Conscious State Research Articles

Medical complications and advance medical decision-making in the minimally conscious state

ABSTRACT Objectives Medical complications occur frequently in MCS and influence advance medical decision-making. This study aimed to report on medical complications and advance medical decision-making in a nationwide group of MCS patients. Methods In this descriptive cross-sectional study, clinical and advance medical decision-making characteristics were collected in a survey, completed by the treating physician. Results The MCS population consisted of 32 patients: 65.6% traumatic etiology, 68.8% male. Patients had a median of five complications: hypertonia/spasticity (81.3%) and pneumonia (50.0%) occurred most frequently. Most patients had curative goals: three patients had a fully curative treatment scenarios, 29 a curative scenario with ≥ 1 treatment restrictions, two a palliative and two a symptomatic scenario. Conversations about advance medical decision-making were complicated by disputes with next of kin, inability to evaluate medical treatment because of medical instability, next of kin not being ready to discuss medical treatment, or a treatment scenario explicitly based on requests of next of kin. Conclusion Medical complications are common in MCS patients and advance medical decision making was complicated. This legitimates realization of specialized care across acute, post-acute and long-term care. Further longitudinal research into advance medical decision-making is recommended.

CNSC-24. REAL-TIME HIGH-DENSITY ECOG MAPPING OF SENSORIMOTOR REGIONS AND CONSCIOUSNESS DIFFERENTIATION IN PERI-ROLANDIC GLIOMA SURGERY

Abstract INTRODUCTION Accurately mapping sensorimotor regions is crucial for preserving motor and sensory functions in the treatment of gliomas located in the peri-Rolandic areas of the brain. OBJECTIVE We examined the use of high-density electrocorticography (ECoG) for passive mapping of sensorimotor regions in treating peri-Rolandic gliomas by analyzing the spatial-temporal and spectral features of real-time somatosensory evoked potentials (SSEPs), and their spectral patterns in differentiating states of consciousness. METHODS During surgery, SSEPs were recorded using high-density ECoG on fourteen patients (n=14), both in anesthetized and awake states. Neural data from 0.6Hz median nerve stimulation were captured at 2.4kHz and processed in real-time using MATLAB Simulink. The system displayed SSEPs’ peak activations as a 2D heat map on a screen, particularly around the 20ms time point (N20), and generated the spectral power in the gamma range using the Stockwell transform. Accuracy in delineating the central sulcus (CS) was assessed using the ROC curve, and paired t-tests compared gamma oscillations between states of consciousness. RESULTS Patients consistently showed clear discrimination between anterior and posterior channels at the 20ms time point, with 93.6±14.9% accuracy. Color contrast delineated the CS, correlating with the sulcus in the 3D reconstructed magnetic resonance imaging of each patient. Late gamma (60–250 Hz) modulation occurred 50 ms after stimulation onset, extending up to 250 ms in the primary somatosensory area. It was suppressed in the anesthetized state and significantly increased in the awake state (delineation accuracy: 81±10.3% and 91±13.4%, respectively). CONCLUSIONS These results demonstrate that SSEPs and gamma modulations can delineate sensorimotor areas and assess consciousness, significantly impacting neurosurgical planning.

NIMG-68. A COMPREHENSIVE REVIEW OF THE USE OF FMRI IN EVALUATING FUNCTIONAL CONNECTIVITY AND ACTIVATION IN DISORDERS OF CONSCIOUSNESS

