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 Fine-tuning Postgraduate Psychiatry Training in South Asia(SAGE Publications, 2024) Williams, S.S.No abstract availableItem 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.Item 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.Item Pharmacoeconomics amidst a financial crisis(Sri Lanka College of Psychiatrists, 2023) Williams, S.S.; Medagedara, A.U.; de Silva, H.A.Cost effective strategies must be implemented amidst an economic crisis in Sri Lanka to mitigate ever increasing medicinal costs. Exploration of measures such as evidence based generic prescribing, cost effectiveness analysis, value-based pricing, identification of low cost, high value medication and being sensitive to the ability of the patient to purchase medicine is a necessity. Clinicians must be sensitised to this issue to contribute actively to the process. Policies in line with pharmacoeconomic realities must be pursued.Item Psychosis after SARS-CoV-2 (COVID-19) infection.(Sri Lanka College of Psychiatrists, 2022) Harshini, M.L.; Jayasundara, D.M.S.P.; Williams, S.S.Psychiatric manifestations associated with COVID-19 infection have become a subject of study in the wake of the global pandemic. Some psychiatric disorders such as anxiety and depression are well recognized with the COVID-19 infection while overt psychosis is less so.We present four cases of first-onset psychotic episodes with a clear temporal relationship to COVID-19 infection. They appear mainly affective in nature, although only time will determine their eventual progression.Item Locked in grief: a qualitative study of grief among family members of missing persons in southern Sri Lanka(BioMed Central, 2021) Isuru, A.; Bandumithra, P.; Williams, S.S.Introduction: The psychological and social issues experienced by family members of missing persons are diferent from normal grief following the death of a loved one. The term “Ambiguous loss” describes this psychological phenomenon. Ambiguous loss acts as a barrier to adjusting to grief, leading to symptoms of depression and intra and interpersonal relational conficts. An in-depth phenomenological understanding of this subjective experience is important. Method: A qualitative study was conducted among close family members of persons who had gone missing during the civil confict and the 2004 tsunami in southern Sri Lanka following formal ethical approval from an university ethics review committee. Purposive and snowballing sampling methods were used to recruit the participants. Theoretical sample saturation was achieved with 24 family members of missing persons. Responders were mothers, fathers, wives, husbands, and siblings of missing individuals. In-depth interviews were recorded with the help of a semi-structured guide, after informed consent. The recordings were transcribed and coded by three independent investigators. The investigators through consensus arrived at the phenomenological themes and grounded them through refexivity. The triangulation process involved cross-checking observational notes made by the interviewers and consulting the interviewees. Results: We interviewed 24 frst degree relatives of missing individuals. Twenty-one of the interviewees were unsure about the fate of the missing individual, while three of them believed the missing individual to be dead. Of the 24 missing individuals, 20 were males and 18 had gone missing in civil conficts and 6 in the Indian Ocean Tsunami. Six predominant phenomenological themes were identifed. Those were lack of closure, hope, guilt, helplessness, perpetual sufering, and an emotional vacuum. These phenomenological experiences are highlighted by the interviewees through a range of utterances that hold profound cultural, social and emotional signifcance of unresolved and vacillating grief. Conclusion: The highlighted phenomenology of grief in surviving family members of those who go missing following traumatic events demands a response from health and social services in every country that experiences disaster. The surviving loved one is ‘locked in grief’ indefnitely and future research on evidence-based interventions to overcome this predicament is warranted.Item Randomized controlled trial evaluating the effectiveness of cognitive behaviour group therapy (CBGT) compared to a waitlist control in the treatment of university students with social anxiety disorder(Postgraduate Institute of Medicine University of Colombo, 2021) Hapangama, A.; de Silva, R.; Williams, S.S.; de Zoysa, P.T.; Wickremasinghe, R.R.; Kuruppuarachchi, K.A.L.A.; Ravindran, A.BACKGROUND: Social anxiety disorder (SAD) is a common mental illness that causes significant functional impairment. Individually delivered cognitive behavioural therapy (CBT) is an effective but costly intervention with limited