Identification and management of Schizophrenia in childhood

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

Since the hospitalized schizophrenic child or adolescent client is often psychotic, the nurse intervenes in the personal system of the child to help him/her process information from the environment. When the child's reality is distorted due to misperceptions of the environment, the nurse must continually clarify these perceptions and correct them (King, 1981). Thought-disordered youngsters may require constant reminders of time and space boundaries, such as mealtimes and locations. Visual charts and schedules may help them in this process. In addition, peers may need to be directed to ignore behaviors on the part of the child that are the result of disordered thinking (Pearson, 1992).

According to Violand and Williams (1994), negative reactions occur among family members when a child is in crisis and has to be hospitalized. Parents feel out of control and need help to dispel feelings of helplessness. Parents must be taught they are an integral part of treatment. Regardless of the level of care, nurses play a key role in the support and psychoeducation of family members of the schizophrenic child. Parents need assistance with parenting skills and management of behavior, which nurses can model. They need education not only on their child's illness, but also on the neuroleptic medications and how to administer them, how to monitor for side effects, and when and whom to call when problems arise. Families can be referred by nurses to community support groups such as the National Alliance for the Mentally Ill (NAMI), which has chapters in most communities throughout the United States. With the movement of much of psychiatric care toward the community setting, nurses are becoming an important part of the delivery of mental health services to children in the home.

Advanced practice nurses and clinical specialists are setting up school-based primary prevention and treatment programs for children and adolescents (Lamb & Puskar, 1991). Nontraditional settings provide opportunities for nurses to work with children in homeless shelters and battered women's shelters (Gilbert, 1988). Clinical specialists may work in community mental health clinics as therapists or advanced practitioners. These settings provide the nurse with a front-line opportunity to do primary prevention, case finding, referrals, and treatment of children with schizophrenia and their families.

Psychiatric nurses can intervene effectively in social systems by assessing the attitudes held by those within the system about thought-disordered schizophrenic children and adolescents. When misconceptions are identified, the nurse has the important task of educating the individuals involved. Securing needed services for a child may simply require an explanation by the nurse that the child is not dangerous. If the child is in a special education program, teachers will be prepared to meet the child's needs, but the mainstream educator may need assistance and education (Pearson, 1992).

Problems With Management and Treatment