DAFTAR KOMPETENSI LAYANAN PRIMER

BAGIAN ILMU KESEHATAN JIWA

1. Gangguan Somatoform
2. Post Traumatic Stress Disorder
3. Gangguan Panik
4. Gangguan Bipolar Episode Maniak dan Depresi
5. Skizofrenia
6. Gangguan Waham
7. Gangguan Psikotik
8. Gangguan Skizoafektif
9. Delirium yang Diinduksi oleh Zat Psikoaktif/Alkohol
10. Insomnia
11. Hipersomnia
12. Intoksikasi Akut Zat Psikoaktif
13. Adiksi/Ketergantungan Narkoba
14. Gangguan Cemas Menyeluruh
15. Gangguan Campuran Cemas Depresi
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580 Substance-Related and Addictive Disorders

Development and Course

No single pattern of development or course characterizes the pharmacologically varied
other (or unknown) substance use disorders. Often unknown substance use disorders will
be reclassified when the unknown substance eventually is identified.

Risk and Prognostic Factors

Risk and prognostic factors for other (or unknown) substance use disorders are thought to
be similar to those for most substance use disorders and include the presence of any other
substance use disorders, conduct disorder, or antisocial personality disorder in the indi-
vidual or the individual’s family; early onset of substance problems; easy availability of
the substance in the individual’s environment; childhood maltreatment or trauma; and ev-
idence of limited early self-control and behavioral disinhibition.

Culture-Related Diagnostic Issues

Certain cultures may be associated with other (or unknown) substance use disorders in-
volving specific indigenous substances within the cultural region, such as betel nut.

Diagnostic Markers
Urine, breath, or saliva tests may correctly identify a commonly used substance falsely
sold as a novel product. However, routine clinical tests usually cannot identify truly un-
usual or new substances, which may require testing in specialized laboratories.

Differential Diagnosis
Use of other or unknown substances without meeting criteria for other (or unknown)
substance use disorder. Use of unknown substances is not rare among adolescents, but
most use does not meet the diagnostic standard of two or more criteria for other (or un-
known) substance use disorder in the past year.
Substance use disorders. Other (or unknown) substance use disorder may co-occur
with various substance use disorders, and the symptoms of the disorders may be similar
and overlapping. To disentangle symptom patterns, it is helpful to inquire about which
symptoms persisted during periods when some of the substances were not being used.
Other (or unknown) substance/medication-induced disorder. This diagnosis should
be differentiated from instances when the individual’s symptoms meet full criteria for one
of the following disorders, and that disorder is caused by an other or unknown substance:
delirium, major or mild neurocognitive disorder, psychotic disorder, depressive disorder,
anxiety disorder, sexual dysfunction, or sleep disorder.
Other medical conditions. Individuals with substance use disorders, including other
(or unknown) substance use disorder, may present with symptoms of many medical dis-
orders. These disorders also may occur in the absence of other (or unknown) substance use
disorder. A history of little or no use of other or unknown substances helps to exclude
other (or unknown) substance use disorder as the source of these problems.

Comorbidity
Substance use disorders, including other (or unknown) substance use disorder, are com-
monly comorbid with one another, with adolescent conduct disorder and adult antisocial
personality disorder, and with suicidal ideation and suicide attempts.
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362 Sleep-Wake Disorders

2nd Edition (ICSD-2) elaborated numerous diagnostic subtypes. DSM-IV was prepared for
use by mental health and general medical clinicians who are not experts in sleep medicine.
ICSD-2 reflected the science and opinions of the sleep specialist community and was pre-
pared for use by specialists.
The weight of available evidence supports the superior performance characteristics
(interrater reliability, as well as convergent, discriminant, and face validity) of simpler, less-
differentiated approaches to diagnosis of sleep-wake disorders. The text accompanying
each set of diagnostic criteria provides linkages to the corresponding disorders included in
ICSD-2. The DSM-5 sleep-wake disorders classification also specifies corresponding non-
psychiatric listings (e.g., neurology codes) from the International Classification of Diseases
(ICD).
The field of sleep disorders medicine has progressed in this direction since the publi-
cation of DSM-IV. The use of biological validators is now embodied in the DSM-5 classi-
fication of sleep-wake disorders, particularly for disorders of excessive sleepiness, such as
narcolepsy; for breathing-related sleep disorders, for which formal sleep studies (i.e.,
polysomnography) are indicated; and for restless legs syndrome, which can often coexist
with periodic limb movements during sleep, detectable via polysomnography.

