Professional Documents
Culture Documents
TABLE OF CONTENTS
Page
Table of Contens
Facilitators
Important Informations
12
Students Project
12
14
Assessment Method
14
Learning Programs
15
52
Curriculum Mapping
59
References
60
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.
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.
NAME
Dr dr Cokorda Bagus Jaya Lesmana, SpKJ (K)
(Head)
DEPARTMENT
PHONE
Psychiatry
0816295779
Psychiatry
0361 7814010
Psychiatry
085737717244
Obgyn
081558101719
DEPARTMENT
PHONE
Lectures
No
NAME
Psychiatry
0816295779
Psychiatry
0361 7814010
Psychiatry
08174709797
Psychiatry
08123813831
Psychiatry
08123806397
Psychiatry
081338748051
Psychiatry
085737717244
Psychiatry
08123926522
Neurology
0811388818
Obgyn
081558101719
Internal Medicine
08155736480
Pharmacology
08123650481
Psychology
08123764595
10
11
Dr dr Wiragotra, SpPD
12
13
Facilitators
Class A
No
Name
10
4
5
6
7
8
Group
A1
A2
A3
A4
A5
A6
A7
A8
A9
A10
Dept
Phone
Clinical
Pathology
Interna
08155735034
081236194672
Microbiology
087862200814
Surgery
081337048460
Anatomy
087860405625
Radiology
08990179750
Opthalmology
081338341860
Anatomy
Pathology
Dermatology
08174761804
Forensic
081338472005
08123978446
Venue
(3rdfloor)
3rd floor:
R.3.09
3rd floor:
R.3.10
3rd floor:
R.3.11
3rd floor:
R.3.12
3rd floor:
R.3.13
3rd floor:
R.3.14
3rd floor:
R.3.15
3rd floor:
R.3.16
3rd floor:
R.3.17
3rd floor:
R.3.19
Class B
No
1
Name
6
7
8
9
10
Group
B1
B2
B3
B4
B5
B6
B7
B8
B9
B10
Dept
Phone
Venue
(3rdfloor)
Psychiatry
0816295779
Public Health
0818560008
Interna
08123853700
Pharmacology
087861030195
Surgery
081558724088
Histology
08124665966
Anasthesi
081338568883
Anatomy
Pathology
Fisiology
08113803933
08174742566
ENT
081338701878
3rd floor:
R.3.09
3rd floor:
R.3.10
3rd floor:
R.3.11
3rd floor:
R.3.12
3rd floor:
R.3.13
3rd floor:
R.3.14
3rd floor:
R.3.15
3rd floor:
R.3.16
3rd floor:
R.3.17
3rd floor:
R.3.19
Time Table
Engglish Class
Day/
Date
1
Tuesday
5 April
2016
2
Wed
6 April
2016
3
Thursday
7 April
2016
4
Fri
8 April
2016
5
Monday
11 April
2016
6
Tuesday
12 April
2016
7
Wed
13 April
2016
8
Thursday
14 April
2016
Time
Activity
Venue
08.00 09.00
Class room
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
Lecture 1: Introduction to
Behavior Changes and Disorders
Independent learning
Group Discussion
Break and student project
Plenary session
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 09.00
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
08.00 09.00
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
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
Conveyer
Dr Sri Wahyuni
Discussion room
Class room
Dr Sri Wahyuni
Class room
DR Wulanyani
Discussion room
Class room
DR Wulanyani
Class room
Dr Alit Aryani
Discussion room
Dr Alit Aryani
Class room
Class room
DR Dr IB Fajar
Discussion room
Class room
DR Dr IB Fajar
Class room
DR Dr Laksmi
Discussion room
Class room
DR Dr Laksmi
Class room
DR Dr Wiragotra
Discussion room
Class room
DR Dr Wiragotra
Class room
Dr Sr Diniari
Discussion room
Class room
Dr Sri Diniari
Class room
Dr Sri Diniari
Discussion room
Class room
Dr Sri Diniari
9
Friday
15 April
2016
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
08.00 09.00
10
Monday
18 April
2016
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
08.00 09.00
11
Tuesday
19 April
2016
12
Wed
20 April
2016
13
Thursday
21 April
2016
14
Friday
22 April
2016
15
Monday
25 April
2016
16
Tuesday
26 April
2016
17
Wed
27 April
2016
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 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 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 09.00
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
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 Dayu
Discussion room
Class room
Dr Dayu
Class room
Dr Indah
Discussion room
Class room
Dr Indah
Class room
Dr Indah
