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All Journal E-Jurnal Medika Udayana Poltekita : Jurnal Ilmu Kesehatan Indonesian Journal of Global Health research JUNCTO: Jurnal Ilmiah Hukum CENDEKIA : Jurnal Ilmu Pengetahuan PAEDAGOGY : Jurnal Ilmu Pendidikan dan Psikologi KNOWLEDGE: Jurnal Inovasi Hasil Penelitian dan Pengembangan HEALTHY: Jurnal Inovasi Riset Ilmu Kesehatan Journal of Law, Poliitic and Humanities Jurnal Hasil Penelitian dan Pengembangan (JHPP)
Luh Nyoman Alit Aryani, Luh Nyoman Alit
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Journal : CENDEKIA : Jurnal Ilmu Pengetahuan

 1 
DELIRIUM PADA ENSEFALOPATI HEPATIK STADIUM LANJUT DENGAN RIWAYAT PENGGUNAAN METAMFETAMIN: TANTANGAN DIAGNOSTIK DAN TERAPI Nahusona, Gladya Florenscia Anggelly; Aryani, Luh Nyoman Alit
CENDEKIA: Jurnal Ilmu Pengetahuan Vol. 5 No. 3 (2025)
Publisher : Pusat Pengembangan Pendidikan dan Penelitian Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51878/cendekia.v5i3.6612

Abstract

Delirium is an acute neuropsychiatric condition characterized by disturbances in consciousness, attention, and cognition, which often develops over a short period due to serious medical conditions, including hepatic encephalopathy. Advanced-stage hepatic encephalopathy (stage III–IV) is typically associated with liver cirrhosis and elevated ammonia levels, and may be precipitated by factors such as infection, gastrointestinal bleeding, or psychoactive substance use. We report a case of delirium in a patient with stage III hepatic encephalopathy and a history of methamphetamine use under a harmful use pattern, currently in early remission. The coexistence of systemic metabolic dysfunction due to liver failure and the neurotoxic effects of stimulant abuse complicates the clinical presentation and management. Comprehensive clinical, psychiatric, and toxicological assessment is essential for accurate diagnosis. Management includes supportive therapy for hepatic encephalopathy, addiction-focused psychiatric care, and family education. This case underscores the importance of interdisciplinary collaboration in managing delirium in patients with comorbid substance use disorders, and emphasizes the need for a biopsychosocial approach to long-term recovery planning. ABSTRAKDelirium merupakan gangguan neuropsikiatri akut yang ditandai oleh gangguan kesadaran, perhatian, dan kognisi, yang dapat berkembang dalam waktu singkat akibat berbagai kondisi medis serius, termasuk ensefalopati hepatik. Ensefalopati hepatik stadium lanjut (stadium III–IV) sering kali berkaitan dengan sirosis hati dan peningkatan kadar amonia, serta dapat diperberat oleh faktor presipitasi seperti infeksi, perdarahan saluran cerna, dan penggunaan zat adiktif. Kami melaporkan kasus seorang pasien dengan delirium et causa ensefalopati hepatik stadium III yang juga memiliki riwayat penggunaan metamfetamin dengan pola penggunaan yang merugikan (harmful use) dan berada dalam masa remisi awal. Kombinasi antara gangguan metabolik sistemik akibat disfungsi hepatik dan efek neurotoksik dari penggunaan stimulan memperumit perjalanan klinis pasien. Diagnosis memerlukan evaluasi menyeluruh secara klinis, psikiatrik, dan toksikologis. Penanganan melibatkan terapi suportif untuk ensefalopati, pendekatan psikiatri adiksi, serta edukasi keluarga. Laporan kasus ini menunjukkan pentingnya kolaborasi lintas disiplin dalam menghadapi kasus delirium pada pasien dengan komorbiditas gangguan penggunaan zat, serta perlunya pendekatan biopsikososial dalam perencanaan terapi jangka panjang.
FEAR OF BREATHING, FEAR OF DEPENDENCE: LAPORAN KASUS GANGGUAN ANXIETAS ORGANIK PADA PASIEN MYASTHENIA GRAVIS PASCATIMEKTOMI DENGAN KETERGANTUNGAN VENTILATOR Karouw, Grace Venny Febe; Kurniawan, Lely Setyawati; Aryani, Luh Nyoman Alit; Mahardika, I Komang Ana
CENDEKIA: Jurnal Ilmu Pengetahuan Vol. 5 No. 3 (2025)
Publisher : Pusat Pengembangan Pendidikan dan Penelitian Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51878/cendekia.v5i3.6613

