SINDROM NEUROTIK, GANGGUAN

SOMATOFORM & GANGGUAN YANG

BERKAITAN DENGAN STRES
Dr. Manoe Bernd Paul SpKJ., MKes
 anixety
• Everyone experiences anxiety.
– diffuse,
– unpleasant,
– vague sense of apprehension,
– accompanied by autonomic symptoms
• headache, perspiration, palpitations, tightness in the
chest, mild stomach discomfort, and restlessness,
indicated by an inability to sit or stand still for long.
 Overview continu

viewed as a family of related but distinct mental

disorders, which include the following as (DSM-IV-
TR):
• (1) panic disorder with or without agoraphobia;
• (2) agoraphobia with or without panic disorder;
• (3) specific phobia; (4) social phobia;
• (5) obsessive-compulsive disorder (OCD);
• (5) posttraumatic stress disorder (PTSD);
• (6) acute stress disorder;
• (7) generalized anxiety disorder.
 Overview continu.. Etiology
NURTURE
Traumatic
life event
/experiental NATURE

Genetic

Anxious
 unknown,
internal, impending Alerting Deal with Anxiety
vague, or danger signal
conflictual.

Known,
external,
definite,
nonconflic impending Alerting
Deal with Fear
tual danger signal
 Pusing / limbung
Pikiran
cepat
Pandangan kabur

Gangguan tidur
Sulit menelan
Rasa sesak/ sulit
bernafas/ nafas Jantung berdebar
pendek
tremor
mual
Berkeringat/
bergetar

Ingin berlari
Panic Disorder & Agoraphobia
Panic Disorder
• An acute intense attack of anxiety accompanied by feelings of impending doom
• Patients with panic disorder present with a number of comorbid conditions, most
commonly agoraphobia
• Women are two to three times more likely to be affected than men
• recent history of divorce or separation.
• most commonly develops in young adulthoodâ the mean age of presentation is about
25 years but both panic disorder and agoraphobia can develop at any age
• abnormal regulation of brain noradrenergic systems is also involved in the
pathophysiology

Agoraphobia
• refers to a fear of or anxiety regarding places from which escape might be difficult
• most disabling of the phobias, because it can significantly interfere with a person's
ability to function in work and social situations outside the home.
 etiology
Biology
• Abn NA system (NE;SE;)GABA
• Autonomic NS
• Sympatethic NS slow addpat to
repeated stimuli
• respond excessively to moderate
stimuli
Biology
• Abn NA system (NE;SE;)GABA
• Autonomic NS Psychodynamic
• Sympatethic NS slow addpat to repeated • Freud dorongan Id
stimuli (unconsious & agresiveness)
• respond excessively to moderate stimuli thd Ego- Represi

Social
• conditioned response to a specific
environmental stimulus
Agoraphobia Social Phobia
Crowds Public speaking
Stores Writing, eating, or drinking in public
Bridges Initiating or maintaining conversations
Tunnels
Traveling on a bus, train, or airplane
Theaters
Standing in a line
Small enclosed rooms
escape might be difficult, embarrassing, Marked and persistent fear of one or
or in which help may be unavailable in the more social or performance situations in
event of having a panic attack which the person is concerned about
negative evaluation or scrutiny by others,
Spesific Phobia Obsessive Compulsive Disorder
Cued by spesific object / situations Obsession : recurrent & persistent
thouhts/impulse/image that inapropriate
such :

flying Contatmination
Hights Repeated doubts
Animal (snakes/spider/chicken) Order
Injection Impulses
Blood Sexual images

Avoidance; anticipatory anxiety Compulsion : repetitive behavior to prevent

Significant distress
or reduce anxiety
Hand washing, counting,repeating
words,praying, ordering, checking
Dystress ; time consuming >1 H /day
Impairment socuial, occupational, ADL
Obsessive Compulsive Disorder
a severe & debilitating anxiety disorder
men = women

afflicting about one adult in 40,  twice as common as

schizophrenia & bipolar disorder,
the fourth most common psychiatric disorder.

