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Gangguan Afektif Bipolar by QolbiBEBEK
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Ã
Mrs. Sorrowati was a forty five years old teacher who lived in the rural area.
About three months ago, she started a fight with her husband like they always did before. A
couple of days after the fight, she started to look gloomy. At times, she would be found in her room
weeping. She often woke up late in the morning, and more often sleep lately after usual bedtime. She
usually lay still while observing the ceiling during her ³not sleeping period.´ She withdrew her hobby
of singing and dancing at the local wedding party. Instead, she locked herself in her room during the
occurrence of the party. She refused to communicate the problem of her concern. In fact, she was very
quite at any time during the day. At work, she always gave her students an assignment instead of
teaching them.
About two months ago, it was noticeable that her weight had decreased. During a silent
observation, her mother caught her dispose her dishes which she brought to her room. When asked
about this, she stated that she no longer had the appetite and refused to eat further. She failed to fulfill
her job to cook for the household. Her mother then took her role in the kitchen. She also failed to
attend to her job location, and was given a warning note from her superior.
About one month ago, she looked more anxious. For every job she failed to do, she blamed
herself for being guilty. At morning, she would complain her fatigue and stated that she won¶t make
anything out of the day. At noon, she would complain her inability to do things straight. And at
evening, she would complain her failure to anything useful that day. Once, her mother caught her
trying to swallow a large quantity of headache pills.
After a family discussion, it was agreed that she would be taken to see an herbalist, but after
seeing no progression towards remission, she was brought to the Psychiatric Clinic by her mother and
her husband. A psychiatric examination was then performed by the attending psychiatrist.
Premorbid History
Ê cirth: spontaneous birth delivery, lead by a doctor
Ê Childhood, adolescence & adult: she was generally considered a nice, cheerful, and
communicable person
Previous Mental Disorder and Organobiologic Development History
Ê About a year ago, she exhibited an odd behavior. cack then, she would talk to everybody
about her intimate activity and laughed out loud at each story. She also spent most of her
wage on charity. She almost never rested without feeling exhausted. This condition was
accounted for at least a month, after which she returned normal gradually.
Ê There was no organobiologic developmental history attributable to present illness.
c ccc
Ê
Family Hitory
Ê She was the third of seven siblings. Her parents treat their children as fair as possible, and
their children were generally happy with their parents. No mental disorder was noted in her
family. Her relationship with her siblings was good, although at sometimes she would fight
for her parents¶ affection.
Educational History
Ê She was quite a reasonable student during her school age. She collected her friends who were
lesser academic performer than her. She would then teacah them, and in turn receive
admiration from them.
Ê She graduate from SMA and started her college at FKIP at her own decision and finished her
study after five years.
Occupational history
Ê Shortly after her graduation, she applied to former SMA and was accepted as a honorary
teacher for three years. At fourth year, she followed the CPNS examination and was granted
the position of permanent teacher. She taught with her heart and never complained about her
work. cut her history was marred by several scandals involving Mrs. Sorrowati and her
student in some kind love affair.
Marital history
Ê She was married to her husband during her study at college. She admitted that the marriage
was not based upon love and devotion, and it was only an accident. Her husband was only a
graduate of SD and never had permanent job (rather opposite from her ideal husband figure),
and she regardes as a ³Mister Know-It-All´. Her husband was regarded as a supicious person
burnt in jealously. Most of their daily life, they fought each other either orally and sometimes
physically.
Ê cefore marrying her husband, Mrs. Sorrowati had numerous, but once at a time boyfriend.
Economical status
Ê The family economi wa supported by Mrs. Sorrowati. They lived a rather deficient life.
Social relationship & activity
Ê At her adolescense, Mrs. Sorrowati was known to be active in most committee of any event,
especially celebrating The Independence Day. She was also known to be fond of singging at
many parties and as a generous girl who lend her clothing to other in charity show, although
she herself was not in an excess condition
Ê She had many friends, most of them were subject for her boastings.
Ê She was regarded as a ³commoner in religion´.
c ccc
Ê
The following information was recorded during autoanamnesis and simultaneous observation. The
voice of Mrs. Sorrowati was generally slow and small.
Examiner Mrs. Sorrowati
Good Morning ma¶am, how may I help Good morning (glanced the eyes briefly
you? (looking the eyes; offering to shake then faced turned down;accepted the hand)
hands)
I¶m physiciatrist here, what is your name Sorrowati
ma¶am?
