Penganta

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Psikopat dr. Shella Thea
Narasumber : Dr. dr. Nurmiati Amir, SpKJ(K)
 1 Psikopatologi
2 Disfungsi Pikiran
3 Disfungsi Perasaan
4
Index Disfungsi Perilaku
 01.
Psikopatol
ogi
 Definisi
Psychopathology --> Psyche + Patho + Logy --> Study of psychological disorders

Personal Distress --> extreme anxiety, sorrow, or pain

Disability --> impairment in some important area of life

(work or relationship)
Dysfunction --> Something that has gone wrong and is
not working as it should

Violation of social norms --> vary a great deal across

culture and ethnic groups

Kring AM & Johnson SL. Abnormal Psychology. 14th ed.

 Definisi
Contoh “Disease Process” dalam Parkinson

Bartus RT et al. Mol Ther, 2013; 22(3)

 Psychopathology is the systematic study of abnormal

Definisi experience, cognition and behaviour

Explanatory --> menjelaskan teori yang melandasi

tentang apa yang terjadi pada pikiran dan perbuatan
pasien; “according to theoretical process”

Descriptive --> Observation (physical appearance,

gestures, facial expression, clothing, make up and so
on) and empathy (feeling oneself into); dilaporkan apa
adanya, hanya mendeskripsikan

Empathy yang akhirnya disebut dengan metode

phenomenology

Oyebode F. Sim’s Symptoms in the Mind: Textbook of Descriptive Psychopathology. 7th ed.
 Definisi

Oyebode F. Sim’s Symptoms in the Mind: Textbook of Descriptive Psychopathology. 7th ed.
 Key
FORM
Concepts CONTENT
Deskripsi dari struktur di dalam konsep fenomenologi, Karakteristik dari gangguan persepsi itu sendiri
dimana persepsi dipresentasikan kepada dokter

PRIMARY SECONDARY
immediate and ultimate, not understandable what emerges from the primary in a way that can be
understood

OBJECTIVITY SUBJECTIVITY
learning capacity, memory span facial expression

Oyebode F. Sim’s Symptoms in the Mind: Textbook of Descriptive Psychopathology. 7th ed.
 Key
Concepts
UNCONCIOUS EXPERIENCE PHENOMENOLOGY
dream, hypnotic Empati

ORGANIC AND NEURAL PROCESS PSYCHOPATHOLOGY

iand the issue of mind-brain duality

Oyebode F. Sim’s Symptoms in the Mind: Textbook of Descriptive Psychopathology. 7th ed.
 Pendekatan
Psikopatologi Paradigma Integratif

Paradigma Faktor
Tunggal
• Genetik
• Neurosains
• Kognitif
• Sosioemosional

Kring AM & Johnson SL. Abnormal Psychology. 14th ed.

 Definisi Gangguan
Mental

World Health Organization. ICD-10 : international statistical classification of diseases and related health problems: tenth revision. 2nd ed. World Health Organization; 2004.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Publishing; 2013.
 Klasifikasi Gangguan
Mental

World Health Organization. ICD-10 : international statistical classification of diseases and related health problems: tenth revision. 2nd ed. World Health Organization; 2004.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Publishing; 2013.
 HiTOP
The Hierarchical Taxonomy of
Psychopathology

Kotov R, Krueger RF, Watson D, Achenbach TM, Althoff RR, Bagby RM, Brown TA, Carpenter WT, Caspi A, Clark LA, Eaton NR. The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional
nosologies. Journal of abnormal psychology. 2017 May;126(4):454.
 02.
Disfungsi
Pikiran
Disfungsi
Pikiran
Penilaian pikiran membutuhkan wawancara terbuka --> membiarkan pasien dapat
menjelaskan dan mengarahkan alur pembicaraan secara mandiri

Bentuk/ Proses Pikir Isi Pikir

Cara seseorang menyatukan/ Apa yang dipikirkan

mengasosiasikan ide-ide seseorang (ide, keyakinan,
sehingga menjadi sebuah preokupasi, obsesi)
pemikiran

