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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

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
Database	MEDical Literature Analysis and Retrieval System OnLINE

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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: Diagnostic Validity and Factor Analysis of Montgomery-Asberg Depression Rating Scale in Parkinson Disease Population.

Ketharanathan, Tharini / Hanwella, Raveen / Weerasundera, Rajiv / de Silva, Varuni Asanka

Journal of geriatric psychiatry and neurology

2016 Volume 29, Issue 3, Page(s) 115–119

Abstract: Background: The Montgomery-Asberg Depression Rating Scale (MADRS) is commonly used to assess major depression in Parkinson disease (PD), but studies on its utility are few. This study examines the validity and factor structure of MADRS in population ... ...

Abstract	Background: The Montgomery-Asberg Depression Rating Scale (MADRS) is commonly used to assess major depression in Parkinson disease (PD), but studies on its utility are few. This study examines the validity and factor structure of MADRS in population with PD. Methods: In 104 patients with idiopathic PD, major depression was diagnosed by Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision; DSM-IV-TR) criteria, and all patients were rated by MADRS. Results: The MADRS showed good concurrent validity with DSM-IV-TR criteria. The diagnostic cutoff was established as 16/17 (sensitivity 97.43, specificity 100%, positive predictive value 100%, and negative predictive value 98.48%). Factor analysis identified 3 factors, accounting for 76% of total variance: "sadness-anhedonia" comprising apparent sadness, reported sadness, concentration difficulties, lassitude, inability to feel, pessimistic thoughts, and suicidal ideas; "anxiety" with reduced sleep and inner tension; and "vegetative symptoms" with reduced appetite. Conclusion: The MADRS has diagnostic utility in major depression in PD. The 3-factor structure of MADRS may help to understand the different dimensions of major depression and identify distinct symptom subgroups in this population.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Anhedonia ; Anxiety/complications ; Anxiety/diagnosis ; Anxiety Disorders ; Depression/classification ; Depression/complications ; Depression/diagnosis ; Depressive Disorder, Major/classification ; Depressive Disorder, Major/complications ; Depressive Disorder, Major/diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Factor Analysis, Statistical ; Female ; Humans ; Male ; Middle Aged ; Parkinson Disease/complications ; Psychiatric Status Rating Scales/standards ; Reproducibility of Results ; Sensitivity and Specificity
Language	English
Publishing date	2016-05
Publishing country	United States
Document type	Journal Article ; Validation Studies
ZDB-ID	1035760-9
ISSN	0891-9887
ISSN	0891-9887
DOI	10.1177/0891988715606232
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Article ; Online: Efficacy and tolerability of venlafaxine versus specific serotonin reuptake inhibitors in treatment of major depressive disorder: a meta-analysis of published studies.

de Silva, Varuni Asanka / Hanwella, Raveen

International clinical psychopharmacology

2012 Volume 27, Issue 1, Page(s) 8–16

Abstract: Specific serotonin reuptake inhibitors (SSRIs) are considered as first-line treatment in major depressive disorder (MDD). There is evidence that venlafaxine may be more effective than several antidepressants in the treatment of MDD. This meta-analysis ... ...

