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,
Showing posts with label mental illness. Show all posts
Showing posts with label mental illness. Show all posts
Thursday, 11 February 2016
Thursday, 28 January 2016
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.
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.
Thursday, 21 January 2016
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.
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.
Wednesday, 11 December 2013
"My Son is Mentally Ill", So Listen Up
I will like to share this article on a mother's struggle with her son's mental illness. Click here.
Today, many sufferers with psychiatric conditions continue to suffer in silence due to the misconceptions and stigma surrounding mental illnesses. Seeking early treatment will help to better the prognosis and outcomes of psychological conditions. Remember, mental illnesses are just like any other medical conditions.
Today, many sufferers with psychiatric conditions continue to suffer in silence due to the misconceptions and stigma surrounding mental illnesses. Seeking early treatment will help to better the prognosis and outcomes of psychological conditions. Remember, mental illnesses are just like any other medical conditions.
Friday, 26 July 2013
ADHD in Children: FAQ Part 1
These are some questions about ADHD readers posted to me. Hope they are of help to both parents and children with ADHD.
- Typically at what age does ADHD surfaces?
Parents will notice ADHD symptoms in their children before the age of 7. Typically, the symptoms become more pronounced once the children go to preschool where they are required to sit through lessons especially when compared to other kids.
- In Singapore, what age is ADHD diagnosed?
In Singapore, ADHD is only diagnosed when the children are at least 6 years of age. Typically most children with ADHD are picked up in lower primary school from 7 years old to 9 years old.
- How do ADHD children behave and what is it about this disorder that causes them to behave in this way?
ADHD children have two main types of symptoms and behaviour, i.e. the inattentive and hyperactive-impulsive types. Most have both types of symptoms.
When kids have Inattentive type symptoms, they have difficulty in paying attention, they make careless mistakes in school, have inability to stay in or to complete tasks and activities, appear not listening to and not follow instructions, they are disorganised and lose things like toys and stationaries easily and are distractible and forgetful.
Hyperactive-impulsive type symptoms include being fidgety, restless and have difficulty staying seated, excessive running and climbing, being always on the "go" and inability to play quietly, talking excessively and blurting out answers before hearing full questions and tendency to disrupt or interrupt activities like classes and will cut queues.
It is however pertinent to note that ADHD children can concentrate if they find something interesting but their symptoms are particularly pronounced when they are bored.
The causes of ADHD are not fully understood. We know that ADHD is hereditary and environmental toxins have also been implicated. In children with ADHD, executive functions which are the processes involving planning, working planning, memory and inhibition and initiation and monitoring of actions are affected.
- When a child has ADHD, what aspects of the child and his/her parents' life is affected ?
ADHD has far reaching consequences for the children and their parents. It impacts not only the child, but also parents and siblings, causing disturbances to family and marital functioning of the parents.
When untreated, ADHD children are found to perform much worse than their peers in school academically. They are seen as different by their classmates and have difficulties making friends and are not invited to social events like parties. Parents are stressed up coping with their behaviour and this often leads to tension between parents. As much more attention is needed for the ADHD child, their siblings are neglected. As a result, family relationships may be severely strained, and in some cases break down, bringing additional social and financial difficulties.
Monday, 13 May 2013
Postpartum Depression
In a study published in March this year in JAMA Psychiatry, 1,396 of 10,000 mothers screened positively for postpartum depression on the Edinburgh Postnatal Depression Scale (EPDS). This study sponsored by the publicly funded National Institute of Mental Health in the US shows that depression after childbirth is a significant problem. Unfortunately, postpartum depression remains underidentified and undertreated. Some of the following are common myths about Postpartum Depression.
Postpartum Depression (PPD) is the same as baby blues.
Unlike baby blues that goes away after a few days, postpartum depression lasts for weeks to months. The symptoms of PPD is the same as for a Major Depressive Episode.
PDD is normal and ok to be sad after having a baby.
Whilst changes in mood may be normal after birth, if they are prolonged or are affecting your ability to care for your child, you should seek medical attention. If left treated, PDD can lead to:
1) Inconsistent and poor childcare
2) Avoidant or venting type of coping strategies with child
3) Insecure attachment between mother and child (may result in anxiety and depression of the child in later life)
4) Risk and danger if mother becomes agitated or suicidal with depression
PDD occurs right after birth.
