Are Insomnia's Effects on the Brain as Bad As They Feel?

Insomniacs don't just suffer at night. During the day, they often feel sleepy, have trouble concentrating and report greater difficulty with work or school performance than individuals who get adequate sleep. But researchers are intrigued by an apparent discrepancy: Despite what insomnia patients experience subjectively, they often seem able to perform cognitive tasks as well as people getting adequate sleep. One possibility is that insomnia doesn't lead to inferior performance after all—maybe it just feels that way.

Using brain imaging technology, researchers monitored 25 people with insomnia and 25 normal sleepers as they performed an eight-minute working-memory task involving the processing and storing of short-term memory. The subjects underwent functional magnetic resonance imaging scans while viewing a series of letters on a screen, one at a time, and identifying which were repeats of letters displayed earlier in the sequence.

As the exercises became more difficult, the normal sleepers had increased activity in parts of the brain such as the dorsolateral prefrontal cortex while the insomnia subjects didn't. And the poor sleepers couldn't turn off the brain's "mind wandering" regions, also known as the "default mode" network, located generally along the brain's midline. These regions are ordinarily active when a person isn't engaged in goal-directed behavior and they are suppressed when the person switches to a task.

Despite the differences in their brain activity, the two groups performed the memory task equally well, said Sean P.A. Drummond, an associate psychiatry professor at the University of California, San Diego, and a sleep researcher at the VA San Diego Healthcare System, who is the study's lead author. The study was published in the September issue of the journal Sleep.

"They're doing the task just fine but their subjective sense is sort of like they're running through mud," said Dr. Drummond. "It's just so much harder to do."

The more the insomnia patients subjectively reported sleepiness and difficulty concentrating, and the worse they subjectively reported performing their task, the greater was their inability to turn off the default-mode regions, as measured by the MRI. "There's no doubt that what's going on in the brain could be measured as less efficient," Dr. Drummond said.

"For the good healthy sleepers, the harder the task becomes the more they recruited the working memory parts of the brain," he added. "The insomnia patients, in contrast, weren't able to ramp up these parts of the brain the way they should have." The subjects with insomnia had primary insomnia, meaning their difficulties falling asleep or staying asleep weren't related to a health condition, such as sleep apnea.

More research is needed to understand how insomnia patients were able to compensate and perform the tasks equally well despite the apparent dysfunction in brain activity. The ultimate goal of this kind of research is to determine the environmental and genetic causes of insomnia and develop novel treatments.

Some 10% to 15% of U.S. adults suffer from insomnia, particularly middle-aged and older adults, women and those with medical or mental health problems, said Nathaniel Watson, co-director of the University of Washington Medicine Sleep Program, in Seattle. The UC study is a "physiological explanation of why [individuals with insomnia] may have trouble in their day-to-day functioning," he said.

Laura Newmark, a 36-year-old in New York City, said she has had difficulty sleeping for six or seven years and feels it many days. "It is hard at work because there are so many details and I have trouble keeping track," said Ms. Newmark, who handles public relations for an artists' market. "I feel like it definitely impacts my ability to be fully present."

Marjohn Heath, a 43-year-old office manager, said she has suffered from insomnia for more than 15 years and she feels her mind wandering after a poor night's sleep.

On a recent Friday at her job at a Bethesda, Md., energy efficiency solutions company, her boss handed her a stack of journals and asked her to photocopy only the ones with Post-its. "I copied all of them," she said. "I read the note and it totally didn't register. I read it with my eyes…but I didn't process it."

"I have to make a significant effort sometimes not to let my mind wander or float away or get involved in things that are distracting," she said.

Daniel Buysse, a professor of psychiatry at the University of Pittsburgh School of Medicine, said he has done studies in people with insomnia that look at regional brain glucose metabolism during sleep and wakefulness using positron emission tomography (PET). The nuclear medical-imaging technique enables researchers to look at which areas of the brain are more or less metabolically active, he said.

The scans have shown that individuals with insomnia, even when asleep, have more activity in the arousal centers in the brain as compared with good sleepers. Ongoing research also has found that during sleep, those with insomnia have more activity in brain centers associated with mind-wandering activity.

"I kind of wonder whether that may be a neurosignature of the experience of insomnia, where people say, 'I feel like I wasn't asleep all night,' " Dr. Buysse said. The ultimate goal, he said, is to see how treatment affects the brain activity.

