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) 9
Important Informations 12
Student’s Project 12
Meeting of the students’ representative 14
Assessment Method 14
Learning Programs 15
Basic Clinical Skill 43
Curriculum Mapping 49
References 50
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
Members Planning Group
No NAME DEPARTMENT PHONE
1
Dr dr Cokorda Bagus Jaya Lesmana, SpKJ (K)
(Head) Psychiatry 0816295779
2 dr Anak Ayu Sri Wahyuni, SpKJ (Secretary) Psychiatry 0361 7814010
3 dr Luh Nyoman Alit Aryani, SpKJ Psychiatry 085737717244
4 Dr dr Ida Bagus Fajar Manuaba, SpOG, MARS Obgyn 081558101719
Lectures
No NAME DEPARTMENT PHONE
1 Dr dr Cokorda Bagus Jaya Lesmana, SpKJ (K) Psychiatry 0816295779
2 dr Anak Ayu Sri Wahyuni, SpKJ Psychiatry 0361 7814010
3 dr Lely Setiawati, Sp.KJ (K) Psychiatry 08174709797
4 dr Ida Ayu Kusuma Wardani, SpKJ, MARS Psychiatry 08123813831
5 dr Ni Ketut Putri Ariani, SpKJ Psychiatry 08123806397
6 dr Ni Ketut Sri Diniari, SpKJ Psychiatry 081338748051
7 dr Luh Nyoman Alit Aryani, SpKJ Psychiatry 085737717244
8 dr I Gusti Ayu Indah Ardani, SpKJ Psychiatry 08123926522
9 Dr dr Ida Bagus Fajar Manuaba, SpOG, MARS Obgyn 081558101719
10 Dr dr Wiragotra, SpPD Internal Medicine 08155736480
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-socio-cultural 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
~ FACILITATORS ~
Regular Class (Class A)
No Name Group Department Phone Venue (2nd
floor) 1 Dr. dr. Bagus Komang Satriyasa, M.Repro A1 Farmacology 081237166686 2R.2.01nd floor:
2 dr. Deny Cintya Yuliatni A2 Public Health 081353380666 2nd floor: R.2.02 3 Prof.dr.Ketut Tirtayasa, M.Sc A3 Fisiology 08123623422 2R.2.03nd floor:
4 dr. Gusti Ngurah Mayun, Sp.HK A4 Histology 08155715359 2R.2.04nd floor:
5 dr. I Gde Haryo Ganesha, S.Ked A5 DME 081805391039 2nd floor: R.2.05 6 Dr.dr. Cokorda Bagus Jaya
Lesmana, Sp.KJ (K) A6
Psychiatry 0816295779 2nd floor:
R.2.06 7 dr. I Kadek Susila Surya Darma,Sp.JP A7 Pulmonology 08113853151 2R.2.07nd floor:
8 dr. Ni Luh Ariwati A8 Parasitology 08123662311 2R.2.08nd floor:
9 dr. I Putu Adiartha Griadhi,
M.Fis, AIFO A9
Fisiology 081999636899 2nd floor:
R.2.21 10 dr. I Wayan Yudiana, Sp.U A10 Urology 081338708195 2R.2.22nd floor:
English Class (Class B)
No Name Group Department Phone (2Venue nd floor)
1 dr. Kadek Ayu Candra Dewi,
Sp.OT B1
Orthopaedi 081933043307 2nd floor:
R.2.01 2 dr. I Gusti Ayu Indah Ardani,
Sp.KJ B2
Psychiatry 08123926522 2nd floor:
R.2.02 3 dr. Ni Nyoman Mahartini, Sp.PK B3 PathologyClinical 081337165577 2R.2.03nd floor:
4 dr. Ida Bagus Wirakusuma, MOH B4 Public Health 08124696647 2R.2.04nd floor:
5 dr. I Gede Eka Wiratnaya,
Sp.OT B5
Orthopaedi 081338493832 2nd floor:
R.2.05 6 dr. Henky, Sp.F., M.BEth, FACLM B6 Forensic 08123988486 2R.2.06nd floor:
7 Dr.dr. I Made Jawi, M.Kes B7 Farmacology 08179787972 2R.2.07nd floor:
8 dr. I Wayan Surudarma, M.Si B8 Biochemistry 081338486589 2nd floor: R.2.08 9 dr. I Wayan Weta, MS, Sp.GK B9 Public Health 081337003560 2nd floor:
Time Table
Regular Class
Day/
Date Time Activity Venue Conveyer
1
Monday 6 June
2016
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00
Lecture 1: Introduction to
Behavior Changes and Disorders
Independent learning Group Discussion
Break and student project Plenary session
Class room
Discussion room
Class room
Dr Sri Wahyuni
Dr Sri Wahyuni
2
Tuesday 7 June
2016
08.00 – 09.00
09.00 – 09.30 09.30 – 12.00 12.00 – 14.00 14.00 – 15.00
Lecture 2: Prenatal Psychobiology (Case of Baby Blues)
Independent learning Group Discussion
Break and student project Plenary session
Class room
Discussion room
Class room
DR Dr IB Fajar
DR Dr IB Fajar
3
Wed 8 June
2016
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00
Lecture 3: Behavior Changes Due to a General Medical Condition
Independent learning Group Discussion
Break and student project Plenary session
Class room
Discussion room
Class room
