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Dr Jacob Rajesh Speaks with Expat Living on the misconceptions of psychiatric medication

Dr Jacob Rajesh Speaks with Expat Living on the misconceptions of psychiatric medication

by | Apr 5, 2022 | Addiction, Adult Psychiatric & Counselling Services, Articles, Dr Jacob Rajesh, Our Services, Promises Team, Psychiatry

Psychiatry Questions … Answered!

28th February 2022 by Dinesh Ajith  4 Min Read

What are some commonly used psychiatric medications?

Depression is a very common disorder, affecting between five to ten percent of people, so we use antidepressants quite often. The medications we’ve been using for the past 25 years are called Selective Serotonin Reuptake Inhibitors (SSRIs). These newer generation drugs have much fewer side effects than those used in the past.

They do have some side effects though, the most common being gastric distress, nausea, headaches and insomnia. Some people also report sexual dysfunction and decreased libido. However, these side effects can be managed once the medication and dose is adjusted. SSRIs are usually more tolerated than older antidepressants.

Another group of drugs is the antipsychotics, which are used to treat schizophrenia and bipolar disorders. The second generation antipsychotics have fewer side effects than older ones, along with fewer cognitive effects and extrapyramidal side effects such as causing tremors or stiffness. However, side effects such as weight gain, increased blood sugar and increased cholesterol can occur with some of these drugs; these side effects need to be screened for on a regular basis

promises healthcare psychiatric medicine and antidepressants

Is psychiatric medication an alternative to therapy? Or do they work hand in hand?

Medication and therapy usually work hand in hand. Being medication-compliant is another important part of the mental health recovery treatment as it helps bring stabilisation to the chemical and biological changes in the sufferer that cause the disorder.

For depression, we prescribe medication for moderate or severe symptoms if it’s causing impairment or distress. We also recommend psychotherapy in its various forms: cognitive behavioural therapy, dialectical behaviour therapy, acceptance and commitment therapy, interpersonal therapy or family therapy, depending on the psychosocial stressors.

For bipolar disorder or psychotic conditions like schizophrenia, medications are the mainstays of treatment. However, psychotherapy methods can also help with regulating emotions and give handles to help regulate distorted thoughts when mild symptoms occur. Psychological therapy also plays a role for Obsessive-Compulsive Disorder (OCD) and eating disorders. Here, psychotherapy has a much more important role.

What are some of the misconceptions people have about psychiatric medication?

The most common misconception is that all psychiatric medications make you feel like a zombie – you can’t function, you can’t go to work, your mental faculties are affected. While some of the older generation antipsychotic medications can cause mental fogginess, there are newer ones with fewer side effects. Some people also believe that if they start taking medication, they might become addicted. It is usually the benzodiazepine class of drugs that are addictive in the long term; antidepressants aren’t addictive in the long term. We also see many patients who’ve been taking medication on a long-term basis, but we work with them to minimise side effects. We do this by adjusting the dosage, changing the class of drugs used and lifestyle modification. It’s also worth mentioning that psychologists cannot prescribe any of these drugs, only psychiatrists can.

Can you tell us more about new techniques like Transcranial Magnetic Stimulation?

Transcranial Magnetic Stimulation (TMS) uses electromagnetic waves to stimulate the brain. Unlike electroconvulsive therapy, which is more for people with severe psychotic depression, TMS doesn’t require any sedation. The patient simply sits in a chair and has a device placed at specific parts of the brain where it sends small electromagnetic waves. It is an outpatient procedure and there aren’t usually any side effects.

TMS is used primarily for people with depression who haven’t responded to antidepressants or have severe side effects from medication. It’s not usually a first-line procedure.

Is it as effective as antidepressants?

It works in combination with them. If that alone isn’t helping, TMS can augment the medication. It can also help by itself, but once the treatment stops the patient can relapse, so it’s better to take medication along with it.

What are some psychiatric issues that people may not realise they have?

