Atlas of Science

Tag: mental illness

  • A neurodynamic theory linking creativity and insanity

    A neurodynamic theory linking creativity and insanity

    Humanity has long suspected a correlation between creativity and mental illness. Those doubting such a relationship assert that psychopathologies inhibit the creative process, while others raise the issue that neither insanity nor creativity have been adequately quantified to establish such a connection. However, a new perspective has emerged through studying highly transparent, brain-like artificial neural systems called Creativity Machines® that originate ideas for which novelty may be quantitatively measured and whose stream of consciousness may be contrasted with a controlled external reality.

    Fig. 1. During a Creativity Machine’s chaotic phase, potential ideas known as “confabulations” form within a matrix of artificial neurons and interconnections due to an abundance of randomly hopping connective disturbances (blue starbursts). These same disturbances block or hinder evaluation of confabulations by other portions of the neural architecture. Later, during a relaxed phase when milder disturbances reactivate past confabulations without corrupting evaluation, reinforcement of the more advantageous or novel of these potential ideas takes place.

    Within these artificial neural architectures, transient disturbances to connection weights stimulate the ongoing formation of both true and false memories. As these memories simultaneously activate, they ‘wire’ themselves into new combinations of memories called confabulations. Up to a point, the greater these synaptic disturbances, the more novel the emerging confabulations become. Other portions of the neural system assess the utility of these candidate notions by predicting their consequences (Fig. 1). Accordingly, these contemplative artificial neural systems may be thought of as collaborating concept generators and evaluators. If the evaluators predict advantageous consequences to a forming confabulation, they may algorithmically command synaptic calm, allowing this candidate idea to be reinforced into a memory. On the other hand, if the evaluation component associates unfavorable consequences with a confabulation, it may allow ongoing disturbances to stimulate alternative notions.

    An important observation regarding the Creativity Machine (CM) depicted in Fig. 1 is that there are no partitions between idea generators and evaluators and hence no option to selectively infiltrate just the generative component with diffusing synaptic disturbances. Instead, perturbations flood the entire system, affecting the evaluating subsystem as well, by either altering connections to corrupt evaluation, or pinning neuron states with an excess of synaptic disturbances to block appraisal. CMs overcome this dilemma by cycling between high and low levels of synaptic perturbation. At higher synaptic disturbance, ideas incubate outside the attention of the evaluating neural components, reinforcing themselves into latent ideas. Then, as the chaos subsides, the evaluating component becomes attentive to these notions now reactivated by milder perturbations. The drawback of this approach, however, is that at higher perturbation levels where novel concepts form, hallucination occurs along with sufficient pinning of neuron activations to render the evaluating component aloof to the merit/veracity of either confabulations or activity within the external environment.

    Fig. 2. In the brain, cycling of the kind depicted in the Creativity Machine of Fig. 1 is presumed to take place as global or “volume” neurotransmitter levels rise and fall. Potential ideas would form subliminally at higher neurotransmitter levels, making themselves known to evaluating neural components as these diffusing molecular disturbances dissipate. More mundane forms of cognition would involve minor swings in neurotransmitter level. Higher intensity variations would result in more novel ideation, and perhaps eminent creativity, along with accompanying psychopathologies.

    Equating such computational synaptic disturbances with the global or “volume” release by the limbic system of either excitatory or inhibitory neurotransmitters into both idea-generating and evaluating components of cortex, we begin to see the connection between creativity and a range of psychopathologies. If this model is correct, creativity involves multiple swings in the concentration of neurotransmitters (e.g., adrenaline or dopamine) randomly diffusing through the open synaptic clefts between neurons. Generally, the more intense these chemical variations, the more novel ideation becomes, with intellectual products rising into consciousness between chaotic and relaxed poles (Fig. 2). Thus, we expect less creative individuals to experience low amplitude neurotransmitter swings with minimal accompanying psychopathologies. However, the cortices of more eminently creative individuals would be subject to higher levels of synaptic agitation that induce hallucination, inability to separate fact from fiction, attention deficit, depressed cognitive flow, and world views significantly differing from the norm.

    Summarily, all knowledge in the brain is contained within the synaptic connections bridging neurons. To conceive ideas that transcend what a brain already knows, such connections must be altered, the most likely mechanism being the cyclic infiltration of cortex by spurious neurotransmitters. Unfortunately, these same meandering connections govern our perceptions, values, and morality, all of which will inevitably deviate from societal preferences as we strive toward profound levels of ingenuity.