DR Dr Wiragotra
DR Dr Wiragotra
4
Thursday 9 June
2016
08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00
Lecture 4: Delirium and Dementia
Independent learning Group Discussion
Break and student project Plenary session
Class room
Discussion room
Class room
Dr Sri Diniari
Dr Sri Diniari
5
Friday 10 June
2016
08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00
Lecturer 5: Schizophrenia
Independent learning Group Discussion
Break and student project Plenary session
Class room
Discussion room
Class room
DR Dr Cok Bagus
DR Dr Cok Bagus
6
Monday 13 June 2016
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00
Lecturer 6: Brief Psychotic and other psychoses disorders
Independent learning Group Discussion
Break and student project Plenary session
Class room
Discussion room
Class room
Dr Sri Diniari
Dr Sri Diniari
7
Tuesday 14 June 2016
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00
Lecture 7: Bipolar Disorders & Mania
Independent learning Group Discussion
Break and student project Plenary session
Class room
Discussion room
Class room
Dr Dayu Kusuma
Dr Dayu Kusuma
8
Wed 15 June
2016
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00
Lecture 8: Depression Disorders, Suicide & other mood disorders
Independent learning Group Discussion
Break and student project Plenary session
Class room
Discussion room
Class room
Dr Putri Ariani
9
Thursday 16 June
2016
08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00
Lecture 9: Insomnia
Independent learning Group Discussion
Break and student project Plenary session
Class room
Discussion room
Class room
Dr Alit Aryani
Dr Alit Aryani
10
Friday 17 June
2016
08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00
Lecture 10:Somatoform Disorders
Independent learning Group Discussion
Break and student project Plenary session
Class room
Discussion room
Class room
Dr Indah Ardani
Dr Indah Ardani
11
Monday 20 June 2016
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00
Lecture 11: Anxiety Disorders (Panic, GAD, OCD)
Independent learning Group Discussion
Break and student project Plenary session
Class room
Discussion room
Class room
Dr Lely Setiawati
Dr Lely Setiawati
12
Tuesday 21 June 2016
08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00
Lecture 12: PTSD
Independent learning Group Discussion
Break and student project Plenary session
Class room
Discussion room
Class room
DR Dr Cok Bagus
DR Dr Cok Bagus
13
Wed 22 June
2016
08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00
Lecture 13: Psycho-Pharmacology
Independent learning Group Discussion
Break and student project Plenary session Class room Discussion room Class room Dr Artini Dr Artini
14
Thursday 23 June 201608.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00
Lecture 14: Sexual Disorders
Independent learning Group Discussion Break
Plenary session
SP Group: A1, A2, A3
Class room
Discussion room
Theater Room
Dr Dayu Kusuma
Dr Dayu Kusuma
15
Friday 24 June
2016
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00
Lecture 15: General Approaches to Substance Abuse
Independent learning Group Discussion Break
Plenary session
SP Group: A4, A5, A6
Class room
Discussion room
Theater Room
Dr Alit Aryani
Dr Alit Aryani
16
Monday 27 June 2016
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00
Clinical Skill: Introduction to Psychiatric Interview & Examination
Independent learning Group Discussion Break
Plenary session
SP Group: A7, A8, A9, A10
Class room
Discussion room
Theater Room
Dr Sri Wahyuni
Dr Sri Wahyuni
17
Tuesday 28 June 2016
08.00 – 15.00 Clinical Skill: Interview with
Anxiety Disorders Patients Skill Lab Psychiatric Team
18
Thursday 30 June
2016
08.00 – 15.00 Clinical Skill: Interview with
19
Friday 1 July 2016
08.00 – 15.00 Clinical Skill: Interview with
Somatoform Disorders Patients Skill Lab Psychiatric Team
20
Monday 11 July 2016
08.00 – 15.00 Clinical Skill: Interview with
