Triune theory 3333

Possible Applications of Possible Applications of Triune Theory in Triune Theory in

Developmental DisordersDevelopmental Disorders

Dr Khalid MansourDr Khalid MansourLocum Consultant Forensic Psychiatrist Locum Consultant Forensic Psychiatrist

in Learning Disabilitiesin Learning DisabilitiesEric Shepherd Unit Eric Shepherd Unit

How does the brain work?How does the brain work? Main functional structure of the brain?Main functional structure of the brain? Brain centres (too simple)Brain centres (too simple) Brain circuits (vague, not clinical)Brain circuits (vague, not clinical) Evolutional/developmental approach Evolutional/developmental approach

(triune):(triune): Strong scientific evidenceStrong scientific evidence More comprehensive theory of brain More comprehensive theory of brain

functioning functioning High clinical potential High clinical potential

Triune TheoryTriune Theory ““The most influential idea in The most influential idea in

neuroscience since World War II” neuroscience since World War II” (Durant in Harrington 1992)(Durant in Harrington 1992)

MacLean’s Triune Brain Concept has MacLean’s Triune Brain Concept has had limited acceptance or been had limited acceptance or been largely ignored by professional largely ignored by professional neurobiologist (Science Journal 1990 neurobiologist (Science Journal 1990 & American Scientist journals 1992) & American Scientist journals 1992) (Cory in in Cory & Gardner 2002) (Cory in in Cory & Gardner 2002)

Triune TheoryTriune Theory

Not favourable attention from some Not favourable attention from some international journals international journals

lacking practical applications to lacking practical applications to human sciences (e.g. psychiatry) human sciences (e.g. psychiatry)

Full potential could be achieved Full potential could be achieved when mixed with clinical sciences when mixed with clinical sciences

(I) Triune theory(I) Triune theory

Senior Research ScientistSenior Research ScientistNational Institute of Mental healthNational Institute of Mental health

1913 - 20071913 - 2007

Triune TheoryTriune TheoryVertebrates can be divided from Vertebrates can be divided from evolutionary point of view into three main evolutionary point of view into three main categories:categories:

1.1. Animal with brains made mainly of Animal with brains made mainly of spinal spinal cord, brain stem, basal ganglia and cord, brain stem, basal ganglia and cerebellumcerebellum ( (reptilian brainreptilian brain, the , the R-ComplexR-Complex or or the the Striatal ComplexStriatal Complex))

2.2. Animals which brain is mainly made from the Animals which brain is mainly made from the R-Complex plus the limbic LobeR-Complex plus the limbic Lobe (diencephalons, Amygdala, septum, (diencephalons, Amygdala, septum, Mammillary body, Fornix, limbic cortex: Mammillary body, Fornix, limbic cortex: Broca’s area, cingulated cortex, hippocampus Broca’s area, cingulated cortex, hippocampus & others)& others)

3.3. Animals which brain is mainly made of: Animals which brain is mainly made of: R-R-Complex, Limbic System and the NeocortexComplex, Limbic System and the Neocortex

Triune TheoryTriune Theory(I) (I)

Animal with brains made mainly of Animal with brains made mainly of Reptilian Reptilian brainbrain ((R-ComplexR-Complex))

1.1. Mainly Mainly ReptilesReptiles, birds & fish, birds & fish

2.2. Evolutionary functions:Evolutionary functions:

a)a) Motor behaviour including motor Motor behaviour including motor routines, motor subroutine, motor routines, motor subroutine, motor memory and motor (non-verbal) memory and motor (non-verbal) communicationscommunications

b)b) Primitive emotions: rage, fear & Primitive emotions: rage, fear & submissiveness submissiveness

c)c) Copulation Copulation

Triune TheoryTriune Theory(II) (II)

Animals which brain is mainly made from Animals which brain is mainly made from the the reptilian brains plus the limbic Lobe:reptilian brains plus the limbic Lobe:

Lower mammals e.g. Rats, cats , dogs Lower mammals e.g. Rats, cats , dogs and monkeys and monkeys

Evolutionary functions: (beginning of Evolutionary functions: (beginning of family)family) Nursing of the offspring (parental Nursing of the offspring (parental

care)care) Vocalisation (audio-vocal Vocalisation (audio-vocal

communication)communication) PlayPlay


(III) (III) Animals which brain is mainly made of: Animals which brain is mainly made of: R-R-Complex, Limbic System and the Neocortex:Complex, Limbic System and the Neocortex:

1.1. Higher mammals e.g. Apes and humansHigher mammals e.g. Apes and humans

2.2. Evolutionary functions: Evolutionary functions: (beginning of (beginning of cultures)cultures)

Problem solving skills (Mentation) Problem solving skills (Mentation) LearningLearning Detailed memoryDetailed memory Verbal communication Verbal communication Preservation of ideasPreservation of ideas

TRIUNE BRAINTRIUNE BRAIN

(II) Basic behavioural brain (II) Basic behavioural brain circuitscircuits

(Affective Neurosciences: Panksepp (Affective Neurosciences: Panksepp 1998)1998)

Jaak PankseppJaak Panksepp

Emeritus Professor of the Department of PsychologyEmeritus Professor of the Department of Psychology Bowling Green State University Bowling Green State University

Basic behavioural brain circuits Basic behavioural brain circuits of Panksepp:of Panksepp:

Arousal system:Arousal system: The self system:The self system: Seeking/Drive Seeking/Drive

system:system: Homeostasis Homeostasis

system: system: Anger/rage Anger/rage

systems:systems:

Family Care Family Care system:system:

Attachment Attachment system:system:

Play system:Play system: Grief system: Grief system: Sexuality system:Sexuality system: Fear system:Fear system:

Basic behavioural brain Basic behavioural brain circuitscircuits

(Affective Neurosciences: Panksepp (Affective Neurosciences: Panksepp 1998)1998)

Based mainly on animal studiesBased mainly on animal studies Brain circuits develop differentially through Brain circuits develop differentially through

the three brain units:the three brain units: R-Complex, Limbic R-Complex, Limbic System and Neocortex System and Neocortex

Main organising behavioural centres : Main organising behavioural centres : Pre-frontal areaPre-frontal area (organise and energise the rest of (organise and energise the rest of

the neocortical behavioural functions)the neocortical behavioural functions) AmygdalaAmygdala (organise and energise the rest of Limbic (organise and energise the rest of Limbic

System functions)System functions) PAG (Peri-aquiductal Gray-matter / Midbrain) PAG (Peri-aquiductal Gray-matter / Midbrain)

(organise and energise the rest of the R-Complex (organise and energise the rest of the R-Complex behavioural functions)behavioural functions)

Different chemical transmitters Different chemical transmitters

Basic behavioural brain Basic behavioural brain circuitscircuits

(Affective Neurosciences: Panksepp (Affective Neurosciences: Panksepp 1998)1998) Through behaviour we can identify which brain Through behaviour we can identify which brain

component executing the behaviour.component executing the behaviour. We can associate this to more specific We can associate this to more specific

substructures and chemical transmitterssubstructures and chemical transmitters Provide neuro-specific data of behaviour Provide neuro-specific data of behaviour Converted behaviour into neurological symptoms Converted behaviour into neurological symptoms

related to problems with specific brain centre/s related to problems with specific brain centre/s disorder disorder

e.g. panic (biological/instinctual), fear e.g. panic (biological/instinctual), fear (personalised), concern (socialised) > other (personalised), concern (socialised) > other features e.g. ADHD > subsystem (Arousal) features e.g. ADHD > subsystem (Arousal) problemsproblems

Clinical Applications of the Clinical Applications of the Triune Theory in Developmental Triune Theory in Developmental

Disorders:Disorders:

1.1. Triune Brain > Triune “Intelligence”Triune Brain > Triune “Intelligence”

2.2. Better clinical assessment and Better clinical assessment and diagnosis of autism diagnosis of autism

3.3. Better diagnostic criteria of AutismBetter diagnostic criteria of Autism

4.4. Better understanding of aetiology Better understanding of aetiology of ASDof ASD

5.5. Schizophrenia and Autism Schizophrenia and Autism

(1)(1) Triune Brain: Triune Brain: Triune Intelligence (?)Triune Intelligence (?)

