GAMBARAN PENGOBATAN DAN LENGTH OF STAY (LOS)  PASIEN SKIZOFRENIA BERBASIS KOMBINASI KLOZAPIN DI RUMAH SAKIT JIWA GRHASIA YOGYAKARTA

Nur Zuhelna; Bambang Hasta Yoga; Dwi Endarti

doi:10.31004/prepotif.v9i3.49322

Authors

Nur Zuhelna Prodi MFK Fakultas Farmasi UGM
Bambang Hasta Yoga Fakultas Kedokteran Kesehatan Masyarakat dan Keperawatan UGM
Dwi Endarti Departemen Farmasetika Fakultas Farmasi UGM

DOI:

https://doi.org/10.31004/prepotif.v9i3.49322

Keywords:

klozapin, haloperidol, LOS, risperidon, skizofrenia, trifluoperazin

Abstract

Skizofrenia adalah gangguan kompleks yang dipengaruhi berbagai faktor. Gejala skizofrenia meliputi gejala delusi, halusinasi, gejala negatif dan gejala kognitif. Pengobatan utama pada gangguan skizofrenia adalah antipsikotik. Monoterapi antipsikotik umumnya disarankan untuk pengobatan skizofrenia, tetapi dalam praktek klinis kombinasi antipsikotik banyak digunakan (40%). Klozapin adalah antipsikotik yang banyak digunakan dalam kombinasi antipsikotik. Tujuan penelitian adalah untuk memahami gambaran terapi dan length of stay (LOS) dari kombinasi antipsikotik yang berbasis klozapin pada pasien skizofrenia. LOS adalah durasi rawat inap pasien untuk satu kali perawatan di Rumah Sakit. LOS berkaitan dengan pasien, penyedia layanan dan asuransi kesehatan. Penelitian dilakukan dengan pendekatan deskriptif melalui metode cross-sectional pada pasien rawat inap RSJ Grhasia Yogyakarta selama bulan Mei sampai Juli 2025. Sumber data berasal dari rekam medis yang dikaji secara retrospektif sebagai data sekunder sehingga diperoleh 3 kombinasi antipsikotik berbasis klozapin yang paling banyak digunakan. Sebanyak 102 pasien yang memenuhi syarat inklusi kemudian dianalisis mengenai LOS pada kombinasi klozapin-risperidon (n=48), kombinasi klozapin-risperidon-haloperidol (n=32) dan kombinasi klozapin-risperidon-trifluoperazin (n=22). Temuan penelitian mendapatkan LOS untuk kombinasi klozapin-risperidon yaitu 12,00±3,41 hari, LOS kombinasi klozapin-risperidon-haloperidol yaitu 18,78±5,22 hari dan LOS kombinasi klozapin-risperidon-trifluoperazin yaitu 15,72±5,11 hari dengan ada perbedaan bermakna pada LOS di ketiga kombinasi (p=0,000). Sedangkan, pada karakteristik pasien tidak ada perbedaan bermakna di antara kombinasi antipsikotik (p > 0,05).

References

Abassi, B., Khelifa, E., Bouguerra, I., Nourchene, K., & Mnif, L. (2022). Hypokalemia : what correlation with psychotic relapse ? European Psychiatry, 65: S461–S461.

Abdulah, R., & Siregar, R. F. (2017). Cost-effectiveness Analysis of Antipsychotic Combination Therapy in Schizophrenia Inpatients. Indonesian Journal of Clinical Pharmacy, 6: 61–66.

Andira, S. & Nuralita, N. S. (2018). Pengaruh Perbedaan Jenis Kelamin terhadap Simtom Depresi Pasien Skizofrenia di Rumah Sakit Jiwa Prof. Dr. M. Ildrem Kota Medan Sumatera Utara Pada Tahun 2017. Buletin Farmatera, 3(2). E-ISSN: 2528-410X.

Azmanova, M., Al-Dissi, A. A., & Shakya, A. K. (2018). Schizophrenia: Synthetic Strategies and Recent Advances in Drug Design. Medicinal Chemistry Communications, 9(5), 759–782. https://doi.org/10.1039/C8MD00034A

Baeza, F. L., Ferraz, L. M., Nascimento, I. P., & Losada, C. (2017). Predictors of length of stay in an acute psychiatric inpatient facility in a general hospital: a prospective study. Revista Brasileira de Psiquiatria, 40: 89–96.

Cheng, P., Zhang, W., Zhang, Y., Zhao, Y., Wang, L., & Li, X. (2022). Factors Related to the Length of Stay for Patients With Schizophrenia: A Retrospective Study. Frontiers in Psychiatry, 12: 818254.

Chokhawala, K., & Stevens, L. (2023). Antipsychotic medications. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519503/.

