This document provides information about schizoaffective disorder, including its definition, epidemiology, etiology, risk factors, clinical presentation, diagnosis, and treatment. Schizoaffective disorder is a mental illness characterized by symptoms of schizophrenia and a mood disorder occurring simultaneously or in close succession. It has a prevalence of less than 1% and usually begins in late adolescence or early adulthood. Both genetic and environmental factors may contribute to its development. Clinically it involves episodes of mania or depression as well as symptoms of schizophrenia like delusions and hallucinations. Diagnosis involves medical exams and tests to rule out other conditions. Treatment includes antipsychotic medications, mood stabilizers, antidepressants, psychotherapy, and in some
This document provides information about schizoaffective disorder, including its definition, epidemiology, etiology, risk factors, clinical presentation, diagnosis, and treatment. Schizoaffective disorder is a mental illness characterized by symptoms of schizophrenia and a mood disorder occurring simultaneously or in close succession. It has a prevalence of less than 1% and usually begins in late adolescence or early adulthood. Both genetic and environmental factors may contribute to its development. Clinically it involves episodes of mania or depression as well as symptoms of schizophrenia like delusions and hallucinations. Diagnosis involves medical exams and tests to rule out other conditions. Treatment includes antipsychotic medications, mood stabilizers, antidepressants, psychotherapy, and in some
This document provides information about schizoaffective disorder, including its definition, epidemiology, etiology, risk factors, clinical presentation, diagnosis, and treatment. Schizoaffective disorder is a mental illness characterized by symptoms of schizophrenia and a mood disorder occurring simultaneously or in close succession. It has a prevalence of less than 1% and usually begins in late adolescence or early adulthood. Both genetic and environmental factors may contribute to its development. Clinically it involves episodes of mania or depression as well as symptoms of schizophrenia like delusions and hallucinations. Diagnosis involves medical exams and tests to rule out other conditions. Treatment includes antipsychotic medications, mood stabilizers, antidepressants, psychotherapy, and in some
This document provides information about schizoaffective disorder, including its definition, epidemiology, etiology, risk factors, clinical presentation, diagnosis, and treatment. Schizoaffective disorder is a mental illness characterized by symptoms of schizophrenia and a mood disorder occurring simultaneously or in close succession. It has a prevalence of less than 1% and usually begins in late adolescence or early adulthood. Both genetic and environmental factors may contribute to its development. Clinically it involves episodes of mania or depression as well as symptoms of schizophrenia like delusions and hallucinations. Diagnosis involves medical exams and tests to rule out other conditions. Treatment includes antipsychotic medications, mood stabilizers, antidepressants, psychotherapy, and in some
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SKIZOAFEKTIF
PERBEDAAN SKIZOFRENIA DENGAN SKIZOAFEKTIF DEFINISI
• Kelainan mental yang ditandai dengan gejala kombinasi antara
