Onawo zvimwe izvi zvimwe zvinhu zvinoenderana neNIMH
- NIMHThe yakataridzika nzira yekufunda chirwere chepfungwa
- Vatsoropodzi vanoti kliniki yebhuku haina kukodzera kutsvakurudza kwepfungwa
- Iyo NIMH Inodzinga Kutsigira kweDMM-5: Kufambiswa kwekupedzisira ihomwe rinonyadzisa kune APA.
- NIMH: Chinodikanwa cheDSM - nevatsoropodzi vayo. Chizvarwa chitsva chinoramba DSM, uye vanopokana-nehupenyu vatsoropodzi
- DSM-5: "A Living Document" Vakafa Pakusvika?
- Iko NIMH Yakanakisisa, Ibenzi, kana Zvose? (Chikamu 1)
Transforming Diagnosis
By Thomas Insel on April 29, 2013
Mumavhiki mashomanana, American Psychiatric Association ichabudisa shanduro yayo itsva yeDaagnostic uye Statistical Manual yeMental Disorders (DSM-5). Iri bhuku richaita kuti tive nezvikamu zvakawanda zvemazuva ano zvinoongororwa, kubva kuAustism spectrum kushungurudzika kunetseka kwepfungwa. Nepo huzhinji hwekuchinja uku kwave kuchiita kukakavara, chigadzirwa chekupedzisira chinosanganisira kunyanya kushanduka kwekushandura kwekare, zvichienderana nemashoko matsva anobuda kubva kutsvakurudza kubvira 1990 apo DSM-IV yakabudiswa. Dzimwe nguva kutsvakurudza uku kwakakurudzira maitiro matsva (semuenzaniso, mafungiro ekuderedza chirwere) kana kuti zvikamu zvekare zvingadonhedzwa (semuenzaniso, Asperger's syndrome).1
Chinangwa chebhuku iri idzva, sekunyorwa kwezvinyorwa zvose zvekare, ndekupa mutauro wakafanana wokutsanangura psychopathology. Kunyange zvazvo DSM yave ichitsanangurwa se "Bhaibheri" yemunda, ndiyo, zvakanakisisa, duramanzwi, ichigadzira seti yemavara uye kujekesa imwe neimwe. Simba rega rega shanduro dzeDMM raive "kuvimbika" - rimwe bhuku rakachengetedza kuti vanachiremba vanoshandisa mazwi mamwechete nenzira imwechete. Kushaya simba ndiko kusakwanisa kwekuita. Kusiyana netsananguro yedu ye ischemic chirwere chemoyo, lymphoma, kana AIDS, kuongororwa kweDMM kwakavakirwa pakubvumirana pamusoro pemasumbu ezviratidzo zvechipatara, kwete chero chinangwa cheLabhoratori yekuyera.
Mune mamwe ese mushonga, izvi zvingave zvakaenzana nekugadzira nzira dzekuongorora dzinoenderana nehunhu hwekurwadziwa pachipfuva kana mhando yefivha. Chokwadi, chiratidzo-chinowanikwa mukuongororwa, chakambojairika mune dzimwe nzvimbo dzekurapa, chakanyanya kutsiviwa mune imwe hafu yezana remakore apfuura sezvatinzwisisa kuti zviratidzo chete hazviwanzo kuratidza sarudzo yekurapa yakanyanya.
Varwere vane zvirwere zvepfungwa vanofanirwa nani.
