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.<\/p>\n
For this Assignment, as you examine the client case study in this week\u2019s Learning Resources, consider how you might assess and treat clients presenting with early onset schizophrenia.<\/p>\n
Learning Objectives<\/p>\n
Students will: <\/p>\n
- \n
- Evaluate clients for treatment of mental health disorders<\/li>\n
- Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders<\/li>\n<\/ul>\n
<\/strong><\/p>\n
The Actual Assignment<\/strong><\/p>\n
Examine Case 3: <\/i>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\u2019s diagnosis and treatment. (Uploaded) or google<\/p>\n
Case #3
A young girl with strange behaviors<\/strong><\/p>\nhttps:\/\/mym.cdn.laureate-media.com\/2dett4d\/Walden\/NURS\/6660\/09\/mm\/decision_tree\/index.html<\/a><\/p>\n
Case #3:A young girl with strange behaviors<\/u><\/strong><\/p>\n
BACKGROUND<\/strong><\/p>\n
Carrie is a 13-year-old Hispanic female who is brought to your office today by her mother and father. They report that they were referred to you by their primary care provider after seeking her advice because Carrie\u2019s behavior has been difficult to manage and they don\u2019t know what to do.<\/p>\n
SUBJECTIVE<\/strong><\/p>\n
Carrie\u2019s parents report that they have concerns about her behavior, which they describe as sometimes \u201cnot normal for a 13-year-old.\u201d They notice that she talks to people who aren\u2019t real. Her behavior is calm and \u201cpassive.\u201d Her parents noted that when she was younger, she was irritable at times, but have noticed that this has given way to passivity. Her parents state that they understand that it\u2019s normal for younger children to have \u201cimaginary friends,\u201d but they feel that at Carrie\u2019s age, she should have grown out of these behaviors. Carrie\u2019s parents report that she has friends that are half-cat and half-human, and \u201cspirits\u201d who speak with her \u201cin her head.\u201d She also reports that the people on television know when she is home and that they have certain shows \u201cjust for her.\u201d<\/p>\n
Carrie\u2019s parents report that they have taken her to her pediatrician who has given her a \u201cclean bill of health.\u201d Carrie\u2019s parents note that they had some early concerns as she was lagging in meeting developmental milestones. Initially, when she first started school, Carrie managed to keep up with her peers in terms of academic performance, but she was noticed by her teachers to be isolative. It was also noted by her teachers and guidance counselor that Carrie\u2019s social skills do not seem to match what they see in other children her age. Initially the school counselor suspected that Carrie may have been suffering from attention deficit hyperactivity disorder (primarily inattentive type), but now is not certain and has recommended a psychiatric evaluation. Her grades were \u201cok\u201d in school up until last year when she left junior high school, and entered high school, where the academic demands began to increase. Carrie\u2019s teachers had wanted to hold her back a grade, but her parents acknowledge that they were \u201cinsistent\u201d that this did not happen. Now they are describing some regrets over this as Carrie seems \u201cmore lost than ever\u201d in her schoolwork. Carrie\u2019s mother produced a copy of a paper that Carrie had to submit as a homework assignment. You attempt to read the assignment, but there does not appear to be any clarity to the work, and it can best be described as a hodge-podge of thoughts and ideas.<\/p>\n
Carrie\u2019s parents want you to know that although they are concerned about Carrie, they are opposed to giving her medications that would turn her \u201cinto a zombie.\u201d Carrie\u2019s mother also confides that her husband\u2019s grandfather spent \u201ca few years in the nut house.\u201d When you probe further, she began crying and said, \u201cHe was schizophrenic \u2026 what if Carrie is schizophrenic?\u201d<\/p>\n
During your interview with Carrie, she seems pleasant, but somewhat distant. When you ask her about her friends at school, she shrugs her shoulders and says, \u201cI don\u2019t really have any. I don\u2019t like those people.\u201d You inquire if she is sad or upset that she doesn\u2019t like them, to which she states \u201cno, why should I be? I guess they would be friends with me if I asked, but I\u2019m not interested. I could make them be my friends if I wanted, but I don\u2019t \u2026 but if I wanted them to, all that I have to do is make up my mind that they will be my friend and they would have to.\u201d When you ask Carrie if she believes that she can control the thoughts of others with her mind, she puts her index finger up to her mouth and looks toward the door. \u201cMy mom gets upset when I talk about these things. I try not to think about them either because if she is close enough, she could read my thoughts and they upset her. She may think that I\u2019m into witchcraft or something.\u201d<\/p>\n
