TABLE OF CONTENTS
Page
Table of Contens 1
Curriculum Block The Behavioral Changes and Disorders 2
The Seven General Core Competencies 3
Planner Team & Lecturers 4
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 41
Curriculum Mapping 48
References 49
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
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 081558219247
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 (K) Psychiatry 085737717244
8 Dr dr Ida Bagus Fajar Manuaba, SpOG, MARS Obgyn 081558101719
9 Dr dr Wiragotra, SpPD Internal Medicine 08155736480
Facilitators
Class A
No Name Group Dept Phone Venue
(3rdfloor)
1 dr. Putu Cintya D.Y, MPH A1 Public Health 081353380666 3R.3.01nd floor:
2 Prof. Dr.dr. I Putu Gede Adiatmika, M.Kes A2 Physiology 08123811019 3R.3.02nd floor:
3 dr. I Kadek Swastika, M.Kes A3 Parasitology 08124649002 3R.3.03nd floor:
4 dr. I Wayan Surudarma, Msi A4 Biochemistry 081338486589 3R.3.04nd floor:
5 Dr. dr. I Nyoman Wande, Sp.PK A5 Clinical Pathology 08124686885 3R.3.05nd floor:
6 Dr. dr. Ni Made Linawati, M.Si A6 Histology 081337222567 3R.3.06nd floor:
7 dr. I Gusti Ayu Harry Sundariyati, S.Ked A7 DME 081805380277 3R.3.07nd floor:
8 dr. Yukhi Kurniawan, Sp.And A8 Andrology 08123473593 3R.3.08nd floor:
9 dr. Ni Nengah Dwi Fatmawati, Sp.MK, Ph.D A9 Microbiology 087862200814 3R.3.21nd floor:
10 dr. Jaqueline Sudirman GranDip RepSc MrepSc A10 Obgyn 082283387245 3R.3.22nd floor:
Class B
No Name Group Dept Phone Venue
(3rdfloor)
1 Dr. dr. Susy Purnawati, M.KK B1 Physiology 08123989891 3R.3.01nd floor:
2 Prof. dr. I G M. Aman, Sp.FK B2 Pharmacology 081338770650 3R.3.02nd floor:
3 dr. I Wayan Subawa, Sp.OT B3 Orthopaedi 081337096388 3R.3.03nd floor:
4 dr. I Wayan Sugiritama, M.Kes B4 Histology 08164732743 3R.3.04nd floor:
5 Dr. dr. I Made Muliarta, M.Kes B5 Physiology 081338505350 3R.3.05nd floor:
6 dr. Muliani, M.Biomed B6 Anatomy 085103043575 3R.3.06nd floor:
7 Dr. dr. A.A. Ngurah Subawa., M.Si B7 Clinical Phatology 08155735034 3R.3.07nd floor:
8 dr. Ida Ayu Sri Wijayanti, M.Biomed, Sp.S B8 Neurology 081337667939 3R.3.08nd floor:
9 Dr. dr. I Dewa Made Sukrama, Msi, Sp.MK (K) B9 Microbiology 081338291965 3R.3.21nd floor:
Time Table
Regular Class
Day/
Date Time Activity Venue Conveyer
1
Monday 4 Sept
2017
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 5 Sept
2017
08.00 – 09.00 09.00 – 09.30 09.30 – 12.00 12.00 – 14.00 14.00 – 15.00
Lecture 2: 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
3
Wed 6 Sept
2017
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 7 Sept
2017
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00
Lecture 4: 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
5
Friday 8 Sept 2017
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00
Lecturer 5: 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
6
Monday 11 Sept 2017
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 12 Sept
2017
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 13 Sept
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 14.00
Lecture 8: Depression Disorders &Suicide
Independent learning Group Discussion
Break and student project
Class room
Discussion room
9
Thursday 14 Sept
2017
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 15 Sept
2017
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 Putri Ariani
Dr Putri Ariani
11
Monday 18 Sept 2017
08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00
Lecture 11: 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
12
Tuesday 19 Sept
2017
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 20 Sept
2017
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 Nova Dr Nova
14
Friday 22 Sept 201708.00 – 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
Monday 25 Sept
2017
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
Tuesday 26 Sept
2017
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
Wed 27 Sept
2017
08.00 – 15.00 Clinical Skill: Interview with Anxiety and Depression Disorders Patients
Skill Lab Psychiatric Team
18
Thursday 28 Sept
2017
08.00 – 15.00 Clinical Skill: Interview with
Somatoform and Bipolar Disorders Patients
19
Monday 2 Oct
2017
