Schizophrenia
1. Pathophysiology & Assessment
Schizophrenia is a chronic condition caused 1. Ensure safety:
by dysregulation of dopamine Alters
thoughts and perception of reality Significant Altered perception of reality impairs judgment
alterations in behavior and functional Safety risk
impairment Assess for warning signs of violence:
Symptoms begin in the late teens to early Assess the content of hallucinations by
adulthood
asking, “What are you hearing or seeing?”
and progress to acute psychosis.
Command hallucinations that tell client to
Having a first-degree relative with the
harm self or others
diseaserisk.
Symptoms are classified as positive or negative Signs ofagitation (pacing, shouting)
Assess for suicidal ideation.
(TABLE 1).
Clients with schizophrenia are at
2. Interventions risk for suicide (see “DEPRESSION & SUICIDE”
CHEAT SHEET).
Interventions for schizophrenia focus on:
1. Ensuring safety
2. Reinforcing reality
3. Using therapeutic communication
4. Maintaining a calm and structured environment
TABLE 1. SYMPTOMS OF SCHIZOPHRENIA
Positive (+) Negative (-)
Extra symptoms not normally present
Absence of normal behaviors or functioning
(worse during acute psychosis)
Delusions (false beliefs) Catatonia (psychologically induced immobility)
Paranoid: “Spies are watching me.” The 6 As:
Persecutory: “My food is being poisoned.” Avolition (lack of motivation)
Grandiose: “I am the chosen one.” Anhedonia (inability to feel pleasure)
Hallucinations (false sensory experiences: Asocial behaviors (social withdrawal)
visual, auditory, gustatory, olfactory, or Anergia (lack of energy)
tactile) Alogia (limited speech)
Disorganized thinking (fragmented, illogical, or Apathy (lack of emotion)
difficult-to-follow thoughts)
Mimicking movements (echopraxia) and
mimicking sounds or words (echolalia)
thinking) and negative symptoms (anhedonia,
Symptoms of schizophrenia include positive apathy, alogia).
symptoms (delusions, hallucinations, disorganized
, @ The nurse must assess for command hallucinations (pacing, shouting), which are warning
or increasing agitation signs
1. Pathophysiology & Assessment
Schizophrenia is a chronic condition caused 1. Ensure safety:
by dysregulation of dopamine Alters
thoughts and perception of reality Significant Altered perception of reality impairs judgment
alterations in behavior and functional Safety risk
impairment Assess for warning signs of violence:
Symptoms begin in the late teens to early Assess the content of hallucinations by
adulthood
asking, “What are you hearing or seeing?”
and progress to acute psychosis.
Command hallucinations that tell client to
Having a first-degree relative with the
harm self or others
diseaserisk.
Symptoms are classified as positive or negative Signs ofagitation (pacing, shouting)
Assess for suicidal ideation.
(TABLE 1).
Clients with schizophrenia are at
2. Interventions risk for suicide (see “DEPRESSION & SUICIDE”
CHEAT SHEET).
Interventions for schizophrenia focus on:
1. Ensuring safety
2. Reinforcing reality
3. Using therapeutic communication
4. Maintaining a calm and structured environment
TABLE 1. SYMPTOMS OF SCHIZOPHRENIA
Positive (+) Negative (-)
Extra symptoms not normally present
Absence of normal behaviors or functioning
(worse during acute psychosis)
Delusions (false beliefs) Catatonia (psychologically induced immobility)
Paranoid: “Spies are watching me.” The 6 As:
Persecutory: “My food is being poisoned.” Avolition (lack of motivation)
Grandiose: “I am the chosen one.” Anhedonia (inability to feel pleasure)
Hallucinations (false sensory experiences: Asocial behaviors (social withdrawal)
visual, auditory, gustatory, olfactory, or Anergia (lack of energy)
tactile) Alogia (limited speech)
Disorganized thinking (fragmented, illogical, or Apathy (lack of emotion)
difficult-to-follow thoughts)
Mimicking movements (echopraxia) and
mimicking sounds or words (echolalia)
thinking) and negative symptoms (anhedonia,
Symptoms of schizophrenia include positive apathy, alogia).
symptoms (delusions, hallucinations, disorganized
, @ The nurse must assess for command hallucinations (pacing, shouting), which are warning
or increasing agitation signs