Bipolar Disorders Patients Skill Lab Psychiatric Team
Tuesday 12 July
2016
Pre-evaluation Break
Wed 13 July
2016
English Class
Day/
Date Time Activity Venue Conveyer
1
Monday 6 June
2016
09.00 – 10.00
10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00
Lecture 1: Introduction to Behavior Changes and Disorders
Student project & break Independent learning Group Discussion Plenary session Class room Discussion room Class room
Dr Sri Wahyuni
Dr Sri Wahyuni
2
Tuesday 7 June
2016
09.00 – 10.00
10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00
Lecture 2: Prenatal Psychobiology (Case of Baby Blues)
Student project & break Independent learning Group Discussion Plenary session Class room Discussion room Class room
DR Dr IB Fajar
DR Dr IB Fajar
3
Wed 8 June
2016
09.00 – 10.00
10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00
Lecture 3: Behavior Changes Due to a General Medical Condition
Student project & break Independent learning Group Discussion Plenary session Class room Discussion room Class room
DR Dr Wiragotra
DR Dr Wiragotra
4
Thursday 9 June
2016
09.00 – 10.00 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00
Lecture 4: Delirium and Dementia
Student project & break Independent learning Group Discussion Plenary session Class room Discussion room Class room
Dr Sri Diniari
Dr Sri Diniari
5
Friday 10 June
2016
09.00 – 10.00 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00
Lecturer 5: Schizophrenia
Student project & break Independent learning Group Discussion Plenary session Class room Discussion room Class room
DR Dr Cok Bagus
DR Dr Cok Bagus
6
Monday 13 June 2016
09.00 – 10.00
10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00
Lecturer 6: Brief Psychotic and other psychoses disorder
Student project & break Independent learning Group Discussion Plenary session Class room Discussion room Class room
Dr Sri Diniari
Dr Sri Diniari
7
Tuesday 14 June 2016
09.00 – 10.00
10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00
Lecture 7: Bipolar Disorders & Mania
Student project & break Independent learning Group Discussion Plenary session Class room Discussion room Class room
Dr Dayu Kusuma
Dr Dayu Kusuma
8
Wed 15 June
2016
09.00 – 10.00
10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00
Lecture 8: Depression Disorders, Suicide & other mood disorders
Student project & break Independent learning Group Discussion Plenary session Class room Discussion room Class room
Dr Dayu Kusuma
9
Thursday 16 June
2016
09.00 – 10.00 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00
Lecture 9: Insomnia
Student project & break Independent learning Group Discussion Plenary session Class room Discussion room Class room
Dr Alit Aryani
Dr Alit Aryani
10
Friday 17 June
2016
09.00 – 10.00 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00
Lecture 10: Somatoform Disorders
Student project & break Independent learning Group Discussion Plenary session Class room Discussion room Class room
Dr Indah Ardani
Dr Indah Ardani
11
Monday 20 June 2016
09.00 – 10.00
10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00
Lecture 11: Anxiety Disorders (Panic, GAD, OCD)
Student project & break Independent learning Group Discussion Plenary session Class room Discussion room Class room
Dr Lely Setiawati
Dr Lely Setiawati
12
Tuesday 21 June 2016
09.00 – 10.00 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00
Lecture 12: PTSD
Student project & break Independent learning Group Discussion Plenary session Class room Discussion room Class room
DR Dr Cok Bagus
DR Dr Cok Bagus
13
Wed 22 June
2016
09.00 – 10.00 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00
Lecture 13: Psycho-Pharmacology
Student project & break Independent learning Group Discussion Plenary session Class room Discussion room Class room Dr Artini Dr Artini
14
Thursday 23 June 201609.00 – 10.00 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00
Lecture 14: Sexual Disorders