"If there are particular regions in the brain that are more active in people with insomnia when they're asleep, we might think of other techniques" for treatment, he said. For example, transcranial magnetic stimulation, a method of treating disorders such as depression and anxiety, can change activity in specific brain regions.

Write to Sumathi Reddy at sumathi.reddy@wsj.com

reference : http://online.wsj.com/news/articles/SB10001424127887323981304579079121055363770

Ellin Virliana / 10410118

New Criteria Increase Number of Men with Depression

A new study finds that depression may be far more common in men than previously estimated.
Women traditionally have been diagnosed with depression about twice as often as men, with about 20% of women becoming depressed at some point in their lives.
In the past decade, however, some researchers have suggested that they simply weren't asking the right questions when talking to men. While women may show their depression through symptoms such as crying or trouble sleeping, depression in men may manifest as anger, aggression, substance abuse or risk taking, such as gambling or womanizing, says lead author Lisa Martin, an assistant professor at the University of Michigan in Dearborn.
When researchers factored in those types of symptoms, they found that about 30% of both men and women had been depressed at some point in their lives, according to a study published Wednesday in JAMA Psychiatry.
Researchers at the University of Michigan based their study on of 3,310 women and 2,382 men. The analysis is the first to look at gender differences in depression rates in a large national sample, Martin says.
Not all experts accept that depression manifests differently in men and women, says Peter Kramer, a clinical professor at Brown University not involved in the new study.
The notion of gender differences in depression symptoms is still a new idea, says Kramer, who describes Martin's findings as preliminary.
Rates of bipolar disorder — in which people may cycle back and forth between depression and mania — are similar between men and women. But rates of many other conditions vary by gender, Kramer says. Autism and attention-deficit hyperactivity disorder are much more common among men, for example, while eating disorders are more common among women.
Yet Martin says that changing the criteria for diagnosing depression could lead to more men getting help.
"If we can get men who have depression to recognize it in themselves and get treatment, that is really significant," Martin says.
Depressed men are typically much less likely to be treated than depressed women, Martin says, partly because some men see asking for help as a sign of weakness.
Martin says clinicians tell her that men are not as likely to walk into their offices of their own free will; Instead, doctors say that men often seek treatment only because "they've been given ultimatums by their wives or their employers," who threaten to divorce or fire them unless the men change their behavior.
Mental and substance use disorders were the leading cause of non-fatal illness in the world in 2010, according to an analysis published Wednesday in The Lancet.
Mental and substance use disorders were responsible for more of the global burden of death and illness than HIV/ AIDS and tuberculosis, diabetes, or car accidents, according to the study.

Reference: http://www.usatoday.com
Ellin Virliana (10410118)

Child Personality Predicts Adult Behavior

Personality traits observed in childhood are a strong predictor of adult behavior according to research from the the University of California, Riverside, the Oregon Research Institute and University of Oregon to be published in Social Psychological and Personality Science.

The researchers drew on data from a study of approximately 2400 ethnically diverse elementary school students in Hawaii in the 1960s, comparing personality ratings by teachers at the time with videotaped interviews of 144 of those individuals forty years later.

Lead author and doctoral candidate Christopher S. Nave explained:

"We remain recognisably the same person. This speaks to the importance of understanding personality because it does follow us wherever we go across time and contexts."

The researchers examined four personality attributes:

• verbally fluent
• adaptable
• impulsive
• self-minimising

Students who had been identified as verbally fluent (defined as unrestrained talkativeness) tended in middle age to be interested in intellectual matters, speak fluently, try to control the situation, and demonstrate a high degree of intelligence. Those who had been rated low tended to seek advice, give up when faced with challenges, and exhibit 'an awkward interpersonal style'.

Students who had been rated as highly adaptable (defined as coping easily and successfully with new situations) tended, in adulthood, to behave cheerfully, speak fluently and show interest in intellectual matters. Those who had been rated low tended to say negative things about themselves, seek advice and exhibit an awkward interpersonal style.

Students who had been rated as impulsive tended, as adults, to speak loudly, display a wide range of interests and be talkative.

Those who had been rated low tended to demonstrate fear or timidity, expressing insecurity and maintaining a distance from others.

