{"title":"Effects of cannabidiol on symptoms in people at clinical high risk for psychosis.","authors":"Sagnik Bhattacharyya,Elizabeth Appiah-Kusi,Robin Wilson,Aisling O'Neill,Michael Brammer,Steven Williams,Jesus Perez,Matthijs G Bossong,Philip McGuire","doi":"10.1002/wps.21253","DOIUrl":"https://doi.org/10.1002/wps.21253","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"22 1","pages":"451-452"},"PeriodicalIF":73.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142246833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hussien Elkholy,Roshan Bhad,Hamed Ekhtiari,Alexander M Baldacchino
{"title":"Addictive disorders through the lens of the WPA Section on Addiction Psychiatry.","authors":"Hussien Elkholy,Roshan Bhad,Hamed Ekhtiari,Alexander M Baldacchino","doi":"10.1002/wps.21256","DOIUrl":"https://doi.org/10.1002/wps.21256","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"35 1","pages":"459-460"},"PeriodicalIF":73.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142246769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Shifting the pendulum - but with checks and balances.","authors":"Tilman Steinert","doi":"10.1002/wps.21232","DOIUrl":"https://doi.org/10.1002/wps.21232","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"48 1","pages":"388-389"},"PeriodicalIF":73.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142246778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Advance care planning: a multifaceted contributor to human rights-based care.","authors":"Heather Zelle","doi":"10.1002/wps.21234","DOIUrl":"https://doi.org/10.1002/wps.21234","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"13 1","pages":"391-392"},"PeriodicalIF":73.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142246788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The ICD-11 CDDR: benefits to health systems and clinical care.","authors":"Oye Gureje","doi":"10.1002/wps.21250","DOIUrl":"https://doi.org/10.1002/wps.21250","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"64 1","pages":"447-448"},"PeriodicalIF":73.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142246824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giampaolo Perna,Daniela Caldirola,Alan F Schatzberg,Charles B Nemeroff
{"title":"Advancements, challenges and future horizons in personalized psychiatry.","authors":"Giampaolo Perna,Daniela Caldirola,Alan F Schatzberg,Charles B Nemeroff","doi":"10.1002/wps.21257","DOIUrl":"https://doi.org/10.1002/wps.21257","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"5 1","pages":"460-461"},"PeriodicalIF":73.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142246782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Physician-assisted dying in people with mental health conditions - whose choice?","authors":"M E Jan Wise","doi":"10.1002/wps.21235","DOIUrl":"https://doi.org/10.1002/wps.21235","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"4 1","pages":"395-396"},"PeriodicalIF":73.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142246770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>In 1966, a researcher at the Massachusetts Institute of Technology introduced ELIZA, a computer program that simulated a psychotherapist in the Rogerian tradition, rephrasing a patient's words into questions according to simple but effective scripts. This was one of the first (and few) successes of early artificial intelligence (AI). To the dismay of its creator, some people took ELIZA for a real psychotherapist, perhaps because of our innate tendency to project consciousness when we detect intelligence, especially intelligent speech.</p> <p>ELIZA's stuttering attempt at AI has now become an immensely eloquent golem. ChatGPT can easily outspeak, outwrite and outperform S. Freud. Because large language models (LLM) benefit from superhuman lexicon, knowledge, memory and speed, artificial brains can now trump natural ones in most tasks.</p> <p>ELIZA was named after the flower-girl in G.B. Shaw's play Pygmalion, supposedly because it learned to improve its speech with practice. The original myth of Pygmalion – the sculptor who carved the ideal woman Galatea out of ivory and hoped to bring her to life – is even more apt: does the creation of AI portend artificial consciousness, perhaps even superhuman consciousness? Two camps are beginning to emerge, with radically different answers to this question.</p> <p>According to the dominant computational/functionalist stance in cognitive neuroscience, the answer is yes<span><sup>1</sup></span>. Cognitive neuroscience assumes that we are ultimately machines running sophisticated software (that can derail and be reprogrammed). Neural algorithms recognize objects and scenes, direct attention, hold items in working memory, and store them in long-term memory. Complex neural computations drive cognitive control, decision making, emotional reactions, social behaviors, and of course language. In this view, consciousness must be just another function, perhaps the global broadcasting of information<span><sup>2</sup></span> or the metacognitive assessment of sensory inputs<span><sup>3</sup></span>. In this case, whenever computers can reproduce the same functions as our brain, just implemented differently (the functionalists’ “multiple realizability”), they will be conscious like we are.