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"Depresi merupakan penyakit yang terbanyak didapati baik pada praktik spesialis maupun umum. Gangguan psikiatrik ini dapat bersifat ringan atau penyakit yang berat. Gangguan penyakit yang berat dapat fatal, karena biasanya penderita mencoba untuk bunuh diri (suicidium). Diagnosis penyakit tidak mudah. Gangguan yang ringan, sering bermanifestasi sebagai penyakit fisik, dan gangguan emosional tersamar oleh keluhan somatiknya. Pada masa akut sering gangguan yang berat menyerupai gangguan lain seperti skizofrenia. Banyak sarjana di bidang psikiatri mencari markah biologik sebagai alat untuk membantu diagnosis depresi. Salah satu markah biologik adalah gambaran poligrafik tidur. Hasil yang positif dari laboratorium tidur sulit dipakai di klinik, karena mahal dan sangat memakan waktu, baik penilaian maupun interpretasi. Kelompok Studi Psikiatri Biologik Jakarta (KSPBJ) telah melakukan modifikasi dari teknik standar dengan teknik yang dinamakan Teknik KSPBJ. Pada teknik ini hanya merekam satu menit dari lima menit selama perekaman yang berlangsung tujuh jam. Dari penelitian kami dengan sukarelawan normal dan pasien depresi didapatkan bahwa Teknik KSPBJ mempunyai agreement yang tinggi dengan teknik standar. Lebih lanjut didapatkan bahwa dengan teknik itu, seperti juga pada teknik standar didapatkan markah biologik untuk depresi. Penderita depresi mempunyai latensi REM yang rendah, yang berbeda dengan normal (P<0,001). Selaln itu ternyata pula pada penderita depresi terjadi shifting p-REM ke 1/3 awal malam dan pada perbaikan depresi terjadi shifting ke 1/3 akhir malam. Penelltian ini konsisten dengan hipotesis adanya ketidak-seimbangan sistem kolinergik - noradrenergik pada mekanisme latency REM, dan ketidak-seimbangan noradrenergik-serotonergik pada phasic REM.

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Sleep In Depressed Patient (A Study On Sleep, REM, and Phasic REM In Depressed Patients)Up to 10 % of all patients seeing a doctor are depressed. This conclusion emerged from an enquiry conducted in 1973 by over 10.000 physicians practicing in Austria, Federal Republic of Germany, France, Italy and Switzerland. Approximately 15% of the severely depressed commit suicide, whereas the moderate and mild forms usually cause reduction in the quality of life of these patients. The diagnosis of depression is not easy. Depressive states often escape diagnosis because these patients are so overwhelmed by the impact of their physical symptoms, particularly since they can more easily accept the idea that their illness is of physical, as opposed to mental origin. By referring only to their physical complaints, and deliberately failing to disclose their slate of mind, they lead the unwary physician up the wrong diagnostic path. In most mental hospitals, or departments of psychiatry, the diagnosis of depression is also not easily made. In the acute and severe forms these condition sometimes are wrongly diagnosed as schizophrenia. Numerous scientists are presently searching for a biological marker of depression. The Ideal biological marker must be sensitive, specific, easy to identify and relatively Inexpensive In its operation. Research over the past two decades has led to the development of a standardized sleep EEG methodology, which has been proven useful for the identification of characteristic sleep abnormalities of depressed patients. Application of REM abnormalities as a biological marker has produced an accurate, reliable and objective laboratory method for a diagnostic aid in the identification of depression. Even though this is proven to be a useful tool, in clinical practice it is not presently practical as a routine screening test in depressed patients. One of the drawbacks of these methods is the limited number of and the access to standard sleep laboratories. Expenses of EEG sleep studies run high, approximately US$ 500.00 per night. The other factor is that it is time consuming to evaluate 1200 pages of EEG sleep records. In 1980 KSPBJ (Study Group for Biological Psychiatry) developed a modification of the Rechtschaffen and Dales method. The KSPBJ technique records only one minute in every five minutes. That is one minute on and four minutes off for a period of seven hours. In this dissertation a comparison was made between the KSPRJ technique and the standard technique. With 18 normal volunteers, 14 new cases of depression, and 13 medicated depressed patients, the conclusion can be made that the KSPBJ technique has a statistically high agreement with the standard technique. (Po m 0.78 - 0.82, Kappa - 0.71 - 0.75). Another result of these studies with 91 depressed patients and 50 normal volunteers is finding that depressed patients have shortened REM Latency (<60 minutes). This shortened REM Latency could be used in predicting the diagnosis of depression with a quite high level of sensitivity (73-76%), and specificity (over 90%). Yet another conclusion with this KSPBJ technique is that in depressed patients, there seem to be a shifting to the left of phasic REM (to one third of initial night), and on recovery a shifting to the right (to one third of terminal night). These findings are consistent with the hypothesis, of choilnergic - noradrenergic balance mechanism in the forming of latency REM, and the balance of noradrenergic - serotonergic mechanism in the forming of phasic REM. When comparing this technique with the standard technique, there is an 80% reduction of the cost of sleep EEG recording, and an 80% saving in time for evaluation. In conclusion, the KSPBJ technique can be considered as a biological marker for depression which is reasonably sensitive and specific, easy to identify, and in addition relatively inexpensive."

"Penelitian tentang Disability Adjusted Life Year (DALY), yang dilakukan pada tahun 1990, menemukan 7 (tujuh) masalah kesehatan yang mempunyai kontribusi paling besar terhadap kesehatan. Dalam penelitian tersebut, masalah kesehatan jiwa menempati urutan ketiga yakni sebesar 10,5 % dan seluruh masalah kesehatan (WHO, 1990). Berdasarkan laporan rumah sakit di Indonesia, ditemukan prevalensi gangguan jiwa cenderung meningkat dari 1.9 % pada tahun 1990 menjadi 2.0 % pada tahun 1995 (DepKes RI,1996). Sedangkan survei Kesehatan Mental Rumah Tangga (SRMRT) yang dilakukan pada tahun 1995 menemukan prevalensi gejala gangguan jiwa sebesar 185 orang per 1000 penduduk (Bahar,1995). Klien yang dirawat di rumah sakit jiwa mempunyai rata-rata lama hari rawat yang tinggi yaitu 54 hari (DepKes RI, 2000) dan klien yang paling lama dirawat adalah skizofrenia yaitu 64,8 hari (DepKes, 1995). Beberapa rumah sakit jiwa mempunyai rata-rata lama hari rawat yang lebih tinggi dari rata-rata nasional, antara lain, RSJP Bogor 115 hari (RSJP Bogor, 2001), RSJP Lawang 95 hari (RSJP Lawang, 2001). Survei tentang rata-rata lama hari rawat klien skizofrenia dengan perilaku kekerasan adalah 42 hari (RSJP Bogor, 2001), sedangkan Morrison (1994) dalam penelitiannya menemukan bahwa rata-rata lama hari rawat Mien perilaku kekerasan dengan diagnosis skizofrenia adalah 14 hari. Berdasarkan hasil focus group discussion dengan sekelompok perawat yang berpengalaman merawat klien perilaku kekerasan ditemukan bahwa upaya yang biasa dilakukan adalah pemberian antipsikotik sesuai program terapi medik, disertai pengontrolan eksternal berupa pembatasan gerak dan pengikatan fisik. Berdasarkan data tersebut didapatkan beberapa masalah yaitu asuhan keperawatan klien perilaku kekerasan belum optimal, lama hari rawat klien masih panjang dan jarak kekambuhan belum diteliti. Penelitian bertujuan untuk memberdayakan klien dan keluarga dalam merawat klien perilaku kekerasan melalui Pendidikan Kesehatan tentang Pencegahan Perilaku Kekerasan (PKPPK) yang diberikan oleh perawat, sehingga menghasilkan kemampuan. Klien yang mengikuti PKPPK dilatih 4 (empat) cara mencegah perilaku kekerasan yaitu cara fisik, cara sosial, cara spiritual dan patuh makan obat. Kemampuan klien melaksanakan keempat cara pencegahan dibagi tiga yaitu mandiri, bantuan dan tergantung. Kemudian dilakukan analisis pengaruh kemampuan yang dimiliki klien terhadap kejadian perilaku kekerasan, lama hari rawat dan jarak kekambuhan. Metode penelitian yang digunakan adalah kuasi eksperimen, dalam bentuk rancangan sari ganda (multiple time series design). Penelitian dilakukan di RSJP Bogor dengan 152 klien dibagi dalam 2 kelompok yaitu 75 orang kelompok eksperimen dan 77 orang kelompok non eksperimen. Intervensi PKPPK diberikan pada klien kelompok intervensi dan keluarganya sesuai pedoman yang telah ditetapkan sampai klien pulang dari rumah sakit. Kemampuan klien diobservasi setiap hari sampai klien pulang dari rumah sakit. Selama 120 hari setelah pulang dilakukan evaluasi kekambuhan setiap bulan melalui surat, telepon, dan daftar klien yang dirawat kembali di rumah sakit jiwa. Hasil penelitian menunjukkan klien pria dua kali lipat lebih banyak dari klien wanita; usia paling banyak 30 tahun ke bawah; paling banyak anak pertama; Sebagian besar berpendidikan menengah dan rendah; tidak bekerja dan tidak kawin. Sebagian besar klien dirawat pertama kali, dan paling banyak dengan diagnosis skizofrenia paranoid. Anggota keluarga yang paling banyak bertanggung jawab adalah orangtua dan saudara kandung. Klien yang mengikuti PKPPK, 86.6% mempunyai kemampuan mandiri dalam mencegah perilaku kekerasan dan klien yang lain mempunyai kemampuan bantuan. Klien yang tidak mengikuti PKPPK, semuanya hanya mempunyai kemampuan tergantung dalam menengah perilaku kekerasan. Kejadian perilaku kekerasan berkurang secara bermakna pada kedua kelompok, namun tidak ada perbedaan yang bermakna antara kelompok yang mengikuti PKPPK clan yang tidak mengikuti PKPPK. Dari analisis bivariat dan multi variat tidak ditemukan variabel yang berpengaruh terhadap kejadian perilaku kekerasan. Klien yang mengikuti PKPPK mempunyai lama hari rawat 23 hari dan yang tidak mengikuti PKPPK 40 hari. Lama hari rawat klien yang mengikuti PKPPK lebih pendek secara bermakna dari pada klien yang tidak mengikuti PKPPK. Dan analisis regresi linier ditemukan model yang fit, dan variabel yang berpengaruh secara bermakna memperpendek lama hari rawat adalah kemampuan mandiri dalam pencegahan perilaku kekerasan, jenis kelamin pria, usia 30 tahun ke bawah, perawatan pertama dan kedua, dan anggota keluarga yang merawat mempunyai latar belakang pendidikan menengah atau tinggi. Klien yang mengikuti PKPPK sebanyak 13.39% (10 orang) kambuh dengan rata-rata jarak kekambuhan 92 hari setelah pulang dari rumah sakit jiwa. Klien yang tidak mengikuti PKPPK sebanyak 20.8% (16 orang) kambuh dengan rata-rata jarak kekambuhan 44 hari setelah pulang dari rumah sakit jiwa. Dari analisis regresi Cox ditemukan model yang fit, dan variabel yang berpengaruh secara bermakna memperpanjang jarak kekambuhan adalah kernampuan mandiri dalam pencegahan perilaku kekerasan, usia 30 tahun ke bawah dan mempunyai diagnosis skizofrenia paranoid. Hasil penelitian membuktikan bahwa kemampuan mandiri dalam pencegahan perilaku kekerasan yang diperoleh klien yang mengikuti PKPPK berpengaruh secara bermakna dalam memperpendek lama hari rawat dan memperpanjang jarak kekambuhan, sehingga klien dapat 65 hari lebih lama di rumah atau masyarakat. Oleh karena itu disarankan agar PKPPK digunakan sebagai pedoman dalam merawat klien skizofrenia dengan perilaku kekerasan.

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The Empowerment Of Client And Family In Caring For Schizophrenia Client With Violence Behavior In Bogor Mental HospitalResearch on Disability Adjusted Life Year (DALY), which was conducted in 1990, found 7 (seven)-health problems which contributed most to health matter. In that research, mental health problem was on the third place about 10.5% of all health problems (WHO, 1990). Based on reports from Indonesian hospitals, it was found that the prevalence of mental disturbance tend to increase from 1.9% in the year 1990 to 2.0% in the year 1995 (DepKes RI, 1996). Meanwhile, survey on the Mental Health of Household conducted in 1995 found the prevalence of mental disturbance symptoms in 185 out of 1000 people (Bahar, 1995). Clients who were hospitalized in mental hospital have an average length of stays (AvLOS) 54 days (DepKes RI, 2000) and the longest time is for schizophrenia, 64.8 days (DepKes, 1995). Some mental hospitals have higher AvLOS compare to national AvLOS, such as in Bogor Mental Hospital 115 days (RSJP Bogor, 2001), Lawang Mental Hospital 95 days (RSJP Lawang, 2001). Survey on the AvLOS for schizophrenia client with violent behavior found 42 days (RSJP Bogor, 2001), while Morrison (1994) in his research found that the AvLOS for client with violent behavior diagnosed with schizophrenia was 14 days.

