Schizophrenia (精神分裂症) in Malaysia ( Petaling Jaya and Kuala Lumpur )

What is Schizophrenia?

Schizophrenia is a serious mental illness and patients experience progressive personality changes and a breakdown in their relationships with the outside world. They have disorganized and abnormal thinking, behaviour and language and become emotionally unresponsive or withdrawn.

Schizophrenia affects people from all over the world. In Malaysia (Petaling Jaya and Kuala Lumpur), high stress levels may trigger the illness. However, there is a strong genetic inheritance in this brain disease.
People who suffer from schizophrenia may have a very broad range of symptoms which can cause great distress to themselves and their families. These symptoms can take many forms including:

a) ‘Positive symptoms’ (abnormal experiences), such as hallucinations (seeing, hearing, feeling something that isn’t actually there), delusions (false and usually strange beliefs) and paranoia (unrealistic fear)

b) ‘Negative symptoms’ (absence of normal behaviour), such as emotional withdrawal, and lack of motivation and enjoyment;

c) Cognitive dysfunction (problems with concentration, learning abilities and memory)

Schizophrenia is now recognised as a severe brain disease that is found all over the world. About 1% of any population will develop schizophrenia during their lifetime. Although schizophrenia affects men and women with equal frequency, the disorder often appears earlier in men, usually in the late teens or early twenties, than in women, who are generally affected in the twenties to early thirties.


The first signs of schizophrenia often appear as confusing, or even shocking, changes in behaviour. People with schizophrenia often go on to suffer terrifying symptoms such as hearing voices not heard by others, or believing that other people are reading their minds, controlling their thoughts, or trying to harm them.

Their speech and behaviour can be so disorganised that they may be incomprehensible or frightening to others.

Coping with the symptoms of schizophrenia can be especially difficult for family members. “Psychosis”, a common condition in schizophrenia, is a
state of mental impairment marked by hallucinations, which are disturbances of sensory perception such as hearing voices and seeing things that others can’t, and delusions, which are strongly held personal beliefs that result from an inability to separate real from unreal experiences.

Living in a world distorted by hallucinations and delusions, individuals with schizophrenia may feel frightened, anxious, and confused. Less obvious symptoms, such as social isolation or withdrawal, or unusual speech, thinking, or behaviour, may precede, be seen along with, or appear later in the course of the illness.

Schizophrenia often affects a person’s ability to “think straight”. Thoughts may come and go rapidly; the person may not be able to concentrate on one thought for very long and may be easily distracted, unable to focus attention. The person may be unable to connect thoughts into logical sequences, with thoughts becoming disorganised and fragmented.

This lack of logical continuity of thought, termed “thought disorder”, can make conversations very difficult and may contribute to social isolation. If people cannot make sense of what an individual is saying, they are likely to become uncomfortable and tend to leave that person alone.

Some people have only one such psychotic episode; others have many episodes during a lifetime, but lead relatively normal lives in between. Yet another group may have a continuous or recurring pattern of illness, and often does not fully recover and typically requires long-term treatment.

Suicide is a serious danger in people who have schizophrenia as approximately 10% to 15% of them (especially younger adult males) commit suicide. If an individual tries to commit suicide or threatens to do so, professional help should be sought immediately.

Due to the frequent, bizarre nature of symptoms, psychosis has frequently been attributed to the supernatural, such as being possessed or charmed, leading family members to seek alternative forms of treatment rather than medical treatment. The delay in medical treatment plays a significant role in the long-term outcome of these patients. The longer the duration of untreated illness, the more difficult it is to treat the patient and results in
more permanent disabilities.

Causes of Schizophrenia

In reality, there is no known single cause of schizophrenia. The old theories that schizophrenia is caused by poor parenting and abnormal interaction within the family have largely been disproved. Many other factors probably interplay with each other to cause the illness.

It has long been known that schizophrenia runs in families. People who have a close relative with schizophrenia are more likely to develop the disorder than are people who have no relatives with the illness. For example, an identical twin of a person with schizophrenia has an almost one in two chance of developing the illness. A child whose parent has schizophrenia has about a one in 10 chance.

By comparison, the risk of schizophrenia in the general population is about one in a 100. It is also likely that the disorder is associated with some imbalance of the complex chemical systems of the brain and abnormalities in brain structure.

