COGNITIVE BEHAVIOUR THERAPY PADA REMAJA DENGAN PERCOBAAN BUNUH DIRI
DOI:
https://doi.org/10.51878/healthy.v3i2.3153Keywords:
Episode Depresif Berat, Perilaku Bunuh Diri, Terapi Perilaku KognitifAbstract
Cognitive Behavioral Therapy (CBT) is a therapeutic approach that has been proven effective in treating various mental health problems, including suicide attempts in adolescents. The World Health Organization states that suicide is the second leading cause of death in the 15-29 year age group. In adolescents with suicide attempts, CBT can be used to help identify negative thoughts that drive suicidal thoughts and develop healthier coping strategies. It is important to note that CBT is not the only solution, but can be combined with other interventions, such as family support, psychoeducational education, and group therapy. This is a qualitative study using a case study approach combining observational studies and biographical studies. A 15-year-old girl, domiciled in Denpasar, junior high school education, unmarried, unemployed. The patient was diagnosed with a Major Depressive Episode without Psychotic Symptoms complaining of sadness since 1 month ago and felt even sadder when she had to go home. The patient felt more sensitive and felt that no one loved and understood her condition. The stressors felt were getting worse since she was suspended from school for not paying school fees and was reprimanded for dating. There are thoughts of drinking bleach and suddenly thinking about drinking the liquid. The patient also feels a loss of interest and joy, gets tired easily, and has difficulty concentrating. The patient is a stubborn and unruly child. When corrected, the patient will get angry and run away from home. Children with more severe depressive symptoms are more likely to benefit from antidepressants. The patient needs to be given pharmacotherapy and non-pharmacotherapy. Pharmacotherapy in this case is fluoxetine 5 milligrams intraorally every 24 hours (morning). Non-pharmacotherapy can be given supportive psychotherapy, CBT, and psychoeducation. Conflict management is not only done to the patient but also to the patient's family. Family conflict and parenting patterns can be one of the factors that aggravate the patient's current condition.
ABSTRAK
Terapi Perilaku Kognitif (CBT) merupakan pendekatan terapeutik yang telah terbukti efektif dalam mengatasi berbagai masalah kesehatan mental, termasuk percobaan bunuh diri pada remaja. Organisasi Kesehatan Dunia mengungkapkan bunuh diri menjadi penyebab kematian terbanyak kedua pada kelompok usia 15-29 tahun. Pada remaja dengan percobaan bunuh diri, CBT dapat digunakan untuk membantu dalam identifikasi pemikiran negatif yang mendorong keinginan untuk bunuh diri serta mengembangkan strategi koping yang lebih sehat. Penting untuk dicatat bahwa CBT bukan menjadi solusi tunggal, namun dapat dikombinasikan dengan intervensi lain, seperti dukungan keluarga, pendidikan psikoedukatif, dan terapi kelompok. Merupakan penelitian kualitatif melalui pendekatan studi kasus menggabungkan antara studi observasi dan studi biografi. Seorang anak perempuan 15 Tahun, domisili Denpasar, Pendidikan SMP, belum menikah, belum bekerja. Pasien didiagnosa dengan Episode Depresif Berat tanpa Gejala Psikotik mengeluh sedih sejak 1 bulan yang lalu dan makin merasa sedih saat harus pulang ke rumah. Pasien merasa lebih sensitif serta merasa tidak ada yang menyayangi dan memahami kondisinya. Stressor yang dirasakan semakin memberat sejak mendapatkan skorsing dari sekolah karena belum membayar uang sekolah dan ditegur karena berpacaran. Terdapat pikiran terlintas untuk minum pemutih pakaian dan secara tiba-tiba berpikir untuk meminum cairan tersebut. Pasien juga merasa kehilangan minat dan kegembiraan, mudah lelah, dan sulit untuk konsentrasi. Pasien merupakan anak yang keras kepala dan sulit diatur. Bila dikoreksi, pasien akan marah dan kabur dari rumah. Anak-anak dengan gejala depresi yang lebih parah kemungkinan besar mendapatkan manfaat dari pemberian antidepresan. Pada pasien perlu untuk diberikan farmakoterapi dan nonfarmakoterapi. Farmakoterapi pada kasus ini berupa fluoxetine 5 miligram intraoral tiap 24 jam (pagi). Nonfarmakoterapi dapat diberikan psikoterapi supportif, CBT, serta psikoedukasi. Penanganan konflik tidak hanya dilakukan kepada pasien saja namun juga kepada keluarga pasien. Konflik keluarga dan pola asuh orang tua bisa menjadi salah satu factor yang memperberat kondisi pasien saat ini.
