Patients with schizophrenia presenting with agitated or violent behavior require pharmacological tranquilization. Olanzapine is the first atypical antipsychotic to have a short acting intramuscular preparation for control of agitation. There is a need to review the efficacy and safety of olanzapine intramuscular compared to intramuscular haloperidol. Objectives: To compare the efficacy of olanzapine intramuscular with haloperidol intramuscular in controlling acute agitation among patients with schizophrenia. Methodology: The authors searched the Cochrane Schizophrenia Group Register (November 2004), Cochrane Database for studies, Cochrane Controlled Trials Register (Issue 1, 2002), MEDLINE (1992 to the present), Clinical Trials.gov, Lilly Trial Registry and ClinicalTrialresults.org. Authors also hand-searched references of journal articles and contacted pharmaceuticals for relevant literature. Articles included in the meta analysis were randomized clinical trials comparing the efficacy of intramuscular olanzapine to intramuscular haloperidol for controlling agitation among patients with schizophrenia. Included studies had participants 18 years old and above who had schizophrenia and were acutely agitated. Intervention included olanzapine intramuscular 10-20 mgs compared with haloperidol 5-10 mgs. Outcomes included were decreased in agitation as measured by time to tranquility, change in PANSS scale or other appropriate scale and mean dose to achieve tranquility. Secondary outcomes measures were occurrence of adverse events, patient and care giver satisfaction and economic costs. Analysis: Two authors independently assessed the quality of the studies. Data were extracted using the Cochrane Data Extraction Form. Missing data from the studies furnished by ClinicalTrialresults.org. Data that were continuous were sing mean change. Difference in mean change was analyzed using inverse variance, fixed effects method at 95% confidence interval. Data that were dichotomous were analyzed using odds or risk ratio using Mantel-Haenszel method at 95% confidence interval. Results: Pooled data from the studies did not show that olanzapine intramuscular was not equal to haloperidol intramuscular in decreasing acute agitation among patients with schizophrenia. In terms of treatment emergent adverse events, the risk for treatment emergent adverse events was more for haloperidol IM compared olanzapine IM. Conclusions: It cannot be said that olanzapine IM and haloperidol IM are not equal in decreasing agitation among patients with schizophrenia. In terms of treatment emergent adverse events, the risk for extrapyramidal side effects and dystonia was more for haloperidal IM compared to olanzapine IM while the risk for abnormal blood pressure was more for olanzapine IM compared to haloperidol IM. There is need to assess other factors like economic cost, patient and caregiver satisfaction which the studies in this meta-analysis did not include.
Human ; Aged 80 and over ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; SCHIZOPHRENIA ; PSYCHOMOTOR AGITATION ; OLANZAPINE ; HALOPERIDOL

This study looks at the demographic characteristics and psychiatric diagnoses of minor perpetrators of sexual abuse. Subjects of the study were all minor perpetrators seen at the Child Protection Unit of the University of the Philippines - Philippine General Hospital from March 1997 to September 1998. Of the seventeen subjects seen by the psychiatrists of the unit, majority were in their adolescence (11-14 years) with 5-10 year of age difference from their victims. All were known to the victim as relatives, playmates or neighbors. One third of the minor perpetrators denied committing the abuse. Among those admitted the abuse, no common reason for the act was obtained. Majority of the perpetrators did not have an existing psychiatric disorder at the time of the abuse and majority attended school. Three of the seventeen minor perpetrators had conduct disorder with two having a co-existing mental retardation. Five of the seventeen had an adjustment disorder with depressed mood following the incident.
Human ; Adolescent ; Child ; MINORS ; SEX OFFENSES

Introduction: The year 2000 World Health Organization reports that the age didtribution of suicide has changed such that the rates for those aged 5-44 years old have increased from 40% to 55%, while those aged 45 and above have decreasing suicide rates of 60% to 45%. In the Philippine General Hospital (PGH), the proportion of child and adolescent suicide cases has increased from 35.8% and 26% in 2003-2004 to 41.7% and 58.4% 2005-2006. To date, local studies on risk factors affecting adolescent suicide have not been done and the number of adolescent attempting to kill themselves in a country known for its close family ties and catholic practices continue to rise. Objectives: To describe the profile of Filipino children who committed suicide or parasuicide and characterize them in terms of history of substance use versus patients without a history of substance use in terms of the following variables: demographics, nature of suicide, and risk factors for suicide. Methods: A retrospective cross-sectional chart review of all Filipino charity patients aged 18 years and below, seen at the PGH Department of Emergency Services (DEMS) from the period January 1, 2006 to October 31, 2007 was done. Data was analyzed using frequency count distribution and ratio and proportion. Results and Conclusions: A total of 56 charts were reviewed for the study. The profile of the Filipino child who attempted suicide in this study can be described as: majority is female, single aged 14-18 years, RC, high school students, and unemployed. Most common method of suicide attempt was through ingestion of silver jewelry cleaner following family conflict. No mortality was reported. Suicide risk factors which appear to be significant in this population are substance use, domestic situation, and involvement in a relationship. Further characterization of the group into those with and without a history of substance use also suggests that increasing age, a lower educational attainment, employment status, family history of suicide, marital status of parents, domestic situation, and involvement in a relationship are factors that may influence substance use among this vulnerable population. Recommendations: Early psychiatric evaluation of alcoholic drinkers among adolescents and parental psycho-education in school should be done to curb the rising incidence of suicide attempts in this vulnerable population. Further, prospective and multicenter studies involving more subjects are needed to validate findings in this study.
Human ; Female ; Adolescent ; SUBSTANCE-RELATED DISORDERS ; SUICIDE ; SUICIDE, ATTEMPTED

OBJECTIVE: The present study aimed to determine the internal validity of the different subscales of the Filipino version of Revised Illness Perception Questionnaire (IPQ-R) among patients with chronic pain.

