National Institute of Mental Health (NIMH): DSM ndi yopanda pake komanso yosatha.

Onaninso zinthu zina zomwe zikugwirizana ndi NIMH

• NIMH Njira yayikulu yophunzirira matenda amisala
• Otsutsa amanena kuti chithandizo chopanda chithandizo cha matenda a maganizo
• NIMH Imasiya Kuwathandiza DSM-5: Kupititsa patsogolo kwatsopano ndi mphepo yochititsa manyazi kwa APA.
• NIMH: Kufunsira kwa DSM - ndi Otsutsa ake. Mbadwo watsopano udzakana DSM, ndi otsutsa-anti-biological
• DSM-5: "Zolemba Zamoyo" Zakafa Pakufika?
• Kodi NIMH Ndiyodabwitsa, Yopusa, Kapena Yonse? (Gawo 1)

Kusintha Kusanthula

By Thomas Insel on April 29, 2013

Mu masabata angapo, American Psychiatric Association idzamasula buku lake latsopano la Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Bukuli lidzagwiritsanso ntchito zizindikiro zingapo zamakono, kuchokera ku autism spectrum zosokoneza maganizo. Ngakhale kuti kusintha kotereku kwakhala kulimbikitsana, zotsatira zomaliza zimaphatikizapo kusintha kosasinthika kwasinthidwa kale, motengera nzeru zatsopano zochokera kufukufuku kuyambira 1990 pamene DSM-IV inasindikizidwa. Nthaŵi zina kufufuza kumeneku kunalimbikitsa magulu atsopano (mwachitsanzo, matenda osokoneza maganizo) kapena kuti magulu akale angachoke (mwachitsanzo, matenda a Asperger).¹

Cholinga cha bukhuli latsopano, monga momwe ziliri ndi matembenuzidwe onse apitalo, ndiko kupereka chinenero chofala kuti afotokoze za matenda a maganizo. Ngakhale kuti DSM imatchulidwa kuti "Baibulo" m'mundawu, ndibwino kwambiri, dikishonale, kupanga malemba ndi kufotokozera aliyense. Mphamvu ya malemba onse a DSM yakhala "kudalirika" - ndondomeko iliyonse yatsimikizira kuti madokotala amagwiritsa ntchito mawu omwewo mofanana. Kufooka ndiko kusowa kwake koyenera. Mosiyana ndi tanthauzo lathu la matenda a mtima a ischemic, lymphoma, kapena Edzi, kuwunika kwa DSM kwatengera mgwirizano wokhudzana ndi masango a zamankhwala, osagwirizana ndi gawo lililonse lachipatala.

Mankhwala ena onse, izi zitha kukhala zofanana ndikupanga njira zamagetsi zodziwira kutengera mtundu wa kupweteka pachifuwa kapena mtundu wa kutentha. Zowonadi, matenda omwe amadziwika ndi zizindikiro, omwe anali ofala m'mbali zina zamankhwala, adasinthidwa kwambiri m'zaka zapakati zapitazi monga momwe tazindikira kuti zizindikiro zokha sizimawonetsa bwino chithandizo chamankhwala.

Odwala omwe ali ndi vuto la maganizo amayenerera bwino.

NIMH yayambitsa Zotsatira Zomangidwe Zowonongeka (RDoC) Ntchito yokonzanso matendawa pogwiritsa ntchito zojambulajambula, zithunzithunzi, sayansi ya chidziwitso, ndi njira zina zowonjezera kuti zikhazikitse maziko a dongosolo latsopano. Kupyolera mndandanda wa zokambirana pa miyezi ya 18 yapitayi, tayesera kufotokozera magulu angapo akuluakulu pa zolemba zatsopano (onani m'munsimu). Njira iyi inayamba ndi malingaliro angapo:

• Njira yochidziwitsira yogwiritsa ntchito biology komanso zizindikiro siziyenera kusemphana ndi magulu a DSM,
• Matenda a m'maganizo ndi matenda okhudza ubongo omwe amayambitsa madera ena a kuzindikira, malingaliro, kapena khalidwe,
• Mlingaliro uliwonse wa kusanthula ukuyenera kumvetsetsedwa muyeso ya ntchito,
• Mapu ozindikira, dera, ndi maumwini osiyanasiyana a matenda a m'maganizo adzapereka zowonjezereka ndi zowonjezereka zothandizira.

