Kesurupan dalam pandangan Ilmu Kedokteran Jiwa - dr. Andri SpKj

1.  Nama : Dr.Andri,SpKJ,FAPM
 Usia : 36 tahun
 Pendidikan :
 Dokter : Fakultas Kedokteran Universitas Indonesia (Lulus 2003)
 Psikiater : Fakultas Kedokteran Universitas Indonesia (Lulus 2008 )
 Pendidikan tambahan di bidang psikosomatik medis dari American Psychosomatic Society di Portland, Oregon, USA tahun
2010 dan Academy of Psychosomatic Medicine di Atlanta, USA tahun 2012, 2013, dan 2014
 Tahun 2013 Mendapatkan pengakuan sebagai Fellow of The Academy of Psychosomatic Medicine (FAPM) di Amerika
Serikat dan merupakan psikiater ke-6 dari Asia dan pertama dari Indonesia yang mendapatkan pengakuan ini.
 Organisasi :
 IDI (Ikatan Dokter Indonesia)
 PDSKJI (Perhimpunan Dokter Spesialis Kedokteran Jiwa Indonesia)
 American Psychosomatic Society
 Academy of Psychosomatic Medicine
 Jabatan :
 Dosen Psikiatri di FK UKRIDA, Jakarta sejak 2008
 Psikiater di Klinik Psikosomatik Omni Hospital, Alam Sutera sejak 2008
 Ketua Sub Kredensial Komite Medik RS OMNI Alam Sutera
 Publikasi Ilmiah
 12 Artikel Ilmiah di terbitkan di Jurnal Kedokteran Nasional
 18 Proceeding abstrak presentasi simposium, poster dan oral communication di seminar nasional dan internasional
 Buku : Medical Commorbidity in Bipolar Patient in Bipolar Disorder : Collection of papers. Mahajudin MS,Haniman
F,Margono HM,editors. Airlangga Univesity Press,2012. ISBN : 978-602-8967-74-7
 Buku : Psychosomatic Disorder in HSC Clinical Updates in Primary Health Care 2012,Gadjah Mada University and
University of Iowa. Claramita M,Sutomo AH,editors. Lokus Publishing,2012. ISBN : 978-602-7664-17-3
 2 Buku non-fiksi (Jangan Sebut Aku Gila terbit 2011, Bagaimana Memaknai Kehidupan dan PSIKOSOMATIK terbit 2013)
 1 letter to editor diterbitkan di Asia Pacific Journal of Psychiatry 2012

2. ANDRI
Bagian Psikiatri Fakultas Kedokteran UKRIDA
Klinik Psikosomatik RS OMNI Alam Sutera
Twitter : @mbahndi
Follow Facebook : Andri Andri
Kesurupan
dalam Pandangan
Ilmu Kedokteran Jiwa

3. Pendahuluan
 Bagaimana mendifinisikan KESURUPAN ?
 Trance ?
 Ego Alteration ?
 Possession ?
 Exorcism ?
 Dissociative disorder ?
 Hysterical reaction?
Bagaimana di Indonesia ?
Kasus-kasus Kesurupan banyak dikaitkan dengan budaya
dan beberapa orang mengkaitkan dengan agama

4. Kesurupan dalam Berita Media

6. “Kesurupan” dalam Ilmu Psikiatri
 Dissociative Disorder ???

7. Tanda dan Gejala Disosiasi
 Perubahan kesadaran, memori dan atau identitas
 Perubahan cara pikir, afeksi emosi, fungsi
sensorimotor dan perilaku
Lima fenomena yg sering muncul berkaitan dengan
disosiasi :
 Amnesia
 Depersonalisation
 Derealisation
 Identity confusion
 Identity alteration

8. What Western People Say About It?
 The category of dissociative disorders includes a wide
variety of syndromes whose common core is an
alteration in consciousness that affects memory
and identity (APA, 1994).
 Impairments of memory and consciousness are often
observed in the organic brain syndromes, but
dissociative disorders are functional: they are
attributable to instigating events or processes that do
not result in insult, injury, or disease to the brain, and
produce more impairment than would normally occur
in the absence of this instigating event or process
(Kihlstrom & Schacter, 2000).

