Gangguan skizoafektif

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Pendahuluan
Gambaran utama gangguan skizoafektif adalah adanya episode depresi mayor,
manik atau campuran yang terdapat bersamaan dengan gejala skizofrenia
(memenuhi kriteria A sizofrenia; waham, halusinasi, perilaku aneh, dan gejala
negatif) berlangsung paling sedikit satu bulan

Kriteria episode depresi mayor

Mood terdepresi yang perpasif (tidak cukup hanya kehilangan minat dan
anhedonia) yang berlangsung paling sedikit dua minggu

Kriteria episode manik

Suasana perasaan melambung meningkat, ekspansif atau irtabel yang
berlangsung paling sedikit satu minggu.

Kriteria episode campuran

Campuran kedua suasana perasaan yang paling sedikit berlangsung satu
minggu

Kriteria episode campuran

Campuran kedua suasana perasaan yang paling sedikit berlangsung satu
minggu
 Patogenesis

2015 2017 2019

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2014 2016 2018

Manifestasi klinis
Anamnesis Pemeriksaan fisik
 Adanya perasaan sedih dan
kehilangan minat berlangsung
Tanda gangguan mood
minimal 2 minggu
depresi (misal; mood
 Perasaan senang yang hipotim dan isolasi sosial)
berlebihan paling sedikit satu
minggu Tanda mania (misal, mood
hipertim, iritabel, banyak
 Gejala tersebut muncul
bicara, aktivitas motorik
bersamaan dengan
meningkat
pembicaraan kacau, waham,
halusinasi, perilaku kacau,
gejala negatif
Kriteria diagnostik
Kriteria Diagnostik Untuk Gangguan Skizoafektif
A. Suatu periode penyakit yang tidak terputus selama mana, pada suatu waktu.
Terdapat baik episode depresif berat, episode manik, atau suatu episode campuran
dengan gejala yang memenuhi kriteria A untuk skizofrenia.
Catatan: Episode depresif berat harus termasuk kriteria A1: mood terdepresi.
B. Selama periode penyakit yang sama, terdapat waham atau halusinasi selama
sekurangnya 2 minggu tanpa adanya gejala mood yang menonjol.
C. Gejala yang memenuhi kriteria untuk episode mood ditemukan untuk sebagian
bermakna dari lama total periode aktif dan residual dari penyakit.
D. Gangguan bukan karena efek fisiologis langsung dari suatu zat (misalnya, obat
yang disalahgunakan, suatu medikasi) atau suatu kondisi medis umum.
Sebutkan tipe:
 Tipe bipolar: jika gangguan termasuk suatu episode manik atau campuran (atau
suatu manik suatu episode campuran dan episode depresif berat)
 Tipe depresif: jika gangguan hanya termasuk episode depresif berat.
Gangguan skizoafektif tipe bipolar
Onset biasanya akut, perilaku sangat
terganggu, namun penyembuhan secara
sempurna dalam beberapa minggu.
Waham kebesaran, waham kejaran mungkin ada.
Gejala skizofrenik juga harus ada, antara lain :
merasa pikirannya disiarkan atau diganggu, ada
kekuatan-kekuatan yang sedang berusaha
mengendalikannya., mendengar suara-suara
yang beraneka beragam atau menyatakan ide-ide
yang bizarre.
Suatu gangguan psikotik dengan gejala-
gejala skizofrenik dan manik bersama-
sama menonjol dalam satu episode
penyakit yang sama.
 Gejala-gejala afektif diantaranya : elasi dan
ide-ide kebesaran, tetapi kadang-kadang
kegelisahan atau iritabilitas disertai oleh
perilaku agresif serta ide-ide kejaran.
 Terdapat peningkatan enersi, aktivitas yang
berlebihan , konsentrasi yang terganggu,
dan hilangnya hambatan norma sosial .
 Gangguan skizoafektif tipe manik
Episode berlangsung lebih lama dari
pada episode manik, dan bisa Pada episode yang sama terdapat
sembuh sempurna.Namun ada gejala-gejala skizofrenia maupun
sebagian yang akhirnya berkembang depresif yang sama-sama menonjol.
menjadi defek skizofrenik.