Students who had been rated as having a tendency to self-minimise (defined as humble, minimising their own importance or never showing off ) were likely to express guilt, seek reassurance, say negative things about themselves and express insecurity as adults. Those ranked low tended to speak loudly, show interest in intellectual matters and exhibit condescending behavior.

Christopher S. Nave commented:

"We think that personality resides within us. It’s a part of us, a part of our biology. Life events still influence our behaviors, yet we must acknowledge the power of personality in understanding future behavior as well." 

Reference:

http://www.psyarticles.com/development/childhood-personality.htm

Ellin Virliana (10410118)

Why you can’t stop checking your phone

DRIVE FOR LONG ENOUGH in America, and you’re bound to see someone texting behind the wheel. Maybe it’ll be the guy ahead of you, his head bobbing up and down as he tries to balance his attention between his screen and his windshield. Or maybe it’ll be the woman weaving into your lane, thumbing at her phone while she holds it above the dashboard. Maybe it’ll be you.

A recent study by the Virginia Tech Transportation Institute showed that drivers who are texting are twice as likely to crash, or almost crash, as those who are focused on the road. It’s a disturbingly common habit: According to a survey analyzed by the Centers for Disease Control and Prevention, nearly one-third of American adults had e-mailed or texted on their phones while driving at least once during the previous month. And while most get away with it unscathed, many do not. The National Safety Council estimates that 213,000 car crashes in the United States in 2011 involved drivers who were texting, up from 160,000 the year before.

Concerned Americans have taken up the fight against this “national epidemic,” as US Transportation Secretary Ray LaHood called it: Forty-one states, including Massachusetts, have outlawed texting while driving, and police are experimenting withincreasingly aggressive enforcement strategies. Meanwhile, advocacy groups are taking a page from past public-safety successes, like the push to get people to wear seat belts and the anti-drunk-driving movement. AT&T has released an array of ads based around the slogan “It can wait,” and commissioned a documentary film by Werner Herzog, in which people who have lost loved ones to texting-anddriving accidents join those who have caused such crashes in begging viewers to abstain.

But there’s a problem with treating the texting and driving threat as simply a matter of public awareness: Most people already know they shouldn’t do it. One federal survey showed that 94 percent of Americans think it should be illegal to text while driving. Yet they persist. Among teens, who are twice as likely as adults to have extended text conversations while driving, the problem is particularly worrisome. According to one analysis, a state antitexting law barely reduces the likelihood a teenager will text and drive.

It seems clear something powerful is at work, overriding people’s knowledge that what they’re doing behind the wheel is dangerous. To figure out what that something might be, psychology and communications researchers around the world have started studying what exactly is happening in our heads when we reach for a phone in the car. What their research so far suggests is that texting and driving is unlike any public safety issue we’ve dealt with before. It’s not like the judgment error of drinking too much and deciding to drive home anyway; it’s not like neglecting to put on your seat belt. That’s because at the center of the problem, the experts say, is an entirely new kind of object—the modern smartphone—that has become embedded in our consciousness in a way that’s changing our behavior on a massive scale.

In this light, the deadly phenomenon of texting and driving is just one manifestation of a broader affliction facing society: Our phones have effectively programmed us with new habits, including a powerful urge to pull them out when we’re not supposed to. That urge—to check our e-mail, to glance at Facebook, to see who just texted us—can be as intense when we’re standing in line or at dinner with our families as it is when we’re driving a car. But it’s only in a car that resisting it becomes a matter of life and death. In order to fight the problem, we need to understand how that urge works—and acknowledge that merely telling people texting and driving is dangerous, and punishing them for doing it, might not be enough.

“You have to start with the question of why it happens,” said Scott Campbell, a communications professor at the University of Michigan who studies compulsive cellphone use. “Once you have a grasp on why it happens, then you can start to attack the actual mechanisms that lead to the behavior. Without that, you’re just experimenting.”

***

DRIVING IS HARD. A lot can go wrong as you operate a two-ton vehicle in a parking lot, never mind at highway speed. Not surprisingly, paying attention to a small computer at the same time makes it much more likely you’ll mess up. And while sending or reading a text message might only take a few seconds, that can be an eternity when you consider how little time it takes for a child to run into the street or for traffic to suddenly slow in front of you. In a car, getting distracted even briefly can be catastrophic: In 2011, official reports listed 387,000 people injured and 3,331 people killed as a result of distracted driving.

