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)

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)

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)

Different immunotherapeutic approaches are in the pipeline for the treatment of drug dependence. “Drug vaccines” aim to induce the immune system to produce antibodies that bind to drugs and prevent them from inducing rewarding effects in the brain. Drugs of abuse currently being tested using these new approaches are opioids, nicotine, cocaine, and methamphetamine. In human clinical trials, “cocaine and nicotine vaccines” have been shown to induce sufficient antibody levels while producing few side effects. Studies in humans, determining how these (...) vaccines interact in combination with their target drug, are underway. However, although vaccines can become a reasonable treatment option for drugs of abuse, there are several disadvantages that must be considered. These include i) great individual variability in the formation of antibodies, ii) the lack of protection against a structurally dissimilar drug that produces the same effects as the drug of choice, and iii) the lack of an effect on the drug desire that may predispose an addict to relapse. In addition, a comprehensive overview of several crucial ethical issues has not yet been widely discussed in order to have not only a biological approach to immunotherapy of addiction. Overall, immunotherapy offers a range of possible treatment options: the pharmacological treatment of addiction, the treatment of overdoses, the prevention of toxicity to the brain or the heart, and the protection of the fetus during pregnancy. So far, the results obtained from a small-scale experiment using vaccines against cocaine and nicotine suggest that a number of important technical challenges still need to be overcome before such vaccines can be approved for clinical use. (shrink)

The two significant zoonotic bacterial infections that have remained a concern due to the complex dynamics involved in transmission and global prevalence are anthrax and brucellosis. The present paper attempts to address some of the most important zoonotic pathogens, highlighting their epidemiology, clinical manifestations, diagnosis, treatment, and prevention strategies. Anthrax is largely transmitted through direct contact with the infected animals or their products resulting in cutaneous, inhalational, and gastrointestinal forms, all with specific clinical outcomes and approaches for treatment. Similarly, (...) the genus Brucella primarily transmits brucellosis to humans by occupational exposure and consumption of contaminated animal products. Its presentation may be acute, chronic, or in relapse. Diagnosis is made by a combination of serological, molecular, and culture-based techniques, while the treatment focuses on antimicrobial regimens specific to the pathogen. However, this increases the problem of antimicrobial resistance, which makes their effective management challenging, necessitating an integrated approach. Mitigating risks through biosecurity measures, vaccination, public health education, and a One Health approach that includes human, animal, and environmental health, all facilitate prevention and control of an outbreak. Advanced surveillance and diagnostic technologies further support the prompt interventions to contain outbreaks. It then goes on to highlight the importance of interdisciplinarity for decreasing the global burden of zoonotic bacterial diseases. (shrink)

BackgroundEnhancement involves the use of biomedical technologies to improve human capacities beyond therapeutic purposes. It has been well documented that enhancement is sometimes difficult to distinguish from treatment. As a subtype of enhancement, neuroenhancement aims to improve one’s cognitive or emotional capacities.Main bodyThis article proposes that the notion of neuroenhancement deserves special attention among enhancements in general, because apart from the notion of treatment, it also overlaps with other concepts such as prevention, pain relief, and pleasure seeking. Regarding (...) class='Hi'>prevention, patients’ mental endurance can be enhanced when a patient is prescribed a selective serotonin reuptake inhibitor for the purpose of preventing the relapse of depression following a stressful situation. As for pain relief, psychiatrists use medication to alleviate distress in patients who experience various types of anxiety; the alleviation of distress is equal to psychological pain relief, but is also an enhancement of the patient’s temperamental traits. Regarding pleasure seeking, insidious transition exists between neuroenhancement and pleasure seeking when using psychotropic drugs. It is well known that people use psychostimulants for recreational purposes and to induce overconfidence in one’s performance. The polysemy of psychotropics derives from their effects on human sensibility. Therefore, when using psychotropic agents, psychiatrists should pay close attention to what the agent is used for on each patient in each situation, and explicitly share the continuity and overlap in the purpose of prescribing a medication with the patients to make a better clinical decision.ConclusionsThe notion of neuroenhancement overlaps not only with the notion of treatment, but also with other concepts of prevention, pain relief, and pleasure seeking. The continuity between those concepts makes the issues concerning the prescription of psychotropic drugs subtler. Psychiatrists should explicitly share the continuity with the patients to make a better clinical decision. (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)

