Journal articles on the topic 'Acquired obsessive-compulsive symptoms'

Obsessive-compulsive disorder (OCD) is a mental illness causing patients to suffer from recurring undesirable thoughts (obsessions) conducting to do affairs repetitively (compulsions). Brain signals recorded by Electroencephalogram (EEG) can be analyzed in order to present a diagnostic procedure considering the localization approach. In this study, the signals acquired by EEG have been recorded from three groups; two case groups; patients with severe obsessive symptoms and patients with severe compulsive symptoms, and one healthy control group. Brain signal processing techniques have been applied on the signals emitted from frontal and parieto-occipital regions to discover the features leading to the best discrimination between case groups and healthy controls. In this regard, after preprocessing, the features of time and frequency domains presenting the significant meaningful relation were nominated for classification by linear discrimination analysis (LDA). Although the parieto-occipital region performed better in the diagnosis for both obsessive and compulsive groups, the features gained from the frontal cortex resulted in better discrimination for only the compulsive group. In addition, time domain features had a more significant influence in diagnosis rather than frequency domain for both case groups. The study presented particular characteristics of brain signals in two dimensions of OCD in specific brain regions leading to more accurate presurgical assessments in the studies between the affected brain regions and behavioral issues.

Coprophagia or the ingestion of faeces has been associated with medical conditions (seizure disorders, cerebral atrophy and tumours) and psychiatric disorders (mental retardation, alcoholism, depression, obsessive compulsive disorder, schizophrenia, fetishes, delirium and dementia). The case of a woman in her 30s presenting with coprophagia and psychotic symptoms following hypoxic brain injury is reported. The case is discussed and literature is reviewed. We investigate cariprazine, a relatively new atypical antipsychotic for treating coprophagia, associated with psychotic symptoms. Psychiatric evaluation revealed cognitive dysfunction and psychotic symptoms. Physical examination and laboratory evaluation were unremarkable. She was treated with haloperidol resulting in resolution of coprophagia. Attempts at switching to alternative antipsychotics, due to side effects, resulted in recurrence of coprophagia. Subsequent relapses required higher doses of haloperidol for remission of coprophagia and psychotic symptoms. She finally responded to cariprazine. While firm conclusions are not possible from the experience of a single case, we suggest cariprazine may also be a treatment option for coprophagia, particularly in patients with psychotic symptoms.

BackgroundStudying the distribution of anatomical abnormalities over the entire cortical surface can help to identify key neural circuits implicated in generating symptoms of neuropsychiatric disorders. There is a significant inconsistency among studies investigating the neuroanatomy of obsessive–compulsive disorder (OCD) because of the confounding influence of co-morbid depression and medication use and the lack of unbiased estimation of whole-brain morphometric changes. It is also unknown whether the distinct surface anatomical properties of thickness, surface area and gyrification, which collectively contribute to grey matter volume (GMV), are independently affected in OCD.MethodThe cortical maps of thickness, gyrification and surface areal change were acquired from 23 unmedicated OCD patients and 20 healthy controls using an unbiased whole-brain surface-based morphometric (SBM) method to detect regional changes in OCD. Subcortical structures were not assessed in this study.ResultsPatients showed a significant increase in the right inferior parietal cortical thickness. Significant increases in gyrification were also noted in the left insula, left middle frontal and left lateral occipital regions extending to the precuneus and right supramarginal gyrus in OCD. Areal contraction/expansion maps revealed no significant regional differences between the patients and controls. In patients, gyrification of the insula significantly predicted the symptom severity measured using Yale–Brown Obsessive–Compulsive Scale (YBOCS).ConclusionsAn alteration in the cortical surface anatomy is an important feature of OCD seen in unmedicated samples that relates to the severity of the illness. The results underscore the presence of a neurodevelopmental aberration underlying the pathophysiology of OCD.

AbstractIntroductionThe aim of this study was to investigate white matter (WM) abnormalities in obsessive-compulsive disorder (OCD) and its relationship to severity of obsessive-compulsive symptoms.MethodsConventional and diffusion tensor imaging were acquired in nine patients with OCD and nine gender- and age-matched healthy volunteers. Changes in fractional anisotropy (FA) and mean diffusivity (MD) were investigated using selected regions of interest (ROIs) analyses and whole brain tract-based spatial statistic analyses. A priori ROIs were placed bilaterally in internal capsule (IC), superior longitudinal fascicule (SLF), cingulate bundle (CB), and corpus calosum (CC).ResultsROIs analyses showed that, as compared to healthy volunteers, patients with OCD exhibited reduced FA values bilaterally in regions of the posterior limb of the IC and in the SLF and increased MD values bilaterally in the posterior limb of the IC, in the left CB, and in the splenium of CC. Voxelwise analysis showed that, as compared to controls, patients with OCD exhibited reduced FA and increased MD in regions of the cortical spinal tract (genu and posterior limb of internal capsule and corona radiata) and the SLF. Severity of OCD correlated with WM alterations in different brain regions, ie, the left (rho=0.70 [MD]) and right (rho=0.70 [MD]) anterior limb of the IC, the left (rho=0.97 [MD]) and right SLF (rho=0.81 [MD]), and the genu of CC (rho=0.66 [MD]; rho=-0.69 [FA]).ConclusionOur findings support the involvement of different WM tracts in OCD and suggest that greater impairment in WM integrity is associated with increased severity of OCD symptoms.

Background Obsessive-compulsive disorder (OCD) is characterized by recurrent intrusive thoughts, urges, or images (obsessions) and repetitive physical or mental behaviors (compulsions). Previous factor analytic and clustering studies suggest the presence of three or four subtypes of OCD symptoms. However, these studies have relied on predefined symptom checklists, which are limited in breadth and may be biased toward researchers’ previous conceptualizations of OCD. Objective In this study, we examine a large data set of freely reported obsession symptoms obtained from an OCD mobile app as an alternative to uncovering potential OCD subtypes. From this, we examine data-driven clusters of obsessions based on their latent semantic relationships in the English language using word embeddings. Methods We extracted free-text entry words describing obsessions in a large sample of users of a mobile app, NOCD. Semantic vector space modeling was applied using the Global Vectors for Word Representation algorithm. A domain-specific extension, Mittens, was also applied to enhance the corpus with OCD-specific words. The resulting representations provided linear substructures of the word vector in a 100-dimensional space. We applied principal component analysis to the 100-dimensional vector representation of the most frequent words, followed by k-means clustering to obtain clusters of related words. Results We obtained 7001 unique words representing obsessions from 25,369 individuals. Heuristics for determining the optimal number of clusters pointed to a three-cluster solution for grouping subtypes of OCD. The first had themes relating to relationship and just-right; the second had themes relating to doubt and checking; and the third had themes relating to contamination, somatic, physical harm, and sexual harm. All three clusters showed close semantic relationships with each other in the central area of convergence, with themes relating to harm. An equal-sized split-sample analysis across individuals and a split-sample analysis over time both showed overall stable cluster solutions. Words in the third cluster were the most frequently occurring words, followed by words in the first cluster. Conclusions The clustering of naturally acquired obsessional words resulted in three major groupings of semantic themes, which partially overlapped with predefined checklists from previous studies. Furthermore, the closeness of the overall embedded relationships across clusters and their central convergence on harm suggests that, at least at the level of self-reported obsessional thoughts, most obsessions have close semantic relationships. Harm to self or others may be an underlying organizing theme across many obsessions. Notably, relationship-themed words, not previously included in factor-analytic studies, clustered with just-right words. These novel insights have potential implications for understanding how an apparent multitude of obsessional symptoms are connected by underlying themes. This observation could aid exposure-based treatment approaches and could be used as a conceptual framework for future research.

