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Abstrak :
Risiko perilaku kekerasan adalah gejala umum yang dirasakan klien dengan skizofrenia berupa reaksi emosional dan agresif untuk mencederai diri sendiri, orang lain, maupun lingkungan di sekitarnya. Klien dengan skizofrenia dapat mencederai atau bahkan menimbulkan kematian, pada akhirnya menyebabkan stigma negatif pada individu dengan skizofrenia. Tujuan penulisan ini untuk melihat penerapan teknik relaksasi napas dalam dengan musik religi bagi klien skizofrenia dengan masalah keperawatan risiko perilaku kekerasan. Analisis dilakukan pada pengelolaan klien di Ruang Arimbi Rumah Sakit Jiwa dr. H. Marzoeki Mahdi Bogor yang dilanjutkan dengan pengelolaan klien secara daring. Klien diberikan intervensi teknik relaksasi napas dalam dengan musik religi selama 6 kali interaksi. Intervensi ini mendukung kemampuan klien mengontrol perilaku kekerasan dengan spiritual. Klien merasa tenang dan mudah fokus saat diberikan musik religi ketika relaksasi napas dalam. Penerapan intervensi generalis teknik relaksasi napas dalam dengan musik religi menunjukkan penurunan tanda dan gejala risiko perilaku kekerasan pada klien skizofrenia. Hal ini ditandai dengan penurunan komponen penilaian tanda dan gejala selama diberikannya tindakan keperawatan Penurunan ditandai dengan berkurangnya 6 tanda gejala pada intervensi kedua. Pada intervensi ketiga, berkurang 10 tanda dan gejala. Pada intervensi keempat berkurang 9 tanda gejala sehingga hanya tersisa 1 tanda gejala yang bertahan sampai hari intervensi keenam. Klien juga mengalami peningkatan kemampuan mengontrol risiko perilaku kekerasan. Klien memiliki 12 dari 13 kemampuan mengontrol risiko perilaku kekerasan setelah diberikan asuhan keperawatan yang sebelum diberikan asuhan klien memiliki 5 kemampuan. Hasil gambaran ini diharapkan dapat menjadi acuan penerapan tindakan keperawatan ners pada klien skizofrenia dengan risiko perilaku kekerasan. ......The risk of violent behavior is a common symptom felt by clients with schizophrenia in the form of emotional and aggressive reactions to injure themselves, others, and the environment around them. Clients with schizophrenia can injure or even cause death, ultimately causing a negative stigma on individuals with schizophrenia. The purpose of this paper is to see the application of deep breathing relaxation techniques with religious music for schizophrenic clients with nursing problems at risk of violent behavior. The analysis was carried out on the management of clients in the Arimbi Room of the Mental Hospital, dr. H. Marzoeki Mahdi Bogor, followed by online client management. The client was given the intervention of deep breathing relaxation techniques with religious music for 6 interactions. This intervention supports the client's ability to control violent behavior spiritually. Clients feel calm and easy to focus when given religious music when deep breathing relaxation. Application of generalist intervention with deep breathing relaxation techniques with religious music showed a decrease in signs and symptoms of risk of violent behavior in schizophrenic clients. This is indicated by a decrease in the components of the assessment of signs and symptoms during the nursing action. The decrease is marked by a reduction in 6 signs of symptoms in the second intervention. At the third intervention, 10 signs and symptoms were reduced. In the fourth intervention, 9 signs of symptoms were reduced so that only 1 symptom remained until the sixth intervention day. Clients also experience an increased ability to control the risk of violent behavior. Clients have 12 out of 13 abilities to control the risk of violent behavior after being given nursing care which before being given client care has 5 abilities. The results of this description are expected to be a reference for implementing nursing actions for schizophrenic clients with the risk of violent behavior.

