1Arch. Gen. Psychiatry 2000 Aug 57: 794-801
PMID10920469
TitleA double-blind, placebo-controlled study of risperidone addition in serotonin reuptake inhibitor-refractory obsessive-compulsive disorder.
AbstractTo date, only 1 controlled study has found a drug (haloperidol) to be efficacious in augmenting response in patients with obsessive-compulsive disorder (OCD) refractory to serotonin reuptake inhibitor (SRI) monotherapy; patients with comorbid chronic tic disorders showed a preferential response. This report describes the first controlled study of risperidone addition in patients with OCD refractory to treatment with SRI alone.
Seventy adult patients with a primary DSM-IV diagnosis of OCD received 12 weeks of treatment with an SRI. Thirty-six patients were refractory to the SRI and were randomized in a double-blind manner to 6 weeks of risperidone (n = 20) or placebo (n = 16) addition. Behavioral ratings, including the Yale-Brown Obsessive Compulsive Scale, were obtained at baseline and throughout the trial. Placebo-treated patients subsequently received an identical open-label trial of risperidone addition.
For study completers, 9 (50%) of 18 risperidone-treated patients were responders (mean daily dose, 2.2 +/-0.7 mg/d) compared with 0 of 15 in the placebo addition group (P<. 005). Seven (50%) of 14 patients who received open-label risperidone addition responded. Risperidone addition was superior to placebo in reducing OCD (P<.001), depressive (P<.001), and anxiety (P =.003) symptoms. There was no difference in response between OCD patients with and without comorbid diagnoses of chronic tic disorder or schizotypal personalty disorder. Other than mild, transient sedation, risperidone was well tolerated.
These results suggest that OCD patients with and without comorbid chronic tic disorders or schizotypal personality disorder may respond to the addition of low-dose risperidone to ongoing SRI therapy.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
2Ceylon Med J 2003 Jun 48: 45-7
PMID12971206
TitleViolence in a general hospital psychiatry unit for men.
AbstractGeneral hospitals are increasingly providing psychiatric services in SRI Lanka. They face special challenges and patient violence is one of them.
To find out the extent of violence and factors that are associated with such violence in general hospital psychiatry units.
General Hospital, Peradeniya, male psychiatry ward.
All violent incidents were prospectively recorded in the male psychiatry unit for one year. The daily patient total, diagnoses and patient activity levels were also tabulated.
118 incidents of serious violence were recorded over one year. 42% of this violence was directed at the nurses. Alcohol withdrawal was the commonest cause of violence (45.7%), and schizophrenia and mania accounted for 43.0%. The other most important factor associated with violence was overcrowding of the wards.
Patient violence is a common problem in general hospital psychiatry wards. Alcohol withdrawal is an important cause of patient violence in this setting. Steps to reduce overcrowding and treatment of alcohol dependence in special alcohol units are likely to reduce such violence.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
3J Clin Psychol 2003 Sep 59: 1031-44
PMID12945066
TitleThe Schizophrenia Proneness (SzP) scale: an MMPI-2 measure of schizophrenia liability.
AbstractWe examined the psychometric properties and construct validity for a Minnesota Multiphasic Personality Inventory-2 schizophrenia Proneness (SzP) scale (Bolinskey et al., 2001) and provided normative statistics. Premorbid participants were offspring of parents with schizophrenia-related illness (SRI), with comparison groups of offspring of parents with major affective disorders and offspring of normals. Postmorbid participants were twins affected with SRI; their unaffected relatives served as a comparison group. Results suggest that an SzP T score of 65 or above is an effective indicator of personality processes associated with increased liability to developing SRI.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
4Prog. Neuropsychopharmacol. Biol. Psychiatry 2003 May 27: 333-46
PMID12691768
TitleObsessive-compulsive symptoms induced by atypical antipsychotics. A review of the reported cases.
AbstractAtypical antipsychotics (APs) are now widely in use in clinical practice. They exert a beneficial effect in patients with schizophrenic disorders, including cases resistant to traditional APs and negative symptoms. They have also enhanced the ratio of therapeutic efficacy to adverse effects. Atypical APs, mainly risperidone and olanzapine, have been used as adjunctive treatment in (selective) serotonin reuptake inhibitor [(S)SRI]-refractory cases with obsessive symptoms. However, de novo emergence or exacerbation of obsessive-compulsive (OC) symptoms during treatment with clozapine, risperidone, olanzapine and quetiapine has been described in the literature. The reported cases and the possible pathogenetic mechanisms involved in their occurrence are discussed and reviewed.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
5Pharmacopsychiatry 2004 Mar 37: 52-6
PMID15048611
TitleClozapine in the treatment of obsessive-compulsive symptoms in schizophrenia patients: a case series study.
AbstractObsessive-compulsive (OC) symptoms have been observed in a substantial proportion of schizophrenic patients. There are some reports describing the appearance de novo or reemergence of preexisting OC symptoms under clozapine (CLZ) therapy. However, there are also reports describing a positive effect of CLZ therapy in OC schizophrenic patients. It seems that comorbid OC symptoms are common among CLZ-treated refractory schizophrenic patients and are likely to be an integral part of their illness. The complex nature of the treatment response in this group of schizophrenic patients is as yet unclear. The effects of CLZ on OC symptoms may vary, with evidence of improvement in some and worsening among others.
The present case series study describes our experience with CLZ as a sole agent (n = 10) or in combination with serotonin reuptake inhibitors (n = 5), in schizophrenic patients with prominent OC symptomatology.
Systematic analysis of clinical features of our patients, as well as findings in the literature to date, led us to suggest some factors that may predict response to CLZ treatment in treatment-resistant schizophrenic patients with prominent OC symptoms: 1) schizophrenic patients who began to exhibit OC symptoms within the course of the psychotic process need and might to be successfully treated with CLZ alone; 2) when OC symptomatology preceded the development of schizophrenic process, CLZ monotherapy is inefficient and may even worsen OC symptoms; therefore, it should be treated concomitantly with specific anti-obsessive agents; 3) in both groups there is a definite dose-related pro-obsessive influence of CLZ when it is given in high doses.
Further controlled investigations in a larger cohort of OC schizophrenic patients are needed to substantiate our hypothesis. OCD:Obsessive-compulsive disorder OCS:Obsessive-compulsive symptoms SRI:Serotonin reuptake inhibitors
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
6Pharmacopsychiatry 2004 Mar 37: 52-6
PMID15048611
TitleClozapine in the treatment of obsessive-compulsive symptoms in schizophrenia patients: a case series study.
AbstractObsessive-compulsive (OC) symptoms have been observed in a substantial proportion of schizophrenic patients. There are some reports describing the appearance de novo or reemergence of preexisting OC symptoms under clozapine (CLZ) therapy. However, there are also reports describing a positive effect of CLZ therapy in OC schizophrenic patients. It seems that comorbid OC symptoms are common among CLZ-treated refractory schizophrenic patients and are likely to be an integral part of their illness. The complex nature of the treatment response in this group of schizophrenic patients is as yet unclear. The effects of CLZ on OC symptoms may vary, with evidence of improvement in some and worsening among others.
The present case series study describes our experience with CLZ as a sole agent (n = 10) or in combination with serotonin reuptake inhibitors (n = 5), in schizophrenic patients with prominent OC symptomatology.
Systematic analysis of clinical features of our patients, as well as findings in the literature to date, led us to suggest some factors that may predict response to CLZ treatment in treatment-resistant schizophrenic patients with prominent OC symptoms: 1) schizophrenic patients who began to exhibit OC symptoms within the course of the psychotic process need and might to be successfully treated with CLZ alone; 2) when OC symptomatology preceded the development of schizophrenic process, CLZ monotherapy is inefficient and may even worsen OC symptoms; therefore, it should be treated concomitantly with specific anti-obsessive agents; 3) in both groups there is a definite dose-related pro-obsessive influence of CLZ when it is given in high doses.
