Bipolar Disorder

Minggu lepas, saya di tanya mengenai penyakit manic depression atau nama lain nya – bipolar disorder.

Ini lah dia, bipolar. Akan tetapi penyakit ini secara amnya ada dua yang sering diperkatakan, bipolar type 1 dan type 2. Type 1 adalah seperti infografik ini, ada waktu murung dan ada waktu tersangat happy. Bagi type 2, murung berlaku selalu tetapi waktu tersangat Happy tak ada. Yang ada, adalah waktu happy yang kecil dan tidak berpanjangan, kita namakannya hypo mania 😅

Untuk yang mempelajari isu bipolar ini diperingkat ijazah tinggi, mengikut kajian ada satu lagi kenos bipolar yang dinamakan mixed phase dan rapid cycling. Mengikut Akiskal, pengkaji terkenal bipolar dari Turki, beliau mengatakan ada berbagai variant bipolar ini 😳

Saya rasa yang penting adalah, walaupun sering diperkatakan, bipolar ini cuma dihidapi lebih kurang 1% rakyat. Yup cuma 1%. Rawatan nya ada di Malaysia. Pesakit memerlukan ubatan yang di panggil mood stabiliser. Kalau dirawat awal, keadaan mereka ini terkawal sangat dan mereka dapat berfungsi dengan sangat baik. Kalau dah tak sihat, biasanya kita akan jumpa mereka pertama kali di A&E memerlukan rawatan rapi dan mungkin terpaksa di jemput tidur di wad. Bila dirawat, insyallah cepat sembuh.

Pesakit bipolar penting dirawat awal oleh kerana simptom mania boleh menjerat diri sendiri. Risiko pengambilan dadah ataupun penglibatan diri dalam situasi tidak baik boleh berlaku. Mereka juga kadangkala di ambil kesempatan di atas.

Ramai orang terkenal sering dikaitkan dengan penyakit ini, antaranya Britney Spears dan Churchill. Maknanya, ramai pesakit ini boleh berjaya pada tahap tinggi. Ramai juga pesakit saya yang bergelar bipolar juga masih bekerja sebagai ahli perniagaan terkenal ataupun pangkat tinggi di syarikat2 di Malaysia. Bipolar yang telah dirawat bukan penghalang. Ada yang dapat berjaya tetapi rahsianya adalah perlu mendapat rawatan, makan ubat tanpa tinggal dan sering memperbaiki diri. Tiada jalan pintas. Usaha masih diperlukan.

Kalau kawan atau keluarga mungkin menghidapi penyakit ini. Datang lah berjumpa dengan kami 😊

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#mentalmalaysia #mentalhealthawareness #letstalkMY

Wanita & Skizofrenia Sering Disalah Erti

Artikel asal di KampusUOLS (link)

Skizofrenia merupakan salah satu penyakit mental yang sering disalah tafsir dan mendapat stigma yang paling tinggi. Malahan, perkataan ‘gila’ yang sering kita dengari selalu dikaitkan dengan simptom – simptom penyakit ini.

Walaupun jumlah pesakit ini sangat kecil, 1% menurut kajian, akan tetapi isu-isu tempatan dan luar negara yang negatif sering dikatakan dilakukan oleh mereka yang mengalami skizofrenia, di antaranya adalah keganasan, isu bunuh dan juga bunuh diri.

Seringkali juga, isu ini dilaporkan oleh kaum lelaki, maka adakah skizofrenia boleh didapati dalam kalangan wanita? Jika ia, adakah adanya persamaan antara lelaki dan wanita jika berpenyakit skizofrenia?

Kajian dan juga pengalaman klinikal menunjukkan bahawa skizofrenia tidak mengenali jantina. Malahan juga, ratio di antara lelaki dan wanita adalah sama. Dalam erti kata lain, kebarangkalian mendapat skizofrenia adalah sama di antara kedua-dua jantina. Tetapi, menurut kajian, kebiasaannya kaum lelaki akan lebih awal menunjukkan simptom dan didiagnosis.

Satu sebab dikatakan bahawa adanya hormon wanita yang mungkin mengurangkan risiko penyakit ini semasa awalan, terutamanya mengikut teori estrogen skizofrenia. Satu lagi teori untuk lelaki didapati lebih sering didiagnosis adalah disebabkan lelaki perlu lebih agresif untuk mendapat kerja dan diperkenalkan kepada tekanan lebih awal berbanding wanita. Akan tetapi, jika adanya kaum keluarga yang adanya penyakit mental dan/atau skizofrenia maka risiko diagnosa awal lebih tinggi bagi kedua-dua jantina.

