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Assignment 1: Early Onset Schizophrenia

Assignment 1: Early Onset Schizophrenia

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.

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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 extra pyramidal effects and tardive dyskinesia Assignment 1: Early Onset Schizophrenia. 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 non response 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.

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 etal.,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)).

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 posses the ethical and moral issue of forced treatment Assignment 1: Early Onset Schizophrenia .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), 372–379. 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

 

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.

 

Learning Objectives

Students will:

  • Compare evidence-based treatment plans for adults versus children and adolescents diagnosed with schizophrenia Assignment 1: Early Onset 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.

 

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. The Sample Paper provided at the Walden Writing Center provides an example of those required elements. All papers submitted must use this formatting. Assignment 1: Early Onset Schizophrenia

 

  1. Introduction
    1. One of the most chronic and severe mental disorders that affects about one percent of the population in the Unites States, is Schizophrenia. Schizophrenia is one mental disorder that impacts the way one thinks, behaves and feels about themselves and others around them. Considering schizophrenia is a chronic mental disorder it comes with many signs and symptoms, effects, risk factors, possible causes, and theories as to why someone may possess this horrible illness.
    2. Schizophrenia is a psychological disorder as it affects the human mind and feelings. “A psychological disorder, also known as a mental disorder, is a pattern of behavioral or psychological symptoms that impact multiple life areas and create distress for the person experiencing these symptoms.” (Cherry, 2018)
    3. Diagnostic criteria for Schizophrenia
      1. Some of the following symptoms need to be resent for at least 6 months to be diagnosed with schizophrenia:
        1. Hallucinations
        2. Delusions
        3. Negative symptoms
        4. Cognitive issues/disorganized thinking
      2. Reasons I chose this topic
        1. Personal experience with my mother being diagnosed with the mental disorder
        2. I want to know more about how the mental illness develops and changes the human mind
      3. Epidemiology
        1. Annually the number of new cases is about 1.5 per 10,000 people
        2. Typical age for onset is adolescence Assignment 1: Early Onset Schizophrenia
        3. Childhood and late-life onset are rare
        4. More men than women are diagnosed
        5. Ages 18-25 for men
        6. Ages 25-35 for women
        7. Urban areas are more affected than rural
      4. Discussion
        1. Detailed description of the disorder
          1. Signs and symptoms of the disorder are consistent with hallucinations, voices, false beliefs and paranoia.
          2. The epidemiology of schizophrenia is the following:
            1. Season of Birth
            2. Birth complications
            3. Parental age
            4. Infections and the Immune system
            5. Autoimmune diseases
            6. Ethnicity
            7. Cannabis use
            8. Urban residence
          3. Subtypes of the disorder are the following:
            1. Paranoid Schizophrenia
            2. Disorganized Schizophrenia
            3. Catatonic Schizophrenia
            4. Undifferentiated Schizophrenia
            5. Residual Schizophrenia
          4. There are three spectrum disorders of schizophrenia which are the following:
            1. Schizoaffective disorder
            2. Schizophreniform disorder
            3. Schizotypal personality disorder
          5. Natural History of Schizophrenia
            1. With treatment, the disorder is always going to be a lifelong disorder requiring treatment
              1. Even with treatment, people with schizophrenia have issues taking their medications as some are not aware of them having the illness
            2. Without treatment for the disorder there are about 30% of patients that can manage schizophrenia without any antipsychotic meds. Women tend to do better in managing without medication more than men.
          6. Methods used to diagnose, evaluate and manage the disorder
            1. The initial diagnoses of schizophrenia are not as simple as a blood test. It is based on an interview with the patient asking certain questions to maintain the aspect of diagnosing.
            2. Ongoing management for schizophrenia is constantly seeing the therapist and getting treatment based on how the meds are working or not working.
          7. Risk Factors
            1. Gene and environment
            2. Brain chemistry and the structure of the brain
          8. Other causative factors Assignment 1: Early Onset Schizophrenia
            1. Family history
            2. Immune system issues
            3. Complications during pregnancy
            4. Drug use
          9. Nervous system structures and/or pathways involved is the CNS – central nervous system.
          10. Neurotransmitters and receptor systems involved in the pathology of the disorder “Changes in the neurotransmitter release pathways in schizophrenia may be important in the pathology of the illness, and recent findings suggest that abnormalities in the Wnt pathway, which controls transcription selectivity in cells, may be involved.” (B., 2002)
          11. Current treatment options
            1. When treating schizophrenia, it is more complicated than giving a pill and calling it day. There is so much more to the process and finding the proper regimen as each case and patient are different. People with schizophrenia can and do take medication but the issues with this is, they decide they are better and stop taking the medication, causing relapse. Treating schizophrenia will consist of a treatment with medication, psychosocial, and/or support therapies. To be stable with this mental illness requires the patient to comply with the treatment plan.
          12. Future areas of research
            1. Better treatment is expanding making it easier for patients to function with the disorder. Assignment 1: Early Onset Schizophrenia
  • Conclusion
    1. After sorting through all the research, I have complied foe my final, I am realizing there’s much more to schizophrenia than what one person experiences. What I mean, my mother has been diagnosed with schizophrenia, she is able to live daily life and care for herself by cooking, cleaning, and function as a normal human being based on society’s expectations. Schizophrenia is a whole other world with sub mental categories that fall under it. Paranoid schizophrenia is one of the sub categories. So, never judge a book by its cover they say, also with people as you never know what horrible mental illness they are fighting to survive in life.

 

References

B., D. (2002, march 1). Understanding the Pathology of Schizophrenia: recent advances from the study of the molecular architecture of postmortem CNS tissue. Postgraduate Medical Journal, 78(917), 142-148.

Barse, M. (2017, July 23). Some Schizophrenia Patients can Cope Without Medication. Retrieved from ScienceNordic: http://sciencenordic.com/some-schizophrenia-patients-can-cope-without-medication

Cherry, K. ( 2018, March 05). Psychological Disorder and Diagnosis. Retrieved from VeryWell Mind : https://www.verywellmind.com/what-is-a-psychological-disorder-2795767 Assignment 1: Early Onset Schizophrenia

Dina Cagliostro, P. (2018, February 14). 5 Schizophrenia Subtypes. Retrieved from PSYCOM: https://www.psycom.net/schizophrenia-5-subtypes

Elements Behavioral Health. (2017, January 03). Schizophrenia: Symptoms, Signs, and Treatment. Retrieved from Elements Behaviroal Health : https://www.elementsbehavioralhealth.com/addiction-resources/mental-health-resources/schizophrenia-symptoms-signs-treatment/

Erick Messias, M. P., Chuan-Yu Chen, P., & William W. Eaton, P. (2007, September ). Epidemiology of Schizophrenia: Review of Findings and Myths. Psychiatric Clinic North America, 30(3), 323-338.

Living with Schizophrenia . (n.d.). How is Schizophrenia Diagnosed? Retrieved from Living with Schizophrenia : https://www.livingwithschizophreniauk.org/advice-sheets/how-is-schizophrenia-diagnosed/ Assignment 1: Early Onset Schizophrenia

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