Buku Asbtrak Simposium Bipolar

MASYARAKAT
NEUROSAINS INDONESIA
(Indonesia Neuroscience Society)
Masyarakat Neurosains Seksi Bipolar dan Gangguan

Indonesia (MNI) Mood lain, PDSKJI
BUKU ABSTRAK SIMPOSIUM

THE 3rd BIPOLAR AND OTHER MOOD
DISORDERS SYMPOSIUM
IN COLLABORATION WITH
THE 2nd NEUROSCIENCE CONGRESS OF THE

INDONESIAN NEUROSCIENCE SOCIETY
“Mood, Cognition and Neurological Problems:
Implementing Neuroscience Perspectives
for Better Education and Society"
June, 13th-15th 2019
www.bipolarneurosains.com
DAFTAR ISI
Perspektif Klinis Penanganan Gangguan Bipolar

Sasanto Wibisono..................................................................................................................... 1
Pengembangan dan Tantangan dalam Mengobati Pasien Dengan Gangguan Bipolar

Nurmiati Amir .......................................................................................................................... 2
Clinical Implication of Current Brain Image studies in Bipolar Disorders

Sri Andreani Utomo ................................................................................................................. 3
The Importance of Cognitive Function in Mood Disorders

Margarita M. Maramis ............................................................................................................. 4
Association Of Fear Aura With Mood and anxiety Disorder in Epileptic Patient
Kurnia Kusumastuti ................................................................................................................. 5
Emotional Pain in Epilepsy in Bipolar Disorder

A.A.A.A. Kusumawardhani ..................................................................................................... 6

A.A.A.A. Kusumawardhani ..................................................................................................... 7
Character Building Model Based on Neuroscience : A Neuro sociological Approach

Ananta Yudiarso S.Sos MSi..................................................................................................... 8
Personality from Eastern Medical perspective and Neuroscience

Abdurachman ........................................................................................................................... 9
Brain and Behavior

Jusuf Sutanto ............................................................................................................................ 10
Aktivitas Musik dan Neuron Mengubah Perilaku

Anwar Wardy W ...................................................................................................................... 11
Music and Neuro Activities Change Behavior

Anwar Wardy W ...................................................................................................................... 12
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‘Wanting’ and ‘Liking’ Brain Mechanisms in Coaching:
A qEEG Study using the CARE Coaching Model
Lyra Puspa1, Nurhadi Ibrahim2, and Paul T. Brown3............................................................. 13
Farmakogenetika, Dapatkah Bermanfaat Bagi Dokter ?

B. Handoko Daeng ................................................................................................................... 14

B. Handoko Daeng ................................................................................................................... 15
Domestic Violence on Mood Disorder and Prospect of Therapy

Lely Setyawati Kurniawan ....................................................................................................... 16
Mitochondrial : The Energy Pathway in Mood Disorders

Debree Septiawan .................................................................................................................... 17
Neuroscience Aspects Of Emotional Disorder In Pediatric Bipolar

Nining Febriyana...................................................................................................................... 18
Aspek Neurosains Gangguan Emosional Pada Bipolar Anak

Nining Febriyana...................................................................................................................... 19
Behavior Therapy for Emotional Disorder in Bipolar Children

Ratna Kurniasari ...................................................................................................................... 20

Ratna Kurniasari ...................................................................................................................... 21
Metafisika Otak, Berpikir Rasional Transendental

Musa Asyarie ........................................................................................................................... 22
Regenerative Medicine and Neurosurgery for Psychiatric Disorders

Abdul Hafid Bajamal, Achmad Fahmi Baabud , Heri Subianto , Agus Turchan ................... 23
Non-invasive Intervention For Neurological Problems

Paulus Sugianto ........................................................................................................................ 24
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Behavioral Effects of Neurological Problem
Soetjipto ................................................................................................................................... 25
Investigating Potential Role of EFA-6 in Neurodegeneration

Gerrick Pantouw ...................................................................................................................... 26
Behavior Management for Traumatic Brain Injury

Elmeida Effendy ...................................................................................................................... 27
Neurosurgery Intervention For Obsessive-compulsive Disorder: Review Of Current

Evidence
Agus Turchan, Achmad Fahmi, Heri Subianto, Muhammad Reza Arifianto .......................... 28
Astrogliosis Plays Role In Hydrocephalic Cognitive Impairment: A Therapeutic

Opportunity
Wihasto Suryaningtyas, M.D., Ph.D, Muhammad Arifin Parenrengi, M.D., Ph.D ................. 29
Astrogliosis Plays Role In Hydrocephalic Cognitive Impairment: A Therapeutic

Opportunity
Wihasto Suryaningtyas, M.D., Ph.D, Muhammad Arifin Parenrengi, M.D., Ph.D ................. 30
Circadian: The Sleep Dysregulation Pathway In Bipolar Disorder

Wardah Rahmatul Islamiyah .................................................................................................... 31
Abnormalitas Reward Sensitivity pada Gangguan Mood

Azimatul Karimah .................................................................................................................... 32
Pharmacological and Psychosocial Intervention for Post Stroke Depression

Erikavitri Yulianti .................................................................................................................... 33

Erikavitri Yulianti .................................................................................................................... 34
Gut and Brain Connection, Nutritional Approach for treating Bipolar Disorder: a New
Paradigm.
Tifauzia Tyassuma ................................................................................................................... 35
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Stress and The Glucocorticoid Pathway
Nalini Muhdi ............................................................................................................................ 36
Neuroscience Intervention For Better Life: From Molecular, Cellular, to Organ

Interventions
Moh Hasan Machfoed .............................................................................................................. 37
Important of Cognitive Neuroscience: impact in clinical Practice

Abdulloh Machin ..................................................................................................................... 38
The Miracle Of The Heart

Muhammad Iqbal Basri ............................................................................................................ 39
Chronic Pain and Bipolar Depression Disorder

Santi Yuliani, Dyah Wiratmi, Adam Kurnia Wandana ........................................................... 40

Santi Yuliani, Dyah Wiratmi, Adam Kurnia Wandana ........................................................... 41
Pathophysiology of Chronic Pain : The Role of Serotonin and Norepinephrine

Dyah Wiratmi Puspitasari ........................................................................................................ 43
Patofisiologi Nyeri Kronis : Peran Serotonin dan Norepinefrin

Dyah Wiratmi Puspitasari ........................................................................................................ 44
The Rule of Opioid In Chronic Pain Treatment

Adam Kurnia Wardana ............................................................................................................ 45
Neuropsychology Changes In Mood Disorder

Yunias Setiawati ...................................................................................................................... 46
Hubungan antara Fibromialgia dengan Gangguan Bipolar yang berkomorbid

The Connection between Fibromyalgia and Comorbid Bipolar Disorder
Tuti Wahmurti AS.................................................................................................................... 47
Somatic & Physical Illness

DR. Dr. Cokorda Bagus Jaya Lesmana, SpKJ(K), MARS ...................................................... 48
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Clinical implication of current brain image and genetic findings in bipolar disorder: State
of The Art.
Yuan-Hwa Chou MD, PhD ...................................................................................................... 49
Spirituality Related To Personality Neuroscience And Disease Management

Taufiq Pasiak............................................................................................................................ 50
v|www.bipolarneurosains.com
Perspektif Klinis Penanganan Gangguan Bipolar
Sasanto Wibisono
Mood, Cognition and Neurological Problems merupakan aspek yang umum menjadi permasalahan
dan gejala klinis dari hampir semua gangguan psikiatri dan neurologi – juga pada banyak kondisi
medik lain.
Aspek-aspek tersebut dalam perspektif neuroscience sudah mengalami perkembangan pesat yang
sangat penting dalam kemajuan pemahaman dan penanganan permasalahan klinis, meskipun dalam
perspektif penanganan klinis praktis masih menyisakan tantangan ilmiah yang luar-biasa.
Presentasi ini bukan bermaksud mengecilkan makna dari segala konsep teori yang sudah dibangun
baik secara empiris maupun berdasarkan penelitian / evidence based lain, namun lebih dimaksudkan
untuk kiat memberi makna yang lebih bermanfaat bagi perkembangan ilmu ditinjau dari perspektif
klinis praktis, bagi kepentingan ‘pasien’, bukan untuk kepentingan teori itu sendiri. Jangan sampai
perkembangan ilmu (neurosains dll.) yang begitu penting dalam memperkaya dan memperluas
wawasan kita, justru mempersempit pandangan klinis dalam mengambil kesimpulan bagi
penanganan pasien. Hal tersebut penting agar supaya kita lebih realistik, objektif, rasional dan
bijaksana dalam menentukan strategi penanganan pasien, dengan memanfaatkan wawasan teoretik
yang kita miliki.
Dalam prospek jangka panjang akan membantu dalam efisiensi/efektifitas tindakan secara lebih
proporsional sehingga dapat menghemat tenaga maupun beaya bagi pasien, keluarga, dan praktisi,
se-optimal mungkin sesuai kondisi individual yang ada.
Judul (topik) difokuskan pada Gangguan Afektif Bipolar,agar tidak terlalu luas dalam membuat
ilustrasi. Pembahasan bersifat umum di sesuaikan dengan berbagai aspek terkait yang dianggap
relefan antara lain:
 Faktor penyebab/risiko (konstitusional/genetic, social-lingkungan, dsb.)
 Pemeriksaan dan diagnosis
 Strategi dan modalitas terapi
 Peran praktisi klinis
 Beberapa ilustrasi dan bahasan
 Kesimpulan
Keywords: wawasan teori, perspektif klinis.
Tema Pertemuan: ‘Mood, Cognition and Neurological Problems: Implementing Neuroscience

Perspective for Better Education and Society’ – Surabaya, Juni 2019
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Pengembangan dan Tantangan dalam Mengobati Pasien Dengan Gangguan Bipolar
Nurmiati Amir
Staf Departemen Medik Psikiatri RSUPN Dr. Ciptomangunkusumo/FKUI
Keterlambatan tegaknya diagnosis merupakan salah satu tantangan pada gangguan bipolar. Rerata
tertundanya diagnosis gangguan bipolar adalah satu dekade. Keterlambatan diagnosis dapat
disebabkan oleh komleksnya dan bervariasinya fenomenologi gangguan bipolar, misalnya subtipe,
perjalanan penyakit, dan presentasi gejalanya yang bergantung usia. Selain itu, simtom depresif
yang pervasif membuat gangguan depresi mayor penting untuk difrensial diagnosis.
Kebanyakan pasien dengan gangguan bipolar mengalami episode gangguan depresi mayor sebagai
episode awal dan episode manik terjadi kemudian. Akibatnya, di awal sakit, diagnosis episode
gangguan depresi mayor lebih sering ditegakkan. Setelah muncul episode manik, diagnosis
gangguan bipolar baru bisa dibuat.
Sulitnya membedakan antara episod hipomanik dengan eutimik juga menjadi tantangan pada
gangguan bipolar. Pada episod hipomanik, fungsi pasien terlihat meningkat dan lebih baik. Baiknya
fungsi ini menjadi tantangan dalam membedakan antara episode hipomanik dengan eutimik.
Adanya komorbiditas antara gangguan bipolar dengan gangguan jiwa lainnya, misalnya dengan
gangguan penyalahgunaan zat, gangguan cemas, dan gangguan kepribadian kelompok B juga
menjadi tantangan dalam mendiagnosis gangguan bipolar.
Terapi gangguan bipolar juga menjadi tantangan. Hal ini disebabkan oleh heterogennya gangguan
bipolar, misalnya berbagai bentuk simtom mood, perjalanan penyakit, dan komorbiditas. Tantangan
lainnya yaitu terjadinya perpindahan episode mood dengan pemberian antidepresan. Misalnya,
terjadinya episode manik atau hipomanik akibat pemberian antidepresan.
Intervensi farmakologi pada lansia dengan gangguan bipolar juga menjadi tantangan. Penyebabnya
adalah kondisi komorbid, gangguan metabolisme, dan potensi interaksi obat yang sering terdapat
pada pasien lansia. Dengan mengetahui berbagai tantangan, pengembangan ke arah perbaikan
dapat dilakukan.
Kata Kunci: gangguan bipolar, tantangan, diagnosis, terapi
Clinical Implication of Current Brain Image studies in Bipolar Disorders
Sri Andreani Utomo
Neuroradiology Consultant
Dr. Soetomo Hospital, Faculty of Medicine, Airlangga University Surabaya, Indonesia
Bipolar disorder is the 12th leading cause of disability in the world, according to the World Health
Organization, ahead of asthma, glaucoma, Alzheimer‟s and drug abuse problems. All of those
illnesses are highly prevalent in national discussion of disease and treatment.
Bipolar disorder causes changes in a person‟s mood and energy. These extreme and intense
emotional states, or mood episodes, can affect their ability to function. People with bipolar disorder
can have periods of normal moods as well.
The loss or damage of brain cells in the hippocampus can contribute to mood disorders. The
hippocampus is the part of the brain associated with memory. It also indirectly affects mood and
impulses.
Study suggests bipolar disorder may cause progressive brain damage. A study by researchers at the
San Francisco VA Medical Center indicates that people with bipolar disorder may suffer
progressive brain damage. More than 2 million Americans suffer from bipolar disorder, commonly
known as manic depression.
Bipolar brain imaging shows how the bipolar brain is different. Brain imaging shows a significant
reduction in grey matter volume. It comes from a study of patients with bipolar disorder. They
found people with bipolar disorder suffer from an accelerated shrinking of their brain.
DTI in attempters demonstrated significantly lower fractional anisotropy than nonattempters in a

