TERAPI

GANGGUAN JIWA

Oleh:
Rusdi
PROGRAM STUDI ILMU KEPERAWATAN
FAKULTAS ILMU KESEHATAN
UNIVERSITAS PEKALONGAN
 MANUSIA (Holistik)

BADAN/SOMA JIWA LINGKUNGAN/ SOSIAL

Farmako terapi Psikoterapi Suportif Terapi Keluarga
ECT/TKL ReedukasiPerilaku, Terapi Sosial
Pembedahan dll Terapi Aktifitas
 Tujuan pengobatan :
Menghilangkan penderitaan & bila mungkin
mengembalikan ke keadaan sehat

01 Somato terapi:
Langsung mempengaruhi badan

02 Psikoterapi
Langsung mempengaruhi jiwa
manusia.
03 Manipulasi lingkungan
Lingkungan fisik (perumahan, cara
berpakaian, pekerjaan, dll), terutama
sosialnya (keluarga, teman, atasan, dll)
demi penyembuhannya.
 1. TERAPI BIOLOGI / SOMATOTERAPI

Farmakoterapi:
Terapi pada Penggolongan
gangguan jiwa Berdasar :
 Kesamaan efek Nama Gejala sasaran
PSikofarmaka /
thd penekanan Antipsikotik Psikotik : waham, halusinasi,dll
Psikotropika :
gejala sasaran Anti depresan Depresi : sedih, hilang minat, dll
obat yg Anti anxietas Anxietas: cemas : takut, dll
 Perbedaan
mempunyai efek Anti manik Manik : euphoria, aktivitas
terapetik susunan kimia
berlebih,
langsung pada atau
Anti hiperkinetik Hiperkinetik pada anak
proses mental mekanisme
Anti insomnia Insomnia
pasien karena kerja
efeknya pada
otak.
ANTIPSIKOTIK

Penggolongan :
1.Tipikal
 Chlorpromazine (Promactil), 50
mg - 1600 mg / hari
 Levomepromazine (Nozinan), 50
mg - 300 mg / hari
 Haloperidol (Serenace), 1,5 mg -
75 mg / hari
 Trifluoperazine (Stelazine), 3 mg
- 45 mg / hari
2.Atipikal
 Sulpiride (Dogmatil), 100 mg - 800 mg / hari
 Clozapine (Clozaril), 15 mg - 75 mg / hari
 Risperidone (Risperdal), 2 mg - 16 mg /hari.
 Olanzapine (Zyprexa), 4 mg - 10 mg / hari (dosis tunggal)
Mekanisme keja :
Memblokade dopamin pada reseptor pasca neuron di otak.
 Efek primer : Menekan sindrom psikotik.
 Efek sekunder berupa Efek Otonomik / hormonal :
 Sedasi dan hambatan psikomotor (cpz,levomepromazine).
 Hipotensi ortostatik (terutama injeksi), mulut kering, kesulitan miksi & defekasi,
hidung tersumbat, mata kabur.
 Takhikardia, ggn irama jantung
 Ggn endokrin : amenorhoe, ginekomasti, galaktorhoe.
 Sindroma neuroleptik malignan : suhu > 38 ° C, tensi naik, ekstrapiramidal efek +, perub
status mental, kesadaran menurun.
Efek neurologis :
 Ggn ekstrapiramidal : parkinsonisme (jalan spt robot), tremor
 Diskinesia : mata terputar ke atas (krisis okulogirik), torticolis, lidah terjulur keluar
(hipersalivasi), sukar menelan, semua karena spasme otot (> haloperidol).
 Akatisia : tidak dapat duduk lama di satu tempat, ber jln2 spt gelisah (restless leg
syndrom).
Efek Lain-lain :
 Alergi
 Ikterus
 Fotosensitivitas / hiperpigmentasi
 Kenaikan berat badan
 Lekopeni / agranulositosis

Cara mencegah efek samping :

 Mulai dg dosis kecil
 Efek ekstrapiramidal : Triheksiphenidil (Artane), 2 mg - 4 mg / 3 x sehari.
 Hipotensi : setelah inj cpz, tiduran 10 - 15 menit (tidak langsung berdiri)
 Rujuk ke RS unit jiwa / dokter.
Cara Pemberian: Dimulai dengan dosis awal minimal  dinaikkan sedikit demi sedikit
sampai dosis optimum  dipertahankan beberapa lama  diturunkan sedikit demi sedikit
sampai stop.
ANTI DEPRESAN

