07. Mental Disorder and Related Key Symptoms (Dr.tuti w)

8/8/2019 07. Mental Disorder and Related Key Symptoms (Dr.tuti w)

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MENTAL DISORDERSMENTAL DISORDERS

andand

RELATED KEY SYMPTOMSRELATED KEY SYMPTOMS

Dr. Tuti Wahmurti AS, dr., SpKJ(K)Dr. Tuti Wahmurti AS, dr., SpKJ(K)



REFERENCESREFERENCES

ICDICD--10 (International Classification of 10 (International Classification of

Disease), 1993Disease), 1993 ± ± WHOWHO

DSMDSM--IV (Diagnostic and Statistical Manual),IV (Diagnostic and Statistical Manual),19941994 ± ± USAUSA

PPDGJPPDGJ--III (Pedoman Penggolongan DiagnosisIII (Pedoman Penggolongan Diagnosis

Gangguan Jiwa di Indonesia),Gangguan Jiwa di Indonesia), 19941994 --

IndonesiaIndonesia



DSMDSM--IV ClassificationIV Classification (1)(1)

Of Mental DisordersOf Mental Disorders

Disorders usually first diagnosed in infancy,Disorders usually first diagnosed in infancy,

childhood, or adolescencechildhood, or adolescence**

DeliriumDelirium**, dementia, dementia**, and amnestic and other , and amnestic and other

cognitive disorderscognitive disorders

Mental disorders due to a general medicalMental disorders due to a general medical

condition not elsewhere classifiedcondition not elsewhere classified SubstanceSubstance--related disordersrelated disorders**




Schizophrenia and other psychotic disordersSchizophrenia and other psychotic disorders**

Mood disordersMood disorders**

Anxiety disorder Anxiety disorder **

Somatoform disordersSomatoform disorders**

Factitious disordersFactitious disorders

Dissociative disordersDissociative disorders Sexual and gender identity disordersSexual and gender identity disorders**




Eating disordersEating disorders

Sleep disordersSleep disorders

ImpulseImpulse--control disorders not elsewherecontrol disorders not elsewhereclassifiedclassified

Adjustment disorders Adjustment disorders

Personality disordersPersonality disorders**

Other conditions that may be a focus of clinicalOther conditions that may be a focus of clinical

attentionattention

Additional codes Additional codes



Key Symptoms of DeliriumKey Symptoms of Delirium(1)(1)

Delirium is marked by shortDelirium is marked by short ± ± term confusionterm confusion

and changes in cognition :and changes in cognition :

1.1. Disturbance of consciousness (reduced clarifyDisturbance of consciousness (reduced clarify

of awareness of environment) with reducedof awareness of environment) with reduced

ability to focus, sustain, or shift attentionability to focus, sustain, or shift attention

2.2. A change in cognition (memory deficit, A change in cognition (memory deficit,disorientation, language disturbance)disorientation, language disturbance) or theor the

development of perceptual disturbancedevelopment of perceptual disturbance



Key Symptoms of DeliriumKey Symptoms of Delirium(2)(2)

3. Develops over a short period of time (hours3. Develops over a short period of time (hours--

days), and tends to fluctuate during thedays), and tends to fluctuate during the

course of the daycourse of the day..4.4. The disturbance is caused by directThe disturbance is caused by direct

physiological consequences of generalphysiological consequences of general

medical conditionmedical condition..

5.5. Rapid improvement when the causativeRapid improvement when the causativefactor is identified and eliminated.factor is identified and eliminated.



Key Symptoms of DementiaKey Symptoms of Dementia(1)(1)

1.1. Multiple cognitive defects : those are :Multiple cognitive defects : those are :

-- impairment in memoryimpairment in memory (recent memory(recent memory

forgetfulness)forgetfulness) withoutwithout impairment inimpairment in

consciousnessconsciousness

-- general intelligence, learning, language,general intelligence, learning, language,

problem solving, orientation, perception,problem solving, orientation, perception,attention and concentration, judgment, andattention and concentration, judgment, and

social abilitiessocial abilities



Key Symptoms of DementiaKey Symptoms of Dementia(2)(2)

2.2. A person¶s personality is also affected A person¶s personality is also affected

3.3. The symptomsThe symptoms significant impairment in significant impairment in

social or occupational functioning social or occupational functioning

significant decline from previous level of significant decline from previous level of

functioningfunctioning



Key Symptoms of Substance-

related disorders(1)

