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KEGAWAT DARURATAN PSIKIATRI
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April 17, 2020
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materi kesehatan
<div><br /> <div class="separator" style="clear: both; text-align: center;"> <img border="0" data-original-height="409" data-original-width="709" height="368" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj28PEBdoI3qML4xYye1t2FqOkz_hyphenhyphenKhxU0H9qeEO6_hAlUXcqIL8MTAgKG3JJofl68CGDV7KNCgzSveKPv59NwGoBtXQoul-jgvT_3dsMZe8amSpynnfJ8Rfpc1nZ0qxis27aWwr0gaKtR/s640/Screenshot_5.png" width="640" /></div> <div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;"> <b style="mso-bidi-font-weight: normal;"><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;"><br /></span></b></div> <div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;"> <b style="mso-bidi-font-weight: normal;"><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">KEGAWAT</span></b><b style="mso-bidi-font-weight: normal;"><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US;"> </span></b><b style="mso-bidi-font-weight: normal;"><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">DARURATAN PSIKIATRI<o:p></o:p></span></b></div> <div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;"> <br /></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Kedaruratan psikiatri merupakan cabang dari Ilmu Kedokteran Jiwa dan Kedokteran Kedaruratan, yang dibuat untuk menghadapi kasus kedaruratan yang memerlukan intervensi psikiatrik. Tempat pelayanan kedaruratan psikiatri antara lain di rumah sakit umum, rumah sakit jiwa, klinik dan sentra primer. Kasus kedaruratan psikiatrik meliputi gangguan pikiran, perasaan dan perilaku yang memerlukan intervensi terapeutik segera, antara lain: (Elvira, Sylvia D dan Gitayanti Hadisukanto, 2010)<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo1; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Kondisi gaduh gelisah<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo1; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Tindak kekerasan (violence)<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l18 level1 lfo1; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Tentamen Suicidum/percobaan bunuh diri <o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo1; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Gejala ekstra piramidal akibat penggunaan obat<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo1; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Delirium<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <u><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Evaluasi<o:p></o:p></span></u></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Menilai kondisi pasien yang sedang dalam krisis secara cepat dan tepat aadalah tujuan utama dalam melakuka evaluasi kedaruratan psikiatrik. Tindakan segera yang harus dilakukan secara tepat adalah:<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l22 level1 lfo2; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Menentukan diagnosis awal<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l22 level1 lfo2; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Melakukan identifikasi faktor-faktor presipitasi dan kebutuhan segera pasien<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l22 level1 lfo2; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Memulai terapi atau merujuk pasien ke fasilitas yang sesuai<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Dalam proses evaluasi, dilakukan:<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l24 level1 lfo3; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Wawancara Kedaruratan Psikiatrik<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Wawancara dilakukan lebih terstruktur, secara umum fokus wawancara ditujukan pada keluhan pasien dan alasan dibawa ke unit gawat darurat. Keterangan tambahan dari pihak pengantar, keluarga, teman atau polisi dapat melengkapi informasi, terutama pada pasien mutisme, tidak kooperatif, negativistik atau inkoheren. Hubungan dokter-pasien sangat berpengaruh terhadap informasi yang diberikan. Karenanya diperlukan kemampuan mendengar, melakukan observasi dan melakukan interpretasi terhadap apa yang dkatakan ataupun yang tidak dikatakan oleh pasien, dan ini dilakukan dalam waktu yang cepat.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l24 level1 lfo3; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Pemeriksaan Fisik<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Pemeriksaan psikiatrik standar<span style="mso-spacerun: yes;"> </span>meliputi: riwayat perjalanan penyakit, pemeriksaan status mental, pemeriksaan status fisik/neurologik dan jika perlu pemeriksaan penunjang. Yang pertama dan terpenting yang harus dilakukan oeh seorang dokter di unit gawat darurat adalah menilai tanda-tanda vital pasien. Tekanan ddarah, suhu, nadi adalah sesuatu yang mudah diukur dan dapat memberikan informasi bermakna. Misalnya seorang yang gaduh gelisah dan mengalami halusinasi, demam, frekuensi nadi 120 per menit dan tekanan darah meningkat, kemungkinan besar mengalami delirium dibandingkan dengan suatu gangguan psikiatrik. Lima hal yang harus ditentukan sebelum menangani pasien selanjutnya:<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l24 level2 lfo3; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Keamanan pasien<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Sebelum mengevaluasi pasien, dokter harus dapat memastikan bahwa situasi di UGD, jumlah pasien di ruangan tersebut aman bagi pasien. Jika intervensi verbal tidak cukup atau kontraindikasi, perlu dipikirkan pemberian obat atau pengekangan.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l24 level2 lfo3; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Medik atau psikiatrik?<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Penting bagi dokter untuk menilai apakah kasusnya medik, psikiatrik atau kombinasi keduanya, sebab penanganannya akan jauh berbeda. Kondisi medik umum seperti trauma kepala, infeksi berat dengan demam inggi, kelainan metabolisme, intoksikasi atau gejala putus zat seringkali menyebabkan gangguan fungsi mental yang menyerupai gangguan psikiatrik umumnya. Dokter gawat darurat tetap harus menelusuri semua kemungkinan penyebab gangguan fungsi mental yang tampak.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l24 level2 lfo3; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Psikosis<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Yang penting bukanlah penegakan diagnosisnya, tetapi seberapa jauh ketidakmampuannya dalam menilai realita dan buruknya tilikan. Hal ini dapat mempengaruhi sikapnya terhadap pertolongan yang kita berikan serta kepatuhannya dalam berobat.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l24 level2 lfo3; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Suicidal atau homicidal<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Semua pasien dengan kecenderungan bunuh diri harus dobservasi secara ketat. Perasaan-perasaan yang berkaitan dengan tindak kekerasan atau pikiran bunuh diri harus selalu ditanyakan kepada pasien.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l24 level2 lfo3; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Kemampuan merawat diri sendiri<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Sebelum memulangkan pasien, harus dipertimbangkan apakah pasien mampu merawat dirinya sendir, mampu menjalankan saran yang dianjurkan. Ketidakmampuan pasien dan atau keluarganya untuk merawat pasien di rumah merupakan salah asatu indikasi rawat inap.<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Adapun indikasi rawat inap antara lain adalah:<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l20 level1 lfo4; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Bila pasien membahayakan diri sendiri atau orang lain,<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l20 level1 lfo4; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Bila perawatan di rumah tidak memadai, dan<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l20 level1 lfo4; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Perlu observasi lebih lanjut.