Kebanyakan simptom skizofrenia adalah sama dalam kalangan lelaki dan wanita. Kebiasaannya diagnosa akan diberikan jikalau adanya simptom positif dan negatif skizofrenia yang aktif iaitu berterusan untuk sebulan. Kadang-kadang simptomnya datang dan pergi dan kebiasaannya diagnosa akan diberikan jika simptomnya melarat untuk enam bulan dan lebih.

Antara simptom positif dan negatif ini termasuk; halusinasi, delusi, kecelaruan pertuturan (disorganised speech), kecelaruan tingkah laku (disorganised behaviour), simptom negatif yang termasuk antaranya, simptom depresi, suka menyendiri, kurang motivasi, kurang bercakap, kurang aktif (avolition)Simptom boleh terhasil dari pelbagai deria tubuh, termasuklah penglihatan dan pendengaran -Gambar sekadar hiasan


Simptom boleh terhasil dari pelbagai deria tubuh, termasuklah penglihatan dan pendengaran -Gambar sekadar hiasan

Untuk diagnosa skizofrenia, perlu dipastikan bahawa tiada penyakit lain seperti kemurungan klinikal, bipolar dan masalah kesihatan fizikal lain seperti sawan, barah atau infeksi otak yang juga boleh menunjukkan simptom yang sama kadang kala.

Maka, tidak mustahil untuk doktor yang merawat mencadangkan agar pesakit diminta untuk mendapatkan kajian imej seperti imej CT ataupun MRI, ataupun mendapat ujian darah sebelum diagnosa tepat diberikan. Ini penting memandangkan, rawatan untuk penyakit fizikal seringkali diperlukan cepat berbanding jika penyakitnya skizofrenia.

Seringkali juga didapati kaum lelaki akan mempunyai lebih simptom negatif berbanding wanita. Kurangnya simptom negatif ini dan juga usia lambat untuk mendapat diagnosis sering dikaitkan juga dengan prognosis yang lebih baik. Kaum wanita juga didapati kurang menyalahgunakan dadah yang juga ada kaitan dengan penyakit ini.

Biasanya dadah digunakan untuk merawati diri sendiri kerana gangguan disebabkan simptom seperti halusinasi contohnya. Ini merupakan satu isu positif bagi kaum wanita yang adanya skizofrenia. Satu peringatan adalah dadah ganja didapati mempercepatkan simptom skizofrenia, maka ia perlu dijauhi terutamanya jika ahli keluarga mengalami masalah ini!

Apakah jika didapati adanya skizofrenia, ia boleh dirawat? Jawapannya adalah, YA! Skizofrenia boleh dirawat dan rawatan awal berkesan untuk mengurangkan dan menghilangkan simptom dan untuk segelintir pesakit, mereka boleh berfungsi seperti sebelum sakit.

Kadangkala akan kehilangan sedikit kebolehan, tetapi ada kes di mana pesakit dapat bekerjaya dan hidup seperti biasa. Tetapi rawatan mesti digunakan setiap hari tanpa lupa dan diagnosis dan rawatan perlu diberikan awal. Malangnya, mengikut kajian juga, lebih 70% pesakit yang baru diberikan diagnosa tidak mengikut rawatan dengan jitu dan sering lupa ubatan.

Malah, ada ahli keluarga dan rakan-rakan yang tidak peka dan percaya akan diagnosis ini menyebabkan ada kes di mana ahli keluarga selepas keluar wad tidak bekerjasama di dalam rawatan pesakit. Sering juga kedengaran bahawa bila dah melarat sahaja, barulah pesakit akan ke hospital dan kadangkala, terlambat!

Kajian kami di Universiti Malaya menunjukkan bahawa ia mengambil lebih kurang lima tahun sakit dan tiga tahun dengan simptom halusinasi dan delusi baru ke hospital. Satu jangka masa yang terlalu panjang.

Walaupun rawatan sedia ada berkesan dan boleh membantu, ada isu-isu dalam kalangan wanita yang perlu diberikan perhatian. Ubatan lama boleh memberikan kesan sampingan pergerakan yang lebih sensitif di kalangan wanita yang menggunakannya, juga ada antara ubatan ini yang boleh menyebabkan selera makan naik dan isu kegemukan.

