Study Guide Behavior Semester IV FK UNUD

Study Guide Behavior Changes and Disorders
TABLE OF CONTENTS
Page
Table of Contens
The Seven General Core Competencies
Planner team & Lecturers
Facilitators
Time Table (Regular Class)
Time Table (English Class)
Important Informations
12
Students Project
12
Meeting of the students representative
14
Assessment Method
14
Learning Programs
15
Basic Clinical Skill
57
Curriculum Mapping
64
References
65
Udayana University Faculty of Medicine, DME
The Seven General Core Competencies

1.
Patient Care
Demonstrate capability to provide comprehensive patient care that is compassionate,
appropriate, and effective for the management of health problems, promotion of health
and prevention of disease in the primary health care settings.
2.
Medical Knowledge Base

Mastery of a core medical knowledge which includes the biomedical sciences,
behavioral sciences, epidemiology and statistics, clinical sciences, the social aspect of
medicine and the principles of medical ethics
3.
Clinical skill
Demonstrate capability to effectively apply clinical skills and interpret the findings in
the investigation of the patients
4.
Communication
Demonstrate capability to communicate effectively and interpersonally to establish
rapport with the patient, family, community at large, and professional associates, that
results in effective information exchange, the creation of a therapeutically and ethically
sound relationship
5.
Information Management
Demonstrate capability to manager information which includes information access,
retrieval, interpretation, appraisal, and application to patiences specific problem, and
maintaining records of his or her proactive for analysis and improvement
6.
Professionalism
Demonstrate a commitment to carrying out professional responsibilities and to
personal probity, adherence to ethical principles, sensitivity to a diverse patient
population and commitment to carrying out continual self-evaluation of his or her
professional standard and competence
7.
Community-based and health system-based practice

Demonstrate awareness and responsiveness to larger context and system of health
care, and ability to effectively use system resource for optimal patient care.
Members Planning Group

No
1
NAME
Dr dr Cokorda Bagus Jaya Lesmana, SpKJ (K)
(Head)
DEPARTMENT
PHONE
Psychiatry
0816295779
dr Anak Ayu Sri Wahyuni, SpKJ (Secretary)
Psychiatry
0361 7814010
dr Luh Nyoman Alit Aryani, SpKJ
Psychiatry
085737717244
dr Wayan Westa, SpKJ (K)
Psychiatry
081999200900
Dr dr Ida Bagus Fajar Manuaba, SpOG, MARS
Obgyn
081558101719
DEPARTMENT
PHONE
Lectures
No
NAME
Psychiatry
0816295779
Psychiatry
081999200900
dr Anak Ayu Sri Wahyuni, SpKJ
Psychiatry
0361 7814010
dr I Gusti Ayu Endah Arjana, Sp.KJ (K)
Psychiatry
08123916842
dr Lely Setiawati, Sp.KJ (K)
Psychiatry
08174709797
dr Ida Ayu Kusuma Wardani, SpKJ, MARS
Psychiatry
08123813831
dr Ni Ketut Putri Ariani, SpKJ
Psychiatry
08123806397
dr Ni Ketut Sri Diniari, SpKJ
Psychiatry
081338748051
dr Luh Nyoman Alit Aryani, SpKJ
Psychiatry
085737717244
10
dr I Gusti Ayu Indah Ardani, SpKJ
Psychiatry
08123926522
11
Dr dr Anak Agung Ayu Putri Laksmidewi Sp.S(K)
Neurology
0811388818
12
Obgyn
081558101719
13
dr Yenni Kandarini, SpPD
Internal Medicine
08123805344
14
dr I Gusti Ayu Artini, M.Sc
Pharmacology
08123650481
15
DR. Ni Made Swasti Wulanyani, S.Psi., M.Erg., Psi
Psychology
08123764595
Curriculum Block The Behavioral Changes and

Disorders
Aims:
1. Comprehend professional competence and ensure the highest quality care to those
with mental illness
2. Comprehend the psychodynamic and psycho pathological process of the behavior
disorders
3. Diagnose and manage patient with mental illness
4. Diagnose and manage patient with behavioral problems related with medical
condition
5. Educate patient and their family, and community about behavior changes and
disorders
Learning Outcomes:
Awareness of lifestyle as a risk factor of behavior changes and psychiatric disorders
and the importance of early treatment and proper management and prevention
Recognizance of the new paradigm of medical practice: beyond bio-psycho-sociocultural model
Define medical and allied sciences, health prevention and health promotion in the
relationship between medical competencies and the contributions of medical and
allied sciences, professional skills and attitudes to the prevention and treatment of
behavioral disorders.
Curriculum Contents:
1. Demonstrate ability to diagnose, manage and refer patient with problems in
developmental stage of personality
2. Demonstrate ability to diagnose, manage and refer patient with psych-organic
syndromes and disorders.
3. Demonstrate ability to diagnose, manage and refer patient with psychosis
symptoms.
4. Demonstrate ability to diagnose, manage and refer patient with bipolar disorders
5. Demonstrate ability to diagnose, manage and refer patient with anxiety disorders
6. Demonstrate ability to diagnose, manage and refer patient with somatoform
disorders.
7. Demonstrate ability to diagnose, manage and refer patient with sexual disorders
8. Demonstrate ability to diagnose, manage and refer patient with insomnia symptoms
9. Demonstrate ability to explain psycho pharmacology
10. Demonstrate ability to diagnose, manage and refer patient with self harm and
suicidal behavior
11. Demonstrate ability to diagnose, manage and refer patient with problem related to
child abuse or neglected
12. Demonstrate ability to promote healing process in psychiatric patients
Facilitators
Class A
No
1
Name
Dept
Phone
Surgery
08123923956
Public Health
08123804985
Anatomy
Pathology
Pharmacology
082237407778
Pediatric
08123641466
Anasthesi
085238514999
Interna
08123974128
Neurology
0811385099
Pediatric
081353286780
Parasitology
081353077733
Orthopaedi
081337870347
Surgery
08123511673
Group
Dept
Phone
dr. Pande Kurniari, Sp.PD
B1
Interna
082147176796
dr Ni Wayan Sucindra Dewi
B2
Pharmacology
08113935700
dr Ni Nyoman Metriani Nesa,

M.Sc.,Sp.A
B3
Pediatric
081337072141
dr Ni Made Susilawathi, Sp.S
B4
Neurology
08124690137
B5
Opthalmology
0818375611
B6
Anasthesi
08123868126
dr. Putu Yuliandari, S.Ked
B7
Microbiology
089685415625
dr. I G.A. Indah Ardani, Sp.KJ
B8
Psychiatry
08123926522
dr. I Wyn Subawa, Sp.OT
B9
Orthopaedi
081337096388
B10
Biochemistry
081239990399
B11
Public Health
081835777
B12
Pulmonology
081916708565/
08123990362
dr. I Gede Budhi Setiawan,

Sp.B(K)Onk
dr. Made Dharmadi , MPH
dr. Juli Sumadi, Sp.PA
dr. Reni Widiastuti
dr. Dewi Sutriani Mahalini , Sp.A
dr. Dewa Ayu Mas Shintya Dewi,

Sp.An
dr. Nyoman Astika, Sp.PD-KgerFINASIM
dr. Desak Ketut Indrasari Utami,
Sp.S
dr. Ayu Setyorini Mestika
Mayangsari, M.Sc,Sp.A
dr. Ni Luh Putu Eka Diarthini,
S.Ked
dr. Anak Agung Gde Yuda
Asmara, Sp.OT
dr. Agus Roy Rusly Hariantana
Hamid, Sp.BP
7
8
9
10
11
12
Group
A1
A2
A3
A4
A5
A6
A7
A8
A9
A10
A11
A12
08174742501
Venue
(3rdfloor)
3nd floor:
R.3.01
3nd floor:
R.3.02
3nd floor:
R.3.03
3nd floor:
R.3.04
3nd floor:
R.3.05
3nd floor:
R.3.06
3nd floor:
R.3.07
3nd floor:
R.3.08
3nd floor:
R.3.20
3nd floor:
R.3.21
3nd floor:
R.3.22
3nd floor:
R.3.23
Class B
No
1
2
3
4
5
6
7
8
9
10
11
12
Name
dr. Ariesanti Tri Handayani ,

Sp.M
dr I Gusti Agung Gede Utara
Hartawan, Sp.An
dr. Ida Ayu Dewi Wiryanthini, M

Biomed
Dr.dr. Dyah Pradnyaparamita
Duarsa, M.Si
dr. Ida Bagus Sutha, Sp.P
Venue
(3rdfloor)
3nd floor:
R.3.01
3nd floor:
R.3.02
3nd floor:
R.3.03
3nd floor:
R.3.04
3nd floor:
R.3.05
3nd floor:
R.3.06
3nd floor:
R.3.07
3nd floor:
R.3.08
3nd floor:
R.3.20
3nd floor:
R.3.21
3nd floor:
R.3.22
3nd floor:
R.3.23
Time Table
Regular Class
Day/
Date
1
Friday
8 May
2015
2
Monday
11 May
2015
3
Tuesday
12 May
2015
4
Wed
13 May
2015
5
Monday
18 May
2015
6
Tuesday
19 May
2015
7
Wed
20 May
2015
8
Thursday
21 May
2015
Time
Activity
Venue
08.00 09.00
Lecture 1: Introduction to
Behavior Changes and Disorders
Independent learning
Group Discussion
Break and student project
Plenary session
Class room
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
08.00 09.00
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
Lecture 2: Mental Status

Examination and Assessment
Group Discussion
Plenary session
08.00 09.00
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
Lecture 3: Psychological Test

Group Discussion
Plenary session
08.00 09.00
Lecture 4: Neurobehavioral
approach to Behavior Disorders
Group Discussion
Plenary session
09.00 09.30
09.30 12.00
12.00 14.00
14.00 15.00
08.00 09.00
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
08.00 09.00
Lecture 5: Prenatal Psychobiology

(Case of Baby Blues)
Group Discussion
Plenary session
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
Lecture 6: Behavior Changes Due

to a General Medical Condition
Group Discussion
Plenary session
08.00 09.00
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
Lecture 7: Delirium and Dementia

Group Discussion
Plenary session
08.00 09.00
Lecture 8: General Approaches to

Substance Abuse
Group Discussion
Plenary session
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
Conveyer
Dr Sri Wahyuni
Discussion room
Class room
Dr Sri Wahyuni
Class room
Dr Sr Diniari
Discussion room
Class room
Dr Sri Diniari
Class room
DR Wulanyani
Discussion room
Class room
DR Wulanyani
Class room
DR Dr Laksmi
Discussion room
Class room
DR Dr Laksmi
Class room
DR Dr IB Fajar
Discussion room
Class room
DR Dr IB Fajar
Class room
Dr Yenni
Discussion room
Class room
Dr Yenni
Class room
Dr Endah
Discussion room
Class room
Dr Endah
Class room
Dr Westa
Discussion room
Class room
Dr Westa

08.00 09.00
9
Friday
22 May
2015
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
08.00 09.00
10
Monday
25 May
2015
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
08.00 09.00
11
Tuesday
26 May
2015
12
Wed
27 May
2015
13
Thursday
28 May
2015
14
Friday
29 May
2015
15
Monday
1 June
2015
16
Wed
3 June
2015
17
Thursday
4 June
2015
Lecture 9: Primary & Secondary

Insomnia
Group Discussion
Plenary session
Lecturer 10: Schizophrenia &
Other Psychoses
Group Discussion
Plenary session
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
Lecturer 11: Delusional &

Schizoaffective Disorders
Group Discussion
Plenary session
08.00 09.00
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
Lecture 12: Bipolar Disorders

Group Discussion
Plenary session
08.00 09.00
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
Lecture 13: Panic Disorders

Group Discussion
Plenary session
08.00 09.00
Lecture 14: Somatoform

Disorders
Group Discussion
Plenary session
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
08.00 09.00
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
Lecture 15: Generalized Anxiety &

Obsessive-Compulsive Disorder
Group Discussion
Plenary session
08.00 09.00
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
Lecture 16: PTSD

Group Discussion
Plenary session
08.00 09.00
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
Lecture 17: Sexual Disorders

Group Discussion
Plenary session
Class room
Dr Alit Aryani
Discussion room
Class room
Dr Alit Aryani
Class room
DR Dr Cok Bagus
Discussion room
Class room
DR Dr Cok Bagus
Class room
Dr Sri Diniari
Discussion room
Class room
Dr Sri Diniari
Class room
Dr Lely
Discussion room
Class room
Dr Lely
Class room
Dr Indah
Discussion room
Class room
Dr Indah
Class room
Dr Indah
Discussion room
Class room
Dr Indah
Class room
Dr Putri
Discussion room
Class room
Dr Putri
Class room
DR Dr Cok Bagus
Discussion room
Class room
DR Dr Cok Bagus
Class room
Dr Westa
Discussion room
Class room
Dr Westa
18
Friday
5 June
2015
19
Monday
8 June
2015
20
Tuesday
9 June
2015
21
Wed
10 June
2015
22
08.00 09.00
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
Lecture 18: Psycho-Pharmacology

Group Discussion
Plenary session
08.00 09.00
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
Lecture 19: Self Harm & Suicide

Group Discussion
Plenary session
SP Group A1, A2, A3
Lecture 20: Child Abuse &
Neglected
Group Discussion
Plenary session
SP Group A4, A5, A6
Clinical Skill: Introduction to
Psychiatric Interview
Group Discussion
Plenary session
SP Group A7, A8, A9, A10
Clinical Skill: Interview with
Anxiety Disorders Patients
08.00 09.00
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
08.00 09.00
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
08.00 15.00
Thursday
11 June
2015
23
25
Wed
17 June
2015
Discussion room
Class room
Dr Artini
Class room
Dr Dayu
Discussion room
Class room
Dr Dayu
Class room
Dr Sri Wahyuni
Discussion room
Class room
Dr Sri Wahyuni
Class room
Dr Sri Wahyuni
Discussion room
Class room
Dr Sri Wahyuni
Skill Lab
Team Psychiatry

Depression Disorders Patients
Skill Lab
Team Psychiatry
08.00 15.00

Somatoform Disorders Patients
Skill Lab
Team Psychiatry
08.00 15.00

Bipolar Disorders Patients
Skill Lab
Team Psychiatry
Monday
15 June
2015
Tuesday
16 June
2015
Dr Artini
08.00 15.00
Friday
12 June
2015
24
Class room
Pre-evaluation Break
26
Thursday
18 June
2015
Examination
English Class
Day/
Date
1
Friday
8 May
2015
2
Monday
11 May
2015
3
Tuesday
12 May
2015
4
Wed
13 May
2015
5
Monday
18 May
2015
6
Tuesday
19 May
2015
7
Wed
20 May
2015
8
Thursday
21 May
2015
Time
Activity
Venue
09.00 10.00
Lecture 1: Introduction to Behavior

Changes and Disorders
Student project & break
Group Discussion
Plenary session
Class room
Dr Sri Wahyuni
Discussion room
Class room
Dr Sri Wahyuni
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
09.00 10.00
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
Lecture 2: Mental Status

