ABSTRACT

Background: Schizophrenia is a severe mental disorder and a major problem in the world of
nursingsoul. Schizophrenia arise because of the stress that accompanies the burden of one'smind.
Stress will cause undesirable new problems if not prevented as early aspossible.Patients with
schizophrenia with symptoms of stress is certainly a profound impact on some people, such as
patients, family burden as caregiver, the economy. Interpersonal interactions are less than the
maximum is one of the causes of stress.
Aim: To identify and analyze the concept of interpersonal interactions that affect the stress in
schizophrenic patients.
Methods: This study used literature study approach from several sources that are selected based on
criteria that have been set researcher.
Results: The literature review consists of 10 articles, three of the studies reporting effective results
such communication can reduce bottlenecks in traumatic stress. obsessive relationship affects of stress
and mental support and training professional triggering stress reactions to overcome the severity of
the stress reaction.
Conclusion:Communication, obsessive relationships and support / training can be developed further
by other supporting research so as the concept of interaction can be combined with the expected
intervention in implementation can be effectively used to cope with stress.

Keywords: interpersonal interaction, Stress,Schizophrenia.


I. INTRODUCTION
1. Background.
Health according to Law No. 36 of 2009
article 1 is a healthy state of physical,
mental, spiritual and social that allows
every person to live socially and
economically productive (MOH, 2010 in
(Hawari, 2013). According to the Act is
clear that mental health or mental health is
an important component in determining a
person's health status. Mental disorders are
one of the major health problems in
addition to degenerative diseases, cancer,
and accidents (Hawari,2013). Mental
disorders also hit almost the entire
population in all countries, including
Indonesia. (Atwoli et al., 2016)
In this globalization era, the challenge
will threaten the life of an individual's
psychological. Psychological become a
major problem that can shake the national
and international world (Horikoshi et al.,
2016). Schizophrenia, is one of the severe
mental disorder. Schizophrenia is a major
problem in the world of nursing soul that
must be faced and resolved. Schizophrenia
is a mental disorder that severely marked
by delusions, hallucinations, speech that is
not organized, motor behavior that is not
normal, negative symptoms and a group of
major mental disorder characterized by the
presence of psychosis, multifactorial and
pressure syndrome, psychiatric (Sun et al. ,
2015). Schizophrenia arise because of the
stress that accompanies the mind of the
person (Dransart et al., 2015)
Stress to onset occurs mental disorders
in individuals, as a result of powerlessness
in the face of the demands of the problems
that occur in certain situations (Shin et al.,
2016a). Stress disturb one's mindset to stay
focused on the positive direction. Stress
will create new problems if not prevented
as early as possible. Stress according to
King, a dynamic state in which humans
interact with the environment to memelihra
balance in growth, development and energy
melibatkanpertukaran deeds and someone
with environmental information to set the
stressor (Alligood,2014).
Mental health remains a significant
health problem in the world. In the world
there were approximately 21 million people
with schizophrenia (Sun et al., 2015). In
Indonesia, a variety of biological,
psychological and social diversity of the
population; the growing number of mental
disorders that affect the country and
decrease the load increase human
productivity in the long term. In the data
shows the prevalence of schizophrenia
disorder to reach 400,000 people, or about
1.7 per 1,000 population (Riskesdas, 2013
in (Hawari, 2013)
One example of regions in Indonesia
such as NTB, there were 9855 people with
schizophrenia (Wijaya,2016). While at the
Mental Hospital NTB pearl Sukma
Schizophrenia stress case, there were 120
people out of 749 people hospitalized with
mild stress details of 48 people, the stress
was 70 people, and stress 2 (Wijaya, 2016)
theory of nursing Imogene M. King
mengeidentifiksi conceptual framework
(conceptual framework) as a framework for
an open system, and this theory as an
achievement of the goals. King has a basic
assumption of the conceptual framework,
that all men (human being) as an open
system that consistently interact with their
