Overview of mental health and well being

 

 

Welcome to Brain Mind Specialist

The World Health Organization (WHO) defined health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”.

Therefore a  complete sense of well being involves the journey of nurturing our physical, mental ( cognitive and emotional ) and spiritual health.

Total mental health involves not only management of emotional issues but discovering and developing the strengths, abilities and talents which is inherent in every individual.

 

“Life is difficult. This is the great truth, one of the greatest truths –  it is a great truth because once we see this truth, we transcend it.”                               
                                                                                                                                                                                                                                        Dr. M. Scott Peck

 

Do you know that mental disorder are often missed and usually goes undetected?

Yes. It is true.

This is because there are no clear measurements for emotional symptoms or distress.

What this means is your love ones could be suffering from mental disorder but there is a high chance that you are not aware of it. It may seems normal to you. But in actual fact, this may not be the case.

How common is this?

Most people do not realized that they may be suffering from depression until their friends or love ones spotted their unusual behavior.

If you consider mental disorder as someone who is of unsound mind, then you are wrong. This is because there are many types of mental disorder. Depression is one of such disorder.

Anyone experiencing the followings MAY be suffering from depression.

  1. their thinking becomes negative,

  2. social isolation

  3. lack of energy

  4. difficulty in sleeping

  5. crying most of the time

  6. frequent having pessimistic thoughts such as death wishes and hopelessness.


Most people tend to “normalized” these symptoms and denied depressed feeling but perceived their symptoms as “normal stressful reaction” just like anyone else.

The reason why most people often misunderstood these is due to the lack of understanding of various types of mental disorders.

Just like any other medical illness, we do not realize that the loss of weight and frequent thirst is a sign of Diabetes Mellitus unless we are informed that these are the symptoms of Diabetes.



What is medical disorder?

Mental illness is a medical condition that is characterized by disturbance of thinking, feeling and behaviours.

Generally, a person is considered as suffering from mental disorder when the disturbances are severe and persistent. It actually affects a person’s daily activities and relationship with others.

In the case of Depressive disorder, the tell tales signs are:


  1. Someone who complained of many symptoms of depression,

  2. Severity of distress in terms of intensity and frequency of distress,

  3. When the distress affects the person’s daily activities, relationships with others, and self care e.g. difficulty eating, difficulty sleeping, poor personal hygiene.


Anyone who complains about the following symptoms for at least 1 week:


  1. feels sad most of the time,

  2. lack motivations,

  3. insomnia,

  4. tired most of the time,

  5. unable to concentrate at work,

  6. feeling hopeless about future,

  7. unable to work or study,


…MAY be suffering from Depressive illness and he definitely requires treatment. His condition should not be taken lightly or being expected to “snap out of it “.

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Dementia (老年痴呆症) in Malaysia ( Petaling Jaya and Kuala Lumpur )

Alzheimer’s Disease

What is Alzheimer’s disease?

Alzheimer’s disease is the most common cause of dementia and accounts for 50% – 60% of all cases. Alzheimer’s disease was first described by a German Physician Alois Alzheimer in 1906. This disease causes a heavy burden both emotionally and financially and the consequences can be quite devastating.

Alzheimer’s disease is a condition in which nerve cells in the brain die, making it difficult for the brain’s signals to be transmitted properly. A person with Alzheimer’s disease has problems with memory, judgment, and thinking, which makes it hard for the person to work or take part in day-to-day life. The death of the nerve cells occurs gradually over a period of years.

Alzheimer’s disease is a form of Dementia.

In Malaysia, especially bigger cities such as Petaling Jaya and Kuala Lumpur,  , the public is becoming more awareness about the availability of treatment for Dementia.

During the course of Alzheimer’s disease, nerve cells die in particular regions of the brain. The brain shrinks as gaps develop in the temporal lobe and hippocampus, which are responsible for storing and retrieving new information. This in turn affects people’s ability to remember, speak, think and make decisions. The production of certain chemicals in the brain, such as acetylcholine is also affected. It is not known what causes nerve cells to die but there are characteristic appearances of the brain after death. In particular, ‘tangles’ and ‘plaques’ made from protein fragments are observed under the microscope in damaged areas of brain. This confirms the diagnosis of Alzheimer’s disease.

