GTU 2015/2016

BLOCK NEUROBEHAVIOUR
Week VII – Psychosis

Week Objective:

1. Describe anatomy and function of Hypothalamus

Anatomy:

Function:

Nucleus Zone(s) Region(s) Functions

Periventricular, Fluid balance, milk let-down, parturition, autonomic
Paraventricular Anterior,Tuberal
Medial & anterior pituitary control
Preoptic Medial, Lateral Anterior Lateral anterior thermoregulation, sexual behavior
Anterior Medial Anterior Lateral anterior thermoregulation, sexual behavior
Suprachiasmatic Medial Anterior Biological rhythms
Supraoptic Medial, Lateral Anterior Fluid balance, milk let-down, parturition
Dorsomedial Medial Tuberal Emotion (rage)
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Ventromedial Medial Tuberal Appetite, body weight, insulin regulation
Periventricular,
Arcuate Tuberal Control of anterior pituitary, feeding
Medial
Posterior Medial Posterior Thermoregulation
Mammillary Medial Posterior Emotion and short-term memory
Lateral Complex Lateral Tuberal Appetite and body weight control

2. Describe the Mental Illness and Social effect of Mental illness

Jujur gue kepikiran nya ini maksudnya, gue ga tau yang mana lagi..

3. Explain the clinical picture signs and symptoms of Psychopathology

Psychopathology terbagi atas:
1. Conscousness
2. Emotion
3. Motoric behavior/conation
4. Thinking
5. Speech
6. Perception
7. Memory
8. Intelligence
9. Insight
10. Judgement

Isi dari ini semua ada di butuk psychopatology yang kecil itu ._. kalo gue masukin semua ga tidur gue.. baca sendiri ya..
gue jg ga baca =_=
4. Sudah ada di case objective
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5. Describe pharmacology and clinical treatment of psychotic

6. Describe the dopamine pathway of schizophrenia and presyanapse of action central neutrotransmitter.
Dopamin pathway
a. Mesolimbic
Transfer dari VTA ke midbrain (nucleus accumbens)
Produksi perasaan puas, enjoy; termasuk perasaan yang dihasilkan saat penggunaan zat adiktif.
Berperan dalam munculnya positive symptoms.
b. Mesocortical
Trasnfer dopamine dari VTA ke frontal cortex (terkait dengan fungsi kognitif)
Mengatur emosi, motivasi -> kalau terjadi trauma menghasilkan emosi yang flat
Berperan dalam munculnya negative symptoms.
c. Nigostriatal
Transfer dopamine dari substansia nigra ke striatum.
Untuk kontrol motorik -> pada proses degenerasi, muncul parkinson.
Terkait adanya tardive diskinesia akibat efek samping obat mual.
d. Tuberoinfendibular
Transfer dari hipotalamus ke pituitary gland.
Terkait hormonal -> inhibisi prolaktin
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7. Substance abuse and psychological aspect, law aspec t and the antidote.
a. Inhibitory
 Benzodiazepam : bind to GABA -> meningkatkan aktifitas GABA
b. Excitatory
 Cocaine : bind to dopa, serotonin, and NE reuptake -> jumlah meningkat
 Amphetamine : masuk di jalur dopa reuptake -> hambat reuptake
 Opiat (heroin dan morphine) :  receptor : inhibit GABA
:  turunkan exitability -> euphoria
Turunkan exitability -> naikkan aktifitas CAMP -> addiction
 Cannabis : bind di anandamide receptor -> turunkan GABA dan aktifitas CAMP
 Ecstacy : inhibit serotonin reuptake
Kalau serotonin menipis & susah distimulasi -> depresi
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Physiological Aspect
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8. Explain Emergency Psychiatry

A psychiatric emergency is any disturbance in thoughts, feelings, or actions for which immediate therapeutic intervention
is necessary. Kalo di kaplan sih sebagian besar ngmgnya tntg suicide.. so here goes nothin
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Table 34.2-6 Common Psychiatric Emergencies

