COVID-19 survivors: the link between C-reactive protein and psychopathologies.

Objective: To investigate several psychiatric implications in survivors of coronavirus disease 2019 (COVID-19), while also exploring its correlation with C-reactive protein (CRP), an important non-specific acute phase reactant in infection and in the presence of psychopathologies. Methods: This study was conducted in February-June 2021 at Universitas Sumatera Utara Hospital and Haji General Hospital, Medan, Indonesia. In total, 182 patients with COVID-19 admitted for hospital treatment were screened for psychiatric symptoms. Sociodemographic and clinical data, including CRP level, were screened. Anxiety and depression scores were measured using the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory-II (BDI-II), respectively. The same screening was repeated 4 weeks after hospital discharge. Unpaired t-test was used to assess gender differences in clinical data and psychiatric symptoms, and Pearson's correlation test was used to investigate the link between CRP level and the symptoms of anxiety and depression. Results: In terms of psychopathological symptoms, patient-reported rates of insomnia, anxiety and depression were 94%, 78% and 34%, respectively. Females had significantly higher baseline scores for both anxiety (mean ± standard deviation: 23.79 ± 5.44 vs 20.56 ± 4.90 in males) and depression (20.04 ± 5.29 vs 18.56 ± 3.90 in males) (P=0.000). Interestingly, 4 weeks after hospital discharge, female COVID-19 survivors still had higher anxiety scores than male COVID-19 survivors (8.02 ± 4.72 vs 5.20 ± 2.98, respectively) (P=0.0001). During the interview, patients reported that they were worried about experiencing COVID-19 symptoms again (89%), re-infection (56%), and not having proper first aid at home (64%). A higher CRP level was significantly correlated with higher anxiety and depression scores (baseline CRP-BAI: r=0.623; baseline CRP-BDI-II: r=0.680; follow-up CRP-BAI: r=0.632; follow-up CRP-BDI-II: r=0.621; P=0.001). Conclusion: This study found that worse inflammation fostered worse psychiatric symptoms. Therefore, psychiatric liaison is important not only for patients with COVID-19 but also for COVID-19 survivors. Early assessment of COVID-19-related psychopathology is recommended so that treatment can be tailored as early as possible.

The Effect of Interleukin-2 -330 T/G Polymorphism in People with Schizophrenia Among The Batak and Javanese Ethnic Groups.

Background: Schizophrenia is a complex disorder involving multiple genes with mild to moderate effects and non-genetic risk factors such as environmental and psychological influences that alter brain chemistry. Significant reduction in interleukin-2 production by peripheral lymphocytes is an immunological finding replicated in schizophrenia across various countries. Investigations on the interleukin-2 -330 T/G polymorphism in people with schizophrenia (PWS) are still minimal, and the study location involves only a few countries with different results. Therefore, this study aims to examine the effect of interleukin-2 -330 T/G polymorphisms in people with schizophrenia among the Batak and Javanese ethnic groups in Indonesia, particularly in North Sumatra. Method: This study used purposive non-probability sampling to recruit people with schizophrenia with 120 Batak and 120 Javanese subjects who were hospitalized at Prof. M. Ildrem Mental Hospital, Medan, Indonesia. The interleukin-2 -330 T/G polymorphism was examined by the PCR method. Result: The results showed that the genotype frequency of the Batak people with schizophrenia is as follows: GG 11.7%, TG 53.3% and TT 35%. Furthermore, the group of Javanese people with schizophrenia is as follows: GG 23.3%, TG 44.2% and TT 32.5%. The OR for the genotypic comparison of GG was found to be 2.154 with 95% CI 0.992-4.678, p=0.053, while that of the TG genotype was 0.892 with 95% CI 0.505-1.574 and p=0.693. The T allele was higher than the G allele in Batak and Javanese ethnic groups, as demonstrated by p=0.713, OR=0.919 with 95% CI 0.641-1.318. Conclusion: There is no statistically significant difference between the occurrence frequency of alleles. In addition, there is no significant relationship between the GG and the TG genotype of the interleukin-2 - 330T/G polymorphism in people with schizophrenia among the Batak and the Javanese ethnic groups.

Psychotherapies for chronic kidney disease patients with hemodialysis: A systematic review of randomized control trials and quasi-experiments.

Chronic kidney disease (CKD) patients, especially those with hemodialysis, frequently struggle with mental health issues like anxiety and depression. Psychotherapy has been known to treat psychological problems, but its effectiveness in managing CKD patients is still rarely scientifically proven. The aim of this study was to analyze the role of psychological treatments in improving the mental health of CKD patients with hemodialysis. We comprehensively reviewed the related studies published in PubMed, Google Scholar, ScienceDirect, and Clinical Key over the last ten years, up to June 7, 2023. A keyword combination was used in the search engine strategies, and all articles about CKD patients receiving hemodialysis and psychotherapy were included. Based on the eligibility criteria, 716 patients were included in 13 out of 18,830 studies in the final analysis. Psychological problem was complained by 399 CKD patients. The psychotherapy included cognitive behavioral therapy (reported in four studies, n=4), diaphragmatic breathing relaxation (n=1), meditation (n=1), hypnotherapy (n=1), Kidney Optimal Health Program (KOHP) (n=1), psychological intervention (n=1), murottal Al-Qur'an therapy (n=3), and spiritual therapy (n=1). These interventions were performed once to four times a week, for ten minutes to five hours during hemodialysis for two to ten weeks. Meditation and KOHP showed no significant improvement in anxiety and depression. The remaining psychotherapies significantly improved the quality of life by reducing anxiety and depression in hemodialysis patients and enhancing sleep quality, self-esteem, hopefulness, medication adherence, and physical condition. In conclusion, psychotherapy should be considered in an interdisciplinary team to treat CKD patients comprehensively. Further studies are still necessary to determine the efficacy of each psychological intervention in CKD patients with psychiatric problems.

Validity and reliability of the Indonesian version of the Scale for the Assessment of Negative Symptoms.

Background: Negative symptoms have long been conceptualized as a core aspect of schizophrenia. Despite widespread recognition of the status of these symptoms as independent dimensions of schizophrenia, they are sometimes difficult to distinguish from depression or cognitive impairment. Therefore, objective assessment of schizophrenia symptoms is critical by obtaining a valid and reliable Indonesian version of the SANS instrument. This study aimed to determine the content validity, concurrent, internal consistency reliability, inter-rater, cut-off value, sensitivity, and specificity of the SANS instrument. Methods: This is a diagnostic study using the cross-sectional method to determine the relationship between the SANS and PANSS instruments on the negative symptom subscale. It was located at the Prof. Dr. M. Ildrem Mental Hospital of North Sumatera Province. Results: Of the 400 subjects, 67.5% were males, and the median age of the subjects was 37 years (18-45). The results of the content validity test were good (mean I-CVI=1.00), and the concurrent validity test comparing the SANS and PANSS instruments on the negative symptom subscale obtained significant results (p < 0.001) with a strong correlation (r = 0.763). Additionally, the consistency reliability test had a very high internal score (Cronbach alpha = 0.969), the overall inter-rater reliability test was "very good" (ICC = 0.985), and the cut-off value was 10.5 with sensitivity and specificity values of 72.9 and 77.9%, respectively. Conclusion: The Indonesian version of the SANS instrument is valid and reliable for measuring negative symptoms in people with schizophrenia in Indonesia.

Factors related to anxiety among resident doctors assigned to emergency room during the COVID-19 pandemic: a multivariate study at Sumatera Utara Affiliated Teaching Hospital.

