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Abstrak :
[ABSTRAK
Gangguan depresi mayor merupakan suatu gangguan kejiwaan ditandai dengan kemurungan, ketiadaan gairah hidup, perasaan tidak berguna dan putus asa dan mengalami minimal empat dari gejala berikut yaitu perubahan berat badan dan nafsu makan, perubahan tidur dan aktivitas, tidak ada energi, rasa bersalah, masalah dalam berfikir dan membuat keputusan, berfikir berulang tentang kematian dan bunuh diri tampa riwayat episode manik, campuran atau hipomanik, sekurang-kurangnya telah dirasakan selama 2 minggu. Survei kesehatan mental dunia pada 17 negara menemukan sekitar 1 dari 20 orang dilaporkan menderita episode depresi setiap tahunnya, paling sering terjadi adalah gangguan depresi mayor. Pengobatan dengan farmakoterapi golongan antidepresan hanya menunjukkan efektifitas 60-70% disertai efek samping yang serius sehingga berbagai modalitas terapi dikembangkan, salah satunya akupunktur. Penelitian ini bertujuan untuk mengetahui efektivitas terapi kombinasi akupunktur dengan antidepresan dibandingkan kombinasi akupunktur sham dengan antidepresan terhadap perubahan skor Hamilton Rating Scale for Depression (HAM-D 17) pada penderita gangguan depresi mayor. Uji klinis acak tersamar tunggal dilakukan pada 48 pasien gangguan depresi mayor dialokasikan ke dalam kelompok kombinasi akupunktur dengan antidepresan dan kelompok kombinasi akupunktur sham dengan antidepresan. Penilaian kemajuan terapi digunakan skor HAM-D 17. Hasil penelitian menunjukkan rerata skor HAM-D 17 pada kelompok kasus sebelum terapi 22,2±3,38 dan setelah terapi ke-12 turun menjadi 7,3±2,64. Sedangkan pada kelompok kontrol rerata skor HAM-D 17 sebelum terapi 21,4±3,10 dan setelah terapi ke-12 turun menjadi 9,3±3,33. Terdapat perbedaan bermakna antara selisih rerata penurunan skor HAM-D 17 sebelum dan setelah 12 kali terapi pada kelompok kasus 14,9±2,45 dibandingan dengan kelompok kontrol 12,2±4,30 (p<0,005). Terapi kombinasi akupunktur dengan antidepresan lebih efektif mengurangi gejala gangguan depresi mayor dibandingkan kombinasi akupunktur sham dengan antidepresan.

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ABSTRACT
Major depressive disorder is a psychiatric disorder that is characterized at least four of the following symptoms, loss of weight and appetite, sleep disturbance and loss of interest of activity, low energy level, guilt, difficulty concentrating and making decisions, recurrent death or suicide, without a history of manic episodes, mixed or hypomanic. These sings and symptoms have been felt at least for 2 weeks. The mental health survey conducted in 17 countries found that about 1 in 20 people are reported to suffer from a depressive episode each year and most are major depressive disorder. The effectiveness of antidepressant medication only 60-70% with serious side effects, so that various therapeutic modalities developed, one of which is acupuncture. This study aims to determine the effectiveness of combination therapy of acupuncture with antidepressants compared to combination of sham acupuncture with antidepressants in patients with major depressive disorder and the outcome was the score Hamilton Rating Scale for Depression (HAM-D 17). Single-blind randomized clinical trial conducted in 48 patients with major depressive disorder and the patients were allocated into two groups, intervention (acupuncture with antidepressants) and control (sham acupuncture with antidepressant). The mean of HAM-D 17 score in the intervention group before treatment was 22,2±3,38 and after treatment was 7,3±2,64. The mean of HAM-D 17 score in control group before treatment was 21,4±3,10 and after treatment was 9,3±3,33. There was significant differences between intervention and control group before and after 12 times of therapy in the mean decrease of score on HAM-D 1714.9±2.45 to12.2±4.30 (p<0.005). A combination of acupuncture therapy with antidepressants is more effective in reducing the symptoms of major depressive disorder compared to sham acupuncture combination with antidepressants, Major depressive disorder is a psychiatric disorder that is characterized at least four of the following symptoms, loss of weight and appetite, sleep disturbance and loss of interest of activity, low energy level, guilt, difficulty concentrating and making decisions, recurrent death or suicide, without a history of manic episodes, mixed or hypomanic. These sings and symptoms have been felt at least for 2 weeks. The mental health survey conducted in 17 countries found that about 1 in 20 people are reported to suffer from a depressive episode each year and most are major depressive disorder. The effectiveness of antidepressant medication only 60-70% with serious side effects, so that