This article raises serious concerns regarding the widespread use of unproven interventions with juveniles who sexually offend and suggests innovative methods for addressing these concerns. Dominant interventions (i.e., cognitive-behavioral group treatments with an emphasis on relapse prevention) typically fail to address the multiple determinants of juvenile sexual offending and could result in iatrogenic outcomes. Methodologically sophisticated research studies (i.e., randomized clinical trials) are needed to examine the clinical and cost-effectiveness of cognitive-behavioral group interventions, especially those delivered in residential (...) settings. The moral and ethical mandate for such research is evident when considering the alternative, in which clinicians and society are willing to live in ignorance regarding the etiology and treatment of juvenile sexual offending and to consign offending youths to the potential harm of untested interventions. Encouraging signs of a changing ethical climate include recent federal funding of a randomized clinical trial examining treatment effectiveness with sexually offending youths and the introduction of separate (i.e., developmentally informed) clinical and legal interventions for juvenile versus adult sexual offenders. (shrink)

The obesity epidemic is one of the most serious public health threats confronting the nation and the world. The majority of overweight individuals want to lose weight, but the overall success of self-administered diets and commercial weight loss programs is very poor. Scientific findings suggest that the problem boils down to adherence. The dietary and physical activity recommendations that weight loss programs promote are effective; however, people have difficulty initiating and maintaining changes. Effective Weight Loss presents 25 detailed sessions of (...) an empirically supported, cognitive-behavioral treatment package called Acceptance-Based Behavioral Treatment. The foundation of this approach is comprised of the nutritional, physical activity, and behavioral components of the most successful, gold-standard behavioral weight loss programs. These components are synthesized with acceptance, willingness, behavioral commitment, motivation, and relapse prevention strategies drawn from a range of therapies. ABT is based on the idea that specialized self-control skills are necessary for weight control, given our innate desire to consume delicious foods and to conserve energy by avoiding physical activity. These self-control skills revolve around a willingness to choose behaviors that may be perceived as uncomfortable, for the sake of a more valuable objective. The Clinician Guide is geared towards helping administer treatment, and the companion Workbook provides summaries of session content, exercises, worksheets, handouts, and assignments for patients and clients receiving the treatment. The books will appeal to psychologists, primary care physicians, nutritionists, dieticians, and other clinicians who counsel the overweight. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Surrender Versus Control:How Best Not to DrinkMark D. Rego (bio)Keywordsaddiction, Alcoholics Anonymous, will, St. AugustineI recall as a teenager noticing that some people modified nouns in, what sounded to me, a peculiar way. A friend's mother who was taking an automotive repair course said, " We're going to learn to fix the brakes next week." The same folks would also use the possessive for common nouns in phrases like: (...) "I'll be ready after I take my shower." Although not incorrect, I believe this type of usage reflected a different attitude about brakes, showers, and other things. These tended to be more hands-on people and thus, in my understanding at least, had a more particular relationship with things in their world than others for whom objects were examples of types of things.This brief vignette serves as an introduction to my qualified enthusiasm for the project taken up by Allison Mitchell in her paper, "Taking Mentality Seriously: A Philosophical Inquiry into the Language of Addiction and Recovery" (Mitchell, 2006). Indeed, as a practicing psychiatrist I would be hard pressed not to endorse the use of language as a key to deeper aspects of experience.My following remarks are mostly contra Mitchell's hypothesis, but before beginning I name one more reason I think this project is worthwhile. In spite of much research and recitations of the motto "treatment works," we do not presently have a reliable treatment for addiction. The linguistic portrait painted by Mitchell allows us to view our treatments in vivo and reflect upon what we see. (For the purpose of this commentary, I consider alcoholism and Alcoholics Anonymous [AA] as a general example of addiction and treatment.)Medication treatment remains almost inconsequential except when applied for comorbid psychiatric disorders rather than the primary addiction. Even then it rarely serves to undo some form of self-medication, but instead only offers an important leg up in battling the addiction.Research and much experience has shown AA to be the single best treatment for alcoholism (Vaillant and Hiller-Sturmhofel 1996). Some investigators have proposed underlying mechanisms for its efficacy (some, like "creating dependency" run very counter to Mitchell) (Vaillant 2005). AA's success is highly dependent upon attendance (McCrady et al. 2004), which can of course be a marker for getting better in the first place and not solely a cause of improvement (i.e., people who are doing better attend more meetings not vice- versa). Even within AA, the dropout rate is quite high (Martin et al. 1996). Workers in this area [End Page 223] have raised questions about AA's approach and have proposed other avenues to sobriety, including interpersonal, cognitive–behavioral, and relapse prevention programs (Witkiewitz and Marlatt 2005, 2004; O'Dwyer 2006). Lamentably, some very large studies failed to show any effective ability to match up alcoholics with a particular treatment modality (Church 2004; Read 2004).Given the lack of clarity with which we still work, I think an approach like Mitchell's is a welcome call for serious reflection. The limitations of a linguistic analysis place an unfortunate constriction on implications to be drawn.Mitchell's chief concern is that the language of recovery, as reflected in twelve-step programs, betrays and even fosters a degree of passivity, which leaves the addict without an adequate sense of agency and autonomy with which to combat addiction. From a more philosophical perspective, Mitchell believes this is due to an incomplete philosophical materialism; one that lacks "mentality" (i.e., the sense that part of our physical being is made up of mental activities such as emotions, motivations, beliefs, etc.). This attitude is manifest in a "pretheoretic conception of the self" that leaves the addict with a dearth of self-awareness as a mental agent of action and change.In place of the standard recovery model in use today, Mitchell suggests cultivating a sense of self that values and fosters engaged agency that is both capable of self-control and responsive to external obligations.A Few ConcernsFirst, I will offer a few concerns about premises at work within the paper. Then, I outline an attempt to make sense of the... (shrink)

