SCHIZOPHRENIA, ketidakmampuan otak untuk membedakan kenyataan, khayalan dan halusinasi

Definisi Skizofrenia:

1.      Skizofrenia adalah kekacauan jiwa yang serius ditandai dengan kehilangan kontak pada kenyataan (psikosis), halusinasi, khayalan (kepercayaan yang salah), pikiran yang abnormal dan menggangu kerja dan fungsi sosial (DSM-IV-TR, 2008)

2.      Skizofrenia adalah sekelompok reaksi psikotik yang mempengaruhi berbagai area fungsi individu, termasuk berpikir dan berkomunikasi, menerima dan menginterpretasikan realitas, merasakan dan menunjukkan emosi dan berperilaku dengan sikap yang tidak dapat diterima secara sosial (Durand dan Barlow, 2007)

3.      Skizofrenia adalah penyakit otak yang timbul akibat ketidakseimbangan pada dopamine, yaitu salah satu sel kimia dalam otak. Ia adalah gangguan jiwa psikotik paling lazim dengan ciri hilangnya perasaan afektif atau respon emosional dan menarik diri dari hubungan antarpribadi normal, sering kali diikuti dengan delusi (keyakinan yang salah) dan halusinasi (persepsi tanpa ada rangsangan panca indera) (Arif, 2006).

Schizophrenia punya banyak jenis dengan berbagai ciri/ gejala. Tapi, yang paling umum adalah halusinasi. Penderita tidak bisa membedakan antara kenyataan dengan dunia fantasi yang ia ciptakan. Halusinasi di sini bisa diartikan sebagai melihat, berinteraksi, dan menjalin persahabatan dengan seseorang yang sebenarnya tidak nyata atau tak bisa dilihat oleh orang lain. Interaksi ini bisa berakibat fatal karena penderita schizophrenia bisa berbuat sesuatu yang di luar nalar sebagai hasil interaksi dengan “orang” dalam pikirannya.

Dengan kata lain, schizophrenia adalah gangguan kejiwaan yang membuat pikiran penderitanya menjadi tersiksa. Sehingga mengakibatkan keselamatan hidup ia dan orang-orang di sekitarnya menjadi terancam. Ketika gejala schizophrenia kambuh, penderita umumnya akan merasakan kecemasan atau ketakutan berlebihan. Banyak yang akhirnya membunuh diri sendiri atau orang lain karena merasa “disuruh” oleh seseorang yang ada dalam
pikirannya.

  JENIS-JENIS SKIZOFRENIA

Terdapat berbagai macam skizofrenia, yaitu sebagai berikut:

1.      Skizofrenia simplex

Yaitu skizofrenia yang sering timbul pertama kali pada masa pubertas (pada beberapa kasus). Gejala utamanya adalah kedangkalan emosi dan kemunduran kemauan. Gangguan proses berpikir biasanya ditemukan, waham dan halusinasinya jarang sekali ada.

2.      Jenis hebrefenik

Yaitu jenis skizofrenia yang permulannya perlahan-lahan dan sering timbul pada masa remaja atau antara 15-25 tahun. Gejala yang menyolok ialah gangguan proses berfikir, gangguan kemauan dan adanya depersonalisasi.

3.      Jenis katatonik

       Yaitu jenis skizofrenia yang timbulnya pertama kali antara umur 15-30 tahun, biasanya akut    serta   didahului oleh stres emosional. Skizofrenia jenis ini melibatkan aspek psikomotorik

4.     Jenis Paranoid

Jenis skizofrenia ini agak berbeda dari jenis-jenis yang lain dalam jalannya jenis penyakit. Jenis ini mulai sesudah umur 30 tahun, penderita mudah tersinggung, cemas, suka menyendiri, agak congkak dan kurang percaya pada orang lain. Hal ini dilakukan penderita karena adanya waham kebesaran dan atau waham kejar ataupun tema lainnya disertai juga dengan halusinasi yang berkaitan.

5.      Skizofrenia Residual

Yaitu jenis skizofrenia dengan gejala mengalami gangguan proses berpikir, gangguan afek dan emosi, ganguan emosi serta gangguan psikomotor. Namun, tidak ada gejala waham dan halusinasi. Keadaan ini timbul sesudah beberapa kali serangan skizofrenia.

6.      Jenis Skizo-Afektif

Yaitu jenis skizofrenia yang selain gejala-gejalanya yang menonjol secara bersamaan juga gejala-gejala depresi atau gejala-gejala mania menyertai. Jenis ini cenderung untuk menjadi sembuh tanpa efek tetapi mungkin juga seringkali timbul lagi.