Abstract PURPOSE Disorders of consciousness (DoC) like vegetative and minimally conscious states pose significant diagnostic and prognostic challenges, compounded by the inherent limitations in communicating with affected patients. We performed a scoping review of the literature to examine the application of functional magnetic resonance imaging (fMRI) to the assessment of functional connectivity (FC) and activation in DoC. METHODS We searched the MEDLINE/PubMed, Web of Science, and Embase databases between the years 2004 and 2024 for English-language studies involving fMRI and DoC in adult populations, adhering to PRISMA guidelines. Included studies were evaluated for study design, DoC subtype, fMRI subtype, cohort size, and FC and/or activation findings. RESULTS Our initial search identified 17,475 results, of which 82 studies were ultimately included with a total of 3917 patients. Only one of the included studies was a randomized controlled trial, 24 were prospective cohort studies, three were retrospective cohort studies, and 54 were observational in design. The majority of studies utilized resting-state fMRI (n=54, 65.9%), and the most commonly investigated disorders of consciousness were minimally conscious states (31.9%), vegetative states (14.4%), and unresponsive wakefulness syndromes (12.9%). Among studies with higher levels of evidence like prospective and retrospective studies, FC and activation findings were heterogeneous, with several studies reporting abnormal connectivity in the default mode and auditory networks. Activation responses among patients also varied, with some patients of the same DoC displaying expected activation patterns while others did not. Normal patterns of connectivity and activation were associated with improved prognosis in eight prospective studies and one retrospective study. CONCLUSIONS These findings underscore the complexity of using fMRI to evaluate consciousness in DoC patients. Though fMRI has the potential to identify residual cognitive function, the variability in responses also indicates the need for personalized approaches and further research to standardize fMRI protocols for this purpose.

TRANCE STEREOTYPIES IN HUMAN AND PRIMATE PANTOMIMICRY

The authors reviewed and analysed Russian and foreign experimental studies on pantomimic stereotypes. Initially, stereotypical behaviuor was negatively evaluated. Modern research considers adaptive functions and possibilities of self-stimulation as a way to harmonise emotional and mental state. A comparative analysis of circular, pendulum and diagonal movements in children and Old World monkeys was conducted using an ethological approach to the study of behavioural patterns. Human observations were conducted in the psychoneurological department of Silischeva Astrakhan Regional Children’s Clinical Hospital, 40 preschool children with mental dysontogenesis participated. Five laboratory macaques and a family of hamadryas baboons kept in an aviary with homologous kinesics were observed in Sukhumi nursery. According to the authors’ team, walking (running) in a circle and diagonally, swinging the body “right-to-leftˮ in the pantomimic production of children and monkeys are associated with self-stimulation of an altered state of consciousness. Trance stereotypes divert attention from external stressors and stimuli and harmonise mental homeostasis. The study may be of interest to anthropologists, primatologists, specialists in the study of the psyche and pathological behaviour of animals and Homo sapiens.

A new ICT system coupling electromyography and coma recovery scale-revised to support the diagnostic process in disorders of consciousness

The Coma Recovery Scale-revised (CRS-r) is the gold standard for the behavioral assessment of patients with Disorders of Consciousness (DoCs). However, the misdiagnosis rate is around 40%. For this reason, recent guidelines suggested enhancing the assessment with neurophysiological measures: among these, surface electromyography (sEMG) represents a convenient bedside solution. This work presents the use of the STRIVEfc system, a wearable device that allows CRS-r administration while recording four sEMG signals. STRIVEfc was employed in 40 sessions on 33 DoCs patients and the sEMG was analyzed to look for voluntary and consistent over threshold (OT) muscular activities. Their duration, amplitude, and number were retained and compared between patients in Unresponsive Wakefulness Syndrome (UWS) and Minimally Conscious State (MCS), revealing more numerous and significantly longer OTs in the latter group. Lastly, the EMG information was exploited to enrich the behavioral assessment by building the instrumented CRS-r score (ICRS-r). In 9/16 UWS sessions, the ICRS-r score suggested a higher-level functioning, not translated into a behavioral response, compatible with MCS diagnosis. Overall, the use of STRIVEfc allows to reveal hidden muscular patterns not detectable by the clinician, thus improving the characterization of DoCs patient’s functional capabilities and supporting the diagnostic process.