Introduction Obsessive-compulsive disorder (OCD) is a disabling psychiatric disorder that affects 2-3% of the population. Pharmacological or cognitive behavioral therapy can reduce symptoms. Deep brain stimulation is emerging for treatment-resistant patients. Objectives We measured neuronal activity in two patients with treatment-resistant OCD, who had DBS electrodes implanted bilaterally in the BNST. Local field potentials were recorded directly from the BNST during and without symptom provocation and without electrical stimulation. Methods In two patients with a diagnosis of treatment resistant OCD (TR-OCD) local field potentials (LFP) were recorded as part of their clinical follow up post-implantation. In both patients, the diagnosis of TR-OCD was confirmed by a neuropsychiatric examination and a multidisciplinary committee comprising both experienced psychiatrists and neurosurgeons from different medical centers in Belgium. We used BrainSense recording technology in the Percept PC to record the LFPs. The LFP recordings in the first patient were acquired on the 15th day after DBS surgery. In the second patient, the interval between implantation and recording was 18 days. Symptom provocation was performed using the MOCCS image set, developed by Mataix-Cols. Results At rest, relative power peaks in the BNST were highest in the theta (4-8 Hz) frequency band for both patients. In both patients switching DBS ON during provocation images appears to cause the LFP signal to closely resemble that recorded during neutral images. Conclusions The main finding of this pilot study is that switching stimulation ON in the BNST during provocation images causes the LFP signal to more closely resemble the LFP recorded during neutral images. Disclosure No significant relationships.

ObjectiveTo investigate the relationship between the severities of symptom dimensions in obsessive-compulsive disorder (OCD) and white matter alterations.MethodsWe applied tract-based spatial statistics for diffusion tensor imaging (DTI) acquired by 3T magnetic resonance imaging. First, we compared fractional anisotropy (FA) between 20 OCD patients and 30 healthy controls (HC). Then, applying whole brain analysis, we searched the brain regions showing correlations between the severities of symptom dimensions assessed by Obsessive-Compulsive Inventory-Revised and FA in all participants. Finally, we calculated the correlations between the six symptom dimensions and multiple DTI measures [FA, axial diffusivity (AD), radial diffusivity (RD), mean diffusivity (MD)] in a region-of-interest (ROI) analysis and explored the differences between OCD patients and HC.ResultsThere were no between-group differences in FA or brain region correlations between the severities of symptom dimensions and FA in any of the participants. ROI analysis revealed negative correlations between checking severity and left inferior frontal gyrus white matter and left middle temporal gyrus white matter and a positive correlation between ordering severity and right precuneus in FA in OCD compared with HC. We also found negative correlations between ordering severity and right precuneus in RD, between obsessing severities and right supramarginal gyrus in AD and MD, and between hoarding severity and right insular gyrus in AD.ConclusionOur study supported the hypothesis that the severities of respective symptom dimensions are associated with different patterns of white matter alterations.

Motivation/Background: We aim at presenting a case that would circumscribe to the concept of schizo-obsessive disorder, in which the onset at the end of adolescence was with OC phenomenology, the negative symptoms appearing subsequently, while the productive perceptual and ideational area (auditory hallucinations and pseudohallucinations, next to the reference delusional ideation and Kandinsky Clerambault syndrome) developed at about one year and a half after social insulation. To be noticed that in residual phases, OC phenomenology acquires other connotations than those prior to schizophrenia onset, the patient never acquiring again a total insight on the disorder. Method: Computed EEG, psychiatric interview, psychodynamic interview, psychiatric and psychological monitoring of daily evolution under treatment, life map, heteroanamnesis, psychological tests, psychodynamic interpretations. Results: According to Poyurovsky’s guide, the case circumscribes to the diagnostic of schizo-obsessive disorder. When obsessions and compulsions were related to the content of delusional ideas and hallucinations, other typical rituals of obsessive-compulsive disorders appeared too, the patient considered sometimes irrational and excessive. Conclusions: Social degradation of the patient is dictated mainly by the negative dimension of schizophrenia, secondly by energy consumption in fulfilling the rituals and compulsions and last but not least by the mood change in depressive sense.

BackgroundThe assessment of inter-regional functional connectivity (FC) has allowed for the description of the putative mechanism of action of treatments such as deep brain stimulation (DBS) of the nucleus accumbens in patients with obsessive–compulsive disorder (OCD). Nevertheless, the possible FC alterations of other clinically-effective DBS targets have not been explored. Here we evaluated the FC patterns of the subthalamic nucleus (STN) and the bed nucleus of the stria terminalis (BNST) in patients with OCD, as well as their association with symptom severity.MethodsEighty-six patients with OCD and 104 healthy participants were recruited. A resting-state image was acquired for each participant and a seed-based analysis focused on our two regions of interest was performed using statistical parametric mapping software (SPM8). Between-group differences in FC patterns were assessed with two-sample t test models, while the association between symptom severity and FC patterns was assessed with multiple regression analyses.ResultsIn comparison with controls, patients with OCD showed: (1) increased FC between the left STN and the right pre-motor cortex, (2) decreased FC between the right STN and the lenticular nuclei, and (3) increased FC between the left BNST and the right frontopolar cortex. Multiple regression analyses revealed a negative association between clinical severity and FC between the right STN and lenticular nucleus.ConclusionsThis study provides a neurobiological framework to understand the mechanism of action of DBS on the STN and the BNST, which seems to involve brain circuits related with motor response inhibition and anxiety control, respectively.