access, and is poorly scalable to meet the need in the population. In this context, cognitive behavioural group therapy (CBGT) is a more viable option. OBJECTIVE: To determine the effectiveness of CBGT as compared to a waitlist control for university students with SAD. METHODS: A single-blind randomized controlled trial consisting of an 8-week treatment of CBGT (N=15) versus a waitlist control (N=15) was conducted in university students meeting Diagnostic and Statistical Manual 5 criteria for SAD. The Liebowitz Social Anxiety Scale –Self Rated Sinhala version (LSAS-SR) was administered at screening, baseline, four weeks and eight weeks of the trial. Manualized and Culturally adopted CBGT was delivered in Sinhala language, to the intervention group by a licensed clinical psychologist. RESULTS: The mean age of the study population was 22 (SD=1.345) and baseline mean LSAS-SR score was 72.33 in the experimental arm and 69.03 in the wait list control. Repeated measures analysis revealed that the mean total score of the LSAS-SR in the CBGT arm was significantly lower (13.262; p<0.001) post-intervention compared to the waitlist group after controlling for age and gender. CONCLUSION: Culturally adapted CBGT in Sinhala for SAD is effective in ameliorating social anxiety symptoms among university students. KEYWORDS: social phobia, social anxiety disorder, cognitive behaviour group therapy, sri LankaItem “Muddling by googling” – Cyberchondria among outpatient attendees of two hospitals in Sri Lanka(Sri Lanka Journal of Psychiatry, 2019) Wijesinghe, C.A.; Liyanage, U.L.N.S.; Kapugama, K.G.C.L.; Warsapperuma, W.A.N.P.; Williams, S.S.; Kuruppuarachchi, K.A.L.A.; Rodrigo, A.BACKGROUND: The internet is widely used as a source of health information, and the negative effects of this practice is well documented. Cyberchondria, the unfounded escalation of concerns about common symptoms based on review of online information has been identified as a major concern. This area has not been studied in Sri Lanka. AIMS: We studied the prevalence, nature and effects of cyberchondria among outpatients in Sri Lanka. METHODS: Data was gathered from 300 outpatients, 150 patients each attending a government and private hospital in Western province using a self-administered questionnaire. RESULTS: Out of 300 participants 178 were female and the average age was 42 years. Only 24% of the participants used the internet as an information source on health related issues. The prevalence of cyberchondria was 16.3% in our study population. Cyberchondria was significantly more common among outpatients of the private hospital. A majority of patients who made a self-diagnosis using online information had made an incorrect diagnosis. One third of internet users felt anxious after searching about their symptoms and 34% sought further medical advice following internet use. CONCLUSIONS: The possible negative effects of online health information is a concern in Sri Lanka. Further studies and public education regarding this area in Sri Lanka are required.Item Unconfirmed death as a predictor of psychological morbidity in family members of disappeared persons(Cambridge University Press, 2019) Isuru, A.; Hewage, S.N.; Bandumithra, P.; Williams, S.S.BACKGROUND: The 2004 tsunami, the civil conflict until 2009 and the youth insurrection in the late 1980s in Sri Lanka resulted in many persons being classified as 'missing' as they disappeared and were unaccounted for. Our aim was to compare the prevalence of major depressive disorder (MDD) and prolonged grief disorder (PGD) in families of disappeared individuals, who eventually received the mortal remains and those who did not. METHOD: An ethically approved cross sectional study was conducted in a purposively selected sample after informed consent. Information on the circumstances of the family member going missing was gathered. Culturally adapted versions of the General Health Questionnaire and the Beck Depression Scale were administered. Those who screened positive were assessed by a psychiatrist on Diagnostic and Statistical Manual of Mental Disorders-5 criteria to arrive at a diagnosis. RESULTS: Of 391 cases of disappearances studied, MDD (17.5% v. 6%) and PGD (22% v. 7%) were significantly higher in those who did not eventually receive the mortal remains of the disappeared person. Among those who did not receive the mortal remains, being unsure whether the disappeared person was dead or alive was highly predictive of MDD and PGD. Mothers and wives, older family members and those with a family history of mental illness were more vulnerable. CONCLUSIONS: Family members of missing individuals unsure whether their loved one was alive or dead have higher psychological morbidity in the form of MDD and PGD.Item 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.