Schizophrenia
Schizophrenia is a chronic, lifelong psychotic disorder characterized by a loss of contact
with reality, affecting thoughts, perceptions, emotions, behavior, and functioning. There is
no single lab test for diagnosis; it is diagnosed clinically using DSM-5-TR criteria after ruling
out medical, substance-related, or medication-induced causes.
The disorder typically begins in late adolescence to early adulthood, presents in phases, and
includes positive, negative, and cognitive symptoms. Early detection and treatment are
associated with better long-term outcomes. Nursing care focuses on safety, therapeutic
relationships, symptom management, medication adherence, education, and
recovery-oriented support.
1. Psychosis: Core Concept
Definition
● Psychosis = loss of reality testing
● Client cannot distinguish hallucinations/delusions from reality
Key Features
● Hallucinations (auditory most common)
● Delusions (fixed false beliefs)
● Disorganized speech or behavior
● Impaired insight (anosognosia)
● Psychosis is a symptom, not a diagnosis
● Can occur in schizophrenia, mood disorders, substance use, or medical conditions
2. Schizophrenia Spectrum & Psychotic Disorders
Schizophrenia Spectrum Disorders Other Psychotic Disorders
● Schizophrenia ● Brief psychotic disorder
● Schizoaffective disorder ● Delusional disorder
● Schizophreniform disorder ● Substance/medication-induced psychotic
disorder
● Schizotypal personality disorder
, ● Psychotic disorder due to medical condition
3. DSM-5-TR Diagnostic Criteria
Must Have: Duration Functional Decline Required
● ≥ 2 symptoms for ≥ 1 month ● Continuous signs ≥ 6 ● Work
months
● ≥ 1 must be: ● Self-care
- Delusions
● Interpersonal
- Hallucinations relationships
- Disorganized speech
Other Possible Symptoms
● Grossly disorganized or catatonic
behavior
● Negative symptoms
4. Assessment & Diagnostics
Mental Status Assessment (MSA / Substance Use Screening Suicide Risk Assessment
MSE)
Evaluates current cognitive and Purpose: rule out CRITICAL in schizophrenia due to
psychological functioning. substance-induced psychosis. increased suicide risk, especially early
in illness.
Appearance & behavior
● CAGE Questionnaire – ● Columbia-Suicide Severity
Speech (rate, coherence, alcohol use Rating Scale (C-SSRS)
tangentiality)
● AUDIT (Alcohol Use ● SAD PERSONS Scale
Disorders Identification
Mood & affect Test)
● Beck Scale for Suicide
Thought process & content ● DAST-10 (Drug Abuse Ideation (BSS)
(delusions, hallucinations) Screening Test)
● PHQ-9 (Question 9
Insight & judgment ● Urine toxicology screen specifically assesses suicidal
(UDS) – objective ideation)
Orientation, memory, attention confirmation
, Assesses:
Common Tools Used: ● CIWA-Ar – if alcohol
withdrawal is ● Suicidal thoughts
● Mini-Mental State suspected ● Intent
Examination (MMSE) – ● Plan
cognition, orientation, ● COWS – if opioid ● Means
memory withdrawal is ● Prior attempts
suspected
● Montreal Cognitive
Assessment (MoCA) –
📌
Substance-induced
mild cognitive impairment psychosis resolves after
substance clears.
● Brief Psychiatric Rating
Scale (BPRS) – severity
of psychotic symptoms
● Positive and Negative
Syndrome Scale
(PANSS) – measures
positive, negative, and
general psychopathology
5. Positive vs Negative vs Cognitive Symptoms
Positive Symptoms (ADDED Negative Symptoms Cognitive Symptoms
behaviors) (TAKEN AWAY)
● Delusions Highest impact on ● Impaired attention
functioning
● Hallucinations ● Poor memory
● Apathy
● Disorganized speech
● Disorganized thinking
● Anhedonia (loss of pleasure
● Disorganized or catatonic
behavior in activities you used to ● Lack of insight
enjoy) (anosognosia)
Types of Delusions ● Alogia (poverty of speech) ● Depersonalization /
● Persecutory derealization
● Flat affect
● Grandiose
● Avolition
● Thought insertion/withdrawal
● Self-neglect
● Control
● Social withdrawal
Schizophrenia is a chronic, lifelong psychotic disorder characterized by a loss of contact
with reality, affecting thoughts, perceptions, emotions, behavior, and functioning. There is
no single lab test for diagnosis; it is diagnosed clinically using DSM-5-TR criteria after ruling
out medical, substance-related, or medication-induced causes.
