Open Journal of Depression 2014. Vol.3, No.1, 5-8 Published Online February 2014 in SciRes (http://www.scirp.org/journal/ojd) http://dx.doi.org/10.4236/ojd.2014.31003 Psychiatric Doubts Massimo Cocchi1,2, Lucio Tonello1, Fab io Gabrielli1 1Institute “Paolo Sotgiu” for Research in Quantitative & Quantum Psychiatry & Cardiology, L.U.de.S. University, Lugano, Switzerland 2Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy Email: massimo.cocchi@unibo.it Received November 16th, 2013; revised December 30th, 2013; accepted January 9th, 2014 Copyright © 2014 Massimo Cocchi. This is an open access article distributed under the Creative Commons At- tribution License, which permits unrestricted use, distribution, and reproduction in any med i u m, provided the original work is properly cited. In accordance of the Creative Commons Attribution License all Copyrights © 2014 are reserved for SCIRP and the owner of the intellectual property Massimo Cocchi. All Copyright © 2014 are guarded by law and by SCIRP as a guardian. Introduction This decade has clocked the review of the new DSM, the fifth in the seri es, the instrument considered the “bible” of psy- chiatry worldwide. The document, which is accomplished today, reveals firmly rooted in traditional conservative psychiatry, ignoring the pro- gress made by the biological research field. Clearly , the dicho- tomy between conservative and progressive psychiatry is not over despite the efforts of the scient ific research in the fields of psychiatry, brain, neurotransmitters, and quantum computation of the brain and consciousness, i.e., the disciplines that belong to neuroscience. It seems correct, from the point of view of ethics, to remember how it is difficult to think of the research in psychiatry as completely independent of influe nti al externa l fac- tors. Recent Major Events in Psychiatry Recently, some major events have paved the way for an in- novative and deeply critical school of thought which started questioning, at a high intellectual and scientific level, the ideo- logical implications of psychiatric diagnosis and the increasing complexity of the nuances in the classification of the psychia- tric disorder. This movement supports the idea of using biolog- ical markers in order to get a reliable diagnosis and appropriate care in the first place, limiting in this way the long-standing psychiatric error in the distinction between bipolar disorder and major depression [1], which ranges today from 40% [1] to 70% (Tenth World Day for the Prevention of Suicide, Rome, 2012). The fifth edition has bee n criticized by a number of authori- ties, even before it was fo rmally published. The main thrust of criticism has been that changes in the DSM have not ke pt pace with advances in scientific understanding of psychiatric dys- function. Another criticism is that the development of DSM-5 was unduly influenced by input from the psychiatric drug in- dustry. A number of scientists have objected that the DSM forc- es clinicians to make distinctions that are not supported by solid evidence, distinctions that have major treat ment implications, including drug prescriptions and the availabi lity of health in- surance coverage. The National Institute of Mental Health in the person of its Director Dr. Thomas R. Insel expresses the following opinions on the new DSM-5 in the course of an interview to the New York Times (2013): …the manual, whi ch will be published in coming weeks, has a scientific “lack of validity.”… …the manual is the best tool that physicians have at this time, but that is doesn’t reflect how complex many mental disorders are… “As long as the research community takes the DSM to be a bible, we’ll never make progress,” “People think that everything has to match DSM criteria, but you know what? Biology never read that book.” …the National Institute of Mental He alth w ill move away from DSM-5—which he likens to a “dictionary” rather than a bible… …“In the rest of medicine, this would be equivalent to creat- ing diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, sympt om-based diagnosis, once com- mon in other areas of medici ne, has been largely replaced in the past half centu ry as we have understood that symptoms alone rarely indicate the best choice of treatment. Patients with mental disorders deserve better.”… The following sentences were written, as reported in full, in 2010 [2], when there was still a lot of skepticism about the possibility to distinguish between major depression and bipolar disorder thanks to biochemical and molecular evaluations, and there was no official position on the recognition of the biologi- cal markers of “Depression”, which was nonetheless at the ho- rizon: “The need for a deep, radical turning point in the world of psychiatry is rapidly growing. Present diagnostic methods can- not continue to be considered acceptable because they are al- most completely based on the psychiatrist's opinion, whic h does not have an objective diagnostic technology and thus has a very high error rate. A debate is essentia l between the advocates of traditional diagnostic and therapeutic methods and advocates of emerging methods resulting from new discoveries. Major de- pressive disorder and other related and nonrelated psychiatric conditions are still characterized and defi ned by descriptive and non-biological criteria, but it is hoped that we can ade- quately characterize this and other psychiatric disorders with the addition of new quantitative approaches”. However, leading scientists commented on the first results OPEN ACCESS 5
