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"[ABSTRAKGangguan bipolar dikenal memiliki kaitan dengan berbagai komorbiditasklinis yang memengaruhi pekerjaan, kehidupan berkeluarga, dan fungsiinterpersonal. Duapertiga pasien dengan gangguan bipolar memiliki komorbidyang akan memperburuk luaran gangguan bipolar dan dapat menganggupenatalaksanaan terhadap penyakitnya. Belum ada penelitian yangmenggambarkan frekuensi komorbiditas fisik yang terjadi pada penderita bipolardi Indonesia. Rumah Sakit Dr. H. Marzoeki Mahdi sebagai rumah sakit jiwa tertuadi Indonesia juga belum memiliki data mengenai jenis dan frekuensi komorbidfisik, mengingat bahwa rumah sakit ini juga menangani rawat inap umum disamping rawat inap psikiatriMetode:Penelitian menggunakan rancangan potong lintang pada 100 orang denganGangguan Bipolar di Poliklinik Jiwa Dewasa dan Bangsal Psikiatri R.S. Dr. H.Marzoeki Mahdi Bogor. Penelitian ini menggunakan instrument StructuredClinical Interview For the DSM-IV Axis I Disorders untuk menentukan GangguanBipolar, dan kriteria diagnostik sepuluh komorbid fisik yang mengacu padakriteria diagnostik masing-masing komorbid fisik.Hasil:Pada penelitian ini didapatkan adanya hubungan bermakna antara umurdengan terjadinya komorbid fisik yaitu p= 0.001(p di bawah 0.005). Pada analisistambahan didapatkan adanya hubungan bermakna antara pemberian obatpolifarmasi/monoterapi dengan terjadinya komobid fisik terbanyak yaknihipertensi (nilai p= 0,0001). Pada sepuluh komorbid fisik yang dinilai, migrain,hipertensi dan dermatitis merupakan yang paling banyak.SimpulanHipertensi, migrain dan dermatitis merupakan tiga besar komorbid fisik diR.S. Dr. H. Marzoeki Mahdi Bogor. Terdapat hubungan bermakna antara umurdengan terjadinya komorbid fisik. Pemberian obat polifarmasi/monoterapi jugabermakna dalam terjadinya hipertensi. Diperlukan kewaspadaan psikiater dalammengawasi terjadinya komorbid fisik pada gangguan bipolar di layanan psikiatri.

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ABSTRACTBipolar disorders are known to cause various clinical comorbidity thatmay affect work, family and interpersonal function. Two third of bipolar disorderhave comorbidities that may worsen the outcome of bipolar itself and interferewith it's therapy. There has not been sufficient study about physical comorbiditiesin bipolar in Indonesia. As the oldest psychiatric hospital in Indonesia that treatsphysical and psychiatric inpatients, Dr. H. Marzoeki Mahdi hospital still lacksdata concerning types and frequencies of physical comorbidities.Method:This research uses cross-sectional design from 100 people with bipolardisorder at Psychiatric Clinic and Psychiatric Ward at Dr. H. Marzoeki MahdiBogor Hospital. This research also uses the Structured Clinical Interview For theDSM-IV Axis I Disorders to ensure the bipolar diagnosis, and criteria diagnosticfor ten physical comorbidities from each of their field.Result:There is a significant relationship in this research between age andphysical comorbidities p=0.001 (p below 0,005). In the additional analysis, thereare significant relationship in this research between polypharmacy / monotherapyand hypertension (p=0,0001). Migraine, hypertension, and dermatitis were thetop three physical comorbidities in this research.Conclusion:Hypertension, migraine and dermatitis are the top three in our physicalcomorbidities in Dr. H. Marzoeki Mahdi hospital. Age has a significantrelationship with physical comorbidities. Polipharmacy and monotherapy alsohas significances in hypertension. Therefore psychiatrist must be aware about thepossibility of physical comorbidity in the psychiatric care, Bipolar disorders are known to cause various clinical comorbidity thatmay affect work, family and interpersonal function. Two third of bipolar disorderhave comorbidities that may worsen the outcome of bipolar itself and interferewith it’s therapy. There has not been sufficient study about physical comorbiditiesin bipolar in Indonesia. As the oldest psychiatric hospital in Indonesia that treatsphysical and psychiatric inpatients, Dr. H. Marzoeki Mahdi hospital still lacksdata concerning types and frequencies of physical comorbidities.Method:This research uses cross-sectional design from 100 people with bipolardisorder at Psychiatric Clinic and Psychiatric Ward at Dr. H. Marzoeki MahdiBogor Hospital. This research also uses the Structured Clinical Interview For theDSM-IV Axis I Disorders to ensure the bipolar diagnosis, and criteria diagnosticfor ten physical comorbidities from each of their field.Result:There is a significant relationship in this research between age andphysical comorbidities p=0.001 (p below 0,005). In the additional analysis, thereare significant relationship in this research between polypharmacy / monotherapyand hypertension (p=0,0001). Migraine, hypertension, and dermatitis were thetop three physical comorbidities in this research.Conclusion:Hypertension, migraine and dermatitis are the top three in our physicalcomorbidities in Dr. H. Marzoeki Mahdi hospital. Age has a significantrelationship with physical comorbidities. Polipharmacy and monotherapy alsohas significances in hypertension. Therefore psychiatrist must be aware about thepossibility of physical comorbidity in the psychiatric care]"

