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ADHD. ATTENTION-DEFICIT-HIPERACTIVITY DISORDER. PENDAHULUAN. KEPUSTAKAAN PERTAMA OLEH GEORGE STILL (1902) YANG MENYEBUTKAN BERUPA DEFISIT OF “MORAL KONTROL” STRAUSS DAN LEHTINEN (1947) MENGUNAKAN MBDS minimal brain damage syndrome

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ADHD

ATTENTION-DEFICIT-HIPERACTIVITY DISORDER


Pendahuluan
PENDAHULUAN

  • KEPUSTAKAAN PERTAMA OLEH GEORGE STILL (1902) YANG MENYEBUTKAN BERUPA DEFISIT OF “MORAL KONTROL”

  • STRAUSS DAN LEHTINEN (1947) MENGUNAKAN MBDS minimal brain damage syndrome

  • CLEMENT DAN PETERS (1962) Abnormalitas pada fungsi ini tanpa dapat dibuktikan kerusakan otak.

  • Kelainan ATENSI dan Kelainan neurologi pada lobus frontalis dan sirkuit frontostriatsal, berupa abnormalitas transmisi dopamin.


Kriteria diagnostik dsm iv
KRITERIA DIAGNOSTIK DSM-IV

  • 1. Enam atau lebih gejala kurang mampu memperha tikan terus menerus sekurang-kurangnya 6 bulan

    a. Sering mendapat kesulitan untuk tetap memperhatikan dalam

    kegiatan tugas atau permainan.

    b. Sering seakan tidak mendengarkan kalau diajak bicara seca-

    ra langsung.

    c. Sering tidak memahami instruksi dan gagal menyelesaikan

    pekerjaan sekolah, pekerjaan sehari-hari atau kantor (bukan

    berupa penantangan).

    d. Sering mendapatkan kesulitan mengatur tugas atau kegiatan


Kriteria diagnosis lanjutan
Kriteria diagnosis (lanjutan)

  • 1.e. Sering menghindar, tidak suka atau enggan terlalu tekun dalam

    tugas yang menuntut upaya mental yang terus menerus.

    f. Sering kehilangan benda-benda yng diperlukan untuk tugas/ ke-

    giatan

    g. Sering gampang terganggu oleh rangsangan yang berlebihan

    h. Sering alpa dalam kegiatan sehari-hari.

    2. Enam atau lebih gejala hiperaktifitas-impulsivitas terus menerus se-

    kurang-kurangnya 6 bulan sampai satu tingkat yang tidak bisa diteri-

    ma atau tidak kosisten dengan tingkat pertumbuhan.

    Hiperaktivitas.

    a Tangan dan kaki tidak bisa diam atau duduk dengan gelisah

    b. Sering meninggalkan kursi di kelas atau dalam situasi lainnya

    ketika diharapakan duduk dengan manis.


Diagnosis lanjutan
Diagnosis lanjutan

  • 2.c.Sering lari kesana kemari atau banyak memanjat-manjat dalam

    situasi diharapkan duduk manis

    d. Sering tidak bisa diam ketika bermain atau menggunakan wak-

    tu luang.

    e. Sering “bergerak terus” atau sering bertindak seakan “didorong

    sebuah motor”

    f. Sering mengomong terus-menerus.

    Impulsivitas.

    a. Sering menjawab sebelum pertanyaan selesai

    b. Sering tidak sabar menunggu giliran

    c. Sering menyela orang lain (mis. Menyela pembicaraan atau per-

    mainan.


Diagnosis lanjutan1
Diagnosis lanjutan

  • B. Beberapa gejala hiperaktif-impulsif atau kurang mampu memper- hatikan yang menyebabkan kelemahan itu telah muncul sebelum usia 7 tahun.

    C. Beberapa kelemahan dari gejala-gejala muncul dalam 2 latar atau lebih (mis. Disekolah, dirumah, kantor)

    D. Harus ada bukti yang jelas tentang kelemahan yang mencolok secara klinis dalam fungsi sosial, akademik atau pekerjaan.

    E. Gejala-gejala itu tidak terus menerus selama terjadi suatu kelainan perkembangan menahun, skizoftrenia,atau kelainan psikotik lainnya dan tidak lebih disebabkan oleh kelainan mental lainnya (misalnya kelainan suasana hati, kecemasan, kelainan non

    sosiatif, atau kelainan kepribadian.)


Patogenesis psikopatologi adhd
Patogenesis & Psikopatologi ADHD

Genetik/lingkungan/gn DAT 1 atau DRD 4 / faktor biologik lain

Disfungsi korteks prefrontal dan perietal, gangliabasalis

Disfungsi sistem inhibisi perilaku

Ganggusn proses, regulasi perilaku

ADHD

Inatensi, hiperaktivity Impulsiviti dll


Gangguan neuroanatomi pada adhd
Gangguanneuroanatomipada ADHD

  • Volume otak 4% lebihkecildibandingkansaudaranya

  • Perangentik

  • Volume otaksaudara ADHD 3,4% lebihkecildibandingkanindividutanpaRiwkeluarga ADHD