The disorder typically begins in late adolescence to early adulthood, presents in phases, and
includes positive, negative, and cognitive symptoms. Early detection and treatment are
associated with better long-term outcomes. Nursing care focuses on safety, therapeutic
relationships, symptom management, medication adherence, education, and
recovery-oriented support.
1. Psychosis: Core Concept
Definition
● Psychosis = loss of reality testing
● Client cannot distinguish hallucinations/delusions from reality
Key Features
● Hallucinations (auditory most common)
● Delusions (fixed false beliefs)
● Disorganized speech or behavior
● Impaired insight (anosognosia)
● Psychosis is a symptom, not a diagnosis
● Can occur in schizophrenia, mood disorders, substance use, or medical conditions
2. Schizophrenia Spectrum & Psychotic Disorders
Schizophrenia Spectrum Disorders Other Psychotic Disorders
● Schizophrenia ● Brief psychotic disorder
● Schizoaffective disorder ● Delusional disorder
● Schizophreniform disorder ● Substance/medication-induced psychotic
disorder
● Schizotypal personality disorder
, ● Psychotic disorder due to medical condition
3. DSM-5-TR Diagnostic Criteria
Must Have: Duration Functional Decline Required
● ≥ 2 symptoms for ≥ 1 month ● Continuous signs ≥ 6 ● Work
months
● ≥ 1 must be: ● Self-care
- Delusions
● Interpersonal
- Hallucinations relationships
- Disorganized speech
Other Possible Symptoms
● Grossly disorganized or catatonic
behavior
● Negative symptoms
4. Assessment & Diagnostics
Mental Status Assessment (MSA / Substance Use Screening Suicide Risk Assessment
MSE)
Evaluates current cognitive and Purpose: rule out CRITICAL in schizophrenia due to
psychological functioning. substance-induced psychosis. increased suicide risk, especially early
in illness.
Appearance & behavior
● CAGE Questionnaire – ● Columbia-Suicide Severity
Speech (rate, coherence, alcohol use Rating Scale (C-SSRS)
tangentiality)
● AUDIT (Alcohol Use ● SAD PERSONS Scale
Disorders Identification
Mood & affect Test)
● Beck Scale for Suicide
Thought process & content ● DAST-10 (Drug Abuse Ideation (BSS)
(delusions, hallucinations) Screening Test)
● PHQ-9 (Question 9
Insight & judgment ● Urine toxicology screen specifically assesses suicidal
(UDS) – objective ideation)
Orientation, memory, attention confirmation
, Assesses:
Common Tools Used: ● CIWA-Ar – if alcohol
withdrawal is ● Suicidal thoughts
● Mini-Mental State suspected ● Intent
Examination (MMSE) – ● Plan
cognition, orientation, ● COWS – if opioid ● Means
memory withdrawal is ● Prior attempts
suspected
● Montreal Cognitive
Assessment (MoCA) –
📌
Substance-induced
mild cognitive impairment psychosis resolves after
substance clears.
● Brief Psychiatric Rating
Scale (BPRS) – severity
of psychotic symptoms
● Positive and Negative
Syndrome Scale
(PANSS) – measures
positive, negative, and
general psychopathology
5. Positive vs Negative vs Cognitive Symptoms
Positive Symptoms (ADDED Negative Symptoms Cognitive Symptoms
behaviors) (TAKEN AWAY)
● Delusions Highest impact on ● Impaired attention
functioning
● Hallucinations ● Poor memory
● Apathy
● Disorganized speech
● Disorganized thinking
● Anhedonia (loss of pleasure
● Disorganized or catatonic
behavior in activities you used to ● Lack of insight
enjoy) (anosognosia)
Types of Delusions ● Alogia (poverty of speech) ● Depersonalization /
● Persecutory derealization
● Flat affect
● Grandiose
● Avolition
● Thought insertion/withdrawal
● Self-neglect
● Control
● Social withdrawal
