TERAPI SKIZOFRENIA

DARI MASA KE MASA

KHUSUS BIMBINGAN

Dr.Deddy Soestiantoro SpKJ MKes(Biored/Farmak)

DASAR MEDIKASI NEUROLEPTIK:

Efikasi pada Simptom
S.POSITIF
S.NEGATIF
S.KOGNITIF

DELUSI,HALUSINASI,
GG.PROSES FIKIR
AFEK DATAR,HILANGNYA
KEHENDAK DAN ENERGI ,
DISINTEGRASI SOSIAL

GANGGUAN PADA DAYA INGAT,CARA

FIKIR ABSTRAK DAN PERHATIAN

S.AFEKTIF

DYSFORIA,DEPRESI SERTA
SUISIDALITAS

TERAPI SKIZOFRENIA
)
EUR

PSIKOTERAPI
TERAPI
LINGKUNGAN

TERAPI SOMATIK
NEUROLEPTIK

ECT-ICT-PSYCHOSURGERY

TERAPI AWAL TERBAIK----NEUROLEPTIK

NEUROLEPTICS CLASSIFICATION
*First Generation Antipsychotics (FGA
Typical/Conventional)

1. Low Potency/High Dose: Chlorpromazine

2. High Potency/Low Dose: Haloperidol

*Second Generation Antipsychotics (SGA New

atypical)

1. Serotonin-Dopamine Antagonists ( SDA )

Risperidone, Ziprasidone, (Sertindole)
2. Multi-Acting Receptor Targeted Agents ( MARTA )
Clozapine, Olanzapine, Quetiapine, Zotepine

*Third Generation Antipsychotics ( TGA )

Dopamine System Stabilizers ( DSS )
Aripiprazole
Next Generation..?

Efficacy of Atypicals extends beyond positive

symptoms of disease

Positive Negative Cognitive

Conventional /
Typical
Antipsychotics

Atypical
Antipsychotics

Affective

PROFIL RESEPTOR
FGA & SGA
5HT1A

5HT2A

M1

H1
5HT2A
1
5HT1D
2
Atypical
Typical
Atypical
SRI
5HT2C
Antipsychotic NRI
Antipsychotic
Antipsychotic
( FGA )
( SDA )
5HT3 ( MARTA ) D1
D2
FGA

D2 5HT6
D2
5HT7
D4 D3
S G A
Stephen M.Stahl; Psychopharmacology of Antipsychotics, 1999

Perkembangan Terapi Medik untuk

Gangguan Psikotik
30s

ICT
ECT

40s

50s

60s 70s 80s

90s 00

04

06 (?)

09-11

Haloperidol
Clozapine*
Aripiprazole
ILOPERIDONE
Fluphenazine
Zotepine*
ASENAPINE
Thioridazine
Risperidone
Olanzapine*
Reserpine
LURASIDONE
Trifluoperazine
Quetiapine*
Paliperidone
Perphenazine
Ziprasidone

Chlorpromazine

Anti-psikotik
Generasi Pertama
FGA
ECT = electro convulsive therapy.

Anti-psikotik
Generasi Kedua
SGA: SDA & MARTA*

Kapur and Remington. Ann Rev Med. 2001;52:503.

Worrel et al. Am J Health Syst Pharm. 2000;57:238. (modified)

Generasi
berikutnya?

TYPICAL NEUROLEPTICS
HYPNOGENIC EFFECT
! Levomepromazine
!
Thioridazine
Reserpin
Chlorpromazine

PROFIL FGA
1.Antagonis D2
2.Kurang efektif pada simptom negatif
dan kognitif
3.Antagonis D2 terkait Efek Samping
EPS, tardive dyskinesia dan hyperprolactinemia

Haloperidol
Perphenazine
Fluphenazine
Pimozide
December 3, 2007

ANTIPSYCHOTIC EFFECT

ANTIPSIKOTIK KONVENSIONAL
(TIPIKAL) dan FUNGSI KOGNITIF
Antipsikotik Konvensional
khususnya hanya mengatasi
gejala positif skizofrenia

Antipsikotik Konvensional
tidak memberi dampak
positif pada fungsi kognitif

Antipsikotik konvensional (dan

beberapa antipsikotik atipik)
dapat menimbulkan EPS

Penggunaan antikolinergik
untuk terapi EPS
dapat menambah berat
disfungsi kognitif