Scoping review on shamanistic trances practices

BackgroundShamanism is a spiritual tradition in which trance practitioners deliberately modify their state of consciousness to seemingly interact with an invisible world to resolve their community members’ problems. This review aims to provide a multidisciplinary overview of scientific research on shamanic trance.MethodsThe search was performed using PubMed and Google Scholar databases. Twenty-seven articles were found to be eligible, and their data were classified into four dimensions, namely, a) phenomenology, b) psychology, c) neuro-physiological functions, and d) clinical applications.ResultsThese studies suggest that these trances are non-pathological, different from normal states of consciousness in terms of phenomenology and neurophysiology, and influenced by multiple personal and environmental variables. Furthermore, while trances may offer therapeutic potential, their scope should be approached cautiously, underscoring the need for rigorous studies to assess the effectiveness of shamanic approaches for complementary therapies.ConclusionOverall, shamanic trance and its potential benefits remain an intriguing and multifaceted area of scientific study, offering insights into the intersections of consciousness, spirituality, and possibly therapy.

Median nerve electrical stimulation for restoring consciousness in patients with traumatic brain injury: study protocol for a systematic review and meta-analysis

IntroductionTraumatic brain injury (TBI) is one of the prevalent critical illnesses encountered in clinical practice, often resulting in a spectrum of consciousness disorders among survivors. Prolonged states of impaired consciousness...

Unpacking Human Rights: Freedom of Consciousness, Bodily Autonomy & Right to Life in the Context of War on Drugs Crimes

Abstract This study explores the interplay between the right to life, right to development, bodily autonomy and freedom of conscience, and demonstrates how these factors collectively shape the concept of freedom of consciousness and simultaneously lead to increased access to altered states of consciousness, cognitive liberty, freedom of development, and the peak experiences that Abraham Maslow researched. Second chapter delves into the intersection of human rights and drug policy, specifically examining the implications of the War on Drugs on individual freedoms. It argues that the War on Drugs has led to a violation of fundamental human rights, including cognitive liberty, bodily autonomy, and the right to life. Through an analysis of international human rights law and case studies from around the world, the paper demonstrates how drug-related crimes have resulted in mass incarceration, violence, and human rights abuses. It also explores decriminalization of drug use, end of War on Drugs and criminalization of its’ crimes. The research results provide insights into the interrelation between these three concepts, shedding light on how they intersect and influence each other and in context of War on Drugs hostile environment. Findings also suggest that the War on Drugs has resulted in a significant violation of fundamental human rights.

Local Neuronal Activity and the Hippocampal Functional Network Can Predict the Recovery of Consciousness in Individuals With Acute Disorders of Consciousness Caused by Neurological Injury.

There is limited research on predicting the recovery of consciousness in patients with acute disorders of consciousness (aDOC). The purpose of this study is to investigate the altered characteristics of the local neuronal activity indicated by the amplitude of low-frequency fluctuations (ALFF) and functional connectivity (FC) of the hippocampus network in patients with aDOC caused by neurological injury and to explore whether these characteristics can predict the recovery of consciousness. Thirty-seven patients with aDOC were included, all of whom completed resting-state functional magnetic resonance imaging (rsfMRI) scans. The patients were divided into two groups based on prognosis of consciousness recovery, 24 patients were in prolonged disorders of consciousness (pDOC) and 13 in emergence from minimally conscious state (eMCS) at 3 months after neurological injury. Univariable and multivariate logistic regression analyses were used to investigate the clinical indicators affecting patients' recovery of consciousness. The ALFF values and FC of the hippocampal network were compared between patients with pDOC and those with eMCS. Additionally, we employed the support vector machine (SVM) method to construct a predictive model for prognosis of consciousness based on the ALFF and FC values of the aforementioned differential brain regions. The accuracy (ACC), area under the curve (AUC), sensitivity, and specificity were used to evaluate the efficacy of the model. The FOUR score at onset and the length of mechanical ventilation (MV) were found to be significant influential factors for patients who recovered to eMCS at 3 months after onset. Patients who improved to eMCS showed significantly increased ALFF values in the right calcarine gyrus, left lingual gyrus, right middle temporal gyrus, and right precuneus compared to patients in a state of pDOC. Furthermore, significant increases in FC values of the hippocampal network were observed in the eMCS group, primarily involving the right lingual gyrus and bilateral precuneus, compared to the pDOC group. The predictive model constructed using ALFF alone or ALFF combined with FC values from the aforementioned brain regions demonstrated high accuracies of 83.78% and 81.08%, respectively, with AUCs of 95% and 94%, sensitivities of 0.92 for both models, and specificities of 0.92 for both models in predicting the recovery of consciousness in patients with aDOC. The present findings demonstrate significant differences in the local ALFF and FC values of the hippocampus network between different prognostic groups of patients with aDOC. The constructed predictive model, which incorporates ALFF and FC values, has the potential to provide valuable insights for clinical decision-making and identifying potential targets for early intervention.

