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In Asian societies, the family carer has a pivotal role in ensuring the wellbeing of a person with mental health needs. In the absence of adequate mental health professionals and services, they take on the responsibility of identifying any changes in emotions and behaviour, convincing the person to seek medical help, accompanying the person on the visits to the doctor, and ensuring treatment compliance, follow up and rehabilitation. They have to buffer the stigma, find the financial resources and even manage the risks. In such situations, the burden on the carer is manifold. The physical and emotional strain can be enormous. Therefore, the treating physicians have to go out of their way to support the carer and ensure that they are adequately educated, supported and comforted on their journey of caregiving. Without their partnership, the care of the patient is destined to fail.

BackgroundThe 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. AimsWe studied the prevalence, nature and effects of cyberchondria among outpatients in Sri Lanka. MethodsData was gathered from 300 outpatients, 150 patients each attending a government and private hospital in Western province using a self-administered questionnaire. ResultsOut 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.

BackgroundThe 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.MethodAn 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.ResultsOf 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.ConclusionsFamily members of missing individuals unsure whether their loved one was alive or dead have higher psychological morbidity in the form of MDD and PGD.

IntroductionThe psychological and social issues experienced by family members of missing persons are different 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 conflicts. An in-depth understanding of this subjective experience is important.MethodA qualitative study was conducted among close family members of persons who had gone missing during the civil conflict and the 2004 tsunami in southern Sri Lanka. Purposive and snowballing sampling methods were used to recruit the participants. In-depth interviews were recorded with the help of a semi-structured guide, after informed consent. The recordings were transcribed and thematically analyzed by three independent investigators. The investigators met to code the themes and ground them through reflexivity. The triangulation process involved cross-checking with the interviewees. ResultsTheoretical sample saturation was achieved with 24 family members of missing persons. Responders were mothers, fathers, wives, husbands, and siblings of missing individuals. Six predominant themes were identified. They lacked closure, hope, guilt, helplessness, perpetual suffering, and effects due to gender roles. ConclusionThe close family member of the missing person has prolonged vacillating grief characterized by hope, guilt, helplessness, and perpetual suffering due to lack of closure. The effects are more pronounced in women through the interplay of socio-cultural factors. The surviving loved one is ‘locked in grief’ indefinitely.

Introduction The psychological and social issues experienced by family members of missing persons are different 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 conflicts. 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 conflict 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 reflexivity. The triangulation process involved cross-checking observational notes made by the interviewers and consulting the interviewees. Results We interviewed 24 first 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 conflicts and 6 in the Indian Ocean Tsunami. Six predominant phenomenological themes were identified. Those were lack of closure, hope, guilt, helplessness, perpetual suffering, and an emotional vacuum. These phenomenological experiences are highlighted by the interviewees through a range of utterances that hold profound cultural, social and emotional significance 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’ indefinitely and future research on evidence-based interventions to overcome this predicament is warranted.

The prevalence of dementia is rising in low-resource countries, where specialist memory services are almost non-existent. The COVID-19 pandemic has created opportunities for innovative remote healthcare. Research shows a lack of dementia literacy and help-seeking behaviour for memory-related problems among older adults in South Asian countries. This paper proposes a remote memory service model and virtual dementia training in South Asian countries, called Memory First Aid (MFA). MFA offers help to a person experiencing memory difficulties until appropriate professional help is received. The MFA course is a 12-h webinar-based package consisting of four weekly modules. It covers dementia awareness and clinical features. The aim is to develop a non-medical workforce able to screen and assess older people with suspected dementia.

BackgroundChronic 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. AimsThe 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. MethodsA 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. ResultsA 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). ConclusionsOne 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.

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

Healthcare workers (HCWs) are at risk of mental health problems during a pandemic. Being stationed at the frontline or not may have implications on their mental health.The aims of this study were to assess depression, anxiety and stress among HCWs, to explore differences between frontline and non-frontline workers, and to investigate associated factors.In this cross-sectional study, frontline and non-frontline HCWs were recruited from a COVID-19 screening hospital in Sri Lanka. Mental health impact was assessed using Depression, Anxiety and Stress Scale (DASS-21). Sociodemographic data and perceptions of social and occupational circumstances were gathered. Categorical variables were analyzed using Chi square and logistic regression. Odds ratios were calculated for the effect of different perceptions on psychological morbidity.A total of 467 HCWs participated, comprising 244 (52.2%) frontline and 223 (47.8%) non-frontline workers, with female preponderance (n=341, 77%). Prevalence of depression, anxiety and stress among HCWs were 19.5%, 20.6%, 11.8%, respectively. Non-frontline group showed a higher prevalence of depression (27% vs. 11%, p0.001), anxiety (27% vs. 14%, p=0.001) and stress (15% vs. 8%, p=0.026). Being married, having children, living with family and higher income were associated with better psychological outcomes. Perceived lack of personal protective equipment, inadequate support from hospital authorities, greater discrimination, and lack of training to cope with the situation predicted poor mental health outcomes, and non-frontline HCWs were more likely to hold such perceptions.Addressing factors leading to negative psychological outcomes in HCWs should be a key concern during this pandemic.

