العلاج التكاملى من منظور تطورى من منطلق العلاج 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, anti- withdrawal... 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 Mobilization of Energy Towards real persons in the group The more real relations are established the less neuroleptics are needed Potent Neuroleptic (in) Group Therapy The center refers symbolically to the “hot seat ”

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 th 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)

Neurotic ( + stability Depressive position Paranoid Position Schizoid Position مراحل النمو Stages of development الموقف البارنوى الكر والـفر Fight  flight الموقف الاكتئابى حيرة العلاقة بالأخر ثنائية الوجدان ambivalence الموقف الشيزيدى اللاموضوع : فى الرحم No object Normal Defenses + Health الدفاعات العادية وتسمى الصحة ( لا مانع !!!!)

Schizophrenia الفصام Paranoid state & symptoms حالات وأعراض بارانوية Depression Psychic pain : less defensive الاكتئاب الألم النفسى : دفاعات أقل, برغم فرط الكبت 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 Neurotic Cover (hyper-normality + alienation). الغطاء العصابى (” فرط العادية“ المغتربة غالبا )

+ Normal ( Neurotic B) Brains Depressive B Paranoid B Trilafon Stelazine Halodol Mellaril Largactil Tryptizol MAOI Diazepines Drugs Corresponding levels of organization Object Relation Melanie Klien, Guntrip etc. Schizoid => Paranoid => Depressive positions Schizoid B

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, ولحدّ إمتى؟ بأمارة إيه ؟ ؟ وليس : ندّى إيه (تشخصيص)؟ إيه (دواء) ؟ كام ؟ على طـول!! حسب جدول الضرب (الخوارزمية!!) بتاعة الخواجة التاجر.

تكامل العلاجات مثال من: العلاج النفسى الجمعى (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”

Pathological excess of Some transmitter Specific drug abolishing the excess Changing the whole pattern Hypothetical Brain Organization Not necessarily normal الفكرة أنه بزيادة أو نقص مادة معينة بالمرض أو بالعلاج يتغير التنظيم الكلى للدماغ وهذا يظهر إكلنيكيا فى كلية نوع التغير فى العلاقة بالموضوع, والعمل, و نبض الوجدان 9

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

Object relational Depression (Do not give anti-depressants) Schiz.Disorg. Haloperidol  Brain is a complex processor of ENERGY and INFORMATION Mobilization of Energy Towards real object Diminish the dose  The more relating to real object the more energy is flowing properly and re-harmonizing is possible.  E.g. in intensive  Individual Therapy  The less neuroleptics are needed

Brain is a complex processor of ENERGY and INFORMATION Mobilization of Energy Towards real persons in the group The more real relations are established the less neuroleptics are needed Potent Neuroleptic (in) Group Therapy The center refers symbolically to the “hot seat ”

Haldol 5

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