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A Young Girl with Strange Behaviors Decision Tree

A Young Girl with Strange Behaviors Decision TreeA Young Girl with Strange Behaviors Decision TreeExamine Case 3: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.At each Decision Point, stop to complete the following:Decision #1: Differential DiagnosisWhich Decision did you select?Why did you select this Decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?Decision #2: Treatment Plan for PsychotherapyWhy did you select this Decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.A Young Girl with Strange Behaviors Decision TreeExplain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?Decision #3: Treatment Plan for PsychopharmacologyWhy did you select this Decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.ORDER A PLAGIARISM-FREE PAPER HEREExplain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?Also include how ethical considerations might impact your treatment plan and communication with clients and their families.BACKGROUNDCarrie is a 13-year-old Hispanic female who is brought to your office today by her mother and father. They report that they were referred to you by their primary care provider after seeking her advice because Carrie’s behavior has been difficult to manage and they don’t know what to do.A Young Girl with Strange Behaviors Decision TreeSUBJECTIVE Carrie’s parents report that they have concerns about her behavior, which they describe as sometimes “not normal for a 13-year-old.” They notice that she talks to people who aren’t real. Her behavior is calm and “passive.” Her parents noted that when she was younger, she was irritable at times, but have noticed that this has given way to passivity. Her parents state that they understand that it’s normal for younger children to have “imaginary friends,” but they feel that at Carrie’s age, she should have grown out of these behaviors. Carrie’s parents report that she has friends that are half-cat and half-human, and “spirits” who speak with her “in her head.” She also reports that the people on television know when she is home and that they have certain shows “just for her.” Carrie’s parents report that they have taken her to her pediatrician who has given her a “clean bill of health.” Carrie’s parents note that they had some early concerns as she was lagging in meeting developmental milestones. Initially, when she first started school, Carrie managed to keep up with her peers in terms of academic performance, but she was noticed by her teachers to be isolative.A Young Girl with Strange Behaviors Decision Tree.  It was also noted by her teachers and guidance counselor that Carrie’s social skills do not seem to match what they see in other children her age. Initially the school counselor suspected that Carrie may have been suffering from attention deficit hyperactivity disorder (primarily inattentive type), but now is not certain and has recommended a psychiatric evaluation. Her grades were “ok” in school up until last year when she left junior high school, and entered high school, where the academic demands began to increase. Carrie’s teachers had wanted to hold her back a grade, but her parents acknowledge that they were “insistent” that this did not happen. Now they are describing some regrets over this as Carrie seems “more lost than ever” in her schoolwork. Carrie’s mother produced a copy of a paper that Carrie had to submit as a homework assignment. You attempt to read the assignment, but there does not appear to be any clarity to the work, and it can best be described as a hodge-podge of thoughts and ideas. Carrie’s parents want you to know that although they are concerned about Carrie, they are opposed to giving her medications that would turn her “into a zombie.” Carrie’s mother also confides that her husband’s grandfather spent “a few years in the nut house.” When you probe further, she began crying and said, “He was schizophrenic … what if Carrie is schizophrenic?” During your interview with Carrie, she seems pleasant, but somewhat distant. When you ask her about her friends at school, she shrugs her shoulders and says, “I don’t really have any.A Young Girl with Strange Behaviors Decision Tree.  