Abstrak :
Latar Belakang: Skizofrenia merupakan gangguan jiwa yang berpotensi berlangsung dalam jangka waktu yang panjang dengan prognosis yang tidak terlalu baik, sehingga diperlukan tata laksana yang tepat guna memperbaiki keluaran pada pasien-pasien dengan Skizofrenia. Penelitian ini berupaya untuk mencermati pola peresepan dan alasan perubahan terapi pasien-pasien dengan Skizofrenia di Indonesia khususnya di Poli Jiwa Dewasa RSCM dengan merujuk pada Konsensus Penatalaksanaan Gangguan Skizofrenia 2011. Metodologi: Penelitian ini merupakan penelitian deskriptif dengan desain kohort retrospektif yang dilakukan dengan cara mengumpulkan data mengenai pola peresepan sejak awal pasien tersebut mendapatkan terapi farmakologi hingga waktu kunjungan yang ditentukan serta alasan perubahan terapi farmakologi bila terjadi perubahan terapi. Penelitian ini menggunakan data rekam medik pasienpasien dengan Skizofrenia di Poli Jiwa Dewasa RSCM yang melakukan kunjungan pada bulan Juli 2013 hingga jumlah sampel terpenuhi. Hasil: Pada 53 (65,4%) rekam medik digunakan antipsikotik monoterapi pada awal terapi. Untuk pengobatan awal, 79 (97,5%) pasien mendapatkan jenis obat yang rasional dan 75 (92,6%) pasien mendapatkan dosis obat yang rasional. Pada pasien yang awalnya mendapatkan monoterapi, sebanyak 14 (43,8%) pasien kemudian mengalami switching ke antipsikotik lain dan sebanyak 18 (56,3%) pasien kemudian mendapatkan antipsikotik kombinasi. Pada pasien yang awalnya mendapatkan terapi antipsikotik kombinasi, sebanyak 7 (26,9%) pasien kemudian mengalami switching, 4 (15,4%) pasien mendapatkan penambahan jenis obat, 1 (3,8%) pasien mengalami pengurangan jenis obat dan 14 (53,8%) pasien mendapatkan antipsikotik monoterapi. Alasan perubahan terapi terbanyak sulit dianalisis karena sebanyak 441 dari 780 (56.5%) perubahan terapi tidak tercantum alasannya. Simpulan: Penggunaan kombinasi antipsikotik pada awal pengobatan pasien dengan Skizofrenia masih didapatkan di Poli Jiwa Dewasa walaupun tidak direkomendasikan oleh panduan tata laksana yang ada. Ketidaklengkapan pencatatan rekam medik menjadikan analisis rasionalitas terapi dan alasan perubahan terapi sulit dilakukan. ...... Background: Schizophrenia is a mental disorder that could potentially progress to a long term disorder with a not very good prognosis, so it requires an adequate treatment in order to improve the outcome. This study aims to examine the prescribing pattern and the reason of therapy changing of patients with Schizophrenia in Indonesia especially in Poli Jiwa Dewasa RSCM regarding the Konsensus Penatalaksanaan Gangguan Skizofrenia 2011. Methodology: This study is a descriptive study with retrospective cohort design that conducted by collecting data on prescribing pattern since the beginning of patients pharmacological treatment until the determined time of visit and the reason of therapy changing. This study uses the medical record data of patients with Schizophrenia in Poli Jiwa Dewasa RSCM who visited in July 2013 until the number of samples provided. Result: In the beginning of Schizophrenia treatment, monotherapy was used in 53 (65,4%) medical records. For the initial treatment, 79 (97,5%) patients received the rational drug and 75 (92,6%) patients received the rational drug dosage. In patients who received monotherapy as initial treatment, 14 (43,8%) patients underwent switching to another antipsychotic and 18 (56,3%) patients received antipsychotic combination. In patients who received antipsychotic combination as initial treatment, 7 (26,9%) patients underwent switching to another antipsychotic, 4 (15,4%) patients received added number of antipsychotic,1 (3,8%) patient received reduced number of antipsychotic and 14 (53,8%) patients received monotherapy. The analysis of reason of therapy changing was difficult to conduct since there was no reason of therapy changing written in 441 of 780 (56.5%) antipsychotic treatment changing. Conclusion: Antipsychotic combination as initial treatment in patient with Schizophrenia is still found in Poli Jiwa Dewasa eventhough the use of antipsychotic combination is not recommended by the available guidelines. Incomplete documentation in medical record makes the treatment rationality analysis difficult.