ObjectiveThe need for symmetry and ordering objects related to a “just right”-feeling is a common symptom in Tourette's syndrome (TS) and resembles symmetry behavior in obsessive-compulsive disorder, but its pathophysiology is unknown. We used a symptom provocation paradigm to investigate the neural correlates of symmetry behavior in TS and hypothesized the involvement of frontal-striatal and limbic brain areas.MethodsPictures of asymmetrically and symmetrically arranged objects were presented in randomized blocks (4 blocks of each condition) to 14 patients with TS and 10 matched healthy controls (HC). A H215O positron emission tomography scan was acquired during each stimulus block, resulting in 8 scans per subject. After each scan, state anxiety and symmetry behavior (the urge to rearrange objects) were measured using a visual analogue scale.ResultsDuring the asymmetry condition, TS patients showed increased regional cerebral blood flow (rCBF) in the anterior cingulate cortex, supplementary motor area, and inferior frontal cortex, whereas HC showed increased rCBF in the visual cortex, primary motor cortex, and dorsal prefrontal cortex. Symmetry ratings during provocation correlated positively with orbitofrontal activation in the TS group and sensorimotor activation in the HC group, and negatively with dorsal prefrontal activity in HC.ConclusionsResults suggest that both motor and limbic circuits are involved in symmetry behavior in TS. Motor activity may relate to an urge to move or perform tics, and limbic activation may indicate that asymmetry stimuli are salient for TS patients. In contrast, symmetry provocation in HC resulted in activation of brain regions implicated in sensorimotor function and cognitive control.

The article is devoted to the analysis of the prospects for research on neurocognitive mechanisms of anxiety disorders. In response to limitations and contradictions in the logic of the categorical method of classification of mental disorders, the popularity of the dimensional approach, in which the emphasis shifts to the assessment of the severity of symptoms. The National Institute of Mental Health has developed the promising approach based on the search for systemic neurobiological foundations of mental disorders. Based on the project RDoC (Research Domain Criteria) the search for trans-diagnostic mechanisms of mental disorders has been updated. The logic of RDoC echoes the position of Russian pathopsychology, in which the syndrome of mental activity disorders is considered in dynamics, the mechanisms of the functioning of the psyche are qualified as identical in norm and pathology. In the study of anxiety-related disorders, the obvious commonality of the spectrum of manifestations that acquire nosological clarification against the background of the escalation of the severity of symptoms and secondary compensatory processes has repeatedly been put forward in the center of research attention. The aim of the article is a theoretical and methodological analysis of the neurocognitive basis of the errors monitoring system, characteristic of normal and excessively expressed in anxiety disorders, including ERP component error related negativity (ERN). As a result, it is shown that this neurocogitive marker, experimentally modeled in conflict tasks (e.g., Eriksens flanker task), is expected to be a probable transdiagnostic basis for anxiety-related disorders (social anxiety disorder, obsessive-compulsive disorder). The increase in the amplitude of ERN in internalization, uniting anxiety-depressive symptoms, is explained by individual differences in the readiness to detect error and sensitivity to incorrect decisions. At the moment, the study of ERN retains the tempted of simplified interpretations, the arbitrary establishment of direct causal connections between the neural basis and mental phenomena.

Abstract Background Among many psychotherapy, beck cognitive therapy was once regarded as a classic therapy for mood disorders and anxiety neurosis. A. T. Beck believes that people's emotional and behavioral problems are related to individual distorted cognition, and abnormal cognition produces abnormal emotion and behavior. A large number of “Automatic negative thinking” In the minds of patients with depression is the root cause of mood disorders such as depression and anxiety. Finding and correcting these unreasonable cognitive patterns is the key to treatment. However, from the perspective of effect feedback, people have some disputes about beck cognitive therapy. Many scholars rely too much on the changing effect of cognitive model, have strong “Psychological aggression”, and are prone to great resistance. With the continuous development of psychological counseling and treatment technology, the new generation of cognitive therapy not only aims at the narrow cognitive process, but also pays more attention to the connection between situation and symptoms, and uses experiential change strategies to supplement direct cognitive preaching strategies, in order to establish a more flexible and broader technical path. Mindfulness cognitive behavioral therapy (mbct), as a representative of the new generation of cognitive behavioral therapy, has achieved remarkable results in the treatment of anxiety and depression, obsessive-compulsive disorder, somatization disorder and chronic pain. Its technical methods are worthy of application and promotion. Important includes six key treatment processes: (1) acceptance: Help the client establish a positive and defenseless attitude, embrace various experiences, and encourage the client not to avoid his / her past experiences. (2) cognitive deconfusion. Cognitive de integration, also known as cognitive dissociation, is to let visitors “Step back” To observe their various ideas, open the distance between them and various ideas, do not fall into the wave of ideas, and let patients try to treat them as psychological events rather than self or accurate inevitable response to reality, so as to achieve the purpose of adjusting thinking, imagination and memory functions. (3) self as context: Change the visitors' understanding of “Self-concept”, and let the visitors realize that the self-concept or self-concept network / system in their mind is not a true reflection of their real self through corresponding metaphor practice and psychological education, so as to liberate the visitors from their “Mind”. (4) being present: Encourage visitors to focus on the current situation and what is happening, rather than focusing on the past and future in their minds, or immersing themselves in various concepts and semantic relationships in their minds. Let visitors learn to feel the real life in a non evaluative way. (5) clarify values: Encourage visitors to find a life direction that is valuable and meaningful to visitors in their own life and professional fields. (6) committed action: Help visitors implement their values into specific short-term, medium-term and long-term goals. Based on the perspective of case rehabilitation, this study investigated the effect of mindfulness cognitive behavior therapy on the counseling and rehabilitation of diffuse anxiety disorder. Subjects and methods In this study, 30 college students diagnosed with diffuse anxiety disorder in a university were selected as the research object. There were three selection criteria: 1. The subjects were clearly diagnosed as anxiety disorder or in an anxiety state by the professional institution, and 2. The effect of the patients was not ideal after taking drugs for more than 3 months. 