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1

PSYCHOSIS

MANAGEMENT ? MULTIMODAL

RSPAD

GS

PREVENTION

SPECIFIC BIOLOGICALRISK (GENE)

NEURODEVELOPMENT/DEGENE-RATIVE

CHILD PSYCHOLOGICALTRAUMA

SPECIFIC RISKCONDITIONS (POVERTY,

ILLNESS, DRUGABUSE)

TREATMENT/REHABILITA

TION

PRODROMAL-ACUTE-CHRONIC

MEDICATION, T SYMPT,SE

DENIAL, COMPLIANCE,RELAPSING

AGITATION-SUICIDE

CBT, FAM TH/, SOCIALINTERVENTION

EARLY DETECTIONASSESSMENT

PSYCHOLOGICAL PROTECTOR/BUFFERPSYCHOEDUCATION. P SOLVING.

RESILIENCE. COPING M

PSYCHOLOGICALREADINESS/FUNCTIONAL

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PREVENTION

2

ELIMINATERISK

FACTORS

# GENETIC 70-80%

## NON GENE20-30%

PREMORBID-NEURODEVELOPMENT

OBSTETRICCOMPLICATION

ENVIRONTMENTPRE-PERINATAL

DEGENERATIVE P

PSYCHOLOGICAL

SOCIAL-CULTURE

PARENTING

MENTAL HEALTHCARE

SPECIALEDUCATION

PSYCHOLOGICALBUFFER

SYMPTOMS

PSYCHOSIS

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MENTAL HEALTHSPECTRUM

MENTALWELL-BEING

MENTALDISORDERS

PSYCHOLOGICAL DISTRESS

BURDENSINVESTMENT

RISKS PRODUCTIVITY AVOIDED LOST

(MENTALCAPACITY

SOCIAL-ECONOMICLOST OPPORTUNITY

LOST

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PSYCHOPATHOGENESIS

FAKTORSOSIAL-BUDAYA

FAKTOR PSIKO-EDUKATIF

FAKTORORGANO-BIOLOGIK

KEPRIBADIAN

LINGKUNGAN

ADAPTIF

(Sehat)

eg.Well-being

+Productive

MAL-ADAPTIF

(Sakit)

eg.Distress+Disabi

lity

COPINGMECHANISM

TRAIT(G!"!#$%B!&'$*)

ABILITY(S+$

B!&'$*)

CHARACTER(M*' B!&'$*)

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NON GENETIC -0

PREGNANCY AND BIRTHCOMPLICATION

PERINATAL AND EARLY CHILHOODBRAIN DAMAGE

FOETAL MALDEVELOPMENT

SEASON OF BIRTH

HEAVY METAL Pb H! A" C $

DRUG ADDICTION

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TREATMENT /REHABILITATION

&

VERY EARLY-EARLY ONSET 11PRODROMAL PHASEFIRST EPISODE OF

PSYCHOSIS

MEDICATIONSCOGNITIVE BEHAVIORAL THERAPY

PSYCHOLOGICAL SUPPORT

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EARLY ONSET PSYCHOSIS

7

ETIOLOGYGENETIC, NON GENE

FACTS SR.. 2 #&, . 34 5 6/- 7.7

BRAIN --------------------------------DNA

ASSESSMENTPRODROMAL INSIDIOUS FIRST EPISODE

MANAGEMENT

INTERVENTIONMEDICATION-PSYCHOTHERAPY-

SOCIAL INTFOCUS MENTAL HEALTH

(PREVENTION)HOLISTIC APPROACH

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BRAIN '''

8

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THEORIES OF SR DINAMIK I8-!9-:;

BIOLOGIK FUNGSI OTAK

- NEURODEGENERATIVE /ABNORMAL BRAIN DEVELOPMENTAL

PRENATAL,VIRUS,TO=IC,INFECTION, AUTOIMUN , STRAVATION, ANO=IA,TRAUMA, STRESS ...DST

- BIOMOLECULAR(GENE PROGRAMMING)

4 KUNCI UNTUK PEMBENTUKAN PROTEINKONEKSITAS DAN

SINAPTOGENESIS

> BDNF(BRAIN DERIVED NEUROTROPC FACTOR)

> DYSBINDIN (DYSTROBREVIN BINDING PROTEIN-3)SINAPSIS

> NEUREGILINNEURONAL MIGRATION,GENESIS GLIA,

MIELINISASI

> DISC-1(DISRUPTED IN SR-3)NEUROGENESIS, MIGRATION,DENDRITIC

ORGANIATION - DOPAMINERGIC-GLUTAMINERGIC PATHWAY

SOSIAL BEBAN HIDUP (STRESSOR PSIKOSOS)

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S(I)OFRENIA *DISREGULASI+,ARAS DOPAMINERGI('

MESOLIMBIK HIPERFUNGSI POSITIFSIMTOM

MESOKORTIKAL (DLPFC)

HIPOFUNGSI

KOGNITIF SIMTOM DAN NEGATIF SIMTOM

MESOKORTIKAL (VMPFC)HIPOFUNGSIAFFEKTIF SIMTOM DAN NEGATIF SIMTOM

NIGROSTRIATAL NORMAL

TUBEROINFUNDIBULAR NORMAL

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@ARAS GLUTAMAT(DESENDING PATHWAY) -@ARAS DOPAMIN (ASENDING P'#&')??

POSITIF SIMTOM DI MESOLIMBIK HIPOFUNGSI GLUTAMINERGIC (CORTICO-BRAINSTEM PRO@ECTION)HIPERFUNGSI DOPAMINERGIC WAHAM

HALUSINASI

HIPO AKTIF DOPAMINERGIC DI MESOKORTIKAL NMDA RECEPTORNEGATIF SIMTOM, KOGNITIF SIMTOM,AFEKTIF SIMTOM.