NIMH yakatanga iyo Tsvakurudzo Domain Criteria (RDoC) chirongwa chekushandura kuongororwa nekubatanidza kuongorora, kufungidzira, svangariro yekuziva, uye mamwe mazamu ehuruzivo kuti aise nheyo yehutsva hutsva hutano. Kuburikidza nehuwandu hwemahotera pamusoro pemwedzi ye18 yapfuura, takaedza kutsanangura mazana emapoka makuru emushumo matsva (tarira pasi apa). Iyi nzira yakatanga nemafungiro akawanda:
- Nzira yekufungidzira inobva ku biology pamwe chete nezviratidzo hazvifaniri kudziviswa nezvikamu zveDMM zvino,
- Zvinetso zvepfungwa zvinokonzerwa nezvinokonzerwa nehutano hunosanganisira uropi dzedikiti dzinobatanidza dzimwe nzvimbo dzekucherechedza, manzwiro, kana mufambiro,
- Zuva rimwe nerimwe rekuongorora rinoda kunzwisiswa kune rumwe rutivi rwebasa,
- Mepu yekunyatsoziva, dunhu, uye mazamu anoenderana nehutano hwepfungwa ichapa zvitsva uye zviri nani pane zvinorapwa.
Yakava yakajeka kuti hatigoni kugadzira hurongwa hunotarisana nehupenyu hwemagetsi kana hutano hwekuziva nokuti hatina deta. Nenzira iyi, RDoC inorongwa yekuunganidza zvido zvekudiwa kwemashoko matsva. Asi zvakakosha kuziva kuti hatigone kubudirira kana tikashandisa zvikamu zveSDM se "yegoridhe muzinga."2 Chirwere chekuongorora chinofanirwa kuve chakavakirwa pane zvitsva zvinotsvakurudza tsvakurudzo, kwete pane izvozvi zviratidzo-zvakatevedzana zvikamu. Fungidzira uchifunga kuti EKGs dzakanga dzisingabatsiri nokuti varwere vakawanda vane kurwadziwa kwepfupa havana EKG kuchinja. Ndizvo zvatave tichiita kwemakumi emakore patinoramba chimiro nekuti hazvioni chikwata cheDMM. Tinofanira kutanga kutanga kuunganidza mazita, mafungiro, physiologic, uye ruzivo rwekuziva kuti sei data yose - kwete zviratidzo chete - masumbu uye kuti masumbu aya anorevei nekupindurwa kwehutano.
Ndicho chikonzero NIMH ichave ichidzokorora kutsvakurudza kwayo kunze kwezvikamu zve DSM.
Kuenda kumberi, tichave tichitsigira zvirongwa zvekutsvagisa zvinotarisisa mumapoka ezvino - - kana kugovera zvikamu zveazvino - kutanga kuvandudza hurongwa hwakanaka. Izvi zvinoreva chii kune vanoita chikumbiro? Miedzo yemakiriniki inogona kudzidza varwere vese mukiriniki yemood kwete iya yekusangana nematanho makuru ekuvhiringidza maitiro. Zvidzidzo zve biomarkers zve "kushungurudzika" zvinogona kutanga nekutarisa kumazhinji kushushikana neanhedonia kana kushushikana kwepfungwa kana psychomotor kudzoka kuti unzwisise kutenderera kuri pasi pezviratidzo izvi. Izvi zvinoreva chii kune varwere? Isu takazvipira kurapa nyowani uye zviri nani kurapwa, asi isu tinonzwa izvi zvichangoitika nekukudza yakanyatsojeka nzira yekuongorora. Chikonzero chakanakisa chekukudziridza RDoC kutsvaga kutsvaga zvirinani.
