Compare, contrast, and apply various pharmacological and psychosocial treatment alternatives.Write a 3-page or more paper, answering the questions below, using the chapter provided, videos, and any other information. This paper should be written in APA 7 format. with a cover page, body, and reference page. a. Compare and contrast three treatment alternatives for schizophrenia in adolescents. One alternative has to be pharmacological. Consider under what circumstances would you apply each of those treatment alternatives. The selected psychosocial treatment alternatives should be ecological systems-based, strengths-based and/or family-based. b. If you were the service provider for an adolescent with a diagnosis or symptoms of schizophrenia, what would you do as a service provider in order to provide adequate treatment? What are some key aspects you would take into account as you are planning your treatment plan?
16
trum
Treatment o f Schizophrenia Spec
osis
ch
sy
P
e
od
is
p
-E
st
ir
F
d
an
rs
de
or
Dis
reizophrenia, but hope exists in the
sch
for
re
cu
no
is
re
the
,
ntly
rre
Cu
within the next decade.
red
ve
co
dis
be
ll
wi
re
cu
a
t
tha
search community
can be prevented in persons
ia
ren
ph
izo
sch
t
tha
ted
dic
pre
is
Additionally, it
derstanding of genes and brain
un
r
the
fur
gh
ou
thr
s
tor
fac
isk
with high-r
y
re yet. There is currently no sure wa
the
t
no
are
we
ly,
ate
tun
for
Un
.
try
chemis
schiz, people who possess risk factors for
to prevent schizophrenia. However
prevent them from getting worse
or
ms
pto
sym
ir
the
ize
nim
mi
ophrenia can
reducing stress, getting adequate
as
h
suc
res
asu
me
ive
tat
ven
pre
by taking
treatol. If symptoms do appear, early
oh
alc
d
an
gs
dru
ng
idi
avo
and
p,
slee
and improve the trajectory
ms
pto
sym
the
of
ty
eri
sev
the
ment may lessen
ly-onset schizophrenia includes a
ear
for
t
en
atm
tre
ive
ect
Eff
er.
ord
of the dis
eutic
chosocial, educational, and therap
combination of medication and psy
interventions.
izorstanding of the trajectory of sch
de
un
the
in
ft
shi
a
n
bee
has
re
The
th the
n with schizophrenia will live wi
phrenia, from the belief that a perso
d recovery from the symptoms
an
ion
iss
rem
on
us
foc
a
to
life
symptoms for
1;
Chiliza, Asmal, & Lehloenya, 201
y,
sJe
Em
.,
e.g
e,
(se
a
eni
phr
izo
sch
of
02). Recovery has varying
20
,
nd
tki
Gu
&
ra,
ntu
Ve
,
icz
ow
Liberman, Kopel
mission” implies that a person is
“re
m
ter
e
Th
.
ure
rat
lite
the
in
meanings
. The
, negative, or cognitive problems
ve
siti
po
no
or
al
nim
mi
ng
nci
e~e
exp
ly a significant remission of
on
t
no
as
d
ibe
scr
de
n
bee
has
term recovery”
in society, both socially and vocaon
cti
fun
to
y
ilit
ab
the
o
als
but
s,
~Ptom
tionalJy (Liberman et al., 2002).
·d
studies eval · the concepts of remission and recovery h ave vane
uating
WideI .
s
fi ndings, with anywhere from 17 to BB percent of person
·
llth
Yl
1
eu
.
.
e
exp
.
al., 200:; Ems ey
nenclllg .ssion
(Andreasen et al., 2005; De Hert et
i
rem
).
et al.,
2011
s suggest that the differences
The overall findings of these studie
248
UND BRS TAN Dl
NG THE ME N
TAL HEA LTH PRO BLE MS
.
recovery and thos e who do not are base d
on
f functioning pno r to the ons et of the illness, age of onset, pro
the level o
.
f ymptoms and trea tme nt, and gender. Thus, tho)C.
