A Pharmacology Breakthrough in the Treatment of Depression: the Melatonergic Approach

Hubungan antara gangguan mood dan ganngguan irama sirkadian sudah lama diketahui. Diperkirakan sebanyak 8091 pasien depresi melaporkan gangguan tidur, berupa Penurunan lama tidur dan gangguan waktu tidur. Penelitian lain menunjukkan gangguan dalam irama sirkadian dari mood, temperatur tubuh dan sekresi neuroendokrin termasuk kortisol, melatonin dan hormon stimulasi tiroid, peningkatan sekresi adrenokortikotropin pagi dan malam, iuga peningkatan prolaktin dan sekresi hormon pertumbuhan. Gangguan irama sirkadian yang luas ini diakibatkan disorganisasi dalam pusat sirkadian menyebabkan gambaran utama depresi. Ada korelasi positif antara derajat gangguan irama sirkadian dengan keparahan geiala depresi. Interaksi antara gangguan irama sirkadian dan depresi amat kompleks dan apakah gangguan ini mencetuskan depresi atau sebagai akibat dari penvakitnya, masih belum diketahui jelas. Tidak dapat diabaikan bahwa keduanya mempunyai etiologi di dalamnva masing-masing. Bagaimanapun gangguan irama sirkadian sebagai penyebab mendasar dari depresi, gangguan ini dapat memperlama episode depresi. Keberhasilan pengobatan paiien perlu diiringi dengan normalisasi irama sirkadian' ^ Hingga saat ini penanganan gangguan depresi yang menimbulkan biaya tinggi, masih belum memuaskan. Semua antidepresan bekerja melalui mekanisme monoaminergik' Untuk meningkatkan penanganan depiesi, dipertimbangkan pendekatan-non-monoaminergik sebagai suatu strategi. Agomelatin yang mempunyai aksi agonis melatonin dan antagonis 5-hydroxytryptamine 2C(5-HT2c) ini, menyasar reseptor melatonin dan bersama dengan aksi pada reseptor S-HT2c. berperan dalam memperbaiki irama sirkadian

Mengenal Gangguan Mood pada Perempuan

Mood Disorders (pada beberapa tulisan disebut sebagai Affective Disorders) atau Gangguan Mood adalah sekelompok gangguan mental dengan ciri utama yang menonjol adalah gangguan mood, apakah sebagian atau sangat berlebihan hingga ekstrim, mengalami perasaan gembira atau sedih. Mood adalah suasana perasaan yang dirasakan di dalam diri, relatif menetap dan dapat diekspresikan keluar. Sindroma atau kumpulan gejalanya pada umumnya tidak disebabkan oleh gangguan fisik atau mental lainnya. Namun demikian, gangguan mood dapat juga terjadi berdasarkan pencetusnya misalnya gangguan mood karena pemakaian zat dan gangguan mood yang terjadi karena faktor penyakit medis atau fisik. Dalam keadaan alamiah/normal, suasana perasaan dalam diri dapat berfluktuasi, namun bila fluktuasinya ringan dan sesaat maka tak mengganggu. Namun bila berfluktuasi lebih tinggi dan lebih sering serta menetap, maka akan berdampak pada diri dan perilaku serta perkataan, hingga dapat menimbulkan ketidaknyamanan serta relasi yang berkonflik dengan siapa saja. Bila ini terjadi, maka dapat merupakan tanda dan gejala dari Gangguan Mood

Depresi Pada Usia Lanjut

Depression is perhaps the most frequent cause of emotional suffering in later life and significantly decreases quality of life in older adults. Depression is perceived as part of accelerated aging. Depressed individuals have a higher risk to get various diseases of aging. So that depressed elderly patients often have chronic comorbid conditions such as diabetes, hypertension, metobolic syndrome, cotonary artery disease, concer asthma and cognitive impairment and dementia. The impait of latelife depression on mortality, morbidity, and.function as well as service utilization is well lonwn. Differential diagnosis of depression in late-life are dementia, delirium or behavioral and psychological symptoms of dementia (BPSD), and often as comorbidity in depression. Depression in late life should be treated as early as possible. The important to treat are avoid the progression of depression and other medical comorbidity. Selection of antidepressant medication should be based on the best side effect profile and the lowest risk of drugs interaction. Add-on treatments including other drugs and psychotherapy can be applied. Involving the caregiver and families in the treatment process is a key to reach optimal outcome. Kqnoor

Penggantian Antipsikotika

Sejak ditemukannya chlorpromazine pada tahun 1952, tahun-tahun selanjutnya hingga saat ini telah banyak golongan obat antipsikotika lain yang ditemukan. Dengan makin banyak golongan dan macam obat antipsikotika di pasaran, maka makin banyak pilihan dan kesempatan seorang pasien memakai berbagai macam obat antipsikotika. Antipsikotika konvensional dan atipikal masing-masing mempunyai profil efek samping yang berbeda dan reaksi pasien terhadap efek samping pun sangat individual. Efikasi antipsikotika pada banyak literatur dikatakan kurang lebih sama, namun demikian tidak jarang klinisi mengalami adanya reaksi efikasi individual. Kedua hal ini memperbesar kemungkinan penggantian antipsikotika pada seorang pasien. Agar penggantian antipsikotika lebih rasional, maka ada beberapa hal yang perlu diperhatikan secara farmakologis, klinis dan sosial antara lain: alasan penggantian, perencanaan pola penggantian, risiko yang dapat terjadi saat penggantian dan kerjasama dengan pasien dan keluarga. Hal ini agar mencegah terjadinya pemakaian polifarmasi yang tidak rasional saat penggantian ataupun terjadinya penggantian yang ’menggantung’ di luar rencana awal

Social Engagement With Cognitive Function In The Elderly At Posyandu Lanjut Usia Mekar Sari, RW V, Mojo, Surabaya

Introduction: The increased number of the elderly dominates the improvement of lifeexpectancy of age in Indonesia. This condition is caused by a variety of health problems, including the decline of cognitive function. One of the risk factors for cognitive decline is social engagement. Social disengagement was associated with lower cognitive function. Aim: The objective of this study was to determine the correlation between social engagement and cognitive function in the elderly at Posyandu Lanjut Usia Mekar Sari, RW V, Mojo, Surabaya. Method: This research is an observational analysis with a cross-sectional study design. The population in this research is all elderly in Posyandu Lanjut Usia Mekar Sari, RW V, Mojo, Surabaya. The sample of this study is the elderly aged above 60 years old. The sampling research in this report is Consecutive Sampling Result: The result of the Rank Spearman correlation test hold the probability value as (Sig.) 0.201. The test showed a result of p > α (α = 0.05) Conclusion: There was no significant correlation between social engagement and cognitive function in the elderly at Posyandu Lansia Mekar Sari, RW V, Mojo, Surabay

Perceived Stress, Stressor and the Holmes-Rahe Life Stress of Female Medical Students

First year female medical students have heterogeneous educational backgrounds and diferent social-economy conditions, as well as changes in instructional system may cause academic pressure that eventually leads to stress. They are also experiencing academic stressors and life stress due to their daily routines. From this situation, it is discernible that stress prevalence among them is high. This study aims to determine stress source and perceived stress, establish correlation between life stress and perceived stress, and establish correlation between life stress and stress source. This cross-sectional study was conducted to 99 female medical students. The instrument used was the stress source questionnaire, the social readjustment rating scale, and the perceived stress scale-10. The obtained data is analyzed using Pearson correlation and logistic regression. The findings reveal that peer competition (P=0,014), loneliness (P=0,003), and inability to do self-adjustment (P=0,002) are the predictors of perceived stress. There was a significant correlation between the life stress and the perceived stress (sig 0,007, p<0,01), peer competition (sig 0,005, p<0,01), and loneliness (sig 0,024, p<0,05). In conclusion, peer competition, loneliness and inability to do self-adjustment are the stress predictors. The life stress with its many conflicts also influence the level of the stress. Consultation service is required to help managing and alleviating the stress such as in the forms of campus orientation program, physical or extracurricular activities, peer, family and institutional supports, creating healthy competitions, increase readiness towards changes, and stress management. Keywords: stress, stressor, life stress, female medical students. DOI: 10.7176/JEP/11-27-13 Publication date:September 30th 202

