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The Nexus of Neuroinflammation and Psychopathology in Neuropsychiatric Systemic Lupus Erythematosus (NPSLE): A Meta-Analysis of Anti-NMDAR, Anti-Ribosomal P Antibodies, and Psychosomatic Manifestations (Depression, Anxiety, Cognitive Dysfunction) Anggi Setiawan; Arina Widya Murni
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1357

Background: Neuropsychiatric systemic lupus erythematosus (NPSLE) significantly impacts patients through diverse neurological and psychiatric symptoms, including prevalent psychosomatic manifestations like depression, anxiety, and cognitive dysfunction. Specific autoantibodies, such as anti-N-methyl-D-aspartate receptor (anti-NMDAR) and anti-ribosomal P protein (anti-RP) antibodies, are implicated in its complex neuroinflammatory pathogenesis. This meta-analysis aimed to quantitatively assess the association between these autoantibodies and these key psychosomatic outcomes in NPSLE. Methods: A systematic literature search of PubMed, EMBASE, Scopus, and PsycINFO (2014-2024) identified observational studies reporting on anti-NMDAR or anti-RP antibodies and depression, anxiety, or cognitive dysfunction in adult NPSLE patients. Data from six eligible studies (850 patients) were extracted and quality was assessed. Pooled odds ratios (ORs) or standardized mean differences (SMDs) were calculated using a random-effects model, with heterogeneity and publication bias evaluated. Results: Anti-NMDAR antibody positivity was significantly associated with increased odds of cognitive dysfunction (OR = 2.85, 95% CI = 1.90-4.28). Anti-RP antibody positivity was significantly linked to increased odds of depression (OR = 3.20, 95% CI = 2.15-4.76) and anxiety (OR = 2.50, 95% CI = 1.65-3.78). Moderate heterogeneity was noted for some analyses. Conclusion: This meta-analysis highlights distinct associations: anti-NMDAR antibodies with cognitive dysfunction, and anti-RP antibodies with depression and anxiety in NPSLE. These findings underscore the potential role of these autoantibodies in specific psychosomatic symptom clusters, guiding further research and clinical consideration in NPSLE management.

Opioid Rotation vs. Dose Titration in Refractory Cancer Pain: A Meta-Analysis of Efficacy and Adverse Events Arina Widya Murni; Dian Arfan As Bahri; Widya Deli Satuti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1375

Background: The management of refractory cancer pain represents a formidable clinical challenge at the intersection of oncology and palliative medicine. When patients with advanced malignancy fail to achieve adequate analgesia or develop intolerable adverse effects from their opioid regimen, clinicians are faced with a crucial decision: to escalate the dose of the current opioid (dose titration) or to switch to a different opioid agent (opioid rotation). The optimal strategy remains a subject of intense debate and variable practice. This meta-analysis was conducted to rigorously compare the efficacy and safety of these two common interventions. Methods: A systematic and comprehensive search was performed in the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases for randomized controlled trials (RCTs) published between January 2015 and December 2024. We included studies that directly compared opioid rotation with dose titration in adult palliative care patients diagnosed with refractory cancer pain. The primary efficacy outcome was the change in pain intensity, analyzed using the Standardized Mean Difference (SMD) to accommodate pain scales such as the Numerical Rating Scale (NRS) and Visual Analogue Scale (VAS). Primary safety outcomes were the incidence of severe neurotoxicity and severe constipation. Data were pooled using a random-effects model, and results were expressed as SMD for the continuous pain outcome and Risk Ratio (RR) for dichotomous adverse events, with corresponding 95% confidence intervals (CI). Results: Seven RCTs, encompassing a total of 962 patients, met the stringent inclusion criteria. The pooled analysis revealed that the strategy of opioid rotation resulted in a statistically significant and clinically substantial greater reduction in pain intensity compared to continued dose titration (SMD -0.65, 95% CI [-0.88, -0.42], p<0.00001; I²=81%). Furthermore, the risk of developing severe neurotoxicity, including delirium and myoclonus, was significantly lower in the rotation group (RR 0.62, 95% CI [0.45, 0.85], p=0.003; I²=18%). There was no statistically significant difference in the incidence of severe constipation between the two intervention groups (RR 0.90, 95% CI [0.71, 1.14], p=0.38; I²=24%). Conclusion: In patients with refractory cancer pain, the strategy of opioid rotation provided superior analgesia and was associated with a markedly lower risk of severe neurotoxicity when compared to the continued dose titration of the same opioid. These findings provide strong, high-level evidence to support the use of opioid rotation as a primary and proactive strategy for managing uncontrolled pain or dose-limiting side effects in the palliative care population.

