Level of insight and clinical features of obsessive-compulsive disorder with and without body dysmorphic disorder

Introduction: Body dysmorphic disorder (BDD) and obsessive-compulsive disorder (OCD) have several similarities and are included among the obsessive-compulsive spectrum of disorders. However, the content of preoccupations and level of insight of BDD patients differ from OCD patients. Objective: To compare the level of insight regarding obsessive-compulsive symptoms (OCS) and other clinical features in OCD patients with and without comorbid BDD. Methods: We evaluated 103 OCD patients (n=25, comorbid BDD), according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria using the Structured Clinical Interview for DSM-IV, the Yale-Brown Obsessive-Compulsive Scale, the University of Sao Paulo Sensory Phenomena Scale, the Beck Depression and Anxiety Inventories, and the Brown Assessment of Beliefs Scale. Resylts: The study groups differed significantly on several clinical features, including level of insight. A worse level of insight regarding OCS was independently associated with the presence of comorbid BDD. Lower educational level, more psychiatric comorbidities, presence of somatic and hoarding obsessions, and presence of intrusive images were associated with BDD comorbidity, even after adjusting for possible confounders. Conclusion: The presence of BDD in OCD patients is associated with poorer insight into obsessional beliefs and higher morbidity, reflected by lower educational levels and higher number of psychiatric comorbid disorders in general.

Dimensional correlates of poor insight in obsessive-compulsive disorder

Background: Cross-sectional studies have associated poor insight in patients with obsessive-compulsive disorder (OCD) with increased OCD symptom severity, earlier age of onset, comorbid depression, and treatment response. The goal of this current study was to examine the relationship between dimensions of OCD symptomatology and insight in a large clinical cohort of Brazilian patients with OCD. We hypothesized that poor insight would be associated with total symptom severity as well as with hoarding symptoms severity, specifically. Methods: 824 outpatients underwent a detailed clinical assessment for OCD, including the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS), the Brown Assessment of Beliefs Scale (BABS), a socio-demographic questionnaire, and the Structured Clinical Interview for axis I DSM-IV disorders (SCID-P). Tobit regression models were used to examine the association between level of insight and clinical variables of interest. Results: Increased severity of current and worst-ever hoarding symptoms and higher rate of unemployment were associated with poor insight in OCD after controlling for current OCD severity, age and gender. Poor insight was also correlated with increased severity of current OCD symptoms. Conclusion: Hoarding and overall OCD severity were significantly but weakly associated with level of insight in OCD patients. Further studies should examine insight as a moderator and mediator of treatment response in OCD in both behavioral therapy and pharmacological trials. Behavioral techniques aimed at enhancing insight may be potentially beneficial in OCD, especially among patients with hoarding. © 2011.

Instantes líricos de revelação: a narrativa poética em A paixão segundo G. H

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

O papel da memória na pedagogia da morte (século XV)

Pós-graduação em História - FCHS

Trans-formações (a) temporais em Il Decameron: de Pasolini a Boccacio

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

A syntactic realization theorem for justification logics

Justification logics are refinements of modal logics where modalities are replaced by justification terms. They are connected to modal logics via so-called realization theorems. We present a syntactic proof of a single realization theorem that uniformly connects all the normal modal logics formed from the axioms \$mathsfd\$, \$mathsft\$, \$mathsfb\$, \$mathsf4\$, and \$mathsf5\$ with their justification counterparts. The proof employs cut-free nested sequent systems together with Fitting's realization merging technique. We further strengthen the realization theorem for \$mathsfKB5\$ and \$mathsfS5\$ by showing that the positive introspection operator is superfluous.

Risk Judgment in Obsessive-Compulsive Disorder: Testing a Dual-Systems Account

Dual-systems theorists posit distinct modes of reasoning. The intuition system reasons automatically and its processes are unavailable to conscious introspection. The deliberation system reasons effortfully while its processes recruit working memory. The current paper extends the application of such theories to the study of Obsessive-Compulsive Disorder (OCD). Patients with OCD often retain insight into their irrationality, implying dissociable systems of thought: intuition produces obsessions and fears that deliberation observes and attempts (vainly) to inhibit. To test the notion that dual-systems theory can adequately describe OCD, we obtained speeded and unspeeded risk judgments from OCD patients and non-anxious controls in order to quantify the differential effects of intuitive and deliberative reasoning. As predicted, patients deemed negative events to be more likely than controls. Patients also took more time in producing judgments than controls. Furthermore, when forced to respond quickly patients' judgments were more affected than controls'. Although patients did attenuate judgments when given additional time, their estimates never reached the levels of controls'. We infer from these data that patients have genuine difficulty inhibiting their intuitive cognitive system. Our dual-systems perspective is compatible with current theories of the disorder. Similar behavioral tests may prove helpful in better understanding related anxiety disorders. (C) 2013 Elsevier Ltd. All rights reserved.

