NTU Mental Health Introduction 2012

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Transcript of NTU Mental Health Introduction 2012

Are You OK?Mental Health in SingaporeDaniel FungVice Chairman Medical Board IMH

Course ObjectivesUnderstanding mental health Basic knowledge of mental disorders Knowledge of resources available in Singapore

FacultyDaniel Fung Child Psychiatrist Married to Joyce 5 children



Week No. 1

TopicsLecture 1: Introduction 1.1 Why is mental health important? 1.2 Mental health not illness: Definitions 1.3 Mental health across the ages Lecture 2: The Family 2.1 Family Function 2.2 Family life cycle 2.3 Dysfunctional Family 2.4 Healthy Familes Lecture 3: Development 3.1 Developmental principles 3.2 Developmental delay 3.3 Developmental disorders 3.4 Sleep and its problems Lecture 4 Learning and Mental Health 4.1 What is Learning 4.2. Foundations of learning 4.3. IQ and learning 4.4 Learning disorders Lecture 5: Adolescence 5.1 Physical changes 5.2 Emotional issues 5.3 Sexuality 5.4 Disorders common in adolescence 5.5 Juvenile delinquency Lecture 6: Personality and Problems 6.1 Personality Theories 6.2 Attachment 6.3 Personality Disorders 6.4 Self image and Anorexia Lecture 7: Human Sexuality 7.1 Sexuality definitions 7.2 Marriage and divorce 7.3 Periods of pregnancy 7.4 Postpartum risks MCQ Quiz before lecture

Readings Chapter 1


Chapter 2


Chapter 3 and 4, 15


Chapters 5 and 6


Chapters 8 and 9


Chapters 10 and 11


Chapters 12 to 14

Week No. 8

Topics Lecture 8: Stress 8.1 Definition of stress 8.2 Signs and Sources of stress 8.3 Management of stress Lecture 9: Emotions and disorders 9.1 Normal emotions 9.2 Anger 9.3 Anxiety 9.4 Depression 9.5 Suicide Lecture 10: Alcohol and Substance use 10.1 Alcoholism 10.2 Substance addictions 10.3 Behavioural addictions Lecture 11: Old Age and Mental Health 11.1 Retirement 11.2 Dementia 11.3 Problems of the Elderly Lecture 12: Psychosis 12.1 Schizophrenia 12.2 Bipolar Disorders 12.3 Other psychotic illnesses

Readings Chapter 16 to 18


Chapters 19 to 21


Chapters 22 and 23


Chapter 25


Chapter 24


Lecture 13: Healing of the Mind 12.1 Psychotropic medications 12.2 Psychotherapy 12.3 Traditional therapies 12.4 Mental Health Services Exams: Essays, Open book

Chapters 28 to 33

IntroductionMental Health Mental Illness Epidemiology of Mental Illness Classification of Mental Illness

Are You Healthy?Health is not merely the absence of disease but a state of complete physical, mental and social well-being .World Health Organization

What is Mental Health?

Defining Mental Health: Mental illnesses are only the tip of the icebergMental Illness

Serious Mental Illnesses: Psychosis, Depression, Anxiety, Dementia, Addiction Disorders, Personality Disorders Minor Psychiatric Morbidity: Adjustment Disorders, Uncomplicated Grief, Situational Reactions

Minor Psychiatric Morbidity

At Risk

Children from dysfunctional families, Individuals with multiple medical conditions, Elderly living alone,

Mentally Healthy

The general population: school children, working adults, young parents, retirees

What is Mental Health?More than just absence of mental illness Balance between all aspects of life

Feelings about ourselves Relationships with others Coping with life Feeling safe and secure

Butthere is no such thing as perfect mental health

Brief HistoryTime Period Ancient civilisation Renaissance period Eighteenth Century Nineteenth Century Twentieth Century Concepts of mental health Mental illness is caused by evil spirits possessed the body and must be driven out Decline in the belief of possession Seen as natural phenomenon - but mental problems seen as irreversible. Scientific inquiry and humanism Need for medical care recognised. Research began and legislation concerning mental health was enacted. The start of the mental health movement. A holistic concept of care and short term care introduced. Goals were to return patients into society, so human service programmes were established. There was a focus on prevention. Biological concepts of mental health strengthened in genetic studies Services Spiritual and religious

Development of specialized care and asylum model of care A reform movement - chains removed. The first mentally ill patient was treated in hospital. Asylums became hospitals for the mentally ill but with long term custodial care. Large state hospitals were built, psychoanalysis developed and community health care centres established.

