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Article: The humanities and its relevance to the practice of medicine

Hanwella, Raveen

2018 Volume 62, Issue 4, Page(s) 207–209

MeSH term(s)	Humanities ; Humans ; Medicine
Language	English
Publishing date	2018-02-01
Publishing country	Sri Lanka
Document type	Journal Article
ZDB-ID	419365-9
ISSN	0009-0875
ISSN	0009-0875
DOI	10.4038/cmj.v62i4.8583
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Article: Achievements and challenges in psychiatric education and training in Sri Lanka.

Hapangama, Aruni / Kuruppuarachchi, K A L A / Hanwella, Raveen

BJPsych international

2022 Volume 20, Issue 1, Page(s) 2–4

Abstract: 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 ... ...

Abstract	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.
Language	English
Publishing date	2022-11-30
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2905058-3
ISSN	2058-6264 ; 2056-4740
ISSN (online)	2058-6264
ISSN	2056-4740
DOI	10.1192/bji.2021.35
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Article ; Online: What Women Want: Mental Health in the Context of Violence Against Women in Sri Lanka-A Qualitative Study of Priorities and Capacities for Care.

Palfreyman, Alexis / Vijayaraj, Kavitha / Riyaz, Safiya / Rizwan, Zahrah / Sivayokan, Sambasivamoorthy / Thenakoon, T H Samanmalee / Dayabandara, Madhubashinee / Hanwella, Raveen / Devakumar, Delan

Violence against women

2024 , Page(s) 10778012241230326

Abstract: Insufficient evidence guides mental health service development for survivors of violence against women in Sri Lanka. Provider and survivor perspectives on (1) what constitutes mental health, (2) quality of care, and (3) priority areas and stakeholders ... ...

Abstract	Insufficient evidence guides mental health service development for survivors of violence against women in Sri Lanka. Provider and survivor perspectives on (1) what constitutes mental health, (2) quality of care, and (3) priority areas and stakeholders for intervention were identified through framework analysis of 53 in-depth interviews. Desired care is chiefly psychosocial-not psychological-prioritizing socioeconomic, parenting, and safe environment needs in non-clinical community settings. Our evidence points strongly to the need to strengthen non-mental health community-based providers as "first contacts" and reassessment of health system-centric interventions which neglect preferred community responses and more holistic approaches accounting for women's full circumstances.
Language	English
Publishing date	2024-02-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2031375-5
ISSN	1552-8448 ; 1077-8012
ISSN (online)	1552-8448
ISSN	1077-8012
DOI	10.1177/10778012241230326
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Article ; Online: Cannabis use among Navy personnel in Sri Lanka: a cross sectional study.

de Silva, Varuni Asanka / Jayasekera, Nicholas / Hanwella, Raveen

BMC research notes

2016 Volume 9, Page(s) 174

Abstract: Background: Prevalence of cannabis use among military populations vary. There is evidence that drug use is associated with combat exposure and PTSD. The objective of the study was to assess the prevalence of cannabis use among Sri Lanka Navy (SLN) ... ...

Abstract	Background: Prevalence of cannabis use among military populations vary. There is evidence that drug use is associated with combat exposure and PTSD. The objective of the study was to assess the prevalence of cannabis use among Sri Lanka Navy (SLN) personnel and to identify any relationship with cannabis use and combat exposure. Methods: This cross sectional study was carried out among representative samples of SLN Special Forces (Special Boat Squadron) and regular forces deployed in combat areas. Both Special Forces and regular forces were selected using simple random sampling. Personnel who had served continuously in combat areas during the 1 year period prior to end of combat operations were included in the study. Cannabis use was defined as smoking cannabis at least once during the past 12 months. Results: The sample consisted of 259 Special Forces and 412 regular navy personnel. Prevalence of cannabis use was 5.22% (95% CI 3.53-6.9). There was no significant difference in prevalence of cannabis use among Special Forces personnel compared to regular forces. Cannabis use was significantly higher in the age group 18-24 years [OR 4.42 (95% CI 2.18-8.97)], personnel who were never married [OR 2.02 (95% CI 0.99-4.12)], or had an educational level less than GCE O'Level [OR 4.02 (95% CI 1.17-13.78)]. There was significant association between cannabis use and hazardous alcohol use [adjusted OR 5.47 (95% CI 2.65-11.28)], PTSD [adjusted OR 4.20 (95% CI 1.08-16.38)], GHQ caseness [adjusted OR 2.83 (95% CI 1.18-6.79)] and multiple somatic complaints [adjusted OR 3.61 (95% CI 1.5-8.7)]. Cannabis use was not associated with smoking. Risk of cannabis use was less in those who had seen dead or wounded [adjusted OR 0.42 (95% CI 0.20-0.85)]. Experiencing hostility from civilians was the only combat exposure that significantly increased the risk of cannabis use [adjusted OR 4.06 (95% CI 1.06-15.56)]. Conclusions: Among Sri Lanka Navy personnel exposed to combat cannabis use was significantly associated with hazardous alcohol use but not smoking. PTSD and other adverse mental health outcomes were associated with an increased risk of cannabis use. Exposure to combat was not associated with increased risk of cannabis use.
MeSH term(s)	Adult ; Cannabis/adverse effects ; Combat Disorders/epidemiology ; Cross-Sectional Studies ; Demography ; Humans ; Mental Health ; Military Personnel ; Prevalence ; Sri Lanka/epidemiology ; Substance-Related Disorders/epidemiology ; Wounds and Injuries/epidemiology
Language	English
Publishing date	2016-03-17
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2413336-X
ISSN	1756-0500 ; 1756-0500
ISSN (online)	1756-0500
ISSN	1756-0500
DOI	10.1186/s13104-016-1988-4
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Article ; Online: Depressive disorder and grief following spontaneous abortion.

Kulathilaka, Susil / Hanwella, Raveen / de Silva, Varuni A

BMC psychiatry

2016 Volume 16, Page(s) 100

Abstract: Background: Abortion is associated with moderate to high risk of psychological problems such as depression, use of alcohol or marijuana, anxiety, depression and suicidal behaviours. The increased risk of depression after spontaneous abortion in Asian ... ...

Abstract	Background: Abortion is associated with moderate to high risk of psychological problems such as depression, use of alcohol or marijuana, anxiety, depression and suicidal behaviours. The increased risk of depression after spontaneous abortion in Asian populations has not been clearly established. Only a few studies have explored the relationship between grief and depression after abortion. Methods: A study was conducted to assess the prevalence and risk factors of depressive disorder and complicated grief among women 6-10 weeks after spontaneous abortion and compare the risk of depression with pregnant women attending an antenatal clinic. Spontaneous abortion group consisted of women diagnosed with spontaneous abortion by a Consultant Obstetrician. Women with confirmed or suspected induced abortion were excluded. The comparison group consisted of randomly selected pregnant, females attending the antenatal clinics of the two hospitals. Diagnosis of depressive disorder was made according to ICD-10 clinical criteria based on a structured clinical interview. This assessment was conducted in both groups. The severity of depressive symptoms were assessed using the Patients Health Questionnaire (PHQ-9). Grief was assessed using the Perinatal Grief Scale which was administered to the women who had experienced spontaneous abortion. Results: The sample consisted of 137 women in each group. The spontaneous abortion group (mean age 30.39 years (SD = 6.38) were significantly older than the comparison group (mean age 28.79 years (SD = 6.26)). There were more females with ≥10 years of education in the spontaneous abortion group (n = 54; SD = 39.4) compared to the comparison group (n = 37; SD = 27.0). The prevalence of depression in the spontaneous abortion group was 18.6 % (95 CI, 11.51-25.77). The prevalence of depression in the comparison group was 9.5 % (95 CI, 4.52-14.46). Of the 64 women fulfilling criteria for grief, 17 (26.6 %) also fulfilled criteria for a depressive episode. The relative risk of developing a depressive episode after spontaneous abortion was significantly higher than in females with a viable pregnancy (RR = 2.19, 95 % CI, 1.05 to 4.56). After adjustment for age and period of amenorrhoea, the difference was not significant. Prevalence of complicated grief was 54.74 % (95 % CI, 46.3-63.18). Conclusion: The relative risk of developing a depressive episode after spontaneous abortion was not significantly higher compared to pregnant women after taking into account age and period of amenorrhoea (POA). Almost half the women developed complicated grief after spontaneous abortion. Of these, a significant proportion also had features of depressive disorder.
MeSH term(s)	Abortion, Spontaneous/epidemiology ; Abortion, Spontaneous/psychology ; Adult ; Depressive Disorder/diagnosis ; Depressive Disorder/epidemiology ; Depressive Disorder/psychology ; Female ; Grief ; Humans ; Pregnancy ; Risk Factors ; Sri Lanka/epidemiology
Language	English
Publishing date	2016-04-12
Publishing country	England
Document type	Journal Article
ISSN	1471-244X
ISSN (online)	1471-244X
DOI	10.1186/s12888-016-0812-y
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Article ; Online: Simvastatin-induced cognitive dysfunction: two case reports.

Suraweera, Chathurie / de Silva, Varuni / Hanwella, Raveen

Journal of medical case reports

2016 Volume 10, Page(s) 83

Abstract: Background: Simvastatin is commonly prescribed for hypercholesterolemia to reduce vascular risk in patients. Some of these patients have dementia with cognitive defects of several domains. Although protective effects seem to be present, there is ... ...

Abstract	Background: Simvastatin is commonly prescribed for hypercholesterolemia to reduce vascular risk in patients. Some of these patients have dementia with cognitive defects of several domains. Although protective effects seem to be present, there is emerging evidence that statins cause cognitive impairment. The role of cholesterol in cognitive function is complex. This is reflected in the effects that statins show on cognition functions. The reduction in cholesterol levels seen with statins is effective in improving learning and memory in some patients. However, there is emerging evidence that statins may worsen cognitive function. Similarly, there are major concerns over whether statins alleviate or worsen cognitive problems. The correlation between cholesterol levels and cognitive function is still controversial, mainly due to a lack of robust evidence. Case presentation: We report the cases of two Asian patients who developed cognitive deficits after starting simvastatin. A 32-year-old man and a 54-year-old woman developed different but clear cognitive deficits that reversed after stopping simvastatin. Conclusions: The possibility of new-onset cognitive dysfunction and the deterioration of existing cognitive deficits should be considered when prescribing simvastatin to patients.
MeSH term(s)	Adult ; Cognitive Dysfunction/chemically induced ; Female ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects ; Hypercholesterolemia/drug therapy ; Male ; Memory Disorders/chemically induced ; Middle Aged ; Simvastatin/adverse effects
Chemical Substances	Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Simvastatin (AGG2FN16EV)
Language	English
Publishing date	2016-04-05
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2269805-X
ISSN	1752-1947 ; 1752-1947
ISSN (online)	1752-1947
ISSN	1752-1947
DOI	10.1186/s13256-016-0877-8
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Article ; Online: Safety monitoring of treatment in bipolar disorder in a tertiary care setting in Sri Lanka and recommendations for improved monitoring in resource limited settings.

Mannapperuma, Uthpali / Galappatthy, Priyadarshani / Jayakody, Raveendra Laal / Mendis, Jayan / de Silva, Varuni Asanka / Hanwella, Raveen

BMC psychiatry

2019 Volume 19, Issue 1, Page(s) 194

Abstract: Background: Safety monitoring of medicines is essential during therapy for bipolar disorder (BD). We determined the extent of safety monitoring performed according to the International Society for Bipolar Disorders (ISBD) guidelines in patients with BD ... ...

