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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Improving psychological well-being among healthcare workers during the COVID-19 pandemic with an online mindfulness intervention: A randomised waitlist-controlled trial(Wiley, 2024) Baminiwatta, A.; Fernando, R.; Solangaarachchi, I.; Abayabandara-Herath, T.; Wickremasinghe, A.R.; Hapangama, A.The high prevalence of psychological problems observed among healthcare workers (HCWs) during the COVID-19 pandemic called for interventions to safeguard their mental health. We assessed the effectiveness of a 6-week online mindfulness-based intervention in improving well-being and reducing stress among HCWs in Sri Lanka. Eighty HCWs were recruited and randomised into two groups: waitlist-control (WLC) and intervention groups. In the intervention, 1-hour online sessions were conducted at weekly intervals and participants were encouraged to do daily home practice. Stress and well-being were measured pre- and post-intervention using the Perceived Stress Scale and WHO-5 Well-being Index, respectively. One-way analysis of covariance was used to evaluate the effectiveness, in both intention-to-treat (ITT) and complete-case (CC) analyses. A significantly greater improvement in well-being occurred in the intervention arm compared to WLC on both ITT (p = .002) and CC analyses (p < .001), with medium-to-large effect sizes (partial η2 = .117-.278). However, the reduction in stress following the intervention was not significant compared to the WLC group on both ITT (p = .636) and CC analyses (p = .262). In the intervention arm, the median number of sessions attended by participants was 3. Low adherence to the intervention may have contributed to the apparent non-significant effect on stress.Item Randomized Controlled Trial Investigating the Effectiveness of Cognitive Behaviour Group Therapy Compared to a Waitlist Control in the Treatment of University Students with Social Phobia(Sri Lanka Medical Association, 2020) Hapangama, A.; de Silva, B.G.R.; de Zoysa, P.T.; Kuruppuarachchi, K.A.L.A.; Ravindran, A.; Wickremasinghe, A.R.; Williams, S.S.INTRODUCTION AND OBJECTIVES: Social phobia causes significant impairment in a person’s personal and professional life. However, individually delivered cognitive behavioural therapy (CBT) is costly, limited by the number of trained therapists and not scalable to meet the need for such therapy in the population. In this context, cognitive behavioral group therapy (CBGT) is the viable option. Objective was to determine the treatment effectiveness of CBGT as compared to a waitlist control of university students with social phobia. METHOD: A single-blind randomized controlled trial consisting of an 8-week treatment phase of CBGT versus a waitlist control was conducted among university students with social phobia. The Liebowitz Social Anxiety Scale –Self Rated Sinhala version (LSAS-SR) was administered at screening, baseline, four weeks and eight weeks of the trial. A culturally adapted CBGT was delivered in Sinhala to the intervention group by a trained clinical psychologist. RESULTS: Thirty university students (15 in each arm) with a mean age of 22, meeting DSM IV criteria for Social Anxiety Disorder were included. Repeated measure analysis of the total scores of the LSAS-SR in the CBGT arm showed statistically significant (p<0.001) reduction in the total scores (13.3) as compared to the waitlist arm after controlling for age and gender. CONCLUSION: CBGT is superior to waitlist control in university students with social phobia.Item Translation and Validation of Abnormal Involuntary Movement Scale (AIMS) into Sinhala(Sri Lanka Medical Association, 2020) Baminiwatta, A.K.A.B.; Bandara, T.R.; Liyanage, H.; Perera, K.M.N.; Kuruppuarachchi, K.A.L.A.; Hapangama, A.INTRODUCTION AND OBJECTIVES: Tardive dyskinesia (TD) is a pattern of abnormal involuntary movements among patients on long-term antipsychotics. As there is no medication universally effective, prevention of TD is important. Non-medical clinicians are now involved in the follow-up of patients on antipsychotics in Sri Lanka; therefore, translation and validation of a screening tool in Sinhala, that can be administered by different mental health professionals, was deemed pertinent. Aim of the study was to translate and validate the Abnormal Involuntary Movement Scale (AIMS) into Sinhala. METHODS: Translation followed standard guidelines. The finalized Sinhala version was administered independently by five raters (two registrars in psychiatry, a medical officer, a community psychiatry nurse (CPN) and a psychiatry social worker) on patients on antipsychotics for a minimum of one year. The gold standard diagnosis of TD was the Diagnostic and Statistical Manual (DSM)-5 criteria conducted by a consultant psychiatrist. Sensitivity, specificity, and Cohen’s kappa values were calculated. RESULTS: Out of 137 patients, 53.3% were male. Mean age was 49 and average duration of antipsychotic treatment was 14 years. The percentage of patients diagnosed with TD using AIMS and DSM-5 were 33% and 34% respectively. Sensitivity and specificity of AIMS to detect TD were 67% and 83.4% respectively. The degree of agreement between AIMS and DSM-5 indicated moderate criterion validity (kappa= 0.5). For different raters, the kappa statistic ranged from 0.41 (CPN) to 0.63 (registrar), signifying modest reliability between raters. CONCLUSION: This provides preliminary evidence for validity and reliability of AIMS in detecting TD, when administered by a range of mental health professionals. Given the clinical experience required and the subjectivity involved in diagnosing TD, the foregoing modest statistical indicators seem reasonable.Item Prevalence and predictors of new onset depression in the acute phase of stroke(Elsevier Science, 2021) Isuru, A.; Hapangama, A.; Ediriweera, D.; Samarasinghe, L.; Fonseka, M.; Ranawaka, U.INTRODUCTION: Post-stroke depression (PSD) is known to be associated with poor functional outcome and high mortality. There is limited data on the prevalence and associated factors of depression in the acute phase after stroke. OBJECTIVES: To determine the prevalence of PSD in the acute phase and its correlates among patients with stroke in a tertiary care hospital in Sri Lanka. METHOD: A cross sectional descriptive study was conducted among patients with stroke admitted to the stroke unit of a tertiary care hospital in Sri Lanka over a 3-year period. Demographic and clinical information was obtained using an interviewer administered questionnaire. Depression was diagnosed using the ICD-10 criteria. Group comparisons were performed using Pearson's Chi-square test and Mann-Whitney U test Multiple logistic regression was used to identify factors associated with PSD. RESULTS: Of 374 patients, 106 patients experienced moderate to severe PSD, with a prevalence of 28.3 % (95 % CI: 23.8 %-32.9 %). Of them, 54.7 % were females, 49 % were above the age of 60 years, and 79.9 % had ischemic strokes. Female gender (OR-2.77, 95 % CI: 1.46-5.07, P = 0.002), a longer duration of hypertension (OR-1.31, 95 % CI: 1.01-1.721, P = 0.004), strokes involving the temporal lobe (OR-7.25, 95 % CI: 2.81-20.25, P < 0.001) and post-stroke functional disability (OR- O.98, 95 % CI:0.97-0.99, P = 0.001) were associated with PSD on multivariate analysis. CONCLUSION: More than one fourth of the patients suffered from PSD in the acute phase of stroke. Female gender, longer history of hypertension, physical dependence and temporal lobe strokes were predictive of PSD. KEYWORDS: Acute phase; Post-stroke depression; Rehabilitation; South Asia; Stroke; Stroke unit.Item Awareness regarding electroconvulsive therapy (ECT) among service users at a tertiary care hospital(Sri Lanka Medical Association, 2019) Hapangama, A.; Gunasekera, T.; Pieris, M.U.P.K.; Fernando, R.; Kuruppuarachchi, K.A.L.A.INTRODUCTION & OBJECTIVES: ECT saves lives and is extremely effective in treatment resistant psychiatric conditions. Despite this there appear to be an unease and stigma attached to ECT. Exploration about the awareness regarding ECT among service users can improve the practice of ECT. Objective was to demonstrate awareness about ECT among services users at a tertiary care hospital. METHODS: Cross-sectional study carried among all consenting service users at a tertiary care Hospital in Sri Lanka using an interviewer administered questionnaire. RESULTS: Out of 221 participants, 54% were careers. 