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <u><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Pertimbangan Dalam Penegakan Diagnosis Dan Terapi<o:p></o:p></span></u></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l11 level1 lfo5; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Diagnosis<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Meskipun pemeriksaan gawat darurat tidak harus lengkap, namun ada beberapa hal yang harus dilakukan sesegera mungkin untuk keakuratan data , misalnya penapisan toksikologi ( tes urin untuk opioid, amfetamin), pemeriksaan radiologi, EKG dan tes laboratorium. Data penunjang seperti catatan medik sebelumnya, informasi dari sumber luar juga dikumpulkan sebelum memulai tindakan.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l11 level1 lfo5; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Terapi<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Pemberian terapi obat atau pengekangan harus mengikuti prinsip terapi <i style="mso-bidi-font-style: normal;">Maximum tranquilization with minimum sedation</i>. Tujuannya adalah untuk:<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l16 level1 lfo6; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Membantu pasien untuk dapat mengendalikan dirinya kembali<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l16 level1 lfo6; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Mengurangi/menghilangkan penderitaannya<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l16 level1 lfo6; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Agar evaluasi dapat dilanjutkan sampai didapat suatu kesimpulan akhir<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Obat-obatan yang sering digunakan adalah:<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l17 level1 lfo7; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Low-dose High-potency antipsychotics seperti haloperidol, trifluoperazine, perphenazine dsb<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l17 level1 lfo7; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Atypical antipsychotics, seperti risperidone, quetiapine, olanzapine.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l17 level1 lfo7; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Injeksi benzodiazepine. Kombinasi benzodiazepine dan antipsikotik kadang sangat efektif.<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"> <br /></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l6 level1 lfo18; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><b style="mso-bidi-font-weight: normal;"><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Keadaan Gaduh Gelisah<o:p></o:p></span></b></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 1.0cm; text-align: justify; text-indent: 21.3pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span>Keadaan gaduh gelisah bukanlah diagnosis dalam arti kata sebenarnya, tetapi hanya menunjuk pada suatu keadaan tertentu, suatu sindrom dengan sekelompok gejala tertentu. Keadaan gaduh gelisah dipakai sebagai sebutan sementara untuk suatu gambaran psikopatologis dengan ciri-ciri utama gaduh dan gelisah. (Maramis dan Maramis, 2009).<b><o:p></o:p></b></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 1.0cm; text-align: justify;"> <u><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Etiologi<o:p></o:p></span></u></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Keadaan gaduh gelisah merupakan manifestasi klinis salah satu jenis psikosis (Maramis dan Maramis, 2009):<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 63.8pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l21 level4 lfo28; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Delirium<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 63.8pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l21 level4 lfo28; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Skizofrenia katatonik<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 63.8pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l21 level4 lfo28; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Gangguan skizotipal<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 63.8pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l21 level4 lfo28; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Gangguan psikotik akut dan sementara<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 63.8pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l21 level4 lfo28; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Gangguan afektif bipolar, episode kini manik dengan gejala psikotik<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 63.8pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l21 level4 lfo28; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Amok<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"> <br /></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l19 level1 lfo29; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Psikosis karena gangguan mental organik: delirium<o:p></o:p></span></b></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Pasien dengan keadaan gaduh-gelisah yang berhubungan dengan sindroma otak organik akut menunjukkan kesadaran yang menurun. Sindroma ini dinamakan delirium. Istilah sindroma otak organik menunjuk kepada keadaan gangguan fungsi otak karena suatu penyakit badaniah (Maramis dan Maramis, 2009).<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Penyakit badaniah ini yang menyebabkan gangguan fungsi otak itu mungkin terdapat di otak sendiri dan karenanya mengakibatkan kelainan patologik-anatomik (misalnya meningo-ensefalitis, gangguan pembuluh darah otak, neoplasma intracranial, dan sebagainya), atau mungkin terletak di luar otak (umpamanya tifus abdominalis, pneumonia, malaria, uremia, keracunan atropine/kecubung atau alcohol, dan sebagainya) dan hanya mengakibatkan gangguan fungsi otak dengan manifestasi sebagai psikosa atau keadaan gaduh-gelisah, tetapi tidak ditemukan kelainan patologik-anatomik pada otak sendiri (Maramis dan Maramis, 2009).<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Secara sederhana dapat dikatakan bahwa pada sindrom otak organik akut biasanya terdapat kesadaran menurun sedangkan pada sindrom otak organik menahun biasanya terdapat dementia. Akan tetapi suatu sindrom otak organik menahun (misalnya tumor otak, demensia paralitika, aterosklerosis otak, dan sebagainya) dapat saja pada suatu waktu menimbulkan psikosis atau pun keadaan gaduh gelisah. Untuk mengetahui penyebabnya secara lebih tepat, perlu sekali dilakukan evaluasi internal dan neurologis yang teliti (Maramis dan Maramis, 2009).<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"> <br /></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l19 level1 lfo29; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Skizofrenia dan gangguan skizotipal<o:p></o:p></span></b></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Bila kesadaran tidak menurun, maka biasanya keadaan gaduh gelisah itu merupakan manifestasi suatu psikosis dari kelompok ini, yaitu psikosis yang tidak berhubungan atau sampai sekarang belum diketahui dengan pasti adanya hubungan dengan suatu penyakit badaniah seperti pada gangguan mental organik.<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Skizofrenia merupakan psikosis yang paling sering didapat di negara kita. Secara mudah dapat dikatakan bahwa bila kesadaran tidak menurun dan terdapat inkoherensi serta afek-emosi yang inadequate, tanpa frustasi atau konflik yang jelas maka hal ini biasanya suatu skizofrenia. Diagnosa kita diperkuat bila kelihatan juga tidak ada perpaduan (disharmoni) antara berbagai aspek kepribadian seperti proses berpikir, afek-emosi, psikomotorik dan kemauan (kepribadian yang retak, terpecah-belah atau bercabang = schizo; jiwa = phren), yaitu yang satu meningkat, tetapi yang lain menurun. Pokok gangguannya terletak pada proses berpikir (Maramis dan Maramis, 2009).<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Dari berbagai jenis skizofrenia, yang sering menimbulkan keadaan gaduh-gelisah ialah episode skizofrenia akut dan skizofrenia jenis gaduh-gelisah katatonik. Di samping psikomotor yang meningkat, pasien menunjukkan inkoherensi dan afek-emosi yang inadequate. Proses berpikir sama sekali tidak realistik lagi (Maramis dan Maramis, 2009).<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 29.45pt;"> <br /></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l19 level1 lfo29; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Gangguan psikotik akut dan sementara<o:p></o:p></span></b></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Gangguan ini timbul tidak lama sesudah terjadi stress psikologik yang dirasakan hebat sekali oleh individu. Stress ini disebabkan oleh suatu frustasi atau konflik dari dalam ataupun dari luar individu yang mendadak dan jelas, umpamanya dengan tiba-tiba kehilangan seorang yang dicintainya, kegagalan, kerugian dan bencana.Gangguan psikotik akut yang biasanya disertai keadaan gaduh-gelisah adalah gaduh-gelisah reaktif dan kebingungan reaktif (Maramis dan Maramis, 2009).