KPDM Gangguan Bipolar
KPDM Gangguan Bipolar
OLEH:
PRISCA ANGELINA K.
DILLONIAR BAHNY ZULFIKAR
WAN ADI SURYA P.
KEVIN HORAS
FREDDY SAGITA PUTRA S.
SUU MYAT NOE H.
Faktor Biologis
•Abnormalitas metabolit amin biogenik di darah, urin, dan CSF pasien dengan
gangguan mood.
•Faktor neurotransmiter lain asetilkolin, GABA
Faktor Genetik
•Memiliki risiko genetik lebih besar dibanding gangguan depresif berat.
•80 – 90 % pasien bipolar memiliki keluarga (orang tua, anak, saudara kandung)
yang memiliki gangguan mood.
Faktor Psikososial
•Peristiwa hidup dan stres lingkungan
•Faktor kepribadian
•Faktor psikodinamik depresi
•Faktor psikodinamik mania
Klasifikasi
Gangguan bipolar
• Ada gejala penyakit namun tidak memenuhi kriteria
yang tidak diagnostik bipolar di atas.
ditentukan
Bipolar I Disorder
Depression + Mania
Depressive Episodes
Children:
• School phobia
• Excessive clinging to parents
Adolescents:
• Poor academic performance
• Substance abuse
• Antisocial behavior
• Sexual promiscuity
• Truancy
• Running away
Depression in Older People
Depressive +
Hypomanic
disorder episode
Anxiety
Alcohol Dependence
Other Substance-Related Disorders
Medical Conditions
Episode
PEMERIKSAAN Depresi
STATUS
MENTAL Episode
Manik
Episode Depresi
Deskripsi umum
• Retardasi psikomotor gejala yang paling umum, meskipun
agitasi psikomotor juga sering ditemukan, khususnya pada pasien
lanjut usia.
• Postur membungkuk, tidak terdapat pergerakan spontan,
pandangan mata yang putus asa, dan memalingkan
pandangan.
Bicara
• Penurunan kecepatan dan volume bicara, berespon terhadap
pertanyaan dengan kata tunggal dan respon yang melambat.
Gangguan persepsi
• Pasien terdepresi dengan waham dan halusinasi dikatakan
menderita episode depresif berat dengan ciri psikotik.
• “Depresi psikotik” digunakan untuk pasien terdepresi yang jelas
teregresi (membisu, tidak mandi, berpakaian kotor).
• Waham sesuai mood adalah waham bersalah, memalukan,
tidak berguna, kemiskinan, kegagalan.
• Waham tidak sesuai mood adalah tema kebesaran berupa
tenaga, pengetahuan, dan harga diri yang melambung.
Episode Depresi
Pengendalian impuls
• 10-15% melakukan bunuh diri, 2/3 lainnya memiliki gagasan bunuh
diri. Terkadang pasien juga berpikiran untuk membunuh orang lain.
• Pasien terdepresi yang paling parah tidak memiliki motivasi atau
energi untuk bertindak menyerang. Biasanya saat mulai membaik
mendapatkan kembali energi yang diperlukan untuk merencanakan
dan melakukan suatu bunuh diri (paradoxical suicide).
Episode Depresi
Reliabilitas
• Diperlukan konfirmasi dari sumber lain.
Episode Manik
Deskripsi umum
• Biasanya pasien banyak bicara, kadang-kadang menggelikan
dan sering hiperaktif.
• Kadang memerlukan pengikatan fisik dan penyuntikan obat
sedatif intramuskular.
Bicara
• Pasien manik tidak dapat disela saat berbicara dan seringkali
rewel dan pengganggu bagi orang-orang di sekitarnya. Saat
dalam fase manik pembiacaraan menjadi lebih lantang, lebih
cepat, dan sulit dimengerti. Saat keadaan teraktivasi lebih
meningkat asosiasi menjadi longgar.
• Kemampuan untuk berkonsentrasi menghilang, menyebabkan
gagasan yang meloncat-loncat (flight of ideas), word salad, dan
neologisme.
Gangguan Persepsi
• 75% mengalami waham.
