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.

Relationship between Caregiver Burden and Expressed Emotion in Families of Schizophrenic Patients.

BACKGROUND: Schizophrenia is a clinical syndrome that is variable, but highly disturbing; its psychopathology involves cognition, emotion, perception, and other aspects of behaviour. Schizophrenic patients who are hospitalised, who return to a family environment characterised by high levels of criticism, excessive emotional involvement, or hostility (referred to as high expressed emotion) are more likely to experience the recurrence than schizophrenic patients returning to families characterised by low expressed emotion. AIM: We aimed to investigate the level of care load in the families of schizophrenic patients. METHODS: This research is an analytic study with a cross-sectional approach. The research site is in the outpatient installation of BLUD Mental Health Hospital of North Sumatra Province using consecutive non-probability sampling. The samples are family members who carry schizophrenic patients go to an outpatient installation at the BLUD Mental Health Hospital of North Sumatra Province that meets the inclusion and exclusion criteria. RESULTS: The burden of care for the families of the most schizophrenic patients was mid load as many as 36 people, namely 36%, the light burden of 34 people, 34%, no burden of 18 people, 18%, and the heavy burden of 12 people, 12%. There is a significant relationship between the burden of treatment with expressed emotion, which is 0.004 (p < 0.05). CONCLUSION: In this study, we showed a significant relationship between the burden of treatment with expressed emotion (p = 0.004). This study is by the study conducted by Darwin in 2013, and Carra in 2012, which showed that there was a significant relationship between the burden of treatment with expressed emotion in the families of schizophrenic patients. Other studies also show that the burden of care has an impact on emotional, physical health, social life, and financial status as a result of caring for sick people.

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 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.

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.

The Correlation Between the Level of Anxiety According to the Hospital Anxiety and Depression Scale-Anxiety Subscale with the Duration of Illness, the Age of the Caregiver, and the Age of First Illness in the Biological Mother Who Takes Care of Boys with Schizophrenia.

BACKGROUND: Caregivers are often described as forgotten patients, and adverse effects are often reported by family caregivers, including anxiety in treating schizophrenic patients. In most cases, it is the mother who takes almost all responsibilities for caring for the patient with schizophrenia. From another study, Mothers showed the highest-burden, followed by fathers and other caregivers. AIM: To find out the correlation between the level of anxiety according to the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) with the duration of illness, the age of the caregiver, and the age of first illness in the biological mother who take care of boys with schizophrenia. METHODS: This study is an Observational Analytical study with a cross-sectional approach. By interviewing 68 mothers who take care of boys with schizophrenia at the Prof Ildrem Mental Hospital Medan using the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A). RESULTS: This study found a significant association between the level of anxiety according to the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) and the age of caregivers in biological mothers who care for boys with schizophrenia (p = 0.019), odds ratio (OR) 12,073 (95 %CI 2.252-64.715). This study also found no association between the level of anxiety according to the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) and the duration of illness in the biological mother who cared for boys with schizophrenia (p = 0.736). There was no association between the level of anxiety according to the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) with age of first illness schizophrenia in the biological mother who cared for boys with schizophrenia (p = 0.068). CONCLUSION: Possibility (odds) is found that the age of caregiver < 45 years old is more likely to have anxiety level according to the Hospital Anxiety and Depression Scale - Anxiety subscale (HADS-A) 12,073 worse compared to the age of caregiver ≥ 45 years old.

Differences in Total Score of Positive and Negative Syndrome Scale between Bataknese and Javanese Men with Schizophrenia Receiving Risperidone Treatment.

BACKGROUND: Schizophrenia is a psychopathological syndrome clinic involving cognition, emotion, perception and other aspects from the individual which interferences. This interference is normally started before age 25, and it can affect all social classes. AIM: To find out the difference in total positive and negative syndrome scale (PANSS) scores in schizophrenia between Bataknese and Javanese who have received treatment with risperidone. METHODS: This study is a prospective study. This study used numeric comparative analytic two unpaired groups to observe the differences of PANSS score of the man with schizophrenia between Bataknese and Javanese who had received risperidone treatment. RESULTS: Our study found that the average score of PANSS for Bataknese was 49.76 ± 12.65 and Javanese was 42.43 ± 9.05. CONCLUSION: There was a difference score of PANSS for the man with schizophrenia between Bataknese and Javanese who had received risperidone treatment for 6 weeks (p = 0.037).

Brain-Derived Neurotropic Factor Serum Level and Severity Symptom of Bataknese Male Patients with Schizophrenia in North Sumatera, Indonesia.

