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JANUARY - MARCH 2014AN IMH QUARTERLY PUBLICATION

MICA (P) 162/07/2011

IMHLINK

WHAT’S INSIDE

CLINICAL

RESEARCH

EDUCATION

UPDATES

ASK THE EXPERT

MY SAY

WHAT’S ON

New Dementia-Friendly Wards

Chronic Pain – More than Meets the Eye

Generalised Anxiety Disorder

IMH officially opened two dementia-friendly wards, with 25 beds each for male and female patients, on 14 February 2014. Named Sunshine Wing, these wards are currently the only dedicated acute geriatric psychiatry inpatient wards in Singapore that treat dementia patients with severe Behavioural and Psychological Symptoms of Dementia (BPSD). Guest-of-honour for the event A/Prof Benjamin Ong, Director of Medical Services, Ministry of Health unveiled a plaque and planted a tree in Sunshine Wing’s therapeutic garden to mark the occasion.

These wards were refurbished from IMH’s existing acute geriatric psychiatry wards built in 1993. The redesign and renovations, completed in 2013, sought to provide a more healing environment for patient rehabilitation, with the goal of returning the patients back to the community. For instance, the homely design of the ward environment aims to encourage the patients to pursue normal activities of daily living in a domestic setting. Dining tables and chairs are arranged in small clusters to encourage social interaction over meals. Colours, blinds, lights, noise reduction materials, and room dividers were purposefully chosen to provide therapeutic surroundings, so as to reduce patient agitation and aggression.

Thoughtful new facilities have also been added, with the needs of the patients and their caregivers in mind:

1. Garden:

The former geriatric psychiatry wards did not have a garden. As a result, some patients with dementia who insisted on going out became agitated, or at times aggressive. With a therapeutic garden in place, the patients are now able to enjoy the natural surroundings. The garden has a gazebo, water feature, and proper pathways with safety bars for patients who like to wander.

2. Reminiscence Room:

Antique objects and materials are displayed in this room to help patients evoke memories and reminisce about the past as part of their therapy.

IMH Opens Dementia-Friendly WardsBy Cheong Yaun Marn, Corporate Communications

Sunshine Wing’s therapeutic garden, where patients can be at one with nature.

3. Gym:

This gym, overlooking the garden, boasts modern exercise machines. Patients undergo various forms of exercise under the supervision of physiotherapists to strengthen their muscles and improve their balance. The view of the garden also encourages the patients to participate in the physical activities.

4. Sensory Room:

The range of sensory equipment available here creates a multisensory environment for patients to explore and relaxin safety.

5. Activity Room:

This room, dedicated for patients’ activities, offers them the opportunity to enjoy the latest video games such as Kinect, where they can play stimulating games that involvelimb exercises.

6. Caregivers Resource Corner:

Caregivers can access this resource corner for information, emotional support and guidance. The ward also conducts psychoeducation sessions and workshops to help caregivers understand issues related to caregiving for patients with dementia.

A 40-year-old daughter of an 80-year-old patient enthused, “Previously, there were no dedicated rooms for family members to use when visiting patients. The new ward now has three such family rooms, and I really appreciate the feeling of privacy when visiting my father. The garden and gym are also very beneficial. As for activities, my father’s favourite is the Kinect bowling game that the nurses taught him. In fact, he is very proud that he beat his 20-year-old niece at it during his Chinese New Year home leave!”

Rozinah Bte Bachik, Deputy Director (Operations), Department of Geriatric Psychiatry (centre, in maroon) sharing the features of the Sunshine Wing dormitory with A/Prof Benjamin Ong, Director of Medical Services, MOH (second from right) as A/Prof Chua Hong Choon, Chief Executive Officer, IMH (in blue lanyard) and Clinical Associate Prof Chiam Peak Chiang, Vice Chairman Medical Board (Education) and Acting Chief, Department of Geriatric Psychiatry, IMH (in blue blouse) look on.

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Behind the Scenes at Occupational Therapy and Medical Social WorkBy Vera Soo, Corporate Communications

1:

TBL:

LM:

Broadly, how has the work of occupational therapists (OTs) and medical social workers (MSWs) in IMH changed since the services first started?

Occupational Therapy refers to the use of meaningful and purposeful activities to restore, improve and maintain an individual’s daily functioning.

In the early days, IMH had many long-stay inpatients who required engagement and rehabilitation to maintain their function and improve their quality of life within the institution. Hence, OTs conducted a lot of large activity groups, such as basketry, art and craft, gardening etc. Patients also picked up basic work skills through sheltered workshops.

