Har ila yau duba waɗannan sauran abubuwan sun dace da NIMH
- NIMHHa'idar girma don nazarin rashin lafiyar kwakwalwa
- Masu faɗar sun ce kullun dakatarwa bai dace da binciken lafiyar hankali ba
- NIMH Redraws Taimakawa ga DSM-5: Sakamakon ci gaba shine abin wulakanci ga APA.
- NIMH: Bukatar DSM - da Masu sukarta. Wani sabon ƙarni zai ƙi DSM, da kuma masu sukar ilimin halitta
- DSM-5: "Matanin Rayuwa" Matattu ne a kan Zuwan?
- Shin NIMH Mai Girma ne, mara hankali, ko duka? (Sashe na 1)
Sake ganewar ganewa
By Thomas Insel on Afrilu 29, 2013
A cikin 'yan makonni, Ƙungiyar Ƙwararrun Ƙwararrun Amurka za ta saki sabon rubutun Labaran Harkokin Kwakwalwa da Ƙididdiga na Matucin Mental (DSM-5). Wannan jujjuya zai yalwata nau'in kwarewa na yau da kullum, daga autism jigilar cuta zuwa yanayin rashin lafiya. Yayinda yawancin wadannan canje-canje sunyi rikice-rikice, samfurin karshe ya ƙunshi mafi yawan canje-canje na bugawar baya, bisa ga sababbin abubuwan da suka samo asali daga binciken tun daga 1990 lokacin da aka buga DSM-IV. Wani lokaci wannan binciken ya ba da shawarar sababbin nau'in (misali, rashin lafiyar dysregulation) ko kuma za a iya cire nau'o'i na baya (misali, Asperger's syndrome).1
Makasudin wannan sabon littafi, kamar yadda dukkanin fassarorin da suka gabata, shine don samar da harshe na kowa don kwatanta ka'idoji. Duk da yake an bayyana DSM a matsayin "Littafi Mai-Tsarki" don filin, shi ne, a mafi kyau, ƙamus, ƙirƙirar alamomi da ma'anar kowane. Ƙarfin kowane ɗigon na DSM ya kasance "tabbaci" - kowane fitowar ya tabbatar da cewa likitoci sunyi amfani da wannan sharuddan a cikin hanyoyi guda. Rashin rauni shine rashin inganci. Ba kamar fassararmu ba game da cututtukan zuciya da cututtukan zuciya, cututtukan fata, ko cutar kanjamau, alamun DSM ya samo asali ne daga yarjejeniya game da alamun bayyanar cututtuka, ba kowane ma'aunin dakin gwaje-gwaje ba.
A cikin sauran magunguna, wannan zai zama daidai da ƙirƙirar tsarin bincike dangane da yanayin ciwon kirji ko ƙimar zazzabi. Tabbas, bayyanar cututtukan asali, sau ɗaya gama gari a wasu wuraren magani, an maye gurbinsa da yawa a cikin ƙarni na rabin da suka gabata kamar yadda muka fahimci cewa alamu kaɗai ke da wuya su nuna zaɓin magani mafi kyau.
Marasa lafiya tare da nakasassu ta jiki ya cancanci mafi kyau.
NIMH ta kaddamar da shi Rukunin Shafin Nazarin (RDoC) aikin don canza ganewar asali ta hanyar hada kwayoyin halittu, hotunan, kimiyya mai zurfi, da sauran matakan bayani don sanya tushe don tsarin sabon tsarin. Ta hanyar jerin tarurruka a cikin watanni 18 da suka wuce, mun yi ƙoƙarin bayyana manyan ɗakunan da za a yi don sabon samuwa (duba ƙasa). Wannan tsarin ya fara da ra'ayi da yawa:
- Dole ne ƙwarewar binciken da aka dogara akan ilmin halitta da kuma alamun bayyanar ba za ta ƙalubalanci ƙungiyoyin DSM na yanzu ba,
- Rashin hankali na tunanin tunani shine ilimin halitta wanda ya shafi kwakwalwa ta hanyar kwakwalwa wanda ya haifar da wasu ƙananan sassa na cognition, halayyar, ko halayen,
- Kowane matakin bincike ya kamata a fahimta a fadin girman aikin,
- Zana tasirin abin da ke tattare da hankali, na kewaye, da kuma kwayoyin cututtukan ƙwayoyin cuta zai haifar da sababbin manufofin magani.
