Preeti Jacob - Academia.edu (original) (raw)

Papers by Preeti Jacob

Archives of Mental Health, 2016

Background: Eating Disorders (ED) were largely thought of as a western phenomenon; however studie... more Background: Eating Disorders (ED) were largely thought of as a western phenomenon; however studies have shown that these disorders exist in India. The exact incidence & prevalence of ED is not known in India. We present data from a 10 year retrospective chart review from a tertiary care child and adolescent psychiatry centre in India. Methodology: A 10 year (March 2002-March 2012) retrospective chart review of children and adolescents (up to 16 years) who had attended the child and adolescent psychiatry outpatient services at our centre and diagnosed to have Eating Disorders according to ICD-10 were included in the study. Results: The 10 year prevalence rate of eating disorders was 0.063%. Eating disorders was more common in females (83.3 %)( n=10) in this sample. The female to male ratio was 5:1. The mean age at presentation was 14.42 years (SD 1.08). 83.3% had a co-morbid psychiatric disorder with obsessive-compulsive disorder and depression being the most common. Conclusion: The ...

Indian Journal of Psychiatry, 2019

Context: Almost 1/5th of the adolescent population suffers from mental morbidity. In older adoles... more Context: Almost 1/5th of the adolescent population suffers from mental morbidity. In older adolescents, clinical challenges are accompanied by unique psychosocial and developmental needs. Recent legislations in India – the Mental Health Care Act, 2017 and the Juvenile Justice Act, 2015 – mandate specific arrangements and provisions for evaluation and treatment of children and adolescents. A separate inpatient Adolescent Psychiatry Center (APC) was started at National Institute of Mental Health and Neurosciences, Bangalore, in 2016. Aims: (a) The aim of this study is to present the need for, development, infrastructure and workforce at APC; (b) to describe clinical profile of adolescents admitted to APC and (c) to identify clinical and psychosocial challenges in the management of older adolescents. Setting and Design: The paper covers consecutive inpatient admissions over the first 7 months of APC. Materials and Methods: Data were gathered from a review of hospital records, staff mee...

Background: Few studies in India have focussed on psychosocial issues and caregiver perspectives ... more Background: Few studies in India have focussed on psychosocial issues and caregiver perspectives on in-patient aggression, which can potentially impact the way aggression is understood and managed. Aims & Objectives: To study the psychosocial variables and caregiver perceptions on the nature, severity, precipitating, provoking factors and the methods employed to manage an aggressive episode in an in-patient tertiary care child and adolescent psychiatry centre. Materials and Methods: All consecutive episodes of aggression from February to April 2011 were recorded prospectively using MINI KID, Overt Aggression Scale (OAS), Children’s Global Assessment Scale (CGAS), and a Semi-structured interview regarding the aggressive episode. Results: 119 episodes of aggression were recorded in 31 in-patients amongst the 131 admissions during the study period. Marital discord and punitive parenting correlated positively with certain subscales on the Overt Aggression Scale (OAS). Psychopathology (2...

Indian Journal of Psychiatry, 2018

Substance use disorders in children and adolescents are a significant cause of concern as they ca... more Substance use disorders in children and adolescents are a significant cause of concern as they can have long term implications in practically every sphere. The etiological factors that contribute to substance use disorders are complex and the formulation must amalgamate and synthesize all the different factors including the predisposing, perpetuating, precipitating and protective factors in order to plan management. Interventions must stem from this comprehensive formulation and must be child-focused, multidisciplinary, multisystemic, with strong family participation and community involvement. The treating team must actively collaborate with the young person and help him/her understand the rationale for treatment in order for them to engage in it. Assessment and treatment of comorbidities are an important part of intervention package. Skill training for problem solving, emotional regulation, social skills, and communication are an essential part of the treatment for substance use di...