Over the years, OTs have progressed in picking up specific skills for intervention with the various diagnostic groups. The aim is to alleviate specific problem areas so that patients can better reintegrate into the community, per the new focus of treatment now.

In tandem with the current emphasis on evidence-based medicine, OT intervention has also become more structured and scientific, with more clearly-defined rehabilitation goals. In practice, we see OTs utilising a lot more assessment tools that are validated and well-researched.

Traditionally, MSWs worked with patients and their caregivers primarily to resolve immediate needs like food, accommodation and finances.

As healthcare provisions, social structures, and the social landscape evolved, MSW work expanded from a largely remedial approach to a systemic one that involves family caregivers, community partners and service providers.

MSWs have also gone into specialised services like family therapy, family psychoeducation, suicide counselling, forensic counselling, family work, social work in dementia care, and so on.

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LM:

What are some of the little-known areas of work that our OTs and MSWs are involved in?

The OT treatment carried out in the different areas of specialisation within a mental health setting differs, although the aims and goals are always functional in nature.

At IMH, we have OTs who are trained as art psychotherapists. We also have OTs who work in with geriatric patients, adult patients who have Autism Spectrum Disorders and learning disabilities, and in forensic settings, with inmates who have psychiatric problems, just to name a few.

What is lesser known is that MSWs also work very closely with secondary clients – meaning those who are impacted by the patient’s illness – to advocate for or contribute to their developmental needs. Children of our patients are an example of our secondary clientele.

The management of family violence, in which patients may either be victims or perpetrators, is another little-known area of MSW work. Once such a situation is identified, much work is done to ensure there is a safety plan in place, appropriate and urgent referrals are made, and legal actions are taken. Sometimes, all these are done within the same day.

Lilian Mark, Head of Medical Social Work in IMH with a family psychoeducation session as it gets under way.

Dr Tan Bhing Leet, Head of Occupational Therapy in IMH, and an art psychotherapy session in progress.

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TBL:

What kind of skills and abilities do I need to become an OT/MSW in the mental health setting?

OTs in mental health should have a good foundation in psychopathology and basic rehabilitation principles. They need to be able to envisage how the patient is able to function in his physical and social environment. OTs also need to be creative and versatile in using whatever resources they have to assess and treat patients. As recovery from mental illness can often be a slow and arduous process, OTs must also be positive, resilient and able to instill hope in patients.

Two special occasions are commemorated in the first quarter of each year at the Institute of Mental Health (IMH), namely the Singapore Occupational Therapists’ Day on 11 January and World Social Work Day on the third Tuesday of March.

Occupational therapy and medical social work services were the first allied health professions established in IMH, dating back to 1955. IMH Link speaks to Dr Tan Bhing Leet (TBL), Head of Occupational Therapy and Lilian Mark (LM), Head of Medical Social Work to learn how their departments and programmes have progressed since.

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EMERITUS AWARD

• Dr Cai Yiming, Emeritus Consultant, Department of Child and Adolescent Psychiatry, and Department of General & Forensic Psychiatry

Dr Cai Yiming has been conferred the title of Emeritus Consultant, making him the fourth eminent doctor in IMH who has received this for distinguished service, teaching and research contributions to IMH and psychiatry.

In his 37 years with Woodbridge Hospital and then IMH, Dr Cai contributed significantly to the foundation and evolution of child psychiatry services in Singapore. As Chief of the Department of Child and Adolescent Psychiatry from 1993 to 2006, he augmented the services in keeping with the needs of the time. He also led a multidisciplinary team in providing specialist mental healthcare for children and adolescents in Singapore.

Dr Cai’s passion rubbed off on his daughter, currently a child psychiatrist at IMH. Dr Chai Suet Bin, Associate Consultant, Department of Child and Adolescent Psychiatry, IMH reminisced, “When I was

LM: MSWs need to be emotionally resilient and have a variety of communication skills as very often, patients or their families are inundated with much stress and crises when MSWs see them. Resourcefulness and creativity are also important because each patient and situation calls for a different solution, and patients often defer to MSWs to help them navigate and access the slew of services available in the community.

Interested in entering or switching to an allied health profession? Scholarships and conversion programmes are available. For more information, log on to caretogobeyond.sg.

