Simptomatolgi &

Pemeriksaan Psikiatrik
Remaja

Eri Achmad
P S I K I AT E R
eriachmad@yahoo.co.id
 Topik bahasan
1. Simptomatologi
2. Pemeriksaan psikiatrik
 2. Simptomatologi
Jenisnya
Psikosis
Neurosis
Gejala pada fungsi
Emosi
Pikiran
Perilaku
 Disorders of consciousness
Kuantitatif (somnolence, sopor, coma)
Kwalitatif (cluding of consciousness,
delirium, fugue)
Contack Rapport
Adekuat, non adekuat
Good rapport-bad rapport
Kurang cukup - baik
 General appearance
Self neglect (dekorum)
Smell
Lack of cleanliness
Unkempt hair
Wearing clothes that have not been look
after
Weight loss
Flamboyant clothing
 Facial appearance
Depressed
Downcast eyes
A vetical furrow in the forehead
Downturning of the corner of the mouth
Mania
May look euphoric and /or irritable
Anxiety
Raised eyebrows, mydriasis, horizontal
furrow of forehead
 Tampak lebih tua, lebih muda, sesuai dengan usia
Tanda-tanda fisik organik lainnya
Parkinsonism
Hipo/hipertiroidisme
Dll
Posture and movements
Hipo Hiper (agitasi, agresifitas)
Echopraxia the automatic imitation by the
patient of another persons movements; it occurs
even when the patient is asked not to do it
 Mannerisms repeated involuntary
movements that appear to be goal-
directed
Negativism a motiveless resistance
to commands and to attempts to be
moved
Posturing the patient adopts an
inappropriate or bizarre bodily
posture continuously for a long time
 Waxy fl exibility (also known as cerea fl
exibilitas) as the examiner moves part of the
patients body there is afeeling of plastic
resistance (res mbling the bending of a soft
wax rod) and that part then remains
moulded by the examiner in the new position
Stupor In psychiatry the term stupor is used
to describe a patient who is mute and
immobile (akinetic mutism) but fully conscious
 DISORDERS OF SPEECH
Disorder of rate and quantity
increased or decreased rate
Increased or decreased quantity
Pressure of speech
Logorrhoea
Poverty of speech
Mutism
Dysarthria, dysprosody
 Disorders of the form of speech/thought
process
Flight of ideas; The speech consists of a stream of
accelerated thoughts with abrupt changes
between topics and no central direction
Circumstantiality
Echolalia
Thought blocking; A sudden interruption in the
train of thought occurs, leaving a blank, after
which what was being said cannot be recalled
Irrelevan, incoherence, loosening association
(asosiasi longgar)
 DISORDERS OF THOUGHT
CONTENT
obsession, phobia (simple phobia, social
phobia, agoraphobia, dll)
Delusion
Persecutory (waham kejar)
Erotomania
Grandiosity ( waham kebesaran)
Nihilistic, somatic, bizarre, systemized
 Thought insertion the patient believes
that thoughts are being put into his/her
mind by an external agency
Thought withdrawal the patient
believes that thoughts are being removed
from his/her mind by an external agency
Thought broadcasting the patient
believes that his/her thoughts are being
read by others, as if they werebeing
broadcas
 DISORDERS OF EMOTION
Affect
Increased decreased
Inappropriate affect
Blunted affect
Flat affect
Mood
Euthymic, hypothimic, hiperthymic
Dysphoria, depression, euforic, ectasy,
irritability, alexithymia
 Sensory deceptions
Illusion
Halluciantion
Olfactory, visual, auditory, somatic (tactile,
visceral)
COGNITIVE DISORDERS
Disorders of attention
Deficit attention
Distractibility
 Disorders of memory
Amnesia
Paramnesia
Confabulation, Deja vu, Jamais vu
Disorders of intelligence
IQ 5070: mild mental retardation
IQ 3549: moderate mental retardation
IQ 2034: severe mental retardation
IQ < 20: profound mental retardation.
 Judgement-Insight
Good
Bad
Partial
Pemeriksaan
Psikiatrik
pada Remaja
 Children are often unable to explicitly verbilize
psychological symptoms
The problem is usually brought to the psychiatrist
attention by someone else (parent, schoolteacher,
paediatrician)
Presenting problem is most commonly a complaint
about the childs abnormal behaviour or performance
Normally means that the clinician is presented with a
non-specific presentation
Problems need to be considered in the context of a
childs developmental stage
Considerations in the assessment of
children
It is often useful to first interview parents or
carers, to obtain a full description of the current
concerns, as well as a complete history
(psychiatric, neurodevelopmental, educational
an medical)
This include, indirect evaluation of parents
personalities, marital relationship and style of
parenting
The assessment style of child should be
tailored to the individual abilities of the child
rather than to their age
 In children who are unable to
articulate their inner experiences, it
is often necessary to observe the in
play situations
The importance of obtaining
collateral information by the teacher
and any other agencies involved
The ICD 10 Classification
1. Intellectual disability (mental
retardation)
2. Developmental disorder (specific
and pervasive)
3. Acquired disorders with onset
usually in childhood or adolescence
4. Acquired adult disorder with onset
in childhood or adolescence
 Presenting Problem

May be age appropriate

behaviour
Consider causes;
bullying, abuse
Consider intellectual
disability

Development Acquired
al disorder disorder

Specific Pervasive Acquired Adult disorders

developmen developmen disorders with with onset
t disorder: t disorder: onset usually usually in
- Languag - Autism in childhood or childhood
e - Asperger adolescence - Mood dis
- Reading - Rett - ADHD - Psychotic
- Spelling synd - Conduct dis - Anxiety dis
- Etc - etc - Emotional - Substance
dis abuse
- etc - etc
 Pemeriksaan Status Mental
Anak-Remaja
Penampilan:
Kualitas sakit: ringan, sedang, berat
Kualitas kesadaran: CM, somnolence, sopor, coma
Kontak/Rapport: adekuat, non adekuat/kurang, cukup, buruk
Dekorum: kebersihan/berpakaian/sopan santun
Interaksi anak-orangtua: buruk, kurang, baik
Orientasi: waktu, tempat, orang
Berbicara dan berbahasa:
spontan/tdk spontan, jelas/tdk jelas, lancar/tdk lancar,
sedikit bicara/banyak bicara
Pressure of speech, flight of idea,
perseverasi/verbegerasi, clang association, mutisme,
selective mutisme, dll
 Mood:
Euthymic, dysforia, wajar/tdk wajar, congruent/incongruent
Hipothymic (depresi, sad, sorrow, dll)
Hiperthymic (euforia, elasai, ektasi)
Afek:
Batas normal
Menurun (afek terbatas, afek datar)
Meningkat (afek meningkat)
Isi pikiran dan proses pikiran
Logis/non logis
Autistik, sirkumtantial, tangential/ asosiasi longgar,
inkoherensi, neologisme, dll
Idea of refference, waham/delusi, dll
Hubungan sosial: baik, sedang/cukup, buruk/kurang
 Perilaku motorik
Normoaktif
Hipoaktif (catatonia posturing, drug side effects, dll)
Hiperaktif (tic, tardive diskinesia, dll)
Kognisi
Sensori
Persepsi
Intelektual/knowledge
Fungsi eksekutif/fungsi luhur
Memori
Immediate (beberapa menit)
Recent (beberapa jam)
Past recent (jam-hari-minggu)
Long term (beberapa minggu-lebih)
Fungsi pertimbangan dan insight
Terganggu/tdk terganggu, kurang(buruk)/cukup/baik, parsial