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SKIZOFRENIA DAN GANGGUAN PSIKOTIK LAIN

DARYANTO

GANGGUAN PSIKOTIK

GANGGUAN JIWA BERAT DENGAN GEJALA GANGGUAN PENILAIAN REALITAS, DISERTAI DISABILITAS KOGNITIF DAN EMOSI SEHINGGA KEMAMPUAN FUNGSI NORMAL SANGAT TERGANGGU

SKIZOFRENIA KATEGORI DSM IV

295.XX SKIZOFRENIA 295.30 SKIZOFRENIA 295.10 SKIZOFRENIA TERORGANISASI 295.20 SKIZOFRENIA 295.90 SKIZOFRENIA 295.60 SKIZOFRENIA

TIPE PARANOID TIPE TAK


TIPE KATATONIK TIPE TAK TERINCI TIPE RESIDUAL

PPDGJ-III F.20 SKIZOFRENIA


F20.0 F20.1 F20.2 F20.3 F20.4 F20.5 F20.6 F20.7 F20.8

SKIZOFRENIA PARANOID SKIZOFRENIA HEBEFRENIK SKIZOFRENIA KATATONIK SKIZOFRENIA TAK TERINCI DEPRESI PASCA SKIZOFRENIA SKIZOFRENIA RESIDUAL SKIZOFRENIA SIMPLEKS SKIZOFRENIA LAINYA SKIZOFRENIA YTT

F21 GANGGUAN SKIZOTIPAL F22 GANGGUAN WAHAM MENETAP F23 GANGGUAN PSIKOTIK AKUT DAN SEMENTARA F24 GANGGUAN WAHAM INDUKSI F25 GANGGUAN SKIZOAFEKTIF F26 PSIKOTIK NON ORGANIK LAINYA F27 GANGGUAN PSIKOTIK NON ORGANIK YTT

SKIZOFRENIA DAN GANGGUAN PSIKOTIK LAINYA


DITANDAI ADANYA GANGGUAN DALAM; KOMUNIKASI, BAHASA, PIKIRAN, PERSEPSI, AFEK PERILAKU

SKIZOFRENIA

1% PENDUDUK DUNIA PENDUDUK KOTA KELOMPOK SOSEK RENDAH INDONESIA ; 1-3 PASIEN PER 1000 PENDUDUK

FASE SKIZOFRENIA (COPEL, 2000) A. FASE PRODROMAL

KEMUNDURAN FUNGSI PERWATAN DIRI, SOSIAL, WAKTU LUANG, PEKERJAAN ATAU AKADEMIK BERLANGSUNG LAMA (6 12 BULAN) TIMBUL GEJALA POSITIF DAN NEGATIF PERIODE KEBINGUNGAN KLIEN DAN KELUARGA

FASE AKTIF

PERMULAAN INTERVENSI ASKEP; KHUSUSNYA HOSPITALISASI PENGENALAN PEMBERIAN OBAT DAN TERAPI MODALITAS LAINYA PERAWATAN DIFOKUSKAN PADA REHABILITASI PSIKIATRIK SAAT KLIEN MULAI BELAJAR HIDUP DENGAN PENYAKIT YG PENGARUHI PIKIRAN, PERASAAN DAN PERILAKU

FASE RESIDUAL

PENGALAMAN SEHARI-HARI DENGAN PENANGANAN GEJALA PENGURANGAN DAN PENGUATAN GEJALA ADAPTASI

Phases of Schizophrenia: Phase I: Schizoid Personality


indifferent to social relationships appear cold and aloof does not always progress to schizophrenia social withdrawal peculiar or eccentric behavior bizarre ideas unusual perceptual experiences neglectful of personal hygiene and grooming lack of initiate, interests, or energy phase may last for many years

Phase II: Prodromal Phase


Phases of Schizophrenia (contd) Phase III: Schizophrenia


delusions and/or hallucinations disorganized speech disorganized or catatonic behavior affective flattening marked decrease in level of functioning persists for at least 6 months usually follows active phase of the disease flat affect and impairment in role functioning residual impairment usually increases each time

Phase IV: Residual Phase

PENYEBAB Schizophrenia

Umunya disebabkan oleh interaksi genetic dan faktor lingkungan: Neurodevelopmental brain abnormalities
Pembesaran ventricles Cortex-left localized Disfungsi lobus Temporal Metabolisme Phospholipid Disfungsi lobus Frontal Disfungsi sirkuit otak Densitas Neuronal NEUROTRANSMITTER SYSTEM Dopamin

