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Increasingly, students with intellectual disabilities (ID) in the United States are overcoming historical barriers to accessing traditionally exclusionary higher education. These gains undoubtedly represent a hard-fought victory for the broader disability rights movement. However, this advance has not come through enforcing the civil rights and non-discrimination statutes that generated disability rights victories in other areas or the disability-specific education laws that promoted access to primary and secondary schooling. Instead, many students with ID are accessing higher education opportunities through specialised programmes, often styled as ‘inclusive’ despite their segregated nature. Such programmes present new arenas for familiar forms of disability-based discrimination to once more manifest — such as suspect admissions criteria, second-class status and biased disciplinary procedures. Thus, despite the proliferation of inclusive post-secondary programmes, there remains an urgent social need to address barriers to full and effective participation in higher education that students with ID continue to face when navigating university and college campuses.
Long perceived as sexually aberrant, persons with disabilities have made headway in recent years breaking down societal and attitudinal barriers that exclude many from leading sexually active lives. This progress has been uneven, often depending on a person’s type of disability. For example, evolving societal attitudes support the equal right of persons with physical disabilities to sexual intimacy, even if the means by which to fulfill this right (e.g., accessible social clubs) remain elusive. By contrast, persons with intellectual disabilities seeking volitional sex still face multitudinous attitudinal barriers.
The troika of chapters in this Part demonstrates, in dissimilar contexts and in varied ways, the deleterious effects of clumsily applying, misconstruing, or violating disability-based civil rights laws. Underlying and uniting the three chapters is the impact of misunderstanding disability as an identity category and a subject of normative social justice. Stated more in line with the book’s theme and its Introduction, these contributions highlight some of the real-world manifestations of viewing disability as deficit rather than as difference.
Protecting patients with disabilities against discrimination in the provision of healthcare, especially violations of their civil or human rights, requires an understanding of the common biases that undermine equal treatment in clinical, diagnostic, and therapeutic contexts. Nevertheless, this topic is rarely acknowledged in legal or social scientific studies of bias in healthcare decision-making. Consequently, prejudices against persons with disabilities – “ableism” – in these settings remain prevalent and unaddressed.
The aim of the current study was to explore the changing interrelationships among clinical variables through the stages of schizophrenia in order to assemble a comprehensive and meaningful disease model.
Twenty-nine centers from 25 countries participated and included 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Multiple linear regression analysis and visual inspection of plots were performed.
The results suggest that with progression stages, there are changing correlations among Positive and Negative Syndrome Scale factors at each stage and each factor correlates with all the others in that particular stage, in which this factor is dominant. This internal structure further supports the validity of an already proposed four stages model, with positive symptoms dominating the first stage, excitement/hostility the second, depression the third, and neurocognitive decline the last stage.
The current study investigated the mental organization and functioning in patients with schizophrenia in relation to different stages of illness progression. It revealed two distinct “cores” of schizophrenia, the “Positive” and the “Negative,” while neurocognitive decline escalates during the later stages. Future research should focus on the therapeutic implications of such a model. Stopping the progress of the illness could demand to stop the succession of stages. This could be achieved not only by both halting the triggering effect of positive and negative symptoms, but also by stopping the sensitization effect on the neural pathways responsible for the development of hostility, excitement, anxiety, and depression as well as the deleterious effect on neural networks responsible for neurocognition.
Historically and across societies people with disabilities have been stigmatized and excluded from social opportunities on a variety of culturally specific grounds. In this collection, the authors explore the impact that the philosophical framing of disability can have on public policy questions, in the clinic, in the courtroom, and elsewhere. They examine the implications of this understanding for legal and policy approaches to disability, strategies for allocating and accessing health care, the implementation of the Americans with Disabilities Act, health care rights, and other legal tools designed to address discrimination. This volume should be read by anyone seeking a balanced view of disability and an understanding of the connection between the framing of disability and policies that have a real-world impact on individuals.
