study guide behavior semester iv tayang 5 april 2016 final1

8/16/2019 Study Guide Behavior Semester IV Tayang 5 April 2016 Final1

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Study Guide Behavior Changes and Disorders

TABLE OF CONTENTS

Page

Table of Contens 1

The Seven General Core Competencies 2

Planner team & Lecturers 3

Facilitators 5

Time Table !nglish Class" #

Time Table $egular Class" %

mportant nformations 12

Stu'ent(s Pro)ect 12

*eeting of the stu'ents( representative 1+

,ssessment *etho' 1+

Learning Programs 15

-asic Clinical S.ill 52

Curriculum *apping 5%

$eferences #/

Udayana University Faculty of Medicine, DME 1


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The Seven General Core Competencies

1. Patient Care0emonstrate capabilit to provi'e comprehensive patient care that is compassionate

appropriate an' effective for the management of health problems promotion of healthan' prevention of 'isease in the primar health care settings

2. Medical Knowledge Base*aster of a core me'ical .no4le'ge 4hich inclu'es the biome'ical sciencesbehavioral sciences epi'emiolog an' statistics clinical sciences the social aspect of me'icine an' the principles of me'ical ethics

3. Clinical sill0emonstrate capabilit to effectivel appl clinical s.ills an' interpret the fin'ings inthe investigation of the patients

!. Co""#nication0emonstrate capabilit to communicate effectivel an' interpersonall to establishrapport 4ith the patient famil communit at large an' professional associates thatresults in effective information echange the creation of a therapeuticall an' ethicallsoun' relationship

$. %n&or"ation Manage"ent0emonstrate capabilit to manager information 4hich inclu'es information accessretrieval interpretation appraisal an' application to patience(s specific problem an'maintaining recor's of his or her proactive for analsis an' improvement

'. Pro&essionalis"0emonstrate a commitment to carring out professional responsibilities an' topersonal probit a'herence to ethical principles sensitivit to a 'iverse patientpopulation an' commitment to carring out continual self6evaluation of his or her professional stan'ar' an' competence

(. Co""#nit)*+ased and ,ealt, s)ste"*+ased -ractice0emonstrate a4areness an' responsiveness to larger contet an' sstem of healthcare an' abilit to effectivel use sstem resource for optimal patient care



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Members Planning Group

No NAME EPA/TMENT P0ONE

10r 'r Co.or'a -agus 7aa Lesmana Sp87 8"9ea'" Pschiatr /:1#2%5;;%

2 'r ,na. ,u Sri G *,$S >bgn /:155:1/1;1%

11 0r 'r


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Curriculum Block The Behavioral Changes andDisorders

Ai"s1 Comprehen' professional competence an' ensure the highest ?ualit care to those

4ith mental illness2 Comprehen' the pscho'namic an' pscho pathological process of the behavior

'isor'ers3 0iagnose an' manage patient 4ith mental illness+ 0iagnose an' manage patient 4ith behavioral problems relate' 4ith me'ical

con'ition5 !'ucate patient an' their famil an' communit about behavior changes an'

'isor'ers

Learning O#tco"es

• ,4areness of lifestle as a ris. factor of behavior changes an' pschiatric 'isor'ers

an' the importance of earl treatment an' proper management an' prevention

• $ecogni@ance of the ne4 para'igm of me'ical practiceA beon' bio6pscho6socio6

cultural mo'el

• 0efine me'ical an' allie' sciences health prevention an' health promotion in the

relationship bet4een me'ical competencies an' the contributions of me'ical an'allie' sciences professional s.ills an' attitu'es to the prevention an' treatment of behavioral 'isor'ers

C#rric#l#" Contents1 0emonstrate abilit to 'iagnose manage an' refer patient 4ith problems in

'evelopmental stage of personalit2 0emonstrate abilit to 'iagnose manage an' refer patient 4ith psch6organic

sn'romes an' 'isor'ers3 0emonstrate abilit to 'iagnose manage an' refer patient 4ith pschosis

smptoms+ 0emonstrate abilit to 'iagnose manage an' refer patient 4ith bipolar 'isor'ers5 0emonstrate abilit to 'iagnose manage an' refer patient 4ith aniet 'isor'ers# 0emonstrate abilit to 'iagnose manage an' refer patient 4ith somatoform

'isor'ers; 0emonstrate abilit to 'iagnose manage an' refer patient 4ith seual 'isor'ers: 0emonstrate abilit to 'iagnose manage an' refer patient 4ith insomnia smptoms% 0emonstrate abilit to eplain pscho pharmacolog1/ 0emonstrate abilit to 'iagnose manage an' refer patient 4ith self harm an'

suici'al behavior 11 0emonstrate abilit to 'iagnose manage an' refer patient 4ith problem relate' to

chil' abuse or neglecte'12 0emonstrate abilit to promote healing process in pschiatric patients

Udayana University Faculty of Medicine, DME


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Facilitators

Class A

No Na"e ro#- e-t P,oneen#e

43rd&loor5

1 'r ,,=gurah Suba4a *si ,1 ClinicalPatholog /:155;35/3+ 3

r'

floorA$3/%

2 'r 'a -agus Putra4an SpP0 ,2

nterna /:123#1%+#;2 3r' floorA$31/

3 'r =i =engah 04i Fatma4ati Sp*8 Ph0

,3*icrobiolog /:;:#22//:1+ 3r' floorA

$311

+ 0r 'r 8etut pthalmolog /:133:3+1:#/ 3r' floorA

$315: 'r Luh Putu in n'raani *a.er

SpP, 8" ,:

,natomPatholog

/:1;+;#1:/+ 3r' floorA$31#

% 'r G , , 04i 8armilaSp88 ,%

0ermatolog /:123%;:++# 3r' floorA$31;

1/ 'r 8unthi Bulianti Sp8F ,1/

Forensic /:133:+;2//5 3r' floorA$31%

Class B

No Na"e ro#- e-t P,one en#e43rd&loor5

1 0r'r Co.or'a -agus 7aa

Lesmana Sp87 8" -1

Pschiatr /:1#2%5;;% 3r' floorA

$3/%2 'r Putu ,riastuti *P9

-2Public 9ealth /:1:5#///: 3r' floorA

$31/

3 'r 8etut *aria'i SpP0-3

nterna /:123:53;// 3r' floorA$311

+ 'r ,gung =ova *ahen'ra *Sc-+

Pharmacolog /:;:#1/3/1%5 3r' floorA$312

5 'r 8etut Suasa Sp- Sp>T8"

-5Surger /:155:;2+/:: 3r' floorA

$313

# 'r G 8amasan =oman ,ri)ana*Si *e'

-#9istolog /:12+##5%## 3r' floorA

$31+

; 'r 8a'e. ,gus 9erana PutraSp,n

-; ,nasthesi /:133:5#:::3 3r' floorA

$315

: 'r =i Putu !.a4ati *$eproSpP,

-: ,natomPatholog

/:113:/3%33 3r' floorA$31#

% 'r *a'e 8risna 0inata *!rg-%

Fisiolog /:1;+;+25## 3r' floorA$31;

1/ 'r 8omang ,n'i 04i SaputraSpT9T6 8L

-1/!=T /:133:;/1:;: 3r' floorA

$31%

Udayana University Faculty of Medicine, DME !


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Ti"e Ta+le

Engglis, Classa)6ate

Ti"e Acti7it) en#e Con7e)er

1

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Lecture 1A %ntrod#ction to

Be,a7ior C,anges and isordersn'epen'ent learningGroup 0iscussion-rea. an' stu'ent pro)ectPlenar session

Class room

0iscussion room

Class room

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Class room

0iscussion room

Class room

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0r ,lit ,rani

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Monda)1: A-ril

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Lecturer 1/A Sc,i>o-,renia =Ot,er Ps)c,osesn'epen'ent learningGroup 0iscussion-rea. an' stu'ent pro)ectPlenar session

Class room

0iscussion room

Class room

0$ 0r Co. -agus

0$ 0r Co. -agus

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Lecturer 11A el#sional =Sc,i>oa&&ecti7e isordersn'epen'ent learningGroup 0iscussion-rea. an' stu'ent pro)ect

Plenar session

Class room

0iscussion room

Class room

0r Sri 0iniari

0r Sri 0iniari

12

9ed28 A-ril

281'

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Lecture 12A Bi-olar isorders =Ot,er Mood /elated isordersn'epen'ent learningGroup 0iscussion-rea. an' stu'ent pro)ectPlenar session

Class room

0iscussion room

Class room

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0r 0au

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Lecture 13A Panic isordersn'epen'ent learningGroup 0iscussion-rea. an' stu'ent pro)ect

