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 Epulo 29, 2013
M'masabata angapo, bungwe la American Psychiatric Association lidzatulutsa buku lake latsopano la Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Bukuli lidzasintha magulu angapo a matenda omwe alipo, kuyambira matenda a autism spectrum mpaka matenda a maganizo. Ngakhale kusintha kwakukulu kumeneku kwakhala kotsutsana, zotsatira zake zomaliza zimaphatikizapo kusintha pang'ono kwa buku lapitalo, kutengera malingaliro atsopano omwe abwera kuchokera ku kafukufuku kuyambira 1990 pomwe DSM-IV idasindikizidwa. Nthawi zina kafukufukuyu adalimbikitsa magulu atsopano (monga matenda amisala) kapena magulu am'mbuyomu akhoza kuchotsedwa (monga matenda a Asperger). 1
Cholinga cha buku latsopanoli, monga momwe zinalili ndi mabuku onse am'mbuyomu, ndikupereka chilankhulo chofanana chofotokozera matenda amisala. Ngakhale kuti DSM yafotokozedwa ngati "Baibulo" la nkhaniyi, ndi dikishonale, yomwe imapanga mayina ndikufotokozera chilichonse. Mphamvu ya buku lililonse la DSM yakhala "yodalirika" - buku lililonse latsimikizira kuti asing'anga amagwiritsa ntchito mawu omwewo m'njira zomwezo. Kufooka kwake ndi kusowa kwake kolondola. Mosiyana ndi matanthauzo athu a matenda a mtima, lymphoma, kapena AIDS, matenda a DSM amachokera pa mgwirizano wokhudza magulu a zizindikiro zachipatala, osati muyeso uliwonse wa labotale.
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 pulojekiti ya Research Domain Criteria (RDoC) kuti isinthe matenda pophatikiza majini, kujambula zithunzi, sayansi ya chidziwitso, ndi milingo ina ya chidziwitso kuti ikhazikitse maziko a dongosolo latsopano logawa magulu. Kudzera mu maphunziro angapo m'miyezi 18 yapitayi, tayesa kufotokoza magulu angapo akuluakulu a nosology yatsopano (onani pansipa). 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.
Zinaonekeratu nthawi yomweyo kuti sitingathe kupanga dongosolo lozikidwa pa zizindikiro za biomarker kapena magwiridwe antchito a chidziwitso chifukwa tilibe deta. Mwanjira imeneyi, RDoC ndi njira yosonkhanitsira deta yofunikira pa nosology yatsopano. Koma ndikofunikira kuzindikira kuti sitingapambane ngati tigwiritsa ntchito magulu a DSM ngati "muyezo wagolide." 2 Njira yodziwira matenda iyenera kuzikidwa pa deta yofufuza yomwe ikubwera, osati pamagulu omwe akuchokera ku zizindikiro zomwe zilipo. Tangoganizani kusankha kuti ma EKG sanali othandiza chifukwa odwala ambiri omwe ali ndi ululu pachifuwa sanasinthe EKG. Ndicho chimene takhala tikuchita kwa zaka zambiri pamene tikukana chizindikiro cha biomarker chifukwa sichizindikira gulu la DSM. Tiyenera kuyamba kusonkhanitsa deta ya majini, zithunzi, thupi, ndi chidziwitso kuti tiwone momwe deta yonse - osati zizindikiro zokha - zimagwirizanirana ndi momwe magulu awa amagwirizanirana ndi yankho la chithandizo.
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.
Pakadali pano, RDoC ndi njira yofufuzira, osati chida chachipatala. Iyi ndi pulojekiti ya zaka khumi yomwe ikuyamba kumene. Ofufuza ambiri a NIMH, omwe kale anali ndi nkhawa ndi kuchepetsedwa kwa bajeti komanso mpikisano wovuta wopeza ndalama zofufuzira, sadzalandira kusinthaku. Ena adzaona RDoC ngati ntchito yophunzirira yosiyana ndi ntchito zachipatala. Koma odwala ndi mabanja ayenera kulandira kusinthaku ngati sitepe yoyamba yopita ku " mankhwala olondola ," kayendetsedwe kamene kasintha matenda ndi chithandizo cha khansa. RDoC ndi njira yosinthira machitidwe azachipatala pobweretsa mbadwo watsopano wa kafukufuku kuti adziwe momwe timadziwira ndikuchiza matenda amisala. Monga momwe akatswiri awiri odziwika bwino a majini amisala adanenera posachedwapa, "Kumapeto kwa zaka za m'ma 19, zinali zomveka kugwiritsa ntchito njira yosavuta yodziwira matenda yomwe imapereka chitsimikizo choyenera cha kulosera. Kumayambiriro kwa zaka za m'ma 21, tiyenera kuyang'ana kwambiri." 3
Malo akuluakulu ofufuzira a RDoC:
Valant Valence Systems
Zosangalatsa Valence Systems
Zoganizira
Njira Zogwirira Ntchito
Kukonzekera / Modulatory Systems
Zothandizira
