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Written for undergraduate and graduate students of finance, economics and business, the fourth edition of Financial Markets and Institutions provides a fresh analysis of the European financial system. Combining theory, data and policy, this successful textbook examines and explains financial markets, financial infrastructures, financial institutions and the challenges of financial supervision and competition policy. The fourth edition features not only greater discussion of the financial and euro crises and post-crisis reforms, but also new market developments like FinTech, blockchain, cryptocurrencies and shadow banking. On the policy side, new material covers unconventional monetary policies, the Banking Union, the Capital Markets Union, Brexit, the Basel 3 capital adequacy framework for banking supervision and macroprudential policies. The new edition also features wider international coverage, with greater emphasis on comparisons with countries outside the European Union, including the United States, China and Japan.
A big part of the integration problem is the difficulty of relating the physiological and the experiential dimension of psychiatric disorders: body and mind. Within psychiatry the question of how body and mind relate is not just an abstract, philosophical question but first and foremost a practical one. Are patients’ altered experiences symptoms of underlying physiological disturbances? Or are psychiatric disorders rather psychological problems with physiological consequences?
So far we have looked at the enactive account of the relation between body and mind and saw that following the life–mind continuity thesis we need to understand both physiological and experiential processes as part of a larger system of living beings interacting with their worlds. This relational approach undercuts the dualist confusions that stem from an inner/outer mind and world. Although the enactive account is a promising basis for an integrative framework of psychiatric disorders, it does not yet suffice.
How does this existential dimension and the space of meaning it opens up fit within the enactive picture? The same feature that made the enactive perspective on the body-mind problem so helpful is now the main source of worry: the life–mind continuity thesis. For if we stress the continuity between living and sense-making, we risk equalising or smoothing out fundamental differences between living beings and their sense-making capacities.
In the previous chapter, I proposed an enactive account of psychiatric disorders that understands them as structurally disturbed patterns of sense-making. We looked at what characterises such disordered patterns: the inaptness of the sense-making in light of its context, the rigidity of both the interactions with the world and the existential stance, and the experience of suffering.
The problem of integrating the heterogeneous factors involved in psychiatric disorders is a central one. This difficulty of how to connect all the possible aspects of psychiatric disorders and their mutual interactions bears on important issues such as how to understand the causality involved in psychiatric disorders and how to understand the effects of different treatments, including medication and psychotherapy. An integrative account of psychiatric disorders addresses these issues.
In her article ‘Why Psychiatry Is the Hardest Specialty’, Dew (2009) sketches the everyday difficulties of psychiatric practice. She writes, ‘Being a psychiatrist means dealing with ambiguity all the time … I go to work and listen to someone describe a vague uneasiness felt for a lifetime. Then after about 45 minutes I’m asked to assign it a name’ (p. 16). Of course, as Dew remarks, assigning a name to something does not make it true.
So far, we have been developing an enactive framework to address psychiatry’s integration problem. In Chapter 1, we looked at the integration problem and how models of psychiatric disorders could be useful. I argued that a useful framework should integrate all four main dimensions that are at stake in psychiatric disorders (experiential, physiological, sociocultural, and existential); showing how they relate.
There are already quite some models available for psychiatry. With so many on offer it is reasonable to ask if we really need yet another. Here I will briefly discuss several common and influential models and highlight their strengths and weaknesses. My aim here is not to provide comprehensive introductions to all of them; my only goal is to evaluate the available models with regard to their suitability to function as a general, integrative framework for psychiatric disorders.
Psychiatry is enormously complex. One of its main difficulties is to articulate the relationship between the wide assortment of factors that may cause or contribute to psychiatric disorders. Such factors range from traumatic experiences to dysfunctional neurotransmitters, existential worries, economic deprivation, social exclusion and genetic bad luck. The relevant factors and how they interact can differ not only between diagnoses but also between individuals with the same diagnosis. How should we understand and navigate such complexity? Enactive Psychiatry presents an integrative account of the many phenomena at play in the development and persistence of psychiatric disorders by drawing on insights from enactivism, a theory of embodied cognition. From the enactive perspective on the mind and its relation to both the body and the world, we can achieve a new understanding of the nature of psychiatric disorders and the causality involved in their development and treatment, thereby resolving psychiatry's integration problem.
