This thesis has explored the relationship between a personality variable, A-B status of the therapist, and his perceived success with various clinical populations. The subjects were 89 Ph.D. psychologists in Indiana who responded to a written questionaire. The therapist's A-B status was determined by the Whitehorn-Betz 10-item A-B scale. The relationship between psychologists' A-B ratings and their perceived success with various nosological groups was studied.The results did not support past A-B research. The correlations between the A-B variable and the therapists' ratings of perceived success with schizophrenic and neurotic patients were not significant. Similarly, correlations between the A-B status of the therapist and his perceived success with alcoholic and drug dependent patients were not statistically significant.

Structured electronic health record (EHR) data are commonly incomplete and can lack diagnostic detail. Clinical reports, on the other hand, are typically comprehensive and contain a wealth of detailed medical information. Pathologists invest considerable time and specialized training to create information-rich pathology reports, but the necessary manual review of these reports for clinical or research use is a high barrier to their routine utilization. The automated extraction of clinical targets directly from pathology reports would allow for the structured aggregation of relevant patient data that are not currently routinely captured in the EHR. In this dissertation, I apply recently developed transformer models to predict clinical targets from cancer pathology report text. In the first chapter, I present a pathology report corpus that I fully processed and made publicly available, and perform a proof-of-concept cancer type classification. In the second chapter, I discuss a set of cancer stage classification models that I fine-tune on the pathology report corpus and then externally validate on reports from Columbia University Irving Medical Center (CUIMC). In the last chapter, I explore additional applications for this methodology, developing a generalizable model to classify prostate cancer reports into primary Gleason score categories, applying a transformer model to classify reports into diagnosis categories for a Barrett’s esophagus patient cohort in a low-data environment, and performing a proof-of-concept prediction of adverse drug events from 1D drug representations.

This paper deals with some of the issues that affect the understanding and functioning of descriptive psychopathology (DP). The latter remains the language of description in psychiatry and the basis for her nosological constructs. DP makes assumptions concerning the nature of its object and its underlying causes (i.e. makes use of the medical model). DP needs historical, clinical and numerical recalibration. It is suggested that in some cases, and against traditional psychometric principles, some instruments will have to be constructed that show flexibility and can be varied according to the descriptive needs presented by individual cases. / En el presente artículo se discuten algunos aspectos que afectan a la comprensión y al funcionamiento de la psicopatología descriptiva (PD), la cual proporciona un lenguaje descriptivo a la psiquiatría y las bases para sus constructos nosológicos. La PD formula postulados sobre la naturaleza de su objeto de estudio y sus causas subyacentes (haciendo uso del modelo médico). Se propone que la PD necesita una recalibración histórica, clínica y numérica. En relación a esto, se sugiere que en algunos casos, en contra de los principios psicométricos tradicionales, ciertos instrumentos deberán ser construidos de un modo flexible que permita que varíen de acuerdo a las necesidades descriptivas que presenten casos individuales.

