A Precision Medicine Approach to the Treatment of Psychiatric Disorders

Author: Michael Raymond Binder, M.D. My Research Story Behavioral healthcare is the only medical field that is still symptom-based rather...

Author: Michael Raymond Binder, M.D.

My Research Story

Behavioral healthcare is the only medical field that is still symptom-based rather than pathology-based. In other words, we are still treating symptoms without really knowing what is causing them or how the treatments work. Hence, it is not surprising that the world is continuing to experience a mental health crisis.

For the last twenty-five years, my goal as a neuropsychiatrist and clinical research scientist has been to solve the mystery of mental illness. This was an enormous undertaking, as the quest to pinpoint the root cause of mental illness has proven to be an insurmountable challenge, even for some of history’s greatest philosophers, scientists, and thinkers. However, with the Lord’s help in conjunction with more than 75,000 hours of clinical observation, I began to recognize that neuronal hyperexcitability played a key role in the pathophysiology of psychiatric disorders. Although the relevance of this neurophysiological abnormality had been described previously, it did not provide a comprehensive explanation for psychiatric symptomatology until it was reconceptualized in the context of two new discoveries: 1) the mechanism by which the mind and the brain communicate with each other [1]; and 2) the mechanism by which psychiatric symptoms wax and wane in severity and morph into other psychiatric symptoms [2]. By recognizing and connecting these three pieces of the puzzle, the mystery of mental was finally able to be solved.

The cornerstone of this scientific breakthrough, known as the Multi-Circuit Neuronal Hyperexcitability (MCNH) hypothesis of psychiatric disorders, is that psychiatric symptoms are driven by pathological hyperactivity in the neuronal circuits that correspond to them [3]. Thus, for example, abnormally-elevated and persistent feelings of anxiety would be the consequence of pathological hyperactivity in anxiety circuits; abnormally-elevated and persistent feelings of depression would be the consequence of pathological hyperactivity in depressive circuits; abnormally-elevated and persistent feelings of anger would be the consequence of pathological hyperactivity in irritability circuits; etc… Beyond causing mental and emotional symptoms, pathological hyperactivity in specific neuronal circuits can cause somatic symptoms, such as migraine headaches, fibromyalgia, and irritable bowel [3]. This is the MCNH explanation for the functional physical symptoms that are often associated with psychiatric symptoms.

Of course, that raises the question of what causes specific neurons and circuits to become pathologically hyperactive. The answer to that question is that, in some persons, the brain’s response to mental stimulation is abnormally amplified. Hence, when such persons experience cognitive-emotional stress, the mind and the brain can become caught in a vicious cycle of mutual overestimation that tends to escalate until either the mind or the brain or both begin to settle down.

Notice here that the mind and the brain are being described as separate entities. Although the distinction between the mind and the brain was, at one time, purely speculative [1], it is now an established fact that these two components of the cognitive-emotional system interact with each other just like we interact with our computers. The mind uses the brain as a computer in the head that allows it to interact with the body [1]. That naturally leads to the question of why the brains of some persons over-react to the mental and emotional signals that they receive from the mind?

The answer to that question is provided by the latest gene research on psychiatric disorders. Numerous large, multi-center, gene association studies have found that most of the candidate genes that have been linked to the major psychiatric disorders code for proteins that are involved in the regulation of neuronal excitability [3]. A failure to regulate neuronal firing would allow specific neurons and circuits to become pathologically hyperactive when stimulated by the corresponding thoughts and emotions. This would explain why every condition and chemical that increases neuronal excitability increases the potential for psychiatric symptoms, and, conversely, every condition and chemical that decreases neuronal excitability decreases the potential for psychiatric symptoms [3]. If we were to apply this simple observation to the treatment of patients, we would expect that any natural or pharmacological intervention that reduced neuronal excitability would promptly reduce the patient’s psychiatric symptoms. Moreover, this should occur irrespective of the symptom-based diagnosis. A simple review of the literature will show that this is precisely what is observed in clinical practice. It is also what is observed when people self-medicate. That is why the most commonly used medications in psychiatric emergencies are tranquilizers (i.e., benzodiazepines and antipsychotics), and why the most commonly used recreational drugs are tranquilizers (i.e., alcohol and cannabinoids). This is also what I have personally observed in clinical practice and is the psychophysiological basis of the treatment approach that I call “focused neuroregulation.” In this first-ever pathology-based approach, anticonvulsants and other brain-calming drugs, which in one way or another regulate the firing of neurons, are used either alone or in combination with one another to reduce psychiatric symptoms irrespective of the symptom-based diagnosis [4]. Regulating the firing of neurons is the simple principle by which I have been able to achieve a nearly one-hundred percent success rate in treating a wide range of psychiatric disorders from anxiety and depression to bipolar disorder and schizophrenia.

