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

ANDRI

Bagian Psikiatri Fakultas Kedokteran UKRIDA

Klinik Psikosomatik RS OMNI Alam Sutera

Twitter : @mbahndiFollow Facebook : Andri Andri

Kesurupan dalam Pandangan

Ilmu Kedokteran Jiwa

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

Kesurupan dalam Berita Media

Kesurupan dalam Berita

“Kesurupan” dalam Ilmu Psikiatri

Dissociative Disorder ???

Baru muncul di DSM III

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

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).

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.

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

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.

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).

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.

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.

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

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).

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)

Apa yg terjadi di otak manusiaDeficit 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).

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

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)

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

Terima Kasih

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