Running head: EARLY ONSET SCHIZOPHRENIA

Early Onset Schizophrenia

Student’s Name

Institution of Affiliation

Course Name

Date
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Decision Point 1: Diagnosis

Diagnosis

Based on the clinical presentation of the client, the diagnosis that is most probable is

Early-Onset Schizophrenia.

Reason for selecting This Decision

Based on the DSM-5 criteria, the diagnosis of schizophrenia warrants that a client should

present with two of these five symptoms: hallucinations, disorganized speech, negative

symptoms, delusions, and grossly disorganized behavior (Tandon, et al., 2013). It also occurs

starting from 13 years or younger and persists. In this case, the 13-year-old Cassie was positive

for delusions, disorganized behavior, and negative symptoms thus the diagnosis of early onset

Schizophrenia.

Expected Outcome from This Decision

Based on the diagnosis decision, it is expected that the client will receive adequate

psychotherapy and pharmacotherapy treatment so that neurocognitive ability is regained. As

highlighted by Tandon, et al., (2013), the management of Early Onset Schizophrenia

encompasses drugs but incorporating psychotherapy has been associated with high-quality

mental health outcomes.

Differences between Expected Outcome and Actual Outcome

There exists no difference between the expected outcome and the actual outcome of the

diagnosis. Schizophrenia is a mental illness that begins in childhood and has the ability to persist

to adulthood and it affects behavior emotions and cognitive function (Tandon, et al., 2013).

Decision Point 2: Treatment Plan for Psychotherapy

Decision
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The psychotherapy decision is to begin Clozaril 100 mg orally daily

Reason for Selecting This Decision

The Food and Drug Administration has approved the use of Clozaril for the management

of schizophrenia that is resistant to treatment (Howes, et al., 2016). However, in this case, the

child is yet to receive any treatment for schizophrenia. Therefore, there is no evidence that the

schizophrenia is resistant to treatment hence its indication for this patient.

Expected Outcome from this Decision

It is expected that as the client will return to the clinic after four weeks, the

neurocognitive problems, delusions, and social withdrawal will be reduced. She will instead

associate freely with people at individual and group levels. As one of the approved treatments for

schizophrenia, Clozaril has proven to be highly effective in enhancing the positive manifestations

of schizophrenia (Shivakumar, et al., 2018). As compared to conventional antipsychotics,

Clozaril also has reduced side effects in the management of patients with either resistant or non-

resistant schizophrenia.

Differences between Expected Outcome and Actual Outcome

It was expected that the client would return after four weeks with a significant reduction

of delusional symptoms and other neurocognitive problems. However, the client reported that

she stopped taking the medication 3 days after starting it. The child’s mother explained that the

drug was stopped since Carrie could sleep for long hours and waking her up was a big problem.

Her symptoms were therefore still persistent and evident with no observed changes from the

initial presentation. The symptoms that were reported by Carrie’s mother are as a result of the

side effects of Clozaril. In adults, the starting dosage is usually 25 mg (Howes, et al., 2016).

Therefore, in a child, the starting dose would definitely be 12.5 mg according to the body weight.
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In this case, the 100mg that was prescribed led to sedation which was experienced by the child

(Shivakumar, et al., 2018). As a concern from the parents, the medication was therefore

withdrawn which led to the re-presentation at the clinic once again. Re-starting the client on

Clozaril 100mg would still lead to sedation and the only option is, therefore, to start it at a dose

of 12.5mg which is much lower while titrating upwards. However, this may also result in errors

in dosing, delays in management and poor mental health outcomes (Howes, et al., 2016).

Therefore, the best option, in this case, would be to stop the medication Clozaril 100mg orally

daily.

Decision 3: Treatment Plan for Psychopharmacology

Decision

The psychopharmacology decision is to start Risperdal 0.5 mg orally twice a day.