The remedy seems simple: Drivers should just decide to ignore their phones in the car. But as cellphone researchers look more deeply into the practice, they are concluding that decision-making may only be part of the story. For many people, they say, using a smartphone may be less a decision than a habit—a move they make without initially thinking about what they are doing or why.

Habits form when we do something so often that it becomes automatic, sometimes even compulsive or involuntary. Researchers who study the psychology of habit formation are finding that for many people, cellphone use fits this category perfectly. In a recent paper, researchers reported the results of an experiment in which 136 test subjects were given smartphones equipped with software that kept track of their usage for six weeks. The subjects pulled out their devices for very brief periods up to 60 times per day, according to lead author Antti Oulasvirta, a senior researcher at the Max Planck Institute for Informatics, and tended to interact with them in ways that met several definitions of habitual behavior. In diary entries, subjects indicated they were moved to pull up certain applications under the same circumstances over and over: Those who repeatedly checked their e-mail or looked at the news, for instance, said they consistently did so when they got bored.

People whose cellphone use is driven by such automated habits are more likely to text and drive, according to a paper published earlier this year by Scott Campbell and his student Joseph Bayer. In the paper, Campbell and Bayer asked 441 college students a series of questions—adapted from a more general questionnaire used by psychologists to assess habit formation—aimed at determining the extent to which their phone use was habitual. Those who scored high on the scale tended to be the same people who admitted to texting while driving on a regular basis.

The tricky thing about fighting habitual behavior is that the brain’s ability to form habits is actually one of its strengths. A habit is a powerful shortcut that helps us stay more productive: If we learn to react automatically to things in our environment, we preserve mental energy for the harder decisions. You don’t want to have to think about it every time you turn out the lights and lock the front door in the morning.

Phones, however, may hold a power over our habitual behavior that we haven’t fully appreciated yet. Psychologists believe habits tend to revolve around triggers: Trundling down the stairwell of a T station, we pull out our Charlie Cards; settling into our desks at work, we automatically check for messages. But Campbell and Bayer, as well as other researchers who have looked closely at the way we use our mobile phones, say the habits people form around the “everything boxes” in our pockets are fundamentally different: Because we use them in so many different situations, and to accomplish so many different tasks, we develop a vast range of triggers and cues associated with pulling them out and looking at them.

These triggers can be quite basic—the phone ringing or buzzing with a message—and they can come from inside as well as out. One’s desire to reach for the phone might be rooted in complex emotions like loneliness and curiosity, for instance. Humans crave resolution, and smartphones offer it: It’s hard to resist seeing whether a crush has texted back, or a co-worker has sent a reply to a crucial e-mail. By connecting us to everybody we know, all the time, smartphones present a novel way to scratch all kinds of itches.

At the heart of the texting and driving problem, according to researchers, is that people who habitually use their cellphones in daily life have a hard time stopping themselves from reacting to that multitude of triggers when they’re behind the wheel. “The idea that you can just turn off all those associations when you get into the car—I just don’t think it’s realistic,” said Stephen O’Connor, a psychologist at Western Kentucky University who recently coauthored a paper linking compulsive cellphone use to a heightened rate of crashes.

Worse yet, driving itself may exacerbate the problem. According to Paul Atchley, a psychologist at the University of Kansas who studies texting and driving, drivers are at a disadvantage when it comes to resisting temptation, because their prefrontal cortex, the part of the brain responsible for inhibition, is engaged by the task of driving. “The part of your brain that would say, ‘Don’t do this, this is bad for you,’ is occupied,” he said.

***

IF SMARTPHONE USE has become more automatic than conscious for a broad swath of the population, it suggests a complete solution to the problem will require more than laws and ad campaigns: What people who text and drive must do is change their behavior in a way that’s akin to kicking a compulsion. One approach to these kinds of compulsive behaviors is to simply remove the temptation, the way a smoker might throw away his lighter and avoid hanging out with other smokers. An idea that’s been floated recently is to have phones automatically shut off when they detect they’re being used in a moving car—in fact, one can already download apps that do this. But until it becomes possible to teach a phone to distinguish between a driver and a passenger, such solutions are unlikely to gain traction.

