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Abstract
Abstrak
Pendahuluan: Gangguan skizoafektif merupakan kondisi psikiatri yang ditandai dengan kombinasi gejala psikotik (halusinasi, waham, perilaku aneh) dan gejala mood (depresi mayor atau mania). Faktor psikososial, seperti perundungan, dapat meningkatkan risiko terjadinya gangguan mental berat pada remaja. Kasus: Pasien wanita berusia 21 tahun datang ke puskesmas dengan keluhan sering menangis tiba-tiba, mengucapkan kata-kata kotor, serta menarik diri sejak dua bulan terakhir. Pasien juga mengalami halusinasi auditorik dan visual, afek datar, hipotimia, dan kehilangan minat. Pasien memiliki riwayat diagnosis skizofrenia pada usia 16 tahun, namun tidak patuh minum obat. Riwayat psikososial menunjukkan adanya perundungan saat SMP dan kehilangan figur ayah akibat pemenjaraan. Pembahasan: Diagnosis ditegakkan skizoafektif tipe depresif (F25.1) dengan pertimbangan gejala psikotik dan afektif yang menonjol pada episode yang sama. Faktor risiko mencakup pengalaman perundungan, stresor dari keluarga, dan ketidakpatuhan minum obat. Literatur menunjukkan perundungan dapat meningkatkan kadar kortisol, memengaruhi fungsi amigdala dan korteks prefrontal, serta berkontribusi terhadap kerentanan terhadap depresi dan gangguan psikotik. Berdasarkan meta analisis menunjukkan bahwa remaja yang mengalami perundungan berisiko 2,77 kali lebih tinggi mengalami depresi dibandingkan yang tidak mengalami perundungan. Kesimpulan: Perundungan pada masa remaja dapat menjadi stresor psikososial penting yang berperan dalam timbulnya gangguan skizoafektif. Intervensi dini dan dukungan keluarga sangat dibutuhkan untuk memperbaiki prognosis.
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References
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References
Arroll MA, Wilder L, Neil J. Nutritional interventions for the adjunctive treatment of schizophrenia: A brief review. Nutr J 2014; 13: 1–9.
Asyifah C, Firmansyah MA, Budiman DA. Kasus Bullying Dunia Pendidikan di Indonesia dari Perspektif Media dan Pemberitaannya. Syntax Literate ; Jurnal Ilmiah Indonesia 2024; 9: 374–383.
Bains N, Abdijadid S. Major Depressive Disorder. 2023. DOI: 10.1016/B978-012373947-6.00245-2.
Duan S, Duan Z, Li R, et al. Bullying victimization, bullying witnessing, bullying perpetration and suicide risk among adolescents: a serial mediation analysis. J Affect Disord. 2020;273:274–9.
Elvira SD, Hadisukanto G. Buku Ajar Psikiatri Edisi Ketiga. Edisi Ketiga. Jakarta, 2013.
Fan H, Xue L, Zhang J, et al. Victimization and depressive symptoms among Chinese adolescents: a moderated mediation model. J Affect Disord. 2021;294:375–81.
Harahap MA, Nelvia DD. Gangguan Psikotik Akut Dan Gangguan Skizoafektif. Jurnal Ventilator. 2023; (1): 66–78.
Hariandja SH, Mutia R, Silaen A. Penggunaan Clozapine pada Pasien Skizofernia : Sebuah Tinjauan Pustaka. Jurnal hasil penelitian dan pengembangan 2023; 1: 142–149.
Hidayati LN, Amalia R. Psychological Impacts On Adolescent Victims Of Bullying: Phenomenology Study. Media Keperawatan Indonesia 2021; 4: 201.
Hidayati B, Sudiyanto A, Fanani M. Pengaruh Terapi Tambahan Asam Folat Dan Kobalamin Terhadap Gejala Skizofrenia Kronik. Interest : Jurnal Ilmu Kesehatan 2017; 6: 118–126.
Marela G, Wahab A, Marchira CR. Bullying verbal menyebabkan depresi remaja SMA Kota Yogyakarta. Berita Kedokteran Masyarakat 2017; 33: 43.
Ramaekers VT, Thöny B, Sequeira JM, et al. Folinic acid treatment for schizophrenia associated with folate receptor autoantibodies. Mol Genet Metab. 2014;113:307–14.
Rivara F, Le Menestrel S. Preventing bullying through science, policy, and practice. Washington DC: National Academies Press; 2016.
Rossouw P. Defining bullying: the role of neurobiological markers. Int J Neuropsychother. 2013;1(1):2–8.
Suprapti R, Fitrikasari A, Pudjo R, et al. Pengaruh Pemberian Ajuvan Asam Folat Terhadap Fungsi Personal Dan Sosial Pasien Skizofrenia Kronik. J Nutr Coll 2021; 10: 243–250.
Ye Z, Wu D, He X, et al. Meta-analysis of the relationship between bullying and depressive symptoms in children and adolescents. BMC Psychiatry. 2023;23:681.
Zugno AI, Canever L, Heylmann AS, et al. Effect of folic acid on oxidative stress and behavioral changes in the animal model of schizophrenia induced by ketamine. J Psychiatr Res. 2016;81:23–35.