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The phenomenology of deep brain stimulation-induced changes in OCD: an enactive affordance-based model

机译:大脑深部刺激引起的强迫症变化的现象学:一种基于主动负担能力的模型

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摘要

People suffering from Obsessive-Compulsive Disorder (OCD) do things they do not want to do, and/or they think things they do not want to think. In about 10% of OCD patients, none of the available treatment options is effective. A small group of these patients is currently being treated with deep brain stimulation (DBS). DBS involves the implantation of electrodes in the brain. These electrodes give a continuous electrical pulse to the brain area in which they are implanted. It turns out that patients may experience profound changes as a result of DBS treatment. It is not just the symptoms that change; patients rather seem to experience a different way of being in the world. These global effects are insufficiently captured by traditional psychiatric scales, which mainly consist of behavioral measures of the severity of the symptoms. In this article we aim to capture the changes in the patients' phenomenology and make sense of the broad range of changes they report. For that we introduce an enactive, affordance-based model that fleshes out the dynamic interactions between person and world in four aspects. The first aspect is the patients' experience of the world. We propose to specify the patients' world in terms of a field of affordances, with the three dimensions of broadness of scope ("width" of the field), temporal horizon ("depth"), and relevance of the perceived affordances ("height"). The second aspect is the person-side of the interaction, that is, the patients' self-experience, notably their moods and feelings. Thirdly, we point to the different characteristics of the way in which patients relate to the world. And lastly, the existential stance refers to the stance that patients take toward the changes they experience: the second-order evaluative relation to their interactions and themselves. With our model we intend to specify the notion of being in the world in order to do justice to the phenomenological effects of DBS treatment
机译:患有强迫症(OCD)的人做他们不想做的事情,和/或他们认为自己不想做的事情。在大约10%的强迫症患者中,没有可用的治疗方法有效。这些患者中的一小部分目前正在接受深度脑刺激(DBS)治疗。 DBS涉及将电极植入大脑。这些电极向植入它们的大脑区域提供连续的电脉冲。事实证明,由于DBS治疗,患者可能会发生深刻的变化。不仅仅是症状在改变;病患似乎宁愿经历一种不同的生活方式。传统的精神病学量表不足以捕获这些总体影响,而传统的精神病学量表主要由症状严重程度的行为量度组成。在本文中,我们旨在捕捉患者现象学的变化,并理解他们报告的范围广泛的变化。为此,我们引入了一个基于报价的积极的模型,该模型从四个方面完善了人与世界之间的动态交互。第一个方面是患者对世界的体验。我们建议用支付能力的领域来指定患者的世界,包括范围的广度(该领域的“宽度”),时间范围(“深度”)和感知的支付能力的相关性(“高度”)的三个维度。 ”)。第二个方面是互动的人方面,即患者的自我经验,尤其是他们的情绪和感觉。第三,我们指出了患者与世界联系的方式的不同特征。最后,存在性立场是指患者对自己经历的变化采取的立场:与他们的互动和自身的二阶评估关系。通过我们的模型,我们打算指定存在于世界中的概念,以公平对待DBS治疗的现象学效应

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