Children and adolescents

Question 1

Why treat and diagnose child?

Answer 1

• Early Schizo associated with worse clinical outcomes
• EI can improve outcomes
• Neurodev hypothesis

Question 2

Difficulty in diagnosing

Answer 2

1. Psychotic symptoms are a major part of diagnosis but they are present in general pop, in autism, mood disorders, personality disorders etc.
2. Hard to diagnose sth when you need a mood and behavioral chance for it
3. We are still define disorders in terms of symptoms profiles as oppose to seeing the large disorder
4. It is easier to mistake a kids ‘anomalous experiences’ as psychosis because they are more imagination + can misunderstand questions
5. 2/3 of kids with Schizo have slow not acute onset —> makes it harder to diagnose

Question 3

Why is symptomatic assessment better than diagnosis?

Answer 3

Better approach to the young patient than giving them early diagnosis

Presenting that you have x, x and x which means you could have y, y and y but we need to look over time

There is diagnostic instablitiy in early psychosis (you can get the dignosis wrong)

The clinical’s illusion’

Question 4

Prescribing to kids and adolescents

Answer 4

1. Not as much evidence-base but also no direct evidence to suggest that the medication wouldn’t work on younger people & a worldwide increase in prescribing
2. Kids have worse side effects
3. Start low, go slow (different pharmacodynamics in kids)
4. Need to target symptoms not diagnosis
5. Aim for monotherapy

Question 5

Pharmacodynamics differences in kids

Answer 5

1. Lower absorption
2. Higher
3. Less permeable blood brain barrier
4. Much higher clearance due to increased hepatic metabolism

Issue of using drugs which mess up with everything