Twenty first Century

Smaller hospitals with greater emphasis on community care. Overreliance on medications

Who are Psychiatrists?Not a good example Singapore examples

Who are Psychiatrists?Medical doctors Trained to specialise in mental illness and work with different groups

Adults Children Elderly Specialised disorders

Usually deals with mental illness rather than mental health

Psychiatrists Models

Medical (Disease) ModelDiagnosis Plan of management follows diagnosis

Compare to other modelsCognitive Psychodynamic Social

Who are the Mentally Ill?

The term mental illness that refers collectively to all disorders associated with the mind (mental). Mental disorders are health conditions that are characterized by problems in:

Thinking (Cognitive) Feelings (Mood) Actions (Behaviour)

Individually or in combination associated with distress and/or impaired functioning.

EpidemiologyStudy of the distribution and determinant of diseases and injuries in human populations

Concerned with frequencies and types of injuries and illness in groups of people Concerned with factors that influence the distribution of illness and injuries

Epidemiology of Mental Illness

The current prevalence estimate is that about 20 percent of the U.S. population are affected by mental disorders during a given year. This estimate comes from two epidemiologic surveys:

the Epidemiologic Catchment Area (ECA) study of the early 1980s the National Comorbidity Survey (NCS) of the early 1990s

Mental Health in Singapore

MOH study (1978): 8.4% of the population as suffering from neurosis. The SAMH Study (1989): 17.95% of the population with minor psychiatric morbidity (MPM).

Fones et al, 1998:

Survey of over 3020 subjects (GHQ-28) Point prevalence of 16.6% with MPM ICD-10 diagnoses using the CIDI (Composite International Diagnostic Interview) on 339 subjects in Clementi 12-month prevalence rate for Affective Disorder = 7.8% 12-month prevalence rate for Anxiety Disorders = 9.3%

Mental health in SingaporeWHO Burden of Disease Study 2001

Mental illness contributes to 17% of the combined burden of premature death and living with disability in Singapore

Registry of Births and Deaths

More people die from suicides than road accidents every year

2004/5 National Mental Health Survey

Anxiety & Depression: 6.5% of population Minor Psychiatric Illness: 15.7% of population Dementia: 5.2% of those > 60 yearsSource: National Mental Health Survey 2003/4

Mental Health in Singapore1998(NUH Study)

2003/4(IMH Study)

Depression & Anxiety

No Combined Data


Depressive Disorders Anxiety Disorders



0.8 -2.5%(12-month, various disorders)


International Studies(WHO 12 month prevalence studies)Anxiety Disorders % USA Belgium France Germany Italy Spain Japan Beijing Shanghai 18.2 6.9 12.0 6.2 5.8 5.9 5.3 3.2 2.4 Mood Disorders % 9.6 6.2 8.5 3.6 3.8 4.9 3.1 2.5 1.7




International Studies(Utilization of Mental Health Care Services)Serious Cases (% receiving treatment) USA Belgium France Germany Italy Spain Japan Beijing Shanghai 52.3 53.9 63.3 49.7 64.5 Total population (% receiving treatment) 15.3 11.0 12.4 7.8 4.5 7.3 5.7 2.7 3.1




National Mental Health Survey of School Children

The prevalence of children estimated to be suffering from mental health problems was 12.5% based on parent reports 2.5% based on teacher reports. Internalising Disorders such as anxiety and depression Parents reported 12.2% Teachers estimated 2.2% Based on child reports, the prevalence of children estimated to have an anxiety syndrome was 9.6% and the prevalence of children estimated to have a depressive syndrome was 17.8%. Externalising Disorders such as attention-deficit hyperactivity disorder, conduct disorder and oppositional defiant disorder Parents reported 4.9% Teachers reported 2.4%

Woo et al 2007

National Mental Health Survey of School Children

Overall Problems Male gender (OR 2.1) Low intellectual ability (OR 3.4) Mothers being single, divorced, widowed, deceased (OR 2.9) Internalising disorders Male gender (OR 2.0) Older age (OR 2.4) Low intellectual ability (OR 3.0) Mothers being single, divorced, widowed, deceased (OR 3.6) Externalising disorders Fathers being less educated (OR 3.5) Low intellectual ability (OR 6.5)

Woo et al 2007

Who Is Affected?Globally, 450 million people suffer from mental illness, 70 million people suffer from alcohol dependence, 50 million have epilepsy, 24 million have Schizophrenia, one million people commit suicide everyday and between 10 - 20 million people attempt it

The World Health Report 2001

Who Is Affected?National Mental Health Survey 2004, IMH: Lifetime prevalence rate of depression amongst adults in Singa