• THE ETIOLOGY OF MENTAL

DISORDER

)
Dr. Profitasari Kusumaningrum, SpKJ
Department of Psychiatry University of Indonesia

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 • MENTAL DISORDER
The interaction of multiple factors

Gene, gene expression, virus, toxin, nutrition, birth trauma, experience, stressor

BRAIN STRUCTURE AND FUNCTION

brain development & degeneration, plasticity change in response to experience, brain chemical,
change in response to drugs and psychotherapy

MENTAL FUNCTION
Consciousness, alertness, attention, speech & language, emotion, memory, thought process

HUMAN UNIQUENESS IN SPECIFIC SOCIAL WORLD

The human behavior and response to social and personal environment

SPECIFIC MENTAL DISORDER

Schizophrenia, mood disorder, dementia, anxiety disorder 2
 PSYCHO
BIOLOGY
LOGY

SOCIAL

Biopsychosocial model: George Engel (1997)

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Anthonio Sabelli - 1989

PSYCHOLOGICAL
SUPREMACY

BIOLOGICAL
PRIORITY

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Factors influencing the degree or severity of illness /
mental disorder of a person

Severe

Severity of Unhealthy / ill

stressor

Healthy
Mild

Resilience / perception
Personality
strong weak
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 • THE GENE AND ENVIRONMENT INTERACTION

A: ill
B: spectrum condition
Enviro A C: normal
nmenta
l risk B

Genetic predisposition

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 • ANXIETY DISORDER

• Frequent overworry
• Physical symptoms: tremor,
muscle tense, palpitation,
ANXIETY pallor, decreased
SYMPTOMS concentration, headache,
nausea
• Insomnia, increased
alertness, easily startled

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 PSYCHOSOCIAL STRESSOR

PSYCHONEUROENDOCRINE SYSTEM

HPA-AXIS SAM AXIS

FEAR / ANXIETY

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• HPA AXIS HYPERACTIVITY

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 ACUTE STRESS

LOCUS CERULEUS   MEDULA ADRENAL 


NOREPINEPHRINE 

VEGETATIVE FUNCTION 
ALERTNESS 
AROUSAL 
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• NEUROTRANSMITTER IN ANXIETY DISORDER

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SYMPTOMS OF DEPRESSION
AFFECT COGNITION PHYSICAL
Sadness Low self esteem Sleep disturbance

Apathy Concentration  Appetite disturbance

Sexual disturbance
Anhedonia Doubt Activity 
Anergy Irritable Body weight change
Guilty feeling Suicide idea
Not enthusiastic

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 CHRONIC STRESS

LONG-TERM ACTIVATION OF
LOCUS CERULEUS

NOREPINEPHRINE MEDIAL FOREBRAIN 

ANERGIA, ANHEDONIA, LIBIDO 

LEARNED HELPLESSNESS
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 INESCAPABLE STRESS (CHRONIC)

CHANGES OF NEUROBEHAVIORAL RESPONS

CORTISOL 
NOREPINEPHRINE, SEROTONIN, DOPAMINE, GABA ↓

HELPLESS, HOPELESS, APATHY

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• DISFUNCTION OF THE BRAIN REGION IN
DEPRESSION

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 • SCHIZOPHRENIA

Severe mental disorder

Delusion, halucination, disturbance in thought

process, catatonia, ect

Impairment in social and occupational function

The disturbance persist for at least 1 month

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 • THE ETIOLOGY OF SCHIZOPHRENIA

The etiology of schizophrenia is still unknown

Factors contribute to schizophrenia

• Genetic factor
• Prenatal and perinatal complications: hypoxia, prenatal viral
infection, substance abuse during pregnancy, head trauma
during delivery

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 • THE BRAIN STRUCTURE ABNORMALITY IN
SCHIZOPHRENIA

• There are several

abnormalities in the brain
structure
BRAIN • Disturbance in neuron
STUDY development before, during
and after birth
(AUTOPSY) • The abnormality of the brain
structures are the areas which
are susceptible to
schizophrenia

