2017 Psikopatologi RBM
2017 Psikopatologi RBM
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Gangguan Kesadaran
Gangguan Kesadaran Kuantitatif:
kesadaran individu menurun atau berkurang:
– somnolen
– sopor
– koma
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Gangguan Kesadaran
Gangguan Kesadaran Kualitatif: kondisi individu yang
mengalami gangguan pada persepsi, pikiran, mood/afek,
ingatan dan motoriknya:
– Delirium – Karakteristik: disorientasi, gangguan
persepsi, mudah disugesti, mudah mengalami
misinterpretasi dan gangguan mood
– obnubilation (twilight state) – mulai dan berakhir tiba-
tiba, amnesia; pasien kacau, perilakunya samasekali tak
bertujuan, kadang-kadang agresif, sulit dimengerti
stuporous
vigilambulant
delirious
Ganser syndromemulyowarnonagoro@msn.com
Gangguan Persepsi
Persepsi: proses memahami sensasi yang diterima oleh
panca indera
Image: suatu pengalaman dalam ingatan, tanpa sensasi
nyata walaupun itu bagian dari realitas
Pseudoilusi – gangguan persepsi terhadap objek yang
sebetulnya tampak samar
Ilusi – adalah fenomena psikopatologis;
terjadi terutama pada kondisi gangguan kesadaran yang
secara kualitatif berubah
Halusinasi – adalah persi tanpa adanya stimulus
apapun terhadap panca indera;
pasien tak dapat membedakannya
mulyowarnonagoro@msn.comdari realitas
Gangguan Persepsi
Halusinasi:
auditorik (akustik) – pendengaran
Visual – penglihatan
Olfaktorik – penciuman
Gustatorik – Pengecapan
taktil – perabaan (sensasi lebih dalam)
Intrapsikik (lebih ke gangguan pikiran)
hypnagogic and hypnopompic (hypnexagogic)
Fungsi-fungsi Kognitif
Gangguan pikiran:
– kuantitatif
– kualitatif
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Gangguan Pikiran Kuantitatif
Blocking - berhenti
Perseverasi
Asosiasi longgar
Neologisme
Verbigerasi
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Gangguan Pikiran Kualitatif
Gangguan pikiran secara kualitatif (gangguan isi pikir):
Delusi (waham):
a) keyakinan yang tidak mempunyai dasar adekuat,
b) tak dapat dipatahkan oeh argumentasi yang rasional
c) bukan suatu keyakinan konvensional
Obsesi (pikiran obsesif) pikiran tertentu yang berulang
muncul secara menetap, impuls atau bayangan yang
memasuki ingatan meskipun individu berusaha
mencegahnya. Fenomena obsesif yang diikuti dengan
tindakan (biasanya seperti ritual – membersihkan,
menghitung, menata) disebut kompulsi.
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Gangguan Pikiran Kualitatif
Divisi delusi/waham:
Berdasar onset
a) primer (waham terkait mood, persepsi)
b) sekunder (sistematik)
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Gangguan Pikiran Kualitatif
Delusi/waham:
Berdasar tema
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Gangguan Suasana Perasaan
Mood Patologis:
– asal – dasarnya patologis, tak ada penyebab psikologis
– jangka waktu – jangka panjang
– intensitas – kuat, perubahan intensitas yang bervariasi
– tak mungkin diubah secara psikologis
– putus asa
Gangguan Inteligensi
Inteligensi:
– abstrak
– practis
– sosial
Gangguan intelek:
– retardasi mental
– demensi
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Gangguan Motorik
Gangguan Motorik sering terjadi pada GJ terutama
skizofrenia katatonik.
kuantitatif: kualitatif:
– mannerism
– hypoaktif – stereotipik
– hyperaktif – posturing
– perilaku agitatif – flexibilitas cerea
– ekhopraxia
– impuls skhizofrenik
– negativism
– short-circuit behaviour
– automatism
– agitation
– tics
– abulia
– compulsions
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Disorders of Volition
Disorders of volition:
– hypobulia
– abulia
– hyperbulia
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Disorders of Personality
Personality means a complex of persistent
mental and physical traits of a person
Disturbances of personality:
– transformation of personality
– appersonalization
– multiple personality (alteration of personality)
– specific personality disorder
– deprived personality
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Multistable perception
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Multistable perception
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Multistable perception
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Multistable perception
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Multistable perception
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Multistable perception
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Multistable perception
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Mental construction
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Mental construction
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Instruction to
manufacturing (straight
from the hell …)
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Schizophrenia
Comes from Greek words meaning
“split” and “mind”
People with schizophrenia do NOT have
split personalities
“split mind” refers to the fact that
people with schizophrenia are split off
from reality and can’t distinguish what
is real from what is not real
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Demographics
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Symptoms
“psychosis” – psychotic element; state
in which people cannot tell what is real
and what is not
Delusions – bizarre, false beliefs;
paranoia, grandiosity
Hallucinations – unreal perceptions of
environment; auditory, visual, olfactory,
tactile
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More Symptoms
Disorganized Thinking/Speech
Negative Symptoms – the absence of
normal behavior
Catatonia – immobility and “waxy
flexibility”
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Types of Schizophrenia
Disorganized Schizophrenia
Catatonic Schizophrenia
Paranoid Schizophrenia
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Brain and Schizophrenia
Larger than normal lateral ventricles – part of
the ventricular system; contain cerebrospinal
fluid
