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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Effect of virgin coconut oil supplementation on cognition of individuals with mild-to-moderate alzheimer's disease in Sri Lanka (VCO-AD study): A randomized placebo-controlled trial(IOS Press, 2023) Fernando, M.G.; Silva, R.; Fernando, W.M.A.D.B.; de Silva, H.A.; Wickremasinghe, A.R.; Dissanayake, A.S.; Sohrabi, H.R.; Martins, R.N.; Williams, S.S.BACKGROUND: Virgin coconut oil (VCO) is a potential therapeutic approach to improve cognition in Alzheimer’s disease (AD) due to its properties as a ketogenic agent and antioxidative characteristics. OBJECTIVE: This study aimed to investigate the effect of VCO on cognition in people with AD and to determine the impact of apolipoprotein E (APOE) ɛ4 genotype on cognitive outcomes. METHODS: Participants of this double-blind placebo-controlled trial (SLCTR/2015/018, 15.09.2015) were 120 Sri Lankan individuals with mild-to-moderate AD (MMSE = 15-25), aged > 65 years, and they were randomly allocated to treatment or control groups. The treatment group was given 30 mL/day of VCO orally and the control group, received similar amount of canola oil, for 24 weeks. The Mini-Mental Sate Examination (MMSE) and Clock drawing test were performed to assess cognition at baseline and at the end of the intervention. Blood samples were collected and analyzed for lipid profile and glycated hemoglobin (HbA1 C) levels.∥ RESULTS: There were no significant difference in cognitive scores, lipid profile, and HbA1 C levels between VCO and control groups post-intervention. The MMSE scores, however, improved among APOE ɛ4 carriers who had VCO, compared to non-carriers (2.37, p = 0.021). APOE ɛ4 status did not influence the cognitive scores in the control group. The attrition rate was 30%.∥ CONCLUSION: Overall, VCO did not improve cognition in individuals with mild-to-moderate AD following a 24-week intervention, compared to canola oil. However, it improved the MMSE scores in APOE ɛ4 carriers. Besides, VCO did not compromise lipid profile and HbA1 C levels and is thus safe to consume.Item Pharmacoeconomics amidst a financial crisis(Sri Lanka College of Psychiatrists, 2023) Williams, S.S.; Medagedara, A.U.; de Silva, H.A.Cost effective strategies must be implemented amidst an economic crisis in Sri Lanka to mitigate ever increasing medicinal costs. Exploration of measures such as evidence based generic prescribing, cost effectiveness analysis, value-based pricing, identification of low cost, high value medication and being sensitive to the ability of the patient to purchase medicine is a necessity. Clinicians must be sensitised to this issue to contribute actively to the process. Policies in line with pharmacoeconomic realities must be pursued.Item The prevalence of depression and its correlates in garment factory employees in Hambantota District, Sri Lanka(Sri Lanka Medical Association, 2021) Obadaarachchi LN, L.N.; Amila, I.L.L.; Vipuladasa, D.D.M.L.; Williams, S.S.Introduction and objectives Garment factory employees are a high-risk population for depression in developing Asian countries. The objective of the study was to determine the prevalence of depression and its association with selected socio-demographic, occupational, personal and family factors in garment factory workers in Hambantota district. Method A cross sectional study using multi stage random sampling was conducted following ethical approval by a recognized ethics review committee. General Health Questionnaire-12 and Beck Depression Inventory–II, previously validated for the Sri Lankan population were used to screen for depression. A specifically designed data collection form was also administered after written informed consent by trained investigators. Results Out of a total sample of 390, the majority were females (n=325, 83.3%). The mean age was 32.9 years (SD 10.45 years). The estimated point prevalence of depression in the study sample was 17.2 % (95 % CI=13.3-21.8%). Depression was associated with presence of a chronic medical condition (OR-3.15, CI 1.53-6.44, p=0.002), family history of psychiatric illness (OR-5.57, CI 2.31-13.47, p<0.001), history of deliberate self-harm (OR-11.23, CI 5.03-25.04, p<0.001), history of psychiatric illness (OR-6.12, CI 2.39-15.73, p<0.001), and being divorced or separated from their partner(OR-3.39, CI 1.51-7.58, p=0.003). The only job-related factor which showed an association with depression was working extra duty hours (CI 1.01-3.02, p=0.04). Conclusions The prevalence of depression among garment factory employees in Hambantota district is higher in comparison to other populations in Sri Lanka. However, it is lower in comparison to garment factory populations in other developing Asian countries.