Early Onset of Schizophrenia

Early Onset of Schizophrenia
Schizophrenia is a long-term, disabling illness that has a big effect on the lives and well-being of people who have it and their families. The condition is rarely seen in children, but signs and symptoms can be seen as the child grows. Because people of different ages show symptoms differently, the criteria for diagnosing schizophrenia depend on their age. Early-onset schizophrenia (EOS) is when the sickness starts before a person turns 18 years old. (Chan, 2017). Aside from when it starts, schizophrenia in children looks the same as it does in adults. Also, most of the treatments for managing the disease in adults are the same as those used for early-onset and childhood-onset schizophrenia. (Grover & Avasthi, 2019). This talk compares the plans for treating schizophrenia in children and adults, as well as the social questions that come up when treating the disease in children and teens.

Plans for treatment based on facts

Adults with schizophrenia can be treated with both drugs and non-drug methods. Treatments for schizophrenia that are based on scientific evidence take into account the expertise of the healthcare provider, the patient’s opinions and values, and the scientific evidence that is available. Recent evidence shows that pharmacological interventions are very important for improving the prognosis of the disease and preventing bad effects in adults. (Chan, 2017). Also important for improving performance are psychosocial interventions like cognitive-behavioral therapy, psychoeducation programs, and family intervention.

Pharmacotherapy

The use of drugs is one of the best treatments for adults with schizophrenia that is supported by data. Research shows that when drug therapy is used, at least 6% of patients with a single case of psychosis recover completely from their symptoms. (Ganguly et al., 2018). When treating schizophrenia, antipsychotics are mostly used to treat the symptoms, not the cause. They help adults and children who act like they don’t know where they are and improve memory impairment. Different first-generation and second-generation antipsychotics are approved in the United States to help people with schizophrenia. Fluphenazine, Haloperidol, and Perphenazine are all drugs from the first group. Aripiprazole, Clozapine, Olanzapine, Risperidone, and many others are all second-generation drugs.

There are differences between how adults, children, and teens use antipsychotics. Guidelines say that people and children with schizophrenia should start with low doses of drugs. The way the medicine is given is a big difference. For adults, both oral and injectable forms are suggested, but there aren’t as many options for children and teens. Grover and Avasthi (2019) say that the American Academy of Child and Adolescent Psychiatry (AACAP) suggests depot antipsychotics for children and teens with long-term symptoms or a history of not taking their medications.

Antipsychotic drugs are the first choice for treating people with EOS, just like they are for adults. But there are some changes in the dosage and choice of drugs for this group of patients. Adults can be helped with just drugs, but children and teens should also get psychological help and antipsychotics, according to guidelines. Only a few antipsychotics, like haloperidol, aripiprazole, asenapine, paliperidone, risperidone, clozapine, ziprasidone, molindone, quetiapine, and olanzapine, have been shown to help people with EOS. (Grover & Avasthi, 2019). Even though these drugs are okay to use in EOS, studies have shown that children and teens have more side effects than adults do. The United States has allowed the use of haloperidol, molindone, risperidone, aripiprazole, quetiapine, paliperidone, and olanzapine to treat schizophrenia in teens who are 13 or older. But it’s been suggested that the drugs should be picked based on how they affect both EOS patients and adult patients.

Cognitive Behavior Therapy

Cognitive-behavioral therapy (CBT) is thought to be helpful for people with depressive disorder. It can also be used to help people with schizophrenia whose symptoms can’t be controlled by medicine. The approach is used to help people with psychotic symptoms deal with them by making them look at their thoughts and how they see things. Studies show that CBT is much better at helping people deal with positive symptoms and get better over time. But there isn’t enough proof that the negative and long-lasting effects of schizophrenia can be lessened in all age groups. The guidelines of the United States and the United Kingdom say that CBT can be used for between 6 and 12 months to make symptoms better. (Chen & Leung, 2013). One method used in CBT is giving the patient with poor coping skills and social withdrawal the power to work with the therapist to come up with effective ways to deal with problems.

There are a few changes between how CBT is used to treat schizophrenia in adults and how it is used to treat schizophrenia in children and teens. For example, teens may need more CBT lessons than adults to deal with positive symptoms. (Grover & Avasthi, 2019). In both groups of patients, the therapy has been shown to be successful at reducing both the distress caused by hallucinations and the certainty and preoccupation with delusions.

Legal and Moral Questions

Healthcare workers who take care of people with schizophrenia face different health problems every day. Mental Health America (MHA) thinks that it should be clear that human rights are being protected when mental care is given to people of all ages. Forcing someone to take medicine should only be done as a last option when the person is a danger to themselves or others. (Noordsy, 2016). The first social problem with forcing children with schizophrenia to take drugs is that it takes away their freedom. Forced administration can be used on children, but parents or guardians should agree to it. Before giving a patient medicine, they have the right to get their permission. But people under the age of 18 are not officially allowed to give consent. (Noordsy, 2016). Healthcare workers can force children and teens to take medicine even if they don’t want to if they don’t get informed permission.

The Mental Health Act allows for psychiatric patients to be treated against their will. This is done by admitting them without their permission and giving them medicine against their will. Also, the World Psychiatric Association’s Hawaii Declaration says that a patient with a mental illness should be forced to go through procedures or get care against his or her will. (Noordsy, 2016). But the forced care should be in the best interest of the patient, and whenever it is done, a neutral and independent body should be there to check in on the situation regularly. The PMHNP should make sure that giving drugs to children and teens against their will is done in their best interest. Before giving the drugs, the nurse must figure out if the patient is able to hurt himself or others. The nurse should also teach the patient and his or her family all they need to know about forced medicine administration and the laws that govern it.

References

Chan, V. (2017). Schizophrenia and psychosis: Diagnosis, current research trends, and model treatment approaches with implications for transitional age youth. Child and Adolescent Psychiatric Clinics of North America. https://doi.org/10.1016/j.chc.2016.12.014

Chien, W. T., Leung, S. F., Yeung, F. K., & Wong, W. K. (2013). Current approaches to treatments for schizophrenia spectrum disorders, part II: Psychosocial interventions and patient-focused perspectives in psychiatric care. Neuropsychiatric Disease and Treatment, 9, 1463–1481.

https://doi.org/10.2147/NDT.S49263

Ganguly, P., Soliman, A., & Moustafa, A. A. (2018). Holistic Management of Schizophrenia Symptoms Using Pharmacological and Non-pharmacological Treatment. Frontiers in Public Health, 6, 166.

https://doi.org/10.3389/fpubh.2018.00166

Grover, S., & Avasthi, A. (2019). Clinical practice guidelines for the management of schizophrenia in children and adolescents. Indian Journal of Psychiatry, 61(Suppl 2), 277–293.

https://doi.org/10.4103/psychiatry.IndianJPsychiatry_556_18

Noordsy D. L. (2016). Ethical Issues in the Care of People With Schizophrenia. Focus (American Psychiatric Publishing), 14(3), 349–353.

https://doi.org/10.1176/appi.focus.20160011

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