Abstract	Specific serotonin reuptake inhibitors (SSRIs) are considered as first-line treatment in major depressive disorder (MDD). There is evidence that venlafaxine may be more effective than several antidepressants in the treatment of MDD. This meta-analysis includes all published, randomized, double-blind, head-to-head trials, which compared venlafaxine and an SSRI in the treatment of MDD in adults. Twenty-six trials comparing venlafaxine with an SSRI were included (total participants: 5858). Meta-analysis using a random effect model showed that venlafaxine was superior to SSRIs in achieving remission [odds ratio (OR)=1.13, 95% confidence interval (CI)=1.0-1.28, P=0.05] and response (OR=1.17, 95% CI=1.03-1.34, P=0.02). Subgroup analysis found that venlafaxine had a significantly better response rate than fluoxetine (OR=1.28, 95% CI=1.05-1.55, P=0.01). There were no significant differences in response or remission between venlafaxine and other individual SSRIs. There was no significant difference in all cause discontinuation between venlafaxine and SSRIs (OR=1.10, 95% CI=0.97-1.25, P=0.15). Venlafaxine had significantly higher discontinuation due to adverse events compared with SSRIs (OR=1.41, 95% CI=1.10-1.79, P=0.006). The superior efficacy of venlafaxine over SSRIs is of clinical importance. However, higher rates of discontinuation due to adverse events for venlafaxine compared with SSRIs are a disadvantage. Findings of this meta-analysis that included only published studies were similar to those from meta-analysis that included unpublished data.
MeSH term(s)	Adult ; Antidepressive Agents, Second-Generation/adverse effects ; Antidepressive Agents, Second-Generation/therapeutic use ; Chi-Square Distribution ; Cyclohexanols/adverse effects ; Cyclohexanols/therapeutic use ; Depressive Disorder, Major/diagnosis ; Depressive Disorder, Major/drug therapy ; Depressive Disorder, Major/psychology ; Evidence-Based Medicine ; Female ; Humans ; Male ; Odds Ratio ; Predictive Value of Tests ; Psychiatric Status Rating Scales ; Randomized Controlled Trials as Topic ; Remission Induction ; Serotonin Uptake Inhibitors/adverse effects ; Serotonin Uptake Inhibitors/therapeutic use ; Treatment Outcome ; Venlafaxine Hydrochloride
Chemical Substances	Antidepressive Agents, Second-Generation ; Cyclohexanols ; Serotonin Uptake Inhibitors ; Venlafaxine Hydrochloride (7D7RX5A8MO)
Language	English
Publishing date	2012-01
Publishing country	England
Document type	Journal Article ; Meta-Analysis
ZDB-ID	632837-4
ISSN	1473-5857 ; 0268-1315
ISSN (online)	1473-5857
ISSN	0268-1315
DOI	10.1097/YIC.0b013e32834ce13f
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Article ; Online: Smoking among troops deployed in combat areas and its association with combat exposure among navy personnel in Sri Lanka.

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

Substance abuse treatment, prevention, and policy

2012 Volume 7, Page(s) 27

Abstract: Background: Among military personnel alcohol consumption and binge-drinking have increased but cigarette smoking has declined in the recent past. Although there is a strong association between smoking and PTSD the association between combat exposure and ...

Abstract	Background: Among military personnel alcohol consumption and binge-drinking have increased but cigarette smoking has declined in the recent past. Although there is a strong association between smoking and PTSD the association between combat exposure and smoking is not clear. Methods: This cross sectional study was carried out among representative samples of SLN Special Forces and regular forces deployed in combat areas. Both Special Forces and regular forces were selected using simple random sampling. Only personnel who had served continuously in combat areas during the one year period prior to end of combat operations were included in the study. Females were not included in the sample. The study assessed several mental health outcomes as well as alcohol use, smoking and cannabis use. Sample was classified according to smoking habits as never smokers, past smokers (those who had smoked in the past but not within the past year) and current smokers (those smoking at least one cigarette within the past 12 months). Results: Sample consisted of 259 Special Forces and 412 regular navy personnel. Prevalence of current smoking was 17.9% (95% CI 14.9-20.8). Of the sample 58.4% had never smoked and 23.7% were past smokers. Prevalence of current smoking was significantly higher among Special Forces personnel compared to regular forces. (OR 1.90 (95% CI 1.20-3.02). Personnel aged ≥ 35 years had the lowest prevalence of smoking (14.0%). Commissioned officers had a lower prevalence (12.1%) than non commissioned officers or other ranks. After adjustment for demographic variables and service type there was significant association between smoking and combat experiences of seeing dead or wounded [OR 1.79 (95%CI 1.08-2.9)], handling dead bodies [OR 2.47(95%CI 1.6-3.81)], coming under small arms fire [OR 2.01(95%CI 1.28-3.15)] and coming under mortar, missile and artillery fire [OR 2.02(95%CI 1.29-3.17)]. There was significant association between the number of risk events and current smoking [OR 1.22 (95%CI1.11-1.35)]. Conclusions: There was significant association between current smoking and combat experiences. Current smoking was strongly associated with current alcohol use. Prevalence of current smoking was less among military personnel than in the general population. Prevalence of smoking was significantly higher among Special Forces personnel.
MeSH term(s)	Adolescent ; Adult ; Alcohol Drinking/epidemiology ; Cross-Sectional Studies ; Health Surveys/methods ; Health Surveys/statistics & numerical data ; Humans ; Male ; Marijuana Abuse/epidemiology ; Military Personnel/psychology ; Military Personnel/statistics & numerical data ; Smoking/epidemiology ; Sri Lanka/epidemiology ; Warfare
Language	English
Publishing date	2012-07-09
Publishing country	England
Document type	Journal Article
ISSN	1747-597X
ISSN (online)	1747-597X
DOI	10.1186/1747-597X-7-27
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Article ; Online: Metformin in prevention and treatment of antipsychotic induced weight gain: a systematic review and meta-analysis.

