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DIAGNOSIS MULTIAKSIAL Psikologi abnormal. DIAGNOSIS MULTIAKSIAL  DSM (Diagnostic and Statistical Manual of Mental Disorder) published by American Psychiatric.

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Presentasi berjudul: "DIAGNOSIS MULTIAKSIAL Psikologi abnormal. DIAGNOSIS MULTIAKSIAL  DSM (Diagnostic and Statistical Manual of Mental Disorder) published by American Psychiatric."— Transcript presentasi:

1 DIAGNOSIS MULTIAKSIAL Psikologi abnormal

2 DIAGNOSIS MULTIAKSIAL  DSM (Diagnostic and Statistical Manual of Mental Disorder) published by American Psychiatric Association (APA)  In Indonesia, mental disorder diagnosis classify in PPDGJ (Pedoman Penggolongan dan Diagnostik Gangguan Jiwa)  based on DSM and ICD (International Classification of Diseases) published by WHO

3 Diagnosis Multiaxial  DSM pertama kali diperkenalkan di tahun  DSM diterbitkan oleh APA (American Psychiatric Association)  Classification in DSM - IV (1994) are description, atheoretical, and multiaxial  more comprehensif (Millon & Davis, 2000)  DSM IV - TR  DSM-IV-TR includes five axes = multiaxial classification system, by requiring judgements on each of the five axes, forces the diagnostician to consider a broad range of information

4  Pada tahun 1939, WHO (World Health Organization) memasukkan gangguan jiwa ke dalam ICD (International List of Causes of Death)

5 5 Axes in DSM-IV-TR  Axes I:  Clinical Disorder  Other conditions that may be a focus of clinical attention  Axes II:  Personality Disorder  Mental Retardation  Axes III: General Medical Condition  Axes IV: Psychosocial and environmental problems  Axes V: Global Assesment of Functioning (GAF) Scale

6 5 Axes in DSM-IV-TR  Axes I:  Clinical Disorder  Other conditions that may be a focus of clinical attention  Axes II:  Personality Disorder  Mental Retardation  Axes III: General Medical Condition  Axes IV: Psychosocial and environmental problems  Axes V: Global Assesment of Functioning (GAF) Scale

7 7  Tujuan Pembedaan Aksis I, II, III: 1. encourage thoroughness in evaluation 2. enhance communication among health professionals  Tidak mengimplikasikan bahwa ada perbedaan fundamental dalam konseptualisasinya  tidak ingin mengatakan bhw. Ggn mental tidak berhubungan dengan proses atau faktor fisik, biologis atau psikososial

8 8 Aksis I dan II:  Isi mata kuliah Psikologi Abnormal (kecuali mental retardation)

9 9 Aksis III: General Medical Condition (GMC)  Current general medical conditions that are potentially relevant to the understanding or management of the individual’s mental disorder.

10 10 GMC can be related to mental disorders in several ways:  Bila GMC merupakan etiologi perkembangan atau memburuknya simtom mental  efek fisiologis, mis. Hypothyroidism penyebab simtom depresi Aksis I: mood disorder due to hypothyroidism with depressive features Aksis III: hypothyroidism  Hub antara GMC mgkn ada, tp tdk jelas Aksis I: dituliskan simtom mentalnya apa Aksis III: GMC nya apa

11 11  GMC dicatat pada Aksis III, meskipun tak berhubungan langsung dengan ggn mental, krn penting untuk memahami keseluruhan treatment individu. Mis. Individu yang depresi karena diagnosis kanker payudara Aksis I: Adjustment disorder with depressed mood Aksis III: kanker payudara  GMC dicatat untuk tujuan pharmacotherapy (supaya tidak overlap dalam pemberian obat)

12 12 Aksis IV: Psychosocial and Environmental Problems  Psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis of mental disorders: - negative life events - environmental difficulties or deficiencies - familial or other interpersonal stress - inadequacy of social support or personal resources - positive stressors (mis. Promosi, pernikahan) yang menyebabkan stress.

13 13 Cara menulis pada Aksis IV:  Problems with primary support group (e.g. death of a family, remarriage of parent)  Problems related to the social environment (e.g. inadequate social support, living alone, retirement)  Educational problems (e.g. academic, discord with teachers)  Occupational problems (unemployment, job dissatisfaction)

14 14  Housing problems (e.g. homelessness, inadequate housing)  Economic problems (e.g. extreme poverty)  Problems with access to health care service (e.g.transport unavailable)  Problems related to interaction with the legal system/crime (e.g. arrest)  Other psychosocial and environmental problems (e.g. exposure to disasters, wars)

15 15  Catatan: - note only those psychosocial and environmental problems that have been present during the year preceeding the current evaluation - bila masalah terjadi lebih dari 1 tahun  catat bila jelas memberi kontribusi, atau telah menjadi fokus treatment

16 16 Aksis 5: Global Assessment of Functioning (GAF) Scale  Berdasarkan pertimbangan berfungsinya secara psikologis, sosial & okupasional, pada suatu kontinum hipotesis dari kesehatan-gangguan mental.  Jangan memasukkan hendaya dalam berfungsi yang berhubungan dengan keterbatasan fisik atau lingkungan.

17 GAF Scale Consider psychological, social, and occupational functioning on a hypothetical continuum of mental heal/illness. Do not include impairment in functioning due to physical (or environment) limitations. 0: Inadequate information 1-10: Persistent danger of severely hurting self or others/ persistent inability to maintain minimal personal hygiene 51-60: moderate symptoms/moderate difficulty in social, occupational, or school functioning : No symptoms, superior functioning in a wide range of activities

18 18 Contoh Penulisan Diagnosis Multiaksial Aksis I : (296.23) Gangguan depresi berat, tanpa ciri psikotik Aksis II: (301.6) Gangguan kepribadian dependen, sering menggunakan mekanisme defense denial Aksis III: tidak ada Aksis IV: ancaman kehilangan pekerjaan Aksis V : GAF=35 (current)

19 Diagnosis Multiaxial Axes I : (296.23) Severe major depression, without psychotic feature Axes II: (301.6) Personality disorder, defence mechanism denial Axes III: none Axess IV: Occupational Problem Axes V : GAF=35 (current)

20 Current issues related to DSM-V  Disorder that might be included in DSM-V  Behavioral Addiction Definition: excessive use sex, shopping, or computers may signal addiction. These behavior can be taken to such extremes that they easily mimic the behaviors of drug addicts.  Binge Eating Disorder Definition: individuals who binge are unable to control periods of overeating and feel guilty or disgusted with themselves. They often become obese. Some eat alone to avoid feelings of shame.

21  Complicated Grief  Definition: after the death of someone close, grief and sadness normally begin to dissipate within six months. But some people continue to mourn for much longer. Current issues related to DSM-V

22  Disorder that might be excluded in DSM-V  The Paraphilia: Intense sexual urges involving animals, children, nonconsensual sex, suffering, or humiliation are classified as paraphilias – a term that was thought to be relatively non judgmental when it replaced “perversions” in  Gender Identity Disorder: Since the DSM-III appeared in 1980, individual who wish to be of the opposite sex- and who are uncomfortable with their own-have been diagnosed with Gender Identity Disorder. Current issues related to DSM-V


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