From plasticity to complexity: a new diagnostic method for psychiatry.
There is growing dissatisfaction regarding the available diagnostic systems for psychiatric disorders (DSM, ICD). Psychiatrists acknowledge that though mental disease reflects brain disorders, the descriptive and symptom based nature of psychiatric diagnosis bears no relation to brain functions. According to Helmut's article published in the October 2003 issue of Science, in the coming decade researchers and psychiatrists will be called upon to propose a basis for the psychiatric diagnostic system of the future. I propose a new etiology-oriented diagnostic system for psychiatry by integrating two recently emerging bodies of knowledge, one regarding plasticity and the other involving complex systems. Plasticity refers to all brain processes involved in dynamic alterations within communicating neuronal ensembles or networks, in the brain. Complexity refers to certain formulations from system theories relevant to brain dynamics and plasticity. It is proposed to divide plasticity processes into three types based on time domains: (1) "developmental plasticity", (2) "tuning plasticity" and (3) "fast stabilizing plasticity". Each type of plasticity is related to different complexity models achieved by the brain, developmental plasticity is life-long brain organization, it is related to state-space configurations molded into brain representations internalized via processes such as Hebbian learning. Tuning plasticity is related to "matching complexity" a measure of adaptability between internal configurations in the brain-system and externally originating event stimuli. Fast stabilizing plasticity is related to "neural complexity" a measure of neural network integration in the brain. Neural complexity meets the mental requirement to extract important features from different sensory inputs and to simultaneously generate coherent perceptual and cognitive states, thus balancing specialized segregated brain processes with coherent globally integrated whole brain activity. Mental disorders can be reconceptualized as disorders of plasticity resulting in disturbances of state-space brain configurations, matching and neural complexities. Personality disorders result from altered internal representations of the psychosocial environment. Depression and anxiety have been recently linked to alterations of adaptive neuronal plasticity thus reconceptualized as disorders of matching complexity. Finally, psychoses, including schizophrenia spectrum disorders, are reconceptualized as disturbances of neural complexity resulting in altered fast stabilizing plasticity. The new diagnostic system generates testable predictions regarding diagnosis and treatments of mental disorders which may be the future of psychiatry.
Peled
Avi
A
Sha'ar Menashe Mental Health Center, Mobile Post Hefer, 38814 Hefer, Hadera, Israel. peled@shaar-menashe.org.il
D003071:Cognition; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology*; D009473:Neuronal Plasticity; D011569:Psychiatric Status Rating Scales; D011570:Psychiatry / Q000379:methods*; D011594:Psychometrics / Q000379:methods*; D011597:Psychomotor Performance; D012720:Severity of Illness Index