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Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
Among 353 healthcare personnel in a longitudinal cohort in 4 hospitals in Atlanta, Georgia (May–June 2020), 23 (6.5%) had severe acute respiratory coronavirus virus 2 (SARS-CoV-2) antibodies. Spending >50% of a typical shift at the bedside (OR, 3.4; 95% CI, 1.2–10.5) and black race (OR, 8.4; 95% CI, 2.7–27.4) were associated with SARS-CoV-2 seropositivity.
Recently, artificial intelligence-powered devices have been put forward as potentially powerful tools for the improvement of mental healthcare. An important question is how these devices impact the physician-patient interaction.
Aifred is an artificial intelligence-powered clinical decision support system (CDSS) for the treatment of major depression. Here, we explore the use of a simulation centre environment in evaluating the usability of Aifred, particularly its impact on the physician–patient interaction.
Twenty psychiatry and family medicine attending staff and residents were recruited to complete a 2.5-h study at a clinical interaction simulation centre with standardised patients. Each physician had the option of using the CDSS to inform their treatment choice in three 10-min clinical scenarios with standardised patients portraying mild, moderate and severe episodes of major depression. Feasibility and acceptability data were collected through self-report questionnaires, scenario observations, interviews and standardised patient feedback.
All 20 participants completed the study. Initial results indicate that the tool was acceptable to clinicians and feasible for use during clinical encounters. Clinicians indicated a willingness to use the tool in real clinical practice, a significant degree of trust in the system's predictions to assist with treatment selection, and reported that the tool helped increase patient understanding of and trust in treatment. The simulation environment allowed for the evaluation of the tool's impact on the physician–patient interaction.
The simulation centre allowed for direct observations of clinician use and impact of the tool on the clinician–patient interaction before clinical studies. It may therefore offer a useful and important environment in the early testing of new technological tools. The present results will inform further tool development and clinician training materials.
Neo-Kantian philosophers see accountability as a key property of autonomy, or of social freedom more broadly. Autonomy, among those theorists, is, I contend, implicitly co-conceived with responsibility, producing a quasi-juridical conception of autonomy and a limiting notion of freedom. This article criticizes the connecting of freedom with accountability on a number of grounds. First, various conceptions of autonomy not only operate without a notion of accountability, but, in fact, would be impaired by an accountability requirement. Second, the neo-Kantians are unable to defend the freedom enhancing properties that are supposedly brought about by the giving of reasons for one’s beliefs and actions. Third, the project of accountability is indifferent to personal outlooks, not because it takes a holistic perspective, but because of its interest in social convergence.
Must we ascribe hope for better times to those who (take themselves to) act morally? Kant and later theorists in the Frankfurt School tradition thought we must. In this article, I disclose that it is possible – and ethical – to refrain from ascribing hope in all such cases. I draw on two key examples of acting irrespective of hope: one from a recent political context and one from the life of Jean Améry. I also suggest that, once we see that it is possible to make sense of (what I call) ‘merely expressive acts’, we can also see that the early Frankfurt School was not guilty of a performative contradiction in seeking to enlighten Enlightenment about its (self-)destructive tendencies, while rejecting the (providential) idea of progress.
Jürgen Habermas’ discourse theory of morality should be understood, in metaethical terms, as a constructivist theory. All constructivist theories face a Euthyphro-like dilemma arising from how they classify the constraints on their metaethical construction procedures: are they moral or non-moral? Many varieties of Kantian constructivism, such as Christine Korsgaard’s, classify the constraints as moral, albeit constitutive of human reason and agency in general. However, this constitutivist strategy is vulnerable to David Enoch’s ‘shmagency’ objection. The discourse theory of morality, by classifying the constraints on the metaethical construction procedure (principles (D) and (U)) as non-moral, can avoid this problem.
Theodor W. Adorno often made reference to Immanuel Kant’s famous essay on enlightenment. Although he denied that immaturity is self-incurred, the first section of this article will show that he adopted many of Kant’s ideas about maturity in his philosophically informed critique of monopoly conditions under late capitalism. The second section will explore Adorno’s claim that the educational system could foster maturity by encouraging critical reflection on the social conditions that have made us what we are. Finally, this article will demonstrate that Adorno links enlightenment to Kant’s idea of a realm of ends.
Many recent commentators have noticed how Adorno, in his late works, borrows Kant’s definition of enlightenment to define key areas of his own critical practice. These discussions, however, have failed to notice how these late borrowings present an image of Kant’s enlightenment which is diametrically opposed to his previous discussions. By tracing the development of Adorno’s engagement with Kant’s essay, I discover Adorno deliberately sublating Kant’s definition as to enable its incorporation into his own works. Further, the article will examine some problems which appear to arise for Adorno when borrowing Kant’s definition of enlightenment in his late works, which coalesce around the topics of negativism and the prospects for societal change.
In this article I press four different objections on Forst’s theory of the ‘Right to Justification’. These are (i) that the principle of justification is not well-formulated; (ii) that ‘reasonableness and reciprocity’, as these notions are used by Rawls, are not apt to support a Kantian conception of morality; (iii) that the principle of justification, as Forst understands it, gives an inadequate account of what makes actions wrong; and (iv) that, in spite of his protestations to the contrary, Forst’s account veers towards a version of moral realism that is prima facie incompatible with Kantian constructivism. I then evaluate Forst’s theory in the light of a distinction made by Sharon Street between restricted and unrestricted constructivism. I show that Forst has reason to deny that it is either the one or the other, but he is not able to show that it is both or neither. I conclude that the arguments Forst advances in support of his constructivist theory of the right to justification entail that it is a metaphysical and comprehensive conception in the relevant, Rawlsian sense. Forst’s theory of the right to justification therefore fails to fulfil one of the main stated aims.