Aim To evaluate and assess knowledge and perception, as well as factors related to the occurrence of anxiety among frontliners, especially resident doctors working in emergency room (ER). Methods This multivariate study was conducted with cross-sectional approach involving 80 eligible subjects (based on inclusion and exclusion criteria) that are consecutively assigned and assessed with GAD-7 questionnaire. The study was held in ER of Universitas Sumatera Utara affiliated teaching hospital from May to August 2020. Results Our study found that variables such as nuptial status (p=0.032), seniority level (p=0.037), history of direct exposure to COVID-19 patients (p=0.001) and weekly work duration(p=0.002) were all statistically significant to correlate with the occurrence of anxiety among resident doctors assigned to work in ER. Conclusion Acknowledgement of these factors might lead to proper and targeted support system strategies to address the anxiety issues among doctors, particularly those who work in ER during COVID-19 pandemic.

The level of tumour necrosis factor-alpha and its relationship to the cognitive function of Malayan-Mongoloid patients with schizophrenia.

Aim Schizophrenia is a mental disorder and one of the suspected causes is cytokines. One of them is tumour necrosis factor-alpha (TNF-α). Cytokines have the potential to affect cognitive function. The study aimed to find a correlation of TNF-α level with the Mini-Mental State Examination (MMSE) score in patients with schizophrenia (PwS), and comparing the level of TNF-α levels between PwS and healthy controls. Methods We conducted a cross-sectional analytic study and the study designs were correlation and comparative analysis, i.e. using a Mann-Whitney U test. A total number of 100 subjects were collected, and they were divided into two groups of PwS and control group, respectively. Results The results found that most of the PwS subjects were 39 men (78.0%), while the control group were 28 men (56.%). The differences in TNF-α levels between PwS and control groups were found to be significant p<0.001, there was no significant correlation between TNF-α level and the score of MMSE of the PwS with p = 0.938, with a very weak correlation that was r = -0.011, and a negative correlation direction. Conclusion There was a significant difference between TNF-α level of PwS and control group, i.e. PwS group had lower TNF-α level compared to the control group. The TNF-α level of PwS group had a very weak effect on the cause of cognitive dysfunction in PwS group, yet the higher level of it could reduce MMSE score in PwS group.

Screening of Anxiety and Depression Related CD4 Count of People Living with HIV/AIDS with Anti-Retroviral in Medan, Indonesia.

BACKGROUND: HIV, which causes AIDS, infects the immune system cells, by destroying or damaging the function of the CD4. PLWHA will have twice the risk of experiencing mental health disorders such as depression and anxiety compared with the general population, thereby suppressing immune function, decreasing their quality of life, decreasing the level of adherence to treatment, and contributing significantly to the occurrence of premature death. AIM: To determine the correlation Anxiety and Depression symptoms and CD4 levels in PLWHA who are undergoing Anti-Retroviral treatment at the HIV/AIDS. METHODS: The study was a cross-sectional study, which assesses the correlation between Hospital Anxiety and Depression Scale scores (HADS) and CD4 levels in PLWHA who are receiving ARV in the HIV/AIDS Special Services Polyclinic Medan Haji general hospital. RESULTS: It was found that the average HADS-A score, PLWHA was 15.286 and the SD ± 2.244. This shows that PLWHA is in moderate to severe anxiety and moderate to severe depression. The mean CD4 level of people with HIV/AIDS/PLWHA was 288.171 and SD ± 88.955. According to WHO criteria, regarding the classification of HIV immunodeficiency in adults, are classified as moderate immunodeficiency. There was a significant correlation between the HADS-A score and CD4 level with a correlation value of r = -0.592 indicating a negative correlation with a moderate correlation strength, and the correlation between HADS-D score and CD4 level. The strength of the relationship between HADS-D score and CD4 level is r = -0.650, shows a negative correlation with strong correlation strength. CONCLUSION: from this study, it was found that there is a relationship between depression and anxiety symptom and CD4 level.

The Effects of Brain Gym on Quality of Sleep, Anxiety in Elderly at Nursing Home Care Case Medan.