Idiopathic thrombocytopenic purpura (ITP) Treatments and drugs

The goal of treating ITP is to ensure a safe platelet count and prevent bleeding complications while minimizing treatment side effects.
In children, idiopathic thrombocytopenic purpura usually runs its course without the need for treatment. About 80 percent of children with idiopathic thrombocytopenic purpura recover completely within six months. Even in children who develop chronic ITP, complete recovery may still occur, even years later.
Adults with mild cases of ITP may require nothing more than regular monitoring and platelet checks. But if your symptoms are troublesome and your platelet count remains low, you and your doctor may opt for treatment. Treatment usually consists of medications and sometimes surgery (splenectomy). Your doctor may also have you discontinue certain drugs that can further inhibit platelet function, such as aspirin, ibuprofen (Advil, Motrin, others) and the blood-thinning medication warfarin (Coumadin).
Medications
Common medications used to treat idiopathic thrombocytopenic purpura include:

• Corticosteroids. The first line of therapy for ITP is a corticosteroid, usually prednisone, which can help raise your platelet count by decreasing the activity of your immune system. Once your platelet count is back to a safe level, you can gradually discontinue taking the drug under the direction of your doctor. In general, this takes about two to six weeks.
  The problem is that many adults experience a relapse after discontinuing corticosteroids. A new course of corticosteroids may be pursued, but long-term use of these medications isn't recommended because of the risk of serious side effects, including cataracts, high blood sugar, increased risk of infections and loss of calcium from your bones (osteoporosis). You and your doctor will want to weigh the benefits of the medication against these risks. If you've taken corticosteroids for longer than three months, your doctor will likely recommend that you take calcium and vitamin D supplements to help maintain your bone density.
• Intravenous immune globulin (IVIG). If you have critical bleeding or need to quickly increase your blood count before surgery, you may receive medications, such as immune globulin, given intravenously. These medications are quick and effective, but the effect usually wears off in a couple of weeks. Possible side effects include headache, nausea and vomiting.
• Thrombopoietin receptor agonists. The newest medications approved to treat ITP are romiplostim (Nplate) and eltrombopag (Promacta). These drugs help your bone marrow produce more platelets, which helps prevent bruising and bleeding. Possible side effects include headache, joint or muscle pain, dizziness, nausea or vomiting, and an increased risk of blood clots.

Surgery
If you have severe ITP and an initial course of prednisone hasn't helped, surgical removal of your spleen (splenectomy) may be an option. This eliminates the main source of platelet destruction in your body and improves your platelet count within a few weeks. Splenectomy for ITP is not as routinely performed as it once was, however. Serious post-surgical complications sometimes occur, and not having a spleen permanently increases your susceptibility to infection. What's more, some people relapse even after splenectomy.
Splenectomy is rarely performed in children because of their high rate of spontaneous remission.
Emergency treatment
Although rare, severe bleeding can occur with ITP, regardless of age or platelet count. Severe or widespread bleeding is life-threatening and demands emergency care. This usually includes transfusions of platelet concentrates, intravenous methylprednisolone (a type of corticosteroid) and intravenous immune globulin.
Other treatments
If neither the initial round of corticosteroids nor a splenectomy has helped you achieve remission and your symptoms are severe, your doctor may recommend another course of corticosteroids, usually at the lowest effective dose.
Other possible treatments include:

• Immunosuppressant drugs. Medications that suppress the immune system, such as rituximab (Rituxan) — the most commonly used of this group — cyclophosphamide (Cytoxan) and azathioprine (Imuran, Azasan), have been used to treat ITP, but they can cause significant side effects, and their effectiveness has yet to be proved.
• Experimental drugs. New medications that increase platelet production, especially eltrombopag and AMG 531, are being studied in clinical trials. Although they appear to be well tolerated, questions about long-term side effects remain, and relapse is possible when the drugs are stopped.
• H. pylori treatment. Some people with ITP are also infected with Helicobacter pylori, the same bacteria that cause most peptic ulcers. Eliminating the bacteria has helped increase platelet count in some people, but the results for this therapy are inconsistent and need to be studied further.

