Intended for healthcare professionals

Practice Guidelines

Recognition and management of psychosis and schizophrenia in children and young people: summary of NICE guidance

BMJ 2013; 346 doi: (Published 23 January 2013) Cite this as: BMJ 2013;346:f150
  1. Tim Kendall, director1, visiting professor2, consultant psychiatrist, medical director3,
  2. Chris Hollis, professor4,
  3. Megan Stafford, systematic reviewer1,
  4. Clare Taylor, senior editor1
  5. On behalf of the Guideline Development Group
  1. 1National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London E1 8AA, UK
  2. 2University College London (Clinical, Educational and Health Psychology), London WC1E 7HB, UK
  3. 3Sheffield Health and Social Care NHS Foundation Trust, Sheffield S10 3TH, UK
  4. 4Division of Psychiatry and Institute of Mental Health, School of Community Health Sciences, University of Nottingham, Nottingham NG7 2UH, UK
  1. Correspondence to: T Kendall tim2.kendall{at}
  • Accepted 6 January 2013

Psychosis, including schizophrenia, comprises a major group of psychiatric disorders characterised by hallucinations and/or delusions (psychotic symptoms) that alter perception, thoughts, affect, and behaviour, and which can considerably impair a child or young person’s development, relationships, and physical health. Schizophrenia is estimated to affect 1.6 to 1.9 per 100 000 in the child population,1 2 with prevalence increasing rapidly from age 14.3 Psychosis and schizophrenia in children (age 12 years and under) and young people (up to age 17 years) are leading causes of disability4 and are more severe and have worse prognosis than if onset is in adulthood, owing to disruption to social and cognitive development. Young people with schizophrenia tend to have a shorter life expectancy than the general population, largely because of suicide, injury, or cardiovascular disease,5 the last partly from antipsychotic medication. Children and young people with transient or attenuated psychotic symptoms are at increased risk of developing psychosis or schizophrenia,6 and delayed treatment can impair longer term outcomes,7 making early recognition and intervention crucial.

This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) guideline on psychosis and schizophrenia in children and young people.8


NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

General principles of care

Health and social care professionals working with children and young people with psychosis or schizophrenia should be trained and competent to work with children and young people with mental health problems of all levels of learning ability, cognitive capacity, emotional maturity, and development. [Based on the …

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