I don’t like those people.” You inquire if she is sad or upset that she doesn’t like them, to which she states “no, why should I be? I guess they would be friends with me if I asked, but I’m not interested. I could make them be my friends if I wanted, but I don’t … but if I wanted them to, all that I have to do is make up my mind that they will be my friend and they would have to.” When you ask Carrie if she believes that she can control the thoughts of others with her mind, she puts her index finger up to her mouth and looks toward the door. “My mom gets upset when I talk about these things. I try not to think about them either because if she is close enough, she could read my thoughts and they upset her. She may think that I’m into witchcraft or something.” When you ask Carrie about the homework assignment that you read, she explains that her teacher “is just miserable. She doesn’t understand how I think—I think high, she just can’t get it.”A Young Girl with Strange Behaviors Decision TreeOBJECTIVE The client is a 13-year-old Hispanic female client who appears appropriately developed for her age. She is dressed appropriately for the current weather, and ambulates with a steady upright gait. She does not appear to be demonstrating any noteworthy mannerisms, gestures, or tics. No psychomotor agitation/retardation apparent.MENTAL STATUS EXAM 4/8/2018 Psychopharmacologic Approaches to Treatment of Psychopathology Her speech is clear, coherent, goal directed, and spontaneous. Carrie self-reports her mood as “good.” However, her affect does appear somewhat constricted. Her eye contact is minimal throughout the clinical interview and at times, Carrie seems preoccupied. Carrie is oriented to person, place, and time. She endorses hearing and seeing strange “things that I talk to. They don’t scare me; they come to see me from another world.” No overt paranoia is appreciated. She does report delusions of reference (she believes that the people on TV play programs “just for her” and at times, television commercials were designed to tell her what to do), as well as other delusional thoughts (as described above). Carrie denies any suicidal or homicidal ideation. At this point, please discuss any additional diagnostic tests you would perform on Carrie.A Young Girl with Strange Behaviors Decision TreeDecision one: Early onset of SchizophreniaDecision #1: Differential Diagnosis: early onset of schizophreniaWhich Decision did you select?Why did you select this Decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?A Young Girl with Strange Behaviors Decision TreeDecision #2Decision #2: Treatment Plan for Psychotherapy is to begin Clozaril 100 dailyWhy did you select this Decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision.RESULTS OF DECISION POINT TWO Client returns to clinic in four weeks Upon return to your office, Carrie’s parents report that they stopped giving Carrie the medication 3 days after it was begun. “We just couldn’t wake her up,” explains Carrie’s mother. Carrie continues to exhibit symptoms, and basically, nothing has changed from the initial presentation.Why were they different?A Young Girl with Strange Behaviors Decision TreeDecision #3: Begin Risperdol 0.5 mg twiceDecision #3: Treatment Plan for PsychopharmacologyWhy did you select this Decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?A Young Girl with Strange Behaviors Decision TreeResults of decision #3Clozapine (Clozaril) is FDA-approved for treatment-resistant schizophrenia. Since the child has not yet been treated with any agent, we have no way of knowing if her schizophrenia is treatment resistant. Additionally, if we were to use Clozapine, the starting dose is approximately 25 mg in adults (perhaps 12.5 mg in a child, depending on body weight). The 100-mg dose prescribed in this case has resulted in the significant sedation that Carrie experienced. As we saw, the parents became concerned about this and withdrew the medication, and several weeks may have lapsed between the cessation of medication and the presentation of Carrie in your office again (assuming the parents would bring her back to see you)A Young Girl with Strange Behaviors Decision Tree. Restarting the medication at 100 mg would result in the same sedation. While sedation is common with Clozapine, we attempt to minimize it by starting at a much lower dose and titrating upward. This type of dosing error (initiating treatment at 100 mg orally daily) would result in a delay in treatment, and possible injury to the client. While Lamotrigine is sometimes used as adjunctive therapy in the treatment of schizophrenia, it is by no means an acceptable first-line treatment. Risperdal 0.5 mg orally twice a day is the best choice in this scenario as the dose is the most appropriate. We can use a smaller dose and titrate upward as needed to achieve symptom control. At this starting dose, side effects would be minimized. It is also FDA-approved for the treatment of schizophrenia in those aged 13 years and older. Recall that with any antipsychotic medication, you should determine fasting plasma glucose levels, monitor weight and BMI during treatment, as well as blood pressure and fasting triglycerides.A Young Girl with Strange Behaviors Decision TreeAlso include how ethical considerations might impact your treatment plan and communication with clients and their families.ConclusionReferences Early Onset Schizophrenia(Case Study)Psychopharmacology of childhood disorders is an area in the clinical practice and research