Incidence of Orthostatic Hypotension in Schizophrenic Patients Using Antipsychotics at Sambang Lihum Mental Health Hospital, South Kalimantan

Schizophrenia is a psychiatric disorder that requires antipsychotics therapy. Antipsychotics cause many side effects, including orthostatic hypotension. The study aimed to describe the incidence of orthostatic hypotensive side effects experiences by schizophrenia patients at the Sambang Lihum Mental Health Hospital, South Kalimantan. This research was observational description research with data sampling by medical records. This research was conducted to 300 medical records of patient’s period January-December 2018 which received antipsychotics medication and data analyzed by univariate analysis. The results showed the number of patients who experienced orthostatic hypotension was 98 patients (32.67%) and no experienced were 202 patients (67.33%). Incidence of orthostatic hypotension in haloperidol 54.35% (N=46); trifluoperazine 100% (N=1); clozapine 84.62% (N=13); olanzapine 100% (N=1); haloperidol-chlorpromazine 27.27% (N=11); haloperidol-haloperidol 42.86% (N=7); clozapinerisperidone 16.67% (N=6); haloperidol-clozapine 15.05% (N=93); haloperidol-olanzapine 50% (N=2); haloperidol-risperidone 31.82% (N=22); trifluoperazine-olanzapine 100% (N=1); trifluoperazineclozapine 22.22% (N=9); trifluoperazine-risperidone 5.56% (N=18); chlorpromazine-haloperidol-haloperidol 33.3% (N=3); chlorpromazine-haloperidol-trifluoperazine 100% (N=3); haloperidoltrifluoperazine-chlorpromazine 100% (N=1); chlorpromazinehaloperidol-clozapine 42.86% (N=7); chlorpromazine-trifluoperazineclozapine 100% (N=1); chlorpromazine-trifluoperazine-olanzapine 100% (N=1); chlorpromazine-trifluoperazine-risperidone 50% (N=2); trifluoperazine-haloperidol-risperidone 100% (N=4); haloperidoltrifluoperazine-risperidone 100% (N=1); trifluoperazine-haloperidolclozapine 40% (N=5); haloperidol-haloperidol-clozapine 80% (N=5); clozapine-risperidone-trifluoperazine 100% (N=4); risperidoneclozapine-haloperidol 20% (N=10). The conclusion from this study was the percentage of orthostatic hypotension on schizophrenia patients at the Sambang Lihum Mental Health Hospital was 32.67% (N=98).


INTRODUCTION
Antipsychotic is the primary therapy for schizophrenia.
Schizophrenia requires antipsychotic therapy for a long time to cause side effects in treatment therapy 6 . One of the side effects of antipsychotics is orthostatic hypotension 7 .
Orthostatic hypotension is characterized by a decrease in systolic blood pressure of at least 20 mmHg or a decrease in diastolic blood pressure of at least 10 mmHg from normal values for three minutes in a standing position 8 .
Antipsychotics affect cholinergic, α-adrenergic, histaminergic, and serotonergic receptors 9 . Therefore, the antipsychotic potential to cause side effects such as orthostatic hypotension, especially antipsychotics that act as α-blockers. Neurogenic and non-neurogenic factors can cause orthostatic hypotension. Drugs, especially antipsychotics, are the most common cause of nonneurogenic orthostatic hypotension 10  Therefore, this study was conducted to assess the incidence of orthostatic hypotension in the use of antipsychotics. The study aimed to describe the incidence of orthostatic hypotension in schizophrenia patients given antipsychotic therapy at the Psychiatric Hospital of Sambang Lihum, South Kalimantan.

Materials
The research instrument used the medical records of patients with schizophrenia from Sambang Lihum Mental Health Hospital. The data were collected using the data collection sheet.  In Table I Based on employment status, it was known that most patients with schizophrenia did not work. Patients with early-onset cause cognitive dysfunction, so that it will adversely affect the education undertaken 19 . Patients with schizophrenia that experience schizophrenia for the first time at a young age generally result in these sufferers dropping out of school, making it difficult to find work and failing to build good relationships with others. Schizophrenia also has adverse effects on the patient's life journey, including marital problems. Not a few in the end cause problems for patients in establishing relationships with partners, which impacts divorce 20 . This was also shown in Table I, in which more patients were divorced/widowed than those who were still married. The second problem is that those specific drug molecules can bind to dopamine receptors in the limbic system or basal ganglia. The effect produced when it binds to dopamine receptors in the limbic system will produce the desired antipsychotic effect. Meanwhile, if these molecules bind to dopamine receptors in the basal ganglia, and extrapyramidal side effects will appear in the form of tremors. Such drug molecules cannot be sent to just one part of the brain and absorbed there but instead distributed to different regions of the brain 23 . The third problem is that, among the receptor classes, many subtypes have been identified, and drug molecules usually not only interact with one subtype but can also bind with other subtypes. For example, it is known that there are approximately 14 subtypes of serotonin receptors, so drugs that work to increase brain serotonin levels will have many effects because some serotonin receptors are inhibitory and some are excitatory 24 .

The research was conducted in Sambang Lihum
Antipsychotics from either class can be used alone or with other psychotropic drugs, such as mood stabilizers or antidepressants. In some patients, especially those with schizophrenia, a combination of more than one antipsychotic drug may be needed to help control symptoms. However, this could pose additional risks for the patient, which must be taken into account 25 . Based on  26 . It is known that the brain has natural neurotransmitters; for example, the brain makes its morphine, known as β-endorphin. The brain also makes its antidepressants, its anxiolytics, and even its hallucinogens. Therefore, drugs often mimic the brain's natural neurotransmitters 27 . Initially, it was thought that each neuron uses only one neurotransmitter to transmit information and uses the same neurotransmitter across all its synapses. However, it is known that many neurons use more than one neurotransmitter at a single synapse.
Besides, the input to each neuron at various locations also involves many neurotransmitters. This is the basis for combining drugs to simultaneously modify several neurotransmitters in mental disorders, such as

DATA AVAILABILITY
None.