Celebrating our Doctors: Awards and AppointmentsBy Fiona Foo and Ng Si Jia, Corporate Communications

2014 started on a positive note of collegiality for IMH doctors as they gathered for the annual Doctors’ Nite event at the Swissotel Equinox on 3 January. Celebratory cheers filled the air as three awards were handed out in recognition of our doctors’ contribution to mental healthcare.

three, my father brought me to the old Woodbridge Hospital on weekends when he did his ward rounds. Although I did not understand the illness fully, I noticed that those who were severely ill would refuse to eat or drink. The nurses attended to them very patiently. It sparked my interest in psychiatry. My father remains my top role model and I am very proud of his achievements and dedication.”

As a mentor, Dr Cai imparts his wealth of knowledge to junior doctors and nurses through his valuable teachings, and his humility has earned him great respect from them. We are indeed grateful for all of Dr Cai’s contributions, and that he is passing on the baton to the next generation!

DR ANG AH LING – IMH ADVANCED PSYCHIATRY TRAINEE AWARD

• Dr Kelvin Ng, Associate Consultant, Department of Community Psychiatry

The Dr Ang Ah Ling Award, inaugurated in 2007 in honour of the late Dr Ang’s distinguished contributions to psychiatry, commends outstanding Advanced Psychiatry Trainees for their contribution to psychiatric care.

Dr Kelvin Ng received this Award for his instrumental role in the development of various community programmes and initiatives. An active trainer in the community, Dr Ng strongly believes in the importance of strengthening community psychiatric care.

IMH CLINICAL MENTORSHIP AWARD

• Dr Somnath Sengupta, Consultant, Department of General Psychiatry

The Clinical Mentorship Award recognises outstanding mentors in IMH. As a mentor, Dr Somnath Sengupta generously and confidently shares knowledge with his ward staff, enabling them to deliver better care to patients. This Award further affirms Dr Sengupta’s passion in mentoring and teaching, for which he received the Dean’s Award for Teaching Excellence (Academic Year 2011/2012) in 2013, conferred by the Yong Loo Lin School of Medicine at the National University of Singapore.

APPOINTMENT OF VICE CHAIRMAN MEDICAL BOARD (CLINICAL QUALITY)

• Dr Alex Su, Chief of General Psychiatry and Head of Emergency Services

Dr Alex Su has been appointed IMH’s Vice Chairman Medical Board (Clinical Quality) with effect from 1 January 2014.

Dr Su, a strong advocate of quality improvement since he became an IMH clinician in 1992, expressed, “Patients and their caregivers may find the current healthcare system rather complex, when all they want is to seek treatment in a straightforward manner. Hence, reviews of and improvements to processes are important aspects of clinical quality, in order to make our services simple and safe for our consumers.”

In this new role, Dr Su will work closely with A/Prof Daniel Fung, Chairman Medical Board, IMH to spearhead and drive the strategies for clinical process improvement and integration in IMH, and also set and maintain the clinical quality standards of professional practice in IMH.

Dr Ng also goes the extra mile for his patients often, and invests time nurturing his juniors as a mentor. Certainly, he is a role model who embodies the values of integrity, professionalism and compassion.

Like father, like daughter: IMH Emeritus Consultant, Dr Cai Yiming (right) and Dr Chai Suet Bin.

A/Prof Daniel Fung, Chairman Medical Board, IMH (right) presenting the Dr Ang Ah Ling Award to Dr Kelvin Ng.

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Studies have shown that the prevalence of chronic pain conditions is 37.3% in developed countries. Chronic pain not only affects an individual’s well-being, productivity and social relationships, it has also been found to be associated with psychiatric disorders, both in studies done in clinical settings and in population-based surveys.

To better understand the impact of chronic pain, a research team from IMH led by principal investigator A/Prof Chong Siow Ann, Vice Chairman Medical Board (Research), IMH used data from the Singapore Mental Health Study (SMHS*) to establish the prevalence, correlates and comorbidities of chronic pain disorders among the resident adult population of Singapore. The team also assessed the quality of life and extent of role disability among individuals with chronic pain. A modified version of the checklist of chronic medical disorders was used, and data collected on different medical conditions was reclassified into eight types of physical disorders, including arthritis or rheumatism, back problems (including disc or spine problems), and migraine headaches.

This study, published in “Pain Research and Management” (2013; 18(4):185-90), was one of the first to examine the comorbidity of common psychiatric disorders with chronic pain disorders in a community sample involving a multiethnic Asian population. The findings revealed that the lifetime prevalence estimates for arthritis, back pain and migraine in the resident adult population were 6.0%, 7.0% and 5.6% respectively. After adjusting for sociodemographic factors, comorbid pain disorders and the presence of other chronic physical conditions, migraine remained significantly associated with major depressive disorder (MDD), general anxiety disorder and alcohol use disorders, while back pain was significantly associated with MDD.

