In this report, we describe the case of a patient who sustained extremely severe traumatic brain damage with diffuse axonal injury in a traffic accident and whose recovery was monitored during 6 years. Specifically, we were interested in the recovery dynamics of 3-dimensional components of selfhood (a 3-dimensional construct model for the complex experiential selfhood has been recently proposed based on the empirical findings on the functional-topographical specialization of 3 operational modules of brain functional network responsible for the self-consciousness processing) (...) derived from the electroencephalographic (EEG) signal. The analysis revealed progressive (though not monotonous) restoration of EEG functional connectivity of 3 modules of brain functional network responsible for the self-consciousness processing, which was also paralleled by the clinically significant functional recovery. We propose that restoration of normal integrity of the operational modules of the self-referential brain network may underlie the positive dynamics of 3 aspects of selfhood and provide a neurobiological mechanism for their recovery. The results are discussed in the context of recent experimental studies that support this inference. Studies of ongoing recovery after severe brain injury utilizing knowledge about each separate aspect of complex selfhood will likely help to develop more efficient and targeted rehabilitation programs for patients with brain trauma. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

Recent results from neuroimaging appear to indicate that some patients in a vegetative state have partially intact awareness. These results may demonstrate misdiagnosis and suggest the need not only for alternative forms of treatment, but also for the reconsideration of end-of-life decisions in cases of disorders of consciousness. This article addresses the second consequence. First, I will discuss which aspects of consciousness may be involved in neuroimaging findings. I will then consider various factors relevant to ethical end-of-life decision-making, and analyse (...) whether and to what extent the above consequence applies to these factors. It will be shown that knowledge of the existence of partial awareness in patients with disorders of consciousness only influences end-of-life decision-making if certain background assumptions are made. (shrink)

Based on the theoretical analysis of self-consciousness concepts, we hypothesized that the spatio-temporal pattern of functional connectivity within the default-mode network (DMN) should persist unchanged across a variety of different cognitive tasks or acts, thus being task-unrelated. This supposition is in contrast with current understanding that DMN activated when the subjects are resting and deactivated during any attention-demanding cognitive tasks. To test our proposal, we used, in retrospect, the results from our two early studies ([Fingelkurts, 1998] and [Fingelkurts et al., (...) 2003]). In both studies for the majority of experimental trails we indeed found a constellation of operationally synchronized cortical areas (indexed as DMN) that was persistent across all studied experimental conditions in all subjects. Furthermore, we found three major elements comprising this DMN: two symmetrical occipito-parieto-temporal and one frontal spatio-temporal patterns. This new data directly supports the notion that DMN has a specific functional connotation – it provides neurophysiologic basis for self-processing operations, namely first-person perspective taking and an experience of agency. (shrink)

Concepts of space and time are widely developed in physics. However, there is a considerable lack of biologically plausible theoretical frameworks that can demonstrate how space and time dimensions are implemented in the activity of the most complex life-system – the brain with a mind. Brain activity is organized both temporally and spatially, thus representing space-time in the brain. Critical analysis of recent research on the space-time organization of the brain’s activity pointed to the existence of so-called operational space-time in (...) the brain. This space-time is limited to the execution of brain operations of differing complexity. During each such brain operation a particular short-term spatio-temporal pattern of integrated activity of different brain areas emerges within related operational space-time. At the same time, to have a fully functional human brain one needs to have a subjective mental experience. Current research on the subjective mental experience offers detailed analysis of space-time organization of the mind. According to this research, subjective mental experience (subjective virtual world) has definitive spatial and temporal properties similar to many physical phenomena. Based on systematic review of the propositions and tenets of brain and mind space-time descriptions, our aim in this review essay is to explore the relations between the two. To be precise, we would like to discuss the hypothesis that via the brain operational space-time the mind subjective space-time is connected to otherwise distant physical space-time reality. (shrink)

In this paper we aim to show that phenomenal consciousness is realized by a particular level of brain operational organization and that understanding human consciousness requires a description of the laws of the immediately underlying neural collective phenomena, the nested hierarchy of electromagnetic fields of brain activity – operational architectonics. We argue that the subjective mental reality and the objective neurobiological reality, although seemingly worlds apart, are intimately connected along a unified metastable continuum and are both guided by the universal (...) laws of the physical world such as criticality, self-organization and emergence. (shrink)

