Penanganan Gangguan Mental Dan Perilaku Edt

7/23/2019 Penanganan Gangguan Mental Dan Perilaku Edt

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rb_j Mama 1

PENANGANAN GANGGUAN

MENTAL DAN PERILAKU

Oleh: Dr.H. Ahmadi NH, SpKJ



rb_j Mama 2

Ski!"re#ia da# Ga#$$%a#

P&ik!'ik Lai#

( Perha'ia# da# per'im)a#$a# pe#a#$a#a#:

*. Si"a' i#di+id%, kel%ar$a da# &!&ialp&ik!l!$i& -$ %#ik

. Pera#a# "ak'!r li#$k%#$a# / p&ik!l!$i& 01 $a#$$%a#

2. Ski!"re#ia3P&ik!'ik mrpk $$# k!mplek&, 'erape%'ik

'%#$$al k%ra#$ e"ek'i"

( Medika&i a#'ip&ik!'ik mrpk i#'i pe#$!)a'a#, i#'er+e#&ip&ik!&!&ial memperk%a' per)aika# kli#i&.

( K!m)i#a&i a#'ip&ik!'ik / P&ik!&!&ial 01 ma#"aa' )e&ar



rb_j Mama 3

Pera4a'a# di R%mah Saki'

( I#dika&i %'ama:

'%5%a# dia$#!&'ik

me#&'a)ilka# medika&i

keama#a# pa&ie# 6)%#%h diri3mem)%#%h7

perilak% ka8a%

'dk mamp% meme#%hi ke)%'%ha# da&ar

6maka#a#, pakaia#, perli#d%#$a#7

( Pe#deka'a# 'erapi: somatik da# psikososial



rb_j Mama 4

Terapi &!ma'ik

1.Antipsikotik/neuroleptik:

a. A#'ip&ik!'ik kla&ik3 k!#+e#&i!#al3'ipikal

e"ek'i"i'a& rela'i" k%ra#$ mem%a&ka#

e"ek mer%$ika# me#$$a#$$% / &eri%&: 6aka'i&ia,

parki#&!#i&me: ri$idi'a& / 'rem!r, 'ardi+e

d-&ki#e&ia / &i#dr!ma #e%r!lep'ik mali$#a#7.

). A#'ip&ik!'ik )ar%3a'ipikal le)ih e"ek'i" 90 $e5ala p!&i'i"#e$a'i"7

e"ek &ampi#$ #e%r!l!$i& mi#imal

rem!;ipride, ri&perid!#e, 8l!api#e



rb_j Mama 5

( Rem!;ipride

a#'a$!#i& r.d!pami# kela& )eda d$ -$ lai#

6'ipikal7 le)ih e"ek'i", e"ek &ampi#$ #e%r!l!$i& mi#imal

e"ek &ampi#$: a#emia apla&'ik

( Ri&perid!#e 6 a#'ip&ik!'ik li#i per'ama7 a#'a$!#i& r.&er!'!#i# / r. d!pami#

1 e"ek'i" $e5ala p!&i'i" / #e$a'i"

e"ek &ampi#$ #e%r!l!$i& mi#imal, 8%k%p ama#

( <l!api#e a#'a$!#i& lemah r.d!pami#, a#'a$!#i& k%a'

r. d!pami#= / a#'a$!#i&'ik &er!'!#er$ik

e"ek &ampi#$: a$ra#%l!&i&'!&i&



rb_j Mama 6

2. Terapi somatik lain:

( Terapi elek'r! k!#+%l&i" 6E<T7: pe&ia# ka'a'!#ik,ke&%li'a# me#$$%#aka# a#'i p&ik!'ik

( K!ma i#&%li#, k!ma )ar)i'%ra'. >aha-a,di'i#$$alka#

( P&-8h!&%r$er-: l!)!'ami "r!#'ali&. K%ra#$ e"ek'i",

mahal, 'dk dimi#a'i

Terapi p&ik!&!&ial:

( Terapi perilak%: la'iha# ke'rampila#

perilak%3la'iha# ke'rampila# &!&ial( Terapi )er!rie#'a&i kel%ar$a: !rie#'a&i

p&ik!di#amika3'ilika#, &%p!r'i"

( P&ik!'erapi i#di+id%al: p&ik!'erapi &%p!r'i",!rie#'a&i 'ilika#.



rb_j Mama 7

G$# p&ik!'ik kr# k!#di&i medi& %m%m /

$$# p&ik!'ik aki)a' a'

( Pe#'i#$ ide#'i"ika&i k!#di&i medi& %m%m a'a% a'-$ 'erli)a'

( Terapi: k!#di&i medi& -a#$ me#da&ari,

$$# me#'al da# perilak%( Pera4a'a# di r%mah &aki' %'k:

e+al%a&i me#-el%r%h

keama#a# pa&ie#( A#'ip&ik!'ik 90 perilak% p&ik!'ik, a$re&i"

( >e#!diaepi# 90 a$i'a&i da# ke8ema&a#.



rb_j Mama 8

( Psikosis pascapersalinan

'erma&%k ke$a4a'a# dlm p&ikia'ri

a#'ip&ik!'ik, li'i%m kada#$ a#'idepre&a# p&ik!'erapi &e'elah peri!de p&ik!&i&, k!!pera'i"

( Ggn skizofreni form pera4a'a# r%mah &aki' %'k e"ek'i"i'a&:

pemerik&aa#, pe#$!)a'a# / pera4a'a#

a#'ip&ik!'ik, E<T 6ka'a'!#ik3depre&i7,

li'hi%m3+alpr!a'e 6epi&!de rek%re#7

p&ik!'erapi



rb_j Mama 9

( Ggn Delusional(paranoia/ggn paranoid7

ra4a' 5ala#, a'a% r%mah &aki':

*7 pemerik&aa# medi&, #e%r!l!$i& k!#di&i medi&.7 pe#$e#dalia# imp%l&, kekera&a# )erh%) d$

4aham 6)%#%h diri3mem)%#%h7.

27 me#&'a)ilka# h%)%#$a# &!&ialpeker5aa#.

"armak!'erapi: a#'ip&ik!'ik, a#'idepre&a#, li'hi%m,

a#'ik!#+%l&a# 68ar)amaerpi#, +alpr!a'e7.

p&ik!'erapi i#di+id%al3kel!mp!k: &%p!r'i",

!rie#'a&i 'ilika#, k!$#i'i", perilak%.

p&ik!'erapi p&ik!di#amika, da# 'erapi kel%ar$a



rb_j Mama 10

( Gangguan skizoafektif

pera4a'a# r%mah &aki', medika&i

"armak!'erapi da# i#'er+e#&i p&ik!&!&ial a#'idepre&a#, a#'ima#ik da# a#'ip&ik!'ik.

'ipe )ip!lar: li'hi%m, 8ar)amaepi#, +alpr!a'e.

'ipe depre&i: a#'idepre&a# da# E<T

( Psikotik akut/singkat

pera4a'a# r%mah &aki':

pemerik&aa#, perli#d%#$a#.

"armak!'erapi: a#'ip&ik!'ik a#'a$!#i&

d!pami# 6hal!perid!l7, da# )e#!diaepi#.

p&ik!'erapi: i#di+id%al, kel%ar$a da# kel!mp!k.



rb_j Mama 11

Ggn MoodAfektif

( T%5%a# pe#$!)a'a#:

keama#a#

pemerik&aa#dia$#!&'ik

pe#-em)%ha#ke&eha'a#

( ?armak!'erapi da# 'erapi

p&ik!&!&ial3p&ik!'erapi epi&!de ma#ik, depre&i", 8amp%ra# da#

pr!"ilak&i&

( Ra4a' 5ala#3Pera4a'a# r%mah &aki' da#



rb_j Mama 12

( Pera!atan ruma" sakit# indikasi:

pr!&ed%r dia$#!&i&

re&ik! )%#%h dirimem)%#%h

pe#%r%#a# kemamp%a# pa&ie#: maka#,perli#d%#$a# $a#$$%a# k!$#i'i" da# 'ilika# )%r%k

perkem)a#$a# $e5ala 8epa', ka8a% da# &i&'em

pe#d%k%#$ 'dk ada

( Terapi psikososial/psikoterapi:

p&ik!'erapi 5a#$ka pe#dek 6'erapi k!$#i'i",

'erapi i#'erper&!#al, 'erapi perilak%7

'erapi )er!rie#'a&i p&ik!a#ali'ik, 'erapi

kel%ar$a 6mem)aha-aka# per#ikaha#, "%#$&i

kel%ar$a da# kel%ar$a &)$ pe#-e)a)#-a7



rb_j Mama 13

$armakoterapi( Depresi %& antidepresan# 'T dan $ototertapi

Antidepresan:

'ri&iklik da# 'e'ra&iklik 6he'er!&iklik7

MAOI 6m!8l!)emide, 'ra#-l8-pr!mi#e,

phe#eli#e7

SSRI 6"l%!;e'i#e, par!;e'i#e, &er'rali#e 6!l!"77

'ria!l!p-ridi#eami#!ke'!# 6)%pr!pi!#7

a#'idepre&a# a'ipikal 6'ra!d!#e, 'ra!#e,

alpra!lam,7

&impa'!mime'ik 6am"e'ami#7



rb_j Mama 14

( Gangguan )ipolar

a#'ik!#+%l&a# 68ar)amaepi#, +alpr!a'e7

li'hi%m 8ar)!#a' )e#!diaepi# 68l!#aepam, l!raepam7

pe#$ham)a' &al%ra# kal&i%m 6+erapamil7

a#'a$!#i& r.adre#er$ik al"a 68l!#idi#e7

a#'ip&ik!'ik 6Hal!perid!l, 8l!api#e7

a#'idepre&a#: k!#+e#&i!#al3'ri&iklik, )%pr!pi!#, dll

a#'i 'ir!id 6le+!'h-r!i;i#e7

'T pa&ie# 'ak re&p!#&i" 'hd "armak!'erapi,

Pa&ie# 'ak dp' me#'!lera#&i "armak!'erapi,

kli#i& &a#$a' parah, diperl%ka# per)aika# 8epa'



rb_j Mama 15

( Prediktor *espon:

*. Di&"%#$&i &!&i& re#dah: re&p!# 'hd ';

i#'erper&!#al

. Di&"%#$&i k!$#i'i" re#dah: '; k!$#i'i", perilak%

"armak!'erapi

2. Di&"%#$&i ker5a: "armak!'erapi

=. Keparaha# depre&i: '; i#'erper&!#al"armak!'erapi

Penanganan Gangguan Mental Dan Perilaku Edt

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