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
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