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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
Blokade reseptor muskarinik :
Pandangan kabur, mulut
Trisiklik
Menghambat reuptake kering, retensi urine,
Amitriptilin
Imipramin katekolamine pada takikardia, konstipasi,
Klomipramin celah sinapsis glaukoma akut
Tianeptine Blokade reseptor alfa-1 :
Hipotensi ortostatik, pusing
Blokade reseptor H1 : Sedasi
Monoamine Menghambat Sedasi, hipotensi ortostatik,
oxidase inhibitor pemecahan pandangan kabur, mulut
(MAO-I) neurotransmitter oleh kering, konstipasi
Krisis hipertensi jika
Moclobemide monoamine oksidase dikonsumsi bersama makanan
yang mengandung tiramin
Disfungsi seksual,
berkeringat, tremor, berat
Selective badan naik
serotonin Gejala SSP : Nyeri kepala,
reuptake Menghambat reuptake insomnia, sedasi, mimpi buruk
inhibitor (SSRI) serotonin pada celah Gejala GIT : Mual, muntah,
Sertraline sinapsis diare, dispepsia, anoreksia
Paroxetine Sindrom serotonin :
Fluoxetine Hipertermi, 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