BAHAN PEMICU 6

SARAF DAN KEJIWAAN

Ivan Buntara
405120049
 Learning Objectives
1. Gangguan neurotik, gangguan berhubungan dengan stres, dan
gangguan somatoform
 F40 Gangguan Ansietas Fobik
F48 Gangguan Neurotik Lainnya
F41 Gangguan Ansietas Lainnya
Gangguan Neurotik,
Gangguan Berhubungan
F42 Gangguan Obsesif-Kompulsif
dengan Stres, dan
Gangguan Somatoform

F43 Reaksi Terhadap Stres Berat

F45 Gangguan Somatoform dan Gangguan Penyesuaian

F44 Gangguan Disosiatif (Konversi)

Maslim R. Diagnosis gangguan jiwa, rujukan ringkas PPDGJ-III.
Jakarta: Bagian Ilmu Kedokteran Jiwa FK Unika Atma Jaya;
2001.
 GANGGUAN ANSIETAS
• F40 Gangguan ansietas fobik
• F 40.0 Agorafobia
• .00 Tanpa gangguan panik
• .01 Dengan gangguan panik
• F 40.1 Fobia sosial
• F 40.2 Fobia khas
• F 40.8 Gangguan ansietas fobik
lainnya
• F 40.9 Gangguan ansietas fobik
YTT
• F41 Gangguan ansietas lainnya
• F 41.0 Gangguan panik
• F 41.1 Gangguan ansietas
menyeluruh
• F 41.2 Gangguan campuran
ansietas dan depresi
• F 41.3 Gangguan ansietas
campuran lainnya
• F 41.8 Gangguan ansietas lainnya
YDT
• F 41.9 Gangguan ansietas YTT
Diagnosis criteria DSM-IV
-Agoraphobia-

Note: Agoraphobia is not a codable disorder. Code the specific disorder

in which the agoraphobia occurs (e.g., panic disorder with agoraphobia
or agoraphobia without history of panic disorder)

• Anxiety about being in places or situations from which escape might be

difficult (or embarrassing) or in which help may not be available in the
event of having an unexpected or situationally predisposed panic attack
or panic-like symptoms.
Agoraphobic fears typically involve characteristic clusters of situations
that include being outside the home alone; being in a crowd or standing
in a line; being on a bridge; and traveling in a bus, train, or automobile.

Note: Consider the diagnosis of specific phobia if the avoidance is

limited to one or only a few specific situations, or social phobia if the
avoidance is limited to social situations
• The situations are avoided (e.g., travel is restricted) or else are
endured with marked distress or with anxiety about having a
panic attack or panic-like symptoms, or require the presence
of a companion
• The anxiety or phobic avoidance is not better accounted for by
another mental disorder, such as social phobia (e.g.,
avoidance limited to social situations because of fear of
embarrassment), specific phobia (e.g., avoidance limited to a
single situation like elevators), obsessive-compulsive disorder
(e.g., avoidance of dirt in someone with an obsession about
contamination), posttraumatic stress disorder (e.g., avoidance
of stimuli associated with a severe stressor), or separation
anxiety disorder (e.g., avoidance of leaving home or relatives)
Diagnostic criteria DSM-IV
-Agoraphobia without panic disorder-
• The presence of agoraphobia related to fear of developing panic-like
symptoms (e.g., dizziness or diarrhea)
• Criteria have never been met for panic disorder
• The disturbance is not due to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication) or a general medical
condition
• If an associated general medical condition is present, the fear
described in Criterion A is clearly in excess of that usually associated
with the condition
 TATALAKSANA AGORAFOBIA DAN
GANGGUAN PANIK
• Psikologis • Farmakologi
• Terapi kognitif dan perilaku → • SSRI → paroksetin
terapi kognitif, relaksasi, latihan • Benzodiazepin → alprazolam
pernapasan, paparan in vivo • Antidepresan trisiklik dan
• Terapi psikososial lainnya → terapi tetrasiklik → klomipramin,
keluarga, psikoterapi berorientasi imipramin
insight • MAOi
• Venlafaksin
• Kombinasi
Teruskan 8 – 12 bulan

Saddock BJ, Saddock VA. Kaplan and sadock’s synopsis of

psychiatry. 10th ed. Philadelphia: Lippincott Williams & Wilkins;
2007.
 GANGGUAN FOBIA
• Fobia spesifik
• Ketakutan yang jelas dan menetap
→ berlebihan
• Jenis : hewan / serangga,
lingkungan (ketinggian / badai),
darah / injeksi / luka, situasional
(pesawat, ruang tertutup), lainnya
(suara keras, badut)
• Fobia sosial
• Ketakutan yang jelas dan menetap
→ bertindak / bertingkah yang
memalukan
• Pada lingkungan dengan orang-
orang yang tidak dikenal / dengan
pengawasan ketat
• Takut berbicara di depan umum,
takut memulai / mempertahankan
pembicaraan, takut dating, takut
makan di tempat umum

