NeuroAnalysis
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A group to promote the integration of systems-theories neural-computation sciences into psychiatry as a way to revolutionize our approach to understanding mental disorders, and unifying psychology, psychoanalysis, psychiatry and neuroscience
Website: http://sites.google.com/site/neuroanalysis/home
Location: gloabal
Members: 19
Latest Activity: Jan 24
N e u r o A n a l y s i s
By introducing complex system sciences, such as computational neuroscience, the currently differed disciplines of Neurology, Psychiatry and Psychology can be unified into one comprehensive complete discipline that merits the title of "NeuroAnalysis."
NeuroAnalysis will be the future discipline of all brain disorders and disturbances, hence the term "Neuro." As a clinical discipline "Analysis" stands for the diagnostics and therapeutic outlooks of this unifying filed of brain disturbances.
The current divide between the disciplines, results from present limited understanding of the way in which the brain accomplishes higher-level mental functions, such as personality and feelings, thus lacking the basic clinical science about the causes of a spectrum of disorders currently titled mental disorders.
The brain is a physical biological system; it is the most complex system known to us, to understand the brain we should apply complex-system-sciences to study its functions and dysfunctions. One such relevant scientific discipline is computational neurosciences where mathematical models of the brain begin to provide insights to how the brain works as a complex system.
With such disciplines we can begin to conceptualize mental disorders as brain disorders, and thus bring back psychiatry and psychology to the realm of brain-related sciences allowing them to merge with neurology and create a unified field of brain-related disorders.
In neurology we are dealing essentially with illnesses that have a clear identifiable damage to brain tissue, in psychiatry it seems that we are dealing with disorders of organization and function of neuronal ensembles within the brain tissue, in other words disturbances of the neural circuitry function instead of structure. This is evident from novel findings related to applications of neural computation methods to brain research.
Three major disturbances are predicted to play a role in all mental disorders, 1) disturbances of basic neuronal organizations responsible for internal representations and contextual processing, 2) disturbances to the optimal matching dynamics of activated neuronal ensembles and 3) disturbances to the connectivity dynamics of brain circuitry.
1) Disturbances of internal representations and contextual processing,
Basic neuronal organizations responsible for internal representations and contextual processing result from Hebbian dynamics, and develop by means of experience-dependent-plasticity, thus allowing for the formation of internal representations of external occurrences.
Such internal representations are conceptualized by psychologists as 'Object Relationships' were objects are the internal representations of others in our past and current psychosocial environment. Object Relationships are the contexts which govern our patterns of perceiving, reacting to, and behaving with others, or in other words, relevant to our personality styles within psychosocial settings.
Consequentially disturbances and biases of internal representations are directly relevant to personality disorders. In personality disorders the internal representations can be immature with general inadequacies toward the psychosocial adaptations needed, or they can be partially, specifically biased in certain contexts only. I any case, - general or specific, - these biases cause non-adaptive interactions with others and are the source of distress within psychosocial settings.
Because a psychotherapeutic session is an interpersonal experience, actually an experience-dependent-plasticity process, - then psychological interventions are in fact brain-changing interventions and can easily integrate into a unified brain-based discipline. This is especially true if psychotherapy is done correctly involving corrective experiences that allow for new internal formations to increase adaptability and coping with psychosocial occurrences thus alleviating sufferings resulting from non-adaptive interactions.
2) Disturbances to the optimal matching dynamics
The process of experience-depended-plasticity involves a continuous update of internal representations according to the ongoing external occurrences, thus there is a continuing process of 'matching' between the internal representations of the individual and his experiences in the world.
A well-adaptive, well-functioning, neuronal system will provide for optimal matching dynamics, one that reduces the 'distances' between internal representations and external events, however if for any reason the resilience of the neuronal systems is hampered, or on the other hand, the occurrences in the real world are abruptly or greatly modified, then the mismatch, or the 'distances,' between internal representations and external events increase and a non-optimal matching dynamics ensues.
We know that depressed mood involves hampered neural resilience, caused by cell death dendrite spines reductions and hormonal metabolic causes, and we know that depressed mood can also be caused by stressful events, which are actually occurrences in the real world that are characterized by abrupt vast modification of occurrences (death of a loved one, loss of a job ect').
As a result we can begin and conceptualize depression as ensuing form de-optimized matching dynamics. 'Matching Complexity' is the neuroscientific neurocomputational mathematical tool (Tononi et al 1996) to conceptualize depression as a brain-related deoptimization dynamic process.
3) Disturbances to the connectivity dynamics of brain circuitry
Connectivity between and within neuronal ensembles in the brain is critical for internal representations to subsist and matching dynamics to transpire. As Hebbian neural ensembles connect to represent information and form memories, they have to disconnect in order to loose and forget the non relevant information.
Remembering and forgetting information relevant for functioning in the dynamic ever-changing world of tasks and challenges calls for connectivity balances between connectivity dynamics and disconnectivity dynamics. In other words connectivity dynamics and disconnectivity dynamics have to go hand in hand, - disconnection dynamics to forget irrelevant information and connection dynamics for the formation of new upcoming memories.
The brain is also hierarchically connected and unimodal specialize processes interconnect to form higher-level multimodal associative experiences,- which in turn globally integrate into whole Transmodal brain organizations allowing for coherent integrative conscious experience and for the highest-most brain functions such as 'motivation' and 'volition. (Mesulam 1998)'
"Neural Complexity" is the mathematical neurocomputational formulation of optimal connectivity balance in the brain (Tononi et al 1994), disorders of neural complexity can result in 1) disconnection dynamics that fragments conscious experience as occur in psychosis, and 2) over-connection dynamics that constrains and limits brain organization hampering hierarchical formation, resulting in the so-called negative deficiency signs and symptoms of schizophrenia process where volition, motivation and high mental functions are lost. In effect the alternating manifestations of positive and negative signs of schizophrenia reflect a disorder to the optimal connectivity balance of brain organization, - where disconnection and over-connection dynamics replace the normal optimal connectivity balance.
To summarize we can see how all mental disorders, - starting from personality disorders, through mood disorder to psychosis and schizophrenia, - can be reconceptualized as brain disorders using knowledge about normal brain dynamics and complex organization (for details read the book titled NeuroAnalysis Peled 2008).
A novel brain-related diagnostic framework can be generate by substituting descriptive diagnostic terms such as 'Depression' with "disorder to neural resilience and matching complexity" or "Schizophrenia" with "disturbance to neural complexity," this novel psychiatric diagnostic framework can be titled "Clinical Brain Profiling" (Peled 2009) making way for a natural scientific merge with neurology.
At first the current descriptive diagnosis can be applied to CBP generating testable predictions toward the real disturbances of the patients, - for example, calling a 'Psychotic' patient 'Disconnection Syndrome' is a prediction that once scanned and imaging-processed in a relevant way,- one will find a disconnection disturbances in the patient's brain.
Once testable predictions of CBP are validated, then the brain-related etiology of mental disorders is unraveled, and the grand-unification with Neurology and Psychology is attainable.
References:
Mesulam, M. From Sensation to Cognition. Brain 1998;121: 1013-1052.
Peled, A. NeuroAnalysis, Bridging the Gap between Neuroscience Psychoanalysis and Psychiatry (Routledge, New York, 2008).
Peled A. Neuroscientific psychiatric diagnosis. Med Hypotheses. 2009;73(2):220-229
Tononi, G., Sporns, O., Edelman, G.M. A measure for brain complexity: relating functional segregation and integration in the nervous system. Proc Natl Acad Sci USA. 1994;91: 5033-5037.
Tononi, G., Sporns, O., Edelman, G.M. A complexity measure for selective matching of signals by the brain. Proc Natl Acad Sci U S A 1996; 93:3422-3427.
NeuroAnalysis will be the future discipline of all brain disorders and disturbances, hence the term "Neuro." As a clinical discipline "Analysis" stands for the diagnostics and therapeutic outlooks of this unifying filed of brain disturbances.
The current divide between the disciplines, results from present limited understanding of the way in which the brain accomplishes higher-level mental functions, such as personality and feelings, thus lacking the basic clinical science about the causes of a spectrum of disorders currently titled mental disorders.
The brain is a physical biological system; it is the most complex system known to us, to understand the brain we should apply complex-system-sciences to study its functions and dysfunctions. One such relevant scientific discipline is computational neurosciences where mathematical models of the brain begin to provide insights to how the brain works as a complex system.
With such disciplines we can begin to conceptualize mental disorders as brain disorders, and thus bring back psychiatry and psychology to the realm of brain-related sciences allowing them to merge with neurology and create a unified field of brain-related disorders.
In neurology we are dealing essentially with illnesses that have a clear identifiable damage to brain tissue, in psychiatry it seems that we are dealing with disorders of organization and function of neuronal ensembles within the brain tissue, in other words disturbances of the neural circuitry function instead of structure. This is evident from novel findings related to applications of neural computation methods to brain research.
Three major disturbances are predicted to play a role in all mental disorders, 1) disturbances of basic neuronal organizations responsible for internal representations and contextual processing, 2) disturbances to the optimal matching dynamics of activated neuronal ensembles and 3) disturbances to the connectivity dynamics of brain circuitry.
1) Disturbances of internal representations and contextual processing,
Basic neuronal organizations responsible for internal representations and contextual processing result from Hebbian dynamics, and develop by means of experience-dependent-plasticity, thus allowing for the formation of internal representations of external occurrences.
Such internal representations are conceptualized by psychologists as 'Object Relationships' were objects are the internal representations of others in our past and current psychosocial environment. Object Relationships are the contexts which govern our patterns of perceiving, reacting to, and behaving with others, or in other words, relevant to our personality styles within psychosocial settings.
Consequentially disturbances and biases of internal representations are directly relevant to personality disorders. In personality disorders the internal representations can be immature with general inadequacies toward the psychosocial adaptations needed, or they can be partially, specifically biased in certain contexts only. I any case, - general or specific, - these biases cause non-adaptive interactions with others and are the source of distress within psychosocial settings.
Because a psychotherapeutic session is an interpersonal experience, actually an experience-dependent-plasticity process, - then psychological interventions are in fact brain-changing interventions and can easily integrate into a unified brain-based discipline. This is especially true if psychotherapy is done correctly involving corrective experiences that allow for new internal formations to increase adaptability and coping with psychosocial occurrences thus alleviating sufferings resulting from non-adaptive interactions.
2) Disturbances to the optimal matching dynamics
The process of experience-depended-plasticity involves a continuous update of internal representations according to the ongoing external occurrences, thus there is a continuing process of 'matching' between the internal representations of the individual and his experiences in the world.
A well-adaptive, well-functioning, neuronal system will provide for optimal matching dynamics, one that reduces the 'distances' between internal representations and external events, however if for any reason the resilience of the neuronal systems is hampered, or on the other hand, the occurrences in the real world are abruptly or greatly modified, then the mismatch, or the 'distances,' between internal representations and external events increase and a non-optimal matching dynamics ensues.
We know that depressed mood involves hampered neural resilience, caused by cell death dendrite spines reductions and hormonal metabolic causes, and we know that depressed mood can also be caused by stressful events, which are actually occurrences in the real world that are characterized by abrupt vast modification of occurrences (death of a loved one, loss of a job ect').
