Original Research

A retrospective chart review of the clinical and psychosocial profile of psychotic adolescents with co-morbid substance use disorders presenting to acute adolescent psychiatric services at Tygerberg Hospital

Anusha Lachman, Rene Nassen, Sue Hawkridge, Robin A Emsley
South African Journal of Psychiatry | Vol 18, No 2 | a351 | DOI: https://doi.org/10.4102/sajpsychiatry.v18i2.351 | © 2012 Anusha Lachman, Rene Nassen, Sue Hawkridge, Robin A Emsley | This work is licensed under CC Attribution 4.0
Submitted: 16 February 2012 | Published: 01 May 2012

About the author(s)

Anusha Lachman, Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Western Cape, South Africa
Rene Nassen, Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Western Cape, South Africa
Sue Hawkridge, Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Western Cape, South Africa
Robin A Emsley, Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Western Cape, South Africa


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Abstract

Background. A large number of adolescents meet criteria for ‘dual diagnosis’ (a psychiatric disorder plus co-morbid substance use disorder (SUD), which prolongs treatment response and complicates intervention strategies. The current service model in Cape Town divides the care of such patients into psychiatric treatment and a separate substance use intervention. Child and adolescent mental health services face the challenge of high rates of readmission of adolescents into psychiatric facilities before utilisation of community-based substance abuse services.

Objective. There is a scarcity of available treatment guidelines for dual-diagnosis adolescents, and a lack of systematically documented epidemiological and clinical data in South African adolescent populations.

Method. A retrospective chart review of adolescent psychiatric admissions to the Tygerberg Adolescent Psychiatric Unit during 2010 was conducted. Relevant epidemiological, clinical and demographic data for those presenting with a dual diagnosis (specifically psychotic disorders and SUD) was recorded.

Results. Results suggest a high prevalence of SUD among adolescents presenting with a first-episode psychosis. Statistically significant correlations with lower levels of education were found in those with ongoing substance abuse (specifically cannabis and methamphetamine), and a significant relationship between choice of debut drug and ongoing drug use was also demonstrated. Risk factors for SUD (psychosocial adversities, childhood trauma, family and community exposure to substances, early debut drug ages), risky sexual behaviours, and clinical psychiatric profiles of adolescents with dual diagnosis are described.

Conclusions. This cohort had an enhanced risk as a result of genetic vulnerability and environmental availability of substances, and the findings emphasise the differences in presentation, choice of drugs of abuse and psychosocial difficulties of adolescents with a dual diagnosis presenting to a psychiatric facility. We aim to influence role-players to provide more integrated services, and highlight the need for future prospective studies in this adolescent group to assist in improving outcomes.


Keywords

adolescent, dual diagnosis, substances, psychosis

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Crossref Citations

1. Factors associated with readmission in South African adolescents discharged from two inpatient psychosocial rehabilitation units
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Journal of Child & Adolescent Mental Health  vol: 28  issue: 3  first page: 199  year: 2016  
doi: 10.2989/17280583.2016.1259165