Browsing by Author "Rathnayake, L.C."

Now showing 1 - 10 of 10

Aspects of moral character, civic purpose and social identity in relevance to the psychological well-being of adolescents in Sri Lanka.
(Journal of the Postgraduate Institute of Medicine, 2019) Chandradasa, M.; Rathnayake, L.C.
ABSTRACT: Moral character is defined as the complex constellation of psychological characteristics that motivate and enable persons to function as moral agents competently. Character is composed of various character strengths, and these are trainable personal characteristics. Purpose is the long-term, progressive intention to accomplish specific aims that are meaningful to self and the broader world. Character strengths and purpose in adolescence is associated with academic achievement and long-term mental and physical well-being. Identity crisis in adolescence is associated with moral character formation, developing a purpose and psychological well-being. Sri Lanka leads human development indices (HDI) in the region. Retention in secondary schooling is high, but higher education enrolment is less than 20% and below the average for lower-middle income countries. Therefore, more than 80% of adolescents exit the educational system without entering a standard tertiary education course. After leaving school, they do not have opportunities in a structured environment to promote desirable character strengths. Despite laws against child cruelty, corporal punishment and psychological aggression are highly prevalent in Sri Lankan schools. There is sound research evidence that this method is counterproductive to long-term mental well-being and character development. Psychiatry is, at times, criticised for only focusing on psychopathology and not on overall positive mental health. Child and adolescent mental health expertise are limited in the country, and psychiatrists need to look beyond diagnostic categories to facilitate and support the character development of young Sri Lankans. Considering this context, there is a need for school-based, culturally relevant character development programmes for Sri Lankan adolescents. These programmes need to be developed recognising moral, ethical, social and cultural values, employing multi-sectoral collaboration. There has been a rising interest world over on character development in adolescents and its relevance to the mental well-being and future workforce of a country. Even though there have been several publications from the West, we could not access any publications on adolescent character development’s relevance to psychological well-being from Sri Lanka. This article discusses recent and relevant literature on character development in adolescence and the potential application of this evidence to the well-being of Sri Lankan adolescents.
Clozapine induced severe weight loss in resistant schizophrenia managed with risperidone add-on therapy
(Sri Lanka College of Psychiatrists, 2020) Chandradasa, M.; Kuruppuarachchi, C.S.; Rathnayake, L.C.; Kuruppuarachchi, K.A.L.A.
ABSTRACT: Clozapine is prescribed for resistant schizophrenia. It is usually associated with weight gain. There have been only a few reports of weight loss associated with clozapine treatment and we report two patients from Sri Lanka. The first patient lost 27% of bodyweight on clozapine while the second lost 17%. Both were clinically stable on clozapine, with marked reduction of psychotic symptoms. Adding risperidone helped to regain the lost weight in the described patients. KEYWORDS: Clozapine, Weight, Schizophrenia, Sri Lanka
Dose-dependent clozapine-induced skin picking and self-injurious behaviour in treatment-resistant schizophrenia
(The Kandy Society of Medicine, 2020) Rathnayake, L.C.; Chandradasa, M.; Mendis, J.
Clozapine is a second-generation antipsychotic used for treatment-resistant schizophrenia. Obsessive-compulsive symptoms induced by clozapine is a known entity. Skin-picking is closely related to obsessions and excoriation disorder is now categorised under obsessive-compulsive and related disorders. Skin-picking associated with clozapine dose increments has been reported in a young male from India. Apart from this, skin-picking and self-injurious behaviour associated with clozapine use are not well described in the literature. Here we report a young Sri Lankan male with treatment-resistant schizophrenia presenting with self-injurious behaviour that is related to clozapine-induced compulsive skin-picking. Due to the partial response, clozapine dose of the described patient was increased above 550 mg/day. Skin-picking was seen only above this dose and the addition of risperidone helped to resolve the psychotic symptoms and keep the clozapine dose at the previous level. The current report is unique in the sense that the self-injurious behaviour was associated with clozapine dose increments.
Early phase child and adolescent psychiatry response after mass trauma: lessons learned from the Easter Sunday attack in Sri Lanka
(London Avenue Publishing Co, 2020) Chandradasa, M.; Rathnayake, L.C.; Rowel, M.; Fernando, L.
BACKGROUND: Sri Lanka is a South-Asian nation with a multi-ethnic population. A 26-year-old armed conflict ended in 2009 and the relative stability over the last decade was unexpectedly disrupted by the Easter Sunday Bombings of Catholic Churches and luxury hotels in 2019. More than 250 were killed and most of the deaths were reported from the St. Sebastian's Church in Negombo in the District of Gampaha. This article describes how mental health services of the District of Gampaha, with a population of 2.3 million and only one child and adolescent psychiatrist responded to the psychological trauma in children. ACTIVITIES: The child and adolescent psychiatry response to the mass trauma was a collaboration between health, educational and voluntary organisations. The psychological support was provided at affected villages, schools and hospital settings. Medical and non-medical personnel were able to refer affected children directly to the child and adolescent psychiatrist. Children who had developed psychological consequences of trauma were provided with evidence-based psychotherapies and psychopharmacology where necessary. In addition, health staff members and teachers were trained to provide psychological support and a booklet was prepared in the local language based on trauma-focused cognitive behaviour therapy. Psychoeducation about the psychological response to trauma was provided through electronic, printed and social media. The limited number of trained psychotherapists and experts in child mental health were a major barrier to implement effective management strategies. CONCLUSIONS: Due to the severe shortage of child mental health experts, practical low-cost methodologies were employed to provide an early response to trauma. Traditional ways of mental health service provision were modified to be implemented via non-experts. KEYWORDS: Psychological trauma; Sri Lanka; adolescent; child; mental health services.
