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What is Intermittent Explosive Disorder?

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Introduction

Intermittent explosive disorder (sometimes abbreviated as IED) is a behavioural disorder characterised by explosive outbursts of anger and/or violence, often to the point of rage, that are disproportionate to the situation at hand (e.g. impulsive shouting, screaming or excessive reprimanding triggered by relatively inconsequential events). Impulsive aggression is not premeditated, and is defined by a disproportionate reaction to any provocation, real or perceived. Some individuals have reported affective changes prior to an outburst, such as tension, mood changes, energy changes, etc.

The disorder is currently categorised in the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) under the “Disruptive, Impulse-Control, and Conduct Disorders” category. The disorder itself is not easily characterised and often exhibits comorbidity with other mood disorders, particularly bipolar disorder. Individuals diagnosed with IED report their outbursts as being brief (lasting less than an hour), with a variety of bodily symptoms (sweating, stuttering, chest tightness, twitching, palpitations) reported by a third of one sample. Aggressive acts are frequently reported to be accompanied by a sensation of relief and in some cases pleasure, but often followed by later remorse.

Also known as Episodic Dyscontrol Syndrome or dyscontrol.

Brief History

In the first edition of the APA’s DSM-I, a disorder of impulsive aggression was referred to as a passive-aggressive personality type (aggressive type). This construct was characterised by a “persistent reaction to frustration are “generally excitable, aggressive, and over-responsive to environmental pressures” with “gross outbursts of rage or of verbal or physical aggressiveness different from their usual behavior”.

In the third edition (DSM-III), this was for the first time codified as intermittent explosive disorder and assigned clinical disorder status under Axis I. However, some researchers saw the criteria as poorly operationalised. About 80% of individuals who would now be diagnosed with the disorder would have been excluded.

In the DSM-IV, the criteria were improved but still lacked objective criteria for the intensity, frequency, and nature of aggressive acts to meet criteria for IED. This led some researchers to adopt alternate criteria set with which to conduct research, known as the IED-IR (Integrated Research). The severity and frequency of aggressive behaviour required for the diagnosis were clearly operationalized, the aggressive acts were required to be impulsive in nature, subjective distress was required to precede the explosive outbursts, and the criteria allowed for comorbid diagnoses with borderline personality disorder and antisocial personality disorder. These research criteria became the basis for the DSM-5 diagnosis.

In the current version of the DSM (DSM-5), the disorder appears under the “Disruptive, Impulse-Control, and Conduct Disorders” category. In the DSM-IV, physical aggression was required to meet the criteria for the disorder, but these criteria were modified in the DSM-5 to include verbal aggression and non-destructive/non-injurious physical aggression. The listing was also updated to specify frequency criteria. Further, aggressive outbursts are now required to be impulsive in nature and must cause marked distress, impairment, or negative consequences for the individual. Individuals must be at least six years old to receive the diagnosis. The text also clarified the disorder’s relationship to other disorders such as ADHD and disruptive mood dysregulation disorder.

Epidemiology

Two epidemiological studies of community samples approximated the lifetime prevalence of IED to be 4–6%, depending on the criteria set used. A Ukrainian study found comparable rates of lifetime IED (4.2%), suggesting that a lifetime prevalence of IED of 4–6% is not limited to American samples. One-month and one-year point prevalence of IED in these studies were reported as 2.0% and 2.7%, respectively. Extrapolating to the national level, 16.2 million Americans would have IED during their lifetimes and as many as 10.5 million in any year and 6 million in any month.

Among a clinical population, a 2005 study found the lifetime prevalence of IED to be 6.3%.

Prevalence appears to be higher in men than in women.

Of US subjects with IED, 67.8% had engaged in direct interpersonal aggression, 20.9% in threatened interpersonal aggression, and 11.4% in aggression against objects. Subjects reported engaging in 27.8 high-severity aggressive acts during their worst year, with 2–3 outbursts requiring medical attention. Across the lifespan, the mean value of property damage due to aggressive outbursts was $1603.

A study in the March 2016 Journal of Clinical Psychiatry suggests a relationship between infection with the parasite Toxoplasma gondii and psychiatric aggression such as IED.

Pathophysiology

Impulsive behaviour, and especially impulsive violence predisposition, have been correlated to a low brain serotonin turnover rate, indicated by a low concentration of 5-hydroxyindoleacetic acid (5-HIAA) in the cerebrospinal fluid (CSF). This substrate appears to act on the suprachiasmatic nucleus in the hypothalamus, which is the target for serotonergic output from the dorsal and median raphe nuclei playing a role in maintaining the circadian rhythm and regulation of blood sugar. A tendency towards low 5-HIAA may be hereditary. A putative hereditary component to low CSF 5-HIAA and concordantly possibly to impulsive violence has been proposed. Other traits that correlate with IED are low vagal tone and increased insulin secretion. A suggested explanation for IED is a polymorphism of the gene for tryptophan hydroxylase, which produces a serotonin precursor; this genotype is found more commonly in individuals with impulsive behaviour.

IED may also be associated with damage or lesions in the prefrontal cortex, with damage to these areas, including the amygdala and hippocampus, increasing the incidences of impulsive and aggressive behaviour and the inability to predict the outcomes of an individual’s own actions. Lesions in these areas are also associated with improper blood sugar control, leading to decreased brain function in these areas, which are associated with planning and decision making. A national sample in the United States estimated that 16 million Americans may fit the criteria for IED.

Diagnosis

DSM-5 Diagnosis

The current DSM-5 criteria for IED include:

  • Recurrent outbursts that demonstrate an inability to control impulses, including either of the following:
    • Verbal aggression (tantrums, verbal arguments, or fights) or physical aggression that occurs twice in a week-long period for at least three months and does not lead to the destruction of property or physical injury (Criterion A1)
    • Three outbursts that involve injury or destruction within a year-long period (Criterion A2)
  • Aggressive behaviour is grossly disproportionate to the magnitude of the psychosocial stressors (Criterion B)
  • The outbursts are not premeditated and serve no premeditated purpose (Criterion C)
  • The outbursts cause distress or impairment of functioning or lead to financial or legal consequences (Criterion D)
  • The individual must be at least six years old (Criterion E)
  • The recurrent outbursts cannot be explained by another mental disorder and are not the result of another medical disorder or substance use (Criterion F)

It is important to note that DSM-5 now includes two separate criteria for types of aggressive outbursts (A1 and A2) which have empirical support:

CriterionOutline
A11. Episodes of verbal and/or non-damaging, non-destructive, or non-injurious physical assault that occur, on average, twice weekly for three months.
2. These could include temper tantrums, tirades, verbal arguments/fights, or assault without damage.
3. This criterion includes high frequency/low-intensity outbursts.
A21. More severe destructive/assaultive episodes which are more infrequent and occur, on average, three times within a twelve-month period.
2. These could be destroying an object without regard to value, assaulting an animal or individual.
3. This criterion includes high-intensity/low-frequency outbursts.

