Bed Site Teaching

GANGGUAN DEPRESIF BERULANG, EPISODE KINI RINGAN

BY :
ABDUL MUHAIMIN M. BP/P : 0810314277 / RP.1223
TIARA DWI PRATIWI BP/P : 0910313256 / P.1414
PRECEPTOR:
!. YA"LINDA YAUNIN "P. #$
P"YCHIATRY DI%I"ION
MEDICAL &ACULTY O& ANDALA" UNI%ER"ITY
R"$ HB "AANIN PADAN'
2014
1
P"YCHIATRIC PATIENT(" "TATU"
Male patient 28 years ol sent to Poli!ini! "i#a RSUP DR$ M$ D%a&il es'orte (y )is
*a&ily on +, "-ne 2,./ #it) ')ie* 'o&plaint patient (ein0 epresse ,sa an serin0
(er&en-n01&en-n0 seniri sin'e one #ee! $
P)*+,-*(. +,-*+*/:
Na&e 2 Mr S
Gener 2 Male
A0e 3 2 22 years ol$
Marital stat-s 2 Un&arrie
Aress 2 linta-, (at-san0!ar, #est s-&atera
O''-pation an S')ool 2 4ia! (er!er%a
Reli0ion 2 Isla&
5iti6en 2 Inonesian
Ra'e 2 Minan0!a(a-
I-*,!-)0 "*)*1.
General appearan'e 2 5o&pos Mentis
Bloo press-re 2 .2,78, &&80
P-lse rate 2 82 9 per &in-te
4e&perat-re 2 +:,: 5
5ario;as'-lar syste& 2 No isorers *o-n
Di0esti;e syste& 2 No isorer *o-n
Spe'i*i' isorer 2 No isorer *o-n
N,1!2023+4)0 "*)*1.
G5S .<, p-pil re*le9 positi;e, 'orneal re*le9 positi;e
5ranial ner;es 2 =ision, s&ellin0, taste, )earin0, tastin0 an ta'tile are all
Nor&al
Menin0eal Si0ns 2 No si0ns present
In'rease Inter'ranial Press-re 2 Pro%e'tile ;o&itin0 >1?,Pro0ressi;e )eaa')e >1?
Eyes
2
1 Mo;e&ent 2 Free to &o;e in all ire'tions
1 Per'eption 2 No nysta0&-s, no iplopia
1 P-pil 2 Ro-n an iso')ori'
1 Li0)t Re*le9 2 @7@
1 5on;er0en'e 2 Not e9a&ine
1 Opt)al&os'opy 2 Not e9a&ine

Motori' 2 E-ton-s, E-trop)i', no tre&or
M-s'le stren0t) A s-perior e9tre&ity <<<7<<<,
in*erior e9tre&ity <<<7<<<
Sensi(ility 2 No isorer *o-n
Spe'i*i' isorer 2 No isorer *o-n
A1*2)-)5-,.+. >tan00al +,
t)
o* "-ni 2,./?
PERTANYAAN $AWABAN I-*,!6!,*).+
3
Ban0, !enal!an !a&i o!ter &-a
ael an o!ter &-a &-)ai&in,
aa yan0 &a- !a&i tanya!an
a(an0, (isa (an0 B
Na&a a(an0 siapa B
Berapa -&-r a(an0 se!aran0 B
A(an0 tin00al i&ana B
Ala) la&o a(an0 tin00al isana B
Se(el-&nya a(an0 tin00al
i&ana B
Kenapa a(an0 i(a#a sa&a &a&a
a(an0 !esini B
Ao (eran0 (eran0 patan0
ir-&a)B
Kini ta- a(an0 i&ana
a(an0 ta)- tan00al (ara !iniB
B-lan %o ta)-nB
Apa yan0 terasa se!aran0 (an0 B
Baa !o! ia& ia& se (an0Bao
&asala)B
Ber'eritla) !e !a&i (an0$$$
Kan !ata &a&a a(an0 -l- a(an0
(intan0 !elas selal- %-ara, tapi aa
&asala) #a!t- UN apa !arena it-
a(an0 seperti se!aran0 B
Ba0ai&ana perasaan a(an0 B
Ke'e#a sa&a siapa B
Ke'e#anya seperti apa B
Bisa
Septi > sa&(ll &en-n-!!an
&-!a ?
> Dia& se%ena! ? 28 ta)-n
Linta-
Al-n la&o (ana
Di &ean
Na! ta-, oran0 it- n0erasa aa
yan0 ane) sa&a a!-, a!-nya
n0erasa (iasa a%a, ya-a) a!-
i!-tin a%a !e&a-annya
Na! aa
4a-, i &$ D%a&il
4a-, +, %-ni
4eria&$$$$$

