Management of mental

disorder (first aid)

Psychiatry and Dentistry

Most psychiatric disorders precede
the onset of orofacial pain and they
tend to run a chronic course.
major depression, persistent social
phobia, and neurotic, fearful, and
obsessivecompulsive personality
mediated by dysfunctional brain
dopamine activity
Scandinavian Journal of Pain, Volume 2, Issue 4, October 2011,
Pages 155-160

 Prevalence of psychiatric disorders in

burning mouth syndrome (BMS) is high
Patients with BMS showed a higher
frequency of current major depressive
disorder, past major depressive
disorder, generalized anxiety disorder,
hypochondria and cancerophobia (p <
0.05).
In the presence of clinical relevant
psychiatric symptoms, patients must be
treated appropriately.
Journal of Psychosomatic Research, Volume 72, Issue 2, February 2012,
Pages 142-146

Common Mental Disorder

Mood Disorders
Major Depressive Disorder
Dysthymic Disorder
Bipolar Disorder
Suicide
Schizophrenia

 Anxiety Disorders
Panic Disorder
Obsessive-Compulsive Disorder (OCD)
Post-Traumatic Stress Disorder (PTSD)
Generalized Anxiety Disorder (GAD)
Social Phobia
Agoraphobia
Specific Phobia
Eating Disorders
Attention Deficit Hyperactivity Disorder
(ADHD)

Management in Psychiatry
Psikofarmaka
Anti
Anti
Anti
Anti
Anti

psikotik
depresan
cemas
mania (mood stabilisator)
insomnia

Non psikofarmaka
Terapi Kejang Listrik
Psikoterapi

Bahan dasar dalam mental

Bio-anatomi
Fisiologi
Cell-signalling (neuro signalling)
Content

TERAPI DALAM GANGGUAN

JIWA
FISIOTERAPI
HIDROTERAPI
ECT

PSIKOTERAPI
PSIKOFARMAKA

MOTORIC TERAPI
ART TERAPI
SOCIAL
RELIGIUS

ECT
(ELECTRO CONVULSIVE THERAPY)
TERAPI KEJANG LISTRIK
PERTAMA KALI DIPERKENALKAN
OLEH :
- 1938-CERLETTI
- 1950-MUSCLE
RELAXANT
- ANAESTHESIE

http://hanamedicalshop.files.wordpress.com/2012/03/electroconvulsive-therapy.jpg

http://www.saudipsych.org/images/articles/princ_photo_of_electroconvulsive_therapy.jpg

INDIKASI ECT

DEPRESI
PENDERITA MENOLAK OBAT
TAK RESPON PSIKOFARMAKA
SKIZOFRENIA
AGITASI/EKSALTASI
MANIA
PENDERITA TAK DAPAT DIBERI
PSIKOFARMAKA

KONTRA INDIKASI ECT

PENYAKIT TULANG
PENYAKIT JANTUNG
TBC PARU CAVERNE
TUMOR OTAK
PERDARAHAN
TEKANAN INTRA CRANIAL YANG MENINGGI

KERJA ECT
MENIMBULKAN STRES AKUT PADA
- SISTEM CARDIOVASKULER
- SISTEM RESPIRASI
- MUSCULOSKELETAL
- SARAF
MENIMBULKAN KEJANG

KERJA / AKSI ECT

SECARA BIOKIMIA
PLACEBO EFFECT
MENGHILANGKAN INGATAN AKAN
PERISTIWA TELAH LALU YANG TIDAK
MENYENANGKAN

http://www.healthcareglobal.com/healthcare_technology/ECT%20depression%20therapy.jpg

PSIKOFARMAKA
MEMPENGARUHI
- PROSES PIKIR
- ALAM PERASAAN / EMOSI
- TINGKAH LAKU (BEHAVIOUR)
- PENGHAYATAN PRIBADI
MANUSIA

ANTI DEPRESAN
(BERDASARKAN SUSUNAN KIMIA)
POLICYCLIC
MONOAMINE
OXIDASE INHIBITOR
NEUROLEPTIK
L-TRYPTOPHAN
HORMON & VITAMIN
STIMULANT

ANTI DEPRESAN BERDASAR

FARMAKODINAMIK
TIMOLEPTIK : EFEK UTAMA MENINGKATKAN
PERASAAN HATI
- DIBENZOCYCLOHEPTADINE
(AMITRIPTYLINE)
TIMERETIK : MENIADAKAN HAMBATAN
PSIKIS (DISINHIBITING EFFECT)
-

ANTI DEPRESAN BERDASAR EFEK

SAMPING
GENERASI PERTAMA
(IMIPRAMINE, AMITRIPTYLINE)
- EFEK SAMPING :
. GANGGUAN JANTUNG, OTONOM,
CARDIOTOXIC, ANTICHOLINERGIK
PERIFER
GENERASI KEDUA
(NOMIFENSINE, MIANSERINE MAPROPTYLIN)
- EFEK SAMPING
. KURANG MEMPUNYAI EFEK SAMPING
TETAPI HARGANYA MAHAL

http://pharmacologycorner.com/w
p-content/uploads/2009/05/drugsnri.png

KONTRA INDIKASI
TRICYCLIC :
HIPERSENSITIVE
INFARK MIOKARD (ABSOLUTE)
GANGGUAN JANTUNG LAIN
HIPERTROFI PROSTAT
GLAUKOMA
EPILEPSI
GAGAL GINJAL (RENAL FAILURE)
GANGGUAN FUNGSI GINJAL LAIN

