A prospective cohort study on the role of nonspecialist staff in preventing relapses and improving clinic attendance of patients with schizophrenia.

BACKGROUND: The 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: Low-cost strategies involving nonspecialist staff can reduce relapses and defaults in patients with schizophrenia.

A retrospective analysis of cannabis use in a cohort of mentally ill patients in Sri Lanka and its implications on policy development.

BACKGROUND: Several epidemiological studies have shown that cannabis; the most widely used illegal drug in the world, is associated with schizophrenia spectrum disorders (SSD). AIMS: 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 METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Symptoms of anxiety and depression in adolescent students; a perspective from Sri Lanka.

BACKGROUND: Sri Lanka recorded an extraordinary high suicide rate for adolescents aged 15 - 19 in the early 1990s (46.5/100,000). With this in perspective, the Ministry of Health in Sri Lanka recommends school programmes for adolescents by mental health units of local hospitals. METHODS: We conducted cross sectional surveys to screen for symptoms of anxiety and depression among students aged 14 - 18 during school mental health programmes. Two schools were randomly selected within the Ratnapura municipality (urban population of approx. 50,000), Sri Lanka and all students aged 14-18 were assessed with self administered (pre tested, Sinhalese translations) questionnaires [Center for epidemiologic studies depression scale, Anxiety screening test of suicide and mental health association international]. RESULTS: A total of 445 students were assessed (male-54.4%, female 45.6%). Thirty six percent screened positive for depression (mild depression-17%, severe depression-19%) and 28% screened positive for severe anxiety. Females screened positive for depression and anxiety significantly more than the males (p = 0.0001, 0.005 respectively). Students in classes facing barrier examinations at the end of the year had the highest positivity rates. Examination related issues (36%) were the most commonly cited problem. RECOMMENDATIONS: It is recommended that: 1. School mental health development programmes in Sri Lanka concentrate more on reducing examination related stress, and in particular focus on the female students. 2. Policy decisions are made to reduce competition for higher education. 3. A nationally coordinated survey on mental health of adolescent students is carried out utilizing the island-wide network of medical officers of mental health.