CRS Insomnia
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8/19/2019 CRS Insomnia
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CASE REPORT SESSIONINSOMNIA
PRECEPTOR : GEMAH NURIPAH ,DR.,SPKJ
PRESENTAN :M RIDHO KURNIANDA
FUJIYARTI
SMF Ilmu kesehaa! "#$a
Rumah Sak# Muhamma%&ah 'a!%u!(
U!#s)a *+
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IDENTITAS PASIENNama : N
Us#a : -+ ahu!
Alama : 'uah 'au
Pe!%#%#ka! : SMA
Peke"aa! : I)u Rumah a!((a
A(ama : Islam
Saus : su%ah me!#kah
Ta!((al Peme#ksaa! : */ "a!ua# / *+-
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KE0UHAN UTAMA sul# #%u.
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ANAMNESA RI1AYAT PENYAKIT
SEKARANG2 AUTOANAMNESA DAN
A00OANAMESA3
Pas#e! %aa!( ke 45l#kl#!#k kesehaa! "#$aMuhamma%&ah 'a!%u!( %e!(a! keluha! sul# #%use"ak 6 )ula! &a!( lalu, 4as#e! measa sul# u!ukmemula# #%u, hal #!# %#asaka! 4as#e! ham4# se#a4
ha# selama - )ula! eakh# #!#. Pas#e! me!(akukesul#a! #%u ese)u ak#)a 4as#e! &a!( selalumem#k#ka! 4eusahaa!!&a &a!( %#kel5la 5leha!ak!&a. Pas#e! me!(aku usaha &a!( %#kel5la 5leha!ak!&a saa #!# se%a!( me!(alam# 4e!uu!a!,
seh#!((a 4as#e! measa selalu mem#k#ka! hal #u,seh#!((a 4as#e! sul# #%u. Pas#e! me!(aku sul# u!ukmemula# #%u.
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Pas#e! )e7e#a )ah$a keluha! #!# %#asaka! se"akusaha &a!( %#kel5la a!ak!&a me!(alam# 4e!uu!a!,
%#sam4#!( #u a%a ka&a$a! 4as#e! &a!( %ulu sem4amem"a%# kak# a!(a!!&a k#!# mem)uka usaha &a!(sama %e!(a! 4as#e!, seh#!((a semua la!((a!a!4as#e! )e4#!%ah ke4a%a usaha ka&a$a! #u, %a!4ase#! measa sa!(a kesal %a! %#kh#a!a# 5lehka&a$a!!&a ese)u.
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Keluha! 4as#e! #!# 4e!ah %#5)a# se)elum!&a, %a!4as#e! measa #%u!&a mula# mem)a#k, ha!&a sa"a
saa #!# 4as#e! kem)al# sul# #%u kae!a 5)a &a!()esa!(kua! su%ah ha)#s
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Pas#e! me!&a!(kal 4e!ah mel#ha aau me!%e!(asesuau &a!( 5a!( la#! #%ak %a4a mel#ha aau
me!%e!(a!&a. Pas#e! "u(a me!&a!(kal mem#l#k#4easaa! malas u!uk me!(e"aka! ak#9#as seha#/ha#!&a se4e# )#asa %a! #%ak measa 7e4a lelahke#ka me!(e"aka! ak#9#as &a!( #!(a!. Pas#e!me!&a!(kal mem#l#k# #$a&a auma, me!(k5!sums#alk5h5l %a! 5)a/5)aa! elaa!(.
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RI1AYAT KE0UARGAHu)u!(a! 4as#e! %e!(a! kelua(a )a#k/)a#k sa"a,#!eaks# %e!(a! ea!((a sek#a %#aku# 4as#e! mas#h
)a#k
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PEMERIKSAAN FISIK Status Generalis
Keadaan Umum: sehat, status gizi cukup
Kesadaran : Compos mentis
Tnda Vital :
T : DBN N : DBN
: DBN S : DBN Status interna : DBN
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Saus Ps#k#a#kus :
R5ma! Muka : el#ha 7emas
Kesa%aa! : C5m45s me!#s
K5!akRa445 : 2;3 A%ekua
O#eas# : T#me < )a#k
Pla7e < )a#k Pes5!< )a#k
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Peha#a! : 'a#k
Pese4s# : #%ak e%a4a halus#!as# %a! #lus#
I!(aa! : e7e! :
#mme%#ae : )a#k
em5e : )a#k
P#k#a!
