Dr Adhiraj Joglekar - Private Child and Adolescent Psychiatrist | London

Dr Adhiraj Joglekar, Private Consultant Child and Adolescent Psychiatrist, London

2014-02-19T17:03:00.011+00:00

Dr. Adhiraj Joglekar

MBBS, MD, MRCPSYCH, CCT in Child and Adolescent Psychiatry

Speciality

Psychiatry / Psychological Medicine

Year Qualified

1992

Post-Pandemic Update:

The pandemic has helped transform service delivery. We can accommodate more referrals by offering virtual meetings where appropriate. The face-to-face appointments are, however, preferred for all initial assessments.

To book a time, please complete this Referral Form

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Dr Joglekar is a qualified doctor who specialises in Child & Adolescent Psychiatry / Mental Health. He offers his services in the independent health sector through a private practice located at Syon Clinic in West London. At busy times, Dr Joglekar may also be available at a site in Ealing, West London via First Step Clinic.

Dr Joglekar provides expertise in the assessment, diagnosis, and treatment of ADHD, Psychosis, Mood and Anxiety Disorders, as well as Eating Disorders, among other conditions in children, adolescents, and young adults. For a full list of psychiatric conditions, click here for the child & adolescent psychiatry services and scope of work.

Dr Joglekar has worked for over 30 years in mental health and has been a Consultant Child & Adolescent Psychiatrist in the UK since 2007. He also spent over a decade working in General Adult Psychiatry. Dr Joglekar was responsible for shaping and developing a Trust Award-winning Adolescent Service in West London.

Dr Joglekar uses pragmatic talking treatments, combining different approaches such as Cognitive Behaviour Therapy, Dialectical Behaviour Therapy, Systemic and Psychodynamic thinking with medication as appropriate.

Other than seeing children and teenagers, Dr Joglekar can provide a service to young adults on a selective basis, provided they remain in University Education and under the age of 25. Dr Joglekar is trained and approved to undertake work in legal statutes such as the Mental Health Act if need be.

Dr Joglekar finds working with young people and families hugely gratifying and would be glad to be of assistance - please email if you wish to make initial enquiries.

Having worked in Bombay for nearly a decade and over the past 18 years in London, two buzzing cosmopolitan cities have allowed Dr Joglekar to train and work in a variety of cross-cultural contexts. He is multi-lingual and fluent in English, Hindi, Marathi and also quite familiar with Gujarati.

Dr Joglekar has Provider Recognition from the following Medical Insurers: BUPA (initial appointment is 30 to 45 minutes, and any FU review is 20 to 30 min).

As of December 2021, we decided to withdraw support for any new AXA patients or policies covered by them due to significant administrative challenges experienced by us. The disproportionately poor tariffs have led to the discontinuation of our work with most other health insurers. You should seek authorisation and approval of the fees as displayed here: Fees

Note: Please note that some colleagues and patients/parents/families refer to me with my abbreviated first name, i.e. Dr Raj (Joglekar).

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Dr Joglekar has an enhanced CRB clearance and is also registered with the Information Commissioner's Office (ICO).
The private practice is duly indemnified by the MDU

GMC 5196960

Book an Appointment with Dr Joglekar

2014-02-18T18:52:00.013+00:00

Post-Pandemic Update:

The pandemic has helped transform service delivery. We can accommodate more referrals by continuing with virtual meetings with very limited face-face appointments under exceptional circumstances.

To book a time you must complete this Referral Form

Please ensure you have referred to our terms and fee structure.

Self-pay referrals are welcome.

It is advisable to seek a GP referral, especially for ADHD assessments - referrals should include the following health checks that the GP must confirm.

Pulse BP, Height and Weight.
ECG - In the event, there is a history of cardiac problems, fainting episodes, a family history of irregular heartbeats (arrhythmia), or anyone in the family dying young from an unexplained condition - an ECG is highly recommended before medication/s can be considered.
If the child is low weight or has a likely eating disorder additional blood tests may be recommended.
Further checks may be needed if starting antipsychotic medication/s.

If covered by Insurance:

Dr Joglekar's Services as a private consultant child and adolescent psychiatrist are recognised by the following Medical Insurers - BUPA (initial appointment is for 30 minutes only in line with their payment tariff which includes a succinct summary and care plan) / PRU Vitality - Standard Health / WPA / CIGNA / AVIVA (initial appointment is for 50 min assuming our fees are approved).

As of December 2021, we decided to withdraw support for any new AXA patients or policies covered (underwritten) by them due to significant administrative challenges experienced by us.

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Private CAMHS Services Offered: Private Child, Adolescent Psychiatry Assessment, Diagnosis And Treatment | London

2014-02-18T14:14:00.002+00:00

Assessment, Diagnosis and Treatment of children, adolescents and adults:

Early-onset psychosis: This may include prodromal presentations, schizophrenia, schizo-affective disorders.
Mood Disorders: Depression and Bipolar Disorders.
Anxiety Syndromes: Generalised Anxiety, Phobias, Obsessive Compulsive Disorders.
Post Traumatic Stress Disorder.
Eating Disorders: Anorexia, Bulimia and Binge Eating problems.
Attention Deficit Hyperactivity (ADHD) includes the predominant inattention variety known as ADD. I also assess and recommend treatments relating to Adult ADHD.
Emerging Personality Disorders / borderline personality disorder.
Self-harm in context of above or psycho-social contexts.
Adjustment Disorders in the context of life events such as parental separation/bullying at school.
Challenging behaviours in children and adolescents.

Work not undertaken - we do not offer urgent care or emergency services, high-risk cases and complex needs are best managed via NHS CAMHS and in the event an assessment was offered, we may recommend a referral to CAMHS and are not obligated to offer continuing care if we felt unable to offer this safely.

NB: Dr Joglekar does not offer Autism (ASD/PDA) related diagnostic assessments.

Dr Joglekar is also able to consider providing clinical consultation and staff training related to mental health:

School Special Needs Coordinators (SEN) and pastoral care staff
Independent Supported Accommodations / Residential Homes / Hostels.
Independent Fostering Agencies.

When might Dr Joglekar decline work:

There may be situations when on basis of referral information or following initial assessment my recommendation may be that your needs may be better met elsewhere. Usually, these are situations where the risk of harm to self may be high, e.g. significant suicidal ideation/attempts (which is different from self-harm) warranting treatment via NHS CAMHS, local Emergency Services or Inpatient Units. Dr Joglekar will endeavour to signpost you to suitable services to the best of my ability in these contexts.

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Reviews and Testimonials | Dr Joglekar, Child & Adolescent Psychiatry Services | London

2014-02-18T08:33:00.000+00:00

The General Medical Council expects all doctors to seek anonymised feedback from patients and colleagues with a view to improving services/practice at least once every 5 years. I periodically collect feedback using a standard questionnaire used widely in NHS.

The NHS Trusts use third-party systems to acquire confidential feedback. The 2018 feedback was collated by the Royal College of Psychiatrist feedback system.

To read the patient feedback from 2014 click here.

To read the patient feedback from 2018 click here.

To read the colleague feedback from 2014 click here.

To read the colleague feedback from 2018 click here.

