Browsing by Author "Champika, L."

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Association of duration of untreated psychosis and functional level, in first episode of schizophrenia attendingan outpatient clinic in Sri Lanka
(Postgraduate Institute of Medicine, University of Colombo, 2016) Chandradasa, M.; Champika, L.; Gunathillaka, K.; Mendis, J.
Schizophrenia is a progressive disorder that affects thoughts, emotions, perceptions and psychosocial behaviour.The duration of untreated psychosis (DUP) is the time period from development of initial psychotic symptom in the patient to the beginning of adequate treatment. Studies in the west have indicated that longer DUP is associated with poorer prognosis and functional levelin schizophrenia. This study aimed to quantify the DUP retrospectively in a group of patients in their first episode of schizophrenia attending the outpatient psychiatry clinic ofNational Hospital of Sri Lanka. Their functional level was assessed using the modified general assessment of functioning scale (mGAF) prospectively over three months. The mean DUP was 35.5 months and a longer DUP was significantly associated with lower mGAF scores. This DUP is higher compared to western and Indian data, and indicates the need for early recognition and management.
Association of family history of bipolar disorder with risk of violence in inpatient mania: a cohort study
(Sri Lanka College of Psychiatrists, 2016) Chandradasa, M.; Champika, L.; Rajapakse, T. N.
BACGROUND: Evidence suggests that a positive family history of bipolar affective disorder is associated with response to lithium and the course of the illness, in people suffering from this disorder. This may indicate a subgroup of patients with unique characteristics and treatment responses. AIMS: To explore associations between a positive family history of bipolar disorder and the risk of violence, in patients hospitalized for treatment of mania. METHODS: Adults receiving inpatient treatment for a manic relapse of bipolar affective disorder, at two tertiary care hospitals in Kandy, Sri Lanka were studied as a cohort. For each participant with a positive family history of bipolar disorder, an age and gender matched adult, also suffering from a manic relapse of bipolar affective disorder but without a family history, was included as a control. A second researcher, who was blind to the participants’ family history, assessed the risk of violence among all participants, at baseline, and at weekly intervals thereafter until discharge, using the historical clinical risk management Scale 20 (HCR-20).RESULTS: A total of 148 participants were included, with 74 each in the study arm and control arm respectively. Of all participants, 57% were females. Significantly higher rates of unemployment, harmful use of alcohol and absence of confiding relationships were found in participants with a positive family history; they also had a significantly higher mean average HCR-20 scores compared to controls. CONCLUSION: A positive family history of bipolar affective disorder was associated with a higher risk of violence during hospitalization for a manic relapse, as indicated by the mean average HCR-20 scores. A positive family history may be a potential identifier of those at a higher risk of violence in bipolar mania.
Commentary: Measuring depression in a non-western war-affected displaced population: measurement equivalence of the Beck Depression Inventory
(Frontiers Research Foundation, 2018) Chandradasa, M.; Champika, L.
Comment on : Measuring depression in a non-western war-affected displaced population: measurement equivalence of the Beck Depression Inventory.[Front Psychol. 2017; 8:1670]
A comparative study of subjective experiences related to driving among outpatient psychotropic users and controls in Ragama, Sri Lanka
(Sri Lanka College of Psychiatrists, 2016) Chandradasa, M.; Champika, L.; Amarasuriya, M.; Wijelakshman, P.; Bandara, S.; Ranaweera, T.; Fernando, L.
Aim: To identify and explore the impact of illness and medications on the driving of patients visiting an outpatient clinic. Method: A retrospective-cohort design was used. The data was collected using a semi-structured, intervieweradministered questionnaire among consecutive patients with schizophrenia or bipolar disorder. An age, gender and vehicle matched control group was obtained. Result: A total of 2887 consecutive clinic patients were asked about driving and 57 (1.9%) who had driven a vehicle regularly during the last 12 months were included in the study group. A majority were in the 30-45 year category (47%). All were men and a majority were motor-bike riders (53%). Collision-accidents were experienced by 42% of participants during the last 12 months. Conclusion: The patient group had lower hours of driving per week, less subjectively claimed earning per day and more with at least one collision-accident during the past year compared to the control group.
Delayed anxiety and depressive morbidity among dengue patients in a multi-ethnic urban setting: first report from Sri Lanka
(BioMed Central, 2018) Gunathilaka, N.; Chandradasa, M.; Champika, L.; Siriwardana, S.; Wijesooriya, L.I.