Substance AbuseSubstance Abuse

1.1.R

ecurrent substance use resulting in failure toR

ecurrent substance use resulting in failure tofulfill major role obligations at work, school, or fulfill major role obligations at work, school, or

homehome

2.2. Recurrent substance use in situation which itRecurrent substance use in situation which it

is physically hazardousis physically hazardous3.3. Recurrent substanceRecurrent substance--related legal problemsrelated legal problems



Key Symptoms of SubstanceKey Symptoms of Substance--

related disordersrelated disorders(2)(2)

Substance DependenceSubstance Dependence

1.1. Tolerance :Tolerance :

-- a need for markedly increase amountsa need for markedly increase amounts

of the substance to achieve desiredof the substance to achieve desired

effect or intoxicationeffect or intoxication

-- markedly diminished effect withmarkedly diminished effect withcontinued use of the same amount of thecontinued use of the same amount of the

substancesubstance



Key Symptoms of SubstanceKey Symptoms of Substance--

related disordersrelated disorders(3)(3)

2.2. Withdrawl syndromeWithdrawl syndrome

3.3. There is a persistent desire or unsuccessfulThere is a persistent desire or unsuccessful

efforts to cutdown or control substance abuseefforts to cutdown or control substance abuse

4.4. A great deal of time is spent in activities A great deal of time is spent in activities

necessary to obtain the substancenecessary to obtain the substance

5.5. Important social, occupational, or recreationalImportant social, occupational, or recreationalactivities are given up or reduced because of activities are given up or reduced because of

substance usesubstance use



Withdrawal SyndromeWithdrawal Syndrome

1.1. The development of a substanceThe development of a substance--specificspecific

syndrome due to the cessation of (or syndrome due to the cessation of (or

reduction in) substance use that has beenreduction in) substance use that has beenheavy and prolonged .heavy and prolonged .

2.2. The substanceThe substance ± ± specific syndrome causesspecific syndrome causes

clinically significant distress or impairment inclinically significant distress or impairment in

social, occupational, or other important areassocial, occupational, or other important areasof functioning.of functioning.



3. The symptoms are not due to a general3. The symptoms are not due to a general

medical condition and are not better medical condition and are not better accounted for by another mental disorder.accounted for by another mental disorder.

Withdrawal SyndromeWithdrawal Syndrome



Key Symptoms of SchizophreniaKey Symptoms of Schizophrenia

and other psychotic disordersand other psychotic disorders(1)(1)

A. A. Characteristic symptoms :Characteristic symptoms :

2 or more of the2 or more of the 55 followingfollowing

1.1. Delusions : false believe that is firmly held,Delusions : false believe that is firmly held,

despite objective and obvious contradictorydespite objective and obvious contradictory

proof or evidence and despite the fact that other proof or evidence and despite the fact that other

members of the culture do not share the belief.members of the culture do not share the belief.





2.2. Hallucinations : false sensory perceptionHallucinations : false sensory perception

occurring in the absence of any relevantoccurring in the absence of any relevant

external stimulation of the sensory modalityexternal stimulation of the sensory modality

involved.involved.

3.3. Disorganized speech,eg. :Disorganized speech,eg. :

-- frequentfrequent derailment : gradual or suddenderailment : gradual or suddendeviation in train of thought withoutdeviation in train of thought without

blocking; sometimes used synonymouslyblocking; sometimes used synonymously

with loosening of associationwith loosening of association





incoherence :incoherence : thought that generally is notthought that generally is not

understandable ; running together of thoughts or understandable ; running together of thoughts or words with no logical or grammatical connection,words with no logical or grammatical connection,

resulting in disorganization.resulting in disorganization.





4. Grossly disorganized behavior 4. Grossly disorganized behavior or catatonicor catatonicbehavior.behavior.

Grossly disorganized behavior :Grossly disorganized behavior :

manifest itself in a variety of ways, ranging frommanifest itself in a variety of ways, ranging fromchildlike silliness to unpredictable agitationchildlike silliness to unpredictable agitation




and other psychotic disordersand other psychotic disorders((55))

Catatonic motor behavior :Catatonic motor behavior :

included a marked decrease in reactivity to theincluded a marked decrease in reactivity to theenvironmnet :environmnet :

-- sometimes reaching an extreme degree of sometimes reaching an extreme degree of

complete unawareness (catatonic stupor)complete unawareness (catatonic stupor)

