Comprehensive Case Report: Bipolar Affective Disorder with a Current Manic Episode and Psychotic Symptoms in an Adolescent Male Triggered by Chronic Bullying in a Rural Area of Southwest Sumba
DOI:
https://doi.org/10.59141/jiss.v7i6.2362Keywords:
bipolar, adolescents, bullying of psycho, risperidone, divalproex sodium, Sumba Barat DayaAbstract
Bipolar affective disorder (BAD) in adolescents is a chronic psychiatric condition with complex clinical manifestations and high risk of psychotic symptoms. Environmental factors, particularly bullying, have been identified as major stressors that can trigger disease onset through the kindling phenomenon. In remote areas such as Southwest Sumba, diagnostic challenges and limited treatment access are major obstacles to patient recovery. To report the clinical journey and successful management of an adolescent male with BAD manic episode with psychotic symptoms triggered by chronic bullying in a rural setting. Case report with data collection through in-depth family interviews, clinical mental status observation, and medical record review over a six-month period. Findings: Patient MPB (17 years) experienced systematic physical and verbal bullying during junior high school leading to school dropout. Psychotic symptoms manifested as visual hallucinations of a "woman in white" giving commands to self-harm. Diagnosis F31.2 (BAD manic episode with psychotic symptoms) was established based on PPDGJ-III. Combination therapy with risperidone (2x2 mg) and divalproex sodium (2x250 mg) showed effective synergy in stabilizing dopaminergic and GABAergic neurotransmission. Within six months, the patient showed stable symptom remission, returned to vocational school (SMK), and achieved GAF score improvement from 70-61 to 90-81. Key recommendations include strengthening anti-bullying policies in schools and expanding access to community-based mental health services in remote (3T) areas.
References
Basrowi, R. W., Wiguna, T., Samah, K., Moeloek, N. D. F., Soetrisno, M., Purwanto, S. A., Ekowati, M., Elisabeth, A., Rahadian, A., & Ruru, B. (2024). Exploring mental health issues and priorities in Indonesia through qualitative expert consensus. Clinical Practice and Epidemiology in Mental Health: CP & EMH, 20, e17450179331951.
Pham, M. D., Wulan, N. R., Sawyer, S. M., Agius, P. A., Fisher, J., Tran, T., Medise, B. E., Devaera, Y., Riyanti, A., & Ansariadi, A. (2024). Mental health problems among indonesian adolescents: Findings of a cross-sectional study utilizing validated scales and innovative sampling methods. Journal of Adolescent Health, 75(6), 929–938.
Susanti, H., Brooks, H., Yulia, I., Windarwati, H. D., Yuliastuti, E., Hasniah, H., & Keliat, B. A. (2024). An exploration of the Indonesian lay mental health workers’(cadres) experiences in performing their roles in community mental health services: a qualitative study. International Journal of Mental Health Systems, 18(1), 3.
Wahdi, A. E., Wilopo, S. A., & Erskine, H. E. (2023). 122. the prevalence of adolescent mental disorders in indonesia: An analysis of indonesia–national mental health survey (i-namhs). Journal of Adolescent Health, 72(3), S70.
Warsini, S., Kristanti, M. S., Saifudin, I. M. M. Y., Fitryasari, R., Marthoenis, M., & Usher, K. (2025). Unveiling shadows: Challenges encountered by mental health nurses and health cadres in the delivery of care to persons with mental illness in Indonesia. International Journal of Mental Health Nursing, 34(1), e13471.
