Considering the facts of the case, Carrie is suffering from a psychiatric disorder known as Early-Onset Schizophrenia. The disease can be characterized by positive, negative, or cognitive symptoms. Besides, its diagnosis in children and adolescents follows similar criteria to that of adults, as set out in DSM-5 (McClellan et al., 2013). To justify the diagnosis that Carrie might have schizophrenia, DSM-5 requires that at least two characteristic symptoms are present during the active phase for at least a month, and they can be either negative, positive, or cognitive. The reason for diagnosing Carrie with the disorder is because she has met the diagnosis criteria that have been analyzed in this report. First, to meet the active phase criteria, two symptoms must be present. Secondly, to fulfill the full criteria of diagnosis, Carrie must display symptoms evidencing schizophrenia for not less than six months and accompanied by a decline in functioning (Sadock et al., 2015). In children, such a decline is often linked to age-appropriate behavior relating to academics or interpersonal development.
First, positive symptoms refer to symptoms such as delusions and hallucinations. Besides, disorganized behavior and particularly disorganized speech is also a major positive symptom of schizophrenia (McCance & Huether, 2014). Carrie’s parents’ report indicates that she shows signs of hallucination. Hallucinations can manifest in different forms such as through audio and vision (McCance & Huether, 2014). The auditory hallucinations exhibited in this case point to the fact that Carrie’s hallucinations are because of hearing some voices. The parents state that she talks to imaginary people. Her imaginary friends include half cats, half-humans, or spirits that can communicate with her.
On the other hand, delusions are beliefs of the individual that contradict their background. The main delusional themes include sexual, religious, somatic, and persecutory, among others (McCance & Huether, 2014). Delusions are associated with paranoid beliefs, and an individual can be involved in conspiracy, spying, ridicule, and persecution. Carrie is presenting delusions of reference, such as when she claims that televised people always notice the moment she is home and start airing shows only meant for her. Besides, she expresses other delusions of thoughts. When she is asked during the interview about her homework, she ridicules her teacher, saying that the teacher would not understand her high thinking capacity and that the teacher is miserable.
As for negative symptoms, they are referring to those symptoms that showcase a particular deficit. Carrie displays some cognitive symptoms that are often mainly characterized by cognitive delays. However, they mostly act as premorbid markers as opposed to sequelae for the disorder (McClellan et al., 2013). Children who develop schizophrenia later on in life often have premorbid abnormalities such as intelligence quotient, social isolation and withdrawal, and working memory. This is due to the gradual development of the condition in children because its onset is always insidious.
Therefore, it takes time that could amount to months or years for a child to meet all the diagnostic criteria of the disorder since it often starts with unusual behavior or inappropriate affect. However, the failure by Carrie to realize some expected academic and social functioning may replace deteriorating functioning as one of the symptoms for diagnosis (Sadock et al., 2015). When she started going to school, she kept academic pace with her peers even though her teachers noticed she was isolative. Her social skills were not a match for her peers. She also appears lost in her schoolwork in high school. A look at one of her homework, submitted by her parents shows her work lacks clarity and looks like a hodge-podge of ideas and thoughts.
Nevertheless, the expectation of the diagnosis was a reduced accuracy in diagnosis. Studies on the accuracy of diagnosis in children indicate the existence of some challenges that make it difficult to make a correct diagnosis. For instance, a majority of children who hallucinate do not satisfy the set criteria for schizophrenia and consequently do not have any psychotic illness (McClellan et al., 2013). Also, the differences in development both in cognition and in language affect the quality and range of symptoms exhibited. Therefore, there is a likelihood of misinterpreting Carrie’s vivid fantasies and overactive imaginations, which are typical experiences in childhood, as the basis for the disorder.
