Week 9: Early-Onset Schizophrenia

NURS 6660 – Week 9 Assignment: Early-Onset Schizophrenia

NURS 6660 – Week 9 Assignment: Early-Onset Schizophrenia

The Assignment (2 pages):
Compare at least two evidence-based treatment plans for adults diagnosed with schizophrenia with evidence-based treatment plans for children and adolescents diagnosed with schizophrenia.
Explain the legal and ethical issues involved with forcing children diagnosed with schizophrenia to take medication for the disorder and how a PMHNP may address those issues
Week 9: Early-Onset Schizophrenia
“I can’t believe he is speaking to me! I have always liked his music, but now here he is on TV speaking directly to me! When I started following him on social media, he must have seen my profile. I know he loves me. He cannot love that model I saw with him in the picture. She must be the person following me to school. I have not seen her, but I know she is there. She does not want me being with him, but I will be with him. He loves me as much as I love him.”
Kaitlyn, age 17
Early-onset schizophrenia is a rare and severe mental illness in which children interpret reality abnormally. There are a range of problems with cognitive functioning, behavior, and emotions. Perceptions may be distorted and children or their parents may report that they have difficulty distinguishing reality. This is a diagnosis that is difficult to confirm in the early stages.
This week, you compare evidence-based treatment plans for adults versus children diagnosed with schizophrenia. You analyze the legal and ethical issues involved with forcing patients with early-onset schizophrenia to take medications for the disorder. You also complete a Decision Tree concerning children with psychotic disorders.
 
Assignment 1: Early Onset Schizophrenia
Children and adolescents with schizophrenia have more difficulty functioning in academic or work settings, and significant impairment usually persists into adulthood. They may have speech or language disorders and in some cases borderline intellectual functioning. These individuals are more likely to complete suicide attempts or die from other accidental causes. Schizophrenia is characterized by positive and negative symptoms. Positive symptoms include hallucinations, delusions, and behavior disturbance. Negative symptoms include blunted affect and attention, apathy, and lack of motivation and social interest.
In this Assignment, you compare treatment plans for adults diagnosed with schizophrenia with treatment plans for children and adolescents diagnosed with schizophrenia. You also consider the legal and ethical issues involved in medicating children diagnosed with schizophrenia.
 
To Prepare for this Assignment:
Review the Learning Resources concerning early-onset schizophrenia.
 
The Assignment (2 pages):
Compare at least two evidence-based treatment plans for adults diagnosed with schizophrenia with evidence-based treatment plans for children and adolescents diagnosed with schizophrenia.
 
Explain the legal and ethical issues involved with forcing children diagnosed with schizophrenia to take medication for the disorder and how a PMHNP may address those issues.
 
Note: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references.
Learning Resources
American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.
· Standard 10 “Quality of Practice” (pages 73-74)
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
· Chapter 31, “Child Psychiatry” (pp. 1268–1283)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
· “Schizophrenia Spectrum and Other Psychotic Disorders”
Note: You will access this book from the Walden Library databases.
 
McClellan, J., & Stock, S. (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child & Adolescent Psychiatry, 52(9), 976–990. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00112-3/pdf
 
Giles, L. L., & Martini, D. R. (2016). Challenges and promises of pediatric psychopharmacology. Academic Pediatrics, 16(6), 508–518. doi:10.1016/j.acap.2016.03.011
Note: You will access this article from the Walden Library databases.
 
Hargrave, T. M., & Arthur, M. E. (2015). Teaching child psychiatric assessment skills: Using pediatric mental health screening tools. International Journal of Psychiatry in Medicine, 50(1), 60–72. Retrieved from http://search.proquest.com.ezp.waldenulibrary.org/docview/1702699596?accountid=14872
Note: You will access this article from the Walden Library databases.
 
Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.
 
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.
· Chapter 57, “Schizophrenia and Psychosis” (pp. 774–794)
 
Review the following medications:

Childhood-onset schizophrenia is a syndrome that consist of positive and negative symptoms of psychosis and can impact the child’s development and social functioning. The etiology of this disease is not fully known, but because it affects structural brain abnormality and genetic risk factors, it is important to diagnose it early and then initiate treatment to limit its morbidity (Rapoport & Gogtay, 2011). This discussion will focus on comparing two evidence based treatment plans used to treat schizophrenia in adults versus one that is used in treating children and adolescent, the legal and ethical consideration to consider when the child or adolescent has to be forced to take medication against their wish or desire will also be addressed.

