Transcript العالج التكاملى من منظور تطورى من منطلق العالج الجمعى مع الذهانيين خاصة Integrative Therapy An Evolutionary Approach Especially with psychotics We need imagination to perceive (rather.

‫العالج التكاملى من منظور تطورى‬
‫من منطلق العالج الجمعى‬
‫مع الذهانيين خاصة‬
Integrative Therapy
An Evolutionary Approach
Especially with psychotics
We need imagination to perceive (rather than
understand) some relevant information.
“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”
Lakoff & Johnson “Philosophy in the Flesh” 1999
(Cognitive Science Challenging Western Thoughts)
Illusive Current Terminology in
Psychopharmacology
Vague Terms
 Neuroleptics
“‫يعنى إيه ”لبتك؟‬
 Pschotropic Drugs
‫يعنى إيه ”تروبيك“؟‬
 Psychoactive Drugs ‫نشط؟ يعنى إيه؟ ”أى نشاط يعنى؟“ ؟‬
Illusive Current Terminology in
Psychopharmacology (Cont.)
Reductionistic terms
 Antidepressants (are not only so)
 Anxiolytics (are not exactly so)
 Anti-psychotic (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
Potency Terminology
Clinically determined, provided that the domain
and target of potency is well defined.
 Very Potent
 Moderately so
 Mild efficacy.
Structural (EVOLUTIONARY) Terminology
Oldest (archaic organization) Brain inhibitors
(potent neuroleptics (= anti devolutionary, antiwithdrawal... e.g. Haldol Olanzopine )
Older brain (paleo- organization) inhibitor
(moderate neuroleptic e.g. Stelazine
 Old brain inhibitors
 Recent brain tranquilizers
 Etc...
Relevant (Appropriate scientific) Language
Energy & Information
 The mind is a processor of energy &
information
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.
Brain is a complex processor of
ENERGY and INFORMATION
The center refers
symbolically to
the “hot
seat”
Towards real
persons in the group
Potent Neuroleptic
(in) Group Therapy
Mobilization
of
Energy
The more real relations
are established the less
neuroleptics are
needed
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”
… Comp 2000 7th edition “
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 state)
‫ثنائية الوجدان‬
‫‪ambivalence‬‬
‫الموقف االكتئابى‬
‫‪Neurotic ( + stability‬‬
‫‪Normal Defenses + Health‬‬
‫حيرة العالقة باألخر‬
‫‪Depressive‬الصحة‬
‫‪ position‬وتسمى‬
‫الدفاعات العادية‬
‫‪Paranoid Position‬‬
‫(ال مانع !!!!)‬
‫‪Schizoid Position‬‬
‫الموقف البارنوى‬
‫الكر والـفر‬
‫‪Fight flight‬‬
‫‪No object‬‬
‫مراحل النمو ‪Stages of‬‬
‫‪development‬‬
‫الموقف الشيزيدى‬
‫الالموضوع ‪ :‬فى الرحم‬
Paranoid state &
Depression
Psychic
symptoms
Schizophrenia
pain : less
Neurotic
Cover
‫الفصام‬
defensive
‫وأعراض‬
‫حاالت‬
(hyper-normality
+
‫بارانوية‬
‫سى‬alienation).
‫االكتئاب األلم النف‬
‫ برغم‬,‫ دفاعات أقل‬:
‫العصابى‬
‫الغطاء‬
‫فرط الكبت‬
)‫(”فرط العادية“ المغتربة غالبا‬
‫مراحل تراجع (فشل) الدفاعات بالتالى لتعرية مستوى يعلن المرض تلوالمرض‬
Stages of subsequent failure of defenses uncovering latent organizations to
declare a disorder after another
chizoid => Paranoid => Depressive positions
Corresponding levels of organization
Object
Relation
Brains
Drugs
+ Normal (Neurotic B)
Depressive B
Diazepines
MAOI
Tryptizol
Paranoid B
Mellaril
Largactil
Schizoid B
Melanie
Klien,
Guntrip etc.