Further controlled investigations in a larger cohort of OC schizophrenic patients are needed to substantiate our hypothesis. OCD:Obsessive-compulsive disorder OCS:Obsessive-compulsive symptoms SRI:Serotonin reuptake inhibitors
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
7Aust N Z J Psychiatry 2005 May 39: 336-43
PMID15860020
TitleAntipsychotic treatment in obsessive-compulsive disorder: a literature review.
AbstractTo review the role of antipsychotic medications in the treatment of obsessive-compulsive disorder (OCD); to explore current hypothesized conceptualizations of their mechanism of action; to highlight evolving interest in the validation of meaningful OCD subtypes within a heterogeneous spectrum of OCD, based on treatment response and other psychobiological variables.
A computerized literature search (MEDLINE: 1966 to December 2003, EMBASE: 1982 to December 2003) was used to locate relevant literature, using the terms obsessive-compulsive, antipsychotic and subtypes, with no restrictions imposed on searches.
Earlier studies of augmentation of serotonergic antidepressants (SRIs) with typical antipsychotics including haloperidol and pimozide in OCD demonstrated favourable responses, also highlighting patient subgroups with robust treatment response. Studies examining augmentation with atypical agents are emerging. SRI-resistant OCD patients are likely to benefit from augmentation with atypical antipsychotics in around 50% of cases.
While there is little role for antipsychotic monotherapy in OCD, there is growing evidence in support of adjunctive antipsychotics in OCD refractory to serotonin-reuptake inhibitors (SRIs). Further controlled trials are warranted. Particular subgroups of OCD patients, notably those with comorbid tic disorder and those with schizotypal personality disorder, have been shown to respond more robustly to augmentation strategies in some trials of both typical and atypical antipsychotics. Dopaminergic mediation with or without a moderating effect on serotonergic systems is likely to be important in the pharmacodynamic mechanisms of action of antipsychotic-SRI combinations in OCD.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
8J Psychiatr Res 2006 Sep 40: 502-10
PMID16904424
TitleObsessive-compulsive disorder: a 3-year prospective follow-up study of patients treated with serotonin reuptake inhibitors OCD follow-up study.
AbstractThis study aimed to evaluate the long-term course of obsessive-compulsive disorder (OCD) in patients treated with serotonin reuptake inhibitors (SRIs) and to identify predictors of clinical outcome. Seventy-nine patients fulfilling DSM-IV criteria for OCD were followed prospectively for 3 years. Baseline information was collected on demographic and clinical characteristics, using standardized instruments. During the follow-up period, the clinical status of each patient was evaluated monthly in the first year and bimonthly thereafter by means of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Hamilton Rating Scale for Depression (HDRS). The cumulative probability of achieving at least partial remission from obsessive-compulsive (OC) symptoms during the 3-year period was 65%. The probability of full remission was 38%. For subjects who achieved at least partial remission, the probability of subsequent relapse was 60%. Significant predictors of poor outcome included a longer duration of illness, a greater severity of OC symptoms at intake, and the presence of comorbid schizotypal personality disorder. The findings confirm that the course of illness in OCD is usually continuous with fluctuations in the intensity of OC symptoms. Despite adequate SRI therapy, relatively few patients achieve a completely asymptomatic state, and of those who achieve at least a partial remission, a substantial proportion subsequently relapse. One third of OCD patients is treatment-resistant. Further studies with large samples are required to adequately identify predictors of long-term outcome of OCD in order to optimize the choice among the existing treatment modalities. The development of alternative strategies is needed to improve the treatment approaches for treatment-resistant OCD patients.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
9Bull. World Health Organ. 2008 Jul 86: 542-51
PMID18670667
TitleSchizophrenia treatment in the developing world: an interregional and multinational cost-effectiveness analysis.
Abstractschizophrenia is a highly disabling disease and is costly to treat. We set out to establish what are the most cost-effective interventions applicable to developing regions and countries.
Analysis was undertaken at the level of three WHO subregions spanning the Americas, Africa and South-East Asia, and subsequently in three member states (Chile, Nigeria and SRI Lanka). A state transition model was used to estimate the population-level health impact of older and newer antipsychotic drugs, alone or in combination with psychosocial intervention. Total population-level costs (in international dollars or local currencies) and effectiveness (measured in disability-adjusted life years averted) were combined to form cost-effectiveness ratios.
The most cost-effective interventions were those using older antipsychotic drugs combined with psychosocial treatment, delivered via a community-based service model (I$ 2350-7158 per disability-adjusted life year averted across the three subregions, I$ 1670-3400 following country-level contextualisation within each of these subregions). The relative cost-effectiveness of interventions making use of newer, "atypical" antipsychotic drugs is estimated to be much less favourable.
By moving to a community-based service model and selecting efficient treatment options, the cost of substantially increasing treatment coverage is not high (less than I$ 1 investment per capita). Taken together with other priority-setting criteria such as disease severity, vulnerability and human rights protection, this study suggests that a great deal more could be done for persons and families living under the spectre of this disorder.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
10Bioorg. Med. Chem. Lett. 2009 Oct 19: 5552-5
PMID19720528
TitleTetrahydrocarbazole-based serotonin reuptake inhibitor/dopamine D2 partial agonists for the potential treatment of schizophrenia.
AbstractA 5-fluoro-tetrahydrocarbazole serotonin reuptake inhibitor (SRI) building block was combined with a variety of linkers and dopamine D2 receptor ligands in an attempt to identify potent D2 partial agonist/SRI molecules for treatment of schizophrenia. This approach has the potential to treat a broader range of symptoms compared to existing therapies. Selected compounds in this series demonstrate high affinity for both targets and D2 partial agonism in cell-based and in vivo assays.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
11Subst Abuse Treat Prev Policy 2010 -1 5: 16
PMID20615208
TitleA retrospective analysis of cannabis use in a cohort of mentally ill patients in Sri Lanka and its implications on policy development.
AbstractSeveral epidemiological studies have shown that cannabis; the most widely used illegal drug in the world, is associated with schizophrenia spectrum disorders (SSD).
To assess the characteristics of cannabis use and its association with SSD in a cohort of psychiatrically ill patients and discuss the implications for policy development
This is a retrospective analytical study of a cohort of psychiatric patients who received treatment in the psychiatry unit of the Provincial General Hospital, Ratnapura, SRI Lanka over five years (2000 - 2004). The schizophrenia spectrum disorders defined in this article include schizophrenia and the schizoaffective disorders.
A total of 3644 patient records were analyzed. The percentage of self reported life time cannabis (LTC) use was 2.83% (103, all males). Sixteen percent (576) of the total cohort was diagnosed with SSD by 2009. Male sex and LTC use were significantly associated with SSD (p < 0.01 and 0.001 respectively). In the majority (91.5%), cannabis use preceded the diagnosis. There were 17(16.5%) patients diagnosed as cannabis induced psychosis and 7 (41.2%) of them were subsequently diagnosed as SSD. This group was significantly more likely to have had a past psychiatric consultation, but other demographic and clinical correlates did not differ from the rest of the LTC users.
Self reported LTC use was strongly associated with being diagnosed with SSD. However we could not identify a particular subgroup of users that are at increased risk to recommend targeted primary prophylaxis. The policy implications of this observation are discussed.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
12Bioorg. Med. Chem. Lett. 2010 May 20: 2983-6
PMID20347298
TitlePotent dihydroquinolinone dopamine D2 partial agonist/serotonin reuptake inhibitors for the treatment of schizophrenia.
AbstractA dihydroquinolinone moiety was found to be a potent serotonin reuptake inhibitor pharmacophore when combined with certain amines. This fragment was coupled with selected D(2) ligands to prepare a series of dual acting compounds with attractive in vitro profiles as dopamine D(2) partial agonists and serotonin reuptake inhibitors. Structure-activity studies revealed that the linker plays a key role in contributing to D(2) affinity, function, and SRI activity.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
13Soc Psychiatry Psychiatr Epidemiol 2010 Jul 45: 733-9
PMID19688283
TitleSri Lankan doctors' and medical undergraduates' attitudes towards mental illness.
