BACKGROUND

COVID-19 was declared as a pandemic by the World Health Organization (WHO) in March 2020. It has affected millions globally and remains as a public health concern until today.

OBJECTIVES

The study aims to identify the prevalence of depression, anxiety and stress among UST hospital frontliners during the COVID-19 pandemic using the Depression, Anxiety and Stress Scale (DASS)-21 scale.

METHODS

A cross-sectional study was conducted among 272 frontliners in a tertiary hospital in Manila, Philippines using the DASS-21 scale.

RESULTS

Based on data gathered from the responses of participants using the DASS-21 scale, the prevalence of depression, anxiety and stress among the frontliners were 28.68%, 35.66% and 14.71%, respectively. Being single, living alone, higher degree of educational attainment (postgraduate), trainees (residents and fellows) and those having pulmonary comorbidities were associated with increasing level of depression and stress. Respondents who had less work experience (less than 5 years) had significant depression; being single presented with higher anxiety; and those who had a previous COVID-19 infection had higher degree of stress. 

CONCLUSION

Several demographic and occupational characteristics, in accordance to the COVID-19 pandemic, yielded significant results regarding the presence of depression, anxiety and stress. The study recommends closer follow-up of participants which recorded high severity scores in the DASS-21 scale as well as regular psychological briefing and counseling to assess if there are other contributory factors to such responses. Ultimately, this may enlighten us on how to provide holistic care to our own hospital staff.

Human ; Covid-19 ; Depression ; Anxiety

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

Introduction: Anxiety and depression are the two most common mental disorders among medically ill patients with prevalence of 10%-50%. Anxiety and depression are prevalent in patient with heart disease and are associated with high morbidity and mortality. This study aims to determine the prevalence of anxiety and depression and its correlation with clinical profile in heart failure patients using the Hospital Anxiety and Depression Scale Filipino Version (HADS-P). Methods: A prospective cross-sectional study was conducted. HADS-P questionnaire was administered to heart failure patients admitted at the University of Santo Tomas Hospital from December 2013 to November 2014. After securing consent from the attending physicians and patients, the HADS-P questionnaires were then administered to the patients at the end of hospitalization by the investigator/s. The recommended cut-off score for HADS-P is score of 11. Chi-square and Independent T-tests were used in this study. Results: 144 heart failure patients were enrolled in this study. The prevalence of depression and anxiety among heart failure patients is 13.2% and 25.7%, respectively. Having prior coronary angiography, coronary angioplasty, EF < 40%, and multiple co-morbidity diseases/s are significant factors for depression. While among patients with anxiety, the significant factor is the length of hospital stay. Conclusion This study shows that depression and anxiety are common among heart failure patients. Heart failure patients should be screened for depression and anxiety especially among those having above mentioned clinical profile. The HADS-P questionnaire is an easily applied screening method. A formal psychiatric referral can be taken and should be a part of the comprehensive management among heart failure patients with depression and anxiety.
Anxiety ; Depression ; Heart Failure ; Heart Diseases

Objectives: The structural abnormality implicated in schizophrenia was supported by eye movement abnormalities, which were considered biological or trait markers of this psychiatric disorder. We aimed to establish the presence of these changes in schizophrenia by comparing the smooth pursuit eye movement latency, fixed amplitude saccade latency and symmetry of optokinetic nystagmus using the electronystagmogram among Filipino patients diagnosed with schizophrenia, their siblings without schizophrenia and controls who were neither related to the patient nor diagnosed with schizophrenia. Methods: Included were twenty patients 18-40 years old diagnosed of schizophrenia based on the DSM-IV Criteria, their siblings and twenty controls. All subjects underwent electronystagmography at the Ear Center, University of Santo Tomas Hospital where the following were measured: fixed amplitude saccade latency; horizontal smooth pursuit latency and symmetry of optokinetic nystagmus. The values obtained were then analyzed using paired t-test and two way ANOVA. Results: There was a significant difference in the latency of the fixed amplitude saccade and horizontal smooth pursuit among the three groups. PAtients with schizophrenia had the most delayed latency followed by their siblings. No delay was noted in controls. Significant asymmetry of the optokinetic nystagmus in schizophrenic patients was noted. Abnormalities present in the healthy siblings of patients indicated their latent vulnerability towards this disease. Conclusion: The findings of the study further strengthened the anatomical substrate of schizophrenia. These eye movement abnormalities are localized in the parietal and frontal cortex. These are the same areas that are necessary for attentional symmetry, for minimizing distractibility and maintaining the focus of attention on task relevant stimuli which are impaired in patients with schizophrenia.

