Somnambulisme

BAGIAN PSIKIATRI

LAPORAN KASUS

FAKULTAS KEDOKTERAN

APRIL 2014

UNIVERSITAS MUSLIM INDONESIA

Kasus :Gangguan Campuran Anxietas dan Depresi F41.2 Refarat : Gangguan Tidur Somnambuisme

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DIBAWAKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIK  BAGIAN PSIKIATRI FAKULTAS FAKULTAS KEDOKTERAN KEDO KTERAN UNIVERSITAS UNIVERSITAS MUSLIM MUS LIM INDONESIA MAKASSAR  2014

A / ,#0DA$%"%A0 Tidur didefinii!"n e#"$"i u"%u !e"d""n #"&"' "d"r di("n" )r"n$ %ere#u% d"*"% di#"n$un!"n den$"n *e(#eri"n r"n$"n$"n en)ri! "%"u den$"n r"n$"n$"n +"inn,"- Tidur '"ru di#ed"!"n den$"n !)(". ,"n$ (eru*"!"n !e"d""n #"&"' "d"r di("n" )r"n$ %ere#u% %id"! d"*"% di#"n$un!"n- Tidur  "d"+"' !e"d""n )r$"ni(e ,"n$ %er"%ur. #eru+"n$. d"n (ud"' di#"+i!!"n ,"n$ di%"nd"i )+e' re+"%if %id"! #er$er"! d"n *enin$!"%"n #e"r %er'"d"* "(#"n$ re*)n %er'"d"* %i(u+i e!%ern"+ re+"%if d"ri !e"d""n %er/"$"- M)ni%)rin$ !e%"% *"d" %idur  "d"+"' u"%u #"$i"n *en%in$ d"ri *r"!%e! !+ini. !"ren" $"n$$u"n %idur erin$ !"+i (eru*"!"n $e/"+" "&"+ d"ri *en,"!i% (en%"+ ,"n$ (en$"n"(- Be#er"*" $"n$$u"n (en%"+ "d"+"' dier%"i den$"n *eru#"'"n !"r"!%eri%i! d"+"( fii)+)$i %idur-13 Tidur di*en$"ru'i )+e' f"!%)r in%ern"+ d"n e!%ern"+

5

1- Fator interna ,"n$ di("!ud diini "d"+"' ir"(" #i)+)$i %u#u'. di("n" d"+"( *eri)de 24 /"(. )r"n$ de&"" %idur e!"+i. !"d"n$ du" !"+i2- Fator esterna  di*en$"ru'i )+e' i!+u %er"n$ $e+"*. ru%ini%" '"ri"n.  *eri)de ("!"n. d"n *en,e+"r" e!%ern"+ +"inn,"- F"!%)r6f"!%)r ini+"' ,"n$ ,"n$ (e(#en%u! i!+u 24 /"(Tidur %erdiri d"ri 2 !e"d""n fii)+)$i. %idur den$"n $er"!"n ("%" %id"!  e*"% NREM  Non Rapid Eye Movement) d"n %idur den$"n $er"!"n ("%" e*"% REM  Rapid Eye Movement). Tidur NREM %erdiri d"ri %"diu( 1 "(*"i %"diu(

4- Tidur REM "d"+"' u"%u /eni %idur ,"n$ #er#ed" e"r" !u"+i%"%if ,"n$ di%"nd"i )+e' %in$!"% "!%i7i%" )%"! d"n fii)+)$i ,"n$ "n$"% "!%if ,"n$ (iri* den$"n !e"d""n %er/"$"-!ir"6!ir" e%e+"' )ne% &"!%u 30 (eni%. %idur NREM #eru#"' (en/"di %idur REM- 1 Pr)*)ri %idur NREM ,"n$ %erd"+"( %"diu( 8 d"n 4 !"d"n$6!"d"n$ dier%"i den$"n !"r"!%eri%i! %er#"n$un ,"n$ %id"! +"9i(- :i!" )r"n$ di#"n$un!"n e%en$"' "(*"i "%u /"( e%e+"' )ne% %idur #i""n," d"+"( %idur $e+)(#"n$ +"(#"% (ere!" %erdi)rien%"i. d"n *i!ir"n (ere!" %erdi)r$"ni"i- Ter#"n$un in$!"% d"ri d"ri %idur $e+)(#"n$ +"(#"% /u$" dier%"i den$"n "(nei" %er'"d"*  *eri%i&" ,"n$ %er/"di e+"(" %er/"$"- Di)r$"ni"i e+"(" %er#"n$un d"ri %"diu( 8 "%"u %"diu( 4 (un$!in (en,e#"#!"n (""+"' %ern%u. e*er%i enurei. )(n"(#u+i(e

