Anda di halaman 1dari 28

by

Dr. Alit Aryani SpKJ


BIOLOGICAL THERAPY

• DRUG THERAPY
• ELECTRO CONVULSIVE THERAPY
THERAPY • SURGICAL THERAPY

PSYCHO THERAPY
 Bekerja selektif pd SSP efek utama thd
aktivitas mental dan perilaku

Narkotika
Bekerja selektif pd SSP  efek utama thd
perubahan kesadaran, hilangnya rasa dan
mengurangi sampai menghilangkan nyeri
 Misuse : digunakan secara salah
 Abuse : disalahgunakan potensi timbul ggn
jiwa
 Intoksikasi : dosis >>
 Harmful use : merusak kesehatan (fisik dan
mental)
 Ketergantungan (dependence) : dorongan
kompulsif memakai zat/obat, toleransi, putus
zat bila dihentikan/withdrawal
 Dosis awal (dosis anjuran) dinaikkan cepat
 Dosis Efektif ( dosis yg mulai berefek
mensupresi gejala sasaran)  dinaikkan
gradual
 Dosis optimal (mengendalikan gejala
sasaran) diturunkan pelan
 Dosis maintenance/pemeliharaan
 Tapering off sampai berhenti
Tdk efektif—efektif (optimal)– efek toksik
(kecil) (besar)
1. Benzodiazephine Receptor Agonists and
Antagonists
2. Dopamine Receptor Antagonists (Typical
Anti Psychotic)
3. Serotonin – Dopamine Antagonists (Atypical
Antipsychotic)
4. Tricyclic and Tetracyclic Antidepresant
5. Selective Serotonin Reuptake Inhibitor (SSRI)
6. Selective Serotonin – Norepinephrine
Reuptake Inhibitors (SSNRI)
7. Lithium
ANTI ANXIETAS
Mekanisme : bereaksi dgn reseptor
benzodiazepin meng reinforce the inhibitory
action of GABA ergic neuron shg hperaktivitas
neurotransmitter mereda)

1. Diazepam (Valium)
2. Lorazepam (Ativan)
3. Alprazolam (Xanax)
4. Estazolam ( Esilgan)
5. Clobazam (Frizium)
6. Clonazepam (Riklona)
 Ketegangan motorik (kedutan otot/gemetar,
tegang/kaku, tdk bisa diam, mudah lelah)

 Hiperaktivitas otonomik (nafas pendek,


jantung berdebar, telapak tangan basah,
mulut kering, kepala pusing, mual, diare,
buang air kecil terus, muka panas, rasa
tersumbat)

 Kewaspadaan berlebih (peka, kaget, sulit


konsentrasi, sukar tidur, mudah tersinggung)
1. Generalized anxiety disorders,
2. Adjusment disorders with anxiety
3. Mixed anxiety – Depressive Disorders
4. Panic Disorders and Social Phobia
5. Obsessive Compulsive Disorders
6. Postraumatic Stress Disorders
7. Insomnia
8. Depression
9. Bipolar I Disorders (Mania)
10. Akathisia
11. Parkinson desease
Anxiety,Irritability, Insomnia, Fatique,
Headache, Muscle Twitching, Sweating,
Dizzines, Concentration Difficulties, Nausea,
Depression, Depersonalization, Increased
Sensory Perception, Derealization.
When benzodiazepine are used for short
periods 1 – 2 weeks
In moderate dosages No significant
tolerance, dependence or withdrawal effects.
ANTIPSIKOTIK
Theyare high affinity Antagonist of Dopamin
Receptors.

Treatment of : Schizophrenia and other


psychotic disorders.

