PSİKİYATRİde TANI
«Altın»ı kim tanır ?
Sarraf mı, Simyacı mı?

Kuyumcu mu , Kimyacı mı ?

Bedirhan Üstün
WHO
Classificatio...
Görünüşe Aldanmak
Sistematiğe Adanmak
İşin iç yüzü
Z
29
47
79
111

Element No. of electrons/shell
copper
2, 8, 18, 1
silver
2, 8, 18, 18, 1
gold
2, 8, 18, 32, 1...
‘Da Vinci’ Şifresi
Şifrenin binbir yorumu

This form of periodic table is more congruent with the
order in which electron shells are filled, ...
Doğa «Geometrik» mi ?
Theodor Benfey's Table
Tüm bunların ne anlamı var ki ?
ALTINa HÜCUM sırasında….
Altın neden değerlidir ?
Metaforlara son !
•
•
•
•
•
•
•

1952
1968
1980
1987
1994
2000
2013

DSM I
DSM-II
DSM-III
DSM-III-R
DSM-IV
DSM-IV-TR
DSM 5

• ICD-6
• ICD-8
...
"Psychiatrists of Europe!
Protect your sanctified diagnoses!”
Cartoon by Emil Kraepelin, "Bierzeitung", Heidelberg 1896
DSM5 disorder groups
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.

Neurodevelopmental disorders
...
Hayali Bir Çin Ansiklopedisinden Alıntı
Hayvanlar şu sınıflara ayrılırlar:
•
•
•
•
•
•
•
•
•
•
•
•
•

imparatora ait olanl...
Gerçek Dünyaya Hoş geldiniz
DSM5 Field Trials Regier et al 2013
Beni kategorize etme
Beni kategorize etme,
benle oynama

Yaftayı yapıştırıp,
bana isim koyma

Karikatürleştirme beni,
ilah...
disorders

NATURE | VOL 496 | 25 APRIL 2013
Dimensions
or Pseudodimensions :

NATURE | VOL 496 | 25 APRIL 2013
NIMH will be re-orienting its research
away from DSM categories and
toward RDoC.

20

Search: ‘Insel transforming diagnosi...
Research Domain Criteria NIMH
Dimensions of Observable neurobiological measures

• Units of analysis
 Genes
 Molecules
...
Heterogeneity of disorders

Michael Owen: “These disorders are not really disorders. There’s
no such thing as schizophreni...
Diagnosis and Treatment of Mental Disorders:
…. But also Half Empty

• Diagnosis by observation
• Late detection
• Poor pr...
DSM criticisms
• Diagnostic concepts are 100 – 2000 years old
• The mind-body distinction for mental disorders

• Limited ...
RDoC: Research Domain Criteria,
October 2012
The RDoC Matrix
Learned Helplessness
Depression
Hypofunctioning of the
dorsolateral prefrontal cortex
in major depressive disorder.
(From Aizenstein et al., 2009[1].
Neurocircuitry
in major depressive disorder (MDD)
Depression
“Dysregulation of mood homeostasis”
• Stuck in ‘blues’ ( Area 25 )
– Hypothalamus:
• Appetite, energy,

Emotion...
Bedensel Hastalıklar
0.8

0.6

Heritability

0.4

0.2

0

Breast
Cancer

Hypertension

Ischemic
Heart
Disease

Rheumatoid
...
Ruhsal Hastalıklar
0.8

Heritability

0.6

0.4

0.2

0
Depression

ADHD

Schizophrenia

Autism

Bipolar
The Meaning of the Human Genome
Project for Neuropsychiatric Disorders
Steven E. Hyman
Provost, Harvard University and Pro...
Gen-Davranış Pathway
(Ustun, 2005)

G1

P1
B1

N1
G2
G3

P2

N2

P3

N3

G4
Genetic

Genotypes

B2
B3

P4
Neurophysiologic...
Attachment - Bağlanım
Korkulu Uyaranlara - Oxytocin
‘Beyin’e bir bilgisayar gibi bakmak?
Beyin Bilim 2013
Gene de parçaları ayırmak gerekiyor
DepressionTreatment
Past
Present
Future

