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Definition

Bipolar Disorder is a se-rious brain disorder that

limits ones ability to

function and to feel a

normal range of moods.

Bipolar disorder is also

known as manic depres-

sion. This serious mental

illness involves mood

swings that range any-

where from depression

to mania.

H i s t o r y

Bipolar Disorder is actu-ally one of the worldsoldest diseases. Usingearly medical records,researchers have found

symptomsof this disease recorded

from since the secondcentury. Aretaeus of Cap-padocia (a medical phi-losopher) first recog-nized and linked symp-toms of mania and de-pression, but his findings

were ignored. Then, in1650, scientist RichardBurton wrote a bookcalled The Anatomy ofMelancholia. Even to-day, he is credited as

being the founding fa-ther of depression as amental illness.

Pr eva l ence

About 4% of people suf-fer from bipolar disor-der. Prevalence is similarin men and women and,

broadly, across differentcultures and ethnicgroups .

I n t r o d u c t i o n

Si g n & sy mpt o ms o f bi po l a r

Bipo l ar bDiso r d er

Bipolar Spectrum 1

Criteria & Subtypes 1

Causes 2

Bipolar Spectrum& Criteria 2

Management 3

Electroconvelsive Therapy 3

BD in specific Population 4,5

HomeRemedies & Life 7

Conclusion & Refer- 7

Aktiviti Farmasi PKDTumpat

8-19

Inside this issue:

Dep r e ssi o n Fo r m

Constantly feeling sad orworthless

Sleep too much or too little

Feeling tired or lackingenergy

Appetite & weight changes

M a n i a F or m

increase in energy level- less need for sleep- easily distracted- nonstop talking

- increased self confidence

- focused on getting thingsdone, but does not accom-plish much

PHARMACY BULLETIN , OCT 2013

Unit Farm asi, Pejabat Kesihatan daerah Tum pat

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Gene t i c

BD tends to be familial

meaning that it runs withinfamilies. About 50% of peo-ples with BD have a familymember with a mood disor-ders, such as depression.

Neu r o c hem i c a l

Brain imaging studiesshowed dysfunction of cer-tain neurotransmitters suchas norepinephrine , seroto-nin and probably many oth-ers in people with BD.

E n v i r o nm e n t a l

There is fairly consistent evi-dence from prospective studiesthat recent life events and inter-personal relationships contributeto the likelihood of onsets andrecurrences of bipolar mood epi-sodes. There have been repeated

findings that between a thirdand a half of adults diagnosedwith bipolar disorder reporttraumatic/abusive experiencesin childhood.

Subs t ances /D r ugs

Drugs can trigger a manic epi-sode in people who are suscepti-ble to BD. For examples:

o Antidepresants

o llicit Drus such as cocaine,amphatemines, etc

o Excessive of appetite sup-presants, and cold prepara-tion.

o Nonantiphychiatric drugssuch as medicine for thyroidproblem or corticosteroid

o Excessive caffeine

PAGE2

c au ses

PHARMACY BULLETIN ,

A third and a half of adults diagnosed

with BD reports traumatic / abusive

experience in childhood

Bi po l a r spec t r u m

Msevere maniaDsevere depres-

sion (unipolar depres-sion)

mless severe mania(hypomania)

dless severe depression
http://en.wikipedia.org/wiki/Severe_depressionhttp://en.wikipedia.org/wiki/Severe_depressionhttp://en.wikipedia.org/wiki/Hypomaniahttp://en.wikipedia.org/wiki/Hypomaniahttp://en.wikipedia.org/wiki/Severe_depressionhttp://en.wikipedia.org/wiki/Severe_depression

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Psychosoc i a l

Psychotherapy is aimed atalleviating core symptoms,recognizing episode triggers,reducing negative expressedemotion in relationships, rec-ognizing prodro-mal symptoms before full-blown recurrence, and, prac-ticing the factors that lead to

maintenance of remission

In general Cognitive behav-ioural therapy,family-focused therapy,andpsychoeducationhavethe most evidence for efficacyin regard to relapse preven-tion, while interpersonal andsocial rhythm therapy andcognitive-behavioural therapyappear the most effective inregard to residual depressivesymptoms.

promote brain to correct im-balances in the brain centersthat are responsible forsleep, appetite, mood andthought processes.

Electroconvulsive Therapay(ECT)formerly known aselectroshock .

