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      Functional Neurologic Disorders, disorders to be managed by neurologists, or are neurologists wandering in a dangerous field with inadequate resources?

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          Abstract

          In recent years, some neurologists reconsidered their approach to Medically Unexplained Symptoms and proposed Functional Neurologic Disorders (FND) as a new entity, claiming that neurology could offer alternative treatment options to the psychotherapies provided in psychiatry settings. FNDs, for this purpose, should include only the disorders listed as Conversion from the Somatic Symptom and Related Disorders (SSRD) group. The present review analyzes the rationale of this position and challenges the arguments provided for its support. The review also discusses the systematization of these disorders as provided by public health systems. It outlines risks stemming from economic support and public funding uncertainty, given their negligible epidemiological dimensions resulting from the parcellation of SSRD. The review underlines the unresolved issue of Factitious Disorders, which are in the same SSRD category of the international classification but are, nonetheless, overlooked by the theoretical proponents of the FND entity. Comorbidity with other psychiatric disorders is also analyzed. We propose a model that supports the continuum between different SSRD conditions, including Factitious Disorders. The model is based on the emergence of feigned death reflex and deception from frontal lobe dysfunction. Finally, the paper summarizes the wealth of historical psychiatric and psychodynamic approaches and critical reviews. The study also puts in context the categorization and interpretation efforts provided by the most eminent researchers of the past century.

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          Complex brain networks: graph theoretical analysis of structural and functional systems.

          Recent developments in the quantitative analysis of complex networks, based largely on graph theory, have been rapidly translated to studies of brain network organization. The brain's structural and functional systems have features of complex networks--such as small-world topology, highly connected hubs and modularity--both at the whole-brain scale of human neuroimaging and at a cellular scale in non-human animals. In this article, we review studies investigating complex brain networks in diverse experimental modalities (including structural and functional MRI, diffusion tensor imaging, magnetoencephalography and electroencephalography in humans) and provide an accessible introduction to the basic principles of graph theory. We also highlight some of the technical challenges and key questions to be addressed by future developments in this rapidly moving field.
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            Neural correlates of consciousness: progress and problems.

            There have been a number of advances in the search for the neural correlates of consciousness--the minimum neural mechanisms sufficient for any one specific conscious percept. In this Review, we describe recent findings showing that the anatomical neural correlates of consciousness are primarily localized to a posterior cortical hot zone that includes sensory areas, rather than to a fronto-parietal network involved in task monitoring and reporting. We also discuss some candidate neurophysiological markers of consciousness that have proved illusory, and measures of differentiation and integration of neural activity that offer more promising quantitative indices of consciousness.
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              The entropic brain: a theory of conscious states informed by neuroimaging research with psychedelic drugs

              Entropy is a dimensionless quantity that is used for measuring uncertainty about the state of a system but it can also imply physical qualities, where high entropy is synonymous with high disorder. Entropy is applied here in the context of states of consciousness and their associated neurodynamics, with a particular focus on the psychedelic state. The psychedelic state is considered an exemplar of a primitive or primary state of consciousness that preceded the development of modern, adult, human, normal waking consciousness. Based on neuroimaging data with psilocybin, a classic psychedelic drug, it is argued that the defining feature of “primary states” is elevated entropy in certain aspects of brain function, such as the repertoire of functional connectivity motifs that form and fragment across time. Indeed, since there is a greater repertoire of connectivity motifs in the psychedelic state than in normal waking consciousness, this implies that primary states may exhibit “criticality,” i.e., the property of being poised at a “critical” point in a transition zone between order and disorder where certain phenomena such as power-law scaling appear. Moreover, if primary states are critical, then this suggests that entropy is suppressed in normal waking consciousness, meaning that the brain operates just below criticality. It is argued that this entropy suppression furnishes normal waking consciousness with a constrained quality and associated metacognitive functions, including reality-testing and self-awareness. It is also proposed that entry into primary states depends on a collapse of the normally highly organized activity within the default-mode network (DMN) and a decoupling between the DMN and the medial temporal lobes (which are normally significantly coupled). These hypotheses can be tested by examining brain activity and associated cognition in other candidate primary states such as rapid eye movement (REM) sleep and early psychosis and comparing these with non-primary states such as normal waking consciousness and the anaesthetized state.
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                17 March 2023
                2023
                : 14
                : 1120981
                Affiliations
                [1] 1Department of Neuroscience, Imaging, and Clinical Sciences, “G. D'Annunzio University” of Chieti-Pescara , Chieti, Italy
                [2] 2Center for Advanced Studies and Technology (CAST), “G. D'Annunzio University” of Chieti-Pescara , Chieti, Italy
                [3] 3Barking, Havering, and Redbridge University Hospitals NHS Trust , London, United Kingdom
                [4] 4Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire , Hertfordshire, United Kingdom
                Author notes

                Edited by: Martina Ardizzi, University of Parma, Italy

                Reviewed by: Antonio Bulbena, Autonomous University of Barcelona, SpainJeroen Antonius Van Waarde, Rijnstate Hospital, Netherlands

                *Correspondence: Marco Onofrj, onofrj@ 123456unich.it

                This article was submitted to Psychopathology, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2023.1120981
                10064068
                37009111
                acd85d4b-3562-4be1-b216-187a346d6aab
                Copyright © 2023 Onofrj, Ajdinaj, Digiovanni, Malek, Martinotti, Ferro, Russo, Thomas and Sensi.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 10 December 2022
                : 24 February 2023
                Page count
                Figures: 4, Tables: 1, Equations: 0, References: 218, Pages: 16, Words: 14891
                Categories
                Psychiatry
                Review

                Clinical Psychology & Psychiatry
                somatic symptom and related disorders,factitious disorder,utilization behavior,deception,hysteria

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