SKIZOFRENIA DAN

GANGGUAN PSIKOTIK LAIN

DARYANTO

GANGGUAN PSIKOTIK

GANGGUAN JIWA BERAT DENGAN

GEJALA GANGGUAN PENILAIAN
REALITAS, DISERTAI DISABILITAS
KOGNITIF DAN EMOSI SEHINGGA
KEMAMPUAN FUNGSI NORMAL
SANGAT TERGANGGU

SKIZOFRENIA
KATEGORI DSM IV

295.XX SKIZOFRENIA
295.30 SKIZOFRENIA
295.10 SKIZOFRENIA
TERORGANISASI
295.20 SKIZOFRENIA
295.90 SKIZOFRENIA
295.60 SKIZOFRENIA

TIPE PARANOID
TIPE TAK
TIPE KATATONIK
TIPE TAK TERINCI
TIPE RESIDUAL

PPDGJ-III
F.20 SKIZOFRENIA

F20.0
F20.1
F20.2
F20.3
F20.4
F20.5
F20.6
F20.7
F20.8

SKIZOFRENIA PARANOID
SKIZOFRENIA HEBEFRENIK
SKIZOFRENIA KATATONIK
SKIZOFRENIA TAK TERINCI
DEPRESI PASCA SKIZOFRENIA
SKIZOFRENIA RESIDUAL
SKIZOFRENIA SIMPLEKS
SKIZOFRENIA LAINYA
SKIZOFRENIA YTT

F21
GANGGUAN SKIZOTIPAL
F22
GANGGUAN WAHAM MENETAP
F23
GANGGUAN PSIKOTIK AKUT
DAN SEMENTARA
F24
GANGGUAN WAHAM INDUKSI
F25
GANGGUAN SKIZOAFEKTIF
F26
PSIKOTIK NON ORGANIK LAINYA
F27
GANGGUAN PSIKOTIK NON
ORGANIK YTT

SKIZOFRENIA DAN GANGGUAN

PSIKOTIK LAINYA

DITANDAI ADANYA GANGGUAN

DALAM;
KOMUNIKASI,
BAHASA,
PIKIRAN,
PERSEPSI,
AFEK
PERILAKU

SKIZOFRENIA

1% PENDUDUK DUNIA
PENDUDUK KOTA
KELOMPOK SOSEK RENDAH
INDONESIA ; 1-3 PASIEN PER 1000
PENDUDUK

FASE SKIZOFRENIA (COPEL, 2000)

A. FASE PRODROMAL

KEMUNDURAN FUNGSI PERWATAN

DIRI, SOSIAL, WAKTU LUANG,
PEKERJAAN ATAU AKADEMIK
BERLANGSUNG LAMA (6 12
BULAN)
TIMBUL GEJALA POSITIF DAN
NEGATIF
PERIODE KEBINGUNGAN KLIEN
DAN KELUARGA

FASE AKTIF

PERMULAAN INTERVENSI ASKEP;

KHUSUSNYA HOSPITALISASI
PENGENALAN PEMBERIAN OBAT
DAN TERAPI MODALITAS LAINYA
PERAWATAN DIFOKUSKAN PADA
REHABILITASI PSIKIATRIK SAAT
KLIEN MULAI BELAJAR HIDUP
DENGAN PENYAKIT YG PENGARUHI
PIKIRAN, PERASAAN DAN PERILAKU

FASE RESIDUAL

PENGALAMAN SEHARI-HARI
DENGAN PENANGANAN GEJALA
PENGURANGAN DAN PENGUATAN
GEJALA
ADAPTASI

Phases of Schizophrenia:
Phase I: Schizoid Personality
indifferent

to social relationships
appear cold and aloof
does not always progress to schizophrenia

Phase II: Prodromal Phase

social

withdrawal
peculiar or eccentric behavior
bizarre ideas
unusual perceptual experiences
neglectful of personal hygiene and grooming
lack of initiate, interests, or energy
phase may last for many years

Phases of Schizophrenia (contd)

Phase III: Schizophrenia
delusions

and/or hallucinations
disorganized speech
disorganized or catatonic behavior
affective flattening
marked decrease in level of functioning
persists for at least 6 months

Phase IV: Residual Phase

usually

follows active phase of the disease

flat affect and impairment in role functioning
residual impairment usually increases each time

PENYEBAB Schizophrenia

Umunya disebabkan oleh interaksi genetic dan

faktor lingkungan:
Neurodevelopmental brain abnormalities
Pembesaran ventricles
Cortex-left localized
Disfungsi lobus Temporal
Metabolisme Phospholipid
Disfungsi lobus Frontal
Disfungsi sirkuit otak
Densitas Neuronal
NEUROTRANSMITTER SYSTEM
Dopamin

Schizophenria

BLEULERS four As
Ambivalenceholding two
different attitudes/emotions/feelings
at the same time
Autistic thinkingdisturbances in
thoughts private fantasy
world/abnormal responses to
people/events of the real world

Bleulers 4 As(cont)

Loosening of Associations-rapid
shift of ideas- unrelated manner
Affective disturbance - may be
blunt, flat,inappropriate/labile

Gejala-gejala Positif

DELUSIONS(paranoid/reference)
HALLUCINATIONS(auditory/visual)
DISORANIZED
SPEECH/THINKING(tangential/loa/incoherent/neo
logisms
GROSSLY DISORGANIZED BEHAVIOR(difficulty
with goal setting/ADLs;unpredictable
agitation/silliness/social disinhibition/bizarre
behaviors
CATATONIC BEHAVIORS(decrease reaction to
environment/bizarre postures/aimless motor
activity)

Gejala-gejala Negative

AFFECTIVE FLATTENING
ALOGIA (poverty of speech/slowed
speech/decrease fluency/content)
AVOLITION(inability to initiate goal
directed behavior)

TYPES OF SCHIZOPHRENIA
Disorganized
Paranoid
Catatonic
Undifferentiated
Residual
Related Psychotic Disorders:
Schizoaffective Disorder
Schizophreniform disorder
Delusional disorder
Brief Psychotic disorder

Paranoid Type

Persistent delusions/persecuatory nature

Auditory hallucinations-single or associated
theme
Guarded,suspicious,hostile,angry,
possibly violent
Pervasive anxiety
Intensive,reserved,controlled social interactions
Onset- later in life
Generally more favorable dx. re: independent
living/occupational functioning.

Disorganized type
Grossly inappropriate/flat affect
Primitive / uninhibited behaivor
Unusual mannerisms-giggle/cry out
loud/distort facial expressions
Hypochondriasis (multiple physical
complaints)
Socially inept/withdrawn
Onset early- prepsychotic period- marked
adjustment problems
Hallucinations/delusions more fragmented

Catatonic Type
Marked

disturbance of
psychomotor activity
May be immobile/or with
psychomotor excitation
Displays negativism/mutism
Posturing
Bizarre positions-waxy flexibility

Undifferentiated type
Florid psychotic symptoms :
delusions/hallucinations
incoherence
disorganized speech/behavior

*do not clearly fit into other

categories

Schizophreniform Disorder

Meets criteria for schizophrenia except:

1) duration-at least 1 month but < 6
mos.
2)Social/ Occupational functioning may
or may not be impaired vs. schizophrenia
where functional disturbances
ie:relationships, school,self care are
present.

Schizoaffective Disorder
Symptoms of both Schizophrenia and
affective (mood)disorders
*delusions/hallucinations/disorganized speech
Major depression, mania, mixed
At least a two week period of psychotic
symptoms only
Onset is later than schizophrenia
Prognosis is better than schizophrenia,but
worse than Affective Disorder.

Residual Type

Client has had at least one acute

episode
Free of psychotic symptoms
Continues to exhibit persistent
social withdrawal/emotional
blunting/illogical
thinking/eccentric behavior

Delusional Disorder

Presence of one or more nonbizarre

delusions persist for ONE month or
more
Bizarre delusion ie:brain removed by
aliens-replaced with computer
vs. nonbizarre delusion- more
believable ie:believes the IRS is going
to prosecute his family for his
wrongdoings.

Subtypes of Delusional Disorder

Erotomanicmay involve stalking/spying

Jealousefforts made to follow & Catch
Grandiosehas extraodinary
talent/knowledge
Persecutoy-victim of a
conspiracy/poisining/spying
Somatic-bodily sensations/believes body
has a foul odor/insects or parasites on/in
body/body part is nonfunctional

SHARED PSYCHOTIC
DISORDER

Delusional disorder also known as

folie `a deux
develops in a person who is
involved in a relationship with
another person who already has a
psychotic d/o with prominent
delusions.

Psychotic Disorder due to medical

conditions

Characterized by: prominent

hallucinations and /or delusions due
to physiologic effect of medical
condition

Substance Induced Psychotic

Disorder

Characterized by: prominent

hallucinations and /or delusions
produced by the physiological
effects of a substance ie:
Drugs

of abuse,medications or toxins
The disorder first occurs during
intoxication or withdrawal stages, but
can last for weeks thereafter.