ii

Lembar Pengesahan

STUDI PENGGUNAAN QUETIAPIN PADA PASIEN

SKIZOFRENIA

(Penelitian Dilakukan di RSJ Dr. Radjiman

Wediodiningrat Lawang)

SKRIPSI

Dibuat untuk memenuhi syarat mencapai gelar Sarjana Farmasi pada Program Studi Farmasi Fakultas Ilmu Kesehatan

Universitas Muhammadiyah Malang 2018

Oleh :

RAHMAT AKBAR NIM : 201410410311155

Disetujui Oleh :

Pembimbing I Pembimbing II

Drs. Didik Hasmono, M.S., Apt. Dra. Lilik Yusetyani., Apt., Sp, FRS

NIP. 195809111986011011 NIP.UMM 114.0704.0450

iii

Lembar Pengujian

STUDI PENGGUNAAN QUETIAPIN PADA PASIEN

SKIZOFRENIA

(Penelitian Dilakukan di Rumah Sakit Jiwa Dr. Radjiman

Wediodiningrat Lawang)

SKRIPSI

Telah diuji dan dipertahankan di depan tim penguji

Pada tanggal 26 Januari 2018

Oleh :

RAHMAT AKBAR NIM : 201410410311155

Tim Penguji

Penguji I

Drs. DidikHasmono, M.S., Apt. NIP: 195809111986011001

Penguji II

Dra. Lilik Yusetyani, Apt., Sp.FRS. NIP: 114.0704.0450

Penguji III

Hidajah Rachmawati, S.Si., Apt., Sp.FRS. NIP. 11406090449

Penguji IV

Ika Ratna Hidayati, S.Farm., M.Sc., Apt. NIP. 11209070480

iv

KATA PENGANTAR

Assalamualaikum Wr. Wb.

Puji syukur ke hadirat Allah SWT atas berkah dan nikmat yang telah dilimpahkan

ke hamba-Nya, karena hanya dengan pertolongan dan izin-Nya lah skripsi yang

berjudul Studi Penggunaan Quetiapin (Seroquel) pada Pasien Skizofrenia

(Penelitian dilakukan pada Rumah Sakit Jiwa Dr. Radjiman Wediodiningrat

Lawang) dapat terselesaikan tepat waktu dan dengan sebaik-baiknya.

Selanjutnya penulis ingin mengucapkan terima kasih yang tidak terhingga kepada:

1. Orang tua Ibu Aida Rosvitawaty dan Bapak Rusdi yang telah memberi

materi, motivasi, dan do’a untuk menyelesaikan skripsi ini.

2. Bapak Faqih Ruhyanudin, M. Kep.,Sp.Kep.MB selaku dekan Fakultas

Ilmu Kesehatan Universitas Muhammadiyah Malang

3. Direktur dan staf Rumah Sakit Jiwa Dr. Radjiman Wediodingrat Lawang

yang telah membantu kelancaran penilitian skripsi hingga akhir.

4. Bapak Drs. Didik Hasmono, Apt., MS selaku pembimbing I yang telah

banyak meluangkan waktu untuk membimbing, mengarahkan, dan

memberi semangat, motivasi, serta menginspirasi penulis selama

menempuh pendidikan sampai terselesaikannya tugas akhir ini, semoga

Allah selalu melimpahkan kesehatan.

5. Ibu Dra. Lilik Yusetyani, Apt., Sp. FRS selaku Pembimbing II yang selalu

bersedia mengorbankan waktu untuk membimbing dan memberikan

movtivasi serta selalu sabar dalam mengarahkan hingga tugas akhir ini

dapat diselesaikan dengan baik dan tepat waktu, semoga Allah selalu

melimpahkan kesehatan.

6. Ibu Hidajah Rachmawati, S.Si., Apt., Sp. FRS dan Ibu Ika Ratna Hidayati,

S.Farm., M.Sc., Apt. selaku penguji I dan II yang telah banyak

memberikan kritikan dan saran demi terselesaikannya tugas akhir ini

dengan sebaik-baiknya, semoga Allah selalu melimpahkan kesehatan.

7. Seluruh jajaran prodi, dosen dan staf tata usaha Farmasi yang telah

memberikan dedikasi yang besar kepada penulis.

v

8. Kepada Aldiala Apriliawati yang selalu memotivasi dan sangat membantu

dalam proses menyusun skiripsi ini hingga skripsi ini terselesaikan.

