PSIKOFARMAKA

 Antipsikotika: memblok reseptor DA paskasinaps

 Antidepresan: menghambat pengambilan
kembali 5-HT
 Antiansietas: bekerja di GABA
 Antimania: bekerja di 3rd messenger di intrasel
 Anti obsesif kompulsif: menghambat pengambilan
Pembagian kembali 5-HT
Psikofarmaka  Anti insomnia: bekerja di GABA
 Penstabil mood: bekerja di GABA dan di 3rd
messenger di intrasel
 Antidemensia: memblok enzim metabolism
asetilkolin
 Anti ADHD: melepas berbagai neurotransmiter
Treatment Algorithm of
Schizophrenia
 Cognitive Behavioural Primary option
Initial 1st
Therapy (risperidone)

commence or review
Secondary options
1st oral antipsychotic
(olanzapine)
medication :

Tertiary options
(haloperidol)

Primary options
(olanzapine)
Acute (acute psychotic intramuscular or
Adjunct
episode) inhaled antipsychotic
Secondary options
(loxapine inhaled)

intramuscular Primary options

Adjunct
lorazepam (lorazepam)

electroconvulsive
Adjunct
therapy (ECT)
 Primary options
(risperidone/olanzapine)
oral second-generation
antipsychotics
Secondary options
(cariprazine/clozapine)
plus psychosocial and other
Ist
interventions

plus health maintenance

Primary options (haloperidol)

oral first-generation
antipsychotics
Secondary options
(fluphenazine/perphenazine)
Ongoing (Chronic plus psychosocial or other
2nd
symptoms) interventions

plus health maintenance

Primary options
(risperidone/olanzapine)
intramuscular second- or first-
generation antipsychotics
Secondary options (haloperidol
decanoat/fluphenazine decanoat)
plus psychosocial and other
3rd
interventions

plus health maintenance

 Primary options
Comorbid bipolar
plus mood stabilisers (lithium/carbamazepine/valp
spectrum symptoms
oric acid)

Primary options
Comorbid
plus antidepressants (fluoxetine/sertraline/mirtaza
depression
pine)
Ongoing
(Chronic
symptoms)
Primary options
Comorbid anxiety plus anxiolytics (alprazolam/clonazepam/diaz
epam/buspirone)

Primary options
plus selected
Prominent negative (fluoxetine/rivastigmine/mino
antidepressants or ginkgo
symptoms cycline/ondansentron/ginkgo
extract or ondansetron
biloba)
Treatment Algorithm of
Depression
 Primary options
(fluoxetine/sertraline/duloxetine/bup
ropiion/mirtazapine)

Second- or third-generation
antidepressant

Secondary options (Reboxitine)

1st Plus : psychotherapy

Supportive Interventions
Low acuity, non-pregnant: low to Primary options
moderate severity symptoms, partial (amitriptyline/nortriptyline)
Acute impairment, no psychotic symptoms,
no suicidal ideation, or no
psychomotor retardation or agitation
Switch to tricyclic
2nd antidepressant or combination
therapy
combination therapy
(fluoxetine/veniafaxine/sertraline)+
(bupropion/mirtazapine/lithium/olan
zapine)

3rd St John's wort

 Primary options
(fluoxetine/sertraline/duloxetine/bupropiion/m
irtazapine)
Second- or third-generation
antidepressant
Secondary options (Reboxitine)

1st Plus : psychotherapy

Insomnia (quetiapine)
Adjunct : immediate symptom
management with
benzodiazepine ± antipsychotic
severe anziety/mild agitation (quetiapine
and/or lorazepam)
Moderate acuity,
non-pregnant:
severe symptoms, Primary options (amitriptyline/nortriptyline)
significant Switch to tricyclic
impairment but no antidepressant or combination
psychotic therapy combination therapy
Acute 2nd
symptoms, no (fluoxetine/veniafaxine/sertraline)+
suicidal ideation, or (bupropion/mirtazapine/lithium/olanzapine)
no severe Plus : psychotherapy
psychomotor
retardation or
agitation Monoamine oxidase inhibitor
Primary options (isocarboxazid/penelzine)
(MAOI)
3rd

Plus : psychotherapy

4th Electroconvulsive therapy (ECT)

 1st : hospitalisation + psychiatric
referral ± electroconvulsive
therapy (ECT)
Primary options
(citalopram/fluoxetine/duloxetine/
bupropion)
Plus : second- or third-generation
antidepressan

high acuity, non-pregnant: Secondary options (reboxetine)

psychotic, suicidal, severe
Acute psychomotor retardation impeding
activities of daily living, catatonia,
or severe agitation

