The First Seventy Admissions to an Adolescent Unit in Edinburgh: General Characteristics and Treatment Outcome

Abstract

Summary1.The clinical functioning of the Young People's Unit, Edinburgh is described. This involves a relatively permissive, democratic ‘milieu‘. Psychotherapeutic efforts are devoted to the resolution of family psychopathology and the achievement of maturational progress for the adolescent.2.Data on the first seventy admittions to the Unit were examined. Two-thirds of the patients were diagnosed ‘developmental crisis’; the majority of these also had a personality disorder.3.Assessments of family functioning showed high levels of disturbance and psychiatric morbidity among the parents. The adolescents had mutually good, positive relationships with their opposite-sexed parents, but markedly negative ones with the same-sexed parents. This was not in accordance with the usual findings in ‘normal’ families. Delinquent and impulsive patients showed uniformly negative family attitudes.4.A simple estimation of treatment outcome at discharge gave results comparable to those of other units, with 70 per cent of patients rated as improved. Neurotic and psychotic patients had a relatively better outcome. Tension-discharge personality disorder and a history of very disruptive or antisocial behaviour were associated with poor outcome.5.The poor response of very disturbed, impulsive adolescents to this type of therapeutic regime is discussed. These individuals do not appear to have sufficient personality resources and organization to benefit from this type of treatment. Emerging from this is a suggestion for an increased provision of specialized units offering containment and intensive care to the very disturbed adolescent.