08.00 – 15.00 Clinical Skill: Community field visit Blahkiuh village Psychiatric Team
20
Tuesday 3 Oct 2017
08.00 – 15.00 Clinical Skill: Community field
evaluation Theater Room Psychiatric Team
Wed 4 Oct
2017
Pre-evaluation Break
Thursday 5 Oct
English Class
Day/
Date Time Activity Venue Conveyer
1
Monday 4 Sept
2017
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 5 Sept
2017
09.00 – 10.00 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00
Lecture 2: Schizophrenia
Student project & break Independent learning Group Discussion Plenary session Class room Discussion room Class room
DR Dr Cok Bagus
DR Dr Cok Bagus
3
Wed 6 Sept
2017
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 7 Sept
2017
09.00 – 10.00
10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00
Lecture 4: 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
5
Friday 8 Sept 2017
09.00 – 10.00
10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00
Lecturer 5: 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
6
Monday 11 Sept 2017
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 12 Sept 2017
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 13 Sept
2017
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 Lely Setiawati
9
Thursday 14 Sept
2017
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 15 Sept
2017
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 Putri Ariani
Dr Putri Ariani
11
Monday 18 Sept 2017
09.00 – 10.00 10.00 – 12.00 12.00 – 13.30 13.30 – 15.00 15.00 – 16.00
Lecture 11: Delirium and Dementia
Student project & break Independent learning Group Discussion Plenary session Class room Discussion room Class room
Dr Sri Diniari
Dr Sri Diniari
12
Tuesday 19 Sept 2017
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 20 Sept
2017
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 Nova Dr Nova
14
Friday 22 Sept 201709.00 – 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
Monday 25 Sept
2017
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
Tuesday 26 Sept 2017
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
Wed
09.00 – 16.00 Clinical Skill: Interview with Anxiety and Depression Disorders
Patients
18
Thursday 28 Sept
2017
09.00 – 16.00 Clinical Skill: Interview with Somatoform and Bipolar Disorders Patients
Skill Lab Psychiatric Team
19
Monday 2 Oct
2017
09.00 – 16.00 Clinical Skill: Community field visit Blahkiuh village Psychiatric Team
20
Tuesday 3 Oct
2017
09.00 – 16.00 Clinical Skill: Community field
evaluation Theater Room Psychiatric Team
Wed 4 Oct
2017
Pre-evaluation Break
Thursday 5 Oct
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 2015 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 Smartphone addiction A1
2 Conversion Disorder A2
3 Factitious Disorder A3
4 Pain Disorder A4
5 Hoarding Disorder A5
6 Serotonine like syndrome A6
7 Impact of Terrorism on Children A7
8 Bulimia Nervosa A8
9 Selective Mutism A9
10 Metabolic Syndrome A10
11 Gender Dysphoria B1
12 Conduct Disorders B2
13 Stigmatization of electroconvulsive therapy B3
14 Deep Brain Stimulation B4
15 Autism Spectrum Disorder B5
16 Extrapyramidal syndrome B6
17 Attention Deficit/Hyperactivity Disorder B7
18 Elimination Disorders B8
19 Euthanasia attitudes B9
20 Psychiatric issues in palliative Care 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 Changes 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.
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
A 55-year-old female health professional was referred for psychiatric assessment before resuming work, having been abstinent from alcohol for 3 months while attending daily Alcoholics Anonymous meetings. Seven years earlier her body mass index was 40, and she underwent Roux-en-Y gastric bypass surgery (RYGB). The surgery was successful, and the patient’s body mass index fell to 32 within 12 months. The patient had a lifetime history of consuming less than 20 g alcohol per week before surgery. She had never smoked or used illicit substances, but she described eating compulsively to alleviate stress and boredom. Her mother and a brother were heavy drinkers, and a maternal uncle had fatal complications of chronic alcoholism.
