1

oleh :

dr.Soetedjo Widjojo,SpS(K)

PENDAHULUAN

Psychiatric Ilness Simptom Neurologik

Depressi Pseudodemensia

Terapi Psychiatric Komplikasi Neurologik

Trangulizer Mayor Distonia acute

Factor Psychiatric Triger Penyakit

Epilepsi & Migraine

Neurological Disease Psychiatric Symptom

Intoxicasi obat Neurologik & Psychiatric

Complication

DD : PENYAKIT ORGANIK - PSYCHIATRY

Comparison of Organic Brain Syndromes and Psychiatry

Symptom Organic disease Psychiatry diseaseClouding of Consciusness Common Rare

Seizures Common Rare

Memory Impaired Often preserved

Visual hallucinations Commonly without auditory hallucinations Rare without auditory hallucinations

Tactile hallucinations Commonly without auditory hallucinations Rare without auditory hallucinations

Focal neurological signs Sometimes Rare

Disturbed sleep Reversal of Sleep cycle Insomnia

Paranoia Common Common

Feelings of Control Rare Sometimes

Headache Sometimes Sometimes

MANIFESTASI PSIKIATRIK dari GANGGUAN NEUROLOGIK

• Kesadaran menurun Gangguan Neurologik

• Anxietas = Metabolik Encepalopati Hipoxia Thyoroxicosis Delirium Tremens

GANGGUAN LOBUS FRONTALIS

• Disinhibition ; Hipomanic, Hipersex

( Orbitofrontal )

• Apathy, Gangguan motor dan Speech

( Mesial Frontal Lessians )

• Gangguan Fungsi Executive, Gangguan Attensi

( Lateral Convex )

HALUSINASI VISUAL

• Acute Confusional State

• Lesi Mata Visual Cortex

• Lesi Batang Otak

• Demensia Lewy Bodies

• Parkinson Levodopa

HALUSINASI PENDENGARAN

• Bersama – sama halusinasi visual

• Khas gangguan Psikiatri

Anxietas25 – 35 % rawat Jalan Neurologis

DepresiParkinson Disease 50 %Epilepsi 38 %Alzheimer Disease 30%Multiple Sclerosis 25 %Stroke 25 %Trauma Kepala 25 %

OBSESIVE COMPULSIVEParkinson DiseaseHuntington’s Disease

EMOTIONAL LABILITYPseudobulbar PalsyMultiple SclerosisCerebrovasculair DiseaseMotoneuron

PATHOLOGICAL LAUGHTER / CRYING

Batang Otak

Thalamus

DELUSION

Alzheimer Disease

Vascular Demensia

Focal Epilepsy

Multiple Sclerosis

Parkinson

Post Traumatic Brain Injury

Psychosis Epilepsi

Post Ictal Psychosis

Ictal

Inter Ictal

Problems with medications used in Neurology and Psychiatry

Drug Use Adverse effect Solution

Dopaminergic agonist Parkinsonism Psychosis and Hallucination

Sulpiride Risperidone

Dopaminergic antagonist

Psychosis, vomiting, vestibular sedative

Parkinsonism and other movement disorders

Procyclidine

Anticonvulsant Epilepsy Sedation, sometimes depression and psychosis

Antidepressant Antipsychotic

Antidepressant Depression Seizures Antileptic

Neuropsychiatric effects of drugs of abuse

Drug Neurological complications

Psychiatric Complications

Alcohol Intoxication stupor and coma, Wernicke’s Encephalopathy, Korsakoff syndrome, seizures, delirium tremens, myopathy, neuropathy, cerebellar symdrome

Acute and chronic auditory hallucinosis, personality disintegration, morbid jealousy

Amphetamine Organic hallucinosis, NMS-type symdrome, cerebral vasculitis

Chronic psychosis

MDMA (ecstasy) Organic hallucinosis, NMS-type symdrome, destruction of serotonergic fibres

Not yet established

Cocaine Organic hallucinosis, stroke (common), subarachnoid and cerebral haemorrhage

Depression, mania, phobic disorders, anxiety disorders

Lysergic acid (LSD) Organic hallucinosis Chronic psychosis, hallucinatory flashbacks

NMS, Neuroleptic, malignant syndrome