. b t enfirsts1gno s
. h f
. .
inuty e we
. n or recovery had hig
er unc tlor
ung prior se
t
rienced rem1.ss10
who e:,,.–pe
t
of
the
dise
ase
afte
r
age
30, and trea tme nt prox.in-.ato
f
the
illne
ss,
onse
•11
e
onset O
set of symptoms,• they were more likely to be female (Lam bert , Kar
to on
hi
lmann & Naber, 2010 ). Those who exp erie nce early-onow,
set
Leucht, Sc mme
,
.
much less likely to ach’ieve reco very than those
With
schizophrenia are
.
.
’11 h
.
erso
ns
with
schi
zop
hren
ia
wi
ave to cop e with the
later onset. Most P
. .
.
ut
life
Psyc
hoso
cial inte rven tion s can help a family copse
symptoms th ro Ugho
·
.
e
with the illness and help youth with activities
of daily func tion ing, but they
are not a substitute for medications.
An example of someone who exp erie nced rem issio
n of sym ptom s and recovery to prior functioning is a you ng man diag nos
ed with schizophrenia
who experienced his first psychotic epis ode in his mid
-twe ntie s. Prior to
experiencing symptoms, he had a successful job, a girl
frie nd, and a close relationship with his parents. He exp erie nced delu sion
s that his parents were
involved in the Oklahoma City bom bing . He stay ed
in his room for days,
making intricate maps and noting the ways that he beli
eved his family was
involved. He hardly slept and refused to eat. At the inst
igat ion of his family,
he was committed to a hospital and requ ired by cou
rt orde r to take medication. Several days after starting on the med icat ion,
he beg an questioning .
his thoughts, but he continued to believe them . Afte
r a few weeks on medication, he reported not knowing why he beli eved som
ethi ng so odd. He was
discharged from the hospital and retu rned hom e to his
family and his job.
experience
between those w110 .
.
Me dic atio n
Treatment for chil dho od schi zop hren ia is mos tly
base d on res e~
conducted with adults (Masi, Mucci, & Pari, 200 6).
Alth oug h antipsychotiC
medication is considered a first line of trea tme nt for ped
iatri c schizophrenia,
th ere are few studies con duc ted with chil dren and adol
escents; howevet, ~
· t·mg
d’
15
stu ies suggest that antipsychotics can be effective in
· children
treating
d
d
an a olescents experiencing psychosis, and the earl
ier the med’1′ ationsare
oll;
started following onse t of psychosi
s, the mor e effective (Correll et al., 2 •
C~rre11&
De Hert, 2013 ). It can take as long as 6 mon ths for ape n~ w”
2005).
ceive the full effects of antipsychotic med icat ions (Lie
1
berman et a .,
TREATMENT OF SCHIZOPHRENIA SPECTRUM
orsonoen.s 249
.
‘tive symptoms often go away within days of start!
ng med1catio
I I
‘Jhe poSJ
n.
“111ptoms, particu ar y negative symptoms, take far lo
nger.
.
h .
.
Others,–the 1950s, anttpsyc ot1c medications have v ti .
.
as y improved
1
. .
Since
·
1 as haloperidol (Haldol) and fl
sue
medications
typical)
uphen.
d .h d
older (
ecreasmg frequency today Th
olixin) are use wtt
· ese older
d .
. .
zine (p r
h
hotics are effective m re ucmg hallucinations and delu .
a
s1ons; ow.
. .
antipsyc
are not effective m treatmg the negative symptoms and th
ey can
. .
.
h
.
ever, th eY
effects sue as tardive dyskinesia (involunta
side
ilitating
b
ry muse1e
. . .
cause d e
Thes
restlessness
and
tremors,
spasms,
ng1d1ty,
muscle
or
nts)
e s1’de
•
moveme
led extrapyramidal side effects, can become permanent.
. .
