Post on 02-Jun-2018
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REMAJA IV
Eri Achmad
P S I K I A T E R
eriachmad@yahoo.co.id
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TOPIK BAHASAN
Early-Onset Schizophrenia
Pengenalan umum PSIKOTERAPI
Is thought that at most one in
every 100 adults withschizophrenia develops it in
childhood
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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
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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
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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
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SKIZOFRENIA F20-F29
Paranoid F20.0
Heberenik F20.1
Katatonik F20.2
Tak Terinci F20.3
Residual F20.5
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PATOFISIOLOGI
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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
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Dopamine Pathway
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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
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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
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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)
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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
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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
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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
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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
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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
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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
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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
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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
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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
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