* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Medical Informatics and Evidence Based Medicine
Autism spectrum wikipedia , lookup
Memory disorder wikipedia , lookup
Comorbidity wikipedia , lookup
Antisocial personality disorder wikipedia , lookup
Eating disorders and memory wikipedia , lookup
Factitious disorder imposed on another wikipedia , lookup
Eating disorder wikipedia , lookup
Conversion disorder wikipedia , lookup
Treatments for combat-related PTSD wikipedia , lookup
Drug rehabilitation wikipedia , lookup
Bipolar II disorder wikipedia , lookup
Separation anxiety disorder wikipedia , lookup
Schizoaffective disorder wikipedia , lookup
Generalized anxiety disorder wikipedia , lookup
Asperger syndrome wikipedia , lookup
Munchausen by Internet wikipedia , lookup
Glossary of psychiatry wikipedia , lookup
Spectrum disorder wikipedia , lookup
Mental disorder wikipedia , lookup
Diagnosis of Asperger syndrome wikipedia , lookup
Depression in childhood and adolescence wikipedia , lookup
Treatment of bipolar disorder wikipedia , lookup
Causes of mental disorders wikipedia , lookup
Dissociative identity disorder wikipedia , lookup
Child psychopathology wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
Pyotr Gannushkin wikipedia , lookup
Study Guide Behavior Changes and Disorders TABLE OF CONTENTS Page Table of Contens 1 The Seven General Core Competencies 2 Planner team & Lecturers 3 Facilitators 5 Time Table (Regular Class) 6 Time Table (English Class) 7 Important Informations 12 Student’s Project 12 Meeting of the students’ representative 14 Assessment Method 14 Learning Programs 15 Basic Clinical Skill 57 Curriculum Mapping 64 References 65 Udayana University Faculty of Medicine, DME 1 Study Guide Behavior Changes and Disorders The Seven General Core Competencies 1. Patient Care Demonstrate capability to provide comprehensive patient care that is compassionate, appropriate, and effective for the management of health problems, promotion of health and prevention of disease in the primary health care settings. 2. Medical Knowledge Base Mastery of a core medical knowledge which includes the biomedical sciences, behavioral sciences, epidemiology and statistics, clinical sciences, the social aspect of medicine and the principles of medical ethics 3. Clinical skill Demonstrate capability to effectively apply clinical skills and interpret the findings in the investigation of the patients 4. Communication Demonstrate capability to communicate effectively and interpersonally to establish rapport with the patient, family, community at large, and professional associates, that results in effective information exchange, the creation of a therapeutically and ethically sound relationship 5. Information Management Demonstrate capability to manager information which includes information access, retrieval, interpretation, appraisal, and application to patience’s specific problem, and maintaining records of his or her proactive for analysis and improvement 6. Professionalism Demonstrate a commitment to carrying out professional responsibilities and to personal probity, adherence to ethical principles, sensitivity to a diverse patient population and commitment to carrying out continual self-evaluation of his or her professional standard and competence 7. Community-based and health system-based practice Demonstrate awareness and responsiveness to larger context and system of health care, and ability to effectively use system resource for optimal patient care. Udayana University Faculty of Medicine, DME 2 Study Guide Behavior Changes and Disorders Members Planning Group No 1 NAME Dr dr Cokorda Bagus Jaya Lesmana, SpKJ (K) (Head) DEPARTMENT PHONE Psychiatry 0816295779 2 dr Anak Ayu Sri Wahyuni, SpKJ (Secretary) Psychiatry 0361 7814010 3 dr Luh Nyoman Alit Aryani, SpKJ Psychiatry 085737717244 4 dr Wayan Westa, SpKJ (K) Psychiatry 081999200900 5 Dr dr Ida Bagus Fajar Manuaba, SpOG, MARS Obgyn 081558101719 DEPARTMENT PHONE Lectures No NAME 1 Dr dr Cokorda Bagus Jaya Lesmana, SpKJ (K) Psychiatry 0816295779 2 dr Wayan Westa, SpKJ (K) Psychiatry 081999200900 3 dr Anak Ayu Sri Wahyuni, SpKJ Psychiatry 0361 7814010 4 dr I Gusti Ayu Endah Arjana, Sp.KJ (K) Psychiatry 08123916842 5 dr Lely Setiawati, Sp.KJ (K) Psychiatry 08174709797 6 dr Ida Ayu Kusuma Wardani, SpKJ, MARS Psychiatry 08123813831 7 dr Ni Ketut Putri Ariani, SpKJ Psychiatry 08123806397 8 dr Ni Ketut Sri Diniari, SpKJ Psychiatry 081338748051 9 dr Luh Nyoman Alit Aryani, SpKJ Psychiatry 085737717244 10 dr I Gusti Ayu Indah Ardani, SpKJ Psychiatry 08123926522 11 Dr dr Anak Agung Ayu Putri Laksmidewi Sp.S(K) Neurology 0811388818 12 Dr dr Ida Bagus Fajar Manuaba, SpOG, MARS Obgyn 081558101719 13 dr Yenni Kandarini, SpPD Internal Medicine 08123805344 14 dr I Gusti Ayu Artini, M.Sc Pharmacology 08123650481 15 DR. Ni Made Swasti Wulanyani, S.Psi., M.Erg., Psi Psychology 08123764595 Udayana University Faculty of Medicine, DME 3 Study Guide Behavior Changes and Disorders Curriculum Block The Behavioral Changes and Disorders Aims: 1. Comprehend professional competence and ensure the highest quality care to those with mental illness 2. Comprehend the psychodynamic and psycho pathological process of the behavior disorders 3. Diagnose and manage patient with mental illness 4. Diagnose and manage patient with behavioral problems related with medical condition 5. Educate patient and their family, and community about behavior changes and disorders Learning Outcomes: Awareness of lifestyle as a risk factor of behavior changes and psychiatric disorders and the importance of early treatment and proper management and prevention Recognizance of the new paradigm of medical practice: beyond bio-psycho-sociocultural model Define medical and allied sciences, health prevention and health promotion in the relationship between medical competencies and the contributions of medical and allied sciences, professional skills and attitudes to the prevention and treatment of behavioral disorders. Curriculum Contents: 1. Demonstrate ability to diagnose, manage and refer patient with problems in developmental stage of personality 2. Demonstrate ability to diagnose, manage and refer patient with psych-organic syndromes and disorders. 3. Demonstrate ability to diagnose, manage and refer patient with psychosis symptoms. 4. Demonstrate ability to diagnose, manage and refer patient with bipolar disorders 5. Demonstrate ability to diagnose, manage and refer patient with anxiety disorders 6. Demonstrate ability to diagnose, manage and refer patient with somatoform disorders. 7. Demonstrate ability to diagnose, manage and refer patient with sexual disorders 8. Demonstrate ability to diagnose, manage and refer patient with insomnia symptoms 9. Demonstrate ability to explain psycho pharmacology 10. Demonstrate ability to diagnose, manage and refer patient with self harm and suicidal behavior 11. Demonstrate ability to diagnose, manage and refer patient with problem related to child abuse or neglected 12. Demonstrate ability to promote healing process in psychiatric patients Udayana University Faculty of Medicine, DME 4 Study Guide Behavior Changes and Disorders Facilitators Class A No 1 Name Dept Phone Surgery 08123923956 Public Health 08123804985 Anatomy Pathology Pharmacology 082237407778 Pediatric 08123641466 Anasthesi 085238514999 Interna 08123974128 Neurology 0811385099 Pediatric 081353286780 Parasitology 081353077733 Orthopaedi 081337870347 Surgery 08123511673 Group Dept Phone dr. Pande Kurniari, Sp.PD B1 Interna 082147176796 dr Ni Wayan Sucindra Dewi B2 Pharmacology 08113935700 dr Ni Nyoman Metriani Nesa, M.Sc.,Sp.A B3 Pediatric 081337072141 dr Ni Made Susilawathi, Sp.S B4 Neurology 08124690137 B5 Opthalmology 0818375611 B6 Anasthesi 08123868126 dr. Putu Yuliandari, S.Ked B7 Microbiology 089685415625 dr. I G.A. Indah Ardani, Sp.KJ B8 Psychiatry 08123926522 dr. I Wyn Subawa, Sp.OT B9 Orthopaedi 081337096388 B10 Biochemistry 081239990399 B11 Public Health 081835777 B12 Pulmonology 081916708565/ 08123990362 2 dr. I Gede Budhi Setiawan, Sp.B(K)Onk dr. Made Dharmadi , MPH 3 dr. Juli Sumadi, Sp.PA 4 dr. Reni Widiastuti 5 dr. Dewi Sutriani Mahalini , Sp.A 6 dr. Dewa Ayu Mas Shintya Dewi, Sp.An dr. Nyoman Astika, Sp.PD-KgerFINASIM dr. Desak Ketut Indrasari Utami, Sp.S dr. Ayu Setyorini Mestika Mayangsari, M.Sc,Sp.A dr. Ni Luh Putu Eka Diarthini, S.Ked dr. Anak Agung Gde Yuda Asmara, Sp.OT dr. Agus Roy Rusly Hariantana Hamid, Sp.BP 7 8 9 10 11 12 Group A1 A2 A3 A4 A5 A6 A7 A8 A9 A10 A11 A12 08174742501 Venue (3rdfloor) 3nd floor: R.3.01 3nd floor: R.3.02 3nd floor: R.3.03 3nd floor: R.3.04 3nd floor: R.3.05 3nd floor: R.3.06 3nd floor: R.3.07 3nd floor: R.3.08 3nd floor: R.3.20 3nd floor: R.3.21 3nd floor: R.3.22 3nd floor: R.3.23 Class B No 1 2 3 4 5 6 7 8 9 10 11 12 Name dr. Ariesanti Tri Handayani , Sp.M dr I Gusti Agung Gede Utara Hartawan, Sp.An dr. Ida Ayu Dewi Wiryanthini, M Biomed Dr.dr. Dyah Pradnyaparamita Duarsa, M.Si dr. Ida Bagus Sutha, Sp.P Udayana University Faculty of Medicine, DME Venue (3rdfloor) 3nd floor: R.3.01 3nd floor: R.3.02 3nd floor: R.3.03 3nd floor: R.3.04 3nd floor: R.3.05 3nd floor: R.3.06 3nd floor: R.3.07 3nd floor: R.3.08 3nd floor: R.3.20 3nd floor: R.3.21 3nd floor: R.3.22 3nd floor: R.3.23 5 Study Guide Behavior Changes and Disorders Time Table Regular Class Day/ Date 1 Friday 8 May 2015 Time Activity Venue 08.00 – 09.00 Lecture 1: Introduction to Behavior Changes and Disorders Independent learning Group Discussion Break and student project Plenary session Class room 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00 08.00 – 09.00 2 Monday 11 May 2015 3 Tuesday 12 May 2015 4 Wed 13 May 2015 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00 Lecture 2: Mental Status Examination and Assessment 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 Lecture 3: Psychological Test Independent learning Group Discussion Break and student project Plenary session 08.00 – 09.00 Lecture 4: Neurobehavioral approach to Behavior Disorders Independent learning Group Discussion Break and student project Plenary session 09.00 – 09.30 09.30 – 12.00 12.00 – 14.00 14.00 – 15.00 08.00 – 09.00 5 Monday 18 May 2015 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00 08.00 – 09.00 6 Tuesday 19 May 2015 7 Wed 20 May 2015 8 Thursday 21 May 2015 Lecture 5: Prenatal Psychobiology (Case of Baby Blues) Independent learning Group Discussion Break and student project Plenary session 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00 Lecture 6: Behavior Changes Due to a General Medical Condition 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 Lecture 7: Delirium and Dementia Independent learning Group Discussion Break and student project Plenary session 08.00 – 09.00 Lecture 8: General Approaches to Substance Abuse Independent learning Group Discussion Break and student project Plenary session 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00 Udayana University Faculty of Medicine, DME Conveyer Dr Sri Wahyuni Discussion room Class room Dr Sri Wahyuni Class room Dr Sr Diniari Discussion room Class room Dr Sri Diniari Class room DR Wulanyani Discussion room Class room DR Wulanyani Class room DR Dr Laksmi Discussion room Class room DR Dr Laksmi Class room DR Dr IB Fajar Discussion room Class room DR Dr IB Fajar Class room Dr Yenni Discussion room Class room Dr Yenni Class room Dr Endah Discussion room Class room Dr Endah Class room Dr Westa Discussion room Class room Dr Westa 6 Study Guide Behavior Changes and Disorders 08.00 – 09.00 9 Friday 22 May 2015 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00 08.00 – 09.00 10 Monday 25 May 2015 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00 08.00 – 09.00 11 Tuesday 26 May 2015 12 Wed 27 May 2015 13 Thursday 28 May 2015 14 Friday 29 May 2015 15 Monday 1 June 2015 16 Wed 3 June 2015 17 Thursday 4 June 2015 Lecture 9: Primary & Secondary Insomnia Independent learning Group Discussion Break and student project Plenary session Lecturer 10: Schizophrenia & Other Psychoses Independent learning Group Discussion Break and student project Plenary session 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00 Lecturer 11: Delusional & Schizoaffective 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 Lecture 12: Bipolar 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 Lecture 13: Panic Disorders Independent learning Group Discussion Break and student project Plenary session 08.00 – 09.00 Lecture 14: Somatoform Disorders Independent learning Group Discussion Break and student project Plenary session 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00 08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00 Lecture 15: Generalized Anxiety & Obsessive-Compulsive Disorder 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 Lecture 16: PTSD 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 Lecture 17: Sexual Disorders Independent learning Group Discussion Break and student project Plenary session Udayana University Faculty of Medicine, DME Class room Dr Alit Aryani Discussion room Class room Dr Alit Aryani Class room DR Dr Cok Bagus Discussion room Class room DR Dr Cok Bagus Class room Dr Sri Diniari Discussion room Class room Dr Sri Diniari Class room Dr Lely Discussion room Class room Dr Lely Class room Dr Indah Discussion room Class room Dr Indah Class room Dr Indah Discussion room Class room Dr Indah Class room Dr Putri Discussion room Class room Dr Putri Class room DR Dr Cok Bagus Discussion room Class room DR Dr Cok Bagus Class room Dr Westa Discussion room Class room Dr Westa 7 Study Guide Behavior Changes and Disorders 18 Friday 5 June 2015 19 Monday 8 June 2015 20 Tuesday 9 June 2015 21 Wed 10 June 2015 22 08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00 Lecture 18: Psycho-Pharmacology 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 Lecture 19: Self Harm & Suicide Independent learning Group Discussion Break and student project Plenary session SP Group A1, A2, A3 Lecture 20: Child Abuse & Neglected Independent learning Group Discussion Break and student project Plenary session SP Group A4, A5, A6 Clinical Skill: Introduction to Psychiatric Interview Independent learning Group Discussion Break and student project Plenary session SP Group A7, A8, A9, A10 Clinical Skill: Interview with Anxiety Disorders Patients 08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00 08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00 08.00 – 15.00 Thursday 11 June 2015 23 25 Discussion room Class room Dr Artini Class room Dr Dayu Discussion room Class room Dr Dayu Class room Dr Sri Wahyuni Discussion room Class room Dr Sri Wahyuni Class room Dr Sri Wahyuni Discussion room Class room Dr Sri Wahyuni Skill Lab Team Psychiatry Clinical Skill: Interview with Depression Disorders Patients Skill Lab Team Psychiatry 08.00 – 15.00 Clinical Skill: Interview with Somatoform Disorders Patients Skill Lab Team Psychiatry 08.00 – 15.00 Clinical Skill: Interview with Bipolar Disorders Patients Skill Lab Team Psychiatry Monday 15 June 2015 Tuesday 16 June 2015 Dr Artini 08.00 – 15.00 Friday 12 June 2015 24 Class room Wed 17 June 2015 Pre-evaluation Break 26 Thursday 18 June 2015 Udayana University Faculty of Medicine, DME Examination 8 Study Guide Behavior Changes and Disorders English Class Day/ Date 1 Friday 8 May 2015 Time Activity Venue 09.00 – 10.00 Lecture 1: Introduction to Behavior Changes and Disorders Student project & break Independent learning Group Discussion Plenary session Class room Dr Sri Wahyuni Discussion room Class room Dr Sri Wahyuni 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00 09.00 – 10.00 2 Monday 11 May 2015 3 Tuesday 12 May 2015 4 Wed 13 May 2015 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00 Lecture 2: Mental Status Examination and Assessment Student project & break Independent learning Group Discussion Plenary session 09.00 – 10.00 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00 Lecture 3: Psychological Test Student project & break Independent learning Group Discussion Plenary session 09.00 – 10.00 Lecture 4: Neurobehavioral approach to Behavior Disorders Student project & break Independent learning Group Discussion Plenary session 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00 09.00 – 10.00 5 Monday 18 May 2015 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00 09.00 – 10.00 6 Tuesday 19 May 2015 7 Wed 20 May 2015 8 Thursday 21 May 2015 Lecture 5: Prenatal Psychobiology (Case of Baby Blues) Student project & break Independent learning Group Discussion Plenary session 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00 Lecture 6: Behavior Changes Due to a General Medical Condition Student project & break Independent learning Group Discussion Plenary session 09.00 – 10.00 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00 Lecture 7: Delirium and Dementia Student project & break Independent learning Group Discussion Plenary session 09.00 – 10.00 Lecture 8: General Approaches to Substance Abuse Student project & break Independent learning Group Discussion Plenary session 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00 Udayana University Faculty of Medicine, DME Conveyer Class room Dr Sr Diniari Discussion room Class room Dr Sri Diniari Class room DR Wulanyani Discussion room Class room DR Wulanyani Class room DR Dr Laksmi Discussion room Class room DR Dr Laksmi Class room DR Dr IB Fajar Discussion room Class room DR Dr IB Fajar Class room Dr Yenni Discussion room Class room Dr Yenni Class room Dr Endah Discussion room Class room Dr Endah Class room Dr Westa Discussion room Class room Dr Westa 9 Study Guide Behavior Changes and Disorders 09.00 – 10.00 9 Friday 22 May 2015 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00 09.00 – 10.00 10 Monday 25 May 2015 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00 09.00 – 10.00 11 Tuesday 26 May 2015 12 Wed 27 May 2015 13 Thursday 28 May 2015 14 Friday 29 May 2015 15 Monday 1 June 2015 16 Wed 3 June 2015 17 Thursday 4 June 2015 Lecture 9: Primary & Secondary Insomnia Student project & break Independent learning Group Discussion Plenary session Lecturer 10: Schizophrenia & Other Psychosis Student project & break Independent learning Group Discussion Plenary session 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00 Lecturer 11: Delusional & Schizoaffective Disorders Student project & break Independent learning Group Discussion Plenary session 09.00 – 10.00 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00 Lecture 12: Bipolar Disorders Student project & break Independent learning Group Discussion Plenary session 09.00 – 10.00 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00 Lecture 13: Panic Disorders Student project & break Independent learning Group Discussion Plenary session 09.00 – 10.00 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00 Lecture 14: Somatoform Disorders Student project & break Independent learning Group Discussion Plenary session 09.00 – 10.00 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00 Lecture 15: Generalized Anxiety & Obsessive-Compulsive Disorder Student project & break Independent learning Group Discussion Plenary session 09.00 – 10.00 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00 Lecture 16: PTSD Student project & break Independent learning Group Discussion Plenary session 09.00 – 10.00 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00 Lecture 17: Sexual Disorders Student project & break Independent learning Group Discussion Plenary session Udayana University Faculty of Medicine, DME Class room Dr Alit Aryani Discussion room Class room Dr Alit Aryani Class room DR Dr Cok Bagus Discussion room Class room DR Dr Cok Bagus Class room Dr Sri Diniari Discussion room Class room Dr Sri Diniari Class room Dr Lely Discussion room Class room Dr Lely Class room Dr Indah Discussion room Class room Dr Indah Class room Dr Indah Discussion room Class room Dr Indah Class room Dr Putri Discussion room Class room Dr Putri Class room DR Dr Cok Bagus Discussion room Class room DR Dr Cok Bagus Class room Dr Westa Discussion room Class room Dr Westa 10 Study Guide Behavior Changes and Disorders 18 Friday 5 June 2015 19 Monday 8 June 2015 20 Tuesday 9 June 2015 21 Wed 10 June 2015 22 09.00 – 10.00 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00 09.00 – 10.00 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00 08.00 – 11.00 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00 09.00 – 10.00 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00 25 Discussion room Class room Dr Artini Class room Dr Dayu Discussion room Class room Dr Dayu Class room Dr Sri Wahyuni Discussion room Class room Dr Sri Wahyuni Class room Dr Sri Wahyuni Discussion room Class room Dr Sri Wahyuni Skill Lab Psychiatric Team 09.00 – 16.00 Clinical Skill: Interview with Depression Disorders Patients Skill Lab Psychiatric Team 09.00 – 16.00 Clinical Skill: Interview with Somatoform Disorders Patients Skill Lab Psychiatric Team 09.00 – 16.00 Clinical Skill: Interview with Bipolar Disorders Patients Skill Lab Psychiatric Team Monday 15 June 2015 Tuesday 16 June 2015 Dr Artini Clinical Skill: Interview with Anxiety Disorders Patients Friday 12 June 2015 24 Class room 09.00 – 16.00 Thursday 11 June 2015 23 Lecture 18: Psycho-Pharmacology Student project & break Independent learning Group Discussion Plenary session SP Group B10, B9, B8 Lecture 19: Self-Harm & Suicide Student project & break Independent learning Group Discussion Plenary session SP Group B7, B6, B5 Lecture 20: Child Abuse & Neglected Student project & break Independent learning Group Discussion Plenary session SP Group B4, B3, B2, B1 Clinical Skill: Introduction to Psychiatric Interview Break Independent learning Group Discussion Plenary session Wed 17 June 2015 Pre-evaluation Break 26 Thursday 18 June 2015 Udayana University Faculty of Medicine, DME Examination 11 Study Guide Behavior Changes and Disorders Student’s Project Every student requires finding a scientific journal based on the topic of their groups and create a review paper as a group project. The journal has to be from year 2013 to recent years. It has to be present in a report format by week 4th to the facilitator and present in the plenary session. No Topic Group 1 2 3 4 5 6 7 8 9 10 A1, B10 A2, B9 A3, B8 A4, B7 A5, B6 A6, B5 A7, B4 A8, B3 A9, B2 A10, B1 Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder Antisocial Personality Disorder Borderline Personality Disorder Histrionic Personality Disorder Narcissistic Personality Disorder Avoidant Personality Disorder Dependent Personality Disorder Obsessive–Compulsive Personality Disorder Report Format Cover Preface Table of Content a. Introduction b. Content c. Discusion d. Summary Space : 1,5 Space Font : Times New Roman 12 Minimum Page: 15 The student’s 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. Udayana University Faculty of Medicine, DME 12 Study Guide Behavior Changes and Disorders Student Project Assessment Form Faculty of Medicine, Udayana University Blok : Behavior Changes and Disorders Name/NIM : Facilitator : Title : Time Table of Consultation Point of Discussion Week Title 1 Translation of Journal 2 Discussion and Summary of Journal 3 Final Report 4 Date Assessment A. Paper structure B. Content C. Discussion : : : 6 6 6 Total Point : (A+B+C)/4 7 7 7 8 8 8 Tutor Sign 9 9 9 10 10 10 = __________ Denpasar, Facilitator Udayana University Faculty of Medicine, DME 13 Study Guide Behavior Changes and Disorders Meeting of Student Representatives and Facilitators Meeting of student representatives and facilitators will be held on the second Friday of the block period if necessary. This meeting will be organized by the planners and attended by lecturers, students group representatives and all facilitators. Meeting with the student representatives will take place at 09.00 until 10.00 am and meeting with the facilitators at 10.00 until 11.00 am. The purpose of the meeting is to evaluate the