brief summary of paper: behavioural neurology of pD by author as an example of bi-dimensional futuristic psychiatry

1. Bi-Dimensional
Model of Personality
Disorders:
An Attempt to
Foresee the Future
of Psychiatry
Dr Khalid Mansour
Locum Consultant Psychiatrist
Mersey Care Trust
September 2018

2. Challenges to Psychiatry

3. Challenges to Psychiatry

4. Challenges to Psychiatry

5. Challenges to Psychiatry

6. Challenges to Psychiatry

7. Challenges to Psychiatry 2

8. Reflections: Important Points of Concern
• Narrow medical angle
• Heavily politicised discipline.
• Too much Subjectivity.
• Functional mental illnesses ?!!
• Symptomatic not curative therapies.
• Too much side effects of meds.
• Does not reflect recent developments
in neurosciences.

10. Future of Psychiatry (Dr. Frank Ochberg)

11. Psychiatry:
The Way Forward

12. Emil Kraepelin 1856 - 1926
Roots of the Problem

13. Kraepelinian approach
vs.
Neuro-behavioural systematic approach
levels of presentation of neuropsychiatric disorders
Pathology /
Neuropathology
Symptoms
(Abnormal Behaviour)
Pathophysiology
Aetiology

14. Pathophysiology: why?
• The natural next
step forward
• Most advances in
research
• The door for other
dimensions

15. FXS: Behavioural Symptoms FXS: Aetiology
• LD (100%) (IQ: 35-70): 
with aging.
• ASD (50 – 60%)
• ADHD (30 – 60%)
• Epilepsy (5 – 20%) (mostly
TLE)
• DSH (10 – 30%)
• Aggression (15 – 35%)
• Prader-Willi phenotype.
• Sensory processing
disorder.
• Psychosis
• Speech abnormalities
• FXS Chromosomes >
constriction of band Xq27.3
• > site of “Fragile X Mental
Retardation-1 Gene”
(FMR1)
• FMR1 gene > produces
“Fragile X Mental
Retardation Protein (FMRP)
• FMRP > a widely expressed
mRNA-binding Translational
Regulator with reportedly
hundreds of potential
targets.
FXS Missing link: Pathophysiology

16. Pathophysiology: what?

17. Structural / Biochemical Pathophysiology
F-MRI in Autism

18. Doya (2000) Motor Learning
Functional Pathophysiology

19. Clinical Model of Functional
Pathophysiology
Personal experience

20. Triune Brain Theory (Paul MacLean)
Senior Research Scientist
National Institute of Mental health
1913 - 2007
Bi-dimensional Psychiatry: Inspiration

23. The Neuro-behavioural Way
• The Neurodevelopmental Principle :
• The Social Development Approach :
• The Clinical Principle:
• The Macroscopic Pathophysiological
Approach:
• The Systemic Approach:
• The Dimensional Approach:
• The Comprehensive Approach:
• The “Open-source” Approach:

24. Environment
.
Behaviour
Basic Brain
Systems
Environment
Maturity

25. VISCERAL INTELLIGENCE
Supportive Subsystem
 Alertness
 Attention (Executive)
 Filtering (Concentration)
 Capacity for data processing (resilience)
 Drive (Energy)
 Impulses Control
 Satisfaction
 Temperament Subsystems
 Fight–Flight Reactivity (basic defensive reflexes)
Executive Subsystem
 Proactive Sensory-Motor Subsystems (motivation)
 Mirroring (observation)

26. Physical/Object Related Intelligence
Supportive Subsystem
As in visceral intelligence but with additions of maturity and
the dimension of Physical Intelligence.
- Object and space permanence
Executive Subsystem
As in visceral intelligence but with additions of maturity and
the dimension of Physical Intelligence.
- Vocalisation
- Possessiveness

27. EMOTIONAL INTELLIGENCE
Supportive Subsystem
As for visceral and physical intelligences but with added
maturity and an added emotional intelligence dimension.
Executive Subsystem
- Theory of Mind (Internal and External)
- Emotional Enjoyment (Play)
- Emotional Care (Nursing)
- Emotional Communication
- Attribution (Internal and External)
- Emotional Attachment

28. SOCIAL INTELLIGENCE
Supportive Subsystem
As for visceral, physical, and emotional intelligence but with added
maturity and an added a dimension of emotional intelligence.
Executive Subsystem
- Mentation:
- Abstract Thinking,
- Relativistic Thinking,
- Imagination (Predictive Thinking).
- Social Anxieties
- Separation anxiety,
- pubertal development anxiety,
- Socioeconomic-gap anxiety.
- Social Autonomy and Identity
- Social Communication
- Social Attachments

29. The Integrative Four Intelligence
Paul Maclean’s Triune Brain Theory

30. Autonomy Basic Trust Coherence
Social
Intelligence
Social
Autonomy
Social Basic
Trust
Social
Coherence
Emotional
Intelligence
Emotional
Autonomy
Emotional
Basic Trust
Emotional
Coherence
Physical
Intelligence
Physical
Autonomy
Physical Basic
Trust
Physical
Coherence
Visceral
Intelligence
Visceral
Autonomy
Visceral
Basic Trust
Visceral
Coherence

31. MATURE AND FUNCTIONAL PERSONALITY
Negative environment
and/or
major illnesses
↓
↑Normal Development
(Maturity)
and
Positive Environment
Systems and subsystems of Visceral, Physical, Emotional
and Social intelligences
Maturity

34. ENVIRONMENTAL NEGATIVE
DEVELOPMENTAL FACTORS
- Deprivation of Care
- Negative Cultures (including
negative rearing patterns)
- Stress (especially overpowering
stress)
- Trauma (lasting damage to core
functions and/or maturity)

35. Management
Positives
Components
Negatives
Components
Treatment
Intelligences:
- Visceral
- Physical
- Emotional
- Social
- Reversible vs.
Irreversible.
- Compensate for vs.
Adapt with.
- Internally
Manageable vs.
Externally
Manageable
Maturity:
- Immaturity
Environmental
Factors:
- Deprivation
- Negative cultures
- Chronic Stress
- Traumas
Outcome:
- Autonomy
- Basic trust
- Coherence

36. Conclusion
• Psychiatrist need to start giving more attention
towards qualitative development of psychiatry
as a scientific discipline and make it compatible
with new discoveries in neurosciences.
• Pathophysiology as an added dimension, on
top of the phenomenology dimension, can be
the way forward in the next stage.
• More detailed and precise characteristics of
psychiatric disorders can reduce subjectivity in
diagnosis and enhance specificity in
management .

37. Thank you
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