Translational Psychiatry, 2021

The possibility of early treatment and a better outcome is the direct product of early identifica... more The possibility of early treatment and a better outcome is the direct product of early identification and characterization of any pathological condition. Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairment in social communication, restricted, and repetitive patterns of behavior. In recent times, various tools and methods have been developed for the early identification and characterization of ASD features as early as 6 months of age. Thorough and exhaustive research has been done to identify biomarkers in ASD using noninvasive neuroimaging and various molecular methods. By employing advanced assessment tools such as MRI and behavioral assessment methods for accurate characterization of the ASD features and may facilitate pre-emptive interventional and targeted therapy programs. However, the application of advanced quantitative MRI methods is still confined to investigational/laboratory settings, and the clinical implication of these imaging me...

Background: This study examines the short term course and outcome of children and adolescents dia... more Background: This study examines the short term course and outcome of children and adolescents diagnosed to have Attention Deficit Hyperactivity Disorder (ADHD) and treated from an out-patient service of a tertiary care centre in India Methodology: 63 children were diagnosed to have ADHD of whom 39 children were available at 6 months for a face- to –face follow up. The tools used were MINIKID, Vineland Social Maturity Scale, Attention Deficit Hyperactivity Disorder-Rating Scale –IV (ADHD-RS), Children's Global Assessment Scale (CGAS) and Clinical Global Impressions Scale. Results: The clinic prevalence of ADHD was 10.5%. ADHD- combined was the most common subtype (92.1%). At the end of 6 months, 84.6% continued to fulfill criteria for ADHD. The mean baseline ADHD-RS and CGAS scores significantly improved over the period of follow up. Severity of illness at baseline and presence of oppositional defiant disorder predicted poorer outcome at 6 months. Conclusion: ADHD is a stable dis...

Bulletin of the Menninger Clinic, 2021

Obsessive-compulsive disorder (OCD) has been described in preschool children as young as 2–3 year... more Obsessive-compulsive disorder (OCD) has been described in preschool children as young as 2–3 years old. A preschool age onset of OCD has unique diagnostic and therapeutic challenges. In this article, the authors review published literature on preschool onset OCD and present data on preschool-onset OCD (age of onset ≤ 5 years) from clinical records at a tertiary care child and adolescent psychiatry center in India. Literature suggests that OCD that starts this early is phenomenologically similar to OCD in older individuals; however, it has very high rates of comorbidity and a family history of OCD. There is a paucity of data on course, treatment, and long-term outcome in this group. At their center, the authors found a 3% prevalence of preschool-onset OCD, with a male predominance (69%) and fairly high comorbidity rates (62%). Qualitative review highlighted delay in treatment seeking, poor follow-up rates, frequent use of pharmacological treatment, and a high remission rate in those ...

Infant Mental Health Journal, 2021

PURPOSE The need to enhance mental health in primary care settings for infants and toddlers is in... more PURPOSE The need to enhance mental health in primary care settings for infants and toddlers is increasingly becoming apparent. However, the lack of trained healthcare personnel and culturally appropriate measures makes it a challenge in low- and middle-income countries. A needs-based assessment of the extent of the problems in toddlers will help address the lacunae in providing mental health services. METHODS A needs-based assessment was carried out of a community sample of 9,287 mothers with toddlers aged between 13 and 25 months in Kerala, India. This assessment was conducted by junior public health nurses using an indigenously developed checklist titled 'Screening checklist for Behavioural, Emotional and Rhythm-related disturbances in Toddlers' (S-BERT). RESULTS According to the mothers surveyed, 30.4% of toddlers had concerning or distress causing behaviours. Three factors, namely behavioural, rhythm-related and emotional disturbances, were deemed significant when the item response theory was used to examine the factor structure of S-BERT. CONCLUSION This study suggests that behaviours that cause distress to mothers of toddlers are common, if queried specifically. Given the constraints in health resources as the cultural factors in operation, use of indigenous tools and principles of collaborative stepped care may be the way forward.