65% thought ECT is a treatment for psychiatric conditions while 58% and 19% thought ECT is used to violence in the absence of a mental illness and to punish opponents respectively. There was no-significant association between educational level and awareness about ECT (p>0.05). The commonest source of ECT was doctors (43%). Cognitive side effects (46%) and headache (59%) were the commonly feared side effects. 5% thought ECT doesn’t 't have a scientific basis-and 20% felt it is an inhuman mode of treatment. 38% felt they would receive ECT if recommended. CONCLUSION: Doctors were the commonest source of information regarding ECT and more than half of the participants knew it was used to treat a psychiatric condition. Surprisingly only a minority thought ECT didn't have scientific basis however 20% felt it was an inhumane mode of treatment. However, a considerable proportion were willing to undergo ECT if recommended. Despite popular beliefs this cohort of participants appeared to have a more favourable awareness about ECT.Item Minimizing wait time for patients with mental health issues at an Emergency Department: An Australian experience(Sri Lanka Medical Association, 2019) Hapangama, A.; Kojadinovic, V.; Katz, P.INTRODUCTION & OBJECTIVES: Efforts have been made globally to re-structure care of patients with mental illnesses by shifting resources from institutionalized care towards the community. However, number of people at a given time with mental illnesses and lack of resources have placed heavy constraints on community psychiatry services resulting in patients with mental illnesses overcrowding at Emergency Departments (EDS). EDS across Victoria appear to struggle in order to deal with them. The Psychiatric Assessment and Planning unit (PAPU) at Maroondah Hospital, Victoria was established with one of its aims being the reduction of overcrowding and waiting time at its emergency department. METHODS; An audit was carried out based on the electronic medical records system and data was extracted regarding the total number of presentations with mental health needs, total number of admissions to PAPU and to see those admitted to PAPU meet the state-established performance goals during the financial year of 2017. RESULTS: Out of the 5636 patients who had presented to ED with mental health issues, 435 met criteria for PAPU and 304 (69.9%) had been assessed within 4 hours of them presenting to the ED. 228(75%) of had occurred between 0830 am and 5 pm. CONCLUSION: preliminary data show that PAPU appears to considerably lower the waiting time at the MaroondahItem Awareness and usage patterns of substances among pre-clinical phase students at a Medical Faculty in Sri Lanka(Sri Lanka Medical Association., 2019) Hapangama, A.; Fernando, R.; Pathmeswaran, A.; Kuruppuarachchi, K.A.L.A.INTRODUCTION AND OBJECTIVES: Availability and usage patterns of psychoactive substances have changed worldwide. Knowledge about new trends of substance use is important for future generation of medical professionals to deliver appropriate treatment. Objective of the study was to determine the awareness and prevalence of substance use among pre- clinical phase medical students in a university in the Western Province, Sri Lanka. METHODS: A cross-sectional descriptive study was carried out using a self-administered questionnaire. RESULTS: Out of 162 students, 61.7% were female, 97.5% were between 20-25 years. 99% were aware of alcohol being a substance of abuse. 34% and 30% were not aware that heroin and cannabis were substances of abuse. Less than half of participants were aware of corex-D (44.4%), volatile substances (39.5%), and methamphetamines (32.7%). Figures for awareness about Psilocybin (9.9%), MDMA (8.6%), LSD (8%), GHB (4.3%), DXM (2.5%). Main sources of information regarding substances were peers and internet. 21% and 18 % of participants had used alcohol and betel respectively at least once while tobacco and corex-D was used among 7.4% and 6.2% respectively. 