Emotional and behavioural dysregulation in children of health care workers in the frontline of COVID-19 response in Sri Lanka
(Sri Lanka College of Psychiatrists, 2020) Rathnayake, L.C.; Chandradasa, M.
ABSTRACT: A novel coronavirus infection (COVID-19) causing respiratory failure was recognised in Wuhan China and the World Health Organization declared the infection a pandemic. Thousands of lives have been lost and the health care workers working in the frontlines are susceptible to morbidity and mortality due to the highly contagious virus. Significant psychological consequences such as sleep disturbance, anxiety, depressive symptoms, somatization, and obsessive-compulsive symptoms in health workers have been reported from China. We were unable to access any reports of mental health consequences in children of health workers. Parental psychological distress is known to affect children’s mental wellbeing significantly and we report three children presenting with emotional and behavioural dysregulation whose parents are frontline COVID-19 health care workers in Sri Lanka.
Frontal lobe neuropathology presenting to Mental Health Services
(Postgraduate Institute of Medicine University of Colombo, 2020) Chandradasa, M.; de Silva, S.; Rathnayake, L.C.; Kuruppuarachchi, C.S.; Kuruppuarachchi, K.A.L.A.
No Abstract Available.
Gender disparity as a threat to the mental well-being of young Sri Lankan women.
(Cambridge University Press, 2019) Chandradasa, M.; Rathnayake, L.C.
ABSTRACT:Sri Lanka ranks highest in the region for human development. Despite producing the first female head of state in the world, the country has failed to achieve substantial gains in the gender inequality indices in the past decade. In recent years, the proportion of females in secondary education has equalled that of males, and young women have become the majority among the university entrants. These educated young women are likely to face psychosocial distress in a patriarchal society where they would be expected to fulfil traditional gender roles. This article describes gender disparities that could affect the mental well-being of young Sri Lankan women and the need for awareness among mental health professionals in the country. KEYWORDS: Asia; Mental health; Sri Lanka; gender; women.
Gender dysphoria and morbid sexual jealousy in an adolescent.
(Kandy Society of Medicine, 2022) Rathnayake, L.C.; Kuruppuarachchi, C.; Abeyrathne, M.; de Silva Rajaratne, P.K.D.H.J.L.; Chandradasa, M.; Kuruppuarachchi, K.A.L.A.
Gender dysphoria is the psychological distress that occurs when an individual’s biologically determined sex and gender identity do not align. Jealousy is likely to occur in any form of intimate partnership, irrespective of sexual orientation. Jealousy in a relationship is affected by sociocultural variables, an individual’s sense of masculinity, femininity, and other factors. We report an 18-year-old assigned female at birth with gender dysphoria presenting with jealous-type delusional disorder. We found no previous reporting of morbid jealousy in adolescents with gender dysphoria.
How the West can help to develop mental health services in resource-limited settings
(Sage Publications, 2018) Chandradasa, M.; Rathnayake, L.C.
Parental perspectives on the lived experience of having a child with autism spectrum disorder in Sri Lanka
(Sri Lanka College of Paediatricians, 2021) Mahagamage, B.A.; Rathnayake, L.C.; Chandradasa, M.
INTRODUCTION: Autism spectrum disorder (ASD) is thought of as a childhood developmental disorder. However, significant costs resulting from the loss of productivity of families have long-lasting consequences. There is a lack of published research on parental perspectives of the living experience with ASD in Sri Lanka. OBJECTIVES: To identify parental perspectives on the challenges and experiences of raising a child with ASD in the Sri Lankan context. METHOD: A qualitative descriptive study was conducted in the outpatient services of the Provincial General Hospital in Ratnapura, Sri Lanka. Thirty purposefully selected parents of children having ASD participated and one-third were fathers. The sample had parents from urban, semi-urban and rural areas. Professionals, semi-skilled and skilled workers were also selected. Participants represented different ethnic and religious backgrounds. Written informed consent was taken from all and ethical clearance was obtained from the Ethics Review Committees of the Faculty of Medicine, University of Kelaniya and Provincial General Hospital Ratnapura. The focused semi-structured interviews were conducted by a trainee speech and language therapist. Recorded interviews were transcribed verbatim into Microsoft Word and analysed thematically. RESULTS: The 30 participants were aged from 35-46 years. The thematic analysis revealed several prominent themes about the parental experience. These themes were emotional stress and impact on the marital relationship, coping strategies and positives related to parenting a child with autism, dealing with challenging behaviours, perceived stigma and worries about future functioning, limited access to health and educational services, financial and caregiving burden. CONCLUSIONS: Most parents expressed negative perspectives on emotional stress, impact on the marital relationship, dealing with challenging behaviours, perceived stigma, limited access to health and educational services, financial burden, caregiving burden and worries about future functioning of their children. However, having a child with autism has allowed a few parents to develop coping strategies and positives related to their family relationships.