(1)(1) Triune Brain: Triune Triune Brain: Triune IntelligenceIntelligence

R-Complex: processing object related data R-Complex: processing object related data > Object-Related Skills / Intelligence> Object-Related Skills / Intelligence

Limbic System: processing emotional data Limbic System: processing emotional data > Emotional Skills / Intelligence> Emotional Skills / Intelligence

Neocortex: processing social data> Social Neocortex: processing social data> Social Skills / IntelligenceSkills / Intelligence

We could have : We could have : Object related intelligence (general intelligence Object related intelligence (general intelligence

- IQ), - IQ), Emotional Intelligence & Emotional Intelligence & Social intelligence Social intelligence


Object Related IntelligenceObject Related Intelligence (general (general intelligence - IQ): managing physical intelligence - IQ): managing physical environment e.g. budgeting and environment e.g. budgeting and travelling travelling

Emotional Intelligence:Emotional Intelligence: managing managing emotional/personalised environment e.g. emotional/personalised environment e.g. emotional bonding, insight and empathy emotional bonding, insight and empathy

Social Intelligence:Social Intelligence: managing social managing social environment e.g. functioning in social environment e.g. functioning in social groups and social appropriateness groups and social appropriateness


Why Three-Dimensional Why Three-Dimensional Intelligence? Intelligence?

Clinical evidence:Clinical evidence: concepts of concepts of Object Related Intelligence (general Object Related Intelligence (general intelligence - IQ), Emotional intelligence - IQ), Emotional Intelligence and Social Intelligence, Intelligence and Social Intelligence, are used in every day clinical workare used in every day clinical work

ASD:ASD: a good example of the a good example of the separation of Object Related separation of Object Related Intelligence from Emotional Intelligence from Emotional Intelligence and Social IntelligenceIntelligence and Social Intelligence


Too many variations Too many variations Better expressed in IQ formatBetter expressed in IQ format

Object related intelligence (General Object related intelligence (General intelligence) IQintelligence) IQ

Emotional intelligence IQEmotional intelligence IQ Social Intelligence IQ Social Intelligence IQ

End of categorical classification of End of categorical classification of ASDASD

Variations of the Tri-dimensional Variations of the Tri-dimensional Intelligence:Intelligence:

(2) Better diagnostic (2) Better diagnostic criteria of Autismcriteria of Autism

(2) Better diagnostic criteria of (2) Better diagnostic criteria of AutismAutism

Current Diagnostic Criteria DSM-IVCurrent Diagnostic Criteria DSM-IV(I) (I) A total of six (or more) items from (a), (b), and (c), A total of six (or more) items from (a), (b), and (c),

with at least two from (a), and one each from (b) and with at least two from (a), and one each from (b) and (c)(c)

(A) qualitative impairment in social interaction:(A) qualitative impairment in social interaction: impairments in nonverbal behaviors such as eye-to-eye gazeimpairments in nonverbal behaviors such as eye-to-eye gaze failure to develop peer relationships failure to develop peer relationships lack of spontaneous seeking to share enjoyment, interests, or lack of spontaneous seeking to share enjoyment, interests, or

achievements achievements lack of social or emotional reciprocity lack of social or emotional reciprocity

(B)(B) qualitative impairments in communication: qualitative impairments in communication: delay in the development of spoken languagedelay in the development of spoken language marked impairment in sustain a conversation marked impairment in sustain a conversation idiosyncratic languageidiosyncratic language lack of social imitative playlack of social imitative play


Current Diagnostic Criteria DSM-IV (cont)Current Diagnostic Criteria DSM-IV (cont)

(C) Restricted repetitive and stereotyped (C) Restricted repetitive and stereotyped patterns of behavior, interests and activities:patterns of behavior, interests and activities: stereotyped and restricted patterns of intereststereotyped and restricted patterns of interest inflexible nonfunctional routines or ritualsinflexible nonfunctional routines or rituals stereotyped and repetitive motor mannerismsstereotyped and repetitive motor mannerisms preoccupation with parts of objectspreoccupation with parts of objects

(II) Delays with onset prior to age 3 years:(II) Delays with onset prior to age 3 years:

(III) The disturbance is not better accounted for by Rett's (III) The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative DisorderDisorder or Childhood Disintegrative Disorder


Proposed Diagnostic CriteriaProposed Diagnostic Criteria(1) Essential features:(1) Essential features:

Poor development of social intelligence/skillsPoor development of social intelligence/skills Lack of social reciprocity Lack of social reciprocity dysfunctional social aspects of play, verbal communication dysfunctional social aspects of play, verbal communication

& non-verbal communication& non-verbal communication Social awkwardnessSocial awkwardness failure to develop peer relationshipsfailure to develop peer relationships

