One hundred and twenty criminal defendants referred to a state hospital forensic unit underwent extensive examinations for the purpose of arriving at psychiatric recommendations regarding competency to stand trial and criminal responsibility. Seventy variables were abstracted from these evaluations via use of a simple checklist. A series of discriminant function analyses utilizing these variables indicated that highly accurate predictions could be made regarding psychiatric recommendations with respect to both competency and responsibility. Factors most influential in determining these recommendations included mental status at the time of the offense, psychotic symptomatology, and DSM-III diagnoses.

Background Behavioural disturbances are a common and challenging issue in the management of neurodevelopmental disorders in children. Treatment with pharmacological methods becomes necessary when these behaviours interfere with the general wellbeing and daily activities of these children, and with therapeutic programmess. There is a growing evidence base for the use of risperidone in this context. However the use of this medication is limited by its side-effect profile and the need for consistent and regular monitoring of these side-effects. Currently there is a paucity of data on the usage patterns of risperidone and its side-effect profile in children in Sri Lanka. Aims To analyse the prescribing patterns, indications and monitoring of risperidone in children with a primary diagnosis of a neurodevelopmental disorder who were prescribed risperidone. Methods This was a retrospective study carried out in University Psychological Medicine Unit, Lady Rideway Hospital for Children, Colombo (LRH). All children diagnosed with Neurodevelopmental disorders in the years 2013 and 2014 who were commenced on risperidone were included. Results A total of 27 children, 14 in 2013 and 13 in 2014 were prescribed risperidone. This amounted to 2.1% of the total number of referrals in 2013 and 2.6% in 2014. Majority were males (77.8%) and ages ranged from 4 years and 3 months to 13 years. The main diagnosis was attention deficit hyperactivity disorder (29%) and aggression was the commonest indication (40.74%). Initial weight of the patient was not measured in 59.3% and weight gain thereafter was monitored only in two patients. Other common side effects were not monitored. Tardive dyskinesia was reported in one child. Pre-treatment investigations were not done in a majority (92.59%). Post-treatment monitoring was not done in 44.4%. Conclusion Prescription of risperidone for neurodevelopmental disorders was found to be used very sparingly in this sample. Deficiencies in monitoring for side effects were identified highlighting the need for regular monitoring.

Avoidant restrictive food intake disorder as introduced in the DSM 5, is an eating or feeding disturbance manifested by persistent failure to meet appropriate nutritional and/or energy needs, associated with significant loss of body weight and nutritional deficiencies. The disorder should not occur during the course of anorexia or bulimia nervosa. We describe a 14-year old adolescent girl who presented with clinical features that met the Brief report Case history N. was a 14-year old school girl who was studying in grade 9. She presented to child and adolescent services with a history of headache and severe weight loss of nine months duration. Her headache had started gradually and progressed, leading to interruption of daily routines and education. At the same time, she started refusing food, claiming that she disliked the taste of the food, even though her appetite was normal. There was no objective evidence of body image distortion such as repeated mirror gazing or frequent weighing, or a desire to be thin. She did not report weight reducing strategies such as binging, purging or excessive exercises. During the latter part of the illness, the food refusals were also manifested when she was angry, as well as to gain attention of her parents. Her parents were submissive, gave in to most of her demands, but also criticized her food habits frequently. By nature Miss N. was a perfectionist, meticulous teenager with excellent grades. Whenever examinations neared, she preferred to study continuously without attending school until she felt confident. She had few close friends, but tended to be reserved-she did not easily share her worries or concerns with parents or friends. At times of difficulties, she preferred to withdraw or even deny conflicts.

Background Somatic symptoms in children constitute a major burden in hospital settings and outpatient departments. Somatic symptoms are often a manifestation of internalization of symptoms in children with distress or anxiety spectrum disorders. Furthermore, since cultural background influences the ways in which a person manifests distress, the influence of cultural variability needs to be considered when interpreting somatic symptoms in children. Aims The objective of this study was to adapt the Children's Somatization Inventory-24 (CSI-24) for use among Sri Lankan Sinhalese speaking children. Methods Cultural adaptation and translation of the CSI-24 was done using the Delphi technique. After translation of the scale into Sinhalese, seven experts were chosen to rate the cultural appropriateness and content validity of each stem of the CSI 24 for use among the Sinhalese population, using a five point likert scale. After discussion and consensus, the tool was pre-tested among ten school children, prior to final evaluation. Results The translated tool had twenty-four items, similar to the original tool, resulting in no change in the scoring system. After discussion among the experts, certain items of the scale were modified and adapted to suit the local Sri Lankan context. Conclusions Through this study, we were able to develop a Sinhala translation of the CSI-24, which is culturally acceptable, and which has sound judgmental validity for the measurement of severity of somatic symptoms in Sri Lankan Sinhalese speaking children.