Interactive pregnancy education on stress, cortisol, and epinephrine level in primigravida of trimester III pregnant: a quasi-experimental

Infant mortality is caused by various health problems, especially since the gestation period, even starting before the gestation period. Stress during pregnancy affects the motor, cognitive, and emotional development of the baby. This study aims to determine the effect of interactive pregnancy education (IPE) on decreasing levels of cortisol, epinephrine, and its relationship with stress levels in third-trimester primigravida pregnant women. This research is a quasi-experimental study using a nonequivalent control group design, which has two groups, namely the experimental group and the control group. The authors compared the experimental group that was given the intervention with the control group that was not given any treatment. This research was conducted in the three Community Health Centers in Indonesia from June 2022 until December 2022. The samples were 30 third-trimester primigravida pregnant women for the intervention and control groups. Data were analyzed using the Mann-Whitney and Wilcoxon tests with SPSS 22 software. The results of this study indicate that IPE has a good impact on pregnant women, where there is a significant relationship in the post-test cortisol and epinephrine levels in the intervention group. This indicates that IPE contributed to the difference in post-test scores in the intervention group. The IPE method is effective in reducing stress levels and cortisol levels in pregnant women, especially in pregnant women with high levels of stress.

Hypnotherapy influence on maternal psychological, breastfeeding, mRNA-OXTR expression, and OXTR protein

Hypnotherapy has emerged as a potential alternative to improve exclusive breastfeeding rates, particularly in countries like Indonesia where they are below optimal levels. This study aims to evaluate the impact of audio hypnotherapy on the psychological, exclusive breastfeeding behavior, the OXTR protein and mRNA expression gene OXTR in mothers of infants aged 0-6 months. This study employed a Pragmatic Randomized Controlled Trial design, conducted from November 2022 to May 2023 in 11 primary health centers. The study population included breastfeeding mothers with infants aged 0-6 months, with a total sample size of 70 respondents who were randomly divided into intervention (received audio hypnotherapy) and control groups (received standard care). The psychological condition was measured using the Depression Anxiety Stress Scale. Exclusive breastfeeding behavior was assessed based on both quality and quantity. Genetic factors were evaluated through mRNA OXTR expression using real-time PCR and protein OXTR levels using ELISA. Analyzing data using linear and logistic regression models. Both bivariate and multivariate analyses revealed significant differences in psychological condition (p < .0001). There were big differences in the exclusive breastfeeding behavior (p < .0001), as well as in the amounts of protein OXTR and mRNA expression of the OXTR gene (p < .0001). We recommend the implementation of audio hypnotherapy as an effective complementary therapeutic approach to manage the psychological well-being, exclusive breastfeeding behavior, the mRNA expression of the OXTR gene and levels of OXTR protein in mothers of infants aged 0-6 months.

OXTR Gene mRNA Expression is Correlated to Prosocial Behavior of Children in the Golden Generation Program of Nusa Tenggara Barat

BACKGROUND: Cases of undernutrition, such as stunting and wasting, in Nusa Tenggara Barat (NTB), Indonesia, was found to be relatively high. Therefore, local government launched a golden generation program called GEN NTB to improve the quality of human resources by achieving a healthy, intelligent, devout, and productive generation in 2045. One of the genes known to be related with prosocial behavior is the oxytocin transferase (OXTR) gene. This study was conducted to determine the association between OXTR gene mRNA expression and prosocial behavior of the GEN NTB children.METHODS: This was an analytical observational case-control study involving 25 children as GEN NTB samples and 26 children as controls. Blood samples were tested for OXTR protein level with enzyme-linked immunosorbent assay (ELISA), and OXTR mRNA expression with real time polymerase chain reaction (RT-PCR). Prosocial behavior was characterized and determined by using a rating method, which valued from 1 to 4 for poor to very good behavior.RESULTS: The average OXTR protein levels of the GEN NTB group was 88.28 ng/mL, which were higher than the average OXTR protein levels of control group (2.41 ng/mL). According to fold change analysis, the OXTR mRNA expression in GEN NTB group was also higher than the control group (10.91 vs. 6.40). Interestingly, observations on the prosocial behavior of the GEN NTB group showed significantly higher rate values compared to the control group (17.3 vs. 8.0, p=0.034). Hence, these findings showed that the OXTR protein level and OXTR mRNA expression was correlated with the better prosocial behavior.CONCLUSION: Higher rating of prosocial behavior of the GEN NTB children is related to the higher OXTR mRNA expression levels. This might be attributed to the interventions of GEN NTB program that may elevate children's quality of life since early childhood.KEYWORDS: GEN NTB, OXTR protein, mRNA expression, prosocial behavior, children