9. Teman satu kelompok skripsi bertema Skizofrenia dan sesama pejuang

klinis yang telah berjuang bersama.

10. Terakhir, seluruh teman-teman jurusan Farmasi angkatan 2014 yang telah

berjuang bersama penulis untuk menyelesaikan pendidikan di Program

Studi Farmasi.

Akhir kata, penulis mohon maaf atas kekurangan dan ketidaksempurnaan

penulisan skripsi dan dengan senang hati menerima kritik dan saran yang

membangun. Semoga skripsi ini bermanfaat dalam mengembangkan ilmu

pengetahuan bidang farmasi klinis bagi penulis maupun pembaca.

Wassalamualaikum Wr. Wb.

Malang 8 Juni 2018

Rahmat Akbar

ix

DAFTAR ISI

KATA PENGANTAR ............................................................................................. iv

RINGKASAN ................................................................................................... vi

ABSTRAK ................................................................................................... vii

ABSTRACT ................................................................................................... viii

DAFTAR ISI ................................................................................................... ix

DAFTAR TABEL ................................................................................................... xiii

DAFTAR GAMBAR ............................................................................................... xv

DAFTAR LAMPIRAN ............................................................................................ xvi

RINGKASAN ................................................................................................... xvii

BAB I PENDAHULUAN ....................................................................................... 1

1.1 Latar Belakang .............................................................................................. 1

1.2 Rumusan Masalah ......................................................................................... 4

1.3 Tujuan Penelitian .......................................................................................... 4

1.4 Manfaat Penelitian ........................................................................................ 4

BAB II TINJAUAN PUSTAKA............................................................................ 5

2.1 Sistem Saraf Pusat ........................................................................................ 5

2.1.1 Anatomi Sistem Saraf Pusat .................................................................. 5

2.1.2 Mikroanatomi Sistem Saraf Pusat ......................................................... 8

2.2 Skizofrenia ................................................................................................... 9

2.2.1 Definisi Skizofrenia .............................................................................. 9

2.2.2 Epidemiologi Skizofrenia ..................................................................... 9

2.2.3 Etiologi Skizofrenia .............................................................................. 11

2.2.4 Klasifikasi Skizofrenia .......................................................................... 15

2.2.5 Gejala dan Gambaran Klinis ................................................................. 17

2.2.6 Patofisiologi Skizofrenia ...................................................................... 20

x

2.2.7 Diagnosis Skizofrenia ........................................................................... 24

2.3 Terapi Skizofrenia ......................................................................................... 26

2.3.1 Tujuan terapi ......................................................................................... 26

2.3.2 Prinsip Terapi........................................................................................ 26

2.3.3 Terapi Non Farmakologi Skizofrenia ................................................... 27

2.3.4 Terapi Farmakologi Skizofrenia ........................................................... 29

2.4 Tinjauan Quetiapin (Seroquel) ...................................................................... 37

2.4.1 Indikasi Quetiapin ................................................................................. 38

2.4.2 Farmakokinetik Quetiapin .................................................................... 38

2.4.3 Farmakodinamik Quetiapin .................................................................. 39

2.4.4 Mekanisme Kerja Quetiapin ................................................................. 40

2.4.5 Dosis Quetiapin .................................................................................... 43

2.4.6 Interksi Quetiapin ................................................................................. 44

2.4.7 Toksisitas Quetiapin ............................................................................. 44

2.4.8 Sediaan Quetiapin di Indonesia ............................................................ 45

BAB III KERANGKA KONSEPTUAL ............................................................... 46

3.1 Kerangka Konseptual .................................................................................... 46

3.2 Kerangka Operasional Studi Penggunaan Obat pada Pasien Skizofrenia ..... 47

BAB IV METODE PENELITIAN ....................................................................... 48

4.1 Rancangan Penelitian .................................................................................... 48