left uncinate fasciculus region extending into left ventral frontal areas, a right uncinate region, and
the right cerebellum. Abnormal Fractional anisotropy is also detected in genu of corpus callosum
in patient with bipolar disorder
Functional connectivity from attempters demonstrated significantly lower functional connectivity
than non attempters from the amygdala to a left ventralprefrontal region, including orbitofrontal,
rostral prefrontal, and ventral anterior cingulate areas, in happy and neutral conditions
With sophisticated MRI scanning to see how the amygdala, a set of neurons that play a key role in
processing emotions reacts as a patient processes facial expressions such as anger, fear, sadness,
disgust and happiness. In people with bipolar disorder, the left side of the amygdala is less active
and less connected with other parts of the brain than in people with depression. The findings from
this study had 80% accuracy in making this distinction.
Keywords: MRI, Functional MRI, DTI, FA
The Importance of Cognitive Function in Mood Disorders
Margarita M. Maramis
Department of Psychiatry, Faculty of Medicine, University of Airlangga
Dr Soetomo General Academic Hospital - Surabaya
Bipolar disorder is a chronic with episodic progress and high relapse rate. Neurocognitive
impairment occur in schizophrenia has been recognized for long ago. Recently have significantly
finding there are neurocognitive deficits in bipolar disorder. Bipolar patients have cognitive
impairment regardless of the phase of illness. Higher cognitive deficits observed in manic episode
especially verbal and working memory, executive function/reasoning, and problem solving. In the
severe course of illness and multiple affective episodes also have higher impairment of cognitive
functions.
Deficits in cognitive function are both transitory (acute phase of illness) and persistent
(chronic/residual symptoms). Neurocognitive impairment are prominent during acute depressive
and also manic episodes, occurs in both bipolar I and bipolar II disorder and for all, still not
resolve during euthymia. Some studies show that more cognitive impairment in bipolar I and
bipolar patients with a history of psychosis, even during affective remission.
Although cognitive deficits in bipolar disorder qualitatively overlap with, but are less severe than,
those in schizophrenia. The importance of cognitive problems in relation to achieve complete
functional recovery and finally decrease quality of life in bipolar disorder patients.
There fore it is important needs to screen cognitive function dynamically in baseline and in
remission, considering treatment choice and prevention efforts targeting cognition in bipolar
patients. Neurocognitive programs for rehabilitation could be perform for each subgroup of
bipolar patients. Clinical assessment and cognitive tests to determine the stability or evolution of
cognitive impairment in time.
Keywords: Cognitive impairment, Bipolar disorders, Screening, Treatment.
Association Of Fear Aura With Mood and anxiety Disorder in Epileptic Patient
Kurnia Kusumastuti
Medical Faculty, Airlangga University, Surabaya, Indonesia
Epilepsy has been associated with behavioral disorders most commonly mood and anxiety
disorders. Behavioral disorders may be explained by psychological factors such as disruption of
social fungtioning, perceive stigma, frustration, and fear of seizures; by brain related factors such
as severity and type or location of epilepsy, and iatrogenic factors such as antiepileptic
drugs(AEDs). In mesial temporal lobe epilepsy , decreased volume and cell loss of anterior
temporal structures, especially hippocampus and amygdala have been reported. Auras reflect
abnormal stimulation of brain areas in close proximity to regions from which clinical seizures
originate. Auras of mesial temporal lobe epilepsy include experiential phenomena such as fear
and deja and jamais vu illusions.
Electrical stimulation of the human amygdala has been reported to produce most commonly fear
and anxiety , déjà vu and hallucinatory experiences and changes in autonomic functioning. Recent
studies linked severe amygdala atrophy with a history of fear at the onset of seizures and a possible
relationship between bilateral amygdala atrophy and aggressive outburst in patiens with temporal
lobe epilepsy. These findings support a possible relationship between mesial temporal lobe epilepsy
and mood disorders.
Keywords: epilepsy, aura, behavioral disorders, amygdala, hippocampus
A.A.A.A. Kusumawardhani
Departemen Psikiatri FKUI/RSCM
Emotional pain atau nyeri emosional disebut juga nyeri psikologik, atau nyeri mental, adalah
perasaan tidak nyaman (suatu penderitaan) yang terjadi akibat dari kondisi psikologis, dan bukan
berasal dari kondisi fisik. Orang dengan epilepsi dan orang dengan gangguan bipolar, akan
mengalami gangguannya dalam jangka waktu yang cukup panjang dan bahkan mungkin seumur
hidupnya. Mudah dimengerti bahwa mereka akan sangat mungkin mengalami emotional pain atau
nyeri emosional tersebut.
Tanda-tanda emotional pain antara lain adanya rasa sedih berkepanjangan, menangis yang tidak
terkendali atau sulit untuk dijelaskan, rasa bersalah, rasa tidak berguna, kehilangan rasa percaya diri,
putus asa, dan tidak berdaya. Tanda dan gejala tersebut tidak cukup khas untuk suatu diagnosis
depresi secara klinis.
Walaupun kejang pada epilepsi dapat terkendali, kondisi epilepsi itu sendiri dapat memengaruhi
kehidupan sehari-hari pasien karena timbulnya kejang sulit untuk diprediksi. Mereka juga dapat
mengalami isolasi sosial karena mereka dianggap tidak mampu mengendalikan otak dan tubuhnya,
serta senantiasa merasa cemas tentang apa yang akan dipikirkan orang terhadap kondisi kejangnya.
Pasien dengan gangguan bipolar akan lebih mudah merasakan emotional pain pada saat episode
depresi. Sementara pada saat episode manik, pasien cenderung merasa segala sesuatu yang
dihadapinya adalah masalah mudah dan menyenangkan. Dalam jangka panjang, ke dua gangguan
ini dapat menyebabkan timbulnya hendaya dalam fungsi khususnya fungsi pekerjaan dan hubungan
interpersonal sehingga dapat menurunkan kualitas hidup mereka.
Terjadinya emotional pain dapat dijelaskan melalui teori stress-diathesis yaitu teori psikologi yang
mencoba menjelaskan terjadinya gangguan sebagai hasil dari interaksi antara predisposisi
kerentanan individu dan stress kehidupan yang dihadapi.
Kata kunci: nyeri emosional, epilepsi, bipolar
A.A.A.A. Kusumawardhani
Psychiatric Department FKUI/RSCM
Emotional pain, psychological pain, or mental pain, is an unpleasant feeling (a suffering) of a

psychological, non-physical origin. People with epilepsy and bipolar disorder, usually suffered for
a long period and may be for all of their life. It is understandable that they are very likely to
experience that kind of feeling.
Emotional pain may be indicated by prolonged sadness, unexplained and uncontrollable crying,
feelings of guilt,  feelings of worthlessness,  loss of self-esteem, despair/hopelessness, and
helplessness. These symptoms, especially taken individually, are not unique to clinical depression.
Although epileptic seizure can be controlled, that condition still influence their daily activities
because off seizure attack is very difficult to predict. They also experience social isolation because
they are considered as someone who cannot control their brain and body, and always worry about
other‟s perception about their seizure condition.
People with bipolar disorder will suffered from emotional pain more frequently in their depressive
episode. While in manic condition, they feel like everything is easy and joyful. Both of this disorder
can cause dysfunction in their job, interpersonal relationship and will decrease their quality of life.
Stress-diathesis theory is a psychological theory which can used to explain how emotional pain
could happen as a result of interaction between individual predisposition vulnerability and life
stress.
Key words: emotional pain, epilepsy, bipolar
Character Building Model Based on Neuroscience : A Neuro sociological Approach
Ananta Yudiarso S.Sos MSi
Faculty of Psychology Surabaya University
The objective of this article is to explain character building based on neuroscience especially neuro
sociological approach. Neuro sociological approach is socio biological perspective that study the
relation between neuronal activities and social action and social structure. This article was focused
on (1) Neuro sociological approach on character building. Character building concept is close to
the concept of personality that have been explained by neural activity of neurotransmitter in
previous studies. (2) The relation between social action and social structure to neuronal mechanism
on character building. Three neural processes and mechanism of mirror neuron, brain plasticity
and epigenetic was emphasized in character building.
Key words : character building, neuro sociological approach, neurotransmitter, brain plasticity,
mirror neuron, epigenetic
Personality from Eastern Medical perspective and Neuroscience
Abdurachman
Department of Anatomy and Histology, Medical Faculty of Universitas Airlangga Surabaya
Background:
Modern medical science has been started since DNA was discovered. DNA discovery is based on
Einstein's relativity, E  m C2. Personality is an energy component (E). Energy has formula that is
different from physical (m).
Aims:
To introduce the concept of personality through quantum physics, then collaborating the concept of
Eastern medical personality with neuroscience.
Method:
By investigating the trusted references on the history of DNA discovery, quantum physics,
personality, Eastern medical theory, and then collaborate with neuroscience.
Results:
In accordance with the formula in quantum physics, personality is a component of energy. Energy
has different rules than physical. Energy and physical are equivalent. Physical changes always
cause energy changes. Physical changes always cause changes in behavior. Changes in living
sedentary behavior cause personality changes. An individual who has undergone a physical change
he has changed his personality. In neuroscience, personality changes will be indicated by changes
in the appearance of the quantity and quality of nerve cells. Neuroscience that addresses behavior
is neurobehavior.
Eastern medicine knowing Five Elements Theory. It correlates with The Big Five Personality in
West.
Conclusion:
To understand personality from the perspective of Eastern medicine is the same as understanding
the personality from quantum physics. Personality changes will cause changes in the quantity and
quality of nerve cells.
Keywords: E  m C2, Personality, Five Elements, The big Five, Neurobehavior
Brain and Behavior
Jusuf Sutanto
The Science of Holistic Relationship and Peace Culture?

