 years) with LHON mitochondrial DNA (mtDNA) mutations, were included in the cohort. 14502(5)11778(4)11778 (...) &11696(1)12811(1)11696(1)3460(1). One patient was positive for aquaporin-4 antibody (AQP4-Ab), and two were positive for myelin oligodendrocyte glycoprotein antibody (MOG-Ab). Three patients were associated with idiopathic optic neuritis (ON). Two patients were with compression optic neuropathy. Three patients were with the central nervous system (CNS) diseases. One patient was with proliferative diabetic retinopathy (PDR) and one with idiopathic orbital inflammatory syndrome (IOIS). At the onset, visual acuity (VA) in eighteen eyes was below 0.1, one eye was 0.5, five eyes were above 0.5, while VA in sixteen eyes was below a 0.1 outcome, three eyes experienced moderate vision loss. MRI images showed T2 lesions and enhancement in nine patients who received corticosteroids treatment; additional immune modulators treatment was performed on two patients. None of the patients had relapse during the follow-up time.ConclusionLeber’s hereditary optic neuropathy can be accompanied with multiple-related diseases, especially different subtypes of ON, which were also exhibited with IOIS and compression optic neuropathy for the first time in this cohort. This condition may be a distinct entity with an unusual clinical and therapeutic profile. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Side Stepping The Issues: Disappointment With An Ethics Consult For A Medically High Risk PatientBrent R. CarrMonths of severe symptoms were a blur—hour after hour of suffering. Sleep is her only respite. Her 5-word diagnosis, “treatment-refractory depression with anxious distress,” seemed too orderly, like a flattened 2-dimensional strip of ribbon that simply ironed out all the chaos and confused distress roiling within her. Anyone entering the psychiatric unit early (...) in the morning could hear her near-breathless sobbing, calling for nursing help, repeatedly pleading to anyone who would listen that she was dying. By afternoon, her wheelchair would be situated off to one side of the milieu to prevent agitation of other [End Page 13] patients. From there, she would summon them with small gestures or brief, incessant outbursts to save her, that her body was decaying, withering before them. Such is the torment of nihilistic delusions. She flailed her arms, rocking back and forth, lamenting that no one would help. Although she possessed full leg strength, she refused to stand from the wheelchair, fearing collapse. These distressed pleas were sustained well past each dinner, the anguish echoing from her room, and during her evening shower. Sometimes a pillow-muffled sigh and silence would disclose when her torments became engulfed in sleep.Two years prior, she had a similar episode that lasted almost 3-years. It had failed to respond to months of psychotherapy and more than 15 medication trials. That time, she had cried with happiness after the mental illness went into full remission after only a three-week course of electroconvulsive therapy (ECT). She described this as her miracle. But as miraculous as the ECT was for her, it was problematic. She is a high-risk patient with ongoing hypertension and Wolff-Parkinson-White Syndrome, a condition that leads to an inappropriately fast pulse from aberrant electrical pathways in the heart. During the final week of ECT, she experienced a marked blood pressure surge that led to severe cardiac pathology—Takatsubo’s cardiomyopathy. This is also known as “stress cardiomyopathy” or “broken heart syndrome,” befitting the vexed emotional state she had been in. The cardiomyopathy resembled a myocardial infarct, and it took several months for her to fully recover. Unfortunately, this prevented the use of ECT as a relapse prevention treatment. By one-year post-ECT, her systolic left ventricular dysfunction had resolved, and her ejection fraction (the heart’s pumping efficiency) had normalized.Now, once again, she was treatment-resistant, and ECT was the treatment of choice. The risk stratification for ECT encompassed her prior Takatsubo’s cardiomyopathy, which has a small but known chance for recurrence. This made her a high-risk patient. This risk was convoluted even more by her depression-induced psychosis, wherein she believed that she was dying, that meds were poisoning her, and that ECT would kill her from a heart attack. Before the psychiatric team consulted the ECT service, a mental health court had already ruled regarding her lack of capacity for her medical decisions. The court had authorized her husband as her proxy with authority to consent for her medical care, including for ECT. My role in this case was as the ECT proceduralist from the neuromodulation service who had been consulted by the primary team. The husband was an informed individual and signed consent for ECT. These events all coincided with the primary attending’s departure on scheduled leave. There was now a new covering attending.The resident psychiatrist was apprehensive about ECT and deliberated that the patient was at least able to identify potential risks of ECT—even if exacerbated by a nihilistic delusion. The resident speculated that perhaps the patient should at least be able to refuse ECT, given her previous cardiomyopathy. The newly arrived attending deferred a response regarding her concern and stated it had already been decided by the “team.” This amplified doubt. The medical students sensed the resident’s apprehension and felt confused about whether the patient should receive ECT or not. This dynamic quickly spilled over into nursing discussions, where some were now hesitating about the decision. The cohesiveness of the psychiatry treatment team was compromised... (shrink)

