PSYCHOLOGICAL SURVIVOR: UUM

1

SELASA | 03 NOVEMBER 2020 2

SELASA | 03 NOVEMBER 2020 3

SELASA | 03 NOVEMBER 2020 4

SELASA | 03 NOVEMBER 2020 5

SELASA | 03 NOVEMBER 2020 GAD 6

9/3/20XX Presentation Title 7

DISCLAIMER

Ini adalah ceramah pendek berkenaan
GAD untuk tujuan pendedahan

sahaja, bukan sebagai latihan atau
pengajaran untuk membuat diagnosa

atau rawatan.

SELASA | 03 NOVEMBER 2020 GAD 8

Normal vs tak normal
Apa itu GAD
Apa punca GAD
Rawatan untuk GAD
Bagaimana mendapatkan rawatan?

SELASA | 03 NOVEMBER 2020 GAD 9

Normal vs Tak Normal Situasi

Normal Reaksi

 Semua orang akan berasa risau /
cemas / takut / gemuruh / gelabah
dan sebagainya dalam situasi
tertentu.

Tindakan

SELASA | 03 NOVEMBER 2020 GAD 10

Situasi  Sesuatu yang tidak diketahui /
difahami

 Sesuatu yang menakutkan

 Tidak tahu apa yang perlu
dibuat

 Tidak tahu apa yang akan
berlaku (masa hadapan)

SELASA | 03 NOVEMBER 2020 GAD 11

Gementar Berdebar Bernafas
laju

Sesak Perut tidak Loya
dada selesa

Reaksi: Kering Rasa Selera
Fizikal mulut tercekik terganggu

SELASA | 03 NOVEMBER 2020 Seram Berpeluh Otot
sejuk tegang

Berasa Rasa tidak
pitam senang Susah tidur
duduk

Cepat letih

GAD 12

Perubahan Mudah marah
emosi

Reaksi: Fokus Cepat lupa
Mental terganggu

SELASA | 03 NOVEMBER 2020 Sukar membuat (Fikiran)
keputusan

(Memori) (Keinginan)

GAD 13

Mengelak situasi / Meluangkan
aktiviti tertentu banyak masa
untuk merancang

Reaksi: Kerap Mengelak
menangguh membuat
Tingkah-laku keputusan

Perlu diyakinkan
berulang-kali

SELASA | 03 NOVEMBER 2020 GAD 14

“Fight or flight”

Tindakan

Fight: Flight:
lari / elak
Lawan /
selesaikan

SELASA | 03 NOVEMBER 2020 GAD 15

Generalized Apabila NORMAL
Anxiety
Disorder menjadi

SELASA | 03 NOVEMBER 2020 GAD TIDAK NORMAL

16

Apa yang TIDAK NORMAL?

Berlebihan
Berpanjangan (>6 bulan)
Sukar dikawal
Membelenggu hampir sepanjang / setiap masa atau hari
Mengganggu / menyekat aktiviti harian
Mengganggu kerja dan produktiviti

Mengganggu aktiviti sosial

SELASA | 03 NOVEMBER 2020 GAD 17

Kategori diagnosa

Diagnostic and Statistical International Classification
Manual of Mental of Diseases 11th Revision

Disorders, Fifth Edition (ICD-11)

(DSM-5)

SELASA | 03 NOVEMBER 2020 GAD 18

SELASA | 03 NOVEMBER 2020 GAD 19

SELASA | 03 NOVEMBER 2020 GAD 20

SELASA | 03 NOVEMBER 2020 GAD 21

• 4.2% daripada tempoh
hayat dibelenggu dengan
ketidak-upayaan (WHO)

SELASA | 03 NOVEMBER 2020 GAD 22

Faktor Risiko

Biologi Psikologi Sosial

Keturunan / genetik Personaliti Ibu bapa: asuhan
Penyakit fizikal / masalah
Neurotransmiter Kemahiran daya
tindak Pengalaman
traumatik
Corak pemikiran
Masalah
kehidupan

SELASA | 03 NOVEMBER 2020 GAD 23

Teori Neurotransmitter & Neuroanatomy

▪ Hippocampus ▪ Frontal lobe

▪ Amygdala ▪ Autonomic nervous system

▪ Norepinephrine, serotonin, dopamine,
gamma-aminobutyric acid (GABA)

SELASA | 03 NOVEMBER 2020 GAD 24

Komorbiditi  Depression
 Panic disorder
 Social phobia & other phobia
 Substance use disorder
 Post Traumatic Stress Disorder

(PTSD)
 Obsessive Compulsive Disorder
 Personality disorder

SELASA | 03 NOVEMBER 2020 GAD 25

GAD & bunuh diri

Keadaan GAD tidak terkawal
+/- kemurungan
+/- PTSD
Stres

GAD 26

Saringan Pemeriksaan Ujian psikometrik:
klinikal
Ujian darah Generalized Anxiety
cth: ECG Disorder 7-item (GAD-7)
cth: Thyroid
Hamilton Anxiety Rating
Scale (HAM-A)

Beck Anxiety Inventory
(BAI)

SELASA | 03 NOVEMBER 2020 GAD 27

Rawatan

Ubat Psikoterapi oleh pakar bertauliah

Bincangkan bersama doktor Cognitive Behaviour Therapy
berdaftar (MMC) Mindfulness
Psychodynamic psychotherapy

SELASA | 03 NOVEMBER 2020 GAD 28

Rujukan

https://web.facebook.com/DrAmerSiddiq
Psy/photos/2092030974255925

SELASA | 03 NOVEMBER 2020 GAD 29

Bagaimana ANDA
boleh membantu?

