Philosophy of psychiatry: theoretical advances and clinical implications.

Work at the intersection of philosophy and psychiatry has an extensive and influential history, and has received increased attention recently, with the emergence of professional associations and a growing literature. In this paper, we review key advances in work on philosophy and psychiatry, and their related clinical implications. First, in understanding and categorizing mental disorder, both naturalist and normativist considerations are now viewed as important - psychiatric constructs necessitate a consideration of both facts and values. At a conceptual level, this integrative view encourages moving away from strict scientism to soft naturalism, while in clinical practice this facilitates both evidence-based and values-based mental health care. Second, in considering the nature of psychiatric science, there is now increasing emphasis on a pluralist approach, including ontological, explanatory and value pluralism. Conceptually, a pluralist approach acknowledges the multi-level causal interactions that give rise to psychopathology, while clinically it emphasizes the importance of a broad range of "difference-makers", as well as a consideration of "lived experience" in both research and practice. Third, in considering a range of questions about the brain-mind, and how both somatic and psychic factors contribute to the development and maintenance of mental disorders, conceptual and empirical work on embodied cognition provides an increasingly valuable approach. Viewing the brain-mind as embodied, embedded and enactive offers a conceptual approach to the mind-body problem that facilitates the clinical integration of advances in both cognitive-affective neuroscience and phenomenological psychopathology.

Heterotypic patterns, psychopathology beyond symptomatology, and the legacy constructs of the DSM-ICD.

This article extends the ideas expressed in a special section on theories of psychopathology by expounding on heterotypic patterns in which different arrangements of symptoms appear over time. With heterotypic continuity, the different arrangements are somewhat predictable; with discontinuity, they are not. Among the reasons the articles in the special section give for heterotypic patterns are the lack of central controllers for producing symptom clusters, the importance of transdiagnostic factors, and the dynamics of gene-environment correlations. The articles also consider what more there is to psychopathology than symptoms-largely by modeling normal, adaptive psychology as flexible and maladaptive psychology too rigid or too pliable. The articles espouse a variety of views on the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) legacy disorders moving forward, with some of them seeking to eliminate DSM-ICD categories from the classification of psychopathology and others seeing the DSM-ICD constructs as having continued roles to play. I use Lakatos' notion that elimination of a theory requires that an alternative theory demonstrate competitive superiority to account for why legacy constructs have not been eliminated. I examine a debate about the existence or not of basic emotions and apply it to psychopathology to identify a common ground or potential point of agreement between those who want to eliminate DSM-ICD categories and those who believe DSM-ICD constructs can continue to be useful moving forward. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Masturbatory insanity: the history of an idea, revisited.

In the eighteenth century, masturbation was extended from the moral to the medical sphere and conceptualized as being the cause of various deteriorative physical illnesses. In the nineteenth century, psychiatrists accepted that difficult to control masturbation was a feature of many mental disorders. They also believed that masturbation could play a casual role in a specific type of insanity with a distinctive natural history. In 1962, E.H. Hare published an article on the concept of masturbatory insanity that became an important explication of the masturbation and mental illness relationship in the history of psychiatry. Historical research published subsequent to Hare's article suggests several updates to his analysis. Hare did not note that the masturbation and mental illness relationship was promoted to the general public by quacks peddling quick cures. Hare emphasized psychiatrists' condemnatory language only, neglecting the aspiration of psychiatrists to treat disorders caused by excessive masturbation, not punish the sin of masturbation. Hare recognized the importance of hebephrenia and neurasthenia to this history but attributed the decline of masturbation related mental illness in part to the rejection of an irrational, unscientific hypotheses about masturbation's causal role. As an alternative, we suggest that before the causal role of masturbation was widely abandoned, the concepts of hebephrenia and neurasthenia gained a competitive advantage and became primary diagnoses for cases that once would have been conceptualized as masturbatory insanity.

Prolonged Grief Disorder and the DSM: A History.

ABSTRACT: In the early 1990s, a research group that included Holly Prigerson and Charles Reynolds established that disordered grief overlaps with depression and anxiety but is not the same. They also developed a research inventory for studying disordered grief. Subsequently, Prigerson focused on measuring disordered grief using advanced psychometric techniques. Because treatment for grief-related depression reduced symptoms of depression but not grief, Katherine Shear was recruited to develop a more effective therapy. Prigerson came to conceptualize disordered grief as prolonged grief that is associated with negative outcomes. Shear came to conceptualize disordered grief as intense grief that is complicated by features that interfere with adaption to the loss. In 2013 a hybrid disorder composed of criteria from both groups was placed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) appendix. Under the leadership of the DSM Steering Committee, a summit meeting in 2019 helped break an impasse, and a revised prolonged grief disorder became an official DSM diagnosis.

