PSYCHOSIS AND SCHIZOPHRENIA IN CHILDREN AND YOUNG PEOPLE' THE NICE GUIDELINE ON RECOGNITION and MANAGEMENT PSYCHOSIS AND SCHIZOPHRENIA IN CHILDREN AND YOUNG PEOPLE RECOGNITION AND MANAGEMENT National Clinical Guideline Number 155 National Collaborating Centre for Mental Health commissioned by The National Institute for Health and Care Excellence published by The British Psychological Society and The Royal College of Psychiatrists 2572_Book.indb 1 6/27/2013 3:50:03 PM Project3 27/06/2013 15:14 Page 1 © The British Psychological Society & The Royal College of Psychiatrists, 2013 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). All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Enquiries in this regard should be directed to the British Psychological Society. British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library. ISBN-: 978-1-908020-60-4 Printed in Great Britain by Stanley L. Hunt (Printers) Ltd. Additional material: data CD-Rom created by Pix18 (www.pix18.co.uk) developed by National Collaborating Centre for Mental Health The Royal College of Psychiatrists 4th Floor, Standon House 21 Mansell Street London E1 8AA www.nccmh.org.uk commissioned by National Institute for Health and Care Excellence 1st Floor 10 Spring Gardens London SWIX 8PG www.nice.org.uk published by The British Psychological Society St Andrews House 48 Princess Road East Leicester LE1 7DR www.bps.org.uk and The Royal College of Psychiatrists 17 Belgrave Square London SW1X 8PG www.rcpsych.ac.uk Contents CONTENTS GUIDELINE DEVELOPMENT GROUP MEMBERS AND NATIONAL COLLABORATING CENTRE FOR MENTAL HEALTH (NCCMH) REVIEW TEAM 6 ACKNOWLEDGEMENTS 9 1 PREFACE 10 1.1 National guideline 10 1.2 The national Psychosis and Schizophrenia in Children and Young People guideline 12 2 PSYCHOSIS AND SCHIZOPHRENIA IN CHILDREN AND YOUNG PEOPLE 15 2.1 The disorder 15 2.2 Incidence and prevalence 22 2.3 Possible causes of schizophrenia 22 2.4 Assessment 23 2.5 Engagement, consent and therapeutic alliance 26 2.6 Language and stigma 27 2.7 Issues for parents and carers 28 2.8 Treatment and management of psychosis and schizophrenia in children and young people in the NHS 29 2.9 Supporting children and young people with psychosis and schizophrenia in school 37 2.10 The economic cost of psychosis and schizophrenia 39 3 METHODS USED TO DEVELOP THIS GUIDELINE 41 3.1 Overview 41 3.2 The scope 41 3.3 The guideline development group 42 3.4 Review questions 44 3.5 Systematic clinical literature review 45 3.6 Health economics methods 58 3.7 The incorporation and adaptation of existing NICE guideline recommendations 62 3.8 From evidence to recommendations 64 3.9 Stakeholder contributions 65 3.10 Validation of the guideline 66 3 2572_Book.indb 3 6/27/2013 3:50:03 PM Contents 4 ACCESS TO AND THE DELIVERY OF SERVICES, AND THE EXPERIENCE OF CARE 67 4.1 Introduction 67 4.2 Clinical review protocol 67 4.3 Sources of information considered 69 4.4 Narrative review of the evidence for access to and delivery of services and current practice 70 4.5 Experience of care 75 4.6 From evidence to recommendations 108 4.7 Recommendations 110 5 AT RISK MENTAL STATES FOR PSYCHOSIS AND SCHIZOPHRENIA IN CHILDREN AND YOUNG PEOPLE: RECOGNITION AND MANAGEMENT 121 5.1 Introduction 121 5.2 Clinical review protocol for at risk mental states for psychosis and schizophrenia in children and young people 123 5.3 Recognition of at risk mental states 126 5.4 Pharmacological interventions 128 5.5 Dietary interventions 139 5.6 Psychosocial interventions 140 5.7 Health economic evidence 154 5.8 From evidence to recommendations 156 5.9 Recommendations 159 5.10 Research recommendations 160 6 PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS 161 6.1 Introduction 161 6.2 Clinical review protocol for the review of psychological and psychosocial interventions for children and young people with psychosis and schizophrenia 163 6.3 Studies considered for review 165 6.4 Arts therapies 166 6.5 Cognitive behavioural therapy 172 6.6 Family intervention 195 6.7 EPPIC treatment as usual 207 6.8 Principles for delivering psychological interventions 211 6.9 Research recommendation 214 7 PHARMACOLOGICAL INTERVENTIONS 215 7.1 Introduction 215 7.2 Initial treatment with antipsychotic medication for fi rst episode psychosis 216 7.3 Antipsychotics in the treatment of subsequent acute episodes of psychosis and schizophrenia 244 4 2572_Book.indb 4 6/27/2013 3:50:04 PM Contents 7.4 Antipsychotics in children and young people with psychosis and schizophrenia whose illness has