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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Unusual presentations of reflex epilepsy in psychiatric practice: A case series(SAARC Psychiatric Federation, 2015) Kuruppuarachchi, K.A.L.A.; Kapugama, K.G.C.L.; Wijesinghe, C.A.No abstract availableItem Gender dysphoria and morbid sexual jealousy in an adolescent.(Kandy Society of Medicine, 2022) Rathnayake, L.C.; Kuruppuarachchi, C.; Abeyrathne, M.; de Silva Rajaratne, P.K.D.H.J.L.; Chandradasa, M.; Kuruppuarachchi, K.A.L.A.Gender dysphoria is the psychological distress that occurs when an individual’s biologically determined sex and gender identity do not align. Jealousy is likely to occur in any form of intimate partnership, irrespective of sexual orientation. Jealousy in a relationship is affected by sociocultural variables, an individual’s sense of masculinity, femininity, and other factors. We report an 18-year-old assigned female at birth with gender dysphoria presenting with jealous-type delusional disorder. We found no previous reporting of morbid jealousy in adolescents with gender dysphoria.Item Why are we still living in the past? Sri Lanka needs urgent and timely reforms of its archaic mental health laws(Cambridge University Press, 2023) Hapangama, A.; Mendis, J.; Kuruppuarachchi, K.A.L.A.Mental health legislation protects the rights of people with mental illnesses. However, despite major social, political and cultural changes, Sri Lankan mental health services still operate on laws enacted mostly during the British rule more than a century ago, in the pre-psychotropics era, and focusing more on the detention of people with mental illnesses than on their treatment. It is high time all stakeholders made efforts for the much-awaited new Mental Health Act to pass through parliament urgently to meet the needs and protect the rights of patients, their caregivers and service providers.Item Sri Lankan medical officers’ attitudes towards the elderly: a pilot study(Postgraduate Institute of Medicine University of Colombo, 2022) Fernando, R.; Ratnayake, G.; Liyanage, N.; Fonseka, M.; Perera, I.; Kuruppuarachchi, K.A.L.A.; Hapangama, A.Ageism among doctors influences treatment options and care of the elderly. Attitudes of Sri Lankan doctors towards the elderly have not been studied previously. This descriptive cross-sectional study using Fraboni’s scale of ageism explored doctors' attitudes towards older people in three selected hospitals in Sri Lanka and the relationship of such attitudes with demographic, employment, education and training-related factors. No association between the attitude of doctors toward the elderly and the factors studied in this pilot study were found.Item Sri Lanka's response to prescribed drug misuse: is it enough?(Cambridge University Press, 2023) Hapangama, A.; Kuruppuarachchi, K.A.L.A.A wide range of medications are being misused by people the world over and Sri Lanka is no exception. Reasons for this misuse are manyfold. Regulatory bodies, prescribers, dispensers, as well as the general public, have significant roles to play in mitigating the misuse of prescribed medications and their harmful consequences.Item COVID-19 pandemic and assessments of final year medical students in psychiatry: an innovative Sri Lankan experience(Sri Lanka College of Psychiatrists, 2021) Hapangama, A.; Kuruppuarachchi, K.A.L.A.No abstract availableItem Maternal mental health services in Sri Lanka: challenges and solutions(Royal College of Psychiatrists, London, 2021) Hapangama, A.; Kuruppuarachchi, K.A.L.A.Sri Lanka boasts of making significant strides in the indicators of maternal healthcare during the past few decades. However, these indicators mostly look only at the physical well-being of women. Lack of awareness regarding maternal mental health problems among grass-root level healthcare workers, poor integration of services, and the culture and stigma regarding perinatal mental disorders are barriers to improving services in maternal mental healthcare in Sri Lanka.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 Achievements and challenges in psychiatric education and training in Sri Lanka(Cambridge University Press, 2023) Hapangama, A.; Kuruppuarachchi, K.A.L.A.; Hanwella, R.ABSTRACT: When compared with other Asian countries, psychiatric education and training in Sri Lanka has made significant developments during the past two decades, such as introducing psychiatry as a separate final year subject in the undergraduate medical curricula. However, further developments in psychiatric training in medical education are needed.