As a result we can begin and conceptualize depression as ensuing form de-optimized matching dynamics. 'Matching Complexity' is the neuroscientific neurocomputational mathematical tool (Tononi et al 1996) to conceptualize depression as a brain-related deoptimization dynamic process.
3) Disturbances to the connectivity dynamics of brain circuitry
Connectivity between and within neuronal ensembles in the brain is critical for internal representations to subsist and matching dynamics to transpire. As Hebbian neural ensembles connect to represent information and form memories, they have to disconnect in order to loose and forget the non relevant information.
Remembering and forgetting information relevant for functioning in the dynamic ever-changing world of tasks and challenges calls for connectivity balances between connectivity dynamics and disconnectivity dynamics. In other words connectivity dynamics and disconnectivity dynamics have to go hand in hand, - disconnection dynamics to forget irrelevant information and connection dynamics for the formation of new upcoming memories.
The brain is also hierarchically connected and unimodal specialize processes interconnect to form higher-level multimodal associative experiences,- which in turn globally integrate into whole Transmodal brain organizations allowing for coherent integrative conscious experience and for the highest-most brain functions such as 'motivation' and 'volition. (Mesulam 1998)'
"Neural Complexity" is the mathematical neurocomputational formulation of optimal connectivity balance in the brain (Tononi et al 1994), disorders of neural complexity can result in 1) disconnection dynamics that fragments conscious experience as occur in psychosis, and 2) over-connection dynamics that constrains and limits brain organization hampering hierarchical formation, resulting in the so-called negative deficiency signs and symptoms of schizophrenia process where volition, motivation and high mental functions are lost. In effect the alternating manifestations of positive and negative signs of schizophrenia reflect a disorder to the optimal connectivity balance of brain organization, - where disconnection and over-connection dynamics replace the normal optimal connectivity balance.
To summarize we can see how all mental disorders, - starting from personality disorders, through mood disorder to psychosis and schizophrenia, - can be reconceptualized as brain disorders using knowledge about normal brain dynamics and complex organization (for details read the book titled NeuroAnalysis Peled 2008).
A novel brain-related diagnostic framework can be generate by substituting descriptive diagnostic terms such as 'Depression' with "disorder to neural resilience and matching complexity" or "Schizophrenia" with "disturbance to neural complexity," this novel psychiatric diagnostic framework can be titled "Clinical Brain Profiling" (Peled 2009) making way for a natural scientific merge with neurology.
At first the current descriptive diagnosis can be applied to CBP generating testable predictions toward the real disturbances of the patients, - for example, calling a 'Psychotic' patient 'Disconnection Syndrome' is a prediction that once scanned and imaging-processed in a relevant way,- one will find a disconnection disturbances in the patient's brain.
Once testable predictions of CBP are validated, then the brain-related etiology of mental disorders is unraveled, and the grand-unification with Neurology and Psychology is attainable.
References:
Mesulam, M. From Sensation to Cognition. Brain 1998;121: 1013-1052.
Peled, A. NeuroAnalysis, Bridging the Gap between Neuroscience Psychoanalysis and Psychiatry (Routledge, New York, 2008).
Peled A. Neuroscientific psychiatric diagnosis. Med Hypotheses. 2009;73(2):220-229
Tononi, G., Sporns, O., Edelman, G.M. A measure for brain complexity: relating functional segregation and integration in the nervous system. Proc Natl Acad Sci USA. 1994;91: 5033-5037.
Tononi, G., Sporns, O., Edelman, G.M. A complexity measure for selective matching of signals by the brain. Proc Natl Acad Sci U S A 1996; 93:3422-3427.
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Comment by Destiny on March 3, 2012 at 4:01am -
This is really good information....
thanks a lot Sir
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Comment by Dr Peled on October 14, 2010 at 5:23am
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C B P M
CLINICAL BRAIN PROFILING MANUAL
Avi Peled M.D.
Bruce and Ruth Rappaport Faculty of Medicine
Technion – Israel Institute of Technology Haifa, Israel
Neuroanalysis@gmail.com
http://neuroanalysis.googlepages.com/
INTRODUCTION
The DSM diagnostic system for psychiatry is descriptive based on signs and symptoms. Clinical Brain Profiling (CBP) proposes to go beyond the DSM and reformulate signs, symptoms and clinical history as disturbances to brain organization. Such proposed reformulation is possible by introducing knowledge and insights from computational neuroscience and complex system theories into psychiatry (6 -13). CBP correlates clinical findings with presumed disturbances to the normal dynamic complex brain organization.
As a hypothetical diagnostic system, CBP should not be introduced before it is proven empirically. The argument in favor of introducing CBP before it has been fully confirmed, is based on the premise that advances in a field of science can be induced by reformulations and rearrangements of its initial presuppositions. Such reformulations can be the preface to a conceptual leap that may revolutionize the field. In this case if psychiatrists will discuss and diagnose their patients in brain-related terminology they will advance psychiatry toward etiological objective psychiatry.
This type of transformation of psychiatric diagnosis is certainly destined to encounter resistance especially because the DSM was designed to be a-theoretical. A-theoretical; because past theoretical formulations (based on psychoanalytic and other theories) resulted in a diagnosis that had low inter-rater reliability, indeed, the fundamental achievement of the DSM is rater-agreement achieved through consensus. The same agreement and consensus can be applied to CBP. In light of these arguments CBP is beneficial and can be as reliable as the DSM. CBP is less stigmatizing, it is a brain-disorder not a person–disorder, and CBP presents psychiatry as a brain-related, neuroscience-based, discipline.
The limitations of CBP in its current early developmental stage are that it is hypothetical and preliminary, and that it is not yet fully developed. Despite these limitations CBP has innovative value as a diagnostic system using fundamental brain-related nomenclature.
