Towards multiple interactions of inner and outer sensations in corporeal awareness

Under normal circumstances, different inner- and outer-body sources are integrated to form coherent and accurate mental experiences of the state of the body, leading to the phenomenon of corporeal awareness. How these processes are affected by changes in inner and outer inputs to the body, remains unclear. Here, we aim to present empirical evidence in which people experiencing a massive sensory disconnect may continue to experience feelings of their body state, suggesting that misperceptions of body awareness are determined by incomplete inner and outer signals. In these clinical populations, despite a long period of massive deafferentation, the activity of the neural structures subserving inner and outer body processing can be manipulated and tuned by means of body illusions that are usually based on multisensory stimulation. We suggest that a multisensory therapeutic approach could be adopted in the context of therapies for patients suffering from deafferentation. In this way, these individuals could regain a more complete feeling of their body state and the sensations they experience, which vary widely depending on their neurological condition

Meditation Experiences, Self, and Boundaries of Consciousness

Our experiences with the external world are possible mainly through vision, hearing, taste, touch, and smell providing us a sense of reality. How the brain is able to seamlessly integrate stimuli from our external and internal world into our sense of reality has yet to be adequately explained in the literature. We have previously proposed a three-dimensional unified model of consciousness that partly explains the dynamic mechanism. Here we further expand our model and include illustrations to provide a better conception of the ill-defined space within the self, providing insight into a unified mind-body concept. In this article, we propose that our senses “super-impose” on an existing dynamic space within us after a slight, imperceptible delay. The existing space includes the entire intrapersonal space and can also be called the “the body’s internal 3D default space”. We provide examples from meditation experiences to help explain how the sense of ‘self’ can be experienced through meditation practice associated with underlying physiological processes that take place through cardio-respiratory synchronization and coherence that is developed among areas of the brain. Meditation practice can help keep the body in a parasympathetic dominant state during meditation, allowing an experience of inner ‘self’. Understanding this physical and functional space could help unlock the mysteries of the function of memory and cognition, allowing clinicians to better recognize and treat disorders of the mind by recommending proven techniques to reduce stress as an adjunct to medication treatment

Psychophysiology of respiratory disease : clinical considerations for the advanced practice nurse

The purpose of this article is to describe the psychophysiology of dyspnea in chronic obstructive pulmonary disease (COPD), identify the unique impact of respiratory disease on the female patient, and discuss the relationship of anxiety and depression in disease manifestation. Current COPD assessment and treatment guidelines published by the United States Department of Health and Human Services, the World Health Organization as well as the National Institute for Health and Care Experience (NICE) will be presented along with implications for the Advanced Practice Nurse (APN). Practitioners treat COPD patients with advanced physiological complications along with psychological comorbidities that worsen the disease perception and progression. Therefore, a recommendation will be made to integrate assessment and evaluation of psychological comorbidities in COPD patients, with particular consideration given to the female patient. Utilizing a holistic, int egrated treatment plan will serve to enhance patient care, alleviate disease burden and impact overall quality of life in the patient with COPD.peer-reviewe

Towards a comprehensive assessment of interoception in a multi-dimensional framework

Interoception has historically been assessed using behavioural tests of accuracy, self-report measures or through the characterisation of neural signals underlying interoceptive processing. More recent conceptualisations of interoception incorporate interoceptive attention and higher-order measures related to the interpretation of interoceptive signals. At present, these interoceptive dimensions are largely assessed in isolation, yet this fails to capture the complexity of interoception. Comprehensive assessment across interoceptive dimensions can determine the full operation of general interoceptive function. Current work suggests that these interoceptive processes may be dissociable across dimensions and bodily axes, with differential mapping to cognitive and emotion processing. To characterise differences in interoceptive profiles, all interoceptive dimensions can be assessed within individuals, both within a single bodily axis (e.g., cardiac) or across bodily axes. Future work can better delineate how these interoceptive measures correspond to different types of processing. Comprehensive interoceptive assessment can help isolate selective interoceptive disruptions in different clinical conditions

Neural Processing of Respiratory Sensations when Breathing Becomes More Difficult and Unpleasant

The accurate perception of respiratory sensations is important for the successful management and treatment of respiratory diseases. Previous studies demonstrated that external stimuli such as affective pictures and distracting films can impact the perception and neural processing of respiratory sensations. This study examined the neural processing of respiratory sensations when breathing as an internal stimulus is manipulated and becomes more difficult and unpleasant. Sustained breathing through an inspiratory resistive load was used to increase perceived breathing difficulty in 12 female individuals without respiratory disease. Using high-density EEG, respiratory-related evoked potentials (RREP) to short inspiratory occlusions were recorded at early versus late time points of sustained loaded breathing. Ratings of perceived intensity and unpleasantness of breathing difficulty showed an increase from early to late time points of loaded breathing (p < 0.01 and p < 0.05, respectively). This was paralleled by significant increases in the magnitudes of RREP components N1, P2, and P3 (p < 0.01, p < 0.05, and p < 0.05, respectively). The present results demonstrate increases in the neural processing of respiratory sensations when breathing becomes more difficult and unpleasant. This might reflect a protective neural mechanism allowing effective response behavior when air supply is at risk