Effect of Probiotic Adjuvant Therapy on Improvement of Clinical Symptoms & Interleukin 6 Levels in Patients With Schizophrenia

OBJECTIVE

This study aims to examine the effect of giving probiotic adjuvant therapy on improving clinical symptoms & IL-6 levels in patients with schizophrenia.

METHODS

This research was a double-blind, placebo-controlled trial conducted at Dadi Psychiatric Hospital, South Sulawesi Province, Indonesia in November-December 2021. The sample of the research was patients with schizophrenia undergoing hospitalization who received therapeutic doses of risperidone with a total of 21 samples in each treatment and control group. Research subjects were measured with Positive and Negative Syndrome Scale (PANSS) at baseline, 2nd, 4th, and 6th weeks. The treatment group received one capsule/12 hours/oral of probiotics for six weeks and the control group received 1 capsule/12 hours/oral placebo for 6 weeks. In addition, two measurements of IL-6 using enzyme-linked immunosorbent assay were performed in both groups, namely at the beginning of week 0 and the end of the 6th week.

RESULTS

We found the decrease in the PANSS value which described the improvement in clinical symptoms of the schizophrenic group after receiving therapeutic doses of antipsychotics and probiotic capsules or the treatment group as well as the schizophrenia group receiving therapeutic doses of antipsychotics and placebo capsules or the control group.

CONCLUSION

Improvements in clinical symptoms and decreased levels of IL-6 in the group of patients with schizophrenia who received risperidone with probiotic adjuvant therapy were better than in the group of patients with schizophrenia who received risperidone without probiotics as adjuvant therapy.

Comparison between Interleukin-2 Serum Levels and Positive and Negative Syndrome Scale Scores of Schizophrenia Patients that Received Haloperidol with Risperidone Therapy

BACKGROUND: There is a possibility of interleukin-2 (IL-2) being involved in the pathophysiology of Schizophrenia. The increase of IL-2 levels has been discovered in the serum of schizophrenic patients in earlier studies. An amount of antipsychotic has been associated with the decrease of IL-2. AIM: Therefore, this study was intended to compare the serum IL-2 levels of schizophrenic patients who received Haloperidol therapy with patients who received Risperidone as well as examine the relationship between serum IL-2 levels with the positive and negative syndrome scale (PANSS) score of schizophrenic patients receiving Haloperidol and Risperidone therapy. METHODS: This study is an observational study with a prospective cohort design consisting of 36 patients who have met the Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria for Schizophrenic patients who did not take antipsychotic drugs for 2 weeks and were hospitalized at the Special Hospital of South Sulawesi Province. Afterwards, the patients were grouped into two groups, where each group consisted of 18 people, namely, the group of patients who received Haloperidol and the group of patients who received Risperidone, and then were furtherly evaluated until the 4th week. The sample examination method used was enzyme-linked immunosorbent assay to see the blood serum IL-2 levels. Clinical symptoms of Schizophrenia were assessed using the PANSS score. RESULTS: The study showed that serum IL-2 levels decreased at the 4th week after conducting antipsychotic therapy among both groups. The decrease in PANSS scores in the Risperidone group was greater compared to the Haloperidol group at week 3 and week 4. In the serum IL-2 levels difference of the group who received Risperidone therapy, the decrease was greater than those receiving Haloperidol therapy (3.72 ± 1.30 ng/ml vs. 2.43 ± 1.39 ng/ml, p = 0.008). In addition, based on the correlation test, no significant correlation was present between the difference in the total PANSS score and the difference in the serum IL-2 levels within the Haloperidol group (p = 0.059, r = 0.453) and the Risperidone group (p = 0.518, r = 0.113). Schizophrenic patients have higher serum IL-2 levels than healthy people. Schizophrenic patients who received antipsychotics for 4 weeks experienced a decrease in serum IL-2 levels. Risperidone administration had a higher decrease in serum IL-2 levels than Haloperidol. CONCLUSION: Changes in serum IL-2 levels as a consideration of one of the Biomarkers are still needed for further evaluation. The therapeutic role of Haloperidol and Risperidone can be attributed as anti-inflammatory in Schizophrenia but cannot be attributed to improvement in the psychopathological status of Schizophrenic patients.

