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How do people with dementia present to the services, and why do they present late? A descriptive study in a Tertiary Care Hospital in Sri Lanka
- Malsha Gunathilake, Chathurie Suraweera
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S253
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Aims
To assess how patients with dementia present to services and reasons for delayed presentation among patients with dementia in Sri Lanka.
MethodA descriptive cross-sectional study was conducted among 83 newly diagnosed patients with dementia and their caregivers at the University Psychiatry Unit, National Hospital of Sri Lanka. They were interviewed using a semi-structured pre-tested questionnaire. Statistical Package for the Social Sciences (SPSS) was utilized for data analysis.
ResultThe mean age of the patients was 71.53(SD = 7.595)years. The commonest type of dementia in the cohort was Alzheimer's disease(N = 49, 59%). The mean untreated duration before the first presentation was 16.33(SD = 16.13) months. A family member or the care-giver had initiated help-seeking in many (N = 65,78.3%). 84.33% of patients had behavioural and Psychological Symptoms of Dementia (BPSD) at first presentation. BPSD was the main reason for help-seeking in 40(48.2%) cases. Among them, psychosis(n = 18,45%), depression(n = 9,22.5%), disinhibition(n = 4,10%) and wandering(n = 3,7.5%) were common.
Lack of awareness on dementia (n = 70,93.3% and n = 68,86.1%) and considering cognitive impairment as a normal part of ageing (n = 39,52% and n = 43,54.4%)were the commonest reasons for delayed presentation reported by patients and care-givers respectively. Twelve patients misattributed the symptoms to their existing medical or psychiatric conditions. The mean untreated duration was significantly higher in the patient group with a family history of dementia (30.5 months) compared to those without a family history (12.8 months)(t = 3.818;p = 0.000). Similarly, the mean untreated duration was significantly higher when there is a family history of dementia among the care-givers (25.53months) compared to the group of care-givers without a family history (13.85 months)(t = 2.532;p = 0.013). Age, sex, education, occupation, income, knowledge on dementia of the patients and the caregivers, illness-related characteristics (type, severity, and presence of BPSD) or being in contact with medical services were not significantly associated with the timing of the first presentation.
ConclusionThere is a delay of more than one year for patients with dementia to present to services in Sri Lanka. The commonest reason for the presentation is BPSD. Lack of prior awareness of dementia and considering the cognitive impairment as a part of normal ageing by both patients and carers were the main reasons for delayed presentation. Patients with a family history of dementia present late than those without a family history. There is no significant association between the timing of presentation and the socio-demographic factors of the patients and care-givers, the presence of prior knowledge on dementia, illness-related characteristics, or contact with medical services.
Prevalence and associations of psychoactive substance use among male supportive staff members in a tertiary care hospital of Sri Lanka
- Chathurie Suraweera, Iresha Perera, Priyanka Rupasinghe, Janith Galhenage
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S293
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- Article
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Aims
The study describes the prevalence and associated socio-demographic variables of psychoactive substance use among male supportive staff members at a tertiary care hospital in Sri Lanka.
MethodA cross-sectional descriptive study was carried out among male supportive staff members of a tertiary care hospital in Colombo District, Sri Lanka by using a self-administered anonymous questionnaire. Participants were recruited using stratified cluster sampling in thirteen overseer divisions of the hospital. Anonymous questionnaires were collected into a sealed box and analysed using Statistical Package for Social Sciences 20.
ResultThe mean age of the 404 male staff members who participated in the study was 38.78(SD = 10.90) years and 71.5% were married. Among them 202 (49.1%) were educated up to grade 6-11 and 30 of them has had encounters with law in the past. Thirty of participants had history of psychoactive substance use in the family. Alcohol was used more than once a month by 127(30.9%) and more than once a week by 19(4.6%) individuals. Among other substances, tobacco, beetle and beedi were used by 104(25.3%), 78(19.0%) and 18(4.4%) respectively at least once a month. Further, 22(5.3%), 20(4.8%), 7(1.7%) and 7(1.7%) participants used Mava, Cannabis, Methamphetamine and Thool respectively at least less than once a month. Heroin, Tramadol and Morphine were used by two individuals at least less than once a month. Among substance using participants, 132 wished to cut down their habit. Most commonly identified (14.1%) adverse consequence was financial issues secondary to psychoactive substance use. Eleven (4.5%) staff members used the substance at hospital. Alcohol use was associated with age more than 35 years (p = 0.039) and history of forensic involvement (p = 0.038). Tobacco(p = 0.000), beetle (p = 0.056), Cannabis (p = 0.000) and mava (p = 0.015) use were significantly associated with positive forensic history. Supportive staff members’ alcohol and cannabis use was associated with tobacco (p = 0.000, p = 0.000) and beetle use (p = 0.001, p = 0.049). Mava use was associated with alcohol (p = 0.060) use in addition to tobacco (p = 0.020) and beetle use (p = 0.008).