Asian Journal of Psychiatry, 2021

Indian Journal of Psychological Medicine, 2020

Background: Tic disorders (TDs) are common neurodevelopmental disorders in children and adolescen... more Background: Tic disorders (TDs) are common neurodevelopmental disorders in children and adolescents. To date, there is very scant literature on TDs in children and adolescents in the Indian setting. Aim: The objectives of this study were to characterize the clinical profile, including comorbidities and pattern of medication use in the treatment of TDs, in children and adolescents. Materials and Methods: The present study is a retrospective chart review of children and adolescents up to age 18 years diagnosed with TD in a tertiary care center in India. Data were derived from case records of patients with a diagnosis of TD, coded as F 95 according to ICD 10, from 1st January 2014 to 31st December 2017. Results: We recruited 85 subjects. The majority (95.29%, n = 81) of them were male, and the mean age of onset was 8.4 years. Chronic tic disorder was the most common subtype, followed by Tourette syndrome and provisional or transient tic disorder. Eighty patients (94%) had a comorbid disorder, with attention deficit hyperactivity disorder being the most common, followed by obsessive compulsive disorder. Eighty-two percent of patients received pharmacotherapy. Risperidone was the most frequently used medication, followed by clonidine, haloperidol, and aripiprazole. Moderate to significant improvement with medications was seen in 88% of the patientsConclusion: The present study of children and adolescents with TDs highlights very high rate of comorbidity and a favorable short-term course with medication use.

Child and Adolescent Psychiatry and Mental Health, 2020

Background Nepal is a developing low-income country in Southeast Asia. There is a huge burden of ... more Background Nepal is a developing low-income country in Southeast Asia. There is a huge burden of child and adolescent mental health (CAMH) in Nepal which has a population of around 29 million and 40–50% of the population comprises of children and adolescents. Child and Adolescent Psychiatry (CAP) has not been formally recognized as a subspecialty in Nepal and there is no standardized curriculum for CAP training. The objectives of the survey were to identify the current status of training, shortfalls and to explore the training experiences of early career psychiatrists (ECPs) in Nepal. Methods The participants were ECPs in Nepal. An online questionnaire was created consisting of 20 questions including 3 questions requiring an answer indicating a level of agreement scored on a ten-point scale. Questionnaire using google form was e-mailed with the uniform resource locator (URL). Respondents anonymously answered the questions. The survey was open from 01/01/2019 to 01/04/2019. Results R...

Molecular Psychiatry, 2020

Journal of Psychiatrists' Association of Nepal, 2019

Introduction: Tourette Syndrome is a type of tic disorder that is not as rare as it was once thou... more Introduction: Tourette Syndrome is a type of tic disorder that is not as rare as it was once thought to be. There is a paucity of literature on Tourette syndrome in children and adolescents in the Indian setting. The objectives of this study were to elucidate sociodemographic and clinical profile of children and adolescents with Tourette syndrome. Material and Method: The present study is a retrospective chart review of children and adolescents up to age 18 years diagnosed with Tourette Syndrome in a tertiary care centre, India. This sample is from a subset of a larger sample of case records of patients with a diagnosis of tic disorder, coded as F 95, according to ICD 10 from 1st January 2014 to 31st December 2017 (4 years duration). Results: The sample included 28 children. All of them were male, and the mean age of onset was 8.2 years. The period prevalence of Tourette syndrome was 0.22%. The entire sample received pharmacotherapy and the most common medication prescribed was Risp...

BMC Psychiatry, 2020

Background Low and middle-income countries like India with a large youth population experience a ... more Background Low and middle-income countries like India with a large youth population experience a different environment from that of high-income countries. The Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA), based in India, aims to examine environmental influences on genomic variations, neurodevelopmental trajectories and vulnerability to psychopathology, with a focus on externalizing disorders. Methods cVEDA is a longitudinal cohort study, with planned missingness design for yearly follow-up. Participants have been recruited from multi-site tertiary care mental health settings, local communities, schools and colleges. 10,000 individuals between 6 and 23 years of age, of all genders, representing five geographically, ethnically, and socio-culturally distinct regions in India, and exposures to variations in early life adversity (psychosocial, nutritional, toxic exposures, slum-habitats, socio-political conflicts, urban/rural living, mental illness in the...