RDoC, yazvino, hwaro hwekutsvaga, kwete kiriniki yekushandisa. Iyi chirongwa chakareba makore gumi chiri kutanga. Vazhinji vaongorori veNIMH, vatove nekushushikana nekuderedzwa kwebhajeti uye makwikwi akaomarara ekutsvagisa mari, havazogashira shanduko iyi. Vamwe vanozoona RDoC seyedzidzo yekurovedza yakarambana nekiriniki maitiro. Asi varwere nemhuri vanofanira kugamuchira shanduko iyi sedanho rekutanga kuenda ku "precision medicine, "Sangano rakashandura chirwere chekuongorora nekurapa. RDoC haisi pasi peurongwa hwokushandura chirongwa chechirongwa nekuunza chizvarwa chetsva chekutsvakurudza kuudza maitiro atinoziva uye kubata zvirwere zvepfungwa. Sezvo mbiri mbiri dzakakurumbira dzepfungwa dzepfungwa dzakagumisa, "Pakupera kwezana remakore re19, zvaive zvine musoro kushandisa nzira iri nyore yekuongororwa iyo yakapa zvinonzwisisika zvinogamuchirwa. Pakutanga kwezana remakore re21, tinofanira kutarisa zvinhu zvedu zvakakwirira. "3
Iyo huru yekuongorora yeDoC domains:
Negative Valence Systems
Positive Valence Systems
Cognitive Systems
Zvirongwa zveMagariro Evanhu
Arousal / Modulatory Systems
References
1 Utano hwepfungwa: Pamuviri. Adhamu D. Zvisikwa. 2013 Apr 25; 496 (7446): 416-8. doi: 10.1038 / 496416a. Hapana abstract yakawanikwa. PMID: 23619674
2 Sei zvakatora nguva yakareba kurapwa kwechirwere chepfungwa kuti zvive nekuedza kuongororwa kwekliniki uye chii chaunofanira kuita nezvayo? 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 Iyo Kraepelinian dichotomy - kuenda, kuenda… asi zvakadaro haina kuenda. Craddock N, Owen MJ. Br J Psychiatry. 2010 Feb; 196 (2): 92-5. doi: 10.1192 / bjp.bp.109.073429. PMID: 20118450
NYAYA: Psychiatry yakakamurwa sehutano hwepfungwa 'bhaibheri' rakashora
- 16: 30 03 May 2013 by Andy Coghlan uye Sara Reardon
Guest editor: "Rimwe bhuku harifanirwe kuraira kutsvagisa hutano hwepfungwa kuUS”NaAllen Frances
Sangano repasirese rekutsvagisa hutano hwepfungwa riri kusiya vhezheni itsva ye "bhaibheri" repfungwa - Diagnostic and Statistical Manual of Mental Disorders, kubvunza kubvumwa kwayo uye kutaura kuti "varwere vane kusagadzikana kwepfungwa vanofanirwa zvirinani". Iri bhomba rinouya kwasara mavhiki mashoma kushambadzirwa kwechishanu kudzokororwa kwebhuku racho, rakadaidzwa DSM-5.
Musi wa29 Kubvumbi, Thomas Insel, director weUS National Institute of Mental Health (NIMH), akatsigira shanduko huru kubva pakuronga zvirwere zvakaita sebipolar disorder uye schizophrenia maringe nezviratidzo zvemunhu. Pane kudaro, Insel anoda kusagadzikana kwepfungwa ku ngazviongororwe zvakare zvakasiyana-siyana uchishandisa genetics, uropi hunotaridzika hunoratidza maitiro asina kukodzera emabasa uye kuongororwa kwepfungwa.
Izvi zvinoreva kurega bhuku iri rakabudiswa neAmerican Psychiatric Association iro rave riri chiitiko chikuru chekuongorora kwepfungwa kwemakore 60.
The DSM rave rakabatanidzwa mukukakavara kwemakore anoverengeka. Vatsoropodzi vakati ivo vane yakabuda yakakosha, yakashandura zvikwangwani zvisiri zvirwere zvechokwadi muhutano, uye zvakave kunyatsotungamirirwa nemakambani emishonga vachitarisira misika itsva yemishonga yavo.
Pakavewo nekunyunyuta kwakatsanangurwa kutsanangurwa kwematambudziko akawanda kwakatungamirira kunyanya kuongororwa kwemamiriro zvakaita se bipolar disorder uye kucherechedza kusakwana kwehutano hwehutano.
Kuongororwa kwakavakirwa pasainzi
Zvino, Inenzi yataura mumushumo we blog rakabudiswa neNIMH kuti anoda kushandura zvakakwana kuongororwa kwakavakirwa nesayenzi kwete zviratidzo.