4.2 Populasi dan Sampel ..................................................................................... 48

4.2.1 Populasi ................................................................................................ 48

4.2.2 Sampel .................................................................................................. 48

4.3 Bahan Penelitian ........................................................................................... 48

4.3.1 Kriteria Inklusi dan Eksklusi ................................................................ 48

4.4 Instrumen Penelitian ..................................................................................... 49

4.4 Lokasi dan Waktu Penelitian ........................................................................ 49

xi

4.5 Definisi Operasional Parameter Penelitian ................................................... 49

4.6 Metode Pengumpulan Data ........................................................................... 49

4.7 Analisis Data ................................................................................................. 50

BAB V HASIL PENELITIAN .............................................................................. 51

5.1 Data Demografi ............................................................................................. 52

5.1.1 Distribusi Berdasarkan Jenis Kelamin Pasien ....................................... 52

5.1.2 Distribusi Berdasarkan Usia Pasien ...................................................... 52

5.1.3 Distribusi Berdasarkan Berat Badan Pasien .......................................... 52

5.1.4 Distribusi Berdasarkan Status Pasien .................................................... 53

5.2 Diagnosis Jenis Skizofrenia .......................................................................... 54

5.3 Pola Penggunaan Terapi Pada Pasien Skizofrenia ........................................ 54

5.4 Pola Penggunaan Terapi Pada Pasien ........................................................... 56

5.4.1 Pola Penggunaan Terapi Tunggal Pasien Rawat Jalan .......................... 56

5.4.2 Pola Penggunaan Terapi 2 Kombinsi Pasien Rawat Jalan .................... 57

5.4.3 Pola Penggunaan Terapi 3 Kombinsi Pasien Rawat Jalan .................... 58

5.4.4 Pola Penggunaan Terapi 4 Kombinsi Pasien Rawat Jalan .................... 59

5.4.5 Pola Penggunaan Terapi 5 Kombinsi Pasien Rawat Inap ..................... 61

5.4.6 Pola Penggunaan Terapi 3 Kombinsi Pasien Rawat Inap ..................... 62

5.4.7 Pola Penggunaan Terapi 5 Kombinsi Pasien Rawat Inap ..................... 62

5.5 Pola Pergantian Terapi Quetiapin (Switching) pada Pasien Skizofrenia ...... 64

5.5.1 Pola Pergantian Terapi Quetiapin (Switching) pada Pasien Rawat Jalan Skizofrenia ........................................................................................... 64

5.5.2 Pola Pergantian Terapi Quetiapin (Switching) pada Pasien Rawat inap Skizofrenia ........................................................................................... 68

5.6 Lama Pemberian Terapi Obat Quetiapin ....................................................... 69

5.6.1 Lama pemberian Terapi Obat Quetiapin pada Saat Rawat jalan ........... 69

5.6.1 Lama pemberian Terapi Obat Quetiapin pada Saat MRS ..................... 69

BAB VI PEMBAHASAN ...................................................................................... 70

xii

BAB VII KESIMPULAN DAN SARAN .............................................................. 79

7.1 Kesimpulan ................................................................................................... 79

7.2 Saran ............................................................................................................. 79

DAFTAR PUSTAKA ............................................................................................ 80

LAMPIRAN ............................................................................................................. 88

xiii

DAFTAR TABEL

Tabel II.1 Prevalensi gangguan jiwa berat di Indonesia ......................................... 11

Tabel II.2 Diagnosis skizofrenia menurut DCM & ICD ......................................... 25

Tabel II.3 Daftar beberapa obat gangguan neurologis ............................................ 30

Tabel II.4 Profil invitro ikatan quetiapin dengan beberapa reseptor ....................... 39

Tabel II.5 Daftar sediaan quetiapin di Indonesia .................................................... 45

Tabel V.1 Distribusi Jenis Kelamin Pasien ............................................................. 52

Tabel V.2 Distribusi Berdasarkan Usia Pasien........................................................ 52

Tabel V.3 Distribusi Berdasarkan Berat Badan Pasien ........................................... 53

Tabel V.4 Distribusi Berdasarkan Perubahan Berat Badan Pasien ......................... 53

Tabel V.5 Distribusi Berdasarkan Status Pasien ..................................................... 53

Tabel V.6 Distribusi Berdasarkan Diagnosa Pasien ................................................ 54

Tabel V.7 Presentase Pola Terapi Pada Pasien Rawat Jalan Skizofrenia ................ 55

Tabel V.8 Pola Penggunaan Terapi Pada Pasien Rawat Jalan Skizofrenia ............. 55

Tabel V.9 Presentase Pola Terapi Pada Pasien Rawat Inap Skizofrenia ................. 56

Tabel V.10 Pola Penggunaan Terapi Pada Pasien Rawat Inap Skizofrenia ............ 56