Abstrak :
ABSTRAK
Ketidakpatuhan terhadap pengobatan merupakan salah satu hambatan dalam penanganan terhadap individu dengan skizofrenia. Ketidakpatuhan ini dapat meningkatkan resiko akan kekambuhan sebesar 3,7 kali lebih besar. Tilikan terhadap kondisinya dan sikap terhadap pengobatan merupakan dua variabel yang konsisten ditemukan berpengaruh terhadap kepatuhan pada individu dengan skizofrenia. Studi literatur menunjukkan terapi kepatuhan merupakan salah satu intervensi berlandaskan motivational interviewing dan pendekatan kognitif yang efektif dalam meningkatkan sikap dan tilikan pada individu dengan simptom psikotik. Oleh sebab itu, peneliti bermaksud untuk meneliti mengenai efektivitas terapi kepatuhan dalam meningkatkan tilikan dan sikap terhadap pengobatan pada individu dengan skizofrenia tahap stabil. Penelitian ini menggunakan pendekatan field experiment dengan pretest-posttest experimental design. Dua belas partisipan pria dipilih sesuai dengan karakteristik subjek dan dibagi ke dalam dua kelompok secara acak. Kelompok eksperimen diberikan terapi kepatuhan dan kelompok kontrol diberikan konseling non spesifik. Setiap individu mendapat kesempatan terapi sebanyak 5 sesi yang berlangsung selama 30-60 menit setiap sesi. Birchwood Insight Scale dan Hogan Drug Attitude Inventory (DAI-30) digunakan untuk mengukur tilikan dan sikap partisipan, sebelum dan sesudah intervensi. Enam partisipan yang menerima terapi kepatuhan menunjukkan peningkatan sikap yang lebih positif terhadap pengobatan. Tilikan terhadap kondisi mereka pada partisipan di kelompok eksperimen juga menunjukkan peningkatan yang signifikan. Uji beda mann whitney-u yang dilakukan menunjukkan perbedaan yang signifikan pada sikap terhadap pengobatan antara kelompok eksperimen dan kelompok kontrol (u= 3.5, p=0.019, ). Perbedaan yang signfikan ini juga ditemukan pada variabel tilikan (u=4.0, p=0.22, ). Dari hasil penelitian, dapat disimpulkan bahwa terapi kepatuhan dapat meningkatkan tilikan dan sikap terhadap pengobatan pada individu dengan skizofrenia.

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ABSTRACT
Nonadherence with the antipsychotic medication regimen is a common barrier to the effective treatment for schizophrenia. Nonadherence patients have an average risk of 3.7 times greater than adherent patients. Insight and Attitude toward medication has been consistently associated with compliance. Literature has shown that compliance therapy, a brief intervention based on motivational interviewing and cognitive approach, can lead to improved attitude toward medication and insight. Objective: this study aimed to examine effectiveness of compliance therapy to improve insight and attitude toward medication on schizophrenic inpatients in Indonesia. Methods: A field experiment approach with pretestposttest experimental design was used. Twelve male schizophrenic inpatient in the same ward who were in stable phase, were divided into two groups: experimental and control. The patients in the experimental group received compliance therapy, whereas those in control group received non-specific counseling. Each treatment consists of 5 sessions lasting 30-60 minutes. Drug Attitude Inventory (DAI-30) was used to measure the patient?s attitude toward medication. Birchwood Insight Scale was used to assess the patient?s insight. The measurement is conducted twice, before and after intervention. Mann-whitney u test is used to compare the differences between two groups. Main Findings: The result revealed that the patients in the experimental group reported a significantly more positive attitude toward medication (u=3.5, p=0.019, ) and better insight (u=4.0, p=0.022, ) than those in the control group. Conclusion: Compliance therapy can improve attitude toward medication and insight on schizophrenic inpatient.