Trilafon
Stelazine
Halodol
Clinical (Artistic) Approach
General Considerations
 No single response could be related to a single
therapeutic variable
 Most drugs are non- specific in relation to
a particular nosological label (Diagnosis)
 Drugs are absolutely specific in relation
to a particular
phase of the disease for a
particular patient in a particular setting along
special therapeutic plan.
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
(Bitaa Kolloh)
 Smart drug (Olanzepine Zeprexia)
 Soothing drug (ativan)
‫السؤال هو‪:‬‬
‫ندّى ”مين“ ”إيه“ ”إمتى“ ؟‬
‫ندّيله قد إيه‪ ,‬ولح ّد إمتى؟‬
‫بأمارة إيه ؟ ؟‬
‫وليس ‪:‬‬
‫ندّى إيه (تشخصيص)؟ إيه (دواء) ؟ كام ؟ على طـول!!‬
‫حسب جدول الضرب (الخوارزمية!!) بتاعة الخواجة التاجر‪.‬‬
‫تكامل العالجات‬
‫ العالج النفسى الجمعى‬:‫مثال من‬
)‫(خاصة للذهانيـين‬
Integrative Management
Example : In Group Therapy
(especially for psychotics)
Factors Judging Drug Administration.
Clinical monitoring should take priority
 Functioning is more important than symptoms
 Most drugs are considered inhibitors to
certain” neuronal net profile ==== 
 This means that they 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”
‫‪Changing the whole pattern‬‬
‫‪Organization‬‬
‫‪Hypothetical Brain‬‬
‫‪Specific drug‬‬
‫‪abolishing the excess‬‬
‫‪Pathological excess of‬‬
‫‪Some transmitter‬‬
‫الفكرة أنه بزيادة أو نقص مادة معينة بالمرض أو بالعالج يتغير التنظيم الكلى للدماغ‬
‫وهذا يظهر إكلنيكيا فى كلية نوع التغير فى العالقة بالموضوع ‪ ,‬والعمل‪ ,‬و نبض الوجدان‬
8
6
Factors Judging Drug Administration.
Remember:
 pattern of neuronal
group
activation can become reinforced if
they occur frequently or if the value
system of the brain ingrains their
profile”
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) particular symptoms
Brain Synchronizing Therapy (BST)=
Rhythm Restoring Therapy (RRT)
As structural diagnostic tool
and
instantaneous energizer
of the reinforced appropriate
neuronal group
( Potentially active Brain= Pace maker)
Brain Synchronizing Therapy (BST)=
Rhythm Restoring Therapy (RRT)
It is not the least
SHOCK (Electroshock)
or
CONVULSIVE (Not ECT)
Both terms are misnomers
Brain Synchronizing Therapy (BST):
Acts according to the preparation along
the therapeutic plan (psychotherapy,
rehabilitation, object relation, meaningful
discourse, identifying a goal ..etc)
 Sometimes one cannot judge, and the
first BST tells us where we are.
Hence timing and immediate close
step by step assessment is the most
important factor in using such therapy.
The response to BST depends on:
 Pre-morbid strength of the normal
pace maker.
 Establishment of object relation.
 Decision to go forward (towards
reality, commitment, relation etc…)
 The immediate utilization of its
result.
 The readiness to stop for further
preparation or to continue for more
reinforcement.
BST has been used:
During the group
Alternating with group sessions
And
As maintenance along and after the
group.
Details impossible in such short time
Brain is a complex processor of ENERGY and 
INFORMATION
Object relational Depression
The more relating
to real object the
more energy is
flowing properly and
re-harmonizing is
possible.
(Do not give anti-depressants)
Mobilization
of
Energy
E.g. in intensive
Individual Therapy
Towards
real object
Haloperidol
Schiz.Disorg.
Diminish the dose
The less
neuroleptics are
needed
Brain is a complex processor of
ENERGY and INFORMATION
The center refers
symbolically to
the “hot
seat”
Towards real
persons in the group
Potent Neuroleptic
(in) Group Therapy
Mobilization
of
Energy
The more real relations
are established the less
neuroleptics are
needed
Haldol 5
Haldol 5
Haldol 5
Thank You
‫شكرا لكم‬