Plenar session

Class room

0iscussion room

Class room

0r n'ah

0r n'ah

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Frida)22 A-ril

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Lecture 1+A So"ato&or"isordersn'epen'ent learningGroup 0iscussion-rea. an' stu'ent pro)ectPlenar session

Class room

0iscussion room

Class room

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0r n'ah

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Monda)2$ A-ril

281'

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Lecture 15A enerali>ed An;iet) =O+sessi7e*Co"-#lsi7e isorder n'epen'ent learningGroup 0iscussion-rea. an' stu'ent pro)ectPlenar session

Class room

0iscussion room

Class room

0r Lel

0r Lel

1'

T#esda)2' A-ril

281'

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Lecture 1#A PTSn'epen'ent learningGroup 0iscussion-rea. an' stu'ent pro)ectPlenar session

Class room

0iscussion room

Class room

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Class room

0iscussion room

Class room

0r 0au

0r 0au

Udayana University Faculty of Medicine, DME #


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1:

T,#rsda)2: A-ril

281'

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Lecture 1:A Ps)c,o*P,ar"acolog)n'epen'ent learningGroup 0iscussion-rea. an' stu'ent pro)ectPlenar session

Class room

0iscussion room

Class room

0r ,rtini

0r ,rtini

1<

Frida)2< A-ril

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Lecture 1%A Sel& 0ar" = S#iciden'epen'ent learningGroup 0iscussion-rea. an' stu'ent pro)ectPlenar sessionSP ro#- A1? A2? A3. A!

Class room

0iscussion room

Class room

0r Lel

0r Lel

28

Monda)2 Ma)281'

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Lecture 2/A C,ild A+#se =Neglectedn'epen'ent learningGroup 0iscussion-rea. an' stu'ent pro)ectPlenar session

SP ro#- A$? A'? A(?

Class room

0iscussion room

Class room

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/eg#lar Classa)6ate

Ti"e Acti7it) en#e Con7e)er

1

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Lecture 1A %ntrod#ction to Be,a7ior C,anges and isorders

Stu'ent pro)ect & brea.n'epen'ent learningGroup 0iscussionPlenar session

Class room

0iscussion roomClass room

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Lecture % Pri"ar) = Secondar)%nso"niaStu'ent pro)ect & brea.n'epen'ent learningGroup 0iscussionPlenar session

Class room


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0r ,lit ,rani

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Lecturer 1/A Sc,i>o-,renia = Ot,er Ps)c,osisStu'ent pro)ect & brea.n'epen'ent learningGroup 0iscussionPlenar session

Class room


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Plenar session

Class room

0iscussion room

Class room

0r Sri 0iniari

0r Sri 0iniari

12

9ed28 A-ril

281'

/%// 1///

1/// 12//12// 133/133/ 15//15// 1#//

Lecture 12A Bi-olar isorders =Ot,er Mood /elated isordersStu'ent pro)ect & brea.n'epen'ent learningGroup 0iscussionPlenar session

Class room


0r 0au

0r 0au

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Lecture 13A Panic isordersStu'ent pro)ect & brea.n'epen'ent learningGroup 0iscussion

Plenar session

Class room

0iscussion room

Class room

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0r n'ah

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Frida)22 A-ril

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Lecture 1+A So"ato&or" isordersStu'ent pro)ect & brea.n'epen'ent learningGroup 0iscussionPlenar session

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Class room


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0r 0au

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Udayana University Faculty of Medicine, DME 1&


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1:

T,#rsda)2: A-ril

281'

/%// 1///1/// 12//12// 133/133/ 15//15// 1#//

Lecture 1:A Ps)c,o*P,ar"acolog)Stu'ent pro)ect & brea.n'epen'ent learningGroup 0iscussionPlenar session

Class room


0r ,rtini

0r ,rtini

1<

Frida)2< A-ril

281'

/%// 1///1/// 12//12// 133/133/ 15//15// 1#//

Lecture 1%A Sel&*0ar" = S#icideStu'ent pro)ect & brea.n'epen'ent learningGroup 0iscussionPlenar sessionSP ro#- B18? B


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St#dent@s Proect

!ver stu'ent re?uires fin'ing a scientific )ournal base' on the topic of their groups an'create a revie4 paper as a group pro)ect The )ournal has to be from ear 2/1+ to recent

ears t has to be present in a report format b 4ee. + th to the facilitator an' present in theplenar session

No To-ic ro#-

1 nternet gaming a''iction ,1

2 Persistent 0epressive 0isor'er ,2

3 8leptomania ,3

+ Conversion 0isor'er ,+

5 Phsician ,ssisste' Suici'e ,5

# Premenstrual 0sphoric 0isor'er ,#; 0issociative 0isor'ers ,;

: Gen'er 0sphoria ,:

% Gambling 0isor'er ,%

1/ Paranoi' Personalit 0isor'er ,1/

11 ,utism Spectrum 0isor'er -1

12 ,ttention60eficitD9peractivit 0isor'er ,090" -2

13 ntellectual 0isabilit -3

1+ 0isruptive *oo' 0sregulation 0isor'er -+

15 -o' 0smorphic 0isor'er -5

1# $eactive ,ttachment 0isor'er -#

1; Persistent Comple -ereavement 0isor'er -;1: -inge !ating 0isor'er -:

1% >ppositional 0efiant 0isor'er -%

2/ Con'uct 0isor'er -1/

/e-ort For"at

Cover PrefaceTable of Content

a ntro'uction

b Contentc 0iscusion' Summar

Space A 15 SpaceFont A Times =e4 $oman 12*inimum PageA 15

The stu'ent(s pro)ect is present starting b the 1:th 'a of the meeting on the plenarmeeting The results 4ill be revie4 b the bloc. planning group for final mar.



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St#dent Proect Assess"ent For"Fac#lt) o& Medicine? da)ana ni7ersit)

-lo. A -ehavior Changes an' 0isor'ers

=ameD=* A

Facilitator A

Title A

Time Table of Consultation

Point o& isc#ssion 9ee ate T#tor Sign

Title 1

Translation of 7ournal 2

0iscussion an'Summar of 7ournal

3

Final $eport +

,ssessment , Paper structure A # ; : % 1/- Content A # ; : % 1/C 0iscussion A # ; : % 1/

Total Point A ,E-EC"D3

0enpasar

Facilitator



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Meeting o& St#dent /e-resentati7es and Facilitators

*eeting of stu'ent representatives an' facilitators 4ill be hel' on the second Frida) of thebloc. perio' if necessar. This meeting 4ill be organi@e' b the planners an' atten'e' b

lecturers stu'ents group representatives an' all facilitators *eeting 4ith the stu'entrepresentatives 4ill ta.e place at 8


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Learning Progra"s

*o'ul1

%ntrod#ction to Be,a7ior and isorders

'r ,na. ,u Sri


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Pschiatr to'a the transformation of our fiel' has gaine' increasing momentum>ur un'erstan'ing of the microstructure an' function of the brain an' of the geneticcontrols of the brain reveals ever more ama@ing information 4hich has alrea' begun totransform clinical practice an' pschiatric e'ucation Further the changes in the 4as 4ehave access to information have le' to 'ramatic improvement of accessibilit to our gro4ing.no4le'ge base Bet the clinical core of our 'iscipline remains the imperative to integratethe best of our humanistic tra'itions 4ith our cutting6e'ge scientific a'vances


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5 9o4 'o ou act as a primar care 'octor to create a process of 'estigmati@ationI

Sel& Assess"ent1 9o4 to 'o a goo' anamnesis for a patient an' his familI2 Can the 'rug given b car'iologist an' b pschiatrist be given simultaneouslI3 Tr to assess using *ulti ,ial 'iagnosis ,is an' "I+


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SCENA/%O ,n emploee gets a promotion to a higher position in another unit in the compan , monthlater the emploee becomes ill sho4e' 'ecrease' in performance an' 4ith'ra4n fromsocial relationship

Learning Tas Please 'iscussN1 ,n pschological tests that can be given an' the reasonN

SCENA/%O , oung bo has )ust become stu'ent in a ocational 9igh School Se.olah *enengah8e)uruan" ,t the en' of the first semester he got ver ba' mar.s 4hereas he has sho4ngoo' aca'emic achievement 4hile atten'ing )unior high school S*P" before 9e 4asfre?uentl absent because of illness =o responses come from the parents although theschool has sent an invitation letter to 'iscuss their son(s problems The bo is oftenpunishe' at school because of bulling his frien's

Learning Tas


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*o'ul3

eneral A--roac,es to S#+stance A+#se'r Luh =oman ,lit ,rani Sp87

A%MS• !mphasi@ing on un'erstan'ing the effects of substance abuse on phsical health

mental social

• Hn'erstan'ing the follo46up of treatment of in'ivi'uals 4ith intoication an' 4ith'ra4al