teaching learning process of the Block. Feedbacks and suggestions are welcome for improvement of the Block educational programs. ~ ASSESSMENT METHOD ~ Assessment will be carried out on the 26th day of the block period. The test will consist of 100 questions with 100 minutes provided for working. The assessment will be held at the same time for both Regular Class and English Class. The passing score requirement is 70. More detailed information or any changes that may be needed will be acknowledged at least two days before the assessment. Udayana University Faculty of Medicine, DME 14 Study Guide Behavior Changes and Disorders 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 physician–patient 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 patient’s 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. Udayana University Faculty of Medicine, DME 15 Study Guide Behavior Changes and Disorders Psychiatry today, the transformation of our field has gained increasing momentum. Our understanding of the microstructure and function of the brain, and of the genetic controls of the brain reveals ever more amazing information which has already begun to transform clinical practice and psychiatric education. Further, the changes in the ways we have access to information have led to dramatic improvement of accessibility to our growing knowledge base. Yet, the clinical core of our discipline remains the imperative to integrate the best of our humanistic traditions with our cutting-edge scientific advances. With all the revising and restructuring though, our approach continues to emphasize an integrative biopsychosocial philosophy in both understanding psychopathology and providing treatment. And, as always, we hold to the view that the context of our understanding and intervention remains the therapeutic alliance we develop and maintain with our patients. SELF DIRECTING LEARNING Basic knowledge that must be known: 1. Psychiatric definition 2. Negative stigma of mental disorders 3. Development of psychiatric intervention 4. Diagnosis formulation 5. Global Assessment Function Scale SCENARIO Since the 1980s, new technologies and fundamental new insights have transformed the biological sciences and most areas of medicine. The completion of the Human Genome Project in 2002 provided a map of all of the genes of the human species. The soon-to-becompleted human haplotype map will provide a guide to individual variation of all of these genes. Along with genomics, neuroscience has become one of the most exciting areas of contemporary research. Recent discoveries have transformed the understanding of the brain, demonstrating how neurogenesis continues throughout adulthood, mapping the dynamic nature of cortical connectivity that can change in response to stimulation, and identifying some of the categorical rules by which information is processed in the brain. By any measure, recent decades have been revolutionary for the understanding of the human genome and how the brain functions, two areas of science fundamental to psychiatry. Yet, during this same period, clinical psychiatry has remained relatively unchanged. Learning Task 1. Explain about psychiatric diagnostic terst 2. What are the major disorders in behavioral changes? 3. Discuss about genomic and neuroimaging progress in how clinicians diagnose or treat the patients with mental disorders 4. Explain about the latest finding in DNA for major disorders in behavioral changes SCENARIO 2: A psychiatric consultant was asked to see a 48-year-old man on a coronary care unit for chest pain deemed “functional” by the cardiologist who had asked the patient if his chest pain was “crushing.” The patient said no. A variety of other routine tests were also negative. The psychiatrist asked the patient to describe his pain. He said, “It’s like a truck sitting on my chest, squeezing it down.” The psychiatrist promptly recommended additional tests that confirmed the diagnosis of myocardial infarction. The cardiologist may have been tempted to label the patient a “bad historian”. Learning Task 1. Expalin about the key skill in psychiatry? 2. What are the different between listening and hearing? 3. What are the trends in psychiatric care? Udayana University Faculty of Medicine, DME 16 Study Guide Behavior Changes and Disorders 4. Explain about the most important tool for healing? 5. How do you act as a primary care doctor to create a process of destigmatization? Self Assessment 1. How to do a good anamnesis for a patient and his family? 2. Can the drug given by cardiologist and by psychiatrist be given simultaneously? 3. Try to assess using Multi Axial diagnosis (Axis I, II, III, IV and V)? 4. What is the main priority in handling the case above? 5. We recognize there is still a negative stigma about mental illness in society. How to overcome this? Udayana University Faculty of Medicine, DME 17 Study Guide Behavior Changes and Disorders Modul 2 Mental Status Examination and Assessment dr Ni Ketut Sri Diniari, SpKJ AIMS: Know mental status examination, and multiaxial diagnostic LEARNING OUTCOME: Can describe the: 1. Mental status examination 2. The diagnostic classification system used in psychiatry 3. Multiaksial diagnostic CURRCIULUM CONTENS: 1. Mental status examination 2. Sign and symptom in mental status examination 3. The diagnostic classification system used in psychiatry 4. Multiaksial diagnostic ABSTRACTS: Establishing rapport and a good therapeutic alliance with patients is critical to both their diagnosis and their treatment. The psychiatric assessment is different from a medical or surgical assessment in that: (1).The history taking is often longer and is aimed at understanding psychological poblems that develop in patients, each with a unique background and social environment; (2). A mental status examination is performed; and (3). The assessment can in itself therapeutic. The mental status examination comprises the sum total of the physician’s observations of the patient at the time of the interview. Of note is that this examination can change from hour to hour, whereas the patient’s history remains stable. The mental status examination includes impressions of the patient’s 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 Udayana University Faculty of Medicine, DME 18 Study Guide Behavior Changes and Disorders SCENARIO A 30-year-old married woman suffers from chronic low mood and lack of enjoyment of life. She is highly dependent on her husband for practical and emotional support, although she frequently flies into rages at him, feeling that he is cold and uncaring. She has had a series of secretarial jobs which she begins enthusiastically, but soon comes to feel that her employers are highly critical and belittling, whereupon she resigns. Her friendships are limited to people with whom she can have very special, exclusive relationships. She deals poorly with change or loss, which frequently triggers episodes of acute dysfunction. When a friend is not sufficiently available to her, she feels betrayed and worthless, her mood plummets, she becomes lethargic, has eating binges, and is unable to work or pursue her usual routine for up to weeks at a time. Learning task a. Does the patient have a psychiatric disorders? b. How severe is the illness? c. What is the diagnosis? d. What is the patient base line level of functioning? e. What the environment, biological and psychological factors contribute to the disorders? SCENARIO 2 A 26-year-old man presented to the emergency department seeking a safe haven from “the mob.” He was convinced that he was being set up to be killed, as evidenced by the sequence of license plate numbers of the cars that had passed him on the way to work. He had initially gone to a police station, which had referred him to the hospital. Learning task a. Please try to identifying the symptoms of the patient above! b. How to make first oriented intervention as psychiatric interview in the patient above? c. How to make therapeutic alliance with the patient above? Self Assessment 1. Can you explain the signs and symptoms of psychotic disorders? 2. Can you explain the signs and symptoms of depression disorder? 3. Can you explain the signs and symptoms of anxiety disorder? 4. If a patient listening to the sounds in the ear there are people who threatened him, but other people do not hear, what is the name of this symptom? 5. What is put in the axis of the underlying psychosocial stressors problem of mental disorder? Udayana University Faculty of Medicine, DME 19 Study Guide Behavior Changes and Disorders Modul 3 Psychological Testing DR. Ni Made Swasti Wulanyani, S.Psi., M.Erg., Psi AIMS: • To understand some of the fundamental principles underlying psychological testing • To understand types of psychological testing that patients needed • To acquaint with some of the important ethical issues relating to psychological testin. LEARNING OUTCOMES: Student will know how to describe: 1. the application of psychological testing 2. types of settings are assessments conducted 3. appropriate psychological testing for patients problems 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 SCENARIO: An employee gets a promotion to a higher position in another unit in the company. A month later, the employee becomes ill, showed decreased in performance and withdrawn from social relationship Learning Task: Please discuss! 1. Any psychological tests that can be given and the reason! SCENARIO A young boy has just become student in a Vocational High School (Sekolah Menengah Kejuruan). At the end of the first semester, he got very bad marks, whereas he has shown good academic achievement while attending junior high school (SMP) before. He was frequently absent because of illness. No responses come from the parents although the Udayana University Faculty of Medicine, DME 20 Study Guide Behavior Changes and Disorders school has sent an invitation letter to discuss their son’s problems. The boy is often punished at school because of bullying his friends. Learning Task What is the likelihood that the child experienced? What would you do? SCENARIO A child cannot write even though she is in 3rd grade of elementary school now. When she was a toddler, she was not able to mimic the circle and other simple images. Learning Task Explain your suspicions to this case and what would you do? SCENARIO A unit at Educational institution, named “Berjaya”, provides psychological testing services for many settings such as educational, business, counseling. Most of unit member are not psychologists. Most of them are school counselor. They use computerized method for scoring. Learning Task Explain your analysis about ethical issues that must be consider by the unit or institution Self Assessments: Explain each of the following terms: 1. assessment 2. Intelligence test 3. Diagnostic 4. accommodation 5. Test user 6. Test developer 7. Test taker 8. Standardized test 9. Confidentiality 10. Responsibility or psychological tester Udayana University Faculty of Medicine, DME 21 Study Guide Behavior Changes and Disorders Modul 4 Neurobehavioral approach to Behavior Disorders Dr dr Anak Agung Ayu Putri Laksmidewi Sp.S(K) AIMS: Student will be expected to know and understand the neurological basis of behavior, memory, and cognition, the impact of neurological damage and disease upon behavior disorders. LEARNING OUTCOMES: Student will be able to describe: 1. How neurobehavior theories develop 2. Approaches to neurobehavior 3. Types of psychological phenomena in patients with brain disease 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: A 20 years old woman complains of behavior disorder. From herrelatives, this woman do not want to communicate each other from 2 weeks ago. She also didn’t want to take a bath, do not want to eat and to make and interaction between her peer groups nor her realtives. Regarding to her father, this patient often talk by her self, and often complain of hearing Udayana University Faculty of Medicine, DME 22 Study Guide Behavior Changes and Disorders voices that only heard by herself. No previous evidence of fever or head injury before the onset of those features. Learning task: 1. What is the properly list of question that need to be asked from the patient and her relatives? 