GANGGUAN CEMAS

Stase Ilmu Kesehatan Jiwa

Rumah Sakit Umum Dustira
Cimahi
2017

I11112008 Jovi Pardomuan Siagian

DEFINISI

NORMAL ANXIETY ABNORMAL ANXIETY

Rasa khawatir yang Sama seperti normal

menyebar, tidak anxiety, tapi berlebihan,
menyenangkan dan berkepanjangan dan
samar tanpa adanya ancaman
PATOPSIKOLOGI

Anxiety
disorders

Psychoanalysis Behavioral Existential

PATOPSIKOLOGI
 Teori psikoanalisis
 Ansietasmerupakan hasil konflik antara keinginan alam
bawah sadar dan realita dunia luar
 Terjadi defense mechanism

“It was anxiety which produced repression and not, as I formerly

believed, repression which produced anxiety.” – Sigmund Freud.
PATOPSIKOLOGI
 Teori behavioral
 Ansietas merupakan respon terhadap stimulus spesifik
dari lingkungan
 Seorang dewasa yang merasa cemas saat melihat ayahnya
yang dulu sering melakukan pelecehan
 Seorang anak yang merasa cemas karena mengimitasi
perilaku cemas dari lingkungannya
PATOPSIKOLOGI
 Teori existensial
 Ansietasyang melibatkan perasaan orang tersebut
terhadap kehidupan yang tidak memiliki arti dan
tujuan
GEJALA UMUM
 Dua komponen ansietas
 Awareness terhadap sensasi fisiologis
 Awareness terhadap rasa gugup dan takut

 Kebingungan dan distorsi persepsi

 Gangguan atensi selektif
KLASIFIKASI
PANIC DISORDER
 Serangan ansietas mendadak yang disertai dengan
perasaan akan mati
 Patopsikologi
 Terjadiakibat defense mechanism yang tidak sempurna
terhadap stimulus yang menyebabkan ansietas
PANIC DISORDER
 Terjadi tiba-tiba dengan intensitas kecemasan
meningkat dalam hitungan menit
PANIC DISORDER
 Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that
reaches a peak within minutes and during which time four (or more) of the following symptoms occur Note: The
abrupt surge can occur from a calm state or an anxious state.
 Palpitations, pounding heart, or accelerated heart rate.
 Sweating.
 Trembling or shaking.
 Sensations of shortness of breath or smothering.
 Feelings of choking.
 Chest pain or discomfort.
 Nausea or abdominal distress.
 Feeling dizzy, unsteady, light-headed, or faint.
 Chills or heat sensations.
 Paresthesias (numbness or tingling sensations).
 Derealization (feelings of unreality) or depersonalization (being detached from one-self).
 Fear of losing control or "going crazy."
 Fear of dying.
 Note: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncontrollable screaming or crying)
may be seen. Such symptoms should not count as one of the four required symptoms.
PANIC DISORDER
 At least one of the attacks has been followed by 1 month (or more) of one or both
of the following:
 Persistent concern or worry about additional panic attacks or their consequences (e.g.,
losing control, having a heart attack, "going crazy").
 A significant maladaptive change in behavior related to the attacks (e.g., behaviors
designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar
situations).
 The disturbance is not attributable to the physiological effects of a substance (e.g.,
a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism,
cardiopulmonary disorders).
 The disturbance is not better explained by another mental disorder (e.g., the panic
attacks do not occur only in response to feared social situations, as in social anxiety
disorder; in response to circumscribed phobic objects or situations, as in specific
phobia; in response to obsessions, as in obsessive-compulsive disorder; in response
to separation from attachment figures, as in separation anxiety disorder).
PANIC DISORDER
 Tatalaksana
 Selective serotonin reuptake inhibitors
 Paroxetine 5-10 mg/hari
 Paroxetine CR 12,5-25 mg/hari

 Benzodiazepine
 Alprazolam3 x 0,25-0,5 mg
 Lorazepam 2 x 0,25-0,5 mg

 Cognitive-behavioral therapy
GENERALIZED ANXIETY DISORDER
 Definisi
 Rasa khawatir berlebih, tidak terkontrol dan tidak
rasional terhadap hal sehari-hari yang menyebabkan
hendaya.
 Gejala Klinis
 Ansietasberlebihan dan berkepanjangan yang disertai
dengan rasa gelisah dan tegang
GENERALIZED ANXIETY DISORDER
 Patopsikologi
 Cognitive-behavioral
 Respon terhadap persepsi bahaya yang tidak akurat
 Psychoanalytic
 Hasil dari konflik bawah sadar yang tidak tuntas
GENERALIZED ANXIETY DISORDER
 Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number
of events or activities (such as work or school performance)
 The individual finds it difficult to control the worry
 The anxiety and worry are associated with 3 (or more) of the following 6 symptoms (with at least some symptoms having been
present for more days than not for the past 6 months);
Note: Only one item is required in children.
 Restlessness or feeling keyed up or on edge.
 Being easily fatigued.
 Difficulty concentrating or mind going blank.
 Irritability.
 Muscle tension.
 Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
 The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
 The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another
medical condition (e.g., hyperthyroidism).
 The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic
disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-
compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in
posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived
appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional
beliefs in schizophrenia or delusional disorder).
GENERALIZED ANXIETY DISORDER
 Tatalaksana
 Psikoterapi

 Selective Serotonin Reuptake Inhibitors

 Setelah2-3 minggu klinis tidak membaik, dapat
dikombinasikan dengan benzodiazepine
 Sertraline 25-50 mg/hari
 Benzodiazepine
 Selama 2-6 minggu, tapering off 1-2 minggu
 Alprazolam 3 x 0,25 mg
 Buspirone 3 x 7,5 mg
SPECIFIC PHOBIA
 Definisi
 Rasa takut yang kuat terhadap suatu benda atau
keadaan
 Gejala Klinis
 Ansietassaat pasien berhadapan dengan benda atau
keadaan tertentu atau bahkan saat pasien hanya
mengantisipasi berhadapan dengan benda dan
keadaan tersebut
SPECIFIC PHOBIA
 Patopsikologi
 Pairingantara suatu benda atau keadaan tertentu
dengan rasa takut atau panik
 Modeling

 Information transfer
SPECIFIC PHOBIA
 Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals,
receiving an injection, seeing blood).
 Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging.
 The phobic object or situation al most always provokes immediate fear or anxiety.
 The phobic object or situation is actively avoided or endured with intense fear or anxiety.
 The fear or anxiety is out of proportion to the actual danger posed by the specific object or
situation and to the sociocultural context.
 The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
 The fear, anxiety, or avoidance causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
 The disturbance is not better explained by the symptoms of another mental disorder, including
fear, anxiety, and avoidance of situations associated with panic-like symptoms or other
incapacitating symptoms (as i n agoraphobia); objects or situations related to obsessions (as in
obsessive-compulsive disorder); reminders of traumatic events (as in post-traumatic stress
disorder); separation from home or attachment figures (as in separation anxiety disorder); or
social situations (as in social anxiety disorder).
SPECIFIC PHOBIA
 Tatalaksana
 Behavior therapy
 Virtual therapy

 Hipnosis

 Family therapy
SOCIAL PHOBIA
 Ketakutan terhadap interaksi sosial seperti bertemu
orang baru atau presentasi
 Cenderung muncul saat remaja atau pasca transisi
dalam kehidupan sehari-hari seperti pada
pernikahan atau berpindah tempat kerja
SOCIAL PHOBIA
 Patopsikologi
 Socialphobia lebih banyak terjadi pada pasien yang
orang tuanya mengidap panic disorder
 Orang tua dengan panic disorder kurang peduli dan justru
lebih protektif
 Terjadi behavioral inhibition
SOCIAL PHOBIA
 Marked fear or anxiety about one or more social situations in which the
individual is exposed to possible scrutiny by others. Examples include social
interactions (e.g., having a conversation, meeting unfamiliar people), being
observed (e.g., eating or drinking), and performing in front of others (e.g.,
giving a speech).
 Note: In children, the anxiety must occur in peer settings and just during
interactions with adults.
 The individual fears that he or she will act in a way or show anxiety
symptoms that will be negatively evaluated (i .e., will be humiliating or
embarrassing; will lead to rejection or offend others).
 The social situations almost always provoke fear or anxiety.
 Note: In children, the fear of anxiety may be expressed by crying, tantrums, freezing,
clinging, shrinking, or failing to speak in social situations.
 The social situations are avoided or endured with intense fear or anxiety.
 The fear of anxiety is out of proportion to the actual threat posed by the
social situations and to the sociocultural context.
SOCIAL PHOBIA
 The fear, anxiety, or avoidance is persistent, typically lasting for 6 months
or more.
 The fear, anxiety, or avoidance causes clinically significant distress or
impairment in social, occupational, or other important areas of functioning.
 The fear, anxiety, or avoidance is not attributable to the physiological
effects of a substance (e.g., a drug of abuse, a medication) or another
medical condition.
 The fear, anxiety, or avoidance is not better explained by the symptoms of
another mental disorder, such as panic disorder, body dysmorphic disorder,
or autism spectrum disorder.
 If another medical condition (e.g., Parkinson's disease, obesity, disfigurement
from burns or injury) is present, the fear, anxiety, or avoidance is clearly
unrelated or is excessive.
SOCIAL PHOBIA
 Tatalaksana
 Psikoterapi

 SelectiveSerotonin Reuptake Inhibitors

 β-blockers
 Atenolol50-100 mg
 Propanolol 20-40 mg

 Benzodiazepine
AGORAPHOBIA
 Ansietas terhadap tempat-tempat di mana jalan
keluar susah didapatkan
 Penderita agoraphobia sangat menghindari
keadaan di mana sulit meminta bantuan
 Olehkarena itu, mereka sering meminta ditemani jika
pergi ke tempat yang ramat serta tempat atau
kendaraan tertutup
AGORAPHOBIA
 Marked fear or anxiety about two (or more) of the following five
situations:
 Using public transportation (e.g., automobiles, buses, trains, ships, planes)
 Being in open spaces (e.g., parking lots, marketplaces, bridges)
 Being in enclosed places (e.g., shops, theaters, cinemas)
 Standing in line or being in a crowd
 Being outside of the home alone
 The individual fears or avoids these situations because of thoughts
that escape might be difficult or help might not be available in the
event of developing panic-like symptoms or other incapacitating or
embarrassing symptoms (e.g., fear of falling in elderly adults; fear
of incontinence).
 The agoraphobic situations almost always provoke fear or anxiety.
 The agoraphobic situations are actively avoided, require the
presence of a companion, or are endured with intense fear or
anxiety.
AGORAPHOBIA
 The fear or anxiety is out of proportion to the actual danger posed by the
agoraphobic situations and to the sociocultural context.
 The fear, anxiety, or avoidance is persistent, typically lasting for 6 months
or more.
 The fear, anxiety, or avoidance causes clinically significant distress or
impairment in social, occupational, or other important areas of functioning.
 If another medical condition (e.g., inflammatory bowel disease, Parkinson's
disease) is present, the fear, anxiety, or avoidance is clearly excessive.
 The fear, anxiety, or avoidance is not better explained by the symptoms of
another mental disorder-for example, the symptoms are not confined to
specific phobia, situational type; do not involve only social situations (as in
social anxiety disorder); and are not related exclusively to obsessions (as in
obsessive-compulsive disorder), perceived defects or flaws in physical
appearance (as in body dysmorphic disorder), reminders of traumatic
events (as in posttraumatic stress disorder), or fear of separation (as in
separation anxiety disorder).
AGORAPHOBIA
 Tatalaksana
 Benzodiazepine
 Alprazolam
 Lorazepam

 Selective serotonin reuptake inhibitors

 Tricyclic agents
 Clomipramine
 Imipramine

 Psikoterapi
TERIMA KASIH