"Latar Belakang Orang dengan Gangguan Jiwa (ODGJ) berat seperti skizofrenia dan skizoafektif sering berada pada rentang usia produktif. Gangguan jiwa tersebut dapat berdampak pada tingginya beban biaya dan munculnya disabilitas, yang dapat lebih besar bila dibandingkan dengan beban biaya dan disabilitas yang disebabkan oleh keganasan dan Human Immunodeficiency Virus. Hal tersebut mendorong peneliti dan klinisi berupaya untuk dapat mengukur disabilitas pada ODGJ secara objektif agar dapat mengelola kasus secara lebih spesifik, termasuk dalam penentuan kebijakan secara luas. UCSD Performance-Based Skills Assesment (UPSA) II merupakan instrumen yang digunakan untuk mengukur disabilitas fungsional pada ODGJ berdasarkan performa. Penelitian ini bertujuan mendapatkan instrumen UPSA II versi Bahasa Indonesia yang sahih dan andal untuk menilai disabilitas fungsional pada ODGJ di Indonesia.Metode Desain pada penelitian ini adalah uji kesahihan isi dan keandalan konsitensi internal instrumen, dengan populasi target pasien skizofrenia dan skizoafektif berusia 18-59 tahun yang mengalami remisi.Hasil Pada uji kesahihan isi didapatkan nilai I-CVI 1,0 dan S-CVI 1,0 untuk semua ranah. Pada uji keandalan didapatkan nilai koefisien Cronbach’s Alpha 0,707 untuk skor total, dan kisaran 0,628-0,852 pada setiap subskala. Pada subjek penelitian dengan remisi parsial didapatkan nilai Cronbach’s Alpha 0,686 sedangkan pada subjek penelitian dengan remisi total didapatkan nilai Cronbach’s Alpha 0,755. Hasil nilai cronbach alpha yang didapat berbeda dengan penelitian yang dilakukan di Spanyol (α=0.9), Portugal (α=0.8) dan Brazil (α=0.8), dan hal tersebut dapat disebabkan status remisi dan tingkat pendidikan yang berbeda dengan subyek pada penelitian ini. Pada Uji T tingkat pendidikan rendah-menengah memiliki rerata yang lebih rendah (67.03 ±22.66) dibandingkan tingkat pendidikan tinggi (78.74 ±19.93), t(98)=-2.268, p=0.026.Kesimpulan Instrumen UPSA II versi Bahasa Indonesia merupakan alat yang sahih dan andal untuk mengukur disabilitas fungsional pada ODGJ.

