Schizophrenia PDF
Schizophrenia PDF
1. Jalur nigrostriatal: dari substantia nigra ke basal ganglia Æ fungsi gerakan, EPS
2. jalur mesolimbik : dari tegmental area menuju ke sistem limbik Æ memori, sikap,
kesadaran, proses stimulus
3. jalur mesocortical : dari tegmental area menuju ke frontal cortex Æ kognisi, fungsi
sosial, komunikasi, respons terhadap stress
4. jalur tuberoinfendibular: dari hipotalamus
1/2/2009 ke kelenjar
Zullies Ikawati's Lecture Notes pituitary Æ pelepasan6
prolaktin
1/2/2009 Zullies Ikawati's Lecture Notes 7
• In human anatomy, the extrapyramidal system is a neural network located in
the brain that is part of the motor system involved in the coordination of
movement. The system is called "extrapyramidal" to distinguish it from the
tracts of the motor cortex that reach their targets by traveling through the
"pyramids" of the medulla. The pyramidal pathways (corticospinal and some
corticobulbar tracts) may directly innervate motor neurons of the spinal cord or
brainstem (anterior horn cells or certain cranial nerve nuclei), whereas the
extrapyramidal system centers around the modulation and regulation (indirect
control) of anterior horn cells.
• Extrapyramidal tracts are chiefly found in the reticular formation of the pons
and medulla, and target neurons in the spinal cord involved in reflexes,
locomotion, complex movements, and postural control. These tracts are in turn
modulated by various parts of the central nervous system, including the
nigrostriatal pathway, the basal ganglia, the cerebellum, the vestibular nuclei,
and different sensory areas of the cerebral cortex. All of these regulatory
components can be considered part of the extrapyramidal system, in that they
modulate motor activity without directly innervating motor neurons.
1/2/2009 Zullies Ikawati's Lecture Notes 8
• serotonergic neurons from the dorsal and median raphe nuclei project to dopaminergic
cell bodies within the VTA and SN of the midbrain.
• Serotonergic neurons primarily from the dorsal raphe project to the terminal fields of
the striatum, nucleus accumbens, and cortex.
• Serotonergic neurons have beenreported to directly terminate on dopaminergic cell
bodies
1/2/2009 and exert an inhibitory influence on Lecture
Zullies Ikawati's mesolimbic
Notes and nigrostriatal dopamine9
Disorganized type
The patient meets the basic criteria for Schizophrenia
All of these symptoms are prominent:
- disorganized behavior
- disorganized speech
- affect that is flat or inappropriate
The patient does not fulfill criteria for Catatonic Schizophrenia
1/2/2009 Zullies Ikawati's Lecture Notes 17
Catatonic Type
The patient meets the basic criteria for Schizophrenia
At least 2 catatonic symptoms predominate:
-Stupor or motor immobility (catalepsy or waxy flexibility)
-Hyperactivity that has no apparent purpose and is not influenced by external
stimuli
-Mutism or marked negativism
-Peculiar behavior such as posturing, stereotypies, mannerisms or grimacing
-Echolalia or echopraxia
Coding Notes
• Negativism is demonstrated when the patient (1) refuses to follow all instructions
without apparent motive or (2) maintains a rigid posture despite the examiner's
physical attempts.
• Mannerisms are unnecessary movements that are part of goal-directed behavior,
such as a flourish of the pen when signing a document).
• Stereotypies are behaviors that do not appear to be goal-directed, such as
flashing a "Victory" sign with two upraised fingers every few seconds.
• Posturing means that the patient spontaneously poses or assumes a posture that
is bizarre or inappropriate. Zullies Ikawati's Lecture Notes
1/2/2009 18
Undifferentiated Type
• The patient meets the basic criteria for Schizophrenia
• The patient does not meet criteria for Paranoid, Disorganized, or Catatonic
types.
Residual Type
• The patient at one time met criteria for Catatonic, Disorganized, Paranoid or
Undifferentiated Schizophrenia.
• The patient no longer has pronounced catatonic behavior, delusions,
hallucinations or disorganized speech or behavior.
• The patient is still ill, as indicated by either
-negative symptoms such as flattened affect, reduced speech output or lack of
volition, or
-an attenuated form of at least 2 characteristic symptoms of schizophrenia,
such as odd beliefs (related to delusions), distorted perceptions or illusions
(hallucinations), odd speech (disorganized speech) or peculiarities of behavior
(disorganized behavior).
1/2/2009 Zullies Ikawati's Lecture Notes 19
Diagnosis
• Pasien didiagnosis menderita skizoprenia jika terdapat 2 atau
lebih tanda-tanda seperti :
• delusi
• halusinasi
• disorganized speech
• perilaku katatonik (aktivitas motorik berlebihan)
• gejala negatif
secara terus menerus sedikitnya dalam waktu enam bulan,
dengan sedikitnya ada satu bulan di mana pasien
menunjukkan gejala-gejala tersebut secara intensif
Note : 6 bln meliputi gejala prodromal dan residual
1/2/2009 Zullies Ikawati's Lecture Notes 20
Prognosis
•Prognosis cukup baik jika : onset lebih lambat,
pemicunya diketahui, sejarah pre-morbid bagus, dan ada
dukungan keluarga Æ 20-30% mungkin bisa kembali
normal
•Kurang lebih 20-30 % mungkin akan mengalami gejala
sedang
•40 – 60% mungkin tidak akan kembali normal seumur
hidupnya
• Ziprasidon
• Aripiprazol
Tahap 2:
Coba SGA tunggal yang lain selain max 12 minggu
yang dipakai pada tahap 1
Respon parsial atau tidak ada Respon parsial atau tidak ada
6 bulan
Tahap 2A Tahap 3
Coba FGA atau SGA yg lain Coba FGA atau SGA yg lain
Respon parsial
atau tidak ada
Tahap 4
Klozapin Menolak klozapin
Tahap 5
Coba satu obat
FGA atau SGA
yg belum dicoba
Stage 5 Clozapin
Respon parsial
Stage 5b
Kombinasi Atipikal+tipikal, atau kombinasi tipikal,
atau kombinasi atipikal, atau atipikal + ECT
Pre-Pregnancy Planning
• Begin prenatal planning at least three months prior to pregnancy
• Make Extra Effort to Maintain Low Levels of Physical, Social and Emotional Stress &
Anxiety (worry) Immediately before, and During Pregnancy
• Take a multivitamin daily for 1 to 3 months prior to conception
• Make sure that any sexually transmitted diseases (eg. Herpes, Chlamydia, etc.) have
been treated by a medical professional prior to pregnancy
• Make an extra effort to be at a healthy weight prior to pregnancy
• Make extra efforts to avoid alcohol and lead exposure prior to, and during
Pregnancy
• Husbands should try to plan to have children when they are younger, rather than
older
• Consider having a longer (greater
1/2/2009
than 27 months) interval between pregnancies,
Zullies Ikawati's Lecture Notes 44
to
maximize mental health of children
Key points: