The presentation of the mind-brain problem in leading psychiatry journals

Objective: The mind-brain problem (MBP) has marked implications for psychiatry, but has been poorly discussed in the psychiatric literature. This paper evaluates the presentation of the MBP in the three leading general psychiatry journals during the last 20 years. Methods: Systematic review of articles on the MBP published in the three general psychiatry journals with the highest impact factor from 1995 to 2015. The content of these articles was analyzed and discussed in the light of contemporary debates on the MBP. Results: Twenty-three papers, usually written by prestigious authors, explicitly discussed the MBP and received many citations (mean = 130). The two main categories were critiques of dualism and defenses of physicalism (mind as a brain product). These papers revealed several misrepresentations of theoretical positions and lacked relevant contemporary literature. Without further discussion or evidence, they presented the MBP as solved, dualism as an old-fashioned or superstitious idea, and physicalism as the only rational and empirically confirmed option. Conclusion: The MBP has not been properly presented and discussed in the three leading psychiatric journals in the last 20 years. The few articles on the topic have been highly cited, but reveal misrepresentations and lack of careful philosophical discussion, as well as a strong bias against dualism and toward a materialist/physicalist approach to psychiatry.

La capacidad de los neonatos de regular sus estados de conciencia y la habituación ¿marcadores tempranos de dificultades en el desarrollo? / Neonatal capacity of regulation of behavioral states and habituation ¿Early markers of neurodevelopment impairment?

Desde la etapa neonatal, la detección temprana de marcadores conductuales de alteraciones sutiles en el neurodesarrollo, es un campo todavía en crecimiento. El objetivo de esta revisión es describir los mecanismos que subyacen a la conducta del neonato durante la aplicación de la subescala de habituación que forma parte de la Neonatal Behavioral Assessment Scale (NBAS), con especial énfasis en la vía visual. Se destacan el papel de la habituación y la regulación de los estados de conciencia como los mecanismos fundamentales durante el primer estímulo y del segundo al décimo estímulo, en dicha escala. Estos procesos representan una capacidad fundamental para la adaptación del recién nacido y se discuten sus posibles implicaciones en el desempeño cognitivo posterior.

Since the neonatal stage, early detection of behavioral markers of subtle impairments in neurodevelopment is a field still under growth. The objective of this review is to describe the mechanisms underlying neonatal behavior during the habituation scale of NBAS, that emphasizes the visual pathway. The role of habituation and the regulation of behavioral states are highlighted during the first stimuli and the second to ten stimuli, during performance of NBAS. Those processes represent a fundamental capacity for newborns´ adaptation and are discussed in line to later cognitive performance.

The dialog between psychoanalysis and neuroscience: what does philosophy of mind say? / O diálogo entre a psicanálise e a neurociência: o que diz a filosofia da mente?

Objective: To briefly review how the main monist and dualist currents of philosophy of mind approach the mind-body problem and to describe their association with arguments for and against a closer dialog between psychoanalysis and neuroscience. Methods: The literature was reviewed for studies in the fields of psychology, psychoanalysis, neuroscience, and philosophy of mind. Results: Some currents are incompatible with a closer dialog between psychoanalysis and neurosciences: interactionism and psychophysical parallelism, because they do not account for current knowledge about the brain; epiphenomenalism, which claims that the mind is a mere byproduct of the brain; and analytical behaviorism, eliminative materialism, reductive materialism and functionalism, because they ignore subjective experiences. In contrast, emergentism claims that mental states are dependent on brain states, but have properties that go beyond the field of neurobiology. Conclusions: Only emergentism is compatible with a closer dialog between psychoanalysis and neuroscience (AU)

Objetivo: Apresentar uma breve revisão sobre como as principais correntes da filosofia da mente, monistas e dualistas, se posicionam sobre a questão mente-corpo e relacioná-las com os argumentos favoráveis e contrários a um diálogo mais estreito entre a psicanálise e a neurociência. Métodos: Foi realizada uma revisão bibliográfica de estudos nas áreas de psicologia, psicanálise, neurociência e filosofia da mente. Resultados: São incompatíveis com um diálogo entre psicanálise e neurociência: o interacionismo e o paralelismo psicofísico, por negligenciarem os conhecimentos sobre o cérebro; o epifenomenalismo, por considerar a mente como um mero efeito colateral da atividade cerebral; assim como o behaviorismo analítico, o materialismo eliminativo, o materialismo redutivo e o funcionalismo, por ignorarem as vivências subjetivas. Diferentemente, o emergentismo considera que os estados mentais dependem dos estados cerebrais, mas apresentam propriedades que vão além do âmbito da neurobiologia. Conclusões: Somente o emergentismo é compatível com uma maior aproximação entre essas duas áreas do conhecimento (AU)