Alzheimer's disease (AD) is the most common form of dementia. Currently, there is no effective medication for the prevention or treatment of AD. This has led to the search for alternative therapeutic strategies. Coconut oil(CO) has a unique fatty acid composition that is rich in medium chain fatty acids(MCFA), a major portion of which directly reaches the liver via the portal vein, thereby bypassing the lymphatic system. Given that brain glucose hypometabolism is a major early hallmark of AD, detectable well before the onset of symptoms, ketone bodies from MCFA metabolism can potentially serve as an alternative energy source to compensate for lack of glucose utilisation in the brain. Additionally, neuroprotective antioxidant properties of CO have been attributed to its polyphenolic content. This review discusses how the metabolism of CO and MCFA may aid in compensating the glucose hypometabolism observed in the AD brain. Furthermore, we present the current evidence of the neuroprotective properties of CO on cognition, amyloid-β pathogenicity, inflammation and oxidative stress. The current review addresses the influence of CO/MCFA on other chronic disorders that are risk factors for AD, and addresses existing gaps in the literature regarding the use of CO/MCFA as a potential treatment for AD.

Cross-sectional, questionnaire-based study.To test the hypothesis that self-perceived functional impairment and religiosity/spirituality (S/R) predict depression among traumatic spinal cord injury (SCI) patients in Sri Lanka.Ragama Rheumatology and Rehabilitation Hospital, Ragama, Sri Lanka.The Spinal Cord Independence Measure, Benefit Through Spirituality/Religiosity Scale, Sheehan Disability Inventory and Beck Depression Inventory-II (BDI-II) were administered to 61 consenting in-patients with traumatic SCI between June and July 2014. A linear regression model on BDI-II score was developed to examine the impact of self-perceived functional impairment and S/R activities on psychiatric outcomes in context of various sociodemographic variables.Psychiatric consequences of SCI were reflected in a 41% prevalence of depression. Thirty-six percent (RPerceived functional impairment in work, social and family domains predicted depressive symptomatology among SCI inpatients in Sri Lanka, while perceived benefit through S/R protected against depression. The findings emphasize the need for rehabilitative programming to support patients' S/R activities and mental wellbeing, promoting reintegration into their community roles.

Background Type 2 diabetes mellitus (DM) patients with co-morbid depression often experience increased morbidity and mortality. Studies in other South Asian countries have shown a high prevalence of depression in patients with newly diagnosed DM.Aims To study the prevalence of depression among newly diagnosed diabetes mellitus patients attending an outpatient clinic in Chilaw, Sri Lanka, and to study the association with socio demographic variables.Methods A cross sectional descriptive study was conducted at the medical clinic of Chilaw District General Hospital from March 2012 to November 2012, to study the prevalence of depression among a group of newly diagnosed patients with type 2 DM. All patients diagnosed with type 2 DM within the previous two months were interviewed by a specialist in psychiatry. The presence of depression was established according to ICD 10 criteria.Results The study population (n=186) consisted of 116 (62%) females and 70 (38%) males with a mean age of 51 years (range 27 to 80 years). Results showed that 13.4% (95% CI 8.5 – 18.3) had mild depression while 15.6% (95% CI 10.4 – 20.8) had moderate depression. There were no cases of severe depression. The proportion of females with depressive disorder was significantly higher than males. There were no significant association between the prevalence of depression and other socio demographic variables such as age, marital status, education, employment, income, ethnicity or religion.Conclusion This study shows that a quarter of the population of newly diagnosed patients with type 2 DM have depressive disorder. This finding highlights the importance of screening patients with DM for depressive disorder.SL J Psychiatry 2015; 6(2): 9-14

Telepsychiatry, the application of telemedicine in the field of psychiatry is defined as the use of electronic communication and information technologies to provide or support clinical psychiatric care at a distance. COVID 19 and its implications related to physical distancing for patients and service providers has made tele- psychiatry and e-consultations an attractive option. Psychiatry, more than any other field in medicine stands to benefit through tele-psychiatry as a physical examination may not be always necessary to arrive at a diagnosis. Some have gone on to suggest that tele psychiatry is likely to replace in person psychiatric assessments pertaining to certain clinical situations. The article reviews the existing evidence for tele-psychiatry and addresses the challenges and pitfalls in the South Asian context.

No abstract available

The trichorhinophalangeal syndrome is a rare genetic disorder with a classical clinical triad of sparse hair, bulbous nose, and short digits. There are three known phenotypes, and the type II with exostoses in long bones is known as Langer-Giedion syndrome. Here, we describe a 28-year-old Sri Lankan male with Langer-Giedion syndrome and high-functioning autism. The karyotype found a microdeletion of the long arm of chromosome 8 with mosaicism [46,XY/46,XY,del(8)(q24.1q24.3)]. This is probably the first report of Langer-Giedion Syndrome with autism and the first report of the genetic syndrome from Sri Lanka. Furthermore, we could only access one previous report of the same microdeletion, which was from an autopsy of a 36-week-old infant.

One hundred and fifty-four flood victims of different ages completed standardised questionnaires measuring PTSD, psychiatric co-morbidity and cognitive distortions. Adolescents and young adults reported significantly fewer PTSD, psychiatric co-morbidity and distorted cognition symptoms than people who were older. Preoccupation with danger and hopelessness were associated with both outcomes for adolescents, people in their thirties and middle-aged/older people. For young adults, helplessness was associated with PTSD; hopelessness and preoccupation with danger with psychiatric co-morbidity.

Psychosocial consequences of traumatic spinal cord injury (SCI) have been well documented in Western populations, but there is no published literature on such incidence in the Sri Lankan population. The purpose of this study was to explore the psychosocial impact of SCI in a Sri Lankan population and to examine this population's coping mechanisms.Participants were recruited purposively at the Ragama Rheumatology and Rehabilitation Hospital, the sole rehabilitation facility for SCI patients in Sri Lanka. Focus groups were conducted with 23 consenting individuals. Interview transcripts were analysed using descriptive thematic analysis.Four domains of life impact, three types of active coping strategies and four types of external supports were identified. Decreased ambulation and burden on family life were significant concerns for male and female participants alike. Religious practices were reported most frequently as active coping strategies, followed by positive reframing and goal-setting. Reported external supports included guided physiotherapy, informational workshops, social support and peer networks.Rehabilitation efforts for Sri Lankan SCI patients should be sensitive to psychosocial concerns in addition to physical concerns in order to help patients re-integrate into their family lives and community. Furthermore, religious practices should be respected as possible aids to rehabilitation. Implications for Rehabilitation Rehabilitative efforts should be conscientious of patients' psychosocial well-being in addition to their physical well-being. Hospital-based rehabilitative efforts for traumatic spinal cord injury patients should promote functional independence and community re-integration. Spiritual and/or religious practices should be respected as ways by which traumatic spinal cord injury patients may confront personal challenges that arise following injury.

Background: A three-decade long conflict between the government military and Tamil rebels in Sri Lanka ended in 2009 with the defeat of the rebels. The civilians were the most affected in the war with reports of scant respect for human rights on both sides of the warring factions. Objective: To conduct a cross-sectional study to assess the prevalence of psychiatric morbidity among married females in two villages in Northern Sri Lanka that was affected significantly in the last phase of the war. Method: All married females in two resettled villages in the Mannar District were interviewed by trained data collectors using the translated K-10 and PSSR-17 questionnaires to estimate the prevalence of post-traumatic stress disorder (PTSD) and depressive disorder. All families in these villages were from internally displaced camps where they had been living for more than a year after having been displaced from their homes and having experienced direct war trauma for weeks. Data was collected from 135 married females between March to May 2011 with ethical approval for the study. Result: Criteria for diagnosis of severe PTSD were met in 57% of all participants and all participants had at least mild symptoms of PTSD. The screening tool for depression showed 63% to have significant depressive symptoms. Both depressive and severe PTSD features were present in 24%. Nearly 73% of participants were having either depression or severe PTSD. Conclusion: Psychiatric morbidity was high in the post-conflict period, in a highly vulnerable population of married females.

IntroductionBipolar 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. MethodsAdult 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. ResultsOf 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. ConclusionsDespite 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.

Background: With more effective treatments and improved outcomes in thalassemia, there is increasing focus on its psychological sequelae. Most published data on this topic are from high-income countries and much less so from low- and middle-income countries, where thalassemia is more prevalent. Aim: The aim of this study was to systematically evaluate the psychiatric morbidity and quality of life in relation to demographic- and illness-related variables among Sri Lankan patients with thalassemia. Methods: This cross-sectional investigation was conducted at the University of Kelaniya Teaching Hospital in Sri Lanka. Patients with all forms of thalassemia, over 12 years of age, and in stable medical condition (n = 120) were recruited. Assessment tools included a general demographic questionnaire, the Beck Depression Inventory-II, and the World Health Organization Quality of Life Measure–Brief. Statistical analysis was conducted using linear regressions, Chi-squares, and analyses of variance. Results: Lack of family support, longer duration of inpatient admission, and female gender were associated with higher depression scores and reduced quality of life. Environmental and social quality of life were positively correlated with levels of peer support in males, while increased support from religion correlated with lower depression scores and higher satisfaction with environmental and psychological quality of life in women. There was no association between the type of thalassemia and either depression or quality of life measures. Conclusion: Several factors may influence the psychological state and well-being of patients with thalassemia in Sri Lanka. Specific service innovations (some gender-specific) may help to address these factors to improve treatment outcome and well-being.

Summary: Persistent delirium is not an uncommon entity in acute clinical settings. It is unrecognized in certain situations and is associated with higher mortality and morbidity. Further, clinicians are impatient for the patients to recover as soon as the underlying medical conditions are treated. This may often be not the case in delirium. Here we report two patients presenting within the same month with prolonged delirium.

A descriptive cross sectional study was carried out to determine prevalence of depression and anxiety and to describe disease perception among patients with tuberculosis (TB) at National Hospital for Respiratory Diseases (NHRD), Welisara. Consecutive patients on anti-TB therapy admitted to wards and attending clinic were recruited until the estimated sample of 430 was reached. They were assessed using Hospital Anxiety and Depression Scale (HADS) and Brief Illness Perception Questionnaire (BIPQ). A total of 254 in-ward patients and 176 clinic patients were included. Of the inward patients, 25.2% had depression and 12.6% had anxiety. Of the clinic patients, 17.6% screened were positive for anxiety and 8.5% screened were positive for depression. Mean BIPQ score was 27.44 for the whole population. Prevalence of depression was significantly higher among in-ward patients (25.2%, p

This review article summarized the empirical findings on resilience in survivors of child sexual abuse (CSA) and discussed the protective factors associated with adaptive functioning. The authors conducted a literature search of several electronic databases, namely PsycINFO, MEDLINE/PubMed, Web of Science, and PSYNDEX plus. Publications upto November 2013 were considered, and further studies were retrieved by use of the snowball technique. A total of thirty-seven articles met inclusion criteria and were included in the review.

Introduction The psychological impact of snakebite on its victims, especially possible late effects, has not been systematically studied. Objectives To assess delayed somatic symptoms, depressive disorder, post-traumatic stress disorder (PTSD), and impairment in functioning, among snakebite victims. Methods The study had qualitative and quantitative arms. In the quantitative arm, 88 persons who had systemic envenoming following snakebite from the North Central Province of Sri Lanka were randomly identified from an established research database and interviewed 12 to 48 months (mean 30) after the incident. Persons with no history of snakebite, matched for age, sex, geograpical location and occupation, acted as controls. A modified version of the Beck Depression Inventory, Post-Traumatic Stress Symptom Scale, Hopkins Somatic Symptoms Checklist, Sheehan Disability Inventory and a structured questionnaire were administered. In the qualitative arm, focus group discussions among snakebite victims explored common somatic symptoms attributed to envenoming. Results Previous snakebite victims (cases) had more symptoms than controls as measured by the modified Beck Depression Scale (mean 19.1 Vs 14.4; p, Author Summary Snakebite envenoming is a neglected public health problem, especially in rural areas of tropical and sub-tropical countries. Little is known about the long term effects, and even less about the possible psychological effects, of snakebites and envenoming. We investigated the possible psychological impact of snakebite in 88 persons who had been envenomed 1 to 4 years ago in a rural agricultural area in Sri Lanka by using accepted measurements of psychological disability and group discussions among victims. 88 persons from the same areas who had not been bitten by a snake, but were of similar age, sex and occupation were also assessed in a similar manner. Compared to those who had not been bitten, snakebite victims had significantly more symptoms suggesting psychological disability, depression and post-traumatic stress. More than a fourth of those bitten claimed that the snakebite caused a negative change in their employment, and 10% had stopped working altogether. 17% claimed to have residual physical disability which they attributed to the bite, although no disability could be detected when they were examined. These findings indicate that snakebite results in ongoing psychological disability even 1 to 4 years after the episode, a complication that has not been previously reported.