Jika tidak dikesan dan dibincangkan, ia akan menyebabkan kurang minat untuk meneruskan rawatan. Ada juga kes di mana ubatan yang diberikan menaikkan hormon prolaktin yang mungkin menyebabkan masalah haid. Maka simptom tiada dan pesakit baik akan tetapi kadangkala rasa tidak ‘lengkap’ oleh kerana tiadanya haid bulanan.

Wanita yang masih di dalam umur reproduktif juga perlu diberi perhatian khusus. Skizofrenia tidak menafikan hak dan kebolehan untuk menjalinkan hubungan, berkahwin dan mengandung. Tetapi, kedua-dua pihak perlu sedar bahawa dengan penyakit kronik sebegini, perbincangan awal untuk berkahwin dan mendapat anak adalah penting. Perbincangan bersama doktor yang merawat juga penting seawal sedar dan inginkan zuriat agar satu perancangan yang baik dapat dilakukan untuk memastikan ibu dan bakal anak selamat dan sihat.

Kesimpulannya, penyakit skizofrenia tidak mengenal jantina tetapi wanita yang berpenyakit ini mempunyai isu-isu unik yang perlu diberikan perhatian dan dibincangkan bersama. Rawatan sedia ada berkesan dan selamat digunakan dan lagi awal dikesan, lebih baik prognosisnya.

Friends in Psychiatry

I had the pleasure to share space during the recently concluded Masters Conjoint Exam with these two young psychiatrists, both my juniors and leading the way in advocacy.

(Dr Fadzli Mohd Isa – addiction psychiatrist, Dr Ahmad Rostam – budding liaison psychiatrist and I)

It was an interesting session we had. We were discussing the way forward for the use of social media for mental health advocacy, apart from the pitfalls which can or has happened as we work in this area using social media. This included responding to questions posed, handling emails and private if not direct messages and also the inadvertent viral tweet/statement/opinion.

Of recent concern is the over eager trainee who advocates with, at times, little knowledge and to much enthusiasm which, can, be a problem. Now we are not saying don’t do it, but be careful. If you’re a trainee you’re bound by the university code of conduct and as a medical doctor, you’re also bound by the medical code. If you’re a Ministry of Health practitioner, you need the relevant clearance too. Also, unless you’re really really good in your studies, you’re also playing with the risk of the halo effect which might be a problem for some.

Nevertheless, we are excited by the interest among our younger colleagues and we believe it augurs well for psychiatry in Malaysia.

To all exam goers – good luck. Results out on Friday 😊

(Dr Ahmad Rostam and I are also members of the #MedtweetMY family)

Meeting Prof John Kane

Prof John Kane and I.

For all #medstudents and in particular trainees in psychiatry, this is one of the “legends” in psychiatry. Even as a medical student, (I), we were taught the Kane Criteria for diagnosing Treatment Resistant Schizophrenia (TRS). TRS are people with schizophrenia who have not responded to available treatments. According to Prof Kane, one needs to have failed 2 types of treatment – with adequate dose and adequate duration – before a diagnosis of TRS is made. The criteria to diagnose TRS is important as it is a reason to start or to justify the use of clozapine, a highly effective treatment for schizophrenia but requires some caution.

We had an extremely fruitful discussion as a group and a more intimate session for some of us in discussing the management of schizophrenia, particularly in the use of long acting injectables (LAIs). If you have been listening to my podcasts. I’ve been using these for my own patients and am convinced that this is way to go to protect brain function, reduce relapse and increase Quality of Life and day to day functionality. I hope to add more podcasts on this to share with all of you my learnings.

Today’s session was also extremely helpful as concerns that Malaysian psychiatrists have in the treatment of this population was no different from the international psychiatrists which was reassuring.

I only wish all medical students and trainees in psychiatry could have met and be inspired by him and his work. He is truly an inspiration as a clinician, scientist and advocate for mental health.

World Mental Health Day Month coming to an end

Hi there everyone.

Sincere apologies for the silence here. I’ve been updating other sites in this crazy month. There has been a number of activities in University Malaya and beyond and it is our hope that you have managed to catch a few of these activities.

