pr.dg. magister

7/27/2019 Pr.dg. Magister

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Hacia una Psicopatologa yDg. Relacional

Dr. Edgardo Thumala


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Emporio celestial de conocimientosbenvolos

El idioma analtico de John Wilkins,1 losanimales se clasifican en:

(a) pertenecientes al emperador,(b)embalsamados,(c) amaestrados,(d)lechones,(e) sirenas,(f) fabulosos,(g) perrossueltos,(h) incluidos en esta clasificacin,(i)

que se agitan como locos,(j) innumerables (k)dibujados con un pincel finsimo de pelo decamello,(l) etctera,(m) que acaban deromper un jarrn,(n) que de lejos parecen

moscas.
http://es.wikipedia.org/wiki/Emporio_celestial_de_conocimientos_ben%C3%A9voloshttp://es.wikipedia.org/wiki/Emporio_celestial_de_conocimientos_ben%C3%A9volos


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Dice Borges en dichorelato: "(...)notoriamente no hay

clasificacin del universo que no seaarbitraria y conjetural. La razn es muysimple: no sabemos qu cosa es el

universo"


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TRAZAD UNA DISTINCION!

"un universo se engendra cundo sesepara o aparta un espacio"...

G. Spencer Brown


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"Clasificar es el proceso por el cualel hombre reduce la complejidad delos fenmenos agrupndolos encategoras y siguiendo unoscriterios establecidos con uno oms propsitos."


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..Toda clasificacin supone una simplificaciny por ello una perdida de informacin pasandopor alto ciertas peculiaridades y caractersticasdel sujeto concreto que estamosestudiando...en ese sentido, aunque no

pudiera afirmarse que construimos el objeto,si cabria decir que construimos unarepresentacin suya. Tal representacin

resulta empobrecida pero, a la vez, operativa."


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"Los objetivos de una clasificacinde los desordenes mentalessiempre deben apuntar en unsentido amplio a la comunicacin,al control y a la comprensin."


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Objetivos de una

Clasificacin (L. Spitzer) Comunicacin

Acuerdo y abreviaturas Standard.

ControlCapacidad de prevenir su presentacin o

modificar su curso.

Comprensin

Entender las causas y el proceso.


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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.


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1) There are balls and there are strikes and I

call them as they are.


call them as I see them.

3) There are no balls and there are no

strikes until I call them.


call them as I use them.

5) Dont call them at all because the game is

not fair


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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.


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la Psicologa del Self

los relacionales e intersubjetivospropiamente tal:

Mitchell, Stolorow Atwood,Orange,Branchaft, Benjamin, Stern.

Cuales serian sus bases?


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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


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A new intellectual framework forPsychiatry

E. KandelAmerican Journal of Psychiatry.Volume 155, Number4, 1998,


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Principio 1.- Todos los procesos mentales,incluso los ms complejos se derivan deoperaciones del cerebro.

Todo tipo de actos cognitivos, ya sean conscientes oinconscientes, tales como hablar, pensar, o la msrefinada obra artstica, son obra del cerebro.

De la misma forma, los trastornos del

comportamiento que caracterizan a las enfermedadespsiquitricas son alteraciones cerebrales aun enaquellos casos en que claramente son el producto deun problema ambiental en su origen.


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Principio 2.-Los genes y sus

productos protenicos son losdeterminantes ms importantesque definen el patrn de

interconexiones entre las neuronasen el cerebro y los detalles de sufuncionamiento.

Los genes, y especficamentecombinaciones de genes, ejercen uncontrol significativo sobre la conducta.


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Principio 3.- La alteracin gentica no explicapor s sola todas las variaciones observadas enlos trastornos psiquitricos.

Factores de desarrollo o de tipo social contribuyen deforma importante, ejerciendo acciones sobre elcerebro que a su vez modifican la expresin de losgenes implicados y a travs de ellos la funcinneuronal. El aprendizaje produce asimismo cambiosen la expresin de los genes.


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Principio 4.- Las alteraciones inducidasen la expresin de los genes por el

aprendizaje dan lugar a cambios en lospatrones de conexiones neuronales.

Estos son, presumiblemente, los responsables

de la iniciacin y el mantenimiento de lasanormalidades del comportamiento que soninducidas por las contingencias sociales.


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Principio 5.- En la medida en que elconsejo o la psicoterapia son efectivos yproducen cambios a largo plazo en laconducta, lo hacen a travs de un

proceso de aprendizaje, produciendopor tanto cambios en la expresingentica que alteran la consistencia delas conexiones sinpticas alterando los

patrones estructurales anatmicos. A new intellectual framework for Psychiatry.

Eric R. Kandel (Dr. E. Garca B.)


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Todas las clulas de nuestro cuerpo tienen


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Todas las clulas de nuestro cuerpo tienenlos mismos genes, pero no producen lasmismas protenas

SEALES EXTERNAS

(NUTRIENTES,HORMONAS, STRESS,

ETC)

Activacin oinactivacin de genes

TIPOS CELULARES

T. seo T. muscular neuronas

G. Rojos

Piel

colgeno

hemoglobina

miosina

queratina

Neurotrans-

misores


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TranscripcinBasal

DNA

RNA

Promotor

RNA pol

ACTIVACIN DE LATRANSCRIPCIN

Transcripcinactivada

DNA

RNA

Promotor

RNA pol

ACTIVADOR

GEN

GEN

A

B


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Transcripcin

DNA

RNA

Promotor

RNA pol

NO Transcripcin

DNAPromotor

RNA pol

operador

represor

REPRESIN DE LATRANSCRIPCIN

E i ti l ti f th BDNF i li ti f


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

AbstractAbnormal brain-derived neurotrophic factor (BDNF) signalingseems 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 BDNF-mediated signaling. BDNF gene has been associated with severaldiseases, 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 mechanismsby which environmental factors induce enduring changes in geneexpression, are suspected to participate in the onset of various

psychiatric disorders


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BDNF

Brain-derivedneurotrophic factor(BDNF) is a 25-kDa CNSprotein implicated inneuronal cell growthand differentiation


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Overall, data demonstrate that early-life eventsinfluence the BDNF gene and behavioral outcome.

