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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Fine-tuning Postgraduate Psychiatry Training in South Asia(SAGE Publications, 2024) Williams, S.S.No abstract availableItem Charles Bonnet syndrome(SAARC Psychiatric Federation, 2015) Dissanayake, D.M.R.M.; Hewarathne, A.; Wijesinghe, C.A.; Amarasinghe, B.; Williams, S.S.A 41 year old married labourer presented with complex visual hallucinations for six months. He had reduced visual acuity, a subluxated lens, and two retained sutures from a previous surgery of the right eye and complete blindness of the left eye. His mental, physical and neurological examinations were unremarkable. Surgical correction of his visual impairment resulted in resolution of symptoms.Item The association between negative experiences during childhood and social anxiety disorder: A cross-sectional study among Sri Lankan university students(Sri Lanka Medical Association, 2023) de Silva, B.G.R.; De Zoysa, P.T.; Pathmeswaran, A.; Williams, S.S.INTRODUCTION: Social Anxiety Disorder (SAD) demonstrates early-onset, chronic course, and impairment in all social spheres. OBJECTIVES: The study objective was to explore the association between negative childhood experiences among a university student sample that indicated a high prevalence of SAD. METHODS: A cross-sectional study was conducted among 1137 students from five state universities. The Liebowitz Social Anxiety Scale – Sinhala version, and a correlates questionnaire including a culturally adapted Adverse Childhood Events Questionnaire and contextually appropriate parenting-related questions, were used as instruments. The analysis included chi-square tests for independence, spearman’s r correlations, and binary logistic regressions. RESULTS: Within the sample, 52.2% were female, and 66% were between 21-23 years. All faculties were represented with 27.5% from engineering. 32.2% of participants were first years. Bivariate analyses identified that being an eyewitness towards violence towards mother, feeling unsafe, feeling mistreated by family, experiencing physical abuse, experiencing sexual abuse, experiencing emotional abuse, experiencing parental dissatisfaction, and parental overcontrol to be significantly (p<0.05) associated with SAD. Continuous variables of Parent dissatisfaction (AOR=1.07, 95% CI 1.01-1.13, p<0.05), parent overcontrol (AOR=1.08, 95% CI 1.02-1.15, p<0.01) and experiences of emotional abuse (AOR=1.31, 95%CI 1.11-1.54, p=0.001) remained independently associated with SAD on regression analysis. CONCLUSIONS: Findings from this study corroborate the literature on the association between childhood experiences and parenting-related factors and SAD. The findings also highlight for the first time that Sri Lankan university students are no exception. An urgent need for awareness and prevention of adverse experiences within the family context, and early intervention to prevent the development of SAD are crucial.Item Psychosis after SARS-CoV-2 (COVID-19) infection.(Sri Lanka College of Psychiatrists, 2022) Harshini, M.L.; Jayasundara, D.M.S.P.; Williams, S.S.Psychiatric manifestations associated with COVID-19 infection have become a subject of study in the wake of the global pandemic. Some psychiatric disorders such as anxiety and depression are well recognized with the COVID-19 infection while overt psychosis is less so.We present four cases of first-onset psychotic episodes with a clear temporal relationship to COVID-19 infection. They appear mainly affective in nature, although only time will determine their eventual progression.Item Locked in grief: a qualitative study of grief among family members of missing persons in southern Sri Lanka(BioMed Central, 2021) Isuru, A.; Bandumithra, P.; Williams, S.S.Introduction: The psychological and social issues experienced by family members of missing persons are diferent from normal grief following the death of a loved one. The term “Ambiguous loss” describes this psychological phenomenon. Ambiguous loss acts as a barrier to adjusting to grief, leading to symptoms of depression and intra and interpersonal relational conficts. An in-depth phenomenological understanding of this subjective experience is important. Method: A qualitative study was conducted among close family members of persons who had gone missing during the civil confict and the 2004 tsunami in southern Sri Lanka following formal ethical approval from an university ethics review committee. Purposive and snowballing sampling methods were used to recruit the participants. Theoretical sample saturation was achieved with 24 family members of missing persons. Responders were mothers, fathers, wives, husbands, and siblings of missing individuals. In-depth interviews were recorded with the help of a semi-structured guide, after informed consent. The recordings were transcribed and coded by three independent investigators. The investigators through consensus arrived at the phenomenological themes and grounded them through refexivity. The triangulation process involved cross-checking observational notes made by the interviewers and consulting the interviewees. Results: We interviewed 24 frst degree relatives of missing individuals. Twenty-one of the interviewees were unsure about the fate of the missing individual, while three of them believed the missing individual to be dead. Of the 24 missing individuals, 20 were males and 18 had gone missing in civil conficts and 6 in the Indian Ocean Tsunami. Six predominant phenomenological themes were identifed. Those were lack of closure, hope, guilt, helplessness, perpetual sufering, and an emotional vacuum. These phenomenological experiences are highlighted by the interviewees through a range of utterances that hold profound cultural, social and emotional signifcance of unresolved and vacillating grief. Conclusion: The highlighted phenomenology of grief in surviving family members of those who go missing following traumatic events demands a response from health and social services in every country that experiences disaster. The surviving loved one is ‘locked in grief’ indefnitely and future research on evidence-based interventions to overcome this predicament is warranted.