However, following the diagnosis decision, there are some notable differences. Her parents state that at her age, she should have outgrown the behaviors they consider reasonable in children. Such a report negates some of the challenges associated with the development of children illustrated earlier. Therefore, since there are no diagnostic tests for schizophrenia, Carrie’s history and examination were useful in arriving at a decision (Owen et al., 2015). Psychopathology and psychotic symptoms analysis based on history and evaluation helped in mitigating the challenges to the accuracy of diagnosis. For instance, after listening to Carrie and her parents concerning her mental state, and the objective information, there was an increased likelihood of early-onset schizophrenia diagnosis.
Decision point 2: Treatment Plan for Psychotherapy
Having diagnosed Carrie with early-onset schizophrenia, this decision point required starting a treatment plan for Carrie’s schizophrenia. The choice at this point was to begin psychotherapy using a psychodynamic approach. It will help Carrie manage the symptoms she has been experiencing. Evidence shows that psychotherapy relationships between the patient and the psychiatrist help the patient develop coping mechanisms or strategies (McCance & Huether, 2014). Additionally, psychotherapists can improve the care provided by identifying the relapse symptoms and stressors that may be present with the patient.
Besides, it would allow for psychological interventions that are more integrated and do not focus only on behavior. Since Carrie might be in the prodromal stage, psychological interventions that are integrated are more effective in comparison to a standardized treatment regime (Sadock et al., 2015). It has the possibility of mediating psychosis, thereby altering the rate of relapse or continued severity of the disorder. Therefore, this treatment method can change both the behavioral and cognitive characteristics relating to the disease that is exhibited by Carrie.
In making the above decision, it was expected that it would enable Carrie to reconnect with a real individual who would provide her with a relationship that is not destructive to her. According to Eells (2000), psychotherapy for schizophrenia offers the patient with skills to help him/her manage the symptoms better. Psychotherapy for schizophrenia is highly symptom-focused and hence provides strategies to cope with the symptoms (Sadock et al., 2015). Therefore, psychosocial intervention would help Carrie be in a position to manage her symptoms by learning the necessary skills. She would learn these coping mechanisms from the therapist.
There was no significant difference between the expectations attached to making the decision and the results. The result of this decision is that Carrie seems more engaged with her therapist. She stated that she could not wait for her next sessions. It shows that Carrie’s relationship with the therapist is building up, and there are positive outcomes since Carrie is now looking forward to spending time with the therapist. However, one main difference between the results of the decision and what I expected is that Carrie was not able to cope with her symptoms yet. Her parents reported that they had not seen any difference or change in the psychotic symptoms. The expectation was that Carrie’s symptoms would reduce (Sadock et al., 2015).
Decision point 3: Treatment Plan for Psychopharmacology
Schizophrenia is managed well in children, especially adolescent-onset schizophrenia, using both pharmacological and psychosocial interventions. When deciding this point, the selected medication choice for Carrie, to begin with, was haloperidol 5mg, administered orally daily. Haloperidol is an older antipsychotic drug useful in the medication of the disorder in kids and can assist the patient manage the symptoms of schizophrenia. Psychotherapy alone could not be enough to help Carrie manage psychotic symptoms (McCance & Huether, 2014).
During this decision point, the expectation was that her parents would readily accept the medication to stabilize the acute symptoms of the disorder. The treatment priority is always the active symptoms of the disease (Sadock et al., 2015). Besides, her parents have reported that psychotherapy alone was not effective in ensuring that her symptoms are managed. They did not achieve the change that they were hoping to accomplish, although she seems to like her relationship with the therapist. Also, her persistent schizophrenic symptoms are not changing through psychotherapy.
However, her parents seem to be reluctant to accept the idea of using drugs, especially those that might turn her into a zombie. It raises an ethical issue on the need to respect the autonomy of the parents and the significance of the medication. In this case, the medication proposed would be helpful in assisting Carrie manage the symptoms. Together with the psychotherapy recommended in the second decision point, this choice could be beneficial in reducing the symptoms of schizophrenia (Sadock et al., 2015). However, their fear seems to emanate from the fact that the grandfather to Carrie’s father was once in a “nut house” since he also had schizophrenia.