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Wijeratne C, Sharma S, Large M. Understanding and addressing racism in clinical encounters. Aust N Z J Psychiatry 2024; 58:297-299. [PMID: 38131317 DOI: 10.1177/00048674231219854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Chanaka Wijeratne
- Euroa Centre, Prince of Wales Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Swapnil Sharma
- Euroa Centre, Prince of Wales Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Matthew Large
- Euroa Centre, Prince of Wales Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, University of New South Wales, Kensington, NSW, Australia
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Wijeratne C, Kay MP, Arnold MH, Looi JCL. Australia needs to implement a national health strategy for doctors. Med J Aust 2022; 217:338-341. [PMID: 36069157 PMCID: PMC9825878 DOI: 10.5694/mja2.51714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/10/2022] [Accepted: 06/17/2022] [Indexed: 01/11/2023]
Affiliation(s)
| | | | - Mark H Arnold
- School of Rural HealthUniversity of SydneyDubboNSW,University of SydneySydneyNSW
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Wijeratne C, Earl J. A guide for medical practitioners transitioning to an encore career or retirement. Med J Aust 2022; 216:106. [DOI: 10.5694/mja2.51378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/04/2021] [Accepted: 06/17/2021] [Indexed: 11/17/2022]
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Abstract
BACKGROUND Medical practitioners experience high levels of mental disorders but may be reluctant to seek care. AIMS To determine medical practitioner attitudes towards other doctors with anxiety/depression, barriers to seeking mental healthcare, treatments received for depression and the effects of age. METHODS Data from the National Mental Health Survey of Doctors and Medical Students, conducted in Australia, were analysed (N = 10 038 medical practitioners). Attitudes to anxiety/depression were assessed with 12 statements (total stigma score, range 12-60). Barriers to seeking professional help, and coping strategies used, for anxiety/depression were measured. Practitioners with a history of depression were asked what personal supports and treatments were received. Practitioners were compared by age-younger (40 years and younger), middle-aged (41-60) and older (61+). RESULTS Attitudes and help-seeking behaviours varied with age. Older doctors had a more positive outlook and less total stigma, with the exception that they believed a doctor with anxiety/depression was less reliable. Younger practitioners were most likely to report barriers, such as confidentiality, impact on career progression and registration, to seeking help. For practitioners with depression, counselling and counselling plus medication were most likely to be received by the younger and middle-aged groups, whereas medication alone was most likely to be received by the middle-aged and older groups. CONCLUSIONS Stigmatizing attitudes towards mental disorder and barriers to help-seeking remain prevalent within the medical profession. Our results suggest doctors' health programs should address mental health stigma in younger practitioners and facilitate education about psychological treatments in older practitioners.
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Affiliation(s)
- C Wijeratne
- Sydney School of Medicine, University of Notre Dame Australia, Sydney, New South Wales 2010, Australia.,School of Psychiatry, University of New South Wales 2052, Sydney, New South Wales, Australia
| | - C Johnco
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales 2109, Australia.,Centre for Cognition, Ageing and Wellbeing, Macquarie University, Sydney, New South Wales 2052, Australia
| | - B Draper
- School of Psychiatry, University of New South Wales 2052, Sydney, New South Wales, Australia
| | - J Earl
- Centre for Cognition, Ageing and Wellbeing, Macquarie University, Sydney, New South Wales 2052, Australia
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Mooney A, Wijeratne C, Earl JK, Gordon J. Practise till you drop: Trialing an online intervention for late-career medical practitioners to promote planning for retirement. Internet Interv 2021; 26:100452. [PMID: 34603971 PMCID: PMC8463851 DOI: 10.1016/j.invent.2021.100452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 11/16/2022] Open
Abstract
Many medical practitioners in Australia work beyond the traditional retirement age. Transitioning to retirement is important, however, because the likelihood of poorer clinical outcomes increases with practitioner age. The objective of the present study was to develop and trial an online educational intervention to promote planning for a smoother transition to retirement using a non-randomized control group pre- and post-test design. Medical practitioners aged 55 or over (N = 262, Mage = 61.9) and working 30 or more hours per week were recruited to complete four online modules that addressed a range of topics (physical, health, financial, social, cognitive, and emotional well-being) and encouraged planning for retirement resources. Outcome measures included work centrality, mastery, and goal perceptions across the aforementioned resource domains. Eighty-one doctors completed post-training measures; a control group who completed only the measures (n = 23) and a training group (n = 58). Pre-post comparisons showed no significant changes for the control group. However, the training group at Time 2 showed lower work centrality t(57) = 2.12, (p = .036), and changes to social t(57) = 2.35, (p = .022), emotional t(57) = 3.18, (p = .002) and health goal perceptions t(57) = -2.02, (p = .049). Controlling for baseline scores and self-selection bias determinants, Generalized Linear Model (GLM) analyses indicated a training group increase in mastery scores (β = 0.87, p = .045) and decrease in negative perception of the consequence of not meeting emotional goals (β = -0.37, p = .043). Although not significant, GLM results also showed an increase in resources, three of four health goal domains and financial goals, indicating the potential for positive training effects in future applications of the program. The online retirement planning resource showed promise in promoting a sense of mastery and a reassessment of retirement plans, taking into consideration resource accumulation and goal setting across five specific goal domains. We discuss the theoretical and practical implications of our findings.
