<![CDATA[Mindmedic]]> <![CDATA[Location Map]]> ]]> <![CDATA[Mental Disorders Due To A General Medical Condition]]> MEDICAL CONDITIONS WITH PSYCHIATRIC PRESENTATION:

Many medical conditions can present with psychiatric features.

Among the common conditions are:
  1. Neurological conditions: Parkinson's disease, Stroke, Brain trauma, Brain infections.
  2. Metabolic imbalance.
  3. Hormonal imbalance: Hypoglycemia, Hyperglycemia, Hypothyroidism, Hyperthyroidism.
  4. Sepsis and many other conditions.

Hence it is very important to rule out all possbile medical causes before deciding that the patient is suffering from a Psychiatric Disorder.

 
PARKINSON'S DISEASE:

There are many Psychiatric aspects to Parkinson’s disease. Generally, the 3 main groups of mental disturbances noted can be classified into (Mjones):
  1. Personality changes
  2. Cognitive changes
  3. Affective changes and Psychoses.

Personality changes may be due to the increasing disability of Parkinson’s disease that results in restriction of activities and dependence upon others. Patient may show egocentricity, querulousness, suspicion etc. Commonly his premorbid personality will be accentuated, e.g. becomes more obsessive or anxious. Some may show hypochondriacal features.

Cognitive changes include memory impairment, mental sluggishness and difficulty to focus. Cortical and subcortical causes are suspected in contributing to these cognitive deficits.

Affective changes especially Depression is clearly established in many studies. Depression is often a reaction to the Parkinson’s disease although there are indications that depression may bear a more integral relationship to the disease process itself. Treatment with antidepressant medication can be highly effective in relieving both mental and physical symptoms of depression associated in Parkinson’s disease.

Sometimes the patient may show features of psychoses such as florid delusions, auditory and visual hallucinations. The reason is debatable although many believe it is due to iatrogenic causes: over-medication, effect of levodopa and atropine, which also has the tendency to cause confusion and delirium in the elderly population.

 ]]> <![CDATA[Cases]]> The following are case history of real-life patients.

For the purpose of confidentiality, their identities have been modified.

  1. a case of depressive disorder.

  2. a case of panic disorder.

  3. a case of chronic schizophrenia.

  4. a case of Alzheimer's Dementia.
]]> <![CDATA[An Overview Of Mental Disorders]]> There have been many misconceptions and myths about mental disorders (mental illnesses). Contrary to the public perception that mental disorders are all about 'Madness', the DSM-IV has listed a wide range of illnesses that encompass disorders seen in the children and adults, including the elderly:

  1. Disorders usually first diagnosed in Infancy, Childhood or Adolescence.

  2. Delirium, Dementia and Amnestic and other Cognitive Disorders.

  3. Mental Disorders due to a General Medical Condition.

  4. Substance-related Disorders.

  5. Schizophrenia and other Psychotic Disorders.

  6.  Mood Disorders.

  7. Anxiety Disorders.

  8. Somatoform Disorders.

  9. Dissociative Disorders.

  10. Sexual and Gender Identity Disorders.

  11. Eating Disorders.

  12. Sleep Disorders.

  13. Impulse-Control Disorders.

  14. Personality Disorders etc.

To get an overview of mental disorders, please click here.

]]> <![CDATA[How To Make A Diagnosis]]>
  • What does the doctor do in order to diagnose a patient? Please click here to know more.

  • What are the common symptoms that the doctor looks for?

  • How common are mental disorders? To learn the figures, please click here.

    •  

     

    ]]>         <![CDATA[Anxiety Disorders]]> Anxiety disorders are the commonest mental disorders which include a wide range of illnesses such as:
    Social phobias, specific phobias, PANIC DISORDER, generalized anxiety disorder (GAD), Posttraumatic Stress Disorder (PTSD), Obsessive Compulsive Disorder (OCD) etc.

    The core symptom are panic attacks and excessive anxiety.

    Panic Disorder is a common anxiety disorder seen in the clinics. Patients will complain of recurrent panic attacks. They are worried about having additional panic attacks in the future and worried about the implications/ consequences of the panic attack (eg: “I am having a heart attack”, or “I think I am going crazy!”).

    So what is a Panic Attack?

    Panic Attack is a discrete period of intense fear/ discomfort which peaks rapidly, usually within 10 minutes, often accompanied by a sense of imminent danger/ impending doom. It comes with a few of these following symptoms and signs:

    Palpitations
    Shortness of breath
    Chest pain/ discomfort
    Choking sensation
    Trembling/ shaking
    Sweating
    Numbness/ tingling sensation
    Chills/ hot flushes
    Nausea/ abdominal distress
    Dizzy/ fainting
                Feelings of unreality (derealization) or depersonalization
                Fear of losing control “going crazy”
                Fear of dying

    These patients may end up in casualty hyperventilating or complaining of chest pain even though all investigations done already rule out a medical condition. It is prudent to ensure the signs and symptoms are not due to drug of abuse (or some medicine).

