You are working on an inpatient psychiatric unit and need to do an initial assessment of R.B., who has just been admitted. He has a diagnosis of schizophrenia, paranoid type

Question

He is 22 years old and has been attending the local university and living at home with his parents. He has always been a good student
and has been active socially. Last semester his grades began declining and he became very withdrawn.
He spends most of his time alone in his room. His grooming has deteriorated; he can go days without
bathing. For several weeks before admission, he insisted on keeping all of the blinds and curtains in the
house closed. He refuses to join family gatherings and games. For the past 2 days he has refused to eat,
saying, "they have contaminated the food." as you approach R.B., you note that he appears to be carrying
on a conversation with someone, but there is no one there. When you talk to him, he looks around and
answers in a whisper but gives you little information. He states, "they are watching me and told me not
to cooperate."

Explain what a negative symptom of schizophrenia is, and identify at least three negative
symptoms of schizophrenia that R.B. might be experiencing.

Explain what a positive symptom of schizophrenia is, and identify at least two positive
symptoms of schizophrenia that R.B. might be experiencing.

Give the definition of each of the following types of delusional thinking:
a. Thought broadcasting
b. Thought insertion
c. Grandeur
d. Ideas of reference
e. Persecution
f. Somatic delusions

What symptoms indicate that R.B. has paranoid schizophrenia?

Why is it important to know R.B.'s history before he is diagnosed with schizophrenia?

What diagnostic screenings are important in evaluating R.B.?

What are the most important initial interventions in treating R.B.?

Answer 1

A negative symptom of schizophrenia is the absence of something that should be present in a
person but is not present. Negative symptoms might include:
• Flat or blunted affect
• Poverty of thought
• Lack of motivation
• Social withdrawal
• Poor grooming
• Anhedonia (inability to experience pleasure)

A positive symptom of schizophrenia is the presence of something that is not normally present,
such as:
• Hallucinations
• Delusions
• Disorganized speech (associative looseness)
• Bizarre behavior

a. Thought broadcasting:Belief that thoughts can be heard by others
b. Thought insertion:Belief that others' thoughts are being inserted or substituted into one's brain or
conversation
c. Grandeur:Belief about grand or exaggerated accomplishments; belief that one is very important
or has great power
d. Ideas of reference:Belief that events are related to one when they are not; giving great personal
significance to a trivial event
e. Persecution:Belief that one is being singled out by others for harmful reasons
f. Somatic delusions:Belief that one's body is changing in an unusual way

• Preoccupation with one or more delusions: He is being "persecuted," "They have contaminated my
food," "They are watching me."
• Frequent auditory hallucinations: "They told me not to cooperate."

• Other factors or conditions can cause psychotic symptoms that are common with schizophrenia.
• Drug use, certain medical or neurologic conditions, and alcohol withdrawal may cause psychosis.
• It is common for people with schizophrenia to experience deterioration in their level of functioning
for up to a year before developing frank psychotic symptoms.

• Family history: medical, neurologic, psychiatric
• Mental status examination
• Physical examination
• Blood and urine drug screen; blood alcohol level
• Complete blood count
• Complete metabolic panel
• Urinalysis

• Protect him from harm to self and others; create a supportive, structured environment
• Engage in supportive and directive communications
• Establish a relationship with the patient in which he feels safe
• Perform acute symptom stabilization—psychopharmacologic treatment