Because of the potential complications of both the disease and its treatment, it's important for you and your doctor to carefully weigh the benefits and risks of treatment. For example, some people find that the side effects of treatment are more burdensome than the effects of the disease itself. Treatment decisions are usually based on:

• Severity of signs and symptoms (active bleeding is usually an indication for treatment)
• Platelet count — even relatively low counts (less than 30,000 platelets per microliter of blood) may not merit treatment, especially if you have no active bleeding and have a fairly sedentary lifestyle
• Your age and willingness to undergo treatment
• Risk of bleeding relative to lifestyle, such as participation in sports or other vigorous physical activities that may predispose you to injury
• Risk of bleeding based on other medical conditions (high blood pressure, infections, alcoholism, chronic liver disease, peptic ulcer) or needed medications, such as aspirin
• Potential side effects of ITP therapies

http://www.mayoclinic.com/health/AboutThisSite/AM00057

Idiopathic Thrombocytopaenic Purpura

What Is Idiopathic Thrombocytopaenic Purpura?

Idiopathic thrombocytopaenic purpura (ITP) is a bleeding disorder in which the blood does not clot as it should. The bleeding is due to a low number of platelets (PLATE-lets), blood cells that help the blood clot and stop bleeding. People with ITP often have purple bruises that appear on the skin. The bruises mean that bleeding has occurred in small blood vessels under the skin.
The words idiopathic, thrombocytopaenic, and purpura mean:

• Idiopathic (id-ee-o-PATH-ick) means that the cause of the disease or disorder is not known.
• Thrombocytopaenic (throm-bo-cy-toe-PEE-nick) means there is a lower-than-normal number of platelets in the blood.
• Purpura (PURR-purr-ah) are purple bruises where bleeding occurs just under the skin. Purple areas may also appear on the mucus membranes (for example, in the mouth). A person with ITP also may have bleeding that looks like tiny red or purple dots on the skin. These dots, often seen on the lower legs, are called petechiae (peh-TEE-kee-ay). Petechiae may look like a kind of rash.

With ITP:

• People may have nosebleeds, bleeding from the gums when they have dental work done, or other bleeding that is hard to stop.
• Women may have heavy menstrual bleeding.
• Symptomatic bleeding in the brain is very rare but can be life threatening if it occurs.

ITP is largely an autoimmune disease. The decrease in platelets occurs because the immune system attacks and destroys the body's own platelets, for an unknown reason. Normally, your immune system helps your body fight off infections and diseases. But when the immune system mistakenly attacks some part of a person's own body, this is called an autoimmune disease. Because "idiopathic" means "of unknown cause," a better name for most cases of ITP is immune thrombocytopaenic purpura.

What Are Platelets and How Do They Work?

Platelets are small blood cells, or thrombocytes (THROM-bo-sites), that are made in your bone marrow (along with other kinds of blood cells). Platelets circulate through the blood vessels and help stop bleeding by sticking together to seal small cuts or breaks in tiny blood vessels.

Types of ITP

There are two types of ITP: acute (temporary or short-term) ITP and chronic (long-lasting) ITP.

• Acute ITP generally lasts less than 6 months. It mainly occurs in children, both boys and girls, and is the most common type of ITP. It typically occurs following an infection caused by a virus. This type of ITP often goes away on its own within a few weeks or months and does not return. Treatment may not be needed.
• Chronic ITP is a long-lasting (6 months or longer) type of ITP that mostly affects adults. However, some teenagers and even younger children get this type of ITP. Chronic ITP affects women two to three times more often than men. Treatment depends on how severe the bleeding symptoms are and the platelet count. In mild cases, treatment may not be needed.

Other Names for Idiopathic Thrombocytopaenic Purpura

• Immune thrombocytopaenic purpura
• Autoimmune thrombocytopaenic purpura

What Causes Idiopathic Thrombocytopaenic Purpura?

In idiopathic thrombocytopaenic purpura (ITP), the immune system treats a person's own platelets as if they were invaders in the body, attacking and destroying them. The immune system attacks platelets by making proteins called antibodies. The antibodies bind to platelets (attach) and then are removed by the spleen (an organ that is part of the immune system and helps fight infection).
Normally, the immune system makes antibodies to fight off germs or other harmful things (called antigens) that enter the body. The reason why the immune system decides to attack platelets is not known.
Children who get the acute (temporary) type of ITP often have had a recent viral infection. It is possible that the infection somehow "triggers" or sets off the immune reaction that leads to ITP in these children. ITP in adults, on the other hand, does not seem to be linked to infections.

Who Is At Risk for Idiopathic Thrombocytopaenic Purpura?

• Both children and adults can develop idiopathic thrombocytopaenic purpura (ITP).
• Children usually get the acute (temporary) type of ITP. This type of ITP often follows an infection caused by a virus.
• Adults tend to get the chronic (long-lasting) type of ITP, rarely the acute type of ITP.
• Women are two to three times more likely than men to get chronic ITP.
• You cannot catch ITP from another person.

