Anxiety Disorder (焦虑症) in Malaysia ( Klang, 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 Klang, 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 ( Klang 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 Klang, 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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