BMS - II

PLENO 1
KELOMPOK B3

Skenario
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.

Hipotesis

Somatoform disorder

Fisiologi Nyeri
Pain 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

the
Cord and Brain Stem
The
Neospinothalamic
Tract and the
Paleospinothalamic
Tract
On entering the spinal
cord, the pain signals
take two
pathways to the brain,
through (1) the
neospinothalamic
tract and (2) the
paleospinothalamic
tract.

Perbedaan Nyeri Psikis & Nyeri

Somatis
Keterangan

Nyeri
Psikogenik

Nyeri
Somatik

Stimulus

Stres, kondisi
emosional

Noxious

Faktor terkait

Depresi, ansietas,
stressor psikososial

Trauma, penyakit
organik

Sifat nyeri

Berkepanjangan,
lokal, nyeri tidak
sesuai

Akut/ kronik,
lokalisasi nyeri jelas

Transmisi

Serabut aferen
primer C;
Melalui traktus
paleospinotalamiku
s

Serabut aferen A
dan C;
Melalui traktus
neospinotalamikus
dan
paleospinotalamiku
s

Sensitisasi

Melibatkan

Perifer dan bisa ke

SOMATOFORM DISORDERS

Klasifikasi
Seven somatoform disorders are listed in the
revised fourth edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSMIV-TR):
1. Somatization disorder
2. Conversion disorder
3. Hypochondriasis
4. Body dismorphic disorder
5. Pain disorder
6. Undifferentiated somatoform disorder
7. Somatoform disorder not otherwise specified

SOMATIZATION DISORDER

The somatoform disorders are a

broad group of illnesses that have
bodily signs and symptoms as a
major component.
Somatization Disorder
Somatization 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.

Etiologi
Psychosocial

factors
Biological factors
Genetics
Cytokines

Epidemiologi & Faktor

Resiko
The 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 &
Patomekanisme
Said 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 & DD

have
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

Komplikasi
Bunuh

diri
Mutilasi diri sendiri
Keterbatasan yang
berkepanjangan
Kecanduan obat
Sexual disorders

Tatalaksana Farmakologi
Giving 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 NonFarmakologi
Best

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

Manifestasi Gangguan Psikis

pada Organ

Prognosis & Indikasi Rujuk

Somatization 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 & Pencegahan

Thank You
Terima Kasih
Danke Schn