Hong Kong teen found dead at sea may have suffered psychotic episodes, inquest told
A forensic psychiatrist has suggested a 15-year-old girl found dead at sea last September experienced psychotic episodes on the day she was last seen by friends and captured on security camera, with the problems surfacing as early as a month before the teen's disappearance.
Robyn Ho Mei-yee told the Coroner's Court on Thursday that Chan Yin-lam appeared to show symptoms of multiple mental illnesses when she was twice admitted to Tuen Mun Hospital in August 2019, suggesting her case was more complex than what her doctors had said was merely rebellious behaviour.
Chan's body was found in waters off Tseung Kwan O on September 22, three days after she was last seen alive. It remains unclear whether the self-taught swimmer drowned herself.
The inquest heard Chan was first diagnosed in March 2019 with oppositional defiant disorder, marked by irritability and argumentative behaviour, when she was admitted to hospital following an emotional outburst during her stay in a juvenile home. Psychiatrists offered the same diagnosis during Chan's two other hospital visits in August.
But Ho, who testified about Chan's mental conditions as seen from an independent expert's perspective, believed the girl's confused state of mind, capricious behaviour and complaints about hearing non-existent voices suggested she was undergoing the first phase of psychosis.
"When facing psychotic symptoms for the first time, many people feel frightened, confused and anxious because it's the first time they undergo such experiences," the expert said.
"It appears Chan was experiencing the very early stage of psychosis. In similar cases, doctors can hardly determine the type of mental illness a patient is suffering."
Ho offered support for her theory by pointing to Chan's mentally ill father, who is now hospitalised in Castle Peak Hospital Tuen Mun for schizoaffective disorder, characterised by symptoms of both schizophrenia and mood disorder.
She said teenagers whose families had a history of mental illness were 10 per cent more likely to suffer from it than their peers with no such history.
Forensic psychiatrist Robyn Ho appeared at the Coroner's Court on Thursday to give evidence. Photo: Winson Wong alt=Forensic psychiatrist Robyn Ho appeared at the Coroner's Court on Thursday to give evidence. Photo: Winson Wong
The psychiatrist stopped short of making a definitive diagnosis, saying her conclusion was based on second-hand findings rather than clinical observations.
"I can hardly make a diagnosis. What I can say is that there are psychotic symptoms, but I cannot tell you which illness gives rise to such symptoms."
According to Ho, psychosis patients have a higher risk of committing suicide than the population at large, and may have difficulty with body coordination during an episode.
She said psychosis could be induced by taking drugs, such as cannabis, which Chan claimed to have tried for the first time on August 11, two days before she was reported to be acting strangely while visiting her pen-pal in prison.
Psychotic episodes induced by drugs could last between a few weeks and a few months, the court has heard.
Although Chan cleared a drug test on August 16, Ho said that did not necessarily mean she had not abused the substance, as cannabis could only be detected within three days of consumption.
Security cameras caught Chan Yin-lam walking around the Hong Kong Design Institute just before her disappearance. Photo: Handout alt=Security cameras caught Chan Yin-lam walking around the Hong Kong Design Institute just before her disappearance. Photo: Handout
In that case, the sedative prescribed to Chan by hospital doctors in August - benzodiazepine - could do little to improve the teen's mental health, as the medication was ineffective for psychosis patients, the expert continued.
Ho said Chan's condition appeared to have improved in late August and early September, but took another turn for the worse days before she disappeared, when she complained again about hearing voices in her head.
On September 19, Chan's final appearance, she reportedly slept on a classroom floor using her classmate's school bag as a pillow, spent half an hour clearing her locker, sat on the floor of a train carriage after she left school with her friends, and later returned that evening to wander the campus for no apparent reason, leaving her personal belongings behind in the process.
Ho said such abnormal behaviour might be symptoms of yet another mental episode. If the September episode was a continuation of what happened in August, it could be possible she was suffering from other mental ailments, such as schizophrenia, schizoaffective disorder and bipolar disorder.
However, she said she was unable to draw that inference because it required long-term observation.
On Friday and next Monday, the inquest will hear supplemental evidence from witnesses earlier called to court. Magistrate Ko Wai-hung is expected to sum up the case next Friday.
This article originally appeared on the South China Morning Post (SCMP).
Copyright (c) 2020. South China Morning Post Publishers Ltd. All rights reserved.
