Transcript Integrative Therapy Biorhythmic Evolutionary Approach

Integrative
‫التكاملى‬
‫العالج‬
Therapy
‫من منظور‬
Biorhythmic
‫إيقاعى تطورى‬
Evolutionary
Approach
Linear Etiological Deterministic Model
(= Mechanical- Chemical or Psychoanalytic)
versus
Evolutionary Structural
Process Oriented Model.
( = Comprehensive Medical
Artistic (Creative and/or Folklore)
Chemical Mechanical Model
‫الشعور“األنا“‬
‫?‬
‫الالشعور‬
‫تشريح الشخصية ‪ :‬فرويد –‬
‫التحليل النفسى الكالسى‬
‫تركيب الدماغ ‪ :‬التجزيئ الكيميائى‬
‫تشابه الحتمية التحليلية الفرويدية مع الحتمية الكيميائية‬
Fragmentation
Localization
sectorization
Dissection
Reductionistic Medical Model
Is essentially localizing &
quantitative following mainly:
Neurological analogy
Endocrinal analogy
Neurology has been reduced to
Localization & quantification (+++ - - -)
While more profound Neurological aspects
worth considering such as:
Cognitive neurosciences
Hierarchical (Evolutionary) organization
(Neo cortex - archi-cerebellum, etc…)
Biorhythmic Nerve Firing etc…
Endocrinology as analogy
Mainly Quantitative
Hyper-secretion
Hypo-secretion
Hyper-functioning
Hypo-functioning & Quantitative Correction
…etc
Comprehensive Medical Model
I-
analogy with GIT & Metabolic S.
Information Processing (input)
Unassimilated Information (memories)
Rumination of Information (Dreams)
Re-patterning (dreams and/or creation)
Foreign Body Mal-adjusted Un-assimilated etc.
Analogy with Orthopedic S.
Break down
Healing
Callous (Scar)
Impossible Identical repair as pre-fracture
status (=Stronger or Different organization of
the outcome after fracture)
analogy with Cardiovascular S.
Biorhythmic : Filling- Unfolding cycles
Information processing (partly rhythmic)
Pacemaker Alternations
(Sleep- Dream-Rhythmicity)
Extra-systoles (Impulsivity)
Nodal- Escape (analogy)
(Dissociation
or
Systematized Psychosis) & Fibrillation (Schizoph)
Electroshock Resuscitation
Brain Cycles are Sophisticated
Biorhythmic
pulsations
of the Brain
Current Recent Scientific Vocabulary &
Frame of references
Examples
Cognitive Neurosciences
New (&Molecular) Genetics
Quantum Physics & Quantum Mathematics
Computing sciences
Chaos & Complexity Sciences
Some New vocabulary & Orientation
“Our brains each have 100 billion neurons and 100 trillion
synaptic connections)
“We are neuronal beings …
“What we call concepts are neural structures
that allow us to mentally categorize our categories
and reason about them”
“Philosophy is in the flesh and in every day
activity, not the least intellectual argumentations”
e.g. The book titled: Philosophy in the Flesh”
Lakoff & Johnson 1999
(Cognitive Science Challenging Western
Thoughts)
Illusive Current Terminology in
Psychopharmacology
Vague Terms
“‫يعنى إيه ”لبتك؟‬
 Neuroleptics
 Psychotropic
‫”تروبيك“؟‬
Drugs
 Psychoactive Drugs
‫إيه‬
‫يعنى‬
!!!
‫نشاط إيه‬
‫على حساب إيه؟ ” قصدك إيه؟“ ؟‬
Illusive Current Terminology in
Psychopharmacology (Cont.)
Certain groupings bear illusive terms
 Antidepressants (are not only so)
 Anxiolytics (are not exactly so)
 Anti-psychotic ( Anti what ? Psychotic
symptoms or psychotic status ?)
 Anti-negative symptoms of
schizophrenia (debate: Schizophrenia
Bulletin Sept 2002 Vol 28 No 2 : Is there a
treatment for negative symptoms?)
Illusive Current Terminology in
Psychopharmacology (Cont.)
Biochemical pseudoscientific terms:
 SSRI (then what ?)
 MAOI (and then ?)