 Hipotesis: syndroma depresi disebabkan oleh defisiensi salah

satu/beberapa aminergic neurotransmitter (spt noradrenalin, serotonin,
dopamin) pada SSP, khususnya sistem limbik
 Mekanisme kerja: ↑ sensitivitas terhdp aminergik neurotransmitter,
menghambat re-uptake aminergik neurotransmitter, menghambat
penghancuran oleh enzim MAO( Mono Amine Oxidase) shg terjadi ↑
aminergik pada SSP
ANTI DEPRESAN
Macamnya :
 Amitriptilin, 75 mg - 150 mg / hari
 Maprotilin (Ludiomil ), 75 mg - 150 mg / hari
 Sertaralin (Zoloft), 50mg - 100 mg / hari
 Fuoxetine (Kalxetin, Prozac), 20 mg - 40 mg / hari
Efek primer :
Meredakan / menghilangkan gejala2 depresi.
Efek samping :
 Sedasi (ngantuk) : Kewaspadaan, psikomotor, kemampuan kognitif menurun
 Antikolinergik efek : Mulut kering, retensi urin, konstipasi, penglihatan kabur.
 Neurotoksis : Tremor halus, gelisah, agitasi, insomnia.
 Overdosis / intoksikasi : Hipertensi, hiperpireksi, konvulsi, kesadaran menurun.
Mekanisme kerja :
Menurunkan ambilan kembali serotonin & norepinefrin.
Efek samping
 Ringan : Biasanya berkurang 2 - 3 minggu.
 Bila berat : rujuk RS unit jiwa / dokter.
ANTI MANIA
Macamnya :
 Lithium carbonat, 250 mg - 500 mg
 Haloperidol
 Carbamazepin (Tegretol), 400 mg - 600 mg.

Efek primer :
Meredakan sindrom mania.
Efek samping :
 Mulut kering, haus, ggn lambung (mual, muntah, diare), kelemahan otot,
 Intoksikasi : Tremor kasar, mengantuk, bicara sulit, gaya berjalan tidak stabil,
kesadaran menurun - koma, hipertonia dan kejang-kejang.

Efek samping :
 Mulut kering, haus, ggn lambung (mual, muntah, diare), kelemahan otot,
 Intoksikasi : tremor kasar, mengantuk, bicara sulit, gaya berjln tidak stabil, kesadaran
menurun - koma, dg hipertonia & kejang2.
ANTI ANXIETAS
Contoh yang sering digunakan :
 Diazepam (Valium), 6 mg - 60 mg / hari, inj 2 - 10 mg im/iv.
 Chlordiazepoxid (Cetabrium), 15 mg - 30 mg, 2 – 3 x sehari
 Lorazepam (Ativan), 2 – 3 x 1 mg / hari
 Alparazolam (Xanax), 0,5 mg - 6 mg
 Clobazam (Frissium), 2 – 3 x 10 mg / hari
 Sulpirid (Dogmatil), 100 – 200 mg, 2 – 3 x sehari
Mekanisme kerja :
 Anxietas terjadi krn hiperaktivitas sistem limbik SSP yang terdiri dari dopaminergik,
serotonergik neuron yang dikendalikan oleh Gabaergik neuron.
 Anti anxietas memperkuat hambatan dr Gabaergik neuron, shg hiperaktivitas dpt
mereda  berkurang.
Efek primer :
Mengurangi gejala-gejala cemas.
Efek samping :
 Sedasi
 Relaksasi otot
 Ketergantungan -pemberian max. 3 bln (dlm dosis terapi).
ANTI HIPERKINETIK

Contoh :
Amphetamine, Metilphenidat, dosis 5 - 60 mg / hari.
Efek primer :
Menaikkan perhatian, menurunkan overaktivitas, impulsivitas, iritabilitas, distrakbilitas.
Efek samping :
Nyeri kepala, nyeri lambung, mual & insomnia.
Indikasi :
 Depresi
 Kataton - gaduh gelisah ataupun stupor
 Manik - depresif
 Skizofrenia akut

