Isiko seSizwe seMpilo yengqondo (i-NIMH): I-DSM iphosakele kwaye iphelelwe yisikhathi.

Kwakhona bona ezi ezinye izinto ezifanelekileyo kwi-NIMH

Ukuguqulwa kwesifo

By Thomas Insel on Aprili 29, 2013

Kwiiveki ezimbalwa, i-American Psychiatric Association iya kukhulula uhlelo lwayo olutsha lwe-Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Lo mqulu uya kulungisa iindidi ezininzi zangoku zokuxilonga, ukusuka kwi-autism spectrum disorders ukuya kwi-mood disorder. Ngelixa uninzi lwezi nguqu ziye zaxambulisana, imveliso yokugqibela ibandakanya uninzi lweenguqulelo ezithobekileyo zohlelo lwangaphambili, olusekwe kwiimbono ezintsha ezivela kuphando ukususela ngo-1990 xa i-DSM-IV yapapashwa. Ngamanye amaxesha olu phando lucebise iindidi ezintsha (umzekelo, ukuphazamiseka kwemood dysregulation) okanye ukuba iindidi zangaphambili zinokuyehliswa (umz., i-Asperger's syndrome).1

Injongo yale ncwadana intsha, njengazo zonke iintlelo zangaphambili, kukubonelela ngolwimi oluqhelekileyo lokuchaza i-psychopathology. Ngelixa i-DSM iye yachazwa njenge "Bhayibhile" yentsimi, eyona nto ingcono, isichazi-magama, idala uluhlu lweelebhile kunye nokuchaza nganye. Amandla ohlelo ngalunye lwe-DSM luye "luthembekile" - uhlelo ngalunye luye lwaqinisekisa ukuba oogqirha basebenzisa amagama afanayo ngeendlela ezifanayo. Ubuthathaka kukunganyaniseki kwayo. Ngokungafaniyo neenkcazo zethu zesifo senhliziyo ye-ischemic, i-lymphoma, okanye i-AIDS, ukuxilongwa kwe-DSM kusekelwe kwimvumelwano malunga namaqela eempawu zeklinikhi, kungekhona nayiphi na injongo yebhubhoratri.

Kulo lonke iyeza, oku kuya kulingana nokudala iinkqubo zokuxilonga ezisekelwe kubume bentlungu yesifuba okanye umgangatho wefiva. Ngokwenene, uxilongo olusekwe kwiimpawu, olukhe lwaxhaphakile kwezinye iindawo zonyango, luthatyathelwe indawo ikakhulu kwisiqingatha senkulungwane edlulileyo njengoko siye saqonda ukuba iimpawu zodwa azifane zibonise olona nyango lulungileyo lonyango.

Izigulana ezinokuphazamiseka kwengqondo zifanelwe ngcono.

I-NIMH isungule i Iikhrayitheriya zoPhando lweDomain (RDoC) iprojekthi yokuguqula uxilongo ngokubandakanya imfuzo, umfanekiso, inzululwazi yokuqonda, kunye namanye amanqanaba olwazi ukubeka isiseko senkqubo entsha yokuhlela. Ngothotho lweeworkshops kwiinyanga ezili-18 ezidlulileyo, sizame ukucacisa iindidi ezininzi zenosology entsha (jonga ngezantsi). Le ndlela yaqala ngeengcinga ezininzi:

  • Indlela yokuxilonga esekelwe kwibhayoloji kunye neempawu kufuneka inganyanzelwa ziindidi zangoku zeDSM,
  • Ukuphazamiseka kwengqondo kukuphazamiseka kwebhayoloji ebandakanya iisekethe zobuchopho ezibandakanya imimandla ethile yokuqonda, imvakalelo, okanye indlela yokuziphatha,
  • Inqanaba ngalinye lohlalutyo kufuneka liqondwe kuwo wonke umlinganiso womsebenzi,
  • Ukwenza imephu yengqondo, isekethe, kunye nemiba yofuzo yokuphazamiseka kwengqondo kuya kunika iithagethi ezintsha nezingcono kunyango.