Episode Manik
Pikiran
• Isi pikiran pasien manik termasuk tema kepercayaan
diri dan kebesaran diri.
• Mudah dialihkan perhatiannya.
Pengendalian Impuls
• 75% pasien manik senang menyerang atau mengancam. Pasien
yang mengancam terutama orang penting lebih sering menderita
gangguan bipolar I daripada skizofrenia.
Reabilitas
• Pasien manik tidak dapat dipercaya dalam informasinya.
Diagnosis
DSM-5 Diagnosis
1. Gangguan bipolar I
One or more Manic Episode or Mixed Manic Episode
Minor or Major Depressive Episodes often present
May have psychotic symptoms
Specifiers: anxious distress, mixed features, rapid cycling,
melancholic features, atypical features, mood-
congruent psychotic features, mood incongruent
psychotic features, catatonia, peripartium onset,
seasonal pattern.
Severity Ratings: Mild, Moderate, Severe (DSM-5, p. 154).
DSM-5 Diagnosis
2. Gangguan bipolar II
One or more Major Depressive Episode.
One or more Hypomanic Episode.
No full Manic or Mixed Manic Episodes.
Specifiers: anxious distress, mixed features, rapid cycling,
melancholic features, atypical features, mood-congruent
psychotic features, mood incongruent psychotic features,
catatonia, peripartium onset, seasonal patter.
Severity Ratings: Mild, Moderate, Severe (DSM-5, p. 154).
DSM-5 Diagnosis
3. Cyclothymia
For at least 2 years (1 in children and adolescents),
numerous periods with hypomanic symptoms that
do not meet the criteria for hypomanic.
Present at least ½ the time and not without for longer than 2
months.
Gejala/Definisi Contoh
Euforia: Elevated (too happy, silly, giddy) and A child laughs hysterically for
expansive (about everything) mood, “out of 30 minutes after a mildly
the blue” or as an inappropriate reaction to funny comment by a peer and
external events for an extended period of despite other students staring
time. at him.
Iritabilitas: Energized, angry, raging, or In reaction to meeting a
intensely irritable mood, “out of the blue” or as substitute teacher, a child
an inappropriate reaction to external events flies into a violent 20-minute
for an extended period of time. rage.
Inflated Self-Esteem or Grandiosity: A child believes and tells
Believing, talking or acting as if he is others she is able to fly from
considerably better at something or has the top of the school building.
special powers or abilities despite clear
evidence to the contrary.
Diagnosis: Gejala Manik di Sekolah
Gejala/Definisi Contoh
Decreased Need for Sleep: Unable to Despite only sleeping 3 hours the
fall or stay asleep or waking up too night before, a child is still
early because of increased energy, energized throughout the day
leading to a significant reduction in
sleep yet feeling well rested.
Increased Speech: Dramatically A child suddenly begins to talk
amplified volume, uninterruptible rate, extremely loudly, more rapidly, and
or pressure to keep talking. cannot be interrupted by the
teacher
Flight of Ideas or Racing Thoughts: A teacher cannot follow a child’s
Report or observation (via rambling speech that is out of
speech/writing) of speeded-up, character for the child (i.e., not
tangential or circumstantial thoughts related to any cognitive or language
impairment the child might have)
Diagnosis: Gejala Manik di Sekolah
Gejala/Definisi Contoh
Distractibility: Increased inattentiveness A child is distracted by sounds in
beyond child’s baseline attentional the hallway, which would typically
capacity. not bother her.
Increase in Goal-Directed Activity or A child starts to rearrange the
Psychomotor Agitation: Hyper-focused school library or clean everyone’s
on making friends, engaging in multiple desks, or plan to build an
school projects or hobbies or in sexual elaborate fort in the playground,
encounters, or a striking increase in and but never finishes any of these
duration of energy. projects.
Excessive Involvement in Pleasurable A previously mild-mannered child
or Dangerous Activities: Sudden may write dirty notes to the
unrestrained participation in an action that children in class or attempt to
is likely to lead to painful or very negative jump out of a moving school bus.
consequences.
