Childhood schizophrenia

Early Onset Schizophrenia also known as Childhood schizophrenia
The information provided in the case study offers sufficient information about the history and presenting complaints of the family and the client. The focus is on the 13-year-old Hispanic female who, on assessment, seems preoccupied, has delusions of references, maintains minimal eye contact, and reports poor performance in classwork, among other important findings. Therefore, in regard to the information provided in the patient scenario, it is important to make three decisions regarding the differential diagnoses, treatment, and management of the client.

Table of Contents

Decision 1: Early Onset Schizophrenia

The decision one is to make a differential diagnosis of early-onset schizophrenia. Early-onset schizophrenia, also known as childhood schizophrenia, occurs before the age of 18 years. It involves a range of problems in the thinking pattern and thought content, behavior, and emotions. Additionally, some hallucinations and delusions can impair the child’s function ability (Driver et al., 2020). Like in the scenario, the client has started experiencing academic performance problems, have poor social skills, and have hallucinations and delusions. Since this condition occurs early, it severely impacts the child’s development and presents various challenges, specifically management, treatment, and diagnosis. Some of the symptoms in teenagers include a drop in school performance, irritability or depression, withdrawal from friends, and lack of motivation, among others (Gallagher III & Jones, 2017). These are symptoms that the client presents with; hence I made this decision.

Selecting this option is important because it is vital to rule out childhood schizophrenia. Additionally, diagnosing the condition at this early time could help develop an effective treatment plan that will improve the patient’s quality of life. It is not definitive that the child has early-onset schizophrenia. However, it is important to have a differential diagnosis to suspect the early-onset schizophrenia and carry out more tests to confirm the suspected diagnosis. The family history of schizophrenia, the presenting signs and symptoms are important in coining the differential diagnosis (Gallagher III & Jones, 2017). Moreover, there were no major differences between the results of the decisions and my expectations. The results were congruent.

Decision 2: Refer for Psychological Testing

Decision two was to refer the client for psychological testing. The main reason why this was selected is to determine the reason for Carrie’s poor performance in school and to assess if it is related to intellectual disability or poor premorbid intellectual functioning. It is important to note that there are no specific tests for schizophrenia; however, the psychologist can administer various tests like Minnesota Multiphasic Personality Inventory; Kaufman Adolescent and Adult Intelligence Test to assess the current behavior’s causes of the client. The psychologist administers the tests to measure and evaluate the client’s behavior, which helps rule out diagnoses, arrive at a diagnosis, and develop a guide for treatment (Kaplan & Saccuzzo, 2017).

With selecting this decision, I expected that the psychologist administers the tests and possibly come up with a decisive diagnosis of the client. Additionally, I expected that the test would reveal if the poor performance is related to either intellectual disability or schizophrenia. This is because the tests can effectively determine why a client is behaving in a specific manner, the possible causes, and the relationships. For instance, aptitude tests can help in diagnosing problems with school performance (Kaplan & Saccuzzo, 2017). I also expected that the test would ultimately confirm the differential diagnosis of early-onset schizophrenia. The main result of decision 2 was that early-onset schizophrenia was highly suspected in the client; hence this corroborates my expectation when I made this decision.

Decision 3: Begin Lurasidone 40mg Orally Daily

I selected the decision to begin Lurasidone 40mg orally daily. This was made with a keen consideration of the parents’ preferences against medications that would make the child look like a zombie. Additionally, the side effects of the drugs were analyzed before deciding on this medication. Long term management with Lurasidone is associated with few relapse cases, less impact on the body weight, and alterations in lipid and glucose profiles. Moreover, it is a second-generation antipsychotic. Hence, it has less extrapyramidal effects, which will make the child not exhibit the zombie-like presentation that the parents don’t want. Efficacy has been realized through a starting dose of 20mg orally daily; hence there is no need for initial titration of the doses. Subsequent doses should be based purely on the clinical judgment and the progress of the client. Those that will have poor progress with the initial doses can benefit from higher doses going forward; moreover, the drug has short-term effectiveness, as in Harvey (2015).

I expected that the administration of this medication would improve the client’s overall presentation. It will lead to improved social relationships over time, reduced reported cases of delusion or hallucinations, improvement in functional status, and daily living activities. This is because of the effectiveness of Lurasidone that has exhibited efficacy in managing schizophrenia (Loebel & Citrome, 2015). The patient had encouraging results; the patent had improved symptoms on return after four weeks; the progress was generally good; hence, it was imperative to maintain the dosage of Lurasidone and monitor the progress further. Therefore, the results were the same to some extent with the expectations. The small difference occurs because the client has been on the drug for a shirt time hence with continuous administration improvements will be noted (Harvey, 2015).

Like consent and patient autonomy, some ethical considerations influence the treatment plan and communication to the client and family. It is imperative to respect the patient’s right to refuse some medication and make further decisions about her health. Therefore, the treatment plan was tailored to meet their requirements and choices. Additionally, they have to consent to prescribed medication; if not, the treatment plan has to be reconsidered to what meets their demands with appropriate guidance. However, it has to be communicated to them the side effects of each medication, how it works, and the pertinent factors to make a decisive conclusion (Smith, 2017).

Conclusion

The major decisions included early-onset schizophrenia as a differential diagnosis, referral for psychological testing, and Lurasidone administration at 40mg. The decisions led to different results than either concurred or differed with the expectations. Additionally, consent and patient autonomy were some of the ethical issues that impacted the treatment plan and communication.

References

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, 29(1), 71-90. https://doi.org%2F10.1016%2Fj.chc.2019.08.017

Gallagher III, B. J., & Jones, B. J. (2017). Early-onset schizophrenia: Symptoms and social class of origin. International Journal of Social Psychiatry, 63(6), 492-497. https://doi.org/10.1177%2F0020764017719302

Harvey P. D. (2015). The clinical utility of Lurasidone in schizophrenia: patient considerations. Neuropsychiatric disease and treatment, 11, 1103–1109. https://doi.org/10.2147/NDT.S68417

Kaplan, R. M., & Saccuzzo, D. P. (2017). Psychological testing: Principles, applications, and issues. Nelson Education. ISBN: 1-337-09813-2

Loebel, A., & Citrome, L. (2015). Lurasidone: a novel antipsychotic agent for the treatment of schizophrenia and bipolar depression. BJPsych bulletin, 39(5), 237–241. https://doi.org/10.1192/pb.bp.114.048793

Smith, G. (2017). Ethical Issues in Mental Health Nursing. In Key Concepts and Issues in Nursing Ethics (pp. 145-157). Springer, Cham.

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