Early Onset Schizophrenia

Early-onset schizophrenia (EOS) is a critical and debilitating disorder associated with social, psychological, poor mental, and physical health and occupational functioning (Stafford et al., 2015).  As Frankenberg (2018) notes in his work, EOS, directly and indirectly, costs an individual, family, and national economy. This paper will compare the EOS treatment plan for an adult and a child or an adolescent. The latter part of the paper will explore both the legal and ethical issues related to medicating children diagnosed with schizophrenia.

For effective EOS treatment, a mental health practitioner targets the disorder’s symptoms, relapse prevention, and enhancing adaptive functioning. In their work, Stafford et al. (2015) argue that pharmacotherapy is a mainstay of schizophrenia. However, residue symptoms tend to persist, and dealing with them requires other non-pharmacotherapy techniques, including psychotherapy. Two evidence-based techniques used in managing EOS among adults include using second-generation antipsychotics, and cognitive behavioral therapy (CBT) adapted for psychosis (Patel et al., 2014). As Frankenberg (2018) journal article concludes, both pharmacological and non-pharmacological treatments are essential in optimizing long-term outcomes.

Atypical and second-generation antipsychotics are known as agents of choice and first-line treatment in EOS in adults and adolescents except for clozapine. As McClellan and Stock (2013) add, various drugs approved by FDA for EOS among children and adolescents (thirteen years and above) and adults include aripiprazole, olanzapine, quetiapine, and risperidone. Atypical or second-class generation antipsychotics are mostly used if patients experience few or none extrapyramidal symptoms, as Patel et al. (2014) argue.  Second-generation antipsychotics cause excessive weight gain, diabetes mellitus, and hyperlipidemia and are associated with cardiovascular issues, especially among schizophrenia patients.

Over the years, various psychosocial interventions have also been effective in schizophrenia treatment among children and adolescents, and adults. In adults, the most effective psychosocial treatment is CBT. As Frankenberg (2018) argues in his work, CBT can be used as a standalone treatment, especially among patients who will not take medication. It is also recommended for acute cases. Frankenberg (2018) study in 2018 revealed that CBT largely reduces psychiatric symptoms severity and helps patients nurture personal and social functioning. CBT for psychosis, also known as CBTp, has largely improved their condition for children and adults. Miller (2016) argues that children and adolescents tend to respond differently to hallucinations, and in this case, CBTp is effective.

Children and adolescent with schizophrenia should be examined in terms of emotional and developmental. If the child is 13 years and above, they should be explained to about their condition and possible treatments (Vitiello, 2012). Since they do not have a legal age, parents become instruments in giving informed consent for various treatments.  It would be imperative for PMHNP to establish clear communication with the child’s parent or guardian. Through such talks, the parents get to know the possible successes and risks associated with various interventions. Psychoeducation about the disorders should also be conducted on the parents to ensure that they take care of the children when discharged. 

Ethically, safety is a relative concept. When using various pharmacology therapies, physicians should help the parent to weigh the potential dangers against the successes (Vitiello, 2012). Failure to treat an acute psychiatric episode may result in major safety issues. Such a health deterioration may even call for injectable antipsychotics use that has major side effects. In this case, PMHNP should weigh the cons of forcing treatment on minors. They should also have the legal and ethical guidelines surrounding the treatment of minors.

EOS is a severe disorder linked with considerable social, psychological, educational and occupational long term impairments.  When managing EOS, pharmacotherapy remains the mainstay. However, residue symptoms remain that calls for non-pharmacological intervention, including psychotherapy. Antipsychotics and CBT are the two main evidenced-based treatments. When working with children, CBTp works best. However, a collaboration between provides, parent/guardian and the minor is required.

References

Frankenburg, F. R. (2018). 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). 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). Schizophrenia: Overview and Treatment Options. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159061/

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.

Vitiello, B. (2012). Principles in using Psychotropic Medication in children and adolescents. In J. M.Rey (Ed.), IACAPAP e-textbook of child and adolescent mental health. Geneva: International Association for child and adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdf