Early onset schizophrenia needs patient-specific management

Early diagnosis and effective, well-tolerated treatment of early-onset schizophrenia are crucial to achieving the higher order outcomes of good functioning and health-related quality of life, Christoph Correll (Charité Hospital, Berlin; and Donald and Barbara Zucker School of Medicine, New York) told CINP 2021 Virtual.

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

 

Prompt diagnosis

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 and weight gain, 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. 

BE-NOTPR-0023; approval date 08/2021

This symposium was supported by Sumitomo Dainippon Pharma/ Sunovion

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

References

1. Immonen J et al. Early Interv Psychiatry 2017; 11(6): 453–460

2. Clemmensen L et al.  BMC Psychiatry 2012 Sep 19;12:150

3. Díaz-Caneja CM et al. NPJ Schizophr. 2015; 1: 14005.

4. Correll CU et al. J Clin Psychiatry 2011;72: 655-670

5. Galling B et al. JAMA Psychiatry 2016 Mar;73(3):247-59.

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