LEA/N%N OTCOMES1 Hn'erstan' pscho'namic substance abuse problems2 Hn'erstan' the tpes of 'rugs in general3 Hn'erstan'ing the smptoms of in'ivi'uals 4ith ob)ect 4ith'ra4al of 'rug poisoning+ Hn'erstan' the initial han'ling of the state of 4ith'ra4al substance intoication is

then able to ma.e a referral

C//%CLM CONTENTS1 The 'efinition of substance abuse tolerance 'epen'ence craving2 Hn'erstan' the role of genetic famil roles pscho6social stress associate' 4ith

substance abuse3 Hn'erstan'ing of the smptoms of the in'ivi'ual in a state of 4ith'ra4al an'

intoication from 'rugs+ -eing able to ma.e a 'iagnosis an' earl treatment an' refer the in'ivi'ual to a

state of 4ith'ra4al or 'rug intoication

ABST/ACTS0rug abuse or =arcotics ,lcohol Pschotropic an' >ther ,''ictive Substances to'a

continues to increase an' the alarming situation 0rug abuse is not onl the case for those4ho are classifie' as unemploe' but has been eten'e' to a'olescents 4ith status asstu'ents civil servants officials la4 enforcement an' so on This problem can not beseparate' from the influence of globali@ation information technolog an' faster transportation

The flurr of parents at least the time to pa attention affection for the chil'ren as4ell as famil life is not harmonious promiscuit outsi'e an' eas to obtain substances D'rugs especiall narcotics 4oul' plunge the in'ivi'ual to a substance abuse problem an'continues to 'epen'ence >nce the in'ivi'ual involve' substance abuse 'epen'encbecame ver 'ifficult to be normal again The stu' sas that onl 1/O of in'ivi'uals'epen'ence can be restore' to normal n un'ergoing the process of this 'epen'encein'ivi'ual 4ill feel the pain an' suffering at the time of eperienceA the state of 4ith'ra4al

intoication craving or the are un'ergoing legal procee'ings an' sent to prison , generalpractitioner shoul' be able to provi'e ai' D earl treatment to in'ivi'uals 4ith a state of 4ith'ra4al 'rug toicit an' referring to the hospital -esi'es general practitioners areepecte' to provi'e outreach to the communit about the 'angers of 'rugs so that peoplecan avoi' 'rug abuse

SELF %/ECT%N LEA/N%N-asic .no4le'ge that must be .no4A

1 Hn'erstan' pscho'namic substance abuse2 Hn'erstan' the tpes of 'rugs in general3 Hn'erstan'ing the smptoms of the in'ivi'ual to the state of 4ith'ra4al 'rug

substance intoication

+ 9an'le the initial han'ling of state 4ith'ra4al of 'rug substance intoication an' 4asable to ma.e a referral

Udayana University Faculty of Medicine, DME 1%


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SCENA/%OCase 1

, 25 ear ol' man ha' an a 5 ear histor of heav alcohol use For three 'as he'i'n(t 'rin. alcohol again t cause' autonomic hperactivit an' 'elirium

Learning Tas 1A1


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*o'ul!

Prenatal Ps)c,o+iolog) 4Case o& Ba+) Bl#es50r 'r 'a -agus Fa)ar *anuaba Sp>G *,$S

A%MS0escribe the clinical management of bab blues ,namnesis 9istor ta.ing *ental State!amination 0iagnosis an' Therap"

LEA/N%N OTCOMES0escribe ho4 toA

1 ,namnesis2 9istor ta.ing3 !amine mental state+ 0iagnosis5 Therap pharmacotherap pschotherap"

C//%CLM CONTENTS1 ,namnesis2 9istor ta.ing fun'amental four an' secret seven" of bab blues an' postpartum

'epression3 *ental state eamination of bab blues an' postpartum 'epression+ 0iagnosis formulation5 *o'alit of treatment of bab blues an' postpartum 'epression

ABST/ACTSPrenatal pscholog is an inter'isciplinar stu' of the foun'ations of health in bo' min'emotions an' in en'uring response patterns to life t eplores the pschological an'

pschophsiological effects an' implications of the earliest eperiences of the in'ivi'ualbefore birth prenatal" as 4ell as 'uring an' imme'iatel after chil'birth perinatal" onthe health an' learning abilit of the in'ivi'ual an' on their relationships ,s a broa' fiel' ithas 'evelope' a variet of curative an' preventive interventions for the unborn at chil'birthfor the ne4born infants an' a'ults 4ho are a'versel affecte' b earl prenatal an'perinatal 'sfunction an' trauma Some of these metho's have not been 4ithout significantcontrovers for eample homebirth in the


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SCENA/%O*ar is a 326ear6ol' marrie' nurse 4ith a histor of panic attac.s that have been 4ellcontrolle' for ears She presents 3 months postpartum follo4ing a 'ifficult pregnanccomplicate' b severe hperemesis gravi'arum an' 'sphoria in a''ition to traumatic'eliver 4ith a thir'6'egree perineal tear *ar no4 complains of cring spells 'ecrease'appetite insomnia an' obsessive 4orr over the bab(s health She feels isolate' from her husban' 4ho is over4helme' b her emotional nee's an' ten's to retreat to 4or.

Learning Tas1


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*o'ul$

Ne#ro+e,a7ioral a--roac, to Be,a7ior isorders0r 'r ,na. ,gung ,u Putri La.smi'e4i SpS8"

A%MSStu'ent 4ill be epecte' to .no4 an' un'erstan' the neurological basis of behaviormemor an' cognition the impact of neurological 'amage an' 'isease upon behavior 'isor'ers

LEA/N%N OTCOMESStu'ent 4ill be able to 'escribeA

1 9o4 neurobehavior theories 'evelop2 ,pproaches to neurobehavior 3 Tpes of pschological phenomena in patients 4ith brain 'isease

C//%CLM CONTENTS

1.


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Tas. to 'oA

1 0o the eamination or observation of the abilit of ta.ing histor of patientQs to

assess the clinical 'iagnosis of this case

2 0o the eamination or observation of the abilit to eamine neurobehavior

assessment to assess the 'iagnosis of this case

3 0o the eamination or observation of the abilit to communicate an' e'ucate

patient professional s.ill"

Case 2 Aa ;/ ear ol' 4oman come to hospital 4ith her husban' 'ue to agitate' an' 4an'ering

several 'as before

Tas. to 'oA1 0o the eamination or observation of the abilit of ta.ing histor of patientQs to

assess the clinical 'iagnosis of this case2 0o the eamination or observation of the abilit to eamine neurobehavior

assessment to assess the 'iagnosis of this case3 0o the eamination or observation of the abilit to communicate an' e'ucate patient

professional s.ill"

*o'ul

'Be,a7ior C,anges #e to a eneral Medical Condition

0r 'r


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ABST/ACTSPschiatric 'isor'ers are fre?uentl un'er6 an' over'iagnose' in the me'icall ill for anumber of reasons First pschiatric smptoms are similar to those of me'ical illness ,s aresult it ma be problematic to 'etermine 4hether such smptoms are manifestations of aphsical 'isease or a comorbi' pschiatric 'isor'er For eample a false6positive 'iagnosisof 'epression ma occur 4hen fatigue anoreia an' 4eight loss cause' b ame'icalillness are mista.enl attribute' to 'epression an' a false6negative 'iagnosis 4hen'epression(s vegetative smptoms are misattribute' to the me'ical illness , variet of approaches have been propose' to 'iminish the effect of me'ical smptoms confoun'ingthe 'iagnosis of 'epression n an JeclusiveK an' JetiologicK approach smptoms that are )u'ge' b the clinician to be etiologicall relate' to a general me'ical con'ition are eclu'e'from the 'iagnostic criteria for ma)or 'epressive 'isor'er *00" 9o4ever ho4 to'etermine 4hich smptoms are 'ue to a me'ical illness an' 4hich are 'ue to 'epressionisunclear n a JsubstitutiveK approach smptoms most li.el confuse' 4ith me'ical illnesssuch as fatigue an' 4eight loss are substitute' 4ith smptoms that are more li.el to be

affective in origin such as irritabilit an' social 4ith'ra4al Such substitution eliminates thenee' to 'istinguish smptoms of me'ical illness from those of 'epression but it alsoeclu'es some somatic smptoms that are core manifestations of 'epression Furthermorevali' criteria to 'etermine 4hich smptoms shoul' be substitute' have not beenestablishe' ,n JinclusiveK approach applies the unmo'ifie'

SELF %/ECT%N LEA/N%N-asic .no4le'ge that must be .no4nA

1 The proce'ure of treatment to -ehavior Changes 0ue to a General *e'icalcon'ition

2 Formulating 'iagnosis for -ehavior Changes 0ue to a General *e'icalCon'ition

3 *anagement of -ehavior Changes 0ue to a General *e'ical Con'ition

*o'ul(

eliri#" and e"entia'r =i 8etut Sri 0iniari Sp87

A%MS0escribe the clinical management of 'elirium sn'romes 'ementia 9istor General*e'ical an' =eurologic !amination *ental Status eamination Laborator Stu'iesmaging an' >ther 0iagnostic Tests 0iagnostic criteria *anagement"


1 0efinition an' 0iagnostic Features2 Common ,ssociate' Features3 Pre'isposing Factors+ Selecte' Causes of 0elirium an' 0ementia5 *anagementA general Principles -ehavioral nterventions Pharmacologic

nterventions phsical restraints"

Udayana University Faculty of Medicine, DME 2!