It can occur right after birth or even up to a year later. Most of the time it occurs within three months.
Treatment for PDD will prevent me from breastfeeding and harm my baby.
Effective treatment is available for PDD. Antidepressants safe for pregnancy can be used to treat PDD after the risks and benefits have been discussed. Psychological therapy with techniques such as CBT is also useful.
It is unfortunate that PDD often goes unrecognised leading to tragedies such as these. Seek help today as PDD can be treated!
Postpartum Depression (PPD) is the same as baby blues.
Unlike baby blues that goes away after a few days, postpartum depression lasts for weeks to months. The symptoms of PPD is the same as for a Major Depressive Episode.
PDD is normal and ok to be sad after having a baby.
Whilst changes in mood may be normal after birth, if they are prolonged or are affecting your ability to care for your child, you should seek medical attention. If left treated, PDD can lead to:
1) Inconsistent and poor childcare
2) Avoidant or venting type of coping strategies with child
3) Insecure attachment between mother and child (may result in anxiety and depression of the child in later life)
4) Risk and danger if mother becomes agitated or suicidal with depression
PDD occurs right after birth.
It can occur right after birth or even up to a year later. Most of the time it occurs within three months.
Treatment for PDD will prevent me from breastfeeding and harm my baby.
Effective treatment is available for PDD. Antidepressants safe for pregnancy can be used to treat PDD after the risks and benefits have been discussed. Psychological therapy with techniques such as CBT is also useful.
It is unfortunate that PDD often goes unrecognised leading to tragedies such as these. Seek help today as PDD can be treated!
Wednesday, 10 April 2013
The Myths About Antidepressants
Antidepressants are the mainstay of treatment for clinical depression and anxiety disorders. These medications are effective and safe for the general population. However, many remain skeptical about antidepressant treatment and many myths remains.
1. I will become reliant on antidepressants and be addicted.
This is one of the main concern that my patients have when they have to be started on an antidepressant medication. It is important to realise that unlike sleeping pills, it is not possible to be addicted to antidepressants. Antidepressants do not cause tolerance or cravings like street drugs do. The fact that there are no street values with antidepressants attest to the fact that they are not addictive. However, if a patient is on high doses of antidepressants for a long time, it is best for him or her to seek the advice of the psychiatrist and not stop medication abruptly as this can cause "discontinuation syndrome". Discontinuation syndrome can lead to physical discomfort and can be completely avoided by weaning off the medication slowly in a few weeks.
2. My condition will become worse that when it started if I stop the medications.
Your condition will not worsen or rebound simply because you stop your medication. Antidepressants treats your depression or anxiety and also protects you from future episodes. If you stop the medication, it is like you taking off your armour. You will be vulnerable to depression or anxiety again.
3. Antidepressants have terrible side effects.
Newer classes of antidepressants like SSRIs are currently the mainstay of treatment. Unlike older antidepressants, these newer medications are well tolerated. At times, side effects can still occur to the minority of people. Known side effects include weight gain, sedation and rarely sexual dysfunction. These side effects are reversible and if any these side effects arises, you must inform your doctor who will switch you to another medication.
4. My brain will be affected by the medications!
Sometimes patients worry that they will be "changed" by the medications and their brain will become different. Antidepressants normalises the neurotransmitters in your brain and this in turn makes your mood normal again. Antidepressants are not "happy"pills. They help by making you cope better so that you can solve the problems you have in life and it is up to you to find new meaning and happiness.
5. I'll have to take medications forever!
Many patients are afraid that once they are on medications, they cannot come off it. Majority of patients will become better once they have been treated and will come off medications. Some patients who have multiple episodes of mood or anxiety problems and may decide to stay on the medications long term. Your doctor will discuss with you the pros and cons of taking medications and how long you will require them. Ultimately, you have the choice of whether to take medications and the choice to stop them.