Vojvodic M, Young A, editors. Toronto notes 2014. Toronto:

Toronto Notes for Medical Students Inc.; 2014.
 KRITERIA DIAGNOSIS GANGGUAN
FOBIA
• Stimulus → segera memicu respon ansietas. Dapat berupa serangan
panik
• Orang mengetahui ketakutannya berlebihan / tidak beralasan
• Situasi dihindari / dipertahankan dengan rasa ansietas atau distres
• Terganggunya rutinitas sehari-hari, fungsi okupasional / sosial, dan
atau distres yang jelas
• < 18 tahun → durasi minimal 6 bulan

Vojvodic M, Young A, editors. Toronto notes 2014. Toronto:

Toronto Notes for Medical Students Inc.; 2014.
 TATALAKSANA GANGGUAN FOBIA
• Psikologis • Biologis
• CBT • Situasi akut, fobia spesifik dengan
• Psikoterapi berorientasi insight serangan panik → β-bloker /
• Hipnosis benzodiazepine
• Terapi suportif • Fobia sosial → β-bloker, SSRI,
benzodiazepin, venlafaksin,
• Terapi keluarga buspiron; kasus berat : MAOi
• Fobia spesifik → terapi paparan,
CBT

Vojvodic M, Young A, editors. Toronto notes 2014. Toronto: Toronto

Notes for Medical Students Inc.; 2014.
Saddock BJ, Saddock VA. Kaplan and sadock’s synopsis of psychiatry.
10th ed. Philadelphia: Lippincott Williams & Wilkins; 2007.
Vojvodic M, Young A, editors. Toronto notes 2014. Toronto:
Toronto Notes for Medical Students Inc.; 2014.
Diagnosis criteria DSM-IV-Panic attack-
• Note: A panic attack is not a codable disorder. Code the specific
diagnosis in which the panic attack occurs (e.g., panic disorder
with agoraphobia)
• A discrete period of intense fear or discomfort, in which four (or
more) of the following symptoms developed abruptly and
reached a peak within 10 minutes
• palpitations, pounding heart, or accelerated heart rate
• Sweating; trembling or shaking
• sensations of shortness of breath or smothering
• feeling of choking; chest pain or discomfort
• nausea or abdominal distress; feeling dizzy, unsteady, lightheaded, or
faint
• derealization (feelings of unreality) or depersonalization (being
detached from oneself)
• fear of losing control or going crazy; fear of dying; paresthesias
• chills or hot flushes
Diagnostic criteria DSM-IV
-Panic disorder without agoraphobia-
• Both (1) and (2):
• recurrent unexpected panic attacks
• at least one of the attacks has been followed by 1 month (or more) of one (or more) of the
following
• persistent concern about having additional attacks
• worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack,
going crazy)
• a significant change in behavior related to the attacks
• Absence of agoraphobia
• The panic attacks are not due to the direct physiological effects of a substance (e.g.,
a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism)
• The panic attacks are not better accounted for by another mental disorder
Diagnostic criteria DSM-IV
-Panic disorder with agoraphobia-
• Both (1) and (2)
• recurrent unexpected panic attacks
• at least one of the attacks has been followed by 1 month (or more) of one (or more) of the
following
• persistent concern about having additional attacks
• worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack,
going crazy)
• a significant change in behavior related to the attacks
• The presence of agoraphobia
• The panic attacks are not due to the direct physiological effects of a substance (e.g.,
a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism)
• The panic attacks are not better accounted for by another mental disorder
 TATALAKSANA GANGGUAN PANIK
• Psikologis • Farmakologi
• CBT → terapi kognitif, relaksasi, • SSRI → fluoksetin, sitalopram,
latihan pernapasan, paparan in paroksetin, fluvoksamin, sertraline
vivo • SNRI → venlafaksin
• Terapi psikososial lainnya → terapi • Antidepresan lain → antidepresan
keluarga, psikoterapi trisiklik, mirtazapine, MAOi
• Benzodiazepin

