Dr. dr. A. Laksmidewi, Sp.

S(K)
Sub Bag Neurobehavior
Ilmu Penyakit Saraf FK UNUD/RSUP Sanglah

laksmidewi2009@hotmail.com
 Neuropsychology/ Neurobehavior is
a scientific study of neural correlates to
cognition (brain) and behavior

Brain Behavior
Relationships
Definisi Sehat Mental (WHO)
Seseorang yang sehat mental/ jiwanya adalah
mereka yang:
1.Merasa Sehat dan Bahagia
2.Mampu menghadapi tantangan hidup
3.Menerima orang lain apa adanya  mampu
berempati dan tidak berprasangka terhadap orang
lain yang berbeda
4.Bersikap positif thd dirinya sendiri & orang lain
 EMPATI
- Memiliki sikap tidak menghakimi
(non judgemental) dan juga tidak
menyalahkan atau membenarkan
-Menerima individu apa adanya
-Mengerti nilai-nilai mereka

Dasar dari EMPATI adalah kasih sayang

(brotherly love) tanpa pamrih
 perilaku,
emosi dan
dorongan
Berbeda dan
Berubah-
ubah

SISTEM
SARAF
Neurotransmitter Associated Psychopathology
Dopamine -Schizophrenia
-Other conditions involving psychosis
-Parkinson Disease
-Depression

Norepinephrine •Depression
•Adrenal Medulla Tumor
(Pheochromocytoma)
Serotonin -Depression
-Violent behavior
-Impulsive behavior
-Fire setting
-Alcohol abuse
-Bulimia
Location of Lesion Effects

Frontal Lobes • Emotional symptoms (e.g. Depression)

• Problems with
attention, motivation, concentration,
orientation and problem solving (dorsolateral
convexity lesions)
• Problems with
Judgment, inhibitions, emotions and personality
(orbitofrontal cortex lesions)

Parietal Lobes  Impaired processing of visual-spatial (right-

sided lesions) information and verbal (left-sided
lesions) information
Location of Lesion Effects

Temporal Lobes •Impaired memory

•Hallucinations
•Personality changes

Limbic Lobes  Poor new learning

(hippocampus)

Limbic Lobes •Decreased aggresive behavior, increased sexual

(Amygdale) behavior and hyperorality
•Decreased learned fear response
•Inability to recognize facial and vocal
expressions of anger in others
Location of Lesion Effects

Hypothalamus •Increased appetite leading to obesity

(ventromedial nucleus damage)
•Loss of appetite leading to weight loss (lateral
nucleus damage)
•Effects on sexual activity and body temperature
regulation
Reticular system Changes in sleep-wake mechanisms (e.g
decreased production of REM sleep via decreased
Ach production)
Loss of consciousness
Basal Ganglia •Disorders of movement, such as Parkinson
disease (substansia nigra), Tourette disorder
(caudate)
F 20 Schizophrenia
is a chronic mental disorder,characterized by:
-Periods of psychosis (active phases)
-Periods between psychotic episodes
(residual phases)
Develops at a younger age in males (15-25 yo)
than in females (23-35 yo)
Etiology
A.Neurological Factors
B.Social Factors
Neurological Factors
1.Hyperactivity of the dopaminergic, serotonergic
and noradrenergic systems
2.Enlargement of the lateral & third ventricles
3.Decreased Glucose use in the prefrontal
cortex
4.Decreased volume of the hippocampus and
amygdala
5.Neuropsychological deficits such as psychomotor
and attentional difficulties

Neuropeptides, GABA, Glutamat, Acetylcholine and Nicotine

Dopamin ⇑ akan menyebabkan Glutamat ⇓
 Skizofrenia ditandai oleh:
-Gejala Positif
-Gejala Negatif

Hipotesis perkembangan neuron prenatal dan postnatal

Hipotesis Peran Glutamat yaitu:

aktivitas Glutamat ⇓ di korteks prefrontal

Dopamin menghambat pelepasan glutamat atau

Glutamat menstimulasi neuron yg menghambat
pelepasan dopamin.
Dopamin ⇑ akan menyebabkan Glutamat ⇓
 Dopamine Hypothesis of Schizophrenia

Mesolimbic pathway hyperactivity

Mesocortical pathway

Nigrostriatal pathway
Tuberoinfundibular pathway
 Faktor epigenetik

Neurotransmitter Reseptor di Interaksi zat neurokimia:

neuron dopamin & serotonin

Mempengaruhi fungsi: Perubahan

Kognitif, Afektif,
Psikomotor anatomi otak:
Pelebaran ventrikel
lateral,
Atrofi korteks bag
frontal
Atrofi cerebellum

Gejala positif &

negatif skizofrenia
 TABLE 9-2 PSYCHIATRIC CONDITIONS AND ASSOCIATED NEUROTRANSMITTER ACTIVITY

Psychiatric Condition Neurotransmitter Activity Increased (↑) or Decreased (↓)

Schizophrenia Dopamine (↑), serotonin (↑), glutamate (↑↓)

Mania Dopamine (↑), GABA (↓)
Depression Norepinephrine (↓), serotonin (↓), dopamine (↓)
Anxiety GABA (↓), serotonin (↓), norepinephrine (↑)
Alzheimer disease ACh (↓), glutamate (↑)
 TABLE 9-3 METABOLITES OF MONOAMINES AND ASSOCIATED PSYCHOPATHOLOGY
Neurotransmitter Concentration of Metabolitea Associated Psychopathology
Dopamine Increased HVA  Schizophrenia
Decreased HVA  Other conditions involving psychosis
 Parkinson disease
 Depression
Norepinephrine Decreased MHPG  Depression
Increased VMA  Adrenal medulla tumor
(pheochromocytoma)
Serotonin Decreased 5-HIAA  Depression
 Violent behavior
 Impulsive behavior
 Fire setting
 Touretted
 Alcohol abuse
 Bulimia
aIn blood plasma, cerebrospinal fluid, or urine.
5-HIAA, 5-hydroxyindoleacetic acid; HVA, homovanilic acid; MHPG, 3-methoxy-4-hydroxyphenylglycol; VMA,
vanillylmandelic acid
 Ggn Mood
◦ Ggn depresi Mayor, ggn Bipolar, ggn Afektif

Ggn Depresi: sedih dan tidak bahagia @ hari dan ber

minggu minggu.