The presence or absence of consciousness is the linchpin of taxonomy for disorders of consciousness (DOCs), as well as a focal point for end-of-life decision making for patients with DOCs. Focus on consciousness in this latter context has been criticized for a number of reasons, including the uncertainty of the diagnostic criteria for consciousness, the irrelevance of some forms of consciousness for determining a patient’s interests, and the ambiguous distinction between consciousness and unconsciousness. As a result, there have been recent (...) suggestions that perhaps consciousness ought not to play the focal role that it does in decision making for persons with DOCs, and that other considerations, such as patient and family values, ought to take center stage. In this article, I take a step back and reexamine the meaning of consciousness in the DOC taxonomy. I propose that, while consciousness in DOC taxonomy is defined as “wakeful awareness,” this definition, while clinically expedient, occasions ethical misunderstanding. Using resources from non-Western philosophy of mind, I argue that the form of consciousness that is ethically relevant in DOCs is intransitive, or pure. I contrast this pure experience with transitive consciousness to highlight why ethical conclusions ought not define consciousness solely as “wakeful awareness,” even if clinical criteria do. (shrink)

Patients in a minimally conscious state (MCS) fall into a different diagnostic category than patients in the more familiar vegetative states (VS). Not only are MCS patients conscious in some sense, they have a higher chance for recovery than VS patients. Because of these differences, we ostensibly have reason to provide MCS patients with care that goes beyond what we provide to patients with some VS patients. But how to justify this differential treatment? I argue we can’t justify it solely (...) by looking to MCS patients’ actual levels of consciousness. We must look also to the ways in which these patients are potentially conscious. Specifically, I argue that certain sensible and well-regarded policy recommendations cannot be justified by looking solely to patients’ actual levels of consciousness, but that they can be justified by looking to patients’ potential for consciousness. Insofar then as we have prima facie reason to follow the recommendations, we also have prima facie reason to view the potential for consciousness as morally salient. If that is true, however, several important implications follow: first, if the potential for consciousness is morally salient, this translates into actual and pressing obligations to patients with disorders of consciousness generally. Second, if the potential for consciousness is morally salient, this has implications that go beyond our obligations to patients with disorders of consciousness. Indeed, if the potential for consciousness is morally salient, this adds an important layer of complexity to the normative landscape, a layer we may not have sufficiently noticed before. (shrink)

Although several studies propose that the integrity of neuronal assemblies may underlie a phenomenon referred to as awareness, none of the known studies have explicitly investigated dynamics and functional interactions among neuronal assemblies as a function of consciousness expression. In order to address this question EEG operational architectonics analysis (Fingelkurts and Fingelkurts, 2001, 2008) was conducted in patients in minimally conscious (MCS) and vegetative states (VS) to study the dynamics of neuronal assemblies and operational synchrony among them as a function (...) of consciousness expression. We found that in minimally conscious patients and especially in vegetative patients neuronal assemblies got smaller, their life-span shortened and they became highly unstable. Furthermore, we demonstrated that the extent/volume and strength of operational synchrony among neuronal assemblies was smallest or even absent in VS patients, intermediate in MCS patients and highest in healthy fully-conscious subjects. All findings were similarly observed in EEG alpha as well as beta1 and beta2 frequency oscillations. The presented results support the basic tenets of Operational Architectonics theory of brain-mind functioning and suggest that EEG operational architectonics analysis may provide an objective and accurate means of assessing signs of (un)consciousness in patients with severe brain injuries. Therefore this methodological approach may complement the existing “gold standard” of behavioral assessment of this population of challenging patients and inform the diagnostic and treatment decision-making processes. (shrink)

