Altered states of consciousness during psychotherapy: a historical and cultural perspective.

This paper reviews the frequent phenomenon of altered states of consciousness in disparate cultural psychotherapeutic contexts. The historical antecedents of contemporary Western psychodynamic psychotherapy are examined and the central importance of altered states in the therapeutic effects of religious institutions such as the Dionysian rite and the Asclepia is illustrated. The continued presence of this phenomenon in Western psychotherapy from Mesmerism to psychoanalysis is shown. The use of trance states in the healing rituals of non-Western societies is culturally variegated therapeutic settings. The ubiquitous nature of the altered state phenomenon in such widely varied cultural contexts suggests the possibility of its being a universal component of psychotherapy.     

Altered states of consciousness in epilepsy: a DTI study of the brain

Background: A disturbance in the level of consciousness is a classical clinical sign of several seizure types. Recent studies have shown that altered states of consciousness in seizures are associated with structural and functional changes of several brain regions. Prominent among these are the thalamus, the brain stem and the default mode network, which is part of the consciousness system. Our study used diffusion tensor imaging (DTI) to evaluate these brain regions in patients with three different types of epilepsies that are associated with altered consciousness: complex partial seizures (CPS), primary generalized tonic–clonic seizures (PGTCS) or secondary generalized tonic–clonic seizures (SGTCS). Additionally, this study further explores the probable mechanisms underlying impairment of consciousness in seizures. Materials and methods: Conventional MRI and DTI scanning were performed in 51 patients with epilepsy and 51 healthy volunteers. The epilepsy group was in turn subdivided into three subgroups: CPS, PGTCS or SGTCS. Each subgroup comprised 17 patients. Each subject involved in the study underwent a DTI evaluation of the brain to measure the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values of nine regions of interest: the postero-superior portion of midbrain, the bilateral dorsal thalamus, the bilateral precuneus/posterior cingulate, the bilateral medial pre-frontal gyri and the bilateral supramarginalgyri. The statistical significance of the measured ADC and FA values between the experimental and control groups was analysed using the paired t-test, and one-way analysis of variance was performed for a comparative analysis between the three subgroups. Results: Statistically significantly higher ADC values (?p < 0.01) were observed in the bilateral dorsal thalamus and postero-superior aspect of the midbrain in the three patient subgroups than in the control group. There were no significant changes in the ADC values (?p > 0.05) in the bilateral precuneus/posterior cingulate, bilateral medial pre-frontal gyri or bilateral supramarginalgyri in the experimental group. Among the three patient subgroups and the ADC values of corresponding brain regions, there were no statistically significant changes. Statistically significantly lower FA values (?p < 0.05) were observed in the bilateral dorsal thalamus of the patients in the three subgroups than in the control group. Significantly lowered FA values from the postero-superior aspect of the mid brain (?p < 0.01) were observed in patients with PGTCS compared with the control group. There were no significant changes in the FA values (?p > 0.05) from the bilateral precuneus/posterior cingulate, bilateral medial frontal gyri or bilateral supramarginalgyri in the experimental group. Among the three patient subgroups and the FA values of the corresponding brain regions, there were no statistically significant changes. Conclusion: In epileptic patients with CPS, PGTCS or SGTCS, there seems to be a long-lasting neuronal dysfunction of the bilateral dorsal thalamus and postero-superior aspect of the midbrain. The thalamus and upper brain stem are likely to play a key role in epileptic patients with impaired consciousness.     

Altered states of consciousness in disorders of daytime sleepiness.

Patients with daytime sleepiness present altered states of consciousness. The occurrence of these states impairs their professional, social and familial activities and may threaten life itself. The automatic behavior syndrome is characterized by continuation of mechanical activity and complete amnesia. Episodes lasting from a few seconds to several hours are correlated with repetitive micro-sleep periods. During cataplectic attacks, patients may have a meshing of reality with hallucinatory dream contents. Sleep-induced apnea may lead to abnormal movement and abnormal ambulation during sleep as well as hallucinations in the early morning. These altered states of consciousness must be considered as diagnostic indexes in differentiating epileptic syndromes from syndromes of daytime sleepiness.     

Altered MR imaging findings in a Japanese female child with PRUNE1-related disorder

Autosomal recessive PRUNE1 mutations on chromosome 1q21.3 are reported to cause a neurodevelopmental disorder with microcephaly, hypotonia, and variable brain malformations. Here, we report a Japanese case with a reported PRUNE1 mutation whose brain magnetic resonance imaging (MRI) showed specific imaging findings that have not been reported before. The patient was a 12-month-old girl, the first child of healthy and nonconsanguineous Japanese parents. She showed global developmental delay, intellectual disability, hypotonia, spastic quadriparesis, and hyperreflexia. Brain MRI showed cerebral and cerebellar atrophy, thin corpus callosum, white matter changes, and abnormal signal intensity of the brainstem, all of which were reported in the literature. In addition, we emphasize the three following imaging findings: a transient cerebral subcortical white matter lesion, atrophy of the midbrain and pontine tegmentum with a preserved pontine base, and abnormal signal intensity of the bilateral swelling putamina and medial portions of the thalami, which emerged after 4 years of age. The whole-exome sequencing (WES) analysis performed at the age of 4 years identified biallelic PRUNE1 variants, namely compound heterozygous mutations (c.[316G > A];[540 T > A],p.[Asp106Asn];[Cys180*]). Although the diagnosis of PRUNE1-related disorder requires WES, we think that these new characteristic MRI findings may help in the diagnosis of PRUNE1-related disorder.     

Metrizamide encephalopathy in a child with hydrocephalus--effects of L-threo-DOPS on persistent disturbance of consciousness and L-dopa on extrapyramidal symptoms

This report describes a case of metrizamide encephalopathy with persistent disturbance of consciousness and extrapyramidal symptoms. These two conditions have rarely been reported among the various adverse effects of metrizamide. An 11-year-old girl had been in almost good health until she was ten years old, at which time she received a ventriculo-peritoneal shunt operation, suffering from hydrocephalus of unknown etiology. At the age of eleven, she was admitted to our hospital due to hydrocephalus recurrence. She was examined by metrizamide shunt-gram (1200 mg iodide/4 ml). On the next day, she became drowsy. The CT scan disclosed the periventricular penetration of metrizamide into the medial part of the thalamus and the caudate nucleus. Thirteen days later, disturbance of consciousness continued, and extrapyramidal symptoms, that is, rigo-spasticity and postural tremor, were observed. Oral administration of L-threo-DOPS, the direct precursor of noradrenaline, was effective against the persistent disturbance of consciousness and L-DOPA was effective against the extrapyramidal symptoms. She soon recovered almost to normal and no neurological deficit remained. We thus conclude that the CT scan findings and effects of L-threo-DOPS and L-DOPA suggest that metrizamide encephalopathy in this case were respectively due to its periventricular penetration into the medial part of the thalamus and the caudate nucleus, and the resultant deficiency of the ascending noradrenergic reticular activating system and the nigrostriatal dopaminergic system.     

Towards a new consciousness

The basis of Primal Therapy treatment is that traumatic events which happened to us early in our lives do not vanish because they are forgotten. Instead, they are stored in the brain and body as painful encoded memories exerting a constant stress on the system. These pains usually result from the deprivation of basic needs such as a proper, natural birth, being held as an infant and child when upset, being touched and caressed by one's parents, being listened to and talked to and being allowed to develop at one's own pace.The encoded needs and the memories of their denial are repressed by an elaborate system of gates in the brain which seem to keep us unaware of our internal suffering. These memories, it is believed, form the substance of our neuroses. Childhood pains, called Primal Pains, form an ever expanding force as the child matures ultimately forcing us to seek measures to quell it such as smoking, drinking and overeating. The gating of pain produces a reverberating circuit of excitation, experienced subjectively as tension. The amount of underlying excitation can be measured and quantified. The amount of resolution of underlying Primal Pain is also subject to quantification. In this way progress in therapy can be objectified.There is commensurate growth of consciousness concomitant with the resolution of Pain leading us to believe that consciousness and unconsciousness are inextricably related to underlying Pain.The resolution of neurosis involves the resolution of early childhood pain, both physical and psychological. The method involves the reliving of those events in a systematic way which involves one hypothesis that cerebral gates are “opened” in measured amounts to liberate repressed material.In my latest book, “Primal Man — The New Consciousness”, co-authored with Dr. Michael Holden, we describe the results of several years research at the Primal Research Laboratory in Los Angeles, California as well as independent research done on our patients by scientist at the UCLA Brain Research Institute.This research sets forth a number of findings: patients in Primal Therapy have a permanent lowering of their vital signs after eight months treatment including pulse, blood pressure and core body temperature It is believed that this finding will have significant importance for sufferers from hypertension and some forms of heart disease. There has been a significant lowering of the general activity of the brain, and a permanent shift in the power of that activity (known as amplitude) to the right cerebral hemisphereWe believe that these findings together with follow-up research on the medical status of Primal patients may indicate a longer life span. The metabolic rate has been slowed. Corroborative research in South Africa (as published in Psychotherapeia) also indicates a continued decrease in metabolic rate.A host of psychosomatic afflictions including asthma, colitis, ulcers and migraine are particularly responsive to the therapy. Rather than using medication to suppress symptoms, treatment is aimed at resolution of repressed pain which gives rise to them.     

Emotion and consciousness: ends of a continuum

We suggest a united concept of consciousness and emotion, based on the systemic cognitive neuroscience perspective regarding organisms as active and goal-directed. We criticize the idea that consciousness and emotion are psychological phenomena having quite different neurophysiological mechanisms. We argue that both characterize a unified systemic organization of behavior, but at different levels. All systems act to achieve intended behavioral results in interaction with their environment. Differentiation of this interaction increases during individual development. Any behavioral act is a simultaneous realization of systems ranking from the least to the most differentiated. We argue that consciousness and emotion are dynamic systemic characteristics that are prominent at the most and least differentiated systemic levels, correspondingly. These levels are created during development. Our theory is based on both theoretical and empirical research and provides a solid framework for experimental work.     

Epilepsy and narcolepsy-cataplexy in a child

We report a 5-year-old boy with epilepsy and narcolepsy-cataplexy. He developed myoclonic seizures at the age of 4 years, which manifested as head shaking to the left. Approximately 6 months later, narcolepsy-cataplexy with excessive daytime sleepiness occurred. Although a short-time electroencephalography (EEG) and 24-hour ambulatory EEG monitoring found epileptiform discharges, no seizures were determined. Oxcarbazepine was used and led to increased attacks. Video EEG testing finally confirmed the diagnosis of epilepsy; therefore, valproate was given and seizures were controlled completely. Typical cataplexy triggered by laughing, together with the positive multiple sleep latency tests confirmed a diagnosis of narcolepsy-cataplexy. Human leukocyte antigens DQB1*0602 was positive, and the hypocretin level in cerebrospinal fluid was found to be decreased. Combination of valproate, methylphenidate, and clomipramine treatment improved the symptoms of both narcolepsy-cataplexy and seizure. The coexistence of both disorders in this single patient indicated that there might be a common mechanism between epilepsy and narcolepsy-cataplexy.     

Astroblastoma in a child

Background Astroblastoma, an uncommon neuroepithelial tumor, typically presents in young adults as a well-circumscribed cortical or subcortical spherical mass. Astroblastoma may cause a diagnostic problem to anyone unfamiliar with its architectural and histological features. Case history We report the case of a 4-year-old boy who was referred for complaints of progressive deficits of balance and difficulty with walking during the previous 3 months. A large fronto-parietal cystic mass with solid mural nodule was discovered. Total removal of the tumor mass was performed, and a diagnosis of high grade (malignant) variant of astroblastoma was made. Postoperatively, the patient received radiation therapy, for a period of 11 weeks, followed by chemotherapy. He is in a good neurological recovery without any evidence of recurrence for 8 months. Prognosis The best treatment modality for astroblastoma is surgical resection if possible, whereas adjuvant therapy (radiotherapy and/or chemotherapy) can be considered in high-grade astroblastomas, with a close follow-up for all cases.     

The child abuse program in a child guidance center

This paper is a case example of how one private child guidance clinic responded to problems of child abuse seen in the clinic and how the center moved from the "micro-level" of treating individual victims and their families to the "macro-level" of education and community involvement. The authors show how case-by-case treatment of abused families can be used as a guide for program development and community education.     

Non-conscious prediction and a role for consciousness in correcting prediction errors

As a result of the evolutionary pressure for survival, the brain relies on a number of non-conscious predictive neural mechanisms which allow for rapid, efficient behavioral responses to the environment. These predictive mechanisms enable the brain to recognize objects by sampling just a few sensory inputs, to anticipate what events are likely to occur and to prepare a response before events actually occur. Consciousness appears to play a role in the detection and correction of prediction errors. The author, a psychotherapist and psychoanalyst, proposes that this monitoring or oversight function of consciousness can be used to understand how conscious awareness facilitates change in the psychotherapeutic treatment of patients who repeat maladaptive patterns of behavior.     

Bezold-Jarisch reflex in sino-aortic denervated malnourished rats

In this study we assessed the role of Bezold-Jarisch reflex (BJR) in the regulation of blood pressure (BP) of malnourished (MN) and control rats (CN) with sino-aortic denervation (SAD). Fischer rats were fed diets containing either 6% (MN) or 15% (CN) protein for 35 days after weaning. These rats underwent sham or SAD and catheterization of femoral artery and vein for BP measurements and drug injection. Phenylbiguanide (PBG 5 μg/kg, i.v.) for activation BJR, produced bradycardia (-317±22 bpm for CN vs. -372±16 bpm for MN) and hypotension (-57±4 mm Hg for CN vs. -54±6 mm Hg for MN. After SAD, MN rats had reduced hypotensive (-37±7 mm Hg for MN vs. -82±6 mm Hg for CN) and bradycardic (-124±17 for MN vs. -414±20 bpm CN) responses to BJR activation. To evaluate the contribution of the parasympathetic component due to BJR for the fall in BP, methyl atropine bromide, was given between two injections of PBG (5 μg/kg) separated by 10 min each other. Both bradycardic (-216±21 bpm before and -4±3 bpm after for CN -226±43 bpm before and -9±20 bpm after for MN) and hypotensive (-42±4 mm Hg before and -6±1 mm Hg after for CN -33±9 mm Hg before and -5±2 mm Hg after for MN) responses were abolished in CN and MN groups. These data indicate that dietary protein malnutrition changes the relation between baroreflex and BJR required for maintenance of the BP during malnourishment.     

Visual consciousness in health and disease

Conscious experience is an essential part of normal human life and interaction with the environment. Yet the nature of consciousness and conscious perception remains a mystery. Because of its subjective nature, consciousness has been difficult to investigate scientifically, but clues have been gained through studies involving patients with cortical lesions. During the past decade, the development of event-related fMRI has provided insights into aspects of conscious perception in control subjects and patients with cortical lesions by correlating awareness and performance with neural activity during visual tasks. This article reviews how recent research has advanced understanding of conscious perception, its relationship to neural activity and visual performance, and how this relationship can be altered by visual dysfunction. It also presents recent research about how conscious awareness of vision might be represented at a neural level in the central nervous system.     

Disturbances of time consciousness from a phenomenological and a neuroscientific perspective

The subjective experience of time is a fundamental constituent of human consciousness and can be disturbed under conditions of mental disorders such as schizophrenia or affective disorders. Besides the scientific domain of psychiatry, time consciousness is a topic that has been extensively studied both by theoretical philosophy and cognitive neuroscience. It can be shown that both approaches exemplified by the philosophical analysis of time consciousness (Husserl) and the neuroscientific theory of cross-temporal contingencies (binding of cognitive processes over time) as the neurophysiological basis of human consciousness implemented in the prefrontal cortex (Fuster) converge in 2 respects. Firstly, a tripartite conception of consciousness divides human cognition in 3 different temporal domains comprising retention, presentation, and protention (Husserl) and the past, the present, and the future corresponding to working memory, interference control, and preparatory set (Fuster). Secondly, both concepts refer to the present as an extended duration that integrates information from the recent past and the future. We propose that the integration of phenomenological and neuroscientific approaches can stimulate the development of enriched pathophysiological concepts of mental disorders. This approach appears to be particularly fruitful with respect to schizophrenia that is interpreted as a structural disturbance of time consciousness.     

Culture and weight consciousness

The relationship between eating disorders, such as anorexia nervosa and bulimia and socio- cultural factors is examined. The syndromes were first described in Western cultures and were reported as particularly rare or absent in other cultures. Epidemiological research shows that the frequency of their presentation has increased over the past two decades, probably as a consequence of changes in cultural norms related to the concepts of feminine beauty with increased emphasis on thinness. Recent research shows that adoption of these cultural values by other societies is associated with the emergence of similar syndromes in their cultures.