Pemicu 6 Blok Saraf & Kejiwaan

Liliani Labitta 405120026

 Gangguan neurotik,
somatoform dan terkait stress
F40 Gangguan anxietas fobik
F41 Gangguan anxietas lainnya
F42 Gangguan obsesif-kompulsif
F43 Reaksi terhadap stress berat dan gangguan penyesuaian
F44 Gangguan disosiatif (konversi)
F45 Gangguan somatoform
F48 Gangguan neurotik lainnya
 Anxiety disorders
• women >2x men
• Associated with significant morbidity and
often are chronic and resistant to treatment
 Biological factors
Genetic factors
Psychosocial factors

Panic disorders:
Panic attack A discrete period of
Pharmacotherapy:
fear/discomfort + 4/> of 13 Daily anti-panic drugs, 8-12 mo
symptoms that abruptly develop and once effective:
reach peak in 10 min SSRI
Tricyclic antidepressant
Benzodiazepines
Panic disorder Recurrent unexpected panic attacks MAOI
1 mo /> :persistent concern about having RIMA
additional attacks, or/and worry about Atypical antidepressant
Other: valproic acid, inositol
consequences , or/and a significant
behaviour change Cognitive & behavioral th:
With/without agoraphobia Cognitive therapy
Agoraphobia Applied relaxation
Anxiety about being in Respiratory training
In vivo exposure
places/situations
The situations are avoided or else are Psychological therapy:
endured with marked distress or with Family therapy
anxiety about having a panic attack or Insight-oriented psychotherapy
panic-like symptoms, or require the
presence of a companion. Not better Combined pharmacotherapy &
psychotherapy
accounted for by another mental disorder
 Biological factors
Genetic factors
Psychosocial factors
Generalized
Anxiety Disorder
most often coexists with another
mental disorder, usually social
phobia, specific phobia, panic
disorder, or a depressive disorder
Associated with somatic
symptoms: muscle tension,
irritability, difficulty sleeping, and
restlessness.
• >>> anxiety and worry 6-mo/>
• worry is difficult to control
Most effective
• 3/>: treatment: combination
• restlessness or feeling of psychotherapeutic,
keyed up or on edge
pharmacotherapeutic,
• being easily fatigued
• difficulty concentrating or and supportive
mind going blank approaches
• Irritability
• muscle tension Anxiolytic: benzodiazepines,
• sleep disturbance the serotonin-specific
• anxiety and worry is not confined reuptake inhibitors (SSRIs),
to features of an Axis I disorder buspirone & venlafaxine
• cause clinically significant distress Treatment should be long
or impairment in social, term, perhaps lifelong
occupational, or other important
areas of functioning
• disturbance is not due to
substance /medical condition/
mood disorder, psychotic disorder,
pervasive developmental disorder
 Biological factors
Genetic factors
Psychosocial factors
Obsessive-
compulsive disorder
a diverse group of symptoms that
include intrusive thoughts, rituals,
preoccupations, and compulsions
Comorbids: social phobia 25%
major depressive disorder 67%
Serotonergic system
Noradrenergic system
Neuroimmunology
Altered brain function
Either Obsessions:
1.recurrent and persistent thoughts, impulses, Pharmacotherapy:
or images that are intrusive and inappropriate SSRI
and cause marked anxiety or distress Tricyclic drug: Clomipramine
2.not simply excessive worries about real-life
problems Behavioral therapy
3.the person attempts to ignore or to neutralize
them with some other thought or action Psychotherapy
4.the person recognizes that those are a
product of his or her own mind (not imposed ECT & psychosurgery: for
from without as in thought insertion) extreme cases that are treatment
Or Compulsions: resistant & chronically debilitating
1.repetitive behaviors or mental acts in
response to an obsession, or according to rules
that must be applied rigidly
2.aimed at preventing or reducing distress or
preventing some dreaded event or situation; not
connected in a realistic way or are clearly
excessive
At some point, the person recognized.
Cause marked distress, time-consuming (>1
h/day), or significantly interfere with the
person's normal routine
Not restricted to other axis I
Not due to substance or a general medical
condition.
Specify if:  With poor insight: if, for most of the
time during the current episode, the person
does not recognize
 Obsessive-Compulsive and
Related Disorders
• Body Dysmorphic Disorder-2.4%
– 9-15% of dermatologic pts Physical Examination Findings &
General Medical Conditions
– 7% of cosmetic surgery pts
• Pain
– 10% of pts presenting for oral or maxillofacial • Pruritus & tingling in the involved areas may be present
• The patterns of hair loss are highly variable
surgery! • Areas of complete alopecia are common
• There may be a pattern of nearly complete baldness except
• Hoarding Disorder- est. 2-6% F<M for a narrow perimeter around the outer margins of the scalp,
particularly at the nape of the neck ("tonsure trichotillomania").

• Excoriation Disorder 1.4% F>M •

•
Eyebrows and eyelashes may be completely absent.
Thinning of pubic hairs
• There may be areas of absent hair on the limbs or torso.
• Trichotillomania 1-2% F:M 10:1! • Trichophagia may result in bezoars (hair balls) that may lead
to anemia, abdominal pain, hematemesis, nausea and
vomiting, and bowel obstruction and even perforation

Treatment
• Supportive and Insight-oriented psychotherapies
• Medications :
• High level of anxiety  Benzodiazepines,
• With or without depressed mood  antidepressant drugs (SSRIs)
• Hypnosis & biofeedback