BACKGROUND: The ageing process of human will cause changes in anatomy and physiology. Biologically, ageing is associated with the gradual accumulation of various molecular and cellular damage. Disorders of sleep quality are influenced by several factors, such as the medical condition of illness, stress, anxiety, and others. Brain gym is a collection of simple movements that aim to connect or unite the mind and body. AIM: To find out the effect of brain gym in the quality of sleep and anxiety in the elderly at nursing home Karya Kasih Medan. SETTING AND DESIGN: This is an experimental pre and post-test design with non-probability consecutive sampling. METHODS: This study involved 68 elderly who undergone brain gym for eight weeks. These patients were recruited from the nursing home Karya Kasih Medan, Indonesia. This study was conducted in July-November 2018. This study was approved by the local ethical committee. The Pittsburgh Sleep Quality Index (PSQI) is used to assess sleep quality. Anxiety is assessed using the Hamilton Rating Scale for Anxiety (HARS). Data were analysed by paired t-test of SPSS version 22. RESULTS: PSQI score pre-test [mean (SD); 16.39 (0.68)] and post-test [mean (SD); 8.99 (0.89)], (p < 0.001). HARS score pre-test [mean (SD); 20.4 (6.7)] after post-test [mean (SD); 10.7 (5.2)], (p < 0.001). CONCLUSION: Brain gym increased the score level of the PSQI and HARS in the intervention group (p < 0.001).

The Comparison of Hospital Anxiety and Depression Scale-Anxiety Scores between Female Caregivers of People with Schizophrenia According to Gender Difference.

BACKGROUND: Caregiver plays an important role for a better outcome in people with schizophrenia, although it usually causes emotional distress for the caregiver. Anxiety is one of the emotional distress. Gender of schizophrenic patients is associated with the emotional distress of caregiver. The differences in HADS-A scores between female caregivers of people with schizophrenia according to gender in Indonesia remain unclear. AIM: To determine whether HADS-A scores are higher in a male group compare with the female group. METHODS: This study was an analytical study with a cross-sectional approach to determine the comparison of HADS-A score between 27 female caregivers of male schizophrenic patients (male group) and 27 female caregivers of female schizophrenic patients (female group) in Prof. Dr M. Ildrem Mental Hospital Medan, using a HADS rating scale. RESULTS: There is no difference between the male and female group in caregivers age, marital status, employment status, family income/month, education time, the relationship with people with schizophrenia, caring time, time spent / weeks, and the patients age, employment status, education time, PANSS score and number of relapses. The comparison between total HADS-A score between the male group and the female group is not significant with 9.52 ± 4.90 v 8.70 ± 4.49 (p = 0.53). CONCLUSION: HADS-A scores are not higher in caregivers of male with schizophrenia compared with caregivers of a female with schizophrenia.

Correlation between Visual Analogue Scale Score and Hospital Anxiety Depression Scale-Depression Score in Patients with Cervical Cancer in the Hospital Vina Cancer, Medan.

BACKGROUND: Makuza said that every year, 528 thousand new cases occur and approximately 266 thousand women die from cervical cancer. In cancer patients, the symptoms that are often experienced are a pain. The pain was found to be significantly associated with psychiatric disorders. The pain had a strong relationship with mood disorders in cancer patients. AIM: To determine the correlation between scores of Visual Analogue Scale (VAS) and Hospital Anxiety Depression Scale-Depression (HADS-D) in patients with cervical cancer in Vina Cancer Center Hospital in Medan. METHODS: This study was an analytical study with a cross-sectional approach to determine the correlation between VAS and HADS-D score between 34 female patients in cervical cancer at Vina Cancer Center Hospital in Medan. RESULTS: VAS was found to be moderate positively significant with HADS-D (p < 0.001, r = 0.59) in patients with cervical cancer in the Hospital Vina Cancer Medan. The value and direction of the correlation (r) VAS and HADS-D score is 0.59. The conclusion drawn value was (p) < 0.001. CONCLUSION: There is a significant correlation between VAS score and HADS-D score in cervical cancer patients, which shows that the higher the VAS score resulted in higher HADS-D scores.