2. What is the etiology of this case in general? 3. Please explain the neurophatogenesis of this case! Case 2: A 52-year-old female is admitted to a medical ward with an acute exacerbation of Crohn’s disease, requiring high-dose steroids and intensive emergency treatment. After a few days, however, she accuses the nurses on the ward of stealing her money and believes that one of the male nurses assaulted her during the night. However, once her steroids are stopped, she starts to settle and no longer voices any bizarre ideations.. Learning task: 1. What is the properly list of question that need to be asked from the patient and her relatives? 2. What is the differential diagnosis of this patient? 3. Please explain the neurophatogenesis from each of the differential diagnosis that has been mentioned above! Case 3: A 68-year-old male is admitted under the medical team for dehydration after refusing to eat or drink. His wife reports that he has been preoccupied with the belief that he has a brain tumour and has lost pleasure in everything. He has lost 12 kg in weight and spends most of his day in bed. He reports that he can smell rotting bodies and believes that he has committed a sinful crime because he has heard voices calling him a paedophile. He feels ashamed of himself. Learning task: 1. What is the properly list of question that need to be asked from the patient and her relatives? 2. What is the proper psychotherapy planned for this patient? Case 4: A 40 years old man comes to private service with difficulty to fall a sleep since 5 days ago. He usually abruptly wake up on midnight while sleeping, hence he didn’t feel well while waking up on the following morning. Learning task: 1. What is the properly list of question that need to be asked from the patient and her relatives? 2. What kind of questionnaire proper to be applied to assess type of sleeping disorder in this patient? Udayana University Faculty of Medicine, DME 23 Study Guide Behavior Changes and Disorders Modul 5 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. Udayana University Faculty of Medicine, DME 24 Study Guide Behavior Changes and Disorders SCENARIO Mary is a 32-year-old married nurse with a history of panic attacks that have been well controlled for years. She presents 3 months postpartum, following a difficult pregnancy complicated by severe hyperemesis gravidarum and dysphoria in addition to traumatic delivery with a third-degree perineal tear. Mary now complains of crying spells, decreased appetite, insomnia, and obsessive worry over the baby’s health. She feels isolated from her husband, who is overwhelmed by her emotional needs and tends to retreat to work. Learning Task: 1. What are the diagnostic features of this patient? 2. How long is the onset of illness on this kind of patient? 3. What is the diagnosed according to DSM-V? 4. Make a systematic screening for the risk factors in addition to current symptoms 5. Explain the differential diagnosis of the above case? 6. What therapy should be given? 7. What is the difference between baby blues and postpartum depression? 8. When reviewing the prognosis for people with baby blues, what kind of onset, gender, and duration suggest a more favorable outcome? 9. Discuss about the possibility when people like above case never get any treatment! 10. Discuss about any prevention work that possible for the relapse of the above case! Self-Assessment: 1. Explain the understanding of reality testing for baby blues! 2. Explain the difference between baby blues, postpartum depression with Postpartum Psychosis! 3. Explain one of the most widely used instruments to assess for postpartum depressive symptomatology is the Edinburgh Postnatal Depression Scale (EPDS)! 4. Read the book title The Secret Life of the Unborn Child. 5. Fiind current research on Welcoming Consciousness Udayana University Faculty of Medicine, DME 25 Study Guide Behavior Changes and Disorders Modul 6 Behavior Changes Due to a General Medical Condition dr. Yenni Kandarini, SpPD AIMS: Describe the clinical management of Behavior Changes Due to a General Medical Condition (Anamnesis, History taking, Mental State Examination, Diagnosis, and Therapy). LEARNING OUTCOMES: Describe how to: 1. Anamnesis 2. History taking 3. Examine mental state 4. Diagnosis 5. Therapy (pharmacotherapy, psychotherapy) 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 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 depression’s 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. Udayana University Faculty of Medicine, DME 26 Study Guide Behavior Changes and Disorders Modul 7 Delirium and Dementia dr. I Gusti Ayu Endah Arjana, Sp.KJ (K) AIMS: Describe the clinical management of delirium syndromes dementia (History, General Medical and Neurologic Examination, Mental Status examination, Laboratory Studies, Imaging, and Other Diagnostic Tests, Diagnostic criteria, Management) LEARNING OUTCOMES: Describe how to: 1. Definition and Diagnostic Features 2. Common Associated Features 3. Predisposing Factors 4. Selected Causes of Delirium and Dementia 5. Management: general Principles (Behavioral Interventions, Pharmacologic Interventions, physical restraints) 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 64-year-old woman admitted to the medical ward with an acute exacerbation of chronic obstructive pulmonary disease. She lived alone following the death of her husband 3 years earlier. Her normal medication was low-dose prednisolone, bronchodilators in inhalers, antihypertensives and ranitidine which were all continued. She was hypoxic on admission and treated with oxygen therapy. All her blood tests were normal apart from a raised Creactive protein. On the chest radiograph, there was a right basilar shadow and she was started on ciprofloxacin for a presumed infection. After 3 days, Mrs A became progressively depressed, inhibited and non-compliant with therapy and routine interventions. She was assessed and referred to a psychiatrist for Udayana University Faculty of Medicine, DME 27 Study Guide Behavior Changes and Disorders ‘depression impairing co-operation and compliance’. On mental status examination she appeared extremely inhibited and apathetic with decreased reaction to stimuli. She had a reduced ability to maintain attention, shortterm memory impairment and mild perception disturbances. There was a history of sleep/wake disturbance from the nursing notes. According to her son, she had no cognitive problems before her admission. Learning Task: 1. From the story above, what need to be asking to the patient? 2. Make the physical and mental examination of this patient. 3. What is the differential diagnosis of this patient? 4. What is the planning diagnosis, that you suggest? 5. What the treatment of this patient? SCENARIO A 73-year-old female presents with increasing confusion, lethargy, and disorientation. On examination, she is obese and has a distinctive deep voice. Her pulse is 40 and blood pressure is 110/72. She complains of constipation. Learning Task: 1. From the story above, what need to be asking to the patient? 2. Make the physical and mental examination of this patient. 3. What is the differential diagnosis of this patient? 4. What is the planning diagnosis, that you suggest? 5. What the treatment of this patient? SCENARIO A 72-year-old male has been experiencing attacks of confusion, memory problems, and visual hallucinations over the last year. Each episode lasts for a few weeks and he is fine between these episodes; however, with subsequent episodes, his condition seems to be getting worse. His medical history shows blood pressure of 150/101 and he has had transient ischaemic attacks in the past. On examination there is an upgoing plantar. Learning Task: 1. From the story above, what need to be asking to the patient? 2. Make the physical and mental examination of this patient. 3. What is the differential diagnosis of this patient? 4. What is the planning diagnosis, that you suggest? 5. What the treatment of this patient? Self assessment; 1. How to do a good anamnesis in delirium and dementia cases? 2. How to do a good Mental and Physical examination? 3. What is the laboratory findings that need to be checked in delirium and dementia cases. 4. What is the etiology of delirium and dementia cases in general. 5. What is management of delirium and dementia cases. Udayana University Faculty of Medicine, DME 28 Study Guide Behavior Changes and Disorders Modul 8 General Approaches to Substance Abuse dr. Wayan Westa, SpKJ (K) AIMS: Emphasizing on understanding the effects of substance abuse on physical health, mental, social Understanding the follow-up of treatment of individuals with intoxication and withdrawal LEARNING OUTCOMES: 1. Understand psychodynamic substance abuse problems 2. Understand the types of drugs in general 3. Understanding the symptoms of individuals with object withdrawal of drug poisoning 4. Understand the initial handling of the state of withdrawal, substance intoxication is then able to make a referral 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 Udayana University Faculty of Medicine, DME 29 Study Guide Behavior Changes and Disorders SCENARIO A man aged 25 years unemployment driven by his friend to the hospital with complaints; fever, snot and tears, pain throughout the body, the hair on the body seemed to stand, also appears there is a pimple like the cold. This patient also complained of nausea and want to vomit. On physical examination found blood pressure 130/80, rather rapid respiration, pulse 96x / min, body temperature 37,80C. Medriasis pupils, reflex + / +. In the interview the patient obtained have been using substances / drugs, beginning with suction means further by means of a syringe. Patients taking these substances last was two days ago. LEARNING TASK 1. In the above situation is the patient? Explain! 2. The substance / drug if the patient used before? 3. Describe how the psychodynamic process so people above fall into substance abuse and addiction / drug! 4. As a general practitioner, what treatment is given? 5. What are the dangers of injecting drug use? 6. What our efforts together so that drug abuse can be reduced? SCENARIO 2 A man aged 40 years, a large body of high body tattooed, work as a guard café. Came to the hospital escorted by his friend and guarded by police, handcuffed her hands as it can go berserk and fight with visitors café. After soothed then conducted an interview, explaining that drinking ALCOHOL patients have long done and once in a while to get drunk. In times of strife and fighting in the café, before he admitted taking ALCOHOL. Furthermore, he felt himself strong, self-confidence increased, bold, look like smallish café visitors so easily defeated. When it peaked emotional, touchy, angry that a fight. Physical examination was normal. Physical illness previously denied. LEARNING TASK 1. Under no circumstances does the male cases mentioned above? Explain! 2. What are consumed by men of the above? Explain! 3. Individuals who are used to the routine of drinking MIRAS suddenly stop taking MIRAS what happens? What was the symptoms? 4. What are the dangers of alcoholic liquor to the physical condition, or mental? Explain! 5. There is argued that the use of alcoholic beverages (MIRAS) is more dangerous than smoking heroin (heroin). Why? Explain! 6. As a general practitioner what actions and help you when dealing with cases of alcohol withdrawal? SELF ASSESSMENT 1. Explain what is included drug / drug! 2. Any Drug / Drug including stimulants and sedatives which euphoria? 3. Explain the notion of amphetamine psychosis, Delerium Tremens (DT's), Psychosis Korchakoff! 