  • Inferior dorsal PFC dan anterior kortek temporal mengecil


Co morbidities
Co-morbidities

  • Oppositional defiant disorder

  • Anxiety disorder

  • Learning disorder

  • Mood disorder

  • Conduct disorder

  • Smoking

  • Substance use disorder

  • Tics


Efek adhd pada pasien dan keluarga
Efek ADHD padapasiendankeluarga

  • Padapasien

    Akademik

    Sosial

    Pekerjaan

    Penyalahgunaanobat

    Kecelakaan

  • Padakeluarga

  • Stres

  • Depresi

  • Hub Kekeluargaan

  • Perobahan status pekerjaan


Penanganan
Penanganan

  • Tujuan

    • Peningkatandayaakademik

    • Kemandirian

    • Perbaikaninteraksisosial

    • Kontroldiri

    • Kausa

    • Komprehensif


  • Komprehensif

    • Orangtua

    • Guru

    • Klinisi

  • melalui

    • Teknikintervensitingkahlaku

    • Nutrisi

    • Obat-obatan


  • Teknikintervensitingkahlaku

    • Penghargaan

    • Sanksi

    • Aktifitasfisik


  • Nutrisi

    • Pemberianmakananygmengandung omega-3 dan omega6

  • Obat-obatan

    • Metilpenidate

    • Amfetamin

    • Peningkatankatekolaminpadacelahsinap

    • Pemberiandimulaidaridosisrendah


  • Atomoxin

    • Inhibitor selektifnorepineprin

    • Dosis 0,5 mg/kg dptditingkatkansampai 1,4 mg/kg

    • Mulaikerjalambattetapibertahan lama


Penatalaksanaan
PENATALAKSANAAN

  • Obat stimulan

    Obat stimulan, simpatomimetik secara struktural

    sama dengan katekolamin endogen bekerja secara

    sentral dan perifer dengan meningkatkan dopamin

    dan “nonadrenergic-transmission”

    Stimulan memperbaiki kemampuan kognitif, perfor-

    man sekolah dan tingkah laku.

    Methylpenidate memfasilitasi aktifitas dopaminergik pada

    Beberapa bagian otak, dan perbaikan hiperaktif dan impul-

    sif dengan menurunkan stimulasi dopaminergik pada bagi-

    an otak yang lain.


Kesimpulan
Kesimpulan

  • Terdapatbuktiketerlibatangangguanotakbaikanatomismaupunneurotransmiternyapada ADHD

  • Dalampenangananterhadappenderita ADHD perludilakukansecarakomprehensifberupapemberianobat-obatan, intervensitingkahlakudannutrisi


  • INATTENTION

    KELAINAN DASAR ADALAH LEMAHNYA ATENSI

    Parents may say

    When I tell her something it goes in one ear and out the other

    I know he can attend; he plays Nintendo for hours.

    He knows all the baseball players but he can’t remember what I

    said a minute ago.

    Teacher may say:

    Sometimes he just seems to be in outer space

    When I call on him, he never seems to have the right place in rea

    ding

    She just has so much trouble following instructions.


  • Impulsivity

    Parents may say

    He`s 10 years old, but still interrupts my conversations.

    He`s got such a short fuse-you never know what to expect.

    I`m afraid to let her ride her bike in the street; she`s had so many accidents.

    Teachers may say:

    You really have to watch this preschooler all the time.

    Other students tease him a lot-they know how to get him to react.

    he has much difficulty waiting to be called; he often just blurts out an answer.


  • Hyperactivity

    Parents may say:

    He was overactive even before he was born.

    This toddler is always in motion.

    When we visit friends she has to touch everything.

    Teachers may say:

    He just can`t stay seated very long.

    she`s always talking to her neighbor in class.

    His drumming that pencil is really annoying.


  • Disorganization

    Parents may say:

    Her room is always a mess.

    He`s always losing things. He just can`t get organized.

    If I ask him to tuch his shirt in, even more of it is out when he`s “fixed” it.

    Teachers may say:

    He can`t even seem to find things that he needs

    Before doing classwork, she`ll take out a pencil, put it way, try to find paper, take out another pencil and sharpenit. It take forever for her to get started.

    His desk is so messy he can`t find anyting.


  • Poor sib/peer relations (social problems)

    Parents may say:

    She says she has no friends.

    Before medications, he was the last one to be asked to a child`s party.

    when he`s in a group, he acts like an idiot.

    Teacher may say:

    He`s such a loner-no one seems to likee him. Sametimes I think he doesn`t finish his work so that he can stay in and avoid recess.

    She gets so hurt when her classmates avoid her.

    He has a real problem playing by the rules at recess.


  • Aggressive behavior

    Parents may say:

    He`s always picking on his brother.

    She seems to defy me when I ask her to do samething.

    When this kid gets angry, he`s like a wild person-you can`t control him.

    Teachers may say:

    this child is so many discipline notices-i`m beginning to think he enjoys it.

    when there is trouble, this kid is always involved.


  • Poor self-concept/self-esteem

    Parents may say:

    He says he`s stupid.

    He seems to get along better with younger kids and other that have problems.

    She says she has no friends.

    Teachers may say:

    Nobady wants to play with this child.

    He seems to give up so easily-he doesn`t try anymore.

    He makes fun of himself and gets loughs.


Neurobiologi adhd
Neurobiologi ADHD

  • Berkurangnya volume prefrontal hemisfer kanan>kiri

  • Kadang-kadang reduksi dari ganglia basalis inti kaudatus kiri

  • Reduksi dari volume serebelum.


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