DSM-IV Diagnosis

The past DSM-IV criteria for IED were similar to the current criteria, however, verbal aggression was not considered as part of the diagnostic criteria. The DSM-IV diagnosis was characterised by the occurrence of discrete episodes of failure to resist aggressive impulses that result in violent assault or destruction of property. Additionally, the degree of aggressiveness expressed during an episode should be grossly disproportionate to provocation or precipitating psychosocial stressor, and, as previously stated, diagnosis is made when certain other mental disorders have been ruled out, e.g. a head injury, Alzheimer’s disease, etc., or due to substance use or medication. Diagnosis is made using a psychiatric interview to affective and behavioural symptoms to the criteria listed in the DSM-IV.

The DSM-IV-TR was very specific in its definition of Intermittent Explosive Disorder which was defined, essentially, by the exclusion of other conditions. The diagnosis required:

  • Several episodes of impulsive behaviour that result in serious damage to either persons or property, wherein
  • The degree of the aggressiveness is grossly disproportionate to the circumstances or provocation, and
  • The episodic violence cannot be better accounted for by another mental or physical medical condition.

Differential Diagnosis

Many psychiatric disorders and some substance use disorders are associated with increased aggression and are frequently comorbid with IED, often making differential diagnosis difficult. Individuals with IED are, on average, four times more likely to develop depression or anxiety disorders, and three times more likely to develop substance use disorders. Bipolar disorder has been linked to increased agitation and aggressive behaviour in some individuals, but for these individuals, aggressiveness is limited to manic and/or depressive episodes, whereas individuals with IED experience aggressive behaviour even during periods with a neutral or positive mood.

In one clinical study, the two disorders co-occurred 60% of the time. Patients report manic-like symptoms occurring just before outbursts and continuing throughout. According to a study, the average onset age of IED was around five years earlier than the onset age of bipolar disorder, indicating a possible correlation between the two.

Similarly, alcoholism and other substance use disorders may exhibit increased aggressiveness, but unless this aggression is experienced outside of periods of acute intoxication and withdrawal, no diagnosis of IED is given. For chronic disorders, such as PTSD, it is important to assess whether the level of aggression met IED criteria before the development of another disorder. In antisocial personality disorder, interpersonal aggression is usually instrumental in nature (i.e. motivated by tangible rewards), whereas IED is more of an impulsive, unpremeditated reaction to situational stress.

Treatment

Although there is no cure, treatment is attempted through cognitive behavioural therapy and psychotropic medication regimens, though the pharmaceutical options have shown limited success. Therapy aids in helping the patient recognise the impulses in hopes of achieving a level of awareness and control of the outbursts, along with treating the emotional stress that accompanies these episodes. Multiple drug regimens are frequently indicated for IED patients. Cognitive Relaxation and Coping Skills Therapy (CRCST) has shown preliminary success in both group and individual settings compared to waitlist control groups. This therapy consists of 12 sessions, the first three focusing on relaxation training, then cognitive restructuring, then exposure therapy. The final sessions focus on resisting aggressive impulses and other preventative measures.

In France, antipsychotics such as cyamemazine, levomepromazine and loxapine are sometimes used.

Tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs, including fluoxetine, fluvoxamine, and sertraline) appear to alleviate some pathopsychological symptoms. GABAergic mood stabilisers and anticonvulsive drugs such as gabapentin, lithium, carbamazepine, and divalproex seem to aid in controlling the incidence of outbursts. Anxiolytics help alleviate tension and may help reduce explosive outbursts by increasing the provocative stimulus tolerance threshold, and are especially indicated in patients with comorbid obsessive-compulsive or other anxiety disorders.

This page is based on the copyrighted Wikipedia articles < https://en.wikipedia.org/wiki/Episodic_dyscontrol_syndrome > AND < https://en.wikipedia.org/wiki/Intermittent_explosive_disorder >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What Do We Mean by ‘Mental State’?

Published on by Andrew MarshallLeave a comment

Introduction

A mental state, or a mental property, is a state of mind of a person. Mental states comprise a diverse class, including perception, pain/pleasure experience, belief, desire, intention, emotion, and memory. There is controversy concerning the exact definition of the term. According to epistemic approaches, the essential mark of mental states is that their subject has privileged epistemic access while others can only infer their existence from outward signs. Consciousness-based approaches hold that all mental states are either conscious themselves or stand in the right relation to conscious states. Intentionality-based approaches, on the other hand, see the power of minds to refer to objects and represent the world as the mark of the mental. According to functionalist approaches, mental states are defined in terms of their role in the causal network independent of their intrinsic properties.

Some philosophers deny all the aforementioned approaches by holding that the term “mental” refers to a cluster of loosely related ideas without an underlying unifying feature shared by all. Various overlapping classifications of mental states have been proposed. Important distinctions group mental phenomena together according to whether they are sensory, propositional, intentional, conscious or occurrent. Sensory states involve sense impressions like visual perceptions or bodily pains. Propositional attitudes, like beliefs and desires, are relations a subject has to a proposition. The characteristic of intentional states is that they refer to or are about objects or states of affairs. Conscious states are part of the phenomenal experience while occurrent states are causally efficacious within the owner’s mind, with or without consciousness. An influential classification of mental states is due to Franz Brentano, who argues that there are only three basic kinds: presentations, judgements, and phenomena of love and hate.

Mental states are usually contrasted with physical or material aspects. For (non-eliminative) physicalists, they are a kind of high-level property that can be understood in terms of fine-grained neural activity. Property dualists, on the other hand, claim that no such reductive explanation is possible. Eliminativists may reject the existence of mental properties, or at least of those corresponding to folk psychological categories such as thought and memory. Mental states play an important role in various fields, including philosophy of mind, epistemology and cognitive science. In psychology, the term is used not just to refer to the individual mental states listed above but also to a more global assessment of a person’s mental health.

Definition

Various competing theories have been proposed about what the essential features of all mental states are, sometimes referred to as the search for the “mark of the mental”. These theories can roughly be divided into epistemic approaches, consciousness-based approaches, intentionality-based approaches and functionalism. These approaches disagree not just on how mentality is to be defined but also on which states count as mental. Mental states encompass a diverse group of aspects of an entity, like this entity’s beliefs, desires, intentions, or pain experiences. The different approaches often result in a satisfactory characterization of only some of them. This has prompted some philosophers to doubt that there is a unifying mark of the mental and instead see the term “mental” as referring to a cluster of loosely related ideas. Mental states are usually contrasted with physical or material aspects. This contrast is commonly based on the idea that certain features of mental phenomena are not present in the material universe as described by the natural sciences and may even be incompatible with it.

Central to epistemic approaches is the idea that the subject has privileged epistemic access to her mental states. In this view, a state of a subject constitutes a mental state if and only if the subject has privileged access to it. It has been argued that this access is non-inferential, infallible and private. Non-inferential access is insufficient as a mark of the mind if one accepts that we have non-inferential knowledge of non-mental things, for example, in regular perception or in bodily experience. It is sometimes held that knowledge of one’s own mental states is infallible, i.e. that the subject cannot be wrong about having them. But while this may be true for some conscious mental states, there are various counterexamples, like unconscious mental states or conscious emotions that we don’t know how to categorise. The most influential characterisation of privileged access has been that it is private, i.e. that mental states are known primarily just by the subject and only through their symptoms like speech acts or other expressions by other people. An influential but not universally accepted argument against this tradition is the private language argument due to Ludwig Wittgenstein. He argues that mental states cannot be private because if they were, we would not be able to refer to them using public language.

