Hasil Pencarian  ::  Simpan CSV :: Kembali

"Gangguan kepribadian ambang (GKA) merupakan gangguan jiwa dengan dampak psikososial yang bermakna dan umumnya lebih sulit ditata laksana dibandingkan dengan gangguan psikiatri lainnya. Sebagian besar Peserta Program Pendidikan Spesialis Kedokteran Jiwa (PPDS-KJ) menyatakan sulit melakukan psikoterapi pada pasien GKA dan belum ada metode pengajaran psikoterapi psikodinamik yang khusus dan terstruktur untuk kasus GKA. Tujuan penelitian adalah menghasilkan Modul Pendidikan Psikoterapi Psikodinamik untuk kasus GKA (PP-GKA) beserta instrumen untuk mengevaluasi hasil pembelajaran PPDS-KJ setelah mengikuti modul pada domain pembelajaran kognitif, afektif, dan psikomotor. Penelitian dilakukan pada Januari–Desember 2023 di sembilan institusi pendidikan psikiatri di Indonesia menggunakan mixed method kualitatif dan kuantitatif dengan desain exploratory sequential, terdiri dari tahap pengembangan modul, pengembangan instrumen evaluasi, dan uji efektivitas modul. Penelitian ini juga mengadaptasi Kuesioner Kirkpatrick level 1 untuk mengevaluasi reaksi peserta terhadap modul. Pengembangan modul dan instrumen dilakukan secara saksama melalui tahapan focus group discussion, survei Delphi, diskusi panel ahli, uji validasi isi modul dan instrumen, serta uji reliabilitas instrumen dengan narasumber dari kalangan PPDS-KJ, psikiater, ahli psikoterapi, dan staf pengajar psikoterapi dari institusi pendidikan psikiatri di Indonesia. Modul yang dihasilkan bersifat valid (S-CVI/Ave = 1), berbentuk pembelajaran daring dengan durasi 12 kali pertemuan. Penelitian juga menghasilkan instrumen evaluasi hasil belajar berupa 50 butir soal pilihan ganda, rubrik penilaian formulasi psikodinamik (RP-FP), dan rubrik penilaian praktik psikoterapi psikodinamik (RP-PPGKA). RP-FP dan RP-PPGKA juga valid (S-CVI/Ave RP-FP = 0,981, RP-PPGKA = 1) dan reliabel (ICC RP-FP = 0,879, RP-PPGKA = 0,727). Uji efektivitas modul dengan pre-test post-test control group design dilakukan kepada 33 orang PPDS-KJ semester 6–7 dari sembilan institusi pendidikan PPDS-KJ di Indonesia yang direkrut berdasarkan stratified random sampling. Berdasarkan hasil analisis instrumen soal pilihan ganda, RP-FP, RP-PPGKA, dan Kuesioner Kirkpatrick level 1 versi Indonesia, Modul Pendidikan PP-GKA efektif memberikan perubahan dalam aspek kognitif, afektif, dan psikomotor serta mendapatkan reaksi yang positif dari peserta. Modul Pendidikan PP-GKA dapat diimplementasikan pada pendidikan PPDS-KJ di Indonesia sebagai panduan pengajaran dan membantu meningkatkan kompetensi PPDS-KJ dalam melakukan psikoterapi psikodinamik untuk kasus GKA di Indonesia.