<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <br /></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l19 level1 lfo29; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Psikosis bipolar<o:p></o:p></span></b></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Psikosisbipolar termasuk dalam kelompok psikosa afektif karena pokok gangguannya terletak pada afek-emosi. Tidak jelas ada frustasi atau konflik yang menimbulkan gangguan mental ini. Belum ditemukan juga penyakit badaniah yang dianggap berhubungan dengan psikosa bipolar, biarpun penelitian menunjuk kearah itu. Tidak ditemukan juga disharmoni atau keretakan kepribadian seperti pada skizofrenia; pada jenis depresi ataupun mania, bila aspek afek-emosinya menurun, maka aspek yang lain juga menurun, dan sebaliknya (Maramis dan Maramis, 2009).<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Pada psikosa bipolar jenis mania tidak terdapat inkoherensi dalam arti kata yang sebenarnya, tetapi pasien itu memperlihatkan jalan pikiran yang meloncat-loncat atau melayang (“flight of ideas”). Ia merasa gembira luar biasa (efori), segala hal dianggap mudah saja. Psikomotorik meningkat, banyak sekali berbicara (logorea) dan sering ia lekas tersinggung dan marah (Maramis dan Maramis, 2009). <o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <br /></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l19 level1 lfo29; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Amok<o:p></o:p></span></b></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Amok adalah keadaan gaduh-gelisah yang timbul mendadak dan dipengaruhi oleh faktor-faktor sosiobudaya. Karena itu PPDGJ-III (Pedoman Penggolongan Diagnosa Gangguan Jiwa ke-III di Indonesia) memasukkannya ke dalam kelompok “Fenomena dan Sindrom yang Berkaitan dengan Faktor Sosial Budaya di Indonesia” (“culture bound phenomena”). Efek “malu” (pengaruh sosibudaya) memegang peranan penting. Biasanya seorang pria, sesudah periode “meditasi” atau tindakan ritualistic, maka mendadak ia bangkit dan mulai mengamuk. Ia menjadi agresif dan destruktif, mungkin mula-mula terhadap yang menyebabkan ia malu,tetapi kemudian terhadap siapa saja dan apa saja yang dirasakan menghalanginya. Kesadaran menurun atau berkabut (seperti dalam keadaan <i style="mso-bidi-font-style: normal;">trance</i>). Sesudahnya terdapat amnesia total atau sebagian. Amok sering berakhir karena individu itu dibuat tidak berdaya oleh orang lain, karena kehabisan tenaga atau karena ia melukai diri sendiri, dan mungkin sampai ia menemui ajalnya(Maramis dan Maramis, 2009).<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <u><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Menilai dan Memprediksi Perilaku Kekerasan<o:p></o:p></span></u></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Tanda-tanda adanya perilaku kekerasan yang mengancam (Sadock, et al, 2007):<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level4 lfo19; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Pernah melakukan tindakan kekerasan beberapa saat yang lalu<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level4 lfo19; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Kata-kata keras /kasar atau ancaman akan kekerasan<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level4 lfo19; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Membawa benda-benda tajam atau senjata<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level4 lfo19; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Adanya perilaku agitatif<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level4 lfo19; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Adanya intoksikasi alkohol atau obat<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level4 lfo19; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Adanya pikiran dan perilaku paranoid<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level4 lfo19; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Adanya halusinasi dengar yang memerintahkan untuk melakukan tindak kekerasan.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level4 lfo19; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Kegelisahan katatonik<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level4 lfo19; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">i.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Episode manik<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level4 lfo19; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">j.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Episode depresi agitatif<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level4 lfo19; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">k.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Gangguan Kepribadian tertentu<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 39.6pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Menilai resiko terjadinya perilaku kekerasan (Sadock, et al, 2007):<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l15 level4 lfo27; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Adanya ide-ide untuk melakukan kekerasan<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l15 level4 lfo27; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Adanya faktor demografik seperti jenis kelamin laki-laki, usia 15 – 24 tahun, status sosioekonomi yang rendah, dukungan sosial yang rendah<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l15 level4 lfo27; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Adanya riwayat kekerasan sebelumnya, </span><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">penjudi, pemabuk, penyalahgunaan zat psikoaktif,percobaan bunuh diri ataupun melukai diri sendiri, psikosis<span style="mso-bidi-font-weight: bold;"><o:p></o:p></span></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l15 level4 lfo27; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Adanya stresor (masalah pernikahan, kehilangan pekerjaan, dan lainnya)<span style="mso-bidi-font-weight: bold;"><o:p></o:p></span></span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 86.4pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <u><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Tatalaksana<o:p></o:p></span></u></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Bila seorang dalam keadaan gaduh gelisah dibawa kepada kita, penting sekali kita harus bersikap tenang. Dengan sikap yang meyakinkan, meskipun tentu waspada, dan kata-kata yang dapat menenteramkan pasien maupun para pengantarnya, tidak jarang kita sudah dapat menguasai keadaan (Maramis dan Maramis, 2009).<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Bila pasien masih diikat, sebaiknya ikatan itu disuruh dibuka sambil tetap berbicara dengan pasien dengan beberapa orang memegangnya agar ia tidak mengamuk lagi. Biarpun pasien masih tetap dipegang dan dikekang, kita berusaha memeriksanya secara fisik. Sedapat-dapatnya tentu perlu ditentukan penyebab keadaan gaduh gelisah itu dan mengobatinya secara etiologis bila mungkin (Maramis dan Maramis, 2009).<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Suntikan intramuskular suatu neuroleptikum yang mempunyai dosis terapeutik tinggi (misalnya chlorpromazine HCL), pada umumnya sangat berguna untu mengendalikan psikomotorik yang meningkat. Bila tidak terdapat, maka suntikan neuroleptikum yang mempunyai dosis terapeurik rendah, misalnya trifluoperazine, haloperidol (5 – 10 mg), atau fluophenazine dapat juga dipakai, biarpun efeknya tidak secepat neuroleptikum kelompok dosis terapeutik tinggi. Bila tidak ada juga, maka suatu tranquailaizer pun dapat dipakai, misalnya diazepam (5 – 10 mg), disuntik secara intravena, dengan mengingat bahwa tranquilaizer bukan suatu antipsikotikum seperti neuroleptika, meskipun kedua-duanya mempunyai efek antitegang, anticemas dan antiagitasi (Maramis dan Maramis, 2009).<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Efek samping neuroleptika yang segera timbul terutama yang mempunyai dosis terapeutik tinggi, adalah hipotensi postural, lebih-lebih pada pasien dengan susunan saraf vegetatif yang labil atau pasien lanjut usia. Untuk mencegah jangan sampai terjadi sinkop, maka pasien jangan langsung berdiri dari keadaan berbaring, tetapi sebaiknya duduk dahulu kira-kira satu menit (bila pasien sudah tenang) (Maramis dan Maramis, 2009).<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Penjagaan dan perawatan yang baik tentu juga perlu, mula-mula agar ia jangan mengalami kecelakaan, melukai diri sendiri, menyerang orang lain atau merusak barang-barang. Bila pasien sudah tenang dan mulai kooperatif, maka pengobatan dengan neuroleptika dilanjutkan per oral (bila perlu suntikan juga dapat diteruskan). Pemberian makanan dan cairan juga harus memadai. Kita berusaha terus mencari penyebabnya, bila belum diketahui, terutama bila diduga suatu sindrom otak organik yang akut. 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src="file:///C:/Users/user/AppData/Local/Temp/msohtmlclip1/01/clip_image002.gif" v:shapes="Object_x0020_1" width="350" /><!--[endif]--></span><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div> <div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Gambar Diagram-alur penanggulangan keadaan gaduh-gelisah.<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Pasien dengan amok, bila sampai kepada kita, biasanya sudah tidak mengamuk lagi, kita tinggal berusaha tambah menentramkan saja dan mengobati keadaan fisik bila sudah terganggu sewaktu dia dalam keadaan amok. Psikosis skizofrenia dan bipolar memerlukan pengobatan jangka panjang dengan neuroleptika (Maramis dan Maramis, 2009).<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <br /></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l6 level1 lfo18; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><b style="mso-bidi-font-weight: normal;"><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">B.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Tindak kekerasan (violence)<o:p></o:p></span></b></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; tab-stops: 1.0cm; text-align: justify; text-indent: 21.3pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Violence atau tindak kekrasan adalah agresi fisik yang dilakukan oleh seseorang terhadap orang lain. Jika hal itu diarahkan kepada dirinya sendiri, disebut mutilasi diri atau tingkah laku bunuh diri <i style="mso-bidi-font-style: normal;">(suicidal behavior)</i>. Tindak kekerasan dapat timbul akibat berbagai gangguan psikiatrik, tetapi dapat pula terjadi pada orang biasa yang tidak dapat mengatasi tekanan hidup sehari-hari dengan cara yang lebih baik.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo8; text-align: justify; text-indent: -14.15pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Gambaran klinis dan diagnosis<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Gangguan psikiatrik yang sering berkaitan dengan tindak kekerasan adalah:<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l28 level1 lfo9; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Gangguan psikotik, seperti skizofrenia dan manik, terutama bila paranoid dan mengalami halusinasi yang bersifat suruhan <i style="mso-bidi-font-style: normal;">(commanding hallucination)</i>,<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l28 level1 lfo9; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Intoksikasi alkohol atau zat lain,<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l28 level1 lfo9; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Gejala putus zat akibat alkohol atau obat-obat hipnotik-seddatif<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l28 level1 lfo9; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Katatonik furor<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l28 level1 lfo9; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Depresi agitatif<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l28 level1 lfo9; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Gangguan kepribadian yang ditandai dengan kemarahan dan gangguan pengendalian impuls (misalnya gangguan kepribadian ambang dan antisosial),<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l28 level1 lfo9; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Gangguan mental organik, terutama yang mengenai lobus frontalis dan temporalis otak.<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Faktor risiko lain terjadinya tindak kekerasan adalah :<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l9 level1 lfo10; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Adanya pernyataan seseorang bahwa ia berniat melakukan tindak kekerasan,<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l9 level1 lfo10; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Adanya rencana spesifik,<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l9 level1 lfo10; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Adanya kesempatan atau suatu cara untuk terjadinya kekerasan,<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l9 level1 lfo10; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Laki-laki,<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l9 level1 lfo10; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Usia muda (15-24 tahun),<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l9 level1 lfo10; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Tatus sosioekonomi rendah,<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l9 level1 lfo10; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Adanya riwayat melakukan tndak kekrasan,<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l9 level1 lfo10; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Tindakan antisosial lainnya<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l9 level1 lfo10; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Riwayat percobaan bunuh diri.<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 31.65pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Tujuan pertama menghadap pasien yang potensial untuk melakukan tindak kekerasan adalah mencegah kejadian itu. Tindakan selanjutnya aadalah membuat diagnoss sebagai dasar rencana penatalaksanaan, termasuk cara-cara untuk memperkecil kemungkinan terjadinya tindak kekerasan berikutnya.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify;"> <u><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Panduan wawancara dan Psikoterapi<o:p></o:p></span></u></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo11; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Bersikaplah suportif dan tidak mengancam, tegas dan berikan batasan yang jelas bahwa kalau perlu pasien dapat diikat (physical restraints). Tentukan batasan itu dengan memberikan pilihan (misalnya pilih obat atau diikat), dan bukan dengan menyuruh pasien secara provokatif: “minum tablet ini sekarang”<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo11; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Kaakan langsung kepada pasien bahwa tindak kekerasan tidak dapat diterima,<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo11; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Tenangkan pasien bahwa ia aman di sini. Tunjukkan dan tularkan sikap tenang dan penuh kontrol.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo11; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Tawarkan obat kepada pasien untuk membantunya lebih tenang.<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <u><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Evaluasi dan penatalaksanaan<o:p></o:p></span></u></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l14 level1 lfo12; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Lindungi diri anda<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 70.9pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo13; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Jangan pernah mewawancarai pasien yang bersenjata<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 70.9pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo13; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Jangan pernah mewawancarai pasien yang bersikap beringas (violent) seorang diri atau di ruang tertutup. Lepaskan hal-hal yang bisa dijambak/ditarik seperti kalung atau dasi.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 70.9pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo13; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Jangan melakukan pengikatan pasien seorang diri, serahkan urusan itu pada anggota staf yang terlatih.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 70.9pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo13; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Duduklah dengan jarak paling tidak sepanjang lengan<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 70.9pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo13; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Jangan menantang atau menentang pasien psikotik.