OBJECTIVE: This paper aims to correlate the white matter changes seen in cranial Magnetic Resonance Imaging (MRI) the severity of cognitive impairment in patients diagnose Alzheimer Disease by using the conventional Cranial MRI weighted and Fluid-attenuated inversion recovery (FLAIR) images.

METHODS: All patients diagnosed with Probable Alzheimer's disease at the Memory Assessment Center in a tertiary hospital in Manila from January 2007 to September 2008 were included in the study who underwent cranial MRI (T2 weighted and FLAIR images), with ages varying from 65-87 years old using the following tests: Alzheimer's Disease Assessment Scale-Cognitive (ADASCOG), Mini-Mental Status Examination (MMSE), Boston Naming, Verbal Fluency, Word List Memory Task, Recall and Recognition, Trail making A and B and Clinical Dementia Rating (CDR). The Cranial MRI images were rated using the Age-Related White Matter Changes (ARWMC) rating scale for MRI. Analyses were done using the Statistical Package for the Social Sciences (SPSS version 14.) Correlation between continuous data was done using the Pearson correlation test while the correlation between ranked data utilized the Spearman test.

RESULT: Four patients with no white matter changes had mild AD while another two had made an AD. Among those with focal lesions, two were categorized as mild AD, another two cases as moderate and one case with severe AD. Among those with the beginning confluence of lesions, three had mild AD, two had moderate AD and one had severe AD. No case had severe age-related white matter changes. We found no significant relationship between the clinical dementia ratings (severity of AD) and the presence or absence of white matter lesions in the cranial MRI (T2 weighted and FLAIR images). 

CONCLUSION: Diffusion tensor imaging (DTI) captures neurodegenerative brain changes that traditional MRI may miss. Further studies using structural and functional imaging methodologies should be promoted to show cognitive performance and its correlation. In particular, compensatory networks in patients were shown to linearly correlate to cognitive performance. Thus, varied approaches to understanding networks could be valuable tools in developing new approaches for early diagnosis of AD and in the future, aid us in the effectivity of treatment strategies.

Human ; Diffusion Tensor Imaging ; Alzheimer Disease ; Cognitive Dysfunction ; Tertiary Care Centers ; White Matter ; Magnetic Resonance Imaging ; Brain ; Memory ; Cognition ; Early Diagnosis ; Social Sciences ; Mental Status And Dementia Tests

BACKGROUND: The Asian population is rapidly aging and a concomitant exponential rise in the number of elderly people with dementia is expected. Early diagnosis of dementia and recognition of concomitant psychiatric symptoms have profound implications for the patient. In our local setting, majority of elderly individuals live with their families due to cultural influence on family ties. However, institutionalization of elderly individuals is gradually being recognized due to the increasing demands of the society on caregivers who usually belong to the working class.

OBJECTIVE: This pilot study evaluates the cognitive status of Filipino elderly individuals residing at Hospicio De San Jose which aims to examine the prevalence of cognitive impairment and neuropsychiatric manifestations in an institutionalized environment and to determine the rate of progression of cognitive decline.