Abstract	Background: Safety monitoring of medicines is essential during therapy for bipolar disorder (BD). We determined the extent of safety monitoring performed according to the International Society for Bipolar Disorders (ISBD) guidelines in patients with BD attending the main tertiary care psychiatry clinics in Sri Lanka to give realistic recommendations for safety monitoring in resource limited settings. Methods: Patients diagnosed with BD on mood stabilizer medications for more than 1 year were recruited. Data were collected retrospectively from clinic and patient held records and compared with the standards of care recommended by ISBD guidelines for safety monitoring of medicines. Results: Out of 256 patients diagnosed with BD, 164 (64.1%) were on lithium. Only 75 (45.7%) had serum lithium measurements done in the past 6 months and 96 (58.5%) had concentrations recorded at least once in the past year. Blood urea or creatinine was measured in the last 6 months only in 30 (18.3%). Serum electrolytes and thyroid-stimulating hormone (TSH) concentrations were measured in the last year only in 34 (20.7%) and 30 (18.3%) respectively. Calcium concentrations were not recorded in any patient. None of the patients on sodium valproate (n = 119) or carbamazepine (n = 6) had blood levels recorded to establish therapeutic concentrations. Atypical antipsychotics were prescribed for 151 (59%), but only 13 (8.6%) had lipid profiles and only 31 (20.5%) had blood glucose concentration measured annually. Comorbidities experienced by patients influenced monitoring more than the medicines used. Patients with diabetes, hypothyroidism and hypercholesterolemia were more likely to get monitored for fasting blood glucose and (p < 0.001), TSH (p < 0.001) and lipid profiles (p < 0.001). Lithium therapy was associated with TSH monitoring (p < 0.05). Therapy with atypical antipsychotics was not associated with fasting blood glucose or lipid profile monitoring (p > 0.05). A limitation of the study is that although some tests were performed, the results may not have been recorded. Conclusions: Safety monitoring in BD was suboptimal compared to the ISBD guidelines. ISBD standards are difficult to achieve in resource limited settings due to a multitude of reasons. Realistic monitoring benchmarks and recommendations are proposed for methods to improve monitoring in resource limited settings based on our experience.
MeSH term(s)	Adolescent ; Adult ; Aged ; Antipsychotic Agents/blood ; Antipsychotic Agents/economics ; Antipsychotic Agents/therapeutic use ; Bipolar Disorder/blood ; Bipolar Disorder/drug therapy ; Bipolar Disorder/economics ; Bipolar Disorder/epidemiology ; Drug Monitoring/economics ; Drug Monitoring/methods ; Female ; Follow-Up Studies ; Health Resources/economics ; Humans ; Lithium/blood ; Lithium/economics ; Lithium/therapeutic use ; Male ; Middle Aged ; Retrospective Studies ; Sri Lanka/epidemiology ; Tertiary Healthcare/economics ; Tertiary Healthcare/methods ; Treatment Outcome ; Young Adult
Chemical Substances	Antipsychotic Agents ; Lithium (9FN79X2M3F)
Language	English
Publishing date	2019-06-24
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1471-244X
ISSN (online)	1471-244X
DOI	10.1186/s12888-019-2183-7
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Article ; Online: Mental health of Special Forces personnel deployed in battle.

Hanwella, Raveen / de Silva, Varuni

Social psychiatry and psychiatric epidemiology

2011 Volume 47, Issue 8, Page(s) 1343–1351

Abstract: Purpose: To compare the mental health problems of Special Forces with regular forces engaged in combat in the Sri Lanka Navy (SLN).: Methods: A population-based descriptive study was carried out to compare the mental health problems of Special Forces ...

