Presentation is loading. Please wait.

Presentation is loading. Please wait.

A Usable Evolutionary Classification System for Mental Disorders Gary Galambos MB BS FRANZCP Consultant Psychiatrist St John of God Hospital, Burwood APS.

Similar presentations


Presentation on theme: "A Usable Evolutionary Classification System for Mental Disorders Gary Galambos MB BS FRANZCP Consultant Psychiatrist St John of God Hospital, Burwood APS."— Presentation transcript:

1 A Usable Evolutionary Classification System for Mental Disorders Gary Galambos MB BS FRANZCP Consultant Psychiatrist St John of God Hospital, Burwood APS Evolutionary Psychology Interest Group 10 th March 2010

2

3

4

5

6 Overview  The paradigmatic failure of psychiatry  Benefits of an evolutionary approach  Does evolutionary psychology or psychiatry have any answers?  Unveiling an evolved classification system…  Test-driving 2 DSM disorders using the model

7 The Paradigmatic Failure of Psychiatry

8 Failed Schools Perspectives  Objective-descriptive (Kraeplin, Janet, Bleuler, Maudsley, Beck)  Psychoanalytic (Charcot, Breuer, Freud)  Existential (Jaspers, Minkowski, Binswanger)  Interpersonal/Social (Meyer, Sullivan)  Eclecticism –DSM –The Biopsychosocial Model (Engel 1980)  Disease  Behavioural  Life-story  Dimensional  Disease

9 DSM a failure?  Achieves its aims of: –Accurate descriptions (language free of theoretical biases) –Reliability among multiple users (high cross-clinician agreement) –Empirical (Akiskal 1989)  allowing researchers to study comparable groups BUT….

10 Criticisms –not guided by any theory about the structure and function of normal minds –encourages simplistic thinking of psychiatric syndromes as discrete diseases (Kendell 1984) –Splits psychiatry from general medical disorders, giving the false impression that the mechanisms are different for both (Waterman 2001) –Neglects maladaptive psychological processes BOTTOM LINE….

11 Poor validity  Developing a descriptive vocabulary that achieves a high degree of cross- clinician agreement may be served by summative reasoning, but its service to condition validity is another matter (McGuire & Troisi 1998)

12 The BPS model a failure?  Essential in vaccinating against dogmatism (biological reductionism or psychoanalytical orthodoxy)  Provides room for an eclectic approach utilising psychotherapy and social work in a neuroscience dominated environment But…

13 Criticisms of the BPS Model  “It is like going to a restaurant & receiving a list of the ingredients rather than a menu” (McHugh 1998)  “Too eclectic to provide useful organising concepts around which to understand psychiatry” (Ghaemi 2005)  Fundamentally dualist model - “Descartes without the pineal connection” - due to linguistic conceptual conventions (Waterman 2001)

14 Consequences  Separation of psychiatry from the rest of medicine  Inequitable distribution of resources  Confusion of aetiology & pathogenesis  Impairment in ability to communicate to students & general public modern psychiatric concepts  Stigmatisation of patients (Waterman 2001)

15 Benefits of an evolutionary approach

16 Answers “why” –Reductionistic (proximate) approaches miss half the story because most research attempts to explain “what” and “how” –Evolutionary approaches examine “why” we are susceptible to maladaptive mental & behavioural phenomena by considering design characteristics

17 What might evolutionary approaches add?  A theory of gene-environment-behaviour interactions –A theory of behaviour, motivations and function  Causal hypotheses –A non-judgmental, normalising, humanising explanatory model for patients  Integration of prevailing models into a framework –An evolutionary classification? McGuire & Troisi 1998 Nesse

18 What is a mental disorder from an evolutionary view?  Abnormal phenomena causing biological disadvantage (Scadding 1967)  Disorders are the result of things that have gone wrong with evolved structures that allow for adequate functioning (Klein 1978) ( which, unabated, leads to reproductive disadvantage)  Also: social undesirability (Wakefield 1992)

19 Why are our minds are poorly designed? DALYs Western Females 18-45yo (WHO)

20

21 Bottom line:  Vast prevalence  Huge comorbidity  Onset at age of peak health  Waxing & waning courses  Huge fitness costs

22 Does evolutionary psychology or psychiatry have any answers?

23 Darwin’s view on emotions Pleasurable sensations … stimulate the whole system to increased action. Hence … pleasurable sensations serve as … habitual guides. But pain or suffering… lessens the power of action, yet is well adapted to make a creature guard itself against any great or sudden evil. …if long continued, causes depression Darwin Francis (ed), The Life & Letters of Charles Darwin, 1887.