Ga! aa, 0a! aa &asala)
A#alnya si) iya, tapi se!aran0
-a) 0a! pe-li la0i
8&& !e'e#a si)
Ke'e#a sa&a oran0 A oran0
Ca !e'e#a a%a
Ko&pos&entis
Orientasi tia!
ter0an00-
)ipoti&
4
Ba0ai&ana pe!er%aan a(an0 B
Kenapa a(an0 0a! (eta) B
Per0a-lan tia! se)atnya seperti
apa (an0 B
A(an0 perna) i!-tan &a!ai an
&in-& B
Apa yan0 terasa setela) &in-&
(an0 B apa perna) &in-& la0i
setela) it- B
Ao perna) &an'alia! (ayan0an
ato s-ara s-aro yan0 &a&an00ia1
&an00ia a(an0, ata- &en'i-& (a-
ane) A ane) B
Bai!la) (an0, teri&a !asi) ya (an0
Atas #a!t-nya
aa, tapi serin0 0a! (eta)
0a! (eta) sa&a oran0 A
oran0nya, oran0 it- &en0an00ap
a!- ane), an per0a-lannya 0a!
se)at, (ea #a!t- a!- i &ean
&ere!a perna) &e&a!ai an
serin0 &in-& A &in-&
&in-& perna), se!ali
p-sin0, tia! ena!, tia! perna)
&in-& al!o)ol la0i
tia! perna)
iya teri&a !asi)

8al-sinasi tia! aa
ALLOANAMNE"I"
1. M)+- !,).2- 27 H2.6+*)0+8)*+2-
Patient *eel epresse ,sa, an (ein0 isolate #it) ot)ers sin'e 2,,8 an patient
ala#ay )a;e pro(le& in *inin0 %o(s $
2. H+.*2!/ 27 I00-,..
Y,)! 2005
5
Bot) o* )is parents al#ays 0ot pro(le& in )is )o-se,ar0-in0 in*ront o* t)eir ')ilren an
e'ie to i;or'e ,sin'e t)en patient seen #it)ra#n ,epresse ,not so'ialise #it)
ot)er people an a#ays isolate )i&sel* in )is roo&$
Y,)! 20099 $10+
Patient enterin0 t)e National E9a& in SMK *or t)e entry to p-rs-e )is st-ies in
-ni;ersity , )o#e;er #)en t)e res-lt #as anno-n'e ,)e i not passe t)e e9a&ination
paa)al Patient #as !no#n as a (rilliant st-ent an al#ays a')ie;e 0oo 0raes in )is
)i0) s')ool $Patient also (een anno-n'e as one o* sis#a PMDK saat peneri&aan SMK,
Patient pasien tia! l-l-s )anya !arena pertanyaan yan0 tia! pentin0$ 8e #as *eelin0
;ery isappointe an seen #it)ra#n a*ter t)at$8is &ot)er tol t)at t)e patient #as
a''ept t)e *a't t)at )e i not passe en0an ia& an ne;er tol to )is &ot)er a(o-t )is
*eelin0s,a *e# ays later patient seen epresse,sa an so&eti&es (ein0 'ryin0 alone in
)is roo& $4)e patient also i not #ant to )an0 o-t #it) )is *riens an al#ays (ein0
isolate in )is $A*ter t)at ,patient trie to enterin0 tes pa!et 5, (-t it i not 0o #ell an
on'e a0ain )e i not passe t)e e9a&$
Y,)! 2010
Pasien enterin0 tes pa!et 5 on'e a0ain an *inally )e passe t)e e9a& $Later on patient
e'ie to 0o to Mean *or tes !-lia) an #as a''epte in Uni;ersitas M-)a&&aya)
S-&atera Utara, (-t patient enterin0 t)e orientation !-lia) in ., ays an t)e patient
#it)ra#n *ro& t)e -ni;ersity #it) t)e reason )e #as ne;er *it #it) st-ies t)ere an )e
*elt t)at )e #as (-ren )is *a&iy *or payin0 )is t-ition *ees
Cear 2,./
Patient is #or! (e*ore t)at ,(-t )e i not s-it in one %o( ,t)ere*ore patient al#ays *inin0
ne# %o($ Patient *elt )e i not *it #it) )is 'ollea0-e an )is $A*ter t)at patient #as lea;e
to t)e Mean an e'ie to stay #it) )is *at)er (-t )e #as e9pelle (y )is o#n *at)er
(e'a-se )is &en0an00ap ana!nya ane) $Patient 'o&e (a'! to stay #it) )is &ot)er in May
(a'! in Paan0 Patient !e&(ali seen epresse ,sa ,an isolate )i&sel* in )is roo&s
an #as i not sleep$8is &ot)er e'ie to (rin0 )i& to Poli!lini! "i#a at RSUP MD
"a&il Paan0
6
3. P!,52!:+ H+.*2!/
In*ant 2 (orn spontaneo-sly, (irt) #as assiste (y &i#i*e, no )istory o*
%a-ni'e, 'yanosis, or sei6-re$
5)il)oo 2 0ro#t) an e;elop&ent s-ita(le *or )is a0e$
Aoles'en'e 2 patient i not )a;e &any *riens, an pre*er to stay at )o&e rat)er t)an
(ein0 o-tsie
A-lt 2 patient i not )a;e &any *rien an )e oesnDt li!e to stay at one %o($
An )e al#ays &o;e to t)e ot)er %o(s$
E14)*+2-)0 B)4;3!21-
E-'ate till t)ir year o* senior )i0) s')ool$
4. W2!; <+.*2!/
5i;il ser;ant$
5. M)!+*)0 .*)*1.
Patient is not &arrie yet
6. "24+2 ,42-25+4 .*)*1.
Patient li;e #it) )is *a&ily in per&anent )o-se, t)ere is #ater so-r'e *ro& PDAM, t)ere
is ele'tri'ity, t)ere is &otor 'y'le in t)e )o-se, t)ey 'an pay all t)ey neee$
7. &)5+0/ H+.*2!/
4)e patientDs *a&ily )as not t)e sa&e sy&pto&s t)at )e )as
E F
E E E F F
=6)*+,-*>