Chronic Pain – More than Meets the EyeBy Adjunct Assistant Professor Mythily Subramaniam, Research Division

These significant associations between pain and psychiatric disorders emphasise the need to screen individuals with chronic pain conditions for psychiatric disorders, particularly depression. There is also a need to develop integrated pharmacological and psychological treatments for both conditions.

* The SMHS is a cross-sectional survey of a representative sample of the adult resident population of Singapore that was conducted in 2010. A total of 6,616 respondents provided informed consent and completed the survey.

Research that Makes a DifferenceBy Dr Edimansyah Abin, Research Fellow, Research Division

Dr Edimansyah Abdin (extreme left) with the rest of the team from the IMH Research Division which worked on the pain study: Principal investigator, A/Prof Chong Siow Ann (extreme right), Adj Asst Prof Mythily Subramaniam (second from left), and Janhavi Vaingankar, Senior Manager, Institute of Mental Health (second from right).

My first experience and interest in mental health research began when, as part of my doctoral thesis at Universiti Sains Malaysia, I explored the effects of stressful job conditions on depression, anxiety and quality of life.

I joined IMH’s Research Division in August 2008, drawn by its reputation in research and the opportunity to gain an advanced understanding of mental health research, take on greater responsibilities in designing studies and utilise statistical techniques in this field. For example, I have acquired a lot of hands-on experience in SAS programming, development and psychometric testing of mental health instruments, and also worked on extensive survey data with complex sampling designs.

As a research fellow, my work is primarily concerned with how data from survey projects is managed, analysed and

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interpreted meaningfully. This involves data monitoring, cleaning, checking, application of statistical techniques and modelling, and the reporting of research findings. All these are critical so that the aims of the research projects and the production of technical documentation, reports and research findings for publication may be accomplished. I also provide statistical consultation to other IMH colleagues for their own research.

The past five years of working in mental health research has been immensely rewarding for me. I have understood the importance of stringent data collection for the appropriate translation to and planning of mental health policies and services for the country. For one, I was on the research team of the SMHS, which yielded a rich body of information on the prevalence of mental disorders and the co-occurrence of physical disorders in the community. It was also through the SMHS that the significant association between pain conditions and psychiatric disorders was evidenced and identified as an area to be addressed.

Studies have found that parental actions, attitudes, and opinions about smoking have an enormous influence on their children’s smoking behaviours.

The Research Division at the Institute of Mental Health (IMH) is undertaking a study to find out more about parents’ perceptions of smoking in Singapore. As part of this study, focus group discussions are conducted where parents of children aged 14 – 29 years are invited to come for a single session to share their thoughts and opinions on smoking among youth, as well as the different types of prevention and cessation programmes in Singapore.

These informal discussions take place at a convenient location and last for around 1½ – 2 hours. The study team is looking for parents who are willing to share their opinions on the subject. You can participate in the discussions if you are*:

• A Singapore Citizen or Permanent Resident

• A parent of someone aged 14 – 29 years

• Fluent in English, Mandarin, Malay or Tamil* More criteria apply

Light refreshments are provided during the discussion and participants will receive an inconvenience fee to compensate for their time and travel.

Wanted: Parents for Focus Group Discussions on Youth Smoking

For more information, please contact Ms Shazana Shahwan, Research Officer, IMH Research Division at 6389 2824 (DID), 9839 3782 (SMS) or e-mail shazana_mohamed_shahwan@imh.com.sg.

These research experiences have motivated me to continue pursuing mental health policy research, with a focus on the epidemiology of common mental disorders and development of mental health instruments in Singapore. Throughout this exciting research journey, I am most grateful to have had the continued guidance and support of my mentors, A/Prof Chong Siow Ann, Vice Chairman Medical Board (Research), IMH and Adj Asst Prof Mythily Subramaniam, Director, Research Division, IMH.

Moving forward, I am anticipating the outcomes from my engagement with the Well-Being of the Singapore Elderly (WiSE) study this year, and also the Mind Matters study, which I will soon be working on. These studies will provide national estimates of disorders among the elderly and mental health literacy respectively.