d"n (i(*i (en"!u%!"n

"%"u ni$'%

%err)r

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4-

Ke(un$!in"n iri ,"n$ *"+in$ (e(#ed"!"n %idur REM "d"+"' (i(*i- Or"n$ ,"n$ %er/"$" e+"(" %idur REM ein$!"+i ;0630 *eren (e+"*)r!"n #"'&" %e+"'  #er(i(*i- Mi(*i d"+"( %idur REM #i""n," "#%r"! d"n ure"+i- Mi(*i /u$" %er/"di e+"(" %idur NREM. %e%"*i #i""n," /erni' d"n den$"n ("!ud %er%en%u- 1 G"n$$u"n %idur d"*"% di#"$i (en/"di 4 !e+)(*)! #e"r (enuru%  Sleep  Disoreders Classification Committee, 1997) ,"i%u 2 1- G"n$$u"n ("u! %idur d"n (e(*er%"'"n %idur ,"n$ die#u% in)(ni"2- G"n$$u"n ,"n$ #er'u#un$"n den$"n %idur<(en$"n%u! ,"n$ #er+e#i'"n. ,"n$ die#u% 'e*er)(ni"8- Difun$i ,"n$ #er'u#un$"n den$"n !)ndii %idur. %"diu( %idur "%"u !e"d""n /"$" ,"n$ #eru#"' if"%. ,"n$ die#u% *"r")(ni"Mi"+n," %idur #er/"+"n SOMNAMBULISME. n$e+indur d"n +"in6+"in-

4- G"n$$u"n ri%(e %idur /"$"G"n$$u"n %idur /u$" d"*"% *u+" di#"$i (en/"di 2. Di)(ni" d"n P"r")(ni"- 8 Di)(ni" "d"+"' $"n$$u"n %idur ,"n$ $"n$$u"n u%"("n," *"d"  /u(+"'n,"- =)n%)' i()(ni" d"n 'i*er)(ni"- In)(ni" (e(i+i!i $"(#"r"n u%"(" !e+u'"n u+i% ("u! %idur "%"u !eu+i%"n (e(*er%"'"n!"n %idur d"+"( !urun &"!%u %er%en%u. e'in$$" (eni(#u+!"n *enderi%""n ""%"u $"n$$u"n d"+"(  #er#"$"i fun$i )i"+ *e!er/""n "%"u*un fun$i6fun$i !e'idu*"n +"inn,">i*er)(ni" "d"+"' /u(+"' &"!%u %idur ,"n$ #er+e#i'"n "%"u r"" !"n%u! 'e#"%  *"d" i"n$ '"ri- Penderi%" enderun$ /"%u' %er%idur e"r" %i#"6%i#" *"d" ""%  #"n$un-8 P"r")(ni" "d"+"' u"%u !e+)(*)! !)ndii !+ini ,"n$ d""rn," #u!"n $"n$$u"n %idur #"n$un %e%"*i "d"n," fen)(en" ,"n$ %er/"di %i#"6%i#" "%"u %er/"di e+"(" "(#"n$ %idur- P"d" u(u(n," *"r")(ni" %er/"di *"d" %"diu( 8 d"n 4. e'in$$" *enderi%" u!"r (en$in$"% !e/"di"n %ere#u% - $"n$$u"n ,"n$ %er("u!   *"r")(ni" "n%"r" +"in S)(n"(#u+i(e. +ee* %err)r d"n ni$'%("re-8 D"+"( ref"r"% ini. *enu+i "!"n (e(#"'" +e#i' d"+"( %en%"n$ $"n$$u"n %idur S)(n"(#u+i(e "%"u ,"n$ erin$ die#u% den$"n %idur #er/"+"n "%"u +ee* &"+!in$A // ,#-A$ASA0