Fear to contamination is an easy-to-provoke, intense, hard-to-control, and extraordinarily persistent fear. A worsening of preexisting psychiatric disorders was observed during the COVID-19 outbreak, and several studies suggest that those with obsessive–compulsive disorder may be more affected than any other group of people. In the face of worsening OCD symptoms, there is a need for mental health professionals to provide the support needed not only to treat patients who still report symptoms, but also to improve relapse prevention. In (...) this line, it is recommended to improve alternative strategies such as online consultations and digital psychiatry. The aim of this study is to develop augmented reality stimuli that are clinically relevant for patients with cleaning OCD and assess their efficiency to obtain emotionally significant responses. Four AR stimuli were developed: a plastic bag full of garbage, a piece of bread with mold, a dirty sports shoe, and a piece of rotten meat. All stimuli were shown to a clinical group and a control group. Relevant results were the design of the AR stimuli. These stimuli were validated with the statistical difference in perceived anxiety in the meat stimuli between the clinical and control groups. Nevertheless, when looking at effect sizes, all stimuli present effect sizes from small to large, with both shoe and bread between small and medium effect sizes. These results are a valuable support for the clinical use of these AR stimuli in the treatment of cleaning OCD. (shrink)

Background: Psychopathy and substance use disorders are highly co-morbid and their co-occurrence is associated with higher severity of addictive behavior and increased risk of violent offending. Both substance use disorders and psychopathy are related to prominent impairments in emotion processing, which are also central features of alexithymia. The nature of the relationship between psychopathy and alexithymia is not well understood and has been particularly understudied among substance dependent individuals. Aims: Our goal was to evaluate the levels of psychopathy and alexithymia (...) in a relatively homogeneous sample of heroin dependent individuals and healthy controls and to examine group differences in the pattern of associations between these constructs. Methods: We examined 62 participants (31 heroin dependent individuals and 31 healthy controls) with the Psychopathy Checklist: Screening version (PCL:SV, Hart et al., 1995) and the Toronto Alexithymia Scale-20 (TAS-20, Bagby et al., 1994). Results: Heroin dependent individuals were characterized by higher levels of both psychopathy and alexithymia as compared to the control group. In addition, heroin dependent individuals with higher levels of psychopathy reported more difficulties in identifying and verbalizing emotional states. In the heroin group, alexithymia was more strongly associated with the impulsive/antisocial characteristics (impulsivity, irresponsibility, antisocial behavior) than with the interpersonal/affective features of psychopathy (grandiosity, manipulativeness, lack of empathy and remorse). Conclusions: Our findings suggest that alexithymia may be one potential mechanism linking psychopathy with opioid use disorders. The development of interventions targeting alexithymia could have significant applications in relapse prevention programs and psychotherapy of substance use disorders with concurrent psychopathy. (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)

Introduction: More than half a century after the introduction of effective pharmacotherapy for the illness, in most patients schizophrenia remains a chronic, relapsing condition with poor long-term outcomes. Methods: We examine the pharmacological treatment of schizophrenia from different perspectives to understand why there have not been significant advances, and to consider what the future might hold in store. Results: We argue that the treatment of schizophrenia addresses the phenotype and not the cause; that the causes may not be treatable even (...) if identifiable; that secondary prevention approaches involving treating the phenotype before full-fledged illness develops have, so far, not yielded promising results; and that shifting the focus of treatment from dopamine to other neurotransmitter systems is merely a tertiary prevention approach which will not reverse the extensive structural and functional pathology of schizophrenia. Conclusions: We believe that, given the current state of our knowledge of the illness, the future of the pharmacotherapy of schizophrenia looks bleak. (shrink)