European Child & Adolescent Psychiatry, 2019

India has a considerable skilled manpower deficit in the area of child and adolescent mental heal... more India has a considerable skilled manpower deficit in the area of child and adolescent mental health, given its population and their needs. To address this deficit, in the recent past, various centres in India have begun specialty training in the field of child and adolescent psychiatry with the lead being taken by the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore. This is a welcome step in the right direction. However, specialty training of this nature cannot exist in a vacuum. There is a need for a comprehensive and cohesive child and adolescent mental health policy which must include adopting certain standards in training in the various sub-specialties of child and adolescent mental health. From this national policy, provisions must be made for a spectrum of care from specialized tertiary care to high-quality community-based care. Dedicated, skilled mental health professionals who will impart training at the highest level as well help train a cadre of specialists (psychiatrists, pediatricians) and non-specialists with various degrees of exposure and training in the field of child and adolescent mental health are the need of the hour to have a stepped model of care. This will go a long way in ensuring effective and equitable distribution of the sparse human resources. Similar issues may operate in other low- and middle-income countries and thus the discussion may be relevant to such populations as well.

Indian Journal of Psychiatry, 2019

10.4103/psychiatry.IndianJPsychiatry_580_18 Operational terms used in the guidelines The term “ch... more 10.4103/psychiatry.IndianJPsychiatry_580_18 Operational terms used in the guidelines The term “child”/“children” will appear in most references to children and adolescents. At some places, distinguishing age groups becomes relevant. The term “child” will be used for all children between 0 and 12 years of age and the term “adolescent” for those between 13 and 18 years of age. To further delineate the early developmental period, where needed, the term “infant” will be used for children 0–12 months of age and “toddler” for children between 12 and 36 months of age. Given that children have to be evaluated and managed in the context of their caregiving environment, parents and the extended family are important informants and an integral part of the treatment plan. The term “parents” will be used for the biological or adoptive parents of the child, and the term “family” will be used for all other individuals who live in the same household (siblings, grandparents, other members in a joint family, etc.). For any other individual involved in primary caretaking responsibilities of the child, the term “caregiver(s)” will be used.

Archives of Mental Health, 2016

Background: Eating Disorders (ED) were largely thought of as a western phenomenon; however studie... more Background: Eating Disorders (ED) were largely thought of as a western phenomenon; however studies have shown that these disorders exist in India. The exact incidence & prevalence of ED is not known in India. We present data from a 10 year retrospective chart review from a tertiary care child and adolescent psychiatry centre in India. Methodology: A 10 year (March 2002-March 2012) retrospective chart review of children and adolescents (up to 16 years) who had attended the child and adolescent psychiatry outpatient services at our centre and diagnosed to have Eating Disorders according to ICD-10 were included in the study. Results: The 10 year prevalence rate of eating disorders was 0.063%. Eating disorders was more common in females (83.3 %)( n=10) in this sample. The female to male ratio was 5:1. The mean age at presentation was 14.42 years (SD 1.08). 83.3% had a co-morbid psychiatric disorder with obsessive-compulsive disorder and depression being the most common. Conclusion: The ...

Indian Journal of Psychiatry, 2019

Context: Almost 1/5th of the adolescent population suffers from mental morbidity. In older adoles... more Context: Almost 1/5th of the adolescent population suffers from mental morbidity. In older adolescents, clinical challenges are accompanied by unique psychosocial and developmental needs. Recent legislations in India – the Mental Health Care Act, 2017 and the Juvenile Justice Act, 2015 – mandate specific arrangements and provisions for evaluation and treatment of children and adolescents. A separate inpatient Adolescent Psychiatry Center (APC) was started at National Institute of Mental Health and Neurosciences, Bangalore, in 2016. Aims: (a) The aim of this study is to present the need for, development, infrastructure and workforce at APC; (b) to describe clinical profile of adolescents admitted to APC and (c) to identify clinical and psychosocial challenges in the management of older adolescents. Setting and Design: The paper covers consecutive inpatient admissions over the first 7 months of APC. Materials and Methods: Data were gathered from a review of hospital records, staff mee...

