Childhood-Onset Schizophrenia Spectrum Disorders Discussion Paper

PRESCRIBING FOR CHILDREN AND ADOLESCENTS

Off-label prescribing is when a physician gives you a drug that the U.S. Food and Drug Administration (FDA) has approved to treat a condition different than your condition. This practice is legal and common. In fact, one in five prescriptions written today are for off-label use.

—Agency for Healthcare Research and Quality

Psychotropic drugs are commonly used for children and adolescents to treat mental health disorders, yet many of these drugs are not FDA approved for use in these populations. Thus, their use is considered “off-label,” and it is often up to the best judgment of the prescribing clinician. As a PMHNP, you will need to apply the best available information and research on pharmacological treatments for children in order to safely and effectively treat child and adolescent patients. Sometimes this will come in the form of formal studies and approvals for drugs in children. Other times you may need to extrapolate from research or treatment guidelines on drugs in adults. Each individual patient case will need to be considered independently and each treatment considered from a risk assessment standpoint. What psychotherapeutic approach might be indicated as an initial treatment? What are the potential side effects of a particular drug? Childhood-Onset Schizophrenia Spectrum Disorders Discussion Paper

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For this Assignment, you consider these questions and others as you explore FDA-approved (“on label”) pharmacological treatments, non-FDA-approved (“off-label”) pharmacological treatments, and nonpharmacological treatments for disorders in children and adolescents.

TO PREPARE

• Childhood-Onset Schizophrenia Spectrum Disorders is the assigned disorder to research for this Assignment.
• Use the Walden library to research evidence-based treatments for your assigned disorder in children and adolescents. You will need to recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating this disorder in children and adolescents. Childhood-Onset Schizophrenia Spectrum Disorders Discussion Paper

THE ASSIGNMENT (1–2 PAGES)

• Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents.
• Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
• Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
• Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources.

LEARNING RESOURCES

Required Readings

• Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental healthLinks to an external site.. American Psychiatric Association Publishing.
  • Chapter 14, “Psychosocial Interventions”
  • Chapter 15, “Psychotherapeutic Interventions”
  • Chapter 16, “Psychopharmacological Interventions”Links to an external site.
• 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.). Wiley Blackwell.
  • Chapter 43, “Pharmacological, Medically-Led and Related Treatments”
• Walden University. (n.d.). Developing SMART goalsLinks to an external site.. https://academicguides.waldenu.edu/ld.php?content_id=51901492Links to an external site.
• Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer. Childhood-Onset Schizophrenia Spectrum Disorders Discussion Paper

Childhood-Onset Schizophrenia Spectrum Disorders (COS) is a rare and severe form of schizophrenia appearing before the age of 13, necessitating tailored treatment approaches (Driver et al., 2020). The purpose of this assignment is to recommend an FDA-approved medication, an off-label drug, and a nonpharmacological intervention to effectively manage COS in children and adolescents, ensuring a comprehensive treatment plan that addresses both symptoms and overall functioning.

FDA-Approved Medication

When treating Childhood-Onset Schizophrenia Spectrum Disorders in children and adolescents, an effective approach includes a combination of pharmacological and non- pharmacological interventions. Risperidone, an FDA-approved atypical antipsychotic, is commonly used due to its efficacy in reducing both positive and negative symptoms of schizophrenia (Corell et al., 2021). Additionally, aripiprazole, an atypical antipsychotic used off-label, provides an alternative treatment option with a different side effect profile. Complementing these medications, Cognitive Behavioural Therapy (CBT) is a valuable nonpharmacological intervention.

Risk Assessment

Risk assessment for treating Childhood-Onset Schizophrenia involves evaluating both the benefits and potential side effects of medications. For Risperidone, the FDA-approved drug, benefits include significant reduction in psychotic symptoms and improvement in daily functioning (Wu et al., 2022). Risks involve weight gain, sedation, increased appetite, and the possibility of extrapyramidal symptoms (EPS) and metabolic changes. Aripiprazole, the off-label drug, offers benefits such as symptom reduction and a lower risk of weight gain. However, it carries risks including nausea, vomiting, insomnia, and akathisia. Balancing these factors is crucial, considering individual patient profiles and monitoring closely for adverse effects. Childhood-Onset Schizophrenia Spectrum Disorders Discussion Paper

Clinical Practice Guidelines

Clinical practice guidelines for Childhood-Onset Schizophrenia Spectrum Disorders are limited but do exist, mainly derived from adult schizophrenia guidelines adapted for paediatric use. The American Academy of Child and Adolescent Psychiatry (AACAP) recommends atypical antipsychotics like risperidone as first-line treatment due to their efficacy and safety profile. Aripiprazole, while off-label, is supported by evidence for its effectiveness in children (Preda et al., 2020). Guidelines emphasize the importance of combining pharmacotherapy with nonpharmacological interventions, such as CBT, to address comprehensive treatment needs. When guidelines are absent, clinicians must consider evidence-based research, individual patient history, and close monitoring of treatment responses.

Conclusion.

When managing patients with childhood onset schizophrenia, it is important to combine both pharmacological and non-pharmacological interventions as these two have been shown to have better outcomes. Before settling on a pharmacological agent, the healthcare provider should do a thorough risk assessment to ensure that the patient is started on a regimen treatment with minimal side effects. Childhood-Onset Schizophrenia Spectrum Disorders Discussion Paper

References

Correll, C. U., Kim, E., Sliwa, J. K., Hamm, W., Gopal, S., Mathews, M., Venkatasubramanian, R., & Saklad, S. R. (2021). Pharmacokinetic Characteristics of Long-Acting Injectable Antipsychotics for Schizophrenia: An Overview. CNS drugs, 35(1), 39–59. https://doi.org/10.1007/s40263-020-00779-5

Driver, D. I., Thomas, S., Gogtay, N., & Rapoport, J. L. (2020). Childhood-Onset Schizophrenia and Early-onset Schizophrenia Spectrum Disorders: An Update. Child and adolescent psychiatric clinics of North America, 29(1), 71–90. https://doi.org/10.1016/j.chc.2019.08.017

Preda, A., & Shapiro, B. B. (2020). A safety evaluation of aripiprazole in the treatment of schizophrenia. Expert opinion on drug safety, 19(12), 1529–1538. https://doi.org/10.1080/14740338.2020.1832990

Wu, H., Siafis, S., Hamza, T., Schneider-Thoma, J., Davis, J. M., Salanti, G., & Leucht, S. (2022). Antipsychotic-Induced Weigh t Gain: Dose-Response Meta-Analysis of Randomized Controlled Trials. Childhood-Onset Schizophrenia Spectrum Disorders Discussion Paper