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.
Hi stor y
Bipolar Disorder is actu-
ally one of the worlds
oldest diseases. Using
early medical records,
researchers have found
symptoms
of this disease recorded
from since the second
century. 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, in
1650, scientist Richard
Burton wrote a book
called The Anatomy of
Melancholia. Even to-
day, he is credited as
being the founding fa-
ther of depression as a
mental illness.



Preval ence
About 4% of people suf-
fer from bipolar disor-
der. Prevalence is similar
in men and women and,
broadly, across different
cultures and ethnic
groups .



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
B
ip
o
l
a
r
b
D
is
o
r
d
e
r

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 PKD
Tumpat
8-19
Inside this issue:
Depr essi on For m
Constantly feeling sad or
worthless
Sleep too much or too little
Feeling tired or lacking
energy
Appetite & weight changes
Mania For m
increase in energy level
- less need for sleep
- easily distracted
- nonstop talking
- increased self confidence
- focused on getting things
done, but does not accom-
plish much
PHARMACY BULLETI N , OCT 2013
Uni t Farmasi , Pej abat Kesi hatan daerah Tumpat
Geneti c
BD tends to be familial
meaning that it runs within
families. About 50% of peo-
ples with BD have a family
member with a mood disor-
ders, such as depression.

Neurochemical
Brain imaging studies
showed dysfunction of cer-
tain neurotransmitters such
as norepinephrine , seroto-
nin and probably many oth-
ers in people with BD.


Envi ronmental
There is fairly consistent evi-
dence from prospective studies
that recent life events and inter-
personal relationships contribute
to the likelihood of onsets and
recurrences of bipolar mood epi-
sodes. There have been repeated
findings that between a third
and a half of adults diagnosed
with bipolar disorder report
traumatic/abusive experiences
in childhood.









Substances/ Drugs
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 drugs
such as medicine for thyroid
problem or corticosteroid
o Excessive caffeine
PAGE 2
c au ses
PHARMACY BULLETI N ,
A thirdanda half of adultsdiagnosed
with BD reportstraumatic/ abusive
experience in childhood
Bi po l a r spec t r u m
Msevere mania
Dsevere depres-
sion (unipolar depres-
sion)
mless severe mania
(hypomania)
dless severe depression

Psychosoci al
Psychotherapy is aimed at
alleviating core symptoms,
recognizing episode triggers,
reducing negative expressed
emotion 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,
and psychoeducation have
the most evidence for efficacy
in regard to relapse preven-
tion, while interpersonal and
social rhythm therapy and
cognitive-behavioural therapy
appear the most effective in
regard to residual depressive
symptoms.





promote brain to correct im-
balances in the brain centers
that are responsible for
sleep, appetite, mood and
thought processes.
Electroconvulsive Therapay
(ECT)formerly known as
electroshock .

During ECT, a small amount
of electrical current is sent to
the brain, producing seizure
activity. This seizure activity
PAGE 3

Pharmamacotherapy
BI POLARB DI SORDER
man ag emen t
ELECTROCONVULSI VE 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 a
year.CBZ and VPA tends to be more effective in treating
mania than depressive symptoms, however, LTG ap-
pears to have stronger antidepressant than antimanic
effects
o Antipsychotic
Antipsychotics used to control phychotic symptom like
delusions or hallucination or mania symptoms. Newer
agents eg Quetiapine ( Seroquel),Olanzapine
(Zyprexa) help provide mood stabilizing effect on
their own.
o Benzodiazepines (eg Diazepam, Clonazepam)
Short courses of benzodiazepines may be used as ad-
junct to medications until mood stabilizing become ef-
fective
with BD abuse alcohol
and drugs as a way to es-
cape. If addiction devel-
ops, treatment become
complicated as both
mental health disorders
and substance abuse
have to be treated at the
Chi ldren/ adolescent
Many parents are chal-
lenged by a child who has
extreme changes in
mood, energy, thinking,
and behavior.
Children with BD are at
greater risk for anxiety
disorders and attention-
deficit hyperactivity dis-
orders.(ADHD) These
co occurring disorders
complicate diagnosis of
BD and contribute to the
lack recognition of ill-
ness.
Moreover, many teen
same time.
Li thium is the onl y
rug approved by FDA
for children.
Psychological treatment
combines normal-
ly education on the dis-
ease, group thera-
PAGE 4
Bi po l ar i n spec i f i c po pu l at i o n