Cardiovascular effects of the intracerebroventricular injection of adrenomedullin: roles of the peripheral vasopressin and central cholinergic systems

Our objective was to investigate in conscious Sprague-Dawley (6-8 weeks, 250-300 g) female rats (N = 7 in each group) the effects of intracerebroventricularly (icv) injected adrenomedullin (ADM) on blood pressure and heart rate (HR), and to determine if ADM and calcitonin gene-related peptide (CGRP) receptors, peripheral V1 receptors or the central cholinergic system play roles in these cardiovascular effects. Blood pressure and HR were observed before and for 30 min following drug injections. The following results were obtained: 1) icv ADM (750 ng/10 µL) caused an increase in both blood pressure and HR (DMAP = 11.8 ± 2.3 mmHg and ΔHR = 39.7 ± 4.8 bpm). 2) Pretreatment with a CGRP receptor antagonist (CGRP8-37) and ADM receptor antagonist (ADM22-52) blocked the effect of central ADM on blood pressure and HR. 3) The nicotinic receptor antagonist mecamylamine (25 µg/10 µL, icv) and the muscarinic receptor antagonist atropine (5 µg/10 µL, icv) prevented the stimulating effect of ADM on blood pressure. The effect of ADM on HR was blocked only by atropine (5 µg/10 µL, icv). 4) The V1 receptor antagonist [β-mercapto-β-β-cyclopentamethylenepropionyl¹, O-me-Tyr²,Arg8]-vasopressin (V2255; 10 µg/kg), that was applied intravenously, prevented the effect of ADM on blood pressure and HR. This is the first study reporting the role of specific ADM and CGRP receptors, especially the role of nicotinic and muscarinic central cholinergic receptors and the role of peripheral V1 receptors in the increasing effects of icv ADM on blood pressure and HR.

The impact of EEG in the diagnosis and management of patients with acute impairment of consciousness / Impacto do EEG no diagnóstico e conduta dos pacientes com alteração aguda do estado da consciência

OBJECTIVES: To assess the frequency of electroencephalogram (EEG) requests in the emergency room (ER) and intensive care unit (ICU) for patients with impairment of consciousness (IC) and its impact in the diagnosis and management. METHODS: We followed patients who underwent routine EEG from ER and ICU with IC until discharge or death. RESULTS: During the study, 1679 EEGs were performed, with 149 (8.9 percent) from ER and ICU. We included 65 patients and 94 EEGs to analyze. Epileptiform activity was present in 42 (44.7 percent). EEG results changed clinical management in 72.2 percent of patients. The main reason for EEG requisition was unexplained IC, representing 36.3 percent of all EEGs analyzed. Eleven (33 percent) of these had epileptiform activity. CONCLUSION: EEG is underused in the acute setting. The frequency of epileptiform activity was high in patients with unexplained IC. EEG was helpful in confirming or ruling out the suspected initial diagnosis and changing medical management in 72 percent of patients.

OBJETIVO: Avaliar a frequência de exames de eletroencefalograma (EEG) solicitados no pronto-socorro (PS) e na unidade de terapia intensiva (UTI) em pacientes com rebaixamento do nível de consciência, bem como seu impacto no diagnóstico e na conduta. MÉTODOS: Acompanhamos pacientes submetidos ao EEG do PS e da UTI com rebaixamento do nível de consciência até a alta ou óbito. RESULTADOS: Realizamos 1679 EEGs no período de estudo; destes, 149 (8,9 por cento) foram solicitados no PS e na UTI. Incluímos 65 pacientes e 94 EEGs para análise; destes, 42 (44,7 por cento) apresentavam atividade epileptiforme. O EEG mudou a conduta em 72 por cento dos pacientes. A razão principal para solicitação do EEG foi rebaixamento do nível de consciência de origem inexplicável (36,3 por cento dos EEGs). Destes, 33 por cento tinham atividade epileptiforme. CONCLUSÃO: Embora o EEG seja pouco usado em condições agudas, a frequência de atividade epileptiforme foi alta nos pacientes com rebaixamento do nível de consciência de origem inexplicável. O EEG foi decisivo para o esclarecimento diagnóstico e implicou mudança da conduta em 72 por cento dos pacientes.