'e!uk 4#k#a!: Real#s#k
Jala! 4#k#a! : k5hee!
Is# 4#k#a! : 1aham, 5)ses#, 85)#a 2/3
Em5s# : m55% : se%#h, kesal, 7emas a8ek : a454#ae
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Dek5um :
S54a! Sa!u! : 'a#k
Caa )e4aka#a! : )a#k
Ke)es#ha! : 'a#k
T#!(kah laku %a! )#7aa : !5m5ak#8 %a! !5mal =5lume : keas, 7uku4
I!s#(h 58 #ll!ess : )a#k
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DD Ga!((ua! %e4es#
Ga!((ua! 7emas me!&eluuh
Ga!((ua! 7am4ua! A!>#eas %a! %e4es#
Ga!((ua! #%u
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DIAGNOSIS
Aks#s I: Ga!((ua! 7am4ua! A!>#eas %a! %e4es# ;(a!((ua! #%u #!##al #!s5m!#a
Aks#s II: #%ak a%a
Aks#s III: 54as# em4e%eu - )ula! &a!( lalu
Aks#s I=:
4e!%#%#ka! : eakh# SMA
Ek5!5m# : measa usaha!&a kua!( ma"uSu445 : 7uku4 )a#k
4s#k5s5s#al: )a#k
Aks#s =: GAF ?+/@: (e"ala seme!aa %a! %a4a %#aas#,%#sa)#l#as #!(a! %alam s5s#al, 4eke"aa! sek5lah, %ll
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PENATA0AKSANAANUmum Jelaska! 4a%a 4as#e! )ah$a 4a!&ak#!&a eka# ea
%e!(a! 4#k#a!, "a%# 4as#e! haus me!(u)ah 45la k#!&aele)#h %ahulu
E%ukas# e!a!( ke)#asaa! #%u &a!( )a#k
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Ps#k5ea4#: Pe!ea4a! elaksas# %#4eluka! u!uk memasukka! suau
asa 4e!(e!%al#a! 4a%a 4as#e! e!a!( #!(ka ke7emasa!%a! elaksas#!&a.
Ps#k5ea4# kelua(a : %#haa4ka! kelua(a!&a %a4amemaham# (a!((ua! 7emas #!# %a! %a4a me!%uku!(seh#!((a mem)a!u mem4e7e4a 45ses 4e!&em)uha!4e!%e#a.
Me%#kas# Al4aB5lam 6 > +, m(h
A!#%e4essa! : Seal#! + m( a) !5 >
Phe!5)a)#al : >
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PROGNOSIS u5 a% 9#am : %u)#a a% )5!am
u5 a% 8u!7#5!am : %u)#a a% )5!am
u5 a% sa!a#5!am : %u)#a a% malam
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PENDAHU0UAN I!s5m!#a a%alah (e"ala kela#!a! %alam #%u )eu4akesul#a! )eula!( u!uk #%u aau mem4eaha!ka!#%u $alau4u! a%a kesem4aa! u!uk #u. Ge"alaese)u )#asa!&a %##ku# (a!((ua! 8u!(s#5!al saa)a!(u! %a! )eak#9#as %# s#a!( ha#. Sek#a se4e#(a5a!( %e$asa me!(alam# kesul#a! memula# #%u%a!aau mem4eaha!ka! #%u %alam seahu!,%e!(a! @ %# a!aa!&a me!(ak#)aka! (a!((ua!kual#as h#%u4
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I!s5m!#a umum!&a meu4aka! k5!%#s# seme!aaaau "a!(ka 4e!%ek. Dalam )e)ea4a kasus, #!s5m!#a%a4a me!"a%# k5!#s. Hal #!# se#!( %#se)u se)a(a#(a!((ua! 4e!&esua#a! #%u kae!a 4al#!( se#!(e"a%# %alam k5!eks s#uas#5!al ses aku, se4e#4eke"aa! )au aau me!"ela!( u"#a!. I!s5m!#a #!#)#asa!&a h#la!( ke#ka sess5 h#la!( aau #!%#9#%uelah )ea%a4as# %e!(a! sess5. Namu!, #!s5m!#aseme!aa se#!( )eula!( ke#ka e(a!(a! )au aauseu4a mu!7ul %alam keh#%u4a! 4as#e!
