Diabetes mellitus is a major global health concern, which has worse mental health outcomes such as suicide, however, suicide is one of the top public health priorities worldwide. The World Health Organization's objectives for suicide prevention emphasize the identification of high-risk groups especially people with comorbidity. This study aims to determine the prevalence of suicidal ideation and its associated factors among diabetic patients and correlate it with socio-demographic, lifestyle, and clinical characteristics. A cross-sectional study including (...) diabetic Libyan patients attending diabetes outpatient clinic health centers in Tripoli, Libya from January to August 2024, using a questionnaire consisting of two parts. Part I contains data about the socio-demographic, lifestyle, and medical data and Part II uses a single item of the 9-item version of the Patient Health Questionnaire-9. Data was analyzed by Chi-square test, and logistic regression was used to identify factors. Odds ratio with 95% CI was used and variables with a p<0.05 in multivariable logistic regression were significant. A total of 395 participants was responding using systematic sampling, 62.8% of them where female, mean age of the patient was 52.98±9.30 years, 85.8% were non-smokers, mean duration of diabetic illness was 10.96±8.02, 59.0% insulin-dependent, 77.7% often committed to their drug, 61.8% had diabetes complication. The highest complication was in the eye 33.9%, 48.9% had comorbidity, 90.4% had no diet commitment, 21.8% had regular physical activity and 63.3% had difficulty to dealing ordinary life, and 26.8% of the patients had reported suicidal ideation. Female was 1.83 times (AOR=1.832 CI95%:1.26, 2.982) more likely to have suicidal ideation than males. The risk of suicidal ideation in age >50 years was 1.04 times that age ≤50 years (AOR=1.042 CI95%: 0.640, 1.698). The diabetic patients who used insulin therapy, the odds of risk higher than participants who used oral antidiabetic was 1.34 times (AOR=1.345 CI95%: 0.849, 2.131). The odds of having suicidal ideation among participants with poor glycemic control was 3.60 times higher when compared with good control diabetes participants (AOR=3.614 CI95%: 1.924, 6.783). The prevalence of suicidal ideation was 26.8% in type II diabetic patients attending Primary Healthcare Centers. There was a significant association between suicidal ideation and female gender, age, and poor glycemic control. (shrink)

Background: This study was conducted to measure depression literacy (D-Lit) and mental health literacy (MHL) and to investigate their relationship with psychological status and quality of life among Iranian patients with type 2 diabetes mellitus (T2DM). -/- Methods: This cross-sectional study was conducted in 2021 among 400 patients with T2DM in Iran. Samples were selected using proportional stratified sampling. Data collection tools comprised a demographic questionnaire, measures of MHL and D-Lit, the diabetes quality of life (DQOL) (...) scale, and the DASS-21. After confirming the normality of the data using the Kolmogorov-Smirnov test, parametric statistical tests (such as one-way ANOVA, independent samples t-test, and Chi-Square) were used to investigate the relationship between the variables using SPSS v22 software. The results of continuous quantitative data are reported in the form of means and standard deviations, and qualitative data are reported in the form of absolute and relative frequencies. -/- Results: In this study, 10.25% of the participants (n = 41) had severe depression, while 36.75% (n = 147) experienced severe anxiety. The mean (standard deviation) of MHL was 80.92 (9.16) from 130 points. Of the participants, only 1.7% (n = 7) did not answer any questions correctly on the D-lit scale, and only 5.8% (n = 23) were able to answer 15 questions or more correctly on the D-lit. MHL had a significant negative correlation with depression (r = −0.236), anxiety (r = −0.243), and stress (r = −0.155) (P < 0.001). There was a positive and significant correlation between MHL and D-Lit (r = 0.186) (P < 0.001). D-Lit had a significant negative correlation with depression (r = −0.192), anxiety (r = −0.238), and stress (r = −0.156) (P < 0.001). There was a positive and significant correlation between the ability to recognize disorders (r = 0.163), knowledge of self-treatment (r = 0.154), and DQOL (P < 0.001). Depression (r = −0.251), anxiety (r = −0.257), and stress (r = −0.203) had a significant negative correlation with DQOL (P < 0.001). -/- Conclusion: MHL and D-Lit levels were found to be inadequate in patients with T2DM. These low levels of MHL and D-Lit among patients with T2DM were associated with higher levels of anxiety, depression, and stress, as well as a lower quality of life. Therefore, designing and implementing preventive programs to improve the mental health of patients with T2DM can help prevent mental disorders and ultimately improve their quality of life. (shrink)

Metformin is considered the first-line treatment as a monotherapy for patients with type 2 diabetes mellitus. Emerging evidence suggests that metformin may have a renoprotective role; therefore, understanding the impact of metformin dose and therapy duration on renal function may significantly improve renal outcomes in type 2 diabetes patients. This study aims to investigate the renoprotective effects of metformin by analyzing its dose-dependent impacts on the estimated glomerular filtration rate in patients with type 2 (...) diabetes mellitus. A retrospective cross-sectional study design was used from September 2022 to October 2023. Data from 302 type 2 diabetes patients were collected from patient files at the Benghazi Diabetic Center and the Aljabal Al-Alkdar Diabetic Center, including all with type 2 diabetes mellitus patients on varying doses of metformin. The collected data included age, gender, metformin dose, duration of metformin therapy, urea, and creatinine. Exclusion criteria included patients with significant comorbidities such as chronic kidney disease (other than diabetic nephropathy), liver disease, heart failure, or malignancy; those taking nephrotoxic medications; individuals with recent acute illnesses or surgical procedures; pregnant or lactating women; participants with inadequate medical records; and patients who were non-adherent to metformin therapy. Survival analysis was conducted to evaluate the effect of different metformin doses on the estimated glomerular filtration rate. The study analyzed 302 diabetic patients, of whom 46.0% were male and 54.0% were female. The age was 58.3±11.9 years. The HbA1c was 7.7%±1.3%. The duration of diabetes was 11.4±8.1 years. The creatinine was 1.0±0.9 mg/dL, and the urea was 36.7±23.8 mg/dL. Data analysis revealed a statistically significant difference in survival distribution across the dose groups. Different metformin doses significantly impact the estimated glomerular filtration rate, suggesting that dosage plays a crucial role in maintaining renal function. (shrink)

Type 2 diabetes mellites (T2DM) is a common complex disease with multiple factors contributing to its development and progression. Dyslipidemia refers to the abnormality of lipid metabolism, characterized by elevated levels of low-density lipoprotein (LDL), total cholesterol (TC), triglycerides (TG), and decreased levels of high-density lipoprotein (HDL). It is a major risk factor for cardiovascular disease in type 2 diabetic patients. This study aimed to evaluate the diagnostic value of glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG) (...) in predicting the risk of developing diabetic dyslipidemia. 86 clinically diagnosed Libyan patients with type 2 diabetes mellitus (44 males: 42 females), 30 years and 70 years of age were engaged in this study. Levels of HbA1C, blood glucose, TC, TG, LDL, and HDL were performed using a Lntegra Cobas 400+ analyzer. The findings showed that HbA1c exhibits a significant positive correlation with TC and TG with no significant correlation with LDL and HDL levels. Thus, this study suggests that HbA1c can be used as a potential dual marker of glycemic control and dyslipidemia in type 2 diabetes mellitus. (shrink)

Uric acid has increasingly been associated with insulin resistance, hyperinsulinemia, and type 2 diabetes mellitus. Diabetic patients who are hyperuricemic have a risk of developing diabetic complications. Pathogenesis of uric acid may decrease nitric oxide bioavailability in vascular smooth muscle, endothelial cells and direct scavenging of nitric oxide by uric acid. A decrease in endothelial nitric oxide production by uric acid has also been associated with endothelial dysfunction and insulin resistance. This study aims to determine the relationship (...) between uric acid and glucose levels in patients with type 2 diabetes mellitus. The study included 161 Libyan patients (67 males and 94 females) diagnosed with type 2 diabetes mellitus. Both levels of serum uric acid and hemoglobin A1c (HbA1c) were determined. The patients were divided into two groups. The controllable diabetic group with HbA1c of less than 06.0% and the uncontrollable diabetic group with HbA1c of more than 06.0%. Patients who are suffering from type 2 diabetes mellitus without complications were included whereas patients with smoking, alcoholism, nephrotic disease, malignancy, hepatitis, and renal failure or kidney disease were excluded. The mean and standard deviation of uric acid, HbA1c and Pearson correlation coefficient test were considered. In the controllable diabetic group, serum uric acid mean was found to be 4.807±1.39 and HbA1c was found to be 5.032±1.39. In the uncontrollable diabetic group, serum uric acid was 4.897±1.66 and HbA1c was 8.396±1.65. Uric acid level has significantly been correlated with HBA1C in controlled and uncontrolled diabetic patients (p<0.05). In addition, the uric acid level was found to be higher in the uncontrolled diabetic group than that in the controlled group (p<0.05). A possible relationship between serum uric acid and the incidence of type 2 diabetes mellitus was noted. Thus, uric acid can be used as a potential biomarker to indicate impaired glucose metabolism. (shrink)

Diabetic ketoacidosis is a serious, medical emergency that can be fatal but treatable, we aimed to evaluate the clinical profile of patients admitted with diabetic ketoacidosis. This case series study enrolled 213 non-pregnant adult and adolescent patients admitted with diabetic ketoacidosis at Tripoli Diabetes Hospital from January to September 2023. Demographic data, clinical characteristics, laboratory findings, precipitating factors, and patient outcomes were extracted from medical records and analyzed. Type 1 diabetes mellitus was present in 187 (87.8%) (...) of patients, the age range 11-84 years, (30.26±13.28), with 130 patients ≤30 years old (61.0%), females accounting for 110 of the patients (51.6%), 109 had a diabetes duration of less than 10 years (51.2%). The most common precipitating factor was insulin omission 92 (43.2%) in patients with known diabetes mellitus, whereas, diabetic ketoacidosis as the first presentation of diabetes mellitus in 24 patients (11.7%), systolic blood pressure ranged 50-160 mmHg (112.82±16.19), diastolic blood pressure varied 30-100 mmHg (70.24±11.32). Plasma glucose at presentation ranged 183-1494 mg/dl (462.92±169.85), with Eu-glycemic diabetic ketoacidosis 100-249 mg/dl were in nine patients (4.2%), whereas most of cases (135 patients, 63.4%) present with plasma glucose 250-500 mg/dl, while hyperosmolar status (≥701 mg/dl) were present in 13 patients (6.1%). Venous pH varied from 6.7-7.42 (7.13±0.14), 132 (62.0%) patients presented with pH <7.24, while severe acidosis was pH < 7 in 32 of patients (14.6%), serum bicarbonate with 10.93±4.95, severe (<5 mmol) in 91 patients (42.7%) and moderate (5-10 mmol) were in 79 patients (37.08%). The mean length of hospital stay was 3.33 days, with an average of 2.11 days spent in the high-dependent unit. Serum potassium varied from 2.4-6.7 meq/L with 3.66± 0.63, most common complications of diabetic ketoacidosis treatment were hypokalemia observed in 82 (35.7%) of cases, and hypoglycemia was detected in 41 patients (19.2%). 170 patients were discharged in good condition (79.8%), and 17.8% of patients were transferred to another hospital to receive further management for co-morbid diseases with diabetes after controlling their hyperglycemic crises. The majority of patients presented with the critical status of diabetic ketoacidosis. The findings emphasize the importance of patient education about prevention measures prompt presentation to the hospital, and clinicians' awareness for early and aggressive treatment of hyperglycemic crises. (shrink)

Vitamin D deficiency and its effect have attracted considerable research interest due to its relation to glucose homeostasis, insulin secretion, sensitivity and synthesis. This study aimed to evaluate vitamin D levels in patients with type II diabetes mellitus aged between 35-65 years and investigate their relations with glycemic control and obesity. The study included 74 Libyan patients with a known history of type II diabetes mellitus (33 males and 41 females). Serum glucose, glycosylated hemoglobin (...) (HbA1c) and vitamin D levels were biochemically estimated in these patients. Further, body mass index (BMI) was calculated for all diabetic patients (weight in kilogram per height in meter square). The mean level of plasma glucose level was 150.58±63.82 mg/dl (mean±SD). The mean of HbA1c level was 7.90±8.48% (mean±SD). The mean level of vitamin D was 22.75±14.97 ng/ml. The mean of BMI was 26.55±4.10 Kg per m2. The findings showed that 58.10% of the cases had vitamin D deficiency (Out of which 24.24% were males and 85.36% were females). This study showed significant differences in glucose, HbA1c, vitamin D and BMI between male and female patients. Moreover, elderly ages for both sexes had adverse effects on vitamin D status. Vitamin D levels have negatively been correlated with levels of glucose, HbA1c and BMI. It is concluded that vitamin D deficiency has an adverse effect on glucose homeostasis in patients with type II diabetes mellitus and this can be a contributing risk factor in complications of type II diabetes mellitus development in Libyan patients. (shrink)

Background: A better understanding of the pattern of epidemic-related referrals to healthcare centers might allow the identification of vulnerabilities and the required changes that the healthcare management system should undergo. Objectives: This study aimed to investigate the COVID-19 referral pattern and the role of media and health management planning in changing the trends. Methods: Data extracted from the electronic medical database of Imam Khomeini Hospital Complex (IKHC), located in Tehran, Iran, from February 20 to June 4, 2020 were examined. Individuals (...) were divided into two groups, COVID-19 positive and negative. We used Google Trends to evaluate Google Internet search queries and also available policy documents, programs, and official news related to COVID-19 in Iran during the mentioned period. Results: In this study, 8647 individuals aged 46.05 ± 16.5 years were referred to IKHC. Approximately 57% were male, and 70% were COVID-19 positive. The most clinical symptoms were dyspnea, fever, cough, and myalgia. Chronic kidney disease (CKD) and type 2 diabetes mellitus were the most common underlying health conditions. In the first two weeks, the percentage of negative cases was higher than positive cases and then the pattern was reversed, when people searched for information about COVID-19 in media. Conclusions: Proper and timely information and education to people through the media and health management measures can be effective in reducing unnecessary visits to health centers, preventing the exhaustion of medical staff, and controlling the disease during epidemics. (shrink)

Coronavirus disease (Covid-19) is an infectious disease caused by the SARS-CoV-2 virus. Spreading rate of mutated corona virus (delta variant) during second wave was very fast. Most of the people infected with the COVID-19 virus experienced mild to moderate to severe respiratory illness. Although patients in the second wave were younger but the duration of hospitalization and case fatality rate were lower than those in the first wave. During first wave of Covid-19 it was observed that persons above 55 years (...) of age and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease and cancer were more susceptible to develop serious illness but in second it was observed that person between 30 to 55 years along with old age and younger people suffering from hypertension, diabetes and respiratory diseases were more susceptible to this covid-19 virus. The most frequent signs and symptoms in both waves were fever, dyspnea, pneumonia, and cough, and the most relevant comorbidities were cardiovascular diseases, type 2 diabetes mellitus, and chronic neurological diseases. Every country has lost its human resources due to covid-19 virus which not only disturb the social life but economic conditions are also very badly affected. Now we use the resources so rapidly that may create economic imbalance in future. The psychological effect is an essential component of disaster management of infectious pandemics. (shrink)

In their insightful article, Brent Kious and Margaret Battin (2019) correctly identify an inconsistency between an involuntary psychiatric commitment for suicide prevention and physician aid in dying (PAD). They declare that it may be possible to resolve the problem by articulating “objective standards for evaluating the severity of others’ suffering,” but ultimately they admit that this task is beyond the scope of their article since the solution depends on “a deep and difficult” question about comparing the worseness of (...) two possible scenarios: letting someone die (who could have been helped) with not letting someone die (whose suffering could only be alleviated by death). In our commentary, we argue that creating such standards is more difficult than the authors assume because of the many types of deep uncertainties we have to deal with: (1) diagnostic, (2) motivational, and (3) existential. (shrink)

This paper offers a philosophical analysis of the connection between mental disorder and suicide risk. In contemporary psychiatry, it is commonly suggested that this connection is a causal connection that has been established through empirical discovery. Herein, I examine the extent to which this claim can be sustained. I argue that the connection between mental disorder and increased suicide risk is not wholly causal but is partly conceptual. This in part relates to the way suicidality is built into (...) the definitions of some psychiatric diagnoses. It also relates to the broader normative assumption that suicidal behavior is by definition mentally disordered behavior. The above has significant epistemological implications, which I explore. I propose that the claim that suicide is connected with mental disorder cannot be justified solely by appealing to empirical evidence but also warrants a justification on conceptual and normative grounds. (shrink)