various therapeutic modalities developed, one of which is acupuncture. This study aims to determine the effectiveness of combination therapy of acupuncture with antidepressants compared to combination of sham acupuncture with antidepressants in patients with major depressive disorder and the outcome was the score Hamilton Rating Scale for Depression (HAM-D 17). Single-blind randomized clinical trial conducted in 48 patients with major depressive disorder and the patients were allocated into two groups, intervention (acupuncture with antidepressants) and control (sham acupuncture with antidepressant). The mean of HAM-D 17 score in the intervention group before treatment was 22,2±3,38 and after treatment was 7,3±2,64. The mean of HAM-D 17 score in control group before treatment was 21,4±3,10 and after treatment was 9,3±3,33. There was significant differences between intervention and control group before and after 12 times of therapy in the mean decrease of score on HAM-D 1714.9±2.45 to12.2±4.30 (p<0.005). A combination of acupuncture therapy with antidepressants is more effective in reducing the symptoms of major depressive disorder compared to sham acupuncture combination with antidepressants]

Abstrak :
Latar Belakang Gangguan jiwa, terutama di Indonesia, memerlukan perhatian khusus karena tingginya angka pasien rawat inap dengan kondisi seperti skizofrenia, depresi, dan bipolar. Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSCM), sebagai pusat rujukan, menghadapi tingkat readmisi yang signifikan, mendorong perlunya pemahaman mendalam mengenai profil risiko pasien untuk meningkatkan manajemen dan layanan kesehatan jiwa di Indonesia. Metode Penelitian menggunakan data rekam medis pasien dewasa dengan skizofrenia, bipolar, atau depresi mayor yang mengalami readmisi dalam 30 hari setelah pulang dari perawatan di RSCM pada tahun 2022. Metode analisis deskriptif kuantitatif digunakan untuk menganalisis data sekunder tersebut menggunakan SPSS, dengan presentasi data dalam bentuk tabel dan naratif. Hasil Dari 258 pasien psikiatri, 19 (7,34%) mengalami readmisi dalam 30 hari pasca pulang. Profil risiko pasien meliputi rentang usia 19-40 tahun, mayoritas perempuan (63.2%), pendidikan tinggi (89.5%), tidak menikah (78.9%), tidak bekerja (78.9%), dan tinggal di perkotaan (100%). Mayoritas menderita skizofrenia (52.6%), tidak memiliki komorbid (73%), menggunakan BPJS (84.2%), tinggal bersama keluarga (89.5%), dan sebelumnya dirawat 1-5 kali (63.2%). Pasca pulang, sebagian tidak patuh dalam pengobatan (57.9%), memiliki upaya bunuh diri (84.2%), dan menggunakan rawat jalan psikiatri (94.7%). Kesimpulan Readmisi 30 hari pasca pulang di RSCM tahun 2022 masih tergolong tinggi jika dibandingkan data secara global, tetapi mengalami penurunan jika dibandingkan dengan data RSCM tahun 2018. Profil risiko pasien dari aspek sosiodemografi, klinis, serta pasca pulang tetap harus diperhatikan untuk dapat mengurangi angka readmisi serta meningkatkan kualitas pelayanan psikiatri di RSCM. ......Introduction Mental disorders, particularly in Indonesia, demand special attention due to the high number of inpatients with conditions like schizophrenia, depression, and bipolar disorder. Cipto Mangunkusumo National General Hospital (RSCM), as a referral center, faces significant readmission rates, underscoring the need for a deep understanding of patient risk profiles to enhance mental healthcare management and services in Indonesia. Method The study utilized secondary data from adult patients diagnosed with schizophrenia, bipolar disorder, or major depression who experienced readmission within 30 days after discharge from RSCM in 2022. Quantitative descriptive analysis through SPSS was employed to analyze the data, presented in tabular and narrative forms. Results Out of 258 psychiatric patients, 19 (7.34%) experienced readmission within 30 days post-discharge. Patient risk profiles included an age range of 19-40 years, mostly females (63.2%), higher education levels (89.5%), unmarried (78.9%), unemployed (78.9%), and residing in urban areas (100%). Majority were diagnosed with schizophrenia (52.6%), had no comorbidities (73%), utilized BPJS (84.2%), lived with family (89.5%), and had been previously hospitalized 1-5 times (63.2%). Post-discharge, some were non-adherent to treatment (57.9%), exhibited suicidal tendencies (84.2%), and utilized outpatient psychiatric care (94.7%). Conclusion Thirty-day readmission at RSCM in 2022 remains relatively high compared to global data, but has seen a decrease when compared to RSCM data in 2018. Patient risk profiles in terms of sociodemographic, clinical, and post-discharge aspects must continue to be considered to reduce readmission rates and enhance the quality of psychiatric care at RSCM.