8/10/2019 REMAJA IV

1/25

REMAJA IV

Eri Achmad

P S I K I A T E R

eriachmad@yahoo.co.id

8/10/2019 REMAJA IV

2/25

TOPIK BAHASAN

Early-Onset Schizophrenia

Pengenalan umum PSIKOTERAPI

Is thought that at most one in

every 100 adults withschizophrenia develops it in

childhood

8/10/2019 REMAJA IV

3/25

Early-Onset Schizophrenia

Schizophrenia is a Neuropsychiatric Disordercharacterized by severe impairments ininterpreting reality

Early Onset Schizophrenia 1 in every 100 young people

Onset in adolescence (prior to age 18)

Childhood-onset Scizohprenia (before age 12-13)

It is thought that at most one in every 100 adults withschizophrenia develops it in childhood

Prognosis poor outcome

8/10/2019 REMAJA IV

4/25

Symptoms

Positive symptoms include:

hallucinations,

delusions,

disorganized speech, or

disorganized or catatonic behavior

Negative symptoms include:

reduction in emotional expression;

lack of motivation and energy; or

loss of enjoyment and interest in activities, includingsocial interaction

8/10/2019 REMAJA IV

5/25

PEDOMAN DIAGNOSIS PPDGJ III

Setidaknya harus terdapat satu gejala berikut ini

yang jelas dan dua atau lebih bila gejala-gejala tsb

kurang tajam Thought echo, thought insertion or withdrawl, thought

broadcasting

Delusion of control, delusion of influence, delusion of

passivity, delusional perception

Halusinasi auditorik

Waham menetap lainnya

8/10/2019 REMAJA IV

6/25

8/10/2019 REMAJA IV

7/25

SKIZOFRENIA F20-F29

Paranoid F20.0

Heberenik F20.1

Katatonik F20.2

Tak Terinci F20.3

Residual F20.5

8/10/2019 REMAJA IV

8/25

8/10/2019 REMAJA IV

9/25

PATOFISIOLOGI

8/10/2019 REMAJA IV

10/25

DopaminePleasure, pain avoidance, sense of inner

and outer reality

Imbalance: hallucinations, reward deficiency

syndrome, addictions, anhedonia

Seeking motivation

Imbalance:impulsive risk

taking, reward deficiencyMood stability

and Thought

Active sociality, normal

sleep and apetite

Imbalance:anxiety, irritability

Norepinephrine

Serotonin

Satifaction with

achievement, normal

sexual response

Imbalance: aggresive,

dysphoria

Cognitive impulse

control, relaxation

Energy,

socialization,

vigilance,

concentration

8/10/2019 REMAJA IV

11/25

Dopamine Pathway

8/10/2019 REMAJA IV

12/25

8/10/2019 REMAJA IV

13/25

Natural History of Schizophrenia

Prodromal Onset Chronic/Residual

Stages of Illness

Healthy

WorseningSeverity ofSigns andSymptoms

Gestation/Birth 10 20 30 40 50Puberty

Premorbid

Deterioration

Negative Sx

Cognitive DeficitsFunctional Impairment

8/10/2019 REMAJA IV

14/25

Prodromal Signs and Symptoms

Poor peer relations/ Socially isolated

Decline in school functioning

Inattentive/difficulty concentrating

Unusual perceptual experiences (illusions)

Unusual beliefs

Unusual thought process

Blunted and/or depressed affect

8/10/2019 REMAJA IV

15/25

PENATALAKSANAAN There is NO cure for Schizophrenia but there are many

treatments that help alleviate the symptoms andallow patients to lead productive lives

Requires a multimodal approach Psychopharmacologic

Family education

Social skills interventions

Appropriate educational placement

Psychopharmacologic Atypical antipsychotic (second generation)

Risperidone, olanzapine, clozapine (less EPS side effect)

8/10/2019 REMAJA IV

16/25

PSYCHOTERAPHY

Psychotherapy is commonly thought of as aninterpersonal process, involving a verbal and/ornonverbal interchange between a patient who

exhibits psychological problems and a

trainedtherapists to aid in life problems

These approaches are usually based on aMedical Model of psychology

Psychotherapy is often used either alone or incombination with medication to treat mentalillnesses

8/10/2019 REMAJA IV

17/25

Goals: increase sense of well-being, reduce discomfort

Learn to identify and change behaviors or thoughts thatadversely affect life

Explore and improve relationships

Find better ways to cope and solve problems

Learn to set realistic goals

Employs range of techniques based on relationshipbuilding, dialogue, communication and behaviorchange designed to improve the mental of individualpatient or group

8/10/2019 REMAJA IV

18/25

How Does Psychotherapy Help?

Understand the behaviors, emotions, and ideas thatcontribute to his or her illness and learning how tomodify them

Understand and identify the life problems or events --like a major illness, a death in the family, a loss of a job,or a divorce -- that contribute to their illness and helpthem understand which aspects of those problemsthey may be able to solve or improve

Regain a sense of control and pleasure in life

Learn coping techniques and problem-solving skills

8/10/2019 REMAJA IV

19/25

Your brain on psychotherapy

Psychotherapy-related changes in brain

activity are strikingly similar within patients

who share the same psychiatric diagnosis.

Psychotherapy and pharmacotherapy achieve

similar efficacy and are associated with

overlapping but not identical changes in brain-

imaging profiles

Roffman J. et al. Neuroimaging and functional neuroanatomy of psychotherapy.

Psychological med 2005 35:1385-1398

8/10/2019 REMAJA IV

20/25

Who seeks therapyand why?

Children behavioral, school, family issues

Adolescents as above and issues of separation and peer relationships

Young adults all of above plus career issues

Mature adults all of above plus issues of changing relationships, family

alignments, health, work and social status Older adults:

all of above plus end of life issues

8/10/2019 REMAJA IV

21/25

Types of Therapy

Individual/Interpersonal:This therapy involves only the

patient and the therapist

Group:Two or more patients may participate in therapy at the

same time. Patients are able to share experiences and learn

that others feel the same way and have had the same

experiences

Marital/couples:This type of therapy helps spouses and

partners understand why their loved one has a mental

disorder, what changes in communication and behaviors canhelp, and what they can do to cope

8/10/2019 REMAJA IV

22/25

Family:Because family is a key part of the team thathelps people with mental illness get better, it issometimes helpful for family members to understandwhat their loved one is going through, how they

themselves can cope, and what they can do to help Brief Psychotherapy

Behavior therapy

Cognitive therapy / CBT Hypnosis

Psychiatric Rehabilitation

8/10/2019 REMAJA IV

23/25

Starting Therapy

Therapy works best when you attend all scheduledappointments. The effectiveness of therapy dependson your active participation. It requires time, effort,and regularity

As you begin therapy, establish some goals with yourtherapist. Then spend time periodically reviewing yourprogress with your therapist. If you don't like thetherapist's approach or if you don't think the therapist

is helping you, talk to him or her about it and seek asecond opinion if both agree, but don't discontinuetherapy abruptly

8/10/2019 REMAJA IV

24/25

Identify sources of stress: Try keeping a journaland note stressful as well as positive events

Restructure priorities: Emphasize positive,effective behavior

Make time for recreational and pleasurableactivities

Communicate: Explain and assert your needs tosomeone you trust; write in a journal to expressyour feelings

Try to focus on positive outcomes and findingmethods for reducing and managing stress

8/10/2019 REMAJA IV

25/25