Crossley, N. A., Constante, M., McGuire, P. & Power, P. (2010). Efficacy of atypical v. typical antipsychotics in the treatment of early psychosis: meta-analysis. The British Journal of Psychiatry, 196(6), pp.434-439. doi:10.1192/bjp.bp.109.066217.

Darsana, I. W., & Suariyani, N. L. P. (2020). Trend Karakteristik Demografi Pasien Skizofrenia di Rumah Sakit Jiwa Provinsi Bali (2013–2018). Archive of Community Health, 7, 41 .

Departemen Kesehatan RI (2004). Pedoman Penggolongan Dan Diagnosis Gangguan Jiwa Di Indonesia III (PPDGJ III). Jakarta: Departemen Kesehatan RI.

DiPiro, J. T., Haines, S. T., Nolin, T. D., Ellingrod, V. L., & Posey, L. M. (2023). Pharmacotherapy: A pathophysiologic approach (11th ed.). McGraw-Hill Education.

Dragoi, A., Radulescu, I., Năsui, B., Pop, A., Varlas, V. & Trifu, S. (2020). Clozapine: An Updated Overview of Pharmacogenetic Biomarkers, Risks, and Safety-Particularities in the Context of COVID-19. Brain Sciences, 10: 840.

Erlina, Soewadi, & Pramono, D. (2010) Determinan terhadap timbulnya skizofrenia pada pasien rawat jalan di Rumah Sakit Jiwa Prof. HB Saanin Padang Sumatera Barat. Jurnal Psikiatri Klinik Indonesia, 9(2), 26–31. https://doi.org/10.22146/jpsi.11212.

Ferrara, M., Curtarello, E. M. A., Gentili, E., Domenicano, I., Vecchioni, L., Zese, R., Alberti, M., Franchini, G., Sorio, C., Benini, L., Little, J., Carozza, P., Dazzan, P., & Grassi, L. (2024). Sex differences in schizophrenia-spectrum diagnoses: results from a 30-year health record registry. Archives of Women’s Mental Health, 27: 11–20.

Foster, A., Buckley, P., Lauriello, J., Looney, S., & Schooler, N. (2017). Combination Antipsychotic Therapies: An Analysis From a Longitudinal Pragmatic Trial. Journal of Clinical Psychopharmacology, 37: 595–599.

Gallego, J. A., Bonetti, J., Zhang, J., Kane, J. M., & Correll, C. U. (2012). Prevalence and correlates of antipsychotic polypharmacy: A systematic review and meta-regression of global and regional trends from the 1970s to 2009. Schizophrenia Research, 138: 18–28.

Gardner, D. M., & Teehan, M. D. (2011). Antipsychotics and Their Side Effects. In Antipsychotic Drugs (pp. 1–26). Springer. https://doi.org/10.1007/978-1-4419-1673-7_1

Goga, L. Y., & Marais, B. S. (2024). Schizophrenia and schizoaffective disorder: Length of stay and associated factors. South African Journal of Psychiatry, 30, Article a2237. https://doi.org/10.4102/sajpsychiatry.v30i0.2237.

Hany, M., Rehman, B., & Rizvi, A. (2024). Schizophrenia. In StatPearls. Treasure Island (FL): StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK539864/.

Kapur, S., Roy, P., Daskalakis, J., Remington, G., & Zipursky, R. (2001). Increased Dopamine D2 Receptor Occupancy and Elevated Prolactin Level Associated With Addition of Haloperidol to Clozapine. American Journal of Psychiatry, 158: 311–314.

Kapur, S., Zipursky, R. B., & Remington, G. (1999). Clinical and Theoretical Implications of 5-HT2 and D2 Receptor Occupancy of Clozapine, Risperidone, and Olanzapine in Schizophrenia. American Journal of Psychiatry, 156: 286–293.

Kementerian Kesehatan RI. (2018). Laporan Nasional RISKESDAS 2018. Jakarta: Badan Penelitian dan Pengembangan Kesehatan, Kementerian Kesehatan Republik Indonesia.

Kementerian Kesehatan RI. (2021). Pedoman Pelayanan Kefarmasian untuk Pasien Gangguan Jiwa. Jakarta: Kementerian Kesehatan Republik Indonesia.

Lähteenvuo, M. & Tiihonen, J. (2021). Antipsychotic Polypharmacy for the Management of Schizophrenia: Evidence and Recommendations. Drugs, 81: 1273–1284.

Lally, J. & Maccabe, J. H. (2015). Antipsychotic medication in schizophrenia : A review. Therapeutic Advances in Psychopharmacology, 5(2), 57–62. https://doi.org/10.1177/2045125314564919.

