neuropsychology Dalam praktek psikiatri

Marlina S. Mahajudin

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konsepNeurodeficit Neuroproduktif

Neurobehavior Neuropsychiatry

neuropsychology

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tujuanMembantu menegakkan diagnosis GMOMembantu deteksi dini gangguan /fungsi otakMembantu mencari lesi gangguan organik

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Penting tahu konsep tes dan penilaiannya.Jangan terpaku pada skoring :

- tahu ada kelainan/gangguan fungsi - cek dan recek dengan anamnese dan gejala klinis - recek dengan tes lain - pengaruh budaya dan pendidikan tak dapat diabaikan

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Monitoring Cognitive FunctionsNine Cognitive Domains

MemoryLanguageVisuospatialPraxisAttention&ConcentrationCalculationJudgment/InsightReasoningAbstract thought

CarefulMonitoring !

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ORIENTATION

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orientationAwareness interview (S.W.Anderson )Structured interview :PersonPlaceTimeItems dealing with appreciation of deficit - motor function - thinking - memory

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Right-left orientation test(RLOT)Benton, Hamsher et al 198320 item test right and left side :Body partssubjects own body or examiner

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Body orientation test (Semmes,1963)Instruksi: Tunjukkan/pegang bagian tubuhNama bagian tubuh yang disentuh pemeriksaSentuh bagian tubuh saya yang saya sebutMeniru pemeriksa apa yang disentuhSentuh bagian tubuh sesuai urutan digambar ini(gambar orang)

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Topographical localization(Lezak)Instruksi gambarkan denah rumah anda (suami) bandingkan dengan gambar istri

Bisa diganti gambar : * arah mata angin * lokasi kota di map Indonesia

tak perlu skoring

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ATTENTION CONCENTRATION TRACKING

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vigilanceExamine the ability to sustain and focus attention itself.Raise the hand or tap, if a number and or a letter is perceived.60 items or more read, display at a rate of one per half-second.Complex : tap after b only after d.

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Short-term storage capacityDigit span - forward span : digits, verbal - reversed span : with distractibilitySentences repetition - kalimat berita berganti kalimat tanya - makin lama makin panjang.

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Mental trackingBrain injury disturbances in keeping one or more lines of thought going ( in cocktail party conversation)Some perceptual tracking or scanning from the stimuliTracking task can be complicated by requiring to track > 2 stimuli, associated ideas simultaneus, alternatively or sequently divided / shifting attention

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Mental trackingDigit backwardReversing serial order : WORLDStroop test (Dodrills Format): - kertas kumpulan 176 kata berwarna 11 kesamping, 16 kebawah - part I baca secepatnya, part II warnaSymbol digit modalities test (SDMT)Trail making test.

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perception

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perceptionVisual perception ; - visual inattention * hemineglect ( clock, line bisection) * marking task (bisa visual scanning) * reading * writing, copying and drawing - visual scanning : bahaya accident prone

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Visual recognition - angulation : * kemampuan mengenali besar/kecil sudut, biasanya lesi hemisfere kanan * Judgement of line orientationRecognition of pictured objectsFace recognition * bukan famous faces(tes memori) * mencari wajah yang sama demgam posisi dan pencahayaan berbeda

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VISUAL INTERFERENCEThe hidden figures test (Talland 1965)The overlapping figures test * Poppelreuter-type overlapping figurePicture searchVisual masking problemsVisual tracking test * Line tracing task ( Talland, 1965)

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Auditory perceptionAUDITORY DISCRIMINATION konsep : kemampuan penderita untuk dapat membedakan suara - konsonsonan & vokal dari dua pasang kata yang hampir sama desis - tepisAPHASIA bisa pakai tes neurologi

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VERBAL FUNCTIONS andLANGUAGE SKILLS

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VERBAL FUNCTIONS AND LANGUAGE SKILLSAPHASIASpontaneus speechRepetitionSpeech comprehensionNamingReadingWriting

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Aphasia screening test (Halsted & Wepman,59) 1. copy a square bentuk lain tanpa angkat pinsil anda 2. apa nama bentukan itu 3. coba eja 4. ikuti saya : saya mau kepasar tuliskan lesi hemisfere kiri bisa copy tidak tulis lesi hemisfere kanan bisa copy bisa tulis

The token test(Boller & Vignolo, 1966) Indonesia tes Tadir

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CONCEPT FORMATION and REASONING

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Concept formation and reasoningConcept formation - focus on quality or process of thinking more than the content of the respons - their scores stand for qualitive judgement of the extent to which the response was * abstact/concrete * complex/simple * apt/irrelevant

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CONCEPT FORMATION TEST IN VERBAL FORMATS 1. proverbs 2.word usage test - comparison & similarities - Stanford-Binnet subtest (Terman & Merril, 1973)VISUAL FORMATS 1. Category test (HCT)Reitan&Wolfson.1993 2.Ravens Progressive Matrices(RPM) 3. Identification of Common Objects (Laine and Butters,1982)

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REASONINGVERBAL REASONING - Comprehension (Wechsler,1981) open ended questions: * common-sense judgement * practical reasoning * meaning of proverbs hati hati verbal memory span ? - Stanford Binet subtest

