oleh :

dr.Soetedjo Widjojo,SpS(K)

PENDAHULUAN
Psychiatric Ilness
Depressi
Terapi Psychiatric
Trangulizer Mayor
Factor Psychiatric
Neurological Disease
Intoxicasi obat

Simptom Neurologik
Pseudodemensia
Komplikasi Neurologik
Distonia acute
Triger Penyakit
Epilepsi & Migraine
Psychiatric Symptom
Neurologik & Psychiatric
Complication

DD : PENYAKIT ORGANIK - PSYCHIATRY

Comparison of Organic Brain Syndromes and Psychiatry
Symptom

Organic disease

Psychiatry disease

Clouding 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

Anxietas
25 35 % rawat Jalan Neurologis
Depresi
Parkinson Disease 50 %
Epilepsi 38 %
Alzheimer Disease 30%
Multiple Sclerosis 25 %
Stroke 25 %
Trauma Kepala 25 %

OBSESIVE COMPULSIVE
Parkinson Disease
Huntingtons Disease
EMOTIONAL LABILITY
Pseudobulbar Palsy
Multiple Sclerosis
Cerebrovasculair Disease
Motoneuron

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, Wernickes

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