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Abraham Peled
MD
Abraham Peled © All rights resaved Oct 2015
To cure mental disorders
the Psychiatrist of the
future will need to
discover the causes of
mental disorders
Abraham Peled...
1) Reformulate mental
disorders as brain-disorders
2) Validate the brain
disorders
3) Develop cure
intervention/device
Abr...
Psychiatric diagnosis is descriptive
it is based on signs (the patient
looks sad) and symptoms (the
patient complains of d...
I feel depressed
I look depressed
Abraham Peled © All rights resaved Oct 2015
While most clinicians agree that
mental disorders are brain
disorders, psychiatric diagnosis
is not
Brain-related
Abraham ...
The term “brain” is not included
in psychiatric taxonomy Brainitis
Brainosis
Connectomics
Connectopathies
Abraham Peled © ...
Without knowing exactly what is
wrong with the brains of our
patients we will never be able to
cure (fix) them
Abraham Pel...
In recent years we have learned a
lot about the brain
Abraham Peled © All rights resaved Oct 2015
For example we know that the
brain is organized as a network
Abraham Peled © All rights resaved Oct 2015
We also know that the brain is
organized as a Small World network
with Clusters and Hubs Clusters
Clusters
Hubs
Abraham Pe...
We know that Small World brain organization
is optimal for modal-specific specialization and
multimodal integration
Unimod...
We also know that Small World brain
organization supports Hierarchy with higher-
level processing
High-Level
Low-Level
Abr...
We know that such Small World brain
organization is optimal for coherent
integrated conscious experience Visual
Auditory
C...
The brain is Plastic. Neurons continually
create (Synaptogenesis) and lose
(Atrophy) connections
Synaptogenesis
Atrophy
Ab...
The Plastic Brain interacts with the
Environment
Environment
Action
sensation
Abraham Peled © All rights resaved Oct 2015
The Plastic Brain learns (Hebb) from the
environment, memories
Environment
Action
sensation
memories
Abraham Peled © All r...
The Plastic Brain uses memories to create an
Internal-Representation of the environment an
internal model of the world
Env...
When ‘Adaptive’ the internal model matches the
environment, difference (free energy) between
environment and internal repr...
Once created the internal model determines how we
view the world and react to it,
Experience-Dependent-Plasticity updates
...
Experience-Dependent-Plasticity updates
continually our internal model of the
world
The internal model determines how we v...
Each of the organizational dynamics described so far
can be disturbed in the brain of our patients
Abraham Peled © All rig...
Network
Organization
Can be disturbed
Abraham Peled © All rights resaved Oct 2015
Plasticity and
Adaptability
Can be disturbed
Abraham Peled © All rights resaved Oct 2015
Internal
Representations
Can be disturbed
Abraham Peled © All rights resaved Oct 2015
Multiple disturbances typically occur together
to various extents
Network
organization
Plasticity and
Adaptability
Interna...
Each type of disturbance generates (causes)
a different set of phenomenology (suffering)
Network
organization
Plasticity a...
Network
organization
Disturbed
consciousness
Psychosis and
schizophrenia
Disturbance to
network organization
generates dis...
Plasticity and
Adaptability
Mood and Anxiety
disorders
Disturbances to
plasticity and
adaptability
causes Mood
and Anxiety...
Internal
Representations
Personality
Disorders
Disturbances to the
Internal -
Representations cause
the different
Personal...
Network
organization
Plasticity and
Adaptability
Internal
Representations
Disturbed
consciousness
Psychosis and
schizophre...
Disturbed
Network
organization
Disturbed
Plasticity and
Adaptability
Disturbed
Internal
Representations
Disturbed
consciou...
Network
organization
Cs
Connectivity
segregation
Ci
Connectivity
integration
Hbu
Hierarchical
bottom-up
insufficiency
Htd
...
Network
organization
Cs
Connectivity
segregation
Ci
Connectivity
integration
Hbu
Hierarchical
bottom-up
insufficiency
Htd
...
Network
organization
Cs
Connectivity
segregation
Ci
Connectivity
integration
Hbu
Hierarchical
bottom-up
insufficiency
Htd
...
CF
CF(b)
Delusions
Hallucinations
Avolition
Psychosis
Negative signs
Mania
Depression
Anxiety
Phobia
Personality
disorder
...
Clinical Brain Profiling
Brain - related etiopathological
Testable
Personalized
Abraham Peled © All rights resaved Oct 2015
CF
CF(b)
Clinical brain Profiling diagnostic
translation is available at:
http://neuroanalysis.org.il/?page_
id=114
All yo...
CF
CF(b)
Clinical Brain Profiling
Abraham Peled © All rights resaved Oct 2015
To read more see PUBMED
To Validate Clinical Brain Profiling
(CBP) a battery of various signal–
processing methods should be put in
place
Pixels, ...
Brain organization can be
monitored continually using EEG
wireless wearables
Pixels, Sensors
Pixels,Sensors
Correlation an...
The Mental Status Examination can be
evaluated (“sensed” ) using wearable,
and monitoring of Cyber - activity
Behavior
Spe...
Sensing Mental Status Examination
can be synchronized with EEG
monitoring
Behavior
Speech
Face expressions
Thought
Cogniti...
Coupling ongoing
phenomenology changes
synchronized with ongoing
monitoring of brain
organization will generate
large data...
It is predicted that Machine-learning alone cannot
complete the discovery process and that a
theory-driven approach simila...
Any therapeutic intervention to eliminate CBP
disturbances will need a feed-back Loop mechanism
one that continually guide...
Such operation will
probably require a Head
Mounted Platform a
hat for the therapy
period/session.
A platform to support
t...
Abraham Peled © All rights resaved Oct 2015
Eventually the entire Head Mounted Platform and
it’s operation, will have to b...
Abraham Peled © All rights resaved Oct 2015
The intervention at the brain level will need to be both
neurological and CBP-...
Abraham Peled
MD
Abraham Peled © All rights resaved Oct 2015
Good luck to us in the
journey for curing
mental disorders
END
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This is the future of psychiatry
Abraham Peled M.D.

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  1. 1. Abraham Peled MD Abraham Peled © All rights resaved Oct 2015
  2. 2. To cure mental disorders the Psychiatrist of the future will need to discover the causes of mental disorders Abraham Peled © All rights resaved Oct 2015
  3. 3. 1) Reformulate mental disorders as brain-disorders 2) Validate the brain disorders 3) Develop cure intervention/device Abraham Peled © All rights resaved Oct 2015
  4. 4. Psychiatric diagnosis is descriptive it is based on signs (the patient looks sad) and symptoms (the patient complains of depression) Abraham Peled © All rights resaved Oct 2015
  5. 5. I feel depressed I look depressed Abraham Peled © All rights resaved Oct 2015
  6. 6. While most clinicians agree that mental disorders are brain disorders, psychiatric diagnosis is not Brain-related Abraham Peled © All rights resaved Oct 2015
  7. 7. The term “brain” is not included in psychiatric taxonomy Brainitis Brainosis Connectomics Connectopathies Abraham Peled © All rights resaved Oct 2015
  8. 8. Without knowing exactly what is wrong with the brains of our patients we will never be able to cure (fix) them Abraham Peled © All rights resaved Oct 2015
  9. 9. In recent years we have learned a lot about the brain Abraham Peled © All rights resaved Oct 2015
  10. 10. For example we know that the brain is organized as a network Abraham Peled © All rights resaved Oct 2015
  11. 11. We also know that the brain is organized as a Small World network with Clusters and Hubs Clusters Clusters Hubs Abraham Peled © All rights resaved Oct 2015
  12. 12. We know that Small World brain organization is optimal for modal-specific specialization and multimodal integration Unimodal Unimodal Transmodal multimodal Abraham Peled © All rights resaved Oct 2015
  13. 13. We also know that Small World brain organization supports Hierarchy with higher- level processing High-Level Low-Level Abraham Peled © All rights resaved Oct 2015
  14. 14. We know that such Small World brain organization is optimal for coherent integrated conscious experience Visual Auditory Conscious integration Abraham Peled © All rights resaved Oct 2015
  15. 15. The brain is Plastic. Neurons continually create (Synaptogenesis) and lose (Atrophy) connections Synaptogenesis Atrophy Abraham Peled © All rights resaved Oct 2015
  16. 16. The Plastic Brain interacts with the Environment Environment Action sensation Abraham Peled © All rights resaved Oct 2015
  17. 17. The Plastic Brain learns (Hebb) from the environment, memories Environment Action sensation memories Abraham Peled © All rights resaved Oct 2015
  18. 18. The Plastic Brain uses memories to create an Internal-Representation of the environment an internal model of the world Environment Action sensation Internal Representations model Abraham Peled © All rights resaved Oct 2015
  19. 19. When ‘Adaptive’ the internal model matches the environment, difference (free energy) between environment and internal representation is reduced Environment Action sensation Internal Representations model Adapt Match Free Energy Reduced Abraham Peled © All rights resaved Oct 2015
  20. 20. Once created the internal model determines how we view the world and react to it, Experience-Dependent-Plasticity updates continually our internal model of the world Abraham Peled © All rights resaved Oct 2015
  21. 21. Experience-Dependent-Plasticity updates continually our internal model of the world The internal model determines how we view the psychosocial world and react to it, this is our personality style Abraham Peled © All rights resaved Oct 2015
  22. 22. Each of the organizational dynamics described so far can be disturbed in the brain of our patients Abraham Peled © All rights resaved Oct 2015
  23. 23. Network Organization Can be disturbed Abraham Peled © All rights resaved Oct 2015
  24. 24. Plasticity and Adaptability Can be disturbed Abraham Peled © All rights resaved Oct 2015
  25. 25. Internal Representations Can be disturbed Abraham Peled © All rights resaved Oct 2015
  26. 26. Multiple disturbances typically occur together to various extents Network organization Plasticity and Adaptability Internal Representations Can be disturbed Abraham Peled © All rights resaved Oct 2015
  27. 27. Each type of disturbance generates (causes) a different set of phenomenology (suffering) Network organization Plasticity and Adaptability Internal Representations Can be disturbed Abraham Peled © All rights resaved Oct 2015
  28. 28. Network organization Disturbed consciousness Psychosis and schizophrenia Disturbance to network organization generates disturbed consciousness Psychosis and schizophrenia Abraham Peled © All rights resaved Oct 2015
  29. 29. Plasticity and Adaptability Mood and Anxiety disorders Disturbances to plasticity and adaptability causes Mood and Anxiety disorders Abraham Peled © All rights resaved Oct 2015
  30. 30. Internal Representations Personality Disorders Disturbances to the Internal - Representations cause the different Personality Disorders Abraham Peled © All rights resaved Oct 2015
  31. 31. Network organization Plasticity and Adaptability Internal Representations Disturbed consciousness Psychosis and schizophrenia Mood and Anxiety disorders Personality Disorders All together we begin to see the correlation between brain disturbances and phenomenology Abraham Peled © All rights resaved Oct 2015
  32. 32. Disturbed Network organization Disturbed Plasticity and Adaptability Disturbed Internal Representations Disturbed consciousness Psychosis and schizophrenia Mood and Anxiety disorders Personality Disorders Thus we can begin and “Translate” phenomenology into brain disorders Abraham Peled © All rights resaved Oct 2015
  33. 33. Network organization Cs Connectivity segregation Ci Connectivity integration Hbu Hierarchical bottom-up insufficiency Htd Hierarchical top-down shift O Optimization D De- Optimization CF Constraint frustration CF(b) Stimulus bound DMN Default Mode Network Plasticity and Adaptability Internal Representations The translation of Phenomenology to brain disturbances can be elaborated to form a comprehensive brain-related psychiatric diagnosis Abraham Peled © All rights resaved Oct 2015
  34. 34. Network organization Cs Connectivity segregation Ci Connectivity integration Hbu Hierarchical bottom-up insufficiency Htd Hierarchical top-down shift O Optimization D De- Optimization CF Constraint frustration CF(b) Stimulus bound DMN Default Mode Network Plasticity and Adaptability Internal Representations For Example: Disturbance to hierarchy Disturbance to connectivity Disturbance to plasticity-related optimization dynamics Disturbed basic configuration Abraham Peled © All rights resaved Oct 2015
  35. 35. Network organization Cs Connectivity segregation Ci Connectivity integration Hbu Hierarchical bottom-up insufficiency Htd Hierarchical top-down shift O Optimization D De- Optimization CF Constraint frustration CF(b) Stimulus bound DMN Default Mode Network Plasticity and Adaptability Internal Representations Thus can be translated to: Abraham Peled © All rights resaved Oct 2015
  36. 36. CF CF(b) Delusions Hallucinations Avolition Psychosis Negative signs Mania Depression Anxiety Phobia Personality disorder Clinical Brain ProfilingPhenomenology Translation This is how we create, “Clinical Brain Profiling” a brain-related psychiatric diagnosis, translating phenomenology into a profile of brain disturbances Abraham Peled © All rights resaved Oct 2015
  37. 37. Clinical Brain Profiling Brain - related etiopathological Testable Personalized Abraham Peled © All rights resaved Oct 2015
  38. 38. CF CF(b) Clinical brain Profiling diagnostic translation is available at: http://neuroanalysis.org.il/?page_ id=114 All you need to do is enter the signs and symptoms of your patient Clinical Brain Profiling Abraham Peled © All rights resaved Oct 2015
  39. 39. CF CF(b) Clinical Brain Profiling Abraham Peled © All rights resaved Oct 2015 To read more see PUBMED
  40. 40. To Validate Clinical Brain Profiling (CBP) a battery of various signal– processing methods should be put in place Pixels, Sensors Pixels,Sensors Correlation analysis (non-linear) Graph analysis (small- world) SPM, DCM Entropy measures Abraham Peled © All rights resaved Oct 2015
  41. 41. Brain organization can be monitored continually using EEG wireless wearables Pixels, Sensors Pixels,Sensors Correlation analysis (non-linear) Graph analysis (small- world) SPM, DCM Entropy measures Abraham Peled © All rights resaved Oct 2015
  42. 42. The Mental Status Examination can be evaluated (“sensed” ) using wearable, and monitoring of Cyber - activity Behavior Speech Face expressions Thought Cognition Abraham Peled © All rights resaved Oct 2015
  43. 43. Sensing Mental Status Examination can be synchronized with EEG monitoring Behavior Speech Face expressions Thought Cognition Abraham Peled © All rights resaved Oct 2015
  44. 44. Coupling ongoing phenomenology changes synchronized with ongoing monitoring of brain organization will generate large data that will point to the correlations between mental disorders and brain disturbance – Machine-Learning will probably work here Abraham Peled © All rights resaved Oct 2015
  45. 45. It is predicted that Machine-learning alone cannot complete the discovery process and that a theory-driven approach similar to CBP will be required Pixels, Sensors Pixels,Sensors Prediction Evidence CBP Compare VALIDATE Abraham Peled © All rights resaved Oct 2015
  46. 46. Any therapeutic intervention to eliminate CBP disturbances will need a feed-back Loop mechanism one that continually guides and estimates corrections, “Brain-Pacing mechanism” Monitor CBP disturbance Correct CBP disturbance Monitored guided correction Correction Estimation Abraham Peled © All rights resaved Oct 2015
  47. 47. Such operation will probably require a Head Mounted Platform a hat for the therapy period/session. A platform to support the sensory-guided intervention. An intervention engine relevant to activate remote non-invasive mediation to correct CBP disturbances Monitor CBP disturbance Correct CBP disturbance Monitored guided correction Correction Estimation Camera Microphone Wireless transmitter Motion sensing Dry EEG electrodes Intervention Engine Abraham Peled © All rights resaved Oct 2015
  48. 48. Abraham Peled © All rights resaved Oct 2015 Eventually the entire Head Mounted Platform and it’s operation, will have to be shrunk to the size of a Sticker and the brain intervention miniaturized to injectable (or sniffed) neuronal-related nanoparticles (the CBP algorithm remains)
  49. 49. Abraham Peled © All rights resaved Oct 2015 The intervention at the brain level will need to be both neurological and CBP-relevant, for example here is a predicted intervention to the interneurons of layer 5 of the Prefrontal cortex for its Hub network-controlling effect for whole–brain organization
  50. 50. Abraham Peled MD Abraham Peled © All rights resaved Oct 2015 Good luck to us in the journey for curing mental disorders END

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