Revising Substance-Related Disorders in the DSM-5: A History.

OBJECTIVE: This article narrates a history of several important changes to the substance-related disorders chapter in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), based on interviews with people involved in the pre-planning and the development of the revisions. These changes include collapsing substance abuse and substance dependence into a single substance use disorder, adding craving as a diagnostic criterion, and incorporating a behavioral addiction--gambling disorder--into the substance-related disorders chapter. Studies using Item Response Theory (IRT) supported the new substance use disorder diagnosis. The IRT analyses demonstrated that the abuse and dependence items can be ordered on a single latent dimension and that some of the presumably milder abuse items indexed a greater level of severity than the presumably more pathological dependence items. Those who opposed collapsing abuse and dependence emphasized the validity and clinical utility of the dependence syndrome on which much important treatment research was based. Both those who favored and those who opposed adding craving agreed that it was redundant with the other diagnostic criteria and did not improve the performance of the criterion set. Nevertheless, some clinicians supported adding craving because of its importance in the conceptualization of substance use disorders, and some researchers supported it because of its potential to be validated as a diagnostically useful biomarker. Those who opposed adding craving argued that considering the validity of an individual criterion alone rather than its contribution to the incremental validity of the criterion set represented a major shift in diagnostic philosophy that had potentially far-reaching implications for future revisions of the DSM. CONCLUSIONS: We conclude by observing that, unlike what occurred in the broader DSM-5 process, despite differences of opinion the work group reached consensus. In part, this may be explained by some shared standards within the work group versus the disagreement about standards across the broader DSM-5 process.

The DSM-5 proposal for attenuated psychosis syndrome: a history.

This article narrates a consensus history of the proposal to include diagnostic criteria for a psychosis risk syndrome in the DSM-5, in part, to document what happened, but also to potentially help focus future efforts at clinically useful early detection. The purpose of diagnosing a risk state would be to slow and ideally prevent the development of the full disorder. Concerns about diagnosing a psychosis risk state included a high false positive rate, potentially harmful use of anti-psychotic medication with people who would not transition to psychosis, and stigmatization. Others argued that educating professionals about what 'risk' entails could reduce inappropriate treatments. During the revision, the proposal shifted from diagnosing risk to emphasizing current clinical need associated with attenuated psychotic symptoms. Within the community of researchers who studied psychosis risk, people disagreed about whether risk and/or attenuated symptoms should be an official DSM-5 diagnosis. Once it became clear that the DSM-5 field trials did not include enough cases to establish the reliability of the proposed criteria, everyone agreed that the criteria should be put in a section on conditions for further study rather the main section of the DSM-5. We close with recommendations about some practical benchmarks that should be met for including criteria for early detection in the classification system.

The Aspirations for a Paradigm Shift in DSM-5: An Oral History.

The initial plans for the DSM-5 revision envisioned a paradigm shift away from traditional diagnostic categories. However, plans for a major move from descriptive to etiologic diagnoses were quickly abandoned as infeasible. Support was much broader for adding dimensional/spectrum constructs to the categorical diagnoses, although this was interpreted in various ways. Delegation of substantial autonomy to work groups with modest central coordination was seen as problematic by some work groups and positively by others. Controversies emerged around the standards for diagnostic change, and the degree to which the same standards should be used across diagnostic groups. The Summit Group was given the final task of trying to forge a consensus among the various review groups. We conclude with thoughts about the difficulty of trying to revise an entire manual all at once and the desirability of developing clear rules for change at the outset of such a diagnostic project.

A novel human induced pluripotent stem cell blood-brain barrier model: Applicability to study antibody-triggered receptor-mediated transcytosis.

We have developed a renewable, scalable and transgene free human blood-brain barrier model, composed of brain endothelial cells (BECs), generated from human amniotic fluid derived induced pluripotent stem cells (AF-iPSC), which can also give rise to syngeneic neural cells of the neurovascular unit. These AF-iPSC-derived BECs (i-BEC) exhibited high transendothelial electrical resistance (up to 1500 Ω cm2) inducible by astrocyte-derived molecular cues and retinoic acid treatment, polarized expression of functional efflux transporters and receptor mediated transcytosis triggered by antibodies against specific receptors. In vitro human BBB models enable pre-clinical screening of central nervous system (CNS)-targeting drugs and are of particular importance for assessing species-specific/selective transport mechanisms. This i-BEC human BBB model discriminates species-selective antibody- mediated transcytosis mechanisms, is predictive of in vivo CNS exposure of rodent cross-reactive antibodies and can be implemented into pre-clinical CNS drug discovery and development processes.