Consciousness-based approaches hold that all mental states are either conscious themselves or stand in the right relation to conscious states. There is controversy concerning how this relation is to be characterised. One prominent early version, due to John Searle, states that non-conscious states are mental if they constitute dispositions to bring about conscious states. This usually leads to a hierarchical model of the mind seeing only conscious states as independent mental phenomena, which is often a point of dispute for opponents to consciousness-based approaches. According to this line of thought, some unconscious mental states exist independently of their conscious counterparts. They have been referred to as the “deep unconscious” and figures in the cognitive sciences and psychoanalysis. But whether this counterargument is successful depends both on allowing that the deep unconscious is actually mental and on how the dependency-relation denied by the deep unconscious is to be conceived.

Intentionality-based approaches see intentionality, i.e. that mental states refer to objects and represent how the world is, as the mark of the mental. This circumvents various problems faced by consciousness-based approaches since we ascribe representational contents both to conscious and to unconscious states. Two main arguments have been raised against this approach: that some representations, like maps, are not mental and that some mental states, like pain, are not representational. Proponents of intentionality-based approaches have responded to these arguments by giving a hierarchical explanation of how non-mental representations depend on mental representations, akin to the relation between unconscious and conscious states suggested in the last paragraph, and by trying to show how apparently non-representational mental states can be characterised as representational after all.

Functionalist approaches define mental states in terms of their role in the causal network. For example, a pain state may be characterized as what tends to be caused by bodily injury and to cause pain expressions like moaning. Behaviourism is one form of functionalism that restricts these characterisations to bodily reactions to external situations, often motivated by an attempt to avoid reference to inner or private states. Other forms of functionalism are more lenient in allowing both external and internal states to characterise the causal role of mental states. Phenomenal consciousness constitutes a difficulty for functionalist approaches since its intrinsic aspects are not captured by causal roles. For example, the causes and effects of pain leave out the fact that pain itself feels unpleasant.

Classifications of Mental States

There is a great variety of types of mental states, which can be classified according to various distinctions. These types include perception, belief, desire, intention, emotion and memory. Many of the proposed distinctions for these types have significant overlaps and some may even be identical. Sensory states involve sense impressions, which are absent in non-sensory states. Propositional attitudes are mental states that have propositional contents, in contrast to non-propositional states. Intentional states refer to or are about objects or states of affairs, a feature which non-intentional states lack. A mental state is conscious if it belongs to a phenomenal experience. Unconscious mental states are also part of the mind but they lack this phenomenal dimension. Occurrent mental states are active or causally efficacious within the owner’s mind while non-occurrent or standing states exist somewhere in the back of one’s mind but do not currently play an active role in any mental processes. Certain mental states are rationally evaluable: they are either rational or irrational depending on whether they obey the norms of rationality. But other states are arational: they are outside the domain of rationality. A well-known classification is due to Franz Brentano, who distinguishes three basic categories of mental states: presentations, judgments, and phenomena of love and hate.

Types of Mental States

There is a great variety of types of mental states including perception, bodily awareness, thought, belief, desire, motivation, intention, deliberation, decision, pleasure, emotion, mood, imagination and memory. Some of these types are precisely contrasted with each other while other types may overlap. Perception involves the use of senses, like sight, touch, hearing, smell and taste, to acquire information about material objects and events in the external world. It contrasts with bodily awareness in this sense, which is about the internal ongoings in our body and which does not present its contents as independent objects. The objects given in perception, on the other hand, are directly (i.e. non-inferentially) presented as existing out there independently of the perceiver. Perception is usually considered to be reliable but our perceptual experiences may present false information at times and can thereby mislead us. The information received in perception is often further considered in thought, in which information is mentally represented and processed. Both perceptions and thoughts often result in the formation of new or the change of existing beliefs. Beliefs may amount to knowledge if they are justified and true. They are non-sensory cognitive propositional attitudes that have a mind-to-world direction of fit: they represent the world as being a certain way and aim at truth. They contrast with desires, which are conative propositional attitudes that have a world-to-mind direction of fit and aim to change the world by representing how it should be. Desires are closely related to agency: they motivate the agent and are thus involved in the formation of intentions. Intentions are plans to which the agent is committed and which may guide actions. Intention-formation is sometimes preceded by deliberation and decision, in which the advantages and disadvantages of different courses of action are considered before committing oneself to one course. It is commonly held that pleasure plays a central role in these considerations. “Pleasure” refers to experience that feels good, that involves the enjoyment of something. The topic of emotions is closely intertwined with that of agency and pleasure. Emotions are evaluative responses to external or internal stimuli that are associated with a feeling of pleasure or displeasure and motivate various behavioural reactions. Emotions are quite similar to moods, some differences being that moods tend to arise for longer durations at a time and that moods are usually not clearly triggered by or directed at a specific event or object. Imagination is even further removed from the actual world in that it represents things without aiming to show how they actually are. All the aforementioned states can leave traces in memory that make it possible to relive them at a later time in the form of episodic memory.

Sensation, Propositional Attitudes and Intentionality

An important distinction among mental states is between sensory and non-sensory states. Sensory states involve some form of sense impressions like visual perceptions, auditory impressions or bodily pains. Non-sensory states, like thought, rational intuition or the feeling of familiarity, lack sensory contents. Sensory states are sometimes equated with qualitative states and contrasted with propositional attitude states. Qualitative states involve qualia, which constitute the subjective feeling of having the state in question or what it is like to be in it. Propositional attitudes, on the other hand, are relations a subject has to a proposition. They are usually expressed by verbs like believe, desire, fear or hope together with a that-clause. So believing that it will rain today, for example, is a propositional attitude. It has been argued that the contrast between qualitative states and propositional attitudes is misleading since there is some form of subjective feel to certain propositional states like understanding a sentence or suddenly thinking of something. This would suggest that there are also non-sensory qualitative states and some propositional attitudes may be among them. Another problem with this contrast is that some states are both sensory and propositional. This is the case for perception, for example, which involves sensory impressions that represent what the world is like. This representational aspect is usually understood as involving a propositional attitude.

Closely related to these distinctions is the concept of intentionality. Intentionality is usually defined as the characteristic of mental states to refer to or be about objects or states of affairs. The belief that the moon has a circumference of 10921 km, for example, is a mental state that is intentional in virtue of being about the moon and its circumference. It is sometimes held that all mental states are intentional, i.e. that intentionality is the “mark of the mental”. This thesis is known as intentionalism. But this view has various opponents, who distinguish between intentional and non-intentional states. Putative examples of non-intentional states include various bodily experiences like pains and itches. Because of this association, it is sometimes held that all sensory states lack intentionality. But such a view ignores that certain sensory states, like perceptions, can be intentional at the same time. It is usually accepted that all propositional attitudes are intentional. But while the paradigmatic cases of intentionality are all propositional as well, there may be some intentional attitudes that are non-propositional. This could be the case when an intentional attitude is directed only at an object. In this view, Elsie’s fear of snakes is a non-propositional intentional attitude while Joseph’s fear that he will be bitten by snakes is a propositional intentional attitude.

Conscious and Unconscious

A mental state is conscious if it belongs to phenomenal experience. The subject is aware of the conscious mental states it is in: there is some subjective feeling to having them. Unconscious mental states are also part of the mind but they lack this phenomenal dimension. So it is possible for a subject to be in an unconscious mental state, like a repressed desire, without knowing about it. It is usually held that some types of mental states, like sensations or pains, can only occur as conscious mental states. But there are also other types, like beliefs and desires, that can be both conscious and unconscious. For example, many people share the belief that the moon is closer to the earth than to the sun. When considered, this belief becomes conscious, but it is unconscious most of the time otherwise. The relation between conscious and unconscious states is a controversial topic. It is often held that conscious states are in some sense more basic with unconscious mental states depending on them. One such approach states that unconscious states have to be accessible to consciousness, that they are dispositions of the subject to enter their corresponding conscious counterparts. On this position there can be no “deep unconscious”, i.e. unconscious mental states that can not become conscious.

The term “consciousness” is sometimes used not in the sense of phenomenal consciousness, as above, but in the sense of access consciousness. A mental state is conscious in this sense if the information it carries is available for reasoning and guiding behaviour, even if it is not associated with any subjective feel characterising the concurrent phenomenal experience. Being an access-conscious state is similar but not identical to being an occurrent mental state, the topic of the next section.

Occurrent and Standing

A mental state is occurrent if it is active or causally efficacious within the owner’s mind. Non-occurrent states are called standing or dispositional states. They exist somewhere in the back of one’s mind but currently play no active role in any mental processes. This distinction is sometimes identified with the distinction between phenomenally conscious and unconscious mental states. It seems to be the case that the two distinctions overlap but do not fully match despite the fact that all conscious states are occurrent. This is the case because unconscious states may become causally active while remaining unconscious. A repressed desire may affect the agent’s behaviour while remaining unconscious, which would be an example of an unconscious occurring mental state. The distinction between occurrent and standing is especially relevant for beliefs and desires. At any moment, there seems to be a great number of things we believe or things we want that are not relevant to our current situation. These states remain inactive in the back of one’s head even though one has them. For example, while Ann is engaged in her favourite computer game, she still believes that dogs have four legs and desires to get a pet dog on her next birthday. But these two states play no active role in her current state of mind. Another example comes from dreamless sleep when most or all of our mental states are standing states.

Rational, Irrational and Arational

Certain mental states, like beliefs and intentions, are rationally evaluable: they are either rational or irrational depending on whether they obey the norms of rationality. But other states, like urges, experiences of dizziness or hunger, are arational: they are outside the domain of rationality and can be neither rational nor irrational. An important distinction within rationality concerns the difference between theoretical and practical rationality. Theoretical rationality covers beliefs and their degrees while practical rationality focuses on desires, intentions and actions. Some theorists aim to provide a comprehensive account of all forms of rationality but it is more common to find separate treatments of specific forms of rationality that leave the relation to other forms of rationality open.

There are various competing definitions of what constitutes rationality but no universally accepted answer. Some accounts focus on the relation between mental states for determining whether a given state is rational. In one view, a state is rational if it is well-grounded in another state that acts as its source of justification. For example, Scarlet’s belief that it is raining in Manchester is rational because it is grounded in her perceptual experience of the rain while the same belief would be irrational for Frank since he lacks such a perceptual ground. A different version of such an approach holds that rationality is given in virtue of the coherence among the different mental states of a subject. This involves an holistic outlook that is less concerned with the rationality of individual mental states and more with the rationality of the person as a whole. Other accounts focus not on the relation between two or several mental states but on responding correctly to external reasons. Reasons are usually understood as facts that count in favour or against something. On this account, Scarlet’s aforementioned belief is rational because it responds correctly to the external fact that it’s raining, which constitutes a reason for holding this belief.

Classification According to Brentano

An influential classification of mental states is due to Franz Brentano. He argues that there are three basic kinds: presentations, judgments, and phenomena of love and hate. All mental states either belong to one of these kinds or are constituted by combinations of them. These different types differ not in content or what is presented but in mode or how it is presented. The most basic kind is presentation, which is involved in every mental state. Pure presentations, as in imagination, just show their object without any additional information about the veridical or evaluative aspects of their object. A judgement, on the other hand, is an attitude directed at a presentation that asserts that its presentation is either true or false, as is the case in regular perception. Phenomena of love and hate involve an evaluative attitude towards their presentation: they show how things ought to be, and the presented object is seen as either good or bad. This happens, for example, in desires. More complex types can be built up through combinations of these basic types. To be disappointed about an event, for example, can be construed as a judgement that this event happened together with a negative evaluation of it. Brentano’s distinction between judgments, phenomena of love and hate, and presentations is closely related to the more recent idea of direction of fit between mental state and world, i.e. mind-to-world direction of fit for judgements, the world-to-mind direction of fit for phenomena of love and hate and null direction of fit for mere presentations. Brentano’s tripartite system of classification has been modified in various ways by Brentano’s students. Alexius Meinong, for example, divides the category of phenomena of love and hate into two distinct categories: feelings and desires. Uriah Kriegel is a contemporary defender of Brentano’s approach to the classification of mental phenomena.

Academia

Discussions about mental states can be found in many areas of study.

In cognitive psychology and the philosophy of mind, a mental state is a kind of hypothetical state that corresponds to thinking and feeling, and consists of a conglomeration of mental representations and propositional attitudes. Several theories in philosophy and psychology try to determine the relationship between the agent’s mental state and a proposition.

Instead of looking into what a mental state is, in itself, clinical psychology and psychiatry determine a person’s mental health through a mental status examination.

Epistemology

Mental states also include attitudes towards propositions, of which there are at least two—factive and non-factive, both of which entail the mental state of acquaintance. To be acquainted with a proposition is to understand its meaning and be able to entertain it. The proposition can be true or false, and acquaintance requires no specific attitude towards that truth or falsity. Factive attitudes include those mental states that are attached to the truth of the proposition – i.e. the proposition entails truth. Some factive mental states include “perceiving that”, “remembering that”, “regretting that”, and (more controversially) “knowing that”. Non-factive attitudes do not entail the truth of the propositions to which they are attached. That is, one can be in one of these mental states and the proposition can be false. An example of a non-factive attitude is believing—people can believe a false proposition and people can believe a true proposition. Since there is the possibility of both, such mental states do not entail truth, and therefore, are not active. However, belief does entail an attitude of assent toward the presumed truth of the proposition (whether or not it’s so), making it and other non-factive attitudes different from a mere acquaintance.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Mental_state >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is a Nurse Practitioner?

Published on by Andrew MarshallLeave a comment

Introduction

A nurse practitioner (NP) is an advanced practice registered nurse and a type of mid-level practitioner.

NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, formulate and prescribe medications and treatment plans. NP training covers basic disease prevention, coordination of care, and health promotion, but does not provide the depth of expertise needed to recognise more complex conditions.