 Tricyclic
 Serotonin ma3rafshi eaih
Practical Clinical Terminology
(1) Potency
(provided that the domain and target of potency is
well defined).
 Very Potent
 Moderately so
 Mild efficacy.
 Rather specific
 Good for nothing
Clinical Terminology (2)
Suggested Evolutionary Terminology
 Oldest Brain inhibitors (?? archaic organizers)
(= potent neuroleptics = anti devolutionary,
anti-withdrawal... e.g. Haldol Olanzopine )
Older brain inhibitor (?? paleo- organizers)
(= moderate neuroleptic e.g. Stelazine
 Old brain inhibitors
 Recent brain tranquilizers
 Broad-spectrum anti-psychotics (Clozaril.etc)
Relevant (Appropriate scientific) Language
Energy & Information
 The mind is a processor of
information
energy &
Energy is contained within the activation of
neuronal circuits.
 Information is contained within the patterns
of activation (=neural net profile = mental
representation)
 The nervous system can function as a
parallel and serial process of information.
Relevant (Appropriate scientific) Language
States of Mind
… the state of activation of the various parts of
the system can cluster into repeated patterns
called states”
“… In the brain a state of mind or mental state
describes the way in which the various neuronal
groups become activated at a given time.”
A neuronal net profile (= repeated pattern of
neuronal
group activation) can become
reinforced if they occur frequently or if the value
system of the brain ingrains their profile”
Consciousness and mental schemata
Schemata are special highly
structured organizations .
They are stimulated (& reactivated)
according to special stimuli .
They possibly correspond to what
is known as Ego states)
Genes are but ingrained DNA &
neuronal programs
‫‪Behavioral level of‬‬
‫‪Normal Defensive‬‬
‫‪Life‬‬
‫ثم ماذا وراء كل ذلك !؟؟‬
‫المستوى السلكوكى‬
‫للحياة العادية‬
‫(ذات الدفاعات الطبيعية)‬
‫‪Normal‬‬
‫‪Defensive‬‬
‫االكتئاب‬
‫‪Life‬‬
‫الحياة العادية‬
‫(ذات الدفاعات الطبيعية)‬
‫العصاب‬
‫هيراركية األمخاخ‬
‫الفصام ‪ :‬التهديد‬
‫األساسى=> بالتفسخ‬
‫والنكوص‬
‫والذوات وحاالت‬
‫العقل‬
‫الكر‪-‬الفر‪ -‬موقف البارانويا‬
Schizoid => Paranoid => Depressive positions
Corresponding levels of organization
Object
Relation
Brains
Drugs
Diazepines
+ Normal (Neurotic B)
Depressive
Brain
MAOI
Tryptizol
Paranoid
Brain
Mellaril
Largactil
Melanie
Klien,
Guntrip etc.
Schizoid
Brain
Trilafon
Stelazine
Halodol
ParanoidPsychic
state &
Depression
symptoms
pain :Neurosis
less
defensive
‫بارانوية‬
‫النفسى‬
‫وأعراضاأللم‬
‫االكتئاب‬
(normal
+ ‫حاالت‬
Schizophrenia
alienation).
