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BIPOLAR DISORDER

International Research Journal of Pharmacy

DEFINISI

Bipolar Disorder ditandai dengan satu atau


lebih episode manik/mixed-manik dan satu
atau lebih episode depresi. Diantara dua
episode manik dan depresi tersebut pasien
kembali ke kehidupan normalnya.
Bipolar Disorder di tandai juga dengan
perubahan mood, energi, dan cara berpikir
yang ireguler.
Sebanyak 25% pasien bipolar disorder
melakukan upaya bunuh diri dan sebanyak
11% berhasil melakukannya.

Epidemiologi

Menurut WHO (2000) prevalence and


Incident :

South Asia, 100.000 : 421


Africa & Europe for Men, 100.000 : 481
Oceania for Women, 100.000 : 491

Menurut U.S National Co-Morbidity Survey :

Lifetime Prevalence Bipolar-I 1%, Bipolar II 11%.


Most common age, 17-21 year.
17-19% patient will die by suicide.

Etiologi dan Patofisologi

Terdapat 3 etiologi :

Faktor Genetik
Faktor Neurochemical
Faktor Lingkungan

Faktor Genetik

Bipolar disorder tends to be familiar, meaning


that it runs in families.
50% orang dengan Bipolar Disorder
mempunyai anggota keluarga dengan Mood
Disorder.
Presentase :

1 Bipolar Parent : 15-25% chance.


Both Bipolar Parent : 40%
Non Identical Twin : 25% chance.
Identical Twin : 40-70% chance.

Faktor Neurochemical

Three
important
brain
chemical
are
norepinephrine, serotonin, and dopamine.
Norepinephrine & serotonin have been
consistently linked to psychiatric mood
disorder such as depression and bipolar.
In recent theory cause of bipolar disorder is
that is related to abnormal serotonin
chemistry in a brain.
Serotonin is strongly affect a person mood.
Serotonin connected to many body function,
sleep wakefulness, eating, sexual activity,
learning and memory.

Faktor Neurochemical

New research has found stress hormone


may change the way gene functions, allowing
illnes like bipolar disorder to emerge.

Faktor Lingkungan

A life event may trigger a mood episode in a


person with a genetic proposition for bipolar
disorder..
Even without clear genetic factors, altered
health habits, alcohol, drug abuseor hormonal
problem can trigger an episode.

Symptoms of Bipolar Disorder

In bipolar disorder it is a combination of


depressive and manic episode.
Symptoms of Mania :

Increased energy level, activity, and restlessness.


Excessive high-euphoric mood.
Extreme irritability
Talking very fast.
Disstractibility, cant concentrate well
Unrealistic belief.
Poor judgement.
Increased sexual drive.

Symptoms of Bipolar Disorder

Symptoms of Depressive episode :

Lasting sad, anxious, or empty mood.


Feeling hopelessness and pessimism.
Feeling guilt, worthlessness, or helplessness.
Loss of interest or pleasure to activities once enjoyed.
Decrease of energy, feeling of fatigue.
Difficulties in concentrating, remembering, making
decisions.
Restlessness or irritability.
Sleeping too much or cant sleep.
Change appetite or weight loss or gain.
Thought of death suicide, or suicide attempts.

Type of Bipolar Disorder

Bipolar I

Bipolar II

Have only Hypomanic.


The person is seen as normally excitable, highly
energised, and very produtive.

Cyclothymia

Has Manic and Depressive episode at least seven days.


Severe manic symptoms that need immediate hospital
care.

There are at least 4 episode per year, combination of


mania, hypomania, or depression.
More chronic unstable mood disorder.

Bipolar Disorder Not Otherwised Specified (BP-NOS)

Diagnosis

Menurut DSM V :

Medications

Mood Stabilizer

Lithium Carbonate. Dosis : 250-500mg/hari.


Asam Valproate Syr 250mg/5ml. Dosis : 2x250mg/hari.
Carbamazepine Tablet 200mg. Dosis 300-600mg/hari.
Lamotrigine, gabapentine, & topiramat.

Atypical Antipsycotic

Clozapine may be helpful as mood stabilizer for people who


do not respond to lithium or anticonvulsant. Clozapine
controlling manic or mixed episode.
Olanzapine help for psychotic depression.
Clonazapine, Lorazepam, & Zolpidem for insomnia
problem.
Quetiapine relieves the symptoms of sudden or severe
manic episode.

Medications

Antidepressant

Fluoxetine Tab 20mg. Dosis : 10-40mg/hari.


Paroxetine
Sertraline Tab 50mg. Dosis : 50-150mg/hari.
Buproprion

Psycotherapy

Cognitive Behavioral Therapy (CBT).


Family Focused Therapy.
Interpersonal and Social Rhythm Therapy.
Psyco-education Theraphy.

Medications

Other Treatment

Electroconvulsive Theraphy (ECT)


Sleep Medication
Herbal Supplement