Characterization of ion channels and O2 sensitivity in gill neuroepithelial cells of the anoxia-tolerant goldfish (Carassius auratus).

The neuroepithelial cell (NEC) of the fish gill is an important model for O2 sensing in vertebrates; however, a complete picture of the chemosensory mechanisms in NECs is lacking, and O2 chemoreception in vertebrates that are tolerant to anoxia has not yet been explored. Using whole cell patch-clamp recording, we characterized four types of ion channels in NECs isolated from the anoxia-tolerant goldfish. A Ca2+-dependent K+ current (IKCa) peaked at ~20 mV, was potentiated by increased intracellular Ca2+, and was reduced by 100 µM Cd2+ A voltage-dependent inward current in Ba2+ solution, with peak at 0 mV, confirmed the presence of Ca2+ channels. A voltage-dependent K+ current (IKV) was inhibited by 20 mM tetraethylammonium and 5 mM 4-aminopyridine, revealing a background K+ current (IKB) with open rectification. Mean resting membrane potential of -45.2 ± 11.6 mV did not change upon administration of hypoxia (Po2 = 11 mmHg), nor were any of the K+ currents sensitive to changes in Po2 during whole cell recording. By contrast, when the membrane and cytosol were left undisturbed during fura-2 or FM 1-43 imaging experiments, hypoxia increased intracellular Ca2+ concentration and initiated synaptic vesicle activity. 100 µM Cd2+ and 50 µM nifedipine eliminated uptake of FM 1-43. We conclude that Ca2+ influx via L-type Ca2+ channels is correlated with vesicular activity during hypoxic stimulation. In addition, we suggest that expression of IKCa in gill NECs is species specific and, in goldfish, may contribute to an attenuated response to acute hypoxia.NEW & NOTEWORTHY This study provides the first physiological characterization of oxygen chemoreceptors from an anoxia-tolerant vertebrate. Neuroepithelial cells (NECs) from the gills of goldfish displayed L-type Ca2+ channels and three types of K+ channels, one of which was dependent upon intracellular Ca2+ Although membrane currents were not inhibited by hypoxia during patch-clamp recording, this study is the first to show that NECs with an undisturbed cytosol responded to hypoxia with increased intracellular Ca2+ and synaptic vesicle activity.

The Philosophy of Nosology.

Many scholars believe that psychiatric nosology is undergoing a crisis of confidence. Some of the issues up for debate hark back to the introduction of the natural history approach to classification in the seventeenth century. Natural histories map sameness and difference rather than speculate about causes. In contrast, the natural classification approach aspires to carve nature at the joints by demarcating classifications by causes. Natural classifications are more ideal scientifically, but speculation about causality has had a poor track record in psychiatric nosology. A natural classification of psychiatric disorders may have the added burden of requiring normative assumptions in addition to the discovery of fact. In the natural classification tradition, the epistemic iteration perspective, the Research Domain Criteria (RDoC) initiative, and dimensional models offer different views about the criteria of naturalness (or validity). Also in this tradition, some thinkers believe that causes can be empirically indexed by latent variable models, especially if the latent variables are moderately heritable, but these assumptions may be neither statistically nor genetically warranted.

Distribution and morphology of cholinergic cells in the branchial epithelium of zebrafish (Danio rerio).

Acetylcholine is an excitatory neurotransmitter important for oxygen sensing in mammals. A cholinergic mechanism in the fish gill has been implicated in the hyperventilatory response to acute hypoxia; however, the identity and distribution of acetylcholine-containing cells in the gills is poorly defined. We test the hypothesis that cholinergic cells are present in the gill filament epithelium in zebrafish (Danio rerio), a model vertebrate for which oxygen chemoreceptors are well characterized, and that these cells would receive nervous innervation. Using immunohistochemistry and confocal microscopy, we observed 10.2 ± 0.6 cells immunoreactive for the vesicular acetylcholine transporter (VAChT) on the efferent aspect of each gill filament, where a high density of serotonergic oxygen-sensitive neuroepithelial cells (NECs) were located. VAChT-positive cells of the efferent epithelium were positioned within 10 µm of NECs. On the afferent aspect of the gill filaments, VAChT-positive cells were greater in number (30.8 ± 3.1 per filament). On the efferent and afferent filament aspects, VAChT-positive cells did not contain serotonin, but did express choline acetyltransferase (ChAT), the enzyme that synthesizes ACh, and were often closely apposed to nerve fibers labeled with the neuronal marker, zn-12. We conclude that cholinergic cells in the zebrafish gills were present in the primary epithelium of gill filaments, and formed contacts with nerve fibers. These studies provide morphological evidence for the presence of a cholinergic system in the zebrafish gill. Such a pathway may contribute to the reflex hyperventilatory response during hypoxia.

