| Course | NUR-7631 Advanced Assessment, Differential Diagnosis, and Management of Psychiatric Disorders Child and Adolescent Populations, Part A |
|---|---|
| Module | Module 6 |
| Paper type | Case analysis: early-onset psychosis |
| Length | About 1,033 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NUR 7631 Module 6
Classmates Who Read His Thoughts: Choosing an Antipsychotic for a 14-Year-Old With Early-Onset Psychosis When Efficacy Is Similar and Weight Gain Is Not
Student Name
M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner, Thomas Edison State University
NUR-7631: Advanced Assessment, Differential Diagnosis, and Management of Psychiatric Disorders: Child and Adolescent Populations, Part A
Mentor Name
Month Day, Year
Classmates Who Read His Thoughts: Choosing an Antipsychotic for a 14-Year-Old With Early-Onset Psychosis When Efficacy Is Similar and Weight Gain Is Not
A Boy Who Stopped Going to School
Andre, an invented patient, is 14 and in eighth grade in Trenton. Since late summer he has been sure that classmates can hear what he thinks and mock it, and a voice now narrates his actions. He stopped going to school six weeks ago and spends most of the day in his room with the curtains closed. His mother noticed him talking to himself. He denies drug use, and a urine screen is negative. He has no history of seizures or head injury. His pediatrician found a normal neurological exam, and blood tests, including thyroid function and a metabolic panel, are normal. An MRI was not considered necessary given the normal exam, though it would be ordered if neurological signs appeared. There is a family history of schizophrenia in an uncle.
Before the illness, Andre was a quiet but sociable boy who played basketball after school and earned average grades. His mother describes a gradual change over the past year: first falling grades and withdrawal from friends, then suspicion and the voice. That slow decline before obvious psychosis is typical of early-onset illness and is one reason the diagnosis is made cautiously but taken seriously.
Diagnosis With Caution
McClellan and Stock (2013), in the AACAP practice parameter on schizophrenia in children and adolescents, emphasize careful diagnosis because psychotic symptoms in youth can arise from mood disorders, trauma, substance use, medical conditions and developmental disorders, and because a diagnosis of schizophrenia carries weight for the young person's future. They recommend a comprehensive evaluation, ruling out medical causes and following symptoms over time. Andre's three months of delusions and hallucinations with declining function, without a mood episode or substance use, point to a schizophrenia spectrum disorder; the exact diagnosis will be confirmed as his course becomes clear, and schizophreniform disorder is the provisional label.
What the Trials Show
Sikich et al. (2008) ran the TEOSS trial, giving 119 young people between 8 and 19 eight weeks of molindone, an older drug, or one of two newer ones, risperidone and olanzapine. Response rates did not differ significantly: 50 percent with molindone, 34 percent with olanzapine and 46 percent with risperidone. The newer drugs put on more weight, olanzapine most of all, along with rises in cholesterol, insulin and liver tests; molindone's main drawback was restlessness. On that evidence the investigators asked why prescribers had abandoned older options for young patients.
Correll et al. (2009) followed young people taking an antipsychotic for the first time for about eleven weeks. Weight rose by 8.5 kilograms with olanzapine, 6.1 with quetiapine, 5.3 with risperidone and 4.4 with aripiprazole, compared with almost none in an untreated group, with significant increases in cholesterol and triglycerides on olanzapine and quetiapine.
| Medication | Evidence of efficacy in youth | Weight gain in first-time users (about 11 weeks) |
|---|---|---|
| Olanzapine | Similar response to other drugs | 8.5 kg |
| Risperidone | Similar response | 5.3 kg |
| Aripiprazole | Approved for adolescent schizophrenia | 4.4 kg |
| Molindone | Similar response; no longer widely available | Less weight gain; more akathisia |
The Choice
Because efficacy appears similar and metabolic harm differs greatly, the choice rests on side effects and approval. Aripiprazole is approved for schizophrenia in adolescents, caused the least weight gain among the newer drugs in the cohort study and raises prolactin less than risperidone. Andre's family is concerned about weight because his mother has diabetes. Aripiprazole is chosen.
Cost and access are considered as well. Generic aripiprazole is covered by his Medicaid plan, and a liquid form is available if he finds tablets hard to swallow, which some adolescents with psychosis do when they become suspicious of pills.
A full medical workup comes before the diagnosis is settled. Thyroid tests, a urine drug screen and a review of his sleep rule out common mimics, and an MRI is ordered because of his age at onset, although in most young people it shows nothing that changes care.
The Prescription and Monitoring
Aripiprazole 2 milligrams daily for two days, then 5 milligrams, increasing to the usual target of 10 milligrams over about a week if tolerated. Akathisia is the most likely early side effect, and his mother is taught to recognize restlessness and pacing. At the first visit the nurse records his height, weight, growth-chart BMI percentile, waist and pressure, and a morning blood draw measures sugar and cholesterol. Weight and blood pressure are measured at each visit for three months and laboratory tests repeated at three months, then at least yearly. If weight rises rapidly, lifestyle changes and, if needed, metformin are considered.
Adherence is discussed openly. Andre is suspicious of the medication at first, believing it might be used to control his thoughts, so the nurse practitioner explains its purpose in plain words, invites his questions and agrees to review side effects with him at each visit. His trust in the prescriber is part of the treatment.