‫ دفاعات أقل‬:
‫الفصام‬
‫الغطاء العصابى‬
)‫(العادية المغتربة غالبا‬
‫التهديد‬
: ‫الفصام‬
‫الدفاعات بالتتالى لتعرية مستوى يعلن المرض تلوالمرض‬
)‫فشل‬
( ‫مراحل تارجع‬
>=‫األساسى‬
‫بالتفسخ والنكوص‬
Stages of subsequent failure of defenses uncovering
latent organizations to declare a disorder after antoher
‫حتى يمكن توصيل أى شىء من بقية الورقة‬
‫مطلوب من فضلكم ‪:‬‬
‫قدر أقل من التبعية‬
‫قدر أكبر من الخيال‬
‫قدر أقل من الخوف‬
‫قدر أكبر من السماح‬
‫قدر أقل من العقلنة‬
‫قدر أكبر من اإلبداع‬
‫‪Art of Healing‬‬
‫فن الألم‬
‫قراءة ونقد النص البشرى‬
‫إلعادة إبداعه معه‬
‫السؤال هو‪:‬‬
‫ندّى ”مين“ ”إيه“ ”إمتى“ ؟‬
‫ندّيله قد إيه‪ ,‬و لح ّد إمتى؟‬
‫بأمارة إيه ؟ ؟ ل ّما يحصل إيه ؟‬
‫وليس ‪:‬‬
‫ندّى”تشخيص ”كذا“ دوا ”كيت“ ‪:‬‬
‫حسب جدول الخواجة الخوارزمى!‬
‫إللى ما شافشى وال حالة بحق!!!!‬
‫السؤال‬
‫هو‪:‬‬
‫ندّيله‬
‫”مين“ ”إيه“ ”إمتى“‬
‫ندّى‬
‫قد إيه‪,‬‬
‫و لحدّ‬
‫إمتى‬
‫ل ّما يحصل إيه ؟‬
‫بأمارة إيه ؟ ؟‬
Clinical (Artistic) Approach
General Considerations
 No single response could be related to a single
therapeutic variable
Drugs are much more
specific in
relation to a particular phase of the disease for a
particular patient in a particular setting along
special therapeutic plan, rather than it could be
specific to a particular diagnostic category
Artistic (Clinical) Terminology
 Decent drug (e.g perphenazine trilafon )
 Aggressive drug (e.g. Haloperidol)
 Broad spectrum drug (Clozaril) Old wise
drug (chlorpromazine)
 Harmonizing drug (e.g. carbamazepine) !! ‫بتاع كله‬
(Bita3 Kolloh)
 Smart drug (Olanzepine Zeprexia)
 Soothing drug (xanax)
‫)‪Lay Smart Terminology (3‬‬
‫•الدوا‬
‫ده ‪ ....‬دمه خفيف‬
‫•‪ ...‬إبن ستين فى سبعين‬
‫• ‪ ....‬ابن حالل‬
‫• ‪,,,,‬م ّيا م ّيا‬
‫• ‪..‬إللى هوا‬
‫• ‪...‬بتاع كله‬
‫• ‪ .....‬ما حصلشى‪ .....‬إلخ‬
Suggested Hierarchical (Structural)
Terminology
 Oldest brain control
 Old brain control
 Relatively old brain control
 Relatively recent brain soothing
 Recent brain energizer
 Broad spectrum harmonizer
 Rhythm restoring stabilizer (Mood stabilizer)
Hypotheses
1.Energy and Information need a
consistent organizing output and goal
2.Most drugs act as reorganizers rather
than quantitative corrective tools
3.Reorganization (re-harmonization)
needs all measures in an artistic
creative reconstructive manner
Hypotheses (Cont.)
4. Hierarchical organizations of the brain are both
competitive and cooperative with each other
5. Therapy is an ongoing process dealing with and
confronting the challenging disease process
6. The unitary concept of psychiatric disorder has
its corresponding application in drug use as well
as regards most therapeutic measures.
7. Drugs are not specific in principle, nevertheless
they are more specific in the context of master
therapeutic plan
TOW MAIN CATASTROPHIES
ARE GOVERNING CLINICAL PRACTIC
1.Algorithmic discipline for drug
administration
2. Monitoring by blood level
Basic assumptions of the art of healing
Clinical monitoring should take priority
 Functioning is more important than symptoms
 Most drugs are considered inhibitors to
certain” neuronal net profile ==== 
 As such they are ultimately releasers to some
other activated net profile.
 Remember the basic rule:
Pattern of neuronal group activation can become
reinforced if they occur frequently or if the value
system of the brain ingrains their profile”
The Re-organizing
Hypothesis
Changing the whole pattern
normal
Not essentially
Organization
Hypothetical Brain
Pathological excess of
Some transmitter
Specific drug
abolishing the excess
‫الفكرة أنه بزيادة أو نقص مادة معينة بالمرض أو بالعالج يتغير التنظيم الكلى للدماغ‬
‫ و نبض الوجدان‬,‫ والعمل‬, ‫وهذا يظهر إكلنيكيا فى كلية نوع التغير فى العالقة بالموضوع‬
Drugs re-pattern certain profiles (Programs/
Brains) after special Habilitation Preparation
8
6
How specific inhibition changes the
whole pattern (Brain-Level-State)
89
How specific inhibition changes the
whole pattern (Brain-Level-State)
83
figurative Illustration
Drug II
83 69
8
9
65
Minor Tranquil.