METHODS: A cross-sectional study involving chronic pain outpatients at the Philippine General Hospital Pain Clinic and inpatients admitted between September 2016 to November 2016 was done. Data were obtained through self-administered Filipino version of the IPQ-R. Internal structure of the questionnaire was analyzed using Cronbach's alpha coefficients and confirmatory factor analysis.

RESULTS: A total of 143 patients with chronic pain participated; mean age was 54.9 years. The consistencies of the Filipino version of IPQ-R dimensions for consequence, illness coherence, timeline (cyclical), and emotional representation were within conventional limits with small variations from the original English IPQ-R. However, timeline (acute/chronic), personal control,and treatment control scales failed to reach consistency. By excluding seven items nevertheless, there was noted improvement in the Cronbach's alpha of the corresponding scales.

CONCLUSION:The inter-factor correlations of the Filipino version were relatively similar to those reported in the original English IPQ-R. The modified questionnaire showed good validity and could be a valuable instrument in the assessment of illness perceptions in the Filipino health care setting.

Human ; Male ; Female ; Factor Analysis, Statistical ; Pain Clinics ; Outpatients ; Chronic Pain ; Inpatients ; Hospitals, General ; Philippines ; Perception ; Emotions ; Pain Management

Objectives: This study described the demographic and clinical profile, mental health problems, prevalence of psychiatric conditions, psychosocial interventions used, and outcomes of the management of mental health problems among in-patients admitted to non-psychiatry units of tertiary hospitals referred to mental health care providers; and described gender-disaggregated data related to mental health care providers and patients receiving psychosocial interventions in tertiary hospitals. Methods: This study employed a mixed-method design, using both qualitative and quantitative methodologies following the convergence model of triangulation. The following were the data sources: (1) cross-sectional review of charts of patients referred for psychosocial problems using the ICD-10 classification; (2) a survey of mental health service providers; (3) key informant interviews of mental health service providers; and (4) focus group discussions of mental health providers. All data were collated, compared, and contrasted, then analyzed using the convergence model of triangulation design. Results: Among the 3,502 patients in the chart review, 1,870 (53.40%) were males. The median age was 46.08 years and 92.06% were adults. The most common diagnosis among the patients were mood disorder (744, 21.25%) and organic mental disorder (710, 20.27%). Combination treatment of psychosocial intervention and pharmacology was the most common strategy received by patients. There was a higher proportion of patients admitted to public hospitals (996, 45.27%) who received psychosocial interventions only compared to those admitted to private hospitals (235, 18.05%). There were 3,453 out of 3,502 in-patients referred for psychiatric intervention. Of these 2,420 (70%) received psychoeducation, 2,365 (68.5%), received supportive psychotherapy/counseling, 535 (15.5%) family therapy, and 286 (8.3%) behavior modification. There were more patients given psychosocial interventions 2,541 (72.56%) who were discharged with instruction to follow-up, while around one in 10 (456, 13.02%) was not instructed to do a follow-up consultation. The types of interventions across all data sources were similar. Conclusion The most common type of management for psychosocial problems of in-patients in tertiary hospitals was a combination of psychosocial intervention and pharmacotherapy. Psychoeducation, supportive psychotherapy/ counseling, and family therapy were the most often given psychosocial interventions. The patient-related reasons for the choice of interventions were patient’s medical status (diagnosis and severity of symptoms) and psychological status (psychological mindedness), while the provider-related factors influencing the choice of intervention were provider’s skills and personal preference. Moreover, resources (human and material) and service provision policies (treatment guidelines and aftercare interventions) were the most common hospital-related factors. Further prospective research to determine the associated patients, providers, and hospital factors in larger geographic and cultural settings will provide evidence for the effectiveness and outcomes of psychosocial interventions.
Psychosocial

Background and Objectives: The daily interactions of teachers with students allow the former to observe behavioral changes in the latter. This can serve as an opportunity to emphasize teachers' role in mental health interventions in the school setting. This study aimed to provide baseline information regarding high school teachers' mental health literacy specifically on the recognition and referral of students with depression and suicidal behavior. Methodology: The study design was descriptive cross-sectional that included 460 high school teachers from a district in the City of Manila. The modified QualisMental Vignette Scale for depression literacy and Adolescent Suicide Behavior Questionnaire for suicide literacy was adapted as assessment tools. Results and Conclusion Results of the study found that 64% correctly identified depression as a mental health problem in the modified case vignette. The highest proportion of respondents chose 'informing the parents' as their preferred mode of referral system. The teachers had varying levels of knowledge on suicidal behaviors. More mental health literacy interventions focusing on depression and suicide must be conducted among teachers to improve their competency on these topics.
Depression ; Suicidal Ideation ; Mental Health