Additional comments outside of NHS Trusts mandated processes -

To read the feedback, reviews and testimonials received in relation to Dr Joglekar, please click here. On the webpage, scroll down to the comments section for details beyond demographics collected by the questionnaire.

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Articles on Disorders Assessed and Treated by Dr Adhiraj Joglekar, Child & Adolescent Psychiatrist in London

2014-02-15T17:35:00.001+00:00

Information covering common mental health problems under age of 18 / young adulthood.

Attention Deficit Hyperactivity Syndrome

Early Onset Psychosis in Children and Adolescents

Self Harm

Emerging borderline personality disorder in adolescents

Thought Diffusion Technique for Distress Tolerance

Sleep disorders in Children & Adolescents: principles of sleep hygiene

Depression in Teenagers

Anxiety Disorders in Children and Adolescents

Early Onset Bipolar Disorder

Anorexia in Adolescents

Managing Challenging Behaviour - Ignoring

Behaviour modification rewards programme - sample and blank sheets to download

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THOUGHT DIFFUSION TECHNIQUE - VIDEO DEMONSTRATION

2014-02-15T06:55:00.000+00:00

DBT and mindfulness training involves exploring various exercises and methods for managing one's thoughts, emotions and behaviours.

The videos below exemplify the thought diffusion technique which is one of many methods used in DBT / CBT to achieve the goal outlined by the serenity prayer - God grant me the serenity, to accept the things I cannot change, courage to change the things I can and wisdom to know the difference.

Thought Diffusion Videos

Hope these videos, each lasting just about a minute get you started on your journey to skill up so you can manage your distress, improve tolerance abilities and reduce self-harm. In time, you will work out what works for you and become more resilient against being overwhelmed by stress.

Video 1: Thought Diffusion - Blowing Balloons

Video 2: Thought Diffusion - Blowing Petals

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Children & Adolescents - Anxiety Disorders - Assessment and Treatment

2014-02-15T06:46:00.000+00:00

What is Anxiety?

It is psycho-biological response generated from within in response to perceived stress or threat. The psychological component includes a cognitive style of thinking the worse was likely to happen alongside the fear that makes up the emotional cog of this presentation. The biological response giving company to the thoughts and feelings includes a gush or chronically high levels of stress hormones and chemicals such as adrenaline which leads to the muscles feeling very tense, shaky limbs, sweats, dry mouth, changes in breathing pattern leading to alteration of blood gasses leading to dizziness and a compelling worry that the mind was going crazy. Butterflies in the tummy, pins and needles in limbs would also be experienced by some.

What causes anxiety?

Anxiety is an important, innate part of all animal kingdom. At the sight of danger, the fear centre is invoked and safety behaviours follow. In the animal world, this ensures survival! Anxiety is thus vital and has a significant role in our lives. Humans are bestowed with thinking abilities and rely (at least they should) less on experiencing fear to ensure survival - we can problem solve instead! People who find their fear centre misfires at the slightest thereby overriding the thinking faculties to a point they can't function would be said to have an anxiety disorder.

Some people would be biologically more vulnerable, they may inherit genes that make them temperamentally anxious and sensitive. For others, the fear centre gets primed by early life experience - parents may role model maladaptive coping in the face of stress, early childhood life events such as trauma/separation/bullying / abuse can disrupt attachment and bonding leading to a very fragile insecure base.

Types of anxiety disorders

Anxiety is experienced on a spectrum and also varies in how it is felt. Some people feel it all the time, they worry about trivial matters, lack self-confidence and esteem, they doubt themselves all the time and remain on the edge continuously. Such a person would be said to have GAD or Generalised Anxiety Disorder.

All of us get irrational, bizarre thoughts which are absurd and impractical. Standing on a platform one may occasionally have thoughts or images randomly thrown up of falling over on the tracks. The thinking faculties normally check these cancel out the thoughts and emotions which are irrational. There is a reining in of a kind which is top-down, when this malfunctions, we are left with irrational thoughts and feelings - sometimes these are unbearable blasphemous or unacceptable cognitions/images. Others may struggle with worry that some harm may befall them or loved ones or get engulfed by repeated worry if they had done something right (e.g. did they switch the gas off?). At times those affected may find doing something helps relieve their anxiety, there is an irrational magical connection made between counting 'n' number of times, praying, checking, ordering certain things.....as they produce relief, these behaviours become entrenched rituals. If you have read thus far, this para described OCD or obsessive-compulsive disorder.

There are those who come to find themselves getting fearful at the thought of being somewhere or doing something - being in a crowd, flying in a plane, going up elevators........the list can be a long one. Such specific anxiety is described as a phobia and usually accompanied by the experience of severe short bursts of anxiety which people usually describe as panic. The latter, however, can be experienced alone as a panic disorder.

Severe trauma can lead to symptom constellation of at times being numb or aroused (anxious) alongside re-experiencing the trauma through flashbacks. Such a syndrome is called PTSD or post traumatic stress disorder.

Treatment of anxiety disorders in children and adolescents

This usually includes use of Cognitive Behaviour Therapy. Specific strategies would be taught alongside general understanding of how fear operates, the former include - relaxation techniques, breathing exercises, use of visualisation methods, positive self talk and cognitive rehearsal, exposure and response prevention. PTSD treatment involves some additional trauma work and specialised treatments such as EMDR (eye movement desensitisation and reprocessing). Moderate to severely affected or those who do not respond to psychological treatments would be candidates for medication.

The best results in the longterm are known to be in those receiving a combination of psychological treatment with medication.

© Dr A Joglekar

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THOUGHT DIFFUSION - A DBT EXERCISE FOR DISTRESS TOLERANCE

2014-02-15T06:37:00.000+00:00

There are numerous CBT and the adapted DBT mindfulness techniques that can be improve one's ability and skill to tolerate distress. One amongst the methods that I like uses our power of imagination creatively to reduce distress and associated behaviours. When practiced and after knowing what works for you thought diffusion as a method will mitigate against self harm episodes by allowing you to de-link thoughts, emotions and behaviours from one other, simply observe them and allow them to pass.

Thought Diffusion exercise (click here for video's):

Practice this when not distressed with neutral thoughts, and feelings so it is easier to apply the technique during distress.
Use this when you start to notice you are getting upset and your mind is flooded with negative thoughts / feelings / urges to act out on impulses such as self harm, cutting, burning, hate, anger, need to punish, internal punitive voices like loser, stupid.........
Close your eyes if needed. Imagine the above as labels or tags, attach them to an object and imagine this object disappear, dissolve, disintegrate.....with it the label and tag as well leaves reducing the negative clutter and chatter in your head.
Here are some examples -

Imagine distressful words tagged to cumulus clouds that are blown away by wind.

Negative feelings / thoughts / urges sat on petals of a flower blown away by the wind.

Imagine you have scribbled 'hate, cut, razor blade.....on sand and a wave washes the thoughts and associated feelings away.

Pop some balloons in your minds eye or for real, imagine writing the negative labels on the balloon and then pop them / explode them.

Make a paper boat or rocket, label them with the troubling words and see them either go down a stream of water or fly in to outer space.

Words can fly - anything goes in your minds eye, so imagine them go father away, as they do, they reduce in size and so does the associated emotion, let them fly away to their oblivion.

Put the words on a paper, tear it / crumple it and bin it.