EEG-Derived Markers to Improve Prognostic Evaluation of Disorders of Consciousness.

Disorders of consciousness (DoC) are characterized by alteration in arousal and/or awareness commonly caused by severe brain injury. There exists a consensus on adopting advanced neuroimaging and electrophysiological procedures to improve diagnosis/prognosis of DoC patients. Currently, these procedures are prevalently applied in a research-oriented context and their translation into clinical practice is yet to come. The aim of the study consisted in the identification of measures derived from routinary electroencephalography (EEG) able to support clinicians in the prediction of DoC patients' outcome. In the present study, a routine EEG was recorded during rest from a sample of 58 DoC patients clinically diagnosed as Unresponsive Wakefulness State (UWS) and Minimally Conscious State (MCS) and followed-up for 3 months. EEG-based features characterizing brain activity in terms of spectral content and resting state networks organization were used in a predictive machine learning model to i) identify which were the most promising features in predicting patients' exit from the DoC, regardless of the clinical diagnosis and ii) verify whether such features would have been the same best discriminating UWS from MCS or specific of the outcome prediction. A predictive machine learning model was built on EEG features related to spectral content and resting state networks which returned up to 85% of performance accuracy in outcome prediction and 76% in DoC state recognition (UWS vs MCS). We provided preliminary evidence for the exploitation of a routine EEG to improve the clinical management of non-communicative patients to be confirmed in a larger DoC population.

Evaluation of simplified wireless EEG recordings in the neurological emergency room.

In the neurological emergency room (nER), timely electroencephalography (EEG) diagnostic is often crucial in patients with altered state of consciousness as well as in patients presenting with a first seizure. Yet, routine-EEG (rEEG) is often not available, especially during off-hours. We analyzed the value of a commercially available, simplified wireless eight-channel EEG recording (swEEG, CerebAir® EEG headset, Nihon Kohden), applied by non-EEG-specialized medical students, in patients presenting in our nER with (suspicion of) epileptic seizures and/or loss of or altered state of consciousness between 08/2019 and 08/2022. We evaluated the feasibility and validity compared to a standard rEEG (21 electrodes according to the international 10/20 system) and also included the clinical follow-up of the patients. 100 patients were included in our analysis (mean age 57.6 ± 20.4 years; 61 male). Median time of electrode application was 7 minutes (range 4-20 minutes), with significantly longer duration in patients with altered level of consciousness (median 8 minutes, p = 0.035). Electrode impedances also differed according to state of consciousness (p = 0.032), and were higher in females (p<0.001). 55 patients received additional rEEG, either during their acute nER stay (25) and/or during the next days (38). Considering normal EEG findings vs. pathological slowing vs. epileptiform activity, swEEG matched first rEEG results in 48/55 cases (87.3%). Overall, swEEG detected the same or additional pathological EEG patterns in 52/55 cases (94.5%). In 7/75 patients (9.3%) who did not receive rEEG, or had their rEEG scheduled to a later time point during their hospital stay, swEEG revealed important additional pathological findings (e.g. status epilepticus, interictal epileptiform discharges), which would have triggered acute therapeutic consequences or led to further diagnostics and investigations. The introduced swEEG represents a practicable, valuable technique to be quickly applied by non-EEG-specialized ER staff to initiate timely diagnostic and guide further investigations and treatment in the nER. Moreover, it may help to avoid under-diagnostic with potentially harmful consequences caused by skipped or postponed regular 10/20 EEG examinations, and ultimately improve the outcome of patients.

