Browsing by Author "Williams, S.S."

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Abuse, maltreatment and bullying in childhood
(Sri Lanka College of Psychiatrists, 2015) Williams, S.S.; Ariyasinghe, D.
Acute hospital care
(Royal College of Psychiatrists, 2002) Kuruppuarachchi, K.A.L.A.; Williams, S.S.
Comment On: Dratcu (Psychiatric Bulletin, 2002, 26, 81-82), No Abstract Available
Anxiety and depression among patients at a tertiary care respiratory clinic in Sri Lanka
(Sri Lanka College of Psychiatrists, 2018) Galhenage, J.S.; Rupasinghe, J.P.N.; Weerasinghe, W.B.D.D.; Abeywardena, G.S.; Williams, S.S.; Gunasena, B.
BACKGROUND: Chronic respiratory diseases are associated with increased risk of mood and anxiety disorders. These disorders in turn may lead to frequent hospital admissions and lower treatment adherence among patients with respiratory disease. AIMS: The objective of this study was to describe the prevalence of anxiety and depression among patients with chronic lung diseases and their association with socio demographic factors. Methods: A descriptive cross sectional study was conducted among patients at a respiratory outpatient clinic at the National Hospital for Respiratory Diseases, Welisara. Demographic data was collected using an interviewer administered questionnaire; a selfadministered Hospital Anxiety and Depression scale was used to examine for the presence of anxiety or depression. Consecutive patients who gave written informed consent to were included in the study. RESULTS: A total of 451 patients were participated in the study, of whom 274 (60.8%) were females. The mean age was 57.4 (SD=15.3) years and the majority (74.7%) were married. The education level of 226 (50.1%) was between grade 5 and grade 11. There was no permanent income for 196 (43.5%). The majority had bronchial asthma (60.3%) and 151 (33.5%) had one or more co-morbid medical illness. The mean score for the anxiety component was 6.78 (SD=3.59) and for the depression component it was 7.03 (SD=3.11). Seventy (15.5%) screened positive for anxiety and another 100 (22.2%) were doubtful cases. Sixty five (14.4%) screened positive for depression and another 128 (28.4%) were doubtful cases. Participants who were unmarried, divorced, separated or widowed had significantly higher levels of anxiety compared to those who were married (p=0.005). Patients who had a monthly income also had more anxiety compared to those who did not have an income (p=0.003). Conclusions: One fifth of the patients attending the respiratory clinic screened positive for anxiety and depression. This indicates the importance of addressing the psychological morbidity among patients with chronic lung disease.
The association between negative experiences during childhood and social anxiety disorder: A cross-sectional study among Sri Lankan university students
(Sri Lanka Medical Association, 2023) de Silva, B.G.R.; De Zoysa, P.T.; Pathmeswaran, A.; Williams, S.S.
INTRODUCTION: Social Anxiety Disorder (SAD) demonstrates early-onset, chronic course, and impairment in all social spheres. OBJECTIVES: The study objective was to explore the association between negative childhood experiences among a university student sample that indicated a high prevalence of SAD. METHODS: A cross-sectional study was conducted among 1137 students from five state universities. The Liebowitz Social Anxiety Scale – Sinhala version, and a correlates questionnaire including a culturally adapted Adverse Childhood Events Questionnaire and contextually appropriate parenting-related questions, were used as instruments. The analysis included chi-square tests for independence, spearman’s r correlations, and binary logistic regressions. RESULTS: Within the sample, 52.2% were female, and 66% were between 21-23 years. All faculties were represented with 27.5% from engineering. 32.2% of participants were first years. Bivariate analyses identified that being an eyewitness towards violence towards mother, feeling unsafe, feeling mistreated by family, experiencing physical abuse, experiencing sexual abuse, experiencing emotional abuse, experiencing parental dissatisfaction, and parental overcontrol to be significantly (p<0.05) associated with SAD. Continuous variables of Parent dissatisfaction (AOR=1.07, 95% CI 1.01-1.13, p<0.05), parent overcontrol (AOR=1.08, 95% CI 1.02-1.15, p<0.01) and experiences of emotional abuse (AOR=1.31, 95%CI 1.11-1.54, p=0.001) remained independently associated with SAD on regression analysis. CONCLUSIONS: Findings from this study corroborate the literature on the association between childhood experiences and parenting-related factors and SAD. The findings also highlight for the first time that Sri Lankan university students are no exception. An urgent need for awareness and prevention of adverse experiences within the family context, and early intervention to prevent the development of SAD are crucial.