4. Why is the use of injectable opiate more dangerous than the opiates suction? 5. The method of treatment in opiate withdrawal, how wide? Explain! 6. Individuals with an overdose of heroin what treatment? Explain! Udayana University Faculty of Medicine, DME 30 Study Guide Behavior Changes and Disorders Modul 9 Primary & Secondary Insomnia dr. Luh Nyoman Alit Aryani, SpKJ AIMS: Describe the clinical management of Primary and Secondary Insomnia (Definition, Etiology, Risk Factor, Diagnose and Management) LEARNING OUTCOMES: Describe how to: 1. Understand the Classification of sleep disorder 2. Explain the Symptoms and Signs of insomnia and hypersomnia 3. Asses the Diagnostic of insomnia and hypersomnia 4. Give treatment for sleep disorder 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 Udayana University Faculty of Medicine, DME 31 Study Guide Behavior Changes and Disorders SCENARIO Case 1 A 45 years old man, single, had 5 year history of fatique and sleepiness in the daytime. He started to sleep at 10.00 PM, and he woke up at 6.00 AM. He had oversleep almost every day. After having lunch he would routinely fell a sleep at the computer. He was free from mental or physical condition. When interviewd the patient was friendly, informative and self assured. He denied depressed mood or loss of interest or pleasure. He was in good health and jogged 4-5 miles daily. He lived with his wife and youngest son. He enjoyed socializing with his families. Learning Task 1: 1. What is the most likely diagnosis? 2. From the story above, what need to be asking to the patient? 3. What is the therapy for the disorder? Case 2 A 28 –year old woman came to psychiatric clinic. She said that she was difficult to sleep for 2 months. It lead inability concentration and fatique in his working. The physical examination was within normal limit. Learning Task 2: 1. What are the differential diagnosis? 2. What are the other symptom and medical history we have to find to asses the diagnostic? 3. What are the medications recommended for the patient? 4. What are the other treatment you recomend? Case 3 A 27 years old woman was referred with symptoms of difficulty falling a sleep, shallow sleep (easily wake up), dream a lot, early rise, fatique after waking up. When interviewing psychiatric patients complain of a very sad, hopeless against the problems that it faces. This complaint accompanied by loss of interest and fatigue, and has been going on for 2 months. Free from physical condition and substance use. Learning Task 3 1. What is the diagnosis of the disorder? 2. What are the baseline assesment must be done ? 3. What are the patients symptoms point preferentally to the diagnosis? 4. What are the medications recommended for the patient? Self Assesment : 1. How to do a good anamnesa in sleep disoerder? 2. What is the classification of sleep disorder and how to get the differential diagnosis ? 3. What are the management of sleep disorder? Udayana University Faculty of Medicine, DME 32 Study Guide Behavior Changes and Disorders Modul 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. Udayana University Faculty of Medicine, DME 33 Study Guide Behavior Changes and Disorders SELF DIRECTING LEARNING Basic knowledge that must be known: 1. The procedure of interviewing Schizophrenia & Other Psychosis 2. Formulating diagnosis for Schizophrenia & Other Psychosis 3. Management of Schizophrenia & Other Psychosis SCENARIO A 30-year-old female is brought to hospital as she has been violent and hostile to her neighbours. According to the patient, her grandfather was a successful writer and she acquired his fortunes recently. However, she believes that her neighbours have found out about it and claims that she has heard them talking about stealing her money. Learning Task: 1. What are the diagnostic features of this patient? 2. How long is the onset of illness on this kind of patient? 3. What is the diagnosed according to DSM V? 4. Explain the differential diagnosis of the above case? 5. What therapy should be given? 6. What is the difference between positive and negative symptoms of schizophrenia? 7. When reviewing the prognosis for people with schizophrenia, what kind of onset, gender, and duration suggest a more favorable outcome? 8. Discuss about the possibility when people like above case never get any treatment! 9. Discuss about any prevention work that possible for the relapse of the above case! SCENARIO 2 An 18-year-old male is brought to hospital by his parents because they have noticed that he has been acting strangely recently. His parents say that the patient has just ‘lost it’ since failing his final examinations. The patient was noted to be giggling to himself, spending almost all his time in his room, and making unusual gestures with his hands. In addition, his speech has been incomprehensible and his parents cannot make any sense of it. Learning Task: 1. What are the diagnostic features of this patient? 2. In relation to personality development what would be the cause for the occurrence of this disorder? 3. What is the diagnosed according to DSM-IV TR? 4. Explain the differential diagnosis of the above case? 5. What therapy should be given? 6. Discuss about the possibility when people like above case never get any treatment! 7. Discuss about any prevention work that possible for the relapse of the above case! Self-Assessment: 1. What is the definition of suspicion, hallucinations, raptus, and abulia? 2. Explain the understanding of reality testing for psychosis! 3. Explain the difference between schizophrenia with organic mental disorders! 4. Explain the terms flat affect, inappropriate, inadequate! 5. Explain about developmental model of schizophrenia 6. Explain about early detection and intervention for schizophrenia Udayana University Faculty of Medicine, DME 34 Study Guide Behavior Changes and Disorders Modul 11 Delusional & Schizoafective Disorders dr. Ni Ketut Sri Diniari, SpKJ AIMS: Describe Delusional disorder and schizoafective disorder, and its management. LEARNING OUTCOME: Can describe the: 1. Interview, mental status examination, diagnostic, and management delusional disorder. 2. Interview, mental status examination, diagnostic, and management schizoafective disorder. CURRCIULUM CONTENS: 1. Psychiatric interview and mental status examination 2. Diagnostic in PPDGJ-III, ICD-X and DSM-5 3. Management of Delusional disorder and schizoafektif disorder ABSTRACTS: The DSM-5 criteria, delutional disorder and Schizoafectif disorder are a part of schizophrenia spectrum and other psychotic disorders. Delutional disorder is made when a person exhibits nonbizarre delutions of the last 1 month’s 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 A 23-year-old male believes that his life and the world are coming to an end after having lost his job. He has stopped looking after himself and has not eaten in 3 days as he believes that his body organs are decaying. Learning task 1. What is the most likely diagnosis? 2. What are sign/ symptom dominant in this case? 3. What is the differential diagnosis of this patient? 4. How to management this disorder? SCENARIO A 26-year-old female has been living on the streets for the last week because she knows that a famous actor is planning a vendetta to kill her. She feels unsafe wherever she goes as she feels that she is constantly under threats of an attack. Udayana University Faculty of Medicine, DME 35 Study Guide Behavior Changes and Disorders Learning task 1. What is the most likely diagnosis for this patient? 2. What are sign/ symptom dominant in this case? 3. What is the differential diagnosis of this patient? 4. How to management this disorder? Scenario A 27-year-old male with no previous psychiatric history is brought to hospital by his family. His parents noticed that he has been ‘high’ for the last few months, and that his behaviour has become increasingly erratic. He was also noted to have strange beliefs, such as the world being flat and the government trying to prevent this fact from being disclosed. He even stated that he has a radio-transmitting device implanted in his head which allowed him to pick up the signals sent from space. His elated mood and strange beliefs continued for a year. Learning task 1. What is the most likely diagnosis for this patient? 2. What are sign/ symptom dominant in this case? 3. What is the differential diagnosis of this patient? 4. How to management this disorder? Self Assessment 1. How to diagnose delusional and schizoaffective disorder? 2. How the characteristics of delusion in delusional and schizoaffective disorders? 3. How to distinguish delusions in schizophrenia and delusional disorders? 4. How to diagnoses schizoafective disorder? 5. what is the differences between schizoafective disorder with bipolar disorder? 6. what the management delutional disorder? 7. what the management schizoafective disorder? Udayana University Faculty of Medicine, DME 36 Study Guide Behavior Changes and Disorders Modul 12 Bipolar Disorders dr Lely Setyawati, SpKJ (K) AIMS: Describe Bipolar Disorder and the clinical management of bipolar disorders LEARNING OUTCOMES: Describe how to: 1. Symptom and Sign of Bipolar disorders 2. Psychodinamic of Bipolar disorders 3. Diagnosis of Bipolar disorders 4. Therapy of Bipolar disorders 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- Udayana University Faculty of Medicine, DME 37 Study Guide Behavior Changes and Disorders IV-TR) criteria for manic episode. Cyclothymia and dysthymia are defined by DSM-IV-TR as disorders that represent less severe forms of bipolar disorder and major depression, respectively. According to DSM-IV-TR, a major depressive disorder occurs without a history of a manic, mixed, or hypomanic episode. A major depressive episode must last at least 2 weeks, and typically a person with a diagnosis of a major depressive episode also experiences at least four symptoms from a list that includes changes in appetite and weight, changes in sleep and activity, lack of energy, feelings of guilt, problems thinking and making decisions, and recurring thoughts of death or suicide. SELF DIRECTING LEARNING Basic knowledge that must be known: 1. The procedure of interviewing bipolar disorders 2. Formulating diagnosis for bipolar disorders 3. Management of bipolar disorders SCENARIO A 25-year-old male is taken to hospital by the police as he was found screaming on the streets. He had been trying to light himself with a lighter, claiming that he was invincible and had the power to fix all evil in the world. His speech was highly pressured and he complains that his thoughts are going out of control. According to hospital records, he had been admitted to hospital three times in the last year for similar episodes.. Learning task: 1. What is the most likely diagnosis? 2. What is the most likely etiology? 3. What is the baseline assesment must be done? 4. What is the patient’s symptoms point preferentally to the diagnosis? 5. What is the first line medications recommended for the patient? 6. What are the other symptoms of bipolar disorder depressive type? 7. Why is Isabel diagnosed as having bipolar I instead of bipolar II disorder? SCENARIO A 28-year-old female presents to the clinic complaining of low mood. She describes her mood as ‘depressing’ and is unable to do anything. Because of her low mood, she has not eaten for 3 days. She mentions that a year ago, she was feeling on top of the world and went through periods when she did not have to sleep. On that occasion, she was admitted to hospital because her parents thought that she was going ‘out of control’. Learning task 1. What is the most likely diagnosis for this patient? 2. What are sign/ symptom dominant in this case? 3. What is the differential diagnosis of this patient? 4. How to management this disorder? Self Assessment: 1. Please describe Depressive Disorder according to ICD-10/PPDGJ-3. 2. What are the diagnosis differential of MDD? Please describe each of them. 3. Is there any relationship between Bipolar Disorder and Suicide? 