BACKGROUND: Schizophrenia is a severe mental disorder that is multi-causative and multi-factor, generally affecting about 1% of the population. The elevation level of brain-derived neurotrophic factor (BDNF) offers several protections from other neurodegenerative processes that occur in schizophrenia since this deficit of neurotrophic factors can contribute to changes in brain structure and function that underlie the schizophrenia psychopathology. AIM: To analyse the correlation between BDNF serum levels and symptom severity by using the Positive and Negative Syndrome Scale (PANSS) instrument in Bataknese male patients with schizophrenia. METHODS: This study was a correlative analytical study with a cross-sectional approach using the Positive and Negative Syndrome Scale (PANSS) instrument to assess symptom severity with 60 subjects of Bataknese male patients with chronic schizophrenia. Moreover, this research was conducted at the Psychiatric Hospital of Prof. Dr M. Ildrem Medan, Indonesia. BDNF serum was analysed with the Quantitative sandwich enzyme immunoassay technique by via Quantikine ELISA Human CXCL8/IL-8 HS. Also, the data analysis was performed through Spearman's correlative bivariate analytics using SPSS software. RESULTS: A negative correlation between the BDNF serum level and the negative scale PANSS score in men with schizophrenia (r = -0.820, p < 0.001) was found. Moreover, there is a negative correlation between BDNF serum levels and PANSS total scores in men with schizophrenia (r = -0.648, p < 0.001). CONCLUSION: BDNF serum level in Bataknese male patients with schizophrenia has a relationship that affects the severity of symptoms in schizophrenic patients, especially for negative symptoms.

The Indonesian Version of Montreal Cognitive Assessment (MoCA-Ina): The Difference Scores Between Male Schizophrenia Prescribed by Risperidone and Adjunctive of Donepezil in Public Hospital of Dr Pirngadi Medan, Indonesia.

BACKGROUND: Prescribing donepezil as an addition in reducing the cognitive dysfunctions among schizophrenia patients that have been given by antipsychotic (risperidone and olanzapine) is commonly used. Also, to determine the presence of the dysfunctions, an assessment is conducted by Montreal Cognitive Assessments based on Indonesian version (MoCA-Ina) to provide a more understandable test. AIM: To determine the score differences of MoCA-Ina between male patients of schizophrenia prescribed with only risperidone, and those with the addition of Donepezil within a certain interval of times. SETTINGS AND DESIGN: It is a pre-post-test experimental design with non-probability of consecutive sampling. METHODS: The study involved 48 of schizophrenia patients who have been prescribed fixed dose risperidone for 4 mg/day orally, and 24 people who were the intervention group were prescribed with the additional of 5 mg of donepezil per day started from the first until sixth week, followed by the increased dosages to 10 mg until twelfth week. These patients were recruited from the Public Hospital of Dr Pirngadi Medan, Indonesia, under the Department of Psychiatry. Then, the statistical data were analysed by Mann Whitney U, Friedman, and Wilcoxon, followed by analysing of SPSS version 21. RESULTS: The addition of five mg of Donepezil increased the MoCA-Ina score significantly compared to those who only prescribed with risperidone during all weeks of observation. CONCLUSION: Based on the results, the addition of donepezil increased the score level of the MoCA-Ina in the intervention group.

The Difference of Fasting Blood Sugar of Male Patients with Schizophrenia Treated with Flexible Dose between Aripiprazole and Risperidone in Medan, Indonesia.

BACKGROUND: Life expectancy among schizophrenic patients is 20% shorter than the general population. Currently, long-term use of antipsychotic drugs can induce metabolic symptoms, including weight gain, glucose intolerance, high blood glucose. AIM: This research aimed to investigate the fasting blood sugar level of a male patient with schizophrenia treated with flexible dose. METHODS: This research is an experimental study, unpaired numerical comparative analytic with non-probability consecutive sampling by recruiting 50 research subjects of men with male patients with schizophrenia. Every 25 people were treated with aripiprazole, and another 25 subjects were treated with risperidone. The flexible dose on how doses are equated with bioequivalent doses between aripiprazole and risperidone was applied. Sampling was carried out in the inpatient and outpatient clinic of the psychiatric hospital Prof. Dr M. Ildrem Medan, North Sumatra, Indonesia, in a span of 6 months from January 2018 to July 2018. The diagnostic test used a Mini structured interview system International Statistical Classification of Diseases-10 (Mini-ICD 10) and the statistical analysis was involving Mann Whitney U Test. RESULTS: This research showed the mean of fasting blood sugar level in week 8 in the group receiving treatment with aripiprazole was 88.96 with a standard deviation of 4.33 and in the group receiving risperidone treatment was 102.80 with a standard deviation of 2.92. The results of the analysis using unpaired t-test in the two groups showed a significant difference in fasting blood sugar levels for men with schizophrenia in the group receiving aripiprazole treatment and the group receiving risperidone treatment in week 8 with a value of p < 0.001 (p < 0.05). CONCLUSION: This research revealed that based on the equivalence of risperidone and aripiprazole dosage given to the male patients with schizophrenia, the treatment using risperidone can significantly increase the fasting blood sugar level compared to the aripiprazole treatment in week 8.

