BIPOLAR DISORDER IN ADULT

Presented by:
AAN DWI PRASETIO
2014104011014
 introduction
Bipolar disorder is characterized by the
occurrence of at least one manic or mixed-
manic episode during the patient’s lifetime.
Most patients also, at other time, have one or
more depressive episodes. In the intervals
between these episodes, most patients return
to their normal state of well-being.
 epidemiology
• Bipolar disorder is the 6thh leading cause of
disability in the developed world among those
between the ages 15 and 44 years. Rates are
similar in men and women across different
cultures and ethnic grups.
• Based on WHO identified, the most common
age of onset of bipolar disorder is 17-21 years,
the suicide rate among patient 17-19 %
greater than in patient with mayor depression.
 Etiology and Pathophysiology
1. Genetic factors
2. Neurochemical factors
3. Environment factors
 Genetic factors
• Bipolar disorder  “it runs in families”
• A person who has one parent with bipolar
disorder has 15-25 % chance of having the
condition.
• A person who has an identical twin (having
exactly the same genetic material) has an even
greather risk developing illness an eightfold
than a nonidentical twin.
 Studies at stanford university  the bipolar
parents I the study who had a childhod history
of ADHD were more likely to have children
with bipolar disorder but not ADHD.
• It’s not necessarily the case that other family
members will also develop the illness, the
following factors might also be involved in the
onset of Bipolar disorder
 Neurochemical factors in bipolar
disorder
• The brain chemical :
Conected to many
– Noradrenalin body fuctions,
– Serotonin sleep , sexual
activity, learning
– Dopamin. and memory.

An imbalance is thought to be caused by irreguler

hormone production or neurotransmitter stress
hormone may be change the way gene function
MRI, fMRI and PET (lession in the frontal and temporal
lobes most frequently associated with bipolar
disorder)
 Environment factors
• Use alcohol or tranquilizer may induce a more
severe depresive phase. While the onset of
Bipolar disorder liked to a stress life event.
• This change in the age of onset may be a
result of social and environment factors that
are not yet understood.
 Types of bipolar disorder
1. Bipolar I disorder
• The person has manic episodes and almost
always experience depression at some stages.
• Manic symptoms occur at least 7 days,
depressive episodes typically lastig at least 2
weeks.
2. Bipolar II disorder
• The preson hav eonly hypomanic. But this
condition may be hard to recognise if the person
is seen as normally excitable, highly energised
and very productive.
3. Cyclothymia (rapid cyclic bipolar disorder)
• There are at least 4 episodes per year, it any
combination of maniac, hypomania or
depression. This is more chrnic unstable mood
disorder.
4. BP NOS ( bipolar disorder nt otherwised
spesified) or “atypical bipolar”.
• It refer to a condition in which people have
experienced periods of elevated mood, but do
not meet criteria for any the other subtypes of
bipolar disorder.
 Respons to medication
• Patient with pure euphoric or pure manic
respond to Lithium 59-91 % and slightly lower
rate to valproate treatment.
• Patient in acute episodes of mixed mania
respond better to valproate than lithium.
Most atypical antipsycotics have an indication
too. Thought combinations are often needed.
• Rapid cycling, usually mmore likely to female,
have hypothyroidism. Conceptually, treatment
parallels mixed episodes in acute episodes
respond better to quatiapine, lamotrigine or
valproate. Usingg a combination with clozapin.
 Medications
• First one  mood stabilizers.
– Lithium it’s the first medication approved FDA for
mania.
– Anticonvulsant; valproate (depacote) or
carbamazepine (tegretol), also have mood stabilizing
effects, it’s useful for difficult to treat bipolar episode.
– Valproate cause hormonal changes in teenage girls
and polystic ovary syndrome in women, it’s to harmful
for pregnant and for fetus.
– The new treatment; lamotrifine (lamicical),
gabapentine (neurotin) and topiramast reduce risk of
pregnancy and lactation
• Atypical antipsycotic, it’s use for people who do
not respond lithium or anticonvulsant, can
controlling manic or mixed episode.
• Olanzapin inj for psycotic depression. Sedative
medication such benzodiazepin (clonazepin or
lorazepam).aripiprazole it’s use for maintenance
treat after severe episode.
• Adding an antidepresant (fluoxetin, paroxetine,
sertaline , bupropion) to mood stabilizer it’s more
effective in treating the depression than using
only a mood stabilizer.
• Psycotherapy  it can provide support, guidance and
education t people. We can use:
1. CBT (cognitive behavioral therapy), learn to people
change harmful or negative thougt pattern and
behaviors.
2. Family-focused therapy, this therapy can improve
comunication and problem solving.
3. Interpersonal and social rhythm therapy, we can help to
impove their relationship with mange their daily routine,
sllep schedule may protect againt manic depression.
4. Psyco-education, to teach about illness and medication,
so it can help people recognize sign of relaps so they can
seek treatent early.
• Other treatment,
– ECT, it may be useful if the medication and
psycotherapy does not work. before ECT, a patient
takes a muscles relaxant and put under anasthesia.
ECT have some short term side effect (confution,
disorientation, and amnesia)
– Sleep medication
– Herbal supplement, Hypericum perforatum as natural
antidepresant may cause switch to maniain some
people. Omega 3 fatty acid (in fish oil) it’s useful for
long term treatment of bipolar disorder
Side effect