DIFFERENCE OF THE TYPE OF DELUSIONS AMONG · PDF fileSuku Jawa Batak Toba n % n % Type of delusion Persecutoric 64 64% 67 67% Grandiosity 14 14% 23 23% Referrence 11 ... Simalungun,

March. 2015. Vol. 5, No.01 ISSN 2307-2083 International Journal of Research In Medical and Health Sciences © 2013-2015 IJRMHS & K.A.J. All rights reserved http://www.ijsk.org/ijrmhs.html

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DIFFERENCE OF THE TYPE OF DELUSIONS AMONG

PATIENTS WITH PARANOID SCHIZOPHRENIA IN

JAVANESE AND BATAK TOBA PEOPLE AT MENTAL

HOSPITAL OF NORTH SUMATERA

AGUSSYAH PUTRA1, DAPOT PARULIAN GULTOM

2, AND ELMEIDA EFFENDY

3

1Residence of Department of Psychiaty, Medical Faculty of North Sumatera University 2 Lecturer at Department of Psychiatry, Medical Faculty of North Sumatera University 3 Lecturer at Department of Psychiatry, Medical Faculty of North Sumatera University

ABSTRACT

Background. Schizophrenia is a chronic psychiatric illness that characterized by psychotic

symptoms such as delusions and hallucinations. The phenomenology of delusions and

hallucinations in schizophrenia is influenced by the culture of the patient.

Aims. To see the difference of type of delusions among patients with paranoid schizophrenia

between the two ethnic groups in one province and one country.

Methods. Total of subject are 200 outpatients or inpatients, 100 from Javanese and 100 from

Batak Toba peoples who diagnosed as paranoid schizophrenia according to the tenth of the

International Classification of Disease (ICD-10) were interviewed and assessed using Positive and

Negative Symptoms Scale (PANNS). If each score of positive scale (P1 to P7) is ≥ 3, they were

included in this study. Then we noted their predominat delusion. The type of delusions on both

ethnic groups were analyzed to know whether there is a difference.

Results. The most type of delusion either in Javanese and Batak Toba people is persecutoric, 64%

in Javanese and 67% in Batak Toba. Delusion of grandiocity mostly in Batak Toba, totally is 23%.

Delusion of referrence in Javenese more than in Batak Toba (11%). Delusion of control mostly in

Javanese (11%).

Conclusion. There are no significant difference in the type of delusions among patients with

paranoid schizophrenia in Javanese and Batak Toba people.

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Keyword: Delusions, paranoid schizophrenia, Javanese, Batak Toba

Introduction

Although the prevalence of schizophrenia is

similar across diverse cultures, the

influential role of ethnocultural factors in the

phenomenology and the symptomatic

expression of schizophrenia has been widely

recognized.1 There is wide variation in the

presentation of patients from different ethnic

backgrounds during a schizophrenic

episode.2 Differences in the content of

schizophrenic delusions and hallucinations

could be successfully interpreted in terms of

culture.3

Religion can act as both a risk and protective

factor as it interacts with the schizophrenia

symptoms of hallucination and delusions.

Cultural influences tend to confound the

association of religion and schizophrenia.

Adherence to treatment has a mixed

association with religiosity.4

Many studied have reported about

difference of type or content of delusion in

schizoprenic patient in two different

cultures. There is different of delusion in

schizophrenic patient in Austria and

Pakistan.5 During the last three decades,

efforts have been made towards finding

cross-cultural differences in the

phenomenology of schizophrenia. These

include the World Health Organization’s

(WHO) international study of schizophrenia

(1973), the comparative study among ethnic

groups in England (Nderei & Vadlher, 1984;

Suhail & Cochrane, 2002), a study of

patients in Japan and China (Fujimori et al.,

1988), a comparison between the two

subcultures of Malaysia (Azhar et al., 1995),


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a comparison between Japanese and

Germans (Tateyama et al., 1993), a

comparison among patients in Tokyo,

Vienna and Tubingen (Tateyama et al.,

1998), a comparison of hallucinations

between patients in Saudi Arabia and

England (Wahass & Kent, 1997), a

comparison of secondary symptoms between

South Africa and Namibia (Maslowski &

Oosthuizen, 1993-1994), and a comparison

of the first rank symptoms of schizophrenia

between UK and Greek immigrants in

Australia (Coffey et al., 1993). These studies

have consistently reported that some types

and content of delusions and hallucinations

may differ among different cultures, which

implies that some cultural elements may

influence the manifestation of psychotic

symptoms in schizophrenia.3

Aims

We want to see the difference of the type of

delusions in paranoid schizophrenia in

Javanese and Batak Toba peoples. No

previous study in Indonesia about type of

delusion in paranoid schizophrenia between

the two ethnic groups.

Batak Toba is the largest ethnic in

all group of Batak people.6 Batak Toba is a

native ethnic who settled in the North

Sumatera Province, Indonesia. The Javanese

is not a native ethnic in the North Sumatera

Province. The Javanese people originated

live in Java Island. The most the Javanese

people who lives in Medan, the capital of the

North Sumatera Province, and in the area

around of it is decendants of the worker who

was imported gradually from Java Island to

Sumatera in 1880 to 1915. They are works

in the plantations of the Dutch in eastern

Sumatera.6

Methods

This study has get permission from Health

Research Ethical Committee of North

Sumatera University c/o Medical School

with license number is 332/KOMET/FK

USU/2013.

Between August 2013 and October

2013, a total of 200 patient with paranoid

schizophrenia, 100 patients of Javanese and

100 patients of Batak Toba peoples has been

selected. Design of this study is analitic

research with cross-sectional approach. The

technique sampling use nonprobability

sampling with consecutive sampling type.

Inclusion criterias are: (1) male or

female, (2) diagnosed by paranoid

schizophrenia, (3) delusions still exist, score

each positive scale of Positive and Negative

Symptoms Scale (PANNS) is ≥ 3, (4)

subjects are Javanese or Batak Toba peoples,

(5) living in Medan or Deli Serdang, (6)

subjects are outpatients or inpatients at

Mental Hospital of North Sumatera

Province, (7) can speak in Bahasa Indonesia,

and (8) they were willing to participates.

Whereas subjects are excluded if there are

comorbidities with general medical

disorders, and using substances (except

caffeine and nicotine)

Patients from Javanese and Batak

Toba people who meet inclusion criterias

were interviewed refer to Mini International

Neuropsychiatric Interview version

International Classification of Disease 10

(MINI ICD-10). The type of delusions were

noted. The type of delusions among these

two ethnic group, then, will analyzed to see

the difference about it. The type of delusions

in paranoid schizophrenia are persecutoric,

grandiosity, referrence, and controlled.

Analysis by chi-square, and if not meet

criteria, we used Kolmogorov-Smirnov test.

Data will processing with Stastistical

Package for Social Science (SPSS) version

22 with significance level is P < 0,05.

Results

Tabel 1. Demographic Data

Javanese Batak Toba

Total 100 (100%) 100 (100%)

Age

˂ 20 2 3

20 - ˂ 30 23 21

30 - ˂ 40 34 39

40 - ˂ 50 26 20


20

50 - ˂ 60 12 9

≥ 60 3 8

Gender

Male 56 76

Female 44 24

Marital status

Married 45 39

No married 55 61

Religion

Islam 100 11

Christian 0 89

Formal education level

Basic ( ≤ 9 years) 68 51

Intermediate ( 9-12 years) 30 44

High ( >12 years) 2 5

Employment

Work 30 19

No work 70 81

The most age of subject is in interval 30

years to <40 years, in Javanese are 34% and

39% in Batak Toba people. The most sex of

subject are male, 56% in Javanese people

and 76% in Batak Toba people. Based

marital status, the most of subject are no

married, 55% in Javanese and 61% in Batak

Toba. All of Javanese people are Islam,

while the most of Batak Toba people are

Christian (89%). The forml education level

of subject is basic level, 68% in Javanese

and 51% in Batak Toba. The most subject

are no work, 70% in Javanese and 81% in

Batak Toba.

Tabel 2. Proportion of type of delusion in paranoid schizophrenic in

Javanese and Batak Toba people

Suku

Jawa Batak Toba

n % n %

Type of delusion Persecutoric 64 64% 67 67%

Grandiosity 14 14% 23 23%

Referrence 11 11% 4 4%

Controlled 11 11% 6 6%

Total 100 100% 100 100%

The most type of delusion in schizophrenic

patients of Javanese people is persecutoric

(64%), and in Batak Toba people is

persecutorik too (67%). Grandiosity more

common in Batak Toba people by 23 people

(23%). Delusion of controlled more common

in Javanese people by 11 people (11%).