Abstract

Patients with Myasthenia Gravis (MG) undergoing thymectomy are at risk of developing postoperative respiratory complications requiring mechanical ventilation. This dependence may lead to severe paradoxical anxiety, characterized by both fear of breathing (anxiety about ventilator removal) and fear of dependence (fear of lifelong reliance on mechanical support). This narrative review analyzed recent literature from the past decade, focusing on neuropsychiatric perspectives of ventilator dependence in MG patients. Fear of breathing involves hyperactivation of brain structures such as the amygdala and insular cortex, resulting in anticipatory dyspnea. Fear of dependence stems from existential anxiety linked to loss of autonomy and identity, mediated by dysregulation in the ventromedial prefrontal cortex and default mode network. These fears contribute to a maladaptive cycle involving learned helplessness and avoidance behavior. Early psychiatric evaluation, cognitive behavioral therapy (CBT), and low-dose SSRI pharmacotherapy have shown promising outcomes. Multidisciplinary collaboration is essential to optimize psychophysical recovery and reduce ICU length of stay. Paradoxical respiratory anxiety in MG patients presents a significant barrier to ventilator weaning and recovery. Integrated psychiatric interventions are crucial to address both physiological and psychological needs, ensuring holistic care in critical settings. ABSTRAKPasien dengan Myasthenia Gravis (MG) yang menjalani tindakan timektomi sering menghadapi komplikasi pernapasan yang memerlukan dukungan ventilator. Ketergantungan ini dapat memunculkan kecemasan berat yang paradoksal, yakni rasa takut saat ventilator dilepas (fear of breathing) dan kecemasan terhadap ketergantungan jangka panjang pada alat bantu napas (fear of dependence). Studi tinjauan pustaka menggunakan literatur dari jurnal internasional yang terbit dalam 10 tahun terakhir, dengan fokus pada aspek neuropsikiatri pasien MG dengan ventilator dependence. Fear of breathing melibatkan disregulasi sistem saraf pusat (amigdala, insula, prefrontal cortex) yang memperkuat anticipatory dyspnea. Sementara itu, fear of dependence muncul dari ketakutan eksistensial akan kehilangan otonomi dan harga diri. Kedua bentuk kecemasan ini memperburuk prognosis melalui siklus learned helplessness dan anxiety-avoidance. Pendekatan psikiatri berbasis Cognitive Behavioral Therapy (CBT), farmakoterapi selektif, dan keterlibatan tim multidisiplin telah terbukti mempercepat pemulihan. Kecemasan respiratorik paradoksal merupakan tantangan penting dalam perawatan pasien MG. Intervensi psikiatri terintegrasi diperlukan untuk mendukung keberhasilan weaning dan menjaga kesehatan mental pasien.
HUBUNGAN KUALITAS HIDUP DAN TINGKAT KEBAHAGIAAN PADA KLIEN TERAPI RUMATAN METADON DI POLIKLINIK ADIKSI RS NGOERAH Ayustama, Fariza; Lesmana, Cokorda Bagus Jaya; Aryani, Luh Nyoman Alit; Putra, I Wayan Gede Artawan Eka; Mahardika, I Komang Ana
CENDEKIA: Jurnal Ilmu Pengetahuan Vol. 5 No. 3 (2025)
Publisher : Pusat Pengembangan Pendidikan dan Penelitian Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51878/cendekia.v5i3.6615