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I!s5m!#a "a!(ka 4e!%ek )ela!(su!( selama /-)ula!. Hal #!# )#asa!&a )ehu)u!(a! %e!(a! 8ak5/8ak5 ses &a!( 4es#se!, %a4a s#uas#5!al 2se4e#kema#a! aau 4e!&ak#3 aau l#!(ku!(a! 2se4e#ke)#s#!(a!3. I!s5m!#a k5!#s a%alah se#a4 #!s5m!#a&a!( )ela!(su!( le)#h %a# - )ula!. Hal #!# %a4a%#ka#ka! %e!(a! )e)a(a# k5!%#s# me%#s %a! 4s#k#a#)#asa!&a 4a%a 4as#e! %e!(a! 4e%#s45s#s# &a!(me!%asa# u!uk #!s5m!#a
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PEM'AHASAN De!nisi "nsomnia
Me!uu DSM/I=, I!s5m!#a %#%e!#s#ka! se)a(a#
keluha! %alam hal kesul#a! u!uk memula# aaumem4eaha!ka! #%u aau #%u !5!/es5a#8 &a!()ela!(su!( se#%ak!&a sau )ula! %a! me!&e)a)ka!(a!((ua! s#(!#ka! aau (a!((ua! %alam 8u!(s##!%#9#%u. The International Classifcation o Diseases me!%e!#s#ka! I!s5m!#a se)a(a# kesul#a! memula#
aau mem4eaha!ka! #%u &a!( e"a%# m#!#mal 6malamm#!((u selama m#!#mal sau )ula!.
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Me!uu The International Classifcation o SleepDisorders, #!s5m!#a a%alah kesul#a! #%u &a!( e"a%#ham4# se#a4 malam, %#sea# asa #%ak !&ama!seelah e4#s5%e #%u ese)u. Ja%#, I!s5m!#a a%alah(e"ala kela#!a! %alam #%u )eu4a kesul#a! )eula!(u!uk #%u aau mem4eaha!ka! #%u $alau4u! a%akesem4aa! u!uk melakuka!!&a. I!s5m!#a )uka!suau 4e!&ak#, ea4# meu4aka! suau (e"ala &a!(mem#l#k# )e)a(a# 4e!&e)a), se4e# kela#!a!em5s#5!al, kela#!a! s#k %a! 4emaka#a! 5)a/5)aa!.I!s5m!#a %a4a mem4e!(auh# #%ak ha!&a #!(kae!e(# %a! suasa!a ha# ea4# "u(a kesehaa!, k#!e"a%a! kual#as h#%u4.
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Klasi!kasi "nsomnia
I!s5m!#a P#me
I!s5m!#a 4#me #!# mem4u!&a# 8ak5 4e!&e)a)&a!( "elas. #!s5m!#a aau susah #%u #!# %a4amem4e!(auh# sek#a 6 %a# + 5a!( &a!( me!%e#a#!s5m!#a. P5la #%u, ke)#asaa! se)elum #%u %a!l#!(ku!(a! em4a #%u se#!(kal# me!"a%# 4e!&e)a)
%a# "e!#s #!s5m!#a 4#me #!#.