Primary options for catatonia

(lorazepam)

Adjunct : immediate symptom

management with benzodiazepine Insomnia (quetiapine/trazodone)
± antipsychotic

Severe anxiety/mild agitasion

(quetiapine and/or lorazepam)
Treatment Algorithm of
Bipolar Disorder
 Primary options
(olanzapine)
1st : intramuscular
With Agitation neuroleptic or
benzodiazepine Secondary options
(haloperidol
lactate/lorazepam)

Oral monotherapy: mood Primary options (lithium/valproate

stabiliser or atypical semisodium/carbamazepine/risperido
antipsychotic ne)
not rapid-cycling and 1st
non-pregnant: acute
Acute
mania, hypomania, or Adjunt : Clonazepam
mixed

Oral monotherapy:
alternative mood
stabiliser or atypical
antipsychotic

Oral combination Primary options (lithium/valproate

2nd therapy: mood stabiliser semisodium/carbamazepine)+
No agitation: mild + atypical antipsychotic (risperidone/olanzapine/quetiapine)
severity

Oral typucal Primary options

antipsychotic (haloperidol/chlorpromazine)

Clozapine or
3rd electroconvulsive
therapy (ECT)

Alternative
pharmacotherapy or
4th alternative brain
stimulation techniques
 Primary options
(lithium/valproate
oral mood stabiliser
semisodium/carbamaz
and/or atypical
epine) AND/OR
antipsychotic
(risperidone/olanzapin
1st e)

Adjunct : clonazepam

Alternative oral mood

stabiliser and/or
atypical antipsychotic

not rapid-cycling and 2nd Adjunct : clonazepam

non-pregnant: acute No agitation: moderate
Acute
mania, hypomania, or to severe severity
mixed
Primary options
Oral typical
(haloperidol/chlorpro
antipsychotic
mazine)

Clozapine or
3rd electroconvulsive
therapy (ECT)

Alternative
4th
pharmacotherapy
 Primary options
Oral mood stabiliser or
(lithium/valproate
atypical antipsychotic
semisodium/carbamazepine
monotherapy
/risperidone/olanzapine)
1st

Plus : removal of
exacerbating factors
Rapid-cycling and non-
Acute
pregnant Primary options
(lamotrigine) AND (lithium)
Combination theraphy AND
(clonazepam/risperidone/ol
anzepine)
2nd

Plus : removal of
exacerbating factors
 Primary options
Mood stabiliser or
(lithium/olanzapine/ris
atypical antipsychotic
peridone

Plus : psychosocial
interventions and
After stabilisation of monitoring
With mania Primary options
Ongoing acute episode: non- 1st
predominant feature (valproate
pregnant
Adjunct : additional semisodium/carbamaz
pharmacotherapy epine/olanzepine/risp
eridone/phenytoin/om
ega-3-acid ethyl)
Adjunct :
electroconvulsive
therapy (ECT)
 Lamotrigine

Plus : psychosocial
interventions and
After stabilisation of monitoring
With depression Primary options
Ongoing acute episode: non- 1st
predominant feature (valproate
pregnant
Adjunct : additional semisodium/carbamaz
pharmacotherapy epine/olanzepine/risp
eridone/phenytoin/om
ega-3-acid ethyl)
Adjunct :
electroconvulsive
therapy (ECT)
 Lithium or valproate
semisodium and/or
quetiapine
Primary options
After stabilisation of (carbamazepine/risper
With both mania and Adjunct : additional
Ongoing acute episode: non- 1st idone/olanzepine/phen
depression pharmacotherapy
pregnant ytoin/omega-3-acid
ethyl esters)
Adjunct:
electroconvulsive
therapy (ECT)
Treatment Algorithm of
GAD
 Primary options
(escitalopram/sertraline/veniaf
axine/duloxetin/buspirone)
Pharmacotheraphy
Secondary options
(imipramine/quetiapine)

1st
Primary options
Adjunct : benzodiazepine
(clonazepam/diazepam)

Adjunct : CBT, applied relaxation,

mediation training, sleep hygiene
education, exercise, self-help

CBT alone
Non-pregnant adults
1st
Adjunct : applied relaxation,
mediation training, sleep hygiene
education, exercise, self-help

Meeting DSM-5 augmented treatment

criteria
2nd
Adjunct : applied relaxation,
mediation training, sleep hygiene
education, exercise, self-help