Syndrome Emergency Manifestations Treatment Issues
Abuse of child or adult Signs of physical trauma Management of medical problems;
psychiatric evaluation; report to authorities
Acquired immune Changes in behavior secondary to organic Management of neurological illness;
deficiency syndrome causes; changes in behavior secondary to management of psychological concomitants;
(AIDS) fear and anxiety; suicidal behavior reinforcement of social support
Adolescent crises Suicidal attempts and ideation; substance Evaluation of suicidal potential, extent of
abuse, truancy, trouble with law, substance abuse, family dynamics; crisis-
pregnancy, running away; eating oriented family and individual therapy;
disorders; psychosis hospitalization if necessary; consultation
with appropriate extrafamilial authorities
Agoraphobia Panic; depression Alprazolam (Xanax), 0.25 mg to 2 mg;
propranolol (Inderal); antidepressant
medication
Agranulocytosis High fever, pharyngitis, oral and perianal Discontinue medication immediately;
(clozapine [Clozaril]- ulcerations administer granulocyte colony-stimulating
induced) factor
Akathisia Agitation, restlessness, muscle discomfort; Reduce antipsychotic dosage; propranolol
dysphoria (30 to 120 mg a day); benzodiazepines;
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diphenhydramine (Benadryl) orally or IV;
benztropine (Cogentin) IM
Alcohol-related emergencies
Alcohol delirium Confusion, disorientation, fluctuating Chlordiazepoxide (Librium); haloperidol
consciousness and perception, autonomic (Haldol) for psychotic symptoms may be
hyperactivity; may be fatal added if necessary
Alcohol intoxication Disinhibited behavior, sedation at high With time and protective environment,
doses symptoms abate
Alcohol persisting Confusion, loss of memory even for all Hospitalization; hypnosis; amobarbital
amnestic disorder personal identification data (Amytal) interview; rule out organic cause
Alcohol persisting Confusion, agitation, impulsivity Rule out other causes for dementia; no
dementia effective treatment; hospitalization if
necessary
Alcohol psychotic Vivid auditory (fat times visual) Haloperidol for psychotic symptoms
disorder with hallucinations with affect appropriate to
hallucinations content (often fearful); clear sensorium
Alcohol seizures Grand mal seizures; rarely status Diazepam (Valium), phenytoin (Dilantin);
epilepticus prevent by using chlordiazepoxide
(Librium) during detoxification
Alcohol withdrawal Irritability, nausea, vomiting, insomnia, Fluid and electrolytes maintained; sedation
malaise, autonomic hyperactivity, with benzodiazepines; restraints; monitoring
shakiness of vital signs; 100 mg thiamine IM
Idiosyncratic alcohol Marked aggressive or assaultive behavior Generally no treatment required other than
intoxication protective environment
Korsakoff's syndrome Alcohol stigmata, amnesia, confabulation No effective treatment; institutionalization
often needed
Wernicke's Oculomotor disturbances, cerebellar Thiamine, 100 mg IV or IM, with MgSO4
encephalopathy ataxia; mental confusion given before glucose loading
Amphetamine (or Delusions, paranoia; violence; depression Antipsychotics; restraints; hospitalization if
related substance) (from withdrawal); anxiety, delirium necessary; no need for gradual withdrawal;
intoxication antidepressants may be necessary
Anorexia nervosa Loss of 25% of body weight of the norm Hospitalization; electrocardiogram (ECG),
for age and sex fluid and electrolytes; neuroendocrine
evaluation
Anticholinergic Psychotic symptoms, dry skin and mouth, Discontinue drug, IV physostigmine
intoxication hyperpyrexia, mydriasis, tachycardia, (Antilirium), 0.5 to 2 mg, for severe
restlessness, visual hallucinations agitation or fever, benzodiazepines;
antipsychotics contraindicated
Anticonvulsant Psychosis; delirium Dosage of anticonvulsant is reduced
intoxication
Benzodiazepine Sedation, somnolence, and ataxia Supportive measures; flumazenil
intoxication (Romazicon), 7.5 to 45 mg a day, titrated as
needed, should be used only by skilled
personnel with resuscitative equipment
available
Bereavement Guilt feelings, irritability; insomnia; Must be differentiated from major
somatic complaints depressive disorder; antidepressants not
indicated; benzodiazepines for sleep;
encouragement of ventilation
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Borderline personality Suicidal ideation and gestures; homicidal Suicidal and homicidal evaluation (if great,
disorder ideations and gestures; substance abuse; hospitalization); small dosages of
micropsychotic episodes; burns, cut marks antipsychotics; clear follow-up plan
