Week 9: Early-Onset Schizophrenia

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 https://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 https://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 https://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.