Ya zama nan da nan ya bayyana cewa ba zamu iya tsara tsarin da yake dogara da masu ba da mahimmanci ko ƙwarewa ba saboda mun rasa bayanai. A wannan mahimmanci, RDoC wani tsari ne na tattara bayanai da ake buƙata don sabon haɓakawa. Amma yana da muhimmanci a gane cewa ba za mu iya ci nasara ba idan muka yi amfani da sunayen DSM a matsayin "ma'auni na zinariya."2 Dole ne tsarin bincike ya dogara ne akan bayanan binciken bincike, ba a kan al'amuran da aka samo asali ba. Ka yi la'akari da yanke shawarar cewa EKGs ba su da amfani saboda marasa lafiya da yawa da ciwon kirji ba su da canje-canjen EKG. Wannan shine abin da muke yi shekaru da dama idan muka karyata mai yin halitta saboda bazai gano nau'in DSM ba. Muna buƙatar fara tattara kwayoyin halitta, hotunan, ilimin lissafi, da kuma fahimtar bayanai don ganin yadda dukkanin bayanai - ba kawai alamar cututtuka - raguwa da kuma yadda waɗannan ɓangarorin suka danganta da amsa maganin.
Wannan shine dalilin da ya sa NIMH zai sake nazarin bincikensa daga sassa na DSM.
Ci gaba, za mu tallafawa ayyukan bincike wanda ya danganci ɓangarorin yanzu - ko rarrabuwa ga ɓangarorin yanzu - don fara haɓaka ingantaccen tsarin. Menene wannan ke nufi ga masu nema? Jarabawar asibiti na iya yin nazarin duk masu haƙuri a asibiti cikin yanayi maimakon waɗanda ke tsaurara matakan babban yanayin rashin damuwa. Nazarin masu ilimin halitta game da “ɓacin rai” na iya farawa ta hanyar kallon matsaloli da yawa na rashin hankalin da ke cikin damuwa ko raɗaɗin tunani ko nuna damuwa game da yanayin. Menene ma'anar wannan ga marasa lafiya? Mun himmatu ga sabbi da ingantattun jiyya, amma muna jin hakan zai faru ne kawai ta hanyar samar da ingantaccen tsarin bincike. Mafi kyawun dalili don haɓaka RDoC shine don neman kyakkyawan sakamako.
