Perbandingan Pengaruh Regimen Terapi Antipsikotik Berbasis Risperidon Terhadap Status Sindrom Ekstrapiramidal, Fungsi Kognitif, dan Gangguan Metabolik Pada Pasien Schizophrenia di RS Ernaldi Bahar Palembang

HENDIK RIAWAN, dr. Cecep Sugeng Kristanto, Sp.KJ (K); Prof. Dr. Zullies Ikawati, Apt

2020 | Tesis | MAGISTER FARMASI KLINIK

Antipsikotik merupakan agen pokok dalam penatalaksanaan schizophrenia. Perbedaan target kerja setiap regimen antipsikotik menimbulkan efek samping yang berbeda baik digunakan secara tunggal maupun kombinasi. Risperidon tunggal, kombinasi risperidon-klorpromazin dan risperidon- klozapin merupakan 3 besar regimen antipsikotik terbanyak yang digunakan di Instalasi rawat jalan RS Ernaldi Bahar Palembang. Penelitian ini bertujuan untuk mengetahui perbandingan 3 regimen terapi antipsikotik berbasis risperidon terhadap kejadian sindrom ekstrapiramidal (EPS), fungsi kognitif, serta gangguan metabolik. Penelitian ini bersifat observasional dengan rancangan deskriptif analitik menggunakan alat bantu kuesioner penelitian Extrapyramidal Symptom Rating Scale (ESRS) untuk mengetahui kejadian EPS, Mini Mental State Examination (MMSE) untuk mengetahui perubahan fungsi kognitif serta mengukur Body Mass Index (BMI), kolesterol total, tekanan darah, dan gula darah sewaktu (GDS) untuk mengetahui adanya gangguan metabolik. Pengambilan data dilakukan pada pasien rawat jalan periode Maret April 2020. Diperoleh sebanyak 361 subyek penelitian, namun akibat pandemi covid-19 maka hanya 180 orang yang memenuhi kelengkapan data untuk dianalisa dan terdistribusi merata ke dalam 3 regimen terapi antipsikotik yang diteliti. Analisis demografi responden sejumlah 180 orang tersebut dilakukan secara deskriptif. Uji Kruskal Wallis digunakan untuk mengetahui perbandingan regimen terapi antipsikotik berbasis risperidon terhadap kejadian EPS, sedangkan untuk melihat perburukan fungsi kognitif dan gangguan metabolik digunakan Uji Chi-square. Hasil penelitian menunjukkan terdapat perbedaan yang signifikan munculnya kejadian Parkinson (p = 0,000) dan Distonia (p = 0,027). Penggunaan obat antikolinergik yang tidak adekuat merupakan faktor pengganggu yang ikut mempengaruhi secara signifikan terhadap kejadian Parkinson (p = 0,048). Tidak terdapat perbedaan yang signifikan dalam perburukan fungsi kognitif (p = 0,465), BMI (p = 0,610), Kolesterol Total (p = 0,167), Tekanan Darah (p = 0,327) dan GDS (p = 0,218) antar 3 regimen terapi antipsikotik berbasis risperidon. Secara umum regimen terapi risperidon-klorpromazin menyebabkan terjadinya perburukan gejala EPS dan fungsi kognitif sedangkan regimen terapi risperidon-klozapin menyebabkan terjadinya perburukan gangguan metabolik.

Antipsychotics are the main agents in the management of schizophrenia. The different work targets of each antipsychotic regimen cause different side effects, both alone and in combination. Single risperidone, a combination of risperidone-chlorpromazine and risperidone-clozapine are the top 3 most antipsychotic regimens used in the outpatient installation of Ernaldi Bahar Hospital Palembang. This study aims to determine the comparison of 3 risperidone-based antipsychotic therapy regimens to the incidence of the extrapyramidal syndrome (EPS), cognitive function, and metabolic disorders. This research is observational with a descriptive-analytical design using the Extrapyramidal Symptom Rating Scale (ESRS) research questionnaire to determine the incidence of EPS, Mini-Mental State Examination (MMSE) to determine changes in cognitive function and measure Body Mass Index (BMI), total cholesterol, blood pressure, and blood sugar (GDS) to detect metabolic disorders. Data were collected on outpatients for the period of March April 2020. As many as 361 study subjects were obtained, but due to the Covid-19 pandemic, only 180 people met the completeness of the data to be analyzed and distributed evenly into the 3 antipsychotic therapy regimens studied. The demographic analysis of 180 respondents was carried out descriptively. The Kruskal Wallis test was used to determine the comparison of the risperidone-based antipsychotic therapy regimen to the incidence of EPS, while the Chi-square test was used to see the deterioration of cognitive function and metabolic disorders. The results showed that there was a significant difference in the occurrence of Parkinson's (p = 0.000) and dystonia (p = 0.027). Inadequate use of anticholinergic drugs was a confounding factor that significantly influenced the incidence of Parkinson's (p = 0.048). There was no significant difference in worsening cognitive function (p = 0.465), BMI (p = 0.610), total cholesterol (p = 0.167), blood pressure (p = 0.327) and GDS (p = 0.218) between the 3 antipsychotic based therapy regimens risperidone. In general, the risperidone-chlorpromazine treatment regimen causes worsening of EPS symptoms and cognitive function while the risperidone-clozapine treatment regimen causes worsening of metabolic disorders.

Kata Kunci : Schizophrenia, antipsikotik, sindrom ekstrapiramidal, fungsi kognitif, gangguan metabolik