PSIKOPATOLOGI

dr. Dimas H. Ariadie

PENDAHULUAN
Pathogenetic theories need to encompass all le els o! "rain str#ct#re and !#nction$ !rom the "asic ne#roanatomical le el$ thro#gh ne#rochemical$ ne#roph%siological and ne#rops%chological !indings. A n#m"er o! other !indings ha e "een reported. &ost o! these are non'speci!ic and tell #s little a"o#t pathogenesis$ "#t there are some cl#es to the processes that might "e in ol ed. Normall% rare de elopmental a"normalities$ s#ch as agenesis o! the corp#s callos#m$ a(#ed#ct stenosis$ ca #m sept#m pell#cid#m$ cere"ral

NEU)O*HE&IST)+
The primar% ne#rotransmitters implicated in the pathogenesis and treatment o! schi,ophrenia are dopamine and serotonin. )ecent theories ha e also implicated gl#tamine and -.amino"#t%ric acid /GA0A1. Ne#rotransmitters are s#"stances that allo2 "rain cells to comm#nicate

a little di!!erent than the "rains o! health% people$ "#t the di!!erences are small. Sometimes the !l#id'!illed ca ities at the center o! the "rain$ called entricles$ are larger in people 2ith schi,ophrenia4 o erall gra% matter ol#me is lo2er4 and some areas o! the "rain ha e less or more meta"olic acti it%. &icroscopic st#dies o! "rain tiss#e a!ter death ha e also re ealed small changes in the distri"#tion or characteristics o! "rain cells in people 2ith schi,ophrenia

Do the brains of people with schizophrenia look The "rains o! different? people 2ith schi,ophrenia loo3

The Schi,ophrenic Disorders

5'5.67 o! pop#lation 899$999 persons hospitali,ed in US a"o#t :97 o! all hospital "eds T%picall% chronic
s%mptoms ma% "e more or less intense "#t seldom reco er completel%

Onset in earl% ;9<s

Positi e S%mptoms
Del#sions Hall#cinations 0i,arre "eha ior =ormal tho#ght disorder
loose associations 2ord salad

Negati e S%mptoms
Apparent a"sence o! moti ation /a olition1 social 2ithdra2al diminished emotional e>pression /"l#nted a!!ect1 diminished er"al e>pression /alogia1 poor ?#dgment poor personal h%giene decrease in le el o! attention decrease in acti it% le el decrease in sel! direction

The h%pothesis o! m#ltiple etiologies o! schi,ophrenia

&a% "e a gro#p o! disorders Perhaps 2ith di!!erent #nderl%ing ne#ro"iological a"normalities Genetic =actors Ne#rotransmiter disorders /No el )esearch1

Dopamine H%pothesis o! Schi,ophrenia

Schi,ophrenia d#e to a"normall% increased dopamine acti it% in the "rain E@IDEN*E A
Antips%chotic /ne#roleptic1 dr#gs s#ch as chlorproma,ine /Thora,ine1 or haloperidol /Haldol1 control s%mptoms in man% patients ne#roleptics "loc3 dopamine receptors magnit#de o! therape#tic e!!ect o! di!!erent ne#roleptics is proportional to the magnit#de o! dopamine "loc3ing e!!ect B a#tops% e idence s#ggests o era"#ndance o!

Amphetamine Ps%chosis
The onl% dr#g e!!ect that is clinicall% indisting#isha"le !rom schi,ophrenia Tr#e dr#g e!!ect not a res#lt o! sleep loss or acti ation o! latent schi,ophrenia Phenothia,ines are e!!ecti e in treating amphetamine ps%chosis Amphetamines in small doses acti ate schi,ophrenic s%mptoms

T2o'S%ndrome H%pothesis
Type I
normal ventricle size and no atrophy predominantly positive symptoms

Type II
enlarged ventricles and cortical atrophy predominantly negative symptoms

Microstructural Abnormalities
P%ramidal cells sho2 disorgani,ed orientation Disr#pted connections in hippocamp#s Also reports o! pro"lems in a n#m"er o! other areas

KESI&PULAN
Teori patogenesis Gangg#an mental meli"at3an pen?a"aran sel#r#h aspe3 str#3t#ral dan !#ngsional ota3 secara holisti3. Pada 3as#s gangg#an mental ?elas terdapat per#"ahan !#ngsi dan str#3t#r ota3 Hingga 3ini$ pemahaman secara m#tla3 tentang pato!isiologi gangg#an mental "el#m ?elas.