The outlook for people with schizophrenia has improved over the last 25 years. The last decade or so has been a time of hope for people with schizophrenia and their families. Research is gradually leading to new and safer medications and unravelling the mysteries behind the causes of the disease.

How serious is Schizophrenia?

Schizophrenia is a serious mental illness but it is not true that people who have schizophrenia are very dangerous – this is rarely the case.

How long does Schizophrenia last? Although schizophrenia is treatable, relapses are common and the illness may never fully resolve.

How is Schizophrenia treated?

Antipsychotic medications have been available since the 1950s and have greatly improved the outlook for patients. These earlier antipsychotic drugs are often very effective in treating certain symptoms of schizophrenia, particularly hallucinations and delusions. Unfortunately, these drugs may not be as helpful with other symptoms, such as reduced motivation and emotional expressiveness. At the same time, these older antipsychotics frequently produce disabling side-effects, which adds to the stigma associated with schizophrenia.

Since 1990, a number of new antipsychotic drugs (the so-called “atypical antipsychotics”) have been introduced and these have revolutionised the treatment of schizophrenia.

These newer medications treat all the symptoms of schizophrenia equally well and at the same time possess a lower propensity to cause the disabling side effects that are associated with the older drugs, allowing patients to stay well, functioning more effectively and appropriately.

The outlook for sufferers has improved greatly in the last few decades and many people can be treated outside hospital and live within the community for most of their lives.

When someone is first diagnosed as suffering from schizophrenia, they are usually treated in hospital, but many people can then have treatment at home, particularly if they have a supportive family.

Treatment includes counselling, social support and rehabilitation.

In addition anti-psychotic medicines are available to treat the worst symptoms of the illness, such as hallucinations, but there is no “cure” at present.

In addition to medical treatment, support from family, friends and healthcare services is also a vital part of therapy.

It is crucial to remember that psychosocial treatment is just as important as medication in treating someone with schizophrenia. Even when patients with schizophrenia are free of psychotic symptoms, many still have difficulty with communication, motivation, self-care, and relationships with others.

Moreover, because patients with schizophrenia frequently become ill during the critical career-forming years of life (for example, ages 18 to 35), they are less likely to complete the training required for skilled work. As a result, many with schizophrenia not only suffer thinking and emotional difficulties, but lack social and work skills and experience as well.

It is with these psychological, social, and occupational problems that psychosocial treatments can help the most. Numerous forms of psychosocial therapy are available, and most focus on improving the patient’s social functioning, whether in the hospital or community, at home, or on the job.

Source : Malaysian Psychiatric Association

Bipolar Disorder (躁郁症) in Malaysia ( Petaling Jaya and Kuala Lumpur )

Bipolar Disorder

What is bipolar disorder?

In Petaling Jaya and Kuala Lumpur (Malaysia) , Bipolar is often misdiagnosed as depression. Besides, some family member may bring the patients for traditional treatment because they suspected that the patient is being possessed during a manic phase.
Bipolar disorder, also known as “manic-depressive illness”, is a brain disease that causes people to have unusual shifts in their mood, energy and ability to function. These mood shifts are very different from the normal ups and downs that everyone goes through; the shifts of the person with bipolar disorder are so severe that they impair the person’s thinking and judgement, resulting in relationships problems, poor work and school performance and even causing them to harm themselves.

This sounds rather frightening, but there is good news behind all these clouds of gloom. The disease can be treated and people with bipolar disorder can live full and productive lives.

People with this illness switch from feeling overly happy and joyful (or irritable) to feeling very sad. Because of the highs and the lows – or two poles of mood – the condition is referred to as “bipolar” disorder or manic depressive illness. In between the mood swings, a person may experience normal moods.

Most individuals with bipolar disorder spend more time in depressed phases than in manic phases. Bipolar disorder causes dramatic and rapid changes in mood swings, from highs to lows that do not follow a set pattern, and depression does not always follow manic phases.

A person may also experience the same mood state several times before suddenly experiencing the opposite mood. Mood swings can happen over a period of weeks, months, and sometimes even years. The severity of the depressive and manic phases can differ from person to person, and in the same person at different times.

The features of a person with mania (“the highs”) include excessive happiness, hopefulness, and excitement, sudden changes from being joyful to being irritable, angry, and hostile, restlessness, talking very fast and loudly, poor concentration, feeling full of energy, less need for sleep, making grand and unattainable plans, tendency to show poor judgment, such as deciding to quit a job and abusing drugs and alcohol.