Sadock BJ, Sadock VA & Ruiz P. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. 10th ed.
 Bentuk Pikir
Bentuk pikir yang koheren mengandung tiga komponen
:
• Linear : arah arus pikiran bersifat lurus, dimana
percakapan dari satu kalimat ke kalimat lain
menyambung/ konsisten, tidak berbelok/ berhenti
mendadak
• Logis : pikiran dan bahasan masuk di akal, dan
kesinambungan antara bahasan cocok dengan nalar
• Goal-oriented : luaran pikiran fokus untuk
mencapai tujuan, yaitu menjawab pertanyaan

Sadock BJ, Sadock VA & Ruiz P. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. 10th ed.
 Bentuk Pikir
Important signs of disorganized thinking :
• Circumstantial and Tangential Thinking
• Flight of Ideas
• Loosening of association (derailment/
knight’s move thinking)

Special forms :
• Thought blocking --> sudden cessation, no
recall
• Neologism --> new words
• Preserveration --> unnecessarily repeat
(palilalia, logoclonia)
• Echolalia --> like parrots
• Irrelevant answers

Sadock BJ, Sadock VA & Ruiz P. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. 10th ed.
Marwick K, Birrell S. Psychiatry. 4th ed. Mosby Elsevier; 2013.
 Isi Pikir
Gangguan pada konten pikiran
Psikopatologi yang dinilai berupa :
• Kuantitas ide : banyak/ miskin
• Elemen pikiran : keberadaan isi pikir patologis seperti
overvalued ideas (preokupasi), waham (delusi), obsesi-
kompulsi
• Overvalued ideas : logical reason; bukan obsesi --> not
experienced intrusive thoughts. Contoh : anorexia
nervosa, hipokondriasis
• Delusi : dinilai oleh orang lain; false reasoning; out from
social and cultural background; klasifikasinya :
⚬ Primary or secondary
⚬ Congruent or incongruent
⚬ Bizzare or non bizzare
⚬ Tergantung jenis2 wahamnya
Sadock BJ, Sadock VA & Ruiz P. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. 10th ed.
 Disfungsi Persepsi

Persepsi : proses mengartikan informasi yang didapat dari

berbagai modalitas sensori (panca indera)

Penilaian persepsi :
• Jenis gangguan persepsi : halusinasi, ilusi, pikiran intrusif
• Indra yang terlibat
• Kompleksitas halusinasi

Marwick K, Birrell S. Psychiatry. 4th ed. Mosby Elsevier; 2013.

 03.
Disfungsi
Perasaan
Disfungsi
Perasaan
MOOD AFEK
Patient’s internal and SUSTAINED TRANSIENT and flow of emotions
emotional state --> SUBJEKTIF dan in respon to stimuli --> OBJEKTIF,
deskripsi terbaik adalah observasi postur, ekspresi wajah,
menggunakan kata-kata pasien reaksi emosional, dll

depressed, elated, anxious, guilty, • Kongruen atau tidak (suicide tapi

frightened, angry, etc. happy)
• Normal range atau blunted/ flat

Sadock BJ, Sadock VA & Ruiz P. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. 10th ed.
 04.
Disfungsi
Perilaku
 Penilaian
Penampilan
• Pada pasien yang kurang komunikatif, penampilan dapat digunakan untuk menilai
perawatan diri, status kesehatan umum

• Keadaan fisik : tampak sesuai umur, status nutrizi, terlihat sakit

• Pakaian : kebersihan, kerapihan, keserasian, eksentrik atau aneh
• Perawatan diri dan kebersihan : kerapihan dan kebersihan (kuku, rambut, bau
badan) dan tanda-tanda bekas luka/ self harm

Sadock BJ, Sadock VA & Ruiz P. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. 10th ed.
 Penilaian Perilaku dan
Bicara
• Aspek perilaku yang dinilai : motivasi dan empati, kontrol impuls, kesesuaian
dengan norma sosial
• Perilaku umumnya dinilai melalui observasi :
⚬ Sikap : kooperatif, apatis, menunjukkan sikap melawan, kontak mata
⚬ Psikomotor : agitasi, retardasi, hiperaktivitas
⚬ Motorik : manerisme, repetitif, akatisia, fleksibiltas cerea, negativisme
⚬ Bicara : artikulasi, volume, intonasi, defek verbal, kuantitas, kualitas,
spontanitas (afasia, disartria, stuttering, dysprosody, slowed/ rapid speech)
• Lainnya : gejala ekstrapiramidal

Sadock BJ, Sadock VA & Ruiz P. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. 10th ed.
Terima Kasih