Canadian Guidelines for the Assessment and Diagnosis of Patients with Schizophrenia Spectrum and Other Psychotic Disorders

Addington, Donald; Abidi, Sabina; Garcia-Ortega, Iliana; Honer, William G.; Ismail, Zahinoor

doi:10.1177/0706743717719899

Cited by 33 publications

(26 citation statements)

References 58 publications

(54 reference statements)

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“…Schizophrenia is a phenotypically heterogeneous and potentially debilitating illness [1]. While a variety of etiological and pathophysiological abnormalities have been implicated in its development, it remains a poorly understood disorder [2].…”

Section: Introductionmentioning

confidence: 99%

Clinically Relevant Anti-Neuronal Cell Surface Antibodies in Schizophrenia Spectrum Disorders

Colijn

Ismail

2019

Neuropsychobiology

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Schizophrenia is a phenotypically heterogeneous and poorly understood disorder. While its etiology is likely multifactorial, immune system dysfunction has increasingly been implicated in its development. As hallucinations and delusions occur frequently and prominently in autoimmune encephalitis (AE), numerous studies have sought to determine whether a small subset of individuals diagnosed with schizophrenia possess anti-neuronal antibodies implicated in AE. Exploring this possibility is of clinical relevance, as identifying individuals with AE who have been misdiagnosed as having a primary psychotic disorder may allow for the implementation of appropriate immune-related therapies as early as possible in the course of the illness, in order to optimize outcomes, reduce illness chronicity, and minimize adverse events. This qualitative review serves to provide an overview of the existing literature on this topic, as well as to update previously published reviews. Although there is some evidence to suggest that in rare cases AE may be misdiagnosed as a primary psychotic disorder, particularly early in the course of the illness, numerous methodological differences between studies likely account for the highly variable findings, and interpretation of the results is particularly limited by a paucity of cerebrospinal fluid data. Moreover, the prevalence of misdiagnosis in chronic and treatment-resistant populations remains understudied. This is particularly problematic, as treatment resistance may represent an enriched population with respect to the presence of anti-neuronal antibodies, and given that such patients have few evidence-based treatment options available to them beyond clozapine.

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Section: Introductionmentioning

confidence: 99%

Clinically Relevant Anti-Neuronal Cell Surface Antibodies in Schizophrenia Spectrum Disorders

Colijn

Ismail

2019

Neuropsychobiology

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“…Given the growing amount of data demonstrating the low clinical yield of neuroimaging in first-episode psychosis, the Canadian Psychiatric Association has recently modified its guidelines from an earlier recommendation that brain imaging be considered as part of a routine investigation of all patients with first-episode psychosis (Addington et al, 2017). The Canadian guidelines now state that ‘ imaging is indicated in the presence of signs and symptoms suggestive of intracranial pathology including headaches, nausea and vomiting, seizure-like activity, and later age at the onset of symptoms ’ (Addington et al, 2017). This is reflected in the recommendations of Choosing Wisely in both Canada and the United Kingdom that clinicians do not routinely order neuroimaging in first-episode psychosis in the absence of signs or symptoms suggestive of intracranial pathology (Choosing Wisely Canada, 2017; Choosing Wisely UK, 2018).…”

Section: Discussionmentioning

confidence: 99%

“…Canadian Guidelines for the Assessment and Diagnosis of Patients with Schizophrenia Spectrum and Other Psychotic Disorders (Addington et al, 2017) Order neuroimaging with CT or MRI based on specific aspects of the history, neurological examination or neuropsychological testing results.…”

Section: Guideline Recommendationmentioning

confidence: 99%

The clinical utility of structural neuroimaging in first-episode psychosis: A systematic review

