ANALISIS FAKTOR-FAKTOR YANG BERPERAN TIMBULNYA GEJALA EKSTRAPIRAMIDAL AKIBAT PEMBERIAN ANTIPSIKOTIK PADA KASUS SKIZOFRENIA DI UNIT INTENSIF PSIKIATRI RSJD dr.RM SOEDJARWADI

JAYUS INASTIAWAN, dr.Silas Henry Ismanto.,Sp.KJ (K);Dr.dr.Ronny Tri Wirasto.,Sp.KJ

2021 | Tesis-Spesialis | ILMU KEDOKTERAN JIWA

Latar Belakang: Sekitar 40 % pasien yang datang ke ruang kegawatdaruratan psikiatrik memerlukan perawatan instensif psikiatri. Pemberian antipsikotik fase akut merupakan pilihan utama yang dapat menimbulkan efek samping diantaranya timbulnya gangguan pada sistem persarafan ekstrapiramidal yang dikenal sebagai gejala ekstrapiramidal (EPS). Faktor resiko seseorang untuk timbulnya EPS sangatlah kompleks dan melibatkan banyak faktor diantaranya faktor demografi, riwayat penggunanaan antipsikotik sebelumnya, wanita, usia tua, penggunaan antipsikotik generasi pertama, durasi pengobatan, ketergantungan zat dan riwayat genetik dilaporkan memiliki insidensi lebih tinggi Tujuan Penelitian: Mengetahui faktor-faktor yang berperan (agresivitas, IMT, vital sign dan hasil laboratorium faal liver dan ginjal) dalam timbulnya gejala ekstrapiramidal pada penatalaksanaan kasus Skizofrenia setelah pemberian antipsikotik Metode Penelitian: Penelitian ini dilakukan dengan jenis observasional cohort retrospektif dengan rancangan deskriptif analitik.Peneliti melakukan telaah rekam medis pada 50 Rekam Medis pasien skiozfrenia pada periode 2019 di ruang perawatan intesif psikiatri. Peneliti menilai faktor-faktor (agresivitas, IMT, Vital Sign dan hasil laboratorium faal liver dan ginjal) yang berperan dalam timbulnya gejala ekstrapiramidal pada kelompok EPS dan non EPS. Data bersifat kontinyu yang terdistribusi normal akan dilakukan perbandingan dengan uji t independen data yang tidak terdistribusi normal akan diuji dengan test Mann Whitney. Hasil Penelitian: Dari 50 subyek penelitian 18 diantaranya mengalami EPS (36%). Analisis bivariate terhadap faktor- faktor yang berperan timbulnya EPS (agresivitas, IMT, vital sign dan hasil laboratorium faal liver dan ginjal) memberikan hasil faktor agresivitas memiliki hubungan terhadap timbulnya gejala ekstrapiramidal (p < 0,001). Faktor IMT,vital sign, hasil laboratorium faal ginjal dan liver, usia, jenis pemakaian antipsikotik dan jenis kelamin tidak memiliki hubungan terhadap timbulnya EPS. Kesimpulan: Dari empat faktor yang menggambarkan kriteria klinis dan laboratorium terhadap kejadian EPS pada pasien Skiozfrenia di perawatan unit intensif psikiatri RSJD dr. RM Soedjarwadi didapatkan hasil bahwa faktor agresivitas memiliki hubungan terhadap kejadian EPS.

Background: About 40% of patients who come to the psychiatric emergency room require intensive psychiatric care. The administration of acute phase antipsychotics is the main choice that can cause side effects, including disturbances in the extrapyramidal nervous system known as extrapyramidal symptoms (EPS). A individual risk factors for developing EPS are very complex and involve many factors including demographic factors, previous history of antipsychotic use, women, old age, use of first generation antipsychotics, duration of treatment, substance dependence and genetic history reported to have a higher incidence. Objectives: To determine the factors that play a role (aggressiveness, BMI, vital signs and laboratory results of liver and kidney function) in the emergence of extrapyramidal symptoms in the management of schizophrenia cases after antipsychotic administration. Methods: This study was conducted with a retrospective cohort observational type with an analytical descriptive design. The researcher reviewed the medical records of 50 schizophrenic patients medical records in the 2019 period in a psychiatric intensive care unit. Researchers assessed the factors (aggressiveness, BMI, Vital Signs and laboratory results of liver and kidney function) that played a role in the occurrence of extrapyramidal symptoms in the EPS and non-EPS groups. Continuous data which is normally distributed will be compared with an independent t test. Data that are not normally distributed will be tested with the Mann Whitney test. Results: Of the 50 research subjects 18 of them experienced EPS (36%). Bivariate analysis of the factors that contribute to the emergence of EPS (aggressiveness, BMI, vital signs and laboratory results of liver and kidney function) showed that aggressiveness factors had a relationship with the onset of extrapyramidal symptoms (p < 0.001). BMI factors, vital signs, laboratory results of kidney and liver function, age, type of antipsychotic use and gender did not have a relationship with the incidence of EPS. Conclusion: Of the four factors that describe clinical and laboratory criteria for the incidence of EPS in Schizophrenic patients in the psychiatric intensive care unit of RSJD dr. RM Soedjarwadi found that the aggressiveness factor has a relationship with the incidence of EPS

Kata Kunci : antipsikotik, gejala ekstrapiramidal, skizofrenia