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 70.9pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo13; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Jangan duduk berdekatan dengan pasien paranoid, yang muungkin merasa bahwa anda mengancamnya<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 70.9pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo13; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Waspadalah terhaddap tanda-tanda munculnya kekrasan. Selalu persiapkan rute untuk melarikan diri seandainya pasien menyerrnag anda. Jangan pernah membelakangi pasien<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l14 level1 lfo12; text-align: justify; text-indent: -14.2pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Waspada terhadap tanda-tanda munculnya kekerasan, antara lain:<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 70.9pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l7 level1 lfo14; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Adanya kekerasan terhadap orang atau benda yang terjadi belum lama ini, gigi yang dikatupkan serta telapak yang dikepal,<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 70.9pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l7 level1 lfo14; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Ancaman verbal,<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 70.9pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l7 level1 lfo14; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Agitasi psikomotor,<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 70.9pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l7 level1 lfo14; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Intoksikasi alkohol atau obat atau zat lain,<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 70.9pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l7 level1 lfo14; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Waham kejar, dan<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 70.9pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l7 level1 lfo14; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Senjata atau benda-benda yang dapat digunakan sebagai senjata (seperti garpu, asbak)<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l14 level1 lfo12; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Pastikan bahwa terdapat jumlah staf yang cukup untuk mengikat pasien secara aman.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l14 level1 lfo12; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Pengikatan pasien hanya dilakukan oleh mereka yang telah terlatih. Biasanya setelah pasien diikat diberikan benzodiazepin atau antipsikotik untuk menenangkan pasien.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l14 level1 lfo12; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">5)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Lakukan evaluasi diagnostik yang tepat, meliputi TTV, pemeriksaan fisik dan wawancara pskiatrik.<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <u><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Terapi Psikofarmaka<o:p></o:p></span></u></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 1.0cm; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Terapi obat tergantung diagnosisnya. Biasanya untuk menenagkan pasien diberikan obat antipsikotik atau benzodiazepin:<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo15; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Flufenazine, trifluoperazine atau haloperidol 5mg per oral atau IM,<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo15; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Olanzapine 2,5-10 mg per IM, maksimal 4 injeksi per hari, dengan dosis rata-rata per hari 13-14mg,<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo15; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Atau lorazepam 2-4 mg, diazepam 5-10mg per IV secara pelahan (dalam 2 menit).<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 1.0cm; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Bila dalam 20-30 menit kegelisahan tidak berkurang, ulangi dengan dosis yang sama. Hindari pemberian antipsikotik pada pasien yang mempunyai risiko kejang. Utnuk penderia epilepsi, mula-mula berikan antikonvulsan misalnya carbamazepine lalu berikan benzodiazepine. Pasien yang menderita ganggauan organik kronik seringkali memberikan respon yang baik dengan pemberian ß-blocker seperti propanolol. (Elvira, Sylvia D dan Gitayanti Hadisukanto, 2010)<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 90.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l6 level1 lfo18; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><b style="mso-bidi-font-weight: normal;"><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">C.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Bunuh diri (suicide)/ Tentamen Suicidum<o:p></o:p></span></b></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; tab-stops: 1.0cm; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Bunuh diri atau suicide atau tentamen suicidum adalah kematian yang diniatkan dan dilakukan oleh seseorang terhadap dirinya sendiri (Elvira, Sylvia D dan Gitayanti Hadisukanto, 2010) atau </span><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">segala perbuatan seseorang yang dapat mengakhiri hidupnya sendiri dalam waktu singkat (Maramis dan Maramis, 2009).</span><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span></span><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Ada macam-macam pembagian bunuh-diri dan percobaan bunuh-diri. Pembagian Emile Durkheim masih dapat dipakai karena praktis, yaitu:</span><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Calibri;"><o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 21.3pt; mso-add-space: auto; mso-list: l5 level2 lfo24; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Bunuh diri egoistik</span><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 7.1pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 14.2pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Individu ini tidak mampu berintegrasi dengan masyarakat. Hal ini disebabkan oleh kondisi kebudayaan atau karena masyarakat yang menjadi individu itu seolah-olah tidak berkepribadian. Kegagalan integrasi dalam keluarga dapat menerangkan mengapa mereka tidak menikah lebih rentan untuk melakukan percobaan bunuh diri dibandingkan dengan mereka yang menikah. Masyarakat daerah pedesaan mempunyai integrasi social yang lebih baik dari pada daerah perkotaan, sehingga angka suiside juga lebih sedikit.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 21.3pt; mso-add-space: auto; mso-list: l5 level2 lfo24; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Bunuh diri altruistik</span><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 21.3pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Individu itu terikat pada tuntutan tradisi khusus ataupun ia cenderung untuk bunuh diri karena identifikasi terlalu kuat dengan suatu kelompok, ia merasa bahwa kelompok tersebut sangat mengharapkannya. Contoh: “Hara-kiri: di Jepang, “puputan” di Bali beberapa ratus tahun yang lalu, dan di beberapa masyarakat primitive yang lain. Suiside macam ini dalam jaman sekarang jarang terjadi, seperti misalnya seorang kapten yang menolak meninggalkan kapalnya yang sedang tenggelam.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 21.3pt; mso-add-space: auto; mso-list: l5 level2 lfo24; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Bunuh diri anomik</span><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 0cm; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 21.3pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hal ini terjadi bila tedapat gangguan keseimbangan integrasi antara individu dengan masyarakat, sehingga individu tersebut meningglakan norma-norma kelakuan yang biasa. Individu itu kehilangan pegangan dan tujuan. Masyarakat atau kelompoknya tidak dapat memberikan kepuasan kepadanya karena tidak ada pengaturan dan pengawasan terhadap kebutuhan-kebutuhannya. Hal ini menerangkan mengapa percobaan bunuh diri pada orang cerai pernikahan lebih banyak dari pada mereka yang tetap dalam pernikahan. Golongan manusia yang mengalami perubahan ekonomi yang drastis juga lebih mudah melakukan percobaan bunuh diri.<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Helber Hendin mengemukakan beberapa hal psikodinamika bunuh-diri sebagai berikut:<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l27 level2 lfo25; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kematian sebagai pelepasan pembalasan (“Death as retaliatory abandonment”).