-- maintaining a rigid posture and resistingmaintaining a rigid posture and resisting

efforts to be moved (catatonic negativism)efforts to be moved (catatonic negativism)





-- The assumption of inappropiate or bizareThe assumption of inappropiate or bizarepostures (catatonic posturing)postures (catatonic posturing)

-- Purposeless and unstimulated excessive motor Purposeless and unstimulated excessive motor activity (catatonic excitement)activity (catatonic excitement)

5.5. Negative symptoms, eg. :Negative symptoms, eg. :

-- affective flattening : is especially commonaffective flattening : is especially common

and is characterized by the person¶s faceand is characterized by the person¶s faceappearing immobile and unresponsive,appearing immobile and unresponsive,

with poor eye contact and reduced bodywith poor eye contact and reduced body

languagelanguage





-- Alogia (poverty of speech) : Alogia (poverty of speech) :

is manifested by brief, laconic, empty replies.is manifested by brief, laconic, empty replies.-- Avolition : is characterized by inability to initiate Avolition : is characterized by inability to initiate

and persist in goaland persist in goal--directed activities.directed activities.





B. Social / occupationalB. Social / occupational

dysfunctiondysfunctionC. Duration : continuous signs of C. Duration : continuous signs of

the disturbance persist for atthe disturbance persist for at

least 6 monthsleast 6 months (include periods of prodromal(include periods of prodromal

and active symptoms)and active symptoms)



Mood disordersMood disorders

It refers to sustained emotional state, not merelyIt refers to sustained emotional state, not merely

to external (affective) expression of or transitoryto external (affective) expression of or transitory

emotional stateemotional state

Syndromes consisting of a cluster of signs andSyndromes consisting of a cluster of signs andsymptoms sustained over weeks to monthssymptoms sustained over weeks to months

Two types of Mood Disorders :Two types of Mood Disorders :

1. Major Depressive Disorder (MDD)1. Major Depressive Disorder (MDD)

= Unipolar Depression= Unipolar Depression

2. Bipolar Disorders consist of 2 episodes :2. Bipolar Disorders consist of 2 episodes :

Depressive Episode and Manic EpisodeDepressive Episode and Manic Episode



Key Symptoms of Major DepressiveKey Symptoms of Major Depressive

Disorder (MDD) / DepressiveDisorder (MDD) / Depressive

EpisodeEpisode(1)(1)

1.1. Depressed mood most of the day, nearlyDepressed mood most of the day, nearly

everyday as indicated by either subjective reporteveryday as indicated by either subjective report

(eg. feels sad or empty) or observation made by(eg. feels sad or empty) or observation made by

others (eg. appears tearful)others (eg. appears tearful)

2.2. Markedly diminished interest or pleasure inMarkedly diminished interest or pleasure inall/almost all, activities most of the day, nearlyall/almost all, activities most of the day, nearly

everydayeveryday



Key Symptoms of Major DepressiveKey Symptoms of Major Depressive

Disorder (MDD) / DepressiveDisorder (MDD) / Depressive

EpisodeEpisode(2)(2)

3.3. Significant weight loss when not dieting, or Significant weight loss when not dieting, or

weight gainweight gain

4.4. Insomnia or hypersomniaInsomnia or hypersomnia

5.5. Fatigue or loss of energy nearly everydayFatigue or loss of energy nearly everyday

6.6. Psychomotor agitation or retardationPsychomotor agitation or retardation

7.7. Feelings of worthlessness or excessive or inFeelings of worthlessness or excessive or inappropiate guiltappropiate guilt

8.8. Diminished ability to think or concentrate nearlyDiminished ability to think or concentrate nearly

everydayeveryday



Key Symptoms of Manic EpisodeKey Symptoms of Manic Episode(1)(1)

A. A. A distinct period of abnormally and persistently A distinct period of abnormally and persistently

elevated (euphoria), expansive, or irritable mood,elevated (euphoria), expansive, or irritable mood,

lasting at least 1 weeklasting at least 1 weekB.B. Three or more of the following symptoms haveThree or more of the following symptoms have

persisted :persisted :

1. inflated self 1. inflated self--esteem or grandiosityesteem or grandiosity

2. decreased need for sleep (eg. feels2. decreased need for sleep (eg. feels

rested after only 3 hours of sleep)rested after only 3 hours of sleep)