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THE BRAIN REGION
RELATED TO
SCHIZOPHRENIA

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• TEMPORAL LOBE

Disturbance in
temporal lobe is
related to:
1. Halucination
2. Delusion
3. Difficulty in
object/face
recognition

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• FRONTAL LOBE

Frontal lobe
hypoactivity:
1. Decreased
cognitive function
2. Disturbance in
behavioral
planning
3. Blunted affect
4. Social isolation
5. Apathy
6. etc

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• THE LIMBIC SYSTEM INVOLVED IN
SCHIZOPHRENIA

Hippocampus

Amygdala

Thalamus

Cingulate Gyrus
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• HIPPOCAMPUS

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• AMYGDALA

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• CINGULATE GYRUS

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• THALAMUS

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• VENTRICLE ENLARGEMENT

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• NEUROTRANSMITTERS IN SCHIZOPHRENIA

Dopamine

Serotonin

Norepinephrine

Acetylcholine

Glutamate
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 Dopaminergic System

Nigrostriatal Pathway
Subs. Nigra to striatum
Motoric control
EPS
Neuronal death
Tuberoinfundibular
leads to Parkinson disease Pathway
Mesolimbic & mesocortical Hypotalamus to hypophiseal
pathway Hormone Regulation
Pregnancy, maternal behavior
Sensory Integration
To NA, Amigdala, Hippocampus, and PFC
Hyperprolactinaemia
. Memory, Motivation and emotional response
. Reward and will , Addiction
. Hallucination
Mesolimbic Hyperactivity  (+) symptoms
mesocortical Hypoactivity  (-) symptoms &
cognitive
deficit

5/17/19 31
 • MOOD DISORDER: BIPOLAR

Bipolar I Bipolar II Bipolar NOS Cyclothymia

• Manic or • Hypomania • Not fullfil • 2 years

mix 4 days the specific • Not fullfil
• Impairment • Never criteria for ther criteria
in manic or bipolar I or for
functioning mix type II depression,
areas & • Recurrent • Hypomania manic or
obvious depression 4 days mix episode
symptoms • Usually • Dysthimia
• Usually with
with recurrent
recurrent depression
depression
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 ACETYLCHOLIN

AN
I ST TA
GO
ON NIS
AG T
DEPRESSION MANIA

1. Psychmotor 1. Motor hyperactivity

retardation 2. Energetic
2. Lethargy 3. No need to sleep
3. Sleep disturbance 4. Self esteem 
4. Learned
helplessness

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 DOPAMINE SYSTEM

TUBERO SUBSTANSIA
INFUNDIBULAR MESOLIMBIC MESOCORTEX
NIGRA

EMOTION EXPR MOTIVATION

CONTROLLED MOTOR LEARNING CONCENTRATION
PROLACTINE ACTIVITY REINFORCEMENT EXCECUTIVE FC
HEDONIA

SUBSTANSIA
PROLACTINE MESOLIMBIC MESOCORTEX
NIGRA

MANIA/DEPRESSION 34
• THE BRAIN FUNCTION

Brain blood flow 

Brain metabolism 

Hipofrontality
• Left hemisphere   depression
• Right hemisphere   mania
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• PREFRONTAL CORTEX DISTURBANCE

Schizophre- Bipolar
nia

• Depressive
• Negative Episode
Symptoms • Anergia
• Apathy • Sad
• Blunted • Cognition
affect &
• Poverty of concentra
speech & tion 
ideas

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• LIMBIC SYSTEM DISFUNCTION

Schizophrenia Bipolar
Possitive Emotional &
Symptoms: behavioral
• hallusination disturbances
• delution

The same symptom might be

shown in schizophrenia and
bipolar, because the limbic
system is involved in both
disorders

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 • CONCLUSION
Mental disorder  multiple factors interaction
Gene interaction with environment
Stressors increase the activation of HPA axis
Stresssors cause various kind of mental disorders
Disturbances of neurotransmitters
Disturbances of neurohormonal
Disturbances of brain function
Disturbances of brain structure
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Thank you
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