Abstract
Background & Objective:Child & adolescent mental health needs to be considered as an integral component of overall health, however significant gaps exist in service provision especially inpatient services in Pakistan. The paper presents the characteristics of admitted youths and response to treatment in Pakistan’s first dedicated child & adolescent psychiatry inpatient unit in Lahore over a period of first seven years. The aim of this study was to better understand the various characteristics of children and youth admitted to this inpatient unit and response to treatment over a seven years’ period since the inception of the unit.Methods:Inpatient medical records of children & adolescents admitted to dedicated Child & Adolescent Inpatient Unit at King Edward Medical University, Lahore were reviewed. Data was extracted regarding referral patterns, sociodemographic factors and diagnosis for the first seven years, from 2012 to 2019. Patients’ scores on Strengths and Difficulties Questionnaire and Clinical Global Impressions Scales administered during intake were also reviewed.Results:Six hundred and thirty-four (634) patients, 56% (355) being females were admitted to the unit during seven years with mean age of 12.3 ± 2.3. Mean duration of admission was 15.60 ± 6.3 days. Most predominant ICD-10 Axis-I psychiatric diagnosis were neurotic, stress related and somatoform disorders (262); mood disorders (78); schizophrenia, schizotypal & delusional disorders (77) and behavioral and emotional disorders with onset usually occurring in childhood and adolescence (44). One hundred and fifty-nine (25%) children had comorbid diagnosis of intellectual disability on Axis-III. Strengths and difficulties questionnaire scores were in abnormal range for significant proportion (>50 %) of patients. CGI mean scores showed marked improvement at discharge.Conclusion:Neurotic, stress related and somatoform disorders are the most common diagnosis in youth needing inpatient treatment in Pakistani setup. Study results indicate that there is a clear need for specialized inpatient child and adolescent services such as ours in low- & middle-income countries.
Highlights
Low income countries like Pakistan face a multitude of social adversities including poverty, malnutrition, rapid urbanization, educational deprivation, drug abuse, increased crime, terrorism etc. increasing the risk of mental health problems in youth
Because of these factors and need for young people to be treated in an environment appropriate to their age and developmental stage, Pakistan’s first specialist inpatient child and adolescent psychiatric unit was established within the public sector at the King Edward Medical University/ Mayo Hospital Lahore with six beds in 2012 (AACAP Newsletter Jan-Feb 2014)
Diagnosis: Most predominant ICD-10 Axis I psychiatric diagnosis were neurotic, stress related and somatoform disorders (262; 41.32%); mood disorders (78; 12.30%); schizophrenia, schizotypal & delusional disorders (77; 12.14%) and behavioral and emotional disorders with onset usually occurring in childhood and adolescence (44; 6.94%) (Table-I) One hundred and fifty nine children had comorbid diagnosis of intellectual disability on Axis-III
Summary
Low income countries like Pakistan face a multitude of social adversities including poverty, malnutrition, rapid urbanization, educational deprivation, drug abuse, increased crime, terrorism etc. increasing the risk of mental health problems in youth. Young children presentation of psychiatric problems differs significantly from adults and they are vulnerable to exploitation by adults and may become extremely distressed with disturbed adult behaviors Because of these factors and need for young people to be treated in an environment appropriate to their age and developmental stage, Pakistan’s first specialist inpatient child and adolescent psychiatric unit was established within the public sector at the King Edward Medical University/ Mayo Hospital Lahore with six beds in 2012 (AACAP Newsletter Jan-Feb 2014). It has dedicated staff including consultant child psychiatrist, clinical psychologists, play therapist, speech therapist and trained nurses and other support staff. Study results indicate that there is a clear need for specialized inpatient child and adolescent services such as ours in low- & middle-income countries
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