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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Predictors of response to electroconvulsive therapy in major depressive disorder: A review of research findings(Springer, 2024) Baminiwatta, A.; Menon, V.PURPOSE OF REVIEW In the context of the current global move towards precision medicine, considering the adverse effects, costs and efficacy limitations of electroconvulsive therapy (ECT) in major depression, this review aimed to identify predictors of ECT response based on recent research.RECENT FINDINGS Established predictors such as older age, psychotic symptoms, melancholic features, shorter episode duration, higher baseline severity, medication failure, and comorbid personality disorder were replicated in recent studies. Genetic polymorphisms showed little utility, whereas potentially useful epigenetic predictors were identified. Neurotrophic factors offer some predictive value. Some evidence for inflammatory markers emerged. Structural neuroimaging mainly implicates the hippocampal structures, amygdala, cingulate cortex, and other frontal lobe regions. Functional neuroimaging suggests an important role of brain functional connectivity, especially involving the default mode network.SUMMARY Many previously recognized demographic and clinical predictors of ECT response were supported, but evidence for biological predictors remains largely inconclusive, and requires further exploration and replication in future research.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 Asian Journal of Psychiatry and Psychiatry in Asia: Time to reconsider human resources to represent cultural diversity in Asia(Elsevier, 2021) Shoib, S.; Gupta, A.K.; Kar, S.K.; Chandradasa, M.; Menon, V.; Ullah, I.; Thuzar, M.; Arafat, S.M.Y.No abstract availableItem Suicide methods in South Asia over two decades (2001-2020)(Avenue Publishing Co, 2021) Arafat, S.M.Y.; Ali, S.A.; Menon, V.; Hussain, F.; Ansari, D.S.; Baminiwatta, A.; Saleem, T.; Singh, R.; Varadharajan, N.; Biyyala, D.; Kar, S.K.; Khan, M.M.BACKGROUND: Suicide is a global preventable public health problem. About a quarter of all suicides in the world occur in South Asia. As means restriction is an important suicide prevention strategy, gaining knowledge of the common suicide methods and their changing trends in each country and region is crucial. AIMS: We aimed to assess the suicide methods in South Asian countries over the last two decades. METHODS: A search was performed in PubMed, PubMed Central, Scopus, and Google Scholar with the search terms. Original articles of quantitative studies, published in the English language, from 2001 to 2020, with full-accessible text, that rank different methods of suicide in eight South Asian countries, were included. RESULTS: A total of 68 studies were found eligible for review. The Maximum number of studies were found from India (n = 38), followed by Bangladesh (n = 12), Pakistan (n = 9), Sri Lanka (n = 6), and Nepal (n = 3). Hanging (n = 40, 55.8%) and poisoning (n = 24, 35.3%) were the two most common suicide methods reported, in that order. Hanging followed by poisoning were the commonest suicide methods in Bangladesh, India, and Pakistan while in Sri Lanka, poisoning was the preferred method to hanging. There is a decline in suicide by poisoning and an increase in suicide by hanging in Sri Lanka, Bangladesh, and India. Although hanging is still the commonest method in Pakistan, the use of firearms is growing in recent years (2011-2020). CONCLUSIONS: There is a steady decline in the incidence of suicides by poisoning following pesticide regulations in South Asian countries. However, there is heterogeneity of study methods, probable under-reporting of suicide, and lack of robust suicide data. KEYWORDS: South Asia; Suicide; hanging; methods; poisoning; suicide prevention.