However, this is only half the story with regard to the advantages of this long-awaited medical breakthrough. The other half is the effect that it will have on illness-prevention and the stigma of mental illness. An explosion of recent studies has identified a link between upper-end-of-normal resting vital signs and the later development of various psychiatric and general medical conditions. Specifically, a resting heart rate above 75 beats/min was predictive of the later development of generalized anxiety disorder, obsessive-compulsive disorder, and schizophrenia [5]. Similarly, a resting respiratory rate above 15 breaths/min was associated with various psychiatric disorders in girls [5]. Persons with higher resting heart and respiratory rates have also been found to be at increased risk of developing any of a wide range of chronic medical illnesses, including diabetes [5], high blood pressure [5], cardiovascular disease [5], cerebrovascular disease [5], cancer [5], dementia [5], and all-cause mortality [5]. The subtle vital-sign elevations with which these conditions are associated are thought to be the consequence of a tonic elevation in basal neurological activity in those persons who inherit the genes for neuronal hyperexcitability [5]. This is the MCNH explanation for why the lifespan of persons with severe mental illness tends to be much shorter than the general population [5]. The reason that psychiatric symptoms tend to precede the development of diagnosable physical abnormalities is that the cognitive-emotional system is more expressive of neuronal excitation than other organs and systems of the body [5]. The physical consequences tend to be delayed because they express the gradual erosive effects of neuronal hyperexcitability, which can take years or even decades to develop [5]. What this means is that psychiatric disorders are not, as was previously thought, distinctly different than physical disorders; rather, they are the first subjective markers of a physiological abnormality that is at the root of nearly all chronic diseases. Then again, it should come as no surprise that a physiological abnormality that involves the brain, the organ that regulates virtually every other organ and system of the body, could cause so many different mental and physical problems. The dawning recognition of the endemic and pernicious nature of the neuronal hyperexcitability trait has the potential to eliminate the divide between mental illness and physical illness and fundamentally change the way we understand chronic disease.

Peer-Reviewed Scientific Articles:

1. Binder MR. Mind-Brain Dynamics in the Pathophysiology of Psychiatric Disorders. Am J Psychiatry and Neurosci 2022; 10 (2): 48-62.

2. Binder MR. Electrophysiology of Seizure Disorders May Hold Key to the Pathophysiology of Psychiatric Disorders. AJCEM 2019; 7 (5): 103-110.

3. Binder MR. The Multi-Circuit Neuronal Hyperexcitability Hypothesis of Psychiatric Disorders. AJCEM 2019; 7 (1): 12-30.

4. 15. Binder MR. Focused Neuroregulation in the Treatment and Prevention of Mental and Physical Illness. AJCEM 2022; 10 (2): 49-58.

5. Binder MR. FLASH Syndrome: Tapping into the Root of Chronic Illness. AJCEM 2020; 8 (6): 101-109.

6. Binder MR. Introducing the term “Neuroregulator” in Psychiatry. AJCEM 2019; 7 (3): 66-70.

7. Binder MR. Gabapentin—The Popular but Controversial Anticonvulsant Drug May Be Zeroing in on the Pathophysiology of Disease. AJCEM 2021; 9 (4): 122-134.

8. Binder MR. Anticonvulsants: The Psychotropic and Medically Protective Drugs of the Future. AJCEM 2021; 9 (5): 174-182.

9. Binder MR. The Neuronal Excitability Spectrum: A New Paradigm in the Diagnosis, Treatment, and Prevention of Mental Illness and Its Relation to Chronic Disease. AJCEM 2022; 10 (1): 1-7.

10. Binder MR. Psychiatric and Functional Physical Symptoms: The More Telling “Fifth” Vital Sign. AJCEM 2021; 9 (6): 233-337.

11. Binder MR. A Pathophysiolgically-Based Approach to the Treatment and Prevention of Mental Illness and Its Related Disorders. AJCEM 2021; 9 (6): 223-232.

12. Binder MR. Neuronal Hyperexcitability: The Elusive But Modifiable Instigator of Disease. AJCEM 2022; 10 (1): 1-7.

13. Binder MR. Neuronal Hyperexcitability: Significance, Cause, and Diversity of Clinical Expression. AJCEM 2021; 9 (5); 157-167.

14. Binder MR. New Hypothesis Unifies Previous Theories of Psychopathology and Identifies Core Biological Abnormality in Psychiatric Disorders. AJCEM 2022; 10 (1): 38-48.

15. Binder MR. New Hypothesis on the Pathophysiology of Psychiatric Disorders Illuminates Shared Mechanism of Past and Emergent Treatment Strategies. AJCEM 2022; 10 (1): 38-48.

16. Binder MR. Suicide: A New Hypothesis on the Pathogenesis of Disease, Method of Screening, and Means of Prevention. AJPN 2022; 10 (3): 111-124.

17. Binder MR. Emergent Success of GABA Modulators Links Neuronal Hyperexcitability to the Pathophysiology of Depression. AJPN 2022; 10 (3): 134-144.

18. Binder MR. Neuronal Hyperexcitability: The elusive Link Between Social Dysfunction and Biological Dysfunction. World J Public Health 2022; 7 (3): 99-110.

19. Binder MR. Mysterious “Wave of Death” Could Mark Critical Divide Between Life and Death. AJCEM 2022; 10:(5): 115-123.

20. Binder MR. Illicit Use of Gabapentin May Reveal More About the Drug’s Benefits Than Its Liabilities. American J Int Med 2022; 10 (6): 114-121.