Discussion room
Class room
Dr Indah
Class room
Dr Lely
Discussion room
Class room
Dr Lely
Class room
DR Dr Cok Bagus
Discussion room
Class room
DR Dr Cok Bagus
Class room
Dr Dayu
Discussion room
Class room
Dr Dayu
18
Thursday
28 April
2016
19
Friday
29 April
2016
20
Monday
2 May
2016
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 09.00
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
08.00 09.00
21
Tuesday
3 May
2016
22
09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00
Wed
11 May
2016
Thursday
12 May
2016
Class room
Dr Artini
Class room
Dr Lely
Discussion room
Class room
Dr Lely
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
08.00 15.00
Skill Lab
Team Psychiatry
08.00 15.00
Skill Lab
Team Psychiatry
08.00 15.00
Skill Lab
Team Psychiatry
Tuesday
10 May
2016
25
Discussion room
Monday
9 May
2016
24
Dr Artini
08.00 15.00
Wed
4 May
2016
23
Class room
Pre-evaluation Break
26
Friday
13 May
2016
Examination
Regular Class
Day/
Date
1
Tuesday
5 April
2016
2
Wed
6 April
2016
3
Thursday
7 April
2016
4
Fri
8 April
2016
5
Monday
11 April
2016
6
Tuesday
12 April
2016
7
Wed
13 April
2016
8
Thursday
14 April
2016
Time
Activity
Venue
09.00 10.00
Class room
Dr Sri Wahyuni
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
Discussion room
Class room
Dr Sri Wahyuni
09.00 10.00
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
Class room
DR Wulanyani
Discussion room
Class room
DR Wulanyani
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
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
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
Conveyer
Class room
Dr Alit Aryani
Discussion room
Class room
Dr Alit Aryani
Class room
DR Dr IB Fajar
Discussion room
Class room
DR Dr IB Fajar
Class room
DR Dr Laksmi
Discussion room
Class room
DR Dr Laksmi
Class room
DR Dr Wiragotra
Discussion room
Class room
DR Dr Wiragotra
Class room
Dr Sr Diniari
Discussion room
Class room
Dr Sr Diniari
Class room
Dr Sr Diniari
Discussion room
Class room
Dr Sri Diniari
9
Friday
15 April
2016
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
09.00 10.00
10
Monday
18 April
2016
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
09.00 10.00
11
Tuesday
19 April
2016
12
Wed
20 April
2016
13
Thursday
21 April
2016
14
Friday
22 April
2016
15
Monday
25 April
2016
16
Tuesday
26 April
2016
17
Wed
27 April
2016
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
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
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
10.00 12.00
12.00 13.30
13.30 15.00
15.00 16.00
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 Dayu
Discussion room
Class room
Dr Dayu
Class room
Dr Indah
Discussion room
Class room
Dr Indah
Class room
Dr Indah
Discussion room
Class room
Dr Indah
Class room
Dr Lely
Discussion room
Class room
Dr Lely
Class room
DR Dr Cok Bagus
Discussion room
Class room
DR Dr Cok Bagus
Class room
Dr Dayu
Discussion room
Class room
Dr Dayu
10
18
Thursday
28 April
2016
19
Friday
29 April
2016
20
Monday
2 May
2016
21
Tuesday
3 May
2016
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
09.00 16.00
Wed
4 May
2016
23
25
Discussion room
Class room
Dr Artini
Class room
Dr Lely
Discussion room
Class room
Dr Lely
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
Skill Lab
Psychiatric Team
09.00 16.00
Skill Lab
Psychiatric Team
09.00 16.00
Skill Lab
Psychiatric Team
Tuesday
10 May
2016
Wed
11 May
2016
Dr Artini
09.00 16.00
Monday
9 May
2016
24
Class room
Thursday
12 May
2016
Pre-evaluation Break
26
Friday
13 May
2016
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 2014 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
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Topic
Internet gaming addiction
Persistent Depressive Disorder
Kleptomania
Conversion Disorder
Physician Assissted Suicide
Premenstrual Dysphoric Disorder.
