Early Onset Schizophrenia

1 Early Onset Schizophrenia Schizophrenia can be classified according to patient age at its onset. Early onset schizophrenia (EOS) is diagnosed when psychotic symptoms begin after 13 years of age, whereas very early onset (VEOS) is diagnosed in children under the age of 13. The diagnosis of schizophrenia in this patient group is thought to be influenced by a variety of factors, including genetics, psychosocial factors, and environmental factors, which increases the vulnerability of the children. The diagnosis of schizophrenia in children presents with a significant problem in regards to its treatment and management. This paper differentiates the treatment of schizophrenia in adults and children. It then provides the ethical and legal issues in forcing treatment on children.

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2 Comparing Evidence Based Treatment Plans for Schizophrenia in Adults and in Children Early-onset schizophrenia is often more severe as compared to adult schizophrenia. In both adults and children, antipsychotic medications are used to treat schizophrenia. The use of antipsychotics is aimed at reducing the symptoms associated with schizophrenia and preventing relapses thus achieving better health outcomes (Patel et al., 2015). However, it has more side effects in children than in adults, owing to the fact that children are still undergoing physical and brain development. Antipsychotics have been associated with having side effects such as rapid weight gain and poor sexual, metabolic, cardiac and bone development (Stafford et al., 2015).

Children are also prone to developing the negative symptoms associated with antipsychotics, which include delusions and hallucinations.

The available evidence for the use of antipsychotics for EOS is limited. So far, no drug has been approved for the treatment of schizophrenia in children. Antipsychotics are used as off-label drugs, with second generation antipsychotics being evidently preferred over fist generation antipsychotics (Stafford et al., 2015). This is because they have lesser side effects and better drug adherence among patients. Drug tolerance and adherence are the other major issues associated with using antipsychotics in children.

Legal and Ethical Issues Involved With Forcing Children Diagnosed With Schizophrenia to Take Medication In some instances, children with schizophrenia have to be forced to take medications for their conditions. This occurs in the case of involuntary commitment or similar scenarios. Involuntary commitment in minors requires the obtaining of court orders and following the required legal process. Children may also face barriers to receiving appropriate care. For example when their parents or guardians are against them receiving treatment. All these may result in ethical and

3 legal implications, considering the fact that minors are incompetent decision makers (Fried & Fisher, 2018).

The biomedical principles of ethics should guide PMHNPs when addressing ethical issues that arise when dealing with minors. They should ensure that decisions made benefit the child and do not inflict any form of harm as per the principles of beneficence and non-maleficence (Fried & Fisher, 2018). To address legal issues, court orders should be obtained and applied when necessary. The child’s right should also be advocated for at all times.

Conclusion The treatment and management of psychiatric conditions in children is faced with a lot of challenges compared to adults. There are few approved drugs with available drug being associated with causing various side effects. In the treatment of EOS, second generation antipsychotics are preferred despite not being approved for use. As a result, refusal of treatment and the subsequent legal and ethical issues are bound to occur.

4 References Fried, A. L., & Fisher, C. B. (2018). Emerging ethical and legal issues in clinical child and adolescent psychology. The Oxford Handbook of Clinical Child and Adolescent Psychology. DOI: 10.1093/oxfordhb/9780190634841.013.9 Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2015). Schizophrenia: overview and treatment options. P & T : a peer-reviewed journal for formulary management, 39(9), 638–645.

Stafford M. R., Mayo-Wilson E., Loucas C. E., James A., Hollis C., Birchwood M., et al. (2015) Efficacy and Safety of Pharmacological and Psychological Interventions for the Treatment of Psychosis and Schizophrenia in Children, Adolescents and Young Adults: A Systematic Review and Meta-Analysis. PLoS ONE 10(2): e0117166. https://doi.org/10.1371/journal.pone.0117166