Excerpt

There is a worse prognosis for psychosis and schizophrenia when onset is in childhood or adolescence, and this new NICE guideline puts much-needed emphasis on early recognition and assessment of possible psychotic symptoms. For the one-third of children and young people who go on to experience severe impairment as a result of psychosis or schizophrenia the guideline also offers comprehensive advice from assessment and treatment of the first episode through to promoting recovery.

This guideline reviews the evidence for recognition and management of psychosis and schizophrenia in children and young people across the care pathway, encompassing access to and delivery of services, experience of care, recognition and management of at-risk mental states, psychological and pharmacological interventions, and improving cognition and enhancing engagement with education and employment.

Contents

• GUIDELINE DEVELOPMENT GROUP MEMBERS AND NATIONAL COLLABORATING CENTRE FOR MENTAL HEALTH (NCCMH) REVIEW TEAM
• ACKNOWLEDGEMENTS
• 1. PREFACE
  • 1.1. NATIONAL GUIDELINE
  • 1.2. THE NATIONAL PSYCHOSIS AND SCHIZOPHRENIA IN CHILDREN AND YOUNG PEOPLE GUIDELINE
• 2. PSYCHOSIS AND SCHIZOPHRENIA IN CHILDREN AND YOUNG PEOPLE
  • 2.1. THE DISORDER
  • 2.2. INCIDENCE AND PREVALENCE
  • 2.3. POSSIBLE CAUSES OF SCHIZOPHRENIA
  • 2.4. ASSESSMENT
  • 2.5. ENGAGEMENT, CONSENT AND THERAPEUTIC ALLIANCE
  • 2.6. LANGUAGE AND STIGMA
  • 2.7. ISSUES FOR PARENTS AND CARERS
  • 2.8. TREATMENT AND MANAGEMENT OF PSYCHOSIS AND SCHIZOPHRENIA IN CHILDREN AND YOUNG PEOPLE IN THE NHS
  • 2.9. SUPPORTING CHILDREN AND YOUNG PEOPLE WITH PSYCHOSIS AND SCHIZOPHRENIA IN SCHOOL
  • 2.10. THE ECONOMIC COST OF PSYCHOSIS AND SCHIZOPHRENIA
• 3. METHODS USED TO DEVELOP THIS GUIDELINE
  • 3.1. OVERVIEW
  • 3.2. THE SCOPE
  • 3.3. THE GUIDELINE DEVELOPMENT GROUP
  • 3.4. REVIEW QUESTIONS
  • 3.5. SYSTEMATIC CLINICAL LITERATURE REVIEW
  • 3.6. HEALTH ECONOMICS METHODS
  • 3.7. THE INCORPORATION AND ADAPTATION Of EXISTING NICE GUIDELINE RECOMMENDATIONS
  • 3.8. FROM EVIDENCE TO RECOMMENDATIONS
  • 3.9. STAKEHOLDER CONTRIBUTIONS
  • 3.10. VALIDATION OF THE GUIDELINE
• 4. ACCESS TO AND THE DELIVERY OF SERVICES, AND THE EXPERIENCE OF CARE
  • 4.1. INTRODUCTION
  • 4.2. CLINICAL REVIEW PROTOCOL
  • 4.3. SOURCES OF INFORMATION CONSIDERED
  • 4.4. NARRATIVE REVIEW OF THE EVIDENCE FOR ACCESS TO AND DELIVERY OF SERVICES AND CURRENT PRACTICE
  • 4.5. EXPERIENCE OF CARE
  • 4.6. FROM EVIDENCE TO RECOMMENDATIONS
  • 4.7. RECOMMENDATIONS
• 5. AT RISK MENTAL STATES FOR PSYCHOSIS AND SCHIZOPHRENIA IN CHILDREN AND YOUNG PEOPLE: RECOGNITION AND MANAGEMENT
  • 5.1. INTRODUCTION
  • 5.2. CLINICAL REVIEW PROTOCOL FOR AT RISK MENTAL STATES FOR PSYCHOSIS AND SCHIZOPHRENIA IN CHILDREN AND YOUNG PEOPLE
  • 5.3. RECOGNITION OF AT RISK MENTAL STATES
  • 5.4. PHARMACOLOGICAL INTERVENTIONS
  • 5.5. DIETARY INTERVENTIONS
  • 5.6. PSYCHOSOCIAL INTERVENTIONS
  • 5.7. HEALTH ECONOMIC EVIDENCE
  • 5.8. FROM EVIDENCE TO RECOMMENDATIONS
  • 5.9. RECOMMENDATIONS
  • 5.10. RESEARCH RECOMMENDATIONS
• 6. PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS
  • 6.1. INTRODUCTION
