1. Ny ATW selalu sedih dan menangis tanpa sebab.

a. Mengapa pasien merasa sedih dan menangis tanpa sebab? Termasuk episode
apakah ini? (Ardi, Kikai)
2. Kemudian kemunduran makin hebat, kurang bisa mengurus diri, tak dapat
mengerjakan pekerjaan sehari-hari, bicara terbatas, ucapan kalimat sepatah-dua kata
tetapi masih dapat dimengerti.
a. Apa makna dari masalah Ny ATW diatas? (kikai kartika)
i. kurang bisa mengurus diri, tak dapat mengerjakan pekerjaan seharihari?
ii. bicara terbatas, ucapan kalimat sepatah-dua kata tetapi masih dapat
dimengerti?
b. Bagaimana cara pemeriksaan GAF Scale? (ardi Kikai)
c. Gangguan apa yang terjadi pada kasus ini? (Kikai Kartika)
d. Bagaimana mengatasi secara komprehensif kasus ini? (Kikai, Jojo)
3. Faktor Resiko ( Kikai, Kartika)
4. Manifestasi Klinis (Ciput Kikai)

It's not known exactly what causes depression. As with many mental disorders, a
variety of factors may be involved, such as:

Biological differences.People with depression appear to have physical changes

in their brains. The significance of these changes is still uncertain, but may
eventually help pinpoint causes.

Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that

likely play a role in depression. When these chemicals are out of balance, it may
be associated with depressive symptoms.

Hormones. Changes in the body's balance of hormones may be involved in

causing or triggering depression. Hormone changes can result from thyroid
problems, menopause or a number of other conditions.

Inherited traits. Depression is more common in people whose biological (blood)

relatives also have this condition. Researchers are trying to find genes that may
be involved in causing depression.

Life events. Traumatic events such as the death or loss of a loved one, financial
problems, high stress, or childhood trauma can trigger depression in some
people.

How Is Biology Related to Depression?

Researchers have noted differences in the brains of people who are depressed as
compared to people who are not. For instance, the hippocampus, a small part of
the brain that is vital to the storage of memories, appears to be smaller in
some people with a history of depression than in those who've never been
depressed. A smaller hippocampus has fewer serotonin receptors. Serotonin is
one of many brain chemicals known as neurotransmitters that allow communication
across circuits that connect different brain regions.
Scientists do not know why the hippocampus may be smaller in some people with
depression. Some researchers have found that the stress hormone cortisol is
produced in excess in depressed people. These investigators believe that cortisol
has a toxic or "shrinking" effect on the development of hippocampus. Some experts
theorize that depressed people are simply born with a smaller hippocampus and are
therefore inclined to suffer from depression. There are many other brain regions,
and pathways between specific regions, thought to be involved with depression, and
likely, no single brain structure or pathway fully accounts for clinical depression.
One thing is certain -- depression is a complex illness with many contributing factors.
The latest scans and studies of brain chemistry suggest that antidepressants can
help sustain nerve cells and allow them to form stronger connections that withstand
biological stresses (called "neurotrophic effects"). As scientists gain a better
understanding of the causes of depression, health professionals will be able to make
better "tailored" diagnoses and, in turn, prescribe more effective treatment plans.

How Is Genetics Linked to the Risk of Depression?

We know that depression can sometimes run in families. This suggests that there's
at least a partial genetic link to depression. Children, siblings, and parents of people
with severe depression are somewhat more likely to suffer from depression than are
members of the general population. Multiple genes interacting with one another in
special ways probably contribute to the various types of depression that run in
families. Yet despite the evidence of a family link to depression, it is unlikely that
there is a single "depression" gene, but rather many genes that each contribute
small effects toward depression when they interact with the environment.

Can Certain Drugs Cause Depression

In certain people, drugs may lead to depression. For example, medications such as
barbiturates, benzodiazepines, and the acne drug Accutane have sometimes been
associated with depression, especially in older people. Likewise, medications such

as corticosteroids, opioids (codeine, morphine), and anticholinergics taken to relieve

stomach cramping can sometimes cause mania, which is a highly elated and
energized state that can also be associated with bipolar disorder.

Whats the Link Between Depression and Chronic Illness?

In some people, a chronic illness causes depression. A chronic illness is an illness
that lasts for a very long time and usually cannot be cured completely. However,
chronic illnesses can often be controlled through diet, exercise, lifestyle habits, and
certain medications. Some examples of chronic illnesses that may cause depression
are diabetes, heart disease, arthritis, kidney disease, HIV/AIDS, lupus, and multiple
sclerosis (MS). Hypothyroidism may also lead to depressed feelings.
Researchers believe that treating the depression may sometimes also help the coexisting illness improve.

Is Depression Linked to Chronic Pain?

When pain lingers for weeks to months, it's referred to as being "chronic." Not only
does chronic pain hurt, it also disturbs your sleep, your ability to exercise and be
active, your relationships, and your productivity at work. Can you see how chronic
pain may also leave you feeling sad, isolated, and depressed?
There is help for chronic pain and depression. A multifaceted program of medicine,
psychotherapy, support groups, and more can help you manage your pain, ease
your depression, and get your life back on track.

Does Depression Often Occur With Grief?

Grief is a common response to loss. Losses that may lead to grief include the death
or separation of a loved one, loss of a job, death or loss of a beloved pet, or any
number of other changes in life, such as divorce, becoming an "empty nester," or
retirement.
Anyone can experience grief and loss, but not everyone will experience depression,
which differs from grief in that depression involves feelings of low self-worth and
suicide, while grief involves feelings of loss and longing for a loved one. Each person
is unique in how he or she copes with these feelings.

Brain Chemistry and Bipolar Disorder

And for the info:

but research has shown that chemical imbalances in the brain play an especially key role
in the onset of the disease. Every adult has more than 90 billion brain cells, or neurons.
These neurons communicate with each other through chemical messengers called
neurotransmitters. Neurotransmitters help control a range of bodily functions such as
thinking, reasoning, and mood. But when they dont function properly then problems can
occur.
Heres how neurotransmitters work, each neurons is composed of an axon, a dendrite, and
cell body. When a neuron fires, an electrical signal is sent to the axon, and down a long
slender tube that functions like an antennae. At the end of the axon the signal is transferred to
the neurotransmitters. These neurotransmitters then travel across a synapse, or gap, to a
dendrite of another neuron which receives the chemical messages. Once the process is
complete the neurotransmitters are pumped back into the releasing neuron.
Under normal circumstances, just the right amount of a neurotransmitter is sent across the
gap to communicate with other neurons, but in cases of bipolar disorder levels of certain
neurotransmitters are abnormally high or low which experts believe can trigger mood
abnormalities. For example, bipolar depression has been linked to low levels of serotonin in
the synaptic gap. Serotonin is a neurotransmitter that helps regulate moods. Manic episodes
have been associated with high levels of norepinephrine; the neurotransmitter that
contributes to our fight or flight response. And too much dopamine, a neurotransmitter
effecting emotions and perceptions, is linked to psychotic symptoms such as hallucinations.
Breakthroughs in diagnostic imaging have revealed that the brain structure of those suffering
from bipolar disorders also differs from those of healthy individuals. Using advanced MRI
and PET scanning technologies, experts now have evidence that experiences of sever
episodes of bipolar depression can lead to changes in different parts of the brain. For
example, the brain has two hypocampii, each located in the temporal lobes. One of the
functions of the hippocampus is to help control learning, emotions, and memory. In some
bipolar patients the hippocampus appears to shrink over time. Other areas of the brains
temporal regions may shrink as well.
Since bipolar disorder often runs in families, scientists are trying to identify the specific
genes that cause the condition. But genes are likely not the only explanation. Studies on
identical twins reveal that if one twin develops bipolar, the other twin has an 80% chanced of
developing bipolar as well. This suggests that while genes are a primary cause, other factors
may also be needed for the disease to manifest itself. People born with the possibility of
bipolar may find that stressful events like divorce, job loss or emotional strain can trigger the
illness
Serontonin, the Brain and Bipolar Disorder
Serotonin can also do the following :
1. It gives us self-confidence, a feeling of safety and security.
2. It causes us to feel sleepy.
3. It increases our appetites.
The part of the brain where it does each of these 3 things is a different part of the brain from
the part where the other 2 things occur. Thus, for example, increasing serotonin in the part of
the brain where self-confidence is will increase your self-confidence, but not your sleepiness.
Unfortunately, we have no medications to increase only the serotonin in one part of the