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Affiliation(s)
- Anna Mooney
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia,Corresponding author at: Department of Psychology, Macquarie University, NSW 2109, Australia.
| | - Chanaka Wijeratne
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia,Sydney School of Medicine, University of Notre Dame, Western Australia, Australia
| | - Joanne Kaa Earl
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Jill Gordon
- NSW Doctors Health Advisory Service, St Leonards, NSW, Australia
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Wijeratne C, Johnco C, Draper B, Earl JK. Older Physicians' Reporting of Psychological Distress, Alcohol Use, Burnout and Workplace Stressors. Am J Geriatr Psychiatry 2021; 29:478-487. [PMID: 33023799 DOI: 10.1016/j.jagp.2020.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Most of the published data on the psychological health of physicians has focused on the youngest members of the profession. The aims of this analysis were to determine how psychological morbidity changes across the career cycle. METHODS We report data from the cross-sectional National Mental Health Survey of Doctors and Medical Students, conducted in Australia. Age differences in psychological distress, suicidal ideation, alcohol use, burnout, workplace, and personal stressors were examined for younger (40 years and younger), middle aged (41-60), and older (61+) physicians. RESULTS A total of 10,038 physicians responded. Older physicians reported significantly less psychological distress, burnout and suicidal ideation than younger and middle aged colleagues, findings that were maintained after adjusting for sex and excluding trainees. There were no group differences in overall alcohol use and high risk drinking. On multivariate analysis, the largest contributor to psychological distress in older physicians was a past history of mental disorder. There was a decline across age groups in the endorsement as "very stressful" of work-life conflict and work-anxiety stressors such as fear of making mistakes. Older physicians were least likely to feel very stressed by all workplace stressors. CONCLUSION The better psychological health of older physicians highlights the need to consider physician health according to age and career stage. Apart from the decline in work stressors, in particular work-life conflict, there may be a survivor effect such that physicians who practice into older age have developed greater resilience and professional maturation.
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Affiliation(s)
- Chanaka Wijeratne
- Sydney School of Medicine (CW), University of Notre Dame Australia, Sydney, Australia.
| | - Carly Johnco
- Centre for Emotional Health, Department of Psychology (CJ), Macquarie University, Sydney, Australia; Centre for Cognition, Ageing and Wellbeing (CJ), Macquarie University, Sydney, Australia
| | - Brian Draper
- School of Psychiatry (BD), University of New South Wales, Sydney, Australia
| | - Joanne K Earl
- Department of Psychology (JKE), Macquarie University, Sydney, Australia
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Wijeratne C, Earl J. A guide for medical practitioners transitioning to an encore career or retirement. Med J Aust 2020; 214:12-14.e1. [DOI: 10.5694/mja2.50870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/05/2020] [Accepted: 06/01/2020] [Indexed: 01/23/2023]
Affiliation(s)
- Chanaka Wijeratne
- University of Notre Dame Australia Sydney NSW
- Royal North Shore Hospital Sydney NSW
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Altendorf A, Draper B, Wijeratne C, Schreiber J, Kanareck D. Neglect of Older People: Touching on Forensic and Pathophysiological Aspects. Gerontologist 2020; 60:e449-e465. [PMID: 31348828 DOI: 10.1093/geront/gnz084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Neglect of older people is common and may result in fatal and nonfatal outcomes. Normal changes of aging and disease-related symptoms may overlap with markers of neglect and lead to under-detection. This review aims to delineate medical, psychiatric, and pathophysiological indicators in the victim-identified in forensic case reports-to point out areas of overlap and raise awareness in Health Care Professionals. RESEARCH DESIGN AND METHODS Medical and forensic databases were searched with the search terms: neglect, elder, elderly, forensic, homicide for detailed case reports on elder neglect. Cases were reviewed as to victim age, sex, medical/psychiatric diagnosis, perpetrator, victim-to-perpetrator relationship, cause of death (if fatal), location of incident, autopsy findings (if fatal), and ancillary studies. A total of 168 publications were retrieved, of these 11 publications, containing a total of 25 cases, yielded sufficient detail on each case to be included in the qualitative analysis. RESULTS Neglect is associated with poor physical, psychological, and mental health. Neglect can be a direct cause of death or contribute to a fatal outcome by exacerbating existing conditions. Red flags of neglect included malnutrition, dehydration, poor hygiene, untreated decubitus ulcers, hypothermia, contractures, and an uncooperative caregiver. However, incontrovertible evidence of neglect is not always easy to obtain due to age and disease-related changes. DISCUSSION AND IMPLICATIONS The findings document the extent and seriousness of elder neglect and highlight the importance of detailed documentation as well as collaboration between clinicians, allied health professionals, law enforcement and medical forensic services to improve patient outcomes and reduce the risk of further incidents.
