Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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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 Masked presentations of dissociative disorder among Sri Lankan adolescents(Sri Lanka Journal of Psychiatry, 2019) Chandradasa, M.; Fernando, W.K.T.R.; Kuruppuarachchi, K.A.L.A.ABSTRACT: Dissociation could occur in adolescence in response to traumatic life experiences disrupting essential areas of psychological functioning. We report three complex presentations of dissociation in adolescents in Sri Lanka. A 16-year-old girl presented with poor sleep, overtalkativeness and euphoric mood after her father had left home a day before. During the war, a 14-year-old boy was brought to hospital as he was speaking in Tamil and mentioning the names of terrorist leaders. Later it was found that he is from a Sinhalese family and had experienced violence at home. A 16-year-old boy presented with irritability, disinhibition and regressed behaviour. A detailed assessment revealed an underlying depressive state in the context of family conflicts. All the above patients presented with features suggestive of mania, misleading clinicians and leading to unsuccessful treatment strategies. Therefore, in-depth psychosocial assessment is needed to diagnose dissociation in adolescents and to plan evidence-based treatment.Item Clinical presentation and comorbidities of obsessive compulsive disorders in children and adolescents presenting to a tertiary care hospital in Sri Lanka(Sri Lanka College of Psychiatrists, 2016) Rohanachandra, Y.M.; Chandradasa, W.M.M.L.; Hettiarachchi, D.B.; Fernando, W.K.T.R.; Gunathilake, I.A.G.M.P.; Wijetunge, G.S.BAKGROUND: Obsessive compulsive disorder (OCD) in children differs from adults in that children do not show ego dystonicity, rarely have pure obsessions and commonly have pure compulsions with hidden obsessions. Comorbid psychiatric diagnoses are seen in more than 50% of children with OCD. AIMS: To describe the socio-demographic factors, clinical presentations and psychiatric comorbidities of children with OCD in a Sri Lanka setting, and to determine the factors associated with comorbidities. METHODS: A retrospective descriptive study design was used. Data was collected from clinic records of all patients diagnosed to have OCD at the child guidance clinic of Lady Ridgeway Hospital for Children, Colombo during the 3-year period from 2013-2016. RESULTS: Fifty two children were included in the study. The mean age of the children was 9.2 years. Males accounted for 71.2%. The majority (55.8%) had both obsessions and compulsions. Multiple obsessions were seen in 15.4% and multiple rituals in 26.9%. The most common theme was contamination (61.5%). Washing was the most common ritual (50%). Comorbidities were present in 55.7%, with attention deficit hyperactivity disorder (ADHD) (17.3%) being the most common. Of the participants, 90.4% had impairments related to OCD. There was a significant association between the gender and the age of the child (p=0.029) in the 5-10 year age group, boys were 5 times more common than girls, while the proportion of boys and girls were equal in children aged more than 10 years. Conclusion: Comorbidities are common in childhood OCD, and all children with OCD should be screened for comorbidities.Item Unusual presentations of delusional parasitosis(SAARC Psychiatric Federation, 2011) Kuruppuarachchi, K.A.L.A.; Fernando, W.K.T.R.; Fonseka, T.P.M.No Abstract Available