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Some 40 participants across various hospitals and schools in Singapore as well as Hong Kong attended the Autism* Diagnostic Observation Schedule (ADOS-2) Training Workshops in November 2013, held in IMH and conducted by trainers Associate Professor Kylie Gray and psychologist Deborah Sweeney from Monash University, Melbourne Australia.  ADOS-2 is a semi-structured, standardised assessment of communication, social interaction and play. It provides a series of standardised contexts in which a child’s social and communication skills and repetitive, stereotyped behaviours can be observed. The ADOS-2 was designed to assist in the diagnosis of autism and pervasive developmental disorders. Standardised toys and activities are used to present the child with opportunities for social and communicative interaction with the therapist. As the child engages in these activities, the therapist will observe and note the absence and presence of behaviours of interest, such as repetitive hand movements and eye gaze.  The training workshops offered those who work with children who have autism a comprehensive overview of the tool in diagnostic assessments of Autism Spectrum Disorders. It is regarded as a “gold standard” child observation tool in such diagnostic assessments, and is regularly used in clinical practice locally, including at IMH. 

The trainer, A/Prof Gray is a registered psychologist and Senior Lecturer in Monash University’s Centre for Developmental Psychiatry and Psychology, and has specialised in the field of autism and developmental disability for approximately 15 years. The majority of her clinical and research work is in the areas of assessment and diagnosis, behaviour and emotional problems in children and young people with autism

Overseas Experts Conduct Training on Diagnosis of Autism and Pervasive Developmental Disorders at IMHBy Penny Chua, Corporate Communications

and with developmental delay or intellectual disability. A/Prof Gray is also a trained administrator and trainer for the Autism Diagnostic Interview – Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS-2). She has been running regular training programmes in these instruments across Australia and the Asia-Pacific region for the past ten years.  Dr Sung Min, Senior Consultant from the Neuro-Behavioural Clinic (NBC) - Autism Services, Department of Child and Adolescent Psychiatry (DCAP), IMH shared, “A/Prof Gray gave great insights that enhanced our understanding of autism. The participants also found the workshop beneficial as they got to engage in hands-on learning, using the ADOS-2 with patients.”

Echoing Dr Sung’s sentiments, Oon Jit Hui, Senior Clinical Psychologist from the NBC – Autism Services (DCAP) commented, “ This has been an excellent course which delivered important knowledge on scoring and administration. The ADOS-2 workshop is essential training for any clinician assessing individuals for Autism Spectrum Disorder. Even clinicians skilled in administering the ADOS-1 would find it very helpful in learning the updated protocols, revised algorithms, comparison score and the new modules. I gleaned much from A/Prof Gray’s extensive research and clinical knowledge.”  * Autism is a brain-based developmental disorder that affects a person’s ability to communicate, be with other people, and engage in developmentally appropriate behaviours.  Autism is a lifelong developmental disorder, and as yet there is no cure. Children do not “outgrow” autism but symptoms may lessen or change as the child develops and receives educational interventions. Source: Autism Resource Centre

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GPs Tackle Patients’ Mental Health Concerns By Penny Chua, Corporate Communications

While following up on his regular patient who had high blood pressure, general practitioner (GP) Dr Chua Teo Ngee (pictured) found out that the patient was also suffering from panic attacks and anxiety disorders, mostly triggered by queueing in crowded places. Dr Chua started him on treatment and after about six months, the patient was coping well and was even able to bring his family on an overseas trip.

Dr Chua is one of the GPs who have successfully completed the Graduate Diploma in Mental Health (GDMH). As the first port of call for the majority of the population when they fall ill, it is essential that GPs are well-equipped to detect and treat patients with minor mental health problems like mild anxiety and depression. There are people in the community who suffer from mental health issues in silence. Some are reluctant to talk about it due to stigma or a lack of awareness. Many times, GPs like Dr Chua are able to pick up mental health issues when treating patients for other medical conditions as patients are more willing to open up when seeing a doctor they are familiar with.

The GDMH enables GPs to update their skills and knowledge in managing mental illnesses, thus enabling them to provide better and more holistic care to their patients. Conducted by psychiatrists with different areas of specialisation, participants will get to leverage on their clinical experience as well as go on clinical attachments for case assessments. 

The Graduate Diploma in Mental Health (GDMH), jointly offered by the Institute of Mental Health (IMH) and the Division of Graduate Medical Studies, National University of Singapore (NUS), is a one-year course that will provide GPs with a comprehensive and structured training programme in psychiatry and counselling, so that they may provide basic mental health services in the community.

Calling all GPs!

At the end of the course, participants will be able to:

• Identify the various types of psychiatric disorders;

• Be familiar with the principles of treatment approach for different psychiatric cases;

• Apply assessment methodology to different mental disorders; and

• Learn management skills and prescriptions of medication.