RDoC, a yanzu, tsarin bincike ne, ba kayan aikin asibiti ba. Wannan aiki ne na tsawon shekaru goma wanda yake farawa. Yawancin masu binciken NIMH, waɗanda tuni suka jaddada ta hanyar rage kasafin kuɗi da kuma gasa mai ƙarfi don tallafin bincike, ba za su maraba da wannan canjin ba. Wasu za su ga RDoC azaman motsa jiki na ilimi wanda aka sake shi daga aikin asibiti. Amma marasa lafiya da iyalai su yi maraba da wannan canjin a zaman matakin farko zuwa “daidai magani, "Motsin da ya canza cutar ganewa da magani. RDoC ba kome ba ne kawai da wani shiri na sake fasalin aikin asibiti ta hanyar samar da sabon bincike na bincike don sanar da yadda zamu gano asali da kuma magance matsalar tunanin mutum. Kamar yadda manyan masanan ilimin likita na zamani suka kaddara, "A ƙarshen karni na 19th, yana da mahimmanci don amfani da tsarin bincike mai sauki wanda ya ba da cikakkiyar samfurin bincike. A farkon karni na 21st, dole ne mu daidaita abubuwan da muke gani. "3
Babban mahimman bincike na RDoC:
Ƙananan La'idodi
Kyakkyawan Ɗaukaka Lamba
Cibiyar bincike
Tsarin tsarin tsarin zamantakewa
Arousal / Modulatory Systems
References
1 Mental tunani: A bakan. Adamu D. Yanayin. 2013 Apr 25; 496 (7446): 416-8. Doi: 10.1038 / 496416a. Ba'a samuwa ba. PMID: 23619674
2 Me ya sa ya dauki tsawon lokaci don nazarin ilmin halitta don bunkasa gwaje-gwaje na asibiti da kuma abin da za a yi game da ita? Kapur S, Phillips AG, Insel TR. Mol malaman zuciya. 2012 Dec; 17 (12): 1174-9. Doi: 10.1038 / mp.2012.105. Epub 2012 Aug 7.PMID: 22869033
3 Tsarin hoto na Kraepelinian - tafi, zai tafi… amma har yanzu bai tafi ba. Craddock N, Owen MJ. Br J Zuciyar. 2010 Feb; 196 (2): 92-5. Doi: 10.1192 / bjp.bp.109.073429. PMID: 20118450
TAMBAYA: Psywararrun ƙwaƙwalwa sun rarrabu kamar yadda ake la'antar da lafiyar 'littafi mai tsarki'
- 16: 30 03 Mayu 2013 ta Andy Coghlan da kuma Sara Reardon
Adireshin edita: "Manualaya daga cikin littattafan bai kamata ya ba da umarnin binciken lafiyar ƙwaƙwalwar Amurka ba”Daga Allen Frances
Babbar cibiyar binciken lafiyar kwakwalwa ta duniya ta yi watsi da sabon littafin "littafi mai tsarki" na tabin hankali - Dokar Hidima da Ta'idodi na Magunguna, Tambaya ta inganci da kuma faɗin cewa "marasa lafiya da ke fama da larurar hankali sun cancanci mafi kyau". Wannan fashewar bam din na zuwa makonni kadan kafin a buga bita na biyar na littafin, wanda ake kira DSM-5.
A ranar 29 ga Afrilu, Thomas Insel, darektan Cibiyar Kula da Lafiya ta Hankali ta Amurka (NIMH), ya ba da shawarar a sauya babbar hanya daga rarrabe cututtuka kamar cututtukan bipolar da sikhizophrenia bisa ga alamun mutum. Madadin haka, Insel yana son rikicewar hankali za a bincikar lafiya fiye da amfani da kwayoyin halitta, ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar da ta nuna alamu na aiki da gwaji.
Wannan yana nufin barin littafin da Cibiyar Harkokin Ƙwararrun Ƙwararrun Amurka ta wallafa ta zama babban mahimmancin binciken bincike na psychiatric na shekaru 60.
The DSM An jefa shi a cikin gardama na tsawon shekaru. Masu faɗar sun ce yana da ƙaddamar da amfani, ya mayar da gunagunin da ba su da lafiya sosai a yanayin kiwon lafiya, kuma ya kasance ƙananan kamfanoni masu rinjaye neman sababbin kasuwanni don kwayoyi.
Har ila yau, akwai gunaguni da suka faɗakar da ma'anar cutar da dama over-ganewar asali na yanayi kamar cuta mai laushi da kuma rashin kulawar rashin lafiya na rashin lafiya.
Bayyanar cututtuka dangane da kimiyya
Yanzu, Insel ya ce a cikin shafin yanar gizo NIMH ta wallafa cewa yana son kammalawa zuwa gaba gwaje-gwaje bisa ga kimiyya ba bayyanar cututtuka ba.
