Revisiting the Major Mental Disorders and Updating the Nosological Schema: A Synthesis

Abstract

Recently, conciliating findings from molecular genetics, evolutionary biology, along with empirical clinical evidence regarding the major mental disorders (MMDs) namely bipolar affective disorder (BPAD), schizophrenia, obsessive compulsive disorder (OCD), the anxieties with depression, autism and attention deficit/hyperactivity disorder (ADHD) all point to a common neural-developmental origin. Genetic loci associated with schizophrenia do not directly lead to the disorder; instead, they code for the expression of lopsided, temperamental, variants in individuals that originate mainly from one part of our human nature which applies also, to the rest of the MMDs. These individuals contribute to the flexibility, robustness, and creative input of our species, concomitantly, they incur vulnerability to the development of a MMD as an evolutionary trade off. MMDs initially, are expressed as periodic epiphenomena on the underlying temperamental extreme variants of brain function. Their expressions tend to become permanent. Underlying, aberrant traits remain unaltered. Their clinical expressions are characterized by "either-or", antithetical substitutes, in addition to co-occurring psychosis. The latter is a common occurrence to other assaults on brain function. Characteristic, "ether-or" symptoms are the result of a disturbed, overall, coordinating property of brain function, normally responsive to the smooth, synchronizing expression of all higher mental faculties. Clinical findings point to the need of modifying the current schema in order to better reflect their collective significance in order to help guide research to a new, more promising direction in elucidating their triggers, development, and mechanisms whereby opening a new horizon for therapy and treatment.

Some Thoughts Regarding the Narrative of the Current Nosological Schema and their Ramifications for Major Mental Disorders with a Focus on Schizophrenia

“…In taking into consideration the postulates presented above can act as facilitating guides in research for delineating the baffling major mental disorders [13].…”

An Emerging Natural History in the Development, Mechanisms and Worldwide Prevalence of Major Mental Disorders

“…In using a metaphor; this property in its expression, is reminiscent to the elegant synchronous waves of murmuration of a flying flock of starlings [ 23 ]. In the case of schizophrenia, during its first occurrence or subsequent relapse, this synchronizing property, switches to that of “a pathologically ordered state” of 'either/or', with spastic, uncoordinated expressions characterized by antithetical substitutes [ 24 ]. Examples of such substitutes are, the 'either/or' concrete-tistic thinking, the ambivalence, ( e.g ., the presence of concomitant opposite feelings towards a person or an idea), apathy punctuated by explosive behavior, the non sequitur thinking ( i.e ., faulty Association), the mismatch of feeling with thinking, and their inappropriate responses towards a given social situation and the feverish activity replaced by prolonged apathy, as well as inability to accommodate ambiguity.…”

“…Examples of such substitutes are, the 'either/or' concrete-tistic thinking, the ambivalence, ( e.g ., the presence of concomitant opposite feelings towards a person or an idea), apathy punctuated by explosive behavior, the non sequitur thinking ( i.e ., faulty Association), the mismatch of feeling with thinking, and their inappropriate responses towards a given social situation and the feverish activity replaced by prolonged apathy, as well as inability to accommodate ambiguity. A kind of a “Psychic Parkinson-ism” [ 24 ], Andreasen calls it “dysmetria” [ 25 ] - all characteristic of schizophrenia as well as the rest of MMDs, namely bipolar disorder involving the normal, smooth, mood modulation, expressed now with an either/or, manic-depressive, antithetical substitutes which contaminate judgment and decisions as well as cause erratic actions. It is important to note that the apparently mono-polar, major depressions (MDs) are in fact bipolar disorders where the depressive phases are markedly prominent while the manic ones are felt in the past by the sufferers, as merely mild transient “emotional rush”, hardly noticed but readily admitted by them if asked.…”