Treating Anxiety Disorders in Singapore

Anxiety Disorders are one of the most commonly treated disorders by Singapore psychiatrists. Treatment is not difficult but again best started early. Fear and “Anxiety” are common emotions that we have all felt at some point of our lives. Anxiety can be described as a tense emotional state associated with a feeling of impending danger, often accompanied by bodily symptoms.

It has also been used to describe the mental and physical response to a feared situation. This would take the form of the Flight or fight response. Anxiety symptoms can however get out of hand, impairing one’s usual functioning and leading to the development of an Anxiety Disorder. Estimated prevalence of Anxiety Disorders in Singapore are at about 5% with a life time risk of about 15%, making them very common disorders in Singapore and worldwide as well. Co-occurrence with Depression is also a feature of this condition.  

A good way of deciding if the fear one feels is normal or not is to consider the following. Fear in anxiety disorders is out of proportion to the trigger, for example, in a simplistic way, seeing a kitten, but reacting as if one has seen a lion. The fear also does not diminish or go away when the trigger is removed and more importantly in anxiety disorders, it affects the persons ability to function in both occupational and social settings.

Anxiety often involves both a physical and mental response. Physical symptoms could include palpitations, sweating, headaches, muscle tension or dry mouth. There could also be sleep disturbances, like insomnia, concentration problems, increased tiredness and irritability. The physical complaints are perhaps what people would commonly see a doctor for. It is common that people with anxiety disorders present to their family doctor and also other specialist such as a cardiologist, ENT doctor, neurologist or gastroenterologist first, before being appropriately seen by a psychiatrist. Psychological symptoms including persistent negative thoughts and catastrophic thinking often occur. The patient may suffer from indecisiveness from over-considering the possibilities, what is sometimes know as "paralysis by analysis". Often, the person also behaves and feels as if the feared conclusion has already happened, increasing the chance of depression. Patients with anxiety would often be able to verbalise that their thinking is excessively negative but find it hard to control or distract themselves.

If such symptoms are present, it would be important to consider if an anxiety disorder is present. Below are more details of some of the common anxiety disorders. It is not uncommon to have a mixture of these anxiety conditions as there is much overlap in their symptoms. A good psychiatrist would also look for other co-existing medical and psychiatric conditions and formulate a plan to best manage the individual patient.

Physical Symptoms of Anxiety

Bowel disturbance
Tremors
Chest discomfort
Headache and Dizziness
Difficulty breathing
Muscle ache
Palpitations

Psychological Symptoms of Anxiety

Poor concentration and memory
Restlessness
Worrying thoughts
Indecisiveness
Sexual Dysfunction
Insomnia
Nightmares

When is Anxiety abnormal?

Since Anxiety can be a common reaction to stress, how can we know it is abnormal? Some of the signals that suggest that the anxiety that you or a love one may have is abnormal would include the following. That is

it is greatly disproportionate to the risks and severity of the danger/stress faced
continues even when the danger/stress is no longer present
interferes with social, vocational or physical aspects of daily life
leads to avoidance of certain situations

Generalised Anxiety Disorder (GAD)

GAD is a common type of anxiety disorder. It presents with symptoms of excessive anxiety and worry (apprehensive expectation), occurring more days than not.

It could concern a number of different events or activities (such as work or school performance) It has also been called a “free floating” anxiety. The person often finds it difficult to control the worry.

Very often these fears when resolved, would be quickly taken over by a new set of worries, hence there would be very little time that the individual would be free from anxiety.

Obsessive Compulsive Disorder (OCD)

OCD is marked by the presence of both obsessional thoughts and compulsive behaviour. Patients who have OCD experience thoughts that have an extremely compelling and repetitive quality associated with increasing anxiety.

These thoughts are experienced by patients as unpleasant, alien and originating from “outside” of themselves. They generally fall into one of several categories, including fears of contamination (associated with compulsive hand-washing), fears of being harmed or causing harm to others or may even contain sexual themes

Panic Disorder

Panic attacks are discrete episodes of severe anxiety which usually reach a peak in about 5-10 minutes. Symptoms include palpitations, sweating and trembling, sensations of shortness of breath with chest pain or discomfort. Nausea and feeling dizzy or faint and fear of losing control or dying as well as sensations of numbness.

Panic disorder happens when there is recurrent episodes of panic attacks which are often unpredictable. This leads to anticipatory anxiety of future attacks and also avoidance phenomenon. Agoraphobia is often the end result of the avoidance phenomenon.

How can anxiety be managed?

Psychiatrist in Singapore usually approach the treatment of anxiety with a combined approach of medication and therapy. Formal psychotherapy employing the principals Cognitive-Behavioural Therapy (CBT) have been developed and found to be effective for the various anxiety disorders. Relaxation techniques such as deep breathing exercises and guided imagery are also skills that can be expected to be learned during the consultation with the psychiatrist.

The mainstay of medical treatment for Anxiety would be the antidepressants. Anti-depressants are effective in both anxiety disorders as well as in depression. Your psychiatrist would explain the pros and cons of the various approaches and advise you on what suits your needs best. You can expect the consultation to be a collaborative process where your input would be greatly appreciated to formulate a best plan with the expert guidance of your psychiatrist.

Anxiety disorders can cause a myriad of different symptoms. They also cause significant suffering and impairment of function. The important thing to bear in mind is that anxiety disorders can be easily treated once identified and appropriate treatment is started. If you are unsure if you have an anxiety disorder, see your family doctor or make an appointment to see a good psychiatrist, it could just set your mind and body at ease again.

Programme featuring Dr Nelson Lee's interview on Anxiety

A simple breathing exercise to cut down on your anxieties

Often when we feel anxious, we start to breathe in a rapid and shallow way. This often leads to physical symptoms that provoke even more anxiety such as numb and tingling sensations and cramping of the muscles.

To begin, sit in comfortable chair. Close your eyes and being breathing through your nose.  Inhale and count to 10 inside of your head as you do so. Hold the breath in for a second and exhale gently, imagine blowing out all your stress and anxieties as you do so. Repeat this for 10 to 20 cycles. you should start to feel more relaxed

It is important to practice this before you feel anxious as you would then have had the rehearsals before a challenging situation. Try doing this every night before sleep as a good practice.