This collection of articles was written over the last 10 years and edited to bring them up to date (2019). All the articles are about human behavior (as are all articles by anyone about anything), and so about the limitations of having a recent monkey ancestry (8 million years or much less depending on viewpoint) and manifest words and deeds within the framework of our innate psychology as presented in the table of intentionality. As famous evolutionist Richard Leakey says, it (...) is critical to keep in mind not that we evolved from apes, but that in every important way, we are apes. If everyone was given a real understanding of this (i.e., of human ecology and psychology to actually give them some control over themselves), maybe civilization would have a chance. As things are however the leaders of society have no more grasp of things than their constituents and so collapse into anarchy is inevitable. -/- The first group of articles attempt to give some insight into how we behave that is reasonably free of theoretical delusions. In the next three groups, I comment on three of the principal delusions preventing a sustainable world— technology, religion and politics (cooperative groups). People believe that society can be saved by them, so I provide some suggestions in the rest of the book as to why this is unlikely via short articles and reviews of recent books by well-known writers. -/- It is critical to understand why we behave as we do and so the first section presents articles that try to describe (not explain as Wittgenstein insisted) behavior. I start with a brief review of the logical structure of rationality, which provides some heuristics for the description of language (mind, rationality, personality) and gives some suggestions as to how this relates to the evolution of social behavior. This centers around the two writers I have found the most important in this regard, Ludwig Wittgenstein and John Searle, whose ideas I combine and extend within the dual system (two systems of thought) framework that has proven so useful in recent thinking and reasoning research. As I note, there is in my view essentially complete overlap between philosophy, in the strict sense of the enduring questions that concern the academic discipline, and the descriptive psychology of higher order thought (behavior). Once one has grasped Wittgenstein’s insight that there is only the issue of how the language game is to be played, one determines the Conditions of Satisfaction (what makes a statement true or satisfied etc.) and that is the end of the discussion. No neurophysiology, no metaphysics, no postmodernism, no theology. -/- It is my contention that the table of intentionality (rationality, mind, thought, language, personality etc.) that features prominently here describes more or less accurately, or at least serves as an heuristic for, how we think and behave, and so it encompasses not merely philosophy and psychology, but everything else (history, literature, mathematics, politics etc.). Note especially that intentionality and rationality as I (along with Searle, Wittgenstein and others) view it, includes both conscious deliberative System 2 and unconscious automated System 1 actions or reflexes. -/- The next section describes the digital delusions, which confuse the language games of System 2 with the automatisms of System one, and so cannot distinguish biological machines (i.e., people) from other kinds of machines (i.e., computers). The ‘reductionist’ claim is that one can ‘explain’ behavior at a ‘lower’ level, but what actually happens is that one does not explain human behavior but a ‘stand in’ for it. Hence the title of Searle’s classic review of Dennett’s book (“Consciousness Explained”)— “Consciousness Explained Away”. In most contexts ‘reduction’ of higher level emergent behavior to brain functions, biochemistry, or physics is incoherent. Even for ‘reduction’ of chemistry or physics, the path is blocked by chaos and uncertainty. Anything can be ‘represented’ by equations, but when they ‘represent’ higher order behavior, it is not clear (and cannot be made clear) what the ‘results’ mean. Reductionist metaphysics is a joke, but most scientists and philosophers lack the appropriate sense of humor. -/- The last section describes The One Big Happy Family Delusion, i.e., that we are selected for cooperation with everyone, and that the euphonious ideals of Democracy, Diversity and Equality will lead us into utopia, if we just manage things correctly (the possibility of politics). Again, the No Free Lunch Principle ought to warn us it cannot be true, and we see throughout history and all over the contemporary world, that without strict controls, selfishness and stupidity gain the upper hand and soon destroy any nation that embraces these delusions. In addition, the monkey mind steeply discounts the future, and so we cooperate in selling our descendant’s heritage for temporary comforts, greatly exacerbating the problems. The only major change in this edition is the addition in the last article of a short discussion of China, a threat to peace and freedom as great as overpopulation and climate change and one to which even most professional scholars and politicians are oblivious so I regarded it as sufficiently important to warrant a new edition. -/- I describe versions of this delusion (i.e., that we are basically ‘friendly’ if just given a chance) as it appears in some recent books on sociology/biology/economics. Even Sapolsky’s otherwise excellent “Behave”(2017) embraces leftist politics and group selection and gives space to a discussion of whether humans are innately violent. I end with an essay on the great tragedy playing out in America and the world, which can be seen as a direct result of our evolved psychology manifested as the inexorable machinations of System 1. Our psychology, eminently adaptive and eugenic on the plains of Africa from ca. 6 million years ago, when we split from chimpanzees, to ca. 50,000 years ago, when many of our ancestors left Africa (i.e., in the EEA or Environment of Evolutionary Adaptation), is now maladaptive and dysgenic and the source of our Suicidal Utopian Delusions. So, like all discussions of behavior (philosophy, psychology, sociology, biology, anthropology, politics, law, literature, history, economics, soccer strategies, business meetings, etc.), this book is about evolutionary strategies, selfish genes and inclusive fitness (kin selection, natural selection). -/- The great mystic Osho said that the separation of God and Heaven from Earth and Humankind was the most evil idea that ever entered the Human mind. In the 20th century an even more evil notion arose, or at least became popular with leftists—that humans are born with rights, rather than having to earn privileges. The idea of human rights is an evil fantasy created by leftists to draw attention away from the merciless destruction of the earth by unrestrained 3rd world motherhood. Thus, every day the population increases by 200,000, who must be provided with resources to grow and space to live, and who soon produce another 200,000 etc. And one almost never hears it noted that what they receive must be taken from those already alive, and their descendants. Their lives diminish those already here in both major obvious and countless subtle ways. Every new baby destroys the earth from the moment of conception. In a horrifically overcrowded world with vanishing resources, there cannot be human rights without destroying the earth and our descendant’s futures. It could not be more obvious, but it is rarely mentioned in a clear and direct way, and one will never see the streets full of protesters against motherhood. -/- The most basic facts, almost never mentioned, are that there are not enough resources in America or the world to lift a significant percentage of the poor out of poverty and keep them there. Even the attempt to do this is already bankrupting America and destroying the world. The earth’s capacity to produce food decreases daily, as does our genetic quality. And now, as always, by far the greatest enemy of the poor is other poor and not the rich. -/- America and the world are in the process of collapse from excessive population growth, most of it for the last century, and now all of it, due to 3rd world people. Consumption of resources and the addition of 4 billion more ca. 2100 will collapse industrial civilization and bring about starvation, disease, violence and war on a staggering scale. The earth loses about 2% of its topsoil every year, so as it nears 2100, most of its food growing capacity will be gone. Billions will die and nuclear war is all but certain. In America, this is being hugely accelerated by massive immigration and immigrant reproduction, combined with abuses made possible by democracy. Depraved human nature inexorably turns the dream of democracy and diversity into a nightmare of crime and poverty. China will continue to overwhelm America and the world, as long as it maintains the dictatorship which limits selfishness. The root cause of collapse is the inability of our innate psychology to adapt to the modern world, which leads people to treat unrelated persons as though they had common interests (which I suggest may be regarded as an unrecognized -- but the commonest and most serious-- psychological problem -- Inclusive Fitness Disorder). This, plus ignorance of basic biology and psychology, leads to the social engineering delusions of the partially educated who control democratic societies. Few understand that if you help one person you harm someone else—there is no free lunch and every single item anyone consumes destroys the earth beyond repair. Consequently, social policies everywhere are unsustainable and one by one all societies without stringent controls on selfishness will collapse into anarchy or dictatorship. Without dramatic and immediate changes, there is no hope for preventing the collapse of America, or any country that follows a democratic system. Hence my concluding essay “Suicide by Democracy”. -/- Those wishing to read my other writings may see Talking Monkeys 2nd ed (2019), The Logical Structure of Philosophy, Psychology, Mind and Language in Ludwig Wittgenstein and John Searle 2nd ed (2019), Suicide by Democracy 3rd ed (2019), The Logical Stucture of Human Behavior (2019) and Suicidal Utopian Delusions in the 21st Century 4th ed (2019) . (shrink)

Postpartum depression is a major maternal health problem after childbirth. It can start at any time within the first year after delivery and continue for several years. It is characterized by an inability to experience pleasure, anxiety symptoms, panic attacks, spontaneous crying and depressed mood. Some women with postpartum depression even have thoughts of harming their child and self-harm. This study aims to find out the status of postpartum depression and the associated factors among postnatal mothers at the first, fourth (...) and sixth month. This study is a prospective descriptive study, carried out in three major health facilities in Misurata. This study consists of a three-part questionnaire. Part 1 covers the demographic characteristics of the participants, while Part 2 explores the associated risk factors according to the variables used. Part 3 consists of the psychological evaluation of the participants. A hundred mothers (ages between 15 and 43 years) were enrolled in this study. The findings revealed that the prevalence of depression is 60.0% and 22.0% are suffering from borderline depression. Development of depression was strongly correlated with sleeping disturbances, the state of the neonate after birth, excess consumption of stimulants, less weight acceptance by mothers during pregnancy and infant illness. There was a weak relation between depression and delivery state, maternal admission to the hospital during the current pregnancy, and infant gender dissatisfaction. No correlation was found with the development of depression regarding miscarriage, maternal medical problems after delivery, previous child sex, maternal age, education, parity or neonate weight. Thus, this study shows that the chance of having a miscarriage and an unhealthy neonate increases with advanced maternal age. It also shows that caesarean section is associated with bad neonatal outcomes, more weight gain and having gestational diabetes or preeclampsia during pregnancy. Maternal sleeping problems are more pronounced in the first month, attributed to the baby's care, compared with the fourth and sixth months. The study indicates that depression is a common state of psychiatric disorders among Libyan women and should have appropriate attention by physicians and gynecologists. (shrink)