Course Outline:

Module 1: Introduction to Psychiatry

Module 2: Psychosis

Module 3: Mood, Anxiety and Grief

Module 4: Addiction/Personality Disorders

Module 5: Child and Adolescent Mental Health including Learning Disabilities

Module 6: Psychogeriatrics

The GDMH is open for registration from 1 March 2014 – 18 July 2014. Government subsidy is available (subject to terms and conditions). For more information, please contact Nirhana Binte Japar at 6389 2831/nirhana_japar@imh.com.sg or Helen Ong at 6389 2968/helen_bc_ong@imh.com.sg.

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A Very Special Christmas Party By Ng Si Jia, Corporate Communications

Ushering in the Lunar New Year with a Book Launch By Cheong Yaun Marn, Corporate Communications

On 13 December 2013, the Neuro-Behavioural Clinic (NBC)-Autism Services under the Department of Child and Adolescent Psychiatry, IMH, teamed up with events company Dream Solutions to throw a Christmas party for its patients.

An annual affair since 2009, this Christmas party, beyond the fun and games, provided a platform for the children to practise their social skills and interact with one another. Pearl Lock, Clinical Psychologist from the NBC-Autism Services shared, “Children with autism suffer from difficulties in social and emotional communication. Often, they do not get invited to parties as social interactions are challenging for them. Hence, this Christmas party provides them with an opportunity to attend a special gathering where they can mingle with others in a group setting.”

On the morning of 7 February 2014, IMH’s Community Mental Health Team (CMHT) organised a Lunar New Year celebration for their patients and a book launch of their Chinese publication, “心路”. A revised and translated version of their English book “Journey to Recovery” launched in 2012, “心路”is a compilation of stories written by patients struggling with mental illness.

“心路”, edited by Dr Lee Cheng, Vice Chairman Medical Board (Clinical), IMH and his team contains touching and inspiring stories about how persons with mental health problems overcame their illnesses to lead meaningful lives in the community. These stories underline the importance of support from loved ones and mental health professionals in the journey of recovery from mental health concerns.

The event, held at IMH’s Lecture Hall, was graced by Mr Seng Han Thong, Member of Parliament for Ang Mo Kio GRC. Staff of the CMHT also showcased their performing talents to entertain patients and guests. A touching moment was when Dr Wei Ker-Chiah, Deputy Chief, Department of Community Psychiatry, invited his patient onstage to perform “My Heart Will Go On” on the recorder with him. A lion dance troupe and the “God of Fortune” also added to the festivities.

The good turnout saw 35 children and their siblings being thoroughly entertained at the party with a magic show, game booths and a photo booth. Fairy and reindeer mascots and balloon sculpting upped the fun factor for the children and their parents alike. Even Santa Claus made an appearance! Gifts and snacks for the party were kindly sponsored by McDonald’s, Lion Corporation, Khong Guan Biscuit Factory, Activhealth and Mondelez International.

Darryl (pseudonym), a 10-year old patient, said he enjoyed himself tremendously at the party, and is looking forward to similar parties in the future.

A day to remember: Volunteers from Dream Solutions and staff of DCAP share a light moment.

Dr Lee Cheng, VCMB (Clinical), IMH (right) presenting guest-of-honour, MP Mr Seng Han Thong (centre) with a copy of “心路” after the scroll of its front cover is unveiled. A/Prof Chua Hong Choon, Chief Executive Officer, IMH (left) shares in the moment.

To request for an e-copy of “心路”, please e-mail enquiry@imh.com.sg. “心路” will also be available for loan from selected public libraries from April 2014 (ISBN: 978-981-07-8852-0).

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Dr P S KumarConsultant Department of General Psychiatry Institute of Mental Health

Ask the Expert- Generalised Anxiety Disorder (GAD)

What is Generalised Anxiety Disorder (GAD)? What differentiates it from excessive worrying?

It is normal for everyone to face stress and anxiety in daily life, and to worry excessively in certain circumstances. However, if you experience excessive and persistent physical and/or psychological symptoms associated with anxiety that is not restricted to any particular event or circumstance, and if the anxiety interferes with day-to-day activities and relationships, you may be suffering from Generalised Anxiety Disorder (GAD).

Q:

A:

What are the symptoms of GAD? How do I know when I need to seek help?

Psychological symptoms of GAD like excessive worrying, concentration difficulties, sleep disturbance, nervousness and apprehension can cause physical symptoms to occur.

Common physical symptoms of GAD include increased muscle tension, trembling, lightheadedness, dry mouth and sweating. Other physical symptoms could include breathing difficulties, palpitations, nausea or abdominal stress. GAD has also been known to aggravate physical problems like hypertension and ischaemic heart disease as it causes further stress on the already burdened cardiovascular system.

