Psychosis can cause great distress concerning symptoms and substantial costs for young people and their families and communities — including the costs of lost human potential when healthy development is interrupted. Research shows that interventions can mitigate the distress and symptoms, particularly if young people receive these early in the disorder’s course. The Children’s Health Policy Centre suggests three recommendations to guide the treatment of psychosis:

1. Ensure careful assessment and diagnosis. Some causes of psychosis, such as substance use, are reversible. Some causes, such as seizures or infections, are also treatable. So, a first step is always to find out what is causing the presenting problem. Diagnosis can then guide treatment planning, for example, considering whether longer-term antipsychotic medications are needed, as with schizophrenia. After the diagnosis has been established, ongoing monitoring is also crucial — to assess a youth’s symptoms, functioning and response to treatment, including any adverse effects.
2. Use antipsychotic medications carefully. Antipsychotics are a mainstay in treating psychosis in young people — both short and long term. Aripiprazole and olanzapine stood out in this review, with two RCTs for each medication showing benefits in young people. Yet adverse events were common and severe, so both choice of medication and dosing need to be carefully monitored to ensure that benefits outweigh harms. Guidelines from the Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children address monitoring for six antipsychotic medications, including aripiprazole and olanzapine. These guidelines need to be closely followed for any youth who is prescribed antipsychotics.
3. Offer psychosocial interventions as well. All youth with psychosis should be offered early psychosis intervention (EPI) programs, as they lead to reduced hospitalizations and psychotic symptoms. EPI programs typically included a range of psychosocial interventions, such as cognitive behavioural therapy, social skills training and family interventions. As well, some youth will have challenges that antipsychotics do not address and these psychosocial interventions will likely benefit them, as well.

For more information, see Vol. 14, No. 4 https://childhealthpolicy.ca/wp-content/uploads/2020/11/RQ-14-20-Fall.pdf  of the Children’s Mental Health Research Quarterly.