We are unlikely to stop seeking pleasure, as this would prejudice our health and well-being. Yet many psychoactive substances providing pleasure are outlawed as illicit recreational drugs, despite the fact that only some of them are addictive to some people. Efforts to redress their prohibition, or to reform legislation so that penalties are proportionate to harm have largely failed. Yet, if choices over seeking pleasure are ethical insofar as they avoid harm to oneself or others, public health strategies should foster (...) ethical choice by moving beyond current risk management practices embodied in the harm reduction movement. The neuroscience of pleasure has much to offer neuroethics and public health strategies. Distinguishing between ‘wanting’ and ‘liking’ fosters new understandings of addiction. These hold promise for directing the search for pharmacotherapies which prevent addiction and relapse or disrupt associated neuromechanisms. They could inform new research into creating lawful psychoactive substances which give us pleasure without provoking addiction. As the health and well being of human and other animals rests upon the experience of pleasure, this would be an ethical objective within public health strategy. Were ethical and neurobiological obstacles to ending addiction to be overcome, problems associated with excessive consumption, the lure of unlawful psychoactive substances and the paucity of lawful means to achieve pleasurable altered states would remain. Non-addictive designer drugs, which reliably provided lawful access to pleasures and altered states, would ameliorate these public health concerns insofar as they fostered citizens’ informed, ethical choices according to a neurobiological taxonomy of pleasures. (shrink)

Evaluation of the potential of a cocaine vaccine requires a detailed understanding of the intended and unintended social consequences of its use. Prospective technology assessment is always difficult, but in the case of treatment and prevention of cocaine addiction we need to understand not only the neuroscience and pharmacology of cocaine addiction, but also social attitudes to drug use and addiction, the social context of drug use, and the factors which make drug use a rational strategy for an addict (...) and make treatment seeking or relapse more or less likely. By considering different scenarios related to differing levels of effectiveness of the vaccine, the authors argue that vaccination will be at best a useful adjunct to existing methods of treatment, rather than a substitute for them. (shrink)

This article recapitulates and develops the attempts in the Nietzschean traditions to address and overcome the proliferation of nihilism that Nietzsche predicted to unfold in the next 200 years (WP 2). Nietzsche approached nihilism not merely as a psychology but as a labyrinthic and pervasive historical process whereby the highest values of culture and founding assumptions of philosophical thought prevented the further flourishing of life. Therefore, he thought nihilism had to be encountered and experienced on many, often opposing, fronts to (...) be fully consumed and left behind. Thus, just as Nietzsche captured the subtle reinventions of nihilism in new forms in his time, in the new doers assumed behind new deeds (WP 488), this article focuses on the contemporary tectonic shifts brought by digital technology and challenges subjectivation and narrativization of algorithmic will to power in human-like interfaces such as ChatGPT. Having identified philosophers and himself as the most advanced nihilists in their overvaluation of truth, in the 4th part of Thus Spoke Zarathustra, Nietzsche grappled with the difficult, perhaps impossible, temporality of post-nihilistic historicity that oscillates between highest creativity and highest truths, especially in the sections entitled The Shadow and At Noon whereby he explored new temporal techniques to evade the relapses into temporal nihilisms of the notions of linear progress or eternity (TSZ, 4). By drawing on this juncture, this article offers ways to address transfigurations of nihilism behind new technological performances of subjectivity. The article points toward creative temporalities beyond narrativity and subjectivity insofar as the statistical operations and probabilistic estimations of language-models exceed grammatical construction of meaning. This multifaceted application of his thought on the contemporary ontic reality is necessary to perceive our comet's incalculable movement as a veritable ray of sunshine. (shrink)

While there has been a significant amount of scholarship done on health and risk in relation to public health and disease prevention, relatively little attention has been paid to therapeutic interventions which seek to manage risks as bodily, and biological, matters. This article elucidates the distinct qualities and logics of these two different approaches to risk management, in relation to Michel Foucault’s conception of the two poles of biopower, that is, a biopolitics of the population and an anatomo-politics of (...) the human body. Using a case study of contemporary addiction biomedicine, the article examines the development and deployment of treatments for addiction that seek to reduce the risks of relapse to drug use, and relates this case to other risk-reducing (but non-curative) medications, particularly cholesterol-reducing medications. The notion of a ‘disease of risk’ is developed in order to identify a range of medical conditions that bear a family resemblance, insofar as they are pharmaceutically managed with risk-reducing medications, and bound up within what is described as a contemporary ‘risk anatomo-politics’. (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)

It is useful in an article of this kind to inform the reader of the author’s background, biases, and rationale for the format and content. As a clinically trained psychiatrist and addiction specialist/researcher, my training and experience have led me to best understand the “clinical side” of alcoholism and substance abuse. A large part of my career has been devoted to treating individuals with alcohol use disorders, especially in the context of clinical trials devoted to finding new medications to reduce (...) craving, drinking, and preventing relapse. I also teach professionals about the diagnosis and treatment of alcohol and other substance abuse disorders. While my focus has been mainly on alcohol use disorders, much of what is known about the neuroscience of addiction is applicable to many, if not all, substances of abuse. I have seen the ravages of these diseases, including death, but I more commonly see the milder forms of these diseases that make people’s lives just plain miserable and/or less enjoyable or productive than they would have been without their addiction. (shrink)

