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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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 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 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 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 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 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 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.