Depresi:
*penurunan aktivitas korteks prefrontal kiri
*peningkatan aktivitas korteks prefrontal kanan

Kiri > depresi

Kanan > manic
 In Mood disorders, emotions that the
individual can not control cause serious
distress and occupational problems, social
problems or both.
 Major cathegories
1.Major depressive disorder
2.Bipolar disorder
3.Dysthymic disorder
4.Cyclothymic disorder
 Bipolar disorder
Bipolar I Disorder: Patients have episodes of
both mania (i.e., greatly elevated mood) and
depression
Bipolar II Disorder: Patients have episodes of
both hypomania (i.e., mildly elevated mood)
and depression.
Biological Factors
1.Neurotransmitter activity
2.Abnormalities of the limbic-hypothalamic-
pituitary-adrenal axis
3.Sleep patterns
◦

Hypothalamus  Negative Feedback

CRH

Anterior
Pituitary
ACTH

Adrenal CORT

HPA Axis Cortex

cortisol
 characterized by distinct episodes of both mania and depression.
 Subdivided into bipolar I and bipolar II disorders.

 Bipolar I disorder is characterized by depression and clear-cut manic symptoms

present during the course of the disease.
-Some of the manic symptoms include a tendency to be quick to anger and
easily bothered (i.e., impulsive and irritable responses),
-a lack of modesty in dress, assaultive behavior,
-delusions of grandeur and power,
-intense feelings of happiness and well-being.

 Bipolar II disorder, depression is coupled instead with hypomania. Some of the

symptoms include a specific period of elevated, irritable, or expansive mood; a
decreased need for sleep; inflated self-esteem; highly talkative; distracted
behavior where attention is given to trivial stimuli; an increase in goal-directed
behavior; and involvement in activities considered pleasurable but that can have
significant negative consequences such as sexual indiscretions and buying sprees.
Axiety Disorders
1.Fear is a normal reaction to a known
environmental source of danger. Individuals with
axiety experience apprehension, but the source
od danger is unknown or is inadequate to
account for the symptoms.
2.The physical characteristics of anxiety are similar
to those of fear.
3.Organic causes
4.The neurotransmitters involved in the
manifestations of anxiety include decreased
GABA and serotonin activity and increased
norepinephrine activity
DEPRESI ?
1.The repeated reliving of memories of the traumatic
experience
2.Avoidance of reminders of trauma, as well as of
emotional numbing. Detachment and emotional
blunting often coexist with intrusive recolections.
3.Increased arousal as expressed by hypervigilance,
irritability, memory and concentration problems,
sleep disturbances.
 PTSD
 1.The Brainstem and Hypothalamus, which are
primarily associated with the regulation of internal
homeostasis.
 2.The limbic system, Which balanced between the
internal world and external reality
 3. The neocortex, which is responsible for analyzing
and interacting with the external world

 The circuitry of the brainstem and hypothalamus is

most innate and stable, while the limbic system
contains both innate circuitry and circuitry modifiable
by experience, while the neocortex is most affected
by environmental input.
Overview of Limbic Circuitry
Wide arrows denote connections
to multiple network structures.
Many additional connections between
the structures shown have been
omitted

Limbic system and hypothalamic

functions are strongly
interconnected..

Spinal cord, cranial nerve,

And neurohumoral pathways
a. Awake State: Beta (14c/s)and alpha(8-13c/s)
waves characterize the EEG of an awake
individual
b. Sleep State: Normal sleep consist of stages
1,2,3 and 4 as well as rapid eye movement
(REM) sleep.
Each stage of sleep is associated with
particular brain wave.
c. Sleep Architecture
d. Neurotransmitters
 The Raphe Nuclei  natural sleep
(Raphe n: lower half of the pons and the medulla oblongata)

Stim nuc of the tractus solitarius sleep

Stim the diencephalon  sleep

(the rostral part of the hypothalamus, area nuc of thalamus)
Action NT Specific Effect
Promote sleep Serotonin ↑(increases) total sleep
time and slow-wave
sleep; damage to the
dorsal raphe nucleus

Acetylcholine *Activity in the

Reticular formation
increases total sleep
time and REM time
Promote wakefulness Norepinephrine Decreases both total
sleep time and REM
sleep

Dopamine *Mania and other

psychotic illness are
associated with
wakefulness
Quisioner Insomnia
 I Have real difficulty falling asleep
 Thoughts rare through my mind and this prevents me
from sleeping
 I wake during the night and can’t go back to sleep
 I wake up earlier in the morning than I would like to
 I’ll lie awake for half an hour or more before I fall
asleep
 I anticipate a problem with sleep almost every night
If you checked three or more boxes, you show
symptoms of insomnia, a presistent inability to fall
asleep or stay asleep.