Christina George - Academia.edu (original) (raw)

Papers by Christina George

Predictive factors for polypharmacy among child and adolescent psychiatry inpatients

Journal of the Indian Academy of Geriatrics, 2020

Indian Journal of Psychological Medicine, 2020

314 Indian Journal of Psychological Medicine | Volume 42 | Issue 3 | May-June 2020 This is an ope... more 314 Indian Journal of Psychological Medicine | Volume 42 | Issue 3 | May-June 2020 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. Access this article online

Indian Journal of Psychological Medicine, 2019

Background: Medical students are subjected to various challenges, which are possibly etiological ... more Background: Medical students are subjected to various challenges, which are possibly etiological in the onset and persistence of depression. There is inadequate research on the longitudinal pattern and correlates of the emotional health of medical students in India. We aim to delineate the longitudinal pattern of depression among medical students and the factors predictive of depression. Methods: An 18-month follow-up design with 350 students (2012 intake) from two medical colleges in Kerala, India, was employed. A semistructured questionnaire and the Patient Health Questionnaire 9 were administered 2, 8, and 18 months into the course. Results: Depression was present in 42.80%, 36.20%, and 42.50% of the students at the three assessments. Variables significantly associated with depression on univariate analysis were the course not being of the student's choice at the first assessment; having an unemployed parent (mother) at the second assessment; alcohol use and male gender at the third assessment. On multivariate analysis, male gender (OR = 1.95[1.11-3.41]) and the presence of depression at 2 months (OR = 2.30[1.31-4.05]) and 8 months (OR = 2.48[1.39-4.44]) were predictive of depression at 18 months. Conclusions: The high rates of depression and the pattern of high rates early in the course among the medical students contrasts with that reported from other countries. Early depression and male gender were predictive of depression later in the course. The implications of this are to be taken into consideration when undergraduate intervention programs are planned.

Psycho-Oncology, 2019

Depression is an easily treatable yet frequently underdiagnosed entity in palliative population w... more Depression is an easily treatable yet frequently underdiagnosed entity in palliative population with deleterious implications on their quality of life. It has been studied poorly in a developing country such as India. Methods-A cross-sectional study was done with 234 consenting subjects attending a palliative care unit. PHQ-9, WHOQOL-BREF and semi-structured pro-forma were used by trained non-mental health professional to collect data. Results-The prevalence of major depression was 70%. Being a resident of nuclear family(p-0.004), absence of insurance coverage(p-0.01), presence of financial difficulties(p-0.002) and absence of cancer recurrence(p-0.001) were significantly associated with major depression in univariate analysis. In multivariate analysis, presence of financial difficulties [ O.R.=3.9, 95%CI 2.00-7.61] and absence of health insurance [O.R.=1.92 95%, C.I 1.02-3.7] were independently associated with major depression. The presence of depression showed significant negative correlation with physical health(p=0.03), psychological health(p=0.002) and environmental (p=0.002) domains of the WHOQOL-BREF. Conclusion-This study brings to the fore the high rates of depression and its negative impact on the quality of life of terminally ill cancer patients. An improvement in their quality of life requires measures to reduce the rate of underdiagnosed psychiatric morbidities, especially in those who are financially burdened and lack insurance coverage.

Kerala Journal of Psychiatry, May 7, 2015

Background: As mental health services in the community are ill-developed, in India, the care of i... more Background: As mental health services in the community are ill-developed, in India, the care of individuals with mental illness lies mostly with the family. Studies elsewhere have shown that families of patients with mental illness have significant levels of caregiver burden, and that such burden has negative consequences on both the patients and the caregivers. Methods: A cross sectional study assessed 46 randomly selected individuals with mental illness registered in a community mental health program and their caregivers. Burden Assessment Schedule and WHO Disability Assessment Scale were employed, and sociodemographic and clinical variables were assessed. Results: The most common diagnosis was psychosis (28.3%), and the caregiver was most commonly the mother (32.6%). The mean score on the WHODAS was 26.48 ± 7.48. The mean levels of caregiver burden on the BAS were-impact on wellbeing: 7.28 ± 2.66, impact on marital relations: 8.10 ± 3.07, appreciation for caregiving: 6.09 ± 1.88, impact on relations with others: 6.67 ± 2.42, and perceived severity of disease: 7.26 ± 2.51. The female and illiterate caregivers reported significantly more burden. Levels of caregiver burden were not associated with any other clinical or sociodemographic variables. Conclusion: Significant levels of caregiver burden were present in the sample of predominantly female caregivers. The resources within mental health services of this country need to be improved to address this aspect. The possible benefits of communitybased services in this context are discussed.