Grief, depression, and the DSM-5: a review and reflections upon the debate / Luto, depressão e o DSM-5: uma revisão e reflexões sobre o debate / Deuil, dépression et le DSM-5: révision et réflexions sur le débat / El duelo, la depresión y el DSM-5: una revisión y reflexiones acerca del debate

Every side in the debate about eliminating or retaining the bereavement exclusion for diagnosing major depressive disorder agreed that the DSM-IV was inconsistent. It exempted symptoms of depression from a depressive disorder diagnosis if they were a response to the loss of a loved one, but diagnosed depression symptoms in response to any other kind of loss or stress as a disorder. The participants in the debate did not agree how to resolve the inconsistency — eliminate the exemption for bereavement, leave it in place, or extend it to all cases with loss & stress-triggered depression symptoms. The difference between how the debate was presented to the general public and the issues debated in the scientific literature is described, as are the facts upon which the various sides readily agreed. Scientific research that casts doubt upon some common assumptions about the psychology of grieving is also reviewed. The article concludes by taking note of both the scientific-empirical and metaphysical facets of the debate, and suggests a pragmatic, verbal solution for one of the metaphysical facets.

Todos os lados envolvidos no debate sobre a eliminação ou a manutenção do luto como critério de exclusão para o diagnóstico do transtorno depressivo concordavam que o DSM-IV era inconsistente. Nele, sintomas de depressão não contavam para o diagnóstico de um transtorno depressivo se fossem resposta à perda de uma pessoa amada, mas sim em relação a quaisquer outros tipos de perda ou estresse. Os participantes no debate não chegaram a um acordo sobre como resolver a inconsistência — eliminar a cláusula de exceção do luto, mantê-la ou estendê-la a todos os casos com sintomas depressivos precipitados por perda ou estresse. A diferença entre como o debate foi apresentado ao público geral e como os tópicos foram debatidos na literatura científica é descrita, assim como os fatos sobre os quais os vários lados prontamente concordaram. Estudo científico que lança dúvida sobre pressupostos comuns acerca da psicologia do sofrimento do luto também é examinado. Em sua conclusão, o artigo aponta tanto os aspectos científico-empíricos como as facetas metafísicas do debate, e sugere uma solução pragmática e verbal para uma dessas facetas metafísicas.

Toutes les parties qui ont participé au débat sur l’élimination ou le maintien du deuil comme critère d’exclusion pour le diagnostic du trouble de la dépression étaient d’accord sur le fait que le DSM-IV était inconsistant, étant donné qu’il n’acceptait pas les symptômes de la dépression liés à la perte d’un proche, mais uniquement ceux liés à tout autre genre de perte ou de stress. Les participants du débat ne se sont pas mis d’accord sur la façon de résoudre l’inconsistance — éliminer l’exception du deuil, la conserver tel quel, ou l’étendre à tous les cas montrant des symptômes de dépression déclenchés par une perte ou par le stress. Cet article décrit la différence entre la façon dont le débat a été présenté au public et les questions discutées par la littérature scientifique, ainsi que les faits sur lesquels les différentes parties se sont mises d’accord. On examine également la recherche scientifique qui met en doute les suppositions courantes sur la psychologie du deuil. Pour conclure, nous mettons en relief les aspects scientifiques-empiriques et les facettes métaphysiques du débat et suggérons une solution pragmatique et verbale pour l’une de ces facettes métaphysiques.

