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2. SOMATOFORM DISORDER Blok XX Psikosomatik UNIVERSITAS TADULAKO 2012

4. Topik • Definisi • Jenis-jenis gangguan somatoform • Proses terjadinya gangguan somatoform • Penatalaksanaan gangguan somatoform

5. DimanakahletakkodeGangguansomatoformdalam ICD X? • F00-F09 Organic, including symptomatic, mental disorders • F10-F19 Mental and behavioural disorders due to psychoactive substance use • F20-F29 Schizophrenia, schizotypal and delusional disorders • F30-F39 Mood (affective) disorders • F40-F48 Neurotic, stress-related and somatoform disorders

6. F40-F48 Neurotic, stress-related and somatoform disorders • F40 Phobic anxiety disorders • F41 Other anxiety disorders • F42 Obsessive - compulsive disorder • F43 Reaction to severe stress, and adjustment disorders • F44 Dissociative [conversion] disorders • F45 Somatoform disorders • F48 Other neurotic disorders

7. Somatoform Disorders (SFD) • A category of psychological disorders characterized by unusual physical symptoms that occur in the absence of a known physical pathology • Disorder in which there is an apparent physical illness for which there is no organic basis. • Involve physical symptoms of serious bodily disorders without any physical evidence of organic causes for them. • The symptoms are real and not under voluntary control

8. W. Hiller et al. / Journal of Psychosomatic Research 68 (2010) 9–19

9. Somatoform Disorders: Time for a New Approach in DSM-V • Am J Psychiatry 2005;162:847-855 • Richard Mayou, M.A., M.Sc., M.Phil., F.R.C.P., F.R.C.Psych et al

10. Somatoform Disorders • Conversion disorder • physical symptoms usually confined to single organ/system and mimic symptoms of neurological condition • Somatization disorder • multiple, vague, physical complaints • Hypochondriasis • morbid preoccupation with imagined illness • Pain disorder • preoccupation with pain • Body dysmorphic disorder • obsessive concern with presumed defects in appearance

11. CONVERSION DISORDER • A dramatic specific disability has no physical cause but instead seems related to psychological problems (psychological problems are “converted” into a physical illness.) • Examples: paralysis, blindness, deafness, seizures, loss of feeling, or false pregnancy (muscles and nerves are intact).

12. Causes • Freudian psychodynamic view is still popular • Focus on past trauma and conversion • Address primary / secondary gain • Detachment from the trauma and negative reinforcement • Treatment • Similar to somatization disorder • Core strategy is attending to the trauma • Remove sources of secondary gain • Reduce supportive consequences of talk about symptoms

13. SOMATIZATION DISORDER • Person feels vague, recurring physical symptoms for which medical attention has been sought repeatedly but no organic cause found. • Example: backpain, dizziness, partial paralysis, abdominal pains

14. Causes • Familial history of illness • Relation with antisocial personality disorder • Weak behavioral inhibition system • Treatment • No treatment exists with demonstrated effectiveness • Reduce tendency to visit numerous medical specialists • Assign “gatekeeper” physician • Reduce supportive consequences of talk about symptoms

15. Hypochondriasis • Preoccupation with fears of having disease, misinterpretation of bodily symptoms • Preoccupation persists despite medical assurances • Fears of disease not delusional, not restricted to concern about appearance • Preoccupation causes distress, impairment in social, occupational, other functioning • Duration is at least 6 months

16. Hypochondriasis Treatment • Patient’s rarely present for Mental Health treatment • Explanations/Treatments vary with theory • Psychoanalysts – repressed conflict • Family clinicians – family dynamics • Behaviorists – reinforced learned behavior • Cognitivists – an attributional bias (attribute everyday experiences to serious illness)

17. Body Dysmorphic Disorder • Preoccupation with imagined specific defects in appearance, excessiveness over slight anomaly • Preoccupation causes distress and impairment in social, occupational, other functioning

18. Body Dysmorphic Disorder Facts • Usually starts during adolescence • Females outnumber males 3 to 1 • More common among single and divorced adults • Shares many characteristics with OCD

19. Body Dysmorphic Disorder Treatment • Difficult to treat because clients avoid confronting their anxiety • Behavioral and Cognitive-behavioral therapy, and medication (SSRI antidepressant) have shown success.

20. Pain disorder Pain with anatomic features: • and objective findings • Lumbosacral radiculopathy, carpal tunnel syndrome 2. without objective findings. • classic migraines, trigeminal neuralgia. Pain with non-anatomic features associated with: 3. stress and somatization. • Psychosocial history, limited/absent objective abnormalities, inconsistent history and/or examination, or bizarre findings on physical examination. • Ex: fibromyalgia syndrome, chronic neck or back pain, conversion disorder 4. perceived physical injury and symptom magnification. • Numerous, inconsistent, contrary to normal physiologic principles, and/or disproportionate to the objective findings. • Soft tissue sprain  >> associated behaviors, “malingering.” • secondary gain

21. PERILAKU NYERI (PAIN BEHAVIOUR) PENDERITAAN (SUFFERING) NYERI (PAIN) NOSISEPSI (NOCICEPTION) “Pain Experience” An unpleasant sensory and emotional experience associated with actual or potential tissue damage “Pain is a personal, subjective experience that comprises : Sensory-discriminative, Motivational-affective and Cognitive-evaluative dimensions” Ronald Melzack, “Textbook of Pain” 4th edition

22. Terapi kognitif Restorasi fungsional PERILAKU NYERI (PAIN BEHAVIOUR) Antidepresan Psikotropika Relaksasi Spiritual PENDERITAAN (SUFFERING) Opioid Tramadol Oxcarbazepine Gabapentin Eperisone HCL Paracetamo OAINS NYERI (PAIN) Blok Lokal Diklofenak Etodolac Dexketoprofen Celecoxib Pembedahan Modalitas fisik NOSISEPSI (NOCICEPTION) TERAPI NYERI Nyeri Nosisepsi (nyeri post operatif dan nyeri punggung bawah BYERS AND BONICA, 2001 MODIFIKASI PENULIS

24. Factitious Disorder • Psychological disorder whereby people feign illness to gain attention • Munchausen’s syndrome

25. Factitious Disorder • Intentional production or feigning of physical, psychological signs, symptoms • Motivation is to assume sick role • External incentives are absent

26. Kesimpulan • Somatoform disorder adalah salah satu kelompok gangguan cemas • Terdapat keluhan nyata, namun perubahan/kerusakan organ tidak ditemukan • Merupakan golongan kasus-kasus psikosomatik