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All Journal Scientia Psychiatrica Jurnal Global Ilmiah Sriwijaya Journal of Neurology
Wayan Wiradana
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Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Dentistry Economics, Econometrics & Finance Environmental Science Health Professions Medicine & Pharmacology Neuroscience Public Health Social Sciences

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Peripheral Inflammatory Markers and Suicidal Behavior in Depressive and Anxiety Disorders: A Systematic Review and Meta-Analysis of Neutrophil-to-Lymphocyte, Platelet-to-Lymphocyte, and Monocyte-to-Lymphocyte Ratios Ni Made Citra Riesti Wulan; Wayan Wiradana
Scientia Psychiatrica Vol. 6 No. 4 (2025): Scientia Psychiatrica
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/scipsy.v6i2.192

Abstract

Introduction: Suicidal behavior is a major public health crisis, intricately linked with depressive and anxiety disorders. A growing body of evidence implicates systemic inflammation in the pathophysiology of these conditions and suicidality. This systematic review and meta-analysis aims to synthesize the evidence on the association between accessible peripheral inflammatory markers—neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR)—and suicidal behavior in patients with depressive or anxiety disorders. Methods: A systematic literature search was conducted in PubMed, Cochrane, ScienceDirect, Ebsco, and SpringerLink for observational studies up to March 2024. Studies comparing NLR, PLR, or MLR between patients with depressive or anxiety disorders with suicidal behavior and those without were included. Data were pooled using a random-effects model. The primary outcomes were the standardized mean difference (SMD) for NLR and mean difference (MD) for PLR and MLR. Results: Thirteen studies comprising 2,392 patients (1,192 with suicidal behavior, 1,200 controls) were included. The analysis revealed that patients with suicidal behavior had significantly higher NLR (Standardized Mean Difference [SMD] = 0.55; 95% CI: 0.26–0.84; p < 0.001), PLR (Mean Difference [MD] = 11.31; 95% CI: 7.48–15.14; p < 0.00001), and MLR (MD = 0.02; 95% CI: 0.01–0.03; p < 0.00001) compared to non-suicidal patients. Significant heterogeneity was observed in the NLR analysis (I2 = 90%). Conclusion: This meta-analysis establishes a significant association between elevated peripheral inflammatory markers (NLR, PLR, MLR) and suicidal behavior in patients with depressive and anxiety disorders. These findings support the inflammatory hypothesis of suicidality. However, substantial heterogeneity and methodological limitations across studies necessitate cautious interpretation. These markers represent promising areas for future research but are not yet suitable for clinical risk prediction.
Psikoterapi dalam Menangani Enuresis Pada Anak Sekolah dengan Gangguan Cemas: Laporan Kasus Wulan, Made Citra Riesti; Rahayu, Wayan Saka; Wayan Wiradana
Jurnal Global Ilmiah Vol. 3 No. 2 (2025): Jurnal Global Ilmiah
Publisher : International Journal Labs

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55324/jgi.v3i2.304

Abstract

Enuresis is a condition of not being able to control urination or unconsciously urinating during the day or at night while asleep1. Secondary enuresis occurs in children who previously experienced a dry period of more than 6 months2. Primary enuresis occurs in children who do not experience any dry periods at all since birth. There is a relationship between mental disorders and enuresis, where as many as 20% of children with enuresis experience mental disorders such as social anxiety disorders and anxiety disorders5 Case: An 11-year-old girl, in grade 5 elementary school, was escorted by her mother to a psychiatric polyclinic because she complained since childhood that she continued to wet her bed every night. The patient admitted that every night he was afraid of sleeping alone. The patient also admitted that at school he was embarrassed to hang out with friends. Then given counseling, the patient is asked to start recording on the calendar. Installation of alarms. Patients are educated to reduce afternoon drinking before bedtime, trying to urinate before going to bed. The patient then came back to control 1 month later, the frequency of wetting was reduced only with psychotherapy. The fear of sleeping alone and missing class has decreased. Discussion: Enuresis is often accompanied by mental disorders such as anxiety disorders or depression. Psychotherapy can be given to look for anxiety and depressive factors, alarm therapy suggestions, optimal urinary practices, fluid intake, and positive reinforcement. The success of psychotherapy is almost 60% to 80%. Desmopressin is a first-line therapy to overcome enuresis. Conclusion: In the case of an elementary school girl who complained of always wetting her bed at night. Treatment is given psychotherapy. A study showed a defined success rate of 14 consecutive nights without wetting.
The Screen as a Shield: Internet Addiction as a Maladaptive Defense Against Childhood Emotional Neglect in a Left-Behind Adult Made Citra Riesti Wulan; Wayan Wiradana
Scientia Psychiatrica Vol. 6 No. 2 (2025): Scientia Psychiatrica
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/scipsy.v6i2.202