Moral injury (MI) is a term that is increasingly being used to describe the psycho-spiritual consequences of events that deeply transgress an individual’s core human values. Stemming most predominantly from the literature on military mental health, MI is understood to be characterized by intense moral emotions such as guilt, shame and anger, as well as existential and spiritual conflict prompted by an event that has deeply disrupted an individual’s beliefs about themselves and the world. Emerging research has shown that exposure to such events as well as particular features of MI distress are associated with increased incidence and severity of mental health problems, such as PTSD and depression. To date, the majority of the research on MI has been conducted in the military context, most predominantly in the United States. Thus, the two studies included in this dissertation come together to evaluate the construct validity of MI by assessing whether a) the patterns of distress identified in military populations to date could also be observed in the Canadian military context, and b) the patterns of distress most pertinent to MI thus identified in the occupational stress literature could be observed in the general population in the context of the COVID-19 pandemic. In Study 1, treatment-seeking military members and Veterans (n = 18) completed a semi-structured interview about the impact of military experiences that deeply disrupted their core beliefs and values. A qualitative analysis was performed and yielded eight main themes: change in moral attitude, increased sensitivity and reactivity to moral situations, loss of trust, disruptions in identity, disruptions in spirituality, disruptions in interpersonal relatedness, rumination, and internalizing and externalizing emotions and behaviours. In addition to the participants who completed the interview, an additional 37 participants (n = 55) completed a structured diagnostic interview and self-report measures of exposure to potentially morally injurious events (PMIEs), combat exposure, guilt, anger, posttraumatic stress disorder (PTSD) and depression. Quantitative analyses revealed that PMIE exposure, but not combat exposure, was related to psychological distress, most notably to symptoms of PTSD. In Study 2, participants recruited from the general population (n = 355) completed an online survey assessing a) exposure to and appraisals of morally-laden COVID-19 stressors, b) mental health symptoms, and c) dispositional characteristics including trait emotions, anxiety sensitivity, sense of duty, and religiosity/spirituality. Path analysis revealed specific indirect associations between self-based moral appraisals and PTSD and depression through guilt, and between both self- and other-based moral appraisals and PTSD and depression through anger. Number of COVID-19 stressors had no influence on these associations. Sense of duty, reparative guilt, and anxiety sensitivity best predicted negative moral appraisals. Together, findings from these studies provide support for the MI construct and extend existing findings by showing that the associations among key features of MI and mental health can be observed in various contexts, and that patterns of distress theorized to comprise the MI construct likely extend to lower-level stressors outside the military context. Potential mechanisms regarding the etiology and maintenance of psychological distress in the context of MI were also identified (e.g., moral appraisals and cognitive features such as rumination), which require further investigation. A better understanding of MI across contexts is likely to help refine approaches to clinical case conceptualization and treatment for those at risk of mental health problems in the aftermath of morally distressing events.

The Diagnostic and Statistical Manual of Mental Disorders arranges co-occurring clusters of symptoms into distinct disorder categories, which theoretically have specific etiologies, pathologies, and treatments. However, researchers and clinicians alike have consistently found DSM diagnoses to have high rates of comorbidity, low diagnostic specificity, and no disorder has proven to be a discrete category. There is mounting evidence that dimensional taxonomies more accurately capture the underlying structure of mental illness and clinical presentations. The recently proposed hierarchical taxonomy of psychopathology presumes to address the issues of categorical nosologies using a data driven approach to create a dimensional model of psychopathology. However, heretofore there are no empirical examinations of HiTOP's ability to predict psychotherapy treatment outcomes. This study compared the predictive validity DSM, RDoC, and HiTOP criteria using natural language processing on free text narrative notes. Of the three GMM run, only the model using DSM criteria as predictors had adequate model fit. Additionally, none of the nosologies significantly predicted treatment course. Implications for the application of RDoC and HiTOP are discussed.

Dans Naissance de la clinique, Michel Foucault mit en évidence l’émergence au XIXe siècle d’un regard médical qui, en faisant taire la théorie au lit du malade, tâche de parler la langue étrangère de la maladie dans la profondeur des tissus. En opposition aux nosographies essentialistes du XVIIIe siècle, une forme de nominalisme médical apparaît progressivement à travers le développement de l’anatomo-pathologie. Cette médecine clinique est parcourue par un concept souvent oublié qui se trame, pourtant, dans l’ombre de son savoir et préfigure son dépassement. Il s’agit du concept de « probabilité ». Bien que celui-ci s’inscrit dans la clinique, l’application du calcul de probabilités ne parvient pas à s’y intégrer. Le XIXe siècle sera le théâtre d’un véritable conflit sur la conjecture qui oppose « les numéristes » et les cliniciens d’obédience hippocratique. L’orthodoxie de l’Ecole de Paris se trouve confrontée à l’émergence de la méthode numérique. La dispute théorique qui en résulte problématise l’application du calcul de probabilités en la médecine : du probable peut-on connaître autre chose que du probable ? Durant tout le XIXe siècle, on s’accorde à rejeter épistémologiquement cette méthode. Elle ne cadre pas avec la positivité des sciences médicales. Ce sera l’hygiène publique qui en fera usage pour pallier à l’inanité clinique dans le traitement des épidémies, des endémies et des épizooties. Cette rencontre conflictuelle de l’individuel et du collectif dans le médical fera naître une nouvelle forme de nosologie au XXe siècle. Il s’agit d’en comprendre l’émergence. / In The Birth of The Clinic, Michel Foucault highlights the emergence of a medical gaze in the 19th-century that – by vanishing the theory at the patient's bedside – tries to speak the foreign language of the disease in the depth of organic tissues. With the development of anatomo-pathology, a form of medical nominalism progressively appears in opposition to the essentialist nosography of the 18th-century. This clinical medicine is shot-through by a concept often forgotten that is framed, however in the shadow of clinical medical knowledge and that prefigures its disappearance. This is the concept of "probability". Even though this concept is part of clinical medicine, the application of probability calculation fails to be part of medical knowledge. The 19th-century was the scene of a conflict over numerical conjecture that opposes "Numerists" and Hippocratic’s Clinician. The Ecole de Paris’s orthodoxy was then confronted with the emergence of the numerical method. The theoretical dispute that results from the application of the calculation of probabilities in medicine gives rise to this question: from what is only probable, can we know anything else than what is probable? Throughout the 19th-century, the numerical method is rejected on epistemological grounds. It is held not to fit with the positivity of medical science. In the treatment of epidemics, endemic diseases, and epizootics, public health services make use of it still. This confrontation between the individual and the collective in medicine gives rise to a new form of nosology in the 20th-century.

