Question of the Week (31st August 2016)

From your expert perspective, at what age is it deemed OK for parents to leave their child at home alone?

It is difficult to define a specific age as children vary in their development and maturity. Pre-schoolers and those under 10 years of age must not be allowed to stay alone at home. Beyond ten, it becomes controversial. In the legislation of some foreign jurisdiction, children up to 15 years old are not allowed to stay at home. As each child is different, it will be best for parents to understand their child's temperament, maturity level and his or her propensity towards being impulsive to determine if their child can be safely left alone at home. 

If a child has to be left alone for any period of time, what tips do you recommend to parents in order for them to keep their child safe?

Firstly, never take safety for granted. Look into safety features such as locking the window grilles. Also, make sure that you are contactable so that the child can reach you immediately if he becomes frightened or has any needs. Having a good relationship with your neighbours will be important as they can sometimes keep a look out for you and the child can also approach them should any emergencies or needs arise.

Post Natal Depression, Q and A. Part 2

Q3: Often, men (dads) seemed to be neglected in the equation of achieving parenting (psycho-emotional) wellness. Why is that so – is it true that they are less susceptible to post-natal and parenting blues?

Post-natal blues by definition pertains only to mums. However, while less likely than mums, dads are vulnerable to parenting blues or even depression. In general, due to societal expectations, the responsibility of child care and parenting still falls on mums. We have tax relief to help working mothers and much longer maternity leave and this is testament that mothers are expected and more likely to sacrifice their careers to care for their child. 

In most circumstances, it is natural that the child forms a much stronger attachment to mums than dads because of the child birth process and breast feeding. As such, the stress and responsibilities that falls on a father is much less. However, societal expectations are shifting. These days, the demands for a dad's involvement in child care and parenting is increasing and we are seeing more fathers who are finding it stressful and having difficulties balancing work and child care, and consequently getting blue.

Q4: Lastly, what can parents do to alleviate fears and anxiety? Is the attitudinal approach the best way to prevent it? Any tips?

As a society, we may want to be more cognizant of the difficulties new parents may face, particularly in this age of small nuclear family with little or no support from extended family. Much has been done to alleviate the financial aspects, as well as to provide longer maternity and paternity leave.I believe as a society we can still do more to educate and support parents. 

Other than attitudinal change, maintaining healthy family dynamics and a strong couplehood will improve support to the parent, allow them to talk about their fears and anxiety and prevent feelings of isolation. Mum and Dad must continue to spend time with each other and go "pak tor". Improving parental relationship will help with improving the care of the child and there is no need to feel guilty for leaving the child behind. Mum and Dad must also have their alone time so that they can have time of the stress of care and continue with their hobbies and meeting up with peers. The other spouse must recognise the need for alone time and not begrudge the other party but instead take turns to do so while the other cares for the child. Commonsensically, parents do need to sleep well, eat healthily, exercise and manage the stress from their career in order to keep these fears and anxiety at bay.

If the blues, anxiety and fears are serious, in that they affect the parent's ability to care for the child or to work, he or she should seek professional help and treatment Postnatal depression and Anxiety disorders can be effectively treated with medications and therapy. Denial of the conditions and leaving them alone can have dire consequences.

Post Natal Depression, Q and A. Part 1

Q1: Why do parents suffer from parenting fears, post-natal or parenting blues?

As with most psychological conditions, exact causes are not known. However, we can understand the reasons from biological, psychological and social cultural factors. Some individuals may be genetically vulnerable to having these conditions and there may be a family history. 

After pregnancy, there is also a fluctuation in female hormones which results in a risk of post natal; blues and even depression in mothers.

 Psychologically, parents may not be prepared for the stress of a new child. There may be a discrepancy between their expectations and reality and only realise that caring for a newborn may not be as easy as it seems, leading to feelings of incompetency, fear and low mood. If the newborn has a difficult temperament, parents may have an even harder time to cope resulting in further stress. 