Black Seed (Nigella sativa) Efficacy in Improving Clinical Symptoms and Interleukin-6 Levels Schizophrenic Patients

BACKGROUND: Schizophrenia with a global prevalence of 0.33–0.75% and one of the top 15 causes of disability. The etiology underlying this disease is still controversial. One of the causes is the Vulnerability Stress-Schizophrenia Inflammatory Model which shows an increase in pro-inflammatory cytokines, one of which is Interleukin-6 (IL-6). AIM: It is hoped that through the adjuvant anti-inflammatory effect of black seed or Nigella sativa can improve the clinical symptoms of schizophrenia and reduce levels of Serum IL-6 as a marker of therapeutic efficacy, as well as observing the effect of treatment on liver function. METHODS: The present study was conducted 22 schizophrenic patients hospitalized at the psychiatric hospital (Rumah Sakit Khusus Daerah) of South Sulawesi aged 20–45 years and received risperidone 4 mg/day therapy. Patients were divided into two groups, the control and treatment groups received N. sativa 1000 mg/d for 4 weeks. Each group was measured for baseline and week 4 clinical symptoms of schizophrenia with Positive and Negative Symptom of Schizophrenia (PANSS) and serum IL-6 levels. The analysis also measured serum IL-6 levels in 14 healthy people by assessing the side effects of N. sativa adjuvants by measuring liver function enzymes of Serum Glutamic Oxaloacetic Transaminase (SGOT) and Serum Glutamic Pyruvic Transaminase (SGPT). RESULTS: Serum IL-6 levels of schizophrenic patients were higher than healthy controls. Administration of adjuvant N. sativa 1000 mg for 4 weeks significantly p < 0.001 improved PANSS value, decreased serum IL-6 levels 2.5 times faster in the treatment group and did not give a significant change in SGOT and SGPT values. CONCLUSION: This study suggests that N. sativa may consider as an adjuvant therapy to improve clinical symptoms of schizophrenia and reduce levels of IL-6 was faster than control group and is safe for liver function.

Foot Hydrotherapy: Non-pharmacology Treatment for Reducing Anxiety in Third Trimester Pregnancy

Objective: This research aims to examine the effect of foot hydrotherapy as one of non-pharmacological therapies for reducing anxiety of pregnancy. Method: The reported study employed Quasi Experimental method by using two Group pretest-posttest design with comparison group. It involved 57 respondents who were recruited using consecutive sampling technique. Hamilton Anxiety Rating Scale (HARS) questionnaire was used to measure the respondents’ anxiety. For bivariate analysis, the data were tested using paired samples t-test and Independent T-test Result. The results of data analysis indicated that before the treatment, the anxiety values in the two groups were almost the same (21±2.3 dan 22.07±1.99). After the treatment in the intervention group, the anxiety value decreased while in the control group, the anxiety score was increased on the third day after the pretest measurement Data analysis which was conducted with Independent Sample t-test revealed that foot hydrotherapy using warm water reduced the anxiety level of pregnant women in the third trimester (p = 0,000). Conclusion: Giving foot hydrotherapy is effective for reducing anxiety in pregnant women. Therefore, the non-pharmacological therapy can be socialized and applied given to the public (society), especially pregnant women

The Effectiveness of Chlorpromazine to Decrease the Level of Tumor Necrosis Factor-Alpha Serum in Schizophrenic Patients with Coronavirus Disease 2019