Made available in DSpace on 2016-06-02T20:12:10Z (GMT). No. of bitstreams: 1 TeseJRBM.pdf: 1767918 bytes, checksum: 200ee529156f1dbfe98eeab387ba9dc6 (MD5) Previous issue date: 2006-12-15 / This doctoral thesis intends to analyze the main concepts of mental disease and the problematic relation between the organicism and the psychodinamism throughout the history of the psychopathologic ideas that came to constitute the scientific clinical psychiatry, from Philippe Pinel, in the beginning of XIX century, until the chaos of the no theoretical pretense descriptive of the official nosography of the end of XX century and beginning of XXI century (I.C.D.-10). The epistemologic conflict between the psychogenic and organogenic doctrines had resulted in many frustrated attempts of solution. The hermeneuticsynthetic psychopathology of Carl Gustav the Jung (1875-1961) and the phenomenonstructural psychopathology of Eugène Minkowski (1885-1972) stand out among the most promising proposals of XX century. The basic concepts of these authors keep an essential similarity, besides belonging to schools have different thoughts. However, their theorization go in parallel thinking about a psychopathologic formularization psychorganodinamic that is similar in its most essential principles. The antimechanist solution, anti-atomicist and antireductionist, of both, remind the current biological psychiatry that the desired and necessary consensual psychiatric theory will not do without a Metapsychopatology of the psychiatry that consider the irreducible biopsychosocial complexity of the normal or pathological human being. And, neither psychiatry will gain a satisfactory nosographic formularization while they don t reveal the mysteries of the complex etiology of mental disorders. / A presente tese de doutorado pretende analisar os principais conceitos de doença mental e a problemática relação entre o organicismo e o psicodinamismo ao longo da história das idéias psicopatológicas que vieram constituir a psiquiatria clínica científica, a partir de Philippe Pinel, no início do século XIX, até o caos da pretensa ateoricidade descritiva da nosografia oficial do final do século XX e início do século XXI (C.I.D.-10). O conflito epistemológico entre as doutrinas psicogênicas e organogênicas resultou em várias tentativas frustradas de solução. Dentre as mais promissoras propostas do século XX, destacam-se as da psicopatologia hermenêutico-sintética de Carl Gustav Jung (1875-1961) e da psicopatologia fenomeno-estrutural de Eugène Minkowski (1885-1972). Os conceitos fundamentais desses autores guardam uma semelhança essencial, apesar de pertencerem a escolas de pensamento diferentes; todavia, suas teorizações caminham paralelamente no sentido de uma formulação psicopatológica psicorganodinâmica muito parecida em seus princípios mais essenciais. A solução antimecanicista, anti-atomicista e anti-reducionista, de ambos, lembram à psiquiatria biológica atual que a tão desejada e necessária teoria psiquiátrica consensual não prescindirá de uma Metapsicopatologia da psiquiatria que considere a complexidade biopsicossocial irredutível do ser humano normal ou patológico. E, tampouco a psiquiatria chegará a uma formulação nosográfica satisfatória enquanto não desvendar os mistérios da etiologia complexa dos transtornos mentais.