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skizofernia - Coggle Diagram
skizofernia
Classification Schizophrenia
Paranoid Schizophrenia
Is characterized by delusions and auditory hallucination but relatively normal intellectual functioning and expression of affect.
Hebephrenic Scizophrenia
It develops between 15-25 years old. Features include like disorganized behavior, thoughts, pranks, gigling, health complains, delusions, and hallucination.
Catatonic Scizophrenia
Includes unusual movements. Sometimes very active sometimes very still. Doesnt talk at all.
Undifferentiated Scizophrenia
Includes signs of paranoid, hebephrenic, catatonic, but doesn’t fit one type alone.
Residual Schizophrenia
Is characterized by a past history of a least one episode of schizophrenia, bur the person currently has no positive symptoms (delusions, hallucinations, disorganized speech of behavior).
Interaksi obat skizofrenia
Haloperidol – Trifuoperazine
Concurrent use causes an increase in the QTc interval. Pharmacodynamic interactions occur with addition effects. This interaction has the potential to harm the patient. This resulted in the use of both drugs need to be monitored closely
Haloperidol – Fluoxetine
The concomitant use of haloperidol and fluoxetine causes an increase in haloperidol levels by affecting the metabolism of the CYP2D6 enzyme in the liver. This interaction is serious. Pharmacokinetic interactions occur with antagonistic effects. The solution is to observe the patient's clinical response. Monitor serum clozapine concentrations and adjust clozapine dose when fluoxetin is started or stopped.
Haloperidol – Chlorpromazine
The concurrent use of haloperidol with chlorpromazine causes both to increase the QTc interval, which is a form of cardiac arrhythmia, which results in a prolongation of the QT interval so that it can cause tachycardia which can be fatal if left untreated. Pharmacodynamic interactions with antagonistic effects.
Trifluoperazine – Chlorpromazine
Concurrent use of trifluoperazine and chlorpromazine causes an increase in the QTc interval. The interactions that occur are pharmacodynamic interactions with antagonistic effects. This resulted in the use of both drugs need to be monitored closely.
SIGNS AND SYMPTOMS OF MENTAL ILLNESS
Distress
the presence of suffering such as pain, discomfort, unease, disturbance, organ dysfunction etc.
Dysfunction
clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.
Deviance
a person is said to be deviant when he or she fails to follow the stated and unstated rules of society, called social norms.
Dangerousness
when behavior represents a threat to the safety of the person or others
DIAGNOSIS CRITERIA
Diagnostic guidelines based on PPDGJ lll
"thought echo" = one's own thoughts repeating in one's head
"thought insertion or withdrawal" = foreign thought content from outside enters his mind (insertion) or his thought content is taken out by something from outside himself (withdrawal)
"thought broadcasting" = the content of his/her thoughts is broadcasted out so that other people or the public know about it.
-"delusion of control" = the delusion of being controlled by some external force
"delusion of influence" = the delusion of being influenced by an external force
"delusion of passivity" = the delusion of being helpless and resigned to an external force.
(of "self" = clearly referring to body/member movements or specific thoughts, actions, or sensations)
-"delusional perception" = an unnatural sensory experience, which has a very unique meaning for the person, usually mystical or miraculous.
Auditory hallucinations:
Hallucinatory sounds that comment continuously on the patient's behavior.
Discussing the patient's behavior
Other types of hallucinatory voices emanating from one part of the body
Other types of sedentary delusions, which are considered culturally unnatural and impossible.
Persistent hallucinations of any of the five senses.
Interrupted flow of thoughts (break), inserts (interpolution), resulting. in incoherence or neologisms.
Catatonic behavior, agitated rowdy state (excitement), certain body postures (posturing flexibility serea), negativism, mutism, and stupor
Negative symptoms: apathy, speechlessness, dulled emotional response, social withdrawal
Differential Diagnoses of Schizophrenia
bipolar 1 disorder with psikotik feature
delusion disorder
skizoafektive disoder
brief psikotik
PHARMACOLOGY & PSYCHOTHERAPY
(FARMAKOKINETIK, FARMAKODINAMIK, & EFEK SAMPING)
Fase akut :
Langkah Pertama:
Berbicara kepada pasien dan memberinya ketenangan.