Objective To review the number of research publications in the field of mental health in Sri Lanka from 1900 to 2009. Methods A search of all publications in psychiatry and mental health from Sri Lanka was conducted using Pubmed, all medical journals published in Sri Lanka and researchers. The identified papers were reviewed for their content and categorised as research in psychiatry and mental health, based on strict inclusion and exclusion criteria. Results A total of 207 papers were identified. The first mental health research publication from Sri Lanka is in 1964. The last decade (2000-2009) accounted for 62% of the publications with the majority of the papers being published in indexed journals. The Ceylon Medical Journal carried the most number of papers and the topic on which most of the research was conducted was suicide and deliberate self harm. Conclusions There is an increasing trend towards research in to psychiatry and mental health in Sri Lanka. (Index words: psychiatric research; research activities; statistics; bibliometrics) DOI: http://dx.doi.org/10.4038/cmj.v56i2.3111 Ceylon Medical Journal 2011; 56 : 61-65

Objective To assess the knowledge and attitudes towards attention deficit hyperactivity disorder (ADHD) among primary school teachers in the Gampaha District. Methods A descriptive cross sectional study was conducted in randomly selected schools of Gampaha district using a stratified sampling method. The knowledge and attitudes on ADHD were assessed by a self-administered questionnaire distributed among all the consenting primary school teachers in the selected schools. Results Total of 202 completed questionnaires of 210 distributed were returned. The majority showed good understanding about ill effects of ADHD, teachers' role in management and counterproductive effects of punishment. Three-fourths had a positive attitude towards behavioural therapy. However, only a minority had adequate knowledge about the presentation of ADHD and its treatment with medication. More than 80% of teachers believed that the parents were to be blamed for the child's ADHD. The majority of participating teachers also believed that behavioural disturbances caused by ADHD children were deliberate and malicious. Teachers who had training in child psychology recorded a significantly higher knowledge and had a more favourable attitude. Conclusions The knowledge of ADHD and its treatment among primary school teachers needs to be improved. Particular focus should be on improving attitudes and disseminating the message that timely interventions can make a difference in the educational and social development of the child. (Index words: attention deficit hyperactivity disorder; teachers’ knowledge and attitude; Sri Lanka) DOI: http://dx.doi.org/10.4038/cmj.v56i2.3108 Ceylon Medical Journal 2011; 56 : 51-54

We report a young girl who presented with painful oral and genital ulcers and a positive pathergy test as a result of acute myeloid leukaemia M4 subtype. This is the first case report of this combination of signs and symptoms reported in acute myeloid leukaemia (AML). Key words: leukaemia, genital ulcer, Behcet's disease DOI: 10.4038/cmj.v54i4.1456 Ceylon Medical Journal Vol.54(4) 2009: 131-132

Background: Dementia patients with anosmia are more likely to have Lewy body pathology at postmortem, but clinicopathological studies have only assessed olfaction in moderate dementia or an average of 5 years before death. It is not known whether, in patients with mild dementia (MMSE score over 20), olfactory function is more impaired in Alzheimer disease (AD) than dementia with Lewy bodies (DLB). Methods: Patients with mild DLB (n = 21), mild AD (n = 27), mild cognitive impairment (MCI) (n = 21) and controls (n = 47) were assessed using a 16-item olfactory identification test and an olfactory threshold test which used sticks impregnated with differing concentrations of butanol. Results: Patients with mild DLB had impaired olfactory identification ability compared with those with mild AD or MCI, independent of age, cognitive function and sex. The sensitivity of a cutoff score of seven correct responses out of 16 was 0.81 for distinguishing mild DLB from mild AD (AUC 0.682). The specificity, positive predictive value and negative predictive value for the same cut-off score were 0.41, 0.48 and 0.73, respectively. The olfactory threshold was not different in the AD and DLB groups. Conclusions: Simple bedside tests of olfactory identification merit further examination for their potential to improve the identification of patients with DLB when used alongside existing criteria. They are insufficiently specific for use in screening.

