Editing Mental Health and Psychosocial Nursing (section)

=== Schizophrenia ===
Two or more of the following for a significant portion of 1 month, with continuous disturbance for at least 6 months, and at least one being delusions, hallucinations, or disorganized speech: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms.

'''Positive symptoms''' (added experiences, respond better to antipsychotics): hallucinations (auditory most common), delusions (persecutory, grandiose, somatic, referential, thought broadcasting or insertion), disorganized speech (loose associations, word salad, neologisms, clang associations, echolalia), and bizarre behavior (echopraxia, waxy flexibility).

'''Negative symptoms''' (the "five A's", more disabling long term and less drug-responsive): affective flattening, alogia (poverty of speech), avolition, anhedonia, and asociality. Add '''attention deficit''' and '''ambivalence''' from classic Bleulerian description.

'''Cognitive symptoms''': impaired working memory, executive function, and attention. These drive functional outcome and adherence more than positive symptoms do.

Related diagnoses: '''schizophreniform disorder''' (1 to 6 months), '''brief psychotic disorder''' (1 day to 1 month with full return to baseline), '''schizoaffective disorder''' (psychosis plus a mood episode, with at least 2 weeks of psychosis without prominent mood symptoms), and '''delusional disorder''' (nonbizarre delusions with otherwise preserved functioning).

Nursing interventions:
* '''Hallucinations''': ask directly what the voices are saying. '''Command hallucinations that direct harm to self or others are a safety emergency.''' Do not argue about whether the voice is real; acknowledge the client's experience and present your reality once: "I do not hear a voice, but I believe you hear one." Reduce stimuli, provide distraction, and use reality-based activities.
* '''Delusions''': do not agree and do not debate. Focus on the underlying feeling: "It must be frightening to believe you are being watched." Avoid whispering or laughing near a paranoid client. For a paranoid client, offer '''food in sealed containers''' and let the client open it, and do not touch without warning.
* '''Milieu''': consistent staff, predictable routine, clear brief communication, one topic at a time, avoid abstractions and idioms with concrete thinkers.
* '''Illness management''': adherence, early warning sign identification, family psychoeducation, and substance use treatment substantially reduce relapse.