Postpartum depression is a major maternal health problem after childbirth. It can start at any time within the first year after delivery and continue for several years. It is characterized by an inability to experience pleasure, anxiety symptoms, panic attacks, spontaneous crying and depressed mood. Some women with postpartum depression even have thoughts of harming their child and self-harm. This study aims to find out the status of postpartum depression and the associated factors among postnatal mothers at the first, fourth (...) and sixth month. This study is a prospective descriptive study, carried out in three major health facilities in Misurata. This study consists of a three-part questionnaire. Part 1 covers the demographic characteristics of the participants, while Part 2 explores the associated risk factors according to the variables used. Part 3 consists of the psychological evaluation of the participants. A hundred mothers (ages between 15 and 43 years) were enrolled in this study. The findings revealed that the prevalence of depression is 60.0% and 22.0% are suffering from borderline depression. Development of depression was strongly correlated with sleeping disturbances, the state of the neonate after birth, excess consumption of stimulants, less weight acceptance by mothers during pregnancy and infant illness. There was a weak relation between depression and delivery state, maternal admission to the hospital during the current pregnancy, and infant gender dissatisfaction. No correlation was found with the development of depression regarding miscarriage, maternal medical problems after delivery, previous child sex, maternal age, education, parity or neonate weight. Thus, this study shows that the chance of having a miscarriage and an unhealthy neonate increases with advanced maternal age. It also shows that caesarean section is associated with bad neonatal outcomes, more weight gain and having gestational diabetes or preeclampsia during pregnancy. Maternal sleeping problems are more pronounced in the first month, attributed to the baby's care, compared with the fourth and sixth months. The study indicates that depression is a common state of psychiatric disorders among Libyan women and should have appropriate attention by physicians and gynecologists. (shrink)

Psychedelics are currently being studied intensively for the treatment of various psychiatric disorders. Ayahuasca, a plant-based extract originating from the Amazonian area, is traditionally consumed in ritualistic group events. The related indigenous traditions date back hundreds of years and have amassed vast amounts of knowledge on the therapeutic use of psychedelic and non-psychedelic plant-based substances. -/- These traditions require a prospective ceremony facilitator to undergo years of intensive training to acquire knowledge, mental power or self-confidence, stability, sensitivity, intuitive treatment (...) outcome prediction skills, musical skills, and sufficient physical strength. These qualities of a facilitator, in the presence of integrity and love, largely determine treatment outcomes. -/- In Europe, predominantly in the first decade of the 2000s and in the early 2010s, some individuals began building connections with diverse indigenous groups and syncretic churches of the Amazonia in an attempt to find cures for their treatment-resistant psychiatric conditions. Small circles of other patients in need of similar treatment formed around them. This led to the formation of decentralized, diverse local ceremony cultures that either followed the principles of the traditional lineages of their origin or synthesized various influences. -/- These unofficial ceremony contexts appeared to complement official healthcare systems, offering efficient methods unavailable in the medical context and correcting the consequences of medical malpractice and neglect. These ceremony contexts appeared highly communal, were largely based on volunteering, and contained mechanisms for self-correcting possible emerging issues. They seemed to function as systems for collecting, preserving, storing, and distributing knowledge of psychedelic therapy methods; in other words, systems for knowledge base building and innovation. -/- doi: 10.13140/RG.2.2.27385.85602. (shrink)

In this chapter, I provide an overview of phenomenological approaches to psychiatric classification. My aim is to encourage and facilitate philosophical debate over the best ways to classify psychiatric disorders. First, I articulate phenomenological critiques of the dominant approach to classification and diagnosis—i.e., the operational approach employed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-10). Second, I describe the type or typification approach to psychiatric classification, which I (...) distinguish into three different versions: ideal types, essential types, and prototypes. I argue that despite their occasional conflation in the contemporary literature, there are important distinctions among these approaches. Third, I outline a new phenomenological-dimensional approach. I show how this approach, which starts from basic dimensions of human existence, allows us to investigate the full range of psychopathological conditions without accepting the validity of current diagnostic categories. (shrink)

In psychiatry some disorders of cognition are distinguished from instances of normal cognitive functioning and from other disorders in virtue of their surface features rather than in virtue of the underlying mechanisms responsible for their occurrence. Aetiological considerations often cannot play a significant classificatory and diagnostic role, because there is no sufficient knowledge or consensus about the causal history of many psychiatric disorders. Moreover, it is not always possible to uniquely identify a pathological behaviour as the symptom of a (...) certain disorder, as disorders that are likely to differ both in their causal histories and in their overall manifestations may give rise to very similar patterns of behaviour. -/- Consider delusions as an example. It wouldn’t be correct to define delusions as those beliefs people form as a result of a neurobiological deficit and a hypothesis-evaluation deficit (as some versions of the two-factor theory of delusions suggest), because for some delusions no neurobiological deficit may be found, and reasoning biases and motivational factors may be contributors to the formation of the delusion (e.g. McKay et al., 2005). Moreover, it would be a mistake to define delusions as symptoms of schizophrenia alone, because they occur also in other disorders, including dementia, amnesia, and delusional disorders. Thus, aetiological considerations may appear in the description and analysis of delusions, but do not feature prominently in their definition. -/- In this paper I argue that the surface features used as criteria for the classification and diagnosis of disorders of cognition are often epistemic in character. I shall offer two examples: confabulations and delusions are defined as beliefs or narratives that fail to meet standards of accuracy and justification. Although classifications and diagnoses based on features of people’s observable behaviour are necessary at these early stages of neuropsychiatric research, given the variety of conditions in which certain phenomena appear, I shall attempt to show that current epistemic accounts of confabulations and delusions have limitations. Epistemic criteria can guide both research and clinical practice, but fail to provide sufficient conditions for the identification of delusions and confabulations, and fail to demarcate pathological from non-pathological narratives or beliefs. -/- Another limitation of current epistemic accounts – which I shall not address here – is the excessive focus on epistemic faults of confabulations and delusions at the expense of their epistemically neutral or advantageous features (see Bortolotti and Cox, 2009). This may lead to a misconception of delusions and confabulations, and to an oversimplification in the assessment of the needs of people who require clinical treatment for their psychotic symptoms. (shrink)

Type 1 diabetes (T1D) is a chronic illness that requires intensive lifelong management of blood glucose concentrations by means of external insulin administration. There have been substantial developments in the ways of measuring glucose levels, which is crucial to T1D self-management. Recently, continuous glucose monitoring (CGM) has allowed people with T1D to keep track of their blood glucose levels in near real-time. These devices have alarms that warn users about potentially dangerous blood glucose trends, which can often be (...) shared with ther people. CGM is consistently associated with improved glycemic control and reduced hypoglycemia and is currently recommended by doctors. However, due to the costs of CGM, only those who qualify for hospital provision or those who can personally afford it are able to use it, which excludes many people. In this paper, I argue that unequal access to CGM results in: (1) unjust health inequalities, (2) relational injustice, (3) injustice with regard to agency and autonomy, and (4) epistemic injustice. These considerations provide prima facie moral reasons why all people with T1D should have access to CGM technology. I discuss the specific case of CGM policy in the Netherlands, which currently only provides coverage for a small group of people with T1D, and argue that, especially with additional considerations of cost-effectiveness, the Dutch government ought to include CGM in basic health care insurance for all people with T1D. (shrink)

It has been argued that non-epistemic values have legitimate roles to play in the classification of psychiatric disorders. Such a value-laden view on psychiatric classification raises questions about the extent to which expert disagreements over psychiatric classification are fueled by disagreements over value judgments and the extent to which these disagreements could be resolved. This paper addresses these questions by arguing for two theses. First, a major source of disagreements about psychiatric classification is factual and concerns (...) what social consequences a classification decision will have. This type of disagreement can be addressed by empirical research, although obtaining and evaluating relevant empirical evidence often requires interdisciplinary collaboration. Second, there is also a type of disagreement over value judgments; namely, disagreements over which aims of psychiatric classification should be prioritized. To address this type of value disagreement, it is helpful to develop a plurality of different psychiatric classification systems, each targeted toward satisfying a different subset of stakeholder aims. (shrink)