Abstract

Introduction: Internet addiction (IA) is frequently conceptualized as an impulse control disorder driven by dopaminergic dysregulation. However, in the context of left-behind children—those raised by grandparents due to parental migration—IA may function as a complex psychodynamic defense mechanism. This study aims to elucidate the role of the smartphone as a digital shield against the resurfacing trauma of Childhood Emotional Neglect (CEN) and attachment deficits. Case presentation: We report the case of a 23-year-old female in Eastern Bali presenting with acute dysphoria, elective mutism, and total insomnia following the confiscation of her smartphone. Assessment included the Internet Addiction Test (IAT), clinical interviews utilizing written communication during the mute phase, and family system analysis. The patient scored 58 on the baseline IAT, indicating moderate addiction. Clinical inquiry revealed a history of split-parenting, where the patient was reared by emotionally distant grandparents. The smartphone served a specific function of displacement, seeking safety in online relationships, and dissociation, used to numb loneliness. The device confiscation triggered a traumatic re-enactment of early childhood abandonment, resulting in physiological hyperarousal incompatible with the moderate IAT score. Treatment involved Fluoxetine (20mg), Clobazam (10mg), and psychodynamic psychotherapy focusing on attachment repair. At the 4-week follow-up, the IAT score decreased to 32, and verbal communication was fully restored. Conclusion: IA in young adults with developmental trauma functions as a maladaptive defense mechanism (The Digital Shield). Clinicians must address the underlying attachment wound rather than focusing solely on digital detoxification to achieve sustainable remission.
Terminal Insomnia as a Phenotypic Biomarker of Geriatric Depression in a Balinese Cohort: A Cross-Sectional Analysis of Circadian Disruption and Sleep Continuity Made Citra Riesti Wulan; Wayan Saka Rahayu; Wayan Wiradana
Sriwijaya Journal of Neurology Vol. 3 No. 2 (2025): Sriwijaya Journal of Neurology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjn.v3i2.242

Abstract

Introduction: Sleep architecture undergoes significant fragmentation during aging, yet the specific phenotypic expression of insomnia in the context of geriatric depression remains under-characterized. While the bidirectional relationship between depression and sleep is established, few studies distinguish between initial, middle, and terminal insomnia subtypes in Southeast Asian geriatric populations. This study aims to characterize the predominant insomnia phenotypes among elderly patients with depression and investigate the association between sociodemographic determinants, chronic morbidity, and specific sleep continuity disturbances. Methods: A cross-sectional analytical study was conducted at the Geriatric Outpatient Clinic of Karangasem Regional General Hospital, Bali, Indonesia (N=58). Psychometric evaluation utilized the Geriatric Depression Scale (GDS-15) to screen for depressive symptoms and the Pittsburgh Sleep Quality Index (PSQI) to assess global sleep quality. Insomnia phenotypes were clinically adjudicated based on diagnostic interviews. To account for potential confounders, body mass index (BMI) and chronic pain scores were included in the analysis. Data were analyzed using Firth’s Penalized Likelihood Logistic Regression to stabilize estimates given the sample size. Results: The prevalence of depression in the cohort was 58.3%. Among depressed elderly patients, terminal (Late) Insomnia was the predominant phenotype, affecting 76.0% of the subgroup, followed by middle insomnia (66.7%) and initial insomnia (36.4%). Multivariate analysis adjusted for age, chronic disease status, BMI, and pain demonstrated that Terminal Insomnia was the strongest independent predictor of depression (Adjusted OR 6.42; 95% CI 2.15–14.8; p<0.001). Conclusion: Terminal insomnia represents a distinct and dominant clinical phenotype of depression in this geriatric cohort, potentially reflecting underlying circadian phase advances and HPA-axis hyperactivity characteristic of melancholic depression. Clinicians should prioritize sleep maintenance strategies over sleep induction pharmacotherapy in this population.
Co-Authors Made Citra Riesti Wulan Ni Made Citra Riesti Wulan Rahayu, Wayan Saka Wayan Saka Rahayu Wulan, Made Citra Riesti