Clélia Quiles

The covariation of independent and dependant variables in neurofeedback: A proposal framework to identify cognitive processes and brain activity variables

This methodological article proposes a framework for analysing the relationship between cognitive processes and brain activity using variables measured by neurofeedback (NF) carried out by functional Magnetic Resonance Imagery (fMRI NF). Cognitive processes and brain activity variables can be analysed as either the dependant variable or the independent variable. Firstly, we propose two traditional approaches, defined in the article as the neuropsychological approach (NP) and the psychophysiology approach (PP), to extract dependent and independent variables in NF protocols. Secondly, we suggest that NF can be inspired by the style of inquiry used in neurophenomenology. fMRI NF allows participants to experiment with his or her own cognitive processes and their effects on brain region of interest (ROI) activations simultaneously. Thus, we suggest that fMRI NF could be improved by implementing the elicitation interview method, which allows the investigator to gather relevant verbatim from participants introspection on subjective experiences.

Keep calm and carry on: Mental disorder is not more “organic” than any other medical condition

Psychiatry as a discipline should no longer be grounded in the dualistic opposition between organic and mental disorders. This non-dualistic position refusing the partition along functional versus organic lines is in line with Jean Delay, and with Robert Spitzer who wanted to include in the definition of mental disorder discussed by the DSM-III task force the statement that mental disorders are a subset of medical disorders. However, it is interesting to note that Spitzer and colleagues ingeniously introduced the definition of mental disorder in the DSM-III in the following statement: there is no satisfactory definition that specifies precise boundaries for the concept mental disorder (also true for such concepts as physical disorder and mental and physical health). Indeed, as for mental disorders, it is as difficult to define what they are as it is to define what constitutes a physical disorder. The problem is not the words mental or organic but the word disorder. In this line, Wakefield has proposed a useful harmful dysfunction analysis of mental disorder. They raise the issue of the dualistic opposition between organic and mental disorders, and situate the debate rather between the biological/physiological and the social. The paper provides a brief analysis of this shift on the question of what is a mental disorder, and demonstrates that a mental disorder is not more organic than any other medical condition. While establishing a dichotomy between organic and psychiatry is no longer intellectually tenable, the solution is not to reduce psychiatric and non-psychiatric disorders to the level of organic disorders but rather to continue to adopt both a critical and clinically pertinent approach to what constitutes a disorder in medicine.

Making psychiatric semiology great again: A semiologic, not nosologic challenge

This article analyzes whether psychiatric disorders can be considered different from non-psychiatric disorders on a nosologic or semiologic point of view. The supposed difference between psychiatric and non-psychiatric disorders relates to the fact that the individuation of psychiatric disorders seems more complex than for non-psychiatric disorders. This individuation process can be related to nosologic and semiologic considerations. The first part of the article analyzes whether the ways of constructing classifications of psychiatric disorders are different than for non-psychiatric disorders. The ways of establishing the boundaries between the normal and the pathologic, and of classifying the signs and symptoms in different categories of disorder, are analyzed. Rather than highlighting the specificity of psychiatric disorders, nosologic investigation reveals conceptual notions that apply to the entire field of medicine when we seek to establish the boundaries between the normal and the pathologic and between different disorders. Psychiatry is thus very important in medicine because it exemplifies the inherent problem of the construction of cognitive schemes imposed on clinical and scientific medical information to delineate a classification of disorders and increase its comprehensibility and utility. The second part of this article assesses whether the clinical manifestations of psychiatric disorders (semiology) are specific to the point that they are entities that are different from non-psychiatric disorders. The attribution of clinical manifestations in the different classifications (Research Diagnostic Criteria, Diagnostic Statistic Manual, Research Domain Criteria) is analyzed. Then the two principal models on signs and symptoms, i.e. the latent variable model and the causal network model, are assessed. Unlike nosologic investigation, semiologic analysis is able to reveal specific psychiatric features in a patient. The challenge, therefore, is to better define and classify signs and symptoms in psychiatry based on a dual and mutually interactive biological and psychological perspective, and to incorporate semiologic psychiatry into an integrative, multilevel and multisystem brain and cognitive approach.