Atypical antipsychotics are widely prescribed and have the potential to cause weight gain, which may result in the development of metabolic syndrome. Also, it is important to monitor the use of atypical antipsychotic for metabolic disturbance. The purpose of this study is to determine the side effects of atypical antipsychotics in increasing body weight in schizophrenia patients after 4 weeks of use. Furthermore, a retrospective design was conducted and data were collected based on consecutive sampling in 80 adult psychiatric inpatients (20 women and 60 men) with initial diagnoses of schizophrenia and with the same daily nutrition. The patients were hospitalized from January to March 2019, within the term (over 4 weeks) of initiation atypical antipsychotic. The patient body weight was collected before and 4 weeks after the treatment of atypical antipsychotic. The results showed that patients (20 women and 60 men) receiving atypical antipsychotic had a mean age of 35.6 years and a percentage of 70% women and 56% men had a weight gain of 1–5 kg over 4 weeks. The mean weight observed among our subjects increased from 57.55±10.743 kg to 59.83±12.205 kg after initiating treatment (p=0.001). However, the dual combination of atypical antipsychotics risperidone and clozapine are the most widely atypical antipsychotic used with a percentage equal to 91.25%, 3.75% clozapine, and 5% risperidone. Furthermore, it can be concluded that atypical antipsychotics use for at least 4 weeks can cause weight gain in schizophrenic patients. Pharmacist and doctors are recommended to monitor the metabolic side effects due to the atypical antipsychotic use. Keywords: Atypical antipsycotic, schizophrenia, weight gain Antipsikotik Atipikal Menginduksi Peningkatan Berat Badan pada Pasien Skizofrenia AbstrakAntipsikotik atipikal banyak diresepkan dan berpotensi menyebabkan kenaikan berat badan yang dapat menyebabkan sindrom metabolik. Ada kebutuhan klinis yang mendesak untuk memantau penggunaan antipsikotik atipikal terhadap gangguan metabolisme. Penelitian ini bertujuan untuk mengetahui efek samping antipsikotik atipikal dalam meningkatkan berat badan pada pasien skizofrenia setelah pemakaian 4 minggu. Melalui desain retrospektif, data dikumpulkan dengan consecutive sampling pada 80 pasien rawat inap psikiatri dewasa (20 wanita dan 60 pria) dengan diagnosis awal skizofrenia dan dengan pengaturan nutrisi harian yang sama. Pasien dirawat di rumah sakit sejak Januari 2019 sampai dengan Maret 2019, dalam jangka menengah (lebih dari 4 minggu) pemberian antipsikotik atipikal. Data berat badan pasien dicatat sebelum dan 4 minggu sesudah pemakaian antipsikotik atipikal. Pasien (20 wanita dan 60 pria) yang menerima antipsikotik atipikal memiliki usia rata-rata 35,6 tahun, semua pasien dengan persentase 70% wanita dan 56% pria memiliki kenaikan berat badan 1–5 kg selama periode 4 minggu. Berat rata-rata yang diamati di antara subyek meningkat dari 57,55±10,743 kg menjadi 59,83±12,205 kg setelah memulai pengobatan (p=0,001). Antipsikotik atipikal yang paling banyak digunakan adalah kombinasi antipsikotik atipikal risperidon clozapin dengan persentase sebesar 91,25%, clozapin 3,75%, risperidon 5%. Kami menyimpulkan bahwa penggunaan antipsikotik atipikal selama setidaknya 4 minggu dapat menyebabkan penambahan berat badan pada pasien skizofrenia. Apoteker dan dokter direkomendasikan untuk memantau efek samping metabolik akibat penggunaan antipsikotik atipikal.Kata kunci: Antipsikotik atipikal, peningkatan berat badan, skizofrenia
The use of atypical antipsychotics often causes an increase in blood glucose levels, body mass index (BMI) and abdominal circumference. This study aims to identify the increased risk of random blood glucose, BMI and abdominal circumference in the schizophrenic patients using clozapine and quetiapine. This cohort study involved 35 schizophrenic patients (19 patients used clozapine and 16 patients used quetiapine). The measurement of random blood glucose BMI and abdominal circumference was done in the zero month, the first month and the second month. The average of random blood glucose, BMI and abdominal circumference were analyzed using Wilcoxon and Chi-square. In the use of clozapine, there is a significant increase in the average of random blood glucose between the first month and the second month (p=0.1) with the difference of 6.37 mg/dl, there is an increase average in BMI between the first month and the second month (p=0.03) with the difference of 0.18 kg/m² and an average increase in abdominal circumference between the zero month and the first month (p=0.04) with the difference of 1.47 cm, between the first month and the second month (p=0.02) with the difference of 1.94 cm. In the use of quetiapine, a significant increase in abdominal circumference between the first month and the second month (p=0.02) with the difference 1.38 cm. The use of clozapine has more risk in increasing random blood glucose (OR 2.00: CI 95% 0.41-9.76), BMI (OR 2.78: CI 95% 0.69-11.10) and abdominal circumference (OR 3.61: CI 95% 0.89-14.64) compared to the use of quetiapine. The use of clozapine has more risk in increasing blood glucose, BMI and abdominal circumference compared to the use of quetiapine.
The adverse drug effect of risperidone and clozapine combination therapy possibly increases the BMI, systolic and diastolic blood pressures of mental victims. This study aimed at determining the relationship between the duration of risperidone and clozapine combination therapy and increase in body mass index (BMI), systolic and diastolic blood pressures of schizophrenic patients. The correlation was obtained using the cohort retrospective method on 59 schizophrenic inpatients at Magelang Mental Hospital from February–May 2019. Participants were grouped into 2 categories, termed <8 and ≥8 weeks with 48 and 11 persons, respectively. Subsequently, patients’ BMI, systolic and diastolic blood pressures were measured during the first day of hospitalization and outpatient consultations, based on NCEP-ATP III cut off-point with the modification of Southeast Asian population’s BMI. Structured questionnaires were used to evaluate calory intake and physical activity as well as generate respondents’ medical records. The bivariate analysis results showed a significant relationship between BMI increase at initial hospitalization and during outpatient consultation on group ≥8 weeks therapy, 22.41±2.98 kg/m2 vs 25.2±6.80 kg/m2 (p=0.023, –2.75 (–5.12–(–0.39)). However, there is no major correlation occurred in systolic 117±11.73 mmHg vs 118±15.42 mmHg (p=0.797, 95%CI –1.07 (–9.41–7.26)) and diastolic blood pressures 76±7.86 mmHg vs 73±8.48 mmHg (p=0.192, 95% CI 3.52 (–1.81–8.86)) for both groups. Furthermore, age, gender, smoking status, dosage, co-medication, calory intake and physical activity indicated no substantial variations, in terms of the increase in BMI, systolic and diastolic blood pressures among two categories.
Latar Belakang: Skizofrenia merupakan gangguan jiwa berat, dengan kekambuhan berulang. Pasien seringkali mengalami gejala depresi. Perasaan putus asa akan kondisi penyakitnya yang tidak kunjung sembuh membuat pasien terpuruk dan kehilangan keyakinan terhadap masa depannya. Konsumsi obat terus menerus yang menimbulkan rasa bosan dan menurunkan tingkat kepatuhan sangat mengganggu proses kesembuhan pada pasien skizofrenia. Banyaknya jumlah obat yang harus mereka konsumsi, akan memperberat depresi, berisiko melakukan tindakan bunuh diri. Terapi permainan kearifan budaya lokal dan neurofeedback merupakan salah satu tatalaksana nonfarmakoterapi yang dapat digunakan terhadap depresi pada pasien pasca skizofrenia. Tujuan: Untuk menganalisis efektifitas terapi permainan kearifan budaya lokal dibandingkan neurofeedback terhadap penurunan derajat depresi pada pasien depresi pasca skizofrenia di RSJ Prof. Dr. Soerojo Magelang. Bahan dan Cara: Jenis penelitian eksperimental semu dengan rancangan pretest dan post test control design. Subyek penelitian adalah pasien depresi pasca skizofrenia di RSJ Prof.Dr. Soerojo Magelang Alat penelitian yang dipergunakan adalah: (1) peralatan permainan kearifan budaya lokal; (2) alat elektromedik neurofeedback; (3) Beck Depression Inventory (BDI); (4) kuesioner sosio-demografi. Responden dibagi menjadi 4 kelompok, yaitu: kelompok yang diberi perlakuan permainan kearifan budaya lokal, kelompok yang diberi neurofeedback, kelompok yang diberi permainan kearifan budaya lokal dan neurofeedback, dan kelompok kontrol yang tidak diberi perlakuan. Efektifitas perlakuan diukur melalui pembandingan data derajat depresi sebelum perlakuan dengan data derajat depresi setelah perlakuan. Teknik analisis statistik yang dipergunakan adalah F-test dan 2-test, dengan = 5%. Hasil: Terjadi penurunan skor depresi yang signifikan pada kelompok responden yang diberi perlakuan permainan kearifan budaya lokal (-61,6%; Fh = 336,135; p < 0,01), neurofeedback (-64,8%; Fh = 265,283; p < 0,01), gabungan permainan kearifan budaya lokal dan neurofeedback (-74,5%; Fh = 397,093; p < 0,01), maupun pada kelompok kontrol (-47,4%; Fh = 106,333; p < 0,01). Kesimpulan: Pemberian permainan kearifan budaya lokal dan neurofeedbak merupakan metode yang efektif untuk menurunkan derajat depresi pada pasien depresi pasca skizofrenia di RSJ Prof. Dr. Soerojo Magelang.
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