3. Anxiety disorder accompanied by depression. The randomized experimental group and the control group were used in the study. There were 16 subjects in the experimental group and 14 in the control group. The experimental group participated in mindfulness cognitive behavior training for 8 weeks, 2 days a week, once a day, a total of 16 times. The control group did not carry out any intervention. One week before the study, the organizer carried out short-term training for the experimental group, and then implemented phased treatment experience as planned to complete: “Live in the present”, “Perceive the body”, “Walk in the present”, “Emotion and body”, “Mindfulness perceive the feelings”, “Smart life, future life” And other mindfulness themes. During the training, encourage patients to communicate their physical feelings and questions. At the same time, the relevant scale is used for state detection. It mainly includes: Self rating anxiety scale (sas), self rating depression scale (sds) and related physiological indexes. To better control the impact of training on anxiety, this study arranged pre-test and post-test in the examination week as an external stressor. However, according to the two results of the two groups before and after the test, the paired sample test within the group and the independent sample test between the groups were carried out respectively. In the inter group difference test, in order to exclude the influence of the initial state, we first conduct an independent sample test on the baseline value of the variable, and then conduct an independent sample test on the difference obtained by subtracting the pre-test score from the post-test score. Results The results showed that in the intra group comparison, the scores of the experimental group and the post test were lower than those of the pre test, and the difference was significant, but there was no significant difference in the control group; in the comparison between groups, the reduction of post test scores in the experimental group was higher than that in the control group, and the difference between the two groups was significant. The above results show that mindfulness training has a positive effect on improving diffuse anxiety and accompanying depression, and the maintenance effect is good. It is generally believed that the realization principle of this function is to improve the ability of emotion management by increasing the current emotional experience and maintaining a neutral and objective attitude, and acquire the skills to get rid of negative thinking and feeling, so as to improve acceptance and reduce empirical avoidance behavior. In exploring the impact of mindfulness cognitive behavior therapy on physiological indicators, the study found that mindfulness cognitive behavior therapy can reduce muscle tension through the regulation of consciousness, improve the efficacy of physiological indicators such as electromyography, skin electricity, heart rate and respiration, activate and amplify positive emotional experience, and alleviate negative emotions such as tension, anxiety and depression. Life in a more peaceful and relaxed state. Affected by this state, the individual's evaluation of external stimuli may weaken the negative degree and enhance the positive degree. Therefore, negative emotions decrease and positive emotions increase. He no longer regards anxiety and depression as his enemy. He can coexist with it instead of living timidly for fear of its recurrence. Conclusion It can be used as an effective therapy to effectively regulate the anxiety of college students with anxiety disorder. It can improve individual negative emotional experience such as anxiety and depression, reduce individual muscle tension, reduce skin electricity, heart rate and respiratory rate, and improve brain wave level, which is helpful to alleviate tension and pressure. In conclusion, mindfulness cognitive behavioral therapy plays an obvious role in the treatment of anxiety neurosis and depression, and can be popularized in public patients. Acknowledgement This paper is supported by Teaching Research Project of Wuchang Shouyi University titled “Evaluation model and training method of innovation ability of robot professionals under OBE mode” with Grant No. 2021Y02 and Doctoral Research Start-Up Fund of Wuchang Shouyi University in 2022.

<p><strong>List of Abstract Titles and authors:<br /></strong></p><p><strong>1. Psychosis: A matter of mental effort?</strong></p><p>M Borg, Y Y van der Zee, J H Hsieh, H Temmingh, D J Stein, F M Howells</p><p><strong>2.In search of an affordable, effective post-discharge intervention: A randomised control trial assessing the influence of a telephone-based intervention on readmissions for patients with severe mental illness in a developing country</strong></p><p><strong></strong>U A Botha, L Koen, M Mazinu, E Jordaan, D J H Niehaus</p><p><strong>3. The effect of early abstinence from long-term methamphetamine use on brain metabolism using 1H-magnetic resonance spectro-scopy (1H-MRS)</strong></p><p>A Burger, S Brooks, D J Stein, F M Howells</p><p><strong>4. The effect of <em>in utero exposure </em>to methamphetamine on brain metabolism in childhood using 1H-magnetic resonance spectroscopy (1H-MRS)</strong></p><p>A Burger, A Roos, M Kwiatkowski, D J Stein, K A Donald, F M Howells</p><p><strong>5. A prospective study of clinical, biological and functional aspects of outcome in first-episode psychosis: The EONKCS Study</strong></p><p><strong></strong>B Chiliza, L Asmal, R Emsley</p><p><strong>6. Stimulants as cognitive enhancers - perceptions v. evidence in a very real world</strong></p><p><strong></strong>H M Clark</p><p><strong>7. Pharmacogenomics in antipsychotic drugs</strong></p><p><strong></strong>Ilse du Plessis</p><p><strong>8. Serotonin in anxiety disorders and beyond</strong></p><p><strong></strong>Ilse du Plessis</p><p><strong>9. HIV infection results in ventral-striatal reward system hypo-activation during cue processing</strong></p><p><strong></strong>S du Plessis, M Vink, J A Joska, E Koutsilieri, A Bagadia, D J Stein, R Emsley</p><p><strong>10. Disease progression in schizophrenia: Is the illness or the treatment to blame?</strong></p><p>R Emsley, M J Sian</p><p><strong>11. Serotonin transporter variants play a role in anxiety sensitivity in South African adolescents</strong></p><p> S M J Hemmings, L I Martin, L van der Merwe, R Benecke, K Domschke, S Seedat</p><p><strong>12. Iron deficiency in two children diagnosed with multiple sclerosis: Report on whole exom sequencing</strong></p><p><strong></strong>S Janse van Rensburg, R van Toorn, J F Schoeman, A Peeters, L R Fisher, K Moremi, M J Kotze</p><p><strong>13. Benzodiazepines: Practical pharmacokinetics</strong></p><p><strong></strong>P Joubert</p><p><strong>14. What to consider when prescribing psychotropic medications</strong></p><p><strong></strong>G Lippi</p><p><strong>15. Current prescribing practices for obsessive-compulsive disorder in South Africa: Controversies and consensus</strong></p><p><strong></strong>C Lochner, L Taljaard, D J Stein</p><p><strong>16. Correlates of emotional and behavioural problems in children with preinatally acquired HIV in Cape Town, South Africa</strong></p><p><strong></strong>K-A Louw, N Phillips, JIpser, J Hoare</p><p><strong>17. The role of non-coding RNAs in fear extinction</strong></p><p><strong></strong>S Malan-Muller, L Fairbairn, W M U Daniels, M J S Dashti, E J Oakleley, M Altorfer, J Harvey, S Seedat, J Gamieldien, S M J Hemmings</p><p><strong>18. An analysis of the management og HIV-mental illness comorbidity at the psychiatric unit