ETIOLOGY OF MENTAL

DISORDERS

INSTRUCTIONAL MATERIAL
1. The Basic Needs
2. General System Theory
3. The Human Life Cycle
4. Etiology of Mental Disorders
4.1 The Biological systems
4.2 The Psychological systems
4.3 The Social systems
THE BASIC NEEDS
TRIAD OF NEEDS
.
Physical Needs Psychological Needs
Social Needs
Family
Community
Physical Needs
. • Nutrition
• Clothing & Shelter
• Exercise & Sensory
stimulation
• Protection from
bodily harm.
Psychological Needs
Loving, trusting, affectionate
relationship, relation of one’s behavior
( by caretakers self control ) to be
assure of one’s worth as a person by
other people.
Social Needs
Multiple role in Society
She / he feels that she /
he is an important
member of a group
( family, at work,
organization in the
community)
GENERAL SYSTEM THEORY
The Biological System
The Psychological
System
The Social
System
THE HUMAN LIFE CYCLE
 Can be divided into different stages of
development.
 Each stage presents a biological,
psychological, and social state.
 If a person goes through these stages
successfully and smoothly mentally
healthy & stable.
• A disturbance in any of the stages
1. Non-progression from one stage to another
(fixation).
2. A return to a former stage (regression).
A Psychological problem
Mental disorder
THE ETIOLOGY OF MENTAL
DISORDER
Integrated systems approach behavior and
disease ( George Engel )
The Biological Systems
The Psychological Systems
The Social Systems
The Biological Systems
1. The brain
1.1 Anatomical brain Systems
1.2 Neurochemical brain Systems
2. Genetics
3. Endocrine
4. Psychoimmunology
5. Others.
The Brain
1.1 Anatomical brain Systems
The prefrontal, the limbic
the basal ganglia systems
interconnected work interactively
memory, language, attention, (“executive function”)
emotional function
perceptual function
(motor, visual, auditory, somatosensory systems)
• Injury
• Lesion
• Infection
• Bleeding
• Tumor
• Toxin
• Atrophy
• Metabolism
disturbance
Brain Conditions
Organic Mental Disorder
( Delirium, Dementia )
Mental Retardation
1.2 Neurochemical brain Systems
Neuron consist of :
 a cell body surrounded by dendrites
to receive information through synaptic input
from other neurons.
  one axon : transfers electrical excitation
from the cell body terminal
neurochemical brain synaps
(neurotransmitter)
4 Key Neurotransmitter Systems
1. Dopamine (DA)
2. Serotonin (5- hydroxytryptamine 5HT)
3. Norepinephrine (NE).
4. Gamma Amino Butyric Acid (GABA).
Dopamine (DA)
Schizophrenia : DA Positive Symptoms
DA some Obsessive Compulsive Disorder
Serotonin (5HT)
5HT ++ Psychotc symptoms
Overactivity of 5HT Impulsive behavior
(Schizophrenia)
Dysregulation of 5HT Obsessive-
Compulsive Disorder
Deficiency of 5HT Depression.
5HT Anxiety
Norepinephrine (NE)
Overactivity of NE neuron Anxiety
NE + + Panic
GABA
Reduced action of GABA Anxiety
Deficiency of GABA Panic
Genetics
Family studies Schizophrenia
Bipolar disorder
Twin studies : has tended to support
familiality potentially the
genetic aspect of
• Schizophrenia
• Mood disorder
• Alcoholism
• Children who were born to parents
with a major mental illness
adopted at birth and reared by
parents without the disorder
• The most difficult studies
Adoption studies
A Combined genetic and environmental interaction :
• Schizophrenia
• Affective disorders
3. Endocrine Disorders
Thyroid : Hyperthyroidism confusion,
anxiety,
agitated
depression
Syndroms
Hypothyroidism paranoia,
depression,
hypomania,
hallucination
Parathyroid : parathyroid hormone ++
hypercalemia delirium,
personality changes, apathy.
Adrenal : chronic adrenocortical <<
(addison’s disease) apathy,
iritability, depression.
Adrenal : cortisol ++ (Cushing’s syndrome)
• Mood disorder, agitated depression
suicide
• Concentration , memory deficit
• psychotic reactions
High doses of exogenous
corticosteroids secondary mood
disorder (mania), severe depression.
Nutrition :
Thiamine (B1) deficiency :
beri-beri + apathy, depression, irritability,
nervousness, concentration <<, severe
memory disorders.