    Stephen L. Thaler
    Imagination Engines, Inc., St. Charles, MO, USA

     

    Publication

    Cycles of insanity and creativity within contemplative neural systems.
    Thaler SL
    Med Hypotheses. 2016 Sep

  • Getting mental health services: not so easy for most people

    Mental illness includes a variety of recognized psychiatric disorders and represents an enormous public health problem in the United States and worldwide. The US has a population of approximately 320 million people. At a given point in time approximately 25% (or 80 million people) meet criteria for a mental disorder. Over the course of one’s life, this increases to 50% (or 160 million people). The burdens of mental illness include deleterious consequences for individuals, their families, and society at large including reduced ability to participate in the activities of everyday life (e.g., family, social activities, work and school), loss of wages and jobs, discrimination and stigmatization, increased risk of homelessness and incarceration, emergency room visits and hospital stays, and earlier than expected death from illness as well as suicide.

    How are we doing as a society in getting treatment to the people in need? Not very well. Of those in need of mental health services, approximately 70% receive nothing at all. The other 30% get a mix of checkered supportive services and most of the time do not receive the treatments developed in scientific research.

    How to fix this. Perhaps we need something called disharmony-dot-com that does matchmaking by bringing together people who need services with those who provide services. Nice idea perhaps but probably would not work because:

    • Too few mental health services are available in general, and the situation is even more dire for ethnic and cultural minorities;
    • Services are not near most people in need (small towns, rural areas, inner cities);
    • The costs of services are not covered for most people in need and therefore are out of reach;
    • Stigma is associated with mental disorders and seeking treatment; and
    • The public often views sources of support (family, religious leaders) as better options than mental health services for their psychological problems.

    A major obstacle that is embedded in the others I have listed is how therapy is provided. In the vast majority of cases, psychotherapy consists of an individual (client), going to a clinic or some other office, and meeting in-person with a mental health professional (therapist, counselor). This is useful and has evidence to show that it can deliver effective treatments. However, this way of providing services is just not up to the task of reaching most people in need.

    Alternatives are needed that can be scaled up to reach many people, that are brought to people rather than requiring people to come to a special clinic, and that are more convenient and user friendly in general. There are many such options to add to what we currently do. For example, we know that lay individuals from the community can be trained and supervised to deliver many effective mental health services and do not need the advanced degree (masters, doctoral). That could increase the “man”power to provide services and bring down the costs. In addition, technology and social media (on line via the Web, “apps”) can deliver effective interventions without clients leaving their homes.

    Psychotherapy research has made major advances in establishing the effectiveness of many treatment techniques. Cognitive therapy for clinical depression is one of the well-established and more familiar examples. A key challenge is getting the treatments out to the millions in need. We would all profit from reduced suffering and impairment of individuals with mental disorders and from a reduction in the billions of dollars annually that untreated mental illness costs. Making services available to individuals in need also is the right and humane thing to do.

    Alan E. Kazdin, PhD

    Sterling Professor of Psychology and Child Psychiatry
    Yale University

     

    Publication

    Interventions and Models of Their Delivery to Reduce the Burden of Mental Illness: Reply to Commentaries.
    Kazdin AE, Blase SL
    Perspect Psychol Sci. 2011 Sep

  • Does your culture create your personality?

    Personality is as much a part of human biology as a liver, yet it is understood and evaluated through society, culture, and emotions. Personality is an individual’s unique patterns of thinking, feeling, and behaving. Unlike the liver, personality is difficult to dissect and is often studied through observation of the thoughts, behaviors, and feelings reported by individuals.

    Personality has been studied and characterized in many different ways but one of the most common ways to describe it is through the Five Factor Model, also known as “The Big Five.” These Five Factors of Personality are Neuroticism, Extraversion, Openness, Conscientiousness, and Agreeableness. Neuroticism is another way of describing a person’s emotional stability. Extraversion is how outgoing an individual is while Agreeableness describes someone’s ability to cooperate with others. Conscientiousness can be vaguely described as self-discipline whereas Openness refers to openness to experience. The Five Factors are used as categories with high and low values that correspond to individual personality traits. Being very extraverted, open, consciousness, and agreeable with no neuroticism is not an ideal personality state that individuals are to aspire for. The presence or absence of these factors do not indicate a disorder or a psychological problem as many agree that all humans have a personality with these characteristics in different intensities.

    The Diagnostic and Statistical Manual of Mental Illness 5th (DSM 5) Edition describes a disorder of personality as problems in self-direction or identity and empathy or intimacy for a long time in many situations without the influence of a mental illness. Though there is some debate as to whether a Personality Disorder is a mental illness due to its pervasive style and inability to treat or manage like many other mental illnesses, certain types of Personality Disorders such as Borderline Personality Disorder are less impairing with appropriate management.