BACKGROUND: The ongoing coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus-2. The COVID-19 pandemic has also had an impact on mental health, including those with schizophrenia (SCH). There were 131 inpatient schizophrenic patients who were confirmed positive for COVID-19 at Dadi Makassar Hospital, South Sulawesi, Indonesia, but all of these patients did not experience any clinical symptoms of COVID-19. Chlorpromazine as an antipsychotic also has antiviral and anti-inflammatory effects in schizophrenic patients with COVID-19, and the schizophrenic neuroinflammatory is very likely to occur in patients with COVID-19 infection. AIM: The researchers tried to examine the effectiveness of chlorpromazine on serum TNF-values in schizophrenic patients with COVID-19. METHODS: This research is a nested case–control study. The study was conducted on schizophrenic patients with mild and asymptomatic cases of COVID-19 at Dadi Mental Hospital with a sample of 40 patients compared to 42 schizophrenic patients who were not COVID-19. Study subjects received chlorpromazine 100 mg/day for 4 weeks. Serum tumor necrosis factor-alpha (TNF-α) concentrations were measured by enzyme-linked immunosorbent assays when COVID-19 was first confirmed and after 4 weeks. Positive and negative syndrome scale (PANSS) and clinical global impression SCH (CGI-SCH) examinations were also performed to measure the clinical symptoms of SCH. RESULTS: The comparison of baseline TNF-serum levels that increased in the schizophrenic group with COVID-19 was 9.33 pg/ml higher, compared to the schizophrenic group without COVID-19. The decrease in TNF-levels in the schizophrenic group with COVID-19 of 7.96 pg/ml (p < 0.001) indicated an improvement in TNF-serum levels at week 4. Meanwhile, there was no significant decrease in serum TNF- levels in the non-COVID-19 schizophrenic group (p > 0.05). CONCLUSION: The serum TNF-value of schizophrenic patients with COVID-19 is higher than schizophrenic patients without COVID-19. Coadministration of chlorpromazine, antipsychotics, and COVID-19 therapy reduces serum TNF- values in schizophrenic patients with COVID-19. The administration of chlorpromazine and antipsychotic in therapeutic doses reduced the total PANSS and CGI-SCH values.

The influence of macronutrient intake, stress and prostaglandin levels (pgf2α) of urine with the incidence of dysmenorrhea in adolescents

OBJECTIVES

This study aimed to analyze the influence of macronutrient intake, stress, and prostaglandin levels (pgf2α) on adolescent dysmenorrhea incidence.

METHOD

This type of study is observational analytic with a cohort study draft done in January-March 2020 at High junior school 21 Makassar. Respondents in this study were grade X and XI students divided into 64 teenagers who had dysmenorrhea and 64 adolescents who did not experience Dysmenrhea. The criteria of the respondent in this study were the reproductive age, already experiencing menstruation, knowing the time and date of menstruation, menstrual cycles were regular, and willing to be respondents. The study used Menstrual Symptoms Questionnaire (MSQ) and used an ultrasonography (ultrasound) examination to perform the sample cervical. Food recall 24 hours to assess the intake of macronutrients, Depression Anxiety Stress Scales (DASS 42) to measure stress levels, and an examination of urine prostaglandin levels using the method Enzyme-Linked Immunosorbent Assay (ELISA). Urine intake is carried out on the second day as much as 2-5cc. Data were analyzed by the Chi-square test and logistics regression backward.

RESULT

A multivariate analysis showed a variable that strongly affects dysmenorrhea is stress with the value p=0.000 and the level of prostaglandins with p-value=0.003 compared to other variables.

CONCLUSION

Stress and prostaglandin levels significantly affect the occurrence of dysmenorrhea in adolescents.

The use of aromatherapy in primary dysmenorrhea

OBJECTIVE

The purpose of this review is to determine the use of aromatherapy in primary dysmenorrhea.

METHOD

This is a literature review by searching article databases through Google Scholar, PubMed, ScienceDirect, Microsoft Academic, ProQuest, Semantic Scholar. The selection period for article publication is from 2015 to 2021. A total of 96 articles were obtained, and 30 articles could be entered according to the inclusion criteria.

RESULTS

Thirty articles were analyzed, it is shown that aromatherapy effectively reduces the intensity of primary dysmenorrheal pain. The sample size of the 30 articles varied from 16 samples to 200 research samples, and the research design used experiments, clinical trials, and ex vivo, in vivo, and in vitro studies.

CONCLUSION

Aromatherapy is an effective alternative intervention that can be used to reduce the intensity of primary dysmenorrhea pain.

