Psych · Child and adolescent psychiatry — early-onset psychosis
Early-onset psychosis
Also known as EOP · Early onset psychosis · Childhood-onset schizophrenia · COS · Very-early-onset schizophrenia · VEOS · Adolescent-onset psychosis · Paediatric schizophrenia · Youth psychosis · Early-onset schizophrenia spectrum
Exam-exhaustive CAP fellowship reference on early-onset psychosis — age definitions (EOP under 18, VEOP/COS under 13), autism/trauma/substance differentials, intensified organic work-up, youth early intervention, start-low antipsychotics with metabolic vigilance, family and school liaison, and clozapine threshold in refractory EOP. Related to adult FEP/schizophrenia but CAP-specific. FRANZCP-primary, globally tagged.
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10 MCQs with explanations
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Meet the patient
A 15-year-old has stopped going to school. For three months he has been convinced his teachers are editing the lecture recordings to humiliate him, and he hears two voices arguing about his marks. He has smoked high-potency cannabis daily since he was 13.[9][13]
The registrar calls it drug-induced. The examiner's question is the one that decides prognosis: "How long has he been psychotic, and how fast can you shorten that clock?" Duration of untreated psychosis is the single most modifiable variable on the page — in youth as in adults.[9][10]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.
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- [2]Kumra S, et al. Clozapine and "high-dose" olanzapine in refractory early-onset schizophrenia: a 12-week randomized and double-blind comparison Biol Psychiatry, 2008.PMID 17651705
- [3]Correll CU, et al. Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents JAMA, 2009.PMID 19861668
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- [5]Stafford MR, et al. Efficacy and safety of pharmacological and psychological interventions for the treatment of psychosis and schizophrenia in children, adolescents and young adults: a systematic review and meta-analysis PLoS One, 2015.PMID 25671707
- [6]Pagsberg AK, et al. Quetiapine extended release versus aripiprazole in children and adolescents with first-episode psychosis: the multicentre, double-blind, randomised TEA trial Lancet Psychiatry, 2017.PMID 28599949
- [7]Kendall T, et al. Recognition and management of psychosis and schizophrenia in children and young people: summary of NICE guidance BMJ, 2013.PMID 23344308
- [8]Galletly C, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders Aust N Z J Psychiatry, 2016.PMID 27106681
- [9]Marshall M, et al. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review Arch Gen Psychiatry, 2005.PMID 16143729
- [10]Correll CU, et al. Comparison of Early Intervention Services vs Treatment as Usual for Early-Phase Psychosis: A Systematic Review, Meta-analysis, and Meta-regression JAMA Psychiatry, 2018.PMID 29800949
- [11]Kane JM, et al. Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program Am J Psychiatry, 2016.PMID 26481174
- [12]Howes OD, Kapur S The dopamine hypothesis of schizophrenia: version III--the final common pathway Schizophr Bull, 2009.PMID 19325164
- [13]Di Forti M, et al. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study Lancet Psychiatry, 2019.PMID 30902669
- [14]Zipursky RB, Menezes NM, Streiner DL Risk of symptom recurrence with medication discontinuation in first-episode psychosis: a systematic review Schizophr Res, 2014.PMID 23972821
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- [16]Schoeler T, et al. Effects of continuation, frequency, and type of cannabis use on relapse in the first 2 years after onset of psychosis: an observational study Lancet Psychiatry, 2016.PMID 27567467
- [17]Hollis C Adult outcomes of child- and adolescent-onset schizophrenia: diagnostic stability and predictive validity Am J Psychiatry, 2000.PMID 11007720
- [18]Clemmensen L, Vernal DL, Steinhausen HC A systematic review of the long-term outcome of early onset schizophrenia BMC Psychiatry, 2012.PMID 22992395
- [19]Driver DI, et al. Childhood-Onset Schizophrenia and Early-onset Schizophrenia Spectrum Disorders: An Update Child Adolesc Psychiatr Clin N Am, 2020.PMID 31708054
- [20]Rapoport JL, Gogtay N Childhood onset schizophrenia: support for a progressive neurodevelopmental disorder Int J Dev Neurosci, 2011.PMID 20955775
- [21]Findling RL, et al. A multiple-center, randomized, double-blind, placebo-controlled study of oral aripiprazole for treatment of adolescents with schizophrenia Am J Psychiatry, 2008.PMID 18765484
- [22]Gardner DM, et al. International consensus study of antipsychotic dosing Am J Psychiatry, 2010.PMID 20360319