on body
Brief psychotic disorder Emotional turmoil, extreme lability; Hospitalization often necessary; low dosage
acutely impaired reality testing after of antipsychotics may be necessary but
obvious psychosocial stress often resolves spontaneously
Bromide intoxication Delirium; mania; depression; psychosis Serum levels obtained (>50 mg a day);
bromide intake discontinued; large
quantities of sodium chloride IV or orally; if
agitation, paraldehyde or antipsychotic is
used
Caffeine intoxication Severe anxiety, resembling panic disorder; Cessation of caffeine-containing substances;
mania; delirium; agitated depression; sleep benzodiazepines
disturbance
Cannabis intoxication Delusions; panic; dysphoria; cognitive Benzodiazepines and antipsychotics as
impairment needed; evaluation of suicidal or homicidal
risk; symptoms usually abate with time and
reassurance
Catatonic schizophrenia Marked psychomotor disturbance (either Rapid tranquilization with antipsychotics;
excitement or stupor); exhaustion; can be monitor vital signs; amobarbital may release
fatal patient from catatonic mutism or stupor but
can precipitate violent behavior
Cimetidine psychotic Delirium; delusions Reduce dosage or discontinue drug
disorder
Clonidine withdrawal Irritability; psychosis; violence; seizures Symptoms abate with time, but
antipsychotics may be necessary; gradual
lowering of dosage
Cocaine intoxication Paranoia and violence; severe anxiety; Antipsychotics and benzodiazepines;
and withdrawal manic state; delirium: schizophreniform antidepressants or ECT for withdrawal
psychosis; tachycardia, hypertension, depression if persistent; hospitalization
myocardial infarction, cerebrovascular
disease; depression and suicidal ideation
Delirium Fluctuating sensorium; suicidal and Evaluate all potential contributing factors
homicidal risk; cognitive clouding; visual, and treat each accordingly; reassurance,
tactile, and auditory hallucinations; structure, clues to orientation;
paranoia benzodiazepines and low-dosage, high-
potency antipsychotics must be used with
extreme care because of their potential to
act paradoxically and increase agitation
Delusional disorder Most often brought in to emergency room Antipsychotics if patient will comply (IM if
involuntarily; threats directed toward necessary); intensive family intervention;
others hospitalization if necessary
Dementia Unable to care for self; violent outbursts; Small dosages of high-potency
psychosis; depression and suicidal antipsychotics; clues to orientation; organic
ideation; confusion evaluation, including medication use; family
intervention
Depressive disorders Suicidal ideation and attempts; self- Assessment of danger to self;
neglect; substance abuse hospitalization if necessary, nonpsychiatric
causes of depression must be evaluated
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L-Dopa intoxication Mania; depression; schizophreniform Lower dosage or discontinue drug
disorder, may induce rapid cycling in
patients with bipolar I disorder
Dystonia, acute Intense involuntary spasm of muscles of Decrease dosage of antipsychotic;
neck, tongue, face, jaw, eyes, or trunk benztropine or diphenhydramine IM
Group hysteria Groups of people exhibit extremes of grief Group is dispersed with help of other health
or other disruptive behavior care workers; ventilation, crisis-oriented
therapy; if necessary, small dosages of
benzodiazepines
Hallucinogen-induced Symptom picture is result of interaction of Serum and urine screens; rule out
psychotic disorder with type of substance, dose taken, duration of underlying medical or mental disorder;
hallucinations action, user's premorbid personality, benzodiazepines (2 to 20 mg) orally;
setting; panic; agitation; atropine reassurance and orientation; rapid
psychosis tranquilization; often responds
spontaneously
Homicidal and Marked agitation with verbal threats Seclusion, restraints, medication
assaultive behavior
Homosexual panic Not seen with men or women who are Ventilation, environmental structuring, and,
comfortable with their sexual orientation; in some instances, medication for acute
occurs in those who adamantly deny panic (e.g., alprazolam, 0.25 to 2 mg) or
having any homoerotic impulses; impulses antipsychotics may be required; opposite-
are aroused by talk, a physical overture, or sex clinician should evaluate the patient
play among same-sex friends, such as whenever possible, and the patient should
wrestling, sleeping together, or touching not be touched save for the routine
each other in a shower or hot tub; examination; patients have attached
panicked person sees others as sexually physicians who were examining an
