Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
Latar Belakang: Skizofrenia merupakan gangguan jiwa berat yang kompleks dengan angka harapan hidup yang rendah karena penyakit kardiovaskular. Orang dengan skizofrenia rentan mengalami sindroma metabolik meskipun tidak mendapat pengobatan antipsikotika. Sebuah penelitian di RSUPN Cipto Mangunkusumo menunjukkan prevalensi sindroma metabolik sebanyak 3,3% sampai 68% yang berhubungan dengan stress oksidatif dan berpotensi menurunkan produksi ATP. Penelitian ini berusaha menjelaskan patofisiologi sindroma metabolik pada skizofrenia dan hubungannya terhadap polimorfisme gen GCLC GAG TNR, stres oksidatif dan aktivitas metabolisme seluler. Metode: Penelitian merupakan penelitian observasional analitik. Subjek sebanyak 25 pasien skizofrenia dan 25 pasien kontrol sehat dilakukan pengambilan fibroblas dan PBMC kemudian dilakukan pengamatan polimorfisme gen GCLC GAG TNR, stres oksidatif (kadar MDA, MnSOD, GSH, GSSG, dan rasio GSH/GSSG), aktivitas metabolisme seluler (kadar ATP), dan parameter sindroma metabolik (lingkar pinggang, Indeks Massa Tubuh (IMT), LDL-c, HDL-c, TG, HbA1C, dan tekanan darah). Hubungan dianalisis dengan uji komparasi atau uji korelasi. Hasil: Terdapat korelasi pada sel fibroblas dengan PBMC yaitu korelasi kuat pada MnSOD (r=0.797) dan korelasi sedang pada GSSG (r=0.581). Didapatkan perbedaan yang bermakna pada kadar stres oksidatif yaitu MDA (p=0.013), GSH (p≤0.001), GSSG (p≤0.001), dan rasio GSH/GSSG (p≤0.001) pada kelompok skizofrenia dan kontrol serta didapatkan hubungan polimorfisme gen GCLC GAG TNR terhadap MDA (p=0.054) dan GSSG (p=0.010) pada kelompok skizofrenia tetapi tidak ditemukan perbedaan kadar ATP dan hubungan antara polimorfisme GCLC GAG TNR terhadap kadar ATP. Pada orang dengan skizofrenia didapatkan lingkar pinggang, IMT, LDL-c, dan HDL-c yang lebih rendah (p=0.025;p=0.003;p=0.022;p=0.010) dan TG yang lebih tinggi (p=0.038) dibandingkan kelompok kontrol. Simpulan: Polimorfisme gen GCLC GAG TNR memiliki hubungan terhadap stres oksidatif tetapi tidak ada hubungan terhadap aktivitas metabolisme seluler. Tidak terdapat perbedaan aktivitas metabolisme seluler pada orang dengan skizofrenia dan tidak ditemukan hubungan antara metabolisme seluler dengan sindroma metabolik. Terjadi perubahan kadar penanda stres oksidatif yang memiliki hubungan terhadap sindroma metabolik pada orang dengan skizofrenia ......Background: Schizophrenia is a complex severe mental disorder with low life expectancy due to cardiovascular disease. People with schizophrenia is prone to metabolic syndrome even if they do not receive antipsychotic. One study in Cipto Mangunkusumo General Hospital showed the prevalence of metabolic syndrome as much as 3.3% to 68% which correlate with oxidative stress and has the potential to reduce ATP production. This study aims to explain the pathophysiology of the metabolic syndrome in schizophrenia and its relationship to the GCLC GAG TNR gene polymorphism, oxidative stress and metabolic activity. Methods: This research is an observational analytic study. Twenty five schizophrenic patients and 25 healthy control patients were admitted to study. Fibroblast and PBMC (peripheral blood mononuclear cell) were taken to measure GCLC GAG TNR gene polymorphism, oxidative stress (levels of MDA, MnSOD, GSH, GSSG, and GSH/GSSG ratio), cellular metabolic activity (ATP levels), and metabolic syndrome parameters (waist circumference, body mass index (BMI), LDL-c, HDL-c, TG, HbA1C, and blood pressure). Relationship between variables were analyzed by comparison test or correlation test. Results: There is a correlation in fibroblast cells with PBMC with a strong correlation in MnSOD (r=0.797) and a moderate correlation in GSSG (r=0.581). There were significant differences in the levels of oxidative stress, namely MDA (p=0.013), GSH (p≤0.001), GSSG (p≤0.001), and GSH/GSSG ratio (p≤0.001) in the schizophrenia and control groups. There was correlation found for the polymorphism of the GCLC GAG TNR gene towards MDA (p=0.054) and GSSG (p=0.010) in the schizophrenia group but found no difference in ATP levels in the schizophrenia and control groups alongside with GCLC GAG TNR polymorphism and ATP levels. In people with schizophrenia, waist circumference, BMI, LDL-c, and HDL-c were lower (p=0.025;p=0.003;p=0.022;p=0.010) and higher TG (p=0.038) than the control group. Conclusion: GCLC GAG TNR gene polymorphism has correlation to oxidative stress but not to cellular metabolic activity. There is no difference in metabolic activity in people with schizophrenia and no relationship between cellular metabolism and the metabolic syndrome. There is alteration of oxidative stress markers which have an association with metabolic syndrome in people with schizophrenia.

