Nice | Psychosis and schizophrenia in children and young people

brainThis guideline is a useful summary. A lot of it is aimed at secondary care, but there are important bits for us.

Presentation:

Alongside the traditional hallucinations and delusions, remember that there may be ‘negative symptoms’ (eg Emotional Apathy, lack of drive, poverty of speech, social withdrawal and self neglect).

Also be aware that there will often be a ‘prodrome’ time of up to 12 months when the child may show altered behaviour (eg social withdrawal and heightened suspicion) alongside transient psychotic episodes.

Management:

Children should be referred urgently to CAMHS or an Early Intervention Psychosis team. NICE is a bit ambiguous about how long the child should have symptoms for before referral, but I suspect most of us would refer straight away anyway.

When referring, consider if there could be other coexistent mental health problems, substance abuse, educational problems or safeguarding concerns (eg due to exploitation or self-neglect).

Shared Care with CAMHS:

Children will often be discharged after 12m if they are well, meaning that their monitoring will fall to the GP. If they are on antipsychotic medication this should include:

  • GP review at least once a year – including monitoring for side-effects, adherence and general health.
  • Weight / Height / Waist and Hip circumference – every 6 months and plotted on centile chart
  • Pulse and BP – every 6 months
  • Prolactin / Fasting glucose / HbA1c / Lipids – every 6 months

Patients should be referred back to CAMHS if:

  • Poor response to treatment
  • Non-adherence to medication
  • Side-effects
  • Request psychological interventions not available in PC
  • Substance Abuse
  • Risk to self or others

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton locum chambers, and Pallant Medical Chambers Clinical Guidelines Lead Partner.

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