Poor development of emotional intelligence/skills : Poor development of emotional intelligence/skills : Self-centredness with poor self awarenessSelf-centredness with poor self awareness lacking empathy (dysfunctional theory of mind) lacking empathy (dysfunctional theory of mind) Lack of emotional reciprocity Lack of emotional reciprocity Poor appreciation of emotional expressionsPoor appreciation of emotional expressions Emotional awkwardnessEmotional awkwardness Poor emotional aspects of play, verbal communication & Poor emotional aspects of play, verbal communication &

non-verbal communication non-verbal communication


Proposed Diagnostic Criteria (Cont)Proposed Diagnostic Criteria (Cont)(2) Compensatory Features:(2) Compensatory Features:

Restricting environments Restricting environments Restricting general interestRestricting general interest Islets of exceptional interests Islets of exceptional interests tendency to keep rigid control over environment tendency to keep rigid control over environment Rigid routines or ritualsRigid routines or rituals

(3) Associated features:(3) Associated features: Existential (not stress related) anxietyExistential (not stress related) anxiety Pathological habits (dysfunctional routines)Pathological habits (dysfunctional routines) Poor development of speechPoor development of speech Poor eye to eye contactPoor eye to eye contact OCD like symptoms and rituals OCD like symptoms and rituals motor mannerisms motor mannerisms Preoccupations with parts of objects Preoccupations with parts of objects

(3) Better clinical (3) Better clinical assessment of autismassessment of autism

(3) Better clinical assessment of (3) Better clinical assessment of AutismAutism

Autism is primarily a disorder of emotional Autism is primarily a disorder of emotional and social development which could be and social development which could be due to developmental abnormalities in due to developmental abnormalities in both limbic system and neocortex. R-both limbic system and neocortex. R-Complex could be intact or affected Complex could be intact or affected

All affected brain functions could take All affected brain functions could take different forms: different forms: lost functions (like in ablation studies) lost functions (like in ablation studies) exaggerated functions (irritation or excitation exaggerated functions (irritation or excitation

studies)studies) partial lost or exaggerated partial lost or exaggerated


General assessment of R-complexGeneral assessment of R-complex1.1. General functioning General functioning

Deals mainly with objects related dataDeals mainly with objects related data Function: survival in physical worldFunction: survival in physical world Produce behavioural routines Produce behavioural routines

2.2. Specific functioning Specific functioning Routines (skills), Routines (skills), Habits, Habits, Communication, Communication, Repetitions (OCD like symptoms) Repetitions (OCD like symptoms)

3.3. Assessment of the subsystemAssessment of the subsystem Arousal or motivation assessment can lead to ADHDArousal or motivation assessment can lead to ADHD Involuntary muscular movementsInvoluntary muscular movements

(3) Better clinical assessment of (3) Better clinical assessment of AutismAutism Development of motor routines Development of motor routines


R-Complex Specific FunctioningR-Complex Specific Functioning Object related Routines: functional motor Object related Routines: functional motor

routines routines Primitive e.g. rocking, territorial behaviour Primitive e.g. rocking, territorial behaviour Advanced e.g. tidying one’s roomAdvanced e.g. tidying one’s room

Object-related Habits (Pathological) : not Object-related Habits (Pathological) : not functional motor routines e.g. pica functional motor routines e.g. pica

Object-related Checking (repetitive) Object-related Checking (repetitive) behaviour: e.g. behaviour: e.g. Exaggerated routines (e.g. hoarding) Exaggerated routines (e.g. hoarding) Failed to execute routines (repetitive behaviour Failed to execute routines (repetitive behaviour

or OCD like symptoms)or OCD like symptoms)


General assessment of Limbic SystemGeneral assessment of Limbic System1.1. General functioningGeneral functioning

deals mainly with emotional (individual-related) datadeals mainly with emotional (individual-related) data Function: survival in the physical world Function: survival in the physical world as an individualas an individual

Not normally functional in autismNot normally functional in autism

2.2. Specific functioning (emotional routines and Specific functioning (emotional routines and habits) habits)

PlayPlay audio-vocal communicationaudio-vocal communication Attachment with othersAttachment with others Theory of mind Theory of mind

3.3. Assessment of the subsystem Assessment of the subsystem ADHD/EADHD/E Attachment disorders Attachment disorders


Limbic System Specific functioning:Limbic System Specific functioning:

New emotional routines: not well New emotional routines: not well developed in ASD e.g.developed in ASD e.g. Self centerednessSelf centeredness Hostile dependence on safe relations Hostile dependence on safe relations Increased anger or increased blaming Increased anger or increased blaming

behaviour, Dysfunctional empathy behaviour, Dysfunctional empathy Pathological emotional habits e.g. Pathological emotional habits e.g.

