Psikiatri dan Neurosains:

Napak Tilas
Narasumber: dr. Khamelia, SpKJ
Presentan: dr. Leslie Melisa
Psikiatri?
• Arti kata psychiatry (dalam Bahasa Inggris)
• Cambridge: the part of medicine that studies mental illness
• Oxford: the study and treatment of mental illness, emotional
disturbance, and abnormal behavior
• APA: the branch of medicine focused on the diagnosis, treatment and
prevention of mental, emotional, and behavioral disorders
• Asal kata
• pertengahan abad ke-19
• dari Bahasa Yunani psukhe ‘soul, mind’ + iatreia ‘healing’ (from iatros
‘healer’)
Neurosains?
• Arti kata neuroscience (dalam Bahasa Inggris)
• Cambridge: the scientific study of the nervous system and the brain
• Oxford: any or all of the sciences, such as neurochemistry and
experimental psychology, which deal with the structure or function of
the nervous system and brain
Psikiatri dan Neurosains…
apa hubungannya?
 Jika aku punya otak
• The Wizard of Oz
• Scarecrow ingin punya otak
• the Wizard akhirnya memberi tahu Scarecrow kalau
dia sudah punya otak, hanya saja dia tidak
mengetahuinya
• Bagaimana dengan psikiatri?
• mirip cerita The Wizard of Oz
• psychiatry was brainless for most of the 20th
century (did not turn its attention to the organ of
thought and emotion until the 1980s)

Lieberman JA, Ogas O. Shrinks: the untold story of psychiatry. New York: Little, Brown and Company; 2016.
Brain vs Heart
• Tidak hanya psikiatri yang mengabaikan otak
• heartbroken atau brainbroken?
• memorize by heart atau memorize by brain?
• Zaman peradaban Mesir
• proses mumifikasi: otak dikeluarkan sementara jantung dipreservasi
karena diperlukan di akhirat (pusat pikiran/intelejensi dan perasaan)

= =
Psikiatri di Abad 20
• 1940s-50s: postmortem specimens; mencari biomarker dengan
meneliti cairan tubuh (darah, CSF, urin)
• 1960s: ‘mauve spots’ di urin ODS
• 1970 awal : CT scan diciptakan
• 1976: Eve Johnstone menemukan pembesaran ventrikel lateral
pada otak ODS
• 1981/1992: MRI digunakan untuk ‘melihat’ otak
• MRS: studi komposisi kimiawi dari jaringan otak
• fMRI: studi aktivitas otak
• DTI: studi traktus/jaras
Lieberman JA, Ogas O. Shrinks: the untold story of psychiatry. New York: Little, Brown and Company; 2016.
Neurosains
• Abad 17: Thomas Willis (neurolog pertama) memulai
Neurocentric Age
• pendekatan yang berbeda: mengobservasi dan mendeskripsikan
perilaku pasien → memeriksa otak pasien setelah meninggal →
membuat korelasi
• menciptakan istilah lobus, hemisfer, dan korpus striatum
• batang otak mengontrol fungsi dasar (pernapasan dan denyut jantung)
• Permulaan abad 18
• Luigi Galvani (Italia) mendemonstrasikan otot katak berkontraksi saat
dirangsang dengan listrik

Higgins ES, George MS. The neuroscience of clinical psychiatry: the pathophysiology of behavior and mental illness. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013.
• 1861: Paul Broca (Prancis) mengonfirmasi bahwa fungsi
tertentu terkait area spesifik di otak
• pasien hanya dapat berucap satu silabel ‘tan’
• dapat mendengar dan mengerti
• post-mortem: lesi di lobus frontal kiri → afasia Broca (dominasi kiri)
• David Ferrier (Skotlandia) & Eduard Hitzig (Jerman) masing2
melokalisasi korteks motorik dengan teknik stimulasi & ablasi
• Camillo Golgi (Italia) menemukan teknik pewarnaan untuk
memvisualisasi sel saraf untuk pertama kalinya
• Santiago Ramon y Cajal (Spanyol): neuroscientist modern
pertama
• doktrin neuron
• dendrit reseptif, BSS eksekutif dan akson penerus informasi jarak jauh

Higgins ES, George MS. The neuroscience of clinical psychiatry: the pathophysiology of behavior and mental illness. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013.
 Eric Kandel – learning changes the
brain

Higgins ES, George MS. The neuroscience of clinical psychiatry: the pathophysiology of
behavior and mental illness. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013.
Penelitian Modern
• Peneliti seperti Willis dan Broca: metode lesi

Higgins ES, George MS. The neuroscience of clinical psychiatry: the pathophysiology of behavior and
mental illness. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013.
Psikiatri di masa depan?
”Psychiatry has always fared best when it managed to avoid both
extremes of reductionist neurobiology and pure mentalism, instead
pursuing a path of moderation that is receptive to findings from all
empirically based sources”

• grounded in neuroscience (gene expression, circuit, neurochemical, etc)

Lieberman JA, Ogas O. Shrinks: the untold story of psychiatry. New York: Little, Brown and Company; 2016.
Reynolds CF, Lewis DA, Detre T. The future of psychiatry as clinical neuroscience. Acad Med. 2009;84:446-50.
Reference
• Lieberman JA, Ogas O. Shrinks: the untold story of psychiatry. New
York: Little, Brown and Company; 2016.
• Higgins ES, George MS. The neuroscience of clinical psychiatry: the
pathophysiology of behavior and mental illness. 2nd ed. Philadelphia,
PA: Lippincott Williams & Wilkins; 2013.
• Reynolds CF, Lewis DA, Detre T. The future of psychiatry as clinical
neuroscience. Acad Med. 2009;84:446-50.