When you ask Carrie about the homework assignment that you read, she explains that her teacher \u201cis just miserable. She doesn\u2019t understand how I think\u2014I think high, she just can\u2019t get it.\u201d<\/p>\n
OBJECTIVE<\/strong><\/p>\n
The client is a 13-year-old Hispanic female client who appears appropriately developed for her age. She is dressed appropriately for the current weather, and ambulates with a steady upright gait. She does not appear to be demonstrating any noteworthy mannerisms, gestures, or tics. No psychomotor agitation\/retardation apparent.<\/p>\n
MENTAL STATUS EXAM<\/strong><\/p>\n
Carries is alert and oriented \u00d7 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. Carrie self-reports her mood as \u201cgood.\u201d However, her affect does appear somewhat constricted. Her eye contact is minimal throughout the clinical interview and at times, Carrie seems preoccupied. Carrie is oriented to person, place, and time. She endorses hearing and seeing strange \u201cthings that I talk to. They don\u2019t scare me; they come to see me from another world.\u201d No overt paranoia is appreciated. She does report delusions of reference (she believes that the people on TV play programs \u201cjust for her\u201d and at times, television commercials were designed to tell her what to do), as well as other delusional thoughts (as described above). Carrie denies any suicidal or homicidal ideation.<\/p>\n
At this point, please discuss any additional diagnostic tests you would perform on Carrie.<\/p>\n
<\/strong><\/p>\n
<\/strong><\/p>\n
<\/strong><\/p>\n
<\/strong><\/p>\n
Decision Point One<\/strong><\/p>\n
BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC\/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO CARRIE?<\/p>\n
In your write-up of this case, be certain to link specific symptoms presented in the case to DSM\u20135 criteria to support your diagnosis.<\/p>\n
- \n
- Early Onset Schizophrenia<\/li>\n
- Schizoaffective Disorder<\/li>\n
- Schizotypal Personality Disorder<\/li>\n<\/ul>\n
My chosen Decision 1: Early Onset Schizophrenia<\/strong><\/strong><\/p>\n
<\/strong><\/p>\n
Decision Point Two<\/strong><\/p>\n
BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS:<\/p>\n
- \n
- Refer for psychological testing<\/li>\n
- Begin Clozaril 100 mg orally daily<\/li>\n
- Begin psychotherapy using a psychodynamic approach<\/li>\n<\/ul>\n
My Chosen Decision 2 is: Begin psychotherapy using a psychodynamic approach<\/strong><\/strong><\/p>\n
RESULTS OF DECISION POINT TWO<\/p>\n
Client returns to clinic in four weeks<\/p>\n
Carrie appears to be engaged with her therapist, and reports that she \u201clooks forward\u201d to seeing her therapist, but her parents are not reporting any appreciable change in psychotic symptoms.<\/p>\n
Decision Point Three<\/strong><\/p>\n
BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.<\/p>\n
- \n
- Increase the frequency of psychodynamic psychotherapy sessions<\/li>\n
- Begin Haloperidol 5 mg orally daily<\/li>\n
- Begin Lurasidone 40 mg orally daily<\/li>\n<\/ul>\n
My Chosen Decision 3 is: Begin Haloperidol 5 mg orally daily<\/strong><\/p>\n
<\/strong><\/p>\n
Guidance to Student<\/strong><\/p>\n
Some authorities have suggested that psychodynamic psychotherapies can be effective in the treatment of schizophrenia, especially modern psychoanalysts. Psychotherapy definitely has a place in terms of helping individuals with schizophrenia (especially in the treatment of residual symptoms), but is not considered a first-line treatment for the disorder.<\/p>\n
Although not FDA-approved for use in children, Lurasidone (Latuda) is used as an off-label drug in this population. There are no legal prohibitions against any prescriber using drugs \u201coff-label\u201d; however, attention must be given to the concept of informed consent. When working with children\/adolescents, the PMHNP must explain pros\/cons, discuss therapeutic endpoints\/goals of treatment, etc. The parent\/guardian must have all of the information needed to make an informed consent. In consideration of an antipsychotic, Lurasidone may be the preferred antipsychotic as it appears to have the least impact on body weight and lipid profile.<\/p>\n