Socio-culturally, especially in present days of having one to two children and every child is precious, there can be a lot of pressure from spouse, in-laws and grandparents to be overly protective to the child and to give the child the best. Conversely, lack of support and marital dysfunction can also lead to fears and blues.

Q2: Stress and anxiety from caring for infant is often identified as the culprit for post-natal depression. To what extent is this true? How can parents adjust expectations and would that help to alleviate post-natal depression?

Stress and anxiety are definitely symptoms which may indicate that there is an increase in the possibility that the mother may be or will be having post-natal depression. It is more pertinent to address the psychosocial issues that are causing these stress and anxiety. 

It is sometimes not only  the parents, but also those around them and even media portrayal that leads to difficult expectations. For example, many mothers have the stress of having to breastfeed there newborn perfectly and feel guilty when they are unable to due to physical reasons. The intense guilt then leads to depression. 

It will be helpful if would be parents are exposed to and educated about the potential difficulties that they may face. Most parents will give their best when caring for their child, and there is no need for perfection or comparison with others. Support and reassurance from spouse and family members are equally important.

Question of the Week (13 August 2016)

Question: Please share your opinion on the psychological benefits that spending in the outdoors can give to - babies, toddler, children and the family.

For children, even at an infant stage, playing is the main way of which they learn social interactions and other skills necessary for normal development. Outdoor activities are an important aspect of play. Outdoor activities allow for the possibility of playing in a large group and enhances the child's social skills and ability to work in a team. Ability to work and to get along with others is a crucial predictor or success in the future. Playing together also enhances the relationships of the family.

Outdoor activities also helps by allowing the child to use the whole of his body during play and this trains coordination, balance and spatial sense. Acquiring these skills and becoming physically stronger and healthier from sports and outdoor activities help a child feel more confident and increases his overall sense of wellbeing.

Getting sunshine outdoors is beneficial too. Getting adequate sunshine helps to regulate the circadian rhythm of our body and allows for better sleep at night and wakefulness in the day. Sunshine is also a natural antidepressant and brings about a positive mindset. Just be sure to drink adequate amount of water and put on your sunblock!

Bipolar Disorder FAQs Part 3

8. What new treatments/ medications are currently available for this group of patients, and how do the medications work to help patients alleviate symptoms? I read a new study which say that antidepressants may in fact, worsen episodes of mania in this group of patients. See link. What is your take on this?

The main stay of treatment for Bipolar Disorder are mood stabilisers which include medications such as Lithium, Sodium Valproate and Lamotrigine. Antipsychotic medications have been shown to have mood stabilising properties as well and are often used in Bipolar Treatment. Antidepressants can be used in the depressive phase of the Bipolar illness but must be used with caution as they may trigger a manic episode. Many a times, multiple medications may be needed to stabilise the high and low episodes that a Bipolar patient encounters. After the mood has been stabilised and the patient is well, he and his loved ones should be educated about the illness process and prevention strategies. Therapy such as social rhythm therapy, a type of behavioral therapy used to treat the disruption in circadian rhythms that is related to bipolar disorder, is beneficial.

9. What are the chances of a remission with treatment? Possible for patients to lead a normal and fulfilling life?

Although we still do not have a cure, Bipolar Disorder is a very treatable illness. Chances of remission is remarkably high at 80% with treatment and most patients return to where they are in their lives before the mood episodes. Most patients with Bipolar Disorder will require long term treatment and it is important for them to remain on treatment when the illness goes into remission as those who are compliant to their treatment are much less likely to experience a relapse.

10.  Can someone having  manic episodes manifest aggressive or unusual behaviours that may warrant hospital admission?

Patients can become aggressive and even physically violent during episodes of mania. They may pick fights over small day to day issues with their family members and this can escalate to physical altercations needing police intervention and admission to a hospital to keep the patient safe. Some patients develop grandiose delusions thinking they are important people and may become paranoid that others want to harm them. They can become aggressive and violent towards the perceived perpetrators. There have been instances where patients think they have special power,

Bipolar Disorder FAQs Part 2

 4. Some women experience mood swings, for instance, during certain times of their menstrual cycle. When are "mood swings" not considered normal, and may warrant medical attention?

