Professional Documents
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neurology
Desi natalia
40510058
(Anxiety Disorders)
GANGGUAN CEMAS
Anxiety
Normal Anxiety
Everyone experiences anxiety. It is
characterized most commonly as a diffuse,
unpleasant, vague sense of apprehension,
often accompanied by autonomic symptoms
such as headache, perspiration, palpitations,
tightness in the chest, mild stomach
discomfort, and restlessness, indicated by an
inability to sit or stand still for long. The
particular constellation of symptoms present
during anxiety tends to vary among persons.
Fear vs Anxiety
Anxiety is an alerting signal; it warns of
impending danger and enables a person to
take measures to deal with a threat. Fear is a
similar alerting signal, but should be
differentiated from anxiety.
Fear is a response to a known, external,
definite, or nonconflictual threat; anxiety is a
response to a threat that is unknown, internal,
vague, or conflictual.
Epidemiology
The anxiety disorders make up one of the most
common groups of psychiatric disorders.
The National Comorbidity Study reported that
one of four persons met the diagnostic criteria for
at least one anxiety disorder and that there is a
12-month prevalence rate of 17.7 percent.
Women (30.5 percent lifetime prevalence) are
more likely to have an anxiety disorder than are
men (19.2 percent lifetime prevalence).
The prevalence of anxiety disorders decreases
with higher socioeconomic status.
Restlessness (e.g.,
pacing)
Tachycardia
Tingling in the
extremities
Tremors
Upset stomach
Urinary frequency,
hesitancy, urgency
Teori Psikoanalitik
Sigmund Freud
Ansietas (cemas) adalah hasil dari konflik
psikis antara pikiran agresif & ancaman dari
superego atau realita eksternal.
Sebagai respons, ego memobilisasi
mekanisme pertahanan (defense) untuk
mencegah munculnya pikiran/ perasaan yang
tidak dapat diterima tersebut dalam alam
sadar.
Teori Perilaku
Ansietas adalah respons terkondisi terhadap
stimulus lingkungan yang spesifik.
Seorang anak perempuan yang biasa dirawat
oleh ayah penyiksa akan cemas setiap kali melihat
ayahnya tersebut.
Teori Eksistensial
Ansietas umum muncul tanpa adanya stimulus
spesifik yang memicu rasa cemas.
Konsep sentral teori ini : seseorang merasa hidup
dalam dunia yang tidak berarah.
Neurotransmitter
Norepinephrine : regulasi sistem noradrenergic
buruk + ledakan aktivitas NE panic attacks,
insomnia, startle & autonomic hyperarousal.
Serotonin
GABA fungsi abnormal reseptor GABA.
HPA axis : cortisol mobilisasi & isi ulang
cadangan energi, kewaspadaan & fokus .
CRH : meningkat saat stress aktivasi HPA axis
(cortisol & DHEA ).
DESCRIPTION
Panic disorder
Specific phobia
Social phobia
Obsessivecompulsive disorder
(OCD)
Generalized anxiety
disorder (GAD)
Phobias:
Specific phobias and social phobia are both included under this
heading. A phobia is described as an intense and irrational fear of a
specific object or situation that is so intense it can cause the individual
to be compelled to go to great lengths to avoid it.
Phobias can be about harmful things or situations that present a risk
but they can also be of harmless situations, objects or sometimes
animals.
Social phobia can include a fear of being judged, scrutinised or
humiliated in some way. It can show itself with a fear doing certain
things in front of others such as public speaking or using the toilet.
2.
Suatu periode adanya rasa takut / tdk nyaman dimana terdapat 4 gejala
atau lebih yg terjadi secara tiba dan mencapai puncak selama 10 menit.