Effects of expectation and caffeine on arousal, well-being, and reaction time

The objective of this study is to determine the impact of expectation associated with placebo and caffeine ingestion. We used a three-armed, randomized, double-blind design. Two three-armed experiments varying instruction (true, false, control) investigated the role of expectations of changes in arousal (blood pressure, heart rate), subjective well-being, and reaction time (RT). In Experiment 1 (N = 45), decaffeinated coffee was administered, and expectations were produced in one group by making them believe they had ingested caffeinated coffee. In Experiment 2 (N = 45), caffeinated orange juice was given in both experimental groups, but only one was informed about the true content. In Experiment 1, a significant effect for subjective alertness was found in the placebo treatment compared to the control group. However, for RT and well-being no significant effects were found. In Experiment 2, no significant expectancy effects were found. Caffeine produced large effects for blood pressure in both treatments compared to the control group, but the effects were larger for the false information group. For subjective well-being (alertness, calmness), considerable but nonsignificant changes were found for correctly informed participants, indicating possible additivity of pharmacologic effect and expectations. The results tentatively indicate that placebo and expectancy effects primarily show through introspection.

A Note on the Use of Sum in the Logic of Proofs

The Logic of Proofs~LP, introduced by Artemov, encodes the same reasoning as the modal logic~S4 using proofs explicitly present in the language. In particular, Artemov showed that three operations on proofs (application~$\cdot$, positive introspection~!, and sum~+) are sufficient to mimic provability concealed in S4~modality. While the first two operations go back to G{\"o}del, the exact role of~+ remained somewhat unclear. In particular, it was not known whether the other two operations are sufficient by themselves. We provide a positive answer to this question under a very weak restriction on the axiomatization of LP.

Shakespeare, the Middle Ages and the Luck of the British: Medievalism and National Identity in The Hollow Crown (2012)

Images of the medieval past have long been fertile soil for the identity politics of subsequent periods. Rather than “authentically” reproducing the Middle Ages, medievalism therefore usually tells us more about the concerns and ideological climate of its own time and place of origin. To dramatise the nascent nation, Shakespeare resorts to medievalism in his history plays. Centuries later, the BBC-produced television mini-serial The Hollow Crown – adapting Shakespeare’s second histories tetralogy – revamps this negotiation of national identity for the “Cultural Olympiad” in the run-up to the 2012 London Olympics. In this context of celebratory introspection, The Hollow Crown weaves a genealogical narrative consisting of the increasingly “glorious” medieval history depicted and “national” Shakespearean heritage in order to valorise 21st-century “Britishness”. Encouraging a reading of the histories as medieval history, the films construct an ostensibly inclusive, liberal-minded national identity grounded in this history. Moreover, medieval kingship is represented in distinctly sentimentalising and humanising terms, fostering emotional identification especially with the no longer ambivalent Hal/Henry V and making him an apt model for present-day British grandeur. However, the fact that the films in return marginalise female, Scottish, Irish and Welsh characters gives rise to doubts as to whether this vision of Shakespeare’s Middle Ages really is, as the producers claimed, “for everybody”.

“Crye Fredome”? Medievalism and Twenty-First-Century Scottish National Identity

It is a well-documented fact that the Middle Ages have had a long history of instrumentalisation by nationalisms. 19th-century Eu¬rope in particular witnessed an origins craze during the process of nation-building. In the post-Shoah, post-modern West, on the other hand, we might expect this kind of medievalist master nar¬rative to have been consigned to the dustbin of history. And yet, as nationalism surges again in Europe, negotiations of national identi¬ties in medieval dress seem to have become fashionable once more. In order to come to terms with the fragmented and often contradictory presence of the Middle Ages in these discourses of national identity, I propose we consider medievalism a utilitarian product of the cultural memory. Rather than representing any ‘real’ Middle Ages, then, medievalism tailors available knowledge of the medieval past to the diverse social needs and ideologies of the present. This paper looks at a selection of Scottish examples of present-day medievalism in an attempt to investigate, in particular, the place of the medieval Wars of Scottish Independence in contemporary negotiations of ‘Scottishness’. Both the relationships envisioned between self and other and the role played by ‘the land’ in these cultural, social and political instances of national introspection offer starting points for critical inquiry. Moreover, the analysis of a scholarly intervention in the run-up to the 2014 Scottish independence referendum indicates an intriguing dialogue of academic and non-academic voices in the context of Scottish medievalist cultural memory. We thus find a wide array of uses of the Scottish Middle Ages, some of which feed into the burgeoning nationalism of recent years, while others offer more pensive and ambivalent answers to the question of what it means to be Scottish in the 21st century.

