Consept Konsep Dasar Ggn Jiwa - Copy

8/10/2019 Consept Konsep Dasar Ggn Jiwa - Copy

http://slidepdf.com/reader/full/consept-konsep-dasar-ggn-jiwa-copy 1/93



Pretest

Gangguan psikiatrik bukanlah penyakit seperti Diabetes maupunSakit jantung.

Masyarakat penderita Gangguan Jiwa seperti schizophrenia,

umumnya membahayakan dan kasar.

Gangguan jiwa adalah akibat dari kesalahan pendidikan mental

dalam keluarga.

Depressi adalah akibat dari kelemahan mental atau kekurangan

dalam mentalitas seseorang, bila mau berusaha kita akan mudahbebas dari depresi.

Schizophrenia adalah ‘jiwa yang terbelah’, dan cara untuk

mengontrol schizophrenia adalah sulit.



Pretest

Depresi adalah proses normal dari penuaan

Depresi dan gangguan lain seperti Gangguan ansietas,

tidak mempengaruhi anak-anak atau adolesen.

Siapa-siapa yang dalam terapi gangguan jiwa, berarti

mereka mempunyai kelemahan.

Addiksi adalah pilihan gaya hidup. Penyalahguna

narkoba memiliki kepribadian yang lemah.

Terapi ECT adalah terapi yang menyakitkan



Apa Sich Gunanya ???

• Pandangan masyarakat :

•

ggn jiwa = gila ?• Penderitaan berkepanjangan bagi individu,

Keluarga, Masyarakat & Negara

• Menurunkan produktivitas

• Dampak Sosial



Basic mental health concepts are usefulin understanding a patient’s behavioral

responses to disease and dysfunction.

Behavior is the manner in which a person

performs any or all of the activities ofdaily living.



Mental health is one’s ability to cope withand ad ust to the recurrent stresses ofeveryday living.

Mental illness is evidenced by a pattern ofbehaviors that is conspicuous, threatening,and disruptive of relationships or deviatesfrom acceptable behaviors.

Assist the patient and family to achievesatisfying and productive ways to deal withdaily living.



During early history, a physically or mentally illperson was thought to be possessed by evilspirits.

For mental illness, the shamans or medicine

men focused on removing evil spirits throughmagical treatments such as spells, potions,noises, or sacrifices and physical treatmentsuch as vomiting, bleeding, massage, andtrephining (cutting holes in the skull to release

evil spirits). If these tribal rites were unsuccessful, the

individual was abandoned to die by starvationor attack by wild animals.



In the Dark Ages, the church became powerful, andknowledge was kept in monasteries. Mental illnesswas punishment for sins committed, possession bythe devil, or caused by witchcraft.

Exorcisms, physical punishment and imprisonment,or banishment became the treatment for mentalillness.

During the 17th and 18th centuries, conditions forthe mentally ill were worse than ever.

Bleeding, starving, beating, purging, andconfinement were the treatments of the day.

During the latter half of the 18th century, psychiatrybecame a separate branch of medicine.



In England, an asylum was built. The carewas to encourage acceptable behavior byproviding a nurturing atmosphere.

In the United States, the PennsylvaniaHospital in Philadelphia was established forthe treatment of the mentally ill.

The 19th century saw the flourishing ofinstitutions and asylums.

Overcrowding and bureaucracy broughtthe decline of care provided by institutions.



The Committee for Mental Hygiene wasformed in 1909; it focused on theprevention of mental illness and theremoval of the stigma of mental illness.

During the 1930s, electroconvulsivetherapy (ECT) and insulin shock therapy

were developed and used to treatschizophrenia.

Frontal lobotomy was used to eliminateviolent behavior.



In the 1940s, the passage of the NationalHealth Act and the establishment of theNational Institute of Mental Health were amongthe most important developments in thepsychiatric medicine in the United States.

The institute established research funding forthe cause, prevention, and treatment ofmental illnesses.

The 1950s brought about the introduction ofpsychotherapeutic drugs. During the 1960s and 1970s, legislatures

brought about changes in mental healthtreatment at the community level.



The Omnibus Budget Reconciliation Act of1981 The act drastically reduced funding forthe mental health system and put the monies

into block grants for the community to use. Deinstitutionalization was rapid, putting many

mentally ill patients from state institutions intothe streets.

Now, in the 21st century, mental healthconcepts and principles are practiced in avariety to settings, including public health andhome health care facilities, outpatient settings,and acute care hospitals.



A positive self-concept

Awareness of responsibility for one’sbehavior and its consequences

Maintenance of satisfying interpersonalrelationships

Adaptability to changes

Effective communication Awareness and acceptance of emotions

and their expressions

Recognition and use of supportive system



Illness is the state of homeostaticimbalance.

Crisis is a time of change or turning pointin life when patterns of living must bemodified to prevent disorganization ofthe person or family.

Some individuals have difficulty copingwith an illness or crisis.



