Skizofrenia Paranoid

Skizofrenia ParanoidDefinisi Faktor predesposisiGejala Preokupasi dengan waham dan halusinasiWaham : kejar dan kebesaranUmur : > tua > 30 tahunMenunjukkan :Tegang, pencuriga, berhati-hati, dan tak ramahBermusuhan atau agresifKecerdasan intak

diagnosisPada saat wawancara tampak rapi, koheren, afek agak tumpulPenatalaksanaanTerapi somatik- antipsikotik konventsional: haloperidol, thioridazine, chlorpromazine.- Newer atypical antipsycotic: risperidone, olanzopine- clozarilTerapi psikososial- Terapi perilaku: latihan ketrampilan sosial untuk meningkatkan kemampuan sosial, kemampuan memenuhi diri sendiri, dan komunikasi interpersonal.- Terapi berorientasi keluarga- Terapi kelompok: meningkatkanrasapersatuandanmeningkatkantesrealitasbagipasien skizofrenia.

Amphetamine-Induced Psychosis7Amphetamine (AMPH)Artificial stimulantRelated to dextroamphetamines and methamphetaminesIncrease breathing, heart rate, blood pressureVisual and auditory hallucinations, lack of organization, self-consciousness, erratic and compulsive behaviourMay be medically prescribed for treatment of Parkinsons8-related compounds have similar effects-hallucinations, lack of organization, self-consciousness and erratic and compulsive behaviour similar to positive symptoms of schizophrenia-because it is used to treat Parkinsons we can infer that amphetamine acts on the dopaminergic systemAmphetamine ActionAMPH acts on the dopamine systemBlocks DA reuptakeActively stimulates production of DA9Proposed Mechanism for Chronic Amphetamine-Induced PsychosisAMPH use (by anyone) causes increased pre-synaptic DA activity which result in positive psychotic symptomsChronic exposure will result in pre-synaptic neuron degeneration causing a relative state of DA deprivation, may result in negative symptomsDecrease in DA results in increased post-synaptic neuron sensitivity which will result in positive symptoms during times of transiently elevated DA10-this mechanism is based on the findings that schizophrenic patients showed increased striatal DA in response to AMPH challenge (compared to normal people)-this indicates that there is an abnormal reactivity of DA transmission in response to AMPH exposure in schizophrenics, which is also associated to behavioural consequences (ie. Increase in positive symptoms)-this reaction in schizophrenics can be due to an increased affinity of D2 receptor for DA or a larger/prolonged DA response or a combination of bothConclusionsAmphetamines target the dopaminergic system and can cause a syndrome of the positive and negative symptoms of schizophreniaFor this reason, amphetamines are currently being experimented with in animals in an effort to create a model of schizophreniaResearch has shown that chronic use of amphetamines can also cause a chronic schizophrenia syndrome after withdrawl from the drug11ConclusionsThe mechanism behind this chronic syndrome apparently involves the sensitization of post-synaptic DA receptorsOne problem with this hypothesis is that not all amphetamine users develop the chronic schizophrenic-like syndrome, thus implicating that there is also may be an underlying diathesis involved (which is not apparent)12