The future prospects of CBP for treatment are substantial. Once the underlying pathology of a mental disorder is known an effective intervention can be designed to cure the disorder. TMS (transcranial magnetic stimulation) DBS (deep brain stimulations) and plasticity inducing medications such as SSRI's (selective serotonin reuptake inhibitors) and future synaptogenetic medications yet to be developed, will facilitate therapeutic options to balance connectivity dynamics and optimize neural resilience to cure psychiatric disorders.
C. B. P.
As mentioned above, CBP involves the rearrangement of clinical findings to assess the relevant disturbances in brain dynamics. CBP has three major pathological dimensions, 1) disorders of basic brain organization and development 2) disorders of connectivity dynamics and balance 3) disorders of plasticity dynamics and neural resilience. It is proposed that CBP can be a useful platform for the development of a brain-related neuroscientific diagnosis for psychiatry. The brain related parameters are detailed in the following (6 -12) a brief glossary is follows.
Neural Complexity: The balance between connectivity that is loose enough to enable change and fixed enough to maintain this change, and a degree of stability over time.
Matching complexity: When a set of connectivity patterns within a system are statistically correlated with the set of input patterns applied to the system matching complexity describes how sets of environmental input occurrences (patterns) shape the internal representations (sets of connectivity formations) in the developing brain.
Optimization and deoptimization. A system is optimal when it reaches a favorable dynamic condition. If that condition changes the system assumes a less favorable dynamic. The optimal condition for the brain system is when connectivity balance is best, and its formation matches the input from the environment. Deoptimization occurs when these conditions are perturbed and violated.
Constrain frustration: Inconsistencies between the values of neuronal activity and the values of their synaptic transfer functions characterize constrain frustration. Moderate inconsistency is normal in active (ever-changing) neural networks, however it can greatly increase in perturbed neural networks such as in hyper, or deoptimized network dynamics.
Cs: Connectivity segregation. Disorder to brain connectivity when disconnection dynamics prevail and different brain regions act statistically independent without the needed normal integration.
Ci: Connectivity integration. Disorder to brain connectivity when over-connection dynamics prevail. Different brain systems are overly connected constraining each other's activity limiting the whole brain activity to a few repetitive states, restricting its computational (cognitive) capabilities.
Hbu: A disorder of hierarchical bottom-up dynamics. A disorder of hierarchical organization where higher levels of hierarchy organization are not achieved leaving the brain hierarchy curtailed at its highest levels of integration.
Htd: A disorder of hierarchical top-down dynamics. A disorder of hierarchical organization in which higher levels of hierarchy organization constrain and bias bottom-up processes.
D: Deoptimization (see optimization above)
O: Optimization (see optimization above)
CF: Constrain frustration (see Constrain frustration above)
CFb: Constrain frustration – bound, when disturbances to constraint are triggered by specific input stimulus.
CSPD: Disturbances to context related processing; context is the set of internal representations that govern attitude to the psychosocial world thus equal to personality traits. Disturbances to this processing explain personality disorders.
Table 1 summarizes the clinical brain-profiling (CBP) hypothesis. Disorders of basic brain organization and development are represented in the first row, disorders of connectivity dynamics and balance occupy the next four rows and finally disorders of plasticity dynamics and neural resilience occupy the last four rows. This is off course a simplified extraction from the detailed and comprehensive explanation given in the book titled ‘NeuroAnalysis’ (12).
Table 1: Clinical Brain Profiling - Diagnoses
Symbol Brain dynamic disturbance Assumed clinical correlate
CSPD Undeveloped disturbed basic brain organization Personality disorders
Cs Disconnectivity dynamics Psychosis and positive signs schizophrenia
Ci Overconnectivity dynamics Repetitive poverty ideation perseverations
Hbu Hierarchical bottom-up insufficiency Avolition and negative signs schizophrenia
Htd Hierarchical top-down shift Systemized organized delusions
D Deoptimization dynamic shift Symptoms and signs of depression
O Hyper-optimization dynamic shift Symptoms and signs of mania
CF Constrain frustration Symptoms and signs of anxiety
CFb Stimulus bound Constrain frustration Symptoms and signs of phobias
The CBP translation matrix is a practical clinical assessment tool based on the CBP formulation, The CBP translation matrix has clinical evaluations as input entries and proposed neuroscientific brain disturbances as outputs. The clinical entries are ordered as follows, first signs, then symptoms and finally clinical history of psychiatric manifestations (left column table 3). To increase reliability each clinical finding is coded "present" with the number "1" and "absent" left empty and un-coded. The output presenting the disordered neuroscientific brain profile is a numerical vector for the set of values 'CSPD,' 'Cs,' 'Ci,' 'Hbu,' 'Htd,' 'D,' 'O,' 'CF' and 'CFb'
Figure 1 is an example of the CBP results (output) for a psychotic (A) depressed (B) and borderline (C) patients are presented as graphs. the ‘X’ axes presents the different brain related disturbances and the ‘Y’ axis estimates to what extent they are disturbed according to the clinical scores.
Fig 1: When the patient’s evaluation is arranged according to CBP, his personal psychiatric condition is readily translated to a set of testable predictions potentially validated with an appropriately designed signal analysis of his imaging data. Initially this will be relevant for research settings, but hopefully in the future successful research will make it relevant for routine clinical practice.
CBP - MANUAL
Establishing a measure’s reliability is generally considered primary, since it is difficult to reach valid judgments without first achieving consistency. To provide for high CBP reliability each of the CBP scores is reduced to ‘present’ or ‘absent’ and examples are given for each score in the CBP reliability Table 2. To maintain reliability also with the DSM diagnostic method and with the traditional scoring scales such as SANS SAPS and others. Many of the CBP items (table 2) relay on DSM and traditional scales (referenced 1-5).
