Skip to main content Accessibility help
×
Home
Hostname: page-component-99c86f546-zzcdp Total loading time: 0.259 Render date: 2021-11-27T21:27:51.039Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

3 - Schizophrenia and schizophrenia-like disorders

Published online by Cambridge University Press:  06 August 2009

Andrew F. Clark
Affiliation:
Prestwich Hospital, Manchester, UK
Christopher Gillberg
Affiliation:
Göteborgs Universitet, Sweden
Richard Harrington
Affiliation:
University of Manchester
Hans-Christoph Steinhausen
Affiliation:
Universität Zürich
Get access

Summary

Introduction

Approximately 20 per cent of people with a lifetime diagnosis of schizophrenia date the first onset of their psychotic symptoms to before the age of 20 years. One of the key tasks therefore, of the child and adolescent psychiatrist is early recognition and treatment of the disorder notwithstanding its rarity in their overall practice. A much larger number of young people, however, are referred to child and adolescent mental health services with the key question ‘might this young person be developing or suffering from the early stages of schizophrenia or some other psychotic disorder?’. The clinician must also therefore, possess expert knowledge of both its typical and atypical presentations and its differential diagnoses.

Other psychotic disorders presenting during adolescence (and more rarely during childhood) are those of acute or transient psychotic disorders not lasting long enough for a diagnosis of schizophrenia, schizoaffective disorders, delusional disorders, psychotic episodes occurring as part of an underlying affective disorder and psychotic disorders secondary to substance misuse or to general medical conditions.

In many instances the clinician will be able to arrive at a clear formulation and diagnostic understanding and to develop a specific treatment plan. In others, however, diagnostic uncertainty will remain despite a full and careful assessment, even one lasting over a period of weeks. In these cases it is important that the clinician is able to tolerate this uncertainty whilst continuing to take a problem-focused approach to the young person's difficulties.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Academy of Child and Adolescent Psychiatry, Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child and Adolescent Psychiatry, 40(7) (2001), Suppl. 4S–23S. Standards and evidence base for current good practice in the assessment and treatment of children and adolescents with schizophrenia.
C. Barrowclough & N. Tarrier, Families of schizophrenic patients: cognitive behavioural intervention. In A practical guide to family intervention strategies. Cheltenham: Stanley Thornes, 1997).
Clark, A. F. & Lewis, S. W., Practitioner review: treatment of schizophrenia in childhood and adolescence. Journal of Child Psychology and Psychiatry, 39 (1998), 1071–81. Practical overview of current treatment issues for young people with schizophrenia, albeit becoming dated in respect of advice regarding use of atypical antipsychotics.Google Scholar
Geddes, J., Freemantle, N., Harrison, P. & Bebbington, P., Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis. British Medical Journal, 321 (2000), 1371–6. Systematic review casting doubts upon the evidence base for use of atypical antipsychotics as first-line drugs – the paper generated much subsequent correspondence expressing views for and against their use.Google Scholar
Hollis, C., Adolescent schizophrenia. Advances in Psychiatric Treatment, 6 (2000), 83–92. Contains outcome data on follow-up study of adolescents with schizophrenia admitted to Maudsley Hospital.Google Scholar
, P. D. McGorry & , H. J. Jackson, The Recognition and Management of Early Psychosis: A Preventive Approach (Cambridge: Cambridge University Press, 1999). Comprehensive discussion of issues and practice in first onset psychosis and early intervention services.
National Institute for Clinical Excellence, Technology Appraisal No. 43: Guidance on the use of newer (atypical) antipsychotic drugs for the treatment of schizophrenia (London: NICE, 2002). UK-based guidance derived from a systematic review of clinical and cost effectiveness of antipsychotic drugs in treatment of schizophrenia.
Pilling, S., Bebbington, P., Kuipers, E.et al., Psychological treatments in schizophrenia: 1. Meta-analysis of family intervention and cognitive behaviour therapy. Psychological Medicine, 32 (2002), 763–82. Concludes that both family interventions and CBT have proven efficacy and should be routinely offered as part of treatment programme.Google Scholar
Pilling, S., Bebbington, P., Kuipers, E.et al., Psychological treatments in schizophrenia: 2. Meta-analyses of randomized controlled trials of social skills training and cognitive remediation. Psychological Medicine, 32 (2002), 783–91. Concludes that neither social skills training nor cognitive remediation have yet been shown as effective for routine clinical practice.Google Scholar
, H. Remschmidt, Schizophrenia in Children and Adolescents (Cambridge: Cambridge University Press, 2001). Comprehensive overview of all aspects of schizophrenia in children and adolescents.
, D. Taylor, , H. McConnell, , D. McConnell & , R. Kerwin, The Maudsley 2001 Prescribing Guidelines (London: Martin Dunitz, 2001). Regularly updated guidelines with useful algorithms. Specific section on psychosis but not to treatment of children and adolescents.
, T. Wykes, , N. Tarrier & , S. Lewis, Outcomes and Innovation in the Psychological Treatment of Schizophrenia (Chichester: Wiley, 1998). Overview of range of psychological interventions appropriate to treatment of schizophrenia in adults.

Send book to Kindle

To send this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Send book to Dropbox

To send content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox.

Available formats
×

Send book to Google Drive

To send content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive.

Available formats
×