Dissociative Disorders
Gender Dysphoria
Gambling Disorder.
Paranoid Personality Disorder.
Autism Spectrum Disorder
Attention-Deficit/Hyperactivity Disorder (ADHD)
Intellectual Disability
Disruptive Mood Dysregulation Disorder.
Body Dysmorphic Disorder.
Reactive Attachment Disorder.
Persistent Complex Bereavement Disorder.
Binge Eating Disorder.
Oppositional Defiant Disorder.
Conduct Disorder.
Group
A1
A2
A3
A4
A5
A6
A7
A8
A9
A10
B1
B2
B3
B4
B5
B6
B7
B8
B9
B10
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
Blok
Name/NIM
Facilitator
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)/3
7
7
7
8
8
8
Tutor Sign
9
9
9
10
10
10
= __________
Denpasar,
Facilitator
13
~ 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
Learning Programs
Modul
1
Introduction to Behavior and Disorders
dr Anak Ayu Sri Wahyuni, SpKJ
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
16
Modul
2
Psychological Testing
DR. Ni Made Swasti Wulanyani, S.Psi., M.Erg., Psi
AIMS:
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
CURRICULUM CONTENTS:
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:
Basic knowledge that must be known:
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
17
18
Modul
3
General Approaches to Substance Abuse
dr. Luh Nyoman Alit Aryani, SpKJ
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
CURRICULUM CONTENTS:
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.
SELF DIRECTING LEARNING
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
19
20
Modul
4
Prenatal Psychobiology (Case of Baby Blues)
Dr dr Ida Bagus Fajar Manuaba, SpOG, MARS
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)
CURRICULUM CONTENTS:
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
4. Diagnosis formulation
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.
SELF DIRECTING LEARNING
Basic knowledge that must be known:
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.
21
22
Modul
5
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
CURRICULUM CONTENTS:
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:
Case 1 :
A 65 year old man complains of forgetfulness (decreased of memory) since 3 months
ago. He also get weakness at the leftside of the body since 6 months ago.
23
Task to do:
1. Do the examination or observation of the ability of taking history of patient's to
assess the clinical diagnosis of this case.
2. Do the examination or observation of the ability to examine neurobehavior
assessment to assess the diagnosis of this case
3. Do the examination or observation of the ability to communicate and educate
patient (professional skill)
Case 2 :
a 70 year old woman come to hospital with her husband due to agitated and wandering
several days before.
Task to do:
1. Do the examination or observation of the ability of taking history of patient's to
assess the clinical diagnosis of this case.
2. Do the examination or observation of the ability to examine neurobehavior
assessment to assess the diagnosis of this case
3. Do the examination or observation of the ability to communicate and educate patient
(professional skill)
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Behavior Changes Due to a General Medical Condition
Dr dr Wira Gotra, 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)
CURRICULUM CONTENTS:
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
4. Diagnosis formulation
5. Modality of treatment of Behavior Changes Due to a General Medical Condition
24
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
SELF DIRECTING LEARNING
Basic knowledge that must be known:
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.
3.
Management of Behavior Changes Due to a General Medical Condition.
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Delirium and Dementia
dr Ni Ketut Sri Diniari, SpKJ
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)
25
CURRICULUM CONTENTS:
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.
SELF DIRECTING LEARNING
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 male patient, 48 years old hospitalized with diagnoses of stroke, after 2 days treatment
patient becomes agitated, screaming, incoherent, start to seeing creepy shadows behind
the curtain, and unable to recognize his accompanied family during that time. His
conciousness is fluctuative. The patient has no previous psychiatric history.
LEARNING TASK
A. What is the psychiatric signs and symptoms of this patient?
B. What is the screening tools to diagnose the patient?
C. What is conciousness condition of delirium patient?
D. How to manage a delirium patient?
E. What is pharmacology theraphy of delirium patient? And how to determined the
dosage?
SCENARIO 2
A female patient, 78 years old, found lost at some road. Seems confused, and did not recall
her way home. She also lost her memory about what just happened to her, but still manage
to recall her home address, her childern name, and her previous profession/activity as a
merchant. She repeatedly mentioned that she will go to market to do her activity as a
merchant. Her test for MMSE = 15.
