REMAJA IV

Eri Achmad
P S I K I AT E R
eriachmad@yahoo.co.id

TOPIK BAHASAN
Early-Onset Schizophrenia
Pengenalan umum PSIKOTERAPI

Is thought that at most one in

every 100 adults with
schizophrenia develops it in
childhood

Early-Onset Schizophrenia
Schizophrenia is a Neuropsychiatric Disorder
characterized by severe impairments in
interpreting reality
Early Onset Schizophrenia

1 in every 100 young people

Onset in adolescence (prior to age 18)
Childhood-onset Scizohprenia (before age 12-13)
It is thought that at most one in every 100 adults with
schizophrenia develops it in childhood
Prognosis poor outcome

Symptoms
Positive symptoms include:

hallucinations,
delusions,
disorganized speech, or
disorganized or catatonic behavior

Negative symptoms include:

reduction in emotional expression;
lack of motivation and energy; or
loss of enjoyment and interest in activities, including
social interaction

 PEDOMAN DIAGNOSIS PPDGJ III

Setidaknya harus terdapat satu gejala berikut ini
yang jelas dan dua atau lebih bila gejala-gejala tsb
kurang tajam
Thought echo, thought insertion or withdrawl, thought
broadcasting
Delusion of control, delusion of influence, delusion of
passivity, delusional perception
Halusinasi auditorik
Waham menetap lainnya

 Atau setidaknya dua gejala dibawah ini yang harus

jelas
Halusinasi yang menetap
Arus pikiran yang terputus, inkoherensi, irelevan, atau
neologisme
Perilaku katatonik, gaduh gelisah, posturing, fleksibilitas
cerea, negativisme, mutisme, dan stupor
Gejala-gejala negatif; apatis, respon emosional yang
menumpul, menarik diri dari pergaulan sosial

Berlangsung satu bulan atau lebih

Hendaya diri yang menetap dan bermakna

 SKIZOFRENIA F20-F29
Paranoid
Heberenik
Katatonik
Tak Terinci
Residual

F20.0
F20.1
F20.2
F20.3
F20.5

PATOFISIOLOGI

Dopamine

Pleasure, pain avoidance, sense of inner

and outer reality
Imbalance: hallucinations, reward deficiency
syndrome, addictions, anhedonia
Satifaction with
achievement, normal
sexual response

Seeking motivation
Imbalance: impulsive risk
taking, reward deficiency

Energy,
socialization,
vigilance,
concentration

Mood stability
and Thought

Active sociality, normal

sleep and apetite
Imbalance:
anxiety, irritability

Imbalance: aggresive,
dysphoria

Cognitive impulse
control, relaxation

Serotonin
Norepinephrine

Dopamine Pathway

Natural History of Schizophrenia

Stages of Illness

Premorbid Prodromal Onset

Healthy

Worsening
Severity of
Signs and
Symptoms

Chronic/Residual

Deterioration

Negative Sx
Cognitive Deficits
Functional Impairment

Gestation/Birth

10 Puberty 20

30

40

50

 Prodromal Signs and Symptoms

Poor peer relations/ Socially isolated
Decline in school functioning
Inattentive/difficulty concentrating
Unusual perceptual experiences (illusions)
Unusual beliefs
Unusual thought process
Blunted and/or depressed affect

 PENATALAKSANAAN
There is NO cure for Schizophrenia but there are many
treatments that help alleviate the symptoms and
allow patients to lead productive lives
Requires a multimodal approach

Psychopharmacologic
Family education
Social skills interventions
Appropriate educational placement

Psychopharmacologic
Atypical antipsychotic (second generation)
Risperidone, olanzapine, clozapine (less EPS side effect)

PSYCHOTERAPHY
Psychotherapy is commonly thought of as an
interpersonal process, involving a verbal and/or
nonverbal interchange between a patient who
exhibits psychological problems and a trained
therapists to aid in life problems
These approaches are usually based on a
Medical Model of psychology
Psychotherapy is often used either alone or in
combination with medication to treat mental
illnesses

 Goals:
increase sense of well-being, reduce discomfort
Learn to identify and change behaviors or thoughts that
adversely affect life
Explore and improve relationships
Find better ways to cope and solve problems
Learn to set realistic goals

Employs range of techniques based on relationship

building, dialogue, communication and behavior
change designed to improve the mental of individual
patient or group

How Does Psychotherapy Help?

Understand the behaviors, emotions, and ideas that
contribute to his or her illness and learning how to
modify them
Understand and identify the life problems or events -like a major illness, a death in the family, a loss of a job,
or a divorce -- that contribute to their illness and help
them understand which aspects of those problems
they may be able to solve or improve
Regain a sense of control and pleasure in life
Learn coping techniques and problem-solving skills

Your brain on psychotherapy

Psychotherapy-related changes in brain
activity are strikingly similar within patients
who share the same psychiatric diagnosis.
Psychotherapy and pharmacotherapy achieve
similar efficacy and are associated with
overlapping but not identical changes in brainimaging profiles
Roffman J. et al. Neuroimaging and functional neuroanatomy of psychotherapy.
Psychological med 2005 35:1385-1398

Who seeks therapyand why?

Children
behavioral, school, family issues

Adolescents
as above and issues of separation and peer relationships

Young adults
all of above plus career issues

Mature adults
all of above plus issues of changing relationships, family
alignments, health, work and social status

Older adults:
all of above plus end of life issues

Types of Therapy
Individual/Interpersonal: This therapy involves only the
patient and the therapist
Group: Two or more patients may participate in therapy at the
same time. Patients are able to share experiences and learn
that others feel the same way and have had the same
experiences
Marital/couples: This type of therapy helps spouses and
partners understand why their loved one has a mental
disorder, what changes in communication and behaviors can
help, and what they can do to cope

 Family: Because family is a key part of the team that

helps people with mental illness get better, it is
sometimes helpful for family members to understand
what their loved one is going through, how they
themselves can cope, and what they can do to help

Brief Psychotherapy
Behavior therapy
Cognitive therapy / CBT
Hypnosis
Psychiatric Rehabilitation

Starting Therapy
Therapy works best when you attend all scheduled
appointments. The effectiveness of therapy depends
on your active participation. It requires time, effort,
and regularity
As you begin therapy, establish some goals with your
therapist. Then spend time periodically reviewing your
progress with your therapist. If you don't like the
therapist's approach or if you don't think the therapist
is helping you, talk to him or her about it and seek a
second opinion if both agree, but don't discontinue
therapy abruptly

 Identify sources of stress: Try keeping a journal

and note stressful as well as positive events
Restructure priorities: Emphasize positive,
effective behavior
Make time for recreational and pleasurable
activities
Communicate: Explain and assert your needs to
someone you trust; write in a journal to express
your feelings
Try to focus on positive outcomes and finding
methods for reducing and managing stress