During ECT, a small amountof electrical current is sent tothe brain, producing seizureactivity. This seizure activity

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P h a rm am a c o t h e r a p y

BIPOLARBD I SORDER

man ag emen t

ELECTROCONVULSIVE THERAPY

o Lithium

Treating acute manic episodes,and preventing relaps

es, more so for manic than for depressive episodes .

o Anticonvulsants as Mood Stabilizerssuch as Car-bamazepine,(CBZ) Valproic Acid(VPA),Lamotrigin(LTG) often prescribed for people with rapid cycling

four or more episodes of mania and depression in ayear.CBZ and VPA tends to be more effective in treatingmania than depressive symptoms, however, LTG ap-pears to have stronger antidepressant than antimaniceffects

o Antipsychotic

Antipsychotics used to control phychotic symptom likedelusions or hallucination or mania symptoms. Neweragents eg Quetiapine ( Seroquel),Olanzapine(Zyprexa) help provide mood stabilizing effect ontheir own.

o Benzodiazepines (eg Diazepam, Clonazepam)

Short courses ofbenzodiazepines may be used as ad-junct to medications until mood stabilizing become ef-fective
http://en.wikipedia.org/wiki/Psychotherapyhttp://en.wikipedia.org/wiki/Prodromalhttp://en.wikipedia.org/wiki/Prodromalhttp://en.wikipedia.org/wiki/Cognitive_behavioural_therapyhttp://en.wikipedia.org/wiki/Cognitive_behavioural_therapyhttp://en.wikipedia.org/wiki/Family_therapyhttp://en.wikipedia.org/wiki/Family_therapyhttp://en.wikipedia.org/wiki/Psychoeducationhttp://en.wikipedia.org/wiki/Psychoeducationhttp://en.wikipedia.org/wiki/Interpersonal_and_social_rhythm_therapyhttp://en.wikipedia.org/wiki/Interpersonal_and_social_rhythm_therapyhttp://en.wikipedia.org/wiki/Benzodiazepineshttp://en.wikipedia.org/wiki/Benzodiazepineshttp://en.wikipedia.org/wiki/Benzodiazepineshttp://en.wikipedia.org/wiki/Benzodiazepineshttp://en.wikipedia.org/wiki/Interpersonal_and_social_rhythm_therapyhttp://en.wikipedia.org/wiki/Interpersonal_and_social_rhythm_therapyhttp://en.wikipedia.org/wiki/Psychoeducationhttp://en.wikipedia.org/wiki/Family_therapyhttp://en.wikipedia.org/wiki/Cognitive_behavioural_therapyhttp://en.wikipedia.org/wiki/Cognitive_behavioural_therapyhttp://en.wikipedia.org/wiki/Prodromalhttp://en.wikipedia.org/wiki/Prodromalhttp://en.wikipedia.org/wiki/Psychotherapy

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with BD abuse alcoholand drugs as a way to es-cape. If addiction devel-ops, treatment become

complicated as bothmental health disordersand substance abusehave to be treated at the

Ch i l d r en / a do l escen t

Many parents are chal-lenged by a child who hasextreme changes inmood, energy, thinking,and behavior.

Children with BD are atgreater risk for anxietydisorders and attention-

deficit hyperactivity dis-orders.(ADHD) Thesecooccurring disorderscomplicate diagnosis ofBD and contribute to thelack recognition of ill-ness.

Moreover, many teen

same time.

L i t h i u m is the onl yrug approved by FDAfor children.

Psychological treatmentcombines normal-ly education on the dis-ease,group thera-

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Bipo l a r in spec if ic po pu l at io n

Caption describing picture or graphic.

others drugs such as diuret-ics, angiotensinconvertingenzyme inhibitor(ACEIs),nonsteroidal anti inflammatorydrugs(NSAIDs),theophyllineand etc that may cause inef-ficacy and toxicity due to in-creased or decreased in levelof Lithium.

Issues affecting treatment

for elderly patient that

should be considered by clini-cians including access totransportation, financial diffi-culties, and recognition forthe need of treatment.

Sign/ Symptoms of Acute Lithi-um toxicity includes:

o Diarea

o Nausea

o Vomiting

o Ataxia

o Tremor

E l d e r l y

BD in later life is a complex

and confounding neuropsychi-atric syndromes with diagnos-tic and therapeutic challenges.

It is because metabolism of

drug can change with aging,and dramatic pharmacokineticdifferences resulting from thechange in adipose tissue, free

water, protein binding anddrug distribution.

For example in elderly taking

lithium, decreased renal clear-ance lead to a half life that isdouble the adult patient.