Cobalamine (B12) deficiency :
apathy, depression, irritability,
moodiness delirium, hallucinations,
dementia sometimes paranoid
Toxins :
Environmental toxins serious threat to
phycical and mental health
Mercury depressions, irritability,
psychosis
Lead encephalopathy : dizziness,
clumsiness, ataxia, irritability,
restlessness, headache, insomnia
vomiting , visual dis -
turbance, convulsion
coma
The Psychological Systems
1. The Predisposing Factors
2. The Precipitating Factors
1. The Predisposing factors
Factors which caused individual vurnarable
1.1 Low intelegence
1.2 Development or Age
* Mental health problem with age
* Young people are more predisposed
than older people to acute illness
1.3 Personality traits / disorders
* Dependency
* Egocentric
* Introvent
* Paranoid
* Others
2. The Precipitating Factors
General Stress Factors
A stressful life events / situation
(internal or external, acute or chronic)
Psychosocial Stressors
Symptoms / Disorders
Thomas Holmes & Richard Rahe :
Listed 43 life events associated with varying
amounts of disruption and stress in average
people’s live
Social Readjustment Rating Scale
( Kaplan, Sadock p. 860 - 2 )
Social Readjustment Rating Scale, e.g :
Life Event
• Death of spouse
• Divorce
• Marital separation from mate
• Death of close family member
• Major personal injury or illness
• Marriage
• Being fired at work
• Sexual difficulties
• Major change in financial state.
• Major change in the number of arguments with
spouse.
• Major change in responsibilities at work.
• Change in residence
The Social Systems
1. Socioeconomic factors
2. Environmental factors
3. Cultural factors
1. Socioeconomic factors
 People’s socioeconomic status (SES) based on :
income, education, occupation and life style
 A positive correlation excists between SES and
mental health
People with high SES have better mental health
Poverty is associated with long-term problem :
poor health, failure, crime, mental disorders
( Kaplan, Sadock : p. 181-2 )
2. Environmental factors
 The environment is estimated to contribute to
 1/4 of today’s health problems.
 Environmental risks :
toxic waste, natural disasters, lead, asbestos
and dioxin
 75 % of all carcinogens come from the
environment
 Mental disorders generally rise among people as
their environments change from the suburban
inner city
( Kaplan, Sadock : p. 182 )
 The concept of universals
 The wide cultural variations
 The implication of culture and its reaction
to diagnosis
( Kaplan, Sadock ; DSM - IV )
The concept of universals
 Behaviors are universal within an age or sex
class
 The taboo against incest and homocide
 The highly variable but always present
institution of marriage, the social construction
of illness and healing
( Kaplan : p. 170 )
The wide cultural variations
* Consept of self, style of communication, coping
mechanisms
* Significant life change
(migration or refugee status )
Affected the integrity of individual’s social network
or the Wider system of social support and values
bereavement or separation experiences
Period of adaptation
+
Individual predisposition / vulnerability
Adjustment disorders
( Culture Shock )
( Kaplan, Sadock ; ICD - 10 )
The implication of culture and its relation to
diagnosis :
Diagnosis assessment can be especially
challenging when a clinician from one ethnic
or cultural group uses the DSM IV
classification to evaluate an individual from
a different ethnic or cultural group.
A clinical who is unfamiliar with the
nuances of an individual’s culture frame of
reference incorrectly judge
( DSM - IV )
BAHAN INSTRUKSIONAL
1 . Dasar Kebutuhan
2 . Sistem Umum Teori
3 . The Life Cycle Manusia
4 . Etiologi Gangguan Mental
4.1 Sistem Biologi
4.2 Sistem Psikologis
4.3 Sistem Sosial
KEBUTUHAN DASAR
TRIAD KEBUTUHAN
.
Fisik Kebutuhan Kebutuhan Psikologis
Kebutuhan sosial
keluarga
masyarakat
Kebutuhan fisik
. • Nutrisi
• Pakaian & Penampungan
• Latihan & Sensory
stimulasi
• Perlindungan dari
kerugian fisik .
Kebutuhan psikologis
Mencintai, percaya , sayang
hubungan , hubungan perilaku seseorang
( Oleh pengasuh kontrol diri ) menjadi
menjamin senilai seseorang sebagai seseorang dengan
orang lain .
Kebutuhan sosial
Beberapa peran dalam Masyarakat
Dia / dia merasa bahwa dia /
ia adalah penting
anggota kelompok
( Keluarga , di tempat kerja ,
organisasi dalam
masyarakat )
SISTEM UMUM TEORI
Biologi Sistem
The Psychological
sistem
The Social
sistem
MANUSIA SIKLUS HIDUP
Dapat dibagi menjadi tahapan yang berbeda dari
pembangunan.
