Prepared by: Supervisor:

Introduction
Bipolar Disorder manic-depressive illness, brain disease causes people to have abnormal shift in mood, energy and ability to function
(Malaysian Mental Health Association, 2007)

Introduction There are 4 main types of bipolar disorder:

Bipolar I Disorder patient has at least one episode of mania or mixed mood and often will experience depression as well Bipolar II Disorder patient had at least one episode of depression and one period of hypomania Cyclothymic Disorder patient go back and forth between mild depression and slightly elevated mood Bipolar Disorder Not Otherwise Specified (BPNOS) patients do not fit into any types as mentioned

Rapid-cycling Bipolar Disorder Patients with four or more episodes of mania and/or depression in a year
(Malaysian Mental Health Association, 2007)

Introduction
Mania can be characterized by:
Grandiosity Decreased need for sleep Pressure to keep talking Flight of ideas Distractibility Increased activity Excessive involvement in pleasurable activities with high potential for painful consequences.
(Ostwald et al., 2007)

Introduction
Antiepileptic Drugs - drugs that are approved and used primarily to treat people who have various kinds of seizures disorders. Commonly prescribed to be used in patients with bipolar disorders E.g. Sodium Valproate, Carbamazepine, Lamotrigine (McDonagh et al., 2008)

Problem Statement Antiepileptic drugs are initially used to treat

seizures or epilepsy, however, they are also commonly used as mood stabilizer for bipolar disorder patients. Valproate shows same efficacy as lithium in treating acute mania
(Pope et al., 1991; Freeman et al., 1992; Bowden et al., 1994).

The exact mechanism of action of antiepileptic drugs as mood stabilizer is still remain unclear.
(Jainer et al., 2011)

Problem Statement
Valproate, lamotrigine and other antiepileptic drugs have an FDA warning that their use might increase risks of suicidal thoughts and behaviors. Lack of conclusive studies on the effectiveness and safety of antiepileptic drugs in treatment of bipolar disorder.
(National Institute of Mental Health, 2008)

Justification
Insufficient data on effectiveness and safety of antiepileptic drugs in managing manic phase of bipolar disorder among the local populations This study will give insight about the effectiveness and safety of antiepileptic drugs as mood stabilizer in bipolar disorder patients

Objective General Objective:

To determine the effectiveness and safety of the use of antiepileptic drugs in managing manic phase of bipolar disorders

Specific Objectives:
i. To identify the prescribing trend of treatment of mania in patients with bipolar disorder ii. To determine the effectiveness of antiepileptic drugs in managing manic phase of bipolar disorder iii. To determine the safety of antiepileptic drugs in managing bipolar disorder

Methodology
Study Design: Retrospective Medical Record Review Sampling Method: Convenient sampling Sample Size: approximately 100 patients Site to conduct data collection: Psychiatry Clinic of Hospital Kuala Lumpur (HKL)

Methodology
Outcome Measures:
Effectiveness of AED in managing bipolar disorder
Patients Mental State Examination (MSE) & improvement of symptoms / Brief Psychiatric Rating Scale (BPRS)

Safety of AED in bipolar disorder patients

Full Blood Count (FBC) Liver Function Test (LFT) Other Adverse Effects Therapeutic Drug Monitoring (TDM)

HKL Psychiatry Clinic database

Methodology
Patient Screening Patient Selection Inclusion Criteria Exclusion Criteria

Record Office HKL Data Collection Data Analysis

Methodology
Inclusion Criteria:
Adult patients between 18-65 years old Diagnosed with any type of bipolar disorder Treated with at least one antiepileptic drug (AED)

Exclusion Criteria:
Patients with other neurologic and psychiatric illness

Statistical Analysis
All data collected will be analyzed using SPSS software. All categorical data are expressed as percentage (%). Categorical data is analyzed using non-parametric analysis, e.g. chi square test. Continuous data is expressed as mean standard deviation, using parametric analysis, e.g. t-test.

Impact of Study
Effectiveness and safety of antiepileptic drugs in bipolar disorder can be identified It might be a reference for the prescribers in determining the first line drug therapy pattern in managing manic phase of bipolar disorder Beneficial for counseling on the correct use of the antiepileptic drugs Therapeutic Drug Monitoring (TDM) can be promoted

Gantt Chart
Work Plan Identify topic of research Jan Feb Mac Apr May Jun

Jul

Aug

Sep

Oct

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Dec

Literature
Review Proposal presentation Data Collection Data Analysis Write Up

References