Journal/Magazine Articles
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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine
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Item Nature, prevalence and determinants of mental health problems experienced by adolescents in south Asia: a systematic review(Elsevier Ltd, 2025-01) Mudunna, C.; Weerasinghe, M.; Tran, T.; Antoniades, J.; Romero, L.; Chandradasa, M.; Fisher, J.BACKGROUND Adolescence is a sensitive phase of human development where individuals, aged 10-19 years, are particularly vulnerable to developing mental health problems (MHPs). South Asia, home to 24% of the world's population, is mostly comprised of low- and middle-income countries (LMIC). Most of the world's young people live in LMICs. This systematic review aims to assess the available evidence on the nature, prevalence and determinants of MHPs experienced by adolescents in south Asia. METHODS Following PRISMA guidelines, searches were conducted in four online databases (Ovid Medline, Ovid EMBASE, Ovid Global Health, Ovid PsycInfo), titles, abstracts, and full-texts were screened, data extracted and quality assessed. Extracted data were categorised into school-based studies (SBS) and non-school-based studies (NSBS). Data were further stratified according to country, MHPs and narratively synthesised. FINDINGS Of the 5847 records identified in the searches, 117 met inclusion criteria. Most (n = 87) were SBS. Key MHPs reported across countries include anxiety disorders and depression. Wide ranges of prevalence rates were reported for anxiety in Indian SBS (1.5-81.6%) and NSBS (1.8-88.1%), and for depression, Pakistani SBS (21-79%) and Indian NSBS (0.4-98.5%). Determinants include individual characteristics; violent victimisation; poor family/home/school environment/peer relationships; already experiencing MHPs and substance use/abuse. Increased physical activity, adequate nutrition, safe/positive homes/family environment, being unmarried females, higher maternal education, peer support/friendship, higher education level and engaging in extra-curricular activities were protective of mental well-being. INTERPRETATION Prevalence of MHPs among south Asian adolescents appears high. Determinants include social, cultural, environmental and socioeconomic factors often beyond individual control. Mental health policies and programs and research appropriate to the cultural context, that address social determinants of MHPs and evidence gaps, are needed to tackle the significant mental health burden among south Asian adolescents. FUNDING Authors CM and MW are supported by a Monash University Research Training Program Scholarship. JF is supported by the Finkel Professorial Fellowship funded by the Finkel Family Foundation.Item Bridging the gap: Policy recommendations to address suicides committed by Indigenous youth in Victoria(AccScience Publishing, 2024-12) Shoib, S.; Das, S.; Saeed, F.; Chandradasa, M.; Zaidi, I.The Aboriginal population comprises 3.3% of the total Australian population, and youth represent 19% of this segment. In general, the Aboriginal inhabitants of Australia experience discrimination, limited access to education, and low socioeconomic conditions, and exhibit high mental disorder rates. The rate of suicide attempts by the Indigenous people of Victoria increased by 75% in 2021. This study examined the possible risk factors associated with suicides committed by Indigenous youth in Victoria. It focused on the health profiles of Victorian Aboriginal individuals, identified stakeholders who could help improve their mental well-being, addressed the needs and issues related to Aboriginal mental health, and examined substance abuse in this population segment. Finally, recommendations are offered to mitigate the studied problem. Rising suicide rates represent an urgent concern because they reflect the diminished mental health conditions of a society, particularly among its marginalized populations. It is crucial to develop an integrated suicide prevention act that takes into account the biological, psychological, social, cultural, and spiritual determinants of this population.Item Silver Russell syndrome: A suspected syndromic child in Sri Lanka presenting with recurrent head-banging associated with force-feeding(Sri Lanka College of Psychiatrists, 2024-10) Vidyatilake, P.; Kodikaraarachchi, D.; Chandradasa, M.; Wijetunge, S.No abstract availableItem Auditory and visual hallucinations in an adolescent following orthotopic liver transplantation(Sri Lanka College of Psychiatrists, 2024-10) Chandradasa, M.; Abeyrathne, M.; Sithara, P.; Kodithuwakku, K.; Fernando, M.No abstract availableItem Brain drain among Sri Lankan psychiatrists(Sri Lanka College of Psychiatrists, 2023) Chandradasa, M.; Kuruppuarachchi, K.A.L.ANo abstract availableItem Religion, spirituality, and coping among the psychiatric population: a narrative review(Academy Publisher, 2024) Shoib, S.; Das, S.; Gupta, A.K.; Ullah, I.; Javed, S.; Nocera, A.; Kar, S.K.; Chandradasa, M.; de Filippis, R.BACKGROUND AND AIMS: The impact of religiosity and spirituality on mental health is still far to be adequately explored. Evidence-based data gathering papers that bring together various perspectives and facets of religion in the mentally ill population is needed. Therefore, we conducted this review to summarise evidence on the subject and raise awareness. METHODS: We searched the literature using generic terms for ‘mental health and psychiatry’, ‘beliefs’, ‘religion’, ‘religious involvement’, ‘religiosity’, ‘spiritual aspects’, and ‘spirituality’, finally summarising all appropriate references. However, for this narrative revision, we collected papers addressing various perspectives, data, and facets of religion in the mentally ill population, a subject with theoretical and practical implications in mental health. RESULTS: The initial literature search found 21,723 total results: 1,723 from PubMed/Medline and Scopus, and up to 20,000 from Google Scholar, Science Direct, and Web of Science. After removing repetitions and applying inclusion and exclusion criteria, only six studies were included in this review on religion as an adaptive resource, and nine studies on religion, spirituality, and mental health. CONCLUSIONS: Evidence-based studies on the topic are still challenging to develop while maintaining a high scientific value. Notwithstanding this, religion and spirituality can have positive/negative clinical implications depending on how they are managed. Indeed, it can reduce suicidal risk, relieve depressive and anxious symptoms, and improve patients’ and caregivers’ coping and resilience. Nevertheless, it can enhance guilt, worsen/ generate obsessions, and compulsions in the obsessive-compulsive disorder and determine or associate with mystical-religious delusions in the maniacal phase of bipolar disorder.Item Factors behind suicides in Muslim countries: a global ecological study(Taylor and Francis Group, 2024) Shoib, S.; Tayyeb, M.; Armiya’u, A.Y.; Raaj, S.; Elmahi, O.K.O.; Swed, S.; Saeed, F.; Nahidi, M.; Bashir, A.; Chandradasa, M.This study examines the relationship between suicide rates and social, political, and economic factors in Muslim-majority countries, considering the influence of Islam and unique socio-cultural factors. Conducted from January to December 2022, it covered 46 countries, collecting data on suicide rates, income, Human Development Index (HDI), poverty rate, life expectancy, literacy rate, and political system. Suicide rates in Muslim-majority countries could be predicted based on HDI, poverty rates, life expectancy, and literacy rates. Frequency of suicide rates varied across continents, with the highest rates in Africa. Culturally sensitive suicide prevention programs are crucial for Muslim-majority countries.Item Parity of esteem: A global COVID‑19 vaccination approach for people with mental illnesses, based on facts from 34 countries; recommendations and solutions(Medknow Publications, 2024) Shoib, S.; Saeed, F.; Philip, S.; Chandradasa, M.; Das, S.; de Filippis, R.; Yousaf, Z.; Ojeahere, M.; Gad, H.K.; Yadivel, R.; Legris, Z.; Jatchavala, C.; Paul, R.; Gupta, A.K.; Handuleh, J.I.M.; Gürcan, A.; Costa, M.P.D.; Dannatt, L.; Ahmad, A.R.; Jaguga, F.; Saleem, S.M.; Sawitri, B.; Ari, N.; Islam, M.S.; Haque, M.A.; Őri, D.; Chumakov, E.; Swed, S.; Roza, T.H.; Islam, S.M.S.BACKGROUND: The coronavirus disease (COVID 19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS CoV 2), has detrimental effects on physical and mental health. Patients with severe mental illness are at higher risk of contracting the virus due to social determinants of health. Vulnerable populations include the elderly, people with pre existing conditions, and those exposed to SARS CoV 2. Unfortunately, only a few countries have updated vaccination strategies to prioritize patients with mental illnesses. Therefore, we aimed to explore whether individuals with mental disorders are prioritized in vaccine allocation strategies in different world regions. They are often neglected in policymaking but are highly vulnerable to the threatening complications of COVID 19. METHODS: A questionnaire was developed to record details regarding COVID 19 vaccination and prioritizations for groups of persons with non communicable diseases (NCDs), mental disorders, and substance use disorders (SUDs). NCDs were defined according to the WHO as chronic diseases that are the result of a combination of genetic, physiological, environmental, and behavioral factors such as cardiovascular diseases, cancer, respiratory diseases, and diabetes. RESULTS: Most countries surveyed (80%) reported healthcare delivery via a nationalized health service. It was found that 82% of the countries had set up advisory groups, but only 26% included a mental health professional. Most frequently, malignancy (68%) was prioritized followed by diabetes type 2 (62%) and type 1 (59%). Only nine countries (26%) prioritized mental health conditions. CONCLUSION: The spread of the coronavirus has exposed both the strengths and flaws of our healthcare systems. The most vulnerable groups suffered the most and were hit first and faced most challenges. These findings raise awareness that patients with mental illnesses have been overlooked in immunization campaigns. The range of their mortality, morbidity, and quality of life could have widened due to this delay.Item Diagnostic overlap between adolescent affective instability in borderline personality and juvenile bipolar disorder in Sri Lanka(Sri Lanka College of Psychiatrists, 2019) Chandradasa, M.; Fernando, W.K.T.R.; Kuruppuarachchi, K.A.L.A.Borderline personality disorder (BPD) and bipolar disorder (BD) could present a diagnostic challenge in the adolescent due to the presence of overlapping symptoms such as impulsivity, affective instability, and sexual arousal. Of these symptoms, affective instability is a central feature of BPD, and there is a rapid shift from the neutral affect to an intense affect, and this is associated with a dysfunctional modulation of emotions. We describe three Sri Lankan adolescents presenting with affective instability, treated with psychopharmacological agents as for BD. While BPD is characterized by transient mood shifts induced by interpersonal stressors, in BD, there are sustained mood changes. A longitudinal assessment of the symptomatic profile and collateral information clarified the diagnosis as being BPD. An examination of the nature of affective instability is vital for a proper diagnosis and provision of evidence-based treatment.Item 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.