24 What are emotions?  “Adaptations” shaped by Natural Selection  Each emotion is a specialised state that adjusts cognition, physiology, subjective experience & behaviour so that the organism can respond effectively in a particular kind of situation  Positive & negative emotions are derived from the two types of basic arousal…

25 Cellular instincts Arousal Inaction/Avoidance Disengagement/Withdrawal Self-defense Threat Opportunity Acquisition Engagement Attack

26 Who do emotions benefit?  The emotions were “designed not to promote the happiness & survival of the individual, but to favor maximum transmission of the controlling genes ” (EO Wilson)

27 EvoPsych "In the distant future I see open fields for far more important researches. Psychology will be based on a new foundation, that of the necessary acquirement of each mental power and capacity by gradation." (Darwin, Origin of Species)

28 Cosmides & Tooby 1995 Our cognitive architecture resembles a confederation of hundreds or thousands of functionally dedicated computers (modules) designed to solve adaptive problems endemic to our hunter-gatherer ancestors… The Massive Modularity Hypothesis “Human nature” refers to the accumulated specialized neural circuits common to every member of a species Our modern skulls house a stone age mind

29 A Darwinian module (Adapted from Murphy & Stich 1998)

30 Mental architecture posited by evopsych (Adapted from Murphy & Stich 1998)

31

32 A proposed EvoPsych classification 1. Disorders Within the Person i.Internal to the module  an individual's special-purpose computer is malfunctioning ii.External to the module  problematic module output due to problematic input (garbage in = garbage out) 2. “Environment/Selection Mismatch” –Genome lag hypothesis 3. Adaptive “deviant” behavioural strategies (Murphy & Stich 1998)

33 Evolutionary Neuroanatomy: Triune Brain (MacLean 1973)

34 The Four “Time-Depths” classification of “Stress & Fear Circuitry” (Anxiety) Disorders  Based on evolved fear circuitry traits that have outlived their usefulness Bracha, 2006

35 Time depths Classification (from Bracha) 1. Mesozoic Era Mammalian- wide fear circuits (140 MYA) Separation anxiety Extreme fear of adult non-kin males in toddlers Extreme fear of high elevations in adults 2. Cenozoic Era Simian-wide fear circuits (20 MYA) Fear of snakes, reptiles, confined spaces, darkness, water immersion, suffocation during forest fire, muscle exhaustion under predation Acute jaw-clenching 3. Paleolithic Era H. Sapiens- wide fear circuits (200-14 TYA) Compulsive Lock & stove checking, washing (Obsessive fear of contamination), hoarding (esp. tools, weapons & leather goods), f ear of insects or mice Fear of scrutiny by non-kin conspecifics (Generalized Social Phobia) 4. Neolithic era Culture-bound genome-specific fear circuits (12 TYA) Primary dissociative disorder Somatoform states: P seudoseizures, Pseudoparalysis (e.g. limping), Imbalance (Pseudocerebellar symptoms), Blindness Epidemic sociogenic illness (“epidemic hysteria”)

36 Archetype disorders  Mental disorders may manifest as a failure to meet biosocial imperatives (goals or social roles) by the 4 archetypal propensities Stevens & Price 2000

37 Biosocial goals 1. The stranger archetype 2. The affiliation and bonding archetype 3. The hierarchical ranking dominance-submission archetype 4. The courtship & mating archetype (Stevens & Price, 2000) 1. Defense (fight or flight) Attachment 2. Attachment 3. Dominance- striving 4. Reproduction (Gardiner, 1988) Archetypal systems