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Introduction People with severe mental disorders such as schizophrenia and schizoaffective are often in the productive age range. Mental disorders can have an impact on the high cost burden and the emergence of disability, which can be greater when compared to the burden of costs disabilities caused by malignancy and the Human Immunodeficiency Virus. This encourages researchers and clinicians to strive to be able to objectively measure disability in ODGJ in order to manage cases more specifically, including in broad policy decisions. UCSD Performance-Based Skills Assessment (UPSA) II is an instrument used to measure functional disability in severe mental disorder patient based on performance. This study aims to obtain a valid and reliable Indonesian version of the UPSA II instrument to assess functional disability in people with severe mental disorder in Indonesia.Method The design in this study was to test the content validity and the instrument's internal consistency reliability, with a target population of schizophrenic and schizoaffective patients aged 18-59 years who had remission.Results Content validity test obtained I-CVI 1.0 and S-CVI 1.0 for all domains. In the reliability test, the Cronbach's Alpha coefficient value is 0.707 for the total score, and the range is 0.628-0.852 on each subscale. In subjects with partial remission Cronbach's Alpha values were 0.686 while subjects with total remission Cronbachs Alpha values were 0.755. The results of the Cronbach alpha values obtained differ from studies conducted in Spain (α = 0.9), Portugal (α = 0.8) and Brazil (α = 0.8), and this can be due to remission status and different educational levels with subjects in this study . In the T-Test the low-secondary education level has a lower mean (67.03 ±22.66) than the level of higher education (78.74 ± 19.93), t (98) = - 2.268, p = 0.026.Conclusion The Indonesian version of the UPSA II instrument is a valid and reliable tool for measuring functional disability in ODGJ."

"ABSTRAKLatar Belakang. Efavirenz adalah salah satu obat antiretroviral lini pertama dalam tatalaksana infeksi HIV. Namun, penelitian dari beberapa negara menunjukkan sekitar 50% pengguna efavirenz mengalami efek samping psikiatrik, seperti gangguan tidur, mimpi buruk, insomnia, cemas, depresi sampai gangguan kognitif. Penelitian ini bertujuan untuk mengetahui prevalensi psikopatologi pada ODHA yang mendapatkan terapi efavirenz, serta faktor yang berhubungan, seperti faktor demografik, mekanisme koping, dan stigma.Metode. Studi potong lintang ini menggunakan kuesioner yang diberikan pada pasien HIV di UPT HIV RSUPN Cipto Mangunkusumo yang menggunakan efavirenz. Psikopatologi diukur menggunakan SCL-90, mekanisme koping dengan Brief COPE, dan stigma dengan Berger HIV Stigma Scale. Selain itu, faktor demografik seperti usia, jeniskelamin, riwayat gangguan jiwa, riwayat penggunaan narkotika, dan stadium HIV.Hasil. Prevalensi psikopatologi pada pasien HIV yang diterapi dengan EFV sebesar 50 dari 112 subjek penelitian (44,6 %). Gejala psikopatologi terbanyak yang didapatkan adalah depresi 25.0% diikuti oleh gejala obsesif kompulsif 17.9%. Faktor yang menunjukkan hubungan signifikan dengan adanya psikopatologi adalah usia (p=0,01), stigma (p=0,01), dan riwayat penggunaan alkohol/zat psikoaktif lainnya (p=0,02).Kesimpulan. Depresi merupakan psikopatologi yang paling banyak didapatkan pada penelitian ini. Faktor usia, stigma, dan riwayat penggunaan alkohol/zat psikoaktif lainnya mempunyai hubungan yang bermakna terhadap munculnya gejala psikopatologi pada pasien yang mendapatkan terapi EFV.

