Global Journal of Medical Research, A: Neurology & Nervous System, Volume 23 Issue 3

the aftermath of the seizure. It is now recognized that seizures are brought to a halt by a host of neuroinhibitory changes that occur in response to the seizures themselves. Known inhibitory mechanisms include glutamate depletion, GABAergic recurrent inhibition, membrane shunting, depletion of energy stores, loss of ionic gradients, endogenous neuromodulator effects, and regulatory input from various brain regions [23]. Hypothetically, this cascade of neuroinhibitory responses explains why ECT is an effective treatment for status epilepticus [24, 25]. Also, based on the known psychotherapeutic effects of calming the brain, the need for a cumulative effect could explain why a course of several ECT treatments is typically needed to achieve a substantial and lasting reduction of psychiatric symptoms. Since its introduction in the late 1930s, the use of ECT has expanded to bipolar disorder, delusional disorder, obsessive- compulsive disorder, schizophrenia, schizoaffective disorder, catatonic states, and neuroleptic malignant syndrome [26], thus reiterating the wide-ranging therapeutic effects of calming the brain and suggesting that many psychiatric disorders could have a shared pathophysiology. b. Repetitive Transcranial Stimulation (rTMS) As one of the newest techniques for treatment- resistant depression, rTMS uses electromagnetic induction to non-invasively depolarize or hyperpolarize neurons in the brain. Consistent with the idea that specific neurological processes affect the corresponding cognitive-emotional processes, rTMS is thought to exert its therapeutic effects by modulating the activity of specific neuronal circuits [27]. c. Deep Brain Stimulation (DBS) Also known as “brain pacemaker,” DBS involves the selective stimulation of specific brain areas via an implanted electronic device. The technique is thought to exert its therapeutic effects by correcting the firing imbalances of neuronal circuits that are believed to be associated with the patient’s symptoms. Thus, for example, in severe intractable depression, symptoms are thought to be relieved by stimulating brain areas that would normally be more active in non-depressed persons. This mimics the effects of psychotropic drugs and rTMS in that it modulates neuronal signaling. d. Vagus Nerve Stimulation (VNS) VNS is another “pacemaker” technique that involves the surgical implantation of electrodes (in this case into the chest) to stimulate specific circuits in the brain. It is used in the treatment of seizure disorders, mood disorders, and chronic pain that is resistant to pharmacotherapy. After the VNS device is inserted under the skin, a wire is connected to the vagus nerve in the neck. Through this connection, the neurostimulator delivers thirty-second pulses of electricity to the vagus nerve, which feeds into the solitary tract nucleus. Affarrents of the solitary tract increase the activity of the inhibitory neurotransmitter GABA while at the same time reducing the activity of the excitatory neurotransmitter glutamate. Solitary tract affarrents also promote norepinephrine signaling via projections to the locus coeruleus and amygdala [28]. This combination of effects is thought to explain the therapeutic effects of VNS in treatment-resistant depression. e. Stellate Ganglion Block (SGB) SGB is now being used to treat a number of conditions, including complex regional pain syndrome, high blood pressure, and some psychiatric disorders, particularly post-traumatic stress disorder [29]. The stellate ganglion is present in approximately 80% of the general population and is composed of the inferior cervical ganglion and the first thoracic ganglion fusion. It is located posteriorly in the neck at the level of the seventh cervical vertebra. SGB involves anesthetizing the stellate ganglion so as to reduce the sympathetic outflow that is relayed through it. In so-doing, the ratio of sympathetic-to-parasympathetic output is reduced, thus helping to quell the flight-or-flight response. As with nearly all of the aforementioned medical interventions, symptom reduction occurs in association with calming the nervous system, thus reiterating the therapeutic value of neuroinhibition in the treatment of psychiatric symptoms. III. A N ew W ay of C onceptualizing M ental I llness a) Anatomical and Functional Relationship Between the Mind and the Brain With the birth of neuroscience, the historical idea that the soul was the seat of thoughts and emotions was replaced with the reductionist idea that thoughts and emotions were the products of complex brain function. However, a burgeoning number of eye- witness reports and testimonials from around the world is beginning to reawaken the idea that consciousness is possible both in conjunction with and independent of brain function. There are now millions of people from diverse ethnic, cultural, and religious backgrounds who claim to have had vivid out-of-body experiences during a close brush with death or, in some cases, an actual pronouncement of death [30-35]. During these so-called near-death experiences (NDEs), those who have had them claim to have left their physical bodies and continued to think, perceive, and remember things that, based on the reductionist view, would have been physically impossible [30-35]. Moreover, many of these accounts have been corroborated by factual information that the NDErs could not possibly have known had they not actually separated from their physical bodies and retained their cognitive, sensory, and memory functions [30-35]. The evidence is now so strong that, in 2022, the New York Academy of Sciences published a 4 Year 2023 Global Journal of Medical Research Volume XXIII Issue III Version I ( DD ) A © 2023 Global Journals Untangling Psychology from Biology in the Treatment of Psychiatric Disorders