Based on the result of focus group discussion with a group of nurses experienced in caring for client with violent behavior, it was found that the common effort was to administer anti-psychotic based on doctor's therapy, along with external control in the form of seclusion and physical restraint. Based on that data, several problems were derived such as: nursing care for client with violent behavior is not optimum yet, client's length of staying is longer and there has been no research on the time of relapse.

This research is intended to empower client and family in caring for client with violent behavior through the health education in preventing violent (HEPV) given by nurses, in order to result in the client's ability to prevent violent behavior. An analysis will then be conducted to find out the effect of clients ability to the occurrence of violent behavior, length of staying and time of relapse.

The method of research is quasi experiment, in the form of multiple time series design. Clients who followed HEPVare trained in 4 (four) ways to prevent violent behavior, namely: physical, social, spiritual and compliant medication. Clients' ability to perform those four preventive ways of violent behavior is divided into three kinds, which are independent, with help, and dependent. The research was conducted in Bogor Mental Hospital with 152 clients divided into two groups, 75 clients in the experimental group and 77 clients in the non-experimental group. HEPV intervention is given to clients in the experimental group and their families according to established HEPV until the clients are discharge from the hospital. The clients' capability is observed daily. For 120 days after their discharge from hospital, evaluation on relapse occurrence is conducted through letters, telephone and list of clients admitted to the mental hospital.

The result of the research showed that the number of male clients is twice as many as the number of female clients, the most common age is 30 and below, first born is also among the most number, most of them have medium and low level of education, most are being admitted for the first time, and the most common diagnosis is schizophrenia paranoid. The family members who are commonly responsible for caring of the client are parents and siblings.

Among the clients who followed HEPV, 86.6 % have the independent capability in preventing their violent behavior and the rest of the percentage has the capability with help. All clients who did not follow HEPV only have dependent capability in preventing their violent behavior. The occurrence of violent behavior decreases significantly in both groups, but there is no significant difference between the groups that follow HEPV and the group that did not follow HEPV. From bivariat and multi variat analysis, it was unable to find the variable that affects the occurrence of violent behavior.

Clients who follow HEPV have 23 days length of staying and clients who did not follow HEPV have 40 days length of staying. The length of staying from clients who follow HEPV is significantly shorter than that of clients who did not follow HEPV. From linear regression analysis was found a fit model, and the variable which have significant effect in reducing the length of staying are the independent capability in preventing violent behavior, male gender age of 30 and below, first and second admission, and the family members responsible for caring have a medium or high level of educational background.

Among the clients who follow HEPV, 13.39 % (10 clients) relapsed with an average relapse time of 92 days upon return from the mental hospital. Among clients who did not follow HEPV, 20.8 % (16 clients) relapsed with an average relapse time of 44 days upon return from the mental hospital. From Cox regression analysis was found a fit model, and the variable which have significant effect in increasing the relapse time are the independent capability in preventing violent behavior, age of 30 and below, and diagnosed with schizophrenia paranoid.

The result of this research has proven that independent capability in preventing violent behavior that the clients received from following HEPV has a meaningful effect in reducing the length of staying and prolong relapse time. Client can stay at home as well as in the community 65 days longer. Therefore, it is advisable that HEPV be used as guidance in caring for schizophrenia clients with violent behavior."