Hence aberrant BDNF gene activity continues to receiveattention as a candidate molecular mechanism throughwhich early-life adversity is able to produce stablemodifications in brain and behavioral plasticity (Alleva andFrancia, 2009; Branchi, et al., 2004; Calabrese, et al., 2009; Casey, et al., 2009;

Cirulli, et al., 2009; Fumagalli, et al., 2007).

"Lasting Epigenetic Influence of
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948595/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948595/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948595/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948595/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948595/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948595/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948595/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948595/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948595/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948595/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948595/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948595/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948595/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948595/


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Lasting Epigenetic Influence ofEarly-Life Adversity on the BDNF

Gene"(Roth et al, 2009)

-Stress-induced changes in behavior may be connected tochanges in neural plasticity in prefrontal cortex (PFC) and thehippocampus

-Newborn rats were exposed to a stressed-abusive mother, apositive caregiving mother, or their own natural mother

RESULTS- Rats with adverse early-life experiences showed an increase inmethylation and decrease of expression ofBDNFgene in PFC,which lasted into adulthood

- Maltreatment (initially) caused increase in mRNA levels inhippocampus, as did rats who were exposed to positivecaregiving mothers exposure to new things!

-increased methylation of BDNF gene was passed on to nextgeneration


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Sequencing analysis in the prefrontal cortex of adults that had experienced favorablesocial interactions and environmental conditions during infancy revealed little or nocytosine methylation across 12 CG dinucleotide sites examined for BDNF exon IV (sitesare numbered and in bold). Conversely, sequencing analysis of adult animals that hadbeen maltreated as infants revealed significant cytosine methylation across the targeted

region. Data recreated from Roth, et al., 2009.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948595/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948595/


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We have shown that elevated amygdala activity and enlarged amygdala volume isrelated 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., inpress)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760671/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760671/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760671/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760671/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760671/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760671/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760671/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760671/


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


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

the Met/Met mouse


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Every form of psychopathology represents a

specific type of limitation of the individualscapacity to be fully alive as a human being.

Thomas Ogden


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Neurobiologa

A growing field of literature establishes anassociation between serotonin transporter (5-

HTT) polymorphisms, vulnerability to stress inan early life environment,and adulthoodpsychopathology


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The two 5-HTT promoter alleles are long (l)and short (s).

Animals that are homogeneous forthe long allele (ll) have more resilience tostress and subsequent pathology, whereas

those that are homogeneous for the shortallele (ss) are vulnerable to psychopathology.

(Caspi et al. 2003; Champoux et al. 2002;

Holden 2003).


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We have come to understand that we are

unlikely to find single gene underpinnings for most

mental disorders, which are more likely to havepolygenetic vulnerabilities interacting with epigenetic

factors (that switch genes on and off) andenvironmental exposures to produce disorders. [[2],

A Research Agenda for DSM-V 2002.


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a diagnostic system that neglects therelational context of disorders is destined to

be inadequatea result that is not surprisinggiven 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.


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Effect of maternal separation stress depends on the timing ofthe insult during developmentally critical periods.

Note. Depending on time of maternal separation stress, adultHMS180 rats can exhibit a potentiated (P


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Effect of early life environment on dendriticcomplexity in the prefrontal cortex andhippocampus in HMS180 rats.


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In summary, many of the behavior changes observedin HMS180 rats resemble the changes observed inhumans with depression.

Besides anxiety-like behavior, anhedonia, and ethanolpreference,

Alterations also occur in sleep microarchitecture;

in particular, the latency to the first rapid eyemovement (REM) sleep episode is reduced, and thefrequency of REM episodes is increased.

Many of these changes are analogous to those

observed in humans with depression.


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Psicopatologa en KarenHorney

El origen:

Resumidas (las condiciones) la gente delmedio del nio, esta demasiado absorta ensus propias neurosis, para poder amar al nioe incluso para concebirle como un

individuoel nio no adquiere una sensacinde confianza sino una profunda inseguridad ala cual yo le doy en nombre de angustiabasica Karen Horney La neurosis y el desarrolloHumano (pag14)


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La presin de esta angustia bsica evitaque el nio se relacione con los dems

con la espontaneidad de sussentimientosy le obliga a hallarformas de hacerles frente


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I had come to feel over the years that therewas an acute need for a discipline that was

determined to study not the individualorganism or the social heritage, but theinterpersonal situations through whichpersons manifest mental health or mental

disorder.HARRY STACK SULLIVAN (1953b, p. 18)

Contemporary Assumptions of


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Contemporary Assumptions ofInterpersonal Theory

Assumption 1: The most importantexpressions of personality and

psychopathology occur in phenomenainvolving more than one person (i.e.,"interpersonal situations).


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Assumption 2:

Interpersonal situations occur betweenproximal interactants andwithin the

minds of those interactants via thecapacity for perception, mentalrepresentation, memory, fantasy, and

expectancy


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Assumption 3:

Agency and Communion provide anintegrative meta-structure for

conceptualizing interpersonal situations


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Assumption 4:

Interpersonal complementarity is mosthelpful if considered a common baseline

for the field regulatory pulls andinvitations of interpersonal behavior.

Chronic deviations fromcomplementarity may be indicative ofpsychopathology

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