Background Snakebite results in delayed psychological morbidity and negative psycho-social impact. However, psychological support is rarely provided to victims. Aim To assess the effectiveness of a brief intervention which can be provided by non-specialist doctors aimed at reducing psychological morbidity following snakebite envenoming. Method In a single blind, randomized controlled trial, snakebite victims with systemic envenoming [n = 225, 168 males, mean age 42.1 (SD 12.4) years] were randomized into three arms. One arm received no intervention (n = 68, Group A), the second received psychological first aid and psychoeducation (dispelling prevalent cultural beliefs related to snakebite which promote development of a sick role) at discharge from hospital (n = 65, Group B), while the third received psychological first aid and psychoeducation at discharge and a second intervention one month later based on cognitive behavioural principles (n = 69, Group C). All patients were assessed six months after hospital discharge for the presence of psychological symptoms and level of functioning using standardized tools. Results At six months, there was a decreasing trend in the proportion of patients who were positive for psychiatric symptoms of depression and anxiety from Group A through Group B to Group C (Chi square test for trend = 7.901, p = 0.005). This was mainly due to a decreasing trend for symptoms of anxiety (chi-square for trend = 11.256, p = 0.001). There was also decreasing trend in the overall prevalence of disability from Group A through Group B to Group C (chi square for trend = 7.551, p = 0.006), predominantly in relation to disability in family life (p = 0.006) and social life (p = 0.005). However, there was no difference in the proportion of patients diagnosed with depression between the three groups (chi square for trend = 0.391, p = 0.532), and the intervention also had no effect on post-traumatic stress disorder. Conclusions A brief psychological intervention, which included psychological first aid and psychoeducation plus cognitive behavioural therapy that can be provided by non-specialist doctors appeared to reduce psychiatric symptoms and disability after snakebite envenoming, but not depression or post-traumatic stress disorder. Trial Registration Sri Lanka Clinical Trials Registry: SLCTR/2011/003, Author Summary Snakebite is an important health problem in many rural communities in tropical countries. However, little is known about the lasting physical and mental health effects following a bite. We recently reported that mental problems, with harmful social outcomes, can occur in many people after they are bitten by a snake. As the affected are often poor farmers or manual workers, this may affect their livelihoods. We, therefore, performed a trial which looked at the effectiveness of short psychological interventions, lasting about 15 and 20 minutes, which can be provided by even non-specialist doctors, in reducing these mental and social problems in people bitten by snakes. Our results show that such interventions may indeed be helpful to reduce some of these problems, but more research is needed to improve these interventions, especially so that they that can reduce post-traumatic stress disorder and depression after snakebite.

not availableDOI: http://dx.doi.org/10.4038/sljpsyc.v5i2.7824Sri Lanka Journal of Psychiatry Vol 5(2):37-39

not availableDOI: http://dx.doi.org/10.4038/sljpsyc.v5i2.7815Sri Lanka Journal of Psychiatry Vol 5(2):13-18

DOI: http://dx.doi.org/10.4038/sljpsyc.v5i1.7080 SL J Psychiatry 2014; 5 (1): 29-31

Normal 0 false false false MicrosoftInternetExplorer4 Objective To determine the proportion of university students that are psychologically distressed when compared to an age and sex matched population sample and to describe the factors that may contribute to their distress. Design A cross-sectional comparison study. Methods The general health questionnaire (GHQ 30), previously validated in Sinhala, was administered as a screening test to random samples of undergraduates in 5 universities. Age and sex matched controls from the respective communities were also administered the screening test. The undergraduates also filled in a pre-tested questionnaire with personal details. Chi-square tests were used to determine statistical significance between groups. Results Among the undergraduates, 104 (39.8%) had scores for psychological distress whereas only 67 (25.7%) from the community sample had scores for similar distress. This difference was significant (p=0.0007). A significantly greater proportion (p=0.009) of those entering from rural schools were psychologically distressed than those from suburban and urban schools, and a greater proportion living in rented rooms and hostels were (p=0.001) distressed than those travelling from their homes. Conclusions The psychological distress among undergraduates was significantly greater than among the general population. More students who enter from rural schools seem to be distressed than those who enter from suburban and urban schools. DOI: http://dx.doi.org/10.4038/cmj.v47i1.6401 Ceylon Medical Journal 2002; 47(1): 13-15

Introduction Post-traumatic stress disorder (PTSD) is an intense, prolonged and sometimes delayed reaction to extremely stressful events such as natural disasters or man-made calamities, characterised by persistent hyperarousal, reexperiencing of images of the stressful event and avoid­ ance of reminders (1). The disorder can become chronic and disabling with delay in treatment (2). PTSD can also be brought on in children, by viewing stressful scenes on television (3). Here we report two such cases.