• Diversity, yet in Unity of Universe. Man made civilization fails to realize. Never
ending conflicts occurred such as World War I (1914-1918) 4 years, 3 months, 2 weeks,
38 million dead. World War II (1939-1945) 6 years, 1 day, 73 million dead-. Followed by
Cold War, Trade War, Cyber War, Terorism, Depression, Split personality etc Internal
Conflicts in all organization are unsolved.
• Information Technology creates infinite diversity. Parent loss control their children
“missing link generation”
• The progress of science and technology can not be stopped. Will our civilization better or
even worst towards Nuclear World War III.
World Population by Ethnics and Languages

• If the world as village with 1000 inhibitants: 58 4 Asians – 134 Africans – 95 East and West
Europe – 84 Latin American -55 ex Soviet Union–52 USA–5 Austrlia and New Zealand –
• 165 Mandarin – 86 English – 83 Urdu – 64 Spanish – 58 Russia – 37 Arabs – The Rest

speak Bengali, Portugis, Indonesia, Japan, German, France and others
Leaders
• 100 people holding weapon for mass destruction. The rest 900 only can pray not used for 3rd
World War
The Brain Decade

„Unity in diversity‟ in neuro-science. To the mind that is still, the whole universe surrender. The
destructive power of nuclear bom is within unpeaceful mind of the leader.
Future Transnational Ideologies:
Pancasila--Universal Declaration of Human Rights and Responsibilities-- Religion, the Science
of Happiness and Peace-- Sustainable Development Goals (SDGs)
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Aktivitas Musik dan Neuron Mengubah Perilaku
Anwar Wardy W
“...musik menyerap setiap energi sosial, dan mampu membiaskan;..musik menyerap setiap tanda,
setiap makna hidup, dan mampu memantulkannya;...musik menyerap setiap pesan indah dan hanya
kita mampu mengunyah, memahami dan menyelaminya...namun kita hanya mampu menjadi
bayangan dari musik yang abadi...” Anwar Wardy W, April 2019
Musik mengaktifkan bagian yang lebih besar dari otak, dan juga rangsangan lain selain selera musik
untuk mengungkapkan keinginan spiritual kita. Musik menstimulasi banyak daerah otak pada saat
yang sama misalnya, bertanggung jawab untuk emosi, memori, rasa dan perilaku pada waktu itu.
Sedangkan syair dari lagu mengaktifkan area Broca dimana terhubung dengan vokalisasi dan
kenangan suara sang penyanyi yang pernah didengar. Setiap orang akan tahu perasaan dan
perjalanan waktu saat mendengarkan sebuah lagu dan akrab; dengan kenangan masa lalu. Musik
mengajarkan pengendalian diri, untuk bergilir dan menahan emosi seperti anak-anak menunggu
nama yang akan dipanggil untuk sebuah kegiatan, menunggu awal dan terstruktur dalam suatu
kegiatan, dengan cara yang tepat. Seorang akan bermitra secara alami dengan musik dalam bentuk
gerakan; memukul, mengetuk, menggesek, meniup, memetik. Gerakan ini merupakan respon
nonverbal bagi seseorag yang belum memiliki kemampuan mengubah perilaku. Musik mengontrol
diri mendorong individu untuk mendengarkan dan bergerak erat bersama orang lain, meningkatkan
kemampuan perilaku mereka untuk menghormati sesame, instruksi pemimpin, guru, dosen, dan bisa
mengukur kekuatan, dan kelemahan diri. Pengaturan diri yang diajarkan adalah keterampilan, yang
diperlukan untuk belajar seumur hidup untuk masa depan dengan bermusik sesuai keinginan.
Musik ciptakan kreativitas dan kebebasan berekspresi yang dipromosikan, memberikan jalan pada
seseorang untuk mendapatkan kepercayaan diri mereka, dan bernyanyi akan memberi suara mereka
yang baik dalam arti harfiah dan kiasan. Musik melibatkan seseorang dengan cara yang menarik
dan nyaman yang dapat dilanjutkan pada pertemuan di rumah, keterampilan yang berharga ini
untuk memperluas pembelajaran di rumah atau masyarakat dan terus diterapkan berlangsung dalam
kehidupan bermasyarakat.
Kata kunci: Musik, Neurosain, Aktifitas Neuron dan Perilaku.Abstrak.anwarwardy.2019
Music and Neuro Activities Change Behavior
Anwar Wardy W
Music activates a larger part of the brain, as well as other stimuli besides the
taste of music to express our spiritual desires. Music stimulates many brain regions
at the same time, for example, is responsible for emotions, memory, taste and
behavior at that time. While the lyrics from the song activate Broca's area where it
is connected with vocalizations and memories of the singer's voice that has been
heard. Everyone will know the feeling and time when listening to a song and be
familiar; with past memories. Music teaches self-control, to take turns and hold
emotions like children waiting for names to be called for an activity, waiting for the
beginning and structured in an activity, in the right way. A person will partner
naturally with music in the form of movement; hit, knock, swipe, blow, pick. This
movement is a nonverbal response for someone who does not have the ability to
change behavior. Music self-control encourages individuals to listen and move
closely with others, improve their behavioral abilities to respect others, instruct
leaders, teachers, and can measure their strengths and weaknesses. Self-regulation
taught is a skill, which is needed for lifelong learning for the future with music as
desired.
Music creates creativity and freedom of expression that is promoted, gives

way to someone to gain their self-confidence, and singing will give them a voice
that is both literal and figurative. Music involves someone in an interesting and
comfortable way that can be continued at home meetings, this valuable skill to
expand learning at home or society and continue to be applied in community life.
Keywords: Music, Neuroscience, Neuron Activity and Behavior
‘Wanting’ and ‘Liking’ Brain Mechanisms in Coaching:
A qEEG Study using the CARE Coaching Model
Lyra Puspa1, Nurhadi Ibrahim2, and Paul T. Brown3
1
Salomon Centre for Applied Psychology, Faculty of Social and Applied Sciences, Canterbury
Christ Church University, Kent, UK; and Vanaya NeuroLab Brain & Behavior Research Center,
Jakarta, Indonesia
2
Department of Medical Physiology, Faculty of Medicine; Medical Technology Cluster IMERI; and
Neuroscience & Brain Development Cluster IMERI; Universitas lndonesia, Jakarta, Indonesia
3
Faculty Professor in Organizational Neuroscience, Monarch Business School, Zurich, Switzerland
Coaching has become increasingly popular for leadership development and behavioral
change in organizations. Recent studies suggest that motivation is essential in enhancing the
effectiveness of workplace coaching. A number of studies revealed that delta and beta oscillations
are associated with the human motivational process through „wanting‟ and „liking‟ mechanisms.
However, the brain mechanisms of motivation in coaching have not been studied. This preliminary
study is the first attempt to explore the „wanting‟ and „liking‟ mechanism of coaching, by
investigating the activity of the delta and beta oscillations during a face-to-face coaching session
through quantitative electroencephalogram (qEEG).
Six male, right-handed, middle managers of an organization (mean age = 31.6) were
recruited voluntarily as participants. The multichannel EEG (19 electrodes, 10/20 System) was
used to record the brain activities in both the resting state and the continuous 45-minute coaching
session using the CARE Model. The artifact-free EEG data was then quantified using event-related
desynchronization and event-related synchronization (ERD/ERS) analysis.
The result shows a significant increase in both delta-band and beta-band activities
throughout all the CARE stages of the coaching session. Increased delta absolute power was found
in the frontal region, whilst increased beta-band activity was significantly detected in the frontal,
posterior temporal, and occipital regions. This preliminary result suggests that coaching, with
regard to the CARE Model, induces both „wanting‟ and „liking‟ mechanisms simultaneously. Thus,
the present findings provide the preliminary neuroscientific underpinning of the role of motivation
in enhancing the effectiveness of workplace coaching through induced „wanting‟ and „liking‟
mental processes.
Keywords:
coaching, motivation, wanting and liking, qEEG, ERD/ERS
B. Handoko Daeng
Psikiater, Konsultan Dalam Bidang Psikiatri Biologi Universitas Katolik Widya Mandala Surabaya
Since the mapping of the human genome was completed in 2003, the genetic application in the
clinical practice is growing rapidly, among others, the diagnosis of disease or medical disorders,
congenital diseases, or their application in pharmacogenetic.
Pharmacogenetics is an individual medicine, where we can find out the possible effectiveness and
side effects of drugs on certain genetic work. At this time polypharmacy is increasingly being
carried out, and with the increasing population of elderly people, it is possible that drug
combination therapy will be higher, even more than five kinds of drugs at once. Thus the treatment
costs, and the possibility of side effects and drug interactions is getting bigger.
So pharmacogenetic studies, will lead therapists to choose drugs as effectively as possible, with the
least possible pattern of side effects, especially in long-term management. So we use drugs that
have the best therapeutic effects, as few side effects as possible, at the lowest possible cost.
At present the application of pharmacogenetics in health services especially in Indonesia is not yet
as standard of care.
Keywords: pharmacogenetic, therapeutic effectiveness, drugs side effect, cost of treatment
B. Handoko Daeng
Sejak pemetaan Genom manusia selesai pada tahun 2003. maka penerapan genetik dalam klnik
berkembang pesat, antar lain diagnosis penyakit atau ganggauan medis, misalnya berapa penyakit
bawaan, atau penerapannya berupa farmakogenetik.
Farmakogenetik adalah sebuah kedokteran individual, di mana kita bisa mengetahui kemungkinan
efektivitas serta efek samping obat terhadap kerja genetik tertentu. Pada saat ini polifarmasi
semakin sering dilakukan, dan dengan meningkatnya populasi orang usia lanjut, maka
kemungkianan terapi kombinasi obat semakin tinggi, bahkan lebih dari lima macam obat sekaligus.
Dengan demikian biaya pengobatan semakin besar, dan kemungkian efek samping serta interaksi
obat semakin besar. Jadi farmakogenetik studi, akan menuntun terapis memilih obat seefektive
mungkin, dengan pola efek samping sekecil mungkin, terlebih dalam penatalaksanaan jangka
panjang. Sehingga kita memakai obat yang punya efek terapeutik terbaik, efek samping yang
sesedikit mungkin, dengan biaya yang semurah mungkin.
Saat ini penerapan farmakogenetik dalam pelayanan kesehatan khususnya di Indonesia masih belum
menjadi standar pelayanan.
Katakunci: farmakogenetik, efek terapeutik, efek samping obat, biaya pengobatan
Domestic Violence on Mood Disorder and Prospect of Therapy
Lely Setyawati Kurniawan
It is not always easy to predict at the beginning of a relationship if it will become abusive. In fact,
many abusive partners may seem absolutely perfect in the early stages of a relationship. Possessive
and controlling behaviors don‟t appear in several months and years, but rather emerge and
intensify as the relationship grows. Abusive relationships have in common is that the abusive
partner does many different kinds of things to have more power and control over their partner.
Recent research has found that experiences of domestic violence are more common among adults
with all types of mental health disorders than the general population.
Domestic violence refers to violence, abuse and intimidation between people who are are currently
or have previously been in an intimate relationship. The perpetrator uses violence to control and
dominate the other person. This causes fear, physical harm and psychological harm. Domestic
violence is a violation of human rights.
Mood disorders are suspected as one of the mental disorders that underlies a person committing
violence against his family, with various social backgrounds they have. Traumatic experiences in
childhood seem to influence the emergence of potential for violence in adulthood and vulnerability
to psychiatric disorders. Mood disorders are often associated with traumatic childhood experiences
and potential emergence of domestic violence.
Early detection and sufficient vigilance of the possibility of a mood disorder need to be educated
and socialized to all married couples, as part of pre-marital counseling, and recognized by every
marriage counselor. Thus when one or both of them apparently suffer from a mood disorder, they
are accustomed to seeking help. With good and structured family psychotherapy, the prospect of
therapy will get better.
Keywords: Domestic Violence - mood disorders - prospects of therapy
Mitochondrial : The Energy Pathway in Mood Disorders
Debree Septiawan
Department of Psychiatry, Division of Biological Psychiatry, Sebelas Maret University, Surakarta,
Indonesian.
Mitochondrial dysfunctions are assuming an increasingly important role in hypotheses of mood

disorders. Neuronal energy supplies are completely dependent on mitochondrial oxidative
phosphorylation, which makes them particularly vulnerable to mitochondrial dysfunction.
Mitochondria pathway use microtubule networks to move around, including synapses and areas of
neurite outgrowth. ATP produced by mitochondria is essential for loading neurotransmitters into
synaptic vesicles and maintaining neuronal membrane potentials. Mitochondria are also involved
in the regulation of intracellular calcium levels, which is crucial at synapses because calcium
stimulates neurotransmitter release and facilitates many other processes (including gene
transcription, the activation of second-messenger pathways, etc.).
________________________________________________________________________________
Keywords: Mitochondrial, energy, pathway, mood.
Neuroscience Aspects Of Emotional Disorder In Pediatric Bipolar
Nining Febriyana
Divisi psikiatri Anak dan Remaja FK UNAIR-RSUD Dr. Soetomo
Emotional dysregulation and rapid mood cycling with mixed episodes are predominant in Pediatric
Bipolar Disorder (PBD)
Compared to adults, children and young adolescents with bipolar disorder are more prone to
exhibit ultrarapid or ultradian cycling. In addition, children and young adolescents may experience
minicycles that are sporadic or interspersed with cycles of longer duration with well-defined onset
and offset.
Although this symptom is nonspecific to PBD, it is present to a significantly greater degree in