ABSTRACTAvoidance towards innocuous cues is a key diagnostic criterion across anxiety-related disorders. Importantly, the most effective intervention for anxiety-related disorders, exposure therapy with response prevention, sometimes does not prevent the relapse of anxiety's symptomatology. We tested whether extinction effects, the experimental proxy of exposure, are enhanced by increasing the discrepancy between the prediction of an unpleasant event happening, and the actual event. Forty-eight individuals first saw pictures of three stimuli. Two pictures were followed by a shock and one (...) was not. Next, participants learned to avoid the US by pressing a computer key. An extinction and response prevention procedure followed. In the first part of it, participants saw unreinforced presentations of all CSs. In the second part, the single group saw unreinforced presentations of the CSA and CS-. The compound group encountered compound unreinforced prese... (shrink)

There seems to be a pervasive trend towards public apologies, forms of national introspection, and appeals to grant forgiveness. Does 'forgiveness' enable a public or political use of the term? Is it possible to forgive on behalf of others, and if so, under what conditions? These conceptual questions are related to reflections on the cultural and religious contexts of expressing forgiveness. Do forgiving words promote a willingness to look ahead and prevent a relapse into conflicting views on the poisonous (...) past? Or do they bring along aversion? Maybe the 'push' towards forgiveness is experienced as highly unfair. Archbishop Tutu's motto that "there is no future without forgiveness" is well known. The South African Truth and Reconciliation Commission has become an important model and source of inspiration for many other countries that want to deal with their past grievances and internal conflicts. This book discusses the role of forgiveness within processes of peace building and transitional justice. (shrink)

In the setting of transplant medicine, decision making needs to take into account the multiple clinical and psychosocial case variables, rather than turn to arbitrary rules that cannot be scientifically supportedThe yearly demand for liver transplants far exceeds the supply of available organs .1 Additionally, alcoholic cirrhosis has been a controversial indication for transplant as these recipients can be viewed as having caused their own illness—an illness that is preventable by abstaining from alcohol . While not categorically denying liver transplantation (...) to those with alcoholic cirrhosis, many hospitals have incorporated a six month alcohol abstinence criterion 2 in an effort to select optimal candidates. The six month rule has two purposes; namely, allowing the liver a chance to recover in the absence of alcohol , and also observation of the patient to verify that he/she remains alcohol free, with the hope of reducing the risk of relapse. Everhart et al,3 determined that 85% of US liver transplant programmes and 43% of third party payers require a defined period of abstinence—for example, three or six months—as part of the waiting list process.Liver transplantation does not cure alcoholism, as evidenced by the fact that roughly 20% of these patients use alcohol following transplant, with one third exhibiting “repetitive or heavy drinking”.4 Arguments abound as to the scientific merit of a six month abstinence criterion in reducing the risk of alcohol relapse following transplant. Some propose that a minimum of six months abstinence itself predicts a lower relapse rate,5 while others argue that six months is not predictive or that other factors—for example, illicit drug use—in combination with a minimum number of months abstinent is predictive.6,7 Even the United …. (shrink)

