Dr.
RONI SUBAGYO, Sp KJ
SCHIZOPHRENIA QUIZ
True False Statement
Schizophrenia is caused by poor parenting
Using drugs causes schizophrenia
A person with schizophrenia has a split personality
Children can be diagnosed with schizophrenia
About half of people with schizophrenia also have problems with subst
ance abuse/dependence
It is very expensive to treat schizophrenia
People with schizophrenia can recover from their illness
Most people with schizophrenia are violent criminals
Schizophrenia affects people of all races, cultures and social classes
People with schizophrenia should not have children
People with schizophrenia are capable of making their own decisions a
bout treatment and other areas of their lives
SCHIZOPHRENIA
A serious mental disorder
The top ten causes of disability
Affects 1 in 100 people worldwide
Approximately 24 million people worldwide
Medical illness
Experience a greater number of other conditions
Stress makes symptoms worse
NOT caused by childhood trauma, bad parenting, or poverty
Proper diagnosis and treatment are available
Not everyone who is diagnosed with schizophrenia has the same sym
ptoms
Warning Signs and Symptoms
Sleep disturbance
Appetite disturbance
Marked unusual behaviour
Speech that is difficult to follow
Marked preoccupation with unusual ideas
Ideas of reference-things have special meanings
Persistent feelings of unreality
Changes in the way things appear, sound or smell
“Positive” Symptoms
Hallucinations
Delusions
Thought disorder
Altered sense of self
“Negative” Symptoms
Lack of motivation or apathy
Blunted feelings or affect
Depression
Social withdrawal
Poverty of speech and thought
Catatonic behaviour
“Cognitive” Symptoms
Problem of attention
Remembering things
Concentrating
Memory impairment
What Causes Schizophrenia ?
1. Viruses
2. Injuries in early life
3. Lack of oxygen at birth
4. Genetic factors
DSM-IV Diagnostic Criteria for
Schizophrenia
A. Characteristic symptoms : Two or more of the following, each present for
a significant portion of time during a one-month period :
- delusions
- hallucinations
- disorganised speech (eg, frequent derailment or incoherance)
- grossly disorganised or catatonic behaviour
- negative symptoms (ie, affective flattening, alogia, or avolition)
Note : Only one Criterion A symptom is required if delusions are bizarre or
hallucinations consist of a voice keeping up a running commentary on t
he person’s behaviour or thoughts, or two or more voices conversing
with each other.
DSM-IV Diagnostic Criteria for
Schizophrenia
B. Social/occupational dysfunction :
since the onset of the disturbance, one or more major areas of functioni
ng, such as work, interpersonal relations, or self-care, are markedly belo
w the level previously achieved
C. Duration : Continous signs of the disturbance persist for at least six mon
ths. This six-month period must include at least one month of symptoms
(or less if successfully treated) that meet Critetion A.
D. Exclusion : of schizoaffective disorder and mood disorder with psychotic
features
DSM-IV Diagnostic Criteria for
Schizophrenia
E. Substance/general medical condition exclusion :
the disturbance is not due to the direct physiological effects of a
substance (eg, a drugs of abuse, a medication) or a general
F. Relationship to a pervasive developmental disorder : if there is a
history of autistic disorder or another pervasive development dis
order, the diagnosis of schizophrenia is made only if prominent d
elusions or hallucinations are also present for at least a mont (or
less if successfully treated).
Early Intervention
“Treatment for schizophrenia is most effective if it
is begun early – as soon as possible after symptoms
Appear. In most countries, ongoing assessments and
Tests will be used to monitor the person’s health and
Wellness – just as in treating any other chronic
medical condition”
Medication
“There is considerable variation in the therapeutic
And side effects of antipsychotic medication.
Doctors and patients must carefully evaluate the
Trade-off between efficacy and side effect in
choosing an appropriate medication. What works
For one person may not work for another.”
Medication treatment
Individual supportive therapy
Cognitive and psychosocial therapies
Family psychoeducation and support
Social support
Case management
Housing
Financial support
Vocational support
“Family and friends should also be
familiar with signs of “relapse”.
These vary betweenIndividuals, but
often a person may withdraw from
Activities and other people, and you
may notice that they are taking less
care of themselves.”
GANGGUAN ANXIETAS
PENDAHULUAN
Dari seluruh gangguan jiwa, mungkin gangguan anxietas
merupakan gangguan yang terbanyak.