Kontra indikasi :
 Decomp cordis, aneurisme aortae, peny. jantung lain.
 Fraktur tulang, osteoporosis, peny tulang berat.
 Tumor otak, peny di otak (mis, perdarahan).
Yang penting :
Berilah waktu kepada obat untuk bekerja secara optimal, jd jangan mengganti obat
sblm waktu tersebut hanya krn blm ada kemajuan (penting ada kerja sama yang baik
dg pasien).
 Efek anti agitasi : waktu singkat sdh tercapai
 Neuroleptik / anti cemas : perlu 2 – 3 minggu untuk efek optimal (Kaplan, 1997)
Setelah dicapai efek terapetik, anti cemas dipertahankan kira2 4 minggu, neuroleptik
sampai 3 bulan sesudah gejala hilang (tergantung keadaan penderita).
Yang penting :
Berilah waktu kepada obat untuk bekerja secara optimal, jd jangan mengganti obat
sblm waktu tersebut hanya krn blm ada kemajuan (penting ada kerja sama yang baik
dg pasien).
 Efek anti agitasi : waktu singkat sdh tercapai
 Neuroleptik / anti cemas : perlu 2 – 3 minggu untuk efek optimal (Kaplan, 1997)
Setelah dicapai efek terapetik, anti cemas dipertahankan kira2 4 minggu,
neuroleptik sampai 3 bulan sesudah gejala hilang (tergantung keadaan penderita).
 Kronis  tidak ditentukan lamanya & dosis naik turun (mirip hipertensi, DM).

 Obat anti cemas menimbulkan toleransi  maka dpt dihentikan 1 – 2 minggu

sesudah pemakaian 3 – 4 minggu, kemudian dimulai lagi.

 Anti depresan : 3 – 4 minggu untuk efek optimal.

 Libur Obat (Drug Holiday) : penghentian neuroleptik selama 2 – 4 minggu sesudah

pemakaian pemakaian terus menerus.

 Kronis  tidak ditentukan lamanya & dosis naik turun (mirip
hipertensi, DM).
 Obat anti cemas menimbulkan toleransi  maka dpt
dihentikan 1 – 2 minggu sesudah pemakaian 3 – 4 minggu,
kemudian dimulai lagi.
 Anti depresan : 3 – 4 minggu untuk efek optimal.
 Libur Obat (Drug Holiday) : penghentian neuroleptik selama
2 – 4 minggu sesudah pemakaian pemakaian terus
menerus.
Anti Parkinson
 Mekanisme kerja: meningkatkan reseptor dopamin, utk
mengatasi parkinsonisme akibat penggunaan obat anti
psikotik
 Efek samping: sakit kepala, mual muntah, dan hipotensi
 Jenis obat: levodova, tryhexifenidil/THF
PERAN PERAWAT DALAM PEMBERIAN OBAT
1. Mengumpulkan data sebelum pengob (diagnosa medis,
riwayat penyakit, riwayat pengob, hasil lab)
2. Mengkoordinasikan obat dengan terapi modalitas
3. Pendidikan kesehatan
4. Monitor efek samping obat
5. Pelaksanaan prinsip-prinsip pengobatan psikofarmakologi
6. Melaksanakan program pengobatan berkelanjutan
7. Menyesuaikan dengan Terapi non farmakologi
8. Ikut serta dalam Riset Klinik Interdisipliner
 Prinsip-prinsip pemberian obat:
1. Persiapan:
 nama obat
 tujuan pemberian obat
 cara kerja obat
 dosis obat
 efek samping
 cara pemberian
 kaji pengetahuan klien dan keluarga tentang obat
2. Laksanakan minimal lima prinsip pemberian obat (5 Benar)
 Obat Benar
 Dosis Benar
 Pasien Benar
 Cara Benar
 Waktu benar
Metode-metode pendekatan khusus dalam
pemberian obat:
1. Pasien Curiga meyakinkan pasien bahwa tindakan yang
diberikan tidak membahayakan pasien dan berguna bagi pasien
Perawat dapat mengontrol perilakunya agar tidak
menimbulkan keraguan pasien
 Harus bersikap jujur komunikasi harus tegas dan ringkas
 Berikan obat dalam bentuk dan kemasan yang sama setiap
hari
 Jika ada perub obat diskusikan dengan pasien terlebih
dahulu
 Untuk pasien yang benar-benar menolak obat, berikan obat
inj sesuai kolaboarasi
Metode-metode pendekatan khusus dalam
pemberian obat:
 2. Pasien potensial bunuh diri - perawat harus bersikap tegas
dan awasi pasien minum obat karena ada ambivalen - berikan
treatment saat pasien mempunyai keinginan hidup - berikan
perhatian untuk ↑ motivasi hidup - pemberian obat
diintegrasikan dengan ↑ harga diri klien
 3. Pasien dependency obat - jelaskan tentang manfaat obat -

terapi obat harus disesuaikan dengan terapi modalitas yang

lain Pendidikan Kesehatan Penkes kepada pasien dan
keluarga mencakup informasi tentang: penyakit, kemajuan
pasien dan cara merawat p
Pendidikan Kesehatan
 Penkes kepada pasien dan keluarga mencakup informasi
tentang: penyakit, kemajuan pasien dan cara merawat pasien
Penkes tentang obat (5 benar obat) Pengelolaan obat
diruangan dari aspek legal merupakan tj perawat obat
harus disimpan dilemari terkunci kunci tidak boleh dibiarkan
dilemari, harus dipegang oleh Karu/penanggung jawab obat
obat harus diberi label dan tempatkan terpisah satu dengan
yang lain jumlah obat harus dihitung dan lapor setiap ganti
dinas untuk obat-obat golongan narkotika simpan ditempat
khusus saat membagi obat, harus dibawa dalam kereta obat
Evaluasi: Reaksi obat efektif jika:  Emosional stabil
Kemampuan hub interpersonal meningkat Halusinasi,
agresi, deluasi dan menarik diri menurun Perilaku mudah
 TERAPI KEJANG LISTRIK / TKL

Terapi Kejang Listrik (TKL) atau ECT (Electro Convultion

Therapy).
 Memberikan aliran listrik ke otak dg ditempel pd samping kepala
(unilateral / bilateral) selama beberapa detik.
 Reaksi penderita : kejang tonik ± 10 dtk  kejang klonik ± 30 dtk 
relaksasi otot  nafas dlm & keras.
 Dilakukan pd saat perut kosong, u/ mencegah aspirasi, muntah
Indikasi :
Depresi
Kataton - gaduh gelisah ataupun stupor
Manik - depresif
Skizofrenia akut
Kontra indikasi :
Decomp cordis, aneurisme aortae, peny. jantung lain.
Fraktur tulang, osteoporosis, peny tulang berat.
Tumor otak, peny di otak (mis, perdarahan).
 3. TERAPI MODALITAS
 Adalah berbagai pendekatan penanganan klien gangguan jiwa yang
bertujuan untuk mengubah perilaku klien dengan gangguan jiwa dari
perilaku mal adaptifnya menjadi perilaku yang adaptif
 Suatu tehnik terapi dengan menggunakan pendekatan secara spesifik.
 Suatu sistem terapi psikis yang keberhasilannya sangat tergantung pada adanya
komunikasi atau perilaku timbal balik antara pasien dan terapis.
 Terapi yang diberikan dalam upaya mengubah perilaku mal adaptif menjadi perilaku
adaptif
 Terapi Modalitas ( Perko & Kreigh, 1988)

Prinsip Pelaksanaan
Perawat sebagai terapis mendasarkan potensi yang dimiliki pasien sebagai
titik tolak terapi atau penyembuhan
Dasar Pemberian Terapi Modalitas
 Gangguan jiwa tidak merusak seluruh kepribadian atau perilaku manusia
 Tingkah laku manusia selalu dapat diarahkan dan dibina ke arah kondisi
yang mengandung reaksi( respon yang baru )
 Tingkah laku manusia selalu mengindahkan ada atau tidak adanya
faktor-faktor yang sifatnya menimbulkan tekanan sosial pada individu
sehingga reaksi indv tersebut dapat diprediksi ( reward dan punishment )
Lanjutan….
 Sikap dan tekanan sosial dalam kelompok
sangat penting dalam menunjuang dan
menghambat perilaku individu dalam kelompok
sosial
 Terapi modalitas adalah proses pemulihan
fungsi fisik mental emosional dan sosial ke
arah keutuhan pribadi yang dilakukan secara
holistik
JENIS TERAPI MODALITAS
 Terapi individual
 Terapi lingkungan ( milleau terapi )
 Terapi Biologi atau terapi somatic
 Terapi kognitif
 Terapi keluarga
 Terapi kelompok
 Terapi Perilaku
 Terapi bermain
TERAPI INDIVIDUAL
 Hubungan terstruktur yang dijalin antara perawat – klien uutuk
merubah klien
 Untuk mengembangkan pendekatan unik penyelesaian konflik,
meredakan penderitaan emosional, mengembangkan cara yang
cocok untuk memenuhi kebutuhan
 Melalui 3 fase ( oerientasi, kerja dan terminasi)

