World Mental Health Day 2019

Mental disorder is no respecter of age, afflicting children and teens, adults and the elderly. Similarly, there is no one-size-fits-all treatment for the mental disorders. The triggers of psychiatric illness also vary at different times of our lives because each age group faces different challenges and stressors. Learn to recognise some of the common mental conditions affecting children, adults and the aged as we seek expert insights from our psychiatrists at Raffles Counselling Centre.

Children & Teens – Autism, Attention-Deficit/Hyperactivity Disorder (ADHD) and Social Anxiety Disorder (with Dr Tan Hwee Sim)

Q: What is Autism or Autistic Spectrum Disorder?

Dr Tan: Autism encompasses the previous diagnoses of autism and Asperger’s syndrome and is regarded as a brain disorder. It is characterised by social impairments, communication difficulties, and restricted and repetitive behaviour.

Q: Can Autism be diagnosed at birth?

Dr Tan: Signs and symptoms of autism usually start to appear between one to two years of age and cannot be diagnosed at birth. Though children do not “outgrow” the illness, the disabilities may lessen as the child develops and receives intervention.

Q: What are the signs and symptoms of Autism?

Dr Tan: Some of the signs and symptoms of Autism include difficulty with verbal and non-verbal communication, unusual ways of playing with toys and other objects, and difficulty understanding, forming and sustaining relationships.

Q: How can I tell if a child has ADHD?

Dr Tan: ADHD is a neurodevelopmental disorder marked by inattention, hyperactivity and difficulties controlling impulses. They can be easily distracted, struggle to follow through with instructions, lose things easily and have difficulty organising tasks and activities.

Q: How early does ADHD develop?

Dr Tan: Seen in early childhood development, ADHD can be present by the age of 12 and the child may not be able to perform at the developmentally appropriate level, causing impairment of major life activities.

Q: How often does ADHD continue into adulthood?

Dr Tan: Two-thirds of childhood ADHD may continue into adulthood.

Q: What does having Social Anxiety Disorder mean?

Dr Tan: Teens with Social Anxiety Disorder have an excessive fear of social and/ or performance situations. These teens constantly feel that they are “on stage,” which can lead to a great deal of self-consciousness. There are two categories of feared situations: performance-based and interaction-based.

Q: How does someone with Social Anxiety Disorder feel?

Dr Tan: They are excessively self-conscious and anxious, have an extreme fear of being watched or judged, worry intensely before a social situation, and are overly concerned that they may do something embarrassing or humiliating, causing others to think badly of them

Adults – Anxiety & Depression, Anger Management and Obsessive Compulsive Disorder (OCD) (with Dr Lim Yun Chin)

Q: How common are anxiety and depression?

Dr Lim: Up to 12 per cent of adults face lifetime risk of developing Anxiety and Depressive Disorders. If untreated, they can be very incapacitating and distressing. Therefore vigilance is important in detecting the symptoms early so as to prevent further development of the disorder.

Q: What are some signs and symptoms of anxiety and depression?

Dr Lim: The symptoms, particularly of anxiety, may be somatic or physical in nature resulting in multiple visits to their General Practitioners. Other symptoms include loss of motivation, thoughts of death and suicide, feelings of helplessness, and neglecting responsibilities.

Q: Can anger lead to other health problems?

Dr Lim: Managing anger is critical for a healthy lifestyle because anger when out of control can cause elevated blood pressure, increased pulse rate, indigestion and other conditions. Anger not dealt with constructively can lead to depression.

Q: When would anger management be recommended?

Dr Lim: If there is constant irritability, rage and anxiety, reacting quickly and violently to small problems, consistently having the same arguments with people, or punching objects to feel a sense of release.

Q: Does OCD always consist of repetitive actions like washing of hands?

Dr Lim: OCD is a type of anxiety disorder. It is characterised by distressing repetitive thoughts, impulses or images that are intense, frightening, absurd, or unusual. These thoughts are followed by ritualised actions that are usually bizarre and irrational. These ritual actions, known as compulsions, initially help to reduce anxiety caused by the individual’s obsessive thoughts. Often described as the “disease of doubt” the sufferer usually knows the obsessive thoughts and compulsions are irrational, but cannot banish them.

Q: What are some thoughts that people with OCD experience?

Dr Lim: They could have a need for order and symmetry, that everything must line up ‘Just Right’. They can also have superstitions, paying excessive attention to something considered lucky or unlucky.

Q: What are some behaviours demonstrated by those with OCD?

Dr Lim: They could excessively double-check things, such as locks and switches. They might also count, tap or repeat certain words to reduce anxiety.

Elderly – Dementia, Depression and Delirium (With Dr Joshua Kua)

Q: What does it mean to have Dementia?

Dr Kua: Dementia describes a condition where there is progressive loss of global brain function beyond that which would be expected in normal aging. With dementia, memory, attention, language, abstract thought, problem solving and judgement can be impaired. In later stages, orientation to time, person and place is lost.

Q: How is Dementia related to Alzheimer’s disease?

Dr Kua: The two most common causes of dementia in our population are Alzheimer’s disease as well as multiple strokes or vascular dementia.

Q: What are some behavioural changes that occur with Dementia?

Dr Kua: There could be subtle short term memory change and confusion, difficulty following storylines and finding the right word to say, changes in mood, and difficulty with abstract reasoning or impaired judgement.

Q: Do the elderly experience depression in the same way as the younger population?

Dr Kua: In the elderly, depression often occurs with other medical illnesses and disabilities and may last longer than in the younger age group. There tend to be negative emotions that adversely impact people’s lives, causing social, educational, personal and family difficulties. People who are more prone to depression are those with physical health issues, those people who experience grief and loss, worry a lot, have a history of prior episodes or a family history of depression or who are subjected to prolonged stressful situation without adequate relief.

Q: How does depression present itself in the older population?

Dr Kua: They could have feelings of worthlessness and persistent low mood or irritability, unexplained or aggravated aches and pains, loss of interest in socialising and hobbies, and negative, pessimistic or suicidal thinking.

Q: What is delirium?

Dr Kua: Delirium is an abrupt disturbance in a person’s mental ability that causes mental confusion and decreased awareness of one’s environment.

Q: What are the signs or symptoms of delirium?

Dr Kua: Individuals may find it difficult to sleep, think, remember things or pay attention. The onset of delirium is usually sudden, often within hours or a few days. Delirium is especially common among the elderly. It is treatable but some may not return to their baseline function. It can occur acutely or sub-acutely and its symptoms can fluctuate.

Q: How can you tell if a person is suffering from delirium?

Dr Kua: They might be unable to stay focused on a topic, have poor memory, especially of recent events, have disturbed sleep habits, or even see things that do not exist.

Unresolved mental disorders in children and teens can filter into adulthood, creating more intractable disabilities and impairment. Unresolved adult mental disorders may worsen in the senior years. Awareness, prompt recognition and intervention can minimise heartache down the road and are the keys to a healthier mind.

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