Find out what works for you, each person is unique. To get started, or to run over this technique with younger kids watch these video demonstrations.

Dr A Joglekar

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Emerging borderline personality disorder in adolescents

2014-02-15T04:27:00.000+00:00

Introduction

There is now a growing recognition that a lot of major mental health illnesses experienced by adults have their onset in mid-adolescence. Similarly, many mental health ailments such as psychosis, depression are accompanied by co-morbid disturbance of the personality makeup - therapy or treatment which may target the main diagnosis and not the underlying personality constructs often leads to limited or poor outcomes.

Borderline Personality Disorder (BPD) - Genesis

The research indicates there is no single cause for someone to end up with borderline personality traits. There is evidence to suggest some genetic predisposition although it may well be that successive generations were exposed to similar environmental/social difficulties. The stress experienced often leads to neurochemical changes which are known to be associated with BPD, one amongst many is the link between reduced serotonin and impulsive behaviours. These theories sit well with the notion that the seeds are usually sown early through any life events which may affect one's experience of attachment and bonding to significant others around you. Childhood trauma, disturbed early relationships, abuse from parent/carer will make a child feel insecure. The child has to deal with making sense of the discordance i.e. the caregiver is the nurturer (good) but also the perpetrator and in its defense, it learns to split the good and bad object which in later years afflicts many relationships. This insecure base leads to frantic reactions triggered by the slightest threat of real or perceived abandonment. Over time this pattern of maladaptive responses becomes entrenched leading to the emergence of BPD as described below.

Features of BPD

Frantic efforts to avoid real or imagined abandonment.
A pattern of unstable and intense interpersonal relationships characterised by an alternation between extremes of idealisation and devaluation.
Identity disturbance - markedly and persistently unstable self-image or sense of self.
Impulsivity in at least two areas that are potentially self-damaging, e.g. spending, sex, substance abuse, reckless driving or binge-eating
Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour.
Affective instability due to a marked reactivity of mood, e.g. intense episodic dysphoria, irritability or anxiety, which usually lasts for between a few hours and several days.
Chronic feelings of emptiness
Inappropriate, intense anger, or difficulty controlling anger, e.g. frequent displays of temper, constant anger or recurrent physical fights.
Transient, stress-related paranoid ideation or severe dissociative symptoms.

BPD and mental illnesses

The above behaviour pattern and responses to the stress put such a person at considerable risk of experiencing traumatic life events. This tends to be secondary to impulsive self-harm, reckless behaviours involving the use of drugs and indiscriminate sex. The underlying emotional frailty predisposes such a person for ending up with Post Traumatic Stress Disorder, Depression and at times Psychotic episodes.

Treatment of emerging borderline personality disorder in adolescents

A range of psychological approaches is possible. Evidence suggests consideration be given to one of the following -

Dialectical Behaviour Therapy (DBT) - An integrative approach which pragmatically mixes cognitive behaviour therapy with mindfulness and learning skills (see an example of one such technique called thought diffusion) for distress tolerance and reducing self-harm.
Cognitive behaviour therapy - Where the focus is on the triangular relationship between thought-feeling-behaviour. Tweak one and the other two have to change.
Schema Focussed Therapy - Also integrates CBT with approaches such as Gestalt therapy
Mentalisation Behaviour Therapy - Focus is on enhancing the ability to infer personal and the other person's mental state - i.e. thoughts, feelings, etc
Medication - SSRI drugs like Fluoxetine may be used to treat impulsivity or depression. Some adolescents affected by BPD display rapid mood fluctuations and may benefit from mood stabilisers. Others require the psychotic episodes to be treated with antipsychotic medication.
Inpatient treatment may be needed in those severely affected and posing a risk to their own or others life.

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Useful Resources related to Child & Adolescent mental health

2014-02-14T23:35:00.000+00:00

National Autistic Society - a Leading charity supporting people with autism / Asperger's Syndrome

Royal College of Psychiatrists - Mental Health Information relating to different disorders, treatment options and medication information.

National Institute of Clinical Excellence - Treatment Guidelines applicable in the UK for various medical conditions.

Young Minds - excellent charity doing pioneering work to better care provision for children and families.

NHS Choice Medicines Page - use the search box and get to information about any medication you may be interested in.

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FAQ: Private Child Psychiatry Assessment and Treatment

2014-02-14T10:03:00.000+00:00

FAQ: Independent Psychiatric Assessment of Children and Adolescents:

Here outline a few of the frequently asked questions and their answers in regards to seeking private child and adolescent psychiatry consultations in the independent health sector. The responses below indicate what you could expect from the services offered by Dr. Joglekar.

Can a parent self-refer?

Yes, unlike the NHS, this is perfectly possible. However, if you are medically insured and hope that the insurance pays for the assessment and treatment, please ask your insurer as often they expect a GP referral without which they will not process your claim.

If we have medical insurance, would we have to pay any fees?

Usually not. Make sure the insurance provider gives you a pre-authorisation letter and code confirming you can proceed to consult me. This information is needed to be able to process the claim on your behalf. If an excess applies to your policy you would pay this directly. If an insurer does not accept to pay the full fees, the patient/parent will would pay the shortfall.

Is there a waiting list / how soon would we be given an appointment?

The turnover time usually is 2 weeks from the time I accept a referral, possibly shorter unless Dr Joglekar is away. At busy times, if an earlier appointment was required, we can open additional slots subject to the diary and schedule allowing this. Please drop us a line if need be.

Can we continue with our psychologist/family therapist while seeing you?

Yes, as a Psychiatrist Dr Joglekar would focus on diagnosis and treatment with medication as appropriate and provide you with an expert opinion. Often he would recommend psychological treatments which you can choose to avail of from a recommended colleague or one you access of your own accord. On occasions Dr Joglekar may offer psychological treatments as well, but in instances where a referral is received from a psychologist, family therapist, etc they would continue to provide care to the patients as appropriate.

Can you provide a private prescription?

Yes. A private prescription can be provided for most medications. Note - a private prescription has to be paid for separately, this cost is not included in the assessment fees.

Would you liaise with other professionals/schools?

This may be required as part of the assessment or at times during treatment stages to monitor progress, get feedback from other professionals or coordinate different aspects of care e.g I would speak with a psychologist who may offer CBT whilst deciding on whether or not an increase in medication dose or change of medication was needed.

Do you prescribe off-label medication under the age of 18?

Almost always we attempt to stick with the licensed medications under the age of 18 when considering the first line of treatment. If this fails or in specific situations when it can be justified, we would consider the use of off-label medication. You will be advised of this, given information, time to think and make an informed choice.

Can care be transferred or simultaneously arranged with NHS?

Yes, please see the guidelines in regards to this that govern this practice.

If you have questions not covered above, please feel free to drop a line, visit the contact and enquiry page to do so.

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Psychosis in Children and Adolescents

2014-02-14T07:51:00.000+00:00

What is Psychosis?

Psychosis is a broad term encompassing a group of severe mental health disorders which disrupt a person's perception, thoughts, emotions and behaviour through delusions and hallucinations. The most common type is schizophrenia - over a lifetime, about 1 in 100 people will develop schizophrenia, but it is most likely to start between the ages of 15 and 35 years. Presentations in mid-late teens are common but on rare occasions, I have encountered younger children with symptoms in keeping with psychosis.

