Advanced Trauma Life Support (ATLS)

Advanced Trauma Life Support (ATLS) is a training program for doctors in the management of acute trauma cases, developed by the American College of Surgeons. The program has been adopted worldwide in over 30 countries; its goal is to teach a simplified and standardized approach to trauma patients. Originally, it was designed for emergency situations where only one doctor and one nurse are present, but nowadays, ATLS is also widely accepted as the standard of care for the initial assessment and treatment in trauma centers. There is no clear evidence that ATLS training impacts on the outcome for victims of trauma.

HISTORY

ATLS has its origins in the United States in 1976, when orthopaedic surgeon Dr. James K. Styner, piloting a light aircraft, crashed his plane into a field in Nebraska. His wife was killed instantly and three of his four children received critical injuries. He carried out the initial triage of his children at the crash site. Dr. Styner had to flag down a car to transport him to the nearest hospital; upon arrival, he found it closed. Even once the hospital was opened and a doctor called in, he found that the emergency care provided at the small regional hospital where they were treated was inadequate and inappropriate.

Upon returning to work, he set about developing a system for saving lives in medical trauma situations. Jim Styner and his colleague Paul 'Skip' Collicott, with assistance from Advanced Cardiac Life Support personnel and the Lincoln Medical Education Foundation, produced the initial ATLS course which was held in 1978. In 1980 the American College of Surgeons Committee on Trauma adopted ATLS and began US and international dissemination of the course. Jim himself recently recertified as an ATLS instructor teaching his Instructor Candidate course in Nottingham UK and subsequently going on to teach in the Netherlands. This follows on from his talk on the birth of ATLS at the American College of Surgeons

Since its inception, ATLS has become rather standard for trauma care in American emergency departments and advanced paramedical services. Since emergency physicians, paramedics and other advanced practitioners use ATLS as their model for trauma care it makes sense that programs for other providers caring for trauma would be designed to interface well with ATLS. The Society of Trauma Nurses has developed the Advanced Trauma Care for Nurses (ATCN) course for Registered Nurses. ATCN meets concurrently with ATLS and shares some of the lecture portions. This approach allows for medical and nursing care to be well coordinated with one another as both the medical and nursing care providers have been trained in essentially the same model of care. Similarly, the National Association of Emergency Medical Technicians has developed the Prehospital Trauma Life Support (PHTLS) course for basic Emergency Medical Technicians (EMT)s. This course is based around ATLS and allows the PHTLS-trained EMTs to work alongside paramedics and to transition smoothly into the care provided by the ATLS and ATCN-trained providers in the hospital.

PRIMARY SURVEY

The first and key part of the assessment of patients presenting with trauma is called the primary survey. During this time, life-threatening injuries are identified and simultaneously resuscitation is begun. A simple mnemonic, ABCDE, is used as a memory aid as to the order in which problems should be addressed.
A Airway Maintenance with Cervical Spine Protection
B Breathing and Ventilation
C Circulation with Hemorrhage Control
D Disability (Neurologic Evaluation)
E Exposure and Environment

A - Airway Maintenance with Cervical Spine Protection

The first stage of the primary survey is to assess the airway. If the patient is able to talk, the airway is likely to be clear. If the patient is unconscious, he/she may not be able to maintain his/her own airway. The aiway can be opened using a chin lift or jaw thrust. Airway adjuncts may be required. If the airway is blocked (e.g, by blood or vomit), the fluid must be cleaned out of the patient's mouth.

At the same time, the cervical spine must be maintained in the neutral position to prevent secondary injuries to the spinal cord. The neck should be immobilised using a semi-rigid cervical collar, blocks and tape.

B - Breathing and Ventilation

The chest must be examined by inspection, palpation, percussion and auscultation. Surgical emphysema and tracheal deviation must be identified if present. Life-threatening chest injuries, including tension pneumothorax, open pneumothorax, flail chest and massive haemothorax must be identified and rapidly treated. Flail chest, penetrating injuries and bruising can be recognised by inspection.

C - Circulation with Hemorrhage Control

Hemorrhage is the predominant cause of preventable postinjury deaths. Hypotension following injury must be assumed to to be due to blood loss until proven otherwise. Haemorrhagic shock is caused by significant blood loss. 2 large bore intravenous line are established and crystalloid solution given. If the patient does not respond to this, type-specific blood, or O-negative if this is not available, should be given . External bleeding is controlled by direct pressure. Occult blood loss may be into the chest, abdomen, pelvis or from the long bones. Chest or pelvic bleeding may be identified on X-ray. Bleeding into the peritoneum may be diagnosed on ultrasound (FAST scan), CT (if stable) or diagnostic peritoneal lavage.