of the Dr George Mukhari Academic Hospital</strong></p><p><strong></strong>M L Maodi, S T Rataemane, T Kyaw</p><p><strong>19. The identification of novel genes in anxiety disorders: A gene X environment correlation and interaction study</strong></p><p><strong></strong>N W McGregor, J Dimatelis, S M J Hemmings, C J Kinnear, D J Stein, V Russel, C Lochner</p><p><strong>20. Collaborations between conventional medicine and traditional healers: Obstacles and possibilities</strong></p><p><strong></strong>G Nortje, S Seedat, O Gureje</p><p><strong>21. Thought disorder and form perception: Relationships with symptoms and cognitive function in first-episode schizophrenia</strong></p><p>M R Olivier, R Emsley</p><p><strong>22. Investigating the functional significance of genome-wide variants associated with antipsychotic treatment response</strong></p><p><strong></strong>E Ovenden, B Drogemoller, L van der Merwe, R Emsley, L Warnich</p><p><strong>23. The moral and bioethical determinants of "futility" in psychiatry</strong></p><p><strong></strong>W P Pienaar</p><p><strong>24. Single voxel proton magnetic resonance spectroscopy (1H-MRS) and volumetry of the amylgdala in social anxiety disorder in the context of early developmental trauma</strong></p><p>D Rosenstein, A T Hess, J Zwart, F Ahmed-Leitao, E Meintjies, S Seedat</p><p><strong>25. Schizoaffective disorder in an acute psychiatric unit: Profile of users and agreement with Operational Criteria (OPCRIT)</strong></p><p><strong></strong>R R Singh, U Subramaney</p><p><strong>26. The right to privacy and confidentiality: The ethics of expert diagnosis in the public media and the Oscar Pistorius trial</strong></p><p><strong></strong>C Smith</p><p><strong>27. A birth cohort study in South Africa: A psychiatric perspective</strong></p><p>D J Stein</p><p><strong>28. 'Womb Raiders': Women referred for observation in terms of the Criminal Procedures Act (CPA) charged with fetal abduction and murder</strong></p><p><strong></strong>U Subramaney</p><p><strong>29. Psycho-pharmacology of sleep wake disorders: An update</strong></p><p>R Sykes</p><p><strong>30. Refugee post-settlement in South Africa: Role of adjustment challenges and family in mental health outcomes</strong></p><p><strong></strong>L Thela, A Tomita, V Maharaj, M Mhlongo, K Jonathan</p><p><strong>31. Dstinguishing ADHD symptoms in psychotic disorders: A new insight in the adult ADHD questionnaire</strong></p><p>Y van der Zee, M Borg, J H Hsieh, H Temmingh, D J Stein, F M Howells</p><p><strong>32. Oscar Pistorius ethical dilemmas in a trial by media: Does this include psychiatric evaluation by media?</strong></p><p>M Vorster</p><p><strong>33. Genetic investigation of apetite aggression in South African former young offenders: The involvement of serotonin transporter gene</strong></p><p>K Xulu, J Somer, M Hinsberger, R Weierstall, T Elbert, S Seedat, S Hemmings</p><p><strong>34. Effects of HIV and childhood trauma on brain morphemtry and neurocognitive function</strong></p><p>G Spies, F Ahmed-Leitao, C Fennema-Notestine, M Cherner, S Seedat</p><p><strong>35. Measuring intentional behaviour normative data of a newly developed motor task battery</strong></p><p><strong></strong>S Bakelaar, J Blampain, S Seedat, J van Hoof, Y Delevoye-Turrel</p><p><strong>36. Resilience in social anxiety disorder and post-traumatic stress disorder in the context of childhood trauma</strong></p><p>M Bship, S Bakelaar, D Rosenstein, S Seedat</p><p><strong>37. The ethical dilemma of seclusion practices in psychiatry</strong></p><p>G Chiba, U Subramaney</p><p><strong>38. Physical activity and neurological soft signs in patients with schizophrenia</strong></p><p>O Esan, C Osunbote, I Oladele, S Fakunle, C Ehindero</p><p><strong>39. A retrospective study of completed suicides in the Nelson Mandela Bay Metropolitan Area from 2008 to 2013 - preliminary results</strong></p><p><strong></strong>C Grobler, J Strumpher, R Jacobs</p><p><strong>40. Serotonin transporter variants play a role in anxiety sensitivity in South African adolescents</strong></p><p><strong></strong>S M J Hemmings, L I Martin, L van der Merwe, R Benecke, K Domschke, S Seedat</p><p><strong>41. Investigation of variants within antipsychotic candidate pharmacogenes associated with treatment outcome</strong></p><p>F Higgins, B Drogmoller, G Wright, L van der Merwe, N McGregor, B Chiliza, L Asmal, L Koen, D Niehaus, R Emsley, L Warnich</p><p><strong>42. Effects of diet, smoking and alcohol consumption on disability (EDSS) in people diagnosed with multiple sclerosis</strong></p><p>S Janse van Rensburg, W Davis, D Geiger, F J Cronje, L Whati, M Kidd, M J Kotze</p><p><strong>43. The clinical utility of neuroimaging in an acute adolescnet psychiatric inpatient population</strong></p><p><strong></strong>Z Khan, A Lachman, J Harvey</p><p><strong>44. Relationships between childhood trauma (CT) and premorbid adjustment (PA) in a highly traumatised sample of patients with first-episode schizophrenia (FES</strong>)</p><p>S Kilian, J Burns, S Seedat, L Asmal, B Chiliza, S du Plessis, R Olivier, R Emsley</p><p><strong>45. Functional and cognitive outcomes using an mTOR inhibitor in an adolescent with TSC</strong></p><p>A Lachman, C van der Merwe, P Boyes, P de Vries</p><p><strong>46. Perceptions about adolescent body image and eating behaviour</strong></p><p><strong></strong>K Laxton, A B R Janse van Rensburg</p><p><strong>47. Clinical relevance of FTO rs9939609 as a determinant of cardio-metabolic risk in South African patients with major depressive disorder</strong></p><p>H K Luckhoff, M J Kotze</p><p><strong>48. Childhood abuse and neglect as predictors of deficits in verbal auditory memory in non-clinical adolescents with low anxiety proneness</strong></p><p>L Martin, K Martin, S Seedat</p><p><strong>49. The changes of pro-inflammatory cytokines in a prenatally stressed febrile seizure animal model and whether <em>Rhus chirindensis</em> may attenuate these changes</strong></p><p><strong></strong>A Mohamed, M V Mabandla, L Qulu</p><p><strong>50. Influence of TMPRSS6 A736v and HFE C282y on serum iron parameters and age of onset in patients with multiple sclerosis</strong></p><p><strong></strong>K E Moremi, M J Kotze, H K Luckhoff, L R Fisher, M Kidd, R van Toorn, S Janse van Rensburg</p><p><strong>51. Polypharmacy in pregnant women with serious mental illness</strong></p><p>E Thomas, E du Toit, L Koen, D Niehaus</p><p><strong>52. Infant attachment and maternal depression as predictors of neurodevelopmental and behavioural outcomes at follow-up</strong></p><p>J Nothling, B Laughton, S Seedat</p><p><strong>53. Differences in abuse, neglect and exposure to community violence in adolescents with and without PTSD</strong></p><p><strong></strong>J Nothling, S Suliman, L Martin, C Simmons, S Seedat</p><p><strong>54. Assessment of oxidative stress markers in children with autistic spectrum disorders in Lagos, Nigeria</strong></p><p><strong></strong>Y Oshodi, O Ojewunmi, T A Oshodi, T Ijarogbe, O F Aina, J Okpuzor, O C F E A Lesi</p><p><strong>55. Change in diagnosis and management of 'gender identity disorder' in pre-adolescent children</strong></p><p>S Pickstone-Taylor</p><p><strong>56. Brain network connectivity in women exposed to intimate partner violence</strong></p><p>A Roos, J-P Fouche, B Vythilingum, D J Stein</p><p><strong>57. Prolonged exposure treatment for PTSD in a Third-World, task-shifting, community-based environment</strong></p><p>J Rossouw, E Yadin, I Mbanga, T Jacobs, W Rossouw, D Alexander, S Seedat</p><p><strong>58. Contrasting effects of early0life stress on mitochondrial