A transdisciplinary public health model for child and adolescent mental healthcare in low- and middle-income countries.

Despite the high burden of child and adolescent mental health problems in LMICs, attributable to poverty and childhood adversity, access to quality mental healthcare services is poor. LMICs, due to paucity of resources, also contend with shortage of trained mental health workers and paucity of standardized intervention modules and materials. In the wake of these challenges, and given that child development and mental health concerns cut across a plethora of disciplines, sectors and services, public health models need to incorporate integrated approaches to responding to the mental health and psychosocial care needs of vulnerable children. This article presents a working model for convergence, and the practice of transdisciplinary Public Health, in order to address the gaps and challenges in child and adolescent mental healthcare in LMICs. Located in a state tertiary mental healthcare institution, this national level model reaches (child care) service providers and stakeholders, duty-bearers, and citizens (namely parents, teachers, protection functionaries, health workers and other interested parties) through capacity building initiatives and tele-mentoring services, public discourse series, developed for a South Asian context and delivered in diverse languages. Role of Funding Source: The Ministry of Women and Child Development, Government of India, provides financial support to the SAMVAD initiative.

Palliative Care in Duchenne Muscular Dystrophy: A Study on Parents' Understanding.

INTRODUCTION: Duchene muscular dystrophy (DMD) is a neuromuscular disease of childhood, which has clear progression. The international standardized care guidelines for DMD suggest that palliative care is essential for the affected children. OBJECTIVE: To explore the parent's understanding of palliative care services available for children with DMD and the challenges faced by them in utilizing the same. METHODS: A cross-sectional qualitative exploratory study was conducted among six families of boys diagnosed with DMD. A semi-structured interview guide with prompts was used to conduct in-depth interviews which lasted for an average of 1 h. Thematic analysis was done to identify the pattern or themes. RESULTS: The major themes identified were "palliative care, living with DMD, Awareness about palliative care services and challenges." Awareness about palliative care services is the dominant theme identified as influencing rest of the experiences narrated by the parents of children with DMD. DISCUSSION: Integration of palliative care services from an early stage of the illness can help the child to make transition from one stage to another stage of the illness. To ensure the utilization of the available palliative care services, there is a need to create awareness about it among the general public. CONCLUSION: Introducing the concept of palliation of symptoms and ensuring quality of life of the child with DMD by accessing the available services can aid the parents to reach out for help for their child.

Clinical characteristics of children presenting with history of sexual abuse to a tertiary care centre in India.

OBJECTIVES: To study the clinical features of children with history of sexual abuse. METHOD: A chart review of 40 children (<16 years) with history of Child Sexual Abuse (CSA) evaluated at the Department of Child and Adolescent Psychiatry at NIMHANS during a three year period. RESULTS: 52.5% (N=21) of the children came from broken families. The most common form of abuse was contact penetrative (67.5%) followed by contact non-penetrative abuse (30%). Seventy-Five percent (N=30) had a psychiatric diagnosis at baseline and 37.5% of these children had comorbidities. The commonest diagnoses were Depressive Disorder (35%) followed by Stress related disorders--PTSD and Acute Stress Disorder (25%). Children abused multiple times were more likely to have psychiatric illness following CSA. Children abused by multiple perpetrators were more likely to have depression, psychiatric comorbidity and more prone to exhibit sexualized behaviour. Sixty five percent of children did not follow up 8 weeks after the initial consultation. DISCUSSION: Psychiatric morbidity is high in the population of children with history of CSA. It is necessary to assess the risk factors, circumstances of abuse along with psychiatric morbidity in order provide flexible and tailor made interventions for this population. In order to ensure the best possible care for these families, focused and time limited intervention that respect the needs of the child and addresses the ground realities of the circumstances of the family and the health system are the need of the day.

Review of electroconvulsive therapy practice from a tertiary Child and Adolescent Psychiatry Centre.

AIMS AND OBJECTIVES: The use of electroconvulsive therapy (ECT) in children and adolescents is a controversial issue. This study was done to examine the pattern and practice as well as the outcome of electroconvulsive therapy administered to children and adolescents admitted to a tertiary care centre. METHODOLOGY: A 10 year retrospective chart review of all children and adolescents (up to 16 years of age) admitted in the Child and Adolescent Psychiatry Centre, National Institute of Mental Health and Neurosciences (NIMHANS) who had received at least 1 session of ECT was done. Information regarding diagnosis, reasons for prescribing electroconvulsive therapy, details regarding the procedure and outcome variables was collected from the records. Clinical Global Impressions (CGI) scale rating of the severity of illness and improvement seen were done by 2 trained psychiatrists independently. RESULTS: 22 children and adolescents received electroconvulsive therapy over 10 years. There were an equal number of boys and girls. All received modified ECT. Most patients who received electroconvulsive therapy were severely ill. Catatonic symptoms 54.5% (12) were the most common reason for prescribing electroconvulsive therapy. It was efficacious in 77.3% (17) of the patients. Electroconvulsive therapy was relatively safe, and most experienced no acute side effects. 68.2% (15) who were on follow up and did not experience any long term side effects due to the electroconvulsive therapy. CONCLUSIONS: Electroconvulsive therapy has a place in the acute management of severe childhood psychiatric disorders. Further long term prospective studies are required.

Clinical characteristics of aggression in children and adolescents admitted to a tertiary care centre.

BACKGROUND AND NEED FOR THE STUDY: Identification and management of aggression is a major mental health priority in hospitalised patients. However, no such studies have been done in child and adolescent in-patients in India. OBJECTIVES: To study the clinical and demographic features; characteristics of the aggression and methods employed to manage aggression in child and adolescent in-patients. MATERIALS AND METHODS: Child and adolescent in-patients between the ages of 4 and 16 years who were aggressive were included. The tools used were the MINI-International Neuropsychiatric Interview (M.I.N.I) KID, Overt Aggression Scale (OAS), Children's Global Assessment Scale (CGAS), and a Semi-structured interview regarding each aggressive episode. RESULTS: 31 patients displayed aggressive behaviour out of the 131 patients who were admitted during the study period. Aggressive acts were more common in males, those with academic difficulties, who had a past history of aggression, with suicidal ideation or suicidal attempts. Aggression occurred across diagnostic categories but a significant proportion was diagnosed to have Disruptive Behaviour Disorders either as a primary diagnosis or as comorbidity. 90.6% were on psychotropic medication prior to admission. Around 2/3rd of aggressive episodes occurred in the evening and family members (85.7%) were the most common targets of aggression. CONCLUSION: There are a few factors that can possibly help identify and predict aggression in children and adolescents in a hospital setting. More research is required to understand aggression in clinical settings.