</p> <p>Admittedly, despite LLMs sounding a lot like conscious humans nowadays, there is no principled way for determining whether they are already conscious and, if so, in which ways and to what degree<span><sup>1</sup></span>. Nor is it clear how we might establish whether they feel anything (just asking, we suspect, might not do…).</p> <p>Cognitive neuroscience typically takes the <i>extrinsic perspective</i>, introduced by Galileo, which has been immensely successful in much of science. From this perspective, consciousness is either a “user illusion”<span><sup>4</sup></span>, or a mysterious “emergent” property. However, as recognized long ago by Leibniz, this leaves experience – what we see, hear, think and feel – entirely unacco
{"title":"Artificial intelligence, consciousness and psychiatry","authors":"Giulio Tononi, Charles Raison","doi":"10.1002/wps.21222","DOIUrl":"https://doi.org/10.1002/wps.21222","url":null,"abstract":"<p>In 1966, a researcher at the Massachusetts Institute of Technology introduced ELIZA, a computer program that simulated a psychotherapist in the Rogerian tradition, rephrasing a patient's words into questions according to simple but effective scripts. This was one of the first (and few) successes of early artificial intelligence (AI). To the dismay of its creator, some people took ELIZA for a real psychotherapist, perhaps because of our innate tendency to project consciousness when we detect intelligence, especially intelligent speech.</p>\u0000<p>ELIZA's stuttering attempt at AI has now become an immensely eloquent golem. ChatGPT can easily outspeak, outwrite and outperform S. Freud. Because large language models (LLM) benefit from superhuman lexicon, knowledge, memory and speed, artificial brains can now trump natural ones in most tasks.</p>\u0000<p>ELIZA was named after the flower-girl in G.B. Shaw's play Pygmalion, supposedly because it learned to improve its speech with practice. The original myth of Pygmalion – the sculptor who carved the ideal woman Galatea out of ivory and hoped to bring her to life – is even more apt: does the creation of AI portend artificial consciousness, perhaps even superhuman consciousness? Two camps are beginning to emerge, with radically different answers to this question.</p>\u0000<p>According to the dominant computational/functionalist stance in cognitive neuroscience, the answer is yes<span><sup>1</sup></span>. Cognitive neuroscience assumes that we are ultimately machines running sophisticated software (that can derail and be reprogrammed). Neural algorithms recognize objects and scenes, direct attention, hold items in working memory, and store them in long-term memory. Complex neural computations drive cognitive control, decision making, emotional reactions, social behaviors, and of course language. In this view, consciousness must be just another function, perhaps the global broadcasting of information<span><sup>2</sup></span> or the metacognitive assessment of sensory inputs<span><sup>3</sup></span>. In this case, whenever computers can reproduce the same functions as our brain, just implemented differently (the functionalists’ “multiple realizability”), they will be conscious like we are.</p>\u0000<p>Admittedly, despite LLMs sounding a lot like conscious humans nowadays, there is no principled way for determining whether they are already conscious and, if so, in which ways and to what degree<span><sup>1</sup></span>. Nor is it clear how we might establish whether they feel anything (just asking, we suspect, might not do…).</p>\u0000<p>Cognitive neuroscience typically takes the <i>extrinsic perspective</i>, introduced by Galileo, which has been immensely successful in much of science. From this perspective, consciousness is either a “user illusion”<span><sup>4</sup></span>, or a mysterious “emergent” property. However, as recognized long ago by Leibniz, this leaves experience – what we see, hear, think and feel – entirely unacco","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"3 1","pages":""},"PeriodicalIF":73.3,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giorgia Michelini, Christina O. Carlisi, Nicholas R. Eaton, Jed T. Elison, John D. Haltigan, Roman Kotov, Robert F. Krueger, Robert D. Latzman, James J. Li, Holly F. Levin-Aspenson, Giovanni A. Salum, Susan C. South, Kasey Stanton, Irwin D. Waldman, Sylia Wilson