The Impact of Alai Suri Kurdayeti Magazine in Disseminating National Awareness

This paper, titled "The Impact of Alai Suri (Red Flag) Kurdayeti Magazine on the Propagation of National Awareness," delves into an examination of the content within Alai Suri Kurdayeti Magazine during the period of the mountain struggle and the revolutionary era, spanning from 1981 to 1982. Despite the protracted history of the Kurdish people's struggle for their national rights, the establishment of a comprehensive national identity remains an indispensable intellectual and vital requirement within Kurdish society, intrinsically tied to the notion of national consciousness. The manifestation of a national identity fundamentally hinges on shared national principles, a common language, culture, religion, history, collective aspirations, and unified political and legal principles, all of which necessitate a heightened state of national consciousness. Throughout the history of the Kurdistan liberation movement, diverse strategies have been employed to attain this identity, with media engagement serving as one prominent avenue. During a particularly sensitive period in Kurdish history within South Kurdistan (1981-1982), the Kurdish Socialist Party (PASOK) issued Alai Suri Kurdayeti Magazine. This publication, apart from accomplishing its political objectives, aimed to acquaint Kurdish society with various facets of life and intellect. Its purpose was to cultivate national thought and consciousness while alerting the community to the imminent threats they faced.

Poisoning with Local Anesthetics Following Circumcision : A Case Report

Introduction: Circumcision or posthectomy is the removal of the foreskin, this act seems commonplace practiced by paramedical personnel or unqualified traditional practitioners who may cause significant complications. Objective: Our work aimed to highlight one of the complications of this act which must remain a supervised medical act. Observation: We report the case of a 2-month-old infant who presented with complications related to anesthesia. the clinic was dominated by convulsions and alteration of the state of consciousness 15 minutes after circumcision in this well infant carrying without any particular history. The evolution was favorable thanks to support rapid and urgent about 20 minutes with the cessation of convulsions and a return to consciousness, the patient was monitored for 48 hours then return home was indicated due to the absence other complications. Conclusion: Circumcision is a widespread act throughout the world either by medical necessity or by religious tradition. its trivialization and its practice by non-experts, explains the multiple complications observed.

Ketamine-induced altered states of consciousness: a systematic review of implications for therapeutic outcomes in psychiatric practices.

This systematic review aims to elucidate the nexus between ketamine's psychoactive properties and its efficacy in treating a broad spectrum of psychiatric disorders. We searched three databases and used citation tracking to include 29 studies. Predominantly, mood disorders, including bipolar disorder (BD) and major depressive disorder (MDD) (MDD + BD: + n = 25studies), a large part of them involve treatment-resistant patients (n = 14studies), substance use disorder (SUD, n = 3studies), and social anxiety disorder (SAD, n = 1study). From all included studies(n=29), 15 (51.72%) of themidentified a positive relation between ketamine-induced altered states of consciousness and clinical outcomes, while 13studies (44.83%)showed no linkage between them, and one study (3.45%)delineated a negative association. Focusing solely on intravenous (IV) ketamine infusions (n = 25), 14 studies(56%)reported a positive modulation of ketamine's psychoactive effects and therapeutic benefits, whereas 10 studies(40%)confirmed no relationship, and one study (4%)showed a negative association. The single study(33.34%) involving subcutaneous ketamine and allthree studies (66.6%)intranasal administration did not demonstrate a significant interaction between ketamine's psychoactive effects and therapeutic response. All three SUD studies reported a positive correlation between ketamine's psychoactive effects and therapeutic response. In contrast, the single SAD study did not find a relationship between these parameters. For studies involvingmood disorders (n = 25), 12 studies (48%)reported a positive relationship between psychoactive effects and therapeutic response.Others 12studies (48%)identified a null relationship, and one study (4%)found a significant negative association. Although we have found a larger association than previous studies between ketamine's psychoactive properties and its efficacy in treating a broad spectrum of psychiatric disorders, its topic remains indeterminate, mainly due to the high heterogeneity.