Moreover, there is a lot of in-

teraction between antipsy-chotics eg.Lithium with many

PHARMACY BULLETIN ,

There is a lot of interaction between

antipsychotics with many other drug that

may cause inefficacy and toxicity
http://en.wikipedia.org/wiki/Psychoeducationhttp://en.wikipedia.org/wiki/Psychoeducationhttp://en.wikipedia.org/wiki/Psychoeducationhttp://en.wikipedia.org/wiki/Group_psychotherapyhttp://en.wikipedia.org/wiki/Group_psychotherapyhttp://en.wikipedia.org/wiki/Psychoeducationhttp://en.wikipedia.org/wiki/Psychoeducation

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Managing BD throughout a

pregnancy is a delicate bal-ance of the risks and benefitsof the illness versus treatment.

Lithium and first generationantipsychotics (Haloperidol)are preferred mood stabilizers

because they consistentlyshow minimal risk to the fe-tus.

Some convulsants such as

Valproic Acid and Carbamaze-pine have been proven harm-ful to fetus, possibly contrib-uting to birth defects.

Bear in mind, while takingLithium, it is important thatthe pregnant mother stay hy-drated to prevent Lithiumtoxicity .

prevent premature contrac-tion.

PAGE5

When Electroconvulsive Ther-

apy (ECT) was used in preg-nancy, it poses fewer risks andcomplications are uncommon.

However, it is important ofpregnant women to stay nour-ished and hydrated to help

BIPOLARBD I SORDER

Bipo l a r d iso r d er in pr eg n a n c y

DID YOU KNOW

Olanzapine (Zyprexa) has beenapproved by FDA for the treat-ment of acute mania is not associ-ated with birth defects.. However,Zyprexa has been asscociatedwith weight gain, gestational dia-

betes, Thus, blood sugar levelsand blood pressure should becarefully monitored in all pregnantwomen takeing Zyprexa.

Bipolar disorder can causesuicidal ideation that leadsto suicidal attempts.

One out of three people withbipolar disorder report pastattempts of suicide or com-plete it,and the annual aver-

age suicide rate is 0.4%,which is 10 to 20 times thatof the general population.

The depressed phase in BDlinked to about 80% of sui-cide attempts and completedsuicides.

Risk factors associated withcompleted suicide in BD in-clude:

o History of attempted sui-cideo Co-morbid anxiety disor-dero Hopelessness

o Alcohol/Substance Abuse

o Younger age of onset

The suicide rate is 10-20 times that of

the general population

20-50% of bipolar patients have at least

one suicide attempt

MORTALITY
http://en.wikipedia.org/wiki/Suicidalhttp://en.wikipedia.org/wiki/Suicidal

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Quit drinking or usingillegal drugs.

Steer clear of un-

healthy relation-

ships.Surround yourself

with people who are a pos-

itive influence and won't

encourage unhealthy be-

havior or attitudes that canworsen your bipolar disor-

der.

PAGE6

Get regular exer-cise.Moderate, regular

exercise can help steady

your mood. Working out

releases brain chemicals

that make you feel good

(endorphins), can help

you sleep

Get plenty ofsleep.managing your

mood.

BIPOLARBD I SORDER

Al t er n at iv e t r eat men t

HO ME REMEDIES & l i f est y l es c h a n g es

Omega-3 fatty

acids.These oils may help improve brain function and depression associated

with bipolar disorder.

Magnesium. Several small studies have suggested that magnesium supplements may

lessen mania and the rapid cycling of bipolar symptoms.

St. John s wort This herb may be helpful with depression. However, it can also interactwith antidepressants and other medications, and it has the potential to

trigger mania in some people.

Acupuncture This ancient Chinese practice of inserting tiny needles into the skin mayrelieve depression, but more studies are needed to confirm its benefits

Yoga. Yoga may help ease depression and mood swings associated with bipo-lar disorder. It also has a number of other health benefits.

Massage therapy. Massage may also help relieve anxiety and stress, which can worsenbipolar symptoms.