Background: Few studies in India have focussed on psychosocial issues and caregiver perspectives ... more Background: Few studies in India have focussed on psychosocial issues and caregiver perspectives on in-patient aggression, which can potentially impact the way aggression is understood and managed. Aims & Objectives: To study the psychosocial variables and caregiver perceptions on the nature, severity, precipitating, provoking factors and the methods employed to manage an aggressive episode in an in-patient tertiary care child and adolescent psychiatry centre. Materials and Methods: All consecutive episodes of aggression from February to April 2011 were recorded prospectively using MINI KID, Overt Aggression Scale (OAS), Children’s Global Assessment Scale (CGAS), and a Semi-structured interview regarding the aggressive episode. Results: 119 episodes of aggression were recorded in 31 in-patients amongst the 131 admissions during the study period. Marital discord and punitive parenting correlated positively with certain subscales on the Overt Aggression Scale (OAS). Psychopathology (2...

Indian Journal of Psychiatry, 2018

Substance use disorders in children and adolescents are a significant cause of concern as they ca... more Substance use disorders in children and adolescents are a significant cause of concern as they can have long term implications in practically every sphere. The etiological factors that contribute to substance use disorders are complex and the formulation must amalgamate and synthesize all the different factors including the predisposing, perpetuating, precipitating and protective factors in order to plan management. Interventions must stem from this comprehensive formulation and must be child-focused, multidisciplinary, multisystemic, with strong family participation and community involvement. The treating team must actively collaborate with the young person and help him/her understand the rationale for treatment in order for them to engage in it. Assessment and treatment of comorbidities are an important part of intervention package. Skill training for problem solving, emotional regulation, social skills, and communication are an essential part of the treatment for substance use di...

Translational Psychiatry, 2021

The possibility of early treatment and a better outcome is the direct product of early identifica... more The possibility of early treatment and a better outcome is the direct product of early identification and characterization of any pathological condition. Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairment in social communication, restricted, and repetitive patterns of behavior. In recent times, various tools and methods have been developed for the early identification and characterization of ASD features as early as 6 months of age. Thorough and exhaustive research has been done to identify biomarkers in ASD using noninvasive neuroimaging and various molecular methods. By employing advanced assessment tools such as MRI and behavioral assessment methods for accurate characterization of the ASD features and may facilitate pre-emptive interventional and targeted therapy programs. However, the application of advanced quantitative MRI methods is still confined to investigational/laboratory settings, and the clinical implication of these imaging me...

Background: This study examines the short term course and outcome of children and adolescents dia... more Background: This study examines the short term course and outcome of children and adolescents diagnosed to have Attention Deficit Hyperactivity Disorder (ADHD) and treated from an out-patient service of a tertiary care centre in India Methodology: 63 children were diagnosed to have ADHD of whom 39 children were available at 6 months for a face- to –face follow up. The tools used were MINIKID, Vineland Social Maturity Scale, Attention Deficit Hyperactivity Disorder-Rating Scale –IV (ADHD-RS), Children's Global Assessment Scale (CGAS) and Clinical Global Impressions Scale. Results: The clinic prevalence of ADHD was 10.5%. ADHD- combined was the most common subtype (92.1%). At the end of 6 months, 84.6% continued to fulfill criteria for ADHD. The mean baseline ADHD-RS and CGAS scores significantly improved over the period of follow up. Severity of illness at baseline and presence of oppositional defiant disorder predicted poorer outcome at 6 months. Conclusion: ADHD is a stable dis...

Bulletin of the Menninger Clinic, 2021

Obsessive-compulsive disorder (OCD) has been described in preschool children as young as 2–3 year... more Obsessive-compulsive disorder (OCD) has been described in preschool children as young as 2–3 years old. A preschool age onset of OCD has unique diagnostic and therapeutic challenges. In this article, the authors review published literature on preschool onset OCD and present data on preschool-onset OCD (age of onset ≤ 5 years) from clinical records at a tertiary care child and adolescent psychiatry center in India. Literature suggests that OCD that starts this early is phenomenologically similar to OCD in older individuals; however, it has very high rates of comorbidity and a family history of OCD. There is a paucity of data on course, treatment, and long-term outcome in this group. At their center, the authors found a 3% prevalence of preschool-onset OCD, with a male predominance (69%) and fairly high comorbidity rates (62%). Qualitative review highlighted delay in treatment seeking, poor follow-up rates, frequent use of pharmacological treatment, and a high remission rate in those ...