The scope of practice for a NP is defined by legal jurisdiction. In 26 states of the United States (US), NPs have full practice authority, while in the remaining 24 states, NPs are required to work under the supervision of a physician. In Australia, the scope of practice is guided by health organisation policy and the individual’s competency, while their right to access Medicare rebates requires a Collaborative Practice Arrangement with a medical practitioner.

Brief History

United States

The present-day concept of advanced practice nursing as a primary care provider was created in the mid-1960s, spurred on by a national shortage of physicians. The first formal graduate certificate program for NPs was created by Henry Silver, a physician, and Loretta Ford, a nurse, in 1965. In 1971, The US Secretary of Health, Education and Welfare, Elliot Richardson, made a formal recommendation in expanding the scope of nursing practice to be able to serve as primary care providers. In 2012, discussions arose between accreditation agencies, national certifying bodies, and state boards of nursing about the possibility of making the Doctor of Nursing Practice (DNP) degree the new minimum standard of education for NP certification and licensure by 2015.

Canada

Advanced practice nursing first appeared in the 1990s in Ontario. These nurses practiced in neonatal intensive care units within tertiary care hospitals in collaboration with paediatricians and neonatologists. Although the role of these nurses initially resembled a blended version of clinical nurse specialists and NPs, today the distinction has been more formally established.

Nurse Practitioners in the United States

Education Requirements

Becoming a nurse practitioner in the US requires either a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP). During their studies, nurse practitioners are required to receive a minimum of 500 hours of clinical training in addition to the clinical hours required to obtain their RN. Upon completion of the graduate program, they must pass the National NP Certification Board Exam, specific to their specialisation. After passing this exam, candidates must apply for NP licensure which varies by state regulations.

Although nurse practitioners are required to be licensed as registered nurses prior to obtaining their advanced practice registered nurse certification, there are several programmes that combine a nursing undergraduate degree with nurse practitioner training. Other nurse practitioner programmes have 100% acceptance rates.

Training Pathways

There are many types of nurse practitioner programs in the United States with the vast majority being in the specialty of a family nurse practitioner (FNP). There are also psychiatric, adult geriatric acute care, adult geriatric primary care, paediatric, cardiac, women’s health, oncology and neonatal nurse practitioner programmes. Many of these programs have their pre-clinical or didactic courses taught online with proctored examinations. Once the students start their clinical courses they have online material, but are required to perform clinical hours at an approved facility under the guidance of an NP or physician. Each clinical course has specific requirements that vary on their programme’s degree/eligibility for certification. For instance FNPs are required to see patients across the lifespan whereas Adult Geriatric NPs do not see anyone below the age of 13.

Quality of Care

A review of studies comparing outcomes of care by NPs and physicians in primary care and urgent care settings were generally comparable, although the strength of the evidence was generally low due to limited study duration and participant numbers. A recent study showed nurse practitioners practicing in states with independent prescription authority were more than twenty times more likely to overprescribe opioids than nurse practitioners in prescription-restricted states, the same study identified that both nurse practitioners and Physician Associates were more likely to over-prescribe opioids compared to physicians. Nurse practitioners and physician assistants were also associated with more unnecessary imaging services than primary care physicians, which may have ramifications on care and overall costs.

One systematic review suggests “that the implementation of advanced practice nursing roles in the emergency and critical care settings improves patient outcomes in emergency and critical care settings”.

Job Setting

Nurse practitioners are currently employed in a wide variety of practice settings. These settings include the ambulatory, inpatient, or emergency room of hospitals, health clinics, and office practices whether private or nurse-run. In addition, they serve in schools and college campuses delivering care as well as nursing homes and assisted living facilities. NPs can work alone or under the supervision of a physician in a wide variety of specialisations.

Scope of Practice

Australia

In Australia, a nurse practitioner-endorsed registered nurse has an expanded scope of practice, allowing them to practice certain advanced clinical skills within their endorsed field. As a nurse practitioner, they can complete advanced health assessments, diagnose and treat diseases, order diagnostic testing such as imaging and pathology, and prescribe medications and therapeutics. They are also able to register for a provider number with Medicare for the services they provide to patients, excluding services provided in public facilities (such as a Queensland Health hospital).

Nurse practitioner items on the Medicare Benefits Schedule, however, provide significantly smaller rebates than equivalent items for General Practitioners, leading to a higher out-of-pocket cost to patients. To claim Medicare rebates, the NP must also be in a documented “Collaborative Practice Arrangement” with a medical practitioner and the episode of care approved by a doctor. Prescriptions issued by NPs must also be verified by a medical practitioner to be eligible to be subsidised under the Pharmaceutical Benefits Scheme.

Canada

In Canada, an NP is a registered nurse (RN) with a graduate degree in nursing. Canada recognizes them in primary care and acute care practice. NPs diagnose illnesses and medical conditions, prescribe Schedule 1 medications, order and interpret diagnostic tests, and perform procedures, within their scope of practice, and may build their own panel of patients at the same level as physicians. Primary care NPs work in places like primary care and community healthcare centres, as well as long-term care institutions. The main focus of primary care NPs includes health promotion, preventative care, diagnosis and treatment of acute and chronic diseases and conditions. Acute care NPs serve a specific population of patients. They generally work in in-patient facilities that include neonatology, nephrology, and cardiology units. There are currently three specialties for nurse practitioners in Canada: family practice, paediatrics, and adult care. NPs who specialise in family practice work at the same level and offer the same services as family physicians with the exclusion of Quebec, where only physicians are allowed to formulate a medical diagnosis.

Ireland

Ireland’s publicly funded healthcare system, the Health Service Executive has the advanced nurse practitioner (ANP) grade. ANPs may prescribe medications.

United Kingdom

In the United Kingdom nurse practitioners carry out care at an advanced practice level. They commonly work in primary care (e.g. GP surgeries) or A&E departments, although they are increasingly being seen in other areas of practice.

United States

Because the profession is state-regulated, the scope of practice varies by state. Some states allow NPs to have full practice authority, however, in other states, a written collaborative or supervisory agreement with a physician is legally required for practice. Autonomous practice was introduced in the 1980s, mostly in states facing a physician shortage or that struggled to find enough healthcare providers to work in rural areas. The extent of this collaborative agreement, and the role, duties, responsibilities, nursing treatments, and pharmacologic recommendations again varies widely between states.

NPs can legally examine patients, diagnose illness, prescribe some medications, and provide treatments. As of 2022, twenty-six states granted full practice authority to NPs and do not require the supervision or collaboration with a physician. Twenty-four states require NPs to have a written agreement with a physician in order to provide care. Eleven of those states require NPs to be supervised or delegated by a physician; this physician may not be on site.

Licensing and Board Certification

Australia

In Australia, nursing registration including endorsement of a RN as a nurse practitioner is overseen by the Nursing and Midwifery Board of Australia (NMBA) and the Australian Health Practitioner Regulation Agency (AHPRA). Registered nurses working in rural and isolated communities can apply for scheduled medicine prescriber endorsement if clinically necessary and trained, and instead become a prescribing registered nurse rather than a nurse practitioner to better meet the need of less-resourced communities. Nurse practitioners are professionally represented by the Australian College of Nurse Practitioners, as well as the Australian College of Nursing. Endorsement as a nurse practitioner in either Australia or New Zealand is recognised by both countries as part of the Trans-Tasman Mutual Recognition Scheme.