//.1. D#F/0/S/

S)(n"(#u+i(e "d"+"' *eru#"'"n u"%u !e"d""n *eru#"'"n !e"d"r"n. ,"n$ di("n" *eru#"'"n fen)(en" %idur d"n #"n$un %er/"di *"d" ""% #er"(""nPPDG:- II. 1338- S)(n"(#u+i(e "%"u %idur #er/"+"n %erdiri d"ri uru%"n *eri+"!u !)(*+e! ,"n$ di(u+"i d"+"( e*er%i$" #"$i"n *er%"(" ("+"( '"ri e+"(" %idur  n)n6REM d"+"( %"diu( 8 d"n 4 d"n erin$ !"+i. &"+"u*un %id"! e+"+u. di+"n/u%!"n %"n*" !e""d"r"n *enu' "%"u in$"%"n %en%"n$ e*i)de %ere#u% !e(udi"n !e(udi"n den$"n (enin$$"+!"n %e(*"% %idur d"n #er/"+"n #er!e+i+in$ ?  !e+i+in$-1.8 Ber/"+"n %idur enderun$ un%u! %er/"di e&"!%u %idur NREM %id"! +"(" %e+"' %idur- P"ien dudu! d"n erin$!"+i (e+"!u!"n %ind"!"n ()%)ri! ,"n$ %e+"' di!en"+. e*er%i #er/"+"n. #er*"!"i"n. *er$i !e !"("r ("ndi. #er#i"r". #er%eri"!. d"n #"'!"n (en$e(udi!"n !end"r""n- Peri+"!u !"d"n$6!"d"n$ #er"!'ir d"+"( !e"d""n %er/"$" den$"n !)nfui e+"(" #e#er"*" (eni%. +e#i' erin$. )r"n$ !e(#"+i %idur d"n %id"! (e(i+i!i in$"%"n %er'"d"* *eri%i&" %idur #er/"+"n- >"+ ini d"*"% #er(u+" *"d" !"n"!6!"n"! d"n d"*"% #er+"n$un$ %eru "(*"i de&"" er%" d"*"% di"n$$"* n)r("+ e#"$"i ("nife%"i !e!ur"n$("%"n$"n uun"n "r"f   *u"%-1.@ Se#er"*"

eriu!"'  sleepwalin!"

B"$i

e#"$i"n

)r"n$.

e*i)de

+ee*&"+!in$ %er/"di !ur"n$ d"ri e!"+i *er #u+"n d"n %id"! (en$"!i#"%!"n !eru$i"n #"$i *"ien "%"u )r"n$ +"in- L"inn," *en$"+"("n e*i)de +e#i' d"ri e!"+i *er #u+"n. %e%"*i %id"! e%i"* ("+"(. d"n %id"! (en$"!i#"%!"n !eru$i"n

 #"$i *"ien "%"u )r"n$ +"in- D"+"( #en%u! ,"n$ *"+in$ *"r"'. e*i)de %er/"di '"(*ir e%i"* ("+"( "%"u #er'u#un$"n den$"n eder" fii!- :i!" #er/"+"n "(#i+ %idur i%u !e+u"r ru("'. "%"u erin$ (en$"+"(i e*i)de d"n eder" ,"n$ %er/"di- 10 An"! (un$!in (er"" ("+u. r"" #er"+"'. !ee(""n d"n !e#in$un$"n !e%i!" (ere!" di#eri%"'u %en%"n$ *eri+"!u +ee*&"+!in$ (ere!"- >"+ ini *en%in$ un%u! (en"n$"ni *er"""n "n"! %en%"n$ +ee*&"+!in$ den$"n '"%i6'"%i- 10 //.2. #,/D#-/!"!G/

Tidur #er/"+"n #i""n," di(u+"i "n%"r" ui" 4 d"n @ %"'un- Pre7"+eni  *un"! "d"+"' *"d" !ir"6!ir" ui" 12 %"'un- G"n$$u"n ini +e#i' erin$ *"d" "n"!  +"!i6+"!i d"ri*"d" *ere(*u"n- S+ee*&"+!in$ #i" (e(i+i!i !eenderun$"n $ene%i!  110