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I!s5m!#a Seku!%e
I!s5m!#a seku!%e )#asa!&a e"a%# ak#)a e8ek %a# hal
la#!, m#sal!&a k5!%#s# me%#s. Masalah 4s#k5l5(# se4e#4easaa! )ese%#h, %e4es# %a! %eme!#a %a4ame!&e)a)ka! e"a%#!&a #!s5m!#a seku!%e #!# 4a%a %a#+ 5a!(. Sela#! #u masalah s#k se4e# 4e!&ak# ah##s,%#a)ees %a! asa !&e# "u(a %a4a me!&e)a)ka!e"a%#!&a #!s5m!#a seku!%e #!# %a! )#asa!&amem4e!(auh# %a# + 5a!( &a!( me!%e#a #!s5m!#a
aau susah #%u. I!s5m!#a seku!%e "u(a %a4a %#se)a)ka!5leh e8ek sam4#!( %a# 5)a/5)aa! &a!( %#m#!um u!uksuau 4e!&ak# ee!u, 4e!((u!aa! 5)a/5)aa! &a!(elaa!( aau4u! 4e!&alah(u!aa! alk5h5l. Fak5 #!# %a4amem4e!(auh# /* %a# + 5a!( &a!( me!%e#a #!s5m!#a.
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Se7aa #!e!as#5!al #!s5m!#a masuk %alam 6 s#sem%#a(!5s#k &a#u I!e!a#5!al 75%e 58 %#a(!5s#s 2ICD3+, D#a(!5s#7 a!% Sa#s#7al Ma!ual 58 Me!al
D#s5%es 2DSM3 I= %a! I!e!a#5!al Class#7a#5! 58Slee4 D#s5%es 2ISD3.
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Dalam ICD +, #!s5m!#a %#)a(# me!"a%# * &a#u:
. O(a!#k
*. N5! 5(a!#k
D&ss5m!#as 2(a!((ua! 4a%a lama, kual#as %a! $aku#%u3
Paas5m!#as 2a%a e4#s5%e a)!5mal &a!( mu!7ul
selama #%u se4e# m#m4u )uuk, )e"ala! sam)#l#%u, %ll3
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Dalam DSM I=, (a!((ua! #%u 2#!s5m!#a3 %#)a(# me!"a%# #4e &a#u:
. Ga!((ua! #%u &a!( )ek5elas# %e!(a! (a!((ua!me!al la#!
*. Ga!((ua! #%u &a!( %#se)a)ka! 5leh k5!%#s# me%#sumum
6. Ga!((ua! #%u &a!( %##!%uks# 5leh )aha!/)aha! aau
kea%aa! ee!u . Ga!((ua! #%u 4#me 2(a!((ua! #%u #%ak)ehu)u!(a! sama sekal# %e!(a! k5!%#s# me!al, 4e!&ak#,aau4u! 5)a/5)aa!.3 Ga!((ua! #!# me!ea4 %a! %#%e#am#!#mal )ula!.
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Berdasarkan "nternational Classi!cation o# Sleep Disordes $ang dire%isi, insomnia
diklasi!kasikan men&adi:
a' (cute insomnia
a' )s$choph$siologic insomnia
a' )arado*ical insomnia +sleepstate misperception-
a' "diopathic insomnia
a' "nsomnia due to mental disorder
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a' "nade.uate sleep h$giene
a' Beha%ioral insomnia o# childhood
a' "nsomnia due to drug or su/stance
a' "nsomnia due to medical condition
a' "nsomnia not due to su/stance or kno0n ph$siologic condition, unspeci!ed
+nonorganic-
a' )h$siologic insomnia, unspeci!ed +organic-
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K0ASIFIKASI MENURUT
SIMTOMATO0OGI / I!#s#al #!s5m!#a : kesul#a! u!uk memasuk# $aku#%u
/ m#%%le #!s5m!#a : )a!(u! 4a%a e!(ah malam %a!%a4a #%u kem)al# %e!(a! susah 4a&ah
/ lae #!s5m!#a : e)a!(u! elalu 4a(# %a! #%ak %a4a#%u kem)al#
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1tiologi "nsomnia
Ses. Kekha$a#a! e!a!( 4eke"aa!, kesehaa! sek5lah, aau kelua(a%a4a mem)ua 4#k#a! me!"a%# ak#8 %# malam ha#, seh#!((a sul# u!uk#%u. Pe#s#$a keh#%u4a! &a!( 4e!uh ses, se4e# kema#a! aau 4e!&ak#%a# 5a!( &a!( %#7#!a#, 4e7ea#a! aau keh#la!(a! 4eke"aa!, %a4ame!&e)a)ka! #!s5m!#a.
