Response-Based Neurology in Psychiatric Practice Robin Routledge, MD
description
Transcript of Response-Based Neurology in Psychiatric Practice Robin Routledge, MD
![Page 1: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/1.jpg)
5
Response-Based Neurology in Psychiatric PracticeRobin Routledge, MD
![Page 2: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/2.jpg)
2
Summary
• The brain is a response to the world.
• The brain is in a systemic balance with the world it perceives. It has many adaptations to context.
• These ideas show responses to extreme adversity are not illness.
![Page 3: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/3.jpg)
Neuron shapes
TOO COMPLICATED
![Page 4: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/4.jpg)
schematic of a neuron
In Middle Out
![Page 5: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/5.jpg)
schematic of a neuronal system
One neuron
Another neuron
![Page 6: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/6.jpg)
schematic of a hundred billion neurons
![Page 7: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/7.jpg)
schematic of a hundred billion neurons
![Page 8: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/8.jpg)
schematic of a neuronal and environmental system
Nervous system
Environment
![Page 9: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/9.jpg)
Mind is social
Mind emerges from interaction between brain and environment
Bateson: Mind and Nature
![Page 10: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/10.jpg)
Human sensation
• Vision* Light* Colour* 3D
• Hearing * Volume* pitch * location
![Page 11: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/11.jpg)
11
Human sensation
• Touch* Size* Shape* texture
• Temperature* Pain* Fast* slow
![Page 12: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/12.jpg)
12
Human sensation
• Taste
• Smell
• Stretch
• Joint position
• vibration
![Page 13: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/13.jpg)
13
Human sensation
• hormone levels• Satiety (grehlin,
leptin, PYY, GLP)• Carbon dioxide • Arterial Pressure
![Page 14: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/14.jpg)
Maintaining the machine
Autonomic control
Hormones
immune response
inflammation
![Page 15: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/15.jpg)
15
Purposeful awareness of perceived sensation is
Mindfulness
![Page 16: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/16.jpg)
Making meaning
local sensation suppresses sensation around it
![Page 17: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/17.jpg)
15
• Competing maps of three dimensional space are assembled from combined sensations and given a sense of time.
Making meaning
![Page 18: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/18.jpg)
16
Making meaning
More than one organization or meaning is generated. These are like competing virtual realities.
![Page 19: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/19.jpg)
17
Making meaning
One “representation” (Plato) suppresses other versions around it.
![Page 20: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/20.jpg)
Making meaning
![Page 21: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/21.jpg)
Making meaning
![Page 22: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/22.jpg)
20
• Networks of neurons located in different parts of the brain hum together like guitar strings. They assemble chords.
20
![Page 23: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/23.jpg)
2121
Certain parts make special contributions but remain interdependent
![Page 24: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/24.jpg)
22
• The brain is split in two halves with very little communication between them.
• Each half organizes perception very differently and the difference allows a subtlety of perception.
22
Making meaning
![Page 25: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/25.jpg)
Memory
1. The brain does not recall exactly. 2. Memories are stored better if they
are emotional.3. Memories are recalled differently
depending on the circumstances at the time of recall.
![Page 26: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/26.jpg)
Brain Action
Parts of our brain cooperate to number
and to name things. These actions
(calculations and language) are like
actions we take on our external world.
![Page 27: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/27.jpg)
25
• “Mirror cells” fire when we see another person do something we understand. Mirror cells act as though we are doing what we perceive the other to be doing.
• This sense of the other may be the foundation of compassion.
![Page 28: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/28.jpg)
26
• The social smoothness of physical
movements is coordinated by the
most foreword part of the frontal
cortical lobes.
• This part of the brain can modify
amygdala’s warning of danger.
![Page 29: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/29.jpg)
27
neuroplasticity
Neurons constantly replace or prune connections. They do this in response to how they are used. So if you do something different, they will slowly make new connections.
![Page 30: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/30.jpg)
28
neuroplasticity
The brain is like a hedge
![Page 31: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/31.jpg)
29
An opening in a hedge
neuroplasticity
![Page 32: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/32.jpg)
30
Summary•The brain is a response to the
world.
•The brain assembles representations of the world.
•The brain adapts to the circumstances it selects.
30
![Page 33: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/33.jpg)
31
Psychiatry is itself a response
a response to current culture
it started with the beginning of industrialism
Psychiatric classification began in the asylums
![Page 34: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/34.jpg)
32
the Psychiatric History of “Trauma”
1. da Costa American Civil War
2. Shell Shock World War One
3. Combat Fatigue World War Two
4. Brain Washing Korean War
5. Post Traumatic Stress Disorder Vietnam War
6. Trauma Informed Care current theory
7. Response Based Care future theory
![Page 35: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/35.jpg)
33
.
Some Brain responses to adversity
Physical Readiness
Option One:•increased muscle tone•increased heart rate•increase breathing•lubricated armpits•increased pupil size (more light in)•Harder to poop or pee
![Page 36: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/36.jpg)
36
Physical Readiness
Option Two:•loss of skeletal muscle tone•decreased heart rate•decrease breathing•decreased pupil size (less light in)•poop and pee
Some Brain responses to adversity
![Page 37: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/37.jpg)
37
Some Brain responses to adversity
Cognitive Readiness•numbed/calm emotional response•heightened alertness & vigilance•altered perception of time•rapid review of meaning of context•evaluation of social “representations”•weighing alternative strategies/tactics
![Page 38: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/38.jpg)
34
Expressed Emotion (EE) studies
show social response to terrible
things has a powerful influence on
outcome. * ”social” as the brain sees it
Social* responses to adversity
![Page 39: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/39.jpg)
schematic of a neuronal and environmental system
Nervous system
Environment
![Page 40: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/40.jpg)
36
Conclusion
• The brain is responsive.
