Approaching the nature of consciousness through a phenomenal analysis of early vision. What is the explanandum?

Loorits (2014) identifies the solution to the hard problem of consciousness in the possibility of fully analyzing seemingly non-structural aspects of consciousness in structural terms. However, research on consciousness conducted in recent decades has failed to bridge the explanatory gap between the brain and conscious mind. One reason why the explanatory gap cannot be filled, and consequently the problem remains hard, is that experience and neural structure are too different or "distant" to be directly compatible. Conversely, structural aspects of consciousness can be found in phenomenal experience. One possible alternative, therefore, is to seek the structure of seemingly non-structural aspects of consciousness not in the neural substrate, but within consciousness itself, through a phenomenal analysis of the qualitative aspects of experience, starting from its simplest forms. An essential premise is to reformulate the explanandum of consciousness, which is usually attributed to qualia and what it is like to be in a certain state. However, these properties do not allow us to identify the fundamental aspects of phenomenal experience. Sensations such as the redness of red or the painfulness of pain are inseparable from the context of the experience to which they belong, making qualia appear as phenomenal artifacts. Furthermore, the simplest qualitative aspects can be found in early vision. They are involved in perceptual organization and necessarily have relational significance. The unitary set of qualities found in early vision-such as those related to being an object, background or detail-constitutes the explanandum of the simplest forms of consciousness and seems to imply a justifying structure. Although early vision is characterized by interdependent qualitative components that form a unitary whole, we cannot find in it the structure of seemingly non-structural aspects of consciousness. Phenomenal appearance alone does not seem sufficient to identify a unitary structure of consciousness. However, the closeness of these characteristics to a unitary structure prompts us to delve into less explored territory, using the components of experience also as possible explanans.

The hidden structure of consciousness.

According to Loorits, if we want consciousness to be explained in terms of natural sciences, we should be able to analyze its seemingly non-structural aspects, like qualia, in structural terms. However, the studies conducted over the last three decades do not seem to be able to bridge the explanatory gap between physical phenomena and phenomenal experience. One possible way to bridge the explanatory gap is to seek the structure of consciousness within consciousness itself, through a phenomenal analysis of the qualitative aspects of experience. First, this analysis leads us to identify the explanandum concerning the simplest forms of experience not in qualia but in the unitary set of qualities found in early vision. Second, it leads us to hypothesize that consciousness is also made up of non-apparent parts, and that there exists a hidden structure of consciousness. This structure, corresponding to a simple early visual experience, is constituted by a Hierarchy of Spatial Belongings nested within each other. Each individual Spatial Belonging is formed by a primary content and a primary space. The primary content can be traced in the perceptibility of the contents we can distinguish in the phenomenal field. The primary space is responsible for the perceptibility of the content and is not perceptible in itself. However, the phenomenon I refer to as subtraction of visibility allows us to characterize it as phenomenally negative. The hierarchical relationships between Spatial Belongings can ensure the qualitative nature of components of perceptual organization, such as object, background, and detail. The hidden structure of consciousness presents aspects that are decidedly counterintuitive compared to our idea of phenomenal experience. However, on the one hand, the Hierarchy of Spatial Belongings can explain the qualities of early vision and their appearance as a unitary whole, while on the other hand, it might be more easily explicable in terms of brain organization. In other words, the hidden structure of consciousness can be considered a bridge structure which, placing itself at an intermediate level between experience and physical properties, can contribute to bridging the explanatory gap.

Healthcare Resource Consumption and Related Costs of Patients Estimated with Treatment-Resistant Depression in Italy.

PURPOSE: To analyse the healthcare resource consumption and related costs for the Italian National Health System of patients estimated to be affected by treatment-resistant depression (TRD) in Italy. PATIENTS AND METHODS: This was an observational retrospective study based on administrative databases, including those related to residential/semiresidential structures, of Veneto Region and the Local Health Unit of Bergamo in Italy (for a total of around 6 million health-assisted subjects). Between July 2011 and December 2017, all adult patients with a third antidepressant (AD) after ≥2 AD (each one with at least ≥4 weeks duration, ≥1 prescription at maximum dosage reported in datasheets, a grace period ≤30 days when switching AD and treatment maintained ≥9 months) were included. Overall and psychiatry-related healthcare resources consumption and related costs were estimated on a 12-months based analysis. Data were re-proportioned to the Italian population. RESULTS: We have previously estimated a total of 101,455 patients with TRD in Italy (130,049 considering the mean maximum dosage of AD). Of them, 44.2% had at least a psychiatric hospitalization/visit or accessed a residential/semiresidential structure, and 31% added another AD or a mood stabilizer/antipsychotic drug. Patients with at least one psychiatry-related hospitalization increased over the number of antidepressant lines from 12.0% during first line up to 24.5% during fourth line. Direct healthcare costs increased from €4,405 for first line to €9,251 from fifth line onwards. Psychiatry-related costs went from €1,817 (first line) to €4,606 (fifth line onwards) and were mainly driven by residential/semiresidential structures and hospitalizations. CONCLUSION: An upward trend with number of AD lines was observed for all healthcare resource utilization and consequently for all direct costs, thus indicating an increasing burden for patients as they move forward AD lines.

Stereotype Knowledge and Endorsement in Schizophrenia.

BACKGROUND: Social cognition is severely impaired in schizophrenia. Emotion processing, attributional biases, and theory of mind are often impaired, as well as the understanding of shared social knowledge. So far, little is known about stereotype knowledge and endorsement in schizophrenia. SAMPLING AND METHODS: White patients with schizophrenia and matched healthy respondents reported both their personal beliefs and the predicted beliefs of other people toward Black (study 1) and Gypsy individuals (study 2). RESULTS: Results showed that respondents in the clinical sample displayed less stereotype endorsement as compared to the matched healthy respondents. Most importantly, the contents of the responses provided by the 2 samples were strongly overlapped. CONCLUSIONS: Findings indicate that individuals with schizophrenia tend to hold less negative attitudes toward stigmatized outgroups and, most notably, that knowledge about culturally transmitted stereotypes is relatively preserved in schizophrenia. Future research should address the generalizability of the findings in relation to the perception of other stigmatized social groups.

Is social attention impaired in schizophrenia? Gaze, but not pointing gestures, is associated with spatial attention deficits.

OBJECTIVE: The nature of possible impairments in orienting attention to social signals in schizophrenia is controversial. The present research was aimed at addressing this issue further by comparing gaze and arrow cues. Unlike previous studies, we also included pointing gestures as social cues, with the goal of addressing whether any eventual impairment in the attentional response was specific to gaze signals or reflected a more general deficit in dealing with social stimuli. METHOD: Patients with schizophrenia or schizoaffective disorder and matched controls performed a spatial-cuing paradigm in which task-irrelevant centrally displayed gaze, pointing finger, and arrow cues oriented rightward or leftward, preceded a lateralized target requiring a simple detection response. RESULTS: Healthy controls responded faster to spatially congruent targets than to spatially incongruent targets, irrespective of cue type. In contrast, schizophrenic patients responded faster to spatially congruent targets than to spatially incongruent targets only for arrow and pointing finger cues. No cuing effect emerged for gaze cues. CONCLUSION: The results support the notion that gaze cuing is impaired in schizophrenia, and suggest that this deficit may not extend to all social cues.

Efficacy and tolerability of Hypericum extract for the treatment of mild to moderate depression.

Depression is a common condition in the community with a significant impact on affected individuals, their relatives and society. Many patients with depression do not seek treatment and are often concerned about the possible adverse effects of antidepressant drugs. Extract of Hypericum perforatum (St. John's wort) has long been recognized as a treatment for depression. Several published trials and meta-analyses have demonstrated the efficacy and tolerability of Hypericum extract for mild to moderate depression. Recent comparative trials of Hypericum extract and other antidepressants, including selective serotonin reuptake inhibitors (SSRIs), provide support for Hypericum extract efficacy. However, since the constituents of Hypericum extract differ between the individual manufacturers, the efficacy cannot be extrapolated from one extract to another. In this review, WS 5572, LI 160, WS 5570 and ZE 117 Hypericum extracts have been shown to be significantly more effective than placebo with at least similar efficacy and better tolerability compared to standard antidepressant drugs.

Ultrastructural changes of corpora cavernosa in men with erectile dysfunction and chronic renal failure.

Erectile dysfunction (ED) is a common and often distressing side effect of renal failure. Uremic men of different ages report a high variety of sexual problems, including sexual hormonal pattern alterations, reduced or loss of libido, infertility, and impotence, thereby influencing their well-being. The pathogenic mechanisms include physiologic, psychologic, and organic causes. To determine the contribution of morphologic factors to impotence we studied the ultrastructure of the corpora cavernosa in 20 patients with end-stage renal disease who were treated with chronic dialysis and compared the findings with 6 individuals with no clinical history of impotence. Our results indicated that in male uremic patients with sexual disturbances there were major changes in smooth muscle cells. This was characterized by reduction of dense bodies in the cytoplasm, thick basement membranes, and increased interstitial collagen fibers with resultant reduction of cell-to-cell contact. In addition, there was thickening and lamination of basement membranes of endothelial cells and increased accumulation of collagen between nerve fibers. These alterations were more evident in patients with longer time on dialysis and were independent of type of primary renal disease. We hypothesize that ED in dialysis patients is not related to the primary disease but to the uremic state.