Ke7emasa! %a! %e4es#. Hal #!# mu!(k#! %#se)a)ka! ke#%akse#m)a!(a!k#m#a %alam 5ak aau kae!a kekha$a#a! &a!( me!&ea# %e4es#.
O)a/5)aa!. 'e)ea4a ese4 5)a %a4a mem4e!(auh# 45ses #%u,emasuk )e)ea4a a!#%e4esa!, 5)a "a!u!( %a! eka!a! %aah, 5)a
ale(#, s#mula! 2se4e# R#al#!3 %a! k5#k5se5#%.
Ka8e#!, !#k5#! %a! alk5h5l. K54#, eh, 75la %a! m#!uma! &a!( me!(a!%u!(ka8e#! a%alah s#mula! &a!( eke!al. N#k5#! meu4aka! s#mula! &a!(%a4a me!&e)a)ka! #!s5m!#a. Alk5h5l a%alah 5)a 4e!e!a!( &a!( %a4amem)a!u sese5a!( "auh e#%u, ea4# me!7e(ah aha4 le)#h %alam#%u %a! se#!( me!&e)a)ka! e)a!(u! %# e!(ah malam.
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K5!%#s# Me%#s. J#ka sese5a!( mem#l#k# (e"ala !&e# k5!#s, kesul#a!)e!a4as %a! se#!( )ua!( a# ke7#l, kemu!(k#!a! meeka u!ukme!(alam# #!s5m!#a le)#h )esa %#)a!%#!(ka! meeka &a!( a!4a (e"alaese)u. K5!%#s# #!# %#ka#ka! %e!(a! #!s5m!#a ak#)a a##s, ka!ke,(a(al "a!u!(, 4e!&ak# 4au/4au, (as5es54ha(eal eu> %#sease2GERD3, s5ke, 4e!&ak# Pak#!s5! %a! 4e!&ak# AlBhe#me.
Peu)aha! l#!(ku!(a! aau "a%$al ke"a. Kelelaha! ak#)a 4e"ala!a! "auhaau 4e(esea! $aku ke"a %a4a me!&e)a)ka! e(a!((u!&a #amas#ka%#a! u)uh, seh#!((a sul# u!uk #%u. R#me s#ka%#a! )e#!%akse)a(a# "am #!e!al, me!(au s#klus #%u/)a!(u!, mea)5l#sme, %a! suhu
u)uh. 'ela"a #!s5m!#a. Hal #!# %a4a e"a%# ke#ka A!%a kha$a# )ele)#ha!e!a!( #%ak )#sa #%u %e!(a! )a#k %a! )eusaha elalu keas u!uk "auhe#%u. Ke)a!&aka! 5a!( %e!(a! k5!%#s# #!# #%u le)#h )a#k ke#kameeka )ea%a "auh %a# l#!(ku!(a! #%u &a!( )#asa aau ke#ka meeka#%ak me!75)a u!uk #%u, se4e# ke#ka meeka me!5!5! T= aaumem)a7a.