 Kata-kata
 Dampingi
 Tidak hakimi

SELASA | 03 NOVEMBER 2020 GAD 30

Masalah Kesihatan Mental

SEMUA orang berisiko mendapat penyakit mental
Boleh dirawat & boleh menjalani kehidupan biasa dengan rawatan
Jangan hentikan rawatan tanpa konsultasi / berbincang dengan doktor
Peringkat awal rawatan mengambil masa  akan bertambah baik
Tidak berjangkit

Tidak semestinya diwarisi

SELASA | 03 NOVEMBER 2020 GAD 31

SELASA | 03 NOVEMBER 2020 GAD 32

9/3/20XX Presentation Title 33

9/3/20XX Presentation Title 34

PANIC DISORDER

 Both recurrent and unexpected panic attacks
 More than 1 attack has been followed by 1

month or more of 1 or more of the following:
 Persistent concern about additional attacks
 Worry about the implications of the attack or
its consequences
 A significant change in behaviors related to
the attacks

 The disturbance is not attributable to
physiological effects of substances or other
medical disorder

 Not better explained by other psychiatric
disorders

SELASA | 03 NOVEMBER 2020 PANIC DISORDER 35

Panic symptoms

Hot flashes

Chest pain Sweating Fear of Headache
loss of control

or death

Abdominal Chills Sense of SOB or Nausea
cramping impending chest tightness

doom

Dissociative Rapid, Trembling dizziness,
pounding heart or shaking lightheaded

rate

Nausea

SELASA | 03 NOVEMBER 2020 PANIC DISORDER 36

POSSIBLE
DIFFERENTI
AL

SELASA | 03 NOVEMBER 2020 PANIC DISORDER 37

Anxiety Disorders

Panic Disorder Social Anxiety

Generalised Disorder
Anxiety
Panic Disorder Disorders Social Anxiety

Separation Disorder
Anxiety
Disorders Agoraphobia

Specific Phobia Agoraphobia

SELASA | 03 NOVEMBER 2020 PANIC DISORDER

Medical / Drugs Related Disorders

Alcohol used
Disorder

Comorbids Thyroid related Cardio-
Disorders pulmonary
related Disorder

Alcohol us

Alcohoeldused
DDisisoorrddee rrs

SELASA | 03 NOVEMBER 2020 PANIC DISORDER 39

Management

Biological Psychological

Spiritual Social

SELASA | 03 NOVEMBER 2020 PANIC DISORDER 40

Target Symptoms

→ Reduction of panic attacks
→ Reduction of avoidance behavior
→ Improve safety behavior
→ Improve mental fortitude

SELASA | 03 NOVEMBER 2020 PANIC DISORDER 41

Away from values Towards values

Behaviours workability: is the work leading you
towards a rich and meaningful life?

1. Includes overt and covert behavior Choice point Can be narrow focus or broad focus
2. Client defines what is away move

3. Any activity can be away or

4. towards move depending on context

Precedes by antecedents: situation and the thoughts or feelings

SELASA | 03 NOVEMBER 2020 PANIC DISORDER 42

ESTABLISHING BEHAVIORAL GOALS

→ What will you do differently?

→ What will you start doing/stop doing?

→ What will you do more of or less of?

→ How will you treat yourself, others, the world differently?

→ What people, places, events, activities, challenges, will you approach, start, resume, or contact
(rather than avoid, withdraw, quit, or stay away from)?

→ The questions above often tend to elicit overt behavioral goals. To establish covert behavioral goals we
can ask questions such as:

→ Are there any tasks or activities you‟ll be better able to focus on or engage in?
→ Are there any people you‟ll be more attentive to or more present with?
→ Is there anyone or anything you‟ll be able to appreciate more, focus on better, engage in more, pay

more attention to?

SELASA | 03 NOVEMBER 2020 PANIC DISORDER 43

The Mindfulness Toolbox

SELASA | 03 NOVEMBER 2020 PANIC DISORDER 44

THANK YOU

@zaidrostam ahmad rostam md zin

SELASA | 03 NOVEMBER 2020 PANIC DISORDER 45

Brush PRESENTER NAME

Presentation Title

Outline Obsessive-Compulsive-
Related Disorders DSM 5

1. Obsessive-Compulsive and
Related Disorders

2. Treatment of the
Obsessive-Compulsive and
Related Disorders

SELASA | 03 NOVEMBER 2020 OCD 48

DSM-IV-TR vs DSM-5

In DSM-IV-TR Obsessive-Compulsive and DSM-5 : new chapter for Obsessive-

Related Disorders was included with Anxiety Compulsive and Related Disorders:
Disorders*
1. OCD
2. Body Dysmorphic d/o
3. Hoarding d/o
4. Trichotillomania
5. Excoriation d/o
6. Substance/medication induced ocd
7. Other specified OCD and related d/o
8. Unspecified OCD and related d/o

SELASA | 03 NOVEMBER 2020 OCD 49

1.Obsessive Repetitive thoughts and
-Compulsive
urges (obsessions)
Disorder Repetitive behaviors and

(OCD) mental acts
(compulsions)

Obsessive- 1.Body Repetitive thoughts and
Compulsive Dysmorphic urges about personal
and Related appearance
Disorders Disorder

SELASA | 03 NOVEMBER 2020 1.Hoarding Repetitive thoughts about
Disorder possessions

OCD 50