Gangguan

Mood
Mood dan Afek

+ Mood: adalah suasana perasaan yang bersifat

pervasive (mendalam) dan bertahan lama, yang
mewarnai persepsi sesorang terhadap kehidupannya.
+ Afek: adalah respons emosional saat sekarang, yang
dapat dinilai melalui ekspresi wajah, pembicaraan,
sikap dan gerak gerik tubuh. Afek mencerminkan
situasi emosi sesaat.
Gangguan Mood / Gangguan
afektif
+ Perubahan suasana perasaan, kearah depresi/ elasi disertai
adanya perubahan pada seluruh tingkat aktivitas maupun
gangguan sekunder lain (PPDGJ).
+ Sindroma yg berlangsung mingguan-bulanan, ditandai
hilangnya sense of control terhadap mood & adanya
perasaan distres berat secara subyektif; mengganggu
kebiasaan harian, & cenderung berulang secara periodik/
siklik (Kaplan)
Yang termasuk gangguan Mood
Afektif:
+ F30 – F39 (PPDGJ III)
Episode Manik
Episode Depresif
Gangguan Afektif Bipolar
Gangguan Depresif berulang
Gangguan Mood Menetap
Episode
Manik (F30.1 –
F30.2)
Mania adalah Kondisi
suasana perasaan
(mood) dan afek yang
meningkat – elasi.
 Episode
Manik (F30.0)
Hipomania
Adalah perubahan suasana perasaan
(mood) yang meningkat ringan,
pikiran lebih tajam, disertai
peningkatan energi dan aktivitas,
Tidak ada gejala psikotik, tidak ada
hendaya berat, tidak perlu perawatan,
durasi episode lebih pendek.
 Episode
Depresif (F32)
Hipotimia
Keadaan mood yang pervasif
didominasi dengan kesedihan dan
kemurungan. Keluhan, kehilangan
semangat tampak dari sikap murung
dan perilakunya yang lamban
Episode Depresif
Menurut PPDGJ-III
Klasifikasi

+ Episode Depresif
+ Gangguan Depresif Berulang
+ Gangguan Distimia
 + 3 trias utama
Afek Depresif
Anhedonia (hilang minat dan kegembiraan)
Episode Anergia (menurunnya energi dan mudah lelah)

Depresif + Gejala Lain

Berkurangnya konsentrasi dan perhatian
Durasi minimal gejala 2 Berkurangnya harga diri dan kepercayaan diri
minggu.
Gagasan rasa bersalah dan tidak berguna
Terdapat tiga derajat
keparahan, yakni ringan Pandangan masa depan yang suram dan
sedang, berat. pesimistis
Gagasan / perbuatan yang membahayakn diri /
bunuh diri
Gangguan tidur
Berkurangnya nafsu makan
 Gangguan Depresif Berulang
+ Merupakan episode berulang dari episode depresif. Rata-rata
berlangsung selama 6 bulan, namun frekuensi lebih jarang
daripada bipolar.
+ Tidak ada riwayat episode tunggal mania
+ Episode dalam berbagai tingkat keparahan dicetuskan peristiwa
kehidupan penuh stress
+ Minimal 2 episode telah berlangsung selama minimal 2 minggu
dengan sela waktu beberapa bulan tanpa gangguan afektif
bermakna.
Distimia (F34.1)

+ Afek depresif… yang sangat lama… yang jarang sekali

cukup parah untuk memenuhi gangguan depresif
berulang ringan atau sedang.
Episode Depresif
Menurut DSM V
Klasifikasi

