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The Hierarchical Taxonomy of Psychopathology (HiTOP) has emerged out of the quantitative approach to psychiatric nosology. This approach identifies psychopathology constructs based on patterns of co-variation among signs and symptoms. The initial HiTOP model, which was published in 2017, is based on a large literature that spans decades of research. HiTOP is a living model that undergoes revision as new data become available. Here we discuss advantages and practical considerations of using this system in psychiatric practice and research. We especially highlight limitations of HiTOP and ongoing efforts to address them. We describe differences and similarities between HiTOP and existing diagnostic systems. Next, we review the types of evidence that informed development of HiTOP, including populations in which it has been studied and data on its validity. The paper also describes how HiTOP can facilitate research on genetic and environmental causes of psychopathology as well as the search for neurobiologic mechanisms and novel treatments. Furthermore, we consider implications for public health programs and prevention of mental disorders. We also review data on clinical utility and illustrate clinical application of HiTOP. Importantly, the model is based on measures and practices that are already used widely in clinical settings. HiTOP offers a way to organize and formalize these techniques. This model already can contribute to progress in psychiatry and complement traditional nosologies. Moreover, HiTOP seeks to facilitate research on linkages between phenotypes and biological processes, which may enable construction of a system that encompasses both biomarkers and precise clinical description.
This article describes a clinical protocol for supporting those presenting with post-traumatic stress disorder (PTSD) and dissociative symptoms, particularly dissociative flashbacks, based on a cross-culturally applicable model. The protocol is discussed from the perspective of working with a refugee and asylum seeker population, although many of the principles will be applicable to clients from any background presenting with these dissociative symptoms. The protocol addresses the assessment and formulation of a client’s dissociative symptoms. It includes guidance on sharing psycho-education with clients regarding the evolutionary function of dissociation and developing practical strategies to monitor and manage dissociative symptoms. The strengths and limitations of this protocol are also discussed.
Key learning aims
After reading this article people will:
(1) Be able to understand a cross-culturally applicable model of dissociation and how it applies to clinical practice when working with clients presenting with dissociative symptoms, particularly dissociative flashbacks, in the context of a diagnosis of PTSD.
(2) Be able to assess and formulate dissociative symptoms as part of an overall PTSD formulation.
(3) Be able to develop practical strategies for assisting clients in monitoring and managing their dissociative symptoms.
(4) Be familiar with adaptations for using this approach with refugee and asylum seeker populations.
“In all candor, I just don't think much about Europe except in connection with a cut in our troop strength there.” So a “Senate leader” confessed to the New York Times in September 1969. His admission comes as no surprise to the student of Congress's role in shaping America's European policy from 1969 to 1990. In those years congressional opinion on Europe was marked by division and uncertainty; the unity of purpose that led Congress to play a decisive role in extricating America from Vietnam was nowhere to be seen. Many legislators did agree that a substantial reduction of American forces in Europe would benefit the American economy, and perhaps the NATO alliance as well. Yet even when strong sentiment prevailed, as on this issue, Congress was not able to unite on a statement expressing the body's will, let alone on legislation to see that will carried out. Legislators tended, in addition, to give very little attention to specifically German issues, and then only in the broader context of Western Europe and NATO. This disinterest stemmed largely from Congress's inability, from the late 1960s on, to discern what precisely the issues that affected Germany were. After Chancellor Willy Brandt's Ostpolitik relieved the atmosphere of crisis that had surrounded the German question, American legislators devoted less attention to Germany.
In studies of German-American relations, the role of the American Congress has received comparatively little attention. This comes as no surprise because even many legislators accepted the primacy of the executive in foreign policy until America's involvement in Vietnam provoked a reassertion of congressional prerogatives. A 1962 study of Congress's role in foreign policymaking concluded that legislative influence was “primarily (and increasingly) one of legitimating and amending policies initiated by the executive to deal with problems usually identified by the executive.” Or, in Robert Dahl's words, “the President proposes, the Congress disposes.”
Although America's policy toward Germany has tended to confirm Congress's deference to the White House, one cannot say that congressional leaders “shied away from foreign policy issues,” even if they did shy away from forcing policy changes. Legislators grappled with many of the most important issues in postwar German-American relations, and rarely could the president - or the government in Bonn - simply ignore congressional opinion. Understanding Congress's role is, therefore, vital to understanding the postwar German-American relationship.
As World War II drew to a close, Congress generally reflected the nation's attitudes toward Germany. Legislators were particularly interested in seeing that those responsible for war crimes be punished. Prior to Germany's collapse, the House Committee on Foreign Affairs considered resolutions defining American policy toward war criminals. Executive and legislature generally agreed on this important issue.
In order to empirically investigate the economic development process in rural areas, factors that are associated with the level and changes in employment must be conceptualized, operationalized and measured accurately. This symposium was organized to discuss the conceptualization, operationalization and measurement of these factors.
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