Relationship between Internet Gaming Disorder with Depressive Syndrome and Dopamine Transporter Condition in Online Games Player.

BACKGROUND: Internet game playing is experiencing rapid growth in both youth and adult populations. The excess playing this game cause negative consequences, including game addiction. Internet Gaming Disorder is an increasingly prevalent disorder, which can have severe consequences in affected young people and their life. AIM: To observe the depressive syndrome and dopamine transporter condition (DAT) to find out the severity of internet gaming disorder. METHODS: To analyse the relationship between IGD and Depressive Syndrome and to analyse the relationship between IGD and DAT in online games player by using Spearman Rank Correlation Analysis. Depression testing is done by using the Patient Health Questionnaire-9 method (PHQ-9). The sample of the experiments of this research was 48 online games players in the internet cafe at Medan Area sub-district, which ages between 20 - 40 years old and have been playing games for at least 12 months. RESULTS: It was found that there was strong one-way relation (0.625) between IGD and PHQ-9 significantly (p < 0.01), however, it was found that strong enough (-0.465) relation between IGD and DAT (p < 0.01) and strong opposite relation (-0.680) between PHQ-9 and DAT (p < 0.01). CONCLUSION: There was a relationship between Internet Gaming Disorder (IGD) with depressive symptoms and Dopamine Transporter (DAT) level. PHQ-9 score was higher in people with a higher score of IGDS9-SF. As well as DAT level, there was opposite strong enough correlation between IGD and DAT that indicating the higher IGD score, the lower DAT level.

Screening of Mental Disorders Related CD4 Count of People Living with HIV/AIDS with Anti-Retroviral Treatment in Medan, Indonesia.

BACKGROUND: Mental disorders are the most common problems in the life of People Living with HIV/AIDS (PLWHA). The frequency in which HIV/AIDS and mental health problems co-exist, and the complex bi-directional relationship between them. Several biological, distress psychological and social dysfunction factors are associated with mental disorders in PLWHA. AIM: To analyse the relationship between the screening of mental disorders using General Health Questionnaire-12 scores and CD4 counts of People Living with HIV/AIDS with Anti-Retroviral Treatment. METHODS: This was a correlative analytical study with a cross-sectional approach using the General Health Questionnaire-12 (GHQ-12) instrument to assess screening mental disorders and the CD4 count. This research was conducted in February 2019 - April 2019 at an HIV/AIDS outpatient clinic. As many 33 subjects were divided into inclusion criteria; participant confirmed HIV seropositivity in stage II or III were undergoing ARV treatment, ranged in age between 25-49 years. The duration of HIV disease was ≤ four years, and the duration of ARV treatment was ≥ six months and informed consent to participate in the study. The patient who had mental disorders and currently drugs user was excluded from this study. RESULTS: There was an association found between change in CD4 and screening mental disorders at univariate analysis among the study participants, whether on antiretroviral treatment. The correlation between the total GHQ-12 scores as a screening of mental disorders and CD4 counts indicated to result in a significant negative correlation, r = -0.670 with p = 0.001. CONCLUSION: Screening mental disorders using General Health Questionnaire-12 from the results of this study shows that it is important to do for PLWHA because with low CD4 levels as biomarkers the progression of HIV infection affects psychological distress and social dysfunction in people living with HIV who have the potential for symptoms of mental disorders.

Postpartum Depression: A Case Report of Bedapu From Aceh Singkil.

BACKGROUND: Postpartum depression is a commonly occurring psychiatric disorder. Prevalence of postpartum depression varies across cultures and countries. Many factors affect, trigger, or aggravate post-partum depression, including sociocultural factor. Bedapu is a unique tradition from Aceh Singkil on post-partum mothers. CASE REPORT: We reported a case of two women with postpartum depression who performed Bedapu tradition on themselves. Edinburgh Postnatal Depression Scale (EPDS) was conducted for screening and DSM-5 as the determinant of diagnostic criteria. CONCLUSION: Postpartum depression has varying symptom spectrum, and Bedapu affected it by aggravating the symptoms of postpartum depression.

