Hacia una Psicopatologa y Dg.

Relacional

Dr. Edgardo Thumala

Emporio celestial de conocimientos benvolos

animales se clasifican en:

El idioma analtico de John Wilkins,1 los

(a) pertenecientes al emperador,(b) embalsamados,(c) amaestrados,(d) lechones,(e) sirenas,(f) fabulosos,(g) perros sueltos,(h) incluidos en esta clasificacin,(i) que se agitan como locos,(j) innumerables (k) dibujados con un pincel finsimo de pelo de camello,(l) etctera,(m) que acaban de romper un jarrn,(n) que de lejos parecen moscas.

Dice Borges en dicho relato: "(...)notoriamente no hay

clasificacin del universo que no sea arbitraria y conjetural. La razn es muy simple: no sabemos qu cosa es el universo"

TRAZAD UNA DISTINCION!

"un universo se engendra cundo se separa o aparta un espacio"... G. Spencer Brown

el hombre reduce la complejidad de los fenmenos agrupndolos en categoras y siguiendo unos criterios establecidos con uno o ms propsitos."

"Clasificar es el proceso por el cual

..Toda clasificacin supone una simplificacin y por ello una perdida de informacin pasando por alto ciertas peculiaridades y caractersticas del sujeto concreto que estamos estudiando...en ese sentido, aunque no pudiera afirmarse que construimos el objeto, si cabria decir que construimos una representacin suya. Tal representacin resulta empobrecida pero, a la vez, operativa."

"Los objetivos de una clasificacin de los desordenes mentales siempre deben apuntar en un sentido amplio a la comunicacin, al control y a la comprensin."

Objetivos de una Clasificacin (L. Spitzer)

Comunicacin Acuerdo y abreviaturas Standard. Control Capacidad de prevenir su presentacin o modificar su curso. Comprensin Entender las causas y el proceso.

Porque Diagnosticar

(Nancy Mac Williams)

Utilidad para planificar el tratamiento. Su informacin implcita sobre el pronostico. Su contribucin para proteger a los consumidores. Su valor para comunicar empatia. Su rol en aumentar la adhesividad al tratamiento.

1) There are balls and there are strikes and I call them as they are. 2) There are balls and there are strikes and I call them as I see them. 3) There are no balls and there are no strikes until I call them. 4) There are balls and there are strikes and I call them as I use them. 5) Dont call them at all because the game is not fair

Existe una psicopatologa relacional?

Lo relacional implica distintos grupos de autores y distintas miradas con una base comn. la respuesta es si. Tenemos una psicopatologa que surge de: los interpersonales (Sullivan) y los culturalistas: Karen Horney por ej.

la Psicologa del Self los relacionales e intersubjetivos propiamente tal: Mitchell, Stolorow Atwood,Orange, Branchaft, Benjamin, Stern. Cuales serian sus bases?

Bases para una psicopatolgia relacional

Investigacin sobre el desarrollo infantil (Stern, Beebe,Lachman, Sandler, Jafee, Lyons Ruth ) Investigacin sobre apego Investigacin neurobiolgica Reconocimiento de la matriz paciente terapeuta

A new intellectual framework for Psychiatry

E. Kandel American Journal of Psychiatry.Volume 155, Number 4, 1998,

Principio 1.- Todos los procesos mentales, incluso los ms complejos se derivan de operaciones del cerebro.
Todo tipo de actos cognitivos, ya sean conscientes o inconscientes, tales como hablar, pensar, o la ms refinada obra artstica, son obra del cerebro. De la misma forma, los trastornos del comportamiento que caracterizan a las enfermedades psiquitricas son alteraciones cerebrales aun en aquellos casos en que claramente son el producto de un problema ambiental en su origen.

Principio 2.- Los genes y sus

productos protenicos son los determinantes ms importantes que definen el patrn de interconexiones entre las neuronas en el cerebro y los detalles de su funcionamiento.

Los genes, y especficamente combinaciones de genes, ejercen un control significativo sobre la conducta.

Principio 3.- La alteracin gentica no explica por s sola todas las variaciones observadas en los trastornos psiquitricos.
Factores de desarrollo o de tipo social contribuyen de forma importante, ejerciendo acciones sobre el cerebro que a su vez modifican la expresin de los genes implicados y a travs de ellos la funcin neuronal. El aprendizaje produce asimismo cambios en la expresin de los genes.