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 “Muddling by googling” – Cyberchondria among outpatient attendees of two hospitals in Sri Lanka(Sri Lanka Journal of Psychiatry, 2019) Wijesinghe, C.A.; Liyanage, U.L.N.S.; Kapugama, K.G.C.L.; Warsapperuma, W.A.N.P.; Williams, S.S.; Kuruppuarachchi, K.A.L.A.; Rodrigo, A.BACKGROUND: The internet is widely used as a source of health information, and the negative effects of this practice is well documented. Cyberchondria, the unfounded escalation of concerns about common symptoms based on review of online information has been identified as a major concern. This area has not been studied in Sri Lanka. AIMS: We studied the prevalence, nature and effects of cyberchondria among outpatients in Sri Lanka. METHODS: Data was gathered from 300 outpatients, 150 patients each attending a government and private hospital in Western province using a self-administered questionnaire. RESULTS: Out of 300 participants 178 were female and the average age was 42 years. Only 24% of the participants used the internet as an information source on health related issues. The prevalence of cyberchondria was 16.3% in our study population. Cyberchondria was significantly more common among outpatients of the private hospital. A majority of patients who made a self-diagnosis using online information had made an incorrect diagnosis. One third of internet users felt anxious after searching about their symptoms and 34% sought further medical advice following internet use. CONCLUSIONS: The possible negative effects of online health information is a concern in Sri Lanka. Further studies and public education regarding this area in Sri Lanka are required.Item Anxiety and depression among patients at a tertiary care respiratory clinic in Sri Lanka(Sri Lanka College of Psychiatrists, 2018) Galhenage, J.S.; Rupasinghe, J.P.N.; Weerasinghe, W.B.D.D.; Abeywardena, G.S.; Williams, S.S.; Gunasena, B.BACKGROUND: Chronic respiratory diseases are associated with increased risk of mood and anxiety disorders. These disorders in turn may lead to frequent hospital admissions and lower treatment adherence among patients with respiratory disease. AIMS: The objective of this study was to describe the prevalence of anxiety and depression among patients with chronic lung diseases and their association with socio demographic factors. Methods: A descriptive cross sectional study was conducted among patients at a respiratory outpatient clinic at the National Hospital for Respiratory Diseases, Welisara. Demographic data was collected using an interviewer administered questionnaire; a selfadministered Hospital Anxiety and Depression scale was used to examine for the presence of anxiety or depression. Consecutive patients who gave written informed consent to were included in the study. RESULTS: A total of 451 patients were participated in the study, of whom 274 (60.8%) were females. The mean age was 57.4 (SD=15.3) years and the majority (74.7%) were married. The education level of 226 (50.1%) was between grade 5 and grade 11. There was no permanent income for 196 (43.5%). The majority had bronchial asthma (60.3%) and 151 (33.5%) had one or more co-morbid medical illness. The mean score for the anxiety component was 6.78 (SD=3.59) and for the depression component it was 7.03 (SD=3.11). Seventy (15.5%) screened positive for anxiety and another 100 (22.2%) were doubtful cases. Sixty five (14.4%) screened positive for depression and another 128 (28.4%) were doubtful cases. Participants who were unmarried, divorced, separated or widowed had significantly higher levels of anxiety compared to those who were married (p=0.005). Patients who had a monthly income also had more anxiety compared to those who did not have an income (p=0.003). Conclusions: One fifth of the patients attending the respiratory clinic screened positive for anxiety and depression. This indicates the importance of addressing the psychological morbidity among patients with chronic lung disease.Item A naturalistic observational study of patients with bipolar affective disorder from two tertiary care hospitals in Sri Lanka(Sri Lanka College of Psychiatrists, 2017) Kandapola Arachchige, P.; Senevirathne, K.M.I.W.M.; Eranga, V.P.; Fernando, P.L.N.; Peris, M.U.P.K.; Kuruppuarachchi, K.A.L.A.; Williams, S.S.INTRODUCTION : Bipolar affective disorder (BAD) is a lifelong condition with a variable course. The objective of this study was to conduct a naturalistic observation of the course of this disorder among patients attending two general hospital psychiatric clinics in Sri Lanka. METHODS: Adult patients with a diagnosis of BAD for more than 12 months were included in this cross sectional descriptive study. Those who were suffering from acute exacerbations, had schizoaffective disorder or alcohol or drug misuse were excluded. Data was collected from the patients, caregivers and clinic records using a pre-tested interviewer administered questionnaire. Outcomes of interests were socio demographic characteristics, duration of the illness, number of relapses, treatment adherence, suicidality and level of functioning. RESULTS : Of the 350 patients studied, majority (55.7%) were females. Most (54.9%) had their first relapse within 2-5 years from onset of their illness. Of them 27.7% experienced their first relapse within one year. The first relapse occurred within 6-10 years of onset of illness in 8.9%, after 10 years in 6.3% and after 20 years in 2.3%. One third (33.4%) of patients had no second relapse. However, 38.3% relapsed for the second time within 2-5 years of diagnosing their illness. A minority (2.4%) had a second relapse within the first year and another minority (2.6%) after 20 years. The likelihood of a relapse for each patient per year was 0.644 in the first 5 years, 0.405 in the next 5-10 years, 0.38 in the next 10-15 years and 0.30 after 15 years. Conclusions : Despite the relapsing nature of BAD, predicting the course of the disorder in individual patients remains elusive. The trend was suggestive of fewer episodes over time, possibly mediated by better medication compliance and positive attitudes to treatment.Item Abuse, maltreatment and bullying in childhood(Sri Lanka College of Psychiatrists, 2015) Williams, S.S.; Ariyasinghe, D.