What Are the Signs and Symptoms of Idiopathic Thrombocytopaenic Purpura?

The signs and symptoms of idiopathic thrombocytopaenic purpura (ITP) are related to increased bleeding due to low numbers of platelets.
Signs include:

• Bruising (purpura): purplish areas on the skin or mucus membranes (such as in the mouth) due to bleeding. The bruises may occur for no apparent reason.
• Petechiae: pinpoint red spots on the skin (typically the legs) that often occur in groups and may look like a rash. The spots are due to bleeding under the skin.
• Bleeding that is hard to stop.
• Bleeding from gums (for example, when dental work is done).
• Nosebleeds.
• Heavy menstrual bleeding in women.
• Blood in the urine.
• Blood in the stool (bowel movement).

Symptomatic bleeding in the brain is very rare but can be life threatening if it occurs.
A low number of platelets causes no symptoms other than increased risk of bleeding. A low number of platelets is not responsible for pain, fatigue, difficulty with concentration, or any other symptoms.

How Is Idiopathic Thrombocytopaenic Purpura Diagnosed?

To diagnose idiopathic thrombocytopaenic purpura (ITP), doctors use your medical history, a physical exam, and blood tests.
Your medical history includes information about:

• Your signs and symptoms of bleeding
• Illnesses you have that could lower your platelet count or cause bleeding
• Medicines or any other supplements or remedies you take that could cause bleeding or lower your platelet count

Your doctor will do a physical exam and look for signs of bleeding and infection.
Your doctor will also order blood tests to measure the platelet count in your blood. These tests usually include:

• A complete blood count, to show the numbers of different kinds of blood cells, including platelets, in a small sample of your blood.
• A blood smear, which involves placing some of your blood on a slide. A microscope is then used to look at your platelets and other blood cells.

A blood smear is important to be sure that the platelet count is correct. In healthy people, the platelet count can be falsely low, since the chemical used in the tube during blood collection may cause platelet clumping.
If blood tests show that you have a low number of platelets, you may need additional tests to help with the diagnosis. For example, bone marrow tests may be used to see if enough platelets are being formed in the bone marrow.
In ITP, the red and white blood cell counts are normal.
A low platelet count can occur when the body destroys platelets or doesn't produce enough platelets, or both. In ITP, the platelet count is low because the body is destroying platelets faster than the bone marrow can make new ones.
Some people with mild ITP have few or no signs of bleeding. In that case, they might be diagnosed only after a blood test done for another reason shows that they have a low number of platelets (thrombocytopaenia). If other causes for low platelet count are ruled out, ITP may then be diagnosed.

How Is Idiopathic Thrombocytopaenic Purpura Treated?

Doctors decide whether to treat idiopathic thrombocytopaenic purpura (ITP) based on your bleeding symptoms and platelet count. When treatment is needed, medicines are often used, at least at first. Treatments used for children and for adults are similar.

ITP in Adults

Adults with ITP who have very low platelet counts or problems with bleeding are usually treated. Adults with milder cases of ITP may not need any treatment, other than monitoring their symptoms and platelet counts.

ITP in Children

The acute (temporary) type of ITP that occurs in children often goes away within a few weeks or months. Children with bleeding symptoms more than merely bruising (purpura) are usually treated. Milder cases in children may not need treatment other than monitoring and followup to be sure the platelet count returns to normal.

Medicines

If treatment is needed for adults or children with ITP, medicines are used first. Corticosteroids (cor-ti-co-STEER-roids) such as prednisone (PRED-ni-zone) are commonly used to treat ITP. These medicines, called steroids for short, help raise the platelet count in the blood by lowering the activity of the immune system. However, steroids have a number of side effects, and some people relapse (get worse) when treatment ends.
Some medicines used to help raise the platelet count are given intravenously (through a needle in a vein). These medicines include immune globulin and anti-(Rh) D immunoglobulin.
Other medicines may be tried if initial treatment doesn't help. These medicines are usually given after a splenectomy (splee-NECK-tuh-mee) has been performed.

Removal of the Spleen (Splenectomy)

If necessary, the spleen may be removed. This treatment is used mostly in adults whose ITP has not responded to steroids. Removing the spleen stops the destruction of platelets in the spleen, but it also may make the person more likely to get infections. It is important for a person without a spleen to watch for signs of infection, such as fever, and to get treatment right away.

