Assessing and Treating Clients with Early Onset Schizophrenia

Assessing and Treating Clients with Early Onset Schizophrenia Essay Assignment Paper

Introduction

In this paper, a thorough discussion of the psychotherapeutic and psychopharmacologic management of a child presenting with early-onset schizophrenia is presented. Besides, an explanation of how ethical considerations are likely to impact communication with a client and her family will also be presented.

Decision #1: Differential Diagnosis

Decision Selected

Early Onset Schizophrenia

Reason for Selecting This Decision

Carrie presented with symptoms of disorganized speech, hallucinations, negative symptoms, and catatonic behavior. Based on the DSM-V criteria for diagnosing mental health disorders, she meets the criteria for schizophrenia (American Psychiatric Association, 2013). A diagnosis of schizoaffective disorder is less likely because, although she has psychotic symptoms, she does not meet the criteria for a mood disorder with either depression or mania occurring concurrently with schizophrenia criterion A (American Psychiatric Association, 2013). Therefore, there is no information to support that Carrie is indeed experiencing a mood disorder.

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The same way, although Carrie has several symptoms which are similar to a schizotypal personality disorder, there are some significant differences that should be noted. For instance, rather than having reference ideas, Carrie has reference delusions. When comparing her writing to her speech and thinking, the latter is odder. This indicates that her thought processes are more disorganized and severe than her speech (American Psychiatric Association, 2013). It is also worth noting that Carrie lacks friends who are much close to her. However, this is yet to be confirmed as to whether it’s because she is not comfortable with interpersonal relationships or if it may be because of her classmates distancing away from her due to her odd behaviors. Primarily, it is highly recommended that mental health practitioners should shun away from making diagnoses relating to personality disorders in pediatric clients. This is attributed to the fact that, during the entire period of childhood, a child’s personality is still in the formation process. Therefore, there are higher chances that schizotypal personality disorder may probably be what is entirely wrong with Carrie. However, the amount of information currently available to make this diagnosis is not sufficient.

Expected Outcomes

It was expected that, based on the client’s presentation of symptoms, after a thorough history taking, mental status examination and assessment, she will meet the DSM-V criteria for early-onset schizophrenia. Based on this diagnosis, it would thereafter be easier to start the patient on the right medications and psychotherapy to improve her overall health.

Difference between Expected Outcome and Actual Outcome

No significant difference was noted between the expected outcome and the actual outcome.

Decision #2: Treatment Plan for Psychotherapy

Decision Selected

Begin Psychotherapy with a Psychodynamic approach.

Reason for Selecting This Decision

It will be possible to easily explore and influence the emotional experiences of the child based on how her state of mind is currently. Cognitive Behavioral therapy is the most preferred psychotherapeutic approach for this client. It maximally utilizes free association, recall, and dream interpretation and is practical in exploring potential barriers that are likely to prevent full recovery (Li, et al., 2015). By exploring the present cognitive state to identify the symptoms that a patient may currently be struggling with, Cognitive behavioral therapy will ensure that the client identifies some her dysfunctional thoughts and behaviors and develop effective strategies in managing them (Li, et al., 2015).

Expected Outcomes

Based on the patient’s dysfunctional thought patterns and behaviors, it was expected that CBT will help her to develop strategies that are highly effective to manage the hallucinations and delusions. Besides, it was expected that she would be able to easily identify the potential triggers that led to the psychotic episodes that she frequently experienced and develop strategies for either reducing or stopping them(Li, et al., 2015).

Difference between Expected Outcome and Actual Outcome

After four weeks, the client returned to the clinic accompanied by her parents. Not only was she fully engaged but also showed interest to see the therapist. The parents, however, reported that they had not seen any positive improvement in their child’s psychotic symptoms and had therefore started to be very concerned. Research evidence from modern psychoanalysts strongly suggests that, although psychodynamic therapies are effective in the management of schizophrenia, they are only helpful in the management of residual symptoms and therefore, should not be used as a first-line treatment due to high chances of it being ineffective (Li, et al., 2015).

Decision #3: Treatment Plan for Psychopharmacology

Decision Selected

Start the patient on Lurasidone 40mg orally daily

Reason for Selecting This Decision

The pillars in the management of schizophrenia are antipsychotic medications. They are highly effective in helping to control symptoms through the release of dopamine. Despite the fact that it has not been approved by the FDA for use in children, in this case, it will be used off label since there are also no legal prohibitions for prescribers to use it off-label (Möller & Czobor, 2015). Before the drug is administered, the mental health practitioner will have to obtain informed consent from the client and her family. This means that the client will have to understand the risks and benefits of the drug and the goals of therapy to make the right decision. Lurasidone has fewer effects with regards to body weight and lipid profile (Möller & Czobor, 2015).