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C//%CLM CONTENTS1 9istor ta.ing of 'elirium an' 'ementia2 Phsical eamination of 'elirium an' 'ementia3 *ental eamination of 'elirium an' 'ementia+ nvestigation routine5 *anagement four main principles of management"

ABST/ACTS0elirium is characteri@e' b acute generali@e' pschological 'sfunction that usuallfluctuation in 'egree Clinical features of 'elirium pro'romal smptoms inclu'eA perpleitagitation hpersensitivit to light an' soun'

, stereotpe' response of the brain to a variet of insults is ver commonl seen inhospital inpatients t is a clinical sn'rome of fluctuating global cognitive impairmentassociate' 4ith behavioural abnormalities Li.e other acute organ failures it is more

common in those 4ith chronic impairment of that organThe clinical management of 'elirium consists of ho4 to ma.e a proper 'iagnosisthrough goo' anamnesis phsical an' mental eamination aetiologi management four main principles

SELF %/ECT%N LEA/N%N-asic .no4le'ge that must be .no4A

1 The prose'ure of 'elirium an' 'ementia 'iagnosis2 *anagement of 'elirium an' 'ementia3 ,ssessment of 'elirium an' 'ementia

SCENA/%O

, male patient +: ears ol' hospitali@e' 4ith 'iagnoses of stro.e after 2 'as treatmentpatient becomes agitate' screaming incoherent start to seeing creep sha'o4s behin'the curtain an' unable to recogni@e his accompanie' famil 'uring that time 9isconciousness is fluctuative The patient has no previous pschiatric histor

L!,$==G T,S8 , 2 , female patient ;: ears ol' foun' lost at some roa' Seems confuse' an' 'i' not recallher 4a home She also lost her memor about 4hat )ust happene' to her but still manageto recall her home a''ress her chil'ern name an' her previous professionDactivit as amerchant She repeate'l mentione' that she 4ill go to mar.et to 'o her activit as amerchant 9er test for **S! 15

L!,$==G T,S8 ,


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! 9o4 to manage a 'ementia patientI

Udayana University Faculty of Medicine, DME 2#


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*o'ul:

Mental Stat#s E;a"ination and Assess"ent'r =i 8etut Sri 0iniari Sp87

A%MS8no4 mental status eamination an' multiaial 'iagnostic

LEA/N%N OTCOMECan 'escribe theA

1 *ental status eamination2 The 'iagnostic classification sstem use' in pschiatr3 *ultia.sial 'iagnostic

C//C%LM CONTENS1 *ental status eamination

2 Sign an' smptom in mental status eamination3 The 'iagnostic classification sstem use' in pschiatr+ *ultia.sial 'iagnostic

ABST/ACTS!stablishing rapport an' a goo' therapeutic alliance 4ith patients is critical to both their 'iagnosis an' their treatment The pschiatric assessment is 'ifferent from a me'ical or surgical assessment in thatA 1"The histor ta.ing is often longer an' is aime' atun'erstan'ing pschological poblems that 'evelop in patients each 4ith a uni?uebac.groun' an' social environmentR 2" , mental status eamination is performe'R an' 3"The assessment can in itself therapeutic

The mental status eamination comprises the sum total of the phsician(s

observations of the patient at the time of the intervie4 >f note is that this eamination canchange from hour to hour 4hereas the patient(s histor remains stable The mental statuseamination inclu'es impressions of the patient(s general appearance speech moo'affect thought process thought content sensorium cognition impuls control insight an' )u'gment !ven a mute or uncooperative patient reveals a large amount of clinicalinformation 'uring the mental status eamination

, 'iagnosis is ma'e b careful evaluation of the 'atabase analsis of theinformation assessment of the ris. factors an' 'evelopment of a list of possibilities the'ifferential 'iagnosis" There are t4o main categorical classification sstem 'iagnostic inpschiatrA C061/ an' 0S*6 n n'onesia 4e use PP0G76 Pe'oman Penggolongan'an 0iagnosis Gangguan 7i4a6" that uses a referral from 0S*6 0S*6 uses amultiaial 'iagnostic 4ith five ais ,is A inclu'es all mental 'isor'er that can be the focusof clinical attention such as schi@ophrenia ma)or 'epression etc ,is A personalit'isor'ers an' mental retar'ation ,is A phsical 'isor'ers an' other general me'icalcon'itions ,is A inclu'es an social or environmental problems that contribute to themental con'ition ,is consists of a score from / to 1// obtaine' from a globalassessment of functioning G,F" sale


1 9o4 to establishing raport therapeutic alliance"2 The proce'ure of psciatric intervie4 an' mental status eamination3 Sign an' smptom in mental status eamination

+ ,ble to ma.e 'iagnostic multia.sial

Udayana University Faculty of Medicine, DME 2$


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SCENA/%O1 , +26ear6ol' man comes to the emergenc room the chief complaint that Jthe men

are follo4ing meK 9e also complains of hearing a voice telling him to hurt others 9etells the eaminer that the ne4s anchorman gives him special messages about thestate of the 4orl' ever night through the T

Learning tas.a


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*o'ul<

Pri"ar) = Secondar) %nso"nia'r Luh =oman ,lit ,rani Sp87

A%MS0escribe the clinical management of Primar an' Secon'ar nsomnia 0efinition !tiolog$is. Factor 0iagnose an' *anagement"


1 Hn'erstan' the Classification of sleep 'isor'er 2 !plain the Smptoms an' Signs of insomnia an' hpersomnia3 ,sses the 0iagnostic of insomnia an' hpersomnia+ Give treatment for sleep 'isor'er

C//%CLM CONTENTS1 Hn'erstan' the Classification of sleep 'isor'er 2 !plain the Smptoms an' Signs of insomnia an' hpersomnia3 ,sses the 0iagnostic of insomnia an' hpersomnia+ Give treatment for sleep 'isor'er

ABST/ACTSSleep is a universal behavior that has been 'emonstrate' in eve animal species stu'from insects to mamalia ,n earlier theor of sleep 4as that the ecitator areas of theupper brain stem the reticular activating sstem simpl fati?ue' 'uring the 4a.ing 'a an'became inactive as a result Circa'ian rhthms are biological process that occur repeate'lon approimatel a t4ent6four6hour ccle Lac. of sleep can lea' to the inabilit

concentration memor complaints an' 'eficit in neuropschological testing ,lthoughseveral classification for sleep 'isor'er eist the 0iagnostic an' Statistical *anual of *ental 0isor'er 0S*6" an' the nternational Classification of Sleep 0isor'er secon'e'ition CS0 2" are the most 4i'el use' The 0S* 6T$ classification is complaintbase' it 'ivi'es sleep 'isor'ers into primar an' secon'ar sleep 'isor'ers base' onclinical 'iagnostic criteria an' presume' etiolog

The 'efinition of Primar Sleep 0isor'er as those not cause b another mental'isor'er a phsical con'ition or a substance but rather a cause' b an abnormal sleep4a.e mechanism an' often b con'itioning 0S*66T$ 'ivi'es primar sleep 'isor'ersintoA 0ssomnias 'isor'ers of ?uantit or timing of sleep" an' Parasomnias abnormalbehaviors 'uring sleep or the transition bet4een sleep an' 4a.efulness" The primarcomplaint of insomnia is 'ifficult in going to sleep ,fter a comprehensive histor thepatient receives a 'etaile' phsical eamination >nce a 'iagnosis has been confirme'patients are offere' approriate treatment nonpharmacologic an' pharmacologic"


1 The phsiolog of sleep2 Classification of sleep 'isor'er 3 Smptom an' sign of insomnia an' hpersomnia+ Clinical 'iagnostic of insomnia an' hpersomnia5 *anagement of sleep 'isor'er