Abstrak :
Penderita skizofrenia yang tidak patuh pada pengobatan akan memiliki risiko kekambuhan yang lebih tinggi. Menurut hasil Riskesdas 2018, penderita skizofrenia yang meminum obat secara rutin hanya sebesar 48,9%. Salah satu penyebab penderita skizofrenia tidak rutin meminum obat adalah tidak berobat rutin. Di Provinsi DKI Jakarta angka penderita skizofrenia tertinggi terdapat pada Kota Administrasi Jakarta Timur. Tujuan dari penelitian ini untuk mengetahui perbedaan kepatuhan berobat pasien skizofrenia di Puskesmas berdasarkan karakteristik pasien dan pendamping berobat. Penelitian ini menggunakan pendekatan cross sectional dan menggunakan data sekunder dari Laporan Penemuan dan Pemantauan Orang Dengan Gangguan Jiwa (ODGJ) berat. Sampel dalam penelitian ini adalah 474 pasien skizofrenia yang berobat selama 1 tahun atau lebih di Puskesmas wilayah kerja Kota Adminstrasi Jakarta Timur tahun 2018 dan memiliki data lengkap. Hasil dari penelitian ini adalah pasien skizofrenia yang patuh berobat sebanyak 303 responden (63,9%), usia ≤40 tahun (62,7%), jenis kelamin laki-laki (62,4%), tingkat pendidikan tinggi (59,9%), status pekerjaan pasien skizofrenia yang tidak bekerja (82,5%), lama sakit ≤ 10 tahun (74,9%), pasien skizofrenia yang memiliki pendamping untuk berobat (58,6%). Menurut hasil bivariat bahwa tidak ada perbedaan kepatuhan berobat berdasarkan usia (PR=1,046; CI=0,907-1,205), jenis kelamin (PR=1,061; CI=0,925-1,216), tingkat pendidikan (PR=1,006; CI=0,876-1,155), status pekerjaan (PR=1,139; CI=0,973-1,333), dan lama sakit (PR=0,919; CI=0,793-1.064) secara statistik dan ada perbedaan kepatuhan berobat berdasarkan pendamping berobat (PR=0,854; CI=0,748-0,976). Oleh karena itu, penyebab dari ketidak patuhan berobat pada pasien skizofrenia penting diketahui sebagai upaya peningkatan pengobatan secara rutin.

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Schizophrenic patients don't adherence to treatment will have a higher risk of recurrence. According to the results of Riskesdas 2018, Schizophrenic patients who take medication regularly are only 48.9%. One of the causes of schizophrenia who don't take medication regularly is inadherence to treatment. In DKI Jakarta Province the highest number of schizophrenic patients is in East Jakarta Administrative City. The purpose of this study was to determine the differences in adherence to treatment of schizophrenic patients at the helath centers based on the characteristics of patients and companion for treatment . This study uses a cross sectional approach and uses secondary data from the Report on the Discovery and Monitoring of People with severe Mental Disorders (ODGJ). The sample in this study were 474 schizophrenic patients who were treated for 1 year or more at the Public Health Center in the East Jakarta City working area in 2018 and had complete data. The results of this study were 303 patients (63.9%), age ≤40 years (62.7%), male sex (62.4%), high education level (59.9 %), occupational status of schizophrenic patients who did not work (82.5%), duration of illness ≤ 10 years (74.9%), schizophrenic patients who had a companion for treatment (58.6%). According to bivariate results that there was no difference in adherence to treatment based on age (PR = 1.046; CI = 0.907-1.205), gender (PR = 1.061; CI = 0.925-1.216), level of education (PR = 1.006; CI = 0.876-1.155) , employment status (PR = 1,139; CI = 0,9731,333), and duration of illness (PR = 0,919; CI = 0,793-1,064) statistically and there were differences in adherence to treatment based on companion for treatment (PR = 0,854; CI = 0,748-0,976) . Therefore, the cause of inadherence to treatment in schizophrenic patients is important to know so that to improve treatment routinely.