Psychiatric research is in crisis because of repeated failures to discover new drugs for mental disorders. Lack of measurement validity could partly account for these failures. If researchers do not actually measure the effects of drugs on the disorders they aim to investigate, one should expect suboptimal treatment outcomes. I argue that this is the case, focusing on depression, and fear & anxiety disorders. In doing so, I show how psychiatric research illustrates a more general phenomenon that I (...) call “validity drift.” A validity drift occurs when, in the course of developing new measurement procedures, researchers end up studying something different from what they originally aimed to study. I analyze the different ways in which scientists attempt to validate procedures for measuring mental disorders for the purpose of testing drugs in animal models. I show how those validation efforts might fail, thereby leading to validity drifts. Overall, this analysis highlights the complex interplay between the development of new measurement procedures, their calibration, and scientific theories of the target phenomena. (shrink)

First-person reports of Major Depressive Disorder reveal that when an individual becomes depressed a profound change or ‘shift’ to one’s conscious experience occurs. The depressed person reports that something fundamental to their experience has been disturbed or shifted; a change associated with the common but elusive claim that when depressed one finds oneself in a ‘different world’ detached from reality and other people. Existing attempts to utilise these phenomenological observations in a psychiatric context are challenged by the fact that (...) this experiential ‘shift’ characteristic of depression appears mysterious and resists analysis in scientific terms. This paper offers a way out of this predicament. The hypothesis proposed is that when an individual becomes depressed, the individual departs from a state of ordinary wakeful consciousness and enters a distinctive global state of consciousness akin to dreaming and the psychedelic state. After unpacking and motivating this hypothesis in the context of research in consciousness science, I outline two of its important implications for the neurobiology of depression and psychedelic psychiatry. The upshot is a promising and conceptually well-motivated hypothesis about depression which is apt for empirical uptake and development. (shrink)

This study investigated changes in the prevalence of depression, stress, and suicidal attempts during the COVID-19 pandemic. The ≥19-year-old population in the Korea National Health and Nutrition Examination Survey in 2019 and 2020 was included. The histories of depression, stress, and suicidal attempts were compared between the 2019 and 2020 cohorts using multiple logistic regression analysis with complex sampling. The prevalence of depression was not significantly different between the 2019 and 2020 groups (4.1% vs. 4.5%, p = 0.326). The prevalence (...) of stress and suicide attempts was also not significantly different between groups (all p > 0.05). The rates of depression, stress, and suicide attempts were not associated with the 2020 group compared to the 2019 group (all p > 0.05). The 19- to 39-year-old group in the 2020 group indicated a higher rate of depression (diagnosed by physicians) than the 19- to 39-year-old group in the 2019 group (adjusted odds ratio = 1.58, 95% confidence intervals = 1.00–2.50, p = 0.049). The risks of depression, stress, and suicidal attempts were not related to the COVID-19 pandemic in Korean adults. A young adult population demonstrated an increased risk of depression associated with the COVID-19 pandemic. (shrink)

Kant’s most canonical argument against suicide, the universal law argument, is widely dismissed. This paper attempts to save it, showing that a suicide maxim, universalized, undermines all bases for practical law, resisting both the non-negotiable value of free rational willing and the ordinary array of sensuous commitments that inform prudential incentives. Suicide therefore undermines moral law governed community as a whole, threatening ‘savage disorder’. In pursuing this argument, I propose a non-teleological and non-theoretical nature – a ‘practical (...) nature’ or moral law governed whole – the realization of which morality demands. (shrink)

This paper brings the concept of affective scaffolding to bear on a much-debated controversy: the expanding use of psy- chiatric medications to treat an increasingly broad range of human discontents. ‘Affective scaffolding’ refers to the variety of ways that agents engage with, recruit or modify their environments to actively shape their emotions, moods, or other affective phenomena. Psychiatric drugs are designed, marketed, and prescribed as technologies that have the special power to transform affective life by intervening on the pathological (...) underpinnings of distress and suffering to change how we feel. The paper develops an account of psychiatric drug use as affective scaffolding and examines how psychiatrization – the complex social process through which psychiatry comes to influence more and more domains of human life – impacts this form of scaffolding. I propose that psychiatrization influences affective scaffolding by biasing individuals toward psychiatric drugs to manage an expanding array of affective experiences. In some cases, I argue, this results in bad pharmaceutical scaffolding. Bad pharmaceutical scaffolding emerges when an agent is influenced to select and rely upon psychiatric drugs in attempts to exert individual control over distress and suffering where (1) at least some of the key determinants of these affective experiences are properties of the agent’s environment, in contrast to, in a strict sense, properties internal to the person, and (2) pharmaceutical scaffolding obviates the need for or displaces other non-pharmaceutical options that would better serve the agent's affective needs and interests. (shrink)

America and the world are in the process of collapse from excessive population growth, most of it for the last century, and now all of it, due to 3rd world people. Consumption of resources and the addition of 4 billion more ca. 2100 will collapse industrial civilization and bring about starvation, disease, violence and war on a staggering scale. The earth loses about 2% of its topsoil every year, so as it nears 2100, most of its food growing capacity will (...) be gone. Billions will die and nuclear war is all but certain. In America, this is being hugely accelerated by massive immigration and immigrant reproduction, combined with abuses made possible by democracy. Depraved human nature inexorably turns the dream of democracy and diversity into a nightmare of crime and poverty. China will continue to overwhelm America and the world, as long as it maintains the dictatorship which limits selfishness. The root cause of collapse is the inability of our innate psychology to adapt to the modern world, which leads people to treat unrelated persons as though they had common interests. The idea of human rights is an evil fantasy promoted by leftists to draw attention away from the merciless destruction of the earth by unrestrained 3rd world motherhood. This, plus ignorance of basic biology and psychology, leads to the social engineering delusions of the partially educated who control democratic societies. Few understand that if you help one person you harm someone else—there is no free lunch and every single item anyone consumes destroys the earth beyond repair. Consequently, social policies everywhere are unsustainable and one by one all societies without stringent controls on selfishness will collapse into anarchy or dictatorship. The most basic facts, almost never mentioned, are that there are not enough resources in America or the world to lift a significant percentage of the poor out of poverty and keep them there. The attempt to do this is bankrupting America and destroying the world. The earth’s capacity to produce food decreases daily, as does our genetic quality. And now, as always, by far the greatest enemy of the poor is other poor and not the rich. Without dramatic and immediate changes, there is no hope for preventing the collapse of America, or any country that follows a democratic system. -/- My writings are available as paperbacks and Kindles on Amazon. -/- Talking Monkeys: Philosophy, Psychology, Science, Religion and Politics on a Doomed Planet - Articles and Reviews 2006-2017 (2017) ASIN B071HVC7YP. -/- The Logical Structure of Philosophy, Psychology, Mind and Language in Ludwig Wittgenstein and John Searle--Articles and Reviews 2006-2016 (2017) ASIN B071P1RP1B. -/- Suicidal Utopian Delusions in the 21st century: Philosophy, Human Nature and the Collapse of Civilization - Articles and Reviews 2006-2017 (2017) 2nd printing with corrections (Feb 2018) ASIN B0711R5LGX -/- Suicide by Democracy: an Obituary for America and the World (2018) ASIN B07CQVWV9C -/- . (shrink)

America and the world are in the process of collapse from excessive population growth, most of it for the last century, and now all of it, due to 3rd world people. Consumption of resources and the addition of 4 billion more ca. 2100 will collapse industrial civilization and bring about starvation, disease, violence and war on a staggering scale. The earth loses about 2% of its topsoil every year, so as it nears 2100, most of its food growing capacity will (...) be gone. Billions will die and nuclear war is all but certain. In America, this is being hugely accelerated by massive immigration and immigrant reproduction, combined with abuses made possible by democracy. Depraved human nature inexorably turns the dream of democracy and diversity into a nightmare of crime and poverty. China will continue to overwhelm America and the world, as long as it maintains the dictatorship which limits selfishness. The root cause of collapse is the inability of our innate psychology to adapt to the modern world, which leads people to treat unrelated persons as though they had common interests. The idea of human rights is an evil fantasy promoted by leftists to draw attention away from the merciless destruction of the earth by unrestrained 3rd world motherhood. This, plus ignorance of basic biology and psychology, leads to the social engineering delusions of the partially educated who control democratic societies. Few understand that if you help one person you harm someone else—there is no free lunch and every single item anyone consumes destroys the earth beyond repair. Consequently, social policies everywhere are unsustainable and one by one all societies without stringent controls on selfishness will collapse into anarchy or dictatorship. The most basic facts, almost never mentioned, are that there are not enough resources in America or the world to lift a significant percentage of the poor out of poverty and keep them there. The attempt to do this is bankrupting America and destroying the world. The earth’s capacity to produce food decreases daily, as does our genetic quality. And now, as always, by far the greatest enemy of the poor is other poor and not the rich. Without dramatic and immediate changes, there is no hope for preventing the collapse of America, or any country that follows a democratic system. -/- Those interested in all my writings in their most recent versions may download from this site my e-book ‘Philosophy, Human Nature and the Collapse of Civilization Michael Starks (2016)- Articles and Reviews 2006-2016’ by Michael Starks First Ed. 662p (2016). -/- All of my papers and books have now been published in revised versions both in ebooks and in printed books. -/- Talking Monkeys: Philosophy, Psychology, Science, Religion and Politics on a Doomed Planet - Articles and Reviews 2006-2017 (2017) https://www.amazon.com/dp/B071HVC7YP. -/- The Logical Structure of Philosophy, Psychology, Mind and Language in Ludwig Wittgenstein and John Searle--Articles and Reviews 2006-2016 (2017) https://www.amazon.com/dp/B071P1RP1B. -/- Suicidal Utopian Delusions in the 21st century: Philosophy, Human Nature and the Collapse of Civilization - Articles and Reviews 2006-2017 (2017) https://www.amazon.com/dp/B0711R5LGX . (shrink)