Abstract

Methadone Maintenance Therapy (MMT) has been proven effective in reducing the risk of opioid relapse. However, psychosocial aspects such as happiness and quality of life are still rarely addressed as indicators of therapeutic success. To assess the relationship between quality of life (WHOQOL-BREF) and happiness level (Oxford Happiness Questionnaire/OHQ) among MMT clients in Bali Province. This study employed an analytical observational design with a cross-sectional approach. A total of 36 respondents from four MMT institutions in Bali were selected purposively. Pearson correlation, chi-square, and multiple linear regression analyses were conducted. The mean total quality of life score (WHOQOL-BREF) was 118.53 ± 12.77, and the mean happiness score (OHQ) was 101.17 ± 15.67. Significant correlations were found between the psychological domain and happiness (r = 0.521; p = 0.001), the environmental domain (r = 0.415; p = 0.012), and the social domain (r = 0.336; p = 0.045). The physical domain was not significantly associated (r = 0.239; p = 0.161). In the multivariate analysis, significant predictors of happiness were marital status (B = -4.589; p = 0.004), duration of methadone use (B = 1.791; p = 0.007), and the psychological domain (B = 0.490; p = 0.022). The model's R² was 0.635, indicating a strong predictive contribution of these variables. There is a significant relationship between quality-of-life scores in the psychological, environmental and social domains with happiness scores. The control variables in the marital status and length of methadone use were significantly related to happiness scores in the multivariate model. The PTRM program needs to integrate supportive psychological, social and environmental approaches as part of holistic recovery. ABSTRAKProgram Terapi Rumatan Metadon (PTRM) terbukti efektif dalam menurunkan risiko kekambuhan opioid. Namun, indikator keberhasilan terapi belum banyak menyoroti aspek psikososial seperti kebahagiaan dan kualitas hidup. Menilai hubungan antara kualitas hidup (WHOQOL-BREF) dan tingkat kebahagiaan (Oxford Happiness Questionnaire/OHQ) pada klien PTRM di Provinsi Bali. Penelitian ini menggunakan desain observasional analitik dengan pendekatan cross-sectional. Sebanyak 36 responden dari empat institusi PTRM di Bali dipilih secara purposif. Analisis korelasi Pearson, chi-square, dan regresi linear multivariat digunakan. Skor rata-rata kualitas hidup (WHOQOL-BREF total) adalah 118,53 ± 12,77, sedangkan skor kebahagiaan (OHQ) adalah 101,17 ± 15,67. Terdapat korelasi signifikan antara domain psikologis dengan kebahagiaan (r = 0,521; p = 0,001), domain lingkungan (r = 0,415; p = 0,012), dan domain sosial (r = 0,336; p = 0,045). Domain fisik tidak menunjukkan hubungan bermakna (r = 0,239; p = 0,161). Dalam analisis multivariat, variabel yang berhubungan signifikan terhadap kebahagiaan adalah status perkawinan (B = -4,589; p = 0,004), lama penggunaan metadon (B = 1,791; p = 0,007), dan domain psikologis (B = 0,490; p = 0,022). R² model sebesar 0,635 menunjukkan kontribusi variabel-variabel prediktor terhadap kebahagiaan cukup kuat. Terdapat hubungan yang signifikan antara skor kualitas hidup pada domain psikologis, lingkungan dan sosial dengan skor kebahagiaan. Variabel kendali berupa perkawinan dan lama penggunaan metadon berhubungan signifikan terhadap skor kebahagiaan dalam model multivariat. Program PTRM perlu mengintegrasikan pendekatan psikologis, sosial dan lingkungan yang mendukung sebagai bagian dari pemulihan holistik.
Co-Authors Anak Ayu Sri Wahyuni, Anak Ayu Sri Ardani, Gusti Ayu Indah Ariani, Ni Ketut Putri Artawan, Gede Ayustama, Fariza Cokorda Bagus Jaya Lesmana, Cokorda Bagus Jaya DAMARNEGARA, ANAK AGUNG NGURAH ANDIKA HARIANDJA, SAHAT HAMONANGAN HARIANJA, SAHAT HAMONANGAN I Gusti Agung Mas Rwa Jayantiari, I Gusti Agung I Nyoman Bagiastra I Nyoman Widiarta I Wayan Gede Artawan Eka Putra, I Wayan Gede Artawan Eka IGA Endah Ardjana, IGA Endah Karouw, Grace Venny Febe Kosim, Hartono Kurniawan, I Gde Yudhi Kurniawan, Lely Setyawati Laksmi, Ida Ayu Dinda MAHARDIKA, I KOMANG ANA MANIK, I GUSTI NGURAH WISUDA Nahusona, Gladya Florenscia Anggelly Ni Ketut Sri Diniari, Ni Ketut Sri Nyoman Hanati PUTRA, I PUTU RISDIANTO EKA Sandra Sandra SETIONO, DENNIS PRISCILLA Simanjuntak, Sarah Michelle Subudhi, I Ketut Raka Sutrisna, I Putu Belly Wardani, Ida Aju Kusuma WIGUNA, GUSTI RAI PUTRA Wiguna, I Gusti Rai Putra WIJAYA, IDA BAGUS JENDRA Yuanita, Savitri