Drozdstoj Stoyanov

In Quest for Scientific Psychiatry: Toward Bridging the Explanatory Gap

The contemporary epistemic status of mental health disciplines does not allow the cross-validation of mental disorders among various genetic markers, biochemical pathway or mechanisms, and clinical assessments in neuroscience explanations. We attempt to provide a meta-empirical analysis of the contemporary status of the cross-disciplinary issues existing between neurobiology and psychopathology. Our case studies take as an established medical mode an example cross-validation between biological sciences and clinical cardiology in the case of myocardial infarction. This is then contrasted with (…) the incoherence between neuroscience and psychiatry in the case of bipolar disorders. We examine some methodological problems arising from the neuroimaging studies, specifically the experimental paradigm introduced by the team of Wayne Drevets. Several theoretical objections are raised: temporal discordance, state independence, and queries about the reliability and specificity, and failure of convergent validity of the interdisciplinary attempt. Both modern neuroscience and clinical psychology taken as separate fields have failed to reveal the explanatory mechanisms underlying mental disorders. The data acquired inside the monodisciplinary matrices of neurobiology and psychopathology are deeply insufficient concerning their validity, reliability, and utility. Further, there have not been developed any effective transdisciplinary connections between them. It raises the requirement for development of explanatory significant multidisciplinary ‘meta-language’ in psychiatry. We attempt to provide a novel conceptual model for an integrative dialogue between psychiatry and neuroscience that actually includes criteria for cross-validation of the commonly used psychiatric categories and the different assessment methods. The major goal of our proactive program is the foundation of complementary ‘bridging’ connections of neuroscience and psychopathology, which may stabilize the cognitive meta-structure of mental health knowledge. This entails bringing into synergy the disparate discourses of clinical psychology and neuroscience. One possible model accomplishment of this goal would be the synergistic (or at least compatible) integration of the knowledge under transdisciplinary convergent cross-validation of the commonly used methods and notions.

Cross-cultural validation of the revised temperament and character inventory in the Bulgarian language.

RATIONALE, AIMS AND OBJECTIVES Health-care professions have long been considered prone to work-related stress, yet recent research in Bulgaria indicates alarmingly high levels of burnout. Cloningers inventory is used to analyse and evaluate correlation between personality characteristics and degree of burnout syndrome manifestation among the risk categories of health-care professionals. The primary goal of this study was to test the conceptual validity and cross-cultural applicability of the revised TCI (TCI-R), developed in the United States, in a culturally, socially and economically diverse setting. METHODS Linguistic validation, test-retest studies, statistical and expert analyses were performed to assess cross-cultural applicability of the revised Cloningers temperament and character inventory in Bulgarian, its reliability and internal consistency and construct validity. RESULTS The overall internal consistency of TCI-R and its scales as well as the interscale and test-retest correlations prove that the translated version of the questionnaire is acceptable and cross-culturally applicable for the purposes of studying organizational stress and burnout risk in health-care professionals. CONCLUSIONS In general the cross-cultural adaptation process, even if carried out in a rigorous way, does not always lead to the best target version and suggests it would be useful to develop new scales specific to each culture and, at the same time, to think about the trans-cultural adaptation.

The challenge of psychiatric nosology and diagnosis.

Associate Professor, Department of Psychiatry and Medical Psychology, Medical University of Plovdiv, Plovdiv, Bulgaria Professor, Department of History and Philosophy of Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Distinguished Professor, Department of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA PhD Student, Department of Psychobiology, University of Salamanca, Salamanca, Spain Distinguished Professor, Department of History and Philosophy of Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA PhD Student, Department of Psychiatry and Medical Psychology, Medical University of Plovdiv, Plovdiv, Bulgaria

Multiple pathways link urban green- and bluespace to mental health in young adults

Background: A growing body of scientific literature indicates that urban green‐ and bluespace support mental health; however, little research has attempted to address the complexities in likely interrelations among the pathways through which benefits plausibly are realized. Objectives: The present study examines how different plausible pathways between green/bluespace and mental health can work together. Both objective and perceived measures of green‐ and bluespace are used in these models. Methods: We sampled 720 students from the city of Plovdiv, Bulgaria. Residential greenspace was measured in terms of the Normalized Difference Vegetation Index (NDVI), tree cover density, percentage of green areas, and Euclidean distance to the nearest green space. Bluespace was measured in terms of its presence in the neighborhood and the Euclidean distance to the nearest bluespace. Mental health was measured with the 12‐item form of the General Health Questionnaire (GHQ‐12). The following mediators were considered: perceived neighborhood green/bluespace, restorative quality of the neighborhood, social cohesion, physical activity, noise and air pollution, and environmental annoyance. Structural equation modelling techniques were used to analyze the data. Results: Higher NDVI within a 300 m buffer around the residence was associated with better mental health through higher perceived greenspace; through higher perceived greenspace, leading to increased restorative quality, and subsequently to increased physical activity (i.e., serial mediation); through lower noise exposure, which in turn was associated with lower annoyance; and through higher perceived greenspace, which was associated with lower annoyance. Presence of bluespace within a 300 m buffer did not have a straightforward association with mental health owing to competitive indirect paths: one supporting mental health through higher perceived bluespace, restorative quality, and physical activity; and another engendering mental ill‐health through higher noise exposure and annoyance. Conclusions: We found evidence that having more greenspace near the residence supported mental health through several indirect pathways with serial components. Conversely, bluespace was not clearly associated with mental health. HighlightsGreen/bluespace might support mental health.We examined pathways underlying the effect.Increased greenspace supported mental health through indirect pathways.Bluespace was not clearly associated with mental health.