Table 2: CBP definitions for reliability
Detected Description for scoring
Is the patient untidy? Appearance is somewhat disheveled i.e., greasy hair, dirty clothes as in ‘Grooming and Hygiene’ section (1)
Is the patient very messy Subject's clothes, body and environment are dirty and foul smelling as in ‘Grooming and Hygiene section’ (1)
Is the patient with excessive jewelry makeup and colored clothing? It is evident that the clothing makeup and jewelry are grossly exaggerated. Excessiveness is the criteria. This score should not be assigned to people who are well groomed.
Moves slowly? Obvious decrease of motor activity at interview as described in level ‘2’ of retardation on the Hamilton Depression Scale (3) together with reduction of usage of expressive body gestures as in ‘Marked’ level of ‘Paucity of expressive gestures’ in the section of ‘Affective Flattening’ (1).
Stiff or frozen? Subject never gesticulates as in ‘Severe’ rating of ’Paucity of expressive gestures’ in the section of ‘affective flattening’ (1). In addition motor activity is reduced as rated for ‘stupor’ in the ‘retardation’ item of the Hamilton Depression Scale.
Restless, moves a lot? As in ‘Fidgets’ in the ‘Behavior at interview’ score according to the Hamilton Anxiety scale (4) the patient finds it difficult to remain seated during the interview, moves a lot in the chair, moves arms legs, changes position often, he is ‘Restless’ as in the ‘Tension’ score (4).
Agitated looks as if on verge of ”exploding”? As in ‘Paces’ in the ‘Behavior at interview’ score according to Hamilton Anxiety scale (4) looks as if making the effort to restrain himself from becoming violent. Finds it hard to remain seated during the interview.
Bizarre unexplainable movement Makes movements that are bizarre and non-purposeful, to the extent that they must be effortlessly noticed as such by interviewer and others. If the movements are explainable and their oddity is questionable then this item must not be scored as ‘present’
Repetitive stereotype movements? Movements that are repeated in the same (similar) manner; they can be ‘repetitive stereotyped behavior’ at the ‘marked’ level of the SANS (1)
Speaks slowly? Speech is slow, words are pronounced slowly and pauses between words are longer than usual, speech must be slower than those who speak slowly. It should be easily and readily evident for the examiner, if there is doubt then this item must not be scored.
Limited verbal communication, gives short responses? Restriction in the amount of spontaneous speech as in ‘Alogia’ section of the SANS (1) answers in single words or very short sentences, no spontaneous speech; the interview takes the form of investigation where the examiner repeatedly asks questions and the patient responds only briefly.
Limited verbal communication, few words only or non at all Restriction in the amount of spontaneous speech as in ‘Alogia’ section of the SANS (1) Subject says almost nothing and frequently fails to answer.
Speech at low tone or whisper ‘Lack of Vocal inflection’ speaks in monotone, as in ‘affective flattening’ section of SANS (1). In addition voice is distinguishably weak
Speaks fast? Sentences are uttered rapidly - word follows word immediately.All speech is distinguishably fast more than the regular higher spectrum of normal speech. It should be easily and readily evident for the examiner, if there is doubt, this item should not be scored.
Speaks a lot, gives long spontaneous responses? Here the emphasis is on the volume of speech (rather than speed, the patient starts to speak continuously even when not asked any questions, once starting he never ends and it is difficult to stop him or insert a question while he is speaking).
Speaks without stopping, jumps from one issue to another? In addition to the description of the above previous score, here the patient is practically unstoppable and speech content is disturbed in the sense that jumping from one concept to unrelated (or loosely related) concepts is the rule.
Speech with elevated tone? Tone is elevated to the extent that the patient seems to be shouting. The tone is higher than the normal range of voice tones, if there is doubt then this item should not be scored.
Speech associations are loose; jumps from one sentence to another each a different topic? As in ‘Marked Derailment’ of the SAPS (2) ‘Frequent instances of derailment: subject is often difficult to follow’ only ‘Marked’ levels warrant a score here, ‘Moderate’ and ‘Mild’ do not.
Words are unrelated within sentences ‘word salad’? As in ‘Severe Derailment’ of the SAPS (2) ‘Derailment so frequent and / or extreme that the subject’s speech is almost incomprehensible’ Here also the ‘Marked and Severe Incoherence’ items of the SAPS (2) apply, ‘At least half of the subject’s speech is incomprehensible’.
Repeating same topics of conversation? The patient is pre-occupied by a set of thoughts and repeatedly expresses them in speech. Typically this is expressed in conversation; no matter where the examiner takes the topics of discussion, the patient inevitably returns to his set of concerns. The examiner cannot divert the patient from his repeated issues for long and the patient returns to his original thoughts.
Repeating/perseverating the same sentences? Here sentences are concretely repeated over and over again
Responding to previous question? The patient is ‘stuck’ answering the first question although other additional questions were already asked. For example what is your name? John, where do you live? John… and so on
Obsessions and compulsions? As in DSM
Delusion, false unshakable belief? As in all delusions of the ‘Delusions’ chapter of the SAPS (2) rated ‘Moderated’ ‘Marked’ or ‘Severe’
Systemized delusion? Delusion is non-bizarre stable over time tends to grow incorporating new events in the experience of the patient. As in the Delusional disorder of the DSM.
Illogical conclusions? As in 'Illogicality' SAPS (2) rated ‘Moderated’ ‘Marked’ or ‘Severe’
Inappropriate affect? As in 'Inappropriate affect' SAPS (2) rated ‘Moderate’ ‘Marked’ or ‘Severe’
Flight of ideas As in 'Pressure of speech ' SAPS (2) rated ‘Moderate’ ‘Marked’ or ‘Severe’
Speech content includes mainly issues of despair, hopelessness, and pessimism. As in Hamilton depression scale (3) items 'Guilt,' Helplessness,' 'Hopelessness' and 'Worthlessness' - scores 1 to 4
Speech content includes mainly issues of megalomania, over empowerment and unrealistic optimism (and plans) The subject is concerned with issues of megalomania, over empowerment and unrealistic optimism (and plans). This must be self-evident and obvious.
Bizarre or overly abstract response to categorization (proverbs) and abstraction? Bizarre or overly abstract response to categorization (proverbs) and abstraction
Concrete interpretation of proverbs? Concrete interpretation of proverbs for example the common characteristic of table chair and cupboard are that they are made of wood instead of that they are all furniture. Concrete responses are given even after assisting the patient with examples of abstraction from related issues - for example "apple banana orange are fruit"
Auditory hallucinations? As in ‘Auditory Hallucinations’ including voices commenting and conversing of the SAPS (2) rated ’Mild’ ‘Moderate’ ‘Marked’ or ‘Severe’
Visual tactile olphactory hallucinations? As in the other ‘Hallucinations’ Visual tactile and olphactory of the SAPS (2) rated ’Mild’ ‘Moderate’ ‘Marked’ or ‘Severe’
Constricted affect As in 'Unchanging facial expression' in the SANS (1) 'Moderate: Subject's expressions are dulled overall, but not absent' and "Marked: Subject's face has a flat 'set' look, but flickers of affect arise occasionally"
Blunt affect? As in 'Unchanging facial expression' in the SANS (1) "Severe: Subject's face looks 'wooden' and changes little, if at all throughout the interview".
Expansive mood elevated affect? The subject seems elated overly happy, mood is excessive in a self-evident unquestionable manner.
Dysphoric (suffering) affect? Facial expression of suffering; uneasy as in an uncomfortable state of mind. Must be evident, if questionable no score is applied.
Depressed affect? Facial expression is of painful sadness (typical triangle form of eyebrow). Must be evident, if questionable no score is applied.
Anxious affect? Facial expression is of anxious form, constricted facial muscles, and bulging eye expression. Startled and / or crying expression. Must be evident, if questionable no score is applied
Detached from examiner? The patient behaves as if the examiner (and others), are not there, seems to be reflecting on inner thoughts and is not available for whatever is occurring in the interview or around him. Must be evident, if questionable no score is applied.
Perplexed, ambivalent? Face expression is similar to that of a person seeing something extraordinary for the first time, and seems to be lost, not knowing where to turn. Must be evident, if questionable no score is applied.
Inappropriately close to examiner (no boundaries)? Attitude toward the examiner is as if he were a 'buddy' of the patient or a close intimate relative. Asks intimate embarrassing intruding questions, sits close to the examiner (may touch or hug him). Must be evident, if questionable no score is applied
Suspicious with examiner? Suspicious attitude toward the examiner as if the examiner is a threat, or wants to harm the patient. Must be evident, if questionable no score is applied.
Threatening to examiner? Seems as if about to get up and hit the examiner. Must be evident, if questionable no score is applied.
Seductive toward examiner (theatrical)? Attitude toward the examiner is as if he were a 'buddy' of the patient or a close intimate relative but with a seducing actively probing attitude. Must be evident, if questionable no score is applied.
Sensitive easily offended? Overly reactive easily offended, tends to respond to regular instructions as if they were harsh criticism. Must be evident, if questionable no score is applied.
Childish dependent regressive? Attitude of the patient gives an impression of a little child, with childish facial expression and intonation of speech. Needs instructions and guidance even for simple tasks. Must be evident, if questionable no score is applied.
Manipulating demanding? The examiner senses a constant uneasy feeling of being pressed or utilized to say, feel or do uncomfortable things. Must be evident, if questionable no score is applied.
Stubborn, obsessive non adaptable? Attitude to examiner and other events are obstinate, inflexible, and repeatedly insisted upon. Must be evident, if questionable no score is applied.
Tend to idealize or devaluate examiner? Attitude to the examiner as if he is the most wonderful and best therapist in the world, or the worst person ever; these attitudes can interchange frequently. Must be evident, if questionable no score is applied.
Egocentric un-empathic? Thinks of no one but himself, unable to see the view point of others, cannot put himself in "others shoes" Must be evident, if questionable no score is applied.
Distractible? Every stimulus from the environment causes the subject to turns his attention from the main course of the interview. Must be evident, if questionable no score is applied.
Disoriented? Unable to orient himself, does not know the time and day, may not recognize faces of relatives.
Memory loss? Unable to remember things of recent past days and weeks. Recall is typically preserved and long term memory is typically present
Complaints of Insomnia or hypersomnia? Insomnia or hypersomnia
Complaints of Early insomnia? Early insomnia, hard to fall asleep
Complaints of Late insomnia? Late insomnia, early wake
Complaints of Anorexia Wight loss Anorexia, Weight loss
Complaints of palpitations, dizziness, and / or abdominal cramps and / or tingling. Palpitations, dizziness, and / or abdominal cramps and / or tingling.
Complaints of anxiety fear of dying or loosing control panic Fear of dying or loosing control panic
Complaints of fear of dying or loosing control panic in specific conditions. Fear of dying or loosing control; panic in specific conditions.
