العلاج التكاملى من منظور تطورى من منطلق العلاج الجمعى مع الذهانيين خاصة

1. العلاج التكاملى من منظور تطورىمن منطلق العلاج الجمعى مع الذهانيين خاصة Integrative Therapy An Evolutionary Approach Especially with psychotics

2. 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)

3. Illusive Current Terminology in Psychopharmacology Vague Terms • Neuroleptics يعنى إيه ”لبتك؟“ • Pschotropic Drugs يعنى إيه ”تروبيك“؟ • Psychoactive Drugs نشط؟ يعنى إيه؟ ”أى نشاط يعنى؟“ ؟

4. 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?)

5. Illusive Current Terminology in Psychopharmacology (Cont.) Biochemical pseudoscientific terms • SSRI (then what ?) • MAOI (and then ?) • Tricyclic

6. Potency Terminology Clinically determined, provided that the domain and target of potency is well defined. • Very Potent • Moderately so • Mild efficacy.

7. 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...

8. 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.

9. 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 The more real relations are established the less neuroleptics are needed Mobilization of Energy

10. 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 “

11. 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)

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

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

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

15. 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 particularnosological 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.

16. 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)

17. 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.

18. تكامل العلاجات مثال من: العلاج النفسى الجمعى (خاصة للذهانيـين) Integrative Management Example : In GroupTherapy (especially for psychotics)

19. 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”

20. 9 Changing the whole pattern Hypothetical Brain Organization Not necessarily normal Pathological excess of Some transmitter Specific drug abolishing the excess 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

21. 8 3 9 5 6

22. 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”

23. 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

24. 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)

25. Brain Synchronizing Therapy (BST)= Rhythm Restoring Therapy (RRT) It is not the least SHOCK (Electroshock) or CONVULSIVE (Not ECT) Both terms are misnomers

26. Brain Synchronizing Therapy (BST): • Acts according to the preparationalongthetherapeutic plan (psychotherapy, rehabilitation, object relation, meaningful discourse, identifying a goal ..etc) • Sometimes one cannot judge, and the first BST tells us where we are. • Hencetimingandimmediate close step by step assessmentis the most important factor in using such therapy.

27. 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.

28. 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

29. Brain is a complex processor of ENERGY and INFORMATION Object relational Depression (Do not give anti-depressants) 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 Mobilization of Energy Towards real object Haloperidol Schiz.Disorg. Diminish the dose

30. 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 The more real relations are established the less neuroleptics are needed Mobilization of Energy

31. Haldol5 Haldol5 Haldol5

32. Thank You شكرا لكم