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

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.