Family, School and Psychosocial Care
The practice parameter recommends combining medication with psychosocial treatment. Andre's family receives education about psychosis, early warning signs of relapse and the importance of taking medication regularly. A gradual return to school is planned with a reduced schedule and a quiet space, and the school's evaluation for an individualized education program is requested. Coordinated specialty care for early psychosis, if available in the area, offers therapy, family support and supported education together.
Measuring Progress
Psychotic symptoms are rated at each visit. School attendance, time out of his room and his own goal, returning to the basketball he used to play, are tracked. An adequate trial lasts four to six weeks at a therapeutic dose; if he does not respond, another antipsychotic is tried, with clozapine reserved for treatment resistance.
Conclusion
Andre's psychosis requires careful diagnosis, with medical and substance causes ruled out. Trial evidence shows newer antipsychotics are no more effective than older ones in youth, while cohort data show large differences in weight gain. Choosing aripiprazole for its lower metabolic risk, monitoring closely and combining medication with family education and school support follows the practice parameter and gives him the best start.
References
Correll, C. U., Manu, P., Olshanskiy, V., Napolitano, B., Kane, J. M., & Malhotra, A. K. (2009). Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents. JAMA, 302(16), 1765-1773. https://doi.org/10.1001/jama.2009.1549
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 and Adolescent Psychiatry, 52(9), 976-990. https://doi.org/10.1016/j.jaac.2013.02.008
Sikich, L., Frazier, J. A., McClellan, J., Findling, R. L., Vitiello, B., Ritz, L., Ambler, D., Puglia, M., Maloney, A. E., Michael, E., De Jong, S., Slifka, K., Noyes, N., Hlastala, S., Pierson, L., McNamara, N. K., Delporto-Bedoya, D., Anderson, R., Hamer, R. M., & Lieberman, J. A. (2008). Double-blind comparison of first- and second-generation antipsychotics in early-onset schizophrenia and schizo-affective disorder: Findings from the Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS) study. American Journal of Psychiatry, 165(11), 1420-1431. https://doi.org/10.1176/appi.ajp.2008.08050756
NUR 7631 Module 6 instructions, in plain terms
Prescriptive authority in the child and adolescent population closes the NUR-7631 catalog text, and as no syllabus is published, this sixth module applies it to early-onset psychosis. Expect a case analysis that rules out medical and substance causes, applies diagnostic criteria cautiously, chooses an antipsychotic from pediatric trials and safety data, writes the prescription and specifies metabolic monitoring, and adds family and school support. Some classrooms set a case of adolescent bipolar disorder or first-episode psychosis in an older teenager instead. Confirm the age and diagnosis. Weigh efficacy and harm separately, and let the family's own risks, such as diabetes, inform the choice. Describe the course of decline that came before the psychosis. List the medical workup that rules out other causes.
Inside the NUR 7631 Module 6 example
Andre's three months of delusions, hallucinations and school refusal open the case, with a negative drug screen and normal medical workup. The practice parameter's call for careful diagnosis leads to a provisional schizophreniform label. A trial comparing molindone, risperidone and olanzapine shows similar response and different side effects, and a cohort study shows weight gain by drug in a four-row table. Aripiprazole is chosen for lower metabolic risk and his mother's diabetes, with a titration plan and monitoring schedule. Family education, a gradual school return, specialty care and measures lead to the conclusion. His suspicion of the medication is met with plain explanation. His drug screen and thyroid tests are reported before the diagnosis.
Reading the NUR 7631 Module 6 grading rubric
Early-onset psychosis cases are graded on a careful diagnosis with medical and substance causes excluded, a medication choice based on pediatric trials and safety data, correct dosing and titration, complete metabolic monitoring and psychosocial support. Mentors look for efficacy and harm considered separately and for the family's risk factors used in the decision. Monitoring should name tests and intervals. Plans for nonresponse, including when clozapine would be considered, show depth. APA references to the practice parameter and trials complete the grade. Attention to adherence and the young person's trust adds depth. Ruling out substances and medical causes before naming schizophrenia earns credit.
NUR 7631 Module 6 help: mistakes that cost marks
Students sometimes diagnose schizophrenia quickly without excluding mood disorders, substances or medical causes. Show the workup. Another common error is choosing a newer antipsychotic on the assumption that it works better; pediatric trials do not show that. Compare weight gain explicitly. Give the starting dose and titration for an adolescent. Name the baseline and follow-up tests. Plan family education and school support, not medication alone. Name your second choice and when you would make the switch. Send the desk your NUR-7631 psychosis case for a first draft written to it, free. Talk with the adolescent about his fears of the medicine. Start low with antipsychotics and track weight monthly.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 7631 Module 6 questions, answered
Where can I find a free NUR 7631 Module 6 sample paper?
Andre's case, with the efficacy and weight gain comparison, is printed above.
Are newer antipsychotics more effective in young people with schizophrenia?
In the TEOSS trial, risperidone and olanzapine were no more effective than the older molindone, but caused more weight gain.
How much weight do adolescents gain on antipsychotics?
In first-time users followed for about eleven weeks, weight rose by 8.5 kg on olanzapine, 6.1 on quetiapine, 5.3 on risperidone and 4.4 on aripiprazole.
Which antipsychotics are approved for adolescent schizophrenia?
Several, including aripiprazole, risperidone, olanzapine, quetiapine and others, for ages 13 to 17; the choice depends largely on side effects.
What monitoring is needed when an adolescent starts an antipsychotic?
Weight, BMI percentile, waist and blood pressure at each visit early on, and fasting glucose and lipids at baseline, around three months and yearly.