Examination and Assessment
Group Discussion
Plenary session
09.00 10.00
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
Lecture 3: Psychological Test

Group Discussion
Plenary session
09.00 10.00
Lecture 4: Neurobehavioral
approach to Behavior Disorders
Group Discussion
Plenary session
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
09.00 10.00
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
09.00 10.00
Lecture 5: Prenatal Psychobiology

(Case of Baby Blues)
Group Discussion
Plenary session
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
Lecture 6: Behavior Changes Due

to a General Medical Condition
Group Discussion
Plenary session
09.00 10.00
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
Lecture 7: Delirium and Dementia

Group Discussion
Plenary session
09.00 10.00
Lecture 8: General Approaches to

Substance Abuse
Group Discussion
Plenary session
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
Conveyer
Class room
Dr Sr Diniari
Discussion room
Class room
Dr Sri Diniari
Class room
DR Wulanyani
Discussion room
Class room
DR Wulanyani
Class room
DR Dr Laksmi
Discussion room
Class room
DR Dr Laksmi
Class room
DR Dr IB Fajar
Discussion room
Class room
DR Dr IB Fajar
Class room
Dr Yenni
Discussion room
Class room
Dr Yenni
Class room
Dr Endah
Discussion room
Class room
Dr Endah
Class room
Dr Westa
Discussion room
Class room
Dr Westa

09.00 10.00
9
Friday
22 May
2015
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
09.00 10.00
10
Monday
25 May
2015
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
09.00 10.00
11
Tuesday
26 May
2015
12
Wed
27 May
2015
13
Thursday
28 May
2015
14
Friday
29 May
2015
15
Monday
1 June
2015
16
Wed
3 June
2015
17
Thursday
4 June
2015
Lecture 9: Primary & Secondary

Insomnia
Group Discussion
Plenary session
Lecturer 10: Schizophrenia & Other
Psychosis
Group Discussion
Plenary session
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
Lecturer 11: Delusional &

Schizoaffective Disorders
Group Discussion
Plenary session
09.00 10.00
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
Lecture 12: Bipolar Disorders

Group Discussion
Plenary session
09.00 10.00
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
Lecture 13: Panic Disorders

Group Discussion
Plenary session
09.00 10.00
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
Lecture 14: Somatoform Disorders

Group Discussion
Plenary session
09.00 10.00
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
Lecture 15: Generalized Anxiety &

Obsessive-Compulsive Disorder
Group Discussion
Plenary session
09.00 10.00
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
Lecture 16: PTSD

Group Discussion
Plenary session
09.00 10.00
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
Lecture 17: Sexual Disorders

Group Discussion
Plenary session
Class room
Dr Alit Aryani
Discussion room
Class room
Dr Alit Aryani
Class room
DR Dr Cok Bagus
Discussion room
Class room
DR Dr Cok Bagus
Class room
Dr Sri Diniari
Discussion room
Class room
Dr Sri Diniari
Class room
Dr Lely
Discussion room
Class room
Dr Lely
Class room
Dr Indah
Discussion room
Class room
Dr Indah
Class room
Dr Indah
Discussion room
Class room
Dr Indah
Class room
Dr Putri
Discussion room
Class room
Dr Putri
Class room
DR Dr Cok Bagus
Discussion room
Class room
DR Dr Cok Bagus
Class room
Dr Westa
Discussion room
Class room
Dr Westa
10
18
Friday
5 June
2015
19
Monday
8 June
2015
20
Tuesday
9 June
2015
21
Wed
10 June
2015
22
09.00 10.00
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
09.00 10.00
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
08.00 11.00
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
09.00 10.00
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
25
Discussion room
Class room
Dr Artini
Class room
Dr Dayu
Discussion room
Class room
Dr Dayu
Class room
Dr Sri Wahyuni
Discussion room
Class room
Dr Sri Wahyuni
Class room
Dr Sri Wahyuni
Discussion room
Class room
Dr Sri Wahyuni
Skill Lab
Psychiatric Team
09.00 16.00

Depression Disorders Patients
Skill Lab
Psychiatric Team
09.00 16.00

Somatoform Disorders Patients
Skill Lab
Psychiatric Team
09.00 16.00
Clinical Skill: Interview with Bipolar

Disorders Patients
Skill Lab
Psychiatric Team
Monday
15 June
2015
Tuesday
16 June
2015
Dr Artini
Clinical Skill: Interview with Anxiety

Disorders Patients
Friday
12 June
2015
24
Class room
09.00 16.00
Thursday
11 June
2015
23
Lecture 18: Psycho-Pharmacology

Group Discussion
Plenary session
SP Group B10, B9, B8
Lecture 19: Self-Harm & Suicide
Group Discussion
Plenary session
SP Group B7, B6, B5
Lecture 20: Child Abuse &
Neglected
Group Discussion
Plenary session
SP Group B4, B3, B2, B1
Clinical Skill: Introduction to
Psychiatric Interview
Break
Group Discussion
Plenary session
Wed
17 June
2015
26
Thursday
18 June
2015
Pre-evaluation Break
Examination
11
Students Project
Every student requires finding a scientific journal based on the topic of their groups and
create a review paper as a group project. The journal has to be from year 2013 to recent
years. It has to be present in a report format by week 4 th to the facilitator and present in the
plenary session.
No Topic
Group
1
2
3
4
5
6
7
8
9
10
A1, B10
A2, B9
A3, B8
A4, B7
A5, B6
A6, B5
A7, B4
A8, B3
A9, B2
A10, B1
Paranoid Personality Disorder

Schizoid Personality Disorder
Schizotypal Personality Disorder
Antisocial Personality Disorder
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
Avoidant Personality Disorder
Dependent Personality Disorder
ObsessiveCompulsive Personality Disorder
Report Format
Cover
Preface
Table of Content
a. Introduction
b. Content
c. Discusion
d. Summary
Space
: 1,5 Space
Font
: Times New Roman 12
Minimum Page: 15
The students project is present starting by the 18th day of the meeting on the plenary
meeting. The results will be review by the block planning group for final mark.
12
Student Project Assessment Form

Faculty of Medicine, Udayana University
Blok
: Behavior Changes and Disorders
Name/NIM
Facilitator
Title
Time Table of Consultation

Point of Discussion Week
Title
Translation of Journal
Discussion and
Summary of Journal
Final Report
Date
Assessment
A. Paper structure
B. Content
C. Discussion
:
:
:
6
6
6
Total Point
(A+B+C)/4
7
7
7
8
8
8
Tutor Sign
9
9
9
10
10
10
= __________
Denpasar,
Facilitator
13
Meeting of Student Representatives and Facilitators

Meeting of student representatives and facilitators will be held on the second Friday of the
block period if necessary. This meeting will be organized by the planners and attended by
lecturers, students group representatives and all facilitators. Meeting with the student
representatives will take place at 09.00 until 10.00 am and meeting with the facilitators at
10.00 until 11.00 am. The purpose of the meeting is to evaluate the teaching learning
process of the Block. Feedbacks and suggestions are welcome for improvement of the
Block educational programs.
~ ASSESSMENT METHOD ~
Assessment will be carried out on the 26th day of the block period. The test will consist of
100 questions with 100 minutes provided for working. The assessment will be held at the
same time for both Regular Class and English Class. The passing score requirement is
70. More detailed information or any changes that may be needed will be acknowledged at
least two days before the assessment.
14
Modul
1
Introduction to Behavior and Disorders
AIMS:
Emphasizes clinical psychiatry and its development in Indonesia and in the world
Describe Mental Health Act in Indonesia, Manual of Indonesian Mental Disorders
and multi axial diagnosis
LEARNING OUTCOMES:
Describe how to:
1. Emphasizes clinical psychiatry
2. Describe history of psychiatry
3. Understand the manual of Indonesian Mental Disorders
4. Use multi axial Diagnosis
CURRICULUM CONTENTS:
1. Psychiatric definition
2. Negative stigma of mental disorders
3. Development of psychiatric intervention
4. Diagnosis formulation
5. Global Assessment Function Scale
ABSTRACTS
The purpose of this lecture is to give general information about all of the subjects that will be
given in this Block. It also creates awareness on how importance the subjects in the medical
education and future medical profession.
This is an exciting time in the field of psychiatry. Scientificprogress has expanded the
diagnostic and therapeutic capabilities of psychiatry at the same time that psychiatry has
begun to play a larger role in the delivery of care to a wider population, both in mental health
and in primary care settings. Psychiatry at the end of the 20th century plays an important
role among the medical specialties.
The physicianpatient relationship provides the framework for quality psychiatric
practice. The skilled clinician must acquire a breadth and depth of knowledge and skills in
the conduct of the clinical interaction with the patient. To succeed in this relationship, the
psychiatristmust have an understanding of normal developmental processes across the life
cycle (physiological, psychological, and social) and how these processes are manifested in
behavior and mental functions. The psychiatrist must also be expert in the identification and
evaluation of the signs and symptoms of abnormal behavior and mental processes and be
able to classify them among the defined clinical syndromes that constitute the psychiatric
nosology.
To arrive at a meaningful clinical assessment, one must understand the etiology and
pathophysiology of the illness along with the contributions of the patients individual
environmental and sociocultural experiences. Furthermore, the psychiatrist must have a
command of the range of therapeutic options for any given condition, including comparative
benefits and risks, andmustweigh the special factors that can influence the course of
treatment such as medical comorbidity and constitutional, sociocultural, and situational
factors.
15

Psychiatry today, the transformation of our field has gained increasing momentum.
Our understanding of the microstructure and function of the brain, and of the genetic
controls of the brain reveals ever more amazing information which has already begun to
transform clinical practice and psychiatric education. Further, the changes in the ways we
have access to information have led to dramatic improvement of accessibility to our growing
knowledge base. Yet, the clinical core of our discipline remains the imperative to integrate
the best of our humanistic traditions with our cutting-edge scientific advances. With all the
revising and restructuring though, our approach continues to emphasize an integrative
biopsychosocial philosophy in both understanding psychopathology and providing
treatment. And, as always, we hold to the view that the context of our understanding and
intervention remains the therapeutic alliance we develop and maintain with our patients.
SELF DIRECTING LEARNING
Basic knowledge that must be known:
1. Psychiatric definition
2. Negative stigma of mental disorders
3. Development of psychiatric intervention
5. Global Assessment Function Scale
SCENARIO
Since the 1980s, new technologies and fundamental new insights have transformed the
biological sciences and most areas of medicine. The completion of the Human Genome
Project in 2002 provided a map of all of the genes of the human species. The soon-to-becompleted human haplotype map will provide a guide to individual variation of all of these
genes. Along with genomics, neuroscience has become one of the most exciting areas of
contemporary research. Recent discoveries have transformed the understanding of the
brain, demonstrating how neurogenesis continues throughout adulthood, mapping the
dynamic nature of cortical connectivity that can change in response to stimulation, and
identifying some of the categorical rules by which information is processed in the brain. By
any measure, recent decades have been revolutionary for the understanding of the human
genome and how the brain functions, two areas of science fundamental to psychiatry. Yet,
during this same period, clinical psychiatry has remained relatively unchanged.
Learning Task
1. Explain about psychiatric diagnostic terst
2. What are the major disorders in behavioral changes?
3. Discuss about genomic and neuroimaging progress in how clinicians diagnose or
treat the patients with mental disorders
4. Explain about the latest finding in DNA for major disorders in behavioral changes
SCENARIO 2:
A psychiatric consultant was asked to see a 48-year-old man on a coronary care unit for
chest pain deemed functional by the cardiologist who had asked the patient if his chest
pain was crushing. The patient said no. A variety of other routine tests were also negative.
The psychiatrist asked the patient to describe his pain. He said, Its like a truck sitting on
my chest, squeezing it down. The psychiatrist promptly recommended additional tests that
confirmed the diagnosis of myocardial infarction. The cardiologist may have been tempted
to label the patient a bad historian.
Learning Task
1. Expalin about the key skill in psychiatry?
2. What are the different between listening and hearing?
3. What are the trends in psychiatric care?
4. Explain about the most important tool for healing?
16

5. How do you act as a primary care doctor to create a process of destigmatization?
Self Assessment
1. How to do a good anamnesis for a patient and his family?
2. Can the drug given by cardiologist and by psychiatrist be given simultaneously?
3. Try to assess using Multi Axial diagnosis (Axis I, II, III, IV and V)?
4. What is the main priority in handling the case above?
5. We recognize there is still a negative stigma about mental illness in society. How to
overcome this?
17
Modul
2
Mental Status Examination and Assessment
dr Ni Ketut Sri Diniari, SpKJ
AIMS:
Know mental status examination, and multiaxial diagnostic
LEARNING OUTCOME:
Can describe the:
1. Mental status examination
2. The diagnostic classification system used in psychiatry
3. Multiaksial diagnostic
CURRCIULUM CONTENS:
1. Mental status examination
2. Sign and symptom in mental status examination
3. The diagnostic classification system used in psychiatry
4. Multiaksial diagnostic
ABSTRACTS:
Establishing rapport and a good therapeutic alliance with patients is critical to both their
diagnosis and their treatment. The psychiatric assessment is different from a medical or
surgical assessment in that: (1).The history taking is often longer and is aimed at
understanding psychological poblems that develop in patients, each with a unique
background and social environment; (2). A mental status examination is performed; and (3).
The assessment can in itself therapeutic.
The mental status examination comprises the sum total of the physicians
observations of the patient at the time of the interview. Of note is that this examination can
change from hour to hour, whereas the patients history remains stable. The mental status
examination includes impressions of the patients general appearance, speech, mood,
affect, thought process, thought content, sensorium, cognition, impuls control, insight, and
judgment.. Even a mute or uncooperative patient reveals a large amount of clinical
information during the mental status examination.
A diagnosis is made by careful evaluation of the database, analysis of the
information, assessment of the risk factors, and development of a list of possibilities (the
differential diagnosis). There are two main categorical classification system diagnostic in
psychiatry: ICD-10 and DSM-IV. In Indonesia, we use PPDGJ-III (Pedoman Penggolongan
dan Diagnosis Gangguan Jiwa-III) that uses a referral from DSM-IV. DSM-IV uses a
multiaxial diagnostic with five axis. Axis I: includes all mental disorder that can be the focus
of clinical attention such as schizophrenia, major depression, etc. Axis II: personality
disorders and mental retardation. Axis III: physical disorders and other general medical
conditions. Axis IV: includes any social or environmental problems that contribute to the
mental condition. Axis V consists of a score from 0 to 100, obtained from a global
assessment of functioning (GAF) sale.
1. How to establishing raport ( therapeutic alliance)
2. The procedure of psyciatric interview and mental status examination
3. Sign and symptom in mental status examination
4. Able to make diagnostic multiaksial
18

