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South African Journal of Psychiatry

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Adolescent-onset psychosis: A 2-year retrospective study of adolescents admitted to a general psychiatric unit

S Paruk, S Ramlall, JK Burns

Abstract


Background. KwaZulu-Natal had no dedicated inpatient
adolescent psychiatric service during the study period, and
adolescents were admitted to general psychiatric wards.
Aim of study. This is a descriptive review of adolescents with
psychotic symptoms admitted to a psychiatric hospital. It aims
to describe their demographic profile, associated risk factors
and clinical profile, and management strategies utilised.
Method. The files of all adolescent patients, aged 12 - 18
years, admitted to a psychiatric hospital with psychotic
symptoms from July 2005 to June 2007 were reviewed.
Results. Seventy adolescents with psychosis were admitted
to adult psychiatric wards over the 2-year period. The age
range was 13 - 18 years. Of the patients 80.0% were male,
37.1% reported a positive family history of mental illness,
50.0% smoked nicotine and 61.4% reported cannabis use.
The most common diagnoses were schizophrenia (30.0%)
and schizophreniform disorder (27.1%). Sixty (85.7%) of
the patients had a trial on a first-generation antipsychotic
and 10 (15.5%) were initiated on a second-generation
antipsychotic de novo. The average length of stay in hospital
was 27.8 days. Of the patients, 40% defaulted follow-up after
discharge.
Conclusions. Schizophrenia was the most common diagnosis.
There were high rates of cannabis use. The adolescents
were managed in general psychiatric wards. The majority of
patients had a trial on first-generation antipsychotics. There
was a high rate of defaulting the first outpatient appointment.
There is a need to develop specialised inpatient adolescent
psychiatric facilities and services, as well as to address comorbid
substance use and non-adherence to treatment.



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