1. I will become reliant on antidepressants and be addicted.
This is one of the main concern that my patients have when they have to be started on an antidepressant medication. It is important to realise that unlike sleeping pills, it is not possible to be addicted to antidepressants. Antidepressants do not cause tolerance or cravings like street drugs do. The fact that there are no street values with antidepressants attest to the fact that they are not addictive. However, if a patient is on high doses of antidepressants for a long time, it is best for him or her to seek the advice of the psychiatrist and not stop medication abruptly as this can cause "discontinuation syndrome". Discontinuation syndrome can lead to physical discomfort and can be completely avoided by weaning off the medication slowly in a few weeks.
2. My condition will become worse that when it started if I stop the medications.
Your condition will not worsen or rebound simply because you stop your medication. Antidepressants treats your depression or anxiety and also protects you from future episodes. If you stop the medication, it is like you taking off your armour. You will be vulnerable to depression or anxiety again.
3. Antidepressants have terrible side effects.
Newer classes of antidepressants like SSRIs are currently the mainstay of treatment. Unlike older antidepressants, these newer medications are well tolerated. At times, side effects can still occur to the minority of people. Known side effects include weight gain, sedation and rarely sexual dysfunction. These side effects are reversible and if any these side effects arises, you must inform your doctor who will switch you to another medication.
4. My brain will be affected by the medications!
Sometimes patients worry that they will be "changed" by the medications and their brain will become different. Antidepressants normalises the neurotransmitters in your brain and this in turn makes your mood normal again. Antidepressants are not "happy"pills. They help by making you cope better so that you can solve the problems you have in life and it is up to you to find new meaning and happiness.
5. I'll have to take medications forever!
Many patients are afraid that once they are on medications, they cannot come off it. Majority of patients will become better once they have been treated and will come off medications. Some patients who have multiple episodes of mood or anxiety problems and may decide to stay on the medications long term. Your doctor will discuss with you the pros and cons of taking medications and how long you will require them. Ultimately, you have the choice of whether to take medications and the choice to stop them.
Friday, 22 March 2013
ADHD Increases Risk of Mental Illness in Adulthood
A 20 year long study conducted by Mayo Clinic published recently showed that not only did symptoms of ADHD persist into adulthood, children with ADHD were also much more likely to be diagnosed with other psychiatric illnesses as adults.
In this study, the researchers followed a cohort of 5718 children born between 1976 and 1982. Within the cohort, 367 were diagnosed with ADHD and 75% received treatment for ADHD as children. 29.3% of the children with ADHD were later found to still have the disorder in adulthood and within this group of children, 81% had at least one other psychiatric condition. The concomitant conditions they had included major depression, generalized anxiety, hypomanic episodes, substance abuse and antisocial personality disorder. Also 57% of all children with ADHD had another psychiatric disorder as adults compared to 35% in the control group. The study also showed that suicide rate amongst ADHD children was five times higher than those without the disorder.
These data are no doubt disturbing and brings to the table stronger evidence to what doctors and psychiatrists have long suspected and observed anecdotally about ADHD. The evidences indicate that ADHD is an illness with serious consequences, morbidity and mortality. Starting treatment young will help the children cope with the hyperactive, inattentive and impulsive symptoms, preventing the eventual pathways leading to other serious mental illnesses, personality disorders and suicide. Treatment into adulthood is often necessary and doctors must be vigilant in assessing and picking up co-morbid psychiatric illnesses.
ADHD is by far the most common neuro-developmental condition in children. It should not be trivialised and ignored as it progresses into long term difficulties for the individual. Seek help today!
In this study, the researchers followed a cohort of 5718 children born between 1976 and 1982. Within the cohort, 367 were diagnosed with ADHD and 75% received treatment for ADHD as children. 29.3% of the children with ADHD were later found to still have the disorder in adulthood and within this group of children, 81% had at least one other psychiatric condition. The concomitant conditions they had included major depression, generalized anxiety, hypomanic episodes, substance abuse and antisocial personality disorder. Also 57% of all children with ADHD had another psychiatric disorder as adults compared to 35% in the control group. The study also showed that suicide rate amongst ADHD children was five times higher than those without the disorder.