Caption describing picture or graphic.
others drugs such as diuret-
ics, angiotensin converting
enzyme inhibitor(ACEIs),non
steroidal anti inflammatory
drugs(NSAIDs),theophylline
and etc that may cause inef-
ficacy and toxicity due to in-
creased or decreased in level
of Lithium.
Issues affecting treatment
for elderly patient that
should be considered by clini-
cians including access to
transportation, financial diffi-
culties, and recognition for
the need of treatment.
Sign/ Symptoms of Acute Lithi-
um toxicity includes:
o Diarea
o Nausea
o Vomiting
o Ataxia
o Tremor
Elderly
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 pharmacokinetic
differences resulting from the
change in adipose tissue, free
water, protein binding and
drug distribution.
For example in elderly taking
lithium, decreased renal clear-
ance lead to a half life that is
double the adult patient.
Moreover, there is a lot of in-
teraction between antipsy-
chotics eg.Lithium with many
PHARMACY BULLETI N ,
Thereisa lot of interaction between
antipsychoticswith many other drugthat
may cause inefficacy and toxicity
Managing BD throughout a
pregnancy is a delicate bal-
ance of the risks and benefits
of the illness versus treatment.
Lithium and first generation
antipsychotics (Haloperidol)
are preferred mood stabilizers
because they consistently
show 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 taking
Lithium, it is important that
the pregnant mother stay hy-
drated to prevent Lithium
toxicity .
prevent premature contrac-
tion.
PAGE 5
When Electroconvulsive Ther-
apy (ECT) was used in preg-
nancy, it poses fewer risks and
complications are uncommon.
However, it is important of
pregnant women to stay nour-
ished and hydrated to help
BI POLARB DI SORDER
Bi po l ar d i so r d er i n pr eg n an c y
DID YOU KNOW
Olanzapine (Zyprexa) has been
approved by FDA for the treat-
ment of acute mania is not associ-
ated with birth defects.. However,
Zyprexa has been asscociated
with weight gain, gestational dia-
betes, Thus, blood sugar levels
and blood pressure should be
carefully monitored in all pregnant
women takeing Zyprexa.
Bipolar disorder can cause
suicidal ideation that leads
to suicidal attempts.
One out of three people with
bipolar disorder report past
attempts of suicide or com-
plete it,and the annual aver-
age suicide rate is 0.4%,
which is 10 to 20 times that
of the general population.
The depressed phase in BD
linked to about 80% of sui-
cide attempts and completed
suicides.
Risk factors associated with
completed suicide in BD in-
clude:
o History of attempted sui-
cide
o Co-morbid anxiety disor-
der
o Hopelessness
o Alcohol/Substance Abuse
o Younger age of onset

Thesuiciderateis10-20 timesthat of
the general population
20-50% of bipolar patientshaveat least
onesuicideattempt
MORTALI TY
Quit drinking or using
illegal 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 can
worsen your bipolar disor-
der.
PAGE 6
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 of
sleep. managing your
mood.
BI POLARB DI SORDER
Al t er n at i v e t r eat men t
HOME REMEDI ES & l i f est y l es c h an 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 interact
with 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 may
relieve 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 worsen
bipolar symptoms.
Sts John Wort
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 on
29/9/2013)
http://www.medicinenet.com/bipolar_disorder/article.htm(accessed
on 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 on
29/9/2013)
References
CONCLUSION
PAGE 7
Editorial Board:
Supervisor
Pn Rohaya Hussin
Peg. Farmasi U48,KKWakaf Bharu

Editor
Cik Canthira a/p Eh Di Pn.Lim Yoke Kuan
Peg. Far,masi U44, Peg. Farmasi U44,KKWB
KK Pgkln Kubor KK Wakaf Bharu
AKTIVITI UNIT FARMASI, PKD TUMPAT
Pelbagai Aktivitivi Penggunaan Ubat bBerkualiti dijalankan seperti ceramah dan pameran
untuk memastikan pengguna mengambil ubat ubatan 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
Ceramah KENALI UBAT ANDA disampaikan kepada kakitangan
Perhutannan Bukit Bakar pada 9th Oct 2013.
AKTIVITI UNIT FARMASI, PKD TUMPAT
AKTI VI TI 5S
Objektif Amalan 5S:
o Mewujudkan persekitaran tempat kerja yang
berkualiti dan produktif
o Hasil kebersihan, kekemasan, & keselamatan yang
nyata
o Lebih banyak idea kreatif & inovatif diketengahkan
oleh pekerja untuk penyelesaikan masalah
&penambahbaikan
o Operasi di tempat kerja lebih senang, pantas, &
selamat.

AKTIVITI UNIT FARMASI, PKD TUMPAT
Aktiviti 5S KK BANDAR
TUMPAT
Ubat Ubatan dilabel dengan kemas dan menggunakan TALL MAN lettering un-
tukubat LOOK ALIKE
Gambar SEBELUM & SELEPAS Aktiviti 5S KK Pengkalan Kubor
BEFORE
BEFORE
AFTER
BEFORE
AFTER
AFTER
Gambar SEBELUM & SELEPAS aktiviti 5S KK Wakaf Bharu
SAMBUNG...
Ga mb a r SEBEL U M & SEL EPAS
a k t i v i t i 5S K K Bu n o h a n
BEFORE
BEFORE
AFTER
AFTER
Kaunt er yang cer i a dan kondusi f
J AMUAN PERPI SAHAN
EN N I K MOH D N OR (P P F U 32)
JASAMU dikenang...
AKTIVITI UNIT FARMASI, PKD TUMPAT
Di Restauran KAFI, Wakaf Bharu
Di Restauran Horizon, Wakaf Cheyeh
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

Graduated with a Bachelor of Pharmacy with Honors,
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
WELLCOMI NG NEW STAFFS
AKTIVITI UNIT FARMASI, PKD TUMPAT

Bibi Norazilah Binti Azuratmi
Pegawai Farmasi U44

Graduated with a Bachelor of Pharmacy with Honors,
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

Graduated with a Bachelor of Pharmacy with Honors,
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

WELLCOMI NG NEW STAFFS
AKTIVITI UNIT FARMASI, PKD TUMPAT
Menimang
cahaya mata
TAHNIAH.
Pn. Rohaya Bt Hussi n Pegawai Farmasi U48
- Melahirkan bayi perempuan ke-5 pada 7 Nov 2013
Akhi rn-