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Affiliation(s)
- Annette Altendorf
- Older Persons Mental Health Service, Prince of Wales Hospital, Randwick, New South Wales
| | - Brian Draper
- Older Persons Mental Health Service, Prince of Wales Hospital, Randwick, New South Wales.,School of Psychiatry, University of New South Wales, Sydney
| | - Chanaka Wijeratne
- Sydney School of Medicine, University of Notre Dame.,Department of Aged Care Psychiatry, Prince of Wales Hospital, Randwick, New South Wales
| | - Jason Schreiber
- Clinical Forensic Medicine (CFM), Victorian Institute of Forensic Medicine (VIFM), Melbourne.,Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniella Kanareck
- Older Persons Mental Health Service, Prince of Wales Hospital, Randwick, New South Wales
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Affiliation(s)
- Chanaka Wijeratne
- Sydney School of Medicine, University of Notre Dame Australia, Darlinghurst
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Wijeratne C, Peisah C, Earl J, Luscombe G. Occupational Determinants of Successful Aging in Older Physicians. Am J Geriatr Psychiatry 2018; 26:200-208. [PMID: 29239799 DOI: 10.1016/j.jagp.2017.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/29/2017] [Accepted: 07/10/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Demographic, physical and psychological associations of successful aging (SA) have been evaluated, but occupational factors have not. Nor has SA been evaluated in a specific occupational group. The aims of this study were to examine the occupational associations of SA in older physicians, and to explore the concept of occupational SA. METHODS Physicians aged 55+ years completed self-ratings of occupational and personal SA on a 10-point visual analogue scale (VAS; 1 being "least successful" and 10 "most successful"). Associations between occupational and personal SA (defined as 8-10 on the VAS), respectively, and demographic and practice characteristics; health; social and financial resources; cognitive, emotional and motivational resources; work centrality; and anxiety about aging were examined. RESULTS Rates of occupational SA (69.2%; 95% CI: 66.3-72.0) were significantly higher than personal SA (63.1%; 95% CI: 60.1-66.0) in the sample of 1,048 physicians. Occupational and personal SA were strongly positively correlated (r = 0.73, N = 1,041, p < 0.001). Personal SA was predicted by demographic (older age, female, international medical graduate, urban practice), physical (better self-rated health), psychological (less depression, better cognitive, emotional and motivational resources, and greater anxiety about aging), and occupational (higher work centrality, fewer practice adaptations and not intending to retire) factors. CONCLUSIONS Occupational factors are central to physicians' self-conceptualization of SA. That greater work centrality, fewer work adaptations and less retirement planning were associated with personal SA suggests older physicians' sense of "success" is intertwined with continuing practice. There is a need for educating physicians to adapt to aging and retirement.
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Affiliation(s)
- Chanaka Wijeratne
- Sydney School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia.
| | - Carmelle Peisah
- The School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Joanne Earl
- Flinders Business School, Flinders University, Adelaide, South Australia, Australia
| | - Georgina Luscombe
- The School of Rural Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Peisah C, Luscombe GM, Earl JK, Wijeratne C. Aging women and men in the medical profession: The effect of gender and marital status on successful aging and retirement intent in Australian doctors. J Women Aging 2017; 31:95-107. [PMID: 29220630 DOI: 10.1080/08952841.2018.1412391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite increasing interest from the medical profession in aging and retirement, we know little about effects of gender, marital status, and cohort on aging within the profession. We surveyed 1,048 Australian doctors from "younger" (55-64) and "older" (65-89) cohorts, investigating gender and marital effects on perceptions of successful aging, career, and retirement intent. Women intend to retire earlier. Younger cohort and married women more frequently viewed their career as a calling, while women in general, and single women more frequently, endorsed personal successful aging more than men. Broader understanding of the different experiences of aging for men and women doctors is needed.
