consept konsep dasar ggn jiwa - copy
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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.
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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
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Apa Sich Gunanya ???
• Pandangan masyarakat :
•
ggn jiwa = gila ?• Penderitaan berkepanjangan bagi individu,
Keluarga, Masyarakat & Negara
• Menurunkan produktivitas
• Dampak Sosial
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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
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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.
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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
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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).
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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.
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sehat
Mental
FisikSosial
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istress
‘ketidakmampuan diri
memikul beban yangberlebihan’ atau tuntutan
yang dihadapi diluar
kapasitas psikofisiknya
tress …?
o what gitu loh… ?!
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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.
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Perubahan perilaku,pola pikir, danperasaan
Ketidaknyamanan
Mengganggu
fungsi
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Gambaran Gangguan Jiwa pada umumnya
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PSIKOSIS NEUROSIS
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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
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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
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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
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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.
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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
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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
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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
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enderita skizofrenia berobat
ke
non medis
Harding (1978): 91 %
Bahar (1982) : 60 % Salan (1983) : 37,9 %
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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
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er em angan pengo a anskizofrenia
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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
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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
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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)
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Mekanisme kerja obat anti depresan
Menghambat reuptake neuotransmiter monoamin
Menghambat
penghancuran oleh enzim Monoamin Oksidase
( Sehingga terjadi peningkatan neurotransmiter monoamine )
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Terlibat dalam Anxietas
Structures involved
Cerebral cortex
Limbic system- hypothalamus, hippocampus, amygdala,cingulum
Thalamus, locus ceruleus, raphe nucleus
NeurotransmittersNorAdrenalin, 5HT (Serotonin), GABA
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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
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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
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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
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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
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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
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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 ( )
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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