How do you feel today? I feel very bad, doc (suddenly she cried)
Why are you crying? I¶m sinful, so much sin had I commit
Are you sure it¶s that much? Yes, and I¶m very sure that I may not be
forgiven
cut God¶mercy is above all « I don¶t know
May I know what are they? I ran away from home, talk to everyone
about the evil of my husband¶s and I
enjoyed it so much
Is it right to do so? Of course not. Why should I felt guilty if
it¶s right
Do you love your husband? No way
Why? He hit my head
(talking to husband) is it right sir? (husband answering) yes, I lost control.
How many times it happened? Twice, the first was when she turned mad a
year ago.
(talking to miss sorowati) have you any ««..
hallucination mam? Sorry?
I mean, voices of which you don¶t see the No
source, or something like a shadow only
you can see?
Okay I think its enough for our initial Thank you
interview. I expect to se you again next
week.
The following interview
Good morning miss sororwati, how are you Fine, actually I feel good today.
feeling today?
c ccc
Ê
Could you explain it? I felt very easy. Now that I¶ve lost the
burden of my shoulder.
If im not mistaken, you¶ve tried to swallow I was considering suicide. I cant hold on
a large amount of pill that day. What do with the burden
you intend to do?
What made you cancel the act? My mother caught me before I commence
it. cut I also think about my children
How are you doing now? I can do many things again. I can cook
again.
What about your job? I don¶t attend school right now. I still think
im a disgrace
So you¶re still feeling sinful? A little, but I think ill recover in time
No do you feel unforgivable? No, I realize my husband¶s fault is his to
consider, not mine
What are your plans afterwards? I want to divorce my husband
And then? I don¶t know next
The physical examination of Mrs. Sorrowati
Ê *ital Sign : clood Pressure 110/60 mmHg, Pulse Rate 62x/min, Respiration rate 15x/min,
Axial temperature 36,90 C.
Ê Physical examination : Normal
Ê Neurological examination : normal
The psychiatrist then concluded the examination by identifying psychopathologies for main
condition, mood/affective state, emotional life, thought process, perception & sensation,
intelligence function, and instinctual & behavioural drive based on comprehensive alloanamnesis,
autoanamnesis, and observation to make the multiaxial diagnoses and therapeutical planning.
1.Ê Fight : certengkar
2.Ê Gloomy : Murung
3.Ê Anxious : Ketegangan, rasa tidak aman dan kekawatiran yang timbul karna
dirasakan akan tejadi sesuatu yang tidak menyenangkan tetapi
sumbernya tidak diketahui
4.Ê Rural area : Daerah pinggir kota
5.Ê Sleep lately : Tidur larut malam
c ccc
Ê
6.Ê Appetite : Nafsu makan
7.Ê Fatigue : Kelelahan secara mental atau fisik
8.Ê clamed : Menyalakan diri sendiri, karna merasa tindakan nya salah
9.Ê Guilty : Perasaan bersalah pada diri sendiri
10.ÊHeadache pills : Obat sakit kepala
11.ÊPsychiatric clinic : Fasilitas layanan kesehatan khusus kejiwaan
12.ÊHerbalist : Ahli tanaman obat
13.ÊRemission : pengurangan atau meredanya gejala suatu penyakit, lama waktu
terjadinya
14.ÊExhibited an add behavior : Memprihakan prilaku aneh
1.Ê Mrs. Sorrowaty 45 yo old teacher who lived in the rural area.
About 3 months ago :
rÊ she started a fight with her husband like they always did before.
rÊ A couple days after the fight, she started to look gloomy.
rÊ She would be found in her room weeping.
rÊ She often wake up late in the morning and more ofte sleep lately after her usual
bed time.
rÊ She usually lay still while observing the ceiling during her ³not sleeping period´.
rÊ She refused to communicate the problem of her concern.
rÊ She was very quiet at anytime during the day.
rÊ At work, she always gave her student an assignment instead of teaching them.
2.Ê About 2 months ago :
rÊ Her weight had decreased.
rÊ She no longer had the appetite and refused to eat further.
rÊ She failed to fulfill her job to cook for the house hold.
rÊ She also failed to attend to her job location and was given a warning note from
her superior.
3.Ê About 1 month ago :
rÊ She looked more anxious
rÊ She blamed her self for being guilty because of every job she failed to do.
rÊ At morning, she would complain her fatigue and stated that she won¶t make
anything out of the day.
c ccc
Ê
rÊ At noon, she woukd complain her inabiity to do thigs right.
rÊ At evening, she would vomplsin her failure to do anything useful that day.
rÊ Her mother trying to swallow a large quantity of headache pills.