AbstractStigmatizing attitudes towards mental illness can impede help-seeking and adversely affect treatment outcomes, especially if such attitudes are endorsed by medical personnel. In order to help identify targets for anti-stigma interventions, we comprehensively examined negative attitudes towards mental illness displayed by SRI Lankan doctors and medical students and compared these with equivalent UK and other international data.
A self-report questionnaire originally developed in the UK was completed by medical students (n = 574) and doctors (n = 74) from a teaching hospital in Colombo. The questions assessed the presence and intensity of stigmatizing attitudes towards patients with schizophrenia, depression, panic disorder, dementia and drug and alcohol addiction.
The study revealed higher levels of stigma towards patients with depression, alcohol and drug addiction in this SRI Lankan sample compared to UK data but attitudes towards schizophrenia were less stigmatized in SRI Lanka. Blaming attitudes were consistently high across diagnoses in the SRI Lankan sample. SRI Lankan medical students displayed more negative attitudes than doctors (P < 0.001). Overall stigma was greatest towards patients with drug addiction, followed by, alcohol addiction, schizophrenia, depression, panic disorder and dementia.
SRI Lankan doctors and undergraduates endorse stigmatizing attitudes towards mental illnesses and are especially prone to see patients as blameworthy. As such attitudes are likely to affect the engagement of patients in treatment and specific interventions that modify negative attitudes towards people with mental illnesses are needed. Ensuring that medical students have contact with recovered patients in community psychiatry settings may be one way of decreasing stigmatizing attitudes.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
14Biochem. Pharmacol. 2011 Oct 82: 842-51
PMID21689641
TitleEndogenous activation of nAChRs and NMDA receptors contributes to the excitability of CA1 stratum radiatum interneurons in rat hippocampal slices: effects of kynurenic acid.
AbstractCA1 stratum radiatum interneurons (SRIs) express ?7 nicotinic receptors (nAChRs) and receive inputs from glutamatergic neurons/axons that express ?3?4?2 nAChRs. To test the hypothesis that endogenously active ?7 and/or ?3?4?2 nAChRs control the excitability of CA1 SRIs in the rat hippocampus, we examined the effects of selective receptor antagonists on spontaneous fast current transients (CTs) recorded from these interneurons under cell-attached configuration. The frequency of CTs, which represent action potentials, increased in the absence of extracellular Mg(2+) and decreased in the presence of the ?3?4?2 nAChR antagonist mecamylamine (3 ?M) or the NMDA receptor antagonist APV (50 ?M). However, it was unaffected by the ?7 nAChR antagonist MLA (10 nM) or the AMPA receptor antagonist CNQX (10 ?M). Thus, in addition to synaptically and tonically activated NMDA receptors, ?3?4?2 nAChRs that are present on glutamatergic axons/neurons synapsing onto SRIs and are activated by basal levels of acetylcholine contribute to the maintenance of the excitability of these interneurons. Kynurenic acid (KYNA), an astrocyte-derived kynurenine metabolite whose levels are increased in the brains of patients with schizophrenia, also controls the excitability of SRIs. At high micromolar concentrations, KYNA, acting primarily as an NMDA receptor antagonist, decreased the CT frequency recorded from the interneurons. At 2 ?M, KYNA reduced the CA1 SRI excitability via mechanisms independent of NMDA receptor block. KYNA-induced reduction of excitability of SRIs may contribute to sensory gating deficits that have been attributed to deficient hippocampal GABAergic transmission and high levels of KYNA in the brain of patients with schizophrenia.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
15J Med Case Rep 2011 -1 5: 189
PMID21592373
TitleAn unusual case of hypothermia associated with therapeutic doses of olanzapine: a case report.
AbstractWe report a case of a 42-year-old man who had symptomatic hypothermia as a result of taking olanzapine for paranoid schizophrenia. According to published data, only a few cases of hypothermia associated with olanzapine have been reported since its introduction into clinical use.