Other Treatments

• Platelet transfusions. Some people with ITP who have severe bleeding may need to have platelet transfusions and be hospitalized. Although the lifespan of transfused platelets is shortened greatly by antiplatelet antibodies, platelets may be transfused before a surgery.
• Treating infections. If a person with ITP has an infection that can lower the number of platelets, treating the infection may help raise the platelet count and reduce bleeding problems.
• Stopping medicines. If an ITP patient is taking medicine that can lower the number of platelets or cause bleeding, stopping the medicine can sometimes help raise the platelet count or prevent bleeding. For example, aspirin and ibuprofen (EYE-boo-pro-fen) are common medicines that reduce platelet function. These medicines should not be used by persons with ITP.

Living With Idiopathic Thrombocytopaenic Purpura

If you have idiopathic thrombocytopaenic purpura (ITP):

• Avoid medicines such as aspirin or ibuprofen that can affect platelet function and increase your risk for bleeding.
• Avoid injury that can cause bruising and bleeding. If your child has ITP, it is important to protect him or her from injuries, especially head injuries that could cause bleeding in the brain. Ask your child's doctor about the need to restrict the child's activities.
• Find a doctor who is familiar with treating ITP patients. Haematologists are doctors who specialize in diagnosing and treating blood diseases and disorders.
• If you have had your spleen removed, you may be more likely to get infections. Watch for signs of infection, such as fever, and get treatment promptly.

ITP in Pregnancy

Pregnant women with ITP have healthy babies. However, some babies born to mothers with ITP are born with or develop low numbers of platelets soon after birth. Their platelets will return to normal without any treatment. Treatment can speed the recovery in the few babies whose platelet counts are very low.
The treatment of ITP in pregnancy depends on the platelet count. If treatment is needed, the doctor will take into consideration the treatment's possible effects on the unborn baby.
Women with milder cases of ITP can usually go through pregnancy without treatment. Pregnant women with a very low platelet count or a lot of bleeding are more likely to have serious heavy bleeding (haemorrhage) during delivery or afterward. To prevent haemorrhage, these women are usually treated.

Key Points

• Idiopathic thrombocytopaenic purpura (ITP) is a bleeding disorder that can lead to bruising and bleeding that are hard to stop.
• In people with ITP, the blood does not clot as it should.
• ITP is caused by a low number of platelets in the blood. Platelets help blood clot and stop bleeding.
• The low number of platelets in ITP occurs when the body's immune system attacks and destroys platelets. The reason for this is not known.
• People with ITP may have signs of bleeding, such as bruises (purpura) that appear for no reason or tiny red dots (petechiae) that are visible on the skin.
• Bleeding in ITP can also occur in the form of nosebleeds, bleeding gums, heavy menstrual bleeding, blood in the urine, or blood in the stool. The most dangerous bleeding from ITP is in the brain, but this is very rare.
• ITP can affect children and adults of all ages. More women than men get ITP.
• There are two types of ITP: acute ITP, which mostly affects children but does occasionally affect adults, and chronic ITP, which mostly affects adults but does occasionally affect children.
• In children, the illness is usually temporary (acute ITP) and often occurs following an infection caused by a virus. Most children get well quickly without any treatment.
• Adults with ITP have the long-lasting (chronic) form of ITP, but symptoms can vary a great deal, and some with mild ITP do not need treatment.
• ITP is not the only cause of low platelet count (thrombocytopaenia), so diagnosis includes ruling out other possible causes of a low number of platelets.
• Treatment depends on the type and severity of the illness. Those who have more severe symptoms are usually treated at first with medicines such as steroids.
• The spleen is sometimes removed if treatment with medicine fails to keep the platelet level high enough to prevent bleeding.