Udayana University Faculty of Medicine, DME 3&


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SCENA/%OCase 1

, 32 ear ol' 4oman single ha' an a 2 ear histor of fati?ue an' sleepiness in the'atime ,s a chil' she sai' she sleep normall 9is 4as be'time 4as 1/// P* an'his 4a.e up alarm 4as set for #3/ ,* 9e overslept at least once a 4ee. on 4or.s'as ,fter lunch he 4oul' routinel fell a sleep at the computer

Learning Tas 1A5


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*o'ul18

Sc,i>o-,renia = Ot,er Ps)c,osis0r 'r Co.or'a -agus 7aa Lesmana Sp87 8"

A%MS0escribe the clinical management of Schi@ophrenia & >ther Pschosis ,namnesis 9istorta.ing *ental State !amination 0iagnosis an' Therap"



C//%CLM CONTENTS1 ,namnesis2 9istor ta.ing fun'amental four an' secret seven" of Schi@ophrenia & >ther

Pschosis3 *ental state eamination of Schi@ophrenia & >ther Pschosis+ 0iagnosis formulation5 *o'alit of treatment of Schi@ophrenia & >ther Pschosis

ABST/ACTSSchi@ophrenia is a clinical sn'rome of variable but profoun'l 'isruptive pschopathologthat involves cognition emotion perception an' other aspects of behavior The epression

of these manifestations varies across patients an' over time but the effect of the illness isal4as severe an' is usuall long6lastingSchi@ophrenia is a lea'ing 4orl'4i'e public health problem that eacts enormous

personal an' economic costs Schi@ophrenia affects )ust less than 1 percent of the 4orl'Qspopulation f schi@ophrenia spectrum 'isor'ers are inclu'e' in the prevalence estimatesthen the number of affecte' in'ivi'uals increases to approimatel 5 percent The conceptof schi@ophrenia spectrum 'isor'ers is 'erive' from observations of pschopathologicalmanifestations in the biological relatives of patients 4ith schi@ophrenia 0iagnoses an'approimate lifetime prevalence rates percent of population" for these 'isor'ers areschi@oi' personalit 'isor'er fractional percentage" schi@otpal personalit 'isor'er 1 to +percent" schi@oaffective pschosis U1 percent" an' 'elusional 'isor'er fractionalpercentage" The relationship of these 'isor'ers to schi@ophrenia in the general population

is unclear but in famil pe'igree stu'ies the presence of a proban' 4ith schi@ophreniasignificantl increases the prevalence of these 'isor'ers among biological relatives

Cognitive impairments an' primar negative smptoms are largel responsible for the poor functional outcome an' lo4 ?ualit of life of most persons 4ith schi@ophrenia


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-asic .no4le'ge that must be .no4nA

1. The proce'ure of intervie4ing Schi@ophrenia & >ther Pschosis

2. Formulating 'iagnosis for Schi@ophrenia & >ther Pschosis

3. *anagement of Schi@ophrenia & >ther Pschosis

SCENA/%OPatient ,- a 326ear6ol' 4oman began to lose 4eight an' became careless about her 4or. 4hich 'eteriorate' in ?ualit an' ?uantit She believe' that other 4omen at her placeof emploment 4ere circulating slan'erous stories concerning her an' complaine' that aoung man emploe' in the same plant ha' put his arm aroun' her an' insulte' her 9er famil 'eman'e' that the charge be investigate' 4hich sho4e' not onl that the charge4as 4ithout foun'ation but also that the man in ?uestion ha' not spo.en to her for months>ne 'a she returne' home from 4or. an' as she entere' the house she laughe' lou'l4atche' her sister6in6la4 suspiciousl refuse' to ans4er ?uestions an' at the sight of her brother began to cr She refuse' to go to the bathroom saing that a man 4as loo.ing inthe 4in'o4s at her She ate no foo' an' the net 'a she 'eclare' that her sisters 4ereJba' 4omenK that everone 4as tal.ing about her an' that someone ha' been having

seual relations 4ith her an' although she coul' not see him he 4as Jal4as aroun'K

Learning Tas1


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1


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fin's man small bits of evi'ence to support this This evi'ence inclu'es theneighbors( leaving their garbage cans out on the street to tr to trip her par.ing their car in their 'rive4as so the can hi' behin' them an' sp on her an' 4al.ing bher house to tr to get a loo. into 4here she is hi'ing She states that her moo'isfine an' 4oul' be better if the 4oul' leave me alone She 'enies hearing theneighbors or anone else tal. to her but is sure that the are out to cause her 'eathan' mahem

Learning tas.1


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*o'ul12

Bi-olar isorders = Ot,er Mood /elated isorders'r 'a ,u 8usuma l' Testament stor of 8ing Saul 'escribes a 'epressive sn'rome as 'oes the

stor of ,)aQs suici'e in 9omerQs lia' ,bout +// -C 9ippocrates use' the terms maniaan' melancholia to 'escribe mental 'isturbances *oo' is a pervasive an' sustaine'feeling tone that is eperience' internall an' that influences a personQs behavior an'perception of the 4orl' ,ffect is the eternal epression of moo' *oo' can be normalelevate' or 'epresse' 9ealth persons eperience a 4i'e range of moo's an' have ane?uall large repertoire of affective epressionsR the feel in control of their moo's an'affects

*oo' 'isor'ers are a group of clinical con'itions characteri@e' b a loss of thatsense of control an' a sub)ective eperience of great 'istress Patients 4ith elevate' moo''emonstrate epansiveness flight of i'eas 'ecrease' sleep an' gran'iose i'eas Patients4ith 'epresse' moo' eperience a loss of energ an' interest feelings of guilt 'ifficult inconcentrating loss of appetite an' thoughts of 'eath or suici'e >ther signs an' smptomsof moo' 'isor'ers inclu'e change in activit level cognitive abilities speech an' vegetativefunctions eg sleep appetite seual activit an' other biological rhthms" These'isor'ers virtuall al4as result in impaire' interpersonal social an' occupationalfunctioning

Patients afflicte' 4ith onl ma)or 'epressive episo'es are sai' to have ma)or 'epressive 'isor'er or unipolar 'epression Patients 4ith both manic an' 'epressiveepiso'es or patients 4ith manic episo'es alone are sai' to have bipolar 'isor'er The termsunipolar mania an' pure mania are sometimes use' for patients 4ho are bipolar but 4ho'o not have 'epressive episo'es

Three a''itional categories of moo' 'isor'ers are hpomania cclothmia an''sthmia 9pomania is an episo'e of manic smptoms that 'oes not meet the full tetrevision of the fourth e'ition of 0iagnostic an' Statistical *anual of *ental 0isor'ers 0S*6

Udayana University Faculty of Medicine, DME 3"


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6T$" criteria for manic episo'e Cclothmia an' 'sthmia are 'efine' b 0S*66T$ as'isor'ers that represent less severe forms of bipolar 'isor'er an' ma)or 'epressionrespectivel

,ccor'ing to 0S*66T$ a ma)or 'epressive 'isor'er occurs 4ithout a histor of amanic mie' or hpomanic episo'e , ma)or 'epressive episo'e must last at least 24ee.s an' tpicall a person 4ith a 'iagnosis of a ma)or 'epressive episo'e alsoeperiences at least four smptoms from a list that inclu'es changes in appetite an' 4eightchanges in sleep an' activitlac. of energ feelings of guilt problems thin.ing an' ma.ing 'ecisions an' recurringthoughts of 'eath or suici'e


1 The proce'ure of intervie4ing bipolar 'isor'ers2 Formulating 'iagnosis for bipolar 'isor'ers3 *anagement of bipolar 'isor'ers

SCENA/%O , 256ear6ol' male is ta.en to hospital b the police as he 4as foun' screaming on thestreets 9e ha' been tring to light himself 4ith a lighter claiming that he 4as invincible an'ha' the po4er to fi all evil in the 4orl' 9is speech 4as highl pressure' an' he complainsthat his thoughts are going out of control ,ccor'ing to hospital recor's he ha' beena'mitte' to hospital three times in the last ear for similar episo'es

Learning tas1


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*o'ul13

Panic isorders'r Gusti ,u n'ah ,r'ani Sp87

A%MS0escribe Panic 0isor'er an' the clinical management of panic 'isor'ers


1 Smptom an' Sign of panic 'isor'ers2 Pscho'inamic of panic 'isor'ers3 0iagnosis of panic 'isor'ers+ Therap of panic 'isor'ers

C//%CLM CONTENTS

1 9istor ta.ing of panic 'isor'ers2 >bservation an' pschiatric intervie4 of panic 'isor'ers3 *o'alit of treatment of panic 'isor'ers

