Dr. Manoe Bernd P. SpKJ.

, MKes
 Depresi
Loss of Energy & interst
Depressed mood
Feelings guilt
Concentrating
Suicide/ idea

Maniakal
Grandious Idea
FOI
De creased sleep
Speech more

Bipolar
 Manik

Bipolar
depresi
 Old Testament
King Saul describes
Depresive Syndromes

1889
Emil Kraeplin
Kriteria dk / 400BC
menggambarkan manik- Hypocrates used term
depresif mania & melancholia

1882 30 AC
German Psychiatrist (Karl Celcus
Kahlbaum) cyclothimia Melancholia =
depression
 A Major Cause of Disability Worldwide

Rank 2000 2020 (Estimated)

1 Lower respiratory infections Ischemic heart disease
2 Perinatal conditions Unipolar major depression

3 HIV/AIDS Road traffic accidents

4 Unipolar major depression Cerebrovascular disease

5 Diarrheal diseases Chronic obstructive

pulmonary disease

Murray, CJ, Lopez AD. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, & Risk Factors in
9
1990 Projected to 2020. Cambridge, MA: 1996.
2004
Murray CJ, Lopez AD. Science 1996; 274:740-743.
 50% alami variasi diurnal gejala pagi parah, sore
& malam lebih ringan
84% mengalami gangguan konsentrasi (+ pelupa),
65% tak mampu berpikir pseudodemensia
Wawasan penyakit baik
Pada anak : fobia sekolah, tak bisa lepas dari orang
tua
Pada remaja : prestasi sekolah <<, PGZ, perilaku
antisosial, mencuri & lari dari rumah
Pada orang tua : > dari populasi umum prevalensi
25-50% berkaitan dengan status sosek <, kehilangan
pasangan hidup, ada penyakit jasmaniah
HDRS (Hamilton Depression Rating Scale) ringan,
sedang, berat
Depre
ssion
Featu Key
res
ICD 10 Diagnosis
Classification
20-40% p
asien De
beresiko presi
Suicide
 Limbic System
Prefrontal
Cortex

Locus Ceruleus (NE

Raphe Nuclei Source)
(5-HT source)

Cooper JR, Bloom FE. The Biochemical Basis of Neuropharmacology. 1996.

 The monoamine hypothesis of gene
action in depression.
If BDNF is no longer made in
appropriate amounts, instead of the
neuron prospering and developing more
and more synapses(right), stress
causes vulnerable neurons in the
hippocampus to atrophy and possibly
undergo apoptosis when their
neurotrophic factor is cut off (left). This,
in turn, leads to depression and to the
consequences of repeated depressive
episodes, namely, more and more
episodes and less and less
responsiveness to treatment. This may
explain why hippocampal neurons seem
to be decreased insize and impaired in
function during depression on the basis
of recent clinical neuroimaging studies.
 Tujuan : menurunkan gejala depresi &
memfasilitasi pasien utk kembali ke
kondisi normal
Strategi : terapi non psikofarmaka dan
psikofarmaka dlm memodulasi
neurokimiawi otak
 Empirical method to choose
antidepression
Fator yg berpengaruh dlm pemilihan
antidepressan
Riwayat respons terapi
Farmakogenetik (riwayat respons th/ pada
keluarga)
Jenis depresi
Kemungkinan interaksi obat
Profil adverse event obat
Harga obat

TATALAKSANA TERAPI

Non Psikofarmaka Psikofarmaka

Psikoterapi
ECT Antidepressan
 manic episode distinct period of an abnormally and persistently
elevated, expansive, or irritable mood (at least 1 week/
week/ less if a patient
must be hospitalized)
hospitalized) .
A hypomanic episode similar to a manic episode except that it is
not sufficiently severe to cause impairment in social or occupational
occupational
functioning, and no psychotic features are present (4 days)
days)
Both mania and hypomania are associated with inflated self-self-esteem,
decreased need for sleep, distractibility, great physical and mental
mental
activity, and over involvement in pleasurable behavior.
bipolar I disorder one or more manic episodes and, sometimes,
major depressive episodes.(
episodes.(DSM-
DSM-IV-
IV-TR)
TR)
A mixed episode is a period of at least 1 week in which both a manic
manic
episode and a major depressive episode occur almost daily. A variant
variant
of bipolar disorder characterized by episodes of major depression
depression
and hypomania rather than mania is known as bipolar II disorder.
 A distinct period of abnormally and persistently elevated, expansive,
expansive,
or irritable mood, lasting at least 1 week (or any duration if
hospitalization is necessary).
During the period of mood disturbance, three (or more) of the
following symptoms have persisted (four if the mood is only irritable)
irritable)
and have been present to a significant degree:
inflated self-
self-esteem or grandiosity
decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
more talkative than usual or pressure to keep talking
flight of ideas or subjective experience that thoughts are racing
racing
distractibility (i.e., attention too easily drawn to unimportant or irrelevant
external stimuli)
increase in goal-
goal- directed activity (either socially, at work or school, or
sexually) or psychomotor agitation
excessive involvement in pleasurable activities that have a high potential
for painful consequences (e.g., engaging in unrestrained buying sprees,
sexual indiscretions, or foolish business investments)

The symptoms do not meet criteria for a mixed episode.

The mood disturbance is sufficiently severe to cause marked
impairment in occupational functioning or in usual social
activities or relationships with others, or to necessitate
hospitalization to prevent harm to self or others, or there are
psychotic features.
The symptoms are not due to the direct physiological effects of
a substance (e.g., a drug of abuse, a medication, or other
treatment) or a general medical condition (e.g.,
hyperthyroidism).
Note: Manic-
Manic-like episodes that are clearly caused by somatic
antidepressant treatment (e.g., medication, electroconvulsive
therapy, light therapy) should not count toward a diagnosis of
bipolar I disorder.
MANIA
Mood yang , ekspansif & iritabilitas
Bicara >>, suara keras, sukar dihentikan, hiperaktif
Dandanan berani & menor, impulsif, abaikan hal-hal
kecil, boros, berlebihan
Preokupasi tema-tema religi, politik, ekonomi, seksual &
rasa dikejar / diincar orang
Toleransi frustrasi rendah marah, hostilitas
Pikiran-pikiran tentang kebesaran - kehebatan diri
75% bisa menyerang (assaultive)
Wawasan penyakit & daya nilai buruk
Suka berbohong
 Antimania (divalprpoic acid,
carbamazepine, oxcarbamazepine)
 Bipolar disorder
is characterized
by various types
of episodes of
affective
disorder,
including
depression, full
mania, lesser
degrees of
mania called
hypomania, and
even mixed
episodes in
which mania
and depression
seem to
coincide.

rapid cycling,
with at least
four switches
into mania,
hypomania,
depression, or
mixed episodes
within a 12-
month period.
This is a
particularly
difficult form of
bipolar disorder
to treat.
TERAPI
HOSPITALISASI
Ada risiko bunuh diri / membunuh,
gejala-gejala berkembang progresif,
tak mampu mengurus diri / tak ada yang mampu
mengurus
PSIKOTERAPI
terapi kognitif, terapi interpersonal, terapi perilaku
FARMAKOTERAPI
antidepresan (trisiklik, tetrasiklik, RIMA, SSRI, Nassa)
antimania (lithium, karbamazepin)
 Prognosis

Gangguan Suasana Perasaan

Menetap

Menetap, fluktuatif tapi tidak bisa disebut episodik

Secara genetik berkaitan dengan gangguan suasana
perasaan
SIKLOTIMIA
Diagnosis ketidakstabilan menetap (dewasa < 2 tahun /
anak-anak < 1 tahun) suasana perasaan (mood) banyak
periode depresi ringan bergantian dengan elasi ringan <<
gejala bipolar I
Prevalensi di masyarakat : 1%, wanita : pria = 3:2 50-75%
onset pada usia 15-25 tahun
Faktor genetik mungkin berperan, 30% pasien punya
keluarga yang menderita bipolar I
Hipomania merupakan upaya asadaruntuk mengatasi SE
yang keras rasa sedih (false euphoria)
Onset insidious pada masa remaja, kronis, 1/3 akan
mengalami gangguan suasana perasaan terutama bipolar II
(episode-episode depresi berat & hipomanik) GANGGUAN
SUASANA PERASAAN MENETAP
TERAPI

Antimania
Antidepresan harus hati-hati karena
sensitifitas pasien terhadap gejala manik-
hipomanik akibat antidepresan
Psikoterapi untuk coping mechanism
pasien terhadap perubahan-perubahan
perasaannya