38 Why are our minds so poorly designed?  Because of past evolutionary compromises & trade offs organisms are not optimally designed McGuire & Troisi 1998 Mayr 1983  Selection does not optimise adaptive traits or strategies as much as it gradually eliminates unfit traits/strategies Tuomi et al 1983

39 A proposed general evolutionary classification 1. Novelty –From pathogens or competitors –From aspects of the modern environment 2. Trade-offs –Genes with costs as well as benefits –All traits are a two-edge sword 3. Constraints 4. Accidents and mishaps (too rare to shape defenses) 5. Defenses (often confused with diseases) Nesse RM 1995

40 A proposed psychiatric evolutionary classification 1. Primary brain abnormalities 2. Environmental trauma or uniqueness 3. Byproducts (adaptive but distressing) (adapted from Nesse RM 1991)

41 Unveiling an upgraded BPS model…

42 M D As The M alfunction- D ysregulation- As ocialisation Model

43 MDA The MDA Model  Places the DSM & BPS (atheoretical) models within a (theoretical) evolutionary framework  General evolutionary explanations (y-axis) grouped alongside organism-specific archetypal (functional) disruption (x-axis)

44 EVOLUTIONARY CLASSIFICATION DISORDER: x Archetypal Disruption (H. Sapiens) Disorders of: A Attachment/ Affiliation Archetype B Hierarchic al/Ranking Archetype C Courtship/ Mating Archetype D Threat Response Archetype 1. Mal- function 2. Dys- regulation 3. Asocial- isation

45 Maintaining a BPS framework  Malfunction correlates with “Bio”  Dysregulation correlates with “Psycho”  Asocialisation correlates with "Socio-cultural” … Makes the evolution from an atheoretical to a theoretical classification system easier, and reduces dualism inherent in BPS and DSM

46 Descriptions vs aetiology  Proposal that each DSM disorder may have more than one possible aetiological basis

47 EVOLUTIONARY CLASSIFICATION DISORDER: x Archetypal Disruption Disorders of: A Attachment/ Affiliation Archetype B Hierarchical /Ranking Archetype C Courtship/ Mating Archetype D Threat Response Archetype 1. Mal- function 1.1 Modular 1.1A1.1B1.1C1.1D 1.2 Integrative 1.2A1.2B1.2C1.2D 2. Dys- regulation 2.1 Environmental Trauma 2.1A2.1B2.1C2.1D 2.2 Maladaptive Meme 2.2A2.2B2.2C2.2D 3. Asocial- isation 3.1 By-product (trade off) 3.1A3.1B3.1C3.1D 3.2 Defense 3.2A3.2B3.2C3.2D

48 EVOLUTIONARY CLASSIFICATION DISORDER: x Archetypal Disruption Disorders of: A Attachment/ Affiliation Archetype B Hierarchical /Ranking Archetype C Courtship/ Mating Archetype D Threat Response Archetype 1. Mal- function 1.1 Modular 1.1A1.1B1.1C1.1D 1.2 Integrative 1.2A1.2B1.2C1.2D 2. Dys- regulation 2.1 Environmental Trauma 2.1A2.1B2.1C2.1D 2.2 Maladaptive Meme 2.2A2.2B2.2C2.2D 3. Asocial- isation 3.1 By-product (trade off) 3.1A3.1B3.1C3.1D 3.2 Defense 3.2A3.2B3.2C3.2D

49 1. Disorders of Malfunction  1.1 Modular - Mental disorders resulting from localised (modular) brain malfunction due to abnormal differentiation.  1.2 Integrative - Mental disorders that result from NON-localised brain malfunction, causing widespread cerebral dysconnectivity.  Secondary to injuries of the developing central nervous system in the context of genetic vulnerability

50 EVOLUTIONARY CLASSIFICATION DISORDER: x Archetypal Disruption Disorders of: A Attachment/ Affiliation Archetype B Hierarchical /Ranking Archetype C Courtship/ Mating Archetype D Threat Response Archetype 1. Mal- function 1.1 Modular 1.1A1.1B1.1C1.1D 1.2 Integrative 1.2A1.2B1.2C1.2D 2. Dys- regulation 2.1 Environmental Trauma 2.1A2.1B2.1C2.1D 2.2 Maladaptive Meme 2.2A2.2B2.2C2.2D 3. Asocial- isation 3.1 By-product (trade off) 3.1A3.1B3.1C3.1D 3.2 Defense 3.2A3.2B3.2C3.2D