This chapter provides an overview of contemporary adaptations of mindfulness. It considers achievements and limitations regarding the rapid expansion of mindfulness‐based interventions, highlighting its evidenced potential for the prevention of depressive relapse. Furthermore, using the example of non‐dual mindfulness and associated states of awareness free of the habitual subject‐object divide it is argued that while the narrative of contemporary mindfulness is beneficial within a treatment context, it may constitute a limitation when transported outside of it and when raised (...) to a de facto standard for meditation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:When Is Enough, Enough?Megan HomsyThis was a case that stuck with many members of our transplant team for a long time. The patient was a 44-year-old Caucasian male evaluated for a liver transplant with a diagnosis of hepatitis C virus (HCV), originally diagnosed 11 years before the transplant evaluation. The patient met the criteria for the following substance use diagnoses: alcohol use disorder moderate in sustained remission, in a (...) controlled environment, opioid use disorder, severe, in sustained remission, on maintenance therapy, in a controlled environment, stimulant use disorder, amphetamine-type, severe, in early remission, in a controlled environment and stimulant use disorder, cocaine-type, severe in early remission, in a controlled environment.The patient had been living in a sober living housing program for approximately ten months prior to his transplant evaluation with me, his social worker. He had also been diagnosed with depression and bipolar disorder. He had been intermittently linked with mental health services and had participated in numerous detox and substance abuse programs over the last ten years, with varying degrees of success. He was in dual diagnosis treatment (i.e., treatment for co-occurring substance use and mental health disorders) through his Suboxone clinic and was completing toxicology screenings on a biweekly basis.After concluding the minimum three months of drug and alcohol treatment set forth by the state's Organ Transplantation Consortium, the patient graduated from his sober living program, moved in with his sister, and was listed for a liver transplant.The patient was transplanted five months after his clinic evaluation. At the time of the surgery, the patient's Suboxone was abruptly discontinued and replaced with IV Dilaudid. Within days of his transplant, the patient frequently expressed concerns about his pain. Several medical services attempted to manage the pain medications, resulting in his pain management plan being changed repeatedly and much confusion over his current medication regimen. During his liver transplant hospitalization, the RN found the patient with a needle in his arm, and after a search of the patient's hospital room, the hospital police found drug paraphernalia and illicit substances. The patient was eventually discharged to an inpatient substance abuse program, which he left before completing the program and against medical advice.During his first year post-transplant, I attempted to arrange other various treatment programs for him (most of which he did not follow through with) and to find housing for him (as he had been forced to leave his sister's home after his relapse). Eventually, the patient was incarcerated on drug-related charges. Numerous times, the patient missed completing his labs and his post-transplant appointments. He did not refill his immunosuppressant medications, and for lengthy periods of time, he was unreachable by the transplant care team, which resulted in my team members and I calling the patient's family, other providers, and the police for safety checks.In the aftermath of these issues, my colleagues and I had to reckon with the realization that we had failed the patient. As a team, our transplant center created a task force to review this case and what to do in the future to prevent such breakdowns in patient care. We created protocols for managing patients who, at the time of their transplant, are on Medication Assisted Treatment (MAT) such as Suboxone and methadone. Staff across the multidisciplinary team attended trainings regarding addiction, pain management, and best practices for MAT services. Additionally, our transplant center collaborated with our hospital's addiction treatment program for a streamlined referral process for transplant patients to addiction services.This patient's case and its sensational nature resulted in many conversations, both professional and unprofessional. Members of the social worker department became aware that personnel within transplant, though not involved in patient care, were inappropriately discussing this patient's case and engaging in unprofessional behavior. Said actions led to the termination of a member of the transplant team. I was placed in the unenviable [End Page E3] position of having to report this behavior to hospital management and legal teams to protect a vulnerable patient.The ethical challenge behind this case really stems from the transplant team attempting to balance two... (shrink)

Significant strides have been made in recent years towards understanding the molecular basis of cell cycle progression in the model bacterium Caulobacter crescentus. At the heart of cell cycle regulation is a multicomponent transcriptional feedback loop, governing the production of successive regulatory waves or pulses of at least three master regulatory proteins. These oscillating master regulators direct the execution of phase‐specific events and, importantly, through intrinsic genetic switches not only determine the length of a given phase, but also provide the (...) driving force that catapults the cell into the next stage of the cell cycle. The genetic switches act as fail safe mechanisms that prevent the cell cycle from relapsing and thus govern the ordered production and the periodicity of these regulatory waves. Here, we detail how the master regulators CtrA, GcrA and DnaA coordinate cell cycle progression and polar development in Caulobacter. BioEssays 28: 355–361, 2006. © 2006 Wiley Periodicals, Inc. (shrink)

Self‐admission to inpatient treatment is a novel approach that aims to increase agency and autonomy for patients with severe psychiatric illness and a history of high utilization of inpatient care. By focusing on brief, preventive hospital admissions in times of increased risk of relapse, self‐admission seeks to reduce the need for prolonged episodes of inpatient treatment. Participants are generally satisfied with the model, which is not surprising given that self‐admission programs allocate a scarce resource—hospital beds—to a select group. However, (...) the patients targeted by these programs are not necessarily those in most need of hospital admission, which may compromise the commonly accepted ‘principle of need’ in allocation of public healthcare resources. In light of the current lack of consistent evidence of the usefulness and cost‐effectiveness of the model, several aspects need to be further studied in order to guide any large‐scale implementation of self‐admission in psychiatry. (shrink)

In spite of the advances in our knowledge of cancer biology, most cancers remain not curable with present therapies. Current treatments consider cancer as resulting from uncontrolled proliferation and are non‐specific. Although they can reduce tumour burden, relapse occurs in most cases. This was long attributed to incomplete tumour elimination, but recent developments indicate that different types of cells contribute to the tumour structure, and that the tumour's cellular organization would be analogous to that of a normal tissue, with (...) a main mass of differentiating cells sensitive to anti proliferative agents, together with a small percentage of quiescent, resistant stem cells responsible for replenishing the tumour: the Cancer Stem Cells (CSCs). Anti‐CSCs targeted therapeutic agents would prevent tumour regeneration. New mouse models tailored to exploit this novel concept will be critical to develop CSC‐based anti‐cancer therapies. Here we review the biological basis and the therapeutic implications of the stem‐cell model of cancer. BioEssays 29:1269–1280, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