BACKGROUND: Although the physical consequences of dengue are well documented, delayed psychological co-morbidities are not well studied to date. Therefore, the objective of the present study was to determine the prevalence of depressive, anxiety and stress symptoms among past dengue patients. METHODS: A community-based, case-control study in a multi-ethnic urban setting was conducted in Sri Lanka involving adults who were diagnosed to have dengue fever by a positive dengue IgM antibody response between 6 and 24 months ago. Self-administered Depression, Anxiety and Stress Scale (DASS-21), Centre for Epidemiological Studies Depression Scale (CESD-20) and a structured clinical interview by a psychiatrist were done in the patients and in an age and gender-matched control group. RESULTS: Fifty-three participants each in the patient (mean age 42.9 years, SD 15.5) and control (mean age 41.6 years, SD 15.3) groups were surveyed. The ages ranged from 18 to 70 years and 64.2% were females. The majority (90.6%; n = 48) of the individuals had been diagnosed with dengue fever followed by dengue haemorrhagic fever (9.4% n = 5). Denguepatients had higher DASS-21 mean depressive scores (means 11.7/9.4, SD 6.4/4.0, t = 2.2, p = .028), anxiety scores (means 10.7/7.2, SD 6.8/1.8, t = 3.6, p = .0005), stress scores (means 12.0/8.8, SD 5.3/3.5, t = 3.6, p = .0004) and CESD-20 scores (means 16.1/11.7, SD 9.4/7.3, t = 2.6, p = .008) than controls. The DSM-5 depressive disorder was clinically detected by the psychiatrist among 15.1 and 7.5% in patient and control groups (OR 2.1; CI .5-7.7; p = .22). Limitations: a limitation is the small sample size. CONCLUSION: Patients with past dengue had significantly higher depressive, anxiety and stress symptoms than the control group according to the DASS-21 and CESD-20 tools. To our knowledge, this is the first report on delayed psychological morbidity related to dengue. This may warrant healthcare professionals to incorporate mental counselling for dengue patients.
Female offenders with Psychiatric disorders
(Sri Lanka College of Psychiatrists, 2015) Chandradasa, M.; Champika, L.; Mendis, S.; Fernando, F.
BACKGROUND: Female offenders are characterised by higher rates of psychiatric morbidity. Studies in developed countries show an increase in the number of female prisoners in recent years. The objectives of this study were first to describe socio-demographic factors and rates of psychiatric morbidity in female offenders, and second, among females with psychiatric illness, to compare those with and without a history of offending. METHODS : A retrospective case control study was carried out among 71 alleged female offenders who had been admitted to the National Institute of Mental Health (NIMH), Sri Lanka over an 18 months period. Females attending an outpatient psychiatry clinic with no prior history of offending were considered as controls. Data were collected from court reports and patient records. RESULTS: Among the alleged offences, 63% were reported as ‘‘behavioural disturbance due to mental illness’’, and 14% as physical assault. The most common diagnoses among female offenders with psychiatric illness were schizophrenia (43%) and bipolar affective disorder (22%). Childhood sexual abuse was reported by 22% of cases compared to 12% of controls (p=0.08). Rates of marriage and employment were significantly lower among the female offenders with psychiatric illness, compared to the controls. CONCLUSION: Patterns of psychiatric illness among female offenders in Sri Lanka may differ from that of the West. Among females with psychiatric illness in Sri Lanka, being single, unemployed and use of alcohol is significantly associated with offending compared to controls. Further research is required to explore these findings.
Fluoxetine-induced severe oral ulceration in a 13-year-old girl
(Mary Ann Liebert, 2017) Chandradasa, M.; Champika, L.
Improving mental health access to multi-religious university students in diverse cultures
(Zagreb, 2018) Chandradasa, M.; Champika, L.
Prolonged Delirium in a tertiary care psychiatry unit in Sri Lanka
(Postgraduate Institute of Medicine University of Colombo, 2016) Chandradasa, M.; Rowel, M.; Champika, L.; Williams, S.
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.
Psychopathology among war-affected children and lessons from Sri Lanka on culturally relevant management
(Science Forecast Publications LLC, 2018) Chandradasa, M.; Champika, L.
Due to armed conflicts, family networks are disrupted with displacement, morbidity, death and ongoing threat to human lives. Children are directly and indirectly affected by conflict-related turmoil physically and mentally. Sri Lanka, an island nation in the Indian Ocean suffered an armed conflict lasting three decades causing more than 60,000 deaths. Elbert et al found that 92% of the minority Tamil children they surveyed in Northern Sri Lanka had experienced traumatizing events such as shelling and bombing and 25% met criteria for PTSD. Children in the South were also impacted by a continuous threat to their own and their parents’ lives due to frequent militant attacks, which included suicide bombers. Sri Lankan experience shows that culturally adapted psychotherapeutic interventions are effective for treating children with psychological trauma related to war and natural disasters. Child mental health professionals from other countries may find the Sri Lankan experience useful for planning their interventions.
