- To Change Your Mind - Details Matter
Brain Measures – The New Psychiatric Standard
Intermittent Explosive Disorder Insights
November 23, 2014Transitions: Thinking And Doing
December 28, 2014New Brain Measures: Technology Improves Mind Targets
… come to think of it, you can't get there from here.
Burt and I: Which way to Millinocket?
But This Old Brain Bus Won't Take You There
A Pervasive Mind Problem: Ask yourself this important question: “Why do so many fear/disdain psychiatric treatment and psychiatric medications?”
This Bus Won't Take You There
In A Word – Unpredictability: The standards for the use of psychiatric medications are based upon appearances, descriptions, and speculation encouraged by the recently “updated” DSM-5 Diagnostic Manual. Brain measures, neuroscience, hard biomedical data, real brain evidence, grows daily, but remains outside of the medical standard of care. However, real mind challenges do exist in measurable realities, beyond the current DSM-5 Diagnostic Manual, beyond current outdated diagnostic frameworks based upon impressions instead of data.
But those contemporary mind realities aren't found in the extant diagnostic bible. Beliefs and dogma now outweigh fresh perceptions.
Overlooked: The complexity of functional biologically-based brain and body measurements. Our collective humanity lives in a complexity of coping with real life beyond standardized label-beliefs and orthodox dogma. That new, measurable cellular and subcellular set of variables includes Brain Function, Metabolic Challenges, Change, Cognition, Context and Working Memory.
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Galileo Would Understand
Remember Galileo: Even today many hesitate to trust new discoveries. Today it's not about revising the Geocentric Universe, the Sun rotating around Rome, it's about the Diagnostic Manual and fresh metaphoric telescopes that provide real laboratory data for more street smart, more universal, more interesting, more precise applications. Our current system of mind care is, as Dr Edward de Bono notes, “Excellent, but not enough.”
Enter Critical Thinking
Too often those accepted appearance criteria contradict the complexity of contemporary mind-science. Missing today: Critical Thinking – see this list of those actively considering the evolution of scientific thought, especially as related to new mind evidence. From Galileo to Walsh, critical thinking remains involved with new perceptions, new discoveries, from neuroscience. Our current understandings of biologic mind complexity today stretch far beyond those early days of dreams and fantasies in the mid 20th century. Yes, we're still using those outdated criteria, while coincidentally ignoring hard laboratory data – from functional brain imaging to epigenetics and the subcellular activities of transporter proteins on presynaptic neurons.
Clarifying diagnostic mind targets simultaneously improves treatment protocols. If the sun isn't rotating around the earth, then let's use measurement technology to understand exactly what is happening in that outdated universe of mind speculation.
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Science, Reality and Cognition
Old beliefs about causality, diagnosis, and how to correct mind imbalances now need serious revision. An additional exemplary, glaring psychiatric oversight: two remarkably significant mind challenges, Reality and Cognition, appear to have almost completely escaped the attempted recent corrections in the “revised” DSM-5 psychiatric diagnostic manual.
It's important to note that the way humans cognitively deal with changing reality does improve our circumstances for safety and endurance among other species. Each individual's relationship with change, from thinking about change to reacting to change, is what sets us apart both as individuals and as a species – but remains almost completely overlooked in 2014.
Cows, Brain Measures And Executive Function
When you read “Executive Function” think: Self Management. Self management is a process over time, not a static label with rampant categorical implications.
Humans are different from cows. Cows live with nearly non-existent executive function. When it rains they simply continue to stand in the field and munch grass. You and I would go inside. Reality, context, does change in the lives of cows, but they don't adjust to that change. Our brain, our executive function tool, lodged mostly in the prefrontal cortex, regularly cognitively identifies then adjusts to each changing reality, and makes helpful adjustments to our ever-changing circumstances in life.
Consider: If we humans need executive function tools for everything from corporate leadership to marital bliss why is executive function so dramatically neglected in contemporary psychiatry?
New mind science, neuroscience evidence, changes thinking.
Increasingly both professionals and the public can easily see the limitations of using only psychopharmacology and outdated appearance diagnoses for the complexity of mind challenges. Medications provide excellent answers for many, but too often dysfunctional mind activities stream on beyond the range of cut and paste medications answers.
The complexity of human life exists as separate perceptions in the lives of every human being, and disdains homogenized solutions. Psychiatric interventions require far more customization, less managed-care commoditization, and far more neuroscience-based medical precision. Without attention to those imperative details we can expect to continue the dark ages before data, before Galileo and informed telescopic interventions.
ADHD & Executive Function – Low Hanging Fruit
Nowhere in psychiatry are these several medical perplexities more fully realized than in the diagnosis and treatment of “ADHD,” only a small tip of the significantly larger Executive Function Iceberg. Nowhere in psychiatry is there more public outcry, medical confusion, labeling consternation and medication imprecision than in the current vagaries of ADHD diagnosis and treatment. Brain measures remain remarkably absent.
The current labeling system is logical, reasonable and often useful for short periods, however it, more frequently than not, disregards the peer-reviewed perceptions of modern brain science associated with informed self management over time. Drifting in the North Atlantic some ADHD icebergs are recognizable from the surface, but the real, the brain functional challenges float beneath the surface as manifest Executive Function Challenges.
Too often ADHD, when fully perceived at it's depths below the surface, is actually Attention Abundance Disorder, the paradoxical opposite of Deficit. The actual functional/processing/reality problem: Abundance. The default/reductionistic/inadequate label: Deficit.
…90% of errors in thinking aren't errors of thinking, but rather errors of perception.
Edward de Bono
Implications For Psychiatric Diagnosis And Treatment
These ADHD superficial assessments, unencumbered by real data, by underlying brain and body function connected to contemporary neuroscience, encourage everyone to continue to effortlessly speculate about both diagnosis and treatment for a number of other mind conditions as well – including depression, anxiety, bipolar, and PTSD. Without science everyone from your family practitioner, to cotton farmers in Possum Hollow become, by default of whimsy, board certified in psychiatry.
If interested in even more excellent information regarding Epigenetic change and Dr William Walsh Connect At This Link.
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ADHD Video Examples For Clinical Brain Measures
As an example, to show how to use brain science to create common sense solutions I've created this playlist that addresses measurable functional variables for assessing and treating ADHD. When you run though these videos notice how simple it is to connect the recognizable functional dots, beyond the veneer of description.
Wend your way through this playlist to see how easily Executive Function Challenges can play out in everyday life: 49 min for the entire list, but you can select specific topics by opening this one up in YouTube 💡 !
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For More On Dr Bill Walsh & Methylation Measures
A four page PDF Summary of his Nutrient Power and Epigenetic challenges that directly change brain function:
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For CorePsych Updates
If interested in more information on applied mind data connect here: http://corepsych.com/connect
Be well, and please consider leaving a comment below…
cp
Dr Charles Parker
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20 Comments
[…] metacognition […]
The American Psychiatric Association highlighted micronutrients as an effective treatment for mental illness this month. My own doctor recommended Hardy Nutritonal’s Daily Essential Nutrients (an affordable micronutrient supplement) YEARS ago, and I have been successful and med-free ever since. It’s great to see the medical professional industry rally behind a natural supplement for mental wellbeing.
You can read more about the practical use of micronutrients in this news article: bit.ly/1KThKCN or on this popular natural health blog: http://www.getbalancednaturally.com/psychiatry/ As someone who both uses Daily Essential Nutrients and works in the medical industry, I personally believe we should strive to get the word out about viable, affordable, natural treatments like this.
Wilfred,
Excellent point – yes the APA this year has taken a very different direction, one in agreement with what I have proposed on these pages for the last 9 years.
cp
Just wanted to raise a question in relation to Bipolar Disorder. Is Lithium the best medication (I have read many articles that it is neuroprotective)?
For a typical patient with ADHD and Bipolar Illness which medication cocktail usually works best: Effexor + Vyvanse + (which Bipolar Meds) as I do not want to block 2D6. I appreciate that there is no hard and fast combination of medications that can be applied to all.
I am also exploring any and all metabolic tests to help treatment efficiency.
Thanks
Mario,
You are clearly on the right track in your deeper considerations. Bipolar can arise from many metabolic challenges. With a deep appreciation of that built in complexity I do stay away from suggestions without data. I’ve seen a girl completely psychotic and mood disordered who suffered with milk/casein allergies who is now off meds altogether following, among other data points, that correct assessment. Stay with the concept of digging deeper.
cp
Dr Parker,
I have a further couple of points here. While I do understand what you are saying with your idea of “attention abundance”- that is only true for some of the time.
Inattentive symptoms are often accompanied by symptoms of drowsiness, and in fact regulation of alertness is an enormous issue in ADHD.
I note that Dr Thomas E Brown lists issues with regulation of alertness and processing speed as one of the 6 main groups of executive functions that he chooses to discuss in the context of ADHD.
Those drowsy states hardly have an abundance of attention!
I note that recent analyses suggest that the majority of our decisions and actions are driven by subconscious responses to information perceived- and that largely that information is sorted for relevance by the emotional tone attached to our perception. IE A signal percieved as threatening will automatically draw our attention.
Most of my hyperactive ADHD patients are effectively in a chronic stress state- sympathetic dominance, and that stress state drives people to be over busy,to overload, to be hypervigilant and to be chasing every little piece of information for relevance- desperately trying to identify the source of the stress. Much of the “attention abundance, in my opinion, is driven by that dynamic.
Equally, I often see pale and lethargic ADHD patients who are mentally quite dull at the time and am seeing those states more and more as being either exhaustion due to the chronic stress state – or a low level physiological “freeze” state.
I think there are a number of problems with our classification of “mental” disorders.
Firstly as you rightly say we ignore body – brain feedback and ignore the “felt sense ” of our experience.
Secondly- behaviours are outputs and the same behaviours can be driven by multiple different causal loops.
The idea of dysfunctional attention in the ADHD label is of great value though as stable attention is required for new learning and for neuroplastic growth of new synaptic pathways. All the BDNF in the world will be of no value without that combination of novel task, repetition, sufficient arousal and stable attention.
I would argue that no matter what the cause, that unstable attention will always create a feedback loop that traps the individual in that instability so that ADHD does become a solid entity by virtue of the facts that its symptoms generate the causes of more attentional instability.
Dr Kinsella,
We agree on every point here. My main reason for emphasis on the abundance side of these matters is that I see it as the most frequently overlooked subset… and even with those who appear dull or listless they do, more often than not, experience a sense of mental overload. As you point out, in referencing Dr Brown, that overload does appear to arise from maladaptive, PFC related, processing speed problems. I also agree with your points about sympathetic over activity in some. The autonomic dysregulation, be it para or straight sympathetic is both measurable and correctable.
I do hope you take a look at http://corepsych.com/walsh-resources, as it looks like you will appreciate his interesting and useful additional, very useful, measurements on the pyrrole and methylation side of these matters.
Thanks for weighing in,
cp
Hi Charles,
I agree with you regarding the failure of the psychiatric profession to consider the brain and executive “functions”.
Regardless of what we think about the material or non material nature of mind- psychiatric disorders are defined by measurable behaviours – and the generation of behaviour (through movements and actions performed or inhibited) is the domain of the brain.
I do question though the terminology “executive functions”- as it is clear that much of what we call “executive functions” are, in fact trainable and therefore should be better understood as “executive skills”.
Certainly, when I teach my patents meditation I am teaching them specifically the skills of developing stable and vivid attention,the capacity to step away from uncontrollable overthinking, emotional awareness and reduction of emotional reactivity, and the capacity to develop more empathic and prosocial behaviours.
Much of this comes down to establishing stable and effective habits- and the establishment of habits does require good function in the basal ganglia. I note with interest the discussions that are suggesting that gluten is a neurotoxin that specifically affects basal ganglia, and one that can cross the blood brain barrier in the inflammatory states associated with chronic stress.
Dr Kinsella,
Excellent points, agree with your perspective and clarification. Both hard & softer forms of Executive Dysfunction can find support and helpful correction with meditation. My concerns here especially address the often overlooked hard forms, more serious refractory dysfunctions that simply don’t respond, even to reasonable medical interventions. That denial is pervasive.
I appreciate the term and measurable process of executive function, even though it can embrace even more cognitive challenges, simply because ADHD, an obvious executive dysfunction, has so many more subtle and often missed presentations because of the ADHD standard relying on appearances, vs function.
cp
Thanks Charles,
I think that the dietary side is somewhat neglected overall.
I would observe that from my own perspective the combination of sitting meditation, rhythm meditation and movement meditation has radically reduced my own need for medication- so that now if I get enough sleep and exercise I may go a week without needing any.
While as a patient and medical practitioner I value medication, I do think that we do best to minimise our need for it.
One area that is clearly coming up with many of my patients is orthostatic intolerance- causing relative cerebral ischaemia when sitting (and a secondary stress response.These two dynamics in themselves can generate inattentive, hyperactive and impulsive symptoms classic of ADHD.
In one of these cases (still under investigation) the driving mechanims appears to be a food allergy-(still under investigation) that is causing peripheral vasodilation and depriving his core of available blood volume.
I have seen a few people arguing that ADHD may be driven by a functional dysautonomia- and that certainly makes sense to me.
Dr Kinsella,
Yes, it’s clear in the literature that IgG – Immunity issues can directly effect brain function – even creating ataxia. It will be interesting to see what you turn up.
cp
[…] Consider: transitions, changes in perspective, drive the evolution of your self management, of your personal reality. Transitions result in either transformation or denial. Reality does change, and we either grow in that new reality or wither in concrete preconceptions. […]
What is your take on Personality Disorders? Are they merely descriptive of people who merely suffer comorbidly from depression, bipolarity and executive dysfunction?
Massimo,
Interesting question as it mixes apples with apples, not with the underlying physiology of the tree. Said another way: personality disorders are called that because they appear free from underlying conflict. That’s because for many years we’ve used only conflict to mark our troubles. With the new technology we don’t have to go to the unconscious [been there] to find the underlying cause, but can find causality in the same neurophysiological challenges that give rise to depression and more easily observable, more identifiable mind imbalances.
New technologies take us into a significantly improved and different assessment landscape – thus this posting. Mind conditions do connect on deeper levels, but one must do the testing to find the specifics.
See videos and explanations here: http://corepsych.com/tests14
cp
I love the Walsh theory of Depression – Undermethylation, Overmethylation, Copper toxicity etc.
However has he not missed the whole immunity issue – the immune system and cytokines play a massive role in Depression – ie Type 1 Diabetics have hugely increased Depressive illness in part due to the overlap of Cytokines rather than Under/Over methylation.
Also chronically elevated Cortisol is not mentioned by Walsh – I see you have picked up on this in the form of Adrenal Fatigue.
Another point I wanted to ask is Antidepressants get a bad wrap and are viewed as only effecting the Monoamines (serotonin and norepinephrine) when they also can positively assist in rebalancing the immune response and HPA axis?
Kudos on all your brilliant articles – loved the book, is book number 2 in production?
Alan,
Many thanks, insightful questions. Bill Walsh is onto those multiple complexities, but does try to remain focused on the Nutrient Power mission, a landscape with sufficient complexity to daunt even the most ardent mind travelers. I’m sure you will hear more from him as time passes, and can find some video remarks by a close associate of his by searching here at CorePsych: Copper, Dr Bowman & Estrogen.
Antidepressants do encourage a number of other positive activities – such as with BDNF – but not in the direct, clinically responsive way, that these nutrient insights can.
I’m thinking hard about my next steps, and a book is mulling around, but I do enjoy working with patients so much it’s hard to break away.
Thanks very much for your kind remarks!
cp
Fabulous article.
CorePsych articles and the new ADHD Medication Rules have become like a Bible to me. I can re-read and continue to get greater understanding. And in the same Biblical metaphor: New knowledge led me to solutions I could put into action to feel better. Now, like a disciple, I want to spread the good news!
There have been big gaps getting the science to patients. The beauty of The New ADHD Medication rules is the emphasis on empowering the patient. The more the patient learns, the smaller the gap between science and patient understanding.
As a professional working without scans and blood test results, The New ADHD Medication Rules challenges me to look at the science and the corresponding clinical symptoms to develop reliable questions for the patients to ask of themselves, the data collectors of their own signs and symptoms.
When patients document and communicate their symptoms, they bring the science to the practitioner – they are now, in a sense “lab partners, working on a hypothesis, arranging puzzle pieces into a picture that makes more sense.
Dr Battinelli,
You’re very kind to write this, – much appreciated. You did catch the serious theme in New Rules: with improved, scientifically based, information both patient and doctor are more likely to connect in productive ways, diminish side effects and encourage improved outcomes.
Thanks for your support out here, it takes a village. Teamwork matters. Participatory medicine is the way forward for all of us.
Best to you and yours for the Holidays!
cp
Why do people fear Psych meds? I agree with your ‘unpredictable’ premise. In addition, There has rarely, if ever, been a cure for any major psychiatric condition. At best, symptoms are controlled and, as stated above, unpredictably. Psychiatric disorders are not akin to a bad infection that can be fully cured by antibiotics.
A challenge for the professional community. A nightmare for those who suffer.
Saipan,
Thanks for your comments. One additional point: The closer were come to the underlying causes for the symptoms we treat as “psychiatric,” the closer we do come to a cure. I’m pleased to report that as my experience grows, simply using these tests – http://corepsych.com/tests14 – I’ve repeatedly seen individuals dramatically decrease their need to psychiatric medications, because the underlying conditions were corrected.
It does take time, and patient perseverance, but it’s increasingly possible to correct underlying causes when measured accurately.
cp