I wanted to share with you one of my smaller initiatives to end the month – the green ribbon campaign – which some of you are aware of. You will note over the past month in the few television appearances and also public appearances that I have with me a green ribbon. This is in support of World Mental Health Day. I’ve run a small project which some of you have participated in. I hope that those of you who did will be able to get one of these ribbons too. It’s a small gesture from me and others but it has a big meaning for everyone struggling with mental illness and mental health issues.

I do hope that I’ll be able to share with you the few pictures of people who have taken part in making this 36 hour campaign a success.

Depression during pregnancy

Depression during pregnancy can happen anytime before, during or after delivery.

We include a simple fact sheet in Malay which was highlighted by Wanita Hari Ini today with Fiza Sabjahan (26/9/2018) for the relevant audience which was made by my undergraduate students and field tested during their community visit.

Phamplet 1

Phamplet 2

You can also learn more about this in these podcasts too

http://shoutengine.com/DrAmerSiddiqonMentalHealth/kemurungan-selepas-bersalin-61402

or

http://shoutengine.com/DrAmerSiddiqonMentalHealth/postpartum-depression-59235

Thank you to TV3 for the support in #mentalhealthawareness

Innovations in Global Health Professions Education 2018

Interesting times are here in medical education.

Currently in a conference for innovations for medical education where a number of innovative strategies are now in place for medical education. Using AI together with current strategies appear to increase learning and eventually service. This to me is ground breaking. I’m hoping that this will introduce better health care provision to the people of Malaysia.

However we must be careful to avoid addictive behaviour and also psychological consequences of technology, especially when we are unprepared.

Excitement in Munich

I wanted to share with you a recent happening in my life. I’m in Munich to attend a conference on smoking cessation but realised on entering that the venue is in the Department of Psychiatry at the Ludwig Maximilian University. At first this was not a big deal, not that it really registered. However, as I was walking to the first keynote, I was greeted by Prof Dr Emil Kraepelin!!

It turns out, I’m in the department which Kraepelin started and later a person named Prof Dr Aloys Alzheimer was also a faculty member here. Yes, that Alzheimer’s!!!

What luck!

So I wanted to share some pictures and a video with you about this so you too can experience what I did. For my students and trainees, you will want to watch this.

Now, for others here, you might be wondering Kraepelin who? Alzheimer’s? Well these two psychiatrists did wonders for the field. One defined what we now understand as schizophrenia and bipolar disorder and the difference between the two. He described schizophrenia as dementia praecox and bipolar as a separate entity. We still use his understanding until now. The other person found the cause of a neurodegenerative disorder of the brain which caused people in late life to lose their memory. His work has allowed us to better understand the brain and as a result have massive research programs to be set up allowing people with this illness to prolong their memory and thinking with new medical inventions and discovery.

Hope you enjoy the video. Another video on the Head of Department introducing his department is in my Facebook feed too.

This video is for all my trainees in psychiatry. Here I am in the Dept which Prof Dr Emil Kraepelin started and sitting in the hall which Prof Kraepelin lectured! I’ll let the HOD of the Dept of Psychiatry Munich introduce to you his beautiful department. Now also listen about the importance of smoking cessation for our patients. My personal take is that if you’re not treating people with mental illness for their tobacco use, you’re doing an injustice to them too. #mentalhealthawareness #mentalmalaysia

Posted by Dr Amer Siddiq on Jumaat, 7 September 2018

We talk about suicide reporting again

Good morning everyone and a friendly reminder to all my friends in the media as we strive to improve mental health care and #suicideprevention in Malaysia

We have been awoken time and time again with sad news on untimely deaths. More importantly the method of reporting at times have been noted to be wanting.

In lieu of this and other reasons, some of us have in recent times taken up the challenge and decided to do a little bit more.

Do take the time to also read our latest paper on this issue. We provide some context on why this is important. We call upon all stakeholders to take part in this effort. We encourage people to improve in the way they report the news.

https://www.mjpsychiatry.org/index.php/mjp/article/view/472

For all my trainees and students, this is also very relevant to you. You are training in a very interesting time for psychiatry. There is slow but steady rise in mental health awareness. You must be ready to take up this challenge when called upon.

As part of our efforts, myself and few others (A/Prof Dr Chan Lai Fong from UKM and Dr Nurashikin from MOH) with the support of University of Malaya will be hosting a workshop on best practices for reporting suicide. Stay tuned 😉

For more you can also listen to podcasts episode 39 and you might want to also hear episode 12

Have a great day