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 F20.0
HeberenikF20.1
Katatonik F20.2
Tak Terinci F20.3
Residual F20.5

PATOFISIOLOGI

Pleasure, pain avoidance, sense

Dopamine of inner
and outer reality
Imbalance: hallucinations, reward
deficiency syndrome, addictions,
anhedonia
Satifaction with
Seeking
achievement,
motivation
normal sexual
Imbalance: impulsive
response
risk taking, reward
Imbalance:
Mood
deficiency
aggresive,
stability and
dysphoria
Thought

Energy,
socialization
, vigilance,
concentratio
n

Active sociality,
normal sleep and
apetite
Imbalance:
anxiety,
irritability

Cognitive
impulse
control,
relaxation

Serotonin
Norepinephr
ine

Dopamine

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 withmedication 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 brain-imaging
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 ofstress: 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

TamaT
Selamat Ujian