de Silva, Varuni Asanka / Suraweera, Chathurie / Ratnatunga, Suhashini S / Dayabandara, Madhubashinee / Wanniarachchi, Nimali / Hanwella, Raveen

BMC psychiatry

2016 Volume 16, Issue 1, Page(s) 341

Abstract: Background: Most antipsychotics are associated with weight gain and other metabolic complications. Several randomized trials have shown metformin to be effective, but this still hasn't been included in clinical guidelines on managing antipsychotic ... ...

Abstract	Background: Most antipsychotics are associated with weight gain and other metabolic complications. Several randomized trials have shown metformin to be effective, but this still hasn't been included in clinical guidelines on managing antipsychotic induced weight gain. Methods: All double blind placebo controlled trials assessing the efficacy of metformin in the treatment of antipsychotic induced weight gain were included. Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE were searched for the period January 2000-December 2015. Meta-analysis was carried out using the random effects model. Results: Meta analysis of 12 published studies with a total of 743 patients found that in patients treated with antipsychotics, metformin treatment resulted in significantly better anthropometric and metabolic parameters than placebo. The mean change in weight was -3.27 kg (95 % CI -4.66 to -1.89) (Z = 4.64, p < 0.001). Metformin compared to placebo resulted in significant reduction in BMI [-1.13 kg/m Conclusion: This meta-analysis confirms that metformin is effective in treating antipsychotic induced weight gain in patients with schizophrenia or schizoaffective disorder.
MeSH term(s)	Antipsychotic Agents/adverse effects ; Antipsychotic Agents/therapeutic use ; Double-Blind Method ; Humans ; Metformin/therapeutic use ; Psychotic Disorders/drug therapy ; Schizophrenia/drug therapy ; Weight Gain/drug effects
Chemical Substances	Antipsychotic Agents ; Metformin (9100L32L2N)
Language	English
Publishing date	2016-10-03
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ISSN	1471-244X
ISSN (online)	1471-244X
DOI	10.1186/s12888-016-1049-5
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Article ; Online: Alcohol use in a military population deployed in combat areas: a cross sectional study.

Hanwella, Raveen / de Silva, Varuni Asanka / Jayasekera, Nicholas E L W

Substance abuse treatment, prevention, and policy

2012 Volume 7, Page(s) 24

Abstract: Background: Alcohol misuse is more prevalent among military populations. Association between PTSD and heavy drinking have been reported in many studies. Most of the studies on alcohol use among military personnel are from US and UK. Aim of this study is ...