Atchley argues for a campaign inspired by the “friends don’t let friends drive drunk” approach to reducing drunken driving. “If it’s a social problem, the solution has to be a social solution,” Atchley said.

That could include abstaining from contacting people we suspect are driving (though, obviously, much of the time we have no idea), or getting passengers to crack down on drivers. But it could also involve drawing lines about phone use in other contexts as well, essentially training ourselves to distinguish between situations where it is and isn’t OK. “If we think it’s socially unacceptable to have one person in a group constantly playing with their phone,” said Atchley, “it’s our responsibility as a friend to say, ‘Can you put the phone down and just hang out with us?’”

Another idea suggested by the new research is that we might fight habit with habit. The goal would be to develop a new trigger for turning the phone off, or even stashing it in the trunk, before getting into the driver’s seat.

Ultimately, the researchers agree, figuring out how to stop grabbing for our phones will depend on recognizing that we’re relating to this new technology with some very ancient instincts—and that we’ll need to take those into account, not just fight them. “It is a new kind of problem,” said Campbell, “and in a way it’s the same old problem we’ve always faced as human beings: that underlying need to connect, to overcome those boundaries between self and other. What I’d call the human condition.”

reference : http://www.bostonglobe.com/ideas/2013/10/06/why-you-can-stop-checking-your-phone/rrBJzyBGDAr1YlEH5JQDcM/story.html

Ellin Virliana / 10410118

SELF CONFIDENT

Self-confidence is one aspect of personality that is very important in human life. Self confident people are confident about their own abilities and have realistic expectations, even when their expectations are not realized; they stayed positive and can take it.

Definition

Self-confidence is a mental or psychological condition of a person who gives a strong confidence in him to do or perform any act. People who do not believe in themselves have a negative self-concept, lack of confidence in his ability, because it is often kept to them. Self confidence is a mental or psychological condition, which individuals can evaluate the entirety of her strong belief in giving him the ability to take action in achieving various goals in life.

People who have good self-confidence, they have positive feelings toward themselves, have strong beliefs on him and had accurate knowledge of the capabilities. People who have good self-confidence are not the only person who feels capable of (but not really afford) but is a person who knows that he can be caused by experience and calculation that he did.

Synonyms:  aplomb, inner strength, positive self-image, self-assurance

Personality traits of people with low self-confidence

When this is linked to the practice of everyday life, people who have low self-confidence or have lost confidence, tend to feel / be as below:

• Do not have anything (desires, goals, targets) which fought energetically

• Do not have a decision to step decisive

• Easily frustrated or give up when faced with a problem or difficulty

• Less motivated to go forward, laziness or half and half

• Often fails to accomplish its tasks or responsibilities

• Awkward in dealing with people

• Can not demonstrate the ability to speak and the ability to listen to a convincing

• Often have unrealistic expectations

• Too perfectionist

• Too sensitive

Help: low self-confindence

Counselling,  life coaching, and hypnotherapy are common therapies used to help improve self-confidence.

according to me, self confident is very important because every one must confident to all of the work. if every one don't have self confident so every one can't be success.

http://artikel-bahasainggris.blogspot.com/2012/11/self-confidence.html

Understanding The Bipolar Personality

Understanding The Bipolar Disorder #2

More complete and detail information about bipolar are obtained from article in Farmacia Magazine Website (http:J/www.maialah-farmacia.com), written by Andra with Prof. dr. Sasanto Wibisono, SpKJ(K) as resource person.

Most symptoms and reasons of this disorder are equal to what have been experienced by Andra.

The following is the descriptions.

“Do not underestimate bipolar disorder!", said by Prof dr Sasanto Wibisono SpKJ(K), Honorable Lecturer of Department of Psychiatry FKUURSCM, as quoted from the daily Pikiran Rakyat on 12 May 2006. He continues, “bipolar disorder can put the mentality into danger if it is not treated well”.

Mental disorder is not only “belonged to” poor countries or developing nations like Indonesia. It begins to be one of four health problems in advanced country. Bipolar disease is one example.

Bipolar disorder incident is not high enough or just ranging between 0.3-1.5%. However, this rate excludes miss-diagnosis cases. Risk of death always follows the bipolar patient. Mortality risk is evident due to high susceptibility to commit suicide. Indeed, suicide risk increases among bipolar patients with less therapy, which counts to 5.5 per 1000 patients. The figure for those with therapy is 1.3 per 1000 patients.