MAOI
HEPATITIS INFEKSIOSA
ICTERUS
CIRRHOSIS HEPATITIS

ANXIOLYTIC
(ANTI CEMAS)
MEMPUNYAI EFEK

ANTI CEMAS
ANTI TEGANG
ANTI AGITASI
SEDATIVA
NON HYPNOTIC

DALAM DOSIS TINGGI DAPAT MENIMBULKAN KETERGANTUNGAN

FISIK & PSIKIS TERUTAMA BAGI MEREKA DENGAN
KEPRIBADIAN DEPENDENT DAN TIDAK MANTAP

ANXIOLITIC BERDASAR
RUMUS KIMIAWI
DERIVAT GLYCOL ---------------------- MAPROBAMATE ------------------------- DERIVAT BICYCLIC

DIPHENILME THANE ----------------- HYDRAZINE, PROCALM, COVATEX

DERIVAT BENZODIAZEPINE -------- DIAZEPAM, CLHORDIAZE POXIDE

http://nawrot.psych.ndsu.nodak.edu/courses/46
5Projects06/Benzo/Page2_files/image004.j
pg

INDIKASI PEMAKAIAN ANXIOLYTIC

GANGGUAN KECEMASAN
KEADAAN GELISAH
GANGGUAN PSIKOSOSIAL
GANGGUAN TIDUR
KONVULSI
SEBAGAI RELAXANT OTOT
SEBAGAI ANESTESI UMUM

KONTRA INDIKASI PEMAKAIAN

ANXIOLITIC

HIPERSENSITIF
GLAUCOMA ACUTE JENIS NARROW
GLAUCOMA JENIS OPEN ANGLE
MYASTHENIA GRAVIS
PEMAKAIAN BERSAMA ALKOHOL DAN
BARBITURAT ATAU PHENOTHIAZINE OLEH
KARENA DAPAT TIMBUL EFEK DERPESI
YANG BERLEBIHAN

PEMILIHAN ANXIOLYTIC
ACUTE ANXIETY
ANXIOLYTIC PARENTAL (DIAZEPAM)
SHORT ACTING
EFEK SAMPING KECIL O.K. AKUMULASI KECIL
RELATIF AMAN UNTUK ORANG TUA, PENDERITA
GANGGUAN GINJAL DAN HEPAR
LONG ACTING
AKUMULASI BESAR
TIDAK BAIK UNTUK ORANG TUA, PENDERITA
GANGGUAN GINJAL DAN HEPAR

HORMON & VITAMIN

THYROTROPIN
THYROXINE
PYRIDOXINE
-----------------STIMULANT :
- DEXAMPHETAMINE

PSIKOTERAPI

Basic Assumptions
Id, ego, superego
Libido love, sex, life force, survival
Aggressive drive hostility, death
force

Basic Assumptions
Freud: Personality structure
EGO:

Conscious
Secondary Process
Memory & Intellect
Rational Thought
Language
Ego functions (Bellak)

Suppression
Repression

PRE-CONSCIOUS: (Superego, morality, shame, guilt, remorse)

ID:

Defense Mechanisms
Unconscious needs
Dreams, free Association
Pleasure seeking
Projective tests
Libidinal & Aggressive Drives
Primary Process
Symbols
Conflicts & Fixations

From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual.
manual. Online document, http://www.efacultylounge.com,
based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach.
approach. Thorofare, NJ: SLACK Incorporated.

Psychotherapy
It can not alter the problem of
world in which patient lives
But it can enhance self
acceptance, empower the patient
to make life changes and help
patient to cope with enviroment
more effectively

Classification of
Psychotherapy
according to who is involved in the
treatment
an individual
a group
a couple
a family therapy

Classification of
Psychotherapy
according to the content and
methods used
analytic
interpersonal
cognitive,behavioral, cognitive behavioral
All psychotherapies are aimed at
changing aspects of the patient

Characteristics common for

all psychotherapies
Based on interpersonal relationship
used verbal communication between
two or more people as healing element
specific expertise on the part of the
therapist in using communication and
relationshop in healing way

Characteristics common for

all psychotherapies
based on rationale or conceptual
structure that is used to understand
the patient problem
use of the specific procedure in the
relationship that is linked to rationale
structure relationship
expectation of improvement

Behavior therapy
Aim : change the behavior.
derived from British empiricism,
Pavlov studies of conditioning,
research on stimulus response
relationship conducted by
behaviorists (such as Skinner, Wolpe,
Eysenck.)

Cognitive therapy
cognitive structures or schemata
shape the way people react and
adapt to a variety of situations that
they encounter in their lives

Cognitive therapy
aim : to abolish negative thoughts
which allow symptoms to persist
(our moods and feelings are influenced
by our thoughts and the psychological
disturbances are caused by habitual
errors in thinking. By correcting these
distorted ways of thinking, therapist
restructure patients views of themselves)

Cognitive therapy
The three major cognitive
patterns observed in
depression (by Beck)
- a negative view of oneself
- a negative
interpretation of experience
- a negative view of future

Cognitive therapy
treatment of depression
the schema that lead to negative
interpretations
the goal : to indentify and
restructure those negative
schemata (that shape p.perception)

Individual psychotherapy

Covers broad range of

psychotherapeutic techniques which
are usually done individually - single
therapist working with single patient

Psychoanalysis
Originally developed by S.Freud ( a
systemic theory to describe the
structure and operations of the
human psyche)
reorganization of character structure
with emphasis on self understanding
and correction of development lags

Psychodynamic
psychotherapy
concepts are embodied in
psychoanalytic theory (it does not
involve rigidly defined techniques
that charakterized classical
psychoanalysis)

Insight oriented
psychotherapy
based on psychodynamic concept
focused on interpersonal relationship
- here and now situation
the patient are encouraged to
achieve an intellectual understanding
of the mainspring of their behavior
that will assist in changing it as
needed

Interpersonal therapy
based on idea that mental illness
may reflect and be expressed in
problems with relationship
emphasizes working on improving
interpersonal realtionship during the
process of psychotherapy