Causes of early-onset psychosis:

Psychosis is more likely to be experienced by individuals who have a genetic predisposition or family history of the condition. However, there will be some people who have an underlying biological predisposition without a family history. The hypothesis most favoured is one of gene-environment (e.g. stressful life events, drug use) interaction wherein the latter uncovers the underlying risk manifesting in the illness.

Types of psychosis in children and adolescents:

As mentioned schizophrenia is the most common but other forms such as brief psychosis, psychosis in the context of either depression or mania (bipolar disorder), drug-induced or organic i.e. where there is an underlying medical condition are also likely. The latter includes endocrine disorders such as those affecting thyroid, parathyroid, steroidal hormones or porphyrias. Other known medical causes are - autoimmune or infectious encephalitis, epilepsy, Wilson's disease and Huntington's chorea.

Clinical features:

Some young people present with acute symptoms out of the blue, others may experience a prodromal phase where the earliest indicators may be mood changes, anxiety, sleep problems, decline in academic performance. There may be attenuated odd beliefs and perceptual abnormalities (hallucinatory experiences) not meeting the threshold of a full diagnosis. A family history or presence of certain specific personality traits may lead to such a person being diagnosed as having an "at risk mental state".

The diagnosis is given when a person presents with more obvious signs and symptoms suggestive of the following - delusions, hallucinations, negative symptoms (apathy, a-motivation, self-neglect amongst other symptoms), disorganised behaviour or features such as incoherent speech/posturing. The Clinical Criteria are not detailed here but a specialist has to consider whether or not certain thresholds are met to give a diagnosis.

Assessment:

This includes a detailed history, mental state and physical examination followed by routine blood tests, CT / MRI, EEG are recommended when onset is early. Specialist tests may have to be considered if need be to evaluate if any of the above metabolic/medical causes underly.

Treatment of Early-onset Adolescent Psychosis:

At risk or prodromal stages: It is recommended that close monitoring of mental state, social support, psychological interventions are considered before medication in these cases.
For those with a clear diagnosis of psychosis (not just schizophrenia) medication is the mainstay of the treatment, this includes the use of atypical antipsychotics such as Olanzapine, Risperidone, Aripiprazole. All options need close monitoring for side effects, treatment is initiated and thought of as a trial as for some people the first medication options may either provide sub-optimal benefits or side effects needing to consider alternative approaches. There are no tests to confirm what will work for whom and this is a process of learning by trial.
Educating the person affected and carer's about the ailment is vital part of the work. Family therapy is considered in situations where there are "expressed emotions" i.e. over-involvement, criticism, harshness in interactions.
Focus should be on eventual recovery - reintegrating back to education, vocation and society in general.
Where medical causes are found, treatment of same is vital, a diagnosis of psychosis may not be given here but treatment of symptoms with anti-psychotics may at times be needed.

Prognosis:

About a fifth recover fully, others however may experience chronic or recurring forms of illness. The importance of medication is well established, the longer it takes to start treatment (duration of untreated psychosis) correlates with poor long term outcomes. Medication compliance with treatment for up to 2 years is also likely to lessen chances of relapses.

© Dr A Joglekar

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Behaviour modification: Rewards programme

2014-02-14T06:58:00.000+00:00

Managing Challenging Behaviours in Children

The principles described below relate to using of reward charts, these methods should in conjunction with the practice of Ignoring

All of the above has to be negotiated and mutually agreed between parent/s and child.

Points/items on wish-list/things to do or not do that are mentioned above are only examples. Parents will need to work out the same for their child based on their child’s need.

In general, it helps to explain to the child that life is about give and take. One has to do something to get something. This is true for all businesses/industries as most ask employees to achieve targets. On getting to the targets one gets paid a salary/bonuses, if not, you may get sacked.

Some items on wish list can be costly. As a general rule, it will be useful to think in terms of how reward points for supermarkets such as Tesco work. To get vouchers worth £10, you need 1000 points. So to get something worth £20, a child has to accumulate 2000 points. This may seem too much for the child. You may hence want to be flexible and at times allow them to have a particular item for less. Also, demonstrate to the child that though 2000 pints seem a lot, she/he could get there quickly as up to 100 points (based on above example) could be earned per day if they chose to. Remind the child that to get costlier things they may want to use points more carefully (i.e. save some).

Be creative – you can set weekly targets or give surprise bonus points (50-100) for doing very well in a given week.

Keep an A4 diary to maintain weekly charts records

Get school involved if need be (so the child can earn separate points at school as well).

Bring charts for follow up visits to the clinic.

For younger children, use stars instead of coins or bring plastic coins and a piggy bank (helps inculcate a habit of saving).

Enter points earned per day at the end of each day and make yourselves available ½ - 1 hour each weekend to sit with the child and discuss chart and what they wish to do with the points. However, younger children may need immediate gratification and might not be able to wait for the goodies until the end of the week.

Remember to praise generously for all positive behaviours.

Ignore negative behaviours of the child. Shouting, screaming etc are forms of negative attention and the child could learn to seek it if it does not get enough of positive attention.

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Download Free - sample and blank reward programme sheets for children from the links below.

Terms and conditions of Engagement - Private Child Psychiatry Assessment & Treatment | London

2014-02-14T06:48:00.007+00:00

You must consider the terms of engagement below while making a choice to access child and adolescent psychiatric treatment privately. The terms are outlined below -

We are a non-statutory provider and offer limited services over 3-4 hours per week. Admin support is largely by email only and limited to 2-3 hours per day, 5 days a week. When on leave, Dr Joglekar may request support from a colleague, where this is possible; however, where this is not available, you will have to request support from the GP. We do not cover emergency or urgent car,e even when you may be receiving our support - this is provided and must be accessed via local NHS Accident and Emergency services, if need be via 111 or 999.

A referral for child psychiatry assessment may be made by self, GP, psychologists, schools or another health professional. We do not offer medico-legal work or expert witness assessments.

Payment may include a booking fee deducted from final fees, which are sessional. Please refer to the fee structure here. We now require all self-pay patients to pre-pay in advance of their appointments. Prescriptions between appointments attract a fee; 7 working days' notice is required. A further 3 working days for dispatch via Royal Mail will need to be factored in. We cannot take responsibility for lost posts, but we will provide another script on such rare occasions.

Payments have to be made within 2 days of the date of the invoice. The invoice note will detail the interest rate that may be payable in case of late payments. Full charges will incur for cancellations 72 hours before the appointment and no-shows. A £50.00 late payment charge will be applied to cover extra administrative costs incurred by us chasing payments.

If you have medical insurance, they must provide you with a letter of pre-authorisation; without this, claims cannot be made on your behalf.

You are responsible for checking with your insurer if you need to pay an excess or have a co-pay arrangement, and arranging to pay this to us directly.

You should note that you will have to accept paying any shortfall in the event that the medical insurance does not pay the fees in full.

Please check with your insurance company if they will limit how many outpatient appointments they will authorise and pay for in case the treatment requires regular follow-up.

All payments, whether made by insurance companies or by self-paying patients, are to be made electronically using BACS unless we agree to other arrangements. Non-payment of fees can lead to us suspending services; you should, however, be able to avail yourself of these from the NHS via your GP.

