Sunday 9 December 2012

A Study on Empathy

Empathy is an innate quality in humans. It ensures that we have the ability to feel for one another and this further promotes kindness and co-operation. The more people are alike, the more they identify with one another. In fact, it has been found that if you did not identify with a victim of  any kind of trauma, you are unlikely to be vicariously traumatised. This may be protective for rescue workers in major disasters or healthcare personnels dealing with patients with PTSD.

In this interesting study on empathy in rats. Watch the video!

Saturday 8 December 2012

Adult ADHD: Simply a Myth?

There has been many research done on adult ADHD which have shown that many adults continue to be affected with ADHD symptoms. Despite this, many still think of ADHD as an illness affecting only children. There is a lack of understanding about adult ADHD both in healthcare professionals as well as the public in general.

In this paper written by doctors from the Institute of Mental Health (IMH), Woodbridge Hospital, Singapore, it is estimated that 5.29% of people may have ADHD. Only 10% will recover fully such that the symptoms no longer affect their lives in any way. This means that in Singapore, 265,000 people have ADHD and about 240,000 people will have ADHD symptoms into adulthood!

Based on this report, about 140,000 Singaporeans suffer from asthma. This is about 100,000 less than ADHD. Yet, it is not uncommon to hear of adults getting treatment for asthma whilst you will almost never hear adults getting treated for ADHD. In fact, many adult with ADHD today may have never been diagnosed in their childhood as the illness was poorly understood in this part of the world when they were children.

This can be due to the fact that the symptoms of adult ADHD is somewhat covert and hidden. As the child grows older, the hyperactivity symptoms (ie fidgeting,  running around, talking excessively) subsides. The adult can control their hyperactive symptoms much better. However, they continue to have inattentive symptoms like forgetfulness, poor time management and disorganisation. These symptoms can often be very disruptive. This is especially so students undergoing tertiary education where academic work can be fast paced and stressful. The ADHD mind may find itself unable to cope or manage in these times of stress where time allocation, organisation and prioritisation of work is critical.

Psycho-stimulant medications like methylphenidate is a very effective treatment for these symptoms. Other therapy such as behavioural modifications or cognitive behavioural therapy are helpful for the individuals suffering from adult ADHD.

Friday 30 November 2012

Depression: Should I See A Doctor?

In life, it is not uncommon to be down and out especially if you have experienced an upsetting event. Clinical depression however, is a separate entity whereby the mood is low for more than two weeks accompanied by various other symptoms (see here). Clinical depression is a medical condition that requires treatment.

Why see a Doctor for Depression?

Many a times, people feel that they are strong enough to will themselves out of depression. Despite wanting to get away from everything, those with depression often soldier on with work and social commitments. In front of friends and family, they put up a strong front as if nothing is wrong. Sometimes in milder cases, the individual may recover shortly but in many cases, without help, the depression and ability to cope will worsen. This results in a vicious cycle.

Physical Assessment
In the assessment of depression, the doctor or psychiatrist will also perform a physical examination and sometimes blood tests to make sure that the low mood is not caused by medical problems such as hypothyroidism.

Suicide Assessment
The psychiatrist is also the most qualified person to perform a suicide assessment. If your friend of love one has depression, there is a risk that he or she may harbour suicide thoughts and may act on them in the future. A suicide risk assessment will help identify individuals at high risk of completing suicide so that immediate help and treatment can be performed.

Brain Changes in Depression
One cannot simply will away depression. It is not due to moral deficits or weakness in personality. It has a biological basis. In depression, actual structural changes of the brain occurs. Depression is associated with changes in metabolism and blood flow in the brain. Medication can protect the brain from these damages and potentially reverse these changes.

Treatment of Depression
Depression is very treatable. 70-85% of sufferers respond to medications. There really is no need to suffer the sleepless nights, endless guilt feelings and hopelessness. In addition to medication and psychological treatment, psychiatrist will advise their patients about practical steps to take to improve their mood. Watch this space for more advice about depression.

Tuesday 27 November 2012

Warning about side effects can increase their occurrence: an experimental model using placebo treatment for sleep difficulty

This paper by Australian researchers showed that when a patient is warned about the side effects of a medication, he is more likely to experience the side effects due to the placebo effect.

In this study, the subjects were give placebo (sugar pills) and told that this was medication for their insomnia. They were also told verbally and in writing of the possible side effects. Unsurprisingly, the subjects given the supposed medication had improvements in their sleep due to the placebo effect. However, surprisingly, 41% of the subjects also experienced the side effects that they were told!

Therefore, when patients experience side effects of medication, it may not be the medication that caused the side effect but the warning itself.

Talking about side effects of treatment has always been a dilemma. It has long been known from studies as well as personal experiences that warning patients of the side effects often lead to patients experiencing the side effects. Yet, as doctors, we have a responsibility and obligation to educate patients as best as we can and to facilitate informed consent.

Sunday 25 November 2012

Natural Born Parents?

Is there such a thing as natural born parents?

You know, those people who can intuitively deal with the incessant crying of their newborns, handle those terrible (terrible) twos, effortlessly impress upon their ten year old kiddo that school is more important than XBOX or Nintendo and can communicate with the not-a-child-not-quite-an-adult adolescent without pulling their hair off from frustration.

Somehow we are made to believe that parents especially mothers have the innate ability to care for their children. I think this is partly true. There exist primitive mechanisms that parents will have to protect their younglings so as to preserve the survival of the species. However, bringing up a child in a modern society and nurturing him/her into a confident, happy and successful person is a totally different story.

In Singapore, this is made worse as most of us stay in small apartments as a nuclear family. The extended family may be living in another neighbourhood and opportunities to learn about how to be a parent is limited. The wisdom of the previous generation in handling a child is unfortunately not passed on.