---

Borderline personality disorder (BPD) is a mental disorder with significant psychosocial impacts and is difficult to manage compared to other psychiatric disorders. The majority of psychiatry residents in Indonesia stated that it was difficult to carry out psychotherapy on BPD patients and that there was no specific and structured psychodynamic psychotherapy teaching method for BPD cases. The aim of this study is to produce a Psychodynamic Psychotherapy Module for BPD cases (PP-BPD) along with the instruments to evaluate the residents’ learning outcomes in the cognitive, affective and psychomotor learning domains after receiving the module. The research was conducted in January–December 2023 at nine psychiatric educational institutions in Indonesia using mixed qualitative and quantitative methods with a sequential exploratory design, consisting of module development stages, evaluation instruments development, and module effectiveness testing. This study also adapted the Kirkpatrick Questionnaire level 1 to evaluate participants' reactions to the module. The development of the module and instruments was carried out carefully through the stages of focus group discussions, Delphi surveys, expert panel discussions, content validation testing of the module and scales, as well as inter-rater reliability testing of the scales with psychotherapy experts and teaching staff as participants. The resulting module, in the form of online learning with a duration of 12 meetings, is valid, (S-CVI/Ave = 1). The learning outcomes evaluation instruments were 50 multiple choice questions, Psychodynamic Formulation Competency Assessment scale (PF-CAS), and a Practical Competency Assessment Scale (PC-CAS) for psychodynamic psychotherapy for BPD. PF-CAS and PC-CAS were valid (S-CVI/Ave PF-CAS = 0.981, PC-CAS = 1) and reliable (ICC PF-CAS = 0.879, PC-CAS = 0.727). The module effectiveness test with a pre-test post-test control group design was carried out on 33 PPDS-KJ students in semesters 6–7 from nine psychiatric educational institutions in Indonesia who were recruited based on stratified random sampling. Analysis of the multiple choice exam, PF-CAS, PC-CAS, and Kirkpatrick Questionnaire level 1 Indonesian Version showed that the PP-BPD Education Module was effective in inducing changes in cognitive, affective and psychomotor aspects and received positive reactions from participants. The PP-BPD Education Module can be implemented in resident education in Indonesia as a teaching guide and to help improve residents’ competency in conducting psychodynamic psychotherapy for BPD cases in Indonesia."

"Menikah dan memiliki keturunan merupakan sebuah fase penting dalam siklus kehidupan. Apabila kehamilan tak kunjung terjadi setelah dua belas bulan berhubungan teratur tanpa pengaman, maka disebut sebagai infertilitas. Fertilisasi in vitro (FIV) dilakukan saat metode lain telah mengalami kegagalan, namun tahapan yang dilalui memberikan stres bagi yang menjalaninya. Melihat kompleksitas permasalahan, perlu untuk dikembangkan model pendampingan, berupa Terapi Kognitif Perilaku (TKP). Penelitian ini bertujuan untuk mengetahui efektivitas TKP dalam memperbaiki faktor psiko-neuro-endokrin.Penelitian terdiri dari dua tahap yaitu uji face validity dan studi eksperimental berupa uji klinis tersamar ganda. Penelitian dilakukan di Klinik Infertilitas Yasmin RSCM dan Klinik Dr Sander B Daya Medika. Waktu penelitian adalah bulan Mei 2016 – Maret 2023. Pengumpulan data menggunakan kuesioner dan penilaian selama prosedur FIV, meliputi kecemasan, depresi, serta kadar hormonal berupa kortisol, norepinefrin, triiodotironin bebas (fT3), estradiol, dan progesteron. Interaksi antara kelompok intervensi dan waktu pengukuran terhadap variabel dianalisis dengan menggunakan mixed-model repeated measure ANOVA dan analisis post-hoc menggunakan uji t tidak berpasangan pada setiap pengukuran.Analisis akhir melibatkan 75 subjek, terdiri dari 38 subjek kelompok kontrol dan 37 subjek kelompok TKP. Distorsi kognitif yang paling sering dialami subjek penelitian adalah fortune telling (34,2%), personalization (22,8%), dan should statement (14,3%). Terdapat penurunan skor kecemasan di sesi 8 TKP (p < 0,001) dan penurunan skor depresi di sesi 6 dan 8 TKP (p = 0,027 dan p = 0,007). Penurunan skor kecemasan sejalan dengan penurunan kadar norepinefrin (p = 0,002), sementara penurunan skor depresi bersesuaian dengan penurunan kadar kortisol (p < 0,001) dan perbaikan kadar estradiol (p = 0,024). Kadar fT3 dan progesteron tidak mengalami perbaikan hingga akhir sesi TKP. Mixed-model repeated measure ANOVA menguatkan hasil dengan adanya tren penurunan kecemasan, depresi, norepinefrin, dan kortisol pada kelompok TKP, dengan ukuran efek kecil hingga sedang.Dari hasil penelitian disimpulkan bahwa TKP terbukti efektif dalam memperbaiki faktor psiko-neuro-endokrin pada perempuan yang mengikuti FIV. Penting untuk dilakukan advokasi hasil penelitian kepada rumah sakit dengan layanan FIV dan mengintegrasikan panduan TKP pada FIV ke dalam prosedur standar dan panduan pelayanan klinis rumah sakit. Penting untuk melakukan penelitian lanjutan pada populasi dengan karakteristik lebih beragam dan mengembangkan bentuk pendampingan bagi pasangan agar dapat memberikan dukungan yang adekuat dan mengoptimalkan luaran FIV.