Experiencias cercanas a la muerte / Near-death Experiences

Las experiencias cercanas a la muerte (ECM) son eventos lúcidos que ocurren cuando una persona está tan comprometida físicamente que moriría si su condición no lograra mejorar. Está inconsciente, sin latidos cardíacos detectables, sin respiración y los registros electroencefalográficos son planos. Las ECM pueden incluir algunos de los siguientes elementos: experiencias fuera del cuerpo o separación de la conciencia del cuerpo físico, incremento en la percepción sensorial, emociones intensas, viaje hacia o a través de un túnel, observación de una luz brillante, encuentro con seres místicos o familiares y amigos fallecidos, sentido de alteración del tiempo y el espacio, revisión de la vida, visualización de paisajes celestiales indescriptibles, encuentro con una barrera o límite, aprendizaje de un conocimiento especial y el regreso voluntario o involuntario al cuerpo físico. La similitud de las ECM en niños y adultos es una evidencia de que son reales y no debidas a creencias preexistentes, influencias culturales o experiencias previas en la vida actual. Las características de las ECM son parecidas en todo el mundo y en personas de diferentes culturas. No existen evidencias que apoyen las hipótesis psicológicas, fisiológicas, neuroquímicas y neuroanatómicas para explicar las ECM. Se han propuesto modelos multifactoriales basados en la combinación de todos los factores señalados (hipoxia cerebral, liberación de serotonina, endorfinas o compuestos similares a la ketamina). Aunque los factores fisiológicos, psicológicos y socioculturales pueden interactuar en las ECM, las hipótesis que se han propuesto son meras especulaciones sin soportes sobre lo que ocurre durante una ECM.

Near-death experiences (NDE) are lucid events that take place when a person is so physically compromised that he would die if its condition does not improve. He is unconscious, without heartbeats and breath, and with a flat-line electroencephalogram. NDE may include some of the following elements: Out of the body experiences or separation of consciousness from the physical body, increase in sensory perception and intense emotions, travel into or through a tunnel, encounter with a brilliant light and mystical beings, deceased relatives or friends, a sense of alteration in time and space, visualization of unworldly realms and a special knowledge, encounter with a barrier or boundary, and a return to the body, either voluntary or involuntary. The fact that children NDE are similar to adult NDE is an evidence that these experiences are real and not due to pre-existing beliefs, cultural influences or previous experiences in the present life. The characteristics of NDE are similar worldwide. No evidence supports the physiological, psychological, neurochemical, and neuroanatomical hypothesis proposed to explain the NDE. Multifactorial models, based on the combination of all of them (brain anoxia or hypoxia, release of serotonin, endorphins and ketamine-like compounds) have also been proposed. Although physiological, psychological, and socio-cultural factors could interact in the NDE, the hypothesis proposed consist essentially in unsupported speculations about what might be happening during the NDE.

O conceito do insight em pacientes com transtorno obsessivo-compulsivo / The concept of insight in patients with obsessive-compulsive disorder

OBJETIVO: Atualizar os clínicos sobre a existência de um possível subtipo do transtorno obsessivo-compulsivo caracterizado por pouco insight. MÉTODO: Revisão opinativa baseada em estudos indexados na base de dados PubMed e PsychINFO, identificados por meio dos unitermos "obsessive-compulsive disorder" e "insight" ou "ego-dystonic" e publicados entre 1966 e outubro de 2009. Os resultados foram examinados de acordo com a estratégia utilizada para abordar o insight, i.e. categórica vs. dimensional. RESULTADOS: Análise dos estudos nos permitiu identificar pontos que colocam em dúvida a existência de um subtipo do transtorno obsessivo-compulsivo bem delimitado caracterizado por pouco insight. Estes pontos incluem 1) prevalência extremamente variável do transtorno obsessivo-compulsivo com insight reduzido encontrada em estudos categóricos, 2) homogeneidade dos achados fenotípicos (i.e. maior gravidade) associados a baixo insight em estudos categóricos e dimensionais e 3) ausência de estudos que investigam "zonas de raridade" entre as formas de transtorno obsessivo-compulsivo com pouco e bom insight. CONCLUSÃO: Embora uma abordagem categórica do insight no transtorno obsessivo-compulsivo seja importante em ambientes clínicos, uma vez que neles existem demandas prementes para tomada de decisões, a abordagem dimensional do insight parece refletir de forma mais fidedigna o fenômeno apresentado pelos pacientes em tela.