deviated sexual interests (paedophilia) deviated sexual interests (paedophilia) Dysfunctional emotional communication Dysfunctional emotional communication

e.g. “one way communication” e.g. “one way communication” phenomenon phenomenon

Existential anxietyExistential anxiety


General assessment of Neocortical General assessment of Neocortical systemsystem

1.1. General functioning of Neocortex General functioning of Neocortex Deals mainly with social (group) dataDeals mainly with social (group) data Function: survival in the physical world Function: survival in the physical world

as an individual who is in the same time as an individual who is in the same time a a member of a social groupmember of a social group

2.2. Specific functioning Specific functioning Social Routines (skills) Social Routines (skills) Social Habits (pathological) Social Habits (pathological) Social CommunicationSocial Communication

3.3. Assessment of the subsystemAssessment of the subsystem Fantasy disorders (?)Fantasy disorders (?)


Neocortical System Specific functioning:Neocortical System Specific functioning: Social routines: how undevelopedSocial routines: how undeveloped

Failure of functions: social isolation, social Failure of functions: social isolation, social awkwardness awkwardness

Exaggerated functions: paranoid social attitudes Exaggerated functions: paranoid social attitudes (Nicky Reilly Syndrome)(Nicky Reilly Syndrome)

Pathological habits: Pathological habits: Drug-misuse-to-fit-in syndrome, Drug-misuse-to-fit-in syndrome, hoax phone calls, hoax phone calls, fire setting fire setting

Social communication disorderSocial communication disorder Poor appreciation of danger (naivety Poor appreciation of danger (naivety

syndrome) syndrome)

(4) Better Understanding of (4) Better Understanding of Aetiology of ASDAetiology of ASD

(4) Better understanding of (4) Better understanding of aetiology of ASDaetiology of ASD

No single aetiology No single aetiology pathway of aetiologies pathway of aetiologies

Upward connections from R-Complex to Upward connections from R-Complex to LS and/or to neocortexLS and/or to neocortex

Downward connection from Neocortex Downward connection from Neocortex and/or LS to R-complex and/or LS to R-complex

Each connection can be disturbed by Each connection can be disturbed by different mechanisms different mechanisms

(4) Better understanding of (4) Better understanding of aetiology of ASDaetiology of ASD

Autism is not a one thing: multiple Autism is not a one thing: multiple aetiologies.aetiologies.

(5) Schizophrenia and (5) Schizophrenia and AutismAutism


Similarities: Similarities: Schizophrenia > disturbance of processing Schizophrenia > disturbance of processing

of social (neocortical system) and of social (neocortical system) and emotional (limbic system) dataemotional (limbic system) data

Late stages Schizophrenia (deficit Late stages Schizophrenia (deficit syndrome)> autistic features syndrome)> autistic features

Differences: Differences: Schizophrenia: acquired, adulthood illness, Schizophrenia: acquired, adulthood illness,

disintegrative (regressive) disintegrative (regressive) Autism: developmental, childhood Autism: developmental, childhood

disorder, progressive disorder, progressive


Can autistics develop schizophrenia ?Can autistics develop schizophrenia ? Autism is primarily a disorder in NS and Autism is primarily a disorder in NS and

LSLS Having hallucinations and delusions Having hallucinations and delusions

does not mean Schizophrenia (autism does not mean Schizophrenia (autism with psychotic symptoms not with psychotic symptoms not schizophrenia like Dementia with schizophrenia like Dementia with psychotic symptoms) psychotic symptoms)

Autistics can mimic, be paranoid and Autistics can mimic, be paranoid and make erroneous judgments but still not make erroneous judgments but still not delusionsdelusions


How to treat autistics with psychotic How to treat autistics with psychotic features?features? Autistics with psychotic features develop further Autistics with psychotic features develop further

while incorporating the psychotic features while incorporating the psychotic features (delusions of grandiosity)(delusions of grandiosity)

psychosis becomes part of the foundation of the psychosis becomes part of the foundation of the personality > functional psychosispersonality > functional psychosis

If treated > more disturbance If treated > more disturbance Only treatment is replacement therapy (not only Only treatment is replacement therapy (not only

removal therapy)removal therapy) Antipsychotic not very effectiveAntipsychotic not very effective Behavioural and environmental therapies more Behavioural and environmental therapies more

effective effective

Triune theory 3333

Health & Medicine

Transcript of Triune theory 3333