SCENARIO
A 30-year-old married woman suffers from chronic low mood and lack of enjoyment of life.
She is highly dependent on her husband for practical and emotional support, although she
frequently flies into rages at him, feeling that he is cold and uncaring. She has had a series
of secretarial jobs which she begins enthusiastically, but soon comes to feel that her
employers are highly critical and belittling, whereupon she resigns. Her friendships are
limited to people with whom she can have very special, exclusive relationships. She deals
poorly with change or loss, which frequently triggers episodes of acute dysfunction. When a
friend is not sufficiently available to her, she feels betrayed and worthless, her mood
plummets, she becomes lethargic, has eating binges, and is unable to work or pursue her
usual routine for up to weeks at a time.
Learning task
a. Does the patient have a psychiatric disorders?
b. How severe is the illness?
c. What is the diagnosis?
d. What is the patient base line level of functioning?
e. What the environment, biological and psychological factors contribute to the
disorders?
SCENARIO 2
A 26-year-old man presented to the emergency department seeking a safe haven from the
mob. He was convinced that he was being set up to be killed, as evidenced by the
sequence of license plate numbers of the cars that had passed him on the way to work. He
had initially gone to a police station, which had referred him to the hospital.
Learning task
a. Please try to identifying the symptoms of the patient above!
b. How to make first oriented intervention as psychiatric interview in the patient
above?
c. How to make therapeutic alliance with the patient above?
Self Assessment
1. Can you explain the signs and symptoms of psychotic disorders?
2. Can you explain the signs and symptoms of depression disorder?
3. Can you explain the signs and symptoms of anxiety disorder?
4. If a patient listening to the sounds in the ear there are people who threatened
him, but other people do not hear, what is the name of this symptom?
5. What is put in the axis of the underlying psychosocial stressors problem of
mental disorder?
19
Modul
3
Psychological Testing
DR. Ni Made Swasti Wulanyani, S.Psi., M.Erg., Psi
AIMS:
To understand some of the fundamental principles underlying psychological testing
To understand types of psychological testing that patients needed
To acquaint with some of the important ethical issues relating to psychological testin.
LEARNING OUTCOMES:
Student will know how to describe:
1. the application of psychological testing
2. types of settings are assessments conducted
3. appropriate psychological testing for patients problems
1. Psychological testing definition
2. The function of psychological testing
3. Assessment Setting
4. Types of psychological testing
5. Standardization
6. Ethics to conduct and report
ABSTRACTS:
The purpose of this lecture is to give general knowledge about psychological testing that
could use to have complete information about human behavior. After learning this topic,
students could analyze the needed of psychological approach of patients and chose the
appropriate types of tests. Ethical issues also build understanding about the legal procedure
to conduct psychological test, so that the result will keep valid.
SELF DIRECTED LEARNING:
1. Psychological testing definition
2. The function of psychological testing
3. Assessment Setting
4. Types of psychological testing
5. Standardization
6. Ethics to conduct and report
SCENARIO:
An employee gets a promotion to a higher position in another unit in the company. A month
later, the employee becomes ill, showed decreased in performance and withdrawn from
social relationship
Learning Task: Please discuss!
1. Any psychological tests that can be given and the reason!
SCENARIO
A young boy has just become student in a Vocational High School (Sekolah Menengah
Kejuruan). At the end of the first semester, he got very bad marks, whereas he has shown
good academic achievement while attending junior high school (SMP) before. He was
frequently absent because of illness. No responses come from the parents although the
20

school has sent an invitation letter to discuss their sons problems. The boy is often
punished at school because of bullying his friends.
Learning Task
What is the likelihood that the child experienced?
What would you do?
SCENARIO
A child cannot write even though she is in 3rd grade of elementary school now. When she
was a toddler, she was not able to mimic the circle and other simple images.
Learning Task
Explain your suspicions to this case and what would you do?
SCENARIO
A unit at Educational institution, named Berjaya, provides psychological testing services
for many settings such as educational, business, counseling. Most of unit member are not
psychologists. Most of them are school counselor. They use computerized method for
scoring.
Learning Task
Explain your analysis about ethical issues that must be consider by the unit or institution
Self Assessments:
Explain each of the following terms:
1. assessment
2. Intelligence test
3. Diagnostic
4. accommodation
5. Test user
6. Test developer
7. Test taker
8. Standardized test
9. Confidentiality
10. Responsibility or psychological tester
21
Modul
4
Neurobehavioral approach to Behavior Disorders
Dr dr Anak Agung Ayu Putri Laksmidewi Sp.S(K)
AIMS:
Student will be expected to know and understand the neurological basis of behavior,
memory, and cognition, the impact of neurological damage and disease upon behavior
disorders.
LEARNING OUTCOMES:
Student will be able to describe:
1. How neurobehavior theories develop
2. Approaches to neurobehavior
3. Types of psychological phenomena in patients with brain disease
1. What is neurobehavior
2. Introduction Approaches to neurobehavior
3. Focal neurobehavioral syndromes
ABSTRACTS:
The nervous system is anatomically and functionally divided into central and peripheral
subsystems. The central nervous system (CNS) includes the brain and spinal cord, and
CNS dysfunction can be subdivided into two general categories, neurobehavioral and
motor/sensory. Neurobehavioral difficulties involve two primary categories: cognitive decline,
including memory problems and dementia; and neuropsychiatric disorders, including
neurasthenia (a collection of symptoms including difficulty concentrating, headache,
insomnia, and fatigue), depression, posttraumatic stress disorder (PTSD), and suicide.
Other CNS problems can be associated with motor difficulties, characterized by problems
such as weakness, tremors, involuntary movements, incoordination, and gait/walking
abnormalities. These are usually associated with subcortical or cerebellar system
dysfunction. The anatomic elements of the peripheral nervous system (PNS) include the
spinal rootlets that exit the spinal cord, the brachial and lumbar plexus, and the peripheral
nerves that innervate the muscles of the body. PNS dysfunctions, involving either the
somatic nerves or the autonomic system, are known as neuropathies.
Neurologic dysfunction can be further classified as either global or focal. For
example, in neurobehavioral disorders, global dysfunction can involve altered levels of
consciousness or agitated behavior, whereas focal changes give rise to isolated signs of
cortical dysfunction such as aphasia or apraxia.
SELF DIRECTED LEARNING:
Students need to explore more theories of neurobehavior:
1. Neurobehavior approach to behavior disorders
2. Research in neurobehavior
3. Laboratory investigation in neurobehavior
SCENARIO:
A 20 years old woman complains of behavior disorder. From herrelatives, this woman do not
want to communicate each other from 2 weeks ago. She also didnt want to take a bath, do
not want to eat and to make and interaction between her peer groups nor her realtives.
22

Regarding to her father, this patient often talk by her self, and often complain of hearing
voices that only heard by herself. No previous evidence of fever or head injury before the
onset of those features.
Learning task:
1. What is the properly list of question that need to be asked from the patient and her
relatives?
2. What is the etiology of this case in general?
3. Please explain the neurophatogenesis of this case!
Case 2:
A 52-year-old female is admitted to a medical ward with an acute exacerbation of Crohns
disease, requiring high-dose steroids and intensive emergency treatment. After a few days,
however, she accuses the nurses on the ward of stealing her money and believes that one
of the male nurses assaulted her during the night. However, once her steroids are stopped,
she starts to settle and no longer voices any bizarre ideations..
Learning task:
relatives?
2. What is the differential diagnosis of this patient?
3. Please explain the neurophatogenesis from each of the differential diagnosis that
has been mentioned above!
Case 3:
A 68-year-old male is admitted under the medical team for dehydration after refusing to eat
or drink. His wife reports that he has been preoccupied with the belief that he has a brain
tumour and has lost pleasure in everything. He has lost 12 kg in weight and spends most of
his day in bed. He reports that he can smell rotting bodies and believes that he has
committed a sinful crime because he has heard voices calling him a paedophile. He feels
ashamed of himself.
Learning task:
relatives?
2. What is the proper psychotherapy planned for this patient?
Case 4:
A 40 years old man comes to private service with difficulty to fall a sleep since 5 days ago.
He usually abruptly wake up on midnight while sleeping, hence he didnt feel well while
waking up on the following morning.
Learning task:
relatives?
2. What kind of questionnaire proper to be applied to assess type of sleeping disorder
in this patient?
23
Modul
5
Prenatal Psychobiology (Case of Baby Blues)
AIMS:
Describe the clinical management of baby blues (Anamnesis, History taking, Mental State
Examination, Diagnosis, and Therapy).
LEARNING OUTCOMES:
Describe how to:
1.
Anamnesis
2.
History taking
3.
Examine mental state
4.
Diagnosis
5.
Therapy (pharmacotherapy, psychotherapy)
1. Anamnesis
2. History taking (fundamental four and secret seven) of baby blues and postpartum
depression
3. Mental state examination of baby blues and postpartum depression
5. Modality of treatment of baby blues and postpartum depression
ABSTRACTS
Prenatal psychology is an interdisciplinary study of the foundations of health in body, mind,
emotions and in enduring response patterns to life. It explores the psychological and
psychophysiological effects and implications of the earliest experiences of the individual,
before birth ("prenatal"), as well as during and immediately after childbirth ("perinatal") on
the health and learning ability of the individual and on their relationships. As a broad field it
has developed a variety of curative and preventive interventions for the unborn, at childbirth,
for the newborn, infants and adults who are adversely affected by early prenatal and
perinatal dysfunction and trauma. Some of these methods have not been without significant
controversy, for example homebirth in the West and in earlier days, LSD psychotherapy for
resolving birth trauma.
The relevance of birth experiences has been recognized since the early days of
modern psychology. Although Sigmund Freud touched on the idea briefly before rejecting it
in favor of the Oedipus complex, one of his disciples Otto Rank became convinced of the
importance of birth trauma in causing anxiety neuroses. Rank developed a process of
psychoanalysis based on birth experiences, and authored his seminal work, 'The Trauma of
Birth'. Freud's initial agreement and then later volte-face caused a rift between them, which
relegated the study of birth trauma to the fringes of psychology. The transcendental and
human aspects of awareness documented from the beginning of life became the core
thread in this holonomic holographic model.
1. The procedure of interviewing the earliest experiences of the individual, before birth
("prenatal"), as well as during and immediately after childbirth ("perinatal").
2.
Formulating diagnosis for baby blues and postpartum depression.
3.
Management of baby blues and postpartum depression.
24

SCENARIO
Mary is a 32-year-old married nurse with a history of panic attacks that have been well
controlled for years. She presents 3 months postpartum, following a difficult pregnancy
complicated by severe hyperemesis gravidarum and dysphoria in addition to traumatic
delivery with a third-degree perineal tear. Mary now complains of crying spells, decreased
appetite, insomnia, and obsessive worry over the babys health. She feels isolated from her
husband, who is overwhelmed by her emotional needs and tends to retreat to work.
Learning Task:
1.
What are the diagnostic features of this patient?
2.
How long is the onset of illness on this kind of patient?
3.
What is the diagnosed according to DSM-V?
4.
Make a systematic screening for the risk factors in addition to current symptoms
5.
Explain the differential diagnosis of the above case?
6.
What therapy should be given?
7.
What is the difference between baby blues and postpartum depression?
8.
When reviewing the prognosis for people with baby blues, what kind of onset,
gender, and duration suggest a more favorable outcome?
9.
Discuss about the possibility when people like above case never get any treatment!
10.
Discuss about any prevention work that possible for the relapse of the above case!
Self-Assessment:
1.
Explain the understanding of reality testing for baby blues!
2.
Explain the difference between baby blues, postpartum depression with Postpartum
Psychosis!
3.
Explain one of the most widely used instruments to assess for postpartum
depressive symptomatology is the Edinburgh Postnatal Depression Scale (EPDS)!
4.
Read the book title The Secret Life of the Unborn Child.
5.
Fiind current research on Welcoming Consciousness
25
Modul
6
Behavior Changes Due to a General Medical Condition
dr. Yenni Kandarini, SpPD
AIMS:
Describe the clinical management of Behavior Changes Due to a General Medical Condition
(Anamnesis, History taking, Mental State Examination, Diagnosis, and Therapy).
LEARNING OUTCOMES:
Describe how to:
1.
Anamnesis
2.
History taking
3.
Examine mental state
4.
Diagnosis
5.
Therapy (pharmacotherapy, psychotherapy)
1. Anamnesis
2. History taking (fundamental four and secret seven) of Behavior Changes Due to a
General Medical Condition
3. Mental state examination of Behavior Changes Due to a General Medical Condition
5. Modality of treatment of Behavior Changes Due to a General Medical Condition
ABSTRACTS
Psychiatric disorders are frequently under- and overdiagnosed in the medically ill for a
number of reasons. First, psychiatric symptoms are similar to those of medical illness. As a
result, it may be problematic to determine whether such symptoms are manifestations of a
physical disease or a comorbid psychiatric disorder. For example, a false-positive diagnosis
of depression may occur when fatigue, anorexia, and weight loss caused by amedical
illness are mistakenly attributed to depression, and a false-negative diagnosis when
depressions vegetative symptoms are misattributed to the medical illness. A variety of
approaches have been proposed to diminish the effect of medical symptoms confounding
the diagnosis of depression. In an exclusive and etiologic approach, symptoms that are
judged by the clinician to be etiologically related to a general medical condition are excluded
from the diagnostic criteria for major depressive disorder (MDD). However, how to
determine which symptoms are due to a medical illness, and which are due to depression,
is
unclear. In a substitutive approach, symptoms most likely confused with medical illness,
such as fatigue and weight loss, are substituted with symptoms that are more likely to be
affective in origin, such as irritability and social withdrawal. Such substitution eliminates the
need to distinguish symptoms of medical illness from those of depression, but it also
excludes some somatic symptoms that are core manifestations of depression. Furthermore,
valid criteria to determine which symptoms should be substituted have not been
established. An inclusive approach applies the unmodified
1. The procedure of treatment to Behavior Changes Due to a General Medical
condition
2.
Formulating diagnosis for Behavior Changes Due to a General Medical
Condition.
26

