Response by Hector Warnes to Thomas A. Ban’s reply
Thomas A. Ban: Neuropsychopharmacology and the Forgotten Language of Psychiatry
Really, I am not qualified to comment on a paper which is written not only by an expert in conditioning reflexes and the neural arc but by a seasoned researcher on the key psychoneuropharmacology issues since the fifties. I understand now that his long preamble was with the intention to amass a working hypothesis, ‘the missing link’ regarding the selection of a homogeneous population of patients with specific psychopathology that could be assigned to the same “nosological matrix based on distinct abnormalities in the processing of signals between levels, within and across three mental structures: type of onset, course of the disease and outcome which would represent the pathological process in its dynamic totality” (p. 50). The latter statements supports his view that nosology must be considered in its totality, temporality and polarity, each with its own variations. This fine discrimination is not taken into account in most neuropsychopharmacology research. Neuronal circuits that respond to CRs and nosological homotyping “might provide the missing link for using abnormality of CR parameters for bridging psychopathology and pathophysiology in the CNS” (p. 50). Prof. Ban’s Project might seem utopic but worth pursuing. In my experience, I am often surprised by the unpredictability of the outcome of most psychiatric illnesses, the frequency of co-morbidity, overlapping of symptoms and epigenetic surprises just around the corner. It is true that most research is limited in time span and the follow up of patients do not take into account Prof. Ban’s search for more precision and specificity in the best tradition of Wernicke and Kleist regarding brain localization (neuro-anatomy) of specific psychopathological manifestations and further, in the tradition of Pavlov, Prof. Ban’s goal is to find specific pathophysiological circuits up to the biological molecular level that would be the target for drug-action
The course and outcome of many disorders in the wider field of medicine such as Rheumatoid Arthritis, Multiple Sclerosis, Lupus, Hypertension, Vascular disease and so on have a spectrum of minor manifestations to severe ones and an outcome that may be considered favourable and others most unfavourable in spite of all the best treatments available up to date. In the earlier stages of most psychiatric disorders we are faced with similar issues. But in later stages when the disease process has been established and has crystallized beyond doubt irreversibility and even deterioration sets in. Then we may wonder if the condition at hand is due to the adverse environment, to improper treatment or to the course of the disease per se.
I do hope that we should be able to find homogeneous populations in order to valídate the selection of patients in a personalized way for specific pharmacotherapeutic agents in the light of molecular biology and accurate psychopathological assessment. Nosological homotyping might rule out certain pathoplastic factors and be in a condition to search for more precise pathogenic factors in Birnbaum’s conception As the decades go by, the boundaries between several psychiatric entities are getting more blurred, particularly those associated with personality disorders at the point that we get bogged down in our purely scientific task regarding the specificity and validity of long term prognosis. I am impressed by the achievements of Karl Leonhard and the Hungarian School in their search for more accurate predictions based on follow-up studies of distinct psychopathological entities. We already have the tools to correlate this distinct psychopathological structures with more precise brain circuits. Hence there is hope for nosological homotyping.
July 23, 2015