terapi ggn jiwa
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Transcript of terapi ggn jiwa
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Prinsip Terapi:1. Masalah G. Jiwa komplek, tdk
berdiri sendiri-- Th/ juga melalui >> pendekatan
2. E/ GG.Jiwa di kel atas 3 faktor: Organobiologik, Psikoedukatif dan Sosiokultural
3. Th/ menganut paham Eklektik (detil dan selektif) serta Holistik (menyeluruh)
PEDOMAN TERAPI GGN JIWA
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A. TERAPI BIOLOGIS: Medikamentosa / Psikofarmaka/
Psikotropik ECT ( Terapi kejang listrik )
B. PSIKOTERAPI: (memperkuat mekanisme pertahanan diri ) dengan cara:
Reassurance Sugesti Ventilasi
C. TERAPI SOSIAL (peran keluarga & ling-kungan, penting dalam proses penyembuh-an pasien):
PEDOMAN TERAPI GNN JIWA
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PSIKOFARMAKA
KLASIFIKASI:1. ANTI PSIKOTIK /NEUROLEPTIK/
MAJOR TRANQUILIZER2. ANTI DEPRESI3. ANTI ANSIETAS/ ANSIOLITIKA/ MINOR
TRANQUILIZER4. AN TI MANIA5. ANTI INSOMNIA/HIPNOTIKA6. ANTI HIPERAKTIVITAS7. ANTI KONVULSI8. ANTI PARKINSON
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ANTI PSIKOTIKJENIS-JENIS:
A. GOL. POTENSI RENDAH ( dosis > 100 mg / hari dan efek sedasi kuat)
1. CHLORPROMAZINE 2. THIORIDAZINE 3. LEVOPROMAZINE B. GOL. POTENSI TINGGI ( dosis < 100 mg / hari dan efek
sedasi kurang) 1. FLUFENAZINE 2. TRIFLUOPERAZINE 3. PERPHENAZINE 4. HALOPERIDOL C. GOL. ATIPIKAL 1. RISPERIDONE 3. OLANZAPINE 2. CLOZAPINE
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ANTI PSIKOTIK
INDIKASI:1. skizofrenia akut & kronis2. psikosis akut lain, termasuk
organik3. depresi berat dg gambaran
psikotik yg jelas4. sindrom gilles de la tourette
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ANTI PSIKOTIKDOSIS TERAPEUTIK:1. Chlorpromazine ( largactil) : 150-
1800 mg / hr2. Thioridazine (melleril) : 100- 800 mg/
hr3. Trifluoperazine ( stelazine) : 5 - 60
mg/ hr4. Haloperidol ( haldol, serenace): 1,5-
100 mg/ hr5. Risperidon (risperdal): 2- 6 mg /hr6. Clozapine ( clozaril) : 25 –100 mg/hr7. Olanzapin (zyprexa): 5 – 10 mg/hari
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ANTI DEPRESIJENIS-JENIS:
A. BERSIFAT SEDATIF: 1. AMITRIPTYLIN: 75-300 MG /HR 2. IMIPRAMIN (TOFRANIL): 75-300
MG/HR B. BERSIFAT ATIVASI / NON SEDATIF: 1. MECLOBEMIDE (AURORIX) 300-600 MG/HR 2. SERTRALINE( ZOLOFT): 50-200 MG/HR
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ANTI ANSIETAS
A. GOL. BENZODIAZEPIN: 1. Diazepam (valium) : 4-50 mg/hr
2. Lorazepam (ativan): 2-10 mg/hr 3. Bromazepam (lexotan): 2-18 mg/hr 4. Clobazam (frisium): 20-30 mg/hr 5. Alprazolam (xanax): 0,75-4 mg/hr
B. GOL. NON-BENZODIAZEPINE: 1. Buspirone (buspar): 10-60 mg/ hr
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ANTI MANIA
1. Lithium Carbonate (Priadel)600-1500 mg /hr
2. Carbamazepine (Tegretol)400-800 mg/hr
3. Clonazepam(Rivotril) 1-10 mg /hr4. Asam Valproat( Depakene) 700-
3800 mg / hr