Pr7"+eni "n%"r" 10 6 80 "n"!6"n"! %e+"' (e(i+i!i e%id"!n," "%u e*i)de %idur #er/"+"n "%"u Sleep #alin! . %"*i *re7"+eni d"ri %idur #er/"+"n "%"u  sleep walin!   +e#i' rend"'. e!i%"r 1 6 - L"*)r"n ur7e, e*ide(i)+)$i d"ri  *re7"+eni e*i)de %idur #er/"+"n "%"u  sleep walin!  #u!"n er"n$"n  sleep walin!  (en/"di 1.0 6 5.0 !e%i!" de&""- D"n did"*"%!"n *u+" d"ri refereni +"in (en$"%"!"n L"*)r"n (edi (enun/u!!"n #"'&" e!i%"r 1@ d"ri *)*u+"i ren%"n %er'"d"* %idur "(#i+ #er/"+"n- >"+ ini +e#i' erin$ %er/"di *"d" "n"!6"n"!  d"ri*"d" *"d" re("/" d"n )r"n$ de&""- An"! +"!i6+"!i +e#i' (un$!in un%u!   #er/"+"n d"+"( %idur di#"ndin$!"n "n"! *ere(*u"n- Pre7e+"ne %er%in$$i +ee*&"+!in$ "d"+"' 1;.5 *"d" ui" 11 "(*"i 12 %"'un  410 //.9. #T/!"!G/

Menuru% A!r),d G-2005- Ad" e(*"% f"!%)r ,"n$ d"*"% (en/"di  *en,e#"#. ,"i%u

•

Gene%i!" S)(n"(#u+i(e +e#i' erin$ %er/"di *"d" !e(#"r ()n)9i$)% d"n e*u+u' !"+i +e#i' erin$ did"*"%!"n /i!" u"%u fir%6de$ree re+"%i7e (e(i+i!i ri&","% )(n"(#u+i(eDi+"*)r!"n *u+" "d"n," *enin$!"%"n fre!ueni "+e+ DCB14 d"n - Gen6 $en DCB1 /u$" %er+i#"% di d"+"(n," n"r)+e*, d"n $"n$$u"n +"in d"ri  *en$end"+i"n ()%)ri! e+"(" %idur. (i"+n," $"n$$u"n *eri+"!u R"*id

•

•

E,e M)7e(en% REM Be'"7i)r Di)rderLin$!un$"n Be#er"*" !)ndii ,"n$ (eru*"!"n *en,e#"# )(n"(#u+i(e "n%"r" +"in 1- Kur"n$n," %idur  2- :"d&"+ %idur ,"n$ %id"! %er"%uri*n)%i!<ed"%i7e- An%ide*re"n (i"+ $%propion, paro&etine, amitriptylined- Neur)+e*%i! (i"+ lit'i%m, re$o&etine e-  Minor tran(%iliers. f- S%i(u+"n$- An%i#i)%i! (i"+ fl%oro(%inolone'- Medi!"i "n%i6*"r!in)n (i"+ levodopa i- An%i!)n7u+"n (i"+ topiramate  /- An%i'i%"(inFii)+)$i P"n/"n$ d"n !ed"+"("n SWS Slow #ave Sleep. ,"n$ +e#i' #e"r *"d" !"n"!6!"n"! "&"+  yo%n! c'ildren. (eru*"!"n f"!%)r ,"n$ (enin$!"%!"n fre!ueni *"r")(ni" *"d" "n"!6"n"!Ke'"(i+"n d"n (en%ru"i (enin$!"%!"n fre!ueni *"ien den$"n

•

 *"r")(ni"- "+"' "%un," "d"+"' )(n"(#u+i(eBer'u#un$"n den$"n !)ndii (edi

" #def$'i-

Ari%(i"='r)ni *"r),("+ 'e(ir"ni"Mi$r"ineFe7erG"%r)e)*'"$e"+ ref+uN)%ur"+ "%'(" N)%ur"+ ei9ure O#%ru%i7e +e* "*ne" G"n$$u"n *i!i"%ri. e*er%i *)%%r"u("%i %re di)rder. *"ni

 /-

"%%"! d"n di)i"%i7e %"%e>i*er%ir)idi(e

//.4. G#6A"A K"/0/S

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Kri%eri" di"$n)%i! un%u! $"n$$u"n %idur #er/"+"n "%"u  sleepwalin! (enuru% DSM6IV  Dia!nostic and Statistical Man%al *f Mental Disorder +o%rt' Edition  "d"+"' e#"$"i #eri!u%4

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