environment. Another assumption that
nursing focuses on human interaction with
the environment and nursing goal is to help
individuals and groups in maintaining good
health. The conceptual framework consists
of three systems of interaction known as
Dynamic interacting systems, include:
personal systems (individuals),
interpersonal systems (group), and social
systems (family, school, industry, secret
societies social, health care systems, and
others ) (Alligood,2014).
Concept of Interacting human this
model was first developed by Imoge M.
King in 1971 begins with developing the
theory of goal attainment (theory of goal
Attainment). The theory of goal attainment
is a theory that is open and dynamic, with
over (9) nine main concept that includes
interaction, perception, communication,
transaction, roles, stress, growth and
development, time and space
(Alligood,2014).
The main elements of the theory of
goal attainment is interpersonal sistems.
According to King, the intensity of
interpersonal system is crucial in setting
and goal attainment of nursing. In such
 interactions occur in activities that are
described as the nine major concepts,
which concepts are related in nursing
practice (Nursalam, 2016).
2. Stress
One of the concepts to be observed in
this study is the interaction, interpersonal
interaction have been less applied to
patients diagnosed with schizophrenia in
the community, general hospitals and
psychiatric hospitals. The application of the
concept of interaction necessary to review
the form of the analysis back to bring up
theories, ideas and new or good opinion of
the researcher's own self, mental health
experts, or source - other relevant sources
so that the concept of interaction by King
can be effectively applied in order pelayann
health.
2. Aim
Of the above problems, the researchers
intend to identify and analyze the concept
of interpersonal interactions that affect the
stress of patients with schizophrenia.
3. Benefits Research
Symptoms of stress with schizophrenia
largely influenced by the lack of
interpersonal interaction as well as lack of
knowledge of the patient's own, then the
benefits of this research are expected to be
used as new information influencing policy
making to improve mental health and
reduce the burden on individuals and
families due to stress problems. Other than
that expected by the results of this study
can be used as a basic breakthrough health
workers, especially nurses to improve the
quality of care in mental health services are
excellent.
II. LITERATURE REVIEW
1. Interpersonal interaction
interpersonal interaction is a process
of perception and communication between
individuals, individuals and groups, the
individual with the environment which is
manifested as verbal and non-verbal
behavior in achieving goals. Interaction
means as a behavior that can be observed
by two or more people in a reciprocal
relationship (Alligood, 2014) in Nursalam
2016). One of the measures to reduce stress
is to make the interaction (Morina et al.,
2016. Another theory suggests the concept
of schizophrenia interpersonal addressed to
clients to encourage achieve effective
interaction (Chen, et al.,2017).
Stress is a dynamic situation where
human interact with an environment to
maintain the balance of growth,
development and actions involving energy
or information exchange between a person
and their environment to regulate stressor
(Alligood, 2014) in Nursalam 2016).
Stress is a situation where the
environmental demands greatly exceeds
the person's ability to respond (Hupbach
and Dorskind,2014). Every thing can
cause stress, if it is accepted as something
unpleasant person (Rayner et al.,2016).
Some of the events that cause stress (eg,
the fierce competition in the academic or
sports) actually spur people to perform
better (Shin et al.,2016b). Stress is not just
due to illness (Murphy et al., 2016), but
also an important factor that determines
the course of an illness (Morina et
al.,2016).
3. Schizophrenia
Schizophrenia is a major mental illness
that is characterized by positive and
negative symptoms, and cognitive
impairment (Murphy et al.,2016). The
onset and course of schizophrenia is
regulated by the interaction of biological
factors, vulnerability, and psychosocial
influences (CHU et al., 2017). There is
evidence that patients with schizophrenia
are exposed to a higher level that
psychosocial stress such as frequent social
life stressful with limited social support and
critical family environment (Hupbach and
Dorskind, 2014). In addition, patients with
schizophrenia report feelings of increased