Schizophenria

BLEULERS four As Ambivalenceholding two different attitudes/emotions/feelings at the same time Autistic thinkingdisturbances in thoughts private fantasy world/abnormal responses to people/events of the real world

Bleulers 4 As(cont)

Loosening of Associations-rapid shift of ideas- unrelated manner Affective disturbance - may be blunt, flat,inappropriate/labile

Gejala-gejala Positif

DELUSIONS(paranoid/reference) HALLUCINATIONS(auditory/visual) DISORANIZED SPEECH/THINKING(tangential/loa/incoherent/n eologisms GROSSLY DISORGANIZED BEHAVIOR(difficulty with goal setting/ADLs;unpredictable agitation/silliness/social disinhibition/bizarre behaviors CATATONIC BEHAVIORS(decrease reaction to environment/bizarre postures/aimless motor activity)

Gejala-gejala Negative

AFFECTIVE FLATTENING ALOGIA (poverty of speech/slowed speech/decrease fluency/content) AVOLITION(inability to initiate goal directed behavior)

TYPES OF SCHIZOPHRENIA Disorganized Paranoid Catatonic Undifferentiated Residual Related Psychotic Disorders: Schizoaffective Disorder Schizophreniform disorder Delusional disorder Brief Psychotic disorder

Paranoid Type

Persistent delusions/persecuatory nature Auditory hallucinations-single or associated theme Guarded,suspicious,hostile,angry, possibly violent Pervasive anxiety Intensive,reserved,controlled social interactions Onset- later in life Generally more favorable dx. re: independent living/occupational functioning.

Disorganized type
Grossly inappropriate/flat affect Primitive / uninhibited behaivor Unusual mannerisms-giggle/cry out loud/distort facial expressions Hypochondriasis (multiple physical complaints) Socially inept/withdrawn Onset early- prepsychotic period- marked adjustment problems Hallucinations/delusions more fragmented

Catatonic Type
Marked

disturbance of psychomotor activity May be immobile/or with psychomotor excitation Displays negativism/mutism Posturing Bizarre positions-waxy flexibility

Undifferentiated type

Florid psychotic symptoms : delusions/hallucinations incoherence disorganized speech/behavior *do not clearly fit into other categories

Schizophreniform Disorder

Meets criteria for schizophrenia except: 1) duration-at least 1 month but < 6 mos. 2)Social/ Occupational functioning may or may not be impaired vs. schizophrenia where functional disturbances ie:relationships, school,self care are present.

Schizoaffective Disorder
Symptoms of both Schizophrenia and affective (mood)disorders *delusions/hallucinations/disorganized speech Major depression, mania, mixed At least a two week period of psychotic symptoms only Onset is later than schizophrenia Prognosis is better than schizophrenia,but worse than Affective Disorder.

Residual Type

Client has had at least one acute episode Free of psychotic symptoms Continues to exhibit persistent social withdrawal/emotional blunting/illogical thinking/eccentric behavior

Delusional Disorder

Presence of one or more nonbizarre delusions persist for ONE month or more Bizarre delusion ie:brain removed by aliens-replaced with computer vs. nonbizarre delusion- more believable ie:believes the IRS is going to prosecute his family for his wrongdoings.

Subtypes of Delusional Disorder


Erotomanicmay involve stalking/spying Jealousefforts made to follow & Catch Grandiosehas extraodinary talent/knowledge Persecutoy-victim of a conspiracy/poisining/spying Somatic-bodily sensations/believes body has a foul odor/insects or parasites on/in body/body part is

SHARED PSYCHOTIC DISORDER

Delusional disorder also known as folie `a deux develops in a person who is involved in a relationship with another person who already has a psychotic d/o with prominent delusions.

Psychotic Disorder due to medical conditions

Characterized by: prominent hallucinations and /or delusions due to physiologic effect of medical condition

Substance Induced Psychotic Disorder

Characterized by: prominent hallucinations and /or delusions produced by the physiological effects of a substance ie:

Drugs of abuse,medications or toxins The disorder first occurs during intoxication or withdrawal stages, but can last for weeks thereafter.