Complaints of tension, restlessness and agitation Tension, restlessness and agitation
Complaints of avolition indifference apathy Anhedonia Avolition, indifference, apathy, anhedonia
Complaints of depressed mood Being sad as in the Hamilton Depression Scale items and major depression
Complaints of depressed mood especially in the morning Being sad as in the Hamilton Depression scale items and major depression especially in the morning
Complaints about Flight of ideas? Head full of racing thoughts
Complaints that things are strange and unfamiliar - changing not as usual (dereisim? depersonalization) A sense that something is not usual, there are hidden meanings to things, there are forces acting behind things, things are connected in a meaningful way to the individual. Must be evident, if questionable no score is applied.
Complaints of external control, mind reading, bugging, persecution (about delusions) Feeling as if controlled by external sources, others can read his mind; he is being persecuted. others intend and plan to hurt him. Must be evident, if questionable no score is applied
Complaints related to Systemized delusion There is a dominating non-bizarre false idea that gradually grows and incorporates all occurrences and aspects of life. Must be evident, if questionable no score is applied
Complaints of low self esteem Feeling worthless.
Complaints bout being easily offended, oversensitive? Easily offended, oversensitive to criticism and insinuations. Interprets even the slightest inattention from others as rejection and humiliation. Must be evident, if questionable no score is applied.
Complaints of being impulsive, over imposing? Reacts immediately without giving it another thought, unable to change the decision or reaction once taken. Must be evident, if questionable no score is applied
History of Delusions? As above
History of Hallucinations? As above
History of thought disorders loosening of associations As above
History of thought disorders perseverations poverty of thought? As above
History of depressions? As in DSM criteria
History of mania? As in DSM criteria
History of anxiety As in DSM criteria
History of phobias As in DSM criteria
History of disturbed upbringing, parental loose Parents were not available (or orphan) the family history is of turmoil, instability and frequent changes. Subject deprived of needed attention care and love, or / and abused maltreated. Must be evident from anamnesis, if questionable no score is applied
History of behavioral problems Problems at school, patient often reprimanded in school because of misbehavior, must be more than regular child’s mischief; later problems with the law are typical. Must be evident from anamnesis, if questionable no score is applied
History of inability to maintain employment and social relationships? Unable to remain employed for an extended period of time, interpersonal relationships. Are generally short and unstable; and frequently changes partners. Must be evident from anamnesis, if questionable no score is applied.
History of unstable interpersonal relationships Interpersonal relationships chaotic, characterized by turmoil. Must be evident from anamnesis, if questionable no score is applied.
History of psychosocial or other stress (regular life stressors) As in Holmes-Rahe life changes scale (5): Changes to different line of work, Change in number of arguments with spouse, Mortgage over $100,000, Foreclosure of mortgage or loan, Change in responsibilities at work, Son or daughter leaving home, Trouble with in-laws, Outstanding personal achievement, Wife begins or stops work, Begin or end school, Change in living conditions, Revision in personal habits, Trouble with boss, Change in work hours or conditions, Change in residence, Change in schools, Change in recreation, Change in church activities, Change in social activities, Mortgage or loan less than $30,000, Change in sleeping habits, Change in number of family get-togethers, Change in eating habits, Vacation, Christmas alone, Minor violations of the law.
History of trauma (stressor exceeding regular life stress) As in Holmes-Rahe life changes scale (5): Death of spouse, Divorce, Martial separation, Jail term, Death of close family member, Personal injury or illnessMarriage, Fired at work, Marital reconciliation, Retirement, Change in health of a family member, Pregnancy, Sex Difficulties, Gain of new family member, Business readjustment, Change in financial state, Death of close friend
Validity refers to whether CBP can make correct classifications representing the true state of brain disturbances of related mental disorders. This task is up to the psychiatric-imaging research community and is the reason for distributing the CBP worldwide.
INSTRUCTION MANUAL
Open the excel ‘CBP_Peled_Matix’ file by clicking twice on the file’s icon. The first column on the left holds the clinical parameters to be scored. The second column marked by the yellow color is the scoring column. The following columns to the right hold the CBP translation matrix and are of no concern to you. A figure graph (partly masking the matrix) represents the output results.
Start from the top according to the reliability definitions of table 2. If you find the relevant clinical finding in the first column then go on and write the number one “1” in the corresponding row in the second (yellow) column. If the patient does not have the relevant clinical item (in the first column) then leave the corresponding row in the second (yellow) column empty.
Going from top downwards you will see that you are asked to assess the ‘signs’ (observations) first, the symptoms (complaints) later and finally the clinical history last. At the end of the assessment you should have the relevant scores in the form of number ones ‘1’ in the second (yellow) column.
Only after the entire column is scored the graph with the output result will show the complete result. By looking at the graph you shall get the information predicting the relevant brain disturbances to be validated. From left to right on the ‘X’ axsis you will find the brain-related parameters in the following order, 'CSPD,' 'Cs,' 'Ci,' 'Hbu,' 'Htd,' 'D,' 'O,' 'CF' and 'CFb.' To further understand the meaning of these graph results see references 6 –13.
REFERENCES
1. Andreasen N.C., The Scale for the Assessment of Negative Symptoms (SANS). Iowa City: University of Iowa, 1983.
2. Andreasen N.C., The Scale for Assessment of Positive Symptoms (SAPS). Iowa City: University of Iowa, 1984.
3. Hamilton M. Development of a rating scale for primary depressive illness. Br J clin Soc Psychol 1967; 6: 278-296
4. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32(1):50-5.
5. Holmes & Rahe (1967). Holmes-Rahe life changes scale. Journal of Psychosomatic Research, Vol. 11, pp. 213-218.
6. Peled A and Geva AB. Brain Organization and Psychodynamics. J Psychotherapy Practice and Research 1999 Winter; 8(1):24-39
7. Peled A. Multiple Constraint Organization in the Brain: A Theory for Serious Mental Disorders. Brain Research Bulletin 1999 49: 245-250.