that is experiencing rapid development in recent days. In fact,childhood psychopharmacology has played second fiddle to adult psychopharmacology, due to minimal research and rare mental cases affecting children being recorded. In recent times, the field has experienced an upsurge in valuable research and methodologies from clinical and experimental psychologists, regarding the happenings in a child’s life. However, it is evident that most of the knowledge applied in handling psychological predicaments amongst children is purely based on experience, ratherthan scientific facts. Schizophrenia is a disease that is common amongst adults. However, cases of young children suffering from its effects have emerged in recent days.A Young Girl with Strange Behaviors Decision TreeOverviewEarly onset schizophrenia(EOS) is very rare, yet it bears severe and chronic consequences on children. Clinicalpsychologists present this illness as being associated with premorbid developmental aberrations, poor prognosis, and inadequate response to neuroleptic treatment. Based on the current knowledge whichis devoid of enough sciencefacts, children who suffer from EOS are forced to rely on second-generation antipsychotic drugs. Albeit the current medication may not sufficiently lead to the desired patient outcomes, it provides sub-optimal responses if administered precisely. Medical practitioners propose that antipsychotic treatment works effectively when incorporated with therapeutic interventions. However,Samartzis, Dima,Fusar‐Poli, andKyriakopoulos (2014) underscore the fact that it is imperative forclinicians to ensure early detection and apply advanced neuroanatomicalpathways to guarantee informed treatment strategies.A Young Girl with Strange Behaviors Decision TreeCase StudyDecision One (Ascertaining EOSthrough Differential Diagnosis)Schizophrenia is a complex psychiatric disorder, with researchers claiming that its pathophysiology can be traced back to the early developmental stages of the victim. EOS is exceedingly rare, and is phenotypically severe. Patients suffering from EOS display massive neurodevelopmental impairments,for instance, diminished psychosocial functioningand linguisticinabilities. Teicher and Samson (2016) stipulate that EOS may arise from child abuse and neglect. The disease, through its neurobiological and phonotypical agents continues its manifestation into adulthood, and victims are compelled to rely on antipsychotics for a long time.A Young Girl with Strange Behaviors Decision TreeFrom the case study,Carrie displays a clear and coherent speech. Her mood is reportedly normal, but she exhibits minimal eye contact. Besides, she has delusional thoughts, stating that she is not scared of what she is told, and that television programs are meant for her viewing. From her explanations, it is evident that she experiences some form of mental instability. Millan, Fone, Steckler and Horan (2014) elaborate that such cognitive deficiencies may be cardinalsymptoms of schizophrenic illnesses. However, health practitioners and psychiatrists ought to apply an improved diagnostic criterion that helps identify more specific and homogenous traits, which characterize a certain disease.A Young Girl with Strange Behaviors Decision TreeIt is apparent that the traits displayed by Carrie may be those of a victim suffering from bipolar disorder. However, through differential diagnosis,health practitioners are able to ascertain early onset of schizophrenia. Since the conditions drive towards the conclusion of one being either bipolar or schizophrenic, it would be imperative that doctors conduct their assessments while the patient is euthymic. This technique enables physicians identify bipolar cases from schizophrenic ones, since it is rare for bipolar patients to be euthymic, as they spend more than 50% of their time experiencing varying symptoms. This technique evidently ascertained that Carrie suffered fromEOS.A Young Girl with Strange Behaviors Decision TreeThe method is effective, as it derives the results expected by the psychiatrists. Carrie’s persistent expressivevariances enabled the doctors to declare her schizophrenic, and prescribe relevant drugs to stabilize her condition. However, in my opinion, I expected the practitioners to treat the teenager of mood-related issues and discharge her after administration of drugs.The decision differed from my expectation, since the medical practitioners incorporated a technique that precisely identified the problem facing the teenager. It clearly displays that the medical field takes into considerationpossibilitiesof schizophrenia affecting young children.A Young Girl with Strange Behaviors Decision TreeDecision Two (Treatment Plan for Psychotherapy by Clozaril 100mg daily)Upon ascertaining that the teenager is schizophrenic, administration of Clozaril 100mg can be recommended. However, prescription of the drug is most common in adults suffering from Schizophrenia. A child may be given 25mg or 12.5mg, depending on the weight. This is a necessary step to ensure stabilization of the conditions. Most commonly, schizophrenic victims rely on antipsychotic agentsto ensure normaloperations. However, patients respond differently to antipsychotics. Meier et al (2014) elaborate that incase a patient responds positively to the prescribed drugs, it is important to incorporate maintenance therapy. It is imperative to apply the strategy, since it helps stabilize the patient’s condition and improve quality of life. In fact,Clozaril is reported to be the most successful antipsychotic when applied for long-termmaintenancetherapy. The drug is effective in stabilizing catatonic andparanoidforms of schizophrenia.A Young Girl with Strange Behaviors Decision TreeClozaril is known to have a lower relapse rate and higher safety profiles. Schneider, Corrigall, Hayes, Kyriakopoulos and Frangou (2014)explain that the drug performs excellent on residual and schizoaffective psychosis, on those patients that respond positively to it. From the case study, the medical practitionersprescribed Clozarilto Carrie. The main objective was to stabilize her condition, and subject her to depend on the drug in the long run. The main reason that informed the choice of Clozaril prescription is that it is the best known antipsychotic. It was expected that Carrie would respond positively to the drug. However, her parents noticed that the drug inactivated her abnormally. They stopped the medication after three days. From this happening, Clozaril did not respond as expected by the physicians. In such cases, physicians recommend stopping of drug administration, although it occurs rarely becauseClozaril is the best known drug for schizophrenia patients. A Young Girl with Strange Behaviors Decision Tree. Carrie was given an overdose of the drug, which overwhelmed her and brought about severe side effects. Since the victim is a teenager,it was necessary forphysicians to prescribe an average dose,for instanceClozaril 25mg, depending on the body weight. Schneider et al.(2014) posit that an overdoseof the drug is known to bear detrimental side effects like constipation, tachycardia, incontinence, dose-related reduction in seizure threshold, and sedation. It is possible that these side effects affected Carrie, to a point of poor response. It is imperative for medical practitioners to incorporate established management strategies for side effects that arise from Clozaril. From the case study, the physicians did not advise Carrie’s parents on management methods in case onset of side effects occurred. It is apparent that the teenager would respond affirmatively to Clozaril, if it the parents would administer the correct dose and help cope with the side effects. Additionally, Brandchaft, Atwood and Stolorow(2014) states that issuing of the drug requires prior knowledge about fasting plasma glucose levels of a patient. It is evident that physicians did not conduct a test to ascertain the levels of plasma glucose on the victim. A combination of these aspectsled to Carrie responding inappropriately to the drug.A Young Girl with Strange Behaviors Decision TreeDecision 3 (Administration of Risperdal 0.5 mg twice a Day)Carrie responded negatively to Clozaril, prompting her parents to visit the physicians for the second time. At this point, it is apparent that the parents overdosed Carrie, leading to sedation. However, it may be difficult for the medical attendants to discover any occurrence of overdosing. Albeit the doctors may discover slim chances of excess issuance of the drug, it is imperative to administer a different antipsychotic, to ensure faster stability and desirable health outcomes. Administration of Risperdal twice per day is among the best options clinicians can consider. Re-issuing of Clozaril is not the best option, since the drug is in excessamounts in the body, subjecting the liver to continuous detoxification. The case of Carrie demanded recommendation of Risperdal, to guarantee stability. Aman et al. (2014)explain that Risperdal is an effective antipsychotic, if administeredprecisely.Aman et al. (2014) conducteda research on schizophrenic patients aged between 6-12 years. They concluded that a dosage of between 0.15mg to 6mg per day resulted in significant reduction in mental instability. Specifically, many of thepatients under study recorded abridged levels of positive and negative syndrome scale (PPANSS). Besides, the research positsthatdosesof more than 3mg increased the rate of adverse effects.It is clearthat moderate or lesser dosagesof antipsychotics work effectively in stabilizing a schizophrenic patient. Notably, administration of 0.5mg of Risperdal to Carrie would significantly help alleviate the condition. Being a teenager, 0.5mg would