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REASONING ABOUT VISUALLY PRESENTED MATERIAL

Picture completion (Wechler,1981)

Picture arrangement (Wechler, 1981)

Picture problems

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SYMBOL PATTERNS

SORTING - SORT & SHIFT * object sorting test (Wegl,1941) buat rancangan sheets seperti naming: untuk pria & wanita pemeriksa menyuruh mengelompokkan dg kategori * Wisconsin card sorting (WCST)

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MATHEMATICAL PROCEDURESARITHMETIC REASONING PROBLEMS - Difficulties in immediate memory, concentration, or conceptual manipulation and tracking skill menurun - Arithmetic story problems(soal cerita) sering dipakai brain teasing - Block counting task (Terman& Marril,1973)CALCULATIONS

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EXECUTIVE FUNCTIONS

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Konsep ada 4 komponenVolitionPlanningPurposive actionEffective performance

Dibuktikan untuk perilaku: appopriate-socially responsible-effectively self-serving adult conduct self-direction & self-regulation

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VOLITION - Capacity for intentional behavior * formulate the goal * motivationinitiate activity - gangguan :apthetic/unappreciative wandering - pemeriksaan :OBSWAN * motivational capacity * capacity of self awareness awareness of physical status, environment&situational,social social awareness

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PLANNING - To cary out an intention or achieve goal constitute planning and involve a number of capacitiesPROTEUS MAZE TEST(Porteus,1965)TOWER OF LONDON(Shalice, 1982)

PURPOSIVE ACTION - intention-plan productive, self-serving activity (switch,stop,sequences in orderly integrated and integrated mannerTinkertoy test(TTT) (Lezak,1982) konstruksi test membangun dan melepaskan BENTUKAN/BANGUNAN

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Assessment of self-regulation: 1. produktivity cari ketidak seimbangan antara INTENTION-ACTION OBSWAN : bisa cerita detail langkah2 plan tapi action ragu/tidak bisa 2. flexibility and the capacity to shift disini ada perceptual-cognitive- response dimension

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Perceptual deficit : scanning and inability to change perceptual set easilyConceptual rigidity : concrete/rigid in understanding-problemsolving and stimulus bound(atensi melekat)Inflexibility in response: perseverative, stereotyped,nonadaptive behavior and difficulties in regulating and modulating motor actsTes : uses of objects (bata, pinsil 5 ) gunanya ? Convergen : stereotype Divergen : banyak /aneh2

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Assessmen of perseveration: contoh : Luria teshyperkinetik-like motor perseveration susah berhenti (lebih ggn motor)2. Perseveration elements, sudah instruksi gambar kedua tapi insert gambar pertama3. Perseveration of features, mempertahankan karakteristik gambar tes pertama3. Perseveration in activities, beri stimulus berbeda tulis huruf-angka kacau

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MOTOR PERFORMANCESERING TIDAK BISA DIBEDAKAN DENGAN GANGGUAN EXECUTIVE!Pemeriksaan apraksiaManual dexterity and strength - Finger tapping test (FTT) (Spreen and Straus, 1991)attention? - Purdue pegboard test (Tiffin1968)

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CONSTRUCTION

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drawingCopying - dari tulis nama, meniru bunga tersukar complex figure testFree drawing - human figure(draw a person, tree cs) -bicycle (ada scoring) -clock face (ada scoring)Building and assembling - block design (weschler two dimensional) - Stick test (Butters and Barton)

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BUILDING and ASSEMBLINGTWO DIMENSIONAL CONSTRUCTION - Block design (Wechler,1981) - Stick test (Benson and Barton,1970) - Object assembly gambar/alat yang dikenal diprotoliTHREE DIMENSIONAL - Block design mudah tumpuklah blok sukar mirip candi/rumah dsb

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MEMORY : TEST PAIRED MEMORY TEST QUESTIONAIRS

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General review of memory functionsHarus mencakup:Span of immediate retention - very short-term retention with interference Learning capacity - recent memory, newly learned - retainedEfficiency of retrieval - both recently learned and long-stored (remote)

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Verbal memoryVerbal automatism - suruh menyebut urutan alfabet, hitungan dalam bentuk seriLetter and digits - serial digit learning diucapkanWords * Rey auditory-verbal learning test * California verbal learning test

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Sentences recallStrory recall tergantung panjang pendeknya cerita dan lama jeda(brain teasing) maka yang dinilai * immediate recall * delayed recall

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VISUAL MEMORYVISUAL RECOGNITIONVISUAL RECALL : REPRODUCTION - Complex figure test : recall administration * Rey Complex Figure * Taylor Complex figure * Medical College of Georgia

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REMOTE MEMORYFAMOUS PEOPLE TEST

PRESIDENTS TEST

AUTOBIOGRAPHICAL MEMORY

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MEMORY BATTERIES,PAIRED AND QUESTIONAIRBATTERIESWeschler memory scale

PAIRED?

QUESTIONAIRESMemory functional scaleSPSMQ

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Mild cognitive impairment ?Tantangan untuk psikiatri-psikologi!! persimpangan Alzheimer(DD/)Tes pejabat publikRey auditory verbal learning testBuschke cued recall selective reminding testLogical memory subtest of Wechler Memory ScaleNew York University paragraph recall test

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