Patterns of Care for Adolescent With Schizophrenia: A Delphi-Based Consensus Study.
Delphi method
adolescent schizophrenia
early diagnosis
expert consensus
pattern of care
treatment gaps
Journal
Frontiers in psychiatry
ISSN: 1664-0640
Titre abrégé: Front Psychiatry
Pays: Switzerland
ID NLM: 101545006
Informations de publication
Date de publication:
2022
2022
Historique:
received:
27
12
2021
accepted:
08
03
2022
entrez:
18
4
2022
pubmed:
19
4
2022
medline:
19
4
2022
Statut:
epublish
Résumé
The current conceptualization of schizophrenia as neurodevelopmental disorder should lead to innovative public health policies in terms of a reorganization of the mental health care systems, particularly in the transition from adolescence to adulthood, to reduce personal, familiar, and social costs and burdens. The purpose of the project was to perform a survey among a panel of Italian schizophrenia experts, to share evidence-based information on adolescent schizophrenia and explore the degree of consensus among professionals in the following four macro-areas: early diagnosis; pharmacological treatment; health care system organization and transition process from adolescent to adulthood; and psychosocial interventions. The consensus process consisted of a two-step web-based Delphi method, which took place between June and November 2021. The survey was developed by a panel of four psychiatrists and four child neuropsychiatrists, identified as key opinion leaders (KOLs). The KOLs identified 21 statements involving a total of 70 items with a major need of clarification on early-onset schizophrenia (EOS). The survey was distributed to 86 specialists in psychiatry and child neuropsychiatry. The results revealed a large agreement among the expert group on all the investigated areas of adolescent schizophrenia patterns of care and management. Consensus was ultimately reached for 67 items of the Delphi survey (95.7%), while negative consensus was reached for 2 items and no consensus was reached for 1 item. Overall, results showed a significant gap between the acquired scientific knowledge and clinical practice. In this scenario, it should be necessary to plan specific initiatives at a multiple level, to edit recommendations on clinical decision-making, as well as to prompt changes at the political and organizational levels, also involving scientific societies, patients, and family associations, to overcome the barriers that delay the implementation process.
Sections du résumé
Background
UNASSIGNED
The current conceptualization of schizophrenia as neurodevelopmental disorder should lead to innovative public health policies in terms of a reorganization of the mental health care systems, particularly in the transition from adolescence to adulthood, to reduce personal, familiar, and social costs and burdens. The purpose of the project was to perform a survey among a panel of Italian schizophrenia experts, to share evidence-based information on adolescent schizophrenia and explore the degree of consensus among professionals in the following four macro-areas: early diagnosis; pharmacological treatment; health care system organization and transition process from adolescent to adulthood; and psychosocial interventions.
Methods
UNASSIGNED
The consensus process consisted of a two-step web-based Delphi method, which took place between June and November 2021. The survey was developed by a panel of four psychiatrists and four child neuropsychiatrists, identified as key opinion leaders (KOLs). The KOLs identified 21 statements involving a total of 70 items with a major need of clarification on early-onset schizophrenia (EOS). The survey was distributed to 86 specialists in psychiatry and child neuropsychiatry.
Results
UNASSIGNED
The results revealed a large agreement among the expert group on all the investigated areas of adolescent schizophrenia patterns of care and management. Consensus was ultimately reached for 67 items of the Delphi survey (95.7%), while negative consensus was reached for 2 items and no consensus was reached for 1 item.
Conclusions
UNASSIGNED
Overall, results showed a significant gap between the acquired scientific knowledge and clinical practice. In this scenario, it should be necessary to plan specific initiatives at a multiple level, to edit recommendations on clinical decision-making, as well as to prompt changes at the political and organizational levels, also involving scientific societies, patients, and family associations, to overcome the barriers that delay the implementation process.
Identifiants
pubmed: 35432022
doi: 10.3389/fpsyt.2022.844098
pmc: PMC9007083
doi:
Types de publication
Journal Article
Langues
eng
Pagination
844098Informations de copyright
Copyright © 2022 Vita, Barlati, Bellomo, Poli, Masi, Nobili, Serafini, Zuddas and Vicari.