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ANTI INSOMNIAA. KHASIAT PANJANG; 1. DIAZEPAM (VALIUM) 4-80 MG /HR
B. KHASIAT MENENGAH: 1. ESTAZOLAM (ESILGAN) 1-4 MG / HR 2. NITRAZEPAM ( MOGADON,
DUMOLID) 2,5 – 5 MG / HR
C. KHASIAT PENDEK: 1.TRIAZOLAM (HALCION) 0,125-2,5 MG
2.LORAZEPAM (ATIVAN) 2-10 MG
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ANTI KONVULSI
1. PHENOBARBITAL (LUMINAL)30-150 MG
2. DIFENYLHYDANTOIN ( DILANTIN) 100-300 MG/HR
3. CARBAMAZEPINE (TEGRETOL) 400-800 MG/HR
4. DIAZEPAM (VALIUM) 4-80 MG/HR5. CLONAZEPAM (RIVOTRIL) 0,75-8 MG
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ANTI HIPERAKTIVITAS
1. METHYLPHENIDATE ( RITALIN) 10-60 MG / HR
2. IMIPRAMINE ( TOFRANIL ) 75-300 MG/HR
3. CARBAMAZEPINE (TEGRETOL) 400-800 MG / HR
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ANTI PARKINSONISME
1. TRIHEXYPHENIDIL ( ARTANE, ARKINE) 4-15 MG / HR
2. DIPHENHYDRAMINE ( BENADRYL) 50 –300 MG / HR
3. SULFAS ATROPIN 0,25 – 1 MG4. DIAZEPAM 4-80 MG
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EFEK SAMPING OBAT PSIKOTROPIK
1. EFEK TERHADAP SISTEM KARDIOVASKULER:
(PADA GOL. ANTI DEPRESI TRISIKLIK) takikardi, kegagalan jtg, cardiac arrest,
gg. tek darah, syok, koma
2. EFEK TERHADAP DARAH: (PADA ANTI PSIKOTIK
CHLORPROMAZINE) anemia, hemolisis, jaundice,
agranulosito-sis
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EFEK SAMPING OBAT PSIKOTROPIK (lanj…
3. EFEK TERHADAP SISTEM ENDOKRIN & METABOLISME GLUKOSA: GALAKTOREA: CPZ, THIORIDAZINE, FLUFENAZINE,
IMIPRAMIN, HALOPERIDOL AMENORE: FENOTHIAZINE GGN. MET. GLUKOSA: MENINGKAT GLUKOSA: ANTIPSIKOTIK MENURUN GLUKOSA : ANTI DEPRESI
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EFEK SAMPING OBAT PSIKOTROPIK (Ljt..)
4. EFEK TERHADAP FUNGSI TIROID: ANTI PSIKOSIS: KOMA, HIPOTERMIA
(HIPOTIROID), TAKIKARDI (HIPERTIROID)
ANTI DEPRESI: ARITMIA JANTUNG5. EFEK THD FUNGSI GENITOURINARIA
PRIA TIORIDAZINE: RETARDED EJACULATION ANTI DEPRESI TRISIKLIK: RETENSI
URINE
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EFEK SAMPING OBAT PSIKOTROPIK (lanj…)
6. EFEK EKSTRA PIRAMIDAL OBAT ANTI PSIKOTIK
INSIDEN : 15 % RINGAN- REVERSIBEL: DISTONIA,
AKATISIA, PARKINSONISME BERAT- IRREVERSIBEL: TARDIVE
DISKINESIA FATAL- RIGIDITAS KATATONIK,
HIPERPIREKSIA (SINDROM NEUROLEPTIK MALIGNA)
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TERAPI KEJANG LISTRIK (ELECTRO CONVULSIVE
THERAPY)
A. INDIKASI: 1. Depresi dg kecendrungan suicide 2. Ggn.Bipolar – Depresi 3. Skizofrenia Katatonik 4. Skizofrenia dg kecendrungan bunuh diri
B. PEMBERIAN 1. 3 x minggu 2. 6-10 x atau 10-20 x
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TERAPI KEJANG LISTRIK (ELECTRO CONVULSIVE
THERAPY)C. METODE PELAKSANAAN 1. BILATERAL 2. UNILATERALD. KONTRA INDIKASI RELATIF: DEMAM,
ARITMIA, HIPERTENSI BERAT, ISKEMIAE. KONTRA INDIKASI ABSOLUT: TEKANAN
INTRAKRANIAL TINGGI KARENA SOL (SPACE OCCUPAYING LESSION)
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