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Article ; Online: Consultation liaison psychiatry in Sri Lanka

Raveen Hanwella

Sri Lanka Journal of Psychiatry, Vol 1, Iss 2, Pp 39-

a case for sub-specialisation

2010 Volume 41

Abstract: Liaison psychiatry has not been established in Sri Lanka as a sub-speciality. However many psychiatrists who work in general hospital settings are required to do liaison work. Patterns of referrals to a university psychiatry liaison unit were studied in ... ...

Abstract	Liaison psychiatry has not been established in Sri Lanka as a sub-speciality. However many psychiatrists who work in general hospital settings are required to do liaison work. Patterns of referrals to a university psychiatry liaison unit were studied in order to identify the requirements in training for liaison psychiatry in Sri Lanka. A retrospective analysis of records of all new patients registered during a six month period from 1st January 2010 in the liaison unit of the University Psychiatry Unit, Colombo was carried out. A total of 1079 patients were referred to the liaison unit during this period. The commonest reason for referral was assessment of patients who were admitted to medical or surgical wards after deliberate self harm. The variety of clinical conditions referred to liaison units highlight that psychiatry trainees need a broad knowledge of general medicine and a wide repertoire of clinical and other skills to effectively manage their patients. Specialised liaison units should be started in the general hospitals and should form the nucleus for training and establishing the field of consultationliaison psychiatry as a subspecialty in Sri Lanka.
Keywords	liaison psychiatry ; Sri Lanka ; Psychiatry ; RC435-571 ; Neurology. Diseases of the nervous system ; RC346-429 ; Neurosciences. Biological psychiatry. Neuropsychiatry ; RC321-571 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Psychiatry ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Subject code	028
Language	English
Publishing date	2010-12-01T00:00:00Z
Publisher	Sri Lanka College of Psychiatrists
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The psychological management of pain:a case report and overview of techniques

Raveen Hanwella / Thushani Henegama

Sri Lanka Journal of Psychiatry, Vol 2, Iss 1, Pp 28-

2011 Volume 30

Abstract: A serviceman seriously injured in battle after recovery from his initial injuries developed severe stabbing pain in his left leg. The pain was persistent, distressing and caused significant functional impairment. The pain failed to remit with ... ...

Abstract	A serviceman seriously injured in battle after recovery from his initial injuries developed severe stabbing pain in his left leg. The pain was persistent, distressing and caused significant functional impairment. The pain failed to remit with pharmacotherapy which included sub cutaneous morphine. At the time of referral the pain had lasted 18 months. The patient was treated with six sessions of cognitive behavioural therapy with significant reduction of his pain. Nine months later, on follow-up, he was pain free and functioning almost normally. The principles of psychological management of pain are also discussed.
Keywords	Psychiatry ; RC435-571 ; Neurology. Diseases of the nervous system ; RC346-429 ; Neurosciences. Biological psychiatry. Neuropsychiatry ; RC321-571 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Psychiatry ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	English
Publishing date	2011-06-01T00:00:00Z
Publisher	Sri Lanka College of Psychiatrists
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: ‘Delusional’ obsessive compulsive disorder responding to behaviour therapy

Raveen Hanwella / Rasitha Perera

Sri Lanka Journal of Psychiatry, Vol 2, Iss 1, Pp 33-

a case report

2011 Volume 35

Abstract: A 35 year old female with severe obsessive thoughts and compulsions of more than 10 years duration was referred for therapy. The obsessions consisted of thoughts that sharp objects embedded in her clothing and other items of use would enter her body and ... ...

Abstract	A 35 year old female with severe obsessive thoughts and compulsions of more than 10 years duration was referred for therapy. The obsessions consisted of thoughts that sharp objects embedded in her clothing and other items of use would enter her body and circulation. The compulsions consisted of extreme precautions taken to avoid contact with sharp objects. These were compounded by the near delusional belief that people around her were conspiring to place sharp objects near her. Though there was some initial pessimism she responded well to exposure and response prevention combined with medication.
Keywords	Psychiatry ; RC435-571 ; Neurology. Diseases of the nervous system ; RC346-429 ; Neurosciences. Biological psychiatry. Neuropsychiatry ; RC321-571 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Psychiatry ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	English
Publishing date	2011-06-01T00:00:00Z
Publisher	Sri Lanka College of Psychiatrists
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Efficacy of clozapine in patients with chronic schizophrenia

Varuni de Silva / Raveen Hanwella

Sri Lanka Journal of Psychiatry, Vol 1, Iss 2, Pp 47-

2010 Volume 50

Abstract: Background Clozapine is the most effective treatment for refractory schizophrenia. There is evidence that clozapine improves social and occupational functioning and patients’ quality of life. Aims To evaluate the presence of psychopathology and level of ... ...