Audit on monitoring of metabolic parameters in patients treated with antipsychotics
(Sri Lanka Medical Association, 2014) Kapugama, K.G.C.L.; Williams, S.S.
INTRODUCTION AND OBJECTIVES: To determine if the unit guidelines regarding baseline monitoring of metabolic parameters, were adhered to in patients at University Psychiatry Unit, North Colombo Teaching Hospital, Ragama. METHODS: A clinical audit was conducted on all in-patients newly commenced on antipsychotics over a period of 12 months. Data was gathered by retrospectively reviewing bed head tickets. RESULTS: Total sample was 71 (34 males, 47.88%). Diagnoses included schizophrenia (21, 29.57%), severe depression (19, 26.76%), manic episode (14, 19.71%), acute and transient psychotic disorder (6, 8.45%), dementia (5, 7.04%) and others (6, 8.45%). Blood pressure was recorded in 56 (78.87%); weight in 17 (23.94%); FBC was monitored in 53 (74.64%); FBS in 50 (70.42%); serum cholesterol in 13 (18.30%); AST/ALT in 42 (59.15%); electrolytes in 45 (63.38%); blood urea in 32 (45.07%); 31 (43.66%) patients had ECG. Height, BMI and waist circumference were not recorded in any of the BHTs. CONCLUSIONS: Baseline metabolic screening of weight, height, BMI, waist circumference, serum cholesterol blood urea and ECG is inadequate. Adherence to unit guidelines is satisfactory in monitoring of FBC, FBS, electrolytes and AST/ALT.
Betel use and schizophrenia.
(Royal College of Psychiatrists, 2003) Kuruppuarachchi, K.A.L.A.; Williams, S.S.
Comment on: McCreadie RG, Scottish Comorbidity Study Group. (Br J Psychiatry. 2002; 181:321-5).No abstract available.
Cardiovascular risk profile of the estate population of Sri Lanka
(Sri Lanka Medical Association, 2010) Pinidiyapathirage, M.J.; Chackrewarthy, S.; Perera, P.S.; Wijayasinghe, Y.S.; Williams, S.; Williams, S.S.; Kato, N.; Wickremasinghe, A.R.
OBJECTIVES: To estimate the prevalence of biochemical and anthropometric risk markers of cardiovascular diseases in the estate population of Sri Lanka. METHODS: Using a cross sectional design, consenting adults aged 35-64 years resident in 3 selected estates in the Nuwara-Eliya District were recruited with the support of estate medical assistants and welfare officers. AH participants were subjected to an interview, blood pressure and anthropometric measurements and collection of fasting blood samples. RESULTS: Of the 401 participants recruited, 53% were females and 99% were cither Indian or Sri Lankan Tamils. The mean age of the participants was 50.3 years (SD 8.5). 47 (12%) participants had a BMI >25, 8 (2%) a BMI >30. 29 males (15%) and 29 females (14%) had a waist circumference [WC] >90cm and >80 cm, respectively. 151 (38%) participants had systolic blood pressure (SBP) > 140mmHg , 127 (32%) had diastolic blood pressure (DBF) > 90mmHg and 170 (42%) had either SBF > 140 or DBF > 90. 41(10%) participants had fasting blood glucose (FBG) >126mg/dL. In 197 (49%) participants, some form of dyslipidaemia was present. Males had a significantly higher mean BMI, FBG and triglyceride (TG) level and a significantly lower high density lipoprotein (HDL) level as compared to females. CONCLUSIONS: Obesity, as defined by BMI or WC, was low in this population as compared to other reported studies from different population groups in the country. But prevalence of hypertension and dyslipidaemia (especially high TG and low HDL levels in males) was high.
Charles Bonnet syndrome
(SAARC Psychiatric Federation, 2015) Dissanayake, D.M.R.M.; Hewarathne, A.; Wijesinghe, C.A.; Amarasinghe, B.; Williams, S.S.
A 41 year old married labourer presented with complex visual hallucinations for six months. He had reduced visual acuity, a subluxated lens, and two retained sutures from a previous surgery of the right eye and complete blindness of the left eye. His mental, physical and neurological examinations were unremarkable. Surgical correction of his visual impairment resulted in resolution of symptoms.
