Inflammation-Nature's Way to Efficiently Respond to All Types of Challenges: Implications for Understanding and Managing "the Epidemic" of Chronic Diseases

Siloed or singular system approach to disease management is common practice, developing out of traditional medical school education. Textbooks of medicine describe a huge number of discrete diseases, usually in a systematic fashion following headings like etiology, pathology, investigations, differential diagnoses, and management. This approach suggests that the body has a multitude of ways to respond to harmful incidences. However, physiology and systems biology provide evidence that there is a simple mechanism behind this phenotypical variability. Regardless if an injury or change was caused by trauma, infection, non-communicable disease, autoimmune disorders, or stress, the typical physiological response is: an increase in blood supply to the area, an increase in white cells into the affected tissue, an increase in phagocytic activity to remove the offending agent, followed by a down-regulation of these mechanisms resulting in healing. The cascade of inflammation is the body's unique mechanism to maintain its integrity in response to macroscopic as well as microscopic injuries. We hypothesize that chronic disease development and progression are linked to uncontrolled or dysfunctional inflammation to injuries regardless of their nature, physical, environmental, or psychological. Thus, we aim to reframe the prevailing approach of management of individual diseases into a more integrated systemic approach of treating the "person as a whole," enhancing the patient experience, ability to a make necessary changes, and maximize overall health and well-being. The first part of the paper reviews the local immune cascades of pro- and anti-inflammatory regulation and the interconnected feedback loops with neural and psychological pathways. The second part emphasizes one of nature's principles at work-system design and efficiency. Continually overwhelming this finely tuned system will result in systemic inflammation allowing chronic diseases to emerge; the pathways of several common conditions are described in detail. The final part of the paper considers the implications of these understandings for clinical care and explore how this lens could shape the physician-patient encounter and health system redesign. We conclude that healthcare professionals must advocate for an anti-inflammatory lifestyle at the patient level as well as at the local and national levels to enhance population health and well-being.

Do violence dynamics matter?

RATIONALE, AIMS AND OBJECTIVES

Intimate partner violence is a complex, non-linear phenomenon. The purpose of this study was to determine whether violence dynamics (pattern, degree of non-linearity, optimal non-linearity) contributed to outcomes in violent relationships.

METHODS

The study was conducted in six primary care clinics, enrolling 200 adult women in violent relationships. In addition to baseline and end-of-study interviews, women completed daily telephone assessments of household environment and partner violence using interactive verbal response. Three non-linearity measures of violence were computed with 'optimal' non-linearity estimated using Z-transformations. Assignment of dynamic patterns (periodic, chaotic, random) was made based upon Lyapunov exponent and correlation dimension. Outcomes across dynamic patterns were analysed using analysis of variance. In addition, stepped multiple linear regression explained factor-analysed outcomes, adjusting for demographic, childhood, mental health and marital variables; attitudinal/behavioural outcomes were also adjusted for when explaining clinical outcomes.

RESULTS

Women experiencing periodic violence recognized the importance of violence and used their active coping to seek mental health care. Those with chaotic dynamics recognized that they were not responsible, experienced fewer psychological symptoms and emotional role limitations, and did not seek help. Those experiencing random violence recognized its unpredictability and uncontrollability. Violence non-linearity predicted negative coping, positive appraisals and hope/support in regression analyses, while optimal non-linearity contributed to readiness for change and symptoms functioning. Of the nine outcomes investigated, violence non-linearity contributed to five outcomes.

CONCLUSION

Dynamic pattern of violence, degree of violence non-linearity and optimal non-linearity correlated with several attitudinal/behavioural and clinical outcomes. Knowledge of violence dynamics may have applications when working with violent couples.

Power laws in covariability of anxiety and depression among newly diagnosed patients with major depressive episode, panic disorder and controls

CONTEXT

Although symptoms of anxiety and depression correlate, they may covary in irregular and unpredictable ways. This non-linear covariation may be important to psychiatric diagnosis, treatment and relapse. This non-linear anxiety-depression interaction suggests that power laws may be observed. Power laws are statistical distributions found when systems vary in complex ways at the interface between chaotic dynamics and periodic dynamics, such that data points vary randomly but are still partially correlated with each other. Such non-linear dynamics and relationships should result in characteristic patterns of interaction among patients, stressors and treatment. This is important because non-linear dynamics could affect our understanding of mental disorders, the need for varied treatment approaches and patterns of early response to treatment.

OBJECTIVE

To determine whether the relationships between anxiety and depression levels, changes and rates of change follow power law distributions among patients with newly diagnosed major depressive episode (MDE), panic disorder (PD) and neither disorder (controls).

DESIGN

Time series of hourly mood variation. Setting Acute and continuity primary care clinics.

PATIENTS OR OTHER PARTICIPANTS

Five adult patients presenting each with MDE, PD and controls based on DSM-IV criteria. Four patients in each group completed 30 days of assessments. MAIN AND SECONDARY OUTCOME MEASURES: Hourly self-assessments (while awake) of levels of anxiety and depression using visual analogue scales for a 30-day period. Covariation in level of symptoms, in the change of symptoms and in the rate of change were assessed. Anxiety-depression matrices were prepared for pooled subjects. Power laws were sought using log-log plots of frequency versus order of that frequency.

RESULTS

Although visual inspection of plots for symptoms levels, change and rates of change all suggest power laws, statistical assessments provide stronger support for power laws in symptom change than for either symptom levels or rates of change. Adjusted R(2) terms are larger for MDE and PD subjects compared with controls while the inverse slope is about 2.5 for controls and 1.7-1.9 for those with MDE or PD. This study found that power laws may be present in both the symptom change data for all three diagnostic groups. Evidence for power laws in symptom levels and rates of change was less compelling. The inverse slopes suggest that the anxiety-depression relationships among subjects with PD and major depression are similar but differ from those among controls.

CONCLUSIONS

First, power laws suggest a scale-free relationship; the differences seen in transition from symptom level to change level may reflect that complex events at the level of mood assessment affect change in mood. Second, this covariation may be due to external factors acting on the patient or multiple internal interrelated factors. Third, different factors and populations can yield different slopes. Future research is needed to confirm these preliminary findings and to understand the origin of these dynamics.

A Global Workspace perspective on mental disorders

Background

Recent developments in Global Workspace theory suggest that human consciousness can suffer interpenetrating dysfunctions of mutual and reciprocal interaction with embedding environments which will have early onset and often insidious staged developmental progression, possibly according to a cancer model, in which a set of long-evolved control strategies progressively fails.

Methods and results

A rate distortion argument implies that, if an external information source carries a damaging 'message', then sufficient exposure to it, particularly during critical developmental periods, is sure to write a sufficiently accurate image of it on mind and body in a punctuated manner so as to initiate or promote similarly progressively punctuated developmental disorder, in essence either a staged failure affecting large-scale brain connectivity, which is the sine qua non of human consciousness, or else damaging the ability of embedding goal contexts to contain conscious dynamics.

Conclusion

The key intervention, at the population level, is clearly to limit exposure to factors triggering developmental disorders, a question of proper environmental sanitation, in a large sense, primarily a matter of social justice which has long been known to be determined almost entirely by the interactions of cultural trajectory, group power relations, and economic structure, with public policy. Intervention at the individual level appears limited to triggering or extending periods of remission, representing reestablishment of an extensive, but largely unexplored, spectrum of evolved control strategies, in contrast with the far better-understood case of cancer.