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Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is more accurate than conventional imaging for primary staging of high-risk prostate cancer and localization of biochemical recurrence. Knowledge of PSMA expression patterns and standardized reporting facilitate accurate interpretation of positive PSMA findings. PSMA PET/CT should be adopted as part of clinical routine, as recommended in international guidelines.

In this paper we focus on some new normativist positions and compare them with traditional ones. In so doing, we claim that if normative judgments are involved in determining whether a condition is a disease only in the sense identified by new normativisms, then disease is normative only in a weak sense, which must be distinguished from the strong sense advocated by traditional normativisms. Specifically, we argue that weak and strong normativity are different to the point that one ‘normativist’ label ceases to be appropriate for the whole range of positions. If values and norms are not explicit components of the concept of disease, but only intervene in other explanatory roles, then the concept of disease is no more value-laden than many other scientific concepts, or even any other scientific concept. We call the newly identified position “value-conscious naturalism” about disease, and point to some of its theoretical and practical advantages.

Most of the epidemiological models of the Covid-19 pandemic contain the reproduction number (R) as a parameter. In this article we focus on some shortcomings regarding its role in driving health policies and political decisions. First, we summarize what R is and what it is used for. Second, we introduce a three-question matrix for the evaluation of any construct or parameter within a model. We then review the main literature about R to highlight some of its shortcomings and apply to them our three-question matrix. Finally, we argue that these shortcomings are important for an epistemic and political evaluation of R.

The Research Domani Criteria framework (RdoC) encourages research on specific impairments present across traditional nosological categories and suggests a list of biological and behavioral measures for assessing them. After a description of RdoC, in this article we focus on impairments of the ability of understanding others, specifically in Theory of Mind and empathy. We illustrate recent evidence on brain anomalies correlating with these deficits in Schizophrenia, Addiction Disorders and Mood Disorders populations. In the last section, we zoom out and consider this kind of research vis-à-vis the objection of being reductionistic that is, in favoring mechanistic accounts of mental disorders. We argue that metaphysical reductionism and explanatory reductionism are not conceptually entailed by the RdoC framework.

In this paper, we analyse the harm requirement in the general definition of mental disorder in the Diagnostic and Statistical Manual for Mental Disorders (DSM). This issue has both philosophical and clinical relevance: on the one hand the harm requirement is a normative, value-laden, non-objective component in the definition of mental disorder; on the other hand, the harm requirement has often been defended on the grounds that it prevents an increase in false positives. The issue is also important in assessing the relationship between psychiatry and somatic medicine, more precisely, between the DSM and the International Classification of Diseases (ICD). We argue that there are good reasons not to maintain the harm requirement in the general definition of mental disorder. After a brief introduction, we overview the history of the harm requirement across the various editions of the DSM. Then, we examine the main objection to the inclusion of the harm requirement in the general definition of mental disorder, that is, the problem of false negatives, and also present several other points – both practical and conceptual – that help demonstrate why the harm requirement is inadequate as a definiens of mental disorder. To conclude, we stress that the decision of the DSM-5 task force not to regard the harm requirement as a necessary component of mental disorder should be endorsed.

Philosophers of medicine have formulated different accounts of the concept of disease. Which concept of disease one assumes has implications for what conditions count as diseases and, by extension, who may be regarded as having a disease (disease judgements) and for who may be accorded the social privileges and personal responsibilities associated with being sick (sickness judgements). In this article, we consider an ideal diagnostic test for coronavirus disease 2019 (COVID-19) infection with respect to four groups of people—positive and asymptomatic; positive and symptomatic; negative; and untested—and show how different concepts of disease impact on the disease and sickness judgements for these groups. The suggestion is that sickness judgements and social measures akin to those experienced during the current COVID-19 outbreak presuppose a concept of disease containing social (risk of) harm as a component. We indicate the problems that arise when adopting this kind of disease concept beyond a state of emergency.

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included the Social (Pragmatic) Communication Disorder (SPCD) as a new mental disorder characterized by deficits in pragmatic abilities. Although the introduction of SPCD in the psychiatry nosography depended on a variety of reasons—including bridging a nosological gap in the macro-category of Communication Disorders—in the last few years researchers have identified major issues in such revision. For instance, the symptomatology of SPCD is notably close to that of (some forms of) Autism Spectrum Disorder (ASD). This opens up the possibility that individuals with very similar symptoms can be diagnosed differently (with either ASD or SPCD) and receive different clinical treatments and social support. The aim of this paper is to review recent debates on SPCD, particularly as regards its independence from ASD. In the first part, we outline the major aspects of the DSM-5 nosological revision involving ASD and SPCD. In the second part, we focus on the validity and reliability of SPCD. First, we analyze literature on three potential validators of SPCD, i.e., etiology, response to treatment, and measurability. Then, we turn to reliability issues connected with the introduction of the grandfather clause and the use of the concepts of spectrum and threshold in the definition of ASD. In the conclusion, we evaluate whether SPCD could play any role in contemporary psychiatry other than that of an independent mental disorder and discuss the role that non-epistemic factors could play in the delineation of the future psychiatry nosography.

Advanced medical imaging, such as CT, fMRI and PET, has undergone enormous progress in recent years, both in accuracy and utilization. Such techniques often bring with them an illusion of immediacy, the idea that the body and its diseases can be directly inspected. In this paper we target this illusion and address the issue of the reliability of advanced imaging tests as knowledge procedures, taking positron emission tomography (PET) in oncology as paradigmatic case study. After individuating a suitable notion of reliability, we argue that (1) PET is a highly theory-laden and non-immediate knowledge procedure, in spite of the photographic-like quality of the images it delivers; (2) the diagnostic conclusions based on the interpretation of PET images are population-dependent; (3) PET images require interpretation, which is inherently observer-dependent and therefore variable. We conclude with a three-step methodological proposal for enhancing the reliability of advanced medical imaging.

The philosophy of advanced medical imaging is a new research field. Here we map the terrain with a provisional division between classical epistemology, social epistemology and ethics of advanced medical imaging. For each broad topic, we indicate what the most important questions are likely to be, review relevant samples of the existing publications, and describe the new contributions contained in this volume.

We raise a problem of applicability of RCTs to validate nuclear diagnostic imaging tests. In spite of the wide application of PET and other similar techniques that use radiopharmaceuticals for diagnostic purposes, RCT-based evidence on their validity is sparse. We claim that this is due to a general conceptual problem that we call Prevalence of Treatment, which arises in connection with designing RCTs for testing any diagnostic procedure in the present context of medical research, and is particularly apparent in this case. We also identify three practical reasons why RCTs do not qualify as the best option for PET validation, which have to do with specific characteristics of nuclear diagnostic imaging, and of radiopharmaceuticals. The paper is meant to contribute both to the philosophical discussion on the EBM hierarchy of evidence, and on the specific debate on radiopharmaceuticals in nuclear medicine.

A quite radical way to look at psychiatry has been recently proposed by Dominic Murphy, who boldly defends a «strong medical model», seeing psychiatry as a branch of cognitive neuroscience. In the present paper, we overview and discuss Murphy's proposal focusing on three different but related theses. First, the claim that a mental disorder must be identified with a pathological process that takes place in the brain and can be eventually individuated with the methodology of cognitive neuroscience. Second, the assertion that psychiatric explanation must be regarded as causal and multilevel: it should eventually aim at discovering what are the underlying mechanisms of mental disorders, but also acknowledge that these mechanisms can be located at different levels, none of which is privileged. Third, the critique to the most relevant nosology of mental disorders, that of DSM-5, which is merely descriptive and classifies mental disorders according to their signs and symptoms.

Trust in healthcare system is a key element for understanding vaccine hesitancy, and for dealing with it. In this paper I outline a conceptual model of the relation of trust between the public and the health care system, drawing from health care studies and the philosophical literature. Key components of the model are values, epistemic authority, vulnerability and credibility. I also briefly suggest how the features of such a model may help implementing communication strategies addressed to hesitant parents.

Recently, there has been increasing interest in methodological aspects of advanced imaging, including the role of guidelines, recommendations, and experts&rsquo, consensus, the practice of self-referral, and the risk of diagnostic procedure overuse. In a recent Delphi study of the European Association for Nuclear Medicine (EANM), panelists were asked to give their opinion on 47 scientific questions about imaging in prostate cancer. Nine additional questions exploring the experts&rsquo, attitudes and opinions relating to the procedure of consensus building itself were also included. The purpose was to provide insights into the mechanism of recommendation choice and consensus building as seen from the experts&rsquo, point of view. Results: Regarding the factors likely to influence the willingness to refer a patient for imaging, the most voted were incorporation into guidelines and data from scientific literature, while personal experience and personal relationship were chosen by a small minority. Regarding the recommendations more relevant to prescribe an imaging procedure, it resulted the incorporation into guidelines promoted by scientific societies (59% of votes), these guidelines also resulted the more trusted. With respect to patients&rsquo, preferences considered when prescribing an imaging procedure, the most voted was accuracy, resulted more important than easy access and time to access to the procedure. The majority of the experts expressed the opinion that there is a scarce use of imaging procedures in prostate cancer. With respect to the most relevant factor to build consensus, it resulted the transparency of the process (52% of votes), followed by multidisciplinarity of contributors. The main obstacle to incorporation of modern imaging procedures into guidelines resulted the lack of primary literature on clinical impact. Conclusions: Firstly, the panelists portray themselves as having Evidence-Based Medicine oriented and scientifically inclined attitudes and preferences. Secondly, guidelines and recommendations from scientific societies, especially clinical ones, are positively taken into account as factors influencing decisions, but panelists tend to consider their own appraisal of the scientific literature as more relevant. Thirdly, in respect of overuse, panelists do not think that advanced diagnostic procedures are overutilized in the specific case of Prostate Cancer, but rather they are underutilized.

The general definition of mental disorder stated in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders seems to identify a mental disorder with a harmful dysfunction. However, the presence of distress or disability, which may be bracketed as the presence of harm, is taken to be merely usual, and thus not a necessary requirement: a mental disorder can be diagnosed as such even if there is no harm at all. In this paper, we focus on the harm requirement. First, we clarify what it means to say that the harm requirement is not necessary for defining the general concept of mental disorder. In this respect, we briefly examine the two components ofharm, distress and disability, and then trace a distinction between mental disorder tokens and mental disorder types. Second, we argue that the decisionnotto regard the harm requirement as a necessary criterion for mental disorder istenable fora numberof practical and theoretical reasons, somepertaining to conceptual issuessurrounding the two components of harm and otherspertaining to the problem of false negatives and the status of psychiatryvis-à-vis somatic medicine. However, we believe that the harm requirement can be (provisionally) maintained among the specificdiagnostic criteria ofcertain individual mental disorders. More precisely, we argue that insofar as the harm requirement is needed among the specificdiagnostic criteria ofcertain individual mental disorders, it should be unpacked and clarified.

The general concept of mental disorder specified in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders is definitional in character: a mental disorder might be identified with a harmful dysfunction. The manual also contains the explicit claim that each individual mental disorder should meet the requirements posed by the definition. The aim of this article is two-fold. First, we shall analyze the definition of the superordinate concept of mental disorder to better understand what necessary (and sufficient) criteria actually characterize such a concept. Second, we shall consider the concepts of some individual mental disorders and show that they are in tension with the definition of the superordinate concept, taking pyromania and narcissistic personality disorder as case studies. Our main point is that an unexplained and not-operationalized dysfunction requirement that is included in the general definition, while being systematically violated by the diagnostic criteria of specific mental disorders, is a logical error. Then, either we unpack and operationalize the dysfunction requirement, and include explicit diagnostic criteria that can actually meet it, or we simply drop it.

In this paper I claim that concepts taken from Wittgenstein's philosophy’s concepts can shed light on the phenomenon of schizophrenia in at least three different ways: with a view to empathy, scientific explanation, or philosophical clarification. I consider two different “positive” wittgensteinian accounts—Campbell’s idea that delusions involve a mechanism of which different framework propositions are parts, Sass’ proposal that the schizophrenic patient can be described as a solipsist-, and a "negative" wittgenste inian account, namely Rhodes’ and Gipp’s account, where epistemic aspects of schizophrenia are explained as failures in the ordinary background of certainties. I argue that none of them amounts to empathic-phenomenological understanding, but they provide examples of how philosophical concepts can contribute to scientific explanation, and to philosophical clarification respectively

Though the divide between reason-based and causal-explanatory approaches in psychiatry and psychopathology is old and deeply rooted, current trends involving multi-factorial explanatory models and evidence-based approaches to interpersonal psychotherapy, show that it has already been implicitly bridged. These trends require a philosophical reconsideration of how reasons can be causes. This paper contributes to that trajectory by arguing that Donald Davidson’s classic paradigm of 1963 is still a valid option.

This Editorial Commentary refers to the article http://dx.doi.org/ 10.1007/s00259-015-3202-7 .

This commentary focuses on Machery's eliminativist claim, that “concept” ought to be eliminated from the theoretical vocabulary of psychology because it fails to denote a natural kind. I argue for the more traditional view that concepts are a functional kind, which provides the simplest account of the empirical evidence discussed by Machery.

Are concepts stable entities, unchanged from context to context? Or rather are they context-dependent structures, created on the fly? We argue that this does not constitute a genuine dilemma. Our main thesis is that the more a pattern of features is general and shared, the more it qualifies as a concept. Contextualists have not shown that conceptual structures lack a stable, general core, acting as an attractor on idiosyncratic information. What they have done instead is to give a contribution to the comprehension of how conceptual structure organized around such a stable core can produce contextually appropriate representations on demand. © 2010 Springer Science+Business Media B.V.

Arguments for ad hoc nature of concepts come from two different sources, namely philosophy of language and psychology of categorization. This chapter focuses on philosophical arguments only. The ad hoc concepts may be useful scientific explananda for various cognitive activities, but their postulation as components of thought is not mandatory on purely philosophical and linguistic grounds. The author draws a map of possible views on the relationships between concepts, meanings and context. He uses as a test a wide-currency example in the contemporary debate, which involves metaphor, and he identifies and presents four alternative positions; two ad hoc concept views and two stable concept views. He describes in detail one of the four, namely the two-level stable concept view, together with some reasons for favouring it. The author defends the two-level stable concept view by providing evidence that concepts are more than words and considers some relevant possible objections. Keywords: ad hoc nature; contemporary debate; linguistic grounds; philosophical arguments; psychology of categorization; relevance theory

This chapter focuses on a recent revival of conceptual analysis, the philosophical method of discovering necessary and a priori contents by describing conceptual relations. According to some philosophers, contents such as 'Red is a color' are true by virtue of the deep structure of our cognitive system, and assuming that this structure is innate, such contents are true independently of experience, i.e., they are a priori. I defend an alternative position, according to which relations among concepts, whether innate or acquired, mirror the relations among the real-world properties they refer to, and our conceptual structure is continuously tested and compared with the characteristics of our environment. In such a view, if a description of our conceptual equipment generates true contents, it generates a posteriori ones.

I argue that a concept is applied correctly when it is applied to the kind of things it is the concept of. Correctness as successful kind-tracking is fulfilling an externally and naturalistically individuated standard. And the normative aspect of concept-application so characterized depends on the relational (non-individualistic) feature of conceptual content. I defend this view against two objections. The first is that norms should provide justifications for action, and the second involves a version of the thesis of indeterminacy of reference.

In this thesis I investigate the notion of harm in psychiatry. The question is whether a person is harmed, and in what way, by a particular condition that is of psychiatric relevance. In other words, I explore whether harm should be one of the criteria to focus on in psychiatric practice - in the process of psychiatric assessment, diagnosis, and treatment of patients. If so, how should we think about, define and conceptualize harm to fit the needs of this context. What harm in psychiatry entails becomes a bit clearer once we consider how it entered into the psychiatric context. The notion of harm entered psychiatry in the 1970s during the process of depathologisation of homosexuality – the removal of homosexuality from the list of mental disorders. The argument was that mental disorders are conditions that harm a person that has them. Seeing as homosexuals are not harmed in virtue of their condition, they are not suffering from a mental disorder. In years following the APA’s decision to depathologize homosexuality, harm would be included in authoritative diagnostic manuals and would be featured in the discussion on mental disorders, which has been a central discussion in philosophy of psychiatry for the last forty years. In this work I argue that harm is an important criterion in psychiatry, rightfully deserving of our attention. Harm is relevant both in theory and practice as one of the criteria that seriously considers the patient’s point of view as we have seen in the case of depathologizing homosexuality. Even though the traditional debate on mental disorders presents the conceptual and methodological landscape of our analysis, in recent years the debate has been strongly objected to. The lion’s share of the criticism has been directed towards traditional philosophical methods like conceptual analysis. Further objections are directed at the methodology of the discussion on mental disorders, questioning the nature of the concept, the intuitions and goals of the discussion and whether we are investigating one concept or many. I take these objections to be justified and side with metatheoretical innovations in the discussion on mental disorders that have come about in recent years (Bortolotti, 2020; Ereshefsky, 2009; Murphy, 2006; Schwartz, 2007a). To place harm in the context of these methodological novelties in philosophy of psychiatry I take Dominic Murphy’s (2006) taxonomy that builds on the traditional positions in the discussion, objectivism and constructivism, by adding the variants – conservativist and revisionist. My contribution to the discussion is an addition to Murphy’s taxonomy, a position which I call “compassionatism”. It is the view that concepts that capture the first-person perspective are and should remain crucial in psychiatry. This includes concepts such as harm, well-being, welfare, suffering and so on. I believe that in highlighting compassionist concepts and making them salient we are bringing attention to a key element of psychiatric practice – the patient’s perspective. I focus on harm as one of these compassionatist concepts. I take the revisionist route of compassionatism in arguing that our analysis of harm should be constructive and normative, rather than a descriptive project. We should decide on what we need and how we should think about harm rather than describe how harm is used in various psychiatric contexts. Our compassionatist concepts, specifically harm, should be constructed according to two principles. First, the concept should as fully and as faithfully capture the patient’s perspective. Second, it should do so while adhering to the precepts of the psychiatric practice. To come to the concept of harm I use an explicationist methodology inspired by Rudolf Carnap (1962). The method consists in taking an imprecise concept (explicandum) and turning it into a precise concept (explicatum) which would fit particular needs and interests. To begin I use the idea of harm in bodily medicine which, I argue, consists in the inability to achieve and maintain homeostasis. I try to transpose this view to psychiatry, being also wary of the differences between them and challenges that such a move would pose. I propose what I consider to be a close approximate of this view in psychiatry. I argue that harm in psychiatry consists in inadequate resources in dealing with the problems of living. I unpack each of the elements of the view – ‘inadequate’, ‘resources’, ‘dealing with’ and ‘problems of living’ showing what they mean and how they work together., U ovom radu se bavim pojmom štete u psihijatriji. Pitanje kojim se bavim je šteti li, i na koji način, osobi određeno stanje koje je od psihijatrijskog interesa. Drugim riječima, istražujem bi li pojam štete trebao biti jedan od kriterija na koji bismo trebali obratiti pažnju unutar psihijatrijske prakse – tijekom procesa psihijatrijskog vrednovanja, dijagnoze i liječenja pacijenata. Ako pretpostavimo da jest, kako bismo trebali promišljati, definirati i konceptualizirati pojam štete da odgovara potrebama psihijatrijskog konteksta. Značenje pojma štete u psihijatriji je jasnije ako razmotrimo okolnosti u kojima je pojam štete uveden u psihijatriju. Pojam štete je uveden u psihijatriju 1970tih tijekom procesa depatologizacije homoseksualnosti – uklanjanja homoseksualnosti s liste mentalnih poremećaja. Argumentom korištenim u tu svrhu se tvrdilo da su mentalni poremećaji stanja koja štete osobama koje boluju od njih. Budući da homoseksualnost sama po sebi ne šteti osobama koje su homoseksualne orijentacije, takvim osobe ne pate od mentalnog poremećaja. U godinama koje su slijedile nakon odluke Američkog psihijatrijskog društva o depatologizaciji homoseksualnosti, pojam štete ulazi u autoritativne dijagnostičke priručnike i proteže se kroz raspravu o mentalnim poremećajima koja je temeljna rasprava u području filozofije psihijatrije posljednjih četrdeset godina. U ovom radu tvrdim da je pojam štete bitan kriterij u psihijatriji koji s pravom zaslužuje našu pažnju. Pojam štete je bitan i u teorijskoj i u praktičnoj psihijatriji kao jedan od kriteriji koji ozbiljno uzimaju u obzir perspektivu pacijenta, kao što smo to vidjeli na primjeru depatologizacije homoseksualnosti. Iako je tradicionalna rasprava o mentalnim poremećajima konceptualni i metodološki temelj naše analize, posljednjih godina dobiva mnoge kritike. Najviše kritika je upućeno tradicionalnim filozofskim metodama poput konceptualne analize. Daljnji prigovori su usmjereni metodologiji rasprave o mentalnim poremećajima koji propituju prirodu pojma, položaj intuicija u raspravi i ciljeve rasprave, te postavljaju pitanje istražuje li se jedan pojam ili više njih. Smatram da su ti prigovori opravdani i priklanjam se metateorijskim inovacijama u raspravi o mentalnim poremećajima koje su iznesene posljednjih godina. Kako bih smjestila pojam štete u kontekst tih metodoloških novina u filozofiji psihijatrije oslanjam se na taksonomiju pozicija Dominica Murphyja. Njegova taksonomija je izgrađena na pozicijama tradicionalne rasprave – objektivizmu i konsktruktivizmu kojima Murphy pridružuje dvije varijante – konzervativizam i revizionizam. Moj doprinos raspravi je dodatak Murphyjevoj taksonomiji, poziciju koju nazivam ‘suosjećajizam’. To je gledište prema kojemu pojmovi koji utjelovljuju perspektivu pacijenta jesu i trebali bi biti važni u psihijatriji. To uključuje pojmove poput štete, dobrobiti, blagostanja, patnje i druge. Stava sam da ističući pojmove suosjećajizma i naglašavajući ih pridajemo pažnju ključnom elementu psihijatrijske prakse – perspektivi pacijenta. U svojoj analizi se usredotočujem na pojam štete koji je jedan od tih pojmova. Zagovaram revizionistički suosjećajizam čime tvrdim da naša analiza štete treba biti normativna, a ne deskriptivna, što znači da bismo trebali moći odlučiti što trebamo od pojma štete te kako bismo trebali promišljati o njemu radije nego da opisujemo kako se pojam koristi u raznim psihijatrijskim kontekstima. Naši ‘suosjećajistički’ pojmovi, posebice šteta, bi trebali biti konstruirani prema dva principa. Prvo, pojam bi trebao što potpunije i vjernije zahvatiti perspektivu pojedinca. Drugo, to bi trebao činiti poštivajući pravila i prilike psihijatrijske prakse. Do pojma štete dolazim koristeći metodu eksplikacije inspiriranu Rudolfom Carnapom. Metoda se sastoji u pretvaranju nepreciznog pojma (explicanduma) u precizniji (explicatum) koji bi odgovarao pretpostavljenim potrebama i interesima. Za početak koristim generalnu ideju štete u medicini koja se sastoji u nemogućnosti postizanja i održavanja homeostaze. Nastojim to gledište štete prenijeti u područje psihijatrije uzimajući u obzir razlike i izazove koje takav potez podrazumijeva. Predlažem definiciju koju smatram bliskom navedenoj definiciji u medicini. Definiram pojam štete kao neadekvatne resurse pri nošenju s životnim problemima. Svaki element te definicije pobliže objašnjavam te pokazujem kako svi elementi funkcioniraju zajedno.

International audience; Over the last few decades, medical imaging has gained an increasing importance in oncology at every step along the cancer care pathway (e.g., detection, staging, post-treatment assessment, detection of recurrence). With the explosion of information available on the internet and shared decision-making, the patients are often aware that imaging results can have a major impact on their care programme. Therefore, they are particularly keen on enquiring about the results as soon as the examination has been completed. The paper proposes an analysis of the philosophical and ethical aspects involved in communicating bad news following imaging examinations of oncologic patients, with special emphasis on nuclear imaging.