Not meeting DSM-5

1st individualised therapy
criteria
Treatment Algorithm of
Panic Disorder
 CBT
reassurance ±
Aute Acute panic attack 1st
benzodiazepines
Primary options
SSRIs or SNRIs (sertraline/fluoxetine/citalo
pram/veniafaxine)
1st
Plus
education/information
about panic and
anxiety

Adjunct : CBT,
benzodiazepine
Primary options
(clonazepam)
Benzodiazepine
Secondary options
(alprazolam/lorazepam/dia
Ongoing Panic Disorder No Comorbidity Plus zepam)
education/information
2nd
about panic and
anxiety

Adjunct : CBT

Tricyclic
Primary options
antidepressants
(imipramine/clomipramine)
(TCAs)
Plus
education/information
2nd
about panic and
anxiety

Adjunct : CBT
 CBT

Primary options
SSRIs or SNRIs (sertraline/fluoxetine/cital
opram/veniafaxine)
1st
Plus education/information
about panic and anxiety

Adjunct : CBT

Tricyclic Primary options

antidepressants (imipramine/clo
(TCAs) mipramine)
With comorbid Plus
Ongoing Panic Disorder 2nd education/information
depression
about panic and anxiety

Primary options
Adjunct : CBT (fluoxetine/citalopra
m/sertraline) +
(veniafaxine) OR
(fluoxetine/citalopra
dual m/sertraline )+
pharmacotherapy (mitrazapine) OR
(fluoxetine/citalopra
Plus m/sertraline)AND(im
education/informati ipramine) OR
3rd
on about panic and (mirtazapine)+
anxiety (imipramine)

Adjunct : CBT
 1st CBT

Primary options
(sertraline/fluoxetine/
SSRIs or SNRIs
citalopram/veniafaxin
e)
Plus
education/informati
1st
on about panic and Primary options
With comorbid anxiety
Panic Disorder (clonazepam)
anxiety
Adjunct : CBT, Benzodiazepine
benzodiazepine Secondary options
(alprazolam/lorazepa
Plus m/diazepam)
education/informatio
2nd
n about panic and
anxiety
Ongoing Tricyclic Primary options
antidepressants (imipramine/clom
2nd Adjunct : CBT (TCAs) ipramine)

Counseling and Plus

2nd 2nd education/informatio
monitoring
Panic attack n about panic and
without panic 1st anxiety
Plus
disordeer education/information
about panic and Adjunct : CBT
anxiety
Treatment Algorithm of
ADHD
 Primary options
(methylphenidate/lisdex
amfetamine:)
stimulant therapy ±
1st
psychological therapy
Secondary options
(dexamfetamine)
atomoxetine ±
ADHD without 2nd
psychological therapy
Ongoing concomitant mood
disorder or anxiety

alternative experimental
treatments including
Primary options
bupropion, antidepressants
3rd (bupoprion/veniafaxine/
and antipsychotic
risperidone)
medication ±
psychological therapy
 ADHD with depression
antidepressants +
(with or without prominent 1st
psychological therapy
anxiety)

Primary options
(methylphenidate/lisdexa
mfetamine)
ADHD with depression
Ongoing (with or without prominent
anxiety) persistent ADHD-like Adjunct : ADHD Secondary options
symptoms medication treatments (dexamfetamine)

persistent anxiety Adjunct : anxiolytic Tertiary options

symptoms despite therapies (bupoprion/veniafaxine)
euthymia on (benzodiazepines and
antidepressants antidepressants)
 ADHD with bipolar
mood stabilisers +
disorder (with or without 1st
psychological therapy
prominent anxiety)

Primary options
(methylphenidate:/lisdex
ADHD with bipolar persistent ADHD-like amfetamine:)
Ongoing disorder (with or without symptoms despite Adjunct : ADHD
prominent anxiety) euthymia on mood medication treatments
stabilisers Secondary options
(dexamfetamine/atomox
etine)

persistent anxiety
symptoms despite Adjunct : anxiolytic
euthymia on mood therapies
stabilisers
 ADHD with anxiety Adjunct : anxiolytic +
1st
disorder alone psychological therapy

Primary options
ADHD with anxiety
Ongoing (methylphenidate/lisdexa
disorder alone
mfetamine)

Persistent ADHD-like
symptoms despite Adjunct : ADHD medication Secondary options
controlled anxiety on treatments (dexamfetamine)
anxiolytics

Tertiary options
(bupoprion/veniafaxine)
 ‫‪Terima Kasih ‬‬

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