Childhood Psychosis Assignment

Posted: December 26th, 2022

Childhood Psychosis Assignment

Childhood psychosis is extremely rare; however, children that present with psychosis must be carefully assessed and evaluated with appropriate interviewing of parent, child, and use of assessment tools. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with early onset schizophrenia. Learning Objectives Students will: Evaluate clients for treatment of mental health disorders Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders The Assignment: Examine Case 3: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment. At each Decision Point, stop to complete the following: Decision #1: Differential Diagnosis Which Decision did you select? Why did you select this Decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different? Decision #2: Treatment Plan for Psychotherapy Why did you select this Decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different? Decision #3: Treatment Plan for Psychopharmacology Why did you select this Decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? Also include how ethical considerations might impact your treatment plan and communication with clients and their families. Childhood Psychosis Assignment

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Introduction

The client in this case study, a 13-year old Hispanic female presented with the parents due to difficult behavior. According to the parents, the client would talk to imaginary friends and had delusional beliefs about people in television recognizing her and making TV shows specifically for her. It was reported that her social skills were poor and her academic performance had significantly dropped. There is a family history of schizophrenia in the client’s family. The MSE confirmed that the client’s delusion experiences of seeing, hearing, and talking to strange things. The first decision will involve making a differential diagnosis for the client. additionally, two decisions regarding the appropriate treatment decisions will be discussed. Finally, ethical issues impacting the treatment for this client will be discussed.

Decision Point One

The diagnosis for the client is early-onset schizophrenia. This diagnosis was chosen because as per the DSM-5 criteria, the client manifests symptoms of early-onset schizophrenia (Stahl, 2014). According to the DSM-5 criteria, the pediatric population with early-onset schizophrenia exhibits the fowling symptoms: hallucinations; delusions; disorganized speech; negative symptoms; and disorganized behavior (Aneja et al., 2018). The client manifests some of these symptoms such as delusions as indicated by the client believing TV shows are specifically designed for her; hallucinations as indicated by the client hearing, seeing and talking to imaginary and strange people; and negative symptoms (Aneja et al., 2018). In individuals with schizophrenia, negative symptoms are characterized by a lack of motivation, flat affect, anhedonia, and a reduced interest in social interactions. Negative symptoms for this client are characterized by reduced interactions with the classmates, blunt affect, and constricted affect. These symptoms support the diagnosis of early-onset schizophrenia for this client.

By selecting this diagnosis for the client, it is expected that the decision would lead to the correct treatment for this client.

Decision Point Two

The second decision is to have the client referred for psychological testing. This decision was chosen because the successful treatment of mental disorders like schizophrenia requires identification of the underlying mental, medical, and psychological risk factors. Additionally, schizophrenia is uncommon in the pediatric population and thus it is essential to perform a compressive assessment to make sure that the right diagnosis is made (Aneja et al., 2018). Therefore, referring the client for psychological testing would ensure that the developmental aspects and cognitive functioning for this client are adequately examined. The psychological testing would also facilitate ruling out other mental disorders presenting with similar symptoms such as bipolar disorder or attention deficit hyperactivity disorder (Bartlett, 2014).  Psychological testing would also prevent misdiagnosis for the client. Examples of tools useful in the psychological testing of this client are the Pre-morbid Adjustment Scale, Symptom Scale, and Schedule for Affective Disorders and Schizophrenia. Childhood Psychosis Assignment

The expected outcome for this decision is that an exhaustive assessment for this client would be performed to come up with an accurate diagnosis. This is because psychological testing allows the assessment of all aspects of cognitive functioning and thus inform the accurate diagnosis (Bartlett, 2014).

As per the earlier diagnosis, the psychological testing confirmed the first diagnosis of early-onset schizophrenia.

Decision Point Three

The third decision is for the client to start Lurasidone 40 mg orally daily. Lurasidone was selected for the treatment of this client because evidence demonstrates the efficacy of the mediation in the treatment of early-onset schizophrenia (Goldman et al., 2017). Lurasidone has been demonstrated to improve functional ability and symptoms in adolescents with schizophrenia. Lurasidone is also well-tolerated in the pediatric population and has minimal side effects such as low weight gain, does not affect cognitive functioning, and has negligible sedation effects (Harvey, 2015). It would be important to educate the parents and the client about the medication including the side effects. Clozapine was not chosen because the safety of clozapine 100 mg dose for the pediatric population is not suggested. Family psychotherapy was not selected because this would not treat the psychosis symptoms for this client (Sadock, Sadock, & Ruiz, 2014).

Selecting Lurasidone expected that the client would manifest significant symptom improvement. Secondly, it is hoped that the client will tolerate the medication. This is because Lurasidone has a good safety profile and the medication is effective in treating early-onset schizophrenia (Goldman et al., 2017).

Ethical Considerations

Informed consent is the relevant ethical issue for the treatment of the client. Therefore, the PMHNP should educate the client and parents about the available treatment options, including the side effects. This way, the parents will make an informed treatment choice. The PMHNP should also educate the client and parents regarding the prescribed medication, proper dose, administration, as well as safety issues and side effects associated with the prescribed medication (Giles & Martini, 2016).

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Conclusion

The diagnosis for the client is early-onset schizophrenia since the client manifests symptoms consistent with the DSM-5 criteria for this mental disorder. The second decision is referring the client for psychological testing to confirm or rule out the diagnosis. Psychological testing confirmed the diagnosis. The last decision was thus for the client to start lurasidone due to the medication’s efficacy in treating early-onset schizophrenia. Informed consent should be obtained before beginning treatment for this client. Childhood Psychosis Assignment

References

Aneja, J., Singhai, K., & Paul, K. (2018). Very early-onset psychosis/schizophrenia: Case studies of spectrum of presentation and management issues. Journal of family medicine and primary care, 7(6), 1566–1570. https://doi.org/10.4103/jfmpc.jfmpc_264_18.

Bartlett J. (2014). Childhood-onset schizophrenia: what do we really know? Health Psychol Behav Med, 1; 2(1): 735–747.

Giles, L. L., & Martini, D. R. (2016). Challenges and promises of pediatric psychopharmacology.  Academic Pediatrics, 16(6), 508-518.

Harvey P. (2015). The clinical utility of lurasidone in schizophrenia: patient considerations. Neuropsychiatr Dis Treat. 1(11), pp: 1103–1109.

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.

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.Childhood Psychosis Assignment