Pemicu 2 - Elfarini

8/17/2019 Pemicu 2 - Elfarini

1/15

Psycotic Disoders

Elfarini

405110034Blok Neuropsikiatri


2/15

Learning Obecti!e

• Psikotik akut" #ki$ofrenia %teori & psikopatologi'

• Pe(eriksaan penunang )*" +,-" EE." Lab

• ga(baran klinik ggn psikosis %sc/i$o" ggn a/a((enetap" psikosis akut" as$ikoafektif'

• Diagnosis berdasarkan diagnosis (ultiaksial siste(%aksis1 deskripsi klinis" 2 ggn kepribadian danperke(bangan" 3 ggn sik" 4 stres psikososial" 5penyusuaian diri dl( seta/un terak/ir'

• *erapi penda/uluan pd keadaan yg bukan e(ergency• ,uukan dan tindakan lanutan sesuda/ diruuk

• #u((ary dari kasus dan prognosis


3/15

#c/i$op/renia

)/aracteristic sy(pto(s %acti!e p/ase' ≥2 of t/efolloing" eac/ present for a signicant portion of ti(eduring a 1-month period %or less if successfullytreated'

–

Delusions – 6allucinations

– Disorgani$ed speec/

– .rossly disorgani$ed or catatonic be/a!ior

– Negati!e sy(pto(s %a7ecti!e 8attening" alogia" or a!elition'

NO*E only 1 a sy(p is re9uired if delutions are bi$arre or/allutination consist of a !oice keeping a running co((entaryof person:s be/a!ior or t/oug/ts" or ;2 !oices con!ersing it/eac/ ot/er


4/15

B #ocial


5/15

#ubtypes

Paranoid:

? preoccupation it/ one or (ore delusions %typicallypersecutory or grandiose' or fre9uent auditory /allucinations

? relati!e preser!ation of cogniti!e functioning and a7ect@ onset

tends to be later in life@ belie!ed to /a!e t/e best prognosis

Catatonic:

? at least to of (otor i((obility %catalepsy or stupor'@e=cessi!e (otor acti!ity %purposeless" not in8uenced by e=ternal

sti(uli'@ e=tre(e negati!is( %resistance to instructions


6/15

Disorganized:

? disorgani$ed speec/ and be/a!iour@ 8at or inappropriate a7ect

? poor pre(orbid personality" early and insidious onset" and continuouscourse it/out signicant re(issions

Undiferentiated:

? sy(pto(s of criteria (et" but does not fall into t/e 3 pre!ioussubtypes

Residual:

? absence of pro(inent delusions" /allucinations" disorgani$ed speec/"grossly disorgani$ed or catatonic be/a!iour

? continuing e!idence of disturbance indicated by t/e presence ofnegati!e sy(pto(s or ;2 sy(pto(s in criteria present in attenuatedfor(


7/15


8/15

Etiology

+ultifactorial disorder is a result of interaction beteen bot/ biological and en!iron(entalfactors

? Genetic C 50 concordance in (ono$ygotic %+G' tins@ 40 if bot/ parents /a!esc/i$op/renia@ 10 of di$ygotic %DG' tins" siblings" c/ildren a7ected

? eurochemistr! C Hdopa(ine /ypot/esisH t/eory e=cess acti!ity in t/e (esoli(bic

dopa(ine pat/ay (ay (ediate t/e positi!e sy(pto(s of psyc/osis %ie delusions"/allucinations" disorgani$ed speec/ and be/a!iour" and agitation'

? euroanatom! C decreased frontal lobe function" asy((etric te(poral


9/15

Pat/op/ysiology

eurodegenerati"e theor!

? natural /istory (ay be rapid or gradual decline in functionand ability to co((unicate

? gluta(ate syste( (ay (ediate progressi!e degeneration

by e=citoto=ic (ec/anis( /ic/ leads to production of freeradicals

eurode"elopmental theor!: abnor(al de!elop(ent oft/e brain fro( prenatal life

? Neurons fail to (igrate correctly" (ake inappropriateconnections" and break don in later life

? inappropriate apoptosis during neurode!elop(ent resultingin faulty connections beteen neurons


10/15


11/15

Prognosis

? */e (aority of indi!iduals display so(e type ofprodro(al p/ase

? )ourse is !ariable so(e indi!iduals /a!e e=acerbations

and re(issions and ot/ers re(ain c/ronically ill@ accurateprediction of t/e long ter( outco(e is not possible

? Early in t/e illness" negati!e sy(pto(s (ay bepro(inent@ positi!e sy(pto(s appear and typicallydi(inis/ it/ treat(ent@ negati!e sy(pto(s (ay

beco(e (ore pro(inent and (ore disabling

? O!er ti(e" 1


12/15

Good Prognostic #actors

? cute onset

? Precipitating factors

? .ood cogniti!e functioning? .ood pre(orbid functioning

? No fa(ily /istory

? Presence of a7ecti!e sy(pto(s

? bsence of structural brain abnor(alities

? .ood response to drugs

? .ood support syste(


13/15

$chizoafecti"e Disorder

Ininterrupted period of illness during /ic/ t/ere is eit/er a +DE%+DE'" (anic episode" or a (i=ed episode concurrent it/sy(pto(s (eeting criteria for sc/i$op/renia

B -n t/e sa(e period" delusions or /allucinations for JA2 eeks in

t/e absence of pro(inent (ood sy(pto(s

) #y(pto(s t/at (eet criteria for a (ood episode are present fora substantial portion of total duration of acti!e and residual periodsof t/e illness

D */e disturbance is not due to t/e direct p/ysiological e7ects of asubstance or .+)

? %reatment antipsyc/otics" (ood stabili$ers" antidepressants

? Prognosis beteen t/at of sc/i$op/renia and of (ood disorder


14/15

Delusional Disorder

NonCbi$arre delusions for &1 (ont/

B )riterion for sc/i$op/renia /as ne!er been (et %t/oug/ patient (ay /a!etactile or olfactory /allucinations if t/ey are related to t/e delusional t/e(e'

) >unctioning not (arkedly i(paired@ be/a!iour not ob!iously odd or bi$arre

D -f (ood episodes occur concurrently it/ delusions" total duration /as beenbrief relati!e to duration of t/e delusional periods

E */e disturbance is not due to t/e direct p/ysiological e7ects of a substance

or .+)

? $u't!pes eroto(anic" grandiose" ealous" persecutory" so(atic" (i=ed"unspecied

? %reatment psyc/ot/erapy" antipsyc/otics" antidepressants

? Prognosis c/ronic" unre(itting course but /ig/ le!el of functioning


15/15

• *oronto Notes 2012

• (erican Psyc/iatric ssociation"D#+ -K %2000'

Documents

Pemicu 2 - Elfarini