NIMH
• Bipolar disorder, also known as mani! depressi"e illness, is a #rain disorder $%a$ a&ses &n&s&al s%i'$s in mood, ener(), a$i"i$) le"els, and $%e a#ili$) $o arr) o&$ dail) $asks*
+SM
• Bipolar disorder aordin( $o $%e +ia(nos$i and S$a$is$ial Man&al o' Men$al +isorders !  Te-$ .e"ision 'o&r$% edi$ion /+SM!I!T. is a mood disorder $%a$ onsis$s o' a$ leas$ one episode o' mani, %)pomani, or mi-ed are &s&all) aompanied wi$% a %is$or) o' maor depressi"e episodes *
2
3pidemiolo()
• Bipolar inidene in $%e ni$ed S$a$es a5e$in( nearl) 6, 7 million people* some s&r"e)s 8olom#ia is done in Ameria, India and apan me s%owed $%a$ Amerian Top #ipolar disorder #) 4*4:, 8olom#ia 2 , 6:, apan 0*7: and $%e lowes$ in $%e India 0*1:*
• From $%e da$a o#$ained alle) .ikesdas 201; men$al
emo$ional (&an inl&din( $%erein #ipolar disorder s%owed a#o&$ <: o' $%e pop&la$ion in Indonesia*
;
 
 
• $%eor) o' ne&ro$ransmi$$ers Mood disorder a&sed #) an im#alane o' ne&ro$ransmi$$ers in $%e 8NS 3-ess amine ompo&nd /N3 and dopamine !>
mania
s%or$a(e N3, dopamine, 6!HT !> depression
Im#alane #e$ween $%e a$i"i$) ? +A and N3 ra$io mood %an(es 'rom depression $o mania
I' N3 down dopamine domina$e %ipomania swi$% or mania
6
S)mp$oms o' mania or a mani episode inl&de@
• Mood 8%an(es
An o"erl) lon( period o' 'eelin( %i(%,C or an o"erl) %app) or o&$(oin( mood
3-$reme irri$a#ili$)*
• Be%a"ioral 8%an(es
Talkin( "er) 'as$, &mpin( 'rom one idea $o ano$%er, %a"in( rain( $%o&(%$s
Bein( &n&s&all) dis$ra$ed
Inreasin( a$i"i$ies, s&% as $akin( on m&l$iple new proe$s
Bein( o"erl) res$less
Ha"in( an &nrealis$i #elie' in )o&r a#ili$ies
Be%a"in( imp&lsi"el) and en(a(in( in pleas&ra#le, %i(%!risk
#e%a"iors*
S)mp$oms o' depression or a depressi"e episode inl&de@
• Mood 8%an(es  – An o"erl) lon( period o'
'eelin( sad or %opeless
 – Loss o' in$eres$ in a$i"i$ies one eno)ed, inl&din( se-*
• Be%a"ioral 8%an(es  – Feelin( o"erl) $ired or slowed downC
 – Ha"in( pro#lems onen$ra$in(, remem#erin(, and makin( deisions
 – Bein( res$less or irri$a#le
 – 8%an(in( ea$in(, sleepin(, or o$%er %a#i$s
 – T%inkin( o' dea$% or s&iide,
or a$$emp$in( s&iide* <
 
  Mild +epression@ A$ leas$ 2 o' $%e ; main s)mp$oms
E A$ leas$ 2 o' $%e o$%er s)mp$oms Li$$le di&l$) a$i"i$ies and e"er)da) $asks
Modera$e +epression@ A$ leas$ 2 o' $%e ; s)mp$oms E A$ leas$ ;!4 o$%er s)mp$oms +i&l$ a$i"i$ies and e"er)da) $asks
+epression@ ; main s)mp$oms E 4 o$%er s)mp$oms
na#le $o a$i"i$ies and e"er)da) $asks
+epression wi$% =s)%o$i S)mp$oms 8ri$eria 'or +epression E S&pposi$ion, %all&ina$ions, depressi"e s$&por /del&sions o' sin, poor, disas$er, %all&ina$ions ins&l$s, a&sa$ions, $%e
s$en% and so on
 
• Mani episode Mood inreased, o"erGowin( E Inrease in p%)sial a$i"i$) and men$al
• %)pomania more li(%$ o' Mania,> siklo$imia 3pisode 'ew da)s +ail) a$i"i$ies disr&p$ed
• Mania i$%o&$ =s)%o$i S)mp$oms Las$in(> 1 week Inreased a$i"i$), spee%, lak o' sleep, (randiose, op$imis$i >>* +ail) a$i"i$ies %ao$i
• Mania wi$% ps)%o$i s)mp$oms > ei(%$ o' Mania i$%o&$ =s)%o$i +el&sions o' (rea$ness, irri$a#ili$), del&sions %ase* +el&sions and %all&ina$ions mood on(r&en$
J
 
• Bipolar A5e$i"e +isorders .e&rren$ episodes /a$ leas$ 2 episodes ne momen$ Mania ? %)pomania /2 weeks!6 mon$%s, w%ile o$%ers +epression /< mon$%s  T%ere is %ealin( $%em
9
Siklotimia
2 )ears +oes no$ mee$ $%e ri$eria 'or depression, mani, or
mi-ed episodes
Bipolar NOS
+oes no$ mee$ $%e spei ri$eria 'or #ipolar I or II, %)pomania 4 da)s s&all) wi$% re&rren$ depression
Bipolar II
 
 
Mood
.e&rren$ depressi"e
11
• An$i!mania@ Li$%i&m ar#ona$e, 8ar#amaOepine, %aloperidol, olanOapine
• An$idepressan$s@ SS.Is@ Fl&o-e$ine, Ser$raline, =aro-e$ine, Fl&"o-amine  Tri)li@ Ami$rip$)line, Imipramine, lomipramine  Te$rasiklik@ Mapro$iline, Amo-apine, Mianserine MAIs@ molo#emide A$)pial@ TraOodone
• 38T@ ! No response $o dr&(s, ! In$olerane, ! 8linial "er) se"ere
• =s)%osoial T%erap) ? =s)%o$%erap)
• M.S@ S&iide risk, Homiide, sel' ne(le$
12