D - Disability (Neurologic Evaluation)

A rapid neurological evaluation is performed at the end of the primary survey. This establishes the patient's level of consciousness, pupillary size and reaction, lateralizing signs, and spinal cord injury level.

The Glasgow Coma Scale is a quick method to determine the level of consciousness, and is predictive of patient outcome. If not done in the primary survey, it should be performed as part of the more detailed neurologic examination in the secondary survey. An altered level of consciousness indicates the need for immediate reevaluation of the patient's oxygenation, ventilation, and perfusion status. Hypoglycemia, and drugs including alcohol, may also influence the level of consciousness. If these are excluded, changes in the level of consciousness should be considered to be due to traumatic brain injury until proven otherwise.

E - Exposure / Environmental control

The patient should be completely undressed, usually by cutting off the garments. It is imperative to cover the patient with warm blankets to prevent hypothermia in the emergency department. Intravenous fluids should be warmed and a warm environment maintained. Patient privacy should be maintained while exposing by closing curtains.

SECONDERY SURVEY

When the primary survey is completed, resuscitation efforts are well established, and the vital signs are normalizing, the secondary survey can begin.

The secondary survey is a head-to-toe evaluation of the trauma patient, including a complete history and physical examination, including the reassessment of all vital signs. Each region of the body must be fully examined. X-rays indicated by examination are obtained.

If at any time during the secondary survey the patient deteriorates, another primary survey is carried out as a potential life threat may be present.

Find your locker

Locker is currently well known as a very important thing for everybody in out home activity especially in public facilities where the activity of most people being held. From student at school, college, university or even people at gym, hospital, office, airport and terminal, such thing is never been doubt has become a primary need for most of us.

The locker producers are not so hard to find. You can made a very simple transaction by surfing virtually through internet. You can visit the locker producer's homepage and view their products review before decide to make a transaction.

One of the best lockers online shop is at lockerixchange.com. Whether you are an individual homeowner or represent a 4000 student facility, you can find the product depth, knowledge, low prices and customer service needed to find a fully customized locker solution designed for your specific needs in this site.

Many kind of lockers type and models provide by this online shop, you can explore in this site. From standard locker, School Lockers , Gym Lockers even locker's benches you can find here. Maybe you are interesting by the material the lockers are made, you can find Steel Lockers, Metal Lockers and even Plastic Lockers.

Interesting to find the best lockers suit your need, just visit this site :-)

Alternative Antidepressants

This is bad news for the millions of people who suffer from depression.

This condition can cause a depressed mood; loss of interest or pleasure in most activities, including sex; fatigue; sleepproblems; feelings of hopelessness and helplessness; and difficulty thinking and making decisions.

Women have a 10 to 25 percent risk and men a 5 to 12 percent risk of developing severe major depression in their lifetime.

Depression has different causes. And each cause needs a different approach to treatment.

Yet many people believe that antidepressants drugs are the answer. Today, one in ten Americans takes an antidepressant.

Unfortunately, new research shows that they don't work and have significant side effects.

In fact, most patients taking antidepressants either don't respond or have only partial response.

And 86 percent of people who take these drugs have one or more side effects, including sexual dysfunction, fatigue, insomnia, loss of mental abilities, nausea, and weight gain.

No wonder half the people who try antidepressants discontinue them after just 4 months.

Now let's talk more about this new research.

A report published in a recent issue of "The New England Journal of Medicine" looked at 74 studies involving 12 drugs and over 12,000 people. Some of these studies were published -- and some weren't.

You see, drug companies don't have to publish all the results of their studies. They only publish those they want to.

The report's researchers really had to dig to find these unpublished studies. When they did, they found that 37 of 38 trials with positive results were published, while only 14 of 36 negative studies were published.

And the negative published studies were twisted to imply the drugs worked when they didn't.

Now that really is depressing news -- and there's no easy fix.

However, Functional Medicine, on which my approach of UltraWellness is based, can help.

Functional Medicine doesn't rely on drugs to suppress symptoms, but uncovers the root causes of depression.

Let me tell you about a few of my patients.