Prothiaden
Stabizers e.g.Carbamazepine
This is not th least the case
The actual art is the result of training.
Tryptizol
Thioridazine Mellar.
Chlorpomazine
Perphenazine Trilaf
Trifluperazine Stelaz
Randolectil
Haloperidol
Majeptil +
Haloperidol
not
Floating
Anxiety
Panic
Anxiety Depression
Depression (1)
Depression (2)
Schizo-agitatied
Schizo-depressive
Schiz. Paranoid ++
Schiz. Paranoid +++
Schiz. Chron. Undif
Schiz. Disorg.
Almost none !!!
Anxiety
Schiz. Simple
least
This is
the
case
The actual art is the result of
training.
+
Mania.
Side Notice about:
The Unitary hypothesis
of Psychiatric Disorders
‫• فرض ”المفهوم الواحدى“ يتناول القضية من‬
‫منظور كل من ‪:‬‬
‫‪ .I‬أصل التطور (فيلوجينيا وأنتوجينيا) ‪Same‬‬
‫‪evolutionary origin‬‬
‫‪ .II‬الوراثة‬
‫‪ .III‬نقلة الزمالت ‪Syndrome shift‬‬
‫‪ .IV‬نقلة األعراض ‪Symptom shift‬‬
‫‪ .V‬األمراض المختلطة (وإلى درجة أقل ‪ :‬المتواكبة)‬
‫واالضطرابات البينية‪Mixed disorders and .‬‬
‫‪Genetic perspective‬‬
‫)‪Intermediate Disorders (& ?? Co-morbidity‬‬
‫نقالت فى العالج النفسى‬.VI
Shifts in
psychotherapy
Shifts due
‫ نقالت فى العالج الدوائى‬.VII
to certain drugs
Outcome of
‫ مآل بعض األمراض‬.VIII
certain syndromes
‫فاعلية نفس الدواء ألمراض مختلفة‬.IX
Efficacy of the same
same drug for different disorders
Therapy in Terms of
Energy and Processing
Certain Theoretical Relevant
Information.
The mind is a processor of energy &
information
Energy is contained within the activation of
neuronal circuits
Pattern of neuronal group activation can
become reinforced if they occur frequently or
if the value system of the brain ingrains their
profile”
Physical
WORK
Object
relation
Imprisoned
Depression
Energy

Energy Overflow  Mania
or Active paranoid reaction
Shut in Disorganizing
Energy  Schizophrenia
Factors Judging Drug Administration (Cont.)
 Displacement of energy
 Reactivation of appropriate pattern of neural group
 Shifts from one level to another are to be judged
clinically in terms of :
 A) actual daily job performance
 B) active (real) object relation
 C) mode of relating (schizoid, paranoid etc.)
 D) last & may be least: particular symptoms
Schizoid Brain
‫المخ البارنوى‬
Paranoid Brain
‫المخ‬
‫الشيزيدى‬
‫المخ العادى‬
‫الواقعى العملى‬
‫المخ االكتئابى‬
‫العالقاتى‬
Depressive
Brain
Confrontational
Relational
Normal
Defensive
Positively
Alienated Brain
Normal +
Productive
Brain
HALOPERIDOL
+++++
‫المخ‬
‫الشيزيدى‬
Normal Productive Life
HALOPERIDOL
Normal Productive Life
+++++
‫المخ‬
‫الشيزيدى‬
‫المخ االكتئابى‬
‫العالقاتى‬
HALOPERIDOL
HALOPERIDOL
‫‪HALOPERIDOL‬‬
‫‪+++++‬‬
‫المخ االكتئابى‬
‫العالقاتى‬
‫المخ العادى‬
‫الواقعى العملى‬
‫‪Stellasine‬‬
‫المخ البارنوى‬
Prothiaden
Tryptizol
Mellaril
Chlorpomazine
Perphenazine Trilaf
Resperidal
Haloperidol
Majeptil +
Haloperidol
DOSE
/1000 ??
900 ??
750 ??
700 ??
500
350
300
100
50
The more drug cohesion and object relation the less the dose
+++
+++
+++
‫الحمد هلل وشكرا لكم‬
‫‪THANK YOU‬‬