Zinaonekera momveka bwino kuti sitingathe kupanga dongosolo lozikidwa pazinthu zodziwika bwino kapena zomveka chifukwa chakuti tilibe deta. Mwa njira iyi, RDoC ndi ndondomeko yosonkhanitsa deta yofunikira pazithunzithunzi zatsopano. Koma n'kofunika kuzindikira kuti sitingapambane ngati tigwiritsa ntchito magulu a DSM monga "golide".² Njira yoyezetsa matenda iyenera kukhazikitsidwa pazomwe zikufufuzidwa kafukufuku, osati pazinthu zamakono zomwe zimagwiritsidwa ntchito. Talingalirani kuganiza kuti EKGs sizinali zothandiza chifukwa odwala ambiri omwe ali ndi kupweteka pachifuwa alibe EKG kusintha. Izi ndizo zomwe takhala tikuchita kwa zaka zambiri tikakana chilengedwe chifukwa sichizindikira chigawo cha DSM. Tiyenera kuyamba kusonkhanitsa ma genetic, imaging, physiologic, ndi chidziwitso cha deta kuti tiwone momwe deta yonse - osati zizindikiro - masango ndi momwe masangowa amakhudzira mankhwala.

Ndicho chifukwa chake NIMH idzayambiranso kufufuza kwake kutali ndi magulu a DSM.

Kupita patsogolo, tikhala tikuthandizira mapulojekiti ofufuza omwe amayang'ana magulu apano - kapenaogawa magawo omwe alipo - kuti ayambe kupanga dongosolo labwino. Kodi izi zikutanthauza chiyani kwa ofunsira? Mayeso azachipatala atha kuphunzirira odwala onse kuchipatala chokhazikika m'malo mokumana ndi okhazikika omwe ali ndi vuto lodetsa nkhawa. Kafukufuku wa zolemba zotsalira za "kukhumudwa" atha kuyamba ndikuwona zovuta zambiri ndi matenda a anhedonia kapena kukondwerera kwamalingaliro kapena psychomotor retardation kuti timvetsetse zomwe zimayambira zizindikirozi. Kodi izi zikutanthauza chiyani kwa odwala? Tili odzipereka ku chithandizo chatsopano komanso chabwinoko, koma tikuwona kuti izi zidzachitika pokhazikitsa njira yolondola yodziwira matenda. Chifukwa chabwino chokhalira RDoC ndikufunafuna zotsatira zabwino.

RDoC, pakadali pano, ndi kafukufuku, osati chida chazachipatala. Iyi ndi ntchito yazaka khumi yomwe ikuyamba kumene. Ofufuza ambiri a NIMH, omwe apanikizika kale ndi kuchepa kwa bajeti komanso mpikisano wovuta wofufuza ndalama, sangalandire kusintha kumeneku. Ena adzawona RDoC ngati maphunziro omwe adasudzulana ndi zamankhwala. Koma odwala ndi mabanja ayenera kulandira kusinthaku ngati gawo loyamba kulowera ku "mankhwala oyenera, "Kayendedwe kamene kamasintha matenda a khansa komanso mankhwala. RDoC ndiponse ndondomeko yosinthira chidziwitso chachipatala pobweretsa mbadwo watsopano wa kafufuzidwe kuti tidziwe mmene timadziwira ndikumatenda matenda. Monga momwe akatswiri awiri ofufuza odwala matenda opatsirana maganizo afika posachedwapa, "Pakutha kwa zaka za 19th, zinali zomveka kugwiritsa ntchito njira yosavuta yowunikira yomwe inapereka umboni wololera. Kumayambiriro kwa zaka za 21st, tifunika kuyang'ana patsogolo. "³