Abstrak :
Penelitian ini membahas dinamika caregiver dalam memilih pengobatan untuk perawatan skizofrenia. Perilaku pengambilan keputusan yang dilakukan caregiver adalah proses dimana mereka merespon penyakit dan mencoba untuk mencari pengobatan yang tepat dan efektif untuk perawatan anggota keluarga yang mengalami skizofrenia. Peneliti mencoba memetakan faktor-faktor apa yang mempengaruhi caregiver dan bagaimana dinamika caregiver dalam merawat dan memilih jenis pengobatan untuk penderita skizofrenia. Studi sebelumnya menyebutkan informasi dan pengalaman percobaan pengobatan, kepercayaan dan kebudayaan, serta tingkat keparahan penyakit mempengaruhi keputusan pengobatan dipilih caregiver. Berdasarkan temuan data peneliti menemukan bahwa kepercayaan akan mitos, persepsi caregiver tentang penyakit, konflik, dan kefektifan pengobatan menjadi hal yang mempengaruhi dinamika caregiver dalam memilih jenis pengobatan. Argumentasi penulis adalah perbedaan keputusan caregiver dalam memilih jenis pengobatan mengalami dinamika dipengaruhi oleh respon terhadap kefektifan pengobatan yang telah dipilih, mitos dan kepercayaan, serta bagaimana caregiver mendefinisikan skizofrenia `penyakit`. Metode yang digunakan dalam penelitian ini kualitatif dengan teknik wawancara mendalam dan observasi untuk mempelajari fenomena dan latar belakang dari perilaku pemilihan jenis pengobatan.  This study discusses the dynamics of caregiver in selecting treatment for treatment of schizophrenia. The behavior of decision making made caregiver is the process by which they respond to ` illness and try to find the appropriate and effective treatment for the care of family members who experience schizophrenia. Researchers are trying to map out what factors affect caregiver and how the dynamics caregiver in treating and choosing the type of treatment for schizophrenia patients. Previous studies mentioning information and experience of experimental treatment, belief and culture, as well as the severity of the disease affects the decision of treatment chosen caregiver. Based on the findings of data researchers found that the belief in myth, perception of caregiver about disease, conflict, and effectiveness of treatment becomes the case that affects the dynamics of caregiver in choosing a type of treatment. The author`s argument is the difference Caregiver decision in choosing the type of treatment experienced the dynamics influenced by the response to the treatment`s effectiveness of selected treatments, myths and beliefs, as well as how caregiver defines Schizophrenia `disease`. The method used in this research is qualitative with in-depth interview techniques and observations to study the phenomenon and background of the behaviour of selection of treatment types

Abstrak :
The riveting story of an American family with twelve children, six of whom were diagnosed with schizophrenia, that became science's great hope in the quest to conquer an elusive disease. Don and Mimi Galvin seemed to be living in the American dream. After World War II, Don's work with the Air Force brought them to Colorado, where their twelve children perfectly spanned the baby boom. There was a script for a family like the Galvins - hard work, upward mobility, domestic harmony - and they all tried to play their parts. But behind the closed doors of the house on Hidden Valley Road was a far different reality: psychological breakdown, sudden shocking violence, and hidden abuse. By the mid-1970s, six of the ten Galvin boys, one after the other, were diagnosed with schizophrenia. And the other six children stood by, horrified, with no way of knowing whether they would be next. What took place on Hidden Valley Road was so extraordinary that the Galvins became one of the first families to be studied by the National Institute of Mental Health. In a tour de force of narrative nonfiction, award-winning journalist Robert Kolker, author of the bestselling Lost Girls, tells the intimate story of the Galvins alongside the epic tale of science's quest to uncover the true nature of a mystifying disease. Each mentally ill brother emerges as wholly individual, with remarkably different expression of the same disorder. The two youngest Galvins, the only girls, are indelible characters: best friends, both victimized by their brothers, who make sharply different choices about how to cope. The Galvins' story crests in a breakthrough that, thanks to their unique DNA, offers hope of eliminating schizophrenia forever. Hidden Valley Road is a captivating medical mystery and a heartbreaking drama. But above all, it is an unforgettable lesson in what it means to be a family