For a RN to apply to the NMBA for nurse practitioner endorsement, they must be able to demonstrate they have completed at least 5000 hours (three years, full-time equivalent) at an “advanced nursing practice” level. Advanced nursing practice is loosely defined, and not a specific role, but rather a recognised process of higher-level clinical practice within a nurse’s existing scope of practice. The RN must also complete an approved nurse practitioner postgraduate master’s degree, or demonstrate they have gained qualifications to an equivalent level in advanced health assessment, pharmacology, therapeutics, diagnostics, and research. Nurses applying through the latter pathway must also demonstrate the equivalent training is clinically relevant to the field for which they wish to apply for nurse practitioner endorsement in.

Canada

In Canada, the educational standard is a graduate degree in nursing. The Canadian Nursing Association (CNA) notes that advanced practice nurses must have a combination of a graduate level education and the clinical experience that prepare them to practice at an advanced level. Their education alone does not give them the ability to practice at an advanced level. Two national frameworks have been developed in order to provide further guidance for the development of educational courses and requirements, research concepts, and government position statements regarding advanced practice nursing: the CNA’s Advanced Nursing Practice: A National Framework and the Canadian Nurse Practitioner Core Competency Framework. All educational programmes for NPs must achieve formal approval by provincial and territorial regulating nurse agencies due to the fact that the NP is considered a legislated role in Canada. As such, it is common to see differences among approved educational programs between territories and provinces. Specifically, inconsistencies can be found in core graduate courses, clinical experiences, and length of programs. Canada does not have a national curriculum or consistent standards regarding advanced practice nurses. All advanced practice nurses must meet individual requirements set by their provincial or territorial regulatory nursing body.

Israel

As of November 2013, NPs were recognised legally in Israel.

United States

The most common path to becoming a nurse practitioner in the US begins by earning a Bachelor of Science in Nursing (BSN) and passing the National Council Licensure Examination (NCLEX) to become an RN. One must then be accepted into and complete a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) (most of which require at least 1-2 years of RN experience) to gain additional medical training in their specialty area. Finally, one must pass a national NP board certification exam.

Salary

The salary of an NP generally depends on the area of specialisation, location, years of experience, and level of education. In 2015, the American Association of Nurse Practitioners (AANP) conducted its fourth annual NP salary survey.[citation needed] The results revealed the salary range to be between $98,760 to $108,643 reported income among full-time NPs. According to the US Bureau of Labour Statistics, NPs in the top 10% earned an average salary of $135,800. The median salary was $98,190. According to a report published by Merritt Hawkins, starting salaries for NPs increased in dramatic fashion between 2015 and 2016. The highest average starting salary reached $197,000 in 2016. The primary factor in the dramatic increase in starting salaries is skyrocketing demand for NPs, recognising them as the fifth most highly sought after advanced health professional in 2016.

Policy during the COVID-19 Pandemic

The pandemic expanded the scope of practice for nurse practitioners in some countries as a result of temporary legislative policy adjustments. In the US, the Trump administration waived many requirements for nurse practitioners, permitting NPs to utilise their abilities to the fullest extent in some cases.

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What is Positivity Offset?

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Introduction

In psychology, the positivity offset is a phenomenon where people tend to interpret neutral situations as mildly positive, and rate their lives as good, most of the time. The positivity offset stands in notable asymmetry to the negativity bias.

Similarities and Differences to Negativity Bias

Two studies were presented within a single study that looked at the difference between positivity offset and negative bias to see if it is good or bad for some people. The first study measured an individual’s reactions to different stimuli such as pictures, sounds, and words. The results from this study have also seen evidence, in comparison to other studies, that the positivity offset is in favour of positive stimuli over negative stimuli. The opposite effect is true for negative bias. An interesting observation that was made in this study was that positivity offset and negative bias was predicted in different behaviors rather than from established measures focused on personality. The second study sought to replicate the findings and compare those to the findings that have been found in other studies. The result of this study has also found evidence to suggest that positivity offset is preferred when the affective level input is not significant, whereas negative bias is favoured when the level of input is significant. One of the keys to understanding both the positivity offset and the negative bias is that the inputs of both are not meant to be separate, but both exist within the affective input level. The affective input level is a process to see what effect a certain stimulus has on an individual.

Two measures that have been used to look at the validity of both positivity offset and negative bias are based on judgement and personality. The measure of judgment focused on if there was a connection between locations of both spatial and affect. In other words, they measure to see if an individual understands what the stimulus is and how it affects them. The personality measure, on the other hand, speculates whether an individual defines a stimulus as being either positive or negative.

Positivity Offset and Negativity Bias in Depression

Regarding depression, there has been evidence to suggest that there is a connection between positivity offset and negative bias affecting the way that stimuli are perceived. The negative bias had a stronger influence than the positivity offset when the participants were depressed. For those who were healthy individuals, the results of both positivity offset, and negative bias were the same. This suggests that the positivity offset occurs when someone’s mind is considered to be healthy. The researchers go on to mention that their results regarding those individuals who were on the depressed side showed evidence that pleasing or neutral stimuli as being less positive compared to the results of the healthy individuals. The results of this study do show similarity to that of other studies in that positive emotions are not likely found in those who are in a depressed state. Those who are depressed may have an aversive side, but their motivational side to do things is not there. The concepts of both positivity offset and negative bias can also be analysed from an element of positive valence.

It is proposed that if this element is defined as being inactive, then there will be more assessments of stimuli that are perceived as being negative rather than as positive. While there may be more ratings with the negative stimuli, at the same time, assessments for positive stimuli of positive valence are hindered. This is the case even with stimuli that are in the middle that is perceived with positivity offset.

In Perception

Social neuroscience researcher John Cacioppo has assembled evidence that people typically see their surroundings as positive, whenever a clear threat is not present. Because of the positivity offset, people are motivated to explore and engage with their surroundings, instead of being balanced inactive between approach and avoidance.

In Life Satisfaction

Across most cultures, nations, and groups of people, the average and median ratings of life satisfaction are not neutral, as one might expect, but mildly positive.

Groups of people who do not show a positivity offset include people with depression, people in severe poverty, and people who live in perpetually threatening situations. However, many groups of people that outsiders would not expect to show the positivity offset do, such as people with paraplegia and spinal injury, very elderly people, and people with many chronic illnesses. In some cases these individuals never become as satisfied or happy with their lives as before their illness or injury, but over time (generally approximately two years), they still stabilise at a level substantially above neutral. That is, they judge themselves overall as satisfied or happy and not dissatisfied or unhappy.

Many of the major psychological publications on life satisfaction ratings have come from Ed Diener and colleagues. This empirical work gathered life-satisfaction judgements from many modern and traditional cultures worldwide.

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What is the Shift-and-Persist Model?

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Introduction

The Shift-and-persist model has emerged in order to account for unintuitive, positive health outcomes in some individuals of low socioeconomic status.