Contoh: Pelaksanaan terapi individu: Mengajari pasien memutuskan

halusinasinya
TERAPI LINGKUNGAN
 Perawat menggunakan semua lingkungan rumah sakit dalam arti
terapeutik
 Perawat memberi kesempatan tumbuh dan berubah perilaku dengan
memfokuskan pada nilai terapeutik dalam aktivitas dan interaksi
 Memberi kesempatan dukungan, pengertian, berkembang sebagai
pribadi yang bertanggung jawab
 Klien dipaparkan pada peraturan, harapan, tekanan peer, dan interaksi
sosial.
 Perawat mendorong komunikasi dan pembuatan keputusan,
meningkatkan harga diri, belajar ketrampilan dan perilaku baru.
 Tujuan : memampukan klien dapat hidup di luar lembaga yang
diciptakan melalui belajar kompetensi yang diperlukan untuk beralih dari
rumah sakit ke komunitas.
TERAPI BIOLOGIS
 Didasarkan pada model medikal : memandang gangguan
jiwa sebagai penyakit
 Tekanan: pengkajian spesifik dan pengelompokan gejala
dalam sindroma spesifik.
 Perilaku abnormal akibat penyakit atau organisme tertentu
dan akibat perubahan ttt
 Jenisnya: medikasi psikoaktif, intervensi nutrisi, fototerapi,
ECT, bedah otak
TERAPI KOGNITIF
 Strategi memodifikasi keyakinan dan sikap yang mempengaruhi
perasaan dan perilaku klien
 Proses : membantu mempertimbangkan stressor dan mengidentifikasi
pola pikir dan keyakinan yang tidak akurat
 Fokus asuhan : reevaluasi ide, nilai, harapan dan memulai menyusun
perubahan kognitif
 Mengembangkan pola pikir yang rasional
 Menggunakan pengetesan realita
 Membantu perilaku dengan pesan internal

Intervensi :
 Mengajar substitusi pikiran
 Penyelesaian masalah
 Memodifikasi percakapan diri negatif
Tujuan Terapi Kognitif
 Mengembangkan pola pikir yang rasional
 Menggunakan pengetesan realita
 Membantu perilaku dengan pesan internal

Intervensi :
 Mengajar substitusi pikiran
 Penyelesaian masalah
 Memodifikasi percakapan diri negatif

Pelaksanaan terapi kognitif

Mengajarkan untuk mensudtitusikan pikiran pasien, belajar
menyelesaikan masalah dan memodifikasi percakapan diri negatif.
TERAPI KELUARGA
 Seluruh keluarga disertakan sebagai unit penanganan
 Semua masalah keluarga diidentifikasi dan kontribusi dari masing-
masing anggota terhadap masalah yang dialami
 Terdiri 3 fase : Fase 1 ( perjanjian ), fase 2 (kerja ) dan fase 3 (terminasi)
 Tujuan : meningkatkan fungsi keluarga

Pelaksanaan Terapi Kelurga.

Keluarga diharapkan dapat mempertahankan perawatan yang
berkesinambungan

Pelaksanaan psikoedukasi anggota keluarga

Terapis berusaha merubah pola interaksi diantara anggota
keluarga
Terapi kelompok

 Perawat berinteraksi dengan sekelompok klien secara teratur

 Tujuan : meningkatkan kesadaran diri, meningkatkan
hubungan interpersonal, merubah perilaku maladaptif
 Ada 3 tahap : tahap pemulaan, fase kerja dan tahap terminasi
 TERAPI PERILAKU
 Premis : perilaku dipelajari, perilaku sehat dapat dipelajari dan disubsitusi
dari perilaku tidak sehat
 Tehnik dasar terapi perilaku :
 Role model
 Kondisioning operan
 Disensitiasi sistematis
 Pengendalian diri
 Terapi aversi ( reflek kondisi )

Pelaksanaan:
 Mengajari pasien cara makan yang baik dan benar
 Memberikan penghargaan kepada pasien terhadap perilaku positif yang
telah dilakukan pasien
 Pasien mempelajari melalui praktik dan meniru perilaku adaptif
TERAPI BERMAIN
 Premis : anak-anak akan berkomunikasi dengan baik melalui
permainan dari pada dengan kemampuan verbal
 Perawat dapat mengkaji tingkat perkembangan, status
emosional, hipotesa diagnostik, intervensi terapeutik
 Terapis membina hubungan yang hangat
 Merefleksikan perasaan anak
 Mempercayai anak dapat menyelesaikan masalah
 Interpretasi perilaku anak
 Indikasi : anak depresi, anak cemas, anak abuse, dewasa dengan
stres pasca trauma.
PRINSIP TERAPI BERMAIN

 Terapis membina hubungan yang hangat

 Merefleksikan perasaan anak
 Mempercayai anak dapat menyelesaikan
masalah
 Interpretasi perilaku anak
 Indikasi : anak depresi, anak cemas, anak
abuse, dewasa dengan stres pasca trauma.
Terimakasih
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