Please refer here for information on the boundaries of confidentiality. We will, if required, make safeguarding referrals, often with your consent and if the situation demands this, without your consent in line with prevailing statutory frameworks and our obligations thereof.

For information on what conditions I would assess and treat, please refer here. I may, based on referral information, advise another service and decline work in certain situations to ensure the best interests and needs of the child and family are met adequately. If beyond the assessment or during the treatment, if it so happens that the needs become complex, or risks to self and others escalate, we would recommend you return to NHS care via your GP. We do not offer urgent or emergency care and are strictly an outpatient provision with planned appointments once every 4-8 weeks.

All enquiries should be made via the Referral Form. We do not offer this over the phone.

The service on offer is strictly a planned outpatient provision. This is not different to similar services provided privately elsewhere or in the NHS. In the event of an emergency, while I will endeavour to be available to guide you, you will have to access emergency and urgent care services via the local / nearest accident and emergency department.

I may advise inpatient treatment on rare occasions; this can be arranged privately if you have medical insurance (they must source the bed) or via the NHS.

During the course of our engagement, if clinically it was appropriate or required or indeed you made a choice to access care from the NHS, your GP would be required to do it with supporting evidence provided by us. Please refer to the principles for the interface between NHS and private medical treatment here.

Correspondence - from receiving a referral to sharing any with you and the GP / referrer, I would do this electronically. I use third-party servers/email and fax services (like most of us would) and would not be responsible for data loss in transit or accesses maliciously. Any information that I record and store, however, will be on an encrypted drive in keeping with data protection laws.

Letters take 10 working days starting the first working day after an appointment, or from the time we have all the information needed. When Dr Joglekar is on leave, letters will take longer. If you are open on my list, I will provide reports at no extra cost following an appointment. Fees of £75.00 apply for updated letters and reports outside scheduled appointments. All letters are sent to patient/s as good practice. The Data Protection Laws are clear that as information within clinic letters relates to a given person, it is for that person (parents in case of minors) to determine with whom the information is shared - typically we encourage and recommend you share this with GP, school and other professionals as appropriate. We are a paper-free service and do not send printed material by post. We do not email reports to GP surgeries unless they contact us with your express consent. The only exception when we may contact professionals from agencies directly is when there is a clear context of child protection or safeguarding concerns.

Unless you wish to make private arrangements, we will expect the GP to arrange all medical investigations as needed - these may include blood tests, scans, and ECG / EEG. GPs will also be expected to provide repeat prescriptions on advice from an independent specialist. You would be responsible for making appointments with the GP on time to progress the above further if it applied to your situation.

We use third-party data processors - electronic health record platforms to do our questionnaires, paid services enabled with Business Associate Agreements for handling healthcare information via AWS, Google or similar. We may use AI tools to improve the quality of note-taking, and at all times, we de-identify identifiable information. The tools used are often used by NHS GPs or Trusts as well.

This note is not exhaustive, and special circumstances will be dealt with as need be; in any event, you will be informed along the way if the engagement is to be outside the terms above. Please check and ask if you have any questions regarding the above at any stage of engagement.

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Self-Harm in adolescents

2014-02-14T06:19:00.000+00:00

Assessment and Treatment of Self-harm in Adolescents

Self-harm is said to occur in 7-14% adolescents at some point in their life. It is commoner in girls than boys.

What constitutes self harm?

Any harm caused without the intention to end one's life could be self harm. The commonest behaviours seen are superficial cutting and medication overdoses (e.g. paracetamol), however self-harm may manifest as scratching, biting, cigarette burns.....

Function of self harm: This can be varied, self-harm may be -

A way of communicating distress to others around
Punishment of self or others
Anger expressed toward self when it can't be expressed outwardly in a safe manner
Replacement of emotional pain with something more tangible / physical
Unlike emotional pain, an act of self-harm can be concrete and gives a sense of control

Does it work?

A lot of people come to rely on this and deem it their coping method (albeit it a maladaptive one). It works for them when one of the above functions is served. Biologically, an injury to the body also leads to a gush of stress hormones in the system - opiates/steroids in the body which also produce a sense of relief rather quickly.

Causes: This usually is a stressful life event causing distress, such as -

parental separation
illness in the family
bullying at school
relationship issues

Are people who self harm mentally ill?

Usually self harm is transient, teenagers would learn better coping methods and move on. Not all self harm is associated with / caused by mental illness. It is important though to have considered this and where needed seek expert help to tease this out as self harm can be one among many other symptoms of an underlying psychiatric disorder such as -

Depression
Post Traumatic Stress Disorder
Abuse (emotional, physical, sexual, neglect)
Psychosis
Emerging Personality Disorders such as borderline and emotionally unstable personality traits
Chronic but problematic family disputes

Is self-harm same as suicidal ideation?

Self harm needs to be distinguished from suicidal ideation or acts of attempted suicide where the intent is to die. At times adolescents who self harm, especially when there is an underlying / associated mental health condition may simultaneously have suicidal thoughts. Repeated self-harm tends to lead to suicidal ideation for a proportion of people as very likely the underlying causal factors perpetuate the difficulties.

Management / treatment:

Parents / adults - it helps to not react with alarm and distress on finding out your child is self harming. Remember self harm has a function, a means to an end and you need to work with the young person to help them find an alternative way of coping.
Intervene to remove the stress factors (i.e. abuse, family disputes, bullying)
Reduce harm - remove or limit access to sharps, pills / medication
Helping children, adolescents to develop positive coping strategies rather than relying on self-harm.
Treat the underlying psychological / psychiatric disorder - Cognitive Behaviour Therapy (CBT), use of medication or both may be needed. Specialist approaches such as Dialectical behaviour Therapy (DBT) or trauma work at times may be needed.
Get expert help through your GP, school counsellors especially if you doubt whether there are associated suicidal ideas/thoughts or acts.

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Managing Challenging Behaviours

2014-02-14T06:16:00.000+00:00

Behaviour modification

When a child is born, it’s mind is like a tabula rasa i.e. a blank slate. Upon this are impressed early life experiences which as you can imagine form the basis of what this person may turn out to be like in the future.

An infant does not come with innate skills to communicate. The brain has much capacity to develop but at this stage the cognitive and language faculties are fledgling to say the least. It is not hard to comprehend why a child has to resort to crying, screaming, flailing its hands and legs, throwing objects around to draw the parents attention to its needs of hunger, sanitation and so on. The tantrum works, the parents attend and meet unmet needs.

As the child develops language and cognitive skills with the development and maturity of the frontal cortex, tantrums will recede (typically after age 4-5) but for some they do not and continue in to adolescent and adult strops. Why may such maladaptive behaviours continue?

The tantrums worked and hence the behaviours are reinforced and continue unabated.
Some parents fail to role model positive coping with stress and may in fact display adult tantrums in face of stress.
In time the transaction or communication patterns get entrenched and one person cues the other, often inviting them to reenact a daily pattern over the most trivial matters.