children and young adolescents compared to older adolescents and adults with bipolar disorder.
Further, severe rage attacks and explosive outbursts are more common in PBD.
Recent brain imaging studies with PBD patients have implicated dysfunction in a network of
cortico-limbic regions. Several functional magnetic resonance imaging (fMRI) studies on cognitive
control that used cognitive or emotional . Stroop tasks and response inhibition tasks have linked
the associated deficits in bipolar disorder (BD) to ventral prefrontal dysfunction, even
independently of mood state. Dysfunction of anterior cingulate cortex (ACC), striatum, and limbic
regions has also been found in patients with BD compared with healthy controls (HC) in Stroop-
like and face emotion processing tasks.
Several studies have examined the neural circuitry mediating face-emotion processing in bipolar
disorder and childhood psychopathology. For both pediatric and adult bipolar disorder, amygdala
dysfunction is perhaps the most commonly reported finding in functional magnetic resonance
imaging (fMRI) studies of the illness, with amygdala hyperactivity being reported in a variety of
paradigms involving face emotions. Of particular note, Pavuluri et al. found increased amygdala
activation during face-emotion processing in pediatric bipolar disorder
In this section, we discuss the unique features of PBD and the implications of these features for the
design of new psychosocial interventions/ therapeutic RAINBOW
Key word : Pediatric Bipolar Disorder- Emotional Disorder-Neuroscience Aspect
Aspek Neurosains Gangguan Emosional Pada Bipolar Anak
Nining Febriyana
Divisi psikiatri Anak dan Remaja FK UNAIR-RSUD Dr. Soetomo
Disregulasi emosi dan siklus mood cepat dengan episode campuran merupakan predominan pada
Bipolar Anak
Dibandingkan dengan dewasa, anak dan remaja awal dengan Gangguan Bipolar lebih cenderung
dalam bentuk siklus ultrarapid atau ultradian serta mengalami siklus mini yang diselingi dengan
siklus sehat dalam jangka waktu yang lebih lama.
Meskipun gejala Bipolar Anak dan remaja awal tidak spesifik, namun derajat keparahan cukup
bermakna dibandingkan Gangguan Bipolar pada remaja akhir dan dewasa. Serangan kemarahan dan
ledakan eksplosif yang cukup parah lebih sering terjadi pada Gangguan Bipolar Anak.
Studi akhir-akhir ini tentang brain imaging dengan pasien Bipolar Anak menunjukkan disfungsi
pada daerah cortico-limbic. Pada Studi dengan pemeriksaan fungsi magnetic resonance imaging
(fMRI) menggunakan sebagai kontrol adalah cognitif atau emosi. Pada Gangguan Bipolar, terjadi
hambatan dalam merespon yang terkait dengan the associated deficits yaitu terjadi disfungsi pada
daerah ventral prefrontal, bahkan secara independen pada moodnya. Disfungsi daerah anterior
cingulate cortex (ACC), striatum, and daerah limbic yang bertugas tentang proses emosi juga
ditemukan pada pasien Gangguan Bipolar dibandingkan pasien sehat.
Beberapa penelitian memeriksa the neural circuitry mediating face-emotion processing pada
Gangguan Bipolar dan psikopatologi masa anak. Untuk Gangguan Bipolar anak dan dewasa,
disfungsi amygdala banyak dilaporkan pada pemeriksaan functional magnetic resonance imaging
(fMRI) dalam bentuk hiperaktifitas amygdala secara bervariasi yang melibatkan emosi. Pada catatan
khusus, Pavuluri dan kawan-kawan menemukan peningkatan aktifitas amygdala selama proses
emosi pada Gangguan Bipolar Anak.
Pada makalah ini, kami tampikan mengenai gambaran unik Bipolar Anak dan mendisain intervensi
psikososial yang disebut terapi RAINBOW .
Kata kunci : Pediatric Bipolar Disorder- Emotional Disorder-Neuroscience Aspects
Ratna Kurniasari
Terapi perilaku merupakan suatu teknik terapi yamg bertujuan untuk menghilangkan perilaku-
perilaku yang tidak dapat diterima secara sosial dan membangun perilaku-perilaku baru yang secara
sosial bermanfaat dan dapat diterima. Terapi perilaku merupakan proses pengobatan yang penting
bagi pasien yang memiliki kelainan perilaku tertentu, misal kebiasaan buruk yang membahayakan
keselamatan dan kesehatannya. Tujuan terapi ini adalah untuk membantu dan mempersiapkan
pasien dalam menghadapi berbagai tantangan tanpa harus beralih ke kebiasaan buruk sebagai
mekanisme pertahanan.
Salah satu contoh penyakit / gangguan yang dapat diobati dengan terapi perilaku adalah gangguan
bipolar. Gangguan bipolar saat ini telah dialami oleh anak dan remaja meskipun tidak tinggi yaitu
sekitar 0,3 – 1,5 % saja. Gangguan bipolar saat ini sudah menjangkiti 10 – 12 % remaja di luar
negeri. Di beberapa kota di Indonesia juga dilaporkan penderita berusia remaja dan resiko kematian
terus membayangi karena mereka sering memakai jalan pintas. Pasien bipolar biasanya tidak dapat
mengekspresikan perasaannya dan pribadi yang mudah tersinggung, pemarah, dan tidak mau
mengalah.
Penderita gangguan bipolar juga berisiko merusak diri dan berakhir dengan kematian akibat bunuh
diri.
Gangguan bipolar pada anak-anak ditandai dengan perubahan suasana hati, mudah kesal, kesulitan
berkonsentrasi, dan merasa tidak berdaya atau tidak berarti. Jika tidak ditangani, gangguan bipolar
bisa memberikan dampak negatif kepada pendidikan anak dan kehidupan sosialnya. Pendekatan
behavioristik / perilaku lebih mengarah pada faktor-faktor situasional seperti kehilangan perasaan
penguatan yang positif. Perubahan pada frekuensi atau efektivitas dari penguatan dapat mengubah
keseimbangan yang ada sehingga merasa hidup menjadi tidak berharga.
Kata kunci : terapi perilaku, gangguan emosional, bipolar anak.
Ratna Kurniasari
Behavioral therapy is a therapeutic technique which aims eliminate socially unacceptable behavior
and build new behaviors that are socially useful and acceptable. Behavioral therapy is an
important treatment process for patients who have certain behavioral disorders, such as bad habits
that endanger their safety and health. The goal of therapy is to help and prepare patients in the face
of various challenges without having to turn to bad habits as a defense mechanism.
One example of a disorder that can be treated with behavioral therapy is bipolar disorder. Bipolar
disorder is currently experienced by children and adolescents, although not high, which is only 0,3
– 1,5 %. Bipolar disorder currently affects 10-12 % of teenagers abroad. In some cities in
Indonesia, it is also reported that sufferers of adolescence and the risk of death continue to
overshadow because they often use shortcuts. Bipolar patients usually cannot express their feelings
and are personally irritable, irritable, and unwilling to budge. People with bipolar disorders also
risk self-damage and end up with suicide.
Bipolar disorder in children is characterized by mood swings, irritability, difficulty concentrating,

and feeling helpless or meaningless. If not treated, bipolar disorder can have negative impact on
children‟s education and social life. The behavioristic approach or behavior is more directed at
situational factors such as losing a positive feeling of reinforcement change in the frequency and
effectiveness of reinforcement can change the balance that exists so that life becomes worthless.
Keywords : behavioral therapy, emotional disorders, bipolar children
Metafisika Otak, Berpikir Rasional Transendental
Musa Asyarie
Otak adalah organ penting dalam tubuh manusia yang menjadi pusat pengaturan sistemik
kehidupannya. Selama ini, otak lebih dilihat dan dipelajari sebagai organ fisik manusia, seperti
dalam dunia kedokteran dan sainteks. Akan tetapi sebenarnya hakikat otak adalah bersifat metafisik.
Dimensi metafisika inilah yang sesungguhnya amat menentukan secara fundamental tentang
keberadaan manusia, termasuk di dalamnya adanya tubuh dan susunan organiknya.
Hakikat otak dalam realitas kehidupan manusia adalah berpikir, dan kemampuan berpikir menjadi
ciri utama manusia dan yang membedakannya dengan makhluq hidup lainnya. Kualitas berpikir
manusia secara metafisika berkaitan dengan ruh (jiwa) dan qalbun (hati) yang memungkinkannya
menembus dunia metafisik. Dalam kaitan ini, perlu dikembangkan berpikir rasional transcendental
agar mampu melihat realitas secara utuh dan multi-dimensional.
Regenerative Medicine and Neurosurgery for Psychiatric Disorders
Abdul Hafid Bajamal, Achmad Fahmi Baabud , Heri Subianto , Agus Turchan
Division of Neuro-Fungsional, Dept.of Neurosurgery.
Faculty of Medicine Airlangga University Dr Sutomo Academic Medical Centre Surabaya,
Indonesia
Not only resulting in enormous social and economic trouble, mental illness is also the single largest
risk factor for suicide. The matter of psychiatric disorders is the classification and diagnosis were
still established based on symptom approach rather than neurobiological criteria.
Psychiatric neurosurgery for the most severe and medically refractory psychiatric disorders
management has been recur since advance in neurosurgery and neurosciences.
A new advances imaging technologies including PET ( Positron Emission Tomography ) and
functional Magnetic Resonance Imaging (fMRI), neurobiology and neurophysiology of psychiatric
disorders reveal the possibilities of brain area that might be answerable for ablative procedures.
Targeted psychosurgery would require that one be able to identify the pathological network
involved in a given patient, to use neurostimulation to safely create a reversible and durable
alteration, mimicking a lesion, in a network compatible with neuroplasticity and to predict which
functional lesion would result in adapted neuronal plasticity to promote recovery.
The potential role of stem cells circulating in peripheral blood as diagnostic and prognostic
markers of psychotic disorders is still open.
As the results of these advancements , the indications and use of neurosurgery in the treatment of
psychiatric disorders is not only as the last tier optional therapy instead of early management for
psychiatric patient with high social disability.
Key Words: psyhiatric disorders, neurosurgery, Stem cells
Non-invasive Intervention For Neurological Problems
Paulus Sugianto
Neurology Department, dr. Soetomo General Hospital