4. What is the different between Bipolar I disorder and Bipolar II disorder 5. Individuals with major mood disorders are at an increased risk of having one or more additional comorbid Axis I disorders. Please describe the comorbidity of Bipolar Disorder. Udayana University Faculty of Medicine, DME 38 Study Guide Behavior Changes and Disorders Modul 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 Mrs K was a 35 year-old woman who initially presented for treatment at yhe medical emergency department at a large university- based medical center. She reported that while sitting at her desk at her job, she had suddenly experienced difficulty breathing, dizziness, tachycardia, shakiness, and felling of terror that she was going to die of a heart attack. A colleague drove her to the emergency department, where she received a full medical evaluation, including ECG and routine blood work, which revealed no sign of cardiovascular, pulmonary and other illness. She was subsequently referred for pshychiatric evaluation, where she revealed that she had experienced two additional episodes over the past month, once when driving from work and once when eating breakfast. However she had no presented for medical treatment because the symptoms had resolved relatively quickly each time, and she worried that if she went to the hospital without ongoing symptoms, “people would think “I’m crazy”. Mrs K reluctantly took the phone number of local psychiatrist but did not call until she experienced a fourth episode of a similar nature. Learning Task 1. What should the doctor do for the first time towards the patient? 2. Explain the sign and symptoms of the above patient! 3. What is the multiaxial diagonosis? Udayana University Faculty of Medicine, DME 39 Study Guide Behavior Changes and Disorders 4. How is the holistic treatment for the patient above? Self Assessment 1. First time checking out a case of panic disorder, what therapeutic atmosphere should be given to the patient?. 2. Explain on making good environment for patient recovery! 3. Explain the basic personality for patient with panic disorders! 4. Explain the role of neurotransmitter in panic disorder! 5. Antianxiety often lead to dependency, as a doctor what is your wise opinion in using this medication? 6. Explain the psychodynamic of panic disorder! Udayana University Faculty of Medicine, DME 40 Study Guide Behavior Changes and Disorders Modul 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 and demonstrable peripheral organs disorder, (2) psychological factors and conflicts that seem important in initiating, exacerbating, and maintaining the disturbances; and (3) symptoms or magnified health corncerns that are not under the patient’s conscious control.and laboratory Because of their intense bodily perceptions, restricted level of physical functioning, and morbid beliefs, these patients have become convinced they harbor serious physical problem. Moreover, their symptoms are not willfully controlled. Whatever their faults and problems, these patients are not malingerers. Yet their physicians physical imfirmity other than the patients vigorous and sincere complaints. Patients with somatoform disorder are convinced that their suffering comes from some type of presumably undetected and untreated bodily derangement. SELF DIRECTING LEARNING Basic knowledge that must be known: 1. The psychological conflict in somatoform disorders Udayana University Faculty of Medicine, DME 41 Study Guide Behavior Changes and Disorders 2. Formulating diagnosis for somatoform disorders 3. Management of somatoform disorders 4. Basic personality in somatoform disorders SCENARIO Mrs A, 38 year-old had complained of nervourness since childhood. She also said she was sickly since her youth, with a succession of physical problems that doctor often indicated were caused by her nerves or depression. She however, believed that she had a physical problem that had not yet been uncovered by the doctors. Besides nervousness, she had chest pain and had been told by variety of medical consultants that she had a nervous heart. She also consulted doctors for abdominal pain and had been told she has a spstic colon. She had seen chiropractors and osteopaths for backaches, for pains in extremities, and for anesthesia of her finger tips. Three months previously, she was vomiting and had chest pain and abdominal pain, and she was admitted to a hospital for hysterectomy. Since the hysterectomy, she had had repeated anxiety attack, fainting spells that she claimed were associated with unconsciousness, vomiting, food intolerance, weakness, and fatique. She had been hospitalized several times for medical workups for vomiting, colitis, vomiting of blood, and chest pain. She had had a surgical procedure for an abscess of the throat. She said she felt depressed but thougth that it was all because her “hormones were not straightened out”. She was still looking for medical explanation for her physical and physchological problems. Learning Task 1. What is the most likely diagnosis for this patient? 2. What are sign/ symptom dominant in this case? 3. What is the differential diagnosis of this patient? 4. How to management this disorder? Self Assessmant 1. How to distinguish somatization disorder with hipochondriac? 2. What is the primary choice for the treatment of somatoform disorders? please explain! 3. Explain the psychodynamic of somatoform disorder 4. Explain the differential diagnosis of somatoform disorder Udayana University Faculty of Medicine, DME 42 Study Guide Behavior Changes and Disorders Modul 15 Generalized Anxiety & Obsessive Compulsive Disorder dr. Ni Ketut Putri Ariani, SpKJ AIMS: Describe the clinical management of generalized anxiety & obsessive compulsive disorders (Anamnesis, History taking, Mental State Examination, Diagnosis, and Therapy) LEARNING OUTCOMES: Describe how to: 1. Anamnesis 2. History taking 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 Udayana University Faculty of Medicine, DME 43 Study Guide Behavior Changes and Disorders SCENARIO A 32-year-old single mother of two children is seeking professional help for her longstanding feelings of anxiety. Despite the fact that her life is relatively stable in terms of financial and interpersonal matters, she worries most of the time that she will develop financial problems, that her children will become ill, and that the political situation in the country will make life for her and he children more difficult. Although she tries to dismiss these concerns as excessive, she finds it virtually impossible to control her worrying. Most of the time, she feels uncomfortable and tense, and sometimes her tension become so extreme that she begins to tremble and sweat. She finds it difficult to sleep at night. During the day she is restless, keyed up, and tense. She has consulted a variety of medical specialist, each of whom has been unable to diagnose a physical problem. Learning task: 1. What is the diagnosis of the presenting case? 2. How is the case of formulation? 3. What is the treatment plan? 4. What is the outcome or prognosis of the case? SCENARIO 2 A 42-year-old seller woman, often complain of headache since last month. She also often feels nausea and appetite-less. She had consulted to a doctor many times who finally suggest her to visit a psychiatrist. She feels sad because her husband was hospitalized by stroke disease and she has financial problem. She worried that her husband will not recovery, and cannot pay for her children’s school. She feels uncomfortable and tense. Leaning task: 1. What is the diagnosis of the presenting case? 2. How is the case of formulation? 3. What is the treatment plan? 4. What is the outcome or prognosis of the case? Self assessment 1. What are the diagnostic features of GAD? 2. What are the diagnostic features of mixed anxiety-depression disorders? 3. Explain the treatment principles in GAD 4. Explain the treatment principle in mixed anxiety-depression disorders 5. Explain about the biopsychosocial aspects of GAD 6. Explain about the biopsychosocial aspects of mixed anxiety-depression disorders ABSTRACTS Obsessions and compulsions are the essential features of OCD. An individual must exhibit either obsessions or compulsions to meet DSM-IV-TR criteria. DSM-IV-TR recognizes obsessions as “persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate,” causing distress. Obsessions provoke anxiety, which accounts for the categorization of OCD as an anxiety disorder. However, they must be differentiated from excessive worries about real-life problems and associated with efforts to either ignore or suppress the obsessions. Typical obsessions associated with OCD include thoughts about contamination (“my hands are dirty”) or doubts (“I forgot to turn off the stove”). Obsessions and compulsions must cause an individual marked distress, consume at least 1 hour per day, or interfere with functioning to be considered above the diagnostic threshold. During at least some point in the illness, adult patients must recognize symptoms of OCD as unreasonable, although there is great variability in the degree to which this is true, both across individuals and in a given individual over time. For example, early in the Udayana University Faculty of Medicine, DME 44 Study Guide Behavior Changes and Disorders course of the disorder, patients may recognize their hand washing as excessive or irrational, but, over a number of years, this recognition may no longer exist. The clinical management of Trichotillomania and Obsessive Compulsive Disorders Consist of how to make a proper diagnosis through good anamnesis, physical examination, psychometric examination and give the patient proper treatment with medical and psychotherapy modality. SELF DIRECTING LEARNING Basic knowledge that must be known: 1. The procedure of Trichotillomania and Obsessive Compulsive Disorders Diagnosis 2. Management of Trichotillomania and Obsessive Compulsive Disorders 3. Psychometric Examination of Trichotillomania and Obsessive Compulsive Disorders SCENARIO A 13 year old girl came to psychiatric clinic accompanied by her mother with main complain repetitive hair pulling that result in significant hair loss. There is an increasing level of tension immediately before hair pulling. There is a sensation of pleasure during hair pulling the pulling is not explained by a general medical condition or other mental disorder. Significant distress of in social occupational or other areas of functioning is as a result of the pulling. Physical examination is a normal. Learning Task 1. From the story above, what need to be asking to the patient? 2. Please explain the psychodynamic from this case! 3. What is the differential diagnosis of this patient? 4. What is the planning diagnosis that you suggest? 5. What treatment you give please explain it? SCENARIO 2: A 6-year-old male complains of feeling sick with stomach ache during school days and refuses to go to school. He cries if his mother attempts to leave him under any circumstance. He finds it difficult to go to bed without his mother being by his side and frequently gets up at night to check on her. When questioned about this, he says that he is worried that something terrible will happen to her and that he will never see her again. These symptoms have developed since his parents divorced 6 months ago. Learning Task 1. From the story above, what need to be asking to the patient? 2. Please explain the psychodynamic for this patient! 3. What is the differential diagnosis of this patient? 4. What is the planning diagnosis that you suggest? 5. What is the planning treatment that you give? Self Assessment 1. How to do a good anamnesis in Obsessive-Compulsive Disorders case? 2. What is the psychometric test you make to the patient? 3. Explain the etiology of Obsessive-Compulsive Disorders! 