9. Dissociative Disorders from DSM IV
 300.12 Dissociative Amnesia (formerly
Psychogenic Amnesia)
 A. The predominant disturbance is one or more episodes of
inability to recall important personal information, usually of a
traumatic or stressful nature, that is too extensive to be
explained by ordinary forgetfulness
 .B. The disturbance does not occur exclusively during the
course of Dissociative Identity Disorder, Dissociative Fugue,
Post traumatic Stress Disorder, Acute Stress Disorder, or
Somatization Disorder and is not due to the direct
physiological effects of a substance (e.g., a drug of abuse, a
medication) or a neurological or other general medical
condition (e.g., Amnestic Disorder Due to Head Trauma).
 C. The symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas
of functioning.

10.  300.13 Dissociative Fugue (formerly
Psychogenic Fugue)
 A. The predominant disturbance is sudden, unexpected
travel away from home or one's customary place of work,
with inability to recall one's past
 .B. Confusion about personal identity or assumption of a
new identity (partial or complete).
 C. The disturbance does not occur exclusively during the
course of Dissociative Identity Disorder and is not due to the
direct physiological effects of a substance (e.g., a drug of
abuse, a medication) or a general medical condition (e.g.,
temporal lobe epilepsy).
 D. The symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas
of functioning

11.  300.14 Dissociative Identity Disorder (formerly
Multiple Personality Disorder)
 A. The presence of two or more distinct identities or
personality states (each with its own relatively enduring
pattern of perceiving, relating to, and thinking about the
environment and self).
 B. At least two of these identities or personality states
recurrently take control of the person's behavior.
 C. Inability to recall important personal information that is
too extensive to be explained by ordinary forgetfulness.
 D. The disturbance is not due to the direct physiological
effects of a substance (e.g., blackouts or chaotic behavior
during Alcohol Intoxication) or a general medical condition
(e.g., complex partial seizures). In children, the symptoms
are not attributable to imaginary playmates or other fantasy
play.

12.  300.6 Depersonalization Disorder
 A. Persistent or recurrent experiences of feeling detached
from, and as if one is an outside observer of, one's mental
processes or body (e.g., feeling like one is in a dream).
 B. During the depersonalization experience, reality testing
remains intact.
 C. The depersonalization causes clinically significant
distress or impaintient in social, occupational, or other
important areas of functioning.
 D. The depersonalization experience does not occur
exclusively during the course of another mental
disorder,such as Schizophrenia, Panic Disorder, Acute
Stress Disorder, or another Dissociative Disorder, and is not
due to the direct physiological effects of a substance(e.g., a
drug of abuse, a medication) or a general medical condition
(e.g., temporal lobe epilepsy).

13.  300.15 Dissociative Disorder Not Otherwise
Specified
 This category is included for disorders in which the
predominant feature is a Dissociative symptom (i.e.,
a disruption in the usually integrated functions of
consciousness, memory, identity, or perception of
the environment) that does not meet the criteria for
any specific Dissociative Disorder. Examples
include
 1. Clinical presentations similar to Dissociative Identity
Disorder that fail to meet full criteria for this
disorder.Examples include presentations in which a) there
are not two or more distinct personality states, or b)
amnesia for important personal information does not occur.
 2. Derealization unaccompanied by depersonalization in
adults.