energy-related proteins in striatum and hippocampus of a rat model of attention-deficit/ hyperactivity disorder</strong></p><p><strong></strong>V Russell, J Dimatelis, J Womersley, T-L Sterley</p><p><strong>59. Attention-deficit hyperactivity disorder in adults: A South African perspective</strong></p><p>R Schoeman, M de Klerk, M Kidd</p><p><strong>60. Cognitive function in women with HIV infection and early-life stress</strong></p><p>G Spies, C Fennema-Notestine, M Cherner, S Seedat</p><p><strong>61. Changes in functional connectivity networks in bipolar disorder patients after mindfulness-based cognitic therapy</strong></p><p>J A Starke, C F Beckmann, N Horn</p><p><strong>62. Post-traumatic stress disorder, overweight and obesity: A systematic review and meta-analysis</strong></p><p><strong></strong>S Suliman, L Anthonissen, J Carr, S du Plessis, R Emsley, S M J Hemmings, C Lochner, N McGregor L van den Heuvel, S Seedat</p><p><strong>63. The brain and behaviour in a third-trimester equivalent animal model of fetal alcohol spectrum disorders</strong></p><p>P C Swart, C B Currin, J J Dimatelis, V A Russell</p><p><strong>64. Irritability Assessment Model (IAM) to monitor irritability in child and adolescent psychiatric disorders.</strong></p><p>D van der Westhuizen</p><p><strong>65. Outcome of parent-adolescent training in chilhood victimisation: Adaptive functioning, psychosocial and physiological variables</strong></p><p>D van der Westhuizen</p><p><strong>66. The effect of ketamine in the Wistar-Kyoto and Sprague Dawley rat models of depression</strong></p><p>P J van Zyl, J J Dimatelis, V A Russell</p><p><strong>67. Investigating COMT variants in anxiety sensitivity in South African adolescents</strong></p><p>L J Zass, L Martin, S Seedat, S M J Hemmings</p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p><strong><br /></strong></p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p>

Since the mid-eighties, personality and mood have undergone vigorous surveillance and repair across new populations in the United States. While government and the psy-complexes 1 have always had a stake in promoting citizen health, it is unique that, today, State, industry, and non-governmental organisations recruit consumers to act upon their own mental health. And while citizen behaviours in public spaces have long been fodder for diagnosis, the scope of behaviours and the breadth of the surveyed population has expanded significantly over the past twenty years. How has the notion of behavioural illness been successfully spun to recruit new populations to behavioural diagnosis and repair? Why is it a reasonable proposition that our personalities might be sick, our moods ill? This essay investigates the cultural promotion of a 'script' that assumes sick moods are possible, encourages the self-assessment of risk and self-management of dysfunctional mood, and has thus helped to create a new, adjustable subject. Michel Foucault (1976, 1988) contended that in order for subjects to act upon their selves -- for example, assess themselves via the behavioural health script -- we must view the Self as a construction, a work in progress that is alterable and in need of alteration in order for psychiatric action to seem appropriate. This conception of the self constitutes an extreme theoretical shift from the early modern belief (of Rousseau or Kant) that a core soul inhabited and shaped being, or the moral self.2 Foucault (1976) insisted that subjects are 'not born but made' through formal and informal social discourses that construct knowledge of the 'normal' self. Throughout the 19th century and the modern era, as medical, juridical, and psychiatric institutions gained increasing cultural capital, the normal self became allegedly 'knowable' through science. In turn, the citizen became 'professionalised' (Funicello 1993) -- answerable to these constructed standards, or subject to what Foucault termed biopower. In order to avoid punishments wrested upon the 'deviant' such as being placed in asylum or criminalised, citizens capitulated to social norms, and thus helped the State to achieve social order. 3 While 'technologies of power' or domination determined the conduct of individuals in the premodern era, 'technologies of the self' became prominent in the modern era.4 (Foucault, 'Technologies of the Self') These, explained Foucault, permit individuals to act upon their 'bodies, souls, thoughts, conduct and ways of being' to transform them, to attain happiness, or perfection, among other things (18). Contemporary psychiatric discourses, for example, call upon citizens to transform via self-regulation, and thus lessened the State's disciplinary burden. Since the mid-twentieth century, biopsychiatry has been embraced nationally, and played a key role in propagating self-disciplining citizens. Biopsychiatric logic is viewed culturally as common sense due to a number of occurrences. The dominant media have enthusiastically celebrated so-called biotechnical successes, such as sheep cloning and the development of better drugs to treat Schizophrenia. Hype has also surrounded newer drugs to treat depression (i.e. Prozac) and anxiety (i.e. Paxil), as well as the 'cosmetic' use of antidepressants to allegedly improve personality.5 Citizens, then, are enlisted to trust in psychiatric science to repair mood dysfunction, but also to reveal the 'true' self, occluded by biologically impaired mood. Suggesting that biopsychiatry's 'knowledge' of the human brain has revealed the human condition and can repair sick selves, these discourses have helped to launch the behavioural health script into the national psyche. The successful marketing of the script was also achieved by the diagnostic philosophy encouraged by revisions of Diagnostic and Statistical Manual or Mental Disorders(the DSM; these renovations increased the number of affective (mood) and personality diagnoses and broadened diagnostic criteria. The new DSMs 6 institutionalised the pathologisation of common personality and mood distresses as biological or genetic disorders. The texts constitute 'knowledge' of normal personality and behaviour, and press consumers toward biotechnical tools to repair the defunct self. Ian Hacking (1995) suggests that new moral concepts emerge when old ones acquire new connotations, thereby affecting our sense of who we are. The once moral self, known through introspection, is thus transformed via biopsychiatry into a self that is constructed in accordance with scientific 'knowledge'. The State and various private industries have a stake in promoting this Sick Self script. Promoting Diagnosis of the Sick Self Employing the DSM's broad criteria, research by the National Institute of Mental Health (NIMH), contends that a significant percentage of the population is behaviourally ill. The most recent Surgeon General report on Mental Health (from 1999) which also employed broad criteria, argues that a striking 50 million Americans are afflicted with a mental illness each year, most of which were non-major disorders affecting behaviour, personality and mood.7 Additionally, studies suggest that behavioural illness results in lost work days and increases demand for health services, thus constituting a severe financial burden to the State. Such studies consequently provide the State with ample reason to promote behavioural illness. In predicting an epidemic in behavioural illness and a huge increase in mental health service needs, the State has constructed health policy in accordance with the behavioural sickness script. Health policy embraces DSM diagnostic tools that sweep in a wide population by diagnosing risk as illness and links diagnosis with biotechnical recovery methods. Because criteria for these disorders have expanded and diagnoses have become more vague, however, over-diagnosis of the population has become common . 