Malo akuluakulu ofufuzira a RDoC:

Valant Valence Systems
Zosangalatsa Valence Systems
Zoganizira
Njira Zogwirira Ntchito
Kukonzekera / Modulatory Systems

Zothandizira

 ¹ Thanzi la m'maganizo: Paziwonetsero. Adam D. Chilengedwe. 2013 Apr 25; 496 (7446): 416-8. yani: 10.1038 / 496416a. Palibe zomveka zomwe zilipo. PMID: 23619674

 ² Nchifukwa chiyani watenga nthawi yaitali kuti matenda a matenda a zaumoyo apange mayesero a zachipatala ndikuyenera kuchita chiyani? Kapur S, Phillips AG, Insel TR. Mol Psychiatry. 2012 Dec; 17 (12): 1174-9. onetsani: 10.1038 / mp.2012.105. Epub 2012 Aug 7.PMID: 22869033

 ³ Dichotomy ya Kraepelinian - ikupita, ikupita… koma sinapitebe. Amanda N, Amanda MJ. Br J Psychiatry. 2010 Feb; 196 (2): 92-5. onetsani: 10.1192 / bjp.bp.109.073429. PMID: 20118450

NKHANI: Psychiatry yogawanika ngati 'bible' yathanzi lamatsutso

• 16: 30 03 May 2013 ndi Andy Coghlan ndi Sara Reardon

Mkonzi wa alendo: "Buku limodzi siliyenera kulamula kuti US afufuze zamaganizidwe”Wolemba Allen Frances

Ofesi yayikulu kwambiri padziko lonse lapansi yofufuza zaumoyo ikusiya mtundu watsopano wamabuku a "psychiatry" - Buku Lophatikiza ndi Kuwerenga kwa Mavuto a Mitsempha, kukayikira kuyenera kwake ndi kunena kuti "odwala omwe ali ndi vuto lamaganizidwe amayenera kukhala bwino". Bomba ili limabwera patangotsala milungu ingapo kuti buku lachisanu lisinthidwe, lotchedwa DSM-5.

Pa 29 Epulo, a Thomas Insel, director of the US National Institute of Mental Health (NIMH), adalimbikitsa kusamuka kwakukulu pogawa matenda monga matenda ochititsa munthu kusinthasintha zochitika komanso schizophrenia malingana ndi zizindikilo za munthu. M'malo mwake, Insel akufuna kusokonezeka kwamaganizidwe amapezeka kuti amagwiritsidwa ntchito moyenera pogwiritsa ntchito majini, ubongo wa ubongo womwe umasonyeza kusalongosoka kwa ntchito ndi kuyesedwa kwa chidziwitso.

Izi zikutanthauza kutaya buku lofalitsidwa ndi American Psychiatric Association lomwe lakhala lopambana pa kufufuza kwa maganizo kwa zaka 60.

The DSM wakhala akutsutsana kwa zaka zingapo. Otsutsa anena kuti izo ziri adawathandiza, watembenuza madandaulo omwe sali matenda kwenikweni ku matenda, ndipo wakhala ali zomwe zimakhudzidwa kwambiri ndi makampani opanga mankhwala kuyang'ana misika yatsopano kwa mankhwala awo.

Pakhalanso zodandaula kuti kufotokoza kwakukulu kwa matenda osiyanasiyana kunayambitsa kudziwiratu kwa zinthu monga matenda osokonezeka maganizo ndi kuchepetsa kuchepa kwa matenda osokonezeka.

Kuzindikira kutengera sayansi

Tsopano, Insel yanena mu post post lofalitsidwa ndi NIMH kuti akufuna kusintha kwathunthu matenda opangidwa ndi sayansi osati zizindikiro.