M. COCCHI ET AL. obtained in 2008 [4] as reported by an interview to Kary Mullis (Nobel Prize for PCR , 1993) a nd Stuart Hameroff (Mullis KB: Interview by Marco Pivato. Ma la depressione è nel sangue. Newspaper: La Stampa, insert: TuttoScienze 2008:5. Hameroff SR: Interview by Marco Pivato. Ma la depressione è nel sangue . Newspaper: La Sta mpa, insert: TuttoScienze 2008:5): “These possibilities represent a genuine revolution not only in psychiatry but more generally in the worlds of neuroscience and medicine”. Many fundamental scientific works of biological approach to psychiatric illnes s have been produced in the last thirty yea rs. The relationship between platelet and serotonin and the recog- nition that pla telet s are considered neuron ambassadors and that they simula te the behavior of the neuron has been addressed in detail by several authors [3-13]. Observed changes in the serotonergic and microtubular sys- tems in the hippocampus following restraint st r ess confirm the structural [14,15] and biochemical [16] vulnerability of this area to stressful conditions. Cytoskeletal changes represent a potential new pathway that may increase our understanding of psychiatric disorders. The question of whether or not changes in 5-hydroxytryptamine (5-HT)-serotonin levels are related to changes in the expression of tubulin needs to be assessed by future studies [17]. Already in 1980 it has been shown a rela- tionship between serotonin receptors and lipid membrane fluid- ity [18,19]: as the membrane lipids become more viscous, the specific binding of serotonin increases steadily. Signal trans- duction, either through activation of adenylate cyclase by the li- gand-receptor complex or by microaggregation of ligand-recep- tor complexes, is associated with lateral movements of compo- nents of the membra ne which are determined, at least partially, by lipid fluidity. The international scientific literature has reported abnormali- ties in the cAMP signalling cascade of the human brain in sui- cidal and depressive subjects for over two decades [20-27]. Similarity between humans and pigs in terms of mutual in- clination to mood disorders is the r ecen tly investigated field [28] concerning puerperal psychosis. Parturition can trigger extreme behavioral disturbances in both women and sows and this can lead, in extreme cases, to infanticide/piglet savaging. Studies have pointed out the existence in both species of a pool of pos- sible genes responsible for the disease. According to Donati et al. [29] there is a further possible condition: the position of Gα (Gsα in particular) within the lipid raft microdoma in and, sinc e it is well known tha t Gsα protein and tubulin have a connexion [30] it is reasonable to raise the question of a possible link to consciousness according to Ha- meroff-Penrose Orch the ory [31,32]. All the se results, togethe r with the many others not cited, could have had practical use and be of great interest in more than one scientific field of applica- tion e.g, in the stu dy of new drugs for psychiatric disorders and in the diagnostic evaluation of depressive disorders. Previously, reference was made to the quantum computation of brain and consciousness, which is likely to emerge strongly in the near future for the scientific understanding of many phe- nomena related to brain activity and major psychiatric disorders, especially mood disorders. Two other recent events have advanced hypotheses about the need for a fundamental overhaul of the psy chiatr ic disorder and consciousness, “the Declaration of Palermo” (2013) and “the Declaration of Cambridge” (2012). “The Declaration of Palermo” A core international group of investigators, offering exper- tise in the fields of psychiatry, biochemistry , physics, computa- tional neuroscience, mathematics, philosophy and theology, ga- thered in Palermo, Sicily, under the auspices of the global QPP (Quantum Paradigm Psychopathology Group) initiative with the aim of assessing the potenti al rel evance of quantum physics and quantum chemistry to mind-brain relations in normal and abnormal states of consciousness applicable to humans and non-human animals. The Declaration of Palermo was written by Dona ld Mender and Ma ssimo Cocchi and edited by: Don Michele Aramini, Gu- stav Bernroider, Francesco Cappello, Fabio Gabrielli, Gordon Globus, Mansoor Malik, Efstratios Manousakis, K ary Mullis, Eliano Pessa, Massimo Pregnolato, Paavo Pylkkänen, Mark M. Rasenick, Lucio Tonello, Jac k Tuszynski, Giuseppe Vitiello, Ursula Werneke, Paola Z izzi. The stateme nt is a prime example of reflection between the quantitative aspects and quantum brain function and the ability to improve therapies in psychiatric disorders concluding: “Even the absence of highly complex synaptic connections among neurons does not preclude the presence of at least ru- dimentary phenomenal experience in organisms endowed with superposed microtubular dimers, orde red water, me mbrane ion channels, and/or crucial lipid raft assemblie s connected to selected second messenger systems. In addition, quantum-bio- physical aspects of these and/or other yet undiscovered struc- tures and related processes may prove to be potent factors in the deeper etiologies and improved treatments of psychiatric disorders.” “The Declaration of Cambridge” actually unties the concept of consciousness from the abstraction of the old psycho-philo- sophical custom and recognizes that each animal forms the self-determination of a conscious state even in the absence of structural complexities of the central nervous syste m, conclud- ing: …“The absence of a neocortex does not appear to preclude an organism from experiencing affective states. Convergent evidence indicates that non-human animals have the neuroa- natomical, neurochemical, and neurophysiological substrates of conscious states along with the capacity to exhibit intention- al behaviors. Consequently, the weight of evidence indicates that humans are not unique in possessing the neurological sub- strates that gene ra te consciousness. Nonhuman animals, in- cluding all mammals and birds, and many other creatures, in- cluding octopuses, also possess these neurological substrates. ” “The Cambridge Declaration” on Consciousness was written by Philip Low and edited by Jaak Panksepp, Diana Reiss, Da- vid Edelman, Bruno Van Swinderen, Philip Low and Christof Koch. The Decla ratio n was publicly proclaimed in Cambridge, UK, on July 7, 2012, at the Francis Crick Memorial Conference on Consciousness in Human and non-Human Animals, at Chur- chill College, University of Cambridge, by Low, Edelman and Koch. This collection of recent events and advances in biological knowledge of the psychiatric field leads to reflections that , ne- cessarily, affect the bioethical evaluations that r elate to the psy - chiatric patient in his relationship of extreme fragility with the doctor, but also of the doctor with respect to the patient. Psychiatry is facing today, albeit with resistance and difficul- ties, a historical contingency that, probably, in the years to come, will be remembered as the turning point t hat opened up a new dimension of scientific psychiatry and a different relation- OPEN ACCESS 6
M. COCCHI ET AL. C Co oc cc ch hi i H Ha am me er ro of ff f M Mu ul ll li is s R Ra as se en ni ic ck k T To on ne el ll lo o M Mo ol le ec cu ul la ar r H Hy yp po ot th he es si is s o of f C Co on ns sc ci io ou us sn ne es ss s, , 2 20 00 08 8 C Co on ns sc ci io ou us sn ne es ss s Q Qu ua an nt tu um m C Co om mp pu ut ta at ti io on n L Li in ne ea ar r M Ma at th he em ma at ti ic c M Mo od de el l N No on n L Li in ne ea ar r M Ma at th he em ma at ti ic c M Mo od de el l R Ra af ft t L Li ip pi id d M Mi ic cr ro od do om ma ai in n M Me em mb br ra an ne e F Fa at tt ty y A Ac ci id ds s Figure 1. The road map of the major molecular connection which can be considered for the better under- standing of the ma j o r psychiatric disorders (Major Depression and Bipolar Disorder) up to con- sciousness involving the Quantum Chemical Scale of Neural Signals. ship with the patient. In this regard, we must recognize that there is, t oda y, the im- perative need for new approaches to psychiatric diagnosis and for a new ethic al and philosophical evaluation of human being recognizing as essential some aspects of the psychiatrist-patient relationship: • Priority of the biological fact with respect to symptom • Embedding of biological data in the experiences of the pa- tient and in the social and cultural expressions of the dis- ease (disease, illness, sickness). • Integration of psychiatry with other disciplines, against any form of ontologic a l re duc ti onism (need, for example , t o make reference to philosophy as transversal knowledge and to complexity of quantum physics and mathematics as inesca- pable survey instruments). • Need for rooting of the disease in the socio-anthropological dynamics in place, to assess the gradual nature and texture of their impact on the disorder (the classifications are never pure). • Revisiting the concept of patient-physician relationship and of empathy in the light of the acquisitions of neuroscience, cognitive science, philosophy of mind. • Designing courses for psychiatrists on the philosophy of the person, the anthropology of pain, the phenomenology of care. 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