Abnormalities in Glucose Blood Level during Antipsychotic Treatment in Schizophrenia Patients

Background: Schizophrenia is one of the mental disorder with many problematic issues, in both psychologically and socially. This disease requires provision of long-term antipsychotic therapy, hence could rise other potential health problems. Antipsychotic treatment can cause serious glucometabolic side-effects, including type 2 diabetes and hyperglycemic emergency. Recent attention has also been focused on antipsychotic-induced hyperglycemic emergencies experienced by new users of typical and atypical antipsychotic. Patients treated with atypical APDs have ~10 times higher risk in developing hyperglycaemic emergencies. In our pre-eliminary study, hyperglycemia condition in new patients occurs in four  in seven patients who received typical and atypical antipsychotics. This condition is often overlooked and is not routinely evaluated. Moreover, it can develop into diabetes and increase the risk of morbidity and mortality in schizophrenia patients. In this study, we would like to determine the acute effects of metabolic (hyperglycemia) in patients treated with antipsychotic (Risperidone and Haloperidol) Measurement of blood sugar levels was performed in groups treated with haloperidol (N = 15) and treated with risperidone (N = 15). Plasma samples were taken at the beginning of treatment, in week IV, and in week VIII. The measurement of glucose levels was performed after meal and in early morning before breakfast (fasting blood glucose level 8 hours). Results: The blood sugar level after meals was significantly higher in the Risperidone group compared to the Haloperidol group  (p <0.001) after IV and VIII weeks. Meanwhile, the fasting blood sugar level was significantly higher in the Risperidone group compared to the Haloperidol group after VIII weeks of treatment ( p <0.001). Conclusions: Both antipsychotics can cause an increase in blood sugar levels. Treatment with Risperidone significantly increased the blood sugar levels compared to treatment with haloperidol. Measurement of blood sugar level is needed to monitor the metabolic effect of antipsychotic, especially in patients treated with Risperidone. It is necessary to have dietary regulation and physical activities to prevent undesired metabolic side effects.

Differentiation in Neurological Soft Sign Scores on Schizophrenic Patients with Antipsychotic Treatment

Background: Schizophrenia is a chronic mental illness that affects cognitive aspect of a patient which need long term care with antipsychotics. Long term use of antipsychotic itself causes neurobiological change in the brain which results in alteration of cognitive function. The latest research had demonstrated that NSS (Neurological Soft Sign) reflect a rather wide range of cognitive impairments in schizophrenia which was not accounted for by age, education or severity of global cognitive deficits. Therefore, we examined the effects and impact of antipsychotic Haloperidol and Risperidone treatment in schizophrenic patient using NSS scores. The Study showed that chronic schizophrenia patients had a higher NSS scores than acute patients. NSS also significantly associated with all neuropsychological domains of MMSE in both groups and were confirmed when age, education and severity of global cognitive deficits were not accounted for. This study also obtained a lower NSS score in patients who received Risperidone therapy compared to Haloperidol with p = 0.003. Out of 5 NSS domain in the Heidelberg scale, there was a significant improvement in motor coordination and motor sequencing (p = 0.004) and (p = 0.048) in patients who received Risperidone therapy compared to Haloperidol. There was an association between the chronicity of the disease and NSS, NSS also shows that it’s not influenced by age, education and severity of global cognitive deficits as a screening instrument. Finally the improvement of NSS scores in the Risperidone group was far superior compared to the Haloperidol group particularly in motor coordination and motor sequencing.

Salivary Alpha-amylase Enzyme and Salivary Cortisol Level in Depression after Treatment with Fluoxetine

Hypothalamic-Pituitary-Adrenal (HPA) axis and its end product cortisol have been extensively investigated in patients with depressive disorders for many years. Recently, salivary alpha-amylase (sAA) had emerged as a new biomarker with non-invasive and more convenience protocol for measuring sympathetic activity which were also associated with depression. Selective Serotonin Reuptake Inhibitor (SSRI) is antidepressant drug extensively used to treat depression. The aim of this study was to determine whether decrease of sAA and salivary cortisol levels could be observed in subjects with depression who were treated by fluoxetine. The total subjects were 25 depressed subjects and 10 healthy controls. sAA was examined before therapy, and after 2, 4 and 6 weeks of fluoxetine administration using a portable cocorometer. Salivary cortisol was examined before therapy, after 4 and 6 weeks of fluoxetine administration with Elisa method. The therapeutic effect was assessed with Hamilton Depression Rating Scale (HDRS). Results: sAA and cortisol level were significantly decreased after fluoxetine administration (p<0.001) followed by at least 50% reduction of HDRS scores after 6 weeks of fluoxetine administration. Levels of sAA and cortisol were higher in the depression group than in the healthy control. Conclusions: Measurement of sAA levels can be used as a potential biomarker of therapeutic response in depressed patients in addition to salivary cortisol.

