Mood Tracker: A Randomized Controlled Trial of a Self-Monitoring Intervention for Emotional Distress After Traumatic Brain Injury.

OBJECTIVE: Persons with traumatic brain injury (TBI) frequently experience emotional distress (ED) manifested in anxiety and depression. However, they may not access mental health services due to external (eg, access, transportation, and cost) or internal (eg, stigma and discomfort with traditional counseling) barriers. Based on substantial literature indicating that self-monitoring can ameliorate several health conditions, we conducted a randomized, parallel group, wait-list control (WLC) trial of a self-monitoring intervention to decrease ED after TBI. SETTING: Community in the southwestern United States. PARTICIPANTS: Persons with medically documented complicated mild, moderate, and severe TBI. DESIGN: About 127 participants were randomized in blocks of 6 to an active treatment (AT) group, wherein they completed multiple assessments of ED each week over a 6-week period via a smartphone app, or a WLC group in a parallel group, controlled trial. Participants received weekly support calls to promote self-monitoring of ED using ecological momentary assessment. MAIN MEASURES: ED (Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7), Satisfaction with Life Scale, and Participation Assessment with Recombined Tools-Objective. RESULTS: Analysis of the primary study outcome at 6 weeks after initiation of treatment for the AT group did not demonstrate that self-monitoring was effective in decreasing ED as compared to the WLC group. Brief support calls made weekly to promote compliance with self-monitoring were effective in achieving the target number of self-assessments. About 80% of support calls lasted less than 5 minutes. Greater ED was associated with lower life satisfaction and lower participation indicating the importance of addressing ED in persons with TBI. CONCLUSION: Additional work is needed to develop nontraditional interventions to circumvent barriers that prevent persons with TBI from accessing care for ED. Brief support calls may be an effective, low-cost intervention to improve compliance with self-monitoring or self-management interventions.

The utilization pattern of psychiatric consultation services at the University of the Philippines-Philippine General Hospital (UP-PGH) from 1999-2008

OBJECTIVE: This study describes the utilization pattern of psychiatric consultation services at the UP-PGH from 1999 - 2008 by reviewing the demographic data of patients referred, describing the Axis I (Clinical Disorders and Other Disorders That May Be a Focus of Clinical Attention) and Axis III (General Medical Conditions) diagnoses of referred patients, and by identifying the sources of, and reasons for the different referrals.METHODS: Relevant data from the annual census of the Consultation - Liaison (CL) Psychiatry Section from 1999 - 2008 was reviewed according to age, sex, civil status, reasons for referral, DSM-IV TR Multi-axial diagnoses and sources of referrals.RESULTS: The percentage of referrals to consultation psychiatry has increased from 1.03% in 1999 to 1.77% in 2008. There is equal distribution between males and females. Majority of the consultation referrals were married and belonged to the 21-40 age group. The top five referring services were general medicine, surgery and trauma, obstetrics-gynecology, otorhinolaryngology and orthopaedic departments. The top three reasons for referring patients were mood problems, agitation and restlessness, and suicide attempts/behaviour. Majority of the axis I diagnoses were adjustment disorder, depressive disorders, and psychological reactions to illness. According to Axis III diagnoses, majority of the referrals were associated with poisoning and injury, neoplasms, and endocrine, nutritional, metabolic and immunity disorders.CONCLUSION: The referral rate to the CL-Psychiatry Section at the UP-PGH has increased throughout the period studied. This may be attributed to programs and activities that improve efficiency in the delivery of psychiatric knowledge and skills, and better personnel supervision. The referral rate of 1.03% to 1.82% was consistent with those in other countries.

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.