"Ba kamar ma'anarmu game da cututtukan zuciya ba, lymphoma ko AIDS, binciken na DSM ya dogara ne akan yarjejeniya game da gungu na alamun asibiti, ba kowane ma'auni na ma'auni ba," Insel ya ce. "A sauran magungunan, wannan zai yi daidai da ƙirƙirar tsarin bincike dangane da yanayin ciwon kirji, ko ingancin zazzaɓi."
Insel ya ce a wasu wurare a maganin likita wannan nau'i na samfurin bayyanar cututtuka an watsar da shi a cikin karni na arni na baya kamar yadda masana kimiyya suka koyi cewa bayyanar cututtuka kawai ba zata iya nuna mafi kyawun magani ba.
Don gaggauta matsawa zuwa tantancewar asalin halitta, Insel ya gamsu da tsarin da aka kaddamar da shirin 18 da suka gabata a NIMH da ake kira Binciken Masarrafan Binciken Nazarin.
Hanya ta dogara ne akan ra'ayin cewa rikice-rikice na kwakwalwa shine matsalolin rayuwa da ke kewaye da kwakwalwar kwakwalwa wanda ya nuna takamaiman ka'idar cognition, halayyar da kuma hali. Dangane akan magance waɗannan matsalolin, maimakon bayyanar cututtuka ana sa zuciya don samar da kyakkyawan yanayin kallon marasa lafiya.
“Ba za mu iya yin nasara ba idan muka yi amfani da shi DSM nau'ikan matsayin ma'aunin zinare, "in ji Insel. “Wannan shine dalilin da ya sa NIMH za ta sake fuskantar binciken ta daga DSM nau'ikan, "in ji Insel.
Mahimman malaman da suka tuntube su New Scientist gabaɗaya tallafawa Insel mai ƙarfin gwiwa. Koyaya, sun ce idan aka ba da lokacin da za a tabbatar da hangen nesa Insel, ganewar asali da magani zai ci gaba da dogara ne da alamun cutar.
Canji mai sauƙi
Insel yana sane da cewa abin da yake ba da shawara zai ɗauki lokaci - mai yiwuwa aƙalla aƙalla shekaru goma, amma yana ganin shi a matsayin matakin farko na isar da “madaidaicin magani” wanda ya ce ya canza cutar kansa da magani.
"Abu ne mai canza wasa, amma yana bukatar ya dogara ne da tushen kimiyya wanda yake abin dogaro ne," in ji shi Simon Wessely na Cibiyar Nazarin tabin hankali a King's College London. "Na gaba ne, maimakon na yanzu, amma duk wani abu da zai inganta fahimtar ilimin halittar jiki da halittar jini zai zama mafi alheri [fiye da yadda ake gano alamomi]."
Sauran ra'ayoyin
Michael Owen, na Jami'ar Cardiff, wanda ke kan wa] anda ke aiki DSM-5, ya yarda. "Bincike na bukatar ficewa daga kangin matsalolin masu cutar yanzu," in ji shi. Amma kamar Wessely, ya ce lokaci ya yi da za a yi watsi da abubuwan da ake da su.
Owen ya ce "Wadannan rikice-rikice ne masu rikitarwa." "Don fahimtar ƙarancin jijiyoyin jiki cikin cikakken zurfin da daki-daki don gina tsarin gano cutar zai ɗauki lokaci mai tsawo, amma a halin yanzu, har yanzu likitoci suna yin aikinsu."
David Clark na Jami'ar Oxford ya ce yana farin ciki cewa NIMH tana ba da gudummawar binciken kimiyya a kan nau'o'in cututtukan yanzu. "Duk da haka, haƙuri haƙuri ne mai yiwuwa wasu hanya a kashe, kuma za a bukatar da za a tabbatar," in ji shi.
Tambaya zata iya ɓacewa a cikin watanni mai zuwa lokacin da American tabin hankali Association yana gudanar da taron shekara-shekara a San Francisco, inda DSM-5 za a kaddamar da shi, kuma a watan Yuni a London lokacin Cibiyar Nazarin Siyasa ta dauka taron kwana biyu a kan DSM.
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