Insomnia Disorder
Diagnostic Criteria 307.42 (F51.01)
A. A predominant complaint of dissatisfaction with sleep quantity or quality, associated
with one (or more) of the following symptoms:
1. Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep
without caregiver intervention.)
2. Difficulty maintaining sleep, characterized by frequent awakenings or problems re-
turning to sleep after awakenings. (In children, this may manifest as difficulty return-
ing to sleep without caregiver intervention.)
3. Early-morning awakening with inability to return to sleep.
B. The sleep disturbance causes clinically significant distress or impairment in social, oc-
cupational, educational, academic, behavioral, or other important areas of functioning.
C. The sleep difficulty occurs at least 3 nights per week.
D. The sleep difficulty is present for at least 3 months.
E. The sleep difficulty occurs despite adequate opportunity for sleep.
F. The insomnia is not better explained by and does not occur exclusively during the
course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep dis-
order, a circadian rhythm sleep-wake disorder, a parasomnia).
G. The insomnia is not attributable to the physiological effects of a substance (e.g., a drug
of abuse, a medication).
H. Coexisting mental disorders and medical conditions do not adequately explain the pre-
dominant complaint of insomnia.
Specify if:
With non–sleep disorder mental comorbidity, including substance use disorders
With other medical comorbidity
With other sleep disorder
Coding note: The code 307.42 (F51.01) applies to all three specifiers. Code also the
relevant associated mental disorder, medical condition, or other sleep disorder imme-
diately after the code for insomnia disorder in order to indicate the association.
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Stressful Life Events and Relapse in Bipolar
Affective Disorder: A Cross-Sectional Study from a
Tertiary Care Center of Southern India

Sivin P. Sam, A. Nisha, P. Joseph Varghese

ABSTRACT
Background: Bipolar affective disorder (BAD) is a severe mental illness which results in serious lifelong struggles
and challenges. The full impact of stressful life events (SLEs) on the course of BAD is poorly understood.
Materials and Methods: A cross-sectional study was conducted on 128 consecutive patients with BAD currently admitted
with a relapse. Our objectives were (1) to estimate the proportion, type, and timing of preonset SLEs in relapsed BAD
patients and (2) to study the association between SLEs and selected clinical variables in this group. Semi-structured
proforma, Young Mania Rating Scale, Hamilton Rating Scale for Depression, Presumptive Stressful Life Events Scale,
and Brief Psychiatric Rating Scale were used. Statistical analysis was done using R software for Windows. Results: About
69.5% (89/128) of patients reported preonset SLEs – among which 50 (56.2%) had mania and 39 (43.8%) had depression.
Conflict with in-laws and financial problems were the commonly reported SLEs. The mean duration between SLEs and the
relapse was 19.73 ± 4.8 days. BPRS score was significantly high in subjects with preonset SLEs (P = 0.022). No significant
association was detected between SLEs and the type of episode during relapse (P = 0.402). Conclusion: This study
emphasizes the significance of SLEs in the relapse and longitudinal course of BAD. Understanding the association of SLEs
and relapse in BAD will help in predicting further relapses and developing newer pharmacological and nonpharmacological
measures targeting this aspect, thereby maximizing both symptom reduction and quality of life in patients with BAD.