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Causes of Schizophrenia:
Genetics
Twin studies have shown that tendency for
both monozygotic twins to develop
schizophrenia is between 30 to 50%; the
tendency for dizygotic twins and siblings to
develop schizophrenia is 15%
Adoption Studies – 13% of biological relatives
of adoptees with schizophrenia had the
disease, but only 2% of biological relatives of
normal adoptees had schizophrenia
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Causes of Schizophrenia:
Environment
Family Stress
Poor social interactions
Infections or viruses at an early age
Trauma at an early age
Genetic makeup combines with non-
genetic factors to cause schizophrenia
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Causes of Schizophrenia:
Neurotransmitters
Dopamine Theory – schizophrenia caused
by an overactive dopamine system in the
brain; dopamine is a neurotransmitter
that allows nerve cells in the brain to
send messages to each other; dopamine
imbalance may affect the way a person’s
brain can react to stimuli
Many drugs for schizophrenia block
dopamine receptors
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Schizophrenia:
Medication
Antipsychotic medications – drugs do
not cure disease, but reduce
symptoms
Some drugs have Parkinson’s Disease-
like side effects
Counseling also helps
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Bipolar Disorder
Characterized by changes in mood,
behavior, and energy levels
Affects approximately 1.2% of the
population
First episode often occurs in
adolescence and can be triggered by a
traumatic event; some people are
symptom-free in between episodes
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Symptoms: Mania phase
Abnormally elevated mood
Inflated self-esteem
Reduced need for sleep
Excessive talkativeness
Racing thoughts
Distractibility
Activities done to excess
Pursuit of risky behavior or activities
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Symptoms: Depression
Phase
Mania can quickly and without warning
change to depression/sadness
Loss of interest
Changes in appetite – weight gain/loss
Changes in sleep patterns
Agitation
Loss of energy
Trouble concentrating/thinking
Repeated thoughts of suicide/death
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Accompanying Symptoms
Psychosis
Delusions
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Bipolar Disorder and the
Brain
Examination of brain tissue after people with BD have died
Brain imaging
New theory – mitochondrial malfunction
Mitochondria – vital organelle for energy production
2000 – Kato, University of Tokyo – based on abnormal brain
energy metabolism in bipolar patients measured by brain
scans and mitochondrial depletion in autopsied bipolar brains;
searched for mutant mitochondrial DNA – two suspect genes
March 2004, Archives of General Psychiatry, Christine Konradi
- Harvard and McLean Hospital - studied brain tissue in
hippocampus and found expression of genes that coded for
mitochondrial proteins in bipolar patients decreased
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Famous People with BD
Abraham Lincoln and Theodore Roosevelt
George Handel, Robert Schumann,
Ludwig van Beethoven
Leo Tolstoy, Virginia Woolf, Ernest
Hemingway, Charles Dickens
Sir Isaac Newton
Patty Duke, Linda Hamilton, Jean-Claude
van Damme
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Multiple Personality
Disorder
Presence of two or more distinct identities,
each with its own unique, and enduring
way of relating to the world or self
At least two of these identities recurrently
take control of the person’s behavior
An inability to recall important personal
information to an extent that is more than
ordinary forgetfulness
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History of MPD
Virtually unknown 30 years ago – became
more common about 10 years ago
Why?
W. S. Taylor and Mabel Martin in 1944 –
fewer than 100 documented cases
1985 to 1995 – abuot 40,000 new cases
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Why More Common?
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Causes
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Case Study: Eve
Thigpen and Cleckley, 1953
Rooted from traumatic events
witnessed growing up in South during
Depression
Eve White – wife and mother; Eve Black
– party girl; Jane – mature intellectual
Total of 22 personalities
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Case Study: Sybil
True name – Shirley Mason
Set the standard for MPD as a
syndrome rooted in child abuse
16 separate personalities all
having unique talents and
characteristics, such as piano
playing or having British accent;
some were male
Dr. Wilbur – Freudian psychologist
1998 – several publications
exposed Sybil case as scam
Dr. Herbert Spiegel - only multiple
personality in psychoanalytic
setting; just extremely suggestible
hysteric
To ensure the book deal, Sybil had
to be multiple; Dr. Wilbur’s
archives will be opened in 2005…
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MPD in Court
Billy Mulligan – accused of robberies and rapes at OSU; by
the time faced trial, 10 of 23 personalities surfaced; one
with British accent, one could write fluent in Arabic, one
was 16, one was 8…
Juanita Maxwell – bludgeoned elderly woman to death
with a lamp but had no memory of crime; went to trial
and violent alter came out
Critics say that vast majority of patients misdiagnosed,
faked, or unconsciously created by clinician who makes
diagnosis
Problem: when evidence overwhelming against
defendant, only way attorney can mitigate sentence is
insanity defense
Often very hard to identify whether truly have disorder
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Rujukan
http://www.mcmanweb.com
http://www.crimelibrary.com/criminal_
mind/psychology/multiples
http://faculty.washington.edu/chudler
/neurok.html
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