Changing the patterns: Ignoring -

Change the rules of transaction, if one person does, the other is forced to as well.
Rather than allow the tantrum to draw your attention either positively by meeting the demands communicated or indeed reinforced negatively by way of attention albeit by entering a shouting screaming match - ignore the tantrum
Learn some mindfulness and coping methods which allow you to accept the tantrum without reacting to it, stay calm , polite but firm, go about your business (house chores) while keeping an eye on the situation (you may intervene only if risk to life is posed at any stage).
Ignoring is powerful, but you must sustain it. Remember the tantrum has worked in the past, so expect the tantrum to get worse for few weeks - the person will raise the stakes, seek to provoke you back in to your entrenched pattern and join a shouting match (negative attention) or give in to their demand (positive attention) - so if the tantrums are getting worse, congratulate yourself and stick with it, you are doing just fine.
Sooner than later the penny drops - realisation that “a tantrum does not get me what I need…...why bother with it”. So you have a burst of tantrum (or any behaviour which is fast becoming useless) to raise stakes before it dies - psychologist call this extinction burst.

Ignoring needs to be combined with other strategies like a rewards programme.

All that attention (positive and negative) that you have withdrawn by ignoring, use all that energy, invest it when the person is at their best behaviour.
When a person exhausts the tantrum, they would calm down and become more civil.
Find such moments to role model problem solving and use of language and cognitive skills to discuss and communicate needs differently.
When the person has demonstrated the acceptable behaviour - reward immediately through praise.
Praise - is not easy, try and make a list of adjectives one may use as praise word.....you may find the need to get a dictionary out to compile a list. Use this creatively but also make praise 'specific' - the person needs to what specific behaviour has drawn your worthy attention and praise is for same.
Material rewards within reason supplement but do not substitute praise and non-material rewards (a stroll in the park or a game of footy in the backyard is more powerful than giving someone candy).
Here is a typical rewards program sample and blank sheets for you to download.

Bribes and Punishments

Rewards demanded and given prior to acceptable behaviour are bribes, do not succumb to this.
Punishment follows an unacceptable behaviour but tends to be less effective, people oft get it wrong.
If you have instituted the above rewards programme, as a rule avoid taking points earned (you don't lose the wages you earned for 20 days work put in if you din't show up one day, do you? Would you go to the job again if this was the case? Do this and in my experience invariably the young person loses interest in staying engaged with the negotiated rewards programme.

The above principles also apply with some differences to dealing with adult or adolescent difficult behaviour.

Difficult behaviour may be due to underlying medical / psychiatric causes - ADHD / learning disability, one needs to get expert help to assess and treat these conditions to allow the above to work in complementary manner.

Dr A Joglekar

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Sleep problems in children and adolescents

2014-02-14T05:45:00.000+00:00

Sleep disorders are common but often transient in Children and Adolescents. Some however can become chronic and require specialist attention.

Types of Sleep Disorders

Parasomnia: These are sleep disruptions where a person is aroused after they have fallen asleep and include sleep walking / talking, nightmare, sleep terrors, bruxism or grinding of teeth, bed-wetting (enuresis).
Dyssomnia: These are disorders related to sleep initiation and includes Narcoplepsy (sudden onset day time sleeping / naps) and obstructive sleep apnea where upper airway gets blocked causing sleep disruption. These two conditions have a physiological basis. By far the commonest sleep problem is insomnia due to poor sleep routine which at times may be associated with underlying mental health disorders.

Sleep Hygiene

This article focuses primarily on re-establishing a good sleep routine by re-introducing a sleep routine / habit which aids sleep initiation. The principles are outlined below -

To sleep at a designated time (e.g. 10 pm).
To wake up at a designated time irrespective of the time one falls asleep. Often people sleep late and wake up late, this way the sleep cycle gets pushed forwards rather than regularise.
Use the bed only for sleeping. Using it for watching TV or playing games, having long telephonic chats or arguments create an association of the bed with these events. Memories of these events are oft triggered when one approaches the given bed.
The sleeping bedroom should ideally be clutter and noise free. There should not be any opportunity to stimulate the mind in anyway (TV, video games, music, distraction via smart phones – BBM / social networks).
Making one self as comfortable as possible is important as well. Attempting to sleep hungry or after overeating is likely to interfere with sleep initiation.
Avoid stimulant foods beyond 3pm – this includes coffee, tea, fizzy drinks (especially coca-cola and Pepsi) and chocolates / hot chocolate. These products contain a high level of caffeine. Simple substitution for decaf options alone may not work as the associated taste / texture / smells cue a conditioned response of arousal that these products trigger.
Avoid oversleeping on weekends and taking afternoon naps. Catch-up sleep at other times may make it easier for the mind to remain aroused at night.
Exercise at least 10-15 minutes a day (a brisk walk will do). The more activities you do during day time the better.
Make sure you avoid taking unresolved matters to the bed. Set out 15 minutes after dinner to reflect over the day. If it’s been a hard day, ensure you resolve / problem solve by thinking through the difficulties (either alone or with someone). At times the problematic thoughts are about matters which can’t be resolved for weeks or months, in such an event, it helps to agree to "park" the problem and revisit it another time as simply brooding endlessly is unlikely to help. This would free up mental space needed to relax and sleep.
When in bed, if it is difficult to fall asleep for any reason, its best to get out of the room. You may consider a light snack, milk; reading a dull book and go back to your room once you feel you are likely to fall asleep. Remember, no matter what time you sleep wake up at a designated time.

Treat the underlying mental health disorder:

Sleep initiation can be hard leading to insomnia when one is experiencing anxiety disorders, depression or the mind is aroused due to mania/hypomania associated with bipolar disorder or fearful paranoid thoughts linked to psychosis. Some children and adolescents with ADHD are very energetic even at fag end of the day and struggle to sleep. Some sleep problems are secondary to post traumatic stress, drug abuse. Occasionally depressed people may sleep excessively (hypersomnia).

If the sleep problems are in the context of any of the above mental health disorders, sleep hygiene is important however it should be alongside treatment of these underlying conditions.

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Early onset Bipolar Disorder

2014-02-13T20:01:00.000+00:00

Incidence / Prevalence

About 1 % of young people under the age of 18 but typically post-pubescent would experience bipolar disorder. The risk of this mental ailment affecting someone is higher in those with a family history. The illness can be triggered by adverse life events which are stressful, illicit substance use, sleep deprivation and on rare occasions by anti-depressants. Medical conditions (e.g hyperthyroidism) may mimic and present similarly at times and specialist intervention is almost always advisable.

Presentation

The presentation characterised by

Elation of mood with the person unjustifiably cheerful or euphoric. The mood may also show signs of irritability and periods of agitation. The mood also shows 'lability' or rapid fluctuations in some switching from elation to crying out of context within seconds.
The person will feel and be observed to have a new found energy, may not sleep and eat excessively or go without food for prolonged periods without getting tired.
Speech often is rapid and at times may become incomprehensible. Others may find it difficult to get a word in. The speech may become disjointed with the person moving from topic to topic.
There is an increased in goal directed activity, seeking pleasure through indiscriminate or excessive sexual behaviours or other pleasurable activities.
The affected person may demonstrate grandiose ideas and at times delusions thinking 'they are the chosen ones to rid the world of it's ills, proclaim to have contacts with famous celebs, and lead to spending sprees.
Some people experience associated hallucinations as well.

Explanation

The illness occurs because the stress induces a chemical imbalance which removes the normally available regulatory control of the higher order faculties leaving the person very dis-inhibited in their behaviours.

