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The hippocampus plays an important role in psychopathology and treatment outcome. While posterior hippocampus (PH) may be crucial for the learning process that exposure-based treatments require, affect-focused treatments might preferentially engage anterior hippocampus (AH). Previous studies have distinguished the different functions of these hippocampal sub-regions in memory, learning, and emotional processes, but not in treatment outcome. Examining two independent clinical trials, we hypothesized that anterior hippocampal volume would predict outcome of affect-focused treatment outcome [Interpersonal Psychotherapy (IPT); Panic-Focused Psychodynamic Psychotherapy (PFPP)], whereas posterior hippocampal volume would predict exposure-based treatment outcome [Prolonged Exposure (PE); Cognitive Behavioral Therapy (CBT); Applied Relaxation Training (ART)].
Thirty-five patients with posttraumatic stress disorder (PTSD) and 24 with panic disorder (PD) underwent structural magnetic resonance imaging (MRI) before randomization to affect-focused (IPT for PTSD; PFPP for PD) or exposure-based treatments (PE for PTSD; CBT or ART for PD). AH and PH volume were regressed with clinical outcome changes.
Baseline whole hippocampal volume did not predict post-treatment clinical severity scores in any treatment. For affect-focused treatments, but not exposure-based treatments, anterior hippocampal volume predicted clinical improvement. Smaller AH correlated with greater affect-focused treatment improvement. Posterior hippocampal volume did not predict treatment outcome.
This is the first study to explore associations between hippocampal volume sub-regions and treatment outcome in PTSD and PD. Convergent results suggest that affect-focused treatment may influence the clinical outcome through the ‘limbic’ AH, whereas exposure-based treatments do not. These preliminary, theory-congruent, therapeutic findings require replication in a larger clinical trial.
We have compiled the X-ray characteristic properties for a unique and homogeneous sample of Type 2 AGN with water megamaser activity observed by XMM-Newton and for a control sample of non-maser galaxies, both analyzed in a uniform way. A comparison of the luminosity distributions confirms previous results (from smaller and/or less systematic studies) that water maser galaxies appear more luminous than non-maser sources. In addition, the maser phenomenon is associated with more complex X-ray spectra, higher column densities and higher equivalent widths of the Fe Kα line. Both a sufficiently luminous X-ray source and a high absorbing column density in the line of sight favor the appearance of the water megamaser phenomenon in AGN.
The editors of this volume have invited me to present here my personal philosophy. But I cannot distinguish between my personal philosophy and my theoretical philosophy. As I explained in my autobiography (Markowitz 1990), when I was in high school I read science at a nontechnical level, like the ABC of Relativity, and the original writings of great philosophers. In particular, I was struck by David Hume’s (1776) argument that even though I release a ball a thousand times and, in every instant, it falls to the floor, that does not prove that it will necessarily fall to the floor the thousand-and-first time. In other words, even though Newton’s law of gravity worked in thousands of instances, that did not prove that it would never fail – such as in explaining the orbit of Mercury! Essentially, my philosophical interest in high school lay in the question “What do we know and how do we know it?”
When I entered the Economics Department at the University of Chicago I was naturally drawn to the economics of uncertainty. In particular, the work of Leonard J. Savage (1954) – building on that of von Neumann and Morgenstern (1944) – presented, to me among many others, a convincing axiomatic argument that, in acting under uncertainty, one should maximize expected utility using probability beliefs where objective probabilities are not known. It is a corollary of the latter conclusion that, as information accumulates, one should shift one’s beliefs according to Bayes’s rule, reviewed later in this essay. (Hume, too, said that one should attach probabilities to beliefs but did not specify that Bayes’s rule should be used in response to growing evidence for or against various hypotheses.)
We systematically search for discrete absorption events in the vast archive of the Rossi X-ray Timing Explorer. This includes dozens of nearby type I and Compton-thin type II AGN and covers timescales from days to over a decade for individual objects. We are sensitive to discrete absorption events due to clouds of full-covering, neutral or mildly-ionized gas with columns 1022−25 cm−2 transiting the line of sight. We detect 13 eclipse events in 8 objects, roughly tripling the number of previously published events from this archive. Despite sensitivity to events with NH up to 1024−25 cm−2, we measured no Compton-thick eclipses in our sample. Peak column densities span 2.5–19 × 1022 cm−2. Event durations span hours to months. We infer the clouds distances from the black hole, assuming Keplerian motion, to span 0.2–80 × 104 Schwarzschild radii. We find no statistically significant difference between the individual cloud properties of type I and II objects. The presence of eclipses in both type Is and IIs argues against sharp-edged cloud distributions. The type II AGN show a level of “base-line” X-ray absorption that is consistent with being constant over timescales from 0.6 to 8.4 yr. This can either be explained by a homogeneous medium, or by X-ray-absorbing clouds that each have NH ≪ 1022 cm−2. Considering the “selection function” of the monitoring, we derive the probability of cloud occultation events. Finally, we derive the first X-ray statistical constraints for clumpy-torus models.