INSEL Scıentific Amerıcan 2010
Yerkes National Primate Research Center
Thomas R. Insel 1993-2002
Sequence divergence %
between humans and other hominids
the genetic difference between
humans and chimps is less than 2%,
John NASH: A Brilliant Mind
My irrational “dreams”,
as I call them,
and my mathematical thoughts
both
came from the same p...
Izmir TPD talk (TURKISH):  PSİKİYATRİde TANI «Altın»ı kim tanır ?  Sarraf mı, Simyacı mı?  Kuyumcu mu, Kimyacı mı ?
Izmir TPD talk (TURKISH):  PSİKİYATRİde TANI «Altın»ı kim tanır ?  Sarraf mı, Simyacı mı?  Kuyumcu mu, Kimyacı mı ?
Izmir TPD talk (TURKISH):  PSİKİYATRİde TANI «Altın»ı kim tanır ?  Sarraf mı, Simyacı mı?  Kuyumcu mu, Kimyacı mı ?
Izmir TPD talk (TURKISH):  PSİKİYATRİde TANI «Altın»ı kim tanır ?  Sarraf mı, Simyacı mı?  Kuyumcu mu, Kimyacı mı ?
Izmir TPD talk (TURKISH):  PSİKİYATRİde TANI «Altın»ı kim tanır ?  Sarraf mı, Simyacı mı?  Kuyumcu mu, Kimyacı mı ?
Izmir TPD talk (TURKISH):  PSİKİYATRİde TANI «Altın»ı kim tanır ?  Sarraf mı, Simyacı mı?  Kuyumcu mu, Kimyacı mı ?
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Izmir TPD talk (TURKISH): PSİKİYATRİde TANI «Altın»ı kim tanır ? Sarraf mı, Simyacı mı? Kuyumcu mu, Kimyacı mı ?

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ICD DSM ICD11 DSM5 RDOC Mental disease descriptions; homeostasis;neuroscience, paradigms

