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"Latar Belakang: Sebagian besar gangguan psikosis muncul pada masa remaja akhir dan dewasa muda awal, sehingga berdampak pada biaya yang besar, beban (burden), morbiditas dan mortalitas. DUP (duration of untreated psychotic) yang panjang berhubungan dengan keparahan gejala, respons yang lambat terhadap pengobatan, peningkatan kekambuhan dan penurunan kualitas hidup. Hal ini masih belum diteliti di Indonesia, padahal dengan DUP yang pendek, deteksi dini dan pengobatan akan memperbaiki outcome pada psikosis episode pertama.Tujuan: untuk mengetahui lama mencari pertolongan medis psikiatrik (DUP) pasien psikosis episode pertama. Selain itu, melihat faktor-faktor yang berhubungan dengan DUP dan tahapan pencarian pertolongan kesehatan jiwa.Metoda: Penelitian ini mengunakan metode disain penelitian deskriptif potong lintang dengan sampel sebanyak 50 orang. Pengambilan sampel secara konsekutif. Instrumen yang digunakan adalah SCID-1V, PANSS,SUMD, IRAOS, Instrumen jalur menuju perawatan, PAS, PSST, GAF, Stigma Scale dan DAS. Analisis Statistik menggunakan program SPSS versi 11.50Hasil: DUP adalah 32,53 minggu (SD 47,265) dan median 14 minggu. Dari analisis bivariat dan multivariat didapatkan hubungan bermakna antara DUP dengan variabel onset (p=0,009), gejala negatif(p=0,005), fungsi premorbid(p=0,016)dan fungsi posmorbid (p=0,10). Pada tahapan pencarian pertolongan pasien psikotik episode pertama didapatkan: hanya 10% yang langsung ke pelayanan kesehatan jiwa, jenis pertolongan pertama 38% pengobatan tradisional & 30% konsultasi dengan pemuka agama. Alasan ke pelayanan kesehatan jiwa adalah perilaku aneh (70%), menganggu lingkungan (32%) dan perilaku agresif subyek (26%). Halangan ke yankeswa : perasaan negatif terhadap yankeswa (62%) dan stigma 46% .Simpulan: Berdasarkan penelitian didapatkan lama mencari pengobatan medis psikiatris pasien psikotik episode pertama adalah 14 minggu (median). Didapatkan hubungan bermakna antara DUP dengan onset penyakit, jenis gejala, fungsi premorbid dan fungsi postmorbid. Kurangnya pengetahuan mengenai gangguan jiwa di masyarakat. Peran pengobatan tradisional dan pemuka agama yang cukup prominen dalam penanganan pertama pasien psikotik episodik pertama. Terdapatnya citra negatif terhadap pelayanan kesehatan jiwa dimasyarakat.

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Background : Most of psychotic disorder is found in late adolescence or early adult life, thus related to bigger cost, burden, morbidity and mortality. Longer DUP is related to severity of symptoms, increasing recurrence and decreasing quality of life. So far no research on DUP has been conducted in Indonesia, although shorter DUP combined with early detection and treatment will improve outcome in first episode psychosis.

Purpose : To find the average DUP in first episode psychosis, its related factors and pathways in seeking mental health service.

Methods : This was a descriptive cross sectional study with 50 respondents, using consecutive sampling method. Instruments used in this study were SCID If , PANSS, SUMD, IRAOS, Health Seeking Action Pathway Instrument, PAS, PSST, GAF, Stigma Scale and DAS Statistical analysis was performed using SPSS version 11.50

Result : Average DUP were 32,53 weeks (SD 47,265) with median 14 weeks. Bivariate & multivariate analysis found significant association between DUP and onset (p=0.009), negative symptoms (p=0.005), premorbid function (p=0.016), and post morbid function (p=0.10). First intervention was traditional treatment (38%) and counseling with religious figures (30%), and only 10% went directly to mental health service. The main reason was strange behavior (70%), social environment disturbance (32%) and aggressive behavior (26%). Negative feeling (62%) and stigma (46%) were the reason of avoiding mental health service.

Contusion : DUP of first episode psychosis are 14 weeks (median). There were significant association between DUP and onset of the disease, type of symptoms, premorbid and post morbid function. There was lack of understanding about mental illness, while traditional approach and counseling to religious figures played prominent role in the intervention of first episode psychosis. There are negative perceptions in mental health service in the society."