7

'!)6<+4 27 +00-,.. 421!.,
"155)!/ 27 P<./4+)*!+4 E?)5+-)*+2-
I. ',-,!)0 A66,)!)-4,
5o-n'io-sness 2 'o&pos &entis
Attit-e 2 'ooperati;e
Motori' 2 a'ti;e
Fa'ial e9pression 2 poor o* *a'ial e9pression,
=er(ali6ation 2 'an tal!, 'learly
P)ysi' 'onta't 2 'an (e one, proper ,lon0 ti&e
Attention 2 less
Initiati;e 2 less
II. "6,4+7+4 C2-+*+2-
A$ A**e'ti;e
.$ A**e'ti;e 'onition 2 (l-nt, an appropriate
2$ E&otional 2
a$ Sta(ility 2 sta(le
($ 5ontrol 2 'ontrolle
'$ E')t7-ne')t 2 e')t
$ Ein*-l-n0 2 inaeG-ate
e$ Deep7s)allo# 2 s)allo#
*$ Di**erentiation s'ale 2 narro#
0$ E&otional *lo# 2 slo#
B$ Intelle't-al 'onition o* *-n'tion
a$ Me&ory 2 less
($ 5on'entration 2 less
'$ Orientation 2 ti&e, pla'e, sit-ation an person
orientation ist-r(e
$ Kno#le0e 2 i**i'-lt to e;al-ate
e$ Dis'ri&inati;e insi0)t 2 ist-r(e
*$ Intelli0en'e prei'tion 2 i**i'-lt to e;al-ate
8
0$ Dis'ri&inati;e %-0&ent 2 ist-r(e
5$ Sensation an per'eption a(nor&alities
.$ Ill-sion 2 none
2$ 8all-'ination 2
A'o-sti' 2 none
=is-al 2 none
Ol*a'tory 2 none
4a'tile 2 none
G-statory 2 none
D$ 4)o-0)t pro'ess 'onition
.$ Spee o* t)o-0)t pro'ess 2 slo#
2$ H-ality o* t)o-0)t pro'ess2
a$ 5lear an s)arp 2 not 'lear an not s)arp
($ In'o)erent 2 e9ist
'$ Sperr-n0 2 none
$ 8e&&-n0 2 none
e$ Fli0)t o* ieas 2 none
*$ =er(i0eration 2 none
0$ Preser;ation 2 none
+$ 4)o-0)t 'onition
a$ 5entral pattern 2 e9ists
($ P)o(ia 2 none
'$ O(session 2 none
$ Del-sion 2 none
e$ S-spi'ion 2 e9ist
*$ 5on*a(-lation 2 none
0$ Rep-lsion 2 none
)$ In*erior *eelin0 2 none
i$ M-')7little 2 little
%$ Feelin0 0-ilty 2 none
!$ 8ypo')onria 2 none
l$ Ot)ers 2 none
E$ Instin't-al ri;e an (e)a;ior a(nor&alities
a$ A(-lia 2 e9ist
($ St-por 2 none
'$ Rapt-s7i&p-lsi;ity 2 none
$ E9'ite&ent state 2 none
e$ Se9-al e;iation 2 none
*$ E')opra9ia 2 none
0$ =a0a(ona0e 2 none
)$ Pyro&ania 2 none
i$ Manneris& 2 none
%$ Ot)ers 2 none
9
F$ O;er an9iety 2 none
G$ Reality testin0 a(ility 2 ist-r(an'e in (e)a;ior, t)o-0)ts, an
*eelin0
MULTIPLE A@I" RE"UME
A9is .$ 5lini'al synro&e