Medical assistance in dying, which includes voluntary euthanasia and assisted suicide, is legally permissible in a number of jurisdictions, including the Netherlands, Belgium, Switzerland and Canada. Although medical assistance in dying is most commonly provided for suffering associated with terminal somatic illness, some jurisdictions have also offered it for severe and irremediable psychiatric illness. Meanwhile, recent work in the philosophy of psychiatry has led to a renewed understanding of psychiatric illness that emphasises the role of the relation (...) between the person and the external environment in the constitution of mental disorder. In this paper, I argue that this externalist approach to mental disorder highlights an ethical challenge to the practice of medical assistance in dying for psychiatric illness. At the level of the clinical assessment, externalism draws attention to potential social and environmental interventions that might have otherwise been overlooked by the standard approach to mental disorder, which may confound the judgement that there is no further reasonable alternative that could alleviate the person’s suffering. At the level of the wider society, externalism underscores how social prejudices and structural barriers that contribute to psychiatric illness constrain the affordances available to people and result in them seeking medical assistance in dying when they otherwise might not have had under better social conditions. (shrink)

In this paper, I am generally concerned with certain mental disorders and the doxastic attitudes that sometimes characterize them. According to recent Anglo-American philosophical studies on this topic, the latter involve beliefs that have somehow “gone wrong”: strange or irrational beliefs and cases of “motivated irrationality”. I aim to focus on pathological and deceptive phenomena such as delusion and self-deception. From a phenomenological perspective, these can also be investigated with regard to their experiential content. Adopting this approach, and starting in (...) particular with the eidetic connection between the living body and its own environment, I will examine disorders of the ecological self. Psychiatric delusion, which is at the core of this examination, is a symptom of a great number of mental disorders, such as Capgras disorder, Cotard disorder and schizophrenia. Integrating dominant (propositional) models of delusion which reduce this pathological phenomenon to a certain kind of belief, I propose an eco-phenomenological understanding of its contours. From this perspective, delusion reveals itself primarily as an illusory experience: a delusional value-perception. In particular, I offer a Schelerian-based description of a peculiar case of delusion: Capgras delusion. People who suffer from Capgras delusion claim that an otherwise familiar individual has been replaced by an impostor. I consider, although in its negative variations, the contextual (rather than internalist) character of this type of delusion. (shrink)

Recently there has been a trend of moving towards biological and neurocognitive based classifications of mental disorders that is motivated by a dissatisfaction with the syndrome-based classifications of mental disorders. The Research Domain Criteria (indicated with the acronym RDoC) represents a bold and systematic attempt to foster this advancement. However, RDoC faces theoretical and conceptual issues that need to be addressed. Some of these difficulties emerge when we reflect on the plausible reading of the slogan “mental disorders are brain disorders”, (...) that according to proponents of RDoC constitutes one of its main presuppositions. Some authors think that endorsing this idea commits RDoC to a form of biological reductionism. We offer empirical and theoretical considerations for concluding that the slogan above should not be read as a reductionist thesis. We argue, instead, that the slogan has a pragmatic function whose aim is to direct research in psychopathology. We show how this function might be captured in the framework of a Carnapian explication as a methodological tool for conceptual engineering. Thus, we argue that a charitable interpretation of the aims of the proponents of RDoC should be understood as an attempt at providing an explication of the concept of mental disorder in terms of brain disorder whose main goal is to provide a more precise and fruitful notion that is expected to have a beneficial impact on classification, research, and treatment of psychiatric conditions. (shrink)

This paper provides a historical analysis of a shift in the way animal models of mental disorders were conceptualized: the shift from the mid-twentieth-century view, adopted by some, that animal models model syndromes classified in manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), to the later widespread view that animal models model component parts of psychiatric syndromes. I argue that in the middle of the twentieth century the attempt to maximize the face validity of animal (...) models sometimes led to the pursuit of the ideal of an animal model that represented a behaviorally defined psychiatric syndrome as described in manuals such as the DSM. I show how developments within psychiatric genetics and related criticism of the DSM in the 1990s and 2000s led to the rejection of this ideal and how researchers in the first decade of the twenty-first century came to believe that animal models of mental disorders should model component parts of mental disorders, adopting a so-called endophenotype approach. (shrink)

In psychiatry, pharmacological drugs play an important experimental role in attempts to identify the neurobiological causes of mental disorders. Besides being developed in applied contexts as potential treatments for patients with mental disorders, pharmacological drugs play a crucial role in research contexts as experimental instruments that facilitate the formulation and revision of neurobiological theories of psychopathology. This paper examines the various epistemic functions that pharmacological drugs serve in the discovery, refinement, testing, and elaboration of neurobiological theories of mental disorders. I (...) articulate this thesis with reference to the history of antipsychotic drugs and the evolution of the dopamine hypothesis of schizophrenia in the second half of the twentieth century. I argue that interventions with psychiatric patients through the medium of antipsychotic drugs provide researchers with information and evidence about the neurobiological causes of schizophrenia. This analysis highlights the importance of pharmacological drugs as research tools in the generation of psychiatric knowledge and the dynamic relationship between practical and theoretical contexts in psychiatry. (shrink)

In a recent Response published in the Journal of Medical Ethics,1 Buturovic provides two criticisms of my argument in ‘Is the exclusion of psychiatric patients from access to physician-assisted suicide discriminatory?’2 First, Buturovic argues that my argument effectively ‘erases the distinction between healthy adults and patients (whether somatic or psychiatric) essentially implying that PAS [physician-assisted suicide] should be available to all, for all reasons or, ultimately no reason’ (Buturovic,1 pg. 1). Second, Buturovic argues that opening the (...) doors to medical assistance in dying (MAID) for psychiatric patients could have a number of undesirable implications. In particular, Buturovic highlights the potential negative implications for relations of trust in medicine—psychiatry in particular—along with potential effects on the rate of organ donation. I would here like to respond to these two criticisms. In short, my response to Buturovic’s first argument is that the slope is not nearly as slippery as Buturovic suggests. The reason for this is that the plausibility of Buturovic’s argument rests on a significant misinterpretation of my argument, along with an important equivocation in her own. Buturovic argues that, under the three criteria that I propose for the provision of MAID—sufficient decision-making capacity, demonstrated treatment resistance, and a lack of substantially negative implications for existing standards of psychiatric treatment and research—the provision of MAID for trivial reasons, even no reason at all, is justifiable. The main problem with this argument is that I propose no such positive criteria. My argument is that none of the three arguments addressed in my previous paper are sufficient to justify the exclusion of any and all psychiatric patients from access to MAID. I do not claim, in other words, that any individual …. (shrink)

Metformin hydrochloride is the first-line anti-diabetic drug used to treat type 2 diabetes mellites and helps to control blood sugar levels. Various brands of metformin are available in the Libyan market which makes it challenging to select, an effective and economical one. This study aimed to compare different brands of metformin available in the Misurata and evaluate the quality parameter according to the British Pharmacopoeia. Six brands of metformin tablets (850 mg) were taken from the market and assessed. (...) To achieve this purpose five tests were done on each brand, the uniformity of weight test shows the average weight and 5.0% deviation, the friability test gives how much the tablet can stand attrition, the disintegration time test shows the time taken by the tablet to disintegrate, dissolution test to confirm the rate of drug release, weight variation and friability test of all brands was within the specified limit. Disintegration time for all the brands was within 30 minutes. All six brands of metformin hydrochloride tablets fulfilled the in-vitro dissolution rate test specification not less than 80% of the drug is released within 45 minutes. Using Ultraviolet-visible (UV) spectroscopy, UV analysis of different samples shows that the percentage content of active ingredients of five brands of metformin hydrochloride tablets was within the monograph specification (95%-105%) of drug content but one brand failed this test. The study indicated that strict quality control of imported drugs should enforced to ensure effective and safe medicines in the Libyan market. (shrink)