Faculty of Medicine, Airlangga University Surabaya
Non-invasive technology has the potential to revolutionize the treatment .of neurological problems.
Transform treatment by gaining access deep within the brain without harming, normalizing
function in aberrant brain circuits, in order to have a positive impact on the patient‟s quality of life
Available pharmacological treatments for neurological problems do not sufﬁciently address

cognitive symptoms, because the downside effect of medication treatment often lead to psychomotor
retardation and memory decline leading to decreasing performance
The novel non-pharmacological strategy is repetitive transcranial magnetic stimulation (TMS), a

therapy that modulates brain activity via electromagnetic pulses discharged through a coil placed
over the patient's head
TMS is a new method for noninvasively stimulating the brain. It has been increasingly used not
only in research but also in clinical settings. The treatment has been shown to improve motor and
non motor control after stroke, aphasia, epilepsy, chronic pain not responsive to pharmacological
treatment. TMS is being used in neuropsychiatric disease for its rehabilitating effect on cortical
functions via induction of neuroplasticity.
Some mental disorders which have good response with the treatment include craving, schizophrenia,
depressive disorders for which TMS has been approved and used extensively as a therapeutic
approach. Meanwhile, application of TMS for other brain disorders such as tinnitus, chronic pain,
migraine, dementia, Parkinson‟s disease, aphasia and dystonia are currently in development.
Beneficial effect of TMS is also shown on the treatment of eating disorders, auditory hallucinations,
autism, Attention-deficit/hyperactivity disorder (ADHD). All these results encourage the future
therapeutic application of non-invasive brain stimulation techniques
Keyword: Non invasive intervention, transcranial magnetic stimulation, brain stimulation,

neuroplaticity
Behavioral Effects of Neurological Problem
Soetjipto
Psychiatrist, consultant staff at the Department of Psychiatry Faculty of Medicine UNAIR / RSUD
Dr. Soetomo, Surabaya.
A neurological disorder is any disorder of the nervous system. Structural, biochemical or electrical
abnormalities in the brain, spinal cord or other nerves can result in a range of symptoms. Examples
of symptoms include paralysis, muscle weakness, poor coordination, loss of sensation, seizures,
confusion, pain and altered levels of consciousness. Some Neurological disorders can have an
effect on behavioral disorders. Some of them are: Brain damage according to cerebral lobe:
Frontal lobe damage, Parietal lobe damage, Temporal lobe damage, Occipital lobe damage, Brain
dysfunction according to type: Aphasia (language), Dysgraphia (writing), Dysarthria (speech),
Apraxia (patterns or sequences of movements), Agnosia (identifying things or people), Amnesia
(memory), Seizure disorders such as epilepsy, Movement disorders of the central and peripheral
nervous system such as Parkinson's disease, Tourette's Syndrome, Multiple Sclerosis and various
types of Peripheral Neuropathy, Sleep disorders such as Narcolepsy, Neuropsychiatric illnesses
(diseases and/or disorders with psychiatric features associated with known nervous system injury,
underdevelopment, biochemical, anatomical, or electrical malfunction, and/or disease pathology
e.g. Attention deficit hyperactivity disorder, Autism, Tourette's syndrome and some cases of
obsessive compulsive disorder as well as the neurobehavioral associated symptoms of
degeneratives of the nervous system such as Parkinson's disease, essential tremor, Huntington's
disease, Alzheimer's disease, multiple sclerosis and organic psychosis.), Multiple sclerosis and
other demyelinating diseases, Infections of the brain or spinal cord (including meningitis), Prion
diseases (a type of infectious agent).
They may be assessed by neurological and psychiatric examination, and studied and treated within
the specialities of neurology and psychiatry.
Alternatively, a condition might first be detected through the presence of abnormalities in mental
functioning, and further assessment may indicate an underlying neurological disorder.
There are sometimes unclear boundaries in the distinction between disorders treated within
neurology, and mental disorders treated within the other medical specialty of psychiatry, or other
mental health professions such as clinical psychology. In practice, cases may present as one type
but be assessed as more appropriate to the other. Neuropsychiatry deals with mental disorders
arising from specific identified diseases of the nervous system.
Keyword: behavioral effects, neurological problem, psychiatric examination, mental disorders.
Investigating Potential Role of EFA-6 in Neurodegeneration
Gerrick Pantouw
Neurons are cells of the nervous system that are specialised in receiving and relaying signals
through their specialised structures dendrites and axon respectively. These specialised structures
are formed during development, and maintained throughout the life of its organism. Microtubule is
an essential component in the development of axons and dendrite, as well as their maintenance.
During development, microtubule play a role in differentiation of neurites that develop into axon or
dendrites, drive axon elongation, and provide transportation highway for motor proteins. In mature
neurons, microtubules form the backbone that maintains cell structure, and important intracellular
transport system. Defect in microtubule organization in axons has been linked to various
neurodegenerative diseases and neurodegeneration due to ageing. Therefore, understanding
mechanisms relating to microtubule organization is important. A newly identified protein, EFA-6, is
hypothesized to play a role in microtubule organization in axons. EFA-6 is a cortically localised
protein that promote microtubule catastrophe at cell cortex. Loss of EFA-6 is hypothesized to be
linked with disorganized axonal microtubule that is likely to cause neurodegeneration. This study
aim to investigate EFA-6 role in maintenance of microtubule in adult brain using Drosophila
melanogaster as a model organism.
The results confirmed the expression of EFA-6 in adult Drosophila brain by immunohistochemistry
analysis of expression of GFP-tagged EFA-6. This result suggests that EFA-6 does play a
microtubule maintenance role in mature axons, which leads to the question whether loss of EFA-6
function would cause neurodegeneration. Therefore, method of detecting neurodegeneration in
adult Drosophila brain was tested. Further research is required to determine significance of EFA-6
function in relation to neuronal survival and possibly injury response. Identification of EFA-6
function both in normal condition and injury response might provide a new target for therapy.
Behavior Management for Traumatic Brain Injury
Elmeida Effendy
Department of Psychiatry-Faculty of Medicine –Universitas Sumatera Utara
Traumatic brain injury (TBI ) is a serious public health issue, considered as a chronic health
condition, which it consequences may continue throughout the individuals ’s life time. TBI affect
10.000 people worldwide each year, and is a leading cause of death and disability. TBI can be can
be classified as mild, moderate and severe. About 80 % of injuries are classified as mild, 20 % of
people with TBI has moderate to severe injury, and suffer impairments in physical,
behavioral ,emotional and cognitive functioning. Psychosocial problems are often more predictive
of poor outcomes than physical sequelae. TBI is related to a variety of neuropsychiatric
disturbances which cause functional impairment and poor quality of life. The disturbances include
mood disorders, behavior, cognition and personality changes. Depression is the most prevalent
psychological distress in TBI, which have been reported between 25 % and 45 %.Many studies
reported that incidence of having anxiety disorders in TBI patients is 44 % in the first year after
injury. Accurate identification of psychosocial problems in TBI patients is an important step to
make an integrative management.
Management of TBI should always include non pharmacological intervention, such as education,
supportive and behavioral psychotherapies, family involvement and cognitive rehabilitation. Long
term monitoring of behavioral and emotional after TBI could improve clinical management Further
research is needed to validate nonpharmacological treatment for TBI.
Key word : behavior management- traumatic brain injury
Neurosurgery Intervention For Obsessive-compulsive Disorder: Review Of Current Evidence
Agus Turchan, Achmad Fahmi, Heri Subianto, Muhammad Reza Arifianto

Neurosurgery Department - Dr. Soetomo Academic General Hospital / Faculty Medicine – Airlangga
University, Surabaya, Indonesia
Introduction
Psychosurgery or Neurosurgery for Mental Disorder (NMD) is a surgical procedure for the
destruction of brain tissue for the purposes of alleviating specific mental disorders carried out by a
stereotactic or other method capable of making an accurate placement of the lesion. The
application of psychosurgery is still controversial yet until now. One of its challenging burden is to
replace the contemporary treatment strategies for Obsessive-compulsive disorder (OCD). It is one
of a most common mental disorder characterised by uncontrollable, reoccurring thoughts
(obsessions) and behaviors (compulsions) which cause marked distress, anxiety or significant
functional impairment. Treatment includes lesioning (destructive procedures) and neuromodulation
(inactivation of deep brain structures by high-frequency electrical stimulation [DBS])
Method
A PubMed literature search was conducted spanning the years 2001–2019. The search was limited
by the following terms: (1) English language, (2) “Neurosurgery”, and (3) “Mental Disorder and/or
Obsessive-compulsive disorder.” Each article was reviewed to determine if the presence of neurosurgical
procedure in mental disorder and/or Obsessive-compulsive disorder existed in the article.
Result
Over 1000 article had been reviewed for identifying history, pathophysiology, management,
guideline and current strategy for neurosurgery in OCD. Review article and current guideline were
simplified into brief discussion based on current pertinent literatures.
Conclusion
Most of the included study stated neurosurgical procedure especially Deep-Brain Stimulation
benefits more than 50% for patients with OCD. It should be seen as an adjunct to, rather than a replacement
of, pharmacological and psychological strategies. Current evidence suggest the efficacy treatment option in
OCD patients who have failed all other therapies, are disabled by their condition, or who may be at risk of
committing suicide.
Keywords: Psychosurgery, Obsessive-compulsive disorder, Deep-brain stimulation, Lesioning
Astrogliosis Plays Role In Hydrocephalic Cognitive Impairment: A Therapeutic Opportunity
Wihasto Suryaningtyas, M.D., Ph.D, Muhammad Arifin Parenrengi, M.D., Ph.D
Department of Neurosurgery
Faculty of Medicine Universitas Airlangga – Dr. Soetomo General Hospital, Surabaya, Indonesia
Hydrocephalus is a common neurological disorder, especially in children, characterized by

abnormal accumulation of cerebrospinal fluid (CSF) results in dilation of cerebral ventricles.
Cognitive dysfunction is often found as clinical presentation, mostly due to chronicity. Two main
mechanisms that underlie the cellular and morphological changes are mechanical pressure and
biochemical cascade. Morphological studies revealed that hydrocephalus progressively damage the
periventricular white matter especially the corpus callosum, external capsule and fornix.
Mechanical pressure also resulted in distortion of pyramidal neurons of the somatosensory cortex
and hippocampus. The total dendritic length of CA1, but not CA3, pyramidal neurons was reduced.
These cortical and hippocampal changes suggest reductions of excitatory connectivity, which could
underlie the learning and memory deficits in hydrocephalus. The only measure to treat this
mechanical problem is interventional procedure with shunting. However, shunting needs some
requirement to achieve satisfactory result. This requirement includes controlling the cellular
reactivity involving microglia and astrocyte. Microgliosis and reactive astrocytosis, together called
as astrogliosis, are the hallmark of cellular reaction in hydrocephalus. Astrogliosis following
neuronal death or pyknotic cells may interfere with myelin degradation, axonal damage, and
synaptic transmission impairment. These structural changes may lead to cognitive disorder and
even further to psychiatric problem. Several studies were conducted to prevent the initiation or
progression of astrogliosis. It brings the new avenues for research in neuroscience and cognitive
science.
Astrogliosis Plays Role In Hydrocephalic Cognitive Impairment: A Therapeutic Opportunity
Wihasto Suryaningtyas, M.D., Ph.D, Muhammad Arifin Parenrengi, M.D., Ph.D
Department of Neurosurgery
Faculty of Medicine Universitas Airlangga – Dr. Soetomo General Hospital, Surabaya, Indonesia
Hidrosefalus adalah kelainan structural neurologis yang sering dijumpai terutama pada anak.
Kelainan ini ditandai dengan penumpukan cairan serebrospinal (CSS) yang menyebabkan dilatasi
ventrikel otak. Gangguan kognitif sering ditemukan pada penderita hidrosefalus terutama yang
kronis. Dua mekanisme utama yang mendasari kelainan patologis hidrosefalus adalah akibat
tekanan intracranial yang meningkat dan kaskade perubahan biokimia yang menyertai. Penelitian
terhadap morfologi pada hidrosefalus menunjukkan kerusakan progresif pada susbtansia alba
terutama di periventrikel, corpus callosum, kapsula eksterna, dan forniks. Tekanan mekanik juga
menyebabkan distorsi neuron pyramidal di korteks somatosensorik dan hipokampus. Perubahan
morfologi korteks dan hipokampus ini menyebabkan penurunan konektivitas eksitatori yang
mendasari gangguan belajar dan memori pada penderita hidrosefalus. Terapi satu-satunya untuk
mengatasi tekanan mekanik ini adalah dengan pemasangan pirau (shunt). Pemasangan pirau sendiri
memerlukan prasyarat agar hasilnya memuaskan. Prasyarat tersebut termasuk pencegahan
terjadinya astrosit reaktif dan aktivasi mikroglia. Astrosit reaktif dan aktivasi mikroglia, yang
bersama-sama disebut sebagai astrogliosis, adalah salah satu petanda perubahan selular utama pada
hidrosefalus. Astrogliosis yang terjadi akibat reaksi kematian neuron atau sel piknotik dapat
menyebabkan degradasi myelin, kerusakan aksonal, dan gangguan transmisi sinaps. Penelitian pada
hidrosefalus saat ini diarahkan untuk mencegah inisiasi atau progresifitas astrogliosis. Ini
merupakan lahan baru yang cukup besar dalam penelitian neurosains dan sains kognitif.
Circadian: The Sleep Dysregulation Pathway In Bipolar Disorder
Wardah Rahmatul Islamiyah
Disruptions in sleep and circadian rhythms are observed in individuals with bipolar disorders (BD). Sleep
and circadian rhythms are disturbed in bipolar patients during both mood episodes and periods of remission.
Such abnormalities may relate to dysfunction of the molecular circadian clock . The most promising
pathways include melatonin synthesis and modulation of melatonin receptors, in particular by monoamine
neurotransmission and pulsatile melatonin release regulations; the brain circadian clock, in particular
ARNTL1, CLOCK, GSK3b, RORA and RORB genes and their regulation and factors (peptide, proteins, light,
etc.) and mechanisms of modulation of the circadian clock and monoamine neurotransmission. There are
multiple links between GABAergic, dopaminergic, serotonergic and glutamatergic systems and circadian
rhythms. The study of sleep and circadian rhythms opens innovative avenues in research to a better
understanding of genes role in bipolar disorder regarding associations of some circadian genes
polymorphisms with bipolar disorder.
Keyword: Circadian rhythms, bipolar disorder, sleep dyregulation, pathophysiology
Abnormalitas Reward Sensitivity pada Gangguan Mood
Azimatul Karimah
Dept. Ilmu Kedokteran Jiwa, Fakultas Kedokteran,
Universitas Airlangga-RSUD dr. Soetomo, Surabaya
Penelitian di bidang neurokognitif semakin banyak membahas keterkaitan antara jalur reward
sensitivity terhadap respon emosi atau mood maupun respon perilaku. Striatum ventral dan korteks
Orbitofrontal diduga memainkan peran dalan sirkuit neural fronto-striatal dalam reward sensitivity
atau Sistem Pendekatan Perilaku-SPP (Behavioral Approach System, BAS). Seseorang yang
mengalami bipolar lebih peka terhadap reward sensitivity (over/hipersensitif) dengan manifestasi
meningkatnya motivasi, dan diikuti dengan gejala psikomotor berupa perilaku bertujuan mencapai
reward, penurunan kebutuhan tidur, peningkatan energy dan harga diri serta iritabilitas ketidak
tujuan tidak tercapai. Gambaran hipersenistivitas ini tampak pada gejala manik dibandingkan
dengan sesorang dengan depresi unipolar (hiposensitif). Pemeriksaan rekaman otak (EEG) pada
bagian frontal saat istirahat, evoked response potential (ERP) dan pemerikaan pencitraan fMRI
membantu klinisi untuk mengidentifikasi sensitivitas reward pasien gangguan mood. Implikasi
klinis pengamatan terhadap reward sensitivity akan membantu klinisi untuk membedakan diagnosis
depresi unipolar dan depresi bipolar, memperkirakan faktor resiko seseorang terhadap gangguan
mood, serta memperkirakan intervensi psikososial yang tepat sehingga memperbaiki prognosis
pengobatan, pencegahan kekambuhan pada pasien dengan gangguan mood.
Kata kunci : reward, sensitivitas, mood
Abstrak