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2aktor esiko "nsomnia
Ham4# se#a4 5a!( mem#l#k# kesul#a! u!uk #%u
4a%a malam ha# ea4# es#k5 #!s5m!#a me!#!(ka "#kae"a%# 4a%a:
1a!#a. Peem4ua! le)#h mu!(k#! me!(alam##!s5m!#a. Peu)aha! h5m5! selama s#klus me!suas#%a! me!54ause mu!(k#! mema#!ka! 4ea!. Selama
me!54ause, se#!( )eke#!(a 4a%a malam ha# %a!h5 ashes se#!( me!((a!((u #%u.
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Us#a le)#h %a# -+ ahu!. Kae!a e"a%# 4eu)aha! %alam45la #%u, #!s5m!#a me!#!(ka se"ala! %e!(a! us#a.
Mem#l#k# (a!((ua! kesehaa! me!al. 'a!&ak (a!((ua!,emasuk %e4es#, ke7emasa!, (a!((ua! )#45la %a! 45s/auma#7 sess %#s5%e, me!((a!((u #%u.
Ses. Ses %a4a me!&e)a)ka! #!s5m!#a seme!aa,sess "a!(ka 4a!"a!( se4e# kema#a! 5a!( &a!( %#kas#h#aau 4e7ea#a!, %a4a me!&e)a)ka! #!s5m!#a k5!#s.Me!"a%# m#sk#! aau 4e!(a!((ua! "u(a me!#!(kaka!#s#k5 e"a%#!&a #!s5m!#a.
Pe"ala!a! "auh 2Je la(3 %a! Peu)aha! "a%$al ke"a.'eke"a %# malam ha# se#!( me!#!(kaka! es#k5 #!s5m!#a.
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Tanda dan Ge&ala "nsomnia Kesul#a! u!uk memula# #%u 4a%a malam ha#
Se#!( e)a!(u! 4a%a malam ha#
'a!(u! #%u elalu a$al
Kelelaha! aau me!(a!uk 4a%a s#a!( ha#
I#a)#l#as, %e4es# aau ke7emasa!
K5!se!as# %a! 4eha#a! )ekua!(
Pe!#!(kaa! kesalaha! %a! ke7elakaa!
Kee(a!(a! %a! sak# ke4ala
Ge"ala (as5#!es#!al
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Diagnosis
U!uk me!%#a(!5s#s #!s5m!#a, %#lakuka! 4e!#la#a!eha%a4:
P5la #%u 4e!%e#a.
Pemaka#a! 5)a/5)aa!, alk5h5l, aau 5)a elaa!(.
T#!(kaa! ses 4s#k#s.
R#$a&a me%#s. Ak#9#as s#k
D#a(!5s#s )e%asaka! ke)uuha! #%u se7aa #!%#9#%ual.
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Kriteria Diagnostik "nsomnia Non3rganik/erdasarkan ))DG4
Hal ese)u %# )a$ah #!# %#4eluka! u!uk mem)ua%#a(!5s#s 4as#:
Keluha! a%a!&a kesul#a! masuk #%u aaumem4eaha!ka! #%u, aau kual#as #%u &a!( )uuk
Ga!((ua! m#!#mal e"a%# 6 kal# %alam sem#!((uselama m#!#mal )ula!
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A%a!&a 4e5ku4as# %e!(a! #%ak )#sa #%u %a! 4e%ul# &a!()ele)#ha! eha%a4 ak#)a!&a 4a%a malam ha# %a! se4a!"a!(
s#a!( ha#
Ke#%ak4uasa! eha%a4 kua!#as %a! aau kual#as #%ume!&e)a)ka! 4e!%e#aa! &a!( 7uku4 )ea %a! mem4e!(auh#8u!(s# %alam s5s#al %a! 4eke"aa!
A%a!&a (a!((ua! "#$a la#! se4e# %e4es# %a! a!>#eas #%akme!&e)a)ka! %#a(!5s#s #!s5m!#a %#a)a#ka!.
