Discussion: Psychosis Diagnosed During Childhood

Discussion: Psychosis Diagnosed During Childhood

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Question Description
I don’t know how to handle this Nursing question and need guidance.

I need you to paraphrase this paper. I need a plagiarism free paper.

Young Girl with Strange Behaviors

Introduction

Understanding that psychosis is not a common problem during childhood and adolescent makes it challenging to determine when an individual present with the symptoms.Psychosis can develop slowly or quickly.Children and youth may begin talking about strange ideas or fears, the may begin to cling to parents or say things that do not make sense.Others may have a change in personality where they use to enjoy being around others, they are now more withdrawn, (Courvoisie, Labellarte, & Riddle, 2001). Therefore, it is crucial that these cases are studied and researched so that it is more understood.This assignment is to make decisions based off choices to form the best outcome for the client.

Decision Point One

For this first decision, I choose the diagnosis of early-onset schizophrenia.

Reason for Selection

Based on the information provided by Carrie and her parents, she is experiencing delusions of people that are not there, she states that her friends are half cat and half human, and she states the television has shows just for her.The school counselor believed at first Carrie was first exhibiting signs of attention deficit disorder, but at this time, due to odd behaviors, believes she needs testing to determine a diagnosis.After mental evaluation and physical to rule out possible organic reasons for behaviors, it is determined that it is psychological.

The three choices of diagnosis are: Early onset schizophrenia, Schizoaffective disorder, and Schizotypal personality disorder.Based on the DSM-5 criteria, my decision is early onset schizophrenia.

Although both schizoaffective and schizotypal personality disorder are appropriate differential diagnosis, Carrie is presenting with behaviors of early onset schizophrenia. The DSM-5 cautions that even though the basic features of schizophrenia are the same in childhood, it is harder to diagnose. Children may experience less grandiose delusions and hallucinations than adults. Visual hallucinations are more common in children and should be distinguished from normal play. Other symptoms such as disorganized speech and behavior, are typically present in schizophrenia, occur as well in many disorders of childhood.At least two of the following five symptoms needs to be present for a month for a schizophrenia diagnosis: Delusions, Hallucinations, Disorganized speech, Grossly disorganized or catatonic behavior, and negative symptoms.

Schizoaffective disorder would be ruled out because Carrie is not demonstrating the signs that are associated more with schizoaffective, such as mania, less sleep, thoughts of self-harm or harming others.Carrie also does not seem to have mood instability or engage in risky behavior.Schizotypal personality disorder typically involves very eccentric behavior, Carrie does not present this way, (Lenzenweger, 2018). Although Carrie does not have many close friends, she does have relationships with her parents.

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Decision Point Two

Selected Decision

For this decision between psychological testing, beginning Clozaril 100 mg daily, or psychotherapy using the psychodynamic approach, my decision is psychological testing.

Reason for Selection

The reason I made this decision is because psychological testing would help to rule out other problems such as intellectual disability and other cognitive disorders which are common in people with schizophrenia. I felt that the difference picking between testing and therapy would be minimal, but the confirmation of the diagnosis would me essential for follow treatment with medications.Clozaril 100 mg daily is a large starter dose that is not recommended for anyone, much less a teenager.

One of the determining diagnosis of schizophrenia is the use of assessment tools to address the characteristics in the behavior presentation. The instruments rely on the self-report of the client and parents, (Hurford, Marder, Keefe, Reise, & Bilder, 2011).

Expected Results

Based on the results of the tests, the diagnosis of early onset schizophrenia.From this point on, medication management and therapy should be started.

Decision Point Three

Selected Decision

Between the choices of Clozapine 100 mg daily, beginning family interventions, or begin Lurasidone 40 mg daily, my choice is to begin Lurasidone 40 mg.

Reason for Selection

Lurasidone is an atypical antipsychotic with dopamine D2 and 5-hydroxytryptamine 2A (5HT2A) receptor antagonism. It also has 5HT7, 5HT1A, and noradrenaline α1c receptor binding affinity. Given the risk of long-term metabolic adverse effects of most atypical antipsychotics, such as Clozaril, lurasidone serves as positive alternative, as it has shown to have fewer effects on weight gain, hyperlipidemia, elevated blood sugar, and insulin resistance in adults,( Lin, Rosenheck, Sugar, & Zbrozek, 2015).

Lurasidone provides early efficacy, and good tolerability, particularly cardimetabolic, (Samalin, Garnier, & Llorca, 2011).As stated before, Clozapine 100 mg, is a large dose for a Carrie.It should also be considered that Clozapine comes with regular blood work and strict adherence for efficacy.

Family interventions are needed to allow the family to educate themselves and speak of the concerns they have for Carrie, but most important at this point is managing her behavior and delusional thoughts.

Impact of Ethical Considerations

Ethical considerations with these decisions are to make the parents and Carrie aware of the side effects of the medication prescribed, making certain they understand possible side effects and adverse reactions.Also, communication should be open and honest, allow for questions and schedule follow-up questions. Providing crisis numbers in case of emergencies would also be important in case behaviors become out of control.

Conclusion

Schizophrenia is a diagnosis that can be difficult to comprehend, the fact that Carrie’s mother has history with the disorder from her grandfather, and knowing he was hospitalized for a long period of time can be even more upsetting.Hopefully, with medication management and therapy, Carrie will not have to be hospitalized and be able to lead a healthy life.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author

Courvoisie, H., Labellarte, M. J., & Riddle, M. A. (2001). Psychosis in children: diagnosis and treatment. Dialogues in Clinical Neuroscience, 3(2), 79–92.

Hurford, I. M., Marder, S. R., Keefe, R. S. E., Reise, S. P., & Bilder, R. M. (2011). A Brief Cognitive Assessment Tool for Schizophrenia: Construction of a Tool for Clinicians. Schizophrenia Bulletin, 37(3), 538–545. http://doi.org/10.1093/schbul/sbp095

Lin, L. A., Rosenheck, R., Sugar, C., & Zbrozek, A. (2015). Comparing antipsychotic treatments for schizophrenia: A health state approach. Psychiatric Quarterly, 86(1), 107-121.

Lenzenweger, M. F. (2018). Schizotypy, schizotypic psychopathology and schizophrenia. World Psychiatry, 17(1), 25–26. http://doi.org/10.1002/wps.20479

Samalin, L., Garnier, M., & Llorca, P.-M. (2011). Clinical potential of lurasidone in the management of schizophrenia. Therapeutics and Clinical Risk Management, 7, 239–250. http://doi.org/10.2147/TCRM.S12701

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