A clinical study of 100 new admissions to an adolescent psychiatric inpatient unit in Singapore.

BACKGROUND: Psychiatric inpatient services for children and adolescents in Singapore began in 1982 when Woodbridge Hospital started the Child and Adolescent Inpatient Unit. To date, this is the only unit with specialised facilities and staff in the management of young patients. Admissions were mainly based on a need for custodial management of acute major behavioural disturbances. Patients were discharged for outpatient treatment once these behaviours subsided. METHODS: This is a retrospective clinical study of 100 consecutive new patients admitted from April 1993 to August 1994. RESULTS: Majority of admissions (92%) were adolescents above age 12, who were either attending secondary or vocational school. Most came from nuclear families. Forty-eight percent of referrals were intradepartmental. Ten percent were from general hospitals with 16% as self referrals. Psychoses accounted for the diagnosis in 43%, schizophrenia being the main type. Neurosis and adjustment disorders formed the other main diagnoses. All patients received individual and family treatment. Liaison with schools was required in a third of the cases. Sixty-one percent received pharmacological treatment. Ninety-one percent were discharged home after a stay of less than 3 months. Majority returned to school upon discharge from the hospital. CONCLUSION: The main criteria for admission in this unit, located in an adult psychiatric hospital, is that of custody of young patients with disturbed and unmanageable behaviour. This provides additional stigma for the admissions of young patients with minor psychiatric problems and interferes with comprehensive care including admission required for some adolescents with psychiatric problems.

Incest and other intrafamilial sexual abuse.

This study describes eight female adolescents who were sexually abused in childhood. Four were victims of incest. The mean age of onset of sexual abuse was 9.8 years and except for one, all had multiple incidents. All were from the lower socioeconomic class. The majority had disorganised families. The reactions of the majority of the victims were fear, intense anger and self mutilation. All were separated from their families on disclosure of the abuse. A significant clinical sequela was that of suicidal tendency in all of them, six of whom attempted suicide repeatedly. Promiscuous behaviour at adolescence occurred in one victim of father-child incest. Lesbianism resulted in one other. None suffered from any formal psychiatric disorder.

Psychiatric illness in Filipino maids admitted to Woodbridge Hospital.

This is a retrospective and descriptive study of 44 Filipino maids who had a psychiatric illness in Singapore and were admitted to the state psychiatric hospital. Of those with psychosis, one quarter was diagnosed to have a Brief Reactive Psychosis, 2 had a Depressive illness, whilst 3 had a Schizophrenic illness. One-fifth had symptoms of an Atypical Psychosis. The onset of illness occurred at the sixth week of stay in Singapore, in the majority of the group. Psychosocial and social-cultural factors were considered as causative to the failure of adaptation resulting in a breakdown of coping mechanisms leading to the illness. Educational and marital status, and lack of integration with the new environment are some of the factors discussed. Life events occurring before the onset of illness were mainly financial and relationship difficulties. Two experienced deaths in their families at home. Auditory hallucinations, present in twenty-six of the group, and delusions, present in sixteen, were the main symptomatology discussed. The delusions had mainly sexual and religious themes. Seven had a history of suicidal attempts.

Noonan's syndrome with mental retardation presenting with an affective disorder--case report.

A 30 year old Chinese lady initially thought to have Turner's Syndrome was rediagnosed as Noonan's Syndrome following admission to a psychiatric hospital for treatment of an Affective Disorder (Hypomania). The genetics and morphological features in Noonan's Syndrome are briefly discussed and the patient's psychiatric presentation is described.