GANGGUAN STRES PASCA TRAUMA (GSPT)

POST TRAUMATIC STRESS DISORDER (PTSD)

Guntara Hari
Psikiater
Eka Hospital BSD
DEFINITION
 An anxiety disorder emerging after exposure to
an extreme traumatic stressor involving actual
or threatened death or serious injury.
 To qualify as ‘‘traumatic,’’ the stressful event
must pose a threat to life or limb.
 The same life-threatening event ≠ traumatic:
 Horrified : a potential candidate for a diagnosis of
PTSD.
 Fearless: non potential.

Carol S.North, Sean H. Yutzy, Goodwin and Guze’s Psychiatric Diagnosis,Sixth Ed,Oxford,2010
EPIDEMIOLOGI

 Prevalensi seumur hidup: satu kali atau lebih

peristiwa traumatik selama hidup
 25% yg bertahan hidup  GSPT

 GSPT sering ko-morbid:

 Depresiberat (MDD)
 Gangguan panik (panic disorder)

 Gangguan cemas menyeluruh (GAD)

 Penyalahguna napza
EPIDEMIOLOGI

 GSPT berulang pada anak – dewasa ko-morbid:

 Hipertensi

 Asma bronkhiale
 Gastritis

 Cephalgia

 Psikosomatik lainnya
ETIOLOGI
Stresor > kapasitas mental
Faktor predisposisi:
 Riwayat gangguan psikiatrik (pasien & keluarga)

 Riwayat trauma masa kanak (fisik, seksual)

 Riwayat trauma luar biasa (bagi pasien)

 Sifat mudah kuatir

 Ciri kep.: ambang, paranoid, dependen, antisosial

 Karakter introvet, isolasi sosial, masalah

penyesuaian diri
 Kebutuhan emosional yang tak terpenuhi
3 KEJADIAN YANG MENINGKATKAN PROBABILITAS

1. Tindak kekerasan interpersonal

2. Kecelakaan / bencana (alam, buatan) 

mengancam jiwa

3. Trauma berulang dan kronik

KARAKTERISTIK TRAUMA JENIS REAKSI PSIKOLOGIS

 Durasi dan intensitas

 Derajat ancaman terhadap kehidupan

 Derajat kehilangan (material, personal)

 Perilaku korban selamat (menolong lainnya /

Selamatkan Diri Masing-masing)
KARAKTERISTIK TRAUMA JENIS REAKSI PSIKOLOGIS

Setelah peristiwa traumatik:

 Sistem keyakinan / religiositas dan budaya

 Dukungan sosial
 ASPEK
BIOLOGIK
GSPT

Respons takut

Pitman,1989
 Potential consequenses of low cortisol during trauma
Excessive catecholamines at the time of trauma

Over consolidation or inappropriate pairing of memories and distress

Traumatic reminders becoming distressing; ‘distress’ provoking traumatic memories

Further pairing of distress with more non-spesific stimuli

Failure of habituation and extinction of trauma-related stimuli

Frequent anxiety

Increase CRF release

Continued, sustained, alterations of the HPA axis

Pitman,1989

Numerous other consequences (behavioural,cognitive,immune system,health,personality and neuroanatomic change)

ASPEK BIOLOGIK GSPT

 Trauma  respons takut:

 Amigdala 
 Sistem saraf simpatis (katekolamin)- ↑ HR & BP 
Fight or flight reaction
 Sistem syaraf parasimpatis: membatasi respons
saraf simpatis
 Aksis hipotalamus-hipofisis-kelenjar adrenal (aksis
HPA)  CRF  ACTH  kortisol
ASPEK BIOLOGIK GSPT