Abstract	Background Clozapine is the most effective treatment for refractory schizophrenia. There is evidence that clozapine improves social and occupational functioning and patients’ quality of life. Aims To evaluate the presence of psychopathology and level of functioning in a cohort of patients treated with clozapine. Methods Sixty seven patients attending a clozapine clinic during a two month period were enrolled. Sociodemographic characteristics, duration of treatment and dose of clozapine were recorded. Symptom severity was measured using a psychopathology scale. Level of functioning was assessed using the "Psycho Social Functioning Scale". Results Of the sample 53.7% were males. Majority were aged 20-39 years. In the sample 7.4% were treated with clozapine for two years or less, 38.8% for 3-5 years and 40.3% for 6-10 years. Of the sample 43.3% were on 225-400 mg/day. In the self care sub scale 61 (95.3%) scored 13-15 from a maximum of 15. In the daily function sub scale 42 patients (65.7%) scored more than 10 from maximum 15 points. Thirteen males (36.1%) and 8 females (25.8%) were engaged in full time paid employment. Three males and 2 females were full time students. Another 6 (19.4%) females did full time household work. Conclusions Patients on long term treatment with clozapine showed low levels of psychopathology. In the majority self care and other daily functions were adequate. Many patients treated with clozapine were engaged in full time employment.
Keywords	clozapine ; schizophrenia ; Sri Lanka ; Psychiatry ; RC435-571 ; Neurology. Diseases of the nervous system ; RC346-429 ; Neurosciences. Biological psychiatry. Neuropsychiatry ; RC321-571 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Psychiatry ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Subject code	616
Language	English
Publishing date	2010-12-01T00:00:00Z
Publisher	Sri Lanka College of Psychiatrists
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Diabetes and impaired fasting glucose in Sri Lankan patients with schizophrenia

Raveen Hanwella / Varuni de Silva

Sri Lanka Journal of Psychiatry, Vol 1, Iss 2, Pp 56-

2010 Volume 59

Abstract: Background: Type 2 diabetes is commoner among South Asians than Europeans. The few studies of South Asian patients with schizophrenia have found increased prevalence of diabetes. Aims: To determine prevalence of diabetes and impaired fasting glucose ... ...

Abstract	Background: Type 2 diabetes is commoner among South Asians than Europeans. The few studies of South Asian patients with schizophrenia have found increased prevalence of diabetes. Aims: To determine prevalence of diabetes and impaired fasting glucose among patients with schizophrenia presenting to an acute psychiatry unit. Methods: The sample consisted of all patients with ICD-10 diagnosis of schizophrenia admitted to an acute psychiatry unit during one year. Data was obtained by retrospective review of patients’ records. Diabetes was diagnosed according to the American Diabetes Association criteria when fasting plasma glucose (FPG) was ≥ 7.0 mmol/l. Impaired fasting glucose (IFG) was diagnosed when FPG was ≥5.6 mmol/l but <7.0 mmol/l. Results: Of the 164 patient records reviewed 104 (63.4%) had a recorded FPG level. There was no significant difference in age, gender and treatment between patients tested and not tested. Of the sample 28 (26.9%) were antipsychotic naive and 76 (73.1) had been treated previously. Mean age of the sample was 35.1 years (SD 12.7). Diabetes was diagnosed in 15 patients. Overall prevalence was 14.4% (females 11.4%, males 16.7%). Prevalence of IFG was 26%. Diabetes rates were highest (26.9%) among 30-39 year age group and IFG rates were highest (54.5%) among 50-59 year age group. Conclusions: Prevalence of diabetes and IFG is higher compared to the general population of Sri Lanka (10.3% and 11.5%) but similar to that of Caucasian patients with schizophrenia. Due to the high risk of dysglycaemia FPG should be done in all patients with schizophrenia.
Keywords	diabetes ; schizophrenia ; Sri Lanka ; Psychiatry ; RC435-571 ; Neurology. Diseases of the nervous system ; RC346-429 ; Neurosciences. Biological psychiatry. Neuropsychiatry ; RC321-571 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Psychiatry ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	English
Publishing date	2010-12-01T00:00:00Z
Publisher	Sri Lanka College of Psychiatrists
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Psychopathology in patients with schizophrenia attending a psychiatry outpatient clinic at a tertiary care hospital