A 23-year-old woman had been on various antidepressants throughout her childhood and adolescence. We discovered that she had food allergies, which cause inflammation. And recent studies suggest that inflammation may be related to depression.

The patient eliminated her food allergies and her depression disappeared. She was able to stop taking her medication -- and she lost 30 pounds to boot.

A 37-year-old had depression that didn't respond to drugs, plus fatigue and a 40-pound weight gain.

When we got the very high levels of mercury out of her body, she soon became happy, thin, and full of energy.

And a 49-year-old man had taken antidepressants for years but was still severely depressed.

We treated his severe deficiencies of vitamin B12, B6, and folate. Now he's free of depression.

As you can see, antidepressants are not the answer.

We need different solutions.

Try the following measures to help alleviate depression. They are based on Functional Medicine which is the foundation of MYpractice and the core of UltraWellness.

1. Try an anti-inflammatory elimination diet that gets rid of common food allergens.
2. Check for hypothyroidism.
3. Treat vitamin D deficiency with at least 2,000 to 5,000 U a day of vitamin D3.
4. Take an Omega-3-fats in the form of 1,000 to 2,000 milligrams (mg) a day of purified fish oil. Your brain is made of up thisfat.
5. Take adequate B12 (1,000 micrograms, or mcg, a day), B6 (25
mg) and folic acid (800 mcg).
6. Get checked for mercury.
7. Exercise vigorously five times a week for 30 minutes. This increases levels of BDNF, a natural antidepressant in your brain.

These are just of few of the easiest and most effective things you can do to treat depression.

quit smoking

Nicotine: A Powerful Addiction

If you have tried to quit smoking, you know how hard it can be. It is hard because nicotine is a very addictive drug. For some people, it can be as addictive as heroin or cocaine.

Quitting is hard. Usually people make 2 or 3 tries, or more, before finally being able to quit. Each time you try to quit, you can learn about what helps and what hurts.

---

Quitting takes hard work and a lot of effort, but you can quit smoking.

---

Good Reasons for Quitting

Quitting smoking is one of the most important things you will ever do:

• You will live longer and live better.


• Quitting will lower your chance of having a heart attack, stroke, or cancer.


• If you are pregnant, quitting smoking will improve your chances of having a healthy baby.


• The people you live with, especially your children, will be healthier.


• You will have extra money to spend on things other than cigarettes.

Five Keys for Quitting

Studies have shown that these five steps will help you quit and quit for good. You have the best chances of quitting if you use them together:

1. Get ready.


2. Get support.


3. Learn new skills and behaviors.


4. Get medication and use it correctly.


5. Be prepared for relapse or difficult situations.

1. Get Ready

• Set a quit date.


• Change your environment.


1. Get rid of ALL cigarettes and ashtrays in your home, car, and place of work.


2. Don't let people smoke in your home.
• Review your past attempts to quit. Think about what worked and what did not.


• Once you quit, don't smoke—NOT EVEN A PUFF!

2. Get Support and Encouragement

Studies have shown that you have a better chance of being successful if you have help. You can get support in many ways:

• Tell your family, friends, and coworkers that you are going to quit and want their support. Ask them not to smoke around you or leave cigarettes out.


• Talk to your health care provider (for example, doctor, dentist, nurse, pharmacist, psychologist, or smoking counselor).


• Get individual, group, or telephone counseling. The more counseling you have, the better your chances are of quitting. Programs are given at local hospitals and health centers. Call your local health department for information about programs in your area.

3. Learn New Skills and Behaviors

• Try to distract yourself from urges to smoke. Talk to someone, go for a walk, or get busy with a task.


• When you first try to quit, change your routine. Use a different route to work. Drink tea instead of coffee. Eat breakfast in a different place.


• Do something to reduce your stress. Take a hot bath, exercise, or read a book.


• Plan something enjoyable to do every day.


• Drink a lot of water and other fluids.

4. Get Medication and Use It Correctly

Medications can help you stop smoking and lessen the urge to smoke.

• The U.S. Food and Drug Administration (FDA) has approved five medications to help you quit smoking:


1. Bupropion SR—Available by prescription.


2. Nicotine gum—Available over-the-counter.


3. Nicotine inhaler—Available by prescription.


4. Nicotine nasal spray—Available by prescription.


5. Nicotine patch—Available by prescription and over-the-counter.
• Ask your health care provider for advice and carefully read the information on the package.


• All of these medications will more or less double your chances of quitting and quitting for good.