Forbes

Stefler

Velakoulis

et al. 2019

Aust N Z J Psychiatry

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Background: Australian and US guidelines recommend routine brain imaging, either computed tomography or magnetic resonance imaging, to exclude structural lesions in presentations for first-episode psychosis. The aim of this review was to examine the evidence for the appropriateness and clinical utility of this recommendation by assessing the frequency of abnormal radiological findings in computed tomography and magnetic resonance imaging scans among patients with first-episode psychosis. Methods: PubMed and Embase database were searched from inception to April 2018 using appropriate MeSH or Emtree terms. Studies were included in the review if they reported data on computed tomography or magnetic resonance imaging scan findings of individuals with first-episode psychosis. No restriction on the geographical location of the study or the age of participants was applied. We calculated the percentage of abnormal radiological findings in each study, separately by the two diagnostic methods. Results: There were 16 suitable studies published between 1988 and 2017, reporting data on an overall 2312 patients with first-episode psychosis. Most were observational studies with a retrospective design and the majority examined patients with computed tomography. While structural abnormalities were a relatively common finding, these rarely required clinical intervention (range across studies: 0–60.7%; median: 3.5%) and were very rarely the cause of the psychotic symptoms (range: 0–3.3%; median: 0%). Only 2 of the 16 studies concluded that brain imaging should be routinely ordered in first-episode psychosis. Conclusion: There is insufficient evidence to suggest that brain imaging should be routinely ordered for patients presenting with first-episode psychosis without associated neurological or cognitive impairment. The appropriate screening procedure for structural brain lesions is conventional history-taking, mental status and neurological examination. If intracranial pathology is suspected clinically, a magnetic resonance imaging or computed tomography scan should be performed depending on the clinical signs, the acuity and the suspected pathology. National guidelines should reflect evidence-based data.

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“…The key features that define these illnesses in youth and adults and assist in confirming an accurate and reliable diagnosis are outlined in our guidelines for the assessment and diagnosis of patients with schizophrenia and other spectrum disorders. 1,3 As with all mental disorders, schizophrenia spectrum and other psychotic disorders in youth are identified on the basis of clinical features. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) 4 emphasizes a dimensional perspective of symptom presentation that is particularly applicable to children and youth, recognizing that symptom domains for psychosis can differ depending on the age and stage of development and can potentially be a manifestation of multiple diagnostic categories.…”

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confidence: 99%

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confidence: 99%

Canadian Guidelines for the Pharmacological Treatment of Schizophrenia Spectrum and Other Psychotic Disorders in Children and Youth

et al. 2017

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Objective: Schizophrenia spectrum and other psychotic disorders often have their onset in adolescence. The sequelae of these illnesses can negatively alter the trajectory of emotional, cognitive, and social development in children and youth if left untreated. Early and appropriate interventions can improve outcomes. This article aims to identify best practices in the pharmacotherapy management of children and youth with schizophrenia spectrum disorders.Methods: A systematic search was conducted for published guidelines for schizophrenia and schizophrenia spectrum disorders in children and youth (under age 18 years). Recommendations were drawn from the National Institute for Health and Care Excellence guidelines on psychosis and schizophrenia in children and youth (2013 and 2015 updates). Current guidelines were adopted using the ADAPTE process, which includes consensus ratings by a panel of experts.Results: Recommendations identified covered a range of issues in the pharmacotherapy management of children and youth with schizophrenia spectrum disorders. Further work in this area is warranted as we continue to further understand their presentation in the developing brain. Conclusions: Canadian guidelines for the pharmacotherapy management of children and youth with schizophrenia spectrum disorders are essential to assist clinicians in treating this vulnerable population. Ongoing work in this area is recommended.Keywords adolescent-onset schizophrenia, early-onset schizophrenia, schizophrenia and psychotic spectrum disorders, clinical practice guidelines, pharmacotherapy, treatment guidelines, children and youth Schizophrenia spectrum and other psychotic disorders are illnesses that carry significant morbidity and mortality for those affected. These illnesses often have their onset in adolescence and can significantly interfere with the normal trajectory of development. Early interventions with appropriate and stage-specific psychological and pharmacological modalities can, however, lead to better and, in some, optimal outcomes in this population. The following recommendations were developed to assist clinicians in providing pharmacological interventions for children and youth up to the age of 18 years (termed early onset) with schizophrenia spectrum and other psychotic disorders. The recommendations and associated discussions were drawn from a number of sources, with the greatest weight placed on evidence based on randomized controlled trials or systematic reviews available in this age range as well as consensus statements

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Canadian Guidelines for the Assessment and Diagnosis of Patients with Schizophrenia Spectrum and Other Psychotic Disorders

Cited by 33 publications

References 58 publications

Clinically Relevant Anti-Neuronal Cell Surface Antibodies in Schizophrenia Spectrum Disorders

Clinically Relevant Anti-Neuronal Cell Surface Antibodies in Schizophrenia Spectrum Disorders

The clinical utility of structural neuroimaging in first-episode psychosis: A systematic review

Canadian Guidelines for the Pharmacological Treatment of Schizophrenia Spectrum and Other Psychotic Disorders in Children and Youth

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