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Affiliation(s)
- Carmelle Peisah
- a School of Psychiatry, Faculty of Medicine , University of New South Wales, Sydney, NSW, Australia.,b Sydney University Medical School , Sydney, NSW , Australia
| | - Georgina M Luscombe
- b Sydney University Medical School , Sydney, NSW , Australia.,c School of Rural Health , Orange , NSW , Australia
| | - Joanne K Earl
- d School of Psychology , Macquarie University , Sydney , NSW , Australia
| | - Chanaka Wijeratne
- a School of Psychiatry, Faculty of Medicine , University of New South Wales, Sydney, NSW, Australia.,e Sydney School of Medicine , University of Notre Dame Australia, Sydney, NSW, Australia
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Wijeratne C, Earl JK, Peisah C, Luscombe GM, Tibbertsma J. Professional and psychosocial factors affecting the intention to retire of Australian medical practitioners. Med J Aust 2017; 206:209-214. [DOI: 10.5694/mja16.00883] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/17/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Chanaka Wijeratne
- Euroa Centre, Prince of Wales Hospital and Community Health Services, Sydney, NSW
| | - Joanne K Earl
- Flinders Business School, Flinders University, Adelaide, SA
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Shah A, Savla-Shah S, Wijeratne C, Draper B. Are elite cricketers more prone to suicide? Further comments on suicides from individual countries of test cricketers. Australas Psychiatry 2016; 24:624. [PMID: 27590076 DOI: 10.1177/1039856216665284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Affiliation(s)
| | - Sharon Reutens
- New South Wales Justice Health and Forensic Mental Health Network, Sydney, NSW
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Abstract
OBJECTIVES It has been hypothesised that the very nature of the game predisposes elite cricketers to higher rates of suicide. AIM We aim to estimate the suicide rate of male Test cricketers and to determine the reasons for suicide. METHODS The suicide rate in male Test cricketers was determined. A psychological autopsy was conducted using published biographical data. RESULTS Twenty suicides amongst 2794 male Test cricketers from 1877 to 2014 yielded a suicide rate of 715.4 per 100,000 for that period. Health, financial and relationship issues were prominent; depression and alcohol misuse were common. CONCLUSIONS Most suicides in Test cricketers occurred post-retirement in mid to late life with similar correlates to those found in the general male population. The idiosyncrasies of cricket are unlikely to contribute to suicide; however, the post-retirement welfare of Test cricketers should remain a focus of concern and the greater supports available to contemporary Test cricketers needs to extend beyond retirement.
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Affiliation(s)
- Ajit Shah
- Honorary Professor, University of Central Lancashire, UK
| | | | - Chanaka Wijeratne
- Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, NSW, and; School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Brian Draper
- Clinical Director, Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, NSW; Conjoint Professor, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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Abstract
OBJECTIVES This paper is a guide to the general psychiatric assessment of the late career medical practitioner (LCP) from a clinical viewpoint. CONCLUSIONS Late career is a specific developmental stage in medical practitioners, a time of transition towards retirement. The treating psychiatrist should be mindful of the welfare of the practitioner, the public and the profession during the assessment, which is conducted from a complex therapeutic and regulatory viewpoint. It is important to assess the physical, psychological and cognitive health of the LCP. Although rates of burnout, depression and suicidal ideation are lowest in Australian doctors over 60, only a small minority of LCPs over 75 are likely to perform at a cognitive level similar to that of younger colleagues. There are a number of therapeutic challenges, including the practitioner's acceptance of their own ageing.
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Affiliation(s)
- Chanaka Wijeratne
- Senior Staff Specialist, Prince of Wales Hospital, Randwick, NSW, and; School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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Affiliation(s)
- Carmelle Peisah
- Specialist Mental Health Services for Older People; Mental Health and Drug and Alcohol; University of Sydney; Sydney New South Wales Australia
- School of Psychiatry; University of New South Wales; Sydney New South Wales Australia
- Capacity Australia; Sydney New South Wales Australia
- Adaptations to Aging Advisory Group; Australia
| | - Chanaka Wijeratne
- School of Psychiatry; University of New South Wales; Sydney New South Wales Australia
- Capacity Australia; Sydney New South Wales Australia
- Adaptations to Aging Advisory Group; Australia
| | - Bruce Waxman
- Academic Surgical Unit; Monash Health; Monash University; Sydney New South Wales Australia
- Adaptations to Aging Advisory Group; Australia
| | - Marianne Vonau
- Queensland Health; University of Queensland; Sydney New South Wales Australia
- Adaptations to Aging Advisory Group; Australia
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Wijeratne C, Peisah C. Accepting the challenges of ageing and retirement in ourselves: the need for psychiatrists to adopt a consensus approach. Aust N Z J Psychiatry 2013; 47:425-30. [PMID: 23399858 DOI: 10.1177/0004867413477220] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chanaka Wijeratne
- Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, Australia
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Affiliation(s)
- Sallyanne Aarons
- Psychologist in private practice; Sydney; New South Wales; Australia