LEARNING TASK
A. What is the psychatric symptoms of this patient?
B. How to assess patients fast-term memory, short-term memory, and long-term
memory?
C. What is the patient diagnose?
D. How to differentiate the diagnose of delirium, dementia, and depression?
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8
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.
SELF DIRECTING LEARNING
Basic knowledge that must be known:
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
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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
CURRICULUM CONTENTS:
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).
SELF DIRECTING LEARNING
Basic knowledge that must be known:
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
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10
Schizophrenia & Other Psychosis
Dr dr Cokorda Bagus Jaya Lesmana, SpKJ (K)
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)
CURRICULUM CONTENTS:
1. Anamnesis
2. History taking (fundamental four and secret seven) of Schizophrenia & Other
Psychosis
3. Mental state examination of Schizophrenia & Other Psychosis
4. Diagnosis formulation
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.
SELF DIRECTING LEARNING
32
Self-Assessment:
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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).
SELF DIRECTING LEARNING
Basic knowledge that must be known:
1. Able to make diagnostic and management Delusional disorder
2. Able to make diagnostic and management schizoafective disorder
SCENARIO
1. A 36-year-old woman is brought to the psychiatrist by her husband because for the
past 8 months she has refused to go out of the house, believing that the neighbors
are trying to harm her. She is afraid that if they see her they will hurt her, and she
34
2. A 21-year-old man is brought to the emergency room by his parents because he has
not slept, bathed, or eaten in the past 3 days. The parents report that for the past 6
months their son has been acting strangely and not himself. They state that he has
been locking himself in his room, talking to himself, and writing on the walls. Six
weeks prior to the emergency room visit, their son became convinced that a fellow
student was stealing his thoughts and making him unable to learn his school
material. In the past 2 weeks, they have noticed that their son has become
depressed and has stopped taking care of himself, including bathing, eating, and
getting dressed. On examination, the patient is dirty, disheveled, and crying. He
complains of not being able to concentrate, a low energy level, and feeling suicidal.
Learning task
1.
2.
3.
4.
SELF ASSESSMENT
1.
2.
3.
4.
5.
6.
7.
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12
Bipolar Disorders & Other Mood Related Disorders
dr. Ida Ayu Kusuma Wardani, SpKJ, MARS
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
CURRICULUM CONTENTS:
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-
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13
Panic Disorders
dr I Gusti Ayu Indah Ardani, SpKJ
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
CURRICULUM CONTENTS:
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.
SELF DIRECTING LEARNING
Basic knowledge that must be known:
1. The procedure of interviewing panic disorders
2. Formulating diagnosis for panic disorders
3. Management of panic disorders
SCENARIO
Miss C, 20 years old, single, high school graduate, I was in a crowded shopping centre
when this happened. I became like a crazy woman within seconds. it was like a nightmare
only I was in an aware condition, everything went dark and my body and my hand was
sweating a lot, even my hair was wet; my back and leg felt very week and couldnt move. I
felt like I was controlled by something stronger. I felt like every faces looking at me but
without bodies; everything was mixed into one. My heart started palpitating inside my head
and ears, I thought my heart going to stop beating, I saw a black and yellow light, I could
hear sound like from a far. I couldnt think anything, except the feeling and how I should get
out or I will die. For me it felt like happen for hours. When I was home I feel exhausted and
I was crying, then I felt normal on the day after.
The first time Miss C experiencing panic attack, she was working at McDonald. It was two
days before her 20th birthday. Because she hand over a BIG MAG to a costumer, she has
her most terrible experience on her life. The earth looks like riven , her heart started to
palpating, she felt been smothered, she sweat, and she was sure that she will having heart
attack and die. After 20 minutes of terror, the panic clam down. She got into her car and
rush home with shaking, never leave her house for almost the next three months. Since
then Miss C had it for three times in one month. She didnt know when they will come. For
one attack, she felt fear, burning chest pain, tighten, strangling, dizziness, and shakiness.