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ABSTRACTBackground. Efavirenz is one of the first-line antiretroviral drugs in the management of HIV infection. However, research from several countries shows that about 50% of efavirenz users experience psychiatric side effects, such as sleep disorders, nightmares, insomnia, anxiety, depression to cognitive disorders. This study aims to determine theprevalence of psychopathology in HIV patients who received efavirenz therapy, as well as related factors, such as demographic factors, coping mechanisms, and stigma.Method. This cross-sectional design used a questionnaire given to HIV patients at UPT HIV Cipto Mangunkusumo General Hospital who used efavirenz. Psychopathology was measured using SCL-90, coping mechanism with COPE Brief, and stigma with Berger HIV Stigma Scale. In addition, demographic factors such as age, sex, history of mentaldisorders, history of drug use, and stage of HIV.Results. The prevalence of psychopathology in HIV patients treated with EFV was 50 out of 112 study subjects (44.6%). The most common psychopathological symptom was depression 25.0% followed by obsessive compulsive symptoms 17.9%. Factors that showed a significant correlation with the prevalence of psychopathology were age (p = 0.01), stigma (p = 0.01), and history of alcohol / other psychoactive substance use (p = 0.02).Conclusion. Depression is the most commonly obtained psychopathology in this study. Age, stigma, and history of using alcohol / other psychoactive substance use have a significant significant correlation with the prevalence of psychopathological symptoms in patients receiving EFV therapy."

"Latar BelakangKetidaktaatan pengobatan pada orang dengan skizofrenia merupakan masalah di seluruh dunia dan merupakan aspek paling menantang dalam menangani pasien dengan skizofrenia. Ketaatan pengobatan merupakan faktor penting untuk memberikan luaran yang baik pada pasien dengan skizofrenia. Terdapat beberapa perbedaan hasil dari berbagai penelitian terhadap faktor yang menyebabkan ketidaktaan pengobatan, namun ketidaktaatan pengobatan tetap merupakan masalah yang konsisten dalam pengobatan skizofrenia. kasus di RSUP Nasional dr. Cipto Mangunkusumo cenderung kompleks. Sehingga penelitian ini dilakukan untuk mengetahui faktor terkait yang menyebabkan ketidaktaatan pengobatan di RSUP Nasional dr. Cipto Mangunkusumo.MetodePenelitian dilakukan secara potong lintang. Sebanyak 1440 subjek berasal dari pasien rawat jalan dengan skizofrenia di poliklinik psikiatri RS dr. Cipto Mangunkusumo. yang ditentukan dengan cluster konsekutif. Pengambilan data dilakukan dengan wawancara terstruktur menggunakan Positive and Negative Symptom of Schizophrenia (PANSS). Penilaian efek samping ekstrapiramidal mengunakan extrapyramidal symptom rating scale (ESRS). Data ketidaktaatan pengobatan diambil dengan menggunakan instrumen self-report medication adherence rating scale (MARS) data yang diperoleh kemdian dilakukan analisis dengan metode regresi logistik.HasilDitemukan proporsi ketidaktaatan pengobatan pada pasien dengan skizofrenia di RSUPN dr. Cipto Mangunkusumo sebesar 21,4%. Tilikan, fungsi kognitif, status ekonomi, keparahan gejala, gejala depresi, efektivitas pengobatan ditemukan memengaruhi ketidaktaan pengobatan. Melalui analisis multivariat hanya tilikan (p 0,003 ; OR = 5,437 ; CI95% 1,752-16,868) dan fungsi kognitif (p = 0.035 ; OR = 3,294 ; CI95% 1,089-9,967) yang menunjukkan pengaruh bermaknak terhadap ketidaktaatan pengobatan.

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Introduction

Medication non-adherence in people with schizophrenia is a worldwide problem and is the most challenging aspect of managing patients with schizophrenia. Adherence to medication is an important factor to provide a good outcome in patients with schizophrenia. There are differences in the results of various studies on the factors that lead to medication non-adherence, but medication adherence remains a consistent problem in the treatment of schizophrenia. the case at dr. Cipto Mangunkusumo General Hospital tends to be more complex. So this research was conducted to determine the related factors that led to medication non-adherence at dr. Cipto Mangunkusumo General Hospital

Methods

we conducted in a cross-sectional research. The sample size was 140 subjects from outpatients with schizophrenia in psychiatric polyclinic at dr. Cipto Mangunkusumo hospital and selected by consecutive clusters. Data were collected by structured interviews using Positive and Negative Symptoms of Schizophrenia (PANSS). Extrapyramidal side effect assessment using extrapyramidal symptom rating scale (ESRS). Medication adherence data were taken using the instrument self-report medication adherence rating scale (MARS). The data obtained were analyzed using logistic regression methods.

