Assignment 1: Prescribing for Children and Adolescents
NRNP 6665 Assignment 1: Prescribing for Children and Adolescents
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
Assignment 1 Prescribing for Children and Adolescents
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.
The Risk Assessment to Use to Inform Treatment Decision Making
Assignment 1 Prescribing for Children and Adolescents
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