Gejalanya antara lain:
a. palpitasi
b. berkeringat
c. gemetar/bergoncang
d. rasa sesak nafas / tertahan
e. perasaan tercekik
f. nyeri dada / perasaan tidak nyaman
g. mual / gangguan perut
h. pusing, bergoyang, melayang
i. derealisasi, depersonalisasi
j. takut mati
k. parestesia
l. menggigil / perasaan panas
F40.0 Agorafobia
Diagnostik : (DSM IV)
Kecemasan berada di dalam suatu tempat atau
situasi
Situasi dihindari atau jika dihadapi penderitaan
yang jelas
Kecemasan atau penghindaran fobia
Terdapat agorafobia
Serangan panik bukan karena efek fisiologis langsung dari
zat/suatu kondisi medis umum
Serangan panik tidak disebabkan oleh gangguan mental lain
Gambaran klinis
Gangguan panik :
Serangan sering dimulai dgn periode gejala yg
meningkat dgn cpt selama 10 mnt
Gejala mental utama ketakutan yg kuat akan
ancaman kematian dan kiamat
Ps. Malami kebingungan dan sulit memusatkan
perhatian
Tanda fisik takikardi, palpitasi, sesak napas,
berkeringat
Serangan berlangsung 20-30 mnt jarang lbh dr 1
jam
Penatalaksanaan
Farmakoterapi
1. Trisiklik dan tetrasiklik
Clomipramine dan imipramine
2. MAOI
Phenelzine dan
tranylcypromine
3. SSRI
Fluoxetine, setraline, dan
paroxetine
4. Benzodiazepine
Nonfarmakoterapi
1. Terapi kognitif
2. Terapi perilaku
Penyakit kardiovaskular
Anemia
Angina
Gagal jtg kongestif
Hipertensi
IM
Penyakit pulmonal
Asma
Hiperventilasi
Embolus paru
Penyakit neurologis
CVD
Epilepsi
Infeksi
migraine
Penyakit endokrin
Intoksikasi obat
Sindroma cushing
Diabetes
Hipertiroidisme
Hipoglikemia
Kokain
Amfetamin
Antikolinergik
Halusinogen
Putus obat
Pendahuluan
Seringkali mulai pada usia remaja dan terpusat pada rasa takut
diperhatikan oleh orang lain dalam kelompok yang relatif kecil
(berlawanan dengan orang banyak), yang menjurus kepada
penghindaran terhadap situasi sosial
Gambarannya:
Jelas terbatas pada makan di tempat umum, atau bicara di tempat
umum, atau menghadapi jenis kelamin lain
Kabur mencakup hampir semua situasi sosial di luar lingkungan
keluarga
Perasaan takut muntah di tempat umum
Biasanya disertai dengan harga diri yang rendah dan takut akan kritik
Keluhan malu (muka merah), tangan gemetar, mual, ingin buang air
kecil serangan panik
A marked and persistent fear of one or more social or performance situations in which the person is exposed
to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or
show anxiety symptoms) that will be humiliating or embarrassing.
Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a
situationally bound or situationally predisposed Panic Attack.
Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from social situations with
unfamiliar people.
Note: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people
and the anxiety must occur in peer settings, not just in interactions with adults.
The feared social or performance situations are avoided or else are endured with intense anxiety or distress.
The avoidance, anxious anticipation, or distress in the feared social or performance situations(s) interferes
significantly with the persons normal routine, occupational functioning, or social activities or relationships,
or there is marked distress about having the phobia.
In individuals under age 18 years, the duration is at least 6 months.
The fear or avoidance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a
medication) or a general medical condition and is not better accounted for by another mental disorder (e.g.,
Panic Disorder With or Without Agoraphobia, Separation Anxiety Disorder, Body Dysmorphic Disorder, a
Pervasive Developmental Disorder, or Schizoid Personality Disorder).
If a general medical condition or another mental disorder is present, the fear in Criterion A is unrelated to it,
e.g., the fear is not of Stuttering, trembling in Parkinsons disease, or exhibiting abnormal eating behaviour in
Anorexia Nervosa or Bulimia Nervosa.