Wanita (30,5% lifetime prevalence) > pria (19,2% lifetime p
revalence)
Kira-kira 2 – 4% penduduk pernah mengalami gangguan a
nxietas
Umumnya mengunjung dokter non psikater dengan keluha
n somatic > stigma gangguan jiwa
Anggapan gangguan jiwa = psikosis = inferioritas
Anxietas Normal dan Patalogis
Anxietas Normal :
Compensated, tidak terganggu
Diperlukan sebagai dorongan
berprestasi dan melindungi diri
Anxietas Patalogis :
- Decompensated > sakit
Prestasi dan performance
terganggu
Gejala Umum Gangguan Anxietas :
Merupakan suatu sindroma :
Rasa cemas
Hiperaktivitas vegetatif
Ketegangan khawatir berlebihan – tentang hal-hal
yang akan datang (apprehensiveexpectation)
Kewaspadaan bertambah
Perlu Diperhatikan :
Pada gangguan anxietas banyak keluhan s
omatic
Tidak semua punya stressor penyebab
Sering komorbid, terutama dengan ganggu
an mood (depresi)
FAKTOR PENYEBAB
STRES KEHIDUPAN
KONFLIK INTERPERSONAL
KONFLIK KELUARGA
PERISTIWA KEHILANGAN/KEKECEWAAN
NAPZA/NARKOBA
PENYAKIT MEDIS
OBAT
PENGALAMAN BURUK MASA LALU
KEPRIBADIAN
GENETIK
GANGGUAN CEMAS MENYELURUH
KEKHAWATIRAN & KECEMASAN SUBYEKTIF >>
WASPADA & SIAGA
TERJADI HAMPIR SETIAP HARI/MENETAP
TIDAK TERBATAS PD SITUASI TERTENTU
KETEGANGAN MOTORIK
HIPERAKTIVITAS OTONOMIK
GANGGUAN PANIK
GX PSIKIS
KECEMASAN HEBAT
TAKUT MATI/KEHILANGAN KONTROL
DEPERSONALISASI
DEREALISASI
GX FISIK
PALPITASI/BERDEBAR, TAKIKARDIA, NYERI DADA
RASA TERCEKIK, SESAK NAPAS
BERKERINGAT, GEMETAR, PUSING, KEPALA
RINGAN, MAU PINGSAN, RASA DINGIN, MUAL
FOBIA SOSIAL
MENGHINDARI SITUASI SOSIAL TERTENTU DI LUAR KELUA
RGA
berbicara/tampil di depan umum
makan minum/menulis di depan umum
menggunakan toilet umum
berkencan, pergi ke pesta/aktivitas sosial lain
berbicara pada atasan
bertemu orang asing
TAKUT MENJADI PUSAT PERHATIAN/DIKRITIK
GANGGUAN OBSESI KOMPULSI
ISI PIKIRAN YG KUKUH/PERSISTEN TTG
SATU HAL
TIMBUL PERASAAN TAKUT/CEMAS
GOK DIRASAKAN PERASAAN ASING, TD
K DISUKAI/DITERIMA, TDK DPT DITEKAN
SADAR AKAN GGN & ADA KEBUTUHAN
UTK MELAWAN
GEJALA CEMAS PD ANAK & REMAJA
TEMPER TANTRUM
ENURESIS
MENOLAK SEKOLAH/MEMBOLOS
PRESTASI BELAJAR TURUN
TERISOLASI DARI TEMAN
PERILAKU MENGAMBIL RESIKO
PENGGUNAAN NARKOBA
MIMPI BURUK
KELUHAN FISIK TDK KHAS
BAGAIMANA MENDIAGNOSIS ?
50-95% PX PSIKIATRI DATANG DG KELUHAN SOMATIK
BIASANYA LBH DARI SATU, TDK JELAS & SULIT DITERAN
GKAN SESUAI PENYAKIT ORGANIK
KELELAHAN
PUSING/SAKIT KEPALA
NYERI DADA, SENDI
MASALAH GASTROINTESTINAL
BB
PENATALAKSANAAN
TUJUAN TERAPI
ME GX KECEMASAN (FISIK, PSIKOLOGIS)
MEMBERIKAN KETERAMPILAN MENGATASI GX
MEMPERBAIKI POLA PIKIR
TERAPI DIBERIKAN SAMPAI GX DPT DIKENDALIKAN
BERFUNGSI NORMAL
DEPRESI
Depresi pada praktek umum
Pasien yang ditemui di praktek umum sering dat
ang dengan keluhan fisik (somatik) bukan keluha
n psikologis
Keluhan somatik yang sering diutarakan oleh pas
ien
- Sakit kepala
- Gangguan saluran nafas
- Gangguan saluran pencernaan
- Nyeri pada berbagai bagian tubuh
DEPRESI
ANXIETAS
Perasaan sedih GEJALA TUMP Gemetar
Kurang minat ANG TINDIH
Kekakuan
Retardasi Gangguan Tidur
otot
psikomotor Kelelahan
Gangguan Sesak nafas
Agitasi psikomotor
nafsu makan Khawatir/rasa ber Berkeringat
Merasa tidak salah Mulut kering
berdaya Sulit berkonsentrasi Mual
Putus asa Ide bunuh diri
90 % pasien depresi mempunyai gejala Anxietas
Angka Prevalensi Depresi pada
Gangguan Medis Kronis
Stroke 47.00%
45.00%
Kanker rawat inap 42.00%
39.00%
Lansia rawat inap 36.00%
33.00%
Rawat Inap 33.00%
9.40%
Populasi umum 5.80%
0.00% 10.00% 20.00% 30.00% 40.00% 50.00%
Depression as a whole body disorder
Endocrine changes.