Key Symptoms of Manic EpisodeKey Symptoms of Manic Episode(2)(2)

3. More talkactive than usual3. More talkactive than usual

4.4. Flight of ideasFlight of ideas

5.5. Distractibility : attention too easily drawn toDistractibility : attention too easily drawn tounimportant or irrelevant external stimuliunimportant or irrelevant external stimuli

6.6. Increase in goalIncrease in goal--directed activity or psychomotor directed activity or psychomotor agitationagitation

7.7. Excessive involvement in pleasureable activitiesExcessive involvement in pleasureable activities

that have a high potential to painfulthat have a high potential to painfulconsequences (unrestrained buying sprees,consequences (unrestrained buying sprees,sexual indiscretious, foolish businesssexual indiscretious, foolish businessinvestments)investments)



Normal AnxietyNormal Anxiety(1)(1)

A diffuse, unpleasant, vague sense of A diffuse, unpleasant, vague sense of

apprehension, often accompanied by autonomicapprehension, often accompanied by autonomic

symptoms such as : headache, perspiration,symptoms such as : headache, perspiration,palpitation, tightness in the chest, mild stomachpalpitation, tightness in the chest, mild stomach

discomfort, and restlessnessdiscomfort, and restlessness

An alerting signal An alerting signal



Normal AnxietyNormal Anxiety(2)(2)

A response to threat that is unknown, internal, A response to threat that is unknown, internal,

vague, or conflictualvague, or conflictual

Adaptive and has lifesaving qualities : anxiety Adaptive and has lifesaving qualities : anxietyprevents damage by alerting the person to carryprevents damage by alerting the person to carry

out certain acts that forestall the danger out certain acts that forestall the danger



Anxiety Disorders Anxiety Disorders

1.1. General Anxiety Disorder General Anxiety Disorder

2.2. Panic Disorder Panic Disorder

3.3. Agoraphobia Agoraphobia



Key Symptoms of General AnxietyKey Symptoms of General Anxiety

DisordersDisorders(1)(1)

Excessive anxiety and worry, difficult to controlExcessive anxiety and worry, difficult to control

the worry :the worry :

Occuring more days for Occuring more days for 6 months about a 6 months about anumber of events or activities restlessness,number of events or activities restlessness,

being easily fatigue, difficulty concentrating,being easily fatigue, difficulty concentrating,

irritability, mucles tension, sleep disturbanceirritability, mucles tension, sleep disturbance



Key Symptoms of General AnxietyKey Symptoms of General Anxiety


Clinically significant distress impairment in social,Clinically significant distress impairment in social,occupational, or other important areas af occupational, or other important areas af




Key Symptoms of Panic DisordersKey Symptoms of Panic Disorders(1)(1)

Recurrent unexpected panic attacks :Recurrent unexpected panic attacks :

A discrete period of intense fear or discomfort, in A discrete period of intense fear or discomfort, in

which 4 of the following symptoms developedwhich 4 of the following symptoms developedabruptly :abruptly :

--Palpitation, pounding heartPalpitation, pounding heart

--SweatingSweating

--Trembling / shakingTrembling / shaking

--Sensation of shortness of breathSensation of shortness of breath



Key Symptoms of Panic DisordersKey Symptoms of Panic Disorders(2)(2)

-- Feeling of chokingFeeling of choking

-- Chest pain / discomfortChest pain / discomfort

-- Nausea / abdominal distressNausea / abdominal distress-- Feeling dizzyFeeling dizzy

-- Fear of losing control/ going crazyFear of losing control/ going crazy

--F

ear of dyingF

ear of dying-- ParesthesiasParesthesias

-- ChillsChills



Key symptoms of AgoraphobiaKey symptoms of Agoraphobia

Anxiety being in places or situatios : outside the Anxiety being in places or situatios : outside the

home alone, being in crowd or standing in line,home alone, being in crowd or standing in line,

being on bridge, travelling in a bus, train, or being on bridge, travelling in a bus, train, or automobileautomobile

The situations are avoided or else are enduredThe situations are avoided or else are endured

with marked distress or with anxiety aboutwith marked distress or with anxiety about

having a panic attack, or require the presence of having a panic attack, or require the presence of companioncompanion



Key Symptoms of SomatoformKey Symptoms of Somatoform


The common feature of the somatoform disorder isThe common feature of the somatoform disorder is

::

