Case 2

Questions
Most likely diagnosis :
Schizophrenia paranoid type

Condition to ruled out :

Skizophrenia due to substance abuse and drug use
must be ruled out

Hospitalized?
Yes, cause he was experiencing auditory
hallucination and show dangerous behavior
• 1% of general population
• Onset 18-25 y o in men, 25-35 in woman
• 20% - 40% attempt suicide
• 10% complete suicide
Risk factor
 Subtypes :
• Paranoid
• Disorganized
• Catatonic
• Undifferenteated
• Residual
 DSM V criteria
At least two for 1 month:
• Delusions
• Hallucination
• Disorganized speech
• Diorganized or catatonic behaviour
• Negative symptom
 DSM V criteria
Only one needed if delusion bizzare, auditory
hallucination :
• Social or occupational dysfunctin
• Symtom for 6 months
• Schizoaffective and mood disorder with
psychotic figure must be ruled out
• Subestance abuse or medical condition must
be ruled out
 Symptom
• Bizarre delusions : delusions totally
implausible
• Delusions : fixed false belief
• Flat affect
• Idea of references
• Loose association : not connected
• Tangentiality
 DD
• Shizoaffective
• Mood disorder wih psychotic feature
 Therapy
Psikofarmaka
Antypsychotic :
• Typical :
• Atypical

Psychotherapy :
Reassureance
Hospitalized
 Follow up
• Clinical symptom
• Kepatuhan obat, dosage and frequency
• Side effect psikofarmaka
• Tv and intake
• Prog : based on risk factor : age
Case 51
 Questions
Most likely diagnosis :
Neurosis, GAD

Tx?
Psychotherapy and psychopharmacology
• Free floating anxiety
• Triad : hyperactivity otonomic, restlessness,
anxiety
• More in woman nral population
• 1% - 4,4 % in gp
 Risk factor
• Family history
• Stress
• History of physical or emotional trauma
• Other anxity disorder
 Symptom
• Restlessness, feeling keyed up or on edge.
• Being easily fatigued.
• Difficulty concentrating or mind going blank.
• Irritability.
• Muscle tension.
• Sleep disturbance (difficulty falling or staying
asleep, or restless, unsatisfying sleep).
 DSM V criteria
• Excessive anxiety and worry (apprehensive
expectation), occurring more days than not for at least
6 months, about a number of events or activities (such
as work or school performance).
• The individual finds it difficult to control the worry
• The anxiety and worry are associated with three (or
more) of the following six symptoms (with at least
some symptoms having been present for more days
than not for the past 6 months):
• Social and occupational impairment
• Not due to substance use
• No better medical condition explained
 Therapy
Psychofarmaka
Anxiety drugs
• Benzo : diazepam, lorazepam, clobazam
• Use clobazam 20-30 mg/ day
• Non benzo : buspirone

Psychotherapy
supportive