    The International Classification of Diseases 10th Edition (ICD-10), an international compilation of illness and disease which also includes mental illnesses has a similar way of looking at Personality Disorders as the DSM 5 but it notes that disharmonious attitudes and behavior with problems in emotion control, sensitivity, impulse control, ways of relating to others, and ways of perceiving and thinking have traits that begin in childhood or adolescence and remain until adulthood. The ICD-10 also notes that “For different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations.” This is because culture is a personality made from a person’s learned, accumulated experience which is socially transmitted, or more briefly, behavior through social learning. This overlap of thoughts, behaviors, and actions on a personal and societal level has often made it complicated for mental health professionals to discern between a personality disorder and a culturally appropriate personality, particularly when they are evaluating individuals who come from a different culture.

    A good way for psychiatrists to determine if someone of a different culture has a personality disorder is to look at the domains of their personality and coping through the DSM-5 Cultural Formulation Interview (CFI). The CFI is a tool intended to help health professionals gather and organize culturally relevant clinical information to determine the presence of a disorder. Understanding the culture in which someone’s personality has formed and operates as well as normal behaviors when people try to communicate to someone of a different background creates improved sensitivity for physicians and therefore, improved treatment.

    Suni Jani1, MD, MPH and Raja Jani2, MHA
    1 Harvard Medical School
    2Touro College of Medicine

    Publication

    Educating Residents on Diagnosing Personality Disorders Across Cultures
    Jani S, Johnson RS
    Acad Psychiatry. 2015 Oct 27

  • Epilepsy spectrum disorders

    Epilepsy spectrum disorders

    Symptoms of mental illness (like depression or hallucinations) tend to change slowly overtime (with or without treatment). At time individuals may experience episodic symptoms like sudden and brief panic attacks or sudden and brief violent episodes. While episodic psychiatric symptoms are not uncommon they have not been researched as extensively as other more enduring type of symptoms. Some evidence has accumulated over the years that at least in a subset of patients exhibiting these symptoms there may be evidence for the presence of an abnormally increased irritability of localized areas of neural (brain) tissue. These focal areas could be in the cerebral cortex (the outer layer of the brain or cortical areas) or in deeper brain structures (subcortical). This increased irritability reflects a dysbalance between the excitatory and inhibitory chemicals in the brain and leads to a state of hyperexcitability. In its extreme form this is the condition that leads to seizures (i.e, epilepsy). In these cases the condition could be conceptualized as an epilepsy spectrum disorder (ESD) with significant treatment implications. Seizures thus represent the tip of the iceberg of a pyramid of increasing degrees of hyperexcitability (Figure).

    Tip of the Iceberg
    Tip of the Iceberg
    There is currently no clear demarcation of this category of symptoms, their prevalence is unknown, there is minimal understanding of how these symptoms are produced by the brain and what is appropriate work up and possible treatments. We here propose that milder degrees of increased neural excitability (i.e., a subthreshold excitation insufficient to cause seizures) may nonetheless be capable of causing observable behavioral changes. The observable behavioral changes depend on the degree of hyperexcitability and the location of the hyperexcitable brain tissue. For example, a hyperexcitable area in the brain system that mediates emotions (limbic system) may manifest as a panic disorder whereas hyperexcitable brain tissue in the frontal lobe area (mediating self-control and cognition) may manifest as rage attacks. The location of the abnormal brain tissue may dictate the initial manifestation of an attack resulting from activation of the hyperexcitable tissue, but the anatomical connectivity (brain areas connected to each other) of the abnormal region will dictate the breadth of the manifestations. The following criteria for diagnosing ESD are proposed:

    A: 1) Probable ESD: Presence of any form of episodic symptoms. An examination by an expert epileptologist is likely useful at this stage to rule out clinically diagnosable epileptic attacks. Episodic symptoms can include but not limited to: panic and other dissociative attacks, episodic violence; and sudden dysphoric mood and/or 2) an elevated score on the Structured Clinical Interview for Complex Partial Seizure-like Symptoms (SCIPS) (we preliminarily recommend a score of 62.8 or higher). The SCIPS is a standardized symptom interview with 35 items describing cognitive, affective, and psychosensory symptoms associated with partial seizure disorders. The predictive value of this SCIPS score for a favorable response to anti-epileptic drugs (AEDs) must be tested in well-designed studies to avoid placing too many patients on potentially toxic AEDs.

    B: Possible ESD: 1) Evidence from electrophysiological studies like the electroencephalogram (EEG) for epilepsy-like activity. Long-term monitoring in specialized epilepsy monitoring units could be able to detect abnormalities particularly during actual episodes; and/or 2) Evidence from positron emission tomography (PET) scanning for a localized abnormality suggestive of an epileptic process; and/or 3) Neuropsychology testing suggestive of focal deficit in a brain region relevant to the clinical presentation.
    C) Definite: A significant clinical response to anticonvulsant medications when the above criteria are present.