Comparison of Brain-derived Neurotrophic Factor Level in Depressed Patients Treated with Fluoxetine and Sertraline

Background: The Brain-Derived NeurotrophicFactor (BDNF) is the main neuronal growth factor in the brain that regulates neurogenesis, neuronal maturity, synaptic formation and plasticity. Studies showed BDNF level decreased in depression and the administration of anti depressant drugs increased BDNF level. In this study, we used fluoxetine and sertraline, which are Selective Serotonin Reuptake Inhibitor (SSRI) but had a different mechanism in influencing the BDNF levels. The purpose of this study was to compare the effect of fluoxetine and sertraline administration tothe BDNF level in depressed subjects. This study was conducted at Wahidin Sudirohusodo Hospital, Makassar, Indonesia and its affiliates from January to February 2019. Twenty outpatient subjects were diagnosed with depression based on DSM-V. The subjects were either antidepressant naïve, or dropping out of antidepressant therapy for at least 3 months since the last administration. Blood samples from each subject were taken by consecutive sampling, and BDNF levels were analyzed before and after administration of fluoxetine and sertraline for six weeks. Also, Hamilton Depression Rating Scale (HDRS) scores are measured before and after administration. The BDNF serum was significantly increased by 100.6% (p<0,001) from the baseline level in the fluoxetine group and 75.4% in the sertraline group. HDRS score was decreased by39.5%  (p<0,001) in the fluoxetine group and 30.1% in the sertraline group after six weeks of administration. This study suggests that fluoxetine was superior to sertraline in increasing the BDNF level in depression.

Potential Link between T102C Polymorphism in the Serotonin Receptors (5-HT2A) Gene and Treatment Response of Risperidone on Schizophrenia

BACKGROUND: Schizophrenia affects 1% of population and its molecular etiology remains enigmatic despite enormous study. Approximately one-third of patients failed to respond with treatment. The 5-HT2A receptor appears to be one of important site of action of atypical antipsychotic drugs. It also has been suggested that the T102C gene polymorphism alters promoter activity and expression of 5-HT2A receptors and might be responsible for the associations with the efficacy of typical antipsychotics. AIM: In this study, we aimed to evaluate the potential link between T102C polymorphism in the Serotonin Receptors (5-HT2A) and their response to risperidone. METHODS: We studied 100 schizophrenia patients and 100 healthy volunteers as a comparison of 5-HT2A receptors gene polymorphism distribution, which were all Indonesian. The peripheral blood samples were obtained from all participants. The patients assessed by Positive and Negative Scale (PANSS) and Clinical Global Impression Scale (CGI) when admitted to the hospital. Clinical improvements then assessed 5 times in 4 weeks (when transferred to sub-acute ward, at the 1st, the 2nd, the 3rd, and the 4th week). To analyze the T102C polymorphism of 5-HT2A receptor gene, we used an allele specific polymerase chain reaction based restriction fragment length polymorphism (PCR-RFLP) method. RESULTS: In this study, there were three various polymorphisms of T102C in the serotonin receptor (5-HT2A) gene: T/T, C/C, and T/C. The patients who had homozygous for T/T genotypes were found to give better improvement to risperidone than the patients who were C/C and T/C genotypes (P:0.001). Moreover, the patients with C allele genotype T/C and C/C had minimal response (P:0.001). We found no significant difference distribution of genotypes between schizophrenia patients and healthy volunteers (P:0.498). CONCLUSION: Our result supported that there was a potential link between T102C polymorphism in the serotonin receptor (5-HT2A) gene and treatment response of risperidone. It suggested the importance of genetic screening such as examination of the Serotonin Receptor 5-HT2A (T102C) gene polymorphism to be performed to optimize therapeutic strategies with antipsychotic.