Setiap tahap menyajikan biologis ,
psikologis , dan sosial negara .
Jika seseorang melewati tahapan ini
sukses dan lancar mental
sehat & stabil .
• Gangguan pada salah satu tahap
1 . Non - perkembangan dari satu tahap ke tahap lainnya
( fiksasi ) .
2 . A kembali ke tahap sebelumnya ( regresi ) .
Masalah Psikologis
gangguan mental
THE ETIOLOGI OF MENTAL
GANGGUAN
Sistem terpadu pendekatan perilaku dan
Penyakit ( George Engel )
Sistem Biologi
Sistem Psikologis
Sistem Sosial
Sistem Biologi
1 . otak
1.1 Sistem otak Anatomi
1.2 Sistem otak neurokimia
2 . genetika
3 . kelenjar endokrin
4 . Psychoimmunology
5 . Lainnya .
Otak
1.1 Sistem otak Anatomi
Prefrontal , limbik
sistem ganglia basal
pekerjaan yang saling berhubungan secara interaktif
memori , bahasa , perhatian , ( " fungsi eksekutif " )
fungsi emosional
fungsi persepsi
(motor , visual, pendengaran , sistem somatosensori )
• Cedera
• Lesi
• Infeksi
• Perdarahan
• Tumor
• Toksin
• Atrophy
• Metabolisme
gangguan
Kondisi otak
Gangguan Mental Organik
( Delirium , Demensia )
Retardasi Mental
1.2 Sistem otak neurokimia
Neuron terdiri dari :
tubuh sel dikelilingi oleh dendrit
untuk menerima informasi melalui masukan sinaptik
dari neuron lain .
satu akson : transfer eksitasi listrik 
dari terminal sel tubuh
synaps otak neurokimia
( neurotransmitter )
4 Kunci Neurotransmitter Sistem
1 . Dopamin ( DA )
2 . Serotonin ( 5 - hydroxytryptamine 5HT )
3 . Norepinefrin ( NE ) .
4 . Gamma Amino Butyric Acid ( GABA ) .
Dopamin ( DA )
Gejala DA Positif : Skizofrenia
DA beberapa Obsessive Compulsive Disorder
Serotonin ( 5HT )
Gejala 5HT + + Psychotc
Overactivity 5HT perilaku impulsif
( Schizophrenia )
Disregulasi 5HT Obsesif -
Gangguan kompulsif
Defisiensi 5HT Depresi .
Kecemasan 5HT
Norepinefrin ( NE )
Overactivity dari NE neuron Kecemasan
NE + + Panic
GABA
Tindakan Mengurangi GABA Kecemasan
Defisiensi GABA Panic
genetika
Keluarga studi Skizofrenia
gangguan bipolar
Studi kembar : cenderung dukungan
familiality berpotensi
Aspek genetik
• Skizofrenia
• Gangguan suasana hati
• Alkoholisme
• Anak-anak yang lahir dari orang tua
dengan penyakit mental utama
diadopsi pada saat lahir dan dibesarkan oleh
orang tua tanpa gangguan
• Penelitian yang paling sulit
studi adopsi
A genetik dan lingkungan interaksi Gabungan :
• Skizofrenia
• Gangguan afektif
3 . Gangguan endokrin
Thyroid : Hipertiroidisme kebingungan ,
kecemasan ,
gelisah
depresi
Sindroma
Hypothyroidism paranoia ,
depresi ,
hypomania ,
khayalan
Paratiroid : hormon paratiroid + +
hypercalemia delirium ,
perubahan kepribadian , apatis .
Adrenal : adrenocortical kronis <<
(penyakit addison s ) apatis ,
iritability , depresi .
Adrenal : kortisol + + ( sindrom Cushing )
• Gangguan suasana hati , depresi gelisah
bunuh diri
• Konsentrasi , defisit memori
• Reaksi psikotik
Dosis tinggi eksogen
suasana sekunder kortikosteroid
gangguan ( mania ) , depresi berat .
gizi:
Tiamin ( B1 ) kekurangan :
beri-beri + apatis , depresi , lekas marah ,
gugup , konsentrasi << , parah
gangguan memori .