Assessment

This includes a detailed clinical history, mental state examination, physical exam as well as blood tests and at times brain scans to rule out medical causes.

Exclusions

ADHD, borderline and unstable personality disorders, some forms of psychosis may present with similar features and need to be considered at the time of assessment.

Treatment

Invariably this involves use of medication to manage acute symptoms. This involves use of anti-psychotic medication such as Risperidone or Olanzapine. Other options such as Quetiapine or Aripiprazole may be considered based on side effect profiles when indicated.
Close monitoring for response, side effects is required until the symptoms resolve.
Treatment is recommended to continue for up to 2 years in first episode. Longer if there are further episodes.
Repeated relapsed may need to be managed by mood stabilisers such as Valproate or Lamotrigine - the former contraindicated in adolescent girls due to tendency to cause polycystic ovarian syndrome. Lithium may also be considered for its mood stabilising abilities in some cases.
Baseline lipid profile, LFT, RFT, TFT, FBC, HBA1C with weight need recording and then repeated at recommended intervals until a person is on medication.
CBT is often introduced at a later stage to help a person cope with stress better. Work includes education to create awareness about the illness for both patient and family / parents.
Family therapy may be indicated if conflicts are likely to cause relational stress which may cause relapses.

Dr A Joglekar

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EATING DISORDER - ANOREXIA IN TEENS

2014-02-13T18:28:00.000+00:00

Eating disorders are fairly common, anorexia can be potentially serious and cause fatality. The information below considers the basics, the book above will details the initial education relating to body physiology, an essential initial step in the treatment.

Normal physiology in teenage girls (anorexia disrupts this significantly)

Puberty – occurs over a range of 4-5 years
Peak height velocity for girls is at 11.5 on average (growing on average 9 cm per year).
Menarche is one of the last events of puberty.
Puberty / Growth Spurts - Growth is especially rapid during puberty, with girls’ mean weight increasing from 34 kg at age 11 years to 48 kg at age 13 years; this represents a 41% increase in 2 years.
The estimated average energy requirement in the UK for healthy girls aged 11–18 years ranges from 1845 kcal to 2110 kcal

Clinical features and physiological features of anorexia:

Starts as adolescent preoccupation with diet / weight
Weighing several times a day
Downward setting of weight goals
Growing list of forbidden food
Egosyntonic thinking (person does not think there is a problem)
Self-induced weight loss by - Skipping meals, avoidance of "fattening foods", self-induced vomiting / purging, excessive exercise, use of appetite suppressants, diuretics and Laxatives.
There is body-image distortion with an intrusive dread of fatness - the patient imposes a low weight threshold on himself or herself.
Presence or absence of binges
Co-morbid emotional disorders
Body weight 15% below that expected weight for height
Pre-pubertal patients fail to make the expected weight gain, delayed or arrested puberty.
A widespread endocrine disorder manifest as amenorrhoea

For details on adverse effects of different body parts go to the presentation

BMI is not helpful in Children and Adolescents: The average BMI in childhood changes substantially with age. At birth = 13 kg/m2, increases to 17 at age 1, decreases to 15.5 at age 6, then increases to 21 at age 20. It hence unreliable as a sole clinical marker in young people. Other factors also make it unreliable, these are detailed on the slide presentation.

Treatment

Motivational interviewing / Education
Re-feeding syndrome – oedema (usually normal), cardiac and respiratory failure, delirium & fits.
Nutritional supplements & monitoring of bloods
Dietetics - Daily intake initially may be ~ 800 (start low in cases with high risk of re-feeding syndrome) to 1800 cal but would have to go up to 3000 cal / day - depends also on level of physical activity, to account for expected growth, a positive energy balance is needed. A weekly weight gain of 0.5 to 1 kg in inpatient settings and 0.5 kg in outpatient settings should be an aim of treatment.
Target weights need changes if growth spurt happens during re-feeding.
Family Based Therapy - mobilise family resources to improve intake first before treating family dysfunction.
Cognitive Behaviour Therapy enhanced for Eating Disorders and other approaches Analytical Therapy / Interpersonal Therapy / CBT (more robust evidence for BN)
Medication – symptomatic (medical) and for psychiatric co-morbidity only (anecdotal use of Olanzapine may help with cognitive rigidity; anti-depressants for severe underlying or co-occurring anxiety or mood problems).

Dr A Joglekar

Dr Joglekar's short book on Understanding Anorexia using knowledge and information imparted in secondary school science lessons can be downloaded as a Kindle e-book via the link below.

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EATING DISORDERS - SLIDE SHOW

2014-02-13T17:56:00.000+00:00

The power point presentation covers the topic of Anorexia in greater depth for those interested. It may be particularly helpful for health professionals in primary care settings.

Click Here to go back to main article on Eating Disorder

This is an embedded Microsoft Office presentation, powered by Office Online.

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Private ADHD assessment in London

2014-02-13T17:29:00.002+00:00

Attention Deficit Hyperactivity Disorder (ADHD) -

The private assessment, diagnosis and treatment involve -

A full developmental and clinical/social history
Mental state examination to rule out other psychological problems which may manifest similarly.
Consideration is given to academic performance and liaison with school teachers as appropriate (done with your consent)
Use standard ADHD Questionnaires alongside the above.
At times, additional tests may be required, e.g. QB or TOVA computerised continuous performance tests, WISC (for IQ) and further testing for Autism Spectrum Disorders. These are done independently at additional costs, and we will make suitable recommendations.
Occasionally, we may require blood tests / ECG before treatment with medication.
Medication information, initiation, and monitoring - we will be happy to draw up a shared care agreement, which would allow your GP / Surgery to provide repeat prescriptions in keeping with standard shared care protocols. This is entirely at the discretion of the GP.
Once settled on the optimal dose, follow-up reviews tend to happen once every 4-6 months or yearly when under shared care with the GP.

To find out more about ADHD, read on -

ADHD is a relatively common condition affecting 2 - 5 % of children and adolescents. The incidence and prevalence vary depending on which clinical criteria (ICD 10 or DSM) are used.

Presentation:

Those affected display symptoms in three areas - hyperactivity, difficulty sustaining attention and impulsive behaviours. A certain number of these features need to be present to meet the diagnostic threshold, and the difficulties are noticed across at least two settings, i.e., school and home. A variant, Attention Deficit Disorder (ADD), is also recognised; here, the symptoms relating to overactivity/impulsivity are not dominant. Such presentations, where difficulty relating to inattention is the main problem, tend to be seen more in girls and are less likely to be noted and reported.

Causal factors:

A variety of theories spanning bio-psycho-social factors have been considered by researchers. Family history tends to increase the chances of getting the condition, as do problems during pregnancy, including drug use. Inconsistent parenting may often be part of the equation.

Diagnostic process:

This will typically involve a clinical interview spanning the early development, ruling out medical and social causes (childhood abuse), and if these explain the presentation better, ADHD may not be diagnosed. Corroborating the findings by acquiring information from the school is vital and often done by direct communication/school observations (if need be) and use of specialised questionnaires, which are also completed by parent/s and the young person, unless too young.

Though the diagnosis can be made at a relatively early age of around 5, it is very common in my practice to see teenagers who have not been diagnosed until very late, in some cases as late as late teens or in young adulthood (adult ADHD is now increasingly recognised).