Abstract	Background: Alcohol misuse is more prevalent among military populations. Association between PTSD and heavy drinking have been reported in many studies. Most of the studies on alcohol use among military personnel are from US and UK. Aim of this study is to describe alcohol consumption patterns among military personnel in Sri Lanka, a country where the alcohol consumption among the general population are very different to that in US and UK. Methods: Cross sectional study consisting of representative samples of Sri Lanka Navy Special Forces and regular forces deployed in combat areas continuously during a one year period was carried out. Data was collected using a self report questionnaire. Alcohol Use Disorder Identification Test (AUDIT) was used to assess alcohol consumption. Results: Sample consisted of 259 Special Forces and 412 regular navy personnel. The median AUDIT score was 2.0 (interquartile range 6.0). Prevalence of current drinking was 71.2 %. Of the current users 54.81 % were infrequent users (frequency ≤ once a month) while 37.87 % of users consumed 2-4 times a month. Prevalence of hazardous drinking (AUDIT ≥ 8) was 16.69 % and binge drinking 14.01 %. Five (0.75 %) had AUDIT total ≥20. There was no significant difference between Special Forces and regular forces in hazardous drinking or binge drinking. Total AUDIT score ≥16 were associated with difficulty performing work. Conclusions: High rates of hazardous drinking and binge drinking described among military personnel in US and UK were not seen among SLN personnel deployed in combat areas. This finding contrasts with previously reported association between combat exposure and hazardous alcohol use among military personnel. Alcohol use among military personnel may be significantly influenced by alcohol consumption patterns among the general population, access to alcohol and attitudes about alcohol use. Similar to findings from other countries, heavy alcohol use was associated with poorer psychological health and functional impairment.
MeSH term(s)	Adult ; Alcohol Drinking/epidemiology ; Binge Drinking/epidemiology ; Combat Disorders/epidemiology ; Combat Disorders/psychology ; Cross-Sectional Studies ; Humans ; Male ; Military Personnel/psychology ; Military Personnel/statistics & numerical data ; Prevalence ; Self Report ; Sri Lanka/epidemiology ; Warfare
Language	English
Publishing date	2012-06-13
Publishing country	England
Document type	Journal Article
ISSN	1747-597X
ISSN (online)	1747-597X
DOI	10.1186/1747-597X-7-24
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Lower estimated glomerular filtration rates in patients on long term lithium: a comparative study and a meta-analysis of literature.

Rodrigo, Chaturaka / de Silva, Nipun Lakshitha / Gunaratne, Ravindi / Rajapakse, Senaka / De Silva, Varuni Asanka / Hanwella, Raveen

BMC psychiatry

2014 Volume 14, Page(s) 4

Abstract: Background: Several studies have shown that long-term lithium use is associated with a subtle decline in estimated glomerular filtration rate. This study compared mean estimated glomerular filtration rates (eGFR) in patients on long term lithium, ... ...

Abstract	Background: Several studies have shown that long-term lithium use is associated with a subtle decline in estimated glomerular filtration rate. This study compared mean estimated glomerular filtration rates (eGFR) in patients on long term lithium, against matched controls. Methods: Patients with bipolar affective disorder, who are on lithium (for at least a year), were compared against controls that were matched (1:1) for age, gender and presence or absence of diabetes or hypertension. The eGFR was calculated from creatinine values according to the 'modification of diet in renal disease study' (MDRD) formula and was compared between cases and controls. A meta-analysis was performed to compare our findings with similar studies in literature. Results: Forty seven patients met the inclusion criteria. They were matched with 47 controls. The eGFR values of lithium users were significantly lower (p = 0.04) compared to controls. This difference persisted between the subgroup of lithium users without comorbidities (diabetes and hypertension) and their controls but disappeared for lithium users with comorbidities and their controls. Nonetheless, lithium users had lower eGFR values in both subgroups. A meta-analysis of 9 studies showed a significant lowering in the glomerular filtration rate in lithium users compared to controls [mean difference -10.3 ml/min (95% confidence interval: -15.13 to -5.55, p < 0.0001)]. Conclusions: Lithium causes a subtle decline in glomerular filtration rate; renal function needs to be monitored in patients on lithium treatment.
MeSH term(s)	Adult ; Antidepressive Agents/administration & dosage ; Antidepressive Agents/adverse effects ; Bipolar Disorder/drug therapy ; Bipolar Disorder/epidemiology ; Bipolar Disorder/urine ; Comorbidity ; Creatinine/urine ; Diabetes Mellitus/epidemiology ; Female ; Glomerular Filtration Rate/drug effects ; Humans ; Hypertension/epidemiology ; Kidney/drug effects ; Kidney/physiopathology ; Lithium Compounds/administration & dosage ; Lithium Compounds/adverse effects ; Male ; Middle Aged ; Time Factors
Chemical Substances	Antidepressive Agents ; Lithium Compounds ; Creatinine (AYI8EX34EU)
Language	English
Publishing date	2014-01-08
Publishing country	England
Document type	Comparative Study ; Journal Article ; Meta-Analysis
ZDB-ID	2050438-X
ISSN	1471-244X ; 1471-244X
ISSN (online)	1471-244X
ISSN	1471-244X
DOI	10.1186/1471-244X-14-4
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