penatalaksanaan gangguan jiwa - dr. mardiatmi s., spkj
DESCRIPTION
psikiatriTRANSCRIPT
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PENATALAKSANAAN GANGGUAN JIWA
Mardiatmi Susilohati,dr,Sp.KJ (K)
Bagian Psikiatri FK UNS-RSUD Dr.Moewardi Surakarta
2010
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Penatalalaksanaan Gangguan Jiwa
• Psikofarmaka• Tetapi kejang
Listrik ( ECT )
Terapi Biologik/Fis
ik
• Psikoterapi• KonselingTerapi
Psikologik
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Psikofarmaka
Antipsikotik Antidepresan
Antianxietas
Antimanik/ mood
stabilizer
: Obat-obat yang memiliki efek utama terhadap proses mental di susunan saraf pusat, seperti proses pikir, perasaan, dan fungsi motorik atau perilaku
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ANTI PSIKOTIK
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Anti Psikotik
Neuroleptik Major tranquilizer
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Anti Psikotik
Penggunaan klinis utama :1. Psikosis2. Gangguan waham3. Mania4. Skizofrenia
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Anti Psikotik
Rumus Kimia
Fenotiazin=Low potency
Nonfenotiazin=High potency
Cara Kerja
Dopamin reseptor antagonis (DA)= Anti psikotik
tipikal
Serotonin Dopamin reseptor antagonis (SDA)=Anti psikotik
atipikal
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Anti psikotik
CPZ ( Chlorpromazin ) Haloperidol, Trifluopenazin Clozapin Risperidon Olanzapin Quetiapin Aripiprazole
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Prinsip Pengobatan
Terapi InisialTerapi PengawasanTerapi Pemeliharaan
1-3 mgg8-10 mgg
2 th/5 th/seumur hidup•Segera setelah Dx tegak•Mulai dosis anjuran•Dinaikkan perlahan-lahan s.d dosis optimal
•Diperoleh setelah dosis optimal•Dipertahankan sebelum masuk ke tahap pemeliharaan
•Dosis minimal tanpa menimbulkan kekambuhan•Konsensus : akut,episode pertama 2 thKronis 5 th kronis,rwyat agresifitas seumur hidup
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Nama Generik Nama dagang Formulasi
Aripiprazole Abilify Tab : 10,15
Chlorpromazine Thorazine Tab : 25,100Inj : 25 mg/ ml
Clozapine Clozaril Tab : 25, 100
Haloperidol Haldol Tab : 1,5 ; 5Inj : 5 mg/ ml
Trifluoperazine Stelazine Tab : 5
Risperidone Risperdal Tab : 1, 2, 3
Olanzapine Zyprexa Tab : 5, 10Inj : 10 mg/ ml
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Nama Obat Minimum effective dose
Maximun dose
Chlorpromazine 200-300 1000
Haloperidol 2-4 30
Trifluoperazine 10-15 50
Risperidone 2-4 16
Clozapine 12,5-200 900
Olanzapine 5-10 20
Quetiapine 150-200 750
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Efek Samping
Akatisia Distonia akut SNM ( Sindrom Neuroleptik Maligna
)
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Akatisia Suatu kondisi yg scr subjektif
dirasakan perasaan tdk nyaman,gelisah & merasa harus menggerak-gerakkan tungkai t.u kaki
Gejala kecemasan/ agitasi Sering sulit dibedakan dr rasa cemas
yg berhub dg gejala psikotik Peningkatan kegelisahan setelah
mendapat anti psikotik harus selalu diperhitungkan kemungkinan akatisia
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Distonia akut
Kekakuan & kontraksi otot secara tiba-tiba (otot leher,lidah, muka & punggung), kadang pada awitan subakut rasa tebal di lidah/ kesulitan menelan
Sangat menakutkan & tdk nyaman Biasanya pd mgg pertama
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Parkinsonism
Kumpulan gejala yg terdiri dari bradikinesia, rigiditas, fenomena roda gerigi, tremor, muka topeng, postur tubuh kaku, gaya jalan spt robot & droling ( tremor kasar tangan spt sedang membuat pil )
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SNM (Sindrom Neuroleptik Maligna)
Reaksi idiosinkrasi yg sangat serius dg gejala utama berupa rigiditas, hiperpiretik, gangguan sistem saraf otonom ( hipertensi, hipotensi, takikardi, diaporesis ) & delirium
Beberapa jam s.d beberapa hari Suddent death
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Penatalaksanaan Efek Samping Menurunkan dosis Mengganti obat Triheksipenidil Diphenhidramin Sulfas Atropin Diazepam
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ANTI DEPRESAN
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Anti Depresan
Sekelompok obat yg heterogen dg efek utama yg terpenting adalah mengendalikan gejala depresi
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Klasifikasi Anti Depresan
Derivat TrisiklikImipraminAmitriptilin
Derivat tetrasiklik
MaproptilinMianserin
Derivat MAOI
(Monoamine Oksidase Inhibitor)Moclobemide
Derivat SSRI (Selective Serotonin Reuptake Inhibitor)