Langkah Kedua:
Pengikatan atau isolasi hanya dilakukan bila pasien berbahaya terhadap dirinya sendiri dan orang lain serta usaha restriksi lainnya tidak berhasil. Pengikatan dilakukan hanya boleh untuk sementara yaitu sekitar 2-4 jam dan digunakan untuk memulai pengobatan.
Fase Stabilisasi :
Tujuan fase stabilisasi adalah mempertahankan remisi gejala atau untuk mengontrol, meminimalisasi risiko atau konsekuensi kekambuhan dan mengoptimalkan fungsi dan proses kesembuhan (recovery).
Setelah diperoleh dosis optimal, dosis tersebut dipertahankan selama lebih kurang 8 – 10 minggu sebelum masuk ke tahap rumatan. Pada fase ini dapat juga diberikan obat anti psikotika jangka panjang (long acting injectable), setiap 2-4 minggu.
Fase Stabil :
Dosis mulai diturunkan secara bertahap sampai diperoleh dosis minimal yang masih mampu mencegah kekambuhan. Bila kondisi akut, pertama kali, terapi diberikan sampai dua tahun, bila sudah berjalan kronis dengan beberapa kali kekambuhan, terapi diberikan sampai lima tahun bahkan seumur hidup.
efek samping
Clorpromazin (CPZ)
EFEK SAMPING
Sedasi.
Gangguan otonomik (hipotensi, anti kolinergik atau parasimpatik, mulut kering, kesulitan dalam miksi dan defekasi, hidung tersumbat, mata kabur, tekanan intra okuler meninggi, gangguan irama jantung).
Gangguan ekstramidal (dystonia akut, akatshia, sindrom parkinson(tremor), bradikinesia, rigiditas).
Gangguan endokrin (amenorhea).
haloperiidol
EFEK SAMPING:
Sedasi dan inhibisi,
gangguan otonomik (hipotensi, parasimpatik, mulut kering, kesulitan dalam miksi dan defekasi, mata kabur, tekanan intra okuler meninggi, gangguan irama jantung).
Trifluoperazin
EFEK SAMPING:
Lesu,gelisah, mengantuk, pusing, sukar tidur, penglihatan buram, otot lemas, hipotensi, gejala ekstrapiramidal,Lesu,gelisah, mengantuk, pusing, sukar tidur, penglihatan buram, otot lemas, hipotensi, gejala ekstrapiramidal
faktor resiko skizofernia
Genetic/Family History
If your brother or sister or one parent has the illness, your chance of having schizophrenia is around 10 percent.
If one parent has the condition, it raises your chances of developing schizophrenia by about 13 percent.
If your identical twin has the illness, you have a roughly 50 percent chance of developing schizophrenia.
If both of your parents have schizophrenia, you have a 40 percent likelihood of developing the illness
viral infektion
Attack certain brain regions and leave others intact
Alter certain processes within a brain cell without killing the cell
Infect someone and then lay dormant for many years before causing illness
Cause minor physical abnormalities, birth complications, and altered fingerprint patterns sometimes found in people with schizophrenia
Affect neurotransmitters
Lead Exposure
Exposure to lead during fetal develop has been shown to significantly influence the likelihood of the development of schizophrenia and psychosis. Lead can be found in things such as:
Gasoline
Paint
Tap water
Children's toys
DEFINITION OF MENTAL DISORDER
A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual.
Associated with present distress (e.g. a painful symptom) or disability (i.e. impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.
Must not be merely an expectable and culturally sanctioned response to a particular event (e.g. the death of a loved one).
A manifestation of behavioral, psychological, or biological dysfunction in the individual.
Neither deviant behavior (e.g. political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual.
Gangguan jiwa menurut PPDGJ III adalah sindrom pola perilaku seseorang yang secara khas berkaitan dengan suatu gejala penderitaan (distress) atau hendaya (impairment) di dalam satu atau lebih fungsi yang penting dari manusia, yaitu fungsi psikologik, perilaku, biologik, dan gangguan itu tidak hanya terletak di dalam hubungan antara orang itu tetapi juga dengan masyarakat.
PATOFISIOLOGI SKIZOFRENIA
