NICE, the healthcare guidance body, is currently developing a clinical guideline on the recognition and management of psychosis and schizophrenia in children and young people. As part of this process, draft recommendations have been published on the NICE website today (9 August) for public consultation.

Psychosis is used to describe a group of severe mental health disorders characterised by the presence of delusions and hallucinations that disrupt a person's perception, thoughts, emotions and behaviour. The most common form of psychosis is schizophrenia. Over a lifetime, about 1 in 100 people will develop schizophrenia, but it is most likely to start between the ages of 15 and 35 years.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: “Schizophrenia affects everyone differently and this is particularly apparent in children and young people, with circumstances and stage of development having a significant impact in determining symptoms and experiences. Relatives may notice early symptoms and changes in behaviour up to a year before the illness fully develops. These may include hallucinations, delusions or small things such as the child becoming socially withdrawn or suspicious, with alterations in expressed feeling.

“Schizophrenia is a serious mental illness that can be extremely debilitating and have lasting effects even when treated, especially if the onset is during childhood. The symptoms are enormously distressing for both the child and their family or carers. However, there are effective treatment options available and spotting the signs of the disorder early can help ensure the individual receives the treatment and support they need to live with the condition.

“This draft guidance issued for public consultation includes a number of recommendations to support healthcare professionals to accurately diagnose psychosis and schizophrenia in children and young people and offer them treatment options that are best suited to them. The guidance also makes clear recommendations on ensuring children and their families or carers have all the information and support they need, encouraging doctors to consider the impact of the diagnosis and treatment.”

Draft recommendations issued for consultation include:

• Referral from primary care for possible psychosis: When a child or young person experiences transient psychotic symptoms or other experiences suggestive of possible psychosis, refer for assessment without delay to a specialist mental health service such as Child and Adolescent Mental Health Services (CAMHS) or an early intervention in psychosis service (14 years and over).
• Treatment options for symptoms not sufficient for a diagnosis of psychosis or schizophrenia: When transient or attenuated psychotic symptoms or other mental state changes are not sufficient for a diagnosis of psychosis or schizophrenia, consider: treatments recommended in NICE guidance for any recognised conditions such as anxiety, depression, emerging personality disorder or substance misuse, or individual or family cognitive behavioural therapy (CBT) to decrease distress.
• Do not offer antipsychotic medication for psychotic symptoms or mental state changes that are not sufficient for a diagnosis of psychosis or schizophrenia, or with the aim of decreasing the risk of psychosis.
• Treatment options for first episode psychosis: If the child or young person and their parents or carers wish to try a psychological intervention alone (family intervention or individual CBT), inform them that there is little evidence that psychological interventions are effective without antipsychotic medication. Agree a time limit (1 month or less) for reviewing treatment options, including introducing antipsychotic medication. Continue to monitor symptoms, level of distress, impairment and level of functioning, including educational engagement and achievement, regularly.
• Treatment of subsequent acute episodes of psychosis or schizophrenia: Before referral for hospital care, think about the impact on the child or young person and their parents, carers and other family members, especially when the inpatient unit is a long way from where they live. Consider alternative care within the community wherever possible. If hospital admission is unavoidable, provide support for parents or carers when the child or young person is admitted.
• Education, employment and occupational activities: For children and young people of compulsory school age, liaise with the child or young person's school and educational authority to ensure that ongoing education is provided.

Ends

Notes to Editors

About the guidance

1. The draft recommendations will be available on the NICE website from 9 August 2012.

2. This guideline covers the care provided by primary, community, secondary, tertiary and other health and social care professionals who have direct contact with, and make decisions concerning, the care of children and young people with psychosis or schizophrenia, including child and adolescent mental health services (CAMHS) and early intervention in psychosis services.

3. The prevalence of psychotic disorders in children aged between 5 and 18 years has been estimated to be 0.4% (the figure across all ages and populations in the UK is 0.7%). Schizophrenia accounts for 24.5% of all psychiatric admissions in young people aged 10-18 years (the overall admission rate is 0.46 per 1000 for this age range) with an exponential rise across the adolescent years. The rise in incidence increases most from age 15 onwards.

4. Although about one-fifth of children and young people with schizophrenia have a good outcome with only mild impairment, one-third have severe impairment that needs intensive social and psychiatric support.

About NICE

5. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health

6. NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies -guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

7. NICE produces standards for patient care:

• quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
• Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients
• Commissioning Outcomes Framework - NICE develops the potential indicators for the COF, the scheme starting in 2013, which will help measure the health outcomes and quality of care commissioned by Clinical Commissioning Groups.

8. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates high quality guidance and evidence-based information to help professionals deliver the best patient care through NHS Evidence.