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 Early-Onset Schizophrenia Nursing 6660

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 Nursing 6660

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. Early-Onset Schizophrenia Nursing 6660

ADDITIONAL INFORMATION;

Early-Onset Schizophrenia in young patients

Introduction

Schizophrenia is a serious mental illness that affects the brain. It can begin at any age, but most often affects young people between the ages of 15 and 25. Early-onset schizophrenia (EO) is when someone develops schizophrenia before the age of 24 years old.

What is schizophrenia?

Schizophrenia is a mental disorder that causes hallucinations and delusions. It can be treated with medication and therapy, but it’s not curable.

Schizophrenia affects 1% of adults in the United States and 2% of children ages 10 to 17 years old. Early-onset schizophrenia (EOS) occurs when symptoms begin before age 18 years; this type of schizophrenia is more common among males than females but has been increasing over time due to better diagnosis methods and earlier intervention opportunities for youth with EOS

When can schizophrenia begin?

Most people think of schizophrenia as a disease that begins in the late teen years or early twenties, but it can appear at any age. The most common time for schizophrenia to begin is before age eighteen (1). However, some individuals experience symptoms of schizophrenia before their teenage years even begin. Presentations of early-onset schizophrenia can include:

• Delusions, hallucinations and disorganized behavior (2)

• Hallucinations that are not easily explained by drugs or substance use (3)

• Experiences with voices telling them what to do or saying things that aren’t true (4)

Are there different types of schizophrenia?

Schizophrenia is a lifelong condition that can be difficult to treat. However, there are different types of schizophrenia: paranoid, disorganized and catatonic. Paranoid schizophrenia is the most common type of the disorder and affects approximately 1% of all people who have it. People with this form of schizophrenia hear voices in their head or feel that others are plotting against them (delusions). They may also believe that others have supernatural powers over them (hallucinations).

Disorganized schizophrenia affects about 2% of those with the disease; this subtype involves loss of self-control due to poor judgment and coordination problems while talking or behaving inappropriately in social situations. Catatonic personality disorder involves extreme motionlessness or stupor (lack movement) caused by intense anxiety/fear rather than hallucinations.

What are the symptoms of schizophrenia in adolescents?

Schizophrenia is a disorder characterized by a combination of positive, negative and cognitive symptoms. The following are some of the most common symptoms:

• Psychotic symptoms

• Hallucinations and delusions

• Disorganized thoughts and speech

• Social withdrawal and isolation

Schizophrenia can be treated with medication or talk therapy but it’s important to know what to expect from treatment if you’re a young patient because adolescence is a time when many people are trying out new things like drugs or alcohol that may affect how they respond to medication.

How do doctors diagnose schizophrenia in young people?

As with adults, doctors will use the same methods to diagnose schizophrenia in young people. They’ll look for symptoms that are consistent with the diagnosis and also consider other medical conditions that may be causing them (such as depression).

The age at which a person is diagnosed with schizophrenia depends on how well they respond to treatment and whether they have other mental health problems first. Many doctors believe early-onset schizophrenia occurs more often than late onset because it’s more difficult to treat someone who hasn’t yet reached adulthood.

How is schizophrenia treated in young patients?

Treatment for early-onset schizophrenia focuses on medication and psychotherapy. Medication is used to treat the symptoms of schizophrenia, while psychotherapy can help patients manage their condition and improve their quality of life.

The National Institute of Mental Health (NIMH) recommends medication as first-line treatment for people with a first episode of psychosis at any age. If you have an episode after the age of 18 years, it may be more difficult to find effective treatments that are safe enough for young people—so it’s important to talk with your doctor about what kind of medications might work best in your case.

Schizophrenia and treatment side effects.

• Medication side effects

• Psychotherapy side effects

• Social side effects

Psychotherapy side effects Psychotherapy is a treatment that can help you manage anxiety, depression, stress or other emotional problems. It can be used alone or in combination with medication and other treatments. Psychotherapy may have some side effects, but these are usually mild and temporary.

Schizophrenia can affect young people and needs to be recognized early.

Schizophrenia can affect young people and needs to be recognized early. Early diagnosis and treatment is key to improving the outcome of schizophrenia.

Early intervention can help prevent long term problems, such as social withdrawal, unemployment and homelessness for young people who develop this mental illness.

Conclusion

Schizophrenia in young people is a serious condition that needs to be addressed early. Diagnosis can be difficult, and treatment options range from medication to talk therapy. Early-onset schizophrenia can affect anyone, but it’s more likely to occur in adolescents and young adults who have already begun puberty when their brain is still developing.