All Articles

Najmeh Maharlouei^1,3, Sharon Cobb², Mohsen Bazargan^3,4, Shervin Assari³*

¹ Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran

² School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA

³ Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA

⁴ Department of Family Medicine, UCLA, Los Angeles, CA

Background: Education, employment, and marital status are among the main socioeconomic status (SES) indicators that are associated with subjective health and happiness. The effects of these SES indicators may, however, be different for various demographic groups.

Aims: To understand if SES indicators differently impact men and women, we tested gender differences in the effects of education, employment, and marital status on the subjective health and happiness of American adults.

Methods: This cross-sectional study used data of the General Social Survey (GSS), a series of nationally representative surveys between 1972 and 2018 in the US. Our analytical sample included 65,814 adults. The main independent variables were education attainment, marital status, and employment. Outcomes were self-rated health (SRH) and happiness measured using single items. Age and year of the study were covariates. Gender was the moderator.

Results: Overall, high education, being employed, and being married were associated with better SRH and happiness. We, however, found significant interactions between gender and educational attainment, marital status, and employment on the outcomes, which suggested that the effect of high education and marital status were stronger for women. In comparison, the effect of employment was stronger for men. Some inconsistencies in the results were observed for SRH compared to happiness.

Conclusions: In the United States, while education, employment, and marital status are critical social determinants of subjective health and happiness, these effects vary between women and men. Men’s outcomes seem to be more strongly shaped by employment, while women’s outcomes are more strongly shaped by education and marital status.

Dinesh K Arya*

ACT Health, 2 Bowes Street, Woden, ACT 2606, Australia

The challenge for mental health services is to ensure that available resources are able to meet the needs of mental health consumers. It is useful to develop a staff resourcing model that is based entirely on the identification of mental health needs of consumers. Such a model has the potential to ensure that available mental health staffing resources are not wasted and mental health consumers receive an appropriate level of mental health support.

Christopher Kam*, Christian R. Bellehumeur

Saint Paul University, Ottawa, Canada

Leah Carter*, Callie Hebert, Owen Carmichael, Robert L. Newton Jr

Pennington Biomedical Research Center, Baton Rouge, Louisiana

Rebecca Jackson¹*, J. Michelle Robertson^1,2

¹Brain Balance Achievement Centers, USA

²Department of Social and Behavioral Sciences, Friends University, Wichita, KS

Children with developmental or learning challenges often have co-occurring difficulties in emotional functioning. There is a longstanding need to identify effective nonpharmacologic treatments to address these emotional difficulties. However, few studies have examined training programs that are multimodal in nature and their effects specifically on mental well-being. The purpose of this study is to estimate the impact of an integrative multimodal training program (Brain Balance^®) on mental well-being in children and adolescents with developmental or learning challenges, as measured by parental surveys. A retrospective review was performed on 4 years of archived survey responses from parents of enrolled students (4-17 years; 70.8% male and 29.2% female) before and after program participation. Before program participation, all students tested below age-appropriate developmental levels. The Brain Balance program consisted of three 1-hour in-center sessions per week (45 minutes of sensorimotor stimulation and 15 minutes of academic activities), along with other multimodal activities targeting proprioception and balance, vestibular functioning, fine motor skills, rhythm and timing, auditory and visual processing, and retained primitive reflexes. Parental responses showed that, after 5-6 months of program participation, 75% of children showed up to 25% improvement, and 25% of children demonstrated 60-85.7% improvement, in the following areas: panic/anxiety attacks, worrying, depression-like symptoms, mood, obsessive thoughts or behaviors, social withdrawal, pessimism, emotional regulation, emotional self-awareness, and emotional expressiveness. These findings suggest the potential value of nonpharmacologic training programs in improving mental well-being in children and adolescents with developmental or learning challenges, especially programs that are comprehensive and multimodal.

Shervin Assari¹*, Hamid Chalian², Mohsen Bazargan^1,3

¹Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA

²Department of Radiology, Department of Radiology, Duke University Medical Center, Durham, USA

³Department of Family Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA

Background: Educational attainment and income are two socioeconomic status indicators with strong protective effects against cigarette smoking. Marginalization-related Diminished Returns, however, refer to less than expected protective effects of socioeconomic status indicators for the members of the racial and ethnic minority groups, particularly Blacks and Hispanics, compared to non-Hispanic Whites.

Aim: Borrowing data from a nationally representative study in the US, this study tested whether racial and ethnic differences exist in the effects of educational attainment and poverty status on cigarette smoking of American adults.

Methods: This cross-sectional study entered 28,329 adult participants of the Population Assessment of Tobacco and Health (PATH; 2013). Both educational attainment and poverty status were the independent variables. The dependent variable was current hookah smoking. Age, gender, and region were the covariates. Race and ethnicity were the effect modifiers (moderators).

Results: Overall, individuals with higher educational attainment were more likely to smoke a hookah. Individuals who lived out of poverty, however, had lower odds of current hookah smoking. Race and ethnicity both showed statistical interactions with both socioeconomic indicators suggesting that Blacks and Hispanics with high educational attainment and those who live out of poverty have disproportionately high odds of hookah smoking, compared to non-Hispanic Whites with high socioeconomic status.

Conclusion: In the United States, middle-class racial and ethnic minority people remain at higher risk of smoking hookah. As a result, we should expect a high tobacco burden in middle-class Black and Hispanic adults. We suggest that policymakers should not take an over-simplistic way and reduce the problem of race/ethnic inequalities in tobacco use to gaps in socioeconomic status between groups. Marginalization-related diminished returns generate tobacco disparities in higher socioeconomic status levels. Middle-class racial and ethnic minority people need extra support to stay healthy.

Carles Barcons Comellas^1,2*

¹Clinical Psychologist, Hospital Sagrat Cor, Serveis de Salut Mental Martorell, Spain

²PhD student. Department of Psychiatry and Forensic Medicine. Universitat Autònoma de Barcelona, Spain

Kelly L. Gilrain*, Alexa M. Hays, Victoria A. Grunberg, Anastasia Bullock, Philip Fizur, Steven E. Ross

Division of Behavioral Medicine, Cooper University Hospital, USA

Srijana Pandey*, Kalpana Shrestha

Nepal Medical College, Nepal

Introduction: Alcoholism is characterized by an increased tolerance of and physical dependence on alcohol, affecting an individual’s ability to control alcohol consumption safely. Worldwide, researchers have been focusing on the effect of alcohol use on the family and children, which interact to diminish the individual’s ability to adapt leading to distress.

Methods: This was a descriptive cross-sectional study with convenience sampling technique in which cage questionnaire was used to identify the alcoholic family and interviewed 162 spouses of alcoholics at Gokarneswor- municipality, Kathmandu, Nepal

Findings: The study revealed that coping level among spouses of alcoholics was average that was 98.1% and well was lowest that was 1.8%. The coping strategies used was in three subscales engaged coping, withdrawal coping and tolerant coping. In three subscale, withdrawal coping scored highest (55.57_+6.74) and engaged coping scored lowest (24.61_+3.43). There was a significant association between level of coping with the duration of alcohol intake and there was no association with other socio-demographic variables such as age, education, occupation, marriage, type of family, no. of children.

Conclusion: The study showed the average coping level and three ways of coping strategy that was withdrawal coping, engaged coping and tolerant coping. Most of the respondents used withdrawal coping. The study recommends the research on identification of alcohol abusers at community and provide early treatment and counselling to the family.

Wenni Chen, Yu Yu, Ruirui Xu, Hui Han, Gengzhen Chen*

Shantou University Medical College, Shantou, China

Background: Both Helicobacter pylori-infected peptic ulcer disease (PUD) and depression are common in older adults. Although H. helicobacter eradication has significantly reduced the risk of PUD recurrence, it remains unknown whether such therapy achieves comparable effect among older patients with and without depression.

Aim: To compare PUD recurrence rates in depressed and non-depressed older patients after successful H. pylori eradication, and to evaluate the prospective effect of self-reported and diagnosed depression on PUD recurrence.

Methods: 978 older patients with previous H. pylori-infected PUD were included after H. pylori eradication, and followed for up to 36 months. Using endoscopic examination, PUD recurrence rates among depressed and non-depressed older patients were compared. Multivariate logistic regression was performed to ascertain the prospective relationship between depression and PUD recurrence.

Results: PUD recurrence rate was higher in patients with self-reported depression (10.9%) than those without (6.2%). Apart from self-reported depression (OR 2.418 (1.232, 4.989), other significant predictors of PUD recurrence included H. pylori reinfection (OR 2.815 (1.198, 4.687), cigarette smoking (OR 2.318 (1.238, 4.862), excessive alcohol drinking (OR 2.287 (1.118, 4.677), high green tea consumption (OR 2.107 (1.025, 4.325), regular ingestion of acetaminophen (OR 2.273 (1.238, 4.218) and NSAIDs (OR 3.341 (2.174, 5.187), as well as regular (OR 3.372 (2.087, 5.298), occasional (OR 3.096 (2.032, 5.162), and infrequent aspirin consumption (OR 2.645 (1.218, 4.562). Similar results were yielded on the association between diagnosed depression and PUD recurrence.

Conclusion: PUD recurrence following H. pylori eradication is higher in depressed than in non-depressed older patients. PUD recurrence is also attributed by other clinical and behavioral factors. Results of this study sheds lights on the pathways underlying the association between multidimensional factors and PUD recurrence, which provides important implication for clinical practice in geriatric settings.

Amy Lawson Moore¹*, Christina Ledbetter²

¹Gibson Institute of Cognitive Research, Colorado Springs, CO, USA

²Louisiana State University Health Sciences Center, Shreveport, LA, USA

Mainstream approaches to treating Attention Deficit Hyperactivity Disorder in children include stimulant medication such as methylphenidate and behavior therapy that target deficits in attention as well as inappropriate behaviors but do not sufficiently address the multiple cognitive deficits associated with the disorder. Deficits beyond attention have been identified in ADHD including working memory, long-term memory, and processing speed. As key elements of cognition and intelligence that contribute to thinking and learning, these are critical deficits found in children with ADHD that must be addressed. In this review, we discuss existing research on cognitive training interventions for ADHD and evaluate their ability to target these multiple cognitive deficits as well as their ability to promote self-efficacy, social cognition, and motivation during training. We describe research on LearningRx, a clinician-delivered cognitive training intervention and suggest that human delivery enhances motivation and promotes social cognition and self-efficacy while strengthening weak cognitive skills associated with ADHD in children.

Wenni Chen¹, Yewei Bao¹, Yu Yu¹, Ruirui Xu¹, Shuyan Yang², Hui Han², Gengzhen Chen¹*

¹Shantou University Medical College, Shantou, China

²Hong Kong Baptist University, Kowloon Tong, Hong Kong, China

Genevieve Ataa Fordjour*, Albert P. C. Chan

Department of Building and Real Estate, The Hong Kong Polytechnic University, China

This study aims to explore the need for occupational psychological health interventions in the construction industry by identifying occupational psychological health conditions among construction employees. To achieve this aim, 300 questionnaires were equally distributed to purposively selected construction professionals and construction trade workers in Ghana. Four main constructs namely: individual lifestyle, psychosocial symptoms, physiological conditions, and work attitudes, were assessed to identify occupational psychological health conditions among the two construction working groups. These four main constructs were further divided into 20 occupational psychological health indicators. Quantitative analysis of the data was done, and a comparison made between the scores obtained from the two construction groups. Using the measures of individual lifestyle and work attitudes, the construction trade workers were found to be more prevalent in adverse occupational psychological health conditions than the construction professionals. The measures of psychosocial symptoms and physiological conditions, however, revealed no much statistically significant differences between the mean scores obtained from the two construction groups. Each of the two-construction group had their participants experiencing some form of adverse occupational psychological health conditions. Differences between the two groups in terms of factors such as task levels, role demands and income levels, are likely to influence their different level of vulnerability to psychological disorders. This study recommends some psychological health interventions to enhance the well-being of all construction employees. The findings from this study form the basic step in designing a preventive occupational psychological health model, with the aim to promote a psychologically safe and healthy construction workplace.

Madeline O. Jansen, K. Brendan Butler, David A. Jansen*

Tulane University School of Medicine, New Orleans, Louisiana, USA

Animation Deformity (AD) is a common and serious complication in breast cancer patients undergoing reconstructive surgery involving subpectoral breast implant placement. AD is associated with an increased risk of poor mental health outcomes, including diminished quality of life, depression, suicidality, body image dissatisfaction, and body dysmorphic disorder. Breast cancer survivors, especially those who elect to undergo reconstructive surgery, are known to be a vulnerable population for the development of mental health disorders. Because effective management of AD can be beneficial to a patient’s psychological wellbeing, this represents an important area of consideration for the surgical community. There are several methods for treating AD, which can involve repositioning the implant or inhibiting pectoralis muscle contraction. Such methods include manual muscle transection, neuromodulation, and selective nerve ablation. Research efforts have yet to examine which techniques produce more satisfactory improvements in psychosocial health. Thus, this may be an important area of focus for future research. This review examines contemporary research findings in order to broaden understandings of the relationship between AD and mental health, as well to highlight the importance of managing this complication.

Krishna A. Kumar*

Kerala Institute of Medical Sciences (KIMS), India

Welfare programs for the disabled individuals have been carried out in many countries, in accordance with UNCRPD, through legislative measures. The social and political developments in India enabled legislation for such measures in India. To avail benefits under such welfare schemes, the degree of their psychosocial disability needs to be assessed quantitatively through valid, reliable and workable instruments. Though Chronic Mentally ill persons were included as a beneficiary group, under the Persons With Disabilities Act 1995 in India, lack of a quantified scale for psychiatric disabilities, deprived the benefits to the mentally ill , available to other category of disabled persons. This prompted the IPS in 2001, to develop a Scale for Psychiatric Disability as a time – bound one year prime project. The IDEAS Scale, thus developed, could get approval from Government of India, as the official Scale for Psychiatric Disability in India, soon after its release by IPS, through effective liaison with Administrators in Government. The internal consistency, face validity, content validity, reliability, comparability with WHO Scale, and utility and utilization for Disability Assistance Programs have all been established through studies since 2005 .The stigma on the mentally ill persons, though not totally eliminated, also got attenuated through inclusion in the spectrum of disabled individuals, covered by welfare and rehablititation programmes. The Rights of Persons with Disabilities Act 2016 (RPWD 2016) and the Mental Health Care Act 2017 (MHC Act 2017) are new legislative measures, implemented in India for the welfare of mentally ill persons. In the wake of these legislations there has been renewed interest, and concerted efforts in IPS to evolve guidelines for effective use of IDEAS and standardization of Disability Certification procedures. The time bound commitment of IPS in 2001, to develop IDEAS and getting its official acceptance by Government of India, through effective liaison, and the renewed interest and present concerted efforts to utilize it for helping large number of disabled chronic mentally ill, form sequential precious contributions for Community Mental Health in India. It seems an inspiring imitable model for professional Mental Health Organizations in other countries, probably with relevance in other health-care disciplines as well.

Abbreviations

IPS : Indian Psychiatric Society

IDEAS : Indian Disability Evaluation and Assessment Scale

UNCRPD : United Nations Convention for Rights of Persons with Disabilities

WHODAS 2.0: World Health Organization Disability Assessment Schedule- 2.0

RPWDA 2016: Rights of Persons With Disabilities Act 2016

MHC Act2017: Mental Health Care Act 2017

Richard Thompson*

36, Dealtry Road, London, SW15 6NL, UK

Exposure to green plants, green space and gardening is now recognised as a valuable type of social prescribing for problems of mental and physical health, and the evidence behind their beneficial effects is strong.

Ignacio Garcia-Cabeza¹*, Ferreira Victor¹, Epifanio Maria M², Enrique de Portugal¹

¹Service of Psychiatry, Gregorio Maranon University Hospital, Complutense University of Madrid, Spain

²Martin de Vargas Health Center, Spain

The authors review the complex relationship between insight, adherence and symptoms with the functioning of the patient with diagnose of psychosis, either directly or as intermediary factors of each other.

Insight has been proposed to act through symptoms or psychodynamic factors. But in turn, adherence and insight are related in a bidirectional way and the first is one of the best predictors of outcomes in psychosis. Similarly symptoms, especially negative ones, are associated with a worse evolution of the disease.

The authors suggest that insight plays a role in the functioning of the patient, producing both a direct effect and also as a mediator by the improvement of adherence.

It is proposed that insight becomes a key therapeutic target in combined programs in order to favor better outcomes in the evolution of psychosis.

Christi A. Patten¹*, James A. Levine², Pamela S. Sinicrope¹, Ioannis T. Pavlidis³

¹Department of Psychology and Psychiatry, Mayo Clinic, Rochester, Minnesota, USA

²Foundation Ipsen, Paris, France; and Case Western Reserve University, Ohio, USA

³Department of Computer Science, University of Houston, Houston, Texas, USA

Smokers have an increased risk of depressive symptoms and depressive disorders. Smokers reporting higher levels of depressive symptoms prior to cessation treatment have greater difficulty quitting smoking. However, few interventions have targeted depressed smokers, a tobacco use disparity group. There is preliminary evidence to support the use of supervised, vigorous intensity exercise interventions to help smokers with depression quit. This Mini-Review addresses the potential role of exercise interventions for this population. We cover: (1) tobacco cessation treatments that have targeted depressed smokers, (2) efficacy of supervised exercise interventions for depression and smoking cessation, (3) results from a pilot study of supervised, vigorous intensity exercise for depressed women delivered in a community setting, and (4) future directions including technologies to scale up delivery of exercise interventions and exercise maintenance strategies. Future studies are needed that broaden the characteristics of participants in trials to include racially diverse men and women with a range of depressive symptoms. Positioning exercise delivery within community settings enhances the possible reach of interventions to a more diverse population of smokers. Delivery of exercise coaching through robotic and other digital technologies could also increase intervention scalability and open new avenues to explore methods and strategies to promote exercise adherence/maintenance.

E. Ahnemark^1*, M. Di Schiena², A.-C. Fredman^2,8, E. Medin^3,4, J. K. Söderling⁵, Y. Ginsberg^6,7

¹Shire, Vasagatan 7, SE-111 20 Stockholm, Sweden

²Prima Child and Adult Psychiatry AB, Stockholm, Sweden

³PAREXEL International, Stockholm, Sweden

⁴Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden

⁵Bell Analytics, Stockholm, Sweden

⁶Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden

⁷Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institute, Stockholm, Sweden

⁸Psychiatry Centre, Stockholm County Council, Södertälje, Sweden

Priyanka Patil, Thomas L. Schwartz*

Dept of Psychiatry, SUNY Upstate Medical University, Syracuse, New York

Background: The standard of care for schizophrenia treatment is the class of medications called the second generation antipsychotics (SGA). However, response rates of schizophrenia to SGA are far from ideal, and approximately one third of patients are likely to need high dosing, polypharmacy or switching of antipsychotics. To do this safely, clinicians’ knowledge of SGA pharmacodynamics, pharmacokinetics, therapeutic drug monitoring (TDM) levels, as well as, dose equivalency is imperative.

Aims:

• To review standard dosing, pharmacokinetic, and pharmacodynamic properties of the SGA.

• To further review the use of high, or “super-dosing”, of SGA.

• To investigate the clinical importance of monitoring drug levels for SGA.

• To describe possible SGA dose equivalency.

Materials and Methods: A Medline, PubMed (including observational studies, randomized controlled trials, meta-analyses, and systematic reviews) and textbook review was conducted without any date or language restriction. Each SGA (risperidone, paliperidone, lurasidone, ziprasidone, iloperidone, olanzapine, quetiapine, asenapine, aripiprazole, brexpiprazole and cariprazine) was searched and cross referenced with higher dosing, TDM, pharmacodynamics and pharmacokinetics. All possible studies were included. This paper focused on schizophrenia and use of SGA by oral route. Clozapine was excluded. Although it is an SGA, its properties and efficacy are different enough from other SGA and were felt beyond the scope of this current paper.

Discussion: A discussion of the concepts of pharmacokinetic failure, pharmacodynamic failure, Therapeutic Drug Monitoring, SGA dosing equivalencies and super dosing of SGA monotherapies is presented. SGA have pharmacodynamic and pharmacokinetic profiles which are distinctive and lead to unique side-effect profiles, drug-drug interactions, and clinical effects. For example, a SGA such as olanzapine, quetiapine and ziprasidone have evidence that high dosing is of value. Also, TDM drug monitoring is more clinically relevant in certain SGA like olanzapine, quetiapine, and risperidone. These differences are critically delineated.

Summary: This review article allows for a formal, evidence-based discussion regarding several advanced psychopharmacologic concepts which should allow the individual prescriber to elevate their prescribing practices.

Rebecca Grzadzinski^1,2*, Catherine Lord³

¹University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA

²Carolina Institute for Developmental Disabilities, Carrboro, NC, USA

³University of California at Los Angeles (UCLA), Los Angeles, CA, USA

Apostolos P. Georgopoulos^1,2,3,4,5*, Lisa M. James^1,2,3,4, Peka Christova^1,2,3, Brian E. Engdahl^1,2,3,6

¹ Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, Minnesota, USA

² Department of Neuroscience, University of Minnesota Medical School, Minneapolis, Minnesota, USA

³ Center for Cognitive Sciences, University of Minnesota, Minneapolis, Minnesota, USA

⁴ Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA

⁵ Department of Neurology, University of Minnesota Medical School, Minneapolis, Minnesota, USA

⁶ Department of Psychology, University of Minnesota Medical School, Minneapolis, Minnesota, USA

Posttraumatic stress disorder (PTSD) is a debilitating disorder that can develop following exposure to a traumatic event. Although the cause of PTSD is known, the brain mechanisms of its development remain unknown, especially why it arises in some people but not in others. Most of the research on PTSD has dealt with psychological and brain mechanisms underlying its symptomatology, including intrusive memories, fear and avoidance (see ref.1 for a broad coverage of PTSD research)¹. Here we focus, instead, on the origin of PTSD, namely on the neural mechanisms underlying its development. Specifically, we propose a two-hit model for PTSD development, with the following components. (a) The 1st hit is a neuroimmune challenge, as a preexisting condition, and the 2nd hit is intense glutamatergic neurotransmission, induced by the traumatic event; (b) the key molecule that mediates the effects of these two hits is intercellular adhesion molecule 5 (ICAM-5) which was found to be differentially expressed in PTSD². ICAM-5 is activated by neuroimmune challenge^3,4 and glutamatergic neurotransmission^5,6, it further enhances glutamatergic transmission⁶, and exerts a potent effect on synapse formation and neural plasticity, in addition to immunoregulatory functions^3,4,7; and (c) with respect to the neural network(s) involved, the brain areas most involved are medial temporal cortical areas, and interconnected cortical and subcortical areas^8-10. We hypothesize that the net result of intense glutamatergic transmission in those areas induced by a traumatic event in the presence of ongoing neuroimmune challenge leads to increased levels of ICAM-5 which further enhances glutamatergic transmission and thus leads to a state of a neural network with highly correlated neural interactions, as has been observed in functional neuroimaging studies^8-10. We assume that such a “locked-in” network underlies the intrusive re-experiencing in PTSD and maintains associated symptomatology, such as fear and avoidance.

Eugenio Fazio*

Department of Fundamental and Applied Sciences for Engineering, Sapienza Università di Roma via A. Scarpa 16, 00161 Roma Italy

Many technologies we use are inspired by nature. This happens in different domains, ranging from mechanics to optics to computer sciences. Nature has incredible potentialities that man still does not know or that he striving to learn through experience. These potentialities concern the ability to solve complex problems through approaches of various types of distributed intelligence. In fact, there are forms of intelligence in nature that differ from that of man, but are nevertheless exceedingly efficient. Man has often used as a model those forms of distributed intelligence that allow colonies of animals to develop places of housing or collective behaviors of extreme complexity. Recently, M. Alonzo et alii (Sci.Rep. 8, 5716 (2018)) published a hardware implementation to solve complex routing problems in modern information networks by exploiting the immense possibilities offered by light. This article presents an addressable photonic circuit based on the decision-making processes of ant colonies looking for food. When ants search for food, they modify their surroundings by leaving traces of pheromone, which may be reinforced and function as a type of path marker for when food has been found. This process is based on stigmergy, or the modification of the environment to implement distributed decision-making processes. The photonic hardware implementation that this work proposes is a photonic X-junction that simulates this stigmergic procedure. The experimental implementation is based on the use of non-linear substrates, i.e. materials that can be modified by light, simulating the modification induced by the ants on the surrounding environment when they leave the pheromone traces. Here, two laser beams generate two crossing channels in which the index of refraction is increased with respect to the whole substrate. These channels act as integrated waveguides (almost self-written optical fibers) within which optical information can be propagated (as happens for the ants that follow traces of pheromone already “written”). The proposed device is a X-junction with two crossing waveguides, whose refractive index contrast is defined by the intensities of the writing light beams. The higher the writing intensity, the greater the induced index variation, as if it were an increasingly intense pheromone trace. The information will follow the most contrasted harm of the junction, which is driven and eventually switched by the writing light intensity. Any optical information that will be sent to the device will follow the most intense trace, i.e. the most contrasted waveguide. The paper demonstrates a device that can be wholly operated using the light and that can be the basis of complex hardware configurations that might reproduce the stigmergic distributed intelligence. This is a highly significant innovation in the field of electronic and photonic technologies, within which artificial cognition and decision processes are implemented into a hardware circuit and not in a software code.

M. Fernández Rodríguez^1,2*, M. Menéndez Granda³, Villaverde González⁴

¹Mental Health Center I “La Magdalena” University Hospital San Agustín de Avilés. Health Area III, Asturias, Spain

²Gender Identity Treatment Unit of Principality of Asturias (UTIGPA), Spain

³Master of General Health Psychology, University of Oviedo, Asturias, Spain

⁴Intern Resident Psychologist, University Hospital San Agustín Avilés. Health Area III Asturias, Spain

The aim of this article is to highlight the historical path of transsexualism diagnosis since its inclusion to its elimination from the catalogue of mental disorders. We analyse the terminological changes that may account for this phenomenon in order to depathologise and just as the controversies raised by its location in the new Manual of International Statistical Classification of Diseases and Related Health Problems ICD-11.

ICD-11 drives out the term "Transsexualism" and replaces it with the term "Gender Incongruence" (GI). This new terminology will no longer be part of the chapter on mental disorders (Chapter 6) but a new chapter (Chapter 17) entitled "Conditions relating to sexual health" is created. These changes of ICD-11 represent a breakthrough and a great sense of freedom for trans people, since WHO has included the different variants of gender in normality by not being considered a mental disorder.

The aim of this paper is to highlight the historical development of the diagnosis of transsexualism from its inclusion to the elimination of the chapter of mental disorders. Terminological changes that can best reflect this phenomenon to depathologize and the controversies raised by its location in the new manual of ICD-11 are analyzed.

Celia Andreu-Sánchez^1*, Miguel Ángel Martín-Pascual^{1, 2}, Agnès Gruart³, José María Delgado-García³

¹Neuro-Com Research Group, Department of Audiovisual Communication and Advertising, Universitat Autònoma de Barcelona, Barcelona, Spain

²Instituto Radio Televisión Española, RTVE, Barcelona, Spain

³División de Neurociencias, Universidad Pablo de Olavide, Sevilla, Spain