Objectives: The purpose of this study was to assess symptom improvement with, and safety (measured as tolerability) of, risperidone as adjunctive therapy to mood stabilizers in the treatment of bipolar I disorder, manic phase. Methods: Eight hundred sixty seven Filipino patients, recruited from 46 centers across the Philippines and diagnosed according to DSM-IV criteria as having bipolar disorder, current phase manic, completed an 8-week open trial of risperidone as add-on therapy to mood stabilizers. Doses of risperidone were started at 0.5 - 2 mg per day for the first 2 days, and escalated or reduced based on clinical judgment on succeeding days. Treatment was evaluated 1, 2, 4 and 8 weeks after baseline assessment. The Young Mania Rating Scale (YMRS), Hamilton Depression Scale (HAM-D), Clinical Global Impression Scale for Severity (CGI-S) and Clinical Global Impression Scale for Improvement (CGI-I) were used to measure symptom reduction with risperidone use, while the Extrapyramidal Symptoms Rating Scale and incidence of adverse events were employed to determine drug safety. Results: Results showed significant reduction in manic and depressive symptoms throughout the study as measured by statistically significant decreases in mean YMRS and HAM-D scores. CGI scores likewise showed significant improvement from baseline to study end with an increasing percentage of patients who showed steady improvement throughout the trial. There was a low incidence of extrapyramidal symptoms (EPS), majority of which were mild. Only 2 other non-EPS adverse events occurred in the study. Conclusion: This study demonstrated reductions in manic and depressive symptoms with risperidone use and showed that risperidone was safe as adjunct therapy to mood stabilizers for the treatment of manic phase bipolar disorder.
Human ; Male ; Female ; Aged 80 and over ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; RISPERIDONE ; CLINICAL TRIAL ; BIPOLAR DISORDER

Objective: The study aimed to compare the efficacy and tolerability of oral risperidone and oral clonazepam with intramuscular haloperidol and oral clonazepam in Filipino patients with acute psychotic agitation. Methods: This study used a prospective randomized design targeting patients who were referred to the emergency department or hospital inpatients exhibiting both psychosis and agitation. Patients were randomized into oral risperidone group or intramuscular haloperidol group. Both groups received oral clonazepam as part of treatment. Patients were observed for 24 hours. The main efficacy parameter was the PANSS agitation cluster score. Other parameters were total PANSS, other PANSS subscale scores, time and incidence of additional clonazepam usage. The safety parameter measured as incidence of adverse events. Results: There were 99 subjects enrolled in the study: 49 in the oral risperidone arm and 50 in the intramuscular haloperidol arm. There were significant reductions in the mean PANSS agitation cluster scores for both groups: -7.6+4.7 for oral risperidone group (p<0.0001) and -6.7+5.0 for intramuscular haloperidol group (p<0.0001). There was no statistical difference observed in the mean change in PANSS agitation cluster scores among the two groups (p=0.3928). Similar trends were observed in the total PANSS and other subscale scores. The incidence of additional clonazepam use is numerically higher in the oral risperidone arm than the intramuscular haloperidol arm (33% vs. 20%), but the difference did not attain statistical significance (p=0.1370). At the end of the study, 17 (33 %) and 18 (36%) of patients in the risperidone and haloperidol groups experienced varying degrees of sedation. No serious adverse event was reported. Conclusion: Oral risperidone is comparable to intramuscular haloperidol in the treatment of acute psychotic agitation in terms of efficacy and safety.

The family practitioner plays an important role in the detection and treatment of mental disorders. It is said that over half of all persons affected with mental illness are initially seen and treated by the non-psychiatrist in the outpatient setting rather than in the specialty mental health clinic. Objective: This paper aims to evaluate perceived level of confidence and competence of the primary care practitioner in the recognition, diagnosis, and management of mental disorders. Methods: A survey of family physicians and general practitioners using a thirteen (13)-point questionnaire during an annual convention of the Philippine Academy of Family Physicians (PAFP) was conducted. The questionnaire included items that attempted to quantify: exposure to psychiatry during residency and current medical practice; proportion of mental illness cases among total patient load; signs and symptoms that would be associated with mental illness; familiarity with standardized criteria for diagnosing mental illness i.e. schizophrenia and depression; familiarity with therapeutic medications; and perceived level of confidence in treating psychiatric cases. Results and Conclusion: The study implies that the family physician, although aware of the general signs and symptoms indicative of mental illness, is still hesitant in formulating a definitive diagnosis. Possible reasons for this attitude may be inadequate training in psychiatry as well as unfamiliarity and perceived difficulty with the DSM-IV.
Human ; Male ; Female ; MENTAL DISORDERS ; DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS ; PHYSICIANS, FAMILY