A 42-year-old SRI Lankan man with schizophrenia who was being treated with a therapeutic dose of olanzapine presented with reduced level of consciousness. He had a core temperature of 32C and was bradycardic. At the time of admission, the electrocardiogram showed sinus bradycardia with J waves. He did not have any risk factors for developing hypothermia except the use of olanzapine. There was improvement in his clinical condition with reversal of electrocardiogram changes following gradual rewarming and the omission of olanzapine.
Hypothermia induced by antipsychotic medications is not uncommon, but olanzapine-induced hypothermia is rare and occurrence has been reported during initiation or increasing the dose. But here the patient developed hypothermia without dose adjustment.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
16Ceylon Med J 2012 Mar 57: 14-8
PMID22453706
TitleDirect and indirect cost of schizophrenia in outpatients treated in a tertiary care psychiatry unit.
AbstractTo estimate the direct and indirect cost of care incurred by patients with schizophrenia attending a tertiary care psychiatry unit in Colombo.
Study was carried out at the National Hospital of SRI Lanka. Systematic sampling selected every second patient with an ICD-10 clinical diagnosis of schizophrenia presenting to the clinic during a two month period. Investigator administered semi-structured questionnaire was used for data collection.
Sample consisted of 91 patients. Direct cost was defined as cost incurred by the patient (out of pocket expenditure) for outpatient care. Mean cost of a clinic visit was Rs. 500. Of the clinic visit cost, highest proportions were travel cost (39.8%) and medication (26.4%). Sixty four (70.3%) had received informal care. The mean cost of informal care during the entire course of the illness was Rs. 33, 540. Mean indirect cost was Rs. 150,190.
Despite low direct cost of care, indirect cost and cost of informal treatment results in substantial economic impact on patients and their families. It is recommended that economic support should be provided for patients with disabling illnesses such as schizophrenia, especially when patients are unable to engage in full time employment. There is a need to educate the public regarding higher cost of care by traditional healers and other informal modes of treatment compared to Western medical care.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
17Asian J Psychiatr 2012 Sep 5: 246-50
PMID22981053
TitleMental health literacy survey among Sri Lankan carers of patients with schizophrenia and depression.
AbstractMental health literacy has been defined as knowledge and beliefs about mental disorders which aid their recognition, management or prevention.
Preliminary investigation on mental health literacy among SRI Lankan carers of patients with schizophrenia and Depression.
Cross sectional descriptive study investigated a convenience sample of 119 carers of a person with Depression or schizophrenia attending a community clinic using vignettes adapted from an existing mental health literacy survey.
The schizophrenia vignette was reported as a crisis by 28% and 35.6% reported the Depression vignette as a crisis. schizophrenia and Depression were identified as mental illnesses by 72% and 64% respectively. Persons with schizophrenia and Depression were reported to be more violent than a member of the community by 61% and 60%. Psychiatrist's help was preferred as the therapeutic intervention in schizophrenia (86.7%) and Depression (91.5%), whereas only 21.7% preferred traditional healers. Carers of persons with schizophrenia (72%) and Depression (61%) held the attitude that the problem is a sign of personal weakness. Sixteen percent of carers wanted to avoid people with similar problems.
Carers had stigmatising attitudes such as persons with mental illness were violent and the illness was a sign of personal weakness. A minority wanted to avoid persons with similar problems, indicating that maintaining social distance was not a major issue. Carers had good knowledge of help seeking locations with a majority identifying psychiatrists and psychiatric wards in general hospitals.
The mental health literacy amongst the carers are lacking in certain areas. They have stigmatising attitudes towards people with mental illness.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
18Indian J Psychiatry 2013 Jan 55: 74-6
PMID23439883
TitleA prospective cohort study on the role of nonspecialist staff in preventing relapses and improving clinic attendance of patients with schizophrenia.
AbstractThe SRI Lankan government employs graduates from local universities (trained in nonpsychiatry disciplines) as Mental Health Development Officers (MHDOs) to fulfill the role of a psychiatric social worker.
