Treatment Principles Copy
While several sets of guidelines exists for medication use in psychotic disorders, the practice parameters for schizophrenia by the American Academy of Child and Adolescent Psychiatry caution that their treatment recommendations are based on the adult literature because of a paucity of research on youth with schizophrenia or other psychotic disorders.
Therefore the principle of starting with a low dose and raising the dose very slowly becomes even more important. Adolescents may be particularly sensitive to side effects associated with medication.
Click here to download a flowchart may be used as a guide in understanding medication strategies.
Individuals frequently discontinue medications when they have recovered from a first episode. Unfortunately, there is no reliable way to predict who belongs to the substantial subgroup of persons with schizophrenia (about 20%) who will not experience a second episode regardless of whether they take maintenance antipsychotic medication. Therefore, some researchers and clinicians have advocated a medication strategy that entails restarting the antipsychotic at the first signs of a relapse.
Despite the fact that an intermittent dosing strategy may be less than ideal, it will occur in clinical situations quite frequently. If the person has had only one episode, experienced a complete symptomatic recovery, and is willing to be closely followed but is very reluctant to take medication, it appears reasonable to try the intermittent approach. However, for someone with schizophrenia who has relapsed quickly, medication should probably be maintained for at least five years.
During trials off medications, the client’s file should not be closed – instead there should be closer monitoring with a well developed relapse prevention plan. The client should have medications at home or readily available in case there is a sudden deterioration.
In general, an individual with early psychosis is well served through:
- Close monitoring
- Collaborative planning between individual, physician and clinician
- Engagement of family or others close to the individual
- Timely review of the diagnosis
- Keeping the dose as low as possible
- Facilitation of ongoing psychosocial interventions
- Facilitation of access to medication
- Ensuring easy access to services if a relapse appears possible.
The master case with David continues here. Print out and then read over the continuation.
The following thought questions are designed for you to think about how your own values and beliefs may impact your work with young people dealing with psychosis.
- How do your own views about the use of medication impact your practice?
- What is your position on use of non-traditional medicines?
- A client refuses to take medication, will you continue treatment? How will you modify your treatment approach?