Todas las partes en el debate acerca de la eliminación o mantenimiento del duelo como criterio de exclusión para el diagnóstico de trastorno depresivo estaban de acuerdo en que el DSM-IV era inconsistente. En él, los síntomas de depresión no contaban para el diagnóstico de un trastorno depresivo si fueran una respuesta a la pérdida de un ser querido, pero se diagnosticaban como trastorno los síntomas depresivos en respuesta a cualquier otra pérdida o el estrés. Los participantes en el debate no estaban de acuerdo sobre la forma de resolver la inconsistencia — eliminar la cláusula de excepción del duelo, mantenerla como estaba, o extenderla a todos los casos con síntomas depresivos precipitados por la pérdida o el estrés. La diferencia entre cómo el debate fue presentado al público general y cómo se trataron los temas de la literatura científica se describe, así como los hechos en que las diversas partes se pusieran de acuerdo fácilmente. El estudio científico que pone en duda los supuestos comunes acerca de la psicología del duelo también se examina. En su conclusión, el artículo señala tanto los aspectos científicos y empíricos como los aspectos metafísicos del debate, y sugiere una solución pragmática y verbal a uno de estos aspectos metafísicos.

Grief, depression, and the DSM-5: a review and reflections upon the debate / Luto, depressão e o DSM-5: uma revisão e reflexões sobre o debate / Deuil, dépression et le DSM-5: révision et réflexions sur le débat / El duelo, la depresión y el DSM-5: una revisión y reflexiones acerca del debate

Every side in the debate about eliminating or retaining the bereavement exclusion for diagnosing major depressive disorder agreed that the DSM-IV was inconsistent. It exempted symptoms of depression from a depressive disorder diagnosis if they were a response to the loss of a loved one, but diagnosed depression symptoms in response to any other kind of loss or stress as a disorder. The participants in the debate did not agree how to resolve the inconsistency — eliminate the exemption for bereavement, leave it in place, or extend it to all cases with loss & stress-triggered depression symptoms. The difference between how the debate was presented to the general public and the issues debated in the scientific literature is described, as are the facts upon which the various sides readily agreed. Scientific research that casts doubt upon some common assumptions about the psychology of grieving is also reviewed. The article concludes by taking note of both the scientific-empirical and metaphysical facets of the debate, and suggests a pragmatic, verbal solution for one of the metaphysical facets.(AU)

Todos os lados envolvidos no debate sobre a eliminação ou a manutenção do luto como critério de exclusão para o diagnóstico do transtorno depressivo concordavam que o DSM-IV era inconsistente. Nele, sintomas de depressão não contavam para o diagnóstico de um transtorno depressivo se fossem resposta à perda de uma pessoa amada, mas sim em relação a quaisquer outros tipos de perda ou estresse. Os participantes no debate não chegaram a um acordo sobre como resolver a inconsistência — eliminar a cláusula de exceção do luto, mantê-la ou estendê-la a todos os casos com sintomas depressivos precipitados por perda ou estresse. A diferença entre como o debate foi apresentado ao público geral e como os tópicos foram debatidos na literatura científica é descrita, assim como os fatos sobre os quais os vários lados prontamente concordaram. Estudo científico que lança dúvida sobre pressupostos comuns acerca da psicologia do sofrimento do luto também é examinado. Em sua conclusão, o artigo aponta tanto os aspectos científico-empíricos como as facetas metafísicas do debate, e sugere uma solução pragmática e verbal para uma dessas facetas metafísicas.(AU)

Toutes les parties qui ont participé au débat sur l’élimination ou le maintien du deuil comme critère d’exclusion pour le diagnostic du trouble de la dépression étaient d’accord sur le fait que le DSM-IV était inconsistant, étant donné qu’il n’acceptait pas les symptômes de la dépression liés à la perte d’un proche, mais uniquement ceux liés à tout autre genre de perte ou de stress. Les participants du débat ne se sont pas mis d’accord sur la façon de résoudre l’inconsistance — éliminer l’exception du deuil, la conserver tel quel, ou l’étendre à tous les cas montrant des symptômes de dépression déclenchés par une perte ou par le stress. Cet article décrit la différence entre la façon dont le débat a été présenté au public et les questions discutées par la littérature scientifique, ainsi que les faits sur lesquels les différentes parties se sont mises d’accord. On examine également la recherche scientifique qui met en doute les suppositions courantes sur la psychologie du deuil. Pour conclure, nous mettons en relief les aspects scientifiques-empiriques et les facettes métaphysiques du débat et suggérons une solution pragmatique et verbale pour l’une de ces facettes métaphysiques.(AU)

