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Review
April3, 2024
MartenScheffer,PhD1; Claudi L.Bockting,PhD2; DennyBorsboom,PhD3; et al RoshanCools,PhD4; ClaraDelecroix,MSc1; Jessica A.Hartmann,PhD5; Kenneth S.Kendler,MD6; Ingridvan de Leemput,PhD1; Han L. J.van der Maas,PhD3; Egbertvan Nes,PhD1; MarkMattson,PhD7; Pat D.McGorry,PhD8; BarnabyNelson,PhD8
Author Affiliations Article Information
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1Wageningen University, Wageningen, the Netherlands
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2Amsterdam UMC, Amsterdam, the Netherlands
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3University of Amsterdam, Amsterdam, the Netherlands
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4Donders Institute, Nijmegen, the Netherlands
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5University of Melbourne, Melbourne, Victoria, Australia
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6Virginia Commonwealth University, Richmond
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7Johns Hopkins University, Baltimore, Maryland
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8Orygen, Parkville, Victoria, Australia
JAMA Psychiatry. Published online April 3, 2024. doi:10.1001/jamapsychiatry.2024.0228
- Review A Dynamical Systems View of Psychiatric Disorders—Theory
MartenScheffer,PhD; Claudi L.Bockting,PhD; DennyBorsboom,PhD; RoshanCools,PhD; ClaraDelecroix,MSc; Jessica A.Hartmann,PhD; Kenneth S.Kendler,MD; Ingridvan de Leemput,PhD; Han L. J.van der Maas,PhD; Egbertvan Nes,PhD; MarkMattson,PhD; Pat D.McGorry,PhD; BarnabyNelson,PhD
JAMA Psychiatry
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Abstract
Importance Dynamical systems theory is widely used to explain tipping points, cycles, and chaos in complex systems ranging from the climate to ecosystems. It has been suggested that the same theory may be used to explain the nature and dynamics of psychiatric disorders, which may come and go with symptoms changing over a lifetime. Here we review evidence for the practical applicability of this theory and its quantitative tools in psychiatry.
Observations Emerging results suggest that time series of mood and behavior may be used to monitor the resilience of patients using the same generic dynamical indicators that are now employed globally to monitor the risks of collapse of complex systems, such as tropical rainforest and tipping elements of the climate system. Other dynamical systems tools used in ecology and climate science open ways to infer personalized webs of causality for patients that may be used to identify targets for intervention. Meanwhile, experiences in ecological restoration help make sense of the occasional long-term success of short interventions.
Conclusions and Relevance Those observations, while promising, evoke follow-up questions on how best to collect dynamic data, infer informative timescales, construct mechanistic models, and measure the effect of interventions on resilience. Done well, monitoring resilience to inform well-timed interventions may be integrated into approaches that give patients an active role in the lifelong challenge of managing their resilience and knowing when to seek professional help.
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April 15, 2024
Precedents in literature and further explorations
Felipe Coelho Argolo, M.D., Ph.D. | University of São Paulo
The article Scheffer et al 1 addresses practical implications for a dynamical systems view of psychiatric disorders. The suggestion to identify optimal moments for interventions to facilitate recovery represents a promising refinement of mental health practice. It is essential to acknowledge that similar concepts have been explored in various medical specialties. For instance, cardioversion techniques in cardiology synchronize electrical shocks with arrythmias, aiming to prevent ventricular fibrillation, while gynecologists routinely monitor menstrual cycles as part of their clinical practice. Furthermore, in Psychiatry, previous works highlighted the latent value of these approaches. Karl Friston emphasized 3 the Later on, we outlined six different rationales 5 that borrow concepts from dynamical systems models, including signal resonance (both constructive and destructive), chaos control techniques such as OGY and Pyragas methods, the detection of optimal points for critical states, the Oberth maneuver, Fatou's Theorem illustrating the evolution of steady states into stable cycles, and probabilistic phenomena like Quantum Tunneling and Quantum Jumping. Despite the intellectual appeal of these concepts, empirical studies are lacking, and further research is crucial to validate their applicability in clinical settings. Therefore, I echo the authors' call for increased investment in research and funding agencies to explore these promising avenues further. Felipe Coelho Argolo, MD, PhD.
As someone deeply interested in the relationship between time and psychopathology, this topic has been central to my research, including my Ph.D. thesis. Our initial suggestion addressed resonance and the usage of a spaceflight maneuver in affective disorders2. Then, we examined the rich body of literature exploring the role of biological rhythms in mental disorders, including the participation of the hypothalamic-pituitary-adrenal (HPA) axis, neurotransmitter’s production and immune system cycles4.
University of São Paulo, Department of Psychiatry.
CONFLICT OF INTEREST: None Reported
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Citation
Scheffer M, Bockting CL, Borsboom D, et al. A Dynamical Systems View of Psychiatric Disorders—Practical Implications: A Review. JAMA Psychiatry. Published online April 03, 2024. doi:10.1001/jamapsychiatry.2024.0228
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