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  • Zamanmakinesi:tarihsel determinism  yenidenbaslasakayninoktada mi olurduk? A classification is a way of seeing the worldOrder of thingsStructure of the systemLogicIntegrationSimple  complex : A “calculus”
  • Dimensions of Observable neuriobiological measuresDimensions with cutpointsNegative Valence SystemsAcute threat (“fear”)Potential threat (“anxiety”)Sustained threatLossFrustrativenonrewardPositive Valence SystemsApproach motivationReward valuationEffort valuation / Willingness to workExpectancy / Reward prediction errorAction selection / Preference-based decision makingInitial responsiveness to rewardSustained responsiveness to rewardReward learningHabitCognitive SystemsAttentionPerceptionVisual PerceptionAuditory PerceptionOlfactory SomatosensoryMultimodal PerceptionWorking memoryActive MaintenanceFlexible UpdatingLimited CapacityInterference ControlDeclarative memoryLanguage behaviorCognitive (effortful) controlGoal SelectionUpdatingRepresentation and MaintenanceResponse Selection,Inhibition or SuppressionPerformance MonitoringSystems for Social ProcessesAffiliation and attachmentAttachment formation and maintenanceSocial CommunicationReception ofFacial CommunicationProduction of Facial CommunicationReception of Non-Facial CommunicationProduction of Facial CommunicationPerception and Understanding of SelfAgencySelf-KnowledgePerception and Understanding of OthersAnimacy PerceptionAction PerceptionUnderstanding Mental StatesArousal and Regulatory SystemsArousalCircadian RhythmsSleep and wakefulness
  • A focused research grant funding initiative (~ 30 funded to date)Research “toward a new classification system”: study and validate dimensional constructs that cut across current disordersGoal: research that aligns with genetics, other areas of neuroscience, & behavioral science to provide a foundation that can lead to more effective diagnosis and interventionsMore homogeneous targets for interventions – developing new treatments, or matching current treatments to diagnosis
  • n Part 1 of Seligman and Steve Maier's experiment, three groups of dogs were placed in harnesses. Group 1 dogs were simply put in the harnesses for a period of time and later released. Groups 2 and 3 consisted of "yoked pairs." A dog in Group 2 would be intentionally subjected to pain by being given electric shocks, which the dog could end by pressing a lever. A Group 3 dog was wired in series with a Group 2 dog, receiving shocks of identical intensity and duration, but his lever didn't stop the electric shocks. To a dog in Group 3, it seemed that the shock ended at random, because it was his paired dog in Group 2 that was causing it to stop. For Group 3 dogs, the shock was apparently "inescapable." Group 1 and Group 2 dogs quickly recovered from the experience, but Group 3 dogs learned to be helpless, and exhibited symptoms similar to chronic clinical depression.In Part 2 of the Seligman and Maier experiment, these three groups of dogs were tested in a shuttle-box apparatus, in which the dogs could escape electric shocks by jumping over a low partition. For the most part, the Group 3 dogs, who had previously learned that nothing they did had any effect on the shocks, simply lay down passively and whined. Even though they could have easily escaped the shocks, the dogs didn't try. Their lack of attempt was due to an effect called retardation of learning. Learning that response and shock are independent made it more difficult to learn that a response does produce relief by terminating shock. The emotional stress that the dogs experience when learning that the trauma is uncontrollable produced failure to escape.[5]
  • Neurocircuitry in major depressive disorder (MDD): In this figure, complex analyses based upon functional neuroimaging can determine not only which specific neuroanatomic areas are hyper or hypofunctional in the MDD patient, but further analyses the strength, or weakness, in the connectivity between brain regions. This may help delineate MDD from control subjects and possibly determine which brain endophenotypic findings need to be remedied to alleviate symptoms (Zenget al., 2012.[32]
  • A NEW ERA AT YERKESThomas R. Insel reflects on his first year as director of the primate research centerResearch aimed at finding the causes and cures for diseases with genetic origins is a priority for Thomas R. Insel, who late last year became the seventh director of the Yerkes Regional Primate Research Center, a division of Emory's Robert W. Woodruff Health Sciences Center."The Yerkes center has gone through a tremendous growth phase, and now it is in the position to become one of the most exciting areas for research in neuroscience and infectious disease gene therapy," Insel says."My vision is to bring in a number of well-trained ambitious, creative investigators who will be on the cutting edge of their disciplines and will use primates as their research subjects."Insel was recruited to Emory from his position as chief of the Unit on Developmental Biopsychology in the Laboratory of Neurophysiology at the National Institute of Mental Health in Bethesda, Maryland. He replaced Frederick A. King, who retired in 1994, after sixteen years as Yerkes director."Two factors drew me here," Insel says. "One, the commitment that Emory had made to biomedical research in general and neuroscience research in particular. And two, the potential of a place like this, in a time when funding is so tight, to continue to grow because of unique resources."Insel is not, as one might expect, a primatologist. He is, instead, a self-described "psychiatrist turned neuroscientist" with interests in the structure and function of the brain and how the brain mediates emotions. He became interested in those subjects while a resident at the Langley Porter Neuropsychiatric Institute at the University of California in San Francisco. After his residency, he moved to the National Institutes of Health, where he investigated the neurobiology of social behaviors, such as mother-infant attachments, pair-bonding, and aggression. Using laboratory animals, he sought to understand how the anatomy and chemistry of the brain influenced these behaviors.According to Insel, the Yerkes Center should excel in three areas: neuroscience; infectious diseases, including AIDS research and vaccine development; and gene therapy techniques. "As we get to know more about the molecular biology of certain diseases--Huntington's chorea, diabetes, all the metabolic diseases--we are beginning to identify specific genes that are involved. We still do not understand precisely how these aberrant genes contribute to these diseases," he says."We now have identified a gene associated with cystic fibrosis. People who are at risk for this disease have a very different gene than those who are not. We can try to do all sorts of things to treat cystic fibrosis medically, but the ultimate cure would be to change that gene. The only way to do that would be if you could take out the cells that have the abnormal gene and put a normal gene in its place. And to do that is going to take some very clever targeting. You have to know where the gene is, you have to have a normal copy of it, and you have to have a way to get it into the correct place so it will override the abnormal gene that is in place."Despite its solid reputation, Yerkes has frequently been a target of animal rights activists. Insel said he has not had much experience dealing with activists, but he knows what his response will be."I think for Yerkes, the most important response to the threat of animal activists is to make important discoveries. If we can come up with a vaccine for AIDS, if we can demonstrate a treatment for a very serious disease like that, then we've made our own argument for animals in research. To me the challenge that animal activists pose is ultimately to do the very best science we can do and to allow our discoveries to demonstrate . . . not just the importance but the necessity of this kind of work."Another of Insel's concerns is that many people in the Emory community don't understand the relationship between Yerkes and the University. "There has always been some confusion . . . about whether Yerkes is part of Emory or part of the federal government. That should not be a source of confusion. This is not in any way, shape, or form a federal laboratory. . . . It is, from top to bottom, part of Emory. Every brick, every animal in this place, is part of Emory University."Insel's predecessor, Frederick King, received praise for the helping hand he provided Zoo Atlanta in the early eighties, when the facility was ranked among the worst zoos in the nation. King agreed to lend the zoo thirteen breeding gorillas if it built them an appropriate, natural environment. The Ford Motor Company followed King's lead and anteed up $500,000 to construct the Ford African Rain Forest, the zoo's premier exhibit. Under King's directorship, Yerkes first received and maintained full accreditation from the American Association for the Accreditation of Laboratory Animals, whose certification is considered the "gold standard" of excellence in laboratory animal care.The Yerkes Center, founded in 1930, is the oldest scientific institute in the world dedicated to primate research. More than one hundred and ninety researchers in the areas of behavioral biology, neurobiology and vision, pathobiology and immunobiology, and reproductive biology work with more than three thousand primates comprising fifteen species, the most diverse collection in the world.--A.B.
  • A phylogenetic tree like the one shown above is usually derived from DNA or protein sequences from populations. Often mitochondrial DNA or Y chromosome sequences are used to study ancient human demographics. These single-locus sources of DNA do not recombine and are almost always inherited from a single parent, with only one known exception in mtDNA (Schwartz and Vissing 2002). Individuals from the various continental groups tend to be more similar to one another than to people from other continents. The tree is rooted in the common ancestor of chimpanzees and humans, which is believed to have originated in Africa. Horizontal distance in the diagram corresponds to two things:Genetic distance. Given below the diagram, the genetic difference between humans and chimps is less than 2%,[3] or 20 times larger than the variation among modern humans.Temporal remoteness of the most recent common ancestor. Rough estimates are given above the diagram, in millions of years. The mitochondrial most recent common ancestor of modern humans lived roughly 200,000 years ago[citation needed], latest common ancestors of humans and chimps between four and seven million years ago.Chimpanzees and humans belong to different genera, indicated in red. Formation of species and subspecies is also indicated, and the formation of races is indicated in the green rectangle to the right (note that only a very rough representation of human phylogeny is given). Note that vertical distances are not meaningful in this representation
  • Izmir TPD talk (TURKISH): PSİKİYATRİde TANI «Altın»ı kim tanır ? Sarraf mı, Simyacı mı? Kuyumcu mu, Kimyacı mı ?