Several conceptual models have been considered for the assessment of personality pathology in DSM-5. This study sought to extend our previous findings to compare the long-term predictive validity of three such models: the Five-Factor Model (FFM), the Schedule for Nonadaptive and Adaptive Personality (SNAP), and DSM-IV personality disorders (PDs).
An inception cohort from the Collaborative Longitudinal Personality Disorder Study (CLPS) was followed for 10 years. Baseline data were used to predict long-term outcomes, including functioning, Axis I psychopathology, and medication use.
Each model was significantly valid, predicting a host of important clinical outcomes. Lower-order elements of the FFM system were not more valid than higher-order factors, and DSM-IV diagnostic categories were less valid than dimensional symptom counts. Approaches that integrate normative traits and personality pathology proved to be most predictive, as the SNAP, a system that integrates normal and pathological traits, generally showed the largest validity coefficients overall, and the DSM-IV PD syndromes and FFM traits tended to provide substantial incremental information relative to one another.
DSM-5 PD assessment should involve an integration of personality traits with characteristic features of PDs.
This study prospectively examined the natural clinical course of six anxiety disorders over 7 years of follow-up in individuals with personality disorders (PDs) and/or major depressive disorder. Rates of remission, relapse, new episode onset and chronicity of anxiety disorders were examined for specific associations with PDs.
Participants were 499 patients with anxiety disorders in the Collaborative Longitudinal Personality Disorders Study, who were assessed with structured interviews for psychiatric disorders at yearly intervals throughout 7 years of follow-up. These data were used to determine probabilities of changes in disorder status for social phobia (SP), generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder and panic disorder with agoraphobia.
Estimated remission rates for anxiety disorders in this study group ranged from 73% to 94%. For those patients who remitted from an anxiety disorder, relapse rates ranged from 34% to 67%. Rates for new episode onsets of anxiety disorders ranged from 3% to 17%. Specific PDs demonstrated associations with remission, relapse, new episode onsets and chronicity of anxiety disorders. Associations were identified between schizotypal PD with course of SP, PTSD and GAD; avoidant PD with course of SP and OCD; obsessive-compulsive PD with course of GAD, OCD, and agoraphobia; and borderline PD with course of OCD, GAD and panic with agoraphobia.
Findings suggest that specific PD diagnoses have negative prognostic significance for the course of anxiety disorders underscoring the importance of assessing and considering PD diagnoses in patients with anxiety disorders.
We integrate appealing features of Markowitz’s mean-variance portfolio theory (MVT) and Shefrin and Statman’s behavioral portfolio theory (BPT) into a new mental accounting (MA) framework. Features of the MA framework include an MA structure of portfolios, a definition of risk as the probability of failing to reach the threshold level in each mental account, and attitudes toward risk that vary by account. We demonstrate a mathematical equivalence between MVT, MA, and risk management using value at risk (VaR). The aggregate allocation across MA subportfolios is mean-variance efficient with short selling. Short-selling constraints on mental accounts impose very minor reductions in certainty equivalents, only if binding for the aggregate portfolio, offsetting utility losses from errors in specifying risk-aversion coefficients in MVT applications. These generalizations of MVT and BPT via a unified MA framework result in a fruitful connection between investor consumption goals and portfolio production.
The aim of this study was to explore the plasticity of fixation in patients with central vision loss. Most of these patients use preferred retinal loci (PRLs) in the healthy eccentric part of the retina to fixate, but fixation stability and retinal location are not always optimal for best visual performance. This study examined whether fixation stability and a new PRL location can be trained and whether these changes in ocular motor control transfer into better reading performance. Six patients with age-related macular degeneration participated in the study. Fixation stability measurements, microperimetry, and auditory biofeedback training were performed with the MP-1 microperimeter. The auditory biofeedback was used during five 1-h long training sessions to improve fixation and relocate the PRL. Fixation location and stability were recorded while viewing four different targets: a cross, a letter, a word, and a nine-cycle radial grating. Visual acuity was assessed with the Early Treatment Diabetic Retinopathy Study (ETDRS) chart and reading performance with the MNRead test. The results showed that all patients developed a new PRL in an optimal location for reading, and they were able to use it consistently while viewing different targets. Fixation stability improved 53% after training. Learning transferred to the old PRL even though fixation stability at this location was not trained. All these improvements in ocular motor control translated into better reading performance: reading speed improved 38% and reading acuity and critical print size gained two lines. We conclude that the ability of the ocular motor system to fixate is flexible in patients with central vision loss: a new PRL can be trained, fixation stability can be improved, and learning transfers to an untrained location. These gains in ocular motor control result in better visual performance. This property can be successfully used to optimize the residual vision of patients with central vision loss.