K#e#a lama #%u 2kua!#as3 #%ak %#(ua!ka! u!ukme!e!uka! a%a!&a (a!((ua!, 5leh kae!a luas!&a 9a#as#
#!%#9#%ual. 0ama (a!((ua! &a!( #%ak meme!uh# k#e#a %# aas2se4e# 4a%a a!s#e! #!s5m!#a3 #%ak %#%#a(!5s#s %# s#!#, %a4a%#masukka! %alam eaks# ses aku 2F6.+3 aau (a!((ua!4e!&esua#a! 2F6.*3
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6 Tatalaksana
Non 2armakoterapi Terapi Tingkah 7aku
Tea4# #!(kah laku )eu"ua! u!uk me!(au45la #%u &a!( )au %a! me!(a"aka! 7aau!uk me!&ama!ka! suasa!a #%u. Tea4#
#!(kah laku #!# umum!&a %#ek5me!%as#ka!se)a(a# ea4# aha4 4eama u!uk 4e!%e#a#!s5m!#a.
Tea4# #!(kah laku mel#4u#
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E%ukas# e!a!( ke)#asaa! #%u &a!( )a#k.
Tek!#k Relaksas#.
Mel#4u# meelaksas#ka! 55 se7aa 45(es#8, mem)ua)#58ee%)a7k, %a! la#ha! 4e!a4asa!. Caa #!# %a4a mem)a!ume!(ua!(# ke7emasa! saa #%u. Sae(# #!# %a4a mem)a!uA!%a me!(5!5l 4e!a4asa!, !a%#, 5!us 55, %a! m55%.
Tea4# k5(!##8.
Mel#4u# meu)ah 45la 4#k# %a# kekha$a#a! #%ak #%u %e!(a!
4em#k#a! &a!( 45s##8. Tea4# k5(!##8 %a4a %#lakuka! 4a%ak5!sel#!( aa4 muka aau %alam (u4.
Res#ks# T#%u.
Tea4# #!# %#maksu%ka! u!uk me!(ua!(# $aku &a!( %#ha)#ska! %#em4a #%u &a!( %a4a mem)ua lelah 4a%a malam )e#ku!&a.
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K5!5l s#mulus
Tea4# #!# %#maksu%ka! u!uk mem)aas# $aku &a!(
%#ha)#ska! u!uk )eak#9#as. I!suks# %alam ea4# s#mulus/k5!5l:
Gu!aka! em4a #%u ha!&a u!uk #%u, #%ak u!ukmem)a7a, me!5!5! ele9#s#, maka! aau )eke"a.
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Pe(# ke em4a #%u ha!&a )#la su%ah me!(a!uk. '#la%alam $aku *+ me!# %# em4a #%u sese5a!( #%ak "u(a)#sa #%u, #!((alka! em4a #%u %a! 4e(# ke ua!(a! la#!
%a! melakuka! hal/hal &a!( mem)ua sa!a#. H#!%a#me!5!5! ele9#s#. '#la su%ah measa me!(a!uk kem)al# keem4a #%u, !amu! )#la alam *+ me!# %# em4a #%u #%ak "u(a %a4a #%u, kem)al# lakuka! hal &a!( mem)ua sa!a#,%a4a )eula!( %#lakuka! sam4a sese5a!( %a4a #%u.
'a!(u! %# 4a(# ha# 4a%a "am &a!( sama a!4ame!(#!%ahka! )ea4a lama #%u 4a%a malam se)elum!&a.Hal #!# %a4a mem4e)a#k# "a%$al #%u/)a!(u! 2k5!5l$aku3.
T#%u s#a!( haus %#h#!%a#.
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Ga$a hidup dan pengo/atan di rumah
'e)ea4a hal &a!( %a4a %#lakuka! u!uk
me!(aas# #!s5m!#a : Me!(au "a%$al #%u &a!( k5!s#se! emasuk4a%a ha# l#)u
T#%ak )ea%a %# em4a #%u ke#ka #%ak #%u.
T#%ak memaksaka! %## u!uk #%u "#ka #%ak )#sa.
Ha!&a me!((u!aka! em4a #%u ha!&a u!uk#%u.
