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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Randomised, placebo-controlled trial on topiramate add-on therapy for weight reduction and symptomatology in overweight/obese persons with Schizophrenia(Elsevier Ltd, 2022) Chandradasa, M.; Ruwanpriya, S.; de Silva, S.; Rathnayake, L.; Kuruppuarachchi, K.A.L.A.Introduction: Higher cardiovascular mortality is seen with schizophrenia due to the disorder itself and antipsychotic use. South Asians are more vulnerable to developing metabolic disorders than others. Resource-limited settings in South Asia have only a few mental health professionals, and individualised case management is mostly unavailable. Therefore, there is less monitoring and personalised support for diet and physical exercise programmes. Topiramate is useful for weight reduction and improvement of psychopathology in schizophrenia. However, there has been only one previous randomised controlled trial (RCT) done in South Asia, which possesses a quarter of the world's population. Methods: We conducted a double-blind RCT in an outpatient setting in Sri Lanka. We compared topiramate 100 mg/day with a placebo in overweight/obese adults with schizophrenia who have been on antipsychotics for at least a year. We obtained monthly anthropometric measurements and assessed the symptomatology using the brief psychiatric rating scale (BPRS). Results: Fifty patients each in the topiramate and placebo arms completed the study. Topiramate add-on therapy led to significant weight/Body Mass Index reduction and improved symptomatology as measured by the BPRS compared to the placebo. The topiramate group had significantly more reporting of loss of appetite. Discussion: According to available data, this is the RCT with most participants assessing the use of topiramate in schizophrenia and only the second in South Asia. Topiramate was shown to be useful for weight reduction and symptomatic improvement in persons with schizophrenia in a resource-limited setting in South Asia.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 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 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 Near-death experiences in a multi-religious hospital population in Sri Lanka(Springer, 2018) Chandradasa, M.; Wijesinghe, C.; Kuruppuarachchi, K.A.L.A.; Perera, M.Near-death experiences (NDEs) are a wide range of experiences that occur in association with impending death. There are no published studies on NDEs in general hospital populations, and studies have been mainly conducted on critically ill patients. We assessed the prevalence of NDEs and its associations in a multi-religious population in a general hospital in Sri Lanka. A randomised sample of patients admitted to the Colombo North Teaching Hospital was assessed using the Greyson NDE scale and clinical assessment. Out of total 826 participants, NDEs were described by 3%. Compared to the NDE-negative participants, the NDE-positive group had a significantly higher mean for age and a ratio of men. Women reported deeper NDEs. Patients of theistic religions (Christianity, Islam and Hinduism) reported significantly more NDEs compared to patients from the non-theistic religious group (Buddhism). NDE-positive patient group had significantly higher reporting of a feeling 'that they are about to die', the presence of loss of consciousness and a higher percentage of internal medical patients. This is the first time that NDEs are assessed in a general hospital population and NDEs being reported from Sri Lanka. We also note for the first time that persons with theistic religious beliefs reported more NDEs than those with non-theistic religious beliefs. Medical professionals need to be aware of these phenomena to be able to give an empathic hearing to patients who have NDE.Item A randomized, double blind, placebo controlled trial on effectiveness of preemptive analgesia with paracetamol on reduction of occurrence of headache after electro convulsive therapy(Sri Lanka Medical Association, 2016) Isuru, L.L.A.; Rodrigo, A.; Wijesekera, C.; Premasinghe, S.; Wijesinghe, C.A.; Ediriweera, D.S.; Kuruppuarachchi, K.A.L.A.INTRODUCTION: Electro convulsive therapy (ECT) is a safe and effective treatment for a wide range of psychiatric disorders. However, its utility is mainly limited by side effects and stigma. Post ECT headache is one of the commonest side effects of ECT. There is little evidence to suggest Pre-ECT analgesia would prevent the occurrence of post ECT headache. OBJECTIVES: Objective was to compare the incidence and severity of the post ECT headache of the patients who had paracetamol 1g, 2hrs before the induction of anaesthesia with those who had a placebo. METHOD: This was a double-blind, placebo controlled trial. Sixty two patients were given placebo and 73 received paracetamol tablets. Ethical approval was granted by an Ethics Review Committee, University of Kelaniya, and the trial was registered in the clinical trial registry (SLCTR/2015/27). Post ECT headache was measured 2 hours after the administration of ECT by a visual analogue test and verbal descriptive scale. Variables were tested for normality and Mann-Whitney U test was used to compare groups. Subsequent analysis was non-parametric, with Mann-Whitney U test. RESULTS: Both intervention and controlled groups had comparable baseline demographic and clinical variables. One third (34%) of the paracetamol group experienced post ECT headache, while 62% of the placebo group experienced same. There was a statistically significant reduction in the incidence and severity of post-ECT headache in the test