Many people don’t realise that depression or anxiety disorders are mental illnesses. They think it’s a weakness in their own personality or the result of external stressors they can’t handle. The stigma of mental disorders also plays a big part. People tend to be quick to seek help for physical issues but still feel uncomfortable seeing a psychiatrist. I think it’s becoming more accepted though. There’s a misconception that psychiatrists just provide medication.

What else do they do?

Psychiatrists work in teams. The team-based approach is very important because we have psychiatrists who are qualified doctors along with psychologists who are trained in psychotherapy. We also have social workers, case managers and occupational therapists.

It’s a misconception that psychiatrists cannot do therapy. There are many psychiatrists who are trained in many forms of therapy, but the psychologists are the professionals who study these critical areas in depth. We refer the patients to them because it is their area of expertise.

What would you tell someone who is unsure about seeking help?

Don’t be ashamed of your symptoms or be self-critical. Many feel their symptoms stem from a weak personality or an inability to handle stress. People need to understand that mental health issues can occur for people who’ve done everything right – people with a good job, a good family life, good support and no financial issues. Depression is a biological response and it can happen without any external stressors so there is no shame in seeking help.

Dr Rajesh is a Senior Consultant Psychiatrist at Promises Healthcare, a provider that offers a wide range of psychiatric and psychological services for patients of all ages. Promises is also the only private centre in Singapore to offer Transcranial Magnetic Stimulation.

For more information on psychiatric medication and treatments offered by Promises Healthcare, click here.
#09-22/23 Novena Medical Center | 6397 7309

This article first appeared in the February 2022 edition of Expat Living and was published on their website. 

 

Dinesh Ajith

Dinesh is a seasoned writer and editor with seven years of experience covering travel, restaurants and bars. His interests include film photography, cheesy 90s monster flicks, and scouring the island for under-the-radar craft beer bars.

An Interview with ANZA magazine on how psychological testing can help your child

An Interview with ANZA magazine on how psychological testing can help your child

by | Apr 5, 2022 | ADHD, Anba, Articles, Children and Adolescent Services, Our Services, Promises Team, Psychological Testing, Tan Su-Lynn

Raising a child is demanding – their emotions and personality trait can change frequently. As a parent, how can you tell if your child’s behaviour is part of growing up or a cause for concern?
Child psychologists at Promises, Tan Su-Lynn and SC Anbarasu speak to the editorial team at ANZA about psychological tests for children and adolescents which help parents better understand the strengths and challenges their child has in areas of cognitive, behavioural, learning and socio-emotional functioning.
Learn more about the types of tests and what goes into one.

 

As parents, we all want the best for our children. We naturally see the good in them and marvel at their every new development and discovery. However, raising a child can be demanding. Even under the greatest circumstances, their emotions and personality traits can change frequently, and it can be difficult to pinpoint when certain behaviours are typical or might need special attention.

Just like us, children experience a huge range of emotions (some more adorable than others!). They can be sad, anxious, aggressive or irritable. They can be restless, reclusive or downright grumpy. In most cases, these feelings are perfectly healthy, but how can you tell if your child’s mannerisms are a part of growing up or a cause for concern?

Promises Healthcare, Psychiatric & Psychological clinic can help to put your mind at ease with their psychological tests for children and adolescents. Carried out by their expert team of senior child and educational psychologists, these evaluations can help parents to better understand the strengths and challenges their child may have in areas of cognitive, behavioural, learning and socio-emotional functioning.

Tan Su-Lynn, Senior Educational Psychologist at Promises

Why take a psychological test?

While the idea of psychological tests for children might sound daunting, they can be essential in helping parents to make educated choices and implement strategies to ensure a child is getting the right support. “Intelligence – sometimes referred to as the Intelligence Quotient (IQ) – includes cognitive functioning, intellectual ability, aptitude, thinking skills, and general ability,” explains Senior Clinical Psychologist at Promises, S C Anbarasu. “Based on the type of assessments used, trained psychologists can obtain a more in-depth understanding of a child’s challenges. Some potential issues that can be detected include emotional or behavioural problems, or delayed learning with writing, spelling, maths or reading. Testing also helps to identify the presence of autism, ADHD or dyslexia.”

Says Tan Su-Lynn, Senior Educational Psychologist at Promises, “When a child is observed to have difficulties with their learning or behaviour in school or at home, this may suggest the possibility of a learning or behavioural disorder. Severity of the difficulties should also be taken into consideration, such as whether they impact their social, home and/or school functioning. Psychological testing can obtain a profile of a child’s strengths and areas that require support.

Reasons for a psychological test can include:

  • Learning difficulties or delays (for example, difficulties with spelling, writing, reading)
  • Emotional or behavioural problems in the classroom or home
  • Admission to special educational programmes
  • Increased understanding of a child’s learning style
  • Concerns regarding possible attentional difficulties
  • Underachievement
  • Giftedness

 

Senior Clinical Psychologist at Promises, S C Anbarasu

What are the tests and how do they work?

Depending on your concerns and your child’s needs, there are two types of psychological tests for children available at Promises to ascertain a child’s profile. “The IQ test measures a range of cognitive abilities and provides a score that is intended to serve as a measure of the child’s intellectual abilities, overall thinking, reasoning skills and potential,” explains Su-Lynn. “Our Academic Testing assesses areas in language, reading, writing, mathematical skills, comprehension and fluency.”

After an initial consultation period, both assessments take place in stages. As each one lasts approximately 6-12 hours, sessions are spaced out to reduce fatigue and distraction. There are no scary school exam style set-ups here: each test involves fun problems, puzzles and questions. “Generally, most children enjoy the testing sessions as it’s an engaging process,” says Anba. “To make sessions as stress-free as possible, we have regular breaks so they can play with their favourite toys. Tasks that involve using hands to construct or fingers to point at pictures appear to appeal the most. Parents are welcome to join their child throughout for support.”

Once completed, a feedback session is arranged to discuss the outcome and provide parents with the opportunity to ask questions. Parents also receive a comprehensive written report with recommendations for home and school settings. Continues Anba, “With psychological tests for children, we can address potential issues early and hopefully prevent the child from feeling demoralised, stressed and anxious in the future.”

When parents and teachers work holistically with Promises, everyone receives a better understanding of the child’s behaviour and game-changing solutions to bring them a brighter and happier future.

Promises Healthcare_Psychological Testing Diagram

Discover more at Promises Healthcare, Psychiatric & Psychological clinic.#09-22/23, Novena Medical Center, 10 Sinaran Drive, 307506. Tel: +65 63977309

 

*This article was first published on ANZA’s website. 

An Interview with HoneyKids Asia on the whats and hows of ADHD in Children

An Interview with HoneyKids Asia on the whats and hows of ADHD in Children

by | Apr 5, 2022 | ADHD, Anba, Articles, Children and Adolescent Services, Our Services, Promises Team, Tan Su-Lynn

While most of us may be familiar with the term ADHD or Attention-Deficit Hyperactivity Disorder, we may be unfamiliar with the challenges and struggles a child diagnosed with ADHD goes through.
Our senior psychologists from the Child and Adolescent team, S. C. Anbarasu and Tan Su-Lynn, spoke to the editorial team at HoneyKids Asia to shed more light on ADHD, how it affects kids, what are the early symptoms, and how parents can support a child with a diagnosis.
What’s the Difference Between a Psychologist and a Therapist?

What’s the Difference Between a Psychologist and a Therapist?

by | May 31, 2021 | Adult Psychiatric & Counselling Services, Articles, Promises Team

Psychologists and Therapists are often misunderstood to be the same profession, but they aren’t one and the same. Both types of mental health professionals, however, do have a vast knowledge of mental processes. As a general rule, they may work closely together to conduct sessions with their clients and work to alleviate the individuals’ mental health status. In this article, we try to help you understand the difference between the two and explain how each can help with your mental health needs.   

Psychologists – not to be confused with Psychiatrists – are mental health professionals who are adept at the study of the mind, and are professionally trained in one or more subfields of psychology. In terms of their clinical orientation, psychologists can have different specialisations. To list a couple of examples, some specialisations may include the treatment of patients with affective disorders, addictions, trauma, or personality disorders. 

Psychologists are skilled at clinical interviews and comprehensive psychological testing and assessments, with common ones such as a Patient Health Questionnaire-9 (PHQ-9), or others including a Wechsler Abbreviated Scale of Intelligence (WASI). Clinical psychologists, while unable to provide neuropharmacological support, are able to make a diagnosis if a patient is suspected to have a mental health condition, before moving on to the treatment process. Generally speaking, psychologists tend to approach treatment by exploring the larger theoretical bases of human thought and behaviour. Through this, they work alongside the patient to sieve through difficult life events, long term anxiety or traumatic experiences, in order to trace back to a possible cause of dysfunction. The most common type of treatment used by psychologists is psychotherapy, or talk therapy. The treatment process certainly isn’t one-size-fits-all, for all individuals and their life experiences are different and unique in their own ways. Psychologists ensure that the course of treatment is tailored to each patient’s needs and goals, and help them work through their concerns in a holistic manner. Psychologists can often work in tandem with psychiatrists,  in order to provide the optimal treatment for a patient.

In contrast, therapists tend to work from a broader perspective. As social relationships are a significant contributor to one’s mental wellbeing, it is important that they are balanced and are not debilitating towards one’s mental health status. Thus, therapy often helps an individual to gain insights into his interpersonal connections, in addition to self-actualisation. Therapists can also have varying specialisations. For instance, a marriage and family therapist can help couples or families resolve interpersonal hardships, a child therapist can help a child overcome developmental disturbance, and a Cognitive Behavioural Therapist can aid one in switching away from destructive life habits. Regardless of their specialisations, therapists are, at their core, there to provide mental health support, focusing mainly on improving an individual’s well-being and their ability to cope with day-to-day stressors. 

Therapy can be exceptionally beneficial for persons who require skill sets involving emotion and problem-solving strategies, such that they are better able to cope with difficult times in a healthy manner without having their emotions rule over them. Therapists are in some sense, a guiding light for patients. By providing guidance and support, therapists can nudge one towards clarifying their emotions and helping them make better life decisions (not making the decisions on their behalf!)

Therapists, like psychologists, are unable to prescribe medications. A therapist’s goal is to help patients make decisions and clarify their feelings in order to solve problems. Therapists provide support and guidance while helping patients make effective decisions within the overall structure of support. 

Just like how your body can react to physical illnesses, issues with mental health (especially if they are persistent) can be debilitating too. Now that you have a better understanding of the differences between psychologists and therapists, how you do choose the right clinician for your mental health issues? A great first step would be to browse our list of professionals at Promises Healthcare and make an appointment with one whose speciality best suits your needs.

References:

  1. https://dictionary.apa.org/psychologist (Accessed 06/05/2021)
  2. https://positivepsychology.com/how-to-become-a-therapist/ (Accessed 06/05/2021)
  3. https://www.humanservicesedu.org/counselor-vs-psych-vs-therapist/ (Accessed 06/05/2021)

 

Evidence-Based Mental Health Disorder Diagnosis: How It’s Done from a Clinical Perspective

Evidence-Based Mental Health Disorder Diagnosis: How It’s Done from a Clinical Perspective

by | Oct 13, 2020 | Adult Psychiatric & Counselling Services, Articles, Mental Wellness, Promises Team

For individuals that are taking the first step to seek help from mental health professionals, it is natural that they may be concerned with the possibility of a misdiagnosis, or perhaps an overdiagnosis. With the pre-existing stigmatisation of mental health disorders, clients would have needed to pluck up their courage to seek treatment in the first place. A misdiagnosis could not only hinder them from receiving the appropriate treatment for their affliction, but also allows for their distress to grow unchecked as their hope for recovery diminishes. In other words, accuracy in evidence-based mental health diagnosis is crucial, and this article aims to help you better understand how the diagnostic process works.

As the term “Evidence-Based Diagnosis” implies, psychiatrists or clinical psychologists take extra care to ensure that any diagnosis made is accurate, objective, and not subject to any form of personal bias. In some sense, this also means allowing for a safe, non-judgemental and compassionate environment. Primarily, clinicians would have to understand the client’s suffering and situation, before thinking about how that might relate to a possible mental disorder. Perhaps you may be unaware of this – clinicians do not simply jump straight into tying the client down with a specific diagnosis of a mental disorder. Before all else, clinicians have to consider if the client’s symptoms meet the definitions of a mental disorder in the first place. As per the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the definition of a mental disorder considers these five factors:

  1. A behavioral or psychological syndrome or pattern that occurs in an individual
  2. Reflects an underlying psychobiological dysfunction
  3. The consequences of which are clinically significant distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning)
  4. Must not be merely an expected response to common stressors and losses (i.e.. the loss of a loved one) or a culturally sanctioned response to a particular event (i.e. trance states in religious rituals)
  5. Primarily a result of social deviance or conflicts with society

With reference to the definition of a mental disorder, it is particularly important to note that the consequences of a mental disorder is clinically significant, and causes a weighty amount of disruption to one’s lifestyle and day-to-day activities. For example, it is completely natural for one to feel upset over certain situations, and this does not necessarily mean that you have a case of depression. However, you might need to get it checked out if you find yourself unable to cope with prolonged feelings of sadness which start to interfere with your daily activities, or are causing you to have suicidal thoughts.  

Of course, clinicians then assess the syndrome one displays. By “syndrome”, we mean a collection of signs or observable aspects of the client’s suffering (i.e outward expression or behaviour). The main point of this is to identify if the syndrome is clustered in an identifiable pattern that is noted to be severe or pervasive. During the assessment phase, clinicians also try to understand the internal experiences of the client. Besides their outward display of distress, their thoughts and feelings are also important information which counts towards the diagnosis of certain disorders. Upon identifying that the client is indeed suffering from a mental condition, clinicians then try “assigning” the client to a particular category. You can think of it as, “can the syndrome be broadly identified?” There are certain broad categories of disorders, such as anxiety disorders, or psychotic disorders. Needless to say, clinicians have to consider which category the client best fits in.

The last step of the diagnosis process concerns the further narrowing and identification of the specific disorder – branching out from the broader, generalised category and into the specific details. For example, a client could be diagnosed with Obsessive-Compulsive Disorder (OCD), a form of an anxiety disorder. Ideally, a specific disorder is identified during the diagnosis process for various reasons – for the sake of the clients themselves, but also for clearer communication with other mental health professionals (in the case of continuity of care), and even for legal or court matters. Under rare circumstances, some clinicians are able to identify the broad category of the mental disorder, yet are unable to specify the exact condition that the client is suffering from. In cases like these, their disorders will be labelled as “unspecified”, as per the 10th version of the International Classification of Diseases. 

As mentioned, evidence-based mental disorder diagnosis is all about diagnosing clients accurately and objectively. To enhance objectivity, some clinicians go the extra mile, stopping to consider if the diagnosis given was biased, or influenced by his or her own culture and history. “Is the syndrome maladaptive?”, “Did I take cultural variables into account?” An objective diagnosis will certainly go a long way in ensuring that the client receives the most appropriate treatment, which will in turn enhance his or her recovery journey. 

Overall, it is safe to say that it takes two hands to clap in every treatment process. Clients and clinicians should try as much as possible to work together, be it in the assessment or treatment phase. For an effective treatment, clinicians will do their best to assess the severity and pervasiveness of any syndrome using understandable language such that clients are well aware of their condition. However, clients also need to understand that transparency on their side is pivotal and that it will drastically impact the treatment process, for better or for worse, depending on their cooperativity and how much they choose to reveal. 

 

References:

Dr Robert Shwartz, Ph.D., PCC-S, Evidence-Based Mental Disorder Diagnosis: How to Increase Accountability, Efficiency and Objectivity, video recording, Mental Health Academy

<https://www.mentalhealthacademy.co.uk/dashboard/catalogue/evidence-based-mental-disorder-diagnosis-how-to-increase-accountability-efficiency-and-objectivity> (Accessed 11/09/2020)