Learning Task
1. How did the patient present to the acute care setting?
2. Was the patient brought in by emergency medical services? Or is the patient in police custody?
3. What concerning statements did the patient make? What did others report about the patient?
4. How did the patient appear?
5. What kind of assessment can be done to the patient?
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
1.
Expalin about the key skill in psychiatry?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
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
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.
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
Martin is a 21 year-old business major at a large university. Over the past few weeks his family and friends have noticed increasingly bizarre behaviors. On many occasions they’ve overheard him whispering in an agitated voice, even though there is no one nearby. Lately, he has refused to answer or make calls on his cell phone, claiming that if he does it will activate a deadly chip that was implanted in his brain by evil aliens.
His parents have tried to get him to go with them to a psychiatrist for an evaluation, but he refuses. He has accused them on several occasions of conspiring with the aliens to have him killed so they can remove his brain and put it inside one of their own. He has stopped attended classes altogether. He is now so far behind in his coursework that he will fail if something doesn’t change very soon.
Although Martin occasionally has a few beers with his friends, he’s never been known to abuse alcohol or use drugs. He does, however, have an estranged aunt who has been in and out of psychiatric hospitals over the years due to erratic and bizarre behavior
.
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-5?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
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
3
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
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.
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?
Modul
4
Anxiety Disorder
dr Lely Setyawati, SpKJ (K)
AIMS:
Describe the clinical management of anxiety 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 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
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 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
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
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.
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)!
Modul
6
Brief Psychotic and Other Psychoses 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:
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 Women 49-year-old bank teller without a psychiatric history is referred to your office for the first time by her internist for an evaluation. For the past 2 months, she has been increasingly convinced that a well-known pop music star is in love with her and that they have had an ongoing affair. She is well-groomed, and there is no evidence of thought disorder or hallucinations. Her husband reveals that she has been functioning well at work and in other social relationships.
Learning task
1. What is the psychatric symptoms of this patient? 2. What is the most likely diagnosis?
3. What the differential diagnosis of this patient?
4. What is the most likely psychodinamic for this process? 5. What is the management this patient?
A 19-year-old woman is brought to the emergency room by her roommate after the patient told her that “the voices are telling me to kill the teacher.” The roommate states the patient has always been isolative and “odd” but for the past 2 weeks she has been hoarding food, talking to herself, and appearing very paranoid. Her personality is suspicious and negative thinking. Her aunt from father family suffering same like patient.
Learning task
1. What is the psychatric symptoms of this patient? 2. What is the most likely diagnosis?
3. What the differential diagnosis of this patient?
4. What is the most likely psychodinamic for this process? 5. What is the management this patient?
6. How to educate this patient and their family?
Self Assesment
1. How to diagnose delusional 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 delusional 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
Mania and depression have been recognized as far back as Western classical antiquity, and recognizable descriptions of bipolar (manic depressive) disorder can be found in the writings of Galen’s contemporary, Aretaeus of Cappadocia (c. 150–200 CE).
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
Mrs. S, 34 years old, married, has not have children yet, private employee, in the last month have become her friend’s attention. Someday, Mrs. S looked so happy, like never run out of energy and even royal by buying food for her friends every day. Mrs. S also become more talkative than usual. She often calls her friend in midnight, does not sleepy even feel fit. Sometimes, Mrs. S also easy to get angry and very sensitive with conversation about her. Her libido also increases, almost every night she persuades her husband to have sexual intercourse. This makes her husband confused because suddenly Mrs. S turn to be moody, often crying without caused and refused to work. Mrs. S often told want to be dead because have no more reason to live. She does not take care of her look and keep thinking of negative stuff.