"Kusiyana netsananguro dzedu dzechirwere chemwoyo ischemic, lymphoma kana AIDS, kuongororwa kweDSM kunoenderana nekubvumirana pamusoro pemasumbu ezviratidzo zvekiriniki, kwete chero chinangwa cherabhoritari," Insel anodaro. "Mukusara kwemushonga, izvi zvingaenzana nekugadzira zvirongwa zvekuongorora zvinoenderana nemarwadzo epachipfuva, kana hutano hwefivha."
Inenzi inoti kune dzimwe nzvimbo mukurapa rudzi urwu rwezviratidzo-hunotarisa hutachiona rwakasiyiwa pamusoro pemakore ekumazana emakore akapfuura sezvo masayendisiti akadzidza kuti zviratidzo chete hazviwanzoratidza sarudzo yakanakisisa yekurapa.
Kuti iwedzere kuchinja kune biologically based based diagnosis, Insel inofarira nzira yakaratidzwa nehurongwa hwakatangwa 18 mwedzi yapfuura paNIMH idana Tsvakurudzo Domain Criteria project.
Nzira yacho inobva pane pfungwa yokuti matambudziko emapfungwa matambudziko ehupenyu anosanganisira mauropi europi anotora maitiro akajeka ekugogodza, manzwiro uye mufambiro. Kunyanya kufunga nezvekurapa matambudziko aya, pane zviratidzo zvinotarisirwa kugovera maonero akanaka kune varwere.
“Hatigone kubudirira kana tikashandisa DSM zvikamu seyero yegoridhe, ”anodaro Insel. “Ndokusaka NIMH ichizogadzirisazve ongororo yayo kure DSM zvikamu, ”anodaro Insel.
Vanokurumbira vezvepfungwa vanobatana ne New Scientist nyatsotsigira Insel kushinga kwekutanga. Nekudaro, ivo vanoti zvakapihwa nguva ichatora kuona chiratidzo chaInsel, kuongororwa uye kurapwa kucharamba kuchienderana nezviratidzo.
Shanduko inononoka
Insel anoziva kuti zvaari kutaura zvinotora nguva - pamwe makore angangosvika gumi, asi anozviona sedanho rekutanga kuendesa "mushonga chaiwo" waanoti wakashandura chirwere chegomarara nekurapwa.
"Izvo zvinogona kuchinja-mutambo, asi zvinofanirwa kuve zvinoenderana nesainzi yepasi yakavimbika," anodaro Simon Wessely weInstitute of Psychiatry kuKing's College London. "Ndezve ramangwana, kwete izvozvi, asi chero chinhu chinovandudza kunzwisiswa kwechirwere uye genetics yechirwere chichava nani [pane zviratidzo zvinoratidzwa nezviratidzo]."
Dzimwe pfungwa
Michael Owen weYunivhesiti yeCardiff, uyo akanga ari boka rekushanda kwepfungwa DSM-5, anobvumirana. "Kutsvagurudza kunofanirwa kubuda mumatambudziko ezvezvino kuongororwa zvikamu," anodaro. Asi saWessely, anoti zvanyanyisa kurasa zvikamu zviripo.
"Aya matambudziko akaoma kunzwisisa," anodaro Owen. "Kuti unzwisise neuroscience zvakadzama zvakakwana uye zvakadzama kuvaka chirongwa chekutora zvinotora nguva yakareba, asi panguva ino, varapi vachiri kufanira kuita basa ravo."
David Clark weYunivhesiti yeOxford anoti anofara kuti NIMH iri kubhadharisa sainzi-yakavakirwa kuongororwa munzvimbo dzechirwere chiripo "Zvisinei, kubatsirwa nemoyo murefu ingangove nzira iri kure, uye kuchada kuratidzwa," anodaro.
Iyo nharo ingangodaro inoputika zvikuru pamusana pemwedzi unouya apo American Psychiatric Association inobata musangano wayo wegore negore muSan Francisco, kupi DSM-5 ichasunungurwa pamutemo, uye muna June muLondon apo Institute of Psychiatry inobata a musangano wemazuva maviri pane DSM.
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