It is advisable to seek help as early as the symptoms are identified. A diagnosis needs to be made by a psychiatrist to ensure that there are no underlying medical conditions causing the symptoms, and to assess if there are other comorbid conditions that need to be treated. Early intervention can bring about a better prognosis.

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What are some of the treatment methods for GAD?

As GAD is considered a chronic illness, treatment options are generally for the long-term. These could include:

1. Medications such as anti-depressants to help control anxiety — such medications have minimal side effects even with regular use. Sometimes, benzodiazepines can be used for short periods.

2. Non-medication treatment options include cognitive methods, where patients are taught about the symptoms and bodily responses related to anxiety, and how to modify thinking errors. Behavioural methods may also be used, in which patients are exposed to possible triggers and taught relaxation techniques. Lifestyle changes could also help GAD patients, as excessive stress can trigger or worsen GAD.

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What are some tips that can help me manage anxiety?

1. Breathe deeplyWhen you feel anxious, your heart tends to beat faster and you breathe faster or hyperventilate. This reduces the amount of oxygen that reaches your brain, which in turn causes you to feel light-headed or dizzy and results in heightened anxiety. Try breathing deeply. Make a conscious effort to draw deep breaths and blow them out slowly. This can help to reverse the physical symptoms and calm you down.

2. Engage your other sensesEngaging your senses will help you to focus on something else and take your mind off the trigger of your anxiety attack. You could look at a photo of something or someone you love, hum your favourite tune, hold an object that comforts you (a memento or even a stuffed animal), or stretch your arms and legs.

3. Talk to a friendSharing your feelings or concerns with a friend or family member who is a good listener can help you feel more relaxed. This will enable you to deal with the anxiety that you are facing.

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A:

How will my life be affected if I have GAD, but do not seek treatment?

Often, people with milder forms of GAD do not seek treatment. This can sometimes lead to serious consequences: their level of functioning may be reduced, they may suffer from some physical problems/illness, miss work frequently and visit the doctor often. If GAD is untreated, it may also lead to other mental illnesses like depression and abuse of illicit substances. It can affect the ability of the individual to progress in their career and in maintaining relationships.

Interested to Know More about Anxiety Disorders?

Published by IMH, “A Way out of Anxiety” is a book for anyone, including professionals and caregivers, who wishes to find out more about anxiety disorders. Each copy costs S$20 nett (delivery charges may apply). To purchase your copy, please visit http://www.imh.com.sg/eShop/.

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Riding the Rollercoaster of My LifeBy Yohanna Abdullah

Rising Above CircumstancesBy J. Ang

Living with bipolar disorder for the last 15 years has been like a rollercoaster ride, with the highs of manic episodes and the lows of depression.

I find the feelings of ecstasy that is mania intoxicating and addictive, as I love doing as I please. My behaviour, rude and irresponsible, shock and mortify my family and friends; I get terrible insomnia, and become increasingly irritable and impulsive as the episode goes by.

At times, I felt I could not bear living with a mental illness, but God has promised in the Quran that after every difficulty, there is relief.

Relief came in the form of Club HEAL, a non-profit organisation set up by Dr Radiah Salim. Club HEAL is where Hope, Empowerment, Acceptance and

It all began in 2008, when I was 19. My life was accelerating then as setbacks hit me like a stack of falling dominoes – a devastating exit from an important relationship, the gruelling lawsuit battle arising from my parents' divorce, my father's diagnosis of terminal stage lung cancer and his eventual departure, and a highly demanding major I was pursuing in a top London university. There were no breathers in between.

Every day, I woke up feeling lost. My perfectionist streak tried to grip a foothold and grasp each upheaval, but to little avail. Every ounce of strength left within me I exhausted, and I was totally drained. I felt as though my organs were shutting down one by one.

My mum was reluctant for me to see a doctor. Nevertheless, I knew myself best – my difficulty in concentrating undermined my capability and productivity. I knew I needed medical treatment. After witnessing my persistent struggles, my mum finally agreed. That

Love prevail and where we find healing from the pain and trauma of mental

illnesses for ourselves and our loved ones. 2013 became a good year for me. I only checked into hospital for 10 days,when I felt my mood was at a “7” on my happiness scale. I rate my mood every day, with “0” as “catatonically depressed”and “10” as “ecstatically out of this world”. I realise that I am stable and yet in my element when I am at a “6”.

I have rated myself a “6” in the past two months, thanks to all the care, concern and training I have received through Club HEAL’s day rehabilitation centres. I conduct expressive therapy every Monday, and I am now employed part-time as their publications executive,

.emit-trap gnitirw nwo ym morf trapaI also speak and share at seminars and talks on mental health. I also received a Heroes of Jurong Lake Run 2013 award, exemplifying the quality of Courage.

was the solace I was seeking to alleviate my torment and end my misery. By then, my depression had evolved into obsessive-compulsive disorder (OCD).

During the course of treatment, I worked full-time in advertising. However, I soon realised that the hectic nature of my job greatly compromised my progress in recovery. Many times, I missed clinic appointments because of work, and I felt I wasn't going anywhere. Seeking my employer’s understanding and empathy to take weekly time out for therapy was a challenge that hindered my recovery.

I began to confront and weigh the importance of Work versus Health. I took the bold step of leaving my job to focus on my recovery, so as to achieve better returns in the long term and enable myself to fulfill my potential.

This time-out of nearly one year bore fruit as my recovery progressed significantly, and I have since rejoined the workforce. I urge employers to be

aware and supportive of employees who have mental illness, as they seek to rebuild their lives.

Mental strength through a positive attitude is so important, and I want to encourage readers who are wrestling with mental health concerns to not lose hope, but rather, forge ahead with an optimistic outlook. I believe that you will come to see the light at the end of the tunnel, just as how I have.

I believe recovery is possible for

everyone with mental illness according to the definition they set for themselves. Recovery to me means being free of symptoms, joining the workforce again, being on good terms with family and friends and living life fearlessly. I am glad to have been able to come so far, and I look forward to an even better year ahead.

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Time to Burst the Silence

* For registration, please e-mail your name and contact details to chat@youthinmind.sg.

Burst the Silence is an ongoing campaign by IMH’s Community Health Assessment Team (CHAT) to destigmatise youth mental health problems, encourage youths to take the first step to seek help for mental health issues, and empower those with existing mental health conditions to step forth to share their stories.

In March, CHAT will present a public exhibition with three components that visitors can look forward to – photostories of youths who have chosen to break the silence, real-life reflections on mental health penned by youths, and a talk by a mental health advocate recovering from mental illness.

Saturday, 8 March 2014 – Monday, 31 March 2014

10am – 9pm

Central Public Library, Level B1 (left of counter), National Library Building, 100 Victoria Street, Singapore 188064

Nearest MRT Stations: Bugis and City Hall

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Burst the Silence Exhibition

Browse this collection of photos and eye-opening stories by individuals who have either had their share of mental health problems and are not afraid to talk about them, or who believe in helping to destigmatise youth mental health conditions. Sneak a peek at these portraits from the photo project’s website at http://burstthesilence.tumblr.com/.

These cards were designed to stimulate thought about mental health issues, and to encourage sharing. The public can view cards which have been filled up at previous events, or pen their thoughts on new cards.

This is not a typical first-person narrative about recovering from psychosis and schizophrenia. Neither does Lishan Chan offer clichés or false optimism. Instead, she chooses to take a proactive stance by proposing that we halt the intuitive urge to find solutions to mental health disorders, and accept them as problems to embrace.

Lishan Chan, the author of “A Philosopher’s Madness”, supports the empowerment of individuals with mental health problems, and speaks out against stigmatising them. You may have seen her on television (Channel NewsAsia and current affairs programme, “On the Red Dot”) and in print (The Sunday Times, The Straits Times, Business Times, and Lianhe Zaobao). Lishan has also spoken at various events organized by the Health Promotion Board, IMH, Singapore Association for Mental Health, and Silver Ribbon Singapore. 

Photo Portraits

Mental Health Post Cards

Talk by Ms Lishan Chan, Mental Health Advocate1

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Saturday, 8 March 2014

11am – 12nn

Central Public Library, Level B1 (left of counter), National Library Building, 100 Victoria Street, Singapore 188064

Nearest MRT Stations: Bugis and City Hall

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"We do not need to ask ourselves, why has this happened to us, or why did we or our family member deserve this? We do not need to ask ourselves what are the root causes and how do we fix it? Rather, we may treat it as an ongoing in life. Illness is as natural as birth and death." 

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EDITORIAL TEAM

Advisor Ting Mei See

Editor Vera Soo

Circulation Coordinator Chris Ngiam

Committee MembersJamilah BeeviFiona FooPenny Chua

Cheong Yaun MarnHan Bing LingNg Si Jia

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