Todas las partes en el debate acerca de la eliminación o mantenimiento del duelo como criterio de exclusión para el diagnóstico de trastorno depresivo estaban de acuerdo en que el DSM-IV era inconsistente. En él, los síntomas de depresión no contaban para el diagnóstico de un trastorno depresivo si fueran una respuesta a la pérdida de un ser querido, pero se diagnosticaban como trastorno los síntomas depresivos en respuesta a cualquier otra pérdida o el estrés. Los participantes en el debate no estaban de acuerdo sobre la forma de resolver la inconsistencia — eliminar la cláusula de excepción del duelo, mantenerla como estaba, o extenderla a todos los casos con síntomas depresivos precipitados por la pérdida o el estrés. La diferencia entre cómo el debate fue presentado al público general y cómo se trataron los temas de la literatura científica se describe, así como los hechos en que las diversas partes se pusieran de acuerdo fácilmente. El estudio científico que pone en duda los supuestos comunes acerca de la psicología del duelo también se examina. En su conclusión, el artículo señala tanto los aspectos científicos y empíricos como los aspectos metafísicos del debate, y sugiere una solución pragmática y verbal a uno de estos aspectos metafísicos.(AU)

Transitioning to a dimensional model of personality disorder in DSM 5.1 and beyond.

PURPOSE OF REVIEW: To propose options for gradually transitioning to a thoroughgoing dimensional model of personality disorder. RECENT FINDINGS: The American Psychiatric Association was less willing to implement a dimensional approach to the diagnosis of personality disorder than the leadership of the DSM-5 anticipated. The next opportunity to implement such an approach will be in the ICD-11 and the DSM 5.1. SUMMARY: Instead of seeking a revolutionary change, attempting a more gradual transition that leads to something significantly better in the long run is likely to be more successful. For the long run, in addition to clinical utility and scientific validity, new diagnostic models must possess user acceptability. Professionals will be more likely to accept a new model if they believe it will allow them to do good work. Competent use of a dimensional model is not only a matter of increased familiarity with personality trait profiles, it requires a different kind of clinical expertise.

Peripheral chemoreceptors in fish: A brief history and a look ahead.

The story of control of cardiorespiratory reflexes by peripheral chemoreceptors includes a chapter on evolution in large part because of the work of Prof. William K. Milsom. Bill has reminded us to think comparatively about O2 and CO2/H(+) sensing. We present a brief review of the fish gill and O2 chemoreceptors, as well as recent results from our laboratory, that were discussed at a symposium in honour of Prof. Milsom's extensive career. In a series of papers from the Milsom laboratory from 1986 to 1995, it was demonstrated that the fish gill is a major site of chemosensory discharge during hypoxia, and that this response is sensitive to multiple neurochemicals involved in chemosensing. These and other more recent studies by Bill et al. are now fundamental and have helped to shape the field as it is today. At the cellular level, we have shown that chemosensitive neuroepithelial cells (NECs) of the gills may possess unique adaptations compared to their mammalian homologues. In addition, we used injection of the styryl dye, FM1-43, to identify gill NECs in zebrafish and demonstrate increased vesicular activity in NECs in vitro during acute stimulation. In vivo, we have identified 5-HT2, 5-HT3, dopaminergic and nicotinic receptor activity involved in the hyperventilatory response in developing zebrafish. With this model we have also traced the fate of mitotic cells in the gills, and demonstrated the regeneration of resected gill filaments and replacement of O2-sensitive NECs.

A diagnostic and statistical manual of mental disorders history of premenstrual dysphoric disorder.

The proposals to include a menstruation-related mood disorder in the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R), and DSM-IV led to intense public and behind-the-scenes controversy. Although the controversies surrounding the DSM-5 revision were greater in number than the controversies of the earlier revisions, the DSM-5 proposal to include a menstruation-related mood disorder was not among them. Premenstrual dysphoric disorder was made an official disorder in the DSM-5 with no significant protest. To understand the factors that led to this change, we interviewed those psychiatrists and psychologists who were most involved in the DSM-IV revision. On the basis of these interviews, we offer a list of empirical and nonempirical considerations that led to the DSM-IV compromise and explore how key alterations in these considerations led to a different outcome for the DSM-5.

Critical slowing down as early warning for the onset and termination of depression.

About 17% of humanity goes through an episode of major depression at some point in their lifetime. Despite the enormous societal costs of this incapacitating disorder, it is largely unknown how the likelihood of falling into a depressive episode can be assessed. Here, we show for a large group of healthy individuals and patients that the probability of an upcoming shift between a depressed and a normal state is related to elevated temporal autocorrelation, variance, and correlation between emotions in fluctuations of autorecorded emotions. These are indicators of the general phenomenon of critical slowing down, which is expected to occur when a system approaches a tipping point. Our results support the hypothesis that mood may have alternative stable states separated by tipping points, and suggest an approach for assessing the likelihood of transitions into and out of depression.