An exploratory study of alternative life experiences in comparison to transcendental near‐death experiences

AbstractThe term near‐death experience (NDE) generally refers to a state of altered consciousness that can occur during real or presumed near‐death circumstances and/or life‐threatening incidents. The NDE usually includes the impression of being conscious while out of and/or away from the physical body, often accompanied by other specific features. Furthermore, when the experient has the impression of being in a perceived locality that transcends the observable physical Earth, it is referred to by researchers as a transcendental NDE. Whereas transcendental NDEs have been widely studied, there is also another type of experience that can occur under similar life‐threatening conditions that I refer to as an alternative life experience (ALE), which consists of a perception of living another alternative life where the experient is aware of the self, but does not believe at the time of occurrence that they are either out of or away from their physical body. After providing a total of 15 examples, I note some similarities and differences between ALEs and transcendental NDEs while providing some qualitative and quantitative results, suggesting that ALEs might be similar to some aspects of transcendental NDEs despite their neglect in the study of altered states of consciousness during near‐death circumstances. I further postulate that ALEs might be subjective psychological experiences of dissociation and/or absorption. It is then pointed out that symptoms of derealization are a common ALE aftereffect and so an awareness of that association is stressed as having therapeutic importance.

The art of music. The representation of musical instruments in the rock art of Zimbabwe

ABSTRACT This article explores the relationship between music and rock art by looking at the occurrence of musical instruments at rock art sites in Zimbabwe. Much of the attention paid to the rich rock art heritage of this country has focused on the documentation of sites, the meaning of the painted and engraved motifs in them and the regional variability they display. Despite some brief mentions, the depiction of musical instruments is still in need of systematic study. This article’s first objective is to compile the information about this type of motifs found in publications and the SARADA archive. Having identified and classified them, it then explores whether musical instruments depicted at rock art sites are connected to altered states of consciousness. The possible relationship between gender and music is also explored and regional differences in the depiction of musical instruments are commented on.

Chinese Version of the Nonverbal Pain Assessment Tool: Critical Patient Reliability and Validity.

To translate and validate the Nonverbal Pain Assessment Tool. Timely assessment of the pain degree of nonverbal intensive care unit (ICU) patients can provide humanistic care. However, there is a lack of pain assessment tools that can meet the needs of patients who cannot use language in ICUs in China. A cross-sectional survey. We conducted forward-backward translation of the Nonverbal Pain Assessment Tool. A total of 300 critically ill patients in the intensive care unit who could not communicate verbally completed the Chinese version of the Nonverbal Pain Assessment Tool and the Critical Care Pain Observation Tool. Exploratory and confirmatory factor analyses were performed to verify structural validity, and content validity and reliability analyses were also conducted. The Nonverbal Pain Assessment Tool demonstrated high internal consistency (α = 0.901) and interrater reliability (intraclass correlation coefficient = 0.981), with good split-half reliability. Content validity was established through acceptable item-level content validity index and scale-level content validity index scores. Exploratory factor analysis showed a single factor explaining 71.79% of total variance, and confirmatory factor analysis confirmed good model fit. The Spearman rank correlation coefficient was 0.917 between the Nonverbal Pain Assessment Tool and the Critical Care Pain Observation Tool. The Chinese Nonverbal Pain Assessment Tool demonstrated significant differences in scores between different states of consciousness and illness severity, supporting its known-groups validity. The Chinese version of the Nonverbal Pain Assessment Tool is a reliable and valid tool for nonverbal pain assessment in ICU patients in China. The Chinese version of the Nonverbal Pain Assessment Tool can assess the pain of patients who cannot use language in ICU, which provides a new valuable assessment tool for Chinese clinicians and nurses in pain assessment and management. Our study followed the STROBE Checklists. Patients actively cooperated and participated in data collection during the implementation of the study.