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Wijeratne C. Behaviour and biomarkers in frontotemporal dementia: implications for general psychiatry. Aust N Z J Psychiatry 2012; 46:477-9. [PMID: 22535297 DOI: 10.1177/0004867412439054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Chanaka Wijeratne
- Prince of Wales Hospital, Randwick & School of Psychiatry, University of New South Wales, Randwick, Australia
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Blignault I, Manicavasagar V, Parker G, Wijeratne C, Sumathipala A. Building capacity in identification and management of mood disorders: an Australia-Sri Lanka collaboration. Australas Psychiatry 2012; 20:53-6. [PMID: 22357677 DOI: 10.1177/1039856211432481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This paper describes a collaborative capacity-building project in the identification and management of mood disorders, involving the Black Dog Institute in Sydney, Australia, and several organizations in Sri Lanka, and presents the qualitative evaluation findings. METHOD The two-year project comprised an initial intensive educational program delivered at the Institute with follow-up via email and an online forum (Phase 1), and continuing collaboration with the eight Sri Lankan clinicians and their respective organizations to build awareness of mood disorders and train others in Sri Lanka (Phase 2). RESULTS The eight trainees planned and executed several joint and separate activities during Phase 2, with an emphasis on raising awareness of mood disorders and health professional training. Evaluations of the local training activities were very positive. CONCLUSIONS The collaborative, systematic and systemic approach, and the train-the-trainer model adopted, has worked well. This project has built capacity in mood disorders among mental health clinicians in Sri Lanka, including those working in primary care. It has contributed to the implementation of national mental health policy, strengthened local networks and established new connections with Australian institutions. 'North-south' collaborations such as this would make good investments for international bodies and development agencies.
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Affiliation(s)
- Ilse Blignault
- Developing Countries Project, Black Dog Institute, Randwick NSW, Australia.
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Abstract
The ageing of the population brings particular challenges to psychiatric practice. Although the clinical presentation of common psychiatric disorders such as mood and psychotic disorders is largely similar to those in younger adults, late life presentations tend to be more complex as co-morbidity with dementia and physical illness is common. Suicide tends to increase with age in most countries. In this chapter we argue that the aetiology of disorders may be best understood within a stress vulnerability model in which neurobiological and psychosocial factors interplay. We further present that management strategies need to be comprehensive, incorporating physical, social, pharmacological, and psychological treatments appropriate to each case. We close with a call for the use of specialised multi-disciplinary services to improve the overall quality of care.
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Affiliation(s)
- C Wijeratne
- School of Psychiatry, University of New South Wales, Sydney, Australia
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Wijeratne C, Draper B. Reformulation of current recommendations for target serum lithium concentration according to clinical indication, age and physical comorbidity. Aust N Z J Psychiatry 2011; 45:1026-32. [PMID: 21961481 DOI: 10.3109/00048674.2011.610296] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There have been significant changes in the nature of psychiatric patient populations and patterns of drug prescribing in mood disorders since serum lithium monitoring was introduced. It seems opportune to review current guidelines for target lithium concentration given the decline in lithium monotherapy and increase in the numbers of older people and those with comorbid physical disease administered lithium. METHOD A review was made of the literature of lithium monitoring and target serum concentration in mood disorders, older people, and comorbid physical illness. RESULTS Current guidelines, which generally recommend a target serum concentration of 0.5/0.6 to 1.1/1.2 mmol/L, have a number of limitations. A target lithium level of > 0.8 mmol/L is inappropriate given poor tolerability, and adequate efficacy when combination lithium-antipsychotic therapy is used at this or lower levels. Guidelines have largely failed to match specific clinical indications to serum levels, and to consider comorbid physical illness factors known to be associated with lithium toxicity. CONCLUSION For most patients, a target serum lithium concentration range of 0.5-0.8 mmol/L, varying according to clinical indication, age and concurrent physical status, seems most appropriate in enhancing efficacy and minimizing adverse effects. The lower end of this range (0.5-0.6 mmol/L) is recommended for patients 50 years and over; those with diabetes insipidus, renal impairment or thyroid dysfunction; those administered diuretics, angiotensin converting enzyme (ACE) inhibitors or non-steroidal anti-inflammatory drugs (NSAIDs)/COX-2 inhibitors; and in the prophylaxis of bipolar depression and management of acute unipolar depression. The higher end of this range (0.7-0.8 mmol/L) is recommended in the management of acute mania and prophylaxis of mania.
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Affiliation(s)
- Chanaka Wijeratne
- University of New South Wales and Prince of Wales Hospital, Randwick, NSW 2031, Australia.
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Affiliation(s)
- Chanaka Wijeratne
- Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick 2031, NSW, Australia.
