Assgn 2 – WK10 (C) Practicum: Decision Tree Childhood psychosis is extremely rare; however, children that present with psychosis must be carefully assessed and evaluated with appropriate interviewing of parent, child, and use of assessment tools. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with early onset schizophrenia. The Assignment: Examine 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.  (N: B. A CASE STUDY WITH ANSWER SAMPLE IS ATTACHED WITH THIS ASSIGNMENT) At each Decision Point, stop to complete the following:                                           · Decision #1: Differential Diagnosis o Which Decision did you select? o Why did you select this Decision? Support your response with evidence and       references to the Learning Resources. o What were you hoping to achieve by making this Decision? Support your      response with evidence and references to the Learning Resources. o 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 Psychotherapy o Why did you select this Decision? Support your response with evidence and      references to the Learning Resources. o What were you hoping to achieve by making this Decision? Support your      response with evidence and references to the Learning Resources. o Explain 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 Psychopharmacology o Why did you select this Decision? Support your response with evidence and      references to the Learning Resources. o What were you hoping to achieve by making this Decision? Support your      response with evidence and references to the Learning Resources. o Explain 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. Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. Case #3 A young girl with strange behaviors BACKGROUND             Carrie 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 ...

1. Assgn 2 – WK10 (C)
Practicum: Decision Tree
Childhood psychosis is extremely rare; however, children that
present with psychosis must be carefully assessed and evaluated
with appropriate interviewing of parent, child, and use of
assessment tools.
For this Assignment, as you examine the client case study in
this week’s Learning Resources, consider how you might assess
and treat clients presenting with early onset schizophrenia.
The Assignment:
Examine
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.
(N: B. A CASE STUDY WITH ANSWER SAMPLE IS
ATTACHED WITH THIS ASSIGNMENT)
At each Decision Point, stop to complete the following:
· Decision #1: Differential
Diagnosis

2. o
Which Decision did you select?
o
Why did you select this Decision? Support your response with
evidence and
references to the Learning Resources.
o
What were you hoping to achieve by making this Decision?
Support your
response with evidence and references to the Learning
Resources.
o
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 Psychotherapy
o
Why did you select this Decision? Support your response with
evidence and
references to the Learning Resources.
o
What were you hoping to achieve by making this Decision?

3. Support your
response with evidence and references to the Learning
Resources.
o
Explain 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
Psychopharmacology
o
Why did you select this Decision? Support your response with
evidence and
references to the Learning Resources.
o
What were you hoping to achieve by making this Decision?
Support your
response with evidence and references to the Learning
Resources.
o
Explain 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

4. treatment plan and
communication with clients and their families.
Note: Support your rationale with a minimum of three academic
resources. While you may use the course text to support your
rationale, it will not count toward the resource requirement.
Case #3
A young girl with strange behaviors
BACKGROUND
Carrie 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.
SUBJECTIVE
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

5. 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. 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

6. 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. 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.”
OBJECTIVE
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.

7. MENTAL STATUS EXAM
Carries is alert and oriented × 4 spheres. 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.
Decision Point One
BASED ON THE INFORMATION PROVIDED IN THE
SCENARIO ABOVE, WHICH OF THE FOLLOWING
DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL
HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO
CARRIE?
In your write-up of this case, be certain to link specific
symptoms presented in the case to DSM–5 criteria to support
your diagnosis.

8. Early Onset Schizophrenia
Schizoaffective Disorder
Schizotypal Personality Disorder
Answer Chosen:
Early Onset Schizophrenia
Decision Point Two
BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF
ACTIONS:
Refer for psychological testing
Begin Clozaril 100 mg orally daily
Begin psychotherapy using a psychodynamic approach
Answer Chosen:
Refer for psychological testing
RESULTS OF DECISION POINT TWO

