Patterns of Care for Adolescent With Schizophrenia: A Delphi-Based Consensus Study

Area of Science:

• Neuroscience
• Psychiatry
• Public Health

Background:

• Schizophrenia is increasingly viewed as a neurodevelopmental disorder, necessitating innovative public health policies.
• Reorganization of mental health care systems is crucial, especially during the transition from adolescence to adulthood, to mitigate personal, familial, and social burdens.
• Evidence-based information sharing and consensus-building among experts are vital for improving adolescent schizophrenia care.

Purpose of the Study:

• To conduct a survey among Italian schizophrenia experts to share evidence-based information.
• To explore the degree of consensus on adolescent schizophrenia management in four key areas: early diagnosis, pharmacological treatment, healthcare system organization, and psychosocial interventions.
• To address the transition process from adolescence to adulthood in schizophrenia care.

Main Methods:

• A two-step web-based Delphi method was employed between June and November 2021.
• A panel of key opinion leaders (KOLs), including psychiatrists and child neuropsychiatrists, developed 21 statements with 70 items for the survey.
• The survey was distributed to 86 specialists in psychiatry and child neuropsychiatry to assess consensus on early-onset schizophrenia (EOS).

Main Results:

• A high level of agreement was observed among experts across all investigated areas of adolescent schizophrenia care and management.
• Consensus was achieved for 67 out of 70 items (95.7%) in the Delphi survey.
• Negative consensus was reached for 2 items, and no consensus for 1 item, indicating strong expert agreement overall.

Conclusions:

• A significant disparity exists between current scientific knowledge and clinical practice in adolescent schizophrenia care.
• There is a need for multi-level initiatives, including clinical recommendations and policy changes, to bridge the gap between research and practice.
• Collaboration among scientific societies, patients, and family associations is essential to overcome implementation barriers and improve care for early-onset schizophrenia (EOS).