Abstrak :
Latar Belakang: Pemulihan kesehatan mental orang dengan gangguan spektrum skizofrenia merupakan faktor penting dalam tatalaksana. Pemulihan kesehatan mental menekankan nilai-nilai humanistik dan pengalaman subjektif, sehingga bersifat sangat individual dan dipengaruhi oleh latar belakang budaya. Salah satu instrumen yang mengukur pemulihan kesehatan mental adalah Recovery Assessment Scale – Domains and Stages (RAS-DS) yang telah divalidasi ke dalam bahasa Indonesia. Namun, pengembangan RAS-DS dilakukan di Australia sesuai dengan persepsi pemulihan kesehatan mental di Australia. Hingga saat ini, belum ada instrumen yang mengukur pemulihan kesehatan mental pada orang dengan gangguan spektrum skizofrenia yang dikembangkan sesuai dengan persepsi pemulihan kesehatan mental di Indonesia. Metode: Penelitian ini merupakan studi kualitatif untuk mendapatkan makna pemulihan kesehatan mental menurut persepsi orang dengan gangguan spektrum skizofrenia di Indonesia, mengembangkan butir-butir SPPS, dan menentukan kesahihan isi SPPS. Pengambilan data kualitatif menggunakan metode focus group discussion (FGD) bersama orang dengan gangguan spektrum skizofrenia (n = 11). Data kualitatif dianalisis menggunakan pendekatan conventional content analysis dengan tipologi thematic survey. Pembentukan butir-butir SPPS dilakukan dengan metode induktif berdasarkan hasil analisis data kualitatif. Uji kesahihan isi dihitung dengan menggunakan content validity index for items (I-CVI) dan content validity index for scales (S-CVI). Uji coba dilakukan kepada subjek (n = 10) untuk menilai durasi pengisian SPPS, tingkat kesulitan SPPS secara keseluruhan, dan butir-butir sulit dalam SPPS. Hasil: Persepsi orang dengan gangguan spektrum skizofrenia di Indonesia mengenai pemulihan kesehatan mental meliputi dimensi sosial, eksistensial, klinis, fungsional, dan fisik. Beberapa persepsi yang unik sesuai dengan situasi sosiokultural di Indonesia adalah aspek keluarga, religi dan spiritualitas, serta stigma. Butir-butir SPPS terdiri dari 40 butir pernyataan yang mencerminkan berbagai dimensi tersebut. SPPS memiliki kesahihan isi yang baik dengan rerata I-CVI sebesar 0,99 dan S-CVI sebesar 0,93. SPPS memiliki tingkat kesulitan mudah dengan rerata durasi waktu pengisian adalah 5,4 menit (rentang 3 – 10 menit). Simpulan: Pemberian layanan pada orang dengan gangguan spektrum skizofrenia perlu mempertimbangkan berbagai dimensi pemulihan kesehatan mental. SPPS dapat digunakan secara rutin sebagai alat bantu untuk mengukur dan memantau pemulihan kesehatan mental secara holistik pada orang dengan gangguan spektrum skizofrenia. ......Background: Mental health recovery of people with schizophrenia spectrum disorders is an essential factor in therapy. Mental health recovery emphasizes humanistic values and subjective experiences, so it is highly individualized and influenced by cultural background. One instrument that measures mental health recovery is the Recovery Assessment Scale – Domains and Stages (RAS-DS), validated in Indonesian. However, the development of RAS-DS in Australia is consistent with the perception of mental health recovery in Australia. To date, no instrument measures mental health recovery in people with schizophrenia spectrum disorders, which has been developed based on the perception of mental health recovery in Indonesia. Therefore, Indonesian Recovery Scale for Patients with Schizophrenia/Skala Pemulihan Pasien Skizofrenia (SPPS) is needed. Methods: This study is a qualitative study to assess the meaning of mental health recovery according to the perceptions of people with schizophrenia spectrum disorders in Indonesia, develop SPPS items, and determine the content validity of SPPS. Qualitative data was collected through focus group discussion (FGD) with people with schizophrenia spectrum disorders (n = 11). Qualitative data were analyzed using a conventional content analysis approach with thematic survey typology. The formation of SPPS items was carried out using an inductive method based on the results of qualitative data analysis. The content validity test is calculated using the content validity index for items (I-CVI) and the content validity index for scales (S-CVI). Trials were conducted on subjects (n = 10) to assess the duration of filling out the SPPS, the overall difficulty level of the SPPS, and the difficult items in the SPPS. Results: Perceptions of mental health recovery of people with schizophrenia spectrum disorders in Indonesia include social, existential, clinical, functional, and physical dimensions. Some perceptions of family, religion, spirituality, and stigma are unique to Indonesia's socio-cultural situation. The SPPS items consist of 40 statements that reflect these various dimensions. SPPS has good content validity with an average I-CVI of 0.99 and an S-CVI of 0.93. SPPS was rated easy to use, with the average duration required to complete the instrument was 5.4 minutes, with a range of 3 – 10 minutes. Conclusion: The provision of services to people with schizophrenia spectrum disorders needs to consider the various dimensions of mental health recovery. SPPS can be used routinely as a tool to measure and monitor holistically mental health recovery in people with schizophrenia spectrum disorders.