Affective Psychopathology Towards the Quality of Life of Breast Cancer Patients with Radiotherapy in Medan, Indonesia.

BACKGROUND: Cancer has to become the scariest disease and tends to reduce the quality of life of the patient. Therefore, it is not only a medical treatment that needs to be conducted but also a psychological treatment. AIM: to analyse the relationship between affective psychopathology and the quality of life of breast cancer patients who are receiving radiotherapy treatment. METHODS: This research was a correlative analytical study with a cross-sectional approach using the Hospital Anxiety and Depression Scale (HADS) instrument to assess psychopathological features and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) to determine the quality of life. This research was conducted in March 2016-July 2016 at Vina Estetika Cancer Center Hospital, Medan, Indonesia. As many as 47 subjects were divided into two criteria; Inclusion criteria, participants with breast cancer who were undergoing radiotherapy, aged over 18 years, with HADS score ≥ 17, and the exclusion criteria, were patients suffering from chronic psychiatry diseases. RESULTS: Affective psychopathology was indicated to result in a significant negative correlation with the quality of life of breast cancer patients which whom were treated with radiotherapy with p = 0.035 and r = -0.267. This suggests that with a higher HADS, a decrease in quality of life will occur. CONCLUSIONS: Affective psychopathological comorbidities have a great influence on the quality of life of patients who are undergoing radiotherapy. Thus, cancer management must include screening for psychopathological morbidity. Moreover, psychological rehabilitation must also be provided along with the cancer treatment.

Indonesian Version of Addiction Rating Scale of Smartphone Usage Adapted from Smartphone Addiction Scale-Short Version (SAS-SV) In Junior High School.

BACKGROUND: The increase of smartphone user among Indonesian junior high school students, particularly for teenagers, indicates the addiction factor of the smartphone. AIM: This research is designed to adapt the Smartphone Addiction Scale-Short Version (SASS-SV) to Indonesian version based on cultural adaptation of the rating scale. METHODS: This study involves 300 participants consisted of 151 of male children and 149 female children with an average age is 13.27 years-of-old. The validity of concurrent was used to obtain the validity, while the internal consistency and Receiver Operating Characteristic (ROC) were conducted to confirm the reliability of the rating scale. RESULTS: In purpose to measure internal consistency, the Cronbach alpha has been applied. The Cronbach alpha value was 0.740, and Concurrent validity was checked to NMP the Nomophobia Questionnaire (NMP-Q) based on Indonesian version. The analysis of ROC showed that the value of Area under the Curve (AUC) was 0.997 (0.990-1.000), with cut-off value accounted for ≥ 32, a sensitivity value of 0.91 and specificity value was 0.973 for the male children. On the hand of female children, the results showed similarity with the AUC was 0.996 (0.998-1.000), and the cut-off, sensitivity and specificity values were accounted for ≥ 34, 0.91, and 0.974 respectively. CONCLUSION: The Indonesian version of SAS-SV provided acceptable validation results as well as the reliability, and this version can be used to evaluate the smartphone addiction in Indonesia.

Sociological and Psychological Factors on Prohibited Substances Abuse in Rehabilitation Centre of Medan City, Indonesia.

INTRODUCTION: Prohibited substances issue and their abuse have become a scourge for people in Indonesia. This situation creates concern for every level of society since this is very influential to damage and can even eliminate generations at a later time. AIM: This study aims to determine the characteristics of age, education, psychological and social problems related to substance dependence experienced by individuals with substance disorders who undergo rehabilitation in Medan, Indonesia. METHODS: This study is a cross-sectional analytic, in which the sample of this study was individuals who underwent rehabilitation in the Rehabilitation Center in Medan City who fulfilled the inclusion and exclusion criteria. A structured interview was carried out with the MINI ICD-10 on part M. disorders related to psychoactive substances. Furthermore, to see the level of dependence, WHO ASSIST questionnaire (The Alcohol, Smoking and Substance Involvement Screening Test) was used. RESULTS: This study discovered that subjects with age above 21 years were the most dominant of the prohibited substance users group as many as 87 people (69%), Batak tribe with 73 people (57.9%), residence originating from outside the city with 70 people (55.6%), Unmarried with 87 people (70.2%), education level is medium (junior high school) with 117 people (92.9%) and work as many as 77 people (61.1%). The study also found that the most dominant number of prohibited substances users were single users of methamphetamine and a combination of two substances, each of which was 49 people (38.9%). There is no relationship between social factors and patterns of prohibited substance use. Also, the most dominant users of prohibited substances who undergo rehabilitation are those based on family and police (involuntary admission). Finally, as many as 70 people used methamphetamine require intensive intervention. CONCLUSION: This study shows that social and demographic factors are not related to the pattern of prohibited substance use.