Erikavitri Yulianti
Kemajuan ilmu pengetahuan dan tehnologi membawa dampak ke berbagai aspek kehidupan
manusia. Modernisasi merupakan salah satu hal yang tak terbendung lagi dan membawa banyak
perubahan pada gaya hidup seseorang. Salah satu hal yang berkaitan dengan perubahan gaya hidup
modern adalah meningkatnya angka kejadian timbulnya penyakit kardiovaskuler, termasuk stroke.
Menurut data Riskesdas 2018, prevalensi stroke di Indonesia terus meningkat sejak 2013 dan
merupakan penyebab kematian ketiga. Yang memprihatinkan adalah saat ini terjadi pergeseran
onset usia penderita stroke ke arah yang lebih muda dan usia produktif.
Stroke dapat mengakibatkan terjadinya disabilitas dan kecacatan dari derajat ringan hingga berat.
Hal ini akan berdampak luas, tidak hanya secara fisik tetapi juga psikologis dan psikososial.
Berbagai manifestasi gejala neuropsikiatri yang sering menyertai stroke adalah depresi, labilitas
emosi, gangguan tidur, perubahan nafsu makan, kecemasan hingg timbulnya waham dan halusinasi.
Diperlukan penatalaksaan yang komprehensif berupa terapi farmakologis dan non farmakologis
untuk menstabilkan stroke dan mencegah serangan ulang. Terapi farmakologis yang dapat dipilih
antara lain antidepresan dan anticemas, sedangkan penggunaan stimulansia seringkali menimbulkan
perdebatan. Pendekatan terapi non farmakologis juga sangat diperlukan untuk membantu pasien
melakukan penyesuaian dengan perubahan fisik yang terjadi setelah mengalami stroke, mengatasi
gangguan emosional yang muncul dan memberikan psikoedukasi kepada keluaga mengenai bentuk
dukungan yang dapat dilakukan untuk membantu memulihkan kondisi pasien setelah stroke,
misalnya melalui latihan fisik, latihan kognitif, terapi musik dan pentingnya ekspresi emosi
keluarga yang positif.
Kata kunci: Depresi, post stroke, farmakologis, intervensi psikososial
Erikavitri Yulianti
The advancement of science and technology has an impact on various aspects of human life.
Modernization is one of the things that is unstoppable and brings many changes to one's lifestyle.
One of the things related to changes in modern lifestyles is the increasing incidence of
cardiovascular disease, including strokes. According to Riskesdas 2018 data, the prevalence of
stroke in Indonesia has continued to increase since 2013 and is the third cause of death. The concern
is that there is a shift in the age of stroke patients to a younger age- productive age.
Stroke can cause disability and body weakness from mild to severe degrees. This will have a broad
impact, not only physically but also psychologically and psychosocially. Various manifestations of
neuropsychiatric symptoms that often accompany strokes are depression, emotional lability, sleep
disturbances, changes in appetite, anxiety to the appearance of delusions and hallucinations.
Comprehensive management is needed in the form of pharmacological and non-pharmacological
therapies to stabilize strokes and prevent repeated attacks. Pharmacological therapies that can be
chosen include antidepressants and anti anxiety, while the use of stimulants often causes debate.
The approach of non-pharmacological therapy is also very necessary to help patients adjust to
physical changes that occur after a stroke, overcome emotional disorders that arise and provide
psychoeducation to the family about the form of support that can be done to help restore the
patient's condition after a stroke, for example through physical exercise, cognitive training, music
therapy and the importance of positive family emotional expression.
Keywords: Depression, post stroke, pharmacological, psychosocial intervention
Gut and Brain Connection, Nutritional Approach for treating Bipolar Disorder: a New Paradigm.
Tifauzia Tyassuma
Advancing Health Literacy on Nutrition and Spiritual Neuroscience Indonesia (AHLINA) Institute - Jakarta
Human intestine consist of trilions of microorganisms, the gut microbiome have an

increasingly recognized impact on human health, including brain functioning. Mood
disorder, is a mental disorder that causes periods of depression and periods of
abnormally elevated mood. The elevated mood is significant and is known as mania or
hypomania, depending on its severity, or whether symptoms of psychosis are present.
Gut microbiota plays an important role in the bidirectional communication between the gut and the
central nervous system. Evidence suggests that gut microbiota can influence the brain function via
neuroimmune and neuroendocrine pathways as well as the nervous system. Advances in gene
sequencing techniques further facilitate investigating the underlying relationship between gut
microbiota and psychiatric disorders. In recent years, researchers have preliminarily explored the
gut microbiota in patients with mood disorders. The studies showed that microbial diversity and
their compositions were significantly different compared with healthy individuals.
Most of these findings revealed that short-chain fatty acids-producing bacterial genera were
decreased, while pro-inflammatory genera and those involved in lipid metabolism were increased
in patients with depressive episodes. Some studies further indicated that specific bacteria were
associated with clinical characteristics, inflammatory profiles, metabolic markers, and
pharmacological treatment. Meta-analyses of non-pharmacologic treatment interventions for mood
disorder showed that plant based diets for may lead to a significant reduction in mood symptoms,
although there is heterogeneity across studies. Plant based diet might influence behavior and their
symptoms by affecting gut microorganisms. The gut microbiome has an increasingly recognized
impact on brain functioning and behavior. Several studies highlight the importance of investigating
the functional effects of microbiome differences in neuropsychiatric disorders. These studies
present preliminary evidence of the important role of gut microbiota in mood disorders, through the
gut- brain connection , which emerges as a promising target for disease diagnosis and therapeutic
interventions in the future.
Key words: gut microbiome - mood disorder - plant based diet - gut-brain connection
Stress and The Glucocorticoid Pathway
Nalini Muhdi
Staf pengajar dan Psikiater di FK Unair – RSUD Dr Sutomo
Mechanism of the hypothalamo-pituitary-adrenal axis (HPA axis) in circulating levels of

glucocorticoids form a key component of the response of an organism to stressful challenges.
Cortisol is the most important human glucocorticoid. Despite the benefits which make it essential
for life, higher and more prolonged levels of cortisol in the bloodstream, such as those associated
with chronic stress have been shown to have negative effects, such as hyperglycemia,
cardiovascular disease, lowered immunity, depression, and inhibit reproductive system or infertility.
Maternal exposure to prenatal stress or exogenous glucocorticoids could also lead to permanent
modification of hypothalamo-pituitary-adrenal function and stress-related behaviors in
offspring. There‟s a study examined the interrelationships among stress, cortisol and observed
depressive behaviours in female rhesus macaques for the first time and explored the possible
mechanism underlying stress and depressive behaviour. Significant correlations were found
between stress and depressive behaviour measures and between cortisol levels and depressive
behaviour. This finding extends the current understanding of stress/cortisol interactions in
depression, especially pertaining to females.
Growing evidence indicates that the pathological manifestations of chronic stress include neuronal
malfunction as well as immunosuppression, but our understanding of the mechanisms is still poor
and calls for more studies not only to identify therapeutic inroads but, also, preventative measures
or ways to delay onset of disorders.
Neuroscience Intervention For Better Life: From Molecular, Cellular, to Organ Interventions
Moh Hasan Machfoed
Neurology Department Medical Faculty, Airlangga University. Dr. SoetomoHospital – Surabaya
Neuroscience (or neurobiology) is the scientific study of the nervous system, that combines
physiology, anatomy, molecular biology, developmental biology, cytology, mathematical modeling
and psychology to understand the fundamental and emergent properties of neurons and neural
circuits.
The scope of neuroscience has broadened over time to include different approaches used to
study the nervous system. Neuroscience intervention is the act of intervening which is usually
intended for better life. This intervention can be carried out on molecular, cellular and organ
systems.
One example of molecular and cellular interventions is stem cells. Stem cells are cells that
can differentiate into other types of cells, and can also produce more of the same type of stem
cells. At present, many studies of stem cells are intended to treat neurological diseases.
Cognitive-affective training is a particularly promising strategy for enhancing cognitive

control over affective processes via modulation of these abnormally functioning neural networks.
Several psychologically based interventions have been developed. Cognitive behavioral therapy
(CBT) and interpersonal psychotherapy (IPT) are two commonly utilized, evidence-based
psychotherapies for treating anxiety and depression.
One example of organ interventions is transplantation. Organ transplantation is a medical