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Abstract
There has been much recent literature on the technical parameters of electroconvulsive therapy (ECT) with regard to improving efficacy and minimizing adverse effects, but relatively little on ECT service delivery. This paper will discuss the development and characteristics of an ECT service at a teaching hospital in metropolitan Sydney, New South Wales, Australia. A mixture of qualitative and quantitative methods, including a selective literature review and audit of ECT use were used. The results of the audit were compared with the 2007 revision of the Royal Australian and New Zealand College of Psychiatrists' clinical memorandum on ECT. We discuss issues, such as the optimal site for ECT delivery, ECT mental health nurse coordinator role, credentialing of psychiatrists, registrar supervision, and the development of an ECT committee. A significant finding of the audit was that the majority of patients were treated under the New South Wales Mental Health Act, and voluntary patients were more likely to have a diagnosis of a depressive disorder, whereas involuntary patients were more likely to have a non-mood disorder diagnosis. This study has shown that auditing of ECT practices and services by mental health nurses is essential for quality improvement processes. The audit highlighted areas of service delivery that should be subject to review and evaluation against professional standards.
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Affiliation(s)
- Scott Lamont
- Mental Health Liaison Nursing Mental Health Service, Prince of Wales Hospital, Sydney, New South Wales, Australia.
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26
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Abstract
Clozapine is associated with weight gain. We report three patients with substantial weight loss following treatment with clozapine. The weight loss observed in the three patients was 33, 18 and 14.4 kg with percentage loss of body weight of 49, 18 and 21 respectively. Two patients had diabetes mellitus. History, physical examination and extensive investigations in the three patients did not reveal any cause that could account for the weight loss.
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Affiliation(s)
- R Hanwella
- Department of Psychological Medicine, Faculty of Medicine, Colombo, Sri Lanka
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27
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Abstract
The aim of the present study was to critically appraise current conceptual approaches; demographic, neurobiological and clinical correlates; and management strategies of treatment-resistant depression (TRD), especially in light of recent research findings. To this end, a review of the relevant English-language literature was undertaken using Medline, Embase and Psychinfo. TRD has been defined in conceptually restrictive terms as symptomatic non-response to physical therapies alone, with little systematic study of aetiology made. It is likely that a range of sociodemographic (such as higher socioeconomic status), genetic (such as variation in functional monoamine polymorphisms) and clinical variables (such as signal hyperintensities seen on structural neuroimaging scans) are responsible for non-response in individuals. There is insufficient evidence to suggest that TRD is associated with specific subtypes of depression, physical comorbidity, personality or chronicity. The large-scale Sequenced Treatment Alternatives to Relieve Depression (STAR*D) and other studies have suggested that a structured psychotherapy such as cognitive behaviour therapy may be as effective as medication in initial drug non-responders. Also conventional alternatives such as the use of older antidepressant classes, pharmacological augmentation or electroconvulsive therapy in established cases of TRD are not as effective as traditionally thought. There is insufficient preliminary evidence to make formal recommendations about the use of novel brain stimulation techniques in TRD. TRD should be re-defined as the failure to reach symptomatic and functional remission after adequate treatment with physical and psychological therapies. Treatment resistance may be more usefully conceived within the context of well-defined cohorts such as patients with specific subtypes of depression. Although neurobiological markers such as gene polymorphisms, which are potentially predictive of medication tolerance and efficacy, may be used in the future, it is likely that sociocultural variables such as beliefs about depression, and evidence-based treatments for it, will also determine treatment resistance.
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Affiliation(s)
- Chanaka Wijeratne
- School of Psychiatry, University of New South Wales, Kensington, New South Wales, Australia.
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28
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Abstract
OBJECTIVE To review the evidence for an association between vascular disease and mania, and in this context, to assess the suitability of previously proposed diagnostic criteria. METHOD Relevant articles were retrieved and reviewed with the aid of search engines [MEDLINE, PsychInfo and EMBASE from 1996 to 2006] using pertinent search terms. Because of the paucity of data, systematic criteria for levels of evidence could not be applied. RESULTS The literature is limited by the preponderance of case reports or case series, the use of overlapping terms, such as secondary mania, disinhibition syndrome and poststroke mania, and variable definitions of mania per se. There is general support for a tentative association between mania and vascular risk factors, and also between mania and cerebrovascular disease. Such associations seem best described by the term vascular mania for the sake of clinical utility, although it erroneously conveys causality. Proposed diagnostic criteria have defined a late-age at onset (50 years +) sub-type of mania, with associated neuroimaging and neuropsychological changes which are not specific to this age group. CONCLUSION Further studies are needed to determine whether mania associated with vascular disease is a specific and separate sub-type with a late-age at onset. An alternative framework for considering vascular mania is proposed.
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Affiliation(s)
- C Wijeratne
- School of Psychiatry, University of NSW, The Prince of Wales Hospital, Sydney, New South Wales, Australia.
