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Are Functional (Psychogenic Nonepileptic) Seizures the Sole Expression of Psychological Processes?, 2021, Sojka, Paredes-Echeverri and Perez

Discussion in 'Other psychosomatic news and research' started by Andy, Mar 27, 2021.

  1. Andy

    Andy Committee Member

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    Abstract
    Functional [psychogenic nonepileptic/dissociative] seizures (FND-seiz) and related functional neurological disorder subtypes were of immense interest to early founders of modern-day neurology and psychiatry. Unfortunately, the divide that occurred between the both specialties throughout the mid-twentieth century placed FND-seiz at the borderland between the two disciplines. In the process, a false Cartesian dualism emerged that labeled psychiatric conditions as impairments of the mind and neurological conditions as disturbances in structural neuroanatomy. Excitingly, modern-day neuropsychiatric perspectives now consider neurologic and psychiatric conditions as disorders of both brain and mind.

    In this article, we aim to integrate neurologic and psychiatric perspectives in the conceptual framing of FND-seiz. In doing so, we explore emerging relationships between symptoms, neuropsychological constructs, brain networks, and neuroendocrine/autonomic biomarkers of disease. Evidence suggests that the neuropsychological constructs of emotion processing, attention, interoception, and self-agency are important in the pathophysiology of FND-seiz. Furthermore, FND-seiz is a multi-network brain disorder, with evidence supporting roles for disturbances within and across the salience, limbic, attentional, multimodal integration, and sensorimotor networks. Risk factors, including the magnitude of previously experienced adverse life events, relate to individual differences in network architecture and neuroendocrine profiles.

    The time has come to use an integrated neuropsychiatric approach that embraces the closely intertwined relationship between physical health and mental health to conceptualize FND-seiz and related functional neurological disorder subtypes.

    Paywall, https://link.springer.com/chapter/10.1007/7854_2021_225
     
  2. Snowdrop

    Snowdrop Senior Member (Voting Rights)

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    One might then legitimately ask why this 'integrated' approach that embraces both the physical and mental components of illness always ONLY deals with these from a psychological perspective and not a physical or even social (as in outside the person's ability to influence) perspective. Or is this a parting of the ways from BPS in order to seems more scientific (I can't really tell)

    This cartesian dualism idea desperately needs addressing. How does one imagine that mind and brain aren't linked or that brain and body are not? Nobady is saying they areen't. This seems like a distraction to me. The question is really one of practicality. How are people to be healed? All the rest is pontification by eminence and seems to obscure more than clarify.

    How does this 'integrated' model explain how healing effectively takes place? It seems as though this part isn't the focus, it's really tertiary to the fact that making tighter and tighter arguments for how the 'integrated' model works will help keep psychiatry in the loop. And in the end THAT'S what matters.

    D.L.P. was funded by the Sidney R. Baer Jr. Foundation and the Massachusetts General Hospital Career Development Award.

    The closest I can get to anyone responsible for funding this is:

    https://vpr.harvard.edu/people/autumn-bennet

    which doesn't name the committee
     
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  3. rvallee

    rvallee Senior Member (Voting Rights)

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    Is there no one concerned about the crippling selective amnesia people working in this field are clearly suffering from? It's considered normal to be completely unaware of, well, reality itself. Or the rank dishonesty behind such statements, which clearly mean "let's focus exclusively on the psychological". Everyone knows this is what it means. No one is confused that the relationship is assumed to be strictly unidirectional and no one pays any attention to the other way around.

    Such a sentence has been written probably hundreds of times dating back over a century. In many instances probably nearly verbatim. It's seriously like the dog in Pixar's Up, but instead of SQUIRREL! it's MIND-BODY!, or whatever.
     
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  4. Woolie

    Woolie Senior Member

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    Oh, yes, everything has a psychological component. I suggest we ensure that any patient admitted to hospital for neurological problems has done the necessary amount of therapy and self-examination before they come crying to the medics.

    Those people going into comas, look deep inside yourself and ask yourself why you so dearly wish to avoid reality.

    Ah, but some people just don't want to get better, do they?
    No, they don't. "Neurologic" disorders are disorders of the brain that impact on our thoughts, feelings and cognitive functions. There is virtually unanimous agreement that they are NOT disorders of the mind. They don't happen because you have the wrong thoughts, behaviours and feelings, and you can't make them better by changing any of those things. "Psychiatric" disorders are still a matter of debate, but I think very few experts today would consider schizophrenia or biploar to be disorders of the mind. They are disorders that affect brain function. You can't think, behave, and/or emote your way into them, and you can't think, behave or emote your way out of them.
    These are NOT neuropsychological constructs. These are psychological constructs. Neuropsychological constructs describe the types of cognitive, affective and behavioral problems that can occur following neurological dysfucntion. e.g., mild cognitive impairment, frontal dysexecutive syndrome, retrograde amnesia, pure alexia (an acquired reading disorder), prosopagnosia (face recognition disorder). FFS, my first year Psyc students can get THIS right.
    Just no, there is no such evidence. Nobody has really bothered to examine what causes these kinds of seizures. All they've done is tried to find support for half-baked neo-Freudian or other types of underspecified psychological theories.[/quote]
    No, this is what we're already doing. The time has come to put the Freud books away, and for doctors to stop using psychology as their bitch every time they can't explain something.
     
  5. Amw66

    Amw66 Senior Member (Voting Rights)

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    One of the kids in a private facebook group.i am in, suffers from.these kinds of seizures.

    Brother has ME , you can draw your own conclusions as to how " consults" go

    Be aware, this is a growth area
     
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  6. dave30th

    dave30th Senior Member (Voting Rights)

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    I can't access a copy of this through Berkeley, for some reason. What I don't understand about all this is why then they do huge studies just of CBT for psychogenic non-epileptic seizures? If they think things are so integrated, where are their integrative treatment approaches? These are pure psych approaches. So it seems to me they are the ones reinforcing the purported Cartesian dualism they complain about.

    They have focused on this hardware/software distinction. Now they acknowledge structural brain changes as well, but they assume it's a downsteam impact of the FND rather than a cause. It's all just assumptions. It seems easy to believe some form of physical rehab could help many people with functional movement disorders to retrain body parts--much. more so than CBT.
     
    Last edited: Mar 28, 2021
  7. Woolie

    Woolie Senior Member

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    Absolutely, @Snowdrop.
    I think Psychiatry is in a deep crisis, with a huge chasm between those who are embracing biological psychiatry, and those that still want to be talking therapists. The turf of psychiatry is constantly threatened on both sides. On the talk therapy side, psychologists threaten to offer more practical talking therapies for less money. On the biological side, each new discovery of a neurological/biological basis for a "psychiatric" disease, moves it out of the domain of psychiatry and into the domain of neurology (e.g., MS, dementia).

    I don't know why so many neurologists have suddenly become interested in expanding their specialty to the psychological (e.g., Jon Stone, Alan Carson). Perhaps they feel powerless most of the time as neurologists, and are seduced by the idea that they might be able to "fix" FND. Or just genuinely bothered by the general dismissal of a huge sector of patients. Or perhaps its the Simon Wessely phenomenon - they really wanted to be historians, or philosophers, but their families pushed them into a more viable profession, So they're looking for the space within their profession where they can speculate, argue and proclaim.
     
    Last edited: Mar 28, 2021
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  8. Sean

    Sean Moderator Staff Member

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    Exactly.
     
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  9. Woolie

    Woolie Senior Member

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    I just read the whole thing and I feel dirty.

    There is a whopping big table with a shopping list of all the "predisposing", "precipitating" and "perpetuating" factors that have been associated with these unexplained seizures. Everything is there, from panic attacks and migraines to childhood trauma, difficulty recognising emotions, insecure attachment, and personality disorders!! But instead of saying "hey, look, some of these findings are incompatible with one another, and there are so many, they can't be correct at the same time, this stuff needs careful reexamination", they assume its all true. Everyone wins a prize!!

    everybody_has_won_and_all_must_have_prizes_postcard-p239537397709421510trdg_400.jpg

    Some stunningly circular reasoning. Like this:

    Childhood adversity etc:
    * Measures of childhood and adult adversity are positively associated with the risk of these unexplained seizures (and with the risk ofr all chronic illnesses, but they don't mention that). So its psychological!
    * Only a subset have such a background factors.
    * But let's not be bothered by annoying details - we'll just say there's a "trauma-related subtype".

    Head injury:
    * In many cases of unexplained seizures follow a head injury
    * But that's not because a head injury damages your brain, oh no, its because of the psychological trauma of the accident!

    Preserve the dodo way of life!!

    Neuroimaging:
    * A complete smorgasbord of reverse inferencing#, with almost every possible abnormality reported at least once, little consistency between studies, many findings being secondary effects (that is, they didn't apply to the whole group but only one subtype, or are not associated with the seizures per se, but to another feature believed to be associated with seizures) - and all interpreted within a psychological framework!

    These people see data not as a source of information, but as a way of supporting what you already think is true.

    (# the reverse inference problem in functional neuroimaging is falsely concluding that because you know what part of the brain got activated, you can infer what cognitive/psychological contribution it was making. You can't!)
     
  10. Sean

    Sean Moderator Staff Member

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    The triumph of linguistic and statistical sophistry.

    The deafening silence from the rest of medicine is worrying. Do they really not know what is going on here?
     
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  11. Sid

    Sid Senior Member (Voting Rights)

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    Any article that mentions the three p's is BPS. No one else formulates a diagnosis in this way, not even psychiatry.
     
  12. Woolie

    Woolie Senior Member

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    Yes, they admit as much.
     
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  13. Sid

    Sid Senior Member (Voting Rights)

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    I've been wondering about this too. Maybe they saw how successful SW and Crawley's approach to career-building has been. If these people had gone into internal medicine or something, they would have been a nothing nobody that no one's ever heard of. But by spotting a niche very early on - a highly stigmatised field that no one else wants to touch with a bargepole - there is immense opportunity to quickly rise to the top by publishing what the govt and insurance companies want to hear. There is very little competition in MUS and what few people work in that field are not even mediocre intellectually, they are literally bottom of the barrel.
     
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  14. Amw66

    Amw66 Senior Member (Voting Rights)

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    ££££
     
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  15. Mithriel

    Mithriel Senior Member (Voting Rights)

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    Remember, Jon Stone's paper on FND in 2008 was written in collaboration with Michael Sharpe when they were both at Edinburgh University.
     
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  16. Snowdrop

    Snowdrop Senior Member (Voting Rights)

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    Also just woke up enough to notice the other funder of this uh explanation of a belief system.

    http://www.baerfoundation.com/

    I understand why they might fund something to do with epileptic seizures but why this?
    It will benefit no-one except the researchers careers / pockets. that seems a very poor return on knowledge investment.

    Again, I think it shows how the ideas of mind / body / brain are getting big fancy philosophical concepts very definitely meant to obfuscate rather than clarify any understanding.

    It would seem to be something that requires the curtain be drawn back to expose the pompous pretense in this 'new and improved' BPS concept.
     

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