Volume 3, Issue 2 – March 2015


Making psychotherapy culturally relevant to South Asia

Burden of mental illnesses in
South Asia

Psychiatric disorders account for more than 14% of the global burden of disease (Prince et al., 2007). It is projected to increase further by 2020 and the situation is more serious in developing countries (Murray & Lopez, 1997).  Considering the higher prevalence of mental disorders in the South Asian region, the need to address this issue is even greater (Steel et al., 2014). Despite its higher prevalence and significant impairment to individuals, mental illnesses are under-treated in South Asia (Chisholm et al., 2007). Studies done in the region on pathways to mental health care found traditional healing methods to be widely accessed (Hashimoto et al., 2015). Lack of cultural relevance has led to poor use of existing mental health services, making traditional healing rituals a popular treatment option for psychiatric conditions in rural and suburban areas (Samarasekare, Lloyd, & Siribaddana, 2012).

Need for cultural modification of psychotherapy

Psychotherapy alone or in combination with other treatment is effective in managing a wide range of mental disorders (Hunsley, 2013).  While both psychiatrists and patients in the region identify psychotherapy as an essential and desirable therapeutic option, its provision and utilization has been low (Holikatti et al., 2012; Wasan, Neufeld, & Jayaram, 2009). One of the main reasons identified is the lack of culturally appropriate psychotherapies.


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by Asiri Rodrigo


Impact of dance, drama, yoga and music therapy workshops on symptom reduction in patients with Schizophrenia: A randomized controlled study

Background: Drama, dance, yoga and music therapy is known to promote self-confidence, enhance interpersonal communication and promote wellbeing in patients with long term mental illnesses such as schizophrenia. Studies done to assess the impact of similar adjunctive treatments on symptom reduction have recommended further evaluation.

Aims: To measure the impact of dance, drama, yoga and music therapy on reduction of positive and negative symptoms of schizophrenia as well as the effect on a patient’s self-confidence.

Methods: Seventy-three patients with schizophrenia were randomly allocated to the drama, dance, yoga and music therapy workshops which span over two months (test group; n=33) and to ‘treatment as usual’ (control group; n=40). Both groups were assessed using PANSS scores before and after the intervention. Rosenberg self-esteem scale (RSES) was administered to the subjects in the test group before and after the workshop.

Results: There was no significant difference between the two groups in PANSS scores prior to commencement of the study (p>0.05 using Mann Whitney U test). Both test and control groups showed significant improvements in the positive, negative, general psychopathological and cumulative scores of the PANSS (2-sided p < 0.0001 across all subscales of PANSS for test and control groups using the Wisconsinsigned rank test), but there was no statistically significant difference among them. When non forensic patients were analyzed separately, a statistically significant difference was observed. There was no statistically significant improvement in forensic patients. In the test group there was a significant improvement in the self-esteem score (2-sided p < 0.001 using Wisconsinsigned rank test).

Conclusions: Exposure to dance, drama, yoga and music therapy lead to symptom reduction as well as a positive effect on self-esteem in the short term, in patients with schizophrenia. Future research conducted on patients with acute schizophrenia, covering lager sample sizes are needed to obtain more conclusive evidence on the impact of creative therapy.

Declaration of interest: None

Key words: Schizophrenia, creative therapy, drama therapy, psychodrama, dance therapy, music therapy, yoga

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by Isuru LLA, Dahanayake DMA, de Alwis A, Weerasinghe A, Hewage SN , Ranasinghe CK


Psychiatric morbidity in patients with Diabetes Mellitus: A hospital based study in Kashmir


Background: Diabetes mellitus (DM) is an illness that in addition to its physical consequences has psychological and social impairments. The association between DM and psychiatric disorders are considered bidirectional and this study looked at the pattern of psychiatric morbidity in patients with DM.

Methodology: We conducted a cross-sectional study over a period of one year in SMHS Government medical college associated Hospital in Srinagar. We selected every alternate patient with DM attending the endocrinology outpatient clinic. A semi structured interview was conducted along with the administration of the Mini International Neuropsychiatric Interview –Plus (MINI - Plus) for evaluation of psychiatric symptoms and diagnosis. An age and sex matched control group (n = 200) was selected from among non-diabetic patients.

Results: Out of total 200 subjects 87 were males (43.5 %), and 113 were females (56.5 %). The mean age was 45 ± 15 years.  71% were married and 11.5% were unmarried. 57% of patients with DM had significant psychiatric morbidity. Only 25.5% of the control group had psychiatric problems (p=<0.005). Depressive disorder (13.5%) was the most common presentation, followed by Adjustment disorder (7.5%), Premenstrual dysphoric disorder (6.5%), Panic disorder (6%), Generalized anxiety disorder (5.5%), Dysthymia (4.5%), Suicidality (4%), Mixed anxiety (1.5%) and OCD and agoraphobia (1.5%) each.

Conclusion: The increased frequency of psychiatric morbidity among patients with DM raises the need for early diagnosis and treatment.

Key words: Diabetes mellitus, psychiatric morbidity.


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by Sheikh Shoib1, Mohammad Maqbool Dar1, Haamid Bashir, Tasleem Arif


Unusual presentations of reflex epilepsy in psychiatric practice: A case series


Reflex seizures have various definitions. According to one well accepted definition, they are a ‘collection of different seizure types distinguished by their ability to be precipitated by a specific stimulus’ (Ritaccio, 1994).  A proposed diagnostic scheme for people with epilepsy and epileptic seizures by the International League Against Epilepsy (ILAE) Task Force Report on Classification and Terminology, reflex epilepsies are regarded as a syndrome in which all seizures are precipitated by sensory stimuli. Further, it proposes the inclusion of reflex seizures that occur in focal and generalized epilepsy syndromes under the rubric of seizure types in order to facilitate the understanding of the aetiology and improve the therapeutic approach (Engel, 2001). In the majority of patients with reflex epilepsy, seizures are precipitated by either internal stimuli such as fatigue, sleep and stress or external stimuli such as visual cues, reading, heat, eating and bathing. Sometimes the precipitants may be quite exotic. Visually provoked seizures account for 5% of the total 6% of reflex seizures. Visual stimuli may include television, disco lights and video games (Kasteleijn-Nolst Trenité, 2012).


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by Kuruppuarachchi KALA, Kapugama KGCL, Wijesinghe CA


Charles Bonnet syndrome


A 41 year old married labourer presented with complex visual hallucinations for six months. He had reduced visual acuity, a subluxated lens, and two retained sutures from a previous surgery of the right eye and complete blindness of the left eye. His mental, physical and neurological examinations were unremarkable. Surgical correction of his visual impairment resulted in resolution of symptoms.


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by Dissanayake DMRM, Hewarathne A, Wijesinghe CA, Amarasinghe B, Williams SS


Recurrence of pseudocyesis in rural Sri Lanka


Pseudocyesis is defined by the DSM-5 as a false belief of being pregnant associated with objective signs and reported symptoms of pregnancy (American Psychiatric Association, 2013). It is found especially in societies where there is cultural pressure on women to have children (Cohen, 1982). The condition tends to recur in 5%, unless proper intervention and psychological support is offered (Bivmi & Klingerm, 1937). We present a case of a woman who had recurrence of pseudocyesis from a rural community in Sri Lanka.


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by Dissanayake DMRM, Hewarathne A, Wijesinghe CA, Amarasinghe B, Williams SS