Abstract	Purpose: To compare the mental health problems of Special Forces with regular forces engaged in combat in the Sri Lanka Navy (SLN). Methods: A population-based descriptive study was carried out to compare the mental health problems of Special Forces with regular forces in the Sri Lanka Navy (SLN) deployed in combat areas for at least 1 year. Participants were selected by simple random sampling. The outcome measures were common mental disorder measured using the General Health Questionnaire, PTSD, fatigue, multiple physical symptoms and hazardous alcohol use. Results: Overall exposure to potentially traumatic events was high in both groups, with Special Forces experiencing significantly more traumatic events. More than 80% of the Special Forces had experiences of discharging weapons in direct combat, engaging in combat with enemy vessels and seeing the dead or wounded. Special Forces had significantly less common mental disorders, fatigue and fair or poor general health than regular forces. Fair or poor general health (21.1%) and fatigue (18.4%) were the commonest problems in the regular forces. Hazardous drinking was the commonest mental health problem among the Special Forces (17%). Prevalence of PTSD was 1.9% in the Special Forces and 2.9% among the regular forces. Exposure to traumatic events and problems with family life were identified as risk factors. Conclusions: Elite troops suffered less negative mental health consequences than regular forces despite higher combat exposure. Comradeship and unit cohesion protected Special Forces from negative mental health outcome of combat.
MeSH term(s)	Adult ; Alcoholism/diagnosis ; Alcoholism/epidemiology ; Combat Disorders/diagnosis ; Combat Disorders/epidemiology ; Combat Disorders/psychology ; Female ; Humans ; Male ; Mental Health ; Middle Aged ; Military Personnel/psychology ; Military Personnel/statistics & numerical data ; Population Surveillance ; Prevalence ; Psychiatric Status Rating Scales ; Risk Factors ; Socioeconomic Factors ; Sri Lanka ; Stress Disorders, Post-Traumatic/diagnosis ; Stress Disorders, Post-Traumatic/epidemiology ; Stress Disorders, Post-Traumatic/psychology ; Surveys and Questionnaires ; Warfare ; Young Adult
Language	English
Publishing date	2011-10-29
Publishing country	Germany
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	623071-4
ISSN	1433-9285 ; 0037-7813 ; 0933-7954
ISSN (online)	1433-9285
ISSN	0037-7813 ; 0933-7954
DOI	10.1007/s00127-011-0442-0
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Article ; Online: Access to information is crucial for science.

Hanwella, Raveen / de Silva, Varuni

Lancet (London, England)

2011 Volume 377, Issue 9775, Page(s) 1404

MeSH term(s)	Access to Information ; Costs and Cost Analysis ; Periodicals as Topic/economics ; Publishing/economics
Language	English
Publishing date	2011-04-23
Publishing country	England
Document type	Comment ; Letter
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(11)60569-2
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Article: Help-seeking behaviour and its impact on patients attending a psychiatry clinic at National Hospital of Sri Lanka

Gomez, D M / Gunarathna, C / Gunarathna, S / Gnanapragasam, K / Hanwella, Raveen

The Ceylon medical journal

2018 Volume 62, Issue 4, Page(s) 222–227

Abstract: Background: Mental illness contributes significantly to the global disease burden. There is great diversity in the manner in which mentally ill patients seek help as this is influenced by their beliefs and the opinion of the family-social support unit. ... ...

Abstract	Background: Mental illness contributes significantly to the global disease burden. There is great diversity in the manner in which mentally ill patients seek help as this is influenced by their beliefs and the opinion of the family-social support unit. The stigma associated with mental illness is a barrier to effective therapy in Sri Lanka where systematic public awareness programmes are minimal. Objective: To study the help-seeking behaviour and its impact on patients attending a psychiatry clinic of the National Hospital of Sri Lanka. Methods: A cross sectional study was carried out among 120 attendees of the psychiatry clinic of the National Hospital of Sri Lanka. Sample was selected using systematic sampling. Data was collected using an interviewer administered questionnaire. Results: More than half the participants sought psychiatric care as their first help-seeking behaviour and found it significantly more useful than non-psychiatric care alternatives. The average time to seek psychiatric care, irrespective of the pathway to care, was less than one month. The recommendation of the family and the social support unit and perceiving that the symptoms were due to a mental illness were the key factors in determining help-seeking behaviour. The average expense on alternative care was zero. There was no significant difference on the impact to employment among those that chose psychiatry care initially from those that did not. Conclusions: Our findings suggest that mentally ill patients presenting to a tertiary care hospital in Colombo, are likely to seek psychiatric care early. This is probably due to better recognition and knowledge regarding available treatment.
MeSH term(s)	Adolescent ; Adult ; Child ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Mental Disorders/therapy ; Middle Aged ; Patient Acceptance of Health Care/psychology ; Psychiatry ; Social Support ; Sri Lanka ; Tertiary Care Centers ; Time Factors ; Young Adult
Language	English
Publishing date	2018-02-01
Publishing country	Sri Lanka
Document type	Journal Article
ZDB-ID	419365-9
ISSN	0009-0875
ISSN	0009-0875
DOI	10.4038/cmj.v62i4.8571
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