Browsing by Author "Isuru, L.L.A."

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A Case series of catatonia: Lessons to learn
(Sri Lanka College of Psychiatrists, 2015) Isuru, L.L.A.; Kuruppuarachchi, K.A.L.A.
Catatonia is a neuropsychiatric syndrome which is associated with a diverse range of psychiatric and medical disorders. Current nosological approach supports the view that catatonia is a separate clinical entity. We present a case series of patients with clear catatonic symptoms associated with or as a result of vitamin B12 and folic acid deficiency, hyponatreamia, Systemic Lupus Erythromatosis (SLE) and viral encephalitis, highlighting the importance of being aware of medical causes of catatonia. The patients with B12 and folic acid deficiency and hyponatreamia made a dramatic recovery after correction of the underlying cause, and the patient with SLE and viral encephalitis also showed a good clinical response following appropriate treatment. Early identification of underlying cause and initiation of treatment facilitates a better outcome in patients with catatonia.
Prevalence and correlates of cognitive impairment among patients with schizophrenia attending psychiatry outpatient clinics at Teaching hospital – Karapitiya
(Sri Lanka Medical Association, 2021) Goonathilake, Y.L.A.; Ruben, R.; Ediriweera, D.S.; Isuru, L.L.A.
INTRODUCTION AND OBJECTIVES: Cognitive impairment is considered a core feature of schizophrenia. This study was designed to estimate the prevalence of cognitive impairment among patients with schizophrenia, to assess the degree of impairment in individual cognitive domains and to identify its sociodemographic and clinical correlates in a Sri Lankan setting. METHODS: A sample of 140 diagnosed patients with schizophrenia was selected from the psychiatry outpatient clinics at Teaching Hospital, Karapitiya. Their cognitive functions were assessed using Addenbrooke’s Cognitive Examination – III Sinhala version (ACE-III-S). Participants who scored below 85.5 in ACE-III-S were categorized as having significant cognitive impairment. Multiple linear regression analysis was conducted to assess correlates with level of significance measured at p = 0.05. RESULTS: In this sample, 89.3% of the participants scored below ACE-III-S cut-off (95% CI [84.09,94.47]). Statistical comparison of proportions of the sample which had impairment in each cognitive domain (attention 60%, memory 65.7%, fluency 55%, language 61.4%, and visuospatial skills 63.6%) did not show a significant difference. The final model of regression analysis showed that patients with shorter duration of formal education (p = <0.001), longer duration of illness (p = <0.001) and higher dose of antipsychotics (p = 0.034) had higher cognitive impairment. CONCLUSION: Nearly nine out of ten people with schizophrenia suffer from significant cognitive dysfunction. The evaluated cognitive domains have been affected equally. The results of this study emphasize the importance of introducing routine cognitive assessment protocols, improving facilities available for cognitive rehabilitation and more frequent review of antipsychotic medications.
A randomized, double blind, placebo controlled trial on effectiveness of preemptive analgesia with paracetamol on reduction of occurrence of headache after electro convulsive therapy
(Sri Lanka Medical Association, 2016) Isuru, L.L.A.; Rodrigo, A.; Wijesekera, C.; Premasinghe, S.; Wijesinghe, C.A.; Ediriweera, D.S.; Kuruppuarachchi, K.A.L.A.
INTRODUCTION: Electro convulsive therapy (ECT) is a safe and effective treatment for a wide range of psychiatric disorders. However, its utility is mainly limited by side effects and stigma. Post ECT headache is one of the commonest side effects of ECT. There is little evidence to suggest Pre-ECT analgesia would prevent the occurrence of post ECT headache. OBJECTIVES: Objective was to compare the incidence and severity of the post ECT headache of the patients who had paracetamol 1g, 2hrs before the induction of anaesthesia with those who had a placebo. METHOD: This was a double-blind, placebo controlled trial. Sixty two patients were given placebo and 73 received paracetamol tablets. Ethical approval was granted by an Ethics Review Committee, University of Kelaniya, and the trial was registered in the clinical trial registry (SLCTR/2015/27). Post ECT headache was measured 2 hours after the administration of ECT by a visual analogue test and verbal descriptive scale. Variables were tested for normality and Mann-Whitney U test was used to compare groups. Subsequent analysis was non-parametric, with Mann-Whitney U test. RESULTS: Both intervention and controlled groups had comparable baseline demographic and clinical variables. One third (34%) of the paracetamol group experienced post ECT headache, while 62% of the placebo group experienced same. There was a statistically significant reduction in the incidence and severity of post-ECT headache in the test group (p <0.05). This remained significant after confounding factors were adjusted for in the regression analysis for the duration of illness and headache during this episode. CONCLUSIONS: Preemptive analgesia with paracetamol, 2hours beforeECT, reduces post ECT headache and this could be routinely practiced to ameliorate ECT induced headache.