Student project & break Independent learning Group Discussion Plenary session
SP Group B10, B9, B8, B7
Class room
Discussion room Theater Room
Dr Dayu Kusuma
Dr Dayu Kusuma
15
Friday 24 June
2016
09.00 – 10.00
10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00
Lecture 15: General Approaches to Substance Abuse
Student project & break Independent learning Group Discussion Plenary session
SP Group B6, B5, B4
Class room
Discussion room Theater Room
Dr Alit Aryani
Dr Alit Aryani
16
Monday 27 June 2016
09.00 – 10.00
10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00
Clinical Skill: Introduction to Psychiatric Interview & Examination
Break
Independent learning Group Discussion Plenary session
SP Group B3, B2, B1
Class room
Discussion room Theater Room
Dr Sri Wahyuni
Dr Sri Wahyuni
17
Tuesday 28 June 2016
09.00 – 16.00 Clinical Skill: Interview with Anxiety Disorders Patients
18
Thursday 30 June
2016
09.00 – 16.00 Clinical Skill: Interview with
Depression Disorders Patients Skill Lab Psychiatric Team
19
Friday 1 July 2016
09.00 – 16.00 Clinical Skill: Interview with
Somatoform Disorders Patients Skill Lab Psychiatric Team
20
Monday 11 July 2016
09.00 – 16.00 Clinical Skill: Interview with Bipolar
Disorders Patients Skill Lab Psychiatric Team
Tuesday 12 July
2016
Pre-evaluation Break
Wed 13 July
2016
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 2014 to recent years. It has to be present in a report format by week 3rd to the facilitator and present in the
14th -16th plenary session meeting.
No Topic Group
1 Internet gaming addiction A1
2 Mild cognitive disorder A2
3 Kleptomania A3
4 Anorexia nervosa A4
5 Cyclothymia A5
6 Premenstrual Dysphoric Disorder. A6
7 Dissociative Disorders A7
8 Dysthymia A8
9 Pathological gambling A9
10 Adjustment disorders A10
11 Asperger's syndrome B1
12 Pyromania B2
13 Intellectual Disability B3
14 Disruptive Mood Dysregulation Disorder. B4
15 Body Dysmorphic Disorder. B5
16 Transsexualism B6
17 Persistent Complex Bereavement Disorder. B7
18 Binge Eating Disorder. B8
19 Oppositional Defiant Disorder. B9
20 Gender identity disorder B10
Report Format
Cover Preface
Table of Content a. Introduction b. Content c. Summary
d. References (Harvard referencing style)
Space : 1,5 Space
Font : Times New Roman 12 Minimum Page: 15
The student’s project is present starting by the 14th day of the meeting on the plenary
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 Date Tutor Sign
Title 1
Translation of
Journals 2
Discussion and
Summary of Journal 3 Final Report 4
Assessment
A. Paper structure : 6 7 8 9 10
B. Content : 6 7 8 9 10
C. Discussion : 6 7 8 9 10
D. References : 6 7 8 9 10
Total Point : (A+B+C+D)/4 = __________
Denpasar,
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 22nd 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
Learning Programs
Modul
1
Introduction to Behavior and Disorders
dr Anak Ayu Sri Wahyuni, SpKJ
AIMS:
Emphasizes clinical psychiatry and its development in Indonesia and in the world Describe Mental Health Act in Indonesia, Manual of Indonesian Mental Disordersand 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.
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-be-completed 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 test
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 45-year-old successful attorney suffering from anxiety and mild depression faced multiple sources of turmoil in his family, including with his spouse. When asked what he valued about the members of his family, he listed many aspects: his long-standing with for the “American Dream” of a white picket fence house, the importance to his career, the responsibility for seeing his children thrive, etc. What he never mentioned was his own need for intimacy and friendship from his wife. When this was pointed out, a whole new area of the patient’s life became exposed.