Salivary Alpha Amylase Enzyme and Salivary Cortisol Level in Depression after Treatment with Fluoxetine

BACKGROUND: Hypothalamic-pituitary-adrenal axis and its end product cortisol have been extensively investigated in patients with depressive disorders for many years. Recently, salivary alpha-amylase (sAA) had emerged as a new biomarker with non-invasive and more convenience protocol for measuring sympathetic activity which were also associated with depression. Selective Serotonin Reuptake Inhibitor is antidepressant drug extensively used to treat depression. AIM: The aim of this study was to determine whether decrease of sAA and salivary cortisol levels could be observed in subjects with depression who were treated by fluoxetine. METHODS: The total subjects were 25 depressed subjects and ten healthy controls. sAA was examined before therapy, and after 2, 4, and 6 weeks of fluoxetine administration using a portable cocorometer. Salivary cortisol was examined before therapy, after 4 and 6 weeks of fluoxetine administration with Elisa method. The therapeutic effect was assessed with Hamilton Depression Rating Scale (HDRS). RESULTS: sAA and cortisol levels were significantly decreased after fluoxetine administration (p < 0.001), followed by at least 50% reduction of HDRS scores after 6 weeks of fluoxetine administration. Levels of sAA and cortisol were higher in the depression group than in the healthy control. CONCLUSIONS: Measurement of sAA levels can be used as a potential biomarker of therapeutic response in depressed patients in addition to salivary cortisol.

Socio-economic-demographic determinants of depression in Indonesia: A hospital-based study

The association of socio-economic-demographic (SED; e.g., income-related) factors with depression is widely confirmed in the literature. We conducted a hospital-based case–control study of 160 patients with psychiatrist-diagnosed clinical depression. The control group comprised 160 participants recruited from local communities. We used a questionnaire to collect SED data from all participants. We replaced missing values using multiple imputation analyses and further analyzed the pooled data of five imputations. We also recorded the results from the original analysis and each imputation. Univariate analyses showed income was associated with depression. Multiple logistic regression analyses revealed that, among all SED variables, high income (odds ratio = 2.088 [95% confidence interval = 1.178–3.700]; p = 0.012), middle-level (completed junior or senior high school) education (1.688 [1.042–2.734]; p = 0.033) and cohabitating with four or more family members (1.632 [1.025–2.597]; p = 0.039) were significant predictors for the case group. We conclude that cash income is a determinant of depression in hospital outpatients in Indonesia. This study suggests health policy implications toward better hospital access and service for people with depression in middle- or low-income households, and recommends considering high income as correlated with a high risk of depression, owing to socio-cultural changes.

The Side Effect of Haloperidol in Schizophrenic Patients: Analysis of Red Blood Cell Distribution Width (RDW) and Mean Platelet Volume (MPV) Values

INTRODUCTION: Like the increase of pro-inflammatory cytokines and oxidative stress as schizophrenia pathophysiology, haloperidol also increases RDW and MPV values. Both of these values ​​have been clinicians concern because they are a risk factor for the various type of vascular disease. OBJECTIVE: This study aims to determine the side effect of haloperidol on RDW and MPV values in schizophrenic patients. METHODS: This research method uses observational analytic design with a prospective cohort approach with pre and posts analysis conducted at the Regional Special Hospital of South Sulawesi Province during May - July 2018 in 30 schizophrenic subjects. The subjects were diagnosed as first episode schizophrenia based on ICD 10, blood samples were taken, for RDW and MPV values ​​before and after haloperidol was given at the 4th and 8th weeks. RESULTS: The results showed that the mean RDW value at the 4th week was higher in 15 mg/day haloperidol group (15.8) compared to 7.5 mg/day haloperidol group (15.3) with p&lt;0.05. Mean RDW value taken at 8th week was higher in 15 mg/day haloperidol group (16.4) compared to 7.5 mg/day haloperidol group (15.6) with p&lt;0.001. Mean MPV value taken at 8th week was higher in 15 mg/day haloperidol group (13.3) compared to 7.5 mg/day haloperidol group (11.6) with p&lt;0.001. CONCLUSION: This study showed an increase in the RDW value in schizophrenia subjects prior to the haloperidol administration. RDW ​​and MPV values were higher after haloperidol treatment compares to before haloperidol treatment. The increase of RDW and MPV values tend to be influenced by haloperidol dosage and administration duration.