BACKGROUND: Schizophrenia affects 7 people per 1000 adult population worldwide and is a severe form of mental illness common in age group 15-35 year old. Paliperidone is the active metabolite of risperidone and was approved for treatment of schizophrenia in the Philippines by the Food and Drug Administration (FDA) in 2007. The drug has been shown to be safe and effective in clinical trials but no local study has investigated its effect among Filipino patients. Hence, the general objective of this study was to assess the safety and effectiveness of paliperidone ER among Filipino patients diagnosed with schizophrenia.

METHODS: The study was a non-randomized, non-comparative, open-label trial involving adult patients seen at initial consult and at the end of study visit. Study duration was eight weeks and was conducted for three years as required by the FDA. The primary outcome for the study was overall severity of the illness at the initial visit and end visit (visit 2) using the Clinical Global Impression tool (CGI-S). This rating scale was used to rate the severity of a subject's pyschotic condition on a 7-point scale ranging from 1 (not ill) to 7 (extremely severe).

RESULTS: A total of 641 Filipino adults were enrolled in the study. Ninety one percent (N=586) had completed the follow-up into the second or end visit resulting in a 9% drop out for the duration of the study. Follow-up period had an average of 58.05 (SD+=9.36) days ranging from a minimum of 4 to a maximum of 98 days. Clinicians' assessment of the severity of illness showed that majority had shown improvement from their baseline clinical state with the use of Paliperidone ER. The proportion of severely ill had decreased by 15% while the proportion of those who were markedly ill had decreased by 15% while the proportion of those who where markedly ill had decreased by 35% by the end of the second visit. Overall, after eight weeks of paliperidone treatment, there was a decrease of 58% in the proportion of subjects evaluated to be mildly ill, borderline mentally ill and normal at the end of the second visit. This means that there was a marked improvement in patients observed and reported symptoms, behavior and functions as assessed by physicians using CGI. Fifteen percent of study participants experienced at least one non-serious adverse event during the study. The five most common non-serious adverse events observed include sleeplessness, extrapyramidal symptoms described as Pseudo parkinsonian tremors, stiffness of body and DOB/EPS reaction hand tremors, depression, akathisia and dizziness.

CONCLUSION: Paliperidone ER administered at 6 mg single dose improved symtoms and clinical signs among adult Filipinos diagnosed with schizophrenia who are moderately and markedly ill. The drug is will-tolerated, but the dose may need to be increased for more severely ill patients. Paliperidone ER is one of the current useful options for the treatment of patients with schizophrenia.

Human ; Male ; Female ; Adult ; Risperidone ; Psychomotor Agitation ; Dizziness ; Depression ; Sleep Initiation And Maintenance Disorders ; Mentally Ill Persons ; Tremor ; Schizophrenia ; Vertigo ; Depressive Disorder

OBJECTIVES: The aim of this study is to compare the White Blood Cell count and morphology in the Cerebrospinal fluid of:1) patients diagnosed with first onset treatment naive schizophrenia; 2) patients with chronic schizophrenia and 3) healthy subjects.
METHODOLOGY: CSF samples from 16 chronic schizophrenics, 15 first onset treatment naive schizophrenics and normal controls were collected and analyzed by histopathology.
RESULTS: The cytological profile of CSF cells were significantly different from those of the control population. Total cell count was significantly higher in patients with first onset and chronic schizophrenia compared to normal subjects except in neutrophils. There was also a difference in the mean number of cells among groups, with chronic schizophrenics having the most number of large lymphocytes compared to first onset schizophrenia and control groups. The number of macrophages and neutrophils were not statistically significant.
CONCLUSION: The finding of atypical lymphocytes in the CSF suggest that immunologic aberration does occur in schizophrenia and point towards a chronic degenerative process.