Konsekuensi yang merugikan

peningkatan prolaktin
Disfungsi
Seksual

Kanker
Payudara

Osteoporosis

Ginekomastia

Prolaktin
meningkat
Fertilitas
menurun

Galactorrhoea

Gangguan
Kardiovaskuler

Amenorrhoea

Halbreich et al 2003

ANTI PSIKOTIK ATIPIKAL

PROFIL SGA
*Antgonis D2, 5HT2A dll.neurotransmiter.
*Efektif pada simptom negatif &kognitif, baik.
*Efek samping BB naik,DM,dyslipidemia, efek
anticholinergik, hypotensi, sedasi dll.

Ciri AP Atipik :Risiko EPS rendah

Meningkatkan
Kepatuhan
Risiko TD
rendah

Tak memberatkan
Gejala Negatif

Keuntungan
EPS rendah
Tak mengganggu
Kognisi

December 3, 2007

Risiko
Dysphoria
kurang

Efek samping
Motorik ringan

Jibson & Tandon 1998

EFEK SAMPING NEUROLEPTIKA ATIPIK

1.BB naik..Olan.,Risp., Quet.,Zipra.,Arip.
2.Disf.Seksual
3.Risiko Kejang naik
4.Hipo/hipertensi
5.Resp. Akathisia ....Risp.,Quet.
6.Agranulos.......................................................................Clozapine
7.Hiperprolaktinemia....Antipsikotik tipikal umumnya
8.Hiperglikemia, DM,
Ketoasidosis ,Koma.Olan.,Risp.,Quet.,Cloz.,Arip.
9.Perpanjangan PR&QTc,QRS, Dep.ST, Flattening/ Notch
T-Waves, Emerg.of U-Waves.........Zipr.,Olan.,Risp.
10.Kreatin Fosfokinase Naik
11.Dyslipidem ................................Cholesterol., Triglyceride.
12.Somnolen....Clozapine
13.Insomnia.... Aripiprazole
14.Nyeri / Agitasi
15.Mulut Kering
16.ALT & AST Naik

High
Potential
Risk of
Metaboli
Syndrome

Here is a look at the conclusions of the American Diabetes Association (published in a joint statement
with the American Psychiatric Association) regarding weight gain (Wt Gn), diabetes risk, and worsening cholesterol levels:

POTENSI KENAIKAN BB NEUROLEPTIK

TARGET TERAPI NEUROLEPTIK

SIMPTOM
POSITIF

-DELUSI
-HALUSINASI
-GG.PROSES FIKIR

SIMPTOM
NEGATIF
-AFEK DATAR
-ENERGI KURANG
-DOR.KEHENDAK
HILANG
HE
-DISINTEGRASI SOSIAL

SKIZOFRENIA
SIMPTOM KOGNITIF
GG.DAYA INGAT
GG.CARA FIKIR ABSTRAK
GG.PERHATIAN

SIMPTOM AFEKTIF
-DYSFORIA
-DEPRESI
-SUISIDALITAS

Efficacy of Atypicals extends beyond positive

symptoms of disease

Positive Negative Cognitive

Conventional /
Typical
Antipsychotics

Atypical
Antipsychotics

Affective

Target
Terapi

Gejala negatif
Gejala kognitif
Gejala afektif
Gejala efek samping

Gejala positif

Hidup Berkualitas

30s

ICT
ECT

40s

50s

60s

70s 80s 90s

00

04

06 (?)

09-11

Haloperidol
Clozapine*
Aripiprazole
ILOPERIDONE
Fluphenazine
Zotepine*
ASENAPINE
Thioridazine
Risperidone
Olanzapine*
Reserpine
LURASIDONE
Trifluoperazine
Quetiapine*
Paliperidone
Perphenazine
Ziprasidone

Chlorpromazine

Anti-psikotik
Generasi Pertama
FGA
ECT = electro convulsive therapy.

Anti-psikotik
Generasi Kedua
SGA: SDA & MARTA*

Kapur and Remington. Ann Rev Med. 2001;52:503.

Worrel et al. Am J Health Syst Pharm. 2000;57:238. (modified)

Generasi
berikutnya?

PEDOMAN PEMILIHAN OBAT

LACK OF

GOOD EFFICACYADVERSE REACTION

BEST PRICE
GOOD COMPLIANCE