The ultimate goal of treating schizophrenia is to treat the symptoms thereby preventing relapse, and improve patient functioning (Patel, Cherian,ohil,&Atkinson,2014).Pharmacological drugs can be used to treat the schizophrenia, but sometimes patient still have residual symptoms when on medications therefore other interventions like psychotherapy is useful (Patel et al, 2014). Evidence has proven that medication administration and cognitive behavior therapy can greatly reduce symptoms in adult. In cases where non- compliance with by mouth medication is prevalent, the client should be encouraged to take a long acting medication by injectionlike Invega sustena, risperidone consta or if first generation medication is working for them Haldol decanoate or prolixin decanoate should be considered.

Research has shown that in adults with schizophrenia 2nd generation antipsychotics should be used because they have less side effects (Patel et al, 2014). The use of medications along with cognitive behavior therapy can lead to better treatment outcome (Patel et al.,2014). Children with schizophrenia should be started on low dose medications, depending on the age of the child. The treatment should also include cognitive behavior therapy, cognitive enhancement therapy and vocation skill training and parental education and support.

When treating schizophrenia in the adolescent and adult population, 2nd generation antipsychotic has proven to work better with less side effects (Patel et al, 2014). Risperidone, aripiprazole, quetiapine, paliperidone, and olanzapine are medications that have been approved by the FDA for treatment of schizophrenia in patients 13 years and older (McClellan & Stock, 2013).

The use of Psychosocial intervention has proven to be an effective treatment of schizophrenia in children as well as adults. Cognitive behavior therapy can be used alone to treat schizophrenia especially in cases where the patient will not take medications (Frankenburg,2018) CBT done by a skilled therapist can reduce symptom severity and improve social functioning capability (Frankenburg, 2018). In children and adolescent however, CBT adapted for psychosis has proven to help children think and adapt to responding to hallucinations and delusions in a manner that does not greatly affect their daily lives (Milller, 2016). Family education and counseling is very essential when treating children. Parental education on what to expect from treatment is vital.

Legal and ethical consideration.

The patient needs to be educated on why it is important to take medication and what medications that they are taking. Parental consent should be obtained prior to children being started on medications. Parents should be educated on the benefits and risk of any medication intervention

and the child diagnosis. They should also be informed that in cases where the child or adolescent is a danger to themselves or medications will have to administered forcefully.it is the duty of the PMHNP to carefully assess the patient and determine the best course to follow with an understanding of legal and ethical principles guiding the provision of care of children. PMHNP should start children with the lowest dose of medications and then gradually increase the dose if needed. Medication should also be given at different intervals since children metabolize medications faster than adults. The child’s age, weight should be taken into consideration when prescribing medications.

References

Frankenburg, F. R. (2018, July 11). Schizophrenia Treatment & Management: Approach Considerations, Antipsychotic Pharmacotherapy, Other Pharmacotherapy. Retrieved from /orders/emedicine.medscape.com/article/288259-treatment#d11

McClellan, J., & Stock, S. (2013). Practice Parameter for the Assessment and Treatment of Children and Adolescents With Schizophrenia. Journal of the American Academy of Child & Adolescent Psychiatry, 52(9), 976-990. doi:10.1016/j.jaac.2013.02.008

Miller, C. (2016, July 26). How Does CBT Help People With Psychosis?. Retrieved from /orders/childmind.org/article/cbt-help-people-psychosis/

Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014, September). Schizophrenia: Overview and Treatment Options. Retrieved from /orders/www.ncbi.nlm.nih.gov/pmc/articles/PMC4159061/

Rapoport, J.L.Gogtay,N. Childhood onset schizophrenia: Support for a progressive

Neurodevelopmental disorder.Int. J Dev Neurosci 2011:29:251.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

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I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. NURS 6660 – Week 9 Assignment: Early-Onset Schizophrenia

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The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

• Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours. Week 9: Early-Onset Schizophrenia

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