---

Marriage and parenthood are significant life stages. When a couple has regular, unprotected intercourse for 12 months without pregnancy, they are considered infertile. In vitro fertilization (IVF) is pursued when other methods fail, though it can cause significant stress for women. This study aims to assess the effectiveness of Cognitive Behavioral Therapy (CBT) in improving psycho-neuro-endocrine factors in women undergoing IVF.

The research comprises two phases: the assessment of face validity and an experimental study designed as a double-blind clinical trial, conducted at the Yasmin Infertility Clinic RSCM and Dr. Sander B Daya Medika Clinic. The research spanned from May 2016 – March 2023. Data were collected through questionnaires and evaluations during the IVF process, focusing on anxiety, depression, and hormonal levels, including cortisol, norepinephrine, free triiodothyronine (fT3), estradiol, and progesterone. The interaction between the intervention group and the timing of measurements for each variable was analyzed using a mixed-model repeated measures ANOVA and post hoc analysis with an unpaired t-test at each measurement interval.

The final analysis comprised 75 participants, 38 assigned to the control and 37 to the cognitive behavioral therapy (CBT) group. The predominant cognitive distortions identified included fortune telling (34.2%), personalization (22.8%), and should statements (14.3%). Notably, there was a significant reduction in anxiety scores observed during session 8 of CBT (p < 0.001), alongside a marked decrease in depression scores during sessions 6 and 8 (p = 0.027 and p = 0.007, respectively). The decline in anxiety scores was significantly correlated with a reduction in norepinephrine levels (p = 0.002), while the decrease in depression scores was linked to a significant drop in cortisol levels (p < 0.001) and an enhancement in estradiol levels (p = 0.024). However, no improvements were noted in the levels of fT3 and progesterone. The mixed-model repeated measures ANOVA corroborated these findings, indicating a significant trend in the reduction of anxiety, depression, norepinephrine, and cortisol within the CBT group, with effect sizes ranging from small to medium.

It can be inferred that CBT is effective in enhancing psycho-neuro-endocrine factors among women undergoing IVF. Consequently, it is crucial to promote these research outcomes within IVF service hospitals and incorporate CBT protocols into standard practices and clinical guidelines. Additional research should be pursued involving more diverse populations and the formulation of support models for couples, aimed at delivering adequate assistance to women undergoing IVF and optimizing the outcomes of the procedure."

"Menikah dan memiliki keturunan merupakan sebuah fase penting dalam siklus kehidupan. Apabila kehamilan tak kunjung terjadi setelah dua belas bulan berhubungan teratur tanpa pengaman, maka disebut sebagai infertilitas. Fertilisasi in vitro (FIV) dilakukan saat metode lain telah mengalami kegagalan, namun tahapan yang dilalui memberikan stres bagi yang menjalaninya. Melihat kompleksitas permasalahan, perlu untuk dikembangkan model pendampingan, berupa Terapi Kognitif Perilaku (TKP). Penelitian ini bertujuan untuk mengetahui efektivitas TKP dalam memperbaiki faktor psiko-neuro-endokrin.Penelitian terdiri dari dua tahap yaitu uji face validity dan studi eksperimental berupa uji klinis tersamar ganda. Penelitian dilakukan di Klinik Infertilitas Yasmin RSCM dan Klinik Dr Sander B Daya Medika. Waktu penelitian adalah bulan Mei 2016 – Maret 2023. Pengumpulan data menggunakan kuesioner dan penilaian selama prosedur FIV, meliputi kecemasan, depresi, serta kadar hormonal berupa kortisol, norepinefrin, triiodotironin bebas (fT3), estradiol, dan progesteron. Interaksi antara kelompok intervensi dan waktu pengukuran terhadap variabel dianalisis dengan menggunakan mixed-model repeated measure ANOVA dan analisis post-hoc menggunakan uji t tidak berpasangan pada setiap pengukuran.Analisis akhir melibatkan 75 subjek, terdiri dari 38 subjek kelompok kontrol dan 37 subjek kelompok TKP. Distorsi kognitif yang paling sering dialami subjek penelitian adalah fortune telling (34,2%), personalization (22,8%), dan should statement (14,3%). Terdapat penurunan skor kecemasan di sesi 8 TKP (p < 0,001) dan penurunan skor depresi di sesi 6 dan 8 TKP (p = 0,027 dan p = 0,007). Penurunan skor kecemasan sejalan dengan penurunan kadar norepinefrin (p = 0,002), sementara penurunan skor depresi bersesuaian dengan penurunan kadar kortisol (p < 0,001) dan perbaikan kadar estradiol (p = 0,024). Kadar fT3 dan progesteron tidak mengalami perbaikan hingga akhir sesi TKP. Mixed-model repeated measure ANOVA menguatkan hasil dengan adanya tren penurunan kecemasan, depresi, norepinefrin, dan kortisol pada kelompok TKP, dengan ukuran efek kecil hingga sedang.Dari hasil penelitian disimpulkan bahwa TKP terbukti efektif dalam memperbaiki faktor psiko-neuro-endokrin pada perempuan yang mengikuti FIV. Penting untuk dilakukan advokasi hasil penelitian kepada rumah sakit dengan layanan FIV dan mengintegrasikan panduan TKP pada FIV ke dalam prosedur standar dan panduan pelayanan klinis rumah sakit. Penting untuk melakukan penelitian lanjutan pada populasi dengan karakteristik lebih beragam dan mengembangkan bentuk pendampingan bagi pasangan agar dapat memberikan dukungan yang adekuat dan mengoptimalkan luaran FIV.

---

Marriage and parenthood are significant life stages. When a couple has regular, unprotected intercourse for 12 months without pregnancy, they are considered infertile. In vitro fertilization (IVF) is pursued when other methods fail, though it can cause significant stress for women. This study aims to assess the effectiveness of Cognitive Behavioral Therapy (CBT) in improving psycho-neuro-endocrine factors in women undergoing IVF.

The research comprises two phases: the assessment of face validity and an experimental study designed as a double-blind clinical trial, conducted at the Yasmin Infertility Clinic RSCM and Dr. Sander B Daya Medika Clinic. The research spanned from May 2016 – March 2023. Data were collected through questionnaires and evaluations during the IVF process, focusing on anxiety, depression, and hormonal levels, including cortisol, norepinephrine, free triiodothyronine (fT3), estradiol, and progesterone. The interaction between the intervention group and the timing of measurements for each variable was analyzed using a mixed-model repeated measures ANOVA and post hoc analysis with an unpaired t-test at each measurement interval.

The final analysis comprised 75 participants, 38 assigned to the control and 37 to the cognitive behavioral therapy (CBT) group. The predominant cognitive distortions identified included fortune telling (34.2%), personalization (22.8%), and should statements (14.3%). Notably, there was a significant reduction in anxiety scores observed during session 8 of CBT (p < 0.001), alongside a marked decrease in depression scores during sessions 6 and 8 (p = 0.027 and p = 0.007, respectively). The decline in anxiety scores was significantly correlated with a reduction in norepinephrine levels (p = 0.002), while the decrease in depression scores was linked to a significant drop in cortisol levels (p < 0.001) and an enhancement in estradiol levels (p = 0.024). However, no improvements were noted in the levels of fT3 and progesterone. The mixed-model repeated measures ANOVA corroborated these findings, indicating a significant trend in the reduction of anxiety, depression, norepinephrine, and cortisol within the CBT group, with effect sizes ranging from small to medium.

It can be inferred that CBT is effective in enhancing psycho-neuro-endocrine factors among women undergoing IVF. Consequently, it is crucial to promote these research outcomes within IVF service hospitals and incorporate CBT protocols into standard practices and clinical guidelines. Additional research should be pursued involving more diverse populations and the formulation of support models for couples, aimed at delivering adequate assistance to women undergoing IVF and optimizing the outcomes of the procedure."

"Latar belakang: Halusinasi auditorik verbal (HAV) dialami 70% dari 23 juta penderita gangguan skizofrenia di seluruh dunia. Data pasien skizofrenia di rawat jalan Departemen Psikiatri RSCM/FKUI periode tahun 2016-2017 kasus HAV resisten pengobatan berkisar 25-30%. Tujuan penelitian ini mengetahui abnormalitas spasiotemporal aktivitas neural otak kondisi istirahat yang berhubungan dengan HAV pada orang dengan skizofrenia (ODS) dan peran rTMS dalam memodulasi abnormalitas tersebut. Metode: Penelitian ini dilakukan di Departemen Psikiatri dan Departemen Neurologi FKUI/RSCM selama Maret 2017 sampai Maret 2019 dengan desain uji klinis acak plasebo tersamar ganda. Studi  mengikutsertakan 120 orang yaitu 40 ODS dengan halusinasi, 40 ODS tanpa halusinasi, 20 subjek saudara kandung dan 20 subjek sehat. Kriteria kelompok intervensi rTMS pasien skizofrenia HAV resisten pengobatan usia dewasa 18-59 tahun. Pemeriksaan dimensi temporal dan spasial aktivitas otak keadaan istirahat menggunakan perekaman elektroensefelografi (EEG). Pemeriksaan simtom halusinasi menggunakan instrumen PSYRATS dan uji kemampuan pemantauan-sumber. Dilakukan rTMS 1 Hz 90% AM 1000 pulse di titik T3P3 selama 10 hari berturut-turut. Data klinis pasien diperoleh dari wawancara atau catatan medis. Informed consentdiperoleh dari pasien dan orang tua atau pasangan pasien. Hasil: Ditemukan perbedaan kekuatan amplitudo gelombang theta di prefrontal kiri dan kanan (skizofrenia = 15.19±4.54 mV, sehat= 7.37±2.49 mV, p 0.004), frontal kiri dan kanan (skizofrenia=18.62±17.55 mV, sehat = 9.90±3.77 mV p 0.007), temporal kiri dan kanan (skizofrenia= 6.97±7.26 mV, sehat= 3.59±1.34 mV , p 0.010). Kelompok skizofrenia ditemukan penurunan gandeng-fase amplitudo theta/gamma di frontal-parietal kiri F3-P3 (sehat=28.06, skizofrenia=24.06), frontal-temporal kiri F3-T3 (sehat=30.89, skizofrenia=22.47) dan frontal sentral kanan FP2-C4 (sehat=25.78, skizofrenia=25.00). Didapatkan peningkatan konektivitas fungsional di jejaring mode-standar yang berkaitan dengan kemampuan ODS memantau sumber stimulus. Antara jejaring mode-standar dengan sentral-eksekutif didapatkan korelasi positif di BA 8L-39L (r = 0.792, p = 0.000), BA 29L-40L (r = 0.522, p = 0.032) dan BA8R-39R (r = 0.480, p = 0.004). Korelasi positif abnormal antara jejaring mode-standar dan eksekutif-pusat berhubungan dengan kesulitan ODS membedakan sumber stimulus. Pemberian rTMS 1 Hz menurunkan konektivitas jejaring mode-standar dan menurunkan gandeng theta-gamma yang menghasilkan perbaikan gejala HAV dan kemampuan pemantauan sumber. Simpulan: Pada ODS keseimbangan aktivitas otak istirahat bergeser ke kekuatan frekuensi rendah, demikian juga peningkatan koherensi kortikal. Didapatkan hiperkonektivitas jejaring mode standar, korelasi abnormal antara DMN dan CEN, serta gandeng theta-beta DMN yang berhubungan dengan halusinasi auditorik verbal. Pemberian rTMS bisa memodulasi abnormalitas spasiotemporal tersebut mendekati kondisi normal dan berakibat perbaikan gejala halusinasi. EEG concordance alfa prefrontal frontal otak berpotensi menjadi kandidat penanda biologi respon terhadap terapi rTMS. 