  • 6.2. CLINICAL REVIEW PROTOCOL FOR THE REVIEW OF PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS FOR CHILDREN AND YOUNG PEOPLE WITH PSYCHOSIS AND SCHIZOPHRENIA
  • 6.3. STUDIES CONSIDERED FOR REVIEW
  • 6.4. ARTS THERAPIES
  • 6.5. COGNITIVE BEHAVIOURAL THERAPY
  • 6.6. FAMILY INTERVENTION
  • 6.7. EPPIC TREATMENT AS USUAL
  • 6.8. PRINCIPLES FOR DELIVERING PSYCHOLOGICAL INTERVENTIONS
  • 6.9. RESEARCH RECOMMENDATION
• 7. PHARMACOLOGICAL INTERVENTIONS
  • 7.1. INTRODUCTION
  • 7.2. INITIAL TREATMENT WITH ANTIPSYCHOTIC MEDICATION FOR FIRST EPISODE PSYCHOSIS
  • 7.3. ANTIPSYCHOTICS IN THE TREATMENT OF SUBSEQUENT ACUTE EPISODES OF PSYCHOSIS AND SCHIZOPHRENIA
  • 7.4. ANTIPSYCHOTICS IN CHILDREN AND YOUNG PEOPLE WITH PSYCHOSIS AND SCHIZOPHRENIA WHOSE ILLNESS HAS NOT RESPONDED ADEQUATELY TO PHARMACOLOGICAL TREATMENT
  • 7.5. SIDE EFFECTS OF ANTIPSYCHOTIC MEDICATION OCCURRING AT OR OVER 12 WEEKS
  • 7.6. HEALTH ECONOMIC EVIDENCE
  • 7.7. FROM EVIDENCE TO RECOMMENDATIONS
  • 7.8. RECOMMENDATIONS
  • 7.9. RESEARCH RECOMMENDATIONS
• 8. COGNITION, EMPLOYMENT AND EDUCATION
  • 8.1. INTRODUCTION
  • 8.2. CLINICAL REVIEW PROTOCOL
  • 8.3. STUDIES CONSIDERED
  • 8.4. COGNITIVE REMEDIATION THERAPY
  • 8.5. VOCATIONAL REHABILITATION
  • 8.6. EDUCATION
  • 8.7. FROM EVIDENCE TO RECOMMENDATIONS
  • 8.8. RECOMMENDATIONS
• 9. SUMMARY OF RECOMMENDATIONS
  • 9.1. GENERAL PRINCIPLES OF CARE
  • 9.2. POSSIBLE PSYCHOSIS
  • 9.3. FIRST EPISODE PSYCHOSIS
  • 9.4. SUBSEQUENT ACUTE EPISODES OF PSYCHOSIS OR SCHIZOPHRENIA
  • 9.5. REFERRAL IN CRISIS AND CHALLENGING BEHAVIOUR
  • 9.6. EARLY POST-ACUTE PERIOD
  • 9.7. PROMOTING RECOVERY AND PROVIDING POSSIBLE FUTURE CARE IN PRIMARY CARE
  • 9.8. PROMOTING RECOVERY AND PROVIDING POSSIBLE FUTURE CARE IN SECONDARY CARE
• APPENDICES
  • APPENDIX 1. SCOPE FOR THE DEVELOPMENT OF THE CLINICAL GUIDELINE
  • APPENDIX 2. DECLARATIONS OF INTERESTS BY GUIDELINE DEVELOPMENT GROUP MEMBERS
  • APPENDIX 3. SPECIAL ADVISERS TO THE GUIDELINE DEVELOPMENT GROUP
  • APPENDIX 4. STAKEHOLDERS WHO SUBMITTED COMMENTS IN RESPONSE TO THE CONSULTATION DRAFT OF THE GUIDELINE
  • APPENDIX 5. RESEARCHERS CONTACTED TO REQUEST INFORMATION ABOUT UNPUBLISHED DATA OR SOON-TO-BE PUBLISHED STUDIES
  • APPENDIX 6. REVIEW QUESTIONS
  • APPENDIX 7. REVIEW PROTOCOLS
  • APPENDIX 8. SEARCH STRATEGIES FOR THE IDENTIFICATION OF CLINICAL STUDIES
  • APPENDIX 9. TEMPLATE DATA EXTRACTION FORM FOR CLINICAL STUDIES AND REVIEWS
  • APPENDIX 10. SEARCH STRATEGIES FOR THE IDENTIFICATION OF HEALTH ECONOMIC EVIDENCE
  • APPENDIX 11. METHODOLOGY CHECKLIST FOR ECONOMIC STUDIES – TEMPLATE
  • APPENDIX 12. HIGH PRIORITY RESEARCH RECOMMENDATIONS
  • APPENDIX 13. CLINICAL EVIDENCE – STUDY CHARACTERISTICS TABLES
  • APPENDIX 14. CLINICAL EVIDENCE – FOREST PLOTS
  • APPENDIX 15. ECONOMIC EVIDENCE: COMPLETED METHODOLOGY CHECKLISTS
  • APPENDIX 16. ECONOMIC EVIDENCE: EVIDENCE TABLES OF PUBLISHED STUDIES
  • APPENDIX 17. CLINICAL AND ECONOMIC EVIDENCE PROFILES
• REFERENCES
• ABBREVIATIONS

The views presented in this book do not necessarily refl ect those of the British Psychological Society, and the publishers are not responsible for any error of omission or fact. The British Psychological Society is a registered charity (no. 229642).