Specify if:
Generalized: if the fears include most social situations, also consider the additional diagnosis of Avoidant
Personality Disorder.
Diagnosis Banding
Gangguan depresif
Agorafobia
Jika sulit dibedakan antara fobia sosial dengan
agorafobia, hendaknya diutamakan diagnosis
agorafobia
Specific Phobias
The person has been exposed to a traumatic event in which both of the following were present:
Either while experiencing or after experiencing the distressing event, the individual has three (or more) of the
following dissociative symptoms:
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
the persons response involved intense fear, helplessness or horror
The traumatic event is persistently re-experienced in at least one of the following ways: recurrent images,
thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience; or distress on exposure to
reminders of the traumatic event.
Marked avoidance of stimuli that arouse recollections of the trauma (e.g., thoughts, feelings, conversations,
activities, places, people).
Marked symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration,
hypervigilance, exaggerated startle response, motor restlessness).
The disturbance causes clinically significant distress or impairment in social, occupational, or other important
areas of functioning or impairs the individuals ability to pursue some necessary task such as obtaining
necessary assistance or mobilizing personal resources by telling family members about the traumatic
experience.
The disturbance lasts for a minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the
traumatic event.
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, is not better accounted for by Brief Psychotic Disorder, and is not merely an
exacerbation of a pre-existing Axis I or Axis II disorder.
Etiology
Symptoms
By definition, acute stress disorder is a result of a traumatic event in which the person experienced or
witnessed an event that involved threatened or actual serious injury or death and responded with intense
fear and helplessness.
Symptoms include dissociative symptoms such as numbing, detachment, a reduction in awareness of the
surroundings, derealization, or depersonalization; re-experiencing of the trauma, avoidance of associated
stimuli, and significant anxiety, including irritability, poor concentration, difficulty sleeping, and
restlessness. The symptoms must be present for a minimum of two days and a maximum of four weeks and
must occur within four weeks of the traumatic event for a diagnosis to be made. See also Post-traumatic
Stress Disorder.
Treatment
The disorder may resolve itself with time or may develop into a more severe disorder such as
PTSD. Medication can be used for a very short duration (up to four weeks) or psychotherapy can be
utilized to assist the victim in dealing with the fear and sense of helplessness.
Prognosis
Prognosis for this disorder is very good. If it should progress into another disorder, success rates
can vary according to the specific of that disorder.
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 person 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 present for more days than not for the past 6 months). Note: Only one item is
required in children.
The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or
worry is not about having a Panic Attack (as in Panic Disorder), being embarrassed in public (as in
Social Phobia), being contaminated (as in Obsessive-Compulsive Disorder) being away from home or
close relatives (as in Separation Anxiety Disorder), gaining weight (as in Anorexia Nervosa), or having a
serious illness (as in Hypochondriasis), and the anxiety and worry do not occur exclusively during
Posttraumatic Stress Disorder.
The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
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 (e.g., hyperthyroidism) and does not occur exclusively
during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder.
Manifestasi klinis
Gejala utamanya adalah :kecemasan, ketegangan
motorik, hiperaktivitas otonom, dan kewaspadaan
kognitif.
Ketegangan motorik sering dimanifestasikan dengan
gemetar, gelisah, dan nyeri kepala.
Hiperaktifitas dimanifestasikan oleh sesak nafas,
keringat berlebihan, palpitasi dan gejala
gastrointestinal.
Gejala lain adalah mudah tersinggung dan dikejutkan.
Pasien sering sekali datang ke dokter umum atau
penyakit dalam dengan keluhan somatik yang spesifik.
