The British Neuropsychiatry Association 2021 annual meeting, 11th March

My bolding.

Programme

09:00 Neurosurgery for severe OCD: the past, the present and the future, Eileen Joyce

Neuromodulation: neurorestoration – Chairs: Laura McWhirter and Camilla Nord

10:00 Intracranial recordings in depression, Katherine Scangos
10:30 The role of neuroimaging and neuromodulation, Mike Fox
11:00 Brain Computer Interface for paralysis, Leigh Hochberg
11:30 – Break

Global neuropsychiatry – Chairs: Marco Mula and Vaughan Bell

12:00 Mass psychogenic illness/Havana Syndrome, Robert Bartholomew
12:30 PTSD and war photo journalists, Anthony Feinstein
13:00 Covid-19 and Neuropsychiatry, Tim Nicholson/Benedict Michael
13:30 – Break

14:00 – 14:55 Poster Datablitz presentations 2 sessions of 5, 3 min presentations each with Q&A after each session - Chairs: Camilla Nord & Thomas Pollak
Member’s Platform – Chairs: Boyd Ghosh and Thomas Cope

14:55 Fibromyalgia and myalgic encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): an interoceptive predictive coding model of pain and fatigue expression, Harriet Sharp
15:10 Is Subjective Cognitive Decline (SCD) a better marker of susceptibility to Functional Cognitive Disorder (FCD) than to neurodegeneration?: the Caerphilly Prospective Study, Harriet Ball
15:25 Temporal and spectral dynamics of reward and risk processing in the amygdala revealed with stereo-EEG recordings in epilepsy, Luis Manssuer
15:40 - Break
16:10 Clinical Update – Chair: Tim Nicholson
Update of delirium Alasdair MacLullich

JNNP Lecture – Chair: David Okai
16:40 When the spark goes out: The neurology of apathy and motivation, Masud Husain

https://bnpa.org.uk/agm/


"What is the role of interoceptive predictive coding in ME/CFS & fibromyalgia? And does it interact with inflammation? Fascinating set of findings by Harriet Sharp & @BendyBrain- evidence for greater interoceptive prediction error, including after inflammatory challenge. #BNPA2021"

Code:

https://twitter.com/camillalnord/status/1370028880040398854

 

A bit on Interoceptive predictive coding for people like me who haven't got a clue:

https://www.frontiersin.org/articles/10.3389/fpsyg.2011.00395/full

"The concept of “predictive coding” overturns classical notions of perception as a largely bottom-up process of evidence-accumulation or feature-detection driven by impinging sensory signals, proposing instead that perceptual content is determined by top-down predictive signals arising from multi-level generative models of the external causes of sensory signals, which are continually modified by bottom-up prediction error signals communicating mismatches between predicted and actual signals across hierarchical levels (see Figure 3). In this view, even low-level perceptual content is determined via a cascade of predictions flowing from very general abstract expectations which constrain successively more detailed (fine-grained) predictions. We emphasize that in these frameworks bottom-up/feed-forward signals convey prediction errors, and top-down/feed-back signals convey predictions determining content. The great power of predictive coding frameworks is that they formalize the concept of inductive inference, just as classical logic formalizes deductive inference"

It was difficult to tease out a more succinct statement. Someone else may have more success. There were some interesting things here but not sure what it all means.

 

If "Fibromyalgia and myalgic encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): an interoceptive predictive coding model of pain and fatigue expression" doesn't turn out to 'prove' that we have false feedback which means that we feel more tired than we actually are then I'd be surprised.

"An interoceptive illusion of effort induced by false heart-rate feedback", https://www.pnas.org/content/116/28/13897 (by different authors) is probably along similar lines.

 

Interoceptive predictive coding is actually reinventing a wheel well established by the work of people like Pat Merton long before I was a student (that's a while). Friston has tried to make predictive coding new and sexy but from what I hear it is beginning to look like mostly hype. In simple terms we feel as if the world is still despite everything rushing across our retina when we move our eyes because our brains know that they have deliberately moved the eyes and factor that in. In fact once you get to how images are formed at a higher level the whole issue of 'bottom-up' and 'top-down' tends to melt away as irrelevant. Everything we experience is based on differences and has to be to make any real sense.

Bringing predictive coding into clinical stuff like this is just using big words to pretend to understand. `mark Edwards did it for functional neurological problems and as far as I could see got it upside down anyway. Thirty years ago there would be someone in the audience like Bob Souhami or Andre McLean who would point out when people were bullshitting but nowadays it seems to be the blind leading the blind much of the time.

 

Interestingly (bolding mine):

As a student, I was sometimes defeated by explanations of signs, symptoms, and mechanisms of disease that didn't seem to make sense—at least to me. Later, I realised that words like “idiopathic” or “functional,” often used as if they meant something other than ignorance, were useless. It seemed to me that good teaching would own up to, and demystify, lack of understanding. I think that a good teacher knows in advance what a student might find difficult and takes care to make things clear. We are lucky in the quality of our medical students in the United Kingdom. I enjoy teaching clinical medicine and this has led to writing textbooks, with others, aimed largely at undergraduates. I can't say that I find writing enjoyable or inspirational, but having to express difficult concepts with clarity sharpens up your thinking. Teaching and training are essential components of medicine. Brilliant lectures and articles and new discoveries and ideas are great rejuvenators.

Souhami R. Given the chance I'd start all over again. BMJ. 2006;333(7582):1322-1323. doi:10.1136/bmj.39062.508067.80
​

Another excerpt from the same series of articles: Why medicine inspires me. BMJ. 2006;333(7582):1320. doi:10.1136/bmj.39064.594190.80

Medicine is currently undergoing many changes. The medical curriculum has changed almost beyond recognition since I was a student. More emphasis is placed on communication and clinical skills, but I am saddened that the basic sciences have almost been forgotten. Students are still trying to learn the 10 causes of, for example, clubbing, when they should really be asking questions about the mechanisms. An understanding of the basic sciences would be much more helpful for elucidating a diagnosis than memorising long lists. The practice of medicine has also changed with advances in technology and the discovery of the actual cause of a disease at a molecular level. All very exciting for an enquiring mind, but we need to change our practice to accommodate these modern changes.

Kumar P. The joy of discovery. BMJ. 2006;333(7582):1321-1322. doi:10.1136/bmj.39062.411875.80​