 Katekolamin: energi utk organ vital tubuh dlm

menghadapi stres
 Kortisol: terminasi proses respons ( umpan balik
negatif aksis HPA)
 Hipotesis Pitman (1989): GSPT terjadi gangguan
regulasi neuropeptida dan katekolamin ↑  siaga
terus menerus; kortisol gagal menghentikan 
‘konsolidasi berlebihan’ dari ingatan traumatik
(gejala GSPT)
ASPEK PSIKOLOGIS DARI GSPT
 Arti subyektif  besarnya dampak
 Kejadian sekarang mereaktivasi konflik psikologis
akibat kejadian lama / masa kanak
 Gagal meregulasi sistem afeksi
 Refleksi dapat timbul sebagai somatisasi / aleksitimia
 Sistem defensi mental yang sering muncul:
penyangkalan, splitting, projeksi, disosiasi dan rasa
bersalah (survival guilt)
 Relasi obyek: projeksi dan introjeksi sebagai penyelamat
/ korban omnipoten
 GAMBARAN KLINIS: KRITERIA DIAGNOSIS DSM IV-TR
A. The person has been exposed to a traumatic event in which both of the following were present:
(1) The person experienced, witnessed, or was confronted with an event or events that
involved actual or threatened death or serious injury or a threat to the physical integrity of
self or others.
(2) The person’s response involved intense fear, helplessness, or horror. Note: In children, this
may be expressed instead by disorganized or agitated behavior.
B. The traumatic event is persistently re-experienced in one (or more) of the following ways:
(1) Recurrent and intrusive distressing recollections of the event, including images, thoughts,
or perceptions Note: In young children, repetitive play may occur in which themes or
aspects of the trauma are expressed.
(2) Recurrent distressing dreams of the event Note: In children, there may be frightening
dreams without recognizable content.
(3) Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the
experience, illusions, hallucinations, and dissociative flashback episodes, including those
that occur on awakening or when intoxicated) Note: In young children, trauma-specific
reenactment may occur.
(4) Intense psychological distress at exposure to internal or external cues that symbolize or
resemble an aspect of the traumatic event
(5) Physiological reactivity on exposure to internal or external cues that symbolize or resemble
an aspect of the traumatic event
GAMBARAN KLINIS: KRITERIA DIAGNOSIS DSM IV-TR

C. Persistent avoidance of stimuli associated with the trauma and numbing of general
responsiveness (not present before the trauma), as indicated by three (or more) of the
following:
(1) Efforts to avoid thoughts, feelings, or conversations associated with the trauma
(2) Efforts to avoid activities, places, or people that arouse recollections of the trauma
(3) Inability to recall an important aspect of the trauma
(4) Markedly diminished interest or participation in significant activities
(5) Feeling of detachment or estrangement from others
(6) Restricted range of affect (e.g., unable to have loving feelings)
(7) Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children,
or
a normal life span)
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two
(or more) of the following:
(1) Difficulty falling or staying asleep
(2) Irritability or outbursts of anger
(3) Difficulty concentrating
(4) Hypervigilance
(5) Exaggerated startle response
 GAMBARAN KLINIS: KRITERIA DIAGNOSIS DSM IV-TR

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more

than 1 month.
F. The disturbance causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
Specify if:
Acute: if duration of symptoms is less than 3 months
Chronic: if duration of symptoms is 3 months or more
Specify if:
With Delayed Onset: if onset of symptoms is at least 6 months after the
stressor

Adapted from diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition text
revision. Washington, DC: American Psychiatric Association, 2000.
PENATALAKSANAAN

 Medikasi berupa antidepresan:

 SSRI: Fluoxetin, Sertralin, Fluvoxamine

 MAOI: Amiltriptilin, Imipramin

 Antipsikotik atipical dan anticemas dapat

digunakan apabila muncul gejala
PENATALAKSANAAN

 Psikoterapi (hipnotherapy, Cognitive and

Behavioral Therapy, group therapy)
 Edukasi (mengenali dan mengerti perubahan
fungsi diri secara fisik dan psikis akibat
kejadian traumatik –adaptif / maladaptif
sehingga mampu mengambil sikap)
PENATALAKSANAAN

 Dukungan sosial (mengurangi stigma negatif

diagnosis GSPT – tak tabah, berserah,
bersyukur)
 Modifikasi pola hidup / rutinitas (diet sehat,
olahraga teratur, hindari kafein, alkohol, rokok,
napza,dll)
PENATALAKSANAAN

 Tehnik meredakan kecemasan:

 Relaksasi = fisik  psikis

 Tehnik olah pernafasan – tenang,kendali

pikiran dan perasaan
 Exposure therapy – desentisisasi
KESIMPULAN
 Gangguan cemas yang muncul setelah
terpaparnya seseorang pada suatu stresor ekstrim
yang menyebabkan kemungkinan kematian yang
nyata atau ancaman kematian atau perlukaan
serius
 25% yg bertahan hidup  GSPT
 GSPT sering co-morbid: MDD, panic disorder, GAD,
penyalahguna napza, hipertensi, asma bronkhiale,
gastritis, cephalgia, dan psikosomatik lainnya
 Penatalaksanaan komprihensif
TERIMA KASIH
TERIMA KASIH