4. Is the Obsessive-Compulsive Disorders ego dystonic? Please explain! Udayana University Faculty of Medicine, DME 45 Study Guide Behavior Changes and Disorders Modul 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 an anxiety disorder in the DSM IV; the characteristic symptoms are not present before exposure to the violently traumatic event. In the typical case, the individual with PTSD persistently avoids all thoughts and emotions, and discussion of the stressor event and may experience amnesia for it. However, the event is commonly relived by the individual through intrusive, recurrent recollections, flashbacks, and nightmares. The characteristic symptoms are considered acute if lasting less than three months, and chronic if persisting three months or more, and with delayed onset if the symptoms first occur after six months or some years later. PTSD is distinct from the briefer acute stress disorder, and can cause clinical impairment in significant areas of functioning. In PTSD, the individual develops symptoms in three domains: reexperiencing the trauma, avoiding stimuli associated with the trauma, and experiencing symptoms of increased autonomic arousal, such as an enhanced startle. Flashbacks, in which the individual may act and feel as if the trauma were recurring, represent the classic form of reexperiencing. Other forms of reexperiencing include distressing recollections or dreams and either physiological or psychological stress reactions when exposed to stimuli that are linked to the trauma. An individual must exhibit at least one reexperiencing symptom to meet criteria for PTSD. Symptoms of avoidance associated with PTSD include efforts to avoid thoughts or activities related to the trauma, anhedonia, reduced capacity to remember events related to the trauma, blunted affect, feelings of detachment or derealization, and a sense of a foreshortened future. An individual must exhibit at least three such symptoms. Symptoms of increased arousal include insomnia, irritability, hypervigilance, and exaggerated startle. An individual must exhibit at least two such symptoms. Because individuals often exhibit complex biological and behavioral responses to extreme trauma, the clinician must identify other medical and psychiatric conditions in the traumatized patient. The clinician must always evaluate whether neurological etiologies Udayana University Faculty of Medicine, DME 46 Study Guide Behavior Changes and Disorders underlie trauma-related symptoms, particularly after traumatic events that involve physical injury. Traumatized patients also can develop mood disorders, including dysthymia and major depression, as well as other anxiety disorders, such as generalized anxiety disorder or panic disorder, and substance use disorders. Finally, recent research suggests that some psychiatric features of posttraumatic syndromes can relate to a patient's state before the trauma. For example, patients with premorbid anxiety or affective syndromes may be more likely to develop posttraumatic symptoms than individuals who are free of mental illness before the trauma. As a result, the clinician should consider the premorbid mental state of the traumatized. SELF DIRECTING LEARNING Basic knowledge that must be known: 1. The procedure of PTSD 2. Management of PTSD 3. Psychometric Examination of PTSD SCENARIO Mr. F. sought treatment for symptoms that he developed in the wake of an automobile accident that had occurred approximately 6 weeks before his psychiatric evaluation. While driving to work on a mid-January morning, Mr. F. lost control of his car on an icy road. His car swerved out of control into oncoming traffic, collided with another car, and then hit a nearby pedestrian. Mr. F. was trapped in his car for 3 hours while rescue workers cut through the car door. After referral, Mr. F. reported frequent intrusive thoughts about the accident, including nightmares of the event and recurrent intrusive visions of his car slamming into the pedestrian. He reported that he had altered his driving route to work to avoid the scene of the accident and that he found himself switching the TV channel whenever a commercial for snow tires appeared. Mr. F. described frequent difficulty falling asleep, poor concentration, and an increased focus on his environment, particularly when he was driving. Leaning task: 1. What is the diagnosis of the presenting case? 2. How is the case of formulation? 3. What is the treatment plan? 4. What is the outcome or prognosis of the case? SCENARIO 2: Trevor was sexually abused as a child by a family relative. Although he was about to get married and had thoughts about planning a family, he still felt haunted by childhood events. He was worried that the events from his past would affect his ability to bond with his children and affect their relationship. Leaning task: 1. What is the diagnosis of the presenting case? 2. How is the case of formulation? 3. What is the treatment plan? 4. What is the outcome or prognosis of the case? SCENARIO 3: Max is a boy nearly four years of age who lived with his family in Battery Park City, across the street from the World Trade Center. Prior to 9/11, he had already experienced numerous traumatic events including surgeries for a chronic condition and hospitalization for a minor burn. In December 2001 Max saw his pediatrician for the first time in several months and Udayana University Faculty of Medicine, DME 47 Study Guide Behavior Changes and Disorders presented with vomiting and poor appetite. Max had an overall positive score on PSC-17 and a positive score for internalizing problems. Since 9/11, Max has reverted to wearing diapers at night, wearing his shoes all the time, has become increasingly introverted and stopped wanting to go to school, although he enjoyed going to school in the past. Over time, pediatric visits grew more frequent as Max continued to experience stomachaches and difficulty breathing despite normal physical exams. Learning task: 1. What is the role of family in this case? 2. What is the role of primary care physician in this case? 3. How do you formulate the intervention? Do you need to referall the patient? 4. What is the prognosis of this patient? Self assessment 1. What are the diagnostic features of PTSD? 2. Explain the treatment principles in PTSD 3. Explain about the biopsychosocial aspects of PTSD 4. Explain the epidemiology of PTSD 5. Explain the differential diagnosis of PTSD Udayana University Faculty of Medicine, DME 48 Study Guide Behavior Changes and Disorders Modul 17 Sexual Disorders dr Wayan Westa, SpKJ (K) 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 Udayana University Faculty of Medicine, DME 49 Study Guide Behavior Changes and Disorders SCENARIO A man aged 50 years foreign nationals were on vacation in Bali staying at one of the hotels in Kuta. He often tours to Bali east in town Amlapura, sightings are very polite and generous attitude and love children so quickly accepted by the public. Children gathered to play given gifts of clothes, money, etc. But the uproar ensued because one of the kids that show strange behavior such as moody, did not venture out. After being asked by the child's parents that she had to serve the sexual appetite through the rectum (sodomy) by these men. Learning Task 1. Sexual Deviations what happened to these men? 2. Explain the psychodynamics of pedophilia! 3. What are the adverse effects of physical and mental side of the victim? 4. What is the initial treatment can be given to victims of the above? What to do next? 5. Efforts to what can be done by the people and government so that such cases can be reduced or eliminated? SCENARIO 2: A man 30 years old unmarried farmer discovered by his neighbors were having sexual intercourse with his pet calf. The incident was reported to the village headman. Finally the meeting was to resolve this problem. Learning Task 1. What is the diagnosis conclusion of the above behaviors? 2. Explain the instinct theory of progress toward normal sexual libido! 3. What do we know of the Oedipus phase - Complex? 4. Explain the notion of: voyeurism, transexualisme, fetishism! 5. The above case is a sexual perversion, do you think another diagnosis? Self Assesment 1. Describe examples of sexual perversion! 2. Sexual Deviations which adversely affect the heaviest? 3. What do you know about GUY and LESBIAN? 4. What is a homosexual sintonik ego and ego-dystonic homosexuality? 5. In your opinion, how do the case of sexual deviance is not increasing in number? Explain Udayana University Faculty of Medicine, DME 50 Study Guide Behavior Changes and Disorders Modul 18 Psycho-Pharmacology dr. I Gusti Ayu Artini, M.Sc AIMS: 1. Describe the rationale drugs can be used for anxiety, insomnia, depression and Psychotic disorders. 2. Describe the pharmacokinetic and pharmacodynamic aspect of drugs used for Psychiatric disorders. LEARNING OUTCOMES: Describe how: 1. The pharmacokinetic and pharmacodynamic aspect of drugs used for psychiatric disorders including sedative-hypnotic, antidepresssant, and antipsychotic drugs. 2. To apply the basic concepts and principles of drugs used for insomniaExamine mental state 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 Udayana University Faculty of Medicine, DME 51 Study Guide Behavior Changes and Disorders with the antipsychotic drugs is the extrapyramidal effect that commonly manifests as Parkinson-like symptoms, akathisia, and dystonia. SELF DIRECTING LEARNING Basic knowledge that must be known: 1. The cycle of neurotransmitter in the synaps 2. The role of neurotransmitter involved in psychiatric disorders 3. The mechanism of action for sedative-hypnotic, antidepressant and antipsychotic drugs 4. The pharmacokinetic and pharmacodynamic aspect of sedative-hypnotic, antidepressant and antipsychotic drugs 5. Drug interaction related to sedative-hypnotic, antidepressant and antipsychotic drugs SCENARIO A 23-year-old male with no previous psychiatric history presents to hospital complaining that his neighbours have been plotting an attack on him. He also mentions that he can hear his neighbours discussing his actions and appearances all the time. He is suspicious all the time and believes that he is under surveillance by hidden cameras. The doctor prescribes this medication, but warns the patient of possible drowsiness and obesity. Learning Task 1. What drugs can be used for patient above? Describe the mechanism of action for the drug. 2. Based on the scenario above, what condition possibly happened to this patient? 3. What are other adverse effects of sedative-hypnotic drugs should aware to? SCENARIO 2 A 45-year-old male patient with a psychotic illness has been unsettled on the ward with increasing signs of agitation. His treatment is currently under review as he had developed neuroleptic malignant syndrome following the use of atypical antipsychotics. He has an argument with a fellow patient and following this, starts screaming and breaking the ward windows. The team decides to treat this acute episode using an intramuscular combination of a short-acting benzodiazepine and this medication. Learning Task 1. What drug can be given to manage patient’s disease? 2. How is the mechanism of action of that drug? 3. What are the adverse effects possibly happened regarding the use of that drug? 4. If there were signs of hallucination and/or delusion found on the patient, what drug should be given? How is the mechanism of action? What are the adverse effects commonly occur regarding the use of that drug? SELF ASSESSMENT 1. Mention classification of sedative-hypnotic drugs 2. How did benzodiazepine and barbiturate exert their action? 3. List adverse effect of sedative-hypnotic drugs 4. Mention classification of antidepressant drugs 5. How is the mechanism of action of each class of antidepressant drugs? 6. List adverse effect of sedative-hypnotic drugs 7. Mention classification of antipsychotic drugs 8. How is the mechanism of action of each class of antipsychotic drugs? 