Thursday, 11 February 2016

Bipolar Disorder FAQs Part 3

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

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

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

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

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

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

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.

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.

Thursday, 17 December 2015

How to get along with your in-laws before and after the wedding.

My interview with Her World with regards to:

How to get along with your in-laws before and after the wedding

Read it here.

Sunday, 13 December 2015

Methylphenidate (Stimulant Medication For ADHD): 4 Points to Note From a Recent Review

A recent systematic review of 185 randomised controlled trials of methylphenidate, "Benefits and harms of methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD)", found that:

1) Methylphenidate can improve some of the core symptoms of ADHD – reducing hyperactivity and impulsivity, and helping children to concentrate. 

2) Methylphenidate can also help to improve the general behaviour and quality of life of children with ADHD.

3) There is no evidence to suggest that methylphenidate increase the risk of serious (life threatening) harms.

4) Methylphenidate is associated with an increased risk of non-serious harms such as sleeping problems and decreased appetite. 

It is important to discuss the potential benefits and risks of starting ADHD treatment for your child with his or her psychiatrist. Whilst this review did not provide any new insights to the treatment of ADHD, it consolidates what we already know in helping children who suffers from ADHD and its related consequences. Future studies will surely shed more light and strategies on ADHD treatment.

Speak to a psychiatrist today should you suspect that your child, or yourself, has ADHD.

Saturday, 5 December 2015

Bipolar Disorder: Interview with Today Newspaper

I was recently interviewed with regards to Bipolar Disorder together with Dr Mok Yee Ming of IMH. You can read the article from this link.

Bipolar Disorder is a debilitating and chronic (long term) illness. Nevertheless, sufferers can lead a completely normal life with medications and treatment. Early treatment will give you the best outcome.

Thursday, 3 December 2015

Question of the week (7 December 2015)

"I know I should take better care of myself but I am still young so I don't have to worry about my diet, sleeping habits, exercise, etc"

When we are young, we tend to live in denial of our mortality and as a result, we erroneously think that we can abuse our body with unhealthy diets, late nights, work stress and inadequate rest. Not only do we wear our bodies out earlier with these bad practices, we also risk them becoming habits of which will be very difficult to change even when we want to when older. 


1) Never use your age as a reason as there can be no excuse to wreck your body. Your body and mind deserves to be respected.
2) The younger you are, the easier it is to form good habits, so start having healthy routines and habits as early as possible.
3) You can just do it. You will realise that living healthily (ie, adequate exercise, good sleep schedules, adequate rest and moderation in food and alcohol) is not hard to achieve at all and will help you feel both mentally positive and physically attractive.