group (p <0.05). This remained significant after confounding factors were adjusted for in the regression analysis for the duration of illness and headache during this episode. CONCLUSIONS: Preemptive analgesia with paracetamol, 2hours beforeECT, reduces post ECT headache and this could be routinely practiced to ameliorate ECT induced headache.Item Psychometric analysis and emotional state in the irritable bowel syndrome (ibs)(Sri Lanka Medical Association, 1997) Kuruppuarachchi, K.A.L.A.; Deen, K.I.INTRODUCTION: Data are lacking on psychometric scores and the emotional state in Sri Lankan patients with the irritable bowel syndrome. AIM: To evaluate patients with IBS using a Hospital Anxiety Depression (I IAD) scale and to assess the accuracy of clinical prediction of the emotional state by a non psychia¬trist clinician. METHODS: Data from 30 patients (20 male, median age - 27 years, range 20 - 50) with IBS titling me manning criteria were compared with 44 age and sex matched controls without IBS. Anxiety rating (median, range) was : Patients 11 (5-17) versus Controls 6 (1-17); P<0.05. Depression rating was : Palients 7 (2 -14 ) versus Controls 5 (0-16) P>0.05, Wilcoxon lest. Prediction of emotional state in patients with IBS correlated well with HAD scores in 17 (56%), was inaccurate in 6 (20%) and equivocal in 7 (24%). All patients in whom clinical prediction of emotional state was inaccurate had combined high anxiety and depression scores. CONCLUSION: Sri Lankan patients with IBS have greater prevalence of anxiety state disorders compared with controls. Clinical prediction of the emotional state by an untrained physician was inaccurate. The HAD scale may be of value in clinical decision making for patients with the irritable bowel syndrome associated with emotional state disorders.Item A prospective study on deliberate self harm(Sri Lanka Medical Association, 1998) Kuruppuarachchi, K.A.L.A.; Rajakaruna, R.R.; Dassanayake, H.; Ratnayake, J.A.W.S.; Gunawardana, W.P.M.; Fernando, P.L.N.INTRODUCTION : Suicide and deliberate self harm [DSH) in Sri Lanka have caused considerable concern due to its dramatic increase over the past few iecades. In global terms Sri Lanka has the highest -ate of suicide amongst females while its second lighest in males. The research work done with regard ,o DSH still appears to be inadequate. OBJECTIVES : To identify the demographical pattern )f DSH; nature of the attempt & methods used, mderlying psychopathology, awareness of helping igencies amongst the patients. METHOD : All patients (91) with DSH refered to the 'sychiatric Unit G.H Ragama within a period of one 'ear from October 1996 were included. ICD 10 riteria was used in the assessment. RESULTS : 53/91 were females. Age distribution 20yrs -21/91; 20-3Oyrs 38/91; 31-40yrs 17/91, 41-Oyrs 10/91; 51-60yrs 2/91; 61-70yrs 3/91. 47/91 /ere single; 42/91 married; 2/91 divorced. 18/91 grochemical poisoning ; 26/91 overdosing, 25/91 ther methods (kerosine oil, oleander etc.) 22/91 sed violent methods. Amongst impulsive acts 19/91) 6 were under the influence of alcohol. 42/91 ad mental illness; 19 affective disodcrs; 12 :hizophrenia; 2 Delusional disorder ; 4 :hizoaffective disorder; 1 mental retardation; 1 bsessive compulsive disorder; 3 psychoactive jbstance abuse. 59/91 wished to be alive; 17/91 'ished to be dead; 15/91 indifferent, 34/91 were ware of helping agencies. CONCLUSIONS : Females outnumbered the males and le commonest age distribution was between 21-)yrs. Overdosing was the commonest method used hile affective disorder was the main sychopathology amongst the mentally ill. An iteresting observation was that only a minority were rare of helping agencies and its worthwhile iproving the awareness of helping agencies nongst the people.Item A study on anxiety and depression among military personnel injured in the war(Sri Lanka Medical Association, 2001) Ariyaratne, R.; Arulrajah, S.; Ariyananda, D.; Ariyaratne, J.; Athanayake, S.; Azhar, M.; Bandara, A.; Bandara, R.; Williams, S.S.; Kuruppuarachchi, K.A.L.A.OBJECTIVES: To determine the proportion of army personnel with symptoms of anxiety and depression following injuries on the battlefield and to identify associated factors. DESIGN, SETTING AND METHODS: We administered a pretested closed and open ended questionnaire and a validated Sinhala translation of the Beck Depression and Beck Anxiety Inventory to 128 injured soldiers at the Military Hospital in Colombo between 9th and 11th of December 1999. We excluded soldiers with head injuries or impaired consciousness and those blind or deaf. RESULTS: In terms of the Beck Depression Inventory 35.15% had scores for severe depression, 15,62% for moderate depression and 28.1% for mild depression. In terms of the Beck Anxiety Inventory 7.81% has scores for severe anxiety, 5.46% for moderate anxiety and 36.7% for mild anxiety. There was a significant association between severity of depression and anxiety (Chi square for linear trend =21.8, p < 0.001). We also found a significant association between severity of depression and thoughts of deserting the army (Chi square for linear trend = 10.674, pO.OOl and severity of depression and problems at work or in the family (Chi square for linear trend = 4.373. p < 0.05). Among those who scored for severe depression there was a suicidal risk in 42.33%. CONCLUSIONS: We found that the majority of injured soldiers had symptoms of depression and nearly half had symptoms of anxiety, There was a significant association between severity of depression and thoughts of deserting the army and problems at work or in the family. The suicidal risk among depressed patients was high.