24. PSIKOSIS

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  • PSIKOSISArlisa WulandariFakultas Kedokteran Universitas Jend A Yani2008

  • Definisi Psikosis : kondisi adanya hendaya berat dalam menilai realitas ( gross impairment in reality testing ) gangguan persepsi gangguan pikiran kesalahan dalam menafsirkan / menilai kenyataan disekitarnya

  • Psikosis menyebabkan :terganggunya kemampuan individu dalam melakukan kegiatan harianterganggunya kemampuan individu dalam melakukan pekerjaanterganggunya kemampuan individu dalam bersosialisasi dengan lingkunganterganggunya kemampuan individu dalam mengurus diri

  • Gejala klasik adalah,Terganggunya kemampuan dalam menilai realitas ( autistik )HalusinasiWaham ( delusi )Ilusi

    Psikosis dapat berdiri sendiri atau timbul sebagai akibat dari gangguan atau penyakitlain.

  • Psikosis dapat terjadi pada berbagai macamkondisi :Gangguan Mental OrganikGangguan Mental dan Perilaku Akibat Penggunaan Zat Psikoaktif SkizofreniaGangguan SkizoafektifGangguan SkizotipalGangguan WahamGangguan Suasana Perasaan ( Gangguan Depresi Berat dengan gejala psikotik )

  • GANGGUAN MENTAL ORGANIKMenurut PPDGJ-III / ICD X (WHO), al

    Demensia : - Demensia Alzheimer - Demensia Vaskular - Demensia pada penyakit lain Sindroma Amnestik Organik bukan akibat alkohol dan zat psikoaktif lain Delirium bukan akibat alkohol dan zat psikoaktif lain Gangguan mental lain, Gangguan kepribadian dan perilaku akibat kerusakan / disfungsi otak dan penyakit fisik

  • GMO

    PRIMER : SEKUNDER :penyakit, cedera, trauma penyakit /gg sistemik langsung pada otak menyerang otak DISFUNGSI OTAK gangguan kognitif

    DIAGNOSIS GMO DITEGAKKAN DENGAN CARA :Membuktikan / menunjukan terdapatnya faktor organik spesifik (penyakit, cedera atau rudapaksa ) yang dinilaisecara etiologi berhubungan dengan gangguan mental ituatas dasar riwayat penyakit, pemeriksaan fisik atau lab

  • Evaluasidari gangguan kognitif MMSE ( Mini Mental State Examination )

    Orientasi Registrasi Atensi dan kalkulasiRecall ( pemanggilan kembali )Tes bahasa Konstruksi

    Total score min: 30< 25: suspek adanya gangguan< 20: definitif adanya gangguan

  • DELIRIUMan impairment of consciousness, a sudden onset (hours ordays) a brief and fluctuating course, and a rapid improvement - Delirium is a syndrome, not a disease, to have many causes,central and systemic, acute confusional state, acute brain syndromes, metabolic encephalopathy, toxic psychosis, and acute brain failure. - (l) the clinical need to identify and treat the underlying cause and - (2) the need to alert the development of delirium related complications. Such complications include accidental injury because of the patients clouded consciousness or impaired coordination or the unnecessary use of restraints.

  • The major causes of delirium: central nervous system disease systemic disease (for example, cardiac failure)intoxication or withdrawal from pharmacological or toxic agentsWhen evaluating a delirious patient, the clinician should assume that any drug the patient has taken may be causatively relevant to the delirium.

    Pathophysiological mechanisms have been sugested for delirium Neurotransmitter hypothesized to be involved in delirium is acetylcholine, and neuroanatomical area is the reticular formation.The delirium associated with alcohol withdrawal has been associated with hypeactivity of the locus ceruleus and its noradrenergic neurons.Other neurotransmitters that have been implicated are serotonin and glutamate.