4.Ê Previous Mental Disorder and Organobiologic Develompment History.
About a year ago, she exhibited an odd behaviour :
rÊ She would talk to everybody about her intimate activity and laughed out loud at
each story.
rÊ She also spent her most wage on charity.
rÊ She almost never rested without feeling exhausted.
This condition was accounted for at least a month, after which she returned
normal gradually.
5.Ê Occupation history
She¶s accepted as an honorary teacher for 3 years. At fourth year, she was granted the
position of permanent teacher. cut her history was mrred by several scandals
involving mrs. Sorowati and her student in some kind f love affair.
6.Ê Marital history :
rÊ She admitted that the marrieage was not bsed upon love and devotion, and it was
only accident.
rÊ Her husband was only graduate of SD and never had any permanent job (rather
opposite from her ideal husband figure), and she regarded her as ³ Mister know-
it-all.´
rÊ Her husband was regarded as a suspicious person burnt in jealously.
rÊ Most of daily life, they fought each other either orally and sometimes physically.
rÊ cefore marrying her hsband, mrs. Sorrowaty had numerous, but once at a time,
boyfriend.
7.Ê Economical status : The family economy was supported by mrs. Sorrowaty. They
lived a rather deficient life.
8.Ê Folowing information was recorded during anamnesis :
1.Ê The voice was generally slow n small
2.Ê Minimal eye contact
3.Ê Affect hipotemic
4.Ê Emosi labil and uncontrol
5.Ê Her husband hit her at her head
c ccc
Ê
1.Ê cagaimana kondisi Mrs. Sorrowati :
rÊ 3 bulan yang lalu
rÊ 2 bulan yang lalu
rÊ 1 bulan yang lalu
2.Ê cagaimana perkembangan kepribadian premorbid Mrs.Sorrowati ?
3.Ê cagaimana riwayat gangguan mental sebelumnya dengan kondisi diatas ?
4.Ê cagaimana hubungan riwayat keluarga dengan kondisinya sekarang?
5.Ê cagaimana hubungan pergaulan dia dengan murid-muridnya dengan kondisinya
sekarang?
6.Ê cagaimana riwayat perkawinan dan kondisi rumah tangganya ?
7.Ê cagaimana hubungan status ekonomi Mrs.Sorrowati dengan keadaannya ?
8.Ê cagaimana interpretasi pemeriksaan fisiknya?
9.Ê cagaimana interpretasi auto anamnesis berdasarkan psikopatologi ?
10.ÊHow to dignose ?
11.ÊDD ?
12.ÊWD?
13.ÊManagement?
14.ÊPrognosis ?
15.ÊKomplikasi?
16.ÊKDU ?
£ £
Mrs. Sorowati, 45 tahun, seorang guru menderita Gangguan afektif bipolar episode kini
depresi berat tanpa gejala psikotik (F31.4).
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Examiner Mrs. Sorrowati Interpretasi
Good Morning ma¶am, how Good morning (glanced the [
! !
!
may I help you? (looking the eyes briefly then faced turned Keadaan fisik baik
eyes; offering to shake hands) down;accepted the hand) *erbal : baik
I¶m physiciatrist here, what is Sorrowati Pasien cooperative
your name ma¶am?
How do you feel today? I feel very bad, doc (suddenly Mood : "#
"
!
$(ĻĻ
she cried) abnormal tonus emosi)
Mood appropriate affect
(dlm keadaan
murung/depressed/suram
& sesuai dgn keadaan yang
dialaminya sekarang ó
menjawab pertanyaan
sambil menangis)
Why are you crying? I¶m sinful, so much sin had I % "
commit &
'
(
Are you sure it¶s that much? Yes, and I¶m very sure that I
may not be forgiven
cut God¶mercy is above all «
I don¶t know
May I know what are they? I ran away from home, talk to Good judgement,
everyone about the evil of my Pernyataan yang benar
husband¶s and I enjoyed it so (merasa kalo apa yang
much dilakukannya itu
Is it right to do so? Of course not. Why should I salah/tidaklah benar)
felt guilty if it¶s right
Do you love your husband? No way £% # '
Why? He hit my head !
' %
(talking to husband) is it right (husband answering) yes, I
sir? lost control.
c ccc
Ê
How many times it happened? Twice, the first was when she
turned mad a year ago.