Déclaration de conflit d'intérêts
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Références
BMJ. 2013 Jan 23;346:f150
pubmed: 23344308
Front Psychiatry. 2019 Nov 15;10:844
pubmed: 31803086
JAMA Psychiatry. 2020 Feb 1;77(2):155-164
pubmed: 31746968
Front Psychiatry. 2019 Mar 20;10:147
pubmed: 30949081
Acta Psychiatr Scand. 1994 Feb;89(2):135-41
pubmed: 8178665
Schizophr Bull. 2021 Apr 29;47(3):692-694
pubmed: 32976579
Brain Behav. 2020 Feb;10(2):e01495
pubmed: 31908151
World Psychiatry. 2020 Jun;19(2):214-232
pubmed: 32394557
NPJ Schizophr. 2018 Oct 15;4(1):21
pubmed: 30323274
Neuropsychobiology. 2012;66(1):63-9
pubmed: 22797279
J Child Adolesc Psychopharmacol. 2016 Jun;26(5):410-27
pubmed: 27136403
Rev Psiquiatr Salud Ment. 2011 Jul;4(3):150-68
pubmed: 23446195
Am J Psychiatry. 2008 Nov;165(11):1420-31
pubmed: 18794207
Child Adolesc Psychiatr Clin N Am. 2006 Jan;15(1):177-206
pubmed: 16321730
CNS Spectr. 2022 Feb;27(1):118-128
pubmed: 33077012
Child Adolesc Psychiatr Clin N Am. 2020 Jan;29(1):71-90
pubmed: 31708054
Schizophr Bull. 2012 Jun;38(4):845-53
pubmed: 21307041
World Psychiatry. 2021 Feb;20(1):4-33
pubmed: 33432763
Schizophr Res. 2007 Sep;95(1-3):1-8
pubmed: 17628441
Eur Psychiatry. 2021 Sep 21;64(1):e62
pubmed: 34544509
Arch Gen Psychiatry. 2008 Jan;65(1):28-37
pubmed: 18180426
Neurol Ther. 2016 Dec;5(2):105-130
pubmed: 27553839
Curr Pharm Des. 2012;18(4):534-41
pubmed: 22239585
Front Psychiatry. 2021 Sep 16;12:662093
pubmed: 34603093
Schizophr Res. 2011 Sep;131(1-3):112-9
pubmed: 21741219
Schizophr Res. 2003 Dec 15;65(2-3):95-103
pubmed: 14630302
Eur Child Adolesc Psychiatry. 2018 Apr;27(4):501-511
pubmed: 29368253
Br J Psychiatry. 1995 Apr;166(4):489-95
pubmed: 7795921
Child Adolesc Psychiatr Clin N Am. 2020 Jan;29(1):183-210
pubmed: 31708047
Psychiatr Serv. 2009 Nov;60(11):1477-83
pubmed: 19880465
Early Interv Psychiatry. 2011 Feb;5(1):3-14
pubmed: 21272270
Acta Psychiatr Scand. 2003 Oct;108(4):285-9
pubmed: 12956829
J Am Acad Child Adolesc Psychiatry. 2014 Jun;53(6):688-96
pubmed: 24839887
JAMA Psychiatry. 2021 Aug 1;78(8):848-858
pubmed: 33877289
JAMA Psychiatry. 2018 Jun 1;75(6):555-565
pubmed: 29800949
Schizophr Bull. 2016 Jul;42(4):896-906
pubmed: 26834024
J Am Acad Child Adolesc Psychiatry. 2017 Mar;56(3):191-202
pubmed: 28219485
J Int Neuropsychol Soc. 2017 Oct;23(9-10):881-892
pubmed: 29198285
Lancet. 2016 Sep 24;388(10051):1280
pubmed: 27673467
Aust N Z J Psychiatry. 2015 Oct;49(10):887-97
pubmed: 26296368
BMJ Open. 2017 Jan 6;7(1):e013881
pubmed: 28062471
Child Adolesc Psychiatr Clin N Am. 2013 Oct;22(4):539-55
pubmed: 24012072
Child Adolesc Psychiatr Clin N Am. 2020 Jan;29(1):171-182
pubmed: 31708046
Biol Psychiatry. 2001 Dec 1;50(11):884-97
pubmed: 11743943
Eur Child Adolesc Psychiatry. 2020 Jul;29(7):1011-1022
pubmed: 31599351
Ann Gen Psychiatry. 2020 Jul 13;19:42
pubmed: 32684942
J Autism Dev Disord. 1992 Dec;22(4):601-24
pubmed: 1483979
Acta Psychiatr Scand. 1994 Mar;89(3):211-8
pubmed: 7909978
Indian J Psychiatry. 2019 Jan;61(Suppl 2):277-293
pubmed: 30745703
Eur Neuropsychopharmacol. 2011 Sep;21(9):655-79
pubmed: 21896369
Eur Neuropsychopharmacol. 2018 Jun;28(6):659-674
pubmed: 29802039
Int Rev Psychiatry. 2007 Aug;19(4):315-24
pubmed: 17671865
Eur Child Adolesc Psychiatry. 2020 Sep;29(9):1195-1205
pubmed: 31758359
BMC Psychiatry. 2012 Sep 19;12:150
pubmed: 22992395
Int J Environ Res Public Health. 2020 May 12;17(10):
pubmed: 32408561
Am J Psychiatry. 2016 Apr 1;173(4):362-72
pubmed: 26481174
Arch Gen Psychiatry. 1984 Feb;41(2):157-61
pubmed: 6696597
J Am Acad Child Adolesc Psychiatry. 2013 Sep;52(9):976-90
pubmed: 23972700
Front Hum Neurosci. 2010 Jan 29;3:79
pubmed: 20140271
Expert Opin Pharmacother. 2008 Feb;9(3):459-65
pubmed: 18220495
Front Psychol. 2017 Mar 27;8:371
pubmed: 28396643
Eur Psychiatry. 2018 Sep;53:107-115
pubmed: 30036773
Lancet Psychiatry. 2021 Nov;8(11):969-980
pubmed: 34653393
Arch Gen Psychiatry. 2012 Mar;69(3):220-9
pubmed: 22393215
Curr Opin Psychiatry. 2018 May;31(3):246-255
pubmed: 29474266
Psychol Med. 2019 Apr;49(5):772-779
pubmed: 29909790
Prim Care Companion CNS Disord. 2012;14(1):
pubmed: 22690369
NPJ Schizophr. 2015 Mar 04;1:14005
pubmed: 27336027
Br J Psychiatry. 2016 Nov;209(5):361-365
pubmed: 27802977
Brain Sci. 2021 Feb 23;11(2):
pubmed: 33672396
Res Psychother. 2020 May 20;23(1):455
pubmed: 32913830
Schizophr Bull. 2008 Jan;34(1):60-71
pubmed: 17923452
Br J Psychiatry. 2014 Aug;205(2):88-94
pubmed: 25252316