In a lecture that Habermas gave on his 90th birthday he ironically, but with serious intent, called a good Kant a sufficiently Marxist educated Kant. This dialectical Kant is the only one of the many Kants who maintains the idea of an unconditioned moral autonomy but completely within evolution, history and in the middle of societal class and other struggles. The article tries to show what Kant could have learned from his later critics to enable him to become a member of the Frankfurt School’s neo-Marxist theory of society.
Habermas dialogically recasts the Kantian conception of moral autonomy. In a legal-political context, his dialogical approach has the potential to redress certain troubling features of liberal and communitarian approaches to democratic politics. Liberal approaches attach greater normative weight to negatively construed individual freedoms, which they seek to protect against the interventions of political authority. Communitarian approaches prioritize the positively construed freedoms of communal political participation, viewing legal-political institutions as a means for collective ethical self-realization. Habermas’ discourse theory of law and democracy seeks to overcome this competition between the negative and positive liberties. Doing so entails reconciling private and public autonomy at a fundamental conceptual level. This is his co-originality thesis, which seeks to show that private and public autonomy are internally connected and evenly balanced. I support his aim but argue that he fails to achieve it due to an unsatisfactory account of private autonomy. I suggest an alternative dialogical conception of autonomy as ethically self-determining agency that would enable him to establish his thesis.
This study investigated subjective memory complaints in older adults and the roles of setting, response bias, and personality.
Cognitively normal older adults from two settings completed questionnaires measuring memory complaints, response bias, and personality.
(A) Neuroimaging study with community-based recruitment and (B) academic memory clinic.
Cognitively normal older adults who (A) volunteer for research (N = 92) or (B) self-referred to a memory clinic (N = 20).
Neuropsychological evaluation and adjudication of normal cognitive status were done by the neuroimaging study or memory clinic. This study administered self-reports of subjective memory complaints, response bias, five-factor personality, and depressive symptoms. Primary group differences were examined with secondary sensitivity analyses to control for sex, age, and education differences.
There was no significant difference in over-reporting response bias between study settings. Under-reporting response bias was higher in volunteers. Cognitive complaints were associated with response bias for two cognitive complaint measures. Neuroticism was positively associated with over-reporting in evaluation-seekers and negatively associated with under-reporting in volunteers. The relationship was reversed for Extraversion. Under-reporting bias was positively correlated with Agreeableness and Conscientiousness in volunteers.
Evaluation-seekers do not show bias toward over-reporting symptoms compared to volunteers. Under-reporting response bias may be important to consider when screening for memory impairment in non-help-seeking settings. The Memory Functioning Questionnaire was less sensitive to reporting biases. Over-reporting may be a facet of higher Neuroticism. Findings help elucidate psychological influences on self-perceived cognitive decline and help seeking in aging and may inform different strategies for assessment by setting.
To characterize the prevalence of and seasonal and regional variation in inpatient antibiotic use among hospitalized US children in 2017–2018.
We conducted a cross-sectional examination of hospitalized children. The assessments were conducted on a single day in spring (May 3, 2017), summer (August 2, 2017), fall (October 25, 2017), and winter (January 31, 2018). The main outcome of interest was receipt of an antibiotic on the study day.
The study included 51 freestanding US children’s hospitals that participate in the Pediatric Health Information System (PHIS).
This study included all patients <18 years old who were admitted to a participating PHIS hospital, excluding patients who were admitted solely for research purposes.
Of 52,769 total hospitalized children, 19,174 (36.3%) received antibiotics on the study day and 6,575 of these (12.5%) received broad-spectrum antibiotics. The overall prevalence of antibiotic use varied across hospitals from 22.3% to 51.9%. Antibiotic use prevalence was 29.2% among medical patients and 47.7% among surgical patients. Although there was no significant seasonal variation in antibiotic use prevalence, regional prevalence varied, ranging from 32.7% in the Midwest to 40.2% in the West (P < .001). Among units, pediatric intensive care unit patients had the highest prevalence of both overall and broad-spectrum antibiotic use at 58.3% and 26.6%, respectively (P < .001).
On any given day in a national network of children’s hospitals, more than one-third of hospitalized children received an antibiotic, and 1 in 8 received a broad-spectrum antibiotic. Variation across hospitals, setting and regions identifies potential opportunities for enhanced antibiotic stewardship activities.
UK Biobank is a well-characterised cohort of over 500 000 participants including genetics, environmental data and imaging. An online mental health questionnaire was designed for UK Biobank participants to expand its potential.
Describe the development, implementation and results of this questionnaire.
An expert working group designed the questionnaire, using established measures where possible, and consulting a patient group. Operational criteria were agreed for defining likely disorder and risk states, including lifetime depression, mania/hypomania, generalised anxiety disorder, unusual experiences and self-harm, and current post-traumatic stress and hazardous/harmful alcohol use.
A total of 157 366 completed online questionnaires were available by August 2017. Participants were aged 45–82 (53% were ≥65 years) and 57% women. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status. Lifetime depression was a common finding, with 24% (37 434) of participants meeting criteria and current hazardous/harmful alcohol use criteria were met by 21% (32 602), whereas other criteria were met by less than 8% of the participants. There was extensive comorbidity among the syndromes. Mental disorders were associated with a high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
The UK Biobank questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed because of selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.