Psychotherapy
The treatment of individuals with psychiatric conditions is a complex process involving administration with medications and other therapeutic interventions such as talk therapy and humanistic therapy. The process becomes even more intricate when dealing with pediatrics (Lock, La-Via, & AACAP Committee, 2016). The psychiatric mental health nurse practitioner comprehensively analyses the mental health of the child before making any clinical decision. The treatment progress of the child is also closely monitored to make the right adjustment to enhance the outcome of care and reduce the risk of side effects (McClellan, 2018). This discussion explores the treatment decision of a 13-year-old Hispanic girl with abnormal behavior.
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Decision Point One
Decision: Diagnosis with Early Onset Schizophrenia
Rationale: A diagnosis of Early Onset Schizophrenia was made for the client. This diagnosis is in line with the DSM-V criteria for schizophrenia. The Criteria has it that the client must present with at least two of the symptoms to be diagnosed with schizophrenia (Dulcan, 2015). These symptoms include decreased emotional expression, hallucinations, catatonic behavior, emotional disturbance, delusions, diminished emotional expression, and disorganized speech (Dulcan, 2015). The two symptoms must be present for at least a month and one of the symptoms has to be delusions, disorganized speech, or hallucinations.
Expected results: Psychiatric health assessment was intended to determine if the child was suffering from Early Onset Schizophrenia, Schizoaffective Disorder, or Schizotypal Personality Disorder.
Differences in results: The diagnosis with Early Onset Schizophrenia is appropriate since Carrie presented with visual and auditory hallucinations, delusions, and diminished emotions. These symptoms have negatively affected Carrie’s academic performance and social life. A family history of schizophrenia also demonstrates an increased possibility for this disorder in the client.
Decision Point Two
Decision: Refer for psychological tests
Rationale: The decision made at this point was to refer the client for psychological testing.
Individuals with abnormal behaviors are subjected to psychological tests to determine the cause and the impact of the symptoms on their health. Despite it is not always necessary to refer a child for psychological tests, such a move is beneficial if the child presents with behaviors that deviate from normal. Psychologists are professionally trained individuals capable of analyzing
psychometric test results to make an accurate diagnosis. Although no specific psychometric tests have been developed for schizophrenia, various psychological tests can be utilized to observe the client's behavior and make a relevant conclusion. Thus, Carrie was subjected to a battery of psychometric tests to evaluate her personality, intellectual capability, and cognitive functioning. Some of the tests performed include the Whitaker Index of Schizophrenic Thinking (WIST) test, Minnesota Multiphasic Personality Inventory, Millon Adolescent Clinical Inventory (MACI), Wide Range Achievement Test- 4, and Kaufman Adolescent and Adult Intelligence Test.
Expected results
These tests were primarily aimed at determining if an intellectual disability contributed the poor academic performance or whether it was due to the poor premorbid intellectual functioning associated with the early onset of schizophrenia
Differences in achieved results
The test scores revealed that the child was most likely suffering from early-onset schizophrenia.
Decision Point Three
Decision: Begin Clozapine 100 mg orally daily
Rationale: Clozapine, which is an atypical antipsychotic medication, was selected for this client since it has the potential to address the symptoms of schizophrenia (Khan & Zaidi, 2017). The FDA has approved this medication for use in treatment-resistant schizophrenia.
Expected result
This use of clozapine was intended to reduce the negative symptoms associated with schizophrenia (Khan & Zaidi, 2017).
Differences in results
Unfortunately, since the child has not been previously treated with other antipsychotic medications, it cannot be determined if her condition is resistant to treatment. The starting dose of 100 mg Clozapine is high for a child. This dosage may be the leading cause of side effects experienced by the child (Stahl, 2014). Clozapine should be adjusted to a lower dose of 25mg to avert potential side effects.
Ethical considerations
Psychotherapy for children must be carried out per the established ethical guidelines (McClellan, 2018). The PMHNP is required to furnish patients and families with details of the benefits and potential dangers of certain treatments. The treatment plan must have clear goals to maintain focus and reduce incidences of adverse outcomes (Lock, La-Via & AACAP Committee 2016). The ethical principle of non-maleficence should be integrated into the treatment to ensure the client is provided with appropriate treatment. In Carrie’s case, Lurasidone 40mg would have been the best intervention since it does not have side effects besides eradicating negative
symptoms. Family involvement during pediatric psychotherapy is also vital since it provides the child with social support besides limiting the risk of relapse.
Conclusion
Despite the complexity of psychotherapy, it is an important approach in the treatment of psychological conditions. The nurses also administer antipsychotic medications to achieve behavior. Pediatric psychotherapy is guided by ethical principles to ensure the client is not exposed to adverse health outcomes. The involvement of the family in psychotherapy helps to provide social and moral support to the client. The possibility of relapse is also averted when the family is actively involved.
References
Dulcan, M. K. (Ed.). (2015). Dulcan's textbook of child and adolescent psychiatry. American Psychiatric Pub.
Khan, A. H., & Zaidi, S. (2017). Clozapine: Improvement of Negative Symptoms of Schizophrenia. Cureus, 9(12), e1973. https://doi.org/10.7759/cureus.1973
Lock, J., La-Via, M. C., & AACAP Committee (2016). Practice parameter for the assessment and treatment of children and adolescents with eating disorders. Focus, 14(1), 75-89.
https://doi.org/10.1016/j.jaac.2015.01.018
McClellan, J. (2018). Psychosis in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 57(5), 308-312.
https://doi.org/10.1016/j.jaac.2018.01.021
Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). Cambridge University Press.