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Luh Nyoman Alit Aryani, Luh Nyoman Alit
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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.
Harmonization of Regulations in Realizing Legal Certainty for the Protection of Medical Records and Personal Data Widiarta, I Nyoman; Jayantiari, I Gusti Agung Mas Rwa; Aryani, Luh Nyoman Alit
Journal of Law, Politic and Humanities Vol. 5 No. 6 (2025): (JLPH) Journal of Law, Politic and Humanities
Publisher : Dinasti Research

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.38035/jlph.v5i6.2162

Abstract

This research is a normative legal study aimed at analyzing the norms governing the protection of patients' medical records under Law Number 17 of 2023 on Health and Law Number 27 of 2022 on Personal Data Protection, as a doctrinal review of related legislation. The method used is a juridical-normative approach through library research of statutory regulations, article explanations, legal doctrines, and secondary legal literature to explore the principles, rights, and obligations of data subjects and controllers. The normative analysis highlights the alignment of the principle of medical record confidentiality as stipulated in Article 177 paragraph 1 of Law Number 17 of 2023 on Health and the obligation to maintain the confidentiality of Personal Data under Article 36 of Law 27/2022, as well as patients’ right to access as regulated in Article 276 of Law 17/2023. The research findings identify an overlap between the long-term retention provisions of medical records and the "right to erasure" principle, which is not specifically regulated in Law 27/2022, thereby indicating the need for harmonization of norms and technical guidelines in the health sector. These findings underscore the importance of formulating a Government Regulation to implement Article 299 of Law 17/2023 in order to bridge the obligations of data retention and the mechanisms for erasing medical data, ensuring legal certainty and the protection of patients’ rights.
Literatur Review: Consumer Protection in Transactions of Tartar Removal Products on E-Commerce: A Legal and Policy Review Laksmi, Ida Ayu Dinda; Bagiastra, I Nyoman; Aryani, Luh Nyoman Alit
Indonesian Journal of Global Health Research Vol 7 No 4 (2025): 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.v7i4.6316

Abstract

The rapid growth of e-commerce has significantly transformed consumer purchasing behavior, including in the health and personal care sectors. However, the online sale of tartar removal products raises serious concerns regarding consumer protection, product safety, and regulatory oversight. This study aims to examine the adequacy of the existing legal framework and policy mechanisms in protecting consumers who purchase tartar removal products through e-commerce platforms.Methods: This research employed a literature review design using a comprehensive strategy. Articles were sourced from international research journal databases accessed via the internet, specifically ScienceDirect, PubMed, and Google Scholar. All searches were conducted in March 2025, focusing on articles published between 2016 and 2024. The keywords used in this literature review were adapted from Medical Subject Heading (MeSH) terms, including "consumer protection in e-commerce transactions," "tartar removal products," "e-commerce platforms," and "legal and policy aspects." The initial search yielded 1098 results, of which 711 were duplicates. Of the 387 remaining results, 29 were retained after a title and abstract review. Following a full-text review, 11 articles were included in the study. Charting and theme identification were conducted by a single author (R.C-D).Results:The study identified major challenges, notably the lack of legal protection for consumers. The absence or weakness of legal safeguards in transactions involving tartar removal products has led to several significant issues, including misleading product claims, a lack of mandatory certification, limited enforcement capacity, and inadequate digital infrastructure for transaction monitoring. By analyzing relevant laws, regulations, and case studies, this study highlights the gaps in current consumer protection practices and proposes policy recommendations to strengthen legal protection. These include reinforcing regulatory frameworks, enhancing technology-based monitoring, and promoting consumer education initiatives.Conclusion: The findings emphasize the need for a more adaptive and proactive legal approach to create a safer e-commerce environment, particularly in sectors impacting public health.
Comparison Digital Internet Addiction Test Bahasa Version and Manual Internet Addiction Test Bahasa Version in Adolescent Sutrisna, I Putu Belly; Aryani, Luh Nyoman Alit; Artawan, Gede
Poltekita : Jurnal Ilmu Kesehatan Vol. 17 No. 4 (2024): February
Publisher : Poltekkes Kemenkes Palu

