To determine the prevalence of psychiatric syndromes among the disaster victims in CABCOM, Pampanga who underwent psychosocial processing.
Human ; Male ; Female ; Adult ; PSYCHOLOGY ; PSYCHIATRY ; DISASTERS

OBJECTIVES: Using the patient’s perspective, the study’s objective was to estimate the economic cost of treatment for adult schizophrenia patients in a tertiary hospital using key informant interviews. METHODS: A guided structured key informant interview was done to determine key practices in the treatment of adult schizophrenic patients in the charity and pay in-patient and out-patient settings of the tertiary hospital. Cost of treatment included direct (medication, room and board, professional fees, ancillaries) and indirect costs (productivity losses of both patient and caregiver) and was computed based on 1 to 4 week length of stay for inpatients and varying intervals of follow-up for outpatients. Total costs were computed depending on the treatment setting. RESULTS: Twenty nine members of the Department of Psychiatry, involving 5 psychiatric nursing staff, 13 residents-in-training, 4 fellows-in-training and 7 consultants were interviewed. The cost, for charity inpatient care, may range from PhP 2332.00 to PhP 44,861.00 (USD 50.88 to 978.86). For charity outpatient care, this may range from PhP 2892.00 to PhP 21,3612.00 (USD 63.10 to 4660.96) annually. For pay patients, costs were estimated to range from PhP15347.00 to PhP 24,6831.00 (USD 334.87 to 5385.80) for inpatient care and PhP 17,292.00 to PhP 1,125,600.00 (USD 377.31 to 25681.04) for outpatient care. The factor that influenced costs the most was the choice of medication. As of October 15, 2015, 1 USD = 45.83 PhP. CONCLUSION Schizophrenia is a chronic psychiatric illness that places a significant financial burden on patients and their caregivers. Based on the data gathered, patients’ and their families could spend from as low as 2332 to as high as 1,125,600 pesos depending on the treatment setting.
Schizophrenia

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 paper aims to describe the knowledge, attitudes, and practices of first-stroke patients regarding sex. It also aims to describe the socio demographic and clinical profiles of first-stoke patients. It is hope of the investigators to come up with recommendations that will respond to the needs of stroke patients as well as the caring physician.
Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; STROKE ; SEXUAL BEHAVIOR ;

This is a case of a 22-year-old female who presented with labile mood, impulsivity and persistent suicidality. Despite numerous pharmacologic and psychotherapeutic regimens, she only had minimal improvement. Subsequently, she revealed traumatic events in younger years.She has been experiencing recurrent intrusive thoughts, low self-worth, guilt and avoidance behavior. Pharmacotherapeutic management was revised as well as her psychotherapy, which resulted in a positive outcome. However, recurrence occurred after she encountered negative life events. Electroconvulsive therapy and revision of pharmacologic treatment eventually led to significant improvement. This case highlights the importance of underlying psychological trauma that caused persistent symptoms. The intensity of impact and the chronic recurrent negative effect of the trauma on the patient influenced the treatment outcome. It is important to optimize therapeutic management with the use of pharmacologic agents, psychotherapy and somatic therapies.
Stress Disorders, Post-Traumatic ; Bipolar Disorder

BACKGROUND: Millennials are the demographic cohort born from 1982-2004. They exhibit optimism, multi-tasking, techno-savy, but with constant need for structure. Medical trainees are no exception. As local studies on this concern have been trending, available data are lacking.
OBJECTIVE: This cross-sectional study describes the characteristics of millennial physicians as to attitudes towards their profession, approach to authority and rules, learning preferences, and healthcare practice.
METHODOLOGY: Focused group interviews and quantitative survey were conducted among 150 physicians, aged 25-34 years, at the University of Santo Tomas Hospital Manila.
RESULTS: Most respondents perceive medical profession as a noble way of contributing to society. However, they rarely consider it as a full-time vocation. Rather, they intend to pursue part-time entrepreneurial endeavors for economic reasons, or otherwise. Respect for authority based on values over professional accomplishments is a prominent finding. They prefer approachable and friendly mentors. They only comply with rules that they agree on, unless it is morally unacceptable. Furthermore, the millennial participants learn most effectively in a quiet environment, by listening and taking notes than reading and discussing with others. They attend medical lectures most of the time but when they don't, no remorse is associated. They learn most efficiently through repetition and demonstration. Practical skills are favored more than theoretical knowledge. All use medical apps for healthcare practice. Majority chooses digital over printed materials in seeking treatment information. However, in patient education, they do not prefer the use of text messages or social networking sites. They put more value in face-to-face teachings to families than sharing links for online health materials.
CONCLUSION: The qualities and preferences of millennial physicians provide insights and challenges for the medical faculty to better engage the future healthcare providers. Actions to address the emerging generational gaps are recommended to meet the demands of young physicians of today.