brain. This explains why medications to increase serotonin in the brain can also cause
increased appetite and sleepiness.
Medications which increase serotonin in the brain (SSRIs such as citalopram, escitalopram,
fluoxetine, paroxetine, and sertraline and SNRIs such as venlafaxine and duloxetine) give us
more self-confidence, and a feeling of safety and security.
By the way, serotonin also exists in our gastrointestinal tracts. In this location, it stimulates
digestion. This is why such medications can cause gastrointestinal upset. But they can also
help constipation.
Norepinephrine, the Brain and Bipolar Disorder
Norepinephrine is a catecholamine with dual roles as a hormone and a neurotransmitter.
As a stress hormone, norepinephrine affects parts of the brain where attention and
responding actions are controlled. Along with epinephrine, norepinephrine also underlies the
fight-or-flight response, directly increasing heart rate, triggering the release of glucose from
energy stores, and increasing blood flow to skeletal muscle.
However, when norepinephrine acts as a drug it will increase blood pressure by its
prominent increasing effects on the vascular tone from -adrenergic receptor activation. The
resulting increase in vascular resistance triggers a compensatory reflex that overcomes its
direct stimulatory effects on the heart, called the baroreceptor reflex, which results in a drop
in heart rate called reflex bradycardia.
Dopamine, the Brain and Bipolar Disorder
Dopamine
Dopamine has many functions in the brain, including important roles in behavior and
cognition, voluntary movement, motivation and reward, inhibition of prolactin production
(involved in lactation), sleep, mood, attention, and learning.
A common hypothesis, though not uncontroversial, is that dopamine has a function of
transmitting reward prediction error. According to this hypothesis, the phasic responses of
dopamine neurons are observed when an unexpected reward is presented. These responses
transfer to the onset of a conditioned stimulus after repeated pairings with the reward.
Further, dopamine neurons are depressed when the expected reward is omitted. Thus,
dopamine neurons seem to encode the prediction error of rewarding outcomes. In nature, we
learn to repeat behaviors that lead to maximize rewards. Dopamine is therefore believed to
provide a teaching signal to parts of the brain responsible for acquiring new behavior.
Temporal difference learning provides a computational model describing how the prediction
error of dopamine neurons is used as a teaching signal.
Bipolar disorder, also known as manic-depressive disorder, refers to a group of mood disorders that varies in the
severity of episodes of mania and depression and the predominant type of episode. Certain chemicals, also
called neurotransmitters, act as messengers between neurons in the brain. A study in the October 2000 issue of
the "American Journal of Psychiatry" reports that several neurotransmitters have been implicated as causal of
the disease, but additional factors contribute to the disorder, including structural differences in areas of the brain.
Also, genetic and environmental triggers contribute to the development of bipolar disorder. The
neurotransmitters suspected of being involved in mediating the symptoms of bipolar disorder regulate mood,
stress, pleasure, reward, sleep, arousal, concentration and attention, among other higher cognitive functions.

Serotonin
Serotonin is a neurotransmitter that is synthesized from the amino acid tryptophan. Decreased levels of
serotonin are commonly found in patients with bipolar disorder and depression. Many antidepressant

medications, including monoamine oxidase inhibitors, selective serotonin reuptake inhibitors and tricyclic
antidepressants reduce the symptoms of depression by increasing the concentration of serotonin in the brain.

Glutamate
The amino acid glutamate is the most abundant excitatory neurotransmitter in the brain. A study published in the
December 2007 issue of "Biological Psychiatry" reports that glutamate levels are higher in certain regions of the
brain in patients with bipolar disorder. Many mood-stabilizing drugs used to treat bipolar disorder are known to
decrease the excitatory actions of glutamate.

GABA
Gamma-amino butyric acid, or GABA, is an inhibitory neurotransmitter synthesized from the amino acid
glutamate. GABA modulates the activity of several other neurotransmitters, including dopamine, serotonin and
norepinephrine. An article in the July 2001 issue of "Neuropsychopharmacology" states that the actions of
GABA in the brains of bipolar patients are significantly blunted.

Dopamine
Dopamine is a neurotransmitter synthesized from the amino acid tyrosine. It is known to affect the reward
centers of the brain and also is involved in regulating sleep, motivation, attention and learning. A review in a
2007 issue of the journal "Acta Psychiatrica Scandinavica Supplementum" concludes that dopamine plays a role
in the cyclical shifts from mania to depression in patients with bipolar disorder. This review notes that several
studies provide evidence that dopamine levels are high during manic episodes and depression is initiated upon
the subsequent down-regulation of dopamine.

Norepinephrine
Norepinephrine is a neurotransmitter that is synthesized from dopamine and is released by neurons in the brain
in response to stress. Patients with bipolar disorder commonly have decreased levels of norepinephrine in the
brain.