    1. 1. PSİKİYATRİde TANI «Altın»ı kim tanır ? Sarraf mı, Simyacı mı? Kuyumcu mu , Kimyacı mı ? Bedirhan Üstün WHO Classifications, Terminologies, Standards
    2. 2. Görünüşe Aldanmak
    3. 3. Sistematiğe Adanmak
    4. 4. İşin iç yüzü Z 29 47 79 111 Element No. of electrons/shell copper 2, 8, 18, 1 silver 2, 8, 18, 18, 1 gold 2, 8, 18, 32, 18, 1 roentgenium 2, 8, 18, 32, 32, 17, 2
    5. 5. ‘Da Vinci’ Şifresi
    6. 6. Şifrenin binbir yorumu This form of periodic table is more congruent with the order in which electron shells are filled, as shown in the accompanying sequence in the left margin. The placement of helium (a noble gas) above beryllium (an alkaline earth metal) ordinarily attracts strong criticism from chemists.
    7. 7. Doğa «Geometrik» mi ? Theodor Benfey's Table
    8. 8. Tüm bunların ne anlamı var ki ? ALTINa HÜCUM sırasında….
    9. 9. Altın neden değerlidir ?
    10. 10. Metaforlara son !
    11. 11. • • • • • • • 1952 1968 1980 1987 1994 2000 2013 DSM I DSM-II DSM-III DSM-III-R DSM-IV DSM-IV-TR DSM 5 • ICD-6 • ICD-8 • ICD-9 • ICD-10 • ICD-11
    12. 12. "Psychiatrists of Europe! Protect your sanctified diagnoses!” Cartoon by Emil Kraepelin, "Bierzeitung", Heidelberg 1896
    13. 13. DSM5 disorder groups 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Neurodevelopmental disorders Schizophrenia spectrum and other psychotic disorders Bipolar and related disorders Depressive disorders Anxiety disorders Obsessive-compulsive and related disorders Trauma- and stressor-related disorders Dissociative disorders Somatic symptom and related disorders Feeding and eating disorders Elimination disorders Sleep-wake disorders Sexual dysfunctions Gender dysphoria Disruptive, impulse-control, and conduct disorders Substance-related and addictive disorders Neurocognitive disorders Personality disorders Paraphilic disorders Other mental disorders
    14. 14. Hayali Bir Çin Ansiklopedisinden Alıntı Hayvanlar şu sınıflara ayrılırlar: • • • • • • • • • • • • • imparatora ait olanlar mumyalananlar evcilleştirilmiş olanlar süt domuzları deniz kızları kaf dağından gelenler başıboş köpekler bu sınıflandırmaya girenler kuduranlar sayılamayacak denli çok olanlar ince deve tüyünden yapılan fırça ile boyanmış olanlar ve saire su testisini kırmış olanlar • uzaktan sineklere benzeyenler Borges 1977
    15. 15. Gerçek Dünyaya Hoş geldiniz DSM5 Field Trials Regier et al 2013
    16. 16. Beni kategorize etme Beni kategorize etme, benle oynama
 Yaftayı yapıştırıp, bana isim koyma
 Karikatürleştirme beni, ilahlaştırma
 Tabulaştırma sakın, tapulaştırma

 Ben seni öyle sevdim, öyle sevdim
 Ben seni öyle sevdim, böyle mi sevdim

 Matematikleştirme beni, çarpma, bölme
 Toplama, çıkartma sakın beni hesaplaştırma
    17. 17. disorders NATURE | VOL 496 | 25 APRIL 2013
    18. 18. Dimensions or Pseudodimensions : NATURE | VOL 496 | 25 APRIL 2013
    19. 19. NIMH will be re-orienting its research away from DSM categories and toward RDoC. 20 Search: ‘Insel transforming diagnosis’
    20. 20. Research Domain Criteria NIMH Dimensions of Observable neurobiological measures • Units of analysis  Genes  Molecules  Cells  Neural Circuits  Physiology  Behaviours  Self Reports
    21. 21. Heterogeneity of disorders Michael Owen: “These disorders are not really disorders. There’s no such thing as schizophrenia. It’s a syndrome. It’s a collection of things psychiatrists have grouped together.” 22
    22. 22. Diagnosis and Treatment of Mental Disorders: …. But also Half Empty • Diagnosis by observation • Late detection • Poor prediction • Unknown etiology • Minimal prevention • Treatment is trial and error
    23. 23. DSM criticisms • Diagnostic concepts are 100 – 2000 years old • The mind-body distinction for mental disorders • Limited knowledge in genetics, neuroscience, behavioral science • Not congruent with medicine
    24. 24. RDoC: Research Domain Criteria, October 2012
    25. 25. The RDoC Matrix
    26. 26. Learned Helplessness
    27. 27. Depression
    28. 28. Hypofunctioning of the dorsolateral prefrontal cortex in major depressive disorder. (From Aizenstein et al., 2009[1].
    29. 29. Neurocircuitry in major depressive disorder (MDD)
    30. 30. Depression “Dysregulation of mood homeostasis” • Stuck in ‘blues’ ( Area 25 ) – Hypothalamus: • Appetite, energy, Emotion – Brain Stem & RAS • Sleep – Amygdala & insula • Anxiety, mood – Hippocampus • Memory processing, attention – Frontal Cortex • Self-esteem, insight Cognition
    31. 31. Bedensel Hastalıklar 0.8 0.6 Heritability 0.4 0.2 0 Breast Cancer Hypertension Ischemic Heart Disease Rheumatoid Arthritis
    32. 32. Ruhsal Hastalıklar 0.8 Heritability 0.6 0.4 0.2 0 Depression ADHD Schizophrenia Autism Bipolar
    33. 33. The Meaning of the Human Genome Project for Neuropsychiatric Disorders Steven E. Hyman Provost, Harvard University and Professor of Neurobiology, Harvard Medical School Boston, MA, USA
    34. 34. Gen-Davranış Pathway (Ustun, 2005) G1 P1 B1 N1 G2 G3 P2 N2 P3 N3 G4 Genetic Genotypes B2 B3 P4 Neurophysiological Psychological Endophenotypes Behavioural Phenotypes
    35. 35. Attachment - Bağlanım
    36. 36. Korkulu Uyaranlara - Oxytocin
    37. 37. ‘Beyin’e bir bilgisayar gibi bakmak?
    38. 38. Beyin Bilim 2013
    39. 39. Gene de parçaları ayırmak gerekiyor
    40. 40. DepressionTreatment Past Present Future INSEL Scıentific Amerıcan 2010
    41. 41. Yerkes National Primate Research Center Thomas R. Insel 1993-2002
    42. 42. Sequence divergence % between humans and other hominids
    43. 43. the genetic difference between humans and chimps is less than 2%,
    44. 44. John NASH: A Brilliant Mind My irrational “dreams”, as I call them, and my mathematical thoughts both came from the same place, same source … In time, I kind of created my own thought police in my mind, I then came to recognize my own irrationality
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