Li, X. J., Wu, J. H., Liu, J. B., Li, K. P., Wang, F., Sun, X. H., & Shi-hong, M. (2015). The Influence of Marital Status On The Social Dysfunction of Schizophrenia Patients in Community. International Journal of Nursing Sciences, 2: 149–152.

Lyngdoh, L. A. M., Antony, S., Basavarajappa, C., Kalyanasundaram, J. R., & Ammapattian, T. (2023). Marriage in persons with severe mental illness: A narrative review-based framework for a supported relationship. Journal of Family Medicine and Primary Care, 12: 3033–3041.

Marques, L. de O., Soares, B. G. O., & Silva de Lima, M. (2004). Trifluoperazine for schizophrenia. Cochrane Database of Systematic Reviews, CD002147. https://doi.org/10.1002/14651858.CD002147.pub2

Newton, R., Rouleau, A., Nylander, A. G., Loze, J. Y., Resemann, H. K., Steeves, S., & Crespo-Facorro, B. (2018). Diverse definitions of the early course of schizophrenia - A targeted literature review. npj Schizophrenia, 4: 21.

Ochoa, S., Usall, J., Cobo, J., Labad, X., & Kulkarni, J. (2012). Gender Differences in Schizophrenia and First-Episode Psychosis: A Comprehensive Literature Review. Schizophrenia Research and Treatment, 2012: 1–9.

Orsolini, L., Pompili, S., & Volpe, U. (2022). Schizophrenia: A Narrative Review of Etiopathogenetic, Diagnostic and Treatment Aspects. Journal of Clinical Medicine, 11: 5040.

Park, T. & Kuntz, K. M. (2014). Cost-Effectiveness of Second-Generation Antipsychotics for the Treatment of Schizophrenia. Value in Health, 17(4), 310–319. https://doi.org/10.1016/j.jval.2014.02.008.

Purwandityo, G. A., Febrianti, Y., & Sari, P. C. (2018). The Influence of Antipsychotic to Decrease the Score of The Positive and Negative Syndrome Scale-Excited Component. Indonesian Journal of Clinical Pharmacy, 7: 19–29.

Rahma, A., Lisa, G. R., Isrona, L., Susanti, R., Ashal, T., & Rahmatini. (2025). Gambaran Skizofrenia dan Penggunaan Triheksipenidil DI RSJ HB Saanin Kota Padang 2: Jurnal Psikiatri Indonesia, 2, 10–16.

Raja, M. (2009). Pharmacotherapy Update: Risperidone in the Treatment of Schizophrenia. Clinical Medicine. Therapeutics, 1: CMT.S1123.

Ren, Y., Wang, H., & Xiao, L. (2013). Improving myelin/oligodendrocyte-related dysfunction: a new mechanism of antipsychotics in the treatment of schizophrenia?. International Journal of Neuropsychopharmacology, 16: 691–700.

Solmi, M., Seitidis, G., Mavridis, D., Correll, C. U., Dragioti, E., Guimond, S., Tuominen, L., Dargél, A., Carvalho, A. F., Fornaro, M., Maes, M., Monaco, F., Song, M., Il Shin, J., & Cortese, S. (2023). Incidence, prevalence, and global burden of schizophrenia - data, with critical appraisal, from the Global Burden of Disease (GBD) 2019. Molecular Psychiatry, 28: 5319–5327. doi: 10.1038/s41380-023-02138-4.

Sommer, I. E., Tiihonen, J., Van Mourik, A., Tanskanen, A., & Taipale, H. (2020). The clinical course of schizophrenia in women and men-a nation-wide cohort study. npj Schizophrenia, 6: 12. doi: 10.1038/s41537-020-0102-z. PMID: 32358572; PMCID: PMC7195359.

Stefan, M., Travis, M., & Murray, M. R. (2002). An Atlas of Schizophrenia, Encyclopedia of visual medicine series. Parthenon Pub. Group, New York.

Stone, K., Zwiggelaar, R., Jones, P., & Mac Parthaláin, N. (2022). A systematic review of the prediction of hospital length of stay: Towards a unified framework. PLOS Digital Health, 1: e0000017. doi: 10.1371/journal.pdig.0000017. PMID: 36812502; PMCID: PMC9931263.

Tarigan, P. A. (2025). Tinjauan Farmakologis Trihexyphenidyl dan Penyalahgunaan di Komunitas 2: Jurnal Farmasi Indonesia, 2, 21–27.

WHO, (2022). Schizophrenia. World Health Organization. https://www.who.int/publications/i/item/9789240045377.

Zubair, U., Ali, S. A., Taj, R., & Batool, S. M., (2020). Comparison of effectiveness of antipsychotics in schizophrenia: Second-generation versus the first-generation. Journal Ayub Med Coll Abbottabad. Jan-Mar;32(1):24-27. PMID: 32468749.