procedure in which an organ is removed from one body and placed in the body of a recipient, to
replace a damaged or missing organ. This kind of transplant has saved a person's life a lot.
Keyword: Neuroscience Intervention – Molecular – Cellular – Organ Interventions
Important of Cognitive Neuroscience: impact in clinical Practice
Abdulloh Machin
Cognitive neuroscience first stated by George miller and Michael Gazzaniga. cognitive neuroscience is
associated with studies of the brain and performance of people with various symptoms of brain damage. in
the late years cognitive neuroscience became the most increasing field of research. there are many scientist
gots noble prize in the field of cognitive neurosciens such as Eric Kandel, John O'keffe, May-Britt Moser,
Edvard I. Moser, etc. cognitive neuroscience became important to undestand cognitive mechanisms in the
brain and their clinical implication. many degenerative dissease may impact cognitive function thus by
understanding the mechanism we can develops methods to relieve symptoms of cognitive dysfuntion.
Key Words: Cognitive, Cognitive neuroscience, degenerative disease
The Miracle Of The Heart
Muhammad Iqbal Basri
Departemen Anatomi, Fakultas Kedokteran Universitas Hasanuddin, Makassar
Seiring dengan perkembangan teknologi, maka semakin banyak hal-hal yang dapat diungkapkan
tentang jantung. Salah satunya adalah terdeteksinya detak jantung pertama bayi dalam kandungan
yaitu sekitar 3 minggu dan 1 hari setelah fertilisasi. Sedangkan otak sendiri baru mulai bekerja
setelah 90 hari. Hal ini juga menunjukkan bagaimana vitalnya fungsi jantung dalam kehidupan.
Keistemewaan lain dari jantung adalah memiliki sistem innervasi tersendiri (sistem otonom), selain
itu juga memiliki sistem konduksi intrinsik karena terdapatnya pacemaker-cell. Sehingga otot
jantung dapat berkontraksi tanpa harus ada stimulasi dari otak. Pakar neurokardiologi menyebut sel-
sel jantung sebagai „ a little brain in the heart „ atau the heart-brain yaitu jantung dapat berfungsi
seperti otak yang dapat membantu untuk menuntun kita dalam bentuk kecerdasan yang lain (the
heart of intelligence). Kekuatan medan elektromagnetik jantung yang ditimbulkan jauh lebih kuat
dibanding medan elektromagnetik yang dihasilkan oleh neuron di otak yaitu sekitar 5000 kali lipat.
Bahkan dapat memancar sekitar 2-3 meter dari luar tubuh kita. Hal tersebut merupakan salah satu
bentuk komunikasi antara jantung dan otak (Heart-Brain Communication) selain jalur nervus
system yang telah kita kenal. Penelitian terkini menunjukkan bahwa koherensi antara jantung dan
otak yang dapat terlihat pada rekaman EEG dan EKG (sinkronisasi) akan memberikan dampak yang
positif terhadap fungsi fisik dan mental diantaranya menurunkan tekanan darah, denyut jantung,
mengontrol kadar kolesterol, mengatasi stres, depresi dan kondisi mental lainnya.
Kata kunci: heart, coherence, the heart of intelligence, heart-brain connection
Santi Yuliani, Dyah Wiratmi, Adam Kurnia Wandana
Psychiatrist, Neurologist, Anesthetist of Prof. Dr. Soerojo Magelang Psychiatric Hospital
People with chronic pain can isolate from others or not be able to reach the mobility they have and
could previously have. Chronic pain is not only related to physical conditions, but also emotional
which has a tremendous influence on one's mind and mood. Chronic pain is also not only related to
physical injury, because it can come from conditions such as heart disease, arthritis, migraine, or
diabetes. Sometimes it is difficult to assess whether chronic pain has caused mood disorders such
as bipolar, especially bipolar depression, or vice versa. People with chronic pain are three times
more likely to develop symptoms of mood disorders or anxiety, and people with depression are
three times more likely to experience chronic pain. Depressed conditions often can cause
unexplained pain, such as headaches or back pain, and people who are depressed may struggle to
improve or maintain physical health. In turn, chronic pain can cause sleep difficulties, increased
stress, or feelings of guilt or worthlessness associated with depression. These influences can create
a cycle that is difficult to break.
Method: Literature review
Summary:
Three different processes in the spinal cord can explain the dramatic changes in sensory processing
in the somatosensory system: increased stimulation, decreased barriers and structural
reorganization. All have been proven to occur and each can contribute separately or together for
various chronic inflammatory and neuropathic pain disorders. The disclosure of the cellular
mechanisms involved both offers the potential to develop new therapeutic strategies, which reduce
functional synaptic plasticity and prevent central atrophic and regenerative responses to injured
neurons, and describe the capacity of the adult nervous system for maladaptive modifications.
Some data also support the role of monoamine, serotonin and norepinephrine neurotransmitters, in
pain modulation. Experiments with pain models in animals show that noradrenergic interventions,
and to a lesser extent serotonergic interventions, reduce pain-related behavior.
Guidelines for treating chronic pain include the duty of doctors not only to offer a solution to limit
the patient's pain, but also carefully observe the patient's reaction to opioids. Opioids are usually
prescribed for pain, with an increasing increase in the number of recipes written every year in
many countries including Indonesia. The challenge remains that doctors have a duty for humanity
(i.e. patients must receive appropriate pain care) and obligations for patient welfare (eg patients
must be monitored carefully so that they do not become dependent on painkillers). A holistic
approach will be very good in the success of pain therapy, not only prioritizing the management of
pharmacotherapy but also non-pharmacotherapy.
Key words: Chronic Pain, Bipolar Depression, Opioid
Santi Yuliani, Dyah Wiratmi, Adam Kurnia Wandana

Psychiatrist, Neurologist, Anesthetist of Prof. Dr. Soerojo Magelang Psychiatric Hospital
Orang dengan nyeri kronis dapat mengisolasi dari orang lain atau tidak dapat mencapai mobilitas
yang sebelumnya pernah dan mampu mereka miliki. Nyeri kronis bukan hanya terkait kondisi fisik
saja, melainkan juga emosional yang memiliki pengaruh luar biasa terhadap pikiran dan suasana
hati seseorang. Nyeri kronis juga tidak hanya terkait dengan cedera fisik, karena dapat berasal dari
kondisi seperti penyakit jantung, radang sendi, migrain, atau diabetes. Terkadang sulit untuk
menilai apakah nyeri kronis telah menyebabkan gangguan suasana perasaan seperti bipolar,
terutama bipolar depresi, atau sebaliknya. Orang dengan nyeri kronis tiga kali lebih mungkin
mengembangkan gejala gangguan mood atau kegelisahan, dan orang dengan depresi tiga kali lebih
mungkin untuk mengalami nyeri kronis. Kondisi depresi seringkali dapat menyebabkan nyeri yang
tidak dapat dijelaskan, seperti sakit kepala atau sakit punggung, dan orang yang mengalami depresi
mungkin berjuang untuk meningkatkan atau mempertahankan kesehatan fisik. Pada gilirannya,
nyeri kronis dapat menyebabkan kesulitan tidur, peningkatan stres, atau perasaan bersalah atau tidak
berharga terkait dengan depresi. Pengaruh-pengaruh ini dapat menciptakan siklus yang sulit
dipatahkan.
Method: Literature review
Summary:
Tiga proses berbeda di sumsum tulang belakang dapat menjelaskan perubahan dramatis dalam
pemrosesan sensorik dalam sistem somatosensori: peningkatan rangsangan, penurunan hambatan
dan reorganisasi struktural. Semua telah terbukti terjadi dan masing-masing dapat berkontribusi
secara terpisah atau bersama-sama untuk berbagai gangguan nyeri inflamasi dan neuropatik kronis.
Terungkapnya mekanisme seluler yang terlibat keduanya menawarkan potensi untuk
mengembangkan strategi terapi baru, yang mengurangi plastisitas sinaptik fungsional dan mencegah
respons atrofi dan regeneratif sentral pada neuron yang cedera, dan menggambarkan kapasitas
sistem saraf dewasa untuk modifikasi maladaptif.
Beberapa data juga mendukung peran neurotransmiter monoamine, serotonin dan norepinefrin,
dalam modulasi nyeri. Eksperimen dengan model nyeri pada hewan menunjukkan bahwa intervensi
noradrenergik, dan pada tingkat lebih rendah intervensi serotonergik, mengurangi perilaku yang
berhubungan dengan nyeri.
Pedoman untuk mengobati nyeri kronis termasuk tugas dokter untuk tidak hanya menawarkan
solusi untuk membatasi rasa sakit pasien, tetapi juga dengan hati-hati mengamati reaksi pasien
terhadap opioid. Opioid biasanya diresepkan untuk rasa sakit, dengan peningkatan yang terus
bertambah dalam jumlah resep yang ditulis setiap tahun di banyak negara termasuk Indonesia.
Tantangannya tetap bahwa dokter memiliki tugas untuk kemanusiaan (yaitu pasien harus menerima
perawatan rasa sakit yang tepat) dan kewajiban untuk kesejahteraan pasien (mis. Pasien harus
dipantau dengan cermat sehingga mereka tidak menjadi tergantung pada obat penghilang rasa
sakit). Pendekatan secara holistic akan sangat bagus dalam keberhasilan terapi nyeri, tidak hanya
mengedepankan tatalaksana farmakoterapi tetapi juga non farmakoterapi.
Key words: Nyeri Khronis, Bipolar Depresi, Opioid
Pathophysiology of Chronic Pain : The Role of Serotonin and Norepinephrine
Abstract
Dyah Wiratmi Puspitasari
Neurologist of Prof. Dr. Soerojo Magelang Psychiatric Hospital
Chronic pain is currently under-diagnosed and under-treated, partly because training of