Mengenal Empat Tipe Kepribadian

Galen, seorang ahli fisiolog Romawi yang hidup di abad ke-2 Masehi , yang pertama kali memperkenalkan teori empat kepribadian. Ia menyatakan bahwa kepribadian manusia bisa dibagi menjadi empat kelompok besar: sanguin (populer), koleris (kuat), melankolis (sempurna), dan phlegmatis (damai). Meski teori ini tergolong sangat kuno, para psikolog masa sekarang mengakui, teori kepribadian ini banyak benarnya.
Menurut teori ini, tipe pertama adalah sanguin, tipe yang mempunyai energi yang besar, suka bersenang-senang, dan supel. Mereka suka mencari perhatian, sorotan, kasih sayang, dukungan, dan penerimaan orang-orang di sekelilingnya. Orang bertipe sanguin suka memulai percakapan dan menjadi sahabat bagi semua orang. Orang tipe ini biasanya optimis dan selalu menyenangkan. Namun, ia tidak teratur, emosional, dan sangat sensitif terhadap apa yang dikatakan orang terhadap dirinya. Dalam pergaulan, orang sanguin sering dikenal sebagai “si tukang bicara”.
Tipe kedua adalah koleris, yang suka berorientasi pada sasaran. Aktivitasnya dicurahkan untuk berprestasi, memimpin, dan mengorganisasikan. Orang bertipe koleris menuntut loyalitas dan penghargaan dari sesama, berusaha mengendalikan dan mengharapkan pengakuan atas prestasinya, serta suka ditantang dan mau menerima tugas-tugas sulit. Tapi mereka juga suka merasa benar sendiri, suka kecanduan jika melakukan sesuatu, keras kepala, dan tidak peka terhadap perasaan orang lain. Orang koleris seperti ini sering diidentifikasi sebagai “si pelaksana”.
Tipe ketiga adalah melankolis yang cenderung diam dan pemikir. Ia berusaha mengejar kesempurnaan dari apa yang menurutnya penting. Orang dalam tipe ini butuh ruang dan ketenangan supaya mereka bisa berpikir dan melakukan sesuatu. Orang bertipe melankolis berorientasi pada tugas, sangat berhati-hati, perfeksionis, dan suka keteraturan. Karenanya, orang melanklolis sering kecewa dan depresi jika apa yang diharapkannya tidak sempurna. Orang melankolis sering diidentifikasi sebagai “si perfeksionis” atau “si pemikir”.
Tipe keempat adalah phlegmatis, yang seimbang, stabil, merasa diri sudah cukup, dan tidak merasa perlu merubah dunia. Ia juga tak suka mempersoalkan hal-hal sepele, tidak suka risiko atau tantangan, dan butuh waktu untuk menghadapi perubahan. Orang bertipe ini kurang disiplin dan motivasi sehingga suka menunda-nunda sesuatu. Kadang, ia dipandang orang lain sebagai lamban. Bukannya karena ia kurang cerdas, tapi justru karena ia lebih cerdas dari yang lain. Orang phlegmatis tak suka keramaian ataupun banyak bicara. Namun, ia banyak akal dan bisa mengucapkan kata yang tepat di saat yang tepat, sehingga cocok menjadi negosiator. Orang phlegmatis kadang diidentifikasi sebagai “si pengamat” atau “si manis”.
Setiap orang mempunyai kombinasi dari dua kepribadian. Umumnya salah satunya lebih dominan, kadang juga keduanya seimbang. Sanguin dan koleris bisa berkombinasi secara alami karena keduanya ekstrovert, optimis dan terus terang. Kombinasi ini menghasilkan individu yang sangat energik. Mereka punya daya tarik serta banyak bicara sambil menyelesaikan pekerjaan mereka, entah melakukannya sendiri atau menyuruh orang lain untuk mengerjakannya.
Phlegmatis dan melankolis bisa berkombinasi karena keduanya introvert, pesimis, dan lembut. Mereka melakukan segala sesuatu dengan sempurna dan tepat waktu, tidak mau mengambil sikap konfrontatif. Namun anak tipe ini akan mudah terkuras energinya jika berurusan dengan orang lain.
Kombinasi koleris-melankolis dan sanguin-phlegmatis menggabungkan optimis dan pesimis, yang suka hura-hura dengan yang tidak suka hura-hura, dan yang supel dengan yang suka menarik diri. Akibatnya anak cenderung tidak seimbang dan berubah-ubah kepribadiannya tergantung keadaan. Kombinasi koleris-melankolis menghasilkan individu yang sangat berorientasi pada tugas. Kombinasi ini akan menjadi peraih prestasi tertinggi, melakukan segala sesuatu dengan cepat dan sesempurna mungkin. Namun mereka bisa menjadi nge-boss dan manipulatif sekaligus mudah stres jika orang lain tak bisa melakukan segalanya dengan benar dan tepat waktu.
Kepribadian sanguin dan phlegmatis juga bisa berkombinasi, menghasilkan orang yang berorientasi pada hubungan. Kombinasi ini menjadikannya teman bagi semua orang. Ia dikagumi karena sifat humornya, selalu rileks, dan menerima orang lain apa adanya. Namun ia cenderung tidak disiplin, tidak suka melakukan apapun, mudah lupa tanggung jawabnya, dan selalu dapat merayu orang lain untuk mengerjakannya bagi mereka.
Kepribadian memang bisa dirubah sedikit demi sedikit setelah tumbuh dewasa. Misalnya, jika ia merasa terlalu emosional, ia bisa merubahnya sedikit demi sedikit sehingga bisa lebih sabar. Namun kepribadian seseorang telah ada sejak ia lahir, dan akan mempengaruhi cara berpikir dan bertindak dalam kehidupannya. Maka ada baiknya jika kita bisa memahami kepribadian diri kita sendiri, juga kepribadian orang-orang di sekitar kita. Karena tiap tipe kepribadian ini mempunyai kelebihan dan kekurangan, dan masing-masing tipe ini akan berinteraksi dengan baik jika dapat saling melengkapi.

