Pretest

Gangguan psikiatrik bukanlah penyakit seperti Diabetes maupun

Sakit 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 mudah
bebas 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 useful

in understanding a patients behavioral
responses to disease and dysfunction.

Behavior is the manner in which a person

performs any or all of the activities of
daily living.

Mental health is ones ability to cope with

and ad ust to the recurrent stresses of
everyday living.

Mental illness is evidenced by a pattern of

behaviors that is conspicuous, threatening,
and disruptive of relationships or deviates
from acceptable behaviors.

Assist the patient and family to achieve

satisfying and productive ways to deal with
daily living.

During early history, a physically or mentally ill

person was thought to be possessed by evil
spirits.
For mental illness, the shamans or medicine
men focused on removing evil spirits through
magical treatments such as spells, potions,
noises, or sacrifices and physical treatment
such as vomiting, bleeding, massage, and
trephining (cutting holes in the skull to release
evil spirits).
If these tribal rites were unsuccessful, the
individual was abandoned to die by starvation
or attack by wild animals.

In the Dark Ages, the church became powerful, and

knowledge was kept in monasteries. Mental illness
was punishment for sins committed, possession by
the devil, or caused by witchcraft.
Exorcisms, physical punishment and imprisonment,
or banishment became the treatment for mental
illness.
During the 17th and 18th centuries, conditions for
the mentally ill were worse than ever.
Bleeding, starving, beating, purging, and
confinement were the treatments of the day.
During the latter half of the 18th century, psychiatry
became a separate branch of medicine.

In England, an asylum was built. The care

was to encourage acceptable behavior by
providing a nurturing atmosphere.
In the United States, the Pennsylvania
Hospital in Philadelphia was established for
the treatment of the mentally ill.
The 19th century saw the flourishing of
institutions and asylums.
Overcrowding and bureaucracy brought
the decline of care provided by institutions.

The Committee for Mental Hygiene was

formed in 1909; it focused on the
prevention of mental illness and the
removal of the stigma of mental illness.
During the 1930s, electroconvulsive
therapy (ECT) and insulin shock therapy
were developed and used to treat
schizophrenia.
Frontal lobotomy was used to eliminate
violent behavior.

In the 1940s, the passage of the National

Health Act and the establishment of the
National Institute of Mental Health were among
the most important developments in the
psychiatric medicine in the United States.
The institute established research funding for
the cause, prevention, and treatment of
mental illnesses.
The 1950s brought about the introduction of
psychotherapeutic drugs.
During the 1960s and 1970s, legislatures
brought about changes in mental health
treatment at the community level.

The Omnibus Budget Reconciliation Act of

1981 The act drastically reduced funding for
the 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 into
the streets.
Now, in the 21st century, mental health
concepts and principles are practiced in a
variety to settings, including public health and
home health care facilities, outpatient settings,
and acute care hospitals.

A positive self-concept
Awareness of responsibility for ones
behavior and its consequences
Maintenance of satisfying interpersonal
relationships
Adaptability to changes
Effective communication
Awareness and acceptance of emotions
and their expressions
Recognition and use of supportive system

Illness is the state of homeostatic

imbalance.
Crisis is a time of change or turning point
in life when patterns of living must be
modified to prevent disorganization of
the person or family.
Some individuals have difficulty coping
with an illness or crisis.

Adaptation

An individuals 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 that

offer protection to the self from a stressful
situation
Blocking conscious awareness of
threatening 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 dengan
orang lain.
Mampu memenuhi kebutuhan hidupnya
serta keluarga/orang yang menjadi
tanggung jawabnya.

Mental

sehat
Sosial

Fisik

Stress ?
So what gitu loh ?!

Distress
ketidakmampuan diri
memikul beban yang
berlebihan atau tuntutan
yang dihadapi diluar
kapasitas psikofisiknya

Gangguan Jiwa
gangguan yang dialami oleh seseorang
dan mempengaruhi
emosi, pikiran dan perilaku
di luar kepercayaan budaya
dan kepribadian, sehingga menimbulkan
efek yang merugikan bagi kehidupan
atau lingkungan.

Mengganggu
fungsi
Ketidak
nyamanan
Perubahan perilaku,
pola pikir, dan
perasaan

Gambaran Gangguan Jiwa

pada umumnya

PSIKOSIS

NEUROSIS

PSIKOSIS
Gangguan jiwa BERAT
yang ditandai dengan
terganggunya
kemampuan seseorang
untuk menilai
kenyataan.

NEUROSIS
Gangguan jiwa RINGAN
masih dapat
melakukan pekerjaan
Biasanya tidak perlu
perawatan khusus di
Rumah Sakit

NEUROSIS

PSIKOSIS
SKIZOFRENIA
DEPRESI BERAT
PSIKOTIK
MANIA PSIKOTIK
GGN MENTAL ORGANIK

GGN. ANSIETAS
GGN. DEPRESI
GGN. GGN. FOBIK
GGN. PANIK
GGN TIDUR
GGN OBSESIF
KOMPULSIF
GGN SOMATISASI
GGN MENTAL ORGANIK

Top Ten Myths about Mental Illness

Psychiatric disorders are not true medical illnesses like
heart 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 of
it 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 psychiatric 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, tidak
berpenghasilan, 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 hakekat
kemanusiaannya. Hak asasi mereka seringkali
diabaikan

Penderita 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

Perkembangan pengobatan
skizofrenia
30s

40s

50s

ECT
Insulin coma therapy
Lobotomy

60s

70s

Haloperidol
Fluphenazine
Thioridazine
Loxapine
Perphenazine

Chlorpromazine

ECT = electroconvulsive therapy.

Kapur and Remington. Ann Rev Med. 2001;52:503.
Worrel et al. Am J Health Syst Pharm. 2000;57:238.

80s

90s

00

02

Clozapine
Risperidone
Olanzapine
Quetiapine
Ziprasidone
Aripiprazole

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

Neurotransmitters
NorAdrenalin, 5HT (Serotonin), GABA

Anxietas
Motor tension
Muscle tension, twitching and shaking, restlessness, .

Apprehension/cemas
Feeling on edge,unable to cope,
poor concentration, insomnia, irritability

Autonomic over-activity
Lightheadedness, sweating, tachycardia, dry mouth,
epigastric discomfort

Effects of HPA axis stimulation

Mediated through CRH, ACTH and cortisol
Promotes 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

Olanzapine (zyprexa)
Efek EPS minimal
Dosis efektif : 5-20 mg/hari
ES : mengantuk, mulut kering, akatisia, insomnia, jarang tjd
orthostatic 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