<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Suiside dapat merupakan usaha untuk mengurangi preokupasi tentang rasa takut akan kematian. Individu mendapat perasaan seakan-akan ia dapat mengontrol dan dapat mengetahui bilamana dan bagaimana kematian itu.</span><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l27 level2 lfo25; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kematian sebagai pembunuhan terkedik (ke belakang) (“Death as retroflexed murder”).</span><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Bagi individu yang mengalami gangguan emosi hebat, suiside dapat mengganti kemarahan atau kekerasan yang tidak dapat direpresikan. Orang ini cenderung untuk bertindak kasar dan suiside dapat merupakan penyelesaian mengenai pertentangan emosi dengan keinginan untuk membunuh.<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l27 level2 lfo25; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kematian sebagai penyatuan kembali (“Death as reunion”).</span><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kematian dapat mempunyai arti yang menyenangkan, karena individu itu akan bersatu kembali dengan orang yang telah meninggal (reuni khayalan). </span><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 7.1pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">4. </span><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kematian sebagai hukuman buat diri sendiri (“Death as self punishment”).<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; tab-stops: 1.0cm; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Menghukum diri sendiri karena kegagalan dalam pekerjaan jarang terjadi pada wanita, akan tetapi seorang ibu tidak mampu mencintai, maka keinginan menghukum dirinya sendiri dapat terjadi. Dalam rumah sakit jiwa, perasaan tak berguna dan menghukum diri sendiri merupakan hal yang umum. Mula-mula mungkin karena kegagalan, rasa berdosa karena agresi, individu itu mencoba berbuat lebih baik lagi, tetapi akhirnya ia menghukum diri sendiri untuk menjauhkan diri dari tujuan itu.</span><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; tab-stops: 1.0cm; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; tab-stops: 1.0cm; text-align: justify;"> <u><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Faktor Risiko<o:p></o:p></span></u></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Berikut ini faktor-faktor resiko untuk bunuh diri (Sadock, et al, 2007):<o:p></o:p></span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level4 lfo19; text-align: justify; text-indent: -21.25pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">l.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Jenis kelamin<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 21.25pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Perempuan lebih banyak melakukan percobaan bunuh diri dibanding laki-laki. Akan tetapi, keberhasilan bunuh diri lebih tinggi pada laki-laki. Hal ini berkaitan dengan metode bunuh diri yang dipilih. Laki-laki lebih banyak dengan gantung diri, meloncat dari tempat tinggi, dengan senjata api. Perempuan lebih banyak dengan overdosis obat-obatan atau menggunakan racun.<o:p></o:p></span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level4 lfo19; text-align: justify; text-indent: -21.25pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">m.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Usia<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 21.25pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Kasus bunuh diri meningkat seiring dengan bertambahnya usia. Pada laki-laki, angka bunuh diri tertinggi pada usia di atas 45 tahun sedangkan pada perempuan angka bunuh diri tertinggi pada usia di atas 55 tahun. Orang yang lebih tua lebih jarang melakukan percobaan bunuh diri, tetapi lebih sering berhasil.<o:p></o:p></span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level4 lfo19; text-align: justify; text-indent: -21.25pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">n.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Ras<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 21.25pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Di Amerika Serikat ras kulit putih lebih banyak melakukan bunuh diri dibanding ras kulit hitam.<o:p></o:p></span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level4 lfo19; text-align: justify; text-indent: -21.25pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">o.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Status perkawinan<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 21.25pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Pernikahan menurunkan angka bunuh diri, terutama jika terdapat anak di rumah. Orang yang tidak pernah menikah dua kali lebih beresiko untuk bunuh diri. Perceraian meningkatkan resiko bunuh diri. Janda atau duda yang pasangannya telah meninggal juga memiliki angka bunuh diri yang tinggi.<o:p></o:p></span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level4 lfo19; text-align: justify; text-indent: -21.25pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">p.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Pekerjaan<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 21.25pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Semakin tinggi status sosial semakin tinggi resiko bunuh diri, tetapi status sosial yang rendah juga meningkatkan resiko bunuh diri. Pekerjaan sebagai dokter memiliki resiko bunuh diri tertinggi dibanding pekerjaan lain. Spesialisasi psikiatri memiliki resiko tertinggi, disusul spesialis mata dan spesialis anestesi. Pekerjaan lain yang memiliki resiko tinggi untuk bunuh diri adalah pengacara, artis, dokter gigi, polisi, montir, agen asuransi. Orang yang tidak memiliki pekerjaan memiliki resiko lebih tinggi untuk bunuh diri.<o:p></o:p></span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level4 lfo19; text-align: justify; text-indent: -21.25pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">q.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Kesehatan fisik<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 21.25pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Satu dari tiga orang yang melakukan bunuh diri memiliki masalah kesehatan dalam 6 bulan sebelum bunuh diri. Hilangnya mobilitas fisik, nyeri hebat yang kronik, pasien hemodialisis meningkatkan resiko bunuh diri.<o:p></o:p></span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level4 lfo19; text-align: justify; text-indent: -21.25pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">r.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Gangguan mental<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 21.25pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Sekitar 95% dari semua orang yang mencoba atau melakukan bunuh diri memiliki gangguan mental. Gangguan mental tersebut terdiri dari depresi 80%, skizofrenia 10%, dan demensia atau delirium 5%. Di antara semua pasien dengan gangguan mental, 25% kecanduan juga kepada alkohol.<o:p></o:p></span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level4 lfo19; text-align: justify; text-indent: -21.25pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">s.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Kecanduan alkohol<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 21.25pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Sekitar 15% pasien kecanduan alkohol melakukan bunuh diri. Sekitar 80% pasien bunuh diri akibat kecanduan alkohol adalah laki-laki. Sekitar 50% dari pasien kecanduan alkohol yang bunuh diri mengalami kehilangan anggota keluarga atau pasangan dalam satu tahun terakhir.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level4 lfo19; text-align: justify; text-indent: -21.25pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">t.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Gangguan kepribadian<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; tab-stops: 1.0cm; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>Sebagian besar orang yang bunuh diri memiliki gangguan kepribadian. Gangguan kepribadian merupakan faktor predisposisi untuk gangguan depresi. Selain itu juga merupakan faktor predisposisi untuk kecanduan alkohol. Gangguan kepribadian juga dapat menyebabkan konflik dengan keluarga dan orang lain.