Preschoolers under 5 may be assessed for the probability of a diagnosis, but firm conclusions may be deferred until a child is close to age 6 or above.

Treatment:

ADHD is best understood as a neurodevelopmental condition wherein the evolved frontal cortex (larger thinking brain at the top) is not sending down sufficient dampening signals (chemicals such as dopamine) to quieten the lower primitive brain structures from where random behaviour, inattention and impulse arise.

Treatment in milder cases and pre-school children helps the child train itself to use the regulatory control of the larger thinking brain more. This is complemented hugely by parents learning the right skills by attending individual or group parenting sessions.

Medication is used above the age of 5 and in moderate - severe conditions or where the above efforts have not yielded sufficient benefit. The medication used may be a stimulant (first choice) or a non-stimulant variety and would supplement the deficient chemicals, such as dopamine, when used in clinical doses, thereby producing a clinical benefit.

Initial private prescriptions have to be paid for separately as medication costs are separate and paid directly to the pharmacy.

Why is it important to treat ADHD?

Left untreated, these children tend to by virtue of their lack of regulatory control get in trouble due to their behaviour and poor academic performance. This leads to being "told off" by adults who are in a position of authority and in time may have a worse effecting exclusion from mainstream schooling for periods of time and at times permanently. Such experiences, other than impacting a sense of self, lead to an antagonistic attitude towards adults and present as Oppositional Defiant Disorder, which may eventually acquire a flavour of Conduct Disorder, leading to anti-social behaviours and contact with the legal system. Young people may end up drug-taking as a way of sensation seeking (a common need seen in those with ADHD) and at times, self-help. The consequences of not treating ADHD, thus, can be significant in terms of the potential for poor long-term outcomes.

Further reading on subtle nuances in the diagnostic process - click here

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Depression in Teenagers

2014-02-13T16:32:00.000+00:00

Mood disorders

This is a rather broad term and includes the commoner depression seen in about 3-5% young adolescents as well as Mania / bipolar disorder which affects 1%.

This article focuses on depression in teens

Over past 30 years it was increasingly recognised that depression is not an illness that affected only adults. Adolescents and younger children demonstrate similar signs and symptoms. The features likely to be noted are -

Low mood / sadness / crying spells
Irritability / easy annoyance and occasionally agitation
Loss of pleasure in previously enjoyed activities
Reduced motivation / drive
Hopelessness and other negative thinking (poor sense of self esteem / worth)
Poor self care
Reduced appetite and weight loss (converse can also happen).
Poor concentration and decline in academic performance
Feelings of guilt
Self harm / not wanting to carry on (suicidal ideation).
Reduced energy
Poor sleep (insomnia)
In severe cases, features of psychosis - delusional thinking and hallucinations may be seen as well.

Causes

Any stressful life event can trigger depression, this may include bullying, parental separation, domestic violence, relational problems, parental mental illness, bereavement..... Depression is more likely in those with family history as stress would trigger expression of the vulnerable genes more easily. Changes in the brain chemistry are known to occur (e.g. decrease in the levels of serotonin) and can be the cause of mood changes in some but not all cases. Medical problems (e.g thyroid dysfunction) and certain medications (e.g. contraceptive pills) or street drugs like cannabis can also induce depression.

Treatment of depression

Self help is recommended in milder forms
Cognitive Behaviour Therapy / Inter-personal therapy are first line options as per National Institute of Clinical Excellence (NICE) guidelines.
Medication i.e. anti-depressants are usually reserved for those who are not responding to talking treatments, when depression is moderate - severe and / or when biological symptoms dominate.
Fluoxetine is the licensed product and first choice failing which off-label alternatives may be considered.
Side effects need monitoring via regular reviews.
Research shows that combination of talking treatments and medication produces best results and longer term outcomes.
Medication needs to continue when it is found helpful for 6 to 9 months as stopping sooner can increase chances of relapse.

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Private Adult Psychiatry Consultations, London

2014-02-13T05:55:00.001+00:00

I am a qualified General Psychiatrist, having done both MD Psychiatry in India and MRCPsych in the UK.

I subsequently specialised further in Child & Adolescent Psychiatry. However, I spent over a decade practising in General Psychiatry and retain the skills required to work with adults. I am Section-12 trained as well as an Approved Clinician and can carry out assessments across the age range. My private practice is indemnified to work with children, adolescents and adults.

Much research now shows that the majority of adult mental health issues start in mid to late adolescence/ young adulthood when the developmental, social and family perspectives need to be held in mind. Dr Joglekar's experience as an Adolescent Psychiatrist is likely to suit young adults.

The experience of working with older adolescents and adults allows Dr Joglekar to work across the threshold of turning 18th birthday seamlessly. The care of an adolescent turning 18, thus, may not require transfer to another specialist. Where this is appropriate, we will recommend transfer of care. Dr Joglekar can offer a service for those at University or in Education up to age 21.

Dr Joglekar assesses and treats conditions that affect young adults - adult ADHD, early-onset mood and anxiety disorders and emergent personality difficulties. Where the cases are complex, high risk, and require polypharmacy (use of multiple medications), Dr Joglekar will recommend or refer you to other colleagues as appropriate.

Please email me if you have any queries - contact@drjoglekar.co.uk or call 0794 85 606 88.

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Want to find out more about a Private child psychiatry assessments?

2014-02-11T09:19:00.005+00:00

Get in touch:

Considering whether or not to seek a private child or adolescent psychiatric assessment? Please feel free to make an initial contact/enquiry regarding a referral for an independent consultation, assessment or treatment by using the referral form

If you have a simple query please send this via the form below.

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Private Child and Adolescent Psychiatrist in London

2014-02-11T08:58:00.002+00:00

Virtual clinic:

The pandemic has been challenging for many, but it has paved way for innovation. Clinicians in mental health particularly have embraced technology and video consults are now a norm. The advantage is that we can offer more slots per week than what is possible when we lease a session of 2-4 hours at a given clinic. With CAMHS waiting times being as long as 1-2 years, private clinicians are over-subscribed. If Dr Joglekar was to operate only face-face we would have 6-month waiting times rather than 6-8 weeks.

Syon Clinic: NB, presently face-face appointments are not possible for Dr Joglekar due to constraints on his diary, competing commitments with work and the need for work-life balance.

The private Child and Adolescent Psychiatry Assessments are carried out at the practice based in West London.

Available by appointment only at BMI Syon Clinic located at - 941 Great West Road, Middlesex, London TW8 9DU (see map below)

BMI Clinic in Syon is ideally placed for those living in North-West London areas such as - Hounslow, Ealing, Chiswick, Kensington, Richmond, Twickenham, Barnes, Harrow, Hammersmith and Fulham.

Saturday: 0900 - 1200 (if busy, additional slots can be opened up on request, please email us if you need an appointment earlier than current availability).

Appointment times: Evenings and weekend

Car Parking is available at the Syon Clinic

By Rail - the clinic is a short walk from Syon Lane Rail Station / Osterley Tube Station (H91 bus available just outside as well)

By Bus - H91 (Hammersmith - Hounslow West) and H28 (Bulls Bridge to Osterley Tesco). One may also use 267 / 237 / 235 and get off at Green School and walk past Syon rail station to get to the clinic.