HEBEPHRENIC SCHIZOPHRENIA A CASE REPORT *Mena Omori Marude, S.Ked **dr. Nyoman Ratep, Sp.Kj(K) ***dr.

Wayan Westa, Sp.Kj(K) * Student, Udayana University/Sang a! "ospita , #enpasar **Revie$er %, &sy'!iatrist, Sang a! (enera "ospita , #enpasar ***Revie$er %%, &sy'!iatrist, Sang a! (enera "ospita , #enpasar Abstract: "e)ep!reni' s'!i*op!renia or disorgani*ed s'!i*op!renia is a '!roni' menta i ness in $!i'! a person 'annot t!in+ or )e!ave norma y and o,ten e-perien'es de usions. %t is asso'iated $it! ear y onset, )et$een t!e age o, ./ and 0/ years o d. 1tio ogy o, !e)ep!reni' s'!i*op!renia are not +no$n ,or sure )ut geneti's and environment are t!oug!t to p ay a ro e 2''ording to #SM3%435R t!e diagnosti' 'riteria ,or !e)ep!reni' s'!i*op!renia in' ude6 disorgani*ed spee'!, disorgani*ed )e!avior, , at or inappropriate a,,e't $!i'! are prominent ,or . mont! period or onger. 5reatment in' udes !ospita i*ation, medi'ations, psy'!ot!erapy, and e e'tro'onvu sive t!erapy. &rognosis o, s'!i*op!renia !e)ep!reni' is t!oug!t to )e poor. Keywords6 S'!i*op!renia, !e)ep!reni', dsm

SKIZOFRENIA HEBEFRENIK LAPORAN KASUS *Mena Omori Marude, S.Ked **dr. Nyoman Ratep, Sp.Kj(K) ***dr. Wayan Westa, Sp.Kj(K) * Ma!asis$i, Universitas Udayana/RSU& Sang a!, #enpasar **Revie$er %, &si+iater, RSU& Sang a!, #enpasar ***Revie$er %%, &si+iater, RSU& Sang a!, #enpasar Abstrak: S+i*o,renia !e)e,reni+ atau disorgani*ed s+i*o,renia ada a! penya+it menta +ronis di mana seseorang +e!i angan !u)ungan dengan rea itas. Ke ainan ini di+ait+an dengan onset dini, yaitu antara usia ./ dan 0/ ta!un. 1tio ogi s+i*o,renia !e)e,reni+ )e um di+eta!ui se'ara je as namun ,a+tor geneti+ dan ing+ungan diduga )erperan. Menurut #SM3%435R +riteria diagnosti+ untu+ s+i*o,renia !e)e,reni+ me iputi6 )er)i'ara tida+ teratur, peri a+u tida+ teratur, a,e+ datar atau a,e+ yang tida+ sesuai dengan situasi, dimana geja a3geja a ini dirasa+an se ama . )u an periode atau e)i!. &enata a+sanaan yang dapat dipi i! termasu+ ra$at inap, o)at psi+oterapi, dan terapi e e+tro+onvu si,. &rognosis s+i*o,renia !e)e,reni+ dianggap )uru+. Keywords6 s+i*o,renia, !e)e,reni+, dsm Back ro!"d S'!i*op!renia is a very serious menta i ness in $!i'! a person 'annot t!in+ or )e!ave norma y de usions. o, and 5!ere o,ten are e-perien'es severa i ness or disorder in $!i'! a person oses !is/!er sense o, rea ity. .,0 "e)ep!reni' s'!i*op!renia is said to )e a severe type o, s'!i*op!renia )e'ause peop e $it! t!is 'ondition may )e una) e to 'arry out routine dai y a'tivities and ta+e 'are o, t!emse ves, su'! as )at!ing, mea s. dressing, 5!is ,orm and o, preparing

types

s'!i*op!renia,

in' uding paranoid type, disorgani*ed type, 'atatoni' type, undi,,erentiated type, and residua type. "e)ep!reni' s'!i*op!renia or no$adays more 'ommon y +no$n as disorgani*ed s'!i*op!renia is one o, severa types o, s'!i*op!renia. %t is a '!roni' menta

s'!i*op!renia is asso'iated $it! ear y onset it is said to )e most y ,ound in peop e )et$een t!e age o, ./ and 0/