Features of autism spectrum disorder, attention-deficit/hyperactivity disorder, learning disorders, intellectual disabilities, and communication and motor disorders usually emerge early in life and are associated with atypical neurodevelopment. These “neurodevelopmental conditions” are grouped together in the DSM-5 and ICD-11 to reflect their shared characteristics. Yet, reliance on categorical diagnoses poses significant challenges in both research and clinical settings (e.g., high co-occurrence, arbitrary diagnostic boundaries, high within-disorder heterogeneity). Taking a transdiagnostic dimensional approach provides a useful alternative for addressing these limitations, accounting for shared underpinnings across neurodevelopmental conditions, and characterizing their common co-occurrence and developmental continuity with other psychiatric conditions. Neurodevelopmental features have not been adequately considered in transdiagnostic psychiatric frameworks, although this would have fundamental implications for research and clinical practices. Growing evidence from studies on the structure of neurodevelopmental and other psychiatric conditions indicates that features of neurodevelopmental conditions cluster together, delineating a “neurodevelopmental spectrum” ranging from normative to impairing profiles. Studies on shared genetic underpinnings, overlapping cognitive and neural profiles, and similar developmental course and efficacy of support/treatment strategies indicate the validity of this neurodevelopmental spectrum. Further, characterizing this spectrum alongside other psychiatric dimensions has clinical utility, as it provides a fuller view of an individual's needs and strengths, and greater prognostic utility than diagnostic categories. Based on this compelling body of evidence, we argue that incorporating a new neurodevelopmental spectrum into transdiagnostic frameworks has considerable potential for transforming our understanding, classification, assessment, and clinical practices around neurodevelopmental and other psychiatric conditions.
{"title":"Where do neurodevelopmental conditions fit in transdiagnostic psychiatric frameworks? Incorporating a new neurodevelopmental spectrum","authors":"Giorgia Michelini, Christina O. Carlisi, Nicholas R. Eaton, Jed T. Elison, John D. Haltigan, Roman Kotov, Robert F. Krueger, Robert D. Latzman, James J. Li, Holly F. Levin-Aspenson, Giovanni A. Salum, Susan C. South, Kasey Stanton, Irwin D. Waldman, Sylia Wilson","doi":"10.1002/wps.21225","DOIUrl":"https://doi.org/10.1002/wps.21225","url":null,"abstract":"Features of autism spectrum disorder, attention-deficit/hyperactivity disorder, learning disorders, intellectual disabilities, and communication and motor disorders usually emerge early in life and are associated with atypical neurodevelopment. These “neurodevelopmental conditions” are grouped together in the DSM-5 and ICD-11 to reflect their shared characteristics. Yet, reliance on categorical diagnoses poses significant challenges in both research and clinical settings (e.g., high co-occurrence, arbitrary diagnostic boundaries, high within-disorder heterogeneity). Taking a transdiagnostic dimensional approach provides a useful alternative for addressing these limitations, accounting for shared underpinnings across neurodevelopmental conditions, and characterizing their common co-occurrence and developmental continuity with other psychiatric conditions. Neurodevelopmental features have not been adequately considered in transdiagnostic psychiatric frameworks, although this would have fundamental implications for research and clinical practices. Growing evidence from studies on the structure of neurodevelopmental and other psychiatric conditions indicates that features of neurodevelopmental conditions cluster together, delineating a “neurodevelopmental spectrum” ranging from normative to impairing profiles. Studies on shared genetic underpinnings, overlapping cognitive and neural profiles, and similar developmental course and efficacy of support/treatment strategies indicate the validity of this neurodevelopmental spectrum. Further, characterizing this spectrum alongside other psychiatric dimensions has clinical utility, as it provides a fuller view of an individual's needs and strengths, and greater prognostic utility than diagnostic categories. Based on this compelling body of evidence, we argue that incorporating a new neurodevelopmental spectrum into transdiagnostic frameworks has considerable potential for transforming our understanding, classification, assessment, and clinical practices around neurodevelopmental and other psychiatric conditions.","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"36 1","pages":""},"PeriodicalIF":73.3,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Galderisi et al<span><sup>1</sup></span> provide an excellent overview of the complex ethical challenges in psychiatry. We subscribe to the authors’ criticism of mental health laws employing a “disorder + risk” schema for involuntary intervention, and their conclusion that these laws discriminate against people with a mental health condition. The authors put forward instead a “single law” proposal in which “involuntary treatment would only be permitted when the objecting person has an impairment of decision-making ability – from any cause – and if treatment is in the person's best interests”<span><sup>1</sup></span>. We strongly endorse the core of this proposal, but would like to suggest three refinements to it.