Two Poles

Equal to magnet, bipolar disorder has “two poles”, mania and depression. The word “bipolar” may come from this root. According to Pedoman Penggolongan dan Diagnosis Gangguan Jiwa (PPDGJ) III, this disorder is the repeating episodes that produce a chaos within patient’s feeling and activity.

This disorder is also indicated with the arousal of feeling or the increase of energy and activity (mania or hypomania), and the decrease of feeling or the deprivation of energy and activity (depression).

The unique is a perfect healing between episodes. Mania episode always starts suddenly and lasts for 2 weeks or even 4-5 months, while depression episode can last longer.

First episode begins in any ages either from kids or olds. Many cases occur in youth between 20-30 years old. The earlier the person to experience bipolar is the heavier the disease risk they subject to, either chronic or refraction.

Based on Diagnostic and Statistical Manual (DSM IV, bipolar disorder is differed into 2, which are bipolar I and II. Bipolar Disorder I or classic type is signed with 2 episodes, mania and depression, while Bipolar Disorder II is characterized with hypomania and depression.

Mania episode is assigned into 3 degrees of seriousness, which are hypomania, mania without psychotic symptom, and mania with psychotic symptom.

Hypomania is identified with a woman who struggles with her ovulation period (“estrus”) or a man when he falls in love. A joy feeling, enthusiasm to be self-active, and an increasing sexual arouse are some hypomania symptoms. Degree of hypomania is lighter than mania because these symptoms are not causing social dysfunction.

At mania case, the symptoms are quite heavy because it can mess up almost all works and social activities. Self-dignity jumps too high with too much optimism. The ease toward suspicion and irritation is more evident than elation (happiness). If these symptoms develop high level of suspicion, diagnosis of mania with psychotic symptom is enforced.

In contrast against hypomania / mania, symptom of depression is reverse. Heart stance is depressive, and it is characterized by the absence of interest and enthusiasm, lack of activity, being pessimist, and easily self-blamed.

Depression episode can last minimally for 2 weeks because the diagnosis can only be made after this period. If depression triggers toward the intention of suicide, it means that the patient has been depressive heavily.

Genetic Virus

Etiology and pato-physiology of bipolar disorder is not easily explained. Virus is once accused as primary cause. It is estimated that virus attacks the brain during fetal phase in the worm or during first year after delivery. However, bipolar disorder manifests truly in the next 15-20 years. The tardiness of this manifestation is obvious because in 15 years old of age, thymus and pineal glands which are important to produce hormone to prevent any psychiatric disorders are decreased their functional to 50 %.

Later, research relates this with genetic involvement. This opinion surfaces when 50% bipolar patients have similar disease background to that in their family. The first descendant of bipolar disorder patient will be risked from having similar disorder for seven times. The risk for twin may be very high, especially for monozygot twin, which can be 40-80 %, while it can be lower for dizygot twin, which can be 10-20 %. Such reduction pattern defies Mendel Law.

Some studies successfully prove the link between bipolar disorder and chromosomes 18 and 12. It is not yet investigated which locus of chromosomes is engaged.

Interestingly from this chromosome study, Down syndrome patients (trisomi 21) have low risk from subjected to bipolar disorder.

Since the invention of agents with success story to relieve bipolar disorder, the author starts to estimate the presence of the relationship between neurotransmitter and bipolar disorder. Neurotransmitter agents are dopamine, serotonin, and noradrenaline.

Gen candidates related to neurotransmitter are begun to be researched, such as the encoder gene of monoamine oxidase A (MAOA), tyrosine hydroxilase, catechol-O-methyl-transferase (COMT), and serotonin transporter (5HTT).

Not stopped in this, the author also has new “suspect”, which is a gene which expresses brain derived neurotrophic factor (BDNF). BDNF is neutrophin which plays a role in regulating synapse plasticity, neurogenesis and brain neuron protection. BDNF also involves within mood process. The regulator gene of DNF is located at chromosome 11p13. Three researches look for the relationship between BDNF and bipolar disorder, and the result is positive.

