Compared with later onset, schizophrenia developing before the age of 18 is associated with greater disease burden, more negative and cognitive symptoms, and greater functional and social impairment,1 perhaps because the disorder occurs during a highly sensitive phase of development, said Professor Correll.
We should aim to reduce duration of untreated psychosis in early-onset patients
Outcome of early onset schizophrenia (EOS) is worse with male sex, poorer premorbid adjustment and more severe symptoms.2,3
These are factors we can do little to alter. But worse clinical, functional and cognitive outcomes are also predicted by longer duration of untreated psychosis3 – and that is something which we can influence -- through improved education of parents and mental healthcare workers in the realities and risks of EOS, Professor Correll argued.
That said, we accept that there are undoubted difficulties in diagnosing EOS: the mental health of adolescents is a moving target affected by biological and social undercurrents; there is overlap with psychotic mood disorders, severe anxiety, trauma and stress; and an imagination that is unusual but not developmentally inappropriate may be difficult to distinguish from psychotic symptoms.
Medication must be well tolerated
Early onset patients may be more vulnerable to prolactin elevation, sedation, weight gain and metabolic effects
Medication is effective in EOS, but Professor Correll noted evidence that young people have a different and potentially greater susceptibility to the adverse effects of pharmacological treatment than adults.4 Early onset patients may be more vulnerable than older patients to prolactin elevation, sedation, weight gain and metabolic effects including dyslipidemia, he reported.
One notable finding is that incidence of type 2 diabetes in young people taking antipsychotics is around twice that among young people with psychiatric problems not receiving antipsychotics and healthy controls.5 Some drugs are more metabolically toxic than others, he said.
Adherence is essential to functional outcome
In choosing an agent, we should focus on efficacy but also tolerability -- so that adherence is maintained, since without adherence it is not possible to achieve the ultimate goal of functional capacity, Professor Correll suggested.
We need to get medication right first time and continue treatment -- since this can prevent relapse.
Choice of antipsychotic needs to be tailored to patient characteristics and needs. He also noted that medication needs to be provided within a context that includes psychoeducation and psychotherapy, with a role also for stress management, sleep hygiene, and attention to diet and substance use.
This symposium was supported by Sumitomo Dainippon Pharma/ Sunovion
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