69% of substance users were male. Use of substances was significantly associated with male gender. CONCLUSION: Alarmingly majority of the participating pre-clinical phase students were not aware of the abuse potential of heroin and cannabis as well as of newer generation recreational drugs. Awareness regarding current trends and misuse potential of psychoactive substances and their consequences should be enhanced among medical students.Item Cross-cultural adaptation and validation of the Leibowitz Social Anxiety Scale (LSAS-SR) sinhala version(Sri Lanka Medical Association, 2020) Hapangama, A.; Kuruppuarachchi, L. A.; de Silva, R.; Wickremasinghe, A.R.; Ravindran, A.; Williams, S. S.No abstract availableItem “Silent” white matter changes in brain MRI in patients with haemoglobinopathies and their clinical significance(Sri Lanka Medical Association, 2016) Premawardhena, A.P.; Ranawaka, U.R.; Hapangama, A.; Pathmeswaran, A.; Hettiarachchi, S.; Salvin, K.A.; Pilapitiya, T.; Sanjaya, G.; Oilvieri, N.F.; Weatherall, D.J.INTRODUCTION AND OBJECTIVES: Increasing interest has been directed to the study of white matter changes and lacunar infarcts in patients with haemoglobinopathies which are thought to be clinically silent. Previous studies suggest an association with splenectomy and thrombocytosis. The objective was to assess the association of white matter changes in patients with haemoglobinopathies. METHOD: Older patients with haemoglobinopthies attending the Hemals Thalassaemia Unit were assessed by a specialist neurologist and simultaneously had MRI brain. Relevant clinical, biochemical and hematological data were collected. A non-thalassaemic control group (age and sex matched) too were assessed. RESULTS: There were 82 patients (25 Thalassaemia Major,24 Intermedia and 33 Haemoglobin E b thalassaemia) and 19 controls. Mean age of the study group was 32yrs. 21 patients (26%) had MRI changes (20%,29%,27% in the three groups respectively) (p=0.73). 10% of controls had MRI changes. 12 (60%) of the patients with MRI changes were asplenic whilst 53.2% without changes were asplenic (P=0.138). There was no difference in the two groups with platelet counts. (Mean platelet count 581 Vs. 452 (p= 0.709) 58% of patients and 53% of controls had headache as a symptom. Headache was commoner among those with MRI changes (85% vs 51.6%; p=0.008). CONCLUSIONS: The white matter changes in MRI occurred in all three sub groups of thalassaemic patients studied in high frequency. To our knowledge, this is the first report of the association of MRI changes with neurological symptoms in thalassaemic patients. The higher frequency of headache in those with MRI changes suggest that these changes may not be silent as previously believed.Item Reliability and factor analysis of the Sinhalese version of the Liebowitz Social Anxiety Scale-Self Reported Version (LSAS-SR)(Sri lanka Medical Association, 2015) Hapangama, A.; de Silva, T.; Kuruppuarachchi, K.A.L.A.; Wickremasinghe, A.R.; Williams, S.S.INTRODUCTION AND OBJECTIVES: Despite being one of the most prevalent mental illnesses, lack of awareness and confusion with shyness contributes to under-diagnosis of social phobia. Our objective was to evaluate test-retest reliability, internal consistency and factor analysis of the Sinhalese version of LSAS-SR - which is widely used in the English speaking world as a screening tool for social phobia. METHOD: The established process of translation by bilingual professionals/ back translation to establish consistency was carried out. Face validity and cultural acceptability of the translation was established using the Delphi technique. Pilot evaluation was conducted and standard psychometric procedures were used to evaluate test- retest reliabilityand internal consistency. The subjects were 871 SriLankan university students. RESULTS: Prevalence of social phobia among study population was 9.2%.Pearson's correlation coefficient was 0.998, 0.994 and 0.993 for fear and avoidance subscales and total sore respectively (p<0.01). Cronbach's alpha for fear and avoidance subscales with total score for each subscale was 0.753 and 0.752 respectively. Cronbach's alpha of total score of each sub scale with total score of LSAS-SR was 0.722.Factor analysis resulted in 5 dimensions and these were: factor I - speaking in a group, factor II-activity in public, factor III - social interaction with unknown person, factor IV - attitude of disagreement/ disapproval and factor V - social interaction in leisure activity. CONCLUSION: The findings confirm that this Sinhalese version of LSAS-SR has similar test-retest reliability, internal consistency and factor analysis as the original instrument and can be usedto screen for social phobia in Sri Lanka.