Learning Task
3. What are the trends in psychiatric care?
4.
Explain about the most important tool for healing?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?
Modul
2
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.
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.
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
Behavior Changes Due to a General Medical Condition
Dr dr Wira Gotra, SpPD
AIMS:
Describe the clinical management of Behavior Changes Due to a General Medical Condition (Anamnesis, History taking, Mental State Examination, Diagnosis, and Therapy).
LEARNING OUTCOMES: Describe how to:
1. Anamnesis 2. History taking
3. Examine mental state 4. Diagnosis
5. Therapy (pharmacotherapy, psychotherapy)
CURRICULUM CONTENTS: 1. Anamnesis
2. History taking (fundamental four and secret seven) of Behavior Changes Due to a General Medical Condition
3. Mental state examination of Behavior Changes Due to a General Medical Condition 4. Diagnosis formulation
5. Modality of treatment of Behavior Changes Due to a General Medical Condition
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.
Scenario
A patient presents to the medical hospital with abdominal pain, nausea, and vomiting for which no physiological cause can be found. She complains about her symptoms, wanting relief from her pain and nausea/vomiting. She uses a normal amount of analgesic and antiemetic medication. She has some underlying anxiety but generally functions well in the community, with no past psychiatric history, substance use history, or psychiatric medications. She denies any body image problems and is not trying to lose weight. She has lost a few pounds over the past two weeks and is mildly dehydrated. Nursing staf report that she is pleasant but withdrawn, is not overly demanding or needy.
Learning Task
1. What are the diagnostic features of this patient? 2. What is the diagnosed according to ICD-10?
3. Explain the differential diagnosis of the above case? 4. What laboratory assessment should be done? 5. What therapy should be given?
Modul
4
Delirium and Dementia
dr Ni Ketut Sri Diniari, SpKJ
AIMS:
Describe the clinical management of delirium syndromes dementia (History, General Medical and Neurologic Examination, Mental Status examination, Laboratory Studies, Imaging, and Other Diagnostic Tests, Diagnostic criteria, Management)
LEARNING OUTCOMES: Describe how to:
1. Definition and Diagnostic Features 2. Common Associated Features 3. Predisposing Factors
4. Selected Causes of Delirium and Dementia
5. Management: general Principles (Behavioral Interventions, Pharmacologic Interventions, physical restraints)
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.
The clinical management of delirium consists of how to make a proper diagnosis through good anamnesis, physical and mental examination, aetiologi, management four main principles.
SELF DIRECTING LEARNING Basic knowledge that must be know:
1. The prosedure of delirium and dementia diagnosis 2. Management of delirium and dementia
3. Assessment of delirium and dementia.
SCENARIO
A male patient, 48 years old hospitalized with diagnoses of stroke, after 2 days treatment patient becomes agitated, screaming, incoherent, start to seeing creepy shadows behind the curtain, and unable to recognize his accompanied family during that time. His conciousness is fluctuative. The patient has no previous psychiatric history.
LEARNING TASK
A. What is the psychiatric signs and symptoms of this patient? B. What is the screening tools to diagnose the patient?
C. What is conciousness condition of delirium patient? D. How to manage a delirium patient?
E. What is pharmacology theraphy of delirium patient? And how to determined the dosage?
SCENARIO 2
A female patient, 78 years old, found lost at some road. Seems confused, and did not recall her way home. She also lost her memory about what just happened to her, but still manage to recall her home address, her childern name, and her previous profession/activity as a merchant. She repeatedly mentioned that she will go to market to do her activity as a merchant. Her test for MMSE = 15.