OCD usually begins gradually. Approximately two-thirds

of the people with OCD develop the disorder in adolescence or early
adulthood.
biology
• SE; NA
• Neuroimunology : Infeksi Streptococcus
• >>aktivitas frontal lobe; basal ganglia; cingulum (corticostriatal area)
• Bilateral caudatus < dari Normal
• Genetic (GAD; TIC;BDD; Hypocondriasis)

Psychosocial
• Perfectionism; concern detail; etc
• Freud ; regresi fase oedipal ke fase anal
• Ambivalence : consciously experience both love & Hate to Love Object
 General Anxiety
Disorder/Overanxious disorder
• Anxiety is an; it warns of 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.
 Normal vs Pathological
Anxiety
Normal Pathologic

Intensitas Relatif Rendah/ sesuai Relatif tinggi/tidak sesuai

situasi dengan situasi
Durasi Cenderung pendek Cenderung bertahan lama
Preokupasi anxietas Tidak ya
Qualitas Tidak nyaman, namun Distressing, menetap, dan
tidak terlalu distress & incapacitating
tidak bertahan lama
Effect on behavior & Tidak berdampak, tidak Bedampak pd perilaku
functioning berdampakk pada fungsi jangka panjang, dan pada
fungsi
 Escessive Anxiety & Worry abouts
events or activities (future oriented)

Occuring more days at least 6 mnth

Restless feeling: easily fatigued/difficult

concentrating/irritability/sleep distrbnc
 GAD cont

Prognosis
• ~ comorbiditas dg sakit lainnya
• Stres Life event
• Dr shoping sejak usia 20 an

Treatment
• Psychotherapy : CBT(memperbaiki distorsi cognitive);
BT (Relaksasibreathing)
• psychopharmacath/: Benzo; Buspirone; SSRI
Reaksi thd Stress & ggn Penyesuaian
 Gangguan yang berhubungan
dengan TRAUMA
REAKSI STRESS AKUT GANGGUAN STRESS GANGGUAN
PASCA TRAUMA PENYESUAIAN
Terjadi segera setelah Terjadi > 1 bulan – 6 Perubahan hidup yg
trauma (stressor luar bulan delayed onset bermakna
biasa) - <1 bln
Gangguan tidur Gangguan tidur Gangguan Tidur
Depresi Depresi Depresi
Cemas Cemas Cemas
Daze (terpaku) Flash back Disabilitas dl ADL
bencana alam, kecelakaan,
perang, serangan tindakan
kriminal, perubahan luar
biasa yg mendadak
 Gangguan Disosiatif
Kehilangan sebagian / keseluruhan dari integrasi Normal (kendali kesadaran)

Amnesia Disosiatif

Trans (kesurupan)

Convulsi

Disosiatif penginderaan
 Gangguan somatoform

Hypochondriasis
• Keluhan fisik tidak dapat di jelaskan (hasil
pemeriksaan dbn)
Somatisasi
• >keluhan fisik, mengakibatkan distress

Gangguan Nyeri Somatoform

• Nyeri berat, menetap ~konflik emosional
Gangguan pada Anak & Remaja
 ggn Keswa Bayi/anak/remaja
Balita/ Batita Anak Remaja
• Ggn bicara, motorik. • KEKERASAN SEKSUAL/FISIK • KEKERASAN SEXUAL/FISIK
Ggn Perkemb Pervasif • Ggn Mood • Penyalahgunaan zat Remaja
Ggn Hiperkinetik Ggn TL (conduct) • Ggn Indentitas Jenis Kelamin
• RM Enuresis • Ggn Mood
• Ringan (50-69) Encorporesis
• Sedang (35-49) Pica
• Berat (20-34) Stuttering
• Autism/ ADHD
• RM
 Gangguan somatoform

Hypochondriasis
• Keluhan fisik tidak dapat di jelaskan (hasil
pemeriksaan dbn)
Somatisasi
• >keluhan fisik, mengakibatkan distress

Gangguan Nyeri Somatoform

• Nyeri berat, menetap ~konflik emosional