Adaptation An individual’s ability to adjust to changing

life situations using various strategies

Coping responses: Used to reduce anxiety brought on by stress

Defense mechanisms

Unconscious intrapsychic reactions thatoffer protection to the self from a stressfulsituation

Blocking conscious awareness ofthreatening feelings



Penyebab gangguan Jiwa

• Organobiologik ( Faktor keturunan, kelainan

otak baik sejak dalam kandungan, saat lahir

maupun akibat kecelakaan serta kelainan/sakit

fisik yang mempengaruhi fungsi otak).• Psikologi & edukasi ( Kepribadian yang rapuh,

Daya tahan kejiwaan yang rendah serta pola

asuh yang tidak baik).

• Sosial & Budaya (Lingkungan & situasi

kehidupan sosial yang tidak pernah

menenteramkan serta adat istiadat dan

kebiasaan yang tidak sehat).



Ciri Orang yang Sehat Jiwa

• Merasa Nyaman terhadap diri sendiri.

• Merasa Nyaman berhubungan denganorang lain.

• Mampu memenuhi kebutuhan hidupnya

serta keluarga/orang yang menjaditanggung jawabnya.



sehat

Mental

FisikSosial



istress

‘ketidakmampuan diri

memikul beban yangberlebihan’ atau tuntutan

yang dihadapi diluar

kapasitas psikofisiknya

tress …?

o what gitu loh… ?!



Gangguan Jiwa

gangguan yang dialami oleh seseorang

dan mempengaruhi

emosi, pikiran dan perilaku di luar kepercayaan budaya

dan kepribadian, sehingga menimbulkanefek yang merugikan bagi kehidupanatau lingkungan.



Perubahan perilaku,pola pikir, danperasaan

Ketidaknyamanan

Mengganggu

fungsi



Gambaran Gangguan Jiwa pada umumnya



PSIKOSIS NEUROSIS



PSIKOSIS NEUROSIS

Gangguan jiwa BERAT

yang ditandai denganterganggunya

kemampuan seseorang

untuk menilai

kenyataan.

Gangguan jiwa RINGAN

masih dapatmelakukan pekerjaan

Biasanya tidak perlu

perawatan khusus di

Rumah Sakit



PSIKOSIS NEUROSIS

• GGN. ANSIETAS

• GGN. DEPRESI• GGN. GGN. FOBIK• GGN. PANIK• GGN TIDUR•

GGN OBSESIFKOMPULSIF• GGN SOMATISASI• GGN MENTAL ORGANIK

• SKIZOFRENIA

• DEPRESI BERATPSIKOTIK

• MANIA PSIKOTIK• GGN MENTAL ORGANIK



Top Ten Myths about Mental Illness

Psychiatric disorders are not true medical illnesses likeheart disease and diabetes. People who have a mental

illness are just "crazy.“

People with a severe mental illness, such as schizophrenia,

are usually dangerous and violent.

Mental illness is the result of bad parenting.

Depression results from a personality weakness or

character flaw, and people who are depressed could just snap out ofit if they tried hard enough.

Schizophrenia means split personality, and there is no way to

control schizophrenia



Top Ten Myths about Mental Illness

Depression is a normal part of the aging process.

Depression and other illnesses, such as anxiety disorders, do not affect

children or adolescents. Any problems they have are just a part of growing up.

If you have a mental illness, you can will it away. Being treated for a psy-chiatric disorder means an individual has in some way "failed" or is weak.

Addiction is a lifestyle choice and shows a lack of willpower. People with a

substance abuse problem are morally weak or "bad".

Electroconvulsive therapy (ECT), formerly known as "shock treatment," is

painful and barbaric.



Skizofrenia adalah gangguan jiwa menahun dengan

disabilitas fungsi psikososial yang luas.

Skizofrenia diderita oleh kurang lebih 1 dari populasi

Dunia

Skizofrenia menimbulkan beban sosial ekonomi yang

sangat besar bagi pasien, keluarga dan masyarakat



Survei morbiditas gangguan psikiatrik di UK

menemukan bahwa hanya 29% dari orang

dengan skizofrenia mempunyai pekerjaan

EPSILON multicenter study di negara negara Eropa

yang mempunyai sistem kesehatan mental modern

ternyata 79% dari mereka yang hidup dengan

skizofrenia tidak mempunyai pekerjaan, tidakberpenghasilan, kualitas hidupnya rendah, dan

memperlihatkan gejala gejala kecemasan dan

depresi yang tinggi



Skizofrenia berakibat luas terhadap berbagai aspek

kehidupan seseorang

Gejala gejala skizofrenia (gejala positif, gejala negatif,

gangguan mood, hendaya kognitif) mengganggu

secara luas fungsi psikososial mereka, baik dalam

bidang pekerjaan, pendidikan, relasi interpersonal,hingga kemampuan merawat diri

Stigma dan perlakuan diskriminasi yang masih berlaku

kuat di masyarakat menghambat kesempatan mereka

untuk menjalani kehidupan sosial sesuai hakekatkemanusiaannya. Hak asasi mereka seringkali

diabaikan



enderita skizofrenia berobat

ke

non medis

Harding (1978): 91 %

Bahar (1982) : 60 % Salan (1983) : 37,9 %



PERMASALAHAN• Pasien skizofrenik pertama kali ke dukun

• Pendd. ortu perbedaan jenis pengobatan

•

tempat tinggal

perb. jenis pengobatan• Berapa lama sakit RSJ

• Anjuran berobat oleh siapa



er em angan pengo a anskizofrenia



30s ’40s ’50s ’60s ’70s ’80s ’90s ’00 ’02

ECT

Chlorpromazine

Haloperidol

FluphenazineThioridazine

Loxapine

Perphenazine

Clozapine

RisperidoneOlanzapine

Quetiapine

Ziprasidone

Aripiprazole

g p gskizofrenia

ECT = electroconvulsive therapy.