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 Nutrition of patients with mild-to-moderate Alzheimers disease using the Mini Nutritional Assessment (MNA)(Sri Lanka Medical Association., 2019) Fernando, M.G.; Silva, K.D.R.R.; de Silva, M.P.; Obadaarachchi, L.N.; Yalegama, L.L.W.C.; Dissanayake, A.S.; Williams, S.S.INTRODUCTION & OBJECTIVES: Focus on the nutrition of patients with Alzheimer's disease is limited despite the need for optimization of overall patient health to improve well being and outcome. The objective of this study was to look at the nutrition and energy intake of patients with mild to moderate dementia. METHODS: Sixty patients with mild-to-moderate AD (Mini Mental State Examination score: 12-25; male:28; female: 32; age >65 years) were recruited from the clinics at the North Colombo Teaching Hospital, Ragama and Lanka Alzheimer's Foundation as part of the VCO-AD study, after informed consent. Baseline nutritional status was assessed by a Mini Nutritional Assessment (MNA) tool and dietary intake via a 24-hour dietary recall. RESULTS: The total energy intake of the study population (men: 1822±645 kcal/day, women: 1380±346 kcal/day) was lower than recommended standards. The percentage energy from fat, protein and carbohydrates (30.7±7.6%, 12.7±2.7%, and 56.8±8.7%, respectively) met recommendations. The energy intake from saturated fat (19.7±6.9%) however was higher than the recommendation. Vitamin C, D, E, folate, calcium, potassium, selenium and iodine intake (37.4±30.4 mg/day, 2.2±3.1 µg/day, 2.4±1.4 mg/day, 219±125 µ/day, 483.8±230.8 mg/day, 1853.9±590.8 mg/day, 38.1±22.7 µg/day, and 59.8±35.4 µg/day respectively) was lower than the estimated average requirements (EAR). MNA results showed that 20% were at risk of malnutrition. CONCLUSION: A higher saturated fat intake and lower vitamin intake were concerns in this population of patients with mild to moderate dementia.Item Psychological morbidity in adult survivors of the 2016 landslide in Aranayaka(Sri Lanka Medical Association, 2018) Bandara, G.R.B.S.; Pathiraja, P.M.R.B.I.; Bandara, I.M.H.W.; Williams, S.S.INTRODUCTION AND OBJECTIVES: A large landslide affected Aranayaka in the Kegalle District in Sri Lanka in May2016 leaving many residents dead or injured and the survivors displaced in temporary camps. This study assessed the prevalence of psychological morbidity one year after this incident. METHODS: A descriptive cross-sectional study was carried out among adult survivors in the relief camps. The number of individuals selected from each site was determined applying probability proportionate to the size technique to achieve a sample size of 405. A self-administered questionnaire, consisting of socio demographic details, the extent of the trauma and the psychological support received and a Sinhala version of the K-10 and PSSR-17 questionnaires were administered after informed consent. RESULTS: The prevalence of depression and moderate or severe PTSD were 22.5% and 19% respectively. Both depression and moderate or severe PTSD were present in 11.6%, and 29.9% had either depression or moderate/ severe PTSD. Lower educational level (P=0.03), single status (P=0.007), lower economic status (P<0.001) and past history of physical (P=0.044) and psychological (P=0.004) illnesses were associated with depression. Female gender (P=Or.026), single status (P=0.028), lower economic status (P=0.000), Tamil ethnicity (P=0.007) and chronic physical illness (P=0.002) were associated with PTSD. Depression and PTSD were also related to exposure to traumatic events (P<0.001). CONCLUSION: Nearly a third of those affected by the disaster had depression or PTSD a year after the event. Those of a lower income and education, females, single, widowed or divorced and those with a history of physical illness or past history of psychological issues were at higher risk.Item Unconfirmed death as a predictor of psychological morbidity in family members of disappeared persons(Cambridge University Press, 2019) Isuru, A.; Hewage, S.N.; Bandumithra, P.; Williams, S.S.BACKGROUND: The 2004 tsunami, the civil conflict until 2009 and the youth insurrection in the late 1980s in Sri Lanka resulted in many persons being classified as 'missing' as they disappeared and were unaccounted for. Our aim was to compare the prevalence of major depressive disorder (MDD) and prolonged grief disorder (PGD) in families of disappeared individuals, who eventually received the mortal remains and those who did not. METHOD: An ethically approved cross sectional study was conducted in a purposively selected sample after informed consent. Information on the circumstances of the family member going missing was gathered. Culturally adapted versions of the General Health Questionnaire and the Beck Depression Scale were administered. Those who screened positive were assessed by a psychiatrist on Diagnostic and Statistical Manual of Mental Disorders-5 criteria to arrive at a diagnosis. RESULTS: Of 391 cases of disappearances studied, MDD (17.5% v. 6%) and PGD (22% v. 7%) were significantly higher in those who did not eventually receive the mortal remains of the disappeared person. Among those who did not receive the mortal remains, being unsure whether the disappeared person was dead or alive was highly predictive of MDD and PGD. Mothers and wives, older family members and those with a family history of mental illness were more vulnerable. CONCLUSIONS: Family members of missing individuals unsure whether their loved one was alive or dead have higher psychological morbidity in the form of MDD and PGD.Item A preliminary study of the psycho-social burden of bipolar disorder on siblings(Sri Lanka Medical Association, 2017) Fernando, P.S.; Ranaweera, H.P.A.L.; Karunarathna, K.A.S.T.; Kaushalya, N.I.; Samarasinghe, G.; Peiris, M.U.P.K.; Williams, S.S.INTRODUCTION & OBJECTIVES: Bipolar disorder (BD) is a recurrent mood disorder with a prevalence of 1-2% in the general population. Individuals with BD experience significant impacts on family and social relationships, suffer from occupational instability, and are at greater risk of self-harm and suicide. This research aims to examine experiences and concerns of siblings of individuals with BD. METHODS: Quantitative data was collected from siblings of persons with BD through the psychiatry clinics at North Colombo Teaching Hospital after informed consent. For data collection, the ‘Sibling Impact Questionnaire–Bipolar Disorder’ (SIQ-BD) was developed. The SIQ-BD measures the impact on a sibling of a person with BD, across three timeframes, the ‘past year’, ‘over the years’, and ’worst time’. RESULTS: Out of 48 siblings (14 males, 34 females; mean age 42.7 years), 44 (11 males, 33 females) act as care givers to their siblings. The highest burden was during the ‘worst time’; and during this ‘worst time’ 16.7% of siblings worried that their sibling may commit suicide ‘very much so’, followed by 12.5% and 6.2% during the ‘whole time’ and ‘past year’ respectively. On a positive note, stigma was reported as high by only one sibling during the ‘worst time’ and none during the ‘past year’ and ‘whole time’. The highest disruption to daily life was experienced during the ‘worst time’. Providing financial support during the past year was significantly associated with higher burden (p=0.002). CONCLUSION: Siblings of persons with BD experience a mixed burden with low perception of stigma in this preliminary study.Item Cognitive behavioral therapy for university students with social phobia: A method to culturally adapt group therapy(Sri Lanka Medical Association, 2016) de Silva, B.G.R.; de Zoysa, P.; Williams, S.S.INTRODUCTION AND OBJECTIVES: Social phobia is a debilitating anxiety disorder with negative social implications. University students in Sri Lanka appear to have high prevalence rates of social phobia according to preliminary studies. Establishing a methodology by which interventions such as, Cognitive Behavioral Group Therapy (CBGT) could be culturally adapted is the objective of this study. METHOD: The gold standard CBGT was used to construct the structure of the intervention. CBGT interventions that have been modified to suit university student participant groups in the West were reviewed to revise the structure of the therapy. Existing cross-cultural therapy adaptation models were identified to derive factors to be taken in to consideration within this adaptation process. A study of other mental health intervention programs that have been cross-culturally adapted in diverse cultural settings was carried out. RESULTS: The methodology obtained constituted of three steps. The intervention program was initially reviewed by a panel of clinical psychologists to assess for appropriateness of content. Thereafter, the finalized layout, including activity worksheets were translated to Sinhala Language, and re-translated to English to test for accuracy. Finally, the translated documents were assessed by a panel of mental health experts in Sri Lanka and consensus was reached. CONCLUSIONS: A practical methodology to cross-culturally adapt psychological therapy for social phobia in the Sri Lankan context was developedItem 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.