Status Psikiatrikus A4
Status Psikiatrikus A4
STATUS PSIKIATRIKUS
Nama :
NIM :
Semester :
Tanggal :
Pembimbing :
Kegiatan :
MENGETAHUI
SUPERVISOR
(.......................................)
2
Keadaan Umum
Sensorium :......................... Suhu :................ Berat Badan :...................
Nadi :......................... Pernafasan :................ Tinggi Badan :...................
Tekanan Darah :......................... Turgor :................ Status Gizi :...................
STATUS NEUROLOGIKUS
Sensibilitas :.................................................................................................
Susunan Syaraf Vegetatif :.................................................................................................
Fungsi Luhur :.................................................................................................
Kelainan Khusus :.................................................................................................
.................................................................................................................................
Darah Rutin..........................................................Khusus......................................................
Urine Rutin...........................................................Khusus......................................................
Tinja Rutin...........................................................Khusus......................................................
Liquor Serebrospinalis (Pungsi Lumbal)...............................................................................
PEMERIKSAAN RADIOLOGI
BRAIN COMPUTERIZED TOMOGRAPHY SCANNING (CT-SCAN OTAK)
HASIL
4
STATUS PSIKIATRIKUS
Umur :
Pendidikan :
KEADAAN UMUM
Kesadaran/Sensorium :.......................................................................................................
Perhatian :.......................................................................................................
Sikap :.......................................................................................................
Inisiatif :.......................................................................................................
Tingkah Laku Motorik :.......................................................................................................
Karangan/Tulisan/Gambaran (bila ada lampirkan)................................................................
Ekspresi Fasial :.......................................................................................................
Verbalisasi :...........................................Cara Bicara :.....................................
Kontak Psikis : - Kontak Fisik :........................................................................................
- Kontak Mata :........................................................................................
- Kontak Verbal :........................................................................................
Pengendalian :........................................Adequacy :
Daya Konsentrasi :
Orientasi : Tempat :
Waktu :
Personal :
Discriminative Judgement :
Discriminative Insight :
Kemunduran intelektual :
Halusinasi :
....................................................................................................................................
...................................................................................................................(deskripsikan)
5. Keadaan Proses Berpikir
Psikomotilitas :
Arus Pikiran
Flight of ideas.............................................Inkoherensi
.....................................................................
Sirkumstansial.............................................Tangensial
.....................................................................
Terhalang.....................................................Terhambat
.....................................................................
Perseverasi..................................................Verbigerasi
.....................................................................
Lain-lain
..............................................................................................................................
Isi Pikiran
Kuantitas.....................................................Pola Sentral
.....................................................................
Waham
..............................................................................................................................
..............................................................................................................................
.............................................................................................................(deskripsikan)
10
Ide terfiksir
..............................................................................................................................
Fobia...........................................................Hipokondria
.....................................................................
Konfabulasi.................................................Rasa permusuhan/dendam
.....................................................................
Lain-lain
..............................................................................................................................
Pemilikan Pikiran
Obsesi
..............................................................................................................................
Alienasi
..............................................................................................................................
Bentuk Pikiran
Autistik/dereistik.........................................Simbolik
.....................................................................
Paralogik.....................................................Simetrik
.....................................................................
Konkritisasi.................................................Lain-lain
.....................................................................
Lain-lain :
PEMERIKSAAN LAIN-LAIN
FOLLOW UP
14
RESUME
I. IDENTIFIKASI
III.STATUS NEUROLOGIKUS
FORMULASI DIAGNOSTIK
17
DIAGNOSIS MULTIAKSIAL
AKSIS I :............................................................................................................................
AKSIS II :............................................................................................................................
AKSIS III :............................................................................................................................
AKSIS IV :............................................................................................................................
AKSIS V :............................................................................................................................
DIAGNOSIS DIFERENSIAL
TERAPI
PROGNOSIS