3.
Management of Behavior Changes Due to a General Medical Condition.
27
Modul
7
Delirium and Dementia
dr. I Gusti Ayu Endah Arjana, Sp.KJ (K)
AIMS:
Describe the clinical management of delirium syndromes dementia (History, General
Medical and Neurologic Examination, Mental Status examination, Laboratory Studies,
Imaging, and Other Diagnostic Tests, Diagnostic criteria, Management)
LEARNING OUTCOMES:
Describe how to:
1.
Definition and Diagnostic Features
2.
Common Associated Features
3.
Predisposing Factors
4.
Selected Causes of Delirium and Dementia
5.
Management: general Principles (Behavioral Interventions, Pharmacologic
Interventions, physical restraints)
1.
History taking of delirium and dementia
2.
Physical examination of delirium and dementia
3.
Mental examination of delirium and dementia
4.
Investigation routine
5.
Management (four main principles of management)
ABSTRACTS
Delirium is characterized by acute generalized psychological dysfunction that usually
fluctuation in degree. Clinical features of delirium, prodromal symptoms include: perplexity,
agitation, hypersensitivity to light and sound.
A stereotyped response of the brain to a variety of insults is very commonly seen in
hospital inpatients. It is a clinical syndrome of fluctuating global cognitive impairment
associated with behavioural abnormalities. Like other acute organ failures it is more
common in those with chronic impairment of that organ.
The clinical management of delirium consists of how to make a proper diagnosis
through good anamnesis, physical and mental examination, aetiologi, management four
main principles.
Basic knowledge that must be know:
1.
The prosedure of delirium and dementia diagnosis
2.
Management of delirium and dementia
3.
Assessment of delirium and dementia.
SCENARIO
A 64-year-old woman admitted to the medical ward with an acute exacerbation of chronic
obstructive pulmonary disease. She lived alone following the death of her husband 3 years
earlier. Her normal medication was low-dose prednisolone, bronchodilators in inhalers,
antihypertensives and ranitidine which were all continued. She was hypoxic on admission
and treated with oxygen therapy. All her blood tests were normal apart from a raised Creactive protein. On the chest radiograph, there was a right basilar shadow and she was
started on ciprofloxacin for a presumed infection.
After 3 days, Mrs A became progressively depressed, inhibited and non-compliant with
therapy and routine interventions. She was assessed and referred to a psychiatrist for
28

depression impairing co-operation and compliance. On mental status examination she
appeared extremely inhibited and apathetic with decreased reaction to stimuli. She had a
reduced ability to maintain attention, shortterm memory impairment and mild perception
disturbances. There was a history of sleep/wake disturbance from the nursing notes.
According to her son, she had no cognitive problems before her admission.
Learning Task:
1. From the story above, what need to be asking to the patient?
2. Make the physical and mental examination of this patient.
4. What is the planning diagnosis, that you suggest?
5. What the treatment of this patient?
SCENARIO
A 73-year-old female presents with increasing confusion, lethargy, and disorientation. On
examination, she is obese and has a distinctive deep voice. Her pulse is 40 and blood
pressure is 110/72. She complains of constipation.
Learning Task:
SCENARIO
A 72-year-old male has been experiencing attacks of confusion, memory problems, and
visual hallucinations over the last year. Each episode lasts for a few weeks and he is fine
between these episodes; however, with subsequent episodes, his condition seems to be
getting worse. His medical history shows blood pressure of 150/101 and he has had
transient ischaemic attacks in the past. On examination there is an upgoing plantar.
Learning Task:
Self assessment;
1. How to do a good anamnesis in delirium and dementia cases?
2. How to do a good Mental and Physical examination?
3. What is the laboratory findings that need to be checked in delirium and dementia
cases.
4. What is the etiology of delirium and dementia cases in general.
5. What is management of delirium and dementia cases.
29
Modul
8
General Approaches to Substance Abuse
dr. Wayan Westa, SpKJ (K)
AIMS:
Emphasizing on understanding the effects of substance abuse on physical health,
mental, social
Understanding the follow-up of treatment of individuals with intoxication and withdrawal
LEARNING OUTCOMES:
1. Understand psychodynamic substance abuse problems
2. Understand the types of drugs in general
3. Understanding the symptoms of individuals with object withdrawal of drug poisoning
4. Understand the initial handling of the state of withdrawal, substance intoxication is
then able to make a referral
1. The definition of substance abuse, tolerance, dependence, craving
2. Understand the role of genetic, family roles, psycho-social stress associated with
substance abuse
3. Understanding of the symptoms of the individual in a state of withdrawal and
intoxication from drugs
4. Being able to make a diagnosis and early treatment and refer the individual to a
state of withdrawal or drug intoxication
ABSTRACTS
Drug abuse or Narcotics, Alcohol, Psychotropic and Other Addictive Substances today
continues to increase, and the alarming situation. Drug abuse is not only the case for those
who are classified as unemployed but has been extended to adolescents with status as
students, civil servants, officials, law enforcement and so on. This problem can not be
separated from the influence of globalization, information technology, and faster
transportation.
The flurry of parents, at least the time to pay attention, affection for the children, as
well as family life is not harmonious, promiscuity outside and easy to obtain substances /
drugs, especially narcotics would plunge the individual to a substance abuse problem and
continues to dependence. Once the individual involved substance abuse dependency
became very difficult to be normal again. The study says that only 10% of individuals
dependence can be restored to normal. In undergoing the process of this dependence
individual will feel the pain and suffering at the time of experience: the state of withdrawal,
intoxication, craving or they are undergoing legal proceedings and sent to prison. A general
practitioner should be able to provide aid / early treatment to individuals with a state of
withdrawal, drug toxicity and referring to the hospital. Besides general practitioners are
expected to provide outreach to the community about the dangers of drugs so that people
can avoid drug abuse.
Basic knowledge that must be know:
1. Understand psychodynamic substance abuse
2. Understand the types of drugs in general
3. Understanding the symptoms of the individual to the state of withdrawal, drug
substance intoxication
4. Handle the initial handling of state withdrawal of drug substance intoxication and was
able to make a referral
30

SCENARIO
A man aged 25 years unemployment driven by his friend to the hospital with complaints;
fever, snot and tears, pain throughout the body, the hair on the body seemed to stand, also
appears there is a pimple like the cold. This patient also complained of nausea and want to
vomit. On physical examination found blood pressure 130/80, rather rapid respiration, pulse
96x / min, body temperature 37,80C. Medriasis pupils, reflex + / +. In the interview the
patient obtained have been using substances / drugs, beginning with suction means further
by means of a syringe. Patients taking these substances last was two days ago.
LEARNING TASK
1. In the above situation is the patient? Explain!
2. The substance / drug if the patient used before?
3. Describe how the psychodynamic process so people above fall into substance
abuse and addiction / drug!
4. As a general practitioner, what treatment is given?
5. What are the dangers of injecting drug use?
6. What our efforts together so that drug abuse can be reduced?
SCENARIO 2
A man aged 40 years, a large body of high body tattooed, work as a guard caf. Came to
the hospital escorted by his friend and guarded by police, handcuffed her hands as it can go
berserk and fight with visitors caf. After soothed then conducted an interview, explaining
that drinking ALCOHOL patients have long done and once in a while to get drunk. In times
of strife and fighting in the caf, before he admitted taking ALCOHOL. Furthermore, he felt
himself strong, self-confidence increased, bold, look like smallish caf visitors so easily
defeated. When it peaked emotional, touchy, angry that a fight. Physical examination was
normal. Physical illness previously denied.
LEARNING TASK
1. Under no circumstances does the male cases mentioned above? Explain!
2. What are consumed by men of the above? Explain!
3. Individuals who are used to the routine of drinking MIRAS suddenly stop taking
MIRAS what happens? What was the symptoms?
4. What are the dangers of alcoholic liquor to the physical condition, or mental?
Explain!
5. There is argued that the use of alcoholic beverages (MIRAS) is more dangerous
than smoking heroin (heroin). Why? Explain!
6. As a general practitioner what actions and help you when dealing with cases of
alcohol withdrawal?
SELF ASSESSMENT
1. Explain what is included drug / drug!
2. Any Drug / Drug including stimulants and sedatives which euphoria?
3. Explain the notion of amphetamine psychosis, Delerium Tremens (DT's), Psychosis
Korchakoff!
4. Why is the use of injectable opiate more dangerous than the opiates suction?
5. The method of treatment in opiate withdrawal, how wide? Explain!
6. Individuals with an overdose of heroin what treatment? Explain!
31
Modul
9
Primary & Secondary Insomnia
dr. Luh Nyoman Alit Aryani, SpKJ
AIMS:
Describe the clinical management of Primary and Secondary Insomnia (Definition, Etiology,
Risk Factor, Diagnose and Management)
LEARNING OUTCOMES:
Describe how to:
1. Understand the Classification of sleep disorder
2. Explain the Symptoms and Signs of insomnia and hypersomnia
3. Asses the Diagnostic of insomnia and hypersomnia
4. Give treatment for sleep disorder
1.
Understand the Classification of sleep disorder
2.
Explain the Symptoms and Signs of insomnia and hypersomnia
3.
Asses the Diagnostic of insomnia and hypersomnia
4.
Give treatment for sleep disorder
ABSTRACTS
Sleep is a universal behavior that has been demonstrated in evey animal species study,
from insects to mamalia. An earlier theory of sleep was that the excitatory areas of the
upper brain stem, the reticular activating system, simply fatiqued during the waking day and
became inactive as a result. Circadian rhythms are biological process that occur repeatedly
on approximately a twenty-four-hour cycle. Lack of sleep can lead to the inability
concentration, memory complaints and deficit in neuropsychological testing. Although
several classification for sleep disorder exist, the Diagnostic and Statistical Manual of
Mental Disorder (DSM-IV) and the International Classification of Sleep Disorder, second
edition (ICSD 2) are the most widely used. The DSM IV-TR classification is complaint
based, it divides sleep disorders into primary and secondary sleep disorders based on
clinical diagnostic criteria and presumed etiology.
The definition of Primary Sleep Disorder as those not cause by another mental
disorder, a physical condition, or a substance but rather a caused by an abnormal sleep
wake mechanism and often by conditioning. DSM-IV-TR divides primary sleep disorders
into: Dyssomnias (disorders of quantity or timing of sleep) and Parasomnias (abnormal
behaviors during sleep or the transition between sleep and wakefulness). The primary
complaint of insomnia is difficulty in going to sleep. After a comprehensive history, the
patient receives a detailed physical examination. Once a diagnosis has been confirmed,
patients are offered approriate treatment (nonpharmacologic and pharmacologic).
1. The physiology of sleep
2. Classification of sleep disorder
3. Symptom and sign of insomnia and hypersomnia
4. Clinical diagnostic of insomnia and hypersomnia
5. Management of sleep disorder
32

SCENARIO
Case 1
A 45 years old man, single, had 5 year history of fatique and sleepiness in the daytime. He
started to sleep at 10.00 PM, and he woke up at 6.00 AM. He had oversleep almost every
day. After having lunch he would routinely fell a sleep at the computer. He was free from
mental or physical condition. When interviewd the patient was friendly, informative and self
assured. He denied depressed mood or loss of interest or pleasure. He was in good health
and jogged 4-5 miles daily. He lived with his wife and youngest son. He enjoyed socializing
with his families.
Learning Task 1:
1. What is the most likely diagnosis?
3. What is the therapy for the disorder?
Case 2
A 28 year old woman came to psychiatric clinic. She said that she was difficult to sleep for
2 months. It lead inability concentration and fatique in his working. The physical
examination was within normal limit.
Learning Task 2:
1. What are the differential diagnosis?
2. What are the other symptom and medical history we have to find to asses the
diagnostic?
3. What are the medications recommended for the patient?
4. What are the other treatment you recomend?
Case 3
A 27 years old woman was referred with symptoms of difficulty falling a sleep, shallow sleep
(easily wake up), dream a lot, early rise, fatique after waking up. When interviewing
psychiatric patients complain of a very sad, hopeless against the problems that it faces. This
complaint accompanied by loss of interest and fatigue, and has been going on for 2 months.
Free from physical condition and substance use.
Learning Task 3
1. What is the diagnosis of the disorder?
2. What are the baseline assesment must be done ?
3. What are the patients symptoms point preferentally to the diagnosis?
4. What are the medications recommended for the patient?
Self Assesment :
1. How to do a good anamnesa in sleep disoerder?
2. What is the classification of sleep disorder and how to get the differential diagnosis ?
3. What are the management of sleep disorder?
33
Modul
10
Schizophrenia & Other Psychosis
AIMS:
Describe the clinical management of Schizophrenia & Other Psychosis (Anamnesis, History
taking, Mental State Examination, Diagnosis, and Therapy).
LEARNING OUTCOMES:
Describe how to:
1. Anamnesis
2. History taking
3. Examine mental state
4. Diagnosis
5. Therapy (pharmacotherapy, psychotherapy)
1. Anamnesis
2. History taking (fundamental four and secret seven) of Schizophrenia & Other
Psychosis
3. Mental state examination of Schizophrenia & Other Psychosis
5. Modality of treatment of Schizophrenia & Other Psychosis
ABSTRACTS
Schizophrenia is a clinical syndrome of variable, but profoundly disruptive, psychopathology
that involves cognition, emotion, perception, and other aspects of behavior. The expression
of these manifestations varies across patients and over time, but the effect of the illness is
always severe and is usually long-lasting.
Schizophrenia is a leading worldwide public health problem that exacts enormous
personal and economic costs. Schizophrenia affects just less than 1 percent of the world's
population. If schizophrenia spectrum disorders are included in the prevalence estimates,
then the number of affected individuals increases to approximately 5 percent. The concept
of schizophrenia spectrum disorders is derived from observations of psychopathological
manifestations in the biological relatives of patients with schizophrenia. Diagnoses (and
approximate lifetime prevalence rates [percent of population]) for these disorders are
schizoid personality disorder (fractional percentage), schizotypal personality disorder (1 to 4
percent), schizoaffective psychosis (<1 percent), and delusional disorder (fractional
percentage). The relationship of these disorders to schizophrenia in the general population
is unclear, but in family pedigree studies, the presence of a proband with schizophrenia
significantly increases the prevalence of these disorders among biological relatives.
Cognitive impairments and primary negative symptoms are largely responsible for
the poor functional outcome and low quality of life of most persons with schizophrenia. Will
new molecular targets result in the first efficacious treatments for these illness components?
What knowledge of etiopathophysiology is required to discover primary and secondary
prevention interventions? Will the multiple genes involved in risk so overlap with affective
and other disorders that current classification of diseases will be invalidated? Will the many
common and small contributors to risk and the many and varied pathophysiological results
require a new disease paradigm? The complexity of this most distinctively human disease
syndrome, however, assures that the conquest of schizophrenia will be one of medicine's
most difficult challenges.
34