These data are no doubt disturbing and brings to the table stronger evidence to what doctors and psychiatrists have long suspected and observed anecdotally about ADHD. The evidences indicate that ADHD is an illness with serious consequences, morbidity and mortality. Starting treatment young will help the children cope with the hyperactive, inattentive and impulsive symptoms, preventing the eventual pathways leading to other serious mental illnesses, personality disorders and suicide. Treatment into adulthood is often necessary and doctors must be vigilant in assessing and picking up co-morbid psychiatric illnesses.
ADHD is by far the most common neuro-developmental condition in children. It should not be trivialised and ignored as it progresses into long term difficulties for the individual. Seek help today!
Wednesday, 9 January 2013
Most adolescent suicidal behavior preceded by mental health treatment
A recent research(1) showed that the lifetime prevalence of suicide ideation among adolescents was 12.1%,
suicide plans 4%, and suicide attempts 4.1%. One-third of adolescents
with suicidal ideation went
on to develop a suicide plan and 33.9% made an attempt. Most
adolescents (88.4%) who transitioned from planning suicide to attempting
suicide did so within a year.
Most adolescents who had suicidal ideation (89.3%) and attempted suicide (96.1%) met lifetime criteria for at least one DSM-IV mental disorder, which included major depressive disorder, specific phobia, oppositional defiant disorder, substance abuse, intermittent explosive disorder and conduct disorder. Most disorders significantly predicted suicidal behaviors, and the prevalence of mental disorders generally increased with the increasing severity of suicidal behaviors.
From this study, we can see that it is important to identify and provide early treatment for these troubled youths. Unlike physical illnesses, parents tend to ignore mental health issues and to believe that such problems will go away by themselves. Otherwise, they may feel that seeking help from a mental health professional is too stigmatising and may do more harm to their children.
Such ignorance, often lead to delay in seeking treatment and may result in the youths and parents defaulting follow-ups. Today, suicidal behaviors are among the leading causes of death in Singapore and worldwide, especially among adolescents and young adults. Seek help early and contact a psychiatric clinic in Singapore.
(1) Prevalence, Correlates, and Treatment of Lifetime Suicidal Behavior Among Adolescents Results From the National Comorbidity Survey Replication Adolescent Supplement
Matthew K. Nock, PhD; Jennifer Greif Green, PhD; Irving Hwang, MA; Katie A. McLaughlin, PhD; Nancy A. Sampson, BA; Alan M. Zaslavsky, PhD; Ronald C. Kessler, PhD
JAMA Psychiatry. 2013;():1-11. doi:10.1001/2013.jamapsychiatry.55
Most adolescents who had suicidal ideation (89.3%) and attempted suicide (96.1%) met lifetime criteria for at least one DSM-IV mental disorder, which included major depressive disorder, specific phobia, oppositional defiant disorder, substance abuse, intermittent explosive disorder and conduct disorder. Most disorders significantly predicted suicidal behaviors, and the prevalence of mental disorders generally increased with the increasing severity of suicidal behaviors.
From this study, we can see that it is important to identify and provide early treatment for these troubled youths. Unlike physical illnesses, parents tend to ignore mental health issues and to believe that such problems will go away by themselves. Otherwise, they may feel that seeking help from a mental health professional is too stigmatising and may do more harm to their children.
Such ignorance, often lead to delay in seeking treatment and may result in the youths and parents defaulting follow-ups. Today, suicidal behaviors are among the leading causes of death in Singapore and worldwide, especially among adolescents and young adults. Seek help early and contact a psychiatric clinic in Singapore.
(1) Prevalence, Correlates, and Treatment of Lifetime Suicidal Behavior Among Adolescents Results From the National Comorbidity Survey Replication Adolescent Supplement
Matthew K. Nock, PhD; Jennifer Greif Green, PhD; Irving Hwang, MA; Katie A. McLaughlin, PhD; Nancy A. Sampson, BA; Alan M. Zaslavsky, PhD; Ronald C. Kessler, PhD
JAMA Psychiatry. 2013;():1-11. doi:10.1001/2013.jamapsychiatry.55
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.
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.
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
Why see a Doctor for Depression?
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.
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.
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.
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