Immune changes.
Cardiovascular changes.
Cancer.
Endocrine changes in depression-1.
Disturbances of the HPA axis lead to:-
Hypercortisolaemia and dexamethasone non-su
ppression (DST test).
Impaired DST test predicts recurrence and chro
nicity of depression.
Impaired TRH test common in depression.
Levels of sex hormones (loss of libido) and grow
th hormone (tissue repair decreased) lower in ch
ronic depression.
Endocrine changes in depression-2.
Consequences of hypercortisolaemia on general
metabolism:-
Disturbance in glucose metabolism leading to in
sulin resistance and diabetes.
Increased protein metabolism leading to loss of
muscle mass and bone calcium;fractures more li
kely.
Change in lipid metabolism and fat distribution;a
therosclerosis more likely.
Inhibition of neurotrophic factor synthesis leadin
g to reduced synaptogenesis and neuronal repai
r: neurodegeneration more likely.
Immune changes in depression-1.
Depression as an inflammatory disorder:-
Over 40 different immune markers ( most of the
m inflammatory markers!) related to depression
( Zorrilla et al,2000)
Increased peripheral and central pro-inflammato
ry cytokines associated with depression ( IL-1,-6,
TNF,IFN). Rise in acute phase proteins.
Epidemiological studies show increase in rheum
atoid arthritis and autoimmune disease in patient
s with depression.
Immune changes in depression-2.
Incidence of dementia increased in patients with
chronic depression.This is linked to the neurode
generative effects of cortisol,the pro-inflammator
y cytokines and inflammatory changes associate
d with the rise in prostaglandin E2 and nitric oxid
e in brain.
Pro-inflammatory cytokines also stimulate HPA
axis and contribute to hypercortisolaemia.
Symptoms of depression ( anorexia,sleep distur
bance,anhedonia,cognitive changes etc) a form
of sickness behaviour ( Dantzer et al.)
Depression and cardiovascular functio
n-1.
Increased peripheral sympathetic activity and su
sceptibility to environmental stressors contribute
to hypertension.
Accumulation of visceral fat and increased fat de
posits in coronary arteries associated with hyper
cortisolaemia and insulin resistance.
Increased blood clotting and elevation of circulati
ng homocysteine contribute to cardiovascular ch
anges.
Cancer and depression-1.
Some epidemiological evidence that high incide
nce of depression preceeds cancer (Shekellel et
al.1981;Linkins & Comstock, 1990).
However,progression of cancer linked to psychol
ogical factors (20/26 studies) rather than initiatio
n of cancer (6/12 studies).
Psychotherapy can enhance period of survival a
fter metastatic breast cancer (Spiegel et al.1989).
Cancer and depression-2.
Possible mechanisms:-
Natural killer cell suppression linked to onco
genic virus induced cancers and lymphoreti
cular cancers (Souberbielle & Dalgleish,199
4).
IFN,TNF,IL-8 &TGF all raised in depression
and involved in angiogenesis necessary for
tumour growth.
Depression
Affective: afek depresi (anak: iritabel), anhed
onia sedikitnya 2 minggu.
Cognitive: merasa tidak berguna/merasa ber
salah, tidak berpengharapan, peragu, bunuh
diri.
Somatic (vegetative): perubahan BB/napsu
makan, tidur (insomnia atau hipersomnia), k
ehilangan energi/fatigue, agitasi/retardasi ps
ikomotor.
GANGGUAN DEPRESI
A. Kriteria mayor
Trias depresi:
1. mood depresi
2. hilang minat dan kesenangan
3. hilang energi dan mudah lelah
B. Kriteria minor
1. sulit konsentrasi
2. hargadiri/ kepercayaan kurang
3. rasa bersalah berlebihan
4. pandangan tentang masa depan yang suram
5. pikiran tentang kematian/ ide-ide bunuh diri
6. perubahan pola tidur
7. perubahan napsu makan
Depresi ringan
2A+2B
Tidak ada gejala yang sangat berat
Hanya ada sedikit kesulitan dalam pek
erjaan dan kegiatan sosial
Gejala harus bertahan minimal 2 mingg
u
Depresi sedang
2 A + 3/4 B
Terdapat hendaya yang nyata dalam pe
kerjaan dan kegiatan sosial
Gejala harus bertahan minimal 2 mingg
u
Depresi berat
3A+4B
Tiak mampu melakukan pekerjaan atau
kegiantan sosial
Gejala harus bertahan minimal 2 minggu
Macam Gangguan Depresi ?
Dua penyebab keadaan depresi yang um
umnya tidak dipertimbangkan sebagai ga
ngguan afektif adalah:
Berkabung
Postpartum blues
Pengobatan Terbaik
Medikasi + terapi psikososial
Terapi psikososial terutama membantu m
engurangi angka kekambuhan