Human ; Male ; Female ; Adult ; Demography ; Faculty, Medical ; Learning ; Mentors ; Morals ; Occupations ; Optimism ; Philippines ; Physicians ; Social Networking ; Surveys And Questionnaires

BACKGROUND: In the recent years, there appeared to be a rise of herbal products in the market. Thus, it becomes imperative for health practitioners to become knowledgeable on this aspect of complementary medicine. However, data on familiarity with and actual utilization of the 10 DOH-endorsed herbal medicine plants by the health practitioners is lacking.
OBJECTIVE: This study was done in order to determine the knowledge and utilization of the 10 DOH-endorsed herbal medicinal plants among the resident physician trainees of the University of Santo Tomas Hospital (USTH).
METHODS: A total of 143 randomly selected trainees from different specialties and year levels were included in this study. A one-time interaction with the residents was done, during which, they were asked to answer a 5-page face to face survey questionnaire.
RESULTS: The study revealed that majority of the respondents is aware of the 10-DOH endorsed herbal medicinal plants. However, most of them perceive the use of herbal medicines to be only " a little effective". Prescribers are prompted mainly by its affordability. The residents can fairly identify the herbal medicinal plants and are adept with the indication for use of these plants. In spite of this, majority of the residents are not familiar with the proper preparation methods.
CONCLUSION: Overall, the respondents appear to be more aware with certain herbal medicinal plants such as ampalaya, bawang, lagundi and sambong but obviously lack familiarity with other plants including ulasimang bato, yerba buena and niyog-niyogan.

Human ; Male ; Female ; Herbal Medicine ; Plants, Medicinal ; Icodextrin ; Phytotherapy ; Glucans ; Glucose ; Complementary Therapies ; Surveys And Questionnaires

BACKGROUND: As part of their requirements for Family Medicine rotation, the postgraduate interns (PGIs) are required to construct and present a family case report. Each team of PGIs, led by a family medicine (FM) resident, identifies a family to be enrolled in the Family Health Care Program. Although this has been ongoing for years, no feedback mechanism has yet been established.
OBJECTIVE: The purpose of this study was to determine the learning experiences and insights of PGIs in constructing and presenting a family case report during their rotation in the Family and Community Medicine.
METHODS: A survey questionnaire, consisting of 10 items, was given to the respondents. The respondents took as much time as they needed to complete the survey.
RESULTS: Overall, the results revealed that the construction and presentation of Family Case Reports provided the PGIs an avenue to practice certain competencies required in primary care setting such as patient engagement, health promotion and family oriented care. Critical thinking skills as well as patient-doctor communication were enhanced during this activity. However, a good number of PGIs resounded their sense of inadequacy and uneasiness with the application and interpretation of family assessment tools. They perceived this to be a main hindrance in coming up with the best possible case report.
CONCLUSION: The family case report remains to be a unique and productive learning endeavor for PGIs assigned in the Department of Family Medicine.

Human ; Male ; Female ; Community Medicine ; Family Health ; Patient Participation ; Family Practice ; Physician-patient Relations ; Primary Health Care ; Health Promotion

INTRODUCTION: Child abuse, sexual and domestic violence are among the most destructive experiences afflicting women and children that result to physical, behavioral, psychological and economic consequences. Physicians in the front line need to be sensitive and vigilant in identifying both overt and subtle signs of these violations. As such, identification of victims is vital to prevent further abuse and injury, as well as to manage the patient holistically.
OBJECTIVE: To assess the skill of Family Medicine (FM) residents in detecting cases of violence against women and children (VAWC).
METHODS: Eight case scenarios were presented to 48 resident trainees from government and private hospitals in Metro Manila. They were tasked to identify cases pertaining to VAWC, and distinguish the case type.
RESULTS: Red flags that were easily detected by more than 80% of trainees were cases of physical abuse towards men, and neglect. Circumstances with moderate challenge were sexual harassment, rape, and abandonment, in that order. On the other hand, respondents had inadequacy in detecting cases of sexual abuse and physical abuse towards children; while the most difficult to recognize was emotional abuse.
CONCLUSION: Acquisition of this new skill set may prove beneficial in providing the ideal environment for proper management and support provision for the VAWC subjects. Lack of knowledge and training in this rising societal and health threat may cause underdiagnosis of common VAWC presentations. Consequently, this leads to failure of identification, assessment, documentation, and management of such patients.

Human ; Male ; Female ; Child ; Sexual Harassment ; Rape ; Physical Abuse ; Domestic Violence ; Child Abuse ; Sex Offenses ; Surveys And Questionnaires

BACKGROUND: Depression and anxiety are the most common mental disorders seen and managed in primary care. Both mental disorders have been increasingly prevalent worldwide. Filipinos are known for being family-centered and the family has been consistently a good ally in healthcare. A family- focused intervention is believed to be a good adjunct in the reduction of symptom severity of depression and anxiety.
Objective: This study aims to systematically analyze the effectiveness of family-focused interventions among patients with depression and anxiety.

METHODS: Studies were obtained from electronic search for literature (PubMed, Cochrane, HERDIN). Additional cross-referencing was done from the reference lists of included studies. Two independent reviewers assessed the methodological quality of included trials.

RESULTS: Two studies met the selection criteria and were included for meta-analysis. There was a total of 224 participants who were all clinically diagnosed with depression and anxiety. Compared with the standard care for depression and anxiety, family-focused intervention was found to be more effective (SMD=-1.20, z=6.92, p=0.001, 95% CI=-1.54 to -0.86). There was also no substantial heterogeneity (I2=13.80%) seen among the included studies (Q=1.16, p=0.281; ?2=0.01).

CONCLUSION: Family-focused intervention was shown to be effective in reducing the symptom severity of depression and anxiety.

RECOMMENDATION: The authors recommend future researchers to use more studies, both published and unpublished, on the utilization of family-focused interventions in the management of depression and anxiety. Applicability of the results in the Asian region, especially in the Philippines, should be explored. This review also suggests the option to provide different family-focused intervention techniques as an adjunct in the management of depression and anxiety in primary care.

Human ; Depression ; Anxiety