A large body of research has previously linked low socioeconomic status to poor physical and mental health outcomes, including early mortality. Low socioeconomic status is hypothesized to get “under the skin” by producing chronic activation of the sympathetic nervous system and hypothalamic–pituitary–adrenal axis, which increases allostatic load, leading to the pathogenesis of chronic disease. However, some individuals of low socioeconomic status do not appear to experience the expected, negative health effects associated with growing up in poverty. To account for this, the Shift-and-Persist Model proposes that, as children, some individuals of low socioeconomic status learn adaptive strategies for regulating their emotions (“shifting”) and focusing on their goals (“persisting”) in the face of chronic adversity. According to this model, the use of shift-and-persist strategies diminishes the typical negative effects of adversity on health by leading to more adaptive biological, cognitive, and behavioural responses to daily stressors.

Shift Strategies

Broadly, “shift” strategies encompass a variety of cognitive and emotion self-regulation approaches that individuals use to deal with stress, including cognitive restructuring, reframing, reappraisal, and acceptance strategies, which change the meaning of a stressor or reduce its emotional impact. These shift strategies particularly focus on changing one’s response to a stressor, instead of attempting to change the situation or stressor itself. As shift strategies depend more on internal processes (self-control and regulation), than external resources, it is hypothesized that shift strategies may be particularly adaptive responses to the chronic, uncontrollable stressors that are associated with low socioeconomic status.

Persist Strategies

According to Chen and Miller, “persist” strategies are any strategies that help individuals to maintain optimism about the future, create meaning from their experiences of challenge and hardship, and persist “with strength in the face of adversity.”

Measurement

To evaluate the combination of shift-and-persist strategy use, distinct “shift” and “persist” constructs were initially measured separately by using multiple, self-report measures of reappraisal, emotional reactivity, and future orientation in early research on this model.

In 2015, Chen and colleagues published the Shift-and-Persist Scale, which is a combined self-report measure that assesses both shift and persist strategies. The Shift-and-Persist Scale has been validated for use with adults and teenagers. The questionnaire asks respondents to rate how well 14 statements about various approaches to dealing with life stressors apply to them on a 1-4 scale. Out of the 14 items on the measure, 4 assess a respondent’s use of shift strategies, 4 load onto persist strategies, and 6 items are non-relevant distractors that are ignored during scoring. When scoring the Shift-and-Persist Scale, one item (#4) is reverse-scored. This scale is publicly available online.

A simplified 5-item Shift-and-Persist scale has also been published for use with younger children and adolescents (ages 9–15). Total scores on this version of the Shift-and-Persist Scale range from 0-20, such that higher scores are indicative of greater use of shift-and-persist strategies. This scale is also publicly available online and has been previously used in research with children from kindergarten through 8th grade.

Proposed Mechanisms

Reduction of the Harmful Biological Effects of Stress

The shift-and-persist model mainly hypothesizes that these strategies have protective effects for the health of low socioeconomic status individuals because they affect biological and physiological stress response tendencies that are relevant for disease. There is some evidence that shift responses (e.g. reappraisal) to acute stressors are associated with attenuated physiological responses to stress, including reduced cardiovascular reactivity. Specifically, reappraisal has been linked to a “healthier” pattern of hypothalamic–pituitary–adrenal axis response characterised by a rapid return to homeostasis (i.e., faster cortisol recovery) in the wake of a stressor. Persist tendencies, such as optimism, have also been associated with adaptive immune responses and faster cortisol recovery. By constraining the magnitude and duration of biological stress responses, including cardiovascular, hypothalamic–pituitary–adrenal axis, and inflammatory responses to stress, shift-and-persist responses are hypothesized to prevent the wear and tear on these systems that increases allostatic load and risk for chronic diseases of aging.

Cross-sectional studies provide some evidence that greater emotion regulation abilities are associated with reduced health risk on a variety of indicators of allostatic load. Similarly, self-reported trait levels of optimism and purpose in life have been linked to better concurrent health and health trajectories over time. However, most of the health benefits associated with shift-and-persist consistent strategies are only seen in low socioeconomic status samples.

Enhancement of Adaptive Biological Stress-Recovery Systems

Another alternative, but not mutually exclusive hypothesis, is that shift-and-persist strategies affect health by increasing or up-regulating biological responses that enhance stress recovery and resilience. In particular, the parasympathetic nervous system’s functioning may be enhanced by shift-and-persist response tendencies. Emotion regulation abilities that are consistent with shift-coping have been linked to greater parasympathetic nervous system functioning at rest, as indexed by higher levels of high-frequency heart rate variability. Further, the parasympathetic nervous system is highly integrated with, and may contribute to the down-regulation of hypothalamic–pituitary–adrenal axis and immune system stress responses that influence allostatic load over time. Although parasympathetic nervous system activity is correlated with aspects of shift-and-persist coping, it is not yet established that the use of these strategies actually increases parasympathetic nervous system activity.

The oxytocin system has also been identified as another potential mechanism by which shift-and-persist strategies could influence health outcomes. Oxytocin is a hormone that has been linked to a wide range of positive social and emotional functions and can be used to effectively attenuate hypothalamic–pituitary–adrenal axis and sympathetic nervous system responses to stress. However, there is little research examining the interplay between shift-and-persist strategy use and the oxytocin system.

Impact on Health Behaviours

It has also been proposed that shift-and-persist strategies may buffer health outcomes in individuals of low socioeconomic status by affecting health behaviours. Previous research has demonstrated that, regardless of socioeconomic status, individuals with emotion regulation difficulties are also likely to engage in poorer health behaviours, including over-eating, sedentary lifestyle, risky sexual health behaviours, and drug use. Individuals of low socioeconomic status who learn to regulate their emotions more effectively, by using “shift” strategies in childhood, may be more likely than their peers with emotion regulation difficulties to establish and sustain positive health behaviours throughout development. Similarly, persist strategies that help individuals to maintain a positive focus on the future may also affect wellbeing through health behaviours. Prior studies have linked being “future-oriented” to lower levels of drug use and sexual risk behaviours. Therefore, it is possible that individuals who regularly use shift-and-persist strategies will be more likely to practice positive health behaviours, which promote healthy development and aging.

However, it is important to note that the relationships between emotion regulation abilities and health behaviour are bidirectional. Health behaviours, such as physical activity and sleep hygiene, can also have powerful effects on our capacity to successfully regulate emotions.

Research Support for Associations with Health

Since 2012, integrative research groups concerned with clinical health psychology, social psychology, psychoneuroimmunology, and public health have begun to evaluate the relationships postulated by the shift-and-persist model. The majority of empirical studies on this topic test whether shift-and-persist strategies are associated with differential health outcomes in low vs. high socioeconomic status samples.

Thus far, high levels of shift-and-persist strategy use have been linked to:

  • Lower total allostatic load in adults who grew up in low, but not high, socioeconomic status households.
  • Lower body mass index in children from low, but not high, socioeconomic status families.
  • Reduced low-grade inflammation in adolescents (and parents) from low socioeconomic status families.
  • A “healthier” profile of hypothalamic–pituitary–adrenal axis functioning, as indexed by diurnal cortisol in children from low socioeconomic status families.
  • Lower levels of asthma-related impairment and inflammation in children from low, but not high, socioeconomic status families.
  • Better asthma profiles in children and teens from families reporting low, but not high, perceived social status.
  • Lower levels of depressive symptoms in Latinx youth from low, but not high, income families.