1. The procedure of interviewing Schizophrenia & Other Psychosis
2. Formulating diagnosis for Schizophrenia & Other Psychosis
3. Management of Schizophrenia & Other Psychosis
SCENARIO
A 30-year-old female is brought to hospital as she has been violent and hostile to her
neighbours. According to the patient, her grandfather was a successful writer and she
acquired his fortunes recently. However, she believes that her neighbours have found out
about it and claims that she has heard them talking about stealing her money.
Learning Task:
1. What are the diagnostic features of this patient?
2. How long is the onset of illness on this kind of patient?
3. What is the diagnosed according to DSM V?
4. Explain the differential diagnosis of the above case?
5. What therapy should be given?
6. What is the difference between positive and negative symptoms of schizophrenia?
7. When reviewing the prognosis for people with schizophrenia, what kind of onset,
gender, and duration suggest a more favorable outcome?
8. Discuss about the possibility when people like above case never get any treatment!
9. Discuss about any prevention work that possible for the relapse of the above case!
SCENARIO 2
An 18-year-old male is brought to hospital by his parents because they have noticed that he
has been acting strangely recently. His parents say that the patient has just lost it since
failing his final examinations. The patient was noted to be giggling to himself, spending
almost all his time in his room, and making unusual gestures with his hands. In addition, his
speech has been incomprehensible and his parents cannot make any sense of it.
Learning Task:
1. What are the diagnostic features of this patient?
2. In relation to personality development what would be the cause for the occurrence of
this disorder?
3. What is the diagnosed according to DSM-IV TR?
4. Explain the differential diagnosis of the above case?
5. What therapy should be given?
6. Discuss about the possibility when people like above case never get any treatment!
7. Discuss about any prevention work that possible for the relapse of the above case!
Self-Assessment:
1. What is the definition of suspicion, hallucinations, raptus, and abulia?
2. Explain the understanding of reality testing for psychosis!
3. Explain the difference between schizophrenia with organic mental disorders!
4. Explain the terms flat affect, inappropriate, inadequate!
5. Explain about developmental model of schizophrenia
6. Explain about early detection and intervention for schizophrenia
35
Modul
11
Delusional & Schizoafective Disorders
dr. Ni Ketut Sri Diniari, SpKJ
AIMS:
Describe Delusional disorder and schizoafective disorder, and its management.
LEARNING OUTCOME:
Can describe the:
1. Interview, mental status examination, diagnostic, and management delusional
disorder.
2. Interview, mental status examination, diagnostic, and management schizoafective
disorder.
CURRCIULUM CONTENS:
1. Psychiatric interview and mental status examination
2. Diagnostic in PPDGJ-III, ICD-X and DSM-5
3. Management of Delusional disorder and schizoafektif disorder
ABSTRACTS:
The DSM-5 criteria, delutional disorder and Schizoafectif disorder are a part of
schizophrenia spectrum and other psychotic disorders. Delutional disorder is made when a
person exhibits nonbizarre delutions of the last 1 months duration that cannot be attributed
to other psychiatric disorders. They usually have to do with phenomena that, although not
real, are nonetheless possible. Treatment use of antipsychotic, and individual supportive
psychotherapy as well as family therapy.
Schizoafectif disorder has feature of both schizophrenia and mood disorders. An
uninterrupted period of illness during which there is a mayor mood episode (major
depressive or manic) concurrent with criterion A of schizophrenia. There are two type i.e:
Schizoafectif disorder, Bipolar type and Schizoafectif disorder, Depressive type. Treatment
are included combination antipsychotic with mood stabilizer, and psychosocial treatment
(family terapy, social skill training, cogitive rehabilitation).
1. Able to make diagnostic and management Delusional disorder
2. Able to make diagnostic and management schizoafective disorder
SCENARIO
A 23-year-old male believes that his life and the world are coming to an end after having lost
his job. He has stopped looking after himself and has not eaten in 3 days as he believes
that his body organs are decaying.
Learning task
2. What are sign/ symptom dominant in this case?
4. How to management this disorder?
SCENARIO
A 26-year-old female has been living on the streets for the last week because she knows
that a famous actor is planning a vendetta to kill her. She feels unsafe wherever she goes
as she feels that she is constantly under threats of an attack.
36
Learning task
1. What is the most likely diagnosis for this patient?
Scenario
A 27-year-old male with no previous psychiatric history is brought to hospital by his family.
His parents noticed that he has been high for the last few months, and that his behaviour
has become increasingly erratic. He was also noted to have strange beliefs, such as the
world being flat and the government trying to prevent this fact from being disclosed. He
even stated that he has a radio-transmitting device implanted in his head which allowed him
to pick up the signals sent from space. His elated mood and strange beliefs continued for a
year.
Learning task
Self Assessment
1. How to diagnose delusional and schizoaffective disorder?
2. How the characteristics of delusion in delusional and schizoaffective disorders?
3. How to distinguish delusions in schizophrenia and delusional disorders?
4. How to diagnoses schizoafective disorder?
5. what is the differences between schizoafective disorder with bipolar disorder?
6. what the management delutional disorder?
7. what the management schizoafective disorder?
37
Modul
12
Bipolar Disorders
dr Lely Setyawati, SpKJ (K)
AIMS:
Describe Bipolar Disorder and the clinical management of bipolar disorders
LEARNING OUTCOMES:
Describe how to:
1. Symptom and Sign of Bipolar disorders
2. Psychodinamic of Bipolar disorders
3. Diagnosis of Bipolar disorders
4. Therapy of Bipolar disorders
1. History taking of Bipolar disorders
2. Observation and psychiatric interview of Bipolar disorders
3. Modality of treatment of Bipolar disorders
ABSTRACTS
The field of psychiatry has considered Major Depression and Bipolar Disorder to be two
separate disorders, particularly in the last 20 years. The possibility that Bipolar Disorder is
actually a more severe expression of major depression has been reconsidered recently,
however. Many patients given a diagnosis of a Major Depressive Disorder reveal, on careful
examination, past episodes of manic or hypomanic behavior that have gone undetected.
Many authorities see considerable continuity between recurrent depressive and bipolar
disorders. This has led to widespread discussion and debate about the bipolar spectrum,
which incorporates classic bipolar disorder, bipolar II, and recurrent depressions.
The Old Testament story of King Saul describes a depressive syndrome, as does the
story of Ajax's suicide in Homer's Iliad. About 400 BC, Hippocrates used the terms mania
and melancholia to describe mental disturbances. Mood is a pervasive and sustained
feeling tone that is experienced internally and that influences a person's behavior and
perception of the world. Affect is the external expression of mood. Mood can be normal,
elevated, or depressed. Healthy persons experience a wide range of moods and have an
equally large repertoire of affective expressions; they feel in control of their moods and
affects.
Mood disorders are a group of clinical conditions characterized by a loss of that
sense of control and a subjective experience of great distress. Patients with elevated mood
demonstrate expansiveness, flight of ideas, decreased sleep, and grandiose ideas. Patients
with depressed mood experience a loss of energy and interest, feelings of guilt, difficulty in
concentrating, loss of appetite, and thoughts of death or suicide. Other signs and symptoms
of mood disorders include change in activity level, cognitive abilities, speech, and vegetative
functions (e.g., sleep, appetite, sexual activity, and other biological rhythms). These
disorders virtually always result in impaired interpersonal, social, and occupational
functioning.
Patients afflicted with only major depressive episodes are said to have major
depressive disorder or unipolar depression. Patients with both manic and depressive
episodes or patients with manic episodes alone are said to have bipolar disorder. The terms
unipolar mania and pure mania are sometimes used for patients who are bipolar, but who
do not have depressive episodes.
Three additional categories of mood disorders are hypomania, cyclothymia, and
dysthymia. Hypomania is an episode of manic symptoms that does not meet the full text
revision of the fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-
38

IV-TR) criteria for manic episode. Cyclothymia and dysthymia are defined by DSM-IV-TR as
disorders that represent less severe forms of bipolar disorder and major depression,
respectively.
According to DSM-IV-TR, a major depressive disorder occurs without a history of a
manic, mixed, or hypomanic episode. A major depressive episode must last at least 2
weeks, and typically a person with a diagnosis of a major depressive episode also
experiences at least four symptoms from a list that includes changes in appetite and weight,
changes in sleep and activity,
lack of energy, feelings of guilt, problems thinking and making decisions, and recurring
thoughts of death or suicide.
1. The procedure of interviewing bipolar disorders
2. Formulating diagnosis for bipolar disorders
3. Management of bipolar disorders
SCENARIO
A 25-year-old male is taken to hospital by the police as he was found screaming on the
streets. He had been trying to light himself with a lighter, claiming that he was invincible and
had the power to fix all evil in the world. His speech was highly pressured and he complains
that his thoughts are going out of control. According to hospital records, he had been
admitted to hospital three times in the last year for similar episodes..
Learning task:
2. What is the most likely etiology?
3. What is the baseline assesment must be done?
4. What is the patients symptoms point preferentally to the diagnosis?
5. What is the first line medications recommended for the patient?
6. What are the other symptoms of bipolar disorder depressive type?
7. Why is Isabel diagnosed as having bipolar I instead of bipolar II disorder?
SCENARIO
A 28-year-old female presents to the clinic complaining of low mood. She describes her
mood as depressing and is unable to do anything. Because of her low mood, she has not
eaten for 3 days. She mentions that a year ago, she was feeling on top of the world and
went through periods when she did not have to sleep. On that occasion, she was admitted
to hospital because her parents thought that she was going out of control.
Learning task
Self Assessment:
1.
Please describe Depressive Disorder according to ICD-10/PPDGJ-3.
2.
What are the diagnosis differential of MDD? Please describe each of them.
3.
Is there any relationship between Bipolar Disorder and Suicide?
4.
What is the different between Bipolar I disorder and Bipolar II disorder
5.
Individuals with major mood disorders are at an increased risk of having one or more
additional comorbid Axis I disorders. Please describe the comorbidity of Bipolar
Disorder.
39
Modul
13
Panic Disorders
AIMS:
Describe Panic Disorder and the clinical management of panic disorders
LEARNING OUTCOMES:
Describe how to:
1. Symptom and Sign of panic disorders
2. Psychodinamic of panic disorders
3. Diagnosis of panic disorders
4. Therapy of panic disorders
1. History taking of panic disorders
2. Observation and psychiatric interview of panic disorders
3. Modality of treatment of panic disorders
ABSTRACTS
The essential feature are recurrent attacks of severe anxiety which are not restricted to any
particular situation or set of circumstances, and which are therefore unpredictable. As in
other anxiety disorders, the dominant symptoms vary from person to person, but sudden
onset of palpitations, chest pain, choking sensations, dizziness, and feelings of unreality
(depersonalization or derealization ) are common. There is also, almost invariably, a
secondary fear of dying, losing control, or going mad.
1. The procedure of interviewing panic disorders
2. Formulating diagnosis for panic disorders
3. Management of panic disorders
SCENARIO
Mrs K was a 35 year-old woman who initially presented for treatment at yhe medical
emergency department at a large university- based medical center. She reported that while
sitting at her desk at her job, she had suddenly experienced difficulty breathing, dizziness,
tachycardia, shakiness, and felling of terror that she was going to die of a heart attack. A
colleague drove her to the emergency department, where she received a full medical
evaluation, including ECG and routine blood work, which revealed no sign of cardiovascular,
pulmonary and other illness. She was subsequently referred for pshychiatric evaluation,
where she revealed that she had experienced two additional episodes over the past month,
once when driving from work and once when eating breakfast. However she had no
presented for medical treatment because the symptoms had resolved relatively quickly each
time, and she worried that if she went to the hospital without ongoing symptoms, people
would think Im crazy. Mrs K reluctantly took the phone number of local psychiatrist but did
not call until she experienced a fourth episode of a similar nature.
Learning Task
1. What should the doctor do for the first time towards the patient?
2. Explain the sign and symptoms of the above patient!
3. What is the multiaxial diagonosis?
40

4. How is the holistic treatment for the patient above?
Self Assessment
1. First time checking out a case of panic disorder, what therapeutic atmosphere should be
given to the patient?.
2. Explain on making good environment for patient recovery!
3. Explain the basic personality for patient with panic disorders!
4. Explain the role of neurotransmitter in panic disorder!
5. Antianxiety often lead to dependency, as a doctor what is your wise opinion in using this
medication?
6. Explain the psychodynamic of panic disorder!
41
Modul
14
Somatoform Disorders
AIMS:
Describe the brief history, general phenomenology, general etiologies and treatment
principal of somatoform disorders (Anamnesis, History taking, Mental State Examination,
Diagnosis, and Therapy).
LEARNING OUTCOMES:
Describe how to:
1. Anamnesis
2. History taking
4. Diagnosis
1. Anamnesis
2. History taking (fundamental four and secret seven) of somatoform disorders
3. Mental state examination of somatoform disorders
5. Modality of treatment of somatoform disorders
ABSTRACTS
There are seven somatoform disorders in the revised fourth edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV-TR), two of which are subsyndromal or
nonspecific disorders. This nosology overlaps with the tenth edition of the International
Statistical Classification of Diseases and Related Health Problems (ICD-10) classification,
yet there are important differences that are apparent from the criteria. The DSM-IV-TR has
conversion disorder and body dysmorphic disorder in its classification, whereas the ICD-10
does not, but instead specifies somatoform autonomic dysfunction and other somatoform
disorders.
Characteristic of somatoform disorders are three enduring clinical features: (1)
somatic complaints that suggest major medical maladies yet have no associated serious
and demonstrable peripheral organs disorder, (2) psychological factors and conflicts that
seem important in initiating, exacerbating, and maintaining the disturbances; and (3)
symptoms or magnified health corncerns that are not under the patients conscious
control.and laboratory
Because of their intense bodily perceptions, restricted level of physical functioning,
and morbid beliefs, these patients have become convinced they harbor serious physical
problem. Moreover, their symptoms are not willfully controlled. Whatever their faults and
problems, these patients are not malingerers. Yet their physicians physical imfirmity other
than the patients vigorous and sincere complaints. Patients with somatoform disorder are
convinced that their suffering comes from some type of presumably undetected and
untreated bodily derangement.
1. The psychological conflict in somatoform disorders
2. Formulating diagnosis for somatoform disorders
42

3. Management of somatoform disorders
4. Basic personality in somatoform disorders
SCENARIO
Mrs A, 38 year-old had complained of nervourness since childhood. She also said she was
sickly since her youth, with a succession of physical problems that doctor often indicated
were caused by her nerves or depression. She however, believed that she had a physical
problem that had not yet been uncovered by the doctors. Besides nervousness, she had
chest pain and had been told by variety of medical consultants that she had a nervous
heart. She also consulted doctors for abdominal pain and had been told she has a spstic
colon. She had seen chiropractors and osteopaths for backaches, for pains in extremities,
and for anesthesia of her finger tips.
Three months previously, she was vomiting and had chest pain and abdominal pain,
and she was admitted to a hospital for hysterectomy. Since the hysterectomy, she had had
repeated anxiety attack, fainting spells that she claimed were associated with
unconsciousness, vomiting, food intolerance, weakness, and fatique. She had been
hospitalized several times for medical workups for vomiting, colitis, vomiting of blood, and
chest pain. She had had a surgical procedure for an abscess of the throat. She said she felt
depressed but thougth that it was all because her hormones were not straightened out.
She was still looking for medical explanation for her physical and physchological problems.
Learning Task
Self Assessmant
1. How to distinguish somatization disorder with hipochondriac?
2. What is the primary choice for the treatment of somatoform disorders? please explain!
3. Explain the psychodynamic of somatoform disorder
4. Explain the differential diagnosis of somatoform disorder
43
Modul
15
Generalized Anxiety & Obsessive Compulsive Disorder
dr. Ni Ketut Putri Ariani, SpKJ
AIMS:
Describe the clinical management of generalized anxiety & obsessive compulsive disorders
(Anamnesis, History taking, Mental State Examination, Diagnosis, and Therapy)
LEARNING OUTCOMES:
Describe how to:
1. Anamnesis
2. History taking
4. Diagnosis
1. Anamnesis
2. History taking (fundamental four and secret seven) of generalized anxiety &
obsessive compulsive disorders
3. Mental state examination of generalized anxiety & obsessive compulsive disorders
5. Modality of treatment of generalized anxiety & obsessive compulsive disorders
ABSTRACTS
Anxiety disorders, in general, are the most common form of mental illness in the USA.
Generalized Anxiety Disorders (GAD) is one of the most common anxiety disorders, with a
lifetime prevalence of 5.1% in the adult US population. GAD typically occurs before the age
of 40, runs a chronic, fluctuating course, and affects women twice as often as men. Despite
historic controversy to the contrary, numerous studies have demonstrated that GAD is a
distinct illness, which occurs at a significant rate with serious consequences. Additionally,
GAD has been found to confer disability at approximately the same level as depression and
other chronic medical illnesses.
Pharmacological, cognitive-behavioral, and psychodynamic approaches have all
proved useful in combating GAD. Most of patients should expect substantial relief from their
symptoms in a relatively brief period. Hence, clinicians in psychiatry and other specialties
must make the proper GAD diagnosis rapidly and initiate treatment.
GAD-associated genetic factors are completely shared with depression, while
environmental determinants seem to be distinct. This notion is consistent with recent models
of emotional disorders that view anxiety and mood disorders as sharing common
vulnerabilities but differing on dimensions including, for instance, focus of attention or
psychosocial liability.
1. The procedure of interviewing generalized anxiety & mixed anxiety-depression
disorders
2. Formulating diagnosis for generalized anxiety & mixed anxiety-depression disorders
3. Management of generalized anxiety & mixed anxiety-depression disorders
44