    A detailed history may reveal an underlying psychological stressor prior to the onset of the panic disorder.

    A very common scenario is when a patient suffers symptoms such as chest tightness, palpitation, difficulty in breathing and numbness and goes about repeatedly checking with the cardiologists who do not find any abnormality to indicate heart disease. The unfortunate patient will spend lots of time and money looking for a cause! He may end up doing unnecessary invasive procedures, and waste many years before being diagnosed appropriately as suffering from Panic Disorder.

    Short term measures include prescribing benzodiazepines to abort a panic attack. However, the long term measures include using antidepressants (with anxiolytic effect), while teaching the patients Relaxation Techniques (breathing exercise, PMR etc) and incorporating Psychotherapies such as Cognitive Behavioral Therapy (CBT) when indicated.

    To learn more please click here.

    For updates on the management of anxiety disorders (6th ASEAN conference for Primary Health Care 2009), kindly click here.
    ]]>         <![CDATA[Mood Disorders]]> Major Depressive Disorder (MDD) is an example of depressive disorder (mood disorder category). Its clinical importance cannot be underestimated as it is widely prevalent and carries a high morbidity and mortality. The prevalence of MDD in the community is about 10%, with a lifetime risk of up to 12% in men, and 25% in women. 15% of patients commit suicide. Therefore it is urgent to manage these patients accordingly.

    Typically, the patient is in her 20s, 30s or 40s and presents with:
    1. biological symptoms of depression such as poor sleep, lack of appetite, losing weight, lack of energy, “always tired” and “being slowed down”. 
      A minority may complain of atypical symptoms such as sleeping too much, keeps on eating, putting on weight and agitation.

      In certain cultures and segment of society, the patient may just emphasize on these biological symptoms rather than talk about the emotional component of depression. It is therefore very important to have high index of suspicion of depression in patients (especially the elderly) who repeatedly present with multiple somatic complaints when all the biological/ medical investigations are normal.

    2. Emotional symptoms such as feeling depressed/ low/ sad/ ‘blue’/ unable to cheer up, and loss of interest. Patient usually says, “Things do not interest me anymore”.
      She may have excessive guilt and a sense of worthlessness and hopelessness.
    3. Cognitive symptoms like reduced concentration, indecisive, recurrent thoughts of death, suicidal ideation, suicidal plan and attempt.
      It is important to remember that depressive disorders are highly associated with other mental conditions such as Anxiety Disorders and Substance Misuse.

      Everyone feels sad at one time or another but when a patient has persistent low mood or loss of interest most time of the day, for nearly everyday in a 2 week period, then it must sound the alarm! Look out for signs and symptoms of depression, and other associated conditions. Treatment is warranted to reduce the duration of ‘suffering’, to reduce the risk of suicide and to quickly get the patient back to her normal level of functioning.

      Antidepressants, such as those in the tricyclics, SSRIs, SNRIs and NaSSA groups, are the main line of treatment. Nevertheless it must be prescribed judiciously based on their   side-effects profile, and toxicity in overdose. The duration of treatment is individualized based on a few factors, but generally the patient should be treated for another 6-9 months after complete symptom remission if it is the first/ initial episode of depression. Recurrence is common, especially if not fully treated. Some patients may need long term medication. Studies have repeatedly shown that a combination of pharmacotherapy and psychotherapy (IPT, CBT) is superior than either one alone in managing patients with depression.

      To learn more please click this link.

      To know more about bipolar disorders, please click here.

     

     
    ]]>         <![CDATA[Schizophrenia & Other Psychosis]]> Schizophrenia is a chronic mental disorder, with some patients showing exacerbations and remissions. The onset is usually gradual although patient may also present with acute onset of disturbed behavior. He may initially complain of sleep disturbances, changes in mood, difficult to concentrate at work, feeling ‘suspicious’ and thinking “people are out against me” during the prodromal phase.

    The core symptoms of Schizophrenia become apparent as the disorder progresses.

    Hallucinations, delusions, disorganized speech and disorganized behavior are the hallmarks. Some patients, especially chronically ill patients, may come with negative symptoms.

    The usual hallucination is auditory in nature where he hears voices talking to him or talking about him. Commonly these voices are derogatory in nature and may be ‘commanding’ too. Visual hallucination and hallucinations in other sensory modalities can also occur.

    Paranoid delusion and delusion of reference are very common where patient firmly (and falsely) believes that people, be it family member, acquaintance or strangers, are harboring ill-thoughts and ill-intentions towards him. Patient may actually react against these people due to his delusion.

    When the patient is acutely ill, he may talk irrelevantly and ‘loosely’ where it becomes difficult to understand what he is saying.

    He may also behave in a grossly disorganized manner by doing strange acts, socially unacceptable behavior and becomes violent.

    The negative symptoms of Schizophrenia include lack of motivation, lack of expression and reduced level of activity. Some refuse to talk or to socialize even with family members. He may prefer to keep to himself, lock himself in the room and refuse to eat. Few may present with catatonia which is life-threatening.

    The advancement in science and medicine has brought new understanding, new treatment and hopes to these patients. The ‘Stress-Diathesis’ model subscribes to the idea of interaction between biological, psychological and environmental factors in the development of Schizophrenia. Therefore, managing these patients is best achieved by a comprehensive and holistic approach. Treatment encompasses conventional and novel antipsychotics. It is important to monitor possible adverse effects such as tremors, stiffness, impaired glucose tolerance etc. Complicated cases with co-morbid conditions must be treated accordingly. Treatment outcome is improved by incorporating psychotherapy and modifying the environmental factors.

    Longitudinal follow-up is essential in picking up signs and symptoms of relapse/ exacerbation such as sleep disturbances, changes in mood, irritability, hallucinations, delusions etc. A concerted effort by all care givers and medical professionals can ensure a better prognosis for patients with Schizophrenia in leading a normal life.

    To learn more please click here.

    Click here to read the real case of a patient suffering from Schizophrenia.

    ]]>         <![CDATA[Treatments]]> There are many medications that are used in the treatment of psychiaric disorders. Please CLICK HERE  to see some of the medicine used.

    ]]>         <![CDATA[Disorders In The Elderly]]> Forgetfulness is part of normal aging. However, in some elderly patients, the process of aging appears to show accelerated cognitive impairment. These patients may show impairment in their daily functions, and may be suffering from Dementia. The commonest types are Alzheimer's Dementia and Vascular Dementia. 

    To know more about Alzheimer's Dementia, please click here. 

    ]]>         <![CDATA[Support Groups]]> Support group is integral in the holistic treatment of patient.
    It is important for the care-givers (family/ relative) to understand, and to share their experience, in order to better help the patients:
    (the information below is correct at the time of printing)

    All Women's Action Society: awam@po.jaring.my. 03 79570221

    Alzheimer's Disease Foundation Malaysia: www.adfm.org.my. 03 79521522

    Cancerlink Foundation: cancerlk@tm.net.my. 03 79569499

    Kiwanis Down Syndrome Foundation: us_kdsf@tm.net.my. 03 79571179

    London College of Clinical Hypnosis: www.hypnosis-malaysia.com

    Malaysian AIDS Council/ Foundation: www.mac.org.my. 03 40451033

    Malaysian Youth Council: www.belia.org.my. 03 91732761

    Malaysian Council for Rehabilitation: www.scsw@tm.net.my. 03 79553510

    Malaysia Mental Health Association: mmha@tm.net.my. 03 77825499

    Montfort Boys Town: www.montfort.org.my. 03 55191735

    National Association for Gifted Children: nagcmy@hotmail.com

    National Cancer Society of Malaysia: www.cancer.org.my. 03 26987351

    Persatuan Mencegah Dadah Malaysia: www.pemadam.org.my. 03 20941188

    Persatuan Penjagaan dan Latihan Kanak-kanak Autistik Hua Ming: www.autism.org.my. 03 77811111

    Persatuan Pure Life: purelife_adm@arc.net.my. 03 77829391

    PT (Pink Triangle) Foundation: isham@pop7.jaring.my. 03 40444611

    Red Crescent Malaysia: www.redcrescent.org.my. 03 42578122

    The Befrienders: www.befrienders.org.my. 03 79568144 or 03 79568145

    Website for Buddhism (Buddha Dharma Education Association Inc): www.buddhanet.net.

    ]]>         <![CDATA[Useful links]]>
  • National Institute of Mental Health, National Institute of Health, USA

  • Institute of Mental Health, Singapore

  • Australian Association of Buddhist Counsellors & Psychotherapists

  • World Health Organization: Mental Health

  • Annals of General Psychiatry (free access to journals and research materials)
    • ]]>         <![CDATA[Photo Gallery]]>  Welcome To Penang
    The Pearl Of The Orient
     
         

     ...Life Is Beautiful...
    Embrace A Brighter Future
      "YOU CAN MAKE IT"

     
       
    Dr. ONG BENG KEAT.

    MBBS (Ind.), M.Med.Psychiatry (Mal.),
    DClin.Hypnosis(UK), PGDip.Public Health (London), A.M.
    Consultant Psychiatrist.     
     
    Public Education     
        
    Public Education in Mental Health. Empowering the people with education.
          

    		 
    Dr. Ong is a regular writer and contributor to health magazines and newspapers, in addition to giving public lectures, as a way to reduce the stigma associated with mental illnesses.

     
       

    Ong Specialist & Counselling Centre Penang, is strategically located between Penang Bridge and the World Heritage City of Georgetown. The Specialist Centre is in the new Penang Waterfront, next to Jelutong Expressway, only 5 minutes from the Penang Bridge, 10 minutes from the city centre and half an hour from the Penang International Airport.
    (for map and direction, please click here)

    ]]>         <![CDATA[Disorders In Children & Adolescents]]> One of the common condition seen in clinical practice is autistic disorder. Click here to learn more about this condition that impairs the child, and poses a challenge to the care-givers.

    ]]>         <![CDATA[Forum]]> <![CDATA[Welcome To MindMedic.org]]> EMPOWERING YOU TO BE WELL & HAPPY !

    Psychiatry or Psychological Medicine is a specialized field of medicine which deals with every aspect of mental health. It involves managing all types of behavioral, emotional and thought disorders. Psychiatry also has a broader role in preventing these disorders by promotion of good mental health practice. It aims to help individuals achieve their best abilities and improves their quality of lives.

    Objectives of MindMedic.org:
    1. To educate the general public about the importance of mental health.
    2. To share information and latest findings about mental disorders.
    3. To empower the people with knowledge of mental health and reducing
        the stigma attached to individuals suffering from mental disorders.
    4. To provide an easy access to local mental health services
        (in Malaysia).

    Recent research showed 11% of Malaysians suffering from mental disorders. This is in keeping with statistics around the world where half a billion people (10% of population) have some form of mental disorders. It is a growing phenomenon with serious socioeconomic implication.

    It is a widespread misconception that mental disorders are all about 'madness', and that an individual who seeks psychiatric help must therefore 'be mad'. The society must understand that mental disorders encompass a very large group of emotional, behavioral, thoughts and neurological disorders.
    In fact, the commonest cases seen by a Psychiatrist are: children with learning disability, children with hyperactivity and autism, disciplinary problems, rebellious behaviour etc. Many adults with stress and sleep problems, anxiety, depression, drug/ alcohol abuse, relationship and sex issues, and dementia (eg. Alzheimer's disease) also seek professional care from Psychiatrist.
    The last decade has seen tremendous growth in the field of Neuroscience that unraveled the causes of these disorders. The advancement of modern medicine has greatly improved treatment and prognosis of mental disorders.

     

     


    Dr. ONG BENG KEAT.
    Consultant Psychiatrist,
    ONG SPECIALIST & COUNSELLING CENTRE (Location Map)
    Add: 8-G, Lebuh Sungai Pinang 1, Bandar Sri Pinang, 11600 Jelutong, Penang.
    Tel: 04-283 8178.


    For e-brochure, kindly click the following free downloads:
    a) first page of e-brochure
    b) second page of e-brochure

     

     


     

     



     

    ]]>         <![CDATA[Substance Misuse]]> Apart from nicotine (smoking), the commonest substance of abuse is alcohol. Click here to learn the life-story of a patient suffering from alcohol dependency and abuse.

    ]]>         <![CDATA[Other Relevant Topics]]>  

    1. Many patients and their families always ask, "Why do I get this (mental) illness?". While there is no one specific cause, it is believed that mental disorders develop as a result of a very dynamic interaction between biological, psychological and environmental causes in what is termed the 'Stress Diathesis Model'. To learn more about this concept, please click here.

    2. In order to 'survive' in today's hectic world, there are many LIFE SKILLS to learn. One of these skills is TIME MANAGMENT. Click here to know more about managing your time effectively.

    3. Please click on the following titles to learn more:
       Stress
       Stress Management
       Cancer Counselling

    4. Post-Traumatic Stress Disorder (PTSD).
      A public service for the people of Indonesia following the tsunami and earthquake disasters. This talk was presented in Bahasa Indonesia. To see the slides and audio-visual presentation, please click here.

    5.  'Pengendalian Pesakit' was presented in Bahasa Malaysia to the Malaysian Police Force in order to better understand the process of restraining violent patients. To learn more please click here.

    6. Signs and Symptoms of Anxiety Disorders. Please click here for free download!

    7. A series of discussion on hypnosis and hypnotherapy; please click on the relevant short topics:
      a) behavioural therapies and hypnotherapy
      b) the healing white light script
      c) psychodynamic in hypnotherapy
      d) hypnosis in treatment of tension headache

     

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