• Child and Adolescent Psychiatry

    Child and Adolescent Psychiatry

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    The Child and Adolescent Psychiatry (CAP) service has been running in the Department from the beginning. Earlier it was primarily an outpatient clinic-based service called Child Guidance Clinic (CGC), but since the starting of DM-CAP course in 2014, the services have been enhanced to inpatient service, special clinics, community psychiatry and telepsychiatry based service. Training of manpower is an essential component.

      Outpatient Services

      Child and Adolescent Services are provided through Room No. 203, Psychiatry OPD on all working days. Children and adolescents with a myriad of neuro-developmental, emotional and behavioural problems are attended to. Some of the common problems and disorders seen are as follows:

        • Intellectual disability
        • Autism, ADHD and other neuro-developmental problems
        • Depression and bipolar disorders
        • Psychotic disorders
        • Anxiety disorders and emotional disorders
        • Dissociative disorders and somatoform disorders

        Interventions include pharmacotherapy and psycho-social interventions including play therapy, family interventions and other psychotherapies.

        Special Clinics

        The following Special Clinics are run for group parent training interventions

        • ADHD (2nd Tuesday of every month)
        • Intellectual disability (3rd Tuesday of every month)
        • Autism Spectrum disorders (4th Tuesday of every month)
        Parent interventions through Telepsychiatry
        A weekly group parent training intervention for ADHD through Telepsychiatry is run.

        Inpatient Services

        A separate Child and Adolescent Psychiatry Ward caters to needs of patients needing admission for purposes of diagnosis and/ or intervention.

    The Department of Psychiatry runs a 3-year DM (Child and Adolescent Psychiatry) training program. The goal of the program is to create such super specialists in the field of CAP, who can function as experts in the field proficient in clinical acumen/skills of patient care; in active teaching; productive research; and advocacy. The content of the curriculum includes clinical CAP, Infant Psychiatry, Child & Adolescent Substance Abuse, Neuro-Development and child neurology, Disabilities and rehabilitation, General Pediatrics as applicable to CAP, C-L Psychiatry, Theories of development and clinical child psychology, Community CAP mental health, Legal, administrative perspectives on child and adolescent mental health and Therapeutics.

    Additionally, Junior Residents (MD trainees) are also posted with Child and Adolescent Psychiatry Services on a rotational basis.

    Service Responsibilities of CAP SR

    Common service responsibilities of CAP SR

    Academic and Research Duties:

    • Attend all academics for DM CAP program and specific academic activities for MD such as Monday seminar, CC, and pediatric psychosomatic rounds
    • Responsibility of guiding the JRs in the patient management and in their academics
    • Teaching of Resident doctors as a part of evening classes of MD Psychiatry curriculum
    • Teaching and training of JRs during their posting in CAP. Classes will be taken by SRs at least three times in a week and will be repeated for every new batch of JRs
    • Participate in the ongoing research work in the Department
    • Suggest new areas of research
    Service responsibilities while posted in CAP OPD

    The SR is overall co-coordinator of the CAP OPD services and ensures smooth functioning of CAP OPD.CAP OPD SR has following responsibilities:

    Clinical responsibility:
    • Runs the Walk-In-Clinic (WIC). In case of 2 DM SRs posted in OPD simultaneously, the second SR shallcarry out detailed evaluations (work up) of child cases on Mondays, Tuesdays and Fridays and for adolescents on Wednesdays, Thursdays and Saturdays.
    • CAP SRs must follow up cases as mentioned in the responsibility of the Follow up SRs in the General Adult Psychiatry section
    • Shall attend to patients in specialty clinics (LD clinic and Autism clinic), including carrying out special assessments and non-pharmacological interventions under supervision of the Faculty I/C
    • Shall participate in parent training group sessions for children with ID
    • Reaches the OPD by 8.00 am (if no academics in the morning), and by 9.15 am on the days of academics
    • Maintains walk–in Register, Appointment–Register for patients, follow up Register and Psychotherapy Register for CAP OPD psychotherapy cases under his/her care
    • Carries out detailed work-up and discusses with a Faculty
    • Allocates cases to JRs for detailed work-up and fixes up consultation with a Faculty
    • Discussion about important issues regarding clinical care with the JR and also make a note in the file
    • Ensures that all details in the file are completed.
    • Clearly write the diagnosis and further plan of management in the file
    • Keep a track of the patients‖ progress and discuss with Faculty from time to time
    • SR follow-up clinic (Tuesday and Thursday afternoon OPD) caters to the old cases for follow-up purpose. This is to evaluate the progress of all patients in detail, and discuss important aspects in patient’s health and treatment strategies with FacultyI/C
    Administrative and legal responsibilities
    • Keep a secure custody of all the MLC files
    • Supervise coding of WIC data by OPD PSW and analyses of the same for the annual statistical meeting
    • Arranges all admissions except emergency admissions and maintains a waiting list for ward admissions

    Service responsibilities while posted in CAP ward

    Clinical responsibility:

    Is the main co-ordinator and overall I/C of the ward

    Following admission of any patient to the ward, the ward SRsmust: o Receive the patient at admission

    First, assess the severity of the patient, prioritize the need of the patient andmanage accordingly must write an admission note

    • In liaison with the Faculty member (I/C of the case) shall conduct evening teaching cum service rounds with the JRs and discuss the cases admitted to the ward. Shall supervise and guide the JRs in carrying out the treatment of the patients
    • Effective communication and coordination among ward SR /CAP and OPD SR
      • Should intimate every day the exact number of vacant beds to SR of CAP OPD
    • Maintain a Psychotherapy Register in which residents record the beginning, and terminal dates of psychotherapy for all such cases under them
    • Periodically update and work as per instructions of the Faculty in-charge of the patient regarding clinical management
    • Post discharge follow up is to be done by CAP SR along with JRs under supervision of Faculty I/C
    • All administrative issues must be informed to HOD through proper channel
    • Ensure that all the treatment related instructions are being followed by JR, nursing staff and the family members of the patients
    • Regularly check case files of all patients in CAP ward for proper documentation of the daily progress notes, investigation done and ensure that discharge summary be prepared and case files be dispatched from CAP ward with in specified limit (48 hrs and one week respectively)
    • Make provisions so that patients with disabilities admitted in the CAP ward get the benefit of legislations, policies and programs pertaining to children and adolescents in India
    • Supervise the play room and ensure that it is well equipped and utilized
    • Supervise coding of clinical data by JRs and analyses of the same for the annual statistical meeting

    Service Responsibilities of CAP JR

    Responsibilities related to work in CAP OPD:
    • On the OPD workup days (currently Monday, Tuesday & Friday) they are expected to reach OPD by 9.15 AM during days in which there are morning academics. Otherwise, they must report to Room no. 210 SR by 8:00 AM
    • They do detailed work-up of the cases, which includes a detailed history, physical and mental examination to establish the diagnosis and make a comprehensive treatment plan. They must not take more than 1 hour to complete each OPD work up. The CAP SR will decide the number of cases allotted to each JR
    • Each case is then discussed with a Faculty for opinion on diagnoses and management, which has to be recorded in the case notes
    • They are responsible for providing the longitudinal care of the patients they have worked up under the supervision of CAP SR
    • CAP SR along with the concerned Junior Resident does follow-up of the patients
    • They are also responsible for the adequate maintenance of the case files. They must record each follow up carefully
    • They record the psychotherapy sessions done on OPD basis, enter them in CAP psychotherapy Register and report the same to CAP SR
    • They must complete all clinical works (investigation, consultations) related to patients admitted in the ward, before coming to the OPD on the workup days
    • They are responsible for total management of patients admitted in CAP ward under the supervision of SR
    • Every JR should be available on call 24X 7 to the nursing staff and other members of treating team in relation to the treatment of their respective patients
    • Inpatient record maintenance procedure is similar to the Psychiatry Ward
      • While handling over the case to another JR they should personally introduce the new JR to the patient and his family members

    About DDTC

    One of the major influences in my training as a psychiatrist was that of Dr. Robert A. Moore of the University of Michigan, USA. He was the Director of Residency Training while I trained there (1963-65).

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    Department of Psychiatry

    Sector 12, Chandigarh-160012

    Telephone: +91-172275-6801 / 6812 / 6818

    Email: psychiatryoffice.pgimer@gmail.com

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