Wageningen University, Wageningen, the Netherlands.
Amsterdam UMC, Amsterdam, the Netherlands.
JAMA Psychiatry. 2024 Jun 1;81(6):618-623. doi: 10.1001/jamapsychiatry.2024.0215.
Psychiatric disorders may come and go with symptoms changing over a lifetime. This suggests the need for a paradigm shift in diagnosis and treatment. Here we present a fresh look inspired by dynamical systems theory. This theory is used widely to explain tipping points, cycles, and chaos in complex systems ranging from the climate to ecosystems.
In the dynamical systems view, we propose the healthy state has a basin of attraction representing its resilience, while disorders are alternative attractors in which the system can become trapped. Rather than an immutable trait, resilience in this approach is a dynamical property. Recent work has demonstrated the universality of generic dynamical indicators of resilience that are now employed globally to monitor the risks of collapse of complex systems, such as tropical rainforests and tipping elements of the climate system. Other dynamical systems tools are used in ecology and climate science to infer causality from time series. Moreover, experiences in ecological restoration confirm the theoretical prediction that under some conditions, short interventions may invoke long-term success when they flip the system into an alternative basin of attraction. All this implies practical applications for psychiatry, as are discussed in part 2 of this article.
Work in the field of dynamical systems points to novel ways of inferring causality and quantifying resilience from time series. Those approaches have now been tried and tested in a range of complex systems. The same tools may help monitoring and managing resilience of the healthy state as well as psychiatric disorders.
精神障碍可能会随着症状在一生中的变化而出现和消失。这表明需要在诊断和治疗方面进行范式转变。在这里，我们受到动力系统理论的启发，提出了一种新的观点。该理论广泛用于解释从气候到生态系统等复杂系统中的临界点、循环和混沌。
在动力系统观点中，我们提出健康状态具有一个代表其恢复力的吸引盆地，而障碍是系统可能陷入的替代吸引子。在这种方法中，恢复力不是一种不可改变的特征，而是一种动态特性。最近的工作已经证明了通用恢复力动态指标的普遍性，这些指标现在被全球用于监测复杂系统（如热带雨林和气候系统的 tipping 元素）崩溃的风险。其他动力系统工具在生态学和气候科学中用于从时间序列推断因果关系。此外，生态恢复的经验证实了理论预测，即在某些条件下，短期干预可能会通过将系统翻转到替代吸引盆地来引发长期成功。所有这些都暗示了精神科的实际应用，本文的第二部分对此进行了讨论。
动力系统领域的工作为从时间序列推断因果关系和量化恢复力提供了新的方法。这些方法已经在一系列复杂系统中进行了尝试和测试。相同的工具可能有助于监测和管理健康状态以及精神障碍的恢复力。