Nurse likelihood to report a pediatric medication error: Examination of the "pre-reporting" period

Each year, hospitalized patients experience 1.5 million preventable injuries from medication errors and hospitals incur an additional $3.5 billion in cost (Aspden, Wolcott, Bootman, & Cronenwatt; (2007). It is believed that error reporting is one way to learn about factors contributing to medication errors. And yet, an estimated 50% of medication errors go unreported. This period of medication error pre-reporting, with few exceptions, is underexplored. The literature focuses on error prevention and management, but lacks a description of the period of introspection and inner struggle over whether to report an error and resulting likelihood to report. Reporting makes a nurse vulnerable to reprimand, legal liability, and even threat to licensure. For some nurses this state may invoke a disparity between a person‘s belief about him or herself as a healer and the undeniable fact of the error.^ This study explored the medication error reporting experience. Its purpose was to inform nurses, educators, organizational leaders, and policy-makers about the medication error pre-reporting period, and to contribute to a framework for further investigation. From a better understanding of factors that contribute to or detract from the likelihood of an individual to report an error, interventions can be identified to help the nurse come to a psychologically healthy resolution and help increase reporting of error in order to learn from error and reduce the possibility of future similar error.^ The research question was: "What factors contribute to a nurse's likelihood to report an error?" The specific aims of the study were to: (1) describe participant nurses' perceptions of medication error reporting; (2) describe participant explanations of the emotional, cognitive, and physical reactions to making a medication error; (3) identify pre-reporting conditions that make it less likely for a nurse to report a medication error; and (4) identify pre-reporting conditions that make it more likely for a nurse to report a medication error.^ A qualitative research study was conducted to explore the medication error experience and in particular the pre-reporting period from the perspective of the nurse. A total of 54 registered nurses from a large private free-standing not-for-profit children's hospital in the southwestern United States participated in group interviews. The results describe the experience of the nurse as well as the physical, emotional, and cognitive responses to the realization of the commission of a medication error. The results also reveal factors that make it more and less likely to report a medication error.^ It is clear from this study that upon realization that he or she has made a medication error, a nurse's foremost concern is for the safety of the patient. Fear was also described by each group of nurses. The nurses described a fear of several things including physician reaction, manager reaction, peer reaction, as well as family reaction and possible lack of trust as a result. Another universal response was the description of a struggle with guilt, shame, imperfection, blaming oneself, and questioning one's competence.^

Leerse a sí mismo : Hermenéutica, política y retórica en Thomas Hobbes

El reconocimiento del conflicto como realidad constitutiva de lo humano y la necesidad de un cierre que pasa por la fijación de la palabra justa encuentran en Hobbes su primera formulación. El pasaje de la instancia retórico-interpretativa a la axiomático-científica se da en Leviatan a través de tres momentos: introspectivo, contractual, estadual; su despliegue permite reconocer a la hermenéutica como resorte imprescindible para la implantación de un orden político fundado en la articulación entre ser (una antropología), decir (una retórica) y actuar (una praxis). El intérprete resulta así un operador clave en el ajuste de las instancias natural y político-social

Entrelíneas para una introspección poética : Rubén Darío y Antonio Machado en 1903

Este trabajo intenta mostrar una actitud poética común coincidente entre Antonio Machado y Rubén Darío. Dicha actitud, que consiste en defender la introspección como fórmula adecuada para la expresión poética, es perceptible en un momento determinado de la trayectoria poética individual de cada uno. Sin embargo, es interesante ver cómo se muestra en el diálogo estético que ambos establecen a través de su creación como ofrenda al otro: aquellos poemas en los que el paratexto se dedica al otro pero el texto no se adecua (no utilizan el ritmo, el tono y el léxico) a quien va dirigida la dedicatoria. Obras que son parte de uno mismo, canto a sí mismo, y, sin embargo, se ofrecen al otro. Esta ofrenda puede apreciarse, desde nuestra perspectiva, en dos poemas concretos: "El canto de los niños", y "Caracol". Dedicados del uno al otro, son analizados en coincidencia estética entre Darío y Machado en torno a la fecha de 1903.

Leerse a sí mismo : Hermenéutica, política y retórica en Thomas Hobbes

El reconocimiento del conflicto como realidad constitutiva de lo humano y la necesidad de un cierre que pasa por la fijación de la palabra justa encuentran en Hobbes su primera formulación. El pasaje de la instancia retórico-interpretativa a la axiomático-científica se da en Leviatan a través de tres momentos: introspectivo, contractual, estadual; su despliegue permite reconocer a la hermenéutica como resorte imprescindible para la implantación de un orden político fundado en la articulación entre ser (una antropología), decir (una retórica) y actuar (una praxis). El intérprete resulta así un operador clave en el ajuste de las instancias natural y político-social