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Opinion Creating a “Brain-Mind-Body Interface Disorders” Diagnostic Category Across Specialties 2023 Maggio, Adams and Perez

Discussion in 'Psychosomatic research - ME/CFS and Long Covid' started by Andy, Oct 19, 2023.

  1. Andy

    Andy Committee Member

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    The COVID-19 pandemic taught us many lessons, including the interconnection between physical and mental health. This observation is not new, however; the intersection of physical and mental health is discussed in early medical writings. At the origins of modern-day psychiatry and neurology, there was great interest in the condition now called functional neurological disorder (FND) (1, 2). Nonetheless, FND has a complex history, including its evolution from “hysteria” to “conversion” to “psychogenic illness” to “FND”; unfortunately, the condition is also stigmatized and erroneously confused with malingering (3). The recognition that FND is common, an emphasis on a rule-in diagnosis, an improved understanding of mechanisms and etiologies, and an expanding therapeutic toolkit have revitalized the field of FND (4). However, disagreements remain, such as the multiplicity of terms used for the seizure subtype of FND (e.g., psychogenic nonepileptic vs. functional vs. dissociative vs. nonepileptic attacks) (5); to unambiguously connect all functional neurological subtypes to FND, we support use of the term “functional seizures.”

    In other specialties, similar transformations have moved away from “medically unexplained” framings. Although certain disciplines have used the qualifier “functional” and this term is well received by some patients and advocacy groups, challenges to a “functional disorders” diagnostic category remain (6). The term “functional gastrointestinal disorders” was changed to “disorders of gut-brain interaction,” in part because “functional” was thought to be too nonspecific (7). The somatic symptom disorder diagnosis has received mixed reviews, and competing terms, such as bodily distress disorders, have arisen (8). These developments have weakened the DSM-5’s “Somatic Symptom and Related Disorders” category. In parallel, the medical literature has codified functional somatic syndromes (e.g., fibromyalgia) with their own diagnostic criteria. Some conditions have been reframed to potentially distance them from a biopsychosocial-informed therapeutic framework (e.g., myalgic encephalomyelitis or chronic fatigue syndrome); conversely, there have been calls to reconceptualize persistent symptoms after traumatic brain injury (also known as postconcussive symptoms or postconcussion syndrome) as an “interface disorder of neurology, psychiatry, and psychology” (9).

    Here, we make the case for a “brain-mind-body interface disorders” diagnostic category spanning medical specialties; this category represents conditions with physical symptoms where there is likely a therapeutic benefit to factor in psychological processes.

    Open access, https://neuro.psychiatryonline.org/doi/10.1176/appi.neuropsych.20230071
     
  2. Trish

    Trish Moderator Staff Member

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    Oh how exciting, another stupid naming category dustbin for us to be thrown in. :banghead:
     
  3. Kitty

    Kitty Senior Member (Voting Rights)

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    It's funny how people with no medical training assume that a brain-mind-body interface is pretty much a given in anybody who's alive, isn't it.
     
  4. rvallee

    rvallee Senior Member (Voting Rights)

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    Well that is a meandering word salad of old tropes trying to justify the same old debunked nonsense yet again. They're just juggling words but equating them right away anyway. It's a level of twisting the facts to bend to their expectations similar to flat earthers and other types of quackery.

    They're not even trying to make sense either. It's just a jumble of all the old tropes that is open and frank that all this is yet another relabeling, which indicates they have pretty much run out of labels and excuses, but are willing to still go at it anyway. In an ironic twist, similar to what is happening with the pandemic: the masks are off. And the smiles behind them as just creepy and obviously insincere.

    Even the opening sentence is just mindless nonsense. If anything, it has taught the opposite, that viruses and the immune system play the main role in everything mislabeled as mental health, but as they demonstrate here, quacks will always hold on to their beliefs, no matter how thoroughly they are debunked. They can actually manage to make a pandemic the reason for something while completely ignoring the role of the virus. Just plain absurd.

    It explains so much about how superstitions have taken hold throughout history, and how it has nothing at all to do with intelligence. Superstitious nonsense is always presented as a thing of the "common folk", simple uneducated people who don't know any better. Oddly enough, this completely debunks it.

    In a way this is a sort of last gasp of the ancient ways, of models built on beliefs and enforced onto vulnerable people through abuse of power. It's just especially absurd that of all places, it's happening in medicine, and stronger than at any point in history. What a time to be alive.
     
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  5. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    Seems a really nice idea. Re-do International Classification of Diseases -11 as.

    ICD-11

    1.
    ........1.1
    .............1.1.1: brain-mind-body interface disorders

    That's the lot!!
     
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  6. Hoopoe

    Hoopoe Senior Member (Voting Rights)

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    So where is the evidence that any of these illness are due to some defect in the interface between mind, brain, body? Can the authors even define clearly what they mean with this?
     
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  7. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    It is called the neck.
     
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  8. Kitty

    Kitty Senior Member (Voting Rights)

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    I always wondered why the glands under my jaw swell up when the PEM hits. They must be interfacing too hard.
     
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  9. Creekside

    Creekside Senior Member (Voting Rights)

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    Hey, don't bring clear definitions into psychiatry. Psychiatry seems to be defined as an avoidance of clear definitions and quantifiable measurements.

    I've been a bit uplifted lately by recent stories of finding actual links between mental disorders and actual biological causes: specific parts of the brain activating, glial dysfunction, specific viruses or bacteria. Yesterday was a story about OCD being linked to a specific part of the brain. I see all that as progress towards an alternative to psychiatry, based on quantifiable factors. Instead of talking about childhood trauma or job stress and getting a prescription for useless antidepressants, you might get a brain scan and a prescription for supplemental fatty acids and some cofactors which actually fix the problem.
     
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  10. Hutan

    Hutan Moderator Staff Member

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    Sounds like a recipe for the physician never being wrong, and providing scope for prejudices to run unrestrained. 'Sure, that person recovered with biomedical treatment, but that doesn't mean that psychological therapy isn't the right treatment for someone else with the same disease.'

    Bad luck, people with a fibromyalgia diagnosis, seems that you get tipped into the 'psychological therapy will certainly fix you' bucket no matter how unhysterical you come across. But for someone with chronic fatigue syndrome, it seems to depend on how the person presents, or the whim of the doctor, or something.


    [​IMG]

    Figure 1

    Also looks like happy days for employers of people who get multiple head traumas in the course of their work e.g. contact sports players. Seems that, just in the way that cigarette companies argued that personality caused cancer, the employers and the associated insurance companies can argue that a faulty brain-mind-body interface is what caused the persisting symptoms, not the repeated concussions.

    This is what the fine minds at Harvard Medical School are producing.

    But, just from a marketing angle, I think 'Brain-Mind-Body Interface Disorder' is unlikely to catch on. It's too long and hasn't got a clever acronym, and what it is suggesting is all too clear. The beauty of 'functional' is that it could mean anything.
     
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  11. Michelle

    Michelle Senior Member (Voting Rights)

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    Isn't the brain, you know, sorta, kinda part of the body? Do they think if they throw in/separate the brain from the body it sounds, somehow, more scientific? o_O
     
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  12. rvallee

    rvallee Senior Member (Voting Rights)

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    Just arbitrary boxes (OK, fine, circles) and labels to suit their fancy. The only difference with the same stuff from the 19th century is a few label changes and that it was hand-drawn back then.

    I made an improved version of their diagram:
     
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  13. rvallee

    rvallee Senior Member (Voting Rights)

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    At this point I think the only non-delusional way of putting it is that the interface is what's neither mind nor body, and where everything is happening. Or whatever, it's not as if this is supposed to be a real explanation. It makes about as much sense as saying "I'm not saying it's ghosts, I would never say such a silly thing. It's ghosts of ghosts, obviously. Now that is serious and real".

    Not dualists, though. You're the dualist.
     
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  14. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    They can't be dualists but what is the right word?

    Trialists?
    Ternalists?
    Trinitists?
    Three-ists?
    Triangulists?
     
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  15. Trish

    Trish Moderator Staff Member

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    Trilobites??
     
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  16. Andy

    Andy Committee Member

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    Tribbles?
     
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  17. Trish

    Trish Moderator Staff Member

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    Tri-psyciatrists
     
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  18. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    Or triplets
     
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  19. rvallee

    rvallee Senior Member (Voting Rights)

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    Wait, they probably worked "very hard" on this so I feel I should be more respectful of that effort.

    Here's a better version:
     
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  20. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

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