This was a prospective interventional cohort study on preventing relapses of schizophrenia by active involvement of MHDOs. The intervention (randomly selected) and control groups each had 25 follow-up patients with schizophrenia (1:1 match for sex, ethnicity, age, and duration of illness). The intervention was to develop a close liaison with the patient/family and build an individualized client oriented follow-up through the MHDOs. The follow-up period was 1 year.
The intervention group had better clinic attendance, less relapses, and defaults. The number needed to follow-up to avert a relapse or a default was 12.5 and 5 respectively.
Low-cost strategies involving nonspecialist staff can reduce relapses and defaults in patients with schizophrenia.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
19Ceylon Med J 2013 Sep 58: 111-5
PMID24081171
TitleSubstance use disorders among mentally ill patients in a General Hospital in Sri Lanka: prevalence and correlates.
AbstractTo determine the prevalence, and demographic and clinical correlates of substance use disorders among the mentally ill.
Cross sectional analytical study. Data were collected from consecutive patients treated at a Tertiary care Psychiatry Unit, Western Province, SRI Lanka using an interview schedule administered by a senior registrar in psychiatry.
Diagnosis was based on ICD 10 criteria and the Clinician Rating Scale: Alcohol Use Scale (AUS) and the Drug Use Scale (DUS). The data were analysed using SPSS and WinPepi software programmes, utilising the chi squared, t test and median test.
Among a sample of 325 patients, 66% were male; 33% were diagnosed with depressive disorder, 30% with schizophrenia, 23% with bipolar affective disorder and 13% with other disorders. Prevalence of comorbid substance use disorders was 43% (95% CI 38 - 49%). Alcohol was the commonest type of substance used. Those who had a comorbid substance use diagnosis were more likely to be male, have a lower educational level, be unemployed and have a poorer level of social support. They were also found to have poorer treatment adherence, increased number of hospital admissions and an increased association with episodes of violence.
A significant proportion of patients were found to have a comorbid substance use diagnosis and associated complications. These findings have important implications for service provision for mentally ill patients with a comorbid substance use disorder.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
20Int J Ment Health Syst 2013 -1 7: 2
PMID23302516
TitleCaregiver strain and symptoms of depression among principal caregivers of patients with schizophrenia and bipolar affective disorder in Sri Lanka.
Abstract
Data on caregiver strain and depression of principal caregivers of patients with mental illnesses are few in developing countries. Findings from developed countries cannot be applied directly to developing countries as culture specific factors may influence the outcome.
A prospective study was carried out in the University Psychiatry Unit of the National Hospital of SRI Lanka (NHSL) to identify symptoms of depression, caregiver strain and dissatisfaction with life in caregivers of patients with schizophrenia and bipolar affective disorder. Participants were assessed using the Center for Epidemiological Studies - Depression Scale, Satisfaction with Life Scale and the Modified Caregiver Strain Index.
Eighty caregivers were interviewed (males; 36, 45%). Symptoms of depression were significant in 37.5%, while 48.8% had unsatisfactory scores on the Satisfaction with Life Scale. Depression and higher caregiver strain were associated with spending more time with the patient, interruption to work, disputes with relations, being assaulted by patient and self admission of needing professional help to overcome mental stress.
This study identified several associations for depression and increased caregiver strain among caregivers in a subset of patients with mental disorder in SRI Lanka. These can be used as markers to screen and increase pretest probability to identify caregivers needing help rather than applying the cumbersome questionnaires to all.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
21Ann Gen Psychiatry 2014 -1 13: 7
PMID24642279
TitleAntipsychotic medication and tobacco use among outpatients with schizophrenia: a cross-sectional study.
AbstractMany studies have shown that the prevalence of smoking in schizophrenia is higher than in the general population. Biological, psychological and social factors influence smoking in patients with schizophrenia.
The study was carried out in psychiatry outpatient clinics in a tertiary care hospital in SRI Lanka. Every third patient was selected using systematic sampling from patients diagnosed with schizophrenia according to ICD-10 clinical criteria. Smoking behaviours were assessed using self-reports. Severity of illness was assessed using Brief Psychiatric Rating Scale (BPRS). Fagerstrom Test for Nicotine Dependence assessed level of dependence. Readiness to Change Questionnaire assessed motivation to change smoking behaviour.
