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

Signs and symptoms of acute mania: a factor analysis

<p>Abstract</p> <p>Background</p> <p>The major diagnostic classifications consider mania as a uni-dimensional illness. Factor analytic studies of acute mania are fewer compared to schizophrenia and depression. Evidence from factor analysis suggests more categories or subtypes than what is included in the classification systems. Studies have found that these factors can predict differences in treatment response and prognosis.</p> <p>Methods</p> <p>The sample included 131 patients consecutively admitted to an acute psychiatry unit over a period of one year. It included 76 (58%) males. The mean age was 44.05 years (SD = 15.6). Patients met International Classification of Diseases-10 (ICD-10) clinical diagnostic criteria for a manic episode. Patients with a diagnosis of mixed bipolar affective disorder were excluded. Participants were evaluated using the Young Mania Rating Scale (YMRS). Exploratory factor analysis (principal component analysis) was carried out and factors with an eigenvalue > 1 were retained. The significance level for interpretation of factor loadings was 0.40. The unrotated component matrix identified five factors. Oblique rotation was then carried out to identify three factors which were clinically meaningful.</p> <p>Results</p> <p>Unrotated principal component analysis extracted five factors. These five factors explained 65.36% of the total variance. Oblique rotation extracted 3 factors. Factor 1 corresponding to 'irritable mania' had significant loadings of irritability, increased motor activity/energy and disruptive aggressive behaviour. Factor 2 corresponding to 'elated mania' had significant loadings of elevated mood, language abnormalities/thought disorder, increased sexual interest and poor insight. Factor 3 corresponding to 'psychotic mania' had significant loadings of abnormalities in thought content, appearance, poor sleep and speech abnormalities.</p> <p>Conclusions</p> <p>Our findings identified three clinically meaningful factors corresponding to 'elated mania', 'irritable mania' and 'psychotic mania'. These findings support the multidimensional nature of manic symptoms. Further evidence is needed to support the existence of corresponding clinical subtypes.</p

Efficacy of clozapine in patients with chronic schizophrenia

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

Phagophobia: a case report

BACKGROUND: Phagophobia is a rare disorder and the literature is sparse. There is no specific treatment described for this life threatening condition. CASE PRESENTATION: The patient is a 25-year-old Sri Lankan female with recurrent difficulty in swallowing. Following her initial episode which lasted one year, she presented to us with inability to swallow for one week. She was dependent on liquids and semisolids. The medical team confidently excluded an organic cause. She had difficulty swallowing solids with behaviours like swallowing with the aid of water and swallowing small boluses. She had difficulty eating in front of a crowd as well. She was preoccupied with misconceptions related to food and gastrointestinal disorders like gastritis. The symptom was soon becoming a maladaptive coping mechanism as it occurred when she was under stress and had difficulty solving a problem. The patient was managed with graded exposure and cognitive techniques. CONCLUSION: The possibility of a psychological cause for dysphagia should be borne in mind although the occurrence is rare. Although no definitive treatment methods for phagophobia are described, cognitive behavioural techniques can successfully be used in the treatment

Community psychiatry service in Sri Lanka: a successful model

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