Ayahuasca is a plant-based brew of indigenous Amazonian origin. It has psychedelic, anti-inflammatory, neuroprotective, cytotoxic, and anti-parasitic effects, which are primarily due to monoamine oxidase inhibitors (MAOIs) and N,N-dimethyltryptamine (DMT). This article describes the case of a woman in her late thirties with complex trauma due to severe, years-long sexual abuse in early childhood, resulting in a decades-long chronic condition involving suicidality. She was diagnosed with bipolar disorder and borderline personality disorder, but refused to accept either of them. She presented (...) with delusional parasitosis and deep dissociation. Despite being severely psychotic in private, she appeared high-functioning in public, hiding most of her symptoms. -/- In her mid-thirties, she participated in an ayahuasca ceremony in a legal setting. It resolved her suicidality, eliminated her social isolation, and reduced her shame related to her early trauma. Nine more ceremonies alleviated her distress further. Her abuser also participated in an ayahuasca ceremony and confirmed her memories of childhood abuse. -/- The first interview was conducted 1.5 years after her first ceremony, and a follow-up interview 2.5 years later. She had experienced sixteen additional ceremonies, recognized the validity of her bipolar disorder diagnosis, and believed her early trauma to be its sole cause. Her core trauma remained partially unresolved, but her dissociative symptoms continued to decrease. She had observed several other instances of psychosis and bipolar disorder in which ayahuasca had resulted in positive effects. This case study contributes to a better understanding of the use of ayahuasca in bipolar disorder and severe traumatization. It also reviews the current state-of-the-art in the treatment of bipolar disorder using low-dose ayahuasca, and a case in which bipolar disorder was resolved with LSD. -/- doi: 10.13140/RG.2.2.21294.18243. (shrink)

The present review of literature surveys two main issues related to self-referential processes: (1) Where in the brain are these processes located, and do they correlate with brain areas uniquely specialized in self-processing? (2) What are the empirical and theoretical links between inner speech and self-awareness? Although initial neuroimaging attempts tended to favor a right hemispheric view of selfawareness, more recent work shows that the brain areas which support self-related processes are located in both hemispheres and are not uniquely activated (...) during self-reflective tasks. Furthermore, self-awareness at least partially relies on internal speech. An activation of Broca's area (which is known to sustain inner speech) is observed in a significant number of brain-imaging studies of self-reflection. Loss of inner speech following brain damage produces self-awareness deficits. Inner speech most likely can internally reproduce social mechanisms leading to self-awareness. Also, the process of self-reflection can be seen as being a problem-solving task, and self-talk as being a cognitive tool the individual uses to effectively work on the task. It is noted that although a large body of knowledge already exists on self-awareness, little is known about individual differences in dispositional self-focus and types of self-attention (e.g., rumination vs. self-reflection). (shrink)

Introduction: During the COVID-19 pandemic, adolescents have increasingly suffered from online problem behaviors and mental disorders. But little research has paid attention to the protective factors among adolescents. Therefore, the present study attempted to investigate the role of positive youth development (PYD) attributes in adolescents’ depression, internet gaming disorder (IGD) and cyberbullying/victimization (CBV). -/- Methods: A total of 995 Chinese adolescents (Mage = 15.97 years, SD = 0.77, 325 boys) from two public high schools in Hubei province were recruited to (...) participate in the three-wave longitudinal study over the span of 1 year during the pandemic (Time 1: November, 2020; Time 2: May, 2021; Time 3: November, 2021). -/- Results: T1 PYD attributes negatively predicted T2 depression and T3 online problematic behaviors. T2 depression positively predicted IGD at T3. T3 IGD significantly predicted greater involvement in T3 CBV, and vice versa. Moreover, depression and one online problem behavior mediated the relationships between PYD attributes and the other online problem behavior, separately and sequentially. (shrink)

Sertraline is one of the most commonly prescribed antidepressants. Major depressive disorder (MDD) is characterized by spontaneous thoughts that are laden with negative affect-a "malignant sadness". Prior neuroimaging studies have identified abnormal resting-state functional connectivity (rsFC) in the spontaneous brain networks of MDD patients. But how antidepressant medication acts to relieve the experience of depression as well as adjust its associated spontaneous networks and mood-regulation circuits remains an open question. In this study, we recruited 22 drug-naïve MDD patients along with (...) 35 normal controls and investigated whether the functional integrity of cortical networks associated with spontaneous thoughts is modulated by sertraline treatment. We attempted to predict post-treatment effects based upon what we observed in the pre-treatment rsFC of drug-naïve MDD patients. In the result, we demonstrated that (1) after the sertraline treatment, the medial temporal lobe of default network (DNMTL) and mood regulation pathway-the fronto-parietal control network (FPCN), the thalamus, and the salience network (SN)-were restored to normal connectivity, relative to the pre-treatment condition; however, the altered connections of FPCN-core DN (DNCORE), FPCN-SN, and intra-FPCN among MDD patients remained impaired; (2) thalamo-prefrontal connectivity provides moderate predictive power (r2 = 0.63) for the effectiveness of sertraline treatment. In summary, our findings contribute to a body of evidence that suggests salubrious effects of sertraline treatment primarily involve the FPCN-thalamus-SN pathway. The pre-treatment rsFC in this pathway could serve as a predictor of sertraline treatment outcome. (shrink)

The aim of this study was to obtain a baseline for clinical application of electroencephalography (EEG) in children and to evaluate the EEG findings in children with various acute and chronic central nervous system disorders and nonepileptic events. EEG records of 250 patients were studied in Neurophysiology Departments of Queen Rania Al-Abdullah Hospital for Children in Jordan. For each patient who had undergone EEG the following data were recorded: age, sex, source of referral (inpatient or outpatient department), reason for EEG, (...) diagnostic impressions, clinical presentation, the result of the EEG examinations and clinical correlation between the seizure type and EEG finding. Males (55%) were slightly outnumbered than females. The majority of cases were between 6-12 years. Total of 63.2% of all referrals for EEG were from outpatient clinics while inpatients accounted for 36.8% of referred cases, with Pediatric Neurology Department referrals being the highest (28.8%). Majority of diagnosis at referral were suspected epilepsy (80%) with epileptiform EEG abnormalities in 32%. Over all 64% the EEG records were normal, including all EEG records of children with syncope and headache. We conclude that there are many unnecessary routine EEG recordings in children. Investigation of epilepsy and acute encephalopathies appear to be the most valuable indications for routine pediatric EEG. EEG can be helpful in classification of seizures. Finding a way to reduce EEG requests is recommended. (shrink)

In this paper I offer an alternative phenomenological account of depression as consisting of a degradation of the degree to which one is situated in and attuned to the world. This account contrasts with recent accounts of depression offered by Matthew Ratcliffe and others. Ratcliffe develops an account in which depression is understood in terms of deep moods, or existential feelings, such as guilt or hopelessness. Such moods are capable of limiting the kinds of significance and meaning that one can (...) come across in the world. I argue that Ratcliffe’s account is unnecessarily constrained, making sense of the experience of depression by appealing only to changes in the mode of human existence. Drawing on Merleau-Ponty’s critique of traditional transcendental phenomenology, I show that many cases of severe psychiatric disorders are best understood as changes in the very structure of human existence, rather than changes in the mode of human existence. Working in this vein, I argue that we can make better sense of many first-person reports of the experience of depression by appealing to a loss or degradation of the degree to which one is situated in and attuned to the world, rather than attempting to make sense of depression as a particular mode of being situated and attuned. Finally, I argue that drawing distinctions between disorders of structure and mode will allow us to improve upon the currently heterogeneous categories of disorder offered in the DSM-5. (shrink)

Case reports about patients undergoing Deep Brain Stimulation (DBS) for various motor and psychiatric disorders - including Parkinson’s Disease, Obsessive Compulsive Disorder, and Treatment Resistant Depression - have sparked a vast literature in neuroethics. Questions about whether and how DBS changes the self have been at the fore. The present chapter brings these neuroethical debates into conversation with recent research in moral psychology. We begin in Section 1 by reviewing the recent clinical literature on DBS. In Section 2, we (...) consider whether DBS poses a threat to personal identity. In Section 3 we argue for engagement with recent empirical work examining judgements of when identity changes. We conclude in Section 4 by highlighting a range of ethical issues raised by DBS, including various cross-cultural considerations. (shrink)

Marion Godman makes the argument that Pathological Withdrawal Syndrome (PWS) makes the case for psychiatric disorders as a natural kind. Godman argues that we can classify kinds according to their shared ‘grounding’, but we need not know what the grounding is to know that the natural is a natural kind. However, I argue that Godman erroneously classifies PWS as its own natural kind when it is in fact a variant of depression, which is its own natural kind. Cooper highlights (...) culture-bound syndromes, which can explain the discrepancy between the different diagnosis rates for psychiatric disorders among different cultures. Taking culture-bound syndromes into account, I conclude that PWS is a type of depression that is culture-specific. (shrink)