Pasien serin0 terli)at &-r-n0, &enyeniri se%a! ta)-n 2,,8 an serin0 (erpina) A pina)
(e!er%a
P)y'iatri' e9a&ination
General 'onition2 'o&pos &entis, 'ooperati;e, a'ti;e, poor o* *a'ial e9pression, ;er(ali6ation is
'an tal! an 'learly, less attention, less initiati;e, psy')i' 'onta't 'an (e one, not proper, s)ort
ti&e$
Spe'i*i' 'onition 2
.$ A**e'ti;e 'onition 2 (l-nt, sta(le, e')t, s)allo#, narro#, slo#
2$ Intelle't-al 'onition o* *-n'tion 2 less &e&ory, less 'on'entration, ti&e, pla'e, sit-ation,
an person orientation is not ist-r(e, !no#le0e is i**i'-lt to e;al-ate, is'ri&inati;e
insi0)t an %-0&ents not ist-r(e$
+$ Sensation an per'eption a(nor&alities 2 no ill-sion ,no )al-sinasion >a-itory, ;is-al,
ol*a'tory, an ta'tile?$
/$ 4)o-0)t pro'ess 'onition 2 not 'learly an not s)arp, 'o)erent, 'entral pattern$
<$ Instin't-al ri;e an (e)a;ior a(nor&alities 2 none
:$ O;er an9iety 2 none
I$ Reality testin0 a(ility 2 ist-r(an'e in (e)a;ior, t)o-0)ts, an *eelin0
A9is II$ Personal isorer an &ental retaration isorer
10
Personality isorer 2 none
Mental isorer 2 none
A9is III$ None

A9is I=$
Pro(le& #it) *inin0 %o(
Pro(le& #it) e-'ation
A9is =$ Glo(al assess&ent *-n'tional
So'ial 2 ist-r(an'e
Daily A'ti;ity 2 ist-r(an'e$
Leis-re7 re'reational a'ti;ity 2 ist-r(an'e$
M10*+60, A?+. +)3-2.+.
I $ F$++$, Re'-rrent Depression #it) &il episoi'
II$ No Dia0nosis
III$ No Dia0nosis
I=$Pro(le& #it) *inin0 %o(
Pro(le& #it) e-'ation
=$ GAF2I, 1 :.
D+77,!,-*+)0 +)3-2.+.
F ++$. Re'-rrent Depression, &oerate episoi'
F +2$J Depression #it) -n'lassi*ie
T<,!)6/
1 Fl-o9etin . 9 . ta(let K 2, &0
1 Merlopa& . 9 < 4a(let K ,,< &0
1 Gin0!o*or'e 2 9 . ta(let
1 Ne-ro(at . 9 . ta(let
11
=ARIABEL PENILAIAN BAIK BURUK
Onset De#asa L
Relaps perna) L
Dia0nosis Gan00-an epresi
(er-lan0 episoi!
rin0an
L
Fa&ily S-pport Bel-& apat inilai
Respon O(at Bai! L
Stat-s Per!a#inan Bel-& &eni!a) L
Keaaan E!ono&i Menen0a) !e (a#a) L
Kepat-)an &in-& o(at Pat-) L
Fa!tor Pen'et-s "elas L
Geneti! 4ia! aa L
Penya!it lain70an00-an lain 4ia! aa L
12