Diagnosis
Gejala anxietas harus sebagai gejala primer yang terjadi hampir setiap hari
untuk beberapa minggu atau beberapa bulan, dan tidak dalam situasi khusus
tertentu(free floating)
Gejala:
Kecemasan (sulit berkonsentrasi, khawatir akan nasib buruk, merasa di
ujung tanduk)
Ketegangan motorik (gelisah, sakit kepala, gemetaran, tidak dapat santai)
Overaktivitas autonomik (kepala terasa ringan, berkeringat, jantung
berdebar, sesak napas, gangguan lambung, pusing, mulut kering)
Pada anak kebutuhan berlebihan untuk ditenangkan, dan adanya
kleuhan somatik berulang yang menonjol
Gejala yang bersifat sementara (mis, depresif), tidak membatalkan
diagnosis gangguan cemas menyeluruh, selama hal tersebut tidak
memenuhi kriteria lengkap dari episode depresif, gangguan anxietas fobik,
gangguan panik, dan gangguan obsesif-kompulsif
Terapi
Pengobatan yang efektif adalah kombinasi
psikoterapi, farmakoterapi dan pendekatan
suportif. Pendekatan psikoterapi utama adalah
terapi kognitif prilaku, suportif, dan
berorientasi tilikan. Dua obat utama adalah
buspiron dan benzodiazepin.
Recurrent and persistent thoughts, impulses or images that are experienced at some time during the disturbance, as
intrusive and inappropriate and that cause marked anxiety or distress.
The thoughts, impulses or images are not simply excessive worries about real life problems.
The person attempts to ignore or suppress such thoughts, impulses or images or to neutralise them with some other
thought or action.
The person recognises that the obsessional thoughts, impulses or images are a product of his or her own mind (not
imposed from without as with thought insertion).
Compulsions are defined as 1 and 2
Repetitive behaviours (e.g. hand washing, ordering checking) or mental acts (e.g. praying, counting, repeating words
silently) that the person feels driven to perform in response to an obsession, or according to the rules that must be
applied rigidly.
The behaviours or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or
situation. However, these behaviours or mental acts either are not connected in a realistic way with what they are
designed to neutralise or prevent or are clearly excessive.
At some points during the course of the disorder, the person has recognised that the obsessions or compulsions are excessive
or unreasonable. Note: this does not apply to children.
The obsessions and compulsions cause marked distress, are time consuming (take more than one hour a day), or significantly
interfere with the persons normal routine, occupational (or academic) functioning, or usual social activities or relationships.
If another axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g. preoccupation
with food in the presence of an eating disorder, hair pulling in the presence of Trichotillomania; concern with appearance in
the presence of Body Dysmorphic Disorder: preoccupation with drugs in the presence of a Substance use disorder :
preoccupation with having a serious illness in the presence of hypochondriasis; preoccupation with sexual urges or fantasies in
the presence of a Paraphilia: or guilty ruminations in the presence or major depressive Disorder.
The disturbance is not due to the direct physiological effects of a substance (e.g. drug of abuse, a medication) or a general
medical condition.
Specify if with poor insight: If, for most of the time during the current episode, the person does not recognise that the
obsessions and compulsions are excessive or unreasonable.
Although people have very different abilities to endure stress, it seems likely that everyone has a breaking point if exposed for
long enough to an extreme enough stressor. Once Posttraumatic Stress Disorder occurs, its symptom pattern is remarkably
uniform regardless of the individuals previous psychological history or cultural background. However different a person is
before developing Posttraumatic Stress Disorder, there is a very human pattern of response to an extreme stressor that
includes avoidance of stimuli that remind the person of the stressor, re-experiencing the stressor in a number of ways, and
increased physiological arousal, particularly on exposure to memory jogging trigger
Pengertian
a. Obsesif
- Obsesif pikiran, perasaan, ide, atau sensasi yang manggangu (intrusif).
- Obsesif isi pikiran yang kukuh (Persistent) timbul, biarpun tidak diketahuinya,
dan diketahuinya bahwa hal itu tidak wajar atau tidak mungkin.
b. Kompulsi
Kompulsi pikiran atau prilaku yang disadari, dilakukan, dan rekuren, seperti
menghitung, memeriksa, mencari, atau menghindari.
Epidemiologi
4th common psychiatric disorder.
