• THE ETIOLOGY OF MENTAL
DISORDER
)
Dr. Profitasari Kusumaningrum, SpKJ
Department of Psychiatry University of Indonesia
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• MENTAL DISORDER
The interaction of multiple factors
Gene, gene expression, virus, toxin, nutrition, birth trauma, experience, stressor
BRAIN STRUCTURE AND FUNCTION
brain development & degeneration, plasticity change in response to experience, brain chemical,
change in response to drugs and psychotherapy
MENTAL FUNCTION
Consciousness, alertness, attention, speech & language, emotion, memory, thought process
HUMAN UNIQUENESS IN SPECIFIC SOCIAL WORLD
The human behavior and response to social and personal environment
SPECIFIC MENTAL DISORDER
Schizophrenia, mood disorder, dementia, anxiety disorder 2
PSYCHO
BIOLOGY
LOGY
SOCIAL
Biopsychosocial model: George Engel (1997)
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Anthonio Sabelli - 1989
PSYCHOLOGICAL
SUPREMACY
BIOLOGICAL
PRIORITY
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Factors influencing the degree or severity of illness /
mental disorder of a person
Severe
Severity of Unhealthy / ill
stressor
Healthy
Mild
Resilience / perception
Personality
strong weak
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• THE GENE AND ENVIRONMENT INTERACTION
A: ill
B: spectrum condition
Enviro A C: normal
nmenta
l risk B
Genetic predisposition
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• ANXIETY DISORDER
• Frequent overworry
• Physical symptoms: tremor,
muscle tense, palpitation,
ANXIETY pallor, decreased
SYMPTOMS concentration, headache,
nausea
• Insomnia, increased
alertness, easily startled
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PSYCHOSOCIAL STRESSOR
PSYCHONEUROENDOCRINE SYSTEM
HPA-AXIS SAM AXIS
FEAR / ANXIETY
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• HPA AXIS HYPERACTIVITY
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ACUTE STRESS
LOCUS CERULEUS MEDULA ADRENAL
NOREPINEPHRINE
VEGETATIVE FUNCTION
ALERTNESS
AROUSAL
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• NEUROTRANSMITTER IN ANXIETY DISORDER
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SYMPTOMS OF DEPRESSION
AFFECT COGNITION PHYSICAL
Sadness Low self esteem Sleep disturbance
Apathy Concentration Appetite disturbance
Sexual disturbance
Anhedonia Doubt Activity
Anergy Irritable Body weight change
Guilty feeling Suicide idea
Not enthusiastic
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CHRONIC STRESS
LONG-TERM ACTIVATION OF
LOCUS CERULEUS
NOREPINEPHRINE MEDIAL FOREBRAIN
ANERGIA, ANHEDONIA, LIBIDO
LEARNED HELPLESSNESS
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INESCAPABLE STRESS (CHRONIC)
CHANGES OF NEUROBEHAVIORAL RESPONS
CORTISOL
NOREPINEPHRINE, SEROTONIN, DOPAMINE, GABA ↓
HELPLESS, HOPELESS, APATHY
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• DISFUNCTION OF THE BRAIN REGION IN
DEPRESSION
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• SCHIZOPHRENIA
Severe mental disorder
Delusion, halucination, disturbance in thought
process, catatonia, ect
Impairment in social and occupational function
The disturbance persist for at least 1 month
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• THE ETIOLOGY OF SCHIZOPHRENIA
The etiology of schizophrenia is still unknown
Factors contribute to schizophrenia
• Genetic factor
• Prenatal and perinatal complications: hypoxia, prenatal viral
infection, substance abuse during pregnancy, head trauma
during delivery
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• THE BRAIN STRUCTURE ABNORMALITY IN
SCHIZOPHRENIA
• There are several
abnormalities in the brain
structure
BRAIN • Disturbance in neuron
STUDY development before, during
and after birth
(AUTOPSY) • The abnormality of the brain
structures are the areas which
are susceptible to
schizophrenia
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THE BRAIN REGION