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33860/jik.v17i4.3297

Abstract

Internet Addiction Test (IAT) is the most common internet addiction questionnaire that is used for internet addiction screening. In the digital era and impact of the COVID-19 pandemic that suggests contactless to prevent widespread infection, we tried to develop the Digital Internet Addiction Test in Bahasa version (E-IAT Ina) to measure internet addiction with contactless and real-time usage. Still, it is needed to evaluate the effectiveness of the usual questionnaire using the manual Internet Addiction test in Bahasa version (M IAT). This study aimed to compare the effectiveness of E-IAT Ina with manual IAT Ina (M-IAT Ina). E-IAT Ina was developed with expert systems forward chaining method web-based applicaton which built using HTML, Laravel and Flowbite framework. This is a cross-sectional study, conducted by 93 students ranging from 12-20 years old. Totally 22 participants from junior high school, 32 participants from senior high school, and 39 participants from college students in Denpasar city were collected by Google form using purposive sampling. Each participant fills out M-IAT Ina and E-IAT Ina directly. The effectiveness of the tools for the score test was analyzed with a Paired t-test and the level of internet addiction was analyzed with the Wilcoxon test using SPSS 25 software. There was no significant difference between E-IAT Ina and M-IAT in all stages of adolescence, where adolescents 12-14 years (p=0,101), 15-17 years (p=0,184), and 18-20 years (p=0,142) by scoring. There was also no significant difference in the level of addiction (p= 0.013, p>0.000). Digital Internet Addiction Test in Bahasa version application (E-IAT Ina) could be used to measure internet addiction in adolescents with the same effectiveness as manual Internet Addiction Test Bahasa version (M-IAT Ina) with contactless and real-time usage to prevent the widespread COVID-19 infection in digital mental health care.
TERAPI PERILAKU KOGNITIF PADA PASIEN LAKI-LAKI DENGAN GANGGUAN CEMAS MENYELURUH DENGAN SERANGAN PANIK: SEBUAH LAPORAN KASUS Putra, I Putu Risdianto Eka; Harianja, Sahat Hamonangan; Aryani, Luh Nyoman Alit; Yuanita, Savitri
HEALTHY : Jurnal Inovasi Riset Ilmu Kesehatan Vol. 4 No. 1 (2025)
Publisher : Pusat Pengembangan Pendidikan dan Penelitian Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51878/healthy.v4i1.4609

Abstract

Generalized Anxiety Disorder (GAD) with panic attacks is a debilitating condition that significantly disrupts daily functioning and quality of life. Cognitive Behavior Therapy (CBT) is an evidence-based intervention known to be effective in treating anxiety-related disorders. This study was a qualitative study with case study appoach using in-dept interview, presenting the treatment process and outcomes of a male patient diagnosed with GAD who frequently experiences panic attacks. The patient underwent structured CBT sessions focusing on cognitive restructuring, exposure techniques, and relaxation strategies. Throughout the treatment, the patient demonstrated a reduction in anxiety symptoms, decreased frequency of panic attacks, and improved coping mechanisms. These findings highlight the effectiveness of CBT in managing GAD with panic attacks and emphasize the importance of an individualized therapeutic approach. This case contributes to the growing body of evidence supporting CBT as a primary treatment modality for anxiety disorders. ABSTRAKGangguan cemas menyeluruh/ Generalized Anxiety Disorder  (GAD) dengan serangan panik adalah kondisi yang melemahkan dan secara signifikan mengganggu fungsi sehari-hari dan kualitas hidup. Terapi Perilaku Kognitif/Cognitive Behavior Therapy (CBT) adalah intervensi berbasis bukti yang dikenal efektif dalam mengobati gangguan terkait kecemasan. Penelitian ini adalah penelitian kualitatif dengan pendekatan studi kasus dengan metode wawancara mendalam yang menyajikan proses perawatan dan luaran dari seorang pasien laki-laki yang didiagnosis dengan GAD dan sering mengalami serangan panik. Pasien menjalani sesi CBT terstruktur yang berfokus pada restrukturisasi kognitif, teknik pemaparan, dan strategi relaksasi. Selama perawatan, pasien menunjukkan penurunan gejala kecemasan, penurunan frekuensi serangan panik, dan peningkatan mekanisme koping. Temuan ini menyoroti efektivitas CBT dalam mengelola GAD dengan serangan panik dan menekankan pentingnya pendekatan terapeutik yang individual. Kasus ini berkontribusi pada pengumpulan bukti yang berkembang yang mendukung CBT sebagai modalitas tatalaksana utama untuk gangguan cemas.
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