Prevalence of 2-3%.
Western countries (adults)
- both sexes
- onset before 20s.
They can occur in children aged 10 & in
adolescent also.
b. Faktor Prilaku
Obsesif adalah stimuli yang dibiasakan. Stimuli yang relatif netral
menjadi disertai dengan ketakutan atau kecemasan, melalui proses
pembiasaan responden dengan memasangkannya dengan peristiwa
yang secara alami adalah berbahaya atau menghasilkan kecemasan.
Jadi objek dan pikiran yang sebelumnya netral menjadi stimuli yang
tebiasakan yang mamapu menimbulkan kecemasan atau gangguan.
Kompulsi dicapai dalam cara yang berbeda, seseorang menemukan
bahwa tindakan tertentu menurunkan kecemasan yang berkaitan
dengan pikiran obsesional.
c. Faktor Psikososial
Faktor Keperibadian
Gangguan obsesif-kompulsif adalah berbeda dari gangguan
keperibadian obsesif-kompulsif . Sebagian besar pasien gangguan
obsesif-kompulsif tidak memiliki gejala kompulsif pramorbid ;
dengan demikian, sejak keperibadian tersebut tidak diperlukan atau
tidak cukup untuk perkembangan gangguan obsesif-kompulsif.
Faktor Psikodinamika
Sigmud Freud menjelaskan tiga mekanisme pertahanan psikologis utama yang
menentukan bentuk dan kualitas gejala dan sifat karakter obsesif-kompulsif :
1. Isolasi
Adalah mekanisme pertahanan yang melindungi seseorang dari aspek dan
impuls yang mencetuskan kecemasan.
2. Meruntuhkan (UNDOING)
Adalah suatu tindakan kompulsif yang dilakukan dalam usaha untuk mencegah
atau menentuksn akibat yang secara irasional akan dialami pasien akibat pikiran
atau impuls obsesional yang menakutkan.
3. Pembentukan Reaksi (Reaction Formation)
Pembentukan Reaksi melibatkan pola perilaku yang bermanifestasi dan sikap
yang asecara sadar dialami yang jelas berlawanan dengan impuls dasar.
Seringkali pola yang terlihat oleh pengamat adalah sangat dilebih-lebihkan dan
tidak sesuai.
Pikiran Magis
Adalah regresi yang mengungkapkan cara pikiran awal, ketimbang impuls ; yaitu
fungsi ego dan juga fumgsi id, dipengaruhi oleh regresi yang melekat pada
pikiran magis adalah pikiran kemahakuasaan.
Faktor prepitasi kebanyakan mengarah kepada kejadian ataupun peristiwa yang
menyebabkan stress karena tidak efektifnya koping individu terhadap stress
tersebut.
Pedoman DIagnosis
Harus ada hampir setiap hari selama sedikitnya 2 minggu berturutturut,dan merupakan sumber distress atau gangguan aktivitas.
Harus dikenal/disadari sebagai pikiran atau impuls dari diri individu
senndiri.
Setidaknya ada satu pikiran atau tindakan yang masih tidak berhasil
dilawan, meskipun ada lainnya yang tidak lagi dilawan oleh
penderita.
Pikiran untuk melaksanakantindakan tersebut di atas bukan
merupakan hal yang memberi kepuasan atau kesenangan (sekadar
perasaan lega dari ketegangan atau anxietas tidak dianggap sebagai
kesenangan seperti maksud di atas).
Pikira, bayangan,atau impuls tersebut harus merupakan
pengulangan yang tidak menyenangkan.
Pemeriksaan
Pemerikasaan Status Mental
Pada pemerikasaan status mental, pasien
gangguan obsesif-kompulsif menunjukkan
gejala depresif. Gejala tersebut ditemukan
pada kira-kira 50 % dari semua pasien.
Beberapa pasien gangguan obsesif-kompulsif
memiliki karakter/sifat yang mengarahkan
pada gangguan keperibadian obsesifkompulsif , tetapi sebagian besar tidak.