Results

The Proportion of medication non-adherence in patients with schizophrenia of 21.4% was found at dr. Cipto Mangunkusumo General Hospital. Insight, cognitive function, economic status, symptom severity, depressive symptoms, and effectiveness of treatment were found to be significant related to medication non-adherence. Multivariate analysis shown only insight (p 0.003; OR = 5.437; 95% CI 1.752-16.868) and cognitive function (p = 0.035; OR = 3.294; 95% CI 1.089-9.967) were found were found significant related to medication non-adherence."

"Spinal merupakan tempat metastasis tumor terbanyak, menyebabkan defisit neurologis akibat kompresi saraf spinal, berpotensi distres sehingga mengakibatkan rendahnya kualitas hidup. Kerentanan terhadap distres dipengaruhi strategi koping. Penelitian potong lintang untuk mengetahui strategi koping dan faktor terkait distres pada pasien tumor metastasis spinal di RSCM. Sebanyak 104 subjek diambil dari rawat jalan maupun rawat inap. Analisis bivariat dan multivariat menilai hubungan antara gambaran masalah, strategi koping, faktor sosiodemografi, serta karakteristik tumor spinal dengan distres. Proporsi distres subjek penelitian ini adalah 57,7% masalah terbanyak spesifik tumor spinal (87,5%), namun hubungannya tidak bermakna terhadap distres. Hubungan bermakna ditemukan pada masalah keluarga dan masalah emosional. Strategi religious-focused coping paling sering digunakan. Subjek yang mengalami distres memiliki median total skor problem-focused coping (PFC) lebih rendah, emotional-focused coping (EFC) dan avoidance coping lebih tinggi dibandingkan dengan yang tidak mengalami distres. Hubungan bermakna juga ditemukan pada faktor usia dan karakteristik tumor spinal berupa gangguan motorik, sensorik, otonom, dan status pengobatan. Gangguan sensorik berisiko lebih tinggi terjadi distres dibandingkan defisit neurologis lain. Analisis multivariat menunjukkan strategi EFC dan avoidance coping sebagai faktor risiko. Perlunya dilakukan skrining dan pendampingan psikiatri pada pasien tumor metastasis spinal, serta peningkatan kerja sama psikiatri dengan layanan tumor terpadu.

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Spinal is the most site of tumor metastases, causing neurological deficits due to spinal nerve compression, potentially causing distress resulting in low quality of life. Vulnerability to distress is influenced by coping strategies. A cross-sectional study to determine coping strategies and factors related to stress in patients with spinal metastatic tumors in RSCM. A total of 104 subjects were taken from outpatient and inpatient. Bivariate and multivariate analyzes assessed the relationship between problem description, coping strategies, sociodemographic factors, and characteristics of spinal tumors with distress. The proportion of the subject's distress in this study was 57.7%, the most problems were spinal tumor-specific (87.5%), but the relationship was not significant to distress. Significant relationships were found in family problems and emotional problems. Religious-focused coping strategies are most often used. Subjects who experienced distress had a lower median total score of problem-focused coping (PFC), emotional-focused coping (EFC) and higher avoidance coping than those who did not experience distress. A significant relationship was also found in the age factor and spinal tumor characteristics in the form of motor, sensory, autonomic disorders, and treatment status. Sensory disturbances are at a higher risk of developing distress than other neurologic deficits. Multivariate analysis showed EFC strategy and avoidance coping as risk factors. The need for screening and psychiatric assistance in spinal metastatic tumor patients, as well as increasing the cooperation of psychiatry with integrated tumor services"

