nurs 6660 practicum decision tree Early onset Schizophrenia essay

For this nurs 6660 practicum decision tree Early onset Schizophrenia essay Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with early onset schizophrenia

Decision Tree Week 9

Introduction

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The client in this case study is about a 13-year-old girl who presented to the office with the parents reporting about her “difficult behavior”. The main complaints included the client “talking” to imaginary friends and having delusions about individuals in the television recognizing her and showcasing for her. The social skills of the client are impaired and her academic performance has declined significantly. The mother further reported a family history of schizophrenia. nurs 6660 practicum decision tree Early onset Schizophrenia essay The mental examination further released that the client sees, hears, and communicates with strange nonexistent things. Accordingly, in this paper, one decision will be made about the diagnosis of the client’s condition while the other two decisions will be made about the treatment of the client. Finally, the ethical issues relevant to the treatment of this client will be discussed.

Decision Point One

The selected diagnosis for the client is early-onset schizophrenia. The rationale behind selection of this decision is that the symptoms the client is manifesting fit the diagnostic criteria of early-onset schizophrenia as per the DSM-5 criteria. According to the DSM-5 criteria, symptoms of early-onset schizophrenia include negative symptoms, delusions, disorganized speech, hallucinations, and disorganized behavior (Stahl, 2014). The American Psychiatric Association (2013) stipulates that a person should manifest two or more of these symptoms to fit the diagnosis of schizophrenia. The client in this case study has three symptoms that include negative symptoms as manifested by constricted affect; delusions as indicated by the television assertions; and hallucinations indicated by the client seeing, hearing and talking to imaginary and strange people. nurs 6660 practicum decision tree Early onset Schizophrenia essay Bartlett (2014) further indicates that negative symptoms in people with schizophrenia include lack of motivation, flat affect, anhedonia, and lacking interest in social interactions. The client in this case study does not have any interest to interact with her classmates, manifests constricted affect, and also manifests blunt affect which is evident when she is asked regarding her assignment indicating symptoms of schizophrenia (Stahl, 2014).

By selecting this diagnosis for the client, the expectation is that this is the correct diagnosis and thus it will facilitate the appropriate treatment for the client.

Decision Point Two

The second decision is referring the client for psychological testing. The reason for suggesting the client be referred for psychological testing is to ensure that the client undergoes psychological tests that will examine her personality, identify any intellectual disability, and also examine the cognitive functioning of the client (Andersen et al, 2016). In addition, comprehensive psychological testing for this client will be used to rule out other causes that are non-psychiatric and may be causing psychosis and other symptoms nurs 6660 practicum decision tree Early onset Schizophrenia essay.

By selecting the decision to have the client undergo psychological testing, is have the diagnosis confirmed or ruled out.  This is because a psychological test will examine the personality of the client, identify any intellectual disability, and also examine the cognitive functioning of the client and at the same time inform if the symptom the client is manifesting may be as a result of other non-psychiatric causes (Andersen et al, 2016).

The outcome of this decision is that the psychological tests indicated a high likelihood of the client having early-onset schizophrenia. This confirmed the earlier diagnosis, as expected.

Decision Point Three

The third decision is having the client start Lurasidone 40 mg orally daily. The reason for choosing Lurasidone for this client is because the efficacy of the medication in treating schizophrenia has been proved and that children tolerate the medication well (Goldman et al, 2017) nurs 6660 practicum decision tree Early onset Schizophrenia essay. A study that was performed by Goldman et al (2017) indicated that administering Lurasidone to the pediatric population with schizophrenia led to significant improvement of symptoms as well as their ability to carry out activities of daily living. Moreover, the medication has few side effects and also weight gain is minimal and low sedative effects. In addition, lurasidone does not interfere with the functioning and cognitive ability of people taking it (Harvey, 2015).

Ethical Considerations

The client involved is a minor and thus all treatment decisions will be made by the parents. Moreover, medications like lurasidone are associated with some side effects, especially with the pediatric population. Therefore, it is important for the PMHNP to seek informed consent from the parents of the client and provide them with all information about the available medications to ensure that they make an informed treatment decision (Harvey et al, 2015).

Conclusion

The diagnosis for this client is early-onset schizophrenia because she is manifesting symptoms of schizophrenia as per the DSM-5 criteria. The second decision that was chosen is to refer the client for psychological testing. This was done to verify the initial diagnosis of early-onset schizophrenia. The psychological testing supported the diagnosis of early-onset schizophrenia for the client. The last decision is for the client to start lurasidone 40 mg orally daily. Lurasidone was selected because the efficacy of the medication in treating schizophrenia in pediatric population has been shown. Lastly, it will be important for the PMHNP to seek informed consent from the parents of the client before starting the treatment nurs 6660 practicum decision tree Early onset Schizophrenia essay.

 

References

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

Andersen D, Vernal D, Bilenberg N, Vaever M & Stenstrøm A. (2016). Early-Onset Schizophrenia: Exploring the Contribution of the Thought Disorder Index to Clinical Assessment. Special Issue: Early-Onset Psychosis and Child and Adolescent Schizophrenia. 4(1). nurs 6660 practicum decision tree Early onset Schizophrenia essay.

Bartlett J. (2014). Childhood-onset schizophrenia: what do we really know? Health Psychol Behav Med. 1; 2(1): 735–747.

Goldman R, Loebel A, Cucciaro J, Deng L & Findling R. (2017). Efficacy and Safety of Lurasidone in Adolescents with Schizophrenia: A 6-Week, Randomized Placebo-Controlled Study. J Child Adolesc Psychopharmacol. 27(6), pp: 516–525.

Harvey P. (2015). The clinical utility of lurasidone in schizophrenia: patient considerations. Neuropsychiatr Dis Treat. 1(11), pp: 1103–1109.

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press nurs 6660 practicum decision tree Early onset Schizophrenia essay.

 

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6660/09/mm/decision_tree/index.html

Decission point #1 I chose =Early onset Schizophrenia

Decision point #2 I chose =Refer for psychological testing

Decision point #3 I chose =Begin Lurasidone 40 mg orally daily

Examine Case 3: 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’s diagnosis and treatment.

At each Decision Point, stop to complete the following:

Decision #1: Differential Diagnosis
Which Decision did you select?
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning
Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they
different?

Decision #2: Treatment Plan for Psychotherapy
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning
Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they
different?

Decision #3: Treatment Plan for Psychopharmacology
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning nurs 6660 practicum decision tree Early onset Schizophrenia essay.
Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they
different?

Also include how ethical considerations might impact your treatment plan and communication with clients and their families nurs 6660 practicum decision tree Early onset Schizophrenia essay.