Schizophrenia Case Study

Which symptoms are positive and which are negative?

Answer explanation

• Positive symptoms: Paranoid delusions (FBI cameras), command hallucinations, disorganized thought process, scanning environment.

• Negative symptoms: Flat affect, poor eye contact, minimal speech (alogia), withdrawal, poor hygiene.

What risks are associated with command hallucinations?

Answer explanation

• Increased risk of self-harm or harm to others, especially when voices give dangerous instructions.

• Patient safety is the highest priority; continuous observation and suicide risk assessment may be required.

What is the nurse’s first priority in the care of John?

Answer explanation

• Safety: Assess suicidal ideation and implement precautions (e.g., 1:1 observation, safe environment, remove harmful objects).

• Safety must be addressed before other needs like nutrition or education.

What interventions will help address John’s refusal to eat?

Answer explanation

Ideas include:

• Offer sealed or packaged foods to reduce paranoia about poisoning.

• Build trust through therapeutic communication.

• Encourage small, frequent meals and allow family involvement if appropriate.

• Monitor nutritional intake and weight.

John states, “The FBI put cameras in my room.” What is the most therapeutic response?

• “That isn’t true, there are no cameras.”

• “I don’t see cameras, but I understand you feel afraid.”

• “Why would the FBI be watching you?”

• “You’re safe here, stop worrying.”

What adverse effect should the nurse monitor for with risperidone?

• Sedation

• Extrapyramidal symptoms (EPS)

• Orthostatic hypotension

• Agranulocytosis

• Decreased appetite

Why might a long-acting injectable antipsychotic be a good option for John?

Answer explanation

• Lots of reasons to consider switching to LAI, including:

• He has a history of poor medication adherence → LAI ensures consistent dosing.

• Provides steady therapeutic levels → fewer relapses and rehospitalizations.

• Reduces daily pill burden and reliance on patient memory/insight.

What community resources could support John and his family after discharge?

Answer explanation

• Some good ideas include:

• Outpatient psychiatry for med management.

• Community mental health services (case management, psychosocial rehab).

• National Alliance on Mental Illness (NAMI) family education and support groups.

• Assertive Community Treatment (ACT) team if available.

• Supported housing/vocational programs to aid independence.