Kapur and Remington. Ann Rev Med. 2001;52:503.

Worrel et al. Am J Health Syst Pharm. 2000;57:238.

Insulin coma therapy

Lobotomy



Significant Loss of Brain Gray Matter

Enlaged Ventricles in the Brain

Enlarged Amygdala

Neurological Abnormalities

( Decreased Synaptic Connectivity, Changes in Cortical and Subcortical Activity)

Impaired Cognitive Function ( verbal memory)

Decreased Prefrontal Brain Function

Impaired Awareness of Ilness

Hipothesis



Hipotesa Depresi

Sindrom depresi disebabkan oleh defisiensi relatif

salah satu atau beberapa neurotransmiter

monoamin (nor adrenalin, serotonin dan

dopamine) pada neuron di SSP

(khususnya pada sistem limbik)



Mekanisme kerja obat anti depresan

Menghambat reuptake neuotransmiter monoamin

Menghambat

penghancuran oleh enzim Monoamin Oksidase

( Sehingga terjadi peningkatan neurotransmiter monoamine )



Terlibat dalam Anxietas

Structures involved

Cerebral cortex

Limbic system- hypothalamus, hippocampus, amygdala,cingulum

Thalamus, locus ceruleus, raphe nucleus

NeurotransmittersNorAdrenalin, 5HT (Serotonin), GABA



Anxietas

Motor tensionMuscle tension, twitching and shaking, restlessness, .

Apprehension/’cemas ’ Feeling on edge,unable to cope,

poor concentration, insomnia, irritability

Autonomic over-activityLightheadedness, sweating, tachycardia, dry mouth,epigastric discomfort



Effects of HPA axis stimulation

Mediated through CRH, ACTH and cortisolPromotes breakdown of glycogen to glucose in liver

Promotes glucose uptake into cells

CRH also activates locus ceruleus



Antipsikotik = neuroleptik Indikasi : gangg psikotik, skizofrenia,

skizoafektif

Efek analgesic (+)

Dosis :

efek Tx tercapai pd H-5

half life 1 hari

psikotik akut (skizofrenia) : 500-600 mg CPZ Psikotik dg agitasi berespon baik dg Tx

kombinasi neuroleptic & benzodiazepine



Berdasar potensi

High potency (OAP HP)

- afinitas tinggi dlm plasma

- dosis rendah mampu berikan efek terapi

- ex : haloperidol, risperidone

Low potency (OAP LP)

- afinitas rendah dlm plasma

- ex : cpz, melleril, clozapin



Berdasar typical/ atypical

Typikal- efek samping neurologis rendah

- peningkatan prolaktin tidak bermakna

- antagonis D1, D2 post sinap, D4

- beraktivitas pd reseptor serotonin (5-HT-2A/2C)

Atypikal- antagonis D2, D4

- hambat reseptor serotonin-2

- efficacy tinggi dibanding tipical

- keuntungan dibanding tipical : menurunkan insiden EPS- ex : clozapin, quetiapin, zotepin, olanzapine, ziprasidone, risperidone,aripiprazole



Clozapine (clozaril)- Derivat benzodiazepine- 1% sebabkan agranulositosis

Risperidone (risperdal)- Efek EPS minimal- Dosis > 6 mg/ hari meningkatkan risiko EPS- Dosis efektif 2-8 mg/ hari- Efek samping :

lelah, sedasi, weight gain, orthostatic hipotensi

prolaktin ↑ (ginekomastia, galaktorea, gg siklus menstruasi) - tdk pernah dilaporkan adanya agranulositosis- Risiko tardive diskinesia, rendah

Ol i ( )



Olanzapine (zyprexa)- Efek EPS minimal- Dosis efektif : 5-20 mg/hari

- ES : mengantuk, mulut kering, akatisia, insomnia, jarang tjdorthostatic hipotensi, nausea, tremor- Efektivitas ↓ pd perokok & penggunaan bersama dg

carbamazepine- Px tua dosis harus diturunkan

Quetiapine (seroquel)- Very low insiden EPS

- ES : orthostatic hipotensi, somnolen, weight gain, dyspepsia,abdominal pain, mulut kering

Ziprasidone (zeldox)- Very low insiden EPS - ES : somnolen, dizzines, nausea, postural hipotensi

Consept Konsep Dasar Ggn Jiwa - Copy

Documents

Transcript of Consept Konsep Dasar Ggn Jiwa - Copy