SCENARIO
A 32-year-old single mother of two children is seeking professional help for her longstanding feelings of anxiety. Despite the fact that her life is relatively stable in terms of
financial and interpersonal matters, she worries most of the time that she will develop
financial problems, that her children will become ill, and that the political situation in the
country will make life for her and he children more difficult. Although she tries to dismiss
these concerns as excessive, she finds it virtually impossible to control her worrying. Most of
the time, she feels uncomfortable and tense, and sometimes her tension become so
extreme that she begins to tremble and sweat. She finds it difficult to sleep at night. During
the day she is restless, keyed up, and tense. She has consulted a variety of medical
specialist, each of whom has been unable to diagnose a physical problem.
Learning task:
1. What is the diagnosis of the presenting case?
2. How is the case of formulation?
3. What is the treatment plan?
4. What is the outcome or prognosis of the case?
SCENARIO 2
A 42-year-old seller woman, often complain of headache since last month. She also often
feels nausea and appetite-less. She had consulted to a doctor many times who finally
suggest her to visit a psychiatrist. She feels sad because her husband was hospitalized by
stroke disease and she has financial problem. She worried that her husband will not
recovery, and cannot pay for her childrens school. She feels uncomfortable and tense.
Leaning task:
Self assessment
1. What are the diagnostic features of GAD?
2. What are the diagnostic features of mixed anxiety-depression disorders?
3. Explain the treatment principles in GAD
4. Explain the treatment principle in mixed anxiety-depression disorders
5. Explain about the biopsychosocial aspects of GAD
6. Explain about the biopsychosocial aspects of mixed anxiety-depression disorders
ABSTRACTS
Obsessions and compulsions are the essential features of OCD. An individual must exhibit
either obsessions or compulsions to meet DSM-IV-TR criteria. DSM-IV-TR recognizes
obsessions as persistent ideas, thoughts, impulses, or images that are experienced as
intrusive and inappropriate, causing distress. Obsessions provoke anxiety, which accounts
for the categorization of OCD as an anxiety disorder. However, they must be differentiated
from excessive worries about real-life problems and associated with efforts to either ignore
or suppress the obsessions. Typical obsessions associated with OCD include thoughts
about contamination (my hands are dirty) or doubts (I forgot to turn off the stove).
Obsessions and compulsions must cause an individual marked distress, consume at
least 1 hour per day, or interfere with functioning to be considered above the diagnostic
threshold. During at least some point in the illness, adult patients must recognize symptoms
of OCD as unreasonable, although there is great variability in the degree to which this is
true, both across individuals and in a given individual over time. For example, early in the
45

course of the disorder, patients may recognize their hand washing as excessive or irrational,
but, over a number of years, this recognition may no longer exist.
The clinical management of Trichotillomania and Obsessive Compulsive Disorders
Consist of how to make a proper diagnosis through good anamnesis, physical examination,
psychometric examination and give the patient proper treatment with medical and
psychotherapy modality.
1. The procedure of Trichotillomania and Obsessive Compulsive Disorders Diagnosis
2. Management of Trichotillomania and Obsessive Compulsive Disorders
3. Psychometric Examination of Trichotillomania and Obsessive Compulsive Disorders
SCENARIO
A 13 year old girl came to psychiatric clinic accompanied by her mother with main complain
repetitive hair pulling that result in significant hair loss. There is an increasing level of
tension immediately before hair pulling. There is a sensation of pleasure during hair pulling
the pulling is not explained by a general medical condition or other mental disorder.
Significant distress of in social occupational or other areas of functioning is as a result of the
pulling. Physical examination is a normal.
Learning Task
2. Please explain the psychodynamic from this case!
4. What is the planning diagnosis that you suggest?
5. What treatment you give please explain it?
SCENARIO 2:
A 6-year-old male complains of feeling sick with stomach ache during school days and
refuses to go to school. He cries if his mother attempts to leave him under any
circumstance. He finds it difficult to go to bed without his mother being by his side and
frequently gets up at night to check on her. When questioned about this, he says that he is
worried that something terrible will happen to her and that he will never see her again.
These symptoms have developed since his parents divorced 6 months ago.
Learning Task
2. Please explain the psychodynamic for this patient!
4. What is the planning diagnosis that you suggest?
5. What is the planning treatment that you give?
Self Assessment
1. How to do a good anamnesis in Obsessive-Compulsive Disorders case?
2. What is the psychometric test you make to the patient?
3. Explain the etiology of Obsessive-Compulsive Disorders!
4. Is the Obsessive-Compulsive Disorders ego dystonic? Please explain!
46
Modul
16
Post Traumatic Stress Disorder (PTSD)
AIMS:
Describe the clinical management of PTSD (Anamnesis, History taking, Mental State
Examination, Diagnosis, and Therapy)
LEARNING OUTCOMES:
Describe how to:
1. Anamnesis
2. History taking
4. Diagnosis
1. Anamnesis
2. History taking (fundamental four and secret seven) of PTSD
3. Mental state examination PTSD
5. Modality of treatment of PTSD
ABSTRACTS
Posttraumatic stress disorder is classified as an anxiety disorder in the DSM IV; the
characteristic symptoms are not present before exposure to the violently traumatic event. In
the typical case, the individual with PTSD persistently avoids all thoughts and emotions, and
discussion of the stressor event and may experience amnesia for it. However, the event is
commonly relived by the individual through intrusive, recurrent recollections, flashbacks,
and nightmares. The characteristic symptoms are considered acute if lasting less than three
months, and chronic if persisting three months or more, and with delayed onset if the
symptoms first occur after six months or some years later. PTSD is distinct from the briefer
acute stress disorder, and can cause clinical impairment in significant areas of functioning.
In PTSD, the individual develops symptoms in three domains: reexperiencing the
trauma, avoiding stimuli associated with the trauma, and experiencing symptoms of
increased autonomic arousal, such as an enhanced startle. Flashbacks, in which the
individual may act and feel as if the trauma were recurring, represent the classic form of
reexperiencing. Other forms of reexperiencing include distressing recollections or dreams
and either physiological or psychological stress reactions when exposed to stimuli that are
linked to the trauma. An individual must exhibit at least one reexperiencing symptom to
meet criteria for PTSD. Symptoms of avoidance associated with PTSD include efforts to
avoid thoughts or activities related to the trauma, anhedonia, reduced capacity to remember
events related to the trauma, blunted affect, feelings of detachment or derealization, and a
sense of a foreshortened future. An individual must exhibit at least three such symptoms.
Symptoms of increased arousal include insomnia, irritability, hypervigilance, and
exaggerated startle. An individual must exhibit at least two such symptoms.
Because individuals often exhibit complex biological and behavioral responses to
extreme trauma, the clinician must identify other medical and psychiatric conditions in the
traumatized patient. The clinician must always evaluate whether neurological etiologies
underlie trauma-related symptoms, particularly after traumatic events that involve physical
47

injury. Traumatized patients also can develop mood disorders, including dysthymia and
major depression, as well as other anxiety disorders, such as generalized anxiety disorder
or panic disorder, and substance use disorders. Finally, recent research suggests that some
psychiatric features of posttraumatic syndromes can relate to a patient's state before the
trauma. For example, patients with premorbid anxiety or affective syndromes may be more
likely to develop posttraumatic symptoms than individuals who are free of mental illness
before the trauma. As a result, the clinician should consider the premorbid mental state of
the traumatized.
1. The procedure of PTSD
2. Management of PTSD
3. Psychometric Examination of PTSD
SCENARIO
Mr. F. sought treatment for symptoms that he developed in the wake of an automobile
accident that had occurred approximately 6 weeks before his psychiatric evaluation. While
driving to work on a mid-January morning, Mr. F. lost control of his car on an icy road. His
car swerved out of control into oncoming traffic, collided with another car, and then hit a
nearby pedestrian. Mr. F. was trapped in his car for 3 hours while rescue workers cut
through the car door. After referral, Mr. F. reported frequent intrusive thoughts about the
accident, including nightmares of the event and recurrent intrusive visions of his car
slamming into the pedestrian. He reported that he had altered his driving route to work to
avoid the scene of the accident and that he found himself switching the TV channel
whenever a commercial for snow tires appeared. Mr. F. described frequent difficulty falling
asleep, poor concentration, and an increased focus on his environment, particularly when
he was driving.
Leaning task:
SCENARIO 2:
Trevor was sexually abused as a child by a family relative. Although he was about to get
married and had thoughts about planning a family, he still felt haunted by childhood events.
He was worried that the events from his past would affect his ability to bond with his children
and affect their relationship.
Leaning task:
SCENARIO 3:
Max is a boy nearly four years of age who lived with his family in Battery Park City, across
the street from the World Trade Center. Prior to 9/11, he had already experienced numerous
traumatic events including surgeries for a chronic condition and hospitalization for a minor
burn. In December 2001 Max saw his pediatrician for the first time in several months and
presented with vomiting and poor appetite. Max had an overall positive score on PSC-17
and a positive score for internalizing problems. Since 9/11, Max has reverted to wearing
48

diapers at night, wearing his shoes all the time, has become increasingly introverted and
stopped wanting to go to school, although he enjoyed going to school in the past. Over time,
pediatric visits grew more frequent as Max continued to experience stomachaches and
difficulty breathing despite normal physical exams.
Learning task:
1. What is the role of family in this case?
2. What is the role of primary care physician in this case?
3. How do you formulate the intervention? Do you need to referall the patient?
4. What is the prognosis of this patient?
Self assessment
1. What are the diagnostic features of PTSD?
2. Explain the treatment principles in PTSD
3. Explain about the biopsychosocial aspects of PTSD
4. Explain the epidemiology of PTSD
5. Explain the differential diagnosis of PTSD
49
Modul
17
Sexual Disorders
AIMS
Emphasizing on the understanding of sexual perversion relation to physical and mental
health
Understanding the follow-up of sexual perversion good behavior of the offender and
victim
LEARNING OUT COMES
1. Understand the notion of sexual deviance
2. Understand the psychodynamics of sexual deviation
3. Understand the types of sexual deviance
4. Understanding of the bad influence of sexual deviation, both physically and mentally
on the victim
5. Understand the initial handling of the victim and the offender is then able to make a
referral
CURRICULUM CONTENTS
1. Understand the definition of sexual deviance
2. Understand the role of genetics, upbringing of parents and psychosocial status were
associated with the occurrence of sexual deviance
3. Understand the influence of bad behavior on the victim's sexual deviation, both
physically and mentally
4. Being able to make a diagnosis of sexual deviations
5. Able to provide initial treatment to the perpetrator and the victim then make referrals
ABSTRACT
Cases of sexual deviation tendency of the number continues to rise. This problem can not
be separated from the role of print media or television broadcast the news. Sexual deviance
is a condition that deviate in the direction and sexual style. Sexual normal when an adult
male sexual desire in a partner of the opposite sex peers. One example of sexual
perversion an adult male sexual arousal to children only. Incidence of sexual deviance is not
independent of the genetic role parenting parents during child development from birth
through adolescence. Babies born has been equipped with instinct. Sexual instinct called
libido associated with pleasure, at the beginning of enjoyment of the lips / mouth so the
baby feel good when sucking the breast and nipple (oral phase), then taste the pleasure of
moving into the rectum (anal phase), new last focused in genital organs (phase phallic).
When parenting parents, especially the mother goes well then psychosexual development
can work well. However, if the phase of sexual development have problems, then comes the
sexual perversion in adulthood.
1. Understand the notion of sexual deviance or paraphilia
2. Understand the psychodynamics and sexual deviation
3. Understand the types of sexual deviance
4. Understand the characteristics of the individual potential to become a pedophile
5. Understand the bad influence, both physically and mentally on victims of pedophile
behavior
6. Able to perform initial therapy and refer victims
50

SCENARIO
A man aged 50 years foreign nationals were on vacation in Bali staying at one of the hotels
in Kuta. He often tours to Bali east in town Amlapura, sightings are very polite and generous
attitude and love children so quickly accepted by the public. Children gathered to play given
gifts of clothes, money, etc. But the uproar ensued because one of the kids that show
strange behavior such as moody, did not venture out. After being asked by the child's
parents that she had to serve the sexual appetite through the rectum (sodomy) by these
men.
Learning Task
1. Sexual Deviations what happened to these men?
2. Explain the psychodynamics of pedophilia!
3. What are the adverse effects of physical and mental side of the victim?
4. What is the initial treatment can be given to victims of the above? What to do next?
5. Efforts to what can be done by the people and government so that such cases can be
reduced or eliminated?
SCENARIO 2:
A man 30 years old unmarried farmer discovered by his neighbors were having sexual
intercourse with his pet calf. The incident was reported to the village headman. Finally the
meeting was to resolve this problem.
Learning Task
1. What is the diagnosis conclusion of the above behaviors?
2. Explain the instinct theory of progress toward normal sexual libido!
3. What do we know of the Oedipus phase - Complex?
4. Explain the notion of: voyeurism, transexualisme, fetishism!
5. The above case is a sexual perversion, do you think another diagnosis?
Self Assesment
1. Describe examples of sexual perversion!
2. Sexual Deviations which adversely affect the heaviest?
3. What do you know about GUY and LESBIAN?
4. What is a homosexual sintonik ego and ego-dystonic homosexuality?
5. In your opinion, how do the case of sexual deviance is not increasing in number?
Explain
51
Modul
18
Psycho-Pharmacology
dr. I Gusti Ayu Artini, M.Sc
AIMS:
1. Describe the rationale drugs can be used for anxiety, insomnia, depression and
Psychotic disorders.
2. Describe the pharmacokinetic and pharmacodynamic aspect of drugs used for
Psychiatric disorders.
LEARNING OUTCOMES:
Describe how:
1. The pharmacokinetic and pharmacodynamic aspect of drugs used for psychiatric
disorders including sedative-hypnotic, antidepresssant, and antipsychotic drugs.
2. To apply the basic concepts and principles of drugs used for insomniaExamine
mental state
1. The pharmacokinetic and pharmacodynamic aspect of sedative-hypnotic drugs
a. Benzodiazepines
b. Barbiturates
c. Misellaneous agents
2. The pharmacokinetic and pharmacodynamic aspect of antidepressant drugs
a. Tricyclic antidepressant
b. Heterocyclic antidepressant
c. Selective Serotonin Reuptake Inhibitor (SSRI)
d. Monoamine Oxidase Inhibitor (MAOI)
3. The pharmacokinetic and pharmacodynamic aspect of antipsychotic drugs
a. Classic drugs (Phenothiazine, Thioxanthene, Butyrophenone)
b. Atypical drugs (Olanzapine, clozapine, risperidone etc.)
ABSTRACTS
Drugs used to treat psychiatric disorders are generally known as psychotropic or
psychotherapeutic drugs. Psychotherapeutic drugs used to treat mental illness include
sedative-hypnotic, antidepressant and antipsychotic (neuroleptic) drugs.
There are three classes of sedative-hypnotic drugs: benzodiazepines, barbiturates
and miscellaneous agents. Benzodiazepines and barbiturates exert their action by
facilitating (potentiating) the inhibitory action of GABA, therefore increasing the frequency or
duration of GABA-mediated chloride ion channel opening. The use of sedative-hypnotic
drugs may cause many adverse effects including dependence, tolerans, CNS depression,
cardiovascular and respiratory depression.
Most antidepressant exert their actions by inhibiting the metabolism or reuptake of
monoamine neurotransmitter particularly norepinephrine (NE) and/or serotonin (5HT). There
are four classes of antidepressant: tricyclic antidepressant (TCA), heterocyclic
antidepressant, selective serotonin reuptake inhibitor (SSRI), and monoamine oxidase
inhibitor (MAOI). Serotonin syndrome and hypertension crisis are the severe toxic effects of
antidepressant should aware to.
Antipsychotic drugs are thought to act by inhibiting or blocking the release of
dopamine in the brain, therefore will supress the symptoms of certain psychotic disorders.
Antipsychotic drug is classified into two group of drugs: classic drugs (including
phenothiazine, thioxanthenes and butyrophenones) and atypical drugs (clozapine,
olanzapine, loxapine, risperidone etc.). The most significant adverse reaction associated
52