.
effects, cai
‘Ihe older antipsychotic medications have been mostly replaced by what
are called new generation medications (atypical antipsychotics). Currently,
five atypical antipsychotics are approved by the US Food and Drug
Administration (FDA) for children and adolescents, with each medication
proved for certain age ranges (see Table 16.1). The older medications are
3
f~r less expensive than the new-generation medications, but the new atypical antipsychotics do not pose as significant a threat of extrapyramidal side
effects as the older antipsychotics. On the other hand, like most medications,
these new-generation medicines each comes with its own set of side effects
(see Table 16.1). Throughout treatment with atypicals, it is extremely important to regularly monitor for weight and metabolic changes. It is estimated
that as many as 62 percent of people with schizophrenia are overweight or
obese, putting them at a high risk for cardiovascular morbidity and mortality
(Ucok & Gaebel, 2008). In addition, persons with schizophrenia experience
type II diabetes at nearly twice the rate of the general population.
The side effects of even the new-generation medications can be scary.
However, they are the first line of treatment, and their benefits must be
weighed against their risks. These newer medications are more effective
in treating the psychotic symptoms (positive symptoms) than the older
medications, and they also treat the negative symptoms. Additionally, some
of lhem appear to be effective in improving depressive symptoms, memory,
an1hd mental functioning and reducing aggression and suicidal ideation.
.
esenew-g
. eneratton antipsychotic medications have contributed greatly to
the,
. .
. .
iocus Ill th 1·
in th b . e iterature on rem1ss1on and recovery.. Each medication works
e rainaJi I .
each of the tt_ e d~erently from the others and different people respond to
to 6 weeks medications differently. Antipsychotic medications need from 4
· effectiveness. If improvement is not seen wit· hi n
this time to determine the1r
.
.
.
.
, a new a t’
n ipsychotic medication should be tned. Often this can
Table 16.1 Atypical antipsychotics for children and adolescents
Brand name
Generic name
IDA approved
age range
Abilify
Aripiprazolc
13-17
Zyprexa
Olanzapine
13- 17
Common side effecU
in children
Possible risk factors to monitor
Forms of
administration
Somnolence (sleepiness) Hyperglycemia (high blood sugar)/ Orally
disintegrating tablet
diabetes
Insomnia
injectable/Injection
Increased cholesterol and
Headache
triglycerides (type of fat in blood
Nausea
Tardive dyskinesia (uncontrolled
Vomiting
body movements)
Stuffy nose
Neuroleptic malignant syndrome
Fatigue
(very rare, life-threatening
Weight gain
reaction characterized by
Increased or decreased
fever, altered mental status,
appetite
muscle rigidity, and autonomic
dysfunction)
Orthostatic hypotension (decreased
blood pressure)
white blood cell count
Low
Uncontrolled movement
Seizures
Increased saliva or
Weight gain
drooling
Increased suicidal ideation
Muscle stiffness
(particularly when used in
combination with Prozac)
Hyperglycemia (high blood sugar)/ Orally
Lack ofenergy
disintegrating
diabetes
Dry mouth
tablet
and
cholesterol
Increased
Increased appetite
triglycerides (type offat) in blood Extended release
Somnolence (sleepiness)
Injectable
dyskinesia (uncontrolled
Tardive
Tremor (shakes)
body movements)
Having hard or
infrequent stools
Dizziness
Changes in behavior
Restlessness
Drug reaction with eosinophilia ~d
systemic symptoms (rare, potentially
life-threatening, drug-induced
hypersensitivity reaction)
Neuroleptic malignant syndrome
(very rare, life-threatening reaction
characterized by fever, altered
mental status, muscle rigidity, and
autonomic dysfunction)
Orthostatic hypotension (decreased
blood pressure)
.