Kuye kwacaca ngokukhawuleza ukuba asikwazi ukuyila inkqubo esekelwe kwi-biomarkers okanye ukusebenza kwengqondo kuba siswele idatha. Ngale ndlela, i-RDoC sisikhokelo sokuqokelela idatha efunekayo kwi-nosology entsha. Kodwa kubalulekile ukuqonda ukuba asinakuphumelela ukuba sisebenzisa iindidi ze-DSM "njengomgangatho wegolide."2 Inkqubo yokuxilongwa kufuneka isekelwe kwidatha yophando oluvelayo, kungekhona kwiindidi zangoku ezisekelwe kwiimpawu. Khawucinge ngokuthatha isigqibo sokuba ii-EKGs bezingeloncedo kuba izigulana ezininzi ezineentlungu zesifuba bezingenayo utshintsho lwe-EKG. Yiloo nto ebesiyenza amashumi eminyaka xa sisala i-biomarker kuba ayiboni udidi lwe-DSM. Kufuneka siqale ukuqokelela i-genetic, imaging, physiologic, kunye nedatha yokuqonda ukubona indlela yonke idatha - kungekhona nje iimpawu - iqoqo kunye nendlela ezi qela zihambelana ngayo nempendulo yonyango.

Yingakho i-NIMH iya kuphinda iphinde iqhube uphando lwalo uphando kwiinkalo ze-DSM.

Ukuqhubela phambili, siya kuxhasa iiprojekthi zophando ezijonge kwiindidi zangoku - okanye ukwahlula-hlula iindidi zangoku - ukuqalisa ukuphuhlisa inkqubo engcono. Kuthetha ntoni oku kubafaki-zicelo? Ulingo lwezonyango lunokufunda zonke izigulana kwikliniki yeemvakalelo kunezo zidibana neendlela ezingqongqo zoxinzelelo olukhulu loxinzelelo. Uphononongo lweempawu zebhayoloji "zoxinzelelo" lunokuqala ngokujonga kuzo zonke iziphazamiso ezininzi nge-anhedonia okanye ukuthambekela kovavanyo lweemvakalelo okanye ukudodobala kwengqondo ukuqonda ukujikeleza okuphantsi kwezi mpawu. Kuthetha ntoni oku kwizigulana? Sizimisele kunyango olutsha nolungcono, kodwa sivakalelwa kukuba oku kuya kwenzeka kuphela ngokuphuhlisa inkqubo yoxilongo echane ngakumbi. Esona sizathu silungileyo sokuphuhlisa i-RDoC kukufuna iziphumo ezingcono.

I-RDoC, okwangoku, yinkqubo yophando, kungekhona isixhobo seklinikhi. Le yiprojekthi yeminyaka elishumi esandula ukuqalisa. Abaphandi abaninzi be-NIMH, esele begxininiswe kukuncitshiswa kwebhajethi kunye nokhuphiswano olunzima lwenkxaso-mali yophando, abayi kwamkela olu tshintsho. Abanye baya kubona i-RDoC njengomsebenzi wezemfundo oqhawule umtshato kwiklinikhi. Kodwa abaguli kunye neentsapho kufuneka balwamkele olu tshintsho njengenyathelo lokuqala eliya “mayeza ochanekileyo,” intshukumo eye yaguqula ukuxilongwa nonyango lomhlaza. I-RDoC ayisiyonto ingaphantsi kwesicwangciso sokuguqula ukwenziwa kweklinikhi ngokuzisa isizukulwana esitsha sophando ukwazisa indlela esixilonga ngayo kunye nokunyanga ukuphazamiseka kwengqondo. Njengoko iingcali ezimbini ezidumileyo zemizila yengqondo kutshanje ziye zaqukumbela ngelithi, “Ekupheleni kwenkulungwane ye-19, kwakusengqiqweni ukusebenzisa indlela elula yoxilongo eyayinikela ubungqina obusengqiqweni. Ekuqaleni kwenkulungwane yama-21, kufuneka sibeke izinto esizibonayo phezulu.”3

Ezona ndawo ziphambili zophando lweRDoC:

IiNkqubo zeValence eziNcedayo
IiNkqubo zeValence eziPositive
IiNkqubo zoQoqosho
IiNkqubo zeeNkqubo zeNtlalo
IiNkqubo zokuVusa/zoModyuli

Ucaphulo

 1 Impilo yengqondo: Kwi-spectrum. UAdam D. Indalo. 2013 Apr 25; 496 (7446): 416-8. doi: 10.1038/496416a. Akukho bungqina bukhoyo. PMID: 23619674

 2 Kutheni kuthathe ixesha elide kangaka ukuba i-biological psychiatry iphuhlise iimvavanyo zeklinikhi kwaye wenze ntoni ngayo? 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 I-Kraepelinian dichotomy-iyahamba, ihamba… kodwa ayihambanga. UCraddock N, uOwen MJ. U-Br J Psychiatre. 2010 Feb;196(2):92-5. doi: 10.1192/bjp.bp.109.073429. PMID: 20118450

INQAKU: I-Psychiatry yohlulwe njengempilo yengqondo 'ibhayibhile' yagxeka

Umhleli weendwendwe: "Enye incwadi akufuneki iyalele uphando lwempilo yengqondo yase-US” nguAllen Frances

Elona ziko likhulu lehlabathi lophando ngempilo yengqondo liyayishiya inguqulelo entsha “yebhayibhile” yezigulo zengqondo – iNcwadi yokuHlola kunye neyoBalo lweZiphazamiso zengqondo, ukuthandabuza ubunyani bayo kwaye ichaza ukuba "izigulane ezinokuphazamiseka kwengqondo zifanelwe ngcono". Le bhombu iza kwiiveki ezimbalwa phambi kokupapashwa kohlaziyo lwesihlanu lwencwadana, ebizwa DSM-5.

Ngomhla wama-29 ku-Epreli, uThomas Insel, umlawuli we-US National Institute of Mental Health (NIMH), wakhuthaza ukutshintshwa okukhulu ekuhlukaniseni izifo ezifana ne-bipolar disorder kunye ne-schizophrenia ngokweempawu zomntu. Endaweni yoko, i-Insel ifuna ukuphazamiseka kwengqondo Ukufunyaniswa ngokungqongqo ngakumbi kusetyenziswa imfuzo, izikrini zengqondo ezibonisa iipatheni ezingaqhelekanga zomsebenzi kunye novavanyo lokuqonda.

Oku kuya kuthetha ukulahla incwadi epapashwe yiAmerican Psychiatric Association ebiyeyona nto iphambili kuphando lwengqondo kangangeminyaka engama-60.

The DSM iye yabandakanyeka kwiimpikiswano kangangenani leminyaka. Abahlalutyi baye bathi kuye kwanjalo kudlule ukusetyenziswa kwayo, iguqule izikhalazo ezingezizo izifo ngokwenene zibe ziimeko zonyango, kwaye kuye kwaba njalo iphenjelelwe ngokungafanelekanga ziinkampani ezixuba amayeza ukukhangela iimarike ezintsha zamachiza abo.

Kukwakho nezikhalazo zokuba iinkcazo ezibanzi zezifo ezininzi ezikhokelele kuko ukuxilongwa ngokugqithiseleyo kweemeko njenge ukuxhuzula kwaye ingqalelo yokungaphumeleli kokugula.

Uxilongo olusekelwe kwinzululwazi

Ngoku, u-Insel uthe kwisithuba seblogi epapashwe yi-NIMH afuna ukutshintsha ngokupheleleyo kuyo Uxilongo olusekelwe kwisayensi hayi iimpawu.

"Ngokungafaniyo neenkcazo zethu zesifo senhliziyo ye-ischemic, i-lymphoma okanye i-AIDS, ukuxilongwa kwe-DSM kusekelwe kwimvumelwano malunga namaqela eempawu zeklinikhi, kungekhona nayiphi na injongo yebhubhoratri," kusho u-Insel. "Kulo lonke iyeza, oku kuya kulingana nokudala iinkqubo zokuxilonga ezisekwe kubume bentlungu yesifuba, okanye umgangatho womkhuhlane."

U-Insel uthi kwezinye iindawo kwezonyango olu hlobo loxilongo olusekelwe kwiimpawu luye lwayekwa kwisithuba senkulungwane edlulileyo njengoko izazinzulu ziye zafunda ukuba iimpawu zodwa azifane zibonise olona nyango lufanelekileyo.

Ukukhawulezisa utshintsho kuxilongo olusekwe kwibhayoloji, i-Insel ithanda indlela equlathwe yinkqubo eyasungulwa kwiinyanga ezili-18 ezidlulileyo kwi-NIMH ebizwa ngokuba Iprojekthi yeekhrayitheriya zeDomain yoPhando.

Indlela isekelwe kuluvo lokuba ukuphazamiseka kwengqondo ziingxaki zebhayoloji ezibandakanya iisekethe zobuchopho eziyalela iipateni ezithile zolwazi, iimvakalelo kunye nokuziphatha. Ukugxila ekuphatheni ezi ngxaki, kunokuba iimpawu zithembeke ukuba zibonelele ngcono kwizigulane.

“Asinakuphumelela ukuba siyasebenzisa DSM Iindidi njengomgangatho wegolide, utshilo u-Insel. “Kungoko i-NIMH iza kube ihlengahlengisa uphando lwayo kude DSM iindidi,” utshilo u-Insel.

Oogqirha bengqondo abaziwayo abaqhagamshelwe ngu Scientist New Ixhasa ngokubanzi inyathelo lenkalipho lika-Insel. Nangona kunjalo, bathi banikwe ixesha eliya kuthatha ukuqonda umbono we-Insel, ukuxilongwa kunye nonyango luya kuqhubeka lusekelwe kwiimpawu.

Utshintsho olucothayo

U-Insel uyazi ukuba le nto ayicebisayo iyakuthatha ixesha - mhlawumbi ishumi leminyaka ubuncinci, kodwa ulibona njengenyathelo lokuqala lokuzisa "iyeza elichanekileyo" athi litshintshile ukuxilongwa nonyango lomhlaza.

"Kunokutshintsha umdlalo, kodwa kufuneka kusekwe kwisayensi esisiseko ethembekileyo," utshilo USimon Wessely weZiko leNgqondo kwiKholeji yaseKing eLondon. "Yeyexesha elizayo, kunokuba kube ngoku, kodwa nantoni na ephucula ukuqonda i-etiology kunye nemfuza yesifo iya kuba ngcono [kunokuxilongwa okusekelwe kwiimpawu]."

Ezinye izimvo

UMichael Owen weYunivesithi yaseCardiff, owayekwiqela elisebenzayo le-psychosis DSM-5, uyavuma. "Uphando kufuneka luphume kuxinzelelo lwamacandelo angoku okuxilongwa," utshilo. Kodwa njengoWessely, uthi kusesekuseni kakhulu ukulahla iindidi ezikhoyo.

UOwen uthi: “Ezi zizifo ezintsonkothileyo. "Ukuqonda i-neuroscience ngobunzulu obaneleyo kunye neenkcukacha zokwakha inkqubo yokuxilongwa kuya kuthatha ixesha elide, kodwa okwangoku, oogqirha kusafuneka benze umsebenzi wabo."

UDavid Clark weDyunivesithi yaseOxford uthi uyonwabile ukuba i-NIMH ixhasa ngezimali uxilongo olusekwe kwisayensi kuzo zonke iindidi zezifo ezikhoyo. “Nangona kunjalo, inzuzo yesigulana mhlawumbi ikude, kwaye kuya kufuneka ibonakaliswe,” utshilo.

Ingxabano kusenokwenzeka ukuba kuqhambuke ngakumbi esidlangalaleni kwinyanga ezayo xa Umbutho wezeMpilo waseMerika ibamba intlanganiso yayo yonyaka eSan Francisco, apho DSM-5 iya kuqaliswa ngokusesikweni, kwaye ngoJuni eLondon xa iZiko leNgqondo yeNgqondo libambe a intlanganiso yeentsuku ezimbini kwiDSM.