with the antipsychotic drugs is the extrapyramidal effect that commonly manifests as
Parkinson-like symptoms, akathisia, and dystonia.
1. The cycle of neurotransmitter in the synaps
2. The role of neurotransmitter involved in psychiatric disorders
3. The mechanism of action for sedative-hypnotic, antidepressant and antipsychotic
drugs
4. The pharmacokinetic and pharmacodynamic aspect of sedative-hypnotic,
antidepressant and antipsychotic drugs
5. Drug interaction related to sedative-hypnotic, antidepressant and antipsychotic drugs
SCENARIO
A 23-year-old male with no previous psychiatric history presents to hospital complaining that
his neighbours have been plotting an attack on him. He also mentions that he can hear his
neighbours discussing his actions and appearances all the time. He is suspicious all the
time and believes that he is under surveillance by hidden cameras. The doctor prescribes
this medication, but warns the patient of possible drowsiness and obesity.
Learning Task
1.
What drugs can be used for patient above? Describe the mechanism of action for
the drug.
2.
Based on the scenario above, what condition possibly happened to this patient?
3.
What are other adverse effects of sedative-hypnotic drugs should aware to?
SCENARIO 2
A 45-year-old male patient with a psychotic illness has been unsettled on the ward with
increasing signs of agitation. His treatment is currently under review as he had developed
neuroleptic malignant syndrome following the use of atypical antipsychotics. He has an
argument with a fellow patient and following this, starts screaming and breaking the ward
windows. The team decides to treat this acute episode using an intramuscular combination
of a short-acting benzodiazepine and this medication.
Learning Task
1.
What drug can be given to manage patients disease?
2.
How is the mechanism of action of that drug?
3.
What are the adverse effects possibly happened regarding the use of that drug?
4.
If there were signs of hallucination and/or delusion found on the patient, what drug
should be given? How is the mechanism of action? What are the adverse effects
commonly occur regarding the use of that drug?
SELF ASSESSMENT
1.
Mention classification of sedative-hypnotic drugs
2.
How did benzodiazepine and barbiturate exert their action?
3.
List adverse effect of sedative-hypnotic drugs
4.
Mention classification of antidepressant drugs
5.
How is the mechanism of action of each class of antidepressant drugs?
6.
List adverse effect of sedative-hypnotic drugs
7.
Mention classification of antipsychotic drugs
8.
How is the mechanism of action of each class of antipsychotic drugs?
9.
List adverse effect of antipsychotic drugs
53
Modul
19
Self Harm & Suicide
dr. Ida Ayu Kusuma Wardani, SpKJ, MARS
AIMS:
Describe the management of disorders mood, thought, and behavior at a time of crisis. Self
harm and suicide one part of the emergency psychiatry
LEARNING OUTCOMES:
Describe how to:
1. Diagnosis
2. Risk factors
3. Pathophysiology
4. Treatment of suicide risk
CURRICULUM CONTENS:
1. Epidemiology
2. Psychiatric and medical risk factors
3. Familial and genetic
4. Pathophysiology
5. Treatment
ABSTRACTS
Emergency psychiatry refers to the management of disorders of mood, thought, and
behavior at a time of crisis. It entails assessment, development of a differential diagnosis of
psychiatric and other medical causes of presenting symptoms, and diagnostic specific
pharmacotherapy, medical and surgical therapy, and psychotherapy. Psychiatric
emergencies are often particularly disturbing because they do not just involve the bodys
reactions to an acute disease state, as much as actions directed against the self.
1. People very distress and change behavior, unsure what to do or not to do
2. Management of psychiatric emergency care
3. Treatment self harm & suicide
SCENARIO
A 23-year-old male was found cutting his arms and thighs with a knife. He claims
that there are bugs crawling underneath his skin and that he is trying to get rid of them. On
examination, he is tachycardic with prominent dilatation of pupils and nasal ulceration. He
appears sexually disinhibited, restless, and excited.
Learning Task:
1. From the story above, why do act self-harm?
2. What are the methods of self-harm?
3. Please explain pathophysiology?
4. What is the diagnosis?
5. What is the holistic treatment?
SCENARIO
A 20-year-old female presents to hospital having lacerated her forearm. She claims that she
had a major argument with her boyfriend and did it so that her boyfriend would worry and
54

not break up with her. According to her, all her relationships in the past have been intense
like this. On examination, there are multiple healed laceration scars on both arms.
55

Learning Task:
1. Explain the psychodynamic of self-harm?
2. What are the methods of self-harm?
3. Please explain pathophysiology?
4. What is the diagnosis?
5. What is the holistic treatment?
SELF ASSESSMENT
1. What is a defense mechanism used by the patient?
2. Which factors are associated with self harm and suicide?
3. What is the relationship between self-harm and suicide with mental disorders?
4. How to prevent self-harm and suicide?
56
Modul
20
Child Abuse & Neglected
AIMS:
Describe evaluation, management, and treatment of child abuse
LEARNING OUTCOMES:
Describe how to:
1. Anamnesis child with child abuse
2. History taking of child abuse
3. Examine mental state of child with child abuse
4. Diagnosis child abuse
5. Therapy (pharmacotherapy, psychotherapy) child abuse
1. Anamnesis child abuse
2. History taking (fundamental four and secret seven) of child abuse
3. Mental state examination of child abuse
4. Diagnosis formulation of child abuse
5. Modality of treatment of child abuse
ABSTRACTS
Abuse and neglect cases can be some of the most disturbing and heartwrenching
eperiences in child and adolescent psychiatry, sometimes evoking horror and a wish to
rescue the victim immediately. Therefore it is important to keep a sense of perspective on
how good the evidence is that abuse is indeed happening, and to have a sympathetic team
for emotional support to stop one becoming overwhelmed by, or cut off from, what is seen.
Within the broad definition of child maltreatment, five subtypes are distinguished
these are physical abuse; sexual abuse; neglect and negligent treatment; emotional abuse
and exploitation. Compiling lists of general or culturally relative risks is a necessary first step
toward assessing the interaction of risk and protective circumstances in each family,
community and culture. However, theories that propose single factors or combinations of
risk factors as invariably leading directly to child abuse will stigmatize families which fall
within the profile and lead to missed cases of child abuse, which do not fit the profile. In
families where child abuse does exist, they may be more likely to hide the abuse as it now
carries a public condemnation. In families where it is not present, stigmatization may
translate into marginalization of the family.
Preventing the abuse of children in settings other than the family (such as schools,
hospitals, psychiatric institutions and prisons), and by persons other than caregivers (such
as members of the clergy, the police and teachers) is also an important area of work, but
one which is likely to require very different strategies to those which have proven effective in
preventing intra-familial child maltreatment.
1. The procedure of interviewing child abuse
2. Formulating diagnosis for child abuse
3. Management of child abuse
57

SCENARIO
Financially comfortable parents lived in a pleasant, clean house in a nice neighborhood, but
they had no friends. Their four teenagers never had visitors. One day, the oldest girl, 17
years of age, went to the police and told them that she had a baby at home and that her
own father was the father of the baby. The girl said that her father had been having sexual
relations with her for more than 4 years and that he was now doing the same with her
younger sisters. The mother admitted knowing about the situation for years, but she had not
reported it to the authorities for fear of losing her husband.
Learning task:
1. Explain the definition of abuse and neglection in children
2. Describe the impacts of abuse and neglected children
3. Explain the symptoms of psychiatric disorders caused by abuse and neglect of
children
4. Explain the strategy of therapy for children who are abused and neglected
5. Explain how to refer patient with abuse and neglect
6. Explain Diagnosis physically abuse children according DSM V
7. Explain Clinical features emotional abuse children
8. Explain Clinical features neglected children
9. Explain Evaluation process child who have been sexually abuse
10. Explain the prevention child abuse in families and community
11. Explain the treatment that can be provided to children that have been physically
abuse
Self Assesment
1. Explain about child maltreatment
2. Explain about interpersonal violence
3. Explain about psychopathology of revictimization
4. Explain about the psychological symptoms of an abused child
58
Modul
BASIC CLINICAL SKILL
INTRODUCTION
AIMS:
Perform ability to collect specific, detailed information about topics constitute the psychiatric
evaluation. Acquiring the database of information for the interviewer to make diagnoses on
five axes and develop a treatment plan acceptable to the patient.
LEARNING OUTCOMES:
Able how to:
1. Warm-up and Chief Complaint
2. Make the Diagnostic Decision Loop
3. Make history and Database
4. Make diagnosing and Feedback
5. Make treatment Plan and Prognosis
1. Anamnesis
2. History taking (fundamental four and secret seven)
3. Mental state examination
4. Healing formulation
5. Modality Treatment
ABSTRACTS
Psychiatric interviewing is a special form of human communication. The interviewer asks the
patient to disclose complaints, share problems, and reveal suffering. According to the
difficulties that the patient experiences with this request, the interviewer shifts the focus
between disorder-centered and patient-centered interviewing. Disorder-centered
interviewing is based on a descriptive, atheoretical model of psychiatric disorders called the
medical model, which is the official model supported by the American Psychiatric
Association (APA) and the World Health Organization (WHO) codified in DSM-IV-TR (2000)
and the International Classification of Diseases (ICD-10). This framework views psychiatric
disorders as similar to medical disorders, using criteria for diagnosis as identifiable clusters
of occurrences from a restricted menu of symptoms, signs, and behaviors that cause
morbidity and mortality.
In contrast, patient-centered interviewing is based on the introspective model, which
emphasizes the individuality of the patient's experience. This model attends to the
intrapsychic battle of conflicts. It is sensitive to the patient's educational, emotional,
intellectual, and social background, the personality, and the individual symptom
constellations tracing their arrival to individual circumstances and the individual's unique
response (cognitive-behavioral model).
1. The procedure of interviewing psychiatric disorders
2. Formulating mental status for psychiatric diagnosis
3. Management of psychiatric disorders
59
Modul
INTERVIEW ANXIETY PATIENTS
AIMS:
Perform ability to collect specific, detailed information about topics constitute the anxiety
patients evaluation. Acquiring the database of information for the interviewer to make
diagnoses on five axes and develop a treatment plan acceptable to the patient.
LEARNING OUTCOMES:
Able how to:
1. Anamnesis
2. History taking (fundamental four and secret seven) of anxiety patients
3. Mental state examination of anxiety patients
4. Healing formulation of anxiety patients
5. Modality Treatment of anxiety patients
ABSTRACTS
Anxiety disorders are the most prevalent mental disorders in the general population.
Approximately one in four adults in the U.S. population has an anxiety disorder at some
point in his or her life. Similar to adults, anxiety disorders are the most common mental
disorder in children and adolescents. However, the rates of specific childhood anxiety
disorders suggest the importance of brain development in the phenotypic expression of
anxiety proneness. This is reflected by the findings of prospective community-based
investigations revealing differential peak periods of onset of specific anxiety disorders:
separation anxiety disorder and specific phobias in middle childhood, overanxious disorder
in late childhood, social anxiety disorder in middle adolescence, panic disorder in late
adolescence, generalized anxiety disorder in young adulthood and obsessive-compulsive
disorder (OCD) in early adulthood. Gender differences in rates appear by 6 years of age
when girls are significantly more likely to have an anxiety disorder than boys.
Psychodynamic psychiatrist views anxiety as a marker of underlying psychological
conflicts to be explored and resolved and a psychiatric symptom that defines the diagnostic
class of anxiety disorders. Although the term anxiety has been applied to diverse
phenomena in the psychoanalytical, learning-based, and neurobiological literature, in the
clinical psychopathological literature, it is used to refer to the presence of fear or
apprehension that is out of proportion to the context of the life situation. Hence, extreme
fear or apprehension can be considered clinical anxiety if it is developmentally inappropriate
(i.e., fear of separation in a 12-year-old child) or inappropriate to an individual's life
circumstances (i.e., a successful banker worrying about supporting his or her family). Since
the 1970s, clinical research has led to a progressive refinement of the nosology for clinical
anxiety disorders. Although these disorders were broadly conceptualized in the early 20th
century, narrower definitions have arisen, partially stimulated by Donald Klein's observations
on pharmacological distinctions between panic and nonpanic anxiety.
60
Modul
INTERVIEW DEPRESSIVE PATIENTS
AIMS:
Perform ability to collect specific, detailed information about topics constitute the depressive
patients evaluation. Acquiring the database of information for the interviewer to make
diagnoses on five axes and develop a treatment plan acceptable to the patient.
LEARNING OUTCOMES:
Able how to:
1. Anamnesis
2. History taking (fundamental four and secret seven) of depressive patients
3. Mental state examination of depressive patients
4. Healing formulation of depressive patients
5. Modality Treatment of depressive patients
ABSTRACTS
Severely depressed patients may also have difficulty concentrating, thinking clearly, and
speaking spontaneously. The intensity of mood disturbance can seem all-consuming and
may well lead to distortions in thinking and perception. Some depressed patients have
psychotic symptoms in addition to cognitive difficulties. The psychiatrist evaluating a
depressed patient may need to be more forceful and directive than usual. It sometimes
seems that the examiner must provide all the emotional and intellectual energy for both
participants. Although depressed patients should not be badgered, long silences are seldom
useful, and the examiner may need to repeat questions more than once. Ruminative
patientsfor example, those who continually repeat how worthless or guilty they areneed
to be interrupted and redirected.
All patients must be asked about suicidal thoughts; however, depressed patients
may need to be questioned more fully. A thorough assessment of suicide potential
addresses intent, plans, means, and perceived consequences, as well as history of
attempts and family history of suicide. Many patients mention their thoughts of suicide
spontaneously. If not, the examiner can begin with a somewhat general question, such as
Do you ever have thoughts of hurting yourself? or Does it ever seem that life Isn't worth
living? These questions can then be followed up with more specific questions. The
examiner must feel comfortable enough to ask simple, straightforward, noneuphemistic
questions. Asking about suicide does not increase the risk. The psychiatrist is not raising a
topic that the patient has not already contemplated. Specific, detailed questions are
essential for prevention.
61
Modul
INTERVIEW SOMATOFORM PATIENTS
AIMS:
Perform ability to collect specific, detailed information about topics constitute the
somatoform patients evaluation. Acquiring the database of information for the interviewer to
make diagnoses on five axes and develop a treatment plan acceptable to the patient.
LEARNING OUTCOMES:
Able how to:
1. Anamnesis
2. History taking (fundamental four and secret seven) of somatoform patients
3. Mental state examination of somatoform patients
4. Healing formulation of somatoform patients
5. Modality Treatment of somatoform patients
ABSTRACTS
Some patients experience and describe emotional distress in terms of physical symptoms.
This is certainly true for the group of somatoform disorders, but it also occurs in some mood
and anxiety disorders and adjustment disorders and as a component of personality style or
personality disorder. Somatizing patients pose a number of difficulties for the consulting and
the treating psychiatrist. They are often referred by an internist or primary care physician,
and the referral itself may be experienced as dismissive. Somatizing patients may be
reluctant to engage in self-reflection and psychological exploration. Moreover, somatic
distress without physical findings can lead to diagnostic uncertainty, which, in turn, makes
treatment less certain. Antidepressant or anxiolytic medications may be helpful, but side
effects are often less tolerable to individuals who are already highly attuned to small
changes in body sensations.
Many somatizing patients live with the fear that their symptoms are not taken
seriously and the parallel fear that something medically serious may be overlooked.
Psychiatrists' main task in dealing with these patients is to acknowledge the suffering
conveyed by the symptoms without necessarily accepting the patient's explanation for the
symptoms. Clinicians should be curious about not only the nature of the physical
complaints, but also the impact of those complaints on the patient's life (e.g., It must be
very difficult to keep on working with such severe headaches, or It sounds as though your
illness has crowded everything else out of your life.).
It is essential that somatizing patients feel that their physical complaints are not
being dismissed. Rather than limiting the scope of inquiry to psychological issues, the
psychiatrist wants to expand discussion to include all aspects of the patient's well-being,
emotional health, and physical health. Many patients become more willing to discuss
personal issues, such as job-related stress or relationship difficulties, when they believe the
62

