OBJECTIVE: This study aims to describe the patients' and caregivers' experience with the care provided to them by the residents at the UP-PGH Emergency Room Complex (ERC).
METHODOLOGY: The study was a cross-sectional survey using a self-report questionnaire. Focus Group Discussions (FGDs) were conducted to document experiences of patients. The outputs of these FGDs were formulated into questions that explored whether problems existed in several identified aspects of health care. The questionnaires were administered among patients and caregivers at the PGH-ER. Frequency distribution of the responses was determined and the 95% confidence interval was calculated to test the validity of the results.
RESULTS: Forty one respondents answered the survey questions. The top 5 items perceived to be a problem were the following: 1) alleviation of anxiety; 2) physician accessibility; 3) reassurance by physician; 4) communicating the impression that maximum effort was being exerted; and 5) explanation of possible complications of treatment. Most of these experiences pertained to the domain of communicating empathy. The items pertaining to technical competence of the physician and communication of medical information ranked lower and seemed to be less of a problem. Aside from this there was also a lack of explanation of potential complications of treatments.
CONCLUSION: The study showed that respondents considered communication of empathy to patients and caregivers as the most significant problem. The study also revealed that residents of the UP-PGH ERC gave more importance to the communication of empathy compared to communication of medical information.

Human ; Female ; Anxiety ; Caregivers ; Communication ; Confidence Intervals ; Emergency Service, Hospital ; Empathy ; Focus Groups ; Physicians ; Self Report ; Surveys And Questionnaires

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.

OBJECTIVES:The main objectives of the Adherence in Schizophrenia (ADHES) survey in the Philippines were to: (1) describe the insights of Filipino psychiatrists on the level of adherence to treatment of patients with schizophrenia; and (2) to identify possible main challenges for treatment adherence in schizophrenia.
METHODOLOGY:The 2012 ADHES Asia Pacific (APAC) survey was a questionnaire-based survey with 4,661responding psychiatrists (24% of recipients) in 13 countries in the Asia-Pacific region, which was administered from January 2012 to April 2012. In the Philippines (n=17), the survey was conducted between March and April 2012 and distributed to psychiatrists by Janssen personnel. The 20-item questionnaire was devised to ascertain psychiatrists' preferred methods of assessing perceptions of the levels of adherence, reasons for non-adherence to treatment in schizophrenia patients, their perceptions of the levels of adherence, reasons for non-adherence and strategies to improve adherence. Gender, age and practice setting of the psychiatrists were also collected for analysis.
RESULTS:A total of 71 psychiatrists responded to the ADHES Survey in the Philippines. The most common approaches used by the psychiatrists in assessing adherence to prescribed doses were asking an informant (e.g. relative, friend, caregiver) (96%) and asking the patient directly (94%). About 48% of the patients were "fully-adherent" or took at least 90% of prescribed doses as assessed by the psychiatrists who were included in the survey. Meanwhile, 23% of the patients were "non-adherent" or took 30% of prescribed doses. According to the psychiatrists, the most were lack of insight (28%) and cognitive impairment (24%). However, the most common reason for stopping medication among the respondents' patients was due to insufficient efficacy of the antipsychotic or having experienced psychotic symptoms with the medication they are taking (30%). Lastly, the most preferred pharmacological strategies used by the respondents to address an adherence problem in patients with schizophrenia were switching to a long-acting anti psychotic medication (27%) and switching to a different oral antipsychotic (23%).
CONCLUSION:Partial or non-compliance to medication is a serious issue in schizophrenia, and insight into illness in schizophrenia, and insight into illness in schizophrenia is the most important reason for treatment non-adherence. Thu, there is a need to continuously assess the level of insight in patients with schizophrenia and institute more pro-active interventions such as direct-observation treatment for oral medications or long-acting injectable antipsychotics. The more wide-spread use objective assessments of medication  compliance can also be explored.

 

 

Human ; Male ; Female ; Antipsychotic Agents ; Asia ; Caregivers ; Cognitive Dysfunction ; Medication Adherence ; Philippines ; Psychiatry ; Psychotic Disorders ; Schizophrenia ; Surveys And Questionnaires ; Patient Compliance ; Patients

BACKGROUND: A reliable and socially validated definition of recovery in schizophrenia is essential to decrease stigma associated with the illness. This study aimed to define recovery in schizophrenia in the Philippine context, determine its specific elements, and describe methods of assessment in clinical practice. METHODS: We invited a group of purposively selected Filipino psychiatrists to participate in six simultaneous roundtable discussions to gather their opinions and perspectives on recovery in schizophrenia. Transcripts of the discussions were then subjected to framework analysis. RESULTS AND CONCLUSION Most Filipino psychiatrists were of the considered opinion that recovery in schizophrenia is possible, and their vision of a recovered patient resembles a combination of psychological and medical models. The mini-FROGS tool was deemed generally applicable in the Philippine setting except for self-esteem and sense of independence primarily because it is difficult to evaluate. The SWN was received with mixed reactions among the psychiatrists. Spirituality as an element of recovery and the family-oriented culture of the Filipinos were emphasized as important considerations in assessing patients. Other suggestions were given to tailor-fit these tools to the Philippine context.
Schizophrenia ; Philippines