Tabel 3. Difference of type of delusion in paranoid schizophrenic based

on difference of ethnicity

Suku

Jawa Batak Toba P

n % n %

Jenis

waham

Persekutorik 64 64% 67 67% 0.072

Kebesaran 14 14% 23 23%


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Referensi 11 11% 4 4%

Dikendalikan 11 11% 6 6%

Total 100 100% 100 100%

Analysis with chi square test found result

that the significance level or P= 0.072

(P>0.050), this is means there is no

significant difference in type of delusion of

patients with paranoid schizophrenic in

Javanese and Batak Toba people.

Discussion

There is no study about difference

of the type of delusions in patients with

paranoid schizophrenia between two ethnic

group in Indonesia. Results of this studi

shows that no significant difference of type

of delusions in patients with paranoid

schizophrenia between two different ethnic

group, in this case on Javanese and Batak

Toba people. Previous studies in other

countries shows there is difference in some

type and content of delusion and

hallucination between different cultural.3

The factors are considered to be

influence about no significant difference in

type of delusions in patients with paranoid

schizophrenia in this study includes:

1. The Javanese people who live in

Medan and Deli Serdang (Eastern

Sumatera) and was taken as sample,

their age not restricted and no

limited the level of their generation.

The most of Javanese people who

live in Medan and Deli Serdang

now is descendant of “koeli

kontrak” (workers) in Dutch

plantation. The workers from Java

Island was shipped to Eastern

Sumatera gradually between 1880

to 1915.7 They were the first

generation of Javanese people in

Eastern Sumatera.

2. The early settlement of worker

from Java in Eastern Sumatera were

separately from the other ethnic

groups. In plantation not allowed a

assimilation.7 Now, the condition

has changed, the Javanese people in

Medan and around has assimilated

with others ethnic group. The

limitation of relationship of

intercultural in colonial era at the

moment not seem anymore.

Batak Toba is the biggest ethnic in

Batak group who traditionally live in North

Sumatera Province, Indonesia. The

anthropologist divide Batak group to six

ethnics i.e: Batak Toba, Batak Mandailing,

Batak Angkola, Batak Karo, Batak

Simalungun, and Batak Pakpak.6

Conclusion

This study conclude that in a plural

community and live in a assimilation of

cultural the difference of the type of

delusions in patients with paranoid

schizophrenia has no significant difference.

Referrence

1. Barrio C, Yamada AM, Atuel H,

Hough RL, Yee S, Berthot B, et.al.

A tri-ethnic examination of

symptom expression on the positive

and negative syndrome scale in

schizophrenia spectrum disorders.

J. Schres. 2003; 60: 259-69

2. Chang N, Newman J, D’Antonio E,

McKelvey J, Serper M. Ethnicity

and symptom expression in patient

with acute schizophrenia.

Psychiatry Research. 2011; 185:

453-55

3. Kim K. Delusions and

hallucinations in east asians with

schizophrenia. Journal of WACP.

2006; 1: 37-42

4. Gearing RE, Alonzo D, Smolak A,

McHugh K, Harmon S, Baldwin S.

Association of religion with

delusions and hallucinations in the

context ofschizophrenia:

Implications for engagement and

adherence. Schizophrenia Research.

2011; 126: 150-63

5. Stompe T, Friedman A, Ortwein G,

Strobl R, Chaudry HR, Najam N,

et.al. Comparison of delusions


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among schizophrenics in austria

and in pakistan. Psychopathology.

1999; 32: 225-34

6. Hasselgren J. Batak toba di medan.

Medan: Bina Media Perintis; 2008

7. Yasmis. Kuli kontrak di

perkebunan tembakau deli-

sumatera timur tahun 1880-1915.

[tesis]. Depok: Universitas

Indonesia, 2007.

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DIFFERENCE OF THE TYPE OF DELUSIONS AMONG · PDF fileSuku Jawa Batak Toba n % n % Type of delusion Persecutoric 64 64% 67 67% Grandiosity 14 14% 23 23% Referrence 11 ... Simalungun,