14.  3 -States of dissociation that occur in individuals who have
been subjected to periods of prolonged and intense
coercive persuasion (e.g., brainwashing, thought re- form,
or indoctrination while captive).
 4. Dissociative trance disorder: single or episodic
disturbances in the state of consciousness, identity, or
memory that are indigenous to particular locations and
cultures.
 Dissociative trance involves narrowing of awareness of
immediate surroundings or stereotyped behaviors or
movements that are experienced as being beyond one's
control.
 Possession trance involves re placement of the customary
sense of personal identity by a new identity, attributed to
the influence of a spirit, power, deity, or other person, and
associated with stereotyped "involuntary" movements or
amnesia.
 Examples include amok (Indonesia), bebainan
(Indonesia), latab (Malaysia), pibloktoq (Arctic), ataque
de nervios (Latin America), and possession (India).
 The Dissociative or trance disorder is not a normal part of a
broadly accepted collective cultural or religious practice.

15.  5. Loss of consciousness, stupor, or coma not attributable to
a general medical condition.
 6. Ganser syndrome: the giving of approximate answers to
questions (e.g., "2 plus 2 equals 5") when not associated
with Dissociative Amnesia or Dissociative Fugue

16.  Dissociative amnesia
 The patient suffers a loss of autbiographical memory for certain
past experiences
 Dissociative Fugue
 The amnesia is much more extensive and covers the whole of
the individual’s past life
 It is coupled with a loss of personal identity
 And often physical movement to another location
 Dissociative Identity Disorder
 A single individual appears to manifest 2 or more distinct
identities.
 Each personality alternates in control over conscious
experience, thought, and action and is separated by some
degree of amnesia from the other(s).
 Depersonalization Disorder
 The person believes that he or she has changed in some way,
or is somehow unreal (derealization).

17. Apakah Pemicunya?
 Gangguan disosiasi dianggap sebagai respon
manusia terhadap stres yang terjadi pada masa
perkembangan awal
 Tingginya laporan masalah kekerasan dan penyangkalan
masa kecil dibandingkan semua masalah psikiatrik lain
 Banyak dikaitkan dengan Gangguan Stres Pasca
Trauma (atau PTSD)
 Dissociative process was the result of the
repression of traumatic material into unconscious
(Breuer & Freud, 1895)

18. Apa yg terjadi di otak manusia
Deficit of Glucose Metabolism
 Markowitsch, Kessler et al. (1998, 2000) found significant reductions
in glucose metabolism in the brain of a patient (case A.M.N.) with
dissociative (psychogenic) amnesia
 All over the cerebrum, but in particular in memory-processing regions
of the medial temporal lobe and the diencephalon (the reductions
amounted to 2/3 of the normal level in both hemispheres)
Release of Stress Hormone
 biological response in the form of a neurotoxic cascade-like release
of stress hormones, such as glucocorticoids (O’Brien, 1997)
Hypometabolic condition
 right temporo-frontal region was hypometabolic in a significant
number of patients, with a significant reduction in the right
inferolateral prefrontal cortex (Brand et al., 2009).

19. Imaging Finding
 magnetization transfer ratio measurement and MR
spectroscopic imaging (methods sensitive to
microstructural and metabolic brain changes )
 Both found evidence of significant metabolic changes and
subtle structural alterations of the white matter in the right
prefrontal region
 In most cases brain metabolic and functional
changes were found, which involved areas that are
agreed upon to play crucial roles in mnemonic
processing

20. Terapi
 Bersifat mengatasi dasar diagnosisnya
 Psikoterapi dan Farmakoterapi
 Saat kondisi akut (saat kejadian) :
 Pisahkan yang pertama kali mengalami “kesurupan”
 Tenangkan, jika tidak berhasil dengan persuasif bisa
dengan menggunakan obat benzodiazepine (diazepam
injeksi)

21. Kesimpulan
 Kesurupan dalam bahasan psikologis dan psikiatris
mempunyai makna gangguan disosiatif
 Karakter gejalanya berupa perubahan kepribadian
disertai dengan amnesia
 Penelitian membuktikan pada beberapa kasus
terjadi perubahan sistem di otak terkait
metabolismenya dan mungkin fungsi anatomisnya
 Functional brain imaging adalah hal yang bisa
membuktikan ke depan adanya kaitan masalah di
otak dengan terjadinya kesurupan