Confluence of Western Psychotherapy and Religious Teachings in Mental Healthcare of an Asian Buddhist Community: Sri Lanka.

Buddha lived 2600 years ago in Northern India, and his teachings were established in Sri Lanka in the third-century BC. In the nineteenth century, the British established the modern mental health services in Sri Lanka. This article aimed to highlight the association between Western psychotherapeutic techniques with Buddhist teachings and the relevance of this confluence to the mental health care in the country. Many schools of Western psychotherapy employ principles which are also described in Buddhist philosophy. Understanding this connection helps to deliver a culturally acceptable and relevant mental health care to the Sri Lankan population.

Near-Death Experiences in a Multi-religious Hospital Population in Sri Lanka.

Near-death experiences (NDEs) are a wide range of experiences that occur in association with impending death. There are no published studies on NDEs in general hospital populations, and studies have been mainly conducted on critically ill patients. We assessed the prevalence of NDEs and its associations in a multi-religious population in a general hospital in Sri Lanka. A randomised sample of patients admitted to the Colombo North Teaching Hospital was assessed using the Greyson NDE scale and clinical assessment. Out of total 826 participants, NDEs were described by 3%. Compared to the NDE-negative participants, the NDE-positive group had a significantly higher mean for age and a ratio of men. Women reported deeper NDEs. Patients of theistic religions (Christianity, Islam and Hinduism) reported significantly more NDEs compared to patients from the non-theistic religious group (Buddhism). NDE-positive patient group had significantly higher reporting of a feeling 'that they are about to die', the presence of loss of consciousness and a higher percentage of internal medical patients. This is the first time that NDEs are assessed in a general hospital population and NDEs being reported from Sri Lanka. We also note for the first time that persons with theistic religious beliefs reported more NDEs than those with non-theistic religious beliefs. Medical professionals need to be aware of these phenomena to be able to give an empathic hearing to patients who have NDE.

Prevalence of hepatitis B and hepatitis C infections and their relationship to injectable drug use in a cohort of Sri Lankan prison inmates.

INTRODUCTION: Prisoners are considered to be at high risk for Hepatitis B (HBV) and Hepatitis C (HCV) virus infections. This is attributed to intravenous drug use and high-risk sexual behaviour. There are no published studies on HBV and HCV among prison inmates or injecting drug users in Sri Lanka. OBJECTIVES: To determine prevalence of HBV and HCV infections, and their relationship to injectable drug use among Sri Lankan prisoners. METHODS: We investigated 393 (median age 42 years (range 16 to 93); 82% males) randomly selected inmates of Mahara and Welikada prisons. RESULTS: Though 167 (42.5%) admitted drug abuse, only 17 (4.3%) had ever used intravenous drugs. Twelve (70.6%) of them reported sharing needles. One inmate was positive for HBsAg but was negative for HBV-DNA. Twenty seven (6.9%) were positive for anti-HCV antibodies, of whom only 2 (0.5%) were positive for HCV-RNA. None of the injecting drug users were positive for HBV-DNA or HCV-RNA. CONCLUSIONS: The prevalence of HBV and HCV infections as well as injecting drug use was very low among this cohort of Sri Lankan prison inmates.

Substance use disorders among mentally ill patients in a General Hospital in Sri Lanka: prevalence and correlates.