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Relaksas# se)elum #%u, se4e# ma!%# a# ha!(a, mem)a7a,la#ha! 4e!a4asa! aau )e#)a%ah
Me!(h#!%a# aau mem)aas# #%u s#a!( kae!a aka! me!&ul#ka!
#%u 4a%a malam ha#.
Me!&#a4ka! suasa!a !&ama! 4a%a kama u!uk #%u, se4e#me!(h#!%a# ke)#s#!(a!
Olaha(a %a! ea4 ak#8, se4e# 5laha(a selama *+ h#!((a 6+me!# se#a4 ha# sek#a l#ma h#!((a e!am "am se)elum #%u.
Me!(h#!%a# ka8e#!, alk5h5l, %a! !#k5#!
Me!(h#!%a# maka! )esa se)elum #%u
Cek kesehaa! se7aa u#!
J#ka e%a4a !&e# %a4a %#(u!aka! a!al(es#k
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Famak5l5(#
Pe!(5)aa! #!s5m!#a se7aa 8amak5l5(# %#)a(#
me!"a%# %ua (5l5!(a! &a#u )e!B5%#aBe4#!e %a! !5!/)e!B5%#aBe4#!e.
'e!B5%#aBe4#!e 2N#aBe4am,T#B5lam, %a! EsaB5lam3
N5! )e!B5%#aBe4#!e 2Chl5al/h&%ae, Phe!5)a)#al3
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Pem#l#ha! 5)a, %##!"au %a# s#8a (a!((ua! #%u :
I!##al I!s5m!#a 2sul# masuk ke %alam 45ses #%u3
O)a &a!( %#)uuhka! a%alah )es#8a Slee4 #!%u7#!(a!#/#!s5m!#a &a#u (5l5!(a! )e!B5%#aBe4#!e 2Sh5A7#!(3 M#sal!&a 4a%a (a!((ua! a!>#eas
Dela&e% I!s5m!#a 245ses #%u elalu 7e4a )eakh#%a! sul# masuk kem)al# ke 45ses #%u sela!"u!&a3
O)a &a!( %#)uuhka! a%alah )es#8a P5l5!( lae!4hase A!#/I!s5m!#a, &a#u (5l5!(a! hee5s#kl#ka!#%e4esa! 2T#s#kl#k %a! Teas#kl#k3
M#sal!&a 4a%a (a!((ua! %e4es#
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'5ke! I!s5m!#a 2s#klus 45ses #%u &a!( !5mal #%akuuh %a! e4e7ah/4e7ah me!"a%# )e)ea4a )a(#a!2mul#4le a$ake!#!(3.
O)a &a!( %#)uuhka! a%alah )es#8a Slee4Ma#!a#!#!( A!#/I!s5m!#a, &a#u (5l5!(a!4he!5)a)#al aau (5l5!(a! )e!B5%#aBe4#!e 205!(a7#!(3.
M#sal!&a 4a%a (a!((ua! ses 4s#k5s5s#al.
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KOMP0IKASI
Ga!((ua! %alam 4eke"aa! aau %# sek5lah.
Saa )eke!%aa, eaks# ee> aka! le)#h lam)a.Seh#!((a me!#!(kaka! eaks# ke7elakaa!.
Masalah ke"#$aa!, se4e# ke7emasa! aau %e4es#
Kele)#ha! )ea )a%a! aau ke(emuka!
Da&a aha! u)uh &a!( e!%ah
Me!#!(kaka! es#k5 %a! ke4aaha! 4e!&ak# "a!(ka4a!"a!(, 75!5h!&a eka!a! %aah &a!( #!((#, sak# "a!u!(, %a! %#a)ees.
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)rognosis
P5(!5s#s umum!&a )a#k %e!(a! ea4# &a!( a%ekua
%a! "u(a ea4# 4a%a (a!((ua! la#! se4e# %e4es# %a!la#!/la#!. 0e)#h )uuk "#ka (a!((ua! #!# %#sea#sk#B54he!#a