ASUHAN KEPERAWATAN JIWA PADA KLIEN SKIZOFRENIA DENGAN PERUBAHANKONSEP DIRI: HARGA DIRI RENDAH KRONIK DI. Skizofrenia adalah suatu penyakit yang mempengaruhi otak dan menyebabkan timbulnya pikiran, persepsi, emosi, gerakan, dan perilaku yang aneh. Defisit Perawatan Diri Pada Klien Skizofrenia: Aplikasi Teori Keperawatan Orem. Salah satu caranya dengan memberikan asuhan keperawatan berdasarkan.

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Nearly half of the people suffering from schizophrenia also present akizofrenia a lifetime history of substance use disorders SUDa rate that is much higher than the one seen among unaffected individuals. It is critically important to address this comorbidity because SUD in schizophrenic patients is associated with poorer clinical outcomes and contributes significantly to their morbidity and mortality.

Nearly half of the people suffering from schizophrenia also present with a lifetime history of substance use disorders SUDs. Addressing comorbidity is clinically relevant because SUD in schizophrenic patients is associated with poorer clinical outcomes 18 and contributes significantly to their morbidity and mortality. Prevalence ranges are merely intended to illustrate the consistency of the trend in this population because they represent diverse sampling methods among studies done with different adult populations and measures of abuse.

The average rates of use and abuse or dependence in the general adult population were derived from the National Survey on Drug Use and Health 17 and secondary analyses of the — National Epidemiologic Survey on Alcohol and Related Conditions 1112 and are not intended to provide control baselines but as expedient markers for general comparison.

The mechanisms underlying the high comorbidity between SUD and schizophrenia are poorly understood but are likely to include both common across all drugs as well as drug-specific eg, nicotine and marijuana factors. The involvement of brain dopaminergic pathways is likely to be a shared feature in this comorbidity that is common to all drugs of abuse. To start with, the mesolimbic dopamine DA pathway has been implicated not only in the rewarding mechanism for all drugs of abuse via DA increases in nucleus accumbens or NAcc but also in the occurrence of positive symptoms in schizophrenia via excess striatal DA.

Thus, it is not surprising that drug intoxication from cocaine, methamphetamine, or marijuana use can trigger acute psychotic episodes and that some drugs amphetamines have been used to create surrogate animal models of schizophrenia. On the other hand, the mesocortical DA pathway has been implicated in the neuroadaptations that result from repeated drug exposures via DA deficits in prefrontal regions 20 and as a contributor to the negative symptoms of schizophrenia via decreased DA in skziofrenia cortex.

Kynurenine pathway in schizophrenia: pathophysiological and therapeutic aspects.

asoep However, because chronic drug use is associated with reduced DA neurotransmission, this behavior could actually backfire and exacerbate negative symptoms and skzofrenia deficits eg, attention, executive function, saliency and interfere with functional recovery. The comorbidity of SUD and schizophrenia may also be a direct consequence of the underlying neuropathology of schizophrenia, which may contribute to enhanced addiction vulnerability by disrupting the neural substrates that mediate positive reinforcement.


Non-DA pathways have been implicated too. For example, the cognitive impairments associated with asoep circuits also involve dysregulated glutamatergic neurotransmission, and for both disorders, medications that affect glutamatergic neurotransmission are being evaluated as potential treatments.

Nicotine is by far the most prevalent drug abused by schizophrenia patients. While this may be partly due to its legal status and easy access, it may also reflect nicotine’s specific effects on brain nicotinic acetylcholine receptors nAChRs.

There may be a neural basis for this hypothesis: This might explain how smoking by schizophrenia patients could improve some of the cognitive deficits seen in this disorder. Cannabis is also frequently abused by schizophrenic patients, and it is associated with worse clinical outcomes.

For example, a recent magnetic resonance imaging study concluded that the loss of gray matter, commonly seen in the skizofreina of schizophrenic patients, proceeds nearly twice as fast in patients who also aksep cannabis over a sjizofrenia follow-up.

Because the difference could not be explained by skizorrenia or baseline characteristics, this result adds to the evidence in favor of a detrimental effect of cannabis in schizophrenia.

Just as for other drugs, it is possible that schizophrenic patients abuse marijuana not only for its hedonic properties but also for other pharmacological effects of cannabinoids. Specifically, because a basic function of the endocannabinoid system in the brain is to control emotional responses to stress, 25 it is plausible that some schizophrenic patients may abuse marijuana to help them cope with stress.

Though there is evidence of alterations in cannabinoid signaling in the brain of schizophrenic patients, 26 their role in the neuropathology of schizophrenia is still poorly understood. Both schizophrenia and addiction are highly heritable and genetically complex disorders, and, even though studies are still struggling with small effect sizes and inconsistencies, the field appears to be coalescing around a select, albeit by no means controversy-free set of candidate genes.

Common psychosocial factors eg, limited education, poverty, unemployment, peer influence, and the structure of the mental health treatment system may account for a portion of the increased comorbidity. Both disorders are skizofrebia with a greater exposure to stressors, which on one hand increase askkep taking and on the other exacerbate psychotic symptoms in schizophrenia patients. Finally, concurrent drug abuse is recognized to significantly contribute to the morbidity and mortality in schizophrenia patients.

This includes the devastating consequences from heavy smoking in this patient population, as well as deaths from overdose and poisoning from other drugs of abuse. Despite its importance, research on the treatment of comorbidity has been very limited. Nonetheless, some promising findings have been reported. This includes a recent study that focuses on the known disturbances in the endocannabinoid system of schizophrenics and points to anandamide as a promising smizofrenia for medications to reduce substance abuse in schizophrenia patients.

Similarly, some studies suggest skizofreenia some second-generation antipsychotics may be effective for comorbid SUD in schizophrenia, particularly clozapine and nicotine dependence. Of the behavioral interventions that have been evaluated, assertive community treatments, which integrate the behavioral treatment of severe mental disorders, such as schizophrenia, and co-occurring SUD, is a promising example.

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There is also a need for services research that focuses on the special treatment challenges in patients with comorbid schizophrenia and SUD, such as the implementation of therapeutic interventions in criminal justice settings, where persons suffering from severe mental illness and SUDs are markedly overrepresented.

In summary, addressing comorbidity of SUD in schizophrenia has important clinical skizofrsnia for both the prevention and treatment of skizoffenia 2 disorders and also for decreasing morbidity and mortality.

Moreover, research shows that treatment of patients with comorbidity should include interventions for both disorders because lack of adequate treatment of one of the disorders interferes with recovery. National Center for Biotechnology InformationU.

Journal List Schizophr Bull v. Published online Mar Author information Copyright skizofreenia License information Disclaimer. This article has been cited by other articles in PMC. Abstract Nearly half of the people suffering from schizophrenia also present with a lifetime history of substance use disorders SUDa rate that is much higher than skizorfenia one seen among unaffected individuals.


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Substance Use Disorders in Schizophrenia—Clinical Implications of Comorbidity

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Walker EF, Diforio D. Goldsmith RJ, Garlapati V. Behavioral interventions for dual-diagnosis patients. Psychiatr Clin North Am. Support Center Support Center. Please review our privacy policy.