  • Diagnostic guidelines

    It may occur at any age but is most common after the age of 60 years. The delirious state is transient and of fluctuating intensity; most cases recover within 4 weeks or less.Delirium lasting, with fluctuations, for up to 6 months is not uncommon

  • For a definite diagnosis, symptoms, mildor severe, should be present in each one of the following areas:

    (a)impairment of consciousness and attention(b)global disturbance of cognition (c)psychomotor disturbances hypo or hyperactivity (d) disturbance of the sleep - wake cycle(e) emotional disturbances ( depression, anxiety or fear, irritability, euphoria, apathy, or wondering perplexity )

  • Clinical Features :

    ArousalOrientationLanguage and CognitionPerceptionMoodAssociated Symptoms

  • Treatment The primary goal is to treat the underlying condition that is causing the delirium. The other important goal of treatment is the provision of physical. sensory, and environmental support. Usually,delerious patients are helped by having a friend or a relative in the room or by the presence of a regular sitter.

  • Pharmacological Treatment

    Treatment are psychosis and insomniaThe drug of choice for psychosis is Haloperidol . Phenothiazines should be avoided delirious patients, because those drugs are associated significant anticholinergic effectInsomnia is best treated with either benzodiazepines with short half-lives or with hydroxyzine . Benzodiazepines with long half lives and barbiturates should be avoided unless they are being used as part of the treatment for the underlying disorder ( for example, alcohol withdrawal

  • DEMENTIADementia is a syndrome due to disease of thebrain, usually of a chronic or progressive nature

    Disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. This syndrome occurs in Alzheimer's disease, in cerebrovascular disease, and in other conditions primarily or secondarily affecting the brain.

  • Dementia produces an appreciable decline in intellectual functioning, and usually some interference with personal activities of daily living, such as washing, dressing, eating, personal hygiene, excretory and toilet activities. Itself will depend largely on the social and cultural setting in which the patient lives.

  • EpidemiologyDementia is essentially a disease of the aged.Of Americans over the age of 65, about 5 percent have severe dementia, and 15 percent have mild dementia.

    50 to 60 percent have dementia of the Alzheimer's type.The second most common type of dementia is vascular dementia-account for 15 to 30 percent of all dementia cases. Other dementia 1 to 5 percent of all

    By the year 2030 an estimated 20 percent of the- population will be more than 65 years old.

  • Etiology Dementia has many causes : Dementia of the Alzheimer's Type Alois Alzheimer in 1907, Senile plaques, Amyloid precursor protein. Neurotransmitter abnormalities. Other potential causes. Vascular Dementia Binswanger'sdisease. Pick's Disease Creutzfeldt-Jakob Disease Huntington's Disease Parkinson's Disease HIV-Related Dementia Head Trauma-Related Dementia Dementia can be a sequela of head trauma

  • Clinical Features : Memory Impairment Orientation Language Impairment Personality Changes Psychosis Other Impairments Psychiatric Neurological Catastrophic reaction Sundowner syndrome

  • Diagnosis

    Diagnostic guidelines : A decline in both memory and thinking which is sufficient to impair personal activities of daily living Difficult to attend to more than one stimulus at a time, and to shift the focus of attention from one topic to another.

    A double diagnosis of delirium superimposed upon dementia is common .

  • TreatmentSome cases of dementia are regarded as treatable The general treatment approach provide supportive medical care, emotional support for the patients and their families, the maintenance of the patient's physical health, . symptomatic treatment Particular attention must be provided to caretakers and family members When the diagnosis of vascular dementia is made, take care of risk factors Pharmacological Treatments Currently available treatments psychoactive drugs Tetrahydroaminoacridine (Tacrine)

  • SKIZOFRENIAEpidemiologiDiperkirakan 1% penduduk AS > 300.000 episode akut SR per tahun.Prevalensi tertinggi kota besarDi RSJ Cisarua 90% penderita kronik SR

  • Batasan / Pengertian

    SR merupakan campuran simptom + dan

    Simptom + Waham : keyakinan yang kacau, salah tafsir tentang persepsi / pengalamannya (Waham kejar, somatik, keagamaan, curiga) Halusinasi : halusinasi dengar,lihat Bicara : berlebih dan kacau Tingkah laku : kacau, agitasi, katatonik

  • Simptom Afek datar : intensitas ekspresi emosi