Proposing an integrative, dynamic and transdiagnostic model for addictions: dysregulation phenomena of the three main modes of the predostatic mind.

Several theories have been proposed to explain the complex diagnostic aspects related to addiction disorders and their development. Recent frameworks tend to focus on dimensional perspectives of symptoms rather than categorical systems, since substance use disorders are frequently comorbid with other psychiatric and especially personality disorders. However, useful transdiagnostic models that could integrate clinical evaluation derived from neuroscientific theories are lacking. In the present manuscript, the authors propose a model based on a new paradigm, in an attempt to better explain this complex, multifaceted phenomenon. The new paradigm presupposes that emotions and behavior are a response to risk prediction. Individuals make choices and engage in actions to manage potential risks/rewards in order to seek or maintain homeostasis in their internal and external environments - a mechanism that the authors call predostatic (predictive mechanism with homeostatic purpose). The model considers three main modes of the predostatic mind: (1) Alarm Mode, activated by high and/or imminent risk prediction; (2) Seek Mode, activated by long-term risk or reward prediction; and (3) Balance Mode, a self-regulating state of mind related to low risk prediction, a soothing system and a calm state. Addiction is seen as a chronic dysregulation of organism systems leading to internalizing or externalizing phenomena mainly related to the Seek and Alarm Modes, which are persistently activated by reward and risk prediction, respectively, thus hindering Balance. Addiction neuroscience research has shown that chronic drug use or engagement in addictive behaviors can lead to neuroadaptations in the brain reward circuitry, disrupting normal balance and the regulation of reward processes. This dysregulation can contribute to persistent drug-seeking/addictive behaviors despite negative consequences. This newly proposed dynamic and integrative model, named dysregulation based on externalizing and internalizing phenomena of the three main modes of the predostatic mind (DREXI3), proposes six dysregulation dimensions with basic emotional and behavioral symptoms, such as neurophysiological alterations, impulsivity, compulsion, cognitive impairment/psychosis, mood, and anxiety/anger. In this paper, the authors explain the rationale behind DREXI3 and present some hypothetical clinical examples to better illustrate the use of the model in clinical practice. The development of this innovative model could possibly guide tailored treatment interventions in the addiction field.

O fanatismo como sobrevivência psíquica durante a pandemia da COVID-19 / Fanaticism as psychic survival during the COVID-19 pandemic

Contextos de crise, como o atual momento de pandemia da COVID-19, parecem estar associados com o aumento do fanatismo. O artigo aborda as origens do pensamento fanático, em nível social e individual, a partir de períodos históricos de recrudescimento do fanatismo, analisando-se os significados psicodinâmicos que podem estar vinculados a posições rígidas e extremadas, além de conceitos psicanalíticos acerca de estados mentais primitivos latentes. Da mesma forma, discute-se sobre o fenômeno das fake news e da perversão como traço marcante no "pensar fanático". Por fim, conclui-se que o fanatismo pode atuar como uma defesa possível à sobrevivência psíquica em determinados contextos de crise, e, ainda, que as capacidades de pensar, empatizar e amar são alternativas a esse desfecho.(AU)

Crisis contexts, such as the coronavirus pandemic, seem to be associated with the augmentation of fanaticism. The article discusses the origins of fanatic thinking, on a social and individual level, from periods in the history of fanaticisms upsurge, analyzing the psychodynamic meanings that could be linked to rigid and extreme positions, beyond psychoanalytic concepts about primitive mental states. In the same way, it discusses the phenomenon of fake news and perversion as an important feature in "fanatical thinking". Finally, it concludes that fanaticism could act as a possible defense to psychic survival in particular contexts of crisis, and that the ability to think, empathize and love are alternatives to this outcome.(AU)

Contextos de crisis, como el actual momento pandémico de COVID-19, parecen estar asociados con el aumento del fanatismo. El artículo analiza los orígenes del pensamiento fanático, a nivel social e individual, considerando períodos históricos de creciente fanatismo y analizando los significados psicodinámicos que pueden vincularse a posiciones rígidas y extremas, además de conceptos psicoanalíticos sobre estados mentales primitivos. De la misma forma, se discute sobre el fenómeno de las fake news y la perversión como característica del pensamiento fanático. Se concluye que el fanatismo puede actuar como una posible defensa para la supervivencia psíquica en determinados contextos de crisis, y también que la capacidad de pensar, empatizar y amar son alternativas a este desenlace.(AU)