Enriching the C-L Educational Experience: Applying Brain Systems Schemas to Understanding Psychopathology

Informative mental schemas are crucial for learners and practitioners. Although psychiatry draws from a broad range of sciences, everyday practice ultimately relies on a set of criteria based on behavior and self-reports. While the DSM is useful as a common reference, its reliance can lead to a reductionist “checkbox” mentality. The rapid growth of clinical neurosciences, genetics, and neuroimaging provides a more biologically-informed basis of psychopathology that is dissolving Kraepelinian notions. However, these advancements generally fail to trickle down to medical education. Bridging this divide requires a translational language that is intuitive, biologically-informed, evidence-based, and future-oriented.



In this workshop, Dr. Hu and Dr. Sayde will conceptualize psychopathology through the lens of systems thinking, which considers the dynamic and adaptive properties of brain networks. Focusing on common CL disorders, we introduce select principles before demonstrating their utility for describing psychopathology and their supporting evidence. Working at the intersection of mind and body, CL psychiatrists are uniquely situated to apply such schemas towards enriching the educational experience.


We explore how equilibrium dynamics are evidenced in psychopathology. Essentially all perturbations, whether it be endocrine, immune, or circadian disruptions, globally increase risk for psychiatric illness. Delirium, with its multitude of causes and phenotypes, is a readily observable exemplar of the result of disequilibrium.



Network connectivity is a useful level of analysis and represents a converging common pathway for psychopathology. Aberrations in network integration and segregation are transdiagnostic markers across psychopathologies, while network normalization corresponds to recovery. This provides a unifying model suggesting that regardless of the initial neurochemical or structural cause, similar patterns of aberrant brain connectivity will produce a common clinical presentation. For example, diverse initial insults such as stroke (vascular deterioration) or dementia (neuronal loss) may produce similar disruptions in brain network dynamics manifesting in a converging depressive phenotype. Similarly, treatments can be understood as improving connectivity, consistent with evidence that antidepressants across classes promote neuroplasticity.



Attractors refer to states where dynamic systems tend to gravitate. Based on the principle of hysteresis, repeated prior exposure to a state facilitates the return to that state. Similar to the concept of “kindling” in epilepsy, recurrent catatonia or mood episodes engender future episodes. Likewise, repeated substance ingestion potentiates persistent affective or psychotic states.



Brain entropy is a quantifiable measurement that refers to the level of neural unpredictability, and thereby a proxy of the brain’s available “mind states.” High entropy states are associated with acute psychosis or psychedelic use. Inflexible or ruminative patterns, characteristic of OCD or depression, correlate with low entropy states. We use this framework to understand how treatments, such as psychedelics, can be used to transiently increase accessible brain states, allowing for healthier thinking patterns.



Dr. Smith will finish with a Q&A session.