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Biomedical subjects

S Gunatilake

Publications and source records attributed to S Gunatilake.

16 recordsLinked to original sources
PubMed2004

Antipsychotic polypharmacy.

The administration of more than one drug for a single medical condition is considered to be polypharmacy. There are many possible reasons for polypharmacy: (1) psychosis is a chronic disease that cannot be cured; (2) expectations to improve patients' quality of life beyond what drugs can actually do is high; (3) the lack of side effects and interactions can cause physicians to be more daring in terms of potential complications; (4) information from the Internet may cause patients and their families to demand medications; (5) the diluted mental health system allows legal guardians and other mental health professionals to force physicians to provide multiple drugs; (6) many new drugs are available; and (7) physicians are forced to shorten hospitalization days. The 1997 American Psychiatric Association Practice Research Network found that 17% of 146 patients with schizophrenia were treated concurrently with more than one antipsychotic medication. Polypharmacy may increase the risk of adverse effects, drug interactions, noncompliance, and medication errors. It is not wise to use polypharmacy only to prevent side effects and drug and interactions. Our attempts to reduce polypharmacy may fail, as academicians also propagate polypharmacy, and all of the algorithms indicate polypharmacy as an option, putting physicians in a legal and ethical bind. Techniques such as experimental ward, peer review, computer information feedback, and comparing different techniques may temporarily reduce polypharmacy but long-term outcome is not affected. Scientific data on the efficacy of polypharmacy is needed in order to sort out good and bad polypharmacy.

Antipsychotic Agents↗
PubMed2004

Side effects of atypical antipsychotic drugs.

Recently there has been increased concern over the side effects of the atypical antipsychotic drugs, including diabetes, hyperlipidemia and obesity. The relationship between diabetes and antipsychotic drugs requires a careful analysis. Patients with schizophrenia are known to suffer from diabetes more often than the general population. In addition, a number of case reports indicate that the conventional antipsychotic as well as atypical antipsychotic drugs produce diabetes. Clozapine and olanzapine, in particular, have been implicated producing diabetes as well as diabetic ketoacidosis. Epidemiological surveys have supplemented the case reports, finding increased incidence of diabetes in patients treated with atypical antipsychotic agents, but these surveys have not yielded consistent results regarding the differential effects of the various atypical antipsychotic drugs. The mechanism by which antipsychotic agents produce diabetes is not elucidated. Weight gain and consequent alteration in triglycerides and cholesterol have been known to occur frequently with olanzapine and clozapine. The ensuing metabolic syndrome itself may cause insulin resistance and diabetes. In the absence of definitive scientific data on the differential effects of antipsychotic drugs in inducing diabetes, clinical prudence and careful monitoring of all patients on atypical antipsychotic drugs is necessary. Aripiprazole and ziprasidone have not been shown to increase weight or produce diabetes, but more information on the diabetogenic effects of ziprasidone and aripiprazole is needed. In order to assess the differential effects of atypical antipsychotic drugs in producing diabetes and the mechanisms by which they produce this reaction, further research is necessary.

Animals↗
PubMed2004

Rehabilitation of schizophrenic patients.

Schizophrenia is a maldevelopmental disorder of the brain that manifests in positive, negative, cognitive and affective symptoms. Currently, the mainstay of treatment involves pharmacotherapy. The limitations of antipsychotic treatment are that they can only control symptoms and cannot cure the illness, and 20% of patients do not respond, thus leading to the requirement of maintenance treatment. Patients that do respond continue to have disabling residual symptoms such as amotivation and isolation, maladaptive behavior, and impaired social functioning. These symptoms prevent patients from attaining educational, occupational, and social roles. Psychosocial interventions and models of quality of life in schizophrenia are based on the notion that increases in psychosocial functioning will be related to improvement in subjective experiences, such as self-esteem and satisfaction with life. The comparative effect of specific treatment methods and the additional benefits of multiple treatments need to be explored. Diversified techniques have also been employed, such as shaping, cognitive process therapy, mastery-oriented skill training, motivation and enhancement. Issues in designing psychosocial interventions and the role of various professionals in providing such interventions need to be carefully considered. Predictor variables and the indications for particular therapies in an individual need to be explored. Generalizability of the gains made by rehabilitation/recovery is also an important consideration. Patients in jail, chronic mental hospitals, private facilities, and the Veterans Administration system are all different in their ability to benefit, their motivations, and the severity of their psychopathology. Therefore, it is very difficult to generalize findings from one setting to another.

Humans↗
PubMed1995

Laughing seizures due to a midline intraventricular neoplasm in tuberous sclerosis.

Laughing seizures have been described in association with hypothalamic hamartomas and precocious puberty. Laughing seizures due to a neoplasm arising from the floor of the left lateral ventricle extending down towards the hypothalamus in a child with tuberous sclerosis is reported. This combination has not been reported before and emphasises the importance of imaging to diagnose such midline lesions in children with paroxysmal laughing.

Humans↗
PubMed1991

Myasthenia gravis in Sri Lanka.

The clinical features and therapeutic aspects of 94 patients with myasthenia gravis seen in the Neurology Institute, General Hospital Colombo, over an eight year period are analysed. The manifestations were similar to that described in the West, but there was a preponderance of male patients, and the ocular myasthenics showed a better response to anticholinesterase medication than described in the world literature. The response to treatment with anticholinesterases, steroids, plasma exchange and thymectomy are assessed.

Adolescent↗
PubMed1989

Behavioural change strategies to enhance child survival.

The evolution of different approaches to health education and additions from educational psychology have brought some guidelines for influencing new health behaviours. The purpose of this article is to take stock of some of the achievements, strengths and limitations within the field of communication and education and to delineate some behavioural science principles and theoretical models that could guide the health educators in child survival efforts.

Child↗
PubMed1985

Integrating occupational health services with primary health care.

In most developing countries, the occupational health services designed according to a Western model fail to reach millions of people working in small industries and agricultural settings. This article describes a WHO-assisted project in Sri Lanka to integrate occupational health with the existing primary health care services.

Occupational Health Services↗