interested in him or her and defends abdomen or performing a rectal examination
against them (e.g., on a man who harbors thinly veiled
unintegrated homosexual impulses)
Hypertensive crisis Life-threatening hypertensive reaction α-Adrenergic blockers (e.g., phentolamine
secondary to ingestion of tyramine- [Regitinel]); nifedipine (Procardia) 10 mg
containing foods in combination with orally; chlorpromazine (Thorazine); make
MAOIs; headache, stiff neck, sweating, sure symptoms are not secondary to
nausea, vomiting hypotension (side effect of monoamine
oxidase inhibitors [MAOIs] alone)
Hyperthermia Extreme excitement or catatonic stupor or Hydrate and cool; may be drug reaction, so
both; extremely elevated temperature; discontinue any drug; rule out infection
violent hyperagitation
Hyperventilation Anxiety, terror, clouded consciousness; Shift alkalosis by having patient breathe
giddiness, faintness; blurring vision into paper bag; patient education;
antianxiety agents
Hypothermia Confusion; lethargy; combativeness; low IV fluids and rewarming, cardiac status
body temperature and shivering; must be carefully monitored; avoidance of
paradoxical feeling of warmth alcohol
Incest and sexual abuse Suicidal behavior; adolescent crises; Corroboration of charge, protection of
of child substance abuse victim; contact social services; medical and
psychiatric evaluation; crisis intervention
Insomnia Depression and irritability; early morning Hypnotics only in short term; e.g., triazolam
agitation; frightening dreams; fatigue (Halcion), 0.25 to 0.5 mg, at bedtime; treat
any underlying mental disorder; rules of
sleep hygiene
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Intermittent explosive Brief outbursts of violence; periodic Benzodiazepines or antipsychotics for short
disorder episodes of suicide attempts term; long-term evaluation with computed
tomography (CT) scan, sleep-deprived
electroencephalogram (EEG), glucose
tolerance curve
Jaundice Uncommon complication of low-potency Change drug to low dosage of a low-
phenothiazine use (e.g., chlorpromazine) potency agent in a different class
Leukopenia and Side effects within the first 2 months of Patient should call immediately for sore
agranulocytosis treatment with antipsychotics throat, fever, etc., and obtain immediate
blood count; discontinue drug; hospitalize if
necessary
Lithium toxicity Vomiting; abdominal pain; profuse Lavage with wide-bore tube; osmotic
diarrhea; severe tremor, ataxia; coma; diuresis; medical consultation; may require
seizures; confusion; dysarthria; focal ICU treatment
neurological signs
Major depressive Major depressive episode symptoms with Antipsychotics plus antidepressants;
episode with psychotic delusions; agitation, severe guilt; ideas of evaluation of suicide and homicide risk;
features reference; suicide and homicide risk hospitalization and ECT if necessary
Manic episode Violent, impulsive behavior; Hospitalization; restraints if necessary;
indiscriminate sexual or spending rapid tranquilization with antipsychotics;
behavior; psychosis; substance abuse restoration of lithium levels
Marital crises Precipitant may be discovery of an Each should be questioned alone regarding
extramarital affair, onset of serious illness, extramarital affairs, consultations with
announcement of intent to divorce, or lawyers regarding divorce, and willingness
problems with children or work; one or to work in crisis-oriented or long-term
both members of the couple may be in therapy to resolve the problem; sexual,
therapy or may be psychiatrically ill; one financial, and psychiatric treatment histories
spouse may be seeking hospitalization for from both, psychiatric evaluation at the time
the other of presentation; may be precipitated by
onset of untreated mood disorder or
affective symptoms caused by medical
illness or insidious-onset dementia; referral
for management of the illness reduces
immediate stress and enhances the healthier
spouse's coping capacity; children may give
insights available only to someone
intimately involved in the social system
Migraine Throbbing, unilateral headache Sumatriptan (Imitrex) 6 mg IM
Mitral valve prolapse Associated with panic disorder; dyspnea Echocardiogram; alprazolam or propranolol
and palpitations; fear and anxiety
Neuroleptic malignant Hyperthermia; muscle rigidity; autonomic Discontinue antipsychotic; IV dantrolene
syndrome instability; parkinsonian symptoms; (Dantrium); bromocriptine (Parlodel) orally;
catatonic stupor; neurological signs; 10% hydration and cooling; monitor CPK levels
to 30% fatality; elevated creatine
phosphokinase
Nitrous oxide toxicity Euphoria and light-headedness Symptoms abate without treatment within
hours of use
Nutmeg intoxication Agitation; hallucinations; severe Symptoms abate within hours of use
headaches; numbness in extremities without treatment
Opioid intoxication and Intoxication can lead to coma and death; IV naloxone, narcotic antagonist; urine and
withdrawal withdrawal is not life-threatening serum screens; psychiatric and medical
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illnesses (e.g., AIDS) may complicate
picture
Panic disorder Panic, terror; acute onset Must differentiate from other anxiety-
producing disorders, both medical and
psychiatric; ECG to rule out mitral valve
prolapse; propranolol (10 to 30 mg);
alprazolam (0.25 to 2.0 mg); long-term
management may include an antidepressant
Paranoid schizophrenia Command hallucinations; threat to others Rapid tranquilization; hospitalization; long-
or themselves acting depot medication; threatened persons
must be notified and protected
Parkinsonism Stiffness, tremor, bradykinesia, flattened Oral antiparkinsonian drug for 4 weeks to 3
affect, shuffling gait, salivation, secondary months; decrease dosage of the
to antipsychotic medication antipsychotic
Perioral (rabbit) tremor Perioral tumor (rabbitlike facial Decrease dosage or change to a medication
grimacing) usually appearing after long- in another class
term therapy with antipsychotics
Phencyclidine (or Paranoid psychosis; can lead to death; Serum and urine assay; benzodiazepines
phencyclidine-like acute danger to self and others may interfere with excretion; antipsychotics
intoxication) may worsen symptoms because of
anticholinergic side effects; medical
monitoring and hospitalization for severe
intoxication
Phenelzine-induced Psychosis and mania in predisposed Reduce dosage or discontinue drug
psychotic disorder people
Phenylpropanolamine Psychosis; paranoia; insomnia; Symptoms abate with dosage reduction or
toxicity restlessness; nervousness; headache discontinuation (found in over-the-counter
diet aids and oral and nasal decongestants)
Phobias Panic, anxiety; fear Treatment same as for panic disorder
Photosensitivity Easy sunburning secondary to use of Patient should avoid strong sunlight and use
antipsychotic medication high-level sunscreens
Pigmentary retinopathy Reported with dosages of thioridazine Remain below 800 mg a day of thioridazine
(Mellaril) of 800 mg a day or above
Postpartum psychosis Childbirth can precipitate schizophrenia, Danger to self and others (including infant)
depression, reactive psychoses, mania, and must be evaluated and proper precautions
depression; affective symptoms are most taken; medical illness presenting with
common; suicide risk is reduced during behavioral aberrations is included in the
pregnancy but increased in the postpartum differential diagnosis and must be sought
period and treated; care must be paid to the effects
on father, infant, grandparents, and other
children
Posttraumatic stress Panic, terror; suicidal ideation; flashbacks Reassurance; encouragement of return to
disorder responsibilities; avoid hospitalization if
possible to prevent chronic invalidism;
monitor suicidal ideation
Priapism (trazodone Persistent penile erection accompanied by Intracorporeal epinephrine; mechanical or
[Desyrel]-induced) severe pain surgical drainage
Propranolol toxicity Profound depression; confusional states Reduce dosage or discontinue drug; monitor
suicidality
Rape Not all sexual violations are reported; Rape is a major psychiatric emergency;
silent rape reaction is characterized by loss victim may have enduring patterns of sexual
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of appetite, sleep disturbance, anxiety, dysfunction; crisis-oriented therapy, social
and, sometimes, agoraphobia; long periods support, ventilation, reinforcement of
of silence, mounting anxiety, stuttering, healthy traits, and encouragement to return
blocking, and physical symptoms during to the previous level of functioning as
the interview when the sexual history is rapidly as possible; legal counsel; thorough
taken; fear of violence and death and of medical examination and tests to identify
contracting a sexually transmitted disease the assailant (e.g., obtaining samples of
or being pregnant pubic hairs with a pubic hair comb, vaginal
smear to identify blood antigens in semen);
if a woman, methoxyprogesterone or
diethylstilbestrol orally for 5 days to prevent
pregnancy; if menstruation does not
commence within one week of cessation of
the estrogen, all alternatives to pregnancy,
including abortion, should be offered; if the
victim has contracted a venereal disease,
appropriate antibiotics; witnessed written
permission is required for the physician to
examine, photograph, collect specimens,
and release information to the authorities;
obtain consent, record the history in the
patient's own words, obtain required tests,
record the results of the examination, save
all clothing, defer diagnosis, and provide
protection against disease, psychic trauma,
and pregnancy; men's and women's
responses to rape affectively are reported
similarly, although men are more hesitant to
talk about homosexual assault for fear they
will be assumed to have consented
Reserpine intoxication Major depressive episodes; suicidal Evaluation of suicidal ideation; lower
ideation; nightmares dosage or change drug; antidepressants of
ECT may be indicated
Schizoaffective disorder Severe depression; manic symptoms; Evaluation of dangerousness to self or
paranoia others; rapid tranquilization if necessary;
treatment of depression (antidepressants
alone can enhance schizophrenic
symptoms); use of antimanic agents
Schizophrenia Extreme self-neglect; severe paranoia; Evaluation of suicidal and homicidal
suicidal ideation or assaultiveness; potential; identification of any illness other
extreme psychotic symptoms than schizophrenia; rapid tranquilization
Schizophrenia in Withdrawn; agitation; suicidal and Suicide and homicide evaluation; screen for
exacerbation homicidal risk medical illness; restraints and rapid
tranquilization if necessary; hospitalization
if necessary; reevaluation of medication
regimen
Sedative, hypnotic, or Alterations in mood, behavior, Naloxone (Narcan) to differentiate from
anxiolytic intoxication thought—delirium; derealization and opioid intoxication; slow withdrawal with
and withdrawal depersonalization; untreated, can be fatal; phenobarbital (Luminal) or sodium
seizures thiopental or benzodiazepine;
hospitalization
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Seizure disorder Confusion; anxiety; derealization and Immediate EEG; admission and sleep-
depersonalization; feelings of impending deprived and 24-hour EEG; rule out
doom; gustatory or olfactory pseudoseizures; anticonvulsants
hallucinations; fuguelike state
Substance withdrawal Abdominal pain; insomnia, drowsiness; Symptoms of psychotropic drug withdrawal
delirium; seizures; symptoms of tardive disappear with time or disappear with
dyskinesia may emerge; eruption of manic reinstitution of the substance; symptoms of
or schizophrenic symptoms antidepressant withdrawal can be
successfully treated with anticholinergic
agents, such as atropine; gradual withdrawal
of psychotropic substances over two to four
weeks generally obviates development of
symptoms
Sudden death associated Seizures; asphyxiation; cardiovascular Specific medical treatments
with antipsychotic causes; postural hypotension; laryngeal-
medication pharyngeal dystonia; suppression of gag
reflex
Sudden death of Myocardial infarction after sudden Specific medical treatments; folk healers
psychogenic origin psychic stress; voodoo and hexes;
hopelessness, especially associated with
serious physical illness
Suicide Suicidal ideation; hopelessness Hospitalization, antidepressants
Sympathomimetic Paranoia; confusional states; depression Most symptoms abate without treatment;
withdrawal antipsychotics; antidepressants if necessary
Tardive dyskinesia Dyskinesia of mouth, tongue, face, neck, No effective treatment reported; may be
and trunk; choreoathetoid movements of prevented by prescribing the least amount of
extremities; usually but not always drug possible for as little time as is
appearing after long-term treatment with clinically feasible and using drug-free
antipsychotics, especially after a reduction holidays for patients who need to continue
in dosage; incidence highest in the elderly taking the drug; decrease or discontinue
and brain-damaged; symptoms are drug at first sign of dyskinetic movements
intensified by antiparkinsonian drugs and
masked but not cured by increased
dosages of antipsychotic
Thyrotoxicosis Tachycardia; gastrointestinal dysfunction; Thyroid function test (T3, T4, thyroid-
hyperthermia; panic, anxiety, agitation; stimulating hormone [TSH]); medical
mania; dementia; psychosis consultation
Toluene abuse Anxiety; confusion; cognitive impairment Neurological damage is nonprogressive and
reversible if toluene use in discontinued
early
Vitamin B12 deficiency Confusion; mood and behavior changes; Treatment with vitamin B12
ataxia
Volatile nitrates Alternations of mood and behavior; light- Symptoms abate with cessation of use
headedness; pulsating headache

9. Explain Classification and Evaluation Multiaxial of Pyschiatry

Axis I : clinical disorder ( diagnosa kejiwaannya)
Axis II : personality disorder /mental retardation
Axis III : somatic (non-mental) medical condition
Axis IV : psychosicial and environtmental problems.
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Axis V : global assesment of functioning

Case Objective:

1. Discuss the differences between drug induced psychosis, schizophrenia and other psychotic disorders
and how these conditions are diagnosed using the DSM IV

Schizophrenia: gangguan bertahan selama 6 bulan dimana 1 bulan itu active phase (criteria schizo)
Schizophreniform: gejala schizo tapi 1-6 bulan doang
Schizoaffective: mood disorder dan active phase terjadi bersamaan OR 2 minggu delusi atau hallusinasi tanpa adanya
mood symptoms
Delusional Disorder: 1 bulan tanpa delusi yang bizzare dan tidak ada active phase
Brief psychotic disorder: gangguan bertahan 1 hari dan terjadi lagi dalam waktu 1 bulan
Shared psychotic disorder: gangguan delusi yang terjadi karena adanya influence dari seseorang yang mempunyai delusi
yang sama
Psychotic disorder due to medical condition: gangguan karena ada efek patofisiologis dari sebuah penyakit
Substance induced psychotic disorder: gangguan karena efek patologis dari sebuah obat
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2. Sudah di WO
3. Sudah di WO
4. Sudah di WO