Internet Gaming Disorder (IGD): A Case Report of Social Anxiety.

BACKGROUND: Internet gaming disorder (IGD) has been included in the 5th edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5). At present, many cases are encountered because of the disruption of this internet game, including in various age groups. Internet gaming addiction is a common disorder and often accompanies depression, hostility and social anxiety. CASE REPORT: We found a case of anxiety disorder in people who play games on the network with the chief complaint that they cannot sleep. A 28-year-old man, a Javanese tribe with a job as a builder who came with his wife to the (Universitas Sumatera Utara) USU hospital psychiatric clinic. Experienced by the patient in about one year. CONCLUSION: From the above case, we report that internet gaming disorder occurs in all age groups and social statuses.

Expressed Emotion in a Woman with Bipolar Disorder: A Case Report from Deli Serdang.

BACKGROUND: Aretaeus of Cappadocia first described the bipolar disorder in 30 Masehi. Falret separated this disorder and called it folie circulaire in 1854. A bipolar patient had a change in mood from depression to mania and vice versa while having normal (euthymic) mood period in between. She experienced mood fluctuations that were typical of bipolar disorder. This case report was aimed to understand the personal experience of a bipolar patient confronting her mood changes and expressing their emotions. CASE REPORT: We presented a case of a 25year-old bipolar woman, makeup artist, unmarried, from Batak tribe. She came alone to seek treatment from a psychiatrist for her mood changes that she could not comprehend. CONCLUSION: We provided psychoeducation to help her recognise her bipolar disorder and direct her emotional expression to more positive things, in her case, makeup and writing.

Post-Dissociative Trance Disorder: Traditional Culture of Nini Pagar from Tigabinanga.

BACKGROUND: Dissociative Trance Disorder is uncommon, particularly in the eastern part of the world. Complexity and uniqueness of the symptoms, triggers, as well as the management strategy of this disease, make it an exceptional burden for the family. CASE REPORT: We reported a 17-year-old woman of a Karo descent who was admitted to Tiga Binanga Primary Health Center by her family due to frequent depressive mood, secluding herself, loss of interest, and frequent fatigue. The complaints persisted for about three weeks. The patient had a confirmed history of dissociative trance disorder known as trance or kesurupan in the local language. This condition is often linked to the local cultural tradition of Nini Pagar performed by the patient. There was neither a history of delusional thoughts, illusions, nor hallucinations. However, the eidetic image was evident. CONCLUSION: Nini Pagar, in this case, induces trans dissociative disorder and feature of this post dissociative trance disorder is moderate depression. We found that the eidetic image with sensorium is clear (compos mentis). Psychotherapy and pharmacotherapy were helping.

Phantom Pain Limb: A Case Report in a Soldier - Theory and Therapy.

BACKGROUND: Incidents in the form of unwanted things at work often occur, including civilians or officials. Like what happened during training at an Active on Duty Military Personnel (ADMP). The incident caused chronic disability and pain that we know as phantom pain limb. The frequency of "phantom pain limb" develops in individuals. Therefore, identifying the best method for treating PLP is very important. This review highlights the field of phantom pain-related investigations, focusing on PLP. CASE REPORTS: We found a case of phantom pain limb, in an Indonesia National Army or called Tentara Nasional Indonesia soldier who is still active; the OS is a referral from the neurology department. The OS was taken to the hospital because of complaints of previous leg pain and had received treatment. CONCLUSION: There are several promising therapies, pharmacology and others, for their treatment, and many theories have been developed to explain what we observe in patient amputations. However, we continue to lack clear evidence and explanation of the reasons that some individuals develop PLP, and some do not, why some pain subsides over time, and other PLPs still exist, and what molecular and biological mechanisms work.