Infant Mental Health Journal, 2021

PURPOSE The need to enhance mental health in primary care settings for infants and toddlers is in... more PURPOSE The need to enhance mental health in primary care settings for infants and toddlers is increasingly becoming apparent. However, the lack of trained healthcare personnel and culturally appropriate measures makes it a challenge in low- and middle-income countries. A needs-based assessment of the extent of the problems in toddlers will help address the lacunae in providing mental health services. METHODS A needs-based assessment was carried out of a community sample of 9,287 mothers with toddlers aged between 13 and 25 months in Kerala, India. This assessment was conducted by junior public health nurses using an indigenously developed checklist titled 'Screening checklist for Behavioural, Emotional and Rhythm-related disturbances in Toddlers' (S-BERT). RESULTS According to the mothers surveyed, 30.4% of toddlers had concerning or distress causing behaviours. Three factors, namely behavioural, rhythm-related and emotional disturbances, were deemed significant when the item response theory was used to examine the factor structure of S-BERT. CONCLUSION This study suggests that behaviours that cause distress to mothers of toddlers are common, if queried specifically. Given the constraints in health resources as the cultural factors in operation, use of indigenous tools and principles of collaborative stepped care may be the way forward.

Asian Journal of Psychiatry, 2021

Indian Journal of Psychological Medicine, 2020

Background: Tic disorders (TDs) are common neurodevelopmental disorders in children and adolescen... more Background: Tic disorders (TDs) are common neurodevelopmental disorders in children and adolescents. To date, there is very scant literature on TDs in children and adolescents in the Indian setting. Aim: The objectives of this study were to characterize the clinical profile, including comorbidities and pattern of medication use in the treatment of TDs, in children and adolescents. Materials and Methods: The present study is a retrospective chart review of children and adolescents up to age 18 years diagnosed with TD in a tertiary care center in India. Data were derived from case records of patients with a diagnosis of TD, coded as F 95 according to ICD 10, from 1st January 2014 to 31st December 2017. Results: We recruited 85 subjects. The majority (95.29%, n = 81) of them were male, and the mean age of onset was 8.4 years. Chronic tic disorder was the most common subtype, followed by Tourette syndrome and provisional or transient tic disorder. Eighty patients (94%) had a comorbid disorder, with attention deficit hyperactivity disorder being the most common, followed by obsessive compulsive disorder. Eighty-two percent of patients received pharmacotherapy. Risperidone was the most frequently used medication, followed by clonidine, haloperidol, and aripiprazole. Moderate to significant improvement with medications was seen in 88% of the patientsConclusion: The present study of children and adolescents with TDs highlights very high rate of comorbidity and a favorable short-term course with medication use.

Child and Adolescent Psychiatry and Mental Health, 2020

Background Nepal is a developing low-income country in Southeast Asia. There is a huge burden of ... more Background Nepal is a developing low-income country in Southeast Asia. There is a huge burden of child and adolescent mental health (CAMH) in Nepal which has a population of around 29 million and 40–50% of the population comprises of children and adolescents. Child and Adolescent Psychiatry (CAP) has not been formally recognized as a subspecialty in Nepal and there is no standardized curriculum for CAP training. The objectives of the survey were to identify the current status of training, shortfalls and to explore the training experiences of early career psychiatrists (ECPs) in Nepal. Methods The participants were ECPs in Nepal. An online questionnaire was created consisting of 20 questions including 3 questions requiring an answer indicating a level of agreement scored on a ten-point scale. Questionnaire using google form was e-mailed with the uniform resource locator (URL). Respondents anonymously answered the questions. The survey was open from 01/01/2019 to 01/04/2019. Results R...