Human ; Schizophrenia ; Lymphocytes ; Cerebrospinal Fluid ; Macrophages ; Leukocyte Count

Psychiatrists are numerous in urban areas, but are lacking in the provinces. Could there be a discrimination of psychiatrists by physicians in the rural areas? Is there a stigma attached to being a psychiatrist in the province? In an attempt to answer the above questions, a questionnaire survey of physicians in the province of Tarlac was conducted. Internal validity of the questionnaire was tested using Cronbach Alpha. Two pretests were conducted; the actual test consisted of 25 items with 92 points. Stigma was defined in terms of a cutoff value above 50% from the total number of points. In 75% of the respondents, there was a stigma attached to being a psychiatrist in Tarlac. The following were cited as disadvantages if being a psychiatrist in the said province: few patients, inadequate facilities and poor income. Some thought that psychiatrists might identify with their patients and acquire the same symptoms. The presence of stigma caries a negative implication as to the delivery of mental health care. There is a need to re-orient and re-educate physicians in Tarlac and reintegrate psychiatry into general medical practice.
Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; PSYCHIATRY ; PHYSICIANS ; ATTITUDE ;

OBJECTIVE: To determine the efficacy and safety of risperidone compared to placebo and haloperidol in the treatment of behavioral and psychological symptoms of dementia. METHODOLOGY: In a systematic review of literature, all articles published from January 1990 - September 2005 that conducted double-blind, randomized controlled clinical trials evaluating the efficacy and safety of risperidone and haloperidol for the treatment of BPSD were selected. The search was performed by means of MEDLINE, PUBMED, Cochrane Library database limited to studies written in English from 1990 to 2005. Key journals and textbooks were also searched in addition to the electronic database search. References mentioned in these studies were likewise reviewed. Two reviewers independently did validity assessment. Analysis of data was done by statistical packs Revman 4.2.7 from Cochrane Collaboration and SPSS (statistical package for the social sciences) v 9.0. RESULTS: Five trials were included in this study. A total of 964 patients were evaluated. Risperidone was superior to placebo as evidenced by significant reduction in the scores of total BEHAVE-AD score (WMD = 2.97, 95% CI = 1.65 - 4.29), BEHAVE-AD aggression subscale (WMD = 1.40, 95% CI = 1.34 - 1.46), and CMAI total aggression subscale (WMD = 3.82, 95% CI = 3.04 - 4.60). Comparison of risperidone and haloperidol showed significant reduction in the total BEHAVE- AD score in patients receiving risperidone (WMD = 1.80, 95% CI = 0.43 - 3.18). Comparing the odds ratio of having an adverse effect, analysis revealed greater chance of developing somnolence (OR = 1.88, 95% CI = 1.27 - 2.77), peripheral edema (OR = 2.43, 95% CI = 1.29 - 4.59) and extrapyramidal symptoms (OR = 1.93, 95% CI = 1.04 - 3.61) with risperidone. CONCLUSION: Risperidone is effective and relatively safe in the treatment of behavioral and psychological symptoms of dementia. Higher incidence of somnolence, peripheral edema and extrapyramidal symptoms was noted with risperidone compared to placebo. Compared with haloperidol, risperidone was superior in the total BEHAVE- AD scale and showed more favorable results in the total CMAI scale, BEHAVE-AD aggression and CMAI total aggression subscales.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Patients ; Risperidone ; Haloperidol ; Dementia ; Meta-analysis