Cognitive behavioral therapy for university students with social phobia: A method to culturally adapt group therapy
(Sri Lanka Medical Association, 2016) de Silva, B.G.R.; de Zoysa, P.; Williams, S.S.
INTRODUCTION AND OBJECTIVES: Social phobia is a debilitating anxiety disorder with negative social implications. University students in Sri Lanka appear to have high prevalence rates of social phobia according to preliminary studies. Establishing a methodology by which interventions such as, Cognitive Behavioral Group Therapy (CBGT) could be culturally adapted is the objective of this study. METHOD: The gold standard CBGT was used to construct the structure of the intervention. CBGT interventions that have been modified to suit university student participant groups in the West were reviewed to revise the structure of the therapy. Existing cross-cultural therapy adaptation models were identified to derive factors to be taken in to consideration within this adaptation process. A study of other mental health intervention programs that have been cross-culturally adapted in diverse cultural settings was carried out. RESULTS: The methodology obtained constituted of three steps. The intervention program was initially reviewed by a panel of clinical psychologists to assess for appropriateness of content. Thereafter, the finalized layout, including activity worksheets were translated to Sinhala Language, and re-translated to English to test for accuracy. Finally, the translated documents were assessed by a panel of mental health experts in Sri Lanka and consensus was reached. CONCLUSIONS: A practical methodology to cross-culturally adapt psychological therapy for social phobia in the Sri Lankan context was developed
Communitry psychiatry in developing countries - Sri Lanka
(Royal College of Psychiatrists, 2001) Kuruppuarachchi, K.A.L.A.; Williams, S.S.
Comment on: Farooq and Minks, (Psychiatric Bulletin, June 2001, 25, 226-227). No Abstract Available
Conflict in Sri Lanka: doctors can influence people and promote peace
(British Medical Association, 2002) Kuruppuarachchi, K.A.L.A.; Williams, S.S.
Comment on: BMJ. 2001 Nov 3;323(7320):1020. No Abstract Available
Cross cultural psychiatric interviews and research instruments
(Royal College of Psychiatrists, 2001) Kuruppuarachchi, K.A.L.A.; Williams, S.S.
No Abstract Available
Delayed psychological morbidity associated with snakebite envenoming
(Public Library of Science, 2011) Williams, S.S.; Wijesinghe, C.A.; Jayamanne, S.F.; Buckley, N.A.; Dawson, A.H.; Lalloo, D.G.; de Silva, H.J.
INTRODUCTION: The psychological impact of snakebite on its victims, especially possible late effects, has not been systematically studied. OBJECTIVES: To assess delayed somatic symptoms, depressive disorder, post-traumatic stress disorder (PTSD), and impairment in functioning, among snakebite victims. METHODS: The study had qualitative and quantitative arms. In the quantitative arm, 88 persons who had systemic envenoming following snakebite from the North Central Province of Sri Lanka were randomly identified from an established research database and interviewed 12 to 48 months (mean 30) after the incident. Persons with no history of snakebite, matched for age, sex, geograpical location and occupation, acted as controls. A modified version of the Beck Depression Inventory, Post-Traumatic Stress Symptom Scale, Hopkins Somatic Symptoms Checklist, Sheehan Disability Inventory and a structured questionnaire were administered. In the qualitative arm, focus group discussions among snakebite victims explored common somatic symptoms attributed to envenoming. RESULTS: Previous snakebite victims (cases) had more symptoms than controls as measured by the modified Beck Depression Scale (mean 19.1 Vs 14.4; p<0.001) and Hopkins Symptoms Checklist (38.9 vs. 28.2; p<0.001). 48 (54%) cases met criteria for depressive disorder compared to 13 (15%) controls. 19 (21.6%) cases also met criteria for PTSD. 24 (27%) claimed that the snakebite caused a negative change in their employment; nine (10.2%) had stopped working and 15 (17%) claimed residual physical disability. The themes identified in the qualitative arm included blindness, tooth decay, body aches, headaches, tiredness and weakness. CONCLUSIONS: Snakebite causes significant ongoing psychological morbidity, a complication not previously documented. The economic and social impacts of this problem need further investigation
Delayed psychological morbidity in victims of snakebite envenoming
(Sri Lanka Medical Association, 2010) Williams, S.S.; Wijesinghe, C.A.; Jayamanne, S.F.; Buckley, N.; Dawson, A.; Lalloo, D.G.; de Silva, H.J.
OBJECTIVES: We assessed delayed somatic symptoms, depressive disorder, post-traumatic stress disorder (PTSD) and impairment in functioning among snakebite victims. The psychological impact of snakebite on its victims has not been systematically studied. METHODS: The study had qualitative and quantitative arms. In the quantitative arm, 88 persons who had systemic envenoming following snakebite from the Polonnaruwa District were randomly identified from an established research database and interviewed 12 to 48 months (mean 30) after the incident. 88 persons with no history of snakebite, matched for age, sex, geograpical location and occupation acted as controls. A modified version of the Beck Depression Inventory, Post-Traumatic Stress Symptom Scale, Hopkins Somatic Symptoms Checklist and Sheehan Disability Inventory, together with a structured questionnaire were administered. In the qualitative arm, focus group discussions among snakebite victims explored common somatic symptoms attributed to envenoming. Results: Snakebite victims had more symptoms as measured by the modified Beck Depression Scale (mean 19.1 vs 14.4) and Hopkins Symptoms Checklist (38.9 vs. 28.2) compared to controls (p<0.001). 48(54%) victims met criteria for depressive disorder compared to 13(15%) controls. 11(12.5%) victims also met criteria for PTSD. 24(27%) claimed that the snakebite caused a negative change in their employment; 9(10.2%) had stopped working. 15(17%) victims claimed residual physical disability, and themes identified in the qualitative arm included blindness, tooth decay, body aches, tiredness and weakness. CONCLUSIONS: Snakebite causes delayed psychological morbidity, a complication not previously documented.
Delusional parasitosis
(Sri Lanka Medical Association, 2003) Kuruppuarachchi, K.A.L.A.; Williams, S.S.
No Abstract Available
Development and assessment of a psychological intervention for snakebite victims
(Sri Lanka Medical Association, 2014) Wiiesinahe, C.A.; Williams, S.S.; Dolawatta, N.; Wimalaratne, A.K.G.P.; Kasturiratne, A.; Wijewickrema, B.; Jayamanne, S.F.; Lalloo, D.G.; Isbister, G.K.; Dawson, A.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: There is significant delayed psychological morbidity and negative psycho-social impact following snakebite. However, no psychological support is provided to victims. We aimed to develop and assess the effectiveness of a brief intervention which can be provided by non-specialist medical officers aimed at reducing psychological morbidity. METHODS: In a single blind clinical trial at Polonnaruwa Hospital, 187 snakebite victims were randomised into three arms. One arm received no psychological intervention (Group A; n=59; control). Group B (n=60) received psychoeducation at discharge from hospital. Group C (n=68) received psychoeducation and a.second intervention one month later based on cognitive behavioural principles. All patients were assessed six months after discharge from hospital using standardised tools for presence of psychological symptoms and level of functioning. RESULTS: Compared with Group A, there was a significant reduction in anxiety symptoms measured by the Hopkins Psychiatric Symptom check list (16.9% vs. 5.9%, p=0.047, Chi-Squared test) and a non-significant trend towards improvement in the level of functioning measured by the Sheehan Disability inventory (6.47 vs. 4.69) in Group C, but not in Group B. There was no difference in rates of depression and post-traumatic stress disorder (PTSD) between the three groups. CONCLUSIONS: Our preliminary findings suggest that brief psychological interventions which include psychoeducation plus cognitive behavioural therapy given by non-specialist doctors, but not psychoeducation alone seem to reduce anxiety and facilitate a trend towards improved function in snakebite victims. However, these interventions had no effect on depression or PTSD.
Eating attitudes and behaviours among adolescent girls in the Colombo District, Sri Lanka
(Sri Lanka Medical Association, 2012) Wijeratne, L.T.; Kuruppuarachchi, K.A.L.A.; Pathmeswaran, A.; Williams, S.S.
INTRODUCTION: Eating disorders are considered by some to be a culture bound phenomena confined to the west. Its prevalence among young adolescents in Sri Lanka is not known. AIMS: To describe the concerns and attitudes regarding weight and body shape among adolescent school girls in the Colombo district. METHODS: A descriptive cross sectional study was conducted in selected National, type 1AB, type 1C and type 2 schools in the Colombo district, using a self administered questionnaire that included demographic data and the Eating Attitude Questionnaire ( EAT26 ). The EAT 26 was translated to Sinhalese and validated using the Delphi technique. Results: The study population consisted of 1564 adolescent school girls from 18 schools. A high risk for developing an eating disorder in terms of the EAT 26 questionnaire was seen in 217 [ 14%) and a moderate risk in 554 ( 36%). 14% believed they were fatter than their peers. Of those who believed they were fatter than others, 25% had an EAT26.score indicating a high risk for developing an eating disorder. Dieting was undertaken by 34% to lose weight. CONCLUSIONS: Risk for eating disorders is present in adolescent girls in Sri Lanka. Clinicians need to consider this differential diagnosis in young females presenting with weight loss.
Effect of virgin coconut oil supplementation on cognition of individuals with mild-to-moderate alzheimer's disease in Sri Lanka (VCO-AD study): A randomized placebo-controlled trial
(IOS Press, 2023) Fernando, M.G.; Silva, R.; Fernando, W.M.A.D.B.; de Silva, H.A.; Wickremasinghe, A.R.; Dissanayake, A.S.; Sohrabi, H.R.; Martins, R.N.; Williams, S.S.
BACKGROUND: Virgin coconut oil (VCO) is a potential therapeutic approach to improve cognition in Alzheimer’s disease (AD) due to its properties as a ketogenic agent and antioxidative characteristics. OBJECTIVE: This study aimed to investigate the effect of VCO on cognition in people with AD and to determine the impact of apolipoprotein E (APOE) ɛ4 genotype on cognitive outcomes. METHODS: Participants of this double-blind placebo-controlled trial (SLCTR/2015/018, 15.09.2015) were 120 Sri Lankan individuals with mild-to-moderate AD (MMSE = 15-25), aged > 65 years, and they were randomly allocated to treatment or control groups. The treatment group was given 30 mL/day of VCO orally and the control group, received similar amount of canola oil, for 24 weeks. The Mini-Mental Sate Examination (MMSE) and Clock drawing test were performed to assess cognition at baseline and at the end of the intervention. Blood samples were collected and analyzed for lipid profile and glycated hemoglobin (HbA1 C) levels.∥ RESULTS: There were no significant difference in cognitive scores, lipid profile, and HbA1 C levels between VCO and control groups post-intervention. The MMSE scores, however, improved among APOE ɛ4 carriers who had VCO, compared to non-carriers (2.37, p = 0.021). APOE ɛ4 status did not influence the cognitive scores in the control group. The attrition rate was 30%.∥ CONCLUSION: Overall, VCO did not improve cognition in individuals with mild-to-moderate AD following a 24-week intervention, compared to canola oil. However, it improved the MMSE scores in APOE ɛ4 carriers. Besides, VCO did not compromise lipid profile and HbA1 C levels and is thus safe to consume.
Elder abuse among outpatient department attendees in a tertiary care hospital in Sri Lanka.
(Sri Lanka Medical Association, 2014) Edirisinghe, P.A.S.; Paranitharn, P.; Perera, W.N.S.; Williams, S.S.
OBJECTIVES: Abuse of older people is a hidden problem. Some believe that it is less in Asian societies as the extended family is a protective factor. The real extent of the problem however, is not researched adequately in Sri Lanka. METHODS: A cross sectional descriptive study was conducted at the North Colombo Teaching Hospital on 530 consecutive adults above 60 years of age attending the out-patient department. The Hwalek-Sengstock elder abuse screening test with modifications to address socio-cultural differences was administered. A brief demographic questionnaire and questions on past and present abuse were also included. RESULTS: Out of 530 elders studied, 32 (6%) were above 80 years of age and the mean age was 68.5 years. Male to female ratio was 1:2. Abuse, either physical, psychological, verbal or neglect was reported by 239 (45%) elders. Physical abuse was reported by 5.6%. The screening test revealed that the study population was vulnerable to psychological and financial abuse. Total overall rate of abuse was 38.5%. Loneliness was reported by 26%. Of the caregivers, 22% were financially dependent on the elders. Having more than three children was a risk factor for psychological and financial abuse and being single was a risk factor for psychological abuse. CONCLUSIONS: Physical, emotional and financial abuse of elders were reported in our study population. A limitation of this study was that it studied elders who sought treatment at a tertiary care hospital. Community studies will be needed to establish the true prevalence of elder abuse.
Fine-tuning Postgraduate Psychiatry Training in South Asia
(SAGE Publications, 2024) Williams, S.S.
No abstract available