Using the concepts of chaotic dynamical systems, we present an interpretation of dynamic neural activity found in cortical and subcortical areas. The discovery of chaotic itinerancy in high-dimensional dynamical systems with and without a noise term has motivated a new interpretation of this dynamic neural activity, cast in terms of the high-dimensional transitory dynamics among “exotic” attractors. This interpretation is quite different from the conventional one, cast in terms of simple behavior on low-dimensional attractors. Skarda and Freeman (1987) presented evidence (...) in support of the conclusion that animals cannot memorize odor without chaotic activity of neuron populations. Following their work, we study the role of chaotic dynamics in biological information processing, perception, and memory. We propose a new coding scheme of information in chaos-driven contracting systems we refer to as Cantor coding. Since these systems are found in the hippocampal formation and also in the olfactory system, the proposed coding scheme should be of biological significance. Based on these intensive studies, a hypothesis regarding the formation of episodic memory is given. Key Words: Cantor coding; chaotic itinerancy; dynamic aspects of the brain; dynamic associative memory; episodic memory; high-dimensional dynamical systems; SCND attractors. (shrink)

Background: Patients in a vegetative state pose problems in diagnosis, prognosis and treatment. Currently, no prognostic markers predict the chance of recovery, which has serious consequences, especially in end-of-life decision-making. Objective: We aimed to assess an objective measurement of prognosis using advanced electroencephalography (EEG). Methods: EEG data (19 channels) were collected in 14 patients who were diagnosed to be persistently vegetative based on repeated clinical evaluations at 3 months following brain damage. EEG structure parameters (amplitude, duration and variability within quasi-stationary (...) segments, as well as the spatial synchrony between such segments and the strength of this synchrony) were used to predict recovery of consciousness 3 months later. Results: The number and strength of cortical functional connections between EEG segments were higher in patients who recovered consciousness (P < .05 – P < .001) compared with those who did not recover. Linear regression analysis confirms that EEG structure parameters are capable of predicting (P = .0025) recovery of consciousness 6 months post-injury, whereas the same analysis failed to significantly predict patient outcome based on aspects of their clinical history alone (P = .629) or conventional EEG spectrum power (P = .473). Conclusions: The result of this preliminary study demonstrates that structural strategy of EEG analysis is better suited for providing prognosis of consciousness recovery than existing methods of clinical assessment and of conventional EEG. Our results may be a starting point for developing reliable prognosticators in patients who are in vegetative state, with the potential to improve their day-to-day management, quality of life, and access to early interventions. (shrink)

The default mode network (DMN) has been consistently activated across a wide variety of self-related tasks, leading to a proposal of the DMN’s role in self-related processing. Indeed, there is limited fMRI evidence that the functional connectivity within the DMN may underlie a phenomenon referred to as self-awareness. At the same time, none of the known studies have explicitly investigated neuronal functional interactions among brain areas that comprise the DMN as a function of self-consciousness loss. To fill this gap, EEG (...) operational synchrony analysis was performed in patients with severe brain injuries in vegetative and minimally conscious states to study the strength of DMN operational synchrony as a function of self-consciousness expression. We demonstrated that the strength of DMN EEG operational synchrony was smallest or even absent in patients in vegetative state, intermediate in patients in minimally conscious state and highest in healthy fully self-conscious subjects. At the same time the process of decoupling of operations performed by neuronal assemblies that comprise the DMN was highest in patients in vegetative state, intermediate in patients in minimally conscious state and minimal in healthy fully self-conscious subjects. The DMN’s frontal EEG operational module had the strongest decrease in operational synchrony strength as a function of selfconsciousness loss, when compared with the DMN’s posterior modules. Based on these results it is suggested that the strength of DMN functional connectivity could mediate the strength of self-consciousness expression. The observed alterations similarly occurred across EEG alpha, beta1 and beta2 frequency oscillations. Presented results suggest that the EEG operational synchrony within DMN may provide an objective and accurate measure for the assessment of signs of self-(un)consciousness in these challenging patient populations. This method therefore, may complement the current diagnostic procedures for patients with severe brain injuries and, hence, the planning of a rational rehabilitation intervention. (shrink)