Haldol should be initiated at 0.5 mg orally daily, with a target dose of 0.05 to 0.15 mg\/kg per day for psychotic disorders. It is generally considered to be a second-line drug after second-generation antipsychotics have been attempted\/failed. Haldol can also cause significant weight gain and alter lipid profiles significantly.<\/p>\n
Recall that with any antipsychotic medication, you should determine fasting plasma glucose levels, monitor weight and BMI during treatment, as well as blood pressure and fasting triglycerides.<\/p>\n
Please answer these questions and support with evidence base references from 2015 to present<\/u><\/strong><\/p>\n
At each Decision Point, stop to complete the following:<\/u><\/strong><\/p>\n
- \n
- Decision #1: Differential Diagnosis\n
- \n
- Which Decision did you select?<\/li>\n
- Why did you select this Decision? Support your response with evidence and references to the Learning Resources.<\/li>\n
- What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.<\/li>\n
- Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?<\/li>\n<\/ul>\n<\/li>\n
- Decision #2: Treatment Plan for Psychotherapy\n
- \n
- Why did you select this Decision? Support your response with evidence and references to the Learning Resources.<\/li>\n
- What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.<\/li>\n
- Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?<\/li>\n<\/ul>\n<\/li>\n
- Decision #3: Treatment Plan for Psychopharmacology\n
- \n
- Why did you select this Decision? Support your response with evidence and references to the Learning Resources.<\/li>\n
- What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.<\/li>\n
- Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?<\/li>\n<\/ul>\n<\/li>\n
- Also include how ethical considerations<\/strong> might impact your treatment plan and communication with clients and their families.<\/li>\n<\/ul>\n
References<\/p>\n
\n American Nurses Association. (2014).
\n Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.)<\/em>. Washington, DC: Author. <\/p>\n- \n
- Standard 10 \u201cQuality of Practice\u201d (pages 73-74)<\/li>\n<\/ul>\n<\/blockquote>\n
\n Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
\n Kaplan & Sadock\u2019s synopsis of psychiatry: Behavioral sciences\/clinical psychiatry <\/em>(11th ed.). Philadelphia, PA: Wolters Kluwer. <\/p>\n- \n
- Chapter 31, \u201cChild Psychiatry\u201d (pp. 1268\u20131283)<\/li>\n<\/ul>\n<\/blockquote>\n
\n American Psychiatric Association. (2013).
\n Diagnostic and statistical manual of mental disorders<\/em> (5th ed.). Washington, DC: Author. <\/p>\n- \n
- \u201cSchizophrenia Spectrum and Other Psychotic Disorders\u201d<\/li>\n<\/ul>\n<\/blockquote>\n
\n McClellan, J., & Stock, S. (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia.
\n Journal of the American Academy of Child & Adolescent Psychiatry<\/em>,
\n 52<\/em>(9), 976\u2013990. Retrieved from
\n http:\/\/www.jaacap.com\/article\/S0890-8567(13)00112-…<\/a>
\n \n<\/p><\/blockquote>\n\n Giles, L. L., & Martini, D. R. (2016). Challenges and promises of pediatric psychopharmacology.
\n Academic Pediatrics<\/em>,
\n 16<\/em>(6), 508\u2013518. doi:10.1016\/j.acap.2016.03.011
\n
\n Note:<\/strong> You will access this article from the Walden Library databases.
\n \n<\/p><\/blockquote>\n\n Hargrave, T. M., & Arthur, M. E. (2015). Teaching child psychiatric assessment skills: Using pediatric mental health screening tools.
\n International Journal of Psychiatry in Medicine<\/em>,
\n 50<\/em>(1), 60\u201372. Retrieved from
\n http:\/\/search.proquest.com.ezp.waldenulibrary.org\/…<\/a>
\n
\n Note:<\/strong> You will access this article from the Walden Library databases.
\n \n<\/p><\/blockquote>\n<\/a><\/p>\n
\n Stahl, S. M. (2014). Prescriber\u2019s Guide: Stahl\u2019s Essential Psychopharmacology <\/em>(5th ed.). New York, NY: Cambridge University Press. <\/a>
\n
\n <\/a>
\n
\n Note:<\/strong> 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.<\/a>
\n
\n <\/a>
\n
\n To access information on the following medications, click on The Prescriber\u2019s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.<\/a><\/p>\n\n<\/p><\/blockquote>\n \n
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- \u201cSchizophrenia Spectrum and Other Psychotic Disorders\u201d<\/li>\n<\/ul>\n<\/blockquote>\n
- Chapter 31, \u201cChild Psychiatry\u201d (pp. 1268\u20131283)<\/li>\n<\/ul>\n<\/blockquote>\n
- Standard 10 \u201cQuality of Practice\u201d (pages 73-74)<\/li>\n<\/ul>\n<\/blockquote>\n
- Decision #1: Differential Diagnosis\n