We have also rapidly developed since independence. Our parents' practices may seem dated and redundant. A generation ago, disciplining children meant corporal punishments and caning. The child was expected to be seen but not heard. Today, parenting skills are all about time-outs, limit setting and star charts. Close your eyes and you can immediately see the grandparents scoffing about such "western techniques" and that if you "spare the cane, you spoil the child."

Many young parents lacking experience and guidance will find in stressful handling their newborns and dealing with parenting. Parents have asked me what IS the best way to discipline or to bring up a child. There really is no one size fits when it comes to parenting. Every child is different and has different needs and requirements. The child-parent dynamics are affected by the temperament of both the child and the parent, the bidirectional interactions between the child and parent and other external circumstances.

Unfortunately, I have seen many parents getting caught in the rat race and focusing on short term targets like music, sports and academic achievements and disregarding the emotional and psychological wellness of their children. The young child can quickly learn that the world is negative and full of struggles and trepiditions. He may develop to become an unhappy genius, never to be satisfied with his own talent.

I believe every single parent will want his or her child to blossom into a confident and happy adult. So start by being mindful that your aim as a parent is to provide a healthy environment for the child to grow, both physically and emotionally.  Once this picture is clear in the mind, the jigsaw pieces of the parenting puzzle will fall into place with nautral ease.

Sunday 18 November 2012

Hobbies: Do you have one?

As a psychiatrist, I often ask my patients about the things that they like to do, such as their hobbies. This can help us identify any changes in their interests towards things and gives us an indication about their mood.

The only problem about hobbies is that many Singaporeans don't have one! Patients would often tell me that Singapore is so stressful and "how to afford" a hobby in their busy schedule.

Some may think, "Is that possible, someone without an interest??!!"

When I first started out with my practice, I too often thought that patients who told me that they do not have hobbies were just having me on. Later, I found out that there were indeed a group of Singaporeans with no hobbies. They work from Monday to Saturday, rest at home on Sunday and go back to work again on Monday. They may sit in front of the television, but may not watching the shows at all. At best, they will sit on their usual seats in the corner of their HDB flats reading Wan Bao.

These are people from the babyboomers generation. Hard working and responsible, what life means to them is simply work and to provide for the family. These are great virtues in an Asian society. A man's worth is measured by his work and contribution to society.

But the problem arises when one day, the individual has to retire and many baby boomers have reached or are reaching this age. Suddenly, he is without a job. Suddenly, he is no longer useful. The day after retiring from his job, he is not only without a job but without any aim or meaning in his life.

It is no wonder that many of these people would become depressed. Sometimes, they may not recognise or refuse to admit their difficulties in their emotions and these may manifest as physical symptoms such as headaches, body weakness, chronic pain and giddiness. Severe cases become suicidal. Not having a job is an important risk factor for suicide.

All these because of (the lack of) a hobby?

Perhaps preparing for one's retirement is the more pertinent issue. You may be the most successful Head of Department but that does not equip you with the skills to live life upon retirement; unless you become an avid golfer. Retirement needs to be planned. One needs to slowly prepare and change his mindset and find new meaning of life beyond the present work.

And hobbies are a great way to do so.

Doing fun things and things you find interesting helps you to relax and relieve you of the stress of work. Upon retirement, you have something to look forward to; something you can put your focus and energy on. Hobbies need not be frivolous fun, they can be journeys of learning and can sometimes become a second career!

So it not about how you can afford to have a hobby. It is about how you cannot afford to live without one. 

Saturday 3 November 2012

What is Psychiatry?

In Singapore, many people do not know what psychiatry is or what psychiatrists do. Even healthcare professionals sometimes get confused between psychiatrist and psychologist. Let me explain what Psychiatry is.

What is Psychiatry?

Psychiatry is a medical specialisation focusing on mental illnesses and disorders. Before Psychiatry, mental disorders were thought of as demonic possessions or character flaws. Sufferers were often locked up and kept away from society. In the 20th century, psychological treatments were discovered for these illnesses. The first medication for psychiatric disorders were discovered in the 1970s.

Who are Psychiatrists?

Psychiatrists are medical doctors who are trained and specialises in the field of psychiatry and psychology. As medical doctors, we are trained to identify and diagnose psychiatric and mental disorders. We can then prescribed the necessary treatment for our patients and these can be therapy, medications and even simple lifestyle changes.

When it comes to talk therapy, the role of psychiatrists, psychologists and counsellors may overlap. Depending on his training, the psychiatrist may decide to perform the talk therapy with the patients himself. Often, he may work with the psychologist or counsellor in his team to implement the therapy.

Psychiatrist vs Psychologist: Who to see?

If you suspect you or your love one has a psychiatric illness or condition, it will be best for you to seek help from a medical doctor. A good staring point may be your family physician or a psychiatrist. Many a times, medical conditions (eg. Hyperthyroidism) can masquerade as low mood, anxiety or poor sleep. You should see someone medically trained to make sure that the psychological condition is not due to a medical problem.

For this reason, in most Singapore public hospital, you will need to consult a psychiatrist before you can be referred to a psychologist or a counsellor for therapy. The psychiatrist is responsible for making the diagnosis and to decide on the treatment plans for you. Only a medically trained doctor can order blood tests or prescribe medications.

For the best outcomes in treatment, a multi-pronged biological-psychological and social approach is recommended. Hence, when considering private care treatment, it is important to remember that a psychiatrist is in the unique position to provide holistic and comprehensive care:

  • Exclude other medical problems
  • Diagnose your condition
  • Prescribe the appropriate medication /  biological therapy
  • Address psychological issues and perform psychological therapy
  • Advise on lifestyle changes