Melatonin
Melatonin is a hormone derived from the amino acid tryptophan. It is secreted by the pineal gland in the brain,
and many of its actions are the result of it acting similar to a neurotransmitter. Melatonin regulates sleep-wake
cycles, and its circulating levels vary throughout the day and night. In addition, melatonin modulates the
activities of GABA and dopamine. A study in the January 2001 issue of the journal "Frontiers of
Neuropharmacology" reports that the release of melatonin is altered in patients with bipolar disorder.

Penyebab dan faktor resiko gangguan

bipolar
Posted on May 20, 2012

Beberapa penyakit mempunyai penyebab yang jelas dan spesifik sehingga pengobatannya juga
bisa khusus atau spesifik untuk mengatasi penyakit tersebut. Bila seseorang menderita kencing
manis maka obatannya adalah dengan mendapat insulin. Bila seseorang terserang usus buntu,
maka obatnya adalah dengan operasi. Namun tidak demikian halnya dengan gangguan bipolar.
Sepertinya penyebab gangguan bipolar bersifat komplek atau multi faktor. Gangguan bipolar
bukan hanya disebabkan oleh adanya gangguan keseimbangan kimia didalam otak yang cukup
disembuhkan dengan minum obat obatan. Para ahli berpendapat bahwa gangguan bipolar
disebabkan oleh kombinasi faktor biologis, psikologis dan sosial.
Ada beberapa faktor yang diduga meningkatkan resiko terkena gangguan bipolar, yaitu:

Mempunyai hubungan darah atau saudara penderita gangguan bipolar

Periode pengalaman hidup yang sangat menekan (stressful).

Penyalah guna obat atau alcohol.

Perubahan hidup yang besar, seperti ditinggal mati orang yang dicintai.

Saat ini berumur di awal 20an tahun.

Menurut teori stress-vulnerability model, ada beberapa resiko atau factor penyebab gangguan
jiwa bipolar, yaitu:
1.

Genetika dan riwayat keluarga. Penderita bipolar lebih sering dijumpai pada penderita
yang mempunyai saudara atau orang tua dengan gangguan bipolar. Riwayat pada keluarga
dengan penyakit bipolar bukan berarti anak atau saudara akan pasti menderita gangguan
bipolar. Penelitian menunjukkan bahwa pada orang orang dengan riwayat keluarga
penderita bipolar maka kemungkinannya terkena bipolar akan sedikit lebih besar
dibandingkan masyarakat pada umumnya. Artinya ada factor predisposisi terhadap
gangguan bipolar. Hanya saja, tanpa adanya factor pemicu, maka yang bersangkutan tidak
akan terkena gangguan bipolar. Faktor predisposisi gangguan bipolar bisa terjadi juga
karena anak meniru cara bereaksi yang salah dari orang tuanya yang menderita gangguan
bipolar.

2. Kerentanana psikologis (psychological vulnerability). Kepribadian dan cara seseorang

menghadapi masalah hidup kemungkinan juga berperanan dalam mendorong munculnya
gangguan bipolar..
3. Lingkungan yang menekan (stressful) dan kejadian dalam hidup (live events). Riwayat
pelecehan, pengalaman hidup yang menekan.
4. Gangguan neurotransmitter di otak.
5. Gangguan keseimbangan hormonal.
6. Factor biologis. Ada beberapa perubahan kimia di otak yang diduga terkait dengan
gangguan bipolar. Hal ini menunjukkan adanya factor biologis dalam masalah gangguan
bipolar.
Beberapa kondisi kesehatan yang biasanya menyertai gangguan jiwa bipolar.
Pada seseorang yang menderita gangguan jiwa bipolar, sebelum mendapat diagnosa atau
beberapa saat setelah didiagnosa, sering ditemukan beberapa penyakit lain. Kondisi tersebut perlu
didiagnosa dan diobati karena dapat memperburuk gangguan bipolar. Beberapa kondisi tersebut
adalah:

Anxiety disorder, gangguan kecemasan termasuk didalamnya post traumatic stress

disorder (PTSD yang banyak diderita tentara Amerika yang berperang di Afghanistan),
phobia social, dan generalized anxiety disorder.

Attention-deficit/ hyperactivity disorder (ADHD), Gangguan hiperaktivitas dan kurang

atensi/ perhatian, ADHD mempunyai gejala yang tumpang tindih (overlap) dengan
gangguan bipolar. Oleh karena itu, gangguan bipolar sering sulit dibedakan dari ADHD.
Gangguan ADHD sering keliru didiagnosa gangguan bipolar, atau sebaliknya. Bahkan
kadang seseorang didiagnosa dengan 2 penyakit sekaligus.