Include : Chlorpromazine, Thioridazine


Haloperidol Trifluoperazine (Stelazine)
Fluphenazine,
Risperidon
Clozapin
Quetiapine
Olanzapine
Ziprasidone
Aripifrazole
 which has fewer Neurological side effect
1. Primary Psychotic Disorders
2. Schizophrenia
3. Bipolar Disorders
4. Secondary Psychosis – Organic Cause
5. Severe Agitation and Violent Behavior
6. Tourette’s Disorders
7. Other Psychiatric and Non Psychiatric Indication
- Anxiety
- Nausea
- Emesis
- Ballismus
1. Non Neurological
a. Cardiac effects – prolong QT and PR Internal – Chlorpromazine
b. Suddent Death
c. Orthostatic/postural hypotension  α adrenergic pressor
agents such as metazaminal (Aramine) and Norepinephrine a
drugs of choice in the treatment
d. Hematological effect : Leucopenia, agranulocytosis
e. Periferal anticholinergic effect : dry mouth, nose, blurred
vision, constipation urinary relention, mydriasis, nausea
vomiting
f. Endocrine effect : galactorrhea, amenorrhea, impotence,
inhibited Orgasm in women. Sexual adverse effects –
impotence treated with sildenafil (viagra) has been successful
g. Weight gain
h. Dermatological effect  pigmentation in retina
i. Jaundice  obstructive / cholestatic jaundice
2. Neurological adverse effects :
a. Neurological Induced Parkinsonism /Extra
Pyramidal SyndromTremor, Rigidity,
bradikinesia treated with anticholinergic
agents : Triheyphenidil, diphenhidramin
b. Acute Dystonia : torticolis colli, oculogyric crisis
c. Acute Akathisia – Restlegsless syndromes
d. Tardive dyskinesia – treated by GABA – drugs,
Dopaminergic Agonist
e. Neuroleptic Malignan Syndromes
f. Epileptogenic effect
g. Sedation  Blockade of histamine tipe I
Receptor
ANTIDEPRESAN
Tricyclic
and Tetracyclic
Antidepressants
Therapeutic Indications
1. Major depressive Disorder
2. Mood disorder due to a general medical
condition (secondary Depression)
3. Panic disorder with agoraphobia
4. Generalized anxiety disorder
5. Obsessive compulsive disorder
6. Eating disorder – anorexia nervosa, bulimia
nervosa
7. Pain disorder
8. Childhood Enuresis
1. Psychiatric effect : Inducing Maniac episode
2. Anticholinergic effect : dry mouth, constipation,
blurred vision, urinary retention
3. Sedation : effect anti histamin
4. Autonomic effect : Ortostatic hypotension
because adrenergic blockade
5. Cardiac effect : prolong QT internal, depressed
ST, flattenal T Waves
6. Neurological : myoclonic, ataxia, tremor
7. Allergic, dermatological effect : Exanthematous
Rashes, agranulositosis
8. Weight gain : blockade of histamine 2 (H2).
Impotence  blockade dopamine receptor in
tubero infundibular tract
Fluoxetin, Sertraline, Paroxetine,, Fluvoxamine, Citalopram
Indications
1. Depression (Suicide, during pregnancy, in the ederly
and medically ill, Chronic depression, in children)
2. Anxiety : OCD, Panic, Social Phobia, PTSD, Bulimia,
Anorexia,
3. Premenstrual dysphoric disorders
4. Premature ejaculation
5. Paraphilia
6. Autistic Disorders
7. Attention deficit hyperactive Disorder
8. Chronic pain Syndromes
9. Psychosomatic Conditions
1. Sexual disfunction – inhibited Orgasm
2. Gastrointestinal adverse effect – nausea,
dearhea, anorexia, vomiting
3. Weight gain
4. Headaches
5. Central Nerrous System adverse effect –
anxiety, insomnia, severe vivid dream,
nightmare
6. Anticholinergic effect : dry mouth, constipation,
sedation. Extrapyramidal symptoms : tremor,
akatisia
7. Serotonin syndromes : tremor, dearhea, ataxia,
myoclonus, hyperthermia, delirium, status
epilepticus, coma
By inhibiting degradation of biogenic amines
serotonin, dopamin, norapinephrin.
Include : phenelzine, isocarboxazid, selegiline
Indication
1. Depression
2. Anxiety : Panic with Agoraphobia, Posttraumatic
disorder, eating disorder, social phobia, pain disorder
Precaution and Adverse Reaction
1. Orthostatic hypotensia
2. Insomnia
3. Weight gain
4. Oedem
5. Sexual disfunction
6. Tyramine induced hypertensive crisis
7. Withdrawal : mood disturbances, somatic symptom
8. Overdosis : Agitasi, hypertermia, coma
 Venlafaxine (Effexor) is an effective
antidepressant drug that may have a faster
onset of action than other antidepressant
Venlafaxine is potent inhibitor of serotonin
and norepinephrine and weak inhibitor of
Dopamine reuptake
 Duloxetine (Cymbalta)
1. Depressions with melancholic features 200 mg
venlafaxine/day may respond in 2 weeks
2. Generalized anxiety disorder dosage 75 to 225
mg/day
3. Other indication : obsessive – compulsive disorder,
agora phobia, social phobia, attention dificit
hyperactivity disorder, chronic pain syndromes

Precaution and adverse Reactions


The most cammon reaction are : nausea, somnolence,
dry mouth, dizzines, nervousness, constipation,
asthenia, anxiety, anorexia, blurred vision,
abnormal ejaculation and orgasm
 Lithium Carbonat
 Carbamazepine
 Asam Valproate
 Natrium Divalproate
Mechanism of action :
 Regulation of Release Serotonin and
Norepinefrin in terminal neuron of central
nervous system
 Trans Membran Pump
 Regulation Pathway Syntase Kinase 3 beta and
Regulasi lithium
 Bipolar Disorder
 Manic Episode
 Skizoafektif
Adverse Reaction
 Tremor
 Diarhea & vomiting
 Fatique
 Konvulsi
 Oligouria
 Oedem