OBJECTIVE: To update clinicians regarding the existence of a putative subtype of obsessive-compulsive disorder based on poor insight. METHOD: Opinionative review based on studies indexed in the PubMed and PsychINFO databases, identified by means of the keywords "obsessive-compulsive disorder" AND "insight" OR "ego-syntonic", and published between 1966 and October 2009. The results were analyzed according to the approach adopted, i.e. a categorical or dimensional view of insight in obsessive-compulsive disorder. RESULTS: The review of recent studies led us to identify some issues that cast doubts over the existence of a clear-cut poor insight subtype of obsessive-compulsive disorder. These issues include 1) an extremely variable prevalence of poor insight obsessive-compulsive disorder in categorical studies, 2) a significant degree of homogeneity in the phenotypical findings (i.e. greater severity) associated with lower levels of insight in obsessive-compulsive disorder in both categorical and dimensional studies and, 3) a lack of studies investigating zones of rarity between poor and good insight obsessive-compulsive disorder. CONCLUSION: Although a categorical approach to the insight issue in obsessive-compulsive disorder is still important in clinical settings, where decision-making is often a critical issue, a dimensional approach seems to reflect levels of impairment in these patients more reliably.

Consciousness from Physiology to Spiritual Experience.

The many researches on the effects of meditation on brain, physiology and psychology have yielded results. Interaction between traditional mediators and neuroscientists have become frequent. Pr D’Aquino speaks of mystical experience as an inhibition of the Orientation Association Area allowing experiences of pure space..Moreover,”slow” experiences like rituals stimulates the parasympathetic system.”quick” experiences like trance through dance excites the sympathetic, and the deeper experiences of mystical union seems to stimulate both systems at the same time. The topic of the December 2006 conference of the DPS in Mussoorie was Emerging demand in the Delivery of Mental Health Services. One of these demands is a more explicit consideration of the spiritual and its force in the inner life of the patients and their families.

Considerações sobre a evolução filogenética do sistema nervoso, o comportamento e a emergência da consciência / Considerations about the nervous system phylogenetic evolution, behavior, and the emergence of consciousness

Tendo como base dados de literatura, esta revisão trata dos aspectos genéricos da evolução filogenética do sistema nervoso central, ressaltando em particular o desenvolvimento evolutivo das estruturas encefálicas relacionadas com o comportamento e com as funções cognitivas que vieram caracterizar o ser humano. Sobre as estruturas límbicas, que por ocasião do advento dos mamíferos evolutivamente se desenvolveram sobre o topo do sistema nervoso mais primitivo dos seus ancestrais, o ulterior desenvolvimento cortical com neurônios dispostos em camadas constituiu a base estrutural que viabilizou a discriminação fina das funções sensitivas e sensoriais, a maior complexidade das funções motoras e o desenvolvimento das funções cognitivas e intelectuais que acabaram caracterizando o ser humano. O conhecimento da evolução filogenética do sistema nervoso central nos permite inferir possíveis correlações entre as estruturas encefálicas que se desenvolveram ao longo do processo evolutivo e o comportamento dos seus respectivos seres. Nesta direção, sem se deter em questões de ordem conceitual, a presente revisão termina discutindo possíveis paralelos entre a evolução do sistema nervoso central e a emergência da consciência, à luz das recentes contribuições sobre o assunto.

This text reviews the generic aspects of the central nervous system evolutionary development, emphasizing the developmental features of the brain structures related with behavior and with the cognitive functions that finally characterized the human being. Over the limbic structures that with the advent of mammals were developed on the top of the primitive nervous system of their ancestrals, the ultimate cortical development with neurons arranged in layers constituted the structural base for an enhanced sensory discrimination, for more complex motor activities, and for the development of cognitive and intellectual functions that finally characterized the human being. The knowledge of the central nervous system phylogeny allow us particularly to infer possible correlations between the brain structures that were developed along phylogeny and the behavior of their related beings. In this direction, without discussing its conceptual aspects, this review ends with a discussion about the central nervous system evolutionary development and the emergence of consciousness, in the light of its most recent contributions.

Can electrocardiogram electrodes replace bispectral index electrodes for monitoring depth of anesthesia?

BACKGROUND: Bispectral index has been introduced to provide optimal level of anesthesia. However, Bispectral index monitoring may not be cost effective in a relatively short procedures due to the high costs of the electrode. The authors conducted the present study to compare the feasibility of commercially available electrocardiogram (ECG) electrodes instead of the Bispectral index (BIS) monitoring. MATERIAL AND METHOD: The authors evaluated the difference in signal quality index (SQI) and BIS values collected from two BIS monitors, using ECG electrodes and BIS electrodes on the same patients before anesthesia, during light anesthesia, deep anesthesia and the emergence period Both sets of electrodes were placed at bifrontal areas throughout the procedure. Statistical analysis was evaluated by mean difference 95% confidence limits of agreement and visualized by Bland-Altman plot. A parametric analysis was analyzed using paired t-test. RESULTS: There were 390 parallel signal quality index and BIS values recorded in the present study. During anesthesia the mean BIS values were 58.63 +/- 18.77 in the ECG electrode group and 56.99 +/- 19.84 in the BIS electrode group, which were not statistically different. The mean SQI values were 79.2 +/- 24.8 and 82.8 +/- 21.6 using ECG electrodes and BIS electrodes, respectively. The mean difference between BIS values was 1.65 with 95% confidence limits of agreement between 0.91 and 2.38. CONCLUSION: Commercial ECG electrodes could be used for monitoring depth of anesthesia with clinically acceptable mean bias and 95% confidence limits of agreement of BIS value obtained from BIS electrode.