Sts John Wort

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Bipolar Disorder ia a major public health problem associated with

significant morbidity and a high mortality risk. Several factors

make treatment complex, including the fluctuation of mood episodes

and the effects of these episodes on patient well being , drug non ad-

herences and co morbid conditions.

http://en.wikipedia.org/wiki/Bipolar_disorder (accessed on29/9/2013)

http://www.medicinenet.com/bipolar_disorder/article.htm(accessedon 29/9/2013)

http://www.webmd.com/bipolar-disorder/(accessed on 29/9/2013)

http://www.moh.gov.my/attachments/3897.pdf (CPG Major Depres-sive Disorder)(accessed on 29/9/2013)

http://www.psychiatry-malaysia.org/file_dir/144334708246e4d861559b8.pdf (Bipolar Disor-der)(accessed on 29/9/2013)

http://www.nimh.nih.gov/health/topics/bipolar-disorder(accessed on29/9/2013)

References

CONCLUSION

PAGE7

Editorial Board:

Supervisor

Pn Rohaya Hussin

Peg. Farmasi U48,KKWakaf Bharu

ditor

Cik Canthira a/p Eh Di Pn.Lim Yoke Kuan

Peg. Far,masi U44, Peg. Farmasi U44,KKWB

KK Pgkln Kubor KK Wakaf Bharu

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AKTIVITI UNT FARMASI PKD TUMPAT

Pelbagai Aktivitivi Penggunaan Ubat bBerkualiti dijalankan seperti ceramah dan pameranuntuk memastikan pengguna mengambil ubatubatan secara rasional.

PROGRAM KENALI UBAT ANDA

Pameran KENALI UBAT ANDA sempena Program Kelab Koperasi Negeri Kelantan

di Sekolah Kebangsaan Getting, Pengkalan Kubor pada 13 Mac 2013

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Ceramah KENALI UBAT ANDA disampaikan kepada kakitangan

Perhutannan Bukit Bakar pada 9th Oct 2013.


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AKTI VI TI 5S

Objektif Amalan 5S:

o Mewujudkan persekitaran tempat kerja yangberkualiti dan produktif

o Hasil kebersihan, kekemasan, & keselamatan yang

nyatao Lebih banyak idea kreatif & inovatif diketengahkan

oleh pekerja untuk penyelesaikan masalah&penambahbaikan

o Operasi di tempat kerja lebih senang, pantas, &selamat.


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Aktiviti S KK BANDAR

TUMPAT

UbatUbatan dilabel dengan kemas dan menggunakan TALL MAN lettering un-

tukubat LOOK ALIKE

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Gambar SEBELUM & SELEPAS Aktiviti 5S KK Pengkalan Kubor

BEFORE

BEFORE

AFTERBEFORE

AFTER

AFTER

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Gambar SEBELUM & SELEPAS aktiviti 5S KK Wakaf Bharu

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SAMBUNG...

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G a m b a r SE BE L U M & SE L E PA S

a k t i v i t i 5S K K B u n o h a n

BEFORE

BEFORE

AFTER

AFTER

Kaunt er yang cer i a dan kondusi f

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J AM UAN PERPI SAHAN

E N N I K M O H D N O R (P P F U 32)

JASAMU dikenang...


Di Restauran KAFI, Wakaf Bharu

Di Restauran Horizon, Wakaf Cheyeh

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Siti Zulaikha Binti Ramly

Pegawai Farmasi U41

Graduated with a Bachelor of Pharmacy with Honors,

University Sains Malaysia (2008-2012)

PRP of HRPZ II,Kota Bharu, Kelantan.(2012-2013)

FRP of PKD Tumpat, Kelantan (KK Tumpat)

Tarikh lapor diri: 27th Jan 2014

Nur Alyaa Bajana Binti Abd Malik

Pegawai Farmasi U41


University Sains Malaysia (2008-2012)

PRP of Hospital Besut, Terengganu( 2012-2013)

FRP of PKD Tumpat, Kelantan (KK Wakaf Bharu)

Tarikh lapor diri: 3th Mac 2014

WELLCOM I NG NEW STAFFS


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Bibi Norazilah Binti Azuratmi

Pegawai Farmasi U44


Universitiy Teknologi Mara (2006-2010)

PRP of HTAA, Kuantan , Pahang (2019-2011)

FRP of PKD Tumpat, Kelantan (KK Wakaf Bharu)

Tarikh lapor diri: 3th Mac 2014

Nur Syamimi Binti Mamat

Pegawai Farmasi U41


University Kebangsaan Malaysia(2008-2012)

PRP of HRPZ II, Kota Bharu , Kelantan.(2012-2013)

FRP of PKD Tumpat, Kelantan (KK Sg. Pinang)Tarikh lapor diri: 10th Apr 2014

WELLCOM I NG NEW STAFFS


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Menimangcahaya mata

T HNI H

Pn Rohaya Bt Hussin Pegawai Farm asi U48

- Melahirkan bayi perempuan ke-5 pada 7 Nov 2013

A khi rn

Buletin 82014

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