Sertralin,FluoxetinFluvoxamine,Escital
opram
Derivat SNRI (Serotonin
Norepineprin Reuptake Inhibitor)VenlafaxineDuloxetine
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Generik Nama dagang
Formulasi Dosis terapeutik
Fluoxetine Prozac Tab : 10, 20 20 – 40
Sertraline Zoloft Tab : 25, 50 50 – 200
Escitalopram Cipralex Tab : 5, 10, 20
10
Amitryptiline Tab : 25 75-100
Fluvoxamine Luvox Tab 25, 50, 100
100 - 200
Mirtazapine Remeron Tab : 15, 30, 45
15 – 45
Venlafaxine Effexor Tab : 25, 50, 75, 100
75 - 375
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Cara Kerja
Sistem neurotransmitter serotonin meningkatkan jumlah serotonin di pasca sinaps
Bekerja di pre sinaps dg cara menghambat enzim yg memecah serotonin sehingga jumlah serotonin yg dilepaskan ke celah sinaps bertambah
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Efek Samping
Hipotensi Gangguan jantung Gejala gangguan saraf otonom dll
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Prinsip Pengobatan
Dosis awal
Dosis terapuetik
Dosis Pemeliharaan
Efek terapi mgg ke-2 atau ke-3
Minimal 6 mgg3-5 tahun
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ANTI ANXIETAS
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Anti anxietas
Sekelompok obat-obat yg digunakan terutama untuk mengatasi kecemasan
Memiliki efek sedasi, relaksasi otot, anti epileptik
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Klasifikasi
Derivat Benzodiazepin
Diazepam,bromazepam,lorazepam,alpraz
olam, clobazam
Derivat GliserolMeprobomat
Derivat barbituratFenobarbital
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Nama Generik
Nama Dagang
Sediaan Dosis
Chlordiazepoxide
Librium Cap : 5, 10, 25
15 – 40 mg
Clorazepate Tranxene Tab : 3,75; 7,5; 15
15 - 40 mg
Diazepam Valium Tab : 2, 5 5 – 40 mg
Lorazepam Ativan Tab : 0,5; 1; 2
1 – 6 mg
Oxazepam Serax Cap : 10, 15, 30
15 – 120 mg
Alprazolam Xanax Tab : 0,25; 0,5; 1; 2
1 – 4 mg
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Cara Kerja
Penguatan inhibisi yang diperantarai asam gamma amino butirat ( GABA ) pada sistem saraf pusat
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Efek Samping
Mengantuk, sakit kepala, disartria, ataksia, nafsu makan meningkat
Mudah terjadi toleransi & dependensi dalam pemberian dosis besar & dalam waktu yg lama
Gejala putus zat apabila dihentikan tiba-tiba
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ANTI MANIK
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Anti manik (Mood Stabilizer)
Sekelompok obat yg berkhasiat terutama mempertahankan stabilitas suasana perasaan, terutama mencegah munculnya kondisi manik
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Klasifikasi
Garam Lithium Lain-lain
Lithium CarbonatPriadelTheralithFrimania
CarbamazepinTegretol
Asam ValproateDepakeneValproic Acid
Natrium divalproate Depakote
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Nama Obat Dosis
Lithium 200-400
Carbamazepine 200-1000
Valproate 250-500
Lamotrigine 50-200
Topiramate 25-200
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Cara Kerja
Menghambat pelepasan NA di celah sinaps neuron adrenergik mengatasi gejala manik
Pelepasan NA ( Noradrenergik ) berlebihan
pada sistem adrenergik
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Efek samping
Tremor halus Diare & muntah-muntah Lelah & vertigo Ataksia Penurunan kesadaran Konvulsi Oliguri Edem
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TERAPI KEJANG LISTRIK = ECT ( Electroconvulsive Therapy ) Suatu terapi yg dilakukan dengan
cara memberikan aliran listrik melalui 2 elektrode yg ditempatkan pada regio di kepala yag dapat menimbulkan kejang
Salah satu jenis terapi fisik yg nerupakan pilihan untuk indikasi pd bbrp kasus gangguan psikiatri
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Indikasi
Depresi berat Alternatif terapi pada pasien yang
tidak respon terhadap pengobatan Kegelisahan katatonik/ stupor
katatonik ( Skizofrenia katatonik ) dll
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Kontraindikasi
Absolut : tumor otak ( ECT Konvensional)
Pemantauan cermat : 1. Peningkatan TIK2. Infark miokardial ( < 3 bln )3. Hipertensi Keadaan lain : osteoporosis,
fraktur
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Efek Samping ECT
Fraktur : t.u ECT konvensional Kejang yang lama Apnoe yang lama Penyulit : gangguan memori bila
pemberian ECT jangka panjang
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TERAPI BIOLOGIK LAIN Light therapy Psychosurgery dll
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Terima Kasih