Monday, 10 November 2014

Bulimia Nervosa FAQ

Bulimia nervosa is an eating disorder characterized by cycles of binge eating and purging, or consuming a large amount of food in a short amount of time followed by an attempt to rid oneself of the food consumed (purging), typically by vomiting, taking a laxativediuretic, or stimulant, and/or excessive exercise, because of an extensive concern for body weight.

What are the common reasons for bulimia?  

The way media portrays and idealizes a slim physique has often been found to be the main culprit. This in turn leads to peer pressure in teenage girls and youths to stay thin and results in distortion of body image. There can also be a biological or genetic predisposition.

What are the warning signs of the disease, if I were a parent, how can I detect it?

If the child starts becoming secretive about her meals, parents need to start taking note. Parents may notice that they try to restrict their diet and then loses control and binge eat at other times. They may disappear or spend a lot of time in the toilet, often to purge or vomit the food out.

What are the dangers of bulimia? Are they the same as anorexia, or more dangerous? (will the stomach acid harm the throat walls, other complications e.g?)

Bulimia and Anorexia are really two sides of the same coin. From a physical point of view, Anorexia and restricting one's diet is more dangerous. However,Bulimia can also cause a myriad of physical problems such as electrolyte imbalance, cardiovascular problems like irregular rhythm, digestive issues and throat and mouth problems. Having Bulimia is likely to predispose one to Anorexia as well.

How different are the profiles of patients of bulimia and anorexia? (since maybe bulimia is a more active way of coping, while anorexia seems passive?)

I believe they are the same illness presenting differently and at different times. Many anorexic patients go on to binge and develop bulimia after the anorexia episode. As such the profile is very much the same. In young adolescent girls exposed to a culture which emphasises a slim physique.
 How is the treatment for bulimia? is it the same as anorexia?


As with anorexia, the first step is to recognise the problem and to seek help. The need for hospitalisation is often lower in Bulimia as compared to Anorexia where low body weight can sometimes be a medical emergency and refeeding needs to be carried out quickly and safely in the hospital. Unlike in Anorexia, medication like antidepressant plays a role in helping with the urge of binging and purging. Psychotherapy is an important component of treatment in both.

Tuesday, 13 May 2014

Attention Deficit Hyper Activity Disorder (ADHD / ADD) Medications Cheatsheet

The use of medications revolutionised the treatment of ADHD /ADD. Today, international consensus often recommends medication as the first line of treatment for ADHD / ADD in patients above the age of 6 years of age. You can visit the following sites for more details:


Medications for ADHD / ADD can be categorised as:

1) Stimulants
2) Non stimulants
3) Antidepressants
4) Supplements

1) Stimulants

Stimulant medications have the best evidence in the treatment of ADHD for children and Adult ADD. As such it is often recommended as the medication of choice to start for both child and adult patients with ADHD. In Singapore, only methylphenidate based medications are available. They may come in short acting forms (lasting 3-4 hours) and long acting forms (lasting 8-10 hours).

Common brand names: Ritalin, Concerta

Advantage: i) Most likely to be effective, ii) works almost immediately, iii) can be taken only when necessary
Disadvantage: i) Can be potentially abused, ii) effects does not last the whole day

Common side effects: Headache, insomnia, poor appetite

2) Non stimulants

Atomoxetine is a selective noradrenaline reuptake inhibitor indicated for the treatment of ADHD /ADD. Unlike stimulants which has immediate effects, the benefits of atomoxetine is gradual and subtle, and its effect is only apparent usually after two weeks. For it to be effective, Atomoxetine has to be taken daily.

Common brand names: Strattera

Advantage: i) No abuse potential, ii) if effective, will last 24/7, iii) may be effective for concomitant depression
Disadvantage: i) Has to be taken daily, ii) only works after two to four weeks, iii) probably less likely to be effective than stimulants

Common side effects: Nausea, headache, insomnia

3) Antidepressants

Bupropion, an antidepressant, used in the treatment of depression and smoking cessation has been shown in some studies to help with the symptoms in ADHD / ADD. However, comparatively, the evidence for Bupropion is not as robust as stimulants and atomoxetine. As such, guidelines often recommends antidepressants as the third line of treatment, after stimulants and atomoxetine.

