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*Corresponding Author: Rosman SV, Physician of functional diagnostics of SBIH, Regional psychoneurological clinic, Tver, Russian Federation, Russia.
Citation: Rosman SV, Shpak LV, Maximova NE. (2021) To the question of the paradigm shift of psychiatry. International Journal of Clinical Case Reports and Reviews. 6(3); DOI: 10.31579/2690-4861/103
Copyright: © 2021 Rosman SV, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 20 December 2020 | Accepted: 15 January 2021 | Published: 20 January 2021
Keywords: new paradigm of psychiatry; diagnosis of mental illness; new EEG method DAFCAR
The main problem of psychiatry is that, having gained huge empirical experience in observing psychopathology, it has not become a full-fledged science. Perhaps this happened because Western medicine followed a path different from Eastern medicine - the path of deep study of private pro-phenomena of diseases and the search for their natural causes. However, huge problems lie along this path - the multifactorial impact of the external environment and the limited knowledge of man. As a result, a paradoxical state of affairs was created in psychiatrics and psychology: not a single objective method of research was created that allows you to diagnose mental illness due to the fact that there is still no one's idea of how the brain performs its main function - to think. That is, the reasons for psychiatry's failures lie in the deep crisis of neurophysiology.
The main problem of psychiatry is that, having gained huge empirical experience in observing psychopathology, it has not become a full-fledged science. Perhaps this happened because Western medicine followed a path different from Eastern medicine - the path of deep study of private pro-phenomena of diseases and the search for their natural causes. However, huge problems lie along this path - the multifactorial impact of the external environment and the limited knowledge of man. As a result, a paradoxical state of affairs was created in psychiatrics and psychology: not a single objective method of research was created that allows you to diagnose mental illness due to the fact that there is still no one's idea of how the brain performs its main function - to think. That is, the reasons for psychiatry's failures lie in the deep crisis of neurophysiology.
Solving all these problems is incredibly difficult, due to established scientific traditions, but it is absolutely necessary objectively - all sensible scientists understand this [16].
Since the ideas that it was the brain that has prevailed is the main creator of all our thoughts and behaviors, researchers have been convinced that the brain is analyzing and synthesizing incoming information - what else? These ideas were the basis of the work of artificial intelligence (AI). However, it is somehow overlooked what technological effort it cost. What complex devices you have to create for this. And most importantly, the resources that have to be used to do so. These are huge energy costs, giant data stores - all to get closer to the intellectual capabilities of the human brain. Unwittingly, the idea that the human brain, having received information, immediately, bypassing the stages of analysis and synthesis, "knows" what to do. Through this idea - the idea that the human brain, as a matter of fact, does not think about anything and cannot cross modern neurophysiologists, although this is what great Russian scientists - I.M.Sechenov and I.P.Pavlov - spoke about in their teaching about the reflex activity of the human brain[1,2]. They simply did not have sufficient knowledge of neurophysiology and cybernetics and were unable to complete their ideas. In general, from all this teaching remained only ideas about reflex arc (Fig. 1)
In many ways, the reflex hypothesis was clarified by P.K.Anokhin[3]. Unlike classical representations of modern scientists, he realized that in nerve centers there is not a simple switching of momentum to executive organs, but a process of "machine coding" of information, which he called afferent synthesis. Based on the results of this synthesis, neural ensembles are created, which are the semantic code of the incoming (afferent) information. Everyone still refers with delight to these advanced, by those times (1930s) ideas, "forgetting" to explain how all this happens. P.K.Anokhin himself was understandably unable to explain this and left the solution to these problems to future generations, creating a theory of functional systems based on the vague incredible computational abilities of neural networks (Fig.2).
Theoretical fabrications are good in that they suit everyone, but bad in that it is impossible to build real life on their basis. From the point of view of psychiatry, these remarkable complex constructions do not explain the mechanisms of psychopathology in any way.
It is clearly proven that the process of recognizing afferent information exists - otherwise, how would we distinguish a cat from a dog? So the afferent synthesis process exists. There is also a mechanism for creating neural associations. With the help of neuroimaging devices (fMRI) we can record the occurrence of clusters of excited neurons in the cerebral cortex, which vary depending on the co-maintenance of information. One question remains unclear - how is the process of transforming the results of afferent synthesis (neurophysiological code) into neural associations of a certain configuration (semantic images of information)?
