Pemicu 6

Dessy
405120170
Panic Disorder
An acute intense attack of anxiety
accompanied by feelings of impending
doom

Treatment: SSRI (paroxetine), tricyclic

antidepressants, benzodiazepin,
cognitive therapy, applied relaxation,
respiratory training, family therapy
Generalized Anxiety Disorder
 Mixed Anxiety-Depressive Disorder
describes patients with both anxiety
and depressive symptoms who do
not meet the diagnostic criteria for
either an anxiety disorder or a
mood disorder
Treatment: ->can include
antianxiety drugs, antidepressant
drugs, or both
•Triazolobenzodiazepines
•drug that affects the serotonin 5-
HT1A receptor, such as buspirone
•Venlafaxine
Diagnosis criteria DSM IV
•Persistent or recurrent dysphoric mood lasting at least 1 month
•The dysphoric mood is accompanied by at least 1 month of four
(or more) of the following symptoms:
difficulty concentrating or mind going blank
sleep disturbance (difficulty falling or staying asleep, or
restless, unsatisfying sleep)
fatigue or low energy; irritability; worry; being easily moved
to tears
Hypervigilance; anticipating the worst
hopelessness (pervasive pessimism about the future)
low self-esteem or feelings of worthlessness
•The symptoms cause clinically significant distress or impairment
in social, occupational, or other important areas of functioning
•The symptoms are not due to the direct physiological effects of
a substance (e.g., a drug of abuse, a medication) or a general
medical condition
•All of the following
criteria have never been met for major depressive disorder,
dysthymic disorder, panic disorder, or generalized anxiety
disorder
criteria are not currently met for any other anxiety or mood
disorder
the symptoms are not better accounted for by any other
mental disorder
Posttraumatic Stress Disorder (PTSD)
A condition marked by the development of
symptoms after exposure to traumatic life
events
Epidemiology: significantly higher in
women. Most likely to occur in those who
are single, divorced, widowed, socially
withdrawn, or of low socioeconomic level
Presdiposing vulnerability factors in PTSD:
•Presence of childhood trauma
•Borderline, paranoid, dependent, or
antisocial personality disoder traits
•Inadequate family or peer support system
•Being female
•Genetic vulnerability to psychiatric illness
•Recent stressful life changes
•Perception of an external locus of control
(natural cause) rather than an internal one
(human cause)
•Recent excessive alcohol intake
Clinical features:
•Painful reexperiencing of the event, a pattern of
avoidance and emotional numbning, and fairly
constant hyperarousal.
•The disorder may not develop until months or
even years after the event.
•The mental status examination often reveals
feelings of guilt, rejection, and humiliation.
•May also describe dissociative states and panic
attacks, and illusions and hallucinations
•Associated symptoms can include aggression,
violence, poor impulse control, depression, and
substance-related disorders
•Cognitive testing may reveal impaired memory
and attention
Treatment-> major approaches are support,
encouragement to discuss the event, and
education about a variety of coping mechanisms
(relaxation)
•Pharmacotherapy: SSRIs (sertraline and
paroxetine)
•Psychotherapy: behavior therapy, cognitive
therapy, and hypnosis
 Somatoform Disorders
Somatization Disorder
Etiology:
•Psychosocial factors: avoid obligations,
symbolize a feeling or a belief, symptoms
substitute for repressed instinctual
impulses
•Biological factors: genetics, cytokines
Clinical features:
Patients classically (but not always)
describe their complaints in a dramatic,
emotional, and exaggerated fashion, with
vivid and colorful language; they may
confuse temporal sequences and cannot
clearly distinguish current from past
symptoms
Treatment:
•a single identified physician as primary
caretaker
•regularly scheduled visits, relatively
brief
•Psychotherapy
Conversion Disorder
Etiology: psychoanalytic factors, learning theory,
biological factors
Clinical features:
•Paralysis, blindness, and mutism
•Sensory symptoms: anesthesia and paresthesia,
deafness, blindness, and tunnel vision
•Motor symptoms: abnormal movements, gait
disturbance (astasia-abasia), weakness, and paralysis
•Seizure symptoms: pseudoseizures
•Other associated features: advantages and benefits
as a result of being sick, La Belle Indifference 
unconcerned about the impairment, unconsciously
model their symptoms on those of someone
important to them
Treatment: insight-oriented supportive or behavior
therapy, a relationship with a caring and confident
therapist, hypnosis, anxiolytics, and behavioral
relaxation exercises , parenteral amobarbital or
lorazepam
 Somatoform Disorders
Hypochondriasis Body Dysmorphic Disorder
Etiology: Etiology:
•Unknown
•misinterpretation of bodily symptoms theory
•Stereotyped concepts of beauty emphasized
•social learning model theory in certain families and within the culture at
•a variant form of other mental disorders, large may significantly affect patients with
among which depressive disorders and anxiety body dysmorphic disorder
disorders are most frequently included theory •psychodynamic models
Treatment
•psychodynamic school of thought theory
•SSRI: Clomipramine, Fluoxetine
Treatment: group psychotherapy •Antipsychotic
Pain Disorders
Etiology: psychodynamic factors, behavioral
factors, interpersonal factors, biological factors
Treatment:
•Pharmacotherapy: Antidepressant (SSRI, TCA),
Amphetamine
•Psychotherapy: therapeutic alliance, Cognitive
therapy, biofeedback, hypnosis,
transcutaneous nerver stimulation, pain
control program
Trichotillomania
•A chronic disorder characterized by repetitive
hair pulling, driven by escalating tension and
causing variable hair loss that is usually-but
not always- visible to others
•Usually begins in early to mid-adolescence
•Etiology: linked to stressful situation,
Clinical features:
disturbance in mother-child relationships, fear
•Hair loss (most commonly the scalp) is often
of being left alone, recent object loss,
characterized by short, broken strands
substance abuse, genetic presdiposition
appearing together with long, normal hairs in
DSM IV – TR Diagnostic criteria for Trichotillomania the affected areas
A. Recurrent pulling out of one's hair resulting in •Painful, pruritus, tingling may occur in the
noticeable hair loss.
involved area
B. An increasing sense of tension immediately
before pulling out the hair or when attempting to •Trichophagy may follow
resist the behavior. •Patients deny the behaviour and often try to
C. Pleasure, gratification, or relief when pulling out hide the resultant behavior
the hair. Treatment:
D. The disturbance is not better accounted for by
•Topical steroids and hydroxyzine
another mental disorder and is not due to a general
medical condition (e.g., a dermatological hydrochloride, antidepressants, serotonergic
condition). agents, antipsychotics
E. The disturbance causes clinically significant •Biofeedback, self monitoring, covert
distress or impairment in social, occupational, or desensitization, habit reversal, hypnotherapy,
other important areas of functioning. behavior therapy