+ Disruptive mood dysregulation disorder

+ MDD / gangguan depresif mayor
+ Dysthymia / gangguan depresi menetap
+ Premenstrual dysphoric disordeer.
+ Gangguan depresi terinduksi zat / obat-obatan
+ Gangguan depresi akibat kondisi medis lain
Gangguan
Afektif Bipolar
(F31) - PPDGJ
The Creative Madness
Episode Berulang
(minimal 2 episode)
Ada penyembuhan
sempurna antar episode
Manik berlangsung 2
minggu sampai 4-5 bulan.
Gangguan
Afektif Bipolar
(F31) – DSM V
The Creative Madness
Bipolar 1 – Classic manic
depressive
Bipolar 2 – 1 depresi mayor dan 1
episode hipomanik
Siklotimia – 2 tahun hipomania dan
episode depresi (tidak pernah
memenuhi kriteria episode mania,
hipomania, atau depresi mayor
Bipolar disorder is also known as manic depression. It is a treatable
illness marked by extreme changes in mood, thought, energy and
behavior. It has symptoms of Mania: The "Highs" of Bipolar
Disorder and Depression: The "Lows" of Bipolar Disorder. These
changes in mood, or "mood swings" are intense and can last for
hours, days, weeks or even months.

People with this disorder typically seek help when they are in the
depressive phase and are often initially diagnosed with unipolar
depression. Some people suffer for years before they are properly
diagnosed and treated. 7 of every 10 people with bipolar disorder are
misdiagnosed at least once. The average length of time to correct
diagnosis and treatment is 10 years.

Bipolar disorder is the sixth leading cause of disability in the world.

Contrary to popular belief, as many men have this disorder as women.
As many as one in five patients with bipolar disorder complete
suicide.
Although a specific genetic link to
bipolar disorder has not been pin pointed,
research shows that bipolar disorder
tends to run in families. About 6 million
adult Americans are affected by bipolar
disorder. That is approximately 2.5%
of the adult population.

artwork from “The Devil and Daniel Johnston” movie

The "lows" of this disorder are much like that of unipolar depression and are sometimes
referred to as "bipolar depression." People with BD experience bipolar depression more often
than mania or hypomania. Bipolar depression is also more likely to be accompanied by disability
and suicidal thinking and behavior.
Symptoms of Depression:
➢ Prolonged sadness or unexplained crying
spells
➢ Loss of appetite and changes in sleep
patterns with sleeping far too much
➢ Irritability, anger, worry, agitation, anxiety
➢ Pessimism, indifference, defeat, feelings of
impending doom
➢ Loss of energy, lethargic
➢ Feelings of guilt, worthlessness
➢ Having problems focusing, remembering,
and making decisions
➢ Unable to enjoy things anymore, social
withdrawal and isolation
➢ Unexplained aches and pains
➢ Suicidal thoughts or attempting suicide.
The "highs" of this disorder come less frequently, but can be very
intense and last for a long period of time.

Symptoms of Mania:
➢ Excessive energy, racing thoughts and rapid talking
➢ Denial that anything is wrong
➢ Extreme “high” or euphoric feelings
➢ Easily irritated or distracted
➢ Decreased need for sleep – possibly days with little or no sleep without
feeling tired
➢ Unrealistic beliefs in one’s ability and powers
➢ Unusually poor judgment
➢ Sustained, unusual behavior
➢ Unusual sexual drive
➢ Abuse of drugs and alcohol
➢ Provocative, intrusive, or aggressive behavior
There are different levels of this disorder.

Bipolar I Disorder — defined by manic or mixed episodes that last at least seven days, or by
manic symptoms that are so severe that the person needs immediate hospital care. Usually,
depressive episodes occur as well, typically lasting at least 2 weeks.

Bipolar II Disorder — defined by a pattern of depressive episodes and hypomanic episodes,

but no full-blown manic or mixed episodes.

Bipolar Disorder Not Otherwise Specified (BP-NOS) — diagnosed when symptoms of the
illness exist but do not meet diagnostic criteria for either bipolar I or II. However, the
symptoms are clearly out of the person's normal range of behavior.

Cyclothymic Disorder, or Cyclothymia — a mild form of bipolar disorder. People with

cyclothymia have episodes of hypomania as well as mild depression for at least 2 years.
However, the symptoms do not meet the diagnostic requirements for any other type of bipolar
disorder.