     

    Publication

    Epilepsy spectrum disorders: A concept in need of validation or refutation.
    Boutros NN, Bowyer S, Wang J, Urfy MZ, Loeb JA
    Med Hypotheses. 2015 Aug 18

  • Antipsychotic medications in pregnancy: Balancing the needs of mother and child

    Antipsychotic medications in pregnancy: Balancing the needs of mother and child

    Consider Jenny, first diagnosed with schizophrenia in her 20’s. After years of suffering the severe symptoms of her illness along with medication side-effects, she was commenced on a new class of medications, “atypical antipsychotics”. She was finally able to live a normal life, employed and in love. She fell pregnant. Not knowing the safety of antipsychotics in pregnancy, Jenny’s doctor stopped her medication. This lead to a devastating cascade of events: Jenny’s relapse in mental illness, the ending of her relationship, an early caesarian section and her child being taken from her. Even after the recommencement of medication, Jenny was unable to see her daughter. In desperation, she ended her life.

    Unfortunately, such tragedies have occurred due to a lack of knowledge surrounding antipsychotic medications in pregnancy. Today, greater efficacy in treating psychotic illness means that women living with these conditions can expect to live normal, productive lives and for more and more women, this includes the chance to become a mother.

    Evidence shows there is a significantly increased risk of severe mental disorders during the perinatal period, including schizophrenia and bipolar disorder. The reasons for this remain unclear, however include major shifts in hormones, the immune system, sleep disturbance and psychosocial stressors.

    During pregnancy, medications are also impacted by dilution, hormonal, liver and kidney factors. An increased dose of antipsychotic medication is subsequently required to achieve the same concentration of the drug in the body. Therefore alterations in medication doses during this time may have more significant effects than anticipated. All psychotropic medications readily diffuse across the placenta to the fetus due to small molecular size and ability to dissolve in lipids.

    As described, the effects of stopping antipsychotic medications in pregnancy can be devastating to women with severe mental illnesses. But what of the potential health effects of continuing treatment, to both the mother and child?

    The Australian National Register of Antipsychotic Medications in Pregnancy (NRAMP)

    NRAMP is an observational nationwide study. The first of it’s kind, it was established in 2005 to address this lack of information.

    In terms of maternal health, weight gain (>15kg) and gestational diabetes occurred at a significantly higher rate than the general Australian population.

    Babies in the NRAMP study had around three times the risk of respiratory distress than the general population. There were also higher rates of preterm babies and those born with withdrawal symptoms.

    Although an increased rate of congenital malformations was found in the study, the malformations found do not support any specific patterns that can be attributed to particular drugs. The increased overall rate was impacted by factors such as other medications, lesser contact with antenatal care services and unhealthy behaviors.

    Importantly, the findings for infant development have been reassuring. Infants observed up to 1 year postpartum have met major milestones including walking, talking and basic socialization.

    Therefore, it needs to be recognized that this is a vulnerable population and where possible, access to specialist perinatal care and tertiary hospitals is recommended. For those using antipsychotic medications for off-label reasons or less severe mental illness, other options of treatment during pregnancy should be explored.

    However, it is clear that there are devastating outcomes associated with discontinuing antipsychotic medications in women with severe psychiatric illness. For these women this research provides reassurance that there are no definitive fetal malformations associated with antipsychotics during pregnancy and the majority of mothers and children do well.

    The most important message is that all women with mental illness of reproductive age need to have a considered discussion with their doctors to discuss the best management plan for them when choosing to have a baby.

     

    Publication

    Antipsychotic use in pregnancy.
    Kulkarni J, Storch A, Baraniuk A, Gilbert H, Gavrilidis E, Worsley R
    Expert Opin Pharmacother. 2015 Jun

  • The neural architecture of trauma

    The neural architecture of trauma

    Mental illness can be a frightening and debilitating experience. Efforts to understand mental illness more accurately and develop more effective treatments are urgently needed. It is the case that many people who experience mental illness report episodes of abuse and trauma in their childhood. From these findings, it appears evident that adverse events in a person’s childhood can have serious consequences for their mental health later in life. It is also the case, however, that not everybody who experiences adverse childhood events goes on to suffer the severe psychological distress of mental illness. Understanding why some people are chronically and seriously affected by childhood trauma and some people are not could help us learn more about mental illness and develop better ways of helping these people. One suggestion is that some people become conflicted about the event they experienced whereas other people are able to somehow reconcile the adversity. From this perspective, the ability to control circumstances and events in one’s life is paramount to contentment, satisfaction, and wellbeing. People who are conflicted, however, are unable to control the experiences and goals that are in conflict. The focus of treatment, therefore, is to help the person explore, understand, and resolve the conflict they are experiencing. In this way, the focus of treatment is not the past trauma but the current conflict.

     

    Publication

    Conflicted control systems: the neural architecture of trauma.
    Carey TA, Mansell W, Tai SJ, Turkington D
    Lancet Psychiatry. 2014 Sep;1(4):316-8