SigN-PQ neuropathic pain questionnaire development and validation in English and Filipino languages

OBJECTIVES: This study aimed to develop and validate a simple questionnaire for chronic neuropathic pain that can be administered as a screening tool by general practitioners and internists in order to help them identify patients with probable neuropathic pain. METHODS: Following a development phase and a pilot study, the revised version of the screening tool which included eleven descriptors associated with neuropathic pain both in English and Filipino languages was validated on 120 consecutive patients with any type of pain except psychogenic pain, recruited in the out-patient clinics of six hospitals. The questionnaire was validated by assessing the sensitivity, specificity, positive and negative predictive value of each item and the overall questionnaire. The internal consistency of the questionnaire items was assessed using the Kuder-Richardson formula 20. RESULTS: Overall, the internal consistency of the SigN-PQ using the Kuder-Richardson formula 20 was 0.7837; the sensitivity was 91.89% with specificity of 80.22%, PV (+) was 65.38% and PV(-) was 96.0%. For the English version, the descriptors with the highest scores were burning (Sensitivity: 100%, Specificity: 93%) and electricity-like (Sensitivity: 100%, Specificity: 93%). For the Filipino version, mainit (burning) has the highest sensitivity of 88% with specificity of 82.6%, followed by gumagapang (tingling) with sensitivity of 86.96% and specificity of 85.42%. The sensation of saksak (stabbing) and hiwa (lancinating) have the lowest sensitivity, 60% and 54% respectively, although their specificity scores are high. Since this study is a validation of a screening tool for neuropathic pain, the investigators decided to choose descriptors with higher sensitivity. Thus, in the final version of the SignN-PQ, the descriptors saksak and hiwa were removed. CONCLUSION: The SigN-PQ Neuropathic Pain Questionnaire has a high overall sensitivity of 91.89% and specificity of 80.22%. The pain descriptors in the questionnaire are consistent with the descriptors cited in the literature. It is a valid screening instrument for neuropathic pain that can be easily incorporated in the daily practice of general practitioners and internists.

Metabolic syndrome among Filipino schizophrenic patients maintained on typical & atypical antipsychotics at the UP-PGH Psychiatry Outpatient Department

Objective: This study identified the prevalence of metabolic syndrome among patients diagnosed with schizophrenia who were maintained on typical and atypical anti-psychotics and have been consulting at the UP-PGH Out-Patient Department by reviewing the values of the laboratory parameters included in the criteria for metabolic abnormalities within a period of 6 months. The prevalence of metabolic syndrome in patients maintained on typical and atypical anti-psychotics was described. Methodology: Patients consulting at the UP-PGH Out-Patient Department who have been diagnosed with schizooophrenia and maintained on typical and atypical anti-psychotics were screened. Only the values of laboratory exams which were reviewed and no new laboratory exams were performed. Parameters used to define the presence of metabolic syndrome as proposed by the International Diabetes Foundation were applied. Results: Fifty-two subjects had a mean age and duration of antipsychotic treatment of 38 and 12.6 years, respectively. Half were taking typical antipsychotics and the other half were maintained on atypical antipsychotics. Of the 52 subjects, 42.3% were noted to have central obesity, 23% had high blood pressure, 9.6% had high fasting glucose, 7.7% had low HDL cholesterol levels and 3.8% were noted to be obese. Four (7.49%) of the 52 subjects were noted to have metabolic syndrome, all of them maintained on atypical antipsychotics. Conclusion: Filipino patients diagnosed with schizophrenia on long-term antipsychotic underscores the need for regular assessment and monitoring of metabolic parameters.

A meta-analysis on the utility of the Structured Clinical Interview for the Diagnostic Statistical Manual (SCID) for a Mental Health Case Registry

A meta-analysis of studies was conducted on the validity of the Structured Clinical Interview for DSM (SCID) as diagnostic tools for the detection of psychiatric disorders: Schizophrenia, Bipolar disorder, major depressive disorder and Substance-related disorders. Looking at sensitivity and specificity, the SCID is seen to perform well, with to high values for all four diagnosis included in the study. In general, SCID was better used in detecting thrue negatives or the non-cases, as shown in higher specificities as compared to sensitivities.

The psychosocial effects of care giving on care givers of persons with schizophrenia seen at the Out-Patient Department of UP-PGH from August-November 2001

Mental illness has always brought distress to the patients as well as their families and/or care providers. Fadden tried to describe the phenomenon of burden among families as "one or more in the household is doing more than their fair share, has activities restricted outside the relationship and experiences a greater or lesser degree of distress". Tronco, et al., in their study in Bulacan found that the concerns were financial burden, inaccessibility health resources, stigma, distress during exacerbations, shame, and isolation. This study was done to describe the psychosocial effects of care giving on primary of persons with Schizophrenia seen at the Psychiatry Out Patient Clinic of UP-PGH. This descriptive cross sectional survey. Those included were adult caregivers of schizophrenic patients. Instruments used were the translated versions of General Health Questionnaire -28 and the Burden Assessment Schedule. A total of 102 respondents were included in the study. Out of these, 76.4% were between the ages 41-65 years, married, mothers of the patients. About 62.4% had been taking care of their patients for more than five years. Using the GHQ, 11.8% were identified to have significant psychiatric symptoms. There was impact on material relationship and the illness was perceived to be was severe to some extent. In all, almost half of the respondents, 52 (50.9%), perceived care giving to be burdensome to some extent. Given the results of the study, one can see that some caregivers develop psychopathology, hence, the need for intervention. This can be done through debriefing sessions, psycho education, and individual therapy, if needed.

Post-marketing surveillance on the efficacy, safety and tolerability of Ziprasidone(Zeldox) in the treatment of schizophrenia and schizoaffective disorder

Objectives: The primary objective of this trial was to evaluate the overall safety of oral ziprasidone among Filipinos diagnosed with acute exacerbation of schizophrenia and schizoaffective disorder based on the incidence of adverse events. Secondarily, the study was undertaken to evaluate the efficacy of oral ziprasidone based on the Clinical Global Impression (CGI)- Severity (S) and CGI-Improvement. Methods: Four thousand three hundred forty patients diagnosed with schizophrenia and schizoaffective disorders were to received Ziprasidone oral capsules. This was an open-label, multicenter study. The minimum expected duration of exposure to ziprasidone treatment for an individual subject was at least 2 weeks. Safety was based on the reported adverse event. Primary efficacy measures included the changes in CGI-S Score and weight and the CGI-I score at the end of treatment. Results: Among the 4,340 patients enrolled in the study, four thousand one hundred twenty seven (95%) patients completed the treatment, with 2% of the patients discontinue due to adverse events. 18% of the patients experienced adverse events which were mild to moderate in severity. Somnolence (3.2%) and dizziness (1.4%) were the most frequently reported adverse events. Conclusions: Ziprasidone is a safe and effective treatment for Filipino patients diagnosed with acute exacerbation of schizoaffective disorder.

Prevalence of hyperglycemia among patients taking atypical antipsychotics seen at the UP-Philippine General Hospital

OBJECTIVE: To determine the prevalence of hyperglycemia among patients taking anti-psychotics in a hospital setting. METHODOLOGY: Twenty-one patients seen at the out patient department and admitted to the in-patient service of UP-PGH, who were taking atypical anti-psychotics such as amisulpiride, clozapine, olanzapine, quetiapine, and risperidone, were screened for hyperglycemia using serum fasting glucose. RESULTS: None of the twenty-one patients taking any of the atypical anti-psychotics tested positive for hyperglycemia. CONCLUSION: Hyperglycemia was not prevalent among this sample of patients taking atypical anti-psychotics.