9. List adverse effect of antipsychotic drugs Udayana University Faculty of Medicine, DME 52 Study Guide Behavior Changes and Disorders Modul 19 Self Harm & Suicide dr. Ida Ayu Kusuma Wardani, SpKJ, MARS AIMS: Describe the management of disorders mood, thought, and behavior at a time of crisis. Self harm and suicide one part of the emergency psychiatry LEARNING OUTCOMES: Describe how to: 1. Diagnosis 2. Risk factors 3. Pathophysiology 4. Treatment of suicide risk CURRICULUM CONTENS: 1. Epidemiology 2. Psychiatric and medical risk factors 3. Familial and genetic 4. Pathophysiology 5. Treatment ABSTRACTS Emergency psychiatry refers to the management of disorders of mood, thought, and behavior at a time of crisis. It entails assessment, development of a differential diagnosis of psychiatric and other medical causes of presenting symptoms, and diagnostic specific pharmacotherapy, medical and surgical therapy, and psychotherapy. Psychiatric emergencies are often particularly disturbing because they do not just involve the body’s 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? 2. What are the methods of self-harm? 3. Please explain pathophysiology? 4. What is the diagnosis? 5. What is the holistic treatment? SCENARIO A 20-year-old female presents to hospital having lacerated her forearm. She claims that she had a major argument with her boyfriend and did it so that her boyfriend would worry and not break up with her. According to her, all her relationships in the past have been ‘intense like this’. On examination, there are multiple healed laceration scars on both arms. Udayana University Faculty of Medicine, DME 53 Study Guide Behavior Changes and Disorders Learning Task: 1. Explain the psychodynamic of self-harm? 2. What are the methods of self-harm? 3. Please explain pathophysiology? 4. What is the diagnosis? 5. What is the holistic treatment? SELF ASSESSMENT 1. What is a defense mechanism used by the patient? 2. Which factors are associated with self harm and suicide? 3. What is the relationship between self-harm and suicide with mental disorders? 4. How to prevent self-harm and suicide? Udayana University Faculty of Medicine, DME 54 Study Guide Behavior Changes and Disorders 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 rescue the victim immediately. Therefore it is important to keep a sense of perspective on how good the evidence is that abuse is indeed happening, and to have a sympathetic team for emotional support to stop one becoming overwhelmed by, or cut off from, what is seen. Within the broad definition of child maltreatment, five subtypes are distinguished – these are physical abuse; sexual abuse; neglect and negligent treatment; emotional abuse and exploitation. Compiling lists of general or culturally relative risks is a necessary first step toward assessing the interaction of risk and protective circumstances in each family, community and culture. However, theories that propose single factors or combinations of risk factors as invariably leading directly to child abuse will stigmatize families which fall within the profile and lead to missed cases of child abuse, which do not fit the profile. In families where child abuse does exist, they may be more likely to hide the abuse as it now carries a public condemnation. In families where it is not present, stigmatization may translate into marginalization of the family. Preventing the abuse of children in settings other than the family (such as schools, hospitals, psychiatric institutions and prisons), and by persons other than caregivers (such as members of the clergy, the police and teachers) is also an important area of work, but one which is likely to require very different strategies to those which have proven effective in preventing intra-familial child maltreatment. SELF DIRECTING LEARNING Basic knowledge that must be known: 1. The procedure of interviewing child abuse 2. Formulating diagnosis for child abuse 3. Management of child abuse Udayana University Faculty of Medicine, DME 55 Study Guide Behavior Changes and Disorders SCENARIO Financially comfortable parents lived in a pleasant, clean house in a nice neighborhood, but they had no friends. Their four teenagers never had visitors. One day, the oldest girl, 17 years of age, went to the police and told them that she had a baby at home and that her own father was the father of the baby. The girl said that her father had been having sexual relations with her for more than 4 years and that he was now doing the same with her younger sisters. The mother admitted knowing about the situation for years, but she had not reported it to the authorities for fear of losing her husband. Learning task: 1. Explain the definition of abuse and neglection in children 2. Describe the impacts of abuse and neglected children 3. Explain the symptoms of psychiatric disorders caused by abuse and neglect of children 4. Explain the strategy of therapy for children who are abused and neglected 5. Explain how to refer patient with abuse and neglect 6. Explain Diagnosis physically abuse children according DSM V 7. Explain Clinical features emotional abuse children 8. Explain Clinical features neglected children 9. Explain Evaluation process child who have been sexually abuse 10. Explain the prevention child abuse in families and community 11. Explain the treatment that can be provided to children that have been physically abuse Self Assesment 1. Explain about child maltreatment 2. Explain about interpersonal violence 3. Explain about psychopathology of revictimization 4. Explain about the psychological symptoms of an abused child Udayana University Faculty of Medicine, DME 56 Study Guide Behavior Changes and Disorders 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 Udayana University Faculty of Medicine, DME 57 Study Guide Behavior Changes and Disorders 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. Udayana University Faculty of Medicine, DME 58 Study Guide Behavior Changes and Disorders 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 patients—for example, those who continually repeat how worthless or guilty they are—need 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. Udayana University Faculty of Medicine, DME 59 Study Guide Behavior Changes and Disorders 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 Udayana University Faculty of Medicine, DME 60 Study Guide Behavior Changes and Disorders psychiatrist will not automatically assume that those issues are the cause of physical symptoms. It is often helpful for the physician to propose a purely pragmatic approach—one that stresses a willingness to use whatever works to relieve the patient's suffering without causing harm. At times, this may include nonstandard approaches, such as meditation, yoga, or acupuncture, in addition to psychotherapy. Udayana University Faculty of Medicine, DME 61 Study Guide Behavior Changes and Disorders 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 sociooccupational 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 Udayana University Faculty of Medicine, DME 62 Study Guide Behavior Changes and Disorders toms; and are devoid of intolerable side effects, thus facilitating long-term compliance with the medication regimen. Remission of symptoms and more importantly “functional recovery”—the primary goals of treatment—are attainable despite the complex and chronic nature of bipolar disorder. STEM QUESTIONS Euphoria Stem Question 1. Some people have periods lasting several days when they feel much more excited and full of energy than usual. Their minds go too fast. They talk a lot. They are very restless or unable to sit still and they sometimes do things that are unusual for them, such as driving too fast or spending too much money. Have you ever had a period like this lasting several days or longer? If this question is endorsed, the next question (the irritability stem question) is skipped and the respondent goes directly to the Criterion B screening question Irritability Stem Question 2. Have you ever had a period lasting several days or longer when most of the time you were so irritable or grouchy that you either started arguments, shouted at people or hit people? Criterion B Screening Question 3. People who have episodes like this often have changes in their thinking and behavior at the same time, like being more talkative, needing very little sleep, being very restless, going on buying sprees, and behaving in many ways they would normally think inappropriate. Did you ever have any of these changes during your episodes of being excited and full of energy or very irritable or grouchy? Criterion B Symptom Questions Think of an episode when you had the largest number of changes like these at the same time. During that episode, which of the following changes did you experience? 1. Were you so irritable that you started arguments, shouted at people, or hit people? This first symptom question is asked only if the euphoria stem question (#1 above) is endorsed 2. Did you become so restless or fidgety that you paced up and down or couldn’t stand still? 3. Did you do anything else that wasn’t usual for you—like talking about things you would normally keep private, or acting in ways that you would usually find embarrassing? 4. Did you try to do things that were impossible to do, like taking on large amounts of work? 5. Did you constantly keep changing your plans or activities? 6. Did you find it hard to keep your mind on what you were doing? 7. Did your thoughts seem to jump from one thing to another or race through your head so fast you couldn’t keep track of them? 8. Did you sleep far less than usual and still not get tired or sleepy? 9. Did you spend so much more money than usual that it caused you to have financial trouble? Udayana University Faculty of Medicine, DME 63 Study Guide Behavior Changes and Disorders ~ CURRICULUM MAP ~ Smstr Program or curriculum blocks 10 Senior Clerkship 9 Senior Clerkship 8 Senior clerkship 7 6 Medical Emergency (3 weeks) Special Topic: -Travel medicine (2 weeks) Elective Study III (6 weeks) Clinic Orientation (Clerkship) (6 weeks) BCS (1 weeks) The Respiratory System and Disorders (4 weeks) The Cardiovascular System and Disorders (4 weeks) The Urinary System and Disorders (3 weeks) The Reproductive System and Disorders (3 weeks) BCS (1 weeks) Alimentary & hepatobiliary systems & disorders (4 Weeks) BCS (1 weeks) The Endocrine System, Metabolism and Disorders (4 weeks) BCS (1 weeks) Clinical Nutrition and Disorders (2 weeks) BCS (1 weeks) Elective Study II (1 weeks) 5 BCS (1 weeks) BCS (1 weeks) BCS (1 weeks) 4 3 2 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) 1 Pendidikan Pancasila & Kewarganegaraan (3 weeks) Udayana University Faculty of Medicine, DME 64 Study Guide Behavior Changes and Disorders References 1. Psychiatry. 4th ed. John Wiley & Sons, 2015. 2. Katzung: Basic and Clinical Pharmacology, 13th ed. McGraw-Hill’s. 2015 3. Neurosciences-From Molecule to Behavior: A University Textbook. Springer Spektrum, 2013 4. Diagnostic and statistical manual of disorders, 5th ed, Arlington: American Psychiatric Association, 2013. 5. Child and adolescent psychiatry. 3rd ed. John Wiley & Sons, 2012 6. Textbook of Clinical Neuropsychiatry, 3rd ed, Taylor & Francis Group, 2012 7. Abnormal Psychology. 6th ed. McGraw-Hill’s, 2010 8. The American Psychiatric Publishing Textbook of Forensic Psychiatry. 2nd ed. American Psychiatry Pub. 2010 9. Principles of social psychiatry. 2nd ed. John Wiley & Sons, 2010 10. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th ed. Lippincott Williams & Wilkins. 2007. 11. Diagnostic Criteria from DSM IV-TR. 1st ed. Washington: American Psychiatric Association. 2000 12. Catatan Ilmu Kedokteran Jiwa. Edisi VI. Surabaya: Airlangga University Press. 1994. 13. ICD-10 Classification Or Mental and Behavioural Disorders. 1st ed. Edinburgh; Churchill Livingstone.1994 14. Pedoman Penggolongan dan Diagnosis Gangguan Jiwa di Indonesia III. Edisi I. Jakarta: Departemen Kesehatan. 1993 Udayana University Faculty of Medicine, DME 65