Causes of Alzheimer’s disease.

The cause of Alzheimer’s dementia is not fully understood, but advancing age and a family history of Alzheimer’s dementia increases one’s risk of developing it. The number of persons with Alzheimer’s dementia doubles every 5 years beyond the age of 65 and by the age of 85, one in 4 can develop this illness, which is about 25% of the population above the age of 85 years. Thus age plays a crucial part in policy and decision making for care of the elderly, this is an alarming figure more so as the baby boomers will be reaching this age soon.

Symptoms

Most patients’ symptoms progress slowly over a number of years. Symptoms may not be noticed early on. Sometimes, it is only when family members look back that they realize when the changes started to occur.

Common symptoms of Alzheimer’s disease include:

a) Impaired memory and thinking. The person has difficulty remembering things or learning new information. In the later stages of the disease, long-term memory loss occurs, which means that the person can’t remember personal information, such as his or her place of birth or occupation, or names of close family members.

b) Disorientation and confusion. People with Alzheimer’s disease may get lost when out on their own and may not be able to remember where they are or how they got there. They may not recognize previously familiar places and situations. They also may not recognize familiar faces or know what time of the day it is, or even what year it is.

c) Misplacing things. The person forgets where he or she put things used every day, such as glasses, a hearing aid, keys, etc. The person may also put things in strange places, such as leaving their glasses in the refrigerator.

d) Abstract thinking. People with Alzheimer’s disease may find certain tasks — such as balancing a checkbook — more difficult than usual. For example, they might forget what the numbers mean and what needs to be done with them.

e) Trouble performing familiar tasks. The person begins to have difficulty performing daily tasks, such as eating, dressing, and grooming. Planning for normal day-to-day tasks is also impaired.

f) Changes in personality and behavior. The person becomes unusually angry, irritable, restless, or quiet. At times, people with Alzheimer’s disease can become confused, paranoid, or fearful.

g) Poor or decreased judgment. People with Alzheimer’s disease may leave the house on a cold day without a coat or shoes, or could go to the store wearing their pajamas.

h) Inability to follow directions. The person has difficulty understanding simple commands or directions. The person may get lost easily and begin to wander.

i) Problems with language and communication. The person can’t recall words, name objects (even ones that are very familiar to them — like a pen), or understand the meaning of common words.

j) Impaired visual and spatial skills. The person loses spatial abilities (the ability to judge shapes and sizes, and the relationship of objects in space) and can’t arrange items in a certain order or recognize shapes.

k) Loss of motivation or initiative. The person may become very passive and require prompting to become involved and interact with others.

l) Loss of normal sleep patterns. The person may sleep during the day and be wide-awake at night.

Diagnosis

It is important to visit a doctor if you or a loved one experiences any of these symptoms so you can receive the proper evaluation and diagnosis. There are other conditions — such as depression, a head injury, certain chemical imbalances, or the effects of some medications –that can produce symptoms that are similar to Alzheimer’s disease. Many of these conditions are treatable.

Your doctor can only determine if the symptoms are probably due to Alzheimer’s disease after a thorough medical, psychiatric, and neurological evaluation. He will evaluate other possible causes of dementia to rule out all other factors before settling on Alzheimer’s disease as a diagnosis.

Currently, no definitive diagnostic test for Alzheimer’s exists. A definite diagnosis of Alzheimer’s disease is possible only after death, when a pathologist can more closely examine a patient’s brain for the telltale changes associated with Alzheimer’s disease.

Prognosis

The course of Alzheimer’s disease varies widely from person to person. The duration of the illness could be short (2-3 years) or long (up to 20 years). Usually the parts of the brain that control memory and thinking are affected first, but over time, cells die in other areas of the brain.

Eventually, a person with Alzheimer’s will need complete care. If the person has no other serious illnesses, the loss of brain function itself will eventually cause death.

Source : Malaysian Psychiatric Association

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.

Symptoms

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.

Diagnosis

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


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