Reason for Selecting This Decision

Risperdal is the drug of choice for the management of schizophrenia in children and

adolescents. This is attributed to high chances of it being tolerated, effectiveness and efficiency

as compared to other conventional antipsychotics. Its mode of action is by blocking serotonin 2A

and dopamine receptors for the purposes of reducing motor side effects and to promote

neurocognitive ability (Wang, et al., 2015). When prescribing, it is important to educate patients

and families on the side effects that should be anticipated on blood pressure, blood glucose and

weight during the course of treatment.

Expected Outcome from this Decision

It is expected that the patient’s maladaptive behaviors will reduce and the patient will be

able to socially interact with others freely. Between one-four weeks, these outcomes on stability,
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neurocognitive function and behavior should be evident (Wang, et al., 2015). Disorganized

behavior and delusional thoughts will also be eliminated.

Differences between Expected Outcome and Actual Outcome

There was no difference between the expected outcome and the actual outcome. This can

be attributed to the fact that Risperdal 0.5 mg was the best choice of drug and dosage in this case.

Apart from being approved by the FDA, Risperdal has the option of using smaller dosages and

gradually titrating upwards to control symptoms as well as the side effects of the drug (Wang, et

al., 2015).

How Ethical Considerations Might Impact Treatment Plan and Communication with

Clients and Families

When providing mental care to patients with schizophrenia, the most notable ethical

concerns that may pose challenges to mental health care providers are confidentiality and

autonomy. In this case, these issues may even be exaggerated since the client is a 13-year-old

female. In the United States, a minor is legally defined as an individual who is below the age of

18 years as it is the client in this scenario (Tambuyzer, Pieters & Van Audenhove, 2014). The

issue of autonomy deals with the ability to make medically informed decisions on individual

health without controlling interferences and individual limitations. Based on the mental status of

the client, the decision on whether or not she can make medically fit decisions may be an issue

that would force health care providers to weigh the options between beneficence and autonomy.

Mental health care providers may be influenced with a moral obligation to make decisions for

such patients which conflicts the principle of autonomy.

When it comes to confidentiality, minors have the right to decline to share personal health

information even with close family members. However, there are certain points of care that
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mental health care providers may be required to share with close family members especially for

the formation of a strong social support system or decisions regarding medications and care to

influence good health outcomes (Petrik et al., 2015). Patients suffering from schizophrenia have

proven to be non-compliant to medication and require social support to adhere to medicines. For

a long-lasting therapeutic relationship, confidential information should only be shared with the

patient’s informed consent (Petrik et al., 2015). Besides, some treatment information should

progressively be withheld to promote patient compliance.

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References

Howes, O. D., McCutcheon, R., Agid, O., De Bartolomeis, A., Van Beveren, N. J., Birnbaum, M.

L., ... & Castle, D. J. (2016). Treatment-resistant schizophrenia: treatment response and

resistance in psychosis (TRRIP) working group consensus guidelines on diagnosis and

terminology. American Journal of Psychiatry, 174(3), 216-229.

Petrik, M. L., Billera, M., Kaplan, Y., Matarazzo, B., & Wortzel, H. (2015). Balancing patient

care and confidentiality: Considerations in obtaining collateral information. Journal of

Psychiatric Practice®, 21(3), 220-224.

Shivakumar, K., Amanullah, S., Shivakumar, R., Saroka, K., Rouleau, N., & Murugan, N. J.

(2018). The Role of Clozapine in Treatment-Resistant Schizophrenia. In Complex

Clinical Conundrums in Psychiatry (pp. 115-122). Springer, Cham.

Tambuyzer, E., Pieters, G., & Van Audenhove, C. (2014). Patient involvement in mental health

care: one size does not fit all. Health Expectations, 17(1), 138-150.

Tandon, R., Gaebel, W., Barch, D. M., Bustillo, J., Gur, R. E., Heckers, S., & Van Os, J. (2013).

Definition and description of schizophrenia in the DSM-5. Schizophrenia Research,

150(1), 3-10.

Wang, J., Zhou, X. L., Liu, W., Zhang, X. F., Li, W., Chen, D., & Du, B. (2015). Clinical effect

of paliperidone palmitate and Risperdal constant in the treatment of patients with

schizophrenia. The Chinese Journal of Clinical Pharmacology, 12, 016.