Abstrak :
Latar Belakang: Salah satu strategi dalam pengelolaan kasus skizofrenia yaitu dengan meningkatkan aliansi terapeutik antara terapis dan pasien. Terjalinnya aliansi terapeutik yang baik diketahui dapat memperbaiki gejala maupun fungsi pasien skizofrenia. Namun ternyata kepatuhan minum obat masih menjadi masalah dalam pengelolaan pasien Skizorenia. Tujuan penelitian ini adalah untuk mengetahui apakah terdapat hubungan antara aliansi terapeutik dengan kepatuhan minum obat pada pasien skizofrenia. Metode: Penelitian potong lintang pada 32 pasien skizofrenia dengan luaran kuesioner Working Alliance Inventory (WAI) versi bahasa Indonesia dan Medication Adherence Rating Scale (MARS) versi bahasa Indonesia di Poliklinik Jiwa Dewasa RS Cipto Mangunkusumo, Jakarta. Analisis bivariat yang digunakan yaitu spearman test. Hasil: Rerata usia ialah 35,97 tahun, laki-laki (65,6%), tingkat pendidikan terbesar SMA (59,4%), dan status pekerjaan terbesar yaitu bekerja (62,5%). Persentase jenis psikoterapi terbesar yaitu psikoterapi suportif (68,75%). Skor WAI total dengan rerata 192,8 ± 32,9, skor WAI T 85,6 ±17.25, dan skor WAI C 114,06 ± 21,40 yang berarti aliansi terapeutik telah terjalin baik. Skor MARS median 9,00 (6,00 - 10,00), subskala perilaku terhadap pengobatan median 4,00 (1,00-4,00), subskala sikap terhadap pengobatan 3 (2,00-4,00) dan subskala efek samping obat 2,00 (0,00-2,00) yang menunjukkan kepatuhan minum obat baik. Hasil uji statistik didapatkan ada hubungan yang kuat dan signifikan antara aliansi terapeutik dengan kepatuhan minum obat (r= 0,558, p=0,001). Simpulan: Terdapat hubungan positif antara aliansi terapeutik dengan kepatuhan minum obat. ......Background: One strategy in the management of schizophrenia cases is to make the therapeutic alliance between the therapist and patient. A good therapeutic alliance is known to improve symptoms and function of schizophrenic patients. However, it turns out that medication adherence is still a problem in the management of schizophrenia patients. The purpose of this study is to determine whether there is a relationship between therapeutic alliances and medication adherence in schizophrenic patients. Methods: A cross sectional study was done on 32 schizophrenic patients at Cipto Mangunkusumo Hospital Jakarta, with the Indonesian version of Working Alliance Inventory (WAI) and Medication Adherence Rating Scale (MARS) as the outcome. Bivariate analysis Spearman test were employed to assess the relationship between therapeutic alliance and medication adherence. Results: The patients enrolled have the mean age of 35.97 years, male (65.6%), the highest education level is high school (59.4%), and the highest occupational status is working (62.5%). The largest percentage of types of psychotherapy is supportive psychotherapy (68.75%). The mean total WAI score was 192.8 ± 32.9, the mean WAI T score was 85.6 ± 17.25, and the mean WAI C score was 114.06 ± 21.40 which means the therapeutic alliance has been well established. The median MARS score was 9.00 (6.00-10.00), the median medication adherence behavior 4.00 (1.00-4.00), attitude to treatment subscale 3 (2.00-4.00) and subscale drug side effects 2.00 (0.00-2.00) which indicates good medication adherence. The results of statistical tests showed that there was a strong and significant relationship between therapeutic alliances and medication adherence (r = 0.558, p = 0.001). Conclusion: There is a positive relationship between therapeutic alliance and medication adherence.

Abstrak :
This volume tries to put current therapy - achievements, shortcomings, remaining medical needs - and emerging new targets into the context of increasing knowledge regarding the genetic and neurodevelopmental contributions to the pathophysiology of schizophrenia. Some of the chapters also deal with respective experimental and clinical methodology, biomarkers, and translational aspects of drug development. The volume concentrates on reviewing the ongoing research attempting to identify novel treatments for the cognitive deficits and negative symptoms of schizophrenia, which are not treated adequately by current antipsychotic medications.