ABSTRACTMajor depressive disorder is a prevalent condition with high relapse rates. There is evidence that cognitive reactivity is an important vulnerability factor for the recurrence of depression. Mindfulness-based interventions are designed to reduce relapse rates, with cognitive reactivity as one of the proposed working mechanisms. In a randomised controlled trial we compared the effect of mindfulness-based cognitive therapy with treatment-as-usual on cognitive reactivity in recurrently depressed patients. Depressive symptoms, cognitive reactivity, and mindfulness skills were assessed pre and post treatment. Patients (...) in the MBCT group reported a significantly greater reduction in cognitive reactivity than those in the TAU group. The reduction of cognitive reactivity appeared to mediate the association between MBCT/TAU and decrease of depressive symptoms, using pre and post scores. The current study provides evidence that MBCT reduces cognitive reactivity and preliminar... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Power of PersuasionG. Bennett HumphreyA long white coat, the title of doctor, a practiced professional persona and an appointment to the staff of a prestigious university medical center allows the physician to be a persuader of clinical decisions affecting patient management. When this power of persuasion is used to encourage patient compliance with a therapeutic regimen that might be curative for a fatal disease, there is justification for (...) trying to influence the patient to make choices resulting in a positive outcome. But when a physician is asking permission to enter the patient into a research protocol where the primary goal of the study is the hope of advancing knowledge, then much thought needs to be given to the potential abuse of this power of persuasion.In the 1960s, I found myself having to think about recruiting children into research protocols. I had just finished two years of residency in internal medicine and wanted to pursue a career in academic medicine. My primary interest was in laboratory research. To strengthen my training in research, I had competed for a position as clinical fellow in a western university. The fellowship program was designed to expose young physicians to both clinical and laboratory research. The first year was spent on one of the clinical research wards and the second year in a research laboratory. The program was open to residents from surgery, medicine and pediatrics but because there was a shortage of pediatricians in the program, I was required to work on the children’s leukemia ward for one year.The learning curve was steep during the first few months. Naturally, the faculty in pediatrics and the medical literature gave me a technical education in the use of protocols for therapeutic treatment of leukemia. For example, the first protocol used was designated as Phase III, and the goal was to try to cure the patient. A remission could be achieved in over 90 percent of children but the disease recurred. The median duration of these remissions in the mid–1960s was one year. A relapse was followed by progressive disease and death in a matter of weeks, but a new drug of unknown efficacy could be administered. This was a Phase II protocol, and while there was a chance of prolonging life for a month or so, the primary goal was the identification of drugs anti–leukemic activity.The pediatric leukemia ward experience for me as a fellow was unusual. There was more to learn than the treatment of leukemia. To my surprise, the children and their mothers gave me insight into the care of pediatric patients. Each month, the patients were admitted for five days of intravenous chemotherapy. The first day was traumatic with venipunctures, bone marrow aspirations and the establishment of an IV for the daily infusion of drugs. The remaining four days were for social rounds: listening to the children who liked to talk; talking with the ones who liked to listen; putting puzzles together with some toddlers; responding to a request to listen to the heart of a much loved teddy bear; exchanging jokes and riddles; stories about school, the family dog, or a favorite friend; enjoying the banter of the adolescents; and not invading the privacy of a few who didn’t like me, the ward or the therapy. These children were sharing their childhood with me and it took couple of months for me to recognize I was bonding with these little patients. I observed and listened to the mothers caring for their children and stood in awe of the resources that they brought to bear on having children with a fatal disease. A feeling of mutual respect and trust developed between these mothers and me. For an internist, these experiences were profound and very different from my experience treating adults.A professor, an internationally known researcher in the field of leukemia, was in charge of the ward. Formal rounds were conducted on Tuesday mornings when the result of the bone marrow aspirates and the toxicity of the chemotherapy were reviewed. The day–to–day responsibility for [End Page 101] treatment and informing the mothers on the remission status on Mondays was my responsibility... (shrink)

The issue of physician refusal of requested treatment has fueled a two-pronged debate in our society-one on the meaning of futility and the other on the limits of patient autonomy. The latter is a genuinely philosophic dispute; the former, it seems, is a modern relapse into nominalism.It is not the meaning of a word, but the moral basis for the actions of the par-ticipants that should be the focus of our attention, Yet the medical literature distracts us with articles titled (...) “Medical Futility: Its Meaning and Ethical Implica-tions” “The Problem with Futility” “Who Defines Futility?,” “The Illusion of Futility,” and even “Beyond Futility.”The history of the futility debate, which was launched by a 1983 study of Bedell and Delbanco that demonstrated the ineffectiveness of CPR for certain catego-ries of patients, has been documented elsewhere. Here we will inquire if the term, and its rapid intrusion into the medical lexicon, serves a useful purpose or if, as Truog suggested, we would all be better off if this new buzzword were jettisoned. (shrink)