References
American Psychiatric Association. (2013), Diagnostic And Statistical Manual Of DSM-5 TM.
Anita Thapar and Daniel S. Pine, J.F.L.S.S.M.J.S. (2015), Rutter’s Child and Adolescent Psychiatry.
Austin, M.C., Janosky, J.E. and Murphy, H.A. (2003), “Increased corticotropin-releasing hormone immunoreactivity in monoamine-containing pontine nuclei of depressed suicide men”, Molecular Psychiatry, Vol. 8 No. 3, pp. 324–332, doi: 10.1038/sj.mp.4001250.
Bach, H., Huang, Y., Underwood, M.D., Dwork, A.J., Mann, J.J. and Arango, V. (2014), “Elevated serotonin and 5?HIAA in the brainstem and lower serotonin turnover in the prefrontal cortex of suicides”, Synapse, Vol. 68 No. 3, pp. 127–130, doi: 10.1002/syn.21695.
Bernstein, H.-G., Tausch, A., Wagner, R., Steiner, J., Seeleke, P., Walter, M., Dobrowolny, H., et al. (2013), “Disruption of Glutamate-Glutamine-GABA Cycle Significantly Impacts on Suicidal Behaviour: Survey of the Literature and Own Findings on Glutamine Synthetase.”, CNS & Neurological Disorders - Drug Targets, Vol. 12 No. 7, pp. 900–913, doi: 10.2174/18715273113129990091.
Brent, D.A., Poling, K.D. and Goldstein, T.R. (2011), Treating Depressed and Suicidal Adolescents: A Clinician’s Guide., Treating Depressed and Suicidal Adolescents: A Clinician’s Guide., Guilford Press, New York, NY, US.
Cash, S.J. and Bridge, J.A. (2009), “Epidemiology of youth suicide and suicidal behavior”, Current Opinion in Pediatrics, Vol. 21 No. 5, pp. 613–619, doi: 10.1097/MOP.0b013e32833063e1.
Costello, E.J., Mustillo, S., Erkanli, A., Keeler, G. and Angold, A. (2003), “Prevalence and Development of Psychiatric Disorders in Childhood and Adolescence”, Archives of General Psychiatry, Vol. 60 No. 8, p. 837, doi: 10.1001/archpsyc.60.8.837.
Dardas, L.A., Xu, H., Franklin, M.S., Scott, J., Vance, A., Van De Water, B. and Pan, W. (2023), “Cognitive behavioural therapy and medication for treatment of adolescent depression: a network meta-analysis”, Behavioural and Cognitive Psychotherapy, Cambridge University Press, Vol. 51 No. 3, pp. 230–245, doi: 10.1017/S1352465822000662.
Lee, R., Petty, F. and Coccaro, E.F. (2009), “Cerebrospinal fluid GABA concentration: Relationship with impulsivity and history of suicidal behavior, but not aggression, in human subjects”, Journal of Psychiatric Research, Vol. 43 No. 4, pp. 353–359, doi: 10.1016/j.jpsychires.2008.04.004.
Lindqvist, D., Janelidze, S., Erhardt, S., Träskman?Bendz, L., Engström, G. and Brundin, L. (2011), “CSF biomarkers in suicide attempters – a principal component analysis”, Acta Psychiatrica Scandinavica, Vol. 124 No. 1, pp. 52–61, doi: 10.1111/j.1600-0447.2010.01655.x.
Liu, R.T., Walsh, R.F.L., Sheehan, A.E., Cheek, S.M. and Sanzari, C.M. (2022), “Prevalence and Correlates of Suicide and Nonsuicidal Self-injury in Children”, JAMA Psychiatry, Vol. 79 No. 7, p. 718, doi: 10.1001/jamapsychiatry.2022.1256.
Lu, J., Gao, W., Wang, Z., Yang, N., Pang, W.I.P., In Lok, G.K. and Rao, W. (2023), “Psychosocial interventions for suicidal and self-injurious-related behaviors among adolescents: a systematic review and meta-analysis of Chinese practices”, Frontiers in Public Health, Vol. 11, doi: 10.3389/fpubh.2023.1281696.