• Everyone who is trying to quit may benefit from using a medication. If you are pregnant or trying to become pregnant, nursing, under age 18, smoking fewer than 10 cigarettes per day, or have a medical condition, talk to your doctor or other health care provider before taking medications.

5. Be Prepared for Relapse or Difficult Situations

Most relapses occur within the first 3 months after quitting. Don't be discouraged if you start smoking again. Remember, most people try several times before they finally quit. Here are some difficult situations to watch for:

• Alcohol. Avoid drinking alcohol. Drinking lowers your chances of success.
• Other smokers. Being around smoking can make you want to smoke.
• Weight gain. Many smokers will gain weight when they quit, usually less than 10 pounds. Eat a healthy diet and stay active. Don't let weight gain distract you from your main goal—quitting smoking. Some quit-smoking medications may help delay weight gain.
• Bad mood or depression. There are a lot of ways to improve your mood other than smoking.

If you are having problems with any of these situations, talk to your doctor or other health care provider.

Special Situations or Conditions

Studies suggest that everyone can quit smoking. Your situation or condition can give you a special reason to quit.

• Pregnant women/new mothers: By quitting, you protect your baby's health and your own.


• Hospitalized patients: By quitting, you reduce health problems and help healing.


• Heart attack patients: By quitting, you reduce your risk of a second heart attack.


• Lung, head, and neck cancer patients: By quitting, you reduce your chance of a second cancer.


• Parents of children and adolescents: By quitting, you protect your children and adolescents from illnesses caused by second-hand smoke.

Using vitamin and mineral supplements wisely

Can you skip your daily servings of fruits and vegetables and take a vitamin and mineral supplement instead? Unfortunately, no.

Dietary supplements aren't meant to be food substitutes, as they can't replicate all of the nutrients and benefits of whole foods, such as fruits and vegetables. But dietary supplements can still play a role in your health by complementing your regular diet if you have trouble getting enough nutrients.
Vitamin and mineral ABCs

Vitamins and minerals are substances your body needs in small but steady amounts for normal growth, function and health. Together, vitamins and minerals are called micronutrients. Your body can't make most micronutrients, so you must get them from the foods you eat or, in some cases, from dietary supplements.

* Vitamins. These nutrients are needed for a variety of biological processes, among them growth, digestion and nerve function. Vitamins are involved in many processes that enable your body to use carbohydrates, fats and proteins for energy and repair. Though vitamins are involved in converting food into energy, they supply no calories.
* Minerals. These nutrients are the main components in your teeth and bones, and they serve as building blocks for other cells and enzymes. Minerals also help regulate the balance of fluids in your body and control the movement of nerve impulses. Some minerals also help deliver oxygen to cells and help carry away carbon dioxide.

Whole foods: Your best source of micronutrients

Whole foods are your best sources of vitamins and minerals. They offer three main benefits over dietary supplements:

* Greater nutrition. Whole foods are complex, containing a variety of the micronutrients your body needs — not just one. An orange, for example, provides vitamin C but also some beta carotene, calcium and other nutrients. A vitamin C supplement lacks these other micronutrients.
* Essential fiber. Whole foods provide dietary fiber. Fiber can help prevent certain diseases, such as diabetes and heart disease, and it can also help manage constipation.
* Protective substances. Whole foods contain other substances recognized as important for good health. Fruits and vegetables, for example, contain naturally occurring food substances called phytochemicals, which may help protect you against cancer, heart disease, diabetes and high blood pressure. Many are also good sources of antioxidants — substances that slow down oxidation, a natural process that leads to cell and tissue damage. If you depend on dietary supplements rather than eating a variety of whole foods, you miss the benefits of these substances.

Who needs dietary supplements?

Many people don't receive all of the nutrients they need from their diet because they either can't or don't eat enough, or they can't or don't eat a variety of healthy foods. For some people, including those on restrictive diets, dietary supplements can provide vitamins and minerals that their diets often don't. Pregnant women and older adults have altered nutrient needs and may also benefit from a dietary supplement.
Choosing and using supplements

If you decide to take a vitamin or mineral supplement, consider these factors:

* Check the supplement label. Read labels carefully. Product labels can tell you what the active ingredient or ingredients are, which nutrients are included, the serving size — for example, capsule, packet or teaspoonful — and the amount of nutrients in each serving.
* Avoid supplements that provide 'megadoses.' In general, choose a multivitamin-mineral supplement — for example, Centrum, One-A-Day, others — that provides about 100 percent of the Daily Value (DV) of all the vitamins and minerals, rather than one which has, for example, 500 percent of the DV for one vitamin and only 20 percent of the DV for another. The exception to this is calcium. You may notice that calcium-containing supplements don't provide 100 percent of the DV. If they did, the tablets would be too large to swallow.
* Look for 'USP' on the label. This ensures that the supplement meets the standards for strength, purity, disintegration and dissolution established by the testing organization U.S. Pharmacopeia (USP).
* Beware of gimmicks. Synthetic vitamins are usually the same as so-called "natural" vitamins, but "natural" vitamins usually cost more. And don't give in to the temptation of added herbs, enzymes or amino acids — they add mostly cost. Note that some herbs can interact negatively with certain medications.
* Look for expiration dates. Dietary supplements can lose potency over time, especially in hot and humid climates. If a supplement doesn't have an expiration date, don't buy it. If your supplements have expired, discard them.
* Store all vitamin and mineral supplements safely. Store dietary supplements in a dry, cool place. Avoid hot, humid storage locations, such as the bathroom. Also, store supplements out of sight and away from children. Put supplements in a locked cabinet or other secure location. Don't leave them on the counter or rely on child-resistant packaging.

Dasar Penyakit Jiwa

a. Definisi Gangguan Jiwa

Menurut American Psychiatric Association (APA, 1994), gangguan mental adalah gejala atau pola dari tingkah laku psikologi yang tampak secara klinis yang terjadi pada seseorang dari berhubungan dengan keadaan distres (gejala yang menyakitkan) atau ketidakmampuan (gangguan pada satu area atau lebih dari fungsi-fungsi penting) yang meningkatkan risiko terhadap kematian, nyeri, ketidakmampuan atau kehilangan kebebasan yang penting dan tidak jarang respon tersebut dapat diterima pada kondisi tertentu.

Menurut Townsend (1996) mental illness adalah respon maladaptive terhadap stresor dari lingkungan dalam/luar ditunjukkan dengan pikiran, perasaan, dan tingkah laku yang tidak sesuai dengan norma lokal dan kultural dan mengganggu fungsi sosial, kerja, dan fisik individu.

Konsep Gangguan Jiwa dari PPDGJ II yang merujuk ke DSM-III adalah sindrom atau pola perilaku, atau psikologi seseorang, yang secara klinik cukup bermakna, dan yang secara khas berkaitan dengan suatu gejala penderitaan (distres) atau hendaya (impairment/disability) di dalam satu atau lebih fungsi yang penting dari manusia (Maslim, 2002).

b. Definisi kesehatan Jiwa

Kesehatan Jiwa adalah Perasaan Sehat dan Bahagia serta mampu mengatasi tantangan hidup, dapat menerima orang lain sebagaimana adanya serta mempunyai sikap positif terhadap diri sendiri dan orang lain (www.dinkes-dki.go.id.htm).

Kesehatan jiwa meliputi:

1. Bagaimana perasaan anda terhadap diri sendiri
2. Bagaimana perasaan anda terhadap orang lain
3. Bagaimana kemampuan anda mengatasi persoalan hidup anda Sehari - hari

c. Gejala Gangguan Jiwa (Maramis, 1995) :

1)Gangguan kesadaran

a) Penurunan kesadaran


(1)Apati

Mengantuk dan acuh-tak-acuh terhadap rangsang yang masuk; diperlukannya rangsang yang sedikit lebih keras dai biasanya untuk menarik perhatiannya.

(2)Somnolensi

Jelas sudah lebih mengantuk dan rangsang yang lebih keras lagi diperlukan untuk menarik perhatiannya.

(3)Sopor

Hanya berespon dengan rangsang yang keras; ingatan, orientasi, dan pertimbangan sudah hilang.