8. Peled A. From plasticity to complexity. A new Diagnostic Method for Psychiatry. Med Hypotheses. 2004; 63(1):110-4.
9. Peled A. Plasticity imbalance in mental disorders the neuroscience of psychiatry: Implications for diagnosis and research. Medical Hypothesis 2005 July 1.
10. Peled A. brain profiling and clinical neuroscience. Medical hypothesis 67, 941-946 2006.
11. Peled A, Brand D. Optimizers 2050 Saga Books 2005
12. Peled A. NeuroAnalysis, Bridging the gap between neuroscience psychoanalysis and psychiatry: Psychology Press; Routledge; July 2008 Europe September 2008 USA)
13. Peled Avi. Neuroscientific psychiatric diagnosis Medical hypothesis submitted
Avi Peled M.D.
Correspondence:
Avi Peled, M.D.
Postal Address: POB 43, Binyamina 30550, Israel
Email: Av_peled@netvision.net.il
Phone: +972-522844050
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DSM-V, RDoC and Brain-Related Psychiatric Diagnosis
Avi Peled M.D.
Recently toward the development of DSM-V, there is a substantial body of published commentaries that voice dissatisfaction about descriptive psychiatry for mental disorders, to the extent that the NIMH has lunched the ‘RDoC’ project the ‘Research Domain Criteria’ project, destined to reconceptualize psychiatric diagnosis as brain-related disturbances.
The RDoC proposes an investigation matrix comprising all levels of the brain system from molecular gene level through circuit network levels to whole brain cognitive behavioral levels, these investigations should relate to a non-DSM phenomenological constructs such as: Negative Affect (e.g., Distress and Aggression). Cognition Attention, Perception, ect,
If we consider an overall look at the literature of these brain functions it becomes immediately evident that they are neither located at any specific brain region or structure, and cannot be traced down to a set of specific genes or any other explicit molecular function within neurons. These are whole-brain phenomena emerging as an ‘Emergent Propriety’ from the organization of the entire brain, Emergent Propriety meaning that the whole is more than the sum of parts, making it irrelevant to trace back a linear one-to-one correlations of anything in the RDoC schemata or matrix.
Two directions can be adopted to confront the problem of a prospective brain related psychiatry: 1) Focus on the best level of description of brain organization, one that will have both the most explanatory power for mental disorders as well as the best prospective for intervention considering future therapeutic efforts for mental disorders. 2) Concentrate on main organizational principles achieved by the brain assuming that their disturbance are probably relatable to dimensions of clinical phenomena seen in mental disorders.
The three main organizational principles achieved by the brain have been detailed out extensively in previous publications (Peled 2008; Peled 2010) they include i) basic brain connectivity organizations, the default network, ii) neural resilience and plasticity that allows for flexible good matching complexity dynamics within experience- dependent- plasticity, and iii) connectivity balances within brain hierarchy and neuronal ensembles spread in the brain.
i) Disturbances of basic brain connectivity formations can be traced roughly to personality disorders, by considering a) the idea of a default network already described as 'ego' by Meynert in 18 hundred, b) the ideas coined by Hebb related to experience-dependent-plasticity and c) neural computation models showing how internal representations such as object-relation dynamics can be achieved by the brain. ii) We have evidence that depression is associated with neuronal death and antidepressant activity relates to synaptogenesis. The plastic brain achieves better experience-depended-plasticity resulting in a better match between occurrences in the environment and internal representations thus matching dynamics can underlie mood and anxiety disorders. Finally iii) disturbed connectivity dynamics has relations to the clinical phenomena of psychosis and schizophrenia spectrum, this has repeated supporting evidence from disconnection syndromes in schizophrenia studies.
Brain related systems for these disturbances are large-scale junction networks i) for the default network hippocampus temporal medial formations, ii) for neural resilience whole-brain cortical networks and thalamic cortical formations and iii) for connectivity balance the Nigra cortical dopaminergic systems. The above perturbations are all interrelated, thus we need not expect a singular disturbance, the most we can diagnose is to what extent one disturbance is predominant, and this also explains why clinically patients have spectrums of symptoms.
Any transition from descriptive diagnosis such as that of the DSM would need an intermediate step before it can be concluded as a brain-based psychiatric diagnosis. A translation matrix titled 'Clinical Brain Profiling' (CBP) (Peled 2008; Peled 2010) that assigns sets of signs and symptoms to the different types of brain perturbations can be drafted based on existing preliminary evidences from the scientific literature (Peled 2010) it offers a set of patient-specific testable predictions. In large-scale research these patient-specific predictions have a critical contribution for choosing the relevant patient populations for relevant brain-imaging studies. These will avoid the confusion due to wrong grouping of patients currently chosen according to the DSM approach, in other words using CBP has a higher probability in identifying the underlying causes of the different mental disorders. CBP can shortcut the long endless search-road to brain-related psychiatry proposed by the RDoC project and it can effectively substitute the descriptive conceptualization of mental disorders offering a more scientific outlook of a brain-related psychiatry.
References:
Peled, A. NeuroAnalysis, Bridging the Gap between Neuroscience Psychoanalysis and Psychiatry (Routledge, New York, 2008).
Peled A. The neurophysics of psychiatric diagnosis: Clinical brain profiling. Med Hypotheses. 2010 Sep 7.
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Contact Daphna Weinshel - see
http://www.cs.huji.ac.il/~daphna/
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Comment by Luiz Pinheiro Duarte Neto on July 19, 2010 at 1:15pm -
Hi...
I'm doing a research on artificial neural networks applied to computer vision. I am interested in meeting people in this field of study. I intend to do a masters at MIT.
Could you help me with some information ... ?
thanks
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