health workers in pain management is often inadequate. This situation seems to get worse with the
rapidly increasing elderly population unless there is a wider application of the best pain
management practice. Finding effective treatment is a challenge in clinical management.
Chronic pain is often described as pain that persists longer than 3 months. This condition is
thought to develop from intense repetitive nociceptive (acute) pain. Chronic pain has various forms,
is classified as nociceptive or neuropathic, depending on whether the integrity of the somatosensory
nervous system is compromised by the underlying disease. Nociceptive pain results from the
activation of receptors (nociceptors) sensitive to noxious stimuli. Prolonged or intense exposure to
these stimuli, for example, chemical mediators released during inflammation, enhances the
responsiveness of nociceptive nerve fibers, termed peripheral sensitization, involves a shift in the
activation threshold of nociceptors and upregulation of voltage-gated sodium channels. Peripheral
sensitization leads to increased action potential firing and transmitter release in the dorsal horn of
the spinal cord, where somatosensory information is processed. Dorsal horn neurons react to the
rising input with heightened excitability, this process termed central sensitization.
Pain signals are modulated at various levels by descending neurones involving various
neurotransmitters such as serotonin, norepinephrine, and endogenous opioids. In normal
circumstances, this descending modulation serves to ﬁlter out extraneous signals, allowing the
passage of normal and important signals. Electrical stimulation of these pathways produces a deep
analgesia by inhibiting the passage of painful stimuli.
In both chronic pain and depression, neurochemical alterations can affect this inhibition,
resulting in disruption of ‘Filtering’ and the passage of abnormal signals. Depletion of serotonin
levels results in increased painful responses to electrical stimuli, and a functional noradrenergic
system is necessary for this descending modulation. Pain can also cause an increased turnover of
serotonin, with a net reduction in pre-synaptic serotonin release. This would lead to a reduction in
the activity of the descending pain control pathways, and result in more pain. This reduction in pre-
synaptic serotonin release could cause the development of depression.
Keywords : chronic pain, pathophysiology, serotonin, norepinephrine
Patofisiologi Nyeri Kronis : Peran Serotonin dan Norepinefrin
Dyah Wiratmi Puspitasari
Dokter Prof. Dr. Soerojo Magelang Psychiatric Hospital
Nyeri kronis saat ini masih kurang terdiagnosis dengan baik, sehingga tatalaksana yang diberikan
pun belum maksimal, sebagian karena pelatihan tenaga kesehatan dalam manajemen nyeri sering
kurang memadai. Situasi ini tampaknya menjadi lebih buruk dengan meningkatnya populasi lansia
yang cepat kecuali jika ada penerapan praktik manajemen nyeri terbaik yang lebih luas.
Menemukan pengobatan yang manjur masih menjadi tantangan dalam tatalaksana klinis.
Nyeri kronis sering digambarkan sebagai nyeri yang menetap lebih dari 3 bulan. Kondisi ini
diperkirakan merupakan perkembangan nyeri nosiseptif akut yang berulang. Nyeri kronis memiliki
berbagai bentuk, diklasifikasikan sebagai nosiseptif atau neuropatik, tergantung pada integritas
sistem saraf somatosensori yang terganggu oleh penyakit dasarnya. Nyeri nosiseptif berasal dari
aktivasi reseptor (nosiseptor) yang sensitif terhadap rangsangan. Paparan stimuli yang
berkepanjangan seperti adanya mediator kimia yang dilepaskan selama peradangan, meningkatkan
daya respon serabut saraf nosiseptif. Hal ini disebut sensitisasi perifer, yang melibatkan perubahan
ambang aktivasi nosiseptor dan peningkatan pengaturan saluran natrium pada neuron. Sensitisasi
perifer yang terjadi menyebabkan peningkatan potensial aksi dan pelepasan neurotransmiter pada
dorsal horn medula spinalis, dimana tempat informasi somatosensori diproses. Neuron pada dorsal
horn medula spinalis ini bereaksi terhadap input eksitabilitas yang meningkat. Proses ini disebut
sensitisasi sentral.
Impuls nyeri dimodulasi pada berbagai level oleh neuron descending, melibatkan berbagai
neurotransmiter seperti serotonin, norepinefrin, dan opioid endogen. Dalam keadaan normal, proses
descending modulation ini berfungsi untuk menyaring impuls nyeri yang berlebihan,
memungkinkan lewatnya impuls sinyal normal dan penting saja. Stimulasi elektrik pada jalur ini
menghasilkan proses analgesia yang dalam dengan penghambatan jalur rangsangan nyeri.
Pada kondisi nyeri kronis maupun depresi, terjadi perubahan neurokimia yang dapat mempengaruhi
proses ini, berakibat terganggunya proses ‘penyaringan’ impuls nyeri, menyebabkan masuknya
impuls abnormal. Penurunan kadar serotonin menyebabkan peningkatan respons nyeri terhadap
rangsangan, dan sistem noradrenergik fungsional diperlukan dalam modulasi ini. Nyeri juga dapat
menyebabkan peningkatan proses pergantian serotonin, sehingga terjadi penurunan jumlah
serotonin presinap yang dilepaskan. Hal tersebut mengakibatkan penurunan aktivitas jalur kontrol
nyeri descenden, sehingga nyeri yang dirasakan semakin kuat. Pengurangan pelepasan serotonin
presinap ini juga dapat menyebabkan timbulnya depresi.
Kata kunci : nyeri kronis, patofisiologi, serotonin, norepinefrin
The Rule of Opioid In Chronic Pain Treatment
Adam Kurnia Wardana
Chronic pain is a major public health problem, which is estimated to affect more than 100 million
people in the United States and about 20–30% of the population worldwide. The prevalence of
persistent pain is expected to rise in the near future as the incidence of associated diseases
(including diabetes, obesity, cardiovascular disorders, arthritis, and cancer) increases in the aging
U.S. population
An opioid is chemical substance that has a morphine like action in the body. Opioid activate
receptors that modulate our perception of painful stimuli. There are three opioid receptors- µ, Ƙ and
δ, but the primary analgesic effect is via the µ receptor. Opioids are the most effective analgesics
for severe pain and the mainstay of acute and chronic pain treatments
Opioids can produce significant side effects, including constipation, nausea, mental clouding, and
respiratory depression, which can sometimes lead to death. In addition, long-term opioid use can
also result in physical dependence, making it difficult to discontinue use even when the original
cause of pain is no longer present
Health care providers are in a difficult position when treating moderate to severe chronic pain;
opioid treatments may lessen the pain, but may also cause harm to patients and other problems of
opioid use, including substance abuse, are unlikely to be problematic.
In the case of chronic pain, functional restoration is a predominant goal of treatment. Because it is
often due to neuronal damage, the pain may be particularly sensitive to nonopioid medications, and
opioids can be reserved for refractory pain. If opioids are chosen, tolerance, dependence, and
addiction can interfere, and safeguards designed to minimize these must be built into the treatment
plan.
Neuropsychology Changes In Mood Disorder
Yunias Setiawati
Lecturer Airlangga University
Mood and anxiety disorder are chronic neurobiologist disorders with the highest mortality and
disability that have relapsing risk cause social and economy burden. Etiology factor of mood
disorder has not been clear yet, 75 % mood disorder finding at below 25 years old known as early
onset bipolar with high disabilty and cause learning disorder at school, difficult sosialize with
friends, relapsing rate and suicidal risk that higher than mood disorder with adult onset. Early
research conclude that patophysiology of mood disorder caused by disorder of neurotransmitter
dopamin, serotonin, GABA, glutamate, norepinephrine, and histamine. Another research emphasize
on brain disorder at amygdala and limbic system area, then research evolve focus on relation
between median prefrontal cortex (mPFC), with cortical area from amygdala, ventral sriatum,
globus pallidus, medial thalamus, and ganglia basalis which related with mood disorder.
Enlargement on gray matter volume and neurophsycological activity related with manic episode
while volume narrowing related with depression episode, genetic factor also be assumpted have
role at this disorder. Chronic psychosocial stressor will destroy cellular relisiency ad related with
mood disorder. Psychological factor of mood disorder have not been yet clear untill now, while
unipolar mood disorder most treated at primary health care. Understanding of affective bipolar
disorder psychopathology has benefit in early detection and intervention has purpose decreasing
disability, persistent disorder and prevent relaps which will be worsening outcome.
Keyword : mood disorder, neuropsychologist, genetic, neurotransmier, brain structure, brain

function intervensidini, outcome.
Hubungan antara Fibromialgia dengan Gangguan Bipolar yang berkomorbid
The Connection between Fibromyalgia and Comorbid Bipolar Disorder
Tuti Wahmurti AS
Fibromialgia (FM) adalah gangguan nyeri yang menyebar luas dan kronis (paling sedikit 3
bulan), dengan rasa perih pada 11 titik dari 18 titik khusus pada persendian, otot, tendon, dan
jaringan lunak. FM menyerang 2% - 4% populasi umum, perempuan lebih banyak (3%) daripada
laki-laki (1%). Hampir 50% pasien FM mengalami episode gangguan depresi, prevalensi gangguan
bipolar (BP) sebanyak 15,2% - 17,9% dengan heterogenitas yang tinggi (aktivitas yang berlebihan,
hipomania, mania). Ketika pasien FM mengalami episode depresi seringkali didiagnosis salah
sebagai depresi unipolar. Komorbiditas FM dengan BP memperberat gejala kedua gangguan
tersebut, makin menurunnya kualitas hidup, dan menyebabkan disabilitas. Dampak neurobiologik
dari komorbiditas ini antara lain menurunnya densitas massa abu-abu korteks prefrontal dan
singulat anterior, densitas talamus dan hipokampus, serta abnormalitas aksis hipotalamus-pituitari-
adrenal. Terdapat risiko genetik yang sama pada FM dan BP yaitu polimofisme gen transporter
serotonin. FM sering dicetuskan oleh stress psikososial. Terhadap gangguan yang rumit dan
menyebabkan disabilitas ini penggunaan antidepresan perlu berhati-hati agar tidak terjadi induksi
mania / hipomania. Belakangan didapatkan bahwa quetiapine bisa menjadi terapi alternatif yang
potensial untuk FM dengan komorbiditas BP.
Kata kunci : Fibromialgia, gangguan bipolar, komorbiditas.
The Association Between Affectivity, Perceived Stress, Pain and Cultural Aspects in Patients with
Bipolar Disorder
Theme: Somatic & Physical Illness
DR. Dr. Cokorda Bagus Jaya Lesmana, SpKJ(K), MARS
Department of Psychiatry, Udayana University, Bali
Bipolar disorder (BD) is characterized to be a chronic, progressive disorder with significant residual
affective symptoms between episodes of depression and mania/hypomania rather than a classically
cyclical illness. BD is a common condition with reported lifetime prevalence in the population and
when people attending general physicians. Many studies have shown that pain is common in
patients with BD and even more frequent than in major depression. Recovery from episodes
normally takes months even if they are appropriately treated receiving mood stabilizing medication.
The burden of total health care for patients with BD is estimated at two to four times higher than for
age and sex matched controls.
In patients with major depression about to be hospitalized, complained of at least one painful
symptom is more than multiple painful symptoms. The presence of bodily pain in patients with
major depression also predicts a more prolonged and a more severe course of the depressive episode.
With recovery and treatment of depression makes physical symptoms decrease indicate a
mechanistic link between pain and depression. Patients with unexplained somatic syndromes shows
more common symptoms of anxiety and depression associated with pain such as irritable bowel
syndrome, fibromyalgia and chronic fatigue syndrome thus supporting a bidirectional mechanistic
link between affectivity and pain.
In a recent meta-analysis, the prevalence of chronic pain was two-fold increased risk compared to
the general population. Impaired recovery of depressive episodes, lower quality of life and an
increased risk of suicide are associated with presence of pain. The presence of perceived stressed is
associated to the present of any pain overall as well to hip and neck pain in patients with BD. It is
known that pain in patients with BD is associated with a lower quality of life and with suicidal
behavior and deteriorate the recovery of affective symptoms. Hence, there are multiple reasons as to
why it is important to identify chronic pain in these patients and to treat not only the psychiatric
symptoms but also to involve coping strategies for stress as well as treatment of pain.
The biomedical model for understanding and treating BD seems to be shared by most health care
professionals globally. However, this does not mean that cultural or psychological factors are
unimportant. The biomedical model need a recognition to expand to the bio-psycho-spirit-social-
cultural model that constitutes the current understanding of psychiatric disorders and treatment
interventions. Cultural factors affected the manner patients present and clinicians understand and
respond to symptoms. It is necessary to be aware of culture-bound features, besides the primacy of
mania. Consequently, there is a need for continued research to identify cultural characteristics in
BD.
Keywords: affectivity, bipolar disorder, cultural, pain, perceived stress
Clinical implication of current brain image and genetic findings in bipolar disorder: State of The
Art.
Yuan-Hwa Chou MD, PhD
Center for Quality Management and Department of Psychiatry, Taipei Veterans General Hospital,
Taipei, Taiwan
Bipolar I disorder (BPI) is among the top 10 most debilitating illnesses globally. A growing body of
studies in brain image and genes has been reported. However, there is still a huge gap between
researches and clinical applications. As a clinician how to correctly interpret the results from these
researches is important. In this presentation, I would like to focus on both brain image and genetic
findings.
The brain image findings will cover the data of magnetic resonance image (MRI) and position
emission tomography (PET), which might be a potential endophenotype of the illness. Furthermore,
several candidate genes have been reported to be potential markers to predict the treatment
responses. These findings would help us to clarify diagnosis as well as discriminate the depression
in BD from that of unipolar depression and identify at-risk individuals who will subsequently
develop the illness.
I will end by reviewing the new research direction in BD, including studies of children with bipolar
disorder, potential medication effects, and the use of newer brain image techniques to help us
achieve the previously mentioned goals of improving BP patients' mental well-being.
Spirituality Related To Personality Neuroscience And Disease Management
Taufiq Pasiak
Sub Bagian Neuroanatomi dan Neurosains

Bagian Anatomi dan Histologi Fakultas Kedokteran UNSRAT Manado
The 'one drug fit for all' approach is increasingly felt to be ineffective. 38% on antidepressant drugs,
40% on asthma drugs, 43% on antidiabetic drugs, 50% on antiarthritis drugs, 70% on Alzheimer's
drugs and 75% on anticancer drugs, indicating treatment failure and toxicity. It is related with the
involvement of genes in an individual's response to drugs (1). The effectiveness of the drug requires
adjusting the drug and medical treatment according to the individual genetic characteristics of
each
patient. Each individual is unique in their genetic structure and predisposition for diseases. It
doesn‟t mean the manufacturing of medicines that are unique to a patient. The concept is based on
the classification of patients of a specific disease into sub-population depending on their genetic
markers, susceptibility to a specific disease or response to a particular treatment (2). Personality is
one of the unique components of humans and is also influenced by genes (3,4,5,6). The form of
personality traits known as the Temperament and Character Inventory (TCI) proposed by Robert
Cloninger provides a complete information for studying personality and biological factor include
brain mechanism (7,8). TCI consists of Temperament and Character which are entirely composed
by 7 dimensions. 4 temperament (Harm Avoidance, Novelty Seeking, Reward Dependence and
Persistence) and 3 character domains (Self-Directedness, Cooperativeness, and SelfTranscendence).
Self-Transcendence (ST) is a trait associated with spiritual ideas and experiences,
such as searching for something elevated and greater than one's individual self (9,10). Based on a
number studies, spirituality has a very important role in disease and health, both physically and
mentally (11). Recent neuroimaging studies have provided evidence that different dimensions of
human personality may be associated with specific structural neuroanatomic and brain
neurotransmitter correlates (12). Related to the disease management the clinician must provide
more attention for the personality neuroscience in this case human spirituality.
Keywords: gen, personality, spirituality, structural neuroanatomy, brain neurotransmitter, disease

management.
MASYARAKAT
NEUROSAINS INDONESIA
(Indonesia Neuroscience Society)
Masyarakat Neurosains Seksi Bipolar dan Gangguan

Indonesia (MNI) Mood lain, PDSKJI

Buku Asbtrak Simposium Bipolar

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MASYARAKAT

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