When we think of mental health problems, we often think of depression, anxiety disorder, obsessive-compulsive disorder, or schizophrenia.
However, there can be a wide spectrum of mental health problems within these diagnoses. For example, bipolar disorders may initially manifest as extreme depression, but when treated for depression, people can become manic (accompanied by hyperactivity and mood swings).
Paranoia (which comes with complaints of various people trying to hurt patients or steal from them) can manifest in dementia patients.
In my medical practice, I have seen patients agitated and upset to the point of being violent towards their loved ones, despite previously being described as kind and considerate. One patient even made numerous police complaints against family members and domestic employees. Such behavior causes great distress to caregivers, who in turn may suffer from insomnia, depression, and anxiety.
Dementia patients can also lose their inhibitions. Some were reported to have removed their clothing and behaved strangely in public. They should not be labeled as a public nuisance as the behavior is related to dementia.
Alzheimer’s disease is not the only form of dementia. Dementia can develop from vascular diseases: repeated minor strokes in the brain can cause memory loss and general weakness, and strokes can affect certain parts of the brain and lead to behavioral disorder.
Minor strokes that affect the visual cortex can cause patients to see funny and frightening images that are very alarming, and their loved ones find this abnormal and worrying as well.
There must be awareness that vascular disease can present with repeated minor strokes, and that vascular problems are associated with old age, high cholesterol, hypertension, obesity, and metabolic disorders such as diabetes.
These may not affect only elderly patients; young patients can also have dementia, strokes and heart attacks, causing morbidity and mortality, so we must take measures in preventive medicine, as well as educate patients (including the very young) to be proactive in their health care .
Medical problems such as dementia, stroke, and metabolic diseases would mean an increased need for caregivers, presenting another complicated problem for society. Additionally, patients who become violent and uncooperative may not be manageable at home. Therefore, there would be a greater need for institutions with trained personnel to care for patients without causing much harm to them and their families.
Recognizing the broad spectrum of mental health problems and accompanying issues that affect families and society can help us to plan for and be proactive in managing our own health.
Quek Koh Choon (Dr.)