Binomial logistic regression revealed alcohol use and beetle use were associated with the number of children in family and above associations.
ConclusionCommonest psychoactive substance consumed by supportive staff members were alcohol, tobacco, beetle, Cannabis and Mava in descending order of frequency. Forensic history was significantly associated with substance use. True prevalence of substance use can be higher than these values.
An analytical cross-sectional study to describe and compare the mental health status of doctors and medical undergraduates in selected institutions in Colombo, Sri Lanka during COVID-19 pandemic
- Chathurie Suraweera, Iresha Perera, Priyanka Rupasinghe, Janith Galhenage
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S293
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- Article
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Aims
The aim of this study was to describe and compare the mental health status of doctors and medical undergraduates in selected institutions during COVID-19 pandemic.
MethodA cross-sectional analytical study was conducted among doctors working in major tertiary care hospitals two of which, risk is unpredictable and high, the other where all patients are positive for COVID-19 and among medical undergraduates. The doctors were selected using disproportionate stratified sampling and medical undergraduates using stratified cluster sampling. Data were gathered using a Google form containing socio-demographic details, perception on the pandemic and the General Health Questionnaire-12(GHQ-12).
ResultThere were 468 participants in the study and among them 243(51.9%) were doctors. Mean age of the doctors’ is 34.54(SD = 7.43) years and more than half (50.06%) were in post graduate training. Majority were worried about their health (65%) and their loved one's health (90.1%). Among doctors 220(90.5%) felt that they have moderate or higher risk of acquiring COVID-19 and 15.6% would not have worked due to the risk. According to GHQ-12, 182(74%) doctors were psychologically distressed (mean GHQ = 12.64, SD = 4.54) and it was significantly associated with age less than 35 years (p = 0.039) and worry about interruption of their daily routines(p = 0.010).
The mean age of 225 medical undergraduates was 25.20 (SD = 1.34) years and 176(78.2%) of the participants were psychologically distressed (mean GHQ = 14.32, SD = 6.67). Majority (59.11%) believed that they are at high risk of getting COVID-19. Their distress was significantly associated with the worry about the impact of COVID-19 related restrictions on their daily routines (p = 0.000).
Binomial logistic regression confirmed that doctors were distressed due to impact on their income whereas both doctors and medical undergraduates were distressed due to impact on daily routines.
ConclusionNearly three quarter of both doctors and medical undergraduates were psychologically distressed during COVID-19 pandemic. The worry was due to contracting illness, financial issues and the COVID-19 regulations.
Prevalence and associated factors of antenatal depression of women attending antenatal clinics in two tertiary care maternity hospitals in Sri Lanka
- Chathurie Suraweera, Iresha Perera, L.L. Amila Isuru, Janith Galhenage
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S292-S293
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- Article
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Aims
To determine the prevalence of depression among antenatal mothers in two tertiary care maternity hospitals in Colombo and associated factors of antenatal depression.
MethodA descriptive cross-sectional study was conducted in antenatal clinics in two tertiary care maternity hospitals in Sri Lanka. Every second woman attending the clinic was recruited using systematic sampling until the calculated sample size was obtained. A structured questionnaire and Edinburgh Postnatal Depression Scale (EPDS) were used for data collection. Data were analysed using SPSS.
ResultA total of 536 pregnant women were participated in the study. Around one third (180, 33.6%) of pregnant women had depression according to the EPDS score (Mean = 7.66, SD = 5.17). The mean age was 29.65(SD = 9.30) years and among them 387(74.3%) had at least secondary education. The majority lived with parents or in-laws (329, 61.4%) in addition to nuclear family members and 266(49.6%) were in their third trimester. Most women were in first pregnancy (149, 39.5%) and 11 (2.1%) had a history of psychiatric illness. Sixty (11.2%) women and 156(29.1%) of partners used psychoactive substances. Verbal abuse and physical abuse were reported by 5(0.9%) and 3(0.6%) respectively. Sixty one (11.4%) women have reported inadequate family support, and 226 (42.2%) had only support of the partner. Among them 346 (64.6%) reported excellent support from partner. One third (186, 34.7%) of pregnancies were unplanned, 328(61.2%) women reported a very good relationship with their partner. Complications were experienced by 123(22.9%) of women during this pregnancy and commonest was gestational diabetes. The presence of depression was significantly associated with living with extended family (p = 0.033) and in-laws(p = 0.014). Multi parity (>2 children) (p = 0.008), partner's substance use (p = 0.002), inadequate family support (p = 0.024), inadequate partner's support (p = 0.003), unsatisfactory relationship with partner (p = 0.000) and unplanned pregnancies (p = 0.001) were also associated with depression. Logistic regression analysis indicated a significant association between depression with partner's substance use, unavailability of family support and poor relationship with the partner.
ConclusionAround one-third of mothers were having antenatal depression. Several spouse related factors and unsatisfactory family support were associated with depression among antenatal mothers.