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

beats/min or an RRR above 15 breaths/min is indicative of the neuronal hyperexcitability trait. Parenthetically, in the more than 100 consecutive outpatients that have been studied thus far, resting heart and respiratory rate measurements have proven to be more sensitive in detecting the neuronal hyperexcitability trait than formal clinical assessments. VII. D iscussion The goal of this review was to address the question that every behavioral health clinician faces— that of deciding whether a patient should be treated with psychotherapy, medical therapy, or a combination of the two. Short of an objective way for either the patient or the clinician to make this determination, self-referral is generally the decisive factor in determining which type of therapy a patient receives, at least initially. As discussed earlier, this is potentially faulty because most patients have limited insight into the psychophysiological underpinnings of their distress, and even experienced clinicians are often unable to tell how much of the patient’s distress is rooted in psychological factors and how much is rooted in biological factors. However, the idea that the inherited trait of neuronal hyperexcitability can drive the same symptoms as purely psychological factors, taken together with the idea that the trait can be identified through resting vital-sign measurements, has the potential to objectivize, for the first time, which type of therapy—psychological or biological—a patient should receive. It also has the potential to determine what percentage of patients who present for behavioral health services are carriers of the neuronal hyperexcitability trait. Under the current system of referral and treatment selection, many patients may be receiving the wrong type of therapy. Some may be receiving psychotherapy when they should be receiving medical therapy, and some may be receiving medical therapy when they should be receiving psychotherapy. There may also be some who are receiving one form of therapy or the other when in fact they should be receiving both forms of therapy simultaneously. Also, because the neuronal hyperexcitability trait continues to be so elusive, some patients may be receiving the wrong type of medication [71, 87, 117]. Fortuitously, all of this could be about to change with the growing recognition that resting vital-sign measurements offer an objective way to determine which form of treatment a patient should receive. Beyond that, recognizing neuronal hyperexcitability as the core abnormality in mental illness could bring with it a highly treatable biological target. This too would be a first in psychiatry because the current system of diagnosis and treatment is symptom-based rather than pathology-based. Guided by the MCNH hypothesis, any patient who was determined, based on resting vital-sign measurements, to have a hyperexcitable brain could first be educated about the natural ways to calm the brain, such as stress reduction, establishment of an early sleep schedule, regular exercise, and the other lifestyle habits that were discussed earlier. Patients with moderate-to-severe symptoms could also be offered anticonvulsant therapy, as the degree of improvement achieved through lifestyle changes alone is typically limited to about 20%. Anticonvulsants, which, based on their putative mechanism of action, could more aptly be called “neuroregulators” [118], go right to the root of the problem. They reduce the excitability of the neurological system, thereby compensating for the gene abnormality that is believed to underlie the neuronal hyperexcitability trait. Moreover, unlike commonly prescribed medications, such as antidepressants, psychostimulants, and antipsychotics, all of which alter the activity of specific receptors and circuits in the brain, neuroregulators simply normalize brain function. This is a healthier approach because the brain, in most of the common psychiatric disorders, is not misfiring but rather over-firing. Hence, if a given neuroregulator were ineffective at reducing symptoms, it could appropriately be replaced with another neuroregulator rather than switching to a different class of drugs; and if one neuroregulator were only partially effective, a second one could be added, and so on. This approach, which could be called “focused neuroregulation” [119], would optimize the effectiveness of neuroregulators and minimize the need for medications that can have unpredictable, conflicting, and sometimes paradoxical effects [7, 72, 117]. As for those patients whose resting vital signs fell below the minimum cutoffs, psychotherapy alone could be recommended as first- line treatment. In such cases, the therapy would be addressing a problem that was fundamentally psychological rather than just helping a patient cope with a problem that was fundamentally neurological. Thus, the MCNH hypothesis in conjunction with resting vital-sign measurements has the potential to fast-track patients to the most efficient and effective treatment approach. Moreover, because resting vital signs can be measured in the comfort of one’s own home, prospective patients would be able to perform the initial screening themselves. In an era of cellphones, smart watches, and a host of new health-tracking devices, this triage system could not be any easier or more practical. VIII. D irections for F uture R esearch Urgently needed are clinical studies aimed at determining the effectiveness of focused neuroregulation in those patients who, irrespective of their DSM diagnosis, present with an RHR above 75 beats/min or an RRR above 15 breaths/min. This approach would allow researchers to circumvent the problem of overlapping and co-occurring diagnoses 10 Year 2023 Global Journal of Medical Research Volume XXIII Issue III Version I ( D ) A © 2023 Global Journals Untangling Psychology from Biology in the Treatment of Psychiatric Disorders