Weight gain
Hyperlipidemia (high concentration
of fats or lipids in the blood)
Tablets
Hyperglycemia (high blood sugar)/
Somnolence (sleepiness)
diabetes
Akathisia (movement
cholesterol and
Increased
disorder that makes it
triglycerides in blood
hard to stay still)
Tardive dyskinesia (uncontrolled
Tremor
body movements)
Dystonia (movement
disorder in which
muscles contract
uncontrollably)
Headache
Abdominal pain
Pain in arms or legs
Tiredness
lnvcga
Paliperidone
12- 17
(Continued)
Table 16.J Contin ued
Brand name
Seroque l
Generic nam~
Quetiapine
FDA approve d
age range
13- 17
Comm on side effects
in childre n
Muscle rigidity
Anxiety
Weight gain
Possible risk factors to monito r
Forms of
admini stration
Neuroleplic maHgnant syndrome
(very rare, life-threatening reaction
characterized by fever, altered
mental status, muscle rigidity, and
autonomic dysfunction)
Tachycardia (excessively
last heart rate)
Hyperglycemia (high blood sugar)/
Drowsiness
d.iabetes
Dizziness
Increased cholesterol and
Fatigue
triglycerides in blood
Nausea
Tardive dyskinesia (uncon trolled
Dry mouth
body movements)
Weight gain
Increased appetite
Vomiting
Neuroleptic malign ant syndro me
(very rare, life-threatening reactio n
characterized by fever, altered
mental status, muscle rigidity, and
autonomic dysfunction)
Tablet, oral
Injectable/Injection
Hypertension (note: for adults
hypotension)
Weight gain
Low white blood cell count
Risperdal
Risperidone
10- 17
Drowsiness
Dizziness
Light-headedness
Droolin g
Nausea
Weight gain
Tiredne ss
Difficulty swallowing
Muscle spasms
Shaking (tremo r)
Mental /mood changes
Interru pted breathi ng
during sleep
Cerebrovascular events, includi ng
stroke
,abets
Oral solutio n
Orally
disinte grating
tables
Neurol eptic malign ant syndro me
(very rare, life-thr eatenin g
reactio n charac terized by
fever, altered mental status,
muscle rigidity, and autono mic
dysfun ction)
Tardive dyskine sia (uncon trolled
body movem ents)
Hyperg lycemi a (high blood sugar) /
diabete s
Hyperp rolactin emia (highe r than
normal hormo ne prolact in, which
affect estroge n and testoste rone)
Orthos tatic hypote nsion
Leukopenia, neutrop enia and
agranulocytosis (severe deficie ncy
of types ofwhite blood cells
import ant to fighting infectio ns)
(Co11tl11ued)
Generic name
FDA approved
age range
All information in chart retrieved from FDAgov.
Brand name
Table 16.1 Continued
Common side effects
in children
Potential for cognitive and motor
impairment
Seizures
Dysphagia (serious medical
condition of difficulty swallowing)
Priapism (prolonged erection of
the penis)
Disruption of body temperature
regulation
Antiemetic effect (important to
management of nausea and
vomiting)
Suicide
Possible risk factors to monitor
Forms of
administration
TREATME NT OP SCHIZOP HRENIA SPECT
RUM DISORDER S
255
·n what seems to families like a long trial-a nd -error pro
d
sult 1
re. which medicatio n will be most effective for an . di ‘d cess to eterm Vl ual. Studies are
.
•
d
J111ne
.
tly under way to etenrune which of the atypica1med’1cattons
is most
ifi
.
,urren
. in treating spec c symptom s.
effective
d
their medicati
. also importan t for persons to follow
on P1an an not stop
. . ,
.
. .
It 1s
a
a psychiatr ists direction · The si”de euects
. their medicatio n without
of
. .
taking
.
d’
medi’cat·
to
related
ns. are often
eneration medicatio
ion 1scontm.
the neW-g
ns i’s that every t·1me a
medicatio
such
all
with
t
factor consisten
One
.
.
. .
uaaon.
person discontinues medicatio n without a doctor’s advice, it becomes more
difficult for him or her to ge~ bac~ to the level of functioning achieved before stopping (Andrease n, Lm, Ziebell, Vora, & Ho, 2013). Because of the
side effects and the way that the psychotro pic medications make them feel,
eople do not want to take these medicatio ns. It is not uncommo n for people
[ cheek their medicine, meaning that they hold it between their gums and
0
cheek and pretend to take it, but instead spit it out when no one is looking.