Lebih Jauh tentang Strategi Difersifikasi

Strategi ini kurang begitu populer karena sulitnya memanage aktivitas bisnis yang berbeda, dan pada umumnya hanya dilakukan oleh perusahaan yang mempunyai kelebihan finansial.  Tiga bentuk strategi diversifikasi :
~ diversifikasi konsentris, dimana dijalankan dengan menambah produk baru yang masih berhubungan dengan core product saat ini, dimana dapat dilaksanakan karena menggunakan fasilitas yang sama, baik teknologi maupun jaringan pemasaran.  Hal ini pada umumnya berhasil apabila dilakukan pada industri yang  tingkat pertumbuhannya rendah, adanya produk baru yang ditawarkan dengan harga kompetitif, dan memiliki tim manajemen yang kuat.
~ diversifikasi horisontal, dimana merupakan strategi menambah ataupun menciptakan produk baru yang tidak berhubungan dengan produk yang ada.  Dengan anggapan bahwa perusahaan sudah memiliki brand yang bagus dan familier dengan pelanggan, serta perusahaan sudah memiliki konsumen yang loyal.  Strategi ini pada umumnya berhasil apabila : ada tambahan produk baru yang akan meningkatkan pendapatan ; tingkat kompetisi yang tinggi dalam industri yang tidak tumbuh; mampu memanfaatkan saluran distribusi yang ada; dan produk yang diciptakan dapat mengkompensasi pola penjualan yang siklikal
~ strategi diversifikasi konglomerasi, dimana perusahaan menambahkan produk baru yang sama sekali tidak berhubungan dengan produk sebelumnya, serta ditujukan untuk pasar baru yang tidak terkait dengan yang ada.  Strategi ini mempunyai pedoman tersendiri yang perlu dicermati yaitu : apabila ada penurunan profit; kemampuan manajerial dan modal untuk berkompetisi; terciptanya nya sinergi finansial antara masing-masing perusahaan; pasar baru bagi produk yang ada sudah jenuh

STRATEGI KORPORASI

Pengertian
Glueck mengartikan strategi sebagai rencana yang disatukan, menyeluruh dan terpadu yang mengaitkan keunggulan stategi perusahaan dengan tantangan lingkungan dan yang dirancang untuk memastikan bahwa tujuan utama perusahaan dapat dicapai melalui pelaksanaan yang tepat oleh perusahaan.  yang lain mendefinisikan strategi sebagai pola tanggapan suatu organisasi terhadap perubahan lingkungan untuk mencapai tujuan.  Pengertian yang paling umum tentang strategi adalah suatu alat cara untuk mencapai tujuan atau sasaran yang diharapkan.
Sesuai dengan hirarki atau tingkatan dalam suatu organisasi maka hirarki strategi juga mengikuti hirarki organisasi.  Pada dasarnya ada 2 tipe perusahaan, yakni perusahaan besar, dimana tipe strategi nya sesuai dengan level pada hirarki organisasi. Ada 4 level yaitu : level korporasi, level divisional, level fungsional dan level operasional.

Tipe perusahaan kecil terdiri dari paling banyak 3 level, yaitu : level perusahaan, level fungsional dan level operasional.  Karena biasanya perusahaan kecil hanya terdiri dari 1 divisi atau bisnis tunggal.

Strategi Level Korporasi

Pada perusahaan besar orang yang bertanggung jawab utama atas strategi yang efektid adalah meliputi berbagai level, termasuk CEO pada level korporasi, presiden atau eksekutif wakil presiden pada level divisi.  Sedangkan pada perusahaan kecil, orang yang bertanggungjawab utama atas strategi yang efektid pada berbagai level meliputi pemilik perusahan atau presiden pada level korporasi, dan orang-orang pada level yang lebih rencah sesuai tingkatan seperti pada perusahaan besar.  Partisipasi dan pemahaman strategi penting diperhatikan dan semua orang bertanggungjawab atas strategic planning pada berbagai level agar membantu perusahaan dalam melakukan koordinasi, fasilitas dan komitmen yang akan menghindarkan diri dari ketidakkonsistensian, inefisiensi serta mis komunikasi.

