Identification and management of Schizophrenia in childhood

Journal of Child and Adolescent Psychiatric Nursing, Apr-Jun 2001 by Lambert, Louise T

An inpatient unit should be a child environment, staffed with a full multidisciplinary team, including educational professionals. Inpatient care is most likely to be needed during the first acute episode in order to do a complete diagnostic assessment and start acute treatments. Families also can be worked with and readily engaged with psychoeducational approaches to be continued after discharge. The goal is to maintain the child in the community with outpatient follow-up care (Werry & Taylor, 1994). Some children have such a slow insidious onset with no acute behavioral problems that they can be managed on an outpatient basis, if there is agreement by all parties to the necessary assessments and interventions. This prevents disruption of family relationships and social contacts (Tolbert, 1996).

Standard antipsychotic drugs appear to be effective for schizophrenic children, and the atypical drug dozapine is helpful for at least 50% of children who do not respond to the typical drugs (Jacobsen & Rapoport, 1998) such as haloperidol, which is a popular choice for acuteonset episodes. Promising newer neuroleptic drugs such as risperidone provide high potency and a rapid onset of action. When using neuroleptic therapy, many clinicians find it helpful to get a baseline score on the Abnormal Involuntary Movement Scale (AIMS) (Psychopharmacology Research Branch, NIMH, 1976) before using an antipsychotic drug on a child, given the high risk of extrapyramidal symptoms (Tolbert, 1996).

Psychotherapy is also an important part of the treatment and management of childhood schizophrenia. All members of the mental health team must educate youngsters and families about the illness. Parents need special help learning to deal with their desires for a "normal" child. Children with schizophrenia need to develop coping skills, and school personnel need to help maximize the benefits of educational mainstreaming.

Nursing Implications

The role of the nurse in the treatment of childhood schizophrenia depends on both the environmental setting and the preparation of the practitioner. It is important to note the paucity of literature on specific psychiatr)ic nursing interventions for schizophrenic children. When inpatient care is indicated, the child is usually treated in a structured child/adolescent therapeutic milieu in an acute, residential, or day-treatment program (Colson, 1998). The three main goals, according to Critchley (1991), are to provide physical and psychological security, to promote normal growth and development, and to ameliorate the psychiatric disorder. The nurse works toward the achievement of these goals as directed by the Standards of Child and Adolescent Mental Health Nursing Practice (ANA, 1985) and the combined Adult and Child and Adolescent PsychiatricMental Nursing Standards (ANA, 1994) in cooperation with the treatment team. Most programs include the use of pharmacological interventions and behavior modification strategies incorporating activities of daily living, peer, staff and family interactions, as well as school and recreational activities.