Psychosocial Interventions
Some of the interventi ons designed for adults with schizophr enia and some
of the interventions designed for treatmen t of other mental health problems
in youth have been adapted to treat childhoo d schizophr enia (Burns &
Hoagwoocl, 2002; Burns, Hoagwoo d, & Mrazek, 1999). As described in
Chapter 2, wraparou nd service is considere d a promising practice for
supporting and improvin g the lives of youth experienc ing severe emotiona l
or behavioral problems and their caregivers. Wraparou nd is not a specific
treatment for schizophr enia; however, its focus on each family’s individua l
needs, strengths, and desires can be an effective model for working with children diagnosed with schizoph renia and their families. Through the incor~oration of formal (includin g evidence -based practices and programs ) and
informal services and commun ity supports, families can receive the support
and strength they need.
an~~o~gh ~edicatio ns treat the symptom s, it does not help the youth
0th arnily with the day-to-da y struggles of dealing with schizophr enia.
d”
·
· I·
ocia Intervent ions are needed to help cope with the 1sease.
.
Sup er Psychos
.
. .
Port1ve th
m
helpful
be
can
on
medicati
with
ion
conjunct
In
~r_a~ies
irnproVin
ind socia~ a~•VIties of daily living such as money managem ent, grooming ,
st
adJu nient and in supportin g caregiver s. Psychoso cial education
L HEA LTH PRO BLE MS
TH E MENTA
NDERsrA.NDIN G
d other family members about schizo~
.
. c
h d
1h
areg1vers, an
ion, iamilies
the youth, c and ava1·1 abl e treatments. roug e ucat
teaches
. s of problems so that they can seek help
·a its trajectory, ear1y sign
‘fy the
phren1 ,
Education can also help families understand
learn to identl
.
xacerbate
can
g
. . and the detrimental effects of discontinuin
c0 re syrnptoms e
.
..
be1
e of medication
1on or the effects of not taking a
rV1s
supe
trist
h’
rtanc
unpo
the
• without psyc ia
‘b d Families can also learn to watch for side effects that
a medication
. tion as prescn e .
,
medica . n from the psychiatrist.
need attentto
256 u
1
Cognitive-Behavioral Therapy
d to be helpful in teaching
n to help _persons
needed skills such as problem-solving and stress reductio
in social skills and
cope with their illnesses (Hogarty et al., 2002). Training
ol and participate·
daily living skills can help youth to function better in scho
early-onset schizin daily activities. Research has found that persons with
ining .educational
ophrenia experience high levels of impairment in atta
occupational goals and financial independence as adults.
CBT in conjunction with medication has been foun
or
Multisystemic Therapy-Psychiatric
tation of the tradi~ultisystemic therapy-psychiatric (MST-P) is an adap
pter 12 (Henggeler
tional multisystemic therapy model discussed in Cha
ningham, 2002;
et aL, 1999; Henggeler, Schoenwald, Rowland, . & Cun
.
Rowland & .We stl ake, 2006)• MST-P is on National Registry of EvidenCCB d
……,
.
ase Practices and programs publishe
lill
Men
and
se
Abu
ce
stan
d by the Sub
Health S .
.-.It h
emces Adm·1m·stration (SAMHSA, 2014) for the treatment of1vv–with b h .
‘–”
ral and menta1health problems. The goal of MST.. P ls tO» “r
e aVIo
childr h
. .
en w o are at risk Of psych1at
Gl’r
r1c hospitalization in their home a11dC
munity Like
a
..-..
:
·
al
..
tional MST., MST-P ut1h
tradi
~
f
.
a
r
ogic
ecol
al
soci
a
zes
.