To do this, we need to take a fresh look at the neurophysiological structure of the brain. Without going into functional details, brain tissue is an association of neurons and glial cells, the space between which is filled with a gel-like inter-weft substance - neural-glial brain network (NGBN) (Fig.3).
Until now, glial cells, in the view of neurophysiologists, represent a framework in which neurons performing computational functions are mounted. Trophic (nutritional) conversion and possibility of transformation of pulses, which are supplied to neuron and those transmitted via neural connections, are allowed. What if it’s not? According to the old reflex arc concept, the who-beat pulse from the receptor is transmitted directly to the neuron, switching on its synapses, and the neuron processes this pulse and generates an action potential, transferring it by axon to the overlying centers to other neurons. However, if this is the case, all neurons must constantly be in a state of excitation - either from receptors or through inter-neuron connections. Such a system is completely inoperable.
What if neuroglia plays a major role? Excitation from the receptor, entering the NGNB, activates not only the neuron, but also the neuroglia, creating a network-propagating fractal process.
NGNB is an iterative-recursive system. Excitation propagating through this network, moving through its loops, somewhere increasing, and somewhere mutually quenching, creates a complex configuration from neurophysiological conditions called fractal (Fig.4, C).
Until now, glial cells, in the view of neurophysiologists, represent a framework in which neurons performing computational functions are mounted. Trophic (nutritional) conversion and possibility of transformation of pulses, which are supplied to neuron and those transmitted via neural connections, are allowed. What if it’s not? According to the old reflex arc concept, the who-beat pulse from the receptor is transmitted directly to the neuron, switching on its synapses, and the neuron processes this pulse and generates an action potential, transferring it by axon to the overlying centers to other neurons. However, if this is the case, all neurons must constantly be in a state of excitation - either from receptors or through inter-neuron connections. Such a system is completely inoperable.
What if neuroglia plays a major role? Excitation from the receptor, entering the NGNB, activates not only the neuron, but also the neuroglia, creating a network-propagating fractal process.
NGNB is an iterative-recursive system. Excitation propagating through this network, moving through its loops, somewhere increasing, and somewhere mutually quenching, creates a complex configuration from neurophysiological conditions called fractal (Fig.4, C).
All these mechanisms work if all links of this flowchart are functionally sound. However, the process of entropy of NGBN interferes here. The essence of it is that NGSMH begins to break down during aging, functional overload or toxic effects, and its functional parameters begin to change and do not meet the necessary criteria. As a result, a distorted NSO is produced, and the NFS ceases to be socially acceptable. This is psychopathology.
The marker of this process is to change the properties of the alpha rhythm of the EEG. The main parameter of this change is dispersion of amplitude-frequency characteristics of alpha-rhythm of EEG - DAFCAR of EEG[8-12]. Apparently, there are other, parameters, for example, phase-frequency characteristic of alpha rhythm, but it is not yet developed in relation to psychopathology.
Simplistically, DAFCAR studies the spectral characteristic of the alpha rhythm, which must be normally distributed with the emphasized dominance of one frequency. This means that the alpha rhythm is produced by a strictly defined frequency, and its fluctuations are unacceptable. Normally, the adult alpha rhythm frequency is 9.5 - 11.5 Hz. Below this range, mental retardation or dementia (depending on age) is observed. Above - increase of cognitive ability, but above 12 Hz comes the limit of neurophysiological functionality of neurons, and the person becomes autistic: information is processed at terrible speed, but only excerpt fragments of it are reproduced (classic example - "Rain Man"). Variations in alpha rhythm frequency in the same person are possible, but only in case of acute functional necessity, for example, in case of stress or transition from rest to active action. At rest these oscillations are not more than ± 0.25 Hz. An extremely important parameter is the synchronization of DAFCAR values in all parts of the brain, especially in the frontal and occipital lobes. If the difference between the frontal and occipital departments exceeds 0.5 Hz, this results in pronounced deviations in human behavior [7, 13-15].
This question is very important for understanding the essence of schizophrenia. In the human brain there is a function of generation of freedom of will, which also distinguishes man from all other animals. It allows people to do not to the accepted standards, to give out an unusual scenario. This is due to the increase in the amount of human degrees of freedom. It is known that the play of the steering wheel of the car is allowed within 10 degrees, but the completely play-free attachment is not very favorable. This is how a person should have a certain degree of freedom to choose the scenarios of his actions in order to find new optimal solutions to life’s problems. Under normal conditions, this capability is realized and functional diagnostics are not recorded. However, when there are deviations in DAFKAR frontal lobes, in light degrees, along with deviations in human behavior, we see higher creativity than others. The degrees of these deviations are varied, and this is expressed in the common observation that all creative personalities are "wrong." Indeed, when we reach a frequency difference between the frontal and occipital lobes of 0.75 Hz or more, we already notice signs of schizophrenia [10].