Molecular Psychiatry, 2020

Journal of Psychiatrists' Association of Nepal, 2019

Introduction: Tourette Syndrome is a type of tic disorder that is not as rare as it was once thou... more Introduction: Tourette Syndrome is a type of tic disorder that is not as rare as it was once thought to be. There is a paucity of literature on Tourette syndrome in children and adolescents in the Indian setting. The objectives of this study were to elucidate sociodemographic and clinical profile of children and adolescents with Tourette syndrome. Material and Method: The present study is a retrospective chart review of children and adolescents up to age 18 years diagnosed with Tourette Syndrome in a tertiary care centre, India. This sample is from a subset of a larger sample of case records of patients with a diagnosis of tic disorder, coded as F 95, according to ICD 10 from 1st January 2014 to 31st December 2017 (4 years duration). Results: The sample included 28 children. All of them were male, and the mean age of onset was 8.2 years. The period prevalence of Tourette syndrome was 0.22%. The entire sample received pharmacotherapy and the most common medication prescribed was Risp...

BMC Psychiatry, 2020

Background Low and middle-income countries like India with a large youth population experience a ... more Background Low and middle-income countries like India with a large youth population experience a different environment from that of high-income countries. The Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA), based in India, aims to examine environmental influences on genomic variations, neurodevelopmental trajectories and vulnerability to psychopathology, with a focus on externalizing disorders. Methods cVEDA is a longitudinal cohort study, with planned missingness design for yearly follow-up. Participants have been recruited from multi-site tertiary care mental health settings, local communities, schools and colleges. 10,000 individuals between 6 and 23 years of age, of all genders, representing five geographically, ethnically, and socio-culturally distinct regions in India, and exposures to variations in early life adversity (psychosocial, nutritional, toxic exposures, slum-habitats, socio-political conflicts, urban/rural living, mental illness in the...

European Child & Adolescent Psychiatry, 2019

India has a considerable skilled manpower deficit in the area of child and adolescent mental heal... more India has a considerable skilled manpower deficit in the area of child and adolescent mental health, given its population and their needs. To address this deficit, in the recent past, various centres in India have begun specialty training in the field of child and adolescent psychiatry with the lead being taken by the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore. This is a welcome step in the right direction. However, specialty training of this nature cannot exist in a vacuum. There is a need for a comprehensive and cohesive child and adolescent mental health policy which must include adopting certain standards in training in the various sub-specialties of child and adolescent mental health. From this national policy, provisions must be made for a spectrum of care from specialized tertiary care to high-quality community-based care. Dedicated, skilled mental health professionals who will impart training at the highest level as well help train a cadre of specialists (psychiatrists, pediatricians) and non-specialists with various degrees of exposure and training in the field of child and adolescent mental health are the need of the hour to have a stepped model of care. This will go a long way in ensuring effective and equitable distribution of the sparse human resources. Similar issues may operate in other low- and middle-income countries and thus the discussion may be relevant to such populations as well.

Indian Journal of Psychiatry, 2019

10.4103/psychiatry.IndianJPsychiatry_580_18 Operational terms used in the guidelines The term “ch... more 10.4103/psychiatry.IndianJPsychiatry_580_18 Operational terms used in the guidelines The term “child”/“children” will appear in most references to children and adolescents. At some places, distinguishing age groups becomes relevant. The term “child” will be used for all children between 0 and 12 years of age and the term “adolescent” for those between 13 and 18 years of age. To further delineate the early developmental period, where needed, the term “infant” will be used for children 0–12 months of age and “toddler” for children between 12 and 36 months of age. Given that children have to be evaluated and managed in the context of their caregiving environment, parents and the extended family are important informants and an integral part of the treatment plan. The term “parents” will be used for the biological or adoptive parents of the child, and the term “family” will be used for all other individuals who live in the same household (siblings, grandparents, other members in a joint family, etc.). For any other individual involved in primary caretaking responsibilities of the child, the term “caregiver(s)” will be used.