Farmakološki izazovi u liječenju bipolarno afektivnog poremećaja

master's thesis

• Title (english): Pharmacological challenges in the treatment of bipolar affective disorder
• Author: Mislav Malović
• Mentor: Lidija Bach-Rojecky (mentor)
• Committee member: Lidija Bach-Rojecky (predsjednik povjerenstva)
• Committee member: Dubravka Vitali Čepo (član povjerenstva)
• Committee member: Željka Vanić (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Department of pharmacology); Zagreb
• Defense date and country: 2024-07-04, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

Bipolarno afektivni poremećaj (BAP) dio je spektra poremećaja ponašanja. To je bolest karakterizirana
neobičnim promjenama raspoloženja koja se kreću u rasponu od pretjerane emocionalne ekscitiranosti
(manije/hipomanije), do stanja emocionalne bezdušnosti (depresije). Procjena je da od BAP-a oboli 1 %
ljudi unutar svjetske populacije, a istraživanja pokazuju da je stopa oboljelih u sve većem porastu. Uzroci
nastanka BAP-a rezultat su složenih međudjelovanja više čimbenika na individualnoj i društvenoj razini, a
većina je rizika obolijevanja genetičke prirode s procjenom nasljeđivanja od oko 60-80 %. Postavljanje je
dijagnoze izazovno, a provodi se korištenjem probirnih alata tj. upitnika. Prema dijagnostičkom i
statističkom priručniku za duševne poremećaje (DSM-V), razlikuju se dva tipa BAP-a: BAP tipa 1 i BAP
tipa 2, a glavna je razlika sadržana u prisutnosti i učestalosti pojave manije i depresije. Liječenje se BAP-a
smatra jednim od najsloženijih terapijskih postupaka. Litij, kao glavni predstavnik skupine stabilizatora
raspoloženja, čini zlatni standard u liječenju. Stabilizatorima raspoloženja vrlo se često dodaju antipsihotici
kao dio kombinacijske terapije koja postiže daleko kvalitetniji i brži odgovor pacijenata na liječenje.
Korištenje antidepresiva u ovoj indikaciji tema je dublje kliničke važnosti, praktično potvrđena, no još
uvijek s nedovoljnim brojem konkretnih podataka iz studija. Nova su istraživanja usmjerena na pronalazak
alternativnih farmakoterapijskih mogućnosti, a u fokusu su proučavanja glutamatni, kolinergički i purinski
sustav, odnosno lijekovi koji učinke ostvaruju putem istih. Psihoterapija, kao dodatna mugućnost liječenja,
osigurava pacijentu bolji uvid u vlastitu bolest, bolje shvaćanje i liječenje čini uspješnijim.

Abstract (english)

Bipolar Affective Disorder (BAD) is part of the spectrum of behavioral disorders. It is a condition
characterized by unusual mood swings ranging from excessive emotional excitement (mania/hypomania) to
states of emotional numbness (depression). It is estimated that 1% of the global population suffers from
BAD, and research shows that the rate of affected individuals is increasing. The causes of BAD result from
complex interactions of multiple factors at both individual and societal levels, with most of the risk being
considered genetic, with an estimated heritability of about 60-80%. Diagnosing BAD is challenging and is
conducted using screening tools, i.e., questionnaires. According to the Diagnostic and Statistical Manual of
Mental Disorders (DSM-V), there are two types of BAD: BAD type 1 and BAD type 2, with the main
difference being the presence and frequency of mania and depression. Treating BAD is considered as one of
the most complex therapeutic procedures. Lithium, as the main representative of mood stabilizers, is the
gold standard in treatment. Mood stabilizers are often supplemented with antipsychotics as part of
combination therapy, which achieves a much higher quality and quicker response in patients. The use of
antidepressants in this indication is a topic of deeper clinical importance, practically confirmed, but still
with an insufficient number of concrete data from studies. New research is focused on finding alternative
pharmacotherapeutic options, with a focus on studying the glutamate, cholinergic, and purinergic systems,
i.e., drugs that achieve effects through them. Psychotherapy, as an additional treatment option, allowing
patients a better insight into their illness, better understanding, and makes treatment more successful.

• Keywords: bipolarno afektivni poremećaj; depresija; manija; stabilizatori raspoloženja; antipsihotici; psihoterapija; glutamatni sustav; kolinergički sustav; melatoninski sustav; purinergički sustav
• Keywords (english): bipolar affective disorder; depression; mania; mood stabilizers; antipsychotics; psychotherapy; glutamate system; cholinergic system; melatonin system; purinergic system
• Language: croatian
• URN:NBN: urn:nbn:hr:163:403252
• Study programme: Title: Pharmacy - integrated undergraduate and graduate - university study; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: sveučilišni magistar farmacije (sveučilišni magistar farmacije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-09-26 10:49:11