2021 surveillance of psychosis and schizophrenia in children and young people: recognition and management

Selecting relevant studies

Studies were considered for inclusion using criteria defined by the guideline review protocols. Evidence from populations of children and young people (less than 18 years) was prioritised for inclusion. Where this was not possible, studies that included people under and over 18 years, but with a mean age of under 25 are used, as per the guideline review protocols (full guideline p.163 and p. 219). The original guideline contains recommendations adapted from adult populations (p.79 and p.101 of CG155 full guideline). Where we have included studies with data exclusively from adults in the evidence summary is clearly stated.

Views of topic experts

We considered the views of topic experts who were recruited to the NICE Centre for Guidelines Expert Advisers Panel to represent their specialty. For this surveillance review, topic experts completed a questionnaire about developments in evidence, policy and services related to the guideline.

We received 6 questionnaire responses from topic experts, including: a general practitioner with a special interest in children and young people's health and mental health commissioning in primary care; an academic with a special interest in psychological interventions and schizophrenia spectrum disorders; a consultant psychiatrist and associate medical director; a professor of child and adolescent psychiatry; an academic and health economist with a special interest in children and young people's mental health; and a consultant mental health pharmacist.

Four topic experts thought guideline recommendations reflected current practice; 3 highlighted that ensuring the currency of recommendations about suspected psychosis remained up to date was a high priority. One topic expert noted that in some circumstances antipsychotics can reduce symptom severity in some children at high risk of transition when psychological therapies have failed. Topic experts raised issues about principles of practice including strengthening recommendations about supporting patient decision making to better enable shared decision making. Topic experts also raised several equalities issues which are discussed below in the equalities section. Topic experts also highlighted new evidence about individual CBT versus group CBT; brief versus longer duration CBT; and the antipsychotics lurasidone, quetiapine and aripiprazole.

Views of stakeholders

Stakeholders are consulted on all surveillance reviews except if the whole guideline will be updated and replaced. Because this surveillance proposal was to not update the guideline, we are consulting with stakeholders.

Implementation of the guideline

We identified the Royal College of Psychiatrists and the Healthcare Quality Improvement partnership's National Clinical Audit of Psychosis (NCAP) which includes data about children and young people. It concludes that there is 'pervasive evidence of wide variations and inequities in provision…and wait times, early intervention programmes (EIP), in provision for children and young people under 18 and…at-risk mental state service provision across England….There is also wide variation in offer, take-up and refusal rates of NICE interventions across EIP teams nationally.'

We did not identify any evidence that CG155's recommendations are contributing to this implementation issue and the NCAP notes (p.56): 'more needs to be done to ensure equitable…provision of evidence-based EIP care across England in line with NICE quality standards.' NHS England and NICE have produced guidance called Implementing the Early Intervention in Psychosis Access and Waiting Time Standard which is based on recommendations and metrics in the NICE guidelines and quality standards about psychosis and schizophrenia for children (CG155 and QS102) and adults (CG178, and QS80).