years o d..,7,8 1tio ogy o, !e)ep!reni' s'!i*op!renia is not +no$n ,or sure )ut geneti's and environment are t!oug!t to p ay a ro e.0,7,8 2 so a)norma )rain '!emi'a s or neurotransmitter may 'ontri)ute to 'ause !e)ep!reni' s'!i*op!renia. 5!is type o, s'!i*op!renia is '!ara'teri*ed )y t!oug!ts, )e!avior, emotions, and spee'! t!at are inappropriate.0 #isorgani*ed t!in+ing or in'o!erent t!oug!t is $!en unre ated ideas jump ,rom one to anot!er. 5!is is re ated to ma+ing up $ords, $!i'! is a so 'ommon in !e)ep!reni' 5!e patient. Written 'ommuni'ations a so are very disorgani*ed. disorgani*ed )e!aviors in' ude $earing many ayers o, ' ot!ing, o,ten e''entri' oo+ing, opposing ot!ers $it!out reason. 1motions inappropriate to t!e situation are a so 'ommon, su'! as a'ting si y, aug!ing oud y, !umming, and singing during a serious event. 2)sent or inappropriate emotiona e-pression, su'! as ) an+ ,a'e and not ma+ing eye 'onta't or not using 'ommon )ody anguage and is anot!er o, are (most y odd 'ommon !e)ep!reni' de usions, auditory), so'ia t!oug!ts..,0,7,8 symptoms o, t!is i ness. Ot!er signs symptoms s'!i*op!renia !a u'inations grima'ing,

2''ording

to

#SM3%435R

t!e

diagnosti' 'riteria ,or !e)ep!reni' s'!i*op!renia in' ude6 disorgani*ed spee'!, disorgani*ed )e!avior, , at or inappropriate onger./ a,,e't $!i'! are ,or are (,irst atypi'a prominent ,or .3mont! period or Main treatments !e)ep!reni' medi'ations or s'!i*op!renia !ospita i*ation, se'ond

generation or typi'a antipsy'!oti' and generation antipsy'!oti'), )asi' s+i s ,or e e'tro'onvu sive dai y a'tivities

t!erapy (195), psy'!ot!erapy, and training..,0 &rognosis o, s'!i*op!renia !e)ep!reni' is t!oug!t to )e poor )e'ause t!e prin'ipa o, treatment is on y to redu'e symptoms. %n t!is 'ase report $i )e i ustrated a !e)ep!reni' s'!i*op!renia 'ase in a 0:3year3o d patient. Case 2 0:3year o d sing e ma e $as )roug!t to emergen'y department o, ;ang i Menta "ospita due to rampage and pun'!ing peop e. &atient $as said to )e a'ting odd sin'e 8 years ago. "e $ou d sudden y )e s'reaming and t!ro$ing stu,, and ot!er time !e $i )e aug!ing $it!out reason, grima'ing, and a'ting si y. &atient $it!dre$ so'ia y and )egan to s!ut !imse , in !is room. &atient<s understanding o, =uestions

postures,

iso ation, and sui'ida

$as poor and !e $ou d )e jumping ,rom one idea to anot!er. "e !ad auditory !a u'inations "e and visua t!e !a u'inations. des'ri)ed

mood $as inade=uate and a,,e't $as inappropriate. &atient<s t!oug!t pro'ess $as not ogi' and unrea isti'. %n'o!eren'y and jumping o, t!oug!ts $ere ,ound. &atient !ad !istory o, insomnia and !ypo)u ia. &atient denied o, !aving sui'ida t!oug!ts. 2''ording to t!ese ,indings patient $as diagnosed or $it! !e)ep!reni' s'!i*op!renia s'!i*op!renia. &atient $as !ospita i*ed due to ,urt!er e-amination and medi'ation. "e $as given !a operido and dia*epam inje'tion and p anned to )e move to inpatient $ard. On'e moved, !e $as given atypi'a antipsy'!oti', risperidone 0-0 mg and psy'!ot!erapy. 2,ter . $ee+ o, treatment, patient stopped reporting auditory and visua !a u'inations. 2 t!oug! !is )e!avior $as sti disorgani*ed, !e $as more $i ing to 'ooperate during medi'a e-aminations. #$sc!ss$o" %n t!is 'ase, ,irst onset ,a s into t!e onset o, age ,or !e)ep!reni' s'!i*op!renia. 5!e ris+ ,a'tor in t!is patient is t!oug!t to )e !is pro) ems $it! !is parents and t!e ,a't t!at !e +ept a t!ese pro) ems to !imse , and not s!ared $it! anyone. 2,ter t!e mani,estation o, !is symptoms, !e $as disorgani*ed3type

auditory !a u'inations as a sing e ma e voi'e, $!i'! $as ta +ing to !im using s!ort and ong senten'es. 5!is voi'e $ou d )e 'ommenting on !is )e!avior and te ing !im to do 'ertain tas+s, in' uding to )rea+ stu,, and pun'! peop e. "is visua !a u'inations in' ude seeing g!ost y> i+e peop e $a +ing around !is room t!at !e ,o o$ed severa times resu ting in !im )eing ost. #uring t!ese 8 years patient said !e $as tied ,or severa times )y !is ,ami y. ;e,ore t!ese symptoms appear patient is said to )e !aving pro) ems $it! !is parents. No !istory o, previous !ea t! 'ondition or ,ami y !istory o, any menta i ness. ?rom system, t!e p!ysi'a pu monary system, status e-amination system, neuro ogy patient<s patient<s vita gastrointestina t!e psy'!iatri' sign, 'ardiovas'u ar

system $ere $it!in norma imit. ?rom appearan'e $as messy, and oo+ed s'ared. &atient<s orientation o, time, p a'e and peop e@ ver)a and visua 'onta't@ memory@ insig!t $ere poor. 5!e 'ognitive ,un'tion o, patient $as good )ut patient 'ou d not give enoug! attention and 'on'entration. &atient<s

tied and +ept inside !is room )y !is ,ami y. 5!is is )e ieved to $orsen !is symptoms even more. ?rom t!e medi'a e-amination, it $as ,ound t!at t!e patient !ad a poor orientation o, time, p a'e and peop e. 5!is 'on,irms t!at t!e patient is osing tou'! $it! rea ity. 5!e patient !ad a poor insig!t o, !is disease@ !e did not !ave t!e understanding o, !is medi'a pro) em. inade=uate inappropriate. &atient<s and mood a,,e't $as $as t!oug!t

5!en patient $as moved to t!e room $!ere !e $as p anned to undergo more psy'!iatri' e-aminations and given risperidone, o, treatment, $!i'! is atypi'a su'! as and antipsy'!oti' medi'ation. 2,ter . $ee+ symptoms o, !a u'inations $ere gone. &atient<s understanding =uestions orientation o, time, p a'e, and peop e $ere getting )etter even t!oug!t !e $as sti some a'ting si y at times. &atient more time. 2,ter )eing $as suggested to )e !ospita i*ed ,or dis'!arge, patient $as re'ommended to 'ontinue t!is medi'ation to !e p !im in !is dai y a'tivities. ;eside medi'ation, patient $as a so given psy'!ot!erapy. 5!e aim o, t!is treatment is not to 'ure )ut to redu'e symptoms so t!at patient $ou d )e a) e to do !is dai y a'tivities, in' uding ta+ing 'are o, !imse , and $or+ing. Re,eren'e6 .. Kap an, ". Sado'+, ;. A Sado'+ 4, 0BBC. Kap an and Sado'+<s6 Synopsis o, &sy'!iatry. tent! edition. Dippin'ott Wi iams A Wi +ins, &!i ade p!ia. 0. Medi'a 0B.B. 2nonymous. 1du'ation #isorgani*ed and Resear'!. at S'!i*op!renia. Mayo ?oundation o, 2vai a) e

&atient<s

pro'ess $as not ogi' and not rea isti'. %n'o!eren'y and jumping o, t!oug!ts $ere ,ound. &atient !ad !istory o, insomnia and !ypo)u ia. 2 ,indings disorder. 2s it is isted in t!e #SM3%435R, t!e diagnosti' 'riteria ,or !e)ep!reni' s'!i*op!renia are disorgani*ed spee'!, disorgani*ed inappropriate onger./ 2 )e!avior, a,,e't, , at $!i'! or are are signs o, o, t!e psy'!oti'

prominent ,or .3mont! period or t!ese symptoms 'an )e ,ound in t!is patient. 5!ere,ore t!e patient<s diagnosis 'an )e 'on,irmed to )e !e)ep!reni' s'!i*op!renia. 5!e treatment p an $as ,irst to !ospita i*ed t!e patient sin'e !e $as )roug!t due to rampage and to redu'e t!e symptoms !a operido patient $as given and dia*epam inje'tion.

!ttp6//$$$.mayo' ini'.'om/!ea t!/dis organi*ed3s'!i*op!renia/#SBBE:8.

2''essed on 0Ct! Novem)er 0B.7. 7. Kraam 2, 0B.0. "e)ep!renia6 a 'on'eptua !istory. "istory o, &sy'!iatry@ 07(8)6 7EC38B7. 8. Kuper)erg, (, 0BBE. ;ui ding Meaning in S'!i*op!renia. #epartment o, &sy'!o ogy 5u,ts University, Massa'!usetts. 9 in 11( Neuros'i@ 7F(0)6 FF3.B0. /. #iagnosti' and Statisti'a Manua o, Menta 0BBB. #isorders. 2meri'an ?ourt! edition. &sy'!iatri'

2sso'iation. :. &!i ips, D. Seidman, D, 0BBE. 1motion &ro'essing in &ersons at Ris+ ,or S'!i*op!renia. "arvard #epartment University. &sy'!o ogy,

S'!i*op!r ;u @ 78(/)6 EEE3FB7.