uncontrolled in the incidence of this stress
(Horan et al., 2005 in (Morina et
al.,2016).Uncertainty is one of the main
factors in generating the response to
physiological stress (Dickerson and
Kemeny, 2004 in (CHU et al., 2017). in
short, the current literature indicates that
psychosocial stress is an important factor in
 schizophrenia clinical pathways, which can
facilitate the transition to psychosis,
triggers the onset of a psychotic episode,
and can memperparahgejala psychotic
(Riani,2017).
III. METHODS
1. flowcharts study
Systematically the steps - steps in
writing the study as shown below:
Literature study
Data collection
The concept under study
Conceptualization
Data analysis
Results and Discussion
Conclusions and recommendations
Figure 1.1 Flowchart concepts studied
2. literature review
study of literature is the methods
used to collect the data or resources
related to the topics raised in a study.
The study of literature can be obtained
from various sources, journals, books,
documentation, internet and library.
Literature study method is a series of
activities related to data collection
methods literature, reading and
recording, as well as manage research
materials (Zed, 2008: 3 in Nursalam
2016). This type of research is the
study of literature review that focuses
on research related to the topic or
variables of the study investigators.
Doing this literature study conducted
by researchers between once they
determine the topic of research and the
establishment of formulation of the
problem, before plunging into the field
to collect the necessary data (Darmadi
2011 in Nursalam, 2016).
3. Data collection
Data were taken from the journal
literature review that contains the
concepts studied. The process of data
collection is done by filtration of 160
sources of literature into 20 literature
based on criteria set by the researcher
of each journal were taken. The
criteria shall include the sources of
literature were taken from 2013 until
2017, the suitability of keyword
research, link research and discussion.
Strategies in the collection of journal
literature use sites accredited journals
such as the American psychological
association - Psyc INFO (www.apa.
org). Cochrane Library
(www.cochranelibrary.com),Pubmed(
www.ncbi.nlm.nih.gov/pubmed),Lilac
s (lilacs.bvsalud.org) and Biomed
Central Psychiatry. How to write an
effective setting of the journal by
entering the appropriate keyword
research titles such as "interpersonal
interaction" AND "stress" AND
schizophrenia, "schizophrenia stress ','
stress schizophrenia" and interaction
of stress.
4. Data analysis
Starting with the material research
results that are sequences note of the
most relevant, relevant, and quite
relevant. Alternatively, for example,
by looking at the years of research
starting from the most cutting-edge,
and berangsung - gradually retreat to a
year longer. Read the abstract any
prior research to assess whether the
issues discussed in accordance with to
be solved in a study. Noting part - an
important part and its relevance to the
research problem, to maintain not get
caught up in plagiarism element, the
researchers should also record the
source - the source of information and
include a bibliography. If that
information comes from the idea or
the work of others. Make a note, quote
or information systematically arranged
so that research can easily be looking
back at any time if necessary.
(Darmadi 2011 in Nursalam, 2016).
Each journal has been selected based
on criteria, made a conclusion that
describes the related explanation about
interpersonal interaction on stress
reduction with schizophrenia. Before
the researchers want to make the
conclusions of some of the results of
the literature, researchers will be
identified in the form of brief
summary in the form of tables beirisi
title of the study, the researcher name,
year of study and research. Following
the identification of some of the
literature has been collected,
researchers will analyze the factors of
the problems which cause stress to
schizophrenia in the form of
discussion.
IV. RESULT
The main focus of this review literature is on "interpersonal interaction" with stress reduction
in schizophrenic patients. Search results through review A total of 160 journals were identified
after screening and application of eligibility criteria. Then after excluded studies obtained 20
journals, after that excluded studies again based on inclusion criteria so that the total number of
articles that qualify for systematic review is 10 journals as illustrated in the chart below:

Figure diagram. 1 Search Process Art

Excluded by title / abstract(n = 70).

a. no treatment intervention (12)
b. publications other than peer
Articles identified through
search (N = 160) review journals (5)
a. PubMed (N = 100) c. Case study (24)
Identification b. Cochrane (N = 30) d. Stress is not the main focus of
c. PsycInfo (N = 15) treatment (30)
d. Lilacs (N = 10) e. english version not available (5)
e. BioMed (N = 5) f. not answer research question (14)

Excluded by full text = 70

Screening Full text articles rated for
eligibility (N = 90)
a. Interpersonal Interaction is not
included as a measure (20)
b. same data reported elsewhere (15)
c. diagnostic size not reported (5)
d. includes teenage sample (8)
e. no treatment intervention (12)
f. group therapy only (10)

Excluded from meta-analysis: 10

Selected articles based on
Inclusion Criteria (N = 20)
Eligibility
journals
a. interaction diagnosis <70%
sample (3)
b. the way analysis is not reported
or can not be obtained (5)
c. The results are not intended for
research purposes (2)

Included Number of eligible articles (N = 10)

 Table. 2 Study Characteristics
Authors (Year) Study design Intervention Sample Instrument Result conflict of theory
Lin et al., cross-sectional Serum 64 schizophrenic Positive and Higher baseline rates of MCP- a. pretreatment MCP-1 was
(2017) and natural Pretreatment patients.With details : Negative 1 were significantly found in significantly correlated with
observational MCP- level 1 a.26 patients were Syndrome schizophrenic patients than in response to risperidone mono
cohort studie involved in the Scale HCs. But the IL-1 level, treatment in schizophrenic patients
risperidone group (PANSS) TNF- did not differ between b. Higher Levels The initial treatment
b.38patients involved the two groups. of MCP-1 shows an inadequate
in the olanzapine response to the treatment of
group. risperidone For fortification
purposes.
Huang et al., A cross- Anti-psychotic Number of patients Positive and There was a significant The long-term use of antipsychotic
(2017) sectional study drug therapy 448 schizophrenia. a. Negative difference between the drugs has been shown to significantly
chronic schizophrenia Syndrome number of TD patients with affect the quality of life compliance
with 46 in Tardive Scale movement disorders in the and treatment.
dyskinesia (PANSS) facial and mouth areas
(TD)groupb.402 in (67.4%), limbs (58.7%) and
the control group torso (37%)
Raihan dan cross treatment of Number of DASS Families of schizophrenic Family conditions based on The Five
Kurniawan sectional survey schizophrenic respondents 34 Questionnaire patients do not Stages of Grief Theory in Shives 2008
(2015) patients people using experiencestress / normal revealed that emotional response is in
accidental sampling although it takes a long time the acceptance stage so they tend to be
method. to care for caring for the resigned and are able to adapt to the
patient(p = 0,591> 0,05) patient's condition.
Atwoli et al., a cross-sectional Potentially The sample of the questionnaire Potentially traumatic events a. the relationship between PTE and
(2016) study traumatic study included 4351 (PTE) provides a broad physical health conditions is not fully
events (85.5%) individuals spectrum risk for chronic mediated by psychiatric disorders
physical conditions, including a common PTE
independent of psychiatric b. found a dose-response relationship
disorders between cumulative exposure to PTE
and the possibility of reporting a
chronic physical health condition and
believed that clinical evaluation of
trauma victims should take into
account mental and physical health
assessments.
Shin et al retrospektif SRH-global 8621 participants Computer Individuals with a lower SRH a. Participants with a superior SRH age
(2016) cross-sectional and SRH-age Assisted age than those with SRH-global had CESD scores statistically lower
Personal tend to be more susceptible to than the reference group.b. Its use of
Interview symptoms of depression. Low general SRH and age-comparability
(CAPI) global SRH with low (b = will be stronger and easier when we
0.654, p <0.001) and medium consider analyzing depression in old
SRH (b = 0.210, p = 0.003) age
indicate hub. with a higher
CESD value.
Ming et al., Study Hierarchical A total of 651 healthy Interview HLM does not show a 5- 5-HTTLPR L shows more symptoms
(2015) longitudinal linear model teens [323 girls and HTTLPR main effect on of anxiety associated with stressful life
multiwave (HLM) 328 boys; ages 14-17 anxiety symptoms. eventsb. The relationship between
(mean = 16.27, symptoms of stress and anxiety is
standard deviation = moderated by 5-HTTLPR. 5-HTTLPR
0.77)] participated in L allele increases the individual
the study. susceptible to anxiety in stressful
situations.