not responded adequately to pharmacological treatment 304 7.5 Side effects of antipsychotic medication occurring at or over 12 weeks 315 7.6 Health economic evidence 335 7.7 From evidence to recommendations 337 7.8 Recommendations 351 7.9 Research recommendations 357 8 COGNITION, EMPLOYMENT AND EDUCATION 358 8.1 Introduction 358 8.2 Clinical review protocol 358 8.3 Studies considered 360 8.4 Cognitive remediation therapy 361 8.5 Vocational rehabilitation 370 8.6 Education 374 8.7 From evidence to recommendations 374 8.8 Recommendations 375 9 SUMMARY OF RECOMMENDATIONS 378 9.1 General principles of care 378 9.2 Possible psychosis 382 9.3 First episode psychosis 383 9.4 Subsequent acute episodes of psychosis or schizophrenia 392 9.5 Referral in crisis and challenging behaviour 394 9.6 Early post-acute period 396 9.7 Promoting recovery and providing possible future care in primary care 397 9.8 Promoting recovery and providing possible future care in secondary care 398 10 APPENDICES 401 11 REFERENCES 484 12 ABBREVIATIONS 506 5 2572_Book.indb 5 6/27/2013 3:50:04 PM Guideline development group members and NCCMH review team GUIDELINE DEVELOPMENT GROUP MEMBERS AND NATIONAL COLLABORATING CENTRE FOR MENTAL HEALTH (NCCMH) REVIEW TEAM Professor Chris Hollis (Chair, Guideline Development Group) Professor of Child and Adolescent Psychiatry, University of Nottingham Professor Tim Kendall (Facilitator, Guideline Development Group) Director, NCCMH, Royal College of Psychiatrists; Medical Director/Consultant Adult Psychiatrist, Sheffi eld Health and Social Care NHS Foundation Trust; Visiting Professor, University College London Ms Henna Bhatti Research Assistant, NCCMH (2010 to 2011) Professor Max Birchwood Professor of Youth Mental Health, School of Psychology, University of Birmingham; Clinical Director, YouthSpace Mental Health Programme, Birmingham and Solihull Mental Health NHS Foundation Trust Mr Rory Byrne Service User Representative; Researcher, Greater Manchester West Mental Health NHS Foundation Trust Ms Melissa Chan Systematic Reviewer, NCCMH (2010 to 2011) Mr Nadir Cheema Health Economist, NCCMH Dr Andrew Clark Consultant in Adolescent Psychiatry, Greater Manchester West Mental Health NHS Foundation Trust Ms Jaeta Egoh Service User Representative Professor Elena Garralda Professor and Honorary Consultant in Child and Adolescent Psychiatry, Imperial College London and Central and North West London Foundation Trust 6 2572_Book.indb 6 6/27/2013 3:50:04 PM Guideline development group members and NCCMH review team Ms Laura Graham Carer Representative; Involvement Worker and Young Person’s Panel Adviser for Rethink Mental Illness Ms Marie Halton Research Assistant, NCCMH (2010 to 2011) Ms Hannah Jackson Research Assistant, NCCMH (2011 to 2012) Dr Anthony James Consultant Child and Adolescent Psychiatrist and Honorary Senior Lecturer, Oxfordshire and Buckinghamshire Mental Health NHS Foundation Trust Dr Linnéa Larsson Project Manager and Research Assistant, NCCMH (2012 to 2013) Ms Christina Loucas Research Assistant, NCCMH (2012 to 2013) Mr Tim McDougall Nurse Consultant, Clinical Director (Tier 4 Child and Adolescent Mental Health Services [CAMHS]) and Lead Nurse (CAMHS), Cheshire and Wirral Partnership NHS Foundation Trust Professor Anthony Morrison Professor of Clinical Psychology, Greater Manchester West Mental Health NHS Foundation Trust Dr Gillian Rose Consultant Child and Adolescent Psychiatrist, Central and North West London NHS Foundation Trust Mrs Kate Satrettin Project Manager, NCCMH (2010 to 2012) Ms Christine Sealey Associate Director, NCCMH Dr David Shiers GP Adviser to the National Audit of Schizophrenia (The Royal College of Psychiatrists) and Rethink Mental Illness Trustee 7 2572_Book.indb 7 6/27/2013 3:50:04 PM Guideline development group members and NCCMH review team Dr Kirsty Smedley Consultant Clinical Psychologist, The Priory Hospital Cheadle Royal; Honorary Lecturer, Manchester University Ms Megan Stafford Systematic Reviewer, NCCMH (2011 to 2013) Ms Sarah Stockton Senior Information Scientist, NCCMH Dr Clare Taylor Senior Editor, NCCMH Mr Darryl Thompson Psychosocial Interventions Development Lead, South West Yorkshire Partnership NHS Foundation Trust Dr David Ward Consultant Adolescent Psychiatrist, Newcastle CAMHS and Early Intervention in Psychosis Service (2010 to 2011) 8 2572_Book.indb 8 6/27/2013 3:50:04 PM Acknowledgements ACKNOWLEDGEMENTS The Guideline Development Group (GDG) and the NCCMH review team would like to thank the following people: Those