Asian Journal of Psychiatry, 2016

Agitation within psychiatry inpatient settings is not well studied in India. There is evidence of... more Agitation within psychiatry inpatient settings is not well studied in India. There is evidence of a high prevalence of agitation (Barlow et al., 2000; Foster et al., 2007) within psychiatry inpatient settings and its adverse effects in western countries (Foster et al., 2007; Hankin and Bronstone, 2011). Elucidating the pattern of agitation may assist in planning more effective intervention strategies within inpatient settings. Recognition of the correlates of agitation will help in early identification and even in prevention of episodes of agitation. Agitation is conventionally conceptualized by health care professionals as a commonly occurring, highly disabling set of emotions and behaviours (Yudosky et al., 1997). It has been variously described. According to experts, it involves extreme forms of arousal that is associated with increased verbal and motor activity (Stewart, 1995; Zayas and Grossberg, 1996). Agitation has also been defined as ''excessive verbal and/or motor behaviour'' that can be loud, disruptive, hostile, sarcastic, threatening, hyperactive, and/or combative. Agitation can be due to a general medical condition, intoxication and withdrawal, and decompensated psychiatric disease (Barlow et al., 2000; Chukwujekwu and Stanley, 2011). Associated motor activity is usually repetitive and non-goal directed and may include wringing, hair pulling, and fiddling with clothes or other objects (Yudosky et al., 1997). Agitation has been described to exist on a continuum from anxiety to high anxiety, to agitation, to aggression. Aggression also has various definitions. It has been defined as a ''psychological state or as a hostile physical or verbal act or as behaviour resulting in injuries of persons or damage to objects'' (Abderhalden et al. 2007). The term ''aggression'' has been used interchangeably with agitation, with agitation scales describing both physical and verbal aggression (Cohen-Mansfield et al., 1989), though the term ''agitation'' is usually employed for more innocuous disturbances. 1.1. Prevalence and predictors of agitation in psychiatry inpatients Agitation among psychiatry inpatients is common (Barlow et al., 2000; Hankin and Bronstone, 2011; Karson and Bigelow, 1987), and, unless recognized early and managed effectively, may rapidly escalate to potentially dangerous behaviours, including physical violence (Hankin and Bronstone, 2011). There are varied findings on the prevalence of aggression in acute inpatient settings with 13.7% being reported in Australia (Barlow et al., 2000),while James and colleagues reported a prevalence of 23% (James et al., 1990). In a multicentric retrospective evaluation, Carr et al reported 25-30% of

Clinical practice and epidemiology in mental health : CP & EMH, Jan 22, 2006

Aim was to determine the predictive factors for polypharmacy among inpatient children and adolesc... more Aim was to determine the predictive factors for polypharmacy among inpatient children and adolescents with psychiatric disorders. Blinded, case-note review of children and adolescents with ICD 10 diagnosis of psychiatric disorders on psychotropic medication was conducted. Data on demography, illness, and treatment was analyzed with univariate and multivariate techniques. Proscribing non-pharmacological interventions (OR = 4.7) and pro re nata medication (OR = 3.3), increased the risk of polypharmacy. Prescribing physical restraint reduced the risk of receiving multiple medications (OR = 0.3). Proscribing non-pharmacological interventions, pro re nata medication and physical restraints increased polypharmacy.