Strategi Pertumbuhan /Ekspansi

Pada kategori strategi pertumbuhan / ekspansi ini dijalankan perusahaan dalam rangka mengejar pertumbuhan korporat, yang dapat berupa kenaikan penjualan, profit, ekspansi usaha dan lain-lain yang akan berdampak pada pertumbuhan perusahaan.  Beberapa strategi yang termasuk dalam kategori strategi pertumbuhan adalah
~ strategi intensif; dilakukan dengan mengerahkan berbagai usaha yang intensif dengan syarat perusahaan dapat memperbaiki posisi kompetitifnya dengan produk yang ada pada saat ini; Strategi ini dibagi menjadi 3 yaitu : Strategi penetrasi pasar, strategi pengembangan pasar, dan strategi pengembangan produk.
~ strategi integrasi; dimana menyatukan beberarapa rentang bsnis mulai dari hulu, jaringan pemasok hingga hilir, jadingan distributor serta secara horisontal kearah pesaing.  Strategi intregrasi ada 3 bentuk yiaitu : strategi integrasi ke depan, strategi integrasi ke belakang, strategi integrasi horisontal.  Secara keseluruhan strategi ini disebut sebagai strategi integrasi vertikal yang dijalankan untuk memperoleh kendali atas distributor, pemasok dan pesaing.
~ strategi diversifikasi.  terdiri dari 3 bentu strategi yaitu konsentris, horisontal dan konglomerasi

Indonesia English Translator and Dictionary

Indonesia English Translator and Dictionary

The 10 Step Spiritual Diet

Overweight and food issues have multiple causes, and thus must be approached from multiple angles—food, exercise, body image, emotional healing, spiritual power, and more. In my work, I use a 10-step program that anyone can use to lose weight, no matter how many times they have failed in the past. Here, in summary, are the 10 steps:
STEP 1: Live the Love-Centered Diet
For many people, food is like a drug, which could explain why many of us just can’t stop bingeing, particularly on junk food. The Love-Centered Diet simplifies your eating and gives your body a 30-day break from refined flour, sugar, and junk food.
STEP 2: Start a Moving Meditation
Learn how to go beyond the “sweat mentality” of exercise and experience physical activity in a whole new way: as a “moving meditation.” This can involve any form of activity. It teaches you to reflect on your inside self.
STEP 3: Develop a Daily Practice
What would it take for you to feel less stressed and more in control of your food and well-being all day long? Just 10 minutes in the morning with a “daily practice,” to set the tone you want for your day.
STEP 4: Appreciate Your Body
Research suggests that learning to accept and, yes, even to love your body just the way it is can actually help you lose weight. Reverse those negative mind-sets for good—and reap the slimming benefits.
STEP 5: Love Yourself Thin
Loving yourself is the most overlooked factor in weight management. If you’re stuck in a self-loathing mind-set, then it’s very hard to do something good for yourself.
STEP 6: Maintain Loving Connections
People who lose weight—and keep it off—generally have help. In one recent study, those who participated in a structured weight-loss program that included weekly group support lost more weight and did a better job of keeping it off for two years than did people who lacked group support.
STEP 7: Eliminate Excuses
We all tell ourselves stories that explain—or make excuses for—how we’ve come to be the way we are. The trick is to create a new narrative, one that reflects your goals, and why and how you can effect the change you’re aiming for.
STEP 8: Examine Your Battleground Beliefs
Your battleground beliefs are the thoughts running through your head 24/7. These opinions from childhood are often subconscious. Examine your outlook and form the positive beliefs you’d like to have.
STEP 9: Connect with Higher Source Thinking
How we approach life and spirituality contributes to our overall well-being. People who tap into their spiritual side have a positive self-image, a sense of purpose in life, and better health than those who don’t, according to a growing body of research.
STEP 10: Pay It Forward
Everyone is looking for the magical answer on how to keep weight off once you’ve lost it. I believe the ultimate answer is to pay it forward by helping others. When you bring a little fresh air into someone’s life, expect some of that refreshing breeze to blow back your way.
http://www.healyourlife.com/author-brad-lamm/2011/01/lifeshelp/get-healthy/the-10-step-spiritual-diet