Dashtbozorgi, B., Ghaemi, K., Kharazmkari, M. H., Ghafarian Shirazi, H. R., & Ghasemzadeh, M. R. (2016). Risperidone versus risperidone plus sodium valproate in treatment of acute mania: A double-blind randomized clinical trial. Iranian Journal of Psychiatry, 11(1), 51–57. https://pmc.ncbi.nlm.nih.gov/articles/PMC4825483/
DelBello, M. P., Kowatch, R. A., Adler, C. M., Stanford, K. E., Welge, J. A., Barzman, D. H., Nelson, E., & Strakowski, S. M. (2006). A double-blind randomized pilot study comparing quetiapine and divalproex for adolescent mania. Journal of the American Academy of Child & Adolescent Psychiatry, 45(3), 305–313. https://pmc.ncbi.nlm.nih.gov/articles/PMC3013630/
Duffy, A., Horrocks, J., Doucette, S., Keown-Stoneman, C., McCloskey, S., & Grof, P. (2017). Kindling of life stress in bipolar disorder: Effects of early adversity. Bipolar Disorders, 14(5), 292–302. https://pmc.ncbi.nlm.nih.gov/articles/PMC5385846/
Geller, B., Luby, J. L., Joshi, P., Wagner, K. D., Emslie, G., Walkup, J. T., Axelson, D. A., Bolhofner, K., Robb, A., Wolf, D. V., Riddle, M. A., Birmaher, B., Naylor, M., Ryan, N. D., Vitiello, B., Tillman, R., Lavori, P., & Reich, W. (2012). A randomized controlled trial of risperidone, lithium, or divalproex sodium for initial treatment of bipolar I disorder, manic or mixed phase, in children and adolescents. Archives of General Psychiatry, 69(5), 515–528. https://pmc.ncbi.nlm.nih.gov/articles/PMC3581342/
Gilman, S. E., Ni, M. Y., Dunn, E. C., Breslau, J., McLaughlin, K. A., Smoller, J. W., & Perlis, R. H. (2015). Contributions of the social environment to first-onset and recurrent mania. Molecular Psychiatry, 20(3), 329–336. https://pmc.ncbi.nlm.nih.gov/articles/PMC4332547/
Halodoc. (2023). Peran keluarga dalam menangani gangguan bipolar. https://www.halodoc.com/artikel/peran-keluarga-dalam-menangani-gangguan-bipolar
Innovative Journal. (2023). Jenis gangguan psikotik berdasarkan PPDGJ III. Innovative: Journal of Social Science Research. https://j-innovative.org/index.php/Innovative/article/download/4691/3297/7100
Jain, A., & Mitra, P. (2023). Bipolar disorder. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK558998/
Jicnusantara. (2023). Dampak bullying sebagai faktor risiko gangguan kesehatan mental dan penurunan prestasi belajar. JIC Nusantara. https://jicnusantara.com/index.php/jicn/article/download/5161/5251/28591
Jurnal Biologi Tropis. (2024). Bipolar disorder in adolescents: Clinical manifestations, causes, and comprehensive management strategies. Jurnal Biologi Tropis/UNRAM. https://jurnalfkip.unram.ac.id/index.php/JBT/article/download/7973/4600/43810
Repository UNAIR. (2023). Gangguan bipolar dan psikoedukasi. Universitas Airlangga Repository. https://repository.unair.ac.id/124409/1/45.%20artikel.pdf
Repository UNAIR. (2023). Screening of bipolar disorders and characteristics of symptoms in various populations in Surabaya, Indonesia. Universitas Airlangga Repository. https://repository.unair.ac.id/124402/1/38.%20Screening%20of%20Bipolar.pdf
Scribd. (2021). Gangguan afektif bipolar episode kini manik dengan ciri psikotik. https://id.scribd.com/document/567569198/Gangguan-Afektif-Bipolar-Episode-Kini-Manik-dengan-Ciri-Psikotik
Syedzasaintika. (2022). [Judul artikel terkait manajemen bipolar di layanan primer]. Jurnal Kesehatan Medika Saintika. https://jurnal.syedzasaintika.ac.id/index.php/medika/article/download/1964/pdf
UCLA Health. (2022). Study finds childhood bullying linked to distrust and mental health problems in adolescence. https://www.uclahealth.org/news/release/study-finds-childhood-bullying-linked-distrust-and-mental
Universitas Airlangga. (2020). Gangguan afektif bipolar episode manik dengan gejala psikotik. Jurnal Psikiatri Universitas Airlangga. https://journal.unair.ac.id/download-fullpapers-psikiatric27896aa80full.pdf
Wulandari, I., Aswin, T., & Fernandez, R. (2023). Gambaran gangguan mental emosional pada penduduk Desa Banfanu, Timor Tengah Utara, Provinsi Nusa Tenggara Timur. Jurnal Biomedika dan Kesehatan. https://www.jbiomedkes.org/index.php/jbk/article/download/111/71/809
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Ni Putu Intan Sri Maharani, I Gusti Ngurah Wisuda Manik
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-ShareAlike 4.0 International. that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