Of course, this case is manifest, but on the basis of the cartogram alone it is not possible to diagnose schizophrenia, although if there are clinical manifestations and obvious deviating behavior, the diagnosis becomes quite obvious.
However, it should be understood that the body has many compensatory possibilities and even with such changes the patient may not be too different from others, although, of course, completely normal behavior is unlikely to differ. His complaints, history, should be examined. Collect information from others and relatives and only then make a judgment.
The issue of schizophrenia and schizophrenia-like symptoms is particularly significant. Schizophrenia is likely an inherited disease; The chances of fully curing it are currently very low, and the level of aggression and autoaggression under it is quite high. At the same time, we often meet with acquired disease of toxic, vascular and traumatic origin, which is very similar to schizophrenia, but with proper targeted treatment of the main cause it is possible to achieve great success. Clinicians do not distinguish these conditions - they can only be distinguished on cartograms.
The application of the DAFCAR technique in childhood is particularly valuable, and it is still possible to restore normal neurophysiological changes in the brain. Without going into detail, it can be said that you can only send a child to school if the modal frequency of alpha rhythm in the occipital leads is not lower than 9 Hz. Otherwise, corrective training is needed. If a child has a significant difference in frequencies in the frontal and occipital leads (pituitary), this is a consequence of neurophysiological immaturity of the frontal lobe: usually accompanied by ADHD and other disorders of behavior, enuresis. Such children need special control and correction of neuro-physiological disorders, otherwise this can develop after the puberty period into schizophrenia-like syndrome, or even schizophrenia.
This study is particularly valuable when conducting mass examinations of persons who are subject to increased demands for mental stability. In addition to isolating suspicious patients for hidden pathology, the need for complex psychological testing is significantly reduced. At present, a device has been developed, which in automaton mode calculates DAFCAR parameters and creates cartograms.
Of course, psychiatrists will receive great help by monitoring DAFCAR parameters in dynamics treatment to find optimal therapy.
All these empirical observations lead us to a completely logical conclusion: psychopathology should be considered from the perspective of neurophysiological disorders, one of the markers of which is DAFCAR. This does not undo all the empirical experience of psychiatry accumulated over the past 3 centuries. On the contrary, reliance on a natural science basis will give a new impetus in the diagnosis and treatment of mental diseases.
We have already put forward general theoretical prerequisites for systematizing psychopathology in the system "3 + 3" [17].
Informational foundations of human psyche formation:
The main criteria for a person's mental state are:
The logical continuation of these theoretical provisions was the neurophysiological systematization of psychopathology, based on the neurophysiological marker - DAFCAR.
General systematization is based on historically very deep ideas about the human mentality. According to them, a person's mentality can be divided into 4 main groups: perfect (mental health), easily changed (in modern systematization - personality disorders), borderline mental disorders and psychopathology.
The systematization of psychopathology consists in the division of DAFCAR changes with a general deceleration of alpha rhythm in all leads (built along the blue arrow), and regional decelerations or accelerations of alpha rhythm (delayed and accelerated frontal expression), mainly in the frontal departments (changes located above and below the blue arrow. At the same time, the deceleration and acceleration of the alpha rhythm can be both monomodal (without a pronounced spread of indicators around the central value) and dispersive (with a pronounced spread of indicators around the central value). The proposed systematization is presented in Fig. 9.
The values of the coefficients presented on it are set forth in theoretical articles on DAFCAR. The basic principle is very simple: the increase in entropy (disorganization) of the neural network leads to a slowdown in alpha rhythm and a decrease in dispersion coefficients. Most often, pronounced slows in alpha rhythm and pronounced dispersion lead to dementia (mental retardation). Regional alpha rhythm disorders in frontal leads (deceleration and acceleration) most often lead to diseases of the "schizoid circle." Naturally, systematization can be expanded on the basis of old categorical diagnostic criteria. The main thing we can get from the application of new systematization is an understanding of the mechanisms of mental disorders and which disorders should be eliminated in order to bring the patient's consciousness back to normal. Thus, it becomes possible to treat not a diagnostic label, but the basis of the disease and the patient himself.
The goal of changing the paradigm of psychiatry and psychological sciences is:
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