(4)Subkoma dan koma

Tidak ada lagi respons terhadap rangsang yang keras; bila sudah dalam sekali, maka reflek pupil (yang sudah melebar) dan reflex muntah hilang lalu timbullah reflex patologik.

b) Kesadaran yang meninggi

Kesadaran yang meninggi adalah keadaan dengan respons yang meninggi terhadap rangsang: suara-suara terdengar lebih keras, warna-warni kelihatan lebih terang: disebabkan oleh berbagai zat yang merangsang otak.

c) Tidur

Gangguan tidur dapat berupa: insomnia, berjalan waktu tidur, mimpi buruk, narkolepsi, kelumpuhan tidur.

d) Hipnosa

Kesadaran yang sengaja diubah (menurun dan menyempit, artinya menerima rangsang hanya dari sumber tertentu saja) melalui sugesti; mirip tidur dan ditandai oleh mudahnya disugesti; setelah itu timbul amnesia.

e) Disosiasi

Adalah sebagian tingkah laku atau kejadian memisahkan dirinya secara psikologik dari kesadaran. Kemudian terjadi amnesia sebagian atau total. Disosiasi dapat berupa: trans, senjakala histerik, fugue, serangan histerik, sindroma ganser, menulis otomatis.

f) Kesadaran yang berubah

Tidak normal, tidak menurun, tidak meninggi, bukan disosiasi, tetapi kemampuan mengadakan hubungan dengan dan pembatasan terhadap dunia luar dan dirinya sendiri sudah terganggu pada taraf “tidak sesuai dengan kenyataan” (secara kwalitatif), seperti pada psikosa fungsional.

g) Gangguan Perhatian

Tidak mampu memusatkan (memfokus) perhatian pada hanya satu hal/keadaan, atau lamanya memusatkan perhatian itu berkurang daya konsentrasi terganggu.

2)Gangguan ingatan

Ingatan berdasarkan tiga proses utama, yaitu pencatatan atau registrasi, penahanan atau resistensi, dan pemanggilan kembali atau recall. Gangguan ingatan terjadi bila terdapat gangguan pada salah satu atau lebih dari ketiga unsur tersebut.

a) Gangguan ingatan umum

Gangguan ingatan tidak terbatas pada suatu waktu tertentu saja dan dapat meliputi: kejadian yang baru saja terjadi dan kejadian yang sudah lama berselang terjadi.

b) Amnesia

Adalah ketidakmampuan mengingat kembali pengalaman, mungkin bersifat sebagian atau total, serta retrograd atau anterograd.

c) Paramnesia
Adalah ingatan yang keliru karena distorsi pemanggilan kembali (recall).

d) Hipermnesia
Adalah penahanan dalam ingatan dan pemanggilan kembali (arecall).


3)Gangguan orientasi

Orientasi adalah kemampuan seseorang untuk mengenal lingkungannya serta hubungannya dalam waktu dan ruang terhadap dirinya sendiri dan juga hubungan dirinya sendiri dengan orang lain.

Disorientasi atau gangguan orientasi timbul sebagai akibat gangguan kesadaran dan dapat menyangkut waktu, tempat, atau orang.

4)Gangguan afek dan emosi

Afek adalah nada perasaan, menyenangkan, atau tidak menyenangkan, yang menyertai suatu pikiran dan biasanya berlangsung lama serta kurang disertai oleh komponen fisiologik. Emosi adalah manifestasi afek ke luar dan disertai oleh banyak komponen fisiologik, lagi pula biasanya berlangsung relatif tidak lama (misalnya: ketakutan, kecemasan, depresi dan kegembiraan). Bilamana afek dan emosi itu sudah begitu keras, sehingga fungsi individu itu terganggu, maka dikatakan telah terjadi gangguan afek atau emosi yang dapat berupa:

a) Depresi

Depresi dengan komponen psikologik, misalnya: rasa sedih, susah, rasa tak berguna, gagal, kehilangan, tak ada harapan, putus asa, penyesalan yang patologis; dan komponen somatik, misalnya: anoreksia, konstipasi, kulit lembab (rasa dingin), tekanan darah dan nadi menurun sedikit.

b) Kecemasan dan ketakutan

Kecemasan dapat dibedakan kecemasan (tidak jelas cemas terhadap apa) dari ketakutan atau fear (jelas atau tahu takut terhadap apa). Komponen psikologiknya dapat berupa: khawatir, gugup, tegang, cemas, rasa tak aman, takut, lekas terkejut, sedangkan komponen jenis somatiknya misalnya: palpitasi, keringat dingin pada telapak tangan, tekanan darah meninggi, respons kulit terhadap aliran listrik galvanik berkurang, peristaltik bertambah, lekositosis.

