Having a little stress and anxiety in your life is absolutely normal. In fact, it may even be beneficial as it helps you to concentrate and focus. But what happens when stress and anxiety get out of control and start to affect your daily life? What can you do to regain control?

Associate Professor Leslie Lim, Senior Consultant from the Department of Psychiatry at Singapore General Hospital, gives detailed answers to your questions.

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How do one handle stress if he or she has a heart disease especially after a triple bypass heart surgery?

Answered by Assoc Prof Leslie Lim, Senior Consultant, Department of Psychiatry, Singapore General Hospital

There are cardiac rehabilitation programmes for patients who have undergone cardiac surgery. Cardiac rehabilitation counsellors should be able to advise on stress management strategies . Many people who have undergone life threatening illness or major surgery have connected with their religion, grateful to God for being given a new lease of life. Spend time with friends, provide support to fellow cardiac disease sufferers, and engage in religious pursuits. Such activities provide meaning to life.

Do not to worry about things that you have no control over. Take daily walks starting with 10 minutes at a time, then slowly increasing the distance until you are walking 30-40 minutes daily. Exercise has been shown by research to reduce stress. Meditation or simple breathing exercises are also effective in reducing stress.

Question by luaconstance@gmail.com

1. Why is there needle pain / ice cold sensation on the head? At times it will be at the whole of entire back of the head, at times it is only one side of the head. Is it due to stress or shampoo or perhaps others?
2. Why does the lower back of my head suffers from some pain which feels like blueblack pain? Even panadol don't help. Is it due to weather change or stress or shampoo or perhaps others? Thank you.

Answered by Assoc Prof Leslie Lim, Senior Consultant, Department of Psychiatry, Singapore General Hospital

I presume that you have gone to see your doctor who would have ordered X-rays and scans of the brain, or alternatively you could have been referred to a Neurologist who could order such investigations.The result of such tests, if negative, would indicate that the person does not have a structural abnormality in the brain e.g. brain tumour, stroke.

Stress, somatic symptom disorder, depression, or generalised anxiety disorder could account for these symptoms. Your doctor could decide to refer you to a psychiatrist who could assess, diagnose, and treat these conditions.

Question by teowhk

Hi, My daughter,14 yrs old, cant code with stress during exam. Her neck will tremble and can’t focus during exam. There was once when her lip trembled when doing presentation at the stage. How can she overcome this?

Answered by Assoc Prof Leslie Lim, Senior Consultant, Department of Psychiatry, Singapore General Hospital

Exam stress is very common. Thousands of students who have to sit for exams experience stress. A small amount of stress even helps one perform better. Tremulousness is a symptom of anxiety and stress. Other symptoms include fast heart beat, breathlessness, chest tightness, dizziness, and difficulty concentrating. Should the student learn how to cope , such symptoms may not manifest themselves.

If the symptoms appear only before exams and disappear after the exam is over, then deep breathing and other relaxation exercises would be helpful. If she is still not better, consult your family doctor. A small dose of anti-anxiety tablets may be necessary to better control these symptoms.

Question by yew.ellen

Hi doctor. I have anxiety issues and have been suffering from elevated cortisol surges past 9 months. The surges last almost an entire day sometimes. Things are slightly better now as I take an adrenal depletion tonic. Can long term cortisol surges cause sharp bodily pains? I read that it is possible. It is terrifying to experience such pain . And can stress really cancer?

Answered by Assoc Prof Leslie Lim, Senior Consultant, Department of Psychiatry, Singapore General Hospital

I am not the best person to advise on these. You should consult an Endocrinologist, who is in a better position to advise. Theres is no evidence that conclusively proves that stress can lead to cancer. Some studies have shown an association between stress and cancer, whereas other studies have not. However, there could be an indirect link in that people under stress may adopt certain behaviours, such as smoking, overeating, or drinking alcohol, which increase a person’s risk for cancer.

Question by turquoise

Dear Dr Leslie, Am given atarax to help me sleep but ended up staying very alert, in addition, is it anxiety or OCD that I always think what will happen or things that happened? Been feeling very dizzy, headache too, is this caused by stress unknowningly? Thank you.

Answered by Assoc Prof Leslie Lim, Senior Consultant, Department of Psychiatry, Singapore General Hospital

Atarax is the trade name for hydroxyzine, an antihistamine which is commonly prescribed for rashes and itch, but which can also induce drowsiness as a side effect. Although it can reduce anxiety it is not effective in inducing sleep. This may explain why you ended up feeling alert after taking it.

If you are constantly worrying about what may happen, and have difficulty sleeping, together with physical symptoms, such as sweating, breathlessness, fast heart beat or trembling, you could be suffering from Generalised Anxiety Disorder.

In the case of Obsessive- Compulsive Disorder, there are intrusive thoughts of contamination which may lead to compulsive rituals such as cleaning and washing. Thoughts about not properly turning off lights, taps and, locking the doors and windows may lead to checking and repetitively turning taps and light switches on and off locking and unlocking doors and opening and shutting windows.

If you are unsure about whether or not you are suffering from Generalised Anxiety Disorder or OCD and if you are experiencing dizziness and headaches you may wish to consult your General Practitioner or a Polyclinic doctor. Even if these could be symptoms of stress and anxiety, the doctor will order tests to exclude any physical causes, and if negative, refer you to a psychiatrist, if necessary.

Question by kmom

Dear Prof My first born turns 1 year old. Lately I've been loosing my tempered to go to a room to scream or become very easily agitated.Either that or I could breakdown uncontrollably for a while. And I question occasionally about the meaning of my life.I thought I could be depressed because this seemed more serious after my husband had to be away and I had to be with the baby 1-1 single handedly for 2 weeks. I just tried to talk to my husband about my behaviour it seemed to feel a little better but doubts of my purpose recurs and more self worth doubt especially when I have more stressful events at work. Is this inability to handle stress? Any suggestions to help me focus or manage better?

Answered by Assoc Prof Leslie Lim, Senior Consultant, Department of Psychiatry, Singapore General Hospital

Looking after a young child singlehandedly can be a very stressful experience. Who helps look after the child when you are at work? How about asking your mother, or do you have sister(s) who could help ? It is not clear whether you have a maid to look after the child ?

As you have discovered, talking about your problem helps. Find someone to talk to on a regular basis, be it a trusted friend, family member, or a counsellor.

Ensure that you have adequate rest each day. A survey has shown that Singaporeans sleep fewer hours than peope from other nations. Aim to retire to bed earlier each night. Make time for regular exercise. Arrange to go for outings with your husband, and bring your child, and a helper along.

Once you have made time to unwind and relax yourself after finishing work you will be refreshed and ready to start work the next day. Your concentration should be better. Take regular breaks at work, stretch yourself, especially the neck and shoulders because these should get stiff after spending a prolonged period in front of the computer.

Ref: R14