<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <u><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Gangguan Jiwa yang sering Berkaitan dengan Bunuh Diri, </span></u><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">adalah gangguan mood, keterantungan alkohol, skizofrenia. Pencegahan tindak bunuh diri yang terbaik adalah dengan mendeteksi dini dan menatalaksana gangguan jiwa yang mungkin menjadi faktor kontribusi tadi.<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <u><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Mengenali pasien yang berpotensi bunuh diri<o:p></o:p></span></u></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Kemungkinan bunuh diri dapat terjadi apabila (Tomb, 2004):<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l23 level4 lfo23; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Pasien pernah mencoba bunuh diri<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l23 level4 lfo23; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Keinginan bunuh diri dinyatakan secara terang-terangan maupun tidak, atau berupa ancaman: “kamu tidak akan saya ganggu lebih lama lagi” (sering dikatakan pada keluarga)<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l23 level4 lfo23; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Secara objektif terlihat adanya mood yang depresif atau cemas<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l23 level4 lfo23; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Baru mengalami kehilangan yang bermakna (pasangan, pekerjaan, harga diri, dan lain-lain)<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l23 level4 lfo23; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Perubahan perilaku yang tidak terduga: menyampaikan pesan-pesan, pembicaraan serius dan mendalam dengan kerabat, membagi-bagikan harta/barang-barang miliknya.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l23 level4 lfo23; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Perubahan sikap yang mendadak: tiba-tiba gembira, marah atau menarik diri.<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <u><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Panduan Wawancara dan Psikoterapi<o:p></o:p></span></u></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo16; text-align: justify; text-indent: -21.25pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Pada waktu wawancaa, pasien mungkin secara spontan menjelaskan adanya ide bunuh diri. Bila tidak, tanyakan langsung.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo16; text-align: justify; text-indent: -21.25pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Mulailah dengan menanyakan:<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo20; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Apakah anda pernah merasa ingin menyerah saja?<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo20; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Apakah anda pernah merasa bahwa lebih baik kalau anda mati saja?<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo16; text-align: justify; text-indent: -21.25pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Tanyakan isi pikiran pasien:<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo21; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Berapa sering pikiran ini muncul?<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo21; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Apakah pikiran tentang bunuh diri ini meningkat?<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo16; text-align: justify; text-indent: -21.25pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Selidiki :<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 43.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l25 level1 lfo22; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Apakah pasien bisa mendapatkan alat dan cara untuk melaukan rencana bunuh dirinya?<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 43.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l25 level1 lfo22; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Apakah mereka sudah mengambilkah aktif, isalnya mengumpulkan obat?<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 43.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l25 level1 lfo22; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Seberapa pesimiskah mereka?<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 43.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l25 level1 lfo22; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Aakah mereka bisa memikirkan bahwa kehidupannya akan membaik?<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify;"> <u><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Evaluasi dan Penatalaksanaan<o:p></o:p></span></u></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Pertolongan pertama biasanya dilakukan secara darurat di rumah (di tempat kejadian) dan atau di Unit Gawat Darurat di rumah sakit, di bagian penyakit dalam atau bedah. Dilakukan pengobatan terhadap luka-luka dan atau keracunan. Bila keracunan atau luka sudah dapat diatasi maka dilakukan evaluasi psikiatrik. Tidak ada hubungan antara beratnya gangguan fisik dengan beratnya gangguan psikologis. Penting sekali dalam pengobatan untuk menangani juga gangguan mentalnya. Untuk pasien dengan depresi dapat diberikan psikoterapi dan obat antidepresan (Maramis dan Maramis, 2009).<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Ketika sedang mengevaluasi pasien dengan kecendrungan bunuh diri, jangan tinggalkan mereka sendiri di ruangan. Singkirkan benda-benda yang dapat membahayakan dari ruang tersebut. Etika mengevaluasi pasien yang baru melakukan percobaan bunuh diri, buatlah penilaian apakah hal itu direncanakan atau dilakukan secara impulsif.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Penatalaksanaan tergantung dari diagnosis yang ditegakkan. Pasien yang depresi berat boleh saja berobat jalan asalkan keluarganya dapat mengawasi pasien secara ketat di ruma. De bunuh diri pada pasien alkoholik umumnya hilang setelah sesudah menghentkan pengguanan alkohol itu. Pasien dengan gangguan kepribadian akan berespon baik bila mereka ditangani secara empatik dan dibantu untuk memecahkan masalah dengancara rasionald an bertanggung jawab.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Rawat inap jangka panjang diperlukan bagi pasien yang cendrung dan mempunyai kebiasaan melukai diri sendiri serta parasuicides. Parasuicides yaitu mereka yang berulangkali melakukan hal-hal berbahaya tetapi menyangkal adanya ide-ide bunuh diri. (Elvira, Sylvia D dan Gitayanti Hadisukanto, 2010)<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"> <br /></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <u><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Terapi psikofarmaka<o:p></o:p></span></u></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 18.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Seorang yang sedang dalam krisis karena baru ditinggal mati biasanya akan berfungsi lebih baik setelah mendapat tranquilizer ringan, tertama bila tidurnya terganggu. Obat pilihannya adalah golongan benzodiazepine, misalnya lorazepam 3x1 mg per hari selama 2 minggu. Jangan memberukan obat dalam jumlah banyak sekaligus terhdap pasien(rrespkan sedikit-seikit saja) dan pasien harus kontrol dalam bebeapa hari.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l6 level1 lfo18; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><b style="mso-bidi-font-weight: normal;"><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">D.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Sindroma Neuroleptik Maligna<o:p></o:p></span></b></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; tab-stops: 1.0cm; text-align: justify; text-indent: 14.2pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Sindrom neuroleptik maligna adalah suatu sindrom toksik yang behubungan dengan penggunaan obat antipsikotik. Gejalanya meliputi : kekakuan otot, distonia, akinesia mutisme dan agitasi.