Approaching the Problem

When a car mechanic (see previous post) refers to spark plugs or fuel injector, other mechanics have clear picture of what the he means. If, on the other hand, he refers to “noisy car” or “slow car”, that leaves plenty of room for possibilities and speculation, in the same way as the labels like ‘avoidant personality’ or ‘oppositional child’ do. Instead of giving descriptive terms (medical names for observable behavior) we must think of specific biological mechanisms that lead to ‘avoidance’ and ‘oppositionality’.

Imagine a woman concerned about her brother who recently had several rear-end collisions (he was the one who hit other cars) talking to her auto mechanic friend.

What’s wrong with his car?” she asks.

There are several possibilities,” he replies, “your brother’s car could have brakes problem; there might be sudden unintended acceleration (SUA) if electronic throttle control or cruise control fail; a gas pedal could get stuck under the mat; a power steering might fail – it’s rare but happens; if the roads are icy, maybe the car needs winter tires. And, by the way, when was the last time he checked his vision?

In contrast, when a mother asks a psychiatrist about her second grader who is hitting children on the playground, she receives a meaningless label – Oppositional Defiant Disorder (ODD) – because that’s what children with this particular label do. ODD is a nonspecific descriptive sticker, a pseudo diagnosis, akin  Hitting-A-Car-In-Front-Of-You Disorder. It doesn’t say what is wrong, only describes how it looks from the outside. It may be good for a referral to a specialuist but not for understanding what is wrong with a child and how to take care of the problem. Can we do better?

AMPERIC  Model of Psychiatric Diseases
For simplicity and ease of communication I divided the brain  into seven modules under the acronym AMPERIC which stands for

Arousal system

Mood plus Reward system

Perseveration system

Executive function system, aka Executive Function Network (EFN)

Reality testing system

Interpersonal (social) skills system

Cognitive skills system

Obviously, our brain faculties are not limited to those listed above. Most psychiatric disorders, however, will present with either dysfunction or mismatch involving one or more of these systems.

We will begin with review of one module at a time starting with the old and powerful Arousal System.

Michael Levin, M.D., Medical Director of EBPG, psychiatric group practice serving San Ramon, Danville, Dublin, Pleasanton, Walnut Creek, and other cities in Contra Costa and Alameda Counties, CA. 

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