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)

Background and aim Healthcare professionals are regularly exposed to moral challenges in patient care potentially compromising quality of care and safety of patients. Preventive clinical ethics support aims to identify and address moral problems in patient care at an early stage of their development. This study investigates the occurrence, risk factors, early indicators, decision parameters, consequences and preventive measures of moral problems. Method Semi-structured expert interviews were conducted with 20 interprofessional healthcare professionals from 2 university hospitals in Basel, Switzerland. A (...) Likert scale questionnaire was completed by the interviewees and analysed using descriptive and inferential statistics. Results Healthcare professionals are frequently exposed to a variety of moral problems, such as end-of-life decisions, resource allocation and assessing the patient's will or decisional capacity. Thirty-four different risk factors for moral problems are identified, e.g. patient vulnerability, divergent values or world views, inadequate resources or poor ethical climate. Twenty-one early indicators are recognised such as disagreement between healthcare professionals, patients and relatives, emotional disturbances, gut feeling or conflict of conscience. A variety of preventive measures are suggested and presented in a preventive clinical ethics support process model. The most helpful measures are early ethical conversations with colleagues, early team-internal ethical case discussions and an ethics-trained contact person on the ward. Ethics training, kerbside consultations, proactive ethics consultations, ethics screening and rounds are also considered helpful. Conclusions Clinical ethics support services should not only offer reactive and complex, but also proactive and low-threshold support for healthcare professionals, patients and relatives. (shrink)

Dans le cadre d’une éthique préventive, nous serons amenés à valider toute la pertinence que requiert la compréhension des logiques de la non-perception d’un risque de contamination du sida par voie sexuelle dans la population guadeloupéenne. En passant par l’analyse des limites sous-jacentes à la séparation de deux populations, celle infectée et celle non infectée, nous pourrons avancer que la non-perception de ce risque relève d’une construction culturelle et sociale où toute confusion, qu’elle soit sexuelle, corporelle, spatiale, participe à la (...) fois d’un sentiment d’invulnérabilité et d’un sentiment de peur. C’est en tenant compte de cette réalité que les différentes instances décisionnelles devraient agir afin d’enrayer une épidémie déjà bien implantée en Guadeloupe. (shrink)

Does A cause B simply if A prevents what would have prevented B? Such a case is known as double prevention: where we have the prevention of a prevention. One theory of causation is that A causes B when B counterfactually depends on A and, as there is such a dependence, proponents of the view must rule that double prevention is causation.<br><br>However, if double prevention is causation, it means that causation can be an extrinsic matter, (...) that the cause and effect need not be connected by a continuous chain of events, that there can be causation by absence, and that there can be causation at a distance. All of these implications jar with strong intuitions we have about the nature of causation. There is, on the other hand, a theory of causation based on an ontology of real dispositions, where causation involves the passing around of powers. This theory in contrast entails that double prevention is not causation and, on this issue, it can claim a victory over the counterfactual dependence account. (shrink)

Preventive use of force may be defined as the initiation of military action in anticipation of harmful actions that are neither presently occurring nor imminent. This essay explores the permissibility of preventive war from a cosmopolitan normative perspective, one that recognizes the basic human rights of all persons, not just citizens of a particular country or countries. It argues that preventive war can only be justified if it is undertaken within an appropriate rule-governed, institutional framework that is designed to help (...) protect vulnerable countries against unjustified interventions while also avoiding unacceptable risks of the costs of inaction. The key to ensuring the fairness of rules governing the preventive use of force is accountability.This essay proposes a scheme that would make those promoting and those rejecting the preventive use of force more accountable. The proposal contains the following crucial features:States proposing preventive war are required to enter into a contract with a diverse body of states as a condition for authorization of their actions;Prior to taking preventive action, states must make an evidence-based case to the UN Security Council, and agree in advance to submit themselves to an evaluation by an impartial body after the preventive action occurred;Both proponents of action and those opposing it will be held accountable ex post for the accuracy of their prior statements and the proportionality of their actions;Sanctions will be imposed against intervening states or states that opposed preventive action, respectively, depending on the findings of the ex post evaluation.If preventive action were blocked in the Security Council, states seeking to engage in preventive action could then present their case in a different body–a coalition of democratic states–with its own ex post and ex ante accountability procedures. (shrink)