@ARAS GLUTAMAT DESENDING PATHWAY ( KORTEKS KE BATANG OTAK) #'+)

NEURON SEL GLIA, SEL PIRAMIDALIS

RESEPTORNYA NMDA (N METYL-8-ASPARTAT) MENGANDUNG GLISIN /8SERINE (GLIA SEL) , GLISIN DIPENGARUHI OLEH 8-SERINE. 8-AMINO ACIDO=YDASE ACTIVATOR (DAOA) MEMECAH 8-SERIN 8'" HYDRO=YPYRUVATE .DAOA (REGULATOR GENE)/NEURODEVELOPMENTAL

ADA 7 @ARAS GLUTAMINERGIC DI PREFRONTAL KORTEKS DARI SEL-SELPIRAMIDALIS SEBAGAI MASTER SWITH HIPOFUNGSI GLUTAMAT DANNMDA RESEPTOR SEBAGAI HIPOTESA DARI SKIOFRENIA . NEGATIFSIMTOM SR TER@ADI HIPOFUNGSI CORTICO-CORTICAL GLUTAMIC PATHWAY

GLUTAMAT MERUPAKAN E=ITATOR MERANGSANG RESEPTOR NMDA IONOTROPIC "9 #!* P#!"#$' (LTP) ,C' 66 !"$"9+'# PLASTISITAS

SINAPTIK DAN E=CITOTO=ICITY

'

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O./.N./..456.

B!*! B$*#& 9

S.6 :.44N./!..""I6;/. N./M!/; < D=./.;. >5. ?

N./

S>;5!..""

N./;4S.4.:

A?./ B/@

D=./.; M>.4; S>;5!..""

:65.. E46;

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NEURODEVELOPMENT

DISC I DISC I

S#! C! S!!%#$" M$9*'#$"D$M!$"'#$"

NRG NRG D>"bDGSDAOA

S"'

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M!::'9! !!%#*$%'/%&!$%' R!%!

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OBAT RESEPTOR DOPAMIN(D),SEROTONIN (7HTA), @ARAS

GLUTAMAT(NMDA RECEPTOR)

TYPI(AL BLO(ADE D2 RESEPTORMESOLIMBI(

ATYPICALBLO(ADE PARTIAL D2RESEPTOR MESOLIMBI(

HT2A HIPO DOPAMINERGI(

HT2A MESO(ORTI(AL

GLUTAMINERGIC DOPAMINERGIC

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F;:$" ' :"';5: .":4." @ @../. ./6;4 6.6b/;. ; "b".. /.4.;". ?:@.6:;4 .//;"6./ @. ">;5: :4.? S>;5:.":4." 6. @. ; ; b /.4.;". "." @.5/.-">;5: 6.6b/;. ; .":4.-6.6b/;. 5/." -

SNARE ; ;/!.-6.6b/;. 5/." -SNARE" T@"SNARE :654. ./;:" @ b@ NSF N-.@>46;4.6.S.". F" 5/. ; SNAP S4b4. NSF A;:@6.P/." ?/6 ; ?" :654. A: 5.;45/5;!; :." :;4:6 ; @. 5/.-">;5:6.6b/;. @:@ ; ATP @>/4>"" b> NSF/."4" ";"".6b4> ? @. SNARE :654. ; 6.6b/;.?" F44! .//;"6./ /.4.;". ">;5: .":4.6.6b/;. :65." ;/. /.:>:4. ; ; .:>:5/:.""

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27

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BRAIN CIRCUITSSYMPTOM

28

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BRAIN DEVELOPMENT

NEURON GENES PROTSYNTHESIS

SYNAPSIS PRESYNAP POSTSYNAP

RECEPTOR 123

EN)YM

PATHJAY DOPAMINERGIC

PATJAY GLUTAMINERGIC

2K

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STRESS INVOLVED TO SOMATIC SYMPTOMS

30

HARMFUL STIMULUS

( STRESS)

ADAPTATIONSYNDROME

DISEASES OFADAPTATION

PROTEIN + FATDEPOTS

HEPATICGLYCOGEN

BLOODSUGAR

TISSUES

TrophicHarmone

CEREBRALCORTE!"CONFLICT#

ANTERIORPITUITARY

Epin

eph

rine

H>5@;4;6"

S

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BIOPSYCHOSOCIAL STRESSOR

31

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-METABOTROPIC

32

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SYNAPTOGENESISLEARNING EMOTIONALMATURITY COGNITIVE DEVELOPMENTAL MOTOR

S(ILLS THROUGHOUT LIFE

33

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MESSAGE SIGNAL TONEURON

3

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SPEED 00 (MH/

3

NEURODEGENERATIVE

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NEURODEGENERATIVEI. ASYMTOMATIC 37 T& GENETIC AT RISKII. PRODROMAL/NEGATIVE SYMPTOMS 37 - T& SOSIAL WITHDRAWLIII. ACUTE PHASE 4 FIRST-SECOND...EPISODE .. FULLSYNDROMESIV. NEGATIVE/COGNITIVE SYMPTOMS 4 5 T& RESISTENCY TH/

E=CITOTO=IC (GENE PROG,PRENATAL ANO=IA,TO=INS,INFECTION) DEMENTIA,PARKINSONS 8,ALS

3&

NEURODEGENERATIVE THEORIES OF SR

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NEURODEGENERATIVE THEORIES OF SRNMDA RECEPTORN-METHYL-8 ASPARTATEPOSITIF SIMTOM AKHIRNYA NEGATIFSIMTOM

37

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CELLULAR STRUCTURES

38

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MITO(HONDRIA GENES NEUROTRANSMITTER

3K

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MOLECULER PSYCHIATRY

0