Some people with bipolar disorder can become psychotic – seeing and hearing things that aren’t there and holding false beliefs from which they cannot be swayed. In some instances they see themselves as having
superhuman skills and powers, or think they are god-like.

A milder form of the “highs” is called “hypomania”. The person with hypomania may feel good and may even be functioning better, but without proper treatment, such hypomanic swings can become severe and can even switch to depression.

During the depressive periods, a person with bipolar disorder may experience feelings of sadness, feeling tired easily, feelings of hopelessness or worthlessness, losing the ability to enjoy things that were once pleasurable, difficulty concentrating, sleep problems, appetite changes and having thoughts of death and suicide.

At this juncture, it is important for families, relatives and friends of people with bipolar disorder to be aware that the illness can strike from two sides, like a “double-edged sword”.

For example, let’s take a physical illness we’ve all had. When we come down with the flu, a host of new, unwanted symptoms (fever, headache) well up and engulf the healthy self. At the same time, we are drained by symptoms which take away personal resources we’ve always depended upon (energy, will, drive to keep going, etc.). The more severe the illness, the more our healthy self is overwhelmed and the more our dependable, resourceful self is diminished.

Also, we have no control over the severity of symptoms that attack us, and during the period we are ill, it’s almost impossible to summon up our dependable responses.

Mental illnesses are no different, except that because they are disorders of the brain, many symptoms of the illness are expressed as complex behaviours instead. When the person with bipolar disorder is affected by his or her symptoms, a host of unfamiliar, unwanted behaviours appear that were never part of the personality; at the same time, many of the resourceful attributes are taken away.

It is important then to understand which added behaviours and diminished responses occur in the person’s illness, which may look to be under his/her control, but are not. This will help us to separate the person from the illness.
According to best estimates, about 1% of the population suffers from bipolar disorder ie there are about 250,000 people with bipolar disorder in the country. Bipolar disorder usually begins in early adulthood, appearing before age 35. Children and adolescents, however, can develop this disease in more severe forms.

Causes of Bipolar Disorder

A definite cause for bipolar disorder is difficult to determine but include genetics, changes in the brain, and environmental factors like stress and major life changes. More research is being done to determine the relationship between these factors and the disorder and how they may help prevent its onset, and what role they may play in its treatment.


A diagnosis of bipolar disorder is made after taking careful note of the symptoms, how they affect the person, how long and how often these symptoms had occurred. The most telling symptoms include severe mood swings (going from extreme highs to extreme lows) that don’t follow a set pattern. Getting further information from close friends and family is often very helpful to distinguish bipolar disorder.

If you or someone you know is experiencing symptoms of bipolar disorder, seek the advice of a doctor or a psychiatrist. The person would require urgent assessment and possibly treatment.

In Malaysia, assessment and treatment services for people with bipolar disorder are available at most government health clinics and private clinics, but in most cases, a more detailed assessment may be required by a psychiatrist.

How serious is bipolar disorder? Bipolar disorder is a long-term illness that requires management throughout a person’s life. People who have numerous (four or more) episodes of mood changes in a year can be much more difficult to treat.

How long does bipolar disorder last?

Bipolar disorder can be an enduring or recurring condition and is a lifelong illness.

How is bipolar disorder treated?

a) There are many treatments available for bipolar disorder, including counselling and medicines, but the first step is always to see a doctor who can accurately diagnose the condition. While general practitioners (family doctors) can sometimes diagnose bipolar disorder, it is preferable that patients exhibiting symptoms of bipolar disorder be evaluated by a psychiatrist.

b) Most patients require the simultaneous use of a combination of medicines to treat not only mood symptoms but also to prevent switching from periods of mania to periods of depression, or vice versa (mood swings). These medications in combination are designed to alleviate depression, control the symptoms of mania and prevent mood swings.

c) A good treatment programme for people with bipolar disorder include making sure that the medications given are in the right amounts and given for an adequate period of time, educating the family, friends and relatives of the person, educating the person about the illness and techniques in self-management, especially identifying early warning signs and making sure that the affected person continues with his education or work with support from the family and the mental health treatment team.

d) With such a treatment programme, the person’s mood can be stabilised. Treatment that is continual has been proven more effective in preventing relapses and controlling the frequent mood changes in people with bipolar disorder. Those who also have a substance abuse problem may need more specialised treatment.