Diagnosa Banding
GAD :
- bound.- It is time bound.
- Involve everyday issues
- Thoughts are realistic
PHOBIA:
- Fear only in presence of stimuli
- Can avoid stimulus.
TOURETTES SYNDROME:
- Motor behavior are involuntary
and unintentional.
HYPOCHONDRIASIS :
- Somatic sensation must be
perceived.
- Vocalize to justify seriousness of
illness.
BODY DISMORPHIC DISORDER :
- Ideational content, complexity &
frequency.
- Self appearance is the main focus.
EATING DISORDER:
- Thoughts of food or weight gain.
- Purposeful.
IMPULSE CONTROL DISORDER:
- Ego syntonic
- Pleasurable
DEPRESSION :
- Real life events.
- Past events.
- Non intrusive & rarely resisted.
OCPD :
- Interferance in life is less
- Ego syntonico syntonic
- No sense of compulsion
Psychotic Disorder
- Presence of hallucination
- Thought insertion.
Prognosis
Suatu prognosis yang buruk dinyatakan oleh mengolah
(bukannya menahan) pada kompulsi, onset pada masa
anak-anak, kompulsi yang aneh (bizarre) perlu
perawata di rumah sakit, gangguan desfresi berat yang
menyertai, kepercayaan waham, adanya gagasan yang
terlalu dipegang (overvalued) yaitu penerimaan obsesi
dan kompulsi dan adanya gangguan keperibadian
(terutama gangguan keperibadian skizotipal).
Prognosis yang baik ditandai oleh penyesuian sosial
dan pekerjaan yang baik, adanya peristiwa pencetus,
dan suatu sifat gejala yang episodik. Isi obsesional
tampaknya tidak berhubungan dengan prognosis
F43
Gangguan stres pasca trauma
Terdiri dari:
1.Pengalaman kembali trauma melalui mimpi
dan pikiran yg menakutkan
2.Penghindaran yg persisten oleh pasien
terhadap trauma
3.Hiperarausal / berjaga jaga terus
Lainnya:
- Rasa bersalah
- Penghindaran
- Keadaan disosiatif
- Serangan panik
- Ilusi
- Halusinasi
- Gangguan daya ingat
dan perhatian
DSM-IV diagnostic criteria for 293.89 Anxiety Disorder due to general medical condition
Prominent anxiety, panic attacks, or obsessions or compulsions predominate in the clinical picture.
There is evidence from the history, physical examination or laboratory findings that the disturbance
is the direct physiological consequence of a general medical condition.
The disturbance is not better accounted for by another mental disorder (e.g. Adjustment Disorder
with anxiety in which the stressor is a serious general medical condition).
The disturbance does not occur exclusively during the course of the delirium.
The disturbance causes clinically significant distress or impairment in social occupational, or other
important areas of functioning.
Specify if:
With generalized anxiety: if excessive anxiety or worry about a number of events or activities
predominates in the clinical presentation.
With panic attacks: if the panic attacks predominate in the clinical presentation.
With Obsessive Compulsive symptoms: If obsessions or compulsions predominate in the clinical
presentation.
Gangguan Somatoform
(F 45)
Somatoform Istilah berasal dari kata soma
(Tubuh), gangguan somatoform adalah
kelompok luas penyakit yang memiliki tanda
dan gejala tubuh sebagai komponen utama
Dari bahasa Yunani Soma : Tubuh
Pendahuluan
Ciri utama
Keluhan gejala fisik berulang disertai permintaan
pemeriksaan medis walaupun sudah berkali2
terbukti hasilnya negatif dan sudah dijelaskan
dokter tidak ditemukan kelainan fisik yang
menjadi dasar keluhannnya
Pasien menolak upaya untuk membahas
penyebab psikologis meskipun gejala anxietas dan
depresi nyata
Perilaku mencari perhatian
Klasifikasi DSM IV
1.