1ocusing treat
. :.:. .~
.
lllent on the youth, caregive
en~
r
othe
or
ol,
scho
rs,
contributing t
to specifi
youth With ~ problems; how1ever, it has been adapted
serious heh . ra and mental health problems rather
avto
venile offende
hiatric in
into the MST rs. MST-P integrates evidence-based psyc
lllodeL
TREATMENT OF SCHIZOPHRENIA SPEC
TRUM DISORDERS
257
different from the trad’t•
1he MST-P team is slightly
I ronal clini I M
.
.
k . ca ST
It includes a part-tune psychiatrist and a crisis cas
ewor er In add’ .
teaII1·
Ihon
-time doctoral-level supervisor and four m t ,
.
as er s-1eve) th era 1st
. .
.
to the full
. dd’ . P s.
training
health
mental
specialized
receive
erapists
in a Ihon to the
.
th h
.
‘Jhe th
Ra er t an bemg the sole provider oft reatment, the
trairung.
MST
.
. .
.
5.day
ul . Y
treatment
Multisystemic
psychiatnst.
the
with
nate
cons tahon is
,0011di
.
expert consultant and an MST expert psych’1atnst.
provt’ded by both an MST
Coordinated Specialty Care for First-Episode
Psychosis
Coordinated specialty care (CSC) is a recovery-oriented, 2- to 3-year,
evidence-based treatment program targeted at youth and young adults
aged IS through 25 experiencing first-episode psychosis (FEP) (Heinssen,
Goldstein, & Azrin, 2014). The goal of CSC is to identify people experiencing
FEP and initiate treatment as quickly as possible, so an important component of a CSC program is active outreach and engagement. A CSC program
consists of a multidisciplinary team trained in PEP that provides services
based on the needs and preferences of the client. Services include case management, medication management, primary care coordination, crisis intervention, therapy, supported employment or education, family education and_
support, substance abuse treatment, and transition of care. One member of
the team is designated as the primary care manager. As in wraparound and
MST, the client, his or her family members, and the multidisciplinary team
work together to develop an individualized treatment plan. Services are provided in the home, community, and in clinic settings.
In 2008, the National Institute for Mental Health (NIMH) funded the
Recovery After an Initial Schizophrenia Episode (RAISE) (Heinssen et al.,
20I4). Through RAISE, the NIMH funded two research projects of CSC, one
project was called RAISE Early Treatment Program (RAISE-ETP) and the
SCcood project was called Recovery After an Initial Schizophrenia Episode
~plementation and Evaluation Study (RAISE-JES). Through the RAISE~ study, the NIMH found that people receiving early treatment through
in treatment longer and experienced improvement in psychosis,
lllent ~hips, and quality of life compared to people receiving typical treatlYork. ~people who received CSC also were more involved in school or
SE-IEs project examined the administrative factors related to
relatt::y~
258
UNDERSTANDING TH E MENTAL HE AL TH
PR OB LE MS
s
ect
asp
al
nic
cli
the
d
ine
am
ex
o
als
ers
rch
sea
Re
m.
gra
pro
establishing a csc
isfaction With
sat
s’
ilie
fam
ir
the
d
an
ts’
en
cli
to
d
ate
rel
s
tor
fac
d
an
C
of CS
oss a
acr
ing
on
cti
fun
d
an
s
tom
mp
sy
t’s
en
cli
d
ine
am
ex
ers
rch
services. Resea
mental health
did
ly
on
t
No
es.
om
utc
g.o
sin
mi
pro
nd
fou
d
an
rs
yea
2
of
span
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ed
nc
rie
pe
ex
o
als
C
CS
ing
eiv
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op
pe
t
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ve,
pro
im
symptoms
CSC
ed
eiv
rec
o
wh
le
op
pe
the
,
ion
dit
ad
In
s.
me
tco
ou
ial
soc
ucational and
with respect and
d
ate
tre
re
we
y
the
se
cau
be
es
vic
ser
the
t
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ab
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siti
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ISE-IEX,
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As
.
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the
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vic
ser
the
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CSC
a
rt
sta
to
ng
nti
wa
ers
oth
by
use
for
ed
lop
ve
de
re
we
als
tools and manu
.nih.gov/health/
mh
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ww
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