-- The presence of physical symptoms that suggestThe presence of physical symptoms that suggesta general medical condition and are not fullya general medical condition and are not fully

explained by a general medical condition, by theexplained by a general medical condition, by the

direct effects of a substance, or by another direct effects of a substance, or by another

mental disorder (eg. Panic disorder)mental disorder (eg. Panic disorder)



Key Symptoms of SomatoformKey Symptoms of Somatoform


-- The symptoms must cause clinically significantThe symptoms must cause clinically significant

distress or impairment in social, occupational,distress or impairment in social, occupational,

or other areas of functioningor other areas of functioning

-- The physical symptoms are not intentionalThe physical symptoms are not intentional

-- There is no diagnosable general medicalThere is no diagnosable general medical

condition to fully account for the physicalcondition to fully account for the physicalsymptomssymptoms



Key Symptoms of Sexual andKey Symptoms of Sexual and

gender identity disordersgender identity disorders

1.1. Sexual dysfunctionSexual dysfunction

2.2. ParaphiliasParaphilias3.3. Gender identity disordersGender identity disorders



1.1. Sexual dysfunction :Sexual dysfunction :

is characterized by disturbance in sexualis characterized by disturbance in sexualdesire and in the psychophysiologicaldesire and in the psychophysiological

changes that characterize the sexualchanges that characterize the sexual

response cycle and cause marked distressresponse cycle and cause marked distress

and interpersonal difficultyand interpersonal difficulty



2. Paraphilia :2. Paraphilia :

recurrent, intense sexually arousing fantasies,recurrent, intense sexually arousing fantasies,

sexual urges, or behaviors generally involvingsexual urges, or behaviors generally involving

-- non human objectnon human object

-- the suffering or humiliation of oneself the suffering or humiliation of oneself

or one¶s partner or one¶s partner

-- children or other nonconsenting personschildren or other nonconsenting persons

that occur over a period of at least 6 months that occur over a period of at least 6 months



3. Gender identity disorders :3. Gender identity disorders :

-- A strong and persistent cross A strong and persistent cross--gender gender

identification, which is the desire to be, or identification, which is the desire to be, or anan

insistence thatinsistence that he or shehe or she is, of the other sexis, of the other sex..

-- As children, both girls and boys show an As children, both girls and boys show anaversion to normative, stereotypically feminineaversion to normative, stereotypically feminine

or masculine clothing and repudiate their or masculine clothing and repudiate their

respective anatomical characteristics.respective anatomical characteristics.



Key Symptoms of PersonalityKey Symptoms of Personality


A. A. An enduring pattern of inner experience and An enduring pattern of inner experience and

behavior that deviates markedly from thebehavior that deviates markedly from the

expectations of the individual¶s culture. Thisexpectations of the individual¶s culture. Thispattern is manifested in two (or more) of thepattern is manifested in two (or more) of the

following areas :following areas :

-- cognition (i.e. ways of perceiving andcognition (i.e. ways of perceiving and

interpreting self, other people, and events)interpreting self, other people, and events)-- affectivity (i.e. the range, intensity, lability, andaffectivity (i.e. the range, intensity, lability, and

appropiateness of emotional response)appropiateness of emotional response)





-- interpersonal functioninginterpersonal functioning

-- impulse controlimpulse control

B.B. The enduring pattern is inflexible and pervasiveThe enduring pattern is inflexible and pervasiveacross a broad range of personal and socialacross a broad range of personal and social

situationssituations

C.C. The enduring pattern leads to clinicallyThe enduring pattern leads to clinically

significant distress or impairment in social,significant distress or impairment in social,occupational, or other important areas of occupational, or other important areas of






D. The pattern is stable and of long duration and itsD. The pattern is stable and of long duration and its

onset can be traced back at least to adolescenceonset can be traced back at least to adolescence

or early adulthoodor early adulthoodE. The enduring pattern is not better accounted for E. The enduring pattern is not better accounted for

as a manifestation or consequences of another as a manifestation or consequences of another

mental disorder mental disorder

F. The enduring pattern is not due to the directF. The enduring pattern is not due to the directphysiological effects of a substance (eg. a drug of physiological effects of a substance (eg. a drug of

abuse, a medication) or a general medicalabuse, a medication) or a general medical

condition (eg. head trauma)condition (eg. head trauma)

07. Mental Disorder and Related Key Symptoms (Dr.tuti w)

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