The Nexus of Neuroinflammation and Psychopathology in Neuropsychiatric Systemic Lupus Erythematosus (NPSLE): A Meta-Analysis of Anti-NMDAR, Anti-Ribosomal P Antibodies, and Psychosomatic Manifestations (Depression, Anxiety, Cognitive Dysfunction) Anggi Setiawan; Arina Widya Murni
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1357

Background: Neuropsychiatric systemic lupus erythematosus (NPSLE) significantly impacts patients through diverse neurological and psychiatric symptoms, including prevalent psychosomatic manifestations like depression, anxiety, and cognitive dysfunction. Specific autoantibodies, such as anti-N-methyl-D-aspartate receptor (anti-NMDAR) and anti-ribosomal P protein (anti-RP) antibodies, are implicated in its complex neuroinflammatory pathogenesis. This meta-analysis aimed to quantitatively assess the association between these autoantibodies and these key psychosomatic outcomes in NPSLE. Methods: A systematic literature search of PubMed, EMBASE, Scopus, and PsycINFO (2014-2024) identified observational studies reporting on anti-NMDAR or anti-RP antibodies and depression, anxiety, or cognitive dysfunction in adult NPSLE patients. Data from six eligible studies (850 patients) were extracted and quality was assessed. Pooled odds ratios (ORs) or standardized mean differences (SMDs) were calculated using a random-effects model, with heterogeneity and publication bias evaluated. Results: Anti-NMDAR antibody positivity was significantly associated with increased odds of cognitive dysfunction (OR = 2.85, 95% CI = 1.90-4.28). Anti-RP antibody positivity was significantly linked to increased odds of depression (OR = 3.20, 95% CI = 2.15-4.76) and anxiety (OR = 2.50, 95% CI = 1.65-3.78). Moderate heterogeneity was noted for some analyses. Conclusion: This meta-analysis highlights distinct associations: anti-NMDAR antibodies with cognitive dysfunction, and anti-RP antibodies with depression and anxiety in NPSLE. These findings underscore the potential role of these autoantibodies in specific psychosomatic symptom clusters, guiding further research and clinical consideration in NPSLE management.

Opioid Rotation vs. Dose Titration in Refractory Cancer Pain: A Meta-Analysis of Efficacy and Adverse Events Arina Widya Murni; Dian Arfan As Bahri; Widya Deli Satuti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1375

Background: The management of refractory cancer pain represents a formidable clinical challenge at the intersection of oncology and palliative medicine. When patients with advanced malignancy fail to achieve adequate analgesia or develop intolerable adverse effects from their opioid regimen, clinicians are faced with a crucial decision: to escalate the dose of the current opioid (dose titration) or to switch to a different opioid agent (opioid rotation). The optimal strategy remains a subject of intense debate and variable practice. This meta-analysis was conducted to rigorously compare the efficacy and safety of these two common interventions. Methods: A systematic and comprehensive search was performed in the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases for randomized controlled trials (RCTs) published between January 2015 and December 2024. We included studies that directly compared opioid rotation with dose titration in adult palliative care patients diagnosed with refractory cancer pain. The primary efficacy outcome was the change in pain intensity, analyzed using the Standardized Mean Difference (SMD) to accommodate pain scales such as the Numerical Rating Scale (NRS) and Visual Analogue Scale (VAS). Primary safety outcomes were the incidence of severe neurotoxicity and severe constipation. Data were pooled using a random-effects model, and results were expressed as SMD for the continuous pain outcome and Risk Ratio (RR) for dichotomous adverse events, with corresponding 95% confidence intervals (CI). Results: Seven RCTs, encompassing a total of 962 patients, met the stringent inclusion criteria. The pooled analysis revealed that the strategy of opioid rotation resulted in a statistically significant and clinically substantial greater reduction in pain intensity compared to continued dose titration (SMD -0.65, 95% CI [-0.88, -0.42], p<0.00001; I²=81%). Furthermore, the risk of developing severe neurotoxicity, including delirium and myoclonus, was significantly lower in the rotation group (RR 0.62, 95% CI [0.45, 0.85], p=0.003; I²=18%). There was no statistically significant difference in the incidence of severe constipation between the two intervention groups (RR 0.90, 95% CI [0.71, 1.14], p=0.38; I²=24%). Conclusion: In patients with refractory cancer pain, the strategy of opioid rotation provided superior analgesia and was associated with a markedly lower risk of severe neurotoxicity when compared to the continued dose titration of the same opioid. These findings provide strong, high-level evidence to support the use of opioid rotation as a primary and proactive strategy for managing uncontrolled pain or dose-limiting side effects in the palliative care population.

Hubungan Faktor Psikologis dengan Atrium Fibrilasi: Suatu Tinjauan Kepustakaan Murni, Arina Widya; Fadella, Annesa
Jurnal Penyakit Dalam Indonesia
Publisher : UI Scholars Hub

Show Abstract | Download Original | Original Source | Check in Google Scholar

Psychological factors influence the onset of cardiac rhythm and dysrhythmia disorders, including atrial fibrillation (AF), which is defined as uncoordinated atrial activation resulting in ineffective contractions. Psychological factors have a bidirectional relationship with AF, as AF symptoms can lead to a decline in mental health, which in turn negatively affects the clinical course. One explanation for how psychological stress impacts the heart and contributes to AF involves the autonomic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. Anxiety and depression are common comorbidities in AF. These conditions can be assessed using standardized instruments, such as the Hospital Anxiety and Depression Scale (HADS), which includes subscales for anxiety (HADS-A) and depression (HADS-D). Additionally, the Beck Depression Inventory (BDI) can be used to assess depression, while the State-Trait Anxiety Inventory (STAI) is useful for evaluating anxiety. Management of psychosomatic disorders requires a bio-psycho-socio-spiritual approach, involving both non-pharmacological and pharmacological therapies. Key components include somatic or symptomatic therapy, psychotherapy or sociotherapy, and psychopharmacotherapy, with the choice of method depending on various factors. In AF patients, treatment of psychological stress, anxiety, and depression generally prioritizes non-pharmacological approaches, such as supportive psychotherapy. If necessary, short-term use of benzodiazepines as anti-anxiety medication can be considered. In cases requiring antidepressants, newer agents such as selective serotonin reuptake inhibitors (SSRIs) are preferred, with close monitoring of heart rhythm due to the potential arrhythmogenic effects of certain medications, especially non-selective antidepressants.

Hubungan Kualitas Hidup dengan Gejala Depresi pada Pasien Artritis Reumatoid di RSUP Dr. M. Djamil Padang Gina Matahati; Siti Nurhajjah; Arina Widya Murni
Jurnal Ilmu Kedokteran dan Kesehatan Indonesia Vol. 5 No. 2 (2025): Juli: Jurnal Ilmu Kedokteran dan Kesehatan Indonesia
Publisher : Pusat Riset dan Inovasi Nasional

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55606/jikki.v5i2.5877

Rheumatoid arthritis (RA), as an autoimmune disease with a chronic inflammatory nature, can decrease quality of life, with depression in RA patients being one of the factors influencing the determination of quality of life. The purpose of this study was to determine the relationship between depression and the quality of life of RA patients at RSUP Dr. M. Djamil Padang. The type of research used is analytical case-control study. There were 60 samples consisting of 20 people with depressive symptoms in the case group and 40 people without depressive symptoms in the control group. The data analysis used was the Chi-Square correlation test. The results of this study showed female respondents, late adult age, and duration of illness less than five years were characteristics of most of the respondents of this study. Analysis with the Chi-Square test showed an association (p<0.05) between the quality of life of the emotion domain (p=0.000) and depressive symptoms in RA patients. Meanwhile, there was no association (p>0.05) between the quality of life of patients in the domains of physical function (p=1.000), physical role (p=0.208), pain (p=0.151), general health (p=0.308), social function (p=0.195), vitality (p=0.389), and mental health (p=0.255) with depressive symptoms in RA patients. To sum up, there is a correlation between depression and the emotion domain of QoL of RA patients but there is no correlation between depression and the physical function, physical role, pain, general health, social function, vitality, and mental health domain of QoL of RA patients.

Experiences of Breast Cancer Patients with Acute Skin Toxicity Undergoing Radiotherapy Agustin, Nia Mitra; Murni, Arina Widya; Huriani, Emil
Indonesian Journal of Global Health Research Vol 6 No 6 (2024): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v6i6.3861

Radiotherapy for breast cancer has been proven to be highly effective, able to significantly reduce the risk of recurrence and lower the risk of death in the long term. However, behind these great benefits, there are side effects that need to be considered, such as skin toxicity, which can have a significant impact on the patient's physical and psychological condition. Therefore, it is necessary to review various literature to determine the various experiences of breast cancer patients with acute skin toxicity who underwent radiotherapy. Objective: To explore and analyze the experiences of breast cancer patients with acute toxicity undergoing radiotherapy through the literature. Method: Search for articles using the keywords acute skin toxicity AND breast cancer AND experience AND radiotherapy. Articles were searched through three online databases, namely sciencedirect (n = 43 articles), pubmed (n = 38 articles), and proquest (n = 32 articles). A total of 113 articles were collected through the data base. Through three screening processes that met the criteria, 4 articles were obtained. Results: This study found an outline of the classification of themes that emerged, namely: physical, functional, psychological impacts, and prevention of skin disorders due to radiotherapy as well as knowledge of breast cancer patients regarding radiotherapy. It is hoped that the results of this research can contribute to improving health care by expanding the scope of services to not only cover physical problems but also non-physical.

Meningkatkan Kesediaan Merawat Orang Dengan HIV/AIDS (ODHA) Pada Perawat Puskesmas Dengan Menggunakan Metode A Brief Intervention: Improving the Willingness to Care for People with HIV/AIDS (PLWHA) Among Health Center Nurses Using the Brief Intervention Method Ari Athiutama; Arina Widya Murni; Tasman
NERS Jurnal Keperawatan Vol. 16 No. 2 (2020): NJK Volume 16, Number 2
Publisher : Fakultas Keperawatan Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/njk.v16i2.146

HIV/AIDS is a problem for health workers, especially nurses, which results in negative things such as the stigma of discrimination in health services so the treatment of PLWHA is being not optimal. The purpose of this study is to determine the effect of a brief intervention on the public health center nurses on the willingness to treat PLWHA. The design of this study is the Quasy Experiment Pre-Post Test With Control Group the sample is 48 nurses consisting of 24 nurses in the intervention group and 24 nurses in the control group selected by using total sampling techniques. Data were collected by using a nursing willingness questionnaire (NWQ) that was translated into Indonesian languages and analyzed using the paired sample t test and independent samples t test. The results showed there were differences in the willingness to care on pre and post-test intervention group (p value = 0.001) and there is difference in the willingness to care the intervention group and the control group (p value = 0.027). The conclusion of a brief intervention method is effective in increasing willingness to treat PLWHA on public health center nurses. A brief intervention method as an innovation method that can be used in public health center to share information, especially regarding willingness to treat PLWHA.

Terapi Mindfulness pada Functional Gastrointestinal Disorders Putra Rio, Yugo Berri; Murni, Arina Widya
Innovative: Journal Of Social Science Research Vol. 4 No. 2 (2024): Innovative: Journal Of Social Science Research
Publisher : Universitas Pahlawan Tuanku Tambusai

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/innovative.v4i2.9122

Functional Gastrointestinal Disorders (FGID) merupakan sekelompok gangguan yang ditandai dengan gejala gastrointestinal, diantaranya: sakit perut, disfagia, dispepsia, diare, sembelit, dan kembung tanpa adanya patologi, dan telah dibuktikan dengan pengujian konvensional. FGID umum terjadi di seluruh dunia dengan prevalensi 40% dan akan berdampak pada kesejahteraan dan kualitas hidup pasien. Gastrointestinal dapat berkaitan dengan stress dan emosi, sehingga penatalaksanaan FGID tidak hanya diarahkan pada gejala yang dialami pasien, namun juga menangani komponen perilaku.. Saat ini terdapat terapi terbaru yakni Mindfulness Based Therapy (MBT) yang menggunakan konsep meditasi dalam membantu pasien menumbuhkan kesadaran namun tidak menghakimi. Ini melibatkan pemantauan kognisi, emosi, persepsi, dan sensasi serta pengembangan non reaktivitas terhadap aspek yang sulit atau negatif dari pengalaman yang dimiliki. Oleh karena itu, Mindfulness Based Therapy dapat menurunkan reaktivitas terhadap pikiran, emosi, dan sensasi fisik yang menyebabkan menurunnya sensitivitas viseral dan meningkatkan kesejateraan pasien.

The Role of Antidepressants in a Malignancy Patient with Palliative Care: A Systematic Literature Review Yovanda, Ryandri; Arina Widya Murni; Widya Deli Satuti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 8 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i8.1051

Background: Depression is a common complication in malignancy patients, and can worsen their quality of life and prognosis. Palliative care aims to improve the quality of life of patients with life-limiting illnesses, and antidepressants are often used in this context. Methods: This systematic review was conducted to evaluate the effectiveness of antidepressants in malignancy patients with palliative care. A literature search was conducted in three databases: PubMed, Cochrane, and ScienceDirect. Search terms included “Antidepressants,” “Malignancies,” and “Palliatives.” Results: Two studies met inclusion criteria: First study: Randomized controlled clinical trial evaluating the effectiveness of mirtazapine compared with escitalopram in malignant patients with depression. The results showed that mirtazapine was more effective in improving quality of life and reducing depressive symptoms compared with escitalopram. Second study: a study evaluating the effectiveness of antidepressants in elderly malignancy patients with depression. The results suggest that antidepressants may be effective in reducing depressive symptoms and improving quality of life, but further research is needed to confirm their effectiveness and safety. Conclusion: Available evidence suggests that antidepressants may be effective in treating depression in malignancy patients with palliative care. However, further research is needed to identify the most effective and safe antidepressants for this patient population.

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