Dranstar et Cross-sectional Support and Professional mental questionnaire professionals identified mental health professionals trigger
al., (2015) training health (N = 666) Professionals with low impact professional stress reactions to
(55.8% sample) characterized overcome the severity of stress
by high support and reactions and discriminant variables.
anticipation Emotional
closeness with, and
responsibility for patients is
typical of professionals with
mild impact (36.6%
Horikoshi et a cross-sectional five cut-off 525 participants Questionnaires After stratification by sex, concerns about frequent relocation and
al., (2016) study scores to living in housing and interviews dissatisfaction with residence dissatisfaction with residence attributed
identify cases is associated with topsychological pressure
with psychologicaldistress, and
psychological plans to move into permanent
and Statistical housing are significantly
Manual of associated with psychological
Mental distress in women
Disorders,
fourth edition
(DSM-IV)
Morina et al., cross- posttraumatic 51 adults Questionnaire Participants with high levels obsessive-compulsive symptoms and
(2016) sectional survey stress disorder of posttraumatic stress traumatic experiences affect the rate of
(PTSD) Significantly more likely to obsessive-compulsive symptoms
have obsessive-compulsive
symptoms, and vice versa
Rainer et al., RCT TAB. ACT Parents primary Questionnaire Online communication Communications technology offers
(2016) group program caretakers children technology is used to reduce potential use as a series of family
is based on 6 aged 0-18 years = barriers in the participation of psychosocial services.
sessions 184 traumatic stress in the elderly
 Methods / Design Study
Among 10 studies that were reviewed,
one study has cross-sectional design and
natural observational cohort studies (Lin,
Yezhe, et al., 2017), 7 as cross-sectional
study design (Huang et al., 2017; Raihan
and Kurniawan, 2015; Atwoli et al., 2016;
Shin et al., 2016; Dranstar et al., 2015;
Horikoshi et l., 2016; Morina et al., 2016),
1 research longitudinal studies multiwave
(Sun et al., 2015), 1 study RCT (Rainer et
al., 2016).
Methods of Interventions
Of the 10 studies reviewed, two studies
using drug therapy (Lin et al., 2017; Huang
et al., 2017), one study using group therapy
(Rainer et al., 2016), one study using PTE
(Atwoli et al., (016); 1 study using PTSD
(Morina et al., 2016); 1 peneltian using Manual
of Mental Disorders, fourth edition (DSM-
IV)(Horikoshiet al., 2016); 1 study uses
treatments patients with
schizophrenia(Raihanand Kurniawan,
2015); 1 study using SRH (Shin et al.,
2016); 1 study using Support and
training(Dranstaret al.,2015);1 study using a
VI.
model of hierarchical linear (HLM)(Sunet al.,
2015).
Findings
In several studies reviewed were
mentioned above, there are three studies
concluded that therapies to reduce stress is
communication(Raineret al.,2016),the
relationship of obsessive(Morinaet al.,
2016), support and training ( Dranstar et al.,
(2015). 7 study no effect in the pen anganan
stress(Lin,Yezhe, et al., 2017; Raihan and
Kurniawan, 2015; Atwoli et al., 2016; Shin
et al., 2016; Huang et al., 2017; Horikoshi
et l., 2016; Ming et al., 2015).
V. DISCUSSION
The main findings were obtained from
the 10 literature of this review, that the
three studies reporting effective results,
including the following: communication
can improve the interaction of a person in
the group (Rainer et al., (2016), the
interaction obsessive affect the level of
obsessive-compulsive symptoms in stress
(Morina et al., (2016), and the support and
training to encourage interaction on
professional stress to cope with the
severity of the stress reaction and variable
diskriminannya (Dranstar et al.,
(2015.Selain the 7 studies (Lin,Yezhe, et al
., 2017; Raihan and Kurniawan, 2015;
Atwoli et al., 2016; Shin et al., 2016;
Horikoshi et l., 2016; Huang et al., 2017;
Sun et al., 2015) report found no results
influential and irrelevant to be applied to
the stress.
Three studies have shown effective
results associated with the implementation
of the interaction of stress, considering this
interaction is needed in the implementation
of stress management in case of service
order ehatan, communities and other areas,
it is necessary to follow up on further
research and collaboration among health
professionals to support the health care
needs of patients. Basically, the interaction
between the individual forming
interpersonal relationships with one
another.
VI. CONCLUSIONS
Communication, obsessive
relationship and support and training in its
development is very important and
effectively applied to handle the stress, so
that communication skills, obsessive
relationship and the support and training is
expected to provide a positive impact on
health services. On the other hand, is based
on literature review, some studies do not
provide significant impact in dealing
with stress. This analysis indicates that
communication, obsessive relationship and
support and training to improve the
effectiveness of interpersonal interactions.
It is expected that the health care
institution able to improve and implement
the concept of interpersonal interaction is
more optimal in developing other forms of
intervention combined with the concept of
this interpersonal interaction.
 VII. Limitations
The results were taken from a journal
which reports its results in English, it
means that there is the risk of failing to
enter the relevant data. This effort to
minimize the risk of missing studies by
performing additional manual searches of
reference lists and contact the author
directly to data reported directly in the
relevant article.
provide significant impact in dealing
with stress. This analysis indicates that
communication, obsessive relationship and
support and training to improve the
effectiveness of interpersonal interactions.
It is expected that the health care
institution able to improve and implement
the concept of interpersonal interaction is
more optimal in developing other forms of
intervention combined with the concept of
this interpersonal interaction.
VIII. Acknowledgments
The author would like to thank all
those who have to provide additional
information or data regarding their
research.
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