skizofrenia dan gangguan afektif yang menonjol pada saat bersamaan, atau dalam beberapa hari yang satu sesudah yang lain, dalam satu episode penyakit yang sama. • Schizoaffective disorder symptoms skizofrenia dan bipolar disorder, oleh karena itu sering terjadi misdiagnosis. EPIDEMIOLOGI • Prevalence estimated at < 1% (0.5-0.8%) in general population • There is consensus that schizoaffective disorder is probably less common than schizophrenia • The incidence of schizoaffective disorders is higher in women than men due to the increased incidence of the depressive type in females. • Depressive subtype may be more common in elderly • Schizoaffective disorder usually begins in the late teen years or early adulthood, often between ages 16 and 30. It's rare in children. ETIOLOGI The exact cause of schizoaffective disorder is unknown. A combination of causes may contribute to the development of schizoaffective disorder. • Genetics. Schizoaffective disorder tends to run in families. This does not mean that if a relative has an illness, you will absolutely get it. But it does mean that there is a greater chance of you developing the illness. • Brain chemistry and structure. Brain function and structure may be different in ways that science is only beginning to understand. Brain scans are helping to advance research in this area. • Stress. Stressful events such as a death in the family, end of a marriage or loss of a job can trigger symptoms or an onset of the illness. • Drug use. Psychoactive drugs such as LSD have been linked to the development of schizoaffective disorder. FAKTOR RISIKO PRE-, PERI-, POST- NATAL TIPE SKIZOAFEKTIF F.25 GANGGUAN SKIZOAFEKTIF F25.0 Gangguan skizoafektif tipe manik KLASIFIKASI F25.1 Gangguan skizoafektif tipe depresif F25.2 Gangguan skizoafektif tipe campuran PPDGJ III F25.8 Gangguan skizoafektif lainnya F25.9 Gangguan skizoafektif YTT • Episode manik GEJALA • Episode depresif KLINIS • Skizofrenia GEJALA KLINIS • Episode mania • Grandiositas atau meningkatnya kepercayaan diri • Berkurangnya kebutuhan tidur • Bicara lebih banyak dari biasanya atau adanya desakan untuk tetap berbicara • Loncatan gagasan atau pengalaman subjektif adanya pikiran yang berlomba • Distraktibilitas • Meningkatnya tingkat aktivitas yang berfokus pada tujuan di rumah, di tempat kerja, atau secara seksual • Keterlibatan berlebihan dalam aktivitas yang menyenangkan yang berpotensi merugikan GEJALA KLINIS • Episode depresi: • Perasaan depresi • Berkurangnya kesenangan atau minat dalam hampir semua kegiatan • Perubahan berat badan dan nafsu makan • Hipersomnia atau insomnia • Retardasi atau agitasi psikomotor • Hilangnya energi atau fatigue • Perasaan tidak berharga atau rasa bersalah yang berlebih • Kesulitan berpikir dan membuat keputusan • Memiliki rencana atau percobaan bunuh diri GEJALA SKIZOFRENIA • Skizofrenia: • Delusion • Halusinasi • Pola pikir tidak teratur • Perilaku aneh atau tidak biasa • Gerak tubuh lambat • Ekspresi wajah dan cara berbicara datar, tidak menunjukkan emosi apa- apa • Tidak termotivasi dalam hidup • Masalah dalam berbicara/berkomunikasi PEDOMAN DIAGNOSTIK SKIZOFRENIA F25 GANGGUAN SKIZOAFEKTIF F25.0 GANGGUAN SKIZOAFEKTIF TIPE MANIK F25.1 GANGGUAN SKIZOAFEKTIF TIPE DEPRESIF F25.2 GANGGUAN SKIZOAFEKTIF TIPE CAMPURAN F25.8 GANGGUAN SKIZOAFEKTIF LAINNYA F25.9 GANGGUAN SKIZOAFEKTIF YTT • Pemeriksaan : • Pemeriksaan status mental • Pemeriksaan fisik • Pemeriksaan neurologis • Pemeriksaan lab : • Hitung darah lengkap • Elektrolit DIAGNOSIS • Thyroid stimulating hormone level • Urinalisis dan serum toxicology screening • Serology • Px. Imaging: • Computed tomography (CT) • Magnetic resonance imaging (MRI) • Electroencephalography (EEG) TREATMENT • Antipsychotic drugs • Mood stabilizers (anti manic) • Antidepressants PROGNOSIS • Prognosis untuk gangguan skizoafektif agak lebih baik daripada prognosis untuk skizofrenia tetapi lebih buruk daripada prognosis untuk gangguan mood. • Insiden bunuh diri secara keseluruhan diperkirakan sekitar 10%. Wanita lebih banyak mencoba bunuh diri daripada pria, tetapi pria lebih sering bunuh diri ANTIPSIKOTIK • Used to target psychosis and aggressive behavior in schizoaffective disorder. • Other symptoms include delusions, hallucinations, negative symptoms, disorganized speech, and behavior. • Most first and second generation antipsychotics block dopamine receptors. • While second-generation antipsychotics have further actions on serotonin receptors. • Antipsychotics include, but are not limited to paliperidone (FDA approved for schizoaffective