TERAPI ANTI PSIKOTIK

(TERUTAMA SKIZOFRENIA)

Dr.Deddy Soestiantoro SpKJ MKes(Biored/Farmak)

DASAR MEDIKASI NEUROLEPTIK:
Efikasi pada Simptom
DELUSI,HALUSINASI,
S.POSITIF GG.PROSES FIKIR

AFEK DATAR,HILANGNYA
S.NEGATIF KEHENDAK DAN ENERGI ,
DISINTEGRASI SOSIAL

GANGGUAN PADA DAYA INGAT,CARA

S.KOGNITIF FIKIR ABSTRAK DAN PERHATIAN

DYSFORIA,DEPRESI SERTA
S.AFEKTIF SUISIDALITAS
 TERAPI SKIZOFRENIA
)

EUR
PSIKOTERAPI

TERAPI LINGKUNGAN

TERAPI SOMATIK
NEUROLEPTIK
ECT-ICT-PSYCHOSURGERY

TERAPI AWAL TERBAIK----NEUROLEPTIK

 NEUROLEPTICS CLASSIFICATION
*First Generation Antipsychotics (FGA “Typical/Conventional”)
1. Low Potency/High Dose: Chlorpromazine
2. High Potency/Low Dose: Haloperidol

*Second Generation Antipsychotics (SGA “New atypical”)

1. Serotonin-Dopamine Antagonists ( SDA )
Risperidone, Ziprasidone, (Sertindole)
2. Multi-Acting Receptor Targeted Agents ( MARTA )
Clozapine, Olanzapine, Quetiapine, Zotepine

*Third Generation Antipsychotics ( TGA )

Dopamine System Stabilizers ( DSS )
Aripiprazole

Next Generation……..?
Efficacy of Atypicals extends beyond positive
symptoms of disease

+ –
Positive Negative Cognitive Affective

Conventional /
Typical
Antipsychotics

Atypical
Antipsychotics
 PROFIL RESEPTOR
FGA & SGA

5HT2A
M1
H1
5HT2A
5HT1D α1
Atypical α2
Typical Atypical 5HT2C
Antipsychotic Antipsychotic Antipsychotic NRI
( FGA ) ( SDA ) 5HT3 ( MARTA ) D1
D2 D2 5HT6 D2
FGA
5HT7 D4 D3
S G A
Stephen M.Stahl; Psychopharmacology of Antipsychotics, 1999
 Perkembangan Terapi Medik untuk
Gangguan Psikotik

’30s ’40s ’50s ’60s ’70s ’80s ’90s ’ 00 ’04 ‘06 (?) ‘09-’11

ICT Haloperidol Clozapine* Aripiprazole ILOPERIDONE

ECT Fluphenazine Zotepine* ASENAPINE
Thioridazine Risperidone LURASIDONE
Reserpine Trifluoperazine Olanzapine* Paliperidone
Perphenazine Quetiapine*
Ziprasidone
Chlorpromazine

Anti-psikotik Anti-psikotik
Generasi Pertama Generasi Kedua Generasi
FGA SGA: SDA & MARTA* berikutnya?

ECT = electro convulsive therapy.

Kapur and Remington. Ann Rev Med. 2001;52:503.
Worrel et al. Am J Health Syst Pharm. 2000;57:238. (modified)
 TYPICAL NEUROLEPTICS
HYPNOGENIC EFFECT
PROFIL FGA
! Levomepromazine
! 1.Antagonis D2
Thioridazine 2.Kurang efektif pada simptom negatif
dan kognitif
3.Antagonis D2 terkait Efek Samping
Reserpin EPS, tardive dyskinesia dan hyper-
prolactinemia
Chlorpromazine

Haloperidol
Perphenazine
Fluphenazine
Pimozide
December 3, 2007
ANTIPSIKOTIK KONVENSIONAL
(TIPIKAL) dan FUNGSI KOGNITIF

Antipsikotik Konvensional Antipsikotik Konvensional

khususnya hanya mengatasi tidak memberi dampak
gejala positif skizofrenia positif pada fungsi kognitif

Antipsikotik konvensional (dan Penggunaan antikolinergik

beberapa antipsikotik atipik) untuk terapi EPS
dapat menimbulkan EPS dapat menambah berat
disfungsi kognitif
Konsekuensi yang merugikan
peningkatan prolaktin