Vojvodic M, Young A, editors. Toronto notes 2014. Toronto: Toronto

Notes for Medical Students Inc.; 2014.
Saddock BJ, Saddock VA. Kaplan and sadock’s synopsis of psychiatry.
10th ed. Philadelphia: Lippincott Williams & Wilkins; 2007.
Diagnosis criteria DSM IV
-Mixed Anxiety-Depressive Disorder-
• Persistent or recurrent dysphoric mood lasting at least 1 month
• The dysphoric mood is accompanied by at least 1 month of four (or
more) of the following symptoms:
• difficulty concentrating or mind going blank
• sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying
sleep)
• fatigue or low energy; irritability; worry; being easily moved to tears
• Hypervigilance; anticipating the worst
• hopelessness (pervasive pessimism about the future)
• low self-esteem or feelings of worthlessness
• The symptoms cause clinically significant distress or
impairment in social, occupational, or other important
areas of functioning
• The symptoms are not due to the direct physiological
effects of a substance (e.g., a drug of abuse, a
medication) or a general medical condition
• All of the following
• criteria have never been met for major depressive disorder,
dysthymic disorder, panic disorder, or generalized anxiety
disorder
• criteria are not currently met for any other anxiety or mood
disorder
• the symptoms are not better accounted for by any other
mental disorder
Vojvodic M, Young A, editors. Toronto notes 2014. Toronto:
Toronto Notes for Medical Students Inc.; 2014.
 TATALAKSANA GANGGUAN OBSESIF-
KOMPULSIF
• Psikologis • Farmakologi
• CBT → paparan dengan • SSRI / SNRI
pencegahan respon; strategi • Klomipramin
kognitif → mengubah kepercayaan • Risperidon

Vojvodic M, Young A, editors. Toronto notes 2014. Toronto:

Toronto Notes for Medical Students Inc.; 2014.
 TATALAKSANA GANGGUAN STRES
PASCA TRAUMA
• Psikologis • Farmakologi
• CBT → terapi paparan, menantang • SSRI
kepercayaan yang disfungsional, • Antidepresan trisiklik
teknik regulasi emosi (pernapasan, • MAOi
relaksasi)
• Trazodone
• Hipnosis
• Benzodiazepin → untuk ansietas
• Teknik manajemen stres akut
• Teknik manajemen terhadap • Antipsikosis atipikal
paparan

Vojvodic M, Young A, editors. Toronto notes 2014. Toronto:

Toronto Notes for Medical Students Inc.; 2014.
 KOMPLIKASI GANGGUAN STRES
PASCA TRAUMA
• Penyalahgunaan zat
• Kesulitan berelasi
• Depresi
• Gangguan fungsi sosial dan okupasional
• Kelainan aksis II

Vojvodic M, Young A, editors. Toronto notes 2014. Toronto:

Toronto Notes for Medical Students Inc.; 2014.
Somatization Disorder
Conversion Disorder
Hypochondriasis
Undifferentiated Somatoform Disorder
Somatoform Disorder Not Otherwise
Specified
Tatalaksana : • Kelainan kronis →
• Farmakologi → steroid topikal dan hidroksizin hidroklorida; mencabut rambut
ansiolitik; antidepresan; agen serotonergic; antipsikosis;
antagonis reseptor dopamin; litium
secara berulang
• Nonfarmakologi → terapi perilaku, terapi berorientasi • Hilangnya rambut →
insight; hipnoterapi biasa dapat diamati
Kriteria diagnosis (DSM-IV-TR) :
A.Recurrent pulling out of one’s hair
resulting in noticeable hair loss
Etiologi :
B.An increasing sense of tension
immediately before pulling out the hair or Trikotilomania • Dihubungkan dengan
when attempting to resist the behavior situasi penuh stres (>
C.Pleasure, gratification, or relief when
1/4 kasus)
pulling out the hair
D.The disturbance is not better accounted • Faktor penting →
for by another mental disorder and is not gangguan hubungan
due to a general medical condition (e.g., a
ibu – anak, takut
dermatological condition)
E.The disturbance causes clinically ditinggal sendiri,
significant distress or impairment in social, kehilangan objek
occupational, or other important areas of
dalam waktu dekat
functioning
 DAFTAR PUSTAKA
• Maslim R. Diagnosis gangguan jiwa, rujukan ringkas PPDGJ-III. Jakarta:
Bagian Ilmu Kedokteran Jiwa FK Unika Atma Jaya; 2001.
• Saddock BJ, Saddock VA. Kaplan and sadock’s synopsis of psychiatry.
10th ed. Philadelphia: Lippincott Williams & Wilkins; 2007.
• Vojvodic M, Young A, editors. Toronto notes 2014. Toronto: Toronto
Notes for Medical Students Inc.; 2014.
• http://calgaryguide.ucalgary.ca/