OBJECTIVES: To determine the prevalence, and demographic and clinical correlates of substance use disorders among the mentally ill. DESIGN AND SETTING: Cross sectional analytical study. Data were collected from consecutive patients treated at a Tertiary care Psychiatry Unit, Western Province, Sri Lanka using an interview schedule administered by a senior registrar in psychiatry. MEASUREMENTS: Diagnosis was based on ICD 10 criteria and the Clinician Rating Scale: Alcohol Use Scale (AUS) and the Drug Use Scale (DUS). The data were analysed using SPSS and WinPepi software programmes, utilising the chi squared, t test and median test. RESULTS: Among a sample of 325 patients, 66% were male; 33% were diagnosed with depressive disorder, 30% with schizophrenia, 23% with bipolar affective disorder and 13% with other disorders. Prevalence of comorbid substance use disorders was 43% (95% CI 38 - 49%). Alcohol was the commonest type of substance used. Those who had a comorbid substance use diagnosis were more likely to be male, have a lower educational level, be unemployed and have a poorer level of social support. They were also found to have poorer treatment adherence, increased number of hospital admissions and an increased association with episodes of violence. CONCLUSION: A significant proportion of patients were found to have a comorbid substance use diagnosis and associated complications. These findings have important implications for service provision for mentally ill patients with a comorbid substance use disorder.

Achievements and challenges in psychiatric education and training in Sri Lanka.

When compared with other Asian countries, psychiatric education and training in Sri Lanka has made significant developments during the past two decades, such as introducing psychiatry as a separate final year subject in the undergraduate medical curricula. However, further developments in psychiatric training in medical education are needed.

Why are we still living in the past? Sri Lanka needs urgent and timely reforms of its archaic mental health laws.

Mental health legislation protects the rights of people with mental illnesses. However, despite major social, political and cultural changes, Sri Lankan mental health services still operate on laws enacted mostly during the British rule more than a century ago, in the pre-psychotropics era, and focusing more on the detention of people with mental illnesses than on their treatment. It is high time all stakeholders made efforts for the much-awaited new Mental Health Act to pass through parliament urgently to meet the needs and protect the rights of patients, their caregivers and service providers.

Sri Lanka's response to prescribed drug misuse: is it enough?

A wide range of medications are being misused by people the world over and Sri Lanka is no exception. Reasons for this misuse are manyfold. Regulatory bodies, prescribers, dispensers, as well as the general public, have significant roles to play in mitigating the misuse of prescribed medications and their harmful consequences.

Randomised, placebo-controlled trial on topiramate add-on therapy for weight reduction and symptomatology in overweight/obese persons with schizophrenia.

INTRODUCTION: Higher cardiovascular mortality is seen with schizophrenia due to the disorder itself and antipsychotic use. South Asians are more vulnerable to developing metabolic disorders than others. Resource-limited settings in South Asia have only a few mental health professionals, and individualised case management is mostly unavailable. Therefore, there is less monitoring and personalised support for diet and physical exercise programmes. Topiramate is useful for weight reduction and improvement of psychopathology in schizophrenia. However, there has been only one previous randomised controlled trial (RCT) done in South Asia, which possesses a quarter of the world's population. METHODS: We conducted a double-blind RCT in an outpatient setting in Sri Lanka. We compared topiramate 100 mg/day with a placebo in overweight/obese adults with schizophrenia who have been on antipsychotics for at least a year. We obtained monthly anthropometric measurements and assessed the symptomatology using the brief psychiatric rating scale (BPRS). RESULTS: Fifty patients each in the topiramate and placebo arms completed the study. Topiramate add-on therapy led to significant weight/Body Mass Index reduction and improved symptomatology as measured by the BPRS compared to the placebo. The topiramate group had significantly more reporting of loss of appetite. DISCUSSION: According to available data, this is the RCT with most participants assessing the use of topiramate in schizophrenia and only the second in South Asia. Topiramate was shown to be useful for weight reduction and symptomatic improvement in persons with schizophrenia in a resource-limited setting in South Asia.

The knowledge and attitude of primary school teachers in Sri Lanka towards childhood attention deficit hyperactivity disorder.

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 ofADHD, 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.

Maternal mental health services in Sri Lanka: challenges and solutions.

Sri Lanka boasts of making significant strides in the indicators of maternal healthcare during the past few decades. However, these indicators mostly look only at the physical well-being of women. Lack of awareness regarding maternal mental health problems among grass-root level healthcare workers, poor integration of services, and the culture and stigma regarding perinatal mental disorders are barriers to improving services in maternal mental healthcare in Sri Lanka.

