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Practitioner Review: Schizophrenia-Spectrum Disorders and the At-Risk Mental State for Psychosis in Children and Adolescents: Evidence-Based Management Approaches

Tiffin, P.A.; Welsh, P.

Authors

P.A. Tiffin

P. Welsh



Abstract

Background: Schizophrenia spectrum disorders are severe mental illnesses which often result in significant distress and disability. Attempts have been made to prospectively identify and treat young people viewed as at high risk of impending nonaffective psychosis. Once a schizophrenia spectrum disorder has developed, prompt identification and management is required. Methods: This article reviews the literature relating to the assessment and management of ‘at-risk mental states’ (ARMS) and the treatment of schizophrenia spectrum disorders in children and adolescents. A systematic search of the literature was undertaken using EMBASE, MEDLINE, PsycINFO databases for the period January 1970–December 2012. Results: Evidence suggests that young people fulfilling the ARMS criteria are at high risk of adverse mental health outcomes but that the majority do not develop nonaffective psychosis over the medium term. Although clinical trial findings have been inconsistent, psychosocial approaches, such as cognitive behaviour therapy, may reduce the risk of transition to psychosis and improve some symptoms, at least over the short term. The effectiveness of psychotropic medication for the ARMS is uncertain although there is accumulating evidence for potential adverse effects of antipsychotic medication, even at low dose, in this population. For the schizophrenias, clinical trial findings suggest that, as in adults, antipsychotics should be selected on the basis of side-effect profile although clozapine may be helpful in treatment refractory illness. There are almost no studies of psychosocial treatments for schizophrenia in young people under 18, and some caution must be exercised when extrapolating the findings of adult studies to younger individuals. Conclusions: A stepped care approach to the ARMS in young people represents a plausible potential management approach for those at high risk of serious mental health problems. However, predictive models currently lack precision and should focus on accurately identifying those at high risk for a variety of poor outcomes who may benefit most from intervention. There is also an urgent need for age-specific research in the area of psychosocial treatments for children and adolescents with schizophrenia.

Citation

Tiffin, P., & Welsh, P. (2013). Practitioner Review: Schizophrenia-Spectrum Disorders and the At-Risk Mental State for Psychosis in Children and Adolescents: Evidence-Based Management Approaches. Journal of Child Psychology and Psychiatry, 54(11), 1155-1175. https://doi.org/10.1111/jcpp.12136

Journal Article Type Article
Publication Date Nov 1, 2013
Deposit Date Jul 19, 2013
Journal Journal of Child Psychology and Psychiatry
Print ISSN 0021-9630
Electronic ISSN 1469-7610
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 54
Issue 11
Pages 1155-1175
DOI https://doi.org/10.1111/jcpp.12136
Keywords Schizophrenia, Psychosis, Risk syndrome, Prodrome, Early recognition.