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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Electroconvulsive therapy in South Asia: Past, present, and future(Elsevier, 2024) Menon, V.; Kar, S.K.; Gupta, S.; Baminiwatta, A.; Mustafa, A.B.; Sharma, P.; Abhijita, B.; Arafat, S.M.Y.The practice of electroconvulsive therapy (ECT) varies both between and within countries. We aimed to review historical and current trends in ECT practices, perceptions, and legislations in South Asia, a region with a high burden of mental illness and suicide. We searched MEDLINE (PubMed) and Google Scholar databases for relevant literature on ECT from each country. Additionally, a team of country-specific investigators performed supplemental searches and contacted key country contacts for relevant information. Relevant data were abstracted under the following headings: ECT practices, perceptions, and legislations. Knowledge gaps and research priorities were synthesized. Modified bitemporal ECT, delivered using brief pulse devices, was most commonly offered across institutions. Schizophrenia, not affective illness, was the most common indication. Electroencephalographic monitoring of seizures was rarely practiced. Thiopentone or propofol was preferred for anesthetic induction, while the favored muscle relaxant was succinylcholine. In India and Sri Lanka, perceptions about ECT were largely favorable; not so in Pakistan and Nepal. Only India and Pakistan had laws that governed any aspect of ECT practice; ECT practice guidelines were available only in India. There is a lack of research on efficacy, ECT in special populations, continuation ECT practices, and interventions to improve ECT-related perceptions. Most regional institutions offered modified brief-pulse ECT, and schizophrenia was the most common indication. Knowledge of and attitude towards ECT varied between countries. There is a need to develop a regional ECT consortium to facilitate uniform training, advocacy efforts, and the development of regional practice guidelines.Item Depression and suicidal behavior in South Asia: a systematic review and meta-analysis(Cambridge University Press, 2022) Arafat, S.M.Y.; Saleem, T.; Menon, V.; Ali, S.A.Z.; Baminiwatta, A.; Kar, S.K.; Akter, H.; Singh, R.Background. Estimates of depression in suicidal behavior in South Asia would help to formulate suicide prevention strategies in the region that hasn’t been assessed yet. Objectives. We aimed to systematically assess the prevalence of depression in fatal and nonfatal attempts of suicide in eight South Asian countries. Methods. We searched Medline, Embase, and PsychINFO by specific search terms to identify articles assessing depression in fatal and non-fatal attempts of suicide in South Asian countries published between 2001 and 2020. Two separate meta-analyses were conducted for fatal and non-fatal attempts. Due to the high heterogeneity of studies (96–98%), randomeffects models were used to calculate pooled prevalence rates. Results. A total of 38 studies was identified from five south Asian countries (India [27], Pakistan [6], Sri Lanka [3], Nepal [1], and Bangladesh [1]). The majority of studies (n = 27) were published after 2010. Twenty-two studies reported non-fatal attempts, and sixteen reported suicide. The prevalence of depression among non-fatal attempts ranged from 14% to 78% where the pooled prevalence rate was 32.7% [95% CI 26–39.3%]. The prevalence of depression among suicides ranged from 8% to 79% where the pooled prevalence estimate was 37.3% [95% CI 26.9–47.6%]. Conclusions. This review revealed the pooled prevalence of depression among fatal and nonfatal suicidal attempts in South Asian countries, which seems to be lower when compared to the Western countries. However, a cautious interpretation is warranted due to the heterogeneity of study methods, sample size, and measurement of depression.