Raveen Hanwella / Arjuna Ellepola / Madhubhashinee Dayabandara / Hiranya Wihesundara

Sri Lanka Journal of Psychiatry, Vol 2, Iss 1, Pp 23-

2011 Volume 27

Abstract: Background Patients with schizophrenia who are not acutely ill continue to experience different levels of psychopathology, despite a relatively stable lifestyle.Aims To describe the pattern of symptoms in patients with schizophrenia attending an ... ...

Abstract	Background Patients with schizophrenia who are not acutely ill continue to experience different levels of psychopathology, despite a relatively stable lifestyle.Aims To describe the pattern of symptoms in patients with schizophrenia attending an outpatient clinic using the Brief Psychiatric Rating Scale Expanded version (BPRS-E).Methods Consecutive patients in an outpatient clinic, with a diagnosis of schizophrenia were assessed. Analysis was based on the four-factor cluster of symptoms: thought disturbance, animation, mood disturbance and apathy identified using the BPRS-E.Results Sample size was 178 (males 54.5 %, mean age = 39.29 years, mean illness duration = 13.29 years, mean total BPRS score = 32.11). Apathy had the highest mean score among the symptom clusters (6.54, SD 3.56), while blunted affect (1.87, SD 1.23) and emotional withdrawal (1.85, SD 1.26) had highest individual item mean scores. Patients on clozapine had significantly more symptoms of thought disturbance and animation compared to others, (P <0.05). There was no significant difference in symptoms between patients on typical and atypical antipsychotics. Those on higher doses of clozapine (>400mg) had significantly higher scores in thought disturbance and apathy. Higher scores on total BPRS, negative symptoms and thought disturbance were associated with lower levels of functioning.Conclusions Patients with schizophrenia on treatment continue to have symptoms. Negative symptoms are the most predominant. Patients on clozapine have a higher level of psychopathology. The degree of negative symptoms and thought disturbance had a significant association with the level of functioning.
Keywords	Psychiatry ; RC435-571 ; Neurology. Diseases of the nervous system ; RC346-429 ; Neurosciences. Biological psychiatry. Neuropsychiatry ; RC321-571 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Psychiatry ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Subject code	150
Language	English
Publishing date	2011-06-01T00:00:00Z
Publisher	Sri Lanka College of Psychiatrists
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Community psychiatry service in Sri Lanka

Pushpa Ranasinghe / Jayan Mendis / Raveen Hanwella

Sri Lanka Journal of Psychiatry, Vol 2, Iss 1, Pp 3-

a successful model

2011 Volume 5

Abstract: In the current practice of psychiatry there is a shift from hospital to community based care. Different models of community psychiatry have been tried in different countries. Though this concept is based on several core principles, each country has to ... ...

Abstract	In the current practice of psychiatry there is a shift from hospital to community based care. Different models of community psychiatry have been tried in different countries. Though this concept is based on several core principles, each country has to find what is best suited for its population. In Sri Lanka too, community psychiatry projects have been initiated by psychiatrists. We describe below one such project started in a postal area in the capital, Colombo, by one of the authors. The project began in late 2008 and by 2010 was functioning independently and fulfilled the criteria for a community based mental health service.
Keywords	Psychiatry ; RC435-571 ; Neurology. Diseases of the nervous system ; RC346-429 ; Neurosciences. Biological psychiatry. Neuropsychiatry ; RC321-571 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Psychiatry ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	English
Publishing date	2011-06-01T00:00:00Z
Publisher	Sri Lanka College of Psychiatrists
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Pharmacological management of bipolar disorder

Raveen Hanwella / Varuni de Silva / Mahesh Rajasuriya

Sri Lanka Journal of Psychiatry, Vol 1, Iss 2, Pp 32-

2010 Volume 38

Abstract: Background Bipolar disorder is a chronic recurrent neuropsychiatric disorder. The management of the different phases of the illness requires different combinations of medicines and other treatment strategies. Aims To synthesize the current evidence for ... ...