disorder), risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, and haloperidol. Clozapine is a consideration for refractory cases, much like in schizophrenia. MOOD STABILIZERS • Patients who have periods of distractibility, indiscretion, grandiosity, a flight of ideas, increased goal-directed activity, decreased need for sleep, and who are hyperverbal fall under the bipolar-specifier for schizoaffective disorder. • Consider the use of mood-stabilizers if the patient has a history of manic or hypomanic symptoms. These include medications such as lithium, valproic acid, carbamazepine, oxcarbazepine, and lamotrigine which target mood dysregulation. ANTIDEPRESSANTS • Used to target depressive symptoms in schizoaffective disorder. • Selective-serotonin reuptake inhibitors (SSRIs) are preferred due to lower risk for adverse drug effects and tolerability when compared to the tricyclic antidepressants, and selective norepinephrine reuptake inhibitors. • SSRIs include fluoxetine, sertraline, citalopram, escitalopram, paroxetine, and fluvoxamine. • It is vital to rule out bipolar disorder before starting an antidepressant due to risk for exacerbating a manic episode. NONFARMAKOLOGI • Psikoterapi • Individual therapy, family therapy, and psychoeducational programs. • The aim is to develop their social skills and improve cognitive functioning to prevent relapse and possible rehospitalization. • This treatment plan includes education about the disorder, etiology, and treatment. • Indicidual therapy • This type of treatment aims to normalize thought processes and better help the patient understand the disorder, to reduce the burden of symptoms. • Sessions focus on everyday goals, social interactions, and conflict' this includes social skills training and vocational training. • Family and/or group therapy • Family involvement is crucial in the treatment of this schizoaffective disorder. • Family education aids in compliance with medications and appointments, and helps provide structure throughout the patient's life given the dynamic nature of the schizoaffective disorder. • Supportive group programs can also help if the patient has been in social isolation and provides a sense of shared experiences among participants. • ECT (Electroconvulsive Therapy) • ECT is usually a last resort treatment. • However, not only has it been used in urgent cases and treatment resistance, but it should also merit consideration in augmentation of current pharmacotherapy. • The most common indicated symptoms are catatonia and aggression. • ECT is safe and effective for most chronically hospitalized patients. GEJALA KLINIS Gejala manik Gejala depresif • Gejala skizofrenia • Terlihat lebih aktif dari biasanya, • Hilang nafsu makan • Delusion (percaya pada hal yang termasuk di kantor, di pergaulan, jelas-jelas tidak benar, dan tetap dan secara seksual • Berat badan turun atau naik bersikukuh bahwa hal tersebut tanpa disengaja adalah nyata meski sudah • Lebih cerewet dan bicara lebih • Perubahan kebiasaan tidur diperlihatkan bukti dan fakta) cepat (menjadi jarang tidur atau malah • Banyak pikiran berseliweran di tidur lama sekali) • Halusinasi kepala (melihat/mendengar/merasakan • Gelisah hal yang tidak nyata, misalnya • Tidak merasa perlu tidur mendengar suara yang berbicara • Hilang energi padanya) • Gelisah, tidak sabaran • Hilang minat pada hal-hal yang • Pola pikir tidak teratur • Berbangga diri biasanya dilakukan setiap hari • Perilaku aneh atau tidak biasa • Konsentrasi muah pecah • Merasa diri tak berarti dan tak punya harapan • Gerak tubuh lambat • Perilaku membahayakan/merugikan diri • Perasaan bersalah atau • Ekspresi wajah dan cara sendiri (menghambur-hamburkan menyalahkan diri sendiri berbicara datar, tidak uang, kebut-kebutan di jalan, menunjukkan emosi apa-apa melakukan seks bebas tanpa • Kesulitan berpikir dan konsentrasi • Tidak termotivasi dalam hidup pengaman, dll) • Memikirkan kematian atau • Masalah dalam bunuh diri berbicara/berkomunikasi GEJALA KLINIS