ABST/ACTSThe essential feature are recurrent attac.s of severe aniet 4hich are not restricte' to anparticular situation or set of circumstances an' 4hich are therefore unpre'ictable ,s inother aniet 'isor'ers the 'ominant smptoms var from person to person but su''enonset of palpitations chest pain cho.ing sensations 'i@@iness an' feelings of unrealit'epersonali@ation or 'ereali@ation " are common There is also almost invariabl asecon'ar fear of 'ing losing control or going ma'


1 The proce'ure of intervie4ing panic 'isor'ers2 Formulating 'iagnosis for panic 'isor'ers3 *anagement of panic 'isor'ers

SCENA/%O*iss C 2/ ears ol' single high school gra'uate 4as in a cro4'e' shopping centre4hen this happene' became li.e a cra@ 4oman 4ithin secon's it 4as li.e a nightmareonl 4as in an a4are con'ition everthing 4ent 'ar. an' m bo' an' m han' 4ass4eating a lot even m hair 4as 4etR m bac. an' leg felt ver 4ee. an' coul'n(t move

felt li.e 4as controlle' b something stronger felt li.e ever faces loo.ing at me but4ithout bo'iesR everthing 4as mie' into one * heart starte' palpitating insi'e m hea'an' ears thought m heart going to stop beating sa4 a blac. an' ello4 light coul'hear soun' li.e from a far coul'n(t thin. anthing ecept the feeling an' ho4 shoul' getout or 4ill 'ie For me it felt li.e happen for hours


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Sometimes she thought that everthing 4as unreal an' she 4ill go cra@ She also thoughtthat she 4ill 'ie

LEA/N%N TASK1


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an' 'emonstrable peripheral organs 'isor'er 2" pschological factors an' conflicts thatseem important in initiating eacerbating an' maintaining the 'isturbancesR an' 3"smptoms or magnifie' health corncerns that are not un'er the patient(s consciouscontrolan' laborator

-ecause of their intense bo'il perceptions restricte' level of phsical functioningan' morbi' beliefs these patients have become convince' the harbor serious phsicalproblem *oreover their smptoms are not 4illfull controlle'


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*o'ul1$

enerali>ed An;iet) = O+sessi7e Co"-#lsi7e isorder 'r Lel Seta4ati Sp87 8"

A%MS0escribe the clinical management of generali@e' aniet & obsessive compulsive 'isor'ers,namnesis 9istor ta.ing *ental State !amination 0iagnosis an' Therap"



C//%CLM CONTENTS1 ,namnesis

2 9istor ta.ing fun'amental four an' secret seven" of generali@e' aniet &obsessive compulsive 'isor'ers

3 *ental state eamination of generali@e' aniet & obsessive compulsive 'isor'ers

+ 0iagnosis formulation

5 *o'alit of treatment of generali@e' aniet & obsessive compulsive 'isor'ers

ABST/ACTS ,niet 'isor'ers in general are the most common form of mental illness in the HS,Generali@e' ,niet 0isor'ers G,0" is one of the most common aniet 'isor'ers 4ith alifetime prevalence of 51O in the a'ult HS population G,0 tpicall occurs before the ageof +/ runs a chronic fluctuating course an' affects 4omen t4ice as often as men 0espitehistoric controvers to the contrar numerous stu'ies have 'emonstrate' that G,0 is a'istinct illness 4hich occurs at a significant rate 4ith serious conse?uences ,''itionallG,0 has been foun' to confer 'isabilit at approimatel the same level as 'epression an'other chronic me'ical illnesses

Pharmacological cognitive6behavioral an' pscho'namic approaches have allprove' useful in combating G,0 *ost of patients shoul' epect substantial relief from their smptoms in a relativel brief perio' 9ence clinicians in pschiatr an' other specialties

must ma.e the proper G,0 'iagnosis rapi'l an' initiate treatmentG,06associate' genetic factors are completel share' 4ith 'epression 4hile

environmental 'eterminants seem to be 'istinct This notion is consistent 4ith recent mo'elsof emotional 'isor'ers that vie4 aniet an' moo' 'isor'ers as sharing commonvulnerabilities but 'iffering on 'imensions inclu'ing for instance focus of attention or pschosocial liabilit


1 The proce'ure of intervie4ing generali@e' aniet & mie' aniet6'epression'isor'ers

2 Formulating 'iagnosis for generali@e' aniet & mie' aniet6'epression 'isor'ers

3 *anagement of generali@e' aniet & mie' aniet6'epression 'isor'ers



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SCENA/%O , 326ear6ol' single mother of t4o chil'ren is see.ing professional help for her long6stan'ing feelings of aniet 0espite the fact that her life is relativel stable in terms of financial an' interpersonal matters she 4orries most of the time that she 4ill 'evelopfinancial problems that her chil'ren 4ill become ill an' that the political situation in thecountr 4ill ma.e life for her an' he chil'ren more 'ifficult ,lthough she tries to 'ismissthese concerns as ecessive she fin's it virtuall impossible to control her 4orring *ost of the time she feels uncomfortable an' tense an' sometimes her tension become soetreme that she begins to tremble an' s4eat She fin's it 'ifficult to sleep at night 0uringthe 'a she is restless .ee' up an' tense She has consulte' a variet of me'icalspecialist each of 4hom has been unable to 'iagnose a phsical problem

Learning tas1 C0 ,n in'ivi'ual must ehibiteither obsessions or compulsions to meet 0S*66T$ criteria 0S*66T$ recogni@esobsessions as Jpersistent i'eas thoughts impulses or images that are eperience' asintrusive an' inappropriateK causing 'istress >bsessions provo.e aniet 4hich accountsfor the categori@ation of >C0 as an aniet 'isor'er 9o4ever the must be 'ifferentiate'from ecessive 4orries about real6life problems an' associate' 4ith efforts to either ignoreor suppress the obsessions Tpical obsessions associate' 4ith >C0 inclu'e thoughtsabout contamination Jm han's are 'irtK" or 'oubts J forgot to turn off the stoveK"

>bsessions an' compulsions must cause an in'ivi'ual mar.e' 'istress consume atleast 1 hour per 'a or interfere 4ith functioning to be consi'ere' above the 'iagnosticthreshol' 0uring at least some point in the illness a'ult patients must recogni@e smptomsof >C0 as unreasonable although there is great variabilit in the 'egree to 4hich this is

true both across in'ivi'uals an' in a given in'ivi'ual over time For eample earl in thecourse of the 'isor'er patients ma recogni@e their han' 4ashing as ecessive or irrationalbut over a number of ears this recognition ma no longer eist

The clinical management of Trichotillomania an' >bsessive Compulsive 0isor'ersConsist of ho4 to ma.e a proper 'iagnosis through goo' anamnesis phsical eaminationpschometric eamination an' give the patient proper treatment 4ith me'ical an'pschotherap mo'alit


1 The proce'ure of Trichotillomania an' >bsessive Compulsive 0isor'ers 0iagnosis2 *anagement of Trichotillomania an' >bsessive Compulsive 0isor'ers3 Pschometric !amination of Trichotillomania an' >bsessive Compulsive 0isor'ers

SCENA/%O



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, 13 ear ol' girl came to pschiatric clinic accompanie' b her mother 4ith main complainrepetitive hair pulling that result in significant hair loss There is an increasing level of tension imme'iatel before hair pulling There is a sensation of pleasure 'uring hair pullingthe pulling is not eplaine' b a general me'ical con'ition or other mental 'isor'erSignificant 'istress of in social occupational or other areas of functioning is as a result of thepulling Phsical eamination is a normal

Learning Tas1 From the stor above 4hat nee' to be as.ing to the patientI2 Please eplain the pscho'namic from this caseN3


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9o4ever the event is commonl relive' b the in'ivi'ual through intrusive recurrentrecollections flashbac.s an' nightmares The characteristic smptoms are consi'ere'acute if lasting less than three months an' chronic if persisting three months or more an'4ith 'elae' onset if the smptoms first occur after si months or some ears later PTS0 is'istinct from the briefer acute stress 'isor'er an' can cause clinical impairment insignificant areas of functioning

n PTS0 the in'ivi'ual 'evelops smptoms in three 'omainsA reeperiencing thetrauma avoi'ing stimuli associate' 4ith the trauma an' eperiencing smptoms of increase' autonomic arousal such as an enhance' startle Flashbac.s in 4hich thein'ivi'ual ma act an' feel as if the trauma 4ere recurring represent the classic form of reeperiencing >ther forms of reeperiencing inclu'e 'istressing recollections or 'reamsan' either phsiological or pschological stress reactions 4hen epose' to stimuli that arelin.e' to the trauma ,n in'ivi'ual must ehibit at least one reeperiencing smptom tomeet criteria for PTS0 Smptoms of avoi'ance associate' 4ith PTS0 inclu'e efforts toavoi' thoughts or activities relate' to the trauma anhe'onia re'uce' capacit to remember events relate' to the trauma blunte' affect feelings of 'etachment or 'ereali@ation an' asense of a foreshortene' future ,n in'ivi'ual must ehibit at least three such smptoms