A volitional account of aesthetic experience.

Aesthetic experience is an altered state of consciousness characterized by a detached absorption in an aesthetic object; it is a pleasant-sometimes ecstatic-liberation from the self and its agenda. I briefly review perceptual-cognitive and affective approaches used by psychologists to understand the phenomenon and suggest the need for a volitional perspective. To illustrate the nature and scope of aesthetic experience, I discuss nine varieties, elicited by different qualities in objects and evoking distinctive responses in perceivers. Over centuries, aesthetic devices have been developed that induce the aesthetic state by manipulating such psychological mechanisms as attention, appraisal, and empathy. I propose explanations for how several important devices operate, and why they are particularly effective in individuals high in the personality trait of Openness to Experience.

Measuring the dynamic balance of integration and segregation underlying consciousness, anesthesia, and sleep in humans

Consciousness requires a dynamic balance of integration and segregation in brain networks. We report an fMRI-based metric, the integration-segregation difference (ISD), which captures two key network properties: network efficiency (integration) and clustering (segregation). With this metric, we quantify brain state transitions from conscious wakefulness to unresponsiveness induced by the anesthetic propofol. The observed changes in ISD suggest a profound shift towards the segregation of brain networks during anesthesia. A common unimodal-transmodal sequence of disintegration and reintegration occurs in brain networks during, respectively, loss and return of responsiveness. Machine learning models using integration and segregation data accurately identify awake vs. unresponsive states and their transitions. Metastability (dynamic recurrence of non-equilibrium transient states) is more effectively explained by integration, while complexity (diversity of neural activity) is more closely linked with segregation. A parallel analysis of sleep states produces similar findings. Our results demonstrate that the ISD reliably indexes states of consciousness.

Neural Correlates of Psychedelic, Sleep, and Sedated States Support Global Theories of Consciousness.

Understanding neural mechanisms of consciousness remains a challenging question in neuroscience. A central debate in the field concerns whether consciousness arises from global interactions that involve multiple brain regions or focal neural activity, such as in sensory cortex. Additionally, global theories diverge between the Global Neuronal Workspace (GNW) hypothesis, which emphasizes frontal and parietal areas, and the Integrated Information Theory (IIT), which focuses on information integration within posterior cortical regions. To disentangle the global vs. local and frontoparietal vs. posterior dilemmas, we measured global functional connectivity and local neural synchrony with functional magnetic resonance imaging (fMRI) data across a spectrum of conscious states in humans induced by psychedelics, sleep, and deep sedation. We found that psychedelic states are associated with increased global functional connectivity and decreased local neural synchrony. In contrast, non-REM sleep and deep sedation displayed the opposite pattern, suggesting that consciousness arises from global brain network interactions rather than localized activity. This mirror-image pattern between enhanced and diminished states was observed in both anterior-posterior (A-P) and posterior-posterior (P-P) brain regions but not within the anterior part of the brain alone. Moreover, anterior transmodal regions played a key role in A-P connectivity, while both posterior transmodal and posterior unimodal regions were critical for P-P connectivity. Overall, these findings provide empirical evidence supporting global theories of consciousness in relation to varying states of consciousness. They also bridge the gap between two prominent theories, GNW and IIT, by demonstrating how different theories can converge on shared neuronal mechanisms.