BIPOLAR DISORDER

SEISA GUMELAR NASTITY

201510401011055
DM RSJ MENUR SURABAYA A24

DEFINITION
According to DSM-IV-TR:
Bipolar I disorder
have had at least one
episode of mania, and
one depressive
episodes

Bipolar II disorder
have a history of major
depressive episodes
and hypomanic
episodes only

Bipolar disorder not

otherwise specified
have evidence of mood
lability, hypomania, and
depressive symptoms
but fail to meet criteria
for bipolar II disorder

Cyclothymic disorder
experience numerous
periods of depressive
symptoms and
numerous periods of
hypomanic symptoms
for at least 2 years

EPIDEMIOLOGY
Bipolar I 0.8% of the adult population
Bipolar II 0.5% of the population
Affects men and women fairly equally
Reported a mean age at onset of 21
years
Onset of mania after age 60 is less
likely to be associated with a family
history of bipolar disorder

 An episodic, lifelong illness with a variable

course
Men are more likely than women to be initially
manic, but both are more likely to have a first
episode of depression
Bipolar disorder should always be considered in
the differential diagnosis of depression
Suicide rates are high among bipolar disorder
patients
Bipolar disorder causes substantial psychosocial
morbidity

SOMATIC TREATMENTS OF
ACUTE MANIC
AND MIXED EPISODES
LITHIUM

Implementation
and dosing
Laboratory
measures and
other diagnostic
tests (BUN and
creatinin,
pregnancy,
thyroid function,
ECG)
Dose: 300 mg
t.i.d, serum
concentration of
0.5-1.2 meq/liter

SIDE EFFECTS

Toxycity

Polyuria,
polydipsia,
weight gain,
cognitive
problems
tremor, sedation
or lethargy,
impaired
coordination,
gastrointestinal
distress, hair
loss, benign
leukocytosis,
acne, and
edema

Toxic effects
with levels
above 1.5
meq/liter; levels
above 2.0
meq/liter
associated with
life-threatening
side effects
Hemodialysis is
the only reliable
method of
rapidly
removing excess
lithium

DIVALPROEX
Implementation and
dosing
initial dose :
2030 mg/ kg per
day in inpatients
250 mg t.i.d in
outpatients
serum concentration
of 50125 mcg/ml
maximum dose of
60 mg/kg per day

SIDE EFFECTS
Sedation or
gastrointestinal
distress, benign
hepatic
transaminase
elevations,
osteoporosis, tremor

CARBAMAZEPINE
Implementation and
dosing
Daily dose of 200
600 mg, given in
three to four divided
doses
Doses can range
from 200 to 1800
mg/day

SIDE EFFECTS
Neurological
symptoms, such as
diplopia, blurred
vision, fatigue,
nausea, and ataxia
Idiosyncratic reaction
= agranulocytosis,
aplastic anemia,
thrombocytopenia,
hepatic failure,
exfoliative dermatitis
and pancreatitis

 Controlled trials of lithium plus an

antipsychotic and of valproate plus an
antipsychotic suggest greater efficacy or more
rapid onset of action with these combinations
than with any of these agents alone.
Suggested anti-psychotic = Olanzapine 15
mg/day
ECT

SOMATIC TREATMENTS OF
ACUTE DEPRESSIVE EPISODES
The primary goal is remission of the
symptoms of major depression and a
return to normal levels of
psychosocial functioning.
Concerns about precipitation of a
manic or hypomanic episode
introduce management issues in the
treatment of bipolar depression that
do not exist for unipolar depression.

Lithium
Anti-Convulsant

Divalproat
CBZ
Lamotrigin
Topiramat

Anti-Depressant

MAO I

Tranylcypromin
Moclobemide

SSRI

Fluoxetin
Paroxetine

TCA

Imipramine
Clomipramine

Anti-Psychotic
ECT

Olanzapine

MAINTENANCE THERAPY
Consider long-term treatment
following a single severe manic
episode (i.e. diagnosis of bipolar I
disorder) because the natural history
of the illness implies that preventing
early relapse may lead to a more
benign illness course

PSYCHOSOCIAL
INTERVENTION

Most patients with bipolar disorder struggle with some of

the following issues
Emotional consequences of episodes of mania and
depression
coming to terms with having a potentially chronic mental
illness
problems associated with stigmatization
delays or major deviations in development
fears of recurrence and consequent inhibition of more
autonomous functioning
interpersonal difficulties, including issues pertaining to
marriage, family, childbearing, and parenting
academic and occupational problems
other legal, social, and emotional problems that arise
from reckless, inappropriate, withdrawn, or violent