Cobalamine ( B12 ) kekurangan :
apatis , depresi , lekas marah ,
kemurungan delirium , halusinasi ,
demensia kadang paranoid
racun :
Racun lingkungan ancaman serius
kesehatan phycical dan mental
Mercury depresi , lekas marah ,
kegilaan
Memimpin encephalopathy : pusing ,
kecanggungan , ataksia , lekas marah ,
gelisah , sakit kepala , insomnia
muntah , penglihatan dis -
turbance , kejang
koma
Sistem Psikologis
1 . Faktor predisposisi
2 . Faktor pencetus
1 . Faktor-faktor predisposisi
Faktor-faktor yang menyebabkan individu vurnarable
1,1 Rendah INTELEGENCE
1.2 Pengembangan atau Umur
* Masalah kesehatan mental dengan usia
* Orang-orang muda lebih cenderung
dari orang tua untuk penyakit akut
Ciri-ciri Kepribadian 1,3 / gangguan
* Ketergantungan
* Egosentris
* Introvent
* Paranoid
* Lainnya
2 . Faktor pencetus
Faktor Stres Umum
Sebuah peristiwa kehidupan / situasi stres
( internal atau eksternal , akut atau kronis )
Stresor psikososial
Gejala / Gangguan
Thomas Holmes & Rahe Richard :
Dipasang 43 peristiwa kehidupan yang berkaitan dengan berbagai
jumlah gangguan dan stres rata-rata
hidup rakyat
Readjustment Sosial Rating Scale
( Kaplan , Sadock p 860 - . 2 )
Readjustment Sosial Rating Scale , mis. :
Kegiatan hidup
• Kematian pasangan
• Perceraian
• Pemisahan Pernikahan dari pasangan
• Kematian anggota keluarga dekat
• cedera pribadi utama atau penyakit
• Pernikahan
• Dipecat di tempat kerja
• kesulitan seksual
• Perubahan besar dalam keuangan negara .
• Perubahan besar dalam jumlah argumen dengan
pasangan .
• Perubahan besar dalam tanggung jawab di tempat kerja .
• Perubahan tempat tinggal
Sistem Sosial
1 . faktor sosial ekonomi
2 . faktor-faktor lingkungan
3 . faktor budaya
1 . faktor sosial ekonomi
 Rakyat ( SES ) berdasarkan :Status sosial ekonomi
pendapatan, pendidikan, pekerjaan dan gaya hidup
A excists korelasi positif antara SES dan
kesehatan mental
Orang dengan SES tinggi memiliki kesehatan mental yang lebih baik
Kemiskinan terkait dengan masalah jangka panjang :
kesehatan yang buruk , kegagalan , kejahatan , gangguan mental
( Kaplan , Sadock : . P 181-2 )
2 . faktor-faktor lingkungan
Lingkungan diperkirakan untuk berkontribusi
1/4 masalah kesehatan saat ini .
:Risiko Lingkungan
limbah beracun , bencana alam , timah , asbes
dan dioxin
75 % dari semua karsinogen berasal dari
lingkungan
Gangguan mental umumnya meningkat antara orang-orang sebagai
lingkungan mereka berubah dari pinggiran kota
dalam kota
( Kaplan , Sadock : . P 182 )
Konsep universal
Variasi budaya yang luas
Implikasi dari budaya dan reaksinya
diagnosis
( Kaplan , Sadock , DSM - IV )
Konsep universal
Perilaku bersifat universal dalam usia atau jenis kelamin
kelas
The tabu inses dan homocide
The sangat bervariasi tetapi selalu hadir
lembaga perkawinan , konstruksi sosial
penyakit dan penyembuhan
( Kaplan : . P 170 )
Variasi budaya yang luas
* Consept diri , gaya komunikasi , mengatasi
mekanisme
* Perubahan hidup yang signifikan
( migrasi atau status pengungsi )
Mempengaruhi integritas jaringan sosial individu
atau sistem yang lebih luas dari dukungan sosial dan nilai-nilai
kehilangan atau pemisahan pengalaman
Periode adaptasi
+
Predisposisi individu / kerentanan
gangguan penyesuaian
( Culture Shock )
( Kaplan , Sadock , ICD - 10 )
Implikasi dari budaya dan kaitannya dengan
diagnosis :
Penilaian Diagnosis bisa sangat
ketika menantang seorang dokter dari salah satu etnis
atau kelompok budaya menggunakan DSM IV
klasifikasi untuk mengevaluasi individu dari
kelompok etnis atau budaya yang berbeda .
Sebuah klinik yang belum terbiasa dengan
nuansa bingkai budaya individu dari
referensi salah hakim
( DSM - IV )