be most appropriate. However, since the body mass is not known, it is advisable to apply lesser dosages, which can be titrated upwards as the treatment and management processesprogress. Besides, Aman et al. (2014)  elaborate that administering lesser dosages helps the victim cope with the side effects easily. Through these considerations, it is evident that Carrie would gain her stable mental health within a short period.A Young Girl with Strange Behaviors Decision TreeEthical ConsiderationsTreating patients with mental problems is a delicate task that requires careful considerations, especially by the clinicians. Notably, most schizophrenics may notofferinformed decisions concerning treatment options. It is therefore imperative that medical practitioners follow the well-laidprocedures to avoid the possibility of legal tussles (Insel, 2014).It is recommended that parents and guardians of a schizophrenic patient be involved indecision making regarding treatment. From the case study, it is apparent that Carrie’s parents were informed about the administration of Clozaril. However, there occurred an overdose of the drug, which would have led to detrimental effects, had the parents continued with issuing.A Young Girl with Strange Behaviors Decision TreeConclusionResearch on mental instabilities affecting children has increased in recent days. In the past¸scholars dedicated most of theirresources and time to research on adult psychopharmacology. However, it is apparent that childrenalso suffer from mental instabilities, a factor that canbe traced back to the developmental age. Indeed, there are children who suffer from schizophrenia, but the issue always appears unnoticed. The aspect is due to limited information on the diseaseamongst children. Early onset schizophrenia severely affects young children. From the case study, Carrie exhibited signs of a mentally disturbed individual. Through differential diagnosis, physicians ascertained the presence of schizophrenia. They recommended on administration of Clozaril. However, the victim’s parents overdosed her, leading to excessive sedation. On the second visit to the hospital, clinicians recommended issuance of Risperdal in small doses, which would be titrated upwards. This aspect would help the patient stabilize. It is imperative for medical practitioners to engage parents and guardians of mentally disturbed patients in matters pertaining medication and treatment processes.Through this act, they would ensure informed decisions which would guarantee desirable healthoutcomes.A Young Girl with Strange Behaviors Decision Tree  ReferencesAman, M. G., Bukstein, O. G., Gadow, K. D., Arnold, L. E., Molina, B. S., McNamara, N. K., … & Butter, E. M. (2014). What does Risperidone add to parent training and stimulant for severe aggression in child attention-deficit/hyperactivity disorder?Journal of the American Academy of Child & Adolescent Psychiatry, 53(1), 47-60. https://doi.org/10.1016/j.jaac.2013.09.022.Brandchaft, B., Atwood, G. E., &Stolorow, R. D. (2014).Psychoanalytic treatment: An intersubjective approach. Routledge.Insel, T. R. (2014). Mental disorders in childhood: Shifting the focus from behavioral symptoms to neurodevelopmental trajectories. Jama, 311(17), 1727-1728.doi:10.1001/jama.2014.1193.Meier, M. H., Caspi, A., Reichenberg, A., Keefe, R. S., Fisher, H. L., Harrington, H., … Moffitt, T. E. (2014). Neuropsychological decline in schizophrenia from the premorbid to the postonset period: Evidence from a population-representative longitudinal study. American Journal of Psychiatry, 171(1), 91-101. https://doi.org/10.1176/appi.ajp.2013.12111438.A Young Girl with Strange Behaviors Decision TreeMillan, M. J., Fone, K., Steckler, T., & Horan, W. P. (2014). Negative symptoms of schizophrenia: Clinical characteristics, pathophysiological substrates, experimental models and prospects for improved treatment. European Neuropsychopharmacology, 24(5), 645-692. https://doi.org/10.1016/j.euroneuro.2014.03.008.Samartzis, L., Dima, D., Fusar‐Poli, P., &Kyriakopoulos, M. (2014). White matter alterations in early stages of schizophrenia: A systematic review of diffusion tensor imaging studies. Journal of Neuroimaging, 24(2), 101-110.https://doi.org/10.1111/j.1552-6569.2012.00779.xSchneider, C., Corrigall, R., Hayes, D., Kyriakopoulos, M., &Frangou, S. (2014).Systematic review of the efficacy and tolerability of clozapine in the treatment of youth with early onset schizophrenia.European Psychiatry, 29(1), 1-10.https://doi.org/10.1016/j.eurpsy.2013.08.001.A Young Girl with Strange Behaviors Decision TreeTeicher, M. H., & Samson, J. A. (2016). Annual research review: enduring neurobiological effects of childhood abuse and neglect. Journal of child psychology and psychiatry, 57(3), 241-266. A Young Girl with Strange Behaviors Decision Tree

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