"Mosiyana ndi matanthauzidwe athu a ischemic heart disease, lymphoma kapena Edzi, matenda a DSM amachokera pamgwirizano wokhudzana ndi masango azizindikiro zamankhwala, osati njira iliyonse yantchito," akutero Insel. "M'mankhwala onse otsala, izi zitha kufanana ndikupanga njira zoyezera kutengera zowawa pachifuwa, kapena kutentha thupi."

Insel imanena kuti kwina kulikonse kuchipatala mtundu uwu wa zizindikiro zozizwitsa zamaganizo unasiyidwa m'zaka zapitazi zapitazo monga asayansi aphunzira kuti zizindikiro zokha sizikuwonetsa chisankho chabwino koposa.

Pofuna kufulumizitsa kusintha kwa chidziwitso cha sayansi, Insel ikuvomereza njira yomwe ili ndi pulogalamu ya 18 miyezi yapitayo ku NIMH Ndondomeko ya Zotsatira za Dera la Kafukufuku.

Njirayi imachokera ku lingaliro lakuti vuto la m'maganizo ndi mavuto omwe alipo okhudza maulendo a ubongo omwe amachititsa njira zina za kuzindikira, malingaliro ndi khalidwe. Kuika maganizo pazothetsa mavutowa, m'malo mozizwitsa, akuyembekeza kuti azitha kuwona odwala bwino.

“Sitingapambane ngati tigwiritsa ntchito DSM m'magulu ngati golide, ”akutero Insel. "Ichi ndichifukwa chake NIMH ikonzanso kafukufuku wake kutali DSM m'magulu, ”akutero Insel.

Odwala matenda opatsirana a m'maganizo omwe amalumikizidwa ndi New Scientist thandizani kulimba mtima kwa Insel. Komabe, akuti atapatsidwa nthawi yokwanira kuti masomphenya a Insel, kuzindikira ndi kulandira mankhwala zipitirire kutengera zomwe ali nazo.

Kusintha pang'onopang'ono

Insel akudziwa kuti zomwe akunena zingatenge nthawi - mwina mwina zaka khumi, koma akuwona ngati njira yoyamba yoperekera "mankhwala molondola" omwe akuti asintha matenda a khansa ndi chithandizo.

"Zitha kusintha masewera, koma ziyenera kukhazikitsidwa ndi sayansi yodalirika," akutero Simon Wessely wa Institute of Psychiatry ku King's College London. "Ndi zamtsogolo, osati zamtsogolo, koma chilichonse chomwe chimawonjezera kumvetsetsa kwamatenda ndi majini amtundu wa matenda chikhala bwino [kuposa kuzindikira kwazizindikiro]."

Maganizo ena

Michael Owen wa ku yunivesite ya Cardiff, yemwe anali pa gulu la ogwira ntchito psychosis DSM-5, akuvomereza. "Kafukufuku akuyenera kuthana ndi zovuta zomwe zapezeka pano," akutero. Koma monga Wessely, akuti ndikumayambiriro kwambiri kuti titaye magawo omwe alipo.

"Awa ndi mavuto ovuta kwambiri," akutero Owen. "Kuti timvetsetse bwino zaubongo wathu komanso mwatsatanetsatane kuti adziwe momwe zingatengere matendawa zimatenga nthawi yayitali, koma padakali pano, madokotala akuyenera kugwira ntchito yawo."

A David Clark aku University of Oxford ati ndiwokondwa kuti NIMH ikupereka ndalama zothandizirana ndi sayansi m'magulu amatenda apano. "Komabe, phindu la kuleza mtima mwina lili kutali, ndipo lidzafunika kutsimikiziridwa," akutero.

Vutoli likhoza kuphulika mosavuta m'mwezi wotsatira pamene a Association of Psychiatric Association amachitira msonkhano wawo wapachaka ku San Francisco, kumene DSM-5 adzakhazikitsidwa mwakhama, ndipo mu June ku London pamene Institute of Psychiatry idzagwira msonkhano wa masiku awiri pa DSM.