1.Suicidality among patients with X-linked dystonia-parkinsonism
Roland Dominic G. Jamora ; Alvin Rae F. Cenina ; Rosalia A. Teleg ; Lillian V. Lee
Acta Medica Philippina 2015;49(1):1-10
BACKGROUND: Sex-linked dystonia-parkinsonism (XDP) is an adult-onset, progressive, debilitating movement disorder that manifests with features of dystonia and parkinsonism. It is endemic among Filipino males from Panay Island. Many of these patients would have peculiar postures and bizarre movements forcing them to retreat to the confines of their home or probably in solitude.
OBJECTIVE: To describe the rate of suicide among XDP patients.
METHODS: We identified the patients from the Philippine XDP registry maintained by the XDP Study Group. A retrospective chart review was then done.
RESULTS: There were 21 deaths attributable to suicide from the 194 deaths from the XDP registry (10.8%). The mean age at suicide was 44 + 11.38 years, around 7.76 + 4.65 years from onset of illness and 5.81 + 4.32 years from the diagnosis. Most patients (17/21) were in the generalized dystonia stage at the time of suicide. Five of the suicide cases belonged to two families. The most common method of suicide were hanging (10, 47.6%), refusal to eat (5, 23.8%), non-accidental organophosphate poisoning and self-mutilation (1 each, 4.8%).
CONCLUSION: There was a high rate of suicide (10.8%) among XDP patients compared to the national suicide rate of 3.59/100,000. Hanging was the most common method used to commit suicide.
2.Suicide among patients with X-linked dystonia parkinsonism (XDP): A retrospective study.
Cenina Alvin Rae F ; Jamora Roland Dominic G ; Teleg Rosalia A ; Lee Paul V ; Lee Lillian V
Philippine Journal of Neurology 2012;16(1):53-
OBJECTIVE: To describe the rate of suicide and explore its possible related factors among patients with X-linked Dystonia Parkinsonism. Specifically, this paper aimed to describe the rate of suicide among patients with XDP based on the Philippine XDP registry and to describe these patients in terms of severity of XDP and psychosocial factors.
BACKGROUND: Chronic progressive neurologic conditions have been associated with serious psychosocial stresses. Suicide among patients with X-linked Dystonia Parkinsonism has been previously reported to be high.
METHODS: A retrospective chart review was done on XDP patients with deaths attributable to suicide. XDP related variables and available psychosocial factors were noted.
RESULTS: The prevalence of suicide among all XDP patients registered is 4.16%. There are 194 deaths in the Philippine XDP registry, 21 of which were attributable to suicide, a proportion of 10.8%. Their mean age at suicide was 44, around 7.76 mean years from the onset of illness. All of the patients were either in generalized dystonia or parkinsonian stage when they had suicide. Psychosocial variables noted were marital and family conflict, and loss of employment. None of the patients had a prior documented psychiatric illness but several of them showed symptoms of depression prior to suicide.
CONCLUSIONS: There is a high rate of suicide among patients with XDP which is comparable to other disabling neurodegenerative diseases. It occurs relatively late in the course where the patient is already in the stage of generalized dystonia or parkinsonism. Possible psychosocial risks include poor family support, marital conflict, loss of employment and symptoms suggestive of depression. The present understanding is that depression and suicide in XDP is more likely reactive to the disease rather than part of its clinical feature. This study supports this view.
Human ; Male ; Female ; Depression ; Dystonia ; Dystonic Disorders ; Family Conflict ; Genetic Diseases, X-linked ; Neurodegenerative Diseases ; Parkinsonian Disorders ; Suicide ;
3.The effectiveness and tolerability of the high dose Donepezil at 23 mg tablet per day for Alzheimer’s disease: A meta-analysis of randomized controlled trials
Adrian I. Espiritu ; Alvin Rae F. Cenina
Acta Medica Philippina 2020;54(3):296-304
Objective:
To assess the effectiveness and tolerability of the 23 mg tablet donepezil in patients with Alzheimer’s disease (AD) using meta-analysis of randomized controlled trials.
Methods:
Major healthcare databases were searched from May to September 2016. Evaluation of relevant trials, assessment of risk of bias, collection and analyses of data were performed.
Results:
A total of 1,774 adult participants with AD were pooled from the two trials included. Pooled data showed that after 24 weeks of treatment, no significant difference was noted between Donepezil 23 mg/day and Donepezil 10 mg/day in terms of cognitive function (1.06 SIB points [-0.13, 2.26]; 1704 participants) and in terms of global clinical assessment (-0.02 CIBIC+ points [-0.13, 0.09]; 1705 participants). The participants who took the higher dose were at higher risk to experience “any adverse event” than those who received the lower dose (1.17 RR [1.09, 1.26]; 1785 participants).
Conclusion
Current evidences do not support the routine use of Donepezil 23 mg tablet for the improvement of cognitive function and global clinical status of patients with AD. The higher dose is also marked with an increased incidence of adverse events compared to the lower dose.
Meta-analysis
Result Analysis
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