Martin, G., Richardson, A.S., Bergen, H.A., Roeger, L. and Allison, S. (2005), “Perceived academic performance, self?esteem and locus of control as indicators of need for assessment of adolescent suicide risk: implications for teachers”, Journal of Adolescence, Vol. 28 No. 1, pp. 75–87, doi: 10.1016/j.adolescence.2004.04.005.
Maya Iohan-Barak and Israel Orbach. (2021), Oxford Textbook of Suicidology and Suicide Prevention.
Menon, V. and Kattimani, S. (2015), “Suicide and Serotonin: Making Sense of Evidence”, Indian Journal of Psychological Medicine, Vol. 37 No. 3, pp. 377–378, doi: 10.4103/0253-7176.162910.
Merali, Z., Kent, P., Du, L., Hrdina, P., Palkovits, M., Faludi, G., Poulter, M.O., et al. (2006), “Corticotropin-Releasing Hormone, Arginine Vasopressin, Gastrin-Releasing Peptide, and Neuromedin B Alterations in Stress-Relevant Brain Regions of Suicides and Control Subjects”, Biological Psychiatry, Vol. 59 No. 7, pp. 594–602, doi: 10.1016/j.biopsych.2005.08.008.
Van Orden, K.A., Witte, T.K., Cukrowicz, K.C., Braithwaite, S.R., Selby, E.A. and Joiner, T.E. (2010), “The interpersonal theory of suicide.”, Psychological Review, Vol. 117 No. 2, pp. 575–600, doi: 10.1037/a0018697.
Pandey, G.N. (2013), “Biological basis of suicide and suicidal behavior”, Bipolar Disorders, Vol. 15 No. 5, pp. 524–541, doi: 10.1111/bdi.12089.
Pelkonen, M. and Marttunen, M. (2003), “Child and Adolescent Suicide”, Pediatric Drugs, Vol. 5 No. 4, pp. 243–265, doi: 10.2165/00128072-200305040-00004.
Roth, T.L., Lubin, F.D., Funk, A.J. and Sweatt, J.D. (2009), “Lasting Epigenetic Influence of Early-Life Adversity on the BDNF Gene”, Biological Psychiatry, Vol. 65 No. 9, pp. 760–769, doi: 10.1016/j.biopsych.2008.11.028.
Sadock, B.J., Sadock, V.A. and Ruiz, P. (2017), COMPREHENSIVE TEXTBOOK OF PSYCHIATRY.
Safitri, D.O. and Kusumawardhani, A. (2021), Aspek Neurobiologi Dan Neuroimaging Bunuh Diri, CDK Edisi CME-3, Vol. 48.
Sequeira, A., Mamdani, F., Ernst, C., Vawter, M.P., Bunney, W.E., Lebel, V., Rehal, S., et al. (2009), “Global Brain Gene Expression Analysis Links Glutamatergic and GABAergic Alterations to Suicide and Major Depression”, PLoS ONE, Vol. 4 No. 8, p. e6585, doi: 10.1371/journal.pone.0006585.
Shaffer, D. and Pfeffer, C.R. (2001), “Practice Parameter for the Assessment and Treatment of Children and Adolescents With Suicidal Behavior”, Journal of the American Academy of Child & Adolescent Psychiatry, Vol. 40 No. 7, pp. 24S-51S, doi: 10.1097/00004583-200107001-00003.
Sudol, K. and Mann, J.J. (2017), “Biomarkers of Suicide Attempt Behavior: Towards a Biological Model of Risk”, Current Psychiatry Reports, Vol. 19 No. 6, p. 31, doi: 10.1007/s11920-017-0781-y.
Witt, K.G., Hetrick, S.E., Rajaram, G., Hazell, P., Taylor Salisbury, T.L., Townsend, E. and Hawton, K. (2021), “Interventions for self-harm in children and adolescents”, Cochrane Database of Systematic Reviews, John Wiley and Sons Ltd, 7 March, doi: 10.1002/14651858.CD013667.pub2.
Zhou, X., Teng, T., Zhang, Y., Del Giovane, C., Furukawa, T.A., Weisz, J.R., Li, X., et al. (2020), Articles Comparative Efficacy and Acceptability of Antidepressants, Psychotherapies, and Their Combination for Acute Treatment of Children and Adolescents with Depressive Disorder: A Systematic Review and Network Meta-Analysis, Vol. 7.
Zulaikha, A. and Febriyana, N. (2018), “Bunuh Diri pada Anak dan Remaja”, Jurnal Psikiatri Surabaya, Vol. 7 No. 2, p. 62, doi: 10.20473/jps.v7i2.19466.