BMS - II

BMS - IIPLENO 1KELOMPOK B3Skenario Seorang perempuan, usia 30 tahun, sudah menikah, datang ke praktik dokter dengan keluhan sakit kepala yang terus menerus. Hal ini sudah dirasakan sejak ia masih remaja, dan pasien sudah berobat ke beberapa dokter lain untuk memeriksakan dirinya. Pasien juga sering mengalami nyeri tengkuk dan punggung, merasa mual, perut kembung, dan nyeri haid. Siklus haid pasien juga tidak teratur, kadang- kadang muncul keluhan pasien merasa lemah pada kedua tungkainya, namun dapat berjalan seperti biasa.More Info Pasien membawa beberapa hasil pemeriksaan laboratorium dan radiologi yang sudah dijalaninya. Semua pemeriksaan menunjukkan tidak ada kelainan. Pada pemeriksaan vital dijumpai hasil dalam batas normal. Pada pemeriksaan fisik dada, abdomen, dan ekstremitas dijumpai hasil dalam batas normal. Dokter menyampaikan bahwa pasien kemungkinan besar tidak menderita sakit, namun pasien mendesak agar dokter melakukan pemeriksaan apapun yang diperlukan agar penyakitnya dapat diobati.HipotesisSomatoform disorderFisiologi NyeriPain Is a Protective Mechanism. Pain occurs whenever any tissues are being damaged, and it causes the individual to react to remove the pain stimulus. Pain has been classified into two major types: fast pain and slow pain.Dual Pain Pathways in theCord and Brain StemTheNeospinothalamic Tract and thePaleospinothalamic TractOn entering the spinal cord, the pain signals take twopathways to the brain, through (1) the neospinothalamictract and (2) the paleospinothalamic tract.

Perbedaan Nyeri Psikis & Nyeri SomatisKeteranganNyeri PsikogenikNyeri SomatikStimulusStres, kondisi emosionalNoxiousFaktor terkaitDepresi, ansietas, stressor psikososialTrauma, penyakit organikSifat nyeriBerkepanjangan, lokal, nyeri tidak sesuaiAkut/ kronik, lokalisasi nyeri jelasTransmisiSerabut aferen primer C;Melalui traktus paleospinotalamikusSerabut aferen A dan C;Melalui traktus neospinotalamikus dan paleospinotalamikusSensitisasiMelibatkan sensitisasi Wide Dynamic Rang Neuron (WDR);Tidak terbukti adanya kelainan medisPerifer dan bisa ke sentral;Terbukti adanya kelainan medisSOMATOFORM DISORDERSKlasifikasiSeven somatoform disorders are listed in the revised fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR): Somatization disorderConversion disorderHypochondriasisBody dismorphic disorderPain disorderUndifferentiated somatoform disorderSomatoform disorder not otherwise specifiedSOMATIZATION DISORDERThe somatoform disorders are a broad group of illnesses that have bodily signs and symptoms as a major component.Somatization DisorderSomatization disorder is an illness of multiple somatic complaints in multiple organ systems that occurs over a period of several years and results in significant impairment or treatment seeking, or both.

EtiologiPsychosocial factorsBiological factorsGeneticsCytokinesEpidemiologi & Faktor ResikoThe lifetime prevalence in general population in 0.2- 2% in women and 0.2% in men.Women are 5 to 20 times more than men.Several studies have noted that somatization disorder commonly coexists with other mental disorders.Patofisiologi & PatomekanismeSaid to be unknown. From a nosological perspective, somatoform disorders were grouped together for the first time in 1980 in the third edition of DSM (DSM-III) as those disorders in which bodily sensations or functions, as the patient's predominant focus, are influenced by a disorder of the mind.Gejala Klinis & DDhave many somatic complaints and long, complicated medical histories. Nausea and vomiting (other than during pregnancy), difficulty swallowing, pain in the arms and legs, shortness of breath unrelated to exertion, amnesia, and complications of pregnancy and menstruation are among the most common symptoms. Patients frequently believe that they have been sickly most of their lives. Pseudoneurological symptoms suggest, but are not pathognomonic of, a neurological disorder. According to DSM-IV-TR, they include impaired coordination or balance, paralysis or localized weakness, difficulty swallowing or lump in throat, aphonia, urinary retention , hallucinations, loss of touch or pain sensation, double vision, blindness, deafness, seizures, or loss of consciousness other than fainting.

Diagnosis

KomplikasiBunuh diriMutilasi diri sendiriKeterbatasan yang berkepanjanganKecanduan obatSexual disorders

Tatalaksana FarmakologiGiving psychotropic medications whenever somatization disorder coexists with a mood or anxiety disorder is always a risk, but psychopharmacological treatment, as well as psychotherapeutic treatment, of the coexisting disorder is indicated. Medication must be monitored, because patients with somatization disorder tend to use drugs erratically and unreliably. Few available data indicate that pharmacological treatment is effective in patients without coexisting mental disorders.Tatalaksana Non- FarmakologiBest treated when the patient has a single identified physician as primary caretaker; otherwise, patients have increased opportunities to express somatic complaints.Regularly scheduled visits, usually at monthly intervals.Relatively brief, although a partial physical examination should be conducted to respond to each new somatic complaint.Additional laboratory and diagnostic procedures should generally be avoided. Psychotherapy, both individual and group, decreases these patients' personal health care expenditures by 50 percent, largely by decreasing their rates of hospitalization. In psychotherapy settings, patients are helped to cope with their symptoms, to express underlying emotions, and to develop alternative strategies for expressing their feelings.Manifestasi Gangguan Psikis pada OrganPrognosis & Indikasi RujukSomatization disorder is a chronic, undulating, and relapsing disorder that rarely remits completely. It is unusual for the individual with somatization disorder to be free of symptoms for greater than 1 year, during which time they may see a doctor several times. Research has indicated that a person diagnosed with somatization disorder has approximately an 80 percent chance of being diagnosed with this disorder 5 years later. Although patients with this disorder consider themselves to be medically ill, good evidence is that they are no more likely to develop another medical illness in the next 20 years than people without somatization disorder.Edukasi & PencegahanThank You

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