1 Thanzi la maganizo: Pankhani ya matenda. Adam D. Nature. 2013 Epulo 25;496(7446):416-8. doi: 10.1038/496416a. Palibe chidule chomwe chilipo. PMID: 23619674
2 N’chifukwa chiyani zatenga nthawi yaitali kuti matenda amisala apangidwe kuti apeze mayeso azachipatala ndipo achite chiyani? Kapur S, Phillips AG, Insel TR. Mol Psychiatry. 2012 Dec;17(12):1174-9. doi: 10.1038/mp.2012.105. Epub 2012 Aug 7.PMID:22869033
3 Kugawikana kwa Kraepelinian – kupita, kupita… koma sikunapitebe. Craddock N, Owen MJ. Br J Psychiatry. 2010 Feb;196(2):92-5. doi: 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
Nkhani yolembedwa ndi alendo: “ Buku limodzi lophunzitsira anthu za matenda amisala ku US siliyenera kulamula kafukufuku wa zaumoyo wamaganizo ” lolembedwa ndi Allen Frances
Bungwe lalikulu kwambiri padziko lonse lapansi lofufuza za thanzi la maganizo likusiya kugwiritsa ntchito Baibulo latsopano la matenda amisala - Buku Lofufuza ndi Kuwerengera la Matenda a Mitsempha , likukayikira kuti ndi lolondola ndipo likunena kuti "odwala omwe ali ndi matenda amisala akuyenera kulandira zabwino". Izi zachitika milungu ingapo isanafike nthawi yofalitsa buku lachisanu losinthidwa la bukuli, lotchedwa DSM-5.
Pa 29 Epulo, Thomas Insel, mkulu wa US National Institute of Mental Health (NIMH), adalimbikitsa kusintha kwakukulu kuchoka pa kugawa matenda monga bipolar disorder ndi schizophrenia malinga ndi zizindikiro za munthu. M'malo mwake, Insel akufuna kuti matenda amisala azindikiridwe bwino pogwiritsa ntchito majini , kusanthula ubongo komwe kumasonyeza machitidwe osazolowereka a ntchito ndi kuyesa kwa chidziwitso.
Izi zikutanthauza kutaya buku lofalitsidwa ndi American Psychiatric Association lomwe lakhala lopambana pa kufufuza kwa maganizo kwa zaka 60.
DSM yakhala ikukangana kwa zaka zingapo. Otsutsa anena kuti yakhala ikugwira ntchito kwa nthawi yayitali , yasintha madandaulo omwe si matenda kukhala matenda, ndipo yakhudzidwa kwambiri ndi makampani opanga mankhwala omwe akufunafuna misika yatsopano ya mankhwala awo.
Palinso madandaulo akuti matanthauzidwe ambiri a matenda angapo apangitsa kuti matenda monga bipolar disorder ndi attention deficit hyperactivity disorder azindikirike mopitirira muyeso.
Kuzindikira kutengera sayansi
Tsopano, Insel wanena mu blog yake yofalitsidwa ndi NIMH kuti akufuna kusintha kwathunthu ku matenda kutengera 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 matenda pogwiritsa ntchito njira zamoyo, Insel ikufuna njira yotsatiridwa ndi pulogalamu yomwe idakhazikitsidwa miyezi 18 yapitayo ku NIMH yotchedwa Research Domain Criteria project.
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 magulu a DSM ngati muyezo wabwino kwambiri," akutero Insel. "Ndicho chifukwa chake NIMH idzasintha kafukufuku wake kuchoka pa magulu a DSM ," akutero Insel.
Madokotala odziwika bwino amisala omwe adalumikizidwa ndi New Scientist akuchirikiza kwambiri kulimba mtima kwa Insel. Komabe, akuti popeza zitenga nthawi kuti Insel akwaniritse masomphenya ake, kuzindikira ndi kuchiza matendawa kudzapitirira kutengera zizindikiro zake.
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.
"Zingasinthe zinthu, koma ziyenera kukhazikika pa sayansi yodalirika," akutero Simon Wessely wa Institute of Psychiatry ku King's College London. "Ndi za mtsogolo, osati za pano, koma chilichonse chomwe chingathandize kumvetsetsa chifukwa chake ndi majini a matenda chidzakhala bwino [kuposa kuzindikira zizindikiro]."
Maganizo ena
Michael Owen wa ku yunivesite ya Cardiff, yemwe anali m'gulu logwira ntchito la matenda amisala la DSM-5 , akuvomereza. "Kafukufuku ayenera kutulukira m'magulu a matenda omwe alipo panopa," akutero. Koma monga Wessely, akunena kuti ndi koyambirira kwambiri kutaya magulu 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.
Mkanganowu ukhoza kubuka kwambiri poyera mwezi womwe ukubwerawu pamene bungwe la American Psychiatric Association lidzachita msonkhano wake wapachaka ku San Francisco, komwe DSM-5 idzakhazikitsidwa mwalamulo, ndipo mu June ku London pamene Institute of Psychiatry idzachita msonkhano wa masiku awiri pa DSM.