Rapid-cycling Bipolar Disorder — An extremely severe form of the disorder. Rapid cycling
occurs when a person has four or more episodes of major depression, mania, hypomania, or
mixed states, all within a year. Rapid cycling seems to be more common in people who have
their first bipolar episode at a younger age. Rapid cycling affects more women than men.
Rapid cycling can come and go.
Although bipolar disorder is equally common in women and men, research indicates that
approximately three times as many women as men experience rapid cycling.

Everyone is different and will experience their own combination of symptoms.

Living with bipolar disorder can be like living on a rollercoaster of emotions With mania, thoughts and feelings come and go quickly. You can
and life events. At its highest point there can be intense mania and at its lowest, feel elated and enthusiastic with intensity and power even
severe depression. Either state can last for days or weeks and the transition invincible. Euphoria and sensuality can pervade. The universe has
from one to the other can be slow. Typically, depression steals away much more meaning and the world is a wonderful place. You are in tune with
time than mania. Both can be extremely damaging to someone’s life. life and it seems there is nothing you can’t do but, unfortunately,
it does not stop there. Your perceptions about yourself and the
world become unrealistic. Making poor decisions, you act on
impulse. The money goes easily, excessive use of alcohol and
drugs can ensue, you might go in for gambling, or engage in risky
sexual behavior. The loss of control can be frightening. Instead of
a wonderful experience, you might become irritable, angry, and
aggressive. Ignoring the consequences, your actions can become
very destructive. In the extreme, mania can become psychosis
complete with paranoia and hallucinations.
There might be long periods of being
simply normal but severe depression
can come. It can be paralyzing and
debilitating, painful emotionally and
physically. Energy and optimism go
away and it could become impossible to
function. This too can last for weeks or
months and will occur more than mania.

The good news is that it can all be

treated such that most people with
bipolar disorder can live normal, happy,
and fulfilling lives.
Strategi Tatalaksana
+ Pastikan Diagnosis Benar + Management:
+ DDx: Medika-mentosa

Gangguan tiroid Non medika mentosa

Substance abuse Atasi komorbiditas

ADHD
Gangguan kepribadian
borderline atau lainnya
Medika Mentosa

Anti Manic Anti Depressant

+ Lithium + SSRI (fluoxetine, sertraline,
paroxetine)
+ Carbamazepine + TCA (amitriptyline,
Imipramine, Clomipramine)
+ Haloperidol
+ Tetracyclic (maproptiline,
+ Olanzapine amoxapine)
+ MAOI (meclobemide)
Bipolar disorder is treatable, and recovery is possible.
One way to treat it is with various forms of psychotherapy.

Cognitive Behavioral Therapy (CBT) - Helps

people with bipolar disorder learn to change
harmful or negative thought patterns and
behaviors.

Family-Focused Therapy - Helps enhance

family coping strategies, such as recognizing
new episodes early and helping their loved one.

Interpersonal and Social Rhythm Therapy -

Helps people with bipolar disorder improve
their relationships with others and manage their
daily routines.

Psychoeducation - Usually done in a group,

teaches people about the illness and its
treatment. Can help to recognize signs of an
impending mood swing so treatment can be
sought early, before a full-blown episode
occurs. It may also be helpful for family
members and caregivers.
There is no one medication for bipolar disorder. Depending on the person,
various combinations of these or similar drugs might be prescribed.

Mood stabilizers: Lithium (helps with mania and

depression), Benzodiazepines (primarily for
mania and related anxiety disorders)
Anticonvulsants Used as Mood Stabilizers:
Depakote (valproic acid), Lamictal, Neurontin,
Topamax, Trileptal Antipsychotics: Olanzapine
(Zyprexa), Aripiprazole (Abilify), Quetiapine
(Seroquel)
Antidepressants: Fluoxetine (Prozac),
Paroxetine (Paxil), Sertraline (Zoloft), Bupropion
(Wellbutrin), and there are others
Indikasi MRS

+ Gejala psikotik / depresif berat

+ Risiko mencelakai diri sendiri / orang lain tinggi
+ Kurangnya dukungan psikososial
+ Perilaku yang membahayakan hubungan, reputasi dan
asset.
+ Perubahan yang berat dengan cepat (hari/jam)