Abstract	Background Bipolar disorder is a chronic recurrent neuropsychiatric disorder. The management of the different phases of the illness requires different combinations of medicines and other treatment strategies. Aims To synthesize the current evidence for management of bipolar disorder. Methods We searched the MEDLINE, Cochrane database of systematic reviews and the Database of Abstracts of Reviews of Effects (DARE) for recent systematic reviews and meta-analysis between 1995 and 2010. Original articles of relevant randomised controlled trials (RCT) were accessed. Results and conclusions For treatment of acute mania lithium, valproate and carbamazepine are more effective than placebo but they have no superiority over antipsychotics. There is evidence from RCTs that second generation antipsychotics (SGA) are more effective than placebo. Haloperidol may be more effective than SGA in treatment of acute mania. Combination of antipsychotic and mood stabiliser is more effective than mood stabiliser monotherapy alone. In treatment of acute bipolar depression the current evidence is inadequate to support the use of lithium as monotherapy. The most effective treatment is combination of a mood stabiliser and an antidepressant which also minimises manic switches. FDA has approved olanzapine-fluoxetine combination and quetiapine monotherapy. Lamotrigine is also effective in the treatment of acute bipolar depression. For prophylaxis lithium, valproate and carbamazepine are effective while lamotrigine is primarily effective in preventing depressive episodes. Lithium is more effective in preventing manic than depressive episodes. Evidence for efficacy of antipsychotics in prophylaxis is limited
Keywords	bipolar disorder ; review ; Psychiatry ; RC435-571 ; Neurology. Diseases of the nervous system ; RC346-429 ; Neurosciences. Biological psychiatry. Neuropsychiatry ; RC321-571 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Psychiatry ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Subject code	610
Language	English
Publishing date	2010-12-01T00:00:00Z
Publisher	Sri Lanka College of Psychiatrists
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Mental health status of Sri Lanka Navy personnel three years after end of combat operations

Raveen Hanwella / Nicholas E L W Jayasekera / Varuni A de Silva

PLoS ONE, Vol 9, Iss 9, p e

a follow up study.

2014 Volume 108113

Abstract: The main aim of this study was to assess the mental health status of the Navy Special Forces and regular forces three and a half years after the end of combat operations in mid 2009, and compare it with the findings in 2009. This cross sectional study ... ...

Abstract	The main aim of this study was to assess the mental health status of the Navy Special Forces and regular forces three and a half years after the end of combat operations in mid 2009, and compare it with the findings in 2009. This cross sectional study was carried out in the Sri Lanka Navy (SLN), three and a half years after the end of combat operations. Representative samples of SLN Special Forces and regular forces deployed in combat areas were selected using simple random sampling. Only personnel who had served continuously in combat areas during the one year period prior to the end of combat operations were included in the study. The sample consisted of 220 Special Forces and 275 regular forces personnel. Compared to regular forces a significantly higher number of Special Forces personnel had experienced potentially traumatic events. Compared to the period immediately after end of combat operations, in the Special Forces, prevalence of psychological distress and fatigue showed a marginal increase while hazardous drinking and multiple physical symptoms showed a marginal decrease. In the regular forces, the prevalence of psychological distress, fatigue and multiple somatic symptoms declined and prevalence of hazardous drinking increased from 16.5% to 25.7%. During the same period prevalence of smoking doubled in both Special Forces and regular forces. Prevalence of PTSD reduced from 1.9% in Special Forces to 0.9% and in the regular forces from 2.07% to 1.1%. Three and a half years after the end of combat operations mental health problems have declined among SLN regular forces while there was no significant change among Special Forces. Hazardous drinking among regular forces and smoking among both Special Forces and regular forces have increased.
Keywords	Medicine ; R ; Science ; Q
Language	English
Publishing date	2014-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Religious Beliefs, Possession States, and Spirits

Raveen Hanwella / Varuni de Silva / Alam Yoosuf / Sanjeewani Karunaratne / Pushpa de Silva

Case Reports in Psychiatry, Vol

Three Case Studies from Sri Lanka

2012 Volume 2012

Keywords	Psychiatry ; RC435-571 ; Neurology. Diseases of the nervous system ; RC346-429 ; Neurosciences. Biological psychiatry. Neuropsychiatry ; RC321-571 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Psychiatry ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	English
Publishing date	2012-01-01T00:00:00Z
Publisher	Hindawi Publishing Corporation
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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