Comorbid

Most bipolar patients not only experience bipolar disorder but also are subjected to other mental disorder (comorbid). Research by Goldstein BI etc, as reported by Am J Psychiatry 2006, has mentioned that of 84 bipolar patients above 65 years old, 38.1 % of them are with alcohol abuse, 15.5 % with dysthymia, 20.5 % with comprehensive anxiety disorder, and 19 % with panic disorder.

Meanwhile, attention deficit hyperactivity disorder (ADHD) can develop into comorbid that mostly found in 90 % children and 30 % teens.

Brain Disorder

There is a different brain sketch between healthy group and bipolar patient. Through the imaging of magnetic resonance imaging (RR) and positron-emission tomography (PET), nigra substance and blood flow are shown deprived in prefrontal subgenual cortex.

Not only that, Blumberg etc, in Arch Gen Psychiatry 2003, have found small volume these liquids in amygdala and hypocampus. Prefrontal cortex, amygdala and hypocampus are the part of brain involved within emotional response (mood and affection).

Other research shows that the expression of myelin-oligodendrocyte decreases in the brain of bipolar patient. Oligodendrocyte has produced myelin membrane which covers the axon such that it accelerates conduction between nerves. If the oligodencrocyte decreases, it is ensured that communication between nerves will not smooth.

Psychiatric Interview

Similar to other mental disorders, the laboratory examination is not too much necessary. Periodic psychiatry interview and physical check up are really adequate to enforce bipolar disorder diagnosis.

First, medical condition shall be assessed to eliminate organic mental disorder (F00-F09). Next, it shall be acknowledged whether mental disorder experienced by patients is due to the use of psychoactive substance (F10-19). Finally, the possibilities of schizophrenia, schizotypal disorder and other suspicion disorder are removed (F20-29).

Medicamentose   

It has been more than 50 years that lithium is used as a therapy for bipolar disorder. Its effectiveness has been proved in healing 60-80 % patients. “Its efficacy” is highly approved because it can save treatment cost and the number of suicide case.

However, it does not mean that lithium is without limit. From few people who with less response to lithium, there are patients with histories of head injury, serious mania (psychotic symptom), and comorbid. If the use of lithium is suddenly stopped, the patients will relapse fast. Besides, its therapy index is too narrow, and therefore, lithium content in the blood must be strictly monitored.

Kidney disorder can be a contra-indication against the use of lithium because it prevents the elimination such that it may produce toxic rate. In addition, lithium is once reported as damaging kidney in the long term usage. Due to this weakness, lithium is abandoned.

Anti-psychotic starts to be used as anti-mania since 1950s. Anti-psychotic is better than lithium for bipolar patients with psychomotoric agitation. Extra attention shall be given to the planning of long term anti-psychotic, especially for first generation (a typical group), because of the presence of side effects such as extra-pyramidal, neuroleptic malignant syndrome, and tardive dyskinesia.

Valproat is optional if bipolar patient does not respond to lithium. Valproat has shifted the domination of lithium as first line regimen. One advantage of valproat is to give good response to rapid cycler group.

Bipolar patient is classified as rapid cycler if only in 1 year, they have experienced 4 or more mania or depression episodes. Therapeutic effect is achieved if the optimal rate in the blood is precisely 60-90 mg/L. Side effects develop when this rate reaches to 125 mg/L which may include nausea, increased weight, liver disorder, tremor, sedation, and broken hair. The recommended acceleration dose of valproat is loading dose of 30 mg/kg in 2 first days, and continued with 20 mg/kg in the next 7 days.

A strive for an alternative agent is still exerted. One is lamotrigine. Indeed, lamotrigrine is an anti-convulsant which is useful to heal epilepsy. Some random studies with double-blinded conclude that lamotrigine is effective as an acute therapy against bipolar disorder episodes such as depression and rapid cycler. Unfortunately, lamotrigine is not good enough for mania episode.

Bipolar disorder must be medicated in continuous fashion without significant break. If so, normal phase will shorten and the relapse can back too often. The shortened normal phase in bipolar disorder case can damage the obedience to the treatment because the patients consider themselves as healed already. Therefore, education can be very important for early treatment to this patient.

reference:
http://olahraga.kompasiana.com/bola/2013/10/17/sikap-chauvinisme-supporter-bola-indonesia-602204.html
Ellin Virliana (10410118)