Disfungsi Kanker
Seksual Payudara

Osteoporosis Ginekomastia
Prolaktin
meningkat
Fertilitas
Galactorrhoea
menurun

Gangguan
Amenorrhoea
Kardiovaskuler

Halbreich et al 2003
 ANTI PSIKOTIK ATIPIKAL

PROFIL SGA
*Antgonis D2, 5HT2A dll.neurotransmiter.
*Efektif pada simptom negatif &kognitif, baik.
*Efek samping BB naik,DM,dyslipidemia, efek
anticholinergik, hypotensi, sedasi dll.
 Ciri AP Atipik :Risiko EPS rendah

Meningkatkan
Kepatuhan
Tak memberatkan Risiko TD
Gejala Negatif rendah

Keuntungan
EPS rendah
Tak mengganggu Efek samping
Kognisi Motorik ringan
Risiko
Dysphoria
kurang

December 3, 2007
Jibson & Tandon 1998
EFEK SAMPING NEUROLEPTIKA ATIPIK
1.BB naik…………………………..Olan.,Risp., Quet.,Zipra.,Arip.
2.Disf.Seksual
3.Risiko Kejang naik
4.Hipo/hipertensi
5.Resp. Akathisia ……..…………………………….….Risp.,Quet.
6.Agranulos.......................................................................Clozapine
7.Hiperprolaktinemia……………....Antipsikotik tipikal umumnya
8.Hiperglikemia, DM,
Ketoasidosis ,Koma………….……Olan.,Risp.,Quet.,Cloz.,Arip.
9.Perpanjangan PR&QTc,QRS, Dep.ST, Flattening/ Notch
T-Waves, Emerg.of U-Waves…….......………..Zipr.,Olan.,Risp.
10.Kreatin Fosfokinase Naik
11.Dyslipidem …................................…Cholesterol., Triglyceride.
12.Somnolen……………………..……………………..Clozapine
13.Insomnia…….……... ……………………………Aripiprazole
14.Nyeri / Agitasi
15.Mulut Kering
16.ALT & AST Naik
 High
Potential
Risk of
Metaboli
Syndrome

Here is a look at the conclusions of the American Diabetes Association (published in a joint statement
with the American Psychiatric Association) regarding weight gain (Wt Gn), diabetes risk, and worsening cholesterol levels:
POTENSI KENAIKAN BB NEUROLEPTIK
TARGET TERAPI NEUROLEPTIK

SIMPTOM SIMPTOM
POSITIF NEGATIF
-DELUSI -AFEK DATAR
-HALUSINASI -ENERGI KURANG
-GG.PROSES FIKIR -DOR.KEHENDAK HILANG
-DISINTEGRASI SOSIAL
SKIZOFRENIA
SIMPTOM KOGNITIF SIMPTOM AFEKTIF
GG.DAYA INGAT -DYSFORIA
GG.CARA FIKIR ABSTRAK -DEPRESI
GG.PERHATIAN -SUISIDALITAS
Efficacy of Atypicals extends beyond positive
symptoms of disease

+ –
Positive Negative Cognitive Affective

Conventional /
Typical
Antipsychotics

Atypical
Antipsychotics
 Gejala negatif
Gejala kognitif
Target Gejala afektif
Terapi Gejala positif Gejala efek samping
Hidup Berkualitas

’30s ’40s ’50s ’60s ’70s ’80s ’90s ’ 00 ’04 ‘06 (?) ‘09-’11

ICT Haloperidol Clozapine* Aripiprazole ILOPERIDONE

ECT Fluphenazine Zotepine* ASENAPINE
Thioridazine Risperidone LURASIDONE
Reserpine Trifluoperazine Olanzapine* Paliperidone
Perphenazine Quetiapine*
Ziprasidone
Chlorpromazine

Anti-psikotik Anti-psikotik
Generasi Pertama Generasi Kedua Generasi
FGA SGA: SDA & MARTA* berikutnya?

ECT = electro convulsive therapy.

Kapur and Remington. Ann Rev Med. 2001;52:503.
Worrel et al. Am J Health Syst Pharm. 2000;57:238. (modified)
PEDOMAN PEMILIHAN OBAT

LACK OF
GOOD EFFICACY ADVERSE REACTION

BEST PRICE
GOOD COMPLIANCE