Pendahuluan: Skizofrenia berdampak besar terhadap pasien dan keluarganya. Awitannya sering pada masa remaja akhir sampai dengan dewasa awal, dengan perjalanan penyakit yang cenderung berlangsung seumur hidup. Potensi kekambuhan dan perburukan gejala semakin memperburuk prognosis gangguan ini. Berdasarkan teori diskonektivitas otak dan gangguan perkembangan saraf (struktur otak dan gangguan konektivitas), diduga patofisiologi yang terjadi adalah akibat efektivitas modulasi sinaptik yang terganggu. Mengenai perubahan konektivitas ini, terdapat perbedaan signifikan ambang motorik antara pasien skizofrenia dan kontrol yang normal, dengan alat TMS. Hal ini menunjukkan potensi besar ambang motorik sebagai penanda biologis neurofisiologi pada skizofrenia. Walau begitu, saat ini belum banyak diketahui faktor yang berpengaruh pada ambang motorik. Dikatakan terdapat perbedaan struktural otak, model perkembangan saraf, serta anisotropi fraksional, terkait awitan dan durasi perjalanan penyakit pasien dengan skizofrenia. Oleh karena itu, akan diteliti lebih lanjut hubungan antara umur saat awitan gejala psikotik dan durasi perjalanan penyakit skizofrenia dengan ambang motorik. Metode: Penelitian dengan desain studi potong lintang, dilakukan di Unit Rawat Jalan Psikiatri Rumah Sakit Cipto Mangunkusumo pada April 2018 sampai dengan Desember 2018 (N= 40, usia 18 hingga 59 tahun), dengan sampling konsekutif. Subjek penelitian adalah pasien dengan skizofrenia resisten pengobatan, yang mengikuti terapi TMS. Setelah diberikan penjelasan rinci dan memberikan persetujuan, data demografi dan klinis dikumpulkan, kemudian dilakukan penilaian ambang motorik oleh tenaga ahli terlatih. Subjek diberikan penutup kepala kain untuk mengukur dan menandai titik yang akan dinilai. Diberikan stimulasi dengan alat TMS, dari intensitas paling kecil yang dinaikkan bertahap sampai didapatkan nilai ambang motorik (respons gerakan/kontraksi otot ibu jari tangan kanan, 50% dari stimulasi). Setelah data terkumpul, dilakukan pengolahan data. Hasil: Rerata hasil pengukuran ambang motorik yang didapatkan adalah 60,2% ± 8,841. Nilai tengah umur saat awitan gejala psikotik sebesar 19,5 ± 6,0, dan nilai tengah durasi perjalanan penyakit skizofrenia sebesar 13,0 ± 14,5 tahun. Pada uji korelasi antara variabel umur saat awitan gejala psikotik dengan ambang motorik didapatkan hasil tidak signifikan, dengan p= 0,063. Demikian pula, hasilnya tidak signifikan pada uji korelasi antara variabel durasi perjalanan penyakit skizofrenia dengan ambang motorik, p= 0,068. Tidak ada perbedaan bermakna rerata ambang motorik, terkait kelompok usia, jenis kelamin, antipsikotik, atau obat lainnya (antikolinergik, penstabil mood, benzodiazepin). Diskusi: Terdapat kesulitan pada pengambilan sampel, tidak semua pasien yang datang bersedia untuk ikut dalam penelitian, karena ragu dan takut akan keamanannya dan waktu yang dihabiskan, sekalipun telah dijelaskan dengan rinci. Tidak ada terjadi efek samping seperti nyeri atau kejang yang dilaporkan. Pengawasan dan penilaian pada penelitian ini dilakukan oleh pakar terlatih. Kekuatan penelitian relatif terbatas. Banyak subjek, terutama yang sudah lebih tua dan tidak ada keluarga, tidak ingat secara pasti mengenai umur saat pertama kali muncul gejala psikotik.
Introduction: Schizophrenia has a major impact on patients and their families, with late adolescence to early adulthood onset, and tends to last a lifetime. There is also a great potential for recurrence and symptoms worsening. Based on the theory of brain disconnectivity and neurodevelopmental disorders, it is suspected that the pathophysiology occurs due to the disrupted effectiveness of synaptic modulation. Regarding changes in connectivity, significant motor threshold differences between schizophrenic patients and normal controls are found using TMS. This shows a great potential of motor threshold to be used as a neurophysiological biological marker in schizophrenia. Nevertheless, currently not many motor threshold influencing factors are known. It is said that brain structural differences, neural development, and fractional anisotropy are related to the onset and duration of the disease in patients with schizophrenia. Therefore, further study will be carried out to see the relationship between onset age of psychotic symptoms or duration of schizophrenia and motor threshold. Method: A cross-sectional study design was carried out in the Psychiatric Outpatient Unit of Cipto Mangunkusumo Hospital in April 2018 to December 2018 (N = 40, ages 18 to 59 years), with consecutive sampling. The research subjects were treatment-resistant schizophrenia patients who underwent TMS. Demographic and clinical data were collected after detailed explanations and subjects gave informed consent. Motor threshold measurements were then carried out by trained experts. The subjects are given a cloth head cover to measure and mark the assessment point, and stimulations are casted from the smallest intensity, gradually increased, with TMS until the motor threshold value is obtained, based on movement / contraction responses of right thumb muscle as much as 50% of the stimulation. After all data is collected, data processing is carried out. Result: The mean result of motor threshold measurements was 60.2% ± 8.841. The median of age at the onset of psychotic symptoms is 19.5 ± 6.0, and the median of duration of illness of schizophrenia is 13.0 ± 14.5 years. The correlation test result between the age at the onset of psychotic symptoms and motor threshold was not significant, with p = 0.063. Similarly, the correlation test result between the duration of illness of schizophrenia and motor threshold was also not significant, with p = 0.068. There were no significant differences in motor thresholds mean, related to age group, gender, antipsychotics, or other drugs, such as anticholinergics, mood stabilizers, or benzodiazepines. Discussion: There were difficulties in sampling, which not all patients who had come were willing to participate in the study, because of their doubts and safety concerns, also worry about have to spend a lot of time, even though it has been explained in detail. There were no side effects that were reported. Monitoring and assessment in this study was carried out by trained experts. The power of the study is relatively limited. There are many research subjects, especially those who are older and have no other family, dont remember for certain about their psychotic symptoms onset. |
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