8 Depression, for example, is broadly defined to include moods ranging from the blues to suicidal ideation. Yet, the Sick Self script is ubiquitously embraced by NGO, industry, and State discourses, calling for consumer self-scrutiny and strongly promoting psychopharmaceuticals. These activities has been most successful; to wit: personality disorders were among the most common diagnoses of the 80's, and depression, which was a rare disorder thirty-five years ago, became the most common mental illness in the late 90's (Healy). Consumer Health Groups & Industry Promotions Health institutions and drug industries promote mood illness and market drug remedies as a means of profit maximisation. Broad spectrum diagnoses are, by definition, easy to sell to a wide population and create a vast market for recovery products. Pharmaceutical and insurance companies (each multibillion dollar industries), an expanding variety of self-help industries, consumer health web sites, and an array of psy-complex workers all have a stake in promoting the broad diagnosis of mood and behavioural disorders. 9 In so doing, consumer groups and the health and pharmaceutical industries not only encourage self-discipline (aligning themselves with State productivity goals), but create a vast, ongoing market for recovery products. Promoting Illness and Recovery So strong is the linkage between illness and recovery that pharmaceutical company Eli Lilly sells Prozac by promoting the broad notion of depression, rather than the drug itself. It does so through depression brochures (advertised on TV) and a web page that discusses depression symptoms and offers a depression quiz, instead of product information. Likewise, Psych Central, a typical informational health site, provides consumers standard DSM depression definitions and information (from the biopsychiatric-driven American Psychiatric Association (APA) or the NIMH, and liberal behavioural illness quizzes that typically over-diagnose consumers. 10The Psych Central site also lists a broad range of depression symptoms, while its FAQ link promotes the self-management of mood ailments. For example, the site directs those who believe that they are depressed and want help to contact a physician, obtain a diagnosis, and initiate antidepressant treatment. Such web sites, viewed as a whole, appear to deliver certified knowledge that a 'normal' mood exists, that mood disorders are common, and that abiding citizens should diagnosis and treat their mood ailment. Another essential component of the behavioural script is the suggestion that the modern self's mood is interminably sick. Because common mood distresses are fodder for diagnosis, the self is always at risk of illness, and requires vigilant self-scrutiny. The self is never a finished product. Moreover, mood sickness is insidious and quickly spirals from risk to full-blown disorder. 11 As such, behavioural illness requires on-going self-assessment. Finally, because mood sickness threatens social productivity and State financial solvency, a moral overtone is added to the mix -- good citizens are encouraged to treat their mood dysfunctions promptly, for the common good. The script thus constructs citizenship as a motive for behavioural self-scrutiny; as such, it can naturally recommend that individuals, rather than experts, take charge of the surveillance process. The recommendation of self-determined illness is also a sales feature of the script, appealing to the American ethic of individualism -- even, paradoxically, as the script proposes that science best directs us to our selves. Self-Managed Recovery Health institutions and industries that deploy this script recommend not only self-diagnosis, but also self-managed treatment as the ideal treatment. Health information web sites, for example, tend to displace the expert by encouraging consumers to pre-diagnose their selves (often via on-line quizzes) and to then consult an expert for formal diagnosis and to organise a treatment program. Like governmental heath organisation's web sites, these commonly link consumer-driven, broad-spectrum diagnosis to psycho-pharmaceutical treatment, primarily by listing drugs as the first line of treatment, and linking consumers to drug information. Unsurprisingly, pharmaceutical companies support or own many 'informational' sites. Depression-net.com, for example, is owned by Organon, maker of Remeron, an SSRI in competition with Prozac.12 Still, even sites that receive little or no funding tend to display drugs prominently; for example, Internet Mental Health, which accepts no drug funding lists drugs immediately after diagnosis on the sidebar. This trend illustrates the extent to which drugs are viewed by consumers as a first step in addressing all types of mood sicknesses. Consumer health sites, geared toward Internet users seeking health care information (estimated to be 43% of the 120 million users) promote the illness-recovery link more aggressively. Dr.koop.com, one of the most visited sites on the Internet, describes itself as 'consumer-focused' and 'interactive'. Yet, the homepage of this site tends to include 'news' stories that relay the success of drugs or report on new biopsychiatric studies in depression or mental health. Some consumer sites such as Consumer health sites, geared toward Internet users seeking health care information (estimated to be 43% of the 120 million users) promote the illness-recovery link more aggressively. Dr.koop.com, one of the most visited sites on the Internet, describes itself as 'consumer-focused' and 'interactive'. Yet, the homepage of this site tends to include 'news' stories that relay the success of drugs or report on new biopsychiatric studies in depression or mental health. Some consumer sites such as WebMD prominently display links to drugstores, (such as Drugstore.com), many of which are owned in part or entirely by pharmaceutical companies.13 Similar to the common practices of direct-to-consumer advertising, both informational and consumer sites by-pass the expert, promote recovery via drugs, and direct the consumer to a doctor in search of a prescription, rather than health care advice. State, informational and consumer web sites all help to construct certain populations as at-risk for behavioural sickness. The NIMH information page on depression -- uncanny in its likeness to consumer health and pharmaceutical sites -- utilises the DSM definition of depression and recommends the standard regime of diagnosis and biotechnical treatments (highlighting antidepressants) most appropriate for a diagnosis of major, rather than minor, depression. The site also elaborates the broad approach to mood illness, and recommends that women, children and seniors -- groups deemed at-risk by the broad criteria -- be especially scrutinised for depression. By articulating the broad DSM definition of depression, a generalisable 'self' -- anyone suffering common ailments including sadness, lethargy or weight change -- is deemed at risk of depression or other behavioural illness. At the same time, at-risk groups are constructed as populations in need of more urgent scrutiny, namely society's less powerful individuals, rather than middle-aged males. That is, society's decision-makers--psychiatric researchers, State policy-makers, pharmaceutical CEO's, (etc) are considered