LEARNING TASK
A. What is the psychatric symptoms of this patient?
B. How to assess patients fast-term memory, short-term memory, and long-term memory?
C. What is the patient diagnose?
D. How to differentiate the diagnose of delirium, dementia, and depression? E. How to manage a dementia patient?
Modul
5
Schizophrenia
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
5. Therapy (pharmacotherapy, psychotherapy)
CURRICULUM CONTENTS: 1. Anamnesis
2. History taking (fundamental four and secret seven) of Schizophrenia & Other Psychosis
3. Mental state examination of Schizophrenia & Other Psychosis 4. Diagnosis formulation
5. Modality of treatment of Schizophrenia & Other Psychosis
ABSTRACTS
Schizophrenia is a clinical syndrome of variable, but profoundly disruptive, psychopathology that involves cognition, emotion, perception, and other aspects of behavior. The expression of these manifestations varies across patients and over time, but the effect of the illness is always severe and is usually long-lasting.
Schizophrenia is a leading worldwide public health problem that exacts enormous personal and economic costs. Schizophrenia affects just less than 1 percent of the world's population. If schizophrenia spectrum disorders are included in the prevalence estimates, then the number of affected individuals increases to approximately 5 percent. The concept of schizophrenia spectrum disorders is derived from observations of psychopathological manifestations in the biological relatives of patients with schizophrenia. Diagnoses (and approximate lifetime prevalence rates [percent of population]) for these disorders are schizoid personality disorder (fractional percentage), schizotypal personality disorder (1 to 4 percent), schizoaffective psychosis (<1 percent), and delusional disorder (fractional percentage). The relationship of these disorders to schizophrenia in the general population is unclear, but in family pedigree studies, the presence of a proband with schizophrenia significantly increases the prevalence of these disorders among biological relatives.
Cognitive impairments and primary negative symptoms are largely responsible for the poor functional outcome and low quality of life of most persons with schizophrenia. Will new molecular targets result in the first efficacious treatments for these illness components? What knowledge of etiopathophysiology is required to discover primary and secondary prevention interventions? Will the multiple genes involved in risk so overlap with affective and other disorders that current classification of diseases will be invalidated? Will the many common and small contributors to risk and the many and varied pathophysiological results require a new disease paradigm? The complexity of this most distinctively human disease syndrome, however, assures that the conquest of schizophrenia will be one of medicine's most difficult challenges.
SELF DIRECTING LEARNING 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
His personal hygiene had to be supervised by the nursing staff; otherwise, he would quickly become dirty and untidy.
Six years after his admission to the hospital, he is described as shiftless and careless, sullen and unreasonable. He lies on a couch all day long. Although many efforts have been made to get the patient to accept therapeutic work assignments, he refuses to consider any kind of regular occupation. In the summer, he wanders about the hospital grounds or lies under a tree. In the winter, he wanders through the tunnels connecting the various hospital buildings and is often seen stretched out for hours under the warm pipes that carry the steam through the tunnels.
Learning Task:
6. What are the diagnostic features of this patient? 7. How long is the onset of illness on this kind of patient? 8. What is the diagnosed according to DSM-5?
9. Explain the differential diagnosis of the above case? 10. What therapy should be given?
11. What is the difference between positive and negative symptoms of schizophrenia? 12. When reviewing the prognosis for people with schizophrenia, what kind of onset,
gender, and duration suggest a more favorable outcome?
13. Discuss about the possibility when people like above case never get any treatment! 14. Discuss about any prevention work that possible for the relapse of the above case!
SCENARIO 2
A man, age 32 years, was admitted to the hospital. On arrival, he was noted to be an asthenic, poorly nourished man with dilated pupils, hyperactive tendon reflexes, and a pulse rate of 120 beats/min. He showed many mannerisms, laid down on the floor, pulled at his foot, made undirected violent striking movements, struck attendants, grimaced, assumed rigid and strange postures, refused to speak, and appeared to be having auditory hallucinations. When seen later in the day, he was found to be in a stuporous state. His face was without expression, he was mute and rigid, and he paid no attention to those about him or to their questions. His eyes were closed, and his eyelids could be separated only with effort. There was no response to pinpricks or other painful stimuli.
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-5?