METHODOLOGY: This is a research study evaluating all Filipino elderly individuals residing at Hospicio de San Jose aged 60 years and above, with or without objective memory complaints. Only literate individuals are included. Exclusion criteria include the presence of acute confusional state or altered sensorium, severe expressive and receptive aphasia, vegetative state, blindness, deafness, and denise hemiplegia in the dominant upper limb. Cognitive status was assessed using the following tests: Mini Mental State Exam (MMSE), US Second Version of Isaac's Set Test of Verbal Fluency (IST), Zasso Cancellation Task, 4-item version of Instrumental Activities of Daily Living: Modified Lawton's Scale (I-ADL). Neuropsychiatric manifestations were evaluated with the use of the Neuropsychiatric Inventory (NPI) and Modified Geriatric Depression Scale (MGDS). Patients were assessed at baseline (BS) and after 6 months (MO). The patients were classified accordingly based on set criteria as follows: Not Cognitively Impaired (NCI), Cognitive Impairment Not Demented (CIND), and Dementia (DEM).

RESULT: There were eighty elderly individuals at Hospicio De San Jose. There were twelve male patients and sixty-eight female home dwellers in total. Twenty-five (25) were included in the study based on the set criteria. Majority were female (84%) and previously employed (70%). The mean age of the population was 70.92 years old and mean level of education (in years) was 10.52. Seventy-two percent (72%) of patients subjectively complained of progressive and insidious memory impairment with an onset ranging from 6 months to 17 years. This pilot study shows that the prevalence of CIND and dementia in an institutionalized care center in our local setting like Hospicio De San Jose is 52% and 8%, respectively.

CONCLUSION: The presentation of the patients is progressive cognitive decline so that careful clinical monitoring is essential. The rate of conversion to dementia within 6 months is negligible. Amongst the several domains evaluated, it is the verbal fluency and speed that is greatly affected which is more compatible with sub cortical white matter changes in an aging brain. The identification of  Filipino home care dwellers at potential risk of dementia is important to lessen caregiver burden, to address early intervention both pharmacologic and non-pharmacologic including improvement of facilities and in-house program to prevent neuropsychiatric complications

Human ; Male ; Female ; Cognitive Dysfunction ; Caregivers ; Activities Of Daily Living ; Persistent Vegetative State ; Prevalence ; Deaf-blind Disorders ; Early Intervention (education) ; Hemiplegia ; Pilot Projects ; Aphasia, Wernicke ; Depression ; White Matter ; Dementia ; Memory ; Memory Disorders ; Institutionalization ; Home Care Services ; Early Diagnosis ; Confusion ; Educational Status ; Cognition

OBJECTIVES

The paper aims to determine the effect of acute ischemic stroke on cognition using the MMSE and other neuropsychological tests.

METHODS

All patients admitted at the University of Santo Tomas Hospital Pay Division for acute ischemic stroke from July to August 2007 were included in the study. Eligible patients underwent Mini-Mental State Examination (MMSE) and a detailed neuropsychological testing to characterize cognitive functioning in 6 domains: attention, executive functioning, language, visuospatial ability, visuomotor speed and memory. Scores were presented as mean standard deviation and frequency of cognitive impairment was determined. Chi square and logistic regression was used to examine the association between stroke and the impaired cognitive domain.

RESULTS

There were twenty-five participants eligible in the study. The mean age of the participants was 58.0 ± 13.3, the mean educational level (in years) was 11.6 ± 3.4, the mean MMSE score was 26.4 ± 3.0 and the mean NIHSS score was 4.2 ± 1.8. With a cutoff score of 23 and below, 4 (16%) patients failed the MMSE. On neuropsychological testing, however, all patients failed in at least one area of cognitive domain being tested. Among these patients, 60% failed in the test for visuospatial and executive functions while 92% failed in the test for visuomotor speed.

