Thomas Embling Hospital

Background and ObjectivesTinnitus is a common and disabling condition that largely remains undertreated in Sri Lanka. Currently, standardized tools that assess and monitor the treatment of tinnitus or the distress it causes are unavailable in either of the two main vernacular languages prevalent in Sri Lanka. The Tinnitus Handicap Inventory (THI) is used internationally to measure tinnitus-induced distress and to monitor treatment efficacy. In this study, we validated the Sinhala version of the THI (THI-Sin).Subjects and MethodsThe THI was translated into Sinhala and back translated into English and finalized by independent translators. The THI-Sin questionnaire and the 12-item General Health Questionnaire (GHQ-12) and Visual Analog Scale of tinnitus annoyance (VAS) were administered to 122 adults who visited the otolaryngology clinic of Colombo North Teaching Hospital, Ragama, Sri LankaResultsTHI-Sin scores showed satisfactory internal consistency (Cronbach’s α=0.902) and were significantly correlated with the GHQ-12 and VAS scores. Factor analysis of the THI-Sin confirmed a three-factorial structure, which did not correspond to the original THI subscales.ConclusionsWe observed significant reliability and validity of the THI-Sin tool for evaluation of tinnitus-induced handicaps among the Sinhalese-speaking population of Sri Lanka.

The present study detailed an initial consensus on the use of MB in FT for PCa. This is until evidence becomes available on the subject.

Inclusion in work and education remains problematic for many people with a mental illness. We describe a structured programme - the Health Optimisation Program for Employment - that supported people with a mental illness to gain employment or commence studies. Twenty hours of the Health Optimisation Program for Employment were delivered to 600 individuals. Participants were asked to complete an evaluation survey encompassing vocational status and ratings of self-efficacy. Of the 364 participants who completed the baseline assessment, 168 responded to the evaluation survey 6 months after the delivery of the Health Optimisation Program for Employment. Of these, 21.5% had started a new job, while a further 42.8% were either volunteering or studying. Satisfaction with the programme was high and self-efficacy ratings improved significantly over the short term only. The Health Optimisation Program for Employment requires further evaluation using rigorous scientific methodology but these initial results are encouraging in terms of vocational attainment for people with a mental illness, in the Australian context.

The only systematic studies of attacks on public figures come from the USA. These studies de-emphasize the role of mental illness and suggest threats are of no predictive value. This study re-examines these questions through a study of attacks on European politicians. All non-terrorist attacks on elected politicians in Western Europe between 1990 and 2004 were analysed. Twenty-four attacks were identified, including five involving fatalities, and eight serious injuries. Ten attackers were psychotic, four drunk, nine politically motivated and one unclassifiable. Eleven attackers evidenced warning behaviours. The mentally disordered, most of whom gave warnings, were responsible for most of the fatal and seriously injurious attacks. A greater awareness of the link between delusional fixations on public figures and subsequent attacks could aid prevention. Equally importantly, recognition would encourage earlier intervention in people who, irrespective of whether they eventually attack, have delusional preoccupations which ruin their lives.

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Asperger's Syndrome is a pervasive developmental disorder on the Autistic spectrum. Antisocial behaviour is frequently described as an accompaniment of Asperger's Syndrome although the strength of any association between Asperger's Syndrome and offending remains uncertain. This paper presents five patients with Asperger's Syndrome with a history of offending. For each of them the offending is understandable in the context of the disorder. The specific and general issues raised by these cases in relation to Fitness to Plead and Legal Insanity are considered. Offenders with Asperger's Syndrome have deficits that raise the likelihood that their disorder will render them unfit or be of exculpatory value.

This study examined the impact of using various archival sources of violence data on the recorded base rate of violence and on the accuracy of violence risk assessments in a sample of civil psychiatric patients. Violence in the community, after release from involuntary hospitalization, was measured with 3 types of archival data: criminal records, psychiatric hospital readmission records, and readmission records from multiple general hospitals. Findings indicated that the different measurement sources each identified unique incidents of violence, which were correlated moderately or not at all with one another, and that the estimated base rate of violence varied substantially as a function of outcome source. Not surprisingly, using a combination of sources identified the highest base rate of violence. Predictive validity estimates also varied widely under different measurement procedures and were more stable when a combination of sources was used. It is important in practical and research terms for studies of psychiatric patient violence to use multiple sources of outcome data.

One of the most difficult tasks facing the clinician in the forensic setting is to engage meaningfully with clients who have been mandated to attend therapy. This article contends that unwillingness to engage in treatment is a complex, murti‐dimensional construct Three major impediments to therapy are identified: little motivation, contextual factors that inhibit treatment involvement and the use of techniques that do not translate to treatment of forensic patients. Beyond the organisational challenges of modifying the context in which unwilling clients find themselves, therapists can work personally on motivation and treatment techniques in engaging such clients. A number of preferred therapeutic strategies are suggested.

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