What is consciousness for?

Organization of behavior is grounded on several stages of processing of information by the nervous system, one of which is identification of the original information, through which it acquires meaning. Only after this stage can a decision be made and can a behavioral pattern, specific to what has been identified, be produced. The conscious process is one of the mechnisms of identification of neural information. At any given moment, consciousness is identifying just an extremely narrow band of what is going on in the nervous system, while most information is being processed by nonconscious mechanisms. This selectivity allows precise attention. Conscious identification of any information is always followed by a specific behavior. Therefore, consciousness is neither a uselles epiphenomenon nor a nonspecific, passive by-product of neural activity which just "watches" what is going on inside and outside of the body. It is neither an initial nor a final stage in the organization of behavior but a specific. highly precise intermediate stage.

Consciousness and controllability: looking for a legitimate temporal code in the brain

Consciousness can be treated as a process by which the central nervous system controls unstable or nonconvergent varieties of representations. Translated into voluntary control over actions, consciousness, in this aspect, may represent a style of computation that works over unstable objects. Through the synchronized combination of modalities of oscillations, we internalize blocks of ordinary language, having the sensation that our mental representations are propositional and nonreducible to cerebral events. Bifurcations and chaos at hte neural level of processing can be candidates to the events that summon conscious control to exert its role. The function of consciousness would be resetting nonconvergent series of events; the form by which it works can be seen as a type of topological computation that appears in phase-transitions; the contents of consciousness are oscillations and synchronization that couple several series of processes and their possible descriptions in ordinary language; the primary feeling of being conscious, qualia, is an emergent property of large amounts of oscillating neuronal assemblies that are recruited during the propagation of an error signal among different loops that try to solve the task. The sensation of volunteerism and of free will is compatible with a deterministic, nonmechanic, view of the process in which consciousness exerts control, vetoing or allowing presumed actions and interpretations of perceptions to go on.

A study of structure of phenomenology of consciousness in meditative and non-meditative states.

Twelve senior Kundalini (Chakra) meditators were assessed during meditation session and non-meditation or control session using Phenomenology of Consciousness Inventory. The data has been analyzed using structural analysis to measure the altered state of consciousness and the identity state by comparing meditative state with non-meditative state. The structural analysis of pattern of consciousness during the meditative state revealed altered experience in perception (percentile rank PR = 90), meaning (PR = 82) and time sense (PR = 87), while positive affect dimension showed increased joy (PR = 73) and love (PR = 67). The imagery vividness (PR = 72), self-awareness (PR = 77), rationality (PR = 73) and arousal (PR = 69) were found to be structurally different from the ordinary state. With regards to identity state meditative experience was found to produce statistically significant changes in terms of intensity in meaning (P < 0.05), time sense (P < 0.05), joy (P < 0.05), love (P < 0.05) and state of awareness (P < 0.01). Our results indicate that long term practice of meditation appears to produce structural as well as intensity changes in phenomenological experiences of consciousness.

El examen mental / Mental examination

El examen mental abarca una serie de ítemes, muchos de los cuales pueden ser aplicados por el médico general para la evaluación del estado mental de un determinado paciente. Se hace una descripción suscinta de los diferentes estados de conciencia, desde la lucidez hasta el coma, con las características distintivas de cada uno. Se dan algunos ejemplos de preguntas que sirven para determinar la orientación, la atención, la memoria y el juicio. Se define el Coeficiente Intelectual (CI) y la forma de calcularlo, dividiendo la edad mental por la edad cronológica. Se expone una tabla sobre puntaje de coeficiente intelectual y sus denominaciones. Se hacen consideraciones sobre la inteligencia; se definen los diferentes grados de déficit intelectual u oligofrenia; como así mismo sobre el deterioro mental fisiológico y patológico hasta la demencia. Se exponen una serie de preguntas -problemas que hacen reflexionar sobre pensamiento abstracto, significado de proverbios, ideas de conjunto, cálculo e información general. Todo ello podrá servir al clínico para la apreciación, o una aproximación, de la capacidad intelectual de una persona o sospechar un deterioro