DYSPNEA FROM NEUROPSYCHYATRIC PERSPECTIVE: A NARRATIVE REVIEW

Dyspnea or breathlessness is a term primarily used in respiratory medicine. Nevertheless, in the last fifteen years, studies from other fields focus on the affective component of this complex phenomenon due to the frequent observation that psychological states can cause or be caused by dyspnea. Research so far shows that besides the biological component, dyspnea has a strong emotional and psychosocial determinant. This means that apart from its biological factors, dyspnea and its intensity are affected by emotions, personality, anxiety and depression, etc. Individuals with psychiatric disorders, in the same conditions, will evaluate their dyspnea as more intense and disturbing compared to individuals without psychiatric comorbidity. Emotional states in healthy individuals can amplify the sense of dyspnea which is of extreme importance for clinical practice in order to consider the whole person and not just the symptom which is being presented. Also, dyspnea seems to be frequent complaint in some groups of patients with psychiatric disorders (e.g.panic disorder), where the fear of suffocation is presented as clinical symptom. Further research of dyspnea as a complex, multicomponent phenomenon, can contribute to better treatment options and better differential diagnosis concerning possible psychiatric background of physical symptoms

MIND-BODY RESPONSE AND NEUROPHYSIOLOGICAL CHANGES DURING STRESS AND MEDITATION: CENTRAL ROLE OF HOMEOSTASIS

Stress profoundly impacts quality of life and may lead to various diseases and conditions. Understanding the underlying physiological and neurological processes that take place during stress and meditation techniques may be critical for effectively treating stress-related diseases. The article examines a hypothetical physiological homeostatic response that compares and contrasts changes in central and peripheral oscillations during stress and meditation, and relates these to changes in the autonomic system and neurological activity. The authors discuss how cardiorespiratory synchronization, which occurs during the parasympathetic response and meditation, influences and modulates activity and oscillations of the brain and autonomic nervous system. Evidence is presented on how synchronization of cardiac and respiratory rates during meditation may lead to a homeostatic increase in cellular membrane potentials in neurons and other cells throughout the body. These potential membrane changes may underlie the reduced activity in the amygdala, and other cortical areas during meditation, and research examining these changes may foster better understanding of the restorative properties and health benefits of meditation

Mirtazapine for chronic breathlessness? A review of mechanistic insights and therapeutic potential

Introduction: Chronic breathlessness is a common and distressing symptom of advanced disease with few effective treatments. Central nervous system mechanisms are important in respiratory sensation and control. Consequently, drugs which may modify processing and perception of afferent information in the brain, may have a role. Antidepressants have been proposed, however current evidence is limited. Of potentially suitable antidepressants, mirtazapine is an attractive option given its tolerability profile, low cost and wide availability, along with additional potential benefits.Areas covered: The paper provides an overview of the physiology of breathlessness, with an emphasis on central mechanisms, particularly the role of fear circuits and the associated neurotransmitters. It provides a potential rationale for how mirtazapine may improve chronic breathlessness and quality of life in patients with advanced disease. The evidence was identified by a literature search performed in PubMed through to October 2018.Expert commentary: Currently, there is insufficient evidence to support the routine use of antidepressants for chronic breathlessness in advanced disease. Mirtazapine is a promising candidate to pursue, with definitive randomised controlled trials required to determine its efficacy and safety in this setting

Relationship between respiratory, endocrine, and cognitive-emotional factors in response to a pharmacological panicogen

Background : The cholecystokinin agonist pentagastrin has been used to study panic attacks in the laboratory and to investigate hypothalamic–pituitary–adrenal axis activity. Its mechanism of panicogenesis remains unclear. Data from other models suggest that respiratory stimulation itself may induce panic, but pentagastrin's effects on respiration are not well established. Data from another model also suggest links between respiratory and HPA axis reactivity and cognitive modulation of both. To further explore these phenomena, we added respiratory measures to a study of cognitive modulation of HPA and anxiety responses to pentagastrin. Methods : Healthy subjects received pentagastrin and placebo injections, with measurement of cortisol and subjective responses, on two different laboratory visits. They were randomly assigned to receive standard instructions or one of two versions of previously studied cognitive interventions (to either facilitate coping or increase sense of control), given before each visit. Capnograph measures of heart rate (HR), respiratory rate (RR), and end-tidal pCO 2 were obtained on 24 subjects. Results : Relative to placebo, pentagastrin induced a significant decline in pCO 2 with no change in RR. Cortisol and HR increased, as expected. Cognitive intervention reduced the hyperventilatory response to pentagastrin. Conclusions : Pentagastrin stimulates respiration, likely via increases in tidal volume. Respiratory stimulation could play a role in its panicogenic potency, though perhaps indirectly. As with HPA axis responses, higher-level brain processes may be capable of modulating pentagastrin-induced hyperventilation. This model may be useful for further study of cortical/cognitive control of interacting emotional, respiratory, and neuroendocrine sensitivities, with potential relevance to panic pathophysiology. Depression and Anxiety, 2010.  © 2010 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78296/1/20725_ftp.pd