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
– Heberenik F20.1
– Katatonik F20.2
– Tak Terinci F20.3
– Residual F20.5
PATOFISIOLOGI
 Pleasure, pain avoidance, sense of inner
Dopamine and outer reality

Imbalance: hallucinations, reward deficiency

syndrome, addictions, anhedonia

Satifaction with
Seeking motivation achievement, normal
Imbalance: impulsive risk sexual response
taking, reward deficiency Imbalance: aggresive,
Mood stability
and Thought dysphoria

Energy,
socialization, Active sociality, normal
vigilance, sleep and apetite
Cognitive impulse
concentration
Imbalance: control, relaxation
anxiety, irritability

Serotonin
Norepinephrine
Dopamine Pathway
 Natural History of Schizophrenia
Stages of Illness

Premorbid Prodromal Onset Chronic/Residual

Healthy


Deterioration
Worsening
Severity of
Signs and
Symptoms
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 brain-
imaging profiles
Roffman J. et al. Neuroimaging and functional neuroanatomy of psychotherapy.
Psychological med 2005 35:1385-1398
 Who seeks therapy…and 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