There is no known way to prevent bipolar disorder. Because its exact cause has not yet been determined, it is especially important to know its symptoms and seek early intervention. Some people who experience bipolar disorder may become suicidal. By knowing how to recognise the symptoms, there is a better chance for effective treatment and finding coping methods that may prevent long periods of illness, extended hospital stays, and suicide.
Source : Malaysian Psychiatric Association

Anxiety Disorder (焦虑症) in Malaysia ( Petaling Jaya and Kuala Lumpur )

What is Anxiety Disorders

Anxiety disorders are a group of neurotic disorders where the main focus of the problem is excessive or uncontrolled worry.

Anxiety disorder is very common. A rough estimate is that all the anxiety disorders together may affect up to 25% to 30% of the population. For panic disorder, the estimate is up to 5%, with women outnumbering men by two to three times. They most commonly develop in early adulthood, with a mean age of presentation about 25 years old, but the disorder can develop at any age. They have been reported in children and adolescents and are probably being under-reported in this age group. Most of them also suffer from depression as a result of severe symptoms and continuing fear and apprehension.

In Malaysia, especially bigger cities such as Petaling Jaya, Kuala Lumpur, Georgetown, Johor Bahru, the rates of anxiety is higher than the smaller cities due to the higher stress level and smaller social support.

Many theories have been postulated for anxiety disorders but the current belief is that it is a combination of biological and psychological changes. The patient probably inherits a gene that predisposes him to the disorder. Almost 50% of e.g. panic disorder patients have parents with the same disorder.

Many researches have also indicated that such patients have biases or abnormalities in their cognitive processing compared to normal subjects. Whether these abnormalities may cause abnormal levels of neurotransmitters in the brain or is a result of them is still debatable, but abnormal levels of neurotransmitters have been established in most patients.

Anxiety is a commonly experiences symptom. Most of us feel anxious and tense in the face of threatening or stressful situations. Such feelings are normal reactions to stress thus anxiety is an alerting signal; it warns of impending danger and enables the person to take measures to deal with a threat.

Anxiety is considered abnormal when they;
Are abnormally severe or prolonged
Occur in the absence of stressful circumstances.
Associated with impaired physical, social or occupational functioning.

Anxiety disorders include a group of disorders in which anxiety is the main symptom.

Below are some anxiety disorders:

Generalised Anxiety Disorders

This means persistent and overblown worry about two or more things, without good reason. It is characterised by unrealistic or excessive anxiety about various everyday circumstances, fear of negative evaluation by others and worries about physical health.

Phobias These are unrealistic fears of certain objects or situations. Examples include simple phobias, such as fear of snakes; social phobiasm such as fear of meeting new people; and agoraphobia, such as being afraid to go outside alone.

Panic Disorders Characterised by a sidden and unexpected sense of terror, and feelings of approaching death. Accompanying physical signs include rapid pulse, nausea and shallow breathing.

Obsessive-Compulsive Disorders Repeated, unwanted thoughts (ruminations) or compulsive behaviours (rituals). Obsessions mean persistent, senseless ideas, such as continual fear of contamination or illness. Examples of compulsions include repetitive cleaning, checking or counting.

Symptoms of Common Anxiety Disorders

a) Worry or fear that something bad will happen
b) Trembling, twitching or feeling shaky
c) Fatigue or restlessness
d) Muscle tension or jitteriness
e) Feeling dizzy or lightheaded – faintness
f) Fast heartbeat or breathing rate
g) Sweatning, or cold and clammy hands

h) Dry mouth, nausea, vomiting or diarrhea
i) Irritability, impatience, easily distracted
j) Shortness of breath – breathlessness- difficulty breathing
k) Difficulty swallowing
l) Sharp pains in the chest or chest discomfort
m) Abdominal pain – stomach pain
n) Hot or cold flashes
o) Fears of losing control, dying or “going crazy”

Some anxiety symptoms may occur in anyone experiencing a difficult situation. The difference between such “normal” anxiety and an anxiety disorder is that the anxiety disorder’s overwhelming tensions happen even when there is no real danger. People with an anxiety disorder may often take extreme actions to avoid the source of their anxiety.

If several of the above symptoms seems clearly associated with a specific situation or object, and persist over time, you may need to seek help from a doctor.