Principio 4.- Las alteraciones inducidas en la expresin de los genes por el aprendizaje dan lugar a cambios en los patrones de conexiones neuronales.
Estos son, presumiblemente, los responsables de la iniciacin y el mantenimiento de las anormalidades del comportamiento que son inducidas por las contingencias sociales.

Principio 5.- En la medida en que el consejo o la psicoterapia son efectivos y producen cambios a largo plazo en la conducta, lo hacen a travs de un proceso de aprendizaje, produciendo por tanto cambios en la expresin gentica que alteran la consistencia de las conexiones sinpticas alterando los patrones estructurales anatmicos.
A new intellectual framework for Psychiatry.
Eric R. Kandel (Dr. E. Garca B.)

Todas las clulas de nuestro cuerpo tienen los mismos genes, pero no producen las mismas protenas Activacin o SEALES EXTERNAS inactivacin de genes
(NUTRIENTES, HORMONAS, STRESS, ETC) miosina TIPOS CELULARES

colgeno
T. seo T. muscular neuronas

Neurotransmisores

hemoglobina
G. Rojos

Piel

queratina

ACTIVACIN DE LA TRANSCRIPCIN
RNA pol

Transcripcin Basal GEN

Promotor

DNA

RNA

ACTIVADOR
RNA pol Transcripcin activada GEN Promotor RNA

DNA

REPRESIN DE LA TRANSCRIPCIN
RNA pol

Transcripcin

DNA

Promotor
RNA

represor
NO Transcripcin
RNA pol DNA Promotor operador

Epigenetic regulation of the BDNF gene: implications for psychiatric disorders F Boulle, D L A van den Hove, S B Jakob, B P Rutten, M Hamon, J van Os, K-P Lesch, L Lanfumey, H W Steinbusch and G Kenis

Abstract Abnormal brain-derived neurotrophic factor (BDNF) signaling seems to have a central role in the course and development of various neurological and psychiatric disorders. In addition, positive effects of psychotropic drugs are known to activate BDNFmediated signaling. BDNF gene has been associated with several diseases, molecular mechanisms other than functional genetic variations can impact on the regulation of BDNF gene expression and lead to disturbed BDNF signaling and associated pathology. Thus, epigenetic modifications, representing key mechanisms by which environmental factors induce enduring changes in gene expression, are suspected to participate in the onset of various psychiatric disorders

BDNF

Brain-derived neurotrophic factor (BDNF) is a 25-kDa CNS protein implicated in neuronal cell growth and differentiation

Overall, data demonstrate that early-life events influence the BDNF gene and behavioral outcome. Hence aberrant BDNF gene activity continues to receive attention as a candidate molecular mechanism through which early-life adversity is able to produce stable modifications in brain and behavioral plasticity (Alleva and
Cirulli, et al., 2009; Fumagalli, et al., 2007).

Francia, 2009; Branchi, et al., 2004; Calabrese, et al., 2009; Casey, et al., 2009;

"Lasting Epigenetic Influence of Early-Life Adversity on the BDNF Gene"(Roth et al, 2009)
-Stress-induced changes in behavior may be connected to changes in neural plasticity in prefrontal cortex (PFC) and the hippocampus -Newborn rats were exposed to a stressed-abusive mother, a positive caregiving mother, or their own natural mother
RESULTS - Rats with adverse early-life experiences showed an increase in methylation and decrease of expression of BDNF gene in PFC, which lasted into adulthood - Maltreatment (initially) caused increase in mRNA levels in hippocampus, as did rats who were exposed to positive caregiving mothers exposure to new things! -increased methylation of BDNF gene was passed on to next generation

Sequencing analysis in the prefrontal cortex of adults that had experienced favorable social interactions and environmental conditions during infancy revealed little or no cytosine methylation across 12 CG dinucleotide sites examined for BDNF exon IV (sites are numbered and in bold). Conversely, sequencing analysis of adult animals that had been maltreated as infants revealed significant cytosine methylation across the targeted region. Data recreated from Roth, et al., 2009.

We have shown that elevated amygdala activity and enlarged amygdala volume is related to a diagnosis of anxiety in children (Thomas et al., 2001; DeBellis et al., 2000) and early postnatal adversity (e.g., previously institutionalized) (Tottenham et al., in press)

Effect of stress & BDNF genotype on hippocampal and amygdala volume. Relative to Met allele carriers (n=14), previously institutionalized individuals homozygous for the Val allele (n=5) were more likely to show a decrease in hippocampal volume ...

Anxiety and Stress response by BDNF genotype. Met allele carriers (n=8), previously institutionalized, are more anxious than individuals with the Val/Val (10) genotype as evidenced by A) more symptoms of separation anxiety and B) higher levels of cortisol during a laboratory challenge. These elevated anxious phenotypes in the Met allele carriers in humans parallel the increased anxiety-related behaviors previously shown in the Met/Met mouse

Every form of psychopathology represents a specific type of limitation of the individuals capacity to be fully alive as a human being.
Thomas Ogden

Neurobiologa

A growing field of literature establishes an association between serotonin transporter (5HTT) polymorphisms, vulnerability to stress in an early life environment,and adulthood psychopathology

The two 5-HTT promoter alleles are long (l) and short (s). Animals that are homogeneous for the long allele (ll) have more resilience to stress and subsequent pathology, whereas those that are homogeneous for the short allele (ss) are vulnerable to psychopathology.
(Caspi et al. 2003; Champoux et al. 2002; Holden 2003).

We have come to understand that we are unlikely to find single gene underpinnings for most mental disorders, which are more likely to have polygenetic vulnerabilities interacting with epigenetic factors (that switch genes on and off) and environmental exposures to produce disorders. [[2], A Research Agenda for DSM-V 2002.

a diagnostic system that neglects the relational context of disorders is destined to be inadequatea result that is not surprising given the strong evidence that social bonding (and particularly pair bonding) is manifested biochemically in the brain..

Steven R. H. Beach, Ph.D. Marianne Z.Wamboldt, M.D.

Effect of maternal separation stress depends on the timing of the insult during developmentally critical periods. Note. Depending on time of maternal separation stress, adult HMS180 rats can exhibit a potentiated (P<0.001), equivalent, or suppressed (P<0.001) stress response in comparison to AFR control rats. The stress response is measured in pg/mL of mean ACTH (adrenocorticotropic hormone)

Effect of early life environment on dendritic complexity in the prefrontal cortex and hippocampus in HMS180 rats.

In summary, many of the behavior changes observed in HMS180 rats resemble the changes observed in humans with depression. Besides anxiety-like behavior, anhedonia, and ethanol preference, Alterations also occur in sleep microarchitecture; in particular, the latency to the first rapid eye movement (REM) sleep episode is reduced, and the frequency of REM episodes is increased. Many of these changes are analogous to those observed in humans with depression.

Psicopatologa en Karen Horney

El origen: Resumidas (las condiciones) la gente del medio del nio, esta demasiado absorta en sus propias neurosis, para poder amar al nio e incluso para concebirle como un individuoel nio no adquiere una sensacin de confianza sino una profunda inseguridad a la cual yo le doy en nombre de angustia basica Karen Horney La neurosis y el desarrollo
Humano (pag14)

La presin de esta angustia bsica evita que el nio se relacione con los dems con la espontaneidad de sus sentimientosy le obliga a hallar formas de hacerles frente

I had come to feel over the years that there was an acute need for a discipline that was determined to study not the individual organism or the social heritage, but the interpersonal situations through which persons manifest mental health or mental disorder.
HARRY STACK SULLIVAN (1953b, p. 18)

Contemporary Assumptions of Interpersonal Theory

Assumption 1: The most important expressions of personality and psychopathology occur in phenomena involving more than one person (i.e., "interpersonal situations).

Assumption 2:

Interpersonal situations occur between proximal interactants and within the minds of those interactants via the capacity for perception, mental representation, memory, fantasy, and expectancy

Assumption 3:

Agency and Communion provide an integrative meta-structure for conceptualizing interpersonal situations

Assumption 4:

Interpersonal complementarity is most helpful if considered a common baseline for the field regulatory pulls and invitations of interpersonal behavior. Chronic deviations from complementarity may be indicative of psychopathology