Although it has been proposed that a variety of psychological interventions for at-risk youth of low socioeconomic status may reduce health disparities, in part, by increasing shift-and-persist tendencies in families, the majority of studies on shift-and-persist have been cross-sectional. Therefore, it remains unknown if shift-and-persist strategies play a causal role in reducing the negative impact of low socioeconomic status on health. More longitudinal and treatment studies are needed to evaluate directional and causal hypotheses based upon the shift-and-persist model.

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What is the Strengths and Difficulties Questionnaire?

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Introduction

The Strengths and Difficulties Questionnaire (SDQ) is a behavioural screening questionnaire for children and adolescents ages 2 through 17 years old, developed by child psychiatrist Robert N. Goodman in the United Kingdom.

Outline

Versions of it are available for use for no fee. The combination of its brevity and non-commercial distribution have made it popular among clinicians and researchers. There are more than 3000 peer-reviewed articles using it that are indexed in PubMed alone. Overall, the SDQ has proved to have satisfactory construct and concurrent validity across a wide range of settings and samples. It is considered a good general screening measure for attention problems, although the sensitivity and specificity are not both over 0.80 at any single cut score, so it should not be used by itself as the basis for a diagnosis of attention-deficit/hyperactivity disorder.

There are three versions of the SDQ designed for use in different situations: a short form, a longer form with an impact supplement, and a follow-up form designed for use after a behavioural intervention. The questionnaire takes 3–10 minutes to complete. There are now self-report (completed by the youth), parent-report, and teacher-report versions. A version designed for adults (age 18+ years) to fill out about themselves has also been developed. The SDQ has been translated into more than 80 languages, including Spanish, Chinese, Russian, and Portuguese.

General population norms are available for the US and UK for some of the variations of the SDQ.

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What is the Suicide Prevention Action Network USA?

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Introduction

The Suicide Prevention Action Network USA (SPAN USA) was a 501(c)(3) organisation that was founded in 1996 by Gerald and Elsie Weyrauch, whose 34-year-old daughter, Terri, died by suicide. SPAN USA was “dedicated to preventing suicide through public education and awareness, community action and federal, state and local grassroots advocacy.”

SPAN’s theme was “Opening Minds. Changing Policy. Saving Lives.”

SPAN USA was the nation’s only suicide prevention organisation dedicated to leveraging grassroots support among suicide survivors (those who have lost a loved one to suicide) and others to advance public policies that help prevent suicide. The organisation was created to raise awareness, build political will, and call for action with regard to creating, advancing, implementing and evaluating a national strategy to address suicide in the United States. Since the organisation was founded, grassroots volunteers and staff have worked in communities, state capitols and in Washington, DC, to advance its public policy response to the problem of suicide in America.

In 2009, SPAN merged with American Foundation for Suicide Prevention to create a public policy programme.

2009 SPAN USA Public Policy Priorities

SPAN USA’s 2009 Federal Public Policy Priorities

  • Funding for the Garrett Lee Smith Memorial Act programmes.
  • Reauthorisation of the Substance Abuse and Mental Health Services Administration.
  • Veterans and Military Suicide Prevention.
  • Additional funding for the National Violent Death Reporting System (NVDRS).
  • Support Evidence-Based Suicide Prevention Research Projects at the Agency for Healthcare Research and Quality (AHRQ).

2009 State Public Policy Priorities

  • Establish and authorise funding for a statewide office of suicide prevention that includes at least one full-time position and directs its efforts across the life span.
  • Adoption by state mental health licensing boards of suicide prevention continuing education requirements.
  • Adoption of state laws that require educational personnel to receive suicide prevention training.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Suicide_Prevention_Action_Network_USA >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Medazepam?

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Introduction

Medazepam is a drug that is a benzodiazepine derivative. It possesses anxiolytic, anticonvulsant, sedative, and skeletal muscle relaxant properties. It is known by the following brand names: Azepamid, Nobrium, Tranquirax (mixed with bevonium), Rudotel, Raporan, Ansilan and Mezapam. Medazepam is a long-acting benzodiazepine drug. The half-life of medazepam is 36–200 hours.

Pharmacology

Medazepam acts as a prodrug to diazepam, as well as nordazepam, temazepam and oxazepam. Benzodiazepine drugs including medazepam increase the inhibitory processes in the cerebral cortex by allosteric modulation of the GABA receptor. Benzodiazepines may also act via micromolar benzodiazepine-binding sites as Ca2+ channel blockers and significantly inhibited depolarisation-sensitive calcium uptake in experiments with cell components from rat brains. This has been conjectured as a mechanism for high dose effects against seizures in a study. It has major active benzodiazepine metabolites, which gives it a more prolonged therapeutic effect after administration.

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What is Meclonazepam?

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Introduction

Meclonazepam-3-methylclonazepam) was discovered by a team at Hoffmann-La Roche in the 1970s and is a drug which is a benzodiazepine derivative similar in structure to clonazepam. It has sedative and anxiolytic actions like those of other benzodiazepines, and also has anti-parasitic effects against the parasitic worm Schistosoma mansoni.

Meclonazepam was never used as medicine and instead appeared online as a designer drug.

Legal Issues

United Kingdom

In the UK, meclonazepam has been classified as a Class C drug by the May 2017 amendment to The Misuse of Drugs Act 1971 along with several other designer benzodiazepine drugs.

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What is Hydrazine?

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Introduction

The hydrazine antidepressants are a group of non-selective, irreversible monoamine oxidase inhibitors (MAOIs) which were discovered and initially marketed in the 1950s and 1960s. Most have been withdrawn due to toxicity, namely hepatotoxicity, but a few still remain in clinical use.

Tranylcypromine, a structurally unrelated MAOI introduced around the same time as the hydrazines, was originally advertised as non-hydrazine as a result of its diminished propensity for causing hepatotoxicity.

List of Hydrazine Antidepressants

  • Marketed:
    • Benmoxin (Neuralex, Nerusil) ‡
    • Iproclozide (Sursum) ‡
    • Iproniazid (Marsilid) ‡
    • Isocarboxazid (Marplan)
    • Mebanazine (Actomol) ‡
    • Nialamide (Niamid) ‡
    • Octamoxin (Ximaol, Nimaol) ‡
    • Phenelzine (Nardil)
    • Pheniprazine (Catron) ‡
    • Phenoxypropazine (Drazine) ‡
    • Pivhydrazine (Tersavid) ‡
    • Safrazine (Safra) ‡
  • Legend: ‡ = Withdrawn from the market; † = Partially discontinued; Bolded names indicate major drugs.
  • Never marketed:
    • Carbenzide
    • Cimemoxin
    • Domoxin
    • Metfendrazine
  • Parkinson’s:
    • Carbidopa
  • Tranquillosedative:
    • Centazolone

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