The aim of this paper was to provide a systematic review and update on the pharmacotherapy of social anxiety disorder (SAD), including the efficacy and tolerability of these agents, the ranking of interventions, and the grading of results by quality of evidence.
The Common Mental Disorder Controlled Trial Register and two trial registries were searched for randomised controlled trials (RCTs) comparing any pharmacological intervention or placebo in the treatment of SAD. We performed a standard pairwise meta-analysis using a random effects model and carried out a network meta-analysis (NMA) using the statistical package, R. Quality of evidence was also assessed.
We included 67 RCTs in the review and 21 to 45 interventions in the NMA. Paroxetine was most effective in the reduction of symptom severity as compared to placebo. Superior response to treatment was also observed for paroxetine, brofaromine, bromazepam, clonazepam, escitalopram, fluvoxamine, phenelzine, and sertraline. Higher dropout rates were found for fluvoxamine. Brofaromine, escitalopram, fluvoxamine, paroxetine, pregabalin, sertraline, and venlafaxine performed worse in comparison to placebo for the outcome of dropouts due to adverse events. Olanzapine yielded a relatively high rank for treatment efficacy and buspirone the worse rank for dropouts due to any cause.
The differences between drugs and placebo were small, apart from a significant reduction in symptom severity and response for paroxetine. We suggest paroxetine as a first-line treatment of SAD, with the consideration of future research on the drug olanzapine as well as brofaromine, bromazepam, clonazepam, escitalopram, fluvoxamine, phenelzine, and sertraline because we observed a response to treatment.
Aristotle argued that there are no true statements of the form <Fx and not-Fx>. In his lectures on history of philosophy Hegel does not challenge this view and in his Science of Logic expresses admiration for Aristotle's rebuttal of Zeno of Elea's attempt to find such contradictions in his paradoxes of motion. Yet more than once in his logics Hegel insists that everything is contradictory. I approach this problem from two directions. First, Widerspruch often means, and is understood by Hegel to mean, ‘opposition’ rather than ‘contradiction’ in the strict logical sense. Thus Catullus's simultaneous love and hatred of Clodia is a contradiction, but not an Aristotelian, or formal logical, contradiction. I defuse Hegel's occasional suggestions of Aristotelian contradictions in motion and time. Second, I exploit Hegel's tacit rejection of Aristotle's official bivalence account of truth and falsity, in favour of the view that truth is approached by successive improvements in our inevitably imperfect attempts to attain it. In this respect Hegel's procedure is similar to that of Aristotle himself, who characteristically constructs his own view of metaphysics, physics, ethics, etc., from the imperfect, but not flatly false, opinions of his predecessors. ‘The truth is the whole’, that is, the whole sequence of our attempts to reach it.
Bipolar disorder (BD) and obsessive compulsive disorder (OCD) are prevalent, comorbid, and disabling conditions, often characterized by early onset and chronic course. When comorbid, OCD and BD can determine a more pernicious course of illness, posing therapeutic challenges for clinicians. Available reports on prevalence and clinical characteristics of comorbidity between BD and OCD showed mixed results, likely depending on the primary diagnosis of analyzed samples.
We assessed prevalence and clinical characteristics of BD comorbidity in a large international sample of patients with primary OCD (n = 401), through the International College of Obsessive–Compulsive Spectrum Disorders (ICOCS) snapshot database, by comparing OCD subjects with vs without BD comorbidity.
Among primary OCD patients, 6.2% showed comorbidity with BD. OCD patients with vs without BD comorbidity more frequently had a previous hospitalization (p < 0.001) and current augmentation therapies (p < 0.001). They also showed greater severity of OCD (p < 0.001), as measured by the Yale–Brown Obsessive Compulsive Scale (Y-BOCS).
These findings from a large international sample indicate that approximately 1 out of 16 patients with primary OCD may additionally have BD comorbidity along with other specific clinical characteristics, including more frequent previous hospitalizations, more complex therapeutic regimens, and a greater severity of OCD. Prospective international studies are needed to confirm our findings.