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All Journal Scientia Psychiatrica Eureka Herba Indonesia Sriwijaya Journal of Forensic and Medicolegal
Jason Willmare
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Public Health

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White-Matter Hyperintensities and Cognitive Decline in Late-Life Depression: A Longitudinal Neuroimaging Study in Medan, Indonesia Taryudi Suharyana; Jason Willmare; Despian Januandri; Brenda Jaleel; Wisnu Wardhana Putra
Scientia Psychiatrica Vol. 6 No. 1 (2025): Scientia Psychiatrica
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/scipsy.v6i1.185

Abstract

Introduction: Late-life depression (LLD) is often associated with cognitive impairment and structural brain changes, particularly white-matter hyperintensities (WMH). This longitudinal study investigated the relationship between WMH burden, cognitive decline, and depressive symptoms in a cohort of older adults with LLD in Medan, Indonesia. Methods: A prospective, longitudinal study was conducted with 120 participants aged 60 years and older. Participants underwent baseline and 3-year follow-up assessments, including structural MRI, neuropsychological testing, and depression severity. Statistical analyses included mixed-effects models to examine longitudinal changes and correlations. Results: At baseline, the LLD group exhibited significantly higher WMH volume compared to controls (p < 0.001). Over the 3-year follow-up, the LLD group showed a significantly greater increase in WMH volume (average increase of 0.4 Fazekas points) compared to controls (average increase of 0.1 Fazekas points, p < 0.001). Greater WMH burden at baseline was associated with worse performance on all cognitive domains in both groups (p < 0.05). In the LLD group, the increase in WMH volume was significantly correlated with a decline in global cognition (r = -0.45, p < 0.001), executive function (r = -0.38, p = 0.003), and processing speed (r = -0.41, p = 0.001). Changes in depression severity were also correlated with WMH progression (r = 0.32, p = 0.012). Conclusion: This study provides evidence that WMH burden is significantly increased in LLD and that WMH progression contributes to cognitive decline and may exacerbate depressive symptoms over time. These findings highlight the importance of assessing and potentially targeting WMH in the management of LLD.
Comparative Efficacy and Acute Tolerability of a Standardized Withania somnifera Root Extract Versus Sertraline in Generalized Anxiety Disorder: A Randomized, Double-Blind, Placebo-Controlled Non-Inferiority Trial Ni Made Nova Indriani; Suyong Zhou; Riri Arisanty Syafril Lubis; Jason Willmare
Eureka Herba Indonesia Vol. 6 No. 1 (2025): Eureka Herba Indonesia
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ehi.v6i1.132

Abstract

Generalized anxiety disorder (GAD) represents a significant psychiatric burden, characterized by chronic hyperarousal and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. While selective serotonin reuptake inhibitors (SSRIs) like Sertraline are the standard of care, their utility is often compromised by delayed onset and adverse effects, specifically sexual dysfunction. Withania somnifera (Ashwagandha) acts as a GABA-mimetic and adaptogen, yet rigorous head-to-head comparisons against pharmaceutical controls are rare. We conducted an 8-week, randomized, double-blind, placebo-controlled trial involving 150 adults with DSM-5 diagnosed GAD. Participants were randomized (1:1:1) to receive High-Concentration Ashwagandha Root Extract (600 mg/day, standardized to >5% withanolides), Sertraline (50 mg/day), or Placebo. Blinding was maintained using mint-scented desiccants to mask the herb's odor. Efficacy was analyzed using Mixed Models for Repeated Measures (MMRM). Of 150 participants, 138 completed the study. Both Ashwagandha (Mean HAM-A reduction -14.2) and Sertraline (-15.1) demonstrated statistical superiority over Placebo (-5.4; p < 0.001). The difference between active arms was not statistically significant, supporting comparable efficacy. Ashwagandha significantly reduced serum cortisol (-24.3%) and improved GAD-7 scores. Crucially, while Sertraline induced significant sexual dysfunction (worsened ASEX scores, p < 0.001) and nausea (28%), Ashwagandha showed a safety profile indistinguishable from placebo. In conclusion, standardized Withania somnifera extract (600 mg/day) offers anxiolytic efficacy comparable to Sertraline (50 mg/day) with a superior safety profile, specifically devoid of sexual and gastrointestinal adverse effects.
Post-Mortem High-Anion-Gap Metabolic Acidosis and Blood Formate Quantitation as Diagnostic Markers of Fatal Oplosan Intoxication: A Retrospective Diagnostic Accuracy Study at a Tertiary Forensic Center in Indonesia Bambang Sutrisno; Sri Mulyati; Karina Chandra; Jason Willmare
Sriwijaya Journal of Forensic and Medicolegal Vol. 4 No. 1 (2026): Sriwijaya Journal of Forensic and Medicolegal
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjfm.v4i1.257

Abstract

Introduction: Bootleg liquor (oplosan) containing illicit methanol remains a leading cause of preventable forensic death in Indonesia, yet objective post-mortem biochemical diagnostic criteria are incompletely standardised. Methods: This retrospective diagnostic accuracy study evaluated post-mortem high-anion-gap metabolic acidosis (HAGMA) and blood formate quantitation as confirmatory markers of fatal methanol intoxication at Hospital X, Central Java, between January 2019 and December 2023. Medical examiner records, autopsy reports, and post-mortem biochemistry data from 120 adult decedents were reviewed: 74 confirmed methanol (oplosan) fatalities and 46 non-methanol metabolic acidosis deaths as the comparison group. The reference standard was post-mortem blood methanol >20 mg/dL with documented oplosan exposure history. Post-mortem blood formate was quantified by gas chromatography–flame ionisation detection (GC-FID). Sensitivity, specificity, PPV, NPV, and ROC analysis were performed with 95% confidence intervals by the Wilson score method. Results: Mean blood formate was 18.8 ± 4.9 mmol/L in the methanol group versus 1.2 ± 0.8 mmol/L in controls (p < 0.001). Post-mortem albumin-corrected anion gap was 28.7 ± 5.1 versus 14.2 ± 4.6 mmol/L (p < 0.001). Blood formate >2.0 mmol/L achieved sensitivity 100% (95% CI 95.1–100%), specificity 80.4% (95% CI 65.9–90.1%), and AUC 0.989 (95% CI 0.971–0.998). HAGMA achieved sensitivity 94.6% (95% CI 86.4–98.0%), specificity 91.3% (95% CI 78.2–97.0%), and AUC 0.976. Combined positivity yielded a specificity 100% and a PPV 100%. Multivariable logistic regression identified formate as the dominant independent predictor (OR 123.8, 95% CI 21.6–709.3). Conclusion: Post-mortem blood formate and HAGMA are highly accurate complementary markers for confirming fatal oplosan intoxication and should be incorporated into standardised Indonesian forensic autopsy protocols.
Co-Authors Bambang Sutrisno Brenda Jaleel Despian Januandri Karina Chandra Ni Made Nova Indriani Riri Arisanty Syafril Lubis Sri Mulyati Suyong Zhou Taryudi Suharyana Wisnu Wardhana Putra