DSM-5 Kriteria Diagnosis Episode
Hipomanik
Gejala/Definisi Contoh
Depressed Mood: Feels or looks sad A child appears down or flat or is
or irritable (low energy) for an cranky or grouchy in class and on
extended period of time. the playground.
Markedly Diminished Interest or A child reports feeling empty or
Pleasure in All Activities: Complains bored and shows no interest in
of feeling bored or finding nothing fun previously enjoyable school or peer
anymore. activities.
Significant Weight Lost/Gain or A child looks much thinner and
Appetite Increase/Decrease: Weight drawn or a great deal heavier, or
change of >5% in 1 month or has no appetite or an exce3sive
significant change in appetite. appetite at lunch time.
Diagnosis: Gejala Depresif Berat
di Sekolah
Gejala/Definisi Contoh
Insomnia or Hypersomnia: Difficulty A child looks worn out, is often
falling asleep, staying asleep, waking groggy or tardy, or reports sleeping
up too early or sleeping longer and through alarm despite getting 12
still feeling tired. hours of sleep.
Psychomotor A child is extremely fidgety or can’t
Agitation/Retardation: Looks say seated. His speech or movement
restless or slowed down. is sluggish or he avoids physical
activities.
Fatigue or Loss of Energy: Child looks or complains of
Complains of feeling tired all the time constantly feeling tired even with
adequate sleep.
Diagnosis: Gejala Depresif Berat
di Sekolah
Gejala/Definisi Contoh
Low Self-Esteem, Feelings of A child frequently tells herself or others
Worthlessness or Excessive “I’m no good, I hate myself, no one
Guilt: Thinking and saying more likes me, I can’t do anything.” She feels
negative than positive things about bad about and dwells on accidentally
self or feeling extremely bad about bumping into someone in the corridor
things one has done or not done. or having not said hello to a friend.
Diminished Ability to Think or A child can’t seem to focus in class,
Concentrate, or Indecisiveness: complete work, or choose unstructured
Increase inattentiveness, beyond class activities.
child’s baseline attentional capacity;
difficulty stringing thoughts together
or making choices.
Diagnosis: Gejala Depresif Berat
di Sekolah
Gejala/Definisi Contoh
Hopelessness: Negative thoughts A child frequently thinks or says
or statements about the future. “nothing will change or will ever be good
for me.”
Recurrent Thoughts of Death or A child talks or draws pictures about
Suicidality: Obsession with death, war casualties, natural disasters,
morbid thoughts or events, or or famine. He reports wanting to be
suicidal ideation, planning, or dead, not wanting to live anymore,
attempts to kill self wishing he’d never been born; he draws
pictures of someone shooting or
stabbing him, writes a suicide note,
gives possessions away or tires to kill
self.
DSM-5 Rapid-Cycling Specifier
Diagnosis
Bipolar I
Bipolar I + episode depresif = gangguan medis, gangguan
neurologis, gangguan mental, schizophrenia.
Bipolar I + episode manik = bipolar II, siklotimia, gangguan mood
yang disebabkan keadaan medis umum, gangguan mood
yang diinduksi zat.
Bipolar II
Gangguan mood lain, gangguan psikotik, gangguan ambang.
TERAPI
Tujuan Terapi
Psikososial
(Nonfarmakologi) Farmakoterapi
Psikoedukasi pada keluarga Menggunakan obat-obat
dan pasien. mood stabilizer.
Psikoterapi Lini pertama: Lithium, asam
valproat, dll.
Pengurangan stress (relaksasi,
yoga, massage, dll). Lini kedua/alternatif:
Carbamazepin, gabapentin,
Tidur cukup, makanan lamotrigin, topiramat
bergizi, olahraga support (antikonsvulsan), nimodipin,
outcomes. verapamil (Ca bloker),
ECT (Electroconvulsive olanzapin, risperidon
Therapy). (antipsikotik atipikal).
Prognosis
BAIK BURUK
Masih dalam episode Disertai penyalahgunaan
manik alkohol
Usia lanjut Disertai gejala psikotik
Sedikit pemikiran bunuh diri Gejala depresi lebih
menonjol
Tanpa atau dengan gejala
psikotik yang minimal