</p> <p>First, we propose combining capacity assessment with supported decision-making, to ensure that no one is found to lack decision-making capacity before all reasonably available resources of supported decision-making have been exhausted. Second, we propose replacing the best interests standard by the substituted judgment standard, to achieve a closer alignment of substitute decisions with the will and preferences of the person concerned. Third, we suggest to explicitly define additional criteria for involuntary intervention, to avoid what we will call “the fallacious inference from substitute decision-making to coercion”. The proposed refinements are based on what we call the “combined supported decision-making model”, a model for the informed consent process that provides a non-discriminatory basis for decision-making about involuntary intervention<span><sup>2-5</sup></span>. In this commentary, we focus on the last two refinements.</p> <p>Galderisi et al refer to a terminological distinction used in a judgment of the German Federal Constitutional Court to show that the “single law” proposal is consistent with the general principles of the United Nations (UN) Convention on the Rights of People with Disabilities (CRPD) and the wording of Article 12, particularly its insistence that “measures relating to the exercise of legal capacity respect the rights, will and preferences of the person”. The terminological distinction is between “free will” (<i>freier Wille</i>) and “natural will” (<i>natürlicher Wille</i>), which, according to the authors, maps on to the CRPD's distinction between “will” and “preferences”.</p> <p>This terminological distinction plays an important role in the legal discourse around the German guardianship law (<i>Betreuungsrecht</i>), which is part of the German Civil Code and applies to all people who need support in managing their own affairs, regardless of whether they have a mental health condition<span><sup>6</sup></span>. The term “free will” (<i>freier Wille</i>) refers to the contemporaneous preferences of a person who possesses decision-making capacity regarding the decision at hand. Expressions of a person's free will must be respected by clinicians and have the status of consent or withdrawal of cons
{"title":"Aligning the “single law” proposal to the CRPD standard of “will and preferences”","authors":"Jakov Gather, Matthé Scholten","doi":"10.1002/wps.21233","DOIUrl":"https://doi.org/10.1002/wps.21233","url":null,"abstract":"<p>Galderisi et al<span><sup>1</sup></span> provide an excellent overview of the complex ethical challenges in psychiatry. We subscribe to the authors’ criticism of mental health laws employing a “disorder + risk” schema for involuntary intervention, and their conclusion that these laws discriminate against people with a mental health condition. The authors put forward instead a “single law” proposal in which “involuntary treatment would only be permitted when the objecting person has an impairment of decision-making ability – from any cause – and if treatment is in the person's best interests”<span><sup>1</sup></span>. We strongly endorse the core of this proposal, but would like to suggest three refinements to it.</p>\u0000<p>First, we propose combining capacity assessment with supported decision-making, to ensure that no one is found to lack decision-making capacity before all reasonably available resources of supported decision-making have been exhausted. Second, we propose replacing the best interests standard by the substituted judgment standard, to achieve a closer alignment of substitute decisions with the will and preferences of the person concerned. Third, we suggest to explicitly define additional criteria for involuntary intervention, to avoid what we will call “the fallacious inference from substitute decision-making to coercion”. The proposed refinements are based on what we call the “combined supported decision-making model”, a model for the informed consent process that provides a non-discriminatory basis for decision-making about involuntary intervention<span><sup>2-5</sup></span>. In this commentary, we focus on the last two refinements.</p>\u0000<p>Galderisi et al refer to a terminological distinction used in a judgment of the German Federal Constitutional Court to show that the “single law” proposal is consistent with the general principles of the United Nations (UN) Convention on the Rights of People with Disabilities (CRPD) and the wording of Article 12, particularly its insistence that “measures relating to the exercise of legal capacity respect the rights, will and preferences of the person”. The terminological distinction is between “free will” (<i>freier Wille</i>) and “natural will” (<i>natürlicher Wille</i>), which, according to the authors, maps on to the CRPD's distinction between “will” and “preferences”.</p>\u0000<p>This terminological distinction plays an important role in the legal discourse around the German guardianship law (<i>Betreuungsrecht</i>), which is part of the German Civil Code and applies to all people who need support in managing their own affairs, regardless of whether they have a mental health condition<span><sup>6</sup></span>. The term “free will” (<i>freier Wille</i>) refers to the contemporaneous preferences of a person who possesses decision-making capacity regarding the decision at hand. Expressions of a person's free will must be respected by clinicians and have the status of consent or withdrawal of cons","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"237 1","pages":""},"PeriodicalIF":73.3,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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