Prescribing for Children and Adolescents Assignment Essay

Prescribing for Children and Adolescents Assignment Essay

Prescribing for Children and Adolescents Assignment Essay

Childhood-onset schizophrenia is a type of psychotic disorder that develops at 12 years or younger. It is mostly chronic and persistently incapacitating, with adverse outcomes than in individuals who develop the disorder later in life. Childhood-onset schizophrenia is diagnosed based on the presence of at least two of the following features: Hallucinations, Delusions, Disorganized speech, Disorganized or catatonic behavior, and Negative symptoms (Driver et al., 2020). The purpose of this paper is to discuss pharmacological and non-pharmacological interventions used to treat childhood-onset schizophrenia and explore clinical practice guidelines for managing the disorder.

Pharmacological and Non-Pharmacological Intervention

Second-generation antipsychotics are the recommended first-line antipsychotic agents for treating schizophrenia in adolescents. Aripiprazole is one of the FDA-approved second-generation antipsychotics for treating schizophrenia in adolescents (Coustals et al., 2021). It was approved by the FDA in 2007 to treat schizophrenia in children from 13 years. Clozapine is a second-generation antipsychotic used off-label to treat childhood-onset schizophrenia. Double-blind studies have found Clozapine to be effective in treating childhood-onset schizophrenia and superior to haloperidol (Rachamallu et al., 2019). Clozapine should only be initiated after the failure of other treatment trials using 2-3 antipsychotics from various classes.

Cognitive remediation therapy (CRT) is my recommended non-pharmacological intervention for managing childhood-onset schizophrenia. Grover and Avasthi (2019) explain that CRT seeks to enhance cognitive processes, including memory, executive function, attention, and social cognition, through repeated practice of a range of cognitive tasks. CRT in adolescents with schizophrenia has been established to enhance their ability to plan and cognitive flexibility.

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The Risk Assessment to Use to Inform Treatment Decision Making

The risk assessment that would guide the treatment decision-making involves evaluating a patient’s blood pressure, weight, glucose, and lipids levels. Second-generation antipsychotics are associated with weight gain and increased total cholesterol and triglyceride levels. Thus, I would evaluate if the benefit of the treatment intervention outweighs the risk. Aripiprazole is associated with severe adverse effects such as neuroleptic malignant syndrome, leukopenia, QT prolongation, and suicide attempts, which must be considered when prescribing (Coustals et al., 2021). Nonetheless, its benefits include efficacy as a maintenance antipsychotic therapy in adolescents since it delays time to exacerbations of psychotic symptoms. Clozapine is not approved for pediatric populations due to its major adverse effects. Rachamallu et al. (2019) explain that children and adolescents with psychotic pathology normally recover with Clozapine but achieve this with a potential risk of chronic and incapacitating side effects like metabolic syndrome and a greater side effect profile compared with the adult population.

Clinical Practice Guidelines

The current clinical practice guidelines for childhood-onset schizophrenia identify antipsychotic agents as the first-line treatment for schizophrenia in pediatric populations and must be used alongside psychosocial management. Among the different antipsychotics, the guidelines recommend second-generation antipsychotics, other than Clozapine, as first-line agents (Grover & Avasthi, 2019). The guidelines further recommend psychosocial interventions such as CRT, CBT, psychoeducation, and family intervention for childhood-onset schizophrenia.

Conclusion

Aripiprazole is my recommended FDA-approved antipsychotic agent for treating childhood-onset schizophrenia, while Clozapine is the recommended off-label drug. Besides, I would recommend cognitive remediation therapy as a non-pharmacological intervention. Both Aripiprazole and Clozapine have associated benefits and risks, which should be considered during the treatment decision-making.

References

Coustals, N., Ménard, M. L., & Cohen, D. (2021). Aripiprazole in children and adolescents. Journal of Child and Adolescent Psychopharmacology, 31(1), 4-32. https://doi.org/10.1089/cap.2020.0014

Driver, D. I., Thomas, S., Gogtay, N., & Rapoport, J. L. (2020). Childhood-Onset Schizophrenia and Early-onset Schizophrenia Spectrum Disorders: An Update. Child and adolescent psychiatric clinics of North America, 29(1), 71–90. https://doi.org/10.1016/j.chc.2019.08.017

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

Rachamallu, V., Elberson, B. W., Vutam, E., & Aligeti, M. (2019). Off-Label Use of Clozapine in Children and Adolescents-A Literature Review. American journal of therapeutics, 26(3), e406–e416. https://doi.org/10.1097/MJT.0000000000000894

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Assignment 1: Prescribing for Children and Adolescents: -Childhood-Onset Schizophrenia spectrum Disorders
Off-label prescribing is when a physician gives you a drug that the U.S. Food and Drug Administration (FDA) has approved to treat a condition different than your condition. This practice is legal and common. In fact, one in five prescriptions written today are for off-label use.

—Agency for Healthcare Research and Quality

Psychotropic drugs are commonly used for children and adolescents to treat mental health disorders, yet many of these drugs are not FDA approved for use in these populations. Thus, their use is considered “off-label,” and it is often up to the best judgment of the prescribing clinician. As a PMHNP, you will need to apply the best available information and research on pharmacological treatments for children in order to safely and effectively treat child and adolescent patients. Sometimes this will come in the form of formal studies and approvals for drugs in children. Other times you may need to extrapolate from research or treatment guidelines on drugs in adults. Each individual patient case will need to be considered independently and each treatment considered from a risk assessment standpoint. What psychotherapeutic approach might be indicated as an initial treatment? What are the potential side effects of a particular drug?

For this Assignment, you consider these questions and others as you explore FDA-approved (“on label”) pharmacological treatments, non-FDA-approved (“off-label”) pharmacological treatments, and nonpharmacological treatments for disorders in children and adolescents.

Reference:

Agency for Healthcare Research and Quality. (2015). Off-label drugs: What you need to know. https://www.ahrq.gov/patients-consumers/patient-involvement/off-label-drug-usage.html

To Prepare
Your instructor will assign a specific disorder for you to research for this Assignment. –
Childhood-Onset Schizophrenia Spectrum Disorders

Use the Walden library to research evidence-based treatments for your assigned disorder in children and adolescents. You will need to recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating this disorder in children and adolescents.
The Assignment (1–2 pages)
Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents.
Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources.