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Objective: The assessment of response to lithium maintenance treatment in bipolar disorder (BD) is complicated by variable length of treatment, unpredictable clinical course, and often inconsistent compliance. Prospective and retrospective methods of assessment of lithium response have been proposed in the literature. In this study we report the key phenotypic measures of the "Retrospective Criteria of Long-Term Treatment Response in Research Subjects with Bipolar Disorder" scale currently used in the Consortium on Lithium Genetics (ConLiGen) study.
Materials and Methods: Twenty-nine ConLiGen sites took part in a two-stage case-vignette rating procedure to examine inter-rater agreement [Kappa (\(\kappa\))] and reliability [intra-class correlation coefficient (ICC)] of lithium response. Annotated first-round vignettes and rating guidelines were circulated to expert research clinicians for training purposes between the two stages. Further, we analyzed the distributional properties of the treatment response scores available for 1,308 patients using mixture modeling.
Results: Substantial and moderate agreement was shown across sites in the first and second sets of vignettes (\(\kappa\) = 0.66 and \(\kappa\) = 0.54, respectively), without significant improvement from training. However, definition of response using the A score as a quantitative trait and selecting cases with B criteria of 4 or less showed an improvement between the two stages (\(ICC_1 = 0.71\) and \(ICC_2 = 0.75\), respectively). Mixture modeling of score distribution indicated three subpopulations (full responders, partial responders, non responders).
Conclusions: We identified two definitions of lithium response, one dichotomous and the other continuous, with moderate to substantial inter-rater agreement and reliability. Accurate phenotypic measurement of lithium response is crucial for the ongoing ConLiGen pharmacogenomic study.
Just do it! Guilt as a moral intuition to cooperate - A parallel constraint satisfaction approach
(2011)
After a long dominance of rational models of judgment and decision-making in moral psychology (e.g. Kohlberg, 1969) there is now a strong interest in how intuitions and emotions influence moral judgments and decisions (e.g. Greene, 2007; Haidt, 2001; Monin, Pizarro, & Beer, 2007). In the literature, the influence of emotions on moral decisions is explained by heuristic or non-compensatory information processing (e.g. Sinnott-Armstrong, Young, & Cushman, 2010; Sunstein, 2005; Tobler, Kalis, & Kalenscher, 2008). However, the process of emotion elicitation is ignored. Appraisal theories postulate that emotion elicitation is due to the incoherence (or discrepancy) of behavioral representations like goals and actions (Moors, 2009). Emotion elicitation and intuitive decision-making can be combined if both processes apply a connectionist information processing structure (e.g. Barnes & Thagard, 1996). The current work contrasts both perspectives of intuitive-emotional decision-making with respect to guilt and cooperation.