The meta‐language of psychiatry as cross‐disciplinary effort: In response to Zachar (2012)

Associate Professor, Department of Psychiatry and Medical Psychology, Medical University of Plovdiv, Plovdiv, Bulgaria Professor, Department of History and Philosophy of Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Distinguished Professor, Department of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA PhD Student, Department of Psychiatry, University of Salamanca, Salamanca, Spain Distinguished Professor, Department of History and Philosophy of Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA PhD Student, Department of Psychiatry and Medical Psychology, Medical University of Plovdiv, Plovdiv, Bulgaria

Lower Noise Annoyance Associated with GIS-Derived Greenspace: Pathways through Perceived Greenspace and Residential Noise

Growing amounts of evidence support an association between self-reported greenspace near the home and lower noise annoyance; however, objectively defined greenspace has rarely been considered. In the present study, we tested the association between objective measures of greenspace and noise annoyance, with a focus on underpinning pathways through noise level and perceived greenspace. We sampled 720 students aged 18 to 35 years from the city of Plovdiv, Bulgaria. Objective greenspace was defined by several Geographic Information System (GIS)-derived metrics: Normalized Difference Vegetation Index (NDVI), tree cover density, percentage of green space in circular buffers of 100, 300 and 500 m, and the Euclidean distance to the nearest structured green space. Perceived greenspace was defined by the mean of responses to five items asking about its quantity, accessibility, visibility, usage, and quality. We assessed noise annoyance due to transportation and other neighborhood noise sources and daytime noise level (Lday) at the residence. Tests of the parallel mediation models showed that higher NDVI and percentage of green space in all buffers were associated with lower noise annoyance, whereas for higher tree cover this association was observed only in the 100 m buffer zone. In addition, the effects of NDVI and percentage of green space were mediated by higher perceived greenspace and lower Lday. In the case of tree cover, only perceived greenspace was a mediator. Our findings suggest that the potential for greenspace to reduce noise annoyance extends beyond noise abatement. Applying a combination of GIS-derived and perceptual measures should enable researchers to better tap individuals’ experience of residential greenspace and noise.

Pathways linking residential noise and air pollution to mental ill-health in young adults

Background: Recent years have seen growing, but still tentative, evidence of the potential associations of environmental noise and air pollution with mental disorders. In the present study, we aimed to examine the associations between residential noise and air pollution exposures and general mental health in young adults with a focus on underlying processes Methods: We sampled 720 students (18–35 years) from one university in the city of Plovdiv, Bulgaria. Residential noise (LAeq; day equivalent noise level) and air pollution (NO2) were assessed at participants residential address by land use regression models. General mental health was measured with a short form of the General Health Questionnaire (GHQ). The following putative mediators were considered: annoyance from environmental pollution, sleep disturbance, restorative quality of the neighborhood, neighborhood social cohesion, and commuting/leisure time physical activity. Structural equation modeling was used to analyze the theoretically‐indicated interplay between exposures, mediators, and GHQ. Results: We observed an association between higher LAeq and GHQ, in which environmental annoyance and neighborhood restorative quality emerged as key mediators. First, LAeq was associated with higher annoyance, and through it with lower restorative quality, and then in turn with lower physical activity, and thus with higher GHQ. Simultaneously, higher annoyance was associated with higher sleep disturbance, and thereby with higher GHQ. NO2 had no overall association with GHQ, but it was indirectly associated with it through higher annoyance, lower restorative quality, and lower physical activity working in serial. Conclusion: We found evidence that increased residential noise was related to mental ill‐health through several indirect pathways. Air pollution was associated with mental health only indirectly. HighlightsA model with multiple pathways was tested.Daytime noise was related to poor mental health.Air pollution had only an indirect effect.Key mediators: annoyance and neighborhood restorative quality.

The Person as Center of Health

Person-centered medical care, bioethical concepts fundamentally based on the notion of the person, discussions of the importance of the person in medical curricula, and the many chapters of this book focused on the person all require some reference to the nature of persons. What they are, what they do or do not do, and what it means to speak of persons in the context of medicine. This chapter defines what a person is. To give an idea of the complexity of the subject we start with a summary statement. A person is an embodied being, purposeful, thinking, feeling, emotional, capable of choosing, reflective, relational, responsible, very complex human individual of a certain personality and temperament, existing through time in a narrative sense, whose life in all spheres points both outward and inward and who does things. Each of these terms is a dynamic function, constantly changing, and requiring action on the part of the person to be maintained—although generally the maintenance is habitual and unmediated by thought.