<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <u><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Gambaran Klinis dan Diagnosis<o:p></o:p></span></u></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Ditandai oleh demam tinggi (dapat mencapai 41,5ºC), kekakuan otot yang nyata sampai seperti pipa (lead-pipe rigidity), instabilitas otonomik (takikardia, tekanan darah yang labil, keringat berlebih) dan gangguan kesadaran. Kekakuan yang parah dapat menyebabkan rhabdomyolysis, myaglobinuria dan akhirnya gagal ginjal. Penyulit lain dapat berupa tombosis vena, emboli paru dan kematian. Biasanya terjadi dalam hari-hari pertama pengguanaan antipsikotik pada saat dosis mulai ditingkatkan, umunya dalam 10 hari pertama pengobatan antipsikotik. Sindrom neuroleptik maligna paling mungkin terjadi pada pasien yang menggunakan antipsikotik potensi tinggi dalam dosis tinggi atau dosis yang meningkat cepat. <o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Menurut DSM-IV-TR, diagnosis sindrom neuroleptik maligna ditegakkan jika terdapat demam dan kekakuan otot yang parah disertai dengan 2 atau lebih gejala berikut:</span><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level4 lfo26; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Diaforesis<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level4 lfo26; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Disfagia<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level4 lfo26; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Tremor<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level4 lfo26; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Inkontinensia<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level4 lfo26; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Penurunan kesadaran<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level4 lfo26; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Mutism<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level4 lfo26; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Takikardia<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level4 lfo26; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Tekanan darah yang meningkat atau labil <o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level4 lfo26; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Leukositosis<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level4 lfo26; text-align: justify; text-indent: -32.4pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Bukti laboratorium adanya kerusakan otot rangka<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <u><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Patofisiologi<o:p></o:p></span></u></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Patofisiologi sindrom neuroleptik maligna belum diketahui secara jelas<b>. </b>Timbulnya sindrom neuroleptik maligna akibat obat yang menghambat reseptor D2 menghasilkan hipotesis bahwa penghambatan reseptor D2 pada berbagai area di otak menjelaskan gejala klinis yang timbul. Hambatan reseptor D2 di formatio retikularis dapat menurunkan kesadaran. Hambatan reseptor D2 di jalur nigrostriatal dapat menyebabkan rigiditas. Hambatan reseptor D2 di hipotalamus dapat menyebabkan instabilitas otonom, gangguan pelepasan panas. Hiperpireksia terjadi akibat disfungsi hipotalamus dan kekakuan otot</span><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <u><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Faktor resiko<o:p></o:p></span></u></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman";">Jenis kelamin laki-laki dua kali lebih beresiko dibanding perempuan.Faktor predisposisi munculnya sindrom neuroleptik maligna adalah dehidrasi, malnutrisi, kelelahan, injeksi intramuskular neuroleptik, cedera kepala, infeksi, intoksikasi alkohol, pengunaan antipsikotik bersama dengan litium (Hall and Chapman, 2006). </span><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Gangguan ini dapat pula terjadi pada pasien yang baru menghentikan terapi dengan obat-obatan agoni dopaminergik seperti carbidopa, levodopa, amantadine dan bromocriptine.<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <u><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Panduan Wawancara dan Psikoterapi<o:p></o:p></span></u></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Sindrom neuroleptik maligna adalah kegawatdaruratan medik sehingga perlu dirawat di ICU. Kesadarannya terganggu, tanyakan perjalanan penyakitnya pada keluarga dan teman-temannya.<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <u><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Evaluasi dan Penatalaksanaan<o:p></o:p></span></u></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo16; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Pertimbangkan kemungkinan sindrom neuroleptik maligna pada pasien yang mendapat antipsikotik yang mengalami demam serta kekakuan otot.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo16; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Bila terdapat rigiditas rinan yang tidak berespon terhdap antikolinergik biasa dan bila demamnya tak jelas sebabnya, buatlah diagnosis sementara sindroma neuroleptik maligna.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo16; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Hentikna pemberian antipsikotik segera.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo16; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Monitor tanda-tanda vital secara berkala.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo16; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Lakukan pmeriksaan laboratorium<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo16; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Hidrasi cepat intrvena daapt mencegah erjadinya renjatan dan menurnkan kemungkinan terjadiny agagal ginjal.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo16; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Sindrom ini biasanya berlangsung selama 15 hari. Setelah sebuh, masalah kemudian adalah pemberian naipsikotik selanjutnya apakah mengganti dari kelas yang berbeda atau kembali ke antipsikotik semula yang efektif.<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <u><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Terapi Psikofarmaka<o:p></o:p></span></u></div> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l13 level1 lfo17; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Amantadine 200-400 mg PO/hari dalam dosis terbagi<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l13 level1 lfo17; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Bromocriptine 2,5 mg PO 2 atau 3 kali/hari , dapat dianikan sampai 45 mg/hari<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l13 level1 lfo17; text-align: justify; text-indent: -18.0pt;"> <!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Levodopa 50-100 mg/hari IV dlam infus terus-menerus<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"> <br /></div> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"> <br /></div> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"> <br /></div> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"> <br /></div> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"> <br /></div> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"> <br /></div> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"> <br /></div> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"> <br /></div> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"> <br /></div> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"> <br /></div> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"> <br /></div> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"> <br /></div> <div class="MsoNormal" style="line-height: 150%;"> <br /></div> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"> <b style="mso-bidi-font-weight: normal;"><span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">DAFTAR PUSTAKA<o:p></o:p></span></b></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%;">Elvira, Sylvia D dan Gitayanti Hadisukanto ed. 2010. <i style="mso-bidi-font-style: normal;">Buku Ajar Psikiatri</i>. Jakarta: Badan Penerbit FKUI<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"> <br /></div> <div class="MsoNormal" style="line-height: 150%; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-theme-font: minor-bidi;">Maramis, W.F. dan Maramis, A.A. 2009. <i style="mso-bidi-font-style: normal;">Catatan Ilmu Kedokteran Jiwa. Edisi 2</i>. Surabaya: Airlangga University Press.<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-theme-font: minor-bidi;">Sadock, B.J., Sadock, V.A., et al. 2007. <i style="mso-bidi-font-style: normal;">Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry</i>, 10th Edition. New York: Lippincott Williams & Wilkins.<o:p></o:p></span></div> <div class="MsoNormal" style="line-height: 150%; text-align: justify;"> <span lang="IN" style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 150%; mso-bidi-theme-font: minor-bidi;">Tomb, D.A. 2004. <i style="mso-bidi-font-style: normal;">Buku Saku Psikiatri</i>. Edisi 6. Jakarta: EGC.<o:p></o:p></span></div> <div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"> <br /></div> <br /></div>
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