(talking to miss sorowati) ««.. Tidak ada halusinasi
have you any hallucination Sorry?
mam?
I mean, voices of which you No
don¶t see the source, or
something like a shadow only
you can see?
Okay I think its enough for Thank you
our initial interview. I expect
to se you again next week.
The following interview Interpretasi
Good morning miss Fine, actually I feel good Mood : euthymic
sororwati, how are you today.
feeling today?
Could you explain it? I felt very easy. Now that I¶ve
lost the burden of my
shoulder.
If im not mistaken, you¶ve I was considering suicide. I Idea of suicide in the past
tried to swallow a large cant hold on with the burden
amount of pill that day. What
do you intend to do?
What made you cancel the My mother caught me before I
act? commence it. cut I also think
about my children
How are you doing now? I can do many things again. I Fungsi pada pekerjaan
can cook again. masih kurang dibanding
What about your job? I don¶t attend school right biasanya, tapi sudah lebih
now. I still think im a disgrace baik dibanding
sebelumnya.
So you¶re still feeling sinful? A little, but I think ill recover Traces idea of sin (masih
in time ada perasaan berdosa, tapi
No do you feel unforgivable? No, I realize my husband¶s kondisi sudah lebih baik
c ccc
Ê
fault is his to consider, not dibanding sebelumnya)
mine
What are your plans I want to divorce my husband Mampu membuat rencana
afterwards? yang akan dilakukan
And then? I don¶t know next dalam jangka waktu dekat
[
! "
!
#$"
$& #$
$)
!
)'
% *
(
Ê Main condition : verbal adekuat, dan ada kontak fisik, kontak mata
minimal, menunjukan sikap kooperatif
Ê Keadaan affective : hypothymic mood, appropriate affect (sikap yang tepat)
Ê Suasana Hati : kesedihan mendominasi, tertekan
Ê Kehidupan emosional : labile, mudah mengekpresikan apa yang dirasakan
Ê Pemikiran : a. Arus pikiran
Normal ( pikiran berjalan dari suatu ide awalóide
tujuan), no flight of idea,menyimpang dll.
b. Pemilikan pikiran
Normal ( individu menghayati pikiran yang dikeluarkan
sebagai miliknya), pikiran obsesi (-), alienasi (-)
c. Isi pikiran
adanya perasaan berdosa dan bersalah
d. centuk pikiran
Normal ó pasien mampu berpikir rasional / logis
kesimpulan:
*Persistent idea of sin
maknanya : gagasan tentang rasa bersalah. Dan merupakan ciri dari adanya gejala depresi
*Suicide ideation
maknanya: merasa beban yang dialaminya terlalu berat, merasa sangat bersalah dan tidak
bisa melakukan apapun. Dan pada akhirnya berpikir tentang kematian karena merasa tidak
ada gunanya lagi hidup.
*Pessimistic vision
*Hostility
Ê Persepsi : pemikiran dan merasa berdosa, penyesalan yang dalam
Ê Pengertian diri : gagal melakukan tindakan yang penting, sedikit
pengertian pada diri sendiri, mempengaruhi penilaian
orang terhadap dirinya
c ccc
Ê
Ê Sensasi : normal, tidak ada halusinasi maupun delusi
Ê Fungsi intelegensi : normal
a. Kesadaran = compos mentis
b.Orientasi = baik
c.Daya ingat = baik /normal
d.Konsenterasi dan perhatian = baik
Ê Instinctual dan kondisi : hipobulia (kehilangan dorongan berkehendak)
perbuatan ingin mengakhiri hidup (suicide act), kehilangan
berat badan, sulit tidur
Ê Anxiety : tidak ada gejala cemas yang terlihat
Ê Tes kemampuan realita : perasaan, pemikiran, persepsi, tingkah laku mengalami
gangguan
+ Ê
!
a.*ital sign
a.Ê Tekanan darah 110/60 = normal rendah
b.Ê Tekanan nadi 62x/mnt = normal
c.Ê Respiration rate 15x/mnt = normal rendah
d.Ê Axial temperatur 36,9 c = normal
b.Pemeriksaan fisik = normal
c.Pemeriksaan neurologis = normal
Ê
!
!
Ê !
%
'£
#
cirth : spontaneous birth
Childhood : nice, cheerfull and communicable person
óÊ Dapat di simpulkan bahwah tidak ada gangguan pada riwayat kelahiran mrs Sorrowati.
% Ê *
' '
%
$ *
!
