Professional Documents
Culture Documents
Disturbances of Sleep
Increase in nocturnal awakening
Reduction in total sleep time
Increased phasic rapid eye movement sleep
Increased core body temperature
Psychodynamic Factors
Disruption of caregiving relationship with primary object Feelings of helplessness
and weakness
Fails to meet their own standards due to highly critical superego Feelings of
worthlessness, guilt, and sense of having failure
Introjection of ambivalently lost objects toward the self Inner sense of guilt, rage,
pain, and loathing
Medical Illness
Substances Abuse
GEJALA KLINIS
F32 Pedoman Diagnostik Depresi (PPDGJ III)
a. Gejala Utama
Afek depresi
Anhedonia : Kehilangan minat dan kegembiraan
Anergia : Kekurangan energi, mudah lelah, aktivitas menurun
b. Gejala Lainnya
Konsentrasi dan perhatian berkurang
Harga diri dan kepercayaan diri berkurang
Gagasan tentang rasa bersalah dan tidak berguna
Pandangan tentang masa depan yang suram dan pesimistis
Gagasan atau perbuatan membahayakan diri atau bunuh diri
Tidur terganggu
Nafsu makan berkurang
c. Gejala tersebut berlangsung selama minimal 2 minggu. Tetapi, periode lebih
pendek dapat dibenarkan jika gejala sangat berat dan berlangsung cepat
TERAPI
Terapi Farmakologi
First line : SSRI Second line : Trisiklik
Mekanisme Contoh Obat
Trisiklik Blokade reseptor muskarinik :
Menghambat
Amitriptilin Pandangan kabur, mulut
reuptake katekolamine
Imipramin kering, retensi urine, takikardia,
pada celah sinapsis
Klomipramin konstipasi, glaukoma akut
Tianeptine Blokade reseptor alfa-1 :
Hipotensi ortostatik, pusing
Blokade reseptor H1 : Sedasi
Sedasi, hipotensi ortostatik,
Menghambat pandangan kabur, mulut
Monoamine oxidase
pemecahan kering, konstipasi
inhibitor (MAO-I)
neurotransmitter oleh Krisis hipertensi jika dikonsumsi
Moclobemide
monoamine oksidase bersama makanan yang
mengandung tiramin
Disfungsi seksual, berkeringat,
tremor, berat badan naik
Selective serotonin
Gejala SSP : Nyeri kepala,
reuptake inhibitor
Menghambat insomnia, sedasi, mimpi buruk
(SSRI)
reuptake serotonin Gejala GIT : Mual, muntah,
Sertraline
pada celah sinapsis diare, dispepsia, anoreksia
Paroxetine
Sindrom serotonin : Hipertermi,
Fluoxetine
hipertensi, berkeringat, agitasi,
diare, inkoordinasi otot, koma
Psychotherapy
1. Cognitive Behavior Therapy
Correcting negative ideations and replacing them by new positive ideations and
behavioral responses
2. Interpersonal Therapy
Attempts to recognise and explore interpersonal stressors, role disputes and
transitions, social isolation, or social skills deficits
3. Psychoanalytic Therapy
Change in personality structure or character, not simply to alleviate symptoms.
Improve interpersonal trust, capacity for intimacy, coping mechanism, capacity
to grieve, and ability to express the emotions
4. Behavior Therapy
Social skills training, problem solving, assertiveness training, self-control therapy,
activity scheduling, decision-making techniques
5. Group Therapy
Decrease intrafamilial and interpersonal difficulties and to reduce of modify stressors