2.
3.
4.
5.
6.
7.
Ciri utama
Gejala fisik bermacam2, berulang, sering
berubah2
Kebanyakan memiliki riwayat pengobatan panjang
dan kompleks ketergantungan atau penyalah
gunaan obat
Keluhan dapat mengenai sistem apapun (paling
sering GI, kulit)
Somatization disorder:
gangguan mental ditandai dengan keluhan somatik
multipel yang tidak dapat dijelaskan secara penuh oleh
kondisi medis umum, atau efek langsung obat, tetapi
secara tidak sengaja atau berpura-pura, mulai sebelum
usia 30 dan terjadi selama beberapa tahun.
keluhan terjadi dari kombinasi sedikitnya gejala nyeri
multipel, gejala gastrointestinal multipel, seksual dan
gejala neurologis.
Gejala sering dimunculkan dengan cara dramatis,
samar-samar, atau dilebih-lebihkan; disebut juga
briquets sindrom
Etiology
Psychosocial Factors
parental teaching, parental example, and ethnic mores may teach some
children to somatize more than others.
somatization disorder come from unstable homes and have been
physically abused. Social, cultural, and ethnic factors may also be involved
in the development of symptoms.
Biological Factors
patients have characteristic attention and cognitive impairments that
result in the faulty perception and assessment of somatosensory inputs.
excessive distractibility, inability to habituate to repetitive stimuli,
grouping of cognitive constructs on an impressionistic basis, partial and
circumstantial associations, and lack of selectivity, as indicated in some
studies of evoked potentials.
decreased metabolism in the frontal lobes and the nondominant
hemisphere.
Etiology
Genetics
in 10 to 20 percent of the first-degree female relatives of probands of
patients with somatization disorder.
first-degree male relatives are susceptible to substance abuse and
antisocial personality disorder.
29 percent in monozygotic twins and 10 percent in dizygotic twins
The male relatives of women with somatization disorder show an
increased risk of antisocial personality disorder and substance-related
disorders.
biological or adoptive parent with any of these disorders increases the
risk of developing antisocial personality disorder, a substance-related
disorder, or somatization disorder.
Cytokines
contribute to some of the nonspecific symptoms of disease, such as
hypersomnia, anorexia, fatigue, and depression. (under investigation)
Ciri utama:
Preokupasi menetap akan kemungkinan
menderita satu atau lebih gangguan fisik yang
serius dan progresif
Keluhan2 somatik menetap
Pengindraan dan penampilan yang normal dapat
dianggap abnormal
Gangguan hipokondrik
Depresi dan anxietas sering menonjol +
memenuhi syarat diagnosis tambahan
Onset jarang > usia 50thn
Tidak boleh ada waham menetap mengenai
gangguan fungsi atau bentuk badan
Nosofobia masuk dalam kategori ini
Dapat mengenai pria dan wanita
Gangguan hipokondrik
DD
Gangguan somatisasi
Gangguan depresif
Gangguan waham
Gangguan anxietas dan gangguan panik
Penatalaksanaan
Psikoterapi suportif (behavior therapy, cognitive therapy,
and hypnosis)
Transquilaizer atau neuroleptika dosis rendah
Th/ keluarga, kelompok, latihan fisik
Group psychotherapy often benefits such patients, in part
because it provides the social support and social
interaction that seem to reduce their anxiety
Gangguan hipokondrik
Prognosis
usually episodic last from months to years and are separated by
equally long quiescent periods.
There may be an obvious association between exacerbations of
hypochondriacal symptoms and psychosocial stressors.
estimated one third to one half of all patients with hypochondriasis
eventually improve significantly.
A good prognosis is associated with high socioeconomic status,
treatment-responsive anxiety or depression, sudden onset of
symptoms, the absence of a personality disorder, and the absence of a
related nonpsychiatric medical condition
Most children with hypochondriasis recover by late adolescence or
early adulthood.