Volume 2, Number 2 - September 2011


Religious devotion: a risk factor for mental illness? Examining the link between religiosity and obsessive-compulsive disorder

Summary: Obsessive Compulsive Disorder (OCD) has similar features comparable with excessive religiosity. Religious rituals in particular have been compared with obsessive rituals. There are differences in frequency and intent. Furthermore, the individuals may not resist religious thoughts or rituals. In this paper we compare these two types of behaviours and draw some conclusions regarding the differences that clinicians may need to be aware of rather than medicalising normal culturally appropriate behaviour. Literature findings are mixed but it appears that organised religion predisposes to OCD is not upheld. It would appear from studies that specific rituals in organised religion may well have some influence on OCD in terms of symptoms, possible explanations, help-seeking and therapeutic alliance once treatment has been initiated. The relationship between OCD and organised religion may need to be investigated further especially in the context of various religions. This may not only improve our understanding of development of OCD, it may help us to establish how these findings can be used to develop and deliver culturally appropriate and sensitive services which patients may find acceptable with better outcomes..


read pdfread full text

by Elisabeth Cosgrove, Sean Cross, Dinesh Bhugra


Ethics in mental health in a resource poor setting: Experiences from Nepal

Simply speaking, ethics is the philosophical / moral framework or theory that can be used to facilitate the discussion and decision-making process that leads to the resolution of the dilemma. The “moral framework” that is chosen for ethical decisions may be based either on the principles of Western bioethics (i.e., autonomy, beneficence, non-maleficence, justice), or on a human rights model, or an international law or a religious faith (Singer and Benatar, 2001; Pathare, 2004).
Medical ethics is primarily a field of applied ethics, which is the study of moral values and judgments as they apply to the field of medicine. Some of the important values that commonly apply to medical ethics are:..


read pdfread full text

by Kapil Dev Upadhyaya , Devbrat Joshi


Psychiatric Training in Sri Lanka and its relevance to South Asia

Abstract: Psychiatric training has to adapt to existing needs. The positive steps in this direction in Sri Lanka and the recent landmark achievements in undergraduate and postgraduate training are discussed. The lessons learnt and the directions for the future can be shared with neighbouring countries in South Asia, which have similar challenges in the context of a shared socio-cultural milieu.. .

read pdfread full text

by Harischandra Gambheera, Shehan Williams


Validation of the Kessler’s psychological distress scale among the Sinhalese population in Sri Lanka

Objective:Kessler’s psychological distress scales, K10 and K6 are short rating scales designed to screen psychiatric morbidity in the population. Despite being increasingly popular elsewhere, they have not been validated in Sri Lanka. We examined the validity of these scales among the Sinhala speaking population in the Gampaha district of Sri Lanka.
Design:The English language version of the K10 and K6 questionnaire were translated into Sinhala using standard methods. The K10 and K6 scores for 27 healthy and 37 psychiatrically ill individuals were compared with the Structured Clinical Interview for DSM disorders (SCID) outcome categories.
Results: The K10 and K6 were sensitive and specific in detecting mental illness, especially depression. Those with schizophrenia had scores similar to healthy individuals. We suggest cut-offs of 12 for K10 and 7 for K6 having 90% sensitivity and 81% specificity for both scales.
Interpretation: K10 and K6 are valid screening tools for non-psychotic psychiatric illness among the Sinhala speaking population in Sri Lanka. They can be used in psychiatric epidemiological studies...


read pdfread full text

by Wijeratne LT, Williams SS, Rodrigo MDA, Peris MUPK, Kawamura N, Wickremasinghe AR


Depressive symptomatology in care-givers of patients with Alzheimer’s disease

Background: The stress and strain of being an Alzheimer's caregiver can cause physical and mental problems. Nearly half of all Alzheimer's caregivers report that they have suffered from depression at some point, according to the Alzheimer’s Association. The objective of this study was to identify depressive symptoms in caregivers of patients with Alzheimer’s disease.
Method: A descriptive study was carried out in the Department of psychiatry, Pakistan Institute of Medical Sciences (PIMS), Islamabad from May 2010 to September 2010. Thirty caregivers participated in the study. Informed written consent was obtained. The Beck Depressive Inventory (BDI) was used.
Results: 57 % of caregivers met criteria for depression. The females scored more on the depressive scale compared...


read pdfread full text

by Asima Mehboob Khan, Rizwan Taj


Behavioural symptoms in patients with Alzheimer's disease in a tertiary care centre of Lahore, Pakistan

Introduction: Persons with Alzheimer’s disease (AD) demonstrate a range of behavioural and psychological symptoms of dementia (BPSD). The description of these symptoms in AD patients will improve treatment. The aim of this study is to describe these symptoms and to correlate it with the severity of the disease.
Method: A cross-sectional observational study was conducted at a tertiary care center in Lahore. Patients suffering from AD diagnosed on the basis of DSM-IV were included. Demographic and clinical data was collected and dementia severity was assessed with the Mini Mental State Examination (MMSE - mild 27-21, moderate 20-11, severe ≤ 10). The behavioural symptoms reported by the patients were recorded using semi-structured interview on the basis of ADAS non-cognitive scale in urdu.
Results: A total of 100 patients were included (mean age 77 ± 7 years, 65% men). Almost all patients (90%) had BPSD at inclusion, 17% of whom reported psychotic episodes. The most prevalent symptoms were lack of concentration (56%), tremors (56%), depression (44%), lack of cooperation (36%), and delusions (32%). Patients with greater BPSD showed a significantly higher prevalence of psychotic symptoms (delusions, hallucinations, and delirium) and tremors, while emotional symptoms (tearfulness and apathy) predominated in patients with less severe BPSD.
Conclusions: Our study showed that patients with AD have a high prevalence of non-cognitive symptoms. These symptoms vary from the list of symptoms provided by the Alzheimer’s Association...


read pdfread full text

by Muhammad Nasar Sayeed Khan


Unusual Presentations of Delusional Parasitos

Delusional parasitosis is an interesting phenomenon in which a person firmly believes that he/she is infested with parasites on inadequate grounds to affirm the bizarre claim. This phenomenon is also known as Ekbom syndrome (Vázquez et al., 2007). In the psychopathology, patients’ experience has been described as a delusion or an over-valued idea and also as a form of tactile hallucinatory state (Sims, 1995). Having this kind of delusions or somatic hallucinations are extremely troublesome to the patient which may ultimately lead to injuries to the skin, subcutaneous tissues and even to the eyes as the patient attempts to remove the “parasites / insects” vigorously and vehemently by scratching continuously without any success.

This condition is more often seen in patients over 50 years of age (Dunn et al., 2007). Among these patients there is a female predominance with a 2:1 female: male sex ratio. But there is an equal ratio in patients younger than 50 years (Dunn et al., 2007; Lyell, 1983). Men tend to present at an early age (Dunn et al., 2007)...


read pdfread full text

by Kuruppuarachchi KALA, Fernando WKTR, Fonseka TPM