What's the difference between neurological disorders in the brain and mental illnesses?

Brain , Neurological , Mental , Illness , Neuroplasticity

- There is a spectrum between things that very clearly fall into the neurological disorder category, such as ALS or Brain tumors. However, the connection between what are considered functional disorders with a “normal” brain and “biological “ disorders is extremely difficult and perhaps impossible to untangle. If someone has distortions of perception and mood, is their brain working normally?

The brain is , among other things, our primary interface with the environment, the other being the immune system, which interfaces with microbial environment, both of which arise from the same embryonic tissue. There is ample evidence that the environment causes physical as well as functional changes to the brain.

Some concrete examples include lasting alterations in opiate receptors expressed on neurons ( increased methylation) that persist for decades after someone has managed to stay clean and sober after being addicted to opiates. This change is most likely due to epigenetic alterations, which are physical and real.

On the flip side, even the most seemingly “physical, neurological” conditions can have a “psychiatric” component. The vast majority of patients who present with pseudoseizures ( behavior that mimics a genuine seizure, but in the presence of a normal EEG) also have a history of genuine seizures. There is very clear evidence that a subset of OCD “psychiatric” patients have OCD due to an autoimmune response to a streptococcal infection (PANDAS) , but are they still psychiatric patients?

“Psychological” issues like trauma and PTSD and Panic Disorder clearly have a physical component that is very real. If exposure to a traumatic cue causes your heart rate to go up to 160 , your blood pressure to skyrocket, and you wind up getting a stroke, having the doctor say it was functional and due to “stress” is not likely to be helpful.

There is mounting evidence that experience changes the brain through epigenetic and other physical factors. The promising part of this is that both medication and environmental manipulations like therapy have potential to have “real” changes.

psychiatry , Psychology , Behavior , Depression , Neuroplasticity

Further, it’s really not possible to separate psychiatry from medicine on a rational basis. The brain is an organ that is part of the body and they are connected- not through mystic crystal revelations, but by proven mechanisms such as nerves and hormones, which are quite real.

An example would be the clear relationship between “stress” ( in the scientific sense of moving an organism away from homeostasis) and depression. Actually , there is some evidence of how this works rather than just saying being “stressed out” causes depression.

There is good evidence that chronic unremitting stress causes increased cortisol secretion from the adrenals, this causes decreased metabolism in the DLPFC ( the part of the brain associated with executive functioning and low activity being associated with depression). But wait, there’s more , quite a bit more and it’s important- persistent high cortisol levels along with impaired DLPFC function often lead to insulin resistance and increased levels of inflammation.

Insulin Resistance is also linked to decreased neuroplasticity, and decreased DLPFC function and decreased levels of serotonin, NE, and dopamine. Both insulin resistance and increased cortisol levels can lead to impaired sleep, which pushes the dysregulation of the metabolism and HPA axis along further. AND, there is evidence that chronic inflammation and insulin resistance are linked to a marked increase in risk of stroke and dementia, which of course are physical, not psychiatric diseases, right? Also, increased Insulin resistance is linked to heart disease, which the number one cause of death in the US, but is not neurologic or psychiatric , supposedly.

Studies have shown good evidence that GLP-1 receptor antagonists are neuroprotective and increase activity in the DLPFC and improve sleep and possibly depression- but they are FDA approved for treatment of Diabetes. And , BTW, they reduced risk of stroke and heart attack by about 40% in a recent large New England Journal of Medicine study.

The above is a vast oversimplification of what is going on, but has some “trutheyness” and my point is that understanding there is no untangling of the brain/mind/body. But this is a good thing because it raises the possibility of different health care specialists actually working together coherently to improve health and well-being.

For example, using one marker of inflammation in the body that is correlated with risk of heart attack, stroke and depression, the C-reactive protein, studies have shown that while statins bring down CRP, so does exercise, diet, yoga, being part of a socially supportive network among other non medication interventions.

So there really is an evidence based, science based approach to “integrative or holistic” medicine and it has actually been around a while started by scientists like Hans Selye in medicine and Walter Cannon in psychology.

Sadly, this evidence based approach, likely to be quite helpful both in the long and short run of improving health, preventing both “mental” and physical illness has been neglected. Traditional medicine, ( my field of psychiatry perhaps being the saddest example) has run off into ultraspecialized mechanistic approaches,

Meanwhile, to tell it like it is, TV hucksters and quacks trying to sell their own particular snake oil have taken genuine evidence based integrative approaches and distorted them into dangerous nonsense fed by the profit motive just as surely as big pharma.

While there is a real evidence based approach, the idea that some supplement to “clean your liver” ( a liver is not a kitchen floor, it does not need cleaning, trust me) or promising a 2 week lemon juice and cayenne pepper will cure you is fraud and endangering lives. This is very, very real, for example, while high dose statins can cause problems and it’s best to control cardiac risk factors with no statins or minimal statins, there is evidence that false information about statins has in fact caused thousands of preventable deaths from stroke and heart disease among patients frightened away from taking their medication.

All this is a lot more complex than taking fish oil each morning, but its getting at the truth and a genuine way to improve medicine and health. IMHO

Also if you are wondering why so many people are dissatisfied with their medical and psychiatric care- this might be a good place to look. Some physicians use this approach, which is grounded in evidence and science.