Using regulatory data free of self-reporting bias for 2007–16, we decompose investment returns of 455 Dutch pension funds according to their key investment decisions, i.e., asset allocation, market timing and security selection. In extension to existing papers, we also assess the impact of benchmark selection. Over time, asset allocation explains 39% of the variation of returns, whereas benchmark selection, timing and selection explain 11%, 9% and 16%, respectively. Across pension funds, asset allocation explains on average only 19% of the variation in pension fund returns. Benchmark selection dominates this by explaining 33% of cross-sectional returns. We relate the choice for a specific benchmark to investment, risk and style preferences.
I am tasked with addressing philosophical hazards in the neuroscientific study of religion. As a philosopher concerned with the well-being of neuroscientists studying religion, I am inclined to begin with the philosophical hazards of philosophy. I am well aware of the extraordinary difficulties of both tasks, for the hazards are many and it is easy to miss the forest for the trees or the trees for the forest. Instead of focusing on one issue in great detail, I shall hang a number of warning signs around a forest of issues that identify various philosophical hazards which deserve particular caution when it comes to neuroscience and religion. Since I am aiming for breadth over depth, my brief remarks on each issue shall be synoptic, non-exhaustive, contentious and suggestive for additional consideration and reflection. To redress such deficits, I have provided references for further reading.1
There is increasing evidence that smoking is a risk factor for severe mental illness, including bipolar disorder. Conversely, patients with bipolar disorder might smoke more (often) as a result of the psychiatric disorder.
We conducted a bidirectional Mendelian randomisation (MR) study to investigate the direction and evidence for a causal nature of the relationship between smoking and bipolar disorder.
We used publicly available summary statistics from genome-wide association studies on bipolar disorder, smoking initiation, smoking heaviness, smoking cessation and lifetime smoking (i.e. a compound measure of heaviness, duration and cessation). We applied analytical methods with different, orthogonal assumptions to triangulate results, including inverse-variance weighted (IVW), MR-Egger, MR-Egger SIMEX, weighted-median, weighted-mode and Steiger-filtered analyses.
Across different methods of MR, consistent evidence was found for a positive effect of smoking on the odds of bipolar disorder (smoking initiation ORIVW = 1.46, 95% CI 1.28–1.66, P = 1.44 × 10−8, lifetime smoking ORIVW = 1.72, 95% CI 1.29–2.28, P = 1.8 × 10−4). The MR analyses of the effect of liability to bipolar disorder on smoking provided no clear evidence of a strong causal effect (smoking heaviness betaIVW = 0.028, 95% CI 0.003–0.053, P = 2.9 × 10−2).
These findings suggest that smoking initiation and lifetime smoking are likely to be a causal risk factor for developing bipolar disorder. We found some evidence that liability to bipolar disorder increased smoking heaviness. Given that smoking is a modifiable risk factor, these findings further support investment into smoking prevention and treatment in order to reduce mental health problems in future generations.
Declaration of interest
W.v.d.B received fees in the past 3 years from Indivior, C&A Pharma, Opiant and Angelini. G.M.G. is a National Institute for Health Research (NIHR) Emeritus Senior Investigator, holds shares in P1vital and has served as consultant, advisor or CME speaker in the past 3 years for Allergan, Angelini, Compass Pathways, MSD, Lundbeck (/Otsuka and /Takeda), Medscape, Minervra, P1Vital, Pfizer, Sage, Servier, Shire and Sun Pharma.
Gender differences in symptomatology in chronic schizophrenia and first episode psychosis patients have often been reported. However, little is known about gender differences in those at risk of psychotic disorders. This study investigated gender differences in symptomatology, drug use, comorbidity (i.e. substance use, affective and anxiety disorders) and global functioning in patients with an at-risk mental state (ARMS) for psychosis.
The sample consisted of 336 ARMS patients (159 women) from the prodromal work package of the EUropean network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI; 11 centers). Clinical symptoms, drug use, comorbidity and functioning were assessed at first presentation to an early detection center using structured interviews.
In unadjusted analyses, men were found to have significantly higher rates of negative symptoms and current cannabis use while women showed higher rates of general psychopathology and more often displayed comorbid affective and anxiety disorders. No gender differences were found for global functioning. The results generally did not change when corrected for possible cofounders (e.g. cannabis use). However, most differences did not withstand correction for multiple testing.
Findings indicate that gender differences in symptomatology and comorbidity in ARMS are similar to those seen in overt psychosis and in healthy controls. However, observed differences are small and would only be reliably detected in studies with high statistical power. Moreover, such small effects would likely not be clinically meaningful.