Treatment approaches for first episode and early-phase schizophrenia in adolescents and young adults: A Delphi consensus report from Europe

Neuropsychiatric Disease and TreatmentCorrell CU, Fusar-Poli P, Leucht S, et al. | February 09, 2022


Although management strategy for first-episode psychosis (FEP) in youth, particularly early-onset schizophrenia (EOS), is similar to that undertaken in adult-onset schizophrenia, approval for only few antipsychotics has been made for people aged 13– 18 years. In this work, areas of uncertainty in EOS management are explored and evidence-based recommendations to mental health specialists are presented.

  • Areas lacking evidence-based strategies are examined using the Delphi methodology; this standardized methodology involves construction of a questionnaire by content experts, submission of which is then done to a broader panel of professionals (panelists) to survey their level of agreement on the topics proposed.

  • The patient management from diagnosis to maintenance treatment was covered in the developed questionnaire.

  • There was development of an initial set of 90 items; in round I, consensus was reached for 83/90 items (92%), while in round II, 7/11 (64%) of the items sent out for rerating reached consensus.

  • Broad agreement was observed in terms of diagnostic standards, multimodal approaches and focus on adverse events, but uncertainty remains concerning pharmacological strategies (including clozapine) in case of failure and antipsychotic dosing in younger patients.

  • Findings suggest existence of knowledge concerning diagnostic clues and integrated management of EOS, however, there is lack of standardization in managing EOS, with safety arguments having a major role in the decision-making process.

  • Researchers support conducting targeted clinical trials and systematic dissemination across Europe of current scientific evidence on the value of early intervention services as these may contribute to standardized and improved quality care for patients with early-phase psychosis and schizophrenia.

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