psychiatrist will not automatically assume that those issues are the cause of physical
symptoms. It is often helpful for the physician to propose a purely pragmatic approachone
that stresses a willingness to use whatever works to relieve the patient's suffering without
causing harm. At times, this may include nonstandard approaches, such as meditation,
yoga, or acupuncture, in addition to psychotherapy.
63
Modul
INTERVIEW BIPOLAR DISORDERS PATIENTS
AIMS:
Perform ability to collect specific, detailed information about topics constitute the bipolar
disorders patients evaluation. Acquiring the database of information for the interviewer to
make diagnoses on five axes and develop a treatment plan acceptable to the patient.
LEARNING OUTCOMES:
Able how to:
1. Anamnesis
2. History taking (fundamental four and secret seven) of bipolar disorders patients
3. Mental state examination of bipolar disorders patients
4. Healing formulation of bipolar disorders patients
5. Modality Treatment of bipolar disorders patients
ABSTRACTS
Bipolar disorders (previously called manic-depressive psychosis) consist of at least one
hypomanic, manic, or mixed episode. Mixed episodes represent a simultaneous mixture of
depressive and manic or hypomanic manifestations. Although a minority of patients
experience only manic episodes, most bipolar disorder patients experience episodes of both
polarity. Manias predominate in men, depression and mixed states in women. The bipolar
disorders were classically described as psychotic mood disorders with both manic and
major depressive episodes (now termed bipolar I disorder), but recent clinical studies have
shown the existence of a spectrum of ambulatory depressive states that alternate with
milder, short-lived periods of hypomania rather than full-blown mania (bipolar II disorder).
Bipolar II disorder, which is not always easily discernible from recurrent major depressive
disorder, illustrates the need for more research to elucidate the relation between bipolar
disorder and major depressive disorder.
The past decade has seen major paradigm shifts in the treatment of bipolar disorder
acute to maintenance treatment, focus on the illness rather than episodes, and a focus on
functional recovery rather than mere syndromal recovery. These three shifts form the
core principles in the long-term management of bipolar illness. They have occurred because
of a realization of 1) the chronic nature of the illness, interspersed by crises involving acute
episodes of mania, depression, and mixed states that are similar to the hypertensive crises
seen in hypertension; and because of 2) a lag in improvement of socio-occupational
functioning among patients despite symptomatic recovery. Maintenance treatment of bipolar
disorder is best accomplished with an approach that combines pharmacological and
psychosocial interventions. Pharmacotherapy involves using medications that, alone or in
combination, prevent the occurrence of new episodes; facilitate socio-occupational
functioning by minimizing the number and intensity of interepisode symp toms; and are
64

devoid of intolerable side effects, thus facilitating long-term compliance with the medication
regimen. Remission of symptoms and more importantly functional recoverythe primary
goals of treatmentare attainable despite the complex and chronic nature of bipolar
disorder.
STEM QUESTIONS
Euphoria Stem Question
1. Some people have periods lasting several days when they feel much more excited and
full of energy than usual. Their minds go too fast. They talk a lot. They are very restless or
unable to sit still and they sometimes do things that are unusual for them, such as driving
too fast or spending too much money.
Have you ever had a period like this lasting several days or longer?
If this question is endorsed, the next question (the irritability stem question) is skipped and
the respondent goes directly to the Criterion B screening question
Irritability Stem Question
2. Have you ever had a period lasting several days or longer when most of the time you
were so irritable or grouchy that you either started arguments, shouted at people or hit
people?
Criterion B Screening Question
3. People who have episodes like this often have changes in their thinking and behavior at
the same time, like being more talkative, needing very little sleep, being very restless, going
on buying sprees, and behaving in many ways they would normally think inappropriate.
Did you ever have any of these changes during your episodes of being excited and full of
energy or very irritable or grouchy?
Criterion B Symptom Questions
Think of an episode when you had the largest number of changes like these at the same
time. During that episode, which of the following changes did you experience?
1. Were you so irritable that you started arguments, shouted at people, or hit people?
This first symptom question is asked only if the euphoria stem question (#1 above) is
endorsed
2. Did you become so restless or fidgety that you paced up and down or couldnt stand
still?
3. Did you do anything else that wasnt usual for youlike talking about things you would
normally keep private, or acting in ways that you would usually find embarrassing?
4. Did you try to do things that were impossible to do, like taking on large amounts of
work?
5. Did you constantly keep changing your plans or activities?
6. Did you find it hard to keep your mind on what you were doing?
7. Did your thoughts seem to jump from one thing to another or race through your head so
fast you couldnt keep track of them?
8. Did you sleep far less than usual and still not get tired or sleepy?
9. Did you spend so much more money than usual that it caused you to have financial
trouble?
65
~ CURRICULUM MAP ~
Smstr
Program or curriculum blocks
10
Senior Clerkship
Senior Clerkship
Senior clerkship
Medical
Emergency
(3 weeks)
Special Topic:
-Travel medicine
(2 weeks)
Elective Study III

(6 weeks)
Clinic
Orientation
(Clerkship)
(6 weeks)
BCS (1 weeks)
The Respiratory
System and
Disorders
(4 weeks)
The Cardiovascular
System and
Disorders
(4 weeks)
The Urinary System

and Disorders
(3 weeks)
The Reproductive
System and Disorders
(3 weeks)
BCS (1 weeks)
Alimentary
& hepatobiliary systems
& disorders
(4 Weeks)
BCS (1 weeks)
The Endocrine
System, Metabolism
and Disorders
(4 weeks)
BCS (1 weeks)
Clinical Nutrition and
Disorders
(2 weeks)
BCS (1 weeks)
Elective Study II
(1 weeks)
BCS (1 weeks)
BCS (1 weeks)
BCS (1 weeks)
Musculoskeletal
system &
connective
tissue disorders
(4 weeks)
Neuroscience
and
neurological
disorders
(4 weeks)
Behavior Change
and disorders
(4 weeks)
BCS (1 weeks)
Hematologic
system & disorders & clinical
oncology
(4 weeks)
BCS (1 weeks)
Immune
system &
disorders
(2 weeks)
BCS(1 weeks)
Infection
& infectious
diseases
(5 weeks)
BCS
(1 weeks)
The skin & hearing
system
& disorders
(3 weeks)
BCS (1 weeks)
Medical
Professionalism
(2 weeks)
BCS(1 weeks)
Evidence-based
Medical Practice
(2 weeks)
BCS (1 weeks)
Health System-based
Practice
(3 weeks)
BCS(1 weeks)
Community-based
practice
(4 weeks)
BCS (1 weeks)
Studium
Generale and
Humaniora
(3 weeks)
Medical
communication
(3 weeks)
BCS (1 weeks)
The cell
as biochemical machinery
(3 weeks)
Growth
&
development
(4 weeks)
BCS (1 weeks)
BCS(1 weeks)
BCS: (1 weeks)
Special Topic :
- Palliative
medicine
-Compleme
ntary &
Alternative
Medicine
- Forensic
(3 weeks)
Elective
Study II
(1 weeks)
Special Topic
- Ergonomi
- Geriatri
(2 weeks)
Elective
Study I
(2 weeks)
The Visual
system &
disorders
(2 weeks)
Pendidikan Pancasila & Kewarganegaraan (3 weeks)
References
66
1. Psychiatry. 4th ed. John Wiley & Sons, 2015.

2. Katzung: Basic and Clinical Pharmacology, 13th ed. McGraw-Hills. 2015
3. Neurosciences-From Molecule to Behavior: A University Textbook. Springer Spektrum,
2013
4. Diagnostic and statistical manual of disorders, 5th ed, Arlington: American Psychiatric
Association, 2013.
5. Child and adolescent psychiatry. 3rd ed. John Wiley & Sons, 2012
6. Textbook of Clinical Neuropsychiatry, 3rd ed, Taylor & Francis Group, 2012
7. Abnormal Psychology. 6th ed. McGraw-Hills, 2010
8. The American Psychiatric Publishing Textbook of Forensic Psychiatry. 2nd ed. American
Psychiatry Pub. 2010
9. Principles of social psychiatry. 2nd ed. John Wiley & Sons, 2010
10. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th
ed. Lippincott Williams & Wilkins. 2007.
11. Diagnostic Criteria from DSM IV-TR. 1st ed. Washington: American Psychiatric
Association. 2000
12. Catatan Ilmu Kedokteran Jiwa. Edisi VI. Surabaya: Airlangga University Press. 1994.
13. ICD-10 Classification Or Mental and Behavioural Disorders. 1st ed. Edinburgh; Churchill
Livingstone.1994
14. Pedoman Penggolongan dan Diagnosis Gangguan Jiwa di Indonesia III. Edisi I. Jakarta:
Departemen Kesehatan. 1993
67

Study Guide Behavior Semester IV FK UNUD

Hochgeladen von

Dokumentinformationen

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Study Guide Behavior Semester IV FK UNUD

Hochgeladen von

Copyright:

Verfügbare Formate

Study Guide Behavior Changes and Disorders

The Seven General Core Competencies

Planner team & Lecturers

Time Table (Regular Class)

Time Table (English Class)

Meeting of the students representative

Basic Clinical Skill

Udayana University Faculty of Medicine, DME

Study Guide Behavior Changes and Disorders

The Seven General Core Competencies

Medical Knowledge Base

Community-based and health system-based practice

Udayana University Faculty of Medicine, DME

Study Guide Behavior Changes and Disorders

Members Planning Group

dr Anak Ayu Sri Wahyuni, SpKJ (Secretary)

dr Luh Nyoman Alit Aryani, SpKJ

dr Wayan Westa, SpKJ (K)

Dr dr Ida Bagus Fajar Manuaba, SpOG, MARS

Dr dr Cokorda Bagus Jaya Lesmana, SpKJ (K)

dr Wayan Westa, SpKJ (K)

dr Anak Ayu Sri Wahyuni, SpKJ

dr I Gusti Ayu Endah Arjana, Sp.KJ (K)

dr Lely Setiawati, Sp.KJ (K)

dr Ida Ayu Kusuma Wardani, SpKJ, MARS

dr Ni Ketut Putri Ariani, SpKJ

dr Ni Ketut Sri Diniari, SpKJ

dr Luh Nyoman Alit Aryani, SpKJ

dr I Gusti Ayu Indah Ardani, SpKJ

Dr dr Anak Agung Ayu Putri Laksmidewi Sp.S(K)

Dr dr Ida Bagus Fajar Manuaba, SpOG, MARS

dr Yenni Kandarini, SpPD

dr I Gusti Ayu Artini, M.Sc

DR. Ni Made Swasti Wulanyani, S.Psi., M.Erg., Psi

Udayana University Faculty of Medicine, DME

Study Guide Behavior Changes and Disorders

Curriculum Block The Behavioral Changes and

Udayana University Faculty of Medicine, DME

Study Guide Behavior Changes and Disorders

dr. Pande Kurniari, Sp.PD

dr Ni Wayan Sucindra Dewi

dr Ni Nyoman Metriani Nesa,

dr Ni Made Susilawathi, Sp.S

dr. Putu Yuliandari, S.Ked

dr. I G.A. Indah Ardani, Sp.KJ

dr. I Wyn Subawa, Sp.OT

dr. I Gede Budhi Setiawan,

dr. Juli Sumadi, Sp.PA

dr. Reni Widiastuti

dr. Dewi Sutriani Mahalini , Sp.A

dr. Dewa Ayu Mas Shintya Dewi,

dr. Ariesanti Tri Handayani ,

dr. Ida Ayu Dewi Wiryanthini, M

Udayana University Faculty of Medicine, DME

Study Guide Behavior Changes and Disorders

Lecture 2: Mental Status

Lecture 3: Psychological Test

Lecture 5: Prenatal Psychobiology

Lecture 6: Behavior Changes Due

Lecture 7: Delirium and Dementia

Lecture 8: General Approaches to

Udayana University Faculty of Medicine, DME

Study Guide Behavior Changes and Disorders

Lecture 9: Primary & Secondary