Learning Task
1. What is the sign and symptoms?
2. What is the diagnosis for patient above? 3. How to manage?
Case 2
Ms. P, 35 years old, has not married yet, private employee, does not get flight ticket to vacation in Labuan Bajo on internet. Her look draw attention in airport, also with heavy make up. Ms. P go to ticketing section in Ngurah Rai International Airport with anger and ask to be served first. Ms. P also mention that she still part of Keraton Jogja Royal Family and if there is no ticket, then Ms. P ask to be serve to purchase the ticket soon. But the officer already said all the flight ticket to Labuan Bajo already sold out for today.
Learning Task
1. What is the sign and symptoms?
2. What is the diagnosis for patient above? 3. How to manage?
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
Modul
8
Depression Disorders, Suicide & other mood disorders
dr Lely Setiawati, SpKJ (K)
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
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
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 Assesment
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 (K)
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.
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
A 27 year old woman was referred with symptoms of talking, mumbling and crying out during sleep. At least twice per week, she screamed in her sleep. Previous health history include a hospitalization for febrile convulsion, opthalmologyc surgery for strabismus during chilhood and tonsilectomy as a teenager.
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?
Somatoform Disorders
dr Ni Ketut Putri Ariani, 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
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. 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
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 Assesment
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
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
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 Man 78 years old ushered the family into the emergency unit due to threaten his grandson with a knife. He was very sure of his grandson will steal his money, even to listen to the voice in his ear that his grandson would kill in order to get the money. Since 1 year ago he looked dazed and often forget to put somethings and money. He didn’t suffer severe medical conditions, but suffered hearing loss. His MMSE = 14.
Learning Task
1. What is the psychatric symptoms of this patient?
2. How to assess patients fast-term memory, short-term memory, and long-term memory?
3. What is the patient diagnose?
4. How to differentiate the diagnose of delirium, dementia, and depression? 5. How to manage a dementia patient?
Case 2
A woman 45 years old was admitted to the hospital after she was found lying on the floor of her bedroom by her daughter. In the hospital, the patient was found to be incoherent. She was also hypervigilant and had disorganized thoughts. She suffered diabetes since 2 years old. Patient disoriented and disoriented. No previous psychiatric history.The result of blood sugar laboratory is 400 mg/dL.
Learning Task
1. What is the psychatric symptoms of this patient? 2. What is patient diagnose?
3. What is the principal therapy in this case? 4. How to manage this patient?
5. What cause of delirium?
Modul
12
AIMS:
Describe the clinical management of PTSD (Anamnesis, History taking, Mental State Examination, Diagnosis, and Therapy)
LEARNING OUTCOMES: Describe how to:
1. Anamnesis 2. History taking
3. Examine mental state 4. Diagnosis
5. Therapy (pharmacotherapy, psychotherapy)
CURRICULUM CONTENTS: 1. Anamnesis
2. History taking (fundamental four and secret seven) of PTSD 3. Mental state examination PTSD
4. Diagnosis formulation
5. Modality of treatment of PTSD
ABSTRACTS
Posttraumatic stress disorder is classified as Trauma- and Stressor-Related Disorders in the DSM-5; the characteristic symptoms are not present before exposure to the violently traumatic event. In the typical case, the individual with PTSD persistently avoids all thoughts and emotions, and discussion of the stressor event and may experience amnesia for it. 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.
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 PTSD2.
Management of PTSD3.
Psychometric Examination of PTSDSCENARIO
Josh is a 27 year-old male who recently moved back in with his parents after his fiancée was killed by a drunk driver 3 months ago. His fiancée, a beautiful young woman he’d been dating for the past 4 years, was walking across a busy intersection to meet him for lunch one day. He still vividly remembers the horrific scene as the drunk driver ran the red light, plowing down his fiancée right before his eyes. He raced to her side, embracing her crumpled, bloody body as she died in his arms in the middle of the crosswalk. No matter how hard he tries to forget, he frequently finds himself reliving the entire incident as if it was happening all over.
Since the accident, Josh has been plagued with nightmares about the accident almost every night. He had to quit his job because his office was located in the building right next to the little café where he was meeting his fiancée for lunch the day she d