Source : Malaysian Psychiatric Association

Depression (忧郁症) in Malaysia ( Petaling Jaya and Kuala Lumpur )

Depression(忧郁症) : symptoms and treatment

Depression is a common illness. It is more common than hypertension or diabetes. The lifetime occurrence of depression in any country is between 8% to 10%. Contrary to common belief it is not an illness of developed countries alone. It occurs in developing countries like ours just as commonly as in other countries. The World Health Organization and the World Bank studied the disability that diseases bring and found that Depression is the fourth most disabling disease in the world. It is predicted that in 2020 it will rise to being the second most disabling disease. The World Health Organization also estimates that more people die from suicide than from Tuberculosis deaths in the Asia Pacific region. The most common cause for death by suicide is Depression.

In Malaysia, the rate of depression is often lower than other developed countries, due to under-reporting.

In Petaling Jaya and Kuala Lumpur, the rates of depression is higher than the smaller cities due to the higher stress level and smaller social support

There are numerous direct and indirect costs that are lost due to depression. These costs include costs due to inability to work, health utilization costs and cost to families who have to look after and support their family members suffering depression. Depression occurs more in women than in men in a ratio of 1:2. There are many postulates to this and some of them include that women may be more willing to discuss their emotional issues. Women have hormonal changes that may increase the risk of depression. Also men may self-medicate their depression with alcohol or drug use.

Symptoms of Depression

The symptoms of depression can differ greatly, but victims suffer low moods and lose interest and enjoyment in aspects of life, feeling sad and anhedonia. Anhedonia is the inability to device pleasure from pleasurable activities. An example of this is when a person who enjoys gardening, just can’t find the mood to do anymore gardening.

Other symptoms include a general feeling of tiredness, changes in weight and loss of appetite, fatigue, sleep disturbance, lack of interest in sex, irritability, anxiety and confusion, poor concentration, a feeling of loneliness, hopelessness, uselessness, and worthlessness, guilt feelings and suicidal thoughts.

Physically, patients can complain of a variety of conditions like back pain, headaches, giddiness, gastic problems and chronic pain.

Depression is different from normal sadness as a diagnosis can only be made if a patient has at least five of the symptoms described above and it has lasted continuously for at least two weeks. The symptoms are significant enough to cause social and occupational impairment as well. There are
various medical conditions that can also cause or that may occur concurrently with depression and these need to be ruled out.

The apathy which accompanies depression often stops sufferers from seeking help.

Causes of Depression

Depression may be triggered by major life events such as the death of a relative or friend. Stressful situations such as divorce, financial difficulties or job loss can also trigger depression. Depression can sometimes be caused by a person’s lifestyle. Childbirth can also trigger post-natal depression in women, as can loneliness, especially in the elderly.

Over the past 20 years, scientists have been investigating the way in which some chemicals in the brain affect a person’s mood. One of these chemicals is serotonin – depressed people are often found to have an imbalance in the way that serotonin works in their brains.

Genetics predisposition

Some types of depression run in families, indicating that a biological vulnerability can be inherited. This seems to be the case with manic-depressive illness. Studies of families, in which members of each generation develop manic-depressive illness, found that those with the illness have a somewhat different genetic makeup than those who do not get ill. However, the reverse is not true: not everybody with the genetic makeup that causes vulnerability to manic-depressive illness has the disorder. Apparently additional factors, possibly a stress environment, are involved in its onset.

Major depression also seems to occur, generation after generation, in some families. However, it can also ossur in people who have no family history of depression. Whether the disease is inherited or not, it is evident that individuals with major depressive disorder often have to little or too much of certain neurochemicals.

People with low self-esteem

Psychologic makeup also plays a role in vulnerability to depression. People who have low self-esteem, who consistently view themselves and the world with pessimism, or who are readily overwhelmed by stress are prone to depression.

Serious or chronic physical illness

Serious or chronic physical illness or major surgery may trigger depression, too. Some commonly prescribed medications, including some cardiovascular drugs, hormones, birth control pills and drugs used to treat Parkinson’s disease, may also bring on depression, or make it worse.

Other causes include:

– Stressful environment
– Adverse life events
– Lack of a supporting relationship

Very often, a combination of genetic, psychologic and environmental factors is involved in the onset of a depressive disorder. Sometimes there are no know triggers at all. Depression can appear suddenly, for no apparent reason.

Whatever the trigger, treatments are available that many have found to be safe and effective.

Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help over 80% of those who suffer from depression.

Source : Malaysian Psychiatric Association


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