استعمال العقاقير النفسية فى العلاج الجمعى من منظور تطورى أ.د. يحيى الرخاوى

1. استعمال العقاقير النفسية فى العلاج الجمعى من منظور تطورى أ.د. يحيى الرخاوى The Use of Psychoactive Drugs in Group Therapy An Evolutionary Approach Y.T.Rakhawy

2. نحن نستعمل العقاقير النفسية فى العلاج الجمعى على نفس الأساس(الفرض) الذى نستعملها به فى علاج الوسط، وعموما، ما أمكن ذلك: أعنى من منظور تطورى. على أن كل المجموعات عادة هى غير متجانسة وتتضمن ذهانيين. Drugs are used in our group therapy therapy on the same basis (hypothesis) as they are applied in our milieu therapy and whenever possible, alone, i.e. from an evolutionary point of view. Almost all our groups are usually heterogeneous including psychotics.

3. نحن نستعمل عددا قليلا من العقاقير أغلبها من النيورولبتات الجسيمة ومضادات الاكتئاب ثلاثية الدوائر، ونرتبها من واقع الخبرة ترتيبا هيراكيا تطوريا فى مقابل الترتيب التركيبى الهيراكى التطورى اللأمراض النفسية، We usually use very few drugs (mostly neuroleptics and to a lesser extent tricyclic anti-depressants) arranged in some evolutionary hierarchical order parallel to the hierarchical order of disorders

4. وهو ترتيب غير مرادف بالضرورة للتصنيف التشخصيى التقليدى، ويتم اختيار العقار وتغييره من منظور إمراضى تركيبى لإعادة تنسيق مستويات المخ (الأمخاخ) لاستعادة الهارمونى والفاعلية. They are indicated and selected according to the structural evolutionary psychopathology rather than according to the traditional nosological diagnoses

5. Clinical Terminology (2) • Suggested Evolutionary Terminology • Oldest Brain inhibitors (?? archaic organizers) • (= potent neuroleptics = anti devolutionary, anti-withdrawal... e.g. Haldol Olanzopine ) • Older brain inhibitor (?? paleo- organizers) (= moderate neuroleptic e.g. Stelazine • Old brain inhibitors • Recent brain tranquilizers • Broad-spectrum anti-psychotics (Clozaril.etc)

6. Relevant (Appropriate scientific) Language • Energy & Information • The mind is a processor of energy & information • Energyis contained within theactivation of neuronal circuits. • Informationis contained within the patterns of activation (=neural net profile = mentalrepresentation) • The nervous system can function as a parallel and serial process of information.

7. Relevant (Appropriate scientific) Language • States of Mind • … the state of activation of the various parts of the system can cluster into repeated patterns called states” • “… In the brain a state of mind or mental state describes the way in which the various neuronal groups become activated at a given time.” • A neuronal net profile (= repeated pattern of neuronal group activation) can become reinforced if they occur frequently or if the value system of the brain ingrains their profile”

8. Consciousness and mental schemata Schemata are special highly structured organizations. They are stimulated (& reactivated) according to special stimuli . They possibly correspond to what is known as Ego states) Genes are but ingrained DNA & neuronal programs

9. Diazepines + Normal (Neurotic B) Depressive Brain Paranoid Brain SchizoidBrain Melanie Klien, Guntrip etc. Halodol Corresponding levels of organization Object Relation Drugs Brains MAOI Schizoid => Paranoid => Depressivepositions Tryptizol Mellaril Largactil Trilafon Stelazine

10. ambivalence Fight flight Schizoid Position Depressive Position Paranoid Position No object

11. ثنائية الوجدان ambivalence الموقف الاكتئابى حيرة العلاقة بالأخر Paranoid Position Neurotic (Ps.normal) + stability Depressive position الموقف البارنوى الكر والـفر Fight flight Schizoid Position No object الموقف الشيزيدى اللاموضوع – فى الرحم مراحل النمو Stages of development

12. التطور = النمو Microgeny repeats Macrogeny Pschopathogeny abnormally aborts & mutilates macrogoeny or microgeny Ontogeny repesat phlogeny Macrogeny repesat ontogeny التدهور = المر ض الاغتراب التفسخ النكوص الإبداع مفتوح النهايية Therapy corrects psychopathogenyy

13. Delusional formation Depressive Brain Controlling Both par and schizoid activities Delusional splint Depressive Brain Biorhythmic Pulsations of different Brains Disorganization threat

14. This is absolutely not the case The actual art is the result of training. Stabizers e.g.Carbamazepine Clozaril Broad Spectrum This is absolutely not the case The actual art is the result of training. Minor Tranquil. Anxiety Floating Anxiety Panic Prothiaden Anxiety Depression Tryptizol Depression (1) Thioridazine Mellar. Depression (2) Chlorpomazine Schizo-agitatied Perphenazine Trilaf. Schizo-depressive Trifluperazine Stelaz Randolectil Schiz. Paranoid ++ Schiz. Paranoid +++ Haloperidol Schiz. Chron. Undif Majeptil + Schiz. Disorg. + Mania. Haloperidol Schiz. Simple Almost none !!!

15. Stabizers e.g.Carbamazepine Clozaril Broad Spectrum C. Normal defenses Control by neurotic Defenses : anxiety n.depression etc Minor Tranquil. Prothiaden Control by opposing and inhibiting evergy Tryptizol Thioridazine Mellar. Chlorpomazine Control by outporing of energy Perphenazine Trilaf. Control lby Delusional splint Trifluperazine Stelaz Randolectil Disorganization positive Haloperidol Disorganiztion negative Majeptil + Haloperidol Disorganiztion negative Detriorat. Zyprexa etc.!!! This is absolutely not the case The actual art is the result of training.

16. The brain is considered as sophisticated processor of energy and information and as far as it is the one which builds and rebuilds itself, our approach is to understand how it is functioning here and now and hence to help it to continue its task in its appropriate direction.

17. Biorhythmic Pulsations of different Brains

18. 9 Changing the whole pattern Hypothetical Brain Organization Not necessarily normal Pathological excess of Some transmitter Specific drug abolishing the excess الفكرة أنه بزيادة أو نقص مادة معينة بالمرض أو بالعلاج يتغير التنظيم الكلى للدماغ وهذا يظهر إكلنيكيا فى كلية نوع التغير فى العلاقة بالموضوع , والعمل, و نبض الوجدان

19. 9 8 3 6

20. Prothiaden Prothiaden Stelazine Stelazine Haloperidol Haloperidol Zyprexa etc.!!! Zyprexa etc.!!!

21. Meanigful Work stel stel Haldol5 stel Haldol5 Haldol5 zypr zypr

22. Prothiaden Prothiaden Stelazine Stelazine Chlorpomazine Haloperidol Chlorpomazine Haloperidol Zyprexa etc.!!! Zyprexa etc.!!!