St John's Medical College Hospital

Child and Adolescent Psychiatry Services

There are hardly a score of full time child psychiatrists in India. Most of the Psychiatrists ought to see Adults and some chose to spend variable amount of time on child mental health issues. At, St. Johns, children were seen by all psychiatrists as part of general services from 1980 onwards.

1993- Early form of a developing discipline. One identified faculty.

1996- more frequent clinics - Two identified faculty. Emphasis on services development.

1997 – active liaison with Pediatrics begun.

  • conference publications on clinical epidemiological data—developmental disorders including ADHD somatoform disorders and emotional disorders.

1998-2001 – Developing community links with schools and special educational centers / Additional staff dedicated to child adolescent mental health

  • Initial studies Heart Rate Variability and child psychopathology

2001 – Began efforts to adapt structured clinical interview into child psychopathology into the local language(MAGIC). Small studies looking at child psychopathology in medical conditions.

2003- More staff, some went overseas on Sabbaticals and were exposed to Cognitive Neuro Scientific explorations in psychiatry. Community explorations of cognition and nutrition and children at risk begun from St.Johns Research Institute by Dr.Srinivasan.

2005-2007 – Larger faculty numbers, Community liaison, PDD related studies begun. Additional staffing situation has increasingly begun to permit more staff time for academic work. Active exploration for developing links to foster research interests of the faculty members.

2004 onwards – Active core member of the Unit of Hope – for children with special needs. Evaluations, treatments and preventive programs have been ongoing.

Faculty Members with dedicated time to Child Psychiatry as of July 2017:

Ashok Mysore V, MD, Professor, Psychiatry

Manohari SM, DPM, DNB, MRCPsych, Professor, Psychiatry

Vijaya Raman, MPhil, PhD, Professor, Clinical Child Psychology

Bhavana Prasad, DNB, Senior Resident in Child Psychiatry

PhD Scholars: Ms. Sahitya Gowda and Ms. Alem

 

Brief glimpse 2016 - Calendar year

Out Patient Registrations in Child and Adolescent Psychiatry: About 125 per week(New Registrations). This includes 30-40 from Pediatrics services from within the hospital. Number of Children following up (Follow-Up Cases): About 150-160 per week.

Number of Children admitted (always with one or more family member): Over 100 in Psychiatry. A ward with four beds dedicated for this purpose, besides Special wards which are used across the age groups.

Experience in the Child and Adolescent team includes: All faculty members are actively involved in conducting workshops and symposia for a variety of professionals including Pediatricians, Lay-Counselors, Special Educators Teachers, and Priests with regard to identification and brief intervention in child mental health issues. Specific research efforts include:

Studying children of Adults with Psychopathology: Alcoholism in Fathers and Depression and Panic disorder in mothers – Interest in role of family history and behavioral outcomes in children and adolescents.

Developing local adaptation of Structured Interviews with child / adolescent psychopathology (MAGIC)

Exposure to neuroimaging and imaging protocols from a social cognition perspective.

Evaluation of therapies in children and adolescents at clinic and community level.

Epidemiological studies – School based and Community based.

Comprehensive studies of children with PDD underway funded by Indian Council for Medical Research.

Role of Iron in ADHD and Hyperkinesis – Funded intra-murally.

Part of an All India study exploring Childhood OCD.

Role of Parental Personality in Childhood anxiety Disorders (ongoing as a doctoral dissertation)

Psychological aspects and Therapies in Chronic medical illnesses, such as Nephrotic Syndrome (ongoing as a doctoral dissertation).

Development of a Depression rating Instrument in Adolescents – in collaboration with Department of Community Health, SJMC and Department of Psychology, University of Miami.

Dissertational studies by MD Psychiatry post graduates: Focused on Autism, Concept of Parental Supervision, ADHD and its correlates, Eating Disorder.

Child Guidance Clinic OPD’s (Room No. 25 – Old OPD building) - 9.30am to 2.30pm

  1. Dr.M.V.Ashok Professor of Psychiatry – Wednesday and Saturday
  2. Dr.S.M.Manohari Professor of Psychiatry – Tuesday, Friday and by appointment on Saturday
  3. Dr.Vijaya Raman –Professor of Clinical Psychology – Tuesday, Wednesday and Saturday.
  4. PhD Scholars who work with the Consultants in the team

Facilities available for assessment and management:

Assessment:

  1. Developmental assessment
  2. Assessment of intelligence
  3. Assessment for specific learning disability
  4. Neuropsychological assessment.
  5. Diagnostic assessments
  6. School and parent completed questionnaires based assessments for behavioral/ emotional problems

Treatment:

  1. Behaviour therapy
  2. Play therapy / Individual Psychotherapy for children and Adolescents.
  3. Parental counseling and Education regarding the Child’s difficulties (Psycho- Education).
  4. Family counseling to improve inter-personal aspects within the family, with a view to helping the child to improve.
  5. Special School placements / Liaison with regular schools and special schools for clinical and certification purposes.
  6. Medications to alleviate certain types of difficulties.

Children who are seen in our clinic include the following:

  1. Children with Mental Retardation or Learning Disabilities
  2. Children with Pervasive Developmental Disorders / Autism Spectrum Disorders
  3. Children who have medical illnesses like diabetes, asthma, thalassemia etc. – psychological issues related to diagnosis and management.
  4. Children with behavioral problems like hyperactivity, conduct problems like stealing, lying, truancy etc., oppositional behavior.
  5. Children with emotional problems like anxiety or fearfulness, shyness, depression, school refusal, bedwetting, soiling, nail biting, thumb sucking etc.
  6. Children with other problems like pain – stomach pain and headache with no known medical causes, Stress related symptoms etc.

Unit of Hope and the Child Mental Health Team

Dr. Ashok MV and Dr. Vijaya Raman are both core members of the Unit of Hope for the last decade. Dr. Ashok also doubles up as the Assistant Co-ordinator of the Unit of Hope team. The services provided are detailed assessments and treatments for children and parents of children with multiple disabilities. Along with all the above mentioned activities that are available for all children registered in the Unit of Hope, the following are the unique services provided in this Unit:

  1. All children and parents from the Unit of Hope are counseled regularly to ensure compliance with the medical treatment of the child.
  2. Parents are specifically evaluated and treated for their own psychological issues that are common when dealing with a child with a chronic illness.
  3. Siblings and other stakeholders are met with regularly to make help available to them.
  4. Children are monitored for their development regularly – both clinically and with assessment tools – and plans made accordingly. This includes the Neonatal Follow-Up Clinic. Detailed reports are given that are shared with Pediatricians, Orthopedicians, Speech therapists, Occupational therapists and other teachers who are involved in the child’s care.
  5. As many children seen in the Unit of Hope have co- morbid emotional and behavior problems, these are evaluated – again clinically and with assessment tools – and treated so that the child’s functioning is improved.
  6. Liaison with the school and centers as well as special schools is offered for all children who are on follow up with the Child Mental Health Team.

Eating Disorder Clinic

This is co-ordinated by Dr. Manohari. This involves consultation with Psychiatrist, Clinical Psychologist, Pediatrician and a nutritionist. This specifically works on first Saturday of the month. However, once registered, concerned teenagers will continue to be seen on a regular basis on other OP days.