Kecanduan obat bius. Banyak penderita gangguan bipolar juga kecanduan rokok, alcohol
atau obat obatan. Obat obatan atau alcohol seperti dapat meringankan gejala bipolar,
namun sebenarnya akan dapat memicu, memperparah atau memperlama depresi atau
mania.

Gangguan kesehatan fisik. Penderita gangguan jiwa bipolar sering menderita sakit jantung,
kelenjar gondok atau kegemukan.

Gangguan bipolar sering menimbulkan komplikasi berupa:

Masalah terkait kepada kecanduan alcohol atau narkoba.

Masalah hukum

Masalah keuangan.

Permasalahan hubungan sosial

Isolasi dan hidup menyendiri

Kinerja buruk di sekolah atau ditempat kerja.

Sering bolos kerja atau sekolah.

Bunuh diri

Neurotransmitter
Terdapat 3 neurotransmitter utama yang berhubungan dengan anxietas, berdasarkan
percobaan pada binatang dan respon terapi, yaitu norepinefrin (NE), serotonin, dan asam
aminobitirat (GABA).
a. Norepinefrin
Gejala kronik yang dialami oleh pasien dengan gangguan cemas seperti serangan
panik, insomnia, terkejut, dan pembangkitan otonom yang berlebihan, merupakan
karakteristik dari peningkatan fungsi NE.
Neuron sistem noradrenergik terletak terutama di lokus seruleus pons dan aksonnya
menuju korteks serebri, sistem limbik, batang otak, dan korda spinalis. Eksperimen
pada primata menunjukkan stimulasi pada lokus seruleus menghasilkan respon rasa
takut.
b. Kortisol

Beberapa bentuk stres psikologis dapat meningkatkan CRH (corticotropin-releasing

hormone),

peningkatan

sintesis

dan

sekresi

kortisol

dan

DHEA

(dehidroepiandrosterone). Kortisol berperan dalam mobilisasi dan pemeyediaan

kembali simpanan energi, dan berkontribusi terhadap peningkatan kewaspadaan,
perhatian terfokus, dan pembentukan memori; menghambat pertumbuhan dan sistem
reproduksi; dan penahanan respon imun. Sekresi kortisol yang berlebihan dan
menetap dapat menyebabkan efek samping yang serius, termasuk hipertensi,
osteoporosis,

imunosupresan,

resistensi

insulin,

dislipidemia,

diskoagulasi,

aterosklerosis, dan penyakit kardiovaskular.

c. Serotonin
Tidak ada pola abnormalitas yang jelas mengenai fungsi 5-HT (reseptor serotonin)
pada pasien dengan serangan panik dan anxietas. Beberapa penelitian menunjukkan
penggunaan antidepresan memiliki efek terapeutik pada beberapa gangguan panik,
namun beberapa penelitian lain menunjukkan obat yang menyebabkan peningkatan
sekresi serotonin mengakibatkan peningkatan kecemasan pada pasien dengan
gangguan cemas.
Neuron mayor serotonergik terletak di nukleus rafe pons.
d. GABA
Peran GABA dalam gangguan cemas didukung oelh penelitian mengenai efikasi
benzodiazepin (obat yang meningkatkan aktivitas GABA pada reseptor GABA tipe
A). Penggunaan obat ini pada pasien dengan gangguan cemas terbukti efektif.
e. Galanin
Penelitian pada tikus menunjukkan pemberian galanin secara sentral memodulasi
tingkah laku yang berhubungan dengan anxietas.
GLOBAL ASSESSMENT OF FUNCTIONING (GAF) SCALE
100 91 Gejala tidak ada, berfungsi maksimal, tidak ada masalah yang tak
tertanggulangi.
90 81 Gejala minimal, berfungsi baik, cukup puas, tidak lebih dari masalah harian
yang biasa.
80 71 Gejala sementara & dapat diatasi, disabilitas ringan dalam sosial, pekerjaan,
sekolah dll.
70 61 Beberapa gejala ringan & menetap, disabilitas ringan dalam fungsi, secara
umum masih baik.

60 51 Gejala sedang (moderate), disabilitas sedang.

50 41 Gejala berat (serious), disabilitas berat.
40 31 Beberapa disabilitas dalam hubungan dengan realita & komunikasi,
disabilitas berat dalam beberapa fungsi.
30 21 Disabilitas berat dalam komunikasi & daya nilai, tidak mampu berfungsi
hampir semua bidang.
20 11 Bahaya mencederai diri/orang lain, disabilitas sangat berat dalam
komunikasi & mengurus diri.
10 01 Seperti diatas => persisten & lebih serius.
0
Informasi tidak adekuat.