 Many women may notice that they have dysphoric or irritable mood before and during their period, These mood changes are often described as mood swings. These mood swings are generally unrelated to Bipolar Disorder as there is no swing into a manic state. However, if the individual experiences irritability, tension or low mood severe enough to interfere with work, social relationships and activities, they may be suffering from Premenstrual Dysphoric Disorder (PMDD).

 5. A local 2010 Singapore Mental Health Study found that the average time taken for bipolar disorder sufferers to seek help was 9 years. - Why do you think they take so long to seek professional help?

When the symptoms of Bipolar disorder is mild, it can be hard to detect. Most of the time, the afflicted individual may not have insight into their symptoms. In fact, many enjoy their "new found" confidence and inflated self esteem. Family members may think that the individual is just stressed out or being difficult instead of recognising the symptoms as due to Bipolar Disorder. The strong stigma that remains associated with psychological conditions also prevents individuals and there loved ones from seeking help with professionals until the condition becomes severe.

6. Based on your experience working with these patients, what usually prompts patients to seek medical attention for their symptoms?

Many seek help during their depressive phase, when they feel lousy about themselves. and through careful history taking with the patient and their loved ones, a history of previous manic episodes can be obtained. Many patients may be admitted by their loved ones to the hospital when they display unusual behaviours or become aggressive during their manic episodes.

7. How common is it for bipolar disorder to go undetected, or dismissed as something not serious? Why is that so?

 Although there are no available data, Bipolar Disorder is one of the most likely diagnosis to go undetected. Unlike many medical condition where lab tests or objective testing is available in making a diagnosis, the diagnosis of Bipolar Disorder can only be based on the history provided by the patient and his loved ones and observations made by the psychiatrist during the consult. In milder case of Bipolar Disorder where the individuals present with issues such as irritability, restlessness, insomnia, and excessive alcohol consumption. For someone who does not know the individual intimately, the mood changes may be assumed to be normal. Even loved ones may sometimes find it hard to decide if the individual's mood is unusually high or he is an exuberant person to begin with. They may see the change as a change in his personality rather than him having a mental illness.

Bipolar Disorder FAQs Part 1

1. At what age does bipolar disorder typically surface, and why?

 It typically surfaces during early adulthood, usually in the 20s. This is attributed to the natural history of the illness and the real reason is not known.

2. What are symptoms of bipolar disorder, and how are they different from depression? (I understand that bipolar patients experience periods of low moods too, so how to differentiate between the two?) 

Patients with Bipolar suffers from episodes of mania or hypomania and depression. The depressive episodes of Bipolar Disorder are indistinguishable from clinical depression. As such patients who have depressive episodes are first diagnosed with clinical depression and the diagnosis will be revised should an episode of mania or hypomania surface. The symptoms of mania are elevated mood, increased energy, increased self esteem, decreased need for sleep, pressure to keep talking or unusual talkativeness, racing thoughts, distractibility, excessive involvement in harmful activities. The symptoms should last for at least one week. In Hypomania, the symptoms are milder and the duration may be shorter.

3. How quickly can a bipolar patient's mood swing from one extreme to another? What are the triggers for the mood changes? 

 Most bipolar disorder consists of mood episodes, depressive or manic, that typically last weeks to months if not treated. A typical example will be one month of mania followed by three months of depression and the rest of the year is normal mood. However, there are patients who suffer rapid cycling bipolar disorder who cycle four times of more a year. Whilst some patients are thought to cycle even more frequently than that, ie. days to even within a day, this remains controversial. Stresses in life, like work stress or family conflict, can sometimes trigger an episode. Sometimes a period of poor sleep, due to exams or work commitments can also lead to episodes.