An Anxiety Case Report with Murotal Alqur'an Approach in Woman Who Got Hemodialysis in Universitas Sumatera Utara Hospital, Medan.

BACKGROUND: Chronic renal failure (CRF) is a term used to describe a decrease in kidney function caused by irreversible damage. Until now, hemodialysis is the main alternative to replacement therapy for renal function in patients with chronic renal failure because of its lower cost and lower risk of bleeding when compared to peritoneal dialysis. The effects that are felt when undergoing hemodialyses, such as muscle cramps, hypotension, headache, nausea, and vomiting. The psychological impact felt by patients is anxiety. To overcome anxiety in patients undergoing hemodialysis, we need to provide relaxation therapy, one of which is murottal Al-Qur'an. The aim is to find out whether there is an effect of giving Murottal Al-Qur' to the anxiety level of hemodialysis patients in North Sumatra Hospital Medan. The instrument in the form of the Hamilton Rating Scale for Anxiety (HRS A). The conclusion, in this case, is that there is the effect of giving Murottal Al-Qur'an therapy to the anxiety level of hemodialysis patients in North Sumatra Hospital Medan. CASE REPORT: Mrs R 48-year-old female, Javanese tribe, Islamic religion, patient complains of palpitations, neck pain and a feeling of suffocation in the chest, anxiously felt by patients almost every day, even throughout the day, patients experience complaints when going through hemodialysis therapy, and the patient cannot cope so that the patient feels very agitated and uneasy, has difficulty sleeping at night and often wakes up, this complaint is experienced by patients 1 month and burdensome in the past 2 weeks. CONCLUSION: Overall, this case has several unique features, the problem of anxiety in patients undergoing hemodialysis and there is an effect of giving Murottal Al-Qur'an therapy to the anxiety level of hemodialysis patients at Medan North Sumatra Hospital.

Hypnotherapy: A Case of Anxiety Person Who Doesn't Want to Use Medication.

BACKGROUND: Anxiety disorder is the most common emotional disorder in the United States. At least 0.9%-1.9% of adult individuals in the United States show one disorder of anxiety in one year. Anxiety disorder is often unknown and carried out therapy in primary care. Hypnotherapy is a penetration of the critical factors of the conscious mind, followed by the acceptance of a suggestion/idea or thought that causes changes in the behaviour of the mental-emotional order. CASE REPORT: We got a case of anxiety disorder that could be cured with hypnotherapy treatment. A 45-year-old male from Batak tribe with complaints of feeling anxious and not cured because the sufferer always thinks his disease, inflammation of the stomach. Often, the anxiety arose when the patient felt weak, and the heart palpitated as he in dying condition. CONCLUSION: From this case, it can be found that patients who experience anxiety disorders (anxiety disorder) can recover without medical drugs but by using hypnotherapy.

Kuda Kepang: A Case Report of Javanese Cultural-Related Trance in Medan.

BACKGROUND: One of the works of Javanese culture is the kuda kepang. None of the historical records explains the origin of this dance. Kuda kepang or also called kuda lumping or jathilan. In the kuda kepang dance, the trance process takes place through the calling of the spirit or called endang through the songs that are played. In the International Classification of Disease Edition (ICD-10), it is called trance and possession disorders and in the Diagnostic and Statistical Manual of Mental Disorders five editions (DSM-5) it is included into Other Specified Dissociative Disorder. CASE REPORT: This is a case of the direct interview with the kuda kepang player, SI (30 years old), and HO (54 years old) both were the Javanese tribe as the owner of the kuda kepang art group called "Kesenian Tunas Baru" in Sukaraya Village, Kutalimbaru District. He was one of the music players in the arts. CONCLUSION: The traditional performance of kuda kepang is a change and innovation that characterises the traditional art world where kuda kepang performances are truly sacred events and now become extraordinary and can be performed. In this case, it appears when the magical side is in the trance condition; this trance can be performed.