Advantage: i) No abuse potential, ii) if effective, will last 24/7, iii) effective for concomitant depression
Disadvantage: i) Has to be taken daily, ii) only works after two to four weeks iii) probably less likely to be effective than stimulants and atomoxetine

Common side effects: Headache, insomnia, anxiety

4) Supplements

There has recently been some research which suggests a decrease level of Omega-3 fatty acids (fish oils) may be associated with ADHD and taking Omega-3 supplements can help in controlling ADHD symptoms. Parents who may not be ready to medicate their children can consider this option as Omega-3 is a natural supplement. A recent product Lipirinen which contains phosphatidylserine-omega 3, EPA enriched, has shown effectiveness in studies, improving symptoms. Omega-3 can be used to supplement current treatment with other medications as well.

Advantage: i) Natural product, ii) no abuse potential, ii) if effective, will last 24/7
Disadvantage: i) Has to be taken daily, ii) only works after at least four weeks iii) probably less likely to be effective than stimulants, atomoxetine and antidepressants

Common side effects: no significant side effects 

Friday, 21 March 2014

2014 Customer Service Award



Dr BL Lim Centre for Psychological Wellness is pleased to announce that our clinic has been awarded the 2014 Customer Service Award from WhatClinic.com.

It is our mission to strive to provide the best patient care possible and to always remember our motto of "Patients First, Always".

Wednesday, 1 January 2014

5 Tips On How To Keep Your New Year Resolutions

Today is the fist working day for the new year and Happy 2014 to all. The festive mood is still lingering and it is normal to feel somewhat lethargic in starting work. You may also notice how you can't help but continue to write down the year as 2013 for your dates.

Habits are not something easy to change and I have a few tips here to help you stick to your new year resolutions what ever they may be.

1. Start (really, really) Small

Failure demotivates a person quickly especially of you are just starting out with the changes you want to make. Many people make the mistake of having difficult targets and after a few early failures, learned helplessness sets in and they give up (until next year). Starting really small helps you to succeed in your first step so that your mind will be naturally motivated to go on.

2. Go Slow

Keeping resolutions should not be a all-or-nothing process. Gradual improvements, starting with small successes, keep things sustainable. Have interim targets with a slow and gradual increase in the difficulty to achieve them. Remember, it's work in progress and you will get there!

3. Reward Yourself

Having success itself can be rewarding. However, you can further motivate yourself by reminding yourself of the good work you have done. This can be achieved by positive self talk and encouragement. You can buy yourself little treats every time you meet your targets to further reinforce the self encouragement.

4. Reward One Another

Where possible, work towards your resolution together with friends and family. Doing things together help you to improve camaraderie instead of taking you away from your loved ones. Motivate one another by supporting, praising and rewarding one another when targets are met.

5. Learn From Failures and Mistakes

You may have had the same resolution last year and maybe even the year before. Spend some time to take stock of things and think of why you did not achieve your targets the last few attempts or why you were not able to sustain these achievements. Often times, positive changes wax and wane and you may relapse back to the undesired behaviour.  Learn from you past mistakes, look out for similar difficulties you may face this year and devise strategies in advance to over come them.

Wednesday, 11 December 2013

"My Son is Mentally Ill", So Listen Up

I will like to share this article on a mother's struggle with her son's mental illness. Click here.

Today, many sufferers with psychiatric conditions continue to suffer in silence due to the misconceptions and stigma surrounding mental illnesses. Seeking early treatment will help to better the prognosis and outcomes of psychological conditions. Remember, mental illnesses are just like any other medical conditions.






Sunday, 10 November 2013

How Common is Depression?

http://www.washingtonpost.com/blogs/worldviews/wp/2013/11/07/a-stunning-map-of-depression-rates-around-the-world/
This picture shows the rates of depression worldwide. The redder the colour, the higher the rates of depression in that country.

This picture is based on a study published recently in the journal PLOS Medicine. In this study, they found depression to be the second leading cause of disability globally, with slightly more than 4 percent of the world diagnosed with it.

However, due to stigmatisation and taboo, many with depression still do not step forward for treatment and suffer silently. If you or your family suffer from symptoms of depression, seek treatment now. Remember, early intervention brings about the best outcome.