Secara bersamaan dalam satu episode terdapat

gejala-gejala skizofrenia
 Merasa pikirannya sedang disiarkan, atau
diganggu, ada kekuatan yang mengendalikan
pikirannya. Pasien yakin sedang di mata-matai,
sedang diincar .
 Mendengar suara yang menghina, mengutuk
dirinya, atau akan membunuhnya. Bahkan seperti
ada yang mendiskusikan dirinya.
Gejala depresi disini ditandai dengan
adanya perilaku yang retardasi, insomnia,
hilangnya enersi, perubahan nafsu makan,
kurang minat, gangguan konsentrasi,
perasaan bersalah, keputusasaan, dan
ide-ide bunuh diri.
Section Break
Insert the Sub Title of Your Presentation
Tatalaksana- Skizoafektif episode manik atau
campuran
Kriteria akut :
 Total skor Positive And Negative Symptom Scale- Excited Component (PANSS)
yaitu P4 = gaduh gelisah; P7 = permusuhan; G4 = Ketegangan; G8= ketidak
kooperatifan; G14 = buruknya pengendalian impuls, minimal satu butir skornya 4
atau lebih
 Kategori nilai the Agitation-Calmness Evaluation Scale (ACES) adalah 1 atau 2 (1=
agitasi berat yaitu meningkatnya aktivitas fisik, banyaknya pembicaraan, dapat
terjadi kekerasan fisik, asien tidak bisa mengontrol agitasinya, memerlukan
perhatian atau supervisis terus menerus. 2= Agitasi sedang yaitu peningkatan
aktivitas fisik derajat sedang, banyak bicara, dan mungkin mengancam secara
verbal, tidak ada kekerasan fisik, dapat mengontrol agitasi, memerlukan supervisi
atau perawatan standar
 Nilai Young Mania Rating Scale (YMRS) adalah 20 dan 2 butir skornya yaitu
iritabilitas, pembicaraan dan isi perilaku agresif
 Nilai 4 pada Clinical Global Impression Severity of Illness (CGI-SI) Psikofarmaka
Tatalaksana- Skizoafektif episode manik atau
campuran
Injeksi
• Olanzapin 2 x 5-10 mg/ hari
• Diazepam 2 x 10 mg/ hari
ORAL
Terapi kombinasi :
• Olanzapin 1 x 10 – 30 mg/hari atau Risperidone 2 x 13 mg/ hari atau quetiapin
hari I (200 mg), hari II (400 mg), hari III (600 mg) dan seterusnya atau aripirazol
1 x 10-30 mg/ hari
• Litium karbonat 2 x 400 mg, dinaikkan sampai kisaran terapeutik 0,8 – 1,2
mEq/L (biasanya dicapai dengan dosis litium karbonat 1200-1800 mg/ hari,
pada fungsi ginjal normal) atau divalproat dengan dosis 3 x 250 mg/ hari (atau
konsentrasi plasma 50-125 ug/L
• Lorazepam 3 x 1-2 mg/ hari kalau perlu
ECT : 3 kali per minggu (untuk pasien refrakter)
Psikoterapi : 2 x/ minggu
Edukasi keluarga : 1 x / minggu
Tatalaksana- Skizoafektif episode depresi mayor
(fase akut)
Evaluasi resiko bunuh diri:
 Adanya ide, keinginan yang kuat
atau rencana bunuh diri
 Aksesnya ke sarana bunuh diri
tersebut atau letalitasnya
 Adanya halusinasi komando, gejala
psikotik lain atau anxietas yang
berat
 Adanya penyalahgunaan zat atau
alkohol
 Riwayat atau pernah melakukan
usaha bunuh diri sebelumnya
 Riwayat bunuh diri dalam keluarga
Kriteria akut :
 Total Montgomery Asberg Depression
Rating Scale (MADRS) minimal 20
dan butir mempunyai nilai 4 atau lebih
pada butir; perasaan sedih yang
terlihat, ketidakmampuan merasakan
(hilangnya minat) dan pikiran-pikiran
bunuh diri
 Total skor Positive And Negative
Symptom Scale- Excited Component
(PANSS) minimal adalah 70 dengan
minimal satu butir mempunyai nilai 4
atau lebih yaitu P1, P3, P6, N2, G3,
G6, G7, G13
Tatalaksana- Skizoafektif episode depresi mayor
(fase akut)
Injeksi
• Olanzapin 2 x 5-10 mg/ hari dengan Diazepam 2 x 10 mg/ hari
ORAL
Terapi kombinasi :
• Litium karbonat 2 x 400 mg, dinaikkan sampai kisaran terapeutik 0,8 – 1,2
mEq/L (biasanya dicapai dengan dosis litium karbonat 1200-1800 mg/ hari,
pada fungsi ginjal normal) atau divalproat dengan dosis 3 x 250 mg/ hari
dan dinaikkan beberapa hari hingga konsentrasi plasma 50-100 mg/L atau
karbamazepin dengan dosis 300-800 mg/ hari dan dosis dapat dinaikkan
200 mg tiap 2-4 hari hingga mencapai kadar plasma 4-12 ug/mL atau
Lamotrigin dengan dosis 200-400 mg/hari
• Antidepresan SSRI, mis; Fluoktesin 1x 10-20 mg/ hari
• Olanzapin 1 x 10 – 30 mg/hari atau Risperidone 2 x 13 mg/ hari atau quetiapin
hari I (200 mg), hari II (400 mg), hari III (600 mg) dan seterusnya atau aripirazol
1 x 10-30 mg/ hari
ECT : 3 kali per minggu (untuk pasien refrakter terhadap obat atau katatonik)
Psikoterapi : 3 x/ minggu
Edukasi keluarga : 1 x / minggu
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You can simply impress your audience and add a unique zing and
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Simple Portfolio
Presentation
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Get a modern PowerPoint Presentation that is beautifully designed. Easy to change

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Style You can simply impress your audience and add a unique zing and
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Template will your Time, Money and Reputation. You can simply
impress your audience and add a unique zing and appeal to your
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Get a modern PowerPoint Presentation that is beautifully

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 Fully Editable Icon Sets: A
You can Resize without
losing quality
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 Fully Editable Icon Sets: B
You can Resize without
losing quality
You can Change Fill
Color &
Line Color

FREE
PPT
TEMPLATES
www.allppt.com
 Fully Editable Icon Sets: C
You can Resize without
losing quality
You can Change Fill
Color &
Line Color

FREE
PPT
TEMPLATES
www.allppt.com