This article provides a retrospective, current and prospective overview on developments in brain research and neuroscience. Both theoretical and empirical studies are considered, with emphasis in the concept of multivariability and metastability in the brain. In this new view on the human brain, the potential multivariability of the neuronal networks appears to be far from continuous in time, but confined by the dynamics of short-term local and global metastable brain states. The article closes by suggesting some of the implications of (...) this view in future multidisciplinary brain research. (shrink)

In our contribution we will observe phenomenal architecture of a mind and operational architectonics of the brain and will show their intimate connectedness within a single integrated metastable continuum. The notion of operation of different complexity is the fundamental and central one in bridging the gap between brain and mind: it is precisely by means of this notion that it is possible to identify what at the same time belongs to the phenomenal conscious level and to the neurophysiological level of (...) brain activity organization, and what mediates between them. Implications for linguistic semantics, self-organized distributed computing algorithms, artificial machine consciousness, and diagnosis of dynamic brain diseases will be discussed briefly. (shrink)

: This article begins with a discussion of persistent vegetative state (PVS), focusing on concerns related to both diagnosis and prognosis and paying special attention to the 1994 Multi-Society Task Force report on the medical aspects of PVS. The article explores the impact of diagnostic and prognostic uncertainties on prospective thinking regarding the possibility of PVS and considers the closely related question of how prospective thinkers might craft advance directives in order to deal most effectively with this possibility.

Research on electroencephalogram (EEG) characteristics associated with major depressive disorder (MDD) has accumulated diverse neurophysiologic findings related to the content, topography, neurochemistry, and functions of EEG oscillations. Significant progress has been made since the first landmark EEG study on affective disorders by Davidson 35 years ago. A systematic account of these data is important and necessary for building a consistent neuropsychophysiologic model of MDD and other affective disorders. Given the extensive data on frequency-dependent functional significance of EEG oscillations, a frequency (...) domain approach may reveal the types of brain functions involved and disturbed in MDD. In this review, we systematize and integrate diverse and often unconnected observations on the content, topography, neurochemistry, and functions of EEG oscillations involved in MDD within the general concept of an EEG oscillatory pattern. (shrink)

The panoply of cognitive, affective, motivational, and social functions that underpin everyday human experience requires precisely choreographed patterns of interaction between networked brain regions. Perhaps not surprisingly, diverse forms of psychopathology are characterized by breakdowns in these interregional relationships. Here, we discuss how functional brain imaging has provided insights into the nature of brain dysconnectivity in mental illness. Synthesizing work to date, we propose that genetic and environmental risk factors impinge upon systems-level circuits for several core dimensions of cognition, producing (...) transdiagnostic symptoms. We argue that risk-associated disruption of these circuits mediates susceptibility to broad domains of psychopathology rather than discrete disorders. (shrink)

Dr. Vukov analyzing patients with disorders of consciousness, proposed that medical well-regarded policy recommendations cannot be justified by looking solely to patients’ actual levels of consciousness (minimally conscious state – MCS versus vegetative state – VS), but that they can be justified by looking to patients’ potential for consciousness. One objective way to estimate this potential (actual physical possibility) is to consider a neurophysiologically informed strategy. Ideally such strategy would utilize objective brain activity markers of consciousness/unconsciousness. The Operational Architectonics (OA) (...) theory of brain-mind functioning is an example of such a strategy. Besides being mathematically simple, neurophysiologically accurate, and compatible with the cognitive/phenomenal perspectives on consciousness, application of OA strategy to quantitative EEG analysis of patients in VS and MCS revealed that the absence of consciousness in VS is paralleled by impairment of overall EEG operational architecture. Specifically, neuronal assemblies become smaller, their life span shortened, and they became highly unstable and functionally disconnected (desynchronized). At the same time, fluctuating (minimal) awareness in patients in MCS was paralleled by partial restoration of EEG operational architecture (increased size, life span, and stability of neuronal assemblies, together with an increased number and strength of functional connections among them), approaching the level found in healthy fully conscious participants. Moreover OA strategy to EEG analysis allowed predicting the emergence of consciousness in VS patients after six years following the brain trauma. Therefore, the OA methodology could reliably predict which patients may regain consciousness, and thus determine which patients may have the potential for consciousness. (shrink)