L.O.

Scenario 1
1. How to face the patient 2. How to make sure that she has GAD or not 3. How to make complete diagnose (5 axis) 4. Treatment (pharmaco & non-pharmaco) 5. Prevalence 6. Prognosis 7. Complication 8. Ethiology 9. More DD 10. How to know the severity 11. What kind of neurotransmitter that take place pharmaco 12. PSKI (cemas)

1. How to face the patient

Approaching Empathy Dont panic treat as human Relaxation Patient centris Dont focus in physical symptom Help her to face by herself Like a family Ask the family (involve & empower) If not cooperative >> allo-anamnesis

2. How to make sure that she has GAD or not

5 Axis Specify by 3 major symptom: GAD: No exact object, everyday
Have one/some (not all) of depression char Worrying about something

Panic: Not everyday PTSD: Have experienced something

3. How to make complete diagnose (5 axis)

1. Clinical disorder:
F.00-F.99
F 41.1 (GAD)

2. Personality & Mental retardation

F.60-F.61
F 60.7 (Gangguan Kepribadian Dependen)

3. General medical condition

ICD 10 chap 1-21
DBN

4. Psychosocial & Environmental

Presipitating factor (come from economy, social, etc)
Problem with primary support group : Son

5. Global assessment of function

70-61

11. What kind of neurotransmitter that take place pharmaco

Serotonin: stimulate happines Serotonergic (buspiron)
Serotonergic system hyperfunction Have char to inhibit Decreased product of serotonin Receptor: 5HT1A

GABA: Stress inhibitor

Decreasing Therapy: Banzodiazepin Normalize GABA receptor

Norepinephrin
By adrenal gland Work with epinephrin to give energy Re-uptake with drug (propanolol 3x10 mg or 2x10 mg peroral)

Area: Occipital lobus

4. Treatment (non-pharmaco)
Psychotherapy:
konseling Cognitive behavior therapy: Thought & behavior modification (relaxation) supportive

tilikan
Konflik bawah sadar

Treatment (pharmaco)
Diazepam (2x2 mg)
Start form low dose

Buspiron (2-3 x 10 mg/day)

5. Prevalence
Average: 31 y.o. (begins early 20s) 30% gangguan jiwa (69%: physical)

6. Prognosis
25% of them lead to Panic 75% of them severe depression (chronic)

9. Differential Diagnosis
GAD Hyperthyroid: Physical disease that followed by the other symptoms Post Traumatical Stress Disease
Hyperactivity autonomic Not know something happen in the past Reexperiencing symptom, avoidance symptom,

Mixing anxiety & depression

Mild (Not severe) There is anxiety & depression category but anxiety is higher anxiety all variant Scenario 3 anxiety criteria (autonomic, motoric & anxiety) & 1 depression (weak)
berkurangnya energi mudah lelah gejala lain: minder

Panic
Afraid of dying alone More extreme than GAD Episodically 10 minutes Pain chest Afraid to being crazy Suddenly happen

9. Differential Diagnosis
Somatoform
Somatisasi & Hypochondric
Hypo: Like having disease but not have Somatisation: History of physical disease for many years
Pain: min. 4 of following (Head, stomatch, back, etc) Gastro-intestinal: min. 2 of following 1 sexual symptom 1 pseudoneurologis

One of two:
Gejala somatisasi bukan dari obat / fisik Kaitan dg medis umum berlebihan

Not manipulation / malingering

10. How to know the severity

Anxiety: Ringan (gejala lain) GAD: Ringan (bukan di poin ke 2) (gejala lain)

12. Islamic Aspect (PSKI)

Story about prophet Muhammad that afraid to meet the angel Wahai orang-orang yang berselimut