Key words: Bipolar affective disorder, relapse, Southern India, stressful life events

INTRODUCTION do not reach full interepisodic remission and continue

Bipolar affective disorder (BAD) is a complex, severe,
disabling, recurrent, and multifactorial psychiatric
illness that affects approximately 1% of the world’s
population.[1] Contrary to the classical teaching about
its episodic course, in reality, several patients with BAD
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to have residual subsyndromal symptomatology,
leading to functional impairment and impaired quality
of life.[1] Convincing evidence exists for the role of
genetic risk factors on the onset and course of this
This is an open access journal, and articles are distributed under
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For reprints contact: reprints@medknow.com

DOI: How to cite this article: Sam SP, Nisha A, Varghese PJ. Stressful life events
10.4103/IJPSYM.IJPSYM_113_18 and relapse in bipolar affective disorder: A cross-sectional study from a
tertiary care center of Southern India. Indian J Psychol Med 2019;41:61-7.

Department of Psychiatry, MOSC Medical College, Kolenchery, Kerala, India

Address for correspondence: Dr. A. Nisha

Department of Psychiatry, MOSC Medical College, Kolenchery - 682 311, Kerala, India. E-mail: drnisha.zalzabeel7@yahoo.co.in

© 2018 Indian Psychiatric Society - South Zonal Branch | Published by Wolters Kluwer - Medknow 61
769235
review-article2018
TPP0010.1177/2045125318769235Therapeutic Advances in PsychopharmacologyT A Rowland and S Marwaha

Therapeutic Advances in Psychopharmacology Review

Epidemiology and risk factors

Ther Adv Psychopharmacol

2018, Vol. 8(9) 251–269

for bipolar disorder DOI: 10.1177/

https://doi.org/10.1177/2045125318769235
https://doi.org/10.1177/2045125318769235
2045125318769235

© The Author(s), 2018.

Reprints and permissions:
Tobias A. Rowland and Steven Marwaha http://www.sagepub.co.uk/
journalsPermissions.nav

Abstract: Bipolar disorder is a multifactorial illness with uncertain aetiology. Knowledge of

potential risk factors enables clinicians to identify patients who are more likely to develop
bipolar disorder, which directs further investigation, follow up and caution when prescribing.
Ideally, identifying directly causative factors for bipolar disorder would enable intervention
on an individual or population level to prevent the development of the illness, and improve
outcomes through earlier treatment. This article reviews the epidemiology of bipolar disorder,
along with putative demographic, genetic and environmental risk factors, while assessing
the strength of these associations and to what extent they might be said to be ‘causative’.
While numerous genetic and environmental risk factors have been identified, the attributable
risk of individual factors is often small, and most are not specific to bipolar disorder but are
associated with several mental illnesses. Therefore, while some genetic and environmental
factors have strong evidence supporting their association with bipolar disorder, fewer have
sufficient evidence to establish causality. There is increasing interest in the role of specific
gene–environment interactions, as well as the mechanisms by which risk factors interact to
lead to bipolar disorder.

Keywords: bipolar disorder, epidemiology, risk factors

Received: 9 November 2017; revised manuscript accepted: 13 March 2018.

Introduction
Bipolar affective disorder (bipolar) is a multicom- recent updates and the role of environmental trig-
ponent illness involving episodes of severe mood gers. To identify relevant literature, searches were
disturbance, neuropsychological deficits, immu- conducted in PubMed and PsycINFO using the
nological and physiological changes, and distur- terms ‘Bipolar Disorder’, combined with ‘risk fac-
bances in functioning.1 It is one of the leading tors’ or ‘epidemiology’. Results were reviewed
causes of disability worldwide2 and is associated with a focus on the most recent evidence and sys-
with high rates of premature mortality from both tematic reviews or large prospective studies, and
suicide and medical comorbidities.3,4 further individual searches were then expanded
for each risk factor category identified. A sum-
The aetiology of bipolar is not well understood mary of the included studies relating to specific Correspondence to:
Tobias A. Rowland
and research into the disorder lags behind disor- risk factors for bipolar are included in Table 1. Unit of Mental Health
ders such as psychosis. However, the last decade and Wellbeing, Division
of Health Sciences,
has seen an expanding evidence into the genetics University of Warwick,
of the disorder, underlying developmental path- Epidemiology of bipolar disorder Coventry, CV4 7AL, UK
t.rowland.2@warwick.
ways, risks and vulnerability factors, gene–envi- Epidemiological studies have suggested a lifetime ac.uk
ronment interactions and the putative features of prevalence of around 1% for bipolar type I in the Steven Marwaha
the bipolar prodrome. general population.54,55 A large cross-sectional Division of Health
Sciences, University of
survey of 11 countries found the overall lifetime Warwick, Coventry, UK
This article summarizes the research into demo- prevalence of bipolar spectrum disorders was Coventry and Warwick-
shire Partnership Trust,
graphic, genetic and environmental risk factors 2.4%, with a prevalence of 0.6% for bipolar type I The Caludon Centre,
for the development of bipolar, with a focus on and 0.4% for bipolar type II.56 Although findings Coventry, UK

journals.sagepub.com/home/tpp 251
Jurnal Ilmiah Keperawatan Indonesia●
Vol 4, No 1, 2020 ISSN: 2580-3077

PENDAHULUAN
Kesehatan jiwa merupakan salah satu dari empat masalah kesehatan utama di
negara-negara maju. Meskipun masalah kesehatan jiwa tidak dianggap sebagai
gangguan yang menyebabakan kematian secara langsung, namun gangguan
tersebut dapat menimbulkan ketidakmampuan individu dalam berkarya serta
ketidak tepatan individu dalam berprilaku yang dapat mengganggu kelompok dan
masyarakat serta dapat menghambat pembangunan karena mereka tidak produktif
(Robertson and Prestia, 2014). Nama lain gangguan jiwa berat yaitu psikosis dan
salah satu contoh psikosis adalah skizofrenia.
Skizofenia merupakan gangguan mental yang menahun dengan gangguan
emosi, pikiran, persepsi dan perilaku dengan prevelensi 1 % di dunia (Lally et al.,
2016). Kasus skizofrenia merupakan pemburukan dari fungsi psikososial dan
kehilangan keterampilan (Medalia and Thysen, 2008). Jenis-jenis skizofrenia
dalam DSM IV TR yang direvisi pada DSM V salah satu dari jenisnya yaitu tipe
paranoid dengan adanya waham dan/atau halusinasi, tetapi tidak ada gangguan
pemikiran, perilaku yang tidak teratur atau ketumpulan afektif (American
Psychiatric Association, 2010).
Gangguan jiwa berat adalah gangguan jiwa yang ditandai oleh terganggunya
kemampuan menilai realitas atau tilikan (insight) yang buruk. Tanda dan gejala
yang menyertai pada gangguan jiwa berat ini antara lain halusinasi, delusi,
waham, gangguan proses pikir, kemampuan berpikir, serta tingkah laku aneh.
Persebaran gangguan jiwa berat di DKI Jakarta 1,1 permil dan di Jawa Barat 1,6
permil (Riskesda, 2013).
Prevalensi gangguan waham menetap di dunia sangat bervariasi, berdasarkan
beberapa literatur, prevalensi gangguan waham menetap pada pasien yang dirawat
inap dilaporkan sebesar 0,5-0,9 % dan pada pasien yang dirawat jalan, berkisar
antara 0,83-1,2 %. Sementara, pada populasi dunia, angka prevalensi dari
gangguan ini mencapai 24-30 kasus dari 100.000 orang (Ariawan dkk, 2014).
Pasien waham merupakan salah satu gejala yang terjadi pada kasus skizofrenia
dan merupakan bagian dari tanda dan gejala yang akan timbul pada pasien. Oleh
karena itu, perlu adanya treatment untuk menekan munculnya gejala yang lebih

http://jurnal.umt.ac.id/index.php/jik/index 65