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29
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Abstract
OBJECTIVE In explaining the dimensions underlying nonpsychotic symptom reporting, traditional psychiatric paradigm has advocated a hierarchical model in which somatic symptoms are subsumed within two correlated psychological dimensions. A more recent alternate view is that somatic symptoms may be clearly separated from typical anxiety and depression symptoms if somatic symptoms are adequately recorded. The main aim of this study is to determine whether discrete somatic dimension(s) could be derived in older people. METHOD Exploratory factor analysis was used to determine the factor structure underlying the responses of 10662 ambulatory primary care patients, aged 60 years and over, who completed the 34-item SPHERE (Somatic and Psychological HEalth REport) questionnaire of somatic and psychological symptoms. In addition, weighted factor scores were compared according to whether there was a physical or psychological reason for presentation to a doctor. RESULTS A clinically interpretable four-factor solution, consisting of mood, cognitive, musculoskeletal, and fatigue symptoms, was derived. When factor analysis was repeated by gender, the only difference was that mood, cognitive, and pain-fatigue factors were derived in males. In the overall sample, all factor scores were higher in patients with a purely psychological reason for presentation. CONCLUSION Somatic symptoms could be measured independently of psychological symptoms in the current sample of older primary care patients.
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Abstract
Separation anxiety has been studied in children and young adults but little is known about this form of anxiety in older people. This study aimed to examine socio-demographic, psychological and physical health correlates of separation anxiety in the elderly. Eighty-six ambulatory subjects aged 62-87 years were recruited from primary medical care practices to participate in this study. The presence of lifetime DSM-IV affective and anxiety disorders was determined by structured clinical interview. Subjects also completed a battery of self-report questionnaires measuring levels of state and trait anxiety, juvenile and adult separation anxiety. Adult separation anxiety scores were moderately correlated with juvenile separation anxiety scores (r= .52, P < .001), trait anxiety (r = .55, P < .001) and state anxiety scores (r = .66, P < .001), as well as younger age (r = .39, P < .001). Higher adult separation anxiety scores were also associated with a lifetime history of any anxiety disorder (t = 3.74, df = 84, P < .001) or any affective disorder (t = 2.12, df = 84, P < .05). However, adult separation anxiety was not associated with increasing age, being widowed, living alone or poorer physical health. Clinicians working with the elderly need to routinely explore this form of anxiety as it may complicate the pattern of presentation of other anxiety and affective disorders, and require specific forms of intervention.
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Affiliation(s)
- Chanaka Wijeratne
- Department of Aged Care, St. George Hospital, University of New South Wales, Kogarah 2217, NSW, Australia.
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Wijeratne C, Brodaty H, Hickie I. The neglect of somatoform disorders by old age psychiatry: some explanations and suggestions for future research. Int J Geriatr Psychiatry 2003; 18:812-9. [PMID: 12949849 DOI: 10.1002/gps.925] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM The somatoform disorders have long been ignored by old age psychiatry. The main aim of this paper is to identify and examine possible reasons for this neglect. METHOD A selective review of the general literature on somatoform disorders. RESULTS Significant conceptual, diagnostic and classificatory problems have impeded the consideration of somatoform disorders in older people. There is a perception that somatoform disorders are infrequent and have not been validated as independent clinical disorders. However, we present evidence that the more broadly defined somatoform disorders are common in all age groups in primary care and meet criteria for the determination of clinical validity. General difficulties in the assessment of psychiatric disorders in primary care, the setting in which somatoform disorders are most common, are compounded by a lack of support from old age psychiatry services. Effective psychological therapies may not be readily available to sufferers. CONCLUSION There is a need for change in the conceptualisation and nosology of the somatoform disorders. The formulation of age appropriate diagnostic criteria and presentations is a prerequisite for determining the clinical validity of these disorders in older people. This can be followed by study of their frequency, associated risk factors and treatment. A system of education that enhances the management of these disorders within primary care and old age psychiatry services is needed.
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Abstract
OBJECTIVE The aim of this study was to compare demographic, illness and personality characteristics, and formal rates of mental disorder between younger (< 65 years) and older (>or= 65 years) patients attending a chronic pain clinic. METHOD Patients with non-malignant pain of > 6 months' duration attending a specialist outpatient clinic were given a structured medical and psychiatric interview, and completed self-report questionnaires assessing disability, personality style and attitudes to illness. RESULTS Fifty patients (26 of whom were older) participated in the study. None of the older patients had experienced the onset of chronic pain before the age of 50 years. Although current and lifetime major depression were common in both groups, there was no specific association between age and depression. The younger group was more likely to have been injured prior to the onset of pain and to be seeking financial compensation, reported more physical and social disability, and was more likely to be preoccupied with somatic discomfort. The younger group was also more likely to be rated as displaying impulsive personality traits and the older group anxious traits, although there was no difference in neuroticism scores. CONCLUSION Despite a greater level of multiple medical morbidity and longer duration of pain, older patients with chronic pain were not more likely to suffer from concurrent depression, were less disabled and less somatically preoccupied than younger patients. There were sufficient differences in illness and psychological characteristics to suggest that the older patients represented an aetiologically distinct sub-group, rather than patients with chronic pain of early onset who have simply grown old. Finally, the utility of DSM-IV defined somatoform disorders, in particular pain disorder, is discussed. A model which integrates medical and psychological mechanisms is needed for clinical use.
