Monthly Archives: November 2013

Bipolar Disorder

Bipolar Disorder, Depression, Issues & Debates

His family came for consultation on behalf, as he wouldn’t come no matter what. According to what his family (wife, son & daughter-in-law), he is in such a hypomanic stage, with spending spree, agitated mood, and not sleeping much day nor night.

However, we were surprised to know that the man has been taking anti-depressant himself. The son said that he was depressed few months ago, so he willingly went to the general hospital to see a psychiatrist, and got some anti-depressant medication. He has since then been taking it, and got better from depression.

Now that he’s in such a hypomanic stage, imagine he’s still continuing with the anti-depressant?! He gets even hyper and manic. He doesn’t listen to his family’s advice to stop the anti-depressant, as he feels good taking them, energetic, filled with drives, jovial… (but manic in others’ eyes).

So after consulting us, we’ve given advice to the family that they will have to find a way to stop the man from taking the anti-depressant but to start with our medicine. Few days later it was the date for the man to go for appointment in the general hospital, where he usually just collects medicine as the appointment bookings for the psychiatrist is always full. So when the son accompanied him there (he’d never accompanied his father to the hospital), again the nurse asked them to collect the same medicine as the appointment booking is full. This time, with the advice from us, the son refused. He said the man’s condition is no longer the same, he can’t take the same medication. They sent him to Accident & Emergency department where the man was asked to do blood test. Only with blood test result coming out few hours later, they got to see the psychiatrist doctor.

Here it shows the importance to regularly have follow ups and reviews with psychiatrist doctor rather than continuously collecting and taking medicine (which is very common in most government and some private practices, most likely due to the shortage of clinical staff and doctors). As people don’t usually get depressed all the time with medicine (other than dysthymic disorder which is another case), they do recover, so they shouldn’t really be taking anti-depressant for long term without medical review, even if it is just a maintenance dosage, review is still needed and important.

Separation Anxiety

Anxiety Disorder, Clinical Case Studies

When the boy first came to us, the parents were very anxious as the boy had already stopped going to school for almost a week. They begged for an earliest possible appointment as they can’t bear the boy missing even one extra day of absentee from school, despite advice that even if the boy came for consultation straightaway he won’t be able to recover immediately and be able to go to school the next day.

The mother told us that the boy has been refusing to go to school, tuition, and any classes. He can go out still, can see crowds (just like when he came to see us, there were a lot of other patients and patients’ family in the waiting room), but whenever it comes to classes and school he just wouldn’t go. It all started about two weeks ago.

When I spoke to the boy, I asked if he felt ok in the waiting room with the crowds, he nodded indicating ok. I asked whether he can accept it if the mother now goes to the washroom and leaves him there alone. He shook his head. “Not even for 5 minutes? 3 minutes?” Again he shook his head. The mother explained that he wasn’t like this before, he could go to school and tuition classes with peers.

With some prompts the mother recalled an incident about two weeks ago, where she was too busy at work and was late to pick him up from school. The boy was in tears when she got there. She now realized it was this incident that leads to her son’s subsequent behaviours. She thought he was just avoiding school, perhaps due to bullies, problems with friends or not completing homework. She thought her son was just being rebellious and never realized she was the reason of his problematic behaviour.

I’ve come across cases like this a number of times. Imagine if the mother didn’t seek help, and insisting, forcing the boy to go to school, what’s going to happen? They are likely to get into frequent rows and arguments, the mother thinks the son is disobedient and doesn’t like schooling, the son thinks the mother doesn’t understand him and love him.

Yet it’s important to look at the root of the problem, as a lot of childhood insecurity starts from small incident like this (“my mother is late for 1 hour to pick me up, I thought she doesn’t want me, she’s going to leave me there” – often depicted in TV as well!). If this conflict isn’t resolved, quite often the child brings the insecurity to adulthood and has trouble forming secure and trusted relationship.