Kecemasan dapat berupa:

(1)Kecemasan yang mengambang ( free-floating anxiety); kecemasan yang menyerap dan tidak ada hubungannya dengan suatu pemikiran;

(2)Agitasi: kecemasan yang disertai kegelisahan motorik yang hebat;

(3)Panik: serangan kecemasan yang hebat dengan kegelisahan, kebingungan dan hiperaktivitas yang tidak terorganisasi.

c) Efori

Rasa riang, gembira, senang, bahagia yang berlebihan; bila tidak sesuai dengan keadaan maka ini menunjukkan adanya gangguan jiwa; jika lebih keras lagi dinamakan elasiâ dan jika keras sekali dinamakan exaltasiâ.

d) Anhedonia
Ketidakmampuan merasakan kesenangan, tidak timbul perasaan senang dengan aktivitas yang biasanya menyenangkan baginya.

e) Kesepian
Merasa dirinya ditinggalkan.

f) Kedangkalan
Kemiskinan afek dan emosi secara umum (berkurang, secara kwantitatif); dapat digambarkan juga sebagai datar, tumpul, atau dingin yang sama maksudnya; istilah-istilah ini tidak menunjukkan gradasi. Umpamanya kedangkalan emosi ialah tidak atau hanya sedikit merasa / kelihatan gembira atau sedih dalam keadaan atau mengenai sesuatu hal yang benar-benar menggembirakan atau menyedihkan.


g) Afek atau emosi tak wajar
Tak wajar atau tak patut dalam situasi tertentu (terganggu secara kwalitatif), umpamanya ketawa terkikih-kikih waktu wawancara. Bila extrim akan menjadi inadequate, yaitu afek dan emosi yang bertentangan dengan keadaan atau isi pikiran dan dengan isi bicara.

h) Afek atau emosi labil
Berubah-ubah secara cepat tanpa pengawasan yang baik, umpamanya tiba-tiba marah-marah atau menangis.

i) Variasi afek atau emosi sepanjang hari
Perubahan afek dan emosi mulai sejak pagi sampai malam hari. Umpanya, pada psikosa manik-depresi maka jenis depresinya lebih keras pada pagi hari dan menjadi lebih ringan pada sore hari.

j) Ambivalensi
Emosi dan afek yang berlawanan timbul bersama-sama terhadap seorang, suatu obyek atau suatu hal.

k) Apati
Berkurangnya afek dan emosi terhadap sesuatu atau terhadap semua hal dengan disertai rasa terpencil dan tidak peduli.

l) Amarah, kemurkaan, dan permusuhan
Sering dinyatakan dalam sifat agresi. Bila ditujukkan kepada pemecahan masalah dan dipakai sebagai pembelaan terhadap suatu serangan yang yata, maka agresi itu konstruktif sifatnya. Agresi itu menjadi: patologik bila tidak realistik, menghancurkan dirinya sendiri, tidak ditujukan kepada pemecahan masalah dan jika merupakan hasil konflik emosional yang belum dapat diselesaikan.

5)Gangguan psikomotor

Psikomotor adalah gerakan badan yang dipengaruhi oleh keadaan jiwa: jadi merupakan efek bersama yang mengenai badan dan jiwa. Gangguan psikomotorik dapat berupa:

a) kelambatan
Secara umum gerakan dan reaksi menjadi lambat.

b) Peningkatan
Aktivitas dan reaksi umum meningkat.

c) Tik (tic)
Gerakan involunter, sekejap serta berkali-kali mengenai sekelompok otot atau bagian badan yang relatif kecil.

d) Bersikap aneh
Dengan sengaja mengambil sikap atau posisi badan yang tidak wajar, yang aneh atau bizar.

e) Grimas
Mimik yang aneh dan berulang-ulang.

f) Stereotipi
Gerakan salah satu anggota badan yang berkali-kali dan tidak bertujuan.

g) Pelagakan (mannerism)
Pergerakan atau lagak yang stereotip dan teatral (seperti sedang bermain sandiwara).

h) Ekhopraxia
Langsung meniru pergerakan orang lain pada saat dilihatnya; ekholalia: langsung mengulangi atau meniru apa yang dikatakan orang lain.

i) Otomatisma perintah (command automatism)
Menuruti sebuah perintah secara otomatis tanpa memikir dulu.

j) Otomatisma
Berbuat sesuatu secara otomatis sebagai pernyataan (expresi) simbolik aktivitas tak sadar.

k) Negativisme
Menentang nasihat atau permintaan orang lain atau melakukan yang berlawanan dengan itu.

