NURS 6660: Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent | Week 9

“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.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

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.

Note: All Stahl resources can be accessed through the Walden Library using the link. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear.

To access information on the following medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

Schizoaffective disorder

Schizophrenia

amisulpride aripiprazole asenapine carbamazepine (adjunct) chlorpromazine clozapine cyamemazine flupenthixol haloperidol iloperidone lamotrigine (adjunct) l-methylfolate (adjunct) loxapine lurasidone mesoridazine molindone olanzapine paliperidone perospirone perphenazine pipothiazine quetiapine risperidone sertindole sulpiride thioridazine thiothixene trifluoperazine valproate (divalproex) (adjunct) ziprasidone zotepine zuclopenthixol

amisulpride aripiprazole asenapine carbamazepine (adjunct) chlorpromazine clozapine cyamemazine flupenthixol haloperidol iloperidone lamotrigine (adjunct) l-methylfolate (adjunct) loxapine lurasidone mesoridazine molindone olanzapine paliperidone perospirone perphenazine pipothiazine quetiapine risperidone sertindole sulpiride thioridazine thiothixene trifluoperazine valproate (divalproex) (adjunct) ziprasidone zotepine zuclopenthixol

Note: Many of these medications are FDA approved for adults only. Some are FDA approved for disorders in children and adolescents. Many are used “off label” for the disorders examined in this week. As you read the Stahl drug monographs, focus your attention on FDA approvals for children/adolescents (including “ages” for which the medication is approved, if applicable) and further note which drugs are “off label.”

Required Media

Laureate Education (Producer). (2017b). A young girl with strange behaviors [Multimedia file]. Baltimore, MD: Author.

Optional Resources

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)

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
• 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 (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

 

 

ADDITIONAL INFORMATION 

Early-Onset Schizophrenia Assesment

Introduction

Schizophrenia is a serious mental illness that affects more than 1 in 100 people. It can be scary to see any of the symptoms of this condition, but early-onset schizophrenia (EOS) is the most serious form of the disease and has some unique symptoms. People with EOS often have an onset between ages 15 and 30, but it’s important for you to know what it looks like so that you can recognize signs as soon as possible.

Does the patient show odd social behavior?

If your patient shows odd social behavior, they may be exhibiting symptoms of early-onset schizophrenia. This can include:

• Social isolation (not being able to make friends)

• Social withdrawal (not wanting to talk with others)

• Inappropriate or unusual body language (e.g., slouching or crossing arms over chest)

• Unusual facial expressions (e.g., wide eyes and mouth open).

Does the patient show any persistent, unusual thought patterns?

If you notice that your patient has a hard time focusing on the present, it’s important to ask about their thoughts. Do they have any persistent, unusual thought patterns?

If your patient seems distracted at all times and doesn’t seem to be paying attention to what you’re saying or doing around them, then this could indicate early-onset schizophrenia.

Does the patient have hearing voices or seeing things that don’t exist?

If you are seeing or hearing things that don’t exist, this may be a sign of hallucination. Hallucinations are common in schizophrenia and often occur when the person is under stress or tired. While some people with schizophrenia experience hallucinations as a result of their illness, others experience them as part of their disorder.

Does the patient have difficulty communicating with others?

Does the patient have difficulty communicating with others?

This is a very important question because it can be one of the first signs that you should be concerned about their mental health. If they are unable to communicate effectively, it may indicate that they have early-onset schizophrenia. In addition, if your loved one has trouble expressing themselves verbally, this could also mean they need help from a professional.

Is the patient preoccupied with odd thoughts or rituals?

Is the patient preoccupied with odd thoughts or rituals?

Are they fixated on things that don’t make sense and won’t let go of them? Do they have difficulty with relationships, schoolwork and/or work because of their obsessions or compulsions? This can be a sign of obsessive compulsive disorder (OCD). It may also mean that you should be looking for another diagnosis.

Is the patient showing signs of depression or anxiety?

Depression and anxiety are two common symptoms of early-onset schizophrenia. They can be a sign that the illness is developing, or they may be caused by other conditions.

Conclusion

If you have any of these symptoms, then it may be worth getting a professional diagnosis and treatment plan. Early management is key to recovery, and every patient deserves the best possible care.