• It grows in the direction it is used.
• The brain is in a systemic balance with
the world it perceives. It has many
adaptations to context. 36
![Page 41: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/41.jpg)
41
ReferencesAPA formatting by BibMe.org.
Bateson, G. (1972). Steps to an ecology of mind. New York: Ballantine Books. Bateson, G. (1979). Mind and nature: a necessary unity. New York: Dutton. Berkowitz, R., Coplan., Reddy., & Gorman. (2007). The human dimension: how the prefrontal cortex modulates the subcortical fear response.. Rev Neurosci., 18(3-4), 191-207. Blackmore, S. J. (2005). Consciousness: a very short introduction. Oxford, UK: Oxford University Press. Blackmore, S. J. (2005). Conversations on consciousness. Oxford: Oxford University Press. Damasio, A. R. (1999). The feeling of what happens: body and emotion in the making of consciousness. New York: Harcourt Brace. Darby, D., & Walsh, K. W. (2005). Walsh's neuropsychology: a clinical a pproach (5th ed.). Edinburgh: Elsevier Churchill Livingstone.
![Page 42: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/42.jpg)
42
References
Das, P., Kemp., Liddell., Brown., Olivieri., Peduto., et al. (2005). Pathways for fear perception: modulation of amygdala activity by thalamo-cortical systems.. NeuroImage, May(15;26(1)), 141-148. Neuroscience Institute of Schizophrenia and Allied Disorders (NISAD), Darlinghurst, NSW, Australia
EDGE: MIRROR NEURONS. (n.d.). Edge.org. Retrieved May 25, 2013, from http://www.edge.org/3rd_culture/ramachandran/ramachandran_p1.html
Gerhardt, S. (2004). Why love matters: how affection shapes a baby's brain. Hove, East Sussex: Brunner-Routledge.
Goleman, D. (2006). Social intelligence: the new science of human relationships. New York: Bantam Books.
Greenfield, S. (1997). The human brain: a guided tour. New York: Basic Books.
Greenfield, S. (2000). The private life of the brain: emotions, consciousness, and the secret of the self. New York: John Wiley & Sons.
Heekeren, H., Marrett., & Ungerleider. (2008). The neural systems that mediate human perceptual decision making. Nature Reviews Neuroscience, 9(June), 467-479.
![Page 43: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/43.jpg)
43
References
Levitin, D. J. (2008). The world in six songs: how the musical brain created human nature. New York: Dutton.
Lewontin, R. C. (1992). Biology as ideology: the doctrine of DNA. New York, NY: HarperPerennial.
McGilchrist, I. (2009). The master and his emissary: the divided brain and the making of the Western world. New Haven: Yale University Press.
McGraw, J. (n.d.). Ramachandran on Consciousness: Neuroscience as Philosophy. Ramachandran on Consciousness: Neuroscience as Philosophy.
Retrieved May 25, 2013, from www.aistpain.it/en/files/CONSCIOUSNESS/Neuroscience_Ramachandran.pdf.aist-pain.it/en/files/CONSCIOUSNESS/Neuroscience_Ramachandran.pdf.
Neisser, U. (1976). Cognition and reality: principles and implications of cognitive psychology. San Francisco: W.H. Freeman.
Ramachandran on Consciousness: Neuroscience as Philosophy. (n.d.). Ramachandran on Consciousness: Neuroscience as Philosophy. Retrieved May 25, 2013, from www.aist-pain.it/en/files/CONSCIOUSNESS/Neuroscience_Ramachandran.pdf
![Page 44: Response-Based Neurology in Psychiatric Practice Robin Routledge, MD](https://reader035.fdocuments.in/reader035/viewer/2022062315/5681594e550346895dc68db3/html5/thumbnails/44.jpg)
44
ReferencesRamachandran, V. S. (2004). A brief tour of human consciousness: from imposter poodles to purple numbers. New York: Pi Press.
Russell, S. A. (2006). Hunger: an unnatural history (Pbk. ed.). New York: Basic Books.
Shea, M. (2005). The brain: a very short introduction. Oxford: Oxford University Press.
Shubin, N. (2008). Your inner fish: a journey into the 3.5-billion-year history of the human body. New York: Pantheon Books.
Siegel, D. J. (2007). The mindful brain: reflection and attunement in the cultivation of well-being. New York: W.W. Norton.
Taylor, J. B. (2009). My stroke of insight. London: Hodder Paperbacks.
Thomas, B. (2012, November 6). What’s So Special about Mirror Neurons? Guest Blog, Scientific American Blog Network. Scientific American Blog Network. Retrieved May 25, 2013, from http://blogs.scientificamerican.com/guest- blog/2012/11/06/whats-so-special-about-mirror-neurons/
Vaughn, Christine, and Julian Leff. "Expressed Emotion In Families. By J. Leff And C. Vaughn. (Pp. 241; Illustrated; £19.95.) The Guilford Press: London. 1985.." Psychological Medicine 17.03 (1987): 794.