What solutions can we find in the research literature for preventing sexual violence, and what psychological theories have guided these efforts? We gather all primary prevention efforts to reduce sexual violence from 1985 to 2018 and provide a bird’s-eye view of the literature. We first review predominant theoretical approaches to sexual-violence perpetration prevention by highlighting three interventions that exemplify the zeitgeist of primary prevention efforts at various points during this time period. We find a throughline in primary (...) prevention interventions: They aim to change attitudes, beliefs, and knowledge (i.e., ideas) to reduce sexual-violence perpetration and victimization. Our meta-analysis of these studies tests the efficacy of this approach directly and finds that although many interventions are successful at changing ideas, behavior change does not follow. There is little to no relationship between changing attitudes, beliefs, and knowledge and reducing victimization or perpetration. We also observe trends over time, including a shift from targeting a reduction in perpetration to targeting an increase in bystander intervention. We conclude by highlighting promising new strategies for measuring victimization and perpetration and calling for interventions that are informed by theories of behavior change and that center sexually violent behavior as the key outcome of interest. (shrink)

In some jurisdictions, the institutions of criminal justice may subject individuals who have committed crimes to preventive detention. By this, I mean detention of criminal offenders (i) who have already been punished to (or beyond) the point that no further punishment can be justified on general deterrent, retributive, restitutory, communicative or other backwardlooking grounds, (ii) for preventive purposes—that is, for the purposes of preventing the detained individual from engaging in further criminal or otherwise socially costly conduct. Preventive detention, thus understood, (...) shares many features with the quarantine measures sometimes employed in the context of infectious disease control. Both interventions involve imposing (usually severe) constraints on freedom of movement and association. Both interventions are standardly undeserved: in quarantine, the detained individual deserves no detention (or so I will, for the moment, assume), and in preventive detention, the individual has already endured any detention that can be justified by reference to desert. Both interventions are, in contrast to civil commitment under mental health legislation, normally imposed on more-or-less fully autonomous individuals. And both interventions are intended to reduce the risk that the constrained individual poses to the public. Yet despite these similarities, preventive detention and quarantine have received rather different moral report cards. (shrink)

This article discusses possible dialogues between medical history and the history of concepts, suggesting that a “socio-conceptual-moral” history of medicine offers insightful elements for the historical analysis of conceptual change. Drawing mainly from Reinhart Koselleck’s Begriffsgeschichte and Ludwik Fleck’s theory of knowledge, I focus on three points of the “socio-conceptual-moral” perspective: the approach to medical statements as part of a semantic field, the interaction between a formulated concept and its practice, and negotiations about the meanings of medical concepts between different (...) social arenas. I take the history of cancer prevention in Brazil as a case study to discuss these three aspects and emphasize the situated character of conceptual change. The article analyzes the period between the 1960s and the 1990s when substantial changes in the conceptual framework of cancer prevention confronted continuities in public health and medicine practices, policies, and institutions. (shrink)

As the ball flew towards us I leapt to my left to catch it. But it was you, reacting more rapidly than I, who caught the ball just in front of the point at which my hand was poised. Fortunate for us that you took the catch. The ball was headed on a course which, unimpeded, would have taken it through the glass window of a nearby building. Your catch prevented the window from being broken.

Healthcare institutions have been making increasing efforts to standardize consultation methodology and to accredit both bioethics training programs and the consultants accordingly. The focus has traditionally been on the ethics consultation as the relevant unit of ethics intervention. Outcome measures are studied in relation to consultations, and the hidden assumption is that consultations are the preferred or best way to address day-to-day ethical dilemmas. Reflecting on the data from an internal quality improvement survey and the literature, we argue that having (...) general ethics education as a key function of ethics services may be more important in meeting the contemporaneous needs of acute care settings. An expanded and varied ethics education, with attention to the time constraints of healthcare workers’ schedules, was a key recommendation brought forward by survey respondents. Promoting ethical reflection and creating a culture of ethics may serve to prevent ethical dilemmas or mitigate their effects. (shrink)

Mike accidentally knocked against a bottle. Seeing that the bottle was about to fall, Jack was just about to catch it when Peter accidentally knocked against him, making Jack unable to catch it. Jack did not grab the bottle, and it fell to the ground and spilled. In double-prevention cases like these, philosophers and nonphilosophers alike tend to judge that Mike knocking into the bottle caused the beer to spill and that Peter knocking into Jack did not cause the (...) beer to spill. This difference in causal judgment is a difficult puzzle for counterfactual theories of causal judgment; if each event had not happened, the outcome would not have, yet there is a difference in people’s causal judgments. In four experiments and three supplemental experiments, we confirm this difference in causal judgments. We also show that differences in people’s counterfactual thinking can explain this difference in their causal judgments and that recent counterfactual models of causal judgment can account for these patterns. We discuss these results in relation to work on counterfactual thinking and causal modeling. (shrink)