'
Ê Satu tahun lalu, Perilaku aneh, sering menceritakan aktivitas pribadinya, tertawa keras di
tiap cerita ó gangguan kepribadian manic (1)
Ê Menyumbangkan sebagian besar pendapatannya pada acara amal ó menunjukkan bahwa
Ny. Sorrowati ingin dipuji oleh banyak orang ó gangguan kepribadian manic (2)
c ccc
Ê
ÊIa hampir tidak pernah istirahat tanpa merasa lelah ó menunjukan bahwa telah erjadi episode
manik pada mrs sorrowati (3)
óÊ Y Y Y
Y
Ê Kondisi pasien ini dilaporkan sedikitnya selama 1 bulan, setelah dia berangsur-angsur
kembali normal.
óÊ ÷
!
$ Ê !
#£
#
Tidak terdapat masalah yang berati dalam riwayat keluarga mrs sorrowati. Hanya
saja, mrs Sorrowati merasa kurang mendapat perhatian dari orangtua.
' Ê '$
£
# '
$
"
Ê Mrs Sorrowati mengumpulkan teman-temannya yang kemampuan akademik diabawahnya
dan mengajarkan mereka, lalu mendapatkan sanjungan dari teman-teman nyaó hal ini
menunjukan bahwa Mrs Sorrowati memiliki kepribadian histrionik yaitu ia Terus-menerus
mencari kepuasan (excitement), apresiasi oleh orang lain dan aktivitas di mana pasien
menjadi pusat perhatian.
Ê $
£
#
Ê Ny. Sorrowati terlibat skandal asmara dengan siswanya ó menunjukkan gangguan
kepribadian histrionik (menunjukan perilaku mencari perhatian yang tinggi)
Ê Pada orang-orang dengan gangguan kepribadian histrionik, impuls seksual mereka mungkin
dilakukan untuk menentramkan diri mereka bahwa mereka menarik bagi jenis kelamin lain.
Ê
$
"
, $
*
#
rÊ Pribadi Ny. Sorrowati yang cenderung untuk berbagi meskipun ia sendiri dalam
kondisi yang tidak memungkinkan, kemudian selalu aktif dalam berbagai cara, sering
membual atau menyombongkan diri menunjukkan
.
c ccc
Ê
Ê Dari hasil anamnesis riwayat pekerjaan, pendidikan, dan sosial tercermin bahwa nyonya
Sorrowati!
% '
"
$
'
- % ". /
01 2Ã
% '
£
Gangguan kepribadian yang ditandai oleh:
a)Ê Ekspresi emosi yang didramatisasikan sendiri, teaterikalitas, dan dibesar-besarkan;
b)Ê cersifat sugestif,mudah dipengaruhi oleh orang lain atau keadaan;
c)Ê Afek datar dan labil;
d)Ê Terus-menerus mencari kepuasan (excitement), apresiasi oleh orang lain dan aktivitas di mana
pasien menjadi pusat perhatian;
e)Ê Kegairahan yang tidak pantas dalam penampilan atau perilaku;
f)Ê Terlalu mementingkan daya tarik fisik.
Gambaran penyerta mungkin mencakup egosentrisitas, pemuasan diri, terus-menerus
mengharapkan apresiasi, perasaan mudah tersinggung dan perilaku manipulatif yang menetap
untuk mencapai kepentingan pribadi.
Ê
£
#
rÊ Kehidupan rumah tangga tidak harmonis.
rÊ Dari scenario di dapatkan bahwa Mrs. Sorrowati menikah Karena
kecelakaan/kehamilan di luar nikah
rÊ status suami lebih rendah dibanding istri, ekonomi RT kekurangan,
sifat suami cemburuan.
rÊ tindak kekerasan dalam rumah tangga (KDRT).
Keadaan ini semua dapat menimbulkan stressor psikis bagi si pasien. Sehingga lama-
kelamaan menyebabkan
" Ê$
!
$ £
#
Ê Mrs Sorrowati adalah tulang punggung keluarga nya dan suaminya tidak memiliki pekerjaan
tetap serta hanya lulus dari sekolah dasar. ó hal ini sangat berpengaruh pada kondisi psikis
mrs Sorrowati yang berdampak pada depresi berat yang dialaminya. ÷
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Ê Ny. Sorrowati mulai bertengkar dengan suaminya dan setelah itu ia tampak murung serta
menangis.
óÊ Kekerasan yang dilakukan suaminya terhadap mrs sorrowati menjadi faktor utama
pemicu depresi.