CONCLUSION

The prevalence of cognitive impairment after an acute ischemic stroke is 16% using the MMSE. Neuropsychological assessment revealed cognitive impairment in all these patients. The results suggest that the role of MMSE in detecting post stroke cognitive impairment in the acute setting maybe limited. More specific neuropsychological tests should be incorporated to detect subtle cognitive impairment especially instruments that test the areas of visuospatial, visuomotor speed and executive functions.

Human ; Cognitive Dysfunction

BACKGROUND: CIND is a common condition among the elderly population that has acquired clinical significance with the prevalence in elderly people about twice that of all forums of dementia gathered The concept of cognitive impairment with no dementia CIND has emerged as an important clinical entity because of its possible progression to dementia. Compared to patients diagnosed with no cognitive impairment, CIND patients have a 47% chance of developing dementia in 5 years. OBJECTIVES: This study aims to depict the Filipino patient diagnosed with CIND based on a consensus. It is further our goal to ascertain the prevalence of CIND among patients referred to the Memory Clinic for screening and assessment and also aims to determine if there is a relationship between the patient's profile and certain neuropsychological tests. METHODOLOGY: This is a research study which included all the patients (n=86) referred to the Memory Assessment Clinic of a tertiary hospital. Patients diagnosed with CIND were further evaluated and characterized based on the patient's profile such as general data, history of present illness, past medical history, family history, laboratories and ancillary procedures and neuropsychological examination. Relationship of patient's profile with various neuropsychological test was examined through linear and logistic regression and Spearman's correlation test. RESULTS: Out of the 86 patients evaluated by the Memory Clinic of a tertiary hospital, 17 (19.76%) were diagnosed with CIND. The mean age of the patients with CIND is 70.06 years, majority of whom are females (64.7&) and had 10 years of education. All are married with most of them residing in Metro Manila. All presented with progressive cognitive decline. Years of formal education showed that majority of patients had more than or equal to 10 years. Majority had co-morbid medical conditions. and majority are non-smokers and non-alcoholic beverage drinkers. Average MMSE is 25.88 points; the memory domain is greaty affected. Among the various neuropsychological tests, Verbal fluency and Maze tests were frequently impaired. The rest of the neuropsychological test such as Boston naming, Frontal assessment battery, Clock drawing test were frequently unimpaired. The ADAS Cog mean value was 16.37. MMSE and ADAS Cog showed no significant relationship with the patients profile based on linear and logistic regression as well as Spearman correlation.CONCLUSION: The prevalence of CIND in the memory Clinic of a tertiary hospital is 19.76%. The presentation of these patients is progressive cognitive decline so that careful clinical monitoring is essential. Majority of CIND patients have co-morbid medical conditions (76%). The identification of people at potential risk of dementia with a view to early therapeutic intervention is important, because it may lessen distress for both patient and family, minimize the risk of accidents, prolong autonomy, and perhaps even ultimately prevent the onset of the dementing process itself.
Human ; Male ; Female ; Dementia ; Nervous System Diseases ; Central Nervous System Diseases ; Brain Diseases ; Mild Cognitive Impairment ; Mental Disorders ; Delirium, Dementia, Amnestic, Cognitive Disorders ; Cognition Disorders ; Diagnosis ; Neuropsychological Tests ; Behavioral Disciplines And Activities ; Psychological Tests

Objective: To determine if there is a significant difference between the prevalence of depression in institutionalized and non-institutionalized elderly individuals. Methodology: Sixty female individuals 65 years and above were included in the study, thirty from the community while the other thirty reside in an institution for the elderly. The Mini Mental Status Examination was used to establish absence of cognitive impairment in the population, after which the Geriatric Depression Scale was administered. Results: The prevalence of depression in both institutionalized and non-institutionalized elderly individuals was 20 percent. The symptoms of depression in the two groups could be considered as depressive episodes since they were transient and did not result in any deterioration of their function. Conclusion: The finding of this study showed that there was no difference between the prevalence of depression in institutionalized and non-institutionalized elderly individuals.
Human ; Female ; Aged 80 and over ; Aged ; DEPRESSION ; AGED