Spot signs of psychosis and schizophrenia early, says NICE

The signs of psychosis and schizophrenia in children and young people need to be identified early to help ensure they receive the treatment and care they need to live with the condition, says NICE.

The signs of psychosis and schizophrenia in children and young people need to be identified early to help ensure they receive the treatment and care they need to live with the condition, says NICE.

In the first clinical guideline to focus specifically on the condition in children and young people up to the age of 18, NICE recommends that GPs refer patients who present with psychotic symptoms or other experiences suggestive of possible psychosis without delay to a specialist mental health services.

Specialist services include Child and Adolescent Mental Health Services (CAMHS) for those up to 17 years of age, or an early intervention in psychosis service for those 14 years or over, which includes a consultant psychiatrist with training in child and adolescent mental health.

Children and young people with a first presentation of sustained psychotic symptoms lasting 4 weeks or more should also be referred urgently from primary care to a CAMHS or an early intervention in psychosis service, according to the guideline.

NICE also recommends that cognitive behavioural therapy (CBT) be offered instead of antipsychotic drugs for children and young people with psychotic symptoms or mental state changes that are not sufficient for a diagnosis of psychosis or schizophrenia.

Oral antipsychotic medication should be offered to children and young people with an acute exacerbation or recurrence of psychosis or schizophrenia, in conjunction with psychological interventions (family intervention with individual CBT).

Before referral for hospital care, NICE recommends that healthcare professionals consider alternative care within the community wherever possible, especially when the inpatient unit is a long way from where the patient lives.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said:“Psychosis is used to describe a group of severe mental health disorders which disrupt a person's perception, thoughts, emotions and behaviour through delusions and hallucinations.

“The most common form 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.

“The guideline 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.”

Professor Chris Hollis, Professor of Child and Adolescent Psychiatry, University of Nottingham and Chair of the Guideline Development Group said: “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 young person and their family receives the treatment and support they need to live with the condition.”

Professor Tim Kendall, Director of the National Collaborating Centre for Mental Health, which developed the guideline for NICE, added: “There are some groups of young people who are especially prone to breaking down into a psychosis; and when they seek help, we can now say that antipsychotics should not be given to them.

“Instead, CBT for the family and the individual has the greatest chance of preventing high risk young people from converting to psychosis.

“We are also much clearer about the place of antipsychotics in the treatment of psychosis and schizophrenia: these drugs have quite severe side effects and need to be used with caution, especially in the young as the side effects can be especially severe. This guideline has really improved our confidence in what we should and shouldn't do.”