The sample consisted of 306 patients with schizophrenia. Mean age was 38.93 years (SD 10.98). There were 148 males (48.4%). Mean duration of illness was 12.63 years (SD 8.38). Current medication was oral atypical antipsychotics 103, clozapine 136, oral typicals 29 and depot typicals 38. Prevalence of tobacco use among males was 30.41% (95% CI 22.91 to 37.90) and among females 1.90% (95% CI -0.25 to 4.05). Prevalence of current smoking among males was 20.27% (95% CI 13.72 to 26.82). None of the females smoked. Prevalence of smokeless tobacco use among males was 10.14 (95% CI 5.22 to 15.05) and among females 1.90 (95% CI -0.03 to 4.05). When patients treated with clozapine were excluded from the analysis, prevalence of tobacco use was 41.6% among males and 3.2% among females and prevalence of smoking was 29.9% among males. Prevalence of tobacco use was lowest in patients treated with clozapine 18.31 (95% CI 9.09 to 27.53) and highest in those treated with depot antipsychotics 47.83 (95% CI 25.74 to 69.91).
Prevalence of smoking was less than in many countries. This is influenced by prevalence in the general population and low affordability. Risk of tobacco use was significantly less among patients treated with clozapine.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
22BMC Res Notes 2015 -1 8: 792
PMID26674072
TitleClozapine induced pancytopenia leading to severe sepsis: an unusual early complication.
AbstractClozapine is a second generation antipsychotic used to treat resistant schizophrenia and other psychotic illnesses. Leucopenia or agranulocytosis is a rare side effect of this drug. Pancytopenia is an extremely rare side effect of clozapine and literature review showed only one such case in where the pancytopenia developed several months after starting clozapine together with other antipsychotic drugs.
A 26-year-old SRI Lankan male was admitted with fever for 3 days. Apart from generalized body aches there were no other significant symptoms. His blood counts showed pancytopenia. He was being treated for a resistant schizophrenia and clozapine was started only 4 weeks before. Common causes for pancytopenia were excluded, and a diagnosis of clozapine induced pancytopenia was made. He was managed in the intensive care unit with broad spectrum antibiotics, antifungals and granulocyte colony stimulating factors. He made a complete recovery after 4 weeks.
This is a rare and probably the first reported case of early onset clozapine induced pancytopenia complicated by severe sepsis recovering completely.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
23J. Psychopharmacol. (Oxford) 2015 Dec 29: 1255-61
PMID26510448
TitleMetformin for treatment of antipsychotic-induced weight gain in a South Asian population with schizophrenia or schizoaffective disorder: A double blind, randomized, placebo controlled study.
AbstractAntipsychotic-induced weight gain causes serious health problems. We investigated the efficacy and safety of metformin in treating antipsychotic-induced weight gain in South Asian patients.
Sixty six adult patients with schizophrenia or schizoaffective disorder treated, with atypical antipsychotics, and who had increased by more than 10% their pre treatment body weight, were randomly assigned to receive metformin or placebo in a double-blind study. Patients received usual treatment and metformin 500 mg or placebo twice daily for 24 weeks. The primary outcome measure was change in body weight from baseline to week 24. Linear mixed models were used in the analysis.
Mean change in body weight in the metformin group was -1.56 kg (95% CI=-3.06 to -0.05) and 1.0 kg (95% CI=0.03-1.97) in the placebo group. Between-group difference was 2.56 kg. At 24 weeks the between-group difference showed significant time-by-treatment interaction (F=3.23, p=0.004). Between-group difference in BMI showed significant time-by-treatment interaction (F=3.41 p=0.03). There was no significant difference in waist-hip ratio or fasting blood sugar.
Metformin is effective in reducing weight in South Asian patients with schizophrenia or schizoaffective disorder who had increased their body by more than 10% after treatment with atypical antipsychotics.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal