Early Onset Schizophrenia Essay

Introduction

            In this paper, a thorough discussion of the psychotherapeutic and psychopharmacologic management of a child presenting with early-onset schizophrenia is presented. Besides, an explanation of how ethical considerations are likely to impact communication with a client and her family will also be presented.Early Onset Schizophrenia Essay

Decision #1: Differential Diagnosis

Decision Selected

Early Onset Schizophrenia

Reason for Selecting This Decision

            Carrie presented with symptoms of disorganized speech, hallucinations, negative symptoms, and catatonic behavior. Based on the DSM-V criteria for diagnosing mental health disorders, she meets the criteria for schizophrenia (American Psychiatric Association, 2013). A diagnosis of schizoaffective disorder is less likely because, although she has psychotic symptoms, she does not meet the criteria for a mood disorder with either depression or mania occurring concurrently with schizophrenia criterion A (American Psychiatric Association, 2013).  Therefore, there is no information to support that Carrie is indeed experiencing a mood disorder.

The same way, although Carrie has several symptoms which are similar to a schizotypal personality disorder, there are some significant differences that should be noted. For instance, rather than having reference ideas, Carrie has reference delusions. When comparing her writing to her speech and thinking, the latter is odder. This indicates that her thought processes are more disorganized and severe than her speech (American Psychiatric Association, 2013). It is also worth noting that Carrie lacks friends who are much close to her. However, this is yet to be confirmed as to whether it’s because she is not comfortable with interpersonal relationships or if it may be because of her classmates distancing away from her due to her odd behaviors. Primarily, it is highly recommended that mental health practitioners should shun away from making diagnoses relating to personality disorders in pediatric clients. This is attributed to the fact that, during the entire period of childhood, a child’s personality is still in the formation process. Therefore, there are higher chances that schizotypal personality disorder may probably be what is entirely wrong with Carrie. However, the amount of information currently available to make this diagnosis is not sufficient.Early Onset Schizophrenia Essay

Expected Outcomes

            It was expected that, based on the client’s presentation of symptoms, after a thorough history taking, mental status examination and assessment, she will meet the DSM-V criteria for early-onset schizophrenia. Based on this diagnosis, it would thereafter be easier to start the patient on the right medications and psychotherapy to improve her overall health.

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Difference between Expected Outcome and Actual Outcome

            No significant difference was noted between the expected outcome and the actual outcome.

Decision #2: Treatment Plan for Psychotherapy

Decision Selected

Begin Psychotherapy with a Psychodynamic approach.

Reason for Selecting This Decision

            It will be possible to easily explore and influence the emotional experiences of the child based on how her state of mind is currently. Cognitive Behavioral therapy is the most preferred psychotherapeutic approach for this client. It maximally utilizes free association, recall, and dream interpretation and is practical in exploring potential barriers that are likely to prevent full recovery (Li, et al., 2015).   By exploring the present cognitive state to identify the symptoms that a patient may currently be struggling with, Cognitive behavioral therapy will ensure that the client identifies some her dysfunctional thoughts and behaviors and develop effective strategies in managing them (Li, et al., 2015). Early Onset Schizophrenia Essay

Expected Outcomes

            Based on the patient’s dysfunctional thought patterns and behaviors, it was expected that CBT will help her to develop strategies that are highly effective to manage the hallucinations and delusions. Besides, it was expected that she would be able to easily identify the potential triggers that led to the psychotic episodes that she frequently experienced and develop strategies for either reducing or stopping them(Li, et al., 2015).

Difference between Expected Outcome and Actual Outcome

After four weeks, the client returned to the clinic accompanied by her parents. Not only was she fully engaged but also showed interest to see the therapist. The parents, however, reported that they had not seen any positive improvement in their child’s psychotic symptoms and had therefore started to be very concerned. Research evidence from modern psychoanalysts strongly suggests that, although psychodynamic therapies are effective in the management of schizophrenia, they are only helpful in the management of residual symptoms and therefore, should not be used as a first-line treatment due to high chances of it being ineffective (Li, et al., 2015).

Decision #3: Treatment Plan for Psychopharmacology

Decision Selected

Start the patient on Lurasidone 40mg orally daily

Reason for Selecting This Decision

            The pillars in the management of schizophrenia are antipsychotic medications. They are highly effective in helping to control symptoms through the release of dopamine. Despite the fact that it has not been approved by the FDA for use in children, in this case, it will be used off label since there are also no legal prohibitions for prescribers to use it off-label (Möller & Czobor, 2015).  Before the drug is administered, the mental health practitioner will have to obtain informed consent from the client and her family. This means that the client will have to understand the risks and benefits of the drug and the goals of therapy to make the right decision. Lurasidone has fewer effects with regards to body weight and lipid profile (Möller & Czobor, 2015).Early Onset Schizophrenia Essay

Expected Outcomes

            It was expected that immediately the patient lurasidone, the psychotic symptoms that she experienced would reduce significantly with very few chances of symptoms relapse. The patient’s physical, social, mental functioning was also expected to improve significantly and be preserved for both the short term and long term (Möller & Czobor, 2015).

Difference between Expected Outcome and Actual Outcome

            After four weeks, the client returned to the clinic accompanied by her parents. They reported no significant improvement in the clients social and psychological functioning. It was also noted that the client had experienced very minimal psychotic episodes within the past four weeks (Möller & Czobor, 2015). However, the parents noted that Carrie had added some weight. Lurasidone, also known as Latuda, is a 2^nd generation antipsychotic medication whose major side effect is weight gain.

Lurasidone also some effects on glucose and cholesterol. This, therefore, requires that mental health practitioners should strive to maintain a balance between the efficacy of a dug and its tolerance. Before and in the entire period of treatment, it is important that the fasting plasma glucose, weight, blood pressure, and fasting triglycerides are monitored more frequently (Möller & Czobor, 2015). Therefore, the best way to address this side effect is through psychotherapy with the collaboration of a dietician. This will require that the client takes physical exercises and observes healthy nutrition.

How Ethical Considerations Might Impact the Treatment Plan and Communication with Client’s And Families

            When managing this patient, some of the most important ethical principles that ought to be given consideration are that of informed consent, beneficence and telling the telling (Appelbaum, 2015).  Since the patient is a minor and has underlying psychotic symptoms that are likely to impair her judgment in making the right decisions, the parents are legally mandated to make this decision. However, the mental health practitioner should ensure that the decision made is in the best interest of the patient and fully match her values (Appelbaum, 2015).  The medications should also have more benefits to the patient as compared to adverse/side effects.Early Onset Schizophrenia Essay

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Appelbaum, P. S. (2015). Ethical challenges in the primary prevention of schizophrenia.

Li, Z. J., Guo, Z. H., Wang, N., Xu, Z. Y., Qu, Y., Wang, X. Q., & Kingdon, D. (2015). Cognitive–behavioral therapy for patients with schizophrenia: a multicentre randomized controlled trial in Beijing, China. Psychological medicine, 45(9), 1893-1905.

Möller, H. J., & Czobor, P. (2015). Pharmacological treatment of negative symptoms in schizophrenia. European archives of psychiatry and clinical neuroscience, 265(7), 567-578.Early Onset Schizophrenia Essay