"Latar Belakang: Penduduk lanjut usia (lansia) terus mengalami peningkatan seiring kemajuan di bidang kesehatan yang ditandai dengan meningkatnya angka harapan hidup, menurunnya angka kematian dan jumlah orang dengan demensia (ODD) yang juga cenderung bertambah. Masalah kesehatan jiwa ini kurang teridentifikasi oleh para tenaga kesehatan dan lansia itu sendiri. Oleh karena itu penting dilakukan identifikasi dan penilaian kebutuhan yang tidak terpenuhi (unmet needs) bagi para lansia dengan demensia khususnya demensia ringan hingga sedang. Kebutuhan yang tidak terpenuhi (unmet needs) yang sudah teridentifikasi disertai dengan persepsi dan harapan para lansia akan menjadi masukan positif dalam merancang program layanan day hospital care.Metode: Penelitian ini menggunakan mixed method design. Penelitian tahap pertama adalah penelitian kuantitatif dengan menggunakan instrumen CANE (Camberwell Assessment of Need for the Elderly) untuk menilai kebutuhan yang tidak terpenuhi (unmet needs) pada lansia dengan Demensia ringan – sedang. Penelitian tahap kedua adalah penelitian kualitatif dengan menggunakan metode Delphi yang dilaksanakan dalam dua putaran dan melibatkan sembilan ahli yang berprofesi dan berkecimpung menangani lansia. Putaran pertama dengan menggunakan kuesioner berisi open-ended question yang dituangkan dari berbagai referensi menghasilkan rancangan konsep awal isi materi modul. Putaran kedua merupakan pengembangan isi materi modul dengan menggunakan kuesioner empat skala Likert. Hasil putaran kedua dianalisis dengan menilai median dan Interquartile Range (IR) untuk menghasilkan konsensus para ahli sehingga modul layanan Day Hospital Care terbentuk.Hasil: Dari penelitian tahap pertama didapatkan lima proporsi unmet needs terbesar, yaitu pertemanan (26,0%), distres psikologis (20,8%), relasi akrab (19,8%), daya ingat (16,7%), dan kegiatan harian (10,4%). Dari putaran pertama metode Delphi diperoleh masukan dari para ahli untuk pengembangan isi materi yang terdapat dalam rancangan konsep awal modul. Hasil putaran kedua dari analisis skala Likert ditemukan adanya konsensus di antara para ahli bahwa isi materi yang tercantum dalam modul telah sesuai dengan target yang ingin dicapai dalam setiap bagian (bagian awal, bagian tengah, dan bagian akhir) dalam modul.Simpulan: Pembuatan modul layanan Day Hospital Care ini melalui dua tahap penelitian yaitu penelitian kuantitatif dan penelitian kualitatif sehingga menghasilkan suatu modul yang terstruktur, yang berisikan materi yang telah sesuai dalam setiap bagian dengan target yang akan dicapai.

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Background: The number of elderly population continues to increase as the advancement in healthcare grows, which is shown by the increase of life expectancy, the declining mortality rates, and the surge of person with dementia (PwD). This mental health issue is barely identifiable by health workers and the elderly themselves. Therefore it is important to evaluate and identify the unmet need of the people with dementia, especially mild to moderate dementia. The unmet needs that have been identified along with the perceptions and expectations of the elderlies will be positive inputs in designing the Day Hospital Care Service program.

Methods: This study uses the mixed method design. The first phase is a quantitative research which utilizes CANE (Camberwell Assessment of Need for the Elderly) instrument to assess the unmet needs of the elderlies with mild to moderate dementia. The second phase is a qualitative research which utilizes the Delphi method that is done in two rounds and involves nine experts who worked with the elderlies. The first round uses a questioner with open-ended questions from various references that assembles an early concept of the module’s contents. The second round is about the development phase of the module’s contents which uses the four scale Likert questionnnaire. The outcome from the second round is analyzed by assessing the median and Interquartile Range (IR) to generate a consensus by the experts so that the Day Hospital Care service module is established.

Results: The first phase of the research procured five substantial unmet needs proportion, which are friendship (26.0%), psychological distress (20.8%), close relations (19.8%), memory dysfunction (16.7%), and daily activities (10.4%). The first round uses the Delphi method which procures insight from experts to develop the early concept of the module’s contents. The results of the second round from the Likert scale, resulting a consensus among the experts regarding the contents that is written in the module are in accordance with the targets to be achieved in each section (the beginning, the middle, and the end) of the module.

Conclusion: The production of The Day Hospital Care Service module requires a two phase research which are quantitative and qualitative research, hence producing a module that is well-structured, which contains materials that has been accurate in every section with a goal to be achieved."