38
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14
Somatoform Disorders
dr I Gusti Ayu Indah Ardani, SpKJ
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
3. Examine mental state
4. Diagnosis
5. Therapy (pharmacotherapy, psychotherapy)
CURRICULUM CONTENTS:
1. Anamnesis
2. History taking (fundamental four and secret seven) of somatoform disorders
3. Mental state examination of somatoform disorders
4. Diagnosis formulation
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
39
SCENARIO
Mr. BS, private employees, 30 years old, he felt he has moveable disease almost for one
year. He complained stiffness, unwell feeling, fullness stomach, and nausea. He also often
felt cold sweating.
Mr BS often felt asphyxiated while breathing. He said that he did ever go to internal
department for treatment, and did some test, but the result of the test was in normal range.
Did not believe of the result; because he felt there was something wrongs within him self.
From the others internist doctor, Mr BS was suggested to visit psychiatric department
because there were probably psychiatric problem that underlying his complain.
After receiving the advice he got angry and saidam I crazy, doc?!, because he felt that
nothing is wrong with his life. Even there was a problem, he mostly keep it to him self and
never share it to others even to his own wife.
LEARNING TASK
1. What is the sign and symptom from the anamnesis of this patient?
2. What is the most probable diagnosis for this patient?
3. How is the comprehensive management of this patient?
SELF ASSESSMENT
1.
2.
3.
4.
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15
Generalized Anxiety & Obsessive Compulsive Disorder
dr Lely Setyawati, SpKJ (K)
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
3. Examine mental state
4. Diagnosis
5. Therapy (pharmacotherapy, psychotherapy)
CURRICULUM CONTENTS:
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
4. Diagnosis formulation
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.
SELF DIRECTING LEARNING
Basic knowledge that must be known:
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
41
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16
Post Traumatic Stress Disorder (PTSD)
Dr dr Cokorda Bagus Jaya Lesmana, SpKJ (K)
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
3. Examine mental state
4. Diagnosis
5. Therapy (pharmacotherapy, psychotherapy)
CURRICULUM CONTENTS:
1. Anamnesis
2. History taking (fundamental four and secret seven) of PTSD
3. Mental state examination PTSD
4. Diagnosis formulation
5. Modality of treatment of PTSD
ABSTRACTS
Posttraumatic stress disorder is classified as Trauma- and Stressor-Related Disorders in the
DSM-5; 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.
43
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.
44
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17
Sexual Disorders
dr. Ida Ayu Kusuma Wardani, SpKJ, MARS
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.
SELF DIRECTING LEARNING
Basic knowledge that must be known:
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
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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
CURRICULUM CONTENTS:
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
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19
Self Harm & Suicide
dr Lely Setyawati, SpKJ (K)
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.
SELF DIRECTING LEARNING
Basic knowledge that must be known:
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?
Ada halusinasi, gatal.
2. What are the methods of self-harm?
Iris tangan dan paha
3. Please explain pathophysiology?
4. What is the diagnosis?
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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?
Modul
20
Child Abuse & Neglected
dr Anak Ayu Sri Wahyuni, SpKJ
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
CURRICULUM CONTENTS:
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
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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
CURRICULUM CONTENTS:
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).
SELF DIRECTING LEARNING
Basic knowledge that must be known:
1. The procedure of interviewing psychiatric disorders
2. Formulating mental status for psychiatric diagnosis
3. Management of psychiatric disorders
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Modul
BASIC CLINICAL SKILL
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. 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
CURRICULUM CONTENTS:
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.
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Modul
BASIC CLINICAL SKILL
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. 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
CURRICULUM CONTENTS:
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.
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Modul
BASIC CLINICAL SKILL
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. 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
CURRICULUM CONTENTS:
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
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Modul
BASIC CLINICAL SKILL
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. 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
CURRICULUM CONTENTS:
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
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~ CURRICULUM MAP ~
Smstr
10
Senior Clerkship
Senior Clerkship
Senior clerkship
Medical
Emergency
(3 weeks)
Special Topic:
-Travel medicine
(2 weeks)
Clinic
Orientation
(Clerkship)
(6 weeks)
BCS (1 weeks)
The Respiratory
System and
Disorders
(4 weeks)
The Cardiovascular
System and
Disorders
(4 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)
References
Udayana University Faculty of Medicine, DME
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