NURS6660 Week 9 Assignment 1: Early Onset Schizophrenia
Assignment 1: Early Onset Schizophrenia 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. 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 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)
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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.
Schizophrenia occurs in both children and adults, with the diagnosis being dependent on the patient’s age. Incidence among adolescents is identified as early onset schizophrenia while incidence among children less than 13 years of age is termed very early onset schizophrenia. The treatment target will depend on the diagnosis, taking into consideration the stage of the disorder as well as the patient’s age. Still, there are commonalities for all patients irrespective of age. Firstly, all forms of treatment for schizophrenia focus on resolving the noted symptoms through pharmacological and psychosocial approaches, identifying the factors that contributed to the condition, and providing the patient with a safe environment that prevents self-harm as well as harm to others. Secondly, treatment focuses on clarifying the diagnosis, establishing a rapport with the family and patient, and providing them with psycho-education (Stahl, 2014). Thirdly, treatment looks at effectiveness of the antipsychotic interventions as well as how to manage the side effects associated with the treatment. Fourthly, once treatment has resolved the immediate acute episode, treatment emphasis then shifts to preventing a relapse through ongoing treatment using antipsychotics. Besides antipsychotics, patients are subjected to psychosocial interventions that focus on treatment adherence, stressors management, and return to normal daily activities. Finally, the later stages of treatment provide rehabilitation that seeks to optimize the treatment interventions and outcomes through continued vigilance to prevent relapse and maintaining the patient’s health for the long-term (American Nurses Association, 2014). NURS6660 Week 9 Assignment 1: Early Onset Schizophrenia.
Despite the similarities between schizophrenia treatment for adults, adolescents and children, there are unique differences. Firstly, treatment for adults does not consider the patient’s development stage whereas treatment for children and adolescents considers the patient’s developmental stage along with family dynamics and perspective. The second difference is that treatment for adults includes psycho-education for both the patient and support structures while treatment for children includes psycho-education for the patient and family, along with other support structures if present. In fact, schools are often included in the treatment of children and adolescents since the condition is accompanied by intellectual impairment that is best addressed through involving the school (Sperry, 2016). The third difference is that while treatment for adults includes control of treatment side effects through diet and exercise, treatment for children and adolescents goes a step further in negotiating the crucial development tasks necessary for transitioning from childhood to adolescents and from adolescents to adulthood. This additional component of treatment for children and adolescents looks at the vocational and social development factors that can be addressed through individual support (Sadock, B., Sadock, V. & Ruiz, 2014). In this respect, schizophrenia treatment for adults, and treatment for adolescents and children have distinctive similarities and differences.
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.
Forced treatment of children has both legal and ethical implications. The law is clear that persons suffering from psychiatric disorders can be forced to receive treatment if the disorder is severe and requires immediate treatment, or if the patient presents an imminent danger to himself/herself or to others within the same environment. In this case, treatment can be forced if the patient lacks autonomous decision-making capacity as is the case with children who do not have the ability to communicate, reason, appreciate and understand. For that matter, the law allows for children to be subjected to involuntary psychiatric treatment when they meet the set conditions for risk for harm, diminished decision-making capacity and severity of the condition (Miller & Hanson, 2016).
While the law allows for forced treatment of children, this approach raises some ethical concerns since the patient is treated against his or her will. Firstly, there is a concern about respect for autonomy since the patient is manipulated and coerced to receive treatment. Still, it can be argued that forcing the patient to receive treatment is justified since it is intended to restore autonomy. Secondly, forced treatment does not respect the patient’s preferences and values, contrary to accepted ethical standards that every individual should have equal recognition irrespective of having a psychiatric disorder. Thirdly, psychiatric treatment is not an exact science and there is a possibility that the treatment could aggravate the condition instead of providing relief. This is a concern when it is considered that antipsychotics change the brain chemistry, and this could end up causing more harm in the long run (American Nurses Association, 2014).
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As a PMHNP and given a situation in which the child is subjected to forced treatment, I should be more concerned with protecting the patient from harm and practicing beneficence rather than considering the patient’s ability to make autonomous decisions about treatment. Also, the issue should be addressed through considering the patient’s attitudes towards treatment and the need for treatment, social circumstances, expected consequences, and follow-up routines. Given that the patient has a right to reject treatment and this right can be restricted, then the decision by medical on forced treatment should be guided by three principles. Firstly, the patient must refuse treatment when recommended and be deemed incapable of making an autonomous decision on whether or not to accept treatment. Secondly, the patient must have an imperative need for the treatment. Finally, the prognosis for the disorder must be serious with unfavorable consequences if left untreated. These three steps should help the PMHNP in addressing the issues concerning forced treatment of children (Miller & Hanson, 2016). NURS6660 Week 9 Assignment 1: Early Onset Schizophrenia.
American Nurses Association (2014). Psychiatric-mental health nursing: scope and standards of practice (2nd ed.). Washington, DC: Author.
Miller, D. & Hanson, A. (2016). Committed: the battle over involuntary psychiatric care. Baltimore, MD: Johns Hopkins University Press.
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.
Sperry, L. (2016). Handbook of diagnosis and treatment of DSM-5 personality disorders: assessment, case conceptualization, and treatment (3rd ed.). New York, NY: Routledge.
Stahl, S. M. (2014). Prescriber’s guide: Stahl’s essential psychopharmacology (5th ed.). New York, NY: Cambridge University Press. NURS6660 Week 9 Assignment 1: Early Onset Schizophrenia.