Blood serotonin level with depression situation and neurocognitive as a reflection of neuron condition in six months after moderate brain injury

Brain injury is still a public health problem that causes a very serious long-term disability and death especially in children and young adults. Of all the events brain injury, in the 70-85% estimate is a moderate brain injury. Neurocognitive deficits that occur after brain injury would be to show an improvement in the first six months and a relative improvement will be slow and almost not visible in six to 12 months after brain injury. Serotonin is the neurotransmitter most often associated with depression and also a key to neurogenesis. This study is an observational analytic study using cross sectional study of patients who had suffered a brain injury six months ago and treated in Dr.Soetomo hospital Surabaya. The result is there is significant correlation between blood serotonin levels in patients with depression situation in six months after brain injury (p = 0.00). There is also significant correlation between blood serotonin levels with some neurocognitive parameters in patients six months after brain injury, namely verbal fluency are examined with the Verbal Fluency Test parameters / VFT (p = 0.015). But serotonin concentration has no significant relationships with several other neurocognitive parameters, namely the accuracy and speed of information processing or reaction time, working memory and the ability to interpret visual information, each of which is checked by using the parameters of Inspection Time Task (ITT, p = 0.083 ), Continuous Performance Task-identical pairs (CPT-IP, p = 0.071) and the Continuous Performance Task-Degraded Stimuli (CPT-DS, p = 0.242)

The Relationship of Visual Support Toward The Clinical Improvement In Children With Autism Spectrum Disorders

Background: The prevalence of autism spectrum disorders (ASD) has increased in the last 30 years from 0.04 to 0.50. This condition increase the parents’ awareness and understanding in early diagnosis, education, management and health services for children with ASD. Purpose: This study aims to analyze the relationship between the uses of visual support for clinical improvement of children with ASD. Method: This study is an observational analytic study. The research was conducted at UPTD ABK Sidoarjo from March to June 2018. The research subjects in this study were four to seven years children with ASD condition. The sampling technique was consecutive sampling and was accomplished during the pre-test and post-test design. The measurement tool for using the Indonesian version of childhood autism rating scale (CARS) that has been validated. Management of visual support has been done for 120 minutes in three months (12 times) consisted of six activities, each activity for 20 minutes with one-one technique (one subject with one therapist). Results: There was no relationship improvement of the CARS based on the pre and post visual support management for three months (12 times) on general impression data, level, and consistency of intellectual responses. The results of paired t-test on the pre and post visual support management for three months (12 times) showed decreasing value of CARS. This result means that social, communication and psychomotor interactions have p<0.01. Conclusion: Management of visual support is associated with clinical improvement in social interaction, communication (non-verbal) and psychomotor (especially gross motoric)

Viral Meningoencephalitis Patient with Comorbid Major Depression with Psychotic Symptoms: A Case Report

Abstract Viral meningoencephalitis causes meninges and brain parenchyma inflammation, thus provoking significant morbidity and mortality. Clinical features include neurological and psychiatric symptoms depending on the brain involved, mild symptoms such as fever, headache, neck stiffness, and confusion, or severe symptoms such as seizures, weakness, hallucinations, and coma. Therefore, the clinical diagnosis and treatment of such cases are challenging to make. This case report describes an adult male patient suffering from viral meningoencephalitis with comorbid major depression with psychotic symptoms