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
Modul
6
Brief Psychotic and Other Psychoses Disorders
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:
Brief psychotic disorder is defined as a psychotic condition that involves the sudden onset of psychotic symptoms, which lasts 1 day or more but less than 1 month. Remission is full, and the individual returns to the premorbid level of functioning. Brief psychotic disorder is an acute and transient psychotic syndrome. Brief psychotic disorder has been poorly studied in psychiatry in the United States, partly because of the frequent changes in diagnostic criteria during the past 15 years. The diagnosis has been better appreciated and more completely studied in Scandinavia and other Western European countries than in the United States. Patients with disorders similar to brief psychotic disorder were previously classified as having reactive, hysterical, stress, and psychogenic psychoses.
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 20-year-old man was admitted to the psychiatric ward of a hospital shortly after starting military duty. During the first week after his arrival to the military base, he thought the other recruits looked at him in a strange way. He watched the people around him to see whether they were out “to get” him. He heard voices calling his name several times. He became increasingly suspicious and after another week had to be admitted for psychiatric evaluation. There he was guarded, scowling, skeptical, and depressed. He gave the impression of being very shy and inhibited. His psychotic symptoms disappeared rapidly when he was treated with an antipsychotic drug. However, he had difficulties in adjusting to hospital light. Transfer to a long-term medical hospital was considered, but after 3 months, a decision was made to discharge him to his home. He was subsequently judged unfit to return to military services.
Learning task
1. What is the most likely diagnosis?
Anthony a 22-year-old senior at a prestigious small college. His family has traditionally held high standards for Anthony, and his father had every expectation that his son would go on to enroll at Harvard Law School. Anthony felt intensely pressured as he worked day and night to maintain a high grade point average, while diligently preparing for the national examination for admission to law schools. His social life became devoid of any meaningful contact. He even began skipping meals, because he did not want to take time away from studying. When Anthony received his scores for the law school admission exam, he was devastated, because he knew that they were too low to allow him to get into any of the better law schools. He began crying uncontrollably, wandering around the dormitory hallways, screaming obscenities and telling people that there was a plot on the part of the college dean to keep him from getting into law school.
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 delutional disorder?
2. How the characteristics of delusion in delusional 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?
Modul
7
Bipolar Disorders & Mania
dr. Ida Ayu Kusuma Wardani, SpKJ, MARS
AIMS:
Describe Bipolar Disorder and the clinical management of bipolar disorders
LEARNING OUTCOMES: Describe how to:
1.
Symptom and Sign of Bipolar disorders2.
Psychodinamic of Bipolar disorders3.
Diagnosis of Bipolar disorders4.
Therapy of Bipolar disordersCURRICULUM CONTENTS:
1.
History taking of Bipolar disorders2.
Observation and psychiatric interview of Bipolar disorders3.
Modality of treatment of Bipolar disordersABSTRACTS
A manic episode is a distinct period of an abnormally and persistently elevated, expansive, or irritable mood lasting for at least 1 week or less if a patient must be hospitalized. A hypomanic episode lasts at least 4 days and is similar to a manic episode except that it is not sufficiently severe to cause impairment in social or occupational functioning, and no psychotic features are present. Both mania and hypomania are associated with inflated self-esteem, a decreased need for sleep, distractibility, great physical and mental activity, and overinvolvement in pleasurable behavior. Bipolar I disorder is defined as having a clinical course of one or more manic episodes and, sometimes, major depressive episodes. A mixed episode is a period of at least 1 week in which both a manic episode and a major depressive episode occur almost daily. A variant of bipolar disorder characterized by episodes of major depression and hypomania rather than mania is known as bipolar II disorder.
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
Ms. C, a 23-year-old woman, became acutely depressed when she was accepted to a prestigious graduate school. Ms. C had been working diligently toward this acceptance for the past 4 years. She reported being “briefly happy, for about 20 minutes” when she learned the good news but rapidly slipped into a hopeless state in which she recurrently pondered the pointlessness of her aspirations, cried constantly, and had to physically stop herself from taking a lethal overdose of her roommate’s insulin. In treatment, she focused on her older brother, who had regularly insulted her throughout the course of her life, and how “he’s not doing well.” She found herself very worried about him. She mentioned that she was not used to being the “successful” one of the two of them. In connection with her depression, it emerged that Ms. C’s brother had had a severe, life-threatening, and disfiguring pediatric illness that had required much family time and attention throughout their childhood. Ms. C had become “used to” his insulting manner toward her. In fact, it seemed that she required her brother’s abuse of her in order not to feel overwhelmed by survivor guilt about being the “healthy, normal” child. “
Learning task
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.
Modul
8
Depression Disorders, Suicide & other mood disorders
dr Ni Ketut Putri Ariani, SpKJ
AIMS:
Describe the management of depression disorders, suicide 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 depression disorders CURRICULUM CONTENS:1. Epidemiology
2. Psychiatric and medical risk factors 3. Familial and genetic
4. Pathophysiology 5. Treatment
ABSTRACTS
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. People very distress and change behavior, unsure what to do or not to do 2. Management of depression disorders
3. Treatment depression disorders, self harm & suicide
SCENARIO
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.
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?
Modul
9
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
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
SCENARIO Case 1
A 32 year old woman, single had an a 2 year history of fatique and sleepiness in the daytime. As a child she said she sleep normally. His was bedtime was 10.00 PM, and his wake up alarm was set for 6.30 A.M. He overslept at least once a week on works days. After lunch he would routinely fell a sleep at the computer.
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 is the medications recommended for the patient? 2. What is the differential diagnosis of the disorder? 3. What is the other symptoms of the main diagnostic?
Case 3
Learning Task 3
1. What is the differential diagnosis of the disorder? 2. What is the baseline assesment must be done ?
3. What is the patients symptoms point preferentally to the diagnosis?
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 is the management of sleep disorder?
Modul
10
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 CONTENS:
1. Recognize the definition of somatoform disorder
2. Recognize the pathogenesis (Psychodynamic, Biochemical) of somatoform disorder 3. Recognize clinical manifestation of somatoform disorder
4. Recognize the examination and diagnosis of somatoform disorder 5. Recognize differential diagnosis of somatoform disorder
6. Recognize the management of somatoform disorder
ABSTRACTS
SELF DIRECTING LEARNING
Basic knowledge that must be known:
1. Recognize the definition of somatoform disorder
2. Recognize the pathogenesis (psychodynamic, biochemical) of somatoform disorder 3. Recognize clinical picture of somatoform disorder
4. Recognize the examination and diagnosis of somatoform disorder 5. Recognize differential diagnosis of somatoform disorder
6. Recognize the management of somatoform disorder
SCENARIO
Mrs A, 42 year-old woman presents to her primary care physician with a chief complaint of backpain for the past 6 months that began after she was knocked down by a man attempting elude the police. She state that the she has extreme pain on the right side of her lower back, near L4 and L5. The pain does not radiate, and nothing makes it better or worse. She says that since the injury she has been unable to function and spends most of her days lying in bed or sitting up, immobile, in a chair. Immediately after the accident, she was taken to an emergency department where a workup revealed back strain but no fractures. Since then, the patient has repeatedly sought help from a variety of specialists, but the ongoing pain has been neither adequately explained nor relieved. She denies other medical problems, although she mentions a past history of domestic violence that resulted in several visits to the emergency department for treatment of bruises and lacerations. On mental status examination, the patient is alert and oriented to person, place, and time. She is cooperative and maintains good eye contact. She holds herself absolutely still, sitting rigidly in her chair and grimacing when she has to move even the smallest amount. Her mood is depressed, and her affect is congruent. Her thought processes are logical, and her thougt content is negative for suicidal or homicidal ideation, delutions or hallucinations.
LEARNING TASK
1. What is the sign and symptom from the anamnesis of this patient? 2. What is the most likely diagnosis of this patient?
3. What is the best approach to this patient?
SELF ASSESSMENT
1. Describe what you know about the definition of somatoform disorder! 2. Describe the etiology of somatoform disorder!
3. Explain the psychodynamic of somatoform disorder
4. Describe the differential diagnosis of somatoform disorder!
Modul
11
Anxiety Disorder
dr Lely Setyawati, SpKJ (K)
AIMS:
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 anxiety disorders 3. Mental state examination of anxiety disorders
4. Diagnosis formulation
5. Modality of treatment of anxiety 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
SCENARIO
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 above? 5. Explain the differences of all anxiety disorders!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
Modul
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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
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. A