Blindsight is a kind of residual vision found in people with lesions to V1. Subjects with blindsight typically report no visual awareness, but they are nonetheless able to make above-chance guesses about the shape, location, color and movement of visual stimuli presented to them in their blind field. A different kind of blindsight, sometimes called type 2 blindsight, is a kind of residual vision found in patients with V1 lesions in the presence of some residual awareness. Type 2 (...) blindsight differs from ordinary visual experience in lacking the particularity, transparency and fine-grainedness often taken to be essential to visual experience, at least in veridical cases. I argue that the case of type 2 blindsight provides a counterexample to the view that these characteristics are essential to veridical visual experience and that this gives us reason to resist the view that visual experience is essentially a perceptual relation to external objects. In the second part of the paper I argue that the case of type 2 blindsight yields important insights into the effects of attentional modulation on perceptual content and that cases of attentional modulation of appearance are not at odds with the view that the phenomenology of visual experience flows from its content. (shrink)

The standard of care in the United States favors stabilizing any adult who arrives in an emergency department after a failed suicide attempt, even if he appears decisionally capacitated and refuses life-sustaining treatment. I challenge this ubiquitous practice. Emergency clinicians generally have a moral obligation to err on the side of stabilizing even suicide attempters who refuse such interventions. This obligation reflects the fact that it is typically infeasible to determine these patients’ level of decisional capacitation—among other relevant (...) information—in this unique setting. Nevertheless, I argue, stabilizing suicide attempters over their objection sometimes violates a basic yet insufficiently appreciated right of theirs—the right against bodily invasion. In such cases, it is at least prima facie wrong to stabilize a patient who wants to die even if they lack a contrary advance directive or medical order and suffer from no terminal physical illness. (shrink)

Advances in emotion and affective science have yet to translate routinely into psychiatric research and practice. This is unfortunate since emotion and affect are fundamental components of many psychiatric conditions. Rectifying this lack of interdisciplinary integration could thus be a potential avenue for improving psychiatric diagnosis and treatment. In this contribution, we propose and discuss an ontological framework for explicitly capturing the complex interrelations between affective entities and psychiatric disorders, in order to facilitate mapping and integration (...) between affective science and psychiatric diagnostics. We build on and enhance the categorisation of emotion, affect and mood within the previously developed Emotion Ontology, and that of psychiatric disorders in the Mental Disease Ontology. This effort further draws on developments in formal ontology regarding the distinction between normal and abnormal in order to formalize the interconnections. This operational semantic framework is relevant for applications including clarifying psychiatric diagnostic categories, clinical information systems, and the integration and translation of research results across disciplines. (shrink)

In this volume, leading philosophers of psychiatry examine psychiatric classification systems, including the Diagnostic and Statistical Manual of Mental Disorders, asking whether current systems are sufficient for effective diagnosis, treatment, and research. Doing so, they take up the question of whether mental disorders are natural kinds, grounded in something in the outside world. Psychiatric categories based on natural kinds should group phenomena in such a way that they are subject to the same type of causal explanations and (...) respond similarly to the same type of causal interventions. When these categories do not evince such groupings, there is reason to revise existing classifications. The contributors all question current psychiatric classifications systems and the assumptions on which they are based. They differ, however, as to why and to what extent the categories are inadequate and how to address the problem. Topics discussed include taxometric methods for identifying natural kinds, the error and bias inherent in DSM categories, and the complexities involved in classifying such specific mental disorders as "oppositional defiance disorder" and pathological gambling. -/- Contributors George Graham, Nick Haslam, Allan Horwitz, Harold Kincaid, Dominic Murphy, Jeffrey Poland, Nancy Nyquist Potter, Don Ross, Dan Stein, Jacqueline Sullivan, Serife Tekin, Peter Zachar. (shrink)

Does DBS change a patient’s personality? This is one of the central questions in the debate on the ethics of treatment with Deep Brain Stimulation (DBS). At the moment, however, this important debate is hampered by the fact that there is relatively little data available concerning what patients actually experience following DBS treatment. There are a few qualitative studies with patients with Parkinson’s disease and Primary Dystonia and some case reports, but there has been no qualitative study yet with patients (...) suffering from psychiatric disorders. In this paper, we present the experiences of 18 patients with Obsessive-Compulsive Disorder (OCD) who are undergoing treatment with DBS. We will also discuss the inherent difficulties of how to define and assess changes in personality, in particular for patients with psychiatric disorders. We end with a discussion of the data and how these shed new light on the conceptual debate about how to define personality. (shrink)

Deep brain stimulation (DBS), a surgical procedure involving the implantation of electrodes in the brain, has rekindled the medical community’s interest in psychosurgery. Whereas many researchers argue DBS is substantially different from psychosurgery, we argue psychiatric DBS—though a much more precise and refined treatment than its predecessors—is nevertheless a form of psychosurgery, which raises both old and new ethical and legal concerns that have not been given proper attention. Learning from the ethical and regulatory failures of older forms of (...) psychosurgery can help shed light on how to address the regulatory gaps that exist currently in DBS research. To show why it is important to address the current regulatory gaps within psychiatric DBS, we draw on the motivations underlying the regulation of earlier forms of psychosurgery in the US. We begin by providing a brief history of psychosurgery and electrical brain stimulation in the US. Against this backdrop, we introduce psychiatric DBS, exploring current research and ongoing clinical trials. We then draw out the ethical and regulatory similarities between earlier forms of psychosurgery and psychiatric DBS. As we will show, the factors that motivated strict regulation of earlier psychosurgical procedures mirror concerns with psychiatric DBS today. We offer three recommendations for psychiatric DBS regulation, which echo earlier motivations for regulating psychosurgery, along with new considerations that reflect the novel technologies used in DBS. (shrink)

Dual-process theories of higher order cognition (DPTs) have been enjoying much success, particularly since Kahneman’s 2002 Nobel prize address and recent book Thinking, Fast and Slow (2009). Historically, DPTs have attempted to provide a conceptual framework that helps classify and predict differences in patterns of behavior found under some circumstances and not others in a host of reasoning, judgment, and decision-making tasks. As evidence has changed and techniques for examining behavior have moved on, so too have DPTs. Killing two birds (...) with one stone, Evans and Stanovich (2013, this issue) respond to five main criticisms of DPTs. Along with addressing each criticism in turn, they set out to clarify the essential defining characteristics that distinguish one form of higher order cognition from the other. The aim of this commentary is to consider the defining characteristics of Type 1 and Type 2 processing that have been proposed and to suggest that the evidence can be taken to support quantitative differences rather than qualitatively distinct processes. (shrink)

This paper deals with Gärdenfors’ theory of conceptual spaces. Let ${\mathcal {S}}$ be a conceptual space consisting of 2-type fuzzy sets equipped with several kinds of metrics. Let a finite set of prototypes $\tilde{P}_1,\ldots,\tilde{P}_n\in \mathcal {S}$ be given. Our main result is the construction of a classification algorithm. That is, given an element ${\tilde{A}}\in \mathcal {S},$ our algorithm classifies it into the conceptual field determined by one of the given prototypes $\tilde{P}_i.$ The construction of our algorithm uses some physical (...) analogies and the Newton potential plays a significant role here. Importantly, the resulting conceptual fields are not convex in the Euclidean sense, which we believe is a reasonable departure from the assumptions of Gardenfors’ original definition of the conceptual space. A partitioning algorithm of the space $\mathcal {S}$ is also considered in the paper. In the application section, we test our classification algorithm on real data and obtain very satisfactory results. Moreover, the example we consider is another argument against requiring convexity of conceptual fields. (shrink)

The paper deals with two central issues in the philosophy of neuroscience and psychiatry, namely those of the nature and the major kinds and types of psychopathological mechanisms. Contrary to a widespread view, I argue that mechanisms are not kinds of systems but kinds of processes unfolding in systems or between systems. More precisely, I argue that psychopathological mechanisms are sets of actions and interactions between brain-systems or circuits as well as between the latter and other systems in one's body (...) and external environment, both physical and social, involved in human psychopathology. According to the kinds of properties of the interacting systems or their component-parts, psychopathological mechanisms may be physical, chemical, biological, psychological, social, or, typically, mixed ones. Furthermore, I focus on two main kinds of psychopathological mechanisms involved in the causation of mental disorders, namely the pathogenetic and pathophysiological ones, stressing the importance of their careful distinction for the integrative understanding of otherwise disparate and apparently incommensurable psychiatric research findings. I illustrate my analysis with an example drawn from contemporary research on the mechanisms of acute psychosis. Finally, I stress the relevance of psychopathological mechanisms to a more scientifi cally-grounded classifi cation of mental disorders. (shrink)