Medical Administration to Schizophrenia Patients

Evidence-based treatment plans for schizophrenia adults vs. children and adolescents
Schizophrenia is a psychological condition that impairs a person’s mental health, making him/her to live under delusions and hallucinations. The next section compares two treatment plans, particularly, their side effects to children, adolescents and adults. They include medical intervention and cognitive remediation therapy. Also, it will examine how these plans vary when applied to adults, children and adolescents.

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Medical intervention
The most common prescription is second generation antipsychotic drugs, applied to all people regardless of their age. A research performed by Divac, Prostran, Jakovcevsk, & Cerovac (2014) on the adverse side effects of second generation antipsychotic established that this form of medication resulted in abnormal weight gain, which renders the patient vulnerable to other complications such as diabetes. Regardless of these common side effects to everybody, there are certain differences.
A research performed by Ninan, Stewart, Theall, Katuwapitiya, & Kam (2014) uncovered that compared to adults, children and adolescents tend to be very sensitive to the side effects of antipsychotic medication. For this reason, it is recommended to increase the dose for children and adolescents progressively, starting with a lower dose, and making adjustments after close monitoring of the outcome, which might be after a period of some days or weeks. A point of contention to this supposition is that drug metabolism is higher in children than in adults due to actively developing metabolic enzymes in young people and infants (Lu & Rosenbaum, 2014). Typically, the rapid drug metabolic reaction suggest the need for higher doses. However, there is no evidence to back up the effectiveness of increasing doses. What is important is to take schizophrenia children and young individuals through a series of psycho-education while undergoing treatment to minimize relapses due to poor long-term compliance to medication.

Cognitive Remediation Therapy
This plan concentrates on enhancing the impaired cognitive functioning of schizophrenia patients. A recent study by Revell, E. R, J, Harte, Khan, & Drake (2015) involving a meta-analysis of 26 controlled trials on a sample population of 1,150 patients indicated the capacity of cognitive remediation to enhance schizophrenia patients’ cognitive performance. In another study, Morin & Franck (2017) performed a meta-data analysis on 40 controlled trials, from which the findings showed that cognitive remediation had the ability to enhance cognitive functioning of schizophrenia patients. However, the degree to which this remedy helps patients varies based on age.

Dickstein, Cushman, Kim, Weissman, & Wegbreit (2015) research findings indicated a reduction in the severity of cognitive impairments among college students compared to their tutors after a post-treatment and 3-month follow-up procedure. Air, Weightman, & Baune (2015) confirmed these findings in their research that also established decreased depressive symptoms in young adults, who initially experienced mild to moderate depression, and relentless depressive symptoms in adults, especially those on inpatient program. This can be attributed to self-denial and loss of hope, which is rampant in adults than in children and young individuals.

Legal and ethical issues involved with forceful treatment of schizophrenia children and how PMHNP can address them
Legally, a mentally sick child cannot make decisions regarding admission on his own; hence, parents make decisions on their behalf, leading to involuntary commitment, especially if the kid is unwilling. Forceful admission is covered by two legal and ethical tenets, namely beneficence and autonomy. According to the notion of beneficence, a medical practitioner is obliged to provide due care to patients. Beneficence to involuntary outpatient treatment holds the opinion that treatment needs to alleviate signs of a severe health condition endangering the life of the patient.
Unfortunately, involuntary patients who were ordered by the court end up failing to comply with their medication, a situation that diminishes their health; hence, the need to forcefully readmit them to an inpatient program (Sjöstrand, Sandman, Karlsson, Helgesson, Eriksson, & Juth, 2015). However, this tends to be unfair to the patient, based on his naivety to understand the usefulness of getting well. Accordingly, the Psychiatric-mental health nurse practitioner (PMHNP) comes in to assure patients that getting treatment is the best course towards regaining their wellbeing. The fundamental basis to achieving this is through devising a friendly approach such as learning the patient’s passion, for instance, music for those who find it soothing in a bid to create a friendly environment that can facilitate appropriate communication. One point to note is that even crazy people do have friends and can socialize, as well as cooperate, provided they are made to understand they are not undermined, judged or considered insane.
In regard to the principle of autonomy, patients have the right to decide what they want. This goes against the principle of beneficence since ordering a patient to accept medication is equated to undermining his/her right to make decisions independently (Sjöstrand, Sandman, Karlsson, Helgesson, Eriksson, & Juth, 2015). However, given the goal of healthcare givers is to ensure the wellbeing of everybody, a legal process is engaged to ensure that patients’ right to autonomy is lost justifiably to beneficence. In reference to this, PMHNP are liable to ensuring that they convince patients that involuntary medication is temporary and will be ended once they show improvement and confirm the ability to gain mental stability. This process might be complex, especially if the patient understands that the law and healthcare givers consider treatment as beneficent regardless of the patient’s autonomy to choose whether to receive medication or not. Either case, medical practitioners are trained to ensure patients feel comfortable regardless of the prevailing situation.

References


1. Air, T., Weightman, M. J., and Baune, B. T. (2015). Symptom severity of depressive symptoms impacts on social cognition performance in current but not remitted major depressive disorder. Frontier in Psychology , 1118.
2. Dickstein, D. P., Cushman, G. K., Kim, K. L., Weissman, A. B., and Wegbreit, E. (2015). Cognitive Remediation: Potential Novel Brain-Based Treatment for Bipolar Disorder in Children and Adolescents. CNS Spectrum , 382-390.
3. Lu, H., and Rosenbaum, S. (2014). Developmental Pharmacokinetics in Pediatric Populations. The Journal of Pediatric Pharmacology and Therapeutics , 262-276.
4. Morin, L., and Franck, N. (2017). Rehabilitation Interventions to Promote Recovery from Schizophrenia: A Systematic Review. Frontiers in Psychiatry , 100.
5. Ninan, A., Stewart, S. L., Theall, L. A., Katuwapitiya, S., and Kam, C. (2014). Adverse Effects of Psychotropic Medications in Children: Predictive Factors. Journal of the Canadian Academy of Child and Adolescent Psychiatry , 218-225.
6. Revell, E. R, N., J, C., Harte, M., Khan, Z., and Drake, R. (2015). A systematic review and meta-analysis of cognitive remediation in early schizophrenia. Schizophrenia Research , 213-222.
7. Sjöstrand, M., Sandman, L., Karlsson, P., Helgesson, G., Eriksson, S., and Juth, N. (2015). Ethical deliberations about involuntary treatment: interviews with Swedish psychiatrists. BMC Medical ethics , 37.
8. Divac, N., Prostran, M., Jakovcevsk, I., and Cerovac, N. (2014). Second-Generation Antipsychotics and Extrapyramidal Adverse Effects. Biomedical research International .

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