OBJECTIVES: To compare the Clock Drawing Test (CDT) performance of Filipino patients with schizophrenia and normal subjects in detecting cognitive impairment and to determine the correlation of symptom severity using Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Syndrome Scale (PANSS) with the CDT performance among schizophrenic subjects.
METHODOLOGY: A descriptive cross-sectional study using convenient sampling. Stable and compliant schizophrenic subjects were recruited at the psychiatry OPD of our institution from July to November 2004. Normal subjects were recruited from the community who were age,sex, and education matched. CDT and MMSE were administered to all the subjects and the scores of the two groups were compared using the two-tailed Student t-test. Symptom severity using BPRS and PANSS were correlated with CDT and Mini Mental Status Exam (MMSE) in schizophrenic subjects using the Pearson;s correlation coefficient.
RESULTS: A total of 66 subjects, 33 schizophrenic and 33 normal subjects were included in the study. Schizophrenic subjects performed poorly on CDT and MMSE compared to the normal subjects. The difference between the mean scores was statistically significant. The examination errors on the clock drawing test was more apparent among schizophrenic subjects. There were positive correlations between CDT and MMSE, and BPRS and PANSS. Negative correlations were observed between the cognitive performance and the symptom severity of schizophrenia.
CONCLUSION: Schizophrenic subjects performed poorly on CDT compared to the normal subjects, thus it is useful in detecting cognitive impairment. Likewise, CDT performance correlates well with symptom severity. Its availability and simplicity makes it very useful in detecting cognitive impairment in our clinical practice.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Brief Psychiatric Rating Scale ; Cognition ; Cognition Disorders ; Cognitive Dysfunction ; Cross-sectional Studies ; Neuropsychological Tests ; Psychiatry ; Schizophrenia

OBJECTIVES: This paper aims to evaluate the competence and confidence of the primary care practitioner in the recognition, diagnosis and treatment of mental disorders.
METHODOLOGY: A validated 13 point questionnaire which incorporated items from the DSM IV was given to the participants of the annual convention of the Philippine Academy of Family Physician held in Davao City Sept 8-10, 2000.
RESULTS: Four hundred eighty five family physicians returned the self administered questionnaire. Fifty one percent (248/ 485) claimed they would immediately refer patients to the psychiatrist while 28% (137/ 485) would initiate treatment on their own. Fourteen percent (68/ 485) and 10.9% (53/ 485) of the respondents indicated that they were familiar with the DSM IV criteria for schizophrenia and depression respectively; however only 11.3 % (55/485)were confident in using the criteria for diagnosis. Fortytwo percent (204/485) described schizophrenic patients as being irritable and aggressive, 30% (146/485) believed that hallucinations were the hallmark symptom, while 18% (88/485) considered bizarre behavior as the most significant indicator of schizophrenia. For depression the subjective feeling of sadness and worthlessness was most indicative of depression for the respondents (63% or 305), while 21% or 102 considered low self esteem or unstable self image as one of the criteria for depression and 16% or 78 thought of diminished interest or pleasure in all activities as the more important symptom to look for when diagnosing depression. Tricyclic antidepressants were still the preferred drug by most family physicians in treating depression (72% or 340) while 62% (301/ 485) prescribed benzodiazepines and 51% (248/ 485) also used the newer selective serotonin reuptake inhibitors. Patients with schizophrenia would be given typical psychotropic drugs like chlorpromazine or haloperidol more commonly (88% or 427), while 46% (224/ 485) had begun to prescribe atypical antipsychotic medications.
CONCLUSION:The family physician seems to be hesitant or unsure with their diagnosing or treating psychiatric patients though willing to administer psychotropic medications.

Human ; Male ; Female ; Psychiatry ; Physicians ; Schizophrenia ; Depression

OBJECTIVE: This study was conducted to determine whether there was a correlation between structural brain abnormalities among the different symptom subsets of schizophrenia. METHODOLOGY: Male chronic schizophrenics from Bocaue, Bulacan were screened using the Positive & Negative Symptom Scale (PANSS) and were then subjected to cranial CT scan. Measurements of the lateral ventricles, third ventricle and interhemispheric fissure were obtained and compared with measurements of normal controls. Values were also compared between positive and negative subsets. RESULTS: Using the Kruskall-Wallis test for 2 groups with 95% confidence interval, it was shown that there was no statistical difference in any of the measurements between control and schizophrenic patients, as well as between the positive and negative symptom subset. CONCLUSION This study did not support the findings of the previously cited reports. Measurements of the schizophrenic group were statistically negligible when compared with the normal and were also insignificant between symptom subsets.
Humans ; Schizophrenia ;