Faktor yang Mempengaruhi Respon Terapi Gangguan Ansietas dengan Alprazolam

Ni Nyoman Yudianti Mendra; Zullies Ikawati; Cecep Sugeng Kristanto

doi:10.22146/farmaseutik.v18i4.66260

Faktor yang Mempengaruhi Respon Terapi Gangguan Ansietas dengan Alprazolam

https://doi.org/10.22146/farmaseutik.v18i4.66260

Ni Nyoman Yudianti Mendra⁽¹⁾, Zullies Ikawati^(2*), Cecep Sugeng Kristanto⁽³⁾

(1) Fakultas Farmasi, Universitas Mahasaraswati Denpasar
(2) Departemen Farmakologi dan Farmasi Klinik, Fakultas Farmasi, Universitas Gadjah Mada
(3) Departemen Ilmu Kedokteran Jiwa, Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan Universitas Gadjah Mada
(*) Corresponding Author

Abstract

Tujuan utama terapi ansietas yakni mencapai remisi dan mencegah terjadinya kekambuhan. Dalam praktek klinik remisi lebih sulit untuk dicapai, sehingga tujuan terapi yang lebih diharapkan ialah ketercapaian respon terapi. Berkaitan dengan hal tersebut, pilihan terapi untuk gangguan ansietas mempertimbangkan beberapa faktor. Salah satu terapi yang umum digunakan untuk menangani ansietas yakni golongan benzodiazepin khususnya alprazolam. Penelitian ini bertujuan untuk mengetahui hubungan antara beberapa faktor terkait yang meliputi usia, jenis kelamin, penggunaan obat lain, dosis alprazolam, dan riwayat penyalahgunaan obat dengan ketercapaian respon terapi pasien dengan gangguan ansietas dengan terapi alprazolam. Penelitian ini merupakan jenis penelitian observasional dengan rancangan cross sectional. Pengambilan data secara retrospektif pada rekam medis dan kartu pengobatan pasien rawat jalan dengan gangguan ansietas periode Januari 2018 – Oktober 2020 di RS Bethesda Yogyakarta. Respon terapi berupa perbaikan gejala dan kondisi pasien selama 6 bulan penggunaan alprazolam yang tertera pada data rekam medis berdasarkan penilaian dokter spesialis kedokteran jiwa. Jumlah subjek penelitian yakni 84 pasien yang terdiri atas 39 subjek dengan perbaikan dan 45 subjek belum menunjukkan perbaikan. Berdasarkan hasil uji Chi-Square dan Fisher’s Exact test, faktor penggunaan obat lain dan dosis alprazolam yang mempengaruhi respon terapi. Kombinasi dengan antidepresan (RR 2,308; 95%CI 1,387-3,840) dan penggunaan alprazolam dosis rendah (RR 2,151; 95% CI 1,508-3,067) memiliki kecenderungan menunjukkan perbaikan terhadap respon terapi.

Keywords

alprazolam; gangguan ansietas; respon terapi

Full Text:

PDF

References

Amirullah, A. (2019). Pengaruh Penggunaan Alprazolam On-Label dan Off-Label Terhadap Outcome Klinik [Tesis, M.Sc]. Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada.

Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of Anxiety Disorders. Dialogues in Clinical Neuroscience, 19(2), 15.

Batelaan, N. M., Bosman, R. C., Muntingh, A., Scholten, W. D., & Huijbregts, K. M. (2017). Risk of Relapse After Antidepressant Discontinuation in Anxiety Disorders, Obsessive-Compulsive Disorder, and Post-Traumatic Stress Disorder: Systematic Review and Meta-Analysis of Relapse Prevention Trials. British Medical Journal, 358, 12. https://doi.org/10.1136/bmj.j3927

Batelaan, N. M., de Graaf, R., Penninx, B. W. J. H., van Balkom, A. J. L. M., Vollebergh, W. A. M., & Beekman, A. T. F. (2009). The 2-Year Prognosis of Panic Episodes in The General Population. Psychological Medicine, 40(1), 147–157. https://doi.org/10.1017/S0033291709005625

Bonn-Miller, M. O., & Moos, R. H. (2009). Marijuana Discontinuation, Anxiety Symptoms, and Relapse to Marijuana. Addictive Behaviors, 34(9), 782–785. https://doi.org/10.1016/j.addbeh.2009.04.009

Brady, K. T., Haynes, L. F., Hartwell, K. J., & Killeen, T. K. (2013). Substance Use Disorders and Anxiety: A Treatment Challenge for Social Workers. Social Work in Public Health, 28(3–4), 407–423. https://doi.org/10.1080/19371918.2013.774675

Campbell, A., Bailey, S. R., Hoffman, K. A., Ponce-Terashima, J., Fankhauser, K., Marino, M., & McCarty, D. (2020). Associations between Psychiatric Disorders and Cannabis-Related Disorders Documented in Electronic Health Records. Journal of Psychoactive Drugs, 52(3), 228–236. https://doi.org/10.1080/02791072.2020.1747665

Center for Behavioral Health Statistics and Quality. (2016). 2015 National Survey on Drug Use and Health: Detailed Tables (p. 3263). Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality.

Chowdhury, Z. S., Morshed, M. M., Shahriar, M., Bhuiyan, M. A., Islam, S. Mohd. A., & Bin Sayeed, M. S. (2016). The Effect of Chronic Alprazolam Intake on Memory, Attention, and Psychomotor Performance in Healthy Human Male Volunteers. Behavioural Neurology, 2016, 1–9. https://doi.org/10.1155/2016/3730940

Denys, D., & de Geus, F. (2005). Predictors of Pharmacotherapy Response in Anxiety Disorders. Current Psychiatry Reports, 7(4), 252–257. https://doi.org/10.1007/s11920-005-0078-4

Ginsburg, G. S., Kendall, P. C., Sakolsky, D., Compton, S. N., Piacentini, J., Albano, A. M., Walkup, J. T., Sherrill, J., Coffey, K. A., Rynn, M. A., Keeton, C. P., McCracken, J. T., Bergman, L., Iyengar, S., Birmaher, B., & March, J. (2011). Remission After Acute Treatment in Children and Adolescents with Anxiety Disorders: Findings from the CAMS. Journal of Consulting and Clinical Psychology, 79(6), 806–813. https://doi.org/10.1037/a0025933

Goodwin, R. D., & Stein, D. J. (2013). Anxiety Disorders and Drug Dependence: Evidence on Sequence and Specificity Among Adults. Psychiatry and Clinical Neurosciences, 67(3), 167–173. https://doi.org/10.1111/pcn.12030

Hershenberg, R., Gros, D. F., & Brawman-Mintzer, O. (2014). Role of Atypical Antipsychotics in the Treatment of Generalized Anxiety Disorder. CNS Drugs, 28(6), 519–533. https://doi.org/10.1007/s40263-014-0162-6

Iii, C. E. G., Kaye, A. M., & Kaye, A. D. (2013). Benzodiazepine Pharmacology and Central Nervous System–Mediated Effects. 13(2), 10.

Jung, M. E., Metzger, D. B., & Hall, J. (2020). The Long-Term but Not Short-Term Use of Benzodiazepine Impairs Motoric Function and Upregulates Amyloid β in Part Through the Suppression of Translocator Protein. Pharmacology Biochemistry and Behavior, 191, 172873. https://doi.org/10.1016/j.pbb.2020.172873

Kedzior, K. K., & Laeber, L. T. (2014). A Positive Association Between Anxiety Disorders and Cannabis Use or Cannabis Use Disorders in the General Population- a Meta-Analysis of 31 Studies. BMC Psychiatry, 14(136), 22. https://doi.org/10.1186/1471-244X-14-136

Kelly, K. M., & Mezuk, B. (2017). Predictors of Remission From Generalized Anxiety Disorder and Major Depressive Disorder. Journal of Affective Disorders, 208, 467–474. https://doi.org/10.1016/j.jad.2016.10.042

Kemenkes RI. (2018). Riset Kesehatan Dasar 2018. Kementerian Kesehatan RI.

Lader, M. (2012). Benzodiazepine Harm: How Can it be Reduced? British Journal of Clinical Pharmacology, 77(2), 295–301. https://doi.org/10.1111/j.1365-2125.2012.04418.x

Locke, A. B. (2015). Diagnosis and Management of Generalized Anxiety Disorder and Panic Disorder in Adults. American Academy of Family Physician, 91(9), 617–624.

O’Brien, P. L., Karnell, L. H., Gokhale, M., Kenneth Pack, B. S., Campopiano, M., & Zur, J. (2017). Prescribing of Benzodiazepines and Opioids to Individuals with Substance Use Disorders. Drug and Alcohol Dependence, 178, 223–230. https://doi.org/10.1016/j.drugalcdep.2017.05.014

Pollack, M. H., Simon, N. M., Worthington, J. J., Doyle, A. L., Peters, P., Toshkov, F., & Otto, M. W. (2003). Combined Paroxetine and Clonazepam Treatment Strategies Compared to Paroxetine Monotherapy for Panic Disorder. Journal of Psychopharmacology, 17(3), 276–282.

Preston, C. L. (2015). Stockley’s Drug Interactions 2015. Pharmaceutical Press.

Rickels, K., Shiovitz, T. M., Ramey, T. S., Weaver, J. J., Knapp, L. E., & Miceli, J. J. (2012). Adjunctive Therapy with Pregabalin in Generalized Anxiety Disorder Patients with Partial Response to SSRI or SNRI Treatment. International Clinical Psychopharmacology, 27(3), 142–150. https://doi.org/10.1097/YIC.0b013e328350b133

Rodriguez, B. F., Weisberg, R. B., Pagano, M. E., Bruce, S. E., Spencer, M. A., Culpepper, L., & Keller, M. B. (2006). Characteristics and Predictors of Full and Partial Recovery From Generalized Anxiety Disorder in Primary Care Patients. The Journal of Nervous and Mental Disease, 194(2), 91–97. https://doi.org/10.1097/01.nmd.0000198140.02154.32

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Anxiety Disorder. In Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry (Eleventh, pp. 832–904). Wolters Kluwer.

SAMHSA. (2014). Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings (p. 184). Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality.

WHO. (2017). Depression and Other Common Mental Disorders: Global Helath Estimates. World Health Organization.

DOI: https://doi.org/10.22146/farmaseutik.v18i4.66260