Browsing by Author "Harshini, M.L."

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    A case of hypotension and heart rate changes on rechallenge with a low dose of clozapine with no apparent secondary cause
    (Sri Lanka College of Psychiatrists, 2022) Harshini, M.L.; Fernando, A.I.W.; Abayawickrama, H.M.T.S.; Ikram, M.I.N.; Rajapakse, S.; Hapangama, A.
    Clozapine is known to cause innocuous as well as severe and or fatal cardiovascular side effects. These side effects are commonly reported at the initiation of clozapine therapy. We report a patient who was stable on clozapine for several years but in whom we had to withhold clozapine for medical reasons and subsequently developed significant hypotension and heart rate changes when rechallenged with a small dose of clozapine.
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    Pre-admission antiplatelet therapy in patients presenting with acute coronary syndrome
    (Sri Lanka Medical Association, 2011) Fonseka, V.N.R.M.; Danansuriya, D.S.T.; Harshanie, R.L.P.; Harshini, M.L.; Thirumavalan, K.
    INTRODUCTION AND OBJECTIVES: Some patients who present with acute coronary syndrome (ACS) are on prophylactic antiplatelet therapy prior to hospital admission. This study aims to describe factors associated with pre-admission antiplatelet use in patients with ACS admitted to a tertiary care setting. METHODS: With informed consent, data was gathered from patients diagnosed with ACS at the Colombo North Teaching Hospital over 18 months, using a validated questionnaire. Demographic data, risk factors, management and early outcome were analysed using SPSS 17. RESULTS: 254 (33.2%) of a total of 765 patients were on antiplatelet therapy prior to hospital admission. 62/254 (24.5%) were on primary prophylaxis, while 192/254 (75.5%) were on secondary prophylaxis for coronary artery disease (CAD). Although 265 patients had a history of CAD, only 192 (72.4%) were on secondary prophylaxis. Most (115/192 - 59.9%) were on two antiplatelet agents at the time they developed ACS this time. The commonest risk factor for commencing primary prophylaxis was diabetes mellitus (47/62 - 75.8%), and most (52/62 - 83.9%) were on a single anti-platelet agent. Early outcome (death, recurrent ACS) was not significantly associated with pre-admission use of antiplatelet agents as primary or secondary prophylaxis. CONCLUSIONS: A quarter of the patients with pre-existent CAD were not on any antiplatelet agent. One-third of patients developed ACS while on antiplatelet therapy. This highlights the need for better strategies for prevention of ACS. Acknowledgements: Japan International Cooperation Agency.
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    Psychosis after SARS-CoV-2 (COVID-19) infection.
    (Sri Lanka College of Psychiatrists, 2022) Harshini, M.L.; Jayasundara, D.M.S.P.; Williams, S.S.
    Psychiatric manifestations associated with COVID-19 infection have become a subject of study in the wake of the global pandemic. Some psychiatric disorders such as anxiety and depression are well recognized with the COVID-19 infection while overt psychosis is less so.We present four cases of first-onset psychotic episodes with a clear temporal relationship to COVID-19 infection. They appear mainly affective in nature, although only time will determine their eventual progression.
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    Validity and clinical utility of a Sinhalese version of the abnormal involuntary movement scale (AIMS)
    (Sri Lanka College of Psychiatrists, 2021) Baminiwatta, A.K.A.B.; Gunesekara, T.; Kuruppuarachchi, K.A.L.A.; Hapangama, A.; Harshini, M.L.; Bandara, T.R.; Perera, K.M.N.
    INTRODUCTION: Tardive dyskinesia (TD) is a movement disorder caused by long-term treatment with dopamine antagonists such as antipsychotics. As there is no medication universally effective for TD, prevention is important. We propose that non-medical clinicians working in psychiatry can also be trained and involved in a screening programme for TD. To facilitate such a programme, validation of a standard tool translated to Sinhala is a need. AIMS: To translate and validate the Abnormal Involuntary Movement Scale (AIMS) into Sinhala. METHODS: Translation and pilot testing followed standard guidelines. The translated version was administered by five raters (two registrars in psychiatry, a medical officer, a community psychiatry nurse (CPN) and a psychiatric social worker) amongst patients treated with antipsychotic medication for a minimum of one year. The goldstandard diagnosis was the Diagnostic and Statistical Manual (DSM)-5 criteria, applied by a psychiatrist. RESULTS: Of the 137 patients screened (53.3% male; mean age = 49 years), the percentage of patients diagnosed with TD using AIMS and DSM-5 were 33% and 34%, respectively. The sensitivity and specificity of AIMS in detection of TD were 67% and 83.4% respectively. The degree of agreement between the AIMS and DSM- 5 indicated moderate criterion validity (Cohen's kappa= 0.5). For different raters, the agreement with the psychiatrist's diagnosis (kappa) ranged from 0.41 (CPN) to 0.63 (registrar), indicating modest reliability between raters. CONCLUSIONS: Our findings provide preliminary evidence for the validity of AIMS in detecting TD among Sinhalaspeaking patients, when administered by a range of mental health professionals. KEYWORDS: Tardive dyskinesia, Abnormal involuntary movement scale