---

Background: Auditory Verbal Hallucinations (AVH) occur in 70% of 23 million people with schizophrenia worldwide. According to the 2016-2017 data on schizophrenia patients in the Outpatient Clinic of the Department of Psychiatry RSCM / FKUI, AVH treatment-resistant cases reach about 25-30%. The aim of this study was to determine the spatiotemporal properties of resting brain neural activities that cause changes in perceptions and abnormal space-time experience in people with schizophrenia, which then manifest as auditory verbal hallucinations, and also to determine the role of transcranial magnetic repetitive stimulation (rTMS) on modulating spatiotemporal abnormalities. 

Method: This study was a double-blind placebo-controlled clinical trial conducted in the Department of Psychiatry and the Department of Neurology of FMUI/RSCM  from March 2017 to March 2019. The study included 120 subjects consisting of 40 schizophrenia patients with hallucinations, 40 schizophrenia patients without hallucinations, 20 siblings of the patients, and 20 healthy subjects. The criteria for the rTMS intervention group were treatment-resistant schizophrenia with AVH of 18-59 years of age. Electroencephalography (EEG) was used to examine temporal and spatial dimensions of resting brain activities. The PSYRATS instrument and source-monitoring ability test were used to assess symptoms of hallucinations. Patients clinical data were collected from interviews or medical records. Informed consents were obtained from patients and their parents or spouses.

Results: Differences in amplitude strength of theta fequency were found at the left and right prefrontal cortices (schizophrenia = 15.19±4.54 mV, healthy = 7.37±2.49 mV, p 0.004), left and right frontal cortices (schizophrenia=18.62±17.55 mV, healthy = 9.90±3.77 mV p 0.007), left and right temporal cortices (schizophrenia= 6.97±7.26 mV, healthy = 3.59±1.34 mV , p 0.010). Temporal cortical activities were shifted to low frequency fluctuations, and there were also decreasing relationships between various brain frequencies. The increase of functional connectivity in default-mode networks was found, which relates to schizophrenics ability to monitor sources of stimuli. This abnormal positive correlation between the default mode and the central executives network might disturb schizophrenics ability to distinguish internal stimuli from external stimuli. The administration of 1Hz of rTMS decreases connectivity in default-mode networks and theta-gamma coupling resulting in improved symptoms of HAV and source monitoring capabilities.

Conclusion: In people with schizophrenia, the balance of resting activity shift to low frequency power, as well as increase in its cortical coherence. It also found functional hyperconnectivity in default mode network among schizophrenia patients with HAV and abnormal positive correlation between DMN-CEN. The resting state theta-gamma coupling was increased in patient with schizophrenia that might underlie HAV. The administration of rTMS modulate spatiotemporal abnormalities to near-normal conditions, resulting in the improvement in hallucinatory symptoms. The alpha EEG cordances of prefrontal and frontal cortices has the potential to become a biological marker of response to rTMS therapy."