least at risk for having defunct selves and productivity functioning. Selling Mood Sickness These brief examples illustrate the standard presentation of behavioural illness information on the Web and from traditional resources such as mailings, brochures, and consumer manuals. Presenting the ideal self as knowable and achievable with the help of bio-psychiatric science, these discourses encourage citizens to self-scrutinise, self-define, and even self-manage the possibility of mood or behavioural dysfunction. Because the individual gathers information, determines her pre-diagnosis, and seeks out a recovery technology, the many choices involved in behavioural scrutiny make it appear to be a free and 'democratic' activity. Additionally, as individuals take on the role of the expert, self-diagnosing via questionnaires, the highly disciplinary nature of the behavioural diagnosis appears unthreatening to individual sovereignty. Thus, this technology of the self solves an age-old problem of capitalist democracy -- how to simultaneously instill citizen's faith in absolute individual liberty (as a source of good government), and, at the same time, the need to achieve the absolute governance of the individual (Miller). Foucault contended that citizens are brought into the social contract of citizenship not simply through social and governmental contracts but by processes of policing that become embedded in our notions of citizenship. The process of self-management recommended by the ubiquitous behavioural script functions smoothly as a technology of surveillance in this era, where the ideal self is known and repaired through biopsychiatric science, the democratic responsibility of a good citizen. The liberal contract has always entailed an exchange of rights for freedoms -- in Rousseau's terms 'making men free by making them subjects.' (Miller xviii) When we make ourselves subjects to ongoing behavioural scrutiny, the resulting Self is not freed, rather it is constrained by a perpetual sickness. Notes 1 This term is used in a Foucaultian sense, to refer to all those who work under and benefit or profit from the dominant biological model of psychiatry dominant since the 1950's in the U.S. 2 For more discussion, see Ian Hacking, Rewriting the Soul; Multiple Personality and the Sciences of Memory. (1995) 3 In his essay 'Technologies of the Self' (1988) Foucault outlines the four major types of technologies that function as practical reason and entice citizens to behave according to constructed social standards. Among these are technologies of production (that permit us to produce things), technologies of sign systems (permitting us to use symbols), and the technologies of power and self mentioned in the above text. Through these technologies, operations of individuals become highly regulated, some visible and some difficult to perceive. The less visible technologies of the self became essential to the smooth functioning of society in the modern era. 4 'Technologies' is used to refer to mechanisms and actions of institutions or simply social norms and habits, that work, ultimately, to govern the individual, or create behaviour that serves desires of the State and dominant social bodies. 5 Peter Kramer, author of the best-selling book Listening to Prozac (1995) contends that his patients using Prozac often credited the drug with helping their true personalities to surface. 6 The two revisions occurred in 1987 and 1994. 7 Of that group, only five percent of that group suffers a 'severe' form of mental illness (such as schizophrenia, or extreme form of bipolar or obsessive compulsive disorder), while the rest suffer less severe behavioural and mood disorders. Similar research (also based on broad criteria) was published throughout the 90's suggesting an American epidemic of behavioural illness; it was claimed that 17% of the population is neurotic, while 10-15% of the population (and 30-50% of those seeking care) was said to possess a personality disorder. (Hales and Hales, 1995) 8 The most widely assigned diagnoses in this category today are: depression, multiple personality, adjustment disorder, eating disorders and Attention Deficit Hyperactivity Disorder (ADHD), which have extremely broad criteria, and are easily assigned to a wide segment of the population. 9The quizzes offered at these sites are standard in psychiatry; the difference here is that these are consumer-conducted. Lilly uses the Zung Self-Assessment Tool, which asks 20 broad questions regarding mood, and overdiagnoses individuals with potential depression. By responding to vague questions such as 'Morning is when I feel the best', 'I notice that I am losing weight', and 'I feel downhearted, blue and sad' with the choice of 'sometimes', individuals are thereby pre-diagnosed with potential depression. (https://secure.prozac.com/Main/zung.jsp) Psych central uses the Goldberg Inventory that is similarly broad, consumer-operated, and also tends to overdiagnose. 10 The DSM and other psychiatric texts and consumer manuals commonly suggest that undiagnosed depression will lead, eventually, to full-blown major depression. While a minority of individuals who suffer ongoing episodes of major depression will eventually suffer chronic major depression, it has not been found that minor depression will snowball into major depression or chronic major depression. This in fact, is one of the many suspicions among researchers that is referred to as fact in psychiatric literature and consumer manuals. A similar case in point is the suggestion that depression is a brain disorder, when in fact, research has not determined biochemistry or genetics to be the 'cause' of major depression. 11 Increasingly, Pharmaceutical sites are indistinguishable from consumer sites, as in the case of Bristol-Meyers Squibb's depression page, (http://www.livinglifebetter.com/src/htdo...) offering a layperson's depression definition and, immediately thereafter, information on its antidepressant Serzone. 12 Like the informational and State sites, these also link consumers to depression information (generally NIMH, FDA or APA research), as well as questionnaires. References American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, D.C: American Psychiatric Press, Inc., 1994. Cruikshank, Barbara. The Will to Empower: Democratic Citizens and Other Subjects. Ithaca, NY: Cornell University Press, 1999. Foucault, Michel. 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Links http://www.drugstore.com http://psychcentral.com/library/depression_faq.htm http://www.wikipedia.com/wiki/DSM-IV http://www.nimh.nih.gov/publicat/depression.cfm http://www.livinglifebetter.com/src/htdocs/index.asp?keyword=depression_index http://my.webmd.com http://www.mentalhealth.com http://www.surgeongeneral.gov/library/mentalhealth/home.html http://www.prozac.com http://my.webmd.com/ http://www.a-silver-lining.org/BPNDepth/criteria_d.html#MDD http://psychcentral.com/depquiz.htm Citation reference for this article Substitute your date of access for Dn Month Year etc... MLA Style Gardner, Paula. "The Perpetually Sick Self" M/C: A Journal of Media and Culture 5.5 (2002). [your date of access] < http://www.media-culture.org.au/mc/0210/Gardner.html &gt. Chicago Style Gardner, Paula, "The Perpetually Sick Self" M/C: A Journal of Media and Culture 5, no. 5 (2002), < http://www.media-culture.org.au/mc/0210/Gardner.html &gt ([your date of access]). APA Style Gardner, Paula. (2002) The Perpetually Sick Self. M/C: A Journal of Media and Culture 5(5). < http://www.media-culture.org.au/mc/0210/Gardner.html &gt ([your date of access]).