Smptoms of increase' arousal inclu'e insomnia irritabilit hpervigilance an'eaggerate' startle ,n in'ivi'ual must ehibit at least t4o such smptoms-ecause in'ivi'uals often ehibit comple biological an' behavioral responses to

etreme trauma the clinician must i'entif other me'ical an' pschiatric con'itions in thetraumati@e' patient The clinician must al4as evaluate 4hether neurological etiologiesun'erlie trauma6relate' smptoms particularl after traumatic events that involve phsicalin)ur Traumati@e' patients also can 'evelop moo' 'isor'ers inclu'ing 'sthmia an'ma)or 'epression as 4ell as other aniet 'isor'ers such as generali@e' aniet 'isor'er or panic 'isor'er an' substance use 'isor'ers Finall recent research suggests that somepschiatric features of posttraumatic sn'romes can relate to a patientQs state before thetrauma For eample patients 4ith premorbi' aniet or affective sn'romes ma be moreli.el to 'evelop posttraumatic smptoms than in'ivi'uals 4ho are free of mental illness

before the trauma ,s a result the clinician shoul' consi'er the premorbi' mental state of the traumati@e'


1 The proce'ure of PTS02 *anagement of PTS03 Pschometric !amination of PTS0

SCENA/%O , +/6ear6ol' man 4atche' the September 11 2//1 terrorist attac. on the


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9e 4as 4orrie' that the events from his past 4oul' affect his abilit to bon' 4ith his chil'renan' affect their relationship

Leaning tas1


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*o'ul1(

Se;#al isorders'r 'a ,u 8usuma


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SCENA/%O , man age' 5/ ears foreign nationals 4ere on vacation in -ali staing at one of the hotelsin 8uta 9e often tours to -ali east in to4n ,mlapura sightings are ver polite an' generousattitu'e an' love chil'ren so ?uic.l accepte' b the public Chil'ren gathere' to pla givengifts of clothes mone etc -ut the uproar ensue' because one of the .i's that sho4strange behavior such as moo' 'i' not venture out ,fter being as.e' b the chil'Qsparents that she ha' to serve the seual appetite through the rectum so'om" b thesemen

Learning Tas1 Seual 0eviations 4hat happene' to these menI2 !plain the pscho'namics of pe'ophiliaN3


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*o'ul1:

Ps)c,o*P,ar"acolog)'r Gusti ,u ,rtini *Sc

A%MS1 0escribe the rationale 'rugs can be use' for aniet insomnia 'epression an'

Pschotic 'isor'ers2 0escribe the pharmaco.inetic an' pharmaco'namic aspect of 'rugs use' for

Pschiatric 'isor'ers

LEA/N%N OTCOMES0escribe ho4A

1 The pharmaco.inetic an' pharmaco'namic aspect of 'rugs use' for pschiatric

'isor'ers inclu'ing se'ative6hpnotic anti'epresssant an' antipschotic 'rugs2 To appl the basic concepts an' principles of 'rugs use' for insomnia!amine

mental state

C//%CLM CONTENTS1 The pharmaco.inetic an' pharmaco'namic aspect of se'ative6hpnotic 'rugs

a -en@o'ia@epinesb -arbituratesc *isellaneous agents

2 The pharmaco.inetic an' pharmaco'namic aspect of anti'epressant 'rugsa Tricclic anti'epressantb 9eterocclic anti'epressantc Selective Serotonin $eupta.e nhibitor SS$"

' *onoamine >i'ase nhibitor *,>"3 The pharmaco.inetic an' pharmaco'namic aspect of antipschotic 'rugsa Classic 'rugs Phenothia@ine Thioanthene -utrophenone"b ,tpical 'rugs >lan@apine clo@apine risperi'one etc"

ABST/ACTS0rugs use' to treat pschiatric 'isor'ers are generall .no4n as pschotropic or pschotherapeutic 'rugs Pschotherapeutic 'rugs use' to treat mental illness inclu'ese'ative6hpnotic anti'epressant an' antipschotic neuroleptic" 'rugs

There are three classes of se'ative6hpnotic 'rugsA ben@o'ia@epines barbituratesan' miscellaneous agents -en@o'ia@epines an' barbiturates eert their action bfacilitating potentiating" the inhibitor action of G,-, therefore increasing the fre?uenc or

'uration of G,-,6me'iate' chlori'e ion channel opening The use of se'ative6hpnotic'rugs ma cause man a'verse effects inclu'ing 'epen'ence tolerans C=S 'epressioncar'iovascular an' respirator 'epression

*ost anti'epressant eert their actions b inhibiting the metabolism or reupta.e of monoamine neurotransmitter particularl norepinephrine =!" an'Dor serotonin 59T" Thereare four classes of anti'epressantA tricclic anti'epressant TC," heterocclicanti'epressant selective serotonin reupta.e inhibitor SS$" an' monoamine oi'aseinhibitor *,>" Serotonin sn'rome an' hpertension crisis are the severe toic effects of anti'epressant shoul' a4are to

,ntipschotic 'rugs are thought to act b inhibiting or bloc.ing the release of 'opamine in the brain therefore 4ill supress the smptoms of certain pschotic 'isor'ers ,ntipschotic 'rug is classifie' into t4o group of 'rugsA classic 'rugs inclu'ing

phenothia@ine thioanthenes an' butrophenones" an' atpical 'rugs clo@apineolan@apine loapine risperi'one etc" The most significant a'verse reaction associate'

Udayana University Faculty of Medicine, DME $


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4ith the antipschotic 'rugs is the etraprami'al effect that commonl manifests asPar.inson6li.e smptoms a.athisia an' 'stonia


1 The ccle of neurotransmitter in the snaps2 The role of neurotransmitter involve' in pschiatric 'isor'ers3 The mechanism of action for se'ative6hpnotic anti'epressant an' antipschotic

'rugs+ The pharmaco.inetic an' pharmaco'namic aspect of se'ative6hpnotic

anti'epressant an' antipschotic 'rugs5 0rug interaction relate' to se'ative6hpnotic anti'epressant an' antipschotic 'rugs

SCENA/%O 1 , +/ ears ol' 4oman came to pschiatric outpatient clinic 4ith her famil complaining'ifficult in sleeping since 3 'as before Patient 4as 'iagnose' as having insomnia

LEA/N%N TASK1 *ention some 'rugs that can be use' as anti6insomnia2 0escribe the mechanism of action for those anti6insomnia3 List some a'verse effects can be occure' 'ue to anti6insomnia use

SCENA/%O 2 , 35 ears ol' man came to pschiatr outpatient clinic 4ith his famil complaine' of havingbra'.inesia rigi'it an' tremor after ta.ing antipschotic me'ication for about # months

LEA/N%N TASK1


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*o'ul1<

Sel& 0ar" = S#icide'r Lel Seta4ati Sp87 8"

A%MS0escribe the management of 'isor'ers moo' thought an' behavior at a time of crisis Self harm an' suici'e one part of the emergenc pschiatrLEA/N%N OTCOMES0escribe ho4 toA

1 0iagnosis2 $is. factors3 Pathophsiolog+ Treatment of suici'e ris.

C//%CLM CONTENS

1 !pi'emiolog2 Pschiatric an' me'ical ris. factors3 Familial an' genetic+ Pathophsiolog5 Treatment

ABST/ACTS!mergenc pschiatr refers to the management of 'isor'ers of moo' thought an'

behavior at a time of crisis t entails assessment 'evelopment of a 'ifferential 'iagnosis of pschiatric an' other me'ical causes of presenting smptoms an' 'iagnostic specificpharmacotherap me'ical an' surgical therap an' pschotherap Pschiatricemergencies are often particularl 'isturbing because the 'o not )ust involve the bo'(s

reactions to an acute 'isease state as much as actions 'irecte' against the self


1 People ver 'istress an' change behavior unsure 4hat to 'o or not to 'o2 *anagement of pschiatric emergenc care3 Treatment self harm & suici'e

SCENA/%O , 236ear6ol' male 4as foun' cutting his arms an' thighs 4ith a .nife 9e claims

that there are bugs cra4ling un'erneath his s.in an' that he is tring to get ri' of them >neamination he is tachcar'ic 4ith prominent 'ilatation of pupils an' nasal ulceration 9eappears seuall 'isinhibite' restless an' ecite'

