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 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 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 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.Item Child and Adolescent Mental Health Services (CAMHS) in a lower-middle income country: A survey from Sri Lanka.(SAGE Publications, 2023) Rohanachandra, Y.M.; Chandradasa, M.; Dahanayake, D.M.A.No abstract availableItem Experience of required foreign specialist training: The lived experiences of Sri Lankan trainee child and adolescent psychiatrists in Australia(Elsevier, 2021) Chandradasa, M.; Dahanayake, D.; Rohanachandra, Y.No Abstract AvailableItem Social media use of adolescents as a component of the comprehensive mental health assessment(Science Forecast Publications LLC, 2018) Chandradasa, M.; Rathnayake, L. C.The mental health assessment of an adolescent involves exploring the interactions with their family, teachers, peers and important others. The modern-day adolescent socially communicates through the social media frequently. Therefore, the mental health assessment needs to be modified to include information about their social media use. The western world has established specialized mental health services targeting unique patient populations. However, many settings in the developing world lack well-distributed subspecialist services including child and adolescent mental health expertise. Due to the unavailability of subspecialists, mental health assessments of adolescents would be done by general specialists and primary-care physicians. This article provides simple instructions on how to assess the online media use of adolescents that could have a major impact on their mental health.Item A Juvenile sex offender with Attention Deficit Hyperactivity Disorder(BbW Publisher, 2018) Chandradasa, M.; Hettiarachchi, D.; Fernando, R.; Gunathilake, M.; Wijetunge, S.; Tennakoon, A.BACKGROUND: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder manifesting in early life. These children are more vulnerable to sexual abuse as victims and offenders. This is a case report of a teenager with previously undiagnosed ADHD presenting with an alleged act of sexual offending. CASE REPORT: According to the 14-year-old accused, he has engaged in penetrative anal intercourse with another schoolmate. that similar past incidents had involved a teenage male relative and insertion of foreign bodies to his anus repeatedly by him. On assessment the accused had features of inattention, such as difficulty in sustaining attention, failing to finish work and features of impulsivity, such as difficulty waiting for his turn and intruding on others. He was diagnosed with ADHD according to Diagnostic and Statistical Manual of Mental disorders (DSM 5) clinical criteria which were supported by the Sinhalese adaptation of the Swanson, Nolan and Pelham questionnaire. The assessment of the non-verbal intelligence was in the normal range, but his school performance was far below the average. DISCUSSION: Undiagnosed ADHD contributes to academic impairment and inappropriate sexual behaviour. It is possible that the described adolescent’s impulsiveness and inattention contributed to his academic failure and risky sexual behaviour. Early detection and proper management of this disorder may have reduced the risk of such behaviour in him.Item High-functioning autism in a Sri Lankan youth with High-functioning autism in a Sri Lankan youth with Langer-Giedion syndrome.(Lippincott Williams & Wilkins, 2018) Chandradasa, M.; Williams, S.The trichorhinophalangeal syndrome is a rare genetic disorder with a classical clinical triad of sparse hair, bulbous nose, and short digits. There are three known phenotypes, and the type II with exostoses in long bones is known as Langer-Giedion syndrome. Here, we describe a 28-year-old Sri Lankan male with Langer-Giedion syndrome and high-functioning autism. The karyotype found a microdeletion of the long arm of chromosome 8 with mosaicism [46,XY/46,XY,del(8)(q24.1q24.3)]. This is probably the first report of Langer-Giedion Syndrome with autism and the first report of the genetic syndrome from Sri Lanka. Furthermore, we could only access one previous report of the same microdeletion, which was from an autopsy of a 36-week-old infant.Item Child and youth mental health in post-war Sri Lanka(Royal College of Psychiatrists, 2017) Chandradasa, M.; Kuruppuarachchi, K.A.L.A.Sri Lanka's civil war and the tsunami in 2004 had enormous psychological impacts on the country's children. Tackling these issues has been difficult due to the lack of specialists in child and adolescent psychiatry. The end of the war in 2009 opened new avenues for the development of mental health services for children and youth in Sri Lanka. The year 2016 was historic in that the first board-certified child and adolescent psychiatrists assumed services in the country, after training in Australia.