Tabel V.11 Pola Penggunaan Terapi Tunggal Pasien Rawat Jalan ......................... 57

Tabel V.12 Pola Penggunaan Terapi 2 Kombinasi Pasien Rawat Jalan .................. 57

Tabel V.13 Pola Penggunaan Terapi 3 Kombinasi Pasien Rawat Jalan .................. 58

Tabel V.14 Pola Penggunaan Terapi 4 Kombinasi Pasien Rawat Jalan .................. 59

Tabel V.15 Pola Penggunaan Terapi 5 Kombinasi Pasien Rawat Jalan .................. 61

Tabel V.16 Pola Penggunaan Terapi 3 Kombinasi Pasien Rawat Inap ................... 62

Tabel V.17 Pola Penggunaan Terapi 5 Kombinasi Pasien Rawat Inap ................... 62

Tabel V.18 Pola Pergantian Terapi Quetiapin(Switching) pada Pasien Rawat Jalan Skizofrenia .......................................................................................... 64

Tabel V.19 Pola Pergantian Terapi Quetiapin (Switching) pada Pasien Rawat Inap Skizofrenia .......................................................................................... 68

xiv

Tabel V.20 Lama Pemberian Terapi Quetiapin pada Saat Rawat Jalan .................. 71

Tabel V.20 Lama Pemberian Terapi Quetiapin pada Saat MRS ............................. 71

xv

DAFTAR GAMBAR

Gambar 2.1 Struktur otak ....................................................................................... 6

Gambar 2.2 Sistem limbik ...................................................................................... 7

Gambar 2.3 Sel saraf atau prekariyon .................................................................... 8

Gambar 2.4 Angka kematian di dunia disebabkan skizofrenia .............................. 10

Gambar 2.5 Skema patofisiologi skizofrenia ......................................................... 21

Gambar 2.6 Jalur dopamine .................................................................................... 23

Gambar 2.7 Perbedaan aktivitas neurotranmiter GABA glutaman dopamine ....... 23

Gambar 2.8 Hubungan dopamine-serotonin ........................................................... 24

Gambar 2.9 Struktur kimia quetiapin ..................................................................... 37

Gambar 2.10 Mekanisme kerja D2 pada mesolimbik ............................................ 41

Gambar 2.11 Mekanisme kerja 5HT2 pada mesokortikal ...................................... 41

Gambar 2.12 Mekanisme kerja SDA pada nigrostriatal ......................................... 42

Gambar 2.13 Mekanisme kerja SDA pada tuberoinfundibular .............................. 42

Gambar 3.1 Kerangka konseptual .......................................................................... 46

Gambar 3.2 Keragka operasonal ............................................................................ 47

Gambar 5.1 Skema kriteria inklusi ......................................................................... 51

xvi

DAFTAR LAMPIRAN

Lampiran 1 : DAFTAR RIWAYAT HIDUP ................................................ 88

Lampiran 2 : SURAT TUGAS ...................................................................... 89

Lampiran 3 : SURAT KETERANGAN SELESAI PENELITIAN .............. 90

Lampiran 4 : SURAT ETCHICAL CLEARENCE ....................................... 91

Lampiran 5 : SURAT HASIL PLAGIASI NASKAH .................................. 92

Lampiran 6 : SURAT PERNYATAAN ........................................................ 95

DAFTAR RINGKASAN

xvii

5-HT : Serotonin

ADL : Activities of Daily Living

CBT : Cognitive Behavioural Therapy

CT Scan : Computerized Tomographic Scan

DA : Dopamin

DSM : Diagnostic and Statistical Manual

ECT : Electro Convulsive Therapy

GABA : Gamma Aminobutyric Acid

LPD : Lembar Pengumpul Data

LSD : Lysergic Acid Diethylamide

mg : milligram

MRI : Magnetic Resonance Imaging

MRS : Magnetic Resonance Spectroscopy

NMDA : N-Methyl-d-aspartat

PFC : Pre Frontal Cortex

Riskesdas : Riset Kesehatan Dasar

RMK : Rekam Medik Kesehatan

RSJ : Rumah Sakit Jiwa

SNRI : Serotonine Norepinephrin Reuptake Inhibitor

SSP : SIstem Saraf Pusat

SSRI : Selective Serotonine Reuptake Inhibitor

TCA : Tricyclic Antidepressants

WHO : World Health Organization

80

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