Learning Tas1 From the stor above 4h 'o act self6harmI

,'a halusinasi gatal2


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SCENA/%O , 2/6ear6ol' female presents to hospital having lacerate' her forearm She claims that sheha' a ma)or argument 4ith her bofrien' an' 'i' it so that her bofrien' 4oul' 4orr an'not brea. up 4ith her ,ccor'ing to her all her relationships in the past have been Wintenseli.e this( >n eamination there are multiple heale' laceration scars on both armsLearning Tas.A

1 !plain the pscho'namic of self6harmI

2


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rescue the victim imme'iatel Therefore it is important to .eep a sense of perspective onho4 goo' the evi'ence is that abuse is in'ee' happening an' to have a smpathetic teamfor emotional support to stop one becoming over4helme' b or cut off from 4hat is seen


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+ !plain about the pschological smptoms of an abuse' chil'

Udayana University Faculty of Medicine, DME !3


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*o'ulBAS%C CL%N%CAL SK%LL

%NT/OCT%ON

A%MSPerform abilit to collect specific 'etaile' information about topics constitute the pschiatricevaluation ,c?uiring the 'atabase of information for the intervie4er to ma.e 'iagnoses onfive aes an' 'evelop a treatment plan acceptable to the patient

LEA/N%N OTCOMES ,ble ho4 toA

1 rgani@ation " co'ifie' in 0S*66T$ 2///"an' the nternational Classification of 0iseases C061/" This frame4or. vie4s pschiatric'isor'ers as similar to me'ical 'isor'ers using criteria for 'iagnosis as i'entifiable clustersof occurrences from a restricte' menu of smptoms signs an' behaviors that causemorbi'it an' mortalit

n contrast patient6centere' intervie4ing is base' on the introspective mo'el 4hichemphasi@es the in'ivi'ualit of the patientQs eperience This mo'el atten's to the

intrapschic battle of conflicts t is sensitive to the patientQs e'ucational emotionalintellectual an' social bac.groun' the personalit an' the in'ivi'ual smptomconstellations tracing their arrival to in'ivi'ual circumstances an' the in'ivi'ualQs uni?ueresponse cognitive6behavioral mo'el"


1 The proce'ure of intervie4ing pschiatric 'isor'ers2 Formulating mental status for pschiatric 'iagnosis3 *anagement of pschiatric 'isor'ers

Udayana University Faculty of Medicine, DME !


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%NTE/%E9 AND%ET PAT%ENTS

A%MSPerform abilit to collect specific 'etaile' information about topics constitute the anietpatients evaluation ,c?uiring the 'atabase of information for the intervie4er to ma.e'iagnoses on five aes an' 'evelop a treatment plan acceptable to the patient


1


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%NTE/%E9 EP/ESS%E PAT%ENTS

A%MSPerform abilit to collect specific 'etaile' information about topics constitute the 'epressivepatients evaluation ,c?uiring the 'atabase of information for the intervie4er to ma.e'iagnoses on five aes an' 'evelop a treatment plan acceptable to the patient


1


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%NTE/%E9 SOMATOFO/M PAT%ENTS

A%MSPerform abilit to collect specific 'etaile' information about topics constitute thesomatoform patients evaluation ,c?uiring the 'atabase of information for the intervie4er toma.e 'iagnoses on five aes an' 'evelop a treatment plan acceptable to the patient


1


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pschiatrist 4ill not automaticall assume that those issues are the cause of phsical

smptoms t is often helpful for the phsician to propose a purel pragmatic approachXone

that stresses a 4illingness to use 4hatever 4or.s to relieve the patientQs suffering 4ithout

causing harm ,t times this ma inclu'e nonstan'ar' approaches such as me'itation

oga or acupuncture in a''ition to pschotherap

Udayana University Faculty of Medicine, DME !$


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%NTE/%E9 B%POLA/ %SO/E/S PAT%ENTS

A%MSPerform abilit to collect specific 'etaile' information about topics constitute the bipolar 'isor'ers patients evaluation ,c?uiring the 'atabase of information for the intervie4er toma.e 'iagnoses on five aes an' 'evelop a treatment plan acceptable to the patient


1


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'evoi' of intolerable si'e effects thus facilitating long6term compliance 4ith the me'ication

regimen $emission of smptoms an' more importantl Jfunctional recoverKXthe primar

goals of treatmentXare attainable 'espite the comple an' chronic nature of bipolar

'isor'er

STEM EST%ONSE#-,oria Ste" #estion1 Some people have perio's lasting several 'as 4hen the feel much more ecite' an'full of energ than usual Their min's go too fast The tal. a lot The are ver restless orunable to sit still an' the sometimes 'o things that are unusual for them such as 'rivingtoo fast or spen'ing too much mone

9ave ou ever ha' a perio' li.e this lasting several 'as or longerIIf this question is endorsed, the next question (the irritability stem question) is skipped andthe respondent goes directly to the Criterion B screening question

%rrita+ilit) Ste" #estion

2 9ave ou ever ha' a perio' lasting several 'as or longer 4hen most of the time ou4ere so irritable or grouch that ou either starte' arguments shoute' at people or hitpeopleI

Criterion B Screening #estion3 People 4ho have episo'es li.e this often have changes in their thin.ing an' behavior atthe same time li.e being more tal.ative nee'ing ver little sleep being ver restless goingon buing sprees an' behaving in man 4as the 4oul' normall thin. inappropriate0i' ou ever have an of these changes 'uring our episo'es of being ecite' an' full ofenerg or ver irritable or grouchI

Criterion B S)"-to" #estionsThin. of an episo'e 4hen ou ha' the largest number of changes li.e these at the sametime 0uring that episo'e 4hich of the follo4ing changes 'i' ou eperienceI1


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~ CU!CULUM M"P ~

Smstr Program or curriculum blocks

10 Senior Clerkship

9 Senior Clerkship

8 Senior clerkship

7

Medical

Emergency

(3 weeks)

BCS (1 weeks)

Special opic!

"ra#el medicine

(2 weeks)

Elec$i#e S$%dy &&&

(' weeks)

Clinic rien$a$ion

(Clerkship)

(' weeks)

6

he espira$orySys$em and

*isorders

(4 weeks)

BCS (1 weeks)

he Cardio#asc%larSys$em and

*isorders

(4 weeks)

BCS (1 weeks)

he +rinary Sys$emand *isorders

(3 weeks)

BCS (1 weeks)

he eprod%c$i#eSys$em and *isorders

(3 weeks)

BCS (1 weeks)

5

Elec$i#e S$%dy &&

(1 weeks)

,limen$ary

- hepa$o"

iliary sys$ems- disorders

(4 /eeks)

BCS (1 weeks)

he Endocrine

Sys$em0 Me$aolism

and *isorders(4 weeks)

BCS (1 weeks)

Clinical %$ri$ion and

*isorders

(2 weeks)

BCS (1 weeks)

Special opic !

" allia$i#e

medicine"Compleme

n$ary -

,l$erna$i#e

Medicine

" orensic

(3 weeks)

Elec$i#e

S$%dy &&

(1 weeks)

4

M%sc%loskele$al

sys$em -connec$i#e

$iss%e disorders(4 weeks)

BCS (1 weeks)

e%roscience

andne%rological

disorders(4 weeks)

BCS (1 weeks)

Beha#ior Change

and disorders(4 weeks)

BCS(1 weeks)

he is%al

sys$em -disorders

(2 weeks)

BCS

(1 weeks)

3

ema$ologic

sys$em - disor"

ders - clinicaloncology

(4 weeks)

BCS (1 weeks)

&mm%ne

sys$em -

disorders(2 weeks)

BCS(1 weeks)

&n6ec$ion

- in6ec$io%s

diseases(5 weeks)

BCS (1 weeks)

he skin - hearing

sys$em

- disorders(3 weeks)

BCS(1 weeks)

2

Medical

ro6essionalism

(2 weeks)

BCS (1 weeks)

E#idence"ased

Medical rac$ice

(2 weeks)

eal$h Sys$em"ased

rac$ice

(3 weeks)

BCS (1 weeks)

Comm%ni$y"ased

prac$ice

(4 weeks)

Special opic

" Ergonomi

" 7eria$ri

(2 weeks)

Elec$i#e

S$%dy &

(2 weeks)

1

S$%di%m7enerale and

%maniora

(3 weeks)

Medicalcomm%nica$ion

(3 weeks)

BCS (1 weeks)

he cellas ioche"

mical machinery

(3 weeks)

BCS(1 weeks)

7row$h-

de#elopmen$

(4 weeks)

BCS! (1 weeks)

endidikan ancasila - 8ewarganegaraan (3 weeks)

/e&erences

Udayana University Faculty of Medicine, DME "1


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1 Pschiatr +th e' 7ohn

study guide behavior semester iv tayang 5 april 2016 final1

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