9. ·
Client returns to clinic in four weeks
·
Although there are no specific psychometric tests available for
schizophrenia, the consulting psychologist administered a
comprehensive psychological battery of tests in order to assess
personality and cognitive functioning as well as to identify any
underlying intellectual disabilities that could account for the
difficulty Carrie is having in school. Tests administered
included the Minnesota Multiphasic Personality Inventory;
Kaufman Adolescent and Adult Intelligence Test; Rorschach
test; Whitaker Index of Schizophrenic Thinking (WIST) test;
Wide Range Achievement Test – 4th Edition (WRAT-4); and the
Millon Adolescent Clinical Inventory (MACI). The consulting
psychologist opined that early-onset schizophrenia was strongly
suspected in this client.
Decision Point Three
BASED ON THE ABOVE INFORMATION, SELECT YOUR
NEXT ACTION. BE CERTAIN TO DISCUSS THE
RATIONALE FOR YOUR DECISION.
Begin Clozapine 100 mg orally daily
Begin family interventions
Begin Lurasidone 40 mg orally daily

10. Answer Chosen
Begin Lurasidone 40 mg orally daily
Guidance to Student
It is not always necessary to procure a consult with a
psychologist. However, psychologists by virtue of their
advanced training and licensure are able to conduct
comprehensive psychological testing on clients more advanced
than those tests that could be conducted by the
psychiatric/mental health nurse practitioner. In this case, we
would like to know if the poor academic performance was the
result of an intellectual disability, versus poor premorbid
intellectual functioning that is often seen in schizophrenia.
In terms of treatment decisions, Clozapine 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). Clozapine 100 mg would most
likely cause significant side effects that both the child and
parents would find objectionable, thus making compliance an
issue.
Although not FDA-approved for use in children, Lurasidone is
used as an off-label drug in this population. There are no legal
prohibitions against any prescriber using drugs “off-label”;
however, attention must be given to the concept of informed
consent. When working with children/adolescents, the PMHNP
must explain pros/cons, discuss therapeutic endpoints/goals of

11. treatment, etc. The parent/guardian must have all of the
information needed to make an informed consent. Therefore,
Lurasidone would be the best choice. Additionally, Lurasidone
may be the preferred antipsychotic, as it appears to have the
least impact on body weight and lipid profile.
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.
Family interventions are important as well, as they do
have a positive benefit on symptom relapse and
admission/readmission to the hospital. Family interventions
should include teaching about the disease, medications, and
anticipatory guidance.
Learning Resources
Required Readings
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
Kaplan & Sadock’s synopsis of psychiatry: Behavioral
sciences/clinical psychiatry
(11th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 31, “Child Psychiatry” (pp. 1268–1283)
American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author.

12. “Schizophrenia Spectrum and Other Psychotic Disorders”
McClellan, J., & Stock, S. (2013). Practice parameter for the
assessment and treatment of children and adolescents with
schizophrenia.
Journal of the American Academy of Child & Adolescent
Psychiatry
,
52
(9), 976–990. Retrieved from
http://www.jaacap.com/article/S0890-8567(13)00112-3/pdf
Giles, L. L., & Martini, D. R. (2016). Challenges and promises
of pediatric psychopharmacology.
Academic Pediatrics
,
16
(6), 508–518. doi:10.1016/j.acap.2016.03.011
Hargrave, T. M., & Arthur, M. E. (2015). Teaching child
psychiatric assessment skills: Using pediatric mental health
screening tools.
International Journal of Psychiatry in Medicine
,
50
(1), 60–72. Retrieved from
http://search.proquest.com.ezp.waldenulibrary.org/docview/170
2699596?accountid=14872
Stahl, S. M. (2014).
Prescriber’s Guide: Stahl’s Essential Psychopharmacology
(5th ed.). New York, NY: Cambridge University Press.

13. Required Media
Laureate Education (Producer). (2017b).
A young girl with strange behaviors
[Multimedia file]. Baltimore, MD: Author. (THE ATTACHED
CASE STUDY IS THE MEDIA)
PLEASE PART OF THE CONTRACT IS TO HAVE IT DONE
IN 12 HOURS. THANKS