'Family ties usual cause of mental illness among Pinoys'

MANILA, Philippines - Family relationship is seen to be the usual cause of mental illness among Filipinos.

Romeo Enriquez, Philippine Psychiatric Association (PPA) president, said having a “dysfunctional family” is the usual problem facing Filipinos.

“There are psycho-social stresses like economics, interpersonal and intrapersonal relationships,” he said. “But for the Filipinos, the heaviest is the family, having a dysfunctional family.”

Enriquez said Filipinos afflicted with mental disorders could be around 0.5 to 1.5 percent of the population based on international estimates, although data are not available.

More Filipinos are now consulting doctors, but adherence to medication is still a big problem in the Philippines, he added.

Enriquez said the primary reason is the cost of treatment, as medicine can cost up to P200 to P300 a day. 

“If you have unusual symptoms, (they think) you are already crazy,” he said.

“For families who have not experienced any person in the family who is sick, when you talk about mental illness, it becomes the butt of jokes.”

Robin Emsley, a professor at the Department of Psychiatry at the University of Stellenbosh in Cape Town, South Africa, said the biggest challenge for a psychiatrist is to get their patients to adhere to medication.

“Until today, we failed miserably in treating the illness schizophrenia,” Emsley said.

Speaking at a forum organized by the PPA and Johnson & Johnson (Philippines) Inc., Emsley said continuous anti-psychotic treatment and early recognition and intervention are major determinants for a person who suffers from schizophrenia.

“Environmental factor, social adversity and drug abuse all combine to eventually lead to this condition of psychosis schizophrenia and the point is, by the time patients come to us with their acute psychosis episodes, it is the end stage of a 20-year process that has been going on already,” he explained.

Emsley said good outcome can be achieved in the early stage of the illness “because it is when the patients are most responsive to anti-psychotic treatment.”

“The first two to five years have been described as the most critical period,” he said.

“That is when the illness is most aggressive – maximum risk of disengagement, relapse, suicide and deterioration... What we know is that early psychotic patients respond very well to treatment.”

At present, however, anti-psychotic long acting injectables are now being favored by many patients because it is not taken every day.

Emsley said schizophrenia is a “relapsing illness and the vast majority of patients in the first five years of illness will experience multiple relapses” primarily due to discontinuation of medication.

“Non-adherence is a huge problem so we need to be doing our best as psychiatrists to address this and there is a lot that we can do. There are many psychosocial and pharmacological interventions that can effectively address non-adherence,” he said.

“The consequences of relapse can be serious. There are many psychosocial risks – self harm, harm to others, jeopardizing relationship and employment and depression.”

While economics plays a role in a patient’s rate of adherence, the illness also “impairs the ability to recognize that they are ill,” thus they are “unconvinced that they need to take medication for a long period of time,” Emsley said

Schizophrenia is a chronic, severe and disabling brain disorder that seriously impairs a persons ability to think clearly, relate to others and to function productively in society.