Assignment 1: 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. 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.
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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. Assignment 1: Early Onset Schizophrenia
Learning Objectives
Students will:
• Compare evidence-based treatment plans for adults versus children and adolescents diagnosed with schizophrenia
• Analyze legal and ethical issues surrounding the forceful administration of medication to children diagnosed with schizophrenia
• Analyze the role of the PMHNP in addressing issues related to the forceful administration of medication to children diagnosed with schizophrenia
To Prepare for this Assignment:
• Review the Learning Resources concerning early-onset schizophrenia.
Please use the following resources and 4 more with in 5 years please.
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)
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
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
Schizophrenia is a severe debilitating psychotic disorder associated with high disability, morbidity and mortality rates. Patients with schizophrenia manifest altered perceptions of reality (hallucinations), fixed false beliefs (delusions), disorganized thought process, abnormal motor behaviors, and negative symptoms. Early-onset schizophrenia is a rare chronic form associated with neuro-developmental problems in early life such as; delayed linguistic capabilities, speech, motor coordination, and psychosocial development (American Psychiatric Association, 2013). Schizophrenia is managed through antipsychotics, psychosocial therapy, and psycho-educational interventions.

Compare evidence-based treatment plans for adults versus children and adolescents diagnosed with schizophrenia

Antipsychotic medications are mainly used for management of early-onset schizophrenia. The choice of acute management and maintenance medication in children and adolescents should be made carefully because of their physical growth, brain development, sexual development, and high vulnerability to fast weight gain. Also children have increased sensitivity to other side-effects of antipsychotic medication, high risk of treatment resistance, co morbidities of disorders. Second-generation antipsychotic are used for first-line treatments of early-onset schizophrenia due to their low risk of causing extrapyramidal effects and tardive dyskinesia. The FDA approved atypical antipsychotics for children include risperidone, aripiprazole, olanzapine, lurasidone, quetiapine and paliperidone (McClellan & Stock, 2013). Children and adolescents are more sensitive to medication effects, therefore; low doses are given when initiating the treatment and gradually titrated upwards. The choice is based on the side-effect profile. Despite their safety and efficacy, they are associated with weight gain and severe metabolic problems, and neurological side effects. In adults, conventional are used for first line treatment of schizophrenia. They include haloperidol and perphenazine. Second generation antipsychotic may also be considered in case of nonresponse to the conventional antipsychotic (John & James, 2015). All antipsychotics have side effects, therefore dietary, lifestyle counseling and monitoring of adverse effects are crucial when on initiation of treatment. Assignment 1: Early Onset Schizophrenia

In adults, various psychosocial interventions like cognitive-behavioral therapies, training in social skills, cognitive remediation, and family therapy have proved helpful in reducing schizophrenic symptoms, improving occupational functioning and relapse prevention. In children and adolescents, multimodal care in terms of family interventions in the care, social skills training, and supportive environment is vital. Psycho-education for the child and their family is vital especially for long-term compliance with medication. Supportive psychotherapy encourages reality and monitoring signs of relapse (Stafford, Mayo-Wilson, Loucas, James, Hollis, Birchwood et al.,2015). Children and adolescents exhibit cognitive impairment, and more negative symptoms compared to adults who have more delusions and hallucinations. This makes family interventions more effective compared to cognitive behavior therapy used for adults (John & James, 2015).

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Legal and ethical issues surrounding the forceful administration of medication to children diagnosed with schizophrenia and the role of PMHNP in addressing the issue

The purpose of antipsychotic therapy is to do good to the patient and avoid harm. Thus the PMHN seeks to help the patients get well through administration of antipsychotics. Schizophrenia adversely affects the cognitive functioning making a person unable to consent to treatment and more so a child who is not of legal age to consent. This possess the ethical and moral issue of forced treatment. The PMHN have the responsibility of involving the family members or the guardian in medication planning and allowing them to provide consent before initiation of treatment. Use of a bio-psychosocial model of holistic care that involves client and family education and shared decision-making in the treatment plan helps in resolving the moral and ethical issue of forced treatment in children. This requires that the PMHN continually engage client and family members in transparent sharing of information on treatment decisions (Mahone, Maphis, & Snow, 2016)

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

John Lally, James H. MacCabe. (2015).Antipsychotic medication in schizophrenia: a review, British Medical Bulletin, Volume 114, Issue 1, 1 June 2015, Pages 169–179, https://doi.org/10.1093/bmb/ldv017

Mahone, I. H., Maphis, C. F., & Snow, D. E. (2016). Effective Strategies for Nurses Empowering Clients With Schizophrenia: Medication Use as a Tool in Recovery. Issues in Mental Health Nursing, 37(5), 372–379Assignment 1: Early Onset Schizophrenia. http://doi.org/10.3109/01612840.2016.1157228

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

Stafford, M. R., Mayo-Wilson, E., Loucas, C. E., James, A., Hollis, C., Birchwood, M., & Kendall, T. (2015). Efficacy and Safety of Pharmacological and Psychological Interventions for the Treatment of Psychosis and Schizophrenia in Children, Adolescents and Young Adults: A Systematic Review and Meta-Analysis. PLoS ONE, 10(2), e0117166. http://doi.org/10.1371/journal.pone.0117166

Assignment 1: Early Onset Schizophrenia

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