Child and youth mental health in postwar Sri Lanka.

Sri Lanka's civil war and the tsunami in 2004 had enormous psychological impacts on the country's children. Tackling these issues has been difficult due to the lack of specialists in child and adolescent psychiatry. The end of the war in 2009 opened new avenues for the development of mental health services for children and youth in Sri Lanka. The year 2016 was historic in that the first board-certified child and adolescent psychiatrists assumed services in the country, after training in Australia.

Topiramate's effectiveness on weight reduction in overweight/obese persons with schizophrenia: study protocol for a randomized controlled trial.

BACKGROUND: Schizophrenia is a psychiatric disorder with a higher mortality than that of the general population. Most of the deaths are due to cardiovascular causes and are related to metabolic risks. This risk is due not only to antipsychotics but also to inherent factors of the disorder. Studies in the West have shown topiramate to be effective in schizophrenia to reduce weight gain and for symptomatic control. Whether this is effective for South Asians is not known. It is important because South Asians have a higher risk of metabolic syndrome. We aim to conduct a double-blind, randomized controlled trial comparing topiramate add-on therapy with treatment as usual with antipsychotics in patients with schizophrenia in an outpatient setting in Sri Lanka. METHODS/DESIGN: Ninety patients with schizophrenia presenting to the Colombo North Teaching Hospital will be randomized to intervention and control groups equally using permuted block randomization. Patients with comorbid metabolic disorders and taking prescribed weight-controlling medications will be excluded. The intervention group will be prescribed topiramate in addition to their antipsychotics in a predefined dosing regimen targeting a dose of 100 mg per day. The control subjects are to receive a placebo. As the primary outcome, anthropometric measurements including weight, waist circumference, skinfold thickness, and body mass index will be recorded at baseline and monthly during the study period of 3 months. The secondary outcome is the change in symptoms according to the clinician-administered Brief Psychiatric Rating Scale. Assessment of capacity will be performed and informed consent obtained from all subjects. Ethics approval has been obtained from the ethical review committee of the Faculty of Medicine, University of Kelaniya, and the trial has been registered in the Sri Lanka Clinical Trials Registry. DISCUSSION: In this double-blind, randomized controlled trial, we will attempt to assess the effectiveness of topiramate as an add-on therapy compared with treatment as usual for weight control in patients with schizophrenia. To our knowledge, this is the first such study in South Asia, where metabolic risks are found to be higher than in the West and could have unique ethnic factors related to weight gain in schizophrenia. TRIAL REGISTRATION: Sri Lanka Clinical Trials Registry, SLCTR/2017/003 . Registered on 20 February 2017. Universal trial number, U1111-1192-9439.

Psychological distress among students from five universities in Sri Lanka.

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.

Organic causation of morbid jealousy.

This article describes the organic contribution to morbid jealousy. Although the true prevalence of morbid jealousy is unknown, organic factors contribute significantly to its development. We present an assortment of five case histories to highlight the importance of organic causation in this phenomenon. The first two cases portray organic delusional disorder arising as an aftermath of cerebral infarcts. They are both associated with left sided brain lesions. Though organic processes generally respond poorly to treatment, case 3 (patient with head injury), is unusual as it describes a young man whose symptoms resolve on recovering from the effects of a head injury. Likewise, case 4 (patient with a meningioma) who made a complete recovery following surgery, emphasizes the need for early detection of reversible causes. The difficulty in identifying the common substrate for a phenomenon with such a wide variety of causations is amply displayed by the abundance of theories forwarded. The blurred demarcation between normal jealousy and pathological jealousy leads to further uncertainty. The excess representation of morbid jealousy in organic conditions is not enlightened by these theories. Organic pathology, by affecting the higher centers of the brain, may remove the control over instinctual behaviour. Evidence for this is hard to establish but the evolutionary perspective of jealousy akin to that of the animal kingdom alludes to possible explanations.