óÊ
!/
Mengalami Gangguan mood (depresi) ó Penurunan kadar neurotransmitter
(pe<<norepinefrin, serotonin, dopamine) ó stabilitas emosi dapat terganggu dan
mempengaruhi pengaturan mood di otak óSedih dan menangis
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Ê Menarik diri dari hobinya, pendiam, dan hanya memberikan tugas kepada murid-muridnya.
óÊ Depresi juga menyebabkan penurunan motivasi dan gairah hidup sehingga mrs sorrowati
menjadi menolak berkomunikasi dengan orang lain dan menarik diri dari masyarakat
sekitar.
Ê Ia telat bangun tidur dan tidur lebih larut dari biasanya, serta sering memandangi langit-langit.
óÊ Mengalami Gangguan mood (depresi) ó Penurunan kadar neurotransmitter
(pe<<norepinefrin, serotonin, dopamine) ó norepineprin dan dopamine yang terutama
mengatur pola tidur ó Sehingga terjadi gangguan pola tidur.
óÊ Gangguan tidur merupakan gejala yang paling sering ditemukan pada pasien depresi.
Sekitar 80 % pasien depresi mengeluh sulit tidur, sering terbangun pada malam hari.
Dalam kasus ini kemungkinan stressor penyebab depresi tersebut adalah kekerasan yang
dilakukan suaminya. Semua stressor ini terus menjadi beban psikis. Inilah yang memicu
terjadinya gangguan tidur. . Kelainan yang ditemukan berupa perlambatan onset tidur,
pemedekan latensi REM (yaitu waktu antara tertidur dan periode REM pertama),
peningkatan panjang periode REM pertama, dan tidur delta yang abnormal.
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Ê Masalah rumah tangga(suami yang tidak sesuai dengan harapan,sering cekcok)óstres
beratómelewati ambang stress yang dapat diterima pasienókerusakkan jaringan pada otak
óhilangnya neuron ó menurunnya sekresi neurotransmitter oleh neuronó penurunan
neurotransmitter diotak (serotonin dan dopamine yang mengatur nafsu makan) ó perubahan
nafsu makanó nafsu makan menurun ó kurangnya intake makanan ke dalam tubuh ó banyak
cadangan makanan yang digunakan untuk menghasilkan energió penurunan cc
Ê Gagal memenuhi pekerjaan rumah tangganya untuk memasak
ó Hal ini merupakan manifestasi dari gangguan depresi berat yang di alamai mrs sorrowati.
Pada orang dengan stres berat akan terjadi perubahan secara fungsional neurotransmitter dan
sistem pemberi sinyal intral neuron khususnya serotonin dan dopamin. Penurunan serotonin
dan dopamin menyebabkan gangguan pada neurotransmiter di otak sehingga pasien menjadi
tidak bisa melakukan aktivitas apa pun/ penurunan aktivitas.
Ê Gagal untuk menghadiri lokasi pekerjaannya dan ia diberi surat peringatan oleh atasannya.
ó Surat peringatan hanya menambah beban psikis Mrs Sorrowati sehingga meningkatkan
progretivitas depresi menjadi lebih parah.
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Ê Terlihat lebih cemas
Pertengkaran dengan suaminya ó memicu timbulnya stress ó sistem noradrenergic teregulasi
secara buruk ó aktivitas badan sel pada sist. noradrenergik (terutama di lokus seruleus di pons
rostral) ó mengeluarkan axon ke kortex serebral, sistem limbik, batang otak, dan medulla
spinalis ó rasa ketakutan dan kecemasan yang berlebihan.
Ê merasa bersalah dengan diri dia sendiri
Stress ó reaksi psikis yang berlebihan ó gangguan isi pikiran ó merasa bersalah berlebihan
akibat tindakan-tindakan yang ia lakukan sebelumnya
Ê Merasa lelah di pagi hari dan tidak bisa melakukan pekerjaan yang bermanfaat
Stress ó mempengaruhi mood dan pikiran ó susah tidur ó saat bangun di pagi hari, Ny.
Sorrowati merasa lebih lelah ó mengurangi kemampuan aktivitas fisiknya ó timbul perasaan
bahwa dia tidak bisa melakukan pekerjaan yang bermanfaat
Ê menelan banyak pil sakit kepala
Stress ó timbul upaya untuk menghilangkan stress ó pengaruh kondisi mood yang buruk ó
upaya berlebihan ó menelan banyak obat sakit kepala.
Ê