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Affiliation(s)
- C Wijeratne
- Consultant Aged Care Psychiatrist, St George Hospital, Conjoint Lecturer, School of Psychiatry, University of New South Wales, Sydney, Australia.
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33
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Abstract
Somatic distress syndromes, which include somatoform disorders and syndromes of chronic
fatigue such as neurasthenia but not somatic presentations of anxiety and depression, are one of the
common expressions of distress in primary care (Ormel et al. 1994) and general hospital settings
(Hemert et al. 1993). They are of considerable importance cross-culturally (Ono et al. 1999), and
often lie at the interface of psychiatry and medicine (Hickie, 1999). They are associated with
significant disability (Ormel et al. 1994; Andrews, 2000) and health-care utilization (Escobar et al.
1991).
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34
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Rajasegaram E, Wijeratne C, Mathangaweera R, Esufali ST. Wound infection survey at Teaching Hospital, Peradeniya. Ceylon Med J 2000; 45:180-1. [PMID: 11293969 DOI: 10.4038/cmj.v45i4.6729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Wijeratne C, Shome S. Electroconvulsive therapy and subdural hemorrhage. J ECT 1999; 15:275-9. [PMID: 10614035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Electroconvulsive therapy (ECT) was used to treat severe depressive illness in two patients, one of whom had undergone recent neurosurgery for subdural hemorrhage (SDH) and another with a concurrent SDH in the absence of raised intracranial pressure. Although the second patient died 1 month after the completion of ECT, in neither case did ECT extend the SDH or lead to other intracranial complications. It would seem that ECT can be performed safely in the presence of SDH without mass effect or after surgical drainage of SDH, although clinicians should proceed cautiously in close collaboration with neurosurgical colleagues, review neuroimaging scans at regular intervals during and after the course of ECT, and use the dose-titration method of treatment with unilateral electrode placement away from the site of the lesion or surgery to minimize adverse effects.
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Affiliation(s)
- C Wijeratne
- Division of Psychiatry, St. George Hospital, Kogarah, New South Wales, Australia
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36
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37
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Abstract
OBJECTIVE The aetiology of primary erotomania is usually discussed in terms of psychological disturbance in the patient. A case associated with demonstrable left temporal lobe abnormalities is described. CLINICAL PICTURE An elderly female patient presented with the delusion of being loved by a physician who had treated her previously. She had received radiotherapy to her left periorbital area in childhood. Structural and functional neuroimaging revealed medial temporal lobe damage. TREATMENT AND OUTCOME She was treated with haloperidol with moderate improvement in her distress. CONCLUSIONS This case illustrates the contribution of both cerebral injury and psychosocial factors in the eventual development of this unusual psychiatric syndrome.
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Affiliation(s)
- C Wijeratne
- Department of Aged Care, St George Hospital, Kogarah, New South Wales, Australia
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38
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Abstract
The recent literature on informal carers of dementia patients is reviewed. Families bear the major responsibility for such care. The production of "burden" in carers is a complex process, involving developmental and cultural factors, in addition to the stressors of dementia itself. Also influential are the carer's gender, coping style, social network, and the carer's level of intimacy with the elder. The interpretation of actual morbidity is complicated by methodologic problems. However, carers appear to suffer from at least moderate levels of psychological symptomatology. Carers tend to judge their own health to be poorer than that of controls. Some studies have also found aspects of caregiving to be associated with elder abuse, but this is controversial. Caregiving in dementia appears to be at least as stressful as that in chronic physical illness and depression. Finally, the implications for service provision and future research are considered.
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Affiliation(s)
- C Wijeratne
- Department of Aged Care, St. George Hospital, Kogarah, Australia
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39
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Wijeratne C. Neuroleptic malignant syndrome and malignant hyperthermia. Aust N Z J Psychiatry 1996; 30:874. [PMID: 9034482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Peiris JB, Gunatilake S, Wijeratne C, Gunatillake N. Myasthenia gravis in Sri Lanka. Ceylon Med J 1991; 36:155-8. [PMID: 1807843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
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.
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Affiliation(s)
- J B Peiris
- Institute of Neurology, General Hospital, Colombo, Sri Lanka
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