51 1.1 Modular Malfunction  Intracranial lesion causing psychosis, mood disorder or cognitive impairment  Malfunction of Theory-of-Mind (ToM) “module” –causes “mindblindness” (Baron-Cohen 1997) –Pts with Autism, Aspergers & acute SCZ perform worse on ToM tasks (Brune 2005) (ToM proposed to be a crucial component of a “social” module in humans)  Machiavellian intelligence is a domain-specific faculty of inferring mental states of others (Brune 2001)

52 EVOLUTIONARY CLASSIFICATION DISORDER: x Archetypal Disruption Disorders of: A Attachment/ Affiliation Archetype B Hierarchical /Ranking Archetype C Courtship/ Mating Archetype D Threat Response Archetype 1. Mal- function 1.1 Modular 1.1A1.1B1.1C1.1D 1.2 Integrative 1.2A1.2B1.2C1.2D 2. Dys- regulation 2.1 Environmental Trauma 2.1A2.1B2.1C2.1D 2.2 Maladaptive Meme 2.2A2.2B2.2C2.2D 3. Asocial- isation 3.1 By-product (trade off) 3.1A3.1B3.1C3.1D 3.2 Defense 3.2A3.2B3.2C3.2D

53 1.2 Integrative Malfunction  Schizophrenia –a disorder of integration (Andreason)  a disorder of integration of the social brain (Burns 2004) –A disorder of over-pruning  investigatory evidence for reduced cortical connectedness  neural network computer simulation –adaptive advantage of robust network pruning = the enhancement of cog functioning …until it pushes up against a “psychotogenic threshold” (McGlashan & Hoffman 2000)

54 EVOLUTIONARY CLASSIFICATION DISORDER: x Archetypal Disruption Disorders of: A Attachment/ Affiliation Archetype B Hierarchical /Ranking Archetype C Courtship/ Mating Archetype D Threat Response Archetype 1. Mal- function 1.1 Modular 1.1A1.1B1.1C1.1D 1.2 Integrative 1.2A1.2B1.2C1.2D 2. Dys- regulation 2.1 Environmental Trauma 2.1A2.1B2.1C2.1D 2.2 Maladaptive Meme 2.2A2.2B2.2C2.2D 3. Asocial- isation 3.1 By-product (trade off) 3.1A3.1B3.1C3.1D 3.2 Defense 3.2A3.2B3.2C3.2D

55 2. Disorders of Dysregulation  Mental disorders that result from dysregulation of established defenses 2.1 Environmental trauma or mismatch– mental disorders may result from normal brain mechanisms becoming dysregulated as a result of exposure to novel environmental circumstances, idiosyncratic learning histories or sensory trauma causing maldevelopment of mind programs. 2.2 Maladaptive memes - behavioural dysfunction resulting from contagious propagation of maladaptive ideas.

56 Types of brain trauma  2.1 –Blunt –Toxins –Somatosensory  2.2 –Ideational

57 EVOLUTIONARY CLASSIFICATION DISORDER: x Archetypal Disruption Disorders of: A Attachment/ Affiliation Archetype B Hierarchical /Ranking Archetype C Courtship/ Mating Archetype D Threat Response Archetype 1. Mal- function 1.1 Modular 1.1A1.1B1.1C1.1D 1.2 Integrative 1.2A1.2B1.2C1.2D 2. Dys- regulation 2.1 Environmental Trauma 2.1A2.1B2.1C2.1D 2.2 Maladaptive Meme 2.2A2.2B2.2C2.2D 3. Asocial- isation 3.1 By-product (trade off) 3.1A3.1B3.1C3.1D 3.2 Defense 3.2A3.2B3.2C3.2D

58 2.1 Environmental Dysregulation  Epidemic of Depression –N=39,000 in 9 studies, in 5 global locations  youth more likely to have had MDE than their elders, esp. in higher economically developed cultures –Mass communications   increased competition, unreachable goals, dissatisfaction with selves & family  decreased interactions, –New technology   disintegration of families & communities (Nesse & Williams, Why We Get Sick, 1995)

59 Triggers of Depression  Loss of attachment – carer, mate  Loss of rank – social status  Loss of resources –Internal  Trauma  Bodily damage –External  Bad decisions e.g. wasted effort pursuing risky goals  Disruption to major life goals and enterprises (Nesse 2000) (Stevens & Price, 2000) (Bowlby)

60 Depression as an Adaptation  Communicate need for help  Signal yielding in hierarchy conflict  Disengage from unreachable goals  Regulate patterns of investment (Nesse, AGP, 2000) (Price, Sloman, Gardner, Gilbert, Rohde, BJP, 1994) (Darwin, 1872)

61 Why doesn’t recovery occur? Brain Level Alternative strategies of the Triune Brain Winning (Escalating) (Positive arousal) Losing (De-escalating) (Negative arousal) 1. CORTEX (Reason) Fight to win Actively submit 2. LIMBIC (Emotion) Get angry Feel chastened 3. REPTILIAN (Instinct) Mood elevation Depression (Stevens & Price, 2000; MacLean, 1973)

62 Adaptive Depression Brain Level Alternative Strategies Winning (Escalating)Losing (De-escalating) 1. CORTEX (Reason) Fight to win Actively submit 2. LIMBIC (Emotion) Get angry Feel chastened 3. REPTILIAN (Instinct) Mood elevation Depression Adaptive depression is where the triune is unified in choosing a de-escalating strategy

63 Maladaptive Depression  Due to Conflict within the "Triune" Brain  Results when all three "central processing assemblies" are not pulling together towards the same objective  Stevens & Price suggest that maladaptive depression requires pharmacotherapy whereas adaptive depression requires psychotherapy

64 Involuntary yielding or "blocked higher level losing" Brain Level Alternative Strategies Winning (Escalating)Losing (De-escalating) 1. CORTEX (Reason) Fight to win Actively submit 2. LIMBIC (Emotion) Get angry Feel chastened 3. REPTILIAN (Instinct) Mood elevation Depression People may develop a depressive illness when the losing strategy of the reptilian level is activated in conjunction with... adoption of the winning strategy at the (neo)cortical &/or limbic levels. i.e. "blocked higher level losing".

65 Reasons for an “upper block” 1. Internal factors : –predisposing personality traits  obsessive & narcissistic traits  high sensitivity to insult 2. External factors : –loser cannot provide winner’s demands –winner continues attacks forcing victim into "learned helplessness"

66 Anger-propagating Depression Brain Level Alternative Strategies Winning (Escalating)Losing (De-escalating) 1. CORTEX (Reason) Fight to win Actively submit 2. LIMBIC (Emotion) Get angry Feel chastened 3. REPTILIAN (Instinct) Mood elevation Depression Intractable anger causing maladaptive depression when something very unjust has been done to the person, which leads to resistance to yielding - often develops secondary to Chronic PTSD

67 PTSD  An “Over-learnt Survival Response” with asynchrony caused by a failure of cortical inhibition to limit the trauma rehearsal (“overconsolidation”) generated by the limbic lobe (Silove 1998; Bracha 2006)

68 Sequence of events in PTSD:  Fear response causes excessive activation of threat response neural circuitry  Inadequate orbital prefrontal feedback  Failure to switch off activation of the threat response system  Failure of recovery

69 EVOLUTIONARY CLASSIFICATION DISORDER: x Archetypal Disruption Disorders of: A Attachment/ Affiliation Archetype B Hierarchical /Ranking Archetype C Courtship/ Mating Archetype D Threat Response Archetype 1. Mal- function 1.1 Modular 1.1A1.1B1.1C1.1D 1.2 Integrative 1.2A1.2B1.2C1.2D 2. Dys- regulation 2.1 Environmental Trauma 2.1A2.1B2.1C2.1D 2.2 Maladaptive Meme 2.2A2.2B2.2C2.2D 3. Asocial- isation 3.1 By-product (trade off) 3.1A3.1B3.1C3.1D 3.2 Defense 3.2A3.2B3.2C3.2D

70 2.2 Meme Dysregulation  Meme = evolution of culture (ideas) –Competitive co-evolution b/w genes & culture –Man must adapt to novel “cultural” environments/ influences (Dawkins, The Selfish Gene, 1976)  Mental disorder caused by: –Conflict b/w culture & gene –Inability to adapt to culture –“Garbage input = garbage output”

71 Mimetic Lexicon http://pespmc1.vub.ac.be/MEMLEX.html  meme –(pron. `meem') A contagious information pattern that replicates by parasitically infecting human minds and altering their behavior, causing them to propagate the pattern. (Term coined by Dawkins, by analogy with "gene".) Individual slogans, catch- phrases, melodies, icons, inventions, and fashions are typical memes. An idea or information pattern is not a meme until it causes someone to replicate it, to repeat it to someone else. All transmitted knowledge is memetic. (Wheelis, quoted in Hofstadter.) (See meme-complex).

72 meme-complex  A set of mutually-assisting memes which have co-evolved a symbiotic relationship. Religious and political dogmas, social movements, artistic styles, traditions and customs, chain letters, paradigms, languages, etc. are meme-complexes. Also called an m-plex, or scheme (Hofstadter). Types of co-memes commonly found in a scheme are called the: bait; hook; threat; and vaccime. A successful scheme commonly has certain attributes: wide scope (a paradigm that explains much); opportunity for the carriers to participate and contribute; conviction of its self-evident truth (carries Authority); offers order and a sense of place, helping to stave off the dread of meaninglessness. (Wheelis, quoted by Hofstadter.)

73 A sociotype of an auto-toxic meme-complex, composed of membots and/or memeoids. (GMG) Characteristics of cults include: self-isolation of the infected group (or at least new recruits); brainwashing by repetitive exposure (inducing dependent mental states); genetic functions discouraged (through celibacy, sterilization, devalued family) in favor of replication (proselytizing); and leader-worship ("personality cult"). (Henson.) cult An infection strategy in which a meme attempts to imitate the semiotics of another successful meme. Such as: pseudo-science (Creationism, UFOlogy); pseudo-rebelliousness (Heavy Metal); subversion by forgery (Situationist detournement). (GMG) mimicry

74 EVOLUTIONARY CLASSIFICATION DISORDER: x Archetypal Disruption Disorders of: A Attachment/ Affiliation Archetype B Hierarchical /Ranking Archetype C Courtship/ Mating Archetype D Threat Response Archetype 1. Mal- function 1.1 Modular 1.1A1.1B1.1C1.1D 1.2 Integrative 1.2A1.2B1.2C1.2D 2. Dys- regulation 2.1 Environmental Uniqueness 2.1A2.1B2.1C2.1D 2.2 Maladaptive Meme 2.2A2.2B2.2C2.2D 3. Asocial- isation 3.1 By-product (trade off) 3.1A3.1B3.1C3.1D 3.2 Defense 3.2A3.2B3.2C3.2D

75 3. Asocialisation Disorders  Diagnosed if the behaviour of the individual leads to severe subjective distress, objective distress (of family/community) AND negative social or harmful consequences.  Characterised by behaviours that are not acceptable to the individual's community BUT are adaptive for their genes (transmission).  The memes of the individual’s social group DIVERGE FROM the adaptive function of the individual's deviant behaviour.

76 Disorders of Sociability  3.1 By-product –Patterns of emotion or behaviour that are painful or socially unacceptable, but nonetheless adaptive  3.2 Defense –An evolved solution to a challenge that may cause suffering & distress as part of the strategy to respond effectively to the threat

77 EVOLUTIONARY CLASSIFICATION DISORDER: x Archetypal Disruption Disorders of: A Attachment/ Affiliation Archetype B Hierarchical /Ranking Archetype C Courtship/ Mating Archetype D Threat Response Archetype 1. Mal- function 1.1 Modular 1.1A1.1B1.1C1.1D 1.2 Integrative 1.2A1.2B1.2C1.2D 2. Dys- regulation 2.1 Environmental Uniqueness 2.1A2.1B2.1C2.1D 2.2 Maladaptive Meme 2.2A2.2B2.2C2.2D 3. Asocial- isation 3.1 By-product (trade off) 3.1A3.1B3.1C3.1D 3.2 Defense 3.2A3.2B3.2C3.2D

78 3.1 By-product  Delusional male sexual jealousy –a mate-guarding tactic –Although an uncomfortable, undesirable state that can give rise to antisocial acts, it is likely to increase reproductive success & be maintained by NS. (Daly, Wilson and Weghorst 1982; Symons 1979)

79 3.2 Defense … to motivate to urgent action for survival (Walter Cannon, 1929) Startle may activate the Fight or Flight Program  Anxiety disorders –Panic disorder

80 Situations evoking anxiety as a defense  Harm from strange humans  Stranger anxiety  Separation from carer  Separation anxiety  Threats to status/group membership  Social anxiety  Socially unaccepted impulses  Obsessive self-doubt  Lack of food or other resources  Obsessive hoarding  Getting sick  Hypochondriasis/Obsessive cleanliness  Dangerous small animals  Small animal phobias  Potential attack to family members  General anxiety  Imminent attack by predator  Panic  Environment in which attack is likely  Agoraphobia (Adapted from Nesse, 1990)

81 The Fight or Flight Program

82 A two-edge sword  Lungs: SOB, choking, parasthesia  Heart: Palps, chest pain, flushes  Muscles: Trembling, tension, sweating  GIT: Dry mouth, butterflies, nausea, belching  Brain: Dizziness, faintness, lightheadedness, catastrophic cognitions & fear  Lungs: ↑blood O2  Heart: ↑O2 blood delivery  Muscles: ↑O2 metabolism  GIT: ↓bld flow to gut  Brain: activation of fear circuitry

83 The Smoke-Detector Principle  Anxiety is a useful defense …but it uses extra calories, makes us less fit for everyday activities & damages tissues  So why is it so readily triggered?  Because the cost of getting killed even once is enormously higher than the cost of responding to 100 false alarms Nesse, 2005

84 Test-driving MDD & Psychosis

85 EVOLUTIONARY CLASSIFICATION DISORDER: Major Depressive Disorder Archetypal Disruption Disorders of: A Attachment/ Affiliation Archetype B Hierarchical /Ranking Archetype C Courtship/ Mating Archetype D Threat Response Archetype 1. Mal- function 1.1 Modular Due to general medical disorder Drug-induced Melancholic & psychotic depression Pseudodementia (subcortical) Dysthymia due to deficit in reciprocal exchange module (McGuire, Murphy) 1.2 Integrative 2. Dys- regulation 2.1 Environmental Trauma Maladaptive depressions (conflict within the Triune brain) e.g. Anger-Induced Depression 2.2 Maladaptive Meme 3. Asocial- isation 3.1 By-product Dysthymic temperament for social cohesion (Akiskal) Adaptive depressions e.g. due to Involuntary Yielding in Social Competition, to disengage from unreachable goals, to regulate patterns of investment 3.2 Defense

86 EVOLUTIONARY CLASSIFICATION DISORDER: Psychosis Archetypal Disruption Disorders of: A Attachment/ Affiliation Archetype B Hierarchical /Ranking Archetype C Courtship/ Mating Archetype D Threat Response Archetype 1. Mal- function 1.1 Modular Due to general medical disorder Drug-induced Schizophrenia as Disorder of Integration due to Over-Pruning, As a Disorder of the Threat Response Archetype 1.2 Integrative 2. Dys- regulation 2.1 Environmental Trauma Shared psychotic (Folie au Deux) 2.2 Maladaptive Meme 3. Asocial- isation 3.1 By-product Delusional jealousy Disorder of Spacing in SCZ 3.2 Defense

87 More… http://www.ep.org.au Links Bibliography Theories Interest Group


Download ppt "A Usable Evolutionary Classification System for Mental Disorders Gary Galambos MB BS FRANZCP Consultant Psychiatrist St John of God Hospital, Burwood APS."

Similar presentations


Ads by Google