21. Binder MR. Exploring the Potential to Prevent Human Disease by Genetically Altering the Excitability of the Neurological System. Am J Psychiatry and Neurosci 2023; 11 (1): 22-29.

22. Binder MR. Probing The Link Between Substance Use and Psychiatric Disorders: Toward A New Paradigm in the Treatment and Prevention of These Intertwined Disorders. Int J Psychiatry Res 2023; 6 (3): 1-13.

23. Binder MR. Untangling Psychology From Biology in the Treatment of Psychiatric Disorders. GJMR 2023; 23 (3) 1.0.

24. Binder MR. A Precision Medicine Approach to the Treatment of Psychiatric Disorders. GJMR 2023; 23 (4): 1.

25. Binder MR. Redefining psychopathology from an anatomical and functional perspective. GJMR 2024; 24 (1) 1.0.

26. Binder MR. Chronic Musculoskeletal Pain and Disability: A Problem of Trapped Lactic Acid. Rehabilitation Science 2022; 7 (4): 43-50.

Authored Books:

Am I Depressed Or am I Bipolar? Help your doctor make the right diagnosis and choose the right treatment for you

The Racing Mind: Brave new insights untangle the ancient mystery of mental illness

The Racing Mind Companion Case Study Guide

Mysteries of the Mind: Two astonishing articles that unveil the mystery

The Golden Book of Muscle Health and Restoration

Images of Heaven: A Book of Love, Wisdom & Truth

Miracles: Ask and Ye Shall Receive

Revelation Revealed

The Racing Mind Video Series (6-12 minute audiovisual animations of the concepts discussed in the Blog).

(From YouTube Channel: CHICAGO MENTAL HEALTH)

Part A: Series Trailer

Part 1: Untangling The Mystery of Mental Illness

Part 2: How Variant Genes Translate into Psychiatric Disorders

Part 3: Genetics of Neuronal Hyperexcitability

Part 4: Quick Self-assessment for Neuronal Hyperexcitability

Part 5: Bipolar Disorders & Neuronal Hyperexcitability

Part 6: Depression and Neuronal Hyperexcitability

Part 7: Practical Consequences of Neuronal Hyperexcitability

Part 8: Anxiety & Neuronal Hyperexcitability

Part 9: ADHD and Neuronal Hyperexcitability

Part 10: Sleep and Neuronal Hyperexcitability

Part 11: Medical Disorders and Neuronal Hyperexcitability

Part 12: Suicide and Neuronal Hyperexcitability

Part 13: Smoking and Neuronal Hyperexcitability

Part 14: Cannabis and Neuronal Hyperexcitability

Part 15: Mental Illness: Many Disorders, One Mechanism

Part 16: Viral Infections and Neuronal Hyperexcitability

Part 17: PTSD and Neuronal Hyperexcitability

Part 18: Social Psychology, Hyperexcitability, and Chronic Disease

Part 19: Hormonally-related Disorders and Neuronal Hyperexcitability

Part 20: Neuronal Hyperexcitability: Medicine’s Most Important Discovery

Part 21: Autoimmune Diseases and Neuronal Hyperexcitability

Part 22: Schizophrenia and Neuronal Hyperexcitability

Part 23: OCD and Neuronal Hyperexcitability

Part 24: Autistic Disorders and Neuronal Hyperexcitability

Part 25: Gun Violence in Relation to Neuronal Hyperexcitability and Psychiatric Disorders

Part 26: Psychiatric Disorders: A Look Inside the Brain

Part 27: Psychophysiology of Mental Illness

Part 28: Physical Symptoms and Neuronal Hyperexcitability

Part 29: Personality Disorders and Neuronal Hyperexcitability

Part 30: Eating Disorders and Neuronal Hyperexcitability

Part 31: Sensory Hypersensitivity and Neuronal Hyperexcitability

Part 32: Relationships and Neuronal Hyperexcitability

Part 33: Psychotherapy and Neuronal Hyperexcitability

Part 34: Exercise and Neuronal Hyperexcitability

Part 35: Diet and Neuronal Hyperexcitability

Part 36: Mental Illness: Tapping into the Root of Chronic Disease

Part 37: Medical Management of Neuronal Hyperexcitability

Part 38: Sensory Processing Disorders and Neuronal Hyperexcitability

Part 39: Relationships and Neuronal Hyperexcitability

Part 40: Attitude and Neuronal Hyperexcitability

Part 41: Tourette’s and Neuronal Hyperexcitability welcome

Part 42: Impulse Control Disorders and Neuronal Hyperexcitability

Part 43: Substance Abuse and Neuronal Hyperexcitability

Part 44: Local and Non-local Consciousness and Neuronal Hyperexcitability

Part 45: Maxillofacial Pain Disorders and Neuronal Hyperexcitability.

Published by Global Journals

https://globaljournals.org/GJMR_Volume23/4-A-Precision-Medicine-Approach.pdf

https://globaljournals.org/GJMR_Volume24/5-Redefining-Psychopathology.pdf

https://globaljournals.org/GJMR_Volume23/1-Untangling-Psychology-from-Biology.pdf

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