Proposed treatment for adolescent psychosis. 1: Schizophrenia and schizophrenia-like psychoses

Andrew Clark has been Senior Lecturer in Adolescent Psychiatry in Manchester since 1997 (McGuinness Unit, Mental Health Services of Salford NHS Trust, Bury New Road, Prestwich, Manchester M25 3BL; e-mail: [email protected]) and was previously Consultant in Adolescent Psychiatry within the West Midlands region from 1990 to 1997. He has particular interests in the assessment and treatment of young people with psychotic disorders. Psychotic disorders in adolescence are uncommon, but often mark the beginning of a lifetime of contact with mental health services. They pose a challenge and anxiety to sufferers, to their families and to professionals involved in assessment and treatment. Accurate and early diagnosis, coupled with appropriate treatment, is essential to minimise secondary handicaps. However, their rarity means that professionals are frequently unfamiliar with some aspects of presentation or management and that appropriate service provision is not readily available (e.g. admission directly into an in-patient bed in an ageappropriate environment). A lack of age-appropriate provision may also mean that adult psychiatrists are occasionally called on to manage and treat a younger teenager presenting with a psychotic disorder. The focus here will be on the assessment and treatment of first-onset psychotic disorder in adolescence and its subsequent longer-term management. Psychotic disorders solely due to substance misuse, or to other organic factors, will be considered in relation to the differential diagnosis and to acute treatment, but not specifically in relation to longerterm management. The longer-term management of psychotic disorders occurring as episodes as part of a bipolar affective disorder is the subject of separate review in a companion paper (Clark, 2001).