RELATED TO
SCHIZOPHRENIA
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• TEMPORAL LOBE
Disturbance in
temporal lobe is
related to:
1. Halucination
2. Delusion
3. Difficulty in
object/face
recognition
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• FRONTAL LOBE
Frontal lobe
hypoactivity:
1. Decreased
cognitive function
2. Disturbance in
behavioral
planning
3. Blunted affect
4. Social isolation
5. Apathy
6. etc
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• THE LIMBIC SYSTEM INVOLVED IN
SCHIZOPHRENIA
Hippocampus
Amygdala
Thalamus
Cingulate Gyrus
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• HIPPOCAMPUS
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• AMYGDALA
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• CINGULATE GYRUS
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• THALAMUS
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• VENTRICLE ENLARGEMENT
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• NEUROTRANSMITTERS IN SCHIZOPHRENIA
Dopamine
Serotonin
Norepinephrine
Acetylcholine
Glutamate
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Dopaminergic System
Nigrostriatal Pathway
Subs. Nigra to striatum
Motoric control
EPS
Neuronal death
Tuberoinfundibular
leads to Parkinson disease Pathway
Mesolimbic & mesocortical Hypotalamus to hypophiseal
pathway Hormone Regulation
Pregnancy, maternal behavior
Sensory Integration
To NA, Amigdala, Hippocampus, and PFC
Hyperprolactinaemia
. Memory, Motivation and emotional response
. Reward and will , Addiction
. Hallucination
Mesolimbic Hyperactivity (+) symptoms
mesocortical Hypoactivity (-) symptoms &
cognitive
deficit
5/17/19 31
• MOOD DISORDER: BIPOLAR
Bipolar I Bipolar II Bipolar NOS Cyclothymia
• Manic or • Hypomania • Not fullfil • 2 years
mix 4 days the specific • Not fullfil
• Impairment • Never criteria for ther criteria
in manic or bipolar I or for
functioning mix type II depression,
areas & • Recurrent • Hypomania manic or
obvious depression 4 days mix episode
symptoms • Usually • Dysthimia
• Usually with
with recurrent
recurrent depression
depression
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ACETYLCHOLIN
AN
I ST TA
GO
ON NIS
AG T
DEPRESSION MANIA
1. Psychmotor 1. Motor hyperactivity
retardation 2. Energetic
2. Lethargy 3. No need to sleep
3. Sleep disturbance 4. Self esteem
4. Learned
helplessness
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DOPAMINE SYSTEM
TUBERO SUBSTANSIA
INFUNDIBULAR MESOLIMBIC MESOCORTEX
NIGRA
EMOTION EXPR MOTIVATION
CONTROLLED MOTOR LEARNING CONCENTRATION
PROLACTINE ACTIVITY REINFORCEMENT EXCECUTIVE FC
HEDONIA
SUBSTANSIA
PROLACTINE MESOLIMBIC MESOCORTEX
NIGRA
MANIA/DEPRESSION 34
• THE BRAIN FUNCTION
Brain blood flow
Brain metabolism
Hipofrontality
• Left hemisphere depression
• Right hemisphere mania
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• PREFRONTAL CORTEX DISTURBANCE
Schizophre- Bipolar
nia
• Depressive
• Negative Episode
Symptoms • Anergia
• Apathy • Sad
• Blunted • Cognition
affect &
• Poverty of concentra
speech & tion
ideas
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• LIMBIC SYSTEM DISFUNCTION
Schizophrenia Bipolar
Possitive Emotional &
Symptoms: behavioral
• hallusination disturbances
• delution
The same symptom might be
shown in schizophrenia and
bipolar, because the limbic
system is involved in both
disorders
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• CONCLUSION
Mental disorder multiple factors interaction
Gene interaction with environment
Stressors increase the activation of HPA axis
Stresssors cause various kind of mental disorders
Disturbances of neurotransmitters
Disturbances of neurohormonal
Disturbances of brain function
Disturbances of brain structure
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Thank you
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