2017 Psikopatologi RBM

PSIKOPATOLOGI
Rh Budhi Muljanto, dr. SpKJ

ISTILAH PSIKIATRIK
 Psikiatri mempelajari penyebab/bagaimana terjadinya
gangguan jiwa, mendeskripsikannya, memperkirakan
perjalanan dan akibatnya di kemudian hari, mencari
prevensinya dan mengupayakan terapi terbaiknya.
 Psikopatologi menjelaskan gejala dari gangguan jiwa.
 Psikiatri mempelajari fenomena psikopatologis, gejala
abnormal dari jiwa:
1. kesadaran 5. mood (emosi)
2. persepsi 6. inteligensi
3. pikiran 7. motorik
4. ingatan 8. kepribadian
mulyowarnonagoro@msn.com
Gangguan Kesadaran
 Kesadaran: pemahaman individu akan diri dan
lingkungannya
 Gangguan kesadaran:
– Kualitatif
– Kuantitatif
 Jangka pendek
 Jangka panjang
 Hypnosis – perubahan kesadaran buatan
 Syncope – hilang kesadaran jangka pendek
Gangguan Kesadaran
 Gangguan Kesadaran Kuantitatif:

kesadaran individu menurun atau berkurang:
– somnolen
– sopor
– koma
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
dari 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)
Pseudohalusinasi - pasien dapat membedakannya

dari realitas
Gangguan Pikiran
 Pikiran
 Fungsi-fungsi Kognitif
 Gangguan pikiran:
– kuantitatif
– kualitatif
Gangguan Pikiran Kuantitatif
Gangguan pikiran secara kuantitatif:

 Pikiran yang mendesak
 Miskin isi pikir
 Blocking - berhenti
 Flight of ideas – pikiran yang meloncat-loncat
 Perseverasi
 Asosiasi longgar
 Inkoheren – word salad
 Neologisme
 Verbigerasi
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.
Divisi delusi/waham:
 Berdasar onset
a) primer (waham terkait mood, persepsi)
b) sekunder (sistematik)
c) didapat (shared - folie a deux)
Delusi/waham:
 Berdasar tema
a) paranoid (persecutory) - d. of reference, w. Cemburu, w.
dikendalikan, w. terkait pikiran yang diambil
b) megalomanik (grandiose, expansive) – w. tentang
kemampuannya, w. keistimewaan dirinya, w. kekuatannya,
w. asmara, w. kekuatan supranatural.........
c) depresif (mikromanik, melankolik) – w. bersalah, w. nihilistik
w. ketidakmampuan, w. hipokhondriakal.......
d) terkait kepemilikan pikiran
 Sisip pikir (thought insertion)
 Pikiran tersedot (thought withdrawal)
 Siar pikir (thought broadcasting)
Gangguan Daya Ingat
 Penyimpanan Sensorik – menyimpan
informasi sensorik selama 0.5 detik
 Ingatan jangka pendek – untuk informasi
verbal dan visual disimpan selama 15-20 detik,
kapasitas rendah
 Ingatan jangka panjang – kapasitasnya lebih
luas dengan penyimpanan lebih permanen
– Ingatan deklaratif (explicit) – episodik (u peristiwa)
atau semantik (u bahasa dan pengetahuan)
– Ingatan prosedural – u motorik berirama
– Priming – ingatan bawah sadar
– Pembiasaan - conditioning – Klasik atau emosional
Gangguan Daya Ingat
Gangguan daya ingat:
 Amnesia – ketidakmampuan mengingat peristiwa
yang lalu
 Jamais vu, déja vu
 Confabulation, amnesic disorientation, Korsakov’s
syndrome
 Pseudologia phantastica
 Hypomnesia
 Hypermnesia
Gangguan Perhatian
 Konsentrasi
 Kapasitas
 Tenasitas
 Irritabilitas
 Vigilitas
 Hypoprosexia (global, selektif)

 Hyperprosexia
 Paraprosexia mulyowarnonagoro@msn.com
Gangguan Suasana Perasaan
Afek Normal – respons emosi yang singkat & kuat
Mood Normal – subjektif dan berlangsung untuk

jangka wktu yang lebih panjang mempengaruhi
situasi dirinya
Emosi yang lebih tinggi:

– intelektualitas
– aestetika
– etika
– sosial
Pathological affect – very strong, abrupt affect with a short
change of consciousness on its peak
Pathological mood – two poles:
– manic
– depressive
Phobia – persistent irrational fear and wish to avoid a
specific situation, object, activity:
– agoraphobia
– claustrophobia
– social phobias
– hipsophobia
– aichmophobia
– keraunophobia
Depersonalization – change of self-awareness, the person
feels unreal, unable to feel emotion
 Mood Patologis:
– asal – dasarnya patologis, tak ada penyebab psikologis
– jangka waktu – jangka panjang
– intensitas – kuat, perubahan intensitas yang bervariasi
– tak mungkin diubah secara psikologis
 Gambaran Pathological mood:

– euforia
– expansif
– exaltasi
– explosif
– mania
– hypomania
– depresi
– apathy (anhedonia)
– Afek tumpul, datar
– emosi labil
– putus asa mulyowarnonagoro@msn.com
Gangguan Inteligensi
 Inteligensi:
– abstrak
– practis
– sosial
 Intelligence quotient (IQ):

IQ = (umur mental : umur kalendar) x 100
 Gangguan intelek:
– retardasi mental
– demensi
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
Disorders of Volition
Disorders of volition:
– hypobulia
– abulia
– hyperbulia
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
Multistable perception
Mental construction
Mental construction
Instruction to
manufacturing (straight
from the hell …)
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
Demographics
 One of the most common mental

illnesses
 Affects 1 % of the population
 Men show first signs in early 20’s while
women in late 20’s
 US spends $32.5 billion per year
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
More Symptoms
 Disorganized Thinking/Speech
 Negative Symptoms – the absence of
normal behavior
 Catatonia – immobility and “waxy
flexibility”
Types of Schizophrenia
 Disorganized Schizophrenia
 Catatonic Schizophrenia
 Paranoid Schizophrenia
Brain and Schizophrenia
 Larger than normal lateral ventricles – part of
the ventricular system; contain cerebrospinal
fluid
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 mulyowarnonagoro@msn.com
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
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
Schizophrenia:
Medication
 Antipsychotic medications – drugs do
not cure disease, but reduce
symptoms
 Some drugs have Parkinson’s Disease-
like side effects
 Counseling also helps
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
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
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
Accompanying Symptoms
 Psychosis
 Delusions
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
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

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
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
Why More Common?
 previously not diagnosed

 does mind choose pathology from
options presented by culture?
 was called something different in the
past – came in form of dead relative
possession in 19th century European
culture
Causes
 Childhood trauma – usually sexual

abuse before age 5
 Experts believe alter arises to protect
person from overwhelming memories
and protect secrets from outsiders
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
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 inmulyowarnonagoro@msn.com
2005…
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 mulyowarnonagoro@msn.com
identify whether truly have
disorder
Rujukan
 http://www.mcmanweb.com
 http://www.crimelibrary.com/criminal_
mind/psychology/multiples
 http://faculty.washington.edu/chudler/
neurok.html

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2017 Psikopatologi RBM

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PSIKOPATOLOGI

Rh Budhi Muljanto, dr. SpKJ

 Gangguan Kesadaran Kuantitatif:

Pseudohalusinasi - pasien dapat membedakannya

Gangguan pikiran secara kuantitatif:

 Miskin isi pikir

 Flight of ideas – pikiran yang meloncat-loncat

 Inkoheren – word salad

c) didapat (shared - folie a deux)

 Hypoprosexia (global, selektif)

Mood Normal – subjektif dan berlangsung untuk

Emosi yang lebih tinggi:

 Gambaran Pathological mood:

 Intelligence quotient (IQ):

 Comes from Greek words meaning

 One of the most common mental

 “psychosis” – psychotic element; state

 Characterized by changes in mood,

 Abnormally elevated mood

 Abraham Lincoln and Theodore

Claude van Damme

 Virtually unknown 30 years ago –

 previously not diagnosed

 Childhood trauma – usually sexual

 Thigpen and Cleckley, 1953

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