Racism toward Mental Health Workers
(Thorofare, N.J. : C.B. Slack, 2017) Chandradasa, M.; Champika, L.
No Abstract Available
Reincarnation Type Presentations of Children with High-Functioning Autism in Sri Lanka
(Elsevier, 2018) Chandradasa, M.; Champika, L.
Autism is characterised by impaired social communication and restricted repetitive behaviours. However, language and intelligence are spared in high-functioning individuals. The symptomatology is complex and culturally diverse. Buddhists and Hindus believe in rebirth and reincarnation type presentations in children are frequently seen among these populations. Here we describe three children from Sri Lanka claiming memories of their past lives and later diagnosed to have high-functioning autism. The first, a seven-year-old Buddhist believes he was killed by terrorists as a soldier in his previous life and attributed his birthmark to be an injury which caused death. The second, a five-year-old Catholic girl suffering from asthma claiming she died of breathing difficulties in her previous life where she was a Buddhist grandmother. The third, an eight-year-old academically superior child claims he was a monk in his previous life and demands parents to allow him to enter the priesthood.
Serious bodily harm related to Obsessions from Sri Lanka
(Zagreb, 2017) Chandradasa, M.; Champika, L.; Hettiarachchi, D.; Wijetunge, S.; Mendis, J.
Subspecialisation in Postgraduate Psychiatry and Implications for a Resource-Limited Specialised Child and Adolescent Mental Health Service
(Springer, 2019) Chandradasa, M.; Champika, L.
Tardive Dyskinesia in an 8-year-old child
(Sri Lanka College of Psychiatrists, 2014) Chandradasa, M.; Champika, L.; Kotalawala, S.; Seneviratne, S.; Siriwardene, G.; Perera, H.
Tardive dyskinesia (TD) is an uncommon presentation in children, which can be disabling and irreversible when it does occur. An 8 year old boy, with a diagnosis of autism spectrum disorder and borderline intelligence, developed features suggestive of TD on withdrawal of long-term haloperidol medication. After recommencing haloperidol at a lower dose his symptoms improved clinically and the Abnormal Involuntary Movement Scale score also decreased. Haloperidol was tailed off gradually and vitamin E was initiated
Topiramate's effectiveness on weight reduction in overweight/obese persons with schizophrenia: study protocol for a randomized controlled trial
(BioMed Central, 2017) Chandradasa, M.; Champika, L.; de Silva, S.; Kuruppuarachchi, K.A.L.A.
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.
Transcultural factors related to depressive psychopathology in Sri Lankan migrants living in Australia
(Sage Publications, 2018) Chandradasa, M.; Champika, L.
Comment on :Becoming a patient-illness representations of depression of Anglo-Australian and Sri Lankan patients through the lens of Leventhal's illness representational model. [Int J Soc Psychiatry. 2017;63(7):569-579]
The use of aripiprazole for tic disorders in children and adolescents and implications for resource limited settings in the developing world
(Elsevier, 2018) Chandradasa, M.; Champika, L.
Comment On: The efficacy and safety of aripiprazole for tic disorders in children and adolescents: a systematic review and meta-analysis. [Psychiatry Res. 2017 ;254:24-32.]
Zoophilia in an adolescent with high-functioning autism from Sri Lanka
(Blackwell Science, 2017) Chandradasa, M.; Champika, L.
OBJECTIVE: Zoophilia is a rare paraphilic disorder with intense sexual urges involving animals. Autism is characterised by impairments in social communication and repetitive, restricted behaviours (RRB). Reported cases of zoophilia are limited worldwide, and zoophilia in autism is rarer. METHOD: This is a case report describing this unique and relatively unrecognised association in a male adolescent from Sri Lanka. RESULTS: A 17-year-old boy diagnosed with autism has average intelligence and academic capabilities. He had spent increasing time at his grandparents' cattle house. First, he was found masturbating near the cows and later having penetrative intercourse with a heifer. The shocked parents first sought traditional healing in the form of 'thovil', a demonic ritual of exorcist nature. Later, clinical evaluation found intense sexual urges towards cattle, which had led to marked distress and academic impairment. Sex hormone profile was normal. The adolescent was treated with a combination of cognitive-behaviour therapy and a selective serotonin reuptake inhibitor. CONCLUSION: We postulate that his persistent social difficulties contributed to the development of a paraphilic disorder. Unlike with his RRBs, he was markedly distressed about this sexual behaviour. Further research is required to explore this rarely reported, potential association.