Journal of Critical Care, 2011

Delirium is a common, difficult-to-diagnose clinical condition in critical care units. The lack o... more Delirium is a common, difficult-to-diagnose clinical condition in critical care units. The lack of recognition of delirium often results in increased morbidity and mortality. The study aimed to determine the validity and reliability of the Intensive Care Delirium Screening Checklist (ICDSC) in a resource-poor medical intensive care setting in South India. Fifty-three patients admitted into the medical intensive care unit of a teaching hospital who were neither mute nor intubated were recruited for the study. Trained residents administered the ICDSC to screen for delirium. A consultant psychiatrist used the International Classification of Diseases, 10th Revision diagnostic criteria for research to determine the presence of delirium. The optimal threshold for screening, as ICDSC total score of 3 or more, was obtained by using a receiver operating characteristic curve. Although a sensitivity and specificity of 75% and 74%, respectively, were obtained at the original cutoff of 4, a sensitivity of 90% and specificity of 61.54% were achieved with a cutoff of 3. In a subsample of 21 patients, interrater reliability was evaluated and found to be 0.947 (95% confidence interval, 0.870-0.979). The ICDSC had good internal consistency, with Cronbach α of .754 and Guttman split-half coefficient of 0.71. Factor analysis revealed a 2-factor structure, namely, altered sensorium/psychopathology and sleep-wake cycle problems. Our findings indicate that in nonintubated intensive care unit patients, the ICDSC can be used to screen for delirium but should not be used as a diagnostic instrument in this patient population and that residents can be trained in the use of the instrument in resource-poor critical care settings. Using a different threshold for positivity of 3 rather than 4 appeared to offer improved screening characteristics in this resource-poor critical care setting.

International Journal of Mental Health Systems, 2011

Objective: To compare and contrast three models of community mental health services in low-income... more Objective: To compare and contrast three models of community mental health services in low-income settings. Data Sources/Study Setting: Primary and secondary data collected before, during, and after site visits to mental health programs in Nigeria, the Philippines, and India. Study Design: Qualitative case study methodology. Data Collection: Data were collected through interviews and observations during site visits to the programs, as well as from reviews of documentary evidence. Principal Findings: A set of narrative topics and program indicators were used to compare and contrast three community mental health programs in low-income countries. This allowed us to identify a diversity of service delivery models, common challenges, and the strengths and weaknesses of each program. More definitive evaluations will require the establishment of data collection methods and information systems that provide data about the clinical and social outcomes of clients, as well as their use of services. Conclusions: Community mental health programs in low-income countries face a number of challenges. Using a case study methodology developed for this purpose, it is possible to compare programs and begin to assess the effectiveness of diverse service delivery models.

Asia-Pacific Psychiatry, 2012

Introduction: The Asian earthquake and subsequent tsunami of December 2004, one of the largest na... more Introduction: The Asian earthquake and subsequent tsunami of December 2004, one of the largest natural disasters in history, resulted in the deaths of over 250,000 people and massive destruction in eight countries. The mental health consequences of the disaster remain relatively poorly explored. This study sought to go beyond the dose-response paradigm to examine the effect of pre-disaster socio-cultural variables on common mental disorders (CMD) after the tsunami. Methods: A cross-sectional survey was conducted 9-11 months after the 2004 tsunami in a low-income setting in South India to assess the association between CMD, disaster-related losses and pre-disaster sociocultural variables in a convenience adult sample of tsunami survivors. Results: Sixty-four percent (339) of the 532 individuals sampled and included in the analysis screened positive for CMD. Multivariate analysis showed that female gender, older age, poor quality marital life before the disaster and death of a primary family member due to the tsunami were associated with CMD. Discussion: A large majority of the sample in an area of South India screened positive for CMD 9-11 months after the tsunami. These data served as an impetus in planning a long-term, five-year post-disaster intervention. Accurate longitudinal data about risk and protective factors after a disaster are needed to plan medium-and long-term interventions.

American Journal of Psychiatry, 2001

... GEORGE, DPM, MD; PRATHAP THARYAN, MD, MRCPSYCH. Am J Psychiatry 2001;158:1331-a-1332. ... All... more ... GEORGE, DPM, MD; PRATHAP THARYAN, MD, MRCPSYCH. Am J Psychiatry 2001;158:1331-a-1332. ... All rights reserved. Share. Get Citation PRIYA MAMMEN, CHRISTINA GEORGE, PRATHAP THARYAN; Questions About Reasons for Living. American Journal of Psychiatry. ...