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

[Hutan]

Trilobites??

You mean those diverse scavenging bottom-dwellers that eventually got overtaken by reality?

 

[Kitty]

Tri-balists, I reckon.

There's always the old-fashioned one: trick cyclists.

 

[Trish]

You mean those diverse scavenging bottom-dwellers that eventually got overtaken by reality?

Exactly. Though they are taking their time reaching extinction, unfortunately.

 

[Jonathan Edwards]

Surprisingly, it was trialist all along:

Monism, dualism, trialism, quadrialism and beyond.
Dualistic theories (dualism) defend two types of substances (for example, body and mind) or two worlds (earth and sky). Trialist theories (trialism) defend the existence of three types of substances or three types of realities.

So now we are faced with potential trialist trialists doing uncontrolled controlled trial (feasibility) trials - randomly.

Can anyone do a Venn diagram for that?

 

[Trish]

How very trying.

 

[Kitty]

Can anyone do a Venn diagram for that?

Here's a live action shot of one being made.

 

[SNT Gatchaman]

Just repeating for summary and emphasis —

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 (e.g., biased attention, fear avoidance, somatic hypervigilance, illness beliefs, alexithymia, catastrophizing, impaired self-agency, and dissociation) as core to the development or maintenance of symptoms.

Brain-mind-body interface disorders generally require the patient to be an active agent of change (treatment is not delivered passively to the patient).

And this tripe was on full display with the recent long Covid clinic report, where the patients were stratified according to their "self-efficacy" and "willingness to change".

 

[Trish]

Errghhh! Wash your mouth out!

 

[Sean]

tripe

 

[SNT Gatchaman]

All of these common clinical features clearly show there is a problem with function which is much more obvious than a subtle problem with structure. If it was the structure then the weakness would not transiently improve, the tremor would not transiently stop, and the gait would not improve.

So what are neurosurgeons doing when they resect a region of cortical dysplasia [1] that is responsible for intractable seizures. Surely, if it were the structure then the seizures would not transiently stop (or be fixed by removing the structural abnormality)?

We may at some stage need to build in an understanding of these structural changes into our models and the way we explain FND. But at the moment we simply don’t have enough data to be able to use this information in a clinically useful way.

'At some stage' looks to be now, with a move away from the term "functional" to this new term 'BMBID' — presumably as they recognise that the structural abnormality findings simply don't support the "nothing actually physically wrong, it's a software problem" explanation. Will this new term last 10 years? I'd bet against.

Neuroscientifically, structure-function relationships are closely coupled, suggesting that functional disorders are essentially also structural disorders, with the distinction being one of scale (macro vs. micro).

Structure and function are indivisible — an idea that has been in basic medical textbooks for decades. This can be anywhere from the level of gross anatomy (eg the heavy load-bearing, "single-axis" function of the knee joint vs the lighter-weight, freely rotating shoulder joint), through to the ultrastructural and biochemical levels (eg mitochondria, DNA, signalling isoforms).

---
[1] Benefits and Risks of Epilepsy Surgery in Patients With Focal Cortical Dysplasia Type 2 in the Central Region (2022, Neurology)

 

[Sean]

If it was the structure then the weakness would not transiently improve, the tremor would not transiently stop, and the gait would not improve.

One hell of an assumption/assertion.

Neuroscientifically, structure-function relationships are closely coupled, suggesting that functional disorders are essentially also structural disorders, with the distinction being one of scale (macro vs. micro).

The whole concept of functional in this framing is actually redundant.

The proof will come when we have genuinely effective treatments, not measured by modifying questionnaire response behaviour.

Structure and function are indivisible

Rhetorical sleight of hand about the word functional. It has two meanings in medicine, and they are conflating them.

 

[livinglighter]

All of these common clinical features clearly show there is a problem with function which is much more obvious than a subtle problem with structure. If it was the structure then the weakness would not transiently improve, the tremor would not transiently stop, and the gait would not improve

So what is the current medical consensus about Encephalopathy’s that are not structural? Because as it stands the term Encephalopathy describes abnormal brain functioning as well as structure.

Can transient symptoms also arise from abnormal neurological functioning of the brain?

 

[Sean]

Creating a[nother] “Brain-Mind-Body Interface Disorders” Diagnostic Category Across Specialties

The less they understand what they are dealing with, the more frequently they invent new names for it.

It is their substitute for progress.

 

[Ash]

Creating a[nother] “Brain-Mind-Body Interface Disorders” Diagnostic Category Across Specialties

The less they understand what they are dealing with, the more frequently they invent new names for it.

It is their substitute for progress.