l) Kataplexia

Tonus otot menghilang dengan mendadak dan sejenak, juga timbul kelemahan umum dengan atau tanpa penurunan kesadaran, yang dapat disebabkan oleh berbagai keadaan emosi.

m) Gangguan somatomotorik pada reaksi konversi

Menggambarkan secara simbolik suatu konflik emosional dan dapat berupa:

(1) kelumpuhan

(2) pergerakan yang abnormal, umpamanya tremor, tik, kejang-kejang atau ataxia

(3) astasia-abasia: tidak dapat duduk, berdiri dan berjalan.

n) Verbigerasi
Berkali-kali mengucapkan sebuah kata yang sama.

o) Berjalan
Tidak tegap, kaku (rigid) atau lambat

p) Gangguan motorik
Yang sebenarnya bukan merupakan gangguan psikomotor, yang mungkin sekali disebabkan oleh: pemakaian obat (umpamanya: tremor, hipokinesa, diskinesa, akatisia, karena neroleptika), gangguan ortopedik atau gangguan nerologik.

q) Kompulsi
Suatu dorongan yang mendesak berkali-kali, biarpun tidak disukai, agar berbuat yang bertentangan dengan keinginannya sehari-hari atau dengan kebiasaan serta norma-norma.

r) Gagap
Berbicara dengan terhenti-henti karena spasme otot-otot untuk bicara, mulai dari berbicara sangat ragu-ragu sampai dengan berbicara explosif.

6)Gangguan proses berpikir

Proses berpikir meliputi proses pertimbangan (judgment, pemahaman (comprehension), ingatan, serta penalaran.

a) Gangguan bentuk pikiran:

Dalam kategori ini termasuk semua penyimpangan dari pemikiran rasional, logik dan terarah kepada tujuan.

(1) Dereisme
Titik berat pada tidak adanya sangkut paut terjadi antara proses mental individu dan pengalamannya yang sedang berjalan. Proses mentalnya tidak sesuai dengan atau tidak mengikuti kenyataan, logika atau pengalaman.

(2) Pikiran otistik
Menandakan bahwa penyebab distorsi arus asosiasi ialah dai dalam pasien itu sendiri dalam bentuk lamunan, fantasi, waham atau halusinasi.

(3) Bentuk pikir yang non-realistik
Bentuk piker yang sama sekali tidak berdasarkan kenyataan, umpamanya: menyelidiki sesuatu yang spektakuler/ revolusioner bila ditemui; mengambil kesimpulan yang aneh serta tidak masuk akal.


b)Gangguan arus pikir

Yaitu tentang cara dan lajunya proses asosiasi dalam pemikiran, yang timbul dalam berbagai jenis:

(1) Perseverasi
Berulang-ulang menceritakan suatu idea, pikiran atau tema secara berlebihan.

(2) Asosiasi longgar
Mengatakan hal-hal yang tidak ada hubungannya satu sama lain.

(3) Inkoherensi
Gangguan dalam bentuk bicara, sehingga satu kalimatpun sudah sukar ditangkap atau diikuti maksudnya.

(4) Kecepatan bicara
Untuk mengutarakan pikiran mungkin lambat sekali atau sangat cepat.

(5) Benturan (blocking)
Jalan pikiran tiba-tiba berhenti atau berhenti ditengah sebuah kalimat.

(6) Logorea
Banyak bicara, kata-kata dikeluarkan bertubi-tubi tanpa kontrol, mungkin koheren ataupun incoherent.

(7) Pikiran melayang (flight of ideas)
Perubahan yang mendadak lagi cepat dalam pembicaraan, sehingga suatu idea yang belum selesai diceritakan sudah disusul oleh idea yang lain.

(8) Asosiasi bunyi (lang association)
Mengucapkan perkataan yang mempunyai persamaan bunyi, umpamanya pernah didengar.

(9) Neologisme
Membentuk kata-kata baru yang tidak dipahami oleh umum.

(10) Irelevansi
Isi pikiran atau ucapan yang tidak ada hubungannya dengan pertanyaan atau dengan hal yang sedang dibicarakan.

(11) Pikiran berputar-putar
Menuju secara tidak langsung kepada idea pokok dengan menambahkan banyak hal yang remeh-remah yang menjemukan dan yang tidak relevan.

(12) Main-main dengan kata-kata
Membuat sajak secara tidak wajar.

(13) Afasi
Mungkin sensorik (tidak atau sukar mengerti bicara orang lain) atau motorik (tidak dapat atau sukar berbicara