"Permintaan layanan psikiatri forensik di Indonesia terus meningkat. Namun, psikiater di Indonesia merasa kurang kompeten dan kurang percaya diri dalam melakukan analisis psikomedikolegal dan melaporkan hasil pemeriksaannya, karena ketiadaan pedoman dan metode pendidikan yang belum seragam. Penelitian ini terdiri atas tiga tahap yang bertujuan untuk mengidentifikasi komponen Kemampuan Berpikir Analisis Psikomedikolegal (KBAP) dan mengembangkan modul pengajaran yang sahih dan mampu laksana. Penelitian menggunakan desain exploratory sequential mixed method. Pada tahap 1, dilakukan penelusuran kepustakaan dan penilaian kebutuhan dari pemangku kepentingan untuk mengidentifikasi komponen KBAP, dilanjutkan dengan teknik delphi melibatkan pakar psikiatri, hukum, dan bidang lain yang relevan. Hasilnya diadaptasi menjadi instrumen penilaian KBAP beserta panduan penilaiannya. Pada tahap 2, dilakukan studi potong lintang terhadap psikiater Indonesia untuk mengetahui skor KBAP dan faktor-faktor yang memengaruhinya. Pada tahap 3, dilakukan pengembangan dan uji coba Modul KBAP. Penelitian tahap 1 menghasilkan 60 butir KBAP yang dibagi empat tahap: persiapan, pemeriksaan, penulisan laporan, serta persiapan dan pemberian keterangan di pengadilan. Instrumen penilaian, berupa rubrik yang dilengkapi panduan pengisian, memiliki validitas isi dan reliabilitas antarpenilai yang baik. Median skor KBAP dari 165 subjek sebesar 37 (rentang nilai 5 sampai 89). Tidak didapatkan faktor yang berhubungan dengan skor KBAP. Modul KBAP yang dikembangkan pada tahap 3, berdasarkan temuan dari tahap 1 dan 2, berlangsung secara daring selama 6 minggu, terdiri atas kegiatan pembelajaran dan evaluasi yang dilakukan secara asinkronus dan sinkronus. Modul KBAP secara keseluruhan dinilai mampu laksana dan sahih. Selain itu, peserta menunjukkan hasil yang baik dalam evaluasi hasil pembelajaran modul. Secara keseluruhan, penelitian ini dirancang untuk dapat menjawab kebutuhan dalam peningkatan keterampilan psikiatri forensik Indonesia dengan memberikan pedoman konkret dan modul pengajaran yang berpotensi untuk dikembangkan lebih lanjut baik dalam aspek pendidikan, penelitian, maupun pelayanan.

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Requests for forensic psychiatry assessments have consistently increased. However, Indonesian psychiatrists still view themselves as incompetent, and thus, unconfident in conducting psychomedicolegal analysis and reporting the results, which may stem from a lack of concrete guidelines and uniform teaching methods throughout the country. Furthermore, psychomedicolegal analysis as a form of clinical reasoning can be influenced by cognitive and emotional factors. Thus, this study aims to identify components of psychomedicolegal analysis competency and to develop its educational module. This study used an exploratory sequential mixed method design. In Part 1 of the study, literature review and needs analysis from stakeholders were conducted to identify components of psychomedicolegal analysis, which were then refined through Delphi technique involving experts from psychiatry, law, and other relevant fields. The components are adapted into a scoring instrument and its user manual. In Part 2, a cross-sectional study was conducted among Indonesian psychiatrists to estimate the level of psychomedicolegal analysis of competence and related factors. In Part 3, a module for psychomedicolegal analysis was developed and tested. Part 1 of this study resulted in 60 items of psychomedicolegal analysis competency, divided into 4 domains: preparation, assessment, report writing, and giving expert testimony. The scoring instrument was designed as a rubric and complemented by a manual containing item explanations and operational definitions. The instrument has acceptable content validity and inter-rater reliability. In Part 2, a sample of 165 psychiatrists had a median psychomedicolegal analysis score of 